British Journal of Oral & Maxillofacial Surgery最新文献

Patients with primary hyperparathyroidism (PHPT) frequently report symptoms that are associated with the disease and impact on their quality of life (QoL). While parathyroidectomy corrects calcium and PTH levels, its impact on improving patients' QoL is not clear. In this single centre prospective study, we aimed to assess the impact of a parathyroidectomy on PHPT patients' pre and post parathyroidectomy QoL over a period of three years and nine months. PHPT patients, undergoing parathyroidectomy, voluntarily completed a modified Pasieka Parathyroidectomy Assessment Score (PAS), a tool correlating 13 PHPT symptoms to QoL. Sixty patients with PHPT (mean age 64 years, female to male 4:1) were included in the study. Pre parathyroidectomy, the most common symptoms were: feeling tired easily (n = 58); being forgetful (n = 51); pain in the joints (n = 49); feeling irritable (n = 48) bone pain (n = 45); feeling weak (n = 45); mood swings (n = 42); and being thirsty (n = 42). Parathyroidectomy reduced severity of mean total PAS by 44%, improving from 509 to 284 (p < 0.01). A total of 77% (n = 46) of patients experienced some improvement of PAS. The five most severe symptoms (highest reported individual PAS) showed a significant reduction post parathyroidectomy (p < 0.01): feeling tired easily (mean PAS 65 vs 38); pain in the joints (52 vs 31); being thirsty (46 vs 22); being forgetful (45 vs 28); and bone pain (45 vs 27). Patients with PHPT demonstrated impaired QoL as evidenced by the PAS, and assessing this is valuable in treatment planning. Parathyroidectomy impacts the symptoms that most affect QoL and significantly improves overall QoL in these patients.

Computed tomography (CT) of the chest is routinely performed as part of head and neck cancer (HNC) staging. Pulmonary nodules incidentally encountered present a clinical dilemma, as they may indicate early malignancy. Clinically indeterminant nodules are those that cannot be classed as definitively malignant or benign. This study aimed to assess the outcomes of pulmonary nodules detected on initial staging chest CT in a consecutive cohort of patients with oral and oropharyngeal squamous cell carcinoma (SCC). A retrospective cohort study of newly diagnosed oral or oropharyngeal SCC patients with pulmonary nodules identified on staging chest CT at a single institution was conducted. Pulmonary nodules were categorised as benign, indeterminant, or malignant. Indeterminant nodules underwent further investigations with either repeat imaging or needle biopsy to exclude malignancy. Descriptive and bivariate statistics were used to evaluate the association between pulmonary metastasis and patient demographics, disease characteristics, and nodular features. P values of ≤ 0.05 were considered statistically significant. Of 579 patients diagnosed with HNC who had undergone staging chest CT between 2010 and 2015, 154 had pulmonary nodules. Indeterminant pulmonary nodules at staging in 26 patients (16.9%) were later confirmed to be lung metastases. Pulmonary nodules of subsolid type found in patients with N2/N3 disease were significantly more likely to be metastatic. Isolated pulmonary nodules in the right lung were more likely to be benign. A HNC-specific protocol for the management of incidental pulmonary nodules should now be developed to guide the interval and duration of required clinical and radiological surveillance, taking into account the disease characteristics and nodular features.

The aim of this narrative review is to discuss current opinions on paediatric temporomandibular disorders (TMDs) due to their increasing incidence in routine secondary care maxillofacial clinics. A MEDLINE and EMBASE search was performed of the literature published in the past three years concerning paediatric TMD. Of 261 papers identified, 89 were selected for relevance, of which 52 full texts were eligible and 41 included. The narrative of this paper follows three domains: myogenous and arthogenous pain, juvenile idiopathic arthritis (JIA), and reconstruction. The principles of treating mild TMD in children are similar to those in adults, with even more emphasis on the management of psychosocial issues and self-care. The use of medication, however, needs to be more cautious. Symptomatic disc displacement should be treated to reduce inflammation, so early arthrocentesis or arthroscopy is relevant. Controversy exists on disc repositioning to reduce or even reverse condylar degeneration in the growing condyle. If undertaken it should ideally be performed arthroscopically by surgeons with significant experience. Arthritic disease is usually associated with JIA so a multidisciplinary approach is the focus of treatment. The role of arthroscopy in the management of symptoms is increasing but it does not prevent disease progression. Surgical correction may be required for secondary deformity. Reconstruction remains a challenge with no ideal autogenous method. Alloplastic joints are gaining popularity, but the long-term outcomes are unknown. Surgery can be undertaken with minimal morbidity, and the use of joint replacements, even as space maintainers, may therefore be more beneficial than repeated failed autogenous treatments.

The reconstruction of post-ablative maxillary defects is controversial. It is accepted that quality of life indicators are poorer for maxillary reconstruction compared with mandibular reconstruction. One factor highlighted is that of post-treatment trismus. Rates of trismus are reviewed comparing free tissue transfer to that of prosthetic obturation. A retrospective review was undertaken comparing rates of trismus at twelve months post-surgery between free tissue transfer and prosthetic obturation. A total of 85 patients were identified who met the inclusion criteria. Both reconstruction techniques were significant for developing trismus, with a higher rate in the free flap reconstruction cohort than the prosthetic obturation cohort by a factor of 2.51. Modern reconstructive head and neck surgery has moved away from 'filling a hole' to a more bespoke, patient-specific reconstruction. The evidence presented here should allow the reconstructive surgeon to better discuss outcomes with patients when considering surgical options for Class II maxillary defects.