Nerve injury associated with orthognathic surgery. Part 1: UK practice and motor nerve injuries.

The head and neck is anatomically complex, and several nerves are at risk during orthognathic operations. Some injuries to nerves are reported more commonly than others. To find out what consultant surgeons tell their patients about the prevalence of common nerve injuries before orthognathic operations, we did a postal survey of fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS). We also reviewed published papers to find out the reported incidence of injuries to cranial motor nerves during orthognathic operations. Only injuries to the facial nerve were commonly reported, and we found only case reports about injuries to the oculomotor, abducens, and trochlear nerves. The risk of temporary facial nerve palsy reported was 0.30/100 nerves (95% CI 0.23 to 0.50) and permanent facial nerve palsy was 0.06/100 nerves (95% CI 0.02 to 0.15).

Nerve injury associated with orthognathic surgery. Part 2: inferior alveolar nerve.

The inferior alveolar nerve (IAN) is the most commonly injured structure during mandibular osteotomies. The prevalence of temporary injury has been reported as 70/100 patients (95% CI 67 to 73/100) or 56/100 nerves (95% CI 46 to 65/100), and the prevalence of permanent alteration in sensation was 33/100 patients (95% CI 30 to 35/100) or 20/100 nerves (95% CI 18 to 21/100) when assessed subjectively. The prevalence varied significantly between different operations (p<0.0001). It was significantly higher for sagittal split osteotomy (SSO) combined with genioplasty than for SSO alone (p<0.0001) or vertical ramus osteotomy (VRO) (p<0.0001). Injury may result from traction during stripping or manipulation of the distal fragment, incorrect placement of the cuts, or misjudged placement of fixation in ramus ostotomy. During SSO, they can occur during retraction to make cuts in the medial ramus, when the bone is cut or split, and on fixation. The impact of injury is generally said to be low as it does not seem to affect patients' opinions about the operation.

Nerve injury associated with orthognathic surgery. Part 3: lingual, infraorbital, and optic nerves.

In the final paper of this 3-part series we review the incidence of injuries to the lingual, infraorbital, and optic nerves during orthognathic operations. We know of few published studies on the incidence of injuries to the lingual or infraorbital nerves, but in most cases they are thought to result from traction and are predominantly temporary. The incidence of permanent injury to the lingual nerve was 2/100 patients (95% CI 1 to 3/100) or 0/100 nerves (95% CI 0 to 1/100). The methods used to assess injury to the infraorbital nerve differed so it was not possible to calculate the incidence. Injuries to the optic nerve, although rare, have a considerable impact on the patients affected.

Dental foundation year 2 training in oral and maxillofacial surgery units - the trainees' perspective.

Most dental foundation year 2 (DF2) training takes place in oral and maxillofacial surgery (OMFS) units. We did a survey of DF2 trainees in these units by telephone interviews and an online questionnaire to find out about their experience of training and their career aspirations. A total of 123 responded, which is roughly 41% of the total estimated number of trainees. Trainees applied for these posts mainly to improve their dentoalveolar skills (50%), and this was cited as the best aspect of the training. Most (81%) were on-call at night and this was generally thought to be a valuable training experience (77%), but 20% thought that it was the worst aspect of the job. Most did not regret taking up the post although the experience had caused 75% to alter their intentions about their future career; general dental practice was the commonest choice. In conclusion, trainees are generally satisfied with their training and these positions have guided their choices about future careers.

Unraveling the realities of vascular access: the Network 11 experience.

Arteriovenous (AV) fistulae are well recognized as the preferred vascular access for hemodialysis, yet national data show that only 23% of patients used an AV fistula in 1997. To identify barriers to the placement of native AV fistulae, the Renal Network of the Upper Midwest, Inc. (End-Stage Renal Disease [ESRD] Network 11) initiated a vascular access project to look at the process of referral for patients beginning hemodialysis in the first 6 months of 1999. Of these patients, 63% began hemodialysis with a catheter as the only access, 22% had an AV fistula placed (but only 14% used an AV fistula for their first dialysis treatment), and 15% began with a graft. About 40% of patients were referred to a nephrologist less than 1 month before dialysis, allowing little chance for permanent access placement. Yet 27% of patients used a catheter on the first hemodialysis treatment and were seen by a nephrologist more than 1 month before starting dialysis, indicating the presence of an opportunity to improve. At 6 months after initiation of dialysis, 25% of patients who began dialysis using a catheter were using an AV fistula and 35% were using a graft. Network 11 plans to use this information to promote early referral of patients to a nephrologist and subsequent prompt referral of such patients to a vascular surgeon. Other activities to improve vascular access management are also indicated.

Expression and function of Ets transcription factors in mammalian development: a regulatory network.

The Ets transcription factor family is involved in a variety of mammalian developmental processes at the cellular, tissue and organ levels. They are implicated in cellular proliferation, differentiation, migration, apoptosis and cell - cell interactions. This article reviews recent studies that demonstrate the integral importance of Ets in the dosage dependent regulation of development. The expression of many Ets genes is associated with mesenchymal - epithelial interactions and changes in extracellular matrix proteins. These inductive processes contribute to tissue remodeling and integrity, particularly during embryonic development. Overlapping as well as unique patterns of Ets expression are evident in developing tissues, including development of the lymphoid and myeloid lineages, brain and central nervous system, bone and mammary gland. Integration of these data will allow the development of predictive models for the regulation of complex developmental processes.