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ABSTRACT: With the increasing use of hyaluronic acid-based injectable fillers for cosmetic enhancement a variety of adverse reactions are being reported in the literature. Although most adverse outcomes occur early we describe an interesting case study of a female presenting with granulomatous complications ten years postoperatively. To our knowledge this is one of the longest reported delayed reactions. For the general dental practitioner offering such treatments it is important to be fully aware of the potential risks and how they may be managed in order to consent appropriately for cosmetic procedures.
British dental journal official journal of the British Dental Association: BDJ online 04/2013; 214(7):339-40. · 1.09 Impact Factor
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ABSTRACT: We describe an enzyme-based electroanalysis system for real-time analysis of a clinical microdialysis sampling stream during surgery. Free flap tissue transfer is used widely in reconstructive surgery after resection of tumours or in other situations such as following major trauma. However, there is a risk of flap failure, due to thrombosis in the flap pedicle, leading to tissue ischaemia. Conventional clinical assessment is particularly difficult in such 'buried' flaps where access to the tissue is limited. Rapid sampling microdialysis (rsMD) is an enzyme-based electrochemical detection method, which is particularly suited to monitoring metabolism. This online flow injection system analyses a dialysate flow stream from an implanted microdialysis probe every 30 s for levels of glucose and lactate. Here, we report its first use in the monitoring of free flap reconstructive surgery, from flap detachment to re-vascularisation and overnight in the intensive care unit. The on-set of ischaemia by both arterial clamping and failure of venous drainage was seen as an increase in lactate and decrease in glucose levels. Glucose levels returned to normal within 10 min of successful arterial anastomosis, whilst lactate took longer to clear. The use of the lactate/glucose ratio provides a clear predictor of ischaemia on-set and subsequent recovery, as it is insensitive to changes in blood flow such as those caused by topical vasodilators, like papaverine. The use of storage tubing to preserve the time course of dialysate, when technical difficulties arise, until offline analysis can occur, is also shown. The potential use of rsMD in free flap surgery and tissue monitoring is highly promising.
Analytical and Bioanalytical Chemistry 02/2013; · 3.78 Impact Factor
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ABSTRACT: The surgical management of advanced cervical metastases with carotid artery involvement in patients with primary squamous cell carcinoma of the head and neck can be difficult. The authors retrospectively reviewed 73 patients over a 15-year period comparing the outcomes of carotid artery resection versus peeling the tumour off the carotid artery. Based on these findings, the authors suggest that in the absence of carotid wall involvement, nodal metastatic tumour should be peeled off the carotid artery where possible. This practice appears to have a lower morbidity than that associated with arterial reconstruction. Steps to minimize cerebrovascular injury are discussed.
International Journal of Oral and Maxillofacial Surgery 12/2012; · 1.51 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 08/2012; · 1.95 Impact Factor
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ABSTRACT: Obstructive sialoadenitis is the most common non-neoplastic disorder of the salivary glands. With advances in the use of diagnostic and interventional sialoendoscopy in the major salivary glands, operations can often be less invasive and treatment can spare the gland and restore normal function. By using an expandable balloon catheter to dilate ductal stenosis during sialoendoscopy it is possible to dilate a stenotic duct and remove large stones with or without a basket. However, the use of different angiocatheters or dedicated balloons is still empirical. In this pilot study we assessed the feasibility and safety of balloon dilatation of the submandibular gland (Wharton's duct). We did balloon catheter sialoplasty on four ducts from two fresh adult cadavers. We used a non-compliant dilating balloon catheter 6mm in diameter at a pressure of 12×10(5)Pa for a total of three minutes and then examined the ducts histologically. There was no damage to the wall of Wharton's duct. Although this is a small study, we have shown the safety of balloon catheter sialoplasty for the first time as assessed histologically after dilatation of the duct. By virtue of the technique histological assessment is not possible after dilatation in patients. Long-term follow up is clearly required in this rapidly evolving area of surgery.
British Journal of Oral and Maxillofacial Surgery 07/2012; · 1.95 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 07/2012; · 1.95 Impact Factor
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ABSTRACT: The British Journal of Oral and Maxillofacial Surgery (BJOMS) publishes many types of papers including original articles, review articles, and short communications. Many of the latter are isolated case reports of rare or interesting diseases or of difficult or unexpected complications. While case reports are sometimes considered to be of little educational or clinical value, and as such do little to advance medical knowledge, they do have an important role, and many trainees begin their publishing careers writing such papers. There is increasing pressure for space in paper medical journals and, for this reason, some journals either limit or do not publish short publications in print copy but instead put them online. Using established criteria, we previously evaluated all 142 short communications published in the BJOMS during 2008-2009 and found that 48% of them had little or no educational value. As a result, the editorial board of BJOMS took the decision to publish most short communications online only. We have now analysed 48 short communications that were published online only during 2010-2011. Most (80%) were single case reports that covered virtually the whole remit of the specialty, and over half (56%) were published by authors based in the UK. While many of these papers did not add important new information to existing knowledge, these types of article are clearly of value both for trainees and for experienced surgeons. We think that these should continue to be supported as, in addition to their educational value, they are an excellent way for trainees to start to write.
