- Email: [email protected]
Gold eyelid weights in long standing facial palsy
266
British
Journal
of Oral
and Maxillofacial
Surgery
Subjects. 200 patients presenting to an oral surgery unit having sustained facial fractures. Design. Prospective selection of patients. A pro-forma asking about: (1) Patient details, (2) Age, (3) Sex, (4) Marital status, (5) Occupation, (6) Highest level of education obtained, (7) Location of traumatic incident, (8) Site of fracture, (9) Aetiology, (10) Habits (smoking, drinking), (11) Other factors, (12) Previous historv of assault. (13) Treatment. Details entered on to a database and analysed. These results were compared to population data and demographic norms, where available. Results. In assault cases single men predominated. Alcohol had frequently been taken in the hours preceding assaults. The weekly alcohol intake was above average. Educational achievements were below average for the population. Unemployment and manual occupations featured disproportionately. More incidents took place in urban settings and after the normal closing times of licensed premises. The victims of unprovoked assaults formed a subgroup with higher educational achievement and better paid employment. Sports injuries were uncommon and had a different profile.
Treatment of recurrent pleomorphic adenomas of the parotid gland: multinodular versus solitary tumours. A. Renehan, M McGurk* & E. N. Gleave. Department of Surgery, Christie Hospital, Manchester, *Department of Oral & Maxillofacial Surgery, UMDS, London, UK. A series of 114 patients with first time recurrent pleomorphic adenomas of the parotid gland treated at the Christie Hospital, Manchester (1952-92) is reviewed. Local excision or enucleation was the initial treatment in all but five cases. The median time to first recurrence was 96 months (range 6-383). Two clinical forms were seen - multinodular (n = 52) and solitary (n = 62). Treatment modality was either surgery alone (SG; n =63) or surgery with radiotherapy (SG + RT; n = 5 1). The type of reoperation was determined by the extent of tumour recurrence with nerve preservation wherever possible; the nerve was sacrificed in 6 patients (partial, 4; trunk, 2). There were 17 (15%) further recurrences - median follow-up 14 years. The median time to second recurrence was 73 (range 5-283) months. Gender, age at initial treatment, duration to first recurrence, type of primary surgery, and extent of second surgery did not influence control rates by univariate analysis. Subanalysis demonstrated that, in the solitary tumour group, recurrence rates were not improved when SG + RT (17%) was compared to SG (14%). In contrast, there was a significant improvement in control where multinodular tumours were treated by SG + RT (3%) compared to SG (37%, P=O.O02). The study demonstrates that, at first recurrence, solitary disease can be adequately controlled by surgery alone, but multinodular recurrence benefits from the addition of adjuvant radiotherapy.
Gold eyelid weights in long standing facial palsy. D. Richardson. Department of Maxillofacial Surgery, Walton Hospital, Liverpool, UK. Facial palsy presents a number of challenges to the reconstructive surgeon. Cornea1 protection is of paramount importance in order to avoid irritation, exposure keratitis, and cornea1 ulceration. A number of surgical procedures are available for either temporary or permanent correction of lagophthalmos, including both static and dynamic techniques. Loading of the upper lid to allow gravity assisted eye closure has been practised for a number of years. Refinements in surgical technique have reduced the problems associated with this technique including infection, implant displacement, dehiscence, discolouration of overlying lid skin, and inappropriate implant weight. We have been using individualised custom made gold implants to restore the blink reflex in facial palsy patients. The implants are individualised for size, shape and weight. The techniques of assessment, manufacture, and placement will be described. There is a low incidence of complications associated with this technique, and a follow-up of 15 consecutive cases will be presented.
