516例头颈部恶性肿瘤根治术后谵妄危险因素分析

目的评估头颈部恶性肿瘤根治术后谵妄的危险因素，为临床制定术后谵妄防治的应对措施提供依据。 方法本研究为回顾性队列研究，纳入2018年10月1日至2021年10月1日于徐州中心医院和上海交通大学医学院附属第九人民医院口腔颌面外科接受头颈恶性肿瘤手术的患者共516例，其中男328例、女188例。对相关危险因素和生命体征进行了回顾和收集。依据谵妄评估量表，将患者分为谵妄组（65例，男44例、女21例）和非谵妄组（451例，男284例、女167例）。采用单变量和多变量Logistic回归分析进行统计学处理。 结果在本项研究中，头颈部恶性肿瘤根治术后谵妄发生率为12.2%（65/516）。组间单因素分析结果显示，年龄（Z = 4.62，P<0.001）、吸烟史（χ² = 5.46，P = 0.019）、酗酒史（χ² = 5.74，P = 0.017）、手术时间（Z = 4.50，P<0.001）、气管切开（χ² = 14.26，P<0.001）、输血（χ² = 22.87，P<0.001）、游离皮瓣移植（χ² = 23.65，P<0.001）、重症监护时间（Z = 2.20，P = 0.028）、术后疼痛VAS值（Z = 3.64，P<0.001）、术后睡眠障碍（χ² = 21.19，P<0.001）、术后发热（χ² = 28.95，P<0.001）与术后谵妄相关。多因素Logistic回归分析结果显示，与谵妄相关的危险因素包括年龄（OR = 1.05，95%CI：1.02 ~ 1.08，P<0.001）、输血（OR = 2.64，95%CI：1.38 ~ 5.03，P = 0.003）、气管切开（OR = 4.02，95%CI：1.61 ~ 10.07，P = 0.003）、术后睡眠障碍（OR = 6.64，95%CI：3.43 ~ 12.84，P<0.001）、发热（OR = 3.28，95%CI：1.39 ~ 7.72，P = 0.007）和术后疼痛视觉模拟评分（VAS）值（OR = 1.42，95%CI：1.17 ~ 1.71，P<0.001）。 结论本研究确定了年龄、是否输血、气管切开、术后睡眠障碍、发热及术后疼痛是头颈部恶性肿瘤根治术后患谵妄的独立危险因素，可采取一定措施，同时提高围手术期的疼痛控制可能有助于预防谵妄的发生。     

头颈重建术后谵妄的研究现状

术后谵妄（postoperative delirium,POD）是一种急性脑功能障碍,在头颈重建（head and neck reconstruction,HNR）术后患者中时有发生。早期发现和及时干预,能够改善患者的术后生活质量,否则将会影响术后恢复,增加患者长期认知障碍的风险,延长住院时间,加重医疗负担。术后谵妄作为一种精神科疾病,容易与其他精神类疾病混淆,给头颈外科医护人员诊断带来困难。本文就谵妄的定义、诊断、术后影响、预防及治疗进行综述,为头颈外科医护人员早期诊治谵妄提供帮助。     

口腔颌面部手术术后谵妄危险因素的Meta分析

目的分析口腔颌面部手术术后谵妄（POD）的相关危险因素,为临床有效预防POD提供依据。 方法检索Web of Science、PubMed、Cochrane Library、EMbase数据库,时间为数据库建库至2018年7月1日,查找关于口腔颌面部手术POD的相关文献,按照纳入、排除标准进行筛选,对纳入的文献进行质量评估,提取关于POD相关因素的数据,采用RevMan 5.3、StataSE 12.0软件进行统计学分析。 结果共纳入11篇口腔颌面部手术POD的相关研究,涉及口腔颌面部手术2429例患者,其中发生POD共415例（发生率17.1%）。研究结果显示,年龄、男性、独居、精神状态、高血压、术前血红蛋白、总蛋白、术中麻醉时间、手术时间、失血量、气管切开术、术后疼痛为口腔颌面部手术POD的危险因素（P<0.05）,而吸烟、酗酒、美国麻醉医师学会（ASA）分级、糖尿病、心脏病、术前血清钠、术前白蛋白、输液量、颈淋巴清扫术、皮瓣转移修复术与POD无明显相关性（P>0.05）。 结论临床上口腔颌面外科医生在术前应密切关注患者的年龄、性别、精神状态、高血压及相关实验室结果（术前血红蛋白、总蛋白）;术中应密切控制麻醉时间和手术时间,减少出血,维持良好通气;术后做好镇痛管理,能有效预防POD发生。     

