National trends in tongue reduction surgery for macroglossia in children

Objectives

To examine the frequency of partial glossectomy performed for the indication of macroglossia in children within the United States, assessing for differences in rates of intervention across various demographics.To identify potential morbidities associated with partial glossectomy in this population and determine how such factors may influence length of stay and cost of admission following tongue reduction surgery.

Long-term changes in dentoskeletal pattern in a case with Beckwith-Wiedemann syndrome following tongue reduction and orthodontic treatment

Long-term changes in the dentoskeletal pattern in a 6-year-old Japanese girl with Beckwith-Wiedemann syndrome were demonstrated. The patient showed macroglossia, which is the most common symptom of the syndrome, protruded lower lip, mandibular protrusion and anterior open bite. The jaw base relationship improved to skeletal Class I and the molar relationship to Angle Class I at the early preadolescent period following tongue reduction and phase I orthodontic treatment using a chin cap and tongue crib. Optimum intercuspation of teeth was achieved after edgewise treatment without orthognathic surgery, and a skeletal Class I apical base relationship and good facial profile were maintained after the retention period of 2 years. This case report suggests that early orthodontic treatment with tongue reduction can be effective in a case with Beckwith-Wiedemann syndrome to improve an abnormal dentoskeletal pattern.     

Effect of Functional Chewing Training on tongue thrust and drooling in children with cerebral palsy: a randomised controlled trial

Tongue thrust, which is an oral reflex associated with sucking behaviour, may cause problems in swallowing, speech, oro‐facial development and also drooling. We aimed to examine the effect of Functional Chewing Training (FuCT) on tongue thrust and drooling in children with cerebral palsy. The study included 32 children with a mean age of 58·25 ± 9·58 months who had tongue thrust. Children were divided into two groups: the FuCT group and control group receiving classical oral motor exercises. Each group received training for 12 weeks. Oral motor assessment was performed. Chewing performance level was determined with the Karaduman Chewing Performance Scale. Tongue thrust severity was evaluated with the Tongue Thrust Rating Scale. The Drooling Severity and Frequency Scale was used to evaluate drooling severity and frequency. The evaluations were performed before and after treatment. Groups were well matched in age, gender and oral motor assessment. No significant difference was found between groups in terms of pre‐treatment chewing function, tongue thrust severity, drooling severity and frequency (P > 0·05). The FuCT group showed improvement in chewing performance (P = 0·001), tongue thrust severity (P = 0·046) and drooling severity (P = 0·002), but no improvement was found in terms of drooling frequency (P = 0·082) after treatment. There was no improvement in chewing performance, tongue thrust, drooling severity and frequency in the control group. A significant difference was found between groups in favour of FuCT group in tongue thrust severity (P = 0·043). This study showed that the FuCT is an effective approach on the severity of tongue thrust and drooling in children with CP.     

Presenting characteristics and treatment outcomes for tongue lacerations in children

PURPOSE: Tongue lacerations in children require treatment decisions by clinicians, but there is conflicting literature on the topic of suturing. METHODS: In this prospective study, 28 patients (mean age 3.0 +/- 2.3 yr) with traumatic tongue lacerations were triaged according to an existing protocol to determine if the laceration would be sutured. At least 2 weeks post-trauma, 22 patients were evaluated by examination or report for quality of result and post-trauma complications. The most common location was anterior dorsum. A fall at home was the most common situation. Mean delay from injury to treatment was 4.5 +/- 9.0 h. No statistically significant difference was found for quality of result or post-trauma morbidity between those lacerations sutured and those not. No significant relationship was found between quality of result and size of laceration or bleeding at the time of presentation. Time delay did not significantly affect the quality of result. CONCLUSION: Results suggest that suturing does not improve outcome or post-trauma course for tongue lacerations in young children.     

Taste after reduction of the tongue in Beckwith-Wiedemann syndrome

We tested the sensitivity of taste after reduction of the tongue in four girls with Beckwith-Wiedemann syndrome. No patient had taste blindness, but the ability to detect salty and bitter tastes declined after reduction of the tongue.     

