• A three-dimensional comparison of torque achieved with a preadjusted edgewise appliance using a Roth or MBT prescription.

      Mittal, Mohit (2015-03)
      OBJECTIVE: To investigate if there are any significant differences in the final inclination of the upper and lower anterior teeth of patients treated with a Roth or an MBT bracket prescription. MATERIALS AND METHODS: Forty sets of posttreatment study models from patients treated using a preadjusted edgewise appliance (20 Roth and 20 MBT) were selected using predetermined inclusion and exclusion criteria. The models were masked and laser-scanned, and the final crown inclinations of UL1, UR3, and LR1 were assessed from the digital images. A two-way analysis of variance was undertaken with the dependent variable of final crown inclination and independent variables of bracket prescription (Roth or MBT) and tooth type. RESULTS: There were no statistically significant differences in terms of the final inclination of the anterior teeth between the two bracket prescriptions (P  =  .132). Statistically significant differences were found between the final inclinations of different tooth types investigated (P < .001). CONCLUSION: In this group of selected patient records, the differences in torque values between the two bracket prescriptions did not lead to any real clinically detectable differences in the final inclination of teeth.
    • Acute dental conditions attending A&E: Is there an epidemic of surgical admissions for dental infections?

      Patton, Claire; Dickenson, Andrew (2014-10)
      Background: Since the introduction of the Dental Contract (April 2006) there has been a perception that the rate of A&E attendance for acute dental conditions has increased. Previous analysis of hospital data suggests that the number of admissions for surgical drainage for dental abscesses has been steadily increasing. If genuine, this has significant public health implications. We retrospectively analysed attendance and admission data for the period 2004-2013 at the Royal Derby Hospital. Method: The A&E database was searched for all attendances that included the key words "dental", "toothache", "abscess" or "swelling". Anomalies were removed by hand. This data was cross referenced with admission data for the same time period. Results: During the 2004-2013 study period there were significant increases in the number of A&E attendances- 56.95% - with a corresponding increase in hospital admission for acute treatment from 9.67% of attenders to 18.42%, 52.49% of which needed to stay in over at least one night. Conclusions: As perceived there has been a significant increase in A&E workload for acute dental conditions. The severity of these conditions appears to have escalated, which is reflected by the increased admission rate. This has a direct impact on the unplanned activity of maxillofacial units. Despite changes in the dental contract emergency admissions for dental conditions remains a major public health issue.
    • An unusual cause for an optic disc haemorrhage.

      Baxter, Julia; Kailasanathan, Anusha; Chen, Hean (2011-02)
      A 51-year-old male on chemotherapy for myeloma presented initially with a unilateral optic disc haemorrhage and signs of optic neuropathy. This rapidly progressed to affect both eyes and within a few days he developed retinal features suggestive of progressive outer retinal necrosis. He was treated with intravenous acyclovir that was subsequently changed to ganciclovir when serological tests for cytomegalovirus were found to be positive for immunoglobulin M antibodies. His visual loss continued to deteriorate despite treatment, and he subsequently developed a retinal detachment in one eye. The causes of optic neuropathy in immunocompromised patients and the importance of eliminating an infective cause are discussed
    • Are the patients discussed at the end of a MDT meeting disadvantaged in terms of the time taken to discuss their case: A prospective audit

      Prado, Naomi; Maguire, Conal; Jones, Keith; Laugharne, David (2016-12)
      Background: Multidisciplinary team (MDT) meetings are an important part of cancer care services. The discussions ensure that a consensus is reached for the treatment of each patient. It has been hypothesized that patients at the end of a MDT meeting may have reduced discussion compared with patients at the start, potentially compromising patient care.Aims: To determine whether there is an association between discussion duration and order of discussion in a MDT meeting.Standards: There are currently no local, regional or national standards for the minimum amount of time a patient should be allocated for discussion in a MDT meeting.Methodology: Data collection: prospective sample of patients discussed at the Head&Neck MDT meetings at Royal Derby Hospital, over a 14month period. Only meetings with every case discussion timed were included in the audit.Sample size: 19 meetings totalling 466 discussions.The data was analysed using Mood's Median test to determine if the duration of patient discussion was influenced by the order in which the discussion took place.Results: The p-value was found to be 0.379, therefore the hypothesized interaction between duration of discussion and position in the list was not found to be significant (p > 0.05).Conclusions: In conclusion it is reassuring that our results suggest that patients discussed at the end of the MDT meeting are not disadvantaged in terms of the time taken to discuss their case. We note that although this conclusion is positive, recommendations have still been made to improve the efficiency of the meetings.
    • Arthrocentesis in the management of internal derangement of the temporomandibular joint.