Postoperative delirium after reconstructive surgery for oral tumor: a retrospective clinical study

The aim of this study was to perform a statistical evaluation of the risk factors for postoperative delirium after oral tumor resection and reconstructive surgery. The records of 69 consecutive patients who underwent major head and neck tumor resection and reconstructive surgery, and who received postoperative management in the high care unit (HCU) or intensive care unit (ICU) of Tsukuba University Hospital between January 2013 and December 2017, were analysed retrospectively. Delirium was diagnosed in 23 patients (33.3%) after surgery. There were significant differences in age, sex, history of diabetes mellitus and chronic obstructive pulmonary disease, recent hospitalization history, sedation period, duration of ventilator use, length of ICU/HCU stay, postoperative blood tests (haemoglobin and potassium), and postoperative medication with a major tranquilizer between those with and without delirium. Logistic regression analysis of selected independent variables revealed a hazard ratio (95% confidence interval) of 1.42 (1.09–1.86) for the sedation period. Delirium was hyperactive type in 15 cases, hypoactive type in five, and mixed type in three. There was no obvious difference in postoperative day of onset or delirium period according to subtype. In conclusion, a history of diabetes and the sedation period were found to be related to postoperative delirium. However, this study was small and retrospective, so further investigation is necessary.     

头颈部手术后谵妄危险因素的meta分析

目的: 分析头颈部手术后谵妄危险因素,为临床有效预防术后谵妄提供依据。方法: 通过计算机检索PubMed、Cochrane library、EMBASE、ISI Web of Knowledge、Google scholar、CNKI数据库、维普数据库和万方数据库,查找关于头颈部手术后谵妄危险因素的文献,截止日期为2014年1月。采用RevMan5.2软件进行统计学分析。结果: 共纳入7篇关于头颈部手术患者术后谵妄危险因素的病例对照研究,共有1664例患者行头颈部手术,谵妄组237例,非谵妄组1427例。研究结果表明,年龄（WMD:5.70,95% CI:1.96-9.43,P<0.001）、性别（OR:1.51,95% CI:1.07-2.12,P<0.05）、独居（OR:2.22,95% CI:1.42-3.48,P<0.001）、术前精神疾病（OR:2.57,95% CI:1.60-4.15,P<0.05）、酗酒（OR:1.74,95% CI:1.79-2.54,P<0.05）及手术麻醉时间（WMD:63.93,95% CI:9.47-118.38,P<0.05）等6项为头颈部手术患者术后谵妄相关因素;而与根治性颈淋巴清扫术、游离皮瓣修复、气管切开、术后制动等因素无显著相关性（P>0.05）。结论: 患者年龄、性别、独居、术前精神疾病、酗酒及手术麻醉时间等6项为头颈部手术患者术后谵妄的危险因素。     

Risk factors for postoperative delirium in patients undergoing free flap reconstruction for oral cancer

The aim of this study was to investigate risk factors for postoperative delirium in patients undergoing free flap reconstruction for defects after oral cancer resection. This was a non-randomized, retrospective cohort study involving 102 patients who underwent oral cancer resection and free flap reconstruction. Data were collected from the medical records. Postoperative delirium occurred in 34 patients (33.3%), of whom 27 were male and seven were female. High preoperative total protein and albumin, diabetes mellitus, history of smoking, use of hypnotics or antipsychotics, time until getting out of bed after surgery, and postoperative insomnia were significantly related to delirium in the univariate analysis (P < 0.05). In a multiple logistic regression model, high preoperative albumin (odds ratio 4.45), postoperative insomnia (odds ratio 10.72), and history of smoking (odds ratio 2.91) were significant risk factors for delirium (P < 0.05). The analysis of laboratory data before and after surgery showed greater decreases in albumin, total protein, and haemoglobin after surgery in patients with postoperative delirium than in those without this condition. These results show that the perioperative maintenance of nutritional status and early postoperative management of the sleep cycle are important to prevent delirium after oral cancer resection and free flap reconstruction.     

