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  • 1.
    Bodin, Ingrid
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Intraoral sensation before and after radiotherapy and surgery for oral and pharyngeal cancer.2004In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 26, no 11, p. 923-929Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients with unilateral oral or pharyngeal cancer often receive bilateral radiotherapy because of the potential for metastases. Because postoperative sequelae are evident on the tumor side, to date little attention has been paid to sensory alterations after radiotherapy on the healthy, nontumor side. The objective of this study was to investigate possible sensory alterations. METHODS: Intraoral sensation was tested bilaterally at standardized sites in 27 patients and 20 controls. Preoperative radiotherapy was bilateral in 19 patients and unilateral in eight patients. Patients were tested before treatment, after radiotherapy, and after surgery at 6 months and 1 year. Comparisons were performed interindividually and intraindividually and between groups. RESULTS: A delayed deterioration of sensation was revealed on the nontumor side 6 months after radiotherapy. There was no recovery 1 year after treatment. CONCLUSIONS: Intraoral sensation cannot be evaluated directly after radiotherapy. It is plausible that sensory deterioration after radiotherapy has an impact on functional rehabilitation after tumor treatment.

  • 2. Brown, J
    et al.
    Jacobs, R
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Lindh, C
    Baksi, G
    Schulze, D
    Schulze, R
    Basic training requirements for the use of dental CBCT by dentists: a position paper prepared by the European Academy of DentoMaxilloFacial Radiology2014In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 43, no 1, article id 20130291Article in journal (Refereed)
    Abstract [en]

    Cone beam CT (CBCT) is a relatively new imaging modality, which is now widely available to dentists for examining hard tissues in the dental and maxillofacial regions. CBCT gives a three-dimensional depiction of anatomy and pathology, which is similar to medical CT and uses doses generally higher than those used in conventional dental imaging. The European Academy of DentoMaxilloFacial Radiology recognizes that dentists receive training in two-dimensional dental imaging as undergraduates, but most of them have received little or no training in the application and interpretation of cross-sectional three-dimensional imaging. This document identifies the roles of dentists involved in the use of CBCT, examines the training requirements for the justification, acquisition and interpretation of CBCT imaging and makes recommendations for further training of dentists in Europe who intend to be involved in any aspect of CBCT imaging. Two levels of training are recognized. Level 1 is intended to train dentists who prescribe CBCT imaging, such that they may request appropriately and understand the resultant reported images. Level 2 is intended to train to a more advanced level and covers the understanding and skills needed to justify, carry out and interpret a CBCT examination. These recommendations are not intended to create specialists in CBCT imaging but to offer guidance on the training of all dentists to enable the safe use of CBCT in the dentoalveolar region.

  • 3.
    Garoff, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Elias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Clinical Sciences, Karolinska Insititutet, Danderyds hospital, Stockholm.
    Carotid calcification in panoramic radiographs: radiographic appearance and the degree of carotid stenosis2016In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 45, no 6, article id 20160147Article in journal (Refereed)
    Abstract [en]

    Objectives: Approximately 7% of patients examined with panoramic radiographs (PRs) for odontological reasons, and with incidental findings of carotid artery calcification (CAC), have significant (≥50%) carotid stenosis (SCS). The aim of this study was to determine if the radiographic appearance of CACs in PRs could be categorized such that we could improve the positive-predictive value (PPV) for SCS detection.

    Methods: This cross-sectional study included 278 patients with CACs identified by PRs, 127 with SCS and 151 without SCS. CACs were categorized based on the following appearances: (1) single, (2) scattered or (3) vessel-outlining. Correlates were derived for each category according to positivity or not for SCS in the corresponding neck sides. For a representative adult population (in dentistry) presenting with CACs in PRs, PPVs for SCS prediction were then calculated for three subgroups based on different combinations of appearances (2) and/or (3).

    Results: Vessel-outlining CACs corresponded to 65% of neck sides with SCS vs 47% without SCS (p < 0.001). Single CACs corresponded to 15% of neck sides with SCS vs 27% without SCS (p = 0.006). Scattered CACs corresponded to 20% of neck sides with SCS vs 26% without SCS (p  = 0.127). In the representative population, the PPVs for SCS detection were comparable (7.2–7.8%) for all three subgroups and when the presence of a CAC is the sole criterion (7.4%).

    Conclusions: Stratifying the radiographic appearance of CACs in PRs does not improve the PPV for SCS detection. Whether different radiographic appearances are associated with future risk of stroke, or other cardiovascular events, remains unknown.

  • 4.
    Garoff, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Elias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Calcium quantity in carotid plaques: detection in panoramic radiographs and association with degree of stenosis2015In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 120, no 2, p. 269-274Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine calcium volume in extirpated carotid plaques, analyze correlations between calcium volume and degree of stenosis, and analyze whether calcium volume influences the possibility of detecting stenosis in panoramic radiographs.

    STUDY DESIGN: Ninety-seven consecutive patients with ultrasonography-verified carotid stenosis were examined with panoramic radiography before surgery. Extirpated carotid plaques (n = 103) were analyzed for calcium volume by cone beam computed tomography (CBCT). Panoramic radiographs were analyzed for carotid calcifications.

    RESULTS: The median calcium volume was 45 mm(3) (first quartile subtracted from the third quartile [IQR], 14-98 mm(3)). We observed no correlation between calcium volume and degree of stenosis. Seventy-eight stenoses were situated within the region included in the panoramic radiographs, and their volumes ranged from 0 to 509 mm(3). Of these, 99% revealed carotid calcifications on panoramic radiographs.

    CONCLUSIONS: We found no association between calcium volume and degree of carotid stenosis. Calcium volume did not influence the possibility of detecting carotid calcifications in panoramic radiographs.

