Orthognathic Surgery with Interdisciplinary Digital Planning in Patients with Geroderma Osteodysplasticum: A Case Report.

Patients with geroderma osteodysplasticum (GO) often times have dentofacial deformities and benefit from orthognathic surgery. Because of generalized osteopenia, operations must be prepared even more meticulously than usual, and the higher risk of unfortunate fractures (bad splits) should be explained to the patients in detail. This case report is intended to portray a digital, interdisciplinary and patient-individualized planning of orthognathic surgery. It points out the individual steps that must be considered and how they can be advantageously used in patients with underlying diseases or syndromes such as GO. Through a careful digital representation of the surgical options, production of the digitally modeled splints, 3D printing and good manual surgical implementation, the quality of life of patients with GO can be increased through orthognathic surgery. Both the functions in the oral, maxillofacial region and the patient's appearance in the case presented here benefited from the interdisciplinary, individualized and digital treatment approach.

[Mortality risk for oral and oropharyngeal carcinomas in Thuringia: a population-based analysis]. / Sterberisiko für Mundhöhlen- und Oropharynxkarzinome in Thüringen: eine bevölkerungsbasierte Analyse.

OBJECTIVE: This population-based study investigates the impact of HPV association on overall survival (OS) of oral cavity (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) in Thuringia and the incidence of HPV-positive (HPV+) and HPV-negative (HPV-) tumors. METHODS: A total of 308 patients (83.4% men; mean age 57.6 years) with a primary diagnosis of OSCC (38%) or OPSCC (62%) from 2008 were included in the study. Descriptive statistics were obtained for the variables. According to Ang's risk classification, patients were classified as low risk of death (HPV+, nonsmokers), intermediate risk (HPV+, smokers) and high risk of death (HPV-smokers). Kaplan-Meier analyses and Cox multivariable regression analysis were performed to examine OS. RESULTS: 22.5% of OPSCC was HPV+ (incidence: 1.89/100,000 population; thereof 80.1% smokers). The proportion of OSCC with HPV+ was 8.5% (incidence: 0.44/100,000; thereof 78.6% smokers). The median follow-up was 31 months. HPV+ patients had significantly better 5-year OS than HPV- patients (81% vs. 49%; p < 0.001). In multivariable analysis lower OS were associated with: HPV-patients (hazard ratio (HR) = 3.2; 95% confidence interval (CI) = 1.6-6.4; p = 0.001), high risk of death according to Ang (HR = 2.3; 95% CI = 1.0-5.4; p = 0.049), older age (HR = 1.7; 95% CI = 1.1-2.4; p = 0.01), T3/T4-classification (HR = 2.1; 95% CI = 1.3-3.2; p = 0.001) and the presence of distant metastases (HR = 2.7; 95% CI = 1.6-4.4; p < 0.001). CONCLUSIONS: HPV+ non-smokers were minority in Thuringia. The majority of HPV+ patients had an intermediate risk of death due to cigarette smoking.

Early Mortality among Patients with Head and Neck Cancer Diagnosed in Thuringia, Germany, between 1996 and 2016-A Population-Based Study.

Population-based studies on early mortality in head and neck cancer (HNC) are sparse. This retrospective population-based study investigated early mortality of HNC and the influence of patients' tumor and treatment characteristics. All 8288 patients with primary HNC of the German federal state Thuringia from 1996 to 2016 were included. Univariate and multivariate analysis were performed to identify independent factors for 30-day, 90-day, and 180-day mortality. The 30-, 90-, and 180-day mortality risks were 1.8%, 5.1%, and 9.6%, respectively. In multivariable analysis, male sex (odds ratio (OR) 1.41; 95% confidence interval (CI) 1.08-1.84), increasing age (OR 1.81; CI 1.49-2.19), higher T (T4: OR 3.09; CI 1.96-4.88) and M1 classification (OR 1.97; CI 1.43-2.73), advanced stage (IV: OR 3.97; CI 1.97-8.00), tumors of the cavity of mouth (OR 3.47; CI 1.23-9.75), oropharynx (OR 3.01; CI 1.06-8.51), and hypopharynx (OR 3.27; CI 1.14-9.40) had a significantly greater 180-day mortality. Surgery (OR 0.51; CI 0.36-0.73), radiotherapy (OR 0.37; CI 0.25-0.53), and multimodal therapy (OR 0.10; CI 0.07-0.13) were associated with decreased 180-day mortality. Typical factors associated with worse overall survival had the most important impact on early mortality in a population-based setting.

