Videofluoroscopic evaluation of mastication and swallowing in individuals with TMD

To study mastication and swallowing disorders in patients with temporomanclibular disorders (TMD). Objective: To investigate mastication and swallowing disorders in patients with severe TMD referred to surgery. Materials and Methods: Clinical and experimental study involving ten individuals with TMD submitted to deglutition videofluoroscopy. These patients did not have posterior teeth, mastication pain and food replacement in favor of pasty consistence food. The assessment of the oral and pharyngeal phases approached the following aspects: side of onset and preferential side for chewing, premature escape, remains of food residues in the oral cavity or in the pharyngeal recesses, number of necessary swallowing efforts, laryngeal penetration and/or tracheal aspiration. Results: During mastication and the oral phase we observed tongue compensatory movements upon chewing (n = 7; 70%), premature escape (n = 4; 40%), food remains in the cavity after swallowing (n = 5; 50%) and an excessive number of deglutition efforts (n = 5; 50%). On the pharyngeal phase we observed food remains in the valleculae (n = 6; 60%), in the pyriform sinuses (n = 4; 40%); laryngeal penetration (n = 1; 10%) and tracheal aspiration (n = 4; 40%). Conclusion: TMD patients may have alterations in their chewing and swallowing patterns, with laryngeal penetration and/or tracheal aspiration. The study indicates the need for a multidisciplinary assessment because of dysphagia in TMD patients.

Endonasal endoscopic exposure of the internal carotid artery: An anatomical study

Objectives/Hypothesis: The aim of this work was to define the anatomical landmarks, limitations, and difficulties of obtaining internal carotid artery (ICA) exposure via endonasal endoscopic approaches (EEA).

A bayesian network meta-analysis on comparisons of enamel matrix derivatives, guided tissue regeneration and their combination therapies

Aims: Guided tissue regeneration (GTR) and enamel matrix derivatives (EMD) are two popular regenerative treatments for periodontal infrabony lesions. Both have been used in conjunction with other regenerative materials. We conducted a Bayesian network meta-analysis of randomized controlled trials on treatment effects of GTR, EMD and their combination therapies. Material and Methods: A systematic literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including June 2011. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts were treated as one group and so were barrier membranes. Results: A total of 53 studies were included in this review, and we found small differences between regenerative therapies which were non-significant statistically and clinically. GTR and GTR-related combination therapies achieved greater PPD reduction than EMD and EMD-related combination therapies. Combination therapies achieved slightly greater CAL gain than the use of EMD or GTR alone. GTR with BG achieved greatest defect fill. Conclusion: Combination therapies performed better than single therapies, but the additional benefits were small. Bayesian network meta-analysis is a promising technique to compare multiple treatments. Further analysis of methodological characteristics will be required prior to clinical recommendations.

Food restrictions of patients who are undergoing treatment for oral and oropharyngeal cancer

Purpose: Oral squamous cell carcinoma and its treatment are associated with facial disfigurement and functional inabilities that may lead to malnutrition or under nourishment. This study assessed the incidence of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. Method: We interviewed 120 patients in two hospitals in Sao Paulo, Brazil, using a structured food frequency questionnaire comprising the most commonly consumed foods in Brazil. This questionnaire was applied twice; the first time to inform dietary patterns prior to the diagnosis of cancer and the second time to assess recent modifications of diet that were associated with the disease and its treatment. Hospital files provided information on clinical status. Multivariate Poisson regression models assessed covariates with prognostic value. Results: One third of patients suffered major food restrictions (i.e., they reduced substantially the intake of more than 50% of the most commonly consumed food items before the diagnosis); 39% suffered a less severe condition (they could not eat less than 50% of the most commonly consumed food items before the diagnosis, and they needed changes in food preparation). Larger tumour size (adjusted incidence ratio IR = 1.45), posterior location (IR = 1.33), radiotherapy (IR = 1.84), loss of tongue mobility (IR = 1.36) and loss of teeth (IR = 1.25) in the surgery were associated significantly with the study outcome. Conclusion: This study identified clinical predictors of food restrictions in patients undergoing treatment for oral and oropharyngeal cancer. This knowledge may contribute to improve patient care and management, and to develop interventions aimed at preventing nutritional depletion of these patients. (C) 2011 Elsevier Ltd. All rights reserved.

