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BMJ Clinical Evidence Nov 2013Candida is a fungus present in the mouths of up to 60% of healthy people, but overt infection is associated with immunosuppression, diabetes, broad-spectrum antibiotics,... (Review)
Review
INTRODUCTION
Candida is a fungus present in the mouths of up to 60% of healthy people, but overt infection is associated with immunosuppression, diabetes, broad-spectrum antibiotics, and corticosteroid use. In most people, untreated candidiasis persists for months or years unless associated risk factors are treated or eliminated. In neonates, spontaneous cure of oropharyngeal candidiasis usually occurs after 3 to 8 weeks.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent and treat oropharyngeal candidiasis in: adults undergoing treatments that cause immunosuppression; infants and children; people with dentures; and people with HIV infection? Which antifungal treatments reduce the risk of acquiring resistance to antifungal drugs? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 47 RCTs or systematic reviews of RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antifungals (absorbed, partially or topically absorbed, or non-absorbed; for example, imidazole [ketoconazole, clotrimazole, toiconazole, miconazole], polyene [amphotericin B, nystatin], triazole [fluconazole, itraconazole], melaleuca and posaconazole), intermittent or continuous prophylaxis, or treatment, and denture hygiene.
Topics: Administration, Oral; Antifungal Agents; Candidiasis, Oral; HIV Infections; Humans; Miconazole; Oropharynx
PubMed: 24209593
DOI: No ID Found -
BMJ Clinical Evidence Feb 2012Candida is a fungus present in the mouths of up to 60% of healthy people, but overt infection is associated with immunosuppression, diabetes, broad-spectrum antibiotics,... (Review)
Review
INTRODUCTION
Candida is a fungus present in the mouths of up to 60% of healthy people, but overt infection is associated with immunosuppression, diabetes, broad-spectrum antibiotics, and corticosteroid use. In most people, untreated candidiasis persists for months or years unless associated risk factors are treated or eliminated. In neonates, spontaneous cure of oropharyngeal candidiasis usually occurs after 3 to 8 weeks.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent and treat oropharyngeal candidiasis in: adults having treatment causing immunosuppression; infants and children; people with diabetes; people with dentures; and people with HIV infection? Which treatments reduce the risk of acquiring resistance to antifungal drugs? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 51 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antifungals (absorbed or partially absorbed, and topical absorbed/partially absorbed/non-absorbed: e.g., amphotericin B, clotrimazole, fluconazole, itraconazole, ketoconazole, miconazole, nystatin, posaconazole) used for intermittent or continuous prophylaxis or treatment, and denture hygiene.
Topics: Administration, Oral; Antifungal Agents; Candidiasis, Oral; Fluconazole; HIV Infections; Humans; Oropharynx
PubMed: 22348417
DOI: No ID Found -
Current Opinion in Otolaryngology &... Apr 2009The goals of this article are: to briefly review oropharyngeal anatomy; to provide a review of the epidemiology of oropharyngeal cancer in the Western Hemisphere; to... (Review)
Review
PURPOSE OF REVIEW
The goals of this article are: to briefly review oropharyngeal anatomy; to provide a review of the epidemiology of oropharyngeal cancer in the Western Hemisphere; to review the literature on the association of human papilloma virus with oropharyngeal cancer; to review the recent literature on evolving diagnostic techniques for oropharyngeal cancer; and to summarize accepted management strategies for oropharyngeal cancer by subsite.
RECENT FINDINGS
The incidence of oropharyngeal cancer may be increasing among younger age groups in the Western Hemisphere, and this may be related to an increased association with human papillomavirus 16. The implications of this viral association with regard to outcomes and management strategies remain under investigation. Screening with toluidine blue, autofluorescence, or both may be useful adjuncts to physical examination and panendoscopy in assessing potentially invasive or dysplastic lesions of the oropharynx. These techniques remain under study. MRI and PET scan are proving to be useful techniques for assessing local extension, regional metastases, and recurrences of squamous cell carcinoma (SCC) of the oropharynx in selected cases. However, serial computed tomography scanning remains the imaging modality of choice in the United States. Early SCCs of the oropharynx (T1-2), in general, may be managed effectively with either surgery or primary irradiation, though, with either technique, clinicians must have a management plan for the neck. Advanced SCCs of the oropharynx (T3-4, nodally aggressive, or both) require multimodal approaches consisting of either surgery along with adjuvant irradiation or concurrent chemoradiation along with salvage surgery (as necessary).
