Treatment anxiety in oral and maxillofacial surgery. Results of a German multi-centre trial.

BACKGROUND: Oral and Maxillofacial operations can be extremely frightening treatment situations. General data on this phenomenon should be acquired through a multi-centre trial. METHOD: A 10-page questionnaire was developed which was answered by 600 oral and maxillofacial patients before individual treatment. Control groups consisted of 800 surgical, dental and general practitioners/internal medicine patients. Twenty six medical practices and hospital departments in 11 German cities were involved in the trial. RESULTS: Both subjective anxiety assessment by patients and objective testing (State Trait Anxiety Inventory; STAI) indicated a high level of treatment anxiety for oral and maxillofacial treatment situations. Oral and Maxillofacial Surgery (OMFS) patients' scores were significantly higher than those of control groups. Especially younger and female patients, patients treated under local anaesthesia and out-patients showed intensive anxiety. Previous treatment experience in OMFS did not modify test results. CONCLUSION: Managing perioperative anxiety is still a major challenge in OMFS. Irrespective of technical, pharmacological and surgical advances, developing and establishing stress-reducing and anxiolytic perioperative techniques is of considerable importance for both patients and surgeons.

Tape recorded hypnosis in oral and maxillofacial surgery--basics and first clinical experience.

BACKGROUND: Surgical treatment of diseases of the oral and maxillofacial region under local anaesthesia is quite commonly restricted by limited patient compliance. 'Medical Hypnosis' could be an alternative to treatment under pharmacological sedation. With this method, both autosuggestive and other suggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient. The purpose of this paper was to see whether there could be any potential for this treatment when operating on oral and maxillofacial patients. METHODS: During a 1-year-trial period, 209 operations under combined local anaesthesia/medical hypnosis were carried out on 174 non-preselected patients between the ages of 13 and 87 years. The surgical range covered oral, plastic and reconstructive, oncological, septic and trauma operations. RESULTS: Medical hypnosis turned out to be a reliable and standardizable method with high patient compliance. Remarkable improvements in treatment conditions for both patient and surgeons were achieved in 93% of cases. CONCLUSION: Controlled clinical studies are now necessary to obtain objective data on the effectiveness of hypnosis-induced intraoperative effects in oral and maxillofacial surgery.

Acceptance of medical hypnosis by oral and maxillofacial patients.

Prognosis in surgical treatment of diseases of the oral and maxillofacial region under local anesthesia is quite commonly restricted by compliance by the patient. An alternative approach, medical hypnosis, has not been used in oral and maxillofacial surgery to any significant degree. As such, hypnosis treatment also depends to a great extent on the cooperation of the patient, and it would seem advisable to collect information concerning the individual motivation for accepting such a treatment option. The questionnaire consisted of 21 questions and was handed out to patients of the department. A total of 310 questionnaires were evaluated statistically, and the result shows a high level of acceptance of medical hypnosis by patients being treated surgically in the oral and maxillofacial region. The authors conclude that the effectiveness of this treatment option should be examined in clinical studies.

[Patient satisfaction after oral and maxillofacial procedures under clinical hypnosis]. / Therapiezufriedenheit mund-, kiefer- und gesichtschirurgischer Patienten nach Operationen unter Klinischer Hypnose.

The Department of Maxillofacial Surgery of the University Hospital Schleswig-Holstein/Campus Lübeck offers intraoperative hypnosis since 2002. Besides clinical evaluation by controlled studies, patients attitudes should be included in the judgement on such adjuvant procedure not established in general.70 patients of the department treated under combined local anaesthesia/hypnosis rated their individual postoperative patient satisfaction by standardised questionnaires. A control group of equal size and demographic/surgical features consisted of patients that were treated without hypnosis in the same interval. Results of the inquiry indicate that intraoperative hypnosis increases significantly postoperative satisfaction of oral and maxillofacial patients. Satisfaction is attributed decisively on the adjuvant procedure.

[Treatment anxiety in oral and maxillofacial surgery]. / Behandlungsangst in der Mund-, Kiefer- und Gesichtschirurgie.

BACKGROUND: Oral and maxillofacial operations are stressful treatment situations for patients. Specific data on this phenomenon were acquired through a multicenter study. MATERIAL AND METHODS: A 10-page questionnaire was answered by 600 oral and maxillofacial patients before individual treatment. Control groups consisted of 800 surgical, dental, internal medicine and general practitioner patients. 26 practices and hospital departments in 11 German cities were involved in the study. RESULTS: Both subjective anxiety assessment by patients and objective measurement (State Trait Anxiety Inventory; STAI) indicated a high level of treatment anxiety for oral and maxillofacial treatment. STAI scores for OMFS patients were significantly higher than in control groups. Especially female patients, patients treated under local anaesthesia and out-department patients showed high anxiety scores. Treatment experience in oral and maxillofacial surgery does not modify anxiety in case of recurrent treatment. CONCLUSION: Managing perioperative anxiety today is still a major challenge in oral and maxillofacial surgery. Irrespective of technical and pharmacological advances further studies on this topic and the development and establishing of stress-reducing and anxiolytic perioperative techniques are of considerable importance.