Causes of oropharyngeal dysphagia according to categories, with corresponding representative conditions [11].
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"84",leadTitle:null,fullTitle:"Theory and Applications of CT Imaging and Analysis",title:"Theory and Applications of CT Imaging and Analysis",subtitle:null,reviewType:"peer-reviewed",abstract:"The x-ray computed tomography (CT) is well known as a useful imaging method and thus CT images have continuingly been used for many applications, especially in medical fields. This book discloses recent advances and new ideas in theories and applications for CT imaging and its analysis.\nThe 16 chapters selected in this book cover not only the major topics of CT imaging and analysis in medical fields, but also some advanced applications for forensic and industrial purposes. These chapters propose state-of-the-art approaches and cutting-edge research results.",isbn:null,printIsbn:"978-953-307-234-0",pdfIsbn:"978-953-51-6427-2",doi:"10.5772/616",price:139,priceEur:155,priceUsd:179,slug:"theory-and-applications-of-ct-imaging-and-analysis",numberOfPages:302,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"1c2713601b49dbbc072998268cdc16eb",bookSignature:"Noriyasu Homma",publishedDate:"April 4th 2011",coverURL:"https://cdn.intechopen.com/books/images_new/84.jpg",numberOfDownloads:53260,numberOfWosCitations:30,numberOfCrossrefCitations:18,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:35,numberOfDimensionsCitationsByBook:1,hasAltmetrics:0,numberOfTotalCitations:83,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"May 18th 2010",dateEndSecondStepPublish:"June 15th 2010",dateEndThirdStepPublish:"September 20th 2010",dateEndFourthStepPublish:"November 19th 2010",dateEndFifthStepPublish:"February 2nd 2011",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"3411",title:"Prof.",name:"Noriyasu",middleName:null,surname:"Homma",slug:"noriyasu-homma",fullName:"Noriyasu Homma",profilePictureURL:"https://mts.intechopen.com/storage/users/3411/images/1650_n.jpg",biography:"Dr. Noriyasu Homma received a BA, MA, and PhD in electrical and communication engineering from Tohoku University, Japan, in 1990, 1992, and 1995, respectively. \nFrom 1995 to 1998, he was a lecturer at the Tohoku University, Japan. He is currently an associate professor of the Cyberscience Center at the Tohoku University. From 2000 to 2001, he was a visiting professor at the Intelligent Systems Research Laboratory, University of Saskatchewan, Canada. His current research interests include neural networks, complex and chaotic systems, soft-computing, cognitive sciences, medical systems and brain sciences. 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Surgical approaches to the cervical spine include anterior, posterior, trans-oral, lateral trans-mandibular which can be done by open, tubular MIS or full endoscopic as described recently.
Anterior cervical spine surgery is commonly performed for the treatment of varieties of cervical spine pathologies that include degenerative, trauma, tumors, deformities and infections [1].
Techniques of anterior cervical spine surgery include anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), for primary stability and fusion different type of devices are used, such as cages, plates, cylinders, as well as bone growth promoters, substitutes, and bone morphogenic protein (BMP) have been use. In selected cases, discectomy alone is also performed especially through MIS or endoscopic techniques [2].
Anterior cervical discectomy and fusion (ACDF) was first described by Smith Robinson in 1968, when he performed discectomy and fusion was done using tricortical bone graft, during 1990s more than 500,000 anterior cervical discectomy and fusion (ACDF) was done in USA [3].
Anterior cervical spine surgery is safe and effective harboring a wide range of indications with a low rate of morbidity and mortality [4]. Complications following anterior cervical spine surgery include airway complications, dysphagia, dysphonia, infection, implant failure, non-union, neurological deficit, vascular injuries, implant subsidence, adjacent level disease and even death [5, 6, 7, 8, 9, 10].
Dysphagia is one of the most common complications following anterior cervical spine surgeries, dysphagia is a symptom indicative of an abnormality in the neural control of, or the structures involved in, any phase of the swallowing process, which involve both voluntary and involuntary/reflex responses. Oropharyngeal dysphagia is an impairment in the speed and/or safe delivery of food materials from entry in the mouth to the upper portion of the esophagus. If present, the patient is at an increased risk of aspiration and may be unable to swallow properly liquids, foods, or saliva. The condition is considered long standing if it is still present more than 4 weeks after surgery [11].
Dysphagia following anterior cervical surgery can occur in the three phases of swallowing process (oral & transport phase, pharyngeal & esophageal) [12].
Postoperative dysphagia is the most common complications following ACSS, the incidence ranges between 1 and 79% [1, 11, 13]. The criteria used to define and detected dysphagia may influence the reported incidence, many factors impact the exact incidence which include:
The severity of dysphagia (mild, moderate, or severe), most of the cases fortunately presents with mild dysphagia.
Timing of postoperative detection (immediate postoperative <2 weeks, 2 weeks, 4
Measurement tools (repeated questionnaires or patients self-reported). The repeated questioning provides a higher incidence than self-reported [16, 17, 18].
Surgical Techniques & Approaches (Revision, ACSS, PCSS, Standalone cage, Cervical Plate, ACDF, ACCD, & Single vs. multilevel) Revision, ACSS, multilevel surgery, cervical plating, ACCD are associated with a higher incidence [19].
Type and design of the study & sample size (retrospective or prospective, no. of the patients in the study, and the presence of control group or not). most of the studies are no controlled retrospective in nature with an intrinsic inability to detect preoperative swallowing difficulties, with no control group [20], the higher sample size the less incidence [21].
The incidence ranges between 28 and 57% in the intermediate and long term postoperative period (1–6 weeks), [17, 22], Riley et al. on a multicentric study that enrolled 454 patient who underwent ACSS in a multicentric study between 1998 and 2001 found that the incidence of postoperative dysphagia was 28.2, 6.8 and 7.8% at 3, 6, and 24 months, respectively, and at both 6 and 24 months the prevalence rate of persistent dysphagia was 21% [21]. On another study, the average incidence varied along the post-operative time after ACSS: 53.2% at 1 month, 31.6% at 2–4 months, 19.8% at 6 months, 16.8% at 12 months and 12.9 at 24 months [11].
Lee et al. reported an overall prevalence rate of postoperative dysphagia over time as the following: 54.0% at 1 month; 33.6% at 2 months; 18.6% at 6 months; 15.2% at 1 year; and 13.6% at 2 years [19].