Do Tobacco and Alcohol Modify Protective Effects of Diet on Oral Carcinogenesis?

Recent systematic reviews concluded that the frequent consumption of fruits and vegetables is inversely associated with the risk of oral cancer. We assessed this association, specifically comparing results obtained to nonsmokers and smokers, as well to nondrinkers and drinkers. We conducted a case-control study involving 296 patients with oral squamous cell carcinoma (cases) attended in 3 major hospitals of Sao Paulo, Brazil, paired with 296 controls, recruited from outpatient units of the same hospitals. Multivariate models assessed the effect of fruits and salads according to smoking and drinking. The intake of fruit was associated with the prevention of the disease in the specific assessment among light [odds ratio (OR) = 0.46; 95% confidence interval (CI) = 0.27-0.78) and heavy (OR = 0.30; 95% CI = 0.14-0.65) smokers. The same was observed for vegetables consumption. For nonsmokers, no fruit (OR = 50; 95% CI = 0.22-1.12) or vegetable (for tomato, OR = 0.53; 95% CI = 0.31-0.93) was associated with reduced risk of oral and oropharyngeal cancer. Similar results were found in the stratified analysis according to drinking status with OR = 0.51 (95% CI = 0.30-0.87) and 0.18 for fruits (95% CI = 0.07-0.45), respectively, for light and heavy drinkers. This observation suggests that the protective effect of fruit and salad intake may modulate the deleterious effects from tobacco and alcohol.

Differences in early biomechanical properties after myopic and hyperopic lasik using mechanical microkeratome Sub-Bowman's Keratomileusis (SBK)

Purpose: To evaluate biomechanical changes measured with the ORA (Ocular Response Analyzer (R); Reichert Ophthalmic Instruments, Buffalo, New York, USA) after Lasik with the Moria One Use Plus and to compare the biomechanics changes after myopic and hyperopic ablations. Methods: Fourteeneyes for hyperopia (H) and 19 eyes for myopia (M) were evaluated with the ORA preoperatively and 1 month after Lasik with thin flap (100 microns) using SBK-OUP (Sub-Bowman Keratomileusis-One Use Plus, Moria (R)). CH (Corneal Hysteresis), CRF (Corneal Resistance Factor), IOPg (gold-standard, Goldmann correlated Intraocular pressure), IOPcc (Corneal compensated Intraocular pressure) and more 38 variables derived from the corneal biomechanical response signal of the ORA were analyzed. The Wilcoxon test was used to assess differences between the variables before and after surgery for each group and the differences between the pre and postoperative (1 month) myopic eyes were compared with those obtained in hyperopic eyes, using the Mann-Whitney test. Results: There was a significant difference before and after Lasik in myopic and hyperopic eyes in IOPg (Wilcoxon, p<0.05), but not in IOPcc. Only myopic eyes showed a significant difference in CH and CRF measurements before and after LASIK, as well as 9 other biomechanical parameters (aspect1, h1, dive1, path1, p1area1, W11, H11, and w2 path11; Wilcoxon, p<0, 05), 8 of these being related to the first sign of flattening. Five parameters related to the sign of the second applanation showed significant variation only in the eyes before and after hyperopic Lasik (aspect2, h2, dive2, mslew2 and H21; Wilcoxon, p<0,05). There was a difference in both myopic and hyperopic on three parameters related to the applanation signal areas (p1area, and p2area p2area1; Wilcoxon, p<0.05). Differences in IOPg and p1area, before and after surgery were significantly higher in myopic eyes than in hyperopic eyes (Mann-Whitey, p<0.05). Conclusion: There are several significant differences in biomechanical parameters after Lasik with Moria OUP_SBK. Overall, the impact of myopic LASIK on corneal biomechanics is higher than of hyperopic Lasik. The parameters derived from the first sign of the ORA are more affected in myopic LASIK, whereas parameters derived from the second applanation are more affected in hyperopic LASIK.

