Orofacial Rehabilitation Research Articles

Prosthetic Rehabilitation of a Maxillectomy Patient with Restricted Mouth Opening Using an Altered Cast Technique: A Case Report

Deformity in the maxillofacial region caused by surgical resection of a tumor have an adverse effect on the patient's ability to swallow, masticate, phonate, and psychological state. These patients may have restricted mouth opening capacity due to several surgical procedures and scar contracture resulting from radiation therapy. Therefore due to restricted access to the oral cavity prosthetic rehabilitation of these patients becomes a challenging task. A precise impression of the resection defect is necessary for accurate obturation. This is not practical for patients who have restricted mouth opening, hence this crucial first step in the making of a good prosthesis is frequently accomplished by altering the conventional impression method. This clinical report details the prosthetic rehabilitation of a patient who was diagnosed with Adenoid cystic carcinoma of the left maxillary sinus. Patient underwent maxillectomy for tumor removal, which was worsened by trismus as a result of the procedure and radiation therapy. For orofacial rehabilitation and defect obturation, the patient was restored with a removable dental prosthesis with a hollow bulb obturator. An altered cast technique was used in the final impression making. This rehabilitation approach was successful in restoring lost function and appearance of the patient. Keywords: Maxillectomy, Hollow Obturator, Altered cast technique

Implant Survival in Tissue-Engineered Mandibular Reconstruction-Early Experiences.

This article is to evaluate the early outcomes of dental implants placed in bone generated with tissueengineering techniques, specifically recombinant human bone morphogenic protein-2 (rhBMP-2), allogeneicbone particulate, and bone marrow aspirate concentrate (BMAC) in patients with resection of benignpathology. To evaluate the long-term prognosis of dental implants placed in tissue engineered mandibular reconstruction. We retrospectively evaluated 12 patient records, all of whom underwent segmental mandibular resection of benign pathology and reconstruction with a combination of BMAC, rhBMP-2, and allogeneic bone. Collecteddata points included the patient's age, gender, medical and social histories, implant site and placement date, resection/reconstruction date, final prosthesis, pathology resected, and follow-up dates (average 25 monthsof follow-up). Implant success was defined as clinical osseointegration (immobility), absence of peri-implantradiolucency, and absence of infection. Twelve patients met inclusion criteria with a total of 46 implants. The overall implant survival rate was 91.3%. There were 4 implant failures occurring in two patients: 1 failure in Patient 3 and 3 failures in Patient 8. Neitherpatient had any existing medical comorbidities or social history known to increase the risk for implant failure. The average implant placement occurred 11.6 months after mandibular reconstruction. Preliminary findings of implant placement in bone generated with tissue engineering techniques have shown to be another predictable alternative for orofacial rehabilitation. Practical Implications: Dental rehabilitationusing dental implants is a predictable treatment option for patients that have required reconstruction of largebony defects status post resection of benign pathology using novel tissue engineering techniques.

Pathways for the rehabilitation of resection defects in the maxilla.

Oral rehabilitation of head and neck cancer patients is an integral component of the care pathway. Maxillectomy procedures can cause significant defects, such as oronasal fistulas, loss of support for the cheek and lip, aesthetic defects in the middle third of the face and functional impairments. Orofacial rehabilitation plays a fundamental role in restoring aesthetics and functional capabilities, such as speech, mastication and deglutition.Rehabilitation of maxillectomy patients poses a challenge for both clinicians and patients. This paper utilises case examples to demonstrate the treatment options for the oral rehabilitation of these patients. We will summarise the treatment pathways for conventional obturators, delayed (secondary) implant retained fixed rehabilitation following composite free flap and early rehabilitation using a zygomatic implant perforated flap technique. This paper aims to highlight the challenges in treatment planning and the importance of a multidisciplinary approach in improving patient outcomes.

Rehabilitation of mandibular defects using unconventional approaches: a case series

In cases of orofacial rehabilitation, quality of life depends upon the outcome of treatment provided by a maxillofacial management team that usually includes oral surgeons, radiologists, prosthodontists, speech specialists and plastic surgeons. Patients with maxillofacial defects often suffer from disturbed psychological status and are often treated as stigma to the society. Prosthodontists have a key role in restoring aesthetics and occlusion of such patients which ultimately aids improve the psychological status and quality of life of such patients. The prosthetic rehabilitation on compromised tissue beds requires meticulous treatment planning and precise execution. Short-listing treatment options become an enigma if conventional approaches for maxillofacial rehabilitation are contraindicated. The following series describes cases of suspected Brown’s tumour (primary hyperparathyroidism) and an odontogenic keratocyst of the mandible in which conventional grafting and implant prostheses were not indicated.

