Oral Pharynx Research Articles

Abstract WP131: Radiation For Head And Neck Cancer And Risk Of Intracranial Hemorrhage

Introduction: Radiation therapy in head and neck cancers has previously been associated with cerebrovascular complications such as aneurysm formation, atherosclerosis, and ischemic stroke. Radiation is also associated with extradural cranial hemorrhagic complications due to weakening of vessel walls and labile hypertension from baroreflex failure. We hypothesized radiation therapy in head and neck cancers would also be associated with intracranial hemorrhage. Methods: We performed a retrospective cohort study using inpatient and outpatient claims between 2008-2018 from a nationally representative 5% sample of Medicare beneficiaries. We included patients ≥65 years old with cancer of the oral cavity, nasal cavity, pharynx, or larynx, defined by ICD-9-CM and ICD-10-CM diagnosis codes, who underwent either radiation therapy or surgical tumor excision, defined by CPT codes. Intracranial hemorrhage was defined using ICD-9-CM and ICD-10-CM diagnosis codes for subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hemorrhage. Cox proportional hazards regression was used to determine the association between radiation therapy and intracranial hemorrhage after adjustment for age, race, atrial fibrillation, coronary artery disease, hypertension, diabetes mellitus, congestive heart failure, chronic kidney disease, tobacco use, and alcohol use. Results: Of 15,990 eligible patients, 5,316 (33%) underwent radiation therapy. A total of 568 (3.5%) patients had an intracranial hemorrhage. In unadjusted analysis, radiation therapy was associated with an increased risk of intracranial hemorrhage (HR, 1.72, 95% CI, 1.40-2.10). This association was present after adjustment for age, race, and vascular risk factors (HR, 1.29; 95% CI, 1.04-1.59). Conclusions: In a nationally representative cohort of Medicare beneficiaries, radiation therapy for head and neck cancer was associated with an increased risk of intracranial hemorrhage.

Применение топических средств комбинированного действия в лечении воспалительных заболеваний полости рта и глотки

Острые инфекционно-воспалительные заболевания полости рта и глотки широко распространены у детей и взрослых. В работе представлены возможности купирования развивающегося при них воспалительного процесса и болевого синдрома с помощью местного применения современного средства Тантум Верде®.

Clinical applications of liquid biopsy in HPV-negative and HPV-positive head and neck squamous cell carcinoma: advances and challenges.

Head and neck squamous cell carcinomas (HNSCCs) represent the most common epithelial tumors that arise from mucosa of the oral cavity, pharynx, and larynx. The development of HNSCCs is usually associated with tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. Most HNSCCs are diagnosed in advanced states, leading to a worse clinical outcome. Screening tests based on potential biomarkers associated with HNSCCs could improve this scenario. Liquid biopsy has emerged as a promising area of cancer investigation, offering a minimally invasive approach to track circulating biomarkers in body fluids that could potentially contribute to the diagnosis, predict prognosis, and monitor response to treatment. This review will discuss translational studies describing the clinical applications of liquid biopsy in HPV-negative and HPV-positive HNSCCs focused on circulating nucleic acids [cell-free DNA (cfDNA) and cell-free RNA (cfRNA)], circulating tumor cells (CTCs), and extracellular vesicles (EVs), which can be found in plasma, serum, and saliva.

Incidence and mortality rates of lip, oral cavity, and pharynx cancers in Brazil: time-trend and age-period-cohort analysis from the last 30 years, Global Burden of Disease Study.

INTRODUCTION: Cancers are the second main cause of morbidity worldwide, but robust information on lip, oral cavity, and pharynx cancers in Brazil is lacking. This study aimed to analyze the trends of incidence and mortality caused by lip, oral cavity, and pharynx cancers and age-period-cohort effects in the Brazilian population of 30 years of age and over, in the period of 1990 to 2019.METHODS: A time series study of the incidence and mortality rates for oral cavity and pharynx cancer (“Lip and oral cavity cancer”, “Nasopharynx cancer”, and “Other pharynx cancer”) was conducted, with corrected data from the Global Burden of Disease Study (GBD) 2019. Age-standardized rates per 100,000 inhabitants, for the global population, were gathered according to the individuals’ sex. The annual average percentage change (AAPC) was estimated, as was the age-period-cohort effects. RESULTS: The incidence and mortality rates were higher for men in the studied anatomical regions. The cancers tended to decrease for men, except for nasopharynx cancer, which increased in individuals of both sexes. Mortality tended to present a decline in most of the groups studied. For men and women, the age-period-cohort model presented a better adjustment for both incidence and mortality. CONCLUSIONS: Incidence and mortality caused by the main head and neck cancers showed a tendency to decline over the past 30 years in Brazil, except for nasopharynx cancer, which showed an increase in incidence and mortality in some segments of the population. Higher rates were found for lip and oral cavity cancers in men.

