Oral L-menthol reduces thermal sensation, increases work-rate and extends time to exhaustion, in the heat at a fixed rating of perceived exertion.

PURPOSE: The study investigated the effect of a non-thermal cooling agent, L-menthol, on exercise at a fixed subjective rating of perceived exertion (RPE) in a hot environment. METHOD: Eight male participants completed two trials at an exercise intensity between 'hard' and 'very hard', equating to 16 on the RPE scale at ~35 °C. Participants were instructed to continually adjust their power output to maintain an RPE of 16 throughout the exercise trial, stopping once power output had fallen by 30%. In a randomized crossover design, either L-menthol or placebo mouthwash was administered prior to exercise and at 10 min intervals. Power output, [Formula: see text]O2, heart rate, core and skin temperature was monitored, alongside thermal sensation and thermal comfort. Isokinetic peak power sprints were conducted prior to and immediately after the fixed RPE trial. RESULTS: Exercise time was greater (23:23 ± 3:36 vs. 21:44 ± 2:32 min; P = 0.049) and average power output increased (173 ± 24 vs. 167 ± 24 W; P = 0.044) in the L-menthol condition. Peak isokinetic sprint power declined from pre-post trial in the L-menthol l (9.0%; P = 0.015) but not in the placebo condition (3.4%; P = 0.275). Thermal sensation was lower in the L-menthol condition (P = 0.036), despite no changes in skin or core temperature (P > 0.05). CONCLUSION: These results indicate that a non-thermal cooling mouth rinse lowered thermal sensation, resulting in an elevated work rate, which extended exercise time in the heat at a fixed RPE.

Corlett loop for microvascular reconstruction in a neck depleted of vessels.

Free tissue transfer has revolutionised reconstruction of the head and neck and there are currently few local factors that preclude its use. These include a lack of suitable recipient vessels in the area for microvascular anastomosis. We describe the use of a Corlett loop in which a temporary arteriovenous fistula (AVF) is created with a transposed cephalic vein to enable reconstruction of a mandibular defect with a fibular free flap.

Use of an inferior orbitotomy for safe removal of a wooden foreign body penetrating the orbit.

Penetrating orbital foreign bodies must be removed in a safe and controlled manner. Adequate access is necessary so that there is no further damage to the orbital structures and to allow haemostasis. We describe a case of a wooden foreign body that penetrated the left orbit and its subsequent removal using an inferior orbitotomy. To our knowledge, this technique has not been previously described for removal of a foreign body.

Ectomesenchymal chondromyxoid tumour of the tongue: Unlikely to originate from myoepithelial cells.

Ectomesenchymal chondromyxoid tumour is a recently described rare entity found almost exclusively in the anterior dorsum of the tongue. We report an additional case, review the pertinent literature and explore the histogenesis of the lesion. The lesion has no discriminating clinical features and diagnosis is only established following histopathological examination including immunohistochemical assessment. The histogenesis of the lesion remains speculative and our study seems to discount myoepithelial cells as a potential source.

Zygomaticus implants for retention of nasal prostheses after rhinectomy.

Malignant tumours of the nose occasionally require rhinectomy. Implant retained prostheses can give good aesthetic results. Predictable biomechanical retention of nasal prostheses can be achieved using osseointegrated implants and Brånemark intra-oral and craniofacial implants have been used previously. Zygomaticus implants are traditionally used for dental rehabilitation of the partially edentulous maxilla with severe bone resorption. We describe two patients in whom zygomaticus implants have been used to aid salvage in prosthetic reconstruction of the nose.

Bifid tongue - a complication of tongue piercing.

Tongue piercing is associated with significant morbidity. We report on a patient with a bifid tongue defect following insertion of a tongue ornament. This abnormality resulted in severe emotional disturbance.

Steroid-induced psychosis complicating orthognathic surgery: a case report.

Psychosis is an uncommon but well-recognised complication of short-term corticosteroid administration. We report a case of steroid-induced psychosis subsequent to a bimaxillary osteotomy.

Bacteraemia following incision and drainage of dento-alveolar abscesses.

Twenty-five patients undergoing routine incision and drainage of dento-alveolar abscesses were screened for bacteraemia during the procedure. In 13 patients, the abscesses were aspirated with a needle prior to incision and drainage, while needle aspiration was omitted in the remaining 12. A blood sample was taken from all individuals immediately before the surgical procedures and at one-minute intervals for a period of 5 minutes after surgery. Needle aspiration of pus resulted in a significant reduction (P less than 0.05) in the bacteraemic episodes (0 out of 13) during subsequent surgery as compared with incision and drainage, without aspiration (3 out of 12). Bacteraemia appeared to be transient, although in one case it was detected at 5 minutes. It is concluded that bacteraemic episodes occur during incision and drainage of dento-alveolar abscesses and this may be reduced by aspiration of the abscess contents prior to incision and drainage. In addition, the aspirates could serve as excellent microbiological samples, uncontaminated with salivary flora. The need for antibiotic cover in at risk patients, however, needs to be established by further studies.

