Stress, Professional Burnout, and Employee Efficiency in the Greek National Organization for the Provision of Health Services.

BACKGROUND: Workplace stress and burnout in the Greek healthcare system had been considered severe even before the high pressure of the COVID-19 pandemic. We aimed to investigate occupational quality of life and burnout effects on workplace errors among the administrative staff in the Greek healthcare system. METHODS: We enrolled 120 administrative healthcare employee participants between April and May 2019. Occupational burnout was assessed using the Maslach Burnout Inventory-Human Services Survey and the Hospital Anxiety and Depression Scale. FINDINGS: Inadequate staffing, a low sense of well-being, exhaustion, and low family income were associated with workplace errors. Increased workload and staff shortages were associated with occupation related quality of life. CONCLUSIONS: Targeted interventions supporting healthcare staff mental health are warranted. APPLICATION TO PRACTICE: Wellness and professional burnout can affect professional efficiency and are associated with workplace errors in the healthcare sector. Targeted interventions are warranted to support the mental health of healthcare staff during work and to prevent incidents of post-traumatic stress. Shortages of staffing may lead to an increase in the cost of the provided services.

Myxoma of the upper lip: a case report and brief review of the literature.

Myxomas are rare neoplasms of mesenchymal origin, which consist of many undifferentiated stellate and spindle-shaped cells in abundant loose myxoid stroma with collagen fibers. A 74-year-old patient presented in our oral and maxillofacial department with a slow growing mass within the upper lip. The mass was surgically excised in the toto, followed by a histological and immunohistochemical examination. The findings revealed that it was a myxoma. These tumors are very rare and should be included in the differential diagnosis of damage of the upper lip. As long as the myxoma is properly removed, there is no risk of recurrence.

Displacement of maxillary third molar into the infratemporal fossa. A case report.

Our study aims to present a new case of maxillary third molar dislodgement into the infratemporal fossa during the effort of extraction and the surgical approach performed to retrieve the tooth. Guidelines to prevent this complication are presented. We describe a new case of maxillary third molar displacement into the infratemporal fossa following an unsuccessful surgical procedure of tooth removal by a general dentist. The location of the displaced tooth was confirmed with computed tomography (CT) scanning with a 3D reconstruction. The tooth was removed under general anesthesia through an intraoral approach. It took less than 10 min for the whole procedure to be accomplished. CT examination is of paramount importance to precisely locate the dislodged tooth. Removal can be successfully accomplished via an intraoral approach with meticulous manipulations. An incision of adequate length and a long Langebeck retractor are valuable to ensure a wide surgical field.

The aid of microsurgical instruments in nasolabial cyst enucleation. A report of two cases with critical review of the therapeutic approach.

Nasolabial cysts are rare non-odontogenic cysts related to epithelial remnants of the nasolacrimal duct, slowly enlarging and provoking extraoral swelling in the nasolabial fold with obstruction of the naris. Two patients of large unilateral nasolabial cysts are reported, appearing as cosmetically unappealing distention of the nasolabial fold. Diagnosis is based on clinical characteristics. Computed tomography imaging reveals the dimensions of the cyst, the correlation to the nasal cavity and might depict a depression on the labial surface of the maxilla. Intraoral surgical enucleation of the cystic wall or nasal marsupialization is the main treatment modalities. However, both procedures are related to a small percentage of recurrence. Microsurgical instruments were used to dissect the cystic wall from the nasal mucosa. The aim of this paper is to stress the implementation of microsurgical instruments to separate the cystic wall of the nasolabial cyst from the thin and friable nasal mucosa to avoid recurrence.

Remodelling of the superficial vascular network of skin flaps in rats, following a vasodilatory cream application, before elevation.

