Cheek Support Research Articles

Enhanced facial esthetics for geriatric patients with customized complete denture for amplified cheek support

Aging is associated with edentulism, resorbed alveolar ridge, reduced muscle activity, and sunken cheeks. When there is not enough muscle mass between zygomatic and mandibular bone, slumping of cheeks occurs. Sunken cheeks lead to facial disfigurement and unesthetic appearance resulting in a negative psychological impact on the patient. The use of conventional complete dentures can rehabilitate the loss to some extent, but excellent denture esthetics can be achieved by providing additional support to the slumped tissues. This clinical case series describes different techniques to provide support for sunken cheeks using detachable maxillary cheek plumper prosthesis in completely edentulous geriatric patients.

A novel and innovative technique for fabrication of customized detachable cheek plumper: A clinical case report

Prosthetic rehabilitation of a completely edentulous patient no longer confines to only replacement of missing teeth. Patients are increasingly demanding improvement in esthetics at the end of treatment. Aging leads to a high impact on external facial esthetics resulting in slumped cheek leading to undesirable facial esthetics. Cheek plumper is a commonly used prosthesis to enhance the support of sunken cheeks providing better esthetics. This clinical report describes a novel technique to fabricate detachable cheek plumber to improve support for sunken cheeks retained with a ball bearing and a new commercially available material.

Prosthetic Rehabilitation of Partially Resected Edentulous Mandible Using Twin-Occlusion- A Case Report

Mandibular defects arising as a result of trauma, infections or ablative tumor surgery usually cause significant facial deformity, functional disabilities, and psychological problems. Successful prosthetic rehabilitation of a patient with partially resected edentulous mandible can be an especially challenging task for a prosthodontist. Apart from the deviation of the remaining mandibular segment, other dysfunctions are observed in mastication, speech, swallowing, respiration, salivary control and mandibular movements which can severely compromise the prosthetic prognosis. Hence, it becomes imperative to judiciously apply the basic principles of denture construction in such cases to obtain optimum retention, stability, support, esthetics & function. The present case report describes the successful prosthetic rehabilitation of an edentulous mandibulectomy patient using two rows of non-anatomic teeth on the unresected side of the maxillary prosthesis. The inner (palatal) row helped in restoring the function while the outer (buccal) row improved the cheek support and esthetics. Non-anatomic teeth were used to minimize the lateral displacing forces and enhance the stability of the dentures. The incorporation of twin-occlusion in this case helped in achieving a satisfactory aesthetic and functional outcome of treatment.

Management of Oral Feeding Challenges in Neonatal Intensive Care Units (NICUs): A National Survey in China.

Objectives: To investigate the current practices of oral feeding difficulties facing high-risk infants in Chinese NICUs.Methods: A questionnaire to survey infant oral feeding practices was distributed to 100 level II and III Chinese neonatal intensive care units (NICUs).Results: Responses were obtained from 88 NICUs. No Units had any structured guidelines regarding the management of infant oral feeding as they transitioned from tube to independent oral feeding. In 54 (61.4%) NICUs, nurses and physicians made shared decisions on when oral feeding were to be initiated. Fifty-four (61.4%) and 22 (25.0%) NICUs used postmenstrual age (PMA) or weight at PMA as a criterion for initiating oral feedings, respectively. The top three criteria to determine introduction of oral feeding were severity of disease, presence of sucking reflex, and trial feeding success. Adverse events were used by 78 Units as indices of oral feeding difficulty. Twenty (22.7%) and 25 (28.4%) Units had access to occupational therapists or nurses who provided oral motor interventions during feeding, i.e., oral support (chin and cheek support, aid to deglutition), non-nutritive sucking with pacifier, and oral stimulation.Conclusions: The management of oral feeding issues in NICUs vary widely in China in relation to the assessment of readiness to oral feeding, daily oral feeding practices and interventions used by staff. It is proposed that an educational program focused on the physiology of infant oral feeding, available evidence-based tools and interventions would assist NICU caregivers develop structured guidelines to improve infants' safe and efficient attainment of independent oral feeding.

