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  1. Article ; Online: Percutaneous tracheostomy in the surgical management of oral malignancy: an emerging standard of care.

    Sato, Takaaki / Alimadadian, Matin / Schache, Andrew / Shaw, Richard

    The British journal of oral & maxillofacial surgery

    2023  Volume 61, Issue 10, Page(s) 696–703

    Abstract: Percutaneous tracheostomy insertion is commonly performed in the critical care setting. However, its applicability and safety in head and neck (H&N) surgery remains uncertain. This study aimed to compare complications and postoperative recovery for ... ...

    Abstract Percutaneous tracheostomy insertion is commonly performed in the critical care setting. However, its applicability and safety in head and neck (H&N) surgery remains uncertain. This study aimed to compare complications and postoperative recovery for percutaneous tracheostomy versus surgical tracheostomy in H&N surgery. A total of 66 patients undergoing percutaneous tracheostomy as part of H&N microvascular surgery were identified retrospectively. A control cohort of 70 consecutive surgical tracheostomy cases performed by another surgical team in the same department was similarly determined. Generally, the complication rates in the percutaneous and surgical tracheostomy groups were similar, with overall rates being 42% and 31%, respectively. The percutaneous group experienced a higher rate of airway obstruction (15%), primarily due to tube displacement. Time to decannulation and duration of inpatient stay were similar in both groups. Notably, an analysis of tracheostomy tube displacement identified high body mass index (BMI) and bilateral neck dissection as potential risk factors, and all cases occurred on postoperative day one. To mitigate this risk we recommend implementation of a percutaneous tracheostomy management protocol, precise tube selection using preoperative imaging, and careful passage of the stoma intraoperatively. In conclusion, this study found that the percutaneous technique exhibited a similar complication profile. It remains unclear whether the rates of longer-term complications, such as delayed stoma healing and tracheal stenosis, differ between techniques. A future prospective study with appropriate elimination of selection and reporting bias would help address this and similar pertinent issues, including patients' perspectives.
    MeSH term(s) Humans ; Tracheostomy/adverse effects ; Tracheostomy/methods ; Retrospective Studies ; Prospective Studies ; Standard of Care ; Mouth Neoplasms/surgery ; Mouth Neoplasms/etiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
    Language English
    Publishing date 2023-10-13
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 605685-4
    ISSN 1532-1940 ; 0266-4356
    ISSN (online) 1532-1940
    ISSN 0266-4356
    DOI 10.1016/j.bjoms.2023.10.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer: A systematic review.

    McDonald, Christopher / Kent, Samuel / Schache, Andrew / Rogers, Simon / Shaw, Richard

    Head & neck

    2023  Volume 45, Issue 11, Page(s) 2754–2779

    Abstract: Background: Elective neck dissection improves survival in early oral cancer. Sentinel lymph node biopsy may also do this with less morbidity. This systematic review compared health-related quality of life, functional outcomes, and complications after ... ...

    Abstract Background: Elective neck dissection improves survival in early oral cancer. Sentinel lymph node biopsy may also do this with less morbidity. This systematic review compared health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer.
    Methods: PRISMA guidelines were followed. Thirteen studies met inclusion criteria.
    Results: Results favoring sentinel lymph node biopsy were found in complications, scar length and appearance, length of hospital stay, time to drain removal, and objective shoulder measures at timepoints up to 12 months. Where differences in health-related quality of life were found, methodological issues make their clinical significance questionable.
    Conclusions: Sentinel lymph node biopsy was associated with fewer complications and statistically better outcomes in a number of physical measures. There is as yet no strong evidence to suggest it is associated with better health-related quality of life outcomes. While a number of health-related quality of life outcome measures show promise, their interpretation is hampered by methodological concerns. Further rigorous research is required to address this.
    MeSH term(s) Humans ; Sentinel Lymph Node Biopsy/adverse effects ; Neck Dissection/adverse effects ; Neck Dissection/methods ; Quality of Life ; Lymphatic Metastasis/pathology ; Neoplasm Staging ; Mouth Neoplasms/surgery ; Mouth Neoplasms/pathology ; Lymph Nodes/pathology
    Language English
    Publishing date 2023-08-29
    Publishing country United States
    Document type Systematic Review ; Journal Article
    ZDB-ID 645165-2
    ISSN 1097-0347 ; 0148-6403 ; 1043-3074
    ISSN (online) 1097-0347
    ISSN 0148-6403 ; 1043-3074
    DOI 10.1002/hed.27495
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Eccentric hamstring muscle training can prevent hamstring injuries in soccer players.

