Improving masticatory and swallowing ability of postoperative oral and maxillofacial tumor patients by telerehabilitation-A randomized controlled trial

OBJECTIVE

To evaluate the effect of telerehabilitation on oral function of oral and maxillofacial tumor patients.

DESIGN

Unicentral, single-blind, randomized controlled trial.

SETTING

Community.

SUBJECTS

Patients with primary oral and maxillofacial tumor receiving surgical treatment.

INTERVENTIONS

Telerehabilitation guidance from therapists.

MAIN MEASURES

At the beginning of training (T0) and 1 month (T1), 3 months (T2) and 6 months (T3) after training, patients' masticatory ability (mastication efficiency-masticatory performance evaluating gum, maximum bite force and mouth opening) and swallowing ability (water swallowing test) was measured. Modified Sato questionnaire and MD Anderson dysphagia inventory (MDADI) were used for self-evaluation of masticatory and swallowing ability.

RESULTS

A total of 64 participants (intervention: 33; control: 31) were included. The masticatory efficiency scores of the intervention group were significantly better than those of the control group at T2 (intervention: 3.67 (0.48); control: 3.03 (0.85)) and T3 (intervention: 4.20 (0.30); control: 3.50 (0.79)); and maximum mouth opening was better at T2 (intervention: 3.18 (0.59); control: 2.77 (0.54)) and T3 (intervention: 3.54 (0.58); control: 3.09 (0.41)). In water swallowing test, the intervention group had better scores at T2 and T3. The scores of MDADI scale in intervention group were better than those in the control group after 3 months of training. In subgroup analysis, the intervention group of oral cancer patients had better swallowing function at T2 and T3, but no significant difference was found in the subgroup of oropharyngeal cancer.

CONCLUSIONS

Telerehabilitation could greatly improve the long-term (3-6 months) training effect under the condition of greatly saving medical resources and reducing personnel contact.

Accuracy of Mixed Reality Combined With Surgical Navigation Assisted Oral and Maxillofacial Tumor Resection

OBJECTIVE

To evaluate the feasibility and accuracy of mixed reality combined with surgical navigation in oral and maxillofacial tumor surgery.

METHODS

Retrospective analysis of data of seven patients with oral and maxillofacial tumors who underwent surgery between January 2019 and January 2021 using a combination of mixed reality and surgical navigation. Virtual surgical planning and navigation plan were based on preoperative CT datasets. Through IGT-Link port, mixed reality workstation was synchronized with surgical navigation, and surgical planning data were transferred to the mixed reality workstation. Osteotomy lines were marked with the aid of both surgical navigation and mixed reality images visualized through HoloLens. Frozen section examination was used to ensure negative surgical margins. Postoperative CT datasets were obtained 1 week after the surgery, and chromatographic analysis of virtual osteotomies and actual osteotomies was carried out. Patients received standard oncological postoperative follow-up.

RESULTS

Of the seven patients, four had maxillary tumors and three had mandibular tumors. There were total of 13 osteotomy planes. Mean deviation between the planned osteotomy plane and the actual osteotomy plane was 1.68 ± 0.92 mm; the maximum deviation was 3.46 mm. Chromatographic analysis showed error of ≤3 mm for 80.16% of the points. Mean deviations of maxillary and mandibular osteotomy lines were approximate (1.60 ± 0.93 mm vs. 1.86 ± 0.93 mm). While five patients had benign tumors, two had malignant tumors. Mean deviations of osteotomy lines was comparable between patients with benign and malignant tumors (1.48 ± 0.74 mm vs. 2.18 ± 0.77 mm). Intraoperative frozen pathology confirmed negative resection margins in all cases. No tumor recurrence or complications occurred during mean follow-up of 15.7 months (range, 6-26 months).

CONCLUSION

The combination of mixed reality technology and surgical navigation appears to be feasible, safe, and effective for tumor resection in the oral and maxillofacial region.

[Prior periodontal intervention lowers incidence of lower respiratory infection in patients receiving oral and maxillofacial tumor surgery]

OBJECTIVE

To investigate whether periodontal infection is a risk factor for lower respiratory infection patients receiving oral and maxillofacial tumor surgery.

METHODS

Patients undergoing oral and maxillofacial surgery for tumors with concurrent periodontal disease between January, 2012 and December, 2016 were randomized into periodontal intervention group and control group (treated with gargle solution containing chlorhexidine gluconate). The one-time periodontal intervention was completed within 24 h in the intervention group and two-week mouthwash was prescribed in the control group before oral and maxillofacial tumor surgery. Five periodontal indexes were examined at baseline and at 6 weeks after the treatment. The clinical symptoms and incidence of lower respiratory infections were compared between the two groups at 6 weeks.

RESULTS

The PLI, BOP, PPD, and CAL were significantly lower and GR was higher in the intervention group than in the control group (P<0.01). The periodontal status was significantly improved in the intervention group. The incidence of lower respiratory infection was significantly lower in the intervention group than in the control group (2.22% vs 7.11%, P<0.01). The incidences of cough and expectoration in the intervention group were significantly lower than those in control group (P<0.01).

CONCLUSIONS

Periodontal infection is one of the risk factors for lower respiratory infection after oral and maxillofacial tumor surgery. The periodontal status can be effectively controlled and improved by periodontal intervention. Compared with mouthwash, periodontal intervention can significantly reduce the incidences of cough and expectoration and lower the incidence of lower respiratory infections.