Candida species biotypes and polyclonality of potentially virulent Candida albicans isolated from oral cavity of patients with orofacial clefts.

This study evaluated the incidence of Candida species, and the genetic diversity and virulence of C. albicans of the oral cavity from patients with cleft lip and palate (CLP). Oral samples were investigated by microbiological and species-specific PCR methods. The genetic diversity of C. albicans was established using isoenzyme markers, Nei's statistics, and clustering analysis. Hydrolytic enzymes (SAPs and PLs) were analyzed in vitro. Oral colonization by Candida species was observed in 29 patients with CLP (65.9%), and C. albicans was highly prevalent. SAP and PL activities were observed in 100% and 51.9% of isolates, respectively. High genetic diversity and patterns of monoclonal and polyclonal oral colonization by C. albicans were observed among patients with CLP. Two major polymorphic taxa (A and B) and other minor polymorphic taxa (C to J) were identified. Only one of the 16 clusters (taxon A) harbored strains from patients with and without CLP, whereas other clusters harbored strains exclusively from CLP patients. The anatomical conditions of the oral cavity of patients with CLP contribute to the high incidence of Candida species (C. albicans, C. krusei, C. tropicalis, and/or Candida spp.). Data suggest high genetic diversity of potentially virulent C. albicans strains in the oral cavity of CLP patients. Microbiological niches in orofacial clefts can contribute to the emergence of a relative clinical genotypic identity of C. albicans. However, orofacial rehabilitation centers can contribute to the direct and indirect sources of transmission and propagation of Candida species.

Atlas of voluntary facial muscle activation: Visualization of surface electromyographic activities of facial muscles during mimic exercises.

Complex facial muscle movements are essential for many motoric and emotional functions. Facial muscles are unique in the musculoskeletal system as they are interwoven, so that the contraction of one muscle influences the contractility characteristic of other mimic muscles. The facial muscles act more as a whole than as single facial muscle movements. The standard for clinical and psychosocial experiments to detect these complex interactions is surface electromyography (sEMG). What is missing, is an atlas showing which facial muscles are activated during specific tasks. Based on high-resolution sEMG data of 10 facial muscles of both sides of the face simultaneously recorded during 29 different facial muscle tasks, an atlas visualizing voluntary facial muscle activation was developed. For each task, the mean normalized EMG amplitudes of the examined facial muscles were visualized by colors. The colors were spread between the lowest and highest EMG activity. Gray shades represent no to very low EMG activities, light and dark brown shades represent low to medium EMG activities and red shades represent high to very high EMG activities relatively with respect to each task. The present atlas should become a helpful tool to design sEMG experiments not only for clinical trials and psychological experiments, but also for speech therapy and orofacial rehabilitation studies.

A practical approach to orofacial rehabilitation in a patient after inferior maxillectomy and rhinectomy with mono framework construction supported on a zygomatic implant placed in the glabella: a case report

BackgroundIn the field of craniofacial tumor surgery, an adequately performed excision, despite being a life-saving procedure, is only a first step to successful treatment. During such a procedure, the main goal is to completely remove the lesion, paying less attention to factors contributing to future rehabilitation possibilities. One ty 2of the possibilities for prosthetic rehabilitation of such cases is utilizing one-piece implants with bicortical anchorage.Case presentationThis case report presents a case of a 48-year-old patient with oral squamous cell carcinoma (OSCC). The treatment protocol consisted of radical surgery to remove the tumor, and intraoral and extraoral rehabilitation with a single framework prosthesis anchored with one-piece implants. Moreover, the intraoral stomatognathic deformity was corrected with a fixed implant-retained prosthesis, and the extraoral defect was covered with a removable epithesis.ConclusionsThe use of one-piece implants with bicortical anchorage may be an additional tool in reconstructing maxillofacial defects. Properly executed treatment may improve the esthetics, speech, masticatory function, muscle support, and the overall quality of life of patients with extensive defects in the maxillofacial region.

