trismus

  • 文章类型: Journal Article
    背景:口腔粘膜下纤维化,OSF是世界槟榔咀嚼带中普遍存在的炎性粘膜病症。尽管有各种治疗方法可用于其管理,没有提供完整的解决方案。姜黄素,一种本土产品,改善灼烧感,张口以及OSF的其他临床症状,是治疗OSF的潜在可行治疗选择。
    目的:评估使用姜黄素改善OSF患者症状的现有证据。
    方法:从2010年1月至2023年7月在电子数据库中进行了系统搜索,以确定将姜黄素与活性和/或非活性对照(安慰剂)进行比较以管理OSF的相关临床试验。
    结果:共20项研究用于定性分析,其中11项研究用于定量合成。发现姜黄素在缓解疼痛/烧灼感方面非常有效,改善张口(MO),脸颊的灵活性,OSF患者的舌头突出并诱导阳性组织学变化。姜黄素组和多种维生素组之间张口的标准化平均差异显示出有利于姜黄素组的统计学显着差异(SMD,0.37,95%CI=0.18-0.56,p-0.0001,I2-0%)。
    结论:统计表明姜黄素与芦荟一样有效,番茄红素和类固醇在缓解1和2期OSF症状和改善MO中的作用。可以改善病变的组织病理学特征,从而表明其在预防恶性转化中的积极作用。发现它在改善OSF患者的张口方面比多种维生素更有效。
    BACKGROUND: Oral Submucous Fibrosis, OSF is an inflammatory mucosal disorder prevalent in areca nut chewing belts of the world. Although various treatments are available for its management, none provide complete resolution.Curcumin, an indigenous product, improves burning sensation, mouth opening along with other clinical signs of OSF and is potentially viable therapeutic option for its management.
    OBJECTIVE: To assess the available evidence for employing curcumin in improving symptoms in patients with OSF.
    METHODS: Systematic search was carried out in e-databases from January 2010 until July 2023 to identify relevant clinical trials comparing curcumin to active and/or nonactive controls (placebo) for the management of OSF.
    RESULTS: A total of 20 studies were used for qualitative analysis out of which 11 studies were considered for quantitative synthesis.Curcumin was found to be highly effective in alleviating pain/burning sensation, improving mouth opening (MO), cheek flexibility, tongue protrusion and induces positive histological changes in patients with OSF.The standardized mean difference in mouth opening between both the Curcumin and Multivitamin group showed a statistically significant difference favouring the Curcumin group (SMD, 0.37, 95% CI = 0.18-0.56, p - 0.0001, I2- 0%).
    CONCLUSIONS: Statistically curcumin was noted to be as effective as Aloe vera, lycopene and steroids in relieving symptoms of OSF in stages 1 and 2 and improving MO. It is seen to improve histopathological picture of lesions thereby suggesting its active role in preventing malignant transformation. Its found to be more effective than multivitamins in improving mouth opening of patients in OSF.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    病理诊断在口咽恶性肿瘤患者的风险分级和个性化治疗计划中起着重要作用。然而,在涉及三体和粘膜下扩散的肿瘤的病例中出现挑战,阻碍传统的内镜活检和开腹活检。在这项研究中,我们检查了对口咽部肿瘤进行经口超声引导下穿刺活检(USCB)的三联肌患者的临床和病理资料,将这种方法与现有的诊断方法进行比较。17例表现为口咽部肿瘤和三联肌的患者接受了经口USCB诊断。其中,14例患者被诊断为鳞状细胞癌,其余3人被诊断为淋巴瘤。该程序导致最小的伤口大小和有效的出血控制通过压缩,没有遇到任何并发症。总之,经口USCB作为一种精确的诊断工具,用于口咽肿瘤和三联体患者,为传统的开放式和内窥镜活检提供了有价值的辅助手段。
    Pathological diagnosis plays a pivotal role in risk classification and personalized treatment planning for patients with oropharyngeal cancers. However, challenges arise in cases involving trismus and tumors with submucosal spread, hindering traditional endoscopic biopsies and open incisional biopsies. In this study, we examined the clinical and pathological data of patients with trismus who underwent transoral ultrasound-guided core biopsy (USCB) for their oropharyngeal tumors, comparing this method with existing diagnostic