A pilot study to determine the potential application of the pressure specified sensory device in the maxillofacial region.

This pilot study was carried out at the Chang-Gung Memorial Hospital in Taiwan. In order to evaluate this instrument, One-point static (IPDS) cutaneous pressure thresholds were estimated in the perioral region utilizing a hand-held pressure specified sensory device (PSSD). Pressure specified two point discrimination (2PDS) could not be estimated due to the extreme sensitivity of the lip. Normative data were collected from 50 adults and a small, further group of 10 persons evaluated on two separate occasions to determine the likely chance of reproducibility and reliability. The normal range for 1PDS as determined using a hand-held technique, lay between 0.01 g/mm2 and 0.08 g/mm2. These results are up to 200 x lower than previously reported by other authors when estimated with Semmes-Weinstein nylon monofilaments. The results obtained suggest that sensitivity may not decline with advancing years, that the upper lip is more sensitive than the lower lip and that there may be a difference in the appreciation of sensation across the mid-line. Re-examination of the smaller group of subjects established values within 0.01 g/mm2 at 82% of points, 0.02 g/mm2 at 90% of points and 0.03 g/mm2 at 100% of points. The results achieved, although highly operator dependent and difficult to reproduce, reflect the exquisite sensitivity of the lip. The instrument, which was designed for assessment of hand sensation, would benefit from modification if its enormous potential as a research tool in the maxillofacial region is to be maximized. Despite a steep operator learning curve the PSSD may well prove itself to be an invaluable clinical tool and this instrument is worthy of further study within individual units.

Pattern assembly--an aid to flap design during oral microsurgical reconstruction.

Surgical ablation of tumors within the oral cavity results in a three-dimensional defect and a potential puzzle for the reconstructive surgeon. Although a myriad of papers discussing the relative advantages and disadvantages of various methods of reconstruction are readily available for consultation, very few publications have provided the surgeon with a guide either to visualization of the defect or to how to reconstruct a three-dimensional defect with an essentially two-dimensional flap. Our intention is not to provide the answer for every oral reconstructive problem--after all, no two patients are alike--but we will demonstrate that an appreciation of the defect in three-dimensions, together with an understanding of oral function, provides a template for flap design and inset. This is achieved by simplifying the complex anatomical shape of the oral cavity into a geometric form from which a series of simple, easily recognisable shapes can be derived and assembled as necessary into a pattern that reproduces the defect, providing a template for flap design and inset.

The trephining of bone from the iliac crest: an anterior approach.

A quick and simple method of trephining moderate amounts of cancellous bone (up to 6 cc) from the iliac crest via an anterior approach is presented. The advantages of this technique are that no muscle or ligamentous attachments are disturbed and postsurgical morbidity is low.

Transfacial access for neurosurgical procedures: an extended role for the maxillofacial surgeon. I. The upper cervical spine and clivus.

A variety of osteoplastic flaps have been devised for transoral or extraoral access to the base of skull and the upper anterior cervical spine. Part I of this two-part review will describe access to the clivus and upper anterior cervical spine. Part II will describe access to the middle cranial fossa, the infratemporal fossa and the pterygoid (retromaxillary) "space".

Transfacial access for neurosurgical procedures: an extended role for the maxillofacial surgeon. II. Middle cranial fossa, infratemporal fossa and pterygoid space.

A variety of osteoplastic flaps have been devised for transoral or extraoral access to the base of skull and the upper anterior cervical spine. Part I of this two-part review describes access to the clivus and upper anterior cervical spine. Part II will describe access to the middle cranial fossa, the infratemporal fossa and the pterygoid (retromaxillary) "space".

Hazard warning. A case of postoperative pulmonary barotrauma.

A case is described in which extensive pulmonary barotrauma occurred due to the application of a face mask to an indwelling cuffed endotracheal tube. The design of the mask is such that a seal was made between the mask and the tube. The design of mask is widely used in theatre recovery areas and clinicians are alerted to this potential hazard.

An obstructed airway: cuff herniation during nasotracheal anaesthesia for a bimaxillary osteotomy.

A case of airway obstruction resulting from lumen occlusion by an inflated endotracheal tube cuff is reported. The possible causes and remedies for this unusual complication are discussed.

Gentamicin impregnated polymethylmethacrylate (PMMA) beads in the treatment of primary chronic osteomyelitis of the mandible.

Primary chronic osteomyelitis (chronic diffuse sclerosing osteomyelitis) of the mandible is an uncommon condition, probably arising as a consequence of infection with bacteria of low virulence, in which bone deposition rather than bone resorption occurs. These bacteria are most likely derived from skin or oral mucosa gaining access to bone from the periodontium or through the circulation. Furthermore, delayed hypersensitivity and ischaemic changes within bone may contribute to the inflammatory response, which once initiated is very difficult to eradicate. When the likely aetiological factors are considered a logical approach to management includes the surgical removal of affected bone and the topical application of a broad spectrum antibiotic to the resultant surgical bed.

Giant enterocystoma within an infant's tongue.

A rare developmental cyst within the tongue and submandibular triangle of a male infant containing heterotopic gastric and intestinal epithelium (enterocystoma) is described and its derivation discussed. This cyst was of such a size as to cause feeding difficulties and partial airway obstruction during sleep. Following C.T. scanning, total obstruction necessitated an emergency tracheostomy. Successful enucleation via a median labiomandibulotomy was performed without further complication and two years later there is no sign of recurrence.

Horizontal-T genioplasty--(a modified technique for the broad or asymmetrical chin).

A modified technique for genioplasty is described. A horizontal, single-slice of bone is sectioned from the inferior border of the chin, with preservation of the lingual soft tissue attachment, in the conventional manner. This is divided sagittally into three segments, which are not necessarily equal, and are then repositioned in the shape of a horizontal 'T'. To achieve this, the lateral segments are advanced and approximated in front of the central fragment which itself is also advanced. These are fixed in position and when desirable any voids may be filled with autogenous bone or hydroxyapatite. This simple technique augments the chin to an equal if not to a greater extent than the conventional 'double slide' genioplasty. It combines augmentation with narrowing and has the flexibility to reposition the chin. This technique is not advocated for routine use but more for the special case when augmentation is required for the patient with a broad, flat or asymmetrical chin. A presentation of four case histories will illustrate the application of this technique.

Spontaneous iliac artery aneurysm-ureteric fistula.

Isolated iliac artery aneurysms occur ten times less frequently than aortic aneurysms. Symptoms of compression of other pelvic structures may cause their presentation and occasionally they rupture into adjacent organs. We describe only the third case of spontaneous rupture of an isolated iliac aneurysm into a ureter which led to massive haematuria.