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Judith Divera de Rooij,1,2 Pravesh Shankar Gadjradj,3 Hans Aukes,4 George Groeneweg,1 Caroline Margina Speksnijder,5 Frank Johannes Huygen1 1Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 2Department of Orthopedics, Physiotherapy Unit, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 3Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA; 4Department of Anesthesiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands; 5Department of Oral and Maxillofacial Surgery, Utrecht Medical Center, Utrecht, the NetherlandsCorrespondence: Judith Divera de Rooij, Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Dr. Molenwaterplein 40, Rotterdam, 2040 CA, the Netherlands, Tel +31 (010) 704 01 40, Email j.derooij@erasmusmc.nlPurpose: Percutaneous cervical nucleoplasty (PCN) is a minimally invasive treatment for cervical radicular pain due to a disc herniation. Preliminary results show equivalent patient-reported outcomes of PCN as compared to conventional anterior cervical discectomy. However, there is a paucity of long-term outcome data. Therefore, the primary objective of this study is to investigate the long-term clinical results of PCN.Patients and Methods: A retrospective analysis was conducted on patients who underwent PCN at a secondary referral center between 2010 and 2014. Before surgery and five days after surgery, numeric rating scales (NRS) for arm pain and neck pain and data on complications were collected. To determine long-term follow-up outcomes, patients were sent a questionnaire booklet containing the Core Outcome Measures Index-Neck (COMI-Neck), NRS for arm pain and neck pain, Likert-scales on patient satisfaction and questions regarding the incidence of reoperations and complications.Results: The baseline characteristics were collected for 158 patients. At a median follow-up of 41.5 months (interquartile range (IQR) 27.0 to 57.5), data were available for 118 patients (74.7%). At short-term follow-up, patients that underwent PCN had a mean decrease of 3.0 on the NRS for arm pain (95% CI 2.5 to 3.6) compared to baseline, while at long-term follow-up, a mean decrease of 2.8 (95% CI 1.0 to 3.6) was observed. At the long-term follow-up, 67.8% of the patients were fully recovered from all symptoms and 93.3% remained satisfied with the PCN treatment results. The reoperation rate for recurrent disc herniation was 21.4% at long-term follow-up.Conclusion: PCN appears to be a safe and effective treatment at short-term and long-term follow-up of a specific selection of cervical herniated discs, with an acceptable long-term reoperation rate. These study results suggest a potential role of PCN as a less invasive treatment option for cervical radicular pain due to a soft disc herniation, before anterior cervical discectomy should be considered.Keywords: percutaneous cervical nucleoplasty, minimally invasive treatment, cervical radicular pain

Background: An integral component of comprehensive temporomandibular disorder (TMD) treatment involves what is commonly referred to in literature as patient counselling or patient education. Despite its importance, a clear definition of the concept is lacking., Objectives: To describe the concept of counselling (i.e. what is it, what should it consist of, and when should it be given) through a concept analysis of the literature., Eligibility Criteria: All papers that include a description of counselling or education for TMD are included., Sources of Evidence: Literature searches were performed in the electronic databases PubMed, Cinahl, and PsycInfo., Charting Methods: A qualitative analysis was done using the principle-based concept analysis approach, where descriptions of counselling from the included papers were analysed by the researchers., Results: A total of 71 articles were included. Based on the qualitative analysis of the included articles and descriptions of counselling, the following content themes were identified: (1) general information on TMD; (2) overuse of the masticatory system; (3) posture education; (4) lifestyle and psychosocial factors; (5) exercise- and thermotherapy; and (6) additional information and therapies., Conclusions: A definition and framework of counselling for TMD has been provided, which can be used in the clinic, research, and educational programs., (© 2024 The Author(s). Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Objectives: Diagnosing adenoid cystic carcinoma (AdCC) is challenging due to histopathological variability and similarities with other tumors. In AdCC pathogenesis, the cellular myeloblastosis gene (c-MYB) often exhibits a MYB::NFIB fusion from a reciprocal translocation. This study aimed to assess the predictive accuracy of MYB immunohistochemistry for detecting this translocation compared to fluorescence in situ hybridization (FISH)., Study Design: This study included 110 AdCC patients (1999-2017) from two Dutch head and neck centers using tissue microarrays and full slides. Median MYB expression levels by immunohistochemistry were compared based on translocation status by FISH, and differences within clinicopathological parameters were examined. An immunohistochemical cut-off was established to estimate the translocation., Results: MYB immunohistochemistry was available in 90/110 patients, with a median expression of 27%. FISH was interpretable in 79/108 tumors, identifying MYB::NFIB fusion in 44 (56%). Among 62 patients with both MYB expression and translocation data, the fusion was present in 38 (61%). These tumors had higher MYB expression (30%) than nontranslocated tumors (6%); P = .02. A 60% MYB expression cut-off yielded 100% specificity for detecting the translocation but had no prognostic value., Conclusions: Although MYB protein expression alone lacks diagnostic precision, protein expression >60% predicted the MYB::NFIB fusion in all tumors., Competing Interests: DECLARATIONS OF INTEREST None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The Sunnybrook Facial Grading System (SFGS) is a well-established grading system to assess the severity and progression of a unilateral facial palsy. The automation of the SFGS makes the SFGS more accessible for researchers, students, clinicians in training, or other untrained co-workers and could be implemented in an eHealth environment. This study investigated the impact on the reliability of the automated SFGS by adding a facial landmark layer in a previously developed convolutional neural network (CNN)., Methods: An existing dataset of 116 patients with a unilateral peripheral facial palsy and 9 healthy subjects performing the SFGS poses was used to train a CNN with a newly added facial landmark layer. A separate model was trained for each of the 13 elements of the SFGS and then used to calculate the SFGS subscores and composite score. The intra-class coefficient of the automated grading system was calculated based on three clinicians experienced in the grading of facial palsy., Results: The inter-rater reliability of the CNN with the additional facial landmarks increased in performance for all composite scores compared to the previous model. The intra-class coefficient for the composite SFGS score increased from 0.87 to 0.91, the resting symmetry subscore increased from 0.45 to 0.62, the symmetry of voluntary movement subscore increased from 0.89 to 0.92, and the synkinesis subscore increased from 0.75 to 0.78., Conclusion: The integration of a facial landmark layer into the CNN significantly improved the reliability of the automated SFGS, reaching a performance level comparable to human observers. These results were attained without increasing the dataset underscoring the impact of incorporating facial landmarks into a CNN. These findings indicate that the automated SFGS with facial landmarks is a reliable tool for assessing patients with a unilateral peripheral facial palsy and is applicable in an eHealth environment., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

