The Paediatric Vault Score (PVS)-A Novel Scoring Tool for Prioritisation of Surgical Management of Craniosynostosis Patients.

Craniosynostosis is the premature fusion of the skull sutures, resulting in abnormal skull shape and volume. Timely management is a priority in avoiding raised intracranial pressure which can result in blindness and neurodevelopmental delay. Due to the COVID-19 pandemic, theater access was reduced. A risk stratification scoring system was thus devised to score patients attending surgery and aid in prioritization according to surgical need. The authors present the Paediatric Vault Score (PVS), which can also be customized to each unit's individual protocols. Ten patients on the waiting list were randomly selected and their clinical information was summarized in uniform anonymized reports. Six craniofacial consultants were selected as assessors and given 1 week to independently rank the patients from 1 to 10. Each scorer's ranking was verified against the PVS template and concordance was analyzed using the Kendall tau correlation coefficient (KT). Three cycles of the scoring process were carried out. Improvements were made to the scoring tool following cycle 1. Cycle 1 revealed 2 clinicians to be concordant with the PVS system and 4 to be discordant. Cycle 2 revealed all 6 clinicians to be concordant, with a mean KT score of 0.61. The final cycle revealed all 6 clinicians to be concordant, with a mean KT score of 0.70. Four scorers increased their concordance once the scoring sheet was introduced. Kendall's correlation of concordance calculated the interrater reliability to be 0.81. The PVS is the first known vault scoring system to aid in risk stratification and waiting list prioritization.

A Large Lipoma of the Tongue: A case report.

This report discusses a rare case of a 75-year-old male presenting with a large lipoma of the tongue. It examines the investigations carried out to aid in diagnosing the lesion and the management options. Since oral lipomas rarely cause symptoms, there tends to be a general delay in seeking treatment. This case report aims to help dental practitioners diagnose intra-oral soft tissue lesions and provide appropriate management for their patients.

Odontogenic keratocyst located in the retromolar trigone.

Odontogenic keratocysts (OKCs) are a commonly occurring, benign cystic intraosseous lesion thought to arise from the cell rests of the dental lamina. Most instances of OKC are commonly found in the posterior aspect of the mandible. In rare instances, there have been reported cases of OKCs arising in the peripheral gingiva, but these cases are few and far between. Rarer still are the few documented cases of OKCs arising in other soft tissues of the mouth. There are many divided opinions on the diagnosis of these lesions and whether they are truly odontogenic in origin, given their location when they are enucleated from a soft tissue area. To the best of our knowledge, we present the first reported case of a patient with a peripheral OKC located in the retromolar trigone. We discuss this unique case and review the current literature on peripheral OKCs.

Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project.

INTRODUCTION: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. AIMS: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. METHODS: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. RESULTS: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include 'advice, analgesia and antimicrobial' from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. CONCLUSION: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.