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Biomedical subjects

S N Rogers

Publications and source records attributed to S N Rogers.

At least 37 records · Page 2Linked to original sources
PubMed2004

The Liverpool Oral Rehabilitation Questionnaire: a pilot study.

There are several validated health-related quality of life (HRQOL) questionnaires designed to record patient-derived outcomes in head and neck cancer. None deals specifically with oral rehabilitation. The aim of this study was to pilot a new questionnaire, the Liverpool Oral Rehabilitation Questionnaire (LORQ). The questionnaire consists of 25 items about oral function and denture satisfaction. A four-point Likert scale is used. Sixty-one consecutive patients attending oral rehabilitation clinics completed the LORQ in combination with the University of Washington Head and Neck questionnaire version 3 (UW-QOL) and European Organisation for Research and Treatment of Cancer H and N quality of life questionnaire (EORTC H and N 35). Forty-two patients received questionnaires at baseline, whereas the rest were provided with the questionnaires at various stages of oral rehabilitation. For each item on the questionnaire, a full range of possible responses were given by patients. Kappa coefficients of agreement for test-retest data indicated moderate to very good agreement between repeat questionnaires. There were significant correlations (P < 0.001) between items in the LORQ and those in the UW-QOL and EORTC HN questionnaires. The LORQ also identified differences in responses between non-cancer and cancer groups of patients undergoing oral rehabilitation. This study of the LORQ is encouraging, although data on its responsiveness over time and to intervention is awaited.

Atrophy↗
PubMed2004

A national survey of health-related quality of life questionnaires in head and neck oncology.

AIMS: To identify the health-related quality of life (HRQOL) questionnaires employed by the physicians and surgeons who manage patients with head and neck cancer. Also, to gain an impression of the perceived difficulties and advantages of their use. METHODS: A national survey was performed of active UK consultant clinicians on the mailing list of the British Association of Head and Neck Oncologists. RESULTS: Of 267 questionnaires, there were 191 replies (71.5%) from clinical oncologists (40), ENT surgeons (53), general surgeon (1), oral and maxillofacial surgeons (59), and plastic surgeons (38). Fifty-five consultants (29%) used HRQOL questionnaires and the most popular questionnaire was the University of Washington Head and Neck Cancer (65%). Questionnaires were most likely to be used both before and after treatment (67%) and administered in clinic by either nursing staff or consultants. The main reasons for not using HRQOL questionnaires included lack of resources and proven value. CONCLUSIONS: Despite the vast amount of literature on the importance of HRQOL in head and neck cancer, this survey shows that there is still a substantial amount of work required before HRQOL measurement becomes an established part of routine practice.

Head and Neck Neoplasms↗
PubMed2003

Factors that influence the outcome of salvage in free tissue transfer.

INTRODUCTION: The success of salvage techniques for free tissue transfer is well documented. The aim of this study was to identify factors that influenced the results of salvage operations in a group of patients who required early exploration. METHODS: From a database survey of 408 patients who had a total of 427 free tissue transfer reconstructions, 65 (16%) returned to the operating theatre within 7 days. A retrospective analysis of their progress was made from the case records. RESULTS: The flap chart was found to be highly accurate for the 65 patients who had returned to the operating theatre, reporting two false positives and one false negative. Forty patients had compromised flaps and 25 had haematomas that required evacuation. The commonest problem with flaps was venous congestion (33/40, 83%), and 29 flaps were successfully salvaged (73%). Most successful salvage attempts were made within 24 hours of the end of the initial operation. The salvage rate was higher for the radial fasciocutaneous flaps (25/30, 83%), than for composite flaps (2/7, 29%). A total of 24/427 flaps failed (6%). CONCLUSIONS: We now recommend hourly observations of the flap for 24 hours followed by 4-hourly monitoring for 48 hours. Improved monitoring techniques for composite grafts may result in more being salvaged and a better overall survival.

Anastomosis, Surgical↗
PubMed2003

Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread.

