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A practical coding system for mandibular fractures
216
British
Journal
of Oral
and Maxillofacial
Surgery
DCP + cancellous bone graft was the most common decision. The results will be presented in detail with a discussion on reduction of donor site morbidity. Magnetic resonance tomography of the orbit using surface coils. J. N.
Hofjinann. Schwenzer.
C.
Pfannenberg,
C.
P.
Cornelius,
Department of Oral and Maxillofacial University of Ttibingen, Ttibingen, Germany.
B.
attenuation or absence of either the gag or cornea1 reflex. Whilst both reflexes were depressed to a greater or lesser extent in 7 subjects (2.8%) only one individual demonstrated total absence of both reflexes. The potential importance of these findings will be further discussed.
Nestle,
Surgery, Retrograde facial nerve dissection in parotid surgery. B. O’Regan, MacLuskey. Department of Oral and Maxillofacial Surgery, Queen Margaret Hospital, Dunfermline, Fife, UK. M.
The aim of the study is to compare the effectiveness of magnetic resonance imaging (MRI) in diagnosing herniation and entrapment of orbital soft tissues in orbital fractures. Fifteen consecutive patients with clinical signs and symptoms of medial orbital wall injury were examined with plain radiography and MRI. The data were subsequently compared with the findings of the surgical exploration with regard to the extent of the wall fractures, the presence of soft tissue herniation and its entrapment. MRI was accurate in demonstrating or excluding orbital wall fractures but, compared to the surgical experiences, slightly underestimated their incidence. While Tl-weighted images are useful for the detection of the fracture site, both Tl- and T2-weighted images are usually necessary for evaluating soft-tissue lesions. The results of this study indicate that surface coil MRI is an important adjunct procedure in the diagnosis and treatment of orbital fractures. Oral squamous-cell carcinoma in patients under the age of 40 years. N. C. Hyde, K. Altman. Norman Rowe Maxillofacial Unit, Queen Mary’s University Hospital, Roehampton, UK. Aims and method: Squamous-cell carcinoma of the oral cavity under the age of 40 is uncommon, accounting for 0.4-5% of all patients presenting with this condition. There has been some suggestion that the disease pattern in this age group is changing, becoming more common and aggressive. In view of the small number of cases encountered by individual units, we embarked on a national postal survey of all maxillofacial units in the country, requesting information on demographic data, known risk factors, management, histology and outcome. Results: Responses were received from 36 of the 128 units circulated, providing information about 45 patients who presented between 1985 and 1996. The age range was 16-39 years and the male to female ratio was 2.3:2.2. Although information was not available for all cases, with regard to risk factors, 38% had a previous history of oral tobacco use, 71% consumed alcohol, and 18% had a historv of a memalignant lesion. Histoloeicallv. 23% were poorly differentiated. The primary treatment modality was surgery in 69% and radiotherapy in 20%. Recurrence occurred in 7 patients, and 10 patients have died to date. This paper will present and discuss a large series of young patients with oral squamous-cell carcinoma.
Loss of protective reflexes with advancing age. C. J. Kerawala. Department of Oral and Facial Surgery, Sunderland District General Hospital, Sunderland, UK. Although the clinical importance of compromised regulatory reflexes has long been established in the comatose patient, it is only relatively recently that depression of protective reflexes at higher levels of consciousness has been appreciated. Advancing age is accompanied by a progressive decrease in the acuity of sensory perception and subsequent reflex activity. Recent years have seen demonstrations of the effect of ageing on perception threshold, reflex latencies and reaction time. The clinical situation at extremes of age to date remains unreported. Oropharyngeal malignancy predominantly affects patients over 55 years of age. Functions of the oropharyngeal environment such as deglutition, respiration and phonation in part rely upon intact reflex activity. The supposition is that patients experiencing functional problems do so entirely as a result of the primary disease or more usually its treatment. Increasing age could, however, be a contributory factor by its deleterious effect on reflex activity. Gag reflex and cornea1 reflex were recorded in 250 patients over the age of 55. Patients with a history of neurological or malignant disease were excluded. In total, 60 patients (24%) demonstrated
The advantages of the retrograde facial nerve dissection over conventional anterograde dissection are outlined. An illustrated description of the retrograde technique An analysis of facial nerve morbidity and recovery surgery in 24 cases, treated over a twelve-month period technique, is presented.