前臂皮瓣修复舌癌术后舌缺损患者的生存质量评价

目的 分析评价前臂皮瓣修复舌鳞状细胞癌术后舌缺损患者的术后生存质量.方法 应用美国华盛顿大学生存质量问卷(University of Washington head and neck quality-of-life questionnaire,UW-QOL)对112例舌鳞状细胞癌术后前臂皮瓣修复舌缺损患者行生存质量评价,并对不同程度、不同部位舌缺损患者的术后生存质量进行对比分析.结果 112例患者的总体生存质量得分为959.6分,达到总分的80%(960/1200);舌缺损≤1/2全舌(＞1/3全舌)患者的总体生存质量得分(979.8分)明显高于舌缺损＞1/2全舌患者(901.7分),其中语言功能的恢复存在明显差异,两组患者的平均得分分别为71.1和58.6分(P＜0.05);缺损未涉及舌根和涉及舌根的患者术后生存质量得分分别为981.6和950.0分,差异无统计学意义(P＞0.05).结论 前臂皮瓣是舌缺损重建的良好选择,修复舌根部缺损也能获得良好治疗效果;前臂皮瓣更适合用于≤1/2全舌(＞1/3全舌)的舌缺损重建.

Abstract：

Objective To evaluate the quality-of-life outcomes in patients with tongue cancer following reconstruction with free forearm flap. Methods Quality-of-life (QOL) outcomes of 112 patients of tongue reconstruction with free forearm flap were assessed using University of Washington head and neck QOL questionnaire (UW-QOL). The QOL outcomes of the patients with different defect range and site were also compared. Results The overall mean QOL scores of the 112 patients was 959. 6, which reached about 80% (960/1200)of the overall score. The QOL scores of the patients with defects not more than 1/2 tongue ( more than 1/3 tongue) were significantly higher than those with defects more than 1/2 tongue ( P ＜0.05 ).There was no significant difference between the QOL scores of the patients with and without tongue base defect (P ＞ 0.05 ). Conclusions Free forearm flap is a good choice for tongue reconstruction and more suitable for the reconstruction of the defects not more than 1/2 tongue ( more than 1/3 tongue).     

Relationship between lip position and drooling in children with cerebral palsy.

AIM: This was to determine whether there is any relationship between lip position and drooling in children with cerebral palsy (CP). METHODS: One hundred and sixty individuals with CP (aged 4-18 years) agreed to take part in the study. The following data were collected in two ways. Firstly the presence or absence of drooling, the dental age, the incisal relationship and lip position were obtained by direct observation of the children. Secondly other data for age, sex, learning disability and type of CP were collected using a questionnaire/form. STATISTICS: This was by simple Chi squared analysis. RESULTS: A significantly greater number of CP children who drooled had incompetent lips (p<0.002). When comparing CP children with drooling (mild + moderate + severe) and those without drooling there was a clear difference in distribution of it between those with and those without competent lips. This difference was found to be highly significant (p<0.005). CONCLUSION: Lip position and oral seal share a potentially important association with drooling.     

Changes in tongue and hyoid positions, and posterior airway space following mandibular setback surgery.

INTRODUCTION: The postural response of the tongue after mandibular setback is clinically important for maintaining normal respiration. Although the hyoid bone moves progressively to adapt physiologically to the altered orofacial configuration following such surgery, it is not clear whether repositioning of the hyoid has an effect on the pharyngeal airway. In the present study, postoperative changes in hyoid position and pharyngeal airway space were assessed retrospectively in patients who had undergone mandibular setback surgery. MATERIAL AND METHODS: Digitized lateral cephalograms from 30 mandibular setback surgery cases taken preoperatively, and 1 month and more than 1 year postoperatively, were used to examine pharyngeal airway morphology and the position of hyoid bone. RESULTS: A significant downward movement of the hyoid bone was found 1 month after surgery, while the pharyngeal airway dimensions at the tongue were maintained. More than 1 year after surgery, the hyoid position returned to its original position, resulting in a significant decrease in retrolingual airway dimension. CONCLUSION: The results indicate that mandibular setback causes airway narrowing late after surgery, while the early postoperative airway dimension is maintained. Long-term observations should be performed because of the changes of oropharyngeal configuration following mandibular setback.     