      Breik, Omar (2018-11)
      BACKGROUND: Temporomandibular disorders (TMD) cover a wide spectrum of disorder; myalgic, arthralgic and psychogenic. The procedure of TMJ arthrocentesis has a role in managing patients with arthralgic pain and limitation if they fail to respond to non-surgical therapy. METHOD: The patient records of a single private specialist OMS were searched over the nine year period of 2006-2014 to identify patients who had arthrocentesis as part of their multidisciplinary management. The detailed demographic, diagnosis, pre and post arthrocentesis procedure were identified and put on a database. Appropriate statistics were performed. RESULTS: Seventy six patients had 115 arthrocentesis procedures performed in the study period. Fifty of 76 had improvement in their pain and 16 of 41 had an increased jaw opening of more than 10mm. There was no complications or morbidity. Analysis of patient variables generally showed no correlations. CONCLUSIONS: Temporomandibular joint arthrocentesis has a role in the multidisciplinary, multimodality treatment of arthralgic TMD.
    • An audit investigating BMI and the prevalence of obesity in orthognathic patients: Are we putting patients at risk?

      Baughan, Sarah; Maguire, Conal (2017-12)
      Introduction: The obese surgical patient presents a number of potential complications to surgeons and anaesthetists alike. We know that currently very few maxillofacial units in the country have a specific protocol in place for an upper BMI limit prior to operating. We hope to discuss the impact obesity has on orthognathic surgery and what can be done to minimise these risks. Methods: A retrospective analysis of the medical records of all 183 patients who had undergone orthognathic surgery from 2012-2015 at the Royal Derby Hospital was carried out, reviewing their BMIs and any intra- or post- operative complications. Results: Orthognathic surgery is being carried out frequently on clinically obese patients. Between 2012-2015, 10.7% of our surgical orthognathic patients had a BMI of greater than 30, of which 6.3% were greater than 35.We note one patient with a BMI greater than 30 who suffered a deep vein thrombosis post-operatively. Conclusion: As orthognathic surgery is elective and requires often lengthy courses of pre-operative orthodontics, there is a unique opportunity to encourage patients to achieve a healthy weight prior to surgery.We propose a guideline for the management of the obese patient seeking orthognathic surgery which we hope will reduce the number of high risk patients
    • Chondroid tenosynovial giant cell tumour: a rarity in the temporomandibular joint.

      Thomas, Mathew (2019-04)
      Tenosynovial giant cell tumours of the temporomandibular joint (TMJ) are extremely rare, particularly the subset of chondroid tumours. They can be broadly divided into localised and diffuse types, of which we know of only 116 reported cases in the TMJ. Rarer still are the subset of chondroid tenosynovial giant cell tumours, of which we know of only 30 cases that have affected the TMJ. We present a case that involved the TMJ, and include a discussion of its management.
    • Chronic granulomatous disease and neovascularisation causing a vitreous haemorrhage.

      Baxter, Julia; Gandhewar, Ravikiran; Holden, Roger (2010-12)
      The authors report the case of a 9-year-old boy with chronic granulomatous disease with longstanding inactive chorioretinal lesions developing a spontaneous vitreous haemorrhage. This was due to an undetected branch retinal vein occlusion and was successfully treated with retinal photocoagulation (laser).
    • Clinical Efficacy and Safety of Ranibizumab Versus Dexamethasone for Central Retinal Vein Occlusion (COMRADE C): A European Label Study.

