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PubMed1989

Clinical psychiatric assessment of patients with burning mouth syndrome resisting oral treatment.

Of 100 consecutive patients referred for investigation of symptoms related to oral galvanism, 18 with persisting symptoms of burning mouth syndrome (BMS) remained after investigation and treatment (Hugoson 1986). In addition to the oral and medical treatment, 16 (14 women, 2 men) of these patients underwent psychiatric investigation. The results of this investigation are presented in this report. The psychiatric investigation was performed as a semistructured interview, elucidating current symptoms, the patient's opinion as to the onset and causes, previous illnesses and psycho-social conditions. Two hours were reserved for each patient interviewed with the aim of obtaining a holistic picture of each individual. The patients with refractory burning mouth syndrome did not differ from the others with respect to oral status, salivary secretion or calculated galvanic currents. No patient had burning mouth as the only symptom, all reporting many symptoms from different organs. Three patients had had symptoms for at least 20 years, 9 for 5-10 years and 4 patients for less than 4 years. Seven patients related the onset of symptoms to oral treatment. Thirteen of the patients reported one or more medical diagnoses and 10 patients were taking 1-3 medicines. Ten patients reported significant negative experiences in connection with previous contacts with the health services and several considered themselves wrongly diagnosed and treated. Most of the patients had experienced catastrophes in their lives in the form of stillborn children or children born with various handicaps, children injured in accidents or prolonged social problems. One patient was judged to have somatic causes of the symptoms, 8 patients somatic and psychological causes, 6 patients psychological causes and in 1 patient the cause was unknown. Three cases are presented in more detail.

Adult↗
PubMed1982

[On the significance of alcoholism for etiology, course and prognosis of cancer of the mouth and oropharynx (author's transl)].

Reviewing the records of 131 patients with malign tumors of the mouth and oropharynx 36 (35%) alcoholics were found among 103 male patients with carcinoma. The highest incidence of alcoholism (58%) was seen in patients with carcinoma of the floor of the mouth. In alcoholics the age distribution showed a peak in the 4th decennium, whereas non-alcoholics had this peak in the 6th decennium. With 64% T3-tumors the alcoholics revealed on an average markedly more advanced tumor stages before treatment than the other patient group with only 29% T3-tumors; metastases in the regional lymphnodes were seen in 50% of the latter, but in 72% of the alcoholics. Skin reaction to radiation therapy appeared particulary pronounced more often in alcoholics (87%) than in the other patients (63%). The 3-year survival rates were 38.5% (alcoholics) and 44.5% (non-alcoholics). These observations suggest that alcoholism with its numerous accompaniments does not only play a role in etiology, but does also have unfavourable effects on the course and the prognosis of cancer of the mouth and oropharynx.

Adult↗
PubMed1995

[The assessment of basement membrane in cancer of the floor of the mouth and larynx].

An immunohistochemical method using a monoclonal antibody to collagen type IV was employed to assess the basement membrane (BM) deposition in 36 cases of cancer of the floor of the mouth and in 32 cases of cancer of the larynx. The BM deposition was scored as extensive or limited, and compared to degree of histologic differentiation of tumor and to 3-year survival rate for patient and regional metastasis. There were 42 cases with extensive and 26 with limited BM deposition between cancer of the floor of the mouth and cancer of the larynx were found. Statistical analysis did not show a relationship between BM deposition of either cancer and the survival of patients or with regional metastasis, however a little better results was obtained for patients with extensive BM deposition. Poorly differentiated carcinoma of the floor of the mouth had a tendency to limited BM deposition.

Antibodies, Monoclonal↗
PubMed1977

Treatment of squamous cell carcinoma of the floor of the mouth.