    Schache, Anthony

    Journal of physiotherapy

    2012  Volume 58, Issue 1, Page(s) 58

    Abstract: Question: Does eccentric muscle training of hamstring muscles reduce the rate of hamstring injuries in male soccer players?: Design: Cluster randomised, controlled trial with concealed allocation.: Setting: The 5 top men's soccer divisions in ... ...

    Abstract Question: Does eccentric muscle training of hamstring muscles reduce the rate of hamstring injuries in male soccer players?
    Design: Cluster randomised, controlled trial with concealed allocation.
    Setting: The 5 top men's soccer divisions in Denmark.
    Participants: First team squad soccer players from teams in the top 5 national soccer divisions were included. Players who joined a team after the start of the trial were excluded. Randomisation of 54 teams allocated 26 to the intervention group and 28 to a control group.
    Interventions: Both groups followed their usual training program. In addition, the intervention group completed 27 sessions of the eccentric hamstring muscle training in a 10-week period during the midseason break, and once a week in the second half of the season. The hamstring exercise (the Nordic curl) involves the player using hamstrings to resist forward falling of the trunk from a kneeling position. Players completed 2-3 sets of 5-12 repetitions of the exercise for 1-3 sessions per week.
    Outcome measures: The primary outcome was the number of overall, new, and recurrent acute hamstring injuries during one full soccer season. A hamstring injury was defined as any acute physical complaint in the region of the posterior thigh sustained during a soccer match or training. Recurrence of an injury already reported in the trial period was not included to avoid recording the same injury more than once.
    Results: 50 teams with 942 players completed the study. At the end of the season, there had been 15 hamstring injuries (12 new, 3 recurrent) in the eccentric hamstring exercise group and 52 injuries (32 new, 20 recurrent) in the control group. The number needed to treat (NNT) to prevent 1 hamstring injury (new or recurrent) was 13 (95% CI 9 to 23). The NNT to prevent 1 new injury was 25 (95% CI 15 to 72) and the NNT for recurrent injury was 3 (95% CI 2 to 6). Apart from short term muscle soreness no adverse events were reported in the exercise group.
    Conclusion: An eccentric strengthening exercise program for the hamstring muscles that can be performed during training can help prevent hamstring injuries in soccer players.
    Language English
    Publishing date 2012
    Publishing country Netherlands
    Document type Comment ; Journal Article
    ZDB-ID 2543915-7
    ISSN 1836-9561 ; 1836-9553 ; 0004-9514
    ISSN (online) 1836-9561
    ISSN 1836-9553 ; 0004-9514
    DOI 10.1016/S1836-9553(12)70074-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: NICO Phase II clinical trial - focus on an emerging immunotherapy strategy for the adjuvant treatment of locally-advanced oral cancers.

    Brooker, R C / Schache, A G / Sacco, J J

    The British journal of oral & maxillofacial surgery

    2020  Volume 59, Issue 8, Page(s) 959–962

    Abstract: Outcomes remain poor for patients presenting with locally-advanced oral cancers and it remains imperative to re-evaluate adjuvant therapies to provide improved outcomes, ideally without compromising on long-term quality of life. We present current ... ...

