'Hello, MaxFax on-call?' - maxillofacial 'bleep sheet' proforma for on-call referrals.

The on-call component of a dental core training (DCT) post in oral and maxillofacial surgery (OMFS) is considered to be the most daunting and challenging aspect of the job. The average trainee is a singly-qualified dentist with limited knowledge and experience of managing OMFS presentations. Given the short duration of DCT posts, there is a continual rotation of junior staff through OMFS departments with a varying skillset and knowledge mix. As such, the consistent recording of appropriate information remains a constant challenge. The coronavirus pandemic has presented a unique situation in which the majority of dental foundation trainees (DFTs) entering OMFS DCT posts will only have around six months experience of independent practice. This lack of experience and onerous on-call workload could be a potentially dangerous combination, especially during nightshift patterns of on-call. We demonstrate that implementation of an on-call bleep-sheet proforma provides a validated, standardised, systematic, and chronological method of record keeping that exceeds the minimum required standard of clinical governance, in an era where junior trainees entering OMFS will have had even more limited experience than normal.

Permanent sensory nerve impairment following third molar surgery: a prospective study.

OBJECTIVE: This prospective study reports the proportion of permanent sensory impairment of the inferior alveolar and lingual nerves and the factors influencing such prevalence after the removal of mandibular third molars under local anesthesia. STUDY DESIGN: There were 1,087 patients with 1,087 mandibular third molars removed under local anesthesia from 1998 to 2003. Standardized data collection included the patient's name, age, gender, radiographic position of extracted tooth, grade of surgeon, proximity of the inferior alveolar nerve, and the prevalence of lingual and/or inferior alveolar nerve paresthesia. RESULTS: Inferior alveolar nerve injury was 4.1% 1 week after surgery and decreased to 0.7% after 2 years of follow-up, and alteration in tongue sensation occurred in 6.5% of patients 1 week after surgery and decreased to 1.0% after 2 years of follow-up. CONCLUSION: The experience of the operator was found to be a significant factor in determining both permanent lingual nerve (P=.022) and permanent inferior alveolar nerve paresthesia (P=.026).

Histiocytoid eccrine sweat gland carcinoma of the eyelid: report of a case.

This report describes the 12th documented case of histiocytoid, diffuse or signet-ring cell eccrine sweat gland carcinoma of the eyelid, a rare neoplasm that characteristically affects older men and mimics distant metastasis. Clinically, the patient was thought to have a colonic metastasis. Histologically, the neoplasm comprised sheets and cords of polygonal, eosinophilic cells, with dispersed larger, rounded single cells resembling histiocytes, and cells with cytoplasmic lumina or a signet-ring appearance. Occasional duct formation was also seen. The features were reminiscent of both the histiocytoid and lobular variants of breast carcinoma. Ultrastructurally, the presence of nonintestinal type microvilli with a length : width ratio in excess of 16 were consistent with an eccrine origin, but also raised the possibility of metastatic mesothelioma. However, a metastatic lesion was excluded by clinical and imaging investigations. There has been no recurrence 3 years after primary excision.

Assessment of oral premalignancy using elastic scattering spectroscopy.

Optical spectroscopy systems have been involved in various clinical fields; however the main interest is still in the diagnosis of premalignant/malignant lesions. The aim of this study was to compare findings of Elastic Scattering Spectroscopy (ESS) with histopathology of oral tissues to see if this technique could be used as an adjunct or alternative to histopathology in identifying dysplasia. The technique involves the use of Mie scattering and is a simple non-invasive method of tissue interrogation. Twenty-five oral sites from 25 patients who presented with oral leukoplakia were examined by ESS using a pulsed xenon-arc lamp. Surgical biopsies were acquired from each of the examination sites. The results of the acquired spectra were then compared with histopathology. Two sets of spectra were obtained, and by using a linear discriminant analysis, a sensitivity of 72% and a specificity of 75% were obtained. These results are promising and could suggest that ESS may be able to identify dysplasia in oral tissues. To prove the usefulness of the ESS in dysplasia detection in oral tissues conclusively, a larger body of data is needed. We aim to continue this study to obtain more data in an attempt to increase the accuracy of the technique. Large, multi-centre trails are needed for each anatomical site, in order to gather more information about the differences between normal and dysplastic tissue.

Optical techniques in diagnosis of head and neck malignancy.

