Objectives: Pain is a common complication in head and neck cancer. The aim of this
paper is to evaluate the evidence from randomised control trials investigating
pharmacological and non-pharmacological methods of pain management in head and
neck cancer.
Material and Methods: Medline, Embase and the Cochrane library
databases were searched. Squamous cell carcinomas of the head and neck excluding
nasopharyngeal and salivary gland cancers were included. The limits were "human"
and "randomised clinical trials". A quality assessment was carried out.
Results: 13 studies were included with a total of 644 participants. The primary
outcome for most of these papers was pain control post-treatment. Levels of bias
varied between the studies. Majority (12 out of the 13 studies) reported
intervention to be superior to the control or standard therapy in pain
management. Only 46% of the studies were carried out on an intention to treat
basis. Two studies reported high dropout rates, with one at 66%.
Conclusions: There is insufficient evidence from randomised clinical trials to
suggest an optimal pharmacological intervention for head and neck cancer pain
post-treatment. Further high quality randomised clinical trials should be
conducted to develop an optimal management strategy for head and neck cancer
pain.
Objectives: The aim of present paper was to discuss issues related to trigeminal
neuralgia with strong emphasis on the aetiology and pathogenesis of this
problem.
Material and Methods: An electronic search of 5 databases (1965 - Oct 2012) and a hand search
of peer-reviewed journals for relevant articles were performed. In addition,
experience acquired from treating 3263 patients in the Department of
Maxillofacial Surgery, Lithuanian University of Health Sciences, were also
summarized.
Results: Generally, aetiological factors can be classified into 3 most popular
theories that were based on: 1) Related to other disease, 2) Direct injury to
the trigeminal nerve, and 3) Propagates the polyetiologic origin of the disease.
In addition, two pathogenesis mechanisms of trigeminal neuralgia were proposed.
First: the peripheral pathogenetic mechanism that is often induced by
progressive dystrophy around the peripheral branches of the trigeminal nerve.
Second, central pathogenetic mechanism which often triggered by peripheral
pathogen that causes long-lasting afferent impulsation and the formation of a
stable pathologic paroxysmal type irritation focus on the central nerve system
(CNS).
Conclusions: Patients with susceptive trigeminal neuralgia should be examined
carefully by specialists who have expertise in assessing and diagnosing of
possible pathological processes and be able to eliminate the contributing
factors so the trigeminal neuralgia can be properly managed.
Objectives: The purpose of the present study was to translate and perform a
cross-cultural adaptation of Manchester Orofacial Pain Disability Scale to the
Portuguese language.
Material and Methods: A synthesis of two independent translations done by bilingual
translators whose mother tongue was the Portuguese language began the process of
translation. From the synthesis of the translated version and totally blind to
the original version, two different non-native English language teachers without
dental knowledge translated the questionnaire back to English. The pre-final
version was done by an Expert committee: the researchers, two other non-native
English language teachers and one native English language speaker. The new
questionnaire was then piloted among 8 patients from the target setting that
were interviewed to probe it on their perceived meaning of each question. The
Manchester Orofacial Pain Disability Scale (MOPDS) thus translated was called
Brasil-MOPDS and was validated in 50 patients with Orofacial pain from TMJ and
Occlusion clinic ambulatory of São Paulo University School of Dentistry. The
Brasil-MOPDS was administered twice by an interviewer (15 - 20 day interval) and
once by a second independent interviewer. The Brazilian version of the short
form oral health impact profile (OHIP-14) questionnaire and the visual analogue
pain scale (VAS) were applied on the same day.
Results: Internal consistency (Cronbach’s α = 0.9), inter-observer (ICC = 0.92)
and intra-observer (ICC = 0.98) correlations presented high scores. Validity of
Brasil-MOPDS compared to OHIP-14 (r = 0.85) and VAS (r = 0.75) shown high
correlations.
Conclusions: Brasil-MOPDS was successfully translated and adapted to be applied to
Brazilian patients, with satisfactory internal and external reliability.
Objectives: The study of cervical muscles and their significance in the development
and perpetuation of Temporomandibular Disorders has not been elucidated. Thus
this project was designed to investigate the association between cervical
musculoskeletal impairments and Temporomandibular Disorders.
Material and Methods: A sample of 154 subjects participated in this study. All subjects
underwent a series of physical tests and electromyographic assessment
(i.e. head and neck posture, maximal cervical muscle strength, cervical
flexor and extensor muscles endurance, and cervical flexor muscle
performance) to determine cervical musculoskeletal impairments.
Results: A strong relationship between neck disability and jaw disability was
found (r = 0.82). Craniocervical posture was statistically different
between patients with myogenous Temporomandibular Disorders (TMD) and
healthy subjects. However, the difference was too small (3.3°) to be
considered clinically relevant. Maximal cervical flexor muscle strength
was not statistically or clinically different between patients with TMD
and healthy subjects. No statistically significant differences were
found in electromyographic activity of the sternocleidomastoid or the
anterior scalene muscles in patients with TMD when compared to healthy
subjects while executing the craniocervical flexion test (P = 0.07).
However, clinically important effect sizes (0.42 - 0.82) were found.
Subjects with TMD presented with reduced cervical flexor as well as
extensor muscle endurance while performing the flexor and extensor
muscle endurance tests when compared to healthy individuals.
Conclusions: Subjects with Temporomandibular Disorders presented with impairments of
the cervical flexors and extensors muscles. These results could help guide
clinicians in the assessment and prescription of more effective interventions
for individuals with Temporomandibular Disorders.
Objectives: Mandibular advancement device therapy is effectively used in the
treatment of obstructive sleep apnea, but also several side effects in the
masticatory system have been reported. The aim of this study was to evaluate the
subjective symptoms and clinical signs of temporomandibular disorders connected
to mandibular advancement device therapy.
Material and Methods: The material consisted of 15 patients (9 men and 6 women, mean age 51.1
years, range 21 to 70 years) diagnosed with obstructive sleep apnea
(OSA). Subjective symptoms and clinical temporomandibular disorders
(TMD) signs were recorded at the beginning of the treatment (baseline)
and at 1-month, 3-month, 6-month and 24-month follow-ups. The degree of
TMD was assessed using the anamnestic (Ai) and the clinical dysfunction
index (Di) of Helkimo. For assessing the effect of TMD the patients were
divided in discontinuing and continuing groups.
Results: According to Ai and Di, the severity of TMD remained unchanged during
the follow-up in most of the patients. Temporomandibular joint (TMJ) crepitation
was found more frequently in discontinuing patients at all follow-ups. The
difference was statistically significant (P < 0.05) at the six-month follow-up.
Masticatory muscle pain during palpation was a frequent clinical sign at the
baseline and during the follow-up period but the difference between
discontinuing and continuing patients was not significant.
Conclusions: It seems that signs and symptoms of temporomandibular disorders do not
necessarily increase during long-term mandibular advancement device therapy.
However, it seems that patients with clinically assessed temporomandibular joint
crepitation may discontinue their mandibular advancement device therapy due to
temporomandibular disorders.