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Treatment of intraoral hemangioma with a sclerosing agent: report of a case
234
British
Journal
of Oral and Maxillofacial
Surgery
A questionnaire consisting of two parts was circulated to all OMFS, ENT and PS consultants in the Yorkshire region. Consultants whose scope of practice involved the surgical treatment of oral/oropharyngeal malignancy were asked to complete and return the questionnaire. Part One identified literature usage by journal and Part Two asked respondents to specify treatment preferences when presented with a range of clinical scenarios based around a patient with a T2 oral tongue carcinoma. The results of the study, which demonstrate noticeable differences in the sample returning the questionnaire, are presented.
Modified staircase T J Ma&s. North
technique for lower-lip Staffordshire Hospital,
reconstruction. Stoke-on-Trent,
D. Hone, UK.
The modified staircase technique for lower-lip reconstruction, based upon Johanson’s original paper, is described. We illustrate the surgical technique and outline its advantages over alternative reconstruction techniques with transposition or rotation flaps. This technique can be used for reconstruction of lower-lip defects up to 60% and allows preservation of the muscle sphincter during advancement of the lower-lip flaps. This gives good symmetrical movement of lips with intact commissures and adequate reconstruction of lip width and height without undue tension or microstomia. The motor and sensory nerve supply is preserved, as is muscle alignment, producing good function. In paramedian defects, symmetry of the commissures is difficult to achieve but, with the use of the asymmetrical bilateral staircase technique, good symmetry can be produced. This asymmetric technique has not been widely published and we illustrate this technique in an elderly patient with a paramedian tumour.
Treatment of intraoral hemangioma with a sclerosing agent: report of a case. I. Karaca. D. Yilmaz, L. Aral, D. A. Vgar, M. iizturk. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Gazi, Ankara, Turkey. Haemangiomas are common benign proliferations of vascular channels with various presentations including capillary hemangiomas and cavernous haemangiomas. They may be present at birth or arise at an early age. Haemangiomas of the oral soft tissue may arise in any mucosal site but are most common in the tongue. Although many haemangiomas spontaneously regress by the time the patient has finished puberty, there are still a large number of lesions that require therapeutic attention. Among the therapeutic modalities that are currently employed, one can choose surgery alone or in combination with systemic or endovascular embolization, intralesional injection of sclerosing agents and cryosurgery. In this report, a case of intraoral haemangioma treated with injection of a sclerosing agent is presented and the literature is reviewed.
Effects of glycerol on the rat infraorbital nerve. I. Karaca’, L. AraP, D. A. Vgar’, G Karabay2, D. Erdoga&. ‘Department of Oral and Maxillofacial Surgery, Faculty of Dentistry; *Department of Morphology and Embryology, Faculty of Medicine, University of Gazi, Ankara, Turkey. This study was undertaken to investigate the effects of glycerol on the peripheral trigeminal nerve utilizing rat infraorbital nerve model. Extraneural glycerol was injected in 35 rats. Saline was applied at the opposite nerve in the same animals as control. Groups of five animals were killed at days 1, 3, 5, 7, 15, 30 and 60 respectively. The nerves were examined with light and electron microscopy. Destructive changes were observed in all specimens from the glycerol group. Myelinated and unmyelinated fibres are affected at random, although the most striking histological changes were seen in the myelinated fibres. Normal morphology was found in the group treated with saline. 30 days after the injection in the glycerol group, signs of regeneration were noted. 60 days after the injection of glycerol, the nerve fibres appeared almost normal. A possible mechanism of action of glycerol applied at the peripheral trigeminal nerve in alleviating trigeminal neuralgia is discussed.
Patients’ perception of follow-up after Kerawala. Department of Oral and Royal Hospital, Sunderland, UK.
head and neck surgery. C. J Facial Surgery, Sunderland
Follow-up of cancer patients imposes a significant workload on many surgical specialties and therefore the combined multidisciplinary clinics proposed by the Calman-Hine review of head and neck services has major manpower implications. Since there is no evidence that early detection of recurrence is associated with a more favourable outcome, considerable lack of consensus exists regarding the frequency and duration of follow-up for oropharyngeal malignancy. The current system is traditionally routinized with little opportunity to discover individual patients’ perception and formulate an intervention to address such needs. The aim of this study was to ascertain patients’ perception of routine follow-up after ablative surgery for head and neck malignancy. 50 consecutive patients were recruited with data collection involving either face-to-face interview or telephone questioning. Whilst the majority of patients expressed satisfaction at the present system, some concerns were identified. The anxiety provoked before appomtments was considerable, with the clinical examination often failing to reassure. Almost universally, patients felt uncomfortable expressing emotional or psychological concerns or asking questions within the multidisciplinary environment presented to them. These findings identify areas for future consideration in an attempt to improve patient satisfaction with follow-up services and so ultimately enhance quality of life.
