The aim of this study was to evaluate the effectiveness of liposome-encapsulated ropivacaine (0.5%) in dental anaesthesia. This randomised, double-blind, crossover, four-period treatment study included 40 volunteers who were given 1.8 ml of the following local anaesthetics into the buccal sulcus at the right level of the upper canine: 0.5% ropivacaine; 0.5% ropivacaine with 1:200,000 adrenaline; liposome-encapsulated 0.5% ropivacaine; and 2% lignocaine with 1:100,000 adrenaline. Onset of pulpal anaesthesia; the success of anaesthesia; and the duration of labial, gingival, and pulpal anaesthesia involving the upper right canine and first premolar were evaluated. At the end of each injection, volunteers rated the pain on injection on a visual analogue scale (VAS). Both ropivacaine and adrenaline, and lignocaine with adrenaline, were more successful anaesthetic agents than liposome-encapsulated ropivacaine or plain ropivacaine (p<0.05). There were no significant differences among the anaesthetic preparations in the onset of pulpal anaesthesia. Ropivacaine and adrenaline and lignocaine and adrenaline gave a significantly longer duration of pulpal anaesthesia. VAS showed no significant differences among the groups tested. The results showed that encapsulation of liposome did not improve the anaesthetic efficacy of ropivacaine.
To examine the nature of maxillofacial injuries that presented to the Birmingham Children's Hospital according to aetiology, incidence and characteristics of patients.
The maxillofacial unit at Diana Princess of Wales Birmingham Children's Hospital serves a catchment area of 5.2 million. We examined all children who presented with maxillofacial trauma from 2002 to 2006. Details including characteristics of patients and aetiology and nature of injury, were entered prospectively into a database.
The total number of patients who presented was 1062. The ratio of boys to girls was 2:1. The main reason for attendance was a fall (70%). 149 (17%) patients presented after interpersonal violence. Soft tissue injuries accounted for 70% of injuries and 14% presented with a maxillofacial fracture.
Our data indicate that the range and mechanism of presenting injuries have not changed within the time frame. Despite public perception of increasing interpersonal violence, this was not reflected in our series of patients.
An experimental study was carried out in hamster tongue cancer induced with 9,10-dimethyl-1,2-benzanthracene (DMBA) to examine the association between the histological features and the incidence of lymph node metastases. Squamous cell carcinoma was induced in 64 of 71 hamsters exposed to DMBA 3 times weekly for a period of 10-24 weeks, and lymph node metastases were found in 8 necks. Various histological variables in the primary lesion were examined, and the mode of invasion, degree of keratinization, and stage of invasion were found to be closely related to the development of neck metastases. We then did a prospective study in 37 human patients with T1-2 tongue cancer, which also showed a close association between the incidence of neck metastases and the histological variables of mode of invasion and degree of keratinization. These experimental and clinical studies suggest that the mode of invasion and degree of keratinization may be risk factors for neck metastases that are independent of T stage, and that the indications for elective neck dissection should be re-evaluated in that light.
Adequate treatment of panfacial injuries often requires tracheostomy or alternating intubation through the nose and the mouth to keep the field free during the operation. Altemir's submental technique is an attractive option in these patients. We used the method with a slight modification in 107 operations in our unit to treat panfacial injuries. We had a low rate of complications and no increased operative time. (c) 2005 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Full length articles such as prospective and retrospective studies, case series, laboratory-based research and reviews form the majority of papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS). We were interested to evaluate the breakdown of these types of articles both by sub-specialty and the type of study as well as the proportion that are written by UK colleagues compared to overseas authors over a 2year period (2010-11). A total of 191 full length articles across all sub-specialties of our discipline were published, with 107 papers (56%) coming from UK authors. There were proportionately more oncology papers arising from the UK than overseas (60 and 30% of total respectively) while the opposite was found for cleft/deformity studies (10% and 22%). There was only one laboratory-based study published from the UK compared with 27 papers from overseas. The number of quality papers being submitted to the Journal continues to increase, and the type of article being published between UK and overseas probably reflects different practices and case-loads amongst colleagues. The relatively few UK laboratory based studies published in BJOMS compared to overseas authors are most likely due to authors seeking the most prestigious journals possible for their work.