Role of Intraparotid and Neck Lymph Node Metastasis in Primary Parotid Cancer Surgery: A Population-Based Analysis.

This population-based study investigated the prognostic role of intraparotid (PAR) and cervical lymph node (LN) metastasis on overall survival (OS) of primary parotid cancer. All 345 patients (median age: 66 years; 43% female, 49% N+, 31% stage IV) of the Thuringian cancer registries with parotid cancer from 1996 to 2016 were included. OS was assessed in relation to the total number of removed PAR and cervical LN, number of positive intraparotid (PAR+), positive cervical LN, LN ratio, log odds of positive LN (LODDS), as well as including the PAR as LODDS-PAR. PAR was assessed in 42% of the patients (22% of these PAR+). T and N classification were not independent predictors of OS. When combining T with LODDS instead of N, higher T (T3/T4) became a prognosticator (hazard ratio (HR) = 2.588; CI = 1.329−5.040; p = 0.005) but not LODDS (p > 0.05). When combining T classification with LODDS-PAR, both higher T classification (HR = 2.256; CI = 1.288−3.950; p = 0.004) and the alternative classification with LODDS-PAR (≥median −1.11; HR 2.078; CI = 1.155−3.739; p = 0.015) became independent predictors of worse OS. LODDS-PAR was the only independent prognosticator out of the LN assessment for primary parotid cancer.

No impact of time to treatment initiation for head and neck cancer in a tertiary university center in 2003, 2008 and 2013.

BACKGROUND: This retrospective study investigated factors influencing time to treatment initiation (TTI) and the influence of TTI on overall survival (OS) of primary head and neck cancer (HNC) patients in cohorts from 2003, 2008 and 2013. METHODS: Two hundred and ninenty seven patients (78.8% men; median age: 62 years) were included. Kaplan-Meier analyses and multivariate Cox regression were performed to investigate OS. RESULTS: Mean times to treatment initiation (TTI) of 2003, 2008 and 2013 were 17.11 ± 18.00, 30.26 ± 30.08 and 17.30 ± 37.04 days, respectively. TTI for patients with T3/T4 tumors was higher than for T1/T2 (p = 0.010). In univariable analysis on OS, TTI > 5 days showed lower OS (p = 0.047). In multivariate analysis, longer TTI had no influence on lower OS [hazard ratio (HR) 1.236; 95% CI 0.852-1.791; p = 0.264], but male gender [HR 2.342; 95% CI 1.229-4.466; p = 0.010], increased age [HR 1.026; 95% CI 1.008-1.045; p = 0.005], M1 [HR 5.823; 95% CI 2.252-15.058; p = 0.003], hypopharynx tumor [HR 2.508; 95% CI 1.571-4.003; p < 0.001] and oral cavity tumor [HR 1.712; CI 1.101-2.661; p = 0.017]. The year of treatment showed no significant effect on OS. CONCLUSION: Median TTI seemed to be very short compared to other studies. There was no clear trend in the impact of TTI on OS from 2003 to 2013.

Gender and risk-taking behaviors influence the clinical presentation of oral squamous cell carcinoma.

OBJECTIVE: The common risk factors for oral squamous cell carcinoma (OSCC) are smoking and alcohol abuse. A small percentage of patients, mostly women, are demonstrating oral cancer without the common risk behavior. This study investigates how gender and different patterns of lifestyle factors influence the clinical presentation of OSCC. PATIENTS AND METHODS: From this retrospective study, demographical and tumor-specific data and lifestyle factors were analyzed. Statistical analyses were performed using the χ2 test or Fisher's exact test for categorical analysis and the t test, ANOVA test, or Kruskal-Wallis test for continuous variables. The influence of the respective lifestyle factors together with their interactions with the gender on tumor characteristics has been tested using logistic and ordinal cumulative link regression models. RESULTS: Among a total of 308 patients, men represented the majority of smokers (87.2%) and the female cohort were largely non-smokers and non-drinkers (64.9%). For age, tumor site and N-stage it looks like that differences of men and women are driven by the different risk behavior. But if the lifestyle factors are taken into account, we observe contrary effects between men and women for T-, N-, and UICC-stage. For different cancer locations we saw opposite effects with gender and risk profile. These effects are not dose-dependent explainable for gender. CONCLUSION: Some but not all differences in the development of OSCC for men and women are explainable by the respective difference in lifestyle behavior. Some further investigations are necessary to find explanations for the obvious differences between men and women in developing OSCC.

