Speeding and maxillofacial injuries: impact of the introduction of penalty points for speeding offences.

On 31 October 2002 the Irish Government introduced a point demerit scheme for road speeding offences. To evaluate the impact of the scheme, we made a comparative assessment of the number of maxillofacial operations necessitated by road crashes at two tertiary surgical centres in the year before and the year after the introduction of penalty points. There were no significant differences in the composition of the groups between the two study periods. There were 57 operations in the year before and 22 in the year after for injuries caused by collisions (a 61% reduction). No changes were seen in the distribution or severity of maxillofacial injuries or in the pattern or severity of other injuries. Severity was assessed using the Abbreviated Injury Scale (AIS) and Maximum Abbreviated Injury Severity Scale (MAIS), and bodily injuries by the Injury Severity Scale (ISS). The number of patients requiring intensive care and the duration of admission to the unit were unchanged, as was the total duration of hospital admission. There were no differences in the requirement for other specialist management.

Donor site morbidity of the anterior iliac crest following cancellous bone harvest.

Anterior iliac crest donor site morbidity was analysed retrospectively at 154 sites in 137 patients who had undergone secondary bone grafting of the cleft alveolus. The applied surgical anatomy and operative technique utilizing a medially based osteoplastic flap are described. The results show a low incidence of donor site morbidity.

Cervical spine injuries in patients with facial fractures: a 1-year prospective study.

A total of 582 consecutive patients with facial fractures were investigated prospectively for evidence of a concomitant cervical spine injury. Of them, 1.04% (6) were found to have a cervical spine injury, all having occurred in road traffic accidents. Only two of the injuries were diagnosable on standard, three-view, plain cervical spine radiographs. Four were diagnosable from computerized tomography scan, while the remaining two required stress views under radiographic screening for definitive diagnosis.

The maxillary antrolith.

The case of a maxillary antrolith discovered as an incidental finding on a panoramic radiograph is presented. The literature is reviewed, with particular reference to etiology, clinical features, and radiographic findings. The value of facial tomographs taken in two directions pertaining to the present and similar cases is discussed.

Osteomyelitis of the mandible as a complicating factor in Paget's disease of bone.

A case of osteomyelitis of the mandible in a patient with extensive Paget's disease of bone is presented. The changes in the bone with Paget's disease makes the diagnosis, clinical assessment and management of the osteomyelitis in such patients a difficult task.

Extracondylar osteochondromas of the jaws.

A review of the literature and the addition of two new cases have revealed that according to a histologic criterion there are presently twenty reported cases of osteochondroma of the jaws located outside the condyles. Although most of the extracondylar lesions have occurred on the coronoid process, cases are now reported on the maxilla and the body of the mandible. The clinical features of these lesions are compared with those located in the condyle, and the radiographic and surgical approaches of the extracondylar lesions are discussed.

Dental management of the irradiated patient.

There is an increasing number of patients receiving radiation therapy for oral malignancies. In many malignant tumors, radiation is often the treatment of choice, while in others it may be used in conjunction with surgery or chemotherapy. There are inherent dental and oral problems associated with radiation therapy. It is the purpose of this paper to deal briefly with the physical principles and the biological basis of radiation therapy. In addition, the specific radiation effects on oral mucous membranes, taste buds, salivary glands, bone, the periodontium and teeth will be discussed. Radiation complications in edentulous patients, and in particular the problems of wearing dentures in such patients will be evaluated. An approach to the problem of dental extractions and other dental treatments in the pre- and post-irradiated patient is suggested.

Traumatic ankylosis of the temporomandibular joint.

Traumatic injuries to the region of the temporomandibular joint (TMJ) may result in varying degrees of hypomobility of the mandible. The physical and psychological problems associated with restricted jaw opening are outlined. The different forms of ankylosis are mentioned. The rationale behind the various surgical approaches to the problem is outlined, and mention is made of current concepts in joint reconstruction. The importance of supportive adjunctive therapy in the postoperative period, is emphasized.

Orofacial odontogenic infections.

Clinical manifestations of odontogenic orofacial infections are protean and are largely dictated by complex microbiota and anatomic routes of spread. Complications such as suppurative mediastinal or intracranial extension, retropharyngeal spread and airway obstruction, pleuropulmonary involvement, and hematogenous dissemination indicate the potentially serious nature of these infections. In this review we emphasize the pathogenetic mechanisms of infection, the principles of antimicrobial therapy, and the need for early surgical intervention.

Necrotizing fasciitis.

Necrotizing fasciitis is a relatively uncommon severe soft tissue infection that is characterized by rapid widespread superficial fascial necrosis with undermining of surrounding soft tissue. Recent advances in anaerobic culture techniques have allowed identification of anaerobic organisms, which are now considered to have a vital role in the pathogenesis of this soft tissue infection. Therapy requires both rapid institution of a high level of antibiotics and a radical surgical incision and drainage procedure. All of the aerobic and anaerobic organisms isolated in the reported case of necrotizing fasciitis arising from a periapically infected mandibular third molar demonstrated in vitro sensitivity to penicillin.