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Intramaxillary fixation is not really necessary for mandibular fractures
Abstracts between January 1991 and December 1995 and had subsequent surgical repair were invited for review. Patients underwent evaluation of best corrected visual acuity, pupil size, degree of enophthalmos, ocular motility restrictions, infraorbital nerve sensation, visibility of surgical scars and the presence of ectropion. The interval following surgery varied from nine months to five years. Complete data were obtained from 27 of the 40 patients (67.5%~). Of these, 44% showed restriction of ocular motilitv and 37% had significant enophthalmos. Twelve per cent of patients had some degree of ectropion and 48% still had some degree of disturbance of infraorbital nerve sensation. Two patients have required further motility surgery. The role of early repair in the orbital blow out fracture remains controversial and this audit emphasizes the need for further prospective studies.
Management of the unfavourahle canine by segmental huccal advancement, via a Le Fort One approach. C. M. E. Avery, P. A. Johnson. The Maxillofacial Unit, The Royal Surrey County Hospital, Guildford, Surrey, UK. We review our experience with a standard Le Fort One downfracture approach to the maxillary buccal segment osteotomy. We have used this technique mainly for the management of the unfavourably impacted canine in 20 cases. The advancement of unilateral or bilateral maxillary segments is an effective single-stage surgical procedure. It allows immediate closure of excess space in the canine and premolar region when the dental arches are reasonably aligned and a good occlusion can be obtained. It is indicated for selected patients who have declined conventional orthodontic or alternative treatment. Many of our patients are older teenagers who prefer a quick surgical solution to prolonged orthodontic or restorative treatment. Some have also undergone additional concurrent orthognathic surgery.
lntramaxillary fixation is not really necessary for mandibular fractures. Z. Lalant. L. Duncon, A. M. Fordyce. A. Songra, A. Carton, J. E. Huwkesfbrd. Catherine Cookson Maxillofacial Unit, Newcastle General Hospital, Newcastle upon Tyne. UK. An audit of one year’s activity in actively treated mandibular fractures was undertaken in the Catherine Cookson Maxillofacial Unit at Newcastle General Hospital. A total of I55 patients were identified by the Audit department with fracture of the mandible. Of these, 81 patients were identified who had: (a) an isolated mandibular fracture; (b) no previous history of facial fractures; (c) fractures treated by open reduction and internal fixation (ORIF). Forty-nine out of eighty-one patients had their fractures reduced without the use of peroperative intermaxillary fixation; only two of these required postoperative intermaxillary elastic traction; both had unilateral condylar fractures. Thirty-two out of eighty-one had fractures that were treated using intraoperative intermaxillary fixation (IMF), of whom 11 required postoperative elastic traction; 9/l 1 had an associated condylar fracture. Overall, there was no difference in the rate of other complications (infection, non-union, malunion trismus, sensory changes). Reduction of fractures without the use of IMF was found to reduce the operating time significantly, is safer for the patient and operator, causes less oral inflammation and discomfort and is cheaper. with the added advantage of there being no wires to remove. We conclude that IMF offers no advantage over manual reduction in mandibular fractures treated by ORIF but has several disadvantages.
The effect of short-term high-dose steroids on the healing vascular anastomosis. J. S. Bro~on, R. M. Brobrne. Walton Liverpool, UK.
of microHospital,
Buckground. High-dose perioperative steroids have been used routinely to reduce swelling and potential airway embarrassment in orthognathic surgery and, in some units in head and neck surgery, to reduce the need for routine tracheostomy. This pilot study was designed to test the hypothesis that the use of steroids
from
1997 BAOMS
Meeting
205
did not have a detrimental effect on the success of free tissue transfer. Method. Forty-two New Zealand white rabbits had anastomes performed on the common carotid artery and anterior facial vein, half with 48 h perioperative high-dose steroids, and half as controls. The vessels were examined for patency and harvested by perfusion fixation for histological examination at 24 h, 3 days, 7 days, 14 days and 3 months. Conclusion. There were no significant differences between the two groups, although the trend was for effect of steroids to be beneficial. We concluded that the high-dose perioperative steroids do not jeopardize the healing of vascular anastomosis in a rabbit model, and may be of benefit in human free tissue transfer.