Flap necrosis on random pattern skin flaps continues to be a challenge. In this study, we evaluated whether topical application of a vasodilator substance (the prostaglandin PGI2 analogue, Iloprost®, in cream form) as pre-treatment, would increase blood flow and improve flap viability. Wistar rats randomly allocated into four groups with 7 rats per group and two flaps 4cm × 2cm in the same rat i.e. 56 flaps were developed. Flaps on the wright side received pre-treatment with Cream in different drug concentrations, 2.5µgr/gr, 5 µgr/gr, and 10µgr/gr and 20 µgr/gr containing the active factor Iloprost®® ZK 36,374(M. W 360.5) prepared with white petrolatum as a base. Flaps on the left side received placebo cream (white petrolatum). After 10 days of flap pre-treatment, evaluation of blood flow by laser Doppler flowmetry (LDF) were recorded, then flap elevation and re suturing back were performed. After 7 days we estimated flap viability on digital imaging and the percentages of flap survival estimated. Means and standard deviations were used to describe blood flow measurements and survival percentages. The significance was set at 0.05 in all cases and the analysis were carried out with the use of the SPSS v23.0. Furthermore, we performed dynamic analyses of circulation using the radioisotope 99mTc which confirmed hyperaemia of the treated areas relative to that observed in control areas. These findings demonstrated that pretreatment of skin flaps with Iloprost® cream for 10 days prior to elevation increased blood flow in the flap and improved their overall survival rate.

Quality of Life in Oral Cancer Patients in Greek Clinical Practice: A Cohort Study.

Cancer of the oral cavity is one of the most common cancers all over the world. Oral cancer and its treatment impacts on patients' Quality of Life (QOL). The purpose of the present study was to assess oral cancer patients' QOL after the completion of surgical therapy, and to investigate factors affecting it. This was a prospective cohort study, conducted at the Department of Oral & Maxillofacial Surgery, of a large general public hospital in Northern Greece. The sample consisted of 135 consecutive eligible cancer patients. Three distinct questionnaires were used. The first one included questions regarding the participants' demographic characteristics and relevant clinical information. The second comprised the European Organization for Research and Treatment core module (EORTC QLQ-C30) and its head and neck module EORTC QLQ-H&N35. The third was the Functional Assessment of Cancer Therapy-General (FACT-G) assessment of quality of life. We also included the physician-completed Karnofsky scale to assess the functional status of the participants. We found that location of the tumor affects QOL and specifically social contact (H = 17.89, p = 0.001), on the first assessment, and nutritional supplements (H = 22.49, p = 0.000), on the fourth assessment. QOL in patients deteriorates immediately after treatment but significantly improves over time. Health care professionals should take into account these results and arrange care plans in order to find ways to increase patients' QOL.

The significance of double mandibular osteotomy for surgical treatment of large aneurysm of internal carotid artery above mandibular angle. A case report and literature review.

The aim of this study is to report a case of an unusual large aneurysm of the internal carotid approached with a doubly mandibular osteotomy in order to prove the significance and the excellent result of the specified surgical procedure because of the cooperation of maxillofacial and vascular surgeons. The double mandibular osteotomy is described, as well as the bypass of the aneurysm and the anastomosis of the peripheral edges of the artery. The double mandibular osteotomy can deliver the internal carotid artery from the bifurcation to its entrance to the skull base through the carotid canal and can offer the opportunity to the vascular surgeon to perform the anastomosis easily, quickly and safely.

Foreign Bodies of Dental Iatrogenic Origin Displaced in the Maxillary Sinus - A Safety and Efficacy Analysis of a Retrospective Study.

Introduction: Foreign bodies (FB) of the paranasal sinuses are an uncommon clinical entities with the maxillary sinuses being those most frequently affected. According to the literature, 60% of paranasal sinus FB are of iatrogenic origin, while 25% are of traumatic origin. This article aims to present an iatrogenic origin series of cases of FB displaced or projecting into the maxillary sinus. Materials and Methods: In this retrospective study, the presence of the foreign body was revealed with radiologic methods and confirmed during the operation with macroscopic or later with histopathologic examination. All cases were treated with osteoplasty with vascularised pedicled bone flap or through minimally invasive intraoral procedure. Results: A total of 27 patients were included in our study, 14 men and 13 women. The age range was 18-65 years with mean age of 46.14 (standard deviation = 10.35) years. Foreign body was displaced fragments of teeth in 11 patients (40.27%), complete teeth in four patients (14.81%), dental implants in five patients (18.51%), dental impression material in 2 cases (7,40%), gutta percha cone in two patients (7.40%), endodontic sealer associated with aspergillosis in two patients (7.40%), and dental burr in one patient (3.7%). The time between dental foreign body displacement and the surgical intervention for its removal was critical for the occurrence of sinusitis. All operated patients remained asymptomatic during a follow-up of at least 1 year. Discussion: Prompt intervention for removal of FB eliminates the risk for chronic inflammation of the affected maxillary sinus and reduces the odds for sequelae.

