Paradigm Change for Intraoperative Surgical Margin Assessment for Oral Squamous Cell Carcinoma.

OBJECTIVE: Achieving clear surgical margins is one of the primary surgical goals in treating oral squamous cell carcinoma (OSCC) and thus aiming to improve overall and disease-specific survival. Therefore, we developed the Goal-Oriented Assessment for Intraoperative Margin ('GAIM') protocol, a novel intraoperative approach for margin assessment, and present here our 5-year experience and outcomes. METHODS: 'GAIM' is a 7-step procedure comprising systematic ruler-aided resection of labeled tumor-bed margins, frozen section (FS) co-produced by both pathologists and operating surgeons, and immediate extension of resection according to FS findings. Data from all patients operated using the 'GAIM' protocol at a single tertiary center between 2018 to 2022 were analyzed, including margin status on FS and final pathology (FP) records, recurrence, and mortality. RESULTS: A total of 196 patients were included, 56.6% (n = 111) stages I-II, and 43.4% (n = 85) stages III-IV. Using the 'GAIM' protocol, we achieved an overall 94.4% of clean and revised clean surgical margins. Patients with a 2-year and longer follow-up (n = 141) had local recurrence in 3.5% when both FS and final margins were clean, 8.1% when FP margins were clean, and 16.7% with close/positive final margins. CONCLUSIONS: The proposed 'GAIM' protocol is a novel, effective, reproducible, and safe approach for margin evaluation that can be systematically applied. It can increase the rate of final clean surgical margins and potentially improve patients' outcomes. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1725-1732, 2024.

Translation, Transcultural Adaptation, and Validation of the Hebrew Language Version of the Orthognathic Quality of Life Questionnaire for the Assessment of Quality of Life in Orthognathic Patients.

INTRODUCTION: Dentofacial deformities impose a negative impact on quality of life (QOL). Orthognathic surgery is the main pillar of treatment for these conditions and has proven its impact on the improvement of the functional and psychosocial aspects of QOL. The Orthognathic Quality of Life Questionnaire (OQLQ), developed by Cunningham and colleagues, is a well-established instrument for assessing QOL in patients with dentofacial deformities. OBJECTIVE: The aim of this study was to perform a translation, transcultural adaptation, and validation of a Hebrew version of the OQLQ. METHODS: Transcultural adaptation was done following guidelines proposed by Beaton and colleagues resulting in a pilot study conducted on 20 patients undergoing orthognathic surgery. Internal consistency, reliability, and sensitivity were evaluated by means of Cronbach alpha, intraclass correlation coefficient (test-retest), and Wilcoxon test, respectively. Validity was assessed by comparing the OQLQ with the Hebrew version of the Oral Health Impact Scale-14 (Oral Health Impact Profile Scale-14) using the Spearman correlation test. RESULTS: Internal consistency showed a good correlation between domains and excellent test-retest reliability. Sensitivity to change was statistically significant in all but 3 questions. The Hebrew version of the OQLQ exhibited a strong correlation with Oral Health Impact Profile Scale-14 in total score and moderate to high correlations among domains. CONCLUSION: The Hebrew version of the OQLQ is a valid and reliable and specific instrument to measure QOL for Hebrew-speaking patients undergoing orthognathic surgery.

Relation between preoperative computed tomographic criteria of injury to the nasofrontal outflow tract and operative findings in fractures of the frontal sinus.

Injury to the nasofrontal outflow tract is important in the treatment of fractures of the frontal sinus. In 2008 preoperative computed tomographic (CT) criteria or signs of such injuries were proposed and stated to be reliable. The aim of this study was to evaluate the validity of these criteria by comparing the radiological evidence with the operative findings. Thirty-nine patients for whom the data from preoperative CT could be compared with operative findings were eligible for the study, all but 4 of whom had at least one indicator of injury to the outflow tract. Patients whose tracts were found to be obstructed at operation had at least 2 preoperative CT signs of obstruction of the tract. If the outflow tract was obstructed all 3 criteria were significantly more likely to be present than if it was intact (p=0.02). Two criteria or fewer did not correlate significantly with obstruction. Fractures were managed by reconstruction (n=18), obliteration (n=11), or cranialisation (n=10). This study is the first to our knowledge to examine the correlation between preoperative CT criteria and operative findings, and there was a significant difference in the number of criteria present depending on whether the outflow tract was intact or injured. Our findings allow for more accurate planning of management of fractures of the frontal sinus.