      Puri, P (2016-05)
      PURPOSE: To compare the efficacy and safety of the European labels of ranibizumab 0.5 mg vs dexamethasone 0.7 mg in patients with macular edema secondary to central retinal vein occlusion (CRVO). DESIGN: Phase IIIb, multicenter, double-masked, randomized clinical trial. METHODS: Patients were randomized (1:1) to receive either monthly ranibizumab followed by pro re nata (PRN) treatment (n = 124) or 1 sustained-release dexamethasone implant followed by PRN sham injections (n = 119). Main outcomes were mean average change in best-corrected visual acuity (BCVA) from baseline to month 1 through month 6, mean change in BCVA, and adverse events (AEs). RESULTS: Of 243 patients, 185 (76.1%) completed the study. No difference was observed in BCVA between ranibizumab and dexamethasone at months 1 and 2. From month 3 to month 6, there was significant difference in BCVA gains in favor of ranibizumab. At month 6, mean average BCVA gain was significantly higher with ranibizumab than with dexamethasone (12.86 vs 2.96 letters; difference 9.91 letters, 95% confidence interval [6.51-13.30]; P < .0001). Mean injection number of ranibizumab was 4.52. Ocular AEs were reported in more patients in the dexamethasone than in the ranibizumab group (86.6% vs 55.6%). CONCLUSIONS: Using the European labels, similar efficacy was observed for ranibizumab and dexamethasone at months 1 and 2. However, ranibizumab maintained its efficacy throughout the study, whereas dexamethasone declined from month 3 onward. The main limitation of the study was that dexamethasone patients received only a single treatment during the 6-month study. In clinical practice, dexamethasone retreatment may be required earlier than 6 months. Safety findings were similar to those previously reported.
    • Corpus Hippocraticum: historical source of treatment of craniomaxillofacial trauma.

      Stathopoulos, Panagiotis (2017-04)
      The works of Hippocrates known in the Western World as the Corpus Hippocraticum have dominated medical thought and surgical practice for centuries. A substantial part of the Hippocratic Collection is dedicated to the description of injuries pertinent to Cranio-maxillofacial surgery and their management. Hippocrates has reached this level of surgical skill despite the limited pre-recorded knowledge and the restriction of post-mortem dissections.
    • Covid-19: face masks can be devastating for people with hearing loss but alternatives are available.

      Poostchi, Ali; Kuet, Mong-Loon; Richardson, PS; Patel, MK (2020-08)
      Chodosh and colleagues and Grote and Izagaren highlight an important matter but overlook the use of face shields, hoods, and other clear barriers that decrease disease transmission, facilitate lip reading, and reduce muffling. Face shields are also easier to manufacture, clean, and reuse. They protect the user’s eyes and are more acceptable than masks in a paediatric setting. The suggestion to adopt masks with clear windows is premature given the lack of evidence that they are more effective than face shields. Using a laser particle counter, we found that face masks and Perspex barriers had similar efficacy in reducing airborne and droplet transmission across a slit lamp. When a higher level of protection is required, clear ventilated hoods can be used and these have been successfully trialled with a view to widespread adoption. The authors have identified a salient problem to which cost effective and viable solutions are available and can be readily applied.
    • Cribriform adenocarcinoma of the minor salivary glands arising in the epiglottis: a previously undocumented occurrence.

      Green, D (2015-09)
      A 39-year-old female was referred to her local Ear, Nose, and Throat department with tonsillar hypertrophy. During intubation for a tonsillectomy, a mass was also noted on the epiglottis. Histopathologic examination showed this mass to be a cribriform adenocarcinoma of the minor salivary glands (CAMSG). As far as the authors are aware, a CAMSG has never been documented in the larynx.
    • Current perspectives on the surgical management of mandibular third molars in the United Kingdom: the need for further research

      Chiu, Geoff (2020-04)
      This survey of expert opinion regarding the management of mandibular third molar (M3M) impaction and its clinical sequelae was circulated to all members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). It was completed by 289 clinicians who reported treating 60003 patients annually. Respondents included 199 (69%) specialists and 58 (20%) primary care clinicians. Most (99%) of the clinicians treated at least one M3M with complete surgical removal (CSR) annually. Only 69% performed one or more coronectomies (COR). Advocates of coronectomy reported lower rates of inferior alveolar nerve (IAN) injury, but IAN, lingual nerve, and adjacent second molar damage were rare, occurring in less than 0.5% of cases, with small differences between the COR and CSR groups. Although these differences are not statistically significant, they are likely to be clinically important. Also, the COR group would have comprised mainly high-risk teeth, while the CSR group would include many teeth at low risk of complications. This might have skewed the results. Those clinicians performing no coronectomies cited three main reasons for being low adopters of COR: the lack of irrefutable evidence to support its benefit, the increased need for a second operation, and more non-IAN complications. Although COR may prevent permanent IAN damage in high-risk cases, this paper highlights clinicians' views that there is a gap in evidence and knowledge to support COR. As a result, 47% of the clinicians surveyed recommended, and were prepared to participate in, further studies to determine the effectiveness and safety of COR.
    • Day-case adenotonsillectomy for sleep apnoea in children?

