Masticatory function and related factors after oral oncological treatment: A 5-year prospective study

Reilly J de Groot, Jan-Willem Wetzels, Matthias A W Merkx, Antoine J W P Rosenberg, Anton F J de Haan, Andries van der Bilt, Jan H Abbink, Caroline M Speksnijder, Reilly J de Groot, Jan-Willem Wetzels, Matthias A W Merkx, Antoine J W P Rosenberg, Anton F J de Haan, Andries van der Bilt, Jan H Abbink, Caroline M Speksnijder

Abstract

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.

Keywords: bite force; head and neck neoplasms; mastication; mixed model analysis; prospective cohort.

© 2018 The Authors. Head & Neck published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Flowchart showing the number of subjects (n) at each assessment stage and the average time since the primary oncological treatment. TFM, Tongue/Floor of the Mouth
Figure 2
Figure 2
Visual presentation of the significant variables and their coefficients of the estimated mixing ability index (MAI) formula. Variables without an interaction with time are presented left of the y‐axis. Impact on the intercept (MAI = 23.9) is shown. The variables without interaction with the assessment moment are shown separately. The continuous variables (MMO, OU, MBF) are presented as the impact for the mean values of those variables. The mean number of occlusal units was 2.9 and the mean MMO was 52 mm. Mean MBF differs per assessment moment and is 326 N before intervention, 145 N directly after intervention, 193 N at 6 months, 194 N at 1 year, and 283 N at 5 years. Factors with positive outcomes increase the mixing ability outcome, reflecting a deterioration of masticatory performance; for convenience, the y‐axis has been inverted. *Reference category in mixed model, equals 0. D, Dentate; ED, edentulous; FD, full denture; FDI, full denture on implants; max: maxilla; Mand, mandible; MBF, maximum bite force; MAI, mixing ability index; MMO, maximum mouth opening; OU, occlusal units; TFM, tongue and floor of the mouth
Figure 3
Figure 3
Estimates of mixing ability index (MAI) and SE rendered using a mixed‐model analysis. The y‐axis inverted for more values entered into the model was that of the mean patient in the cohort, calculated using a least‐squares method. The outcome presented is divided by the location of the primary tumor over a 5‐year follow up. Differences between groups are presented in the table under the figure. MAI ranges from 0 to 30, where 0 represents the best and 30 the worst possible outcome; thus for convenience, the y‐axis has been inverted. *A significant difference (P < .05) between that and the next assessment; † A significant difference (P < .05) between 2 groups at the same assessment time point, calculated using a restricted maximum likelihood approach. Only the assessment at 5 years after treatment of the maxillary tumor group was not significantly different from the control group (P = .27). Max, Maxilla; Mand, Mandible; TFM, Tongue/Floor of the Mouth