SUMMARY
Management of SCC of the oropharynx is in a period of transition because of evolving changes in our understanding of the oncogenic process; evolving diagnostic techniques; and evolving combinations of therapies, both surgical and nonsurgical. For the time being, we propose using local subsite and disease stage to guide therapeutic decision-making.
Topics: Carcinoma, Squamous Cell; Combined Modality Therapy; Humans; Incidence; Magnetic Resonance Imaging; Mandibular Neoplasms; Neck Dissection; Neoplasm Staging; Oropharyngeal Neoplasms; Oropharynx; Palate, Soft; Papillomavirus Infections; Positron-Emission Tomography; Tomography, X-Ray Computed; Tonsillar Neoplasms
PubMed: 19373958
DOI: 10.1097/moo.0b013e32832984c0 -
Recent Results in Cancer Research.... 2017Anatomically, the oropharynx can be divided into four subsites: the soft palate, pharyngeal wall, base of tongue, and the tonsillar complex. Surgical access to these... (Review)
Review
Anatomically, the oropharynx can be divided into four subsites: the soft palate, pharyngeal wall, base of tongue, and the tonsillar complex. Surgical access to these tumours is often challenging due to the anatomic localization. For this reason, such tumours were traditionally managed with open surgical techniques, usually involving a mandibulotomy, to provide better visualization and access to the oropharynx, followed by free-flap reconstruction of the oropharyngeal defect. However, the invasiveness of this approach could lead to significant morbidity, including speech, swallowing, and airway dysfunction, in addition to poor cosmetic outcomes. In response, less invasive approaches (Mercante et al. 2013) have been developed including minimally invasive surgical approaches (chiefly transoral surgery) as well as non-surgical methods, primarily radiotherapy, and chemotherapy (Mercante et al. 2013).
Topics: Humans; Minimally Invasive Surgical Procedures; Oropharyngeal Neoplasms; Oropharynx; Plastic Surgery Procedures
PubMed: 27699539
DOI: 10.1007/978-3-319-43580-0_14 -
Pediatric Emergency Care Dec 2007Oral cavity and oropharyngeal injuries are common among pediatric patients seen in emergency rooms for head and neck trauma. The appropriate treatment of such injuries... (Review)
Review
BACKGROUND
Oral cavity and oropharyngeal injuries are common among pediatric patients seen in emergency rooms for head and neck trauma. The appropriate treatment of such injuries is often controversial.
PATIENTS AND METHODS
Audit of 6 months' admissions to the pediatric emergency room in a secondary care referral center. Sixty-four patients were treated for various injuries. Charts were reviewed for relevant data.
RESULTS
Description of distribution of types and sites of injuries and discussion of treatment recommendations.
CONCLUSIONS
Most of oropharyngeal injuries heal without any intervention and therefore can be left untreated after being diagnosed. However, in certain injuries, treatment is indicated for better outcome results.
Topics: Adolescent; Child; Child, Preschool; Emergency Service, Hospital; Humans; Infant; Oropharynx; Wounds and Injuries
PubMed: 18091606
DOI: 10.1097/pec.0b013e31815f6fa8 -
Clinics in Geriatric Medicine Aug 1992Considerable evidence exists to suggest that normal aging alone does not cause significant impairment to the ability to swallow. Although there are changes in muscular... (Review)
Review
Considerable evidence exists to suggest that normal aging alone does not cause significant impairment to the ability to swallow. Although there are changes in muscular tension, speed of responses, taste sensitivity, and smell, the physiology of swallowing remains relatively intact. There is evidence suggesting that the duration of the oropharyngeal swallow is longer in older females and that esophageal motility slows in normal aging. Elderly persons do produce multiple lingual gestures and may eat softer and less spicy foods. These changes are subtle and subclinical but do not indicate oropharyngeal dysphagia. Oropharyngeal dysphagia in the elderly is the specific result of a pathologic condition or illness that may occur more commonly in elderly persons. These conditions are neurologic, neuromuscular, systemic, immunologic, psychiatric, environmental, or societal in nature. Oropharyngeal dysphagia is commonly found in institutionalized elderly populations and presents an ethical dilemma in treatment.