The log odds of positive neck lymph nodes is a superior lymph node predictor for overall survival in head and neck cancer: a population-based analysis in Germany.

BACKGROUND: This population-based study investigated the influence of different lymph node (LN) classifications on overall survival (OS) in head and neck cancer (HNC). METHODS: 401 patients (median age: 57 years; 47% stage IV) of the Thuringian cancer registries with diagnosis of a primary HNC receiving a neck dissection (ND) in 2009 and 2010 were included. OS was assessed in relation to total number of LN removed, number of positive LN, LN ratio, and log odds of positive LN (LODDS). RESULTS: Mean number of LODDS was 0-0.96 ± 0.57. When limiting the multivariate analysis to TNM stage, only the UICC staging (stage IV: HR 9.218; 95% CI 2.721-31.224; p < 0.001) and LODDS > - 1.0 (HR 2.120; 95% CI 1.129-3.982; p = 0.019) were independently associated with lower OS. CONCLUSION: LODDS was an independent and superior predictor for OS in HNC in a population-based setting with representative real-life data.

Long-Term Facial Nerve Outcome in Primary Parotid Cancer Surgery: A Population-Based Analysis.

OBJECTIVES/HYPOTHESIS: To determine immediate postoperative and long-term facial nerve dysfunction after parotid cancer surgery, risk factors, and the role of facial reanimation surgery. STUDY DESIGN: Population-based long-term analysis for all new primary parotid carcinoma cases in Thuringia from 1996 to 2019. METHODS: Data of the cancer registries of Thuringia, a federal state in Germany, were analyzed in combination with hospital-based data on facial function. RESULTS: About 477 patients (42.3% women; median age: 68 years) were included. It was observed that 6.7% had a preoperative facial nerve dysfunction, 11.7% received a radical parotidectomy, that is, that 5% had a normal preoperative facial function but needed radical surgery because of intraoperative detection of tumor infiltration into the facial nerve. About 10.2% received facial nerve reconstruction surgery. Immediate postoperative facial nerve dysfunction in the other patients was observed in 34.4% of the patients. Advanced T classification (odds ratio [OR] = 2.140; confidence interval [CI] = 1.268-3.611; P = .004) and neck dissection (OR = 2.012; CI = 1.027-3.940; P = .041) were independent risk factors for immediate postoperative facial nerve dysfunction. In addition, 22.0% showed no recovery during follow-up. Advanced T classification (OR = 2.177; CI = 1.147-4.133; P = .017) and postoperative radiotherapy (OR = 2.695; CI = 1.244-5.841; P = .012) were independent risk factors for permanent postoperative facial nerve dysfunction. CONCLUSION: Patients with primary parotid cancer are at high risk for long-term facial nerve dysfunction. It seems that the possibilities of facial reanimation surgery needs to be utilized even more effectively. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2694-2700, 2021.

Gender Disparities in Epidemiology, Treatment, and Outcome for Head and Neck Cancer in Germany: A Population-Based Long-Term Analysis from 1996 to 2016 of the Thuringian Cancer Registry.

This study determined with focus on gender disparity whether incidence based on age, tumor characteristics, patterns of care, and survival have changed in a population-based sample of 8288 German patients with head neck cancer (HNC) registered between 1996 and 2016 in Thuringia, a federal state in Germany. The average incidence was 26.13 ± 2.89 for men and 6.23 ± 1.11 per 100,000 population per year for women. The incidence peak for men was reached with 60-64 years (63.61 ± 9.37). Highest incidence in females was reached at ≥85 years (13.93 ± 5.87). Multimodal concepts increased over time (RR = 1.33, CI = 1.26 to 1.40). Median follow-up time was 29.10 months. Overall survival (OS) rate at 5 years was 48.5%. The multivariable analysis showed that male gender (Hazard ratio [HR] = 1.44; CI = 1.32 to 1.58), tumor subsite (worst hypopharyngeal cancer: HR = 1.32; CI = 1.19 to 1.47), and tumor stage (stage IV: HR = 3.40; CI = 3.01 to 3.85) but not the year of diagnosis (HR = 1.00; CI = 0.99 to 1.01) were independent risk factors for worse OS. Gender has an influence on incidence per age group and tumor subsite, and on treatment decision, especially in advanced stage and elderly HNC patients.