Later, Riley et al. in a systematic review found that the incidence of postoperative dysphagia decreased with time after surgery and reach plateau at rate of 13–21% at one year [1].
Most cases of postoperative dysphagia are mild and transient, resolving gradually within 3 months [19, 23, 24] without any specific treatment. Most of the cases of postoperative dysphagia resolve within 1 year, however, about 5–7% of cases of dysphagia after ACSS are still present 6–24 months after surgery [11].
Yue et al. reported 15% rate of dysphagia after 5 years of ACSS [24]. The predominant cause of persistent postoperative dysphagia appears to be an increase of the thickness of posterior pharyngeal wall above the upper esophageal sphincter [25].
Anterior cervical spine surgery impact both physiological and anatomical function of the swallowing, and these factors impact the neural, muscular & mucosal structures [19, 26]. However, in some cases dysphagia can occur in the absence of any noticed postoperative complication in anterior cervical spine surgery (ACSS).
We can summarize the etiology of dysphagia following anterior cervical spine surgery as the following:
Prevertebral soft tissue swelling is result of hemorrhage or intraoperative soft tissue trauma which leads to oedema which may cause transient dysfunction of the esophageal movement by impairing the upper esophageal sphincters. Nevertheless, Kang et al. failed to find a significant correlation between the thickness of prevertebral soft tissue and the incidence of dysphagia [27, 28].
The presence of anterior cervical osteophyte, diffuse idiopathic skeletal hyperostosis can cause dysphagia secondary to mechanical impingement of esophagus, as well as inflammation causing adhesion and fibrosis.
In ACDF with plating, the presence of a plate can contributes to the same pathophysiology cause of dysphagia. Although the concept is not yet fully established, it has been proven that a thicker cervical plate is associated with a higher incidence of dysphagia [22].
Several studies confirmed that standalone cages are associated with less incidence of dysphagia when compared with ACDF with plating. However, this conclusion is not universally accepted [29].
Retraction of esophagus during surgery to expose the anterior cervical spine is one of the possible cause of postoperative dysphagia while some studies concluded that esophageal retraction may cause ischemia of the esophageal wall which in turn compromise the motility [12], one study failed to confirm the association between the intraoperative pressure of esophageal retraction and postoperative dysphagia [30].
Intraoperative nerve traction or injury is another possible cause of postoperative dysphagia. Different nerves traction will cause different esophageal segment dysphagia. For example damage or traction to Hypoglossal nerve will impact the oral phase of swallowing, while injury or traction to the connection between the pharyngeal plexus and pharyngeal muscle will impact the pharyngeal phase of swallowing. Injury of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) are both operative in the development of postoperative dysphagia, reason why a sound knowledge of their anatomy and meticulous surgical technique are essential to decrease the postoperative dysphagia [11].
Anderson et al. [11] summarized the causes of oropharyngeal dysphagia as seen in Table 1.
Categories of causes | Representative conditions |
---|---|
Collagen diseases | Scleroderma, dermatomyositis |
Conditions that give rise to fixed mechanical obstruction | Previous surgical treatment, tumor, cervical rings or webs, radiation/radiotherapy (pharyngeal phase) |
Congenital neurologic/structural disorders/malformations | Dysautonomia, cleft palate, cerebral palsy, muscular dystrophy |
Iatrogenic | Medications (chemotherapy, neuroleptics, etc.); pill injury (intentional; oral preparatory phase) |
Infectious | Botulism, diphtheria, Lyme disease, mucositis (herpetic lesions, cytomegalovirus, Candida, aphthous ulcers); syphilis (oral preparatory phase) |
Intrinsic functional disturbances | Cricopharyngeal achalasia, Zenker diverticulum (pharyngeal phase) |
Medical | Advanced chronic obstructive pulmonary disease, deconditioning, intubation (prolonged endotracheal), rheumatoid arthritis, some viral infections |
Metabolic | Amyloidosis, Cushing syndrome, thyrotoxicosis, Wilson disease |
Myopathic | Connective tissue disease (overlap syndrome), myotonic dystrophy, paraneoplastic syndromes, polymyositis, sarcoidosis |
Neurologic | Dementia, Guillain-Barré syndrome, Huntington disease, metabolic encephalopathies, polio, postpolio syndrome, traumatic brain injury, seizure disorders, tardive dyskinesia, brainstem tumor, cerebral vascular accident |
Neuromyogenic | Myopathies (inflammatory, metabolic), parkinsonism, head trauma, stroke (oral preparatory phase and pharyngeal phase) |
Progressive neurologic disorders | Dystonia, progressive supranuclear palsy, oculopharyngeal dystrophy, myasthenia gravis, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s disease (oral preparatory phase and pharyngeal phase) |
Neurosurgical procedures | Aneurysm clippings, anterior cervical spine surgery; resection of tumor |
Structural | Extrinsic compression, cervical osteophytes, scar tissue (oral/pharyngeal), stenosis (postsurgical/radiation/idiopathic), cricopharyngeal bar, skeletal abnormalities (pharyngeal phase) |
Causes of oropharyngeal dysphagia according to categories, with corresponding representative conditions [11].
Regarding the surgical techniques, the causes of dysphagia are described in Table 2.