Peripheral Osteoma of the Mandibular Condyle-Case Series.

The purpose of this article is to present four new cases of peripheral osteoma of the mandibular condyle and the literature review. A retrospective study of files from our Department of Oral and Maxillofacial Surgery over the last 6 years revealed four cases of peripheral osteomas located in the area of the mandibular condyle. Diagnostic procedure included clinical, radiographic, and histologic criteria. Gardner's syndrome was excluded from patient history and clinical evaluation. One patient had only an aesthetic disturbance, with facial swelling, and the other three patients presented disturbances of the mandibular function, including deviation during mouth opening along with malocclusion. Three of the patients were male and one was female; all were of middle age (45-65 years old). The proposed surgical treatment was accepted by half of the patients, while the remaining half declined the operation after a confirmation of the diagnosis. Peripheral osteomas of the maxillofacial region are uncommon, and some cases with multiple osteomas are related to Gardner's syndrome. An osteoma of the mandibular condyle is very rare and surgical treatment is challenging for the surgeon with regards to the approach selection and the related complications. In the two cases that accepted the proposed surgical treatment, no recurrence and no complication was observed.

Ten-year developmental-evolution of a solitary osteoma of the mandibular ramus: Report of a case and short review.

Osteomas of the maxilla and the mandible are rare, benign, and slow-growing tumors arising from the bone cells. They are more frequently located on the mandible than the maxilla, with mandibular body, angle, and condyle being more frequently affected. The development of a peripheral osteoma at the mandibular ramus is a rare occurrence, and few cases have been published in English literature. Even though the developmental process of this pathologic entity is characterized as slow growing, little data are known about the developmental rate of the peripheral osteomas of the mandible. In our paper, we present a case of peripheral osteoma of the external surface of the right mandibular ramus that was diagnosed 10 years earlier; its dimensions were measured precisely at that time with CT. The patient declined a surgical operation, and 10 years after the initial diagnosis, she visited our department with an increase in the size of the lesion and asked for a re-evaluation. A new CBCT was performed, and accurate measurement of the new dimensions of the lesion was conducted; this was compared with the previous dimensions. The comparison of the current CBCT with the CT performed 10 years earlier permitted to calculate the growth rate of osteoma that was approximately 2.0 mm/year.

An Endoscopic-Assisted Open Removal of a Retained Foreign Body From Frontal Sinus.

Facial penetrating injuries can cause retention of foreign bodies in the frontal sinus. This rare condition can remain underdiagnosed for years, since non-specific symptoms, such as headaches and nasal obstruction, can be developed. So far, removal by an endoscopic approach is the most preferred treatment option because it is less invasive with a short recovery time. However, removal by an open surgical approach remains the method of choice for large foreign bodies, especially in cases of coexistent non-reducible fractures of the anterior table of the frontal bone. We present a case where a combined approach - open and endoscopic - was necessary to successfully remove a retained foreign body from a frontal sinus. With the assistance of a transnasal endoscope, the retained stone was mobilized and removed from the open frontal sinus followed by osteosynthesis of the anterior table. Therefore, in special circumstances, a combination of both techniques should be considered for the optimal outcome.

The Value of Three-Dimensional Modeling on Repositioning and Soft Tissue Filling in Microsurgical Reconstruction of Secondary Mandibular Defects: A Retrospective Study.

