Role of robotic surgery in oral and maxillofacial, and head and neck surgery

We review the current status of robotic surgery in the head and neck region and its role in oral and maxillofacial surgery.     

Non-technical skills in oral and maxillofacial and head and neck surgery: systematic review

The importance of teams’ and individuals’ non-technical skills in reducing adverse events is well-recognised. We undertook a systematic review of the published literature to assess the research undertaken to date on non-technical skills and behaviours within oral and maxillofacial, and head and neck (OMFS-H&N) surgery. The aim was to assess the applicability of published studies to current practice, to look at how these studies could guide future research, and look for areas that could be developed further. The search terms included ‘non technical skills’, ‘nontechnical skills’, ‘NOTSS’, ‘non-technical skills for surgeons’, ‘oral surgery’, ‘oral maxillofacial surgery’, ‘OMFS’, ‘maxillofacial surgery’, ‘head and neck surgery’, ‘microsurgery’, ‘behavioural markers’, ‘behavioural assessment tool’, and ‘behavioural ratings system’. Three publications were included, involving 83 participants. Participants consistently achieved the highest scores in the ‘situational awareness’ category and showed a tendency to achieve lower mean scores in the ‘communication and teamwork’ and ‘decision-making’ categories. The majority of research into surgeons’ non-technical skills has occurred in simulated environments and not in the genuine environments in which actual surgery is being performed on patients. Research involving ‘real’ patients has been done in the field of OMFS-H&N and this places the specialty in a stronger position than many other surgical specialties.     

Robotic surgery in oral and maxillofacial,craniofacial and head and neck surgery: A systematic review of the literature

A systematic review of the literature concerning robotic surgery in oral and maxillofacial (OMF), craniofacial and head and neck surgery was performed. The objective was to give a clear overview of the different anatomical areas of research in the field of OMF, craniofacial and head and neck surgery, in all its fields (pre-clinical and clinical). The present indications are outlined and the critical reader is invited to assess the value of this new technology by highlighting different relevant parameters. A PubMed and Cochrane library search yielded 838 papers published between 1994 and 2011. After screening the abstracts, 202 articles were considered clinically or technically relevant and were included. These full papers were screened in detail and classified as articles on synopsis (n = 41), educational aspects (n = 3), technical/practical aspects (n = 11) and clinical papers (n = 147). Regarding clinical feasibility this systematic review revealed the following main indications: transoral robotic surgery (TORS) for upper digestive and respiratory tract lesions; TORS for skull base surgery; and TORS for trans-axillary thyroid and endocrine surgery. Regarding functional outcome, this systematic review revealed a promising reduction of morbidity in patients with cancer of the upper digastric and respiratory tract.     

Salvage surgery in head and neck cancer

Salvage surgery after failed organ preservation treatment offers challenges for both the patient and the surgeon. The outcome is often uncertain and even today, 5‐year overall survival does not exceed 50 per cent. The chemoradiotherapy induced toxicity asks for meticulous discussion and planning in a multidisciplinary manner in a changing environment of increasing incidence of human papillomavirus induced oropharyngeal tumours, evolving surgical techniques and patient participation. Herein, we discuss the latest literature on salvage surgery and the need for identifying the proper prognosticators to ensure for an optimal treatment plan in potentially salvageable patients.     

负压封闭引流在颌面外科术后严重颌面颈部感染的应用

目的探讨应用持续负压封闭引流技术（VSD）治疗口腔颌面外科术后经持续换药后未见明显好转、且呈持续性加重的颌面颈部感染的疗效。 方法采用VSD治疗8例口腔颌面外科术后经持续换药未见好转、且呈持续性加重的严重颌面颈部感染,在去除术后感染区坏死物质、彻底清创后,以负压封闭引流材料覆盖创口,0.9%氯化钠溶液冲洗,持续负压引流,直至引流液清亮、创缘组织无红肿、无压痛后,撤除VSD装置。 结果6例患者明确感染后,使用传统换药约7 ~ 8 d,感染呈进行性加重,遂使用VSD装置置于感染区,持续引流5 ~ 15 d后,可见引流液清亮,颌面部肿胀基本消失,创缘周围可见肉芽组织增生,伤口基本愈合;所有病例中有1例为放射性颌骨骨髓炎行腓骨肌皮瓣修复,明确感染、持续换药约20 d后,感染呈进行性加重,放置VSD 5 d后于手术室清除病灶骨,术后继续换药,伤口愈合;1例术后并发食管瘘患者使用VSD时间长,撤除VSD后,引流液清亮,颌面部肿胀较前明显减轻,创口可见肉芽组织增生,但左颈部仍可见到1个大小约1 cm × 1 cm的瘘管,邻近瘘管可见颈部膨隆明显,扪诊质硬,无波动感。左颈部磁共振成像（MRI）增强示：左颈部见3.9 cm × 2.3 cm × 5.0 cm大小的不规则占位病变,右颈部见1个大小约2.3 cm × 1.4 cm团块状病变,考虑淋巴结肿大（术后复发）。 结论VSD有利于控制感染,防止术后感染扩散,促进术后创面组织的愈合;同时肿瘤患者使用VSD存在促癌细胞转移、增殖的可能,在应用过程中应充分考虑其适应证,并密切监测创区变化,当发现可疑病变或创面延迟愈合时,应立即撤除VSD装置,根据具体情况行进一步治疗。     

