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PubMed1982

Profile of malignant disease in the mouth clinic.

Between 1973 and 1981, 2,056 new patients were seen in the Mouth Clinic at Sunnybrook Hospital. Of these 109 proved to have malignant disease, with squamous cell carcinoma being the commonest type. Lower lip and floor of mouth were the most frequent sites. There was a high proportion of small tumors and local surgical excision was the most widely employed primary method of treatment. Radiation and combined treatment were used in larger lesions. Twenty-four patients have so far died of mouth cancer and the presence of enlarged lymph nodes at presentation was an ominous sign. Although containing the usual high proportion of heavy smokers and drinkers this group of patients at present exhibits a lower incidence of second primary malignancies than in some published series. It is concluded that surgery and radiotherapy have equivalent effectiveness in treating small primary lesions, where a policy of observation of the clinically negative neck appeared justified. The best treatment for large lesions and the most appropriate management of the clinically negative neck in intermediate size lesions has not been determined.

Adult↗

PubMed1981

[Flap-reconstruction in mouth and oropharynx. A clinical comparison of methods (author's transl)].

The possible methods for plastic reconstruction after resection of malignant tumors in the mouth and oropharynx are reported. A total of 165 patients, operated upon between 1973 and 1980, has been reviewed. The tumor was located 26 times in the tongue, 4 times within the base of the tongue, 27 times in the floor of the mouth, 10 times in the floor of the mouth and in the tongue and 80 times in the tonsils. For reconstruction 8 times the deltopectoral flap, 51 times the forehead flap, 42 times the tongue flap, 7 times the myocutaneous sternocleido-mastoideus island flap were used. 8 times other methods were applied, like for instance skin grafts, and in 41 cases a primary closure of the defect was possible. Complete necrosis of the flap were rare, more frequent in contrast were partial dehiscences with or without a fistula. Thus in the forehead flap 5 times a necrosis occurred whereas in 15 cases a dehiscence was seen. Even better results were achieved for the deltopectoral- and tongue flap. In contrast, the skin island of the myocutaneous sternocleidomastoideus flaps all became necrotic, but only once a temporary fistula developed. Of the pectoralis myocutaneous island flaps the first two became necrotic, probably due to lack of surgical experience. Taking into account the surgical expenditure, the functional as well as cosmetical results, the methods may be scaled according to clinical value as follows: The pectoralis major myocutaneous island flap and the tongue flap equally range on the first place, followed by the myocutaneous sternocleidomastoideus island flap, and on the 3. and 4. place by the deltopectoral and forehead flap.

Humans↗

PubMed1980

[The mouth-plate, an aid in respiratory treatment in intensive care units (author's transl)].

The mouth plate is a new auxiliary device used in respiratory therapy. It is applied to patients who cannot adapt to conventional mouth pieces owing to different anatomical-functional difficulties. Easy clinical application and the air tight effect of the mouth plate permitted efficient respiratory therapy with IPPB in 20 cases with the mentioned difficulties so that some would not need more invasive measures such as endotracheal intubation or even mechanical ventilation. Other possible application in the intensive care unit and also in emergency medicine are mentioned briefly.

Adolescent↗

PubMed1993

Athletic mouth guards--one town's approach.

A program to produce inexpensive, custom mouth guards for high school basketball players was implemented by teams of dentists who took impressions, fabricated and then delivered the mouth guards. This community service involved three hours of donated time; the player or school was charged $7.50 for materials per mouth guard. The potential reduction of dental related injuries is immeasurable, and it is hoped that other cities will adopt a similar program.

Adolescent↗

PubMed1995

[Whole mouth gustatory test (Part 1)--basic considerations and principal component analysis].