Caries prevalence after submandibular duct retroposition in drooling children with neurological disorders

This study is a long-term follow up of 17 patients surgically treated for uncontrolled drooling, by retroposition of the ducts from the submandibular glands. Mean age was 16.8 years (range 7-31), with an average postoperation time of 9.2 years (range 1-18). Clinically, no subject revealed an impression of an extremely dry mouth, but most patients showed obvious permanent decrease in drooling after the surgical treatment. They had a highly significant increase in caries prevalence of the mandibular incisal and canine area, and this caries prevalence was related to the severity of cerebral palsy.     

Supragingival calculus in children with gastrostomy feeding: significant reduction with a caregiver-applied tartar-control dentifrice

PURPOSE: This study assessed the anti-calculus benefit of Crest Dual Action Whitening Toothpaste in gastrostomy (GT) children compared to a control anti-caries dentifrice. METHODS: A double-blind randomized crossover design was used to compare the two dentifrices. A convenience sample of 24 GT subjects, 3-12 years old, was given a consensus baseline Volpe-Manhold Index calculus score by 2 trained examiners, followed by a dental prophylaxis to remove all calculus. Each child was randomly assigned to either study or control dentifrice groups. Caregivers brushed subjects' teeth twice daily with the unlabelled dentifrice for at least 45 seconds. Calculus was scored at 8 weeks (+/- 1 week) by the same investigators. Subjects then had a prophylaxis and received the alternative dentifrice. Subjects returned 8 weeks (+/- 1 week) later for final calculus scoring. RESULTS: The study dentifrice significantly reduced supragingival calculus from baseline by 58% compared to control dentifrice (p<0.005 need exact p-value unless it is <.001; maybe it's reported in the paper). Calculus levels decreased by 68% over the study duration, irrespective of dentifrice. ANOVA found no significant differences in calculus scores based on gender, race, history of reflux, aspiration pneumonia, or oral intake of food. Calculus was significantly related to history of aspiration pneumonia (p<0.05 need exact p-value here). CONCLUSION: Crest Dual Action Whitening Toothpaste was effective and better than anti-caries control dentifrice in reducing calculus in GT children.     

Compartment syndrome following oral and maxillofacial surgery

Compartment syndrome must be included in the differential diagnosis in any patient who complains of pain or neuromuscular deficit in an extremity. The etiology, differential diagnosis, clinical features, and treatment of compartment syndrome are reviewed to assist in proper diagnosis and management. Although the exact etiology in this case will never be ascertained, delay in diagnosis and treatment resulted in a neuromuscular deficit. It is therefore imperative that proper patient positioning during the perioperative period be closely monitored to avoid this complication.     

Hematoma following periodontal surgery with a torus reduction: a case report

BACKGROUND: There are no published case reports that hematomas occur on the floor of the mouth as a result of periodontal surgery. REPORT: These three case reports document post surgical hematoma formation on the floor of the mouth that pose problems with the diagnosis, prognosis, and patient management. All cases involved periodontal surgery where extensive reduction of tori and bony exostoses were required. Two cases resulted in hematomas in the floor of the mouth. However, a change in the post surgical management for a third case demonstrated possible prevention of hematoma formation. SUMMARY: Hematomas in the floor of the mouth can be a resolving post surgical phenomenon or a serious vascular insult to this region of the oral cavity. This report clarifies the diagnosis, prognosis, and the best management protocol through the presentation of three cases.     