  • 5.
    Garoff, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Johansson, Elias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Detection of calcifications in panoramic radiographs in patients with carotid stenoses ≥50%2014In: Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, ISSN 1079-2104, E-ISSN 1528-395X, Vol. 117, no 3, p. 385-391Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Carotid stenoses ≥50% are associated with increased risk for stroke that can be reduced by prophylactic carotid endarterectomy (CEA). Calcifications in arteries can be detected in panoramic radiographs (PRs). In a cross-sectional study, we analyzed (1) extirpated plaques for calcification, (2) how often PRs disclosed calcified plaques, (3) how often patients with stenoses ≥50% presented calcifications in PRs, and (4) the additional value of frontal radiographs (FRs).

    STUDY DESIGN: Patients (n = 100) with carotid stenosis ≥50% were examined with PRs and FRs before CEA. Extirpated carotid plaques were radiographically examined (n = 101).

    RESULTS: It was found that 100 of 101 (99%) extirpated plaques were calcified, of which 75 of 100 (75%) were detected in PRs; 84 of 100 (84%) patients presented carotid calcifications in the PRs, in 9.5% contralateral to the stenosis ≥50%.

    CONCLUSIONS: Carotid calcifications are seen in PRs in 84% of patients with carotid stenosis ≥50%, independent of gender. FRs do not contribute significantly to this identification.

  • 6.
    Gustafsson, Nils
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ahlqvist, Jan B.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Department of Clinical Sciences, Karolinska Institutet Danderyds Hospital, Stockholm, Sweden..
    Buhlin, Kare
    Gustafsson, Anders
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Calcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study2018In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 125, no 2, p. 199-205Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this case-control study was to investigate whether patients with a first myocardial infarction (MI) had a higher prevalence of calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs) than age-, gender-, and residential area-matched controls without MI. Study Design. Six hundred ninety-six cases with a first MI and 696 controls were included in this substudy of the Swedish multicentre PAROKRANK study. All participants underwent panoramic radiography, and the PRs were evaluated for CCAAs. Results. The prevalence of CCAAs detected by PR was 33.8% (235 of 696) in cases and 27.6% (192 of 696) in controls (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.44; P = .012). Among males, 32.7% of cases (184 of 562) and 26.5% of controls (149 of 562) displayed CCAAs on PRs (OR 1.24; 95% CI 1.03-1.48; P = .022). Among both genders, bilateral CCAAs were significantly more common among cases than among controls (P = .002). Conclusions. Cases with recent MIs had a significantly higher prevalence of CCAAs on PRs compared with controls without MIs. This difference between groups was more pronounced for bilateral CCAAs. These findings supported the hypothesis that CCAA detection could serve as a risk indicator for future MIs.

  • 7.
    Gustafsson, Nils
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Long-term skill improvement among general dental practitioners after a short training programme in diagnosing calcified carotid artery atheromas on panoramic radiographs2019In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 23, p. 54-61Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To study general dental practitioners (GDPs) ability to detect calcified carotid artery atheromas (CCAAs) in panoramic radiographs (PRs) and if their diagnostic accuracy in long term is improved after a short training programme.

    METHODS: Fourteen GDPs had their diagnostic accuracy regarding CCAA in PR assessed at baseline, 2 weeks and 1 year after training. Comparison was made with a reference standard based on consensus results from two experienced oral and maxillofacial radiologists. At each session, 100 radiographs were assessed individually by the GDPs. After the baseline assessment, the GDPs participated in a 2-hour training programme comprising a lecture and diagnostic training by calibration. The GDPs results before and after training were compared, as well as between follow-up sessions.

    RESULTS: A significant improvement in diagnostic accuracy was observed with increased sensitivity (from 41.8% to 55.7%, P = 0.02) without a significant decrease in specificity (from 87.2% to 86.7%, P = 0.87). The Kappa values also increased (from 0.66 to 0.71, P = 0.04). At 1-year follow-up, the improvement compared to baseline remained significant. There were no significant changes between the 2-week and 1-year follow-up assessment.

    CONCLUSION: A short training programme can significantly and sustainable improve GDPs diagnostic accuracy regarding CCAA.

  • 8.
    Holmlund, Thorbjörn
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Franklin, Karl A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindqvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Larsson, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Sahlin, C.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Tonsillectomy in adults with obstructive sleep apnea2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, p. 161-161Article in journal (Other academic)
  • 9.
    Holmlund, Thorbjörn
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Franklin, Karl A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Lindqvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Larsson, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Sahlin-Ingridsson, Carin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Tonsillectomy in adults with obstructive sleep apnea2016In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 126, no 12, p. 2859-2862Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis To study whether tonsillectomy is effective on obstructive sleep apnea (OSA) in adults with large tonsils. Study Design A multicenter prospective interventional study. Methods The study comprised 28 patients with OSA, an apnea-hypopnea index of > 10, large tonsils (Friedman tonsil size 3 and 4), and age 18 to 59 years. They were derived from 41 consecutive males and females with large tonsils referred for a suspicion of sleep apnea to the ear, nose, and throat departments in Umea, Skelleftea, and Sunderbyn in northern Sweden. The primary outcome was the apnea-hypopnea index, measured with polygraphic sleep apnea recordings 6 months after surgery. Secondary outcomes included daytime sleepiness, as measured with the Epworth Sleepiness Scale, and swallowing function, using video-fluoroscopy. Results The apnea-hypopnea index was reduced from a mean of 40 units per hour (95% confidence interval [CI] 28-51) to seven units per hour (95% CI 3-11), P < 0.001, at the 6-month follow-up after surgery. The apnea-hypopnea index was reduced in all patients and 18 (64%) were cured. The Epworth Sleepiness Scale was reduced from a mean of 11 (95% CI 8-13) to 6.0 (95% CI 4-7), P < 0.001. A swallowing dysfunction was found in seven of eight investigated patients before surgery. Of those, swallowing function improved in five patients after surgery, whereas no one deteriorated. Conclusion Tonsillectomy may be effective treatment for adult patients with OSA and large tonsils. Tonsillectomy may be suggested for adults with OSA and large tonsils. Level of Evidence 4.