Mediastinal emphysema complicating a zygomatic fracture: a case report and review of the literature.

A case of a man with an otherwise simple facial fracture which was complicated by mediastinal emphysema is reported. A review of the literature indicating the pathogenesis, clinical and radiographic features and management of this condition is given.

Rhinolith: an unusual cause of palatal perforation.

An unusual case of a large rhinolith, which initially presented as an oronasal fistula, is reported. The surgical removal of the rhinolith through a maxillary osteotomy at the Le Fort I level with immediate direct fixation using 'Champy' plates is described. This approach provided excellent access for removal of the mass and repair of the oronasal fistula.

An unusual parotid foreign body presenting as recurrent trismus.

A case is reported of a foreign body in the left parotid gland, which presented in an unusual manner following a trivial injury and posed a difficult diagnostic problem, trismus being the most prominent clinical feature. The importance of having a high index of suspicion for retained foreign bodies is stressed.

Direct external pin fixation of maxillary fractures using premaxillary pins.

A simple technique for the fixation of maxillary fractures using premaxillary pins is described. Three case reports have been used to illustrate the technique which is recommended when maxillary fractures occur in conjunction with craniofacial or multiple injuries and when conventional methods of fixation are difficult to apply.

A modified surgical approach for parapharyngeal space tumours: use of the inverted 'L' osteotomy.

Removal of tumours from the parapharyngeal space is often difficult because of limited surgical access. Mandibulotomy has proved useful for improving access but may cause damage to the inferior dental and lingual nerves. Use of the inverted 'L' osteotomy provides excellent access avoiding damage to the nerves and the technique is illustrated with three surgical cases.

Reconstruction of nasal defects with implant-retained nasal prostheses.

Predictable biomechanical retention of nasal prostheses can now be achieved using Brånemark osseointegrated implants. These prostheses are tissue compatible, simple in design and easy to place, can be worn independently of spectacles and can in the majority of cases be provided soon after surgical excision. We have treated 14 patients (30 implants) 8 of whom had the implants placed at the time of surgical excision of the tumour. The longest survival so far has been 62 months (mean 38 months). Craniofacial osseointegration changes patients' perceptions of a nasal prosthesis and improves quality of life. Initial reconstructive surgery after radical nasal excision should be limited to reconstruction of the upper lip and preparation of the surgical defect for an implant-retained prosthesis.

Papillary cystadenocarcinoma of the sublingual gland presenting as a ranula.

A case is reported of a papillary cystadenocarcinoma of the sublingual gland which presented as a ranula. This is both rare in site and mode of presentation.

Juxtacortical osteosarcoma of the jaws.

Osteosarcoma is a highly malignant tumour which despite modern surgery and chemotherapy still retains a relatively poor prognosis. This prognosis is, however, much better in the rare variant known as juxtacortical osteosarcoma. Both types of osteosarcoma mainly affect the long bones but the juxtacortical variant may be treated less aggressively and has a much better survival rate. The authors report four cases of juxtacortical osteosarcoma affecting the jaws and discuss these unusual tumours and their management.

Cross-match requirements in orthognathic surgery: an audit.

A retrospective audit was undertaken of the value of routine cross-matching of blood for patients undergoing orthognathic surgery at Canniesburn Hospital, Glasgow. Overall, routine cross-matching of blood was wasteful of resources for all but the more major types of osteotomy procedure: Le Fort III, Le Fort II, malar osteotomies requiring a bicoronal flap and bimaxillary osteotomies. The study has financial implications regarding the proper use of cross-matching in selected patients undergoing elective orthognathic surgery. A blood ordering tariff has been suggested for the various procedures studied.

Randomized prospective study of the influence of steroids on postoperative eye-opening after exploration of the orbital floor.

OBJECTIVE: To find out if giving steroids reduces postoperative swelling in orbital surgery. DESIGN: Prospective, randomized, double-blind trial. SETTING: Regional unit, teaching hospital, UK. SUBJECTS AND INTERVENTIONS: 20 patients who require orbital floor exploration after injuries. Patients were given methylprednisolone 250 mg (or placebo identically packaged) at induction of anaesthesia, with a further three doses at 6-hourly intervals postoperatively. MAIN OUTCOME MEASURE: Differences in interpalpebral width before and after operation. RESULTS: Those given steroids (n=11) had a significantly increased interpalpebral width compared with placebo (n=9) postoperatively (P < 0.01, 95% confidence intervals of the difference = 1 mm-6 mm). CONCLUSION: Short courses of steroids therapy should be considered in orbital surgery for appropriate patients. There is an advantage in being able to assess the globe postoperatively.

Central acinic cell carcinoma of the mandible: report of a case.

A case is reported of a central acinic cell carcinoma of the mandible. This is an unusual site for this rare tumour and to our knowledge only three cases have been previously reported in the literature.