References

    1. Moroi HH, Okimoto K, Terada Y. The effect of an oral prosthesis on the quality of life for head and neck cancer patients. J Oral Rehabil. 1999;26:265‐273.
    1. Burlage FR, Coppes RP, Meertens H, Stokman MA, Vissink A. Parotid and submandibular/sublingual salivary flow during high dose radiotherapy. Radiother Oncol. 2001;61(3):271‐274.
    1. Specht L. Oral complications in the head and neck radiation patient. Support Care Cancer. 2002;10(1):36‐39.
    1. Korfage A, Schoen PJ, Raghoebar GM, et al. Five‐year follow up of oral functioning and quality of life in patients with oral cancer with implant‐retained mandibular overdentures. Head Neck. 2011;33:831‐839.
    1. Wells M, Swartzman S, Lang H, et al. Predictors of quality of life in head and neck cancer survivors up to 5 years after end of treatment: a cross‐sectional survey. Support Care Cancer. 2016;24(6):2463‐2472.
    1. Morimata J, Otomaru T, Murase M, Haraguchi M, Sumita Y, Taniguchi H. Investigation of factor affecting health‐related quality of life in head and neck cancer patients. Gerodontology. 2013;30(3):194‐200.
    1. Speksnijder CM, van der Glas HW, van der Bilt A, van Es RJJ, van der Rijt E, Koole R. Oral function after oncological intervention in the oral cavity: a retrospective study. J Oral Maxillofac Surg. 2010;68(6):1231‐1237.
    1. Wetzels JW, Koole R, Meijer GJ, de Haan AFJ, Merkx MAW, Speksnijder CM. Functional benefits of implants placed during ablative surgery: a 5‐year prospective study on the prosthodontic rehabilitation of 56 edentulous oral cancer patients. Head Neck. 2016;38(S1):E2103‐E2111.
    1. Thexton AJ. Mastication and swallowing: an overview. Br Dent J. 1992;173(6):197‐206.
    1. Hatch JP, Shinkai RSA, Sakai S, Rugh JD, Paunovich ED. Determinants of masticatory performance in dentate adults. Arch Oral Biol. 2001;46(7):641‐648.
    1. Curtis DA, Plesh O, Miller AJ, et al. A comparison of masticatory function in patients with or without reconstruction of the mandible. Head Neck. 1997;19(4):287‐296.
    1. Ammajan RR, Joseph R, Rajeev R, Choudhary K, Vidhyadharan K. Assessment of periodontal changes in patients undergoing radiotherapy for head and neck malignancy: a hospital‐based study. J Cancer Res Ther. 2013;9(4):630‐637.
    1. Wetzels JGH, Merkx MAW, de Haan AFJ, Koole R, Speksnijder CM. Maximum mouth opening and trismus in 143 patients treated for oral cancer: a 1‐year prospective study. Head Neck. 2014;36(12):1754‐1762.
    1. Ono T, Kohda H, Hori K, Nokubi T. Masticatory performance in postmaxillectomy patients with edentulous maxillae fitted with obturator prostheses. Int J Prosthodont. 2007;20(2):145‐150.
    1. Namaki S, Matsumoto M, Ohba H, Tanaka H, Koshikawa N, Shinohara M. Masticatory efficiency before and after surgery in oral cancer patients: comparative study of glossectomy, marginal mandibulectomy and segmental mandibulectomy. J Oral Sci. 2004;46(2):113‐117.
    1. Reitemeier B, Unger M, Richter G, Ender B, Range U, Markwardt J. Clinical test of masticatory efficacy in patients with maxillary/mandibular defects due to tumors. Onkologie. 2012;35(4):170‐174.
    1. Speksnijder CM, Abbink JH, van der Glas HW, Janssen NG, Van Der Bilt A. Mixing ability test compared with a comminution test in persons with normal and compromised masticatory performance. Eur J Oral Sci. 2009;117(5):580‐586.
    1. Fritz AG. International Classification of Diseases for Oncology (ICD‐O). Geneva: World Health Organization; 2000:240.
    1. Patel SG, Shah JP. TNM staging of cancers of the head and neck: striving for uniformity among diversity. CA Cancer J Clin. 2005;55(4):242‐258.
    1. van der Bilt A, Speksnijder CM, de Liz Pocztaruk R, Abbink JH. Digital image processing versus visual assessment of chewed two‐colour wax in mixing ability tests. J Oral Rehabil. 2012;39(1):11‐17.
    1. Slagter AP, Bosman F, van der Glas HW, van der Bilt A. Human jaw‐elevator muscle activity and food comminution in the dentate and edentulous state. Arch Oral Biol. 1993;38(3):195‐205.
    1. McCord J, Grant A. Registration: stage II‐‐intermaxillary relations. Br Dent J. 2000;188:601‐606.
    1. Witter DJ, Creugers NHJ, Kreulen CM, de Haan AFJ. Occlusal stability in shortened dental arches. J Dent Res. 2001;80(2):432‐436.
    1. Beumer J Jr, Curtis T, Marunick M. Maxillofacial Rehabilitation; Prosthodontic and Surgical Considerations. St Louis, Tokyo: Ishiyaku EuroAmerica; 1996:240‐324.
    1. Stenson K, MacCracken E, List MA, et al. Swallowing function in patients with head and neck cancer prior to treatment. Arch Otolaryngol Head Neck Surg. 2016;126:371‐377.
    1. Nicoletti G, Soutar DS, Jackson MS, Wrench AA, Robertson G. Chewing and swallowing after surgical treatment for oral cancer: functional evaluation in 196 selected cases. Plast Reconstr Surg. 2004;114(2):329‐338.
    1. Loewen IJ, Boliek CA, Harris J, Seikaly H, Rieger JM. Oral sensation and function: a comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck. 2010;32(1):85‐95.
    1. Kosaka T, Ono T, Kida M, et al. A multifactorial model of masticatory performance: the Suita study. J Oral Rehabil. 2016;43(5):340‐347.
    1. Yamashita S, Sakai S, Hatch JP, Rugh JD. Relationship between oral function and occlusal support in denture wearers. J Oral Rehabil. 2000;27(10):881‐886.
    1. van der Bilt A. Assessment of mastication with implications for oral rehabilitation: a review. J Oral Rehabil. 2011;38(10):754‐780.
    1. van der Bilt A, Olthoff LW, Bosman F, Oosterhaven SP. Chewing performance before and after rehabilitation of post‐canine teeth in man. J Dent Res. 1994;73(11):1677‐1683.
    1. Sumida T, Kobayashi Y, Ishikawa A, et al. Bite force and masticatory performance using implant‐supported overdentures after treatment of mandibular cancer. Anticancer Res. 2016;36(8):4077‐4080.
    1. Roumanas ED, Chang T‐L, Beumer J. Use of osseointegrated implants in the restoration of head and neck defects. J Calif Dent Assoc. 2006;34(9):711‐718.
    1. Korfage A, Schoen PJ, Raghoebar GM, Roodenburg JLN, Vissink A, Reintsema H. Benefits of dental implants installed during ablative tumour surgery in oral cancer patients: a prospective 5‐year clinical trial. Clin Oral Implants Res. 2010;21(9):971‐979.
    1. Dijkstra PU, Kalk WWI, Roodenburg JLN. Trismus in head and neck oncology: a systematic review. Oral Oncol. 2004;40(9):879‐889.
    1. Speksnijder CM, van der Bilt A, Abbink JH, Merkx MAW, Koole R. Mastication in patients treated for malignancies in tongue and/or floor of mouth: a 1‐year prospective study. Head Neck. 2011;33(7):1013‐1020.
    1. Inukai M, John MT, Igarashi Y, Baba K. Association between perceived chewing ability and oral health‐related quality of life in partially dentate patients. Health Qual Life Outcomes. 2010;8(1):118.
    1. Prado DG d A, Berretin‐Felix G, Migliorucci RR, et al. Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial. J Appl Oral Sci. 2018;26(0):e20170164.
    1. Vissink A, Burlage F, Spijkervet F, Jansma J, Coppes R. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213‐225.
    1. Matsuo K, Palmer JB. Coordination of mastication, swallowing and breathing. Jpn Dent Sci Rev. 2009;45(1):31‐40.
    1. Speksnijder CM, Van Der Bilt A, Van Der Glas HW, Koole R, Merkx MAW. Tongue function in patients treated for malignancies in tongue and/or floor of mouth; a one year prospective study. Int J Oral Maxillofac Surg. 2011;40(12):1388‐1394.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir