2012 - The year when BAOMS and its officers prevented closure of all UK shortened medical and dental courses.

In Spring 2011 the Department of Health (DH) received a request to review European Union Directive 2005/36 EU - the directive relating to the recognition of professional qualifications. The Department of Health lawyer raised concerns that the existing shortened dental courses may be in breach of EU law. There were three shortened dental courses in the UK: 4year graduate entry courses in Liverpool/Peninsula and 3-year Dental Programme for Medical Graduates (DPMG) in Kings, London. During the summer the General Dental Council (GDC) was made aware of these concerns. In autumn 2011 the Chief Dental Officer for England with the GDC, told the Dental Deans' Council (DDC) that shortened dental courses were illegal. On 12th Jan 2012 students on the DPMG were told that they would have to complete a full 5-year dental degree. The GDC said that this interpretation of EU law would also impact on shortened medical courses. In view of the potentially enormous impact that this would have on OMFS training, BAOMS engaged all the resources it could and by assembling legal opinions including written contributions from Sir David Edward, whose opinion was being misinterpreted by the GDC and DH, and by sharing these resources with all the stakeholders, BAOMS was able to preserve shortened dental and medical courses. Now that the UK has left the European Union, negotiations around mutual recognition of qualifications may mean this issue will resurface. We should remain vigilant.

Are we 'on the right trach?' The National Confidential Enquiry into Patient Outcome and Death examines tracheostomy care.

OBJECTIVES: The National Confidential Enquiry into Patient Outcome and Death presents a detailed survey of practice, encompassing the care pathway for patients with a new tracheostomy formed in hospital, alongside a review of organisational aspects of care. RESULTS: Tracheostomy formation has come to be regarded as a relatively low-risk procedure that can be carried out safely at the bedside, even in high-risk patients. Information on how many procedures are carried out percutaneously has been poor and not captured by existing UK data collection systems. CONCLUSION: The study reinforces recommendations made by other healthcare groups, and presents new information which can be used as a basis for discussion and future planning to improve patient outcomes. The importance of meticulous ongoing care of a tracheostomy is recognised as important to prevent patient complications. Bedside staff must have the knowledge, competencies and confidence to deal with common and potentially life-threatening emergencies when they occur.

QTL mapping of complex binary traits in an advanced intercross line.

An advanced intercross line (AIL) is an easier and more cost-effective approach compared to recombinant inbred lines for fine mapping of quantitative trait loci (QTL) identified by F(2) designs. In an AIL, a complex binary trait can be mapped through analysis of either continuously distributed proxy traits for the liability of the binary trait or the liability itself, the latter presenting the greater statistical challenge. In another work, we successfully applied both approaches in an AIL to fine map previously identified QTL underlying anatomical parameters of the cardiac inter-atrial septum including patent foramen ovale. Here, we describe the statistical methods that we used to analyse complex binary traits in our AIL design. This is achieved using a likelihood-based method, with the expectation-maximisation algorithm allowing use of standard logistic regression methods for model fitting.

The role of thoracic computed tomography in staging newly-diagnosed oral squamous cell carcinoma.

Patients who present with squamous cell carcinoma (SCC) in the head and neck have a serious risk of coincident thoracic malignancy. The aim of this study was to identify the incidence of thoracic malignancy in newly diagnosed, previously untreated, oral and oro-pharyngeal SCC, and to evaluate the role of thoracic computed tomography (CT) in its management. Of 116 consecutive patients who were identified prospectively 81(70%) had oral and 35 (30%) oropharyngeal SCC. Ten patients (9%) had suspicious thoracic CT findings. After investigation or follow up, four (3.5%) of these patients were shown to have coincident thoracic malignancies. This large prospective series of newly diagnosed oral and oropharyngeal SCC had a lower incidence of coincident thoracic malignancy than had previously been shown.

Sensory deficit in the donor hand after harvest of radial forearm free flaps.

Fifty patients undergoing radial forearm free flap reconstruction of head and neck defects were examined to find out the extent of sensory defect at the donor site. Flaps (mean length 6 cm, range 4-9) and mean width 4.7 cm (range 3.5-7) were raised. Of the 50 patients 38 (76%) were aware of some sensory loss over the radial distribution in the donor hand. There was objective evidence of a reduction in at least one sensory function in 32 of these patients (84%). The mean affected area was 44.3 cm(2) (range 6-125). The mean length of the affected area was 11.3 cm (range 4.3-12.1) and the mean width 5.1cm (range 2.1-8.4). Of the 12 patients (24%) who reported no feeling of sensory loss all modalities of sensation were preserved in 11 (92%).

Palmar arch backflow following radial forearm free flap harvest.

