Donor-site morbidity of free fibula and DCIA flaps.

PURPOSE: This study evaluated and compared the long-term donor-site morbidity of the free fibula flap with the deep circumflex iliac artery (DCIA) flap in maxillofacial reconstruction. MATERIALS AND METHODS: Thirty-four patients (19 in the fibula group and 15 in the DCIA group) were evaluated for long-term morbidity. All clinical data were analyzed, including primary disease, type of defect, type of flap, length of bone harvested, total blood loss, operating time, length of hospitalization, and postoperative unaided gait. Subjective evaluation included cosmesis, function, and pain. Objective evaluation included physical examination, neurosensory assessment, Stony Brook Scar Evaluation, gait assessment, and goniometric measurement of range of movement. RESULTS: In the subjective evaluation, no significant differences in cosmetic outcome, functional loss, wound healing, or pain between the 2 groups were noted (P > .05). However, neurosensory deficit was worse in the DCIA group (P ≤ .05). In the objective evaluation, 4 patients (27%) in the DCIA group had neurosensory deficit in the lateral thigh region. The DCIA group had a better Stony Brook Scar score (median, 5) than the fibula group (median, 4; P ≤ .05). However, there was no difference in walking ability between the 2 groups (P > .05). Goniometric measurement showed a significant difference between the operated and unoperated sites in the 2 groups; however, it was not severe enough in either group to affect patients' function. In the fibula group, 7 patients (38.9%) had claw toe deformity and 2 patients (12.1%) had weakness of the great toe, and the mean American Orthopedic Foot and Ankle Society score was 96.89. In the DCIA group, 1 patient (8.3%) had a hernia and the mean Harris Hip score was 98.33. CONCLUSION: Given that these 2 options present donor-site concerns, the authors consider the fibula free flap the first choice for maxillofacial reconstruction in most cases and the DCIA free flap a reliable complementary flap in selected patients.

Speech and swallowing following tongue cancer surgery and free flap reconstruction--a systematic review.

This was a systematic review of the current research on speech and swallowing outcomes and the factors affecting these outcomes after primary resection of tongue cancer and free flap reconstruction. A structured search in various electronic databases and relevant journals was performed. Retrieved articles were critically appraised in three rounds according to the level of evidence, the methodological quality, and the specific domain of speech and swallowing. A total of 21 articles were in the final review and the findings were categorized according to the area of tongue resection. For patients with resection and free flap reconstruction limited to either the oral tongue or the base of tongue (BOT), significant decline in speech and swallowing function was evident in the early postoperative phase, but the majority recovered close to preoperative level after 1 year. Poorer speech and swallowing outcomes were found following resections involving both oral and base of tongue (OBOT) regardless of the type of free flap reconstruction. Results overall were influenced by multiple factors including tumor size, area of resection, method of reconstruction and the use of adjuvant therapy. The use of free flaps in the immediate reconstruction of the tongue after tumor resection should aim at the maintenance of the mobility of the residual tongue and restoration of tongue bulk in order to optimize the recovery of speech and swallowing function. Future research in this field should employ standardized and reliable evaluation of speech and swallowing outcomes using multiple modalities in well-designed cohort studies with longer follow-up.

Biomaterials for repair of orbital floor blowout fractures: a systematic review.

