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Journal of Applied Research in... May 2024Chewing difficulty, poor oral health, inadequate and imbalanced nutrition are serious health problems in individuals with intellectual disabilities. The participants'...
BACKGROUND
Chewing difficulty, poor oral health, inadequate and imbalanced nutrition are serious health problems in individuals with intellectual disabilities. The participants' chewing abilities, oral health and nutritional status were analysed in this study.
METHODS
Forty-five adult participants with intellectual disabilities were included. Anthropometric measurements, oral health assessments, chewing ability evaluations and dietary intake analyses were conducted.
RESULTS
A 56.8% of the participants were classified as overweight or obese. Teeth grinding was reported in 33.3% of the participants, while 40.0% experienced drooling. All participants with Down syndrome and 58.6% of the participants with developmental delay had chewing difficulties. Inadequate nutrient intake was observed and the fibre, vitamins B1, B3, B9, sodium, phosphorus and iron intakes were significantly lower than reference values in those with chewing difficulty (p < .05).
CONCLUSIONS
Chewing difficulties were associated with lower intake of certain nutrients, highlighting the importance of addressing oral health and dietary counselling in this population.
Topics: Adult; Humans; Nutritional Status; Cross-Sectional Studies; Oral Health; Intellectual Disability; Mastication
PubMed: 38504582
DOI: 10.1111/jar.13225 -
Journal of Reconstructive Microsurgery Mar 2024Oral cavity cancers requiring excision of the oral commissure and free flap reconstruction often requires commissuroplasty to manage oral incontinence. We aimed to...
BACKGROUND
Oral cavity cancers requiring excision of the oral commissure and free flap reconstruction often requires commissuroplasty to manage oral incontinence. We aimed to evaluate the implications of primary versus delayed commissuroplasty on drooling, and interincisal distance outcomes in this cohort.
METHODS
A retrospective query of head and neck cancer patients operated by a single surgeon from 2017 to 2020 was performed. Patients were included if they underwent free flap reconstruction of the oral commissure, had an immediate or delayed commissuroplasty, and had 2 years of follow-up data including Thomas-Stonell and Greenberg drooling rating scales and interincisal distance measurements.
RESULTS
Thirty-five patients were included in the review. Twelve patients received immediate commissuroplasty and 23 patients had delayed commissuroplasty. Interincisal distance was similar at baseline, although significantly varied between immediate and delayed commissuroplasty groups at 1 month and 2 years postoperative. Drooling scores were significantly elevated in the group treated with delayed commissuroplasty, but eventually normalized after staged surgery and follow-up. Patients treated with adjunct radiation therapy had lower interincisal distance than patients who did not have radiation.
CONCLUSION
Delayed commissuroplasty increased interincisal distance and normalize drooling in patients who required full-thickness excision of the buccal mucosa and oral commissure and free tissue reconstruction. The presented data can help to educate patients on expected postoperative outcomes and likely advocates for a second-stage procedure after completion of adjunct radiotherapy to achieve optimal commissural placement and oral competence.
PubMed: 38499044
DOI: 10.1055/s-0044-1782659 -
Parkinsonism & Related Disorders Jun 2024Sialorrhea is a common neurological manifestation of Parkinson's disease (PD). No specifically designed prospective study has tested the effects of deep brain... (Clinical Trial)
Clinical Trial
INTRODUCTION
Sialorrhea is a common neurological manifestation of Parkinson's disease (PD). No specifically designed prospective study has tested the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) on sialorrhea in patients with advanced PD. We focused on the effect of STN-DBS on the incidence of sialorrhea in patients with PD.
METHODS
This multicenter, prospective, non-randomized concurrent clinical trial analyzed the incidence of sialorrhea during long-term follow-up in 170 patients with advanced PD (84 patients with STN-DBS and 86 patients with medication therapy).
RESULTS
After STN-DBS, 58.1% of patients presented with sialorrhea (Drooling Rating Scale (DRS) > 5) compared with 39.3% of patients with medication therapy (P < 0.001). STN-DBS stimulation demonstrated a significant increase in DRS and Drooling Severity and Frequency Scale (DSFS) compared with the patients with medication therapy (P < 0.001). At follow-up, the onabotulinumtoxin-A (BTX-A) injection ratio was significantly higher in the STN-DBS group (29.8% vs. 11.9%, P = 0.0057) compared with the patients with medication therapy.
CONCLUSIONS
STN-DBS increased the risk of sialorrhea in patients with advanced PD.
TRIAL REGISTRATION
clinicaltrials. gov (NCT06090929).