approaches. Seventeen patients presenting with oropharyngeal tumors and trismus underwent transoral USCB for diagnosis. Of these, 14 patients were diagnosed with squamous cell carcinoma, while the remaining 3 were diagnosed with lymphoma. The procedure resulted in minimal wound size and effective bleeding control through compression, without encountering any complications. In conclusion, transoral USCB emerges as a precise diagnostic tool for patients with oropharyngeal tumors and trismus, offering a valuable adjunct to conventional open and endoscopic biopsies.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Case Reports
    一名30多岁的妇女有12个月的张口减少和下颌骨右侧肿胀的病史。触诊时肿胀不嫩且坚硬。拔除龋齿后,肿胀开始增加。组织病理学和血清学检查证实了IgG4相关疾病的诊断,表现为下颌骨中的肿块。患者在8周内以逐渐减少的剂量口服皮质类固醇。三个月后,患者的张口改善,肿胀的大小减少。患者仍在后续护理中。将IgG4相关疾病纳入口腔软组织肿块的潜在诊断列表是至关重要的,鉴于他们对医疗的积极反应,强调准确诊断以防止不必要的手术的重要性,口腔病变可能在多器官并发症出现之前作为早期指标。
    A woman in her 30s presented with a 12-month history of reduced mouth opening and swelling on the right side of her mandible. The swelling was non-tender and firm on palpation. The swelling began to increase in size after the extraction of her carious wisdom tooth. Histopathological and serological examinations confirmed the diagnosis of IgG4-related disease, manifested as a mass in the mandible. The patient was prescribed oral corticosteroids at a tapering dosage over 8 weeks. After 3 months, there was an improvement in the patient\'s mouth opening and a reduction in the size of the swelling. The patient remains in follow-up care. Including IgG4-related disease in the list of potential diagnoses for oral soft tissue masses is crucial, given their positive response to medical treatment, highlighting the significance of an accurate diagnosis to prevent unnecessary surgery, with oral lesions potentially serving as early indicators before multiorgan complications arise.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    目的:本研究旨在比较基于社会认知理论的移动健康干预与标准护理对最大张口的影响。行使合规性,接受质子和重离子治疗的头颈部癌症患者的自我效能。
    方法:这个开放标签,平行组,随机化,优势试验涉及自行开发的“健康享受系统”干预措施。我们评估了最大张口,行使合规性,和基线自我效能感(T0),治疗后(T1),放疗后1个月(T2)和3个月(T3)。广义估计方程用于分析各组之间随时间的差异,结果报告为P值和95%置信区间(CI)。
    结果:该研究包括44名参与者。在T3时,干预组比对照组的最大切缝开口增加了6mm(平均差异=6.0,95%CI=2.4至9.5,P=0.001)。两组之间的运动依从性也存在显着差异(平均差异=31.7,95%CI=4.6至58.8,P=0.022)。然而,两组的自我效能感没有显著差异.
    结论:这项研究表明,在中国接受质子和重离子治疗的头颈癌患者中,结合行为改变理论的mHealth干预措施可以有效增强或维持最大张口。这种方法在治疗期间和治疗后提供了有价值的支持。
    背景:ChiCTR:ChiCTR2300067550。注册于2023年1月11日。
    OBJECTIVE: This study aimed to compare the effects of a mobile health intervention based on social cognitive theory with standard care on maximal mouth opening, exercise compliance, and self-efficacy in patients receiving proton and heavy ion therapy for head and neck cancer.
    METHODS: This open-label, parallel-group, randomized, superiority trial involved a self-developed \"Health Enjoy System\" intervention. We assessed maximal mouth opening, exercise compliance, and self-efficacy at baseline (T0), post-treatment (T1), and at 1 month (T2) and 3 months (T3) after radiotherapy. Generalized estimating equations were used to analyze differences between the groups over time, with results reported as P values and 95% confidence intervals (CIs).
