British Journal of Oral and Maxillofacial Surgery - Articles in Press

Complications following interventional laser surgery for oral cancer and precancerous lesions - Corrected Proof

M.L. Goodson, K. Sugden, S. Kometa, P.J. Thomson — 2012-02-03

Abstract: Interventional carbon dioxide laser surgery is the preferred method to treat oral precancerous lesions and early invasive squamous cell carcinomas (SCCs). Little is known, however, about the complications that patients experience after such treatment. We retrospectively reviewed the hospital records of 82 patients with new dysplastic oral lesions or early invasive oral SCCs treated by laser surgery in the maxillofacial unit at Newcastle General Hospital. The most common postoperative complications were pain for more than two weeks after operation (n=28), bleeding (n=4), difficulties with speech (n=5), paraesthesia of the lingual nerve (n=17), difficulty swallowing (n=2), obstructive swelling of the submandibular gland (n=22), and tethering of the tongue (n=10). Overall, 78% of patients had one or more complication. In the absence of randomised controlled trials, this study provides the best available evidence for complication rates following interventional surgery. In addition to aiding in the preoperative counselling of patients, the data will help to inform and advise patients particularly during the immediate postoperative period.

Patient information preferences and behaviour in relation to oral biopsies - Corrected Proof

P. López-Jornet, F. Camacho-Alonso, M. Sanchez-Siles — 2012-02-03

Abstract: Our aim was to study the impact of information on the behaviour of patients who were to have an oral biopsy specimen taken. Patients were randomly assigned either to be given the basic information about oral biopsy or a more extensive amount of information. The Krantz Health Opinion Survey was used as a measure of preferences in decisions made about oral biopsy, and we used a questionnaire to assess anxiety. A total of 260 patients were studied. The participants were satisfied with the information provided (both form and content), but significantly more of those given basic information would have liked to know more (p=0.02). We conclude that information exerts a clear effect on patients’ attitude to oral biopsy. Provision of preoperative information leads to significantly less anxiety in all patients having a procedure under local anaesthesia. The results emphasise that patients need to be adequately informed about oral biopsy.

Mobile elogbook app for maxillofacial trainees - Corrected Proof

Nabeela Ahmed, Kavit Amin, Michael Williamson, Kathleen F.M. Fan — 2012-02-03

We wish to bring to the attention of the wider readership a smartphone app that has been co-written by a current maxillofacial trainee, Matthew Kennedy. The mobile elogbook app, which is currently only available on the iPhone platform (the Android version is in production), allows users to enter data directly into their smartphone and upload it at leisure to the elogbook site. It was designed in co-operation with the Royal College of Surgeons of Edinburgh.

Hydroxyapatite/collagen block with platelet rich plasma in temporomandibular joint ankylosis: a pilot study in children and adolescents - Corrected Proof

D. Mehrotra, S. Kumar, S. Dhasmana — 2012-01-31

Abstract: The aim of this study was to evaluate the feasibility of using preshaped hydroxyapatite/collagen condyles as carriers for platelet-rich plasma after gap arthroplasty in patients with temporomandibular ankylosis, to assess the aesthetic and functional outcomes, and to find out if neocondylar regeneration was possible. We studied 19 patients with temporomandibular joint ankylosis (25 joints), in whom preshaped hydroxyapatite/collagen condyles with platelet-rich plasma were fixed to the ramus with a titanium miniplate, and temporal fascia was placed in between. We evaluated the type of ankylosis, mouth opening before and after operation, deviation on mouth opening, lateral excursion, protrusion, postoperative anterior open bite, radiographic assessment, and complications. All patients showed appreciable improvements in mouth opening and excursion of the jaw. There were a few complications such as mild fever, and temporary involvement of the facial nerve, which improved with time. No open bite or recurrence was reported during the 18 months’ follow up. Radiographic evaluation at 3 months showed a less opaque condyle, but the opacity at 18 months was more defined, suggesting a newly formed condyle. A preshaped hydroxyapatite/collagen condyle with platelet-rich plasma improves both aesthetics and function. However, a long term study is required to follow the growth patterns to see if the patients develop any facial deformity as they grow.

Coronectomy practice paper. Technique and trouble shooting - Corrected Proof

Clare F. Gleeson, Vinod Patel, Jerry Kwok, Chris Sproat — 2012-01-30

Abstract: Coronectomy is a technique that reduces morbidity of the nerve after operation on high-risk mandibular third molars. This two-part paper aims to give an overview of the technique and a description of common problems that can be encountered during and after operation. In this paper we discuss the technique as an overview and then each type of impaction more specifically. We also explore common problems encountered during the procedure and their subsequent management.

Stabilisation of premaxillary segment in bilateral cleft palate during alveolar bone graft - Corrected Proof

Mark Singh, Tim Flood, Rizwan Mahmood, Nisha Sanghrajka — 2012-01-27

Secondary alveolar bone grafting was first popularised due to work by Boyne and Sands 40 years ago. Stabilisation of the premaxillary segment in bilateral cases during bone grafting can be difficult, particularly after being repositioned. Occlusal wafers and arch bars constructed to the final position of the maxillary segment are widely used although some authors advocate miniplates, placement of which has the potential to harm developing teeth if the screws are placed incorrectly. Mucosal stripping to make space for the plates may also compromise the vascular supply to the premaxilla through its labial pedicle. We present a simple new method to provide additional stability to the premaxillary segment using a Kirschner wire.

Cytogenetics of primary embryonal rhabdomyosarcoma of the cheek - Corrected Proof

Esther Manor, Ben-Zion Joshua, Michael Nash, Peter A. Brennan, Lipa Bodner — 2012-01-27

Abstract: Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumour of childhood and has two main subtypes: embryonal and alveolar. The embryonal subtype accounts for most cases in the genitourinary tract and head and neck. Oral presentations are rare, and mainly in the tongue, palate, or cheek. Cytogenetically, alveolar RMS is characterised by the translocation t(2;13)(q35;q14), which plays an important part in diagnosis, but no consistent and unique genetic alterations have been identified in embryonal RMS. It is currently not known whether oral embryonal RMS is similar to those that arise from other sites, as only one cytogenetic report has been published to date. We present the case of a 9-year-old boy with embryonal RMS of the cheek, and discuss the cytogenetic alterations in his case.

