股前外侧皮瓣修复口腔恶性肿瘤切除术后缺损的临床疗效分析

目的 探讨股前外侧皮瓣(anterolateral thigh flap,ALTF)修复口腔恶性肿瘤切除术后软组织缺损的临床疗效.方法 收集四川省医学科学院·四川省人民医院2017年6月至2019年2月收治的136例口腔恶性肿瘤扩大切除术后同期行ALTF修复缺损患者的临床资料,回顾分析皮瓣成活率、术后并发症的发生情况及...     

Immediate reconstruction following resection of oral cancer with free rectus abdominis myocutaneous flap

目的：研究游离腹直肌肌皮瓣即刻修复口腔颌面部恶性肿瘤切除术后缺损的方法并评价其作用。方法：６例患者在进行广泛的口腔癌切除术后,应用游离腹直肌肌皮瓣进行缺损即刻修复,３例颊癌患者分别切除唇,颊,下颌骨及上颌骨后造成大面积洞穿性缺损,２例舌癌及１例下颌骨恶性肿瘤患者在进行舌切除及下颌骨切除后造成大面积及复杂的缺损,缺损修复的转移皮瓣最大面积达１１０ｍｍ×２３０ｍｍ。结果：游离腹直肌肌皮瓣及供区无严重的手术并发症,６例游离腹直肌肌皮瓣有５例愈合无并发症,１例皮瓣出现部分坏死,供皮区腹壁无组织感染及裂开。结论：游离腹直肌肌皮瓣使口腔颌面部缺损修复在功能和美观上达到满意的效果,提高了口腔颌面部恶性肿瘤患者广泛切除术后的生存质量。     

97例口腔癌患者术前生存质量的初步评价

目的:描述口腔癌患者术前的生存质量(quality of life,QOL)状况;分析社会人口学特点、临床特点对术前QOL的影响.方法:采用36条目简明健康状况调查问卷(SF-36)中文版和华盛顿大学生存质量问卷(UW-QOL)第4版,对97例口腔鳞癌患者术前的QOL进行测量.将97例患者分别按社会人口学特点和临床特点分组.组间差异采用SPSS12.0软件包进行Mann-Whitney U检验.将癌症患者SF-36的得分与普通人群参考值进行独立样本t检验.结果:①与普通人群配伍组比较,高龄患者有着相似的QOL值,而低龄患者则在躯体角色、身体疼痛和情感角色等领域表现出较低的QOL值;②T分期是影响术前QOL的最重要因素;③社会人口学特点如性别、年龄和共病等对QOL的影响主要体现在活力、躯体功能、躯体角色、情绪等反映身体状况和心理状况的指标上,而与口腔相关的特异性问题(口干除外)基本无关.而临床特点如肿瘤分期和部位对QOL的影响则不仅表现在与口腔相关的多项特异性问题上,如咀嚼、吞咽、发音、味觉等,还与身体疼痛、躯体角色、情感角色等反映身体状况和心理状况的指标密切相关.结论:与普通人群参考值进行比较.能更精确地反映口腔癌患者的QOL信息;临床特点对术前QOL的影响大于社会人口学特点;将普适性测量与头颈特异性量表结合,能更全面地评价口腔癌患者的QOL.联合使用UW-QOL和SF-36能较好地达到这一目的.     

口腔扁平苔藓患者口腔健康相关生活质量的初步研究

目的通过口腔健康影响程度量表（OHIP）-14中文版了解口腔扁平苔藓患者口腔健康相关生活质量情况,探讨其应用于口腔扁平苔藓临床诊疗的可靠性和准确性。方法采用OHIP-14中文版对51例口腔扁平苔藓患者进行问卷调查,同时采用视觉类比标尺（VAS）对疼痛程度进行评分,REU评分系统对病损情况进行评分。通过SPSS 16.0软件对量表的信度和效度进行统计分析。结果OHIP-14的得分为21.67±9.45,量表的内部一致性Cronbach’s α系数为0.901,因子分析提取的5个公因子与量表各领域有密切的逻辑关系,量表得分与REU分值和VAS分值间呈正相关关系（r=0.608,0.807;P<0.000）。结论OHIP-14中文版评测口腔扁平苔藓患者的口腔健康相关生活质量具有较好的信度和效度,可为病情评估提供参考。     

