2012 Jan-Mar; Vol 3, No 1
Head and Neck Cancer Pain: Systematic Review of Prevalence and Associated Factors
J Oral Maxillofac Res 2012 (Jan-Mar);3(1):e1
Objectives: Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC.
Material and Methods: The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies.
Results: There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related.
Conclusions: The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.
Keywords: cancer; head and neck cancer; pain; epidemiology; prevalence; review.
Advances in the Aetiophatogenesis of Sjögren’s Syndrome: a Literature Review
J Oral Maxillofac Res 2012 (Jan-Mar);3(1):e2
Objectives: The purpose of present paper is to review and critically address the recent advances on the aetiopathogenesis of the Sjögren’s syndrome, taking into account the attained clinical features, with particular relevance given to the oral involvement.
Material and Methods: A comprehensive review of the available literature between 1970 and 2012, regarding to the aetiopathogenesis and clinical findings related to Sjögren’s syndrome was conducted. Eligible studies were identified by searching the electronic literature PubMed, Medline, Embase, and ScienceDirect databases for relevant reports (last search update January 2012), combining the MESH heading term "Sjögren’s syndrome", with the words "salivary glands, xerostomia, xerophtalmia, aetiology". The authors checked the references of the selected articles to identify additional eligible publications and contacted the authors, if necessary.
Results: This article addresses a large number of the recent advances in the aetiopathogenesis of the disease, taking into account the attained clinical features of both local and systemic nature. Detailed mechanisms of the hypothesized influence of viral infections, genetic and hormonal factors, and the relevance of the altered glandular homeostasis are critically discussed with particular relevance given to the local and systemic involvement of Sjögren’s syndrome.
Conclusions: The increasing number of data published recently on the aetiophatogenesis of Sjögren’s syndrome strengthens the hypothesis that this condition, as all autoimmune diseases, is a multifactor disorder. Genetic predisposition, hormonal and environmental factors are thought to be implicated.
Keywords: oral pathology; Sjogren's syndrome; salivary glands; xerostomia; xerophthalmia; aethiology.
Diagnostic Approaches to Sjögren’s Syndrome: a Literature Review and Own Clinical Experience
J Oral Maxillofac Res 2012 (Jan-Mar);3(1):e3
Objectives: The purpose of present paper is to critically address the recent advances on diagnostic procedures of Sjögren’s syndrome, taking into account the attained local and systemic features of the disease.
Material and Methods: A comprehensive review of the available literature regarding to the diagnostic approaches to Sjögren’s syndrome was conducted. Eligible studies were identified by searching the electronic literature PubMed, Medline, Embase, and ScienceDirect databases for relevant reports (last search update January 2012) combining the MESH heading term "Sjögren’s syndrome", with the words "diagnosis, diagnostic procedures, salivary gland function, ocular tests, histopathology, salivary gland imaging, serology". The authors checked the references of the selected articles to identify additional eligible publications and contacted the authors, if necessary.
Results: Presented article addresses the established diagnostic criteria for Sjögren’s syndrome and critically evaluates the most commonly used diagnostic procedures, presenting data from author’s own clinical experience. Diagnostic criteria for Sjögren’s syndrome are required both by healthcare professionals and patients, namely in order to provide a rational basis for the assessment of the symptoms, establish an individual disease prognosis, and orientate the therapeutic intervention.
Conclusions: Sjögren’s syndrome is quite a common autoimmune disease of which the diagnosis and treatment are not easily established. Due to its systemic involvement, it can exhibit a wide range of clinical manifestations that contribute to confusion and delay in diagnosis. The use of proper diagnostic modalities will help to reduce the time to diagnosis and preserve the health and quality of life of patients with Sjögren’s syndrome.
Keywords: Sjogren's syndrome; oral pathology; salivary glands; xerostomia; minor salivary glands; diagnosis.
Surface Properties and Osteoblastic Cytocompatibility of Two Blasted and Acid-Etched Titanium Implant Systems with Distinct Microtopography
J Oral Maxillofac Res 2012 (Jan-Mar);3(1):e4
Objectives: The aim of this study is to compare two commercially available screw-type sandblasted and acid-etched (SLA) Ti implant systems from Eckermann Laboratorium S.L., with similar geometry and distinct microtopography, regarding surface properties and osteoblastic cytocompatibility.
Material and Methods: Implant I (referred as a conventional SLA system) and Implant II (a system patented as Eckcyte®) were characterized for macro and microtopograpphy, surface roughness and chemical composition. For the cytocompatibility studies, human bone marrow osteoblastic cells were seeded over the implants’ surface, and the cell response was assessed for cell adhesion and proliferation, alkaline phosphatase (ALP) activity and matrix mineralization.
Results: Implant I presented a rough surface with irregularly shaped and sized cavities among flatter-appearing areas, whereas Implant II exhibited a homogeneous rough microporous surface. Compared to Implant I, Implant II presented higher Ra values (0.8 [SD 0.008] μm and 1.21 [SD 0.15] μm, respectively, P < 0.05) and also increased values of Rz, Rt and Rsm, a more negative value of Rsk, and similar RKu values. XPS showed the expected presence of Ti, O, C and N; Al, Si, F, P and Ca were detected in low concentrations. Implant II exhibited significantly lower Al levels. Both implants supported the adhesion, proliferation and differentiation of osteoblastic cells. Implant II showed a thicker fibrilar cell layer and an earlier onset and more abundant matrix mineralization.
Conclusions: The homogeneous rough and microporous surface of Implant II is most probably a main contributor for its improved cell response.
Keywords: dental implants; surface properties; bone marrow; osteoblasts; differentiation cell; cell culture.
Bimaxillary Advancement as the Initial Treatment of Obstructive Sleep Apnea: Five Years Follow-Up of the Pori Experience
J Oral Maxillofac Res 2012 (Jan-Mar);3(1):e5
Objectives: Bimaxillary advancement surgery has proven to be effective treatment of obstructive sleep apnea syndrome. According to the Stanford protocol upper airway soft tissue surgery or advancement of tongue by chin plastic surgery is first carried out and if obstructive sleep apnea persists, then bimaxillary advancement is done. This study describes the 5 year outcome of 13 obstructive sleep apnea patients in whom the Stanford protocol was omitted and bimaxillary advancement was carried out as initial surgical treatment.
Material and Methods: Patients were divided in two groups. Group A comprised patients with obstructive sleep apnea (OSAS) confirmed by polysomnography in whom ODI-4 (oxygen desaturation index) was 5 or more. Group B consisted of patients with occlusal problems needing orthognathic surgery and with OSAS symptoms but no clear disease on polysomnography, where the ODI-4 index was less than 5. Both groups were treated with bimaxillary advancement surgery (BAS) as initial therapy.
Results: In the group A mean ODI-4 was 17.8 (SD 12) before treatment and 3.5 (SD 3.4) at 5-year follow-up (P = 0.018 in paired differences t-test). In group B the ODI-4 remained below 5. In group A mean saturation improved from 94.3% (SD 1.6) to 96.3% (SD 2), P = 0.115 and in group B from 96.3% (SD 1.2) to 97.8% (SD 1.7), P = 0.056 (in paired differences t-test). The static charge sensitive bed evaluation showed improvement in all patients except one.
Conclusions: Bimaxillary advancement surgery is safe and reliable as an initial surgical treatment of obstructive sleep apnea syndrome.
Keywords: obstructive sleep apnea; sleep-disordered breathing; maxillofacial orthognathic surgery; mandible; LeFort osteotomy; sagittal split ramus osteotomy.