RGMa and RGMb expression pattern during chicken development suggest unexpected roles for these repulsive guidance molecules in notochord formation, somitogenesis, and myogenesis

Background: Repulsive guidance molecules (RGM) are high-affinity ligands for the Netrin receptor Neogenin, and they are crucial for nervous system development including neural tube closure; neuronal and neural crest cell differentiation and axon guidance. Recent studies implicated RGM molecules in bone morphogenetic protein signaling, which regulates a variety of developmental processes. Moreover, a role for RGMc in iron metabolism has been established. This suggests that RGM molecules may play important roles in non-neural tissues. Results: To explore which tissues and processed may be regulated by RGM molecules, we systematically investigated the expression of RGMa and RGMb, the only RGM molecules currently known for avians, in the chicken embryo. Conclusions: Our study suggests so far unknown roles of RGM molecules in notochord, somite and skeletal muscle development. Developmental Dynamics, 2012. (C) 2012 Wiley Periodicals, Inc.

Diet and the risk of head and neck cancer: a pooled analysis in the INHANCE consortium

We investigated the association between diet and head and neck cancer (HNC) risk using data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium. The INHANCE pooled data included 22 case-control studies with 14,520 cases and 22,737 controls. Center-specific quartiles among the controls were used for food groups, and frequencies per week were used for single food items. A dietary pattern score combining high fruit and vegetable intake and low red meat intake was created. Odds ratios (OR) and 95% confidence intervals (CI) for the dietary items on the risk of HNC were estimated with a two-stage random-effects logistic regression model. An inverse association was observed for higher-frequency intake of fruit (4th vs. 1st quartile OR = 0.52, 95% CI = 0.43-0.62, p (trend) < 0.01) and vegetables (OR = 0.66, 95% CI = 0.49-0.90, p (trend) = 0.01). Intake of red meat (OR = 1.40, 95% CI = 1.13-1.74, p (trend) = 0.13) and processed meat (OR = 1.37, 95% CI = 1.14-1.65, p (trend) < 0.01) was positively associated with HNC risk. Higher dietary pattern scores, reflecting high fruit/vegetable and low red meat intake, were associated with reduced HNC risk (per score increment OR = 0.90, 95% CI = 0.84-0.97).

Comparison of the area of the pharynx during wakefulness and induced sleep in patients with Obstructive Sleep Apnea (OSA)

The study of obstructive sleep apnea (OSA) has received growing attention over the past years since various aspects have not been sufficiently established. Aim: To evaluate, with the use of magnetic resonance imaging (MRI), changes in the area of the pharynx during wakefulness and induced sleep in patients with OSA. Materials and Methods: A prospective study of thirty-two patients with a polysomnographic diagnosis of OSA. All patients were submitted to MR imaging in order to obtain high-definition anatomical sagittal sequences during wakefulness and during sleep induced with Propofol. An area was defined on the sagittal plane in the midline of the pharynx. This region was called pharyngeal midplane (PMP) area. Results: A significant difference in PMP area (mm(2)) was observed between wakefulness and induced sleep in each patient (p < 0.000001). Conclusion: The patients with OSA suffer a significant reduction of 75,5 % in the area of the pharynx during induced sleep compared to wakefulness.