Relief of palatal injection pain by liposome-encapsulated 2% lignocaine prepared by ultrasonic dental scaler - Corrected Proof

Jarin Paphangkorakit, Chaichan Sangsirinakagul, Aroonsri Priprem — 2012-01-25

Abstract: Injections into the palate are common in dental treatment and are unpleasant for the patient. A liposomal encapsulation technique was developed to improve the efficacy of 2% lignocaine dental injection so that it could be used as a topical anaesthetic. Liposome-encapsulated 2% lignocaine was prepared as needed by sonicating 2% lignocaine hydrochloride dental injection (with 1:100,000 adrenaline) with a lipid mixture using a dental ultrasonic scaler for 1min. The time to onset and time to take effect were calculated by a pinprick test in the palatal mucosa in 10 normal subjects. In another experiment, the preparation was tested in a further 22 subjects for its pain-relieving effect during a standard palatal injection, and compared with 18% benzocaine/2% tetracaine gel. The results showed that the mean (SD) time to onset and time to take effect of the liposome-encapsulated 2% lignocaine were 39.0 (21.4) and 157.5 (2.3)s, respectively, and the mean (SD) pain score measured on a visual analogue scale (VAS) during injection was 4.1 (2.3)cm. After the application of the gel the corresponding measurement was 4.8 (2.8)cm (p=0.045). The encapsulation of 2% lignocaine dental injection in liposomes by a dental ultrasonic scaler was effective in improving the efficacy of the anaesthetic for topical application.

The ‘acrylic technique’ to check arch coordination in orthognathic surgery patients - Corrected Proof

Farhad B. Naini — 2012-01-25

Arch coordination is one of the most important preparatory requirements for orthognathic surgery, the objective being to make certain that the maxillary and mandibular dental arches will fit together well at the time of surgery, with corresponding arch forms and good labial and buccal segment interdigitation. Inadequate arch coordination can jeopardize the quality of the surgical result.

Effects of hydrofluoric acid and anodised micro and micro/nano surface implants on early osseointegration in rats - Corrected Proof

Yongfeng Li, Yuan Gao, Bo Shao, Jianrui Xiao, Kaijin Hu, Liang Kong — 2012-01-18

Abstract: Our aim was to evaluate the effects of hydrofluoric acid and anodised micro and micro/nano surface implants on bony ingrowth in the earliest stage of implantation in rats. Sixty cylindrical screwed titanium alloy implants with machined, micro, and hierarchical hybrid micro/nano surfaces (n=20 in each group) were inserted into the distal femurs of 30 female Sprague-Dawley rats. In vivo microcomputed tomography (micro CT) was used to assess microarchitectural changes in the bone around the implants 2 weeks after implantation. All the animals were then killed and the femurs with implants harvested for histological analysis and pull-out testing. Micro CT analysis showed that the trabecular thickness and the bone:volume ratio (bone volume:total volume) (BV:TV) increased significantly in the micro/nano group compared with the other two groups, while the trabecular separation decreased significantly in the micro/nano group compared with the machined group. The mean (SD) bone-implant contacts (%) were 38.94 (9.48), 41.67 (8.71), and 51.49 (12.49) in the machined, micro, and micro/nano groups, respectively. The maximum pull-out forces (N) were 64.95 (6.11), 71.45 (7.15), and 81.90 (13.1), respectively. Both bone-implant contacts and maximum pull-out forces were significantly higher in the micro/nano group, but there was no significant difference between the micro group and the machined group. These data indicate that the hierarchical hybrid micro/nano surface of the implant can promote osseointegration in the earliest stage of implantation, and may be a promising option for further clinical use.

Excision of a submandibular gland: a safe day case procedure? - Corrected Proof

S. Laverick, J. Chandramohan, P.M. McLoughlin — 2012-01-16

Abstract: There are considerable benefits, both for patients and hospitals, if operations are done as day case procedures. Excision of a submandibular gland is a relatively common operation and it is usual practice for surgeons to be cautious, admit the patient for an overnight stay, and leave a drain in place. To assess the amount of postoperative bleeding into the wound (and hence potential risk to the airway) we have studied prospectively the amount of drainage that occurs. Sixty consecutive patients admitted for overnight postoperative monitoring after excision of a submandibular gland had a suction drain placed as part of the procedure. Drainage was measured by departmental staff at regular intervals during the following 24h. Nearly all the patients drained 40ml or less (mean 18ml) and in all cases there was a clear decrease in the volumes drained over the first 6–8h postoperatively. Drainage then became negligible. The plateau in drainage was evident regardless of the initial volume drained. Surgeons should be confident that drainage will cease after 6–8h in most patients, and residual drainage is negligible.

Nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate - Corrected Proof

2012-01-16

Abstract: The objective of this study was to evaluate the association between nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate (CUCLP). Frontal and basal photographs of 60 consecutively treated children with CUCLP (cleft group: 41 boys and 19 girls, mean (SD) age 11 (2) years) and 44 children without clefts (control group: 16 boys and 28 girls, mean (SD) age 11(2) years), were used for evaluation of nasolabial symmetry and aesthetics. Nasal and labial measurements were made to calculate the coefficient of asymmetry (CA). The 5-grade aesthetic index described by Asher-McDade et al. was used to evaluate nasolabial appearance. Correlation and regression analysis were used to identify an association between aesthetics and CA, sex, and the presence of CUCLP. Ten measurements in the cleft, and 2 in the control, group differed significantly between the cleft and non-cleft (or right and left) sides, respectively. The significantly higher values of 9 of 11 CA in the children with CUCLP indicated that they had more asymmetrical nasolabial areas than children without clefts. However, the regression analyses showed that only a few CA were associated with nasolabial aesthetics. In conclusion, nasolabial aesthetics and nasolabial symmetry seem to be only weakly associated in patients with CUCLP.

A “star” retractor in head and neck surgery - Corrected Proof

Richard Burnham, Alan Attard, Gary Walton — 2012-01-12

The Lone Star Retractor™ (Lone Star Medical Products, Stafford, UK) has its origins in anorectal surgery as a specially designed, single use retractor ring using elastic stays that provide optimal exposure while taking up the minimum of room. The specially designed stays come in a number of different ergonomic designs including a “rake”, “blunt hook”, and “sharp hook” (). They were designed for the friable anal mucosa and are gentle enough to use in the head and neck.