Predicting length of stay in head and neck surgery. C. J. Kerawala. Department of Oral and Facial Surgery, Sunderland Royal Hospital, Sunderland, UK. There have been vast changes in surgical bed usage over the past decade. The introduction of day-stay lists and radical changes in preoperative assessment and postoperative care have produced major reductions in overall length of stay. Previous attempts at predictive modelling of hospital stay are based on a linear technique which assumes that beds are used in a homogenous fashion and that there is normal (Gaussian) distribution for the length of stay. Neither premise may be true in current maxillofacial practice. The development of elective day-case lists has resulted in a two-speed system of rapid turnover beds in addition to longer-term care. As a result, beds are no longer used in a homogenous fashion and normal distribution for length of stay may no longer apply. The elderly population undergoing surgery for head and neck malignancy are unpredictable and difficult to model. However, without the ability to identify the percentage of patients staying longer than expected it is difficult to address surgeon and social service factors which may be adjustable. In general, surgery exponential models such as the POSSUM scoring system exist to predict outcome after operation. Since the physical status of the patient and the operative severity of the procedure on which such systems are based may also influence time in hospital, they are theoretically of use in predicting length-of-stay in maxillofacial surgery. In order to test this hypothesis, a modification of the POSSUM system was devised to be of relevance to head and neck surgery and then applied to 50 consecutive patients admitted for elective treatment of oropharyngeal malignancy. By this means, it was possible to derive an equation expressing length of stay which could be applied in the future as an audit tool.
Training in out-patients. C. J Kerawala. Department of Oral Facial Surgery, Sunderland Royal Hospital, Sunderland, UK.
and
The quality and quantity of surgical training in the UK is under intense scrutiny. Thus far, assessment of training programmes has largely been directed at quantifying consultant supervision of operative training with little evaluation of teaching in the out-patient department. This study attempted to assess the level of training in maxillofacial out-patients with particular reference to the consequences of different clinic organizations. A prospective audit of out-patient supervision was undertaken in two maxillofacial units within one region. The two units organized their clinics such that in one trainees saw a mixture of new
British
Journal
of Oral and Maxillofacial
Surgery
A questionnaire consisting of two parts was circulated to all OMFS, ENT and PS consultants in the Yorkshire region. Consultants whose scope of practice involved the surgical treatment of oral/oropharyngeal malignancy were asked to complete and return the questionnaire. Part One identified literature usage by journal and Part Two asked respondents to specify treatment preferences when presented with a range of clinical scenarios based around a patient with a T2 oral tongue carcinoma. The results of the study, which demonstrate noticeable differences in the sample returning the questionnaire, are presented.
Modified staircase T J Ma&s. North
technique for lower-lip Staffordshire Hospital,
reconstruction. Stoke-on-Trent,
D. Hone, UK.
The modified staircase technique for lower-lip reconstruction, based upon Johanson’s original paper, is described. We illustrate the surgical technique and outline its advantages over alternative reconstruction techniques with transposition or rotation flaps. This technique can be used for reconstruction of lower-lip defects up to 60% and allows preservation of the muscle sphincter during advancement of the lower-lip flaps. This gives good symmetrical movement of lips with intact commissures and adequate reconstruction of lip width and height without undue tension or microstomia. The motor and sensory nerve supply is preserved, as is muscle alignment, producing good function. In paramedian defects, symmetry of the commissures is difficult to achieve but, with the use of the asymmetrical bilateral staircase technique, good symmetry can be produced. This asymmetric technique has not been widely published and we illustrate this technique in an elderly patient with a paramedian tumour.
Treatment of intraoral hemangioma with a sclerosing agent: report of a case. I. Karaca. D. Yilmaz, L. Aral, D. A. Vgar, M. iizturk. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Gazi, Ankara, Turkey. Haemangiomas are common benign proliferations of vascular channels with various presentations including capillary hemangiomas and cavernous haemangiomas. They may be present at birth or arise at an early age. Haemangiomas of the oral soft tissue may arise in any mucosal site but are most common in the tongue. Although many haemangiomas spontaneously regress by the time the patient has finished puberty, there are still a large number of lesions that require therapeutic attention. Among the therapeutic modalities that are currently employed, one can choose surgery alone or in combination with systemic or endovascular embolization, intralesional injection of sclerosing agents and cryosurgery. In this report, a case of intraoral haemangioma treated with injection of a sclerosing agent is presented and the literature is reviewed.