复发性口腔溃疡患者生存质量的初步研究

目的探讨复发性口腔溃疡患者的健康状况及生存质量,并对其影响因素进行初步分析。方法选择复发性口腔溃疡患者65例为患病组和与患病组具有可比性的65例健康者做为对照组,采用病例配对方法,患病组与对照组人员按照要求填写简明健康状况调查问卷(SF-36量表)和口腔健康影响程度量表(OHIP-14),然后计算量表得分并归类,采用SPSS17.0软件包对数据进行统计学分析。结果量表SF-36结果显示,患病组躯体功能引起的角色受限、机体疼痛、总体健康评价、活力等条目以及总分的得分低于对照组(P<0.05);量表OHIP-14结果显示,患病组功能限制、生理性疼痛、心理障碍及总分的得分高于对照组(P<0.05)。结论复发性口腔溃疡患者生存质量较健康人群低,疾病对患者的生存质量造成一定的影响,临床治疗中应重视患者的心理调节。     

感觉性游离皮瓣修复口腔颌面部缺损的临床评价及研究进展

游离组织瓣移植是目前修复口腔颌面部缺损的常用方法，由于游离皮瓣位置灵活、血供可靠，不仅可以保证口腔恶性肿瘤扩大切除的彻底性，而且有助于术后功能的恢复。表面感觉与口腔功能密不可分，如咀嚼、吞咽、语言、唾液分泌、机体防御等都与口腔感觉密切相关。口腔颌面部缺损修复术后口腔感觉的恢复直接影响口腔功能的改善和生活质量的．提高，利用感觉性游离皮瓣修复口腔颌面部缺损的目的就是最大可能地恢复口腔颌面部的感觉功能。     

中文版口腔健康影响程度量表（OHIP-49）的研制

目的：中文版口腔健康影响程度量表（OHIP-49）的翻译及验证研究。方法：按国际标准程序,对英文原版口腔健康影响程度量表（OHIP-49）进行翻译、回译及跨文化适应过程,形成中文版OHIP-49。使用该量表和自评口腔健康状况调查表,对随机抽取的患有不同口腔疾病的患者和社区居民进行口腔健康相关生活质量调查,考评量表的信度和效度。结果：发放问卷360分,回收有效量表333份。OHIP-49各维度及量表总得分的内部一致性Cronbach＇sα系数为0.79～0.96,重测系数为0.83～0.97;量表得分与自评口腔健康呈显著正相关（P〈0.001）;量表各维度及总得分在不同自我评价治疗需要的人群中有显著差异。结论：OHIP-49中文版具有良好的信度、效度,适合在中国人群中应用。     

OHIP-14量表在评价全口义齿修复效果中的应用研究

目的：应用口腔健康影响程度量表中文版(Oral Health Impact Profile,OHIP-14)测量老年无牙颌患者初次全口义齿修复前后的口腔健康相关生活质量的变化,对比老年患者全口义齿修复后的主观感受,分析OHIP-14量表在评价全口义齿修复效果中的作用。方法：对1050名老年无牙颌患者进行全口义齿修复并与修复前由患者本人填写OHIP-14量表,修复后1个月复诊填写OHIP-14量表及满意度调查表。采用SPSS17.0软件包对量表数据进行相关统计分析。结果：(1)全口义齿修复1月后OHIP量表总得分及七个方面得分均明显降低,差异统计学意义(P<0.01)。(2)全口义齿修复前后OHIP-14得分差值与满意度得分呈负相关关系(Spearman秩相关,rs=0.351, P<0.05)。结论：OHIP-14量表可以客观评价全口义齿修复效果及患者对全口义齿的满意度,可以作为临床修复效果的评估提供参考。     