In children with juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) can be involved. To prevent TMJ damage due to inflammation, early recognition is important, for which contrast-enhanced magnetic resonance imaging (MRI) is the gold standard. In this study, the interobserver reliability and construct validity of the Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ) was assessed. Two radiologists independently examined 38 MRIs using the JAMRIS-TMJ scoring system. Inter-observer reliability was assessed by Cohen's (weighted) kappa (κ), 95% confidence intervals (CIs) and absolute agreement (%). Construct validity was assessed by correlation between the JAMRIS-TMJ items and TMJ involvement, active maximum interincisal mouth opening (AMIO), and anterior maximum voluntary bite force (AMVBF). The interobserver reliability for the JAMRIS-TMJ items varied from poor to good (κ = 0.18-0.61). Joint enhancement had the highest reliability (κ = 0.61). Correlations were found between TMJ involvement, AMIO, and the JAMRIS-TMJ items, although variation between radiologists and TMJ side existed. No correlation was found between AMVBF and the JAMRIS-TMJ items for both radiologists. The strongest correlations were found between most of the JAMRIS-TMJ items and AMIO. Our findings support the utility of AMIO as a clinical measure of TMJ status in children with JIA., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Mandibular range of motion (MROM) variables are widely used to evaluate oral function., Objective: The aim of this study was to establish the reliability of MROM variables in healthy children., Methods: In this cross-sectional study, healthy children were examined 2 weeks apart. The following MROM variables were established: active maximum interincisal opening (AMIO), passive maximum interincisal opening (PMIO), protrusion and left and right laterotrusion. The reliability of the MROM measurements was determined by analysing the intra-class correlation coefficient (ICC), standard error of measurement (SEM), smallest detectable change (SDC) and limits of agreement (LoA)., Results: A total of 167 healthy children were examined. The ICC indicated good reliability for AMIO (0.885); excellent reliability for PMIO (0.925); and moderate reliability for protrusion (0.578), laterotrusion left (0.601) and laterotrusion right (0.634). The SDC was 0.9 mm for AMIO, 0.4 mm for PMIO, 2.2 mm for protrusion, 1.6 mm for laterotrusion left and 1.4 mm for laterotrusion right. The LoA was -5.67 to 5.82 for AMIO, -3.90 to 3.57 for PMIO, -3.89 to 3.55 for protrusion, -2.99 to 2.77 for laterotrusion left, and - 2.71 to 2.77 for laterotrusion right., Conclusions: AMIO and PMIO measurements are both highly reliable in healthy children. The low SDC indicate that AMIO and PMIO are promising longitudinal measurements. Protrusion and laterotrusion measurements had moderate reliability. These results support our clinical recommendation to measure AMIO rather than PMIO, as PMIO is more difficult and more time-consuming to perform than AMIO., (© 2024 The Author(s). Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment., Methods: This study was conducted over two stages (January 2022-July 2023). The first phase involved a survey to MASCC-MSG members (January 2022-May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023-May 2023). Consensus was defined as agreement on a parameter by >80% of respondents., Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus)., Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice., Funding: No funding was received., Competing Interests: The authors report no potential conflicts of interests to declare., (© 2024 Published by Elsevier Ltd.)

Background: Graftless sinus floor augmentation shows good results in bone gain, radiology and implant survival. Clinically, this technique can be recommended as an alternative to conventional procedures using augmentation materials., Objectives: This study aims to assess masticatory performance, masticatory ability and patient satisfaction after graftless sinus floor augmentation., Methods: The study group consisted of patients who had received a graftless sinus lift procedure in a split-mouth design and was compared to patients with maxillary implant-supported overdentures without augmentation and a natural dentition group. To assess objective masticatory performance, the mixing ability test was performed. Three questionnaires were used to assess patient reported outcomes related to mastication and patient satisfaction., Results: Each group included ten patients. Both the graftless sinus lift group and the edentulous control group had a worse masticatory performance compared to the natural dentition group. Masticatory ability, measured by patient reported outcomes, was not different between the graftless sinus floor augmentation group and implant-retained overdentures group without augmentation, but the natural dentition group showed better results. Thereby, the better the masticatory performance in patients with a graftless sinus membrane elevation the better the patient satisfaction for 'prosthesis', 'appearance of prostheses', 'speech' and 'mastication and eating'., Conclusions: Patients with implant-supported overdentures show inferior masticatory function compared to those with natural dentition. There were no significant differences in masticatory performance between patients with implant-retained overdentures, with or without graftless augmentation. The decision on the preferred procedure should consider additional factors such as anatomical, surgical-technical aspects and patient's preferences., (© 2024 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

Background: During the last decade, twelve studies have been published investigating physical exercise interventions (PEIs) in patients with head and neck cancer (HNC) during radiotherapy (RT), chemoradiation (CRT) or bioradiation (BRT). These studies showed that these PEIs are safe and feasible. However, only two of these studies were randomised clinical trials (RCTs) with a satisfying sample size. Thereby, there is no cost-effectiveness study related to a PEI during RT, CRT or BRT ((C/B)RT) for patients with HNC. Therefore, the aim of this study is to investigate and compare physical performance, muscle strength, fatigue, quality of life (QoL), body mass index (BMI), nutritional status, physical activity, treatment tolerability, and health care related costs in patients with HNC with and without a 10 week PEI during (C/B)RT., Methods: This study, based on a trial within cohorts (TwiCs) design, will contain a prospective cohort of at least 112 patients. Fifty-six patients will randomly be invited for an experimental 10 week PEI. This PEI consists of both resistance and endurance exercises to optimize physical performance, muscle strength, fatigue, QoL, BMI, nutritional status, physical activity, and treatment tolerability of (C/B)RT. Measurements are at baseline, after 12 weeks, 6 months, and at 12 months. Statistical analyses will be performed for intention-to-treat and instrumental variable analysis., Discussion: This study seeks to investigate physical, QoL, and economic implications of a PEI. With a substantial sample size, this study attempts to strengthen and expand knowledge in HNC care upon PEI during (C/B)RT. In conclusion, this study is dedicated to provide additional evidence for PEI in patients with HNC during (C/B)RT., Trial Registration: protocol was registered at clinicaltrials.gov with number NCT05988060 on 3 August 2023., (© 2024. The Author(s).)

(1) Background: Chemoradiotherapy (CRT) for head and neck cancer (HNC) is associated with severe toxicity resulting in fatigue and weight loss, including loss of skeletal muscle mass. Exercise interventions might positively affect physical fitness and quality of life. Sufficient adherence and compliance rates are necessary for optimal effects. This study aimed to gain insight into expectations and experiences and factors influencing adherence, retention and compliance of HNC patients participating in exercise intervention during CRT. (2) Methods: Consecutive participants were invited for semi-structured interviews, conducted pre- and post-intervention. A deductive approach was used to identify themes and factors influencing adherence, retention and compliance. (3) Results: Thematic saturation was reached after interviewing 14 patients pre-intervention. Five themes were identified: planning and time management, treatment toxicity, motivation to exercise, exercise intervention and supervision by a physiotherapist. The intensity of the treatment schedule and treatment toxicity were important barriers. Facilitators mentioned were physical and emotional benefits, social support as well as the simplicity and home-based setting of the intervention. (4) Conclusions: A personalised approach, considering the individual facilitators and barriers of HNC patients, is important to increase adherence, retention and compliance to exercise intervention and to reap the optimal effects of the program.

