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International Journal of Nursing Studies Feb 2021Extensive surgery and chemo/radiation therapy (C/RT) to manage head and neck cancer (HNC) patients affects their ability to swallow food and liquids, risk of aspiration... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Extensive surgery and chemo/radiation therapy (C/RT) to manage head and neck cancer (HNC) patients affects their ability to swallow food and liquids, risk of aspiration and greatly influences their quality of life (QOL).
OBJECTIVES
Ascertain the effectiveness of swallowing exercises on improving swallowing function, performance status, mouth opening, risk of aspiration/penetration and QOL in HNC patients.
DESIGN
Systematic review and meta-analysis of randomized controlled trials DATA SOURCES: PubMed, Ovid-Medline, Embase, Cochrane Library, CINAHL and Web of Science and included all available RCTs.
REVIEW METHODS
We followed the PRISMA guidelines and standard methods for conducting a systematic review and meta-analysis. Comprehensive Meta-analysis 3.0 using the random effects model was used for data analysis.
RESULTS
In total, 19 RCTs with 1100 participants were identified and included in the current review. Swallowing exercises had significant small effect on swallowing function 0.33 (95%CI = 0.00-0.65) and moderate effect on mouth opening 0.60 (95%CI = 0.21-0.99) immediately after intervention and small effect at 6-month follow-up 0.46 (95%CI = 0.11-0.81). However, non-significant effects were observed on risk of aspiration/penetration, performance status and all domains of QOL.
CONCLUSION
Swallowing exercises demonstrated effectiveness in improving swallowing function and mouth opening in HNC patients undergoing multimodal treatment. This is the first comprehensive systematic review and meta-analysis of RCTs to assess the effect of swallowing exercises in HNC patients undergoing multimodal treatment. Nurses can play an important role in assisting the delivery of oropharyngeal swallowing exercises including jaw exercises, tongue exercises and swallowing maneuvers with assistance and guidance from speech pathologists to help improve HNC complications and QOL for HNC survivors.
Topics: Deglutition; Deglutition Disorders; Exercise Therapy; Head and Neck Neoplasms; Humans; Quality of Life
PubMed: 33352439
DOI: 10.1016/j.ijnurstu.2020.103827 -
Oral Diseases Oct 2019The aim of the present study was to assess the outcomes of radical and conservative treatment approaches of solid/multicystic and unicystic ameloblastoma in terms of... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of the present study was to assess the outcomes of radical and conservative treatment approaches of solid/multicystic and unicystic ameloblastoma in terms of recurrence rates.
MATERIAL AND METHODS
A systematic review and meta-analysis was conducted based on the PRISMA statement. Search was performed using PubMed, Embase, SCOPUS, and Web of Science for articles published from January 1969 until March 2018. Quality assessment of the selected articles was conducted using the Quality Appraisal of Case Series Studies Checklist. The meta-analysis was performed using the MedCalc program.
RESULTS
The search strategy yielded 6,984 articles; 20 studies met the eligibility criteria and were included in the meta-analysis. The pooled recurrence rate of solid/multicystic ameloblastomas following radical treatment was 8%, while conservative treatment caused recurrences in 41%. For unicystic ameloblastomas, these values were 3% and 21%, respectively. The risk of recurrences in both types of ameloblastomas following radical treatment was lower than following conservative treatment.
CONCLUSIONS
The present study showed statistically significant differences in recurrence favoring radical treatment for both unicystic and solid/multicystic ameloblastoma. The solid/multicystic type showed more recurrences than the unicystic type. Unfortunately, since only retrospective studies were available, the evidence is less strong as wished for.
Topics: Ameloblastoma; Checklist; Conservative Treatment; Humans; Jaw Neoplasms; Neoplasm Recurrence, Local; Netherlands; Retrospective Studies; Treatment Outcome
PubMed: 30548549
DOI: 10.1111/odi.13014 -
The Cochrane Database of Systematic... Oct 2017Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some individuals to certain medicines commonly used in the treatment of... (Review)
Review
BACKGROUND
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some individuals to certain medicines commonly used in the treatment of cancer and osteoporosis (e.g. bisphosphonates, denosumab and antiangiogenic agents) and involves the progressive destruction of bone in the mandible or maxilla. Depending on the drug, its dosage, and the duration of exposure, the occurrence of this adverse drug reaction may be rare (e.g. following the oral administration of bisphosphonate or denosumab treatments for osteoporosis, or antiangiogenic agent-targeted cancer treatment) or common (e.g. following intravenous bisphosphonate for cancer treatment). MRONJ is associated with significant morbidity, adversely affects quality of life (QoL), and is challenging to treat.