Approach/technique | Possible resulting condition |
---|---|
Dissection or retraction | Damage of the aerodigestive pathway; muscle and serosa injuries and edema; tissue damage with subsequent edema; bruising or laceration of tissues |
SLN injury, most at risk with surgery involving C3-C4 , which can cause laryngeal sensory impairment | |
Injuries to the pharyngeal plexus or vagus nerve, glossopharyngeal nerve, or hypoglossal nerve (most at risk with surgery at or above C3) | |
Dysfunction of the pharyngeal plexus, which affects the motility of the visceral wall | |
Dissection or retraction of the longus colli muscle | Muscle and subperiosteal bleeding; prevertebral soft tissue swelling |
Retraction | Denervation of the pharyngeal plexus (involving the glossopharyngeal nerve and the pharyngeal branch of the vagus nerve) |
Excessive or prolonged retraction | Dysphagia |
Esophageal edema, impingement, ischemia, denervation, re-perfusion injury | |
Posterior pharyngeal wall edema, preventing a full epiglottic deflection | |
Soft tissue fibrosis; soft tissue swelling; scar tissue formation | |
Significant tension during lateralization of the larynx (RLN most at risk with surgery involving C3–C4 and C5–T1) | RLN injury, which can cause vocal fold paresis or paralysis |
RLN stretch injury and/or RLN compression injury from ET cuff compression | RLN palsy, which can cause vocal fold paresis or paralysis |
Use of rh-BMP-2 | Early local inflammatory response to rh-BMP-2 (dose-related) |
Concurrent intraoperative traction on both the RLN and pharyngeal plexus | RLN injury |
Direct esophageal injury | Impaired opening of the upper esophageal sphincter |
Localized denervation of portions of the esophagus and hypopharynx | |
Pharyngeal wall ischemia | |
Hemostatic or coagulopathy | Hematoma formation |
Use of instrumentation | Any mechanical irritation or impingement against the esophagus |
Differences in postoperative cervical kyphotic-lordotic deformity | |
Thickness or anterior profile of anterior cervical plates and instrumentation | Irritation and inflammation |
Plate on the esophagus | Mass effect |
Use of graft | Craft (implant) protrusion, graft extrusion or cord compression |
Improper halo or collar positioning | Cervical hyperextension |
Causes of oropharyngeal dysphagia according to operative approach and operative technique.
Abbreviations: ET, endotracheal; rhBMP-2, recombinant human bone morphogenetic protein-2; RLN, recurrent laryngeal nerve; SLN, superior laryngeal nerve.
Smith-Hammond et al. [20] found that older patients have an higher risk of dysphagia following ACDF, while Lee et al. [19] and Bazaz et al. [19] found the no correlation between the age and the risk of dysphagia.
Female gender harbors an increased risk of dysphagia following ACDF [13, 19], while other studies failed to find the association between sex and dysphagia [21, 31].
The longer the surgical time, which happens in complex procedures or in surgeries performed by less experienced surgeons, the higher contribution to the development of dysphagia, although some studies failed conclude it.
Some studies have shown that multiple levels surgeries represent a significant risk factor for dysphagia [19], however others did not find any correlation between the multilevel and risk of dysphagia [31].
In cases of revision surgeries, the presence of scar tissue can distort the anatomy compared to index surgery, rendering esophageal injury more likely [19].
Depending on the surgical indications related to the pathology, the level affected and the presence of deformity, different implants are used in anterior cervical surgeries. According to his/her experience and preferences, the surgeon may use stand-alone cage, hybrid cage, cervical plating, or total disc replacement [34].
The use of cervical plate in ACDF remain a controversy issue, especially in single and two levels degenerative disc disease, but many studies support its use in more than 2 levels in degenerative spine, in trauma, tumor, infections, especially if corpectomies are advocated.
Plating has the advantage of increase fusion rate, better lordotic reconstruction, enhanced primary stability of the construct, superior disc height preservation and lower subsidence rate [35]. However these benefits come at the cost of screw pullout, loosening of plate, hardware breakage, increase in the operative time and overall costs, and increased risk of dysphagia [34].
Total disc arthroplasty (TDR) become popularized in last decades as a motion preserving technique in the anterior cervical surgeries, avoiding the fusion and decrease the adverse effect of ACDF, in selected indications. However, studies found no difference in the risk of dysphagia when comparing between TDR and ACDF [36].
Bone morphogenetic protein is used during cervical surgery to increase the fusion rate especially in cases of accrued risk of pseudoarthrosis. Some studies found that BMP may constitute a risk factor for dysphagia following ACDF as it induces inflammation and oedema which will affect the surrounding soft tissue, including the esophagus [37, 38].
Studies found that a high level of cervical spine surgery, such as C3-4, is associated with more dysphagia than the lower levels. In the upper cervical spine, the risk of superior laryngeal nerve injury is amplified which entails an increased risk of dysphagia. As the retropharyngeal space in the upper cervical spine is more generous than in inferior cervical spine, the soft tissue swelling will be potentially more severe [39].
Significant blood loss impacts in the overall surgical outcome and is associated with many adverse effects that includes postoperative recovery and infection rate. In fact, some studies have shown than blood loss superior to 300 ml is associated with an enhanced risk of dysphagia following ACSS [21].
Patients present with dysphagia due to alteration in swallowing mechanisms that include [25]:
Increased aspiration.
Thickening of the pharyngeal wall.
Poorer pharyngeal constriction and peristalsis.
Prolonged transit time.
Reduced hyoid displacement.
Reduced opening of the pharyngoesophageal segment opening.
Impaired epiglottic inversion
As a result of dysphagia, patients may develop other symptoms that may include:
Reflexive coughing or wet/gurgle voice during or right after swallowing.
Extra effort or time needed to chew or swallow.
Food or liquid leaking from the mouth or getting stuck in the mouth.
Recurring pneumonia or chest congestion after eating.
Persistent & severe dysphagia may result in weight loss, dehydration, risk of aspiration pneumonia, chronic lung disease and psychological problems [40].
The presence of long-standing dysphagia should raise the suspicion of esophageal perforation and thus be adamantly investigated.
Non-validated questionaries to evaluate the severity of dysphagia following ACSS include:
Depending on liquid and/or solid food difficulty swelling, they graded the severity into none, mild, moderate, and severe, as described in Table 3 [13].
Severity of dysphagia | Difficulty swallowing liquids | Difficulty swallowing solids |
---|---|---|
None | None | None |
Mild | None | Rare |
Moderate | None or rare | Occasionally (only with specific foods) |
Severe | None or rare | Frequent (majority of solids) |
Bazaz dysphagia scoring system [2].
It is a modification of Bazaz Dysphagia Score into a ten-points scale recorded daily for four days, with dysphagia being defined as a cumulative four-day score of ≥12 [30] . As seen in Table 4.
Points | Severity of dysphagia | Definition |
---|---|---|
0 | None | No episodes of difficulty swallowing |
1–3 | Mild | Only rare episodes of difficulty swallowing |
4–6 | Moderate | Occasional swallowing difficulty with solid foods |
7–10 | Severe | Swallowing difficulty with solids and liquids |
Modified Bazaz dysphagia scoring system [15]. Assessment is undertaken on the day of operation and on the first, third and fifth post-operative days; the scores are added together, with dysphagia defined as a cumulative score of ≥ 12.
Assess the postoperative dysphagia using numeric scale [31].
Includes also physical function and emotional domains [31].