Cervical epidural abscess presenting as giant cell arteritis - Corrected Proof

Christopher J. Mannion, Anastasios Kanatas, Martin Telfer — 2012-01-12

Abstract: Maxillofacial surgeons may be involved in the initial investigation and management of temporal arteritis. We present a case of a cervical epidural abscess with clinical features of temporal arteritis.

Applying aviation factors to oral and maxillofacial surgery – the human element - Corrected Proof

Leonie Seager, Dave W. Smith, Anish Patel, Howard Brunt, Peter A. Brennan — 2012-01-12

Abstract: There are many similarities betwfeen flying commercial aircraft and surgery, particularly in relation to minimising risk, and managing potentially fatal or catastrophic complications, or both. Since 1979, the development of Crew Resource Management (CRM) has improved air safety significantly by reducing human factors that are responsible for error. Similar developments in the operating theatre have, to a certain extent, lagged behind aviation, and it is well recognised that we can learn much from the industry. An increasing number of publications on aviation factors relate to surgery but to our knowledge there is a lack of research in our own specialty. We discuss how aviation principles related to human factors can be translated to the operating theatre to improve teamwork and safety for patients. Clinical research is clearly needed to develop this fascinating area more fully.

Computer assisted dental rehabilitation in free flaps reconstructed jaws: one year follow-up of a prospective clinical study - Corrected Proof

S.M. Meloni, G. De Riu, M. Pisano, O. Massarelli, A. Tullio — 2012-01-12

Abstract: Continuity defects in bone after resection of the jaw may cause problems, and osseo-myocutaneous free flaps are the gold standard for their reconstruction. Implant-supported prosthetic rehabilitation is reliable with these microvascular options, although it is still a serious challenge. The aim of this prospective clinical study was to describe the advantages of implants restored according to a computer-assisted surgical protocol. A group of 10 consecutive patients (both sexes) had already been treated and followed up for at least 1 year after prosthetic loading. The NobelGuide protocol had to be modified to adapt the technique for these patients who had had reconstructions. A total of 56 fixtures were installed and, when possible, immediately loaded (overall survival of implants 95%). Every patient was given correct provisional prosthetic rehabilitation, which was most satisfactory as far as chewing, social functioning, and overall quality of life were concerned. Three-dimensional computed tomographic (CT) examination showed a mean (SD) marginal bone loss of 1.06 (0.5)mm. We used a modified technique of computer-assisted implant surgery in jaws that had been reconstructed with free flaps; from these preliminary findings this approach seems valid when it comes to function, improving prosthetic restoration, and aesthetics.

A review of post-operative feeding in patients undergoing resection and reconstruction for oral malignancy and presentation of a pre-operative scoring system - Corrected Proof

Karen A. Eley, Rupali Shah, Stephen E. Bond, Stephen R. Watt-Smith — 2012-01-10

Abstract: Percutaneous endoscopic gastrostomy (PEG) and nasogastric tubes (NGT) are routine after resection and reconstruction of oral cancer. The selection of the most appropriate method of feeding can be challenging, as both methods carry morbidity. This makes correct selection paramount. The objectives of this retrospective review were to identify the benefits and complications of feeding with PEG and NGT in patients with oral malignancy. We retrospectively reviewed 144 patients who had undergone oral cancer resection and reconstruction, to compare PEG and NGT feeding and to identify the key factors that aid selection of the most appropriate feeding method. We used these factors to develop the Key to Appropriate Replacement Enteral Nutrition (KAREN) scoring system. One hundred and twenty of the 144 patients were managed with PEG, and of these, 9 used it for less than 28days. The mean (range) duration of use was 13 (5–63) days, and 1.9 (1–5) tubes/patient were used. The KAREN scoring system assigned the correct method of feeding in 92% of cases. The scoring system requires prospective validation but could provide clinicians with a tool to assist in a sometimes difficult decision.

Re: Herd MK, Anand R, Brennan PA. Use of propofol emulsion for intraoperative lubrication of oral and maxillofacial surgical instruments [Br. J. Oral Maxillofac. Surg. 49 (2011) 666–667] - Corrected Proof

David Dunleavy — 2012-01-09

I found the recent technical note by Herd et al. interesting. All too often we find ourselves in the position of trying to complete surgery with less than ideal tools. Often when the problem presents during an operation the choices are to wait for a replacement pack to be found and opened, or to make-do and complete the case.

Cytogenetic findings in benign and malignant oral tumors – the role of autologous human plasma - Corrected Proof

Esther Manor, Sarit Tetro, Peter A. Brennan, Lipa Bodner — 2012-01-09

Abstract: The present study examined the possible use of autologous human plasma (AHP) to improve the in vitro culture for cytogenetics of benign and malignant oral tumor cells.The effect of AHP on the growth of a variety of benign and malignant head and neck tumor cells was studied by inverted microscope and cytogenetic analysis. Minced tumor biopsies of cases of hemangioma (HM), lipoma (LP), central giant cell granuloma (GC), pleomorphic adenoma (PA), schwannoma (SW), oral squamous cell carcinoma (SCC), Ewing sarcoma (ES), Merkel cell carcinoma (MCC) and adenoid cystic carcinoma (ACC), were cultured in medium supplemented with either AHP, allogeneic pooled human plasma (PHP), or fetal calf serum (FCS).More fibroblasts were seen in the FCS supplemented cultures, while in HP or PHP culture medium, more epithelial-like tumor cells were noted. The karyotypes of HM, LP, GC and PA were normal in all 3 different mediums.Cytogenetic analysis of SW and SCC revealed random numerical changes in all cultures. However, in AHP cultures a clone bearing translocation was found in SW t(2;13). In the SCC cultures one tumor had t(12;14) and the other t(3;21) translocations. Complex karyotype was found in all kinds of cultures in ES, MCC and ACC.AHP by itself does not cause chromosomal aberrations but may improve the ability to find chromosomal aberrations in some tumors over medium containing FCS. The spectrum of oral tumors where AHP can improve the cytogenetic analyses should be further studied on a greater number of tumors.