      Kamani, Tawakir; Wilkinson, Sophie (2015-12)
      OBJECTIVES: Many clinicians are concerned about possible airway or respiratory complications following adenotonsillectomy for sleep related breathing disorder (SRBD), and routinely admit such patients for overnight monitoring. However, published guidelines suggest this is unnecessary in some cases. This study firstly aimed to establish current UK practice, and secondly to investigate whether children with mild/moderate SRBD experience respiratory problems during the first post-operative night. METHODS: To establish current UK practice, we carried out a telephone survey asking if the procedure was carried out as a day-case, and admission criteria. For the second aim, a prospective study of children admitted following adenotonsillectomy for mild/moderate SRBD was carried out to investigate occurrence of respiratory complications on first post-operative night. RESULTS: Forty-two UK ENT doctors responded to the telephone survey, 50% routinely admitted patients having adenotonsillectomy for SRBD. Discharge criteria included stable observations and eating and drinking (14 hospitals), no bleeding (1), stable oxygen saturations (1) and age above 5 years (1); four had no specific criteria. Of 51 children admitted following adenotonsillectomy for mild/moderate SRBD, 11 (21.6%) experienced oxygen desaturations overnight. Of these, nine were under 4 years old, and two older children had asthma. Irrespective of comorbidities, 9/27 (33.2%) children under 4 years old experienced desaturations. The only children aged more than 4 years that had desaturations were ones that had additional comorbidities. CONCLUSION: Half of surveyed doctors admit all children following surgery for SRBD. The number of admissions could be reduced, because same-day discharge for otherwise-healthy children over 4 years old having adenotonsillectomy for mild/moderate SRBD appears to be safe.
    • Dealing with vascular anomalies during radial forearm free flap harvest: report of two cases and review of the literature.

      Breik, Omar; Selbong, Uthaya; Laugharne, David; Jones, Keith (2019-06)
      Radial forearm free flap reconstruction for head and neck cancer is very common, and it is widely considered a workhorse flap. Although this flap has a relatively reliable anatomy, surgeons need to be aware of possible anatomical variations and how to deal with them. This paper presents the cases of two patients who underwent oral reconstruction, in whom anomalies of the radial artery were identified while raising a radial forearm free flap. Case 1 demonstrates the dominant branch of the radial artery joining the common interosseous artery approximately 9 cm from the first wrist crease. Case 2 demonstrates abnormal distal branching of the radial artery approximately 4 cm from the first wrist crease. Reconstruction with the flap was successful in both cases. A literature review of reported anomalies of the radial artery is presented, and how to deal with such vascular anomalies is discussed.
    • Dental treatment in children with asthma - a review.

      Prado, Naomi (2016-03)
      This article aims to explain the effects of long-term use of asthma medications. It will discuss the effects of asthma on the oral cavity, as well considerations for the dentist when treating asthmatic patients. It will also explain how to manage asthma in the dental setting and provide advice on maintaining oral health for asthmatic patients.
    • Did King Philip II of Ancient Macedonia Suffer a Zygomatico-Orbital Fracture? A Maxillofacial Surgeon's Approach.

      Stathopoulos, Panagiotis (2017-09)
      Philip II, father of Alexander the Great, succeeded his brother, Perdiccas III, to the throne of Macedonia in 360 BC. He has been described by historians as a generous king and military genius who managed to achieve his ambitious plans by expanding the Macedonian city-state over the whole Greek territory and the greater part of the Balkan Peninsula. The aim of our study was to present the evidence with regard to the facial injury of King Philip II of Macedonia and discuss the treatment of the wound by his famous physician, Critobulos. We reviewed the literature for historical, archaeological, and paleopathological evidence of King Philip's facial injury. We include a modern reconstruction of Philip's face based on the evidence of his injury by a team of anatomists and archaeologists from the Universities of Bristol and Manchester. In the light of the archaeological findings by Professor Andronikos and the paleopathological evidence by Musgrave, it can be claimed with confidence that King Philip II suffered a significant injury of his zygomaticomaxillary complex and supraorbital rim caused by an arrow as can be confirmed in many historical sources. To the best of our knowledge, this is the first attempt to present the trauma of King Philip II from a maxillofacial surgeon's point of view.