British Journal of Oral and Maxillofacial Surgery - Articles in Press

The use of a T-shaped contoured unilocking titanium radial plate for prophylactic internal fixation of the radial osteocutaneous donor site - Corrected Proof

C.M.E. Avery, S. Parmar, Tim Martin — 2010-03-08

Abstract: The radial osteocutaneous flap retains a limited role in reconstructive maxillofacial surgery The application of prophylactic internal fixation, using straight 3.5mm plates, has become established to substantially reduce the incidence of fracture at the radial donor site. New lower profile T-shaped 2.4mm plates and anatomically contoured 3.5mm plates are now available, both with unilocking screw fixation systems. These plates are easy to apply and allow the removal of up to 50% of the circumference of the radial bone, including the maximum amount of good quality bone from the distal radius. Although there have been no reports of complications as a result of a stress shielding effect with larger plates these refinements in plate design should lessen any remaining concerns.

Re “Prognostic factors in malignant tumours of the salivary glands” by Speight and Barrett [Br. J. Oral Maxillofac. Surg. 47 (8) (2009) 587–593] - Corrected Proof

James A. McCaul, Cyrus J. Kerawala — 2010-03-08

In the recent review of prognostic factors in salivary malignancy, Speight and Barrett repeat the assertion that tumours exceeding 4cm in diameter carry a poorer prognosis regardless of management strategy.

Comminuted orbital blowout fracture after vigorous nose blowing that required repair - Corrected Proof

Benjamin B. Rahmel, Cameron R. Scott, Anthony J. Lynham — 2010-03-08

Abstract: A fracture of the orbital floor as a result of nose blowing is rare and we know of only three reported cases. We present a 40-year-old man who required repair of a blowout fracture of the orbital floor as a result of vigorous nose blowing. Patients who present with acute periorbital emphysema after nose blowing require careful assessment with potential blowout fractures in mind.

Ridge augmentation with the coronoid-temporalis muscle pedicled flap - Corrected Proof

Nima Moharamnejad, Mohammad Bayat, Behnam Bohluli — 2010-03-04

Many techniques are available for augmentation of the alveolar ridge before an implant is placed. Distraction osteogenesis and microvascular reconstruction give good results but other techniques are unpredictable. The coronoid process is developed from secondary proliferation of mandibular cartilage and is one of the sources of bone for reconstruction of the orbital floor. Our aim was to describe a new technique for augmentation of the posterior of maxilla with a temporalis myo-osseous pedicled flap, which has been used by some authors for difficult reconstructions.

Europe's forgotten Cancer, what is OMF Surgery's role? - Corrected Proof

Luke Cascarini, Darryl M. Coombes, Sandeep Cliff, Peter Ward Booth — 2010-03-04

Abstract: We outline the principles of management of skin cancers, and highlight the role of oral and maxillofacial surgery.

Corrected Proof

Tim Mellor — 2010-03-02

This title Minimally Invasive Facial Rejuvenation is part of a five volume series edited by Mark A. Codner. The contents of this volume range from discussion of Botulinum Toxin A injections through chemical peels into fat grafting and the use of barbed suture techniques in facial rejuvenation.

Incidence of second primary tumours in patients with squamous cell carcinoma of the tongue - Corrected Proof

Zhengjiang Li, Tian Ee Seah, Pingzhang Tang, Velopillai Ilankovan — 2010-02-26

Abstract: We retrospectively studied 329 patients with squamous cell carcinoma (SCC) of the tongue who were treated at The Chinese Academy of Medical Sciences, Peking Union Medical College, Department of Head and Neck Surgery of Cancer Hospital during the past 25 years (1975–2000). The patients were followed up for more than 36 months, and 28 (9%) developed 29 second primary carcinomas. The characteristics of the index tumour including the clinical appearance (10% nodular, 8% ulcerated), the site (10% anterior, 9% posterior, and 6% lateral), the classification (13% T1, 9% T2), the stage (12% stage I, 11% stage II, and 7% stage III), the histological appearance (7% well-differentiated, 14% moderately differentiated, 36% poorly differentiated, and 2% unknown), and the type of treatment given (18% resection only, 4% radiation only, and 6% combined treatment) were recorded. Twenty-three of the 29 second primary lesions developed in the upper aerodigestive tract with the oesophagus the most common site (79%). During the follow-up period, 14 patients died from causes associated with the second primary lesion and 5 from unrelated causes, and 9 patients were still alive at the time of follow-up. The prognosis for patients who develop second primary lesions is poor.

Facial tuberculoid leprosy: case report - Corrected Proof

K. Ali, G. Sittampalam, M.A. Malik — 2010-02-26

Abstract: Leprosy is a chronic, infectious, systemic disease caused by Mycobacterium leprae and is classified as paucibacillary and multibacillary types. It is contagious and has an insidious onset. Clinical presentation is characterised by hypopigmented skin lesions with reduced sensation. Presence of acid-fast bacilli in tissue specimens is regarded as a gold standard for diagnosis. Treatment is based on multi-drug regimens. We report a case of borderline tuberculoid leprosy in a 31-year-old woman.