238例头颈肿瘤患者重建术后谵妄危险因素分析

目的 探讨头颈肿瘤患者重建术后谵妄发病的相关危险因素。方法 选择2018年10月—2019年10月于上海交通大学医学院附属第九人民医院接受头颈肿瘤术后重建患者238例,其中男160例,女78例;年龄16~85岁,平均（56.52±15.31）岁。依据《谵妄评估量表》结果,将患者分为谵妄组和非谵妄组,采用SPSS 17.0软件包分析患者术后谵妄的发病率和相关危险因素。结果 头颈肿瘤重建术后谵妄发病率为10.1%（24/238）。组间单因素分析发现,高龄、高血压、既往谵妄、术前睡眠紊乱、术后睡眠紊乱、术中输血、术后疼痛差异有统计学意义（P<0.05）;多因素Logistic回归分析发现,高龄（OR=1.090）、术后睡眠紊乱（OR=15.248）、术中输血（OR=1.003）、术后疼痛（OR=1.398）是患者术后发生谵妄的独立危险因素。结论 头颈肿瘤重建术后高龄、术中输血、术后睡眠紊乱和术后疼痛是谵妄发病的高危因素,应采取一定的预防措施,减少术后谵妄的发生。     

Risk factors for postoperative delirium in patients undergoing head and neck cancer surgery

This study was carried out to determine risk factors for delirium after major head and neck cancer surgery. The postoperative experience of 38 patients who underwent major head and neck cancer surgery and were managed in the high care unit was retrospectively examined by reviewing their medical records. Delirium was defined as confusion and abnormal behavior that interfered with postoperative recovery. Postoperative delirium occurred in 10 patients (26.3%) who all had stage IV cancer, flap reconstruction, an operative time of more than 10 h, blood transfusion of more than 4 units or infusion of more than 5000 ml, which together suggested the risk of delirium increased significantly with extensive surgery. Delirium occurred less frequently in patients with minor tranquilizer use for postoperative sleep disorder. Multivariative analyses showed an operative time of >10 h and no use of minor tranquilizer as significant factors for increasing the incidence of delirium, with odds ratios (95% confidence interval) of 11.4 (1.5-83.8) and 9.8 (1.5-66.0), respectively.     

Perioperative safety and complications in treatment of oral and maxillofacial surgery patients under general anesthesia with obstructive sleeping disorders

Patients with sleeping disorders, such as obstructive sleep apnea, (OSA) have a higher risk for postoperative complications after maxillofacial surgery under general anesthesia. The aim of this study was to detect specific complications after oral and maxillofacial surgery.Sixty-nine cases of patients with middle or severe sleep apnea who underwent an operation under general anesthesia in the oral and maxillofacial region were retrospectively analyzed. This group was compared with an age and diagnosis matched group without sleep apnea receiving the same operative treatment.We found a significant difference between the two groups concerning body mass index, the ASA-Index, the Cormack-Mallampati Index, the number of pre-existing conditions, and home medication (p < 0.05). Concerning the length of stay, overrun of estimated mean length of stay, and number of surgical complications and hypertonic events, no difference could be detected. Almost 28% of the patients with OSA in our study suffered a substantial respiratory complication even under intensive care observation. The number of patients with oxygen desaturation was 9% in the control group, which differed significantly (p = 0.0093) from the number of such patients in the OSA group.In this study, we have shown that the presence of OSA in patients undergoing elective maxillofacial surgery is associated with a considerable number of comorbidities in the postoperative period. Through preoperative OSA screening and OSA evaluation, an improvement in management of surveillance resources could be achieved and the OSA-specific risk could be assessed more precisely and also reduced.     

Nurse’ prediction prevention and management on post-operative delirium in geriatric patients with hip fracture: The development of a protocol to guide care

BackgroundA high prevalence for the development of delirium after hip fracture was found in the group of geriatric patients. The National Institute for Health and Clinical Excellence has introduced a guideline for the management delirium (NICE, 2010). Protocols composed of detection, prevention and management of post-operative delirium required some adaptation to meet the needs of local nurses.AimA protocol with a nursing care plan referenced from an international guideline and other literature was developed to predict, prevent and manage post-operative delirium for geriatric patients with hip fracture.MethodsThe literature suggests numerous risk factors are associated with post-operative delirium and its preventive interventions were adopted to develop the protocol and nursing care plan.FindingsSix major risk categories included mental and behavioural influence, sensory impairment, physiological influence, immobility influence, electrolyte disturbance and infection influence. These were used for screening patients, accompanied by various preventive interventions. A protocol was developed to strive for the best management of geriatric patients receiving hip fracture surgery from admission to discharge.ConclusionsThe protocol incorporated with the Risk Assessment for Management of Postoperative delirium (RAMP) care plan was adapted for staff to implement in their local clinical area. Further study is required to determine its effectiveness on the prevention of the development of post operative delirium (POD) in the future.     