Treatment of 88 selected patients with Stages I and II squamous cell carcinoma of the floor of the mouth by monobloc resection has produced a high five year cure rate. The death of one patient in the series postoperatively was considered a surgical one. Disability after such a procedure is minimal, and dental complications are not a factor. Elective irradiation of the neck is recommended in those instances of positive sublingual or submandibular nodes found in the monobloc specimen and in all patients with Stages III and IV lesions. Radiation therapy is recommended for highly anaplastic neoplasms, for instances when speech impairment is important, for lesions in the posterior limits of the floor of the mouth, for edentulous patients without bone invasion, for the treatment of recurrent lesions after operation and for synchronous multiple primary carcinomas of the head and neck if one of which is a carcinoma of the floor of the mouth.

Carcinoma in Situ↗
PubMed1998

[Reconstruction of the mouth floor using a musculo-mucosal buccinator flap supplied by facial vessels. Report of ten cases].

The buccinator muscle is a wide, flat quadrangular muscle. Its medial surface is covered by the oral mucosa. It receives its arterial blood supply from two main arteries: the facial and buccal arteries. A musculo-mucosal flap can be raised on the facial artery with or without the facial vein. In the case of absence of the facial vein, venous drainage is possible into the peri-arterial loose areolar tissue. A nasolabial skin incision facilitates facial artery identification and simplifies flap dissection in the loose areolar plane, superficial to the facial artery. The mean dimensions of the flap are 3.5 cm in width and 7 cm in length. The flap extends from the superior buccal sulcus to the inferior alveolar ridge. Its rotation enables reconstruction of the anterior and lateral floor of the mouth. The donor site is closed in two layers. The authors present a series of ten patients reconstructed with this flap after excision of a squamous cell carcinoma of the floor of the mouth. The results are excellent with perfect tongue function and no esthetic sequelae. The facial artery should be preserved during neck dissection, and the ipsilateral mandibular molar teeth must be extracted. Its simplicity and reliability makes this flap a useful alternative in floor of mouth reconstruction.

Adult↗
PubMed2002

Fasciocutaneous flap reconstruction of the tongue and floor of mouth: outcomes and techniques.

OBJECTIVES: To quantify functional and other outcomes after major resection and fasciocutaneous free-flap reconstruction of the tongue and floor of mouth, and to describe reconstructive technique. DESIGN: A hypothesis-generating, retrospective cohort study of 43 patients who underwent, at minimum, a hemiglossectomy and resection of the floor of the mouth for oral cancer followed by fasciocutaneous free-flap reconstruction. SETTING: A tertiary academic medical center in the midwestern United States. MAIN OUTCOME MEASURES: Speech intelligibility, swallowing, interval to decannulation, length of stay, free-flap success rates, patient survival, and complications. RESULTS: Thirty patients underwent oral tongue reconstructions, and 13, tongue base reconstructions. Median intelligibility scores were greater among patients in the tongue base group (98% intelligibility) than in the oral-tongue group (76% intelligibility) (P<.001). Of the 38 patients undergoing swallowing evaluation, 32 (85%) were able to feed entirely by mouth, most with mild to moderate dysphagia. All patients underwent decannulation (mean interval, 13.7 days). The mean length of hospital stay was 11 days, and free flaps in 42 patients (98%) survived. Twenty-eight patients (65%) were still alive by the end of the study, yielding a mean survival time of 27.4 months. Seven patients (16%) had severe medical and 3 (7%) had major surgical complications. CONCLUSION: The folding techniques used in this study for reconstruction of the tongue with fasciocutaneous free flaps were associated with recovery of adequate speech and swallowing in most patients.

Adult↗
PubMed1975

Carcinoma of the oral tongue and floor of mouth: fifteen years' experience with linear acceleration therapy.