Brian Francis Conroy MBE M. Univ FIMPT LCGI 1932–2010 - Corrected Proof

John Langdon — 2010-02-24

Brian Conroy died on 16th January following a long and dignified battle with interstitial lung disease. It is perhaps unusual for the British Association of Oral & Maxillofacial Surgeons to note the passing of a colleague who was not a surgeon. However many generations of maxillofacial surgeons have good cause to be grateful for Brian's contribution to their training whilst they worked at Queen Mary's Hospital, Roehampton. During his lifetime Brian achieved a great many things to advance the art, science, technology and clinical application of cranio-maxillofacial prosthetics. His greatest professional achievement was to found the Institute of Maxillofacial Prosthetists & Technologists (IMPT).

Unusual case of spontaneous discharge of pus (infected cyst) through the dorsum of the tongue - Corrected Proof

R. Goddard, J. Madigan, P. Mehanna — 2010-02-22

Abstract: Neck swellings are often a result of infections that spread from the teeth. This case highlights an unusual presentation of spontaneous pustular discharge from the anterior dorsum of the tongue.

Review article: oral surgery and TMJ-related papers published in BJOMS in 2008 and 2009 - Corrected Proof

H.R. Spencer, A. Morrison, A. Braga, P.A. Brennan — 2010-02-22

Abstract: This review summarises the 81 papers relating to oral surgery and to the temporomandibular joint (TMJ) published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) January 2008–December 2009. They include full length articles on distraction osteogenesis, imaging, extraction techniques, implants, and the management of facial pain and disorders of the TMJ including joint replacement. Many short communications were also published, but an editorial decision was taken in August 2009 to publish most of these in future in the online journal only. As BJOMS encompasses the whole remit of the specialty, and other specialist journals on oral surgery are available, it was encouraging to see that authors still choose submit their work to our journal.

Correction of skeletal Class II—anterior deep bite and prominent chin by forced surgical rotation of the mandible - Corrected Proof

Maurice Y. Mommaerts, José M. López-Arcas, Anne-Mie Schurmans — 2010-02-19

Abstract: The purpose of this paper is to describe a technique of forced surgical rotation of the mandible used in skeletal Class II patients with deep bite and prominent chin. Posterior occlusal composite onlays combined with preoperative orthodontic treatment without anterior intrusion increase the posterior rotational component of the surgical mandibular advancement, when removed during operation. This manoeuvre allows for the surgical closure of the posterior open bite, while anteriorly the deep bite is opened. This technique avoids bimaxillary rotation surgery with dorsal impaction in mild to moderate cases. In any case, a chin setback osteotomy with compromised aesthetics can be avoided.

Surgically assisted rapid palatal expansion (SARPE) - Corrected Proof

R. Goddard, H. Witherow — 2010-02-19

SARPE is an effective and stable method of addressing severe maxillary transverse discrepancy in patients over the age of 15 years of age. A number of modifications of the surgical technique have been described, although most utilise a form of subtotal Le Fort I osteotomy with a midline palatal cut between the maxillary central incisors. The midline cut has potential to damage the roots of these teeth, adjacent periosteum and compromise bone and soft tissue perfusion ().

Precautions required for needle cricothyroidotomy - Corrected Proof

Anjum Ahmed-Nusrath, Muzzammil A. Nusrath, Douglas Bryant — 2010-02-18

We read the technical note on management of the airway with a Ravussin cannula with interest. We routinely place a cricothyroid cannula pre-emptively if serious difficulty is anticipated in intubation, and for endolaryngeal surgery.

The WHO Surgical Safety Checklist: Are we measuring up? - Corrected Proof

Khalid Abdel-Galil — 2010-02-12

In June 2008, the World Health Organisation (WHO) launched a Global Patient Safety Challenge, ‘Safe Surgery Saves Lives’, to reduce the number of surgical deaths worldwide. The goal of the initiative was to strengthen the commitment of clinical staff to address safety issues within the surgical setting. This includes improving anaesthetic safety practices, ensuring correct site surgery, avoiding surgical site infections and improving communication within the team.

Review of the radial free flap: still evolving or facing extinction? Part two: osteocutaneous radial free flap - Corrected Proof

C.M.E. Avery — 2010-02-04

Abstract: The osteocutaneous radial flap is robust, reliable, and relatively simple to harvest, which will ensure that it remains one of the established reconstructive options in most maxillofacial units. Evidence based on clinical observational studies and biomechanical studies supports the routine or selective use of prophylactic internal fixation to strengthen the radial osteocutaneous donor site. This allows safe harvesting of the maximum volume of available bone, up to half of the circumference, with minimal risk of fracture or long term complications. The incidence of fracture with the plate placed either anteriorly or posteriorly is equally low, but the anterior position is technically easier and probably less likely to cause additional morbidity. This approach probably produces the least morbidity that may currently be achieved when managing the inherent flaws of the radial hard tissue donor site. The introduction of prophylactic internal fixation consolidates the role of the osteocutaneous radial flap for repair of defects that require a relatively small volume of bone and an appreciable area of thin soft tissue, particularly when a long vascular pedicle is desirable. This includes low level defects of the maxilla, some defects of the mandible, and niche reconstructions, such as the orbital rim. It remains useful as a first choice of flap when there is appreciable peripheral vascular disease, when there are other serious coexisting medical conditions; if it is the preferred choice of the patient for functional reasons such as mobility of the lower limb or hip, and as a salvage flap when other reconstructive options have been exhausted.

