Titanium miniplate removal after joint orthodontic-orthognathic surgery treatment: a 10-year retrospective hospital-based audit.

INTRODUCTION: The reported incidence of titanium miniplate removal after orthognathic surgery varies widely, making delivery of risk information to patients problematic. This variation relates to potential biases introduced during the study design, for example, with the pooling of different patient types, creating heterogeneous study samples. This study reduces sampling bias by limiting the cohort to only consecutive orthognathic cases. The primary aim of the study was to identify the incidence of miniplate removal following orthognathic surgery. The secondary aim was to assess the indications and any risk factors for miniplate removal. METHODS: Data from the clinical records of 907 orthognathic surgery cases treated within a centralised oral and maxillofacial hospital service over a 10-year period were collected by two operators and analysed. Every identified case qualified for inclusion. Patient demographics (age, sex, medical comorbidity, smoking), operations (type of surgery, duration, third molar removal, complications) and the indication, timing and site of miniplate removal were analysed. RESULTS: Only 19 patients required postoperative miniplate removal, with the most common indication being infection (63%). There was no significant difference in any of the factors assessed except that significantly more miniplates were removed from female patients (68%) (p<0.001) and from mandibular sites (84.2%) (p=0.003). CONCLUSIONS: The incidence of miniplate removal for this sample was 2.1%. Female sex and miniplate location in the mandible were the only statistically significant risk factors for miniplate removal.

Is Blu-tack as effective at attenuating sound as over-the-counter ear plugs?

OBJECTIVE: To demonstrate that Blu-tack is equally effective at attenuating sound as over-the-counter ear plugs. METHODS: Nineteen healthy volunteers had their hearing thresholds assessed before and after the insertion of over-the-counter ear plugs. The results were compared with hearing thresholds following the insertion of Blu-tack. Thresholds were tested at: 0.5, 1, 2, 3, 4, 6 and 8 kHz. The differences were compared, and p values of less than 0.02 were regarded as significant. Using a visual analogue scale, volunteers were asked to assess the comfort and ease of insertion of the ear plugs and Blu-tack, and their peace of mind whilst using the ear plugs and Blu-tack. RESULTS: Blu-tack was less effective at attenuating sound at low frequencies, but was as effective as over-the-counter ear plugs at attenuating sound above 3 kHz. Blu-tack was significantly more comfortable to wear (p = 0.006). There was no difference in terms of ease of insertion and peace of mind. CONCLUSION: Blu-tack can be regarded as a comfortable alternative to over-the-counter ear plugs for the attenuation of everyday sound.

Potential of information technology in dental education.

The use of information technology (IT) in dentistry is far ranging. In order to produce a working document for the dental educator, this paper focuses on those methods where IT can assist in the education and competence development of dental students and dentists (e.g. e-learning, distance learning, simulations and computer-based assessment). Web pages and other information-gathering devices have become an essential part of our daily life, as they provide extensive information on all aspects of our society. This is mirrored in dental education where there are many different tools available, as listed in this report. IT offers added value to traditional teaching methods and examples are provided. In spite of the continuing debate on the learning effectiveness of e-learning applications, students request such approaches as an adjunct to the traditional delivery of learning materials. Faculty require support to enable them to effectively use the technology to the benefit of their students. This support should be provided by the institution and it is suggested that, where possible, institutions should appoint an e-learning champion with good interpersonal skills to support and encourage faculty change. From a global prospective, all students and faculty should have access to e-learning tools. This report encourages open access to e-learning material, platforms and programs. The quality of such learning materials must have well defined learning objectives and involve peer review to ensure content validity, accuracy, currency, the use of evidence-based data and the use of best practices. To ensure that the developers' intellectual rights are protected, the original content needs to be secure from unauthorized changes. Strategies and recommendations on how to improve the quality of e-learning are outlined. In the area of assessment, traditional examination schemes can be enriched by IT, whilst the Internet can provide many innovative approaches. Future trends in IT will evolve around improved uptake and access facilitated by the technology (hardware and software). The use of Web 2.0 shows considerable promise and this may have implications on a global level. For example, the one-laptop-per-child project is the best example of what Web 2.0 can do: minimal use of hardware to maximize use of the Internet structure. In essence, simple technology can overcome many of the barriers to learning. IT will always remain exciting, as it is always changing and the users, whether dental students, educators or patients are like chameleons adapting to the ever-changing landscape.

Is there predictive criteria for transfer of patients to a rehabilitation ward after hip and knee total arthroplasty? Elaboration of French clinical practice guidelines.

