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INTRODUCTION: Oral cancer surgery is complicated by the diverse nature of clinical and histopathological presentations that occur. Current National guidance recognises the significant role that surgical margin status plays in the overall survival of patients. Many other histopathological factors influence patient survival, the importance of which varies between the literature. MATERIALS AND METHODS: In this prospective longitudinal study, all patients diagnosed with squamous cell carcinoma who had primary surgical treatment under general anaesthesia were included. Surgery was performed by one surgical team within this tertiary referral centre. Patients were followed up for a maximum of 7 years following their surgery. RESULTS: A total of 250 patients were included from 2015 to 2022. Patients were 61.44 years old (SD 13.23) at diagnosis, and 56.4% were male (n = 141). Pathology was mainly pT1 (39.1%) and the most common sites were the border of tongue (31.2%) and floor of mouth (18.8%). 43.4% of patients had clear surgical margins, with overall survival being significantly associated with margin status (p = 0.0079). Extra-capsular spread was significantly associated with higher risk of death from metastatic head and neck cancer (p = 0.014), whereas presence of high-grade dysplasia at surgical margins and depth of invasion of tumour were not. CONCLUSION: This study has reinforced the importance of surgical margin clearance and as such the development of intra-operative techniques to ensure this is imperative. The significance of extra-capsular spread in survival has also been demonstrated. Discussion regarding the current deficiency in accurate pre-operative diagnostic methods for extra capsular spread is covered.
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Márgenes de Escisión , Neoplasias de la Boca , Humanos , Masculino , Persona de Mediana Edad , Femenino , Pronóstico , Estudios Prospectivos , Estudios Longitudinales , Neoplasias de la Boca/cirugía , Neoplasias de la Boca/patología , Reino Unido/epidemiología , Recurrencia Local de Neoplasia/patología , Estudios RetrospectivosRESUMEN
Head and neck cancer has a significant impact on a patient's health related quality of life (HRQOL). The head and neck specific Patient Concerns Inventory (PCI-HN) has been utilised to enhance doctor-patient dialogue in routine consultations. To date there has been no formal training for oral and maxillofacial surgery (OMFS) surgical trainees in the use of the PCI-HN in consultations. The aim of the study was to evaluate training for OMFS surgical trainees in the use of the PCI-HN, using simulated follow-up HNC consultations, in order to improve doctor-patient communication skills. MATERIAL AND METHODS: Ten oral and maxillofacial surgical trainees completed actor simulated HNC consultations before and after training. A study-specific mark scheme was developed based on the ComOn-Coaching rating scales and used to score the doctor-patient interaction. A group debrief afterwards explored the trainee's experiences of the training and consultations. RESULTS: All trainees showed an improvement in doctor-patient communication scores following their training. Overall, the six participants who were Specialty registrars, year 3 (ST3) or above, scored higher, than the four Specialty registrars, year 1-2 (ST1-2). The scores were higher if fewer PCI-HN items were discussed (3-4). The most frequently avoided PCI-HN items were intimacy and relationships. The trainees considered that their training was useful for organising their consultations and for providing holistic care. CONCLUSION: Although training improved surgeon-patient communication, further evaluation is required with a larger number of trainees and actual consultations in clinic.
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Neoplasias de Cabeza y Cuello , Intervención Coronaria Percutánea , Humanos , Calidad de Vida , Comunicación , Encuestas y CuestionariosRESUMEN
Managing the physical sequelae of facial trauma is routine for the maxillofacial surgeon. However, managing the psychological consequences is more challenging. The often violent mechanism of injury, changes in appearance, altered self-perception, and self-confidence can significantly impact daily life. This review summarises the literature regarding post-traumatic stress disorder (PTSD) and facial trauma, highlighting evidence to guide clinical practice. PubMed and MEDLINE were searched for relevant keywords and MeSH headings. Articles between 2000-2022 were independently reviewed by two authors. Articles were excluded if the full text was not available in English, did not relate to facial trauma, or was not related to PTSD/psychological sequelae. A total of 211 articles were retrieved. The most common reasons for exclusion were papers not reporting psychological outcomes (n = 68) or not relating to facial trauma (n = 35). Articles were sub-categorised to enable evaluation of key themes. Categories included children and adolescents, cross sectional, longitudinal studies, and interventional studies. Whilst there were potential confounders such as socioeconomic factors, overall, patients who had experienced facial trauma (regardless of the mechanism of injury) had an increased risk of PTSD and anxiety/depression. PTSD following facial injury is increasingly recognised as an important issue. A robust evidence base is desirable to inform clinical practice and provide holistic care to often vulnerable patients. Identifying those at increased risk of negative psychological sequelae is essential. We have appraised the literature relevant to OMFS trauma clinicians.