Swallowing-quality of life (SWAL-QOL) questionnaire is a validated 93-item questionnaire that quantifies dysphagia on the basis of severity and duration as well as its psychological impact [32], although it is has been shown to be valid and reliable, its length and complexity make it less practical in the clinical setting.
Videoflouroscopic swallow evaluation (VSE) is a gold standard for the assessment of swallowing impairment also referred to as a modified barium swallow study [41].
The aim of treatment in postoperative dysphagia following ACSS is to maximize the food transit, minimize or prevent respiratory aspiration and related adverse effect [42].
Currently there is no specific treatment for dysphagia, as many patients with postoperative dysphagia will resolve with time. The available treatment include behavioral, postural changes, sensory input enhancement, swallowing maneuvers, voluntary control in effort exerted during swallowing and diet modification [43].
The best form of treatment is prevention, as discussed in the next section.
For persistent dysphagia that extends for more than 12–18 months, some authors recommend surgical treatment to debride the adhesion or anterior cervical instrumentation to immobilize the spine to avoid esophagus tethering and traction [44].
Many studies evaluated the techniques and recommendation to decrease the incidence of postoperative dysphasia following ACSS.
The intra-operative local application of steroids in is regarded as a preventive measure to abort the development of postoperative dysphagia. This is based on the pathogenesis, as soft tissue swelling, and local inflammation will be decrease when the steroids are used. In this respect the use of IV Methylprednisolone is recommended [45], while the local application of triamcinolone in the retropharyngeal space may decrease the incidence of dysphagia postoperatively [46].
Excessive endotracheal tube pressure may impact locally by increasing transmural pressure translating in a putative risk of soft tissue injury and dysphagia development following ACSS, Accordingly, some authors recommend decreasing the endotracheal tube pressure to 20 mmHg during the period of cervical traction [47], or the release of the endotracheal tube pressure and reinflate it after retractor placement to minimize the pressure related damage to the RLN [48].
A plate can cause postoperative dysphagia due to mass effect or induction of inflammation, plate redesign to a low profile by decreasing its thickness will endure a minimization of postoperative dysphagia [22]. Equally, the use of a zero profile cage and plate or hybrid cage has shown a smaller incidence of postoperative dysphagia [49].
The concept behind the preoperative tracheal traction exercise is to increase the compliance of the esophagus, thereby reducing the pressure required by retraction to expose an adequate operative field, the exercises were performed twice daily (15 times each time) for three days, starting four days before the operation [50].
An effort to limit the operative time should be undertaken to decrease the postoperative dysphagia. Appropriate surgical training should focus on acquiring a sound knowledge of anatomical variation of the RLN & SLN, a meticulous plan by plan surgical dissection, control of blood loss to better identify anatomical structures, avoid excessive blade retraction to reduce mechanical transmural esophageal pressure and anchoring the blades under the dissected longus coli to avoid injury to RLN and SLN [11, 48, 51].
Dysphagia following anterior cervical spine surgery is a common complication, in most cases it is mild and resolved with time, no specific treatment is required.
There are risk factors to increase the risk that include multiple levels, smoking, cervical plating, increase the operative time, revision surgeries.
The authors declare no conflict of interest.
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His teaching areas are energy metabolism and regulation, integration and organ specialization and metabolic adaptation.",institutionString:null,institution:{name:"Artois University",institutionURL:null,country:{name:"France"}}},editorTwo:null,editorThree:null},{id:"18",title:"Proteomics",coverUrl:"https://cdn.intechopen.com/series_topics/covers/18.jpg",isOpenForSubmission:!0,annualVolume:11414,editor:{id:"200689",title:"Prof.",name:"Paolo",middleName:null,surname:"Iadarola",slug:"paolo-iadarola",fullName:"Paolo Iadarola",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSCl8QAG/Profile_Picture_1623568118342",biography:"Paolo Iadarola graduated with a degree in Chemistry from the University of Pavia (Italy) in July 1972. He then worked as an Assistant Professor at the Faculty of Science of the same University until 1984. In 1985, Prof. Iadarola became Associate Professor at the Department of Biology and Biotechnologies of the University of Pavia and retired in October 2017. Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. In this context, he has developed and validated new methodologies (e.g., Capillary Electrophoresis coupled to Laser-Induced Fluorescence, CE-LIF) whose application enabled him to determine both the amounts of biochemical markers (Desmosines) in urine/serum of patients affected by Chronic Obstructive Pulmonary Disease (COPD) and the activity of proteolytic enzymes (Human Neutrophil Elastase, Cathepsin G, Pseudomonas aeruginosa elastase) in sputa of these patients. More recently, Prof. Iadarola was involved in developing techniques such as two-dimensional electrophoresis coupled to liquid chromatography/mass spectrometry (2DE-LC/MS) for the proteomic analysis of biological fluids aimed at the identification of potential biomarkers of different lung diseases. He is the author of about 150 publications (According to Scopus: H-Index: 23; Total citations: 1568- According to WOS: H-Index: 20; Total Citations: 1296) of peer-reviewed international journals. He is a Consultant Reviewer for several journals, including the Journal of Chromatography A, Journal of Chromatography B, Plos ONE, Proteomes, International Journal of Molecular Science, Biotech, Electrophoresis, and others. He is also Associate Editor of Biotech.