Tongue Blade Research Articles

Concurrent Chemoradiation in Oropharyngeal Cancer: Does Omission of 1 or More Cycles of Chemotherapy Diminish Survival or Tumor Control?

Materials/Methods: Five patients with OPC who were unable to use bite block or tongue blade underwent computed tomographic simulations with neutral tongue position and stuck-out tongue for planning IMRT (IMRT-N and IMRT-S, respectively). Planning objectives were to deliver 70 Gy, 63 Gy, and 56 Gy in 35 fractions to 95% of PTVs using simultaneously integrated boost technique, with mean doses (Dmean) of <26 Gy to the parotid gland, <30 Gy to the submandibular gland, and <36 Gy to the oral cavity (OC). For other organs at risk (OARs), Radiation Therapy Oncology Group (RTOG) recommended dose constraints were applied. Planning was optimized to minimize doses to OARs without compromising coverage of PTVs. Radiation plans with IMRT-N and IMRT-S were compared. Results: IMRT-N and IMRT-S showed equivalent radiation target coverages with sparing OARs, except OC. Dmean of OC was 34.8 1.6 Gy and 30.7 3.0 Gy with IMRT-N and IMRT-S, respectively (PZ.006). OC volume receiving 36 Gy (V36) was 34.1 19.0% using IMRT-N compared to 28.0 15.9% with IMRT-S (PZ.03). Dmean of oral tongue was 39.6 2.7 Gy and 31.7 3.5 Gy in IMRT-N and IMRT-S, respectively (PZ.01). The distance from palate to surface of tongue tend to increase in IMRT-S with 0.9 0.3 cm compared to IMRT-N with 0.1 0.2 cm (PZ.003). Conclusion: In 5 patients with OPC, an IMRT-S significantly reduced radiation dose to oral cavity, specifically oral tongue, compared to IMRT-N without compromising radiation target coverage or other OARs. For the patients with OPC who were unable to use bite block or tongue blade, stuck-out tongue during radiation therapy can provide less radiation dose to OC, which could lead to fewer radiation-related side effects in OC. Author Disclosure: W. Kil: None. C.M. Kulasekere: None. V. Harwalkar: None. J.R. Bugno: None. L.D. Jefferson: None. J.Z. Baskin: None. C.J. Nock: None. R.D. Derrwaldt: None. R. Raju: None. C.L. Hatch: None.

An Optimal Set of Flesh Points on Tongue and Lips for Speech-Movement Classification.

The authors sought to determine an optimal set of flesh points on the tongue and lips for classifying speech movements. The authors used electromagnetic articulographs (Carstens AG500 and NDI Wave) to record tongue and lip movements from 13 healthy talkers who articulated 8 vowels, 11 consonants, a phonetically balanced set of words, and a set of short phrases during the recording. We used a machine-learning classifier (support-vector machine) to classify the speech stimuli on the basis of articulatory movements. We then compared classification accuracies of the flesh-point combinations to determine an optimal set of sensors. When data from the 4 sensors (T1: the vicinity between the tongue tip and tongue blade; T4: the tongue-body back; UL: the upper lip; and LL: the lower lip) were combined, phoneme and word classifications were most accurate and were comparable with the full set (including T2: the tongue-body front; and T3: the tongue-body front). We identified a 4-sensor set--that is, T1, T4, UL, LL--that yielded a classification accuracy (91%-95%) equivalent to that using all 6 sensors. These findings provide an empirical basis for selecting sensors and their locations for scientific and emerging clinical applications that incorporate articulatory movements.

Prevalence of oro-dental anomalies among schoolchildren in Sana'a city, Yemen

Practitioners and policy-makers need information about the relative frequency of dental anomalies among children in their region. This study investigated the prevalence of different oral anomalies among schoolchildren in Sana'a city, Yemen. A sample of 1000 private and public schoolchildren aged 4-12 years were examined by the same examiner using disposable tongue blades. The total prevalence of oral anomalies was 15.1%, most commonly in boys (male:female ratio 3.2:1) aged 7-12 years. The most prevalent dental anomaly related to hard tissues was tooth hypoplasia (2.8%), followed by hypocalcification (2.6%), then microdontia (0.5%), macrodontia (0.4%), hypodontia (0.4%), supernumerary teeth (0.3%), tooth transposition (0.3%), dental fusion (0.2%) and gemination (0.2%). The most prevalent soft tissues anomaly was fissured tongue (4.0%), followed by ankyloglossia (1.8%), geographic tongue (0.9%), macroglossia (0.4%) and hairy tongue (0.3%). Appropriate measures need to be taken early to mitigate the negative impact and later costs of treatment of anomalies.