Morbidity related to the lip-split mandibulotomy approach: a systematic and narrative review

The lip-split mandibulotomy (LSMA) is an access procedure that has been used in head and neck (H&N) surgery as an aid to surgical resection of inaccessible tumours of the postertior oral cavity and oropharynx. Anecdotal evidence suggests that it has significant morbidity. Voices of concern within the H&N surgical community suggest that it has been abandoned in favour of technological advances such as robotic surgery. We report here the first (to our knowledge) registered systematic review of its kind, documenting the safety and efficiency of LSMA in H&N surgery. We performed a PRISMA-guided systematic review (PROSPERO-registered) and identified reports using a search algorithm in MEDLINE/EMBASE. LSMA-related surgical complications were recorded using the Clavien-Dindo classification. Secondary outcomes included swallowing dysfunction, facial cosmesis, and patient satisfaction recorded in health-related quality of life questionnaires (HRQoL). From 125 studies identified, 54 met the inclusion criteria (3872 patients). The LSMA mortality rate was 0%; we did not identify a single case of perioperative death. The median rate of osteoradionecrosis was 5.4%, whereas fistula formation was 5.7%. Malunion was noted in 4.9%. Other complications (surgical site infection, plate exposure) were around 5%. There was significant between-study variation with regards to swallowing assessment tools, but overall there was no significant difference in outcomes. This was also the case for the HRQoL questionairres. LSMA is a safe procedure with an acceptable rate of complications, and should definitely remain in the armamentarium of H&N surgery.     

Clinical observations of postoperative delirium after surgery for oral carcinoma

The aim of the present study was to clarify the clinical characteristics of postoperative delirium and to determine appropriate postoperative management for its prevention. The authors analysed 132 cases of primary surgery for oral carcinoma and observed 24 (18%) cases of postoperative delirium. Univariate analysis revealed that significant risk factors for postoperative delirium were older age, male gender, extensive surgery and morphine pain control. Logistic regression analysis showed that older age and male gender were significant risk factors for postoperative delirium, while patient-controlled analgesia with fentanyl was effective for prevention of postoperative delirium. There was a trend for postoperative delirium to be associated with extensive surgery. In those who had delirium, blood tests revealed that alkaline phosphatase, total protein, sodium, chlorine, red blood cell count, haemoglobin and haematocrit were significantly diminished after surgery. These results indicate that general condition is closely related to the onset of postoperative delirium, and suggest that appropriate postoperative management can reduce the incidence of this complication.     

The modified superior based pharyngeal flap. Part III. A retrospective study

A retrospective study of 31 patients who had diagnosed velopharyngeal incompetence and were surgically managed with the modified superior based pharyngeal flap was completed. The following were analyzed: age at time of operation, gender, physical status, diagnostic protocol, length of operation (length of total surgery) and length of superior based pharyngeal flap, length of postoperative hospital stay, length of total hospital stay, length of follow-up, speech results, complications, patient care, and medication. The result showed that the optimal timing for correction of velopharyngeal incompetence was between 3 and 6 years of age. The mean length of total hospital stay was 2.7 days, postoperative complications were minimal, and speech results were generally good.     

Frailty and risk of complications in head and neck oncologic surgery. Systematic review and dose-response meta-analysis