    Abstract Outcomes remain poor for patients presenting with locally-advanced oral cancers and it remains imperative to re-evaluate adjuvant therapies to provide improved outcomes, ideally without compromising on long-term quality of life. We present current available evidence that supports the use of immune checkpoint inhibitors (ICI) in squamous cell carcinoma (SCC) of the head and neck and discuss trials examining the integration of ICI into the locoregional management of such lesions that are resectable. We focus particularly on the Neoadjuvant and adjuvant nivolumab as Immune Checkpoint inhibition in Oral cavity cancer (NICO) trial which is investigating the integration of neoadjuvant and adjuvant ICI into the treatment of resectable locally-advanced oral cavity cancers.
    MeSH term(s) Antineoplastic Combined Chemotherapy Protocols ; Humans ; Immunotherapy ; Mouth Neoplasms/drug therapy ; Nivolumab ; Quality of Life
    Chemical Substances Nivolumab (31YO63LBSN)
    Language English
    Publishing date 2020-08-20
    Publishing country Scotland
    Document type Clinical Trial, Phase II ; Journal Article
    ZDB-ID 605685-4
    ISSN 1532-1940 ; 0266-4356
    ISSN (online) 1532-1940
    ISSN 0266-4356
    DOI 10.1016/j.bjoms.2020.08.059
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Immediate postoperative care on high dependency unit or ward following microvascular free tissue transfer: lessons learnt from a change in practice imposed during the COVID-19 pandemic.

    James, P / Bekiroglu, F / Broderick, D / Khattak, O / Lowe, D / Schache, A / Shaw, R J / Rogers, S N

    The British journal of oral & maxillofacial surgery

    2021  Volume 60, Issue 3, Page(s) 343–349

    Abstract: The COVID-19 pandemic resulted in sudden changes to the established practice of using the high dependency unit (HDU) for the first night of postoperative care following microvascular free tissue transfer. Patients were managed instead on the head and ... ...

    Abstract The COVID-19 pandemic resulted in sudden changes to the established practice of using the high dependency unit (HDU) for the first night of postoperative care following microvascular free tissue transfer. Patients were managed instead on the head and neck ward. This retrospective case-note review aimed to report outcomes in consecutive patients treated before and during the pandemic, and to reflect on the implications of ward-based rather than HDU care. A total of 235 patients had free tissue transfer between 3 January 2019 and 25 February 2021: 125 before (lockdown 23 March 2020), and 110 during the pandemic (52 ward-managed and 58 HDU-managed). There were subtle case-mix differences during the pandemic, with 92% of ward-treated patients having oral cancers compared with 64% of HDU patients, and 73% of ward patients having a tracheostomy compared with 40% of HDU patients. Ward patients were less likely to receive electrolyte replacement (45% HDU vs 0% ward) and inotropes (12% HDU vs 2% ward). There were fewer returns to theatre for evacuation of a haematoma or re-anastomosis during the pandemic than there were before it. Other than fewer haematoma complications during the pandemic, the nature of complications was similar. In conclusion, the dramatic changes imposed by the pandemic have shown that the ward is a safe place for patients to be cared for immediately postoperatively, and it alleviates the bed pressures experienced in HDU. Careful case selection and clear criteria are required to identify patients who need the HDU.
    MeSH term(s) COVID-19 ; Communicable Disease Control ; Hematoma ; Humans ; Pandemics ; Postoperative Care/methods ; Prospective Studies ; Retrospective Studies
    Language English
    Publishing date 2021-08-26
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 605685-4
    ISSN 1532-1940 ; 0266-4356
    ISSN (online) 1532-1940
    ISSN 0266-4356
    DOI 10.1016/j.bjoms.2021.08.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: A new classification of mandibular fractures.

    Brown, J S / Khan, A / Wareing, S / Schache, A G

    International journal of oral and maxillofacial surgery

    2021  Volume 51, Issue 1, Page(s) 78–90

    Abstract: There is no accepted method of reporting mandibular fracture that reflects incidence, treatment and outcome for individual cases. As most series include anatomical site only for all fractures, the aim was to establish a new method to report fractures ... ...