Association of the Preoperative Body Mass Index With Postoperative Complications After Treatment of Oral Squamous Cell Carcinoma.

PURPOSE: Nutritional status is believed to influence surgical outcome. Because of a lack of actual reports in the literature, this study evaluated the surgical outcome of patients after treatment for oral squamous cell carcinoma (OSCC), with special focus on the preoperative body mass index (BMI). PATIENTS AND METHODS: This retrospective cohort study investigated the association between preoperative BMI and surgical outcome for patients with OSCC, focusing on local and medical complications. This research also analyzed common clinical and demographic parameters, such as age, gender, TNM stage, tumor differentiation, risk behavior, Karnofsky Index, duration of operation, and length of hospital stay. Statistics were performed using the χ2 test or Fisher exact test for categorical analysis and the t test or analysis of variance and Pearson correlation test for continuous variables. Multivariate analysis was computed for BMI with a multivariate linear regression model and for local and medical complications with multivariate Poisson regression. RESULTS: In the sample of 419 patients with OSCC, 8.6% were underweight, 54.7% were normal weight, and 36.8% were overweight (overall mean BMI, 24.28 kg/m2). BMI was significantly associated with age (P = .0017), consumption of nicotine (P = .0178) and alcohol (P = .0008), dental status (P = .0163), tumor differentiation (P = .0288), and tumor status (P = .0005). Underweight in particular was negatively correlated with local postoperative complications (P = .0047). Local complications were associated with the need for operative revisions (P < .0001) and an increase of hospital length of stay (P < .0001) using multivariable analysis. CONCLUSION: These results indicate that evaluation of preoperative morbidity and nutritional status, especially in underweight patients, is worthwhile to improve medical and economic postoperative outcomes after surgical therapy of OSCC.

Quality of Postoperative Pain Management After Maxillofacial Fracture Repair.

BACKGROUND: Effective pain management is an essential component in the perioperative care of surgical patients. However, postoperative pain after maxillofacial fracture repair and its optimal therapy has not been described in detail. MATERIALS AND METHODS: In a prospective cohort study, 95 adults rated their pain on the first postoperative day after maxillofacial fracture repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Quality Improvement in Postoperative Pain Management allowed for a standardized assessment of patients' characteristics and pain-related parameters. RESULTS: Overall, the mean maximal pain and pain on activity (numeric rating scales) were significantly higher in patients with mandibular fractures than in patients with midface fractures (P = 0.002 and P = 0.045, respectively). In patients with mandibular fractures, a longer duration of surgery was significantly associated with higher satisfaction with pain intensity (P = 0.015), but was more frequently associated with postoperative vomiting (P = 0.023). A shorter duration of surgery and an absence of preoperative pain counseling in these patients were significantly correlated to desire for more pain medication (P = 0.049 and P = 0.004, respectively). Patients with mandibular fractures that received opioids in the recovery room had significantly higher strain-related pain (P = 0.017). In patients with midface fractures, a longer duration of surgery showed significantly higher levels of decreased mobility (P = 0.003). Patients receiving midazolam for premedication had significantly less minimal pain (P = 0.021). CONCLUSIONS: Patients with mandibular fractures seem to have more postoperative pain than patients with midface fractures. Monitoring of postsurgical pain and a procedure-specific pain-treatment protocol should be performed in clinical routine.

Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management.

OBJECTIVES: Postoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients' characteristics, pain parameters, outcome, and pain therapy process parameters. RESULTS: Pain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (p = .037). Significantly lower satisfaction with postoperative pain intensity (p > .001) and significantly higher desire for additional pain medication (p = .023) were detected, when duration of surgery was above the median of 107.5 min. CONCLUSIONS: Inadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand. CLINICAL RELEVANCE: Only the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.

Cross-Sectional Study of four Serological Bone Turnover Markers for the Risk Assessment of Medication-Related Osteonecrosis of the Jaw.