OBJECTIVE: To develop clinical practice guidelines concerning predictive criteria for transfer of patients to a rehabilitation ward after hip and knee total arthroplasty. METHOD: The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. RESULTS: From systematic literature review and collection of French professional practice, we cannot distinguish the patients undergoing THA and TKA who can transfer to a rehabilitation ward. For both types of patients, the main criteria determining transfer are demographic criteria such as older age or female sex; psychosocial and environmental criteria such as living alone, feeling unable to return home directly (pre-operative education could modify this criterion); and surgeon advice based on the pre and post-operative clinical and functional status. CONCLUSION: Studies with good methodological quality are urgently needed to evaluate the use of predictive tools such as the RAPT, separating THA and TKA, and using as parameters of assessment functional status and handicap reduction.

Stabilisation of the unstable fractured zygomatic arch with a Kirschner wire.

Although relatively uncommon, isolated fractures of the zygomatic arch can sometimes be difficult to stabilise following reduction. We present a simple method of stabilisation using a Kirschner wire.

Analysis of paediatric dental care provided under general anaesthesia and levels of dental disease in two hospitals.

OBJECTIVE: To compare the level of dental disease and the pattern of dental treatment under controlled airway general anaesthesia for ASA I and II children and ASA III and IV children in two hospitals. DESIGN: Prospective analysis. SETTING: Hospital and postgraduate dental teaching institution, UK 1996 - 2000. SUBJECTS AND METHODS: During a four-year period (1996-2000), data were collected on children aged 1 to 16 years who were admitted for treatment of dental caries under general anaesthesia. Outcome measures Levels of dental disease (dmft/DMFT), treatment provided. RESULTS: A total of 515 ASA I and II and 430 ASA III and IV children were treated. The dmft and DMFT values of the ASA I and II children were significantly higher than those of the ASA III and IV children (p = 0.03). A significantly greater number of restorations and fissure sealants were carried out for permanent teeth in ASA III and IV children (p < 0.001). The number of extractions for both primary and permanent teeth was significantly greater in the ASA I and II group (p < 0.05). CONCLUSIONS: The ASA III and IV children had significantly lower levels of dental caries than the ASA I and II children and received a higher level of preventive and restorative care.

Portable method for the determination of snoring site by sound analysis.

It has been shown that computerized sound frequency analysis can be used to distinguish between different snoring sites. The aim of this study was to investigate whether a portable recording method using audiotapes and digital minidisc formats could produce waveforms similar to a computer recording. The snores of 12 subjects in their natural sleep were recorded onto audiotape, minidisc and directly onto a computer. For each snorer and recording method 30 snore samples were analysed and their power ratio was calculated indicating the relative amount of sound below and above a set frequency. It was found that the power ratios from audiotape recordings were significantly different to those from computer recordings for all snoring sites (p = 0.0007), whereas there was no significant difference between minidisc and computer recordings (p = 0.41). These results indicate that it would be possible to base a portable snore analysis system for site determination on minidisc, but not on audiotape recordings.

Sound frequency analysis and the site of snoring in natural and induced sleep.

The aim of this study was to compare the snoring sounds induced during sleep nasendoscopy, and to compare them with those of natural sleep using sound frequency spectra. The snoring of 16 subjects was digitally recorded during natural and induced sleep, noting the site of vibration during sleep nasendoscopy. Patients with palatal snoring during sleep nasendoscopy had a median peak frequency at 137 Hz (118 snore samples). The peak frequency of tongue-base snoring was 1243 Hz (10 snore samples), and simultaneous palate and tongue was 190 Hz (six snore samples). The median power ratios were 7, 0.2 and 5 respectively. The centre frequencies were 371, 1094 and 404 Hz respectively. Epiglottic snores had a peak frequency of 490 Hz (five snore samples). Comparison of the induced (n = 118) and natural (n = 300) snore samples of the 12 palatal snorers showed a significant difference in both the power ratio and centre frequencies (P = 0.031 and P = 0.049). The peak frequency position was similar (P = 0.34). Our results indicate that induced snores contain a higher frequency component of sound, not evident during natural snoring. This is consistent with an element of tongue-base snoring. Although there is good correlation generally, sleep nasendoscopy may not accurately reflect natural snoring.

Venous obstruction caused by a self-adhesive drape: a cautionary tale.

The use of disposable drapes during operations is becoming more widespread, and their advantages are well documented. I describe how use of such a drape led to venous constriction which caused troublesome oozing from the operative sites during sagittal split osteotomy. When the drape was removed, there was a clear red indentation on the patient's neck, and the bleeding stopped immediately. The patient made an uneventful recovery.

Prognostic value of electrocochleography in patients with unilateral Menière's disease undergoing saccus surgery.