The "gold standard" of assessing pathological changes in tissue is currently histopathology. However, the processing of biopsy material and the interpretation of the results inevitably leads to diagnostic delay and the added possibility of taking an unrepresentative sample. Recently, there has been increasing interest in the use of optical spectroscopy systems to be able to provide tissue diagnosis in real-time, non-invasively and in situ. These systems rely on the fact that the optical spectrum derived from any tissue will contain information about the histological and biochemical make up of that tissue. The technique has not only been shown to have a role in the detection of dysplasia and malignancy but also in performing guided biopsies, monitoring of haemoglobin tissue perfusion in free-flaps and therapeutic drug levels during chemo- and photodynamic therapy. The assessment of surgical margins and a role in sentinel node biopsy are also interesting developments. The obvious advantages of being able to accurately diagnose pathology without the need to remove a tissue sample diminish patient trauma as well as having financial implications.

Inferior alveolar nerve injury and surgical difficulty prediction in third molar surgery: the role of dental panoramic tomography.

OBJECTIVE: The purpose of this study was to evaluate the relationship between preoperative panoramic radiological findings and postoperative inferior alveolar nerve paresthesia following third molar surgery, and to assess the surgical difficulty. METHODOLOGY: This retrospective study involved two groups of patients who were randomly selected. The first group presented with inferior alveolar nerve (IAN) paresthesia following surgery, and the second group presented with no complications, including IAN paresthesia. Radiological findings were collected from the panoramic radiographs of those patients and compared to postoperative paresthesia. The degree of surgical difficulty was also assessed radiographically. RESULTS: The application of Chi-square testing on the numbness group and the control group, as well as the numbness group (two years postoperatively) and the control group, showed that parameters like type of impaction (fully impacted), depth of impaction (depth C), ramus/space (class 3), spatial relationship (distoangular and horizontal), number of roots (multiple and incomplete), shape of root (thick and incomplete), shape of the tip of root (curved and incomplete), and relation to IAN (touching, superimposed, or non-specific) are highly significant (p < 0.001) in predicting the incidence of temporary and permanent paresthesia. Logistic regression showed that a patient whose lower third molar is > or = 1 mm from IAC has a 98% probability of no numbness, while if the tooth is touching the IAC the probability of numbness between one week and < two years is 60%. Numbness probability of darkening of the root is 48% for > two years, deflection of the root has a 42% probability of > two years numbness, narrowing of the root has 87% of numbness between > one month and < two years, a dark and bifid root has a 97% of numbness between > six months and < two years, interruption of the IAC has a 54% chance of numbness between > one month and < two years, diversion of the canal has a 60% probability of > six months to > two years numbness, while narrowing of the canal has a probability of 100% of > six months to > two years numbness. By using logistic regression, cases that were recorded as "very difficult," according to the Pederson Difficulty Index, were more likely to develop permanent paresthesia (95%). The application of logistic regression on the radiological findings showed that we can use them in predicting nerve paresthesia following third molar surgery. A classification tree has been developed and found to be very accurate in predicting permanent numbness (95%) and no numbness (100%) in third molar surgery depending on the radiological findings. CONCLUSION: Surgical difficulty of impacted third molars may be assessed radiographically through seven factors, including spatial relationship, depth of impaction, ramus relationship/space available, type of impaction, number and shape of roots, shape of the tip of the root, and relation of the root to the inferior alveolar nerve. The application of logistic regression on the radiological findings showed that we could use them in predicting nerve paresthesia following third molar surgery. By developing a classification tree, it is easier to predict the possibility of temporary or permanent paresthesia. A full collaboration between clinicians and radiologists may help to uncover more parameters that can lead to a more accurate prediction of temporary and permanent paresthesia.

Paraesthesia of the lip and chin area resolved by endodontic treatment: A case report and review of literature.

Lower lip numbness is a symptom that may be due to entirely benign causes, or it may be the first sign of a more sinister problem. It has been reported as being the sole symptom of pathological lesions and metastatic tumours in the mandible.

Florid cemento-osseous dysplasia in a young Indian woman. A case report.

We present a rare case of florid cemento-osseous dysplasia (FCOD) occurring in a 27-year-old Indian woman. She presented with three lesions, two of them symmetrical, at the posterior region of the mandible. Another lesion appeared nine months later, symmetrical to the existing third lesion. This confirmed the diagnosis of florid cemento-osseous dysplasia as being symmetrical asymptomatic bone lesions occurring in the jaw. The diagnosis was made radiographically depending on a series of radiographs, as biopsy is contraindicated. No treatment was required as the lesions were asymptomatic, causing no problem to the patient. The patient continues to be reviewed annually. The case is rare in its unusual combination of the disease itself (FCOD), age (27 years) and race (Indian). Clinical and radiological features are presented.

Assessment of bony resection margins in oral cancer using elastic scattering spectroscopy: a study on archival material.

