Five-year prospective fistula audit in a single center. TIG training negates consultant learning curve, but surgeons should beware the mid-range palatal defect.

The aim of primary palatoplasty is to achieve optimum speech with minimal morbidity. Symptomatic fistulae are well-recognised complications of palatoplasty and may require additional surgical intervention, increasing the burden of care. Our aims were to better understand fistula experience in our unit and compare fistula rates between an established consultant and a newly appointed training interface group (TIG) trained consultant. Post-operative fistulae were prospectively and independently recorded by Cleft Clinical Nurse Specialists as part of routine 6-week post-operative reviews. Cleft type and intra-operative hard-soft palate junction (HSPJ) width were prospectively recorded by operating surgeons. Data were collated and analysed using Microsoft Excel. Between 1 January 2014 and 31 December 2018, 250 primary palatoplasties were performed. The overall fistula rate was 8% (0% SMCP, ICP 7%, UCLP 8%, BCLP 22%). Fistulae clustered in clefts with a mid-range HSPJ width of 12-16 mm. Numerically, fistula rates remained similar over time despite increased unit activity (doubling of primary surgeries in 2017 and 2018). There was no significant difference in fistulae rates between surgeons (P > 0.05). Overall fistulae rate compared favourably with published data. TIG fellowships were designed in the context of cleft surgery to address issues relating to steep operative learning curves. These data demonstrate that results from a newly appointed TIG-trained surgeon are comparable to that of an established TIG-trained surgeon. Data also suggest surgeons should be aware of the risk of fistulae in the mid-range palatal defect and in HSPJ widths of 12-16 mm.

Reducing the need for general anaesthesia in children: use of LAT gel in treating facial lacerations.

Facial lacerations in children are common emergencies that often require debridement and closure under general anaesthesia because of poor cooperation by the patient. General anaesthesia in children is not without risk so any technique that avoids its use is beneficial. LAT gel (lidocaine, adrenaline, and tetracaine) is a topical anaesthetic, which is ideal for suturing facial lacerations in children. In our experience its use has resulted in the effective treatment of these injuries, and has reduced distress and discomfort, and the need for hospital admission and general anaesthesia.

Medics against violence--the development of a new violence prevention intervention for schools.

UNLABELLED: This article outlines the rationale, evidence base and development of a new anti-violence intervention for schools delivered in the school setting by healthcare professionals. It is an example of multi-professional and mutli-disciplinary working and demonstrates how all healthcare professionals can be involved in wider healthcare issues. CLINICAL RELEVANCE: The majority of victims of violence are young men. Most incidents of interpersonal violence involve injury to the head and neck area, including the dentition. The Medics against Violence Schools Project is very relevant to Oral and Maxillofacial Surgeons, Oral Surgeons and General Dental Practitioners all of whom may have to deal with the sequelae of such injuries.

Secondary alveolar bone grafting (CLEFTSiS) 2000-2004.

OBJECTIVE: To determine whether alveolar bone graft outcomes improved with reorganization of Scottish cleft services following the Clinical Services Advisory Group United Kingdom finding of 58% success and to determine the accuracy of results from CLEFTSiS (national managed clinical network for Scottish cleft services) annual audits. DESIGN: Retrospective random analysis of electronic radiographs by two observers. SETTING: Surgical-orthodontic care provided through National Health Service. PATIENTS, PARTICIPANTS: Sixty-three of 261 patients eligible for alveolar bone grafting by cleft type did not undergo surgery. Nine surgeons operated on 198 patients (2 regrafts). Radiographs were available for 115 subjects (one was excluded). INTERVENTIONS: A standard protocol involved presurgical maxillary expansion (where necessary) and bone harvesting from the iliac crest. MAIN OUTCOME MEASURE(S): The Kindelan Bone-Fill Index evaluated radiographic success with weighted kappa statistics for intraobserver and interobserver reproducibility. Two-sample t-tests were used to determine whether outcomes for ilateral and unilateral cleft lip and palate patients differed and to examine the effects of operator volume, presurgical expansion, and age at the time of grafting. RESULTS: Intraobserver (0.93 to 0.97) and interobserver (0.83 to 0.85) reproducibility were almost perfect. Grafts were successful in 76% of patients, while 23% were partial failures and 1% of cases were total failures. Patients who underwent presurgical expansion (n = 64) had statistically significantly better results (p = .046). However, there was no statistically significant effect for unilateral versus bilateral patients (p = .77), patients treated by the highest volume operator (p = .78), and patients under 11 years of age (p = .29). CONCLUSIONS: CLEFTSiS alveolar bone graft results between 2000 and 2004 were improved on the Clinical Services Advisory Group study and annual CLEFTSiS audits. Patients who underwent maxillary expansion prior to surgery were more successful.

Facial symmetry in unilateral cleft lip and palate following alar base augmentation with bone graft: a three-dimensional assessment.

OBJECTIVE: The aim of this study was to assess the outcome of bone grafting using a corticocancellous block of iliac crest to reconstruct the support for the deformed, volume-deficient alar base in treated patients with unilateral cleft lip and palate (UCLP). The main outcome being measured was nasal symmetry. DESIGN: This was a prospective study using a noninvasive three-dimensional stereophotogrammetry system (C3D) to assess the position of the alar base. Images were captured immediately preoperatively and at 6 months following the augmentation of the alar base with a block of bone graft. These images were used to calculate facial symmetry scores and were compared using a two sample Student's t test to assess the efficacy of the surgical method in reducing facial/nasal asymmetry. PATIENTS: This investigation was conducted on 18 patients with one patient failing to attend for follow-up. The results for 17 patients are presented. RESULTS: Facial symmetry scores improved significantly following the insertion of the bone graft at the deficient alar base (p=0.005). CONCLUSIONS: 3D stereophotogrammetry is a noninvasive, accurate, and archiveable method of assessing facial form and surgical change. Nasal symmetry can be quantified and measured reliably with this tool. Bone grafting to the alar base region of treated UCLP patients with volume deficiency produces improvement in nasal symmetry.

A sample method of measuring bone graft volume, technical note.

A simple method of measuring the volume of cortico-cancellous bone grafts is described. The method is quick and reliable. Only materials readily available in the operation theatre are used.