口干燥症的神经电刺激治疗

口干燥症相关生活质量受损的患者需要长期治疗,神经刺激器通过电刺激相关分泌神经促进唾液分泌,具备提供天然唾液和对口干燥症患者长期管理的优势。多项临床试验初步证明了神经电刺激治疗口干燥症的疗效,然而,电刺激治疗至今未成为口干燥症的主流治疗方式,仍需要进行大规模的前瞻性随机对照临床试验以证实其长期有效性及安全性。另外,神经刺激器的设计对于临床推广具有重要意义。口外神经刺激器及第一代口内神经刺激器由于体积庞大,治疗不便,阻碍了临床的应用推广;第二代及第三代口内神经刺激器装置小巧,使用便捷,具有巨大应用前景。治疗口干燥症的神经刺激器的研发主要集中在欧美国家,国内研究甚少,亟需掌握神经刺激器研发的核心技术。小型化、高效供电、数据回馈以及封装方面的创新将是唾液电刺激设备未来研发的关键问题。本文对口干燥症的神经电刺激治疗方式及其研究进展进行综述,以期为我国基于口干燥症患者治疗的神经刺激器研发、临床转化应用及相关基础研究提供参考。     

放射性龋的产生与预防

放射性龋的产生与预防广西医科大学口腔系（５３００２７）关淑妮综述头颈部肿瘤患者经大剂量放射治疗后，口腔粘膜、牙齿及颌骨可出现多种反应和并发症。其中最常见的有口干症和放射性龋。本文对放射性龋的产生以及防治等有关问题作一综述。一、放射性龋的特征龋坏最先出...     

乌拉胆碱治疗放疗后口干燥症的临床试验

乌拉胆碱是β-甲基胆碱的氨基甲酯、乙酰胆碱的笋似物,具有蕈毒碱和烟碱—胆碱能活性。能抵抗胆碱酯酶的破坏,作用时间较长。本试验旨在评价乌拉胆碱治疗放疗后口干燥症的疗效和副作用。 材料和方法 鳞状细胞癌接受头颈放射治疗后的患者29人,男20,女9,平均年龄56岁。淋巴瘤接受外放射治疗后的患者5人,男3,女2,平均年龄40岁。所     

颌骨放射性骨坏死的预防

头颈部肿瘤的放射治疗日趋广泛应用,颌骨放射性骨坏死的发生率较高且治疗困难,患者的外形与功能常受影响。因此,预防放射性骨坏死更显得重要。本文围绕颌骨放射性骨坏死的病因,就预防方面的最新进展作了阐述。     

颌骨放射性骨坏死的预防

头颈部肿瘤的放射治疗日趋广泛应用，颌骨放射性骨坏死的发生率较高且治疗困难，患者的外形与功能常受影响。因此，预防放射性骨坏死更显得重要。本文围绕颌骨放射性骨坏死的病因，就预防方面的最新进展作了阐述。     

鼻咽癌放疗患者放射性龋的预防

目的:探讨鼻咽癌放疗患者放射性龋的有效预防方法。方法:对75例接受放疗的鼻咽癌患者于放疗前进行口腔检查和治疗、自我口腔清洁方法的指导,放疗后进行随访。结果:有50例鼻咽癌放疗患者进行了1~3年随访,其中有4例发生了放射性龋。本文发现不良的口腔卫生习惯为放射性龋的主要诱因。结论:放射治疗前进行口腔诊疗,指导患者掌握并坚持正确的口腔清洁方法,放疗后局部用氟,每3~6个月接受口腔复查,采取这些综合口腔预防措施可有效减少或预防放射性龋的发生。     

呼吁建立我国的口干燥症分级标准

口干燥症(xerostomia)这一术语于1889年由Hutchinson提出并通用至今[1].口干燥症常见于舍格伦综合征、头颈部癌常规放疗后、糖尿病等患者,长期口干燥症严重影响患者的生存质量[2-5].     

