Biomedical subjects
Publications and source records attributed to A N Kanatas.
The issue of prophylactic antibiotic therapy in third molar surgery is highly controversial. The current evidence questions the benefits of routine prophylactic antibiotic therapy which does not appear to overcome the risk of undesirable outcomes after third molar removal. In our opinion there is no justification for routine antibiotic prophylaxis for third molar surgery.
Oral and maxillofacial surgeons often use hyperbaric oxygen (HBO). Our aim was to find out the referral pattern of these surgeons for HBO. We contacted oral and maxillofacial units in England, Wales, and Scotland and identified 125 consultants who are involved in the management of patients with cancers of the head and neck. We sent these surgeons a postal questionnaire and 91 (73%) replied. Eighty-five of these consultants (93%) saw patients with osteoradionecrosis and only five of these never referred patients for HBO. About half the respondents (57%) saw patients for the insertion of osseointegrated implants after radiotherapy to the jaw, and seven of these never referred patients for HBO. All the respondents saw patients who required mandibular molar extractions after radiotherapy and 30 (33%) never referred these patients for HBO. Most consultants were unaware of the method of delivery of HBO. This survey suggests that most surgeons consider HBO to be part of the management of osteoradionecrosis, but their knowledge about delivery is weak and protocols vary.
BACKGROUND: The aim of this study is to compare complication rates of miniplates versus reconstruction plates in the fixation of vascularized grafts into segmental mandibular defects. METHODS: Retrospective analysis of 143 consecutive successful microvascular composite flaps performed between 1993 and 2001 was performed. Data were gathered from a computerized database, case notes and pathology reports. Complications were classified as dehiscence, infection, plate or bone removal. RESULTS: In the series, 49% of patients received miniplates, and 51% received plates. No significant differences in complication rates were found between those grafts fixed with miniplates (27%) and those with reconstruction plates (30%). Plate choice was primarily determined by consultant preference. No significant differences were found in patient, defect, treatment, or follow-up characteristics between the plate groups. Twenty-nine percent of patients had at least one late complication at the reconstructed site, and this was higher (39%) in those who had postoperative radiotherapy. CONCLUSIONS: No evidence was found in this study that the increased rigidity offered by reconstruction plates influences the rate of plate or bone removal, infection, or plate exposure. Thus, the decision to use reconstruction or miniplates is not dependent on the rate of plate complications.
AIMS: To identify the health-related quality of life (HRQOL) questionnaires employed by the physicians and surgeons who manage patients with head and neck cancer. Also, to gain an impression of the perceived difficulties and advantages of their use. METHODS: A national survey was performed of active UK consultant clinicians on the mailing list of the British Association of Head and Neck Oncologists. RESULTS: Of 267 questionnaires, there were 191 replies (71.5%) from clinical oncologists (40), ENT surgeons (53), general surgeon (1), oral and maxillofacial surgeons (59), and plastic surgeons (38). Fifty-five consultants (29%) used HRQOL questionnaires and the most popular questionnaire was the University of Washington Head and Neck Cancer (65%). Questionnaires were most likely to be used both before and after treatment (67%) and administered in clinic by either nursing staff or consultants. The main reasons for not using HRQOL questionnaires included lack of resources and proven value. CONCLUSIONS: Despite the vast amount of literature on the importance of HRQOL in head and neck cancer, this survey shows that there is still a substantial amount of work required before HRQOL measurement becomes an established part of routine practice.
OBJECTIVES: To analyse the antibiotic prescribing trends for exodontia and minor oral surgery in patients with a history of radiotherapy. Also, to evaluate the use of hyperbaric oxygen as a separate modality in the prevention of osteoradionecrosis. DESIGN: A survey of antibiotic prescribing involving the analysis of a questionnaire which included the management of three patients with a history of head and neck malignancy. METHOD: The heads of the departments in each unit in the UK were sent a closed-response questionnaire. Antibiotic prescribing was assessed in three case scenarios. Case one referred to a patient that had surgery alone as part of the management of head and neck cancer, who needed the surgical removal of second molar roots. Case two referred to a patient that had surgery and adjuvant radiotherapy as part of the management of head and neck cancer, and needed the same procedure as in case one. Case three included a patient with a history of surgery and adjuvant radiotherapy, who required the extraction of three mobile and periodontally-involved lower incisors. Consultants were also asked about the use of hyperbaric oxygen in the patients who had radiotherapy as part of their treatment strategy. RESULTS: A total of 109 questionnaires were sent to all the Maxillofacial Units in the UK. The response rate was 73%. In patients with a history of radical surgery alone for the management of head and neck cancer, 20% of the surgeons advocated pre-operative antibiotics for the surgical removal of lower posterior teeth. In contrast, in the patient with a history of adjuvant radiotherapy 86% supported pre-operative antimicrobial use for the surgical removal of the same teeth. In the extraction of mobile and periodontally involved lower incisors in the previously irradiated patient, 63% of the clinicians supported pre-extraction antibiotics. Postoperative antibiotics were advocated in 52% in the first case, 89% in the second case and 71% in the third case. 34% of the clinicians advocated hyperbaric oxygen for surgical removal of posterior teeth and 15% for the extraction of mobile anterior teeth. CONCLUSIONS: The use of peri-extraction antibiotics was favoured among oral and maxillofacial surgeons. There was little enthusiasm towards the use of hyperbaric oxygen as a prophylactic measure, alone or in conjunction with an antimicrobial regime. Control randomised trials that will measure the effectiveness of hyperbaric oxygen and the appropriate use of antibiotics for prophylaxis in pre- and post-operative regimes are necessary to evaluate the use of these modalities.
Dental extractions or minor oral surgery in patients who have undergone radiation therapy for cancer in the head and neck carry the risk of one of the most serious and devastating complications of head and neck radiotherapy, that of osteoradionecrosis (ORN). A totally unified approach to dental extractions following radiotherapy is lacking. The role of the general dental practitioner in management of patients following radiotherapy is crucial. Contrary to clinical impression, the risk of ORN does not decrease with time. When contemplating exodontia or minor oral surgery in the irradiated patient, special consideration should be given to issues such as radiotherapy history, surgical assessment, surgical procedure and the role of antibiotics and hyperbaric oxygen.