Submandibular Gland Schwannoma - Case Report

Schwannomas are benign tumors that originate in the myelin sheath of neurons, more specifically in Schwann cells. Between 25-45% of these tumors occur in the topography of the head and neck, and may appear in various anatomical sites –oral cavity, larynx, pharynx, parapharyngeal space, and others. The main complaints are a painless, slow-growing mass and symptoms related to compression of nearby structures by the lesion. Its diagnosis is almost always given with the anatomopathological study after resection of the lesion, since fine-needle punctures usually show indeterminate results and imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI) cannot confirm this diagnosis, although they bring important information about location, size and contact with adjacent structures. Treatment, if there is no contraindication, is through surgical excision of the tumor. In this report, we present the case of a 47 year-old female patient complaining of left submandibular nodulation, whose diagnosis of schwannoma was only given after a left submaxillaryectomy, through the pathological examination.

Lubrication of saliva layer on oral and throat mucosa and its friction reduction effect of swallowing

Swallowing disorder has been becoming a serious issue with increasing in elderly people. Disorder sometimes appears with a decrease in saliva, because saliva has an important role in lubrication over the oral cavity and throat. Though the structure of biological mucosa has been studied physiologically, there are only few studies that examined the influence of its oral and throat mucosa on fluid lubrication. Therefore, we investigated the friction reduction effect on the oral cavity and pharynx. There is a thin liquid phase with a thickness of about 0.1 mm called saliva layer on oral and throat mucosa. It is necessary to evaluate the rheological properties of mucus with low viscosity and high spinnability like saliva layer using a PEO solution, because of the viscosity characteristics different from the shear viscosity. The PEO solution concentration was determined from the measurement of the viscous characteristic by the rotational viscometer to set the same viscosity as that of saliva. Therefore, we investigated the rheological characteristics by measuring the extensional viscosity to make a mucus using a PVA coating. We measured friction torque on the artificial mucosa lubricated by PEO solution. The effect of torque reduction of friction by high-viscosity liquids (100% glycerin solution) on the artificial mucosa was clarified in this study. We considered apparent slip occurs in the saliva layer. However, there was no effect of friction reduction on the low viscosity (40% glycerin aqueous solution). Even if apparent slip occurs in the artificial mucosa, the viscosity on the artificial mucosa is the same as that of the liquids.

Analysis of main statistical indicators of oral and pharyngeal cancer in the Republic of Uzbekistan

Relevance: According to GLOBOCAN data for 2020, oral and pharyngeal cancer ranked 25th in mortality (98 412 cases, 0.5% of all cancer deaths) and 26th in the number of diagnosed new cases (48 143 cases, 0.5% of all new cancer cases) in the world. Oral and pharyngeal cancer
 incidence is growing steadily globally and in the Republic of Uzbekistan. Oral and pharyngeal cancer ranks 16th in the structure of cancer incidence in the Republic of Uzbekistan, with a rate of 1.8 per 100 000 people.
 The purpose of the study was to analyze the main statistical indicators for tumors of the oral cavity and pharynx in the Republic of Uzbekistan in 2015-2021.
 Methods: We analyzed the main statistical indicators for tumors of the oral cavity and pharynx in the Republic of Uzbekistan for 2015-2020 obtained from the Reporting Form #7 “Information about malignant neoplasms cases.”
 Results: Over the past six years, the incidence rate per 100,000 people has increased from 1.4 in 2015 to 1.8 in 2020. In 2015-2020, in the Republic of Uzbekistan, 2,240 patients died from malignant neoplasms of the oral cavity and pharynx. The mortality rate per 100,000 people
 decreased from 1.4 in 2015 to 1.2 in 2020.
 Conclusions: Tumors of the oral cavity and pharynx rank 16th in the structure of cancer incidence in the Republic of Uzbekistan and tend to grow. A recent increase in oral and pharyngeal cancer incidence and its late detection could be explained by worsening detection and diagnostics. The stabilization of oral and pharyngeal cancer mortality results in socio-economic losses for the Republic. The provided statistical data is the basis for improving the indicators of incidence and mortality related to oral and pharyngeal cancer in the Republic of Uzbekistan