Atypical fibroxanthoma: Case series of 16 patients - Corrected Proof

Jennifer Wylie, Nick Hampton, Martin R. Telfer, Andrew M.T. Clarke — 2010-02-03

Abstract: Atypical fibroxanthoma is an unusual tumour of skin seen mainly in the head and neck region of elderly patients. Clinically it appears as red, ulcerated nodules, which can be difficult to differentiate from other tumours without histopathological examination. Immunohistochemical analysis also aids diagnosis. The mainstay of treatment is operation. We present a case series of 16 patients with 17 atypical fibroxanthomas over a 5-year period in a district general hospital.

Osteoconduction of different sizes of anorganic bone particles in a model of guided bone regeneration - Corrected Proof

Xinwen Zhou, Zhenting Zhang, Song Li, Yuxing Bai, Hui Xu — 2010-01-27

Abstract: The aim of this study was to evaluate the effect of two different sizes of anorganic bone particles (300–500 and 850–1000μm) on the formation of new bone in a model of guided bone regeneration. In both groups, newly formed bone was seen histologically adjacent to the original surface of the skull, and there were outgrowths to the centre of the secluded graft 4 weeks after implantation. Some particles near the surface were in contact with the newly formed bone, and osteoconductive bone growth was present along their surface. Ten weeks after implantation the area created by grafting with small particles seemed to have a denser structure than that created with large particles. Histomorphometric analysis showed a higher density of newly formed bone in the small-particle group than in the large-particle group both 4 and 10 weeks after implantation. The total contact length between newly formed bone and particles and the ratio of bone:space between the particles were also significantly higher in the small-particle group at both time points. We conclude that the size of grafted particles of bone and the spaces between particles are important determinants of osteogenesis during guided bone regeneration.

Use of a right-angled screwdriver in repairs to fractures of the orbital floor and anterior cranial fossa - Corrected Proof

Montey Garg, Sajid Sainuddin, Daljit K. Dhariwal — 2010-01-25

The right-angled screwdriver (90° screwdriver, rectangular screwdriver, angled screwdriver) is being used increasingly in maxillofacial surgery as an alternative to transbuccal systems as it facilitates the transoral management of condylar fractures with endoscopic assistance. It has also been recommended for use in fixation of segments in bilateral sagittal split osteotomies, and placement of distractors for surgically assisted rapid palatal expansion (SARPE). We have also found it helpful in the repair of fractures of the orbital floor and anterior cranial fossa where straight-line access may be difficult to achieve.

Blunt injury of the neck resulting in life-threatening compromise of the airway - Corrected Proof

M. Patel, K. Shekar, N. Mackenzie, C. Pratt — 2010-01-22

Abstract: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder. Histologically the lesion has a fragile capillary bed that could result in a catastrophic bleed after a minor injury, as in this case.

Intravascular papillary endothelial hyperplasia (Masson's tumour) of the oral mucosa - Corrected Proof

V. Murugaraj, G.T. Kingston, M. Patel, R. Anand — 2010-01-21

Abstract: Intravascular papillary endothelial hyperplasia (IPEH) is an unusual benign vascular lesion that is caused by an excessive proliferation of endothelial cells in blood vessels. These lesions are benign and therefore have an excellent prognosis and are usually cured by simple excision. Recurrences are extremely rare.IPEH has been rarely described in the oral region and in this case report we will outline an uncommon presentation and discuss pathogenesis, differential diagnosis and histopathological aspects.The purpose of this report is to alert clinicians to consider this unusual lesion when formulating a differential diagnosis of an enlarging blue oral mucosal lesion.

A library-based ecological study to investigate the contribution of ethnicity to the incidence of oral cancer within health authorities in England and Wales - Corrected Proof

2010-01-21

Abstract: Our aim was to investigate the incidence of oral cancer in three ethnic groups, Indian, Pakistani, and Bangladeshi residents of the UK, to try to establish a link between ethnic background and the incidence of oral cancer. We used data from the 1991 and 2001 censuses to calculate approximate percentages of the number of Indian, Pakistani, and Bangladeshi residents in each Health Authority (HA) region and correlated these with rates of oral cancer from the Office of National Statistics (ONS) cancer atlas for the same period. Data about lung cancer and oesophageal cancer were used as proxies for the confounding variables of smoking and alcohol, respectively, in a multiple regression analysis. There was a strong significant correlation between figures for lung cancer and variations in oral cancer rates among HAs (p<0.001). Ethnicity contributed weakly and insignificantly to variations in rates of oral cancer among HAs. In summary, we found only a weak correlation between ethnicity and oral cancer in the UK population, unlike previously published studies, while simultaneously showing a stronger relation with the proxy for smoking trends. There are various drawbacks inherent in library-based ecological studies in general, and in this study in particular, that may have been responsible for this.