The whole mouth method gustatory test is a simple gustatory test. It can be applied easily, and can be used to assess overall taste which a subject is supposed to be feeling. In the present study, a new series of taste solutions for the use in the whole mouth gustatory test was prepared. In order to determine the normal range of gustation and relationships between each taste solution, gustatory threshold tests were conducted on 123 healthy volunteers (17-22 years old). The series of taste solutions represented 4 tastes, i.e., sweet, salty, sour, and bitter, and was prepared using sucrose, salt, tartaric acid and quinine, respectively. Recognition thresholds measured for each taste solution yielded normal ranges i.e., 0.0165 mol/l for the sweet solution, 0.0316 mol/l for the salty solution, 0.000734 mol/l for the sour solution, and 0.0000203 mol/l for the bitter solution which were almost the same as those published. The average thresholds obtained for all solutions were at almost always at the middle concentration level, i.e., level 6. Thus, this method can serve as a standard method of performing the whole mouth taste test. Principal component analysis of the thresholds obtained revealed that the primary component mainly demonstrated taste detection function, and that it could more or less be represented by the simple sum of each detection threshold. The analysis also showed that approximately 90% of taste threshold variation is explained by the 4 principal components. These findings provide further evidence that these four tastes comprise the basic elements of taste.

Adolescent↗

PubMed1995

Hyoid bone and atlas vertebra in established mouth breathers: a cephalometric study.

The position of hyoid bone and atlas vertebra in 29 established mouth breathers (17 boys and 12 girls) in the age group of 10-14 years were cephalometrically evaluated and compared with 23 nose breathers (11 boys and 12 girls). The children of both the groups were selected on the basis of history and clinical examination. The comparisons were made using univariate analysis for male and female groups separately as well as combined. It was observed that mouth breathers do maintain an extended head posture, which was evident from a decrease in distance between the occiput and dorsal arch of atlas vertebra. However the results of the present study did not reveal any distinct characteristics of hyoid bone and atlas vertebra that can be used to predict or associate the craniofacial pattern of mouth breathers.

Adolescent↗

PubMed1997

Relationship between transdiaphragmatic and mouth twitch pressures at functional residual capacity.

The clinical application of transdiaphragmatic twitch pressure (Pdi,tw) response to phrenic nerve stimulation has been hindered by the requirement for placement of oesophageal and gastric balloons. Investigators have reported that mouth twitch pressure (Pmo,tw) estimates Pdi,tw accurately at lung volumes above and below functional residual capacity (FRC). However, it is not known whether Pmo,tw estimates Pdi,tw accurately when stimulation is performed at FRC during relaxed conditions. The aim of this study was to develop a simple method whereby measurements of Pmo could be used to predict oesophageal twitch pressure (Poes,tw) and possibly Pdi,tw at FRC. The study was performed in 11 healthy volunteers during phrenic nerve stimulation. At FRC, 9 of the 11 subjects showed a poor correlation between Pmo,tw and Poes,tw, and between Pmo,tw and Pdi,tw, probably due to varying degrees of glottic closure. Stimulations performed while subjects maintained an inspiratory flow of approximately 50 mL x s(-1), or at the point of reattaining FRC during an inspiration preceded by a limited exhalation, produced good correlations between Pmo,tw and Poes,tw (r=0.97 in both instances) and Pmo,tw and Pdi,tw (r=0.96 and r=0.95, respectively), with a steep slope. The respective slopes for the Pmo,tw Poes,tw relationship were 0.88 and 0.94, and for the Pmo,tw Pdi,tw relationship, 0.59 and 0.54. Unfortunately, these manoeuvres produced a significant increase in transpulmonary pressure (3.6+/-0.6 (SE) and 5.6+/-1.4 cmH2O, respectively), suggesting change in diaphragmatic length. Stimulations delivered while subjects performed an inspiratory effort or during exhalation against a high resistance preceded by a limited inhalation could not be used to predict Poes,tw and Pdi,tw from Pmo,tw. In conclusion, although transdiaphragmatic and oesophageal twitch pressure could be predicted from mouth twitch pressure during some inspiratory manoeuvres mouth twitch pressure was not reliable for the prediction of the oesophageal and transdiaphragmatic twitch pressure at functional residual capacity during relaxed conditions in healthy volunteers.

Adult↗

PubMed1996

[Simple artificial mouth model].

