Post-operative avascular necrosis of the maxilla: a rare complication following orthognathic surgery.

We present a patient with sickle cell trait who suffered avascular necrosis of the maxilla as a complication of maxillary osteotomy. Understanding the blood supply of the maxilla and how possible patient related, anaesthetic and operative factors affect it, is important in understanding how the vascularity of the maxilla can become compromised in a surgical procedure. The perioperative parameters were analysed to identify any prognostic elements. Avascular necrosis of the maxilla is a rare complication of orthognathic surgery with few cases reported in the literature. There are identifiable risk factors that can influence the blood supply of the maxilla. Careful preoperative assessment is required to exclude patient factors that have the potential to affect tissue vascularity. This in conjunction with sound anaesthetic and surgical technique should all minimize the risk of avascular necrosis. Even so it is still possible for this rare complication to occur.

The versatility of the Karapandzic flap: A review of 65 cases with patient-reported outcomes.

OBJECTIVE: The Karapandzic flap is an established technique for reconstruction of large lip defects and in our experience is particularly valuable in repair of the upper lateral lip and the commissures as well. We present our experience in a case series of 65 patients under one consultant. METHOD: This is a retrospective study of patients who underwent Karapandzic flap repair for lip defects following cancer resection from 2007 to 2014 in North Yorkshire. A data collection tool was used which incorporated patient demographics, tumour location, histology, complications, resection margins and recurrence including functional and aesthetic outcomes. The Patient and Observer Scar Assessment Scale (POSAS) was used to assess postoperative outcome at more than 1 year. RESULTS: The clearance rate was 98.4%. For those with a follow-up greater than 1 year, there was no recurrence or surgical revision, whilst the most common concern was temporary lip paraesthesia. The mean POSAS scores were low for both patients and observers reflecting a high satisfaction rate. CONCLUSION: The technique of Karapandzic flap reconstruction for defects in both upper and lower lip allows adequate margin clearance with a low level of complications. The advantages of this technique include preservation of both function and sensation utilising local tissue to allow successful aesthetic outcomes.

Laryngeal leishmaniasis: case report of a rare infection.

BACKGROUND: We report a case of laryngeal leishmaniasis in a United Kingdom (UK) resident who lived in Spain for 5 years. METHODS AND RESULTS: The patient presented with a history of hoarseness. He had returned to the UK after spending 5 years in Spain as a retiree. His past medical history includes chronic obstructive pulmonary disease (COPD). Histology of a vocal cord biopsy was suggestive of leishmaniasis and polymerase chain reaction (PCR) test was positive for Leishmania donovani. His use of steroid inhaler probably contributed to his acquiring this extremely unusual infection. He was successfully treated with intravenous amphotericin. CONCLUSIONS: Laryngeal leishmaniasis is an extremely rare infection and is rarely reported in the UK. The ease of travel ensures that many tropical infections may present to UK clinicians.