Management of impacted third molars based on telemedicine: a pilot study.

PURPOSE: The incorporation of new technologies into clinical daily practice is nowadays a fact in the field of medicine. Within these new technologies, telemedicine is turning out to be a working tool that is used with increasing frequency in medical centers. The systems of telemedicine have still not reached the same development in oral and maxillofacial surgery that they have reached in other medical specialties. This study describes the preliminary results of a store-and-forward telemedicine system (SFTMS) aimed at the presurgical management of impacted third molar pathology. MATERIALS AND METHODS: A multicenter, longitudinal, descriptive, evaluative pilot study of an SFTMS aimed at the presurgical management of patients with impacted third molar pathology was conducted at the Oral and Maxillofacial Surgery Unit of Virgen Macarena University Hospital (Seville, Spain) and 4 primary care areas located between 15 and 95 km from the hospital. The study was carried out between January and December 2009. RESULTS: Over a period of 12 months, 97 patients were enrolled in the study, from 102 teleconsultations received and evaluated within the same period. Patients managed through telemedicine were included on the surgical wait list on within a mean interval of 3.33 days (95% confidence interval [CI], 2-4.65 days) since the visit to the primary care dentist, with only 1 visit to the hospital that was on the day of surgery. The mean waiting interval of patients managed through the conventional referral system was 28 days (95% CI, 24.51-29.6 days), with at least 2 visits to the hospital before the final intervention. The on-the-day surgery cancellation rate of the series was 7.8% (95% CI, 3.8%-10.5%) because 8 patients did not have surgery on the scheduled day. The cancellation rate in the sample of patients managed through the conventional system was 8.85% (95% CI, 5.62%-11.81%; P < .005). CONCLUSIONS: The SFTMS was effective and accurate as a preoperative tool for impacted third molar pathology. It avoids unnecessary visits to the hospital and shortens waiting intervals. Further randomized studies are needed, however, to establish real advantages, in clinical and economic terms, against the conventional presurgical management systems.

Manejo del SAHS mediante dispositivos de avance mandibular. Estudio preliminar / Sleep apnea-hypopnea syndrome management using a mandibular advancement device. Preliminary study

El tratamiento que ha demostrado mayor eficacia en los pacientes con síndrome de apneas-hipopneas del sueño (SAHS) es la presión positiva continua de la vía aérea (CPAP). Los mayores inconvenientes son la incomodidad y la sensación de claustrofobia, que en algunos pacientes provoca rechazo o intolerancia. Una alternativa son los dispositivos de avance mandibular (DAM), que insertados en las arcadas dentarias producen el avance de la mandíbula y de la lengua, aumentando el volumen de la vía aérea. Objetivo: Presentar nuestra experiencia en el tratamiento del SAHS mediante dispositivos de avance mandibular tipo Herbst. Metodologia: Estudio de seguimiento prospectivo desde junio de 2006 hasta enero de 2009 de 7 pacientes del Área Hospitalaria Virgen Macarena con SAHS que rechazan el tratamiento con CPAP y a los que se ofrece tratamiento con DAM. Las variables analizadas son: índice de apneas-hipopneas por hora, índice de desaturaciones por hora, intensidad subjetiva del ronquido y el test de somnolencia de Epworth, antes del tratamiento y al menos 6 meses después desde el inicio de su uso. Utilizamos el test de Wilcoxon para detectar diferencias estadísticas significativas (p<0,05). Resultados: Se observó una reducción estadísticamente significativa del índice de apneahipopneas por hora (p<0,018) y del índice de desaturaciones por hora (p<0,018), así como una reducción no significativa del ronquido y de la somnolencia. Conclusiones: El uso de DAM tipo Herbst en pacientes afectos de SAHS que rechazan el uso de la CPAP podría ser útil, mejorando clínica y funcionalmente su situación(AU)

The most effective treatment in patients with sleep apnea-hypopnea syndrome (SAHS) is CPAP (continuous positive airway pressure). The main drawback of CPAP is the discomfort and claustrophobic sensation that it causes, which elicits rejection or intolerance by some patients. A non-surgical alternative to CPAP is the mandibular advancement device (MAD), which consists of a plastic splint inserted between the dental arches to shift the jaw and tongue forward and thus increase airway volume. Objective: Report our experience with the treatment of SAHS using the Herbst mandibular advancement device. Material and method: A prospective follow-up study was carried out from June 2006 until January 2009 at the Virgen Macarena University Hospital with 7 patients with SAHS who refused treatment with CPAP and were treated with the mandibular advancement device. The outcome variables analyzed were: apnea-hypopnea disruptions per hour index, desaturations per hour index, subjective intensity of snoring, and the Epworth Sleepiness Scale. Variables were evaluated pre-treatment and at least once 6 months after initiation MAD use. The Wilcoxon test for paired samples was used to detect statistically significant differences (p<0.05). Results: A statistically significant reduction in the hourly indices of apnea-hypopnea disruptions (p<0.018) and desaturations (p<0.018) was observed, as well as a statistically nonsignificant reduction in snoring and sleepiness. Conclusions: Use of the Herbst mandibular advancement device in patients with obstructive sleep apnea syndrome who refuse CPAP may be helpful as it improves the clinical and functional parameters of the condition(AU)

Quality of life in long-term oral cancer survivors: a comparison with Spanish general population norms.

PURPOSE: Health-related quality-of-life (HRQOL) data are becoming an important supplement to information pertaining to treatment outcomes for cancer patients. The purpose of this study was to evaluate the HRQOL of patients undergoing primary surgery for oral squamous cell carcinoma > or =5 years after treatment compared with the Spanish general population norms. MATERIALS AND METHODS: A total of 50 oral cancer patients (mean age 55.78 years, 80% male) with cancer-free survival of > or =5 years after surgery were enrolled. HRQOL was assessed with a standardized questionnaire: the Medical Outcomes Study Short Form 36-Item Health Survey. RESULTS: The Medical Outcomes Study Short Form 36-Item Health Survey scores of the oral cancer patients did not differ significantly from those of an age- and gender-matched sample from the Spanish normative population, except for the pain and social functioning domains. The patients had significantly better results compared with the population norms (Wilcoxon test, P < .05) in the physical function, general health, and vitality domains. CONCLUSIONS: These results provide patient-reported evidence that oral cancer survivors have a similar HRQOL compared with the general Spanish population. We also believe that it would be necessary to analyze the quality of life > or =5 years after treatment or from the moment the patient was discharged.