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PubMed2002

[Burning mouth syndrome and depression: a case report].

We present a 63-year-old male patient with major depression, characterised by prominent somatic symptoms localised especially around the mouth, whose complaints started just after a prostate operation. The symptoms consisting of burning in the mouth, pain, dry mouth (xerostomia), an unpleasant and strange feeling of taste and itching, are all consistent with burning mouth syndrome. Burning mouth syndrome is a common disorder, usually affecting elderly females, characterised by intractable pain and burning in the oral cavity, evident especially in the tongue, together with a normal mouth mucosa. In the scientific literature a variety of terms are used to describe similar symptoms, such as glossodynia, glossopyrosis, stomatodynia and oral dysestesia. Most patients suffer from the syndrome for a long time, ranging from months up to years. The onset was reported to be gradual for most of the subjects, although many patients relate the onset of symptoms to previous dental procedures or to a previous medical illness. Burning mouth syndrome has a multifactorial etiology. Anxiety disorder, hypochondriasis, conversion disorder and especially depression may be considered amongst the psychological factors responsible for this situation. The psychological findings in burning mouth syndrome patients may be either the consequence of the chronic pain condition or its cause. It is well known that those patients had a relatively high percentage of psychiatric or psychological treatment in the past and/or present. After excluding organic factors, depression should be considered in old patients with predominant mouth complaints.

English Abstract↗
PubMed1985

[Effect of electroacupuncture and morphine on evoked potentials in the oral and caudal trigeminal nuclei in the cat].

Electroacupuncture effects on the functions of the oral and caudal trigeminal nuclei were comparatively analyzed in acute experiments on cats narcotized by hexinal (50 mg/kg). Responses evoked in the caudal nucleus by tooth pulp stimulation were inhibited while responses to mouth mucosa stimulation remained unchanged. In the oral nucleus responses to both types of stimulation were relieved. The same results were obtained in an experiment with systemic injection of morphine (5 mg/kg). It is suggested that different parts of the caudal nucleus are responsible for the transmission of discriminative and diffuse components of the nociceptive signals to the specific and nonspecific projection systems. The oral nucleus may be involved in the transmission of signals about mouth lesions conveying the necessity for defense reactions.

Acupuncture Therapy↗
PubMed1985

Trigger activation of the paradoxical salivatory response to atropine in the parasympathetically denervated human parotid gland.

The author describes a specific intermediate condition of the response to atropine during the 2nd stage of denervation of the human parotid gland. Of the entire cohort of 110 subjects, some 20 subjects have been observed systematically. They demonstrated an extremely intense atropine salivation that followed an additional trigger activation, namely food or acid irritation of the mouth mucosa. The initial phase of such a stimulation was characterized by a sharp, explosive increase in secretion. The following conclusions have been inferred: (1) in the 2nd stage of parasympathetic denervation of the human parotid gland, there emerges a specific intermediate condition of 'readiness' for an extremely intense paradoxical salivatory response to atropine and other cholinolytics; (2) the pre-start 'readiness' state may be activated by means of adding a trigger signal followed by an explosive occurrence of abundant secretion; (3) only food or acid irritation, even to a minimal extent, of the mouth cavity may serve a specific trigger signal; (4) a stable state of this trigger readiness has been observed in 20 subjects for years, while in other subjects it has been observed as a transitory event between the 1st and the 3rd stages of denervation and during the regression of symptoms in the rehabilitation period; (5) suggestions have been made concerning the trigger activation mechanism of the atropine salivatory paradox and the evolutionary, model and clinical significance of the events described.

Atropine↗
PubMed2005

Efficacy of Rhizophora mangle aqueous bark extract (RMABE) in the treatment of aphthous ulcers: a pilot study.

OBJECTIVE: Rhizophora mangle aqueous bark extract (RMABE) (CIKRON-H), has been used as antiseptic and skin wound healing promoter. The present study was a randomised, single-blinded, placebo control trial conducted to asses the efficacy of RMABE in treating oral aphthous ulcers. RESEARCH DESIGN AND METHODS: Patients (n = 32) with aphthous ulcers were randomised to received placebo solution or RMABE topically, once a day, from Monday to Friday, until they healed. The efficacy of the treatment was evaluated by physician clinical observations (time to heal, change in condition), the quality of the patient's life and the tolerability through recording adverse effects. RESULTS: No demographic differences were noted between the two groups at base-line. Seven days after treatment, 12 of the 17 patients in the RMABE group (71%) were completely healed of their aphthous ulcers, with repaired mucosa and no symptoms of ulcers, compared with one in 15 patients in the placebo group (7%) (p < 0.0001). The time taken for the signs and symptoms of ulcers to diminish was also higher in the placebo than in RMABE-treatment group (erythema: placebo 10.54 +/- 1.24, RMABE 4.94 +/- 0.72 days, p = 0.0003; ardour: placebo 7.00 +/- 0.76, RMABE 2.93 +/- 0.49 days, p = 0.0001; and pain: placebo 7.43 +/- 1.21, RMABE 2.92 +/- 0.23 days, p = 0.0011). No subject showed any sign of adverse effects. CONCLUSIONS: These observations demonstrate that the R. mangle aqueous bark extract reduced the time to repair mucosal tissue, erythema, ardour and pain persistence. There was no evidence any adverse effects. This is the first time that the R. mangle extract has been reported to have mouth mucosa healing properties.