Topics: Humans; Deep Brain Stimulation; Parkinson Disease; Sialorrhea; Male; Female; Subthalamic Nucleus; Middle Aged; Aged; Prospective Studies; Botulinum Toxins, Type A; Follow-Up Studies
PubMed: 38492517
DOI: 10.1016/j.parkreldis.2024.106075 -
Neurological Sciences : Official... Mar 2024
PubMed: 38478254
DOI: 10.1007/s10072-024-07454-3 -
European Journal of Neurology Jun 2024This update of the guideline on the management of amyotrophic lateral sclerosis (ALS) was commissioned by the European Academy of Neurology (EAN) and prepared in...
European Academy of Neurology (EAN) guideline on the management of amyotrophic lateral sclerosis in collaboration with European Reference Network for Neuromuscular Diseases (ERN EURO-NMD).
BACKGROUND
This update of the guideline on the management of amyotrophic lateral sclerosis (ALS) was commissioned by the European Academy of Neurology (EAN) and prepared in collaboration with the European Reference Network for Neuromuscular Diseases (ERN EURO-NMD) and the support of the European Network for the Cure ALS (ENCALS) and the European Organization for Professionals and Patients with ALS (EUpALS).
METHODS
Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the effectiveness of interventions for ALS. Two systematic reviewers from Cochrane Response supported the guideline panel. The working group identified a total of 26 research questions, performed systematic reviews, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available.
RESULTS
A guideline mapping effort revealed only one other ALS guideline that used GRADE methodology (a National Institute for Health and Care Excellence [NICE] guideline). The available evidence was scarce for many research questions. Of the 26 research questions evaluated, the NICE recommendations could be adapted for 8 questions. Other recommendations required updates of existing systematic reviews or de novo reviews. Recommendations were made on currently available disease-modifying treatments, multidisciplinary care, nutritional and respiratory support, communication aids, psychological support, treatments for common ALS symptoms (e.g., muscle cramps, spasticity, pseudobulbar affect, thick mucus, sialorrhea, pain), and end-of-life management.
CONCLUSIONS
This update of the guideline using GRADE methodology provides a framework for the management of ALS. The treatment landscape is changing rapidly, and further updates will be prepared when additional evidence becomes available.
Topics: Amyotrophic Lateral Sclerosis; Humans; Europe; Neurology; Neuromuscular Diseases
PubMed: 38470068
DOI: 10.1111/ene.16264 -
Journal of Veterinary Diagnostic... May 2024Neoplasia is one of the main causes of euthanasia in geriatric captive nondomestic felids. However, few studies have examined oral tumors in these animals. We describe...
Neoplasia is one of the main causes of euthanasia in geriatric captive nondomestic felids. However, few studies have examined oral tumors in these animals. We describe here the clinicopathologic features of gingival squamous cell carcinoma (SCC) in 2 lions () from separate zoologic collections. In both cases, the lions had a history of sialorrhea, bloody oral discharge, and anorexia. Autopsy findings in both lions were similar and were characterized by poorly circumscribed, friable, and bloody gingival masses with grossly apparent invasion of the mandibular bone; a pathologic fracture was observed in 1 case. Histologically, the masses consisted of poorly circumscribed, unencapsulated, densely cellular proliferations of neoplastic epithelial cells arranged in irregular islands, cords, and anastomosing trabeculae with formation of keratin pearls, which, coupled with positive immunohistochemistry for pancytokeratin, were diagnostic for SCC. Although no metastases were found in either animal, both lions were ultimately euthanized because of poor prognosis.
Topics: Animals; Animals, Zoo; Carcinoma, Squamous Cell; Fatal Outcome; Gingival Neoplasms; Lions
PubMed: 38465898
DOI: 10.1177/10406387241236748 -
Clinical and Translational Science Mar 2024Sialorrhea or drooling is a common problem in children and adults with neurodevelopmental disorders. It can negatively impact the quality of life due to its physical and...
Sialorrhea or drooling is a common problem in children and adults with neurodevelopmental disorders. It can negatively impact the quality of life due to its physical and psychological manifestations. Providers commonly prescribe atropine eye drops for topical administration to the oral mucosa, as an off-label treatment to manage sialorrhea. However, the off-label use of atropine eye drops can be associated with medication and dosing errors and systemic side effects. To address these limitations of treatment, we developed a mucoadhesive topical oral gel formulation of atropine as an alternative route to off-label administration of atropine eye drops. In this clinical pharmacokinetic (PK) study, we evaluated the safety and PK of atropine gel (0.01% w/w) formulation after single-dose administration to the oral mucosa in 10 healthy volunteers. The PK data showed that after topical administration to the oral mucosa, atropine followed a two-compartment PK profile. The maximum plasma concentration and area under the curve extrapolated to infinite time were 0.14 ng/mL and 0.74 h·ng·mL , respectively. The absorption rate constant calculated by the compartmental analysis was 0.4 h . Safety parameters, such as heart rate, blood pressure, and oxygen saturation, did not significantly change before and after administration of the gel formulation, and no adverse events were observed in all participants who received atropine gel. These data indicate that atropine gel formulation has a satisfactory PK profile, is well-tolerated at the dose studied, and can be further considered for clinical development as a drug product to treat sialorrhea.
