Management of Pediatric Condyle Fractures.

INTRODUCTION: Mandibular condyle fractures are a common type of facial fracture in children. The authors aimed to examine the demographics, etiology, treatment, and outcomes of these fractures managed in a single pediatric trauma unit. MATERIALS AND METHODS: A retrospective review was performed of patients presenting to a pediatric hospital between 2003 and 2016 with mandibular condyle fractures. Initial data was extracted from a dedicated trauma database. Included patient's medical records and imaging were then reviewed. Data on demographics, etiology, fracture type, and treatment were recorded. Univariate statistical analysis was performed. RESULTS: Forty-four patients with 49 condyle fractures were included. The average age of patients was 11.4 years (range 3-15 years). A fall from a bicycle/scooter was the most common mechanism. Twenty-six fractures were isolated and 23 involved a further fracture of the mandibular arch. The condylar neck was the most common site of fracture (55%). There was no statistical significance between age (0-10 years, 10-16 years) and site of fracture or the presence of an associated arch fracture. The majority of isolated fractures (73%) were treated conservatively without inter-maxillary fixation. Thirty-nine patients attended the follow-up and the median follow-up period was 196 days (interquartile range 21-165 days). Two patients had a malocclusion at follow-up that required intervention. CONCLUSION: There was a broad range of presentations in our cohort. Conservative management in isolated fractures resulted in stable outcomes and this large case series supports the consensus that management of pediatric condyle fractures should be as conservative as possible.

Admission patterns and outcomes of patients admitted to critical care in the UK with surgically treated facial infection: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database.

Facial infections are common and can occasionally be severe. A small number of patients may develop severe sepsis or airway compromise requiring critical care admission. We examined a national intensive care database to assess patterns of admission and outcomes for patients in this cohort. An analysis was performed of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database. Data were extracted on case mix and outcomes for patients coded as 'mandible, facial bones, dental, and salivary infection' admitted to critical care between 2010 and 2019. Data included admission numbers, demographics, comorbidities, physiology scores, and outcomes including length of stay and mortality. There were 2820 admissions for patients with facial infections from 212 CCUs over the ten-year period. Admissions increased from 194 in 2010 to 368 in 2019. These admissions accounted for 0.16% of overall admissions in 2010 and 0.21% in 2019, a statistically significant increase in the rate of admissions, p < 0.001. The median age of patients was 48 years and 62.7% were male. Sepsis was present in 77.6% of patients. The median length of stay in critical care was 49 hours (IQR 23.2, 100.3 hours). The median total hospital stay was 7 days (IQR 4, 16 days). The rate of admissions to CCUs for facial infection remains low overall but has significantly increased over the last decade. With increasing demand for this resource ongoing monitoring of utilisation is important.

Presentation and surgical management of a patient with a true cleft mandible.

Clefts involving the mandible and lower lip are very rare, with less than 80 cases having been reported worldwide. The objective of this case report is to highlight this unusual type of facial cleft, and to present the principle features and management typically associated with it. We carefully describe our surgical planning and management of the patient alongside a compilation and comparison of different surgical techniques described in the literature thus far. In this report, we discuss a patient with a cleft of the lower lip, true cleft mandible with independent movements of his mandibular segments, ankyloglossia, and a fistula extending from the mandible to the suprasternal notch complicated with congenital heart abnormalities. We explore the different approaches of when to close the hard and soft tissues, however, there is still no clear surgical protocol for treating cleft mandibles but with more cases and their management and outcomes being reported, this is something which will be useful to develop.

Osteosclerotic metaphyseal dysplasia, dysosteosclerosis or osteomyelitis? Paediatric case presentation with associated mandibular swelling and a review of the literature.