Neuromuscular Monitoring: Does the use of acceleromyography in comparison to the unaided clinical assessment result in lower occurrences of postoperative residual neuromuscular blockade in patients admitted to the post anesthesia care unit?

The occurrence of postoperative residual neuromuscular blockade continues to affect a considerable percentage of patients admitted to the post anesthesia care unit (PACU). Recent evidence suggest 17-36% of patients that arrive to the PACU present with objective manifestation of incomplete neuromuscular blockade reversal as determined by train-of-four ratios less than 0.90.1(p389) Patients presenting to the PACU with a train of four (TOF) ratio &lt; 0.90 are considered to have residual neuromuscular blockade and are at an increased risk for experiencing adverse respiratory events such as reduced upper airway volumes, airway obstruction, hypoxemia events, and postoperative pulmonary complications.2 Research supports the proponents of quantitative acceleromyography for monitoring neuromuscular blockade and recovery. Qualitative neuromuscular monitoring includes peripheral nerve stimulator and clinical sign assessment such as the 5-second head-lift test, tongue blade stability between the incisors to a quantitative approach (ex. acceleromyography). However, this change in practice is accompanied by hesitancy and uncertainty from practitioners across the nations who underestimate the occurrence of postoperative residual neuromuscular blockade and its effects. The rationale to switch from the qualitative assessments for a more quantitative approach using an accelerometer needs review. The purpose of this report is to determine if objective acceleromyography in comparison to subjective peripheral twitch monitors and clinical assessment are more effective in decreasing the occurrence of post-operative residual neuromuscular blockade.

Endoscope-guided coblator tongue base resection using an endoscope-holding system for obstructive sleep apnea.

Multilevel obstruction in obstructive sleep apnea commonly includes retroglossal obstruction. To improve surgical success rates, tongue volume reduction with posterior midline glossectomy and/or lingual tonsillectomy is widely performed. Nasotracheal intubation was utilized, and the combined tongue procedure was performed as a final step after palatal surgery. The tongue was pulled maximally by a retraction suture and a McIVOR (Karl Storz, Tuttlingen, Germany) or Davis mouth gag (Karl Storz,Tuttlingen, Germany), and a medium-length tongue blade was applied to expose the tongue base. A 70-degree rigid endoscope was fixed by the holding system and introduced into the oral cavity. Endoscope-guided coblator tongue base resection was then performed. The surgeon could use both hands for the surgery, enabling a more delicate resection of tongue base tissue. This technique was acceptable and can be successfully used in patients with a large tongue, in whom exposing the tongue base for surgery is difficult.

Analysis of distinctive feature matching with random error generation in a lexical access system

A matcher for a distinctive feature-based lexical access system is tested using degraded feature inputs. The input speech comprises 16 conversation files from a map task in American English, spoken by 8 female speakers. A sequence of predicted features are produced from a generation algorithm, and the results are randomly degraded at levels from zero to full degradation, for various combinations of the features. Two series of experiments are conducted: the first progressively degrades only single features while leaving all others intact, while the other builds up the system using single, then multiple features. From these experiments, introducing errors into particular articulator-free features, such as vowel, consonant, or sonorant; or articulator-bound features, such as the aspirated feature, pharyngeal features, the nasal feature, the velar feature, or the lateral and rhotic features, do not strongly degrade matching performance. However, matcher performance is more sensitive for errors in the other articulator-free features, and for the articulator-bound features related to vowel place and consonant place, especially, the tongue blade features. For combinations of features, degrading consonantal features, vowel place features, or tongue blade features leads to faster decline in performance, suggesting that these features play more important roles in lexical access.