Educational article: What gets accepted for presentation?—A study of submitted abstracts for the 2009 BAOMS Conference - Corrected Proof

Samantha Brooke Stewart, Rachel S. Oeppen, Luke Cascarini, Peter A. Brennan — 2010-01-20

Abstract: The Annual Scientific Conference of the British Association of Oral and Maxillofacial Surgeons (BAOMS) provides an opportunity for colleagues to present papers to their peers, which can be beneficial both for professional development and for trainees to enhance their future career prospects. Each year far more abstracts are submitted than slots are available for oral presentation. These abstracts are reviewed by a paper selection committee, made up of several BAOMS colleagues. To our knowledge, there have not been any previous studies that have evaluated whether the type of study submitted (retrospective study, audit, prospective and so on) or the surgical sub-specialty is more likely to be accepted for presentation. Of 237 abstracts submitted for oral presentation at the 2009 conference, 99 were accepted (42% overall acceptance rate). Oncology and salivary gland disease formed the greatest proportion of total submissions (23%) followed by miscellaneous clinical papers (19%). The commonest type of submissions were retrospective studies (19%) followed by case report/series (15%). The greatest acceptance rate in this series was for orthognathic and TMJ papers (P<0.01) while for type of presentation, research/laboratory studies, technical procedures and randomised trials were most likely to be accepted (P<0.01 for all).It is possible that there are a certain number of slots allocated for presentation in each sub-category, which may increase competition in certain areas, but further work is necessary in this area. We recommend some general points for the successful acceptance of abstracts.

Changes in admission rates for spreading odontogenic infection resulting from changes in government policy about the dental schedule and remunerations - Corrected Proof

Richard Burnham, Rishi Bhandari, Chris Bridle — 2010-01-18

Abstract: The government changed the system of payment to general dental practitioners on 1 April 2005 from a fee/item to a banding system. The figures collected have shown that there has been a 62% increase in the number of patients who require admission for surgical treatment of spreading odontogenic infections compared with the 3-year period before this date.

Systematic review of primary osseointegrated dental implants in head and neck oncology - Corrected Proof

A.J. Barber, C.J. Butterworth, S.N. Rogers — 2010-01-18

Abstract: The aim of this paper is to provide a systematic review of articles concerning primary osseointegrated dental implants in the head and neck oncology setting. We searched MEDLINE (1950 to March 2009) and Embase (1980 to March 2009) using the terms head and neck, oral, maxillofacial, craniofacial, jaws, mandible, maxilla, zygoma, dental implants, osseointegrated implants, implants, tumour, cancer, oncology, immediate, simultaneous, and primary. Two authors independently reviewed the abstracts, and all those written in the English language that referred to the placement of primary dental implants in patients with cancer of the head neck were included. Articles that referred to craniofacial or extraoral implants were excluded. Of 892 abstracts 83 were eligible for further consideration; the full articles were evaluated, and 41 that complied fully with the inclusion criteria are presented as a tabulated summary. There are three case reports, 13 reviews, and 25 clinical studies. Eight of the clinical studies refer solely to the insertion of dental implants at the time of primary oncological resection, and only two were of a prospective design. We have concisely summarised publications concerning primary dental implants, and our findings will help to inform head and neck cancer teams, particularly oncological surgeons, restorative dentists, and maxillofacial prosthodontists of the evidence base surrounding this approach to oral rehabilitation.

Orthognathic surgery and related papers published in the British Journal of Oral and Maxillofacial Surgery 2008–2009 - Corrected Proof

Z. Sadiq, D.M. Coombes, L. Cascarini, P.A. Brennan — 2010-01-18

Abstract: This paper provides a review of articles relating to deformity, orthognathic surgery, and distraction osteogenesis published in the British Journal of Oral and Maxillofacial Surgery during 2008 and 2009. A total of 42 papers (26 full length articles, 5 technical notes, and 11 short communications or letters to the editor) were published. It was pleasing that 62% were full length articles; this is encouraging as such papers have a high educational value and are likely to be cited in future publications.

Encapsuloma: a case report - Corrected Proof

K. Valand, P.M. McLoughlin — 2010-01-14

Abstract: We describe what we have termed an ‘encapsuloma’. To our knowledge it is the largest reported encapsulation of a prosthetic temporomandibular joint that incorporated the facial nerve.

Bilateral pneumothorax and pneumomediastinum after treatment with continuous positive airway pressure after orthognathic surgery - Corrected Proof

Naji Abou Chebel, Dany Ziade, Rana Achkouty — 2010-01-13

Abstract: We describe a 25-year-old woman who developed hypoxaemia secondary to pulmonary atelectasis after orthognathic surgery. Treatment with continuous positive airway pressure (CPAP) through a face-mask postoperatively was complicated by subcutaneous emphysema, pneumomediastinum, and bilateral pneumothoraces. CPAP has been advocated for the treatment of postoperative hypoxaemia, but when used in the presence of facial trauma or when the oral mucosa has been disrupted it can cause subcutaneous emphysema. We suggest that it is not used after orthognathic surgery.

Modification of the elastic internal traction method for temporary inter-fragment reduction prior to internal fixation - Corrected Proof

Vikas Sood, Terrence Lowe — 2010-01-11

Many techniques have been employed for temporary fracture reduction prior to definitive fixation. Methods used include: bone-holding forceps, osseous wiring, bi-cortical screw placement, wire/screw combination, hand held reduction, arch bars, inter-maxillary screws and direct wiring. We describe a simple and effective modification of the Elastic Internal Traction method as previously described by Scafati et al. The modification utilizes 2mm AO mono-cortical screws and elastomeric orthodontic chain (EOC) instead of elastic bands.