游离组织瓣修复口腔颌面部创伤性组织缺损

探讨游离组织瓣在口腔颌面部创伤性组织缺损重建中的应用.方法回顾北京大学口腔医学院·口腔医院口腔颌面外科1999至2007年应用游离组织瓣重建创伤性组织缺损病例20例,分析受伤原因、缺损情况、游离组织瓣类型、手术并发症和术后功能恢复情况.结果 20例合并大型口腔颌面部软硬组织缺损患者中,单纯软组织缺损8例,软硬组织复合缺损12例;15例为Ⅱ期手术,5例为同期手术或与骨折复位固定术同期完成.20块游离组织瓣应用于缺损修复,其中腓骨瓣11例、髂骨瓣1例、前臂皮瓣7例、肩胛皮瓣1例,全部皮瓣均移植成功,未出现皮瓣坏死.结论 游离组织瓣移植安全可靠,可以修复口腔颌面部创伤性软硬组织缺损.腓骨瓣和前臂皮瓣是最常用的游离组织瓣.早期应用游离组织瓣修复创伤性软硬组织缺损可有效避免局部瘢痕和组织变形移位,缩短治疗时间,提高治疗效果.     

逆行面动脉-颏下动脉岛状肌皮瓣修复口腔颌面部缺损的探讨

目的评价逆行面动脉-颏下动脉岛状肌皮瓣修复口腔颌面部缺损的可行性。方法用逆行面动脉-颏下动脉岛状肌皮瓣修复18例恶性肿瘤切除术后口腔颌面部缺损。男性11例，女性7例，年龄28～90岁。舌鳞癌7例、颊黏膜鳞癌4例、腭鳞癌3例、口咽癌和面部皮肤基底细胞癌各2例。肌皮瓣面积最小为4．0cm×12．0cm，最大为5．0cm×15．0cm。结果17例肌皮瓣存活，1例缺血坏死。肌皮瓣受区外观满意、功能恢复良好，供区瘢痕隐蔽。经术后6～18个月，平均11．8个月随访，1例术后10个月对侧颈部淋巴结转移。结论逆行面动脉-颏下动脉岛状肌皮瓣是口腔颌面部中型缺损的理想修复材料。     

Salivary dysfunction and quality of life in Sjögren syndrome: a critical oral-systemic connection

BACKGROUND: The importance of oral health to systemic health and quality of life (QOL) is gaining attention. Although several studies have examined generic (general) QOL in Sj?gren syndrome (SS), little information exists on the effect of oral health on QOL and relationships among self-reported oral health, systemic health and objective clinical measures of health. The authors conducted this study to characterize these relationships in a sample of patients with SS. METHODS: Thirty-nine patients with a diagnosis of SS ascertained by means of the 2002 American-European Consensus criteria completed both the Oral Health Impact Profile (OHIP-14) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) QOL questionnaires. OHIP-14 measures pain; functional limitation; and psychological, emotional and social disability associated with the mouth. SF-36 measures physical and emotional health and the ability to perform usual activities. Additional measures included the number of self-reported autoimmune symptoms and an index of disease damage. Statistical analysis was performed by using hierarchical regression analysis. RESULTS: Both generic and oral health-related QOL were poor in these patients. Specifically, the findings indicated that salivary flow rate was correlated significantly with both Disease Damage Index and OHIP-14 ratings, the number of autoimmune symptoms was correlated significantly with both oral and generic QOL, and oral health accounted for a significant percentage of variance in SF-36 domains of general health and social function. CONCLUSIONS: Oral health appears to have an independent influence on general QOL in patients with SS. These findings underscore the importance of proactive dental management of the oral manifestations of SS. CLINICAL IMPLICATIONS: Dentists and physicians must work collaboratively to maintain oral health and quality of life for patients with Sj?gren syndrome. The dentist should address patients' concerns of xerostomia and hyposalivation in an aggressive manner.     

口腔癌患者健康相关生活质量及其影响因素调查

目的:调查口腔恶性肿瘤患者手术后生活质量状况及其影响因素。方法:选择郑州大学第一附属医院口腔颌面外科2011年5月~2013年1月收治的85例口腔恶性肿瘤患者,使用中文版口腔健康影响程度量表(oral health impact profile,OHIP-49)及华盛顿大学头颈肿瘤生活质量量表(University of Washington Quality of Life Scale,UW-QOL),在患者术后至少12个月后进行生活质量评测。结果:发出问卷85份,回收76份,完成问卷调查89.4%。UW-QOL调查问卷得分最高的项目是疼痛(77.3±6.3)分,其次是焦虑(76.4±7.8)分,第三是活力(74.3±8.2)分;得分最低的3项依次是:咀嚼(34.5±8.3)分、唾液(46.4±4.8)分、味觉(49.9±3.9)分。OHIP-14量表得分最好的项目是残障(38.5±7.4)分,其次是生理性疼痛(46.8±10.2)分,第三是心理障碍(50.9±5.8);得分差的3项依次是:功能限制(62.4±12.3)分、心理不适(57.8±9.2)分、社交障碍(55.8±12.8)分。结论:口腔癌根治性治疗对患者生活质量有显著的影响。对口腔恶性肿瘤应切实做好疾病护理,同时加强营养支持和心理疏导,并加强社会支持。     