Purpose: To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD)., Materials and Methods: A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding their experience using an e-Health application, Physitrack. The modified telemedicine satisfaction and usefulness questionnaire and pain intensity score before and after treatment were collected from the patients., Results: Ten OPTs, of which nine actively used Physitrack, described that the e-Health application can help to provide personalised care to patients with TMD, due to the satisfying content, user-friendliness, accessibility, efficiency, and ability to motivate patients. Ten patients, of which nine ended up using Physitrack, felt that shared decision-making was very important. These patients were positive towards the application as it was clear, convenient, and efficient, it helped with reassurance and adherence to the exercises and overall increased self-efficacy. This was mostly built on their experience with exercise videos, as this feature was most used. None of the OPTs or patients used all features of Physitrack. The overall satisfaction of Physitrack based on the telemedicine satisfaction and usefulness questionnaire (TSUQ) was 20.5 ± 4.0 and all patients (100%) showed a clinically relevant reduction of TMD pain (more than 2 points and minimally 30% difference)., Conclusion: OPTs and patients with TMD shared the idea that exercise videos are of added value on top of usual physical therapy care for TMD complaints, which could be delivered through e-Health.Implications for RehabilitationPhysical therapists and patients with temporomandibular disorders do not use all features of the e-Health application Physitrack in a clinical setting.Exercise videos were the most often used feature and seen as most valuable by physical therapists and patients.Based on a small number of participants, e-Health applications such as Physitrack may be perceived as a valuable addition to the usual care, though this would need verification by a study designed to evaluate the therapeutic effect (e.g., a randomised clinical trial).

Background: Total laryngectomy (TL) is a surgical procedure commonly performed on patients with advanced laryngeal or hypopharyngeal carcinoma. One of the most common postoperative complications following TL is the development of a pharyngocutaneous fistula (PCF), characterized by a communication between the neopharynx and the skin. PCF can lead to extended hospital stays, delayed oral feeding, and compromised quality of life. The use of a myofascial pectoralis major flap (PMMF) as an onlay technique during pharyngeal closure has shown potential in reducing PCF rates in high risk patients for development of PCF such as patients undergoing TL after chemoradiation and low skeletal muscle mass (SMM). Its impact on various functional outcomes, such as shoulder and neck function, swallowing function, and voice quality, remains less explored. This study aims to investigate the effectiveness of PMMF in reducing PCF rates in patients with low SMM and its potential consequences on patient well-being., Methods: This multicenter study adopts a randomized clinical trial (RCT) design and is funded by the Dutch Cancer Society. Eligible patients for TL, aged ≥ 18 years, mentally competent, and proficient in Dutch, will be enrolled. One hundred and twenty eight patients with low SMM will be centrally randomized to receive TL with or without PMMF, while those without low SMM will undergo standard TL. Primary outcome measurement involves assessing PCF rates within 30 days post-TL. Secondary objectives include evaluating quality of life, shoulder and neck function, swallowing function, and voice quality using standardized questionnaires and functional tests. Data will be collected through electronic patient records., Discussion: This study's significance lies in its exploration of the potential benefits of using PMMF as an onlay technique during pharyngeal closure to reduce PCF rates in TL patients with low SMM. By assessing various functional outcomes, the study aims to provide a comprehensive understanding of the impact of PMMF deployment. The anticipated results will contribute valuable insights into optimizing surgical techniques to enhance patient outcomes and inform future treatment strategies for TL patients., Trial Registration: NL8605, registered on 11-05-2020; International Clinical Trials Registry Platform (ICTRP)., (© 2024. The Author(s).)

Introduction: Maxillary implant overdenture therapy is a good treatment option for treating patients experiencing problems with their conventional maxillary denture. Retaining the overdenture with four implants and a bar attachment system serves as the current gold standard. However, there is a demand for less costly and less invasive treatment options. The aim of this randomized controlled trial was to compare marginal bone level change (MBLC), implant and overdenture survival, clinical, masticatory, and patient-related outcomes (PROMs) of maxillary implant overdentures with either two or four implants and a bar attachment system., Materials and Methods: Forty edentulous participants were randomly allocated to two groups (n = 20), to receive either two or four implants in the maxilla. After healing, all the participants received an implant overdenture retained by a bar attachment system. All the participants were evaluated 1 and 12 months after overdenture placement. The primary outcome was MBLC. Secondary outcomes were implant and overdenture survival, clinical, masticatory, and PROMs. The outcomes were analyzed using parametric and non-parametric tests., Results: MBLC was -0.03 mm in the 2-implant group and -0.16 mm in the 4-implant group (p = 0.21). Implant survival was 83.3% in the 2-implant group and 94.4% in the 4-implant group (p = 0.03). The median pocket depth change and clinical outcomes were low, and masticatory performance along with PROMs improved in both groups and did not differ significantly between them., Conclusion: Maxillary 4-implant overdentures perform better than maxillary 2-implant overdentures with a bar attachment system in terms of implant and overdenture survival and therefore remains the gold standard. However, both overdentures perform similarly in terms of MBLC, clinical, masticatory, and PROMs., (© 2023 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Purpose: To systematically review the literature on effectiveness of remote physiotherapeutic e-Health interventions on pain in patients with musculoskeletal disorders., Materials and Methods: Using online data sources PubMed, Embase, and Cochrane in adults with musculoskeletal disorders with a pain-related complaint. Remote physiotherapeutic e-Health interventions were analysed. Control interventions were not specified. Outcomes on effect of remote e-Health interventions in terms of pain intensity., Results: From 11,811 studies identified, 27 studies were included. There is limited evidence for the effectiveness for remote e-Health for patients with back pain based on five articles. Twelve articles studied chronic pain and the effectiveness was dependent on the control group and involvement of healthcare providers. In patients with osteoarthritis (five articles), total knee surgery (two articles), and knee pain (three articles) no significant effects were found for remote e-Health compared to control groups., Conclusions: There is limited evidence for the effectiveness of remote physiotherapeutic e-Health interventions to decrease pain intensity in patients with back pain. There is some evidence for effectiveness of remote e-Health in patients with chronic pain. For patients with osteoarthritis, after total knee surgery and knee pain, there appears to be no effect of e-Health when solely looking at reduction of pain. Implications for rehabilitationThis review shows that e-Health can be an effective way of reducing pain in some populations.Remote physiotherapeutic e-Health interventions may decrease pain intensity in patients with back pain.Autonomous e-Health is more effective than no treatment in patients with chronic pain.There is no effect of e-Health in reduction of pain for patients with osteoarthritis, after total knee surgery and knee pain.