One hundred fourteen patients with carcinoma of the oral tongue and floor of mouth were treated with high-dose megavoltage radiation at Stanford University from 1956 to1970. Actuarial 5-year survival for 56 patients with oral tongue lesions was: T', 73; T', 37%; and T', 19%. Similarly, for 58 patients with lesions of the floor mouth, 5-year survival was: T', 73%; T', 37%; and T', 25%. Local control of the primary was obtained in oral tongue T' lesions 10 of 11 times; T', 5 of 8; and T', 13 of 36 times. For floor of mouth, local control was: T', 22 of 26;T', 7 of 14; andT', 3 of 15. There was an indication that better control was obtained if interstitialtherapy was a planned part of the treatment. Dose for local control when external radiation alone was utilized was usually over 1900 rets. Patients with initially clinicallynegative nodes (TXNO) who had a low radiation dose to primary echelon lymph nodes developed later cervical lymph node metastases 38% of the time. In no case did late metastatic disease appear in patients whose necks were treated prophylactically.

Aged↗
PubMed2001

Interventions for the treatment of burning mouth syndrome.

BACKGROUND: The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders. OBJECTIVES: The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies. SEARCH STRATEGY: Electronic databases (The Cochrane Library, the Cochrane Oral Health Group's Specialised Register, MEDLINE, EMBASE), Clinical Evidence Issue No. 3, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication. SELECTION CRITERIA: Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort DATA COLLECTION AND ANALYSIS: Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop-outs. Due to differences in patient type, treatment and outcome measures, statistical pooling of the data was inappropriate. MAIN RESULTS: Six trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial) and vitamin complexes (one trial). The participants included in the six identified trials reported suffering from BMS from six months to 20 years. Diagnostic criteria were not always clearly reported. Out of the six trials included in the review, only two interventions demonstrated a reduction in BMS symptoms; vitamin complexes and cognitive behavioural therapy. Neither of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect. REVIEWER'S CONCLUSIONS: Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.

Analgesics↗
PubMed2005

Interventions for the treatment of burning mouth syndrome.

BACKGROUND: The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders. OBJECTIVES: The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register (20 October 2004), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004), MEDLINE (January 1966 to October 2004), EMBASE (January 1980 to October). Clinical Evidence Issue No. 10 2004, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication. SELECTION CRITERIA: Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort. DATA COLLECTION AND ANALYSIS: Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop outs. Due to both clinical and statistical heterogeneity statistical pooling of the data was inappropriate. MAIN RESULTS: Nine trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial), alpha-lipoic acid (three trials) and anticonvulsants (one trial). Diagnostic criteria were not always clearly reported. Out of the nine trials included in the review, only three interventions demonstrated a reduction in BMS symptoms: alpha-lipoic acid (three trials), the anticonvulsant clonazepam (one trial) and cognitive behavioural therapy (one trial). Only two of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect. AUTHORS' CONCLUSIONS: Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.

Analgesics↗
PubMed1993

Ultrasonic imaging of the tongue, mouth, and vocal cords in normal children: establishment of basic scanning positions.

We examined the soft tissue anatomy of the tongue, mouth, and vocal cords in 25 healthy children by ultrasonography, and established basic scanning positions for these organs. In the tongue and the mouth--four scanning positions: the midline sagittal, the paramidline sagittal, the anterior coronal, and the posterior coronal--covered major anatomical components. We could delineate vocal cords in all subjects by transverse scanning on the thyroid cartilage. Although disorders associated with the tongue, floor of the mouth, and vocal cords are less frequent in children, one should recognize normal ultrasound findings to distinguish them from abnormalities.

Adolescent↗
PubMed1997

Foot- and-mouth disease as zoonosis.

