Peri-operative complications of sphenopalatine artery ligation: a 10-year series from two secondary care centres.

BACKGROUND: There is currently limited evidence regarding the potential complications of sphenopalatine artery ligation. The post-operative outcomes at two secondary care centres over a 10-year period were reviewed. METHODS: A retrospective review was undertaken of patients undergoing emergency and elective sphenopalatine artery ligation between January 2011 and January 2021. Their demographics, peri-operative care and post-operative outcomes were recorded. The median follow-up time was 54 days (range, 0-2657 days). RESULTS: Ninety-one patients were included. Four patients (4.4 per cent) had a septal perforation at post-operative review. Nineteen patients (20.9 per cent) had post-operative bleeding that extended their in-patient stay, with five patients (5.5 per cent) requiring revision surgery. Pre-operative non-dissolvable nasal packing was used a median of 1 time (range, 0-8 times). CONCLUSION: Further research on outcomes of sphenopalatine artery ligation is needed. Pre-operative non-dissolvable nasal packing, concurrent septal surgical procedures, surgical techniques, and co-morbidities such as hypertension represent potential confounding factors that could not be further assessed in this small, retrospective study.

Variations in funding for treatment of obstructive sleep apnoea in England.

OBJECTIVES: This study aimed to review the funding policies of clinical commissioning groups for treatment of obstructive sleep apnoea in England. METHODS: Published policies from a randomly selected sample of 60 out of 190 clinical commissioning groups were reviewed. RESULTS: Continuous positive airway pressure was funded based on a clinical assessment or according to criteria that were in line with national guidelines in most clinical commissioning groups (49 of 60), with 11 clinical commissioning groups offering no policy. Mandibular advancement devices, tonsillectomy and nasal surgery were funded based on a clinical assessment or certain criteria in 16, 25 and 16 clinical commissioning groups, respectively. In contrast, only one clinical commissioning group provided funding for soft palate, tongue base or mandibular surgery. Hypoglossal nerve stimulation was not mentioned in any clinical commissioning group's policy. CONCLUSION: Although most clinical commissioning groups provide funding for the use of continuous positive airway pressure, the availability of funding for other obstructive sleep apnoea treatment modalities is heterogeneous, leaving continuous positive airway pressure intolerant patients with limited therapeutic options in some regions.

Extended endoscopic approaches to the maxillary sinus.

OBJECTIVES: Treatment of inflammatory and neoplastic disease in the maxillary sinus, pterygopalatine and infratemporal fossae requires appropriate surgical exposure. As modern rhinology evolves, so do the techniques available. This paper reviews extended endoscopic approaches to the maxillary sinus and the evidence supporting each technique. METHODS: A literature search of the Ovid Medline and PubMed databases was performed using appropriate key words relating to endoscopic approaches to the maxillary sinus. RESULTS: Mega-antrostomy and medial maxillectomy have a role in the surgical treatment of refractory inflammatory disease and sinonasal neoplasms. The pre-lacrimal fossa approach provides excellent access but can be limited because of anatomical variations. Both the transseptal and endoscopic Denker's approaches were reviewed; these appear to be associated with morbidity, without any significant increase in exposure over the afore-described approaches. CONCLUSION: A range of extended endoscopic approaches to the maxillary sinus exist, each with its own anatomical limitations and potential complications.

Tension pneumo-orbit secondary to minor blunt force trauma.

INTRODUCTION: Tension pneumo-orbit is a rare but eye-threatening sequelae of orbital trauma. Minimal trauma to the lamina papyracea can result in a valve effect leading to rapid-onset proptosis and optic nerve compression in the absence of a haematoma. CASE REPORT: We describe a case of medial orbital wall fracture in a 35-year-old lady following a minor fall at home. She presented with severe proptosis of the left eye. Imaging showed marked pneumo-orbit, which was managed definitively by endoscopic orbital decompression. DISCUSSION: Tension pneumo-orbit requires prompt recognition and surgical decompression. An endonasal approach may be used to decompress the orbit via the medial wall.

Dietary intakes and anthropometric measures of Indigenous Australian women and their infants in the Gomeroi gaaynggal cohort.

