Territorial disputes.
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Dissent and Disputes↗
Biomedical subjects
M McGurk
Publications and source records attributed to M McGurk.
How satisfied are head and neck cancer (HNC) patients with the information they receive pre-treatment? Results from the satisfaction with cancer information profile (SCIP).
Recent UK government recommendations state that high quality information must be provided for cancer patients. The objectives of this study were firstly, to explore how satisfied head and neck cancer (HNC) patients were with information provided about their illness and treatment, in order to identify areas of improvement. Secondly, to assess the extent to which satisfaction with information before treatment was predictive of long-term outcomes. Patients completed the satisfaction with information profile (SCIP), the Hospital Anxiety and Depression Scale (HADS) and the SF-12 Health Survey (SF-12v2) before treatment (n=82), 1 month after the end of treatment (n=68) and 6-8 months later (n=50). Patients were generally satisfied with information, however key areas of improvement were identified, such as the provision of information about support groups, where to go for financial advice and the long-term affects of treatment on ability to work, physical functioning and QoL. Satisfaction with information before treatment was predictive of depression and Mental Component Summary scores (HR-QoL) 6-8 months after the end of treatment. This study highlights the need for tailored information provision and the impact on longitudinal outcomes of satisfying patient's needs for information prior to treatment.
Adult↗
Patient delay in oral cancer: a qualitative study of patients' experiences.
Up to 30% of patients delay seeking the advice of a healthcare professional after self-discovery of symptom(s) of oral cancer. Reasons for this patient delay are poorly understood. The aim of the present study was to explore patients' initial experiences and reactions to developing symptoms of oral cancer, and to identify factors influencing their decision to consult a health care professional. In-depth semi-structured interviews were conducted with 17 consecutive patients who had received a diagnosis of oral squamous cell carcinoma, but had yet to start treatment. Participants were asked about their beliefs about their symptoms over the course of the disease and their decision to seek help. The tape-recorded interviews were transcribed verbatim and analysed using 'Framework analysis'. Oral symptoms were rarely attributed to cancer and were frequently interpreted as minor oral conditions. As a result of these beliefs, patients tended to postpone seeking help or fail to be concerned over their symptoms. Prior to seeking help, patients responded to symptoms by using self-medication, changing the way they ate and disclosing their discovery of symptoms to friends or family. Problems with access to healthcare professionals and patients' social responsibilities acted as barriers to prompt help-seeking. This study has documented that an individual's interpretation of oral cancer symptoms may be misguided and this can adversely affect subsequent help-seeking behaviour.
Adaptation, Psychological↗
At risk individuals.
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Carcinoma, Squamous Cell↗
Mandibular fractures: Historical perspective.
The principles of the treatment of mandibular fractures have changed recently, although the objective of re-establishing the occlusion and masticatory function remains the same. Splinting of teeth is an old way of immobilising fractures but the advent of modern biomaterials has changed clinical practice towards plating the bone and early restoration of function. We present a brief historical overview of techniques and systems that have been used for stabilisation of mandibular fractures.
External Fixators↗
Head and neck cancer: to what extent can psychological factors explain differences between health-related quality of life and individual quality of life?
AIMS: To assess the extent to which individualised quality of life (QoL) was related to standardised health-related quality of life (HR-QoL), and to assess how much of the variation in each of these measures could be explained by psychological variables. METHODS: Fifty-five patients with newly diagnosed head and neck cancer completed the following outcome measures: the Patient Generated Index (PGI), the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the Short Form 12 version 2 (SF-12v2). Explanatory factors were measured with the following: the Illness Perceptions Questionnaire-Revised (IPQ-R), the Beliefs about Medicines Questionnaire (BMQ), the Hospital Anxiety and Depression Scale (HADS), and the Brief COPE (a shortened version of the COPE). MAIN FINDINGS: Standardised and individualised QoL measures were correlated only partly. The PGI correlated only with EORTC QLQ-C30 domains of emotional and cognitive functioning and SF-12 domains of mental health, emotional role, social, and physical role. The underlying psychological factors explaining each of the three outcome measures were different. CONCLUSIONS: Respondent-generated measures such as the PGI could be used as an adjunct to more standardised measures of HR-QoL clinically. This has implications for assessing the impact of head and neck cancer on individualised QoL and also for improving patients' outcome through interventions aimed at targeting underlying psychological factors.
Activities of Daily Living↗
Endoscopically assisted operative retrieval of parotid stones.
The treatment of large parotid stones remains a problem. We describe a technique in which microendoscopy is used to locate the stone and facilitate its removal. Over a 12-month period, eight patients were treated and seven stones removed successfully. The remaining duct was obstructed by a stricture. In six instances, the parotid duct was repaired and in two ligated. The mean follow up was 10 months (range 6-18) and there have been no complications. Our initial experience suggests that microendoscopy to locate the stone and facilitate its removal is an option in the management of persistent parotid stones.
Adult↗
Association between polymorphisms of the GPX1 gene and second primary tumours after index squamous cell cancer of the head and neck.
