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Buurman DJM, Willemsen ACH, Speksnijder CM, Baijens LWJ, Hoeben A, Hoebers FJP, Kessler P, Schols AMWJ. Tooth extractions prior to chemoradiation or bioradiation are associated with weight loss during treatment for locally advanced oropharyngeal cancer. Support Care Cancer 2022; 30:5329-38. [PMID: 35278135 DOI: 10.1007/s00520-022-06942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/26/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Prior to radiotherapy combined with chemotherapy (CRT) or biotherapy (BRT) for oropharyngeal squamous cell carcinoma (OPSCC), teeth with poor prognosis that pose a risk for post-RT osteoradionecrosis (ORN) are removed. The effect of tooth loss on body weight loss and tube feeding (TF) dependency during CRT/BRT is unknown. This study aimed to evaluate the effect of incomplete dentition, tooth extractions prior to CRT/BRT, and the subsequent loss of functional units on (1) weight loss during CRT/BRT and (2) the need for TF during CRT/BRT for OPSCC. METHODS OPSCC patients treated with CRT/BRT between 2013 and 2016 were included in this retrospective cohort study. Dental status was determined during the dental assessment at first visit and after tooth extractions prior to the start of CRT/BRT. Weight loss during CRT/BRT was scored dichotomously, comparing weight loss > 5% to stable or increased weight. Potential factors associated with weight loss were identified, including patient, tumor, and treatment characteristics. RESULTS Seventy-seven OPSCC patients were included. Forty patients (52%) experienced weight loss > 5% during CRT/BRT. Extractions were performed in 66% of the OPSCC patients. The mean number of extracted teeth was 4.1 ± 5.6 per patient. Tooth extractions prior to CRT/BRT were associated with weight loss > 5% during CRT/BRT (HR 1.130 (95% CI 1.011-1.262), p = 0.031). None of the dental status-related parameters showed any significant associative value for TF during CRT/BRT. CONCLUSIONS Pre-CRT/BRT tooth extractions intended to reduce the risk of ORN, are a risk factor for weight loss during CRT/BRT for OPSCC. TRIAL REGISTRATION NUMBER This study was approved by the medical ethics committee of the MUMC + (METC 2020-1589) on July 28, 2020.
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Lee SM, Leem DH. Nasal septal abscess with a dental origin: a case report and a review of the literature. J Korean Assoc Oral Maxillofac Surg 2021; 47:135-140. [PMID: 33911046 PMCID: PMC8084746 DOI: 10.5125/jkaoms.2021.47.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/19/2019] [Accepted: 09/11/2019] [Indexed: 11/07/2022] Open
Abstract
Since the first report of a nasal septal abscess (NSA) from a dental origin (1920), six articles have been published in the English literature to date. The most common cause of NSA is an infection of the nasal septal hematoma after trauma. This is a report of an uncommon cause of NSA with a dental origin. A PubMed search performed regardless of year and country using the terms (“nasal septal abscess”) OR (“nasal septum abscess”) initially yielded 229 articles. After screening, seven articles (eight patients) were selected. Addition of two related articles produced a total of nine articles (10 patients) to be included. The age of the included patients ranged from 7 to 69 years (mean, 32.82 years; standard deviation, ±23.86 years). The sex composition was as followed: males (n=7; 63.6%), females (n=4; 36.4%). Dental histories were various: periapical lesions, caries, extraction, endodontic therapy, and cystic lesions. The maxillary incisor dominated as the tooth of origin. Early diagnosis and treatment of NSAs are important to avoid not only facial deformity, but also severe complications (e.g., intracranial infection). If NSA is suspected in patients without facial trauma, the possibility of a dental origin, especially from the maxillary incisor area, should be considered.
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Affiliation(s)
- Sang Min Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Dae Ho Leem
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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Xue H, Wang XH, Shi L, Wei Q, Zhang YM, Yang HF. Dental focal infection-induced ventricular and spinal canal empyema: A case report. World J Clin Cases 2020; 8:3114-3121. [PMID: 32775394 PMCID: PMC7385611 DOI: 10.12998/wjcc.v8.i14.3114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/10/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare, severe, acute disease that is clinically associated with extremely high morbidity and mortality. Traditional cerebrospinal fluid (CSF) bacterial culture is time-consuming, with a low positive rate, which frequently results in severe irreversible consequences. The next-generation sequencing technique is an emerging pathogenic microorganism detection method that can obtain results in a short time with high accuracy, thus providing great assistance in the clinical diagnosis and treatment of this disease.
