Vascular neoplasms of the parotid gland: Parotid vascular tumors

Vascular neoplasms of the parotid gland are common in early childhood, particularly in females. We reviewed the clinical, histologic, and treatment details of 10 cases of hemangiomas and one case of lymphangioma that involved the parotid gland. Histologically, the cellularity and increased division figures in these lesions should not be interpreted as a sign of a malignant condition. A watchful expectancy for spontaneous regression and preservation of the facial nerve at surgery are advocated.     

Comparison of restorative dentistry referrals to a district general hospital and to a teaching hospital using a pilot Index of Restorative Dental Treatment Need

The purpose of this study was to identify differences between referral patterns and the clinical conditions of patients referred to consultant-led Restorative Dentistry clinics in a district general hospital and a London dental teaching hospital. The Index of Restorative Dental Treatment Need was used to classify patients into those patients whose treatment was appropriate for any dental graduate in general practice, for an experienced dentist in general practice, and for a dentist with specialist training. Demographic and clinical details were recorded for one hundred patients at each hospital. The results of the study showed that the proposed treatment of 21% of the patients seen at the district general hospital and 16% of the patients seen at the teaching hospital was appropriate for specialist care. The results support the expansion of specialist restorative dentistry services in district general hospitals.     

Noma in children in a hospital environment in Bobo-Dioulasso: epidemiologic, clinical and management aspects]

A retrospective study covering ten years (1987-1996) was conducted to assess the epidemiology, clinical features and management of cancrum oris (noma) in children from Burkina Faso. Fifty nine (59) children were admitted with cancrum oris at the paediatrics and maxillo-facial surgery units of Bobo-Dioulasso, the second town of Burkina Faso. The hospital prevalence of noma is 1.5/1000. 81% of the cases were in the 1 to 5 years age group and 58% were females. Predisposing factors include poverty, lack of immunization, malnutrition, bad oral hygiene, measles and parasitic diseases. The cheek was involved in 31% of the cases. Cure was obtained in 80% of patients after medical and surgical treatment. However, many sequels were observed. Post operative outcome is complicated by the children's growth and often results in retractions, recurrence of ulcers or constriction. Psychological and social problems are associated. Management is difficult in our setting because of the lack of information, cost of the treatment and the absence of well-equipped plastic surgery units.     

Parotid gland disease in childhood: diagnosis and indications for surgical intervention

We retrospectively analysed the clinicopathological profiles of all 9 patients aged 16 years and under who had had parotidectomies at York Hospital, UK from 1995 to 2009. The operations were superficial parotidectomy (n=3), partial parotidectomy (n=4), and total parotidectomy with preservation of the facial nerve (n=2). The histological diagnoses were anomalies of the remnant of the branchial arch (n=4), and pleomorphic adenoma, haemangioma, cat scratch disease, juvenile chronic parotitis, and sarcoidosis (n=1 each) The histological diagnosis matched the clinical diagnosis in only 5. The most common complication (n=6) was transient weakness of the facial nerve. Various conditions that may be difficult to diagnose clinically can affect the parotid gland in young patients and require intervention. We describe our investigations, and indications for intervention in the management of parotid disease in children.     

Subjective perception of paraesthesia of the lower lip after bilateral sagittal split osteotomy at a district general hospital

Our aim was to assess patients’ perception of paraesthesia of the lower lip after bilateral sagittal split osteotomy (BSSO) at a district general hospital. Patients who had BSSO between August 2013 and August 2014 (n = 46) were asked to score their perception of numbness between 0–10 (0 = normal sensation. 10 = complete loss of sensation/total numbness) one day postoperatively and then weekly for seven weeks, and at three months, 6 months, and one year. Data