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorTwo:{id:"201414",title:"Dr.",name:"Simona",middleName:null,surname:"Viglio",slug:"simona-viglio",fullName:"Simona Viglio",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRKDHQA4/Profile_Picture_1630402531487",biography:"Simona Viglio is an Associate Professor of Biochemistry at the Department of Molecular Medicine at the University of Pavia. She has been working since 1995 on the determination of proteolytic enzymes involved in the degradation process of connective tissue matrix and on the identification of biological markers of lung diseases. She gained considerable experience in developing and validating new methodologies whose applications allowed her to determine both the amount of biomarkers (Desmosine and Isodesmosine) in the urine of patients affected by COPD, and the activity of proteolytic enzymes (HNE, Cathepsin G, Pseudomonas aeruginosa elastase) in the sputa of these patients. Simona Viglio was also involved in research dealing with the supplementation of amino acids in patients with brain injury and chronic heart failure. She is presently engaged in the development of 2-DE and LC-MS techniques for the study of proteomics in biological fluids. The aim of this research is the identification of potential biomarkers of lung diseases. She is an author of about 90 publications (According to Scopus: H-Index: 23; According to WOS: H-Index: 20) on peer-reviewed journals, a member of the “Società Italiana di Biochimica e Biologia Molecolare,“ and a Consultant Reviewer for International Journal of Molecular Science, Journal of Chromatography A, COPD, Plos ONE and Nutritional Neuroscience.",institutionString:null,institution:{name:"University of Pavia",institutionURL:null,country:{name:"Italy"}}},editorThree:null}]},overviewPageOFChapters:{paginationCount:2,paginationItems:[{id:"82297",title:"The Climate Change-Agriculture Nexus in Drylands of Ethiopia",doi:"10.5772/intechopen.103905",signatures:"Zenebe Mekonnen",slug:"the-climate-change-agriculture-nexus-in-drylands-of-ethiopia",totalDownloads:18,totalCrossrefCites:0,totalDimensionsCites:0,authors:null,book:{title:"Vegetation Dynamics, Changing Ecosystems and Human Responsibility",coverURL:"https://cdn.intechopen.com/books/images_new/11663.jpg",subseries:{id:"40",title:"Ecosystems and Biodiversity"}}},{id:"81999",title:"Climate Change, Rural Livelihoods, and Human Well-Being: Experiences from Kenya",doi:"10.5772/intechopen.104965",signatures:"André J. 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He received his Ph.D. in Environmental Analytical Chemistry from Assiut University, Egypt, in 1989. His research interest is in analytical and environmental chemistry with special emphasis on: (1) monitoring and assessing biological trace elements and toxic metals in human blood, urine, water, crops, vegetables, and medicinal plants; (2) relationships between environmental heavy metals and human diseases; (3) uses of biological indicators for monitoring water pollution; (4) environmental chemistry of lakes, rivers, and well water; (5) water and wastewater treatment by adsorption and photocatalysis techniques; (6) soil and water pollution monitoring, control, and treatment; and (7) advanced oxidation treatment. Prof. Rashed has supervised several MSc and Ph.D. theses in the field of analytical and environmental chemistry. He served as an examiner for several Ph.D. theses in analytical chemistry in India, Kazakhstan, and Botswana. He has published about ninety scientific papers in peer-reviewed international journals and several papers in national and international conferences. He participated as an invited speaker at thirty international conferences. Prof. Rashed is the editor-in-chief and an editorial board member for several international journals in the fields of chemistry and environment. He is a member of several national and international societies. He received the Egyptian State Award for Environmental Research in 2001 and the Aswan University Merit Award for Basic Science in 2020. 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She is now a lecturer at the University of Witwatersrand, South Africa, and a principal researcher at the Health Economics and Epidemiology Research Office (HE2RO), South Africa. Dr. Moolla holds a Ph.D. in Psychology with her research being focused on mental health and resilience. In her professional work capacity, her research has further expanded into the fields of early childhood development, mental health, the HIV and TB care cascades, as well as COVID. She is also a UNESCO-trained International Bioethics Facilitator.",institutionString:"University of the Witwatersrand",institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"342152",title:"Dr.",name:"Santo",middleName:null,surname:"Grace Umesh",slug:"santo-grace-umesh",fullName:"Santo Grace Umesh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/342152/images/16311_n.jpg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"333647",title:"Dr.",name:"Shreya",middleName:null,surname:"Kishore",slug:"shreya-kishore",fullName:"Shreya Kishore",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/333647/images/14701_n.jpg",biography:"Dr. Shreya Kishore completed her Bachelor in Dental Surgery in Chettinad Dental College and Research Institute, Chennai, and her Master of Dental Surgery (Orthodontics) in Saveetha Dental College, Chennai. She is also Invisalign certified. She’s working as a Senior Lecturer in the Department of Orthodontics, SRM Dental College since November 2019. She is actively involved in teaching orthodontics to the undergraduates and the postgraduates. Her clinical research topics include new orthodontic brackets, fixed appliances and TADs. She’s published 4 articles in well renowned indexed journals and has a published patency of her own. Her private practice is currently limited to orthodontics and works as a consultant in various clinics.",institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"323731",title:"Prof.",name:"Deepak M.",middleName:"Macchindra",surname:"Vikhe",slug:"deepak-m.-vikhe",fullName:"Deepak M. Vikhe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/323731/images/13613_n.jpg",biography:"Dr Deepak M.Vikhe .\n\n\t\n\tDr Deepak M.Vikhe , completed his Masters & PhD in Prosthodontics from Rural Dental College, Loni securing third rank in the Pravara Institute of Medical Sciences Deemed University. He was awarded Dr.G.C.DAS Memorial Award for Research on Implants at 39th IPS conference Dubai (U A E).He has two patents under his name. He has received Dr.Saraswati medal award for best research for implant study in 2017.He has received Fully funded scholarship to Spain ,university of Santiago de Compostela. He has completed fellowship in Implantlogy from Noble Biocare. \nHe has attended various conferences and CDE programmes and has national publications to his credit. His field of interest is in Implant supported prosthesis. Presently he is working as a associate professor in the Dept of Prosthodontics, Rural Dental College, Loni and maintains a successful private practice specialising in Implantology at Rahata.\n\nEmail: drdeepak_mvikhe@yahoo.com..................",institutionString:null,institution:{name:"Pravara Institute of Medical Sciences",country:{name:"India"}}},{id:"204110",title:"Dr.",name:"Ahmed A.",middleName:null,surname:"Madfa",slug:"ahmed-a.