Pre-emptive analgesia with the combination of tramadol plus meloxicam for third molar surgery: a pilot study - Corrected Proof

2012-01-06

Abstract: The aim of this pilot study was to evaluate pre-emptive analgesia using the combination tramadol plus meloxicam compared with each individual drug alone for the reduction of pain after extraction of third molars. Fifty-one patients were randomised into three groups (n=17 in each), using a series of random numbers: the first group was given tramadol 25mg and meloxicam 7.5mg; the second tramadol 50mg, and the third meloxicam 15mg, all intramuscularly. Treatments were prepared in identical syringes by an independent investigator and were given immediately. The teeth were removed 50min after the analgesics had been given. Intensity of pain, consumption of analgesics, and adverse effects were evaluated. The intensity of pain was evaluated using a visual analogue scale (VAS) and the area under the curve of the VAS showed significant differences amongst the groups. In conclusion, the study showed that the combination of tramadol 25mg and meloxicam 7.5mg had an analgesic effect similar to that of meloxicam 15mg, but both were better than tramadol 50mg for relief of pain after the extraction of mandibular third molars.

Case series of undetected intranasal impression material in patients with clefts - Corrected Proof

Simon D. Jones, David J. Drake — 2012-01-05

Abstract: We report the cases of two female patients in their twenties who had had corrective surgery for bilateral cleft lip and palate as babies. They had both had residual palatal fistulas and had had further treatment that required repeated dental impressions. Several years later both had complained of persistent nasal discomfort and discharge, and routine clinical examination and investigations had failed to identify the cause. Full examination of the whole nasal cavity under general anaesthesia, in both cases, showed the presence of displaced dental impression material in the nasal floor. Removal resulted in complete resolution of symptoms.

Acrylated stainless steel basket splint for mandibular fractures in children - Corrected Proof

Geoff A. Chiu, Irvail S. Prabhu, Maire E. Morton, Gavin J. Carmichael — 2012-01-05

Children who sustain maxillofacial trauma are a special group. Compared with adults there are important differences that need to be taken into consideration when managing them. Depending on age, the differences vary, and include the small size of bones, primary or mixed dentition, potential for growth, developing tooth germs, and the co-operation of the patient. It is estimated that 1% of facial fractures occur in patients younger than 5 years old. We describe the fabrication of a stainless steel reinforced acrylic splint for a 3-year-old boy who sustained a fractured mandible.

Trans-mastoid facial nerve localisation for malignant neoplasms confined to the parotid gland - Corrected Proof

Nazia Munir, Sankalap Tandon, James S. Brown, Tristram H.J. Lesser — 2012-01-04

Abstract: Up to 32% of parotid neoplasms are malignant, and treatment for resectable parotid carcinomas remains primarily surgical. Resection is centred round the identification and preservation (where possible) of the main trunk of the facial nerve. Limited dissection of the temporal bone and identification of the facial nerve proximally in the mastoid portion can facilitate resection for all parotid carcinomas that occur in the preauricular portion of the gland. Dissection in the narrow space between the ear or base of the skull and the tumour reduces the risk of tumour spillage, and the margin for resection is optimised. Intramastoid localisation of the facial nerve allows a posterior approach, and access to the dissection plane lies medial to the nerve. We describe the technique in a series of eight patients undergoing resection for parotid malignancies. In our experience the technique promotes adequate resection margins, reduces the risk of tumour spillage, and allows better access for nerve grafting if the facial nerve has to be sacrificed.

Are blood investigations, or group and save, required before orthognathic surgery? - Corrected Proof

Montey Garg, Mary Coleman, Daljit K. Dhariwal — 2012-01-03

Abstract: Most patients who require orthognathic surgery are young patients of American Society of Anesthesiologists’ (ASA) grade I, and current publications recommend a policy of group and save, with antibody screening for all such patients. We retrospectively studied 284 patients who had orthognathic procedures over a 5-year period at one hospital. We identified patients with a history of bleeding disorders, and those with abnormal coagulation. No blood transfusions were required for any patient, and abnormal coagulation screens in patients with no history of bleeding disorders made no difference to perioperative medical or surgical management. We therefore recommend that grouping and saving blood with antibody or coagulation screening are not necessary before orthognathic operations in ASA grade I patients who have no history of bleeding disorders or previous blood transfusion. However, a routine full blood count should still be done, in keeping with the current National Institute for Clinical Excellence (NICE) guidelines.

Treatment of alveolar cleft with distraction osteogenesis using anchorage with a tooth–microimplant joint in a dog model - Corrected Proof

Dai-Ying Huang, Ji-Bing Zhang, Xiang Li, Song-Ling Chen — 2012-01-03

Abstract: Our aim was to investigate the efficacy of correction of an alveolar cleft with distraction osteogenesis using anchorage with a tooth–microimplant joint in a canine model, which was established in 12 adult mongrel dogs that were subsequently randomised into two groups (n=6 in each). The first group comprised dogs that had osteogenesis using anchorage with a tooth (tooth group), while in the second, anchorage with tooth–microimplant joint (microimplant group) was used. All animals were killed one month after completion of distraction. Samples were collected for gross observation and histological examination. There was a significant difference in the degree of movement of the anchorage teeth in the transport discs between the 2 groups (p<0.01). There was less prominent inclination and shift of the natural teeth in the transport disc and less bony resorption around the root in the microimplant group than in the tooth group. These changes were less remarkable in the microimplant group. Treatment of alveolar cleft by distraction osteogenesis using anchorage with a tooth–microimplant joint is practical, and yields better results.

