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Steele P, McMahon J, Dickson K, Zubair F, Puglia F, McMahon G, Wales C, McCaul J, Ansell M, Hislop S, Thomson E, Subramaniam S. Applying the British Association of Oral and Maxillofacial Surgeons quality outcomes metrics to a UK oncology and reconstructive surgery service - benchmarking the data. Br J Oral Maxillofac Surg 2021; 59:1079-1084. [PMID: 34275677 DOI: 10.1016/j.bjoms.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/15/2022]
Abstract
The British Association of Oral and Maxillofacial Surgery is soon to implement the Quality Outcomes in Oral in Maxillofacial Surgery (QOMS) to provide a platform for quality management across the specialty in the UK. The initial oncology and reconstruction audits for QOMS involves data collection on specific procedures and metrics. The aim of this report is to determine their appropriateness using extant audit datasets in our institution that overlap substantially with the QOMS audits. Pre-existing datasets comprising information on patients treated for oral cavity SCC with curative intent were analysed. Data on surgical margins, lymphadenectomy lymph node yield, delay between surgery and adjuvant radiotherapy, duration of hospital stay, and complications including flap failures were analysed. All statistical analyses were performed with SPSS 25. Run charts describing longitudinal data were generated using SPC for Excel version 6. Twenty three patients (3.1%) of 701 resections had a positive surgical margin reported. Seventeen (4.3%) of patients had less than 18 LNs in the ND specimen analysed. Mean time to start date of adjuvant therapy was 62 days. Only 9% of patients commenced adjuvant therapy within 6 weeks. The median duration of stay was 18 days. In 1153 free flaps a failure rate of 4.3% was identified. A total of 1349 complications (CD I-V) were recorded in the 1111 patients undergoing major surgery with free flap reconstruction. The QOMS selected metrics for oncology and reconstruction are clinically relevant, readily measurable, and likely to be actionable by the surgical team.
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Affiliation(s)
- P Steele
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - J McMahon
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - K Dickson
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - F Zubair
- University of Glasgow Medical School, Faculty of Life Sciences, United Kingdom.
| | - F Puglia
- BAOMS Royal College of Surgeons of England, 35/43 Lincoln's Inn Fields, London, United Kingdom.
| | - G McMahon
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - C Wales
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - J McCaul
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - M Ansell
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - S Hislop
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - E Thomson
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - S Subramaniam
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
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McMahon J, Steele P, Kyzas P, Pollard C, Jampana R, MacIver C, Subramaniam S, Devine J, Wales C, McCaul J. Operative tactics in floor of mouth and tongue cancer resection - the importance of imaging and planning. Br J Oral Maxillofac Surg 2020; 59:5-15. [PMID: 33143945 DOI: 10.1016/j.bjoms.2020.08.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
Complete tumour resection (R0 margin) is an axiom of surgical oncology. Oral cancer ablation is challenging, due to anatomical, functional, and aesthetic considerations. R0 margin is strongly linked to better survival outcomes with great variation in the R0 % across units. This is commonly attributed to disease biology. Without disputing the importance of biological characteristics, we contend that image-based anatomical surgical planning has an important role to play in achieving complete resection. Here, we present our approach utilising cross-sectional imaging, anatomical characteristics and spatial awareness in planning resections for floor of mouth (FOM) and oral tongue cancers. We highlight the challenge of controlling the deep tumour margin lingual to mandible due to anterior vector constraints and emphasise the importance of resecting the genial muscles in a planned fashion and that any rim resection should be obliquely sagittal. In resecting lateral FOM tumours, assessing extension to the parapharyngeal fat is crucial; and mandibular rim resection at a sagittal plane below the mylohyoid line is often required. Assessing the proximity of the contralateral neurovascular pedicle, pre-epiglottic space and hyoid bone are crucial parameters to determine the extent of tongue tumour resection. Our cohort included 173 patients with FOM SCC and 299 patients with tongue SCC. Six patients (3.5%) from the FOM group and eight patients (3%) from the tongue group had involved (R1) margins following surgery. This was associated with local relapse (p<0.05). In conclusion, we demonstrate that image-based planning can aid achieving R0 resections and reduce disease relapse.
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Affiliation(s)
- J McMahon
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - P Steele
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - P Kyzas
- Dept of OMFS/H&N Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals Trust, BB2 3HH.
| | - C Pollard
- Dept of Neuroradiology, Institute of Neurosciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF.
| | - R Jampana
- Dept of Neuroradiology, Institute of Neurosciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF.
| | - C MacIver
- Maxillofacial/Head and Neck Unit, SSMC Hospital in partnership with Mayo Clinic, Abu Dhabi.
| | - S Subramaniam
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - J Devine
- Maxillofacial/Head and Neck Unit, SSMC Hospital in partnership with Mayo Clinic, Abu Dhabi.