Prevalence of psychologic, dental, and temporomandibular signs and symptoms among chronic eating disorders patients: a comparative control study.

AIMS: To compare the prevalence of psychologic, dental, and temporomandibular disorder (TMD) signs and symptoms between young women suffering from chronic eating disorders (ED) and a control group of age-matched, healthy women, and to evaluate the impact of frequent vomiting on these signs and symptoms among the ED group. METHODS: Clinical examination and self-administered questionnaires were used to evaluate psychologic, dental, and TMD signs and symptoms among 79 women hospitalized because of chronic ED and 48 age-matched healthy women (as controls). ED patients were further analyzed according to their habit of daily vomiting (43 vomiting versus 36 nonvomiting patients). Pearson chi-square and analysis of variance were used to analyze categorical differences between study groups. RESULTS: Women with ED showed a significantly higher sensitivity to muscle palpation (P < .001) and higher levels of depression, somatization, and anxiety (P < .001), as well as a higher prevalence of intensive gum chewing (P < .001), dental erosions (P < .001), and attrition (P < .001), than the healthy controls. Vomiting patients showed higher muscle sensitivity to palpation than nonvomiting patients (P < .001) and greater emotional and psychologic distress (P < .001). CONCLUSION: Women with chronic ED suffer from higher muscular sensitivity to palpation, greater emotional distress, and more hard tissue destruction (dental erosions, dental sensitivity) than healthy women.

[Etiology of maxillofacial trauma--a 10-year survey at the Chaim Sheba Medical Center, Tel-Hashomer].

BACKGROUND: The management of cranio-maxillofacial trauma includes treatment of facial bone fractures, dentoalveolar trauma, and soft tissue injuries. Integration of several specialties is often needed due to the proximity of the cranial bones to important organs such as the eyeballs, the nose, the ears, and the brain. The epidemiology of facial fractures varies in type, severity, and cause depending on the population studied. The differences between populations in the causes of maxillofacial fractures may be the result of risk factors and cultural differences between countries but are more likely to be influenced by the injury severity. Many epidemiologic investigations of maxillofacial fractures have appeared in the scientific literature over the years. Six main causes of injury were identified: motor vehicle accidents, occupational accidents, sport accidents, falls, assaults, and gun shot wounds. However, few reports, representing continuous long-term data on maxillofacial fractures in the state of Israel, are to be found. AIMS: This study was undertaken to provide information regarding gender, age, etiology and diagnosis of patients with maxillofacial fractures, gleaned from our experience in the last 10 years (1996-2005), and to compare this information to the findings from the years 1985-1995, at the Department of Oral and Maxillofacial Surgery in the Chaim Sheba Medical Center, Tel Hashomer. METHOD: The present study reviews retrospectively hospital records of 775 patients. Data regarding the 753 patients treated at the department in the years 1985-1995 was taken from previous publication. The diagnosis was based on radiographic data and clinical examination. The statistical analysis was carried out by the Statistics Department of Tel Aviv University. RESULTS: The majority of patients (74.2%) were males, the average age was 33.4 years, and the largest subgroup of patients (34%) was in the third decade of life. The most common cause of injury was falls (35%), followed by motor vehicle accidents (29%), and assaults (18%). The most frequent fractures in the male group involved the zygomatic complex (23.4%), followed by the subcondylar area (13.5%). In contrast, the most frequent fractures among females involved the subcondylar area (20.4%) followed by the zygomatic complex (18%). The average age of male patients was 31.2 years, whereas the average age of female patients was 39.6 years. In regard to gender, the first five decades were dominated by male patients, the sixth decade showed an equal distribution, and the females dominated the patient group in the seventh to tenth decades. A rise in the number of patients hospitalized due to falls and assaults, and a decrease in patients hospitalized due to motor vehicle accidents was noted during the years 1996-2005 compared to the years 1985-1995. CONCLUSIONS: Data from the world literature is similar to our findings, as regard to gender and age. Major differences between males and females regarding age, etiology, and diagnosis were found in our study. Nevertheless, the two most common fracture sites among males and females are the Zygomatic complex and the subcondylar area. Apparently, the Israeli society is becoming more violent, whereas the technological improvements, especially in the field of motor vehicle passenger safety, may play an important role in the decrease of upper body injuries.