Effects of glycerol on the rat infraorbital nerve. I. Karaca’, L. AraP, D. A. Vgar’, G Karabay2, D. Erdoga&. ‘Department of Oral and Maxillofacial Surgery, Faculty of Dentistry; *Department of Morphology and Embryology, Faculty of Medicine, University of Gazi, Ankara, Turkey. This study was undertaken to investigate the effects of glycerol on the peripheral trigeminal nerve utilizing rat infraorbital nerve model. Extraneural glycerol was injected in 35 rats. Saline was applied at the opposite nerve in the same animals as control. Groups of five animals were killed at days 1, 3, 5, 7, 15, 30 and 60 respectively. The nerves were examined with light and electron microscopy. Destructive changes were observed in all specimens from the glycerol group. Myelinated and unmyelinated fibres are affected at random, although the most striking histological changes were seen in the myelinated fibres. Normal morphology was found in the group treated with saline. 30 days after the injection in the glycerol group, signs of regeneration were noted. 60 days after the injection of glycerol, the nerve fibres appeared almost normal. A possible mechanism of action of glycerol applied at the peripheral trigeminal nerve in alleviating trigeminal neuralgia is discussed.
Patients’ perception of follow-up after Kerawala. Department of Oral and Royal Hospital, Sunderland, UK.
head and neck surgery. C. J Facial Surgery, Sunderland
Follow-up of cancer patients imposes a significant workload on many surgical specialties and therefore the combined multidisciplinary clinics proposed by the Calman-Hine review of head and neck services has major manpower implications. Since there is no evidence that early detection of recurrence is associated with a more favourable outcome, considerable lack of consensus exists regarding the frequency and duration of follow-up for oropharyngeal malignancy. The current system is traditionally routinized with little opportunity to discover individual patients’ perception and formulate an intervention to address such needs. The aim of this study was to ascertain patients’ perception of routine follow-up after ablative surgery for head and neck malignancy. 50 consecutive patients were recruited with data collection involving either face-to-face interview or telephone questioning. Whilst the majority of patients expressed satisfaction at the present system, some concerns were identified. The anxiety provoked before appomtments was considerable, with the clinical examination often failing to reassure. Almost universally, patients felt uncomfortable expressing emotional or psychological concerns or asking questions within the multidisciplinary environment presented to them. These findings identify areas for future consideration in an attempt to improve patient satisfaction with follow-up services and so ultimately enhance quality of life.
Predicting length of stay in head and neck surgery. C. J. Kerawala. Department of Oral and Facial Surgery, Sunderland Royal Hospital, Sunderland, UK. There have been vast changes in surgical bed usage over the past decade. The introduction of day-stay lists and radical changes in preoperative assessment and postoperative care have produced major reductions in overall length of stay. Previous attempts at predictive modelling of hospital stay are based on a linear technique which assumes that beds are used in a homogenous fashion and that there is normal (Gaussian) distribution for the length of stay. Neither premise may be true in current maxillofacial practice. The development of elective day-case lists has resulted in a two-speed system of rapid turnover beds in addition to longer-term care. As a result, beds are no longer used in a homogenous fashion and normal distribution for length of stay may no longer apply. The elderly population undergoing surgery for head and neck malignancy are unpredictable and difficult to model. However, without the ability to identify the percentage of patients staying longer than expected it is difficult to address surgeon and social service factors which may be adjustable. In general, surgery exponential models such as the POSSUM scoring system exist to predict outcome after operation. Since the physical status of the patient and the operative severity of the procedure on which such systems are based may also influence time in hospital, they are theoretically of use in predicting length-of-stay in maxillofacial surgery. In order to test this hypothesis, a modification of the POSSUM system was devised to be of relevance to head and neck surgery and then applied to 50 consecutive patients admitted for elective treatment of oropharyngeal malignancy. By this means, it was possible to derive an equation expressing length of stay which could be applied in the future as an audit tool.
Training in out-patients. C. J Kerawala. Department of Oral Facial Surgery, Sunderland Royal Hospital, Sunderland, UK.
and
The quality and quantity of surgical training in the UK is under intense scrutiny. Thus far, assessment of training programmes has largely been directed at quantifying consultant supervision of operative training with little evaluation of teaching in the out-patient department. This study attempted to assess the level of training in maxillofacial out-patients with particular reference to the consequences of different clinic organizations. A prospective audit of out-patient supervision was undertaken in two maxillofacial units within one region. The two units organized their clinics such that in one trainees saw a mixture of new