This study aimed to compare open and closed treatment for unilateral mandibular condyle neck and base fractures by final three-dimensional (3D) condylar position at 6 months follow-up. 3D position was associated with mandibular functioning and pain. A total of 21 patients received open (n = 11) or closed (n = 10) treatment. 3D positions were assessed on cone-beam computed tomography scans. Volume differences, root mean square, translations, and rotations were obtained related to the pursued anatomical position and compared between treatment groups by the Mann-Whitney U test. The 3D position parameters were associated with the maximum interincisal opening (MIO), mixing ability test (MAT), Mandibular Function Impairment Questionnaire (MFIQ), and pain based on Spearman correlation coefficients (r s ). Translation in the medial-lateral direction was smaller after open treatment (P = 0.014). 3D position was not associated with the MAT; however, worse position was associated with a smaller MIO. A larger pitch rotation was associated with a worse MFIQ (r s  = 0.499, P = 0.025). Volume reduction of the affected condyle was associated with more pain (r s  = -0.503, P = 0.020). In conclusion, after unilateral condylar fractures, worse 3D position is associated with a smaller mouth opening and worse patient-reported outcomes. This is independent of the chosen treatment, despite a better anatomical reduction after open treatment., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To study clinical variables defining temporomandibular function in adults with juvenile idiopathic arthritis (JIA) and healthy controls., Methods: In this cross-sectional study, the temporomandibular joint (TMJ) screening protocol, mandibular range of motion (MROM), and anterior maximum voluntary bite force (AMVBF) were compared between adults with JIA and healthy controls. Unadjusted and adjusted models with corrections for sex and disease duration were constructed for active maximum interincisal mouth opening (AMIO) and AMVBF., Results: A total of 100 adults with JIA and 59 healthy adults were included in this study. In adults with JIA, 56% had clinically established TMJ involvement. AMIO was the MROM variable most reduced by TMJ involvement; AMIO was 8.8 mm (95% CI -11.40 to -6.12; P < 0.001) less in adults with JIA with TMJ involvement compared to JIA without TMJ involvement. No differences of AMIO were found between healthy adults and adults with JIA without TMJ involvement (-2.52, 95% CI -5.13 to 0.10; P = 0.06). Male sex was associated with a higher AMIO, and disease duration was associated with a decreased AMIO. Collinearity between the subtype prebiologic era and disease duration was found. AMVBF did not differ between adults with JIA and healthy adults., Conclusion: The high prevalence of clinically established TMJ involvement in adults with JIA indicates the need for awareness of TMJ problems in adults with JIA. TMJ involvement negatively influenced AMIO and should therefore be part of the TMJ screening in adults with JIA. AMVBF seems to have less utility for TMJ screening in adult populations., (Copyright © 2023 by the Journal of Rheumatology.)

Background and Purpose: Prior to radiotherapy (RT), teeth with poor prognosis that pose a risk for post-RT osteoradionecrosis (ORN) are removed. To allow enough time for adequate wound healing prior to RT, decisions are made based on the estimated radiation dose. This study aimed to gain insight into (1) the overall number of teeth extracted and (2) the patient and tumor characteristics associated with the number of redundantly extracted teeth., Materials and Methods: Patients with head and neck cancer (HNC), treated with RT between 2015 and 2019, were included in this cross-sectional study. For each extracted tooth the radiation dose was calculated retrospectively. The cut-off point for valid extraction was set at ≥ 40 Gy in accordance with the national protocol. Potential factors for doses ≥ 40 Gy were identified, including age, sex, tumor location, tumor (T) and nodal stage (N), overall tumor stage and number of teeth extracted., Results: A total of 1759 teeth were removed from 358 patients. Of these 1759 teeth, 1274 (74%) appeared to have been removed redundantly, based on the mean dose (D mean ) of < 40 Gy. Using the maximum dose (D max ) of < 40 Gy, 1080 teeth (61%) appeared to have been removed redundantly. Tumor location and N-classification emerged as the most important associative variables in the multivariable regression analysis., Conclusion: To our knowledge this is the first study to provide insight into the amount of teeth redundantly extracted prior to RT and represents a step forward in de-escalating the damage to the masticatory system prior to RT., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Swallowing rehabilitation in curative treated patients with oral cancer is still a challenge. Different factors may influence these patients' swallowing function. The aim of this study was to identify factors associated with swallowing function up to 5 years after cancer treatment., Methods: Swallowing duration and frequency of 5 mL water and 15 mL applesauce were measured in 123 patients treated for oral cancer. Mixed model analyses were performed to identify associated factors., Results: Age influenced all measured swallowing outcomes. Assessment moment, gender, tumor location, maximum tongue force, and tactile sensory function of the tongue were associated with both water and applesauce swallowing duration, tumor classification was associated with water swallowing duration, and alcohol consumption was associated with applesauce swallowing duration. Assessment moment, cancer treatment, maximum tongue force, and tactile sensory function of the tongue were associated with water and applesauce swallowing frequency., Conclusion: Patients who are older at diagnosis, women, and patients who regularly consume alcohol before their treatment may have poorer swallow functioning after curative oral cancer treatment. Patients that fit these criteria should have their swallowing evaluated during clinical follow-ups and sent to swallowing therapy when needed. During this therapy, optimizing tongue function needs attention to maintain an optimal swallowing function.

Background: The aim of this prospective cohort study was to investigate swallowing function in relation to personal and clinical factors among patients with head and neck cancer (HNC) from diagnosis up to 2 years after treatment., Methods: The 100 ml water swallow test was measured before treatment, and 3, 6, 12, and 24 months after treatment. Linear mixed-effects model analysis was conducted to investigate changes over time and the association with personal (sex and age) and clinical (tumor site, tumor stage, and treatment modality) factors., Results: Among 128 included patients, number of swallows increased from baseline to 3 months after treatment and decreased to baseline again at 6 months after treatment. The number of swallows was associated with age and treatment modality., Conclusions: In patients with HNC, swallowing (dys)function changes over time with the worst score 3 months after treatment. A higher age and being treated with surgery are factors associated with swallowing dysfunction over time., (© 2022 The Authors. Oral Diseases published by Wiley Periodicals LLC.)

Purpose: In order to assess the severity and the progression of a unilateral peripheral facial palsy the Sunnybrook Facial Grading System (SFGS) is a well-established grading system due to its clinical relevance, sensitivity, and robust measuring method. However, training is required in order to achieve a high inter-rater reliability. This study investigated the automated grading of facial palsy patients based on the SFGS using a convolutional neural network., Methods: A total of 116 patients with a unilateral peripheral facial palsy and 9 healthy subjects were recorded performing the Sunnybrook poses. A separate model was trained for each of the 13 elements of the SFGS and then used to calculate the Sunnybrook subscores and composite score. The performance of the automated grading system was compared to three clinicians experienced in the grading of a facial palsy., Results: The inter-rater reliability of the convolutional neural network was within the range of human observers, with an average intra-class correlation coefficient of 0.87 for the composite Sunnybrook score, 0.45 for the resting symmetry subscore, 0.89 for the symmetry of voluntary movement subscore, and 0.77 for the synkinesis subscore., Conclusions: This study showed the potential of the automated SFGS to be implemented in a clinical setting. The automated grading system adhered to the original SFGS, which makes the implementation and interpretation of the automated grading more straightforward. The automated system can be implemented in numerous settings such as online consults in an e-Health environment, since the model used 2D images captured from a video recording., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The objective of this study was to assess the association between psychosocial factors (in terms of anxiety, somatization, depression, and optimism) and pain (in terms of headache pain intensity and pain-related disability), in patients with a painful temporomandibular disorder (TMD) and one of the following headache types: migraine, tension-type headache (TTH), or headache attributed to TMD, corrected for the influence of bruxism. A retrospective study was conducted at an orofacial pain and dysfunction (OPD) clinic. Inclusion criteria were painful TMD, with migraine, TTH, and/or headache attributed to TMD. Linear regressions were performed to assess the influence of psychosocial variables on pain intensity and on pain-related disability, stratified per headache type. The regression models were corrected for bruxism and the presence of multiple headache types. A total of 323 patients (61% female; mean age 42.9, SD 14.4 years) were included. Headache pain intensity only had significant associations in TMD-pain patients with headache attributed to TMD, and anxiety showed the strongest relation (β = 0.353) with pain intensity. Pain-related disability was most strongly associated with depression in TMD-pain patients with TTH (β = 0.444), and with somatization in patients with headache attributed to TMD (β = 0.399). In conclusion, the influence of psychosocial factors on headache pain intensity and pain-related disability depends on the headache type presenting., (© 2023 The Authors. European Journal of Oral Sciences published by John Wiley & Sons Ltd on behalf of Scandinavian Division of the International Association for Dental Research.)