-madfa",fullName:"Ahmed A. Madfa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204110/images/system/204110.jpg",biography:"Dr. Madfa is currently Associate Professor of Endodontics at Thamar University and a visiting lecturer at Sana'a University and University of Sciences and Technology. He has more than 6 years of experience in teaching. His research interests include root canal morphology, functionally graded concept, dental biomaterials, epidemiology and dental education, biomimetic restoration, finite element analysis and endodontic regeneration. Dr. Madfa has numerous international publications, full articles, two patents, a book and a book chapter. Furthermore, he won 14 international scientific awards. Furthermore, he is involved in many academic activities ranging from editorial board member, reviewer for many international journals and postgraduate students' supervisor. Besides, I deliver many courses and training workshops at various scientific events. Dr. Madfa also regularly attends international conferences and holds administrative positions (Deputy Dean of the Faculty for Students’ & Academic Affairs and Deputy Head of Research Unit).",institutionString:"Thamar University",institution:null},{id:"210472",title:"Dr.",name:"Nermin",middleName:"Mohammed Ahmed",surname:"Yussif",slug:"nermin-yussif",fullName:"Nermin Yussif",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/210472/images/system/210472.jpg",biography:"Dr. Nermin Mohammed Ahmed Yussif is working at the Faculty of dentistry, University for October university for modern sciences and arts (MSA). Her areas of expertise include: periodontology, dental laserology, oral implantology, periodontal plastic surgeries, oral mesotherapy, nutrition, dental pharmacology. She is an editor and reviewer in numerous international journals.",institutionString:"MSA University",institution:null},{id:"204606",title:"Dr.",name:"Serdar",middleName:null,surname:"Gözler",slug:"serdar-gozler",fullName:"Serdar Gözler",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/204606/images/system/204606.jpeg",biography:"Dr. Serdar Gözler has completed his undergraduate studies at the Marmara University Faculty of Dentistry in 1978, followed by an assistantship in the Prosthesis Department of Dicle University Faculty of Dentistry. Starting his PhD work on non-resilient overdentures with Assoc. Prof. Hüsnü Yavuzyılmaz, he continued his studies with Prof. Dr. Gürbüz Öztürk of Istanbul University Faculty of Dentistry Department of Prosthodontics, this time on Gnatology. He attended training programs on occlusion, neurology, neurophysiology, EMG, radiology and biostatistics. In 1982, he presented his PhD thesis \\Gerber and Lauritzen Occlusion Analysis Techniques: Diagnosis Values,\\ at Istanbul University School of Dentistry, Department of Prosthodontics. As he was also working with Prof. Senih Çalıkkocaoğlu on The Physiology of Chewing at the same time, Gözler has written a chapter in Çalıkkocaoğlu\\'s book \\Complete Prostheses\\ entitled \\The Place of Neuromuscular Mechanism in Prosthetic Dentistry.\\ The book was published five times since by the Istanbul University Publications. Having presented in various conferences about occlusion analysis until 1998, Dr. Gözler has also decided to use the T-Scan II occlusion analysis method. Having been personally trained by Dr. Robert Kerstein on this method, Dr. Gözler has been lecturing on the T-Scan Occlusion Analysis Method in conferences both in Turkey and abroad. Dr. Gözler has various articles and presentations on Digital Occlusion Analysis methods. He is now Head of the TMD Clinic at Prosthodontic Department of Faculty of Dentistry , Istanbul Aydın University , Turkey.",institutionString:"Istanbul Aydin University",institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"240870",title:"Ph.D.",name:"Alaa Eddin Omar",middleName:null,surname:"Al Ostwani",slug:"alaa-eddin-omar-al-ostwani",fullName:"Alaa Eddin Omar Al Ostwani",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/240870/images/system/240870.jpeg",biography:"Dr. Al Ostwani Alaa Eddin Omar received his Master in dentistry from Damascus University in 2010, and his Ph.D. in Pediatric Dentistry from Damascus University in 2014. Dr. Al Ostwani is an assistant professor and faculty member at IUST University since 2014. \nDuring his academic experience, he has received several awards including the scientific research award from the Union of Arab Universities, the Syrian gold medal and the international gold medal for invention and creativity. Dr. Al Ostwani is a Member of the International Association of Dental Traumatology and the Syrian Society for Research and Preventive Dentistry since 2017. He is also a Member of the Reviewer Board of International Journal of Dental Medicine (IJDM), and the Indian Journal of Conservative and Endodontics since 2016.",institutionString:"International University for Science and Technology.",institution:{name:"Islamic University of Science and Technology",country:{name:"India"}}},{id:"42847",title:"Dr.",name:"Belma",middleName:null,surname:"Işik Aslan",slug:"belma-isik-aslan",fullName:"Belma Işik Aslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/42847/images/system/42847.jpg",biography:"Dr. Belma IşIk Aslan was born in 1976 in Ankara-TURKEY. After graduating from TED Ankara College in 1994, she attended to Gazi University, Faculty of Dentistry in Ankara. She completed her PhD in orthodontic education at Gazi University between 1999-2005. Dr. Işık Aslan stayed at the Providence Hospital Craniofacial Institude and Reconstructive Surgery in Michigan, USA for three months as an observer. She worked as a specialist doctor at Gazi University, Dentistry Faculty, Department of Orthodontics between 2005-2014. She was appointed as associate professor in January, 2014 and as professor in 2021. Dr. Işık Aslan still works as an instructor at the same faculty. She has published a total of 35 articles, 10 book chapters, 39 conference proceedings both internationally and nationally. Also she was the academic editor of the international book 'Current Advances in Orthodontics'. She is a member of the Turkish Orthodontic Society and Turkish Cleft Lip and Palate Society. She is married and has 2 children. Her knowledge of English is at an advanced level.",institutionString:"Gazi University Dentistry Faculty Department of Orthodontics",institution:null},{id:"178412",title:"Associate Prof.",name:"Guhan",middleName:null,surname:"Dergin",slug:"guhan-dergin",fullName:"Guhan Dergin",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178412/images/6954_n.jpg",biography:"Assoc. Prof. Dr. Gühan Dergin was born in 1973 in Izmit. He graduated from Marmara University Faculty of Dentistry in 1999. He completed his specialty of OMFS surgery in Marmara University Faculty of Dentistry and obtained his PhD degree in 2006. In 2005, he was invited as a visiting doctor in the Oral and Maxillofacial Surgery Department of the University of North Carolina, USA, where he went on a scholarship. Dr. Dergin still continues his academic career as an associate professor in Marmara University Faculty of Dentistry. He has many articles in international and national scientific journals and chapters in books.",institutionString:null,institution:{name:"Marmara