Facial feminisation: an overview of the role of the surgeon and orthodontist.

Facial feminisation surgery (FFS) aims to feminise the face by changing masculine facial features to feminine ones. It is commonly undertaken for transsexual individuals who are transitioning from male to female or for women who wish to further feminise their facial appearance. Assessment and treatment planning by a multidisciplinary team is essential for any patient considering FFS. Orthodontists have an important role within this team as patients may first present to an orthodontist expressing concerns about the appearance of their jaws. Therefore, it is important that orthodontists have a detailed understanding of FFS procedures, to enable good patient communication, thorough patient assessment and onwards referral where required. This article reviews the common FFS procedures, their indications, and the benefits and risks of each procedure and highlights the role of the orthodontist.

Assessing the psychological predictors of benefit finding in patients with head and neck cancer.

BACKGROUND: Some individuals are able to gain psychological benefits from illness and adversity, such as a greater sense of purpose and closer relationships, termed 'benefit finding' (BF). The main aim of this study was to explore the extent to which BF is reported in patients with head and neck cancer (HNC). Secondary aims were to establish the relationships between BF, other patient-reported outcomes and predictive factors such as coping strategy and level of optimism. METHODS: This repeat measures study was conducted with 103 newly diagnosed patients with HNC. Self-completion questionnaires were used to assess BF pre-treatment and 6 months after treatment and pre-treatment coping, optimism, quality of life, anxiety and depression. Sixty-eight patients (66%) completed follow-ups. RESULTS: Moderate to high levels of BF were reported. Anxiety, depression and quality of life were not related to BF. Regression models of BF total score and three new factor analysed BF scales indicated that use of emotional support and active coping strategies were predictive of finding more positive consequences. Optimism, living with a partner and higher educational attainment were also found to have a protective effect. The amount of variance in BF explained by these five pre-treatment factors ranged from 32 to 46%. CONCLUSIONS: These findings demonstrate that both dispositional and potentially modifiable factors, in particular optimism and coping strategies, were associated with patients identifying positive consequences of a diagnosis of HNC. To maximise patient's longer-term resilience and adaptation, components of BF, either directly or via coping strategies, could be targeted for intervention.

"Cancer doesn't mean curtains": benefit finding in patients with head and neck cancer in remission.

There is an increasing awareness that there are often aspects of the experience of cancer that patients view as positive or beneficial despite substantial physical and psychological impacts. Individuals with head and neck cancer (HNC) are unique with respect to the possible facial disfigurement and functional limitations following disease and treatment. This qualitative study aimed to explore whether patients with HNC experience positive consequences posttreatment, and to investigate the nature of any benefit finding. Emerging master themes included a change in life priorities, greater closeness to family and friends, a greater awareness of self, for example, an increase in self-confidence and empowerment, and a greater awareness of faith and spirituality. Despite the adverse affects often associated with HNC, patients report some degree of positive growth following treatment.

Granulomatosis with polyangiitis: potentially lethal gingival lesions presenting to the dentist.

Gingival pathology is a daily presentation, however a small number of systemic conditions can manifest similar to a common gingival condition and have fatal results. Dentist referred 56-year-old woman to Oral and Maxillofacial Surgery department with a 2-week medical history of gingival bleeding not responding to local measures. Biopsy showed eosinophilic infiltrate and vasculitis, and blood tests showed positive markers including cytoplasmic antineutrophil cytoplasmatic antibodies. Granulomatosis with polyangiitis is a rare disease affecting the respiratory tract, blood vessels and kidneys. Oral lesions are rarely the primary presenting feature. When left untreated, most cases are fatal within a year of diagnosis. The diagnosis can only be made when certain criteria are found, including granular oral lesions exhibiting an eosinophilic inflammatory infiltrate on biopsy. With 5% of cases showing intraoral lesions as the primary feature, it is essential that dentists have the knowledge of this rare disease to refer and not to treat as a common gingival condition.

Longstanding unilateral dislocation of the temporomandibular joint in a 6-year-old girl.

Unilateral longstanding dislocation of the temporomandibular joint (TMJ) is rare in children. These patients may demonstrate some function in opening and closing of the mouth due to the formation of a pseudo-joint in the dislocated position. In this report we describe a case of longstanding unilateral dislocation of the TMJ in a 6-year-old girl, highlighting the diagnostic difficulty and management of the condition.

Associations between quality of life, coping styles, optimism, and anxiety and depression in pretreatment patients with head and neck cancer.

BACKGROUND: Head and neck cancer is often diagnosed at a late stage and consequently radical treatment is necessary. The pretreatment phase is a time of high anxiety and depression for patients. This study aimed to investigate whether anxiety and depression are related to quality of life, coping styles, and dispositional optimism. METHODS: One hundred and three patients were recruited after diagnosis to a questionnaire study. Measures included the Hospital Anxiety and Depression Scale; SF12v2 Health Survey; Brief COPE, and the Revised Life Orientation Test. RESULTS: Quality of life, in particular emotional role explained a large proportion of the variance in pretreatment anxiety and depression. In addition, the use of negative coping styles was related to high anxiety levels and low levels of optimism were related to higher levels of depression. CONCLUSION: There are a small but significant proportion of pretreatment patients that may benefit from individualized support.

Injury to the brachial plexus in neck dissections.

Injury to the brachial plexus is a rare complication of neck dissection. We present a case of a 65-year-old man who developed a lesion of the nerve root of C5 and C6 as a result of radical neck dissection.