ABSTRACT
To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma. Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non-smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded. Of the study population (Nâ¯=â¯287), 24.4% were NSND and 9.75% were NSND elderly (older than 70â¯years) females. >50% of tumours arose from the oral tongue in NSND patients (pâ¯=â¯0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, pâ¯=â¯0.005). Disease specific survival at 5â¯years was significantly reduced when NSND elderly females were compared to all other patients (pâ¯<â¯0.001) as well as age matched controls (pâ¯=â¯0.006). This effect was verified independently in each cohort.The results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes.
Subject(s)
Mouth Neoplasms/mortality , Neoplasm Recurrence, Local/epidemiology , Squamous Cell Carcinoma of Head and Neck/mortality , Age Distribution , Age Factors , Aged , Aged, 80 and over , Alcohol Abstinence/statistics & numerical data , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mouth Neoplasms/therapy , Neck Dissection , Non-Smokers/statistics & numerical data , Radiotherapy, Adjuvant/methods , Retrospective Studies , Risk Factors , Sex Factors , Squamous Cell Carcinoma of Head and Neck/therapy , Survival Analysis , Treatment OutcomeABSTRACT
Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non-specialist management of traumatic injuries of the orbit and facial skeleton.
Subject(s)
Emergency Medicine/methods , Eye Injuries , Maxillofacial Injuries , Orbit/injuries , Airway Obstruction/etiology , Australia , Eye Injuries/diagnosis , Eye Injuries/therapy , Fractures, Bone/diagnosis , Fractures, Bone/therapy , Humans , Maxillofacial Injuries/complications , Maxillofacial Injuries/diagnosis , Maxillofacial Injuries/therapyABSTRACT
Oral pain and odontogenic infections are common reasons for patients to present to EDs and general medical practice in Australia. Although most odontogenic infections can be managed on an outpatient basis, because of their proximity to the airway, infections in this region can be life threatening, requiring urgent surgical intervention and ICU management. This article focuses on the emergency assessment, triage and non-specialist management of oral pain and odontogenic infections.
Subject(s)
Emergency Medical Services , Pain Management/methods , Tooth Diseases , Australia , Humans , Maxillary Diseases/diagnosis , Maxillary Diseases/etiology , Maxillary Diseases/therapy , Tooth Diseases/diagnosis , Tooth Diseases/etiology , Tooth Diseases/therapy , Toothache/diagnosis , Toothache/therapyABSTRACT
Dentoalveolar trauma and dislocations of the temporomandibular joint are common reasons for patients to present to EDs in Australia. The majority of medical practitioners receive very little formal training in the management of these injuries and might not have ready access to dental services out of hours for advice. This article focuses on the emergency assessment, triage and non-specialist management of dentoalveolar trauma and injuries to the temporomandibular joint.
Subject(s)
Emergency Service, Hospital , Facial Injuries , Temporomandibular Joint/injuries , Tooth Injuries , Emergencies , Facial Injuries/diagnosis , Facial Injuries/therapy , Humans , Soft Tissue Injuries/diagnosis , Soft Tissue Injuries/therapy , Tooth Avulsion/diagnosis , Tooth Avulsion/therapy , Tooth Injuries/diagnosis , Tooth Injuries/therapy , TriageABSTRACT
PURPOSE: To assess clinical behavior, response to treatment, and factors affecting survival in maxillofacial osteosarcoma treated at a tertiary referral center. PATIENTS AND METHODS: Ethics-approved retrospective review of clinical and pathological records was undertaken for 15 patients managed by the Royal Melbourne Hospital Head and Neck Oncology Tumor Stream. RESULTS: Treatment was a combination of surgery and chemotherapy. Chemotherapy was given as adjuvant, neoadjuvant, or in combination. The overall 2-, 5-, and 15-year disease-free survival rates in this study were 92%, 74%, and 74%, respectively. Using Kaplan-Meier analysis with log rank tests, increasing T stage (P = .01) and positive margins (P = .003) were found to affect survival significantly. Neoadjuvant chemotherapy was not significantly associated with tumor necrosis or improved survival. CONCLUSIONS: Tumor size and adequacy of local control were found to be the most important predictors of outcome.
