British Journal of Oral & Maxillofacial Surgery最新文献

The necessity of routine carotid sheath removal during neck dissections for head and neck carcinomas, particularly in clinically N0 and N+ necks without extranodal extension (ENE), remains debatable. This prospective study aimed to document the incidence of pathological involvement of the carotid sheath in such cases. A total of 121 patients with oral squamous cell carcinoma underwent neck dissections with the carotid sheath left intact unless infiltration was suspected. Among these, only one patient (0.8%) exhibited carotid sheath involvement, while 120 (99.2%) did not. No regional recurrences were observed during a minimum follow up of six months. These findings suggest that routine resection of the carotid sheath is unnecessary during elective or therapeutic neck dissection for head and neck carcinomas, as it does not increase the risk of regional recurrence. Preserving the carotid sheath may therefore be a viable approach, potentially reducing surgical morbidity without compromising oncological outcomes. To the best of our knowledge, this study, which includes 121 patients and 145 necks, is the largest sample size to date to examine carotid sheath involvement in routine neck dissections.

Nasal reconstruction post-rhinectomy is challenging. Nasal prostheses using the Medicon epiplating system (Medicon) provides a simpler alternative with good patient outcomes. Eight patients (mean age 65 years; equal gender distribution) underwent immediate nasal rehabilitation using a unilateral nasal Epiplate implant for magnet-retained prostheses post-rhinectomy, with follow-up from five to 37 months (mean 13 months). No implants failed or required unplanned removal. The Medicon epiplating system is a low-morbidity, quick, cost-saving procedure which should be considered as a viable alternative to zygomatic implants.

Oral epithelial dysplastic (OED) lesions have an increased risk of malignant change compared to normal mucosa. Multidisciplinary teams (MDTs) are widely used in medicine including for the management of patients with OED. There is little consensus in treatment, but a management algorithm from a joint oral medicine-oral and maxillofacial surgery (OM-OMFS) dysplasia management clinic was proposed in 2015 (the Liverpool Algorithm). We wished to determine the use of OM-OMFS MDTs for managing patients with OED in dental hospitals in the UK and Ireland using an online survey with results anonymised for analysis. We surveyed oral medicine units in the UK and Ireland reporting their use of joint clinics and management algorithms. All nineteen units responded with eight having OM-OMFS MDTs. Three used a published algorithm (Liverpool algorithm) and five used the algorithm with adaptations. 50% of units always excised lesions with moderate or severe dysplasia, with varying review intervals for different degrees of dysplasia. Seven of eight units kept patients with mild dysplasia under review for five years before discharge; for severe dysplasia some units never discharged. A total of 42% of oral medicine units in the UK and Ireland have MDTs for patients with OED. Most MDTs use the Liverpool Algorithm, or a slight variation of it, to help manage their patients. Wider adoption of MDTs and use of published algorithms may improve patient care by promoting consistent monitoring and management criteria.

In many developing countries, successful care for patients with jaw tumours often focuses on morbidity and survival rates. Limited attention is accorded to the impact of the disease and its treatment on patients' health-related quality of life (HRQoL). This study evaluated HRQoL among patients before and in the short term following jaw resection as treatment for oral tumours using the University of Washington quality of life (UW-QoL) questionnaire. Forty participants were consecutively recruited over a period of two years; 70% of whom were female, 75% had mandibular lesions and half of them had ameloblastoma. Their mean age was 34.4 years. Participants returned high scores on most of the 12 disease-specific domains, suggesting a low level of dysfunction. Shoulder dysfunction, taste and speech returned the best scores, whereas chewing, appearance, and saliva returned the lowest scores. Saliva had reduced scores after surgery, with an increase in proportion of participants who reported it as an important issue. Mean scores for physical functions were lower than were for socio-emotional functions. Surgical care had a positive impact on socio-emotional functions such as activity, mood and recreation, but with a negative impact on physical functions such as chewing, swallowing, and saliva. Male patients as well as patients with benign and mandibular tumours returned higher scores when compared with female patients as well as patients with malignant and maxillary tumours, respectively. This study revealed important changes in the HRQoL of patients with jaw tumours in Kenya, which ought to be considered during their care.

The aim of this retrospective large-scale study was to investigate long-term the association between proton pump inhibitors (PPIs) and risk of dental implant failure. This is a retrospective analysis of a cohort of patients rehabilitated with dental implants in the dental clinics of the universities that contribute data to the BigMouth network. Patients' characteristics including age, gender, ethnicity, race, tobacco use, systemic medical conditions, and intake of PPIs were analysed. Implant failure was defined as the removal of a dental implant for any reason. A total of 20,274 patients who received a total of 50,333 dental implants over a 12-year period were included. At the patient level, omeprazole users exhibited 1.77 (95% CI: 1.30 to 2.42) odds of experiencing implant loss compared with non-users. The use of PPIs was significantly associated with implant loss, with PPI users demonstrating 1.40 (95% CI: 1.04 to 1.88) odds of implant failure. At the implant level, implants placed in pantoprazole users showed a significant protection against implant loss, while implants in omeprazole users demonstrated a significantly lower survival time compared with those in non-users. Cox regression analysis demonstrated that implants placed in omeprazole users exhibited a significantly higher hazard ratio (HR: 1.45, 95% CI: 1.07 to 1.96) compared with those placed in non-users. Within the limitations of this study, omeprazole was significantly associated with implant failure both at a patient and implant level. At patient level, PPI users demonstrated a significantly higher risk of dental implant failure.