Outcomes and complications associated with malar onlays: literature review and case series of 119 implants.

Alloplastic malar onlays have been used by surgeons to correct or enhance the midfacial skeleton for over 40 years. Case series have shown respectable results using different alloplastic materials in various maxillofacial subsites. However, these articles include small numbers of patients with limited follow up. We present a literature review specifically concentrating on porous polyethylene (Medpor, Stryker) and polyethyl ether ketone (PEEK) malar onlays. We illustrate the technique used by a single oral and maxillofacial surgeon for placement of 119 implants in 61 patients over a 14-year period, and show the results of this work with long-term follow up. A complication rate of 2.5% in this cohort was reported, with follow up of three years, demonstrating that this technique for midfacial correction is successful in both the short and the long term.

The effect of deprivation on the incidence of mandibular fractures in a British city.

AIM: To examine the relationship between social and material deprivation and mandibular fractures. METHOD: Three hundred and forty three consecutive patients who underwent mandibular fracture fixation were selected for the study. After exclusions, 290 were divided into age groups and ranked according to their Index of Multiple Deprivation (IMD) score. Rankings were determined using postcodes, and divided into quintiles for statistical analysis. RESULTS: Ages ranged from 7 to 82 with 146 (50%) patients aged between 20 and 29. Males accounted for 85% of cases. The most common site of fracture was the angle (n = 195) and assault was shown to be the most common mechanism of injury (63.3%). A strong relationship was demonstrated between fractures of the mandible and worsening deprivation, with the most striking relationship seen with fractures sustained as a consequence of assault. Females were less likely than males to sustain a fracture of the mandible as a consequence of assault; however, when assault was the mechanism of injury they were also likely to be from a deprived background. CONCLUSION: This study has demonstrated that a strong relationship exists between deprivation and the incidence of mandibular fractures in our catchment area. Fractures that resulted from interpersonal violence were shown to have a particularly strong correlation with deprivation.

A review of cervical spine injury associated with maxillofacial trauma at a UK tertiary referral centre.

INTRODUCTION: The aim of this study was to determine the incidence and patterns of cervical spine injury (CSI) associated with maxillofacial fractures at a UK trauma centre. METHODS: A retrospective analysis was conducted of 714 maxillofacial fracture patients presenting to a single trauma centre between 2006 and 2012. RESULTS: Of the 714 maxillofacial fracture patients, 2.2% had associated CSI including a fracture, cord contusion or disc herniation. In comparison, 1.0% of patients without maxillofacial trauma sustained a CSI (odds ratio: 2.2, p=0.01). The majority (88%) of CSI cases of were caused by a road traffic accident (RTA) with the remainder due to falls. While 8.8% of RTA related maxillofacial trauma patients sustained a CSI, only 2.0% of fall related patients did (p=0.03, not significant). Most (70%) of the CSIs occurred at C1/C2 or C6/C7 levels. Overall, 455, 220 and 39 patients suffered non-mandibular, isolated mandibular and mixed mandibular/non-mandibular fractures respectively. Their respective incidences of CSI were 1.5%, 1.8% and 12.8% (p=0.005, significant). Twelve patients with concomitant CSI had their maxillofacial fractures treated within twenty-four hours and all were treated within four days. CONCLUSIONS: The presence of maxillofacial trauma mandates exclusion and prompt management of cervical spine injury, particularly in RTA and trauma cases involving combined facial fracture patterns. This approach will facilitate management of maxillofacial fractures within an optimum time period.

Amaurosis, ophthalmoplegia, ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anaesthesia.

BACKGROUND: Ophthalmic complications following inferior alveolar nerve anaesthesia are rare. They include transient blindness (amaurosis), ophthalmoplegia, ptosis, mydriasis and diplopia. These events may occur following the intravascular administration of anaesthetic solution and are distressing to both patient and operator alike. CASE REPORT: We report the unusual case of a young patient who experienced amaurosis, total ophthalmoplegia, complete upper eyelid ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anaesthesia. Similar but less profound signs were observed in the same patient on a subsequent occasion. This was following general anaesthesia, during which she had received local anaesthetic prior to mandibular wisdom tooth removal. CONCLUSIONS: Ophthalmic complications following inferior alveolar nerve anaesthesia are rare but distressing events. In particular, amaurosis is an extremely rare event and usually heralds a more sinister pathology such as stroke. Clinicians should be aware of these complications to minimise anxiety and reassure their patients appropriately.