| | - C Wales
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - J McCaul
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
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McMahon J, Handley T, Bobinskas A, Elsapagh M, Wales C, MacIver C, Ross E. Can a peri-operative multimodal care (ERAS) program reduce postoperative complications in patients undergoing major head and neck surgery with flap repair? Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Smith A, Changez H, Wright P, Wales C, Holland I, MacIvor C, McMahon J. Oral surgery: The role of microbiology. Br Dent J 2014; 217:161. [PMID: 25146784 DOI: 10.1038/sj.bdj.2014.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Shujaat S, Khambay BS, Ju X, Devine JC, McMahon JD, Wales C, Ayoub AF. The clinical application of three-dimensional motion capture (4D): a novel approach to quantify the dynamics of facial animations. Int J Oral Maxillofac Surg 2014; 43:907-16. [PMID: 24583138 DOI: 10.1016/j.ijom.2014.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 11/18/2022]
Abstract
The aim of this pilot study was to evaluate the feasibility of measuring the change in magnitude, speed, and motion similarity of facial animations in head and neck oncology patients, before and after lip split mandibulotomy. Seven subjects (four males, three females) aged 42-80 years were recruited. The subjects were asked to perform four facial animations (maximal smile, lip purse, cheek puff, and grimace) from rest to maximal position. The animations were captured using a Di4D motion capture system, which recorded 60 frames/s. Nine facial soft tissue landmarks were manually digitized on the first frame of the three-dimensional image of each animation by the same operator and were tracked automatically for the sequential frames. The intra-operator digitization error was within 0.4mm. Lip purse and maximal smile animations showed the least amount of change in magnitude (0.2mm) following surgery; speed difference was least for smile animation (-0.1mm/s). Motion similarity was found to be highest for lip purse animation (0.78). This pilot study confirmed that surgery did influence the dynamics of facial animations, and the Di4D capture system can be regarded as a feasible objective tool for assessing the impact of surgical interventions on facial soft tissue movements.
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Affiliation(s)
- S Shujaat
- Oral & Maxillofacial Surgery, Faculty of Medicine, MVLS College, Glasgow University Dental Hospital and School, Glasgow, UK
| | - B S Khambay
- Oral & Maxillofacial Surgery, Faculty of Medicine, MVLS College, Glasgow University Dental Hospital and School, Glasgow, UK
| | - X Ju
- Oral & Maxillofacial Surgery, Faculty of Medicine, MVLS College, Glasgow University Dental Hospital and School, Glasgow, UK
| | - J C Devine
- Regional Maxillofacial Unit, Southern General Hospital, Glasgow, UK
| | - J D McMahon
- Regional Maxillofacial Unit, Southern General Hospital, Glasgow, UK
| | - C Wales
- Regional Maxillofacial Unit, Southern General Hospital, Glasgow, UK
| | - A F Ayoub
- Oral & Maxillofacial Surgery, Faculty of Medicine, MVLS College, Glasgow University Dental Hospital and School, Glasgow, UK.
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McAllister P, MacIver C, Wales C, McMahon J, Devine J, McHattie G, Makubate B. Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates. Br J Oral Maxillofac Surg 2013; 51:714-8. [DOI: 10.1016/j.bjoms.2013.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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Virdi RS, Handley TPB, Wales C, Maciver C. Novel technique to visualise pharyngeal free flap reconstructions. Br J Oral Maxillofac Surg 2013; 52:95-6. [PMID: 24216386 DOI: 10.1016/j.bjoms.2013.05.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 05/20/2013] [Indexed: 11/24/2022]
Affiliation(s)
- R S Virdi
- Southern General Hospital, 1345 Govan Road, Glasgow, Scotland G51 4TF, United Kingdom.
| | - T P B Handley
- Southern General Hospital, 1345 Govan Road, Glasgow, Scotland G51 4TF, United Kingdom
| | - C Wales
- Southern General Hospital, 1345 Govan Road, Glasgow, Scotland G51 4TF, United Kingdom
| | - C Maciver
- Southern General Hospital, 1345 Govan Road, Glasgow, Scotland G51 4TF, United Kingdom
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Siddiqui A, Lowe T, Wales C. The accuracy of surface (/topical) anatomic landmarks in predicting the location of the greater auricular nerve: a prospective study. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2013.07.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Thomas LH, Boyle B, Kallay AA, Wales C, Wilson CC. Structural diversity in layered organic materials through templating co-crystallisation. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311090866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Colgan L, Cross J, Morrison J, Wales C, Markose G, Currie W, Hislop W. An audit of visual acuity recording in mid-face trauma. Br J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.bjoms.2011.03.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paterson T, McMahon J, Wales C, Fogg Q. Anterolateral corridor approach to extended maxillectomy. Br J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.bjoms.2011.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liew C, Liew C, McMahon J, Wales C, Morrison J, Robertson G, Devine J. Correlates and patterns of nodal disease in head and neck cancer. Do they validate the tenets of head and neck surgery. Br J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.bjoms.2009.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Martin C, Jibson A, Wales C, Parkin A. Controlling the formation of co-crystal polymorphs. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308084328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Siotia AK, Morton AC, Mofidi S, Wales C, Newman C, Gunn J. Targeting drug-eluting stents to lesions at high risk of restenosis: a flawed approach? Heart 2007; 93:251-2. [PMID: 17228076 PMCID: PMC1861370 DOI: 10.1136/hrt.2006.089243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Pollard SD, Munks K, Wales C, Crossman DC, Cumberland DC, Oakley GDG, Gunn J. Position and Mobilisation Post-Angiography Study (PAMPAS): a comparison of 4.5 hours and 2.5 hours bed rest. Heart 2003; 89:447-8. [PMID: 12639880 PMCID: PMC1769276 DOI: 10.1136/heart.89.4.447] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
A policy of selective implantation of drug eluting stents, in a minority of lesions most likely to benefit, seems to be a rational way to employ this new and currently costly technology.
