Textbook Outcome After Oral Cancer Surgery as a Composite Measure for Survival and Quality-of-Care Evaluation

Objective: To enhance survival outcomes for oral cavity cancer (OCC) surgery, a composite measure has been developed: “textbook outcome” (TO). Three studies have reported on this concept in OCC, but the need for population-level results remains. This study investigates OCC surgery, focusing on survival and hospital-level results.Study Design: Cohort study.Setting: National multicenter study.Methods: All first primary OCC patients who underwent curative tumor resection between 2018 and 2021 were selected from the Dutch Head and Neck Audit database. Resections were categorized as local or extensive, the latter including neck dissection and/or free or pedicled flap reconstruction. TO was defined as the absence of 30-day mortality, hospital readmission, prolonged length-of-stay, severe complications, surgical margins &lt;1 mm, and &lt;18 lymph nodes per side. Adjusted hazard ratios (aHRs) were determined for 2-year overall survival (OS) and disease-free survival (DFS).Results: TO was reached in 81.1% and 46.9% after local (1039 patients) and extensive (1227 patients) resection, respectively. Reduced TO rates were observed in females, non-squamous cell carcinoma, cT3-T4, and floor of mouth compared to tongue. Obtaining TO was significantly associated with less adjuvant therapy and improved 2-year survival after local (aHR 0.55 OS P =.004, 0.70 DFS P =.085) and extensive (aHR 0.61 OS P ≤.001, 0.69 DFS P =.002) surgery. After correction for population differences, no interhospital variation in TO remained.Conclusion: Achieving TO is strongly linked to improved survival, highlighting its importance as a short-term composite quality-of-care indicator. The separate outcomes that were influential to the hospital's TO score differed between hospitals, indicating opportunities to improve outcomes.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prosthetic Rehabilitation of Head and Neck Cancer Patients Focusing on Mandibular Dentures in Irradiated Patients

Purpose: This retrospective study assessed treatment outcomes and patient satisfaction of irradiated head and neck cancer patients treated with mandibular implant overdentures (IODs) or conventional dentures (CDs). Materials and Methods: Fifty-one irradiated head and neck cancer patients, out of a total of 158 patients included, completed the standardized questionnaire and underwent a clinical assessment. Nineteen patients were treated with removable CDs and 32 patients received IODs between January 2006 and January 2011. The mean follow-up of patients was 5.75 years (range: 1 to 23 years). Results: A total of 45 (88.3%) mandibular dentures were in function at the time of assessment. The overall denture satisfaction was 7.3 (range: 1 to 10, SD: 2.14). Patients being treated with adjuvant concepts, including surgical tumor ablation, scored worse than patients after radiation therapy alone. Edentulous patients seem to benefit from implants, especially with respect to prosthesis retention. Men take more benefit from IODs compared with women. Conclusions: The results are comparable to other studies of head and neck cancer patients and also of healthy individuals. Surgical interventions in adjuvant therapy concepts lead to reduced denture satisfaction. The concept of prosthetic rehabilitation as part of oncologic treatment can be judged as successful

Bone invasion by oral squamous cell carcinoma—Is there a link to periodontal disease? A retrospective single center cohort study: 2010–2020

Objectives: The aim of this study was to clarify if bone invasion by oral squamous cell carcinoma (OSCC) is associated with periodontal disease (PD), dental status, or tumor location in patients with primary OSCC. Additional overall survival (OS) and recurrence-free survival (RFS) were related to bone invasion and PD. Patients and methods: Retrospectively, 278 patients with OSCC between 2010 and 2020 were included. Uni- and multivariate analyses were performed to assess the association between PD, dental status, tumor location, and the presence of bone invasion by OSCC. Kaplan-Meier curves and logrank tests were used to assess differences in 5-year OS and RFS for the presence of bone invasion and PD. Results: In dentate patients (n = 168) periodontal disease was more common in patients with bone-invasive OSCC (90%) compared to patients without OSCC bone invasion (70%), (p = 0.009; OR 3.7 (1.4–9.0)). Floor of mouth (FOM) tumors are more frequent when PD was present (41%). No statistically significant difference was seen in dental status and bone invasion (p = 0.10). Moderate periodontitis was associated with worse OS (55%) compared to severe and no periodontitis (67% and 68% respectively) (p = 0.03; mean survival 42.7 months (SD26.5)). Favorable OS and RFS were significantly associated with no bone invasion (p = 0.047 and 0.035 respectively). Conclusion: PD is 3.7 times more common in OSCC with bone invasion and tumor location is related to PD (p < 0.0001). Thus, periodontitis could be a risk factor for bone-invasive OSCC. Elimination of PD might lead to higher OS

