RESUMO
Tumour thickness and the status of resection margins are of prognostic significance in the treatment of oral cancer. In a single blind prospective study, 14 patients with biopsy proven oral squamous cell carcinoma had intraoral ultrasound imaging done preoperatively to measure tumour thickness, and intraoperatively to measure the deep surgical margin half way during resection. The cut surface was demonstrated on ultrasound by placing a metal, ultrasound-reflective, retractor into the surgical cut. The ultrasound measurements were compared to the subsequent histological measurements. Using the threshold of 5mm as indicator of margin clearance, there was agreement in 10 out of 14 cases between ultrasound and histology. Ultrasound detection of close surgical margins had a sensitivity of 83% and a specificity of 63%. For preoperative tumour thickness measurement, ultrasound imaging showed a high degree of correlation with histology (Pearson correlation coefficient=0.95, P<0.01). This original paper demonstrates that high resolution ultrasound imaging applied intraorally is a reliable tool in objectively assessing both the tumour thickness and the surgical margin clearance at the time of surgery.
Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Bucais/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Métodos Epidemiológicos , Humanos , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , UltrassonografiaRESUMO
An innovative method of using ultrasound imaging intraoperatively is reported. Multiple radiopaque and radiolucent foreign bodies within soft tissues were localized in theatre using high resolution ultrasonography. Depth of injury and vessel status were also ultrasonically assessed. Surgical removal of all foreign bodies was aided by intraoperative ultrasound guidance. In addition, this new approach of using intraoperative ultrasonography was pivotal in confirming the removal of all foreign bodies from the wound at the time of the operation.
Assuntos
Corpos Estranhos/diagnóstico por imagem , Cuidados Intraoperatórios , Pescoço/diagnóstico por imagem , Ultrassonografia de Intervenção , Acidentes de Trabalho , Adulto , Seguimentos , Corpos Estranhos/cirurgia , Humanos , Masculino , Pescoço/cirurgia , Lesões do Pescoço/diagnóstico por imagemRESUMO
OBJECTIVE: To study the relationship between the full moon and oral and maxillofacial emergencies. STUDY DESIGN: Retrospective analysis of 2416 referrals to the Department of Oral and Maxillofacial Surgery, St. Bartholomews and The Royal London Hospital, London, over a 16-month period (17 lunar months). Frequency distributions were used to assess emergency workload during the week of the full moon. RESULTS: There was a rise in referrals in the latter part of the 7-day period surrounding the full moon. There was a persistent reduction in emergency workload in the 3-day period leading up to the full moon. The results approach but do not reach significance. CONCLUSIONS: The effect of the moon on oral and maxillofacial referrals cannot be proven.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Lua , Cirurgia Bucal/estatística & dados numéricos , Análise de Variância , Humanos , Londres , Periodicidade , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Carga de Trabalho/estatística & dados numéricosRESUMO
Diagnostic ultrasound is used widely to identify the presence of fluid collections preoperatively. Although its role in other parts of the body is well established, this report describes the technique of using diagnostic ultrasound intraoperatively to aid drainage of a large fascial space abscess in the head and neck. Following previously inadequate drainage of a large superficial abscess from a blindly placed drain, a second procedure was carried out, using ultrasound imaging to locate the persisting abscess. Furthermore, ultrasound demonstrated the adequacy of drainage and helped the surgeon to position the drain in the correct tissue space. We consider that intraoperative use of ultrasound has a role as a guidance tool to drain superficial fascial space abscesses in the head and neck region.
Assuntos
Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Pescoço/diagnóstico por imagem , Região Parotídea/diagnóstico por imagem , Região Parotídea/cirurgia , Drenagem/métodos , Fáscia/diagnóstico por imagem , Fasciotomia , Feminino , Humanos , Cuidados Intraoperatórios , Músculo Masseter/diagnóstico por imagem , Músculo Masseter/cirurgia , Pessoa de Meia-Idade , Pescoço/cirurgia , Reoperação , UltrassonografiaRESUMO
Real-time intraoperative ultrasonography was used to detect and facilitate removal of an airgun pellet from the tongue of a 14-year-old boy. Diagnostic ultrasound was crucial in clarifying the positional relation between the foreign body and the instrument used, enabling safe, precise and rapid retrieval during a potentially hazardous surgical operation.