PURPOSE: To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults. MATERIALS AND METHODS: A systematic search of the English literature was performed in the databases of PubMed, Cochrane Library, and EMBASE. The study selection process was adapted from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, and 55 articles complied with the study inclusion criteria. The primary outcome measures were diplopia, enophthalmos, graft extrusion/displacement, and infection related to the graft material. The secondary outcome measures were infraorbital paresthesia, orbital dystopia, orbital soft tissue entrapment, and donor-site complications. RESULTS: Of 55 articles, 41 (74.5%) evaluated were retrospective case series, 9 (16.4%) were retrospective case-control studies, 3 (5.5%) were controlled trials, and 2 (3.6%) were prospective case series. Autogenous graft materials were predominantly used in 19 studies, alloplastic materials were used in 33 studies, and the remaining 3 articles reported on allogeneic materials. Overall, 19 different types of implant materials were used in 2,483 patients. Of 827 patients with diplopia before surgery, 151 (18.3%) had diplopia postoperatively. Of 449 patients with enophthalmos before surgery, 134 (29.8%) had enophthalmos postoperatively. Only 2 patients (0.1%) and 14 patients (0.6%) had graft extrusion/displacement and infection related to the graft material, respectively; alloplastic biomaterials were used in all of these cases. CONCLUSIONS: All graft materials used were successful to variable degrees because all studies reported improvement in terms of the recorded outcome measures. A guideline for choice of implant material based on defect size was developed.

Risk factors for osteoradionecrosis after head and neck radiation: a systematic review.

OBJECTIVE: This systematic review aimed to answer the clinical question, "What is the current risk of developing osteoradionecrosis of the jaws among irradiated head and neck cancer patients?" STUDY DESIGN: A systematic review of published English-language randomized controlled trials on the outcome of radiation therapy was performed via Medline and Embase databases. Data on osteoradionecrosis/bone toxicity were collected and analyzed. RESULTS: Twenty-two articles reporting on a total of 5,742 patients were selected for final review based on strict eligibility criteria. An estimated 2% of the head and neck-irradiated patients are at risk of developing osteoradionecrosis. Patients receiving adjunctive radiotherapy, accelerated fractionation without dose reduction, and chemoradiotherapy show no increase in osteoradionecrosis risk. Accelerated fractionation with dose reduction is associated with a reduced risk, whereas hyperfractionation shows elevated risk of developing osteoradionecrosis. CONCLUSIONS: The risk of developing osteoradionecrosis among the irradiated head and neck cancer patient has significantly declined in recent years.

Interaction of hope and optimism with anxiety and depression in a specific group of cancer survivors: a preliminary study.

BACKGROUND: Anxiety and depression have been identified as a common psychological distress faced by the majority of cancer patients. With the increasing number of cancer cases, increasing demands will be placed on health systems to address effective psychosocial care and therapy. The objective of this study was to assess the possible role of hope and optimism on anxiety and depression. We also wanted to investigate if there is a specific component of hope that could play a role in buffering anxiety and depression amongst cancer patients. METHODS: A retrospective cross sectional study was conducted in the outpatient station of the Oral and Maxillofacial Surgery at the University of Hong Kong, Hong Kong SAR, PR-China. Fifty patients successfully treated for OC cancer were recruited after their informed consents had been obtained during the review clinic. During their regular follow-up controls in the outpatient clinic the patients compiled the hospital anxiety and depression scale (HADS), hope scale (HS) and the life orientation scale-revised (LOT-R). RESULTS: Hope was negatively correlated with depression (r = -.55, p < .001) and anxiety (r = -.38, p < .05). Similar pattern was found between optimism and the latter adjustment outcomes (depression: r = -.55, p < .001; anxiety: r = -.35, p < .05). Regression analyses indentified that both hope and optimism were significant predictors of depression. Hope and optimism had equal association with depression (hope: ß = .40 versus optimism: ß = .38). Hope and optimism together were significantly predictive of anxiety, whereas neither hope nor optimism alone was significant individual predictors of anxiety. CONCLUSIONS: Hope and optimism both negatively correlated with patients' level of anxiety and depression. Besides theoretical implications, this study brings forward relevant findings related to developing specific clinical psychological care in the field of oncology that to date has not been researched specifically in the field of oncology. The results of this study will help guide the direction of future prospective studies in the field of oncology. This will contribute significantly to increasing patients quality of life as well enabling health care facilities to provide all cancer patients a more holistic cancer care.

The roles of hope and optimism on posttraumatic growth in oral cavity cancer patients.

