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1.
J Oral Maxillofac Surg ; 78(7): 1078-1087, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32275900

RESUMO

PURPOSE: We sought to obtain baseline statistics regarding the amount of opioid tablets prescribed by oral and maxillofacial surgeons (OMSs) in the New England area after office-based procedures and to identify factors that might be predictors of their prescription patterns. MATERIALS AND METHODS: An anonymous online survey was e-mailed to practicing OMSs in the New England area. The survey explored the quantity of opioid medications prescribed for various procedures, how opioid precautions were given, practitioners' attitude toward opioid dependency, and whether certain surgeon- or patient-related factors influenced prescription behavior. Statistical analyses were used to categorize the OMSs according to their prescription patterns and to identify the most common factors affecting their decision to prescribe opioids. RESULTS: Of 315 OMSs, 151 (43%) responded to the survey. Our analyses were of complete data obtained from 118 respondents. For procedures, such as extraction of 7 or more teeth, the placement of 4 or more implants, office-based sinus surgery, cortical block grafts, and removal of third molar teeth, respondents indicated they typically prescribed 8 to 12 opioid tablets. For all other procedures, they typically never or rarely prescribed opioid tablets. The respondents were grouped into low-, medium-, and high-quantity opioid prescribers. Regardless of their grouping status, the respondents showed general agreement regarding their roles in reducing opioid prescription-related issues. No group differences were found in terms of the demographic variables. Relative to the factors predicting increased prescribing habits, the results suggested that OMSs working either exclusively or primarily in academic settings tended to prescribe fewer opioid tablets than those working primarily in the private setting (ß = -2.73; P < .001). Additionally, 109 respondents (92.4%) reported that OMSs could play a role in decreasing opioid dependency. CONCLUSIONS: Most practicing OMSs in the New England area prescribed opioids after office-based surgery and are cognizant of the risks of opioid medications.


Assuntos
Analgésicos Opioides , Cirurgiões Bucomaxilofaciais , Humanos , Dente Serotino , Dor Pós-Operatória , Padrões de Prática Odontológica , Padrões de Prática Médica , Inquéritos e Questionários
2.
Head Neck ; 41(9): 2976-2982, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31025799

RESUMO

BACKGROUND: To evaluate recategorization of pT1-3N0 oral tongue cancer, from seventh to eighth editions of the American Joint Committee on Cancer (AJCC) staging classification, and impact on overall survival (OS). METHODS: Using the National Cancer Database, 1277 patients were categorized using tumor size and depth of invasion with seventh and eighth AJCC staging systems and evaluated for OS. RESULTS: Tumor-category was unchanged in 82.9% and upstaged in 17.1% patients with eighth AJCC. The 3-year OS was 85.3%, 76.6%, and 77.0% with seventh AJCC compared to 87.1%, 75.1%, and 81% with eighth AJCC, for patients with pT1N0, pT2N0, and pT3N0 disease, respectively. Improved discrimination of pT1N0 vs pT2N0 for OS on multivariate analysis was seen for eighth AJCC (hazard ratio [HR] = 1.43, 95% confidence interval [CI]: 1.03-1.98, P = .03) but not for patients with pT3N0, with seventh AJCC (HR = 1.02, 95% CI:0.53-1.98, P = .95), and eighth AJCC (HR = 0.86, 95% CI: 0.52-1.42, P = .55). CONCLUSION: Eighth edition AJCC staging leads to improved discrimination of OS between pT1N0 and pT2N0 but not for patients with pT3N0.


Assuntos
Carcinoma de Células Escamosas/patologia , Estadiamento de Neoplasias/normas , Neoplasias da Língua/patologia , Idoso , Carcinoma de Células Escamosas/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias da Língua/mortalidade , Estados Unidos/epidemiologia
3.
J Oral Maxillofac Surg ; 76(3): 656-663, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28886357

RESUMO

PURPOSE: The submental artery island pedicled flap (SMIF) is an underused alternative for reconstruction of head and neck defects after tumor ablation. The purpose of this study was to perform a comparative evaluation of reconstructive outcomes based on surgical site and ablative defect volume in patients who underwent reconstruction with the SMIF versus the forearm free flap (FFF). MATERIALS AND METHODS: A retrospective cohort study of all patients with oral cavity and oropharyngeal defects reconstructed with the SMIF and a cohort of patients with similar volume defects reconstructed with the FFF were compared for oncologic safety and viability of equivalent reconstructive outcomes. All statistical comparisons were assessed by analysis of variance and Fisher exact test. RESULTS: Average age was 61.8 years in the SMIF group versus 57.9 years in the FFF group. The most common defect was located in the tongue, with squamous cell carcinoma being the most common pathology identified. Flap volumes were similar (SMIF, 38.79 cm3; FFF, 39.77 cm3). Significant comparative outcomes identified with SMIF versus FFF reconstruction included shorter anesthesia times (815 vs 1,209 minutes; P < .001), shorter operative times (653 vs 1,031 minutes; P < .001), and less blood loss (223 vs 398 mL; P = .04). Postoperative Eastern Co-operative Oncology Group performance score increased more for the FFF than for the SMIF group (+0.33 vs + 1.25; P = .0019). Recipient site complication rates were lower for the FFF group (0.17 vs 0.42 per patient) but were not statistically relevant. There were equal rates of recurrence at the local surgical site and no differences in speech and swallowing function. Mean follow-up was 15.5 months. CONCLUSIONS: This is the first study to compare the SMIF with the FFF for reconstruction of oral cavity defects based on ablative volume deficit. The SMIF is a viable surgical option compared with the FFF that can be considered oncologically safe in the N0 neck, allowing for an excellent esthetic reconstruction, with decreased operative time, hospital stay, and donor site morbidity.