A Comment on Application of Hand Towel Drape over Dingman Mouth Gag.

www.e-acfs.org pISSN 2287-1152 eISSN 2287-5603 102 Copyright © 2015 The Korean Cleft Palate-Craniofacial Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Correspondence: Kun Hwang Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea E-mail: jokerhg@inha.ac.kr No potential conflict of interest relevant to this article was reported. Received May 4, 2015 / Revised June 25, 2015 / Accepted July 15, 2015 To the Editor: I have read with great interest the article entitled, “Application of Hand Towel Drape over Dingman Mouth Gag,” by Choi and Park (Arch Craniofac Surg 2015;16:29-30) [1] and wish to share a comment. In the paper, the authors describe the usage of a towel drape over the mouth gag site. In Figs. 1 and 2, the towel covers the two lateral cheek retractors, tongue blades, and most of the upper and lower springs. While the authors state that this towel prevents suture material from being caught in the gag, I am afraid this precisely defeats the very purpose of the spring coils, whose design it is to hold sutures in place until they are ready to be tied. e idea of suture-indexing spring coils was rst adopted to mouth gag by Professor Kilner at Oxford prior to World War II. I would leave this comment with the quotation of someone who personally knew both Drs. Kilner and Dingman–Dr. Millard Jr. A Comment on Application of Hand Towel Drape over Dingman Mouth Gag

Rai′s modified tongue blade: Reply to letter to the editor

Rai′s modified tongue blade: Reply to letter to the editor

Miralax Mix Up: A Case Report on Caustic Injury to the Esophagus

Introduction: Ingestion of caustic agents causes a variety of injuries to the esophagus making management difficult. We describe an interesting case of ingestion of an unknown caustic agent and briefly discuss the current recommendations on diagnosis and treatment. Case Report: A 68-year-old Caucasian male presented with a 2 day history of painful swallowing after drinking what he believed was Miralax with water. The patient denied any recent antibiotic or steroid use. The patient’s past medical and surgical history is significant for congestive heart failure status post defibrillator, type 2 diabetes mellitus, coronary artery disease status CABG, bipolar disorder, tobacco abuse and polysubstance abuse. On evaluation, the patient’s vital signs were within normal limits. Physical exam was remarkable for scattered white patches on the surface of the oropharynx, which revealed a denuded area when removed by scraping with a tongue blade. Labs were significant for an elevated white blood cell count of 17,500. Basic metabolic panel was within normal limits. Examination by a fiberoptic nasolaryngoscope revealed burns of the oropharynx and hypopharynx. Esophagogastroduodenoscopy (EGD) showed severe diffuse esophageal injury (Grade 2A/2B) likely related to an inadvertent caustic ingestion. Patient was treated with a proton pump inhibitor drip and broad spectrum antibiotics. After several days, the patient was able to tolerate a clear liquid diet. He continued to improve clinically and was discharged on a soft diet with crushed medications. A follow-up EGD was scheduled for 8 weeks. Discussion: Ingestion of caustic agents occurs most commonly by accident in the pediatric population and as a suicide attempt in adults. These agents include both acidic and alkali chemicals commonly found in household cleaning products, which cause tissue injury resulting in both systemic and focal injuries. Most serious and long-term complications occur in the esophagus and include esophageal ulcerations, edema, perforation, strictures, and an increased lifetime risk for carcinoma. Presenting symptoms can vary from no symptoms to life threatening symptoms depending on the extent of tissue damage. Endoscopy should ideally be performed within 24 hours of ingestion. A 6-point grading system based on endoscopy findings is often used to predict clinical outcomes and treatment plans. Treatment is mainly focused on supportive care depending on the extent of injury and often includes gastric acid suppression and broad spectrum antibiotics until the patient recovers and complications such as strictures and perforations are treated.

English

Low CD4 counts is currently considered to be one of the main indicators of the progression of human immunodeficiency virus (HIV)-induced immune depression, but few studies have analyzed its relationship to the presence of oral cytological changes. The aim of this cross sectional study was to analyze the relationship between total CD4 lymphocyte count and the occurrence of cytological changes. The present cross-sectional study included 40 HIV infected patients seen at a clinic for sexually transmitted diseases and HIV. Oral smears were obtained from dorsum of the tongue and the buccal mucosa using tongue blade and smear was transferred on a glass slide and fixed. The samples were assessed for the presence or absence of cytological changes, and correlated it with their CD4 counts. The CD4 lymphocyte counts of each of the 40 cases was noted and categorized as those below 500 cells/mm3 and above 500 cells/mm3. A total of 24 cases showed CD4 counts less than 500 cells. It was observed that the lesser the CD4 lymphocyte count, the greater the cell yield. These findings suggest that oral cytological changes could be a useful clinical marker of patients with HIV and can also be used as an adjuvant to CD4 counts. In view of these results, emphasis should be placed on the importance of thorough examination of the oral cavity and obtaining oral smears, as these changes provides indirect information about the patient&rsquo;s immune state. &nbsp; Key words: Human immunodeficiency virus (HIV) infection, oral cytology, CD4 counts.