  • 10.
    Holmlund, Thorbjörn
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Franklin, Karl A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Effects of Radiofrequency versus Sham Surgery of the Soft Palate on Daytime Sleepiness2014In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 124, no 10, p. 2422-2426Article in journal (Refereed)
    Abstract [en]

    Objectives/Hypothesis: To evaluate the effect of radiofrequency surgery of the soft palate on daytime sleepiness in snoring men with mild or no sleep apnea Study design: Randomized controlled trial Methods: Thirty-five men were recruited from consecutive patients referred to the Ear, Nose and Throat Clinic due to snoring and complaints of daytime sleepiness. The inclusion criteria were an apnea-hypopnea index of ≤ 15, male gender and age 18-65 years. Patients were randomized to either radiofrequency or sham surgery of the soft palate. All but one chose and received the option of three treatments. All patients participated in a follow-up including an overnight sleep apnea recording and questionnaires 12 months after the last treatment. The primary outcome was daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) and other questionnaires. Secondary outcomes were effects on the apnea-hypopnea index and subjective snoring. Results: Thirty-two of 35 patients, 19 of 20 in the radiofrequency surgery group and 13 of 15 in the sham surgery group, completed the study. No differences between the two groups in relation to the ESS or apnea-hypopnea index were found at follow-up. Conclusion: Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no sleep apnea, one year after surgery.

  • 11.
    Hägglund, Patricia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Fält, Anna
    Hägg, Mary
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Clinical Sciences, Karolinska Institutet Danderyds Hospital, Stockholm, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Swallowing dysfunction as risk factor for undernutrition in older people admitted to Swedish short-term care: a cross-sectional study2019In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 31, no 1, p. 85-94Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Swallowing dysfunction and risk of undernutrition increase the risk of pneumonia, morbidity, and mortality. Short-term care is an unexplored care context, where many older people stay yearly.

    AIM: This cross-sectional study aimed to describe and analyze the relationship between swallowing dysfunction and risk of undernutrition among older people in short-term care, including potential gender-related differences.

    METHODS: In total, 391 people (209 women), aged ≥ 65 years (median age 84 years) and admitted to short-term care in five Swedish counties participated. They went through a timed water swallow test to assess swallowing dysfunction, including abnormal swallowing capacity and signs of aspiration (i.e., cough and voice change). Risk for undernutrition was assessed using the Minimal Eating Observation and Nutrition Form-version II.

    RESULTS: Swallowing dysfunction was observed in 248 of 385 (63%) participants, including abnormal swallowing capacity in 213 of 385 (55%) and aspiration signs in 127 of 377 (34%). Abnormal swallowing capacity was more frequent among women (p = 0.030), whereas men with normal swallowing capacity exhibited signs of aspiration more frequently (cough p = 0.038, voice change p = 0.004). Risk of undernutrition was found in 91 of 390 (23%) participants, more frequently among women (p = 0.007). A logistic regression model revealed an increased risk of undernutrition among older people with abnormal swallowing capacity (OR 1.74, 95% CI 1.04-2.92, p = 0.034).

    CONCLUSIONS: The high prevalence of swallowing dysfunction and risk of undernutrition highlight the need for a systematic screening program and feasible treatment to improve swallowing function for adequate and safe food intake among older people in short-term care.

    CLINICAL TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov on July 4, 2016, under NCT02825927.

  • 12.
    Hägglund, Patricia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Hägg, Mary
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Effects of oral neuromuscular training on swallowing dysfunction among older people in intermediate care - a cluster randomized, controlled trialManuscript (preprint) (Other academic)
  • 13.
    Hägglund, Patricia
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Susanne, Koistinen
    Olai, Lena
    Ståhlnacke, Katri
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Older people with swallowing dysfunction and poor oral health are at greater risk of early death2019In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528Article in journal (Refereed)
    Abstract [en]

    Objectives: We investigated the associations between swallowing dysfunction, poor oral health and mortality among older people in intermediate care in Sweden.

    Methods: This prospective cohort study investigated 391 older people in 36 intermediate care units (clusters). Swallowing function was assessed with the timed water swallow test (TWST), and oral health with the revised oral assessment guide (ROAG) at baseline. Data were collected on age, sex, education level, multimorbidity, cognitive impairment, care dependency and body mass index (BMI). Time to mortality was recorded during the following year. The mixed effects Cox regression model with cluster as a random factor was used to estimate hazards ratios (HR) with 95% confidence intervals (CI).

    Results: The median age of the participants was 84 years (interquartile range [IQR]: 11), and 53.3% were females. Mortality within one year was 25.1%. In the adjusted model, swallowing dysfunction and poor oral health were both independently associated with mortality (adjusted HR [aHR]: 1.67, 95% CI 1.02‐2.75; P = .041 and aHR: 1.98, 95% CI 1.07‐3.65; P = .029, respectively). Participants with combined swallowing dysfunction and poor oral health showed the highest mortality (35.0%) and 2.6 (95% CI 1.15‐5.89; P = .022) times higher mortality risk than those with normal swallowing function and good oral health (13.0%).

    Conclusions: Swallowing dysfunction and poor oral health were identified as independent risk factors for mortality in older people in intermediate care. Although further studies are required to verify these findings, they suggest that systematic assessment of swallowing function and oral health status should be performed for care considerations.