    Abstract There is no accepted method of reporting mandibular fracture that reflects incidence, treatment and outcome for individual cases. As most series include anatomical site only for all fractures, the aim was to establish a new method to report fractures based on a systematic review of the literature and an internal audit. The classification proposed is: Class I; condyle, II; angle, IIc; II+condyle, III; body/symphysis, IIIc; III+condyle, IV; multiple fractures not including condyle, IVc; IV+condyle, V; bilateral condyle±other fracture(s). A total of 10,971 adult and 914 paediatric cases were analyzed through systematic review, and 833 from the regional audit. Only 32% (14/44) of reported series could be reclassified which, when added to the audit data, showed Class IV was most common (29%), with similar proportions of Class III, Class IIIc and Class II (18-23%). External validation (literature review) in terms of treatment and outcome was non-informative, but the internal validation (audit) demonstrated an increasing requirement for adding maxillomandibular fixation (MMF) to open reduction and internal fixation (ORIF) as class increased. The heterogeneity of data reporting found in the systematic review confirms the need for a classification such as this, likely to enhance comparison of varying management protocols.
    MeSH term(s) Adult ; Child ; Fracture Fixation, Internal ; Humans ; Incidence ; Jaw Fixation Techniques ; Mandibular Condyle ; Mandibular Fractures ; Treatment Outcome
    Language English
    Publishing date 2021-06-04
    Publishing country Denmark
    Document type Journal Article ; Systematic Review
    ZDB-ID 353721-3
    ISSN 1399-0020 ; 0901-5027
    ISSN (online) 1399-0020
    ISSN 0901-5027
    DOI 10.1016/j.ijom.2021.02.012
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  7. Article ; Online: Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors.

    Gormley, Mark / Creaney, Grant / Schache, Andrew / Ingarfield, Kate / Conway, David I

    British dental journal

    2022  Volume 233, Issue 9, Page(s) 780–786

    Abstract: Introduction Head and neck cancer appears to be increasing in incidence, with potential changes in aetiology proposed. This paper aims to provide a narrative overview of the epidemiological literature to describe the disease burden and trends in terms of ...

    Abstract Introduction Head and neck cancer appears to be increasing in incidence, with potential changes in aetiology proposed. This paper aims to provide a narrative overview of the epidemiological literature to describe the disease burden and trends in terms of incidence and mortality both in the UK and globally and to review the evidence on current risk factors.Methods A search was performed on multiple databases (PubMed and Epistemonikos), applying filters to identify systematic reviews and meta-analyses which investigated head and neck cancer incidence, mortality and risk factors. International and UK cancer registries and sources were searched for incidence and mortality data.Results Multiple definitions of head and neck cancer are employed in epidemiology. Globally, incidence rates have increased in recent decades, largely driven by oropharyngeal cancer. Mortality rates over the last decade have also started to rise, reflecting the disease incidence and static survival rates. Major risk factors include tobacco smoking alone and in combination with alcohol consumption, betel chewing (particularly in Southeast Asian populations) and the human papillomavirus in oropharyngeal cancer.Conclusions These epidemiological data can inform clinical and preventive service planning for head and neck cancer.
    MeSH term(s) Humans ; Head and Neck Neoplasms/epidemiology ; Head and Neck Neoplasms/etiology ; Oropharyngeal Neoplasms/epidemiology ; Risk Factors ; Papillomaviridae ; Incidence ; Papillomavirus Infections/complications ; Papillomavirus Infections/epidemiology
    Language English
    Publishing date 2022-11-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 218090-x
    ISSN 1476-5373 ; 0007-0610
    ISSN (online) 1476-5373
    ISSN 0007-0610
    DOI 10.1038/s41415-022-5166-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Health-related quality of life in patients with T1N0 oral squamous cell carcinoma: selective neck dissection compared with wait and watch surveillance.

    McDonald, C / Lowe, D / Bekiroglu, F / Schache, A / Shaw, R / Rogers, S N

    The British journal of oral & maxillofacial surgery

    2019  Volume 57, Issue 7, Page(s) 649–654

    Abstract: Management of the neck in patients with clinical T1N0 oral squamous cell carcinoma (SCC) is controversial. The aim of this study was to report the health-related quality of life (HRQoL) in a consecutive group of patients with stage 1 disease at a time ... ...

