Craniofacial and three-dimensional palatal analysis in cleft lip and palate patients treated in Spain.

Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.

Traumatismo penetrante facial por arpón. A propósito de un caso / Penetrating facial injury caused by a speargun: A case presentation

Los traumatismos penetrantes causados por el disparo de un fusil de pesca submarina son extremadamente raros. El tratamiento quirúrgico está condicionado por el «mecanismo de barba», que impide una retirada segura de la flecha en sentido contrario al de su entrada, ya que la aleta del fusil provocaría graves daños. Presentamos un caso clínico y un sistema sencillo de bloqueo del retroceso de la aleta que permitió una retirada segura en sentido retrógrado (AU)

Penetrating injuries caused by firing an underwater speargun are exteremely rare. The surgical treatment is determined by the «barb mechanism», which hinders the safe withdrawal of the spear in the opposite direction to its entrance, since the fin of the spear could cause serious injury. We present a clinical case and a simple system of blocking the backward movement of the fin which allowed the safe withdrawal in the retrograde direction (AU)

Is organizational progress in the EFQM model related to employee satisfaction?

BACKGROUND: To determine whether there is greater employee satisfaction in organisations that have made more progress in implementation of the European Foundation for Quality Management (EFQM) model. METHODS: A series of cross-sectional studies (one for each assessment cycle) comparing staff satisfaction survey results between groups of healthcare organisations by degree of implementation of the EFQM model (assessed in terms of external recognition of management quality in each organisation). SETTING: 30 healthcare organisations including hospitals, primary care and mental health providers in Osakidetza, the Basque public health service. PARTICIPANTS: Employees of 30 Osakidetza organisations. INTERVENTION: Progress in implementation of EFQM model. MAIN OUTCOME MEASURES: Scores in 9 dimensions of employee satisfaction from questionnaires administered in healthcare organisations in 4 assessment cycles between 2001 and 2010. RESULTS: Comparing satisfaction results in organisations granted Gold or Silver Q Awards and those without this type of external recognition, we found statistically significant differences in the dimensions of training and internal communication. Then, comparing recipients of Gold Q Awards with those with no Q Certification, differences in leadership style and in policy and strategy also emerged as significant. CONCLUSIONS: Progress of healthcare organisations in the implementation of the EFQM Excellence Model is associated with increases in their employee satisfaction in dimensions that can be managed at the level of each organisation, while dimensions in which no statistically significant differences were found represent common organisational elements with little scope for self-management.

Cell therapy in bisphosphonate-related osteonecrosis of the jaw.

OBJECTIVE: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition found in patients who have received intravenous or oral bisphosphonate therapy for various diseases related to bone. This report describes a novel treatment of BRONJ using autologous bone marrow stem cells, platelet-rich plasma, beta tricalcium phosphate, and demineralized bone matrix. STUDY DESIGN: We report a 71-year-old woman with history of multiple myeloma treated with intravenous zoledronic acid during 4 years. After a tooth extraction, the patient presented with a painful BRONJ lesion with no healing wound and cortical bone exposure. The patient was surgically managed with a standardized protocol of autologous stem cell therapy combining bone marrow harvest, cell concentration procedures, and intraoral surgery. RESULTS: CT scan performed 6 months later showed improvement of bone and concentric ossification. Cellular therapy might be considered a new strategy to heal BRONJ lesions.