Adult↗
PubMed1998

The use of processed allograft dermal matrix for intraoral resurfacing: an alternative to split-thickness skin grafts.

BACKGROUND: The standard reconstruction of significant mucosal defects in head and neck surgery has been split-thickness skin grafting (STSG). OBJECTIVE: To examine the use of a commercially available acellular dermal matrix as an alternative to STSG to reduce the scarring and contracture inherent to meshed split-thickness autografting and avoid the additional donor site morbidity. PATIENTS AND METHODS: Twenty-nine patients with full-thickness defects of the oral cavity were included in this retrospective chart review. Candidate patients had their operative procedure performed at a tertiary care center during a 24-month period. Allograft dermal matrix, an acellular tissue-processed biomaterial, was applied to these intraoral defects. The defects were reconstructed with an acellular dermal graft matrix in the same technical fashion as with an autologous skin graft. Patients were evaluated for rate of "take," functional return time to reepithelialization, average surface area of graft, associated pain and discomfort, evidence of restrictive graft contracture, patient diagnosis, and graft location within the oral cavity. Any evidence of incomplete graft reepithelialization was considered grounds for graft failure, either complete or incomplete. Epithelialization and contracture were assessed during outpatient clinical examinations. Patient complaints with regard to discomfort at the graft bed were considered evidence of pain. RESULTS: Graft locations included 9 in the tongue (32%), 5 in the maxillary oral vestibule (17%), 4 in the mandible (14%), 4 in the floor of mouth (14%), 3 in the hard and/or soft palate (10%), 3 in the tonsil (10%), and 1 in the lip (3%). The overall rate of take was 90% with complete epithelialization noted on clinical evaluation within 4 weeks. Patients were followed up for an average of 8.6 months. The average grafted surface area was 25 cm2. Pain or discomfort was noted in 3 patients (12%). One patient (4%) was noted to have clinical evidence of graft contracture. CONCLUSIONS: Allograft dermal matrix was successful as a substitute to autologous STSG for resurfacing of intraoral defects. Allograft dermal matrix may be considered a useful reconstructive option for patients with oral mucosal defects.

Biocompatible Materials↗
PubMed2004

Decreased short- and long-term swallowing problems with altered radiotherapy dosing used in an organ-sparing protocol for advanced pharyngeal carcinoma.

OBJECTIVE: To determine the effect of a reduced radiotherapy dose on short- and long-term swallowing problems after organ-sparing treatment. DESIGN: Prospective case series. SETTING: Tertiary care referral center. PATIENTS: A consecutive sample of 29 patients with advanced oropharyngeal or hypopharyngeal cancer who were treated with intravenous hydroxyurea and concomitant hyperfractionated, accelerated radiotherapy. INTERVENTIONS: Initial experience with 74.4 Gy of radiation demonstrated severe long-term swallowing problems, prompting a dose reduction to 60.0 Gy. Eighteen patients were followed up for this study in the 74.4-Gy group, while 11 were in the 60.0-Gy group. MAIN OUTCOME MEASURES: Swallowing variables were assessed in both patient groups at 4 months and at 12 months following completion of therapy. RESULTS: Patient demographics and tumor characteristics were similar in each group, while significant differences were noted in the posttreatment clinical swallowing variables. Persistent severe odynophagia at 4 months (89% [16/18] vs 30% [3/10]) and at 12 months (64% [7/11] vs 11% [1/9]) was greater in the 74.4-Gy group (P =.002). Clinical signs of aspiration were also increased in the 74.4-Gy group, with 81% (13/16) vs 11% (1/9) at 4 months and 60% (6/10) vs 11% (1/9) at 12 months (P<.05). Most striking, however, was the incidence of long-term gastrostomy, with 78% (14/18) of patients receiving 74.4 Gy requiring gastrostomy feedings at 12 months compared with 18% (2/11) in the 60.0-Gy group (P =.002). Local control was unchanged by the altered dosing, with median follow-ups of 43.5 and 24.0 months in the 74.4-Gy and 60.0-Gy groups, respectively. CONCLUSION: Decreased radiation doses can maintain disease control and reduce treatment-related long-term swallowing complications.