下颌后退术后舌骨、舌体位置和咽腔间隙变化的锥形束CT分析

目的研究正畸-正颌联合治疗骨性Ⅲ类错畸形对舌骨、舌体位置和咽腔间隙的影响,分析下颌后退与舌骨、舌体位置改变和咽腔间隙缩窄之间的相关性。方法选取经正畸-正颌联合治疗的患者20例为研究对象,于正颌手术前1周及术后6个月拍摄锥形束CT,三维重建颅颌面、气道及舌骨的立体模型,建立以蝶鞍中心（S）点为原点的三维坐标系。测量治疗前后咽腔各段最窄处的矢状径、冠状径、截面积,各段容积和咽腔总容积,同时测量颏前点、舌骨点、舌根点的三维位置,分析颏前点的变化与咽腔间隙及舌骨、舌体位置变化的相关性。结果治疗后,咽腔间隙呈现整体缩窄趋势。舌骨发生了后下移位,其中向后、向下平均移动距离分别为5.72、2.76 mm（P<0.05）;舌根点向后平均移动了4.04 mm（P<0.01）。19项相关性比较中,有统计学意义的项目有14项,其中下颌后退量与咽腔总容积改变的相关性最强（r=0.834,P<0.01）。结论正畸-正颌联合治疗骨性Ⅲ类错畸形可造成咽腔缩窄,舌骨后下移位,舌体向后移位;下颌后退量与咽腔间隙缩窄、舌骨和舌体位置的改变具有较强的相关性。     

Psychosocial factors associated with pain outcomes in patients with painful temporomandibular disorders and headaches

The objective of this study was to assess the association between psychosocial factors (in terms of anxiety, somatization, depression, and optimism) and pain (in terms of headache pain intensity and pain-related disability), in patients with a painful temporomandibular disorder (TMD) and one of the following headache types: migraine, tension-type headache (TTH), or headache attributed to TMD, corrected for the influence of bruxism. A retrospective study was conducted at an orofacial pain and dysfunction (OPD) clinic. Inclusion criteria were painful TMD, with migraine, TTH, and/or headache attributed to TMD. Linear regressions were performed to assess the influence of psychosocial variables on pain intensity and on pain-related disability, stratified per headache type. The regression models were corrected for bruxism and the presence of multiple headache types. A total of 323 patients (61% female; mean age 42.9, SD 14.4 years) were included. Headache pain intensity only had significant associations in TMD-pain patients with headache attributed to TMD, and anxiety showed the strongest relation (β = 0.353) with pain intensity. Pain-related disability was most strongly associated with depression in TMD-pain patients with TTH (β = 0.444), and with somatization in patients with headache attributed to TMD (β = 0.399). In conclusion, the influence of psychosocial factors on headache pain intensity and pain-related disability depends on the headache type presenting.     

The management of drooling problems in children with neurological dysfunction: a review and case report

Drooling in children with neurological dysfunction indicates neurogenic failure to coordinate the muscles of the tongue, soft palate, and face which act in the first stage of swallowing. This causes excessive pooling of saliva in the anterior part of the mouth and consequent overspill. Treatment for drooling includes behavioral, pharmacological, and surgical modalities. Correcting a malocclusion has also been reported to help eliminate drooling. This paper describes the treatment of a child with neurofibromatosis, psychomotor, developmental, and neurologic retardation, and difficulty with speech. The patient was referred to our clinic to correct his drooling. Simple orthodontic treatment succeeded in eliminating the drooling and Improving his speech .     

The relationship between feeding characteristics and feeding function in children with intellectual disability

To develop strategies to support feeding and swallowing functions from early stage, we evaluated chief complaints regarding feeding, and assessment of the feeding function. The subjects consisted of 53 preschool children and their guardians, who participated in feeding consultation in a welfare center. In this study, we extracted chief complaints and assessment of the feeding function, and made comparisons. The primary illnesses were intellectual disability (n= 20), autism (n= 16), and Down's syndrome (n= 17). Chief complaints regarding food selectivity, self-feeding, utensils, and chewing were common, and, particularly, the frequency of chief complaints concerning self-feeding and utensils was significantly higher in the groups with intellectual disability or autism, compared to children with Down's syndrome. As for evaluation of the feeding function, the proportion of children classified as having a disordered self-feeding function was significantly higher in the groups with intellectual disability and autism (approximately 70%) than children with Down's syndrome. As a result of comparing chief complains reported by guardians and assessment of the feeding function, in the groups with intellectual disability and autism, many children with chewing as the chief complaint were classified as having a disordered self-feeding function. Regarding children with Down's syndrome, however, a disordered food-capturing or chewing function was prevalent, even in those with self-feeding as the chief complaint. Thus, children with intellectual disability exhibited many problems regarding chewing, the self-feeding function, and cognitive function. Additionally, inconsistencies between chief complaints and functional evaluation often occurred, suggesting that there is a need for appropriate actions and support.