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Traumatismos Maxilofaciales , Trastornos por Estrés Postraumático , Niño , Adolescente , Humanos , Estudios Transversales , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología , Depresión/etiología , Agresión , Traumatismos Maxilofaciales/complicacionesRESUMEN
There is a surprising lack of evidence documenting the volumetric symmetry of the bony orbit. This paper establishes reference values for orbital volume (OV) and symmetry in the 25 - 40 year old caucasian population. Secondarily, this paper sets a landmark for the tolerances in OV that can be expected when reconstructing the bony defects which may occur from trauma. A standardised method of quantitative OV measurement was developed using CT sinus examinations acquired for indications unrelated to orbital trauma. Sex, ethnicity, age, right and left OV were recorded. Data for 100 patients was obtained (50 male, 50 female). Mean left OV was 23.1cm3 and mean right OV was 23.3cm3. Left and right OV were strongly positively correlated (correlation coefficient: 0.96). Mean female OV was 21.6cm3 and mean male OV was 24.8cm3. On average, male OV is 3.2cm3 larger than female OV. The mean difference between left and right OV was 0.5cm3 in females and 0.6cm3 in males. The intra-class coefficient score between the two assessors was 0.973 (excellent). There is strong positive correlation between left and right OV in this study population. Previous work suggests that orbital volume loss less than 1cm3 would not lead to significant clinical symptoms of orbital fracture. When orbital reconstruction is undertaken, this study suggests that a volume symmetry difference of <0.5cm3 in females and <0.6cm3 in males would be consistent with the variation seen in the study population of uninjured caucasian 25-40 year olds and is therefore a reasonable goal of surgical management.
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Lesiones Oculares , Fracturas Orbitales , Procedimientos de Cirugía Plástica , Adulto , Lesiones Oculares/cirugía , Femenino , Humanos , Masculino , Órbita/diagnóstico por imagen , Órbita/cirugía , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/cirugía , Procedimientos de Cirugía Plástica/métodos , Tomografía Computarizada por Rayos XRESUMEN
This systematic review provides a summary of all studies published between 2000 and 2019 using a health-related quality of life (HRQOL) patient-completed questionnaire to report outcomes following diagnosis and treatment of thyroid cancer. The search terms were "thyroid cancer" or "thyroid carcinoma," "quality of life" or "health related quality of life," and "questionnaire" or "patient reported outcome." EMBASE, PubMed, Medline, PsycINFO, CINAHL, and HaNDLE-On-QOL search engines were searched between 2 February and 23 February 2020. A total of 811 identified articles were reduced to 314 when duplicates were removed. After exclusion criteria (not thyroid specific, no quality of life questionnaires, and conference abstracts) were applied, 92 remained. Hand searching identified a further 2 articles. Of the 94 included, 16 had a surgical, 26 a primarily medical, and 52 a general focus. There were articles from 27 countries. A total of 49 articles were published from 2015 through 2019 inclusive. A total of 72 questionnaires were used among the articles and a range of 7 to 2215 participants were included within each article. This review demonstrated an increasing number of publications annually. The scope of enquiry into aspects of HRQOL following thyroid cancer is broad, with relatively few addressing surgical aspects and many focusing on the impact of radio-iodine. More research is required into shared decision-making in initial management decisions and HRQOL and interventions aimed specifically at addressing long-term HRQOL difficulties.
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Calidad de Vida , Neoplasias de la Tiroides , Humanos , Medición de Resultados Informados por el Paciente , Encuestas y Cuestionarios , Neoplasias de la Tiroides/terapiaRESUMEN
Introduction The use of general anaesthesia in paediatric dentistry should be appropriate and justified. During the treatment of children, a clinician should have foresight into the future dental requirements of the patient and whether a future general anaesthetic will be required in quick succession. Efforts should be made when possible to avoid this.Aims This service evaluation was performed to gather information regarding repeat dental general anaesthetics within Sheffield Children's Hospital NHS Foundation Trust.Methods All children's records who had experienced a repeat dental general anaesthetic between 1 January 2015 and 31 December 2018 were analysed. Those who had experienced a repeat dental general anaesthetic within two years were investigated.Results Overall, 0.63% of children had a repeat dental general anaesthetic within a two-year period. These repeat dental general anaesthetics were mainly justified due to new dental caries. 43.9% had modifying factors, such as a complex medical history, that could have impacted the need for a second dental general anaesthetic.Conclusion The repeat rate in Sheffield Children's Hospital NHS Foundation Trust is low. We believe this is a result of specialist treatment planning and appropriate use of both 'extraction only' and 'restorative and extraction' GA lists.
