Evidence-Based Oral and Maxillofacial Surgery: Some Pitfalls and Limitations

Abstract

After arriving in Leipzig, the primary author (P.P.) sat at his desk contemplating what he has learned from the Fourth European Head and Neck Society European Conference on Head and Neck Oncology in Athens, Greece, March 4 to 6, 2010. In the “Grand Debate” session, Professor Alexander D. Rapidis, the moderator and local president, introduced the clinical scenarios (eg, the management of oral cancer in a pregnant patient or the nonsurgical approach to unresectable oropharyngeal tumors). The panel seemed to proceed to the high-level evidence, eg, randomized controlled trials (RCTs). However, Drs James Brown and Christopher Nutting, the key delegates, suggested the difficulties in surgical RCTs, including study design and standardization and patient consent. Evidence-Based Oral and Maxillofacial Surgery: Some Pitfalls and LimitationsJournal of Oral and Maxillofacial SurgeryVol. 69Issue 7PreviewPitak-Arnnop et al1 in a recently published article in this journal provided insight into the applicability of an evidence-based schema for decision-making processes in arriving at the most appropriate surgical therapy. The investigators correctly noted that the weaknesses in this process as they related to surgery arise from giving undue credence to randomized controlled trial outcomes. However, as the hospital dental service's director of quality assurance at a major university teaching center, a member of that institution's peer-review committee, and a member of a similar committee at a federal facility, I was dismayed by the inclusion in the article of the following 2 referenced sentences: In many instances, the preference of patients will differ greatly from their surgeon and scientific evidence. Full-Text PDF