    RESULTS: The study included 44 participants. At T3, the intervention group showed a 6 mm greater increase in maximal interincisal opening than the control group (mean difference = 6.0, 95% CI = 2.4 to 9.5, P = 0.001). There was also a significant difference in exercise compliance between the groups (mean difference = 31.7, 95% CI = 4.6 to 58.8, P = 0.022). However, no significant difference in self-efficacy was found between the groups.
    CONCLUSIONS: This study demonstrated that an mHealth intervention incorporating behavior change theory could effectively enhance or maintain maximal mouth opening in patients undergoing proton and heavy ion therapy for head and neck cancer in China. This approach provides valuable support during and after treatment.
    BACKGROUND: ChiCTR: ChiCTR2300067550. Registered 11 Jan 2023.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    临床医生应考虑咀嚼肌疾病,包括翼状外侧肌,作为拔牙后出现吞咽困难和三联肌的鉴别诊断。
    Clinicians should consider disorders of masticatory muscle including lateral pterygoid muscle as a differential diagnosis in patients presenting with dysphagia and trismus after tooth extraction.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Case Reports
    背景:艾萨克综合征,也称为神经肌强直或周围神经过度兴奋,是一种影响周围神经系统的罕见疾病。临床发现包括抽筋,束感,和Myokymia;然而,很少有关于牙关治疗的报道。
    方法:一名因Isaacs\'综合征而出现了三联肌的患者,其右下第一磨牙周围的牙龈出现肿胀和疼痛。他在家附近的一名牙医诊断出患有慢性根尖周炎。然而,患者被告知,由于存在艾萨克综合征,无法进行牙科治疗和药物治疗,两周后,他访问了九州大学医院的老年牙科和围手术期口腔护理中心。当时患者的无痛张口距离(门牙之间)为20毫米,和药物,包括阿莫西林胶囊和对乙酰氨基酚,因为拔牙钳或牙髓器械很难插入口腔进行治疗。在他初次访问两个月后,病人来看望我们,抱怨同一区域疼痛。然而,他最近在神经科接受了血浆置换治疗,以缓解张口受限和全身肌痛,导致无痛的张口距离约为35毫米。在这个临时时期,他没有张嘴的限制,我们在下颌右第一磨牙上进行了拔牙和牙桥修复,并创建了一种用于睡眠磨牙症的口腔矫治器。
    结论:血浆置换疗法可短暂减少三联肌,使牙科干预可行,虽然是暂时的。本病例报告强调了神经学家和遇到类似病例的牙医之间密切合作的重要性,同时提供有价值的见解以告知牙科治疗计划。
    BACKGROUND: Isaacs\' syndrome, also known as neuromyotonia or peripheral nerve hyperexcitability, is a rare disorder that affects the peripheral nervous system. Clinical findings include cramps, fasciculations, and myokymia; however, there are few reports of dental treatment for trismus.
    METHODS: A patient with trismus due to Isaacs\' syndrome experienced swelling and pain in the gingiva surrounding his right lower first molar. He was diagnosed with chronic apical periodontitis by a dentist near his home. However, the patient was informed that dental treatment and medication could not be administered because of the presence of Isaacs\' syndrome, and he visited the Geriatric Dentistry and Perioperative Oral Care Center at Kyushu University Hospital 2 weeks later. The patient\'s painless mouth-opening distance (between incisors) was 20 mm at that time, and medication, including amoxicillin capsules and acetaminophen, was administered because the dental extraction forceps or endodontic instruments were difficult to insert into the oral cavity for treatment. Two months after his initial visit, the patient visited us complaining of pain in the same area. However, he had recently undergone plasmapheresis treatment in neurology to alleviate limited mouth opening and systemic myalgia, resulting in a pain-free mouth-opening distance of approximately 35 mm. During this temporary period in which he had no restriction in mouth opening, we performed tooth extraction and bridge restoration on the mandibular right first molar and created an oral appliance for sleep bruxism.
