- Email: [email protected]
An audit of visual acuity recording in mid-face trauma
Poster presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S26–S116
in 6 months and 12 months and from this we aim to identify any weaknesses in training and recommendations for improvement. doi:10.1016/j.bjoms.2011.03.060 P53 An audit of visual acuity recording in mid-face trauma L. Colgan ∗ , J. Cross, J. Morrison, C. Wales, G. Markose, W.J.R. Currie, W.S. Hislop Crosshouse Hospital, Kilmarnock, United Kingdom Introduction/aims: Facial trauma is assessed by many different specialties in the context of the patient presenting with poly-trauma or head injury. Injuries to the middle third of the face can have deleterious effects on vision. Serious or blinding injury has an incidence of 11.6%. The incidence of retrobulbar haemorrhage in mid face trauma is 0.6%. Therefore initial assessment should include an objective visual acuity measurement. The aim of our audit was to compare the documentation of visual acuity in A&E with the gold standard of 100% documentation. Materials/methods: All patients who presented to A&E with mid face trauma were included in the audit. The records were scrutinised for documentation of visual acuity and recorded retrospectively on a standard audit proforma. Results: The initial audit revealed 77% of patients with mid face trauma did not have a visual acuity documented in the notes. A programme of education was undertaken followed a period of re-audit which showed little change in the documentation. This was followed by a further programme of education and a further audit which revealed improved compliance. Conclusion: The basic assessment of facial injuries is a generic skill required by all doctors who are involved in the care of the trauma patient. In an attempt to prevent vision threatening injuries, it is imperative that an objective visual acuity is recorded as part of the assessment. The results have demonstrated the need for an ongoing programme of education due to the turnaround in junior staff every 4–6 months. doi:10.1016/j.bjoms.2011.03.061 P54 An overview of parotid gland surgery by a single OMFS surgeon in a district general hospital L. Colgan ∗ , C.P. Chambers, W.J.R. Currie, W.S. Hislop Crosshouse Hospital, Kilmarnock, United Kingdom Introduction: Tumours of the salivary glands represent 2–4% of head and neck neoplasms. Pleomorphic Salivary Adenomas (PSAs) comprise 85% of all salivary gland neoplasms. Sialectasis and bacterial infections can also result in
S45
swelling of the parotid gland and regularly present to OMFS departments for treatment. Aims: The aim of our study was to provide an overview of parotid gland surgery carried out in the OMFS department at Crosshouse Hospital. The procedures and postoperative complications were considered. Materials and method: An analysis of the most recent 50 parotid surgical cases was carried out retrospectively. Information was gathered including the patients demographics, presenting complaint, treatment, histological results and correlation with FNAc results and post operative complications. Results: 50 procedures were carried out on 48 patients. Histology results confirm malignancy in 17 cases. PSAs accounted for 12 of the 50 cases. 34 cases had FNAc analysis carried out and of these 25 correlated with the definitive histology. Post op complications including facial nerve weakness and Frey’s syndrome were present in 21 cases and did not resolve completely in 6 patients. A superficial parotidectomy was carried out in 42 cases. Other procedures included radical parotidectomy with and without neck dissection, enucleation of orbit and reconstruction with rectus flap. Discussion: Although superficial parotidectomy is the most common parotid procedure, it is sometimes necessary for more radical surgery and complex reconstruction. The surgeon carrying out the treatment should be adequately trained and able to provide all aspects of this surgery. doi:10.1016/j.bjoms.2011.03.062 P55 An unusual response of dental sepsis to antibiotics: parallels with the Jarisch-Herxheimer reaction J. Collier ∗ , H. Moss, S. Collier Barts and The London NHS Trust, United Kingdom Dental sepsis is a common presentation to OMFS units. Patients may present with a spectrum of systemic upset for which the initial treatment includes the administration of intravenous fluids and antibiotics to optimise the patient prior to surgical intervention. On rare occasions, administration of these medications can result in an acute decompensation of the patient’s systemic wellbeing. The mechanism of this is not always clear although immediate antibiotic-mediated lysis of hypersensitive bacteria can result in massive endotoxin release leading to a significant systemic upset. This shares features with the Jarisch-Herxheimer (JH) reaction which was originally described following the administration of penicillin to patients with syphilis. Typical features of a JH reaction include agitation, paranoia, flushing, hyperventilation but not hypotension or shock. We present the illustrative case of a 21 year-old man with a submandibular space infection of short duration and no
