德国口腔颌面肿瘤外科临床技术管窥

介绍作者在德国工作期间所见德国口腔颌面肿瘤外科技术和经验,并将德国经验与国内做法进行比较,分析了德国经验的优点.     

对分课堂在口腔颌面肿瘤学住院医师规培教学中的应用

目的:探讨对分课堂在口腔颌面肿瘤学住院医师规范化培训中的应用效果.方法:选取参加2017与2018年在空军军医大学第三附属医院口腔颌面外科规范化培训的住院医师(以下简称规培医师)各20名为研究对象,分为试验组20名(2018年)和对照组20名(2017年).回顾性对比分析两组教学效果.结果:试验组规培医师口腔颌面肿瘤学...     

中国口腔颌面肿瘤学进展50年

20世纪 5 0年代以前 ,中国口腔医学尚未建立 ,因而没有一支从事口腔颌面肿瘤的专业队伍 ;2 0世纪 5 0年代 ,随着口腔医学事业的发展在一些有独立建制的口腔颌面外科单位才陆续开展了口腔颌面肿瘤的诊治工作。当时由于专门从事头颈肿瘤的单位为数寥寥 ,也为口腔颌面外科医师在诊治口腔颌面肿瘤提供了一个广阔的创业天地。至 1986年 ,我国成立第一个头颈肿瘤外科学术组织———中国抗癌协会头颈外科专业委员会时 ,已基本形成了一支较完整的从事口腔颌面肿瘤诊治与研究工作的专业队伍。在由头颈外科医师、耳鼻咽喉科医师及口腔颌面外科医师共同…     

Clinical negligence claims in oral and maxillofacial surgery over the last 10 years

According to NHS Resolution, the cost of harm from clinical activity in the last year was £8.3 billion. The steady increase in litigation within the National Health Service (NHS) has led to concerns being raised regarding the sustainability of the NHS, the increasing practice of defensive medicine, and the psychological impact on healthcare professionals. To our knowledge, litigation within oral and maxillofacial surgery has not been investigated in the UK since 2010, therefore our aims were to identify the trends within our specialty and the common reasons for negligence claims over the last 10 years. A freedom of information request was made to NHS Resolution for all clinical negligence claims from 2010 to 2020. A total of 1,122 claims were registered and the total for damages paid was £32,631,131. The claims were categorised by the primary injury and further divided into groups of cause codes. Four types of primary injury comprised 65.4% (n = 734) of all negligence claims and were as follows: additional or unnecessary operations (n = 313, 27.9%), unnecessary pain (n = 156, 13.9%), nerve damage (n = 139, 12.4%), and dental damage (n = 126, 11.2%). The damages associated with nerve damage were the costliest, with a total of £8,033,737 being paid. The significant increase in the number and cost of clinical negligence claims is concerning. The lessons from these claims must be shared and implemented to reduce the burden on the NHS, and ensure that we are providing a high quality of care with improved patient outcomes.     

Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review

Surgical site infections are a complication of oral and maxillofacial procedures, with the potential for significant morbidity and mortality. Use of preoperative, perioperative, and postoperative antibiotic prophylaxis to reduce the incidence of surgical site infections must be balanced with considerations of a patients’ risk of antibiotic-related adverse events. This review aimed to provide evidence-based recommendations for antibiotic prophylaxis. Searches were conducted using MEDLINE, the Cochrane Library, EMBASE, and PUBMED for maxillofacial procedures including: treatment of dental abscesses, extractions, implants, trauma, temporomandibular joints, orthognathics, malignant and benign tumour removal, and bone grafting, limited to articles published since 2000. A total of 98 out of 280 retrieved papers were included in the final analysis. Systematic reviews were assessed using AMSTAR criteria. Randomised controlled trials were assessed for bias using Cochrane Collaborative tools. The overall quality of evidence was assessed using GRADE. Prophylactic antibiotic use is recommended in surgical extractions of third molars, comminuted mandibular fractures, temporomandibular joint replacements, clean-contaminated tumour removal, and complex implants. Prophylactic antibiotic use is not routinely recommended in fractures of the upper or midface facial thirds. Further research is required to provide recommendations in orthognathic, cleft lip, palate, temporomandibular joint surgery, and maxillofacial surgical procedures in medically-compromised patients.     

Referrals to the neurology clinic from oral and maxillofacial surgery clinics

As part of an ongoing prospective study of referrals from surgical clinics to general neurology outpatient clinics, I audited direct referrals from oral and maxillofacial surgery clinics to neurology outpatient clinics to identify the number, sources, and any common indications for referral that might suggest specific training needs, or indicate areas for the development of care pathways.     