The aim of this study was to record clinical function using an 11-item clinical examination and identify the main postoperative functional deficits. Of 132 consecutive patients undergoing surgery for previously untreated disease between January 1995 and June 1997, 130 were recruited in the study. An 11-domain clinical examination was made on the day before operation, and at 6 and 12 months afterwards. This examination assessed lip competence, tongue movement, oral mucosa, dental state, mouth opening, speech, drooling, diet, appearance, oral sensation and shoulder movement. Preoperatively there were deficits in natural dentition, consistency of diet and tongue protrusion. Postoperatively functional scores fell particularly for tongue movements, mouth opening, mucosa, dentition, speech, diet, appearance, lip sensation and tongue sensation. At 1 year, dental status, sensation and oral mucosa were particularly defective. Patients with large tumours, free tissue transfer, or adjuvant radiotherapy had the worst levels of function.A simple clinical examination provides a rapid assessment of function that can be used in conjunction with validated questionnaires to provide a more comprehensive evaluation of outcome.
In a randomized controlled clinical trial 110 edentulous patients with severe mandibular bone loss have been treated with ITI-dental implants using three different treatment strategies: (1) a mandibular overdenture supported by two implants with ball attachments, (2) two implants with an interconnecting bar or (3) by four interconnected implants. As implant surgery involves elevation of the mucoperiosteum, bone remodelling at the implant site and insertion of implants close to the mental foramen, altered sensations of the mental nerve caused by the surgery are to be expected. An altered sensation of the lower lip can also be caused by pressure of an ill-fitting lower denture on the mental foramen, or in the case of severe bone loss of the alveolar ridge, on the alveolar nerve itself. This article presents the results of the patients' perception of the sensation of their lower lip before, 10 days after and 16 months after implant surgery in the mandible. It shows that 25% of the patients describe a sensory disturbance before treatment. This 25% also showed high scores on the Hopkins Symptoms Check List indicating a tendency to somatize complaints. Eleven percent of the patients report a sensory disturbance in the lower lip 10 days after surgery. Ten percent report a sensory disturbance 16 months after surgery of which one third also reported a disturbance before the treatment. This implies the risk of a sensory disturbance of the lower lip to be a possible complication after implant surgery. Therefore patients must be informed about this phenomenon before treatment.
Of a total of 1118 uranostaphyloplasties in a maxillofacial hospital in Kiev, 819 have been operated on since 1980 by a new technique; 424 (52%) of these were in children under the age of 3 years. Analysis of the anatomical and the functional results of the operation, anthropometric studies, and data on logopaedic training showed that the proposed method of uranostaphyloplasty (cleft-palate repair) was effective both anatomically and functionally.
To assess the socioeconomic factors, presentation, aetiological factors, microbiology, and management of deep neck abscesses.
Tertiary health care centre.
We studied 120 patients with deep neck abscess who were managed in the department of otolaryngology between May 2004 and December 2005.
There were 54 male patients (45%) and 66 female (55%) with ages ranging from 18 months to 60 years. Most of the patients were of low socioeconomic status and 84 (70%) were illiterate. None were aware of the predisposing factors and potential complications of deep neck abscess. Ninety-six (80%) had poor orodental hygiene with dental infections and extraction as the most common predisposing factor followed by recurrent oropharyngeal infections. The median duration of delay before the patient presented to us was 1 week, and only 6 (5%) were aware of the primary health services available in their locality. The most common site was the submandibular region. Pain, fever, and dysphagia were the most common presenting symptoms, and Staphylococcus aureus was the most common micro-organism. All patients were treated by incision and drainage, and 10 required emergency tracheostomy. All patients responded with no complications.
Socioeconomic factors, particularly ignorance, illiteracy, and poverty, are important contributory factors towards the high incidence of deep neck abscess in developing countries.
The concentrations of cytokines were measured by an ELISA in the synovial fluid from 117 patients with temporomandibular disorders (TMD) and correlated with degenerative changes of the condyle and clinical symptoms.Fifty-seven patients had degenerative changes of the condyle. The fluid from seven healthy volunteers was used as controls. The concentrations of interleukin-1beta (IL-1beta), tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and interleukin-8 (IL-8) were significantly higher in the synovial fluid of patients than controls (P<0.05). The concentration of IL-6 was significantly higher in the patients with degenerative changes than in other patients (P<0.05). The detection of IL-8 correlated with the concentrations of IL-6 and TNF-alpha. However, there was no correlation between the concentrations of any cytokines and symptoms. In conclusion, the cytokines in the synovial fluid may participate in the pathogenesis of TMD. In particular, IL-6 is important and may be associated with the development of osteoarthritis.