Cheek support affects lung mechanics measurements of tidal-based spontaneous breathing

Background and Objective: Patients are required to support their cheeks during breath-occluding lung function tests. This prevents cheek expansion which would alter pressure measured at the mouth, and, consequently, lung mechanics measurements. To date, the effect of cheek support on airway resistance measurements has been assessed. However other lung mechanics have not been studied as thoroughly, and no algorithm to account for the effect of missing cheek support on lung mechanics measurements has been developed.Methods: Lung mechanics were assessed with a breath occlusion test during light panting in healthy subjects with and without cheek support in a body plethysmograph. Average model-based airway resistance, lung elastance, and a parameter representing the viscoelastic were measured. Results were compared to quantify the effect of cheek support on these three parameters.Results: In the nine healthy subjects (5 Female, 4 Male) recruited for this study, all mechanics tended to be underestimated when cheeks were unsupported. Changes in elastance, resistance, and viscoelastic parameter ranged between 1.6–66.8 %, -4.5–21.8 %, and -4.7–68.2 %, respectively, when cheek support was added. The underestimation was due to reduced mouth pressure during cheek expansion when the breath was occluded. The variance of lung mechanics parameters did not change with cheek support in all subjects.Conclusions: The error in lung mechanics measurement caused by unsupported cheeks was subject dependent. Hence, no rule-of-thumb could be identified to reconstruct missing cheek support. For correct lung mechanics measurements during breath-occluding lung tests, patients must have adequate cheek support.Abbreviations:ROCC: Occlusion resistance; COPD: Chronic Obstructive Pulmonary Disorder; SB: spontaneous breathing.

Denture Esthetics: There is more than teeth replacement

The success of prosthetic treatment is predicted not only on the dentist's manual dexterity but also on the ability to understand the patient needs. Patient with complete edentulism undergoes many esthetic consequences among which sunken appearance of cheek has a great psychological effect on the individual that can add ages to a patient age. Prosthetic rehabilitation of such patient not only confines to replacement of missing teeth but also restoring the lost cheek support. This article focuses on simple, effective and a noninvasive method for restoring the slumped facial musculature by incorporating cheek plumper in the dentures and an innovative technique for the fabrication of detachable cheek plumper through custom made attachment.

Evaluación de la medición de las resistencias pulmonares por técnica de interrupción

Pulmonary function tests allow an objective assessment of the degree of bronchial obstruction in collaborative subjects. The measurement of airway resistance using passive methods is very helpful in non-collaborative subjects. The objective of this study was to assess the applicability of measuring airway resistance by the interrupter technique (Rint) in pediatric subjects, determining its reproducibility, reliability and accuracy versus other techniques to measure airway resistance. Cross-sectional study in healthy children and in children with an obstructive airway disease, all aged 2-18 years old. The Rint was measured using a portable device and results were compared to airway resistance measured by oscillometry and plethysmography. The reproducibility of measurements and the infuence of the different outcome measures (use of mask or mouthpiece, cheek support, or nose clip) were assessed. Valid measurements were obtained in 82.6% of 460 children (47.6% younger than 7 years old). Reproducibility was very good (ICC= 0.9412; p <0.00001), and no differences were found among the measurements obtained at separate time intervals (0.75 ± 0.3 versus 0.74 ± 0.28; p= 0.435). None of the factors indicated before had an effect on the reproducibility of measurements. Resistance values obtained by plethysmography and oscillometry were higher than those obtained using the Rint, with a positive correlation between them. The higher the degree of airway obstruction, the worse the correlation with plethysmography. The Rint measurement is a plausible and reproducible technique, and has an adequate correlation with the resistance measurements obtained using oscillometry or plethysmography, thus making it useful for non-collaborative patients. In patients with airway obstruction, this technique could underestimate resistance, so it would be a hurdle to use it to follow-up subjects with a moderate to severe obstructive disease or in bronchial challenge tests.

Influence of cheek support on respiratory impedance measured by forced oscillation technique

The forced oscillation technique (FOT) is a useful tool to assess respiratory resistance and reactance during tidal breathing in patients with respiratory diseases, specifically asthma and chronic obstructive pulmonary disease. Although the FOT has been clinically used, results of respiratory impedance can be affected by various factors such as upper airway artifact. We investigated the effects of cheek support on respiratory resistance and reactance measured by a commercially available FOT equipment MostGraph-01. Respiratory resistance at 20 Hz (R20) with support of the cheeks was significantly higher than those without the cheek support in healthy subjects. Two different cheek support protocols, support of the cheeks by subjects themselves and an operator, were compared in healthy volunteers and patients with respiratory diseases. The cheek support protocols significantly affected respiratory resistance at 5 Hz (R5) and reactance at 5 Hz (X5) in the patient group but not in the healthy subjects. Moreover, for X5, there was a significant interaction between cheek support protocols (by a subject or operator) and groups (healthy or diseased). In conclusion, during impedance measurements using the FOT, application of cheek support either by subjects or the operator is recommended to reduce upper airway artifacts, however, results obtained by two protocols may be different in patients with respiratory diseases. Contribution of the chest wall and position of the arms to the mechanical properties should be carefully considered in physiological studies in which the FOT is attempted.