British Journal of Oral and Maxillofacial Surgery 05/2012; 50(6):569-73. · 1.95 Impact Factor
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ABSTRACT: Facial skin lesions present routinely to clinic and are largely dermatological in origin. Odontogenic infections are an unusual cause of facial lesion and are well-described in the dental literature; however they are regularly overlooked and mismanaged, often to considerable aesthetic detriment. We present such a case and highlight important avoidable pitfalls.
Journal of Plastic Reconstructive & Aesthetic Surgery 04/2012; · 1.49 Impact Factor
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ABSTRACT: Unusual or unexpected medical causes for free flap failure do occur but are uncommon. We present a rare case of a fibula free flap failure due to an acute vasculitis which was undiagnosed until after the flap had failed. In addition to two successful flap salvages and intravenous heparin, an epoprostenol infusion was commenced but a third salvage was not successful. The vasculitis resulted in marked blood vessel wall thickening, and cutaneous manifestations which presented as late signs. High peri-nuclear anti nuclear cytoplasmic antibody (pANCA) and myeloperoxidase (MOP) titres were subsequently found and histology from several blood vessels showed marked inflammation throughout the wall. A diagnosis of microscopic polyangiitis was made and high dose steroids were subsequently commenced. Interestingly, he had vasculitis several years previously treated with oral steroids but had been discharged from the rheumatology clinic. This rare case illustrates the potential hazards of free flap surgery in the vasculitides and discusses the warning signs and various management options to reduce the likelihood of flap failure in these patients.
Journal of Plastic Reconstructive & Aesthetic Surgery 04/2012; 65(11):1586-8. · 1.49 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 02/2012; 50(7):680-1. · 1.95 Impact Factor
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British Journal of Oral and Maxillofacial Surgery 02/2012; 50(3):280. · 1.95 Impact Factor
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ABSTRACT: The management of salivary gland disease forms an appreciable part of the work undertaken by our specialty. Fast-track and one-stop clinics for head and neck lumps allow for early diagnosis of salivary gland tumours in most units, and for the sharing of cases between our ear, nose and throat (ENT) colleagues. The emphasis on benign salivary gland disease is very much on outcome after operation, and there have been improvements in surgical technique, particularly in relation to minimal dissection of salivary adenomas and sialendoscopy. This article continues a series of reviews, which aim to provide readers with a quick overview and update of recent publications in the British Journal of Oral and Maxillofacial Surgery (BJOMS) within a particular subspecialty.
British Journal of Oral and Maxillofacial Surgery 09/2011; 49(8):627-9. · 1.95 Impact Factor
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ABSTRACT: Technical notes form an important part of the British Journal of Oral and Maxillofacial Surgery (BJOMS). Many ideas are novel and some change practice. During 2009-2010, 39 technical notes were published in the journal, and they covered the whole remit of the specialty. In this article we briefly review and summarise these articles, and highlight the salient points.
British Journal of Oral and Maxillofacial Surgery 09/2011; 49(8):657-60. · 1.95 Impact Factor
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ABSTRACT: Litigation claims are increasing in medicine but we know of little detailed analysis of those published concerning oral and maxillofacial surgery (OMFS) despite information being freely available from the NHS Litigation Authority (NHSLA) under the Freedom of Information Act. We obtained information from the NHSLA on clinical and non-clinical negligence claims in OMFS from April 1995 to August 2010, and analysed the data with outcomes and a further breakdown of subspecialty. During the period 318 claims relating to OMFS were registered. As expected, because of the high volume of patients treated, the highest number of claims related to dentoalveolar surgery and minor oral surgery. The total amount paid out was in excess of £5 million, and the highest claim (more than £300,000) during the period was for misdiagnosis of an oral cancer. Litigation in OMFS is increasing, as is the number of cases that necessitate compensation by the NHSLA. We discuss the trends and implications.
British Journal of Oral and Maxillofacial Surgery 07/2011; 50(5):385-8. · 1.95 Impact Factor
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ABSTRACT: Lymphoma commonly presents as a painless enlarging lump in the neck. With the establishment of the neck lump one-stop clinic, patients can be assessed promptly. Historically an open node biopsy specimen was required for definitive diagnosis, but in the last few years, many clinicians have advocated use of image-guided core biopsies, and some specialist centres monitor patients with fine needle aspiration cytology (FNAC) combined with other diagnostic techniques such as flow cytometry. In this article, we present current published papers on the management of suspected lymphoma in a patient who presents with a neck mass. We discuss the role of FNAC, core biopsy, open node biopsy, and imaging in the diagnosis of lymphoma before the patient is referred to the oncologist.