Purpose Secondary mandibular defect reconstruction is a challenging operation. It is performed rather rarely, as in most of the cases a primary reconstruction is preferable. Restoration of function and symmetry, in secondary reconstruction of mandibular defects, requires accurate repositioning of segments and appropriate soft tissue filling. The purpose of this study is to estimate the value of three-dimensional (3D) digital modeling to meet the above requirements, in secondary microsurgical reconstruction of mandibular defects. Methods Five cases of mandibular defects, with various degrees of asymmetry and dysfunction, were restored secondarily, with fibula flaps, after virtual reconstruction on a 3D model derived from their computed tomography, with the utilization of CAD-CAM software. Software reproduced symmetrical 3D models by mirroring the healthy side. Occlusion was restored by fine adjustments on 3D models and finally a reconstruction plate was pre-bent on them, prior to its sterilization for use in surgery. Three out of the five cases received an osteo-cutaneous flap, while in the other two patients, an osseous flap was used. Lower face symmetry, mouth opening, and main patient's complaints were evaluated pre- and postoperatively to assess the value of the 3D modeling. Results All flaps survived. Hematoma occurred in two patients and was resolved after evacuation. In two patients, a fistula observed, was attributed to screw loosening, and treated after a surgical debridement and screw replacement. Intraoral exposure in the posterior part of the fibula flap was recorded in one patient, possibly from wound dehiscence due to tension of the intraoral tissue, and successfully covered with an ipsilateral nasolabial flap. The resulting symmetry and function were satisfactory in all the patients. Conclusion Secondary mandibular defects are often related with cosmetic disfigurement, misalignment of mandibular segments, and mandibular malfunction. For the correction of mandibular continuity, symmetry, and restoration of function, preoperative 3D modeling may be an important tool, according to our results.

Quality of Life in Patients With Tongue Cancer After Surgical Treatment: A 12-Month Prospective Study.

Aim of the study The project assessed the quality of life in post-operative patients with tongue cancer at three-month intervals in the first year after the operation. Material and methods A longitudinal prospective cohort study was conducted in the oral and maxillofacial department of a large public general hospital in northern Greece. Fifty-six patients out of a total of 156 with oral cancer were chosen for the study, who completed distinct quality-of-life surveys (EORTC QLQ-C30, and QLQ Head & Neck Module FACT-G). Results Tumor size correlated negatively with various EORTC QLQ-C30 scores, such as role functioning (p = 0.004) and cognitive functioning (p = 0.007), in the third evaluation. Tumor size correlated positively with subscale problems such as social eating (p = 0.001) and weight loss (p = 0.004) in the QLQ Head & Neck Module. The role functioning subscale (p = 0.003), the pain subscale (p = 0.001), and the speech issues QLQ Head & Neck module subscale (p = 0.003) adversely correlated with cancer stage. Patients who received flap reconstruction significantly differed from those who did not, on the EORTC QLQ-C30 cognitive functioning (U = 139.0, p = 0.006), dyspnea (U = 391.5, p = 0.006), and diarrhea (U = 425.0, p = 0.007) subscales during the third evaluation. Differences were also found in the QLQ-H&N35 subscale of sticky saliva (U = 391.0, p = 0.006). Patients with flap reconstruction did not significantly differ from those with immediate closure after one year. Differences concerned the EORTC QLQ-C30 subscales of cognitive functioning, dyspnea, and diarrhea, and the QLQ Head & Neck Module subscale of sticky saliva on the third assessment. No statistically significant correlations were observed between tumor size and cancer stage in the fourth assessment, but the grade of cancer positively correlated with the EORTC QLQ-C30 subscale of constipation (p = 0.000). Conclusions Our study suggests that quality of life is impaired in patients with tongue cancer who have undergone surgical interventions, particularly within the first month post-operation. However, quality of life is fully restored one year after the surgical excision. Future studies should explore early interventions to help healthcare providers better treat this unique group of patients.

The incidence of nausea and vomiting in cancer patients in Greek clinical practice: A longitudinal study.