Assuntos
Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Língua/lesões , Adolescente , Humanos , Masculino , Língua/diagnóstico por imagem , Língua/cirurgia , Ultrassonografia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/cirurgiaRESUMO
Ultrasound imaging is becoming widely used in the head and neck region as a first-line investigation to assess soft tissue swellings. Clinicians should be aware of the potential of diagnostic ultrasound to identify important signs of malignant disease involving bone. Involvement of the mandible by osteosarcoma is uncommon. A young adult patient presented with facial swelling and an apparently infected lower third molar extraction socket. Subtle signs were missed on dental radiographs. Diagnostic ultrasound investigation was pivotal in identifying sinister signs: namely, soft tissue mass associated with bone thinning, erosion, expansion, and the "sunray" appearance of the buccal cortex, which were suggestive of osteosarcoma. These findings enabled priority to be given to subsequent investigations using other modalities. We present a first report of the ultrasound features of osteosarcoma of the mandible and consider this to be a useful modality in an initial investigation.
Assuntos
Neoplasias Mandibulares/diagnóstico por imagem , Osteossarcoma/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Granuloma Piogênico/diagnóstico , Humanos , Masculino , Doenças Mandibulares/diagnóstico , Dente Serotino/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Extração Dentária/efeitos adversos , Alvéolo Dental/patologia , UltrassonografiaRESUMO
We undertook a retrospective study of all isolated mandibular fractures which had required active management over a 1-year period at the Maxillofacial Unit at Newcastle General Hospital. Patients with single or multiple fractures of the mandible were included in the study, if there were other simultaneous fractures of the facial skeleton, those patients were excluded. All case notes and radiographs were reviewed by a single operator. A total of 202 cases of fractured mandible were identified of which 115 fulfilled the selection criteria of: isolated fracture, no previous facial fracture, treatment by open reduction and internal fixation using titanium osteosynthesis miniplates, and all case notes and radiographs available to study. Sixty-six patients had their fractures reduced manually to obtain anatomical reduction without the use of peroperative intermaxillary fixation (IMF). Forty-nine were treated conventionally using peroperative IMF. The two groups were broadly similar in severity and type of fracture, and the method of reduction seemed to be decided by the operator according to their preference. IMF was not used routinely postoperatively. Overall there were significantly fewer occlusal discrepancies in the early postoperative period in those patients treated by anatomical reduction (6/66 compared with 16/49, P = 0.002) but there was no difference in the final outcome of the occlusion between the two methods of reduction. Avoidance of the use of peroperative IMF is more economical in time and cost, is safer for the operator, and more comfortable for the patient. As this technique produces comparable results in the long term with fewer early complications, we conclude that IMF is not usually necessary to reduce fractures confined to the mandibular bone.
Assuntos
Fixação de Fratura/métodos , Fraturas Mandibulares/cirurgia , Placas Ósseas , Custos e Análise de Custo , Oclusão Dentária , Feminino , Seguimentos , Fixação de Fratura/economia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Imobilização , Masculino , Côndilo Mandibular/lesões , Fraturas Mandibulares/classificação , Fraturas Mandibulares/diagnóstico por imagem , Satisfação do Paciente , Radiografia , Estudos Retrospectivos , Segurança , Fatores de Tempo , Titânio , Resultado do TratamentoRESUMO
Haemophilia A, the most common of bleeding disorders is characterized by bruising and spontaneous bleeding into the joints but may remain undiagnosed if present in the mild form. A case is discussed where episodes of bruising and joint swelling as a child were misdiagnosed as rheumatic fever and the bleeding disorder was diagnosed following recurrent episodes of bleeding after extraction of an upper molar tooth.
Assuntos
Assistência Odontológica para Doentes Crônicos , Hemofilia A/diagnóstico , Hemorragia Bucal/etiologia , Extração Dentária/efeitos adversos , Adolescente , Desamino Arginina Vasopressina/uso terapêutico , Feminino , Hemofilia A/complicações , Hemostáticos/uso terapêutico , Humanos , Masculino , Hemorragia Bucal/tratamento farmacológicoRESUMO
The release of [3H]GABA from superfused slices of rat cerebral cortex was investigated in the presence and absence of the GABA-transaminase inhibitor aminooxyacetic acid (AOAA). In the latter case, an ion-exchange column chromatographic technique was used to separate [3H]GABA from tritiated metabolites released with it into the superfusate. In the absence of AOAA, omission of Ca2+ from the superfusion medium reduced the release of [3H]GABA evoked by a 30 mM K+ pulse by 81.6%, whereas in comparable experiments carried out in the presence of AOAA omission of Ca2+ reduced the K+-evoked release by only 23.5%. Similar results were obtained when a 50 mM K+ pulse was used, whereupon omission of Ca2+ reduced [3H]GABA release by 78.7% in the absence of AOAA as compared with a reduction of only 47.9% when AOAA was present. It is concluded that the presence of AOAA decreases the Ca2+-dependence of K+-evoked [3H]GABA release in this system.