A simple artificial mouth model is established under our laboratory condition. Development of monobacterial plaque and mixed bacterial plaque was studied in this artificial mouth model. The samples were subjected to viable count, microhardness measurement, etc. The result showed that the controlled conditions of the model can be used to study plaque development and earlier enamel lesion production on a time-dependent basis. It is concluded that the simple artificial mouth model is suitable for a wide range of dental applications.

Artificial Organs↗

PubMed1994

Management of dry mouth in elderly patients.

Xerostomia is not a natural consequence of the aging process. Although dry mouth is not often found to be a chief complaint of elderly patients, it is a common problem that usually receives inadequate attention. Xerostomia is the feeling of dry mouth due to insufficient secretion of saliva. It is most common among the elderly as a result of adverse effects of drug therapy, head and neck radiation, or autoimmune diseases. Chronic xerostomia has a debilitating effect on the integrity of the hard and soft tissues of the mouth. It often causes difficulty in speaking, tasting, eating, swallowing and denture retention. The goals of treatment are to stimulate salivary flow, or to restore oral moistness and prevent or alleviate the uncomfortable, harmful sequelae of xerostomia. Dentists can significantly enhance the quality of life for xerostomia sufferers by effectively managing the xerostomia sequelae in a compassionate, understanding manner.

Aged↗

PubMed1998

[Effects of limited mouth opening capacity (trismus) on lung function].

In the present study pulmonary function test data were obtained from 15 healthy volunteers and 15 patients with slightly impaired ventilation during both normal and maximally reduced opening of the mouth (trismus, intercuspid position). The aim of the study was to examine the effects of complete trismus on pulmonary function using objective and subjective parameters. In maximally reduced mouth opening, both groups showed an impairment of all subjective and objective pulmonary function test data. In healthy volunteers, the significant changes in the test data (p < 0.05) simulated mild to moderate pulmonary impairment, whereas patients with an already impaired pulmonary function showed a marked deterioration of their initial respiratory condition. The results of the subjective and objective parameters examined indicate that an intercuspid position (trismus) further aggravates pulmonary functional impairments. Complete trismus can be considered a risk factor to pulmonary function in patients using mouth-breathing as primary or supportive mode of respiration.

Adult↗

PubMed1976

The mouth in health and disease.

Medical, dental and psychiatric conditions may cause dysfunction of the mouth in health and disease. The principle of clinical assessment of the patient, which includes a thorough assessment of the physical, social and psychological factors, is of paramount importance. This paper has attempted to describe some of the more common conditions affecting the mouth in general practice, and to underline important causes of pain which can occur in the face arising from conditions in the mouth.

Candidiasis, Cutaneous↗

PubMed1986

Late effects of radiation treatment of tongue and floor-of-mouth cancer on the dentition, saliva secretion, mucous membranes and the lower jaw.

The purpose of this study was to determine retrospectively any changes in the dentition, saliva secretion, mucous membranes and the lower jaw resulting from the radiation treatment given to patients with cancer of the tongue or floor of the mouth. The study covers 29 patients treated at the Department of Radiotherapy and Oncology of Helsinki University Central Hospital between 1972 and 1981. 23 of the patients were treated for cancer of the tongue and the remaining 6 for cancer of the floor of the mouth. The radiation doses ranged from 5300 to 6700 rad. Clinical examination revealed that the number of carious teeth doubled as a result of radiotherapy, while the incidence of cervical lesions increased by a factor of 10, both compared with the controls. About 70% of the patients studied were found to have either moderate or extensive fungal growth. Stimulated saliva secretion had fallen to about 20% and resting saliva secretion to about 30% of the values for the control group. Radiography revealed pathological changes in the mandible in 34% of the patients. Clinically, 2 patients were found to have extra-oral fistulae. In 1 of these, the spontaneously fractured end of the mandible was visible for several cms. 3 of the patients had undergone hemimandibulectomy because of osteoradionecrosis.

Adult↗

PubMed2003

Midline (dermoid) cysts of the floor of the mouth: report of 16 cases and review of surgical techniques.

