Medical practitioners' educational competence about oral and oropharyngeal carcinoma: a systematic review and meta-analysis.

Medical practitioners' (MP) role is pivotal in primary prevention, early diagnosis, prompt referral and effective management of oral and oropharyngeal carcinomas (OC/OPC), which raises the importance of their effective OC/OPC education at all levels of medical education. The purpose of this systematic review was to summarise the available scientific evidence about their educational competence in dealing with OC/OPC. We made a systematic search of papers in the English language in MEDLINE, Scopus, Cochrane Library CENTRAL and CINAHL databases from their inception until December 2018. Overall, 23 cross-sectional and three interventional studies have been selected for the systematic review and 18 of these were included in the meta-analyses. Excluding tobacco use (synthesised estimate of 95% of respondents identified tobacco as an OC/OPC risk factor, 95% CI of synthesised estimate 92% to 97%) and alcohol consumption (65%, 95%CI 52% to 77%), less than half of MP (approximately) were knowledgeable about important OC/OPC risk factors including human papilloma virus (42%, 95% CI 30% to 54%), poor diet (34%, 95% CI 17% to 54%), and advancing age (45%, 95% CI 21% to 70%). There was a low to moderate level of awareness among MP regarding common precancerous oral lesions involving leukoplakia (56%, 95% CI 32% to 79%), erythroplakia (30%, 95% CI 8% to 58%), and oral lichen planus (13%, 95% CI 0 to 41%). Moderate knowledge was also recorded about frequent sites of OC development involving the tongue (48%, 95% CI 33% to 64%) and floor of the mouth (37%, 95% CI 19% to 57%). Most MP enquired about tobacco use (86%, 95% CI 74% to 96%), and alcohol consumption (73%, 95% CI 47% to 94%) during history taking, and expressed willingness to be given supplementary OC/OPC education (78%, 95% CI 54% to 96%), as well. With regard to the incidence of intraoral screening, 27% of MP (95% CI 12% to 46%) make an intraoral examination as a routine. Interestingly, studies from each continent yielded significantly different outcomes to some research questions in the review. From the MP's perspective, clinical time restrictions and deficiencies in organised training were recognised as the main barriers towards their OC/OPC educational competence. The findings of this systematic review indicated the existence of deficiencies in knowledge and misconceptions, neglected preventive responsibilities, and associated barriers towards OC/OPC. A need for improved OC/OPC training at all levels of medical education is required to increase competence worldwide.

Flared sign of flail mandible on computed tomography: an unstable fracture associated with a compromised airway.

A mandibular fracture alone rarely causes a life-threatening injury. The aim of this paper was to emphasise the importance of prompt identification of the radiological signs of a flail mandible in a patient with maxillofacial trauma who eventually needed definitive management of her airway.

Parapharyngeal space tumors: surgical approaches in a series of 13 cases.

Tumors originating in the parapharyngeal space are rare; they comprise approximately 0.5% of head and neck tumors. Most (70-80%) are benign and the most frequent origins are salivary and neurogenic. The aim of this study is to present the surgical procedures used for the treatment of 13 patients with parapharyngeal space tumors; 11 of them were suffering from benign tumors (the most frequent being pleomorphic adenoma; 8 cases) and 2 from malignant lesions. The following surgical approaches were used: intraoral (2 cases), transcervical (4 cases) and transmandibular (7 cases) with different types of mandible osteotomies. The type of surgical approach was dictated by the type of the lesion (malignant or benign), the exact location, the size, the vascularity and the relation of the tumor to the neck neurovascular bundle. In all cases the selected surgical approach allowed the complete resection of the tumor, obtaining clear margins in cases of malignancy, without adding to the patient's preoperative morbidity. It was concluded that the surgical approach to the parapharyngeal space tumors must be adjusted to the tumor characteristics and be as wide is necessary to achieve its complete removal with safety.

A method for marking histopathological specimens of neck--technical note.

The authors present a technical note for marking the location of lymph nodes of the neck for histopathological examination. A more precise histopathological report permits more effective overall management of patients with neoplastic disease of the head and neck.

Nuclear fractal dimension as a prognostic factor in oral squamous cell carcinoma.