Surgically facilitated maxillary expansion and occlussl stability. G. M. L. McLellun, P. R. Ayl@e, P. A. Johnson. Royal Surrey County Hospital, Guildford, Surrey, UK. Surgically facilitated rapid maxillary expansion has now become a routine procedure in orthognathic surgery. Few studies have examined the post-expansion stability of this technique. Twenty patients treated at the Royal Surrey County Hospital over a three-year period were examined retrospectively. Occlusal results were assessed using a modification of Huddart’s technique and the stability of palatal arch form was examined using a new simple technique. The results of this study show that surgically facilitated rapid maxillary expansion is a useful tool with low morbidity, giving exceptionally stable results.
Fine needle aspiration cytology: Who should do it? M. K. Jandu*, K. Websterf. *The Medical School, University of Birmingham: tRussells Hall Hospital, Dudley, West Midlands, UK. Objective: To assess the influence of operator experience on the sensitivity and specificity of the use of fine needle aspiration cytology (FNAC) in diagnosing head and neck lesions, Design: Retrospective record-based study. Setting: Oral and maxillofacial surgery departments in two District General Hospitals. Subjects: 95 patients with a mass in the head and neck undergoing FNAC for whom adequate documentation existed. Results: Overall, sensitivity and specificity were 90% and 97% respectively. If operator experience is taken into account, then accuracy was 100% when performed by a Consultant and falls to 9 I ‘Xi when performed by an SHO. Conclusion: Overall sensitivity and specificity are comparable with other studies. With all grades of operators, accuracy improves with experience. In our opinion, FNAC should be performed by trained experienced operators.
The use of optical surface scanning in the planning of facial asymmetry. C. Hopper, P. M. Goodwin, J. P. hfoss. Departments of Maxillofacial Surgery Physics. University College London Hospitals Dental Institute, London, UK.
and evaluation A. D. Linney, and Medical and Eastman
The use of optical scanning using a low-power laser was originally designed to visually plan orthognathic surgery using threedimensional images and in the subsequent assessment of facial growth and development. The quantitative assessment of facial soft tissue asymmetry is difficult and has traditionally been restricted to mainly twodimensional anthropometric measurements. In this paper, we describe the use of optical scanning in the quantification of facial asymmetry and how this technique may be adapted for use in surgical planning. Ten patients with clinically evident facial asymmetry were studied. All patients had baseline scans performed which were then analysed to quantify and locate the asymmetry by mirror imaging. With this information, in addition to standard investigations, patients subsequently underwent corrective surgery. Postoperative scans were repeated to evaluate treatment. Primary analysis of the results show this method to be reproducible and accurate to within approximately 1 mm. The obvious
Management of the unfavourahle canine by segmental huccal advancement, via a Le Fort One approach. C. M. E. Avery, P. A. Johnson. The Maxillofacial Unit, The Royal Surrey County Hospital, Guildford, Surrey, UK. We review our experience with a standard Le Fort One downfracture approach to the maxillary buccal segment osteotomy. We have used this technique mainly for the management of the unfavourably impacted canine in 20 cases. The advancement of unilateral or bilateral maxillary segments is an effective single-stage surgical procedure. It allows immediate closure of excess space in the canine and premolar region when the dental arches are reasonably aligned and a good occlusion can be obtained. It is indicated for selected patients who have declined conventional orthodontic or alternative treatment. Many of our patients are older teenagers who prefer a quick surgical solution to prolonged orthodontic or restorative treatment. Some have also undergone additional concurrent orthognathic surgery.
lntramaxillary fixation is not really necessary for mandibular fractures. Z. Lalant. L. Duncon, A. M. Fordyce. A. Songra, A. Carton, J. E. Huwkesfbrd. Catherine Cookson Maxillofacial Unit, Newcastle General Hospital, Newcastle upon Tyne. UK. An audit of one year’s activity in actively treated mandibular fractures was undertaken in the Catherine Cookson Maxillofacial Unit at Newcastle General Hospital. A total of I55 patients were identified by the Audit department with fracture of the mandible. Of these, 81 patients were identified who had: (a) an isolated mandibular fracture; (b) no previous history of facial fractures; (c) fractures treated by open reduction and internal fixation (ORIF). Forty-nine out of eighty-one patients had their fractures reduced without the use of peroperative intermaxillary fixation; only two of these required postoperative intermaxillary elastic traction; both had unilateral condylar fractures. Thirty-two out of eighty-one had fractures that were treated using intraoperative intermaxillary fixation (IMF), of whom 11 required postoperative elastic traction; 9/l 1 had an associated condylar fracture. Overall, there was no difference in the rate of other complications (infection, non-union, malunion trismus, sensory changes). Reduction of fractures without the use of IMF was found to reduce the operating time significantly, is safer for the patient and operator, causes less oral inflammation and discomfort and is cheaper. with the added advantage of there being no wires to remove. We conclude that IMF offers no advantage over manual reduction in mandibular fractures treated by ORIF but has several disadvantages.