Pharyngocutaneous fistula following total laryngectomy

Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy. Objectives: To establish the incidence of this complication and to analyze the predisposing factors. Method: This is a cross-sectional study of a historical cohort including 94 patients who underwent total laryngectomy. The following aspects were correlated to the occurrence of PCF: gender, age, tumor site, TNM staging, type of neck dissection, previous radiation therapy, previous tracheotomy, and use of stapler for pharyngeal closure. The following were considered in PCF cases: the day into postoperative care when the fistula was diagnosed, duration of occurrence, and proposed treatment. Results: Twenty (21.3%) patients had PCF. The incidence of PCF was statistically higher in T4 tumors when compared to T2 and T3 neoplasms (p = 0.03). The other analyzed correlations were not statistically significant. However, 40.9% of the patients submitted to tracheostomy previously had fistulae, against 21.1% of the patients not submitted to this procedure. Conclusion: Advanced primary tumor staging is correlated with higher incidences of PCF.

Surgical complications in 550 consecutive cochlear implantation

Cochlear implantation is a safe and reliable method for auditory restoration in patients with severe to profound hearing loss. Objective: To describe the surgical complications of cochlear implantation. Materials and Methods: Information from 591 consecutive multichannel cochlear implant surgeries were retrospectively analyzed. All patients were followed-up for at least one year. Forty-one patients were excluded because of missing data, follow-up loss or middle fossa approach. Results: Of 550 cochlear implantation analyzed, 341 were performed in children or adolescents, and 209 in adults. The mean hearing loss time was 6.3 +/- 6.7 years for prelingual loss and 12.1 +/- 11.6 years for postlingual. Mean follow-up was 3.9 +/- 2.8 years. Major complications occurred in 8.9% and minor in 7.8%. Problems during electrode insertion (3.8%) were the most frequent major complication followed by flap dehiscence (1.4%). Temporary facial palsy (2.2%), canal-wall lesion (2.2%) and tympanic membrane lesion (1.8%) were the more frequent minor complications. No death occurred. Conclusion: There was a low rate of surgical complications, most of them been successfully managed. These results confirm that cochlear implant is a safe surgery and most surgical complications can be managed with conservative measures or minimal intervention.

Bifurcation analysis of an aeroelastic system with concentrated nonlinearities

Analytical and numerical analyses of the nonlinear response of a three-degree-of-freedom nonlinear aeroelastic system are performed. Particularly, the effects of concentrated structural nonlinearities on the different motions are determined. The concentrated nonlinearities are introduced in the pitch, plunge, and flap springs by adding cubic stiffness in each of them. Quasi-steady approximation and the Duhamel formulation are used to model the aerodynamic loads. Using the quasi-steady approach, we derive the normal form of the Hopf bifurcation associated with the system's instability. Using the nonlinear form, three configurations including supercritical and subcritical aeroelastic systems are defined and analyzed numerically. The characteristics of these different configurations in terms of stability and motions are evaluated. The usefulness of the two aerodynamic formulations in the prediction of the different motions beyond the bifurcation is discussed.

Adjunct effect of the antimicrobial photodynamic therapy to an association of non-surgical and surgical periodontal treatment in modulation of gene expression