CASE SUMMARY This paper reports a rare case of dental focal infection-induced ventricular and spinal canal empyema. During the course of treatment at a local hospital, the patient had negative results from repeated CSF bacterial cultures and was empirically given vancomycin treatment. After transfer to our hospital, the next-generation sequencing technique was adopted to determine that the pathogenic microorganisms were multiple anaerobic infectious bacteria derived from the oral cavity. The antibiotic therapeutic scheme was adjusted in a timely manner, and the ventricular and spinal canal inflammation was also controlled. However, the antibiotics that had been applied at the local hospital were not able to cover all pathogenic microorganisms, which resulted in irreversible injury to the brain stem, finally leading to patient death.
CONCLUSION Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare, severe, acute disease with high morbidity and mortality. Any delay in diagnosis and treatment will result in irreversible consequences. The early application of the next-generation sequencing technique can obtain results in a short time and clarify a diagnosis. Appropriate antibiotic treatment combined with suitable surgical intervention is the key to managing this disease.
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Affiliation(s)
- Hang Xue
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Hui Wang
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Lin Shi
- Department of Neurosurgery, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun 130021, Jilin Province, China
| | - Qiang Wei
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yi-Ming Zhang
- Department of Neurosurgery, Dong’e Hospital Affiliated to Shandong First Medical University, Dong’e 252200, Shandong Province, China
| | - Hong-Fa Yang
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Schuurhuis JM, Stokman MA, Witjes MJH, Reintsema H, Langendijk JA, Vissink A, Spijkervet FKL. Patients with advanced periodontal disease before intensity-modulated radiation therapy are prone to develop bone healing problems: a 2-year prospective follow-up study. Support Care Cancer 2018; 26:1133-1142. [PMID: 29090383 PMCID: PMC5847027 DOI: 10.1007/s00520-017-3934-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Intensity-modulated radiation therapy (IMRT) has changed radiation treatment of head and neck cancer (HNC). However, it is still unclear if and how IMRT changes oral morbidity outcomes. In this prospective study, we assessed the outcome of reducing post-IMRT sequelae by means of pre-radiation dental screening and eliminating oral foci. METHODS All consecutive dentate patients > 18 years, diagnosed with primary oral or oropharyngeal carcinoma, referred for pre-treatment dental screening between May 2011 and May 2013, were included and followed for 2 years. Patients were treated with IMRT or IMRT with chemotherapy (CHIMRT). Dental screening data, demographic data, and data on oral sequelae during follow-up were recorded. Diagnosed oral foci were treated before start of the radiation therapy. RESULTS Oral foci were found in 44/56 (79%) patients, consisting predominantly of periodontal breakdown. Bone healing problems after radiotherapy occurred more often in patients with periodontal pockets ≥ 6 mm at baseline (19 vs. 4% in patients with pockets < 6 mm). Osteoradionecrosis developed in 4/56 patients (7%) during follow-up. In line with this observation, multiple logistic regression analysis showed that the periodontal inflamed surface area, which is higher in patients with more severe periodontal disease, predicted that a patient has a higher risk on developing osteoradionecrosis or bone healing problems (p = 0.028). CONCLUSIONS Patients with severe periodontal disease before IMRT/CHIMRT are more prone to develop bone healing problems post-radiotherapy.
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Affiliation(s)
- Jennifer M Schuurhuis
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Huispostcode BB70, P.O. Box 30001, 9700 RB, Groningen, the Netherlands
| | - Monique A Stokman
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Huispostcode BB70, P.O. Box 30001, 9700 RB, Groningen, the Netherlands
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Huispostcode BB70, P.O. Box 30001, 9700 RB, Groningen, the Netherlands
| | - Harry Reintsema
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Huispostcode BB70, P.O. Box 30001, 9700 RB, Groningen, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, the Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Huispostcode BB70, P.O. Box 30001, 9700 RB, Groningen, the Netherlands
| | - Frederik K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Huispostcode BB70, P.O. Box 30001, 9700 RB, Groningen, the Netherlands.
