Apert syndrome: an informative long-term dentofacial outcome.

The management of patients with Apert syndrome (AS) is complex and reflects the multisystem disease as a result of premature fusion of cranial vault, cranial base and midface sutures as well as extremity anomalies characterised by syndactyly. Early cranial sutural fusion results in craniocerebral disproportion which can lead to crisis surgical intervention due to raised intracranial pressure, ophthalmic and compromised airway concerns. Childhood inventions are often determined by psychosocial concerns and adult surgical interventions are often determined by cosmetic concerns. Treatments are provided by many different specialists within multidisciplinary teams (MDT). The treatment pathway extends from birth well into adulthood and is often associated with a heavy burden of care. Due to the extensive nature of the interaction with these patients MDT members have opportunities to provide enhanced patient-centred care and support.This case report provides an overview of the current knowledge of the aetiology of AS, illustrates the pathway of surgical and non-surgical management of AS and provides a long-term review of the dentofacial treatment outcomes.By having a better understanding of the impact of AS and treatment provided, MDT members can not only provide improved clinical treatment but also offer improved patient experiences for those with craniofacial anomalies, in particular, an increased awareness of the psychosocial challenges they endure.

Long-term treatment outcomes from the perspective of a patient with unilateral cleft lip and palate.

The management of patients with orofacial cleft (OFC) often extends from diagnosis or birth well into adulthood and requires many different specialists within multidisciplinary teams (MDT). The aims of treatment are to restore form and function relating to hearing, speech, occlusion and facial aesthetics. People with OFCs that include the lip, alveolus and palate (cleft lip and palate (CLP)) require several different staged and coordinated surgical and non-surgical interventions, and the treatment pathway is associated with a heavy burden of care. Due to the extensive nature of the interaction with these patients, MDT members have opportunities to provide enhanced patient-centred care and support. This case report provides an overview of the current knowledge of the aetiology of OFC and the management of these patients. It provides a unique perspective from one of the coauthors who has a unilateral CLP (UCLP) and reports on his treatment experiences and long-term treatment outcomes. By having a better understanding of the impact of UCLP and treatment provided, MDT members can not only provide improved clinical treatment but also offer improved patient experiences for those with craniofacial anomalies, in particular, an increased awareness of the psychosocial challenges, they endure throughout their treatment pathway and beyond.

Efficacy of Transcaruncular approach to reconstruct isolated medial orbital fracture.

BACKGROUND: Traditional approaches used to repair medial orbital wall fracture include transcutaneous incision such as advocated by Killian and Lynch, or coronal approach. Transcaruncular approach provides an anatomically safe and efficient alternative, allowing generous exposure without the cutaneous scar. METHODS: Patients presenting with medial orbital wall fractures were identified through the trauma database over a 5 year period. Data of twelve consecutive patients who presented with isolated medial wall fracture and treated via a transcaruncular approach were analysed. The extent of the injury, operative and follow up details were documented. RESULTS: There were ten male patients and two female patients. On computed tomography, vertical defect ranged from 8 to 16 mm (mean 12 mm) and longitudinal defect ranged from 14 to 31 mm (mean 22 mm). All but three patients were followed up for 9 months postoperatively. Two patients were assessed as having a slightly enlarged caruncle on the operated side, but neither patient was aware of this. Of the 2 patients who complained of diplopia, only one had objective restriction beyond 30° of abduction from primary gaze. CONCLUSION: Transcaruncular approach allows satisfactory exposure for repair of isolated medial orbital wall fracture. It is an anatomically safe and efficient technique, with superior cosmetic result. Postoperative morbidity is minimal and follow up data demonstrates no permanent complications.

Role of alcohol in maxillofacial fractures.

BACKGROUND: Excessive consumption of alcohol results in impaired judgement and inappropriate behaviour, and is often a major contributor to interpersonal violence and motor vehicle accidents. This study examines the experience of a tertiary centre in alcohol-related facial fractures. METHODS: A retrospective database of patients presenting to the Oral and Maxillofacial Surgery Service at Christchurch Hospital (New Zealand) during an 11-year period was reviewed. Variables examined include demographics, type of fractures, mode of injury, and treatment delivered. RESULTS: 2581 patients presented with facial fractures during the study period, 49% of these being alcohol-related. Males accounted for 88% of alcohol-related fractures and 59% were males in the 15 to 29 year age group; 78% of alcohol-related fractures were due to interpersonal violence and 13% to motor vehicle accidents; 65% required hospital admission and 58% underwent surgery. CONCLUSION: The majority of alcohol-related facial fractures were due to interpersonal violence, with young men in the 15 to 29 year age group being predominantly affected. Alcohol-related fractures were associated with an increase in the incidence of hospitalisation and surgery. The high prevalence of alcohol as a contributing factor to facial fractures indicates a need to push for community awareness and public education on the harmful effects of alcohol.