Recent advances in reconstructive oral and maxillofacial surgery - Corrected Proof

Indran Balasundaram, Ihsaan Al-Hadad, Sat Parmar — 2011-12-30

Abstract: Reconstruction within the head and neck is challenging. Defects can be anatomically complex and may already be compromised by scarring, inflammation, and infection. Tissue grafts and vascularised flaps (either pedicled or free) bring healthy tissue to a compromised wound for optimal healing and are the current gold standard for the repair of such defects, but disadvantages are their limited availability, the difficulty of shaping the flap to fit the defect and, most importantly, donor site morbidity. The importance of function and aesthetics has driven advances in the accuracy of surgical techniques. We discuss current advances in reconstruction within oral and maxillofacial surgery. Developments in navigation, three-dimensional imaging, stereolithographic models, and the use of custom-made implants can aid and improve the accuracy of existing reconstructive methods. Robotic surgery, which does not modify existing techniques of reconstruction, allows access, resection of tumours, and reconstruction with conventional free flap techniques in the oropharynx without the need for mandibulotomy. Tissue engineering and distraction osteogenesis avoid the need for autologous tissue transfer and can therefore be seen as more conservative methods of reconstruction. Recently, facial allotransplantation has allowed whole anatomical facial units to be replaced with the possibility of sensory recovery and reanimation being completed in a single procedure. However, patients who have facial allotransplants are subject to life-long immunosuppression so this method of reconstruction should be limited to selected cases.

Acute cervico-facial infection in Scotland 2010: patterns of presentation, patient demographics and recording of systemic involvement - Corrected Proof

J. Byers, T. Lowe, C.A. Goodall — 2011-12-29

Abstract: Acute bacterial cervicofacial infection is a common problem that is most often secondary to dental infection. Most cases present as localised abscesses but some may be associated with serious morbidity including scarring, embarrassment of the airway, SIRS (systemic inflammatory response syndrome), and sepsis syndrome. Fourteen oral surgery or maxillofacial surgery units in Scotland took part in a clinical audit of acute infection during two four-week cycles (August and November) in 2010. Information regarding the patients, signs and symptoms, and management was recorded. Training material was distributed between cycles with information on SIRS, sepsis, and the prescription of antibiotics. Overall, 140 patients presented with acute infection. There was an equal sex distribution and ages ranged from 5 to 87 years. There was an association with deprivation and 36% of patients were from the lowest socioeconomic quintile. Most infections were dental (n=120, 86%), and patients presented with pain and swelling (n=120, 86% and n=134, 96%, respectively) Twenty-three patients (16%) met the criteria for SIRS. A further 23 (16%) had at least one positive SIRS marker with incomplete recording of the remaining markers. Twenty-six patients (19%) had no recorded SIRS markers. Cervicofacial infection can be associated with serious morbidity and mortality, which may be better managed if the systemic signs and symptoms of sepsis are recognised and recorded at presentation. This study showed that the recording of signs of sepsis was variable even with training. Further training of junior staff to recognise severe acute bacterial infection may improve management.

Current status of temporomandibular joint arthroscopy in the United Kingdom - Corrected Proof

Sangeetha M. Thomas, N. Shaun Matthews — 2011-12-29

Abstract: In an era during which minimally invasive procedures are increasingly becoming the norm, arthroscopy of the temporomandibular joint (TMJ) seems to be infrequently used for diagnosis and treatment of disorders of the TMJ. The reasons for this are not clear. The purpose of this study was to find out the current state of arthroscopy of the TMJ in the UK and, more specifically, how often it is used, the indications for its use, the level of experience of practising surgeons, and the reasons for not using it. Information was gathered between 2009 and 2010 from a postal and e-mail questionnaire to all oral and maxillofacial consultants in the UK. Of the 346 consultants, 215 (60%) responded to the questionnaire. Forty-two said that they currently used arthroscopy of the TMJ, and 33 of those (81%) have more than 5 years’ experience. During the past year, a total of 8 consultants nationally have done 20 arthroscopies or more. Thirty-three of the procedures (81%) were done for both diagnosis and treatment. Lack of perceived need of patients and lack of interest in this specialty were the main reasons given for not doing arthroscopy, lack of training being a key secondary reason. The Storz and Olympus systems were the most commonly used within the UK. Results seem to support the opinion that arthroscopy of the TMJ is under-used, and consideration should be given to ensuring that trainees are instructed in its use, which is important in the diagnosis and treatment of disorders of the TMJ.

Comparative biomechanical evaluation of mono-cortical osteosynthesis systems for condylar fractures using photoelastic stress analysis - Corrected Proof

2011-12-29

Abstract: Fractures of the condyle account for 20–30% of all mandibular fractures, and are therefore one of the most common facial injuries. Precise evaluation of the mechanical stresses that develop in a fractured mandible is essential, particularly for the testing of systems currently used for stabilisation of the condylar fragment. Photoelastic stress analysis can be used to visualise alterations in the strain that is induced in the mandible by a fracture, and in the osteosynthesis materials used to stabilise it. This method, used on currently used osteosynthesis materials, showed that stabilisation of a subcondylar fracture with a single miniplate does not provide enough stability, whereas the use of two miniplates – properly positioned – offers sufficient stability in all loading conditions. A microplate may be used as a tension-resisting plate with equally good results.

Re: L.A. Shanks, T.W. Walker, P.J. McCann, M.J. Kerin, Oral cavity examination: beyond the core curriculum? [Br J Oral Maxillofac Surg 2011] - Corrected Proof

David Dunleavy — 2011-12-28

I read with interest the study by Shanks et al. on the experience of medical students in learning how to examine the oral cavity. They correctly point out that current teaching in this skill is hit and miss; many students graduate with no formal teaching whatsoever and often they have little perception that it may be a necessary skill for their future practice.

Incidence of central giant cell granuloma of the jaws with clinical and histological confirmation: an archival study in Northern India - Corrected Proof

V. Reddy, S. Saxena, P. Aggarwal, P. Sharma, M. Reddy — 2011-12-26

Abstract: To record the demographics, and correlate histological findings in central giant cell granulomas (CGCGs) of the jaws with their clinical behaviour, 30 paraffin-embedded samples of CGCG were retrieved from the archives of the Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut, India. The diagnosis in each case was made on the basis of clinical, radiographic, and histological findings. Data about age, sex, anatomical site, presentation, radiological features, and laboratory investigations were analysed. Histomorphometric analyses were made in each case with respect to the number of giant cells, mean number of nuclei and giant cells, fractional surface area occupied by giant cells, index of relative size, and mitotic activity. The peak incidence of CGCG was during the second decade of life with a slight female predilection, and the mandible was the most common site. Of the 30 samples considered, 20 tumours were classified clinically as non-aggressive, and 10 as aggressive, based on their clinical behaviour. Histomorphometric analysis showed significant changes between the two groups with respect to the number of giant cells, the fractional surface area, and the mitotic activity. The data obtained showed clinical and histomorphometric features that may be reliable indicators for the differentiation between aggressive and non-aggressive CGCG. These data should be taken into consideration to improve planning of individual treatment and follow-up.

