Predictability of the virtual surgical plan for orthognathic surgery with the mandible surgery first sequence.

The aim of this study was to compare the virtually planned position to the postoperative position of the maxilla, having performed the maxilla-first sequence or mandible-first sequence orthognathic surgery. An audit of 64 patients who underwent bimaxillary surgery between 2017 and 2020 was performed. Thirty patients had maxilla-first surgery and 34 had mandible-first surgery. The planned and post-surgical positions were analyzed using specific skeletal landmarks. Differences were calculated and the two-sample t-test was used to compare the groups. Measured differences between the planned and postoperative results differed significantly between the mandible-first and maxillary-first surgery groups (P < 0.001). The maxillary central incisors were under-advanced in the anterior-posterior direction in both groups. Most data points showed deviation from the surgical plan ≤ 2 mm and ≤ 4°. Secondarily, maxillary under-advancement in the mandible-first cohort was evaluated; these patients were subdivided into rigid and non-rigid fixation groups. The non-rigid fixation group showed less accuracy compared to the rigid fixation group, which was statistically significant (P = 0.014). The findings of this study demonstrate that virtual surgical planning can be less accurate in predicting the maxillary incisor position when performing mandible-first surgery, but this inaccuracy is within the acceptable range and can be mitigated by rigid fixation of the mandible.

Analysis of an implantable venous anastomotic flow coupler: experience in head and neck free flap reconstruction.

Monitoring microvascular free flaps can present a difficult challenge. This is especially true in cases of buried or intra-oral free flaps. The authors conducted a retrospective review of 19 consecutive free flaps for head and neck reconstruction using a novel monitoring device, which combines a venous anastomotic coupler and an implantable microdoppler (Synovis Micro Companies Alliance Inc., Birmingham, AL, USA). 20 venous anastomoses were performed and monitored with the venous flow coupler device. Monitoring ranged from intra-operatively to postoperative day 7 (mean 4.2 days). Accurate flow signal interpretation was correct in 18 of 20 anastomoses (90%) but only 14 of the 20 coupled anastomoses (70%) were monitored for the complete period of time as desired by the surgeons. All 19 flaps survived. The venous anastomotic flow coupler appears to be a reliable adjunct to free flap monitoring and may help to improve it, with early detection of flap compromise and salvage.

Osteochondroma of the condyle: review of 8 cases.

This study is a retrospective review of the records of all cases treated in the authors' department since 1991 to identify patients with condylar masses diagnosed as osteochondromas. In 2186 cases of benign and malignant cysts/tumours of the maxillofacial region (1560 malignant and 626 benign), 8 osteochondromas of the mandibular condyle were identified. These 8 cases and the current English literature are reviewed.

Variations in the course of the hypoglossal nerve: a case report and literature review.

The extracranial hypoglossal nerve has a well described course as it traverses the neck, and is frequently identified during neck dissection, carotid endarterectomy and other procedures involving the deep spaces of the neck. A case is presented which demonstrates aberrancy of its anatomic position. Variations of its course are well documented, however none have demonstrated a course lateral to the internal jugular vein. This serves to alert the surgeon to be mindful of such atypical presentations as the consequences of iatrogenic injury to such structures may be significant.

Paediatric mucoepidermoid carcinoma of the palate.

The purpose of this paper is to review our experience with mucoepidermoid carcinoma (MEC), a rare tumour in minor salivary glands, in a small series of paediatric patients. A retrospective analysis of minor salivary gland tumours seen by one surgeon from March 1991 to December 1999 was undertaken. A total of 58 cases were identified and of these, five (9%) occurred in children. There were 23 cases of MEC, four (17%) of which occurred in patients under the age of 18 who presented with T1 or T2N0M0 low- to intermediate-grade MEC of the palate and adjacent structures. These patients form the basis of this study. All patients were treated with wide local excision, obtaining tumour-free margins, and followed for a mean number of 58 months. None of these tumours invaded bone and resection of bone was not performed in any case as the periosteum was intact and the tumours were low to intermediate grade. To date, all patients remain free of disease. One patient who went elsewhere for treatment, was treated with local resection only, and has also experienced no recurrence. Wide local excision is the treatment of choice for low to intermediate grade MEC of the minor salivary glands in paediatric patients.