Search

Donor site complications, following microvascular free tissue transfer, can limit recovery in patients treated for head and neck cancer, with a curative intent. The Patient Concerns Inventory (PCI-HN) is a prompt list that provides patients with repeated opportunities to raise issues they feel are important and want to discuss. Here, we look at baseline results from a cluster preference randomised control trial with consultants either "using" or "not using" the PCI package in clinic to identify patient concerns. UWQOL results were presented from 67 consecutive patients having reconstruction with free tissue transfer and PCI results from 25 of these patients in the PCI arm of the trial. During early review consultations patients most wanted to discuss issues related to dental health, dry mouth, and chewing. Donor site morbidity, in our patient sample, did not appear to be an issue that patients wanted to discuss. [ABSTRACT FROM AUTHOR]

Contemporary advances in technology have enabled the transfer of industrial laser melting technology to surgery, and its use can improve the accuracy of orbital restoration. The aim of this study therefore was to evaluate the accuracy of primary orbital reconstruction with the use of selective laser melted, patient-specific implants and navigation. A total of 100 patients with complex orbital fractures were included. Planned orbital volumes were compared with those achieved, and angles were compared with the unaffected side. Analysis included the overlay of postoperative on planned images (iPlan® 3.0.5, Brainlab). The mean (SD) orbital volume of the unaffected side was 27.2 (2.8) ml in men and 25.0 (2.6) ml in women. Fractures that involved the posterior third of the orbital floor and comminuted fractures showed significant orbital enlargement (p = 0.026). The mean (SD) reconstructed orbital volume was 26.9 (2.7) ml in men and 24.26 (2.5) ml in women. Three-dimensional analysis of the colour mapping showed minor deviations when compared with the unaffected side. The results suggest that a high degree of accuracy can be routinely achieved in these complex cases. [ABSTRACT FROM AUTHOR]

Oral squamous cell carcinoma is the most common intraoral malignancy, for which we advocate radical primary resection with adjuvant treatment where indicated. The main aims of this paper are to identify the overall survival of a consecutive series of patients and to relate survival to clinical and pathological factors. Kaplan–Meier curves were produced for site, sex, TNM status, and use of postoperative radiotherapy. The data were analysed using IBM SPSS Statistics for Windows and probabilities of less than 0.05 were accepted as significant. A total of 921 patients were recorded in the database with a diagnosis of oral squamous cell carcinoma out of a total of 1958 with salivary gland conditions or other cancers of the head and neck (43.1%). The earliest date of diagnosis was 1973, and the data were censored at 31 March 2016. The database comprised 340 women (36.9%) and 581 men (63.1%). A total of 339 patients died (34.5%): 117 women (33.7%) and 222 men (65.5%). The mean (range) age at death was 73.4 (31.4–97.5) years for women and 68.7 (33.3–95.5) years for men (t (337) = 3.28, p = 0.001). Our overall survival was somewhat better than the 56% five-year survival reported for oral cancer in England in 2010, which may be a reflection of the treatment. This work supports the view that aggressive management may improve overall survival. [ABSTRACT FROM AUTHOR]

Abstract: Thirty-one patients were assessed for changes in pain and maximal mouth opening (MMO) before and after total temporomandibular joint (TMJ) replacement. All prosthetic joint replacements used the Christensen fossa-eminence prosthesis system; 18 were unilateral and 13 bilateral. There were more women (n =22) than men (n =9), and their mean age was 45 years (women 46, range 18–74, and men 42, range 28–69). Indications for replacement included osteoarthritis, ankylosis, and “other”. There were overall significant improvements in pain scores for the whole group at one year (95% CI 6.3–8.5 compared with 0.2–3.0) and for women alone (6.5 to 9.2 compared with −0.5 to 2.0). There were also significant improvements in pain scores in both those with osteoarthritis (95% CI 8.1 to 8.9 compared with −0.8 to 3.8) and the group with “other” diagnoses at the 12-month follow-up (95% CI 4.4 to 10.7 compared with −0.2 to 0.5). Finally, there was a significant improvement in MMO in the whole group at the time of 12-month follow-up (95% CI 15.8–23.5 compared with 24.0–32.3). [Copyright &y& Elsevier]

Abstract: We describe the outcome of 46 patients 12 months after partial or total replacement of the temporomandibular joint (TMJ) using the Christensen implant system (TMJ Implants Inc, Golden, CO, USA). The study group comprised 35 women and 11 men; the women were slightly older than the men at the time of operation. We studied three diagnostic groups in detail: patients who had ankylosis, internal derangement, and osteoarthritis. Those with ankylosis were slightly older than the others. Pain decreased over time in all three groups. There was a significant reduction between preoperative pain and that recorded 1 month postoperatively. After this point the pain decreased slowly, and by year 1 it had decreased significantly with respect to preoperative scores. Women reported worse preoperative pain than men, but not significantly so. [Copyright &y& Elsevier]