To investigate the association of the positive coping strategies, hope and optimism, on posttraumatic growth (PTG) in oral cavity (OC) cancer patients. A retrospective cross-sectional study was conducted and performed in the outpatient station of the Oral and Maxillofacial Surgery at the University of Hong Kong, Hong Kong SAR, PR China. Fifty patients successfully treated for OC cancer were recruited after their informed consents had been obtained during the review clinic. During their regular follow-up controls in the outpatient clinic, the patients compiled the posttraumatic growth inventory (PTGI) questionnaire, hope scale (HS) and the life orientation scale-revised (LOT-R). Hope and optimism correlated significantly positive with PTG and accounting together for a 25% variance of posttraumatic growth. Hope positively correlated with posttraumatic growth (r=.49, p<.001) as well as optimism (r=.31, p<.05). When compared to unmarried patients, married patients showed high levels of PTG and hope (married participants: mean=53.15, SD=11.04; unmarried participants: mean=41.00, SD=6.36; t (48)=2.403, p<.05). Hope and optimism represent important indicators for PTG in OC cancer patients. An intact dyad relationship seems to be important for hope and consecutive higher levels of PTG when compared to unmarried patients. Supportive psychological treatment strategies related to these two coping factors might be beneficial for OC cancer patients.

Effects of Class III malocclusion on young male adults' vocal tract development: a pilot study.

PURPOSE: To compare the vocal tract configuration between male speakers with Class III malocclusion and their normally developing counterparts and to investigate the concomitant acoustic changes caused by the alterations in vocal tract configuration. PATIENTS AND METHODS: Eight young male patients with Class III malocclusion and 8 normally developing counterparts participated in this study. Acoustic reflection technology was used to measure vocal tract dimensions in the 2 groups. A continuous speech sample and 4 sustained vowels (/a/, /æ/, /i/, and /u/) were recorded from each participant to obtain the fundamental frequency and the first 3 formant frequencies (F1, F2, and F3). RESULTS: The results showed significantly greater oral length and oral volume for young male patients with Class III malocclusion than their cohorts. The F1 of vowel /u/ was found to be significantly higher in male patients with Class III malocclusion than their cohorts. The vowel space of the 4 recorded vowels was reduced and the F1-F2 formant map for /u/ was relatively more scattered in male patients with Class III malocclusion than in the control speakers. CONCLUSION: This study has provided preliminary information on the effects of Class III malocclusion on vocal tract configuration and concomitant acoustic changes in young male patients.

Change in quality of life after combined orthodontic-surgical treatment of dentofacial deformities.

OBJECTIVE: To determine changes in quality of life (QoL) after orthodontic-surgical treatment in patients with dentofacial deformities, using generic health, generic oral health, and condition-specific QoL approaches. STUDY DESIGN: Patients were evaluated at baseline (T(0)), postoperative 6 weeks (T(1)), postoperative 6 months (T(2)), and after orthodontic treatment (T(3)). Generic health-related QoL, generic oral health-related QoL, and condition-specific QoL were assessed using the 36-item Short Form Health Survey (SF-36), the 14-item Short Form Oral Health Impact Profile (OHIP-14), and the 22-item Orthognathic Quality of Life Questionnaire (OQLQ), respectively. RESULTS: There were significant changes in Physical-Health Component Scores (PCS) (P < .001) and Mental-Health Component Scores (MCS) (P < .01) of SF-36, in OHIP-14 scores (P < .001), and in OQLQ scores (P < .001) during the trajectory of treatment. A transient decrease in PCS was found at T(1) (P < .001) and an increase in MCS was found only at T(3) (P < .05). There was a significant decrease in OHIP-14 scores at T(2) and T(3) (P < .001) and in OQLQ scores at all time points compared with T(0) (P < .05). CONCLUSION: Significant changes in QoL occurred after orthodontic-surgical treatment. A comprehensive assessment of QoL using generic health, generic oral health, and condition-specific approaches proved to be useful in determining the trajectory of changes.