Man's susceptibility to the virus of foot- and-mouth disease (FMD) was debated for many years. Today the virus has been isolated and typed (type O, followed by type C and rarely A) in more than 40 human cases. So no doubt remains that FMD is a zoonosis. Considering the high incidence of the disease (in animals) in the past and in some areas up to date, occurrence in man is quite rare. In the past when FMD was endemic in Central Europe many cases of diseases in man showing vesicles in the mouth or on the hands and feet were called FMD. The first suggestion of a human infection with FMD was reported in 1695 by Valentini in Germany [7]. All reports before 1897, the year of the discovery of the virus of FMD by Loeffler and Frosch [2], were not of course confirmed either by isolation of the virus or by identification of immunoglobulins after infection. Nevertheless the successful self-infection reported by Hertwig in 1834 most likely seems to have been FMD in man: each of three veterinarians drank 250 ml of milk from infected cows on four consecutive days. The three men developed clinical manifestations. The diseases most often confused with FMD are infections with several viruses of the Coxsackie A group (this infection is referred to as "hand and mouth disease"), herpes simplex and sometimes vesicular stomatitis. Beginning in 1921 up to 1969 at least 38 papers were published, which described clinically manifest FMD in man in more than 40 proven cases. One further reported described an asymptomatic infection with FMD in man [10]. Criteria for establishing a diagnosis of FMD in man are the isolation of the virus from the patient and/or identification of specific antibodies after infection. Laboratory tests for diagnosis of human FMD are the same as for animals. Proven cases of FMD in man have occurred in several countries in Europe, Africa and South America. The type of virus most frequently isolated man is type O followed by type C and rarely A. The incubation period in man, although somewhat variable, has not been found to be less than two days and rarely more than six days.

Animals↗
PubMed1986

Behavioural and pharmacological characterization of the mouth movements induced by muscarinic agonists in the rat.

Pilocarpine administered in doses of 1.25-10.0 mg/kg (IP) produced a variety of mouth movements in the rat. The most frequent of these movements was a chewing behaviour, which increased up to a mean frequency of over 40 per min at the highest doses. Tongue protrusion and gaping also showed dose-dependent increases. Yawning tended to increase in some doses, though these increases were not significant, and yawning was relatively infrequent. Pre-treatment with scopolamine reduced these responses, while pre-treatment with methyl scopolamine did not. Injections of oxotremorine or arecoline, but not carbachol, produced dose-related increases in mouth movements similar to those produced by pilocarpine. These results suggest that mouth movements in the rat are caused by stimulation of central muscarinic receptors. This may prove to be an important behavioural sign of central cholinomimetic activity.

Animals↗
PubMed1980

[Incidence of yeasts isolated from the mouth and toothbrushes in Venezuela].

117 yeast strains from the mouth, and 69 from toothbrushes of 229 patients from the Hospital Universitario of Caracas (Venezuela) were studied. Candida albicans was found to be the most frequent yeast in both materials with 56.4%, and 52.1% in the mouth and toothbrushes, respectively. C. tropicalis with 16.2%, and C. parapsilosis with 7.6% followed C. albicans in the mouth. In the toothbrushes C. parapsilosis with 11.5%, and C. tropicalis with 6.0% followed C. albicans. The incidence of other yeasts was not significative. Torulopsis glabrata was not found in the material studied.

Candida↗
PubMed1987

[Mechanisms of supralaryngeal airway obstruction in normal persons and habitual mouth breathers].

We examined oronasal flow partitioning in 27 volunteers with normal or slightly increased nasal resistance (mean +/- SD, 0.24 +/- 0.19 kPa/l/s). Mean percentage of inspiratory nasal flow contribution was measured during spontaneous oronasal breathing. The averaged nasal admixture of airflow differed considerably within and between all subjects (mean +/- SD, 20.9% +/- 16.5%; range 1%-70%), showing no correlation to nasal resistance. Five of 27 subjects with a history of habitual mouth breathing had a significantly lower nasal admixture as compared with controls (2.5% +/- 1.7% vs 25.1% +/- 15.4%; P less than 0.005), but with no statistical difference in nasal resistance. To evaluate the hypothesis that velopharyngeal narrowing is due to an increased tone of the soft palate, measurements were also performed under positive nasal pressure, inspiratory resistive loading at the mouth, and during breath-holding. There was no significant difference of airflow distribution between these modifications and unloaded breathing in either group. These data suggest, therefore, that oronasal flow distribution is due to active positioning of the soft palate, and that habitual mouth breathing without any nasal obstruction may be associated with closure of the velopharyngeal isthmus as a consequence of disturbed neural control mechanisms.