Purpose: The aim of this study was to find explanatory variables for objective and patient-reported long-term masticatory functioning in patients treated with maxillomandibular fixation for unilateral condylar neck or base fractures. These outcomes were compared to healthy control subjects., Methods: Patients treated between 1996 and 2013 were enrolled in the study. Objective measurements included the mixing ability test (MAT) for masticatory performance, and range of motion of the mandible. Patient-reported measurements included the mandibular function impairment questionnaire (MFIQ) for masticatory ability, and the visual analogue scale for pain. Healthy subjects were recruited between October 2018 and January 2019, and performed the MAT and MFIQ., Results: Twenty-one patients and 30 healthy subjects were included. The average follow-up period was 11.67 years. In adjusted regression analysis, the amount of occlusal units (OU) was associated with the MAT (P = 0.020; R 2  = 0.253) and MFIQ (P = 0.001, R 2  = 0.454). The MAT outcome was similar in both groups when correcting for OU (P = 0.001; R 2  = 0.201). The MFIQ was inferior in the patient group (P = 0.001)., Conclusion: Long-term masticatory performance was similar in patients with a history of condylar neck or base fracture and healthy subjects; however, masticatory ability was inferior in patients compared to healthy subjects., (© 2021. The Author(s).)

Background: Oral functioning and rehabilitation in patients after condylar trauma can be measured by objective functional outcomes and patient-reported outcomes. The similarities or differences between these outcomes may contribute to the decision if open treatment (OT) or closed treatment (CT) will obtain the most advantageous results., Objectives: The aim of this study was to compare OT versus CT for unilateral condylar mandibular neck or base fractures in a two-centre controlled clinical trial by objective functional outcomes and patient-reported outcomes measured at 6 weeks and 6 months follow-up. Additionally, these outcomes were compared within each group., Methods: Patients were enrolled between January 2017 and November 2019. In one centre, patients received OT by extra-oral open reduction and internal fixation. In another centre, patients received CT by maxillomandibular fixation. Objective measurements included the mixing ability test (MAT) and mandibular active range of motion (ROM). Patient-reported outcomes included the mandibular function impairment questionnaire (MFIQ) and visual analogue scale (VAS) for pain. Independent t-tests and Mann-Whitney U-tests were used to determine differences between the treatment groups at 6 weeks and 6 months follow-up. Paired t-tests and Wilcoxon signed rank tests were used to determine differences within each group., Results: Thirty-three patients were enrolled. No differences were found between the groups treated with OT or CT for MAT, ROM, MFIQ and VAS. Both groups showed functional improvement., Conclusion: Good objective functional outcomes and patient-reported outcomes were achieved with both OT and CT in patients with unilateral condylar mandibular neck or base fractures., (© 2022 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)

In children with juvenile idiopathic arthritis (JIA) the temporomandibular joint (TMJ) can be involved. As a consequence, the oral function can be impaired due to joint and/or muscle involvement of the masticatory system with a negative influence on the maximum bite force. The aim of this cross-sectional study was to establish the reliability of AMVBF in children with JIA and healthy children. Children with JIA and healthy children conducted three attempts of AMVBF. The reliability of AMVBF measurement was determined by the intra-class correlation coefficient (ICC) by age, standard error of measurement (SEM), smallest detectable change (SDC), and limits of agreement (LoA). A total of 298 children with JIA and 168 healthy children were examined. The AMVBF measurements showed an good to excellent reliability in children with JIA based on the ICCs corrected for age (0.782-0.979). In healthy children, the reliability was moderate to excellent (0.546-0.999). The SDC in our study indicated that values above 11.4N might be a clinical relevant change over time in children with JIA. The LoA showed a wide spread of variability in both children with JIA (-72.6-44.4N) and healthy children (-79.9-72.8N). The Bland-Altman plots indicated that the differences between the test and retest increased in value proportionally to the biteforce value., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 de Sonnaville et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The choice for the most optimal strategy for patients with a cT 1-2 N 0 carcinoma of the oral cavity, sentinel lymph node biopsy (SLNB) or elective neck dissection (END), is still open for debate in many head and neck cancer (HNC) treatment centers. One of the possible benefits of the less invasive SLNB could be reduced neck and shoulder morbidity. Recent studies have shown a benefit in favor of SLNB the first year after intervention, but the long-term consequences and differences in neck morbidity remain unclear. This cross-sectional study aimed to research differences in neck and shoulder morbidity and Health-Related Quality of Life (HR-QoL) in patients with a cT 1-2 N 0 carcinoma of the oral cavity, treated with either END or SLNB. Neck and shoulder morbidity and HR-QOL were measured with patient-reported questionnaires (SDQ, SPADI, NDI, NDII, EORTC-QLQ-C30, EORTC-QLQ-HN35) and active range of motion (AROM) measurements. In total 18 patients with END and 20 patients with SLNB were included. We found no differences between END and SLNB for long-term neck morbidity, shoulder morbidity, and HR-QOL. The significant differences found in the rotation of the neck are small and not clinically relevant.

Background: Most patients with temporomandibular joint (TMJ) issues are successfully treated with nonsurgical methods. However, when end-stage TMJ pathologies occur, invasive management can be required, such as a total TMJ replacement. This cross-sectional pilot study aimed to provide insight into the functioning of the masticatory system, pain, and patient satisfaction in patients treated with a total joint replacement (TJR)., Methods: A cross-sectional pilot study was conducted to determine the postoperative clinical results of an alloplastic TJR TMJ. Masticatory performance and also insight into maximum voluntary bite force (MVBF), active and passive maximum mouth opening (aMMO/pMMO), pain, and patient satisfaction were measured. Masticatory performance, MVBF, and aMMO of patients with a TJR TMJ were compared with healthy individuals., Results: Masticatory performance is equal between patients with a TJR TMJ and healthy individuals, but both MVBF and aMMO were significantly smaller in patients with a TJR TMJ. However, patients had almost no pain and were very satisfied with the TJR TMJ treatment., Conclusion: This study revealed that most patients with an alloplastic TJR TMJ were able to function without pain, showed good masticatory performance, and were highly satisfied with their alloplastic TJR TMJ. However, MVBF and aMMO were lower than in healthy individuals.

