Major Research Findings

Drug-induced tongue disorders are a growing concern for oral healthcare professionals due to the increasing global use of medication. 8 provides an overview of various drugs known to cause tongue disorders, highlighting the need for awareness among healthcare providers.

Neurogenic thoracic outlet syndrome (nTOS) is a condition that often requires surgical intervention, however, a robust evidence base for its effectiveness is lacking. 4 presents the first randomized clinical trial (STOPNTOS Trial) specifically designed to objectively evaluate the impact of thoracic outlet decompression (TOD) on nTOS.

Individuals undergoing long-term immunosuppressive therapy after organ or cell transplantation are more vulnerable than healthy individuals to developing oral cavity pathologies. 9 highlights the increased risk of oral cavity changes, including precancerous lesions, oral cancers, viral infections, fungal infections, drug-induced gingival overgrowth, stomatitis, and tongue disorders, among these patients.

Palifermin (Kepivance) is a recombinant biological agent approved for the treatment of oral mucositis, a painful side effect of high-dose chemotherapy and radiation, in patients with hematologic malignancies who require hematopoietic stem cell support. 13 provides a comprehensive review of the clinical use of palifermin, demonstrating its effectiveness in reducing the incidence, severity, and duration of severe oral mucositis, while also being well-tolerated.

Treatment Summary

8 offers a comprehensive overview of drug-induced tongue disorders, providing information about various tongue abnormalities that can be caused by medication.

3 systematically reviews the outcomes of different surgical approaches for neurogenic thoracic outlet syndrome (TOS), including transaxillary first rib excision (TAFRE), supraclavicular first rib excision with scalenectomy (SCFRE), and supraclavicular release leaving the first rib intact (SCR), and interprets treatment effects from a Bayesian perspective.

2 highlights the lack of rigorous scientific investigation leading to evidence-based management of thoracic outlet syndrome (TOS) despite numerous reports of both operative and non-operative interventions.

4 presents the first randomized clinical trial (STOPNTOS Trial) to objectively evaluate the effectiveness of thoracic outlet decompression (TOD) for neurogenic thoracic outlet syndrome (nTOS).

9 reports a higher susceptibility of organ and cell transplantation recipients receiving long-term immunosuppressive therapy to developing oral cavity pathologies, including precancerous lesions, oral cancers, viral infections, fungal infections, drug-induced gingival overgrowth, stomatitis, and tongue disorders.

13 demonstrates the effectiveness of palifermin (Kepivance) in treating oral mucositis, a complication of chemotherapy and radiation therapy, in patients with hematologic malignancies requiring hematopoietic stem cell support.

6 performs a meta-analysis to assess whether first rib resection (FRR), performed via a supraclavicular (SCFRR) or transaxillary (TAFRR) approach, is necessary for patients with neurogenic thoracic outlet syndrome (nTOS).

10 analyzes the structure, types, and volumes of dental care provided to adults with tongue disorders under the obligatory medical insurance program. The study revealed that treatment of tongue disorders within municipal dental polyclinics is practically non-existent, with only 3 out of 7 service types considered treatment manipulations.

5 presents a consensus statement on the management of neurogenic thoracic outlet syndrome (nTOS) by the European Association of Neurosurgical Societies' section of peripheral nerve surgery. The report emphasizes the lack of level 1 evidence for nTOS management and provides a consensus statement on nTOS treatment developed by experienced neurosurgeons.

7 examines thoracic outlet syndrome (TOS) in females, highlighting that while standard textbooks report a predominance of females (70%) in the TOS population, comparative studies on sex differences in presentation, treatment, and outcomes for various types of TOS are limited.

11 addresses the lack of clear anatomical resources in the literature, which has hindered research on the human tongue and delayed progress in diagnosing and treating tongue disorders. This report aims to bridge this gap by presenting the tongue's anatomy in various ways using serial axial images and computer-generated 3D models.

12 explores oral mucositis (OM), a debilitating side effect of high-dose chemotherapy and radiotherapy, particularly prevalent in patients with hematologic malignancies undergoing myeloablative therapy and autologous hematopoietic stem cell transplantation (HSCT). The study highlights the approval of palifermin (Kepivance) for both prevention and treatment of OM in Europe in 2005. Palifermin works at the epithelial level, protecting cells from damage and stimulating new cell growth, thus strengthening the mucosal barrier. The study discusses the shift in nursing practice from managing OM symptoms to preventing it.

14 investigates the potential of palifermin (recombinant human keratinocyte growth factor) to reduce oral mucosal injury caused by cytotoxic therapy, a complication of intensive chemotherapy and radiotherapy with no effective treatment.

1 presents a randomized trial comparing two surgical approaches for thoracic outlet syndrome (TOS): supraclavicular neuroplasty of brachial plexus (SNBP [no rib resection]) and transaxillary first rib resection (TFRR). The study focuses on the difference in outcomes between the two surgeries when pain is the dominant clinical problem.

