Effect of a domiciliary facial cooling system on generic quality of life after removal of mandibular third molars.

To evaluate quality of life (QoL) and patients' perceptions of a domiciliary facial cooling system (Hilotherm®, Hilotherapy UK Ltd, Coventry, UK), we asked 30 patients to complete a paper-based EQ-5D-3L QoL questionnaire (EuroQol Group 1990, Rotterdam, The Netherlands) each day for seven days after the removal of mandibular third molars. They were returned by 14 of the 20 patients who had not used the system and by all 10 who had. Patients aged between 18 and 25 who had their teeth removed in outpatients (in accordance with National Institute for Health and Care Excellence guidelines) under general anaesthesia (American Association of Anesthesiologists (ASA) class I or II) and did not smoke, were included. They were all treated by the same surgeon in the day surgery unit of a district general hospital. Patients found the system helpful and easy to use. They had no complications, their QoL was significantly improved (p<0.001), and the time taken to return to normal activities was reduced. The Hilotherm® domiciliary facial cooling system is safe and helps in the management of postoperative pain and swelling. Our findings confirm recently published meta-analyses that show the effectiveness of hilotherapy after facial surgery.

Measurement of generic compared with disease-specific quality of life after removal of mandibular third molars: a patient-centred evaluation.

Our aim was to evaluate patients' perceptions and their responsiveness to a generic quality of life (QoL) scale after removal of mandibular third molars. We asked 40 consecutive patients who met NICE guidelines for removal of third molars to rank items from the generic EuroQuol three-dimensional questionnaire (EQ 5D 3L) and the disease-specific Oral Health Impact Profile (OHIP-14) based on what they perceived to be important outcomes. Each item was then assigned a numerical value that depended on its rank, and an overall score calculated. Fifty consecutive patients were then invited to complete a paper-based EQ 5D 3L QoL questionnaire daily for seven days after removal of third molars. Most of the generic QoL items ranked more highly than disease-specific ones. The generic EQ 5D 3L questionnaire indicated an initial fall in QoL after removal of the teeth, before improving for all participants over the first seven postoperative days. The responses to questions about "overall QoL", "pain/discomfort", and "anxiety/depression" in the EQ 5D 3L tool were strongly correlated. The EQ 5D 3L is used to assess fluctuations in QoL during the early postoperative period after removal of third molars, and describes items that are perceived by patients to be more important than those recorded by the disease-specific OHIP-14 QoL questionnaire. It is therefore more relevant for counselling patients preoperatively. Development of measures of early outcomes after removal of third molars should incorporate generic items to remain useful.

Systematic review and meta-analysis of the efficacy of hilotherapy following oral and maxillofacial surgery.

Craniofacial surgery causes immediate postoperative pain, oedema, and functional limitations. Hilotherapy delivers cooled water to the face at 15°C and may reduce the postoperative recovery time. This work presents a meta-analysis of short-term postoperative outcomes after hilotherapy. Following a systematic literature search, comparative trials of patients undergoing surgical interventions in the maxillofacial region and receiving either hilotherapy or ice-cooling therapy were included for meta-analysis. Demographics and surgical outcomes were extracted. Data were analysed using Comprehensive Meta-Analysis software. Mean (SEM) data were calculated for demographic variables and standardized mean differences with the 95% confidence interval for surgical outcomes. Five trials were analysed, providing 206 patients for evaluation; mean patient age was 29.4 (9.4) years. Hilotherapy reduced pain (10-point visual analogue scale) at 48 h (P<0.010) and 72 h (P<0.050), as well as postoperative facial oedema (P<0.010), compared to ice-cooling treatment. Trismus and facial neurological scores were also improved (P=0.08). Patients preferred hilotherapy to other cooling methods (P<0.010). Hilotherapy appears to be effective in reducing postoperative facial pain, oedema, and trismus, and in improving patient-reported outcomes. Well-designed randomized controlled clinical trials are required to clarify the procedure-specific efficacy of postoperative hilotherapy and optimal durations of treatment.

Patient-reported outcome measures in nonmelanoma skin cancer of the face: a systematic review.

Nonmelanoma skin cancer (NMSC) is the most common malignancy in the western world, with an incidence of 98,000 in the U.K. Since 2009 the Department of Health (DoH) has collected patient-reported outcome measure (PROM) data following four common surgical procedures. However, a DoH PROM for NMSC does not exist. A systematic review of questionnaires published on patient concerns due to NMSC of the face was conducted. Keywords relevant to PROMs, NMSC and the facial region were comprehensively searched in medical databases. Inclusion criteria stipulated that questionnaires from relevant papers recruited patients with NMSC for both the item formulation and subsequent validation. Questionnaires were then discussed by a multispecialty skin cancer research team. Initially 2548 papers were found; after exclusion criteria were applied, 73 articles were retrieved. Four patient questionnaires for NMSC featured adequate development and validation according to the inclusion criteria. The Facial Skin Cancer Index (FSCI) was the only PROM specific to facial NMSC. Additional questionnaires identified included the Skin Cancer Quality of Life Impact Tool, Skindex, and Dermatology Life Quality Index. There is a scarcity of data relating to NMSC PROMs and appearance concerns. Only one questionnaire--the FSCI--was specific to patients with facial NMSC. We recommend nationally standardized data collection from patients with NMSC in order to create an evidence-based validated PROM for patients with facial skin cancer.

Classification of surgical approaches to the mandibular condyle.

Published articles on surgical approaches to the mandibular condyle seem to be confusing. We present a classification system that describes and differentiates between surgical approaches to the mandibular condyle and is based on the relation to the facial nerve, height of the approach, and choice of skin incision.

Retained throat packs: results of a national survey and the application of an organisational accident model.

Throat packs are commonly placed in the patient's pharynx before oral surgical procedures under general anaesthesia. The pack is thought to protect the airways from aspiration of surgical debris, but if it is retained after extubation it can obstruct the airway. Adverse incidents after retention of throat packs have been reported anecdotally, but to our knowledge the risk management practices undertaken and common events surrounding retention of throat packs, have not been published before. We investigated the management of throat packs in 2007, by sending a questionnaire to maxillofacial surgeons and anaesthetists in the UK. We discuss the results and apply them to an organisational accident model.

Prophylactic antibiotics and surgery for primary clefts.

There are currently no evidence-based guidelines about the use of antibiotic prophylaxis in repair of cleft lip and palate. After the designation of regional cleft centres in the UK, a postal questionnaire was sent to cleft surgeons in 2004 to enquire about the use of routine antibiotic prophylaxis for primary repair of cleft lip and palate. The results showed a lack of consensus and wide disparity among centres. The findings show that there is a need for a random control clinical trial to establish national recommendations for the rational use of prophylactic antibiotics in primary cleft surgery.

A life-threatening complication of acute parotitis.

We present a case of necrotising fasciitis that complicated an episode of acute parotitis caused by Streptococcus milleri infection. Early diagnosis and aggressive therapy is necessary to reduce the incidence of mortality of this severe infection.