Indigenous Australians continue to experience disparities in chronic diseases, many of which have nutrition-related trajectories. Optimal nutrition throughout the lifespan is protective for a number of adverse health outcomes, however little is known about current dietary intakes and related anthropometric outcomes of Indigenous women and their infants. Research is required to identify nutrition issues to target for health promotion activities. The Gomeroi gaaynggal programme is an ongoing, prospective cohort of pregnant Indigenous Australian women and their children. A cross-sectional examination of postnatal dietary intakes and anthropometric outcomes of mothers and children are reported. To date, 73 mother-child dyads have participated postpartum. Breastfeeding initiation was 85.9% and median (interquartile range) duration of any breastfeeding was 1.4 (0.5-4.0) months. Infants were introduced to solid foods at 5.0 months (4.0-6.0) and cow's milk at 12.0 (10.0-13.0) months. At 12 months postpartum, 66.7% of women were overweight or obese, 63.7% at 2 years. Compared with recommendations, reported median maternal nutrient intakes from 24-h recall were low in fibre, folate, iodine, calcium, potassium and vitamin D and high in proportions of energy from total and saturated fat. Limitations of this study include a small sample size and incomplete data for the cohort at each time point. Preliminary data from this ongoing cohort of Indigenous Australian women and children suggest that women may need support to optimize nutrient intakes and to attain a healthy body weight for themselves and their children.

Management of isolated cricopharyngeal dysfunction: systematic review.

OBJECTIVE: A systematic review was performed to evaluate the safety and efficacy of different therapeutic interventions available for the management of isolated cricopharyngeal dysfunction. METHODS: Studies were identified using the following databases: Ovid (Medline, Embase), the Cochrane Library, PubMed and Google Scholar. An initial search identified 339 articles. All titles and abstracts were reviewed. Fifty-six relevant articles were inspected in more detail; of these, 47 were included in the qualitative analysis. RESULTS: No relevant randomised trials were found. A range of case series were used to perform a qualitative analysis. Botulinum toxin A injection and cricopharyngeal dilatation were associated with a higher risk of recurrence, but appear to be more suitable in elderly and co-morbid patients. In those patients requiring formal myotomy, endoscopic approaches appear to be as effective but less morbid when compared with classical open surgery. CONCLUSION: There is good evidence for the safety and efficacy of the different therapeutic options for isolated cricopharyngeal dysfunction. However, further studies are required to compare the efficacy of the various treatment modalities.

A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study.

Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the child's first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5-43.2, n=110), median birth weight was 3180 g (910-5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.

Ridge preservation: important buzzwords in dentistry.

Ridge preservations is the prevention of the 40-60% jawbone atrophy that normally takes place two to three years postextraction. It is the new paradigm in patient care that is effective, simple, and beneficial for a multitude of reasons. It is achieved by the immediate grafting of the extraction socket with or without the use of an immediate implant. The ability to not only preserve the alveolar ridge for future restorative dentistry but also to preserve and restore esthetics and prevent postoperative pain and bleeding makes this modality important for all practicing dentists.

Postextraction ridge preservation using a synthetic alloplast.

Ridge preservation is the prevention of the 40% to 60% jaw-bone atrophy that normally takes place 2 to 3 years postextraction and continues at a rate of 0.25% to 0.5% per year until death. It is achieved by the immediate grafting of the extraction socket with or without the use of an immediate implant. It offers the dentist the ability to preserve the alveolar ridge for future implant and restorative dentistry, to achieve anterior esthetics, and to prevent postoperative pain and bleeding. The practice of ridge preservation involves advanced extraction therapy and replacement therapy.

Placement of implants into ridges grafted with bioplant HTR synthetic bone: histological long-term case history reports.

Following alveolar ridge grafting procedures for ridge preservation, for example, the immediate filling of extraction sockets, and ridge augmentation, for example, the building up of the atrophic jawbone, punch biopsies were obtained at various times postextraction prior to the placement of endosseous root-form implants. These histological sections provided an opportunity to study the bony regenerative response to an osteoconductive synthetic graft material and longer term interactions over a period from 8 months to 12 years. The formation and remodeling of healthy dense lamina of bone in areas where bone voids previously existed either from healed or immediate extraction sockets or where there was jawbone atrophy resulting from multiple tooth loss was observed. The grafting procedures enabled dentists to place implants into sites that would have been impossible if not for these preimplant grafting procedures. The jawbone areas studied involved grafted single sites and quadrants as well as full arch augmentation with a calcified microporous copolymer (Bioplant HTR Synthetic Bone, Bioplant Inc, South Norwalk, Conn) graft material. Retrospective case reports of 24 patients were followed radiographically and clinically to 12 years post-alveolar-ridge grafting and subsequently to 5 years after implants were placed into these augmented ridges. Implant and grafting histories from 4.7 months to 17 years are reported for three of these patients. General applications of synthetic bone grafting before implant placement are recommended.

Five-year 224-patient prospective histological study of clinical applications using a synthetic bone alloplast.