BACKGROUND: Most surgeons advocate an Allen test (for occlusion of the radial or ulnar artery) and Doppler ultrasound examination before harvesting a forearm flap. In this study we attempted to correlate the results of these tests with intraoperative measurement of backflow pressure in the radial artery stump. METHOD: Stump pressures were measured in 30 patients after the flap had been harvested and were compared with preoperative assessment and intraoperative measurements of mean arterial pressure (MAP). RESULTS: Mean arterial backflow pressure (MABP) in the arterial stump varied from 27 to 55mm Hg (mean 40.5). The ratio of this value to the mean arterial pressure ranged from 0.39 to 0.89 (mean 0.59) and exceeding 0.5 in 21 patients (70%). There was no correlation between this ratio and the preoperative assessment. CONCLUSIONS: These findings suggest that in the presence of a satisfactory Allen test and Doppler examination, there is adequate pressure in the palmar system to maintain vascular integrity of the donor hand after sacrifice of the radial artery. Despite the possibility of anatomical variants, the routine use of more invasive imaging is unnecessary.

The role of vital tissue staining in the marginal control of oral squamous cell carcinoma.

Since vital staining has been advocated as a sensitive method of displaying epithelial atypia, 14 oral squamous cell carcinomas were stained immediately preoperatively with toluidine blue and then resected 1 cm outside clinically abnormal or positively staining tissue. The integrity of the entire tissue margin was histologically examined in each case. Whilst vital staining delineated all 14 invasive carcinomas at the centre of each resected specimen, 10 foci of carcinoma-in-situ or severe dysplasia were identified not to have stained at the resection margins. Toluidine blue may, therefore, be an adjunct in identifying invasive tumour at mucosal resection margins. However, it would appear to be of no benefit in delineating positive resection margins due to carcinoma-in-situ or severe dysplasia, and hence it may be of little value in reducing the incidence of local recurrences.

The effects of operator technique and bur design on temperature during osseous preparation for osteosynthesis self-tapping screws.

OBJECTIVE: Although the importance of atraumatic preparation of bone before the placement of osseointegrated implants has long been emphasized, the situation during placement of self-tapping screws has received little attention. Because the production of excessively high temperatures during osseous drilling is known to impair bony regeneration, the strict thermal criteria that are set for implant placement should theoretically be extended to trauma and orthognathic internal fixation. STUDY DESIGN: Temperatures achieved during the drilling of thawed human cadaveric bone before the insertion of osteosynthesis self-tapping screws were measured in vivo with thermocouples. Combinations of 2 drilling systems and 2 bur designs were studied. Variations in surgical technique were incorporated by altering both the force applied by the operator and the application of irrigant. Statistical significance was examined through use of a Student t test. RESULTS: One of the 2 bur designs and careful operator technique were associated with significantly smaller increases in temperature. Irrigation had the greatest effect on temperature recorded, the absence of irrigant resulting in temperatures in excess of 70 degrees C. CONCLUSIONS: These findings emphasize the importance of careful surgical technique and constant irrigation during osseous preparation if the potential for bone regeneration around osteosynthesis self-tapping screws is to be maximized.

The role of thorax imaging in staging head and neck squamous cell carcinoma.

The overall survival rate for patients with head neck squamous cell carcinoma remains disappointingly static despite improved locoregional control. This has been attributed to the development of distant metastases and second primary malignancies in these patients, a large proportion of which occur in the thorax. We retrospectively analysed the incidence of thoracic malignancies in 138 patients presenting with newly diagnosed (n = 107) or recurrent (n = 31) cancer of the head and neck over a 4-year period. All 138 patients had undergone both computerised tomography of the thorax (CT) and conventional chest radiography within one month of presenting with biopsy proven squamous cell carcinoma. Seventeen percent of these were found to have simultaneous thoracic malignancies. CT thorax was more sensitive in detecting simultaneous thoracic malignancies compared with standard chest X-ray (24/138 versus 9/138, odds ratio of 3:1 in favour of CT). All thoracic malignancies detected by chest X-ray were also detected by CT thorax. Patients presenting with recurrent tumors were significantly more likely to have simultaneous thoracic malignancies than those with newly diagnosed cancer (11/31 versus 13/107, chi2 test with Yates correction, chi2 = 4.66, p = 0.03). The primary site (laryngeal, oral or pharyngeal) or presence of nodal disease did not have an effect on the incidence of simultaneous thoracic malignancies. The presence of distant metastases and second primary malignancies has major implications in the management and prognosis of patients presenting with head and neck squamous cell carcinoma, with a large proportion of such patients succumbing to their disease within one year of diagnosis. As CT scanning of the thorax was a more effective screening investigation than standard chest X-ray in the detection of simultaneous thoracic malignancy, we recommend it for use in the staging of patients presenting with cancer of the head and neck.