Use of patient-reported outcome measures in oral and maxillofacial trauma surgery: a review

In the UK, about one person/100/year sustains a facial injury, so trauma surgery accounts for a considerable part of the caseload in oral and maxillofacial surgery (OMFS). Patient-reported outcome measures (PROM) allow for patient-centred assessment of postoperative outcomes, but to our knowledge, most research in OMFS trauma does not currently include them. To investigate their use, we searched Medline to find relevant studies that reported outcomes from inception in January 1879 to August 2016. Those not in the English language and those that did not report operations were excluded. We retrieved 416 articles, of which 21 met the inclusion criteria (five randomised controlled trials and 16 cohort studies) yielding 16 outcome measures. Most of these had been devised by authors (eight studies), four studies reported use of the Geriatric Oral Health Assessment Index, and three the Nasal Obstruction Symptom Evaluation. Most were used in studies on mandibular surgery (n = 13), followed by those on nasal and facial surgery (n = 3 each). There is a great heterogeneity in the use of these assessments in OMF trauma. In view of their increasing importance compared with simpler objective measures that may not be relevant to the patients’ own perception, more research is needed to establish which of them can be used to measure the QoL of patients treated for OMF trauma.     

Botulinum toxin A: a review of 1,085 oral and maxillofacial patient treatments.

PURPOSE: Botulinum toxin A (Botox; Allergan, Inc, Irvine, CA) has been used safely and effectively for the management of rhytids and dynamic lines of the face. Much of the initial anecdotal experience with Botox has changed with experience and is reported by the author. PATIENTS AND METHODS: In a 56-month period, 439 vials of Botox were used for primarily cosmetic improvement of facial lines and rhytids. Four hundred seventeen patients underwent 1,085 treatment episodes with an estimated 17,000 injections that were tracked on a database and reviewed. RESULTS: Botox is a safe and effective treatment for the temporary improvement of facial lines and dynamic rhytids in selected anatomic regions. The techniques of reconstitution, storage, use, dose, and technique may not be as sensitive as originally described. CONCLUSION: When following minimal guidelines, the use of Botox for cosmetic facial applications is safe, predictable, and without serious complications and provides generalized patient satisfaction.     

Usefulness of fat-suppression magnetic resonance imaging for oral and maxillofacial lesions

In magnetic resonance imaging (MRI) of the oral and maxillofacial region, where large amounts of fat are normally present, the high signal intensity of fat on T1-weighted images (T1WI) and the chemical-shift artifact have limited the utility of paramagnetic contrast agents. Eliminating fat signal by fat-suppression techniques can increase the value of contrast-enhanced MRI. The present study was designed to evaluate the utility and role of chemical-shift imaging for fat suppression in the detection of oral and maxillofacial lesions in 22 patients (17 with malignant tumors, two with benign tumors, and three with inflammation). The depiction of lesions on the postcontrast fat-suppression T1WI was compared with that of conventional pre-and postcontrast T1 and T2WI on a four-grade scale (grades 0–3). The postcontrast fat-suppression T1WI (average grade, 2.86) were significantly superior to the precontrast T1WI (0.82) and postcontrast T1WI (1.86) and T2WI (1.68). Postcontrast fat-suppression T1WI were particularly beneficial in the detection of central necrosis or extracapsular invasion of metastatic neck lymph nodes as well as in defining the lesion extent at fat-containing areas such as the bone marrow or cheek. These findings demonstrated that the fat-suppression technique is extremely useful in the delineation of oral and maxillofacial lesions without increase of the scan time or image postprocessing procedures.     

我国口腔颌面部肿瘤学科现状——记全国第七次口腔颌面外科学术会议

经过半个多世纪、几代口腔医务工作者呕心沥血的努力，我国口腔颌面部肿瘤在诊断和治疗方面已积累了非常丰富的经验。在国内率先开展和规范了以口腔颌面部为主的头颈部良恶性肿瘤的外科治疗、放疗、局部及全身化疗、热疗、生物治疗及中医药治疗等一系列治疗方法；率先开展了头颈部复合组织缺损的修复重建，极大地丰富和推动了我国的修复重建外科，形成了具有中国特色并有国际影响的，集头颈肿瘤外科、修复重建外科、放射治疗、化学药物治疗和社会心理治疗等多学科交叉的学科体系。     

Navigation-guided oral and maxillofacial surgery (reconstructive and plastic, orthognathic, oncology)

Purpose: Advance in the field of compeer assisted surgery enables the surgical procedures to be less invasive and more accurate for the support of diagnosis imaging, pre-operative simulation and intraoperative navigation.     

Sarcomas of the oral and maxillofacial region: a review of 88 cases in Zimbabwe

We reviewed the case notes of 88 patients who were treated for sarcomas of the oral and maxillofacial region over a period of 24 years. There were 51 men (mean age 23 years) and 37 women (mean age 29). Forty-six tumours were in the mandible. Osteosarcoma accounted for 31 cases, and rhabdomyosarcoma 21 (usually under the age of 10 years).     

Nuclear medicine in oral and maxillofacial diagnosis: a review for the practicing dental professional

Nuclear medicine studies often play a significant role in the diagnosis and treatment of oral and maxillofacial diseases. While not commonly used in everyday dental practice, the dental provider should have a conversational knowledge of these imaging modalities and understand the indications and limitations of these studies. The purpose of this review is to discuss the nuclear medicine studies that have applications in the head and neck region as well as their indications, limitations, and diagnostic conclusions that can be drawn from these studies.     

