Predictors of distress associated with altered appearance and function in people treated surgically for oral cancers: a cross-sectional study.

This cross-sectional study was performed to examine sources of variation in distress associated with altered appearance and fundamental functions in oral cancer patients at 2 months, 12-15 months, 24-36 months, and ≥ 5 years post-definitive treatment. Eligible patients completed six scales from the FACE-Q Head and Neck Cancer Module. Pre-specified regression models were used to examine sources of variation in study outcomes for 145 patients. Patient self-reports indicated that distress associated with altered appearance and fundamental functions was highly variable, and distress was present beyond 5 years post-definitive treatment in some patients. Associations between distress scores and time post-definitive treatment, reconstructive surgery, and adjuvant therapy were not statistically significant. There was, however, moderate to strong evidence against the null hypothesis of no association between eating distress scores and sex, primary cancer site, and T-stage; smiling distress scores and age and primary cancer site; appearance distress scores and geographical remoteness and primary cancer site; and speaking distress scores and primary cancer site. Primary cancer site was the only significant independent predictor of multiple distress scores. These findings suggest that predicting the psychological impact of oral cancer treatment remains a challenge for the multidisciplinary team. Screening and interventions for psychological distress are essential beyond the preoperative and acute care settings.

The impact of travel distance to treatment centre on oral tongue squamous cell carcinoma survival and recurrence.

There have been no prior studies examining the effect of distance to the treatment centre on oral squamous cell carcinoma outcomes in Australia. The purpose of this study was to analyse the impact of travel distance on oral tongue squamous cell carcinoma (OTSCC) outcomes. This was a retrospective analysis of 243 patients who received surgical treatment ± adjuvant therapy between 2007 and 2016. The overall survival (OS), disease-specific survival (DSS), and freedom from loco-regional failure (FFLRF) survival analyses were conducted using Kaplan-Meier curves and a multivariate Cox proportional hazards model. A competing risk (CR) analysis was conducted. Patients living ≥200 km from the treatment centre, when compared with those living within 40 km, had worse OS (hazard ratio (HR) 3.11, 95% confidence interval (CI) 1.74-5.54), DSS (HR 2.58, 95% CI 1.30-5.12), and FFLRF (HR 2.47, 95% CI 1.22-5.01). These discrepancies were significant when adjusted for socioeconomic status (OS P < 0.001, DSS P 0.004, FFLRF P = 0.005) and in the presence of CR (OTSCC-specific death with CR 'non-disease-related death' P =0.030, FFLRF with CR 'any cause death' P = 0.013, FFLRF with CR 'OTSCC-specific death' P = 0.004). Patients with OTSCC living ≥200 km from the treatment centre were found to have worse outcomes than those living within 40 km.

Lateral temporal bone resections for peri-auricular cutaneous squamous cell carcinoma: prognostic indicators and radiological predictive values.

BACKGROUND: Lateral temporal bone resections are used in the management of locally advanced peri-auricular cutaneous squamous cell carcinomas, but there is still conflicting evidence regarding the staging, surgical and adjuvant treatment decisions. METHODS: A retrospective analysis was performed on all patients who underwent lateral temporal bone resection for cutaneous squamous cell carcinoma between January 2015 and December 2019 at a dedicated tertiary oncology referral centre. RESULTS: Twenty-nine patients were included, with a median age of 77 years. Computed tomography, magnetic resonance imaging and positron emission tomography showed good diagnostic accuracy in identifying disease in the parotid gland, external auditory canal and mastoid bone, but had poor sensitivity in identifying cervical nodal metastasis. Six patients had recurrence at a median of 4.8 months post-operatively. Tumour differentiation (p = 0.0040) and post-operative radiotherapy (p = 0.0199) were associated with significantly better recurrence-free survival. CONCLUSION: Lateral temporal bone resection for peri-auricular cutaneous squamous cell carcinoma requires careful surgical planning using clinico-radiological correlation, particularly in patients with poorly differentiated tumours.

Facial artery musculomucosal flaps in oropharyngeal reconstruction following salvage transoral robotic surgery: a review of outcomes.

OBJECTIVE: There has been little reported on the transoral reconstructive options following salvage transoral robotic surgery. This paper describes the facial artery musculomucosal flap as a method to introduce vascularised tissue to a previously irradiated resection bed. METHODS: A facial artery musculomucosal flap was used to reconstruct the lateral pharyngeal wall in 13 patients undergoing salvage transoral robotic surgery for oropharyngeal squamous cell carcinoma. Outcomes recorded include flap and donor site complications, length of stay, and swallowing and speech outcomes. RESULTS: There were no immediate or late flap complications, or cases of delayed wound healing in this series. There were two facial artery musculomucosal related complications requiring surgical management: one bleed from the facial artery musculomucosal donor site and one minor surgical revision. Healing of the flap onto the resection bed was successful in all cases. CONCLUSION: The facial artery musculomucosal flap provides a suitable transoral local flap option for selected patients undergoing salvage transoral robotic surgery for oropharyngeal malignancies.

