The use of zygomatic implants for the retention of nasal prosthesis following rhinectomy: the Morriston experience.

Reconstruction and rehabilitation following rhinectomy remains controversial and presents a complex problem. Although reconstruction with local and microvascular flaps is a valid option, the aesthetic results may not always be satisfactory. The aesthetic results achieved with a nasal prosthesis are excellent; however patient acceptance relies on a secure method of retention. The technique used and results obtained in a large series of patients undergoing rhinectomy and receiving zygomatic implants for the retention of a nasal prosthesis are described here. A total of 56 zygomatic implants (28 patients) were placed, providing excellent retention and durability with the loss of only one implant in 15 years.

Successful Harvest of Free Fibula Flap in a Rare Anomalous Variant of the Peroneal Artery.

We present a case of successful harvest and anastomosis of a free fibula flap with 15 cm of bone where the peroneal artery was only 1.0 cm long and situated in the distal 1/3rd of the fibula.

Management of macroglossia in Beckwith-Wiedemann syndrome.

Beckwith-Wiedemann syndrome (BWS) is a rare congenital disease of low prevalence. Its most common feature is macroglossia, being present in most cases. Clinically macroglossia can compromise the airway, cause dysphagia, drooling and poor cosmesis. Functionally it can cause dentoskeletal discrepancy, protrusion of teeth, and speech abnormalities leading significant psychological issues both with the patient and their families. Surgical excision remains the mainstay of management and a variety of techniques have been described. Because of the high vascularity of the tongue, intra-operative blood loss could be significant and have high morbidity in the pediatric patient. We present a technique for tongue reduction in macroglossia associated with BWS using the Ultrasonic Dissector (Harmonic Scalpel). The principles of Ultrasonic dissection are discussed along with the potential advantages of the technique.

Necrotising fasciitis of the submandibular region; a complication of odontogenic origin.

Inadequate treatment or neglect of odontogenic infections can have serious consequences. The potential for spreading through fascial planes and intracranially can cause compromise of the airway and cavernous sinus thrombosis respectively. On rare occasions this can lead to a rapidly progressing necrotising fasciitis, with destruction of soft tissue, making reconstruction difficult. Antibiotic administration without removal of the cause is inadequate and can complicate subsequent management. We report the presentation and successful management of a 13-year-old boy, who developed necrotising fasciitis in the submandibular region as a result of inadequate initial treatment of a carious, lower molar resulting in significant skin and soft tissue loss.

A form for referral of injured patients between maxillofacial and ophthalmology units.

We have designed a form to facilitate referral of injured patients between maxillofacial and ophthalmology units. This form improves communication, gives a written record of referral, and can be used for audit.

Blood transfusion requirements in bimaxillary osteotomies.

The over-ordering of cross-matched blood to cover operations can result in blood shortages and is costly; it can never be free of risk. Current published guidelines recommend cross-matching 2 units of blood for bimaxillary orthognathic procedures with an additional 2 units if combined with a genioplasty. We reviewed the records of 115 consecutive cases of simultaneous bimaxillary osteotomies at Morriston Hospital over a 5-year period (January 1996 to December 2000). Ordering and use of blood were investigated and the cost analysed. Blood loss was minimised using a strategy of controlled moderate hypotension and meticulous haemostasis. Nine patients were given transfusions of blood but five of these were deemed inappropriate. No predisposing factors for transfusion were identified. We recommend that the tariff for ordering blood for bimaxillary osteotomies should be revised to a "group and save" with antibody screen, providing that a 30-min indirect antibody cross-match is available.

Post-traumatic orbital cellulitis.

Orbital cellulitis is uncommon. It may arise as a sequel to eyelid infection, or from direct spread of infection from the paranasal sinuses; it may be of odontogenic origin and has been reported after meningitis and after nasoorbital fractures with pre-existing sinusitis. Clinically, orbital cellulitis is of great importance, as it is a severe disease with potentially disastrous consequences. It may lead to optic neuritis, optic atrophy, blindness, cavernous sinus thrombosis, superior orbital fissure syndrome, meningitis, subdural empyema, and even death. We report two cases of severe post-traumatic orbital cellulitis with subperiosteal abscesses. These were managed surgically and vision was preserved. We describe the anatomy, a classification of orbital infection, and the importance of multidisciplinary management of these cases.

'Do-it-yourself' dental treatment: a case report.

The use of topical desensitizing agents and the placement of superficial restorations at cervical margins are part of a conventional treatment plan for hypersensitive teeth. This case report describes a dental-phobic patient who employed a rather peculiar 'do-it-yourself' approach to alleviate the problems of hypersensitivity, by covering her teeth with a mixture of candle wax and 'household' glue.