We have evaluated the transmasseteric anterior parotid (TMAP) approach in the treatment of 163 condylar fractures in 129 patients. Ninety-five patients presented with unilateral, and 34 with bilateral, fractures. The inclusion criteria were patient's choice for open reduction and internal fixation, displaced unilateral condylar fractures with occlusal derangement, and displaced bilateral condylar fractures with anterior open bite. Mean (SD) maximum interincisal opening after 3 months was 44(5)mm. There were no differences in lateral movements during the reviews 6 weeks and 3 months postoperatively. Protrusive movement at the end of 3 months was 7(2)mm. All patients achieved functional occlusion identical to the pretraumatic occlusion and good reduction of the condyles. No patient developed temporary or permanent facial palsy, sialocele, salivary fistula, or Frey syndrome. The mean (SD) operating time was 46(11)min. The TMAP approach avoids the complications of incision of the parotid gland, minimises the risk of facial nerve palsy, and offers excellent access to the fractured condyle.
Ameloblastoma is uncommon in the maxilla, comprising about 15% of all reported ameloblastomas. Ameloblastomas are locally aggressive and, when involving the maxilla, potentially lethal. The long term outcome of 13 patients with ameloblastoma in the maxilla for whom surgery was the primary treatment between 1951-1990 was studied. Patient records from both private and public practices in Melbourne, Australia were examined as were those cases reported to the Bone Tumour Registry at the University of Bristol, England. The study showed that control of disease was achieved in all patients where the tumour was limited to the confines of the maxilla (10 cases). The mean follow-up period in this group was 7 years (range 2-20 years). In the three cases that recurred all had preoperative radiological evidence of posterior maxillary sinus wall destruction and/or pterygoid plate erosion. Two patients died of extensive local recurrence and one has persistence of the disease. Histopathological examination confirmed the diagnosis of ameloblastoma in each case with a variety of histological patterns being noted. It is concluded that notwithstanding histological type, the extent of the tumour at presentation and the adequacy of the surgical approach and removal were the main factors in successfully managing the disease.
A common and serious intraoperative complication of sinus floor lift is perforation of the sinus lining. Several strategies to prevent or treat it have had varying results. We report the results of an audit of 13 consecutive sinus grafts in 11 patients in which nasal suction was used to facilitate raising the sinus lining, and to reduce the risk of perforation.
Details of injuries to the face and teeth have been collected over a five-year period. One hundred and thirty patients were seen with injuries resulting from 21 different sports. Estimates of the numbers of people playing various team sports in the Bradford area suggest that the incidence of facial injuries is most common in rugby, followed by soccer and cricket. Miniature motor cycling and horse-riding are the most dangerous individual sports. The ages of injured patients varied widely in different sports, but the severity of injuries sustained is less than those due to other causes.
The purpose of this study was to investigate the use of oral rehabilitation in a group of patients who had primary resection of oral and oropharyngeal squamous cell carcinoma. Of 132 consecutive patients operated on for previously untreated disease between January 1995 and June 1997, 130 were recruited. The University of Washington Quality of Life questionnaire was completed on the day before operation at 6 and 12 months, and at last review. A larger similar dataset was used to predict survival. Twenty-eight patients (22%) were seen by the oral rehabilitation team. The median (IQR) time from operation to start of treatment was 12 months (6-21). The median (IQR) time from beginning to end of rehabilitation was 14 months (5-49). Patients with larger tumours (P=0.06) and patients who were edentulous with dentures in the maxilla (P=0.07) were most likely to be seen for oral rehabilitation.
We made a retrospective study of the casenotes of 132 patients with bite injuries who were treated in the departments of craniomaxillofacial surgery in Berlin and Bochum university hospitals. Dogs caused most of the injuries (n=121, 92%) and the lips were most commonly involved. Nearly half the patients had superficial injuries. More than 70% of the patients presented to the clinic within 6h after the bite, and developed fewer wound infections than the patients who presented late. A total of 71 patients were given antibiotics for prophylaxis. Patients who were given amoxycillin with clavulanic acid developed no wound infections. Surgical management included cleansing and primary closure of the wound. Infected wounds were closed primarily after insertion of a drain. Wound cultures showed mainly streptococcus. We concluded that antibiotic prophylaxis is essential for several indications and the antibiotic of first choice is amoxycillin-clavulanic acid. Primary wound closure is an approved principle even in infected wounds.