Assuntos
Retalhos de Tecido Biológico/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/cirurgia , Feminino , Antebraço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Neoplasias Orofaríngeas/cirurgia , Orofaringe/cirurgia , Estudos Retrospectivos
4.
J Craniomaxillofac Surg ; 45(12): 2120-2127, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29126769

RESUMO

BACKGROUND: To determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction. METHODS: A series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson Comorbidity Index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes. RESULTS: Twenty patients developed CC (9.7%) with transient cardiac arrhythmia (6.5%) and myocardial infarction (2.8%) occurring most frequently. Univariate analyses demonstrated significant differences between the two groups in terms of their age, smoking status, occurrence of peripheral vascular disease, CCI, RCRI, length of hospitalization and duration of anesthesia. Multivariate analyses showed that RCRI (p < 0.001) and amount of blood transfused (p = 0.02) were independent predictors of CC. CONCLUSIONS: Cardiac complications are uncommon in head and neck microvascular flap surgery. The RCRI is a useful screening tool for estimating cardiac complication risk and improving patient and flap outcomes.


Assuntos
Doenças Cardiovasculares/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Avaliação de Resultados da Assistência ao Paciente , Procedimentos de Cirurgia Plástica/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
5.
J Craniofac Surg ; 24(3): 992-5, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23714930

RESUMO

BACKGROUND: Access to the frontal sinus remains a challenging problem for the craniofacial surgeon. A wide array of techniques including minimally invasive endoscopic approaches have been described. Here we present our technique using medical modeling to gain fast and safe access for multiple indications. METHODS: Computer-aided surgery involves several distinct phases: planning, modeling, surgery, and evaluation. Computer-aided, precise cutting guides are designed preoperatively and allowed to perfectly outline and then cut the anterior table of the frontal sinus at its junction to the surrounding frontal bone. The outcomes are evaluated by postoperative three-dimensional computed tomography scan. RESULTS: Eight patients sustaining frontal sinus fractures were treated with the aid of medical modeling. Three patients (37.5%) had isolated anterior table fractures, and 4 (50%) had combined anterior and posterior table fractures, whereas 1 patient (12.5%) sustained isolated posterior table fractures. Operative times were significantly shorter using the cutting guides, and fracture reduction was more precise. There was no statistically significant difference in complication rates or overall patient satisfaction. CONCLUSIONS: The surgical approach to the frontal sinus can be made more efficient, safe, and precise when using computer-aided medical modeling to create customized cutting guides.


Assuntos
Algoritmos , Seio Frontal/cirurgia , Fraturas Cranianas/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Feminino , Seio Frontal/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Tomografia Computadorizada por Raios X
6.
Artigo em Inglês | MEDLINE | ID: mdl-16301149

RESUMO

Scurvy is a nondiscriminatory disease process resulting from a nutritional deficiency of ascorbic acid (vitamin C). The severe vitamin deficiency produces a breakdown in the cellular structure of the body. This case report describes a middle-age woman with a history of edema, bruising of the lower extremities, anemia, and severe periodontal disease. Her presentation and medical history are classic for the signs of scurvy. Scurvy is now only uncommonly seen in developed countries, but there are still vulnerable populations whose nutritional status can lead to scurvy. The aim of this report is to help the clinician identify and treat scurvy, a disease that was once feared for its high mortality but is now easily treatable, even in cases that have progressed to multiple organ dysfunction and failure.


Assuntos
Escorbuto/diagnóstico , Escorbuto/tratamento farmacológico , Adulto , Anemia/tratamento farmacológico , Anemia/etiologia , Ácido Ascórbico/uso terapêutico , Feminino , Gengivoplastia , Halitose/etiologia , Halitose/terapia , Humanos , Doenças Periodontais/etiologia , Doenças Periodontais/cirurgia , Púrpura/tratamento farmacológico , Púrpura/etiologia , Extração Dentária , Vitaminas/uso terapêutico
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