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BMJ Open Nov 2018To explore the influences of facial disfigurement and social support for psychosocial adjustment in patients with oral cancer.
OBJECTIVE
To explore the influences of facial disfigurement and social support for psychosocial adjustment in patients with oral cancer.
DESIGN
A cross-sectional design was used for the study.
PARTICIPANTS AND SETTING
A convenience sample of 77 patients with oral cancer was recruited from the otolaryngology and oral and maxillofacial surgery outpatient clinics of three general hospitals in Taiwan.
MEASURES
Data were collected using the study questionnaires, including the Facial Disfigurement Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale.
RESULTS
The mean score on the Psychosocial Adjustment to Illness Scale was 413.01 (SD=32.32); 71.4% of the participants were maladjusted. Results of multiple regression analysis showed statistically significant main effects of tumour site (beta=0.37), facial disfigurement (beta=0.35) and social support (beta=-1.01), and the interaction effect of facial disfigurement and social support (beta=0.79) (all p<0.05) on psychosocial adjustment after controlling for other sociodemographic and clinical variables. All variables together explained 62% of the variance in psychosocial adjustment (F(16, 55)=14.98, p<0.001).
CONCLUSIONS
The level of psychosocial adjustment in patients with oral cancer was suboptimal. Poorer psychosocial adjustment was reported by patients with more severe facial disfigurement and less social support. Patients with cancers in other areas of the oral cavity also reported poorer psychosocial adjustment than patients with cancers in the buccal mucosa. Medical professionals may use these variables to identify higher risk groups for early intensive intervention.
Topics: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Emotional Adjustment; Face; Female; Humans; Male; Middle Aged; Mouth Neoplasms; Psychological Tests; Social Support; Surveys and Questionnaires; Taiwan
PubMed: 30478118
DOI: 10.1136/bmjopen-2018-023670 -
Anales Del Sistema Sanitario de Navarra 2004There are two clearly differentiated attitudes in the treatment of haemangiomas: the expectant attitude and the therapeutic, medical or surgical attitude. The expectant... (Review)
Review
There are two clearly differentiated attitudes in the treatment of haemangiomas: the expectant attitude and the therapeutic, medical or surgical attitude. The expectant attitude can be appropriate in cases of small haemangiomas, far from areas of possible functional damage, and with a slow rate of growth; however, it must be remembered that after reaching their maximum involution, about 25% of haemangiomas show a significant deformity. Treatment should be applied to those haemangiomas that obstruct the visual axis, the airway, the auditory channel, (with alteration of functions such as vision, breathing, swallowing and urinary or intestinal functions); to those of rapid growth that produce or might produce tissue destruction or significant disfiguration, ulcerated lesions, and lesions with a great cutaneous extension or visceral affection, which can lead to congestive cardiac insufficiency, or haematological alterations. The recommended treatment is systemic corticosteroids, with an initial dose of 2 to 3 mg/kg/day of prednisone or prednisolone, administered once a day in the morning. The most frequent result is that growth is arrested, while a reduction in size is observed in less than half the cases. Intralesional administration of corticosteroids at intervals of between 4 and 8 weeks is an effective treatment that manages to avoid the adverse effects of systemic corticosteroids. Because of its adverse neurological effects, interferon is only recommended for lesions with a vital or severe functional risk that do not respond to corticosteroids. Cytotoxic drugs are another treatment group: intralesional bleomycin, vincristine, cyclophosphamide and pingiangmycin. Finally, other forms midway between medical and surgical treatment, such as intermittent compression, radiotherapy, cryotherapy, sclerotherapy, or the implantation of intralesional metals, might have a role to play in some specific haemangiomas.
Topics: Adrenal Cortex Hormones; Antineoplastic Agents; Child; Child, Preschool; Hemangioma; Humans; Interferon-alpha
PubMed: 15148514
DOI: No ID Found -
PLoS Neglected Tropical Diseases Sep 2022Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and... (Review)
Review
INTRODUCTION
Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal.
MATERIALS AND METHODS
A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,-the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score.
RESULTS
A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25-50%), Grade-3 (50-75%), Grade-1 (0-25%), and Grade-4 (75-100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma.
DISCUSSION
The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one's family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity.
