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Introduction: Treatment for oral cancer can impair oral functions such as mastication, which may negatively affect quality of life (QoL). In this review, an overview is provided of masticatory ability in patients treated for oral cancer., Methods: The PubMed (MEDLINE), Embase and Cochrane databases were systematically searched for scientific literature on masticatory ability in relation to QoL in patients treated for oral cancer. Studies were included when oral cancer treatment was provided, and the University of Washington Quality of Life (UW-QoL) questionnaire was used. Risk of bias (MINORS) was independently assessed by two authors., Results: The PubMed (MEDLINE), Embase and Cochrane search yielded 575 unique records of which 111 were assessed full text, and 27 studies were included. The UW-QoL mastication scores ranged from 31.9 to 97.4. There was a wide variety in methodology, patient groups, tumour site, treatment and assessment moment, to such a degree that outcome scores are difficult to compare., Conclusion: The wide variety in studies exploring health-related QoL in relation to mastication in oral cancer patients prevents the identification of possible relations between treatment, masticatory ability and QoL. Our findings underline the limitations in currently available literature and indicate the necessity for more comparable research., (© 2022 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.)

Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5-17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To research the difference in shoulder morbidity and health-related quality of life between patients with cT 1-2 N0 oral cavity squamous cell carcinoma that undergo either elective neck dissection (END) or a sentinel lymph node biopsy (SLNB) based approach of the neck., Materials and Methods: A longitudinal study with measurements before surgery, 6 weeks, 6 months, and 12 months after surgery. Shoulder morbidity were determined with measurements of active range of motion of the shoulder and patient-reported outcomes for shoulder morbidity (SDQ, SPADI) and health-related quality of life (HR-QoL) (EQ5D, EORTC-QLQ-HN35). Linear mixed model analyses were used to analyze differences over time between patients that had END, SLNB or SLNB followed by complementing neck dissection., Results: We included 69 patients. Thirty-three patients were treated with END. Twenty-seven patients had SLNB without complementing neck dissection (SLNB), and nine were diagnosed lymph node positive followed by completion neck dissection (SLNB + ND). Ipsilateral shoulder abduction (P = .031) and forward flexion (P = .039) were significantly better for the SLNB group at 6 weeks post-intervention compared to the END and SLNB + ND group. No significant differences for shoulder morbidity, or health-related quality of life were found at 6 weeks, 6 months, and 12 months between the three groups., Conclusion: With oncologic equivalence for the END and SLNB as strategies for the cN 0 neck already demonstrated, and the SLNB being more cost-effective, our demonstrated benefit in short-term shoulder function strengthens the choice for the SLNB as a preferred treatment strategy., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purposes: Being diagnosed with oral cancer is a life-threatening life event. It often induces social, emotional and psychological consequences and may cause depressive disorders. The primary aim of this study was to identify and quantify the personal and clinical characteristics involved in depression for patients who have been treated for oral cavity malignancies, with a 5-year follow-up period after treatment. The secondary aim of this study was to identify the clinical factors that increase a patient's risk of experiencing depression 5 years after treatment., Methods: Patients with primary oral cancer were assessed for up to 5 years after primary treatment. A mixed-model analysis was performed, with depression measured by the Center for Epidemiologic Studies Depression Scale as outcome measure., Results: A total of 141 patients were included in the study. Factors associated with depression were gender, tumour location and having an emotion-oriented coping style. The occurrence of depression within 5 years after treatment could be reliably predicted by a patient's gender, the location of their tumour and the extent to which they had an emotion-oriented coping style., Conclusions: This study revealed that being female, having a maxillary tumour and having an emotion-oriented coping style are associated with higher levels of depressive symptoms in patients treated for oral cancer up to 5 years post-treatment. A substantial proportion of the patients with oral cancer experienced high levels of depression both before and after their treatment, suggesting that adequate diagnostics and care are needed to try to prevent severe depression in these patients.

Purpose: The purpose of this study was to observe the impact of oral oncological treatment, including the recovery of several tongue functions (force, mobility, and sensory functions), and to determine the influence of these functions on masticatory performance., Materials and Methods: Masticatory performance and tongue force, mobility, and sensory functions were determined in 123 patients with oral cavity cancer. The assessments were performed 4 weeks before treatment and 4 to 6 weeks, 6 months, 1 year, and 5 years after treatment. Generalized estimation equations and mixed model analyses were performed, correcting for previously identified factors in the same population., Results: A significant deterioration in tongue mobility and sensory function was observed in patients with mandible and tongue and/or floor-of-mouth tumors. Better tongue force and sensory function (thermal and tactile) positively influenced masticatory performance, and this effect was stronger where fewer occlusal units were present. The effect of both the tongue force and maximum bite force was weaker in dentate patients in comparison with patients with full dentures. A web-based application was developed to enable readers to explore our results and provide insight into the coherence between the found factors in the mixed model., Conclusions: Tongue function deteriorates after oral oncological treatment, without statistically significant recovery. Adequate bite and tongue forces are especially important for patients with a poor prosthetic state. Patients with sensory tongue function deficits especially benefit from the presence of more occluding pairs.

