Removable partial prosthesis combined with swallowing training is an efficient clinical solution for oral cancer post-operation patients with palatal defect and dysphagia: a prospective study.

OBJECTIVE: Dysphagia is one of the major complications of oral cancer patients, and is disturbing thousands of patients worldwide. Our study aim to evaluate the clinical efficacy of prosthesis combined with swallowing training on palatal defect and dysphagia in post-operative oral cancer patients. MATERIALS AND METHODS: Sixteen oral cancer patients with palatal defect and dysphagia post-operation were treated with removable prosthesis and individualized swallowing function training. Swallowing function of patients before and after treatment was analyzed and compared by videofluoroscopic swallowing examination. The severity of depression and life quality were evaluated by Depression Scale (SDS) and Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) scores, respectively. RESULTS: Oral transit time (OTT) significantly shortened after treatment (P < 0.01), and Penetration-Aspiration Scale (PAS) scores was significantly higher after treatment (P < 0.001). Different consistency bolus showed different risk of aspiration. Thickened liquids were related to lower PAS scores (P < 0.001). SDS standard score was significantly lower after treatment (P < 0.05). The total score of FACT-H&N after treatment was significantly higher (P < 0.05). No patients came back for regressed swallowing function during the follow-up period (17.06 ± 2.376 months). CONCLUSION: Removable prosthesis and swallowing training can significantly improve swallowing function, reduce depression degree, and improve quality of life (QOL). CLINICAL RELEVANCE: Removable prosthesis combined with swallowing training is a cheap and effective method to improve QOL in patients with palate defect and dysphagia after oral cancer.

Reconstruction of Acquired Segmental Mandibular Defects Using Pedicled Mandibular Muscle Flap and Evaluation of Speech Function and Aesthetic Outcomes.

PURPOSE: The purpose of this study was to investigate the clinical effect of pedicled mandibular osteomuscular flap in the reconstouring of repair of acquired segmental mandibular defects. PATIENTS AND METHODS: Thirteen patients with acquired segmental mandibular defects requiring secondary repair were included into the study. Pedicled mandibular osteomuscular flap was applied with strong internal fixation to repair the mandibular defects. The patients' speech, swallowing function, and aesthetic changes were evaluated upon follow-up. RESULTS: The flaps were viable in all patients. Average speech function score was 7.6±0.6. All patients had a drinking test rating of grade I or II with good masticatory efficiency. The postoperative self-assessment Visual Analog Scale score of appearance was 7.8±0.8. CONCLUSIONS: Pedicled mandibular osteomuscular flap is a viable choice in the secondary repair and reconstruction of mandibular acquired segmental defects. This flap could achieve better oral function with good aesthetic results.

Reconstruction of Large Acquired Palatal Defects Using Facial-Submental Artery Island Flap.

OBJECTIVE: To evaluate the feasibility and clinical effect of facial-submental artery island flap (FSAIF) in the repair of palatal defects, and to provide reference for the clinical application of submental artery island flap. METHODS: Nine patients with palatal defects, the range of nasal palatal perforation defects were 3 cm × 4cm to 3 cm × 6 cm (median 3 cm × 5.4 cm), were repaired by FSAIF, and the sizes of FSAIF were 4 cm × 9cm to 4 cm × 12 cm (median 4 cm × 10.4 cm,). Postoperative clinical efficacy was evaluated, including infection and necrosis of mucosal flap and postoperative palatal fistula perforation. Patients were followed up to evaluate their chewing, swallowing, speech function, and satisfaction of appearance. RESULTS: All patients were successfully repaired with FSAIF. Followed up 13∼35 months, there was no palatal fistula perforation in all patients. The speech, agitation, and swallowing function were not affected and the patients were satisfied with the appearance. CONCLUSION: FSAIF is a safe and reliable method for palatal defect repair.

Outcomes of patients with mucoepidermoid carcinoma of minor salivary gland in palate undergoing radical resection followed by submental flap reconstruction.