A study of out-of-hours facilities in otolaryngology: current provision and problems.

'Action on ENT' has recently published advice as to the minimum requirements for equipment required to provide a safe and suitable out-of-hours service in ENT. Our objectives were to determine the availability of a dedicated ENT treatment room for seeing patients out of hours, appropriately maintained specialized ENT equipment and availability of appropriate assistance. In addition, the mechanism for disinfection of nasoendoscopes out of hours was determined. Telephone questionnaires of 106 ENT units in England, which provide an out-of-hours ENT service, were taken. At each unit the standard questionnaire was answered by the first on-call ENT doctor. One hundred and one units (95 percent) had access to a dedicated treatment room out of hours. The number of units with a microscope was 91 (86 percent), headlight/lamp and mirror was 105 (99 percent), flexible nasoendoscope was 86 (81 percent) and cautery (electrical or chemical) was 105 (99 percent). Seventy-nine units (75 percent) found that their treatment rooms were adequately stocked, and 62 units (58 per cent) had assistance available when needed. Twenty-four units (23 percent) sterilized their scopes adequately, 22 units (21 percent) used endosheaths, 26 units (24 percent) used a variety of inadequate cleaning methods, and 34 respondents (32 percent) were unsure how their scopes were cleaned. This survey has shown that not all ENT units have appropriately equipped out-of-hours facilities. There is a need for nationally agreed guidelines stating the minimum equipment and assistance required to provide a safe, adequate and suitable out-of-hours service. National guidelines on out-of-hours disinfection of flexible nasoendoscopes are also required.

Ball valve nasal obstruction following incomplete inferior turbinectomy.

An interesting case is presented of a 53-year-old male who was seen with a 10-year history of intermittent, unilateral nasal obstruction following a bilateral total inferior turbinectomy. A pedunculated mass was seen in the right posterior nasal space acting as a ball valve. This was removed and found to be residual turbinate tissue.

Dynamic evaluation and early management of altered motor control around the shoulder complex.

Altered dynamic control appears to be a significant contributing factor to shoulder dysfunction. The shoulder relies primarily on the rotator cuff for dynamic stability through mid-range. Hence, any impairment in the dynamic stabilizing system is likely to have profound effects on the shoulder complex. The rotator cuff appears to function as a deep stabilizer, similar to the transversus abdominus and vastus medialis obliquus, with some evidence of disruption to its stabilizing function in the presence of pain. Similarly, serratus anterior appears to function as a dynamic stabilizer, also demonstrating altered function in painful shoulders. Examination of dynamic control begins with a detailed examination of posture, evaluation of natural movement patterns and functional movements and assessment of the specific force couples relevant to shoulder function. One useful strategy in management of altered motor control related to these force couples is that of training isolated contraction of the rotator cuff prior to introduction of loaded activity, together with facilitation and training of appropriate scapular muscle force couples--serratus anterior and trapezius, in relation to arm elevation.

Specific evaluation of the function of force couples relevant for stabilization of the glenohumeral joint.

Two clinical evaluation procedures for assessment of dynamic stability of the glenohumeral joint are presented in this paper, together with the biomedical evidence on which they are based. They are the Dynamic Rotary Stability Test (DRST) and the Dynamic Relocation Test (DRT). The purpose of the tests is presented and the technique required to perform the tests are described in detail.

Variation in shoulder position sense at mid and extreme range of motion.

OBJECTIVE: To determine the effect of different joint positions on position sense of asymptomatic shoulders. DESIGN: Repeated-measures design. SETTING: Laboratory in an educational institution. PARTICIPANTS: Thirty-four asymptomatic, right-handed men. INTERVENTIONS: The ability of subjects to replicate 3 criterion positions was examined on subjects' right shoulders by using an isokinetic dynamometer. Three criterion positions were the 50th, 75th, and 90th percentiles of each individual's total passive shoulder rotation range measured from the full internal rotation position. MAIN OUTCOME MEASURE: Repositioning accuracy, indicating the difference in degrees between the criterion and matching positions. RESULTS: All subjects were able to reproduce the criterion position near the end of external rotation range more accurately and consistently than in the middle range of motion (ROM). CONCLUSIONS: Position sense acuity at the shoulder complex varied across the ROM and may be enhanced near the end of rotation range where there is more tension on the restraints to movement. Therefore, an individual's ROM should be factored into any attempt to assess or rehabilitate shoulder proprioception.

The Musculoskeletal Physiotherapy of Australia position on pre-manipulative testing for the cervical spine.

The MPA undertook a survey of its members in 1997 to determine their compliance with and opinion of the APA Protocol for Pre-Manipulative Testing of the Cervical Spine (Magarey et al 2000a, Magarey et al submitted-a). As a result of that survey and a comprehensive literature review, the MPA developed a new set of guidelines for premanipulative procedures for the cervical spine (Magarey et al 2000b, Magarey et al submitted-b).