Topics: Child; Cross-Sectional Studies; Disease Progression; Ethiopia; Face; Humans; Noma; Retrospective Studies
PubMed: 36099293
DOI: 10.1371/journal.pntd.0010372 -
Frontiers in Oncology 2021Cutaneous squamous cell carcinoma (CSCC) of the head and neck can require complex and disfiguring surgery in order to achieve cure, which can be morbid and negatively...
BACKGROUND
Cutaneous squamous cell carcinoma (CSCC) of the head and neck can require complex and disfiguring surgery in order to achieve cure, which can be morbid and negatively impact patient quality of life. The management of advanced CSCC has been revolutionized by immunotherapy with current clinical trials also exploring its role in the neoadjuvant and adjuvant settings. Patients may decline morbid curative surgery, such as orbital exenteration, and the outcomes of immunotherapy use in this unique group of patients require further investigation.
METHODS
We reviewed the records of 119 patients treated at a major Australian quaternary oncology centre with immunotherapy (either cemiplimab or pembrolizumab) for advanced CSCC.
RESULTS
We identified 7 patients recommended curative surgery involving orbital exenteration after multidisciplinary discussion, who declined surgery due to concerns about morbidity and/or disfigurement. All 7 patients demonstrated a response to treatment, and six avoided orbital exenteration. Two patients experienced pseudoprogression.
CONCLUSIONS
The management of CSCC can be complex and requires the input of a multidisciplinary team. Immunotherapy to avoid or reduce the extent of morbid definitive surgery is an emerging treatment option.
PubMed: 35117997
DOI: 10.3389/fonc.2021.796197 -
Eye and Brain 2018Optic nerve sheath meningiomas are rare benign neoplasms of the meninges surrounding the optic nerve. They are a significant cause of morbidity. While the mortality rate... (Review)
Review
Optic nerve sheath meningiomas are rare benign neoplasms of the meninges surrounding the optic nerve. They are a significant cause of morbidity. While the mortality rate is practically zero, these tumors can blind or disfigure patients. Given that the clinical course can be variable, and treatment has the capacity to cause morbidity itself, the management of these patients can be difficult. We review the literature to discuss the prevalence of optic nerve sheath meningiomas, the association with neurofibromatosis type 2, natural history, and management options and strategies.
PubMed: 30498385
DOI: 10.2147/EB.S144345 -
Frontiers in Surgery 2023Facial vascularized composite allotransplantation (FVCA) is an emerging field of reconstructive surgery that represents a dogmatic shift in the surgical treatment of... (Review)
Review
Facial vascularized composite allotransplantation (FVCA) is an emerging field of reconstructive surgery that represents a dogmatic shift in the surgical treatment of patients with severe facial disfigurements. While conventional reconstructive strategies were previously considered the goldstandard for patients with devastating facial trauma, FVCA has demonstrated promising short- and long-term outcomes. Yet, there remain several obstacles that complicate the integration of FVCA procedures into the standard workflow for facial trauma patients. Artificial intelligence (AI) has been shown to provide targeted and resource-effective solutions for persisting clinical challenges in various specialties. However, there is a paucity of studies elucidating the combination of FVCA and AI to overcome such hurdles. Here, we delineate the application possibilities of AI in the field of FVCA and discuss the use of AI technology for FVCA outcome simulation, diagnosis and prediction of rejection episodes, and malignancy screening. This line of research may serve as a fundament for future studies linking these two revolutionary biotechnologies.
PubMed: 38026484
DOI: 10.3389/fsurg.2023.1266399 -
Biomedicines Dec 2022Disease and treatment-related symptoms and dysfunctions can interfere with the psychosocial adjustment of patients with oral cancer. Identifying factors influencing...