Psychosocial considerations of the post-treatment of head and neck cancer patients

The quality of life factor in the rehabilitation of head and neck cancer patients following surgery or other forms of treatment can be summarized as follows: 1. Because of serious functional disabilities, such as speech impairment and chewing-swallowing difficulties, along with facial disfigurement, these individuals suffer the most problems of any type of cancer patient. 2. Without skilled rehabilitation intervention, their emotional, social, economic, and physical well-being will be greatly impacted, perhaps for life. 3. With skilled intervention, building on patients' often amazing recuperative powers, successful rehabilitation to normal, or near-normal, levels comparative with their predisease condition may be achieved in a period between 6 months and a year. 4. Given continuing research and more generally available rehabilitation treatment, the prognosis is favorable. However, it would be less than honest to ignore one highly disquieting fact. Despite better treatment methods today, despite higher survival rates, we have not sufficiently changed our attitudes toward cancer rehabilitation. The same social stigma has stubbornly lingered, together with the fears of morbidity, uncertainty, and unpredictability. To help the patient recover old skills and pleasures, we must overcome these obstacles. To feel like a useful human being without any stigma attached, without undue fears and pressures but with a sense of being needed and wanted, that is what life is all about. All our rehabilitation efforts should be directed toward that goal, with the professional as well as the layman feeling optimism without feeling reservation and contagiously exuding it. To some extent, a real effort must be made to educate the professional as well as the layman to face the diagnosis of cancer without evasion and go forward from there. It is heartening that with support from both the government and private sectors there have been increasing numbers of major centers for rehabilitation established throughout the United States in recent years. The American Cancer Society, the National Cancer Institute, and the volunteers and philanthropists of America have been in the vanguard of this movement. With only some exceptions as noted above, the profession, including nurses as well as physicians, has responded to the call for more intensive rehabilitation efforts, as have social workers, family counselors, physical therapists, occupational therapists, speech pathologists, and other specialists. The challenge is enormous. Each patient has his or her own highly individual mind set and emotional characteristics and cultural, religious, economic, and class backgrounds, all of which will affect the response to the rehabilitation program.(ABSTRACT TRUNCATED AT 400 WORDS)     

Research training for oral and maxillofacial surgery

The specialty of oral and maxillofacial surgery (OMFS) is unique among UK medical and dental specialties in having clinical and academic training pathways whose entry criteria, curricula and exit examinations are quite different. The Academic Advisory Committee for Oral and Maxillofacial Surgery (AACOMS) pathway offers a formal academic training but with a limited clinical curriculum, while training within the National Health Service (NHS) offers little or no access to research but a more comprehensive clinical curriculum. As a result, there are few doubly qualified consultants in senior university positions, and limited opportunities for dental and medical undergraduates to be exposed to the full scope of the specialty. A further consequence is that research in certain disciplines, such as head and neck oncology and facial trauma, is absent from the majority of universities. Until this situation is corrected, maxillofacial trainees who wish to undergo a comprehensive clinical and research training must find time and funding to support their research training outwith their clinical education. The purpose of this paper is to identify key steps in deciding when, where and how a maxillofacial trainee can gain accomplished research experience in the context of current UK maxillofacial training.     

口腔颌面头颈部鳞癌超声热化疗中国专家共识

口腔颌面头颈部鳞癌确诊时多为中晚期,单纯化疗难以使晚期患者总生存获益。超声热化疗是常规治疗手段之外,目前发展较快的一种新的针对恶性肿瘤的有效治疗方法。然而,目前超声热化疗在口腔颌面头颈部恶性肿瘤治疗中尚未普及,为推广和规范超声热化疗在此领域的临床实践,特制订口腔颌面头颈部鳞癌超声热化疗专家共识, 以提高患者远期生存率和生活质量。     

Cosmetic oral and maxillofacial surgery

The dental specialty of oral and maxillofacial surgery over the last fifteen years has been intimately involved in not only altering the bony facial skeleton, but also the esthetic defects of the facial soft tissue drape. These procedures are currently being taught, in many of our residency programs, along side the art and science of dentoalveolar surgery. When one combines the modification of both the skeletal and soft tissues, the resultant effect can be greater than the sum of its parts. Should one take this a step further and add to the list, proper arch form as prepared by the orthodontist along with cosmetic shape and appearance of the dentition by the restorative dentist using the latest in cosmetic dental techniques, what transforms is a result that has never been seen heretofore in the annals of dentofacial care. To follow are a number of case reports illustrating some salient points.     

