Primary oral squamous cell carcinoma: a review of 92 cases.

PURPOSE: This is a retrospective review of 92 cases of oral squamous cell carcinoma treated by one department of oral and maxillofacial surgery. PATIENTS AND METHODS: The medical records of 92 patients with oral squamous cell carcinoma were reviewed, and standard epidemiologic data were obtained. In addition, cases were identified as to site, stage, risk behavior, histologic classification, primary and secondary surgical treatment, adjunctive therapy, and survival rates. RESULTS: The results indicate a higher-than-predicted 2-year survival rate. The association between alcohol and tobacco consumption and incidence of disease is supported. There was a correlation between tumor size and survival rate, but no correlation between histologic classification and prognosis. CONCLUSION: Mortality increases in relation to the stage at which the diagnosis of oral squamous cell carcinoma is made. Patients with stage III or IV lesions have a much poorer prognosis than those with stage I or II lesions. However, histologic classification and prognosis were not correlated.

Considerations in the management of maxillofacial infections in the pregnant patient.

PURPOSE: The pregnant patient who presents with a maxillofacial infection requires additional management considerations. The maternal-fetal unit requires particular attention to maintain fetal viability, assure a normal pregnancy, and obtain a desirable outcome. The purpose of this article is to inform the oral and maxillofacial surgeon of the clinically relevant material that one needs to understand and consider when treating maxillofacial infections in this particular patient population.

The training and surgical scope of oral and maxillofacial surgeons: the International Survey 1994.

In 1992, the International Association of Oral and Maxillofacial Surgeons (IAOMS) published its training guidelines document. The following survey was conducted to determine the current status of the training and scope of practice of oral and maxillofacial surgeons (OMS) worldwide. Currently, 55% of OMS practice with a single degree, predominantly a dental degree (DDS), while only 16% of the responding countries require dual qualification (MD, DDS). There is a trend toward the dual degree (MD, DDS) in the remaining 29%. In general, in those countries where dual qualification is mandatory, the scope is broadest; however, the scope in a number of countries in which surgeons practice with only the DDS degree - for example, Japan - is equally broad. This baseline information will be used to monitor the growth and development of the speciality in the future.

Intraoperative life-threatening emphysema associated with endotracheal intubation and air insufflation devices: report of two cases.

Two cases of life-threatening body emphysema with decompensating pneumothoraces, pneumomediastinum, and pneumopericardium intraoperatively have been presented. The most likely cause was tracheal perforation combined with high pressure ventilation. Although subcutaneous emphysema and pneumomediastinum are self-limiting conditions with rapid recovery with conservative treatment, life-threatening complications may arise requiring prompt recognition and specific surgical management in order to save the patient's life.

Prosthodontic and surgical considerations for pediatric patients requiring maxillectomy.

The quality of treatment and rehabilitation for the head and neck cancer patient, especially the pediatric patient, has progressed markedly over the years due to the cooperation of specialists involved in the total care of the patient. Defects of the oral cavity caused by trauma or removal of malignant or benign tissue require special treatment considerations with the pediatric patient. Aside from radiation and chemotherapy, other forms of adjuvant therapy, such as physical therapy, and patient and family counseling, are needed for proper rehabilitation. In addition, oral hygiene is essential in the overall rehabilitative process. Pediatric dental, orthodontic, prosthodontic, and oral and maxillofacial surgery specialties become integrated in treating the pediatric patient. The concentrated multidisciplinary treatment reduces post-treatment morbidity by shortening recovery and immediate rehabilitation time and by providing long-term care during the critical growth period.

Management of maxillofacial infections: a review of 50 cases.

Maxillofacial infections often place the oral and maxillofacial surgeon in situations where timely decisions have to be made. These decisions can be life-saving. This study reviews 50 infections treated over a 3-year period. The results reveal rapid resolution of the infections by adhering to fundamental principles in their management: recognition of airway compromise, surgical intervention, and the administration of the appropriate antibiotic. A protocol for the management of maxillofacial infections is described.

A survey of oral and maxillofacial surgeons concerning their knowledge, beliefs, attitudes, and behavior relative to parameters of care.

In December 1990, a survey was sent to 1,296 randomly selected members of the American Association of Oral and Maxillofacial Surgeons (AAOMS) to determine their previous experience with standards and criteria of care, their type of practice, the educational methods that influence their professional decisions, and their attitudes about the development and use of parameters of care. A 55.7% response was obtained. This article reports the results of this survey. The average age of responding surgeons was 45 years and they had been in practice an average of 15 years. The majority were in private practice, had hospital staff privileges, worked between 31 and 55 hours per week, spent 90% of their working week in direct patient care, and devoted an average of 9.16 hours per month to professional affairs outside of their practice. Forty-two percent (42%) of the practitioners were in solo practice, whereas 50% practiced in groups. Surgeons concentrated 65% of their patient care time on dentoalveolar surgery and a significant number planned increases in practice activity in implant, orthognathic, and temporomandibular joint surgery. They learned new clinical skills in various ways, there being a difference between the most convenient and effective methods of learning. A majority of surgeons had been involved with quality assurance activities in the past 5 years. They were predominantly favorable to parameters now and when they first learned about them, but few thought they had a clear understanding about how parameters of care would be used.(ABSTRACT TRUNCATED AT 250 WORDS)

Multicenter clinical trial of ibuprofen and acetaminophen in the treatment of postoperative dental pain.

Pharmacological management of pain for acute and chronic conditions has been guided by a scientific understanding of peripheral and central acting mechanisms for the control of inflammation as well as pain. Oral surgery pain is a reliable model to reference the effectiveness of commonly used analgesics such as ibuprofen and acetaminophen. A total of 706 patients who were experiencing moderate to severe pain received a single dose of ibuprofen, acetaminophen, or placebo. After 6 hours, the degree of pain relief and tolerance was assessed. Ibuprofen has important implications for postoperative pain in clinical practice.

Technical considerations in mandibular ridge reconstruction with collagen/hydroxylapatite implants.

A surgical technique for placement of a collagen-hydroxylapatite implant to augment severely atrophic mandibles is described.

Temporomandibular joint dysfunction in infancy.

Temporomandibular joint (TMJ) dysfunction describes a pain-dysfunction phenomenon that usually afflicts persons in their 4th or 5th decade. The syndrome can be produced by a variety of etiologic factors including occlusal disharmony, articular disorders, and muscle imbalance. It may cause severe otalgia and refer pain to the temple, occiput, nape of neck, and shoulders. Often, associated joint clicking or popping, aural fullness, vertigo, tinnitus, subjective hypoacusis, and nausea occur. As it has not been previously reported in infants, we would like to describe our experience with this disorder in an 11-month-old boy who was referred to our clinic with a presumed diagnosis of otitis media. The embryology of the temporomandibular joint is reviewed and appropriate treatment with anti-inflammatory analgesics, warm compresses, orthodontics, and external brace appliances is discussed. Because of referral patterns in the infant age group, the pediatric otolaryngologist should be similar with this entity and its presentation in children.