Although a controversial operation, saccus surgery has continued to be used in patients with severe Menière's disease in whom hearing preservation is the objective. The aim of this study was to determine if electrocochleography (ECoG) could predict the patients who would be free of vertigo, 2 and 5 years after surgery. Seventy patients with severe Menière's syndrome underwent ECoG prior to endolymphatic sac surgery. Eighty-four per cent of the patients had an abnormal electrocochleogram. The patients were interviewed 2 and 5 years after surgery. At 2 years, 4/10 (40%) patients with normal ECoG were relieved of dizziness compared to 38/51 (75%) with abnormal ECoG (P < 0.05). At 5 years, 5/8 (63%) patients with normal ECoG were relieved of dizziness compared to 30/30 (100%) with abnormal ECoG (P < 0.001). The patients with a normal ECoG do have less severe measurable hearing impairment (P < 0.05) although they are more likely (P < 0.05) to complain of constant tinnitus. Their history of dizziness is longer and their dizziness more disabling before surgery. In conclusion, patients with a normal ECoG will be less likely to benefit from saccus surgery in the first 5 years. These patients may represent a different nosological entity.

ENT open access clinic: an audit of a new service.

Ear, nose and throat emergencies constitute a heavy but unpredictable workload for the junior otolaryngologist. Patients are often seen in the treatment room on the ward or in the casualty department. Many patients referred as emergencies can in fact be seen the following day without detriment. This audit examined the change in treatment room workload when an open access ENT clinic was set up each weekday morning. The results demonstrate that around 75 per cent of the patients seen were suitable for waiting until the next day. The clinic was considered a success as it provided benefits for GP access, routine clinics, junior doctor teaching and concentration of aural toilet cases under expert nurse care.

Cochlear implantation following temporal bone fracture.

Seven cases of profound hearing impairment following either unilateral or bilateral temporal bone fracture are presented who were implanted with the Nucleus 22 channel or Ineraid devices. Six patients suffered bilateral temporal bone fractures. One patient had prior congenital unilateral profound hearing impairment. This patient suffered a unilateral temporal bone fracture. Six patients became regular users of their implants. One gained little benefit and became a non-user. Two of the regular users experienced facial nerve stimulation, which could not be programmed out. In these two cases the implant was removed and the contralateral ear successfully implanted. Implant-aided audiometry demonstrated a hearing threshold of 40-50 dB at nine months after switch-on. The reliability of computed tomography (CT) scanning in predicting cochlear patency in cases of temporal bone fracture will be discussed. The benefit of complimentary imaging with magnetic resonance (MR) is highlighted.

Adult obstructive sleep apnoea syndrome and tonsillectomy.

A surgical cure for adult obstructive sleep apnoea syndrome (OSAS) is an attractive alternative to nasal continuous positive airway pressure, but current research suggests that uvulopalatopharyngoplasty is not effective in all patients. No subgroup of these patients, who might benefit from surgery to the oropharynx, has as yet been identified. In this study we examined the results of tonsillectomy either as an isolated procedure or as part of uvulopalatopharyngoplasty in seven patients, who had tonsillomegaly. In all seven there was a short-term improvement between the pre-operative and post-operative apnoea/hypoapnoea (A/H) index (100-65 per cent), which could not be accounted for by change in the body mass index (BMI). In one patient a diagnosis of Non-Hodgkin's lymphoma was made from histological examination of the tonsils. The results suggest that adult patients with tonsillomegaly may represent a subgroup of patients with OSAS, who would benefit from surgery aimed at the oropharynx.

Primary tumours of the vestibule and inner ear.

Seven primary tumours of the vestibule and inner ear are described, six schwannomas and one traumatic fibroma. Schwannomas in this situation may occur as sporadic tumours, or may be a feature of neurofibromatosis type 2 (NF-2). In the latter condition they may occur in isolation or in association with, but separate from, schwannomas arising in the internal meatus. Direct extension into the vestibule of an intrameatal vestibular schwannoma is well reported, but extension of an intravestibular tumour into the internal meatus is not described. Traumatic fibromas of the vestibule are rare and the trigger could be an attack of labyrinthitis. Intravestibular tumours, although rare, are likely to be diagnosed with increasing frequency with the widespread use of MR imaging.

Cavernous sinus thrombosis following manipulation of fractured nasal bones.

Septic cavernous sinus thrombosis is a serious infective condition with a high mortality and morbidity. We report the first case to our knowledge of septic cavernous sinus thrombosis following manipulation of fractured nasal bone under general anaesthesia. The patient later developed complications of pneumonia with pleural effusion, a vegetative lesion of the mitral valve, and blindness.