Osteosclerotic metaphyseal dysplasia (OMD) is an extremely rare form of osteopetrosis, which bears significant clinical similarities to dysosteosclerosis (DSS). We aim to present a rare case of OMD with mandibular swelling and osteomyelitis infection including diagnosis journey as well as management in 7-year-old patient. Literature review completed for OMD cases. Case report investigative methods include genetic testing, CT facial bones and MRI scan, orthopantogram and bone biopsies. An initial suspected diagnosis of DSS with chronic osteomyelitis was made. However, following genetic testing, a diagnosis of OMD was confirmed. Our patient underwent a surgical debulking procedure and antibiotic treatment. Less than 10 patients with this condition have been reported within the international literature. There is a wide range of presentation. OMD, DSS and osteomyelitis are all within a similar spectrum of bone conditions. Our understanding, regarding OMD, remains limited and, hence, further research is required to elucidate a thorough clinical picture.

Septic Arthritis of the Temporomandibular Joint with Intracranial Extension: A Case Report.

Septic arthritis of the temporomandibular joint (TMJ) is rare with few cases reported in the literature. We present a case of septic arthritis of the left TMJ in an 18-year-old man who was initially referred as a suspected TMJ dislocation. He had a 3-day history of pain, trismus and malocclusion with left preauricular swelling and became clinically septic with a positive blood culture containing Fusobacterium necrophorum. Computed tomography revealed left TMJ effusion. A later scan showed evidence of a temporal space collection and development of an intracranial extension in the left middle cranial fossa. The patient underwent needle arthrocentesis and drainage, followed by six weeks of antibiotic therapy following advice from neurosurgery and microbiology. Further imaging revealed resolution of the collection. Few cases have been reported of this unusual diagnosis, and this case demonstrates the importance of close multidisciplinary input in forming an accurate diagnosis and managing appropriately.

Admission patterns and outcomes of postoperative oral cavity and oropharyngeal cancer patients admitted to critical care in the UK: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database.

Surgery for head and neck malignancy may be complex with postoperative admission to critical care units (CCUs) often required. There are, however, increasing demands on this resource. We examined a national intensive care database to assess patterns of admission and outcomes for patients following surgery for malignancies of the oral cavity and oropharynx. An analysis was performed of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database. Data were extracted on case mix and outcomes for patients coded as 'malignant neoplasm of the oropharynx requiring surgery' admitted to critical care between 2010 and 2019. Data included admission numbers, demographics, comorbidities, physiology scores, and outcomes including length of stay and mortality. There were 9,843 admissions for patients with malignancies of the oral cavity and oropharynx from 156 CCUs over the ten-year period. Admissions increased from 486 in 2010 to 1,381 in 2019. These admissions accounted for 0.42% of overall admissions in 2010 and 0.78% in 2019. The median age of patients was 63 years and 63.5% were male. The median length of stay in critical care was 38 hours (Interquartile range (IQR) 20.4-64.3 hours). The median length of total hospital stay was 15 days (IQR 10-23 days). Mortality in critical care was low (0.7%). Admissions to CCUs following surgery for malignancies of the oral cavity and oropharynx have increased over the last decade but remain low overall. With increasing demand for this resource, ongoing monitoring of utilisation is important.

Masseter muscle defined sarcopenia and survival in head and neck cancer patients.

Sarcopenia is increasingly recognised as a poor prognostic factor in older patients undergoing cancer treatment. Recently, masseter muscle cross sectional area (MMCSA) has been shown to accurately identify sarcopenic patients. We aimed to apply this novel technique to a head and neck cohort to identify any potential relationship with survival. A retrospective review was undertaken of patients over 65 years, diagnosed with squamous cell carcinoma of the head and neck and treated with curative intent in our unit between October 2009 and October 2017. MMCSA was measured on staging CT scans using a validated technique. Patients were categorised into tertiles and also high and low MMCSA groups based on gender based tertile and mean MMCSA values. Survival analysis was performed using the Kaplan-Meier and Cox regression methods. A total of 111 patients were included in the study. The average age was 74 years (range 65-92 years) and 69% were male. The majority of patients had malignancies of the oral cavity (41%) or larynx (37%). The overall survival was 46% with a follow-up between 24 and 60 months. MMCSA was significantly associated with worse overall survival when defined using a gender based mean cut-off point (p=0.038) or tertile groupings (p=0.026), but did not maintain significance in multivariable analysis. Masseter muscle defined sarcopenia was associated with worse survival in our cohort in univariate analysis.Opportunistic measurement of this new factor on staging scans may aid prognostication and management in older patients.

