Bilateral Distraction Osteogenesis of Vascularized Iliac Crest Free Flaps Used in Mandibular Reconstruction.

Vascularized free flaps have become the gold standard in reconstructing large segmental mandibular defects; however, even when bony union and soft-tissue coverage is achieved, insufficient bone stock and altered facial contour can create functional and cosmetic problems for the patient. There have been limited case reports on the use of secondary distraction osteogenesis to address these issues. The authors report a case of bilateral mandibular distraction of deep circumflex iliac artery free flaps, used for mandibular reconstruction after total mandibulectomy for treatment of osteosarcoma. Performed for reasons of retrognathia and facilitation of dental prosthetic rehabilitation, this is the first case of bilateral horizontal distraction osteogenesis of deep circumflex iliac artery free flaps reported in the literature.

An uncommon complication of arterial embolization for treatment of epistaxis.

Although uncommon, patients should be advised that soft tissue necrosis may be a complication of arterial embolization used for treatment of epistaxis.

Kimura's disease: an uncommon cause of head and neck masses with potentially serious sequelae.

Kimura's disease (KD) typically presents as a mass in the head and neck region in association with eosinophilia and elevated serum IgE. Excisional biopsy is often required in order to obtain an adequate sample for histological diagnosis and exclude malignancy. If suspected, patients should also be investigated for renal involvement as this may complicate KD. Treatment options include surgical excision and medical therapies such as corticosteroids depending on the extent and severity of disease.

Addressing alcohol-related harms within maxillofacial trauma practice.

PURPOSE: A brief intervention, conducted in the short-term care setting after an alcohol-related injury, has been reported to be highly beneficial in reducing the risk of reinjury and in reducing the subsequent level of alcohol consumption. This project aimed to understand Australasian oral and maxillofacial surgeons' attitudes, knowledge, and skills in alcohol screening and brief intervention within short-term care settings for patients admitted with facial trauma. MATERIALS AND METHODS: A Web-based survey was made available to all members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (200 to 250 members), promoted through a number of e-mail bulletins sent by the association to all members. Implied consent was assumed for participants who completed the online survey. The survey explored the surgeons' current level of involvement in treating patients with alcohol-related facial trauma, as well as their knowledge of and attitudes toward alcohol screening and brief intervention. The survey also explored their willingness to undergo further training and involvement in implementing a screening and brief intervention program. Parts of the survey were based on a hypothetical case with facial injury and a drinking history that was presented to the participants, and the participants were asked to give their response to this scenario. RESULTS: A total of 58 surgeons completed the online survey. Of the surgeons surveyed, 91% were men and 88% were consultant surgeons. Seventy-one percent would take an alcohol history, 29% would deliver a brief alcohol intervention, and 14% would refer the patient to an alcohol treatment service or clinician. Forty percent agreed that they had adequate training in managing patients with alcohol-related injuries, whereas 17% and 19% indicated that they had adequate time and adequate resources, respectively. Of the surgeons, 76% reported the need for more information on where to refer patients for appropriate alcohol treatment. CONCLUSIONS: The study findings confirm the challenges and barriers to implementing a brief alcohol intervention in current practice. Service gaps, as well as opportunities for training, exist.

Bacterial comparison of preoperative rinsing and swabbing for oral surgery using 0.2% chlorhexidine.

AIM: The aim of the present study was to compare bacterial load using preoperative rinsing and swabbing techniques for oral surgery with 0.2% chlorhexidine (CHX). METHODS: Participants were healthy volunteers undergoing a general anesthetic for the removal of teeth. Participants were randomly allocated to receive 15 mL of 0.2% CHX for 60 s as either a rinse or have their mouths swabbed. Plaque samples were aseptically collected pre- and post-rinsing from the same sites in all patients (the distal surface of all second molar teeth). RESULTS: Patients in the swab group had similar bacteria counts before and after the application of CHX (143.4 vs 138.5 colonies, P = 1.000). After rinsing with CHX, there was an eightfold reduction of bacterial load (71 vs 8.8 colonies, P < 0.001). CONCLUSION: The present study demonstrates that the use of CHX as an antimicrobial agent is effective in reducing the overall number of bacterial colonies in the oral cavity. Rinsing is a more effective method of doing this.