Purpose: To assess the implant and prosthesis survival rates, the clinical, radiographical and patient-related outcome measures, and the masticatory performance of maxillary overdentures supported by two implants in patients with an atrophic maxilla., Methods: In this case series, 15 consecutive patients who were eligible for maxillary implant overdenture therapy, but who had insufficient bone volume to place at least four implants and were unwilling to be treated with reconstructive surgery were asked to participate. After giving consent, participants received two implants in the maxilla under local anaesthesia. After 3 months of osseointegration, a maxillary overdenture with palatal coverage and solitary attachments was fabricated. Implant and overdenture survival, marginal bone level change, clinical outcome measures, masticatory performance and patient-related outcomes were evaluated at baseline and 1 year after overdenture placement., Results: Fourteen out of 15 participants completed the follow-up period of 12 months. Implant and overdenture survival rate were 89.3% and 85.7%, respectively. Change in marginal bone level (- 0.5 ± 0.7 mm), change in probing depth (0.0 ± 1.0 mm), and clinical outcomes were favourable. Masticatory performance and patient-related outcomes improved significantly compared to baseline. Complications were minimal., Conclusions: Within the limitations of this study, it can be concluded that patients with extreme resorption of the maxilla that are unwilling to be treated with reconstructive surgery, benefit from two-implant maxillary overdentures retained by solitary attachments in terms of improved masticatory functioning and denture satisfaction. However, they have relatively high risk of implant loss., Trial Registration: UMCG Trial Register (RR201900060), registered 22 January 2019., (© 2022. The Author(s).)

Smile appearance has a major psychological impact. Orthognathic surgery, which has harmonizing results on skeletal structures, can negatively influence the smile appearance due to soft tissue effects. To enhance the aesthetic effects of orthognathic surgery on soft tissues, reference models for large parts of the hospital’s adherent area are called for. This study aims to create average facial models for different sex and age groups in two facial exercises: maximum closed smile, and pouting. These models were created using coherent point drift and Procrustes algorithms in MATLAB. Principal component analysis was performed, and of 20 surgical landmarks, the in-group variation using standard deviation was calculated. Three distances were analyzed: nasal width, philtral width, and mouth width. To correct for facial size, these distances were analyzed as a ratio of intercanthal width. In total, 328 healthy subjects were included in the study. Subjects were grouped by sex, and in age categories spanning four years each, with an adult group with all ages >16 years. For both smiling and pouting faces, all ratios increased with ageing. These templates and data can benefit facial surgeons, to obtain an expected outcome according to the age of the patient.

This study aimed to determine the reliability of three-dimensional (3D) stereophotogrammetry as a measurement instrument for evaluating soft tissue changes in the head and neck area. Twelve patients received a bilateral sagittal split osteotomy (BSSO). Test and retest 3D photographs were captured within the first three postoperative weeks, and a reference 3D photograph was capture at three months postoperatively. Distance measurements, mean and root mean square of the distance map, and volume differences were obtained. Reliability of these parameters was assessed by intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and smallest detectable change (SDC). All distance measurements had an ICC > 0.91, and the distance map parameters and volume differences showed ICCs > 0.89. The neck region presented the largest SEMs (5.09 mL) and SDC (14.1 mL) for the volume difference. In conclusion, 3D stereophotogrammetry is reliable for distance and volume measurements of soft tissues in patients after a BSSO advancement.

Introduction: Head and neck cancer (HNC) and its treatment often negatively impact swallowing function. The aim was to investigate the course of patient-reported swallowing problems from diagnosis to 3, 6, 12, and 24 months after treatment, in relation to demographic, clinical, and lifestyle factors., Methods: Data were used of the Netherlands Quality of Life and Biomedical Cohort Study in head and neck cancer research (NET-QUBIC). The primary outcome measures were the subscales of the Swallowing Quality of Life Questionnaire (SWAL-QOL). Linear mixed-effects models (LMM) were conducted to investigate changes over time and associations with patient, clinical, and lifestyle parameters as assessed at baseline., Results: Data were available of 603 patients. There was a significant change over time on all subscales. Before treatment, 53% of patients reported swallowing problems. This number increased to 70% at M3 and decreased to 59% at M6, 50% at M12, and 48% at M24. Swallowing problems (i.e., longer eating duration) were more pronounced in the case of female, current smoking, weight loss prior to treatment, and stage III or IV tumor, and were more prevalent at 3 to 6 months after treatment. Especially patients with an oropharynx and oral cavity tumor, and patients receiving (C)RT following surgery or CRT only showed a longer eating duration after treatment, which did not return to baseline levels., Conclusion: Half of the patients with HNC report swallowing problems before treatment. Eating duration was associated with sex, smoking, weight loss, tumor site and stage, and treatment modality, and was more pronounced 3 to 6 months after treatment., (© 2022. The Author(s).)

Objective: Chemoradiotherapy (CRT) for head and neck cancer (HNC) is associated with high toxicity that adversely affects physical functioning, body composition, fatigue, quality of life and treatment outcomes. Exercise interventions during treatment might counteract these negative effects. We therefore assessed the feasibility of an exercise programme for HNC patients during CRT., Methods: Forty patients were offered a tailored 10-week endurance and resistance training with supervised and home-based sessions. Feasibility endpoints were (1) adherence (main outcome): ≥60% attendance; (2) recruitment: ≥30%; (3) retention rate: ≥85% and (4) compliance rate: ≥60%. Physical performance, muscle strength, body composition, quality of life and fatigue were assessed pre- and post-intervention., Results: Overall adherence was 54%. The recruitment rate was 36%, and the retention rate was 65%. Compliance to the supervised intervention protocol was 66%. Statistically significant decreases were found in mean grip strength, fat-free mass and clinically relevant deteriorations on several domains of quality of life, and fatigue subscales were found., Conclusion: We conclude that this exercise programme for HNC patients during CRT in its current form is feasible for only a minority of patients. We suggest adaptations to improve adherence and retention rates for a definitive multicentre trial., Trial Registration: This study is registered at the Netherlands Trial Register (NTR7305), 6 June 2018, retrospectively registered., (© 2022 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.)

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.)

