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Psychological sequelae of maxillofacial trauma
212
British
Journal
of Oral
and Maxillofacial
Surgery
But does it work in practice? Should we return to sporadic evening operating, and use the lists for elective cases? Our experience with two new trauma lists over the past two years is presented. Psychological sequelae of maxillofacial trauma. J P. Shepherd, J. Z. B&on, M. Dhutia. University of Wales College of Medicine, Cardiff, UK. maxillofacial trauma can be followed by distressing psychological sequelae. Aim: to determine the prevalence and detection rate of psychological sequelae and the relative importance of a range of risk factors. Methods: retrospective analysis of 50 patients’ case notes followed by a prospective assessment of 66 consecutive maxillofacial trauma patients was performed using appropriate psychometric scalesand assessment of risk factors for the development of psychological sequelae. Results: in the retrospective study, only eight (17%) of 47 case notes contained any reference to mental status. In the prospective study, 43 patients completed initial assessment and seven-week questionnaires. Twelve (27%) were suffering from post-traumatic stress disorder at seven weeks. Factors significantly associated with poorer outcome were higher initial anxiety, depression and impact of events scores, injuries sustained in assault, fractures rather than lacerations and prediction of psychological sequelae by junior oral surgeons. Conclusion: over a quarter of patients in the prospective study developed post-traumatic stress disorder. These results suggest that psychological sequelae can be predicted by oral surgery house surgeons using basic initial assessment. Background:
A retrospective analysis of 182 salivary gland turnours. J. Taylor, A. Moody, C. Avery, J. D. Langdon. King’s College Hospital, London, UK. We present a retrospective analysis of 182 salivary gland tumours in 178 patients (85 male, 93 female), ranging in age from eight to ninety years old. They were all managed by one surgeon over a 20-year period (1977-1997) and include 60 malignant tumours, 102 benign lesions and 16 others. A total of 116 tumours occurred in the parotid gland, 46 in minor glands intraorally, 16 in the submandibular gland and four in the sublingual gland. Of particular interest are a group of nine patients who had multiple salivary gland tumours of identical or differing histologies and which occurred synchronously or metachronously. Clinical presentation, protocols for management, postoperative complications and long-term outcome, including the recurrence rate will be evaluated for this series of patients. Diary of a craniofacial fellow. M. S. Dover. West Midlands Craniofacial Unit, Birmingham Children’s Hospital, Birmingham, UK. The West Midlands Supraregional Craniofacial Unit has been active since 1978. Over 600 cases have been undertaken to date with no mortality. Four consultants have been involved from the outset. This experience was recognized by the Department of Health, and supraregional status awarded in 1984. The volume and case mix were deemed sufficient to warrant the appointment of a craniofacial fellow in 1989. The training provided was considered by the SACS in neurosurgery, plastic surgery and oral and maxillofacial surgery, and all three gave recognition to this post for training purposes by 1995. It remains unique in this country in this respect. The Fellowship offers a wide range of training opportunities in craniofacial, neuro- and plastic surgery. In addition, links with ENT maintain a trainee’s exposure to head and neck malignancy and microsurgical and implant-based reconstructions. During the six months in post, I performed or taught 106 major or major complex procedures. A detailed timetable, logbook and some personal observations of the value of this type of programme will be presented. Emphasis will be placed on the benefits of this
particular fellowship to maxillofacial trainees, irrespective of their clinical interests.
A retrospective comparative analysis of 152 consecutive parotidectomies performed for inflammatory and neoplastic lesions. A. B. A4oody, J. Taylor, C. M. E. Avery, J. D. Langdon. Department of Maxillofacial Surgery, King’s College Hospital, London, UK. The demographic profile and complications (including facial-nerve paralysis, Frey’s syndrome, sialocoele and salivary fistula) are compared and contrasted in 152 consecutive parotidectomies. Forty of these parotidectomies were performed for inflammatory lesions and the remainder for neoplastic lesions. All the cases were managed under the care of one surgeon over a 20-year period. The overall incidence of permanent facial-nerve paralysis was less than 1% in both groups but temporary paralysis occurred in 45% of operations performed for neoplastic lesions and in 60% of those performed for inflammatory lesions. The overall incidence of Frey’s syndrome was less than 10% in both groups and both salivary gland fistulae and sialocoeles are exceedingly rare.