Development of a training curriculum for microsurgery - Corrected Proof

Indran Balasundaram, Rajesh Aggarwal, Lord Ara Darzi — 2010-01-06

Abstract: Recent changes in healthcare necessitate revision of the current apprenticeship model of surgical training. Current methods of assessment such as examinations and logbooks are not criteria-based, so are subjective and lack validity and reliability. The objective feedback of technical skills is crucial to the structured learning of surgical skills. We review current publications about training and methods of assessment in microsurgery. Searches on PubMed using keywords (microsurgery, training, assessment, simulation, and skill) were used to retrieve relevant articles, and further cross-referencing was done to obtain more information. New methods of assessment that are objective include checklists, global rating scales (GRS), and dexterity analysis, which give feedback of technical skills during training. Vital (living), non-vital, prosthetic, and virtual reality simulation models can be used to train surgeons to a proficient level outside the operating theatre before they operate on real patients. After reviewing the current evidence we propose a curriculum for microsurgical training that starts outside the operating theatre. The surgical community should follow the example of other high-risk industries such as aviation, where continuous assessment on simulators is a part of training, but further research is necessary before such methods can be used for summative assessment and revalidation.

Biopsy examination of squamous cell carcinoma of the tongue: Source of significant prognostic information? - Corrected Proof

2010-01-04

Abstract: Histological analysis of tumour resection for squamous cell carcinoma (SCC) of the tongue yields prognostic information. We analysed histological slides of biopsy and tumour resection specimens using an adapted malignancy grading score and analysed variables of neck dissections. There was moderate correlation between biopsy and tumour resection using malignancy grading scores (correlation coefficient 0.45); good agreement of tumour grade (79%), tumour depth (76%), and type of invasive front (80%), but correlation was only fair to moderate (κ=0.38, κ=0.51, and κ=0.41, respectively). Correlation of the biopsy grading score and invaded nodes in the neck, extra capsular spread, and soft tissue disease was not significant.

A systematic review of patient self-completed questionnaires suitable for oral and maxillofacial surgery - Corrected Proof

A.N. Kanatas, S.N. Rogers — 2010-01-04

Abstract: Patient reported outcomes (PRO) have an established role when reporting treatment outcomes. This data is usually collected using patient self-completed questionnaires. There are numerous questionnaires available and selecting the most appropriate one can be difficult.Aim: The aim of this article was to carry out a systematic review of the literature to identify publications using patient self-completed questionnaires suitable for oral and maxillofacial surgery. The questionnaires were collated and grouped according to sub-speciality interests.Method: The ISI search engine with cross-reference using Pub Med and Ovid was searched for publications between 1981 and March 2009. Abstracts written in English were reviewed by two of the authors independently.Results: A total of 511 abstracts were reviewed and the paper cites 56 studies with self-administered instruments. The number of subsite specific questionnaires identified were; cleft lip and palate (1), craniofacial surgery (2), dentoalveolar surgery (6), distraction osteogenesis (1), facial aesthetic surgery (4), facial pain (1), head and neck cancer (14), maxillofacial injury (3), oral medicine and oral mucosal disorders (2), orthognathic surgery (1), pre-prosthetic surgery and dental implants (15), skull base surgery (7), temporomandibular joint (2).Conclusion: There is a tremendous variety of validated questionnaires available that are suitable for oral and maxillofacial surgery. This summary serves as a useful reference point when selecting a questionnaire for an audit or research projects. It also describes publications, which have used the various questionnaires, thus readily identifying papers that might be useful for comparison.

2-Butoxyethanol model of haemolysis and disseminated thrombosis in female rats: a preliminary study of the vascular mechanism of osteoarthritis in the temporomandibular joint - Corrected Proof

G. Amir, A.W. Goldfarb, M. Nyska, M. Redlich, A. Nyska, D.W. Nitzan — 2009-12-25

Abstract: Female rats develop haemolytic anaemia and disseminated thrombosis and infarction in multiple organs, including bone, when exposed to 2-butoxyethanol (BE). There is growing evidence that vascular occlusion of the subchondral bone may play a part in some cases of osteoarthritis. The subchondral bone is the main weight bearer as well as the source of the blood supply to the mandibular articular cartilage. Vascular occlusion is thought to be linked to sclerosis of the subchondral bone associated with disintegration of the articular cartilage. The aim of this study was to find out whether this model of haemolysis and disseminated thrombosis supports the vascular hypothesis of osteoarthritis. Six female rats were given BE orally for 4 consecutive days and the two control rats were given tap water alone. The rats were killed 26 days after the final dose. The mandibular condyles showed histological and radiological features consistent with osteoarthritis in three of the four experimental rats and in neither of the control rats. These results may support the need to explore the vascular mechanism of osteoarthritis further.

Gas in the cavernous sinus—iatrogenic or pathological? - Corrected Proof

M.A. Nusrath, K.R. Postlethwaite, P.J. Thomson — 2009-12-25

A 46-year-old man was referred from the emergency department to the maxillofacial unit with a 3-day history of swelling and pain in the left lower eyelid. He was given flucloxacillin 500mg four times a day at the time of presentation, but the swelling had increased in size. He was taking warfarin for a deep venous thrombosis that had developed during a long haul flight 3 months previously.