University",country:{name:"Turkey"}}},{id:"178414",title:"Prof.",name:"Yusuf",middleName:null,surname:"Emes",slug:"yusuf-emes",fullName:"Yusuf Emes",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178414/images/6953_n.jpg",biography:"Born in Istanbul in 1974, Dr. Emes graduated from Istanbul University Faculty of Dentistry in 1997 and completed his PhD degree in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery in 2005. He has papers published in international and national scientific journals, including research articles on implantology, oroantral fistulas, odontogenic cysts, and temporomandibular disorders. Dr. Emes is currently working as a full-time academic staff in Istanbul University faculty of Dentistry Department of Oral and Maxillofacial Surgery.",institutionString:null,institution:{name:"Istanbul University",country:{name:"Turkey"}}},{id:"192229",title:"Ph.D.",name:"Ana Luiza",middleName:null,surname:"De Carvalho Felippini",slug:"ana-luiza-de-carvalho-felippini",fullName:"Ana Luiza De Carvalho Felippini",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192229/images/system/192229.jpg",biography:null,institutionString:"University of São Paulo",institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"256851",title:"Prof.",name:"Ayşe",middleName:null,surname:"Gülşen",slug:"ayse-gulsen",fullName:"Ayşe Gülşen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256851/images/9696_n.jpg",biography:"Dr. Ayşe Gülşen graduated in 1990 from Faculty of Dentistry, University of Ankara and did a postgraduate program at University of Gazi. \nShe worked as an observer and research assistant in Craniofacial Surgery Departments in New York, Providence Hospital in Michigan and Chang Gung Memorial Hospital in Taiwan. \nShe works as Craniofacial Orthodontist in Department of Aesthetic, Plastic and Reconstructive Surgery, Faculty of Medicine, University of Gazi, Ankara Turkey since 2004.",institutionString:"Univeristy of Gazi",institution:null},{id:"255366",title:"Prof.",name:"Tosun",middleName:null,surname:"Tosun",slug:"tosun-tosun",fullName:"Tosun Tosun",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/255366/images/7347_n.jpg",biography:"Graduated at the Faculty of Dentistry, University of Istanbul, Turkey in 1989;\nVisitor Assistant at the University of Padua, Italy and Branemark Osseointegration Center of Treviso, Italy between 1993-94;\nPhD thesis on oral implantology in University of Istanbul and was awarded the academic title “Dr.med.dent.”, 1997;\nHe was awarded the academic title “Doç.Dr.” (Associated Professor) in 2003;\nProficiency in Botulinum Toxin Applications, Reading-UK in 2009;\nMastership, RWTH Certificate in Laser Therapy in Dentistry, AALZ-Aachen University, Germany 2009-11;\nMaster of Science (MSc) in Laser Dentistry, University of Genoa, Italy 2013-14.\n\nDr.Tosun worked as Research Assistant in the Department of Oral Implantology, Faculty of Dentistry, University of Istanbul between 1990-2002. \nHe worked part-time as Consultant surgeon in Harvard Medical International Hospitals and John Hopkins Medicine, Istanbul between years 2007-09.\u2028He was contract Professor in the Department of Surgical and Diagnostic Sciences (DI.S.C.), Medical School, University of Genova, Italy between years 2011-16. \nSince 2015 he is visiting Professor at Medical School, University of Plovdiv, Bulgaria. \nCurrently he is Associated Prof.Dr. at the Dental School, Oral Surgery Dept., Istanbul Aydin University and since 2003 he works in his own private clinic in Istanbul, Turkey.\u2028\nDr.Tosun is reviewer in journal ‘Laser in Medical Sciences’, reviewer in journal ‘Folia Medica\\', a Fellow of the International Team for Implantology, Clinical Lecturer of DGZI German Association of Oral Implantology, Expert Lecturer of Laser&Health Academy, Country Representative of World Federation for Laser Dentistry, member of European Federation of Periodontology, member of Academy of Laser Dentistry. Dr.Tosun presents papers in international and national congresses and has scientific publications in international and national journals. He speaks english, spanish, italian and french.",institutionString:null,institution:{name:"Istanbul Aydın University",country:{name:"Turkey"}}},{id:"171887",title:"Prof.",name:"Zühre",middleName:null,surname:"Akarslan",slug:"zuhre-akarslan",fullName:"Zühre Akarslan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/171887/images/system/171887.jpg",biography:"Zühre Akarslan was born in 1977 in Cyprus. She graduated from Gazi University Faculty of Dentistry, Ankara, Turkey in 2000. \r\nLater she received her Ph.D. degree from the Oral Diagnosis and Radiology Department; which was recently renamed as Oral and Dentomaxillofacial Radiology, from the same university. \r\nShe is working as a full-time Associate Professor and is a lecturer and an academic researcher. \r\nHer expertise areas are dental caries, cancer, dental fear and anxiety, gag reflex in dentistry, oral medicine, and dentomaxillofacial radiology.",institutionString:"Gazi University",institution:{name:"Gazi University",country:{name:"Turkey"}}},{id:"256417",title:"Associate Prof.",name:"Sanaz",middleName:null,surname:"Sadry",slug:"sanaz-sadry",fullName:"Sanaz Sadry",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/256417/images/8106_n.jpg",biography:null,institutionString:null,institution:null},{id:"272237",title:"Dr.",name:"Pinar",middleName:"Kiymet",surname:"Karataban",slug:"pinar-karataban",fullName:"Pinar Karataban",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/272237/images/8911_n.png",biography:"Assist.Prof.Dr.Pınar Kıymet Karataban, DDS PhD \n\nDr.Pınar Kıymet Karataban was born in Istanbul in 1975. After her graduation from Marmara University Faculty of Dentistry in 1998 she started her PhD in Paediatric Dentistry focused on children with special needs; mainly children with Cerebral Palsy. She finished her pHD thesis entitled \\'Investigation of occlusion via cast analysis and evaluation of dental caries prevalance, periodontal status and muscle dysfunctions in children with cerebral palsy” in 2008. She got her Assist. Proffessor degree in Istanbul Aydın University Paediatric Dentistry Department in 2015-2018. ın 2019 she started her new career in Bahcesehir University, Istanbul as Head of Department of Pediatric Dentistry. In 2020 she was accepted to BAU International University, Batumi as Professor of Pediatric Dentistry. She’s a lecturer in the same university meanwhile working part-time in private practice in Ege Dental Studio (https://www.egedisklinigi.com/) a multidisciplinary dental clinic in Istanbul. Her main interests are paleodontology, ancient and contemporary dentistry, oral microbiology, cerebral palsy and special care dentistry. She has national and international publications, scientific reports and is a member of IAPO (International Association for Paleodontology), IADH (International Association of Disability and Oral Health) and EAPD (European Association of Pediatric Dentistry).",institutionString:null,institution:null},{id:"202198",title:"Dr.",name:"Buket",middleName:null,surname:"Aybar",slug:"buket-aybar",fullName:"Buket Aybar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/202198/images/6955_n.jpg",biography:"Buket Aybar, DDS, PhD, was born in 1971. She graduated from Istanbul University, Faculty of Dentistry, in 1992 and completed her PhD degree on Oral and Maxillofacial Surgery in Istanbul University in 1997.