OBJECTIVE: To investigate the outcomes of patients with mucoepidermoid carcinoma of the palate undergoing pedicled facial-submental artery island flap (FSIF) reconstruction following resection. PATIENTS AND METHODS: 41 patients with early stage disease and 9 patients with advanced-stage disease underwent radical excision and neck dissection. 37 IIb, 4 class IIa and 9 IIIb maxillary defects were reconstructed with FSIF, folded FSIF or folded FSIF with titanium mesh respectively. The skin paddles were 3 × 8 to 5 × 15 cm and 3 × 8 to 5 × 14 cm, respectively. 5 patients with high grade disease were treated with cobalt 60 adjuvant radiotherapy after operation. RESULTS: One flap failure occurred, yielding a success rate of 98.0% in the reconstruction of palate II and III defects with FSIF or titanium mesh. The patients were seen for follow-up for 16-60 months postoperative. 76.0% patients alive with no disease (AND); 14.0% patients alive with disease (AD) and 10.0% died of disease (DD). Rates of AND, AD and DD differed significantly according to histopathologic grade and TNM stage (P < 0.001); rates of AND, AD and DD differed obviously according to necrosis of the tumors lymph node metastasis, and tumour cell anaplasia and treatment (P < 0.05). CONCLUSIONS: Radical resection with wide safety margins of normal tissues including neck dissection is the mainstay of treatment modality. The patients with high grade disease should be treated with postoperative radiotherapy. The FSIF is a reliable and safe method for repairing Brown class II maxillary defects.

Treatment of donor site wounds using facial skin remaining in the scar area.

Reconstruction of cheek skin defects is surgically challenging. We evaluated the outcomes of using cheek skin remaining in the scar area for treating donor site wounds following the repair of cheek skin defects using full-thickness skin. We conducted a retrospective case series study that included 12 patients with a scar of the cheek. The patients included seven females and five males. The donor site was treated using the cheek skin remaining in the scar area following repair of the cheek skin defect with a full-thickness skin graft from the inner side of the upper arm. Minor flap necrosis of the full-thickness skin graft in the cheek developed in one patient. The postoperative esthetic results were excellent and satisfactory in 11 and 1 patient, respectively. Patients were followed up for 18-32 months; no lagophthalmos or ectropion was noted. However, there were two cases of hyperpigmentation in cheek grafts, and two of graft hypertrophy in the arm. The facial skin remaining in the scar area can be used to treat donor site wounds following a full-thickness skin graft from the inner side of the upper arm to repair a large cheek skin defect.

Vermilionectomy followed by reconstruction of the vermilion mucosa using allograft dermal matrix in patients with actinic cheilitis of the lower lip.

BACKGROUND: When treating actinic cheilitis (AC), it is essential to minimize the risk of malignant transformation (MT) and maintain lip functionality and cosmesis. AIMS: We evaluated the outcomes of vermilionectomy followed by reconstruction of the vermilion mucosa using allograft dermal matrix (ADM) in patients with AC of the lower lip. MATERIALS AND METHODS: We evaluated eight patients with lower lip AC who underwent vermilion mucosa reconstruction using ADM after vermilionectomy. We enrolled five males and three females ranging in age from 55 to 70 years (mean, 62.1 years). The ADM ranged in area from 1.3 × 5.0 to 1.7 × 5.8 cm (median, 1.6 × 5.5 cm). All patients were followed up for at least 3 months postoperatively by a panel of three surgeons who assessed the esthetic results, and orbicularis oris and speech functions. RESULTS: All patients underwent successful reconstruction of the vermilion mucosa using ADM after vermilionectomy, without complications. The postoperative esthetic results, and the orbicularis oris and speech functions, were satisfactory to excellent in all patients. Patients were followed up for 18-38 months (median, 26.1 months). No MT or recurrence was noted. CONCLUSIONS: Vermilionectomy followed by reconstruction of the vermilion mucosa with ADM is safe and feasible for AC patients.

Dysphagia in Tongue Cancer Patients Before and After Surgery.

