Complications with use of the Epistat in the arrest of midfacial haemorrhage.

Control of midfacial haemorrhage can be difficult, especially in the multiply injured patient, either at the scene of injury, or in the Accident and Emergency Department. The use of Epistats has proven invaluable in this setting. Potential problems exist with their use and this is illustrated with examples, together with strategies for overcoming them. A summary of the didactic method of safe use of this life saving technique is insert the Epistat, aiming for a fingertip placed at the soft palate;inflate the posterior cuff;withdraw the Epistat slightly, to position the posterior cuff within the nasal choanae;inflate the anterior (intranasal) cuff.

Ultrasound imaging in the preoperative estimation of the size of tracheostomy tube required in specialised operations in children.

BACKGROUND: Some children are dependent on a tracheostomy for many years. As they grow, larger tracheostomy tubes may be required. Although tables of sizes of tracheas exist for different age groups, they are estimations of normal and may not be accurate for atypical cases. Chest radiographs and computed tomograms (CT) have been used experimentally to estimate tracheal sizes, but are not in regular use. METHOD: High-resolution diagnostic ultrasound imaging was used to estimate the internal and external transverse tracheal diameter, and the depth of the trachea from the skin surface. This allowed selection of the correct standard pattern tracheostomy tube, or the construction of a custom-made tube preoperatively. RESULTS: Four children with various abnormalities who were being considered for replacement tracheostomies were scanned. In one, diagnostic ultrasound confirmed that a new larger fenestrated tube could be placed, which subsequently improved vocalisation and respiration. In the other three, the scan showed there was no space to allow a larger tube to be placed. The standard tables were not suitable for any of these patients. CONCLUSION: High-resolution ultrasound has a role in the non-invasive measurement of the size of the tube needed for specialised operations in children.

The moon and its relationship to oral and maxillofacial emergencies.

OBJECTIVE: To study the relationship between the full moon and oral and maxillofacial emergencies. STUDY DESIGN: Retrospective analysis of 2416 referrals to the Department of Oral and Maxillofacial Surgery, St. Bartholomews and The Royal London Hospital, London, over a 16-month period (17 lunar months). Frequency distributions were used to assess emergency workload during the week of the full moon. RESULTS: There was a rise in referrals in the latter part of the 7-day period surrounding the full moon. There was a persistent reduction in emergency workload in the 3-day period leading up to the full moon. The results approach but do not reach significance. CONCLUSIONS: The effect of the moon on oral and maxillofacial referrals cannot be proven.

Use of an orthopaedic fixator for external fixation of the mandible.

A patient presented with a chronically infected, non-united fracture of the mandible, with considerable bone loss. He was treated with a metacarpal fixator, the miniPennig external fixator. The fixator is stable and smaller than conventional mandibular fixators. It can be applied and removed under local anaesthesia, if necessary, requires little maintenance and produces minimal scarring. The successful outcome in this patient is encouraging and we commend the use of the fixator in similar difficult cases.

Intracranial metastases from oral squamous cell carcinoma.

We present two cases of histologically confirmed intracerebral metastases from oral squamous cell carcinoma (SCC). This site of distant spread has not to our knowledge previously been reported. The only common feature in all these cases was the long period over which the patients had untreated primary disease (12--24 months). Both patients developed symptoms from their cerebral deposit within a short time of diagnosis and treatment of the primary disease. They died rapidly of their cerebral metastases despite extensive and effective treatment of the primary site and regional lymph nodes. We recommend that a magnetic resonance (MR) scan of the brain is considered for patients who present with long-standing untreated primary oral SCC.

Percutaneous osteosynthesis of the zygomatic buttress.

We describe a technique of percutaneous miniplate osteosynthesis of the zygoma, using the transbuccal approach. It can be used in conjunction with an extraoral approach, or in isolation. Excellent access was achieved to the posterior zygomatic buttress and arch of zygoma, and the infraorbital rim. No complications developed in the two cases presented. This technique is a useful addition to the armamentarium of maxillofacial surgeons.

Metachronous bilateral primary adenocarcinoma of the submandibular glands.

A young woman developed an unusual adenocarcinoma in each submandibular salivary gland at an interval of 30 months. This presentation has not been described previously. The possible etiology for this and treatment options are discussed. The choice of diagnostic imaging (ultrasound versus magnetic resonance imaging) is highlighted. As a result of regular follow-ups using diagnostic ultrasound, a second tumor was observed to reach a dimension of 8 mm in less than 6 months. This is probably the first report documenting the extent of initial growth of this rare tumor.

Squamous cell carcinoma presenting as a peritonsillar abscess.

Peritonsillar abscess is a rare presentation of squamous cell carcinoma of the tonsil. We report two cases illustrating the need to be aware of the possibility and reinforcing the need to send all excised tissue for histopathological diagnosis.

Staphylococcal submandibular lymphadentitis of childhood.

The presentation of two patients with the condition is described. The difficulty of finding an underlying cause of the infection is discussed, and the importance of a history of recent head and neck infection emphasised. Recommendations are made for appropriate antibiotic therapy to cover Staphylococci as well as the more common Streptococci.

Tongue piercing resulting in hypotensive collapse.

Tongue piercing remains popular. A variety of complications have been reported, including life-threatening infection, airway problems and damaged teeth or mucosal surfaces. A patient who collapsed after continuous profuse bleeding following tongue piercing is presented. It is recommended that piercing practitioners be licensed and inspected. A list of written post piercing instructions for customers is included on how to deal with, or who to contact regarding potential complications including haemorrhage.