Background: The Headache Screening Questionnaire (HSQ) was created and validated to enable health professionals to screen for migraine and tension-type headaches., Objectives: The objective of this study was to translate and cross-culturally adapt the HSQ, creating the Brazilian version of the HSQ (HSQ-BR)., Design: This was a cross-sectional study., Method: The Brazilian version of the HSQ was developed following the processes of translation, synthesis, back-translation, expert committee review, and pre-testing. The translation phase involved two independent translators whose mother language was Brazilian Portuguese and who also were fluent in Dutch. The back-translation phase involved two independent translators whose mother language was Dutch and who also were fluent in Portuguese. The expert committee based their decisions on semantic, idiomatic, experiential, and conceptual equivalences. To verify the comprehension of the questionnaire, 60 subjects (73.3% women) with headaches with a mean age of 32.8 ± 12.0 years, participated in the pre-test phase., Results: During the translation process, some terms and expressions were changed to obtain cultural equivalence to the original HSQ. The process of translation and cross-cultural adaptation of the HSQ to the Brazilian culture and Portuguese language, including its scoring algorithms for migraine and tension-type headache, was successfully concluded, as the comprehension of each item of the questionnaire was over 90% on the pre-test., Conclusion: The HSQ-BR has been created., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: Prior to radiotherapy combined with chemotherapy (CRT) or biotherapy (BRT) for oropharyngeal squamous cell carcinoma (OPSCC), teeth with poor prognosis that pose a risk for post-RT osteoradionecrosis (ORN) are removed. The effect of tooth loss on body weight loss and tube feeding (TF) dependency during CRT/BRT is unknown. This study aimed to evaluate the effect of incomplete dentition, tooth extractions prior to CRT/BRT, and the subsequent loss of functional units on (1) weight loss during CRT/BRT and (2) the need for TF during CRT/BRT for OPSCC., Methods: OPSCC patients treated with CRT/BRT between 2013 and 2016 were included in this retrospective cohort study. Dental status was determined during the dental assessment at first visit and after tooth extractions prior to the start of CRT/BRT. Weight loss during CRT/BRT was scored dichotomously, comparing weight loss > 5% to stable or increased weight. Potential factors associated with weight loss were identified, including patient, tumor, and treatment characteristics., Results: Seventy-seven OPSCC patients were included. Forty patients (52%) experienced weight loss > 5% during CRT/BRT. Extractions were performed in 66% of the OPSCC patients. The mean number of extracted teeth was 4.1 ± 5.6 per patient. Tooth extractions prior to CRT/BRT were associated with weight loss > 5% during CRT/BRT (HR 1.130 (95% CI 1.011-1.262), p = 0.031). None of the dental status-related parameters showed any significant associative value for TF during CRT/BRT., Conclusions: Pre-CRT/BRT tooth extractions intended to reduce the risk of ORN, are a risk factor for weight loss during CRT/BRT for OPSCC., Trial Registration Number: This study was approved by the medical ethics committee of the MUMC + (METC 2020-1589) on July 28, 2020., (© 2022. The Author(s).)

Purpose: After treatment for head and neck cancer (HNC), patients often experience major problems in masticatory function. The aim of this prospective cohort study among patients with HNC was to investigate which personal and clinical factors are associated with masticatory function from diagnosis up to 2 years after treatment with curative intent., Methods: Masticatory function was measured using the Mixing Ability Test (MAT) before treatment (baseline), and 3, 6, 12, and 24 months after treatment. A linear mixed-effects model with a random intercept and slope was conducted to investigate changes over time and the association with personal (sex, age) and clinical (tumor site, tumor stage, treatment modality) factors as measured at baseline., Result: One-hundred-twenty-five patients were included. The prevalence of masticatory dysfunction was estimated at 29% at M0, 38% at M3, 28% at M6, 26% at M12, and 36% at M24. A higher (worse) MAT score was associated with age, tumor stage, tumor site, timing of assessment, and the interaction between assessment moment and tumor site., Conclusion: In patients with HNC, masticatory function changed over time and dysfunction was associated with a higher age, a tumor in the oral cavity, a higher tumor stage, and a shorter time since treatment. The prevalence of masticatory dysfunction ranged from 26 to 38%., (© 2022. The Author(s).)

Background: Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health., Purpose: To assess the needs, facilitators and barriers of the use of an e-Health application from the perspective of both orofacial physical therapists and patients with TMD., Methods: A descriptive qualitative study was performed. Eleven physical therapists and nine patients with TMD were interviewed using a topic guide. Thematic analysis was applied, and findings were ordered according to four themes: acceptance of e-Health, expected utility, usability and convenience., Results: Physical therapists identified the need for e-Health as a supporting application to send questionnaires, animated exercises and evaluation tools. Key facilitators for both physical therapists and patients for implementing e-Health included the increase in self-efficacy, support of data collection and personalization of the application. Key barriers are the increase of screen time, the loss of personal contact, not up-to-date information and poor design of the application., Conclusions: Physical therapists and patients with TMD are positive towards the use of e-Health, in a blended form with the usual rehabilitation care process for TMD complaints.Implications for rehabilitationThe rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications.Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care.Especially during the treatment process, there is a need for clear animated videos and reminders for the patients.

Background: Migraines and tension-type headaches (TTH) are primary headaches that can be screened with the Headache Screening Questionnaire (HSQ). However, the HSQ scoring algorithms rely on manual calculation, which is laborious and carries a risk of human error., Objective: To develop an automated tool to calculate the output of the HSQ scoring algorithm and to determine the agreement between the automated and manual calculation., Design: A cross-sectional design was used., Methods: The automated tool was developed as a Microsoft Excel spreadsheet that was tested with all possible answers for the HSQ. An experienced researcher had access to answers to the HSQ from 163 people with headaches and manually applied the migraine and TTH algorithms to obtain the final scores and classifications. After that, the same answers were uploaded into the spreadsheet and scored by the automated algorithm. The agreement between manual and automated scoring was calculated for the total score using Intraclass Correlation Coefficients (ICC 2,1 ), Standard Error of Measurement (SEM), and Limits of Agreement. The agreement between the classification obtained by the automated tool and the classification obtained by manual calculation for migraine and TTH was calculated using weighted Kappas (k-values)., Results: The total score showed excellent agreement for migraine (ICC = 0.97, 95% CI = 0.96-0.98, SEM = 0.36) and good agreement for TTH (ICC = 0.87, 95% CI = 0.82-0.90, SEM = 0.55). The classification demonstrated excellent agreement for migraine (k-value = 0.93, 95% CI = 0.89-0.97) and for TTH (k-value = 0.78, 95% CI = 0.70-0.86)., Conclusion: Implementation of the automated tool in clinical practice is suggested when using the HSQ to screen patients with primary headaches., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To assess variations in nutritional interventions during chemoradiotherapy (CRT) among the Dutch Head and Neck Oncology centres (HNOCs)., Methods: An online questionnaire about nutritional interventions and dietetic practices was sent to 14 oncology dietitians of the HNOCs., Results: The response rate was 93%. The number of scheduled dietetic consultations varied from two to seven during CRT. Most centres (77%) reported using a gastrostomy for tube feeding in the majority of patients. Gastrostomies were placed prophylactically upon indication (39%) or in all patients (15%), reactive (15%), or both (31%). For calculating energy requirements, 54% of the dietitians used the Food and Agriculture Organization/World Health Organization and United Nations University (FAO/WHO/UNU) formula and 77% uses 1.2-1.5 g/kg body weight for calculating protein requirements. Almost half of the centres (46%) reported to remove the gastrostomy between 8 and 12 weeks after CR. Most centres (92%) reported to end dietary treatment within 6 months after CRT., Conclusion: This study shows substantial variation in dietetic practice, especially in the use of a gastrostomy for tube feeding, between the HNOCs. There is a need for concise dietetic guidelines., (© 2021 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.)