OBJECTIVES
To assess the effects of interventions versus no treatment, placebo, or an active control for the prophylaxis of MRONJ in people exposed to antiresorptive or antiangiogenic drugs.To assess the effects of non-surgical or surgical interventions (either singly or in combination) versus no treatment, placebo, or an active control for the treatment of people with manifest MRONJ.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 23 November 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 10), MEDLINE Ovid (1946 to 23 November 2016), and Embase Ovid (23 May 2016 to 23 November 2016). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Embase Project to identify all clinical trials and add them to CENTRAL.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing one modality of intervention with another for the prevention or treatment of MRONJ. For 'prophylaxis of MRONJ', the primary outcome of interest was the incidence of MRONJ; secondary outcomes were QoL, time-to-event, and rate of complications and side effects of the intervention. For 'treatment of established MRONJ', the primary outcome of interest was healing of MRONJ; secondary outcomes were QoL, recurrence, and rate of complications and side effects of the intervention.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the search results, extracted the data, and assessed the risk of bias in the included studies. For dichotomous outcomes, we reported the risk ratio (RR) (or rate ratio) and 95% confidence intervals (CI).
MAIN RESULTS
We included five RCTs (1218 participants) in the review. Three trials focused on the prophylaxis of MRONJ. Two trials investigated options for the treatment of established MRONJ. The RCTs included only participants treated with bisphosphonates and, thus, did not cover the entire spectrum of medications associated with MRONJ. Prophylaxis of MRONJOne trial compared standard care with regular dental examinations in three-month intervals and preventive treatments (including antibiotics before dental extractions and the use of techniques for wound closure that avoid exposure and contamination of bone) in men with metastatic prostate cancer treated with zoledronic acid. The intervention seemed to lower the risk of MRONJ: RR 0.10; 95% CI 0.02 to 0.39 (253 participants; low-quality evidence). Secondary outcomes were not evaluated.As dentoalveolar surgery is considered a common predisposing event for developing MRONJ, one trial investigated the effect of plasma rich in growth factors (PRGF) for preventing MRONJ in people with cancer undergoing dental extractions. There was insufficient evidence to support or refute a benefit of PRGF on MRONJ incidence when compared with standard treatment (RR 0.08, 95% CI 0.00 to 1.51; 176 participants; very low-quality evidence). Secondary outcomes were not reported. In another trial comparing wound closure by primary intention with wound closure by secondary intention after dental extractions in people treated with oral bisphosphonates (700 participants), no cases of intraoperative complications or postoperative MRONJ were observed. QoL was not investigated. Treatment of MRONJOne trial analysed hyperbaric oxygen (HBO) treatment used in addition to standard care (antiseptic rinses, antibiotics, and surgery) compared with standard care alone. HBO in addition to standard care did not significantly improve healing from MRONJ compared with standard care alone (at last follow-up: RR 1.56; 95% CI 0.77 to 3.18; 46 participants included in the analysis; very low-quality evidence). QoL data were presented qualitatively as intragroup comparisons; hence, an effect estimate of treatment on QoL was not possible. Other secondary outcomes were not reported.The other RCT found no significant difference between autofluorescence- and tetracycline fluorescence-guided sequestrectomy for the surgical treatment of MRONJ at any timepoint (at one-year follow-up: RR 1.05; 95% CI 0.86 to 1.30; 34 participants included in the analysis; very low-quality evidence). Secondary outcomes were not reported.
AUTHORS' CONCLUSIONS
Prophylaxis of MRONJOne open-label RCT provided some evidence that dental examinations in three-month intervals and preventive treatments may be more effective than standard care for reducing the incidence of MRONJ in individuals taking intravenous bisphosphonates for advanced cancer. We assessed the certainty of the evidence to be low.There is insufficient evidence to either claim or refute a benefit of either of the interventions tested for prophylaxis of MRONJ (i.e. PRGF inserted into the postextraction alveolus during dental extractions, and wound closure by primary or secondary intention after dental extractions). Treatment of MRONJAvailable evidence is insufficient to either claim or refute a benefit for hyperbaric oxygen therapy as an adjunct to conventional therapy. There is also insufficient evidence to draw conclusions about autofluorescence-guided versus tetracycline fluorescence-guided bone surgery.