Analysis of main statistical indicators of oral and pharyngeal cancer in the Republic of Uzbekistan

Relevance: According to GLOBOCAN data for 2020, oral and pharyngeal cancer ranked 25th in mortality (98 412 cases, 0.5% of all cancer
 deaths) and 26th in the number of diagnosed new cases (48 143 cases, 0.5% of all new cancer cases) in the world. Oral and pharyngeal cancer
 incidence is growing steadily globally and in the Republic of Uzbekistan. Oral and pharyngeal cancer ranks 16th in the structure of cancer
 incidence in the Republic of Uzbekistan, with a rate of 1.8 per 100 000 people.
 The purpose of the study was to analyze the main statistical indicators for tumors of the oral cavity and pharynx in the Republic of Uzbekistan in 2015-2021.
 Methods: We analyzed the main statistical indicators for tumors of the oral cavity and pharynx in the Republic of Uzbekistan for 2015-
 2020 obtained from the Reporting Form #7 “Information about malignant neoplasms cases.”
 Results: Over the past six years, the incidence rate per 100,000 people has increased from 1.4 in 2015 to 1.8 in 2020. In 2015-2020, in the
 Republic of Uzbekistan, 2,240 patients died from malignant neoplasms of the oral cavity and pharynx. The mortality rate per 100,000 people
 decreased from 1.4 in 2015 to 1.2 in 2020.
 Conclusions: Tumors of the oral cavity and pharynx rank 16th in the structure of cancer incidence in the Republic of Uzbekistan and tend
 to grow. A recent increase in oral and pharyngeal cancer incidence and its late detection could be explained by worsening detection and diagnostics. The stabilization of oral and pharyngeal cancer mortality results in socio-economic losses for the Republic. The provided statistical
 data is the basis for improving the indicators of incidence and mortality related to oral and pharyngeal cancer in the Republic of Uzbekistan

Burden of cancer attributable to consumption of alcohol in Japan in 2015

Alcohol can cause or contribute to the development of many non-communicable diseases, including cancer. We calculated the proportion of cancer incidence and mortality in 2015 attributable to alcohol consumption in 2005. Data on alcohol consumption, provided in go, a traditional Japanese alcohol measurement unit, was derived from the 2005 Japanese National Health and Nutrition Survey for each sex and age group, then converted into grams of ethanol per day. The optimal consumption of alcohol for the purpose of this study was determined to be none, based on a global assessment derived from previous observational studies that have looked at the association between alcohol consumption and cancer. Using standard formulas, population attributable fractions (PAFs) for all cancers positively associated with alcohol drinking - oral cavity, pharynx, esophagus, stomach, colorectum, liver, larynx, and female breast - were calculated for each sex and age group and aggregated to obtain the PAF among total cancer incidence and mortality. For Japan in 2015, 59,838 cases of cancer incidence and 23,929 cancer deaths were attributable to alcohol consumption. The estimated PAF for cancer incidence and mortality attributable to alcohol consumption was 6.2% and 6.5%, respectively. For both cancer incidence and mortality, the highest percentage of alcohol-attributable cancer sites was esophageal (54.0% for incidence, 52.3% for mortality). Avoidance of alcohol consumption would reduce the burden of alcohol on cancer in Japan.

The Effect of Radiation and Chemoradiation Therapy on the Head and Neck Mucosal Microbiome: A Review.

