Surgically-assisted maxillary expansion

A combined surgical and orthodontic technique for management of transverse maxillary deficiencies in mature patients is described and discussed. Special references are made to the surgical release of several circummaxillary articulations to facilitate the use of a fixed expansion device, and to the authors' addition of an osteotomy below the nasal spine, to ensure that the nasal septum remains independent of the maxillary segments. Indications for the use of this surgically-assisted maxillary expansion technique, and its advantages when compared with segmented surgical expansion, are also presented.     

Nicorandil-induced severe oral ulcerationA newly recognized drug reaction

Nicorandil, a potassium-channel activator used for the long-term treatment of ischemic heart disease, has been recently implicated as having a drug side effect of recurrent aphthous stomatitis. Three patients are reported with drug-induced aphthouslike ulceration secondary to nicorandil.     

Midfacial fractures and the eye: the development of a system for detecting patients at risk of eye injury

Maxillofacial trauma is often complicated by injury to the eye. Such injuries may be difficult to detect and may therefore be missed. Detailed ophthalmic examinations were carried out prospectively on 363 patients who had sustained midfacial fractures. Fifty four parameters comprising maxillofacial, radiological and ophthalmic data were recorded and coded for each patient. All encoded data were divided into predictors (the data potentially available to the maxillofacial surgeon) and outcome (the data potentially available to the ophthalmologist). Statistical methods of regression, and the analysis of contingency tables, led to the identification of the principal predictors indicative of underlying ophthalmic injury and thence to a scoring system which predicts the severity of such injuries. Impaired visual acuity is the principal predictor and when employed alone gives a sensitivity value of 80%. Pure blow-out fracture or comminuted facial fracture, double vision and amnesia emerged as additional factors which yielded an efficient scoring system with a sensitivity of 89% and specificity of 90% for the population upon which it was based. A score sheet is provided in the paper. These predictors can be remembered from the acronym Blow-out fracture, Acuity, Diplopia, Amnesia, Comminuted Trauma. As many such injuries result from a BAD ACT, it is easily remembered. This scoring system requires to be tested upon a new population of individuals in order to determine its efficacy.     

Gentamicin impregnated polymethylmethacrylate (PMMA) beads in the treatment of primary chronic osteomyelitis of the mandible

Primary chronic osteomyelitis (chronic diffuse sclerosing osteomyelitis) of the mandible is an uncommon condition, probably arising as a consequence of infection with bacteria of low virulence, in which bone deposition rather than bone resorption occurs. These bacteria are most likely derived from skin or oral mucosa gaining access to bone from the periodontium or through the circulation. Furthermore, delayed hypersensitivity and ischaemic changes within bone may contribute to the inflammatory response, which once initiated is very difficult to eradicate. When the likely aetiological factors are considered a logical approach to management includes the surgical removal of affected bone and the topical application of a broad spectrum antibiotic to the resultant surgical bed.     

Dentofacial features of a family with Crouzon syndrome. Case reports

Crouzon syndrome is an autosomal dominant condition characterized by craniosynostosis with associated dentofacial anomalies. This paper describes the variable clinical features in affected individuals over two generations of a family with particular reference to the dentofacial deformities and discussion of management strategies.     

Bilateral fracture of the mandible in chronic lymphocytic leukaemia. Case report

The development of osteolytic bone lesions in patients with chronic lymphocytic leukaemia (CLL) is extremely rare and has not been reported to involve the mandible. A case of bilateral pathologic fracture of the mandible extensively involved with multiple bony deposits of CLL is reported.