Novel use of an aerospace selective laser sintering machine for rapid prototyping of an orbital blowout fracture.

The authors describe the novel use of a selective laser sintering (SLS) machine, commonly used in the aerospace industry, to produce an accurate model of an orbital blowout fracture. Standard stereolithographic apparatus (SLA) technology failed to reproduce either orbital floor of a patient with a blowout fracture. The use of SLS technology using the same CT dataset to produce a superior model, highlights potential limitations of routine SLA technology and the high accuracy of SLS models. A custom-made titanium implant was constructed by hand using the SLS model as a template, it was positioned surgically and the patient's symptoms resolved uneventfully.

Bilateral ankylosis of the jaw treated with total alloplastic replacement using the TMJ concepts system in a patient with ankylosing spondylitis.

Minimal documentation exists regarding bilateral temporomandibular joint (TMJ) involvement in ankylosing spondylitis (AS) and surgical management of this specific manifestation. Use of TMJ concepts prostheses in AS patients has not been previously described. This case demonstrates that TMJ replacement with prosthetic joints in AS is technically possible and appropriate.

Superficial parotidectomy: antegrade compared with modified retrograde dissections of the facial nerve.

We compared two techniques of superficial parotidectomy: conventional antegrade dissection of the facial nerve, and retrograde dissection. A total of 89 parotidectomies were included and the results presented of a retrospective case study during a six-year period. Superficial parotidectomy involves identification of the facial nerve. We present 49 parotidectomies in 45 patients using the conventional technique of antegrade dissection of the nerve, and 40 parotidectomies in 39 patients using retrograde dissection of the buccal branch of the facial nerve from 4cm in front of the alatragal line to the main trunk of the nerve. The incidence of postoperative complications (facial nerve palsy, Frey syndrome, haematoma, and wound infection) were compared. The Facial nerve function was assessed by patient complaints and clinical examination. There was no significant difference in the incidence of postoperative complications between the groups. We describe an alternative technique for identifying the main trunk of the facial nerve.

Anterior cranial fossa dermoid cyst: case report.

We report a case of an intracranial mass that presented with proptosis and diplopia, and proved to be a dermoid cyst. Resection was successful and there had been no recurrence after 5 years.

Local anaesthesia: to warm or alter the pH? A survey of current practice.

Warming or buffering local anaesthetic solutions prior to injection has been shown to reduce the pain experienced by patients. Although clinical practice varies widely, this practice has been commonplace within dental surgery for many years. A postal survey was carried out to ascertain the current practices of a group of general surgeons and maxillofacial surgeons with regard to their local anaesthetic technique. Significant differences existed between the two groups in both their practice and knowledge of this subject.

A review of 23 patients with tuberculosis of the head and neck.

OBJECTIVE: to review the clinical features and management of tuberculosis of the head and neck and to identify those features which may aid diagnosis. DESIGN: retrospective study. SETTING: teaching hospital, England, UK. SUBJECTS: Twenty-three patients with tuberculosis of the head and neck diagnosed by culture of specimens obtained by fine needle biopsy (n = 8) or by open biopsy of the lumps in the neck (n = 15) who presented between 1990 and 1993. MAIN OUTCOME MEASURES: methods of diagnosis and management. RESULTS: thirteen of the 23 patients (57%) presented with either a fluctuant mass or a discharging sinus in the neck. Nine (39%) had uncomplicated enlarged lymph nodes and 12 (55%) had systemic symptoms. The supraclavicular region was the most common site (n = 11) and 8 of these 11 had abnormalities in the chest radiograph. In 3 patients the disease was resistant to treatment with standard antituberculous treatment. CONCLUSIONS: atypical mycobacterial lymphadenitis is usually resistant to standard antituberculous treatment, so it is essential to obtain a microbiological diagnosis. Excision is usually the treatment of choice for such patients.

Metastatic thyroid carcinoma: an unusual presentation.

A case is described in which the presentation of symmetrical thyroid lesions combined with their unusual site and histological appearance served initially to mask the underlying thyroid neoplasm.

The Dautrey procedure--a case for reassessment.

The use of the Dautrey procedure for the treatment of recurrent condylar dislocation is discussed. One cause of failure of the procedure is highlighted and a regime for pre-operative assessment is suggested.

'Turret exostosis' of the coronoid process.

A case is reported of Turret Exostosis of the Coronoid Process. This lesion is believed to bear a close relationship to the osteo-cartilagenous exostosis. The presentation and case management are described.