Uma nova abordagem na determinação da resistência das vias aéreas: técnica do interruptor vs. pletismografia

To determine the agreement between interrupter resistance (Rint) and airway resistance (Raw) by plethysmography in order to verify the clinical applicability of the interrupter technique. The Rint technique was performed with the patients in a sitting position, during exhalation, with a nose clip and cheek support. Plethysmography was carried out in accordance with standard protocols. All measurements were taken prior to and after the administration of an inhaled bronchodilator via a metered dose inhaler with a spacer. The study comprised 99 consecutive patients referred to the Porto Alegre Hospital de Clínicas, located in the city of Porto Alegre, Brazil, for pulmonary function testing. Patient ages ranged from 18 to 82 years, and 52 of the patients were women. In the patients with FEV1 ≥ 60% of predicted, there was good agreement between the methods (r = 0.8; intraclass correlation coefficient = 0.8). The Rint values were lower than were those of Raw by plethysmography in the patients with more severe disease. However, there was good agreement between Rint ≥ 4 cmH2O L(-1) s(-1) and Raw by plethysmography > 2.5 cmH2O L(-1) s(-1) (likelihood ratio > 8; kappa coefficient = 0.73). In the patients with less severe disease, there was good agreement between Rint and Raw by plethysmography. The agreement between the two methods was also strong regarding the detection of an increase in Raw. The Rint technique is a potentially useful method for the evaluation of adult patients.

Restoration of blinking reflex and facial symmetry in a Bell′s palsy patient

Patients afflicted with Bell's palsy are faced with both functional and esthetic impairment. Prominent among these are the inability to close the eyelids and abnormal facial appearance, with concomitant difficulty in eating, drinking and speaking. Rehabilitation of such patients can be achieved by a multispecialty approach, with the prosthodontist functioning as an integral part of the treatment team. This article describes a simple and effective approach to restore the blinking reflex of the upper eyelid with custom gold implant and facial esthetics with cheek support prosthesis.

Effect of natural panting frequency and cheek support on the plethysmographic determination of thoracic gas volume in patients with chronic obstructive pulmonary disease

The authors studied the effects of natural panting frequency (NF) and the cheek support on the plethysmographic measurement of thoracic gas volume (TGV) in 8 normal subjects (non-smokers) and 46 patients with chronic obstructive pulmonary disease (COPD). The patients were divided into 2 groups according to the degree of airway obstruction (group I; specific airway conductance (SGaw) greater than 0.1 (n = 18), group II; SGaw less than 0.1 (n = 28)). TGV was measured with a pressure-type body plethysmograph (BP). NF was 2.00 +/- 0.43 Hz (mean +/- SD) in control subjects, 1.92 +/- 0.78 Hz in group I, and 1.39 +/- 0.59 Hz in group II, respectively, indicating lower NF in the patients with severe airway obstruction. In control subjects and group I, the differences between TGV at NF and at 0.5-1.0 Hz (TGVNF-TGV1.0) were -0.01 +/- 0.07L, and -0.06 +/- 0.16L, respectively, and cheek support did not alter the difference. On the other hand, in group II, the difference was slightly larger than other groups in spite of the lower NF, and this overestimation was abolished by cheek support (0.13 +/- 0.25L-----0.06 +/- 0.27L, p less than 0.05). These results suggest that, in patients with severe airway obstruction, TGVNF may be overestimated even if NF is relatively low. This overestimation may be mainly due to the extrathoracic airway compliance including the cheek.

Pharyngeal swallowing rhythm in response to oral sensorimotor programs in preterm infants

AimTo evaluate swallowing rhythm to achieve greater understanding of the mechanisms involved in two oral sensorimotor programs in preterm infants. Study designForty-three preterm infants were allocated to 3 experimental and Control groups. Six selected swallowing sound parameters were measured when the premature infants fed at its own rhythm and statistically analyzed using repeated-measures analysis of variance with birthweight as covariate (ANCOVA). Results and conclusionANCOVA showed significantly increased numbers of swallows and swallowing bursts, significantly reduced isolated swallows and increased numbers of swallows into medium size bursts in the 3 experimental groups compared to the Control group. Moreover, quantification of these acoustic parameters was of value to assess the effects of oral support on swallowing skills. Our oral support protocol provides chin and cheek support, an aid to deglutition and training for swallowing–breathing coordination with an appropriate rhythm to achieve successful feeding.