  • 14.
    Ibrahimi, Pranvera
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jashari, Fisnik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Carotid ultrasound accurately detects arterial calcification quantified by cone beam computed tomography2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, no Supplement 1, Meeting abstract P3519, p. 636-636Article in journal (Other academic)
  • 15.
    Isberg, A
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring-Jäghagen, E
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dahlström, M
    Dahlqvist, A
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Persistent dysphagia after laser uvulopalatoplasty: a videoradiographic study of pharyngeal function.1998In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 118, no 6, p. 870-874Article in journal (Refereed)
    Abstract [en]

    In a follow-up study of 79 patients two years after laser uvulopalatoplasty 21 (27%) reported persistent postoperative dysphagia, with aspiration symptoms in 22%. None of the patients had suffered from recurrent pneumonia. A total of 4% of the patients regretted the treatment because of their dysphagia problems. The objective of this study was to examine oral and pharyngeal function videoradiographically during swallowing in the patients with persistent dysphagia, to determine whether the subjective symptoms of dysphagia correlated with objective signs of pharyngeal dysfunction. Pharyngeal function during swallowing was deviant in 76% of the dysphagic patients. In 52% of the dysphagic patients premature leakage of bolus down to different levels of the pharynx, from the tongue base to sinus piriformis, was observed before the swallowing reflex was elicited. In the dysphagic patients substantial bolus retention was observed on the epiglottis or in the valleculae alter the propagation wave had passed (43%) as well as epiglottal dysmotility (24%). Of the dysphagic patients, 10% could not avoid aspiration during the examination. These findings could explain the symptoms reported by the patients.

  • 16.
    Jashari, Fisnik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Ibrahimi, Pranvera
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Johansson, Elias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology.
    Jäghagen, Eva Levring
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Atherosclerotic Calcification Detection: A Comparative Study of Carotid Ultrasound and Cone Beam CT2015In: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 16, no 8, p. 19978-19988Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: Arterial calcification is often detected on ultrasound examination but its diagnostic accuracy is not well validated. The aim of this study was to determine the accuracy of carotid ultrasound B mode findings in detecting atherosclerotic calcification quantified by cone beam computed tomography (CBCT).

    METHODS: We analyzed 94 carotid arteries, from 88 patients (mean age 70 ± 7 years, 33% females), who underwent pre-endarterectomy ultrasound examination. Plaques with high echogenic nodules and posterior shadowing were considered calcified. After surgery, the excised plaques were examined using CBCT, from which the calcification volume (mm3) was calculated. In cases with multiple calcifications the largest calcification nodule volume was used to represent the plaque. Carotid artery calcification by the two imaging techniques was compared using conventional correlations.

    RESULTS: Carotid ultrasound was highly accurate in detecting the presence of calcification; with a sensitivity of 88.2%. Based on the quartile ranges of calcification volumes measured by CBCT we have divided plaque calcification into four groups: <8; 8-35; 36-70 and >70 mm3. Calcification volumes ≥8 were accurately detectable by ultrasound with a sensitivity of 96%. Of the 21 plaques with <8 mm3 calcification volume; only 13 were detected by ultrasound; resulting in a sensitivity of 62%. There was no difference in the volume of calcification between symptomatic and asymptomatic patients.

    CONCLUSION: Carotid ultrasound is highly accurate in detecting the presence of calcified atherosclerotic lesions of volume ≥8 mm3; but less accurate in detecting smaller volume calcified plaques. Further development of ultrasound techniques should allow better detection of early arterial calcification.

  • 17.
    Johansson, Elias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Meimermondt, Amanda
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Carotid calcifications on panoramic radiographs: a 5-year follow-up study2015In: Oral surgery, oral medicine, oral pathology and oral radiology, ISSN 2212-4403, E-ISSN 2212-4411, Vol. 120, no 4, p. 513-520Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to determine whether people with calcifications in the area of the carotid arteries on panoramic radiographs (CALPANs) have an increased prevalence of vascular risk factors or an increased risk of future vascular events. Materials and Methods. We included 113 consecutive patients with CALPANs and 116 gender- and age-matched controls without CALPANs. Vascular risk factors were generally known in the study population, since it was recorded in a population-based community-screening program. Results. Patients with CALPANs had a higher prevalence of vascular risk factors than controls independent of previous vascular events. During the 5.4-year follow-up, patients with CALPANs had a higher risk of a combined endpoint of vascular events (5.6%/yr) compared with the controls (2.4%/yr) (P = .004 by log rank test; unadjusted hazard ratio (HR) 2.4; 95% CI 1.3-4.3). This difference was not significant when previous vascular events and risk factors were taken into account (adjusted HR; 1.2; 95% CI 0.6-2.3; P = .62; Cox regression). Conclusions. People with CALPANs are very likely to have vascular risk factors, but these factors might be unknown when CALPANs are detected. Accordingly, patients with CALPANs should be advised to have their vascular risk factors regularly checked in order to receive advice on preventive lifestyle modifications and medical treatment when indicated. However, it remains unknown whether CALPANs add information about the independent risk of future vascular events. Therefore, further studies are warranted to investigate whether the detection of CALPANs indicates a need for additional or more intense vascular treatment.

  • 18.
    Johansson, Elias P
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ahlqvist, Jan
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Garoff, Maria
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Karp, Kjell
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study2011In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, no 44, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background: Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications. Methods: This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy. Results: Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5%) had a carotid stenosis - not significant over the 5% pre-specified threshold (p = 0.232, Binomial test). However, there was a significant sex difference (p = 0.008), as all stenoses were found in men. Among men, 12.5% (95% CI 4.2-20.8%) had carotid stenosis - significantly over the 5% pre-specified threshold (p = 0.014, Binomial test). Conclusions: The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy.