Clinical, sialographic and histopathological findings in chronic obstructive parotid and submandibular gland disease. J. I? P. Tighe, M. Z. Khan, M. Stavrou, B. M. W. Bailey, C. E. C. Todd. Norman Rowe Maxillofacial Unit, Queen Mary’s University Hospital, Roehampton, UK. The authors had noted a tendency for the definitive histopathological report received after superficial parotidectomy or submandibular gland excision for chronic obstructive disease to suggest less severe inflammation than that expected from the history and preoperative sialographic investigation. The clinical records, preoperative sialograms and histopathological slides of 33 patients who underwent surgery for obstructive salivary gland symptoms were reviewed. The sialograms and histopathological slides were graded according to the degree of inflammation demonstrated. Twenty patients underwent superficial parotidectomy and 13 submandibular gland excision. A tendency for preoperative sialograms to suggest a greater degree of inflammation than was actually noted by final histopathological examination was discovered (50% parotid, 31% submandibular cases). In the parotid study, patients with longer duration of symptoms exhibited both more severe sialographic and histopathological changes. However, the reverse was found in the submandibular group, perhaps reflecting differing aetiologies and natural histories of obstructive disease in the two glands.
Cardiopulmonary resuscitation training of SHOs in oral and maxillofacial surgery in the UK. G. C. S. Cousin, G. S. Bassi, J. C. Lowry. East Lancashire Maxillofacial Service, Blackburn Royal Infirmary, Blackburn, UK. Despite a rigorous training pathway for higher trainees in OMFS, much of the immediate management of patients depends on singly, dentally qualified SHOs. A certain level of proficiency in basic cardiopulmonary resuscitation (CPR) is expected of dentists working in the community and in hospitals. Although junior hospital doctors are required to attend CPR training, hospital dentists are not always as well trained. The scope of OMFS continues to expand with complex surgical procedures undertaken on an ageing population with significant comorbidity. It seems probable, therefore, that SHOs in the specialty will be increasingly called upon to use their CPR skills. Our study investigated the CPR training of 100 SHOs in OMFS in the UK, examining such parameters as the frequency, level and location of the training, and the SHOs’ confidence in their ability to resuscitate patients. This would appear to be the first study of its kind. The study identified an area where the SHOs considered that their training could be improved. In addition, the authors suggest an option which could improve the SHOs’ confidence and practical skills at cardiopulmonary arrests.
British
Journal
of Oral
and Maxillofacial
Surgery
But does it work in practice? Should we return to sporadic evening operating, and use the lists for elective cases? Our experience with two new trauma lists over the past two years is presented. Psychological sequelae of maxillofacial trauma. J P. Shepherd, J. Z. B&on, M. Dhutia. University of Wales College of Medicine, Cardiff, UK. maxillofacial trauma can be followed by distressing psychological sequelae. Aim: to determine the prevalence and detection rate of psychological sequelae and the relative importance of a range of risk factors. Methods: retrospective analysis of 50 patients’ case notes followed by a prospective assessment of 66 consecutive maxillofacial trauma patients was performed using appropriate psychometric scalesand assessment of risk factors for the development of psychological sequelae. Results: in the retrospective study, only eight (17%) of 47 case notes contained any reference to mental status. In the prospective study, 43 patients completed initial assessment and seven-week questionnaires. Twelve (27%) were suffering from post-traumatic stress disorder at seven weeks. Factors significantly associated with poorer outcome were higher initial anxiety, depression and impact of events scores, injuries sustained in assault, fractures rather than lacerations and prediction of psychological sequelae by junior oral surgeons. Conclusion: over a quarter of patients in the prospective study developed post-traumatic stress disorder. These results suggest that psychological sequelae can be predicted by oral surgery house surgeons using basic initial assessment. Background:
A retrospective analysis of 182 salivary gland turnours. J. Taylor, A. Moody, C. Avery, J. D. Langdon. King’s College Hospital, London, UK. We present a retrospective analysis of 182 salivary gland tumours in 178 patients (85 male, 93 female), ranging in age from eight to ninety years old. They were all managed by one surgeon over a 20-year period (1977-1997) and include 60 malignant tumours, 102 benign lesions and 16 others. A total of 116 tumours occurred in the parotid gland, 46 in minor glands intraorally, 16 in the submandibular gland and four in the sublingual gland. Of particular interest are a group of nine patients who had multiple salivary gland tumours of identical or differing histologies and which occurred synchronously or metachronously. Clinical presentation, protocols for management, postoperative complications and long-term outcome, including the recurrence rate will be evaluated for this series of patients. Diary of a craniofacial fellow. M. S. Dover. West Midlands Craniofacial Unit, Birmingham Children’s Hospital, Birmingham, UK. The West Midlands Supraregional Craniofacial Unit has been active since 1978. Over 600 cases have been undertaken to date with no mortality. Four consultants have been involved from the outset. This experience was recognized by the Department of Health, and supraregional status awarded in 1984. The volume and case mix were deemed sufficient to warrant the appointment of a craniofacial fellow in 1989. The training provided was considered by the SACS in neurosurgery, plastic surgery and oral and maxillofacial surgery, and all three gave recognition to this post for training purposes by 1995. It remains unique in this country in this respect. The Fellowship offers a wide range of training opportunities in craniofacial, neuro- and plastic surgery. In addition, links with ENT maintain a trainee’s exposure to head and neck malignancy and microsurgical and implant-based reconstructions. During the six months in post, I performed or taught 106 major or major complex procedures. A detailed timetable, logbook and some personal observations of the value of this type of programme will be presented. Emphasis will be placed on the benefits of this
particular fellowship to maxillofacial trainees, irrespective of their clinical interests.