Radiation (RT) and chemoradiation therapy (CRT) play an essential role in head and neck cancer treatment. However, both cause numerous side effects in the oral cavity, paranasal sinuses, and pharynx, having deleterious consequences on patients’ quality of life. Concomitant with significant advances in radiation oncology, much attention has turned to understanding the role of the microbiome in the pathogenesis of treatment-induced tissue toxicity, to ultimately explore microbiome manipulation as a therapeutic intervention. This review sought to discuss current publications investigating the impact of RT and CRT-induced changes on the head and neck microbiome, using culture-independent molecular methods, and propose opportunities for future directions. Based on 13 studies derived from a MEDLINE, EMBASE, and Web of Science search on November 7, 2021, use of molecular methods has uncovered various phyla and genera in the head and neck microbiome, particularly the oral microbiome, not previously known using culture-based methods. However, limited research has investigated the impact of RT/CRT on subsites other than the oral cavity and none of the studies aimed to examine the relationship between the head and neck microbiome and treatment effectiveness. Findings from this review provide helpful insights on our current understanding of treatment-induced oral mucositis, dental plaque, and caries formation and highlight the need for future research to examine the effect of RT/CRT on the sinonasal and oropharyngeal microbiome. In addition, future research should use larger cohorts, examine the impact of the microbiome on treatment response, and study the effect of manipulating the microbiome to overcome therapy resistance.

Role of Nurses in the Prevention and Early Detection of Oral Cavity and Pharynx Cancers

Purpose: The incidence of oral cavity and pharynx cancer is rising in the United States and South Dakota (SD) (2009-2018). In 2018, it was estimated that 396,937 of Americans were living with oral cavity and pharynx cancer. The 5-year relative survival rate for oral cancer is 66.2%, which is less than the survival rates for breast, colorectum, and prostate cancers. Tobacco and alcohol use and human papillomavirus (HPV16) exposure are some of the risk factors for oral cancer. Overall rural populations have higher cancer mortality than no rural population due to higher poverty, lower access to health services, and cigarette use. The purpose of this study is to investigate the prevalence of the oral cancer risk factors (e.g., cigarette smoking), HPV vaccination rates, and to identify the spatial distribution of social and environmental factors (e.g., social vulnerability, dental care access) in SD. Finally, this article discusses how nurses can contribute to oral cancer prevention and early detection. Methods: This descriptive study used data from multiple data sources (e.g., SD Department of Health, HRSA, County Health Rankings). Maps were created using ArcGIS. Findings: From the 66 SD counties, nearly 17% presented high-level shortage scores and were also highly socially vulnerable. HPV vaccination among youth was higher than the national average. Studies showed that improving nurse’s knowledge by training on oral cancer is needed and this may increase nurses’ practice in oral cancer prevention and control. Conclusions: Primary care professionals like nurse practitioners can assist in early detection of oral cancer and promote awareness of signs and main risk factors in rural areas. As part of the total patient care, nurses hold a vital role in prevention and early detection of oral cancer. These efforts with referral to oral cancer screening are vital for decreasing oral cancers morbidity and mortality rates primarily. Keywords: Rural health, Nurses, oral cancer, dentalcare access, Geographic Information Systems DOI: https://doi.org/10.14574/ojrnhc.v21i2.692

Survival analysis of 8785 malignant lymphoma cases in the oral and nasal cavities in the USA: a cohort study

ObjectiveTo identify the factors associated with the survival of malignant Hodgkin and non-Hodgkin lymphomas in oral and nasal cavities.Study design. Retrospective cohort survival analysis.MethodsThe Surveillance, Epidemiology and End Results 18...

Morphological Changes and Durability of Skin and Mucosal Flaps in Intraoral and Pharyngeal Reconstructions: Long-term Follow-up and Literature Review for Potential Second Carcinomas.