Adult↗
PubMed1975

Snuff-dippers lesion. A ten-year follow-up.

A population of over 15,000 snuff users and tobacco chewers were observe for cytological, histological, and clinical evaluation. The original observation was for 5 1/2 years. The same group was observed for an additional 4 1/2 years, bringing the total time to ten years. Of the original group of 1,751 patients showing mucosal change, i was able to follow up 1,550. No patient developed carcinoma or serious mucosal changes. From this ten-year study we concluded that snuff, per se, or chewing do not act as carcinogens.

Acanthosis Nigricans↗
PubMed1977

DiGeorge syndrome associated with multiple squamous cell carcinomas.

Experimental evidence and clinical experiences have have shown that immune mechanisms and cancer are closely related. A case of a 42-year-old man with DiGeorge syndrome is presented as an interesting example of an impaired immune mechanism and is described in association with multiple squamous cell carcinomas of the upper respiratory system. The congenital absence of the thymus gland in DiGeorge syndrome results in an absence of a cell-mediated immune response. There are plasma cells and germinal centers in lymph nodes, but lymphocytes in the paracortical areas are sparse. Patients wiith DiGeorge syndrome have no delayed hypersensitivity, cannot be actively sensitized with dinitrochlorobenzene, reject allografts poorly, and have no lymphocytic response to phytohemagglutinin antigens.

Adult↗
PubMed1982

Inadvertent endobronchial intubation with nasogastric tube. Occurrence after head and neck surgery.

Inadvertent endobronchial intubation with nasogastric tubes is hazardous. Massive aspiration can be fatal after nasogastric feeding. In this study, methods of blind nasogastric tube insertion and conventional techniques of confirming the site of the tube are discussed. We stress that direct laryngoscopy either during or immediately after placement or a chest roentgenogram should be considered in the case of nasogastric feeding after major head and neck surgery.

Aged↗
PubMed1984

Skin grafts in intraoral reconstruction. A new stenting method.

The results of skin graft reconstruction in intraoral cancer in 65 consecutive cases were uniformly good. There were only 11 wound complications and all resolved spontaneously without additional surgery. Skin grafts were used successfully in conjunction with coronal resections of the mandible, incontinuity modified neck dissections, and composite resections. Postoperative radiation therapy had no ill effects on the grafts or oral hygiene. A new stenting method with a dental tissue conditioner was employed. When used to immobilize intraoral skin grafts, it improved oral hygiene and patient deglutition, thereby hastening rehabilitation. The success of grafts performed with the new stent was equal to (if not better than) the success of grafts performed with the traditional stent.

Adult↗
PubMed1985

Extended palatal island mucoperiosteal flap.

The extended palatal island mucoperiosteal flap was used in 53 cases over a ten-year period. Its many uses include reconstruction of the soft palate and resurfacing of retromolar and cheek defects. Its reliability with a success rate of 96% and spontaneous epithelialization of the donor site at three months makes it an attractive method of reconstruction.

Adenocarcinoma↗
PubMed1986

Prostaglandin inhibitor and radiotherapy in advanced head and neck cancers.

Radiotherapy is the usual mode of treatment for unresectable head and neck cancer. To improve cure rates, extend survival, and reduce morbidity, we use accelerated hyperfractionation radiotherapy and an adjuvant drug to inhibit prostaglandin synthesis. In this study, 19 patients received 300 rad/day of radiotherapy in two equally divided doses to a total dose averaging 6,200 rad. Either indomethacin, 25 mg, or placebo was given four times a day in a double-blind fashion during therapy. Radiation mucositis was graded as 0 to 4+; pain, nutritional status, and tumor status were monitored daily and recorded biweekly. Evaluation of the data showed delayed mucositis in the experimental group for grades 1 to 3, with a significant difference at grade 3 compared with controls. The significance of a long-term comparison of cure rates would be doubtful considering the heterogeneity of the primary sites and regional disease in this group coupled with the small size of our study.

Clinical Trials as Topic↗
PubMed1987

Toxicity of oral radiotherapy in patients with acquired immunodeficiency syndrome.

Although radiotherapy is a standard form of management of head and neck tumors, treatment of the oral cavity in patients who have the acquired immunodeficiency syndrome has produced unacceptable toxicity. Five such patients are described as a warning of enhanced toxicity of oral radiotherapy in this patient population.

Acquired Immunodeficiency Syndrome↗