A survey of multidisciplinary cleft palate and craniofacial team examination formats.

We surveyed 229 multidisciplinary cleft and craniofacial teams listed in the American Cleft Palate-Craniofacial Association directory regarding frequency of meetings, numbers of patients treated, sources of funding, their format of examination of children, and their satisfaction with that format. One hundred fifteen (50%) of 229 surveys were completed. Thirty-seven percent of clinics report meeting monthly; 43% of clinics report actively following up 300 or less patients; 40% of clinics report funding by third-party insurance reimbursement, and 38% by government funding; 48% of clinics report the patients moving from one examination room to another to see specialists, in another 33%, the patient stays in 1 examination room while the specialists move, and in only 20%, all specialists see a patient simultaneously. Significantly more specialists are dissatisfied with clinics where they move to examine children; significantly more families are satisfied in clinics where specialists move to examine the child or examine them simultaneously.

Variable osteology of the sixth cervical vertebra in relation to stellate ganglion block.

BACKGROUND AND OBJECTIVES: Stellate ganglion block is often carried out using palpation of surface landmarks to guide needle placement. However, anatomic variation of the surface landmarks used is common and block failure has been reported in as many as 30% of patients, even when the surface landmarks that guide needle placement can be easily identified. METHODS: Computed tomography (CT) images of the cervical spine of 70 adult patients were examined to measure the distances in the coronal and sagittal planes between various points on the cricoid cartilage, anterior tubercle, posterior tubercle, and nadir of the vertebral gutter. The width of the tubercle in the caudal and cephalad plane was determined through multiplanar reformatted CT images in 6 randomly chosen patients. RESULTS: The mean distance from the lateral margin of the cricoid cartilage laterally to the anterior tubercle was 13 +/- 5 mm (range 3-22 mm) in men and 12 +/- 3 mm (range 6-22 mm) in women. The mean depth of the anterior tubercle as measured posteriorly from the midpoint of the trachea was 20 +/- 4 (range 10-33 mm) in men and 19 +/- 4 mm (range 9-33 mm) in women. The maximal and minimal cephalad-caudad dimensions of the transverse process of C6 were 9.3 +/- 0.3 mm, and 6.7 +/- 0.3 mm, respectively. CONCLUSIONS: Large variability was observed in the size and location of the landmarks used for needle placement during stellate ganglion block. Placement of the needle medially where the transverse process joins the lateral margin of the vertebral body provides a larger bony target that may potentially provide a safer, more reliable block.

Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management.

OBJECTIVE: To present to general dentists the typical signs and symptoms associated with adult acute (primary) herpetic gingivostomatitis. The pertinent laboratory tests, management options and current pharmacotherapy are also reviewed. REVIEW DESIGN: The clinical files of 13 adult patients were reviewed. All had no history of herpes simplex virus infection and presented with oral lesions suggestive of primary herpetic infection. The subjects were all patients of one of the investigators, and their workup included Tzanck testing and viral culture. RESULTS: The patients ranged in age from 18 to 79 (mean 37.2, standard deviation 19.6) years. Nine (69%) were men. Viral culture was confirmed as the gold standard for diagnosis. The sensitivity of Tzanck testing was 77% (10/13), slightly higher than that reported previously (40% to 50%). In this patient group the febrile lymphadenopathic profile was typical of younger patients (18 to 42 years of age), whereas older patients presented with predominantly oral symptoms. CONCLUSIONS: Primary herpetic gingivostomatitis is not limited to children but can affect people of any age. Proper diagnosis and treatment are essential, particularly in elderly and immunocompromised patients. Tzanck testing may serve as a useful adjunct in diagnosis. Antiviral agents such as valacyclovir and famciclovir should be considered part of early management. Dentists are often the first health care professionals to be consulted by patients with this condition, and recognition of the infection is paramount.