The prognostic significance of extracapsular spread of cervical metastases in oral cancer is still controversial. To investigate the importance of extent of extracapsular spread; the relationship between extracapsular spread and both traditional measures of metastatic disease and clinical/histological features of the primary tumour, and to determine their relative prognostic significance. The survival of 173 patients undergoing radical surgery and simultaneous neck dissection for oral/oropharyngeal squamous cell carcinoma with histologically confirmed nodal metastasis and followed for 2.2-12.3 years is reported and related to pathological features. The most predictive clinical/histopathological features were determined by Cox regression modelling. The 3-year survival probability was similar for patients with macroscopic and only microscopic extracapsular spread (33 and 36%, respectively, compared with 72% for patients with intranodal metastasis). The Cox model showed the most predictive factor was extracapsular spread followed by status of resection margins. Extracapsular spread should be incorporated into pathological staging systems. Even microscopic extracapsular spread is of critical importance and must be sought especially in small-volume metastatic disease.

Adult↗
PubMed2003

The prognostic implications of the surgical margin in oral squamous cell carcinoma.

The prime objective of tumour ablation in oral squamous cell carcinoma (OSCC) is the removal, with a 'margin' of normal tissue, of the whole tumour. Definition of what constitutes margin involvement varies. This study aims to examine the factors associated with close and involved surgical margins in the management of OSCC. A cohort of 200 consecutive patients with previously untreated OSCC provided the material for the study. Various clinical, operative and pathological parameters were related to the status of the surgical margin, as well as time to recurrence, and survival. Cox regression analysis of the survival was also undertaken. Of the 200 patients 107 (53.5%) had clear margins, 84 (42%) close and 9 (4.5%) involved. Poor correlation was found between the status of the surgical margin and clinical factors, but in contrast high correlation between histological indicators of aggressive disease and close or involved surgical margins. These results imply that close surgical margins in OSCC could be regarded as an indictor of aggressive disease.

Aged↗
PubMed2002

A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity.

OBJECTIVES: To analyse the antibiotic prescribing trends for exodontia and minor oral surgery in patients with a history of radiotherapy. Also, to evaluate the use of hyperbaric oxygen as a separate modality in the prevention of osteoradionecrosis. DESIGN: A survey of antibiotic prescribing involving the analysis of a questionnaire which included the management of three patients with a history of head and neck malignancy. METHOD: The heads of the departments in each unit in the UK were sent a closed-response questionnaire. Antibiotic prescribing was assessed in three case scenarios. Case one referred to a patient that had surgery alone as part of the management of head and neck cancer, who needed the surgical removal of second molar roots. Case two referred to a patient that had surgery and adjuvant radiotherapy as part of the management of head and neck cancer, and needed the same procedure as in case one. Case three included a patient with a history of surgery and adjuvant radiotherapy, who required the extraction of three mobile and periodontally-involved lower incisors. Consultants were also asked about the use of hyperbaric oxygen in the patients who had radiotherapy as part of their treatment strategy. RESULTS: A total of 109 questionnaires were sent to all the Maxillofacial Units in the UK. The response rate was 73%. In patients with a history of radical surgery alone for the management of head and neck cancer, 20% of the surgeons advocated pre-operative antibiotics for the surgical removal of lower posterior teeth. In contrast, in the patient with a history of adjuvant radiotherapy 86% supported pre-operative antimicrobial use for the surgical removal of the same teeth. In the extraction of mobile and periodontally involved lower incisors in the previously irradiated patient, 63% of the clinicians supported pre-extraction antibiotics. Postoperative antibiotics were advocated in 52% in the first case, 89% in the second case and 71% in the third case. 34% of the clinicians advocated hyperbaric oxygen for surgical removal of posterior teeth and 15% for the extraction of mobile anterior teeth. CONCLUSIONS: The use of peri-extraction antibiotics was favoured among oral and maxillofacial surgeons. There was little enthusiasm towards the use of hyperbaric oxygen as a prophylactic measure, alone or in conjunction with an antimicrobial regime. Control randomised trials that will measure the effectiveness of hyperbaric oxygen and the appropriate use of antibiotics for prophylaxis in pre- and post-operative regimes are necessary to evaluate the use of these modalities.

Antibiotic Prophylaxis↗
PubMed2002

Clinical function after primary surgery for oral and oropharyngeal cancer: an 11-item examination.