Strong theoretical reasons exist for using fractal geometry in measurements of natural objects, including most objects studied in pathology. Indeed, fractal dimension provides a more precise and theoretically more appropriate approximation of their structure properties and especially their shape complexity. The aim of our study was to evaluate the nuclear fractal dimension (FD) in tissue specimens from patients with oral cavity carcinomas in order to assess its potential value as prognostic factor. Relationships between FD and other factors including clinicopathologic characteristics were also investigated. Histological sections from 48 oral squamous cell carcinomas as well as from 17 non-malignant mucosa specimens were stained with Hematoxylin-Eosin for pathological examination and with Feulgen for nuclear complexity evaluation. The sections were evaluated by image analysis using fractal analysis software to quantify nuclear FD by the box-counting method. Carcinomas presented higher mean values of FD compared to normal mucosa. Well differentiated neoplasms had lower FD values than poorly differentiated ones. FD was significantly correlated with the nuclear size. Patients with FD lower than the median value of the sample had statistically significant higher survival rates. Within the sample of patients studied, FD was proved to be an independent prognostic factor of survival in oral cancer patients. In addition this study provides evidence that there are several statistically significant correlations between FD and other morphometric characteristics or clinicopathologic factors in oral squamous cell carcinomas.

Lingual thyroid: a new surgical approach--a case report.

Ectopic lingual thyroid is a rare developmental anomaly, presenting in the adult with obstructive symptoms during respiration, deglutition and speech. The main therapeutic issue after exact diagnosis is the restoration of thyroid function, and surgical intervention, when necessary, has to deal with problems related to the site and function of the ectopic gland. A case of a 25-year-old female with dyspnoea and dysphagia due to a 3 x 4 cm ectopic lingual thyroid, excised by an original peroral approach via a mandibular midline osteotomy, is reported. Our surgical technique is described and the diagnostic and therapeutic problems are reviewed.

A modified anterior maxillary osteotomy: 15 years experience.

A modified technique of anterior maxillary osteotomy is described, based mainly on the Wassmund (buccal aspect) and the Wunderer (palatal aspect) methods. Experience of 148 cases operated on during 15 years is presented.

[Surgical removal of a lower semimpacted wisdom tooth displaced in the pterygomandibular space]. / Cheirourgike aphairese sophronistera tes kato gnathou apothemenou ston pterygognathiaio choro. Parousiase periptoseos.

In the case which is reported in this paper there was a dislodgement of a semimpacted lower left third molar (38) into the pterygomandibular space, from a removal attempt, without the usual fracture of the lingual plate of the alveolar bone. There is an anatomical description of the pterygomandibular space, the operative complications during removal of impacted lower teeth and more specific the displacement of teeth or roots into adjacent soft tissues, ways of prevention and treatment of such complications. Finally, we describe the technique which we followed to extract the dislocated lower molar in our case.

[Indications for tracheostomy in patients with oral and maxillofacial problems]. / Endeixeis tracheistomias se astheneis me gnathocheirourgiko prolema.

Tracheostomy encounters in several conditions in oral and maxillofacial surgery. Upper airway obstruction is the most common, often occurring secondary to maxillofacial trauma. Obstruction may also be caused by neoplasms of the oral cavity, by hematoma, oedema, abscess or allergy. In this paper we discuss the indications for tracheostomy in patients with oral and maxillofacial problems and the complications that may occur in patients from the procedure itself.

[Apicoectomy and reverse filling procedure in posterior teeth]. / Akrorrhizektomes kai anastrophes emphraxeis opisthion odonton.

In this paper, we present the apicoectomy with reverse filling procedure in posterior teeth, as an alternative surgical method, in those cases where conservative endodontic treatment is unable or fails to bring successful results (prosthetic restorations, broken instruments, calcified and tortuous root canals, dens in dente, unfinished root apex). We choose to restrict our presentation in posterior teeth where the surgical procedure is more difficult due to anatomical conditions (maxillary sinus, mandibular canal, number of root canals, inaccessible posterior oral cavity, etc). We analyse the indications of such an operation and the elements we examine to evaluate the cases. We are showing the different stages of the operation as well as the usage of original instruments for the retrograde amalgam procedure. There is a further discussion on problems from the usage of the filling material, the dental amalgam, and, the problems throughout the procedure (level and degree of the apical bevel, cavity preparation, etc).