Systematic review of the current evidence in the use of postoperative radiotherapy for oral squamous cell carcinoma - Corrected Proof

J.S. Brown, R.J. Shaw, F. Bekiroglu, S.N. Rogers — 2011-12-26

Abstract: Improved disease-free survival for oral squamous cell carcinoma (SCC) with the use of postoperative radiotherapy (PORT) has to be balanced against the risk of recurrence, the relative morbidity of radiotherapy, reduced options for treatment, and survival with recurrent disease. In the absence of randomised trials, a review of current evidence is timely because of increasing differences in outcome and response to treatment for cancers of the larynx, oropharynx, and oral cavity. From a search of 109 papers, 25 presented relevant data in tabular form, and reported local, regional, and total recurrence, and overall survival. Most data come from non-randomised studies that compared the effects of interventions with previous or historical information. A summary of the results shows local recurrence of 11%, 17%, and 15% for early, late, and all stages after operation alone, compared with 13%, 16%, and 19% after PORT. Regional recurrence is reported as 13%, 12%, and 11% for early, late, and all stages after operation alone compared with 6%, 11%, and 9% after PORT. Overall survival is reported as 76%, 74%, and 77% for operation alone compared with 65%, 62%, and 62% for early, late and all stages of oral SCC, respectively. It is acknowledged that this is a weak level of evidence as patients who have PORT probably have a high pathological-stage of disease. Knowing that PORT increases morbidity and reduces salvage rates and options for treating recurrent disease, this difference in overall survival emphasises the need for randomised studies or a re-evaluation of our current protocols.

Peri-implantitis - Corrected Proof

Hatem Algraffee, Farzad Borumandi, Luke Cascarini — 2011-12-26

Abstract: The number of osseointegrated dental implants is increasing. Healthy peri-implant soft and hard tissues are required for the stability and survival of dental implants. In this paper we review factors that lead to peri-implant mucositis and peri-implantitis, and review treatment.

Aesthetic incision for neck dissection - Corrected Proof

Akshay Gulati, Kishore Shekar, I.P. Downie — 2011-12-26

The incision for a neck dissection should allow adequate access to allow good nodal harvest with minimal morbidity. Another concern is aesthetics. Patients with head and neck cancer have extensive operations, and scarring from the surgical wounds contributes to morbidity. We describe an incision that gives adequate access, is aesthetically satisfactory, and does not compromise the yield of lymph nodes.

Thyroid surgery - Corrected Proof

Leo H.-H. Cheng, Iain L. Hutchison — 2011-12-23

Abstract: Diseases of the thyroid are common and surgical treatment is often the preferred option. Thyroid surgery is becoming subspecialised and falls within the repertoire of maxillofacial, and head and neck surgeons. Multidisciplinary management of most patients with diseases of the thyroid is key to providing the best care particularly for those with malignancies and retrosternal extension. To reduce postoperative complications a meticulous search for, and protection of the recurrent laryngeal nerve and parathyroid glands, with an incision along the skin crease in the lower neck, which can be extended for neck dissection, are paramount. Recent advances in thyroid surgery include ultrasound-guided cervical plexus block, use of the Harmonic Scalpel® (Ethicon Endo-Surgery, Inc., USA), intraoperative nerve stimulation to monitor the recurrent laryngeal nerve, use of TissuePatch™ 3 (Tissuemed Ltd., Leeds, UK) adhesive sealant, and minimal access surgery.

West of Ireland facial injury study. Part 1 - Corrected Proof

2011-12-22

Abstract: The pattern, presentation, and volume of facial injury in the west of Ireland are subjectively different from that in the United Kingdom. We know of no prospective regional study of facial injury in Ireland to date, and nationally there is no system in place to collect data on injury. The epidemiology of facial trauma has important implications for the development of health services, the education and training of clinicians, workforce planning, prevention of injury, and promotion of health. Over one week we did a multicentre prospective data collection study involving all emergency departments in the west of Ireland. All patients who attended with facial injuries were included, and those with injuries solely of the scalp and neck were excluded. The proforma recorded patients’ characteristics, details of injury and presentation, treatment and follow-up. It also included relation with sport, alcohol, assault, and animals. During the study period 325 patients were injured (5% of attendances at emergency departments in the region). The mean was 29.8%, and 68% were male. Falls caused 39% of injuries, sport 27%, and assault 14%. Sixteen percent of patients were treated in oral and maxillofacial surgery departments, and 16% in plastics, and ear, nose and throat (ENT) departments combined. There were 166 serious injuries. The busiest 24h were from Saturday at 09:00. Forty-five percent presented between 1 and 2h after injury. Different approaches and methods may be needed to prevent injury because of differences in aetiology, and staff in emergency departments will need training in this area, given the large proportion of facial injuries in the region.

Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck - Corrected Proof

2011-12-22

Abstract: The anteromedial thigh (AMT) perforator flap is usually thin, pliable, and nearly hairless, making it particularly suitable to repair defects of the head and neck. We studied the topography and outcomes of AMT perforator flaps in such defects after excision of tumours. We retrospectively reviewed the casenotes of 11 consecutive patients who had had reconstructions of the head and neck with the initial intent of using an AMT perforator flap from January 2010 to July 2011. For each patient we recorded the size and thickness of the flap; the length of the pedicle; and the number, external diameters, anatomical types, source vessels, and sites of the sizeable perforators. Of the 11 patients, 10 had successful reconstruction using AMT perforator flaps, but one had no AMT perforator big enough. The mean (range) number of sizeable perforators/flap was 1.3 (1–2), length of pedicle 10.6 (7–13) cm, and diameter of the artery 1.1(1.0–1.5) mm. Of the 13 sizeable perforators, 3 were direct and septocutaneous. The remaining ones were all musculocutaneous. Most of them were located in the middle third of the thigh. Primary closure of the donor site was achieved in all patients. One flap was successfully revised after compression of the perforator. All flaps survived with good functional and aesthetic outcomes. The free AMT perforator flap is suitable for reconstructions of the head and neck if a sizeable perforator can be found. The AMT flap may be used as a primary flap rather than as an alternative to the anterolateral thigh flap or a component of a chimeric flap.

