Faculty Bibliography

Preservation of fertility is important to adolescent and young adult (AYA) survivors of cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total-body irradiation, radiation to the gonads, and chemotherapy regimens containing high-dose alkylators can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. The most effective and established means of preserving fertility in this population is embryo cryopreservation in women and sperm cryopreservation in men before the initiation of cancer-directed therapy. Cryopreservation of mature oocytes is also becoming more commonplace as methods of thawing become more sophisticated. The use of in vitro fertilization and intracytoplasmic sperm injection has added to the viability of sperm and oocyte cryopreservation. Cryopreservation and transplantation of gonadal tissue in both males and females remains experimental but continues to be evaluated. Hormonal suppression has not been shown to be effective in males but may have promise in females, although larger scale trials are needed to evaluate this. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the AYA population at the time of diagnosis. Given the competing demands of providing complicated and detailed information about cancer treatment, the evolving information related to fertility preservation, and the ethical issues involved, it may be preferable, where possible, to have a specialized team, rather than the primary oncologist, address these issues with AYA patients.

AIM: The aim of this unregistered evidence-based systematic review was to determine the state and quality of evidence on the effects of oral motor exercises (OME) on swallowing physiology, pulmonary health, functional swallowing outcomes, and drooling management in children with swallowing disorders. METHOD: A systematic search of 20 electronic databases was completed to identify relevant peer-reviewed literature published in English between 1960 and 2007. Experimental or quasi-experimental design studies examining OME as a treatment for children with swallowing disorders were appraised for methodological quality by two assessors and reviewed by a third. RESULTS: Sixteen studies of varying methodological quality were included. No study examining the effects of OME on pulmonary health in children was identified. The included studies incorporated a wide variety of OME, and mixed findings were noted across all of the outcomes targeted in this review. INTERPRETATION: Based on the results of this evidence-based systematic review, there is insufficient evidence to determine the effects of OME on children with oral sensorimotor deficits and swallowing problems. Well-designed studies are needed to provide clinicians with evidence that can be incorporated into the preferences of the client and the clinicians' knowledge of anatomy, physiology, and neurodevelopment in the management of this group of children.

OBJECTIVE/HYPOTHESIS: We hypothesize that the central response during swallowing rehabilitation is critical and may be exploited to maximize the therapeutic benefit. We seek to provide preliminary data regarding the neural networks associated with commonly employed rehabilitation strategies to increase our understanding of the neural bases underlying these maneuvers. STUDY DESIGN: Case series. METHODS: Ten healthy adults (five males, five females), ranging in age from 20 to 30 years (mean age = 25 years, SD = 2.5 years) with no previous history of neurologic illness or swallowing complaint were subjected to a single-trial functional magnetic resonance imaging (fMRI) paradigm. The experimental tasks consisted of three swallow maneuvers, dry swallow, Effortful swallow, and the Mendelsohn maneuver. RESULTS: Multiple regions including the cingulate gyrus, inferior frontal gyrus, insula, pre- and postcentral gyrus, inferior parietal lobe, superior frontal gyrus, supramarginal gyrus thalamus, were detected. The Effortful swallow, when compared to the dry swallow, elicited significant differential activation in the left superior temporal gyrus, left insula, left inferior parietal lobe, bilateral medial frontal gyrus, and right anterior cingulate. The Mendelsohn maneuver, when compared to the dry swallow, elicited significant activation in the bilateral postcentral gyrus, bilateral precentral gyrus, bilateral cingulate gyrus, bilateral medial frontal gyrus, left inferior parietal lobe, left supramarginal gyrus, and right insula. CONCLUSIONS: Our findings suggest that a single-trial design is sensitive to delineate a widespread neural network of activation in both hemispheres associated with rehabilitation tasks. Both the Effortful swallow and Mendelsohn maneuvers elicited significantly higher responses in regions related to swallowing, suggestive of enhanced cortical activation during these tasks

PURPOSE: To conduct an evidence-based systematic review and provide an estimate of the effects of oral motor interventions (OMIs) on feeding/swallowing outcomes (both physiological and functional) and pulmonary health in preterm infants. METHOD: A systematic search of the literature published from 1960 to 2007 was conducted. Articles meeting the selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality. RESULTS: Twelve studies were included and focused on 3 OMIs-nonnutritive sucking (NNS), oral/perioral stimulation, and NNS plus oral/perioral stimulation. Six studies addressed the effects of OMI on the feeding/swallowing physiology outcomes of feeding efficiency or sucking pressures. Ten studies addressed the functional feeding/swallowing outcomes of oral feeding or weight gain/growth. No studies reported data on pulmonary health. Methodological quality varied greatly. NNS alone and with oral/perioral stimulation showed strong positive findings for improvement in some feeding/swallowing physiology variables and for reducing transition time to oral feeding. Prefeeding stimulation showed equivocal results across the targeted outcomes. None of the OMIs provided consistent positive results on weight gain/growth. CONCLUSIONS: Although some OMIs show promise for enhancing feeding/swallowing in preterm infants, methodological limitations and variations in results across studies warrant careful consideration of their clinical use

Osteoradionecrosis (ORN) of the mandible is a significant complication of radiation therapy for head and neck cancer. In this condition, bone within the radiation field becomes devitalized and exposed through the overlying skin or mucosa, persisting as a non-healing wound for three months or more. In 1926, Ewing first recognized the bone changes associated with radiation therapy and described them as "radiation osteitis". In 1983, Marx proposed the first staging system for ORN that also served as a treatment protocol. This protocol advocated that patients whose disease progressed following conservative therapy (hyperbaric oxygen (HBO), local wound care, debridement) were advanced to a radical resection with a staged reconstruction utilizing a non-vascularized bone graft. Since the introduction of Marx's protocol, there have been advances in surgical techniques (i.e. microvascular surgery), as well as in imaging techniques, which have significantly impacted on the diagnosis and management of ORN. High resolution CT scans and orthopantamograms have become a key component in evaluating and staging ORN, prior to formulating a treatment plan. Patients can now be stratified based on imaging and clinical findings, and treatment can be determined based on the stage of disease, rather than determining the stage of disease based on a patient's response to a standardized treatment protocol. Reconstructions are now routinely performed immediately after resection of the diseased tissue rather than in a staged fashion. Furthermore, the transfer of well-vascularized hard and soft tissue using microvascular surgery have brought the utility of HBO treatment in advanced ORN into question.