    CONCLUSIONS: Plasmapheresis therapy transiently reduced trismus, rendering dental interventions feasible, albeit temporarily. This case report underscores the importance of close collaboration between neurologists and dentists who encounter similar cases while furnishing valuable insights to inform dental treatment planning.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    了解接受头颈部辐射的患者的预防性吞咽和三联肌锻炼的障碍和促进因素可能有助于锻炼依从性。该分析审查了所有已发布的运动依从性报告,并根据PRISMA指南进行了严格评估。共确定了137篇潜在论文;20项研究符合纳入标准。最常报道的吞咽和牙关练习的促进者是定期的临床医生联系和在线资源,以加强指导,设定目标,管理辐射毒性。据报道,社会支持和锻炼带来的好处也有所帮助。运动最常见的障碍是辐射毒性,焦虑,感觉被信息淹没了,不理解练习的原因。在为接受头颈部癌症放射治疗的患者设计运动干预措施时,了解促进者和依从性障碍至关重要。
    Understanding the barriers and facilitators for prophylactic swallowing and trismus exercises for patients undergoing radiation to the head and neck may help exercise adherence. The analysis reviews all published reports of exercise adherence with a critical appraisal following PRISMA guidelines. A total of 137 potential papers were identified; 20 studies met the inclusion criteria. The most commonly reported facilitators for swallowing and trismus exercises were regular clinician contact and online resources to reinforce instructions, set goals, and manage radiation toxicities. Social support and perceived benefit from exercises were also reported to be of help. The most common barriers to exercise were radiation toxicities, anxiety, feeling overwhelmed with information, and not understanding the reason for the exercises. Understanding facilitators and barriers to adherence is critical when designing exercise interventions for patients undergoing radiation for head and neck cancer.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Case Reports
    一名73岁的男子表现为亚急性三端和小脑功能障碍。脑影像学和血常规检查结果无明显变化。胸部计算机断层扫描显示右上肺的肺肿块不明显增强4.7×2.5×1.8-cm3,右气管旁和肺门淋巴结肿大。右锁骨上淋巴结活检证实转移癌,小细胞癌和低分化癌的鉴别诊断,表明肺癌是主要来源。副肿瘤免疫组织化学筛选显示血清中抗Hu抗体的滴度为1:7680(正常范围<1:240),脑脊液(CSF)中抗Hu抗体的滴度为1:256(正常范围<1:2)。线印迹方法对血清中的抗Zic4抗体产生阳性结果,效价>1:10(正常范围<1:10),而CSF抗Zic4为阴性(正常范围<1:2)。患者出现无反应性医院获得性肺炎和呼吸衰竭,并不顾医嘱自行出院.这种罕见的病例表明,三聚体可能是抗Hu副肿瘤神经综合征的初始表现,强调临床意识的重要性。
    A 73-year-old man presented with subacute trismus and pancerebellar dysfunction. Brain imaging and routine blood test results were unremarkable. Chest computed tomography revealed an indistinctly enhancing 4.7 × 2.5 × 1.8-cm3 pulmonary mass in the right upper lung, with enlarged right paratracheal and hilar lymph nodes. Biopsy of the right supraclavicular lymph node confirmed metastatic carcinoma, with differential diagnoses of small cell carcinoma and poorly differentiated carcinoma, indicating lung cancer as the primary source. Paraneoplastic immunohistochemistry screening revealed anti-Hu antibodies in the serum at a titer of 1:7680 (normal range <1:240) and in the cerebrospinal fluid (CSF) at a titer of 1:256 (normal range <1:2). The line blot method yielded positive results for anti-Zic4 antibodies in serum, with a titer of >1:10 (normal range <1:10), whereas CSF anti-Zic4 was negative (normal range <1:2). The patient developed non-responsive hospital-acquired pneumonia and respiratory failure, and discharged himself against medical advice. This rare case indicates that trismus can be an initial manifestation of anti-Hu paraneoplastic neurological syndrome, and emphasizes the importance of clinical awareness.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    长期牙科手术后出现张口受限和下颌骨偏转病史的患者,由于估计其患病率高29%,因此怀疑颞下颌关节紊乱病(TMD)。肌肉松弛剂和常规的积极物理治疗建立了正常的运动范围,并且通过TENS疗法和镇痛药可以减轻疼痛。然而,偏转的非沉降引发了最初对TMD的怀疑,该怀疑被MRI推翻.MRI评估显示左侧内侧翼状脓肿。必须理解,尽管有很强的病史和相关的临床特征,对于明确的诊断,影像学评估具有很高的贡献。TMD由于其相似的表现而误诊可能对患者的健康和生活质量有重大影响。内侧翼状脓肿的临床特征,包括张口受限和疼痛,与TMD相似。这些脓肿最常见的原因是牙源性感染,但也可能是败血症下牙槽神经阻滞技术的结果。翼状体间隙脓肿的文献报道有限,但是肌内和内侧翼状脓肿是绝对罕见的。与败血症下牙槽神经阻滞的因果关系进一步使该病例报告成为有趣的阅读。