Adult↗
PubMed1994

Ultrasonographic evaluation of the tongue and the floor of the mouth: normal and pathological findings.

An ultrasonographic study of the tongue and the floor of the mouth was performed in 30 healthy children (aged from 1 day to 15 years) in order to assess the normal US anatomy of this region. The scans were performed in sagittal and coronal planes with a 7.5-mHz transducer. Moreover, 22 children (aged from 1 day to 15 years) presenting with various clinical symptoms underwent US examination. This series included infectious and congenital diseases. The US findings were correlated with surgery and pathology in 19 cases, with the clinical follow-up in 2 cases and with the nuclear study in 1 case. In each case, US could anatomically locate the lesion with very good accuracy. We conclude that US of the tongue and the floor of the mouth in children yields overall very good accuracy in the investigation of diseases of this region. In this study, our purpose was (1) to evaluate the normal sonographic anatomy of the tongue and the floor of the mouth in children and (2) to determine whether it was possible to correctly localize various lesions and to evaluate their nature in order to guide the therapeutic approach.

Adolescent↗
PubMed1994

Foot-and-mouth disease in Ethiopia from 1988 to 1991.

During the period 1988 to 1991 samples from 16 foot-and-mouth disease outbreaks in Ethiopia were examined at the National Veterinary Institute, Ethiopia, and at the FAO World Reference Laboratory for Foot-and-Mouth Disease, UK. Typing of the virus responsible was possible in 13 of these outbreaks representing 10 separate disease events; 8 of these were caused by serotype O and 2 by serotype SAT2. This is the first record of the presence of serotype SAT2 foot-and-mouth disease virus in Ethiopia. In contrast to earlier studies serotypes A and C were not detected.

Animals↗
PubMed1996

The bamboo skewer: airway management in a patient with penetrating injury of the floor of mouth.

PURPOSE: To report a safe airway management option in patients with penetrating injury of the floor of the mouth, reinforcing the similar experience of others and illustrating the importance of proper assessment and planning before airway negotiation. CLINICAL FEATURES: A 23-yr-old man was admitted with a penetrating injury of the floor of mouth caused by falling on bamboo and with the foreign body in situ. The extent of penetration could not be assessed clinically but computerized tomography (CT) was used to assist in preoperative evaluation of the airway. After atropine iv, fentanyl iv, topical cocaine and lidocaine spray, awake fibreoptic guided nasal intubation was performed successfully and the patients airway secured before induction of anaesthesia. Elective tracheostomy was performed postoperatively which was removed on day 5. Post-operative recovery was uneventful. CONCLUSION: Awake fibreoptic guided nasal intubation was useful in managing the airway of a patient with a penetrating injury of the floor of mouth and foreign body in situ. Thorough previous evaluation of the patients airway by CT scan, careful topicalisation of the airway, and judicious use of iv sedation and anti-sialogue contributed to the safe and successful airway management.

Adult↗
PubMed2000

Is the open-mouth odontoid view necessary in children under 5 years?

OBJECTIVES: Questionnaires (984) were submitted to pediatric radiologists to determine how often odontoid fractures were missed on lateral views and detected on open-mouth odontoid views in children under 5 years. Other questions relating to imaging protocols of the odontoid also were included, and there were 432 respondents. RESULTS: Of these, 161 respondents indicated that an open-mouth odontoid view was not routinely included in their imaging protocol. CONCLUSIONS: There was considerable variability on how the problem of imaging of the odontoid was addressed, but overall there were enough data to begin to consider the concept that the open-mouth odontoid might not be needed in patients under 5 years of age if a lateral view is normal.

Child, Preschool↗