AIM OF THE STUDY: To assess nausea and vomiting in cancer patients during two cycles of chemotherapy, and the impact on their quality of life. MATERIAL AND METHODS: A longitudinal study was conducted in an oncology department of a large general public hospital in Northern Greece. The sample consisted of 200 cancer patients. Data were collected with the MASCC-Antiemesis Tool and FACT-G questionnaire and specific demographic and clinical characteristics. RESULTS: In cycle 2, acute vomiting was experienced by 16% of the patients and delayed vomiting by 14%; acute nausea was experienced by 27.5% and delayed nausea by 38%. In cycle 3, acute and delayed vomiting were experienced by 17.5% and 15% of the patients, respectively, acute nausea by 29.5%, and delayed nausea by 36.5%. The comparison of severity in acute vomiting between cycle 2 and cycle 3 yielded a statistically significant (p = 0.003) difference; similar results were obtained in the comparison of severity of acute nausea (p < 0.001). The correlation of severity of acute nausea with physical, emotional, and functional well-being as well as the total score of quality of life in two measurement points was statistically significant (p < 0.005). Multiple forward linear regression analysis showed that the total score of quality of life was significantly associated with age, gender, educational status, occupational status, type of cancer, family status, and diet. CONCLUSIONS: Our study confirms that nausea and vomiting are significant clinical problems that influence quality of life. Further research is needed to evaluate the predictors of acute and delayed nausea and vomiting during chemotherapy.

When a pedodontic examination leads to the diagnosis of osteopetrosis: A case report.

BACKGROUND/AIM: Osteopetrosis is an inherited disease characterized by increased bone density. Its genetic variability results in various phenotype expressions, whereas clinically are classified in three types: malignant infantile, intermediate and adult. The various oral manifestations of the disease give a crucial role to the pediatric dentists in diagnosis. CASE PRESENTATION: A 7-year-old girl with persistent swelling on right cheek visited a pedodontic clinic. After extra- and intra-oral examination/findings, the patient was referred for further investigation concerning a possible general pathological background. An extraction, included in the initial dental treatment plan, led to the diagnosis of osteopetrosis. Various medical examinations co-led to the diagnosis of osteopetrosis but without genetic identification. Extractions of carious teeth, under general anesthesia, and full cover or sealants, on chair, of unaffected teeth were conducted respectively to minimize the microbial load and to prevent from osteomyelitis relapse and new caries. Two more general anesthesia sessions took place due to relapse of lower jaw osteomyelitis. Follow-up was conducted every 3 months for 2 years. CONCLUSION: Osteopetrosis' diagnosis can be triggered by its oral manifestations (rampant caries, osteonecrosis, enamel defects, malformed roots/crowns, missing teeth), for which the pediatric dentist could be the first observer. Management of these patients needs multidisciplinary approach and follow-up appointments should be very frequent.

Risk factors for local recurrence of basal cell carcinoma and cutaneous squamous cell carcinoma of the middle third of the face: a 15-year retrospective analysis based on a single centre.

Non-melanoma skin cancer (NMSC) is the commonest malignancy worldwide (>80% located in the head and neck area). The aim of this study was to assess risk factors predisposing to local recurrence of NMSC of the middle third of the face (MTF). This was a single-centre retrospective analysis of patients with NMSC of the MTF treated during 1995-2010. Data on epidemiological and tumour characteristics were collected. Survival analysis was performed and log-rank tests were used to compare differences in survival for each variable. A total of 531 patients with basal cell carcinoma (BCC) of the MTF were identified. Most tumours were nodular type (28.4%), located on the nose (34.3%), and confined to the dermis (75.5%). Negative margins were achieved in 91% of cases. Median follow-up time was 35 months and 15.2% of patients developed local recurrence. Incomplete excision was the only variable predisposing to local recurrence. The cohort also included 114 patients with squamous cell carcinoma (SCC). Most tumours were well differentiated (43.9%), located at the zygomatic area (49.1%), excised with negative margins (93%), and confined to the dermis (67.8%). At a median follow-up time of 42 months, local recurrence occurred in 15.7% of patients. Tumour size, depth of invasion, and prior history of head and neck SCC were risk factors for local recurrence. The variables predictive of recurrence of BCC were incomplete excision and for SCC tumour size, depth of invasion, and a prior history of head and neck SCC.