The aim of this study was to record clinical function using an 11-item clinical examination and identify the main postoperative functional deficits. Of 132 consecutive patients undergoing surgery for previously untreated disease between January 1995 and June 1997, 130 were recruited in the study. An 11-domain clinical examination was made on the day before operation, and at 6 and 12 months afterwards. This examination assessed lip competence, tongue movement, oral mucosa, dental state, mouth opening, speech, drooling, diet, appearance, oral sensation and shoulder movement. Preoperatively there were deficits in natural dentition, consistency of diet and tongue protrusion. Postoperatively functional scores fell particularly for tongue movements, mouth opening, mucosa, dentition, speech, diet, appearance, lip sensation and tongue sensation. At 1 year, dental status, sensation and oral mucosa were particularly defective. Patients with large tumours, free tissue transfer, or adjuvant radiotherapy had the worst levels of function.A simple clinical examination provides a rapid assessment of function that can be used in conjunction with validated questionnaires to provide a more comprehensive evaluation of outcome.

Activities of Daily Living↗
PubMed2002

Health-related quality of life and clinical function after primary surgery for oral cancer.

Clinical function and health-related quality of life (HRQoL) are both important outcome parameters following surgery for oral and oropharyngeal cancer. The aim of this project was to explore the relationship between an 11-point clinical examination and HRQoL. Of 132 consecutive patients undergoing surgery for previously untreated disease between January 1995 and June 1997, 130 were recruited into the study. The University of Washington Quality of Life Questionnaire (UW-QoL) was completed by each patient on the day before operation and 6 and 12 months later. On each occasion the first author made an 11-point clinical examination. The main predictors of cumulative UW-QoL scores were tumour size, clinical functional score and type of operation. The trend was for a fall from preoperative levels at 6 months and then for a slight improvement at 1 year. The differential in respect of baseline function was present at all three time points in each patient group. This suggests that functional deficits at presentation persist following treatment.

Activities of Daily Living↗
PubMed2002

Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy.

The vascularized iliac crest graft with internal oblique muscle as a method of reconstruction after maxillectomy has been used routinely at the Regional Maxillofacial Unit in Liverpool since 1993. Twenty-four consecutive operations have now been done and this paper reports an audit of our experience. An analysis of case-notes was made retrospectively after checking theatre diaries and records. A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis, the complications and the outcome in terms of recurrence and disease survival. The type of defect was recorded, as was whether it had been possible to rehabilitate the patient both dentally and facially. At the time of this study 9 patients (38%) had died of their disease leaving 15 surviving. In 13 cases full dental and facial rehabilitation had been achieved or patients were waiting for an implant-retained prosthesis. Donor site problems important enough to be recorded in the notes were minimal, one case of abdominal wall weakness was noted, which required no intervention. The vascularized iliac crest graft with internal oblique muscle offers a complete solution for reconstruction after maxillectomy, providing there has been no sacrifice of the overlying facial skin and oral sphincter. There is sufficient height and depth of bone to maintain a facial profile and the muscle epithelializes to provide an ideal oral and nasal lining. This flap provides a base to enable full dental and facial prosthetic rehabilitation with either implant-retained or conventional prostheses.

Abdominal Muscles↗
PubMed2002

Importance-rating using the University of Washington quality of life questionnaire in patients treated by primary surgery for oral and oro-pharyngeal cancer.

BACKGROUND: There are now several validated and widely accepted head and neck cancer questionnaires. These record patients subjective levels of function and dysfunction, as well as symptoms related to their cancer and its treatment. One popular measure is the University of Washington head and neck cancer questionnaire (UW-QOL). Domain importance-ratings were added to the second version of the questionnaire, which was published in 1997. It is unique amongst head and neck cancer questionnaires in this respect. AIM: The purpose of the study was to evaluate UW-QOL with particular reference to domain importance-rating. It was also the intention to investigate how the importance-ratings related to 'quality of life' and comment on the cumulative scoring of the questionnaire. METHODS: Forty-eight patients with previously untreated oral or oro-pharyngeal cancer were recruited. All were treated by primary surgery. Questionnaires were completed pre-operatively, 6 months and 1 year post-operatively. RESULTS: This study demonstrates a wide variation in importance-ratings. Both pre- and post-treatment there was a general lack of correlation between importance-rating and domain scores. At all time points, patients tended to rate speech, chewing and swallowing as more important than the other UW-QOL domains. The cumulative UW-QOL score correlated strongly with the new single item QOL question. CONCLUSION: It remains unclear how best to incorporate importance-ratings into a single UW-QOL total score. However, for individual patients they can assist in setting priorities in treatment strategies.