Purpose: Before and after treatment for head and neck cancer (HNC), many patients have problems with mastication, swallowing, and salivary flow. The aim of this study was to investigate the association between objective test outcomes of mastication, swallowing, and salivary flow versus patient-reported outcomes (PROs) measuring mastication-, swallowing-, and salivary flow-related quality of life., Methods: Data of the prospective cohort "Netherlands Quality of Life and Biomedical Cohort Study" was used as collected before treatment, and 3 and 6 months after treatment. Spearman's rho was used to test the association between objective test outcomes of the mixing ability test (MAT) for masticatory performance, the water-swallowing test (WST) for swallowing performance, and the salivary flow test versus PROs (subscales of the EORTC QLQ-H&N35, Swallow Quality of Life questionnaire (SWAL-QoL-NL) and Groningen Radiation-Induced Xerostomia (GRIX))., Results: Data of 142 patients were used, and in total, 285 measurements were performed. No significant correlations were found between the MAT or WST and subscales of the EORTC QLQ-H&N35. Significant but weak correlations were found between the MAT or WST and 4 subscales of the SWAL-QoL-NL. Weak to moderate correlations were found between the salivary flow test and GRIX at 3 and 6 months after treatment, with the highest correlation between salivary flow and xerostomia during the day (Spearman's rho =  - 0.441, p = 0.001)., Conclusion: The association between objective test outcomes and PROs is weak, indicating that these outcome measures provide different information about masticatory performance, swallowing, and salivary flow in patients with HNC., (© 2021. The Author(s).)

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.)

Objective: To gain insight into the level of unmet needs and limitations in physical health experienced by survivors of head and neck cancer, and to evaluate whether unmet needs in physical health and limitations in physical performance are associated., Materials and Methods: In this cross-sectional study, unmet needs were measured with Supportive Care Needs Surveys (SCNS-SF34, SCNS-HNC). Limitations in physical health were measured for maximal mouth opening, neck and shoulder function, hand grip strength and lower body strength, level of mobility and walking ability., Results: The SCNSs showed that 48% had a cancer generic unmet need and 46% had at least one HNC-specific unmet need. In total, 76% of sHNC had a cancer generic limitation in physical health and that 58% had an HNC-specific limitation in the mobility of neck and shoulders or maximum mouth opening. The domain of physical and daily living needs showed a weak association with lateral flexion of the neck to the left (R = -0.319; p = 0.024)., Conclusion: Survivors of HNC might benefit from the use of both SCNSs and physical performance measurements during usual care follow-up for early and optimal identification of unmet needs and limitations in physical health., (© 2021 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.)

Background: Dysphagia may occur in up to 44% of patients with head and neck cancer (HNC) treated with radiation therapy and up to 84% of patients treated with surgery. To test the extent of dysphagia, the 100 mL water swallow test (WST) was developed. In this study, reliability of the 100 mL WST was determined in patients with HNC and healthy subjects., Methods: Thirty-three patients and 40 healthy subjects performed the WST twice on the same day. To assess reliability, the intraclass correlation coefficient (ICC 2,1 ), standard error of measurement, smallest detectable change, and limits of agreement were calculated., Results: Good to excellent correlations were found for patients with HNC (number of swallows; ICC = 0.923, duration; ICC = 0.893), and excellent correlations for healthy subjects (number of swallows; ICC = 0.950, duration; ICC = 0.916)., Conclusion: The 100 mL WST has a good to excellent reliability in patients with HNC and healthy subjects., (© 2021 The Authors. Head & Neck published by Wiley Periodicals LLC.)

Background: Recognition of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA) has gained increasing attention in the past decade. The clinical assessment of mandibular range of motion characteristics is part of the recommended variables to detect TMJ involvement in children with JIA. The aim of this study was to explore explanatory variables for mandibular range of motion outcomes in children with JIA, with and without clinically established TMJ involvement, and in healthy children., Methods: This cross-sectional study included children with JIA and healthy children of age 6-18 years. Mandibular range of motion variables included active and passive maximum interincisal opening (AMIO and PMIO), protrusion, laterotrusion, dental midline shift in AMIO and in protrusion. Additionally, the TMJ screening protocol and palpation pain were assessed. Adjusted linear regression analyses of AMIO, PMIO, protrusion, and laterotrusion were performed to evaluate the explanatory factors. Two adjusted models were constructed: model 1 to compare children with JIA and healthy children, and model 2 to compare children with JIA with and without TMJ involvement., Results: A total of 298 children with JIA and 169 healthy children were included. Length was an explanatory variable for the mandibular range of motion excursions. Each centimeter increase in length increased AMIO (0.14 mm), PMIO (0.14 mm), and protrusion (0.02 mm). Male gender increased AMIO by 1.35 mm. Having JIA negatively influenced AMIO (3.57 mm), PMIO (3.71 mm), and protrusion (1.03 mm) compared with healthy children, while the discrepancy between left and right laterotrusion raised 0.68 mm. Children with JIA and TMJ involvement had a 8.27 mm lower AMIO, 7.68 mm lower PMIO and 0.96 mm higher discrepancy in left and right laterotrusion compared to healthy children., Conclusion: All mandibular range of motion items were restricted in children with JIA compared with healthy children. In children with JIA and TMJ involvement, AMIO, PMIO and the discrepancy between left and right laterotrusion were impaired more severely. The limitation in protrusion and laterotrusion was hardly clinically relevant. Overall, AMIO is the mandibular range of motion variable with the highest restriction (in millimeters) in children with JIA and clinically established TMJ involvement compared to healthy children.

Background: In children with juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) can be involved, resulting in dysfunction of the masticatory system. Bite force is one of the variables that reflects the function of the masticatory system. The aim of this study was to compare maximum bite force in children with JIA, with and without TMJ involvement and with healthy children., Methods: Children with JIA and healthy children between the ages 6 and 18 were included in this cross-sectional study. The clinical examination consisted of measuring the anterior maximum voluntary bite force (AMVBF), assessment of the TMJ screening protocol items and TMJ, masseter and temporal muscle palpation pain. Unadjusted linear regression analyses were performed to evaluate the explanatory factors for AMVBF. Two adjusted models were constructed with corrections for age and gender differences: model 1 to compare children with JIA and healthy children and model 2 to compare children with JIA with and without TMJ involvement., Results: In this cross-sectional study, 298 children with JIA and 169 healthy children participated. AMVBF was 24 Newton (N) lower in children with JIA, when compared with healthy children (95%CI: -35.5--12.4, p = .000). When children with JIA also had clinically established TMJ involvement, AMVBF was reduced 42 N (component JIA:-16.78, 95% CI -28.96--4.59, p = .007 and component TMJ involvement:-25.36, 95% CI -40.08--10.63, p = .001). Age and male gender increased AMVBF., Conclusion: Children with JIA had a reduction in the AMVBF compared with healthy children. In children with JIA and clinically established TMJ involvement, AMVBF was more reduced., (© 2021 John Wiley & Sons Ltd.)