The 70-degree telescope as a teaching tool for cleft palate repair and pharyngoplasty surgery

ObjectiveTo determine the optimum positioning of a 70-degree telescope to provide a maximum view of the palate and posterior pharynx for observers while minimally obstructing the direct view of a surgeon. DesignSimulator testing of clinical protocol. SettingSimulation center of an academic tertiary care children's hospital. InterventionsThe palate and pharynx of an infant airway mannequin was exposed with a Dingman mouthgag. A 4mm, 70-degree endoscope was secured to the Mayo stand to provide a projected image of the simulated operative procedure. Various positions of the 70-degree telescope were photodocumented by manipulating the angle of the scope, the extension past the lower lip, and the distance of the scope tip away from the midline. Using a 4-point Likert scale, three surgeons rated the randomized photos from both the direct operative view and the projected endoscopic view. ResultsAverage rating for the adequacy of the view for pharyngeal surgery was 2.4/4.0 and for palate surgery was 3.1/4.0 (p=.001). Only 4 of 22 scope positions were rated as minimally obstructive to direct view by all three surgeons. Only 1 position – scope parallel and just lateral to the tongue blade – was rated as minimally obstructive and adequate for both pharyngeal and palatal surgery by all three surgeons. ConclusionsIn training centers, a 70-degree telescope attached to a Mayo stand may be useful for teaching and assessing cleft palate and pharyngoplasty surgery, while providing minimal obstruction to direct view by the surgeon.

Investigation on the characteristics and management of dental waste in Urmia, Iran

The objective of this study was to identify the components, composition, generation rate and management of dental waste in Urmia, Iran. Fifteen dental centers including eight general dental offices, five specialist dental offices and two dental clinics were selected and two samples were taken from each office. Then, the wastes were manually separated in 31 components and weighted. The results showed that total dental waste generation in all general dental offices, specialist dental offices and dental clinics were 58.94, 17.92 and 10.22 kg/day, respectively. Domestic, potentially infectious, toxic and chemical and pharmaceutical waste also constituted 35.46, 34.24, 11.83 and 5.56 % of total waste, respectively. Only 11 components including blood-contaminated paper towel, saliva-contaminated paper towel, saliva-contaminated cotton, extracted teeth, blood-contaminated gauze, inseparable components, nylon glove, tongue blade, latex glove, saliva ejector and blood-contaminated cotton constituted more than 80 % of total infectious waste generation. There was no management program (waste minimization, separation, reuse and recycling) in the dental offices. Source reduction, separation, reuse and recycling activities should be conducted to decrease the hazards of dental wastes. It is also suggested that each fraction of dental waste should be separately collected and disposed in the accordance with its related criteria.

Tongue Motion Patterns in Post-Glossectomy and Typical Speakers: A Principal Components Analysis

In this study, the authors examined changes in tongue motion caused by glossectomy surgery. A speech task that involved subtle changes in tongue-tip positioning (the motion from /i/ to /s/) was measured. The hypothesis was that patients would have limited motion on the tumor (resected) side and would compensate with greater motion on the nontumor side in order to elevate the tongue tip and blade for /s/. Velocity fields were extracted from tagged magnetic resonance images in the left, middle, and right tongue of 3 patients and 10 controls. Principal components (PCs) analysis quantified motion differences and distinguished between the subject groups. PCs 1 and 2 represented variance in (a) size and independence of the tongue tip, and (b) direction of motion of the tip, body, or both. Patients and controls were correctly separated by a small number of PCs. Motion of the tumor slice was different between patients and controls, but the nontumor side of the patients' tongues did not show excessive or adaptive motion. Both groups contained apical and laminal /s/ users, and 1 patient created apical /s/ in a highly unusual manner.

“We Need to Cut the Neck!”: Confronting Psychological and Moral Distress during Emergency Cricothyrotomy