Activities of Daily Living↗
PubMed2002

A practical guide for patients undergoing exodontia following radiotherapy to the oral cavity.

Dental extractions or minor oral surgery in patients who have undergone radiation therapy for cancer in the head and neck carry the risk of one of the most serious and devastating complications of head and neck radiotherapy, that of osteoradionecrosis (ORN). A totally unified approach to dental extractions following radiotherapy is lacking. The role of the general dental practitioner in management of patients following radiotherapy is crucial. Contrary to clinical impression, the risk of ORN does not decrease with time. When contemplating exodontia or minor oral surgery in the irradiated patient, special consideration should be given to issues such as radiotherapy history, surgical assessment, surgical procedure and the role of antibiotics and hyperbaric oxygen.

Antibiotic Prophylaxis↗
PubMed2001

Death certification in patients whose primary treatment for oral and oropharyngeal carcinoma was operation: 1992-1997.

The aim of this study was to report the cause and place of death of patients with oral cancer as recorded by death certification and their survival with regard to comorbidity and age. From the departmental head and neck oncology database, 322 patients were identified with previously untreated oral and oropharyngeal squamous cell carcinoma diagnosed between 1992 and 1997 inclusive. Three-hundred were matched with the Office for National Statistics (ONS) and copies of death certificates generated on 6 March 1999. Of the 286 patients primarily treated by operation, 203 were alive and 83 had died. In 56 (68%), oral cancer was a contributory factor to the patient's death. Patients with a medical history recorded on their admission for operation had similar survival curves compared to those having no problems recorded. Although most patients (n= 46 55%) died in hospital, only 13 (16%) died in the Regional Maxillofacial Unit. Almost half of those patients who died were not recorded as dead on the departmental oncology database. This study shows that it is useful to link with the ONS to obtain accurate data on date and place of death. The death certificate also gives a useful indication of the cause of death and this seems unrelated to preoperative comorbidity.

Age Factors↗
PubMed2001

A comparison of aesthetic, functional and patient subjective outcomes following lip-split mandibulotomy and mandibular lingual releasing access procedures.

Good access to the site of oral cancer is essential to allow for adequate three-dimensional resection of the tumour. Splitting the lower lip in conjunction with a mandibulotomy offers excellent access to all areas of the mouth and pharynx, but this inevitably produces a facial scar and there is morbidity associated with the healing of the mandibulotomy. An alternative approach is the mandibular lingual releasing technique, which provides good access to the oral cavity and avoids the morbidity associated with lip-split mandibulotomy. The aim of this study was to compare aesthetic, functional and patient subjective outcomes between the two access procedures. One hundred and fifty patients had oral access procedures between 1992-95 (ninety lip-split mandibulotomy and sixty mandibular lingual release). Thirty patients fulfilled selection criteria (primary surgery as treatment, tumour size < 5.1 cm, anterior oral cavity tumours, and reconstructed with a radial forearm free flap) and 10 patients from each group were able to attend a review appointment for objective clinical assessment of their speech, tongue mobility, lip competence and temperomandibular signs. Using items from the University of Washington quality of life questionnaire patient subjective outcomes were assessed. Using standardised photographs the clinician and lay persons assessed the overall post-operative facial appearance. The patients also assessed their own facial appearance using a similar scoring method. Resection margins were similar in both groups and it would seem that both methods provide adequate access to the anterior oral cavity. Clinical examination showed no differences in function between the two access procedures. Although there was a small number, the lip-split mandibulotomy group reported significantly better speech, swallowing and chewing. Previous concerns about a possible detrimental effect on appearance following lip-split, were not borne out in this study.

Child↗
PubMed2001

The relationship between length of stay and health-related quality of life in patients treated by primary surgery for oral and oropharyngeal cancer.

