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A modified miniplate for use in malar complex fractures
334
British
Journal
of Oral
and Maxillofacial
Surgery
Although not directly comparable with the data considered so far, it is interesting to look at the incidence of carcinoma of the tongue in Scotland in men and women under the age of 50 for the period 1980-1992 (Fig. 1). This confirms the increasing incidence in both sexes, but the trend (Fig. 2) shows that the rise is much steeper in men than women. In contrast to England and Wales, the incidence of carcinoma of the alveolus in Scotland has changed little between the two periods. We wonder about the significance of the apparently large increase in alveolar carcinoma reported by Worrall.’ There are problems in the coding of alveolar carcinoma because there is a degree of overlap between the ICD9 codes 143 and 145. ICD9 143 codes for ‘malignant neoplasm of gum’ and includes alveolar ridge mucosa, upper gum, lower gum and gum, unspecified. ICD9 145 codes for ‘malignant neoplasm of other and unspecified parts of mouth’ including upper and lower buccal sulci, hard palate and retromolar area. This can make precise classification difficult. For example, what might be recorded as a lower alveolar ridge carcinoma (ICD9 143) by one clinician might be coded as a retromolar area tumour (ICD9 145) by another. This latitude in coding together with the relatively small number of alveolar carcinomas compared with the much larger number of unspecified carcinomas, means that these data should be interpreted with caution. Carcinoma of the floor of mouth has increased in both sexes in Scotland. Again the numbers are small but there appears to have been a striking increase in incidence in young males. The data from the Scottish Cancer Registry show some interesting changes in the incidence of oral cancer in No. PATIENTS I
T\Jl I%30
1981 1982 1983 -
1984 1986
MALES
+
Fig. 1 - Incidence of tongue Scotland 1980-1992.
1986 1967 1988 FEMALES
cancer
+
in patients
1989 1990
1991 1992
TOTAL
under
R. Mitchell ChM, FRCS Consultant Department of Maxillofacial City Hospital Edinburgh
Surgery
References 1. Worrall SF. Oral J Oral Maxillofac
cancer incidence between Surg 1995; 33: 195-196.
A MODIFIED MINIPLATE COMPLEX FRACTURES
1971 and 1989. Br
FOR USE IN MALAR
Sir, I was interested to read Mr Smyth’s paper published in the June edition of The British Journal of Oral and Maxillofacial Surgery.’ It shows some remarkable similarities to my own publication regarding such modifications to miniplates which was published in 1994,’ although I note the variations in the technique he describes. It is unclear from the text, and indeed from the photographs, whether the plate has been constructed by modifying a plate of a different variety or whether it has been cut to shape from a piece of titanium plate. In either case I would counsel against such modifications since the reproducibility and, therefore, consistency of the plate must be highly dubious. An almost identical modified mini-plate is available to the design I described and is manufactured in titanium by De Puy Ltd.* Although it is not currently listed in their standard catalogue it is available on request and not only facilitates the reduction of zygomatic fractures but is useful in the fixation of osteotomies and in reducing mandibular fractures under direct vision. C. M. Hill Consultant Department of Oral and Maxillofacial University Dental Hospital Cardiff
Surgery
References 1. Smyth AG. A modi6ed miniplate for use in malar complex fractures. Br J Oral Maxillofac Surg 1995; 33: 169-170. 2. Hill CM. A modification to miniplates to allow adjustment in position of the bone fragments. Br J Oral Maxillofac Surg 1994; 32: 52-53. *De Puy Healthcare, Millshaw House, Manor Mill Lane, Leeds, LSll SLQ.
No. PATIENTS
I li60
R. Crasher FDS, FRCS Registrar
50 years in
20
”
Scotland and some apparent differences between Scotland and England and Wales. We present the Scottish data without being able to explain either the changes or the differences.
SURGICAL
+ + +. + + + + + ( 1961 1962 1983 IS84 -
Fig. 2 -Tongue cancer trend 1980-1992.
1985 1936
MALES
in patients
+
1 I 1997 1988 1989
/ 1990
I 1 I 1991 1992
FEMALES
under
50 years in Scotland:
AUDIT
SYSTEM
Sir, Three years ago, with the support of the Faculty of Dental Surgery at the Royal College of Surgeons and funding provided from the Department of Health, two locally networked surgical audit systems were introduced to two major teaching hospitals-The Royal London Hospital and Leeds Dental Institute/General Infirmary.