Topics: Adult; Child; Humans; Healthy Volunteers; Quality of Life; Sialorrhea; Area Under Curve; Ophthalmic Solutions; Atropine Derivatives; Administration, Oral
PubMed: 38465519
DOI: 10.1111/cts.13753 -
Indian Journal of Pharmacology Jan 2024We hereby describe a rare case of levosulpiride-induced atypical parkinsonism presenting with sluggish movements, atypical kinetic tremors (tremors with voluntary...
We hereby describe a rare case of levosulpiride-induced atypical parkinsonism presenting with sluggish movements, atypical kinetic tremors (tremors with voluntary movement), periorbital tremors, dystonia, difficulty in speech and coordination, postural imbalance, with additional features of difficulty in swallowing and drooling with associated recent onset psychiatric disturbances such as anxiety and low-lying depression. The dechallenge of levosulpiride and medications for associated anxiety and low-lying depression caused a complete remission of the disease within 2 ½ months.
Topics: Humans; Tremor; Rabeprazole; Depression; Anxiety; Drug Combinations; Sulpiride
PubMed: 38454589
DOI: 10.4103/ijp.ijp_929_21 -
Journal of Cranio-maxillo-facial... May 2024The aim of this study was to evaluate the postoperative course and long-term functional and aesthetic outcomes in patients with Beckwith-Wiedemann syndrome (BWS)...
The aim of this study was to evaluate the postoperative course and long-term functional and aesthetic outcomes in patients with Beckwith-Wiedemann syndrome (BWS) following surgical reduction of macroglossia, using multiple questionnaires. Patients with BWS who underwent keyhole reduction for macroglossia were included in this study. The postoperative course for each patient was recorded, and multiple questionnaires were administered to evaluate aesthetic concerns, oral incompetence or feeding difficulties, sleep-disordered breathing symptoms, and speech. Nine patients underwent ten reduction glossoplasty surgeries. The mean age at surgery was 22 months. The postoperative course for each case was uneventful, except for one patient who had wound dehiscence. The questionnaires revealed significant improvements in tongue appearance, feeding, drooling, facial appearance, and psychosocial outcomes. There was also a significant reduction in sleep-disordered breathing symptoms after surgery. Keyhole reduction glossoplasty is a safe and effective procedure for the treatment of macroglossia in BWS patients, with excellent functional and aesthetic outcomes and a low complication rate.
Topics: Humans; Macroglossia; Beckwith-Wiedemann Syndrome; Male; Female; Infant; Treatment Outcome; Child, Preschool; Surveys and Questionnaires; Glossectomy; Esthetics; Plastic Surgery Procedures
PubMed: 38443190
DOI: 10.1016/j.jcms.2024.02.019 -
Indian Journal of Otolaryngology and... Feb 2024To find out the utility of the island nasolabial flap in patients with oral cavity malignancy.
AIM
To find out the utility of the island nasolabial flap in patients with oral cavity malignancy.
MATERIALS AND METHODS
This was an observational study conducted at a super-specialty hospital in Maharashtra from October 2019 to December 2021. Patients with oral malignancy planned for island nasolabial flaps were only considered.
RESULTS
A total of 20 patients were operated on, out of which 16 were males and 4 were females. All the patients were followed up for a minimum period of 6 months. The hospital's online reporting system is used for the data collection including the post-operative assessment. Out of the 20 patients, 10 patients were suffering from tongue carcinoma, 6 patients from buccal mucosal carcinoma, two from hard palate carcinoma and one patient each from the floor of the mouth and lip carcinoma. The mean age of the series was 52.3 years, the average duration of the surgery is 169.4 min and the average hospital stay in the series was 4.35 days. The Ryle's tube was removed on an average of 4.35 days. No flap-related complications were noted during the series, and healing of the donor site was uneventful. The functional outcomes after the reconstruction are acceptable in all the cases except in the lip reconstruction patient where there was post-operative drooling.
CONCLUSION
The island nasolabial flap is relatively easy to harvest and less time-consuming. The other advantages include the post-operative surgical scar falls along the nasolabial fold, long pedicle length with preservation of the facial pedicle for future microvascular use, early transfer to the oral feed from the nasogastric feed, and early de-cannulation. In our small study, we observed that the island nasolabial flap is a very useful flap for the small to moderate-sized defects of the oral cavity. We feel, one of the disadvantages of this flap is that it is not an ideal flap for lip reconstruction.
PubMed: 38440504
DOI: 10.1007/s12070-023-04177-3