BACKGROUND: Despite the benefits related to the use of bisphosphonates and denosumab, medication-related osteonecrosis of the jaw (MRONJ) is a serious complication. The purpose of this study was to investigate the utility of 4 biochemical markers including serum c-terminal telopeptide cross-link of type I collagen (s-CTX), serum osteocalcin (s-OC), serum parathormon (s-PTH), and serum bone-specific alkaline phosphatase (s-BAP) as useful clinical tools to help assess the risk for MRONJ prior to invasive oral surgery. MATERIALS AND METHODS: Twenty patients diagnosed with MRONJ and 20 controls who have been on antiresorptive therapies with no occurrence of MRONJ were included in this 2-arm cross-sectional study. The s-CTX, s-OC, s-PTH, and s-BAP values were measured. Mann-Whitney U test compared the s-CTX, s-OC, s-PTH, and s-BAP values of the MRONJ group and the controls (P < 0.05). RESULTS: Lower values were observed in the MRONJ group compared with the control group for s-CTX (130.00 pg/mL versus 230.0 pg/mL; P = 0.12) and for s-OC (10.6 ng/mL versus 14.80 ng/mL; P = 0.051) both without significance and for s-BAP (0.23 µkat/L versus 0.31 µkat/L; P = 0.002) with significance. By contrast, the median s-PTH value of the MRONJ group was higher (30.65 ng/L versus 25.50 ng/L; P = 0.89), but without significance. CONCLUSIONS: The evaluation of the 4 biochemical markers showed that only the value of s-BAP was significantly decreased in the MRONJ patients compared with the controls. Presently, because of the lack of evidence, a routine check prior to oral surgery for the risk assessment of MRONJ cannot be recommended.

Degree of Keratinization Is an Independent Prognostic Factor in Oral Squamous Cell Carcinoma.

PURPOSE: Keratinization is a routinely reported histologic feature in head and neck cancer. In contrast to numerous clinicopathologic parameters, the prognostic value of keratinization in oral squamous cell carcinoma (OSCC) is rarely reported in the literature. The purpose of this study was to review the outcome of patients with OSCC with a special focus on the degree of keratinization. PATIENTS AND METHODS: In this retrospective cohort study, we evaluated the medical records at the Department of Oral and Maxillofacial Surgery, Jena University Hospital, and investigated the outcome of patients with OSCC with disease-free survival and disease-specific survival according to the degree of keratinization. This research also analyzed common clinical and histologic parameters such as age, gender, tumor site, T category, N category, resection margin, lymphovascular invasion, and extracapsular spread. Descriptive statistics were performed, and survival was calculated by the Kaplan-Meier method. Prognostic factors were analyzed by multivariate Cox analysis. RESULTS: In the sample of 151 OSCC patients, with a median age of 57.5 years and a male-female ratio of 4.03:1, 119 had tumors with no or low keratinization (K0 to K2) and 32 had tumors with good or high keratinization (K3 or K4). More recurrences were seen in patients with OSCC with low keratinization (P = .0008). The 5-year disease-free survival rate was significantly decreased for OSCC with low keratinization (52.9%) compared with good or high keratinization (93.2%) (P = .0008). The 5-year disease-specific survival rate was reduced to 66.1% (P = .0136) for patients with OSCC with low keratinization. Multivariate analysis showed that extracapsular spread (P = .001) and keratinization (P = .002) are independent, significant prognostic factors for recurrence in OSCC. CONCLUSIONS: Besides extracapsular spread, the degree of keratinization seems to be an important prognostic factor for recurrence and survival in OSCC. Our results indicate that the degree of keratinization should be considered in decisions regarding treatment and prognosis for OSCC.

Evaluation of a post-treatment follow-up program in patients with oral squamous cell carcinoma.

