[Support at home for a patient with cancer of the jaw]. / Accompagnement au domicile d'une patiente atteinte d'un cancer de la mandibule.

Home care presents specific difficulties. The support of Ms. C, suffering from a malignant tumour of the lower jaw illustrates a difficult care context due to a painful and poorly-healing wound, low self-esteem and communication difficulties. Maintaining the right distance and providing professional support are therefore essential in order to give high quality care to this patient.

Assessment of quality of life in giant ameloblastoma adolescent patients who have had mandible defects reconstructed with a free fibula flap.

BACKGROUND: The reconstruction of mandibular defects after giant ameloblastoma resection is one of the most challenging problems facing reconstructive surgeons. Mandibular resection has been associated with a poor quality of life (QOL), particularly in adolescent patients reconstructed with a free fibula flap. This study aims to evaluate QOL outcomes in adolescent patients who have had mandibular resections of giant ameloblastoma and reconstruction with a free fibula flap and to collect information about their socio-cultural situation. METHODS: The present study assessed 45 adolescent patients who had undergone immediate mandible reconstruction with a free fibula flap for faint ameloblastoma using University of Washington Quality of Life (UW-QOL) and 14-item Oral Health Impact Profile (OHIP-14) questionnaires. RESULTS: Thirty-five of the 54 questionnaires were returned (64.81%). In the UW-QOL, of the twelve disease-specific domains, the best three scores from the patients related to pain, shoulder and appearance and the worst three scores related to chewing, anxiety and saliva. In the OHIP-14, the lowest-scoring domain was handicap, followed by physical pain and social disability. CONCLUSIONS: Mandibular reconstruction with a free fibular flap significantly influenced the adolescent patients' QOL. Adolescent patients pay more attention to postoperative facial appearance; this should be considered in surgical planning.

Patients with oral tumors. Part 2: Quality of life after treatment with resection prostheses. Resection prosthetics: evaluation of quality of life.

In the present study, the oral health-related quality of life of 18 patients (13 men and 5 women) was evaluated using validated questionnaires as proposed by the European Organization of Research and Treatment of Cancer (EORTC). The patients belonged to a cohort of 48 patients, whose prosthetic treatment was performed during the years 2004-2007. In the course of tumor resection, 12 patients underwent graft surgery and 14 patients radiotherapy. One patient required a nasal epithesis since resection of the nose became necessary. Five patients underwent a full block resection of the mandible, and tumor resection in 3 patients resulted in a large oronasal communication. Prosthetic rehabilitation was performed in all patients, and the follow-up period with regular care covered a minimum of 3 years. Eleven patients received dental implants for better support and retention of the prostheses. In spite of compromised oral conditions, functional restrictions, and some difficulties with the prostheses, the answers to the questionnaire were quite positive. The majority judged their general health as good or even excellent. The subjective perception of the patients may contradict the objective view by the dentist. In fact, the individual patient's history and experience provide a better understanding of the impact of oral tumors on daily life. The overall assessment identified 4 items that were perceived as major problems by all patients: swallowing solid food, dry mouth, limited mouth opening, and appearance. Prosthetic rehabilitation has only a limited influence on such problems.

Quality of life of patients with maxillofacial defects after treatment for malignancy.

PURPOSE: The purpose of the study was to investigate how cancer patients with maxillofacial defects evaluate their quality of life after prosthodontic therapy, complemented by a retrospective interview for judging the various therapy steps. The results were compared with a nontumor control group (multiple tooth extractions) and with population-based norm data. MATERIALS AND METHODS: A total of 34 patients were included in the study, 17 in each group. Patients first filled in a questionnaire and then answered additional questions in a standardized interview. RESULTS: At the time of investigation, tumor patients did not significantly differ from nontumor patients regarding global quality of life. However, tumor patients had significantly less favorable values regarding role functioning, speech, mouth opening, and dry mouth, as well as pain and swallowing. In comparison with the reference data of the German population, tumor patients had considerable deficits (> 20 points) regarding role functioning, dyspnea, and financial difficulties. Other deficits (> 10 points) became apparent in global quality of life, fatigue, insomnia, and appetite. When reflecting the course of disease and recovery, tumor patients rated the diagnosis as the most stressful event and reported that the family was most instrumental in the recovery process. CONCLUSION: Patients with maxillofacial defects after treatment for malignancy suffer from numerous clearly definable quality of life-related symptoms and problems, even after prosthodontic treatment. These patients need psychologic care at the time of diagnosis to alleviate the burden of the cancer diagnosis and prepare for the demanding treatment. After completion of the prosthodontic treatment, therapy options for pain or speech problems should be offered.

[The dynamics of psychologic distress in patients with maxillofacial and laryngeal malignancies]. / Dinamika narushenii psikhicheskogo statusa u bol'nykh so zlokachestvennymi novoobrazovaniiami cheliustno-litsevoi oblasti i gortani.

The study of psychological dynamics involved in malignancies of the maxillofacial area and larynx included 38 male patients (tumors in maxillofacial area--26; neoplasia of larynx--12). Patients were given different regimens of radiation and radiotherapy; 11 were operated on. Psycho-disorders induced by tumor disease and admission to cancer ward were reported in 35 (92%). With time, such disorders were progressively overshadowed by somato-psychic changes, with asthenic syndrome prevailing, and subsequently psychopath-like features developed. Psycho-organic syndrome was registered in 16 patients as they were approaching terminal stage.

Therapeutic effects of maxillofacial prostheses.

Thirty-nine patients with maxillofacial defects were restored by prostheses. A questionnaire was completed both before and after the prosthetic rehabilitation, measuring such psychological aspects as changes in self-image, optimism, and feelings of health. Thirty-three patients were found to respond favorably. Improvement was most pronounced where the facial defect had been caused by trauma (accidents). It was less conspicuous in patients with congenital malformations, whereas oncologic patients' average experimental change was minimal. It is concluded that cancer patients require more than a well-fitting prosthesis for successful rehabilitation.