The functional module to the comprehensive computerised record for head and neck malignancy. S. N. Rogers, M. Pa&l, J. S. Brown, E. D. Vaughan & J. C. Beirne. The Maxillofacial Unit, Walton Hospital, Aintree Trust, Liverpool, UK. In the policy framework for commissioning cancer services, Calman et al. 1995 emphasised the need for information on quality and outcome of care, together with quality assurance and audit. Patient outcome should routinely include a quality of life evaluation in addition to survival and recurrence figures. The purpose of this project was to establish a computerised head and neck oncology functional record suitable for routine use in clinical practice. The first 50 consecutive ‘new’ patients presenting in 1995 with previously untreated oral and oro-pharyngeal cancer were recruited. Questionnaire and clinical examination were made pretreatment, at 3 months, 6 months and 1 year. The questionnaires comprised the University of Washington Quality of Life questionnaire (UW QOL), the short form 36, the EORTC core and head and neck modules and 14 additional questions. The short clinical examination involved a 20 point examination of the head and neck region and donor sites. Of the 50 patients, 45 agreed to participate, 43 were treated surgically and 2 with primary radiotherapy. 36 microvascular free flap reconstructions were performed. Comparison will be made between demographic parameters, stage of disease, treatment modalities, and conventional indices of outcome. Also, correlation will be made between quality of life questionnaire response and functional aspects of clinical examination. The process of assessing outcome will be reviewed. This study was supported by a grant from the British Association of Oral and Maxillofacial Surgeons. Dancing cheek to cheek. Magnetic Resonance Imaging, an aid to diagnosis. A. Rogers & M. J. C. BXe. Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK. The diagnosis and management of soft tissue lesions in the cheek has always presented a diagnostic challenge to the clinician. It is valuable to have as much information as possible as to the nature of the lesion its anatomical position and its relationship to a number of vital structures within the area. Following histological diagnosis, surgery can then be planned. With the increasingly widespread availability of Magnetic Resonance Imaging to Oral and Maxillofacial Surgery Units in the UK, I should like to present a series of cases recently seen, to illustrate the value and pitfalls of this form of imaging in the assessment of soft tissue lesions of the cheek and to demonstrate the information they provide in planning appropriate management and surgery, using T, and T, weighted images and the contrast agents Gadolinuim DTPA. Malignant minor salivary gland tumour of the lower lip karapandzic flat reconstruction. M Rudralingam. G. B. McBride, S. Napier & W J. Primrose. Departments of Otolaryngology Head and Neck Surgery and Dental Pathology, UK. Cystadenocarcinomas are an ill-defined group of low-grade salivary neoplasms which are characterised by a cystic growth pattern not specific of another salivary cancer. The karapandzic flap is an increasingly popular method for lip reconstruction. The labial artery pedicle provides reliable vascularity and sensory function permitting reconstruction of a defect up to 90%. An otherwise healthy 64-year-old male presented with a 1 cm diameter slowly expanding lesion in the lip near the left buccal commissure which was present for several months. On histological examination, the tumour showed features of a mutinous cystadenocarcinoma. The possibility of metastasis was considered particularly from large bowel, however the long history of slow growth, microscopic appearances and the absence of primary tumours elsewhere were suggestive of an origin from a minor salivary gland. The rhomboid shape defect was reconstructed using a karapandzic flap technique; producing excellent functional and cosmetic result.
British
Journal
of Oral
and Maxillofacial
Surgery
Subjects. 200 patients presenting to an oral surgery unit having sustained facial fractures. Design. Prospective selection of patients. A pro-forma asking about: (1) Patient details, (2) Age, (3) Sex, (4) Marital status, (5) Occupation, (6) Highest level of education obtained, (7) Location of traumatic incident, (8) Site of fracture, (9) Aetiology, (10) Habits (smoking, drinking), (11) Other factors, (12) Previous historv of assault. (13) Treatment. Details entered on to a database and analysed. These results were compared to population data and demographic norms, where available. Results. In assault cases single men predominated. Alcohol had frequently been taken in the hours preceding assaults. The weekly alcohol intake was above average. Educational achievements were below average for the population. Unemployment and manual occupations featured disproportionately. More incidents took place in urban settings and after the normal closing times of licensed premises. The victims of unprovoked assaults formed a subgroup with higher educational achievement and better paid employment. Sports injuries were uncommon and had a different profile.
Treatment of recurrent pleomorphic adenomas of the parotid gland: multinodular versus solitary tumours. A. Renehan, M McGurk* & E. N. Gleave. Department of Surgery, Christie Hospital, Manchester, *Department of Oral & Maxillofacial Surgery, UMDS, London, UK. A series of 114 patients with first time recurrent pleomorphic adenomas of the parotid gland treated at the Christie Hospital, Manchester (1952-92) is reviewed. Local excision or enucleation was the initial treatment in all but five cases. The median time to first recurrence was 96 months (range 6-383). Two clinical forms were seen - multinodular (n = 52) and solitary (n = 62). Treatment modality was either surgery alone (SG; n =63) or surgery with radiotherapy (SG + RT; n = 5 1). The type of reoperation was determined by the extent of tumour recurrence with nerve preservation wherever possible; the nerve was sacrificed in 6 patients (partial, 4; trunk, 2). There were 17 (15%) further recurrences - median follow-up 14 years. The median time to second recurrence was 73 (range 5-283) months. Gender, age at initial treatment, duration to first recurrence, type of primary surgery, and extent of second surgery did not influence control rates by univariate analysis. Subanalysis demonstrated that, in the solitary tumour group, recurrence rates were not improved when SG + RT (17%) was compared to SG (14%). In contrast, there was a significant improvement in control where multinodular tumours were treated by SG + RT (3%) compared to SG (37%, P=O.O02). The study demonstrates that, at first recurrence, solitary disease can be adequately controlled by surgery alone, but multinodular recurrence benefits from the addition of adjuvant radiotherapy.