Facial skin sensibility in a young healthy chinese population.

OBJECTIVE: To quantify normal neurosensory facial sensibility in a young healthy Chinese population for use as a reference when evaluating postoperative nerve damage. STUDY DESIGN: One hundred consecutive eligible normal young Chinese individuals were included. Each subject underwent objective neurosensory testing (static light touch, 2-point static, and pain detection thresholds) at 8 facial sites within the distribution of the trigeminal nerve. Data were calculated into means and standard deviations, and paired t tests were used to compare values between the left and right sides and quadrants; unpaired t test was used to compare the values between genders. A P value of

Craniofacial profile in Southern Chinese with hypodontia.

The association between craniofacial morphology and congenitally missing teeth is at present unclear. The aims of this study were to investigate whether hypodontia is associated with changes in the sagittal skeletal profile and to identify putative relationships between the skeletal profile and the severity of hypodontia. In a cross-sectional analytical study, the craniofacial structure and profile based on two-dimensional lateral cephalograms of Southern Chinese hypodontia patients (n = 49, 24 males, 25 females, mean age 16.4 years) and a comparison group without hypodontia (n = 41, 15 males, 26 females, mean age 16.7 years) were compared. The hypodontia patients were divided into three subgroups according to the severity of hypodontia (mild: < or =5, moderate: 6-9, and severe: > or =10 congenitally missing permanent teeth). All hypodontia patients had a significantly reduced mandibular plane, ANB, and face height compared with the control group (P < 0.05). A significant increase in chin thickness was also observed in the hypodontia patients (P < 0.05). As the severity of hypodontia increased from moderate to severe, a tendency to develop a retrognathic maxilla and a Class III skeletal relationship was noted in addition to the above features, making the already thick chin even more prominent. Statistically significant correlations (Pearson's correlation coefficient) were found between the number of missing teeth and SNA, NAFH, and ANB angles, the mandibular plane, chin thickness, and face height. In Southern Chinese subjects, hypodontia was associated with a shorter face, a flatter mandibular plane, a more pronounced chin, and a Class III skeletal profile. In severe hypodontia subjects, the maxilla was more retrognathic with a greater predilection to a Class III skeletal relationship.

The effect of tranexamic acid on blood loss during orthognathic surgery: a randomized controlled trial.

PURPOSE: Tranexamic acid has been used to reduce blood loss and the subsequent need for transfusion in orthopedic, spinal, and cardiac surgery. Orthognathic surgery can be associated with significant bleeding yet its efficacy in this setting is not clear. The purpose of this study was to investigate the effect of tranexamic acid on blood loss during bimaxillary osteotomy. PATIENTS AND METHODS: Seventy-three consecutive patients, scheduled for elective bimaxillary osteotomy, were included in this double blind, randomized, controlled trial. They received either a bolus of tranexamic acid (20 mg/kg) or placebo (normal saline) intravenously just before surgery. All patients received induced mild hypotension and had surgery according to a standard protocol. Intraoperative blood loss, operation time, transfusion of blood products, perioperative hemoglobin, and hematocrit were recorded. RESULTS: The total blood loss and blood loss during maxillary surgery was reduced significantly in the tranexamic acid group compared with the control group (878.6 +/- 577.7 mL vs 1,257.2 +/- 817.8 mL and 428.0 +/- 233.3 mL vs 643.8 +/- 430.0 mL, respectively; P < .05). Considering the duration of operation and the treatment groups only, the mean total blood loss in the control group was 422 mL more than that in the tranexamic acid group (P < .001). There was no significant difference in blood transfusion or the length of hospital stay between the 2 groups. CONCLUSION: Preoperative intravenous bolus administration of tranexamic acid at 20 mg/kg reduces blood loss compared with placebo during bimaxillary osteotomy.

Translation and evaluation of a Chinese version of the Child Oral Health-related Quality of Life measure.

