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OBJECTIVES: : Many conditions of the oral and maxillofacial region require hospitalization and in-patient care. The average length of stay (LOS) of these patients varies and is usually affected by multiple confounding variables. However, even with an increasing number of hospital admissions, published evidence on the factors that affect the LOS of oral and maxillofacial patients is lacking. Therefore, this study assessed the LOS of in-patients at the oral and maxillofacial surgery department of a government-funded, multi-specialty hospital in Malaysia, based on their reasons for admission and other factors. MATERIALS AND METHODS: Our samples were collected retrospectively over a 5-year period and included patients with maxillofacial infections, post-trauma stabilization, facial bone fracture surgery, benign and malignant lesion surgery, dentoalveolar surgery, and other maxillofacial surgeries as reasons for admission. Factors potentially affecting LOS were also recorded, and their significance was determined using multiple logistic regression analyses. A P-value of less than 0.05 was considered to be statistically significant. RESULTS: A total of 1,380 patients were included in this study. Most (84.5%) of our in-patients were of Malay ethnicity, and males outnumbered females in our sample by 502 subjects. The median LOS of our in-patients was 3 days. Sex, ethnicity, age, reason for admission, and American Society of Anesthesiology (ASA) classification were factors that significantly affected LOS. CONCLUSION: The median LOS reported in this study was 3 days. LOS was significantly affected by sex, ethnicity, age, reason of admission and ASA classification.
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PURPOSE: To ascertain the complications arising from open reduction and internal fixation of mandibular fractures and to elucidate if different osteosynthesis plating systems vary in treatment outcome. MATERIALS AND METHODS: This is a retrospective study. Parameters such as patient data, injury details, osteosynthesis implant system information, stability of fracture fragments, occlusion and complications were evaluated at different time intervals and logistic regression applied to determine the association of these factors with complications. RESULTS: Five hundred and ninety-three patients with mandibular fractures were included in this study (male 87.9% and female 12.1%), age range of 13-72 years (median = 22 years). Most fractures were caused by motor vehicle accidents (85.8%), assault (6.2%) and falls (4.7%). Parasymphyseal fractures were the most common (50.1%), followed by angle (35.2%) and body of mandible (25%). Median time interval between injury and intervention was 7 days (IQR 4-10). Median duration of follow-up from date of surgery was 72 days (IQR 30-230). 76.9% (456) were completely free of complications. Most complications (46%) occurred in the intermediate post-surgical period (1-6 weeks). Median interval period between surgery and complication was 15 days (IQR 7-67.5). Nerve injury and surgical site infection were the most common complications at 6.7% and 5.7%, respectively. There was a significant difference between the plating system in terms of complication outcome (p = 0.017). CONCLUSION: Whilst the miniplate dimensions may be similar across different manufacturers, the complication outcome may differ between systems.
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Objective: To gauge surgical outcome in breast cancer patients with particular reference to overall survival and recurrence free survival among breast cancer patients in Hospital Sultanah Nora Ismail Batu Pahat, Johor, Malaysia. Methods: Patients undergoing ablative breast cancer surgery were identified and clinical records were assessed. Inclusion criteria for enrolment were stage I-IV breast malignancy necessitating resection with or without radiotherapy/ chemotherapy from 2007 to 2013. All individuals had a pre-operative assessment. The post operative assessment period ranged from 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves. Results: A total of 121 patients were included in this study, with an age range of 28-78 years. Some 98% had undergone local excision/ lumpectomy/ mastectomy with axillary clearance. While 81% of patients underwent chemotherapy, only 69% had radiotherapy. Tumours were oestrogen receptor positive in 58% of cases and progesterone receptor positive in 62%. Local recurrence was detected in 10%. The mean age at diagnosis was 51.3 + 10.4 years. The overall survival analysis was based on 22 deaths among the 121 patients (18.2%). Three-year and five-year survival rates were 87.6% and 78.4%, respectively. Analysis of recurrence-free-survival (RFS) was based on 12 events among 121 patients. The Kaplan-Meier RFS analysis revealed that in 90% of the patients with recurrence, it occurred within 45 months. The five year RFS rate was 84.5%. The median time taken from diagnosis to ablative surgery was 51 days (upper limit of 791 days). Only distant metastasis was a significant factor that impacted on both overall survival and recurrence-free survival (p<0.001). Conclusion: Overall survival among our breast cancer patients in our facility is comparable to other in other tertiary centres in the country. A trend for earlier detection was noted.
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Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Metástasis Linfática/patología , Malasia , Mastectomía/métodos , Persona de Mediana Edad , Análisis de Supervivencia , Tasa de Supervivencia , Adulto JovenRESUMEN
BACKGROUND: Treatment for tumors of the oral cavity and the oropharynx disrupts normal swallow function. The ability for oral diet postoperatively varies and may be influenced by surgery and patient-related factors. METHODS: In all, 114 patients treated with surgery with and without chemoradiotherapy for advanced oral/oropharyngeal cancer were recruited. Clinicopathologic tumor parameters and reconstruction modalities were recorded. Swallow function was determined by oral intake, using the Functional Oral Intake Scale (FOIS) pretreatment and posttreatment. RESULTS: The median time to first attaining swallow function was 14 days. Patients were less likely to attain tube independence within 1 year of surgery if they received radiotherapy or had a low FOIS score preoperatively. Patients' time to first attaining swallow function postsurgery was inversely related to the FOIS score presurgery. CONCLUSIONS: Swallow function recovery postsurgery is better in patients with higher FOIS presurgery, smaller tumors, and no requirement for radiotherapy.