Topics: Aged; Aging; Deglutition; Deglutition Disorders; Humans; Oropharynx
PubMed: 1504946
DOI: No ID Found -
Annals of the New York Academy of... Sep 2016Oropharyngeal dysphagia (OD) affects older and neurological patients, causing malnutrition and dehydration and increasing the risk for aspiration pneumonia. There is... (Review)
Review
Oropharyngeal dysphagia (OD) affects older and neurological patients, causing malnutrition and dehydration and increasing the risk for aspiration pneumonia. There is evidence that sensory deficits in those populations are closely related to swallowing disorders, and several research groups are developing new therapies based on sensory stimulation of this area. More information on the sensory innervation participating in the swallow response is needed to better understand the pathophysiology of OD and to develop new treatments. This review focuses on the sensory innervation of the human oropharynx and larynx in healthy people compared with patients with swallowing disorders in order to unravel the abnormalities that may lead to the loss of sensitivity in patients with OD. We also hypothesize the pathway through which active sensory-enhancement treatments may elicit their therapeutic effect on patients with swallowing dysfunctions. As far as we know, this is the first time a review covers the anatomy, histology, ultrastructure, and molecular biology of the sensory innervation of the swallowing function.
Topics: Deglutition; Deglutition Disorders; Humans; Laryngeal Nerves; Larynx; Neural Pathways; Oropharynx; Sensory Receptor Cells; Treatment Outcome
PubMed: 27442852
DOI: 10.1111/nyas.13150 -
Canadian Journal of Anaesthesia =... Jul 2019
Topics: Child, Preschool; Foreign Bodies; Humans; Male; Oropharynx; Tomography, X-Ray Computed; Wounds, Penetrating
PubMed: 30877590
DOI: 10.1007/s12630-019-01345-4 -
Clinical Gastroenterology and... Nov 2019
Topics: Endoscopy, Digestive System; Esophagoscopes; Gastrointestinal Diseases; Humans; Laryngoscopes; Mouth Diseases; Oropharynx; Otorhinolaryngologic Neoplasms; Precancerous Conditions; Risk Factors
PubMed: 31154026
DOI: 10.1016/j.cgh.2019.05.038 -
Archives of Pathology & Laboratory... Nov 2015The incidence of oropharyngeal squamous cell carcinoma has increased during the past decade and is related primarily to the human papillomavirus. This change in... (Review)
Review
CONTEXT
The incidence of oropharyngeal squamous cell carcinoma has increased during the past decade and is related primarily to the human papillomavirus. This change in etiology, from tobacco and alcohol to human papillomavirus, has resulted in improved survival for the disease. In the United States, open resection had largely been replaced by concurrent chemotherapy and/or radiotherapy by the early 2000s. The advent of transoral surgery has led to an increase in surgery as the primary treatment for both early- and advanced-stage oropharyngeal squamous cell carcinoma because it has potential advantages over open surgery and nonsurgical modalities.
OBJECTIVE
To provide an overview of transoral robotic surgery for oropharyngeal squamous cell carcinoma and contrast it with other surgical and nonsurgical modalities.
DATA SOURCES
Articles from 2000 to 2014 were accessioned on PubMed and reviewed for utility by the primary authors.
CONCLUSIONS
Transoral surgery has become more commonly used as a minimally invasive approach to treat oropharyngeal tumors. Other strategies, including radiation, chemotherapy with radiation, and open surgery, are still important treatment approaches. The treatment options for an individual patient rely on multiple factors, including the tumor location and size, features of the tumor, and patient comorbidities. The continued study of these techniques is important to match the patient with the most appropriate treatment.
Topics: Carcinoma, Squamous Cell; Humans; Oropharyngeal Neoplasms; Oropharynx; Quality of Life; Robotic Surgical Procedures; Treatment Outcome
PubMed: 26288397
DOI: 10.5858/arpa.2014-0573-RA