Topics: Angiogenesis Inhibitors; Anti-Bacterial Agents; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Denosumab; Dental Care; Diphosphonates; Female; Humans; Hyperbaric Oxygenation; Imidazoles; Intercellular Signaling Peptides and Proteins; Jaw Diseases; Male; Oral Health; Osteonecrosis; Postoperative Complications; Prostatic Neoplasms; Quality of Life; Randomized Controlled Trials as Topic; Time Factors; Tooth Extraction; Zoledronic Acid
PubMed: 28983908
DOI: 10.1002/14651858.CD012432.pub2 -
Clinical Oral Implants Research Oct 2018his review evaluated implant survival in geriatric patients (≥75 years) and/or the impact of systemic medical conditions. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
his review evaluated implant survival in geriatric patients (≥75 years) and/or the impact of systemic medical conditions.
MATERIALS AND METHODS
Systematic literature searches were performed to identify studies reporting on geriatric subjects with dental implants and on implant patients who had any of the seven most common systematic conditions among geriatric patients. Meta-analyses were performed on the postloading implant survival rates. The impact of systemic medical conditions and their respective treatment was qualitatively analyzed.
RESULTS
A total of 6,893 studies were identified; of those, 60 studies were included. The fixed-effects model revealed an overall implant survival of 97.3% (95% CI: 94.3, 98.7; studies = 7) and 96.1% (95% CI: 87.3, 98.9; studies = 3), for 1 and 5 years, respectively. In patients with cardiovascular disease, implant survival may be similar or higher compared to healthy patients. High implant survival rates were reported for patients with Parkinson's disease or diabetes mellitus type II. In patients with cancer, implant survival is negatively affected, namely by radiotherapy. Patients with bone metastases receiving high-dose antiresorptive therapy (ART) carry a high risk for complications after implant surgery. Implant survival was reported to be high in patients receiving low-dose ART for treatment of osteoporosis. No evidence was found on implant survival in patients with dementia, respiratory diseases, liver cirrhosis, or osteoarthritis.
CONCLUSIONS
Implant prostheses in geriatric subjects are a predictable treatment option with a very high rate of implant survival. The functional and psychosocial benefits of such intervention should outweigh the associated risks to common medical conditions.
Topics: Age Factors; Aged; Aged, 80 and over; Alveolar Bone Loss; Bone Density Conservation Agents; Cardiovascular Diseases; Dementia; Dental Implantation, Endosseous; Dental Implants; Dental Restoration Failure; Diabetes Complications; Diabetes Mellitus, Type 2; Humans; Lung Diseases; Neoplasm Metastasis; Neoplasms; Osteoporosis; Parkinson Disease; Radiotherapy; Risk Factors; Survival Analysis; Xerostomia
PubMed: 30328186
DOI: 10.1111/clr.13288 -
Medicina Oral, Patologia Oral Y Cirugia... May 2020The aim of the present study was to analyse the incidence, risk ratio (RR) and prognoses of two types of medication-related osteonecrosis of the jaws (MRONJ):... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of the present study was to analyse the incidence, risk ratio (RR) and prognoses of two types of medication-related osteonecrosis of the jaws (MRONJ): denosumab-related osteonecrosis of the jaws (DRONJ) and Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ) in cancer patients under treatment with denosumab or zoledronic acid (ZA).
MATERIAL AND METHODS
An electronic and manual search was conducted for randomized controlled trials (RCTs) until May 2019. Assessment of the identified studies, risk of bias and data extraction were performed independently by two reviewers. The incidence of DRONJ and BRONJ and the RR to develop MRONJ were calculated at 1 year, 2 years and 3 years of exposure. It was also calculated the odds ratio (OR) of their respective prognoses. They were calculated normalizing the values of the individual studies to 1 year, 2 years or 3 years when necessary through robust regression models using a statistical program.
RESULTS
From 1.277 references identified, 8 RCTs were included, which comprised a total of 13.857 patients with a variety of neoplasms. The incidence of DRONJ in cancer patients under treatment with denosumab ranged from 0.5 to 2.1% after 1 year, 1.1 to 3.0% after 2 years, and 1.3 to 3.2% after 3 years of exposure. The incidence of BRONJ in cancer patients under treatment with ZA ranged from 0.4 to 1.6% after 1 year of exposure, 0.8 to 2.1% after 2 years, and 1.0 to 2.3% after 3 years of exposure. Statistically significant differences were found between denosumab and ZA in the risk of developing MRONJ after 1, 2 and 3 years of exposure. Nevertheless, there were no significant differences in terms of patient prognosis.
CONCLUSIONS
Denosumab is associated with a significantly higher risk of developing MRONJ compared to ZA. Nevertheless, no differences were found in its prognoses.