Introduction: Mastication has been assessed in several ways in the past. Both patients reported and objective assessment methods have been developed. The University Medical Center (UMC) Utrecht has developed a mixing ability test (MAT) using a two-coloured wax tablet. The present study investigates the association between the mixing ability test and a chewing related questionnaire in patients treated for oral malignancies., Patients and Methods: In a cohort study, patients treated for oral malignancies were assessed 4-6 weeks before and 4-6 weeks after treatment, as well as 6 months, 1 year and 5 years after treatment. The mixing ability test was assessed using 10 and 20 chewing strokes and was compared to seven questions about several aspects of mastication. Regression analysis was performed and density plots were drawn for statistical analysis., Results: One hundred and twenty-three patients were included in this study. The questionnaire was less predictive for the 10-chewing stroke test and the test was less discriminatory for different food types than the 20-chewing stroke mixing ability test. Three questions about the ability to chew solid, soft and thickened liquid food types were found to be significantly predictive for the 20-chewing stroke test. Threshold values on the mixing ability index were around 20 for the ability to chew solid food types and 24 for soft food types., Conclusion: The 10-chewing stroke mixing ability test is less suitable than 20-chewing strokes for patients with and treated for oral cancer. The 20-chewing stroke mixing ability test has a fair association with self-reported outcomes., (© 2018 The Authors. Journal of Oral Rehabilitation Published by John Wiley & Sons Ltd.)

Background: Chewing ability is often compromised in patients with oral cancer. The aim of this study was to identify which factors affect masticatory performance in these patients., Methods: Patients with primary oral cancer were assessed for up to 5 years after primary treatment. Healthy controls were assessed once. A mixed-model analysis was performed, with masticatory performance as outcome measure., Results: A total of 123 patients were included in the study. Factors positively associated with masticatory performance were number of occlusal units (OU), having functional dentures, and maximum mouth opening (MMO). The impact of tumor location and maximum bite force (MBF) differed per assessment moment. Masticatory performance declined for up to 1 year but recovered at 5 years after treatment., Conclusion: Masticatory performance in patients treated for oral cancer is affected by MBF, MMO, number of OU, and dental status. These should be the focus of posttreatment therapy., (© 2018 The Authors. Head & Neck published by Wiley Periodicals, Inc.)

Objectives: The aim of this study was to compare costs and clinical outcomes of two protocols for implant placement in edentulous oral cancer patients: implant placement during ablative surgery and postponed implant placement., Material and Methods: All edentulous patients who underwent curative tumor surgery between 2007 and 2009 at the Radboud university medical center (Radboudumc) and UMC Utrecht, both in the Netherlands, were included retrospectively. At the Radboudumc, 79 of 98 patients received implants during ablative surgery. At the UMC Utrecht, 18 of 95 patients received implants after a disease-free period of at least 6 months, because satisfying conventional dentures could not be made. Costs, implant details and clinical outcomes were recorded retrospectively up to 5 years after tumor surgery., Results: Individual costs of implant placement were lower in the during-ablative-surgery protocol (€2235 vs. €4152), while implant failure and loading were comparable to the postponed-placement protocol. In the during-ablative-surgery protocol, more patients received implant-retained overdentures (62% vs. 17%) and more patients had functioning dentures (65% vs. 47%), which were placed at an earlier stage (291 vs. 389 days after surgery). Overall costs of the during-ablative-surgery protocol were higher, as more patients received implants and functioning implant-retained dentures, which were more expensive than conventional dentures., Conclusions: Placing implants during ablative surgery lowered the individual costs of implant placement and led to more patients with functioning dentures, while implant failure and loading were comparable to postponed placement., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The timing of placement as well as the functional benefit of interforaminal implants in edentulous patients treated for oral cancer is unclear., Methods: Fifty-six patients were recruited at 2 institutions. In 1 institution, interforaminal implants were placed during ablative surgery, the other institution used conventional prosthodontics with optional placement of implants postsurgery (postponed-placement). Masticatory performance, bite force, and subjective masticatory function were assessed before and 6 months, 1 year, and 5 years after surgery., Results: Implant-retained overdentures (IODs) demonstrated the highest bite force and the least problems with solid food and food choice. Masticatory performance was equal for IODs and conventional dentures. After 5 years, IODs from patients in the during-ablative-surgery cohort tend to have higher bite force and masticatory performance than those from patients in the postponed-placement cohort., Conclusion: IODs produce the highest overall masticatory function. Implant placement during ablative surgery seems to be functionally beneficial. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2103-E2111, 2016., (© 2016 Wiley Periodicals, Inc.)