颌面头颈外科术后气道管理困难的手术因素分析

目的: 探讨影响颌面头颈外科手术术后发生气道管理困难的手术因素。 方法: 对我院2015年1月—12月间的180例颌面头颈外科术后带人工气道入SICU患者进行回顾分析。根据手术类型分为3组,即肿瘤切除术组（60例）、先天性畸形矫正术组（60例）和创伤手术组（60例）。使用SPSS 13.0软件包对各组围术期资料进行χ²检验和t检验,筛选差异指标。 结果: 肿瘤切除术组手术和麻醉时间较另外2组长（P<0.05）,需行清醒气管插管比例高（P<0.05）,术中出血量多（P<0.05）,术后带管时间较长（P<0.05）。创伤手术组镇静不足、躁动发生率较另外2组高（P<0.05）。 结论: 颌面头颈外科手术患者因局部解剖结构改变,出血、水肿压迫气道等原因,气道梗阻风险较高,给予适度的镇静、镇痛,保留气管插管并延迟拔管,可以避免发生严重并发症。     

Nutritional evaluation prior to oral and maxillofacial surgery

Proper wound healing requires specific nutritional requirements which must be met to allow optimal repair of the tissues. It is important for the surgeon to have an understanding of the presurgical nutritional state of the patient in order to adequately plan for and prevent any complications which might arise due to a poor healing of the tissues. At the time of the initial clinical examination, the surgeon should perform in addition to the necessary and routine tests, a thorough history and physical examination. One should be aware of the previously mentioned signs and symptoms which may indicate the presence of a nutritional deficit. If a nutritional deficit exists, it should be corrected prior to surgery by using a balanced diet with supplements of the deficient nutrient. If one is unable to correct this prior to surgery then the patient should be prescribed postoperative nutritional support to maintain an adequate protein calorie intake to promote complete would healing.     

口腔颌面-头颈鳞癌的分子生物学研究

口腔颌面-头颈鳞癌是发病率和死亡率较高的全球性疾病。临床常用的TNM分期不能对其遗传学特征和生物学特性作出正确的判断：肿瘤的分子特点对治疗方案选择、降低死亡率和提高生存率有一定帮助。特异基因表达谱的应用．能改善诊断方法．为个体化治疗提供基础；头颈鳞癌分子谱型的应用，可以对淋巴结转移和手术切缘作出正确的诊断．以便正确指导手术范围的确定。2000～2005年，约有40多篇有关头颈鳞癌基因表达谱的研究报道，本文就研究中发现有变化的基因进行综述和分析。结果表明，在肿瘤和非肿瘤之间，存在多个基因的变化。GO分类分析结果表明．这些基因涉及22种生理功能；进一步对这些变化基因进行基因组、蛋白组和功能的研究，将对揭示头颈鳞癌的分子病理学发生机制产生积极作用。     

Radiotherapy-induced oral morbidities in head and neck cancer patients

The cumulative effect of radiation and the extent of related morbidities on oral tissues are enormous and increase over time. The numerous radiation-related side effects have a strong, negative influence on the oral functions and are responsible for a drastic reduction in the oral-health-related quality of life of the cancer survivors. In a significant deviation to the earlier approach of advising extraction of all remaining teeth before RT, the concept of preserving a maximum number of teeth in a state of health and for better oral functions postcancer cure has been globally accepted and is adhered to. The effects of radiation and their impact on the general well-being of the patients underscore the relevance of understanding the sequelae of radiation therapy on healthy oral tissues, preexisting oral diseases and their progression, impact on oral treatment needs, limitations in performing the indicated treatment, and shortcoming in treatment outcomes. It is vital for the professionals involved in head and neck cancer care to follow a well-devised referral system for oral care before and after RT and educate patients for a life-long follow-up     

Extubation criteria for oral and maxillofacial surgery patients

An overview is presented of some of the factors that should be considered before extubating a patient who has undergone an oral and maxillofacial surgical procedure. A discussion of the possible preoperative assessment of the patient, complications of intubation, effects of narcotics and muscle relaxants, assessment of airway edema, and criteria for extubation is included.