in 6 months and 12 months and from this we aim to identify any weaknesses in training and recommendations for improvement. doi:10.1016/j.bjoms.2011.03.060 P53 An audit of visual acuity recording in mid-face trauma L. Colgan ∗ , J. Cross, J. Morrison, C. Wales, G. Markose, W.J.R. Currie, W.S. Hislop Crosshouse Hospital, Kilmarnock, United Kingdom Introduction/aims: Facial trauma is assessed by many different specialties in the context of the patient presenting with poly-trauma or head injury. Injuries to the middle third of the face can have deleterious effects on vision. Serious or blinding injury has an incidence of 11.6%. The incidence of retrobulbar haemorrhage in mid face trauma is 0.6%. Therefore initial assessment should include an objective visual acuity measurement. The aim of our audit was to compare the documentation of visual acuity in A&E with the gold standard of 100% documentation. Materials/methods: All patients who presented to A&E with mid face trauma were included in the audit. The records were scrutinised for documentation of visual acuity and recorded retrospectively on a standard audit proforma. Results: The initial audit revealed 77% of patients with mid face trauma did not have a visual acuity documented in the notes. A programme of education was undertaken followed a period of re-audit which showed little change in the documentation. This was followed by a further programme of education and a further audit which revealed improved compliance. Conclusion: The basic assessment of facial injuries is a generic skill required by all doctors who are involved in the care of the trauma patient. In an attempt to prevent vision threatening injuries, it is imperative that an objective visual acuity is recorded as part of the assessment. The results have demonstrated the need for an ongoing programme of education due to the turnaround in junior staff every 4–6 months. doi:10.1016/j.bjoms.2011.03.061 P54 An overview of parotid gland surgery by a single OMFS surgeon in a district general hospital L. Colgan ∗ , C.P. Chambers, W.J.R. Currie, W.S. Hislop Crosshouse Hospital, Kilmarnock, United Kingdom Introduction: Tumours of the salivary glands represent 2–4% of head and neck neoplasms. Pleomorphic Salivary Adenomas (PSAs) comprise 85% of all salivary gland neoplasms. Sialectasis and bacterial infections can also result in
S45
swelling of the parotid gland and regularly present to OMFS departments for treatment. Aims: The aim of our study was to provide an overview of parotid gland surgery carried out in the OMFS department at Crosshouse Hospital. The procedures and postoperative complications were considered. Materials and method: An analysis of the most recent 50 parotid surgical cases was carried out retrospectively. Information was gathered including the patients demographics, presenting complaint, treatment, histological results and correlation with FNAc results and post operative complications. Results: 50 procedures were carried out on 48 patients. Histology results confirm malignancy in 17 cases. PSAs accounted for 12 of the 50 cases. 34 cases had FNAc analysis carried out and of these 25 correlated with the definitive histology. Post op complications including facial nerve weakness and Frey’s syndrome were present in 21 cases and did not resolve completely in 6 patients. A superficial parotidectomy was carried out in 42 cases. Other procedures included radical parotidectomy with and without neck dissection, enucleation of orbit and reconstruction with rectus flap. Discussion: Although superficial parotidectomy is the most common parotid procedure, it is sometimes necessary for more radical surgery and complex reconstruction. The surgeon carrying out the treatment should be adequately trained and able to provide all aspects of this surgery. doi:10.1016/j.bjoms.2011.03.062 P55 An unusual response of dental sepsis to antibiotics: parallels with the Jarisch-Herxheimer reaction J. Collier ∗ , H. Moss, S. Collier Barts and The London NHS Trust, United Kingdom Dental sepsis is a common presentation to OMFS units. Patients may present with a spectrum of systemic upset for which the initial treatment includes the administration of intravenous fluids and antibiotics to optimise the patient prior to surgical intervention. On rare occasions, administration of these medications can result in an acute decompensation of the patient’s systemic wellbeing. The mechanism of this is not always clear although immediate antibiotic-mediated lysis of hypersensitive bacteria can result in massive endotoxin release leading to a significant systemic upset. This shares features with the Jarisch-Herxheimer (JH) reaction which was originally described following the administration of penicillin to patients with syphilis. Typical features of a JH reaction include agitation, paranoia, flushing, hyperventilation but not hypotension or shock. We present the illustrative case of a 21 year-old man with a submandibular space infection of short duration and no