Odontogenic infection as cause of orbital cellulitis

BACKGROUND: Orbital cellulitis is a potentially life-threatening condition. Compression of the optical nerve can cause total or partial loss of vision. Early diagnosis is crucial to prevent complications. In case of a unilateral sinusitis as cause of a unilateral orbital cellulitis complete clinical and dental examination combined with imaging are essential in diagnostics. CASE DESCRIPTION: A 53-year-old man presented with left eye movement impairment, intermittent diplopia and moderate swelling of the left lower eyelid. His diagnosis was post septal orbital cellulitis and despite administration of oral antibiotics no clinical improvement was observed. Orbital imaging by CT could not exclude a dental cause of his unilateral maxillary sinusitis. He was referred to the department of oral and maxillofacial surgery where clinical examination showed a dental cause. After removal of two decayed upper molars a complete recovery was accomplished. CONCLUSION: Odontogenic causes for unilateral orbital cellulitis should always be considered in diagnostics in adults. Clinical presentation and dental examination combined with adequate imaging can confirm the diagnosis

Odontogenic infection as cause of orbital cellulitis

BACKGROUND: Orbital cellulitis is a potentially life-threatening condition. Compression of the optical nerve can cause total or partial loss of vision. Early diagnosis is crucial to prevent complications. In case of a unilateral sinusitis as cause of a unilateral orbital cellulitis complete clinical and dental examination combined with imaging are essential in diagnostics. CASE DESCRIPTION: A 53-year-old man presented with left eye movement impairment, intermittent diplopia and moderate swelling of the left lower eyelid. His diagnosis was post septal orbital cellulitis and despite administration of oral antibiotics no clinical improvement was observed. Orbital imaging by CT could not exclude a dental cause of his unilateral maxillary sinusitis. He was referred to the department of oral and maxillofacial surgery where clinical examination showed a dental cause. After removal of two decayed upper molars a complete recovery was accomplished. CONCLUSION: Odontogenic causes for unilateral orbital cellulitis should always be considered in diagnostics in adults. Clinical presentation and dental examination combined with adequate imaging can confirm the diagnosis

Dual-Energy CT in Head and Neck Imaging

PURPOSE OF REVIEW: To explain the technique of Dual-energy CT (DECT) and highlight its applications and advantages in head and neck radiology. RECENT FINDINGS: Using DECT, additional datasets can be created next to conventional images. In head and neck radiology, three material decomposition algorithms can be used for improved lesion detection and delineation of the tumor. Iodine concentration measurements can aid in differentiating malignant from nonmalignant lymph nodes and benign posttreatment changes from tumor recurrence. Virtual non-calcium images can be used for detection of bone marrow edema. Virtual mono-energetic imaging can be useful for improved iodine conspicuity at lower keV and for reduction of metallic artifacts and increase in signal-to-noise ratio at higher keV. SUMMARY: DECT and its additional reconstructions can play an important role in head and neck cancer patients, from initial diagnosis and staging, to therapy planning, evaluation of treatment response and follow-up. Moreover, it can be helpful in imaging of infections and inflammation and parathyroid imaging as supplementary reconstructions can be obtained at lower or equal radiation dose compared with conventional single energy scanning

The accuracy of dual energy CT on evaluation of bone invasion caused by oral squamous cell carcinoma - a comparison to MRI

Bone marrow edema (BME) is a key sign of bone invasion by malignancies, alongside cortical involvement. Dual-energy CT virtual non-calcium (VNCa) reconstructions can visualize BME in the head and neck, but its role in evaluating bone invasion by oral squamous cell carcinoma (OSCC) remains underexplored. This study aimed to evaluate the accuracy of Dual energy CT (DECT) and additional virtual non-calcium (VNCa) reconstructions in detecting OSCC- related bone invasion in comparison to MRI using histology as reference standard. This retrospective study included 59 consecutive participants (mean age 68 years ± 12, 33 male) with primary OSCC who underwent both contrast-enhanced DECT and MRI. DECT weighted average (DECT WA) and DECT VNCa reconstructions were assessed for bone invasion based on the presence of cortical erosion, cortical disruption and cortical erosion combined with BME. DECT WA(erosion) showed a sensitivity and specificity of 95 % and 86 % comparable to MRI (92 % and 86 % respectively). Addition of VNCa-reconstructions to DECT WA did not improve sensitivity or specificity (84 % and 86 % respectively). Overall, accuracy of DECT is excellent and comparable to MRI for detecting bone invasion caused by OSCC. However, additional diagnostic benefits of VNCa reconstructions could not be shown in this study