OBJECTIVES: The duration and the frequency of follow-up after treatment of oral squamous cell carcinoma are not standardized in the current literature. The purpose of this study was to evaluate our local standard post-treatment and follow-up protocol. MATERIALS AND METHODS: Overall, 228 patients treated curatively from 01/2006 to 07/2013 were reviewed. To evaluate the follow-up program, data on the secondary event were used. To determine risk groups, all patients with tumor recurrence were specifically analyzed. Relapse-free rate were estimated by the Kaplan-Meier product limit method. The chi-square test was used to identify independent risk factors for tumor relapse. RESULTS: In total, 29.8 % patients had a secondary event. The majority of the relapse cases (88.2 %) were detected within 2 years postoperatively, 61.8 % of them within the first year. Most events were local recurrences (34.7 %). UICC-stage IV was significantly associated with tumor recurrence (p = 0.001). Gender (p = 0.188), age (p = 0.195), localization (p = 0.739), T-stage (p = 0.35), N-stage (p = 0.55), histologic grade (p = 0.162), and tobacco and alcohol use (p = 0.248) were not significantly associated with tumor recurrence. Patients with positive neck nodes relapsed earlier (p = 0.011). The majority of relapses (86.3 %) were found in asymptomatic patients at routine follow-up. CONCLUSIONS: The results of this study suggest an intensified follow-up within the first 2 years after surgery. CLINICAL RELEVANCE: Given the higher relapse rate of patients exhibiting an UICC-stage IV and/or positive neck nodes, it seems to be from special interest to perform in this group a risk-adapted follow-up with monthly examinations also in the second year.

Cranio-maxillofacial reconstruction with microvascular radialis flaps-parameters and correlations of postoperative pain management.

OBJECTIVES: Postoperative pain management is of highest interest for patients undergoing maxillofacial surgery including microvascular reconstructive surgery. Currently, there is a lack of information regarding process and outcome of postoperative pain management after microvascular reconstruction. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following microvascular reconstruction with a radial forearm flap using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It enables a standardized assessment of patients' characteristics, pain parameters, outcome and pain therapy process parameters. RESULTS: Pain management consisted predominately of premedication with midazolam, sufentanil and metamizol intraoperatively, piritramid in the intensive care unit and metamizol, tramadol and fentanyl patches on ward. Nineteen patients (61.3 %) showed inadequate pain management with pain levels ≥4. Among other significant relations, patients exhibiting an age below the median presented significant higher levels of pain under strain (p = .041) and maximum pain (p = .006) as well as rate of breathing (p = .009) and mood (p = .006) disturbance. Performance of pain counselling showed specific impact on pain under strain (p = .008), maximum pain (p = .004) and satisfaction with pain intensity (p = .001). Whether microvascular reconstruction was performed with primary or secondary intention or performance of a neck dissection did not show significant influence. CONCLUSIONS: QUIPS helped us to adequately evaluate the procedure-specific quality of postoperative management following microvascular reconstruction with a radial forearm flap. It helped us to identify a surprisingly high amount of inadequate pain management. Postoperative pain levels seem to be primarily influenced by the performed reconstruction. CLINICAL RELEVANCE: Establishment of a continuous and procedure-specific evaluation of postoperative pain levels should help to avoid inadequate pain management, which is widely prevalent according to the literature and our study. Preoperative pain counselling is essential and should be procedure specific to be its best.

Role of comorbidity on outcome of head and neck cancer: a population-based study in Thuringia, Germany.

To examine the impact of comorbidity on overall survival (OS) in a population-based study of patients with head and neck cancer who were treated between 2009 and 2011. Data of 1094 patients with primary head and neck carcinomas without distant metastasis from the Thuringian cancer registries were evaluated concerning the influence of patient's characteristics and comorbidity on OS. Data on comorbidity prior to head and neck cancer diagnosis was adapted to the Charlson Comorbidity (CCI), age-adjusted CCI (ACCI), head and neck CCI (HNCCI), simplified comorbidity score (SCS), and to the Adult Comorbidity Evaluation-27 (ACE-27). Most patients were male (80%; median age: 60 years; 50% stage IV tumors). Smoking, alcohol abuse, and anemia were registered for 38%, 33%, and 23% of the patients, respectively. Predominant therapy was surgery + radiochemotherapy (30%), surgery (29%), and surgery + radiotherapy (21%). Mean CCI, ACCI, HNCCI, SCS and ACE-27 were 1.0 ± 1.5, 2.6 ± 2.1, 0.6 ± 0.8, 4.4 ± 4.2, and 0.9 ± 0.9, respectively. Median follow-up was 25.7 months. Multivariable analyses showed that higher age, higher UICC stage, no therapy, including surgery or radiotherapy, alcohol abuse, and anemia, higher comorbidity were independent risk factors for worse OS (all P < 0.05). According to the discriminatory power analysis none of the five comorbidity scores was superior to the other scores to prognosticate OS. This population-based study showed that comorbidity is frequent in German patients with head and neck cancer and is an important risk factor for poor OS. Comorbidity should be routinely assessed and taken into account in prospective clinical trials.

