Many socioeconomically disadvantaged adults manifest negative psychological outcomes even 1 year after an orofacial injury. Poor social support and unmet social service needs immediately after the injury, as well as high PTSD symptoms at 1 month postinjury, are strongly associated with the risk of developing chronic PTSD. The surgical management of orofacial injuries in disadvantaged individuals should integrate case management that addresses psychosocial sequelae and patient service needs.

By implication, patients with MMF self-report fewer problems in the early days after placement of the intra-arch wire compared with patients with RIF.

Purpose-While surgery related stress may interfere with the patient's ability to concentrate on instructions, language difficulty or low health literacy may also impede appropriate doctor/patient communication. The purpose of this study is to understand from a sample of minority patients the types of problems encountered during healing and the level of information regarding elements of postoperative instructions they recalled receiving at an inner-city safety net hospital. We initiated a qualitative study to understand the care sequence process and provision of informed consent and postoperative instruction. Methods-AfricanAmerican or Latino patients, 18 years of age or older, who had third molars removed under general anesthesia or received treatment for a mandibular fracture were recruited to participate in a focus group to discuss their treatment. Patients described their problem and any informed consent given about treatment risks and benefits and postoperative information they recalled.Results-A total of 137 former patients were approached, 57 agreed to participate (42%) and 34 of those (60%) completed the interview. Subjects included 14 females and 20 males. Five categories of patient problems were reported: physical, eating, treatment-related, psychosocial, and other problems. People reported 5 categories of coping strategies: medication use, physical treatments, dietary solutions, rest, and clinical assistance. Twenty people recalled being given The type and level of information that patients may require to make an informed decision in deciding specific treatment types is not well understood. Professional standards state that the health care provider must inform the patient about risks and benefits of each treatment. Nonetheless, the clinician struggles to succinctly and clearly present relevant information to a patient. 7Good communication is also critical in assisting patients to appropriately deal with postoperative management. Studies have shown that adequate postoperative education can improve patient satisfaction and reduce postsurgical morbidity. 8 Malins 5 pointed out that patients from ethnic minorities might need printed instructions in their native language and the services of an interpreter. Moreover, verbal or a combination of verbal and written instructions are preferred by most patients, particularly those with lower education. 3,4,6 However, without written reinforcement the understanding and retention of verbal instructions over a lengthy period of recovery cannot be assured.Alexander 3,9 stated that it is time for dental professionals, particularly those in the surgical specialties, to pay more attention to the phrasing, jargon, and terminology used in their postoperative instruction forms, as well as in their office brochures, informed consent forms, and the like. The purpose of this study was to elicit information from a minority sample about the types of problems encountered following oral surgery, the coping strategies they used to manage the problems, and the level of infor...

Context-Owing to its putative advantages over conventional maxillomandibular fixation (MMF), open-reduction and rigid internal fixation (ORIF) is frequently used to treat mandible fractures, particularly in noncompliant patients. The resource intensive nature of ORIF, the large variation in its use and the lack of systematic studies substantiating ORIF's attributed benefits compel a randomized controlled investigation comparing ORIF to MMF treatment.Objectives-To determine whether ORIF provides better clinical and functional outcomes than MMF in non-complying type of patients with a similar range of mandible fracture severity.Study Design-A prospective randomized controlled study with repeated assessments over a 1-year follow-up. Setting-Inner-city Level-1 Trauma centerMethods-From a total of 336 patients who sought treatment for mandible fractures, 142 patients with moderately-severe mandible fractures were randomly assigned to receive MMF or ORIF and followed prospectively for 12 months. A variety of clinician and patient-reported measures were used to assess outcomes at the 1, 6 and 12 months follow-up visits. These measures included clinicianreported number of surgical complications, patient-reported number of complaints, as well as Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript cumulative costs of treatment., Pain intensity was measured on a 10-point scale and the 12-item General Oral Health Assessment Index (GOHAI) was used to assess the patients' oral health related quality of life. Because the protocol allowed clinical judgment to overrule the randomly assigned treatment, outcomes were compared on an "intent-to-treat" basis as well as in terms of actual treatment received.Results-The sociodemographic and clinical characteristics of the injury did not differ among the two groups On an intent-to-treat basis, the difference in complication rates was not significant but favored MMF; 8.1% of patients developed complications with MMF vs. 12.5% with RIF. Differences in the rate of patient complaints were not significant on an intent-to-treat basis, but a significant between-group difference (p = 0.012) favoring MMF was noted on an as-treated basis at the 1 month recall, with 40% of ORIF patients reporting >1 complaint vs. 18.8% of MMF patients. No significant differences were detected between the two treatment groups at any time point with respect to oralhealth related quality of life reflected by the GOHAI scores. In-patient days and total costs did not differ significa...

Background-Patient preferences for treatment choices may depend on subject characteristics.

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