ABSTRACT
We conducted a regional 2-stage prospective audit involving 5 different maxillofacial units in the Yorkshire region of the UK to evaluate the effectiveness of perioperative antimicrobial prophylaxis in the treatment of mandibular fractures. In the first stage (145 patients) we surveyed current practice concerning antimicrobial prophylaxis and found out the current infection rate after open reduction and internal fixation (ORIF) of mandibular fractures. In the second stage (157 patients) we implemented a common antimicrobial protocol in all units and recorded the infection rates using the new regimen. In the first stage a wide range of antimicrobial prophylaxis was used in different units. The agreed perioperative antimicrobial protocol in the second stage was to begin amoxicillin or clarithromycin and metronidazole intravenously on admission and include 2 postoperative doses. The infection rates were 10.3% and 8.9%, respectively, and the difference between the two groups was not significant (χ(2)=0.051, df=1, p=0.83). The infection rate in the Yorkshire region was similar to results from other centres. We recommend short perioperative antimicrobial prophylaxis with a maximum of 2 postoperative doses after ORIF of mandibular fractures.
Subject(s)
Antibiotic Prophylaxis , Dental Audit , Fracture Fixation, Internal/methods , Fractures, Open/surgery , Mandibular Fractures/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Child , Clarithromycin/administration & dosage , Clarithromycin/therapeutic use , England , Female , Humans , Male , Metronidazole/administration & dosage , Metronidazole/therapeutic use , Middle Aged , Postoperative Care , Prospective Studies , Surgical Wound Infection/diagnosis , Treatment Outcome , Young AdultABSTRACT
The term inflammatory pseudotumour is given to a group of benign lesions, which are comprised of spindle myofibroblasts and chronic inflammatory cells. They rarely present out with the orbit in the head and neck and can appear sinister in their clinical and radiological presentation. Local resection is curative, whilst steroids and radiotherapy can be helpful adjuncts. Accurate histological diagnosis is essential to avoid radical and disfiguring resections being undertaken.
Subject(s)
Granuloma, Plasma Cell/pathology , Maxillary Diseases/pathology , Nose Diseases/pathology , Face/pathology , Female , Glucocorticoids/administration & dosage , Granuloma, Plasma Cell/drug therapy , Granuloma, Plasma Cell/surgery , Humans , Maxillary Diseases/drug therapy , Maxillary Diseases/surgery , Middle Aged , Nose Diseases/drug therapy , Nose Diseases/surgery , Prednisolone/administration & dosageABSTRACT
We describe a 54-year-old man whose obstructive sleep apnoea was cured by resection of a pleomorphic salivary adenoma, and emphasise the importance of a full examination of the upper airway in the assessment of a patient with symptoms of sleep apnoea.
Subject(s)
Adenoma, Pleomorphic/surgery , Pharyngeal Neoplasms/surgery , Sleep Apnea, Obstructive/etiology , Adenoma, Pleomorphic/complications , Humans , Male , Middle Aged , Pharyngeal Neoplasms/complications , Sleep Apnea, Obstructive/surgeryABSTRACT
The development of ischaemia in the hand after harvest of a radial forearm flap is extremely rare. Previous cases have been caused by anatomical anomalies or conditions that may have been detectable by ultrasonography. We report the development of ischaemia after harvest of a radial forearm flap despite a normal preoperative Allen's test and a normal Doppler ultrasound scan, in a non-smoker with no evidence of peripheral vascular disease. Angiographic appearances suggested that the ischaemia may have been secondary to an incomplete superficial palmar arch. This case highlights the potential for development of ischaemia despite normal preoperative investigations, with obvious ramifications for obtaining consent.
