Elective surgical cricothyroidotomy in oral and maxillofacial surgery.

Surgical Cricothyroidotomy is regarded as an emergency procedure today even though it has a good evidential record as an elective surgical airway. A misunderstanding of Jackson's landmark paper in 1921 has made the simple and safe procedure unpopular because of the fear of subglottic stenosis. We present the incidence of subglottic stenosis after surgical cricothyroidotomy, discuss evidence for elective surgical cricothyroidotomy, and suggest potential applications in oral and maxillofacial surgery.

Three-dimensional assessment of early surgical outcome in repaired unilateral cleft lip and palate: Part 1. Nasal changes.

OBJECTIVE: To evaluate three-dimensional nasal morphology following primary reconstruction in children with unilateral cleft lip and palate relative to contemporaneous noncleft data. DESIGN: Prospective, cross-sectional, controlled study. SETTING: Glasgow Dental Hospital and School, Faculty of Medicine, Glasgow University. PATIENTS AND PARTICIPANTS: Two groups of 3-year-old children (21 with unilateral cleft lip and palate and 96 controls) with facial images taken using a three-dimensional, vision-based capture technique. METHODS: Three-dimensional images of the face were reflected so the cleft was on the left side to create a homogeneous group for statistical analysis. Three-dimensional coordinates of anthropometric landmarks were extracted from facial images by a single operator. A set of linear measurements was used to compare cleft and control subjects on right and left sides, adjusting for sex differences. RESULTS: The mean nasal base width and the width of the nostril floor on right and left sides differed significantly between control and unilateral cleft lip and palate groups. The measurements were greater in children with unilateral cleft lip and palate. The differences in the mean nasal height and mean nasal projection between the groups were not statistically significant. Mean columellar lengths were different between the left and right sides in children with unilateral cleft lip and palate. CONCLUSIONS: There were significant nasal deformities following the surgical repair of unilateral cleft lip and palate.

Three-dimensional assessment of early surgical outcome in repaired unilateral cleft lip and palate: Part 2. Lip changes.

OBJECTIVE: To evaluate three-dimensional lip morphology, following primary reconstruction in children with unilateral cleft lip and palate relative to contemporaneous noncleft data. DESIGN: Prospective, cross-sectional, controlled study. SETTING: Glasgow Dental Hospital and School, University of Glasgow, U.K. PATIENTS AND PARTICIPANTS: Two groups of 3-year-old children (21 with unilateral cleft lip and palate and 96 controls) with facial images taken using a three-dimensional vision-based capture technique. METHODS: Three-dimensional images of the face were reflected so the cleft was on the left side to create a homogeneous group for statistical analysis. Three-dimensional coordinates of anthropometric landmarks were extracted from facial images. Three-dimensional, generalized Procrustes superimposition was implemented and a set of linear measurements were used to compare cleft and control subjects for right and left sides, adjusting for sex differences. RESULTS: Crista philtri on both the cleft and noncleft sides were displaced laterally and posteriorly; there was also a statistically significant increase in philtrum width. No significant differences between cleft and control regarding the cutaneous height of the upper lip. The lip in the cleft patients was flatter than in the noncleft individuals, with less prominence of labialis superioris. CONCLUSIONS: Stereophotogrammetry allows detection of residual dysmorphology following cleft repair. There was significant increase of the philtrum width. The lip appeared flatter and more posterior displaced in unilateral cleft lip and palate patients compared with controls.

Juvenile idiopathic arthritis (JIA): a screening study to measure class II skeletal pattern, TMJ PDS and use of systemic corticosteroids.

OBJECTIVE: To screen patients with oligoarticular and polyarticular forms of Juvenile Idiopathic Arthritis (JIA) to determine (i) the severity of their class II skeletal pattern; (ii) temporomandibular joint signs and symptoms and (iii) use of systemic corticosteroids. DESIGN: Cross-sectional screening. SUBJECTS AND SETTING: Sixty-eight children with JIA aged between 9 and 16 years old who were screened at four regional treatment centres in the UK. METHOD: Patients were screened clinically and radiographically for the presence of class II skeletal pattern and temporomandibular (TMJ) pain dysfunction syndrome. In addition, the JIA sub-type and history of disease activity and medication were recorded. MAIN OUTCOME MEASURES: Class II skeletal pattern, TMJ signs and symptoms, use of systemic corticosteroids. RESULTS: The mean ANB values were 4.2 degrees (SD = 2.9 degrees) in the oligoarticular group and 5.1 degrees (SD = 3.8 degrees) in the polyarticular group. Just under one-third of children had a moderate or severe class II skeletal pattern and a further quarter of children had a mild class II skeletal pattern. Clinical signs and symptoms of temporomandibular joint pain dysfunction syndrome were low (<20%), except for crepitus and click which affected between 24 and 40% of JIA children. Radiographically, 57% of oligoarticular and 77% of polyarticular cases exhibited condylar erosion. Use of systemic corticosteroids varied between centres, but overall, was prescribed more in polyarticular cases (P = 0.001). CONCLUSIONS: Just under one-third of oligoarticular and polyarticular JIA patients exhibited a moderate or severe class II skeletal pattern. It is, therefore, likely that any future clinical trial to investigate the effect of functional appliance treatment in JIA patients, will need multicentre co-operation to fulfil potential sample size requirements. Clinical signs and symptoms of temporomandibular joint pain dysfunction syndrome were low except for crepitus and click. However, radiographic evidence of condylar erosion was high particularly in the polyarticular group. Use of systemic corticosteroids was prescribed more in polyarticular cases and this is likely to reflect the severity of the disease.

Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls.

OBJECTIVE: To evaluate dental arch relationships and dimensions, relative to an age matched noncleft sample, in Caucasian 3-year-old children with repaired unilateral cleft lip (UCL) or unilateral cleft lip and palate (UCLP). DESIGN: Prospective, cross-sectional, case-control study performed in Scotland, U.K. PARTICIPANTS: Eleven children with repaired unilateral cleft lip, 16 children with repaired unilateral cleft lip and palate, and 78 children as controls. MAIN OUTCOME MEASURES: Dental arch relationships and linear arch dimensions. RESULTS: Prevalence of Class III incisor relationship was 31.3% in children with unilateral cleft lip and palate compared with 9.1% in children with unilateral cleft lip. A buccal crossbite was present in 36% of children with unilateral cleft lip, compared with 75.6% of children with unilateral cleft lip and palate.Mean linear maxillary arch dimensions did not differ significantly between children with unilateral cleft lip and the controls. Except for second intermolar width, statistically significant differences existed in mean linear maxillary arch dimensions between the unilateral cleft lip and the unilateral cleft lip and palate groups; the mean linear maxillary arch dimensions were significantly greater in the control group than in the unilateral cleft lip and palate group. The mean cleft-affected anterior quadrant length appeared to be the arch dimension with the greatest power of discrimination among the three groups. There were no significant differences in mean linear mandibular arch dimensions among the three groups. CONCLUSIONS: Anterior crossbite was almost three times more common in the unilateral cleft lip and palate group than in the unilateral cleft lip group. Mean linear maxillary arch dimensions differed significantly between the unilateral cleft lip and palate group and the control group. There were no significant differences in mean linear maxillary arch dimensions between unilateral cleft lip and controls or between mean linear mandibular arch dimensions for unilateral cleft lip, unilateral cleft lip and palate, and controls.