A novel method for describing orbital floor and wall fractures - Corrected Proof

R.J. Banks, L. Ormondroyd, M.L. Goodson — 2009-12-21

Considerable data exists surrounding the assessment, investigation, and surgical correction of fractures of the orbital floor and wall. Clinical examination and measurement of enophthalmos are often augmented with Hess charts, measurement of binocular single vision (BSV), and use of plain radiographs. More recently magnetic resonance imaging (MRI) and in particular computed tomography (CT) have become the investigations of choice before and after operation to assess size, site, and change in the volume of orbital defects. To evaluate fracture patterns objectively so that the effectiveness of operative or non-operative interventions can be measured for audit and research purposes, a simple, reproducible method of describing orbital defects is required.

The role of alcohol in oral precancer: observations from a North-East England population - Corrected Proof

M.L. Goodson, O. Hamadah, P.J. Thomson — 2009-12-18

Abstract: Alcohol is known to be a risk factor for oral precancerous lesions, but evidence has been weakened by subjective estimates of alcohol intake from patients, and confounded by their use of tobacco. Red cell macrocytosis, assessed by calculation of mean corpuscular volume (MCV), may be a useful objective indicator of chronic alcohol intake. The aim of this study was to compare subjective and objective measures of alcohol intake in patients with oral precancerous lesions and assess the use of reported alcohol intake and MCV on assessing the degree of dysplasia at presentation and their role as markers of the behaviour of such lesions by assessing clinical outcome after treatment. Fifty-four new patients were recruited. All were smokers and had histologically confirmed single dysplastic oral precancerous lesions, but had had no previous treatment. Subjective data about their alcohol consumption were recorded, and blood samples taken for the assessment of MCV. All patients had laser excision of their lesions, which were assessed histopathologically for signs of dysplasia. Patients were followed up for 2 years. The significance of differences was assessed using Fisher's exact test. Alcohol intake of more than 28units/week and MCV of over 100 were associated with increased dysplasia at presentation (p=0.01 and p=0.03, respectively). Thirty-six patients were disease-free at 2 years, but 18 developed further disease, often at new sites. Alcohol intake of more than 28units/week was significantly associated with an increased risk of further disease (p=0.03), particularly recurrence at the same site (p=0.02).

A case of Collet–Sicard Syndrome presenting to the Oral and Maxillofacial Surgery Department and a review of the literature - Corrected Proof

Neil John Opie, Khaleeq Ur-Rehman, Graham J. James — 2009-12-17

Abstract: A case of Collet–Sicard Syndrome caused by skull base metastasis of probable breast adenocarcinoma is reported. A 79-year-old lady presented to the Oral and Maxillofacial Surgery Department with progressive left-sided tongue symptoms that she described as swelling. This was initially attributed to local disease, and a biopsy showed the patient was suffering from Necrotizing Sialometaplasia. However, her symptoms rapidly evolved into cranial nerve palsies affecting IX–XII, not initially diagnosed. Subsequent imaging revealed the cause of her worsening symptoms to be a metastatic lesion at her left skull base. Cranial nerve palsies due to metastases to the skull base are rare, and the authors would advise clinicians to adopt a high-index of suspicion in ruling out cranial nerve pathology at the skull base when encountering unusual signs and symptoms in the head and neck region.

Perforation of the inferior alveolar nerve by the maxillary artery: An anatomical study - Corrected Proof

Mujahid M. Khan, Hasem H. Darwish, Walid A. Zaher — 2009-12-17

Abstract: The infratemporal fossa is a clinically important anatomical area for the delivery of local anaesthetic agents in dentistry and maxillofacial surgery. We studied the infratemporal fossas in white cadavers, and in particular the topographical relations of the inferior alveolar nerve and the maxillary artery. In 3 of the 50 fossas dissected the maxillary artery passed through the inferior alveolar nerve, splitting it into superficial and deep divisions. Entrapment of the maxillary artery may cause numbness or headache and may interfere with injection of local anaesthetics into the infratemporal fossa.

Acceleration of consolidation period by thrombin peptide 508 in tibial distraction osteogenesis in rats - Corrected Proof

S. Cakarer, V. Olgac, N. Aksakalli, A. Tang, C. Keskin — 2009-12-17

Abstract: We aimed to find out whether a single local injection of two different doses of thrombin peptide 508 (TP508) could accelerate consolidation of bone in sites of tibial distraction osteogenesis in rats. Forty-eight adult male Sprague–Dawley rats were divided equally (n=16 in each group) into controls (given saline alone), and two experimental groups, given injections of TP508 10μg or 100μg. The animals were killed on days 14 and 28 after distraction. Histomorphometric evaluation showed that the TP508 resulted in significantly larger areas of newly formed bone (p<0.003 and p<0.0001) than saline alone. At 2 weeks, more new bone had formed in the group given TP508 100μg than in the group given 10μg, but the difference was not significant (p=0.8). However, the difference was significant at 4 weeks (p=0.03). These findings suggest that a single injection of TP508 given at the end of the distraction period increased the degree of consolidation. The higher dose was more effective at the later time point.