  • 19.
    Jäghagen, Eva Levring
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Dahlqvist, Ake
    Umeå University, Faculty of Medicine, Clinical Sciences, Otorhinolaryngology.
    Isberg, Annika
    Prediction and risk of dysphagia after uvulopalatopharyngoplasty and uvulopalatoplasty.2004In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 124, no 10, p. 1197-1203Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that preoperative asymptomatic pharyngeal swallowing dysfunction predisposes for the development of symptoms of dysphagia after uvulopalatopharyngoplasty (UPPP) and uvulopalatoplasty (UPP). MATERIAL AND METHODS: A total of 42 patients who snored were scheduled to undergo UPPP (n = 20) or UPP (n = 22). UPP was performed using either a CO2 laser or a conventional steel scalpel. Preoperatively and 1 year postoperatively all patients were examined videoradiographically to assess pharyngeal swallowing function. They also completed a questionnaire pre- and postoperatively concerning their snoring problems and swallowing function as well as the outcome of surgery. RESULTS: Preoperatively, 7 (17%) patients reported dysphagia. Pharyngeal swallowing dysfunction was demonstrated in 6/7 patients with preoperative dysphagia while pharyngeal swallowing dysfunction was evident preoperatively in 18/35 non-dysphagic patients. Of the 35 patients without preoperative dysphagia, 10 (29%/) developed dysphagia after surgery. There was no significant risk of development of postoperative dysphagia for patients with compared to patients without preoperative pharyngeal swallowing dysfunction. Only one of the seven patients with preoperative dysphagia experienced worsening of the problem. A total of 93% of the patients reported a decrease in snoring and 95% reported a decrease in daytime sleepiness. CONCLUSIONS: Preoperative pharyngeal swallowing dysfunction was not proven to predict the development of dysphagia after UPPP or UPP. The surgical method did not influence the frequency of postoperatively acquired dysphagia. The results do not indicate that patients with preoperative dysphagia should be excluded from treatment with UPPP or UPP.

  • 20.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Nielun toiminnan häiriöt vaarantavat terveyden ja heikentävät elämänlaatua, Videofluorografia avuksi2009In: Suomen Hammasläökärilehti, ISSN 0355-5094, Vol. 16, no 3, p. 58-69Article in journal (Other academic)
  • 21.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Svalgfunktionen: videoradiografisk undersökning under sväljning och tal2009In: Tandläkartidningen, ISSN 0039-6982, Vol. 101, no 1, p. 68-78Article in journal (Other academic)
  • 22.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Videografisk undersökning av svalgfunktion under tal och sväljning2009In: Tandlægebladet, ISSN 0039-9353, Vol. 113, no 2, p. 92-105Article in journal (Refereed)
    Abstract [sv]

    Att ha ett svårförståeligt tal är ett socialt handikapp som kan misstolkas som att individen har en intellektuell funktionsnedsättning. Sväljningssvårigheter som aspiration med hosta och risk för kvävning, kan i värsta fall vara livshotande men också socialt och fysiskt handikappande eftersom måltiden är viktig såväl i det sociala umgänget som för nutrition.

    Svalget (farynx) utgör förbindelsen mellan näsa och mun till struphuvudet (larynx) och matstrupen (esofagus). Farynx är därmed delaktig i de livsuppehållande funktionerna andning och sväljning samt under tal, hostning, kräkning och kväljning. Farynxdysfunktion kan ge  avvikande tal, sväljningssvårigheter, snarkning, sömnapné och kan i värsta fall leda till kvävning.

    Videoradiografisk undersökning är en viktig del vid bedömning av avvikelser i farynx funktion under tal och sväljning samt som underlag för val av behandlingsstrategi. Bariumsulfatbaserad kontrastmedel används vid undersökningarna för att visualisera mjukvävnaderna i farynx under tal samt som bolus vid bedömning av tugg- och sväljningsfunktion.

  • 23.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology, Oral and Maxillofacial Radiology.
    Videoradiografisk undersökning av svalgfunktion under tal och sväljning2009In: Den norske tannlegeforenings tidende, ISSN 0029-2303, E-ISSN 1894-180X, Vol. 119, no 1, p. 38-47Article in journal (Other academic)
  • 24.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berggren, D
    Isberg, A
    Swallowing dysfunction related to snoring: a videoradiographic study.2000In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 120, no 3, p. 438-43Article in journal (Refereed)
    Abstract [en]

    Biopsy studies of the soft palatal and oropharyngeal tissues in habitual snorers and patients suffering from obstructive sleep apnoea have shown signs of neurogenic lesions. These lesions might affect the pharyngeal swallowing function, which is dependent on adequate sensitivity. The objective of the present study was to test the hypothesis that snoring is associated with aberrant pharyngeal swallowing function. Forty-one consecutive patients without dysphagia, seeking medical attention because of heavy snoring and various degrees of daytime sleepiness, were prospectively selected. Fifteen non-snoring volunteers without dysphagia served as controls. Patients and volunteers were videoradiographically examined in lateral and posteroanterior views during the oral and pharyngeal phases of swallowing. The hypothesis was verified. Snoring patients demonstrated deviant pharyngeal swallowing function seven times more frequently than did the non-snoring volunteers. Deviant pharyngeal swallowing function was observed in 22 (54%) of the snorers compared with 1 (7%) of the non-snoring volunteers. Impaired bolus control with premature leakage of bolus into the pharynx and a delayed evocation of the swallowing reflex was the most common finding, followed by bolus residual in the pharynx and laryngeal penetration. The conclusion was that snoring is associated with subclinical pharyngeal swallowing dysfunction.

  • 25.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Bodin, Ingrid
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Isberg, Annika
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Pharyngeal swallowing dysfunction following treatment for oral and pharyngeal cancer: Association with diminished intraoral sensation and discrimination ability2008In: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 30, no 10, p. 1344-1351Article in journal (Refereed)
    Abstract [en]

    Background.

    Swallowing disorders following treatment for oral and pharyngeal cancer are mainly considered a surgical sequel. The recent finding that radiotherapy-induced decline in intraoral sensory abilities established an incentive to elucidate any association between the degree of sensory decline and the degree of swallowing dysfunction.

    Methods.

    Oral and pharyngeal swallowing was cineradiographically examined in 15 patients with oral or pharyngeal cancer before and after treatment. The patients were also tested for intraoral sensation, shape recognition, and hole size identification.

    Results.

    Swallowing function deteriorated in 67% of the patients 6 months posttreatment, with no significant improvement after 12 months. The degree of swallowing dysfunction was statistically significantly associated with the degree of diminished intraoral sensation and shape recognition.

    Conclusion.

