Brian Bisase

Evaluation of speech outcomes using English version of the Speech Handicap Index in a cohort of head and neck cancer patients

The aim of this study was to explore post-treatment speech impairments using English version of Speech Handicap Index (SHI) (first speech-specific questionnaire) in a cohort of oral cavity (OC) and oropharyngeal (OP) cancer patients. Sixty-three consecutive OC and OP cancer patients in follow-up participated in this study. Descriptive analyses have been presented as percentages, while Mann-Whitney U-test and Kruskall-Wallis test have been used for the quantitative variables. Statistical Package for Social Science-15 statistical software (SPSS Inc., Chicago, IL) was used for the statistical analyses. Over a third (36.1%) of patients reported their speech as either average or bad. Speech intelligibility and articulation were the main speech concerns for 58.8% and 52.9% OC and 31.6% and 34.2% OP cancer patients, respectively. While feeling of incompetent and being less outgoing were the speech-related psychosocial concerns for 64.7% and 23.5% OC and 15.8% and 18.4% OP cancer patients, respectively. Worse speech outcomes were noted for oral tongue and base of tongue cancers vs. tonsillar cancers, mean (SD) values were 56.7 (31.3) and 52.0 (38.4) vs. 10.9 (14.8) (P<0.001) and late vs. early T stage cancers 65.0 (29.9) vs. 29.3 (32.7) (P<0.005). The English version of the SHI is a reliable, valid and useful tool for the evaluation of speech in HNC patients. Over one-third of OC and OP cancer patients reported speech problems in their day-do-day life. Advanced T-stage tumors affecting the oral tongue or base of tongue are particularly associated with poor speech outcomes.

Role of robotic surgery in oral and maxillofacial, and head and neck surgery

We review the current status of robotic surgery in the head and neck region and its role in oral and maxillofacial surgery.

Resorption of fibula bone following mandibular reconstruction for osteoradionecrosis

The free fibular flap is commonly used for mandibular reconstruction because of its length, consistent blood supply, and relative ease of harvest. The bone has been shown to maintain mass over time, which confers a potential advantage over other osseous flaps. We know of no published papers on changes in height of fibular bone in patients treated for osteoradionecrosis (ORN). We measured the change in bony height over time as an indirect measure of bone mass. We identified 17 patients (mean age 65, range 49-80 years) who had had reconstruction with a free fibular flap for mandibular ORN. Of them, 10 had fixation with a reconstruction plate, and serial radiographs were available for inclusion in the study. Three measurements were taken on at least 2 rotational tomograms for each patient. Two observers recorded measurements at 25, 50, and 75% of the distance along the bone. Mean change in fibular height (mm) and percentage change were calculated. The interval between radiographs ranged from 5 months 4 days to 20 months 14 days. There was a reduction in fibular height in 8/10 cases, with a mean reduction of 1.5mm (range 2.6-0.3), or 11%. Our results show a moderate reduction in fibular height, which is comparable with a previously published series of patients without ORN who had reconstruction with miniplates. The stress shielding effects of reconstruction plates were less evident in our patients than in previously published material.

Cook-Swartz Implantable Doppler: The UK experience - a retrospective analysis

domain than did Crouzon’s patients (p=0.017). Females with Apert’s syndrome had a statistically poorer QoL in the social domain than Apert’s affected men (p=0.037). Conclusions: Following a literature search, we think this is the first such study in the UK and the largest in the world to date. Overall, these patients represent a resilient group who may have responded well to previous psychological support. Management strategies should be targeted towards the social domain, particularly in female patients with Apert’s syndrome.