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Cho JY, Kim HM, Ryu JY. Cavernous sinus thrombosis progression from trismus. J Korean Assoc Oral Maxillofac Surg 2015; 41:43-7. [PMID: 25741468 PMCID: PMC4347033 DOI: 10.5125/jkaoms.2015.41.1.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/23/2014] [Accepted: 09/28/2014] [Indexed: 11/18/2022] Open
Abstract
In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature.
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Affiliation(s)
- Jin Yong Cho
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyeon Min Kim
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Young Ryu
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Yeo GS, Kim HY, Kim H, Kwak EJ, Jung YS, Park HS, Jung HD. Cavernous sinus thrombosis caused by a dental infection: a case report. J Korean Assoc Oral Maxillofac Surg 2014; 40:195-8. [PMID: 25247150 PMCID: PMC4170663 DOI: 10.5125/jkaoms.2014.40.4.195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 11/15/2022] Open
Abstract
Cavernous sinus thrombosis not only presents with constitutional symptoms including fever, pain and swelling but also with specific findings such as proptosis, chemosis, periorbital swelling, and cranial nerve palsies. It is known to occur secondary to the spread of paranasal sinus infections in the nose, ethmoidal and sphenoidal sinuses. However, paranasal sinus infection of dental origin is rare. The following is a case of cavernous sinus thrombosis due to the spread of an abscess in the buccal and pterygomandibular spaces via buccal mucosal laceration.
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Affiliation(s)
- Gi-Sung Yeo
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyun Young Kim
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | | | - Eun-Jung Kwak
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Young-Soo Jung
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Sik Park
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hwi-Dong Jung
- Department of Oral and Maxillofacial Surgery, Oral Science Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
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Bakathir AA, Moos KF, Ayoub AF, Bagg J. Factors Contributing to the Spread of Odontogenic Infections: A prospective pilot study. Sultan Qaboos Univ Med J 2009; 9:296-304. [PMID: 21509313 PMCID: PMC3074787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 10/28/2009] [Accepted: 11/04/2009] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVES Spreading odontogenic infections (SOI) are the commonest type of serious infections encountered in the orofacial region. A prospective multi-centre study was conducted in the West of Scotland to investigate the contributing role of social, systemic and microbial factors in the pathogenesis of SOI. METHODS Twenty-five patients with severe odontogenic infections were recruited over a period of six months. At admission, clinical assessment included temperature rise, haematological and biochemical investigations. Demographic data, social and past medical histories were obtained. Microbiology samples were collected to identify causative microorganisms and the clinical management of each infection was recorded. RESULTS Most infections were associated with teeth or roots. Eighty percent of the patients were tobacco smokers and 72% came from deprived areas. Five patients were intravenous drug users, four admitted chronic alcohol abuse, six had underlying systemic disorders and two were at high risk of malnutrition. A raised C-reactive protein at admission was a useful indicator of the severity of infection. Inappropriate prior antibiotic treatment in the absence of surgical drainage was common. Microbiology results showed a predominance of strict anaerobes, notably anaerobic streptococci, Prevotella and Fusobacterium species. CONCLUSION SOIs remain surprisingly common and our present pilot study showed a particular association with social deprivation and tobacco smoking. Further elucidation of the role of malnutrition in SOI would be of interest. Molecular characterisation of the microflora associated with SOI may help to highlight whether bacterial factors play a role in converting a localised dentoalveolar abscess into a serious, spreading odontogenic infection.
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Affiliation(s)
- Abdulaziz A Bakathir
- Oral Health Department, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Khursheed F Moos
- Biotechnology and Craniofacial Section, Glasgow University Dental School, UK
| | - Ashraf F Ayoub
- Biotechnology and Craniofacial Section, Glasgow University Dental School, UK
| | - Jeremy Bagg
- Infection and Immunity Section, Glasgow University Dental School, UK
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