A retrospective review of 16 cases of midline (dermoid) cysts of the floor of the mouth is presented, evaluating the different surgical approaches. Sixteen cases of patients with a diagnosis of midline cyst of the floor of the mouth, treated at the Maxillofacial Surgery Department of the School of Medicine and Surgery of the "Federico II" University of Naples (Naples, Italy), were observed over a 10-year period, between 1988 and 1998; age, sex, localization, diagnostic technique, and type of treatment were evaluated. Male patients were more frequently affected, with a male-to-female ratio of 3:1 (12:4 cases). Patients ranged in age from 5 to 51 years (average age, 27.8 years). The preoperative assessment was made using ultrasonography in all cases but one, computed tomography in eight cases, and magnetic resonance imaging in three cases. Regarding surgical techniques used, a transcutaneous approach was adopted for median geniohyoid cysts, an extended median glossotomy technique was used for very large median genioglossal cysts, a median glossotomy technique was used for median genioglossal cysts, and a midline incision of the oral mucosa along the lingual frenulum was used for sublingual cysts. During the postoperative course, there were no complications except for modest edema in three cases. Follow-up ranged between 24 months and 12 years; no relapses or malignant changes were observed. In the authors' experience, the intraoral approach was also effective for the treatment of large lesions and led to very good cosmetic and functional results, whereas the extraoral incision was necessary only when the cysts were under the geniohyoid muscle.

Adolescent↗

PubMed2002

Lining the mouth floor with prelaminated fascio-mucosal free flaps: clinical experience.

Soft-tissue defects of the mouth floor need thin, foldable, and pliable tissues able to preserve local anatomy as well as chewing, phonation, and deglutition. The oral mucosa is made of a stratified, nonkeratinized, epithelium-secreting mucus, which lubricates the oral cavity and facilitates tongue movements. No flap exists that can reproduce the physiology of the oral mucosa better than the oral mucosa itself. Prefabrication of mucosal flaps may represent the best solution. Therefore, 10 consecutive cases of mouth floor cancer were treated with prelamination of the fascia antibrachialis with mucosal grafts obtained from the healthy cheek, and with subsequent transplantation 3 weeks later. A significant increase in mucosal graft surface was seen in all cases, with a mean size twice the original. All flaps healed uneventfully. Follow-up time ranged between 2-60 months (average, 26.6 months). Morphological and functional results were excellent. Tongue motility, speech intelligibility, and swallowing were reestablished in all treated cases. Mucosal prelamination of the forearm fascia is feasible and allows physiological reconstruction of oral cavity defects up to 6 x 4 cm.

Carcinoma, Squamous Cell↗

PubMed2007

[The central island tongue flap for the reconstruction of the anterior floor of the mouth].

BACKGROUND: There are several techniques described for the reconstruction of the anterior floor of mouth after tumour surgery. Here, we point out the advantages of the central island tongue flap for this indication. PATIENTS AND METHODS: We report on 20 patients with medium sized defect in the anterior floor of mouth, which was reconstructed with the central island tongue flap. Besides this surgical technique, we discuss the results of oral rehabilitation after a follow-up period of at least 3 months. RESULTS: There was now flap necrosis or loss, and the median time for flap formation was less than 45 min. In the follow-up we found successful oral rehabilitation in speech and swallowing.

Aged↗

PubMed1989

Effects of migrating Gasterophilus intestinalis larvae (Diptera: Gasterophilidae) on the mouth of the horse.

