Clinical Articles
Pain, function, and psychologic outcome before, during, and after intraoral tumor resection*

https://doi.org/10.1053/joms.2002.33244Get rights and content

Abstract

Purpose: The aim of the present study was to determine the quality of life of patients with respect to pain before, during, and after ablative intraoral tumor surgery. Patients and Methods: The Bochum Questionnaire on Rehabilitation was used to determine 147 items including the morphologic, functional, and psychosocial aspects of rehabilitation. One thousand six hundred fifty-two of 3,500 patients (47.2%) (413 women and 1,239 men) completed the questionnaire. The statistical investigation was carried out using 2-sample (independent) and paired (dependent) t tests. Results: Pain and the functional impairment of chewing and swallowing are the most important parameters before treatment. Immediately after surgical treatment, other variables, such as speech intelligibility and mobility disorders in the head, neck, and shoulder regions, became more apparent. Pain was reported in the shoulder region in 38.5% and in the neck in 34.9% of patients after surgery. The temporomandibular joint was painful in 20.1%, the oral cavity in 18.7%, and the face in 8.2%. Pain was described by 7.4% of patients in other regions of the head. Seventy-five percent of 1527 patients were not taking pain medications during the investigation. The rate of physiotherapy consequently applied after surgery was less than 10%. Conclusions: Quality of life after ablative intraoral surgery is not greatly affected by pain. Because functional disorders play the dominant role in the impairment of postoperative quality of life, functional reconstruction, using microvascular techniques, and early rehabilitation, including physiotherapy, should be intensified. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:772-777, 2002

Section snippets

Patients and methods

A retrospective investigation was carried out based on a standardized rehabilitation questionnaire that included 147 items. A total of 3,500 patients who had been treated for oral squamous cell carcinoma (SCC) were invited to participate in this study. Of the 3,500 patients, 1,652 filled out the questionnaire. The other 1,848 patients did not answer. We were able to enroll 1,652 patients (413 women [25.0%] and 1,239 men [75.0%]) for the statistical investigation of this study. Their age

Results

From the clinical record, it was noted that in this inhomogeneous group of patients, different treatment modalities had been used. Early-stage SCCs were treated exclusively surgically, whereas late-stage diseases often received a combined treatment regimen of adjuvant radiotherapy and/or chemotherapy (Table 1).

. Tumor staging and treatment modalities

Stage*Surgery % (n = 644)Surgery and Radiotherapy % (n = 362)Surgery and Chemotherapy % (n = 53)Surgery, Radiotherapy, and Chemotherapy % (n = 107)
I

Discussion

In the last decade, QOL assessment has attracted increasing attention as a method for both clinical studies and routine follow-up in cancer treatment.20 In the head and neck region, especially, this had led to the development of new measures of QOL such as the EORTC-questionnaire's head and neck module21 and other scales.17, 22, 23

It is well accepted today that the measurement of QOL should rely on the patients' own reports and be multidimensional, reflecting physical, functional, and

Acknowledgements

The authors wish to express their appreciation to the German-Austrian-Swiss Association for Head and Neck Tumors for their support. In addition, we are grateful to those of all of the departments of oral and maxillofacial surgery that contributed their patients and their time and efforts to this work.

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    Address correspondence and reprint requests to Dr Gellrich: Department of Oral and Maxillofacial Surgery, University of Freiburg, Hugstetterstr 55, D-79106 Freiburg, Germany; e-mail: [email protected]

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