    A patient presenting with a history of restricted mouth opening and deflection of the mandible after a prolonged dental procedure raises a suspicion of temporomandibular joint disorder (TMD) due to its estimated high prevalence of 29%. Muscle relaxants and routine active physiotherapy established normal range of movement and pain reduction was achieved through TENS therapy and analgesics. However, the non-subsidence of deflection prompted an initial suspicion of TMD which was overturned by MRI. The MRI evaluation revealed left side medial pterygoid abscess. It is imperative to understand that despite strong history and relevant clinical features, for the definitive diagnosis radiographic evaluation is highly contributory. Misdiagnosing TMD due to its similar presentation can have significant implications for the patient\'s well-being and quality of life. The clinical features of medial pterygoid abscess including restricted mouth opening and pain can be similar to that of TMD. These abscesses are most commonly caused by odontogenic infections but can also occur as a result of septic inferior alveolar nerve block techniques. Limited literature reports of pterygoid space abscess have been described, but intramuscular and medial pterygoid abscess is an absolute rarity. Causal relationship to septic inferior alveolar nerve block further makes this case report an interesting read.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    喉部填塞在口腔颌面手术中是必不可少的,以防止血液和组织碎片吸入。减少术后并发症。传统的口服途径方法往往不足,特别是在口腔粘膜下纤维化(OSMF)等严重的三聚体病例中,TMJ强直,和创伤后的条件,由于有限的张口。这项研究介绍了一种使用鼻咽气道(NPA)进行咽喉包装的新技术。该方法包括通过NPA插入止血敷料,确保最小的侵入性和有效的气道管理。用喉镜或纤维镜确认正确的定位,并且敷料被固定以防止移位。这项技术很简单,可重复,与传统方法相比,伤害更小。在我们的中心,通过NPA对35例全身麻醉下手术的患者进行咽喉填塞,结果满意度高,无并发症报告。
    Throat packing is essential in oral and maxillofacial surgeries to prevent blood and tissue debris aspiration, reducing postoperative complications. Traditional oral route methods are often inadequate, especially in severe trismus cases like Oral Submucous Fibrosis (OSMF), TMJ Ankylosis, and post-traumatic conditions due to limited mouth opening. This study introduces a novel technique using a nasopharyngeal airway (NPA) for throat packing. The method involves inserting a hemostatic dressing through an NPA, ensuring minimal invasiveness and effective airway management. Proper positioning is confirmed with a laryngoscope or fiberoptic scope, and the dressing is secured to prevent dislodgement. This technique is easy, reproducible, and less injurious compared to traditional methods. At our center, throat packing via NPA was performed on 35 patients undergoing surgery under general anesthesia, resulting in high satisfaction and no reported complications.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

公众号