Factors Associated With Successful Surgical Exposure of Impacted Maxillary Canines.

PURPOSE: Impacted maxillary canines occur in up to 3% of the population and their eruption is of great importance in establishing, maintaining the shape, aesthetics, and function of the dental arch. Hence, surgical exposure of canines for the purpose of aligning them is a common surgical procedure. This study identifies the frequency and the statistically significant factors associated with successful surgical exposure of impacted maxillary canines and the relative risk factors for repeat surgery. METHODS: This is a retrospective cohort study of 182 patients who underwent surgical exposure of impacted maxillary canines and orthodontic alignment, over a 5-year period between 2014 and 2018. The variables recorded and analyzed included demographics (age and gender), type of surgery (closed or open exposure), grade of surgeon, and radiographic features on orthopantomogram (canine overlap of adjacent tooth root, vertical canine crown height, canine angulation to midline, position of canine root apex). Outcome data recorded were successful surgical exposure and orthodontic alignment and the need for repeat operation or surgical removal due to ankylosis. The data were analyzed to identify the statistically significant correlates of successful surgical exposure and the relative risk factors associated with repeat surgery. RESULTS: A total of 182 patients and 232 bone-impacted maxillary surgical canine exposures were analyzed, as 50 patients had bilateral impaction. Mean age was 15 years (range = 10-38 years), with 122 (67%) female to 60 (33%) male ratio. Total of 222/232 (96%) impacted maxillary canine teeth were successfully surgically exposed and 10/232 (4%) required re-exposure surgery. Correlates of successful surgical exposures were open exposure technique (P < .002) and reduced distance of vertical canine crown height from alveolar bone margin (P < .033). Relative risk factors for repeat surgery were increased age, male, closed surgical exposure, grade of surgeon, central impaction, increased overlap of adjacent root, increased vertical height, increased angulation to midline, canine apex position above second premolar and procedure done under local anesthetics. CONCLUSIONS: This is the largest impacted maxillary canine study to date which has identified the factors that result in successful surgical exposure, hence allow selection of the patients most suitable for this treatment. Secondly, patients with relative risk factors for repeat surgical intervention may be consented appropriately, triaged for a closer orthodontic follow-up and prioritized for surgery to reduce overall treatment time.

Accuracy of MRI in prediction of tumour thickness and nodal stage in oral squamous cell carcinoma.

We aim to compare radiological with histological tumour thickness (RTT with HTT) for oral squamous cell carcinoma (OSCC), and the ability of both to predict cervical metastasis. The MRI images and histopathology reports of 102 consecutive OSCC cases were compared and the relationship between RTT and HTT, calculated as a "shrinkage factor" by the gradient of the best fitting regression line. Most (69%) tumours appeared thicker on MRI than was revealed by histopathology. Shrinkage factor was 0.70 (interquartile range 0.63-0.77, correlation co-efficient 0.63) for all cases, 0.87 (IQR 0.80-0.95, CC 0.88) for tongue and 0.65 (IQR 0.49-0.82, CC 0.45) for floor of mouth sub-sites. RTT did not correlate well with the presence of nodal metastases in any sub-site, i.e. there was no clinically applicable cut-off value of RTT to determine the prescription of elective neck dissection. Although RTT has some predictable relationship with HTT, this varies between sub-sites with tongue the most accurately predicted shrinkage using axial MRI. It is not possible from either the MRI staging of neck or tumour thickness to safely determine the need for neck dissection in OSCC. It is necessary to re-evaluate the benefit of MRI as a staging investigation (particularly for early stage OSCC) and further explore the contribution of molecular biomarkers and ultrasound.

Relapse in fronto-orbital advancement: a pilot study.

Our unit policy in fronto-orbital advancement (FOA) and remodeling has been initial overcorrection to improve the ultimate aesthetic outcome of surgery. To assess relapse of anteroposterior (AP) correction in patients with cranial synostosis undergoing FOA and remodeling, a retrospective pilot study identified patients from the unit database. Serial AP calvarial measurements were used to record surgical and postsurgical changes. Patients showing a change in measurements toward preoperative values were considered to have relapsed. Associated factors were recorded, and statistical analysis was carried out using SPSS.Thirty-one patients (female n = 10, male n = 21) with a median age at surgery of 17 months and a mean weight of 11 kg were included in the study. The mean hospital stay was 7 days. The mean advancement was 13 (SD, 4) mm, and relapse occurred in 65% (20/31). Mean AP relapse at 5 months was 6.2 mm. No patient required subsequent FOA. No significant correlation was found between relapse and age, weight, hospital stay, and syndromic status. Anteroposterior relapse of the fronto-orbital segment occurred in two thirds (65%) of our cohort at 5 months. A prospective study is now under way to analyze this further. The results of this pilot study suggest that strategies to minimize or to compensate for relapse may enhance the ultimate surgical result.

Traumatic neuroma: a late complication of otoplasty.

We report on the development of traumatic ear lobe neuromas as a late complication of bilateral otoplasty performed 16 years previously. To our knowledge, this is the first and only described case of traumatic neuromas arising as a late complication of otoplasty in the English literature. Traumatic neuroma should be considered in the differential diagnosis of any nodular lesions that develop within the external ear in patients who have had otoplasty or any other form of external ear surgery or trauma.

The assessment of fatigue in primary Sjögren's syndrome.

OBJECTIVE: Disabling fatigue is a prominent feature of primary Sjögren's syndrome (PSS). We evaluated a number of questionnaires for their ability to discriminate fatigue in PSS from that in other rheumatic disorders and healthy controls. METHODS: 33 female caucasian patients with PSS, 45 with rheumatoid arthritis (RA), 16 with systemic lupus erythematosus (SLE) and 30 controls completed self-administered questionnaires including; Visual Analogue Scales (VAS), the Chalder Fatigue Scale (CFS), the Nottingham Health Profile (NHP) and the Medical Outcomes Short Form 36 Questionnaire (SF-36). RESULTS: All patient groups scored significantly worse than controls on the 'Energy' dimension of the NHP, the fatigue VAS and the 'Vitality' domain of the SF-36. No significant differences were observed between PSS patients and controls using the CFS. CONCLUSIONS: The NHP. VAS and SF-36 are useful in identifying fatigue in these rheumatic disorders. Further work is required to identify the characteristic features of fatigue in these conditions.