PURPOSE: To define factors influencing postoperative aspiration in tongue cancer patients and to analyze the characteristics of dysphagia before and after surgery. MATERIALS AND METHODS: A total of 112 tongue cancer patients participated in this work. Videofluoroscopic swallowing studies were performed in all patients before and after surgery. A Penetration-Aspiration Scale score of 3 or greater was defined as an aspiration risk. Qualitative data were collected on a frame-by-frame basis from each videofluoroscopic swallowing study and analyzed. RESULTS: Smoking (58.14%, P < .01), tongue resection greater than 50% (38.71%, P < .05), and advanced tumor stage (49.18%, P < .01) were strong risk factors for aspiration. High incidences of inadequate tongue movement, delayed oral transit time, reduced hyoid bone elevation, poor aspiration or penetration, vallecula epiglottica, and residual material in the pyriform sinuses were evident after surgery (all P < .001). The Penetration-Aspiration Scale score was significantly higher after surgery than before surgery. The incidence of silent aspiration increased to 6.25% postoperatively. CONCLUSIONS: Smoking, larger tongue resection, and advanced tumor stage were strong risk factors for postoperative aspiration and dysphagia complications in tongue cancer patients. The aspiration rate was higher after surgery. Further studies should focus on the prevention and early treatment of dysphagia, especially postoperative aspiration, in tongue cancer patients.

Characteristics of temporomandibular joint vibrations in anterior disk displacement with reduction in adults.

The objective to the present study was to compare temporomandibular joint (TMJ) vibration in anterior disk displacement with reduction (ADDWR) in adults and to explore the diagnostic value of frequency spectrography of TMJ vibrations. Twenty-one patients with ADDWR formed the case group and were further divided into three subgroups according to the degree of disk displacement, and 26 symptomless adults formed the control group. The joint vibration was recorded during rhythmic maximal open-close jaw movement using JVA/JT, BioPAK (Bioresearch, Inc., Brown Deer, WI)). The sensitivity and specificity of the total integral for diagnosis of ADDWR was calculated. All TMJ vibration parameters, including total integral, integral>300Hz, integral<300Hz, >300/<300 ratio, peak amplitude, peak and median frequencies of the case group were significantly higher than that of the control group. Along with the degree of disk displacement, the amplitude and frequency of TMJ vibrations increased, and the total integral significantly increased. The total integral demonstrated high sensitivity and specificity for diagnosis of ADDWR (85.7% and 84.6%, respectively). TMJ vibration was significantly higher in adults with ADDWR than that in the symptomless control group. Different pathological stages of disk displacement have different TMJ vibrations.

[Relationship between occlusal plane and masticatory path in youth with individual normal occlusion].

OBJECTIVE: To investigate the characteristics of and relationship between occlusal plane and masticatory path in young adults with individual normal occlusion, and to provide clinical implications on both morphological and functional reference of occlusal plane location. METHODS: Forty-three young adults with individual normal occlusion were included. Lateral projections of cephalometric radiographs were taken. The parameters of anatomical landmarks were analyzed. The BioEGN mandibular kinesiography analyzer was used to record the path of incisal edge of mandibular central incisor movement during mastication. The Pearson's linear correlation analysis was performed to analyze the relationship of inclination of occlusal plane and data mentioned above with SPSS13.0 software. RESULTS: The inclination of occlusal plane (the angle between occlusal plane and Camper's line OP-CP) was (2.1 ± 3.8)° in youth with normal occlusion. Means of maximal distances of 3-dimensional masticatory mandibular movement paths were as follow: the vertical length was (20.22 ± 4.28) mm, the anterior-posterior width was (11.42 ± 2.45) mm, and the lateral width was (8.62 ± 1.52) mm. The inclination of occlusal plane was negatively correlated to the lateral width of masticatory path in frontal plane (r = -0.39, P < 0.05). Occlusal plane was approximately vertical to the opening and closing path in the vicinity of intercuspal position during mastication. The inclination of occlusal plane was positively related to occlusal plane-closing angles in the upper segments of closing path during mastication (P < 0.05). Masticatory axis angle was (66.50 ± 7.98)° with no significant correlation to the inclination of occlusal plane (P > 0.05). CONCLUSIONS: These results suggest that the sagittal inclination of occlusal plane can influence 3-dimensional morphology of masticatory path.The inclination of occlusal plane has a guiding effect on masticatory movement in the upper segments of closing path.