A retrospective comparative analysis of 152 consecutive parotidectomies performed for inflammatory and neoplastic lesions. A. B. A4oody, J. Taylor, C. M. E. Avery, J. D. Langdon. Department of Maxillofacial Surgery, King’s College Hospital, London, UK. The demographic profile and complications (including facial-nerve paralysis, Frey’s syndrome, sialocoele and salivary fistula) are compared and contrasted in 152 consecutive parotidectomies. Forty of these parotidectomies were performed for inflammatory lesions and the remainder for neoplastic lesions. All the cases were managed under the care of one surgeon over a 20-year period. The overall incidence of permanent facial-nerve paralysis was less than 1% in both groups but temporary paralysis occurred in 45% of operations performed for neoplastic lesions and in 60% of those performed for inflammatory lesions. The overall incidence of Frey’s syndrome was less than 10% in both groups and both salivary gland fistulae and sialocoeles are exceedingly rare.
Clinical, sialographic and histopathological findings in chronic obstructive parotid and submandibular gland disease. J. I? P. Tighe, M. Z. Khan, M. Stavrou, B. M. W. Bailey, C. E. C. Todd. Norman Rowe Maxillofacial Unit, Queen Mary’s University Hospital, Roehampton, UK. The authors had noted a tendency for the definitive histopathological report received after superficial parotidectomy or submandibular gland excision for chronic obstructive disease to suggest less severe inflammation than that expected from the history and preoperative sialographic investigation. The clinical records, preoperative sialograms and histopathological slides of 33 patients who underwent surgery for obstructive salivary gland symptoms were reviewed. The sialograms and histopathological slides were graded according to the degree of inflammation demonstrated. Twenty patients underwent superficial parotidectomy and 13 submandibular gland excision. A tendency for preoperative sialograms to suggest a greater degree of inflammation than was actually noted by final histopathological examination was discovered (50% parotid, 31% submandibular cases). In the parotid study, patients with longer duration of symptoms exhibited both more severe sialographic and histopathological changes. However, the reverse was found in the submandibular group, perhaps reflecting differing aetiologies and natural histories of obstructive disease in the two glands.
Cardiopulmonary resuscitation training of SHOs in oral and maxillofacial surgery in the UK. G. C. S. Cousin, G. S. Bassi, J. C. Lowry. East Lancashire Maxillofacial Service, Blackburn Royal Infirmary, Blackburn, UK. Despite a rigorous training pathway for higher trainees in OMFS, much of the immediate management of patients depends on singly, dentally qualified SHOs. A certain level of proficiency in basic cardiopulmonary resuscitation (CPR) is expected of dentists working in the community and in hospitals. Although junior hospital doctors are required to attend CPR training, hospital dentists are not always as well trained. The scope of OMFS continues to expand with complex surgical procedures undertaken on an ageing population with significant comorbidity. It seems probable, therefore, that SHOs in the specialty will be increasingly called upon to use their CPR skills. Our study investigated the CPR training of 100 SHOs in OMFS in the UK, examining such parameters as the frequency, level and location of the training, and the SHOs’ confidence in their ability to resuscitate patients. This would appear to be the first study of its kind. The study identified an area where the SHOs considered that their training could be improved. In addition, the authors suggest an option which could improve the SHOs’ confidence and practical skills at cardiopulmonary arrests.