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Affiliation(s)
- J Gunn
- Cardiovascular Research Group, Division of Clinical Sciences (Northern General Hospital), University of Sheffield, Sheffield,
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Abstract
OBJECTIVE To investigate a population of elderly people for atrial fibrillation and to determine how many of the cases identified might benefit from treatment with anticoagulants. METHODS From a practice of four primary care physicians, 1422 patients aged 65 years and over were identified, of whom 1207 (85% of the total population) underwent electrocardiographic screening to detect the presence of atrial fibrillation. Patients with the arrhythmia were further evaluated by echocardiography and interview, to stratify their risk of stroke based on echocardiographic and clinical risk factors, their perceived risk from anticoagulation, and their attitude towards this treatment. Their primary care physician was also interviewed to determine the factors influencing the prescription of anticoagulants. RESULTS The arrhythmia occurred in 65 patients (5.4% overall), its prevalence increasing markedly with age (2.3% in 65 to 69 years age group; 8.1% in those over 85). Warfarin was being prescribed to 21.4% of these patients, although the findings of the study indicate that a further 20% were eligible for this treatment. Symptoms suggestive of cardiac failure were common (32.1%) and coexisting pathology was often identified by cardiac ultrasound in these patients (left ventricular hypertrophy, 32.1%; impaired left ventricular contractility, 21.4%; left atrial dilation, 80.4%; mitral annular calcification, 42.9%; mitral stenosis, 7.1%; mitral regurgitation, 48.2%; aortic stenosis, 8.9%). In all but one case, the decision to anticoagulate was based on the clinical rather than the echocardiographic findings. CONCLUSIONS Individual risk-benefit assessment in elderly patients with atrial fibrillation suggests that almost half (41.4%) are eligible for full anticoagulation with warfarin, whereas presently only one fifth are receiving this treatment. The decision to anticoagulate can be made on clinical grounds in most cases. If these results are confirmed, a doubling of the current number of patients taking anticoagulants can be anticipated.
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Affiliation(s)
- N M Wheeldon
- Cardiothoracic Unit, Northern General Hospital, Sheffield, UK
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Siegel RJ, Gunn J, Ahsan A, Fishbein MC, Bowes RJ, Oakley D, Wales C, Steffen W, Campbell S, Nita H. Use of therapeutic ultrasound in percutaneous coronary angioplasty. Experimental in vitro studies and initial clinical experience. Circulation 1994; 89:1587-92. [PMID: 8149525 DOI: 10.1161/01.cir.89.4.1587] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Previous studies have shown the feasibility of peripheral arterial ultrasound angioplasty. METHODS AND RESULTS In this report, we describe the use of percutaneous therapeutic ultrasound for coronary angioplasty. In vitro, 11 postmortem, atherosclerotically occluded coronary arteries were obtained to assess catheter-delivered ultrasound for arterial recanalization as well as for assessment of the size of particulate debris. Clinically, coronary ultrasound angioplasty was performed in 19 patients (mean age, 56 years) to assess safety and feasibility for the treatment of obstructive coronary atherosclerosis. Three patients with unstable angina and 16 with exercise-induced myocardial ischemia were treated with a prototype 4.6F coronary catheter ultrasound ablation device with a 1.7-mm diameter ball tip. The ultrasound coronary catheter delivered ultrasound energy at 19.5 kHz, with a power output of 16 to 20 W at the transducer. Energy is delivered in a pulsed mode with a 50% duty cycle of 30 milliseconds. Patients were treated for a mean of 493 seconds (range, 130 to 890) with intracoronary ultrasound ablation. All lesions were treated with adjunctive balloon angioplasty. All 11 postmortem coronary occlusions were recanalized, and 99% of the particulates generated were < 10 microns in diameter. We found that after ultrasound, mean (+/- SD) coronary arterial stenosis fell from 80 +/- 12% to 60 +/- 18% (P < .001) and to 26 +/- 11% (P < .001) after adjunctive balloon angioplasty. Mean pressures required to achieve full balloon inflation were 2.7 atm (range, 1 to 5.5) with a median of 3.0-mm balloon size (2.5 to 3.5). No ultrasound-related complications were identified. CONCLUSIONS Intracoronary ultrasound plaque ablation appears to be safe. Our findings suggest that catheter-delivered high-intensity, low-frequency ultrasound may be useful for lesion debulking and enhancing arterial distensibility, allowing balloon dilation at relatively low pressures.
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Affiliation(s)
- R J Siegel
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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