Quality of life in patients with dentofacial deformity: a comparison of measurement approaches

The aim of this study was to examine the effect of dentofacial deformity on quality of life (QOL) as assessed by generic health, generic oral health and condition-specific approaches. A case-control study was performed involving 154 subjects: 76 with dentofacial deformity (non-cleft) and 76 without dentofacial deformity. Generic health-related QOL was assessed employing the 36-item Short Form Health Survey (SF-36), generic oral health-related QOL was assessed by the 14-item short form Oral Health Impact Profile (OHIP-14) and condition-specific QOL was assessed by the 22-item Orthognathic Quality of Life Questionnaire (OQLQ). No significant difference in SF-36 scores between case and control groups was observed (P>0.05). There were significant differences in overall OHIP-14 scores (P<0.001) and overall OQLQ scores (P<0.001) between case and control groups. The results suggest that dentofacial deformity affects individuals in many aspects of their lives, and that generic oral health and condition-specific approaches to assessing QOL are able to discriminate patients with dentofacial deformities from those without, and thus have value in determining the impact of dentofacial deformities on QOL.     

Association between general and oral health-related quality of life in patients treated for oral cancer

Background

Less is known about the association between general health-related quality of life (HRQoL) and oral HRQoL (OHRQoL) among patients with specific diseases. The aim of this study was to assess the association between patient-centered outcome measurements (HRQoL and OHRQoL) of oral cancer patients at least 6 months after treatment.

Material and Methods

HRQoL was measured with the 12-Item Short Form Health Survey (SF-12); OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14) and the Oral Impacts on Daily Performances (OIDP).

Results

Higher OHRQoL scores were associated with lower SF-12 domains scores. The OHIP-14 explained 16.5 % of the total variance of SF-12 Physical Component Summary (PCS) and the OIDP explained 16.1 %. In the SF-12 Mental Component Summary (MCS), the total variance explained was 23.9 % by the OHIP-14 and 21.8 % by the OIDP.

Conclusions

There was a significant association between long-term OHRQoL and HRQoL in oral and oropharyngeal cancer patients. These results may help to carry out new interventions aiming to improve patient´s life overall. Key words:Mouth neoplasms, quality of life, health status, oral health.     

Assessment of quality of life after soft tissue resection of head and neck carcinoma and reconstruction with double-paddle peroneal artery perforator free flap

We aimed to assess the quality of life for head and neck carcinoma (HNC) patients who underwent soft tissue resection and reconstruction with double-paddle peroneal artery perforator (DPAP) free flap. The quality of life was assessed by means of the University of Washington quality of life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14) questionnaires at 12 months postoperatively. Data from 57 patients were retrospectively analysed. Out of these, 51 patients were at TNM stage III or IV. Finally, 48 patients finished and returned the two questionnaires. In the UW-QOL questionnaire, the mean (SD) higher scores were pain 76.5 (6.4), shoulder 74.3 (9.6), and activity 71.6 (6.1), whereas the lower scores were chewing 49.7 (5.2), taste 51.1 (7.7), and saliva (56.7 (7.4). In the OHIP-14 questionnaire, the higher-scoring domains were psychological discomfort (69.3 (9.6) and psychological disability 65.2 (5.8), whereas the lower-scoring domains were handicap 28.7 (4.3) and physical pain 30.4 (8.1). The DPAP free flap significantly improved appearance, activity, shoulder, mood, psychological discomfort, and handicap compared with pedicled pectoralis major myocutaneous flap reconstruction. In conclusion, DPAP free flap for reconstruction of tissue defects after soft tissue resection of HNC significantly improved the patients' QOL compared to pedicled pectoralis major myocutaneous flap reconstruction.     

