Long-term stability of limiting nasal alar base width changes with a cinch suture following Le Fort I osteotomy with submental intubation.

The aim of this study was to assess the effectiveness of the nasal alar base cinch suture following Le Fort I osteotomy at long-term follow-up. One hundred and forty participants (89 female, 51 male) aged between 16 and 51 years underwent Le Fort I osteotomy with submental intubation. Anthropometric measurements of the nose were taken intraoperatively, immediately postoperative, and for up to 3 years postoperative: the maximum lateral convexity of the alae (Al-Al) and the lateral extremity of the alar base curvature at the alar groove (Ac-Ac). The use of a cinch suture was recorded. The results were analysed using a linear mixed-effects model analysis. One hundred and six participants had cinch sutures and 34 had no cinch sutures. Following Le Fort I osteotomy, there were significant increases in Ac-Ac (by 4.29mm) and Al-Al (by 3.70mm) (both P<0.0001). Cinch sutures significantly reduced the widths back to preoperative values (P<0.0001). Alar width remained stable over 3 years, with an increase of 0.36mm for Al-Al (P>0.05) and 1.03mm for Ac-Ac (P<0.05) compared to the postoperative measurement. In conclusion, a cinch suture was helpful in reducing the unwanted alar base width changes, which were found to be relatively stable at 3 years.

Postoperative fractures of the lingual plate after bilateral sagittal split osteotomies.

We encountered the unusual complication of postoperative fracture of the lingual plate in four patients after bilateral sagittal split osteotomy. We then did a retrospective review to identify possible risk factors. Over a 1-year period we did 52 bilateral split osteotomies. The patients' casenotes were examined and a number of variables were recorded, including surgical technique, and the patient's sex, age, presence or absence of third molars, and the height of the mandible in the region of the osteotomy. Significant risk factors were a vertical mandibular height of 2 cm or less distal to the last molar tooth (p=0.02), and a depth of 0.6 cm or less from the apex of last molar root or impacted third molar to the lower border (p=0.005).

Long term results of mandibular distraction.

Mandibular distraction osteogenesis has become a popular surgical modality due to its many advantages over conventional orthognathic surgical procedures. However, in spite of the technique having been used for over 15 years, no concrete long term results are available regarding the stability of results. We discuss the various studies which have reported either in favour or against the stablility of results after distraction. We report a series of 6 cases (3 unilateral and 3 bilateral distraction) where distraction was carried out before puberty and followed them up to seven years after removal of distractors. This case series shows that results achieved by distraction osteogenesis are unstable or best unpredictable with respect to producing a permanent size increase in the mandible. The role of the distraction osteogenesis in overcoming the pterygomassetric sling is questionable. We suggest a multicenter study with adequate patient numbers treated with a similar protocol and documented after growth cessation to have meaningful conclusions on the debate of distraction osteogenesis versus orthognathic surgery.

Use of the buccal fat pad in the reconstruction and prosthetic rehabilitation of oncological maxillary defects.

We evaluated the effectiveness of the buccal fat pad as a pedicled flap for intraoral reconstruction after partial maxillectomy for neoplastic disease in 24 patients, and subsequently, in providing support for a denture. In all patients the buccal fat pad was covered with a split-skin graft and an acrylic plate. There was complete healing of the buccal fat pad flap within 6 weeks in 18 patients with no major complications, and minimal effects on speech and eating. In six cases there was partial dehiscence of the flap, which healed spontaneously in one patient and was repaired with local flaps in two others. There were no cases of complete breakdown of the flap. Eight patients so far have been rehabilitated with small dentures. In conclusion, the buccal fat pad flap is a simple, quick, and reliable method of reconstruction of small to medium-sized posterior maxillary alveolar defects.

Management of oral and maxillofacial infection.

Maxillofacial infections are common but can potentially be life threatening. Accurate diagnosis is essential to prevent mismanagement with potential severe consequences. This article discusses the aetiology, differential diagnosis, host response, spread of infection and treatment.

Principles of management in oral cancer.

Squamous cell carcinoma is the most common oral malignancy, with a relatively poor prognosis. Treatment of oral cancer has a major impact on afflicted patients because it affects speech, swallowing and mastication. Surgery is the main treatment of oral cancer, as a single modality or combined with radiotherapy. Vigilance is vital for early diagnosis and better overall prognosis.