The long-term changes in tissues implanted in the oral cavity and pharynx after head and neck reconstruction have not been fully evaluated. This study aimed to clarify the morphological changes, long-term durability, and potential for secondary carcinogenesis in such tissues. In our single-center study, the rough morphological changes in 54 cases of intraoral and pharyngeal skin and mucosal flaps were evaluated more than 10 years after flap transfer. In addition, the literature on the development of second carcinomas from skin flaps was reviewed. The mean follow-up period for transferred flaps was 148 months. The reconstruction areas and the probability of morphological changes were significantly correlated (p=0.006), especially in cases with tongue, lower gingiva, and buccal mucosal reconstruction. Free jejunal flap surfaces were well maintained, whereas tubed skin flaps showed severe morphological changes in cases with pharyngeal reconstruction. None of the flaps in our series developed second primary carcinomas. Skin flaps generally had good durability for > 10 years in intraoral environments, while mucosal flaps had better durability for pharyngeal reconstruction. Second squamous carcinomas arising from skin flaps are extremely rare; however, surgeons should take this possibility into consideration and conduct meticulous and long-term follow-up.

Diseases with oral manifestations among adult asthmatics in Finland: a population-based matched cohort study

ObjectivesMany comorbidities are associated with adult asthma and may exacerbate the asthma burden of disease. This study aims to investigate the risk for major oral diseases or oral-manifesting diseases in...

Multiple microRNA signature panel as promising potential for diagnosis and prognosis of head and neck cancer.

MicroRNAs are small non-coding RNA that regulate gene expressions of human body. To date, numerous studies have reported that microRNAs possess great diagnostic and prognostic power in head and neck cancer and had governed a lot of attention. The factor for the successfulness of miRNAs in these aspects is due to cancer being fundamentally tied to genetic changes, which are regulated by these miRNAs. Head and neck cancer, leading the world record for cancer as number sixth, is caused by multiple risk factors such as tobacco consumption, alcohol consumption, dietary factors, ethnicity, family history, and human papilloma virus. It derives at locations such as oral cavity, pharynx, larynx, paranasal sinus and salivary gland and have high rate of mortality with high recurrence rate. Besides, head and neck cancer is also usually having poor prognosis due to its asymptomatic nature. However, this diagnostic and prognostic power can be further improved by using multiple panels of miRNA as a signature or even combined with TNM staging system to obtain even more remarkable results. This is due to multiple factors such as tumour heterogeneity and components of the tumour which may affect the composition of miRNAs. This review covers the examples of such miRNA signatures, compare their diagnostic and prognostic powers, discuss some controversial roles of unreported miRNAs, and the molecular mechanisms of the miRNAs in gene targeting and pathways.

Reduction in perioperative blood loss using ultrasound-activated scissors during tumour surgery

The aim of this study was to compare the effectiveness of Harmonic Focus+ scissors with the conventional surgical method regarding surgical blood loss and transfusion of blood products in the surgical treatment of head and neck tumours. In a retrospective study, the intraoperative blood loss, number of units of transfusion products given, operating time, and inpatient length of stay of 74 patients with squamous cell carcinoma were compared. Patients who underwent classic tumour surgery were compared with a group treated with Harmonic Focus+ scissors. A significantly lower intraoperative blood loss (496.15⬰ml vs 1096.0⬰ml, respectively; P⬰=⬰0.002) and shorter operation time (436.89 minutes vs 493.13 minutes, respectively; P⬰=⬰0.030) were achieved using the Harmonic Focus+ scissors when compared to the classic tumour surgery. Additionally, fewer units of blood products needed to be transfused (administration of red cell concentrates, P⬰<⬰0.001) and the length of stay in the intensive care unit was shorter for patients treated with the Harmonic Focus+ scissors (P⬰=⬰0.009). The study results indicate that the use of Harmonic Focus+ scissors during surgery for cancer of the oral cavity and pharynx is a safe and cost-effective method. This is of paramount importance during a pandemic when medical resources are scarce, including access to blood reserves.

Second Primary Malignancy in Patients with Hypopharyngeal Carcinoma: A SEER-Based Study.

