Mark T. Marunick

Factors predictive of severity of osteoradionecrosis of the mandible

An analysis of risk factors predictive of severe mandibular osteoradionecrosis (ORN) is needed to aid prophylaxis and management of this condition.

Mastication in patients treated for head and neck cancer: A pilot study

Patients with head and neck cancer will experience alteration of oral anatomy and physiology caused by the disease and the treatment required. Despite the implied effects on the dynamics of mastication, objective studies have not been conducted to evaluate masticatory function of these patients. Masticatory performance and swallowing threshold performance were evaluated with Frito corn chips as the test substance. Edentulous patients treated for cancer demonstrated deficiencies in both tests. Masticatory performance and swallowing threshold performance improved with prosthodontic rehabilitation but this improvement was less than with comparable controls. Techniques to evaluate masticatory factors such as dentition, dentures, biting force, temporomandibular joint status, range of motion, and saliva are suggested.

Occlusal force after partial mandibular resection

Surgical resection of a segment or loss of mandibular continuity can adversely affect most of the structures essential for maximum occlusal force. Five subjects who had partial mandibular resections for treatment of squamous cell carcinoma were studied. Occlusal force was recorded before and after cancer treatment and following prosthetic rehabilitation. A gnathodynamometer was used to record anterior occlusal force. Five edentulous and five dentate cancer-free subjects matched for age were studied to establish comparable normative data. The null hypothesis that partial mandibular resection would not affect maximum occlusal force was rejected (p = 0.0101). Mandibular resection did alter maximum occlusal force. The impact of the decrease in maximum occlusal force on masticatory function is yet to be determined.

The effect of surgical intervention for head and neck cancer on whole salivary flow: A pilot study

For many patients, rehabilitation and quality of life after treatment of head and neck cancer are issues that confront both them and their physicians. Various levels of xerostomia are often reported as one of the side effects of treatment. This study evaluated the effects of surgical intervention (alone) that involve major salivary glands on whole salivary flow. Five subjects with head and neck cancer who lost a submandibular gland at surgery were evaluated before and after treatment to determine resting and stimulated whole salivary flow rates. Three subjects demonstrated a decrease in resting and three a decrease in stimulated flow rates compared with pretreatment levels. Two subjects rebounded to near or above presurgery flow rates. Although a trend was identified for a decrease in resting and stimulated flow rates, the sample size was too small to statistically validate this trend. The decreases in flow rates recorded at the last test were of insufficient magnitude to elicit a complaint of xerostomia.

Maxillary dental arch form related to voice classification: A pilot study

This pilot study evaluated maxillary dental arch form dimensions and volume to determine if these parameters could be predictors for or related to voice classification. Nine white female professional singers ranging in age from 26 years to 53 years were studied. A maxillary dental impression and stone dental casts were made using standard dental procedures. Measurements were made from 10 points on each cast to determine the depth of the palate measured from first molar (depth A) and from first bicuspid (depth B), the width measured from cuspid-to-cuspid (width A) and from second molar to second molar (width B), and the length of the palate. An impression of the palatal arch of each cast was made to determine the volume of the palate using fluid displacement methods. Audio recordings were made for each subject, and based on speaking fundamental frequency, spectral analysis, voice profile, and tessitura confirmation, the actual voice classification of each subject in soprano, mezzo, and alto was achieved. Correlation and discriminant analysis tests were performed on the data. The discriminant analysis revealed that no single measurement is a predictor for voice classification. However, the discriminant analysis applied to the predictors depth A, depth B, and volume gives optimal results, ie, each subject was classified in her true group.

Rehabilitation of Patients with Extended Facial and Craniofacial Resection

Surgery of benign and malignant disease of the nose and sinuses can result in disfigurement and disability. Many patients have speech, mastication, and swallowing problems, anosmia, and pain. If the orbit is retained, visual loss, dystopia, diplopia, and epiphora can occur.

Timing of edentulation and extraction in the management of oral cavity and oropharyngeal malignancies

Pretreatment dental evaluation is an essential element in the management of the head and neck cancer patient. Frequently, the dental condition requires edentulation or multiple extractions prior to radiotherapy. These extractions may be carried out at the time of oncologic resection. Such practice is routine for some surgeons but resisted by others who fear increased postoperative wound complications. To date, no study evaluating the safety and efficacy of extractions at the time of surgical resection has been reported. This paper retrospectively examines the postoperative course of head and neck cancer patients with varying strategies of dental management.

Osteoradionecrosis related to mastication and parafunction.

This article discusses mastication and parafunctional habits as possible etiologic factors in the development of osteoradionecrosis. From the three case reports presented it was noted that bone necrosis can occur after extended periods after radiation therapy, is seen most frequently in the mandible, and occurs most often at dosage levels exceeding 6500 rad. Recommendations after treatment to patients receiving 6500 rad or more should include caution regarding consistency of diet, use of existing prostheses, and the potential harmful effects of parafunctional habits.

Prosthodontic treatment considerations for patients with oral sinonasal mucosal malignant melanoma: A clinical report

Patients with a diagnosis of mucosal malignant melanoma involving the maxilla or paranasal sinuses requiring surgery are referred to the maxillofacial prosthodontist for treatment. The standard protocol of surgical, interim, and definitive obturator treatment is usually anticipated. Depending upon the stage and presence or absence of metastasis, it is generally accepted that the prognosis for cure of this disease is poor. This clinical report reviews the current literature regarding treatment and the overall guarded prognosis for this disease, and reports the prosthodontic treatment intervention for 8 patients. Prosthodontic treatment strategies are recommended that are consistent with the reality of the diagnosis to achieve optimal function and quality of life for these patients.

Mandibular pathological fracture during treatment with a dynamic mouth opening device: A clinical report

Trismus is a well-known complication of head and neck cancer treatment. It is defined as a progressive tonic contraction of the muscles of mastication that results in decreased mouth opening. This condition can lead to impairment of speech and eating, malnutrition, poor oral hygiene, and difficulty with dental treatment. Its prevalence in patients with head and neck cancer ranges from 5% to 38%. Different treatments are available to improve muscle length and function. Mouth opening devices along with exercising of the mandible immediately after surgery and/or radiation therapy have been found to be effective in reducing the trismus induced by cancer therapy. Presently, only limited defined guidelines are available for initiating or monitoring trismus therapy in this patient population. This clinical report presents a patient with head and neck cancer and a history of progressive recurrent trismus as a sequela of extensive surgery and chemoradiation, who experienced a pathological fracture of the mandible during treatment with a mouth opening device.