Postoperative Cognitive Dysfunction (POCD) after Oncological Oral and Maxillofacial Surgery

Postoperative Cognitive Dysfunction (POCD) after Oncological Oral and Maxillofacial Surgery
Hojjat Shadman Zahroodi,^1,* Melika Mollaye,² Behrad Yadollahii,³ Narges Tavahodi,⁴ Salehe Akhondian,⁵
1. student research committee, Mashhad University of Medical Sciences, Mashhad , Iran
2. Dentistry student, student research committee, faculty of dentistry, mazandaran university of medical sciences, sari, iran
3. Dentistry student, student research committee, faculty of dentistry, mazandaran university of medical sciences, sari, iran
4. Dentistry student, student research committee, faculty of dentistry, mazandaran university of medical sciences, sari, iran
5. Dentistry student, student research committee, faculty of dentistry, mazandaran university of medical sciences, sari, iran
Introduction: Introduction: POCD is known as a decrease in cognitive function based on preoperative to postoperative, neurological and psychological tests, which in some patients It will last more than 30 days and, in some patients, more than 6 years. Gender, age, duration of anesthesia, trauma, surgery, and hemodynamic changes that lead to ischemia are considered as risk factors of POCD. Cardiac surgery and some orthopedic procedures can cause POCD in patients. Oral surgeries have shown an increase in serum NSE and S100B levels after surgery; there is also a link between their increase and the incidence of POCD, so it can be said that POCD occurs after oral surgery. POCD can have influence on person's concentration, memory, learning ability, emotions, movements as well as the quality of recovery after anesthesia, quality of life and Duration of hospitalization. It can even affect the mortality of patients after surgery. aim: The aim of this study was to evaluate the effect of POCD after oral and maxillofacial surgeries in patients with oral cancer, on the patient's recovery.
Methods: Method: To this narrative review we limited our search to 2015-2020 and considered the studies that met our exclusion criteria. Then we assessed the three studies known to be relevant to our topic from six English articles by searching four databases such as: PubMed Central, Science Direct, Cochrane and Google Scholar by medical subheadings (MeSH) of oral cancer, maxillofacial cancer surgery, POCD, incidence, epidemiology, risk factors. The exclusion criteria are relating title and abstract and content of article to POCD after oral and maxillofacial surgery. The measure of this study was that we wide examined the factors contributed to the occurrences of POCD in patients after Oral and maxillofacial surgery.
Results: POCD can have different causes. Factors like gender, age, trauma, duration of the surgery and even the patient's level of education might affect the occurrence of POCD. In this study the results of three articles were considered. Two of them directly studies patients with a total group of 935 participants. Out of 935 who were studied, only 222 patients could successfully finish the test. 46 of these were in the study group, and 176 others were in the control group. Participants' average age was 52.67, including 106 females (47.74%) and 116 males (52.25%). 49 participants (22.07%) were frequent smokers and 82 of them (36.93%) were nonsmokers. 34 participants (15.31%) were alcoholic and 93 (41.89%) occasionally consumed alcohol. 21 participants (9.45%) were diabetic. We understood that factors like diabetes, smoking, alcohol may not be very effective in the occurrence of POCD. Although some articles claimed that Dementia is the most significant factor associated with POCD, the etiology of it is still unclear.
Conclusion: Conclusion: POCD can highly occur after surgery (especially orthopedic and cardiac surgery). It can have great influence on patient's concentration, memory, learning ability, emotional state, movements as well as the quality of recovery after anesthesia, quality of life and duration of hospitalization. It can even increase the mortality of patients after surgery. According to the results of the study, we found that dementia is the most significant factor associated with the occurrence POCD but we are not certain whether diabetes, smoking and consuming alcohol can significantly change the occurrence of POCD. It is suggested that optimized anesthesia guided by processed EEG indicates in patients with dementia could reduce the risk of POCD. Further studies with more participants are required to elucidate the right strategies for reducing the incidence of POCD after oral surgeries.
Keywords: POCD, postoperative cognitive dysfunction, surgery, oral cancer, maxillofacial cancer