Quality of life related to both general and oral health two years after treatment for subcondylar fracture

The success of treatment for condylar fractures is usually assessed by functional outcomes, while studies on patient perceptions are scarce. A cross-sectional study was performed to assess the middle-term quality of life, related to both general health and oral health, of patients treated for subcondylar fracture, either by open reduction or by closed fixation, compared to healthy volunteers. In a single trauma centre, among 226 consecutive patients with subcondylar fractures that were treated in years 2018–2019 (two to three years prior to the survey), 148 fulfilled the selection criteria. They were classified as those with other facial fractures that were treated by open reduction (n = 79), and those without other fractures that were treated either by open reduction (n = 34) or by closed fixation (n = 35). An age matched group of healthy volunteers (n = 65) also participated in the study. All participants replied to the Short-Form-Health-Survey (SF-36) and the Oral-Health-Impact-Profile (OHIP-49), using the social messenger platform WhatsApp. The SF-36 showed that patients with closed-fixation reported better mental health than patients with open reduction, but worse than healthy volunteers. Contrariwise, on the OHIP-49, compared to patients with open reduction (with/without other facial fractures) and to healthy volunteers, patients with closed-fixation reported worse quality of life on physical pain, psychological discomfort, and physical disability. The influence of age was evident just on the OHIP-49, on the report of physical limitation and physical pain. Two to three years after the subcondylar fracture, patients treated either by open reduction or closed fixation might report decreased quality of life compared to healthy volunteers; patients treated by open reduction might report lesser mental health related quality of life (SF-36), but superior oral health related quality of life (OHIP-49) than patients treated by closed fixation.     

Health-related quality of life after mandibular resection for oral cancer: Reconstruction with free fibula flap

Objectives: Mandibular resection for oral cancer is often necessary to achieve an adequate margin of tumor clearance. Mandibular resection has been associated with a poor health-related quality of life (HRQOL), particularly before free fibula flap to reconstruct the defect. The aim of this study was to evaluate health-related quality of life in patients who have had mandibular resections of oral cancer and reconstruction with free fibula flap. Study Designs: There were 115 consecutive patients between 2008 and 2011 who were treated by primary surgery for oral squamous cell carcinoma, 34 patients had a mandibular resection. HRQOL was assessed by means of the 14-item Oral Health Impact Profile (OHIP-14) and University of Washington Quality of Life (UW-QOL) questionnaires after 12 months postoperatively. Results: In the UW-QOL the best-scoring domain was mood, whereas the lowest scores were for chewing and saliva. In the OHIP-14 the lowest-scoring domain was social disability, followed by handicap, and psychological disability. Conclusions: Mandible reconstruction with free fibula flap would have significantly influenced on patients’quality of life and oral functions. The socio-cultural data show a fairly low level of education for the majority of patients. Key words:Health-related quality of life, free fibula flap, mandibulectomy, UW-QOL, OHIP-14.     

Quality of life in patients with burning mouth syndrome

Objective:  To study the quality of life in patients with burning mouth syndrome (BMS), our primary aim was to compare BMS patients with healthy controls and the secondary aim was to compare subgroups of BMS patients on the type of therapy received; using the Medical Outcome Short Form Health Survey Questionnaire (SF-36) and the Oral Health Impact Profile (OHIP-49) as measurement instruments.
Method:  Sixty consecutive patients (10 males and 50 females) with BMS were studied in the Department of Oral Medicine (Faculty of Medicine and Dentistry, University of Murcia, Spain), while 60 healthy patients were used as controls. The Spanish version of the SF-36 was used to evaluate general quality of life, together with the OHIP-49 in its Spanish version.
Results:  Regarding general quality of life as assessed with the SF-36, and on comparing the BMS vs. the control groups, lower scores were obtained in the former in all domains ( P  < 0.001). The OHIP-49 in turn yielded significant differences in each of the domains vs. the controls. No significant differences were found between the patients with BMS in any domain regarding parafunctional habits and the presence of dentures. In relation to the different treatments, significant differences were recorded in functional limitation ( P  = 0.02) and physical pain ( P  = 0.033).
Conclusion:  Patients with BMS yield poorer scores on all scales vs. the healthy controls when applying the SF-36 and OHIP-49.