The use of hyaluronic acid in individuals with cleft lip and palate

Since the Resolution 198/2019 of Brazilian Dental Council, which regulates orofacial harmonization as a dental specialty, and the advent of various uses of facial fillers, such as hyaluronic acid (HA), it is possible to perform both esthetic and functional corrections in individuals. Individuals with cleft lip and palate (CLP) present lip irregularities even after orofacial rehabilitation with an interdisciplinary team with several corrective surgeries, interfering with the esthetics, which can cause problems in self-esteem and social insertion. Thus, facial filling is an innovation that, together with dentistry, contributes to the individual's esthetics and well-being. Considering the patient safety and health, more research is progressively being conducted to make such procedures less invasive. This work conducted a literature review on the use of HA as a facial filler to correct lip scars in patients with CLP. By a literature and transverse search in Scientific Electronic Library Online and PubMed databases using specific descriptors, the studies that met the inclusion criteria were selected, from 1990 to 2020. It can be concluded that the use of HA as a facial filling material in the correction of lip scars from reparative surgeries related to CLP has been shown to be effective both for correction of facial asymmetry and to improve the quality of life of patients who used the procedure.

Orofacial rehabilitation after severe orofacial and neck burn: Experience in a Brazilian burn reference centre

ObjectiveTo quantify the benefits of a functional oral rehabilitation program for impairment caused by full thickness orofacial and neck burns, comparing the effects of early and late intervention. MethodsAn observational cross-sectional study was conducted in a burn reference center over a two-year period. Patients with full thickness orofacial and neck burns were divided in two groups: Group 1 was composed by 14 patients who began the rehabilitation program 3–12 months after the burn injury; Group 2 was composed by 15 patients who began the rehabilitation program more than 12 months after the burn injury. Treatment was based on current strategies of non-surgical exercises for orofacial contracture management. Outcome measurements included an oral motor clinical evaluation and the assessment of the mandibular range of movement. ResultsThe functional rehabilitation program was effective in reestablishing the oral motor functions (i.e deficits reduced to approximately 15% when compared to the optimal possible scores) and in restoring horizontal mouth opening dimensions, with more than 70% of the patients presenting measurements within the expected normal limits at the end of treatment. Our results did not indicate differences in performance between the group of patients in neither set of assessments, i.e. pre and post treatment (p > 0.05). ConclusionThe results of this study indicate that non-invasive orofacial contracture management is effective for patients with orofacial and neck burns, including those with long term sequelae.

A systematic review of the computerized tools and digital techniques applied to fabricate nasal, auricular, orbital and ocular prostheses for facial defect rehabilitation

A systematic review was conducted in early 2019 to evaluate the articles published that dealt with digital workflow, CAD, rapid prototyping and digital image processing in the rehabilitation by maxillofacial prosthetics. The objective of the review was to primarily identify the recorded cases of orofacial rehabilitation made by maxillofacial prosthetics using computer assisted 3D printing. Secondary objectives were to analyze the methods of data acquisition recorded with challenges and limitations documented with various software in the workflow. Articles were searched from Scopus, PubMed and Google Scholar based on the predetermined eligibility criteria. Thirty-nine selected papers from 1992 to 2019 were then read and categorized according to type of prosthesis described in the papers. For nasal prostheses, Common Methods of data acquisition mentioned were computed tomography, photogrammetry and laser scanners. After image processing, computer aided design (CAD) was used to design and merge the prosthesis to the peripheral healthy tissue. Designing and printing the mold was more preferred. Moisture and muscle movement affected the overall fit especially for prostheses directly designed and printed. For auricular prostheses, laser scanning was most preferred. For unilateral defects, CAD was used to mirror the healthy tissue over to the defect side. Authors emphasized on the need of digital library for prostheses selection, especially for bilateral defects. Printing the mold and conventionally creating the prosthesis was most preferred due to issues of proper fit and color matching. Orbital prostheses follow a similar workflow as auricular prosthesis. 3D photogrammetry and laser scans were more preferred and directly printing the prosthesis was favored in various instance. However, ocular prostheses fabrication was recorded to be a challenge due to difficulties in appropriate volume reconstruction and inability to mirror healthy globe. Only successful cases of digitally designed and printed iris were noted.

Oro-facial rehabilitation of cancer patients: 'Zygomatic 2019'-1-2 March 2019, London, UK.