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Carcinoma de Células Escamosas/terapia , Quimioradioterapia/efectos adversos , Trastornos de Deglución/epidemiología , Neoplasias de la Boca/terapia , Neoplasias Orofaríngeas/terapia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Quimioradioterapia/métodos , Estudios de Cohortes , Terapia Combinada , Trastornos de Deglución/diagnóstico , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Análisis Multivariante , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: The impact of ablative oral cancer surgery was studied, with particular reference to recurrence and nodal metastasis, to assess survival probability and prognostic indicators and to elucidate if ethnicity influences the survival of patients. METHODS: Patients who underwent major ablative surgery of the head and neck region with neck dissection were identified and clinical records were assessed. Inclusion criteria were stage I-IV oral and oropharyngeal malignancies necessitating resection with or without radiotherapy from 2004 to 2009. All individuals had a pre-operative assessment prior to the surgery. The post operative assessment period ranged from 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves. RESULTS: 87 patients (males:38%; females:62%) were included in this study, with an age range of 21-85 years. Some 78% underwent neck dissections while 63% had surgery and radiotherapy. Nodal recurrence was detected in 5.7% while 20.5% had primary site recurrence within the study period. Kaplan-Meier survival analysis revealed that the median survival time was 57 months. One year overall survival (OS) rate was 72.7% and three year overall survival rate dropped to 61.5%. On OS analysis, the log-rank test showed a significant difference of survival between Malay and Chinese patients (Bonferroni correction p=0.033). Recurrence-free survival (RFS) analysis revealed that 25% of the patients have reached the event of recurrence at 46 months. One year RFS rate was 85.2% and the three year survival rate was 76.1%. In the RFS analysis, the log-rank test showed a significant difference in the event of recurrence and nodal metastasis (p<0.001). CONCLUSION: Conservative neck is effective, in conjunction with postoperative radiotherapy, for control of neck metastases. Ethnicity appears to influence the survival of the patients, but a prospective trial is required to validate this.
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Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/cirugía , Disección del Cuello , Recurrencia Local de Neoplasia/cirugía , Neoplasias de las Glándulas Salivales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Metástasis Linfática , Malasia , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Neoplasias de las Glándulas Salivales/mortalidad , Neoplasias de las Glándulas Salivales/patología , Tasa de Supervivencia , Adulto JovenRESUMEN
An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs and imaging are reviewed in this paper. Discussion of case presentation and management are done for evaluation. A wide range of other compressive lesions can cause trigeminal neuralgia. This paper illustrates the clinical presentation of atypical trigeminal neuralgia and emphasises the value of diagnostic imaging in trigeminal neuralgia patient. Suggested algorithm for management of trigeminal neuralgia.
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Neuralgia del Trigémino/etiología , Anciano , Anciano de 80 o más Años , Ameloblastoma/complicaciones , Ameloblastoma/diagnóstico , Enfermedades Cerebelosas/complicaciones , Enfermedades Cerebelosas/diagnóstico , Neoplasias Cerebelosas/complicaciones , Neoplasias Cerebelosas/diagnóstico , Ángulo Pontocerebeloso/patología , Neoplasias de los Nervios Craneales/complicaciones , Neoplasias de los Nervios Craneales/diagnóstico , Diagnóstico Diferencial , Quiste Epidérmico/complicaciones , Quiste Epidérmico/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Leucemia de Células Pilosas/complicaciones , Leucemia de Células Pilosas/diagnóstico , Linfoma de Células B/complicaciones , Linfoma de Células B/diagnóstico , Masculino , Neoplasias Mandibulares/complicaciones , Neoplasias Mandibulares/diagnóstico , Persona de Mediana Edad , Neurilemoma/complicaciones , Neurilemoma/diagnóstico , Osteocondroma/complicaciones , Osteocondroma/diagnóstico , Neoplasias de la Parótida/complicaciones , Neoplasias de la Parótida/diagnóstico , Neoplasias de la Base del Cráneo/complicaciones , Neoplasias de la Base del Cráneo/diagnóstico , Hueso Esfenoides/patología , Enfermedades del Nervio Trigémino/complicaciones , Enfermedades del Nervio Trigémino/diagnóstico , Neuralgia del Trigémino/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: A 10- year-old patient presented with a slow growing jaw swelling. The initial general examination did not reveal any significant findings. METHODS: Conservative enucleation of the cyst confirmed it to be an odontogenic keratocyst. The patient remained asymptomatic for the following 2 years and subsequently presented cystic lesions in jaws with displaced teeth. These cysts were enucleated and were confirmed to be odontogenic keratocysts . The patient has been on regular follow up since then and subsequent scans have shown further occurrence of cysts in the jaws with displacement of the third molars. RESULTS: Clinical examination also revealed macrocephaly, fronto-parietal bossing, pitting on palmar and plantar surfaces, calcification of falx cerebri and splayed ribs, confirming the diagnosis of nevoid basal cell carcinoma syndrome. He also presented with a cafi au lait patch and skin pits on the neck. The family history was negative for features of nevoid basal cell carcinoma syndrome. CONCLUSION: Nevoid basal cell carcinoma syndrome is a condition that can cause significant morbidity if not detected early. Over the years this syndrome has presented with many other non specific phenotype presentation, of which the current finding may be one of This calls for meticulous assessment and examination of patients and a standardized protocol in screening and managing these patients that may facilitate a more beneficial outcome for the patient.