Background: Patients with oral cancer can develop restricted mouth opening (trismus) because of the oncologic treatment., Methods: Maximum mouth opening (MMO) was measured in 143 patients shortly before treatment and 0, 6, and 12 months posttreatment, and the results were analyzed using a linear mixed-effects model., Results: In every patient, MMO decreased after treatment. The patients who underwent surgery, recovered partially by 6 and 12 months after treatment, whereas the patients who received both surgery and radiotherapy or primary radiotherapy did not recover. Tumor location, tumor size, and alcohol consumption had independent effects on MMO. Having trismus (MMO <35 mm) 1 year after treatment was associated most strongly with pretreatment MMO, receiving both surgery and radiotherapy, and maxillary or mandibular tumor involvement., Conclusion: Postoperative radiotherapy and maxillary or mandibular tumor involvement are the highest contributing risk factors to decreasing MMO and the subsequent development of trismus after oral cancer treatment., (© 2014 Wiley Periodicals, Inc.)

Background: Neck and shoulder complaints can be a direct result of a neck dissection., Methods: Maximal active lateral flexion of the neck, forward flexion and abduction of the shoulder, and self-perceived function were determined in 145 patients treated for oral cancer., Results: No short-term influence of radiotherapy was found on measured range of motion and self-perceived neck and shoulder function (p > .05). One year after a bilateral neck dissection, patients showed deteriorated lateral flexion of the neck, whereas patients treated with a unilateral modified radical neck dissection still reported pain during neck movements. Maximal forward flexion of the shoulder recovered to the level of healthy controls, but maximal abduction was still reduced in all patients., Conclusions: Neck dissection, tumor site, and extensive reconstruction are related to deterioration of shoulder function shortly after intervention. Maximal active shoulder abduction was affected most., (Copyright © 2012 Wiley Periodicals, Inc.)

Progress in (reconstructive) surgery and radiotherapy tends to improve survival and reduce oral functional deficits. Despite the growing sophistication of cancer treatment, patients still report deterioration in tongue function. Sensory function, mobility, and force of the tongue were determined in 45 patients with a carcinoma of tongue and/or floor of mouth. Measurements were performed before surgery, shortly after surgery, shortly after radiotherapy, 6, and 12 months after surgery. Surgery had a negative impact on tongue sensory function and mobility. Post-surgery radiotherapy did not further deteriorate sensory function, mobility, or force of the tongue. Patients in the surgery-radiotherapy group (SRG) had significantly worse tongue sensory function and mobility than patients in the surgery group (SG), probably caused by more advanced tumour stage and more extensive reconstructions and related scar tissue. The tongue force in patients in both groups significantly increased in the first 6 months after surgery, but this increase disappeared in the next 6 months. The authors conclude that surgery had a significant negative influence on tongue function, especially in the group of patients treated with radiotherapy. No further deterioration of tongue function was observed after post-surgical radiotherapy within the first year after surgery., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)

Background: People confronted with oral cancer run a high risk of deteriorated masticatory performance. Reduced masticatory function may affect quality of life and food choice. An altered food choice may result in lower intakes for key nutrients and weight loss., Methods: Dental state, bite force, and masticatory performance were determined in a group of 45 patients with squamous cell carcinoma of the tongue and/or floor of mouth. Measurements were performed before surgery and at various moments after surgery and/or radiotherapy., Results: Surgical intervention had a large negative impact on oral function. Radiotherapy further worsened oral function. Also, the recovery of oral function 1 year after surgery was less prominent for the surgery-radiotherapy group than for the surgery group., Conclusion: Objective determination of oral function 1 year after surgery showed that patients treated for malignancies in the tongue and/or floor of mouth had significantly deteriorated masticatory performance, bite force, and dental state., (Copyright © 2010 Wiley Periodicals, Inc.)

Purpose: To assess self-perceived oral function of patients with oral cavity cancer at different stages of treatment, ie, before oncologic intervention, 5 weeks after intervention, and 5 years after intervention., Patients and Methods: A cohort of 158 patients with malignancy in the oral cavity treated by surgery in 1999 or 2000 was included. From this cohort we interviewed 69 patients by telephone in 2005 and collected data on dental status, disorders of chewing and swallowing, xerostomia, preference of food consistency, tube nutrition, weight loss, and speech for different stages of treatment., Results: For patients treated in the maxilla region we observed a significant (P < .05) recovery of perceived chewing ability after 5 years to the level experienced before oncologic intervention. Patients treated in the mandible region reported a deteriorated dental state, chewing ability, lip competence, and xerostomia after 5 years. Patients treated in the tongue and mouth-floor region experienced deterioration for dental state, chewing ability, and xerostomia after 5 years compared with the level before the oncologic intervention., Conclusions: Our telephone interview on oral function provided supplementary information on how patients experienced their problems with oral function during various phases of oncologic treatment. A retrospective interview may thus help to add information to incomplete retrospective data., (2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)