Update on melanoma: the present position - Corrected Proof

Daryl Godden, Peter A. Brennan, James Milne — 2009-12-16

Abstract: Cutaneous melanoma is becoming increasingly common among people with fair skins, and this has been blamed on exposure to ultraviolet radiation from sunbathing, the use of sun beds, and holidays abroad. The key to controlling the epidemic of melanoma is prevention, but also important are the organisation of the skin cancer service, surgical advances, and the development of neoadjuvant treatments. Because there are many of these tumours in the head and neck region, head and neck surgeons are increasingly involved in the management of such patients. We review the current philosophy in the management of melanoma.

Stability of osteosynthesis with bicortical screws placed in a triangular shape in mandibular sagittal split 5mm advancement osteotomy: Biomechanical tests - Corrected Proof

Geha Hadi, Bruyere-Garnier Karine, Caire Yves, Lapelerie Pierre — 2009-12-15

Abstract: Sagittal split ramus osteotomy (SSRO) is common in orthognathic surgery, and osteosynthesis with bicortical titanium screws placed in a triangular shape is used for stabilisation. We biomechanically tested the stability of this configuration in 5mm advancement SSRO with condylar replacement in the initial position using six fresh frozen human mandibles raised subperiosteally for surgical simulation. Osteotomy was done after marking the initial positions of the condyles and the symphysis on graph paper. The condyle was set in its initial position and the symphysis advanced exactly 5mm; this position was maintained during osteosynthesis using 2.7mm bicortical screws placed in a triangular shape. The mandible was then placed horizontally on the testing machine and a continuous static force was applied perpendicularly at a displacement speed of 5mm/min. A stainless steel plate was used to transmit the forces independently of the teeth.A mean force of 129.6Newtons (N) was applied at the elastic/plastic limit on an effort/displacement curve, which is well beyond the maximal mean (SD) chewing forces of 21N (14) measured after bilateral sagittal split ramus osteotomy (BSSRO). A linear equation relating force to displacement was worked out from this experiment.Osteosynthesis using three bicortical screws mounted triangularly after advancement SSRO of 5mm is experimentally stable, and our results could be used experimentally to compare two osteosyntheses using the equation.

ASA grade and disease-free mortality in head and neck cancer patients: A prospective study - Corrected Proof

2009-12-09

Abstract: Complex surgery with curative intent as part of the care of patients with head and neck cancer, who also have serious coexisting conditions is sometimes viewed critically as being unduly, optimistic. We have used American Society of Anesthesiologists’ (ASA) grading by a single anaesthetist prospectively as a baseline to investigate a possible link between coexisiting conditions and disease-free survival in 114 patients with head and neck cancer patients treated by the same anaesthetist and surgical team, and found that the ASA grade is not a reliable predictor of disease-free survival. There was no significant association between ASA grade and overall mortality, but there was a significant association between ASA grade and mortality associated with metastatic disease. However, the test for trend was not significant, which suggested that deaths from metastatic disease did not increase in line with ASA grading. All patients in ASA grades II and III were alive 2 years after their initial operation and the risk of mortality after 2 years may increase by up to 10%.

An oral cancer awareness intervention in community pharmacy - Corrected Proof

S.N. Rogers, D. Lowe, M. Catleugh, D. Edwards — 2009-12-03

Abstract: We investigated the impact on 95 community pharmacies of an educational package on awareness of oral cancer, which consisted of a training evening, pharmacy protocol, and information for patients. Results of a questionnaire and the experience of a mystery shopper before the intervention and 6 months later were used to evaluate its effectiveness.Before the intervention 29% of pharmacies advised “my 60-year-old friend who has had an ulcer in his mouth for 4 weeks” to see a doctor or a dentist. Afterwards this rose to 45% with advice being confined to seeing a doctor. There was also a substantial reduction in advice being given to buy a product. The questionnaire showed that although responses between the baseline and follow up were similar regarding health behaviours and signs and symptoms in relation to oral cancer, more (74–89%) thought that drinking alcohol, and less (46–36%) thought that passive smoking increased the risk of oral cancer. There was also an increase in the number who thought that burning sensations (42–57%), white patches (52–76%), red patches (57–76%), speckled patches (46–68%), and a persistent ulcer (82–91%) might be signs or symptoms of oral cancer.The intervention was well received, and changes in knowledge and practice were evident, but the study showed that there is potential for much greater awareness of oral cancer amongst pharmacists and their staff.

Using a novel self-inflating hydrogel expander for intraoral gingival tissue expansion prior to bone augmentation - Corrected Proof

C. von See, M. Rücker, K.-H. Bormann, N.-C. Gellrich — 2009-12-03

The success of bony augmentation is jeopardised by inadequate perfusion and dehiscence of the soft tissue that covers the bone, and the wound should be closed primarily without tension so that vascularisation is not compromised. The increase in bony volume, however, sometimes makes it impossible to achieve tension-free soft-tissue coverage, particularly when a large amount of augmentation material is required, so a mucoperiosteal flap is often raised and mobilised through a periosteal incision. This, however, reduces the perfusion of the mucoperiosteal flap. A possible solution could be soft-tissue expansion. Keeping tissue under constant tension leads to the formation of new cells and growth of tissue. For technical reasons expanders have not yet been used intraorally routinely, but their use is now possible with miniaturised self-inflating hydrogel expanders, which need not be filled from an external source.