Oral squamous cell carcinoma has been shown to infiltrate local bone necessitating either a local or segmental resection for clearance. The current decalcification process takes several weeks before histological examination of the margins is possible. The aim of this study was to determine whether elastic scattering spectroscopy (ESS) could be used to identify bone resection margins positive for tumour. We used an ESS biopsy (optical biopsy) system to assess formalin fixed bone margins resected for squamous cell carcinoma of the oral cavity and compared the results with the histopathological diagnosis. Archival specimens obtained in oral cancer resections over the last 10 years were used, the ESS spectra were obtained from residual resection margins immediately adjacent to the area from which sections were cut and the results correlated with the histopathological diagnosis. Three hundred and forty-one spectra were used in this study taken from the mandibular specimens of 21 patients, of which 231 spectra were taken from histologically positive sites and the rest were of normal tissue. Two different sets of spectra were obtained and using a linear discriminant analysis, a sensitivity of 87% and a specificity of 80% were obtained. These results suggest that ESS may identify tumour involvement of resection margins. This study, on formalin fixed tissue, was shown to be reliable and may significantly reduce pathology workload. If these findings can be applied in vivo, this would be an accurate and instant mechanism for assessment of margins in clinical practice.

Use of the buccal fat pad in the reconstruction and prosthetic rehabilitation of oncological maxillary defects.

We evaluated the effectiveness of the buccal fat pad as a pedicled flap for intraoral reconstruction after partial maxillectomy for neoplastic disease in 24 patients, and subsequently, in providing support for a denture. In all patients the buccal fat pad was covered with a split-skin graft and an acrylic plate. There was complete healing of the buccal fat pad flap within 6 weeks in 18 patients with no major complications, and minimal effects on speech and eating. In six cases there was partial dehiscence of the flap, which healed spontaneously in one patient and was repaired with local flaps in two others. There were no cases of complete breakdown of the flap. Eight patients so far have been rehabilitated with small dentures. In conclusion, the buccal fat pad flap is a simple, quick, and reliable method of reconstruction of small to medium-sized posterior maxillary alveolar defects.

Detection of cervical intranodal metastasis in oral cancer using elastic scattering spectroscopy.

While histopathology remains the gold standard for tissue diagnosis, several new diagnostic techniques are being developed that rely on physical and biochemical changes that mirror or precede malignant change within tissue. The aim of this study was to compare findings of elastic scattering spectroscopy (ESS) with histopathology on formalin fixed neck dissection specimens to see if this technique could be used as an adjunct or alternative to histopathology in defining nodal involvement. The technique involves the use of Mie scattering and is a simple non-invasive method of tissue interrogation. One hundred and thirty lymph nodes were examined from 13 patients who underwent neck dissection. The nodes were formalin fixed, bivalved and examined by ESS using a pulsed xenon lamp. The intensity of the spectrum at 4 points was considered for comparison; at 360, 450, 630 and 690 nm. The nodes were then routinely processed and haematoxylin and eosin-stained sections examined histopathologically, and the results compared. Using this technique, a sensitivity of 98% and a specificity of 68% were obtained.

Management of oral and maxillofacial infection.

Maxillofacial infections are common but can potentially be life threatening. Accurate diagnosis is essential to prevent mismanagement with potential severe consequences. This article discusses the aetiology, differential diagnosis, host response, spread of infection and treatment.

Current practice in the management of frontal sinus fractures.

Fractures of the frontal sinus are seen predominantly, although not exclusively, in young men and are usually the result of road traffic accidents or falls. These types of injury may present to either ENT, Maxillofacial, Plastic or Neurosurgery teams, and understanding of a clear management protocol is desirable for each of the specialties. The optimal management of these injuries is becoming more uniformly adopted although some areas of contention still persist. The aim of treatment has always been directed at creating a 'safe sinus' that is not complicated by the late sequelae of infection or mucocele formation. The difficulty lies in being able to predict which patients are likely to develop these complications. The aim of this paper is to evaluate the literature and offer a rationale for the management of these injuries.

Principles of management in oral cancer.

Squamous cell carcinoma is the most common oral malignancy, with a relatively poor prognosis. Treatment of oral cancer has a major impact on afflicted patients because it affects speech, swallowing and mastication. Surgery is the main treatment of oral cancer, as a single modality or combined with radiotherapy. Vigilance is vital for early diagnosis and better overall prognosis.

Orbital volume measured by a low-dose CT scanning technique.

A method for measuring orbital volume using low-dose CT with contiguous 3 mm transaxial sections is described. The accuracy of the method is 1.6%, as demonstrated by comparing CT volume measurements with those derived directly from alginate impressions and on repeat scanning the precision of the measurement was judged as 1.3%. Within the same individual, the right and left orbital volumes were observed to be within 0.6 cm3 (s.d. +/- 0.33 cm3) of each other. This study demonstrates that low-dose CT scanning is a practical method of determining orbital volume and could be used to advantage in the management of traumatic enophthalmos and blow-out fractures of the orbit.