Functional outcomes following mandibulectomy and fibular free-flap reconstruction.

There remains a paucity of evidence with regards to functional outcomes following the reconstruction of segmental defects in the mandible. It is, however, well recognised that oral rehabilitation following head and neck surgery is a driver of improved quality of life outcomes. We present a prospective service review of functional outcomes of a consecutive cohort of patients following segmental mandibulectomy and virtual surgical planning (VSP) composite fibular free-flap reconstruction. Twenty-five patients, who were identified as having a complete dataset with a minimum of 12 months' follow up, ultimately met the inclusion criteria. Validated functional outcome measures were used primarily to assess speech, diet, and swallowing outcomes. The results demonstrate a decline in both speech and swallowing outcomes at three months postoperatively, with a decline of 37% in the Speech Handicap Index from the preoperative baseline, and a decline of 35% in the MD Anderson Dysphagia Inventory score over the same period. The MD Anderson Dysphagia Inventory score improved at 12 months, whereas the Speech Handicap Index did not. Fundamentally a collaborative approach is required between members of the multidisciplinary team (MDT) to enable optimal patient outcomes.

Dosimetry-guided virtual surgical planning in the reconstruction of mandibular osteoradionecrosis.

Patients with osteoradionecrosis (ORN) of the mandible pose additional challenges to the attending clinician when it comes to major reconstructive head and neck surgery. We present a novel technique to assist in the virtual surgical planning of mandibular ORN, which involves deforming previously delivered radiation dosimetry data on to the virtual mandible to aid in the assessment of surgical resection margins. This is a retrospective case series of patients whose treatment involved a traditional virtual surgical planning approach or dosimetry-guided virtual surgical planning. All the patients whose treatment involved dosimetry-guided virtual surgical planning had evidence of bony consolidation between the native mandible and fibular free flap. In comparison, only three of the nine patients in the traditional virtual surgical planning group demonstrated bony healing on subsequent imaging. In this known cohort of difficult-to-manage patients, any technique that helps to improve outcomes is a welcome addition to the armamentarium of the surgeon.

Dental Abscess in Pediatric Patients: A Marker of Neglect.

OBJECTIVES: Neglect is defined as the persistent failure to meet a child or young person's basic physical or psychological needs. Dental caries is explicitly mentioned in guidance on child maltreatment. We discuss the link between dental caries and child abuse in patients presenting to the emergency department. METHODS: A review of patient medical records was undertaken within the Paediatric Emergency Department at Sunderland Royal Hospital, with the aim to determine whether neglect was considered as a possible contributory factor when a child or young person presented at triage with an "oral cavity" problem. RESULTS: Of the applicable cases with inferences of possible safeguarding concerns, 13% had these concerns documented. CONCLUSIONS: Child abuse recognition has become a prominent issue in recent years due to high profile cases. It is clear from this work, which resonates with the reported literature, that there is a lack of recognition of dental neglect being a possible indicator of more systemic abuse.There is likely underreporting of these cases to the relevant authorities.

Human bite injuries to the head and neck: current trends and management protocols in England and Wales.

INTRODUCTION: Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper. MATERIALS AND METHOD: A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate. The collated results of the survey were entered onto a spreadsheet (Microsoft Excel©) for the purpose of statistical review. RESULTS: A 68% response rate from A&E departments throughout England and Wales demonstrated a lack of consensus in the initial management and subsequent treatment of human bite injuries. Written protocols are in place for human bite injuries in 54.4% of units. In 100% of units, initial management involves irrigation +/- debridement of the wound, though there is a lack of agreement on the surgical management of the wound. 77.9% of units follow 'needle stick protocols' when stratifying risk for blood-borne viruses. CONCLUSION: Human bites pose a number of unique problems, ranging from cellulitis to the transmission of communicable diseases. The maxillofacial surgeon has the added dilemmas surrounding subsequent repair and reconstruction. Appreciation of the complexity of human bite injuries will ensure optimal care for the patient. We propose a set of guidelines developed 'in-house' to assist in the management of human bite injuries.

The S-Tunnel for tunnelled dialysis catheter: an alternative approach to the prevention of displacement.

PURPOSE: Vascular access has been described in the literature anywhere from the 'Achilles Heel' to the 'Cornerstone' of haemodialysis. Displacement of a central venous catheter is not an uncommon occurrence. We discuss an alternative method of placement for the tunnelled central venous catheter to prevent displacement in those patients with excess anterior chest wall soft tissue. METHODS: A new surgical technique for placement of a tunnelled central venous catheter was developed in an attempt to reduce the number of displacements. This involved the creation of a second tunnel at a 90° angle to the original retrograde tunnelled path. RESULTS: The authors have currently placed five 'S-Line' tunnelled central venous catheters with no reports of displacement or line infection over a period of 18 months. CONCLUSIONS: The 'S-Line' offers a simple, straightforward and most importantly safe method to reduce the incidence of tunnelled right internal jugular central venous catheter displacement.