British
Journal
of Oral
and Maxillofacial
Surgery
Although not directly comparable with the data considered so far, it is interesting to look at the incidence of carcinoma of the tongue in Scotland in men and women under the age of 50 for the period 1980-1992 (Fig. 1). This confirms the increasing incidence in both sexes, but the trend (Fig. 2) shows that the rise is much steeper in men than women. In contrast to England and Wales, the incidence of carcinoma of the alveolus in Scotland has changed little between the two periods. We wonder about the significance of the apparently large increase in alveolar carcinoma reported by Worrall.’ There are problems in the coding of alveolar carcinoma because there is a degree of overlap between the ICD9 codes 143 and 145. ICD9 143 codes for ‘malignant neoplasm of gum’ and includes alveolar ridge mucosa, upper gum, lower gum and gum, unspecified. ICD9 145 codes for ‘malignant neoplasm of other and unspecified parts of mouth’ including upper and lower buccal sulci, hard palate and retromolar area. This can make precise classification difficult. For example, what might be recorded as a lower alveolar ridge carcinoma (ICD9 143) by one clinician might be coded as a retromolar area tumour (ICD9 145) by another. This latitude in coding together with the relatively small number of alveolar carcinomas compared with the much larger number of unspecified carcinomas, means that these data should be interpreted with caution. Carcinoma of the floor of mouth has increased in both sexes in Scotland. Again the numbers are small but there appears to have been a striking increase in incidence in young males. The data from the Scottish Cancer Registry show some interesting changes in the incidence of oral cancer in No. PATIENTS I
T\Jl I%30
1981 1982 1983 -
1984 1986
MALES
+
Fig. 1 - Incidence of tongue Scotland 1980-1992.
1986 1967 1988 FEMALES
cancer
+
in patients
1989 1990
1991 1992
TOTAL
under
R. Mitchell ChM, FRCS Consultant Department of Maxillofacial City Hospital Edinburgh
Surgery
References 1. Worrall SF. Oral J Oral Maxillofac
cancer incidence between Surg 1995; 33: 195-196.
A MODIFIED MINIPLATE COMPLEX FRACTURES
1971 and 1989. Br
FOR USE IN MALAR
Sir, I was interested to read Mr Smyth’s paper published in the June edition of The British Journal of Oral and Maxillofacial Surgery.’ It shows some remarkable similarities to my own publication regarding such modifications to miniplates which was published in 1994,’ although I note the variations in the technique he describes. It is unclear from the text, and indeed from the photographs, whether the plate has been constructed by modifying a plate of a different variety or whether it has been cut to shape from a piece of titanium plate. In either case I would counsel against such modifications since the reproducibility and, therefore, consistency of the plate must be highly dubious. An almost identical modified mini-plate is available to the design I described and is manufactured in titanium by De Puy Ltd.* Although it is not currently listed in their standard catalogue it is available on request and not only facilitates the reduction of zygomatic fractures but is useful in the fixation of osteotomies and in reducing mandibular fractures under direct vision. C. M. Hill Consultant Department of Oral and Maxillofacial University Dental Hospital Cardiff
Surgery
References 1. Smyth AG. A modi6ed miniplate for use in malar complex fractures. Br J Oral Maxillofac Surg 1995; 33: 169-170. 2. Hill CM. A modification to miniplates to allow adjustment in position of the bone fragments. Br J Oral Maxillofac Surg 1994; 32: 52-53. *De Puy Healthcare, Millshaw House, Manor Mill Lane, Leeds, LSll SLQ.
No. PATIENTS
I li60
R. Crasher FDS, FRCS Registrar
50 years in
20
”
Scotland and some apparent differences between Scotland and England and Wales. We present the Scottish data without being able to explain either the changes or the differences.
SURGICAL
+ + +. + + + + + ( 1961 1962 1983 IS84 -
Fig. 2 -Tongue cancer trend 1980-1992.
1985 1936
MALES
in patients
+
1 I 1997 1988 1989
/ 1990
I 1 I 1991 1992
FEMALES
under
50 years in Scotland:
AUDIT
SYSTEM
Sir, Three years ago, with the support of the Faculty of Dental Surgery at the Royal College of Surgeons and funding provided from the Department of Health, two locally networked surgical audit systems were introduced to two major teaching hospitals-The Royal London Hospital and Leeds Dental Institute/General Infirmary.