    Abstract Management of the neck in patients with clinical T1N0 oral squamous cell carcinoma (SCC) is controversial. The aim of this study was to report the health-related quality of life (HRQoL) in a consecutive group of patients with stage 1 disease at a time closest to two years after primary surgery. Of 216 patients treated between 2007 and 2012 (after excluding early death and regional recurrence), 195 were eligible. HRQoL was measured using the University of Washington quality of life questionnaire version 4. The overall response rate was 65% (126/195). HRQoL outcomes were good, but compared with patients in the wait and watch group, those who had selective neck dissection (SND) had more problems regarding appearance (14% compared with 1%, p=0.008) and pain (19% compared with 6%, p=0.04). Similar trends were seen for shoulder (14% compared with 8%), mood (16% compared with 8%), and speech (5% compared with 1%), and for poorer overall QoL (30% compared with 16%). It is difficult to establish why patients did or did not have neck dissection in a retrospective sample, but it is likely that those who had SND had larger tumours. The findings highlight the impact that SND has on HRQoL in domains such as appearance, pain, speech, swallowing, and chewing. Previous studies on SND have tended to focus on injury to the accessory nerve and shoulder function, but these new data emphasise the need to include other domains in future trials that compare wait and watch, SND, and sentinel lymph node biopsy.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery ; Health Status ; Humans ; Middle Aged ; Mouth Neoplasms/pathology ; Mouth Neoplasms/surgery ; Neck Dissection/methods ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Quality of Life/psychology ; Retrospective Studies ; Treatment Outcome ; Watchful Waiting
    Language English
    Publishing date 2019-06-21
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 605685-4
    ISSN 1532-1940 ; 0266-4356
    ISSN (online) 1532-1940
    ISSN 0266-4356
    DOI 10.1016/j.bjoms.2019.05.021
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years.

    Brown, J S / Lowe, D / Kanatas, A / Schache, A

    The British journal of oral & maxillofacial surgery

    2017  Volume 55, Issue 2, Page(s) 113–126

    Abstract: To explore the techniques for mandibular reconstruction with composite free flaps and their outcomes, we systematically reviewed reports published between 1990 and 2015. A total of 9499 mandibular defects were reconstructed with 6178 fibular, 1380 iliac ... ...

    Abstract To explore the techniques for mandibular reconstruction with composite free flaps and their outcomes, we systematically reviewed reports published between 1990 and 2015. A total of 9499 mandibular defects were reconstructed with 6178 fibular, 1380 iliac crest, 1127 composite radial, 709 scapular, 63 serratus anterior and rib, 32 metatarsal, and 10 lateral arm flaps including humerus. The failure rate was higher for the iliac crest (6.2%, 66/1059) than for fibular, radial, and scapular flaps combined (3.4%, 202/6018) (p<0.001). We evaluated rates of osteotomy, non-union, and fistulas. Implant-retained prostheses were used most often for rehabilitation after reconstruction with iliac crest (44%, 100/229 compared with 26%, 605/2295 if another flap was used) (p<0.001). There were no apparent changes in the choice of flap or in the complications reported. Although we were able to show some significant differences relating to the types of flap used, we were disappointed to find that fundamental outcomes such as the need for osteotomy, and rates of non-union and fistulas were under-reported. This review shows the need for more comprehensive and consistent reporting of outcomes to enable the comparison of different techniques for similar defects.
    Language English
    Publishing date 2017-02
    Publishing country Scotland
    Document type Journal Article ; Review
    ZDB-ID 605685-4
    ISSN 1532-1940 ; 0266-4356
    ISSN (online) 1532-1940
    ISSN 0266-4356
    DOI 10.1016/j.bjoms.2016.12.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Integration of Checkpoint Inhibitors into the Management of Locally Advanced Head and Neck Cancer - Future Perspectives.

    Brooker, R C / Sacco, J J / Schache, A G

    Clinical oncology (Royal College of Radiologists (Great Britain))

    2019  Volume 31, Issue 7, Page(s) 424–431

    Language English
    Publishing date 2019-05-14
    Publishing country England
    Document type Editorial
    ZDB-ID 1036844-9
    ISSN 1433-2981 ; 0936-6555
    ISSN (online) 1433-2981
    ISSN 0936-6555
    DOI 10.1016/j.clon.2019.04.011
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