Fiona S. Ryan

Impact of dentofacial deformity and motivation for treatment: A qualitative study

INTRODUCTION Satisfaction with the outcome of orthognathic treatment is generally high; however, an important minority remains dissatisfied with the results. The reasons for this could be inadequate patient understanding and preparation, external motivation, and unrealistic expectations. In-depth appreciation of these issues can be obtained using qualitative research methods, but there is a paucity of qualitative research in this field. METHODS This was a cross-sectional qualitative study of orthognathic patients conducted at a teaching hospital. In-depth interviews were conducted with 18 prospective orthognathic patients. The data were managed by using the framework approach and analyzed by using the critical qualitative theory. RESULTS Two main themes were explored in the interviews: the impact of the dentofacial deformity and the motivation for treatment. Both the everyday problems of living with a dentofacial deformity and the motivation for seeking treatment could be classified either as exclusively practical (including functional and structural), exclusively psychological (including psychosocial and esthetic), or a combination. Different coping strategies were also described. The sources of motivation ranged between purely external to purely internal, with most subjects between these 2 extremes. CONCLUSIONS In this article, we present a classification of the impact of dentofacial deformity that is a refinement of the traditional one that includes esthetic, functional, and psychosocial factors. The motivating factors, together with the triggers for accessing treatment and the source of motivation, are generally linked directly or indirectly to the problem and the impact of the condition. However, in a few patients, the motivation might not relate to the impact of the problem but to a complex array of other factors such as personality, upbringing, and relationships. Therefore, clinicians should not make assumptions but explore these factors on an individual basis without preconceived ideas.

Information-seeking behavior of adolescent orthodontic patients

INTRODUCTION Health-information-seeking behavior is the purposive search for health-related information. The literature contains few articles examining this behavior as it relates to orthodontics; therefore, the aim of this study was to investigate how adolescent orthodontic patients seek information about their treatment, why they search for this information, and how they prefer the information to be available. METHODS In-depth interviews were conducted with 15 subjects, 10 to 16 years old, who were considering orthodontic treatment. The purpose of the interviews was to identify themes that were then used to develop a questionnaire to investigate information-seeking behavior. The questionnaire was distributed to 50 adolescent orthodontic patients. RESULTS The main sources of information were talking to a dentist or an orthodontist (84%), talking to peers (66%), and reading information leaflets (64%). Surprisingly few respondents had used the Internet (8%). The preferred sources of information were talking to an orthodontist (26%) and family members (12%), followed by talking with the general dentist (10%), viewing a DVD (10%), or reading information leaflets (10%). CONCLUSIONS The preferred method of obtaining information was verbal, followed by audiovisual and written. Audiovisual information could be beneficial for those who find reading difficult or who struggle to retain verbal information. Few patients accessed information via the Internet, and this was attributed to concerns about the reliability of the information.

Histiocytoid eccrine sweat gland carcinoma of the eyelid: report of a case

This report describes the 12th documented case of histiocytoid, diffuse or signet‐ring cell eccrine sweat gland carcinoma of the eyelid, a rare neoplasm that characteristically affects older men and mimics distant metastasis. Clinically, the patient was thought to have a colonic metastasis. Histologically, the neoplasm comprised sheets and cords of polygonal, eosinophilic cells, with dispersed larger, rounded single cells resembling histiocytes, and cells with cytoplasmic lumina or a signet‐ring appearance. Occasional duct formation was also seen. The features were reminiscent of both the histiocytoid and lobular variants of breast carcinoma. Ultrastructurally, the presence of nonintestinal type microvilli with a length : width ratio in excess of 16 were consistent with an eccrine origin, but also raised the possibility of metastatic mesothelioma. However, a metastatic lesion was excluded by clinical and imaging investigations. There has been no recurrence 3 years after primary excision.

Long term results of mandibular distraction.

Mandibular distraction osteogenesis has become a popular surgical modality due to its many advantages over conventional orthognathic surgical procedures. However, in spite of the technique having been used for over 15 years, no concrete long term results are available regarding the stability of results. We discuss the various studies which have reported either in favour or against the stablility of results after distraction. We report a series of 6 cases (3 unilateral and 3 bilateral distraction) where distraction was carried out before puberty and followed them up to seven years after removal of distractors. This case series shows that results achieved by distraction osteogenesis are unstable or best unpredictable with respect to producing a permanent size increase in the mandible. The role of the distraction osteogenesis in overcoming the pterygomassetric sling is questionable. We suggest a multicenter study with adequate patient numbers treated with a similar protocol and documented after growth cessation to have meaningful conclusions on the debate of distraction osteogenesis versus orthognathic surgery.

Transmigration of a maxillary canine. A case report.

In the oral cavity, transmigration is defined as a tooth that crosses the mid-line by more than half its length. Following extensive literature review, it was found that, although well documented with respect to mandibular canines, there were only two publications detailing maxillary cuspid transmigration. This report presents a case of transmigration where the left maxillary canine gradually crossed the mid-line and migrated to the right side in a patient with hemifacial microsomia and cleft palate. The Mupparapu classification of the migratory pattern of the mandibular canines is discussed. Various clinical considerations, as well as guidelines for general practitioners to diagnose and manage such a condition, are also discussed.