British Journal of Oral and Maxillofacial Surgery 05/2011; 50(4):309-13. · 1.95 Impact Factor
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ABSTRACT: Serum testosterone levels are known to have diurnal variation and to decrease by up to 2% per year after the age of 40. They can also be affected by stress and aggressive behaviour as well as various medical conditions. Although studies have investigated the role of mood and stress, none has specifically evaluated the effect of operative procedures on surgeons testosterone levels, particularly those in our own specialty, one that has historically been associated with perceived 'high testosterone' levels. We devised a suppositional study, particularly pertinent for publication at the beginning of April. This was a prospective randomised study of five male consultant maxillofacial surgeons (including two with male pattern baldness) and assayed serum testosterone levels at rest, during, and after a series of major ablative and reconstructive procedures. The resting testosterone levels were found to be similar in all surgeons (220 ± 120.9 mcg/ml). During major head and neck procedures, a statistically significant increase in serum testosterone was found (up to a maximum concentration of 1062.50 mcg/ml). Multivariate analysis revealed that the likely predictors of increasing serum testosterone were: size and extent of tumour and complexity, and type of microvascular reconstruction (all P<0.001). The long-term effects of chronically raised serum testosterone warrant further investigation but recent evidence has found that it may be cerebro-protective against conditions including Alzheimer's syndrome.
British Journal of Oral and Maxillofacial Surgery 04/2011; 49(3):190-3. · 1.95 Impact Factor
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ABSTRACT: This review summarises all head and neck oncology and related papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) during the period 2009-2010. A similar review, covering the years 2007-2008 was published in the Journal in 2009 and was well received by readers, as evidenced by the high number of downloads from the BJOMS website. In this article, we include all head and neck oncology-related articles published in the print version of the journal during 2009/10 and concentrate on summarising the full length article papers. Compared to the previous 2-year period, there has been a 25% increase in number of articles published in this sub-specialty.
British Journal of Oral and Maxillofacial Surgery 03/2011; 49(5):368-75. · 1.95 Impact Factor
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ABSTRACT: Ultrasound (US) is a valuable technique for the assessment of salivary gland disease and regional nodes. When used in combination with fine needle aspiration cytology (FNAC) or core biopsy it has a high sensitivity and specificity in the diagnosis of tumours. The role of additional cross-sectional imaging (computed tomography (CT) or magnetic resonance (MR)) to help with the diagnosis of benign parotid tumours is questionable except when there is deep lobe extension or the suggestion of malignancy. We investigated 37 FNAC-confirmed benign parotid tumours in patients who had undergone both US and CT or MRI investigations, to find out whether cross-sectional imaging had provided any further useful diagnostic information before operation. Three patients had bilateral Warthin tumours. Tumours ranged in size from 11 to 45 mm (mean 22). Of the 37 patients 35 (95%) had a clearly delineated mass in the superficial lobe of the parotid on US and no further information was gained from additional CT or MRI. On US 34 patients (92%) had features suggestive of a benign tumour, and three had features suggestive of malignancy but these were found to be benign on FNAC and after operation. CT or MRI confirmed these suspicious findings. In two different patients the deep margin was not visible on US (suggestive of deep lobe extension) and this was confirmed on MRI. The mean time delay between US and CT or MRI was four weeks (range 1-44). These results suggest that additional imaging is not required in most patients with a sonographically and FNAC confirmed benign lesion confined to the superficial lobe of the parotid and confirmed by FNAC or biopsy examination.
British Journal of Oral and Maxillofacial Surgery 03/2011; 50(4):333-7. · 1.95 Impact Factor
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ABSTRACT: The considerable anatomical variation of the thin walled cervical thoracic duct predisposes it to inadvertent damage during neck dissection. If this is not recognised at the time of surgery, a chyle leak can result in potentially serious complications as well as delaying the patient's discharge from hospital. This article summarises the basic anatomy of the terminal thoracic duct in the neck and discusses the pathophysiology of a chyle leak. We present the latest ideas for managing this problem when it is identified at the time of surgery, and review the diagnosis and contemporary management options available for dealing with this difficult problem when it is found to occur post-operatively.
British Journal of Oral and Maxillofacial Surgery 03/2011; 50(3):197-201. · 1.95 Impact Factor
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ABSTRACT: We describe a simple technique to control the hair before conventional draping for serious operations to the head and neck to minimise the need for hair washing after long procedures.
British Journal of Oral and Maxillofacial Surgery 02/2011; 50(2):181-2. · 1.95 Impact Factor
