Submental island flap for oropharyngeal reconstruction: UK experience of 25 cases.

Since the first description of the submental island flap 24 years ago, advances in techniques have expanded the indications for its use and improved its characteristics to make it a favourable reconstructive option for orofacial oncological defects. We describe our experience (particularly perioperatively) of its use, the complications, and the precautions adopted. We retrospectively reviewed the cases of 25 patients and focused on the operating time, use of tracheostomy, duration of postoperative inpatient stay, oropharyngeal function, and associated morbidities. Eighteen patients had defects of the tongue. Other defects were retromolar (n=2), buccal (n=1), mandibular (n=2), and maxillary (n=2). The mean (range) operating time was 250 (152-370) minutes and the mean (range) postoperative stay was 11 (4-16) days. Only four patients required a tracheostomy, and four required postoperative monitoring in the intensive care unit (ICU). The complications were partial flap loss (n=6), sialocele (n=1), and seroma (n=1). The flap has shown its merit as an option for oral reconstruction because of its reliability, versatility, and relative ease of application. To our knowledge, our case series is the largest in the United Kingdom, and we hope that in future, this humble flap will be a standard reconstructive option for small to medium oral resection defects.

Local anesthesia blocks the antiemetic action of P6 acupuncture.

The incidence of postoperative illness was monitored for 6 hours in 74 women premedicated with nalbuphine, 10 mg, and undergoing short gynecologic operations of similar duration under methohexitalnitrous oxide-oxygen anesthesia. Each patient received P6 acupuncture for 5 minutes at the time of administration of premedication. In random order the site of the acupuncture had been previously infiltrated with normal saline solution in half of the patients and 1% lidocaine in the remaining patients. Postoperative emetic sequelae occurred significantly more often in those who received lidocaine compared with the group that received saline solution. This demonstrates the ability of a local anesthetic administered at the point of stimulation to block the antiemetic action of P6 acupuncture in a manner similar to that shown by others for analgesia.

Compliance with the minimum dataset of the British Orthodontic Society/British Association of Oral and Maxillofacial Surgeons for record keeping for orthognathic patients: retrospective comparative multicentre audit.

Accurate and timely collection of clinical records is of utmost importance in planning, evaluating, and auditing orthognathic operations. The minimum dataset guidelines of the British Orthodontic Society (BOS) and the British Association of Oral and Maxillofacial Surgeons (BAOMS) were published in an attempt to standardise the collection of clinical records of patients having orthognathic operations. This multicentre retrospective audit aimed to assess and compare compliance with the guidelines in 3 maxillofacial units over a 1-year period. A total of 105 cases were reviewed. Compliance varied. Documentation of altered sensation was consistently poor and too many unnecessary radiographs were taken. There may be a need to circulate the guidelines again to increase awareness and reduce variability between centres.

Idiopathic cervical osteomyelitis presenting as dysphagia.

We discuss a case of idiopathic cervical epidural abscess, complicated by osteomyelitis, presenting with dysphagia as the main complaint. No predisposing factors were identified and blood cultures were negative. Case was treated conservatively by long course of IV antibiotics. We present a review of presentation of spinal epidural abscesses and indications for surgical intervention.