We investigated the association between genetic polymorphisms in GPX1 gene amongst patients who had index squamous cell carcinoma (SCCHN) and a second primary tumour (SPT) after a primary SCCHN in a case-control study. GPX1 genotypes were determined for 61 patients with SPT and for 259 control subjects by a PCR technique using a fluorescent-labelled primer. Analysis was by an ABI automated fluorescent sequencer. The associations between specific genotypes and the development of SPT were examined by logistic regression. A significant difference was found between the control group and the SPT cases in allele frequencies of GPX1 ALA( *)6 and ALA( *)7 (p(trend)=0.04). These results suggest that polymorphisms in the GPX1 gene may be a marker for SPT development and further studies are indicated.
Adult↗
Are psycho-social and behavioural factors related to health related-quality of life in patients with head and neck cancer? A systematic review.
The survival rate in advanced cancer of the head and neck has remained at approximately 50%, and efforts are now directed towards reducing the impact of the disease and its treatment in terms of functioning and health related-quality of life (HR-QoL). Factors such as stage, site of disease and type of treatment all impact on HR-QoL, but it is unclear what additional factors influence HR-QoL. A systematic review was undertaken of studies that have investigated psycho-social or behavioural factors associated with HR-QoL in this patient group. Literature was systematically searched using electronic databases and hand-searching relevant journals. Data were sought on HR-QoL and studies were only included if the measurement instrument was recognised as a reliable and valid measure of HR-QoL. Studies had to include at least one psycho-social or behavioural predictor variable. Sixteen studies fulfilling the inclusion criteria were identified and reviewed. Five main factors were associated with varying degrees with HR-QoL, personality, social support, satisfaction with consultation and information, behavioural factors, such as consuming alcohol and smoking, and depressive symptoms. The major difficulty with synthesising the findings was the amount of different indices of QoL that have been used. However, a number of psycho-social factors have been investigated in relation to HR-QoL in head and neck cancer patients, some of which are potentially modifiable, such as those related to informational needs. Further research is needed to investigate other psychological factors which may influence aspects of HR-QoL. By understanding the relationship between HR-QoL and potentially modifiable variables, interventions can be designed with the aim of improving a patient's long-term well-being.
Alcohol Drinking↗
Image-guided navigation in oral and maxillofacial surgery.
Image-guided surgery is the logical extension of imaging as it integrates previously acquired radiological or nuclear medicine images with the operative field. In conventional image-guided surgery, a surgeon uses a surgical instrument or a pointer to establish correspondence between features in the preoperative images and the surgical scene. This is not ideal because the surgeon has to look away from the operative field to view the data. Augmented reality guidance systems offer a solution to this problem but are limited by deformation of soft tissues. Real-time intraoperative imaging offers a potential solution but is currently only experimental. The additional precision and confidence that this technology provides make it a useful tool, and recent advances in image-guided surgery offer new opportunities in the field of oral and maxillofacial surgery. Here, we review the development, current technologies, and applications of image-guided surgery and illustrate them with two case reports.
Adult↗
Modern management of salivary calculi.
BACKGROUND: The aim was to investigate the results of a minimally invasive approach to the management of salivary calculi. METHODS: Four hundred and fifty-five salivary calculi (323 submandibular and 132 parotid) were treated using extracorporeal shock-wave lithotripsy (ECSWL), fluoroscopically guided basket retrieval or intraoral stone removal under general anaesthesia. The techniques were used either alone or in combination. RESULTS: ECSWL achieved complete success (stone and symptom free) in 87 (39.4 percent) of 221 patients (84 of 218 primary and all of three secondary procedures; 43 of 131 submandibular, 44 of 90 parotid). Basket retrieval cured 124 (74.7 percent) of 166 patients (103 of 136 primary and 21 of 30 secondary procedures; 80 of 109 submandibular, 44 of 57 parotid). Intraoral surgical removal was successful in a further 137 (95.8 percent) of 143 patients with submandibular stones (99 of 101 primary, 36 of 38 secondary and two of four tertiary procedures). The overall success rate for the three techniques was 348 (76.5 percent) of 455. CONCLUSION: A minimally invasive approach to the management of salivary calculi is to be encouraged. All three techniques described have low morbidity and afford the possibility of retaining a functional gland.
Adolescent↗
Delay in diagnosis and its effect on outcome in head and neck cancer.
We examined the records of two cohorts of patients who were seen from 1960 to 1999 with a diagnosis of squamous cell carcinoma (SCC) of the mouth and throat, one series being retrospective (n=400) and the other prospective (n=213) to find out about delays in diagnosis. The median delay in both cohorts was 3 months and the patients were responsible for the delay in most cases (n=319, 81% and n=160, 78%, respectively). Half the patients in each cohort had delayed diagnoses (n=217, 54% and n=119, 56%, respectively) and similar percentages (n=110, 53% and n=172, 47%) presented with advanced disease (stage III or IV). These were not the same patients for there was no correlation between delay and stage or survival. Logistic regression analysis showed that non-white race (p=0.01) and high-grade histology (p=0.002) predicted advanced disease. The proportion of patients presenting with advanced disease had not changed in 40 years despite public education. We suggest that some tumours may be silent and that initial symptoms do not reliably predict early disease.