A patient's length of hospital admission is simple to measure, whilst their health related quality of life (HRQOL) is much more challenging. Similar clinical and demographic factors may exist between an increased length of stay (LOS) and a worse HRQOL outcome. The aim of this study was to assess whether LOS could serve as a proxy marker of HRQOL. One hundred and thirty consecutive patients with previously untreated oral and oropharyngeal squamous cell carcinoma were recruited. All had primary surgery. The University of Washington questionnaire (UW-QOL) and the European Organisation for Research and Treatment core cancer questionnaire (EORTC C30) were self-completed preoperatively, after 6 months and 1 year. The median LOS following laser/primary closure/split skin grafts (21 patients) was 2 days compared to 16 days following microvascular free flap reconstruction (105 patients). In the free flap group the best predictors of LOS were age, tumour size and early medical/surgery complications. Patients with a LOS greater than 16 days (median) reported significantly worse chewing (P = 0.008), swallowing (P = 0.002) and cumulative UW-QOL score (P = 0.01). No significant differences were seen in the EORTC C30. Length of stay is potentially a useful indicator of health related quality of life because it is linked by tumour size, however, the relationship is confounded by age, which tends to influence length of stay more than health related quality of life.

Adult↗
PubMed2000

A modified classification for the maxillectomy defect.

BACKGROUND: At present no widely accepted classification exists for the maxillectomy defect suitable for surgeons and prosthodontists. An acceptable classification that describes the defect and indicates the likely functional and aesthetic outcome is needed. METHODS: The classification is made on the basis of the assessment of 45 consecutive maxillectomy patients derived prospectively from the database (September 1992) and retrospectively from 1989. RESULTS: The classification of the vertical component is as follows: Class 1, maxillectomy without an oro-antral fistula; Class 2, low maxillectomy (not including orbital floor or contents); Class 3, high maxillectomy (involving orbital contents); and Class 4, radical maxillectomy (includes orbital exenteration); Classes 2 to 4 are qualified by adding the letter a, b, or c. The horizontal or palatal component is classified as follows: a, unilateral alveolar maxillectomy; b, bilateral alveolar maxillectomy; and c, total alveolar maxillary resection. CONCLUSION: This practical classification attempts to relate the likely aesthetic and functional outcomes of a maxillectomy to the method of rehabilitation.

Adult↗
PubMed2000

Distinct patient groups in oral cancer: a prospective study of perceived health status following primary surgery.

Health-related quality of life (HRQOL) is an important consideration in the management of patients with cancer. Pre-treatment data can give an indication of the anticipated response following cancer treatment. However, in order to use HRQOL data meaningfully it is essential to have an appreciation of how different patient groups respond. The aim of the study was to identify distinct patient groups at baseline using the University of Washington head and neck cancer questionnaire (UW-QOL). It was also the intention to see how these groups differed in their: (1) clinical and demographic attributes; (2) European Organisation for Research and Treatment of Cancer (EORTC) C30 and SF 36 scores; and (3) longitudinal trends over 6 and 12 months. One-hundred and thirty consecutive patients with previously untreated oral and oro-pharyngeal cancer were recruited. All were treated by primary surgery. Attrition was evident in the study but care was taken to allow for this. There were two distinct groups of patients identified by the cumulative UW-QOL score at presentation. These groups discriminated throughout the EORTC C30 and SF 36, at baseline and longitudinally, with the exception of mental health. This study demonstrates that HRQOL items are interrelated. There are difficulties in using baseline scores for treatment selection, and scores need to be interpreted in the light of clinical and demographic factors.

Adult↗
PubMed2000

Three years' experience of collaborative care pathways on a maxillofacial ward.

Collaborative care pathways (CCPs) provide a framework for multidisciplinary patient care. They provide guidelines and a mechanism for audit, and were first introduced at the Regional Unit, Walton Hospital, Liverpool, in November 1994. They have been designed for many surgical groups. Between August 1996 and 31 July 1997, 955 patients were admitted on to the nine established pathways: fractured mandible (n=213), fractured zygoma (n=117), minor oral surgery (n=244), abscess (n=18), examination under anaesthesia (n=73), nasal surgery (n=73), osteotomy (n=80), salivary (n=63), and temporomandibular joint (n=74). The purpose of this article is to report the introduction of CCP in a maxillofacial ward and give results from a one-year audit. CCP have proved to be an extremely useful tool and have several advantages over traditional documentation. They are more accurate, easily computerized, and facilitate audit. They promote the development of guidelines and standardized perioperative care, and this in turn facilitates training and raises standards of care.

Abscess↗