The mesioangular third molar--to extract or not to extract? Analysis of 776 consecutive third molars.

Introduction Distal caries in lower second molars has been associated with mesioangular third molars. Caries detection and restoration can be difficult. If caries progresses, root canal treatment or extraction of the second molar can be necessary.Aims To identify the prevalence of caries in lower third molars and the distal aspect of corresponding lower second molars in patients referred for lower third molar assessment.Methods Analysis of OPG X-rays for 420 consecutive patients (776 third molars) referred to three maxillofacial centres over a five month period.Results Thirty-four percent of third molars were mesioangular. There was radiographic evidence of distal second molar caries in 42% of these. When unerupted mesioangular third molars were excluded this increased to 54%. There was no difference in age or dental health of these patients compared to the whole group. There was no angulation of the mesioangular third molar for which distal caries in the second molar was more likely.Conclusion Distal caries in lower second molars related to a mesioangular third molar is a common finding in oral and maxillofacial patients in secondary care, especially if the third molar is fully or partially erupted. If such a third molar is left in situ, close monitoring and regular bitewing radiographs are recommended.

Distraction in a case of otopalatodigital syndrome type II.

INTRODUCTION: Otopalatodigital syndrome type II is a rare X-linked recessive disorder with generalized skeletal dysplasia and hearing anomalies. Its features include conductive hearing loss, unusual facies, cleft palate, micrognathia, and overlapping flexed fingers and toes. It is a more lethal variant of otopalatodigital syndrome type I. There are many consistently reported craniofacial and dental findings; however, no case has been published in dental literature. CASE REPORT: We report a case of otopalatodigital syndrome type II with micrognathia, cleft of the soft palate, and partial anodontia, and discuss the combined orthodontic and surgical management. CONCLUSION: We also discuss the differential diagnosis and consider more recent theories on possible aetiology as well as clinical management strategies for such cases.

One hundred cases of endoscopic brow lift.

The senior author's experience of using the endoscopic brow lift for rejuvenation of the upper third of the face is presented. One hundred patients underwent endoscopic brow elevation. In 98 cases this was done in combination with other aesthetic procedures. Patient follow-up ranged from 4 months to 53 months (mean: 17 months). No major complications were experienced, although a patient questionnaire identified a number of troublesome but transient minor complications. Levels of patient satisfaction were found to be high. The continuing evolution of this technique is reviewed, particularly relating to methods of brow fixation.

Latex agglutination testing in bacterial meningitis.

The value of the latex agglutination test in meningitis was assessed. This was positive in 60% cases of Streptococcus pneumoniae, 93% of Haemophilus influenzae type b, and 39% of Neisseria meningitidis infections. We cannot support the view that this test was more valuable than Gram staining in partially treated meningitis and cannot recommend its routine use. It may, however, be valuable if Gram staining does not identify an organism or if it suggests meningococcal infection.

A new scale to assess radiographic success of secondary alveolar bone grafts.

OBJECTIVES: To propose a new scale for evaluating the position of the bone graft within the cleft and assess its inter- and intraobserver reliability. DESIGN: Sixty-six patients (70 cleft sites) over a 14-year period were assessed, 90% of patients retrospectively and 10% prospectively. The radiographs were reviewed by two clinicians in controlled conditions twice, with 1 week between assessments. Both clinicians were blind to patient identity. OUTCOME MEASURES: A new scale subdividing the position of the bone into one of six categories was used. The radiographs were also assessed using the Bergland scale. RESULTS: Using the Bergland scale, 62.9% of the cleft sites were type I, 21.4% type II, 4.3% type III, and 5.7% type IV. It was not possible to assess 5.7% of the clefts with this scale because the canine was unerupted. Using the Chelsea alveolar bone graft scale, 58% were category A, 20% B, 7% C, 3% D, 3% E, and 9% F. CONCLUSIONS: The above scale can be used to determine accurately the position of bone within the cleft site. It can be used in the mixed dentition prior to eruption of the canine. It demonstrated moderate to substantial inter- and intraobserver reliability and offers several advantages, compared with other scales.

Oral presentation of lymphoma: case report of T-cell lymphoma masquerading as oral Crohn's disease, and review of the literature.

A 15-year-old male with labial swelling, mouth ulcers and mucosal tags is reported. While the features were clinically consistent with oral Crohn's disease the patient proved to have a fatal T-cell lymphocytic lymphoma.