This first truly global conference on the use of zygomatic implants for the oral reconstruction of patients with compromised or deficient maxillae was held at the Museum of London from 1 to 2 March 2019. It attracted over 200 clinicians and academics from 24 nations and reviewed over 25 years’ experience and research in this field. This conference presented concepts heralding new opportunities for the oro-facial rehabilitation of doctor-induced osteonecrosis of the jaw (ONJ), both osteonecrosis radiation-induced (ORN) and medication-induced ONJ (MRONJ) in oncology patients.

Management of drooling in children with cerebral palsy: A French survey

After the age of 4 years, drooling becomes pathological and impacts the quality of life of children with cerebral palsy. The aim of the communication is to characterise children with cerebral palsy and pathological drooling in France, and to describe care pathways, assessment and treatment. A transversal, observational, descriptive survey of the practices and opinions of 400 health professionals potentially involved in the care of children with cerebral palsy, was carried out nationally across France in 2013. The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (< 25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine ® ) (94%) botulinum toxin injections (66%) and surgery (34%). Scopolamine was considered to be less effective than botulinum toxin and to have more side effects. Regarding the protocol, Botox ® is the most commonly used, with a median dose of 1 U/Kg/gland, injected both in parotid and sub-mandibulars glands. The period between two injections is from 3 to 6 months. Glands are located by ultrasound examination. The analgesic method differs from injection centers. The rate of pathological drooling in children with cerebral palsy is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however professionals consider that botulinum toxin is more effective and has less side effects. For now there is no general agreement for the protocol of toxin injection. Further studies should be conducted to define a standardized protocol for injections.

Management of drooling in children with cerebral palsy: A French survey

After the age of 4 years, drooling becomes pathological and impacts the quality of life of children with cerebral palsy. The aim of the communication is to characterise children with cerebral palsy and pathological drooling in France, and to describe care pathways, assessment and treatment. A transversal, observational, descriptive survey of the practices and opinions of 400 health professionals potentially involved in the care of children with cerebral palsy, was carried out nationally across France in 2013. The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (< 25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine ® ) (94%) botulinum toxin injections (66%) and surgery (34%). Scopolamine was considered to be less effective than botulinum toxin and to have more side effects. Regarding the protocol, Botox ® is the most commonly used, with a median dose of 1 U/Kg/gland, injected both in parotid and sub-mandibulars glands. The period between two injections is from 3 to 6 months. Glands are located by ultrasound examination. The analgesic method differ from injection centers. The rate of pathological drooling in children with cerebral palsy is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however professionals consider that botulinum toxin is more effective and has less side effects. For now, there is no general agreement for the protocol of toxin injection. Further studies should be conducted to define a standardized protocol for injections.

The prevalence of ankyloglossia in 302 newborns with breastfeeding problems and sucking difficulties in Barcelona: a descriptive study.

Oral and maxillofacial development is influenced by the lingual frenulum and also affects breathing, occlusion, sucking, swallowing, speech, among others. Ankyloglossia in the newborn may result in breastfeeding difficulties: maternal nipple pain and/or erosion or mastitis, poor weight gain and excessively long breastfeeds. The main objective of this work is to study the prevalence of ankyloglossia in newborns with breastfeeding difficulties. This is a transversal descriptive study of 302 patients, between 0 and 6 months, who attended the hospital as a result of breastfeeding difficulties. All patients with sucking problems and ankyloglossia were included in this study and followed the multidisciplinary treatment protocol made up of the services of Breastfeeding, Speech Therapy and Orofacial Rehabilitation and Oral and Maxillofacial Surgery. 1,102 newborns were seen at the paediatric service of Hospital de Nens, Barcelona (Spain) during 2 years; 302 had breastfeeding difficulties and of these, 171 were diagnosed with ankyloglossia (60 girls and 111 boys). Coryllos Grade 3 ankyloglossia was the most prevalent (59.6%) type; 85 infants (49.7%) were exclusively breastfed and 26 (50.35%) were mixed fed (formula and breastfeeding). Only 43 patients had a family history of tongue-tie (25.1%). Ankyloglossia linked to breastfeeding difficulties must be treated by a multidisciplinary team. We have found a high prevalence of the condition since the population studied are newborns with sucking problems. If a frenotomy is necessary, we recommend stimulating suction with myofunctional therapy before and after surgery to avoid scar retraction.

Electrical stimulation of hyoid muscles in post-stroke dysphagia.