BackgroundA population-based analysis of the risk of secondary primary malignancy (SPM) in patients with hypopharyngeal carcinoma (HPC) has been lacking in the literature. Therefore, we conducted this study to determine the risk factors and assess the effects of SPM on the overall survival (OS) and cancer-specific survival (CSS) of patients with HPC.MethodsData on selected patients diagnosed with HPC from the Surveillance, Epidemiology and End Results (SEER) database between 1973 and 2015 were examined through logistic regression, Cox regression and nomogram methods.ResultsThe overall risk of SPM in patients with HPC was higher than that in the general population (SIR: 2.77; P < 0.05). The specific-site, including the oral cavity, pharynx, digestive system, respiratory system and endocrine system, had a relatively higher risk of SPM. The overall risks of the subgroup of people 55–75 years of age and all subgroups of sex, race and latency were significantly elevated. In addition, patients with HPC were more likely to have been diagnosed in 2010–2015 (vs 2004–2009; P = 0.002), to be unmarried (vs married; P = 0.008), to have distant metastasis (vs no metastasis; P = 0.016) and to have had no surgery for the first tumor (vs surgery for the first tumor; P = 0.021), and these aspects were associated with a significantly elevated risk of developing SPM. SPM was independently associated with better OS and CSS. The OS and CSS in patients with HPC with SPM were better than those in patients without SPM (log rank P < 0.0001). The C indexes of the nomogram constructed with ten influencing factors including SPM were 0.681:0.699 for OS and 0.705:0.724 for CSS (training cohort:validation cohort).ConclusionAlthough the overall risk of SPM in patients with HPC was elevated, SPM did not decrease the OS and CSS in patients with HPC. This finding is inconsistent with clinical observations and thus requires further research and exploration. It possibly because HPC might have a shorter survival time, or the follow-up time was not long enough.

Obstructive Sleep Apnea in Patients with Head and Neck Cancer-More than Just a Comorbidity?

Obstructive sleep apnea is the most common type of sleep-disordered breathing with growing prevalence. Its presence has been associated with poor quality of life and serious comorbidities. There is increasing evidence for coexisting obstructive sleep apnea in patients suffering from head and neck cancer, a condition that ranks among the top ten most common types of cancer worldwide. Routinely, patients with head and neck cancer are treated with surgery, radiation therapy, chemotherapy, immunotherapy or a combination of these, all possibly interfering with the anatomy of the oral cavity, pharynx or larynx. Thus, cancer treatment might worsen already existing obstructive sleep apnea or trigger its occurrence. Hypoxia, the hallmark feature of obstructive sleep apnea, has an impact on cancer biology and its cure. Early diagnosis and sufficient treatment of coexisting obstructive sleep apnea in patients with head and neck cancer may improve quality of life and could also potentially improve oncological outcomes.

Alcohol Drinking Pattern and Risk of Head and Neck Cancer: A Nationwide Cohort Study.

Alcohol consumption is a major risk factor for head and neck cancer (HNC), yet little data exist examining drinking patterns and HNC risk. In this population-based, retrospective cohort study, 11,737,467 subjects were recruited from the Korean National Health Insurance Service database. The risks of overall HNC and HNC subtypes according to average alcohol consumption, drinking frequency, and daily amount were examined using Cox proportional hazard models. Over the median follow-up of 6.4 years, 15,832 HNC cases were identified. HNC risk linearly increased with drinking frequency (p-trend < 0.01; adjusted hazard ratio [aHR] 1.55, 95% confidence interval [CI] 1.45–1.67 in subjects who drank 7 days/week). HNC risk also increased according to daily amount of alcohol consumption (p-trend < 0.01), but plateaued from 5–7 units/occasion (aHR 1.25, 95% CI 1.19–1.31) to >14 units/occasion (aHR 1.26, 95% CI 1.13–1.40). When stratified by average alcohol consumption, drinking frequency, but not daily amount, showed a linear relationship with HNC risk in moderate and heavy drinkers. When comparing the HNC subtypes, similar tendencies were observed in cancers of the oral cavity, pharynx, and larynx, but not in the salivary gland. In conclusion, drinking frequency is a stronger risk factor for HNC, especially for cancer of the oral cavity, pharynx, and larynx, than the daily amount of alcohol consumption.

Draft Genome Sequences of Viridans Streptococci Causing Bacterial Endophthalmitis in Humans.

ABSTRACTThe viridans streptococci are a group of bacteria that are commensals of the oral cavity and pharynx. These species tend to cause severe cases of bacterial endophthalmitis with poor prognoses but remain largely uncharacterized in this context. Here, we report the whole-genome sequences of 21 strains of viridans streptococci isolated from endophthalmitis in humans.