Assessment of the effect of combined multimedia and verbal information vs verbal information alone on anxiety levels before bond-up in adolescent orthodontic patients: A single-center randomized controlled trial

INTRODUCTION Despite the high prevalence of dental anxiety in children, there is little research examining anxiety before orthodontic procedures. This parallel-group randomized controlled trial assessed whether provision of additional multimedia information regarding the bond-up procedure affected anxiety in adolescent orthodontic patients. The effects of sex, ethnicity, and age were also investigated. METHODS Participants were recruited from the orthodontic department of the Eastman Dental Hospital, University College London Hospitals Foundation Trust, in the United Kingdom; all were 10 to 16 years of age, with no history of orthodontic treatment, and patient assent and parental consent were obtained. The participants were randomized into control (n = 45) and intervention (n = 45) groups using a random number table. Both groups were given verbal information regarding the bond-up procedure, and the intervention group was additionally given a DVD showing a bond-up. Anxiety was assessed in the department immediately before the bond-up using the State-Trait Anxiety Inventory for Children, with state anxiety as the primary outcome measure. The researchers were unaware of group allocations while enrolling patients, scoring questionnaires, and analyzing data. RESULTS A statistically significant difference was found between groups, with a difference in scores of 2 (95% confidence interval for the difference = 0.15 to 3.85). The median state anxiety was 32 in the control group (n = 42) and 30 in the intervention group (n = 43; P = 0.012). Sex, ethnicity, and age did not significantly affect anxiety. No harmful effects were noted. CONCLUSIONS Additional information reduces anxiety levels, but other methods could be more cost-effective than the DVD. Sex, ethnicity, and age did not statistically affect the anxiety levels.

A qualitative study of orthognathic patients’ perceptions of referral to a mental health professional: Part 1—questionnaire development

Objectives The aim of this study was to develop a measure to assess orthognathic patients’ perceptions of referral to a mental health professional. Design Prospective qualitative study. Setting UCLH Foundation Trust. Subjects and methods The study was divided into two parts. The first phase involved developing a patient-centred questionnaire by carrying out semi-structured interviews with 10 orthognathic patients and 10 clinicians involved in orthognathic treatment provision. The transcripts from these interviews were then analysed using the N6© software package for qualitative research and thematic content analysis was carried out. As key themes and theories of patients’ perceptions of referral to a mental health professional began to emerge from the data, this directed the source of further interviews, allowing exploration and validation of all theories. When new themes ceased to arise, it was assumed that data saturation was reached, and no further interviews were undertaken. A questionnaire was then developed using the key themes from the interviews and this was piloted. Results Analysis of the interviews revealed that patient views could be divided into two main themes: service provision and perceptions of mental health professionals. These themes were incorporated into a questionnaire. Conclusions A new measure of patients’ perceptions of referral to a mental health professional is presented.

Shared decision making in healthcare

Shared decision making is at the core of the new-look NHS. Everyone will be familiar with ‘no decision about me without me’ but how familiar are we with actually making shared decisions in practice?

A new style of orthognathic clinic.

The Orthognathic Team at the Eastman Dental Hospital has developed a new style of multidisciplinary clinic to supplement the traditional orthognathic consultation. The aim of the new clinic is to increase patient satisfaction and involvement in the consent and decision making process, as well as optimizing the information given to prospective patients regarding all aspects of this complex elective treatment. Results of a survey of patients attending the clinic found that 80% thought that the information given was ‘just the right amount’ and 96% were satisfied with the new structure. They particularly found it useful to meet a patient who had completed treatment. All of those who attended said that they understood the information given to them and would recommend the clinic to those considering orthognathic treatment. They also liked having other patients there with them on the clinic.

Social anxiety in orthognathic patients

There is evidence that patients seeking orthognathic treatment may be motivated by social anxiety disorder (SAD). The aim of this study was to investigate SAD in orthognathic patients using the Brief Fear of Negative Evaluation Scale (BFNES) and to compare these findings with those of the general population. This was a cross-sectional, questionnaire study conducted in two parts. Firstly, a national survey was conducted to yield data for the BFNES from a large, random sample of the UK general population. Secondly, orthognathic patients completed the BFNES. The BFNES scores are reported in two formats: the original 12-item scale (O-BFNES) and a shorter eight-item version (S-BFNES). With regards to the national survey, 1196 individuals participated. The mean O-BFNES score was 29.72 (standard deviation (SD) 9.39) and S-BFNES score was 15.59 (SD 7.67). With regards to the orthognathic sample, 61 patients participated. The mean O-BFNES score was 39.56 (SD 10.35) and the mean S-BFNES score was 24.21 (SD 8.41). Orthognathic patients had significantly higher scores than the general UK population (P<0.001), and multiple linear regression revealed that age, gender, and patient status were all independent predictors of BFNES scores. From the results of this study, orthognathic patients experience significantly higher levels of social anxiety than the general population.