The effect of short-term high-dose steroids on the healing vascular anastomosis. J. S. Bro~on, R. M. Brobrne. Walton Liverpool, UK.
of microHospital,
Buckground. High-dose perioperative steroids have been used routinely to reduce swelling and potential airway embarrassment in orthognathic surgery and, in some units in head and neck surgery, to reduce the need for routine tracheostomy. This pilot study was designed to test the hypothesis that the use of steroids
from
1997 BAOMS
Meeting
205
did not have a detrimental effect on the success of free tissue transfer. Method. Forty-two New Zealand white rabbits had anastomes performed on the common carotid artery and anterior facial vein, half with 48 h perioperative high-dose steroids, and half as controls. The vessels were examined for patency and harvested by perfusion fixation for histological examination at 24 h, 3 days, 7 days, 14 days and 3 months. Conclusion. There were no significant differences between the two groups, although the trend was for effect of steroids to be beneficial. We concluded that the high-dose perioperative steroids do not jeopardize the healing of vascular anastomosis in a rabbit model, and may be of benefit in human free tissue transfer.
Surgically facilitated maxillary expansion and occlussl stability. G. M. L. McLellun, P. R. Ayl@e, P. A. Johnson. Royal Surrey County Hospital, Guildford, Surrey, UK. Surgically facilitated rapid maxillary expansion has now become a routine procedure in orthognathic surgery. Few studies have examined the post-expansion stability of this technique. Twenty patients treated at the Royal Surrey County Hospital over a three-year period were examined retrospectively. Occlusal results were assessed using a modification of Huddart’s technique and the stability of palatal arch form was examined using a new simple technique. The results of this study show that surgically facilitated rapid maxillary expansion is a useful tool with low morbidity, giving exceptionally stable results.
Fine needle aspiration cytology: Who should do it? M. K. Jandu*, K. Websterf. *The Medical School, University of Birmingham: tRussells Hall Hospital, Dudley, West Midlands, UK. Objective: To assess the influence of operator experience on the sensitivity and specificity of the use of fine needle aspiration cytology (FNAC) in diagnosing head and neck lesions, Design: Retrospective record-based study. Setting: Oral and maxillofacial surgery departments in two District General Hospitals. Subjects: 95 patients with a mass in the head and neck undergoing FNAC for whom adequate documentation existed. Results: Overall, sensitivity and specificity were 90% and 97% respectively. If operator experience is taken into account, then accuracy was 100% when performed by a Consultant and falls to 9 I ‘Xi when performed by an SHO. Conclusion: Overall sensitivity and specificity are comparable with other studies. With all grades of operators, accuracy improves with experience. In our opinion, FNAC should be performed by trained experienced operators.
The use of optical surface scanning in the planning of facial asymmetry. C. Hopper, P. M. Goodwin, J. P. hfoss. Departments of Maxillofacial Surgery Physics. University College London Hospitals Dental Institute, London, UK.
and evaluation A. D. Linney, and Medical and Eastman
The use of optical scanning using a low-power laser was originally designed to visually plan orthognathic surgery using threedimensional images and in the subsequent assessment of facial growth and development. The quantitative assessment of facial soft tissue asymmetry is difficult and has traditionally been restricted to mainly twodimensional anthropometric measurements. In this paper, we describe the use of optical scanning in the quantification of facial asymmetry and how this technique may be adapted for use in surgical planning. Ten patients with clinically evident facial asymmetry were studied. All patients had baseline scans performed which were then analysed to quantify and locate the asymmetry by mirror imaging. With this information, in addition to standard investigations, patients subsequently underwent corrective surgery. Postoperative scans were repeated to evaluate treatment. Primary analysis of the results show this method to be reproducible and accurate to within approximately 1 mm. The obvious