    In the quest for rehabilitation after treatment for oral and pharyngeal cancer, the impact of impaired intraoral sensation and discrimination ability on swallowing function should be taken into consideration

  • 26.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Franklin, KA
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Isberg, A
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Snoring, sleep apnoea and swallowing dysfunction: a videoradiographic study2003In: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 32, no 5, p. 311-316Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Snoring is associated with subclinical pharyngeal swallowing dysfunction, probably owing to vibration trauma to the pharyngeal tissues caused by snoring. Negative intrathoracic pressure during apnoea causes stretching of the velum and pharynx. The aim of this study was to investigate whether patients with severe sleep apnoea have an increased frequency of videoradiographically diagnosed subclinical pharyngeal swallowing dysfunction compared with snoring patients with or without mild sleep apnoea as well as with non-snoring controls. METHODS: Eighty consecutive patients referred for sleep apnoea recordings because of snoring were examined. Fourteen of these patients were excluded because they suffered from dysphagia. Fifteen non-snoring, non-dysphagic volunteers served as controls. Videoradiography was performed to examine the oral and pharyngeal swallowing function in patients and controls. Overnight sleep apnoea recordings were used to evaluate the apnoea-hypopnoea index (AHI). RESULTS: Pharyngeal swallowing dysfunction was observed in 34/66 (52%) of the snoring patients and in 1/15 (7%) of the non-snoring controls. Pharyngeal swallowing dysfunction was observed in 50% of patients with an AHI of >or=30, in 61% of patients with an AHI of 5-29 and in 43% of patients with an AHI of <5. There was no significant difference in the frequency of pharyngeal swallowing dysfunction between snoring patients with different AHIs. CONCLUSION: Snoring patients run an increased risk of developing subclinical pharyngeal swallowing dysfunction independent of concomitant sleep apnoea.

  • 27.
    Levring Jäghagen, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nilsson, M E
    Isberg, A
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persisting dysphagia after uvulopalatoplasty performed with steel scalpel.1999In: The Laryngoscope, ISSN 0023-852X, E-ISSN 1531-4995, Vol. 109, no 1, p. 86-90Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES/HYPOTHESIS: The aim of the present study was to determine the incidence of postoperative persisting dysphagia after uvulopalatoplasty performed with conventional steel scalpel (UPP) and to videoradiographically evaluate the oral and pharyngeal phases of swallowing in patients reporting persisting dysphagia. The hypothesis to be tested was that patients treated with UPP would demonstrate a lower incidence of persisting dysphagia than previously found after uvulopalatoplasty performed with laser technique (LUPP).

    STUDY DESIGN: Retrospective.

    METHODS: Sixty-eight of 76 consecutive patients treated with UPP answered a questionnaire concerning outcome and late complications after the operation. The patients who reported postoperative dysphagia were additionally interviewed at a minimum of 1 year postoperatively, and the oral and pharyngeal phases of swallowing were videoradiographically examined in those with persisting dysphagia.

    RESULTS: The incidence of persisting dysphagia after UPP was 29%. Videoradiographically 71% of the dysphagic patients showed a deviant pharyngeal swallowing pattern.

    CONCLUSION: The incidence of persisting dysphagia after UPP did not differ from that reported after laser uvulopalatoplasty. Dysphagia after UPP was mostly associated with videoradiographic signs of deviant pharyngeal swallowing function. Patients should be informed that there is a risk of developing dysphagia after uvulopalatoplasty.

  • 28.
    Lindblom, Ulrika
    et al.
    Department of Clinical Sciences, Otorhinolaryngology, Lund University, Lund, Sweden ; Department of Otorhinolaryngology, Kirkenes Hospital, Kirkenes , Norway Correspondence: P. Nilsson, Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden.
    Gärskog, Ola
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Kjellén, Elisabeth
    Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden.
    Laurell, Göran
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wahlberg, Peter
    Department of Clinical Sciences, Otorhinolaryngology, Lund University, Lund, Sweden.
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nilsson, Per
    Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden.
    Radiation-induced trismus in the ARTSCAN head and neck trial2014In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, no 5, p. 620-627Article in journal (Refereed)
    Abstract [en]

    Trismus, a well-known sequelae after treatment of head and neck cancer, decreases a patient's oral function and quality of life. The main objectives of this study were to: 1) investigate the long-term prevalence of radiation-induced trismus in patients treated for head and neck cancer according to two different fractionation schedules; and 2) model a dose-response relationship for trismus. MATERIAL AND METHODS: Patients were recruited from the Swedish ARTSCAN trial, a prospective randomised multicentre study comparing conventional and accelerated fractionation. A total of 124 patients agreed to a clinical ENT examination 21-127 months (median 66 months) after beginning radiation therapy. Trismus-related scores were assessed using the EORTC H&N35 Quality of Life questionnaire. The TheraBite(®) range of motion scale was used to measure maximal interincisal distance. The dose-response relationship for structures important for mastication and the temporomandibular joints was investigated by normal tissue complication probability modelling. RESULTS: No significant differences in patient-reported trismus or maximal interincisal distance were found between the two trial arms. Patient-reported moderate to high scores regarding trismus increased from 3% at the start of radiation therapy to 25% at the long-term follow-up. Maximal interincisal distance correlated significantly with patient-reported scores of trismus. The best dose-response fit to the endpoint data was found for the dose to the ipsilateral masseter. CONCLUSIONS: Trismus is a persistent complication after radiotherapy with 3D-conformal radiation therapy. We found no difference between the severity and prevalence of trismus between conventional and accelerated fractionation, but a significant correlation between the absorbed dose to the mastication structures and opening of the mouth. Further prospective studies may determine whether a reduced dose to structures important for mastication using intensity-modulated radiation therapy will reduce problems with trismus.