“We Need to Cut the Neck!”Confronting Psychological and Moral Distress during Emergency Cricothyrotomy1 Stephanie Cooper Enough You didn’t die in the ER, but rather, began your inexorable demise. The last, first, and only words I ever heard you utter was the weak mewl “tight, tight” as the blood pressure cuff constricted your left arm. You were 98–years–old, bed–bound, at the end. Your world was already partitioning itself from us, your brain tunneling down the uneven corridors of consciousness. A concretion of otoliths muffled your hearing, and fatigue burdened your ancient heart. Your name–band encircled your skinny ankle like a bird. Deformed by arthritis, you were caged within yourself, imprisoned by senescence. You could not declare yourself to us. Words disintegrated into moans and your grimace became animal. When you came back from x–ray—hypotensive with multiple neck fractures confirmed—you could speak no more. Your pulse slowed, your blood pressure plummeted. I jammed a gloved finger against your femoral pulse, faint and tired. [End Page E5] “What’s her DNR status?” I gravely asked your nurse. The DNR paperwork for once had arrived with the patient. “No CPR” she said with relief. But then the paperwork went on, forcing me—the waitress of tragedy—to serve up the hash of an impossible menu. As health care providers, we are all often tasked with performing contradictory actions: the pain of IV insertion followed by the morphine push, drilling deeper into broken bone in order to plate it, the inadvertent cracking of ribs during chest compressions. We sometimes must perform violent action in the hope of sustaining and resurrecting life. We are asked to perform the impossible, the contradictory, the painful. And sometimes the actions we must take catalyze an inexorable chain reaction of actions, which can end in death–prolonging and painful interventions that we did not intend. Although our culture may imagine that one can choose one’s meal at the end–of–life fast–food franchise of death, such is not the case. You can’t suddenly decide you’re a vegetarian. You can’t order the cheeseburger without the cheese—and we all are getting the burger, in the end. Ordering the heart–squeezing drugs without the CPR to circulate them, or the antibiotics without the fluid to counter dehydration, is like ordering the burger without the bun. Sometimes the possible choices are not necessarily realistic choices. You get served what you get served, and perhaps we should question the assumption that we have the ability to choose at all. Your DNR form proclaimed no CPR but then said that antibiotics and intubation were okay—the cheeseburger without the cheese. An unfortunate choice for you, me, and the rest of us, as your death menu led to a very unhappy meal. You were comatose. I stuck a tongue blade deep into your desiccated throat. You did not gag. This means I should have intubated you, but morally, I couldn’t. To what end? You were 98 years old, broken, moribund. If you hadn’t suffered multiple neck fractures, or if you were a vibrant elder who had just walked off Mt. Rainier, maybe the story would have been different. But you? I doubted that you truly had a chance of ever feeling joy again. You were somebody’s wife, somebody’s mother. I knew this step would lead to the domino of unstoppable steps. I refused to flog your corpse. I called your daughter Kay on her cell phone, told her that you were in critical condition and that she should come to the ER immediately. But how to begin to tell a daughter her mother is dying, let alone over a cell phone? Gentle but surreal and impersonal, my voice tried to tell your daughter that the interventions you needed would likely kill you. I have seen enough human suffering to know. To me, the choices were clear: death by nature’s irrefutable course, versus a more painful, protracted, and violent death by what we’d do to you. Kay arrived in a wheelchair and scooted up to your bedside. Like all daughters, she wasn’t ready for you...

Vowel production in Mandarin accented English and American English: Kinematic and acoustic data from the Marquette University Mandarin accented English corpus

Few electromagnetic articulography (EMA) datasets are publicly available, and none have focused systematically on non-native accented speech. We introduce a kinematic-acoustic database of speech from 40 (gender and dialect balanced) participants producing upper-Midwestern American English (AE) L1 or Mandarin Accented English (MAE) L2 (Beijing or Shanghai dialect base). The Marquette University EMA-MAE corpus will be released publicly to help advance research in areas such as pronunciation modeling, acoustic-articulatory inversion, L1-L2 comparisons, pronunciation error detection, and accent modification training. EMA data were collected at a 400 Hz sampling rate with synchronous audio using the NDI Wave System. Articulatory sensors were placed on the midsagittal lips, lower incisors, and tongue blade and dorsum, as well as on the lip corner and lateral tongue body. Sensors provide five degree-of-freedom measurements including three-dimensional sensor position and two-dimensional orientation (pitch and roll). In the current work we analyze kinematic and acoustic variability between L1 and L2 vowels. We address the hypothesis that MAE is characterized by larger differences in the articulation of back vowels than front vowels and smaller vowel spaces compared to AE. The current results provide a seminal comparison of the kinematics and acoustics of vowel production between MAE and AE speakers.

Re-Evaluating the Diagnostic Accuracy of the Tongue Blade Test: Still Useful as a Screening Tool for Mandibular Fractures?