Longterm quality of life after oncologic surgery and microvascular free flap reconstruction in patients with oral squamous cell carcinoma

BACKGROUND: Quality of life (QoL) has become increasingly important in cancer treatment. It refers to the patient's perception of the effects of the disease and therapy, and their impact on daily functioning and general feeling of well-being. MATERIAL AND METHODS: In this prospective study, a total of 100 patients treated at our institution, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific EORTC QLQ-H&N35 module. The questionnaires were distributed to the patients between 12 and 60 months postoperatively. RESULTS: Global QoL score was 58.3 and mean score for functioning scale was 76.7. Fatigue (28.7 ± 26.1), followed by financial problems (27.7 ± 33.5), insomnia (26.7 ± 34.5) and pain (26.3 ± 29.9) had highest symptom score on QLQ-C30. Fatigue (r = -0.488), insomnia (r = -0.416) and pain (r = -0.448) showed highest value for significantly negative correlation to global QoL. In the H&N35 module, restriction of mouth opening (43.3 ± 38.6), dry mouth (40.7 ± 36.9), sticky saliva (37.3 ± 37.1) and eating in public (33.8 ± 31.9) were the four worst symptoms. Swallowing problem (r = -0.438), eating in public (r = -0.420) and persistent severe speech (r = -0.398) ranked as the three worst symptoms with highest value for significantly negative correlation to global QoL. CONCLUSIONS: Longterm QoL after oncologic surgery and microvascular free flap reconstruction in patients with oral cancer is satisfactory. Measuring QoL should be considered as part of the evaluation of cancer treatment

The isolated orbital floor fracture from a transconjunctival or subciliary perspective-A standardized anthropometric evaluation

BACKGROUND: The influence of orbital fractures and their repair on the rate of deformities of the lower eyelid is an ongoing source of discussion in the literature. Most of the present studies include isolated blow-out as well as combined orbital fractures. MATERIAL AND METHODS: We present a retrospective evaluation of a series of 100 patients after isolated blow-out fracture repair using reference anthropometric data on standardized photographs. Analysis included eye fissure width and height, lid sulcus height, upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion and entropion. It was clearly distinguished between operated and contralateral eyelid, whether a transconjunctival or a subciliary approach was performed and amount of fracture. Our main interests were changes of the aforementioned parameters with regards to eyelid deformities. RESULTS: Surgery per se did not significantly influence eyelid deformities. However, the surgical approach selected significantly affected eye fissure index, lower iris coverage and rate of scleral show, indicating retraction of the lower eyelid. CONCLUSIONS: The standardized measurements described here are accurate and objective to evaluate postoperative results. The subciliary approach included the highest risk of lower lid retraction as compared to transconjunctival approaches

The isolated orbital floor fracture from a transconjunctival or subciliary perspective-A standardized anthropometric evaluation.

BACKGROUND: The influence of orbital fractures and their repair on the rate of deformities of the lower eyelid is an ongoing source of discussion in the literature. Most of the present studies include isolated blow-out as well as combined orbital fractures. MATERIAL AND METHODS: We present a retrospective evaluation of a series of 100 patients after isolated blow-out fracture repair using reference anthropometric data on standardized photographs. Analysis included eye fissure width and height, lid sulcus height, upper lid height, upper and lower iris coverage, position of cornea to palpebra inferior, canthal tilt, scleral show, ectropion and entropion. It was clearly distinguished between operated and contralateral eyelid, whether a transconjunctival or a subciliary approach was performed and amount of fracture. Our main interests were changes of the aforementioned parameters with regards to eyelid deformities. RESULTS: Surgery per se did not significantly influence eyelid deformities. However, the surgical approach selected significantly affected eye fissure index, lower iris coverage and rate of scleral show, indicating retraction of the lower eyelid. CONCLUSIONS: The standardized measurements described here are accurate and objective to evaluate postoperative results. The subciliary approach included the highest risk of lower lid retraction as compared to transconjunctival approaches.