Rigid versus non-rigid fixation for bilateral mandibular angle fractures: a retrospective multicentre review.

BACKGROUND: Fractures involving the bilateral mandibular angle are an uncommon occurrence with limited evidence to inform the ideal fixation requirements for adequate treatment. The aim of this study was to evaluate the outcomes of managing bilateral mandibular angle fractures and determine if rigid fixation on one side improves outcomes compared to bilateral non-rigid fixation. METHODS: Patients with isolated bilateral mandibular angle fractures surgically treated at the Royal Brisbane and Women's Hospital, Princess Alexandra Hospital, Gold Coast University Hospital and Townsville University Hospital between January 1, 2010 and December 31, 2022 were retrospectively identified. Data collected included patient demographics, mechanism of injury, fixation scheme, postoperative occlusion and the occurrence of postoperative complications and subsequent management. RESULTS: Eighty-four patients met the inclusion criteria. Fifty-two patients had non-rigid fixation applied to both fractures, and thirty-two had rigid fixation placed on at least one side. All cases proceeded to union. There was no statistically significant difference between the groups for occlusal outcomes, wound dehiscence, infection or plate or screw loosening. CONCLUSION: Our results suggest that bilateral non-rigid fixation can be used to treat bilateral mandibular angle fractures in the appropriate clinical context.

Compound heterozygote myocilin mutations in a pedigree with high prevalence of primary open-angle glaucoma.

PURPOSE: To describe the phenotype of ocular hypertension and primary open-angle glaucoma in a family with individuals compound heterozygote for Gln368STOP and Thr377Met myocilin (MYOC) mutations. METHODS: Family members of the proband underwent comprehensive ocular clinical examination and DNA sequencing for MYOC mutations. RESULTS: A 34-year-old woman with marked ocular hypertension was found to carry Gln368STOP and Thr377Met MYOC mutations. Three other siblings carried both mutations, while one carried Gln368STOP alone. Three of five siblings had received treatment for ocular hypertension or early glaucoma, with the average age of diagnosis 28 years; one required trabeculectomy at age 27. The mother of the proband was found to be a carrier for Gln368STOP alone, which indicates that her offspring with both Gln368STOP and Thr377Met carry variants on opposing alleles. CONCLUSIONS: This pedigree is the first report with individuals compound heterozygote for the two most common glaucoma-causing MYOC variants. The combination of mutations manifests a more severe phenotype than either alone. Identification of gene changes associated with glaucoma within the family has enabled unaffected members to stratify their risk of future disease and institute closer monitoring and early treatment.

Solitary fibrous tumor of the orbit with intracranial involvement.

Solitary fibrous tumor of the orbit is a rare neoplasm that often follows a benign course. Additional involvement beyond the orbit is even rarer, having only been reported in 2 cases previously. The authors describe a 62-year-old patient with a primarily intracranial lesion including orbital extension which was debulked and initially diagnosed as meningioma. Two recurrences 3 and 4 years later disclosed a solitary fibrous tumor, with the initial histopathology being revised to the same diagnosis. This rare presentation of an orbital solitary fibrous tumor highlights the surgical challenge faced when the tumor straddles the cranio-orbital junction and demonstrates the potential for rapid regrowth after incomplete excision.

Design and synthesis of binucleating macrocyclic clefts derived from Schiff-base calixpyrroles.

The syntheses, characterisation and complexation reactions of a series of binucleating Schiff-base calixpyrrole macrocycles are described. The acid-templated [2+2] condensations between meso-disubstituted diformyldipyrromethanes and o-phenylenediamines generate the Schiff-base pyrrolic macrocycles H(4)L(1) to H(4)L(6) upon basic workup. The single-crystal X-ray structures of both H(4)L(3).2 EtOH and H(4)L(6).H2O confirm that [2+2] cyclisation has occurred, with either EtOH or H2O hydrogen-bonded within the macrocyclic cleft. A series of complexation reactions generate the dipalladium [Pd2(L)] (L=L(1) to L(5)), dinickel [Ni2(L(1))] and dicopper [Cu2(L)] (L=L(1) to L(3)) complexes. All of these complexes have been structurally characterised in the solid state and are found to adopt wedged structures that are enforced by the rigidity of the aryl backbone to give a cleft reminiscent of the structures of Pacman porphyrins. The binuclear nickel complexes [Ni2(mu-OMe)2Cl2(HOMe)2(H(4)L(1))] and [Ni2(mu-OH)2Cl2(HOMe)(H(4)L(5))] have also been prepared, although in these cases the solid-state structures show that the macrocyclic ligand remains protonated at the pyrrolic nitrogen atoms, and the Ni(II) cations are therefore co-ordinated by the imine nitrogen atoms only to give an open conformation for the complex. The dicopper complex [Cu2(L(3))] was crystallised in the presence of pyridine to form the adduct [Cu2(py)(L(3))], in which, in the solid state, the pyridine ligand is bound within the binuclear molecular cleft. Reaction between H(4)L(1) and [Mn(thf){N(SiMe(3))2}2] results in clean formation of the dimanganese complex [Mn2(L(1))], which, upon crystallisation, formed the mixed-valent complex [Mn2(mu-OH)(L(1))] in which the hydroxo ligand bridges the metal centres within the molecular cleft.