Preoperative incisor inclination in patients with Class III dentofacial deformities treated with orthognathic surgery - Corrected Proof

Cecília L. Pereira-Stabile, Mark W. Ochs, Márcio de Moraes, Roger W.F. Moreira — 2011-12-12

Abstract: Our aim was to evaluate cephalometrically the preoperative inclination of the incisors in a group of 50 patients with Class III dentofacial deformities whose immediate preoperative lateral cephalometric radiographs were analysed after they had been treated by maxillary advancement. The radiographs were hand-traced by the same operator who made the cephalometric analysis. Mean values for each measurement were compared with the normal values using Student's t-test (p<0.05). Results showed significantly increased inclination of the upper incisors, with a mean U1-NA angle of 27.58° and a mean U1-PP angle of 116°. The lower incisors were also inclined lingually, with a mean L1-NB angle of 22.53° and a mean IMPA of 83.13°. Thirty-five of the patients had labial inclination of the upper, and 28 lingual inclination of the lower, incisors. Mean inclinations of upper and lower incisors differed from the normal values, and the inclination of the lower incisors was more likely to be decompensated than that of the upper incisors.

Management of mandibular fractures in children with a split acrylic splint: a case series - Corrected Proof

Ayman Hegab — 2011-12-08

Abstract: Five children with mandibular fractures were treated with a split acrylic splint, which secured the fracture by wiring around the mandible. The occlusion was satisfactory, without infection or malocclusion. None required revision, and there was no deviation of the mandible, ankylosis, or disturbances of growth.

Three-dimensional fixation of fractures of the mandibular condyle with a resorbable three-dimensional osteosynthesis mesh - Corrected Proof

Matthias Schneider, Bernd Stadlinger, Richard Loukota, Uwe Eckelt — 2011-12-08

Abstract: We describe the use of a resorbable mesh fixed by ultrasound-activated pins, and report the satisfactory outcome in the first 5 patients treated.

Biomechanical optimisation of the length ratio of the two endosseous portions in distraction implants: a three-dimensional finite element analysis - Corrected Proof

2011-12-08

Abstract: Insufficient alveolar height is one of the most common problems in oral implantation, and it may preclude placement of an implant or compromise the final aesthetic outcome of the restoration. To solve this problem, distraction implants (DIs) have been introduced because they can fulfill the functions of bony augmentation and implantation simultaneously and facilitate the operation, minimise the trauma, and shorten the duration of treatment. However, the high risk of complications such as device fracture from uneven distribution of stress or transport bone resorption from insufficient blood supply, has impeded their clinical use. As the cortical transport portion of the DI is more important for bearing occlusal force than the apical support portion, and the length of the transport portion is normally the height of the transport bone segment, lengthening the transport portion may help to obtain a rational distribution of stress and increase the blood supply to the transport bone. For those cases in which alveolar height is limited, the dimension of the DI must be minimised to be applicable, so it is important to find an optimised balance between the lengths of the transport and support portions for a better performance. We have made a finite element analysis to optimise the length ratio of transport:support portions. The effects of the length ratios on the stress distribution in the jawbones were evaluated. A ratio of 8:2 showed the minimum stress and most resistance to displacement. These results provide a valuable reference for further improvement of designs of DI and help to promote its clinical application.

Cleft palate and bilateral congenital cataract: a familial observation: a new syndrome? - Corrected Proof

2011-12-08

Abstract: We report a family with a rare association of congenital bilateral cataract and cleft palate that has not to our knowledge been previously reported. The lineage has unveiled abnormalities over four generations affecting 21 people with congenital bilateral cataract, with or without cleft palate. The transmission seems autosomal dominant. Four brothers and sisters presented with this defect, and a fifth sister is healthy. The mother has facial dimorphism, congenital bilateral cataract, submucous cleft palate, clinodactyly, and scoliosis. The propositus’ karyotype was normal. Array comparative genomic hybridisation (CGH) analysis showed an interstitial amplification in Xp21.1, found in the mother, in all the affected siblings but one, and in the healthy girl. Thisl association is not rare and has been reported in over 50 syndromes but rarely in familial observations. Based on the genetic-clinical discordance we wonder about the deleterious impact of the Xp21.1 amplification that might be a copy number polymorphism.

Incidence and impact of previous orthodontic treatment in patients attending orthognathic combined clinics: a survey - Corrected Proof

Leila Khamashta-Ledezma, Jonathan Collier, Pratik K. Sharma, Nayeem Ali — 2011-12-07

Abstract: This prospective questionnaire-based study was designed to determine the incidence of patients attending orthognathic combined clinics who have previously had orthodontic treatment, and to assess the impact, if any, this has had on their proposed surgical treatment. Contemporaneous and historical data from consecutive patients at different stages of treatment who were attending clinics at two London hospitals during a three-month period were included. In total 22/56 patients (39%) had previously had orthodontic treatment, and of those, it had had an undesirable effect on the current management of 10 (45%). The effects included a reduced range of dental movements available to orthodontists (8/23, 35%), undesirable extractions (5/23, 22%), and a prolonging of preoperative orthodontics (5/23, 22%). The median age at which previous orthodontic treatment had been started was 13.5 (range 11–26). Nearly a third of patients reported that they had not been advised by their referring practitioner that a combined orthodontic and surgical approach might be required. The study suggests that preliminary assessment should be improved. Patients should be informed about and prevented from undergoing orthodontic treatment that may limit future surgical management, otherwise they may have to face repeated and prolonged orthodontic treatment, unexpected operations, and potential limitations to the outcome of surgical treatment. This could be achieved through the training and education of all practitioners and the development of referral guidelines.

Lingual necrosis secondary to mucormycosis - Corrected Proof

R. Dua, T. Poate, F. Abe, S. Diaz-Cano — 2011-12-07

Abstract: Mucormycosis is a rare fungal infection with a high mortality that affects immunocompromised patients. This is an unusual case of necrosis of the tongue in a patient with pulmonary mucormycosis, diabetes mellitus, and aplastic anaemia.

