The stability of the downgrafted maxilla in the cleft lip and palate patient.

Vertical stability following maxillary downgrafting in cleft patients is poor with an average relapse of 42 per cent (ranged 0-100 per cent). Overcompensation should, therefore, be undertaken with 2 mm added to the downgraft movement for bony relapse and 1 mm added to the downgraft movement for upper lip lengthening. The Tideman et al. method for advancement of the lesser maxillary segment is a very stable procedure (less than 8 per cent relapse). Semi-rigid fixation with plates, bone grafting and 'ramping' enhances stability; and freeway space assessment preoperatively is an important guide to relapse potential in the downgrafted cleft maxilla. All surgical prediction tracings should be done with the patient at the occlusal vertical dimension to prevent inadequate maxillary advancement and subsequent reverse overjet or excessive anterior incisor proclination developing with vertical relapse.

Minoxidil overdose.

A 52-year-old man ingested 60 ml of 2 percent topical minoxidil solution resulting in severe hypotension and tachycardia. He was resuscitated with intravenously administered crystalloid solution and treated with intravenously administered dopamine, resulting in a partial hemodynamic improvement. Further treatment with intravenously administered phenylephrine infusion resulted in resolution of hypotension. The patient suffered a non-Q-wave myocardial infarction as a result of the ingestion. The toxicity of this increasingly common preparation is profound.

Langerhans cell disease associated with pathological fracture of the mandible.

A 27-year-old male suffered a fractured mandible following extraction of a tooth. It was subsequently found that the fracture occurred in an area pathologically weakened by a localized lesion of Langerhans cell disease. Since lesions of the jaws may be seen either as the first manifestation or as a complication of widespread Langerhans cell disease, the dentist has a major role in the diagnosis and management of such cases.

An intraoral splint for the prevention of microstomia from facial burns.

Microstomia may be a disfiguring complication of severe burn injuries of the soft tissues of the face. The constriction of the perioral myocutaneous tissues following such trauma poses several problems and usually necessitates major plastic and reconstructive intervention. A novel technique is described which limited the anticipated constriction of perioral tissues in a 21-year-old female who suffered full skin thickness burns to 65 per cent of her body, including her face, following a self-induced petrol burn.

Regional macrodontia and regional bony enlargement associated with congenital infiltrating lipomatosis of the face presenting as unilateral facial hyperplasia. Brief review and case report.

Congenital infiltrating lipomatosis of the face (CIL-F) is a rare lesion. Presented here is a review of the literature concerning this condition, with the report of a case with clinical signs indistinguishable from those of unilateral facial hyperplasia. Previously unreported clinical and radiographic features of regional bony hypertrophy and macrodontia associated with this case of CIL-F are described and the proposition raised that previously reported cases of unilateral facial hyperplasia may have been due to CIL-F. It is suggested that the clinical findings in this case of facial asymmetry associated with CIL-F, regional macrodontia and regional bony enlargement may constitute a previously undescribed syndrome.