  • 29. Lindblom, Ulrika
    et al.
    Nilsson, Per
    Gärskog, Ola
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Kjellen, Elisabeth
    Laurell, Göran
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Wahlberg, Peter
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Aspiration as a late complication after accelerated versus conventional radiotherapy in patients with head and neck cancer2016In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, no 3, p. 304-311Article in journal (Refereed)
    Abstract [en]

    Conclusion Neck dissection after radiotherapy increased the risk of aspiration as a late effect in a sub-sample of patients treated for head and neck cancer in the ARTSCAN study. Patients treated with accelerated fractionation (AF) developed aspiration, with or without coughing, more frequently than patients treated with conventional fractionation (CF). Objectives A long-term follow-up study was conducted to determine the frequency of aspiration as a late effect in patients with head and neck cancer treated with AF or CF. Method One-hundred and eight patients were recruited from two centres of the Swedish multi-centre study, ARTSCAN, where AF and CF were compared. Patients with positive lymph nodes were treated with neck dissection after completing radiotherapy. The follow-up was performed at a median of 65 months after initiation of radiotherapy and included an ENT and a videofluoroscopic examination. Results Aspiration was found in 51/108 (47%) and silent aspiration in 34/96 (35%) patients. Neck dissection (n = 47 patients) was significantly associated with both aspiration and silent aspiration. Aspiration was more common among patients treated with AF (34/61; 56%) compared to CF (17/47; 36%; p = 0.053). Silent aspiration was also more common after AF (24/54; 44%) than after CF (10/42; 24%; p = 0.052).

  • 30.
    Ottosson, Sandra
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Lindblom, Ulrika
    Lunds universitet.
    Wahlberg, Peter
    Lunds universitet.
    Nilsson, Per
    Lunds universitet.
    Kjellén, Elisabeth
    Lunds universitet.
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Laurell, Göran
    Uppsala universitet.
    Weight loss and Body Mass Index in relation to aspiration in patients treated for head and neck cancer: a long-term follow-up2014In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 22, no 9, p. 2361-2369Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Persistent severe swallowing dysfunction with aspiration is a common and sometimes overlooked sequelae after treatment for squamous cell carcinoma of the head and neck (SCCHN) and may impact food intake and nutritional status. More knowledge is needed to increase the understanding of severe swallowing dysfunction as a risk factor for persistent nutritional deteriorations in SCCHN survivors. The purpose of the study was to investigate weight loss and body mass index (BMI) in relation to pharyngeal swallowing function in a long-term perspective in patients after SCCHN treatment.

    METHODS: Data from 101 patients were available for the analyses. Swallowing function was assessed by videofluoroscopy at a mean of 71.6 months after the start of radiotherapy (RT). Percent weight change (calculated with weight at the start of RT as the reference) and BMI at follow-up were the primary nutritional measures.

    RESULTS: Aspiration was present in 48 of 101 patients (48 %). Patients with aspiration had a significantly higher mean weight loss and a lower BMI (-10.9 % and 23.1, respectively) at follow-up compared with patients without aspiration (-2.8 % and 26.0, respectively). Patients with aspiration were unable to gain weight after 23 months. Only ten of 101 patients (10 %) were underweight at follow-up.

    CONCLUSIONS: Swallowing dysfunction with aspiration was related to long-term weight loss and reduced BMI. Few patients were underweight despite the high prevalence of swallowing dysfunction.

  • 31.
    Shah, Farhan
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Holmlund, Thorbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Stål, Per
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Unique expression of cytoskeletal proteins in human soft palate muscles2016In: Journal of Anatomy, ISSN 0021-8782, E-ISSN 1469-7580, Vol. 228, no 3, p. 487-494Article in journal (Refereed)
    Abstract [en]

    The human oropharyngeal muscles have a unique anatomy with diverse and intricate functions. To investigate if this specialization is also reflected in the cytoarchitecture of muscle fibers, intermediate filament proteins and the dystrophin-associated protein complex have been analyzed in two human palate muscles, musculus uvula (UV) and musculus palatopharyngeus (PP), with immunohistochenmical and morphological techniques. Human limb muscles were used as reference. The findings show that the soft palate muscle fibers have a cytoskeletal architecture that differs from the limb muscles. While all limb muscles showed immunoreaction for a panel of antibodies directed against different domains of cytoskeletal proteins desmin and dystrophin, a subpopulation of palate muscle fibers lacked or had a faint immunoreaction for desmin (UV 11.7% and PP 9.8%) and the C-terminal of the dystrophin molecule (UV 4.2% and PP 6.4%). The vast majority of these fibers expressed slow contractile protein myosin heavy chain I. Furthermore, an unusual staining pattern was also observed in these fibers for β-dystroglycan, caveolin-3 and neuronal nitric oxide synthase nNOS, which are all membrane-linking proteins associated with the dystrophin C-terminus. While the immunoreaction for nNOS was generally weak or absent, β-dystroglycan and caveolin-3 showed a stronger immunostaining. The absence or a low expression of cytoskeletal proteins otherwise considered ubiquitous and important for integration and contraction of muscle cells indicate a unique cytoarchitecture designed to meet the intricate demands of the upper airway muscles. It can be concluded that a subgroup of muscle fibers in the human soft palate appears to have special biomechanical properties, and their unique cytoarchitecture must be taken into account while assessing function and pathology in oropharyngeal muscles.

