Structural outcomes in the Cleft Care UK study. Part 2: dento-facial outcomes.

OBJECTIVES: To compare facial appearance and dento-alveolar relationship outcomes from the CSAG (1998) and CCUK (2013) studies. SETTING AND SAMPLE POPULATION: Five-year-olds born with non-syndromic unilateral cleft lip and palate. Those in the original CSAG were treated in a dispersed model of care with low-volume operators. Those in CCUK were treated in a more centralized, high-volume operator model. MATERIALS AND METHODS: We compared facial appearance using frontal view photographs (252 CCUK, 239 CSAG) and dental relationships using study models (198 CCUK, 223 CSAG). Facial appearance was scored by a panel of six assessors using a standardized and validated outcome tool. Dento-alveolar relationships were scored by two assessors using the 5-Year-Olds' Index. Ordinal regression was used to compare results between surveys. RESULTS: Excellent or good facial appearance was seen in 36.2% of CCUK compared with 31.9% in CSAG. In CCUK, 21.6% were rated as having poor or very poor facial appearance compared with 27.6% in CSAG. The percentage rated as having excellent or good dento-alveolar relationships was 53.0% in CCUK compared with 29.6% in CSAG. In CCUK, 19.2% were rated as having poor or very poor dento-alveolar relationships compared to 36.3% in CSAG. The odds ratios for improved outcome in CCUK compared to CSAG were 1.43 (95% CI 1.03, 1.97) for facial appearance and 2.29 (95% CI 1.47, 3.55) for dento-alveolar relationships. CONCLUSIONS: Facial and dento-alveolar outcomes were better in CCUK children compared to those in CSAG.

Three-dimensional digital models for rating dental arch relationships in unilateral cleft lip and palate.

Objective : To determine the reliability and reproducibility of using three-dimensional digital models as an alternative to plaster models for rating dental arch relationships in patients born with unilateral cleft lip and palate. Design : Reliability and reproducibility study. Methods : Study models of 45 patients born with unilateral cleft lip and palate were made available in plaster and three-dimensional digital models. Records were scored a week apart by three examiners using the 5-year-olds' index reference models in the same two formats as the patient models. To assess reproducibility the study was repeated 4 weeks later under similar conditions to minimize the influence of memory bias on the results. The reliability of using the three-dimensional digital models was determined by comparing the scores for each examiner with the plaster model scores. Results : Weighted kappa statistics indicated repeatability for the plaster models was very good (.83 to .87). For the three-dimensional digital models it was good to very good (.74 to .83). Overall, the use of the three-dimensional digital models showed good agreement with the plaster model scores on both occasions. Conclusion : Three-dimensional digital models appear to be a good alternative to plaster models for assessing dental arch relationships using the 5-year-olds' index.

The 5-year-olds' Index: determining the optimal format for rating dental arch relationships in unilateral cleft lip and palate.

The aim of this investigation was to determine the optimal format for presenting the 5-year-olds' Index reference models for the assessment of dental arch relationships in unilateral cleft lip and palate (UCLP). The 5-year-olds' Index reference models were presented in four different formats: plaster models, coloured acrylic models, and two digital formats, which included three-dimensional digital models (3D), and black and white photographs. These formats were used to rate 45 plaster models of patients born with UCLP by a total of seven examiners comprising experienced and inexperienced examiners. Scoring was undertaken 1 week apart for each format with the patient models reassigned on each occasion to reduce the effect of memory bias. For intra-examiner agreement, the patient models were scored 3 weeks later under similar conditions by the same examiners. The reliability of using the different formats was determined using the plaster reference models as the 'gold' standard for comparison. Analysis of the results using weighted kappa (k) statistics showed the magnitude of agreement for all the formats of the 5-year-olds' Index were good to very good between examiners. The more experienced examiners were consistently more reliable in their scoring using the different formats. This study clearly demonstrated that 3D digital models of the 5-year-olds' Index could prove to be a promising alternative to physical models of the 5-year-olds' Index.

Rare post-tonsillectomy complication in human immunodeficiency virus positive patient: ulcero-necrotic lesion of tonsillar fossa.

OBJECTIVE: Post-tonsillectomy complications are common. The majority are easily recognised because of their frequent occurrence and can be managed as required. Infrequent complications may be misdiagnosed or managed inappropriately. We present a previously unreported complication of tonsillectomy. CASE REPORT: A 45-year-old Afro-Caribbean man underwent routine tonsillectomy. Eight weeks post-operatively, he developed an ulcero-necrotic lesion of the tonsillar fossa. Subsequent investigation revealed that he was human immunodeficiency virus positive. It is highly likely that the patient's underlying immuno-compromised state, secondary to human immunodeficiency virus infection, contributed to this ulcero-necrotic lesion. CONCLUSIONS: This case highlights the importance of clinician awareness of rare complications of tonsillectomy, in order to facilitate identification and appropriate investigation.

The 'parent's kiss': an effective way to remove paediatric nasal foreign bodies.

INTRODUCTION: The objectives of this study were to: (i) evaluate the effectiveness of 'parent's kiss' as a technique for removal of nasal foreign bodies in children; and (ii) determine whether this technique reduces the number of children requiring general anaesthesia for their removal. PATIENTS AND METHODS: This was a prospective observational study in the accident and emergency and ENT departments at Luton and Dunstable Hospital. The participants were 31 children with nasal foreign bodies, under the age of 5 years, presenting via the acute services over a 6-month period. The primary outcome measured was successful removal of nasal foreign body with the 'parent's kiss' technique. Secondary outcome was reduction in the number of general anaesthetics following introduction of the technique. RESULTS: The technique was successful in 20 out of the 31 children (64.5%) in the study group. Only one patient required general anaesthesia for removal of nasal foreign body (3%). This compares with a rate of 32.5% requiring removal under general anaesthetic in the preceding 6-month period. The 'parent's kiss', when not successful, seemed to improve the visibility of the foreign body making their subsequent removal easier. CONCLUSIONS: The 'parent's kiss' is an effective technique. It is non-traumatic, both physically and emotionally, for the child subjected to it. We advocate that it should be used routinely as a first line of management in children with a nasal foreign body in the primary care setting.

Bitter sweet tympani.

During cholesteatoma surgery, the chorda tympani nerve must often be divided. We present an interesting case of a patient whose severe dysgeusia due to cholesteatoma resolved following section of the chorda tympani nerve.

Salivary gland choristoma of the middle ear.

A salivary gland choristoma is an extremely uncommon tumour in the middle ear space. It appears to be a developmental abnormality and may be associated with abnormalities of adjacent structures. It usually presents with unilateral conductive deafness which may be long-standing and the tumour often pursues a benign, slow growing course. It is usually possible to excise it, but problems may arise as there may be variable associated anatomical abnormalities of the middle ear. We present the nineteenth recorded case, review the literature and discuss the management of this condition.

Haemangiopericytoma of the nose and paranasal sinuses.

The uncertain course and rarity of haemangiopericytoma in the nose and paranasal sinuses has interested both pathologists and clinicians. This tumour arises from proliferation of pericytes which invest capillary endothelium. A benign course is more common in the nose and paranasal sinuses. The first nasal haemangiopericytoma was reported by Stout in 1949. Since then only twenty cases have been reported in the literature. We present three further cases.