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Anestesia Dental , Atención Dental para Niños , Caries Dental , Anestesia General , Niño , Humanos , Medicina Estatal , Extracción DentalRESUMEN
BACKGROUND/AIMS: Traumatic dental injuries, including avulsion, are relatively common, with a reported prevalence of up to 4.5%. The Internet and video-sharing websites are frequently used as a resource for patient accessible health information. YouTube™ , the online video leader, is a popular choice with patients, who decide to seek advice when managing an avulsed tooth. The aim of this study was to examine the quality of information offered by videos on YouTube™ for those individuals seeking information regarding the emergency management of an avulsed tooth. The quality of information was compared to the guidelines of the International Association of Dental Traumatology (IADT). METHODS: YouTube™ was searched systematically for videos on avulsion using the terms 'knocked tooth out' and 'dental avulsion'. Strict inclusion and exclusion criteria were adhered to, and videos were assessed on several variables. The usefulness of the selected videos in providing adequate information about avulsed teeth was then evaluated using a 9-point score based on the IADT guidelines. Descriptive statistics were consequently generated. RESULTS: A total of 120 videos were analysed, 13% (n = 16) of which met the inclusion-exclusion criteria. Most had been uploaded by healthcare professionals (81%, n = 13) in the United States (63%, n = 10). Videos had generally low completeness scores (mean: 4.375 ± 1.9; range: 2-7). Completeness was not affected significantly, either by viewers' interactions or by the date of upload. CONCLUSION: YouTube™ generally hosts videos with low usefulness with regard to the management of avulsed teeth. Therefore, dentists should be aware of this resource and warn parents/carers regarding the reliability of information and the misleading content which is available on YouTube™ videos.
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Educación del Paciente como Asunto , Medios de Comunicación Sociales , Avulsión de Diente , Humanos , Internet , Padres , Reproducibilidad de los Resultados , Avulsión de Diente/etnología , Estados Unidos , Grabación en VideoRESUMEN
This article introduces dental care professionals to the poorly understood notion of modern day slavery and what this may entail. Recent data from the government indicate that the number of modern day slaves in the UK is increasing. Therefore, there is a high likelihood that we come across such individuals on a more frequent basis than we think. As dentists, we are in the unique position to identify and intervene appropriately when suspecting an individual of being a modern day slave. This article discusses how to recognise a modern day slave and how best to refer them to onward services and provide support. We need to collaborate with other healthcare professionals through identification and appropriate referral of these patients, with the ultimate aim of eliminating modern day slavery in the UK.
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Esclavización , Humanos , Derivación y ConsultaRESUMEN
PURPOSE: This study aimed to elicit willingness to pay (WTP) values for fluoride varnish application from participants using the publically-funded health services in Brazil and the UK, and to identify differences in the variables impacting these values. A secondary aim was to compare WTP values from parents for their own preventive treatment and their child's. MATERIALS AND METHODS: This was a cross-sectional analysis of quantitative data collected from participants attending routine dental appointments. The clinics were hosted by the Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brazil and Newcastle Dental Hospital, UK. RESULTS: The mean WTP for Brazilian adults was R$60.37 (=£15.97). WTP was highly variable and factors affecting it were difficult to identify. UK parents valued fluoride varnish at mean values of £28.21 and £28.12 for themselves and their child, respectively. Regression modelling found those with higher incomes had higher WTP in both samples. In the UK, parental and child WTP increased when parents had higher self-perceived need for dental treatment, had experienced recent dental pain, or their child had received restorations in the last 2 years. CONCLUSIONS: WTP for fluoride varnish varied dramatically between individuals. In both countries, it was difficult to predict this variance, as factors which would likely impact upon on WTP had a limited effect and were sometimes counter-intuitive. WTP values for a parent and their child were not statistically significantly different.