\nDr. Aybar is currently a full-time professor in Istanbul University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery. She has teaching responsibilities in graduate and postgraduate programs. Her clinical practice includes mainly dentoalveolar surgery.\nHer topics of interest are biomaterials science and cell culture studies. She has many articles in international and national scientific journals and chapters in books; she also has participated in several scientific projects supported by Istanbul University Research fund.",institutionString:null,institution:null},{id:"260116",title:"Dr.",name:"Mehmet",middleName:null,surname:"Yaltirik",slug:"mehmet-yaltirik",fullName:"Mehmet Yaltirik",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/260116/images/7413_n.jpg",biography:"Birth Date 25.09.1965\r\nBirth Place Adana- Turkey\r\nSex Male\r\nMarrial Status Bachelor\r\nDriving License Acquired\r\nMother Tongue Turkish\r\n\r\nAddress:\r\nWork:University of Istanbul,Faculty of Dentistry, Department of Oral Surgery and Oral Medicine 34093 Capa,Istanbul- TURKIYE",institutionString:null,institution:null},{id:"172009",title:"Dr.",name:"Fatma Deniz",middleName:null,surname:"Uzuner",slug:"fatma-deniz-uzuner",fullName:"Fatma Deniz Uzuner",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/172009/images/7122_n.jpg",biography:"Dr. Deniz Uzuner was born in 1969 in Kocaeli-TURKEY. After graduating from TED Ankara College in 1986, she attended the Hacettepe University, Faculty of Dentistry in Ankara. \nIn 1993 she attended the Gazi University, Faculty of Dentistry, Department of Orthodontics for her PhD education. After finishing the PhD education, she worked as orthodontist in Ankara Dental Hospital under the Turkish Government, Ministry of Health and in a special Orthodontic Clinic till 2011. Between 2011 and 2016, Dr. Deniz Uzuner worked as a specialist in the Department of Orthodontics, Faculty of Dentistry, Gazi University in Ankara/Turkey. In 2016, she was appointed associate professor. Dr. Deniz Uzuner has authored 23 Journal Papers, 3 Book Chapters and has had 39 oral/poster presentations. She is a member of the Turkish Orthodontic Society. Her knowledge of English is at an advanced level.",institutionString:null,institution:null},{id:"332914",title:"Dr.",name:"Muhammad Saad",middleName:null,surname:"Shaikh",slug:"muhammad-saad-shaikh",fullName:"Muhammad Saad Shaikh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Jinnah Sindh Medical University",country:{name:"Pakistan"}}},{id:"315775",title:"Dr.",name:"Feng",middleName:null,surname:"Luo",slug:"feng-luo",fullName:"Feng Luo",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Sichuan University",country:{name:"China"}}},{id:"423519",title:"Dr.",name:"Sizakele",middleName:null,surname:"Ngwenya",slug:"sizakele-ngwenya",fullName:"Sizakele Ngwenya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of the Witwatersrand",country:{name:"South Africa"}}},{id:"419270",title:"Dr.",name:"Ann",middleName:null,surname:"Chianchitlert",slug:"ann-chianchitlert",fullName:"Ann Chianchitlert",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419271",title:"Dr.",name:"Diane",middleName:null,surname:"Selvido",slug:"diane-selvido",fullName:"Diane Selvido",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"419272",title:"Dr.",name:"Irin",middleName:null,surname:"Sirisoontorn",slug:"irin-sirisoontorn",fullName:"Irin Sirisoontorn",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Walailak University",country:{name:"Thailand"}}},{id:"355660",title:"Dr.",name:"Anitha",middleName:null,surname:"Mani",slug:"anitha-mani",fullName:"Anitha Mani",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"355612",title:"Dr.",name:"Janani",middleName:null,surname:"Karthikeyan",slug:"janani-karthikeyan",fullName:"Janani Karthikeyan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"334400",title:"Dr.",name:"Suvetha",middleName:null,surname:"Siva",slug:"suvetha-siva",fullName:"Suvetha Siva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"SRM Dental College",country:{name:"India"}}},{id:"334239",title:"Prof.",name:"Leung",middleName:null,surname:"Wai Keung",slug:"leung-wai-keung",fullName:"Leung Wai Keung",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Hong Kong",country:{name:"China"}}}]}},subseries:{item:{id:"6",type:"subseries",title:"Viral Infectious Diseases",keywords:"Novel Viruses, Virus Transmission, Virus Evolution, Molecular Virology, Control and Prevention, Virus-host Interaction",scope:"The Viral Infectious Diseases Book Series aims to provide a comprehensive overview of recent research trends and discoveries in various viral infectious diseases emerging around the globe. 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She is the founder of the Department of Zoology and former controller of examinations at Shaheed Benazir Bhutto University, Hazara University, and Kohat University of Science and Technology. She is the author of 150 high-impact research papers, 135 abstracts, 40 authored books, 9 chapters, and 9 edited books. She is also a student supervisor. 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Sc in Forestry from Universiti Putra Malaysia (UPM) and an M. S from the University of Nebraska-Lincoln (UNL), USA. He was then honored with a prestigious fellowship from the Canadian Commonwealth to pursue a Ph.D. degree at the University of British Columbia (UBC), Canada, where he worked on the application of remote sensing for forest resources management. He has been involved in numerous collaborative international research projects that led to publications in reputable journals. Altogether, he has published a total of 14 books and more than 200 research publications. His research interests cover several aspects of forestry, mainly forest modeling, forest ecology, and biodiversity. He received the UiTM’s Best Researcher and Top Talent Awards in 2015 and 2021, respectively. He served as the Deputy Vice-Chancellor (Research and Innovation) from 2018 to 2021.",institutionString:"Universiti Teknologi MARA",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"3",institution:{name:"Universiti Teknologi MARA",institutionURL:null,country:{name:"Malaysia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null}],selectedSeries:null,selectedSubseries:null},seriesLanding:{item:null},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"chapter.detail",path:"/chapters/4673",hash:"",query:{},params:{id:"4673"},fullPath:"/chapters/4673",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()