technique is given. following using this
A practical coding system for mandibular fractures. P. Magennis*, A. Begleyf. *Regional Maxillofacial Unit, Walton Hospital, Liverpool; tQueen’s Medical Centre, Nottingham, UK. Having a useful code for describing fractures easescommunication, facilitates record-keeping and makes the compilation of data on computers much sneedier. In 1989. Cooter and David’ described a computer-based coding for fractures of the craniofacial region. This is a well-thought-out system for documentation of all craniofacial fractures, but has limited use in describing fractures of the mandible, particularly where these are the principle injury. Practical Mandibular Fracture Coding uses within it the CooterDavid code to anatomically locate the fracture or fractures, adding subdivisions to the second grade. In addition, two further alphanumeric elements are added. The first element describes the dentition, the total number of fractures, and includes a three-part assessment of the reliability of the occlusion to stabilize the fracture. The second element adds a complication letter or letters to the coding of individual fractures. It is hoped that the use of these codes will ease communication, make records in fracture books more useful and allow more efficient audit of the management of mandibular fractures. References 1. Cooter RD, David DJ. Computer-based coding of fractures in the craniofacial region. Br J Plast Surg 1989; 42( 1): 17-26. Small plate osteosynthesis-the anonymous implant: a survey of plating systems used and current practice at oral and maxillofacial units in the UK. P. Magennis*, A. Begleyf. *Regional Maxillofacial Unit, Walton Hospital, Liverpool; tQueen’s Medical Centre, Nottingham, UK. Small-plate osteosynthesis has revolutionized the management of facial fractures since its introduction during the 1980s. Initial practice followed that of orthopaedic surgeons in that plates were usually removed after the fracture had healed, this is no longer the case. This survey involved 137 oral and maxillofacial surgery units in the UK asking questions about the types of plating systems and how they were used. Ten different makes of plating systems are currently used and there are more than 24 variations of plate design/material and screw heads within these brands. Manufacturers of plates also regularly change these specifications. Only 2 of 93 respondents said they routinely recorded the make and pattern of plates in the operation notes. No units gave any details of plate or screw type directly to the patient. Of 93 responding to the question, 91 said they removed only plates causing symptoms. It is impossible to foresee the problems plates may cause in the future, but it is certain that some will require removal. Few surgeons have avoided the situation where a plate inserted at another unit with a different system requires removal. It is recommended
British
Journal
of Oral
and Maxillofacial
Surgery
DCP + cancellous bone graft was the most common decision. The results will be presented in detail with a discussion on reduction of donor site morbidity. Magnetic resonance tomography of the orbit using surface coils. J. N.
Hofjinann. Schwenzer.
C.
Pfannenberg,
C.
P.
Cornelius,
Department of Oral and Maxillofacial University of Ttibingen, Ttibingen, Germany.
B.
attenuation or absence of either the gag or cornea1 reflex. Whilst both reflexes were depressed to a greater or lesser extent in 7 subjects (2.8%) only one individual demonstrated total absence of both reflexes. The potential importance of these findings will be further discussed.
Nestle,
Surgery, Retrograde facial nerve dissection in parotid surgery. B. O’Regan, MacLuskey. Department of Oral and Maxillofacial Surgery, Queen Margaret Hospital, Dunfermline, Fife, UK. M.
The aim of the study is to compare the effectiveness of magnetic resonance imaging (MRI) in diagnosing herniation and entrapment of orbital soft tissues in orbital fractures. Fifteen consecutive patients with clinical signs and symptoms of medial orbital wall injury were examined with plain radiography and MRI. The data were subsequently compared with the findings of the surgical exploration with regard to the extent of the wall fractures, the presence of soft tissue herniation and its entrapment. MRI was accurate in demonstrating or excluding orbital wall fractures but, compared to the surgical experiences, slightly underestimated their incidence. While Tl-weighted images are useful for the detection of the fracture site, both Tl- and T2-weighted images are usually necessary for evaluating soft-tissue lesions. The results of this study indicate that surface coil MRI is an important adjunct procedure in the diagnosis and treatment of orbital fractures. Oral squamous-cell carcinoma in patients under the age of 40 years. N. C. Hyde, K. Altman. Norman Rowe Maxillofacial Unit, Queen Mary’s University Hospital, Roehampton, UK. Aims and method: Squamous-cell carcinoma of the oral cavity under the age of 40 is uncommon, accounting for 0.4-5% of all patients presenting with this condition. There has been some suggestion that the disease pattern in this age group is changing, becoming more common and aggressive. In view of the small number of cases encountered by individual units, we embarked on a national postal survey of all maxillofacial units in the country, requesting information on demographic data, known risk factors, management, histology and outcome. Results: Responses were received from 36 of the 128 units circulated, providing information about 45 patients who presented between 1985 and 1996. The age range was 16-39 years and the male to female ratio was 2.3:2.2. Although information was not available for all cases, with regard to risk factors, 38% had a previous history of oral tobacco use, 71% consumed alcohol, and 18% had a historv of a memalignant lesion. Histoloeicallv. 23% were poorly differentiated. The primary treatment modality was surgery in 69% and radiotherapy in 20%. Recurrence occurred in 7 patients, and 10 patients have died to date. This paper will present and discuss a large series of young patients with oral squamous-cell carcinoma.