Background There is emerging evidence that frail individuals present a decreased physiological reserve, decreased ability to maintain homeostasis, and increased vulnerability to stressors. The concept of frailty has become increasingly recognized as a valuable measure in oncological surgical patients, including those with head and neck cancer. Preoperative screening for frailty may provide an individualized risk assessment that can be used by an interdisciplinary team for preoperative counseling and to improve outcomes. The aim of this meta-analysis was to evaluate the relationship between frailty and the risk of major postoperative complications in frail individuals submitted to head and neck oncologic surgery.Material and Methods PubMed, SCOPUS, Web of Science, Google Scholar and OpenThesis were systematically searched to identify studies that evaluated the risk of major postoperative complications in frail individuals undergoing head and neck oncologic surgery. The search was performed on August 31, 2020, without language or date restrictions. Two independent investigators screened the searched studies based on each paper’s title and abstract. Relevant studies were read in full and selected according to the eligibility criteria. Frailty was assessed by modified Frailty Index (mFI-11) and major postoperative complications were measured by the Clavien-Dindo classification. We performed a categorical and dose-response meta-analysis using a random-effects model to evaluate the association between frailty and the risk of major postoperative complications in patients submitted to head and neck oncologic surgery. The results of the meta-analysis were expressed as relative risk (RR) and 95% confidence interval (95% CI). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).Results Four studies (9,947 patients) were included in this systematic review and meta-analysis. Frail patients presented an increased risk of life-threatening complications requiring intensive care unit (ICU) admission (RR = 4.67; 95% CI 1.54–14.10) and 30-day mortality (RR = 8.10; 95% CI 2.30–28.57) compared to non-frail patients. We found evidence of dose-response trend between mFI-11 and major postoperative complications.Conclusions Higher frailty scores are associated with a significant increase in ICU-level complications and 30-day mortality after head and neck oncologic surgery. Key words:Frailty, head and neck neoplasms, postoperative complications, mortality.     

Patient safety with orthognathic surgery in an outpatient setting

Orthognathic surgery is traditionally performed in inpatient care. The question is whether patient safety is maintained when orthognathic surgery is performed in outpatient care. This retrospective cohort study was conducted to investigate patient safety in selected single-jaw orthognathic surgeries performed in outpatient care compared to inpatient care. Postoperative infection, postoperative bleeding, postoperative pain, plate removal, and re-operation, as well as emergency visits/phone calls and postoperative admission during the first 12 months after surgery were recorded. Predictor variables were sex, age, smoking, general disease, antibiotics, operation type, and operation time. Of the 165 patients included, 58 were treated in inpatient care and 107 in outpatient care. No significant difference was found between the groups regarding postoperative bleeding, pain, plate removal, re-operation, or emergency visits/phone calls. Ninety-four percent of outpatients (n = 101) were able to leave the hospital on the day of surgery as planned. There was an increased risk of postoperative infection in the outpatient care group (odds ratio 2.46, P = 0.049). Selected single-jaw orthognathic surgery can be performed in the outpatient setting, with maintained patient safety. The reason for the increased risk of postoperative infection among patients operated in outpatient care should be investigated in further studies.     

Donor-site local anaesthetic infusion catheter as an opioid-sparing agent in free flap reconstruction of the head and neck: a valuable adjunct to an enhanced recovery protocol

This paper presents the results of a retrospective case-controlled cohort study to investigate the effectiveness of a donor-site local anaesthetic infusion protocol to reduce opioid requirements, length of intensive therapy unit (ITU) stay, and incidence of postoperative delirium. Adult free flap head and neck patients were identified from a prospective database (n = 86). There was a significant reduction in mean opioid requirements (p < 0.001). Postoperative delirium was observed in 12 of 35 patients before introduction of the protocol, and in 10 of 51 patients after its introduction (p = 0.139). Donor-site local anaesthetic infusion reduces opioid requirements for patients undergoing head and neck free flap reconstruction, and is a valuable adjunct to an enhanced recovery protocol.     

Study of surgical treatment for elderly patients with head and neck cancer

The aim of this study was to evaluate the clinical results of surgery for head and neck cancer (HNC) in elderly patients and to determine whether surgery for elderly HNC patients is safe and what types of surgery result in the most favourable outcomes for this age group. The cases of 637 elderly patients who were diagnosed with HNC and underwent surgical treatment were studied retrospectively. Patient demographic characteristics and treatment data were extracted from the appropriate patient records and analysed. Age did not significantly predict postoperative complications or death rates. Flap reconstruction surgery had no significant association with necrosis, haemorrhage, infection, need for rescue treatment, or length of intensive care unit stay. Age was not a risk factor for surgical treatment of HNC in the elderly patients. Flap reconstruction should not be considered riskier for elderly patients. The treatment choice for elderly patients with HNC should be based on medical assessments but not on age.     

Surgical correction of congenital lower lip sinuses in Van der Woude syndrome.