OBJECTIVE: This study aims to translate and evaluate the performance of a Chinese version of the Child Oral Health-related Quality of Life (COHQoL) measure composed of the Child Perception Questionnaire (CPQ), Parental Perception Questionnaire (PPQ), and Family Impact Scale (FIS). BASIC RESEARCH DESIGN: Chinese versions of the measures were derived through a forward-backward translation. A consecutive sample of 168 children attending paediatric dental and orthodontic clinics in Hong Kong were recruited along with their attending primary caregiver. Children self-completed the 37-item CPQ and their attending primary caregiver self-completed the 31-item PPQ and 14-item FIS consecutively and independently. Reassessments were conducted prior to their next appointment. RESULTS: CPQ, PPQ, and FIS scores were associated with children's global rating of oral health (P < 0.05) and oral well-being (P < 0.05) supporting their construct validity. In addition, variations in CPQ, PPQ, and FIS were apparent with respect to patient group (P < 0.05) supporting their ability to distinguish between patient groups. Cronbach alpha values (internal reliability) and intraclass correlation coefficient values (test-retest reliability) for the three measures were > 0.80. CONCLUSION: A Chinese version of the three components of the COHQoL measure was developed with minor modifications. In psychometric testing, the validity of the three components was supported and they demonstrated acceptable reliability.

Impact of orthognathic surgery on quality of life.

PURPOSE: To determine changes in quality of life (QOL) following orthognathic surgery in patients with dentofacial deformity, using generic health, generic oral health, and condition-specific QOL approaches. MATERIALS AND METHODS: Thirty-six patients were evaluated at baseline presurgical (T(0)), 6 weeks postoperatively (T(1)), and 6 months postoperatively (T(2)). Generic health-related QOL was assessed using the 36-item Short Form Health Survey (SF-36), generic oral health-related QOL was assessed by the 14-item Short Form Oral Health Impact Profile (OHIP-14), and condition-specific QOL was assessed by the 22-item Orthognathic Quality of Life Questionnaire (OQLQ). RESULTS: There was a significant reduction (deterioration) in SF-36 summary physical (P < .01) and mental health scores (P < .001) at 6 weeks after surgery but no significant change in overall OHIP-14 or OQLQ scores. At 6 months after surgery, SF-36 summary scores returned to baseline levels and significant reduction (improvements) in OHIP-14 (P < .001) and OQLQ mean scores (P < .001) were observed. CONCLUSIONS: Significant changes in QOL occurred following orthognathic surgery. A marked but transient deterioration in many aspects related to general well being was noted in the early postoperative period and significant improvement was documented by 6 months. A comprehensive assessment of QOL using generic health, generic oral health, and condition-specific approaches proved useful in determining such changes.

Stereomodel-assisted fibula flap harvest and mandibular reconstruction.

PURPOSE: To describe a method for stereomodel-assisted fibula flap harvest and mandibular reconstruction utilizing multiple fibula bony segments. MATERIALS AND METHODS: Stereomodels of the mandible and the fibula were obtained from computed tomography scan data. The length of fibula to be harvested was predetermined by measurement of the stimulated of existing mandibular defect on the mandibular stereomodel. A titanium reconstruction plate was shaped to fit the original mandibular contour. The stereomodel fibula was divided into multiple segments and the segments were placed on the mandibular stereomodel in the ideal edentulous position against the upper dentition and simulate the angular contour of the mandible for best comesis. The predetermined bony segments were measured and the system was then transferred to the patient in the operation theater using acrylic locating splints. RESULTS: Experience with 8 patients (2 primary and 2 secondary reconstructions) indicated that a good clinical outcome in terms of mandibular contour and positions of the reconstructed segment was possible. The outer facial appearance and symmetry were consistently excellent and no instability or malposition of the graft segments was encountered. CONCLUSION: Stereomodel-assisted fibula flap harvest and insertion is a worthwhile attempt at improving the results of mandibular reconstruction and deserves further attention.