  • 32.
    Shah, Farhan
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Laboratory of Muscle Biology, IMB, Umeå University.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Holmlund, Thorbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Franklin, Karl A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Stål, Per
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Upregulated expression of brain-derived neurotrophic factor in soft palate muscles of snorers and obstructive sleep apnea patientsManuscript (preprint) (Other academic)
  • 33.
    Shah, Farhan
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Franklin, Karl A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holmlund, Thorbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Stål, Per
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Desmin and dystrophin abnormalities in upper airway muscles of snorers and patients with sleep apnea2019In: Respiratory Research, ISSN 1465-993X, Vol. 20, article id 31Article in journal (Refereed)
    Abstract [en]

    The pathophysiology of obstruction and swallowing dysfunction in snores and sleep apnea patients remains unclear. Neuropathy and to some extent myopathy have been suggested as contributing causes. Recently we reported an absence and an abnormal isoform of two cytoskeletal proteins, desmin, and dystrophin, in upper airway muscles of healthy humans. These cytoskeletal proteins are considered vital for muscle function. We aimed to investigate for muscle cytoskeletal abnormalities in upper airways and its association with swallowing dysfunction and severity of sleep apnea. Cytoskeletal proteins desmin and dystrophin were morphologically evaluated in the uvula muscle of 22 patients undergoing soft palate surgery due to snoring and sleep apnea and in 10 healthy controls. The muscles were analysed with immunohistochemical methods, and swallowing function was assessed using videoradiography. Desmin displayed a disorganized pattern in 21 +/- 13% of the muscle fibres in patients, while these fibers were not present in controls. Muscle fibres lacking desmin were present in both patients and controls, but the proportion was higher in patients (25 +/- 12% vs. 14 +/- 7%, p = 0.009). The overall desmin abnormalities were significantly more frequent in patients than in controls (46 +/- 18% vs. 14 +/- 7%, p < 0.001). In patients, the C-terminus of the dystrophin molecule was absent in 19 +/- 18% of the desmin-abnormal muscle fibres. Patients with swallowing dysfunction had 55 +/- 10% desmin-abnormal muscle fibres vs. 22 +/- 6% in patients without swallowing dysfunction, p = 0.002. Cytoskeletal abnormalities in soft palate muscles most likely contribute to pharyngeal dysfunction in snorers and sleep apnea patients. Plausible causes for the presence of these abnormalities is traumatic snoring vibrations, tissue stretch or muscle overload.

  • 34.
    Shah, Farhan
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Laboratory of Muscle Biology, IMB, Umeå University.
    Franklin, Karl
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Holmlund, Thorbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Stål, Per
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Desmin and dystrophin myopathy in the upper airway of snoring and obstructive sleep apnea patientsManuscript (preprint) (Other academic)
  • 35.
    Shah, Farhan
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Holmlund, Thorbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Franklin, Karl A
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Stål, Per
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Axon and Schwann Cell Degeneration in Nerves of Upper Airway Relates to Pharyngeal Dysfunction in Snorers and Patients With Sleep Apnea2018In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 154, no 5, p. 1091-1098Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The pathophysiologic mechanism of nocturnal obstruction and swallowing dysfunction commonly occurring in patients with sleep apnea is unclear. The goal of this study was to investigate whether nerve injuries in the upper airways of snorers and patients with sleep apnea are associated with pharyngeal dysfunction and severity of sleep apnea.

    METHODS: Twenty-two patients undergoing palatal surgery due to snoring and sleep apnea were investigated for a swallowing dysfunction by using videoradiography. Twelve healthy nonsnoring subjects were included as control subjects. Tissue samples from the soft palate at the base of the uvula were obtained in all patients and control subjects. Nerves and muscle were analyzed with immunohistochemical and morphologic methods, and the findings were correlated with swallowing function and degree of sleep apnea.

    RESULTS: In the soft palate of patients, nerve fascicles exhibited a significantly lower density of axons (5.4 vs 17.9 x 10(-3) axons/mu m(2); P = .02), a smaller percentage area occupied by Schwann cells (17.5% vs 45.2%; P = .001) and a larger number of circular shaped Schwann cells lacking central axons (43.0% vs 12.7%; P < 0.001) compared with control subjects. The low density of axons was significantly related to degree of swallowing dysfunction (r = 0.5; P = .03) and apnea-hypopnea index > 5 (P = .03). Regenerating axons were frequently observed in patients compared with control subjects (11.3 +/- 4.2% vs 4.8 +/- 2.4%; P = .02).

    CONCLUSIONS: Axon degeneration in preterminal nerves of the soft palate is associated with pharyngeal dysfunction in snorers and patients with sleep apnea. The most likely cause for the nerve injuries is traumatic snoring vibrations and tissue stretch, leading to swallowing dysfunction and increased risk for upper airway obstruction during sleep.

  • 36.
    Shah, Farhan
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Laboratory of Muscle Biology, IMB, Umeå University.
    Holmlund, Thorbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berggren, Diana
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Franklin, Karl A.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Stål, Per
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Axon and Schwann cell degeneration in nerves of upper airway relates to pharyngeal dysfunction in snorers and sleep apnea patientsManuscript (preprint) (Other academic)
  • 37.
    Söderström, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Nilsson, Per
    Laurell, Göran
    Zackrisson, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Dysphagia - Results from multivariable predictive modelling on aspiration from a subset of the ARTSCAN trial2017In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 122, no 2, p. 192-199Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To establish predictive models for late objective aspiration and late patient-reported choking based on dose-volume parameters and baseline patient and treatment characteristics, for patients with head and neck cancer undergoing definitive radiotherapy (RT). The impact of electively treated volume on late aspiration was also investigated.

    METHODS AND MATERIAL: This prospective cohort is a subsample of 124 survivors from the ARTSCAN study. Late aspiration was identified with videofluoroscopy, at a minimum of 25months after the start of RT. Patient-reported choking was analysed at 12 and 60months post RT using the EORTC Quality of Life Module for Head and Neck Cancer 35. Univariable and multivariable analyses were performed to describe the association between clinical factors and dose-volume descriptors for organs at risk (OARs) and late dysphagia.

    RESULTS: Aspiration was found in 47% of the eligible patients. Mean dose to the middle pharyngeal constrictor (MPC), neck dissection post RT and age at randomisation in ARTSCAN were associated to late aspiration. Mean dose to the superior pharyngeal constrictor (SPC) and swallowing complaints at baseline were associated to patient reported choking at both time-points.

    CONCLUSIONS: Three separate risk groups for late aspiration, and two risk groups for late patient-reported choking were identified based on number of risk factors. The size of the electively treated volume could be used as a surrogate for individual OARs predicting late aspiration.

1 - 37 of 37
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