Clinical and histologic evaluations of a synthetic bone were performed in 224 patients in a well monitored environment. This material (Bioplant HTR, Bioplant Inc., South Norwalk, CT) was used to obliterate cysts, treat periodontal defects, correct jawbone contours and deficiencies, and gain sufficient support for the placement of dental implants in maxillary subantral augmentation. Implants were positioned either at the time of the synthetic bone graft or after the new supporting tissue was formed. Evidence of new bone formation between the synthetic granules and host tissue was observed during histological examinations. After the material was placed, tissue that could strengthen and augment the inferior wall of the maxillary sinus formed in 3 months. This was observed both clinically and radiographically. After 8 to 12 months, this tissue provided sufficient hard tissue support for the placement of dental implants. This clinical study reconfirmed the applicability of a synthetic bone for bone replacement and augmentation in oral and maxillofacial surgery. No complications caused by infection, inflammation, or rejection of the implanted graft material were observed.

Investigating the influence of achievement on self-concept using an intra-class design and a comparison of the PASS and SDQ-1 self-concept tests.

BACKGROUND: The formation and measurement of self-concept were the foci of this research. AIMS: The study aimed to investigate the influence of achievement on academic self-concept and to compare the Perception of Ability Scale for Students (PASS, Boersma & Chapman, 1992) with the Self-Description Questionnaire-1 (SDQ-1, Marsh, 1988). SAMPLE: The participants were 479 grade 5 (mean age 126.6 months) coeducational Australian students, located in 18 schools. METHOD: An intra-class research design was used to investigate the influence of frame-of-reference on self-concept development. RESULTS: As students' academic scores rose above their class mean their self-concepts increased and as students' academic scores fell below their class mean their self-concepts decreased. Students' difference from class mean predicted their self-concept scores. This finding was consistently shown across the reading, spelling, and mathematics domains using test and teaching rating data. A comparison between the PASS and the SDQ-1 demonstrated concurrent validity across self-concept domains. CONCLUSION: The findings support the notions that the social environment is a significant agent that influences self-concept, and that teacher ratings and standardised tests of achievement and the PASS and the SDQ-1 are valid measures for self-concept research.

The social and community involvement of older Australians with intellectual disabilities.

This paper describes the involvement of older people with intellectual disabilities in residential- and community-based activities and programmes. The 446 participants were selected from a national database of people of 55 years of age and over with intellectual disabilities in Australia. The data indicate that participants made infrequent use of public amenities and social and recreational facilities. With the exception of those living with relatives, most had limited contact with family and friends. The discussion draws attention to the need for independence training which will enable the current generation of middle-aged people with an intellectual disability to make decisions and choices about social and community activities.

The use of a particulate, microporous, calcified copolymer as a ridge maintenance device in dogs.

HTR polymer Synthetic Bone was found to be an osteoconductive, biocompatible, reliable nonresorbable matrix ridge maintenance material (Ridge Preservation). When used as socket implants immediately after the extraction of teeth over a one-year period in 16 beagle dogs, HTR was observed clinically and radiographically and compared with controls (unimplanted, sutured) extraction sites. As the control areas resorbed, the stability and effectiveness of the synthetic bone material in the operative sites became more clearly delineated. Quantitative analyses could not be made using radiographic techniques, but radiographs supported by subjective clinical observations as well as study casts taken of the height and width of the implanted areas, showed greater ridge retention compared with controls. Histological sections demonstrated dense laminar bone gradually forming into and around the HTR particulate material.

Employment, retirement and elderly persons with an intellectual disability.

A national Australian study of people with an intellectual disability of 55 years of age and over investigated their employment and retirement patterns, attitudes to work and retirement, and the degree to which they were involved in leisure or recreational programmes. Two cohorts were recruited: one included all known members of the target group who agreed to participate in the study in the states of Queensland and Western Australia; and the second was a proportional, random sample drawn from a national database on a state population basis. A large number of the participants had never been involved in full- or part-time employment, either in a competitive or supported environment, or in workshops. The majority of those who had worked expressed strong positive attitudes toward employment and concern about retirement, suggesting the need for pre-retirement programmes including transition and choice-making skills to prepare participants for the future.

Ridge augmentation for immediate postextraction implants: eight year retrospective study.

Implant placement immediately after tooth extraction has become a well accepted treatment modality. It is used to replace either a single tooth or several teeth in an edentulous ridge. Various augmentation materials are used to build up the edentulous ridge, to maintain it, and to prevent resorption upon extraction. The learning objective of this paper is to present an 8-year retrospective study of 55 screw-type implant placement in 40 patients, using an alloplast (mixed with autogenous blood) as the augmentation material. The paper reviews the progress of implant technology and describes the method and materials used in this particular study. Four cases are used to illustrate the simultaneous implantation and ridge augmentation procedure.