颌骨放射性骨坏死的诊疗现状

颌骨放射性骨坏死的诊疗现状解雪涛，邱蔚六颌骨放射性骨坏死（ＯｓｔｅｏｒａｄｉｏｎｅｃｒｏｓｉｓｏｆＪａｗｓＯＲＮＪ）是口腔、鼻咽和头颈部恶性肿瘤经放射治疗后所发生的严重颌骨损害。该疾病危害较大，常导致颌面部组织不愈、器官缺损而严重影响肿瘤患者治疗后的...     

颌下腺转位预防放射性口干的初步研究

目的评价颌下腺转位于颏下间隙后腺体功能及预防头颈部放疗导致的口干的效果。方法将3例头颈癌患者的颌外动脉和面前静脉近心端切断，保留该动静脉的远心端，并将其作为蒂，游离颌下腺后将其转位于颏下间隙。颈部放疗时屏蔽转住的颌下腺。术前术后以及放疗后检测颌下腺唾液流量，并填写华盛顿大学生活质量调查表。结果通过唾液流量分析，3例转住的颌下腺均成活。其中2例经放疗后20个月随访的患者，转住的颌下腺保存一定的泌唾功能，患者无口干症状。结论颌下腺转位于颏下区可保存其功能，有助于预防头颈癌患者放疗导致的口干。     

Preventive resins in the management of radiation-induced xerostomia complications.

The article focuses on caries problems that can arise in oncology patients following radiation of the salivary glands. Preventive restoration techniques are described that utilize fluoride-releasing resins. The particular difficulties associated with the management of areas of exposed incisal and gingival dentine in older patients are given special attention. Positive results are described for a 14-month period that appear to indicate that the technique leads to prevention of recurrent decay and retention of restorations in dehydrated areas of the mouth.     

Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer

The aim of this study was to evaluate the effectiveness of acupuncture in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer. A total of 24 consecutive patients receiving > 5000 cGy radiotherapy (RT) involving the major salivary glands bilaterally were assigned to either the preventive acupuncture group (PA, n = 12), treated with acupuncture before and during RT, or the control group (CT, n = 12), treated with RT and not receiving acupuncture. After RT completion, clinical response was assessed in all patients by syalometry, measuring the resting (RSFR) and stimulated (SSFR) salivary flow rates, and by the visual analogue scale (VAS) regarding dry mouth-related symptoms. Statistical analyses were performed with repeated-measures using a mixed-effect modeling procedure and analysis of variance. An alpha level of 0.05 was accepted for statistical significance. Although all patients exhibited some degree of impairment in salivary gland functioning after RT, significant differences were found between the groups. Patients in the PA group showed improved salivary flow rates (RSFR, SSFR; p < 0.001) and decreased xerostomia-related symptoms (VAS, p < 0.05) compared with patients in the CT group. Although PA treatment did not prevent the oral sequelae of RT completely, it significantly minimized the severity of radiation-induced xerostomia. The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT.     

Acupuncture treatment of patients with radiation-induced xerostomia

Xerostomia is a common and usually irreversible side effect in patients receiving radiation therapy (> 50 Gy) for head and neck cancer. Of 38 patients with radiation-induced xerostomia, 20 in the experimental group were treated with classical acupuncture and 18 patients in the control group received superficial acupuncture as placebo. Within both groups the patients showed significantly increased salivary flow rates after the acupuncture treatment. In the experimental group 68% and in the control group 50% of the patients had increased salivary flow rates at the end of the observation period. Among those patients who had had all their salivary glands irradiated, 50% in both groups showed increased salivary flow rates (> 20%) by the end of the observation period of 1 year. The study indicates that among the patients who had increased salivary flow rates already after the first 12 acupuncture sessions, the majority had high probability of continual improvement after the completion of acupuncture treatment. The improved salivary flow rates usually persisted during the observation year. The changes observed in the control group were somewhat smaller and appeared after a longer latency phase. Significant differences for salivary flow rates could be observed only within each group, and there were no statistically significant differences between the groups. There were no differences in the improvement of salivary flow rates between those patients who were irradiated within a year before the acupuncture treatment and those who had received radiation therapy several years earlier. The results indicate that acupuncture might be a useful method for the treatment of radiation-induced xerostomia, and that superficial acupuncture should preferably not be used as placebo acupuncture.     