Second primary head and neck squamous cell cancers with aggressive behavior in patients with chronic myeloid leukaemia - Corrected Proof

2011-11-28

Abstract: Patients with chronic myeloid leukaemia (CML) are at considerable risk of developing second primary neoplasms. However, mucosal squamous cell cancers (SCCs) of the head and neck have not been reported. We review the data of 7 patients with mucosal SCC of the head and neck that presented as metachronous second primary tumours in patients with CML. All 7 patients were men (median age 48 years, range 31–67) (site:oral cavity n=6, hypopharynx n=1). The median interval between diagnosis of CML and head neck cancer was 6 years (range 2–15). Treatment was curative in 4 and palliative in 3. At median follow up of 14 months (range 2–44), 3 patients had died of head and neck cancer, 1 of CML, and 3 were alive and free of disease. Mucosal cancers of the head and neck can occur in long-term survivors of CML. They are aggressive and tend to recur.

Biomechanical evaluation of malleable noncompression miniplates in mandibular angle fractures: an experimental study - Corrected Proof

Alparslan Esen, Doğan Dolanmaz, Hakan Hıfzı Tüz — 2011-11-28

Abstract: The purpose of this experimental study was to test the reliability of a single malleable titanium miniplate using Champy's method of fixing fractures of the mandibular angle. Eighteen sheep hemimandibles were used to evaluate 2 plating techniques. The groups were tested with either a single non-compression titanium miniplate or a single malleable titanium miniplate. A cantilever bending biomechanical test model was used for the samples. Each group was tested with vertical forces using a servohydraulic testing unit. The displacement values in each group at each 10N stage up to 90N were compared using 2-way analysis of variance (ANOVA). The displacement values for the 2 groups differed significantly (p<0.01). The variance analyses showed that the biomechanical behaviour of a single non-compression miniplate was better than that of a single malleable miniplate. The non-compression miniplate fixed by screws had greater resistance to occlusal loads than the malleable plate fixed by screws, and the malleable plate alone was not sufficient to withstand the early postoperative bite force.

Natural course of acute closed lock of the temporomandibular joint - Corrected Proof

Shinya Yura — 2011-11-28

Abstract: To clarify the features of acute closed lock of the temporomandibular joint we compared the clinical condition of patients with acute and chronic closed lock, and investigated the natural history of acute closed lock. Forty patients with unilateral acute closed lock who were given no treatment and 40 patients with unilateral chronic closed lock were enrolled in the study.The duration of locking in those with acute closed lock ranged from 1 to 7 days, and that of those with chronic closed lock from 3 to 4 months. Differences between the groups in sex, age, maximum mouth opening, and joint pain were analysed. In those with acute closed lock who had had no treatment, maximum mouth opening and joint pain were measured at the initial visit and after 2, 4, 8, and 12 weeks. The number of dysfunctional joints was counted during each period and the natural course of the acute closed lock investigated. There were more women and older patients among those with chronic, than among those with acute, closed lock. We found no significant differences in the symptoms in the two groups. After 2 weeks of allowing the acute closed lock to take its natural course only 15 of the 40 had not resolved successfully, and after 12 weeks of taking its natural course only 2 had been unsuccessful. The number of joints that did not resolve successfully decreased progressively over time. Any treatment for acute closed lock should be easier and more effective than that of following its natural course.

Reliability of the Kindelan scoring system for alveolar bone grafting with and without a pre-graft occlusal radiograph in patients with cleft lip and palate - Corrected Proof

L.M. Dobbyn, T.J. Gillgrass, M.F. Devlin — 2011-11-24

Abstract: We aimed to compare the reliability of the Kindelan system using one postoperative radiograph to assess the success of alveolar bone grafts with the use of two occlusal radiographs (before and after operation). This retrospective reliability study took place at Glasgow Dental Hospital cleft unit, and two examiners scored 84 radiographs two weeks apart. The sample was taken from a database of patients having alveolar bone grafts between 2007 and 2010. They had an upper anterior occlusal radiograph taken before the graft and another at a mean of 6 months (range 3–12 months) postoperatively. Kappa scores were used to measure intraobserver and interobserver agreement. Intraexaminer agreement ranged from good to very good using one or two radiographs, and interexaminer agreement ranged from moderate to good for both systems. Reliability when scoring with either one or two radiographs was similar, and ranged from good to very good.

Exact three-dimensional skull-related repositioning of the maxilla during orthognathic surgery - Corrected Proof

Alexander Füglein, Dieter Riediger — 2011-11-24

Abstract: The LeFort I osteotomy is standard for corrective repositioning of the maxilla, but intraoperative, skull-related, three-dimensional repositioning of the maxilla remains unsolved. Different ways of improving the accuracy of intraoperative, preoperatively planned, skull-related, correcting movements have been described, including the measurement of vertical maxillary shift, use of positioning devices (such as a face bow or a halo frame), and computer-assisted navigation. Nevertheless, intraoperative three-dimensional control of maxillary shift is not standard. Intraoperatively adjusted positioning pins define an exactly reproducible skull-related position for a reference splint. Skull-related repositioning of the maxilla after osteotomy can be done precisely in combination with two further splints, each allowing for different, well-defined repositioning of the reference splint in relation to the maxillary dental arch. The positioning device can be inserted using the standard intraoral approaches of the Le Fort I osteotomy. It does not result in further radiation exposure for the patient besides that usually necessary for preoperative planning. Three-dimensional imaging and expensive, computer-assisted navigational systems are not required. In contrast to previous procedures, the new device allows for intraoperative, three-dimensional, skull-related repositioning of the maxilla exactly according to the position planned preoperatively.

Thyroid surgery in the UK and on board the Mercy Ships - Corrected Proof

Leo H.H. Cheng, Lord McColl, Gary Parker — 2011-11-21

Abstract: Diseases of the thyroid are common in the developed and developing world. We retrospectively compared surgical pathologies, types of thyroidectomy, and postoperative complications between 2 case series, one from the Mercy Ships in West Africa with 87 patients, and the other from London in the United Kingdom with 120 patients. In both, the most common operation was hemithyroidectomy, and nodular hyperplasia was the most common disease. The postoperative complication rate of sero-haematoma was comparable with large international series.