Incidence of palatal fistula after palatoplasty with levator veli palatini retropositioning according to Sommerlad - Corrected Proof

Yong Lu, Bing Shi, Qian Zheng, Qinggang Hu, Zhiyong Wang — 2009-11-30

Abstract: The purpose of this study was to find out the incidence of palatal fistula and study the factors that influence its development after palatoplasty with repositioning of the levator veli palatini. We retrospectively reviewed 176 consecutive repairs of cleft palates during a 2-year period (2004–2006). The age of the patients at the time of repair ranged from 12 to 30 months (mode 17 months). All the palatoplasties were done either by a senior surgeon or a resident surgeon. The chi square test was used to assess whether the development of postoperative fistulas was influenced by sex, extent of cleft (as estimated by the Veau classification), age at repair, and operating surgeon. There were 12 palatal fistulas (7%), 8 of which were at the junction of the hard and soft palate, 3 in the hard palate, and 1 in the soft palate. There was no evidence to suggest that sex or age were associated with their development. Patients whose clefts had been treated by the senior surgeon had fewer fistulas (2/82, 2%) than those by the resident surgeon (10/94, 11%) (p=0.04). The incidences of palatal fistulas in patients with clefts of the hard and soft cleft palate (7/44, 21%), and bilateral cleft lip or palate (2/21,10%), were significantly higher than those in patients with cleft soft palate (1/37, 3%), and unilateral cleft lip or palate (2/74, 3%) (p=0.03). Our results show that palatal fistula after repair is related mainly to the extent of the cleft and the experience of the operating surgeon.

Randomised controlled trials in HBO: “A call to arms” for HOPON & DAHANCA-21 - Corrected Proof

2009-11-30

On many occasions review articles highlight the inadequacies of published evidence and in their conclusions call for better quality research or randomised controlled trials. The two reviews published in BJOMS on the subject of prevention and treatment of osteoradionecrosis with HBO do not differ from the trend in this regard.

Hyperintensity signal in the joint space of the temporomandibular joint on fat-saturated T2-weighted magnetic resonance imaging - Corrected Proof

Shinya Yura, Koji Nobata, Tsuyoshi Shima — 2009-11-27

Abstract: Our aim was to investigate the incidence of a hyperintense signal in the joint space of the temporomandibular joint (TMJ) on fat-saturated T2-weighted magnetic resonance images (MRIs). We studied 112 patients (224 joints) with disorders of the TMJ who were examined by T2-weighted MRI, and recorded the association between displacement of the disc and the hyperintense signal using the κ coefficient. A hyperintense signal was found in 4 of 91 joints (4%) when the disc was in the normal position, in all 19 joints with anterior disc displacement with reduction, and in 108 of the 114 joints (95%) with anterior disc displacement without reduction. There was a significant correlation between displacement of the disc and the hyperintense signal (p<0.001). The κ coefficient was 0.91. Such a signal in the joint space of the TMJ on fat-saturated T2-weighted MRI may indicate the presence of synovial fluid in the joint space with displacement of the disc.

An update on the use of ultrasound imaging in oral and maxillofacial surgery - Corrected Proof

Rachel S. Oeppen, Daren Gibson, Peter A. Brennan — 2009-11-26

Abstract: Ultrasound is a relatively inexpensive, non-invasive, and readily available technique that is well tolerated by patients. It is particularly useful in the examination of superficial structures where the use of a high frequency linear probe (7.5–12MHz) produces high definition multi-planar images. The spatial resolution achieved is superior to other methods of cross-sectional imaging and, when combined with tissue biopsying techniques such as fine needle aspiration cytology (FNAC) or core biopsy samples, it is rendered a highly specific diagnostic tool. This article provides an overview of the use of ultrasound for common head and neck conditions, including its use in salivary gland disease, and for the assessment of cervical lymphadenopathy.

A novel technique to secure the occlusal wafer during orthognathic surgery - Corrected Proof

Ahmed Abdelrahman, Colin Johnston, Philip Earl, Neil Opie — 2009-11-26

Occlusal wafers are an essential adjunct for maintaining a stable occlusion and intermaxillary fixation during orthognathic surgery. Many techniques exist for securing an occlusal wafer to the dental arch. A commonly accepted technique involves fixation of a wafer to the dentition using a wire ligature running between a hole or cleat in the wafer and hooks on the orthodontic appliance. Suboptimal wafer fixation may result from an inadequate number or position of orthodontic hooks or loosening of the orthodontic bracket itself.

Pleomorphic adenoma (benign mixed tumour) of the salivary glands: its diverse clinical, radiological, and histopathological presentation - Corrected Proof

Ravi K. Lingam, Ahmed A. Daghir, Ezra Nigar, Syeda A.B. Abbas, Mahesh Kumar — 2009-11-20

Abstract: Pleomorphic adenoma is the single most common salivary gland tumour. It has a diverse histological presentation because of varying proportions of different epithelial and mesenchymal elements, and presents clinically and radiologically in various ways as it occurs at many different sites in the head and neck region. The choice of imaging is influenced by its site and size, and a range of options for treatment includes both operation and radiotherapy. The tumour can also present in various ways if it is not removed or treated successfully.