On prediction of the cesarean delivery risk in a large private practice.

OBJECTIVE: This study was undertaken to develop an easily usable integrated formula for predicting the probability of cephalopelvic disproportion/failure to progress (CPD) and cesarean delivery (CS) as a function of demographic factors in a middle-class private practice, and to evaluate risk factors for CS in a low-risk primiparous population. METHODS: We studied 3355 primiparous women who delivered singleton births between February 1993 and July 2001 in a large private practice. We calculated body mass index (BMI) and weight gain during pregnancy by using clinical data from a comprehensive clinical database. Multivariable logistic regression analysis was used to estimate the relationship between the probability of CS and CS carried out for CPD and 6 demographic factors: maternal age, maternal height, initial pregnancy BMI, pregnancy weight gain, gestational age, and birth weight. Three methods were used to assess the accuracy of the model: the Hosmer-Lemeshow goodness-of-fit statistic, association of predicted probabilities, and direct comparison of the formula to the actual data. Odds ratios with a 95% CI are also calculated for each of these factors. RESULTS: The overall rate of primiparous CS for the practice is 21.7%, with 11.7% carried out for CPD. Formulas were developed to predict the probability of CS and the probability of CS caused by CPD. Our analysis shows that both the risk of CS and the risk of CS caused by CPD are significantly associated with all 6 demographic factors. We also develop an easily usable Web page-based calculator to instantly estimate any woman's probability of a CS or CPD at the beginning or at the end of her pregnancy. CONCLUSION: The probability of CS and CS performed for CPD is higher for shorter, older, more obese women with large pregnancy weight gains, larger fetal birth weights, and longer gestation ages. Accurate formulas that predict the probabilities of CS and CS performed for CPD in this large private practice have been developed.

Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain.

OBJECTIVE: The purpose of this study was to examine body mass index and pregnancy weight gain as risk factors for primary cesarean delivery in nulliparous women in a middle-class private practice. STUDY DESIGN: Primiparous women who delivered in a private practice setting between February 1993 and July 13, 2001, were included. CIs along with Z statistics for paired count data were used to assess the statistical significance and relative importance of the relationships of body mass index and maternal weight gain to cesarean delivery. The effect of body mass index was examined as related to known confounders such as gestational age, birth weight, maternal age, and maternal height. RESULTS: The overall cesarean delivery rate for primiparous women was 21.76%. Risk of cesarean delivery increased consistently and significantly (P <.0001) with increasing body mass index. This effect was primarily mediated through an increase in cesarean delivery carried out for cephalopelvic disproportion/failure to progress. In our practice, the primiparous woman whose body mass index is >30 kg/m(2) is six times more likely to have a cesarean delivery for the diagnosis of cephalopelvic disproportion/failure to progress than the primiparous woman whose body mass index is <20 kg/m(2). This differential in cesarean delivery rate persisted when controlled for birth weight and gestational age and continues to persist when maternal age and height are also controlled. Excessive pregnancy weight gain exerted a statistically significant effect on cesarean delivery rate. This increase was primarily related to cephalopelvic disproportion/failure to progress among the nonobese women. CONCLUSION: Maternal body mass index is related strongly to the ability of primiparous women to be delivered vaginally without great difficulty. In fact, lean patients are excellent labor performers, particularly in contrast with obese patients. The relationship of increased body mass index to increased cesarean delivery is due to an increased rate of cephalopelvic disproportion/failure to progress. Excessive pregnancy weight gain is associated with a doubling of cephalopelvic disproportion/failure to progress rate in nonobese patients.