The purpose of this study was to evaluate swallowing changes in post-stroke patients with dysphagia after four weeks of suprahyoid muscles electrical stimulation. This was a prospective randomized study of early stage stroke patients with dysphagia. Electrical stimulation of suprahyoid muscles was given to a group of 54 patients (26 men, average age 70 years) for 20 minutes a day, 5 days a week. Standard orofacial rehabilitation without electrical stimulation was carried out on a control group of 54 patients (31 men, average age 69 years). Swallowing was evaluated at the beginning of the study and at the end, by videofluoroscopy - measuring the time for oral and pharyngeal phases. The difference in duration of oral transit time (OTT) after the therapy between the study group (average: 0.55 ± 0.01) and the control group (average: 0.29 ± 0.03) was statistically significant (P=0.01). Difference in duration of the pharyngeal transit time (PTT) after the therapy between the study group (average: 0.37 ± 0.02) and control group (average: 0.15 ± 0.02) was also statistically significant (P=0.009). Electrical stimulation of suprahyoid muscles significantly reduced the duration of the oral and pharyngeal phases: in the post-stroke patients with dysphagia used in this study. The result is improved swallowing. This is a recently recommended approach and your study confirms its efficacy.

Management of drooling in children with cerebral palsy: A French survey

The aim of this study was to characterize children with cerebral palsy (CP) and pathological drooling in France, and to describe care pathways, assessment and treatment. A transversal, observational, descriptive survey of the practices and opinions of 400 health professionals potentially involved in the care of children with CP, was carried out nationally across France in 2013. The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (< 25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine ® ) (94%) botulinum toxin injections (BT) (66%) and surgery (34%). Scopolamine was considered to be less effective than BT and to have more side effects. The rate of pathological drooling in children with CP is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however, professionals consider that BT is more effective and has fewer side effects.

Effects of Targeted Orofacial Rehabilitation in Patients after Stroke with Speech Disorders

Effects of Targeted Orofacial Rehabilitation in Patients after Stroke with Speech Disorders

Anquiloglosia y problemas de succión, tratamiento multidisciplinar: terapia miofuncional orofacial, sesiones de lactancia materna y frenotomía

IntroductionThe limitation of lingual mobility in newborns can cause problems in lactation. Among these problems are, soreness, cracked nipples or mastitis in the mother, poor weight gain of the newborn, and an excessively prolonged period of time in each breastfeed. The aim of this study is evaluate the effectiveness of the treatment received by the newborns with breastfeeding problems and ankyloglossia. Material and methodsA preliminary study of the effectiveness of the circuit established between the Oral and Maxillofacial Surgery, Speech Therapy and Orofacial Rehabilitation and the Breastfeeding Department to treat patients that attended the hospital with breastfeeding problems and were diagnosed with ankyloglossia. ResultsA total of 61 patients with ages between 0 and 6 months had ankyloglossia were seen due to clinical problems related to breastfeeding. Of these, 20 (32.8%) were girls and 41 (67.2%) were boys. Three groups were established in accordance with the treatment carried out: group1 (n=6) solely from the Breastfeeding Sessions (BFS), group2 (n=19) Myofunctional Therapy (MFT) and BFS, and group3 (n=36) Frenotomy, followed by MFT and BFS. Ankyloglossia type3 was the most frequent lingual frenulum (57.4%). From the total sample, improvements were observed in the parameters that assessed the effectiveness and comfort of breastfeeding. ConclusionsImproving breastfeeding is possible, and in some cases, surgery should not be necessary. If surgery is required, it is recommended to stimulate suction before and after the frenotomy with myofunctional therapy.

Orofacial rehabilitation with zygomatic implants: CAD-CAM bar and magnets for patients with nasal cancer after rhinectomy and partial maxillectomy

Nasal carcinoma extending into the premaxilla requires radical surgical excision including rhinectomy and partial maxillectomy. Rehabilitation is complex and involves the use of removable prostheses. Three patients treated with zygomatic implants and custom-milled bars to retain an obturator and nasal prosthesis are presented.

Management of drooling in children with cerebral palsy: A French survey.

To characterise children with cerebral palsy (CP) and pathological drooling in France, and to describe care pathways, assessment and treatment. A transversal, observational, descriptive survey of the practices and opinions of 400 health professionals potentially involved in the care of children with CP, was carried out nationally across France in 2013. The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (<25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine(®)) (94%) botulinum toxin injections (BT) (66%) and surgery (34%). Scopolamine was considered to be less effective than BT and to have more side effects. The rate of pathological drooling in children with CP is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however professionals consider that BT is more effective and has less side effects.