Clinical experience and results with a Rhombic Plate for transoral endoscopically-assisted osteosynthesis of fractures of the condylar neck.

The intraoral approach is favoured by many patients and surgeons for the treatment of fractures of the condylar neck, but the limited space offered by this approach can make positioning and fixation of the osteosynthesis plate difficult. A rhombic-shaped plate was designed specifically for use with the intraoral approach, and introduced into our clinical practice in 2012. We present the clinical and functional results in 81 patients with 98 fractures of the condylar neck who we have treated with this technique. Of these six required surgical revision, and ultimately all but two had satisfactory occlusion and mandibular function. Our complication rate of 6/81 (7.4%) compares favourably with those reported elsewhere, and confirms that open reduction and internal fixation of condylar fractures using the Rhombic plate through an intra-oral approach provides good outcomes.

Mandibular fractures - towards a national standard for "time to theatre" - national audit by the BAOMS Trauma Specialist Interest Group.

Recent studies have shown that in most patients, a delay of several days in the treatment of mandibular fractures is not associated with adverse outcomes, and this has challenged the traditional practice of recommending treatment within 24hours. Longer hospital stays cost more and lower the patients' quality of life, but we know of no standard recommendation about when these patients should be treated. Our aim therefore was to find out how many patients had reduction and fixation of a fractured mandible by the end of the next working day, with a view to developing a national standard. We invited all oral and maxillofacial surgery (OMFS) units in the UK to participate in a prospective audit over two months, and 35 agreed. Overall, 506 patients (80%) were operated on by the end of the next working day. The time to theatre varied from 1 hour 15minutes to 11 days, 20hours and 51minutes (median 22hours 7minutes). Patients admitted to units with an OMFS trauma list were more likely to be operated on by the next working day (p=0.011) as were those operated on at the weekend (p=0.019). We think that early fixation, return of function, and discharge, benefit patients most in terms of quality of life. Also, shorter hospital stays and reduced costs increase the availability of resources for elective operations. Setting a standard will improve our service and the care we deliver.