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Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26–S116    S33

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 treat-ment 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 squa-

mous 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 recruitedinto thestudy. Allhad

retrospectively been managed for oral squamous cell carci-

noma (OSCC) within the past 2 years and completed a fullcourse of treatment.

Patients were interviewed and questioned on theirsatisfac-

tion 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 informa-

tion 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 abnormali-

ties: 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 imag-

ing techniques has dramatically increased our knowledge

of embryology and presented surgeons from all specialties

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 pre-

natal glioma, which was managed, in our tertiary centerafter being detected at 20 weeks gestation. Such craniofacial

malformations present multiple challenges and the maxil-

liofacial 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 malfor-

mations 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 malfor-

mations.

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 makeappropriate decisions.Guidanceon 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 guide-

lines in informed consent for elective and emergency

orbito-zygomatic trauma surgery and to make recommen-

dations 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 orbito-

zygomatic surgery over a 12-month period (January toDecember 2010). The medical notes were assessed for the

presence of consent forms,the legibility of the doctor’s name,

the simplicityof language used including surgicalapproaches

and the extent to which risks of the operation were docu-

mented.

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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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.

doi:10.1016/j.bjoms.2011.03.030

P22

The role of ultrasound in the hands of oral and maxillo-

facial 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 inthe diagnosis of extracranial head and neck soft tissue.

Although our specialist radiologists are providing vital ser-

vices 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 con-

tralateral thyroid mass after hemithyroidectomy.

•  Drainage of superficial head and neck skin collections or

abscesses.

Discussion: Visualisation of superficialstructures to facil-itate various surgical, anaesthetic and diagnostic procedures

under ultrasound guidance have been widely used by inten-

sivists 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 struc-

tures can be performed by trained surgeons to facilitate

patient care, reduce complications and treatment planning.

doi:10.1016/j.bjoms.2011.03.031

P23

Patient related outcome measures: a new audit tool for

oral and maxillofacial surgery

R. Bhandari∗, P. Naredla, S. Stagnell, C. Bridle, M. Millwa-

ters

 Barts and The London NHS Trust, United Kingdom

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 indi-

vidual patient’s 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 dis-

cuss 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

theirdevelopmentthroughoutour individual areasof practice.

doi:10.1016/j.bjoms.2011.03.032

P24

Breast metastases to the neck—is 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 suchpatients as M1 between 1987 and 2002 the demonstration

that patients with regional stage IV disease had better out-

comes 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 impressionwas 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. Ouraim was thereforeto determinecurrent practice and

opinion.