Loss of protective reflexes with advancing age. C. J. Kerawala. Department of Oral and Facial Surgery, Sunderland District General Hospital, Sunderland, UK. Although the clinical importance of compromised regulatory reflexes has long been established in the comatose patient, it is only relatively recently that depression of protective reflexes at higher levels of consciousness has been appreciated. Advancing age is accompanied by a progressive decrease in the acuity of sensory perception and subsequent reflex activity. Recent years have seen demonstrations of the effect of ageing on perception threshold, reflex latencies and reaction time. The clinical situation at extremes of age to date remains unreported. Oropharyngeal malignancy predominantly affects patients over 55 years of age. Functions of the oropharyngeal environment such as deglutition, respiration and phonation in part rely upon intact reflex activity. The supposition is that patients experiencing functional problems do so entirely as a result of the primary disease or more usually its treatment. Increasing age could, however, be a contributory factor by its deleterious effect on reflex activity. Gag reflex and cornea1 reflex were recorded in 250 patients over the age of 55. Patients with a history of neurological or malignant disease were excluded. In total, 60 patients (24%) demonstrated
The advantages of the retrograde facial nerve dissection over conventional anterograde dissection are outlined. An illustrated description of the retrograde technique An analysis of facial nerve morbidity and recovery surgery in 24 cases, treated over a twelve-month period technique, is presented.
technique is given. following using this
A practical coding system for mandibular fractures. P. Magennis*, A. Begleyf. *Regional Maxillofacial Unit, Walton Hospital, Liverpool; tQueen’s Medical Centre, Nottingham, UK. Having a useful code for describing fractures easescommunication, facilitates record-keeping and makes the compilation of data on computers much sneedier. In 1989. Cooter and David’ described a computer-based coding for fractures of the craniofacial region. This is a well-thought-out system for documentation of all craniofacial fractures, but has limited use in describing fractures of the mandible, particularly where these are the principle injury. Practical Mandibular Fracture Coding uses within it the CooterDavid code to anatomically locate the fracture or fractures, adding subdivisions to the second grade. In addition, two further alphanumeric elements are added. The first element describes the dentition, the total number of fractures, and includes a three-part assessment of the reliability of the occlusion to stabilize the fracture. The second element adds a complication letter or letters to the coding of individual fractures. It is hoped that the use of these codes will ease communication, make records in fracture books more useful and allow more efficient audit of the management of mandibular fractures. References 1. Cooter RD, David DJ. Computer-based coding of fractures in the craniofacial region. Br J Plast Surg 1989; 42( 1): 17-26. Small plate osteosynthesis-the anonymous implant: a survey of plating systems used and current practice at oral and maxillofacial units in the UK. P. Magennis*, A. Begleyf. *Regional Maxillofacial Unit, Walton Hospital, Liverpool; tQueen’s Medical Centre, Nottingham, UK. Small-plate osteosynthesis has revolutionized the management of facial fractures since its introduction during the 1980s. Initial practice followed that of orthopaedic surgeons in that plates were usually removed after the fracture had healed, this is no longer the case. This survey involved 137 oral and maxillofacial surgery units in the UK asking questions about the types of plating systems and how they were used. Ten different makes of plating systems are currently used and there are more than 24 variations of plate design/material and screw heads within these brands. Manufacturers of plates also regularly change these specifications. Only 2 of 93 respondents said they routinely recorded the make and pattern of plates in the operation notes. No units gave any details of plate or screw type directly to the patient. Of 93 responding to the question, 91 said they removed only plates causing symptoms. It is impossible to foresee the problems plates may cause in the future, but it is certain that some will require removal. Few surgeons have avoided the situation where a plate inserted at another unit with a different system requires removal. It is recommended