Schimmel M, Ono T, Lam O L T, Müller F
Division of Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland.
J Oral Rehabil. 2017 Apr;44(4):313-326. doi: 10.1111/joor.12486. Epub 2017 Mar 1.
Stroke is considered one of the leading causes of death and acquired disability with a peak prevalence over the age of 80 years. Stroke may cause debilitating neurological deficiencies that frequently result in sensory deficits, motor impairment, muscular atrophy, cognitive deficits and psychosocial impairment. Oro-facial impairment may occur due to the frequent involvement of the cranial nerves' cortical representation areas, central nervous system pathways or motoneuron pools. The aim of this narrative, non-systematic review was to discuss the implications of stroke on oro-facial functions and oral health-related quality of life (OHRQoL). Stroke patients demonstrate an impaired masticatory performance, possibly due to reduced tongue forces and disturbed oral sensitivity. Furthermore, facial asymmetry is common, but mostly discrete and lip restraining forces are reduced. Bite force is not different between the ipsi- and contra-lesional side. In contrast, the contra-lesional handgrip strength and tongue-palate contact during swallowing are significantly impaired. OHRQoL is significantly reduced mainly because of the functional impairment. It can be concluded that impaired chewing efficiency, dysphagia, facial asymmetry, reduced lip force and OHRQoL are quantifiable symptoms of oro-facial impairment following a stroke. In the absence of functional rehabilitation, these symptoms seem not to improve. Furthermore, stroke affects the upper limb and the masseter muscle differently, both, at a functional and a morphological level. The rehabilitation of stroke survivors should, therefore, also seek to improve the strength and co-ordination of the oro-facial musculature. This would in turn help improve OHRQoL and the masticatory function, subsequently preventing weight loss and malnutrition.
中风被认为是导致死亡和后天残疾的主要原因之一，在80岁以上人群中的患病率达到峰值。中风可能导致使人衰弱的神经功能缺陷，常常引发感觉缺陷、运动障碍、肌肉萎缩、认知缺陷和心理社会障碍。由于颅神经的皮质代表区、中枢神经系统通路或运动神经元池经常受累，口面部功能障碍可能会出现。本叙述性非系统性综述的目的是探讨中风对口面部功能和口腔健康相关生活质量（OHRQoL）的影响。中风患者表现出咀嚼功能受损，这可能是由于舌力降低和口腔感觉紊乱所致。此外，面部不对称很常见，但大多不明显，而且唇部约束力降低。患侧和健侧的咬力没有差异。相比之下，健侧的握力和吞咽时舌与腭的接触明显受损。OHRQoL显著降低主要是由于功能障碍。可以得出结论，咀嚼效率受损、吞咽困难、面部不对称、唇部力量降低和OHRQoL是中风后口面部功能障碍的可量化症状。在缺乏功能康复的情况下，这些症状似乎不会改善。此外，中风在功能和形态层面上对上肢和咬肌的影响有所不同。因此，中风幸存者的康复也应致力于提高口面部肌肉组织的力量和协调性。这反过来将有助于改善OHRQoL和咀嚼功能，进而防止体重减轻和营养不良。