UK Oral and Maxillofacial Surgery Trainee Perceptions of Flexible Nasal Endoscopy.

INTRODUCTION AND AIM: Flexible nasal endoscopy (FNE) is a useful adjunct in diagnosis and follow-up of oncology patients as well as in airway assessment. Proficiency in this technique is also listed as part of the Oral and Maxillofacial Surgery (OMFS) curriculum. We aimed to explore OMFS trainee perceptions of training and confidence in this technique. MATERIALS AND METHODS: An electronic survey was undertaken of OMFS higher surgical trainees in the UK. A 10-item questionnaire was formulated using online survey software (SurveyMonkey) and distributed to Specialty Registrars in all deaneries via their regional representatives. Questions on training, exposure to and confidence in FNE were asked. RESULTS: A total of 43 responses were received which included all grades of higher surgical trainees. A large proportion had undertaken FNE in oncology rotations (78.6%) and as part of airway assessment (85.6%). Nearly half of trainees (47.6%) were confident in diagnosing pathology using FNE although 16.6% had low levels of confidence in the technique. Only 38% had received formal training, and the majority of this training was a teaching session from a senior. A very large proportion of trainees (90.5%) feel formal training should be available in FNE and 76% would undertake a formal OMFS training course in FNE if available. CONCLUSIONS: Trainees have high levels of exposure to FNE but variable levels of confidence in the technique. Trainees appear to receive limited formal training in the technique, and the introduction of more formalised training could be explored.

YouTube™ as a source of information on extraction of third molars.

INTRODUCTION AND AIM: Healthcare information is becoming more readily available and searched for online, particularly on websites such as YouTube™. The accuracy and content of these websites is often questionable. We aimed to evaluate the quality of information available on surgical extraction of wisdom teeth on YouTube™. MATERIALS AND METHODS: We searched for the terms 'wisdom teeth', 'third molar', and 'wisdom tooth extraction' on YouTube™. The first 3 pages of results for each search term were assessed for inclusion and were independently rated by two assessors. Three separate scales to rate the quality of online information were used-DICSERN (range 0-5), HONcode (range 0-8) and the Global Quality Scale (GQS)(range 1-5). Cohen's kappa test was used to assess inter-rater reliability. RESULTS: The searches returned 179 videos, but 114 were excluded (37 duplicates, 3 unrelated, 57 non-surgical, 13 <10k views, 4 non-English). Of the 65 videos included, the average length was 6 minutes and 34 seconds, and the average percentage positivity was 89%. The mean DISCERN score was 1.47 (SD 1.13), and the mean score for GQS was 2.15 (SD 0.6). No video met all HONcode criteria with the mean score being 2.96 (SD 0.9). There was good inter-rater reliability for the DISCERN score (kappa= 0.744) and HONcode score (kappa =0.866) but less reliability for GQS (kappa = 0.204). CONCLUSION: The standard of information on YouTube™ on surgical extraction of wisdom teeth varies, but is of poor quality overall. Patients should be advised to be cautious of such sources for information on this topic.

Management of acute dislocation of the temporomandibular joint in dental practice.

Acute dislocation of the temporomandibular joint is a situation that, although rare, may present to the dentist in practice at any time. A number of activities, such as removal of a tooth, may cause dislocation. The event is painful and distressing for the patient, their family and the dental team. Prompt management minimises discomfort, distress and long-term morbidity to the patient. We describe the aetiology of acute dislocation and outline a number of techniques that will aid the clinican in dealing with this event.

Ischaemic necrosis of the tongue.

Necrosis of the tongue is a rare clinical finding. The rich vascularity of the tongue means necrosis is uncommon but it has been reported secondary to giant cell arthritis, radiotherapy and ischaemia. We report the case of a 61-year-old man admitted with an acute abdomen, who later developed gross swelling of the tongue, secondary to ischaemic necrosis, which necessitated tracheostomy placement. The ischaemia was managed conservatively with heparinisation and by allowing the ischaemic area to demarcate and slough off naturally.