Effects of oral stimulation and oral support on non‐nutritive sucking and feeding performance in preterm infants

This study compared the effects of oral stimulation with those of oral support on non-nutritive sucking and feeding parameters in preterm infants. Preterm infants (23 males, 20 females) born between 29 and less than 34 weeks' gestational age (GA; mean GA 31.2wks [standard error of mean{SEM} 0.39]; mean birth-weight 1580g [SEM 120]) were allocated to one of three experimental groups: (Stimulation+support [five males, four females]; Stimulation [four males, seven females]; and Support [seven males, five females]) or a control group. Non-nutritive sucking pressure and sucking activity were quantified in the gavage and transition periods. Oral support minimizes fluid loss, stabilizes the jaw, and organizes deglutition. The time of transition, the quantity of milk ingested per day, and the number of bottle feeds per day were recorded. Variables were analyzed by repeated-measures analysis of variance, with birth-weight as covariate (ANCOVA). Transition time was reduced (p<0.0001) for the Stimulation+support and Support groups. ANCOVA computed during gavage showed increased non-nutritive sucking pressure and sucking activity (p<0.001) for the Stimulation and Stimulation+support groups. ANCOVA computed during transition revealed increases in non-nutritive sucking pressure and daily bottle feeds (p<0.001) for the three experimental groups and in daily milk ingested (p=0.002) for the Stimulation+support and Support groups. We demonstrated that oral support is the result of both the action of chin and cheek support, and the aid to deglutition. An analysis of the organization of sucking patterns should be undertaken to provide better understanding of the mechanisms involved in oral support.

Concomitant reconstruction of mandibular basal and alveolar bone with a free fibular flap

Repair of long-span mandibular defects with a free fibular flap is now a routine procedure. However, the bone height of the neo-mandible after reconstruction with a fibular flap is about half that of the dentulous mandible. When a fibular graft is placed only at the inferior border of the mandible, the resulting vertical discrepancy between the graft segment and the occlusal plane can adversely affect implant mechanics or denture stability and retention.To overcome these problems, we developed a technique for two-strut type mandibular reconstruction. A vascularized fibular segment is used to reconstruct the inferior basal portion of the neo-mandible, while a non-vascularized residual fibular segment is used to simulate the superior alveolar portion.We used this technique in 22 patients. Graft survival, graft resorption, and the ability to place implants were assessed as compared with those after the conventional one-strut type technique. The fibular segment grafted to the alveolar region was removed in one patient with intraoral wound dehiscence and in two with postoperative infection. All vascularized fibular flaps were successful. The resorption rate was 13.6±7.2% for non-vascularized segments and 3.0±3.7% for vascularized segments. Dental implants were placed in five of our 22 patients. The crown:fixture length ratio was improved to 1:1.7, as compared with a ratio of 1:1.21 with use of a conventional fibular flap. We conclude that our technique is very easy and safe and provides substantially improved lower-lip and cheek support and implant–prosthetic mechanics than conventional procedures for the repair of long-span mandibular defects.

Prosthetic management of a total glossectomy defect after free flap reconstruction in an edentulous patient: A clinical report

Total glossectomy with surgical reconstruction can result in a significantly altered mandibular arch anatomy. In edentulous patients, lingual vestibules along with the mandibular alveolar ridge can be obliterated. With the absence of lower anterior dentition, support of the lower lip is lost and traction from surgical closure can cause the lower lip to collapse into the oral cavity. This report describes the prosthetic treatment of an edentulous total glossectomy patient with an unconventional custom impression procedure to develop and record proper lower lip and cheek support. It also discusses some issues involved in the prosthetic management of the total glossectomy patient. (J Prosthet Dent 2003;89:119-22.)

Within- and between-day variability of respiratory impedance, using impulse oscillometry in adolescent asthmatics.