Abstract: Our aim was to develop a way of measuring trismus and evaluating it in terms of reliability and validity for use by nurses who care for patients with head and neck cancer. We developed a method from existing resources and tested it for interoperator reliability and validity against a “gold standard”. We showed that within the variables outlined, nursing staff could use it after minimal training to identify patients broadly as being “at risk”, “low risk”, or having “normal mouth opening”. Interexaminer reliability was poor. There was a trend towards a group of people having reasonable interexaminer reliability, and this same group showed consistency towards the gold standard. Nurses’ accuracy and consistency in using a simple method of assessing trismus depends on more than the method used, and neither validity nor reliability can be assumed. The accurate assessment of trismus for comparison across studies is complex, and future research must define exactly what method was used. [Copyright &y& Elsevier]

Abstract: Oral dysplastic lesions may have an increased chance of becoming oral squamous cell carcinoma, but to date their management remains controversial. The aim of this survey was to explore the current practical aspects of the management of patients with dysplasia by oral and maxillofacial consultants in the UK. In the survey we asked consultants about the numbers of patients they see with oral premalignant lesions, the frequency and specialty of designated hospital clinics, their use of photographs and biopsy, factors that influence their decision whether to biopsy a lesion at the first appointment, the procedure for treatment and follow-up and their use (if any) of chemopreventive agents. We found a wide variation in the practical aspects of managing patients with dysplasia, and the lack of consistency among clinicians supports the idea of an initiative to establish more robust national guidelines to use as a gold standard in the future. [Copyright &y& Elsevier]

Abstract: Histological analysis of tumour resection for squamous cell carcinoma (SCC) of the tongue yields prognostic information. We analysed histological slides of biopsy and tumour resection specimens using an adapted malignancy grading score and analysed variables of neck dissections. There was moderate correlation between biopsy and tumour resection using malignancy grading scores (correlation coefficient 0.45); good agreement of tumour grade (79%), tumour depth (76%), and type of invasive front (80%), but correlation was only fair to moderate (κ =0.38, κ =0.51, and κ =0.41, respectively). Correlation of the biopsy grading score and invaded nodes in the neck, extra capsular spread, and soft tissue disease was not significant. [ABSTRACT FROM AUTHOR]

Abstract: Patient reported outcomes (PRO) have an established role when reporting treatment outcomes. This data is usually collected using patient self-completed questionnaires. There are numerous questionnaires available and selecting the most appropriate one can be difficult. Aim: The aim of this article was to carry out a systematic review of the literature to identify publications using patient self-completed questionnaires suitable for oral and maxillofacial surgery. The questionnaires were collated and grouped according to sub-speciality interests. Method: The ISI search engine with cross-reference using Pub Med and Ovid was searched for publications between 1981 and March 2009. Abstracts written in English were reviewed by two of the authors independently. Results: A total of 511 abstracts were reviewed and the paper cites 56 studies with self-administered instruments. The number of subsite specific questionnaires identified were; cleft lip and palate (1), craniofacial surgery (2), dentoalveolar surgery (6), distraction osteogenesis (1), facial aesthetic surgery (4), facial pain (1), head and neck cancer (14), maxillofacial injury (3), oral medicine and oral mucosal disorders (2), orthognathic surgery (1), pre-prosthetic surgery and dental implants (15), skull base surgery (7), temporomandibular joint (2). Conclusion: There is a tremendous variety of validated questionnaires available that are suitable for oral and maxillofacial surgery. This summary serves as a useful reference point when selecting a questionnaire for an audit or research projects. It also describes publications, which have used the various questionnaires, thus readily identifying papers that might be useful for comparison. [ABSTRACT FROM AUTHOR]

Abstract: Radial forearm free flaps (RFFFs) are safe, but critical ischaemia of the hand has been described and is catastrophic. Every effort should therefore be made to improve the safety margin even further. Colour flow duplex ultrasound (US) is a simple, non-invasive and effective assessment tool. We compared it with Allen''s test to identify serious vascular anomalies. We studied 121 patients who were listed to have a RFFF harvested, all of whom had both duplex US assessment and Allen''s testing of the selected arm. The significance of differences in proportions was assessed using McNemar''s test. Five of the 121 patients had an alternative flap selected as a consequence of the duplex assessment. A single flap failed. There were no ischaemic vascular complications that affected the hand. [Copyright &y& Elsevier]

Abstract: Lugol''s iodine is currently under investigation as a technique to detect dysplasia, carcinoma in situ and invasive carcinoma at resection margins, plus further afield. Lugol''s iodine is inexpensive and easy to use. We present two cases where the technique revealed abnormal mucosa (one carcinoma, one squamous cell carcinoma in situ) at distant sites from the tumour being treated within oral cavity and oropharynx. [Copyright &y& Elsevier]

Abstract: Published articles on surgical approaches to the mandibular condyle seem to be confusing. We present a classification system that describes and differentiates between surgical approaches to the mandibular condyle and is based on the relation to the facial nerve, height of the approach, and choice of skin incision. [Copyright &y& Elsevier]