BackgroundMandibular fractures are one of the most frequently seen injuries in trauma. In terms of facial trauma, mandible fractures constitute 40%–62% of all facial bone fractures. The tongue blade test (TBT) has been shown to be a sensitive screening tool when compared with plain films. However, recent studies have demonstrated that computed tomography (CT) scan is more sensitive for determining mandible fractures than the traditionally used plain films. ObjectiveThe purpose of the study was to determine the sensitivity and specificity of the TBT as compared with the new gold standard of radiologic imaging, CT scan. MethodsAny patient suffering from facial trauma was prospectively enrolled during the study period (August 1, 2010 to April 11, 2012) at a single urban, academic Emergency Department. A TBT was performed by the resident physician and confirmed by the supervising attending. CT facial bones were then obtained for the ultimate diagnosis. Inter-rater reliability (κ) was calculated, along with sensitivity, specificity, negative predictive value, and likelihood ratio (–) based on a 2 × 2 contingency table generated. ResultsDuring the study period, 190 patients were enrolled. Inter-rater reliability was κ = 0.96 (95% confidence interval [CI] 0.93–0.99). The following parameters were then calculated based on the contingency table: sensitivity 0.95 (95% CI 0.88–0.98), specificity 0.68 (95% CI 0.57–0.77), negative predictive value 0.92 (95% CI 0.82–0.97), and likelihood ratio (−) 0.07 (95% CI 0.03–0.18). ConclusionsBased on the test characteristics calculated (negative predictive value 0.92, sensitivity 0.95, likelihood ratio −0.07), the TBT is a useful screening tool to determine the need for radiologic imaging.

Herniation of an endotrachial tube through the tongue blade of the Boyle-Davis Gag during paediatric adenotonsillectomy

Herniation of an endotrachial tube through the tongue blade of the Boyle-Davis Gag during paediatric adenotonsillectomy

Massive lingual swelling following cleft palate repair

We report two cases of massive tongue edema in routine palatoplasty. All patients had uneventful recovery. We postulated that the macroglossia was secondary to ischemia and venous congestion after prolonged use of Killner Dott mouth gag with slotted tongue blade exaggerated by hyperextension of neck and Trendelenberg position.

How to optimize laryngeal and hypopharyngeal exposure in transoral robotic surgery

The aim of this study was to present the various strategies adopted in our center to improve and overcome problems with exposure of the operative field in 48 patients who underwent TORS for the treatment of laryngeal and hypopharyngeal cancer. We present our operative and preoperative treatment protocols for patients undergoing TORS for laryngeal and hypopharyngeal cancer. In particular, we emphasize the role of preoperative exposure assessment and the usefulness of simple measures to overcome problems with exposure of the operative field. In 12 patients (25%), we experienced difficult laryngeal-hypopharyngeal exposure. However the correct positioning of the robotic arms, the proper use of the laryngeal and tongue blade and some simple maneuvers, such as the anterior traction of the tongue and the partial epiglottectomy, ensured the feasibility of TORS with negative margins in all patients. In TORS, the exposure of larynx and hypopharynx can be difficult, but the adoption of certain methods may make it possible in most patients. An accurate preoperative evaluation under general anesthesia is the primary strategy for reducing the number of cases terminated intraoperatively. Currently, TORS is not feasible in all patients, but in our opinion, reductions in the size of robotic equipment and development of new devices will extend the application of TORS to a larger number of patients.

An imaging‐based approach to the evaluation of xerostomia

Goal was to evaluate the potential of in vivo optical coherence tomography (OCT) imaging to determine the response of patients with xerostomia to a dry mouth toothpaste versus fluoride toothpaste placebo. Ten subjects with xerostomia participated in this double-blind, crossover, placebo-controlled study. After examination and OCT imaging, subjects used the first product for 15 days, followed by a 7-day washout period, and then they used the second product for 15 days. Data were acquired at 5-day intervals, also before and after the washout. Visual examination and tongue blade adhesion test did not reflect response to the product. Two imaging-based markers were identified: (i) In OCT images, epithelial thickness increased significantly (P < 0.05) after use of the dry mouth toothpaste, but did not change significantly (P > 0.05) after the use of a fluoride toothpaste and (2) Optical backscattering data showed progressive characteristic changes from baseline with use of the active product. In this pilot study using in vivo OCT imaging, it was possible to detect and measure oral epithelial response to the dry mouth product versus placebo in patients with xerostomia. This approach may permit site-specific assessment of xerostomia, individualized treatment planning and monitoring, and sequential mucosal mapping in patients with dry mouth.