Comparison between interpersonal violence and motor vehicle accidents in the aetiology of maxillofacial fractures.

BACKGROUND: Maxillofacial fractures commonly present to the emergency department, interpersonal violence (IPV) and motor vehicle accidents (MVA) being two of the main causes. There is a changing trend in these two aetiologies, which is reflected in a change in demographics, the pattern of fractures and the treatment of maxillofacial fractures. METHODS: A prospective database of patients presenting to the Oral and Maxillofacial Surgery service at Christchurch Hospital during an 11-year period was reviewed. Of a total of 2581 patients with radiographic confirmation of facial fractures, 1135 patients sustained injuries following IPV and 286 patients following MVA. Variables examined include demographics, type of fracture, mode of injury, and treatment. RESULTS: The male:female ratio was 9:1 in patients following IPV and 7:3 following MVA; 16-30-year-olds accounted for greatest proportion of injuries (48 and 68%, respectively). There was alcohol involvement in 87% of fractures caused by IPV, compared with 58% for MVA. Mid-facial fractures were more frequently seen in MVA, whereas mandibular fractures were more prevalent in IPV. Sixty-two per cent of the patients from MVA required active treatment and 87% were hospitalized, compared with 56% actively treated and 59% hospitalized in the IPV group. CONCLUSION: Interpersonal violence has continued to be the main cause of maxillofacial fractures. Both IPV and MVA commonly involve alcohol and young male adults. They frequently require hospitalization and surgical intervention.

Head injury and associated maxillofacial injuries.

AIMS: To review patients admitted with head injuries under a regional neurosurgical service, to document the incidence and features of associated maxillofacial trauma, and to assess any delay in referral to a maxillofacial surgeon for definitive management of facial injuries. METHODS: The details of all patients admitted under the neurosurgical service at Christchurch Hospital over the preceding 7 years (1995-2002) were reviewed via that department's database. The records of those patients noted to have a maxillofacial injury were requested, and the following data obtained: demographics, diagnosis, and mode of injury (including specific variables such as alcohol consumption and seatbelt usage in motor vehicle accidents). RESULTS: 2307 patients were admitted under the neurosurgical service at Christchurch Hospital over a 7-year period. Five percent of those patients had an associated maxillofacial injury. Three-quarters were men, with an average age of 27 years. Motor vehicle accidents and assaults were the most common cause of injury. Nearly one-third of those persons in motor vehicle accidents were not wearing seatbelts. Alcohol was more frequently involved in mild and moderate head injuries and these patients were more likely to have been assaulted than those admitted with severe head injuries. There were no significant delays in referring patients admitted who had an associated maxillofacial injury to a maxillofacial surgeon. CONCLUSIONS: A small but significant number of patients admitted with head injuries will have an associated maxillofacial injury.

Management of isolated orbital floor blow-out fractures: a survey of Australian and New Zealand oral and maxillofacial surgeons.

BACKGROUND: This is the first report of involvement of Australian and New Zealand oral and maxillofacial surgeons in the management of isolated orbital floor blow-out fractures and was conducted to obtain comparisons with the results from a recent similar survey of British oral and maxillofacial surgeons. METHODS: A questionnaire survey was sent to all 113 practising members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons in April 2002 with a second mailout 1 month later. RESULTS: Sixty-nine per cent of the respondents were referred isolated orbital floor blow-out fractures for management, and just over half of these respondents estimated that 50% or more of the cases went to surgery. The materials most commonly used in orbital floor reconstruction were resorbable membrane for small defects and autologous bone for large defects. CONCLUSION: As in Britain, management of isolated orbital floor blow-out fractures comprises part of the surgical spectrum for many oral and maxillofacial surgeons in Australia and New Zealand. The management protocol was observed to be very similar between the two groups.