Topics: Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Denosumab; Diphosphonates; Humans; Neoplasms; Zoledronic Acid
PubMed: 32271321
DOI: 10.4317/medoral.23324 -
Oral Oncology Mar 2022There is a wide range of commercial and custom-made devices available for the treatment of trismus (restricted jaw opening). They are used often in conjunction with a... (Review)
Review
BACKGROUND
There is a wide range of commercial and custom-made devices available for the treatment of trismus (restricted jaw opening). They are used often in conjunction with a prescribed exercise program with the aim of improving maximal inter-incisal opening (MIO). This study compared the efficacy (MIO and patient reported outcome results), adverse events, consumer experience and cost of the different types of devices available.
METHODS
Four databases were searched between the years 2001-2021 using the terms 'trismus' and 'device'. Two independent authors assessed each paper for inclusion, then conducted a quality analysis.
RESULTS
Thirty-two studies met the criterion required for inclusion. The majority (n = 27) were in the context of established trismus, where the remaining five used the device preventatively. The trismus device improved MIO in 23 of the rehabilitation programs (pooled mean MIO increased by 9.5 mm in the intervention arm compared to 2.4 mm for controls; p = 0.0001). Improved MIO was not observed in the prevention studies. The Therabite ® was the most common trismus device investigated and with a mean increase in MIO of 10.0 mm and cost of $499AUD. Forces applied by trismus devices were regulated by the perception of pain experienced by the patient, rather than a prescribed force by the treating health professional. Despite this guidance, several adverse events occurred (n = 8), including mandibular and molar fractures. Barriers experienced by consumers included pain, ill-fitting mouthpiece, adverse events, exercise adherence and cost.
CONCLUSION
Trismus devices which use the application of force to the jaw can improve the MIO of patients with established trismus. However, their role is unproven in the setting of trismus prevention during radiotherapy and several significant barriers such as cost, exercise adherence and safety concerns have been demonstrated for the intervention setting.
Topics: Exercise Therapy; Head and Neck Neoplasms; Humans; Pain; Prospective Studies; Quality of Life; Trismus
PubMed: 35104753
DOI: 10.1016/j.oraloncology.2022.105728 -
Special Care in Dentistry : Official... 2024This study aimed to assess the overall incidence of osteonecrosis of the jaw (ONJ) caused by bisphosphonates and denosumab when used for controlling bone cancer... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to assess the overall incidence of osteonecrosis of the jaw (ONJ) caused by bisphosphonates and denosumab when used for controlling bone cancer metastasis or as adjuvant therapy.
SUBJECTS AND METHODS
A systematic search of the PubMed, Embase, and Cochrane Library databases and major meetings' proceedings as of July 30, 2022, identified randomized controlled trials (RCTs) and observational trials that evaluated ONJ caused by denosumab or bisphosphonates. The total incidence and risk ratio (RR) for ONJ were calculated using a random-effects model.
RESULTS
A total of 42 003 patients with various solid tumors reported in 23 RCTs were included. The overall ONJ incidence in cancer patients receiving denosumab or bisphosphonates was 2.08% (95% CI 1.37-2.91; p < .01; I = 94.99%). Patients receiving denosumab had a higher ONJ incidence than those receiving bisphosphonates (RR 1.64, 95% CI 1.10-2.44; p < .05; I = 65.4%). Subgroup analyses showed that prostate cancer patients receiving denosumab and receiving zoledronic acid had the highest ONJ incidences, 5.0% and 3.0%, respectively. The incidence of ONJ induced by different doses was also different.
CONCLUSIONS
The incidence of ONJ caused by denosumab and bisphosphonates is low, the dose of the drug and the type of cancer have certain influence on ONJ. Therefore, clinicians should use the drug reasonably to improve the quality of life of patients.
Topics: Male; Humans; Diphosphonates; Denosumab; Incidence; Bone Density Conservation Agents; Osteonecrosis; Neoplasms; Bisphosphonate-Associated Osteonecrosis of the Jaw
PubMed: 37219080
DOI: 10.1111/scd.12877 -
Journal of Cranio-maxillo-facial... Oct 2014Keratocystic odontogenic tumors (KCOTs) are locally aggressive benign tumors which occur in the bones of both jaws with a high recurrence rate. The aim of the present... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Keratocystic odontogenic tumors (KCOTs) are locally aggressive benign tumors which occur in the bones of both jaws with a high recurrence rate. The aim of the present study was to define and evaluate the post-treatment recurrence of KCOT lesions in non-syndromic and syndromic patients.