Tie-over bolster dressings may not be necessary to secure small full thickness skin grafts.

BACKGROUND: The accepted method for securing full thickness skin grafts (FTSG) is with a tie-over bolster dressing, with or without basting sutures. We question the need for tie-over bolster dressings for small FTSGs. OBJECTIVE: We describe our method of FTSG reconstruction and the outcome in a consecutive series. METHODS: Thirty patients with surgical defects following tumour excision from the face24, scalp1, ear2, and finger3 ranging in diameter from 8 to 45 mm (mean 20 mm) were reconstructed with a FTSG. Interrupted monofilament nylon perimeter sutures only were used, with antibiotic ointment at the wound edge with either a light dressing or no dressing. RESULTS: A series of 30 FTSG secured without a tie-over bolster dressing or basting sutures is described, all with good to excellent long term results. In two cases there was early superficial necrosis of the graft, but ultimately 100% graft take. CONCLUSION: We have found tie-over bolster dressings and basting sutures to be unnecessary in our series of small FTSG. This technique saves time and material and minimizes handling of the graft.

The application of toluidine blue as a diagnostic adjunct in the detection of epithelial dysplasia.

The detection of premalignant lesions of the oral mucosa allows for treatment that may be sufficiently early to prevent their progression to invasive carcinoma. Although a number of techniques for supplementing clinical examination have been described, on the whole they rely on laboratory-based investigations with variable false-negative rates. Toluidine blue vital staining, on the other hand, has been advocated as a simple, inexpensive, and sensitive chairside test. Most of the clinical series investigating its efficacy, however, have relied on clinically abnormal mucosa or tissue that stained. For the purpose of quantifying the true sensitivity of toluidine blue, the present study involved the examination of clinically normal mucosa as well as abnormal tissue and compared it with the presence or absence of staining. With this technique the false-negative rates of 42% and 58% obtained for carcinoma-in-situ and mild-to-moderate dysplasia, respectively, suggest restricting the use of vital staining to selective cases.

Identification of quantitative trait loci for prolificacy and growth in mice.

Marker-quantitative trait locus (QTL) linkage was evaluated in F2 intercross and backcross mouse populations derived from stocks differing dramatically in prolificacy and mature weight. A highly prolific outbred Quackenbush-Swiss mouse line, or an inbred line derived from it (16.62 +/- 0.22 and 14.64 +/- 0.27 pups per litter, respectively) were used as one of the grandparents in these populations. The less prolific C57BL/6J inbred mouse line (6.67 +/- 0.37 pups per litter) was used as the other grandparent. Linkage was evaluated in a three-step process that involved selective genotyping of F2 intercross progeny representing extremes for prolificacy, genotyping of the full F2 for chromosomal regions potentially associated with prolificacy, and genotyping of the backcross for genomic regions significantly associated with prolificacy in the F2. Segments of Chromosomes (Chrs) 2 and 4 were significantly (P < 0.05, experiment-wise error rate) associated with prolificacy, and LOD scores suggestive of linkage were observed for litter size on Chr 9 and growth on Chrs 4 and 11. Existence of growth QTL was also supported by marker effects that were significant (P < 0.05) or approaching significance (P < 0.10) in the backcross. Additive litter size QTL effects ranged from 0.56 to 0.79 pups per litter, and dominance deviations ranged from -0.56 to 1.19 pups per litter, suggesting overdominance as a possible mode of gene action in some cases. The observation of pleiotropic or linked QTL for growth and prolificacy corresponds well with results from many selection experiments identifying positively correlated responses to selection for these two traits.

Lower eyelid reconstruction using pedicled skin flap and palatal mucoperiosteum.

BACKGROUND: Full-thickness lower eyelid reconstruction requires functional as well as aesthetic considerations to be successful in the long term. The three elements necessary for a stable result are skin, mucosa, and a semirigid "skeleton" to provide the support that prevents the development of ectropion. A number of techniques combining these elements are described in the literature, with reconstruction in one or more stages. OBJECTIVE: We report a simple method of reconstruction of a full-thickness lower eyelid defect, in which palatal mucoperiosteum provided both the mucosal and the "skeletal" components following tumor excision. METHODS: Literature review and report of illustrated case. RESULTS: A cosmetically acceptable result with no functional deficit or donor site morbidity. CONCLUSION: Palatal mucoperiosteum provides an abundant supply of tissue that may be used successfully in the reconstruction of the lower eyelid. It functions both as a mucosal lining in addition to a semirigid supporting framework.

