Pilot study of intraoperative digital imaging with the use of a mammograph for assessment of bone surgical margins in the head and neck region.

AIM: To investigate alternative possibilities for the intraoperative evaluation of surgical margins after bone resection utilizing more conventional hospital infrastructure technologies. MATERIALS AND METHODS: A small pilot study was performed using digital mammograph imaging intraoperatively on 16 surgical specimens of bone tumours or malignancies with bone infiltration of the head and neck area, with the aim of evaluating the resection margins. RESULTS: In thirteen cases the intraoperative specimen images indicated clinically complete excision. In two cases incomplete resection or close proximity of margins was detected, which required additional resection. CONCLUSIONS: The results indicated that intraoperative specimen radiography can prove useful in evaluating completeness of excision. The significance of intraoperative assessment of surgical margin is of paramount importance when immediate reconstruction is performed. This proposed method is cheap, easy to perform and fast. Its cost-benefit ratio is superior than that of any other available technique. Intraoperative analysis of specimens with digital mammography imaging can potentially become a useful tool for immediate evaluation of osseous margins after resection.

Spontaneous regression of bilateral dentigerous cysts associated with impacted mandibular third molars.

A case is described where a routine panoramic radiograph revealed radiolucencies, compatible with dentigerous cysts, associated with the crowns of bilateral impacted lower third molars. Both cysts had regressed in a follow up radiograph three years later with no intervention. This is the first reported case of spontaneous regression of bilateral dentigerous cysts.

Pirogoff's Triangle revisited: an alternative site for microvascular anastomosis to the lingual artery. A technical note.

This technical note aims to draw the surgeon's attention to the lingual artery in its course through Pirogoff's Triangle when looking for an appropriate recipient artery in the neck. Nowadays, free vascularised tissue transfer is used routinely in the reconstruction of defects in the maxillofacial area. Comfortable access to a healthy recipient artery is a major factor in ensuring a successful result. Traditionally, Pirogoff's Triangle is the ideal site to expose the lingual artery for ligation in case of severe haemorrhage of the tongue. This study shows that the lingual artery at this site is also well suited to perform a microvascular anastomosis, as the Triangle offers a convenient access, which is relatively horizontal and not hampered by the mandibular border. The artery is of good calibre and seems fairly resistant against arteriosclerosis.

Ultrasound imaging in assessment of fractures of the orbital floor.

Twenty patients who had sustained facial trauma with clinical evidence of an orbital floor fracture were examined by ultrasound in a blinded prospective study to assess the utility of ultrasound in the diagnosis of orbital floor fractures. Ultrasound detected the presence of an orbital floor fracture with an overall accuracy of 86% and a sensitivity of 85% compared with computed tomography (CT) or direct surgical exploration of the orbital floor. This is lower than that quoted in previous reports. Although less sensitive than CT in the detection of orbital floor fractures, the technique appears useful as an adjunct to physical examination in the assessment of patients with facial trauma where an orbital floor fracture is suspected. The technique may also be useful in cases of coexistent cervical spine trauma or in assessment of uncooperative patients where CT is impracticable.