Proposal for establishment of the UK Cranial Reconstruction Registry (UKCRR).

BACKGROUND: The increasing utilisation of decompressive craniectomy for traumatic brain injury and stroke has led to an increase in the number of cranioplasties undertaken. Cranioplasty is also undertaken following excision of tumours originating from or invading the skull vault, removal of bone flaps due to post-operative infection, and decompressive craniectomy for the management of rarer causes of brain oedema and/or refractory intracranial hypertension. The existing literature which mainly consists of single-centre, retrospective studies, shows a significant variation in practice patterns and a wide range of morbidity. There also exists a need to measure the outcome as perceived by the patients themselves with patient reported outcome measures (PROMs; functional outcome, quality of life, satisfaction with cosmesis). In the UK, the concept of long-term surveillance of neurosurgical implants is well established with the UK shunt registry. Based on this background, we propose to establish the UK Cranial Reconstruction Registry (UKCRR). AIM: The overarching aim of the UKCRR is to collect high-quality data about cranioplasties undertaken across the UK and Ireland in order to improve outcomes for patients. METHODS: Any patient undergoing reconstruction of the skull vault with autologous bone, titanium, or synthetic material in participating units will be eligible for inclusion. Data will be submitted directly by participating units to the Outcome Registry Intervention and Operation Network secure platform. A Steering Committee will be responsible for overseeing the strategic direction and running of the UKCRR. OUTCOME MEASURES: These will include re-operation due to a cranioplasty-related issue, surgical site infection, re-admission due to a cranioplasty-related issue, unplanned post-operative escalation of care, adverse events, length of stay in admitting unit, destination at discharge from admitting unit, mortality at discharge from admitting unit, neurological status and PROMs during routine follow-up. CONCLUSION: The UKCRR will be an important pillar in the ongoing efforts to optimise the outcomes of patients undergoing cranioplasty.

Treatment with infliximab: Implications in oral surgery? A case report.

Infliximab is a tumour necrosis factor-alpha (TNF-alpha) inhibitor (neutralising antibody), which is increasingly being used as an immunosuppressant to manage inflammatory conditions including rheumatoid arthritis, ankylosing spondylitis and Crohn's disease. Its side effects include diabetes mellitus, an increased incidence of lymphoma and greater susceptibility to infections such as pulmonary tuberculosis. In patients on infliximab, the oral cavity may act as a bacterial reservoir leading to unwanted local or systemic complications. To date no report describes the potential implication/s of infliximab in patients having oral surgery. This case report may be the first in the English language to report the development of mandibular osteomyelitis after surgical extraction in a patient on infliximab.

Surgical emphysema following a restorative procedure: A case report.

UNLABELLED: Surgical emphysema is a rare complication following a restorative procedure, despite the use of air-driven handpieces. Although most cases resolve spontaneously, it should be correctly managed to avoid potentially life-threatening situations, such as pneumomediastinum and pneumothorax. CLINICAL RELEVANCE: Surgical emphysema, although rare, can occur following certain dental procedures. It should be avoidable but, when it occurs, appropriate management is essential.

Glossodynia and necrosis of the tongue caused by giant cell arteritis.

Spontaneous, endogenous pain in the tongue (glossodynia) is rare, particularly when this progresses to ulceration and necrosis of the tongue. We report the case of a 74-year-old woman who presented with glossodynia that eventually resulted in necrosis of the tongue. The diminished blood supply was the result of histologically confirmed giant cell arteritis.