Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26S116

ment and allows consultants to better select trainees applying

for higher training.
doi:10.1016/j.bjoms.2011.03.027
P19
Patients perception of information delivery during treatment for oral squamous cell carcinoma
M.L. Goodson , H. Beattie, R.J. Banks, A. Burns
Sunderland Royal Hospital, United Kingdom
Introduction: Assessment of the quality of information
delivery to patients associated with a diagnosis of oral squamous cell carcinoma is frequently a neglected aspect of
management. The aim of this study was to assess quality
of information delivery from the multidisciplinary team.
Methods: 70 patients were recruited into the study. All had
retrospectively been managed for oral squamous cell carcinoma (OSCC) within the past 2 years and completed a full
course of treatment.
Patients were interviewed and questioned on their satisfaction of information delivery following a diagnosis of 0SCC.
Using a Likert Scale, patients were asked to identify whether
they had received sufficient information on the causes and
types of oral cancer, biopsy, further investigations, treatment
and expectations after treatment.
Results: 89% patients questioned felt they had received
sufficient information in this study and that information was
easy to understand. Most patients were happy with information received, but 26% would have preferred more on the
causes of OSCC and post surgical management (20%). 80%
patients preferred information to be given verbally and 75%
requested information be given by the Consultant Surgeon.
More than 63% patients felt they had sufficient access to their
Surgeon, Head and Neck nurse and Oncologist to acquire
information during management.
Conclusions: Greater attention to delivery of information
regarding aetiology of OSCC and post surgical management
is required to ensure patients are more aware of the pre and
post operative aspects of OSCC management.
doi:10.1016/j.bjoms.2011.03.028
P20
The evolving world of prenatal craniofacial abnormalities: advancements in detection and management
I. Beegun , R. Dua, R. Bentley, S. Coner
Kings College London and the London School of Surgery,
United Kingdom
The fetus presenting as a patient has now become a
reality for the majority of clinicians. The evolution of imaging techniques has dramatically increased our knowledge
of embryology and presented surgeons from all specialties

S33

with new challenges. There can be no doubt that at some

point in our surgical career we will be faced with a fetal
patient. Our work will provide great insight into the rapidly
evolving world of fetal medicine and arm the surgeon with
the knowledge to guide their management of both the fetus
and their family. We present the fascinating case of a prenatal glioma, which was managed, in our tertiary center
after being detected at 20 weeks gestation. Such craniofacial
malformations present multiple challenges and the maxilliofacial surgeon is a key member of the multidisciplinary
team which must provide counseling, differential diagnosis,
genetic screening, safe delivery and ultimately appropriately
timed surgical management. We discuss craniofacial malformations which are increasingly being detected prenatally and
review new methods to ensure the safe delivery of children
born with potential airway compromise. Finally we discuss
the potential differential diagnosis which are pertinent to
prenatally detected craniofacial lesions, the indications and
timing of surgical management of these craniofacial malformations.
doi:10.1016/j.bjoms.2011.03.029
P21
An audit of informed consent for orbito-zygomatic
trauma
N. Berridge , D. Haider, P. Naredla, C. Bridle
Barts and The London, United Kingdom
Introduction: The primary purpose of informed consent
is to formalise the process by which patients are empowered
to make appropriate decisions. Guidance on informed consent
varies according to the country and jurisdiction in which the
surgical procedure is to occur. In England, the guidance has
been issued by the Royal Colleges, the Government, NHS
Trusts and hospital departments.
Objective: To measure compliance with available guidelines in informed consent for elective and emergency
orbito-zygomatic trauma surgery and to make recommendations to improve the process of consenting at the Royal
London Hospital.
Method: A retrospective study of 200 medical notes
of patients undergoing elective and emergency orbitozygomatic surgery over a 12-month period (January to
December 2010). The medical notes were assessed for the
presence of consent forms, the legibility of the doctors name,
the simplicity of language used including surgical approaches
and the extent to which risks of the operation were documented.
Result: We are in the process of finalising the results of
the 200 medical notes assessed. However, we can state at this
stage that there existed a great variation in the language used
to consent patients for surgical treatment of orbito-zygomatic
trauma. In addition, the documentation of risks was found to
be incomplete.