Benefits and Risks

Benefits Summary

Provides a comprehensive overview of drug-induced tongue disorders, offering information about various tongue abnormalities caused by medication. 8

Systematically reviews outcomes of different surgical approaches for neurogenic thoracic outlet syndrome (TOS) and interprets treatment effects from a Bayesian perspective. 3

Presents the first randomized clinical trial (STOPNTOS Trial) to objectively evaluate the effectiveness of thoracic outlet decompression (TOD) for neurogenic thoracic outlet syndrome (nTOS). 4

Demonstrates the effectiveness of palifermin (Kepivance) in treating oral mucositis, a complication of chemotherapy and radiation therapy, in patients with hematologic malignancies requiring hematopoietic stem cell support. 13

Performs a meta-analysis to assess whether first rib resection (FRR), performed via a supraclavicular (SCFRR) or transaxillary (TAFRR) approach, is necessary for patients with neurogenic thoracic outlet syndrome (nTOS). 6

Risks Summary

Highlights the growing concern for oral healthcare professionals due to drug-induced tongue disorders, which are a side effect of increasing medication use. 8

Reports a higher susceptibility of organ and cell transplantation recipients receiving long-term immunosuppressive therapy to developing oral cavity pathologies, including precancerous lesions, oral cancers, viral infections, fungal infections, drug-induced gingival overgrowth, stomatitis, and tongue disorders. 9

Palifermin may cause adverse reactions, including rash, pruritus, erythema, edema, pain, fever, arthralgia, mouth or tongue disorders, and taste alteration. 12

Research Comparisons

Research Similarities

All of these studies emphasize the importance of understanding the treatment options and potential risks associated with specific medical conditions, such as tongue disorders and neurogenic thoracic outlet syndrome (TOS). They suggest that medical treatments can play a crucial role in managing these conditions and highlight the need for further research to evaluate treatment effectiveness.

Research Differences

These studies differ in terms of the conditions they investigate, the methods used, and the specific outcomes examined. 8 provides a comprehensive overview of drug-induced tongue disorders, while 3 , 4 , and 6 focus on clinical studies evaluating the effectiveness of different treatment approaches for neurogenic thoracic outlet syndrome (TOS). 9 centers around the risk of oral cavity pathologies in organ and cell transplantation recipients undergoing long-term immunosuppressive therapy. 13 , 12 , and 14 investigate the effectiveness and safety of palifermin for treating oral mucositis. These studies offer diverse perspectives on the treatment and risks associated with medical conditions, providing a more holistic understanding.

Consistency and Contradictions of Results

Many of these studies demonstrate the effectiveness of specific treatments for certain medical conditions. For instance, 13 shows that palifermin can reduce the incidence, severity, and duration of oral mucositis caused by chemotherapy and radiation. 4 suggests the effectiveness of thoracic outlet decompression (TOD) for neurogenic thoracic outlet syndrome (nTOS). However, 2 emphasizes the lack of rigorous scientific investigation leading to evidence-based management for thoracic outlet syndrome (TOS). The discrepancies between these studies highlight the need for further research and a deeper understanding of specific medical conditions, prompting further investigation.

Applying Research to Real-Life Situations: Considerations

These research findings can serve as valuable resources for physicians and healthcare professionals in choosing treatment options for specific medical conditions. They also provide information for patients to discuss potential risks and benefits of specific treatments with their doctors. It's important to remember that these research results might not apply to all individuals, and each patient's condition and needs should be considered when determining treatment. It is crucial to seek guidance from a physician and follow their instructions when implementing any treatment approach.

Limitations of Current Research

Many of these studies were conducted with limited numbers of patients, limiting the generalizability of their findings. Additionally, many of these studies did not investigate the long-term effects of specific treatments. Future research should involve larger patient populations and explore long-term outcomes.

Directions for Future Research

These studies unveil various opportunities for developing and improving treatments for medical conditions. Future research should focus on including larger patient populations, investigating long-term effects of specific treatments, and exploring preventive strategies for these conditions.

Conclusion

These studies offer valuable insights into medical conditions like drug-induced tongue disorders, neurogenic thoracic outlet syndrome (TOS), and oral mucositis. They provide information for patients to discuss potential risks and benefits of treatments with their doctors. It is crucial to recognize that treatment for these conditions is complex, requiring consideration of individual patient circumstances and needs. Consulting a physician for guidance and following their instructions when undergoing any treatment is paramount. Furthermore, these studies emphasize the ongoing need for research and a deeper understanding of these conditions, urging continued research efforts towards developing and improving effective treatments.

Treatment List

The following treatment keywords were extracted from the research papers for medical conditions like drug-induced tongue disorders, neurogenic thoracic outlet syndrome (TOS), and oral mucositis:

• Thoracic Outlet Decompression (TOD)
• Transaxillary First Rib Excision (TAFRE)
• Supraclavicular First Rib Excision with Scalenectomy (SCFRE)
• Supraclavicular Release (Leaving the First Rib Intact) (SCR)
• Palifermin (Kepivance)