The use of drains in oral and maxillofacial surgery: A review and a new approach

The use of drains in oral and maxillofacial surgery is reviewed and discussed. Their relative advantages and disadvantages and potential complications are explained, and principles for wound drainage are developed. Use of the Jackson-Pratt drainage system, a versatile type of suction that minimizes the complications associated with wound drainage, is described.     

Efficacy and safety of biodegradable osteofixation devices in oral and maxillofacial surgery: a systematic review

The use of osteofixation devices should be evidence-based if uncomplicated bone healing is to be achieved. Numerous studies describe and claim the advantages of biodegradable over titanium devices as a bone fixation method. Here, we systematically review the available literature to determine the clinical efficacy and safety of biodegradable devices compared with titanium devices in oral and maxillofacial surgery. In addition, related general aspects of bone surgery are discussed. We conducted a highly sensitive search in the databases of MEDLINE (1966-2005), EMBASE (1989-2005), and CENTRAL (1800-2005) to identify eligible studies. Eligible studies were independently evaluated by two assessors using a quality assessment scale. The study selection procedure revealed four methodologically 'acceptable' articles. Owing to the different outcome measures used in the studies, it was impossible to perform a meta-analysis. Therefore, the major effects regarding the stability and morbidity of fracture fixation using titanium and biodegradable fixation systems were qualitatively described. Any firm conclusions regarding the fixation of traumatically fractured bone segments cannot be drawn, due to the lack of controlled clinical trials. Regarding the fixation of bone segments in orthognathic surgery, only a few controlled clinical studies are available. There does not appear to be a significant short-term difference between titanium and biodegradable fixation systems regarding stability and morbidity. However, definite conclusions, especially with respect to the long-term performance of biodegradable fixation devices used in maxillofacial surgery, cannot be drawn.     

Low burnout risk and high engagement levels among oral and maxillofacial surgeons

Little is known about the well-being of oral and maxillofacial surgeons. The aim of this study was to measure the levels of burnout risk and the demanding work aspects of Dutch oral and maxillofacial surgeons, as well as the levels of positive work engagement and stimulating aspects of the work environment. The Maslach Burnout Inventory, Dutch version (UBOS), and inventories on positive engagement, work demands, and stimulating aspects of work, were sent to all 179 Dutch oral and maxillofacial surgeons currently in clinical practices. With a 70% response, UBOS mean scores on Emotional Exhaustion and Depersonalization appeared lower, and on Personal Accomplishment appeared higher, when compared with relevant reference scores. Engagement scores appeared to be relatively high. Mean scores on the work demands subscales were all well below the scale midpoint, whereas work resources were all well above. Dutch oral and maxillofacial surgeons showed relatively favorable burnout and engagement levels. The aspects of the work environment that best explain differences in burnout are 'Practice demands and organization' and 'Lack of variation and perspective in work'. Differences in engagement are best explained by 'Variety in work' and 'Positive effect upon patients'. It is remarkable that all work demands show relatively low levels and all stimulating work aspects show relatively high levels.     

Systematic review of lymphoma in oral cavity and maxillofacial region

The aim of this paper is to determine, compare and summarize presentation characteristics of patients with lymphoma of the oral cavity and maxillofacial region using the results of different primary studies. Articles from the PubMed database published between 1990 and 2010 were reviewed. The key words "Lymphoma" and "Oral" were used to search for titles, identifying 215 articles, of which 178 were excluded and 37 were used for this review. After evaluation, the researchers agreed to include 15 of the papers in the study. This paper describes the author year published, number of cases, sex, age, location, signs and symptoms, classification, diagnosis, staging and treatment reported in each of the 15 studies. A total 714 patients are described. In 11 out of 13 studies, there were more cases in males than females. Ages ranged from 3 to 96 years. Presentation was most frequently the gingiva and the main sign was swelling. Staging was described for only 177 cases and treatment was described for only 110 cases. It is concluded that the presentation of most of the lymphomas of the oral cavity and maxillofacial region is extranodal, non-Hodgkin's. The most common locations are gingiva in the oral activity and Waldeyers's ring in the maxillofacial region. Although these lymphomas are rare pathological entities, it is important to describe the complete manifestation of their natural history in order to provide knowledge of their development.     

The psychosocial dimensions of oral and maxillofacial surgery: a critical review of the literature.

The validity of the literature on the relationships between psychosocial factors and surgery for facial esthetics is diminished by theoretical bias, changing cultural values, vague measuring criteria, and inadequate experimental designs. Many persons who seek cosmetic surgery have psychiatric diagnoses and may experience postoperative emotional disturbances. Almost all patients report long-term satisfaction postoperatively. Patients who are treated by oral surgeons appear to have fewer emotional problems than those treated by plastic surgeons.