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Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26S116

Conclusion: The goal of consent process is to ensure that

relevant information has been presented appropriately and
understood. We offer recommendations that can be used to
improve the consent process by way of operation-specific
consent forms, a pro forma or the more judicious use of aide
memoirs.

P23

doi:10.1016/j.bjoms.2011.03.030

Barts and The London NHS Trust, United Kingdom

P22

Introduction: In the immediate future the collection and

interpretation of outcome data is expected to play a central
role not only in how units and individual practitioners will be
assessed but also in how individual interventions are judged.
To this end Patient Related Outcome Measures (PROMS)
have been championed and developed to allow monitoring
of the relative success of a procedure according to the individual patients judgement. They rely on the use of pre- and
post-operative questionnaires to calculate and quantify health
gains. To date, these have only been actively employed in four
areas; Hip replacement, Knee replacement, Hernia repair and
Varicose Vein surgery. As of April 2009, all NHS providers
have been asked to provide data in these areas for placement
on the NHS information centre website.
Discussion: There are no reports in the literature of any
attempted development or local application of PROMS in
OMFS. We therefore decided to undertake local development
of PROMS. Our initial areas were in third molar surgery and
mandibular fracture management. In our presentation, we discuss the development of our data collection tools and their
local application along with our ideas for innovative use of
technology to enhance patient participation. We also discuss
how we are using our experiences with PROMS to influence
their development throughout our individual areas of practice.

The role of ultrasound in the hands of oral and maxillofacial surgeons

R. Bhandari , R. Sothinathan, L. Cheng, C. Offiah, J.
Makdissi
Barts and The London NHS Trust, Homerton University NHS
Trust, United Kingdom
Introduction: Significant advances in high resolution
ultrasound technology have allowed maximal efficiency in
the diagnosis of extracranial head and neck soft tissue.
Although our specialist radiologists are providing vital services in staging and diagnosing complex head and neck
conditions, there are diagnostic, anaesthetic and surgical
procedures on superficial pathology and structures under
ultrasound guidance which can be performed by surgeons
with appropriate training. We present a list of procedures
which can be performed by trained surgeons within the head
and neck region.
Ultrasound guided procedures:
Cervical plexus regional nerve block with levobupivacaine
for thyroid and other neck surgery.
Botulinum toxin intramuscular injections ultrasound
provides accurate siting of needles within hypertrophic
masticatory and sternomastoid muscles with qualitative
measurement.
Incisional biopsy or fine needle aspiration cytology
(FNAC) of vascular superficial head and neck masses
visualisation of blood vessels and mass.
Intraoperative FNAC of suspicious neck mass and contralateral thyroid mass after hemithyroidectomy.
Drainage of superficial head and neck skin collections or
abscesses.
Discussion: Visualisation of superficial structures to facilitate various surgical, anaesthetic and diagnostic procedures
under ultrasound guidance have been widely used by intensivists in percutanous tracheostomy, and anaesthetists in
regional nerve block, central venous line insertion and other
invasive procedures. Ultrasound technique has also become
part of medical training in some European countries.
Conclusions: Ultrasound guided diagnostic, anaesthetic
and surgical procedure for superficial head and neck structures can be performed by trained surgeons to facilitate
patient care, reduce complications and treatment planning.
doi:10.1016/j.bjoms.2011.03.031

Patient related outcome measures: a new audit tool for

oral and maxillofacial surgery
R. Bhandari , P. Naredla, S. Stagnell, C. Bridle, M. Millwaters

doi:10.1016/j.bjoms.2011.03.032
P24
Breast metastases to the neckis there currently an
evidenced-based approach in UK practice?
B. Bisase , C. Kerawala
Royal Marsden Hospital, United Kingdom
Introduction: Cervical metastases from breast carcinoma
are rare and their management is controversial. Whilst the
American Joint Committee on Cancer (AJCC) staged such
patients as M1 between 1987 and 2002 the demonstration
that patients with regional stage IV disease had better outcomes than visceral stage IV disease lead to a re-classification
of the former to stage IIIC in 2003. Since the literature is
scarce and inconsistent regarding the fate of breast carcinoma
patients with cervical disease, our impression was that despite
the attendant morbidity of treatment and lack of knowledge
regarding the influence of management on long-term survival
a unified understanding and approach to these patients did not
exist. Our aim was therefore to determine current practice and
opinion.