The effect of radiation-induced xerostomia on saliva and serum lysozyme and immunoglobulin levels.

Saliva and serum lysozyme, immunoglobulin, albumin, and total protein levels were monitored in thirty patients with cancer of the head or neck before, during, and after radiotherapy and compared with those of a group of non-irradiated noncancer control subjects. The mean volume-based saliva lysozyme and total protein concentrations were significantly higher in the cancer patients before radiotherapy than in the control group. During radiotherapy, the mean volume-based concentrations of all protein components assayed increased as the saliva flow rate decreased. Protein-based ratios of saliva albumin, IgG, and lysozyme and the ratio of IgG/IgA increased as the xerostomia intensified. Ratios of saliva total protein and IgA to flow rate paralleled the flow rate decrease. Such increased concentrations in saliva immunoproteins were offset, however, by a greater than 93 per cent reduction in total saliva output. This reduced saliva output, therefore, resulted in an immunoprotein deficit. There were no significant differences between the mean serum lysozyme levels of the cancer and control groups at any point of comparison. The mean serum immunoglobulin concentrations in the cancer patients before radiotherapy were significantly higher than those in the control group. During radiotherapy, there was a decrease in the mean serum total protein, albumin, and immunoglobulin levels which reverted toward the pretreatment values during the postirradiation period.     

Electrostimulating device in the management of xerostomia

INTRODUCTION: The present study was undertaken to evaluate the safety and effectiveness of a recently developed electrostimulating device mounted on an individualized intra-oral removable appliance. MATERIALS AND METHODS: The device, containing electrodes, a wetness sensor, an electronic circuit and a power source, was tested on patients with xerostomia in a crossover, randomized, sham-controlled, double-blinded, multicenter study. Electrical stimulation and also sham were delivered during 10 min to the oral mucosa, in the mandibular third molar region. Oral dryness was measured by the sensor. As the primary outcome, sensor dryness and xerostomia symptom changes as a result of device wearing were assessed, and compared between active and sham modes. In addition, side-effects were recorded. RESULTS: Electrostimulation resulted in a significant decrease in sensor dryness, leading to a beneficial effect on patients' subjective condition. No significant side-effects were observed.     

An update of the etiology and management of xerostomia

Salivary gland disease gives rise to salivary gland enlargement, pain, and prolonged xerostomia (dry mouth). Xerostomia is the most common long-standing problem for the majority of affected patients. There are many causes of dry mouth, with long-standing xerostomia being a particular problem in Sj?gren's syndrome and after radiation to the head and neck region. Xerostomia is usually managed with saliva substitutes, but a large number of potential systemic therapies of long-standing xerostomia now exist. Some-particularly immunosuppressants-are of fundamental interest for the potential reduction of gland damage in Sj?gren's syndrome but as yet are of limited clinical usefulness. Others, particularly pilocarpine and cevimeline, are, or have the potential to be, clinically useful in stimulating salivation by virtue of their action on cholinergic receptors.     

我国口腔颌面肿瘤的诊治和研究现状

新世纪第一年时中华口腔医学会口腔颌面外科专业委员会的口腔颌面肿瘤学组在成都正式成立 ,并同时召开了学术研讨会。这是继世纪之交在上海举行的“2 0 0 0年国际暨全国第六届头颈肿瘤外科学术会议”后对我国口腔颌面肿瘤的诊治和研究现状的又一次检阅和学术交流。连续两年的学术交流均显示我国口腔颌面肿瘤的诊治及研究水平均处于高水平持续发展之中 ;它主要反映在以下几方面 :一、综合序列治疗的概念已被普遍接受多年来 ,我国口腔颌面恶性肿瘤的治疗效果能处于国际先进水平 (如口腔鳞癌 5年生存率达 65 %以上 ;颅颌面联合切除术治疗晚期颌…