Gold eyelid weights in long standing facial palsy. D. Richardson. Department of Maxillofacial Surgery, Walton Hospital, Liverpool, UK. Facial palsy presents a number of challenges to the reconstructive surgeon. Cornea1 protection is of paramount importance in order to avoid irritation, exposure keratitis, and cornea1 ulceration. A number of surgical procedures are available for either temporary or permanent correction of lagophthalmos, including both static and dynamic techniques. Loading of the upper lid to allow gravity assisted eye closure has been practised for a number of years. Refinements in surgical technique have reduced the problems associated with this technique including infection, implant displacement, dehiscence, discolouration of overlying lid skin, and inappropriate implant weight. We have been using individualised custom made gold implants to restore the blink reflex in facial palsy patients. The implants are individualised for size, shape and weight. The techniques of assessment, manufacture, and placement will be described. There is a low incidence of complications associated with this technique, and a follow-up of 15 consecutive cases will be presented.
The functional module to the comprehensive computerised record for head and neck malignancy. S. N. Rogers, M. Pa&l, J. S. Brown, E. D. Vaughan & J. C. Beirne. The Maxillofacial Unit, Walton Hospital, Aintree Trust, Liverpool, UK. In the policy framework for commissioning cancer services, Calman et al. 1995 emphasised the need for information on quality and outcome of care, together with quality assurance and audit. Patient outcome should routinely include a quality of life evaluation in addition to survival and recurrence figures. The purpose of this project was to establish a computerised head and neck oncology functional record suitable for routine use in clinical practice. The first 50 consecutive ‘new’ patients presenting in 1995 with previously untreated oral and oro-pharyngeal cancer were recruited. Questionnaire and clinical examination were made pretreatment, at 3 months, 6 months and 1 year. The questionnaires comprised the University of Washington Quality of Life questionnaire (UW QOL), the short form 36, the EORTC core and head and neck modules and 14 additional questions. The short clinical examination involved a 20 point examination of the head and neck region and donor sites. Of the 50 patients, 45 agreed to participate, 43 were treated surgically and 2 with primary radiotherapy. 36 microvascular free flap reconstructions were performed. Comparison will be made between demographic parameters, stage of disease, treatment modalities, and conventional indices of outcome. Also, correlation will be made between quality of life questionnaire response and functional aspects of clinical examination. The process of assessing outcome will be reviewed. This study was supported by a grant from the British Association of Oral and Maxillofacial Surgeons. Dancing cheek to cheek. Magnetic Resonance Imaging, an aid to diagnosis. A. Rogers & M. J. C. BXe. Royal Shrewsbury Hospital, Shrewsbury, Shropshire, UK. The diagnosis and management of soft tissue lesions in the cheek has always presented a diagnostic challenge to the clinician. It is valuable to have as much information as possible as to the nature of the lesion its anatomical position and its relationship to a number of vital structures within the area. Following histological diagnosis, surgery can then be planned. With the increasingly widespread availability of Magnetic Resonance Imaging to Oral and Maxillofacial Surgery Units in the UK, I should like to present a series of cases recently seen, to illustrate the value and pitfalls of this form of imaging in the assessment of soft tissue lesions of the cheek and to demonstrate the information they provide in planning appropriate management and surgery, using T, and T, weighted images and the contrast agents Gadolinuim DTPA. Malignant minor salivary gland tumour of the lower lip karapandzic flat reconstruction. M Rudralingam. G. B. McBride, S. Napier & W J. Primrose. Departments of Otolaryngology Head and Neck Surgery and Dental Pathology, UK. Cystadenocarcinomas are an ill-defined group of low-grade salivary neoplasms which are characterised by a cystic growth pattern not specific of another salivary cancer. The karapandzic flap is an increasingly popular method for lip reconstruction. The labial artery pedicle provides reliable vascularity and sensory function permitting reconstruction of a defect up to 90%. An otherwise healthy 64-year-old male presented with a 1 cm diameter slowly expanding lesion in the lip near the left buccal commissure which was present for several months. On histological examination, the tumour showed features of a mutinous cystadenocarcinoma. The possibility of metastasis was considered particularly from large bowel, however the long history of slow growth, microscopic appearances and the absence of primary tumours elsewhere were suggestive of an origin from a minor salivary gland. The rhomboid shape defect was reconstructed using a karapandzic flap technique; producing excellent functional and cosmetic result.