Disease and treatment-related symptoms and dysfunctions can interfere with the psychosocial adjustment of patients with oral cancer. Identifying factors influencing psychosocial maladjustment is important because at-risk individuals can be targeted for early intervention. This prospective longitudinal study investigated psychosocial adjustment changes and associated factors in postoperative oral cancer patients. Data on psychosocial adjustment, facial disfigurement, symptoms, and social support were collected before surgery (T1) at one month (T2), three months (T3), and five months after discharge (T4). Fifty subjects completed the study, and their data were included in the analysis. Psychosocial maladjustment was reported in 50%, 59.2%, 66%, and 62% of subjects at T1, T2, T3, and T4, respectively. The subjects' psychosocial adjustment deteriorated after surgery. Results from generalized estimating equations indicated that financial status, cancer stage, pain, speech problems, social eating problems, and less sexuality were significant predictors of changes in psychosocial adjustment. Patients with insufficient income, stage III/IV cancer, severe pain, speech problems, social eating problems, and less sexuality were at higher risk for postoperative psychosocial maladjustment. Continued psychosocial assessment and appropriate supportive measures are needed to strengthen the psychosocial adjustment of these high-risk groups.
PubMed: 36551986
DOI: 10.3390/biomedicines10123231 -
Contemporary Oncology (Poznan, Poland) 2013Basal cell carcinoma is the most common skin cancer in the Caucasian population. The cancer arises in sun exposed areas of the skin. The incidence of morbidity is high... (Review)
Review
Basal cell carcinoma is the most common skin cancer in the Caucasian population. The cancer arises in sun exposed areas of the skin. The incidence of morbidity is high and it is still growing. The metastatic rate is low, but the enlarging tumor may cause severe tissue disfigurement and a poor cosmetic outcome. The diagnosis is usually clinical but there are many subtypes of this carcinoma and correct diagnosis is the clue to appropriate treatment of the lesion. The main problem in basal cell carcinoma management is the high recurrence rate.
PubMed: 24592119
DOI: 10.5114/wo.2013.35684 -
Clinical Trials (London, England) Apr 2024We developed an observer disfigurement severity scale for neurofibroma-related plexiform neurofibromas to assess change in plexiform neurofibroma-related disfigurement...
BACKGROUND/AIMS
We developed an observer disfigurement severity scale for neurofibroma-related plexiform neurofibromas to assess change in plexiform neurofibroma-related disfigurement and evaluated its feasibility, reliability, and validity.
METHODS
Twenty-eight raters, divided into four cohorts based on neurofibromatosis type 1 familiarity and clinical experience, were shown photographs of children in a clinical trial (NCT01362803) at baseline and 1 year on selumetinib treatment for plexiform neurofibromas ( = 20) and of untreated participants with plexiform neurofibromas ( = 4). Raters, blinded to treatment and timepoint, completed the 0-10 disfigurement severity score for plexiform neurofibroma on each image (0 = not at all disfigured, 10 = very disfigured). Raters evaluated the ease of completing the scale, and a subset repeated the procedure to assess intra-rater reliability.
RESULTS
Mean baseline disfigurement severity score for plexiform neurofibroma ratings were similar for the selumetinib group (6.23) and controls (6.38). Mean paired differences between pre- and on-treatment ratings was -1.01 (less disfigurement) in the selumetinib group and 0.09 in the control ( = 0.005). For the disfigurement severity score for plexiform neurofibroma ratings, there was moderate-to-substantial agreement within rater cohorts (weighted kappa range = 0.46-0.66) and agreement between scores of the same raters at repeat sessions ( > 0.05). In the selumetinib group, change in disfigurement severity score for plexiform neurofibroma ratings was moderately correlated with change in plexiform neurofibroma volume with treatment ( = 0.60).
CONCLUSION
This study demonstrates that our observer-rated disfigurement severity score for plexiform neurofibroma was feasible, reliable, and documented improvement in disfigurement in participants with plexiform neurofibroma shrinkage. Prospective studies in larger samples are needed to validate this scale further.
Topics: Child; Humans; Neurofibroma, Plexiform; Neurofibromatosis 1; Prospective Studies; Reproducibility of Results
PubMed: 37877369
DOI: 10.1177/17407745231206402 -
Industrial Psychiatry Journal Oct 2021A number of incurable, deadly, and disfiguring diseases are associated with stigma which worsens the quality of life of the sufferer. Unfortunately, at the beginning of...
A number of incurable, deadly, and disfiguring diseases are associated with stigma which worsens the quality of life of the sufferer. Unfortunately, at the beginning of the COVID-19 pandemic, the disease was associated with severe stigma and extreme prejudice. Stigma of COVID-19 and its adverse effects are briefly discussed and solutions suggested.
PubMed: 34908707
DOI: 10.4103/0972-6748.328827