The objectives of the present study were to: 1) assess spirometric indices and respiratory impedance with forced oscillation (FO), using impulse oscillometry (IOS) in clinically stable asthmatic children over 3 consecutive days; 2) assess FO reactance (X), using an integrated index and resistance (R) separately during inspiration and expiration; and 3) assess effects on FO of hand support of cheeks vs. no hand support. Our hypotheses were: 1) because of increased sensitivity, IOS manifests day-to-day variability not demonstrable by spirometry; 2) IOS R during expiration exceeds that during inspiration; and 3) hand support of cheeks affects IOS R and X only minimally. We obtained triplicate twice-daily measures of IOS R and X in asthmatic adolescents at summer camp, in a convenience sample of children willing, with parental permission, to undergo repeated testing on consecutive days. Subjects received all medications between 6:30-7:30 AM, and were bronchodilated at time of testing. Subjects underwent IOS tests without hand support of cheeks, followed by tests with both hands supporting cheeks. ANOVA and regression analyses were used to discern technique differences.Significant differences in IOS inspiratory R5, R5 - R15 (frequency dependence of R), and low frequency reactance area (AX) occurred across 3 days, but spirometric indices were unchanged. Inspiratory R at 5 Hz (R5) was significantly smaller than expiratory R5 (P < 0.0001). ANOVA revealed no significant differences between hand and facial muscle cheek support for IOS R and X below 15 Hz, but significant differences occurred above 15 Hz. In conclusion, inspiratory R5, R5 - R15, and AX are sensitive measures for detecting changes in bronchomotor tone in adolescent asthmatic subjects, while expiratory R5 may be influenced by additional factors. Manual support of cheeks does not appear to affect IOS indices of peripheral airway obstruction in adolescent asthmatics. IOS is a practical method for quantifying respiratory mechanics, and its potential role in disease management warrants further study.

Effect of Jaw and Cheek Support on Nutritional Intake

Effect of Jaw and Cheek Support on Nutritional Intake

Effect of Jaw and Cheek Support on Nutritional Intake

The purpose of this study was to determine the effect of jaw and cheek support on nutritional intake. A 32-month-old child who had experienced a brainstem stroke was spoon fed, with and without jaw and cheek support, in an ABAB single case fashion. Jaw and cheek support elicited an increased amount of solid food consumption by the participant. There was no difference, between control and intervention sessions, in the amount of solid food expelled onto the bib. Jaw and cheek support enabled a 32-month-old child with a brainstem stroke to consume more solid foods than without support.

Measurements of respiratory system resistance by the interrupter technique in healthy and asthmatic children.

We studied respiratory system resistance by the interrupter technique (Rint) in healthy and asthmatic children, paying special attention to the effect of cheek compliance and the effects of supporting the cheeks, the influence of lung volume at which interruption was performed, the effect of direction of flow before occlusion (inspiration vs. expiration), and short-term reproducibility of this method. One hundred and thirty-two children (36 controls and 96 asthmatics) were included in the study (mean, 9.0 +/- SD 3.6 years). Rint was calculated from the ratio of the alveolar pressure (estimated from moth pressure during occlusion) to the flow prior to interruption. We observed that 1) underestimation of airway resistance due to upper airway compliance can be minimized by supporting the cheeks; Rint was significantly lower when measured without supporting the cheeks than with support of the cheeks in controls (3.9 +/- 0.9 vs. 4.7 +/- 1.2 cmH2O.L-1.s, respectively) and asthmatics (5.2 +/- 1.6 vs 6.9 +/- 2.0 cmH2O.L-1.s); the quantitative differences of Rint with and without cheek support was larger in small children and in the most obstructed children; 2) performing occlusion at mid-tidal volume accurately reflected the respiratory system resistance of the whole respiratory cycle since we observed no difference in Rint when performing occlusion at different volumes during quiet respiration or at the middle of tidal volume; 3) Rint measured during expiration was higher than Rint obtained during inspiration in controls and in asthmatics; moreover, the effect of direction of flow before occlusion was greater in the small children; 4) Rint was closely correlated to height in controls (r = -0.82; P < 0.001); and 5) short-term reproducibility (at 15 min intervals) was satisfactory in controls and asthmatics (coefficients of variation were 9% and 7%, respectively).

Multiple-tiered deep support of cheeks in meloplasty and rhytidectomy.

Maintaining satisfactory long-term results in a face-lift on an aging face is an important aspect of facial plastic surgery. While undermining and support of the SMAS in the posterior cheek has achieved recent popularity, plication of the fascia in the cheeks has been at least equally effective and safer. Variations of this technique have been used for 30 years with satisfactory results.