Sonographic observations of the gastroduodenal junction of dogs.

OBJECTIVES: To determine the sonographic dimensions and an imaging protocol for the pyloric region of the normal canine stomach, and whether sonography could be used to demonstrate antroduodenal motility. ANIMALS: 20 clinically normal, mixed-breed dogs (mean +/- SD, 15.1 +/- 7.1 kg). PROCEDURE: In vitro sonographic observations of the gastroduodenal junction were made after each had been mounted on an acrylic rack placed in an organ bath. The in vivo studies were performed in anesthetized dogs. RESULTS: The wall of the pyloric antrum was 4 to 5 mm thick, that of the pylorus was 3 to 4 mm thick, and that of the cranial part of the duodenum was 2 to 3 mm thick. The pyloric canal had a length of 16 to 17 mm and overall in vivo diameter of 22 mm, and the muscular part of its wall was 2 to 3 mm thick. In vivo sonographic images were best made with the dog in dorsal recumbency, tilted 30 degrees to the right-the feasibility study clearly demonstrated the form and function of antroduodenal motility, including gastric and duodenal peristalsis, opening and closing of the pyloric canal, and duodenogastric reflux of fluid and gas. CONCLUSIONS AND CLINICAL RELEVANCE: The use of a routine imaging protocol, accompanied by mensuration of the gastroduodenal junction, will permit an opinion to be given as to whether the structure and function of the region are normal or whether pathologic change exists.

Stability of the Le Fort I osteotomy in patients with cleft lip and palate.

Relapse of the maxilla was studied retrospectively in a group of 61 patients with previously repaired cleft lip and palate who had undergone Le Fort I osteotomy. The extent of surgical move and relapse over a mean period of 28 months was measured with reference to the cranial base, and found to be similar to those in other studies. The use of direct bone plates for fixation of the maxilla is associated with a significantly more stable postoperative result.

Electron microscopy of the seminiferous epithelium in the triploid (ZZZ and ZZW) fowl, Gallus domesticus.

The ultrastructure of cells of the seminiferous epithelium is described in both triploid ZZZ and ZZW fowls, especially cytological aberrations influencing the development of morphologically abnormal spermatids and spermatozoa. Mitotic divisions in triploid fowls are similar to those in diploid fowls, but meiosis in both the ZZZ and ZZW triploid fowl is abnormal and many defective gametes are produced. The majority of spermatids have structural abnormalities and this is attributed to the aneuploidy expected from meiotic chromosome pairing in a triploid. Some spermatids were observed to possess an irregularly shaped head, 2 centriolar complexes, 2 acrosomes and 2 tails and this type differentiated into large-headed spermatoza. Such spermatids and spermatozoa are suggested to be near diploid due to their large nuclear size and 2 sets of organelles. Other spermatids, observed with only 1 centriolar complex, 1 acrosome and 1 tail, are suggested to be near haploid. Differentiation of these spermatids is similar to the process observed in diploid fowls except that there is a high percentage of abnormally shaped heads. The fact that morphologically normal spermatozoa were rare is consistent with the expectation that very few spermatozoa would be exactly haploid. In both ZZZ and ZZW triploid fowls, triple pairing of chromosomes is observed in synaptonemal complexes (SC) during meiosis and recombination nodules are distributed at random in the central regions of the triple pairing SC. In ZZW triploid fowls gamete formation is more severely affected than in ZZZ triploid fowls and it is suggested that many of the degenerative changes occurring in ZZW fowls could be attributed to those spermatids that possess a W sex chromosome, since normal male fowls are the homogametic sex (ZZ) and normal spermatids and spermatozoa contain only a Z sex chromosome.

Anatomic and radiographic appearance of a sesamoid bone in the tendon of origin of the supinator muscle of the cat.

Results of radiologic and anatomic studies of each cubital articulation (elbow) of a group of 50 adult cat cadavers indicated that a sesamoid bone may be located in a constantly present sesamoid cartilage associated with the tendon of origin of the supinator muscle. Radiography revealed a sesamoid bone in 40 of the 100 tendons of origin of the supinator muscles dissected from the elbows. The sesamoid bone articulated with the craniolateral aspect of the head of the radius, and the larger sesamoid cartilage, which contained the bone, articulated with the head of the radius and the capitulum of the humerus. Of several possible functions of the sesamoid cartilage (bone), it was considered that protection of the craniolateral part of the humeroradial articulation and maintenance of the complex anatomic system during joint movement were important. In radiographic views of the elbows of lame cats, the sesamoid bone should not be mistaken for a chip fracture or an osteocartilaginous loose body.