OBJECTIVE: To review the clinical outcome for patients with Van der Woude syndrome undergoing surgical excision of congenital lip sinuses. DESIGN: Retrospective chart review. SETTING: Multidisciplinary cleft-craniofacial team within a tertiary care hospital. PATIENTS, PARTICIPANTS: Seventeen patients with Van der Woude syndrome were identified from hospital records as having cleft lip and/or palate surgery performed at the University of Iowa, and six of these patients underwent simple surgical excision of lower lip sinuses. Main OUTCOME MEASURES: Incidence of postoperative complications and number of surgeries required per patient for correction of lower lip defect. RESULTS: All six patients undergoing surgical excision of lip sinuses had postoperative mucocele formation. These uniformly required one or two further surgeries for correction. There were no other complications associated with the procedures and no patient had a pre- or postoperative whistling deformity. Cosmetic outcome was thought to be satisfactory in all cases. CONCLUSIONS: Despite the overall improvement in cosmetic appearance following simple surgical excision of congenital lower lip sinuses, the high rate of mucocele formation and repeat surgery has led to cautious preoperative counseling regarding the risks and benefits of the procedure.     

Premedication with cyclooxygenase-2 inhibitor meloxicam reduced postoperative pain in patients after oral surgery

The efficacy of the selective cyclooxygenase-2 (COX-2) inhibitor meloxicam for treatment of postoperative oral surgical pain was assessed in a randomized controlled trial. Patients undergoing unilateral mandibular 3rd molar extraction surgery were allocated to 3 groups, A, B and C. After oral premedication of meloxicam 10 mg in group A, ampiroxicam 27 mg in group B and placebo in group C, surgery was completed within 30 min under local anaesthesia using 2% lidocaine. For postoperative pain relief the patients were allowed to take oral loxoprofen (60 mg per tablet). Postoperative pain was evaluated at the clinic on the 1st, 7th and 14th postoperative day (POD) using a visual analogue scale (VAS), as was the number of loxoprofen tablets consumed, and the results were compared among the 3 groups with statistical significance of P<0.05. VAS scores on 1 POD were significantly lower in group A than in group C. Loxoprofen consumption on the day of surgery and 1 POD was significantly lower in group A than in group C (P<0.01). Total analgesic consumption was significantly lower in groups A and B than in group C (P<0.02). The COX-2 inhibitor, meloxicam 10 mg used for premedication reduced postoperative pain compared with control in oral surgery.     

Independent predictors of satisfaction in impacted third molar surgery patients

Kim YK, Kim SM, Myoung H. Independent predictors of satisfaction in impacted third molar surgery patients. Community Dent Oral Epidemiol 2010; 38: 274–286. © 2010 John Wiley & Sons A/S Abstract – Objectives: Patient satisfaction and dissatisfaction are critical dimensions leading to favorable or unfavorable treatment outcomes. Although impacted third molar (ITM) surgery is one of the most common dental surgical procedures, it is a challenging operation because of numerous potential complications and patients generally suffer from severe psychosomatic symptoms as a result of severe perioperative anxiety. We hypothesize that multiple independent factors, including perioperative anxiety and various postoperative complications, affect satisfaction of the ITM surgery patients. Methods: Survey data from 219 participants encompassed basic patient demographic traits, difficulty of surgery, perioperative anxiety, pain sensation and common postoperative complications. The t‐test and one‐way anova with Duncan’s multiple‐range tests were applied to detect differences in mean values of perioperative anxiety, perioperative pain sensation and satisfaction based on basic demographic characteristics and postoperative complications. The significance of postoperative complications according to demographic data and difficulty of extraction was also analyzed. A paired t‐test was applied to detect the significance of anxiety level and pain sensation changes over time. Lastly, univariate and multiple stepwise regression analyses were used to analyze the relationships among perioperative anxiety, pain sensation and satisfaction to determine the predictive factor of patient satisfaction. Results: Basic demographic traits proved not to have a direct significant effect on satisfaction in ITM surgery patients, but some demographic factors and difficulty of surgery showed significant relationships with postoperative complications. Univariate analysis revealed that perioperative anxiety, pain sensation, postoperative infection, numbness/paresthesia and ecchymoses have a significant influence on patient satisfaction. In particular, preoperative anxiety level and numbness/paresthesia were independent predictive factors of patient satisfaction upon multivariate analysis. Conclusions: This study demonstrates that the patients who undergo ITM surgery often have severe anxiety that seriously impacts patient satisfaction and resultant treatment outcomes. In addition, patient satisfaction directly depends on the occurrence of some postoperative complications. Appreciation of these predictive factors and increasing patient satisfaction may help clinicians to provide optimal care for ITM surgery patients.