The purpose of this study was to determine the blood supply to lyophilized amniotic membranes when used as graft material in vestibuloplasties. 133Xe clearance technique was used to measure the blood flow to the grafts. A total of 20 patients had either Clark (10) or Kazanjian (10) vestibuloplasties. The blood flow was determined at 2-3 days preoperatively and at 10 and 30 days postoperatively. The preoperative mandibular anterior alveolar mucosal blood flow was 34.4 +/- 10.7 and 23.1 +/- 13.1 ml/100 g/min for the Clark and Kazanjian groups, respectively. Ten days after vestibuloplasty operation with lyophilized amniotic membrane graft application the blood flow to the graft increased to 56.8 +/- 45.4 and 62.6 +/- 30.4 ml/100 g/min for the Clark and Kazanjian groups, respectively. The corresponding values at 30 days postoperatively were 24.6 +/- 10.2 and 22.2 +/- 9.2 ml/100 g/min, indicating the return to normal levels. The changes in blood flow as a function of time were statistically significant in each group (P<0.05). Our results demonstrated the angiogenic effect of lyophilized amniotic membranes until mucoid degeneration after 10-15 days.
A prospective study of 134 patients undergoing excision of a facial lesion was undertaken. Considerable clinical diagnostic difficulty was experienced, with 21% of clinical diagnoses being incorrect. A tendency towards a clinical over-diagnosis of basal cell carcinoma was noted and whilst this is not unreasonable, a number of benign lesions inevitably were diagnosed as malignant with unnecessary sacrifice of tissue. Incisional biopsy of lesions should be considered when sited close to important anatomical structures to enable accurate diagnosis prior to definitive surgery. Although a few definite indications for a particular reconstructive technique exist (Table 1), a choice is more often available. Repair of the excisional defect with a local flap as opposed to a skin graft resulted in a reduced length of hospital admission with fewer postoperative complications and better final cosmesis. As a consequence, a local flap is recommended as the method of repair where direct closure is not feasible.
We retrospectively reviewed 137 cases of histologically confirmed pyogenic granuloma of the oral cavity from the records of the Department of Oral Surgery, Bharat Heavy Electricals Hospital, Trichy, India between 1996 and 2006. The most commonly affected site was the gingiva (n=114, 83%). Mean age of patients was 31 years (range 6-85, male to female ratio 1:2.6). Simple excision is enough to prevent recurrence, but the aetiology and pathogenesis of the lesion must be known to understand its nature.
Fourteen patients or their immediate family were interviewed about their experiences of having either unilateral or bilateral external distraction osteogenesis of the mandible. The patients showed a high level of co-operation with treatment. Six of the 14 patients required repeat distractions, and had been informed and accepted that this was a possibility before the initial distraction. However, patients or their parents expressed some reservations about the extraoral distractors, which prevented them from practising their favourite sport and made them vulnerable to bullying by their friends and colleagues. Patients had moderate pain when the appliances were removed. They all expressed their satisfaction with the results and would recommend this treatment to others. Problems, including speech, eating, pain, and sleeping difficulties, were encountered by patients at all stages of treatment. Of considerable concern was the disruption of education when the child was treated during the school term.
A survey of 141 cases of osteomyelitis of the jaws is presented. The salient clinical features, the aetiology and treatment of the lesions are described. A high incidence of the disease in the maxilla is noted. Lesions of the maxilla mainly occurred in patients in the first decade of life, whilst those of the mandible affected individuals in the third decade. The possible relationship between infection, blood supply to the jaw bone, and associated debilitating conditions is examined.
The aim of this study was to measure and analyse morphological data about the upper lips of healthy children in Chengdu, Western China. The characteristics and patterns of growth and development of the upper lip may be helpful in guiding the treatment of cleft lip. A total of 1500 healthy children aged between 2 and 12 were divided into 11 groups according to their age. Seven points on the upper lip were measured directly: the length from the alar base to the commissure, the length of the philtrum, the length from the tip of the Cupid's bow to the commissure, the width of one limb of the Cupid's bow, the length from the alar base to the central columella, the area of the unilateral upper lip, and the angle of the line of the alar base to the commissure and the line of the tip of the Cupid's bow to the commissure. Five aspects were significantly different among the groups: the length from the alar base to the commissure (p=0.04), the length from the tip of the Cupid's bow to the commissure (p=0.02), the width of the upper lip (p=0.02), the area adjacent to the lip (p=0.03), and the area of the unilateral upper lip (p=0.04). These data may be useful for reference to cleft lip repair.