Lesions were formed in the mouth of the horse by first- and second-stage Gasterophilus intestinalis larvae. The lesions resulted as larvae burrowed through the top millimeter of the tongue and then became embedded in the interdental gingiva. Appearance of the lesion was dependent on the degree of larval burrowing activity and healing that had taken place. Active tunneling production occurred at the posterior end of the lesion. Extensive change in configuration and color was apparent along the longer lesions with active larvae. Virtually all tissue in the path of the larvae was removed while forming a tunnel. Tissue destroyed included tops of the lamina propria mucosae evaginations and the deeper portions of the lamina epithelialis mucosae. Histopathologic findings showed that the tissue removed included the nerve and blood supply of the proprial evaginations. Hemorrhage and exocytosis into the tunnels included erythrocytes mixed with some macrophages, lymphocytes and scant numbers of eosinophils. Air shafts excavated in the tongue by larvae enabled bacteria to enter into the tunnels. Bacteria became adhered to larvae and initiated microabscesses. Microabscesses were composed of clotted erythrocytes, bacteria, disintegrating epithelial cells, and large numbers of neutrophils. Cells surrounding the tunnel exhibited pyknosis, epithelial hydropic degeneration and became separated from each other. Healing of tongue lesions occurred as epithelial cell growth below raised the tunnel upward and affected tissue desquamated. Interdental gingiva invaded by larvae were hyperemic and denuded of epithelia. Recession and ulceration of the gingiva produced periodontal pockets. Extensive invasion by larvae led to compound periodontal pockets. Larval mouth hooks were embedded in the submucosa of the pockets and tore at engorged capillaries. The cephalic portion of embedded larvae became surrounded by a cellular exudate containing erythrocytes and mononuclear cells. Attachment of second-stage larvae at the root of the tongue did not produce observable damage.

Animals↗

PubMed2002

The clinical relevance of epithelial dysplasia in the surgical margins of tongue and floor of mouth squamous cell carcinoma: an analysis of 37 patients.

BACKGROUND: The clinical relevance of the presence of epithelial dysplasia in the margins of surgically removed oral squamous cell carcinoma is still unclear. METHOD: In a retrospective study, the presence of mild or moderate epithelial dysplasia in the surgical margins of tongue and floor of mouth squamous cell carcinoma was examined histologically. Patients with tumor cells within 0.5 cm of the surgical margins were excluded. Also patients with severe dysplasia were excluded, as this is usually regarded as carcinoma in situ. Patients that received postoperative irradiation were also excluded. Only patients who completed a follow-up period of five years were included. All together, a total number of 37 patients fulfilled the inclusion criteria. RESULTS: Epithelial dysplasia was observed in 7 out of the 37 patients. Five of these patients, and two of the 30 patients with no dysplasia, had a local recurrence (P < 0.01). CONCLUSION: The presence of mild or moderate epithelial dysplasia in the margins of surgically removed oral squamous cell carcinoma carries a significant risk for the development of local recurrence. However, it should be noted that this study was of a retrospective nature and that the group of patients with epithelial dysplasia in the surgical margins was rather small. On the other hand, the inclusion criteria were somewhat strict, by limiting the oral subsite to tongue/floor of mouth, by excluding patients in whom tumors cell were found within 0.5 cm of the surgical margins and by excluding patients who received postoperative radiotherapy, amongst others.

Carcinoma, Squamous Cell↗

PubMed2004

The status of the deep surgical margins in tongue and floor of mouth squamous cell carcinoma and risk of local recurrence; an analysis of 68 patients.

The objective of this study is to retrospectively assess the clinical relevance, i.c. the event of a local recurrence, in patients surgically treated for tongue and floor of mouth squamous cell carcinoma when tumour cell are observed histopathologically at a distance of less than 0.5 cm. Furthermore, the pattern of invasion and the presence or absence of perineural spread were recorded. A total of 68 patients, surgically treated because of a tongue or floor of mouth squamous cell carcinoma, were examined. Patients in whom any degree of epithelial dysplasia was observed in the mucosal surgical margins had been excluded beforehand. Local recurrence occurred in 2 out of 30 patients with a free surgical margins >0.5 cm and in 3 out of 38 patients with a free surgical margin <0.5 cm, the difference being not statistically significant. Apparently, the presence of tumour cells within a distance of less than 0.5 cm, but not into the deep surgical margin, does not necessarily seem to require additional treatment. The pattern of invasion and the presence or absence of perineural spread were not significantly related with local recurrence either.

Carcinoma, Squamous Cell↗