METHODS
A systematic review of the literature and meta-analysis was conducted according to the PRISMA statement. Seven electronic databases were searched from their start up to August 2013 for clinical studies on human patients without limitation to year, language or publication status.
RESULTS
A total of five case series studies with 323 treated KCOT lesions were included in the quantitative synthesis. The recurrence rate of KCOTs for three treatment forms ranged from 7% to 28%. Comparisons among the various treatments suggest that resection or marsupialization might be associated with fewer recurrences. However, high risk of bias and effect imprecision preclude the making of clinical recommendation. Existing evidence regarding nevoid basal cell carcinoma patients was likewise scarce.
CONCLUSIONS
The absence of studies with low risk of bias precludes the making of safe recommendations about the optimal management of KCOTs.
Topics: Basal Cell Nevus Syndrome; Bias; Combined Modality Therapy; Humans; Jaw Neoplasms; Neoplasm Recurrence, Local; Odontogenic Tumors; Syndrome
PubMed: 24815763
DOI: 10.1016/j.jcms.2014.03.020 -
The Journal of Craniofacial Surgery Jun 2017Intraosseous schwannomas of the mandible are rare tumors that usually arise from peripheral nerve sheaths of the main trunk or branches of the inferior alveolar nerve... (Review)
Review
Intraosseous schwannomas of the mandible are rare tumors that usually arise from peripheral nerve sheaths of the main trunk or branches of the inferior alveolar nerve (IAN).A systematic review of the English literature through PubMed was conducted from 1945 to 2016. Forty-nine patients of mandibular intraosseous schwannomas were identified. The most common location of the tumor was the posterior mandible (61.2%). There were 28 patients in whom the tumor involved the IAN (57.1%). The most commonly performed procedures included enucleation through a mucoperiosteal flap and a bone window (73%), curettage (10%), segmental mandibulectomy (10%), and sagittal split ramus osteotomy (6%). The recurrence rate was 6%: all 3 recurrent patients occurred in the posterior area. The authors report a 72-year-old female with a schwannoma of the IAN which was removed through a sagittal split of the mandible, although there was a bony defect of the external cortex after biopsy of the lesion. The nerve was reconstructed with a sural nerve graft.Due to the slow growing nature and encapsulation of schwannomas, surgical resection seems the best treatment with optimal functional outcomes and low recurrence rate even with a minimally invasive approach. Sagittal split ramus osteotomy and segmental mandibulectomy are reserved to large or posterior lesions to aid with radical resection or improve exposure and reconstruction.
Topics: Female; Humans; Male; Mandible; Mandibular Neoplasms; Mandibular Nerve; Mandibular Osteotomy; Neoplasm Recurrence, Local; Neurilemmoma; Neurosurgical Procedures; Osteotomy, Sagittal Split Ramus; Sural Nerve
PubMed: 28212127
DOI: 10.1097/SCS.0000000000003557 -
Journal of Stomatology, Oral and... Dec 2023Oral cancers in pregnancy (OCiP) are rare, however when diagnosed it complicates both the treatment of cancer and the outcome of pregnancy. The aim of this systematic...
PURPOSE
Oral cancers in pregnancy (OCiP) are rare, however when diagnosed it complicates both the treatment of cancer and the outcome of pregnancy. The aim of this systematic review was to assess the factors impacting the foetal and maternal outcome in OCiP.
MATERIALS AND METHODS
A systematic search was performed on the following electronic databases: PubMed, Scopus, ScienceDirect and Google Scholar. Only histopathologically diagnosed cases of oral cancer in pregnant patients were included. The Joanna Briggs Institute questionnaire for case reports was used to assess the risk of bias. Logistic regression analysis was used to assess the factors impacting foetal and maternal outcome.
RESULTS
Out of the 40 cases reported, 28 were squamous cell carcinomas and 7 osteosarcomas. Logistic regression analysis demonstrated a non-significant association between age of patient, staging, trimester and treatment to maternal and foetal outcome. The overall recurrence, maternal death and foetal death for OCiP was 25 %, 30.77 % and 3.45 % respectively.
CONCLUSION
It could be concluded with low evidence level that none of the factors explored in this SR affected the maternal and foetal outcome. A regular oral check-up, particularly the tongue of pregnant females is recommended to identify any early signs of inflammation or oral cancer and subjected to biopsy to identify malignancy or dysplasia.
Topics: Female; Humans; Pregnancy; Mouth Neoplasms; Pregnancy Complications, Neoplastic
PubMed: 37783336
DOI: 10.1016/j.jormas.2023.101647