A three-dimensional soft tissue study of the results of surgery in a group of 16 skeletal Class III adult patients following orthognathic surgery was carried out using laser scans (Arridge et al., 1985). The patient group was compared to a control group of the same population. Laser scans were taken prior to surgery, 3 months post-surgery, and at least 1 year after retention. Preoperative comparison to the control groups revealed that the facial disproportion related to both the maxilla and the mandible. Le Fort I advancements resulted in broadening of the lateral aspects of the nose, advancement of the dorsum, and overcorrection of the alar bases. There was a degree of change over the cheeks bilaterally, because of alterations in the general drape of the soft tissues. There was a degree of overcorrection in the female group following mandibular set back but the male group were still more prognathic, when compared to the control group. There was a marked degree of relapse in the mandible from 3 months to 1 year postoperatively, with a resultant anterior movement of the maxillary arch. Laser scanning has proved to be a simple non-invasive method of measuring three-dimensionally, and is a very useful tool in auditing surgical outcome and measuring surgical relapse.
Human papillomavirus type 16 (HPV-16) has been established beyond doubt as a causative agent in oropharyngeal squamous cell carcinoma (SCC). The incidence of oropharyngeal cancer has risen in recent decades, as has the proportion of patients who have a biologically relevant HPV-16 infection. Combined data from 14 recently published studies (2006-2010) show that 57% of 1316 reported cases of oropharyngeal SCC were HPV-16 positive. They had significantly better prognosis (hazard ratio (HR) for 5-year overall survival range 0.05-0.64), although smoking and higher T stage often appear as confounding factors to this favourable prognostic benefit. HPV-16 therefore has increasing importance as a clinically useful prognostic biomarker, but a benefit in survival has been seen in the use of surgery, radiotherapy, and chemotherapy, so specific changes in the preferred methods of treatment are hard to justify. Future trials that include oropharyngeal SCC will consider HPV-16 routinely as a stratification factor, and its use as a predictive biomarker awaits the development of effective targeted treatments. The undeniable and impressive prognostic significance of HPV-16 should hasten its addition to standard pathological reporting of oropharyngeal SCC, and ultimately to its inclusion in TNM staging systems of the American Joint Committee on Cancer (AJCC) and the International Union against Cancer (UICC).
The purpose of this study was to investigate the prevalence of human papillomaviruses (HPVs) 16 and 18 infection, and p53 mutation in oral squamous cell carcinomas (SCCs) in Japanese patients. Our results showed a higher incidence of HPV16 and 18 infections than previous studies because we combined the findings of a consensus polymerase chain reaction (PCR), restriction fragment length polymorphism by using the restriction enzyme digestion of the PCR products and Southern blot hybridization. Each HPV16 and 18 E6/E7 DNA was detected in 9 (20%) and 25 (54%) of 46 samples. The p53 mutation in the exons from 5 to 8 were detected in 20 out of 46 samples (43%) by a PCR-single strand conformation polymorphism analysis. There was a significant relationship between HPV16 and the p53 mutation (P =0.02) suggesting that HPV16 infection has a mutagenic effect in oral SCC. However, neither HPV infection nor p53 mutation influenced survival.
Head and neck chondrosarcomas are rare, accounting for less than 12% of all chondrosarcomas. Few studies with larger series approach the clinicopathological characteristics of these tumours. The aim of this study was describe clinical findings, management and outcome of 16 cases of head and neck chondrosarcoma from a single institution.
The files of the Cancer Hospital A.C. Camargo were reviewed, and data from patients with head and neck chondrosarcoma were collected.
Mean age was 36 years, with slight male predilection. The most common site affected was maxilla (43%). Surgery was the main modality treatment performed in 10 patients. Overall 5-year survival rate was 56.4%. Although it was not statistically significant, the most important factor affecting overall survival was tumour size.
Early diagnosis and adequate surgical resection are important to get better survival rates.
We examined 66 oral squamous cell carcinomas (OSCCs) for human papillomavirus-16 (HPV-16) infection to evaluate its prognostic significance. Cox regression analysis of 5-year survival demonstrated that patients without nodal metastasis or with intratumoural HPV-16 showed better prognoses compared with each counterpart. In Kaplan-Meier survival analysis, nodal status but not HPV-16 status was statistically significant. The 5-year survival rate of HPV-16 positive patients without nodal metastasis (94%) was extremely high, compared with that of HPV-16 negative patients with nodal metastasis (25%). These results suggest that HPV-16 status as well as nodal status may provide prognostic significance in patients with OSCC.