Background: This study has evaluated the effect of antimicrobial photodynamic therapy (aPDT) used in conjunction with non-surgical and surgical periodontal treatment (PT) in modulating gene expression during periodontal wound healing. Methods: Fifteen patients with chronic periodontitis, presenting bilaterally lower molars with class III furcation lesions and scheduled for extraction, were selected. In initial therapy, scaling and root planing (SRP) was performed in the Control Group (CG), while SRP + aPDT were performed in the Test Group (TG). 45 days later, flap surgery plus SRP, and flap surgery plus SRP + aPDT were performed in the CG and TG, respectively. At 21 days post-surgery, the newly formed granulation tissue was collected, and Real-time PCR evaluated the expression of the genes: tumor necrosis factor-?, interleukin-1?, interleukin-4, interleukin-10, matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase-2 (TIMP-2), osteoprotegerin (OPG), receptor activator of nuclear factor- ?B ligand (RANKL), type I collagen, alkaline phosphatase, osteopontin, osteocalcin, and bone sialoprotein. Results: There were statistically significant differences between the groups in relation to mRNA levels for MMP-2 (TG = 3.26 ± 0.89; CG = 4.23 ± 0.97; p = 0.01), TIMP-2/MMP-2 ratio (TG = 0.91 ± 0.34; CG = 0.73 ± 0.32; p = 0.04), OPG (TG = 0.84 ± 0.45; CG = 0.30 ± 0.26; p = 0.001), and OPG/RANKL ratio (TG = 0.60 ± 0.86; CG = 0.23 ± 0.16; p = 0.04), favoring the TG. Conclusion: The present data suggest that the aPDT associated to nonsurgical and surgical periodontal therapy may modulate the extracellular matrix and bone remodeling by up regulating the TIMP- 2/MMP-2 and OPG/RANKL mRNA ratio, but the clinical relevance needs to be evaluated in further studies.

Treatment of gingival recessions in heavy smokers using two surgical techniques: a controlled clinical trial

Smokers have small root coverage which is associated with bad vascularity of periodontal tissues. This study evaluated a technique that can increase the blood supply to the periodontal tissues compared with a traditional technique. Twenty heavy smokers (10 males and 10 females) with two bilateral Miller class I gingival recessions received coronally positioned flaps in one side (Control group)and extended flap technique in the other side (Test group). Clinical measurements (probing pocket depth, clinical attachment level, bleeding on probing, gingival recession height, gingival recession width, amount of keratinized tissue, and width and height of the papillae adjacent to the recession) were determined at baseline, 3 and 6 months postoperatively. Salivary cotinina samples were taken as an indicator of the nicotine exposure level. No statistically significant differences (p>0.05) were detected for the clinical measurements or smoke exposure. Both techniques promoted low root coverage (Control group: 43.18% and Test group: 44.52%). In conclusion, no difference was found in root coverage between the techniques. Root coverage is possible and uneventful even, if rather low, in heavy smoker patients with low plaque and bleeding indices.

Validade discriminante do questionário de qualidade de vida da Universidade de Washington no contexto brasileiro

OBJETIVO: Avaliar a validade discriminante do questionário de qualidade de vida da Universidade de Washington para pacientes com câncer de cabeça e pescoço e identificar possíveis fatores sociodemográficos que modifiquem seus resultados. MÉTODOS: Foram entrevistados 47 pacientes com câncer de boca e orofaringe em estágio pré-cirúrgico em um hospital no sul do município de São Paulo em 2007, e 141 pacientes sem câncer, pareados por sexo e idade em uma proporção de três para um, que foram atendidos em ambulatórios do mesmo hospital em 2008. Os resultados obtidos para os dois grupos foram comparados pelo teste t de Student. Para os pacientes sem câncer utilizou-se análise de regressão de Poisson para avaliar possíveis fatores de modificação da qualidade de vida. RESULTADOS: O escore geral de qualidade de vida foi significantemente mais elevado (p < 0,001) para os pacientes sem câncer (91,1) do que para os pacientes com câncer (80,6). Observações análogas foram efetuadas para oito dos doze domínios de qualidade de vida compreendidos no questionário (dor, aparência, deglutição, mastigação, fala, ombros, paladar e ansiedade). Como possíveis fatores de modificação dos escores de qualidade de vida foram identificados renda familiar (com impacto nos domínios de recreação, p = 0,017, e função dos ombros, p = 0,049), escolaridade (em ansiedade, p = 0,003), sexo (em função dos ombros, p = 0,038) e dor de dente (em mastigação, p = 0,015). CONCLUSÕES: O questionário tem validade discriminante, pois seus escores são especificamente mais afetados para pacientes com câncer. Reforça-se a indicação do questionário para monitorar o tratamento e recomenda-se avaliar os fatores que podem causar impacto nesses indicadores.