Impact of secondary alveolar bone grafting on the symptoms of reflux in oronasal fistulas: a patient-related outcome study.

Objective : To establish for the first time the prevalence of fistula symptoms and the effectiveness of secondary alveolar bone grafting to treat these symptoms in a single surgeon cohort in Bristol, United Kingdom. Design : Direct questioning of 233 consecutive patients with cleft before and after secondary alveolar bone grafting as to the presence of fistula symptoms. Setting : Southwest and South Wales Cleft Centre, Frenchay Hospital, Bristol, United Kingdom. Participants : Consecutive patients with cleft who were being treated for secondary alveolar bone grafting. Outcome Measure : Patients reporting presence of fistula symptoms. Data collection on cleft type (unilateral, bilateral), date of birth, and age at secondary alveolar bone grafting. Results : Of the 167 unilateral patients with cleft lip and palate and 66 patients with bilateral cleft lip and palate, 45% had symptoms of a fistula before alveolar bone grafting and 10% had symptoms of a fistula after surgery. There were no statistically significant differences between the presence of symptoms before or after secondary alveolar bone grafting between cleft types or by age at secondary alveolar bone grafting. Conclusion : This is the first study examining the rates of fistula symptoms before and after secondary alveolar bone grafting in the United Kingdom. This study used the patient-centered outcome of the presence of symptoms as a way of measuring the presence of fistulas in this group. Secondary alveolar bone grafting reduces the incidence of symptomatic fistula in this setting.

Hyperglobus, do not forget the sinister.

Hyperglobus is an elevation of the ocular globe with the majority of the orbit remaining intact. We present a case of hyperglobus caused by a metastatic mass from a prostate carcinoma. There are no other reported cases in the literature.

Surgical management of temporomandibular joint ankylosis in ankylosing spondylitis.

Relatively few patients develop such severe degenerative temporomandibular joint (TMJ) disease that they require total joint replacement. Current indications include those conditions involving condylar bone loss such as degenerative (osteoarthritis) or inflammatory joint disease (ankylosing spondylitis, rheumatoid, and psoriatic). Ankylosis of the temporomandibular joint (TMJ) secondary to ankylosing spondylitis remains an under investigated entity. We aim to provide an overview of treatment objectives, surgical procedures, and our experience with total TMJ replacement for this condition.

Facial basal cell carcinoma in a young patient with Crohn disease.

A 26-year-old man with Crohn disease developed a 10-mm-diameter facial basal cell carcinoma. He was referred to our department, and the tumor was excised with a clear margin. The wound was closed by primary closure, and he made an uneventful postoperative recovery with a satisfactory cosmetic result. Although the increased risk of nonmelanoma skin cancer in immunosuppressed solid organ transplant patients is well known, the association with inflammatory bowel disease remains unclear. There are few articles in the literature on this topic, and the authors believe this to be the first documented case of facial basal cell carcinoma occurring in the context of Crohn disease. Of particular interest is the very young age at presentation.

Alveolar bone grafting: results of a national outcome study.

INTRODUCTION: In 1998, the Clinical Standards Advisory Group (CSAG) report demonstrated a successful radiographic outcome of 58%, for alveolar bone grafting, from 157 cases of unilateral cleft lip and palate (UCLP) in children aged 12 years. No further national studies have assessed the current level of radiographic outcome following the re-organisation of cleft services since the recommendations from the CSAG report. PATIENTS AND METHODS: In 2008, radiographic images were requested for alveolar bone grafts performed in calendar year 2006 from each of the now established UK cleft centres. A sample of 206 patients with 235 grafted sites was scored by a panel of trained assessors, following a calibration exercise, using a modified Kindelan index. Inter- and intra-observer variation was assessed. RESULTS: The overall radiographic success rate for the 2006 images assessed was 85%. There was no statistical difference for radiographic success between centres or surgeons or cleft type when defined as either a bilateral or unilateral alveolar defect for a patient. CONCLUSIONS: Alveolar bone grafting appears to have improved radiographic outcomes when compared with the CSAG report following the re-organisation of surgical services for children with cleft lip and/or palate.

Sudden hypotensive syncope and significant iatrogenic maxillofacial trauma following administration of oral sodium phosphate purgative solution.

Oral sodium phosphate (NaP) solution is used globally as a bowel preparation for colonoscopy, surgery and medical-imaging (Balaban 2008). We present a case of a patient who suffered sudden hypotensive syncope and iatrogenic mandibular fractures within an hour of ingesting a NaP solution. We discuss the uses of these medicines and highlight the need to warn patients of possible adverse side effects to avoid patient harm and subsequent litigation.

The outcome for secondary alveolar bone grafting in the South West UK region post-CSAG.

OBJECTIVE: In 1998 the delivery of cleft care in the United Kingdom was examined by the Clinical Standards Advisory Group, the outcomes of which led to the wide restructuring of cleft services in the United Kingdom. We present a retrospective study evaluating the radiographic outcome of 53 consecutively performed alveolar bone grafts following the regional centralization of secondary alveolar bone grafting to the South West Cleft Centre between 2004 and 2006. METHODS: A retrospective audit of one surgeon's outcome of 53 consecutively performed alveolar bone grafts, assessed radiographically using the Kindelan method. RESULTS: That 94% of bone-grafted sites achieved a successful radiographic outcome compares favorably with the previously published Clinical Standards Advisory Group data of 58% with Bergland scores. CONCLUSION: The radiographic outcome for alveolar bone grafting has improved with centralization. A small number of patients are being grafted after the ideal chronological age, and this needs to be addressed throughout the region. The Kindelan assessment provides a reliable method of early assessment for alveolar bone grafting.

The proximal tibia donor site in cleft alveolar bone grafting: experience of 75 consecutive cases.

BACKGROUND: The optimum donor site for cleft alveolar bone grafting is still debated. Donor site morbidity is an important factor in deciding the site for harvest of cancellous bone. Use of the proximal tibia as donor site is associated with few complications. The occurrence of a proximal tibia fracture following cancellous bone harvest from this site, prompted a review of the last 75 consecutive cases carried out at our unit. MATERIAL AND METHOD: The medical notes of 75 consecutive patients undergoing cleft alveolar bone graft were reviewed and postal questionnaires were sent to patient's parents and family physicians. The review focused on donor site morbidity. RESULTS: Fracture of the proximal tibia, a hitherto unreported complication, occurred in two out of 75 cases (2.7%) within our series. Post-operative mobilization was achieved rapidly with normal joint function and donor site healing progressed satisfactorily in all cases. In 1 out of 75 cases the graft was repeated at a later date due to recipient site infection. The incidence of other morbidity was low with most representing local complications only. Length of hospital stay was 3 days (range 2-5 days). CONCLUSION: Based on our findings we feel that the proximal tibia offers a reliable site for harvest of sufficient quantities of good quality cancellous bone. Recommendations are made as to the technique of bone harvest, to minimize the fracture risk.