Lipoma of Parotid Gland: Report of Two Cases.

INTRODUCTION: Lipoma is a benign mesenchymal tumor originating from adipose tissue cells. In the head and neck, this tumor is not common. The occurrence of lipomas in the parotid gland is extremely rare, ranging between 0.6 and 4%. CASE REPORTS: In this article, we present two clinical cases of lipomas of the superficial lobe of the parotid gland. DISCUSSION: Clinical diagnosis of parotid gland lipomas is difficult, while usually, they are asymptomatic and presented as a painless swelling of the parotid gland. Tomographic imaging modalities are very accurate in preoperative diagnosis in contrast to FNA or FNAB which is not helpful in the case of lipoma. This pathological entity should be considered in the differential diagnosis of parotid gland's mass lesions. The usual indication for surgical intervention is cosmetic appearance. Meticulous surgical excision should be performed to avoid disturbing adverse events.

The use of mineralized bone allograft as a single grafting material in maxillary sinus lifting with severely atrophied alveolar ridge (1-3 mm) and immediately inserted dental implants. A 3- up to 8-year retrospective study.

OBJECTIVE: The primary aim of our study was to evaluate the efficacy of mineralized bone allograft alone in sinus floor augmentation with simultaneous implant placement in cases with severe atrophy of the residual maxillary bone (bone height < 4 mm). METHODS: Thirty-five dental implants were placed in 29 patients who underwent sinus augmentation via traditional lateral window technique from 2008 to 2013. Patients with residual alveolar height between 1 and 3 mm at the site of implantation were included in the study. The height of residual bone was initially estimated by plain panoramic X-ray and reevaluated intraoperatively by precise micrometric measurement at the site of implantation. Implants of 13 mm height and 3.5 or 4.3 mm in diameter were inserted simultaneously. Mineralized bone allograft was used alone to augment the sinus floor. RESULTS: No wound dehiscence was recorded. In one case there was a postoperative site infection which subsided with antibiotics without implant failure. One implant migrated during the postoperative period to the maxillary sinus and was removed. One implant failed. The remaining 33 implants were successfully loaded. Follow-up ranged from 3 to 8 years. CONCLUSIONS: Maxillary sinus lift in severely absorbed alveolar ridges with simultaneous implant placement could be safely performed using mineralized allograft alone, rendering the procedure less invasive and less time-consuming.

Palatal Perforation as a Rare Complication of Nasal Septoplasty.

BACKGROUND: Nasal septoplasty is one of the most commonly performed surgical procedures by otolaryngologists or plastic surgeons and is generally performed to improve the quality of life. Although nasal surgeries are generally safe and effective procedures, various complications have been described in the literature. METHODS: In this article, we present a rare case of fracture of a part of the hard palate resulting in palatal perforation after nasal septoplasty surgery early diagnosed and successfully treated. RESULTS: Patient follow-up 1 year after oronasal closure revealed complete healing of the hard palate without the presence of fistula. CONCLUSIONS: Palatal perforation during septoplasty is extremely rare and, even though it is not a life-threatening complication, has potentially annoying effects; according to its size, it can result in nasal speech, oral health problems, and nasal regurgitation of liquids and is sometimes related with reconstructive challenging problems. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors. www.springer.com/00266 .

Inflammatory myofibroblastic tumour of the maxillary sinus and the oral cavity.

BACKGROUND: Inflammatory myofibroblastic tumours (IMT) are benign lesions that mimic malignant neoplastic processes due to their infiltrating and destructive nature. They can be found anywhere in the body, although they are most commonly located in the lung. IMTs of the head and neck region are rare entities. CASE REPORT: We report a case of a maxillary IMT with an enlarged intraoral component which was adequately treated with surgical excision without long-lasting additional corticosteroid treatment. DISCUSSION: Inflammatory myofibroblastic tumours can be easily misdiagnosed as malignant neoplastic processes due to their destructive nature. Proper diagnosis is essential to avoid mutilating and disfiguring surgical procedures.