Adolescent↗
A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars.
We randomised 128 patients who required operations on mandibular third molars and who had radiological evidence of proximity of the third molar to the canal of the inferior alveolar nerve to one of two operations: extraction [n=102], and coronectomy [n=94]. Some roots were dislodged during intended coronectomy and were therefore removed, resulting in two subgroups (successful coronectomy n=58, and failed coronectomy n=36). The mean (S.D.) follow up was 25 (13) months. Nineteen nerves were damaged (19%) after extraction, none after successful coronectomy, and three (8%) after failed coronectomy (p=0.01). The incidence of dry socket infection was similar in the three groups (10/102, 10%, 7/58, 12%, and 4/36, 11%, respectively). No root required removal or reoperation. To our knowledge this is the first clinical trial of the efficacy of coronectomy in preserving the inferior alveolar nerve. The length of follow up was about 2 years, which for the assessment of delayed eruption of the root fragments is not sufficient as this process may continue for up to 10 years. However, it seems that coronectomy reduces the incidence of injury to the inferior alveolar nerve without increasing the risk of dry socket or infection.
Adult↗
Objective evaluation of iatrogenic lingual nerve injuries using the jaw-opening reflex.
The extent of reflex inhibition of masseteric electromyographic activity, after an electrical stimulus applied to lingual mucosa, was used as a test of the ability of the lingual nerve to conduct nerve impulses and this was compared with the results of standard clinical tests. Two groups of subjects were assessed: healthy subjects (n=10) and patients with lingual nerve injuries (n=17). The patients were tested 8-9 weeks after their injury and retested 6 months later when they were retrospectively allocated to either a temporary injury or a permanent injury group. The group measure of reflex inhibition after stimulation of the tongue on the opposite side to the injury was no different from the same measure in controls, whereas two-point discrimination did differ. Group measures of inhibition and of subjective function after stimulation on the side of the injury were significantly different from controls whereas light touch and two-point discrimination were not. There was good agreement between quantified masseteric inhibition and subjective function, but it was not possible at 8-9 weeks after the injury to differentiate between those that would recover and those that would be permanent.
Adult↗
New method for the objective evaluation of injury to the lingual nerve after operation on third molars.
Existing tests of function of the lingual nerve are either subjective or, when they elicit the jaw-opening reflex, are dependent on the cooperation of the subject. We report a study in 12 healthy volunteers and 12 patients with iatrogenic injury to the lingual nerve. A bite block (containing stimulating electrodes) was held between the teeth and the tongue was held on to the electrodes by suction. When the lingual nerve was intact, an electrical stimulus elicited brief inhibition of masseteric electromyographic activity. Local analgesia and iatrogenic injury to the lingual nerve altered nerve conduction and caused a reduction in reflex inhibition. Two methods, compatible with limited numbers of applications of the stimulus, were used to quantify responses. One used an indirect measurement of intervals between action potentials of muscle and the other used a measurement of rectified signals falling below the mean amplitude before and after the stimulus. Both methods gave values that correlated with subjective sensations. The first gave an estimate of the probability of defining major malfunction of the nerve objectively; the second gave a linear measurement that allowed recovery of the nerve to be followed.
Action Potentials↗
Wilfred Batten Lewis Trotter 1872-1939.
The general surgeon, Wilfred Trotter (1872-1939), earned a reputation for his advances in head and neck surgery and his important contribution to the founding concepts of bio-sociology. He pioneered an operation for resection of tumours of the oropharynx, which he published in 1920. He also recognised the importance of total excision of tumours regardless of anatomical boundaries. At a time when antibiotics were not available, Trotter advocated extraction of all teeth before operations and relied on elective tracheostomy to secure the airway and to reduce infection, of both the lungs and tissues of the neck. He persevered with surgery at a time when the introduction of radiotherapy was completely altering the management of head and neck cancers. Unfortunately he did not publish his results, but nevertheless, made an important contribution to the subject of pharyngeal cancer.
General Surgery↗
Positron emission tomography (PET) in the management of oro-pharyngeal cancer.
AIMS: To investigate the specific role of FDG-PET in the management of head and neck cancer patients. METHODS: In a retrospective study, 112 patients with head and neck cancer treated over a 5-year period had FDG-PET scans. The image of the tumour (local, regional and distant) was compared to, clinical, CT/MRI examination, pathological findings and the clinical course of the disease. RESULTS: FDG-PET correctly identified 95.3% of primary lesions, and 94.1% of the recurrences at the primary site. FDG-PET data was supportive of intended treatment in 31 cases and sufficient to alter the management of seven patients. CONCLUSIONS: Overall FDG-PET has a useful role in the diagnosis of head and neck cancers, and in the demonstration of occult or hidden tumours, distant and metastatic disease.
Adult↗
Surgical release of a stone from the hilum of the submandibular gland: a technique note.
A minimally invasive surgical technique using an intra-oral approach for release of salivary stones from the proximal submandibular duct and hilum is described in detail. The different surgical steps are illustrated.
Equipment Design↗