Informed consent practices in oral and maxillofacial surgery setups - an audit report.

OBJECTIVE: To evaluate the existing practices of obtaining and documenting informed consent in cases of oral and maxillofacial surgery. METHODS: The cross-sectional study was conducted from April to June 2017 at the Oral and Maxillofacial Surgery departments of five teaching hospitals of Rawalpindi and Islamabad, Pakistan, and comprised patients who underwent surgery under general anaesthesia. Data was collected using questionnaire-based interviews a day after the surgery in each case regarding multiple aspects of the informed consent practices. Data was analysed using SPSS 21. RESULTS: Of the 100 patients, 58(58%) were males and 42(42%) were females, while 81(81%) were adults aged >18 years. In 42(42%) cases, the consent document was signed by the patient, and by a relative in 38(38%) cases. In the remaining 20(20%) cases, only verbal consent was taken. In 54(54%) cases nursing staff and in 46(46%) cases residents took the consent. Most patients were informed about nature of their disease 87(87%), proposed treatment 86(86%) and type of anaesthesia 100(100%). Fewer patients were informed about any alternative treatments 38(38%), and possible complications of the surgery 51(51%) or anaesthesia 26(26%). Overall, 44(44%) patients did not fully understand the written information, and 23(23%) said they were encouraged to ask questions. CONCLUSIONS: The quality of informed consent practices was found to be sub-optimal in oral and maxillofacial surgery setups.

Assessment of complications of the open treatment of mandibular condylar fractures

The objective of our study was to analyze the complications of open treatment of mandibular condylar fractures operated via various surgical approaches. Thirtyeight patients with 42 fracture sides having moderate to severely displaced condylar fractures were studied. Open treatment was performed, and patients were assessed for complications of open treatment in terms of facial nerve paresis, unaesthetic scar, salivary fistula/sialocele. Facial nerve paresis was noted in 13 (31%) cases, mostly transient in nature (n=9, 69.2%), that recovered within 8 weeks. Furthermore, 5 (11.9%) patients had unaesthetic scar formation, while just 1 (2.4%) case of salivary fistula was observed. Facial nerve paresis was the most common complication of open treatment of mandibular condylar fractures and most of them were observed in cases operated by preauricular approach.

Management of Obstructive Sleep Apnea Syndrome Associated with Severe Micrognathia.

Obstructive sleep apnea syndrome (OSAS), commonly associated with mandibular micrognathia, is a serious condition that can lead to various devastating cardiovascular and neurocognitive consequences. Patients of OSAS with micrognathia present with many functional and esthetic problems. Therefore, comprehensive management of these patients requires multiple surgeries and frequent follow-up. Several surgical and non-surgical treatment options have been proposed for the treatment of OSAS. Distraction osteogenesis (DO) in maxillofacial region, although a newer treatment modality, is being increasingly favoured by many surgeons because of its many advantages over other treatment methods. We present comprehensive management of a case of OSAS associated with post temporomandibular joint ankylosis severe micrognathia. Various surgical treatment methods including DO and conventional orthognathic surgical procedures were employed in management of this patient of obstructive sleep apnea. Both functional and esthetic complaints of the patient were addressed, and we achieved exceptional results at the end of treatment.