EMG and strength correlates of selected shoulder muscles during rotations of the glenohumeral joint.

OBJECTIVE: To identify activation patterns of several muscles acting on the shoulder joint during isokinetic internal and external rotation. DESIGN: Combined EMG and isokinetic strength analysis in healthy subjects. BACKGROUND: EMG studies of the shoulder region revealed intricate muscular activation patterns during elevation of the arm but no parallel studies regarding pure rotations of the joint could be located. METHODS: Fifteen (n=30 shoulders) young, asymptomatic male subjects participated in the study. Strength production during isokinetic concentric and eccentric internal and external rotations at 60 and 180 degrees /s was correlated with the EMG activity of the rotator cuff, biceps, deltoid and pectoralis major. Analysis of the smoothed EMG related to the timing of onset of the signal and to the normalized activity at the angle of the peak moment. Determination of the association between the EMG and the moment was based on strength ratios. RESULTS: Findings indicated that for both types of rotations, the rotator cuff and biceps were active 0.092+/-0.038-0.215+/-0.045 s prior to the initiation of the actual movement and 0.112-0.034 s prior to onset of deltoid and pectoralis major activity. These differences were significant in all of the eight conditions (P<0.05). In terms of the strength ratios, strong association was found between electrical activity and moment production in the subscapularis and infraspinatus (r(2)=0.95 and 0. 72, respectively) at the low and high angular velocities. CONCLUSIONS: Prior to actual rotation of the shoulder joint, normal recruitment of the rotator cuff and biceps is characterized by a non-specific presetting phase which is mainly directed at enhancing the joint 'stiffness' and hence its stability. Once movement is in progress, the EMG patterns of these muscles become movement specific and are correlated with the resultant moment. RELEVANCE: Muscular dysfunction relating to delayed onset activity or altered activation patterns, due to pain, perturbed mechanics or disturbed neural activation have been implicated as concomitant factors in other joint associated pathologies. Through highlighting the role of the rotator cuff in shoulder joint rotations, this study lends further support to the argument that a parallel situation may prevail with respect to shoulder joint dysfunction. This could lead to the development of rehabilitation protocols aimed specifically at redressing such dysfunction.

Differences in stakeholder expectations in the outcome of physiotherapy management of acute low back pain.

OBJECTIVE: To compare stakeholder expectations of outcome of physiotherapy management of acute low back pain. DESIGN: Observational design using interviews and questionnaires. SETTING: Practice/workplace. STUDY PARTICIPANTS: The study sample was from South Australia. It comprised 74 physiotherapists randomly selected from professional association listings (49.3% response rate), 121 physiotherapy patients (recruited by participating physiotherapists when attending their first physiotherapy treatment for acute low back pain), 21 general practitioners randomly selected from medical practitioner listings in the metropolitan telephone book (36.2% response rate) and 13 third party payers of a total of 16 available insurers in the metropolitan area (82% response rate). MAIN OUTCOME MEASUREMENTS: Stakeholders reported expectations of outcome at the end of the first treatment session and at the completion of the episode of care. RESULTS: There were differences in expectations between stakeholders, as well as between naive and experienced patients. Overall, patients expected symptom relief at the end of the first treatment. Naive patients decided to return for further treatment based on the relationship established with the therapist, whereas experienced patients also expected some advice on their condition during the first contact. Physiotherapists and referrers expected symptom relief and then long-term management strategies to be provided, and third party payers expected cost-efficient management of the condition and patient satisfaction. CONCLUSION: Physiotherapists need to address potential imbalance of consumer knowledge and foster a quality partnership with their patients on the first visit to physiotherapy. Patients who are in pain may not derive full value from information provided in an untimely manner.

Biomedical considerations and clinical patterns related to disorders of the glenoid labrum in the predominantly stable glenohumeral joint.

SUMMARY. The roles of the glenoid labrum and long head of biceps are reviewed together with their significance in stability of the glenohumeral joint. Clinical presentations related to disorders of the glenoid labrum and long head of biceps not associated with frank instability but commonly responsible for dysfunction in the athletic shoulder, are reviewed from the perspective of pertinent anatomical, biomechanical and kinematic knowledge. Copyright 1996 Harcourt Publishers Ltd.

Clinical diagnosis and management of minor shoulder instability.

The term minor instability refers to a condition in which chronic microtrauma involving the stabilising mechanisms of the glenohumeral joint leads to subluxation of the humeral head. The condition is commonly associated with athletes involved in repetitive high-velocity activities such as throwing or swimming. Minimal signs are found on physical examination of the shoulder joint but the patient presents with vague pain, catches of pain, apprehension with overhead movement or an impingement-like condition which appears resistant to treatment. The clinical examination findings which might alert the physiotherapist to the potential diagnosis of minor instability are reviewed. Following this, an approach to management with emphasis on establishing muscular control in the early stages of rehabilitation is presented.