Post-traumatic orbital reconstruction: anatomical landmarks and the concept of the deep orbit.

Dissection deep within the orbit is a cause for concern to surgeons because of the perceived risks of injuring critical structures such as the contents of the superior orbital fissure and the optic nerve. Although "safe distances" (those distances within which it is considered safe to dissect within the orbit) have been described, these are of limited value if the orbit is severely disrupted or is congenitally shallow. In addition, traumatic defects in the orbital floor, in particular, often extend beyond these distances. Reliable landmarks based on the relations between anatomical structures within the orbit, rather than absolute distances, are described that permit safe dissection within the orbit. We present the concept of the deep orbit and describe its relevance to repair of injuries.

Effects of proprietary oral rinses containing chlorhexidine, hexetidine and benzydamine on the proliferation of human buccal epithelial cells in culture.

Cell cultures were established from small samples of buccal tissue, using a 3T3 fibroblast feeder-layer technique. After exposure to increasing dilutions of three proprietary oral rinses for 22 h or 2 h, the effects upon cell proliferation were studied by measurement of [3H]-thymidine incorporation into cellular DNA. Cell membrane damage was assessed by measurement of lactate dehydrogenase content. Cultures exposed to hexetidine-containing or chlorhexidine-containing rinses for 22 h at dilutions of 250-fold or lower showed almost complete inhibition of [3H]-thymidine incorporation. Cultures treated with benzydamine-containing rinse at the same dilutions showed no significant inhibition of incorporation. Exposure to the same dilutions of hexetidine- and chlorhexidine-containing rinses for 2 h resulted in 65% and 20% inhibition of incorporation, respectively. Lactate dehydrogenase content decreased to negligible levels after exposure to the rinse containing hexetidine at a 250-fold dilution, but was unaffected by the other two rinses. Thus dividing buccal epithelial cells in vitro may be adversely affected by exposure to certain commercial oral rinses.

Combined latissimus dorsi-serratus anterior/rib composite free flap in mandibular reconstruction.

The serratus anterior/rib composite flap can be used alone or in combination with a latissimus dorsi myocutaneous flap in mandibular reconstruction. The combined flap is particularly useful in reconstructing large anterior mandibular defects, and 4 cases are described which illustrate its use both as a pedicled flap and as a free tissue transfer.

Doppler sonography for the assessment of central mandibular blood flow.

In this study we evaluated the role of Doppler sonography in the assessment of central mandibular blood flow. We assessed the characteristics of blood flow in the mental artery, the larger terminal branch of the inferior alveolar artery, in 30 healthy volunteers equally distributed in the age groups 20-39, 40-59 and over 60 years. We used a DWL Multi-Dop X4(R) Doppler sonography machine (DWL GmbH) with an 8 MHz probe applied intraorally. The variables analysed were patency, time averaged maximum velocity (TAMV), pulsatility index (PI), discomfort and the duration of the procedure. All the arteries analysed were patent. The TAMV and PI decreased as age increased and there were significant differences between the age groups: TAMV (P = 0.01), PI (P = 0.006). Pair-wise comparisons also showed significant differences (P< 0.05) between the 20-39 and the over 60 age group, 40-59 and the over 60 age group for TAMV, and between the 20-39 and over 60 age group for PI. The difference in measurements between the right and left sides in individual patients was not significant. The assessment took about 20 minutes and caused little discomfort. The technique is simple and could potentially be used to influence clinical decisions.

A nationwide study to investigate current opinion amongst maxillo-facial and neurological surgeons with regard to access surgery for neurosurgical procedures.

Over the past two decades there has been much interest in the use of craniofacial disassembly techniques to improve difficult access to some neurosurgical lesions, However, it is not known to what extent these techniques have been adopted throughout the UK. The aim of this study was to establish how many maxillofacial surgeons and neurosurgeons are currently involved in this type of collaborative surgery and to determine current opinion regarding the use of these procedures. A self-completion questionnaire was sent to all consultant maxillofacial surgeons and neurosurgeons within the UK. The results of the questionnaire suggest that there is a high level of interest in this type of collaborative surgery within the UK. It has demonstrated some interesting differences of emphasis regarding possible advantages and disadvantages of these procedures, and the areas to which access can be particularly improved. In addition, the future of this type of collaborative surgery and some of the difficulties involved in its organization were highlighted.

Cranial fasciitis of the orbit and maxilla: extensive resection and reconstruction.

A case of cranial fasciitis of childhood is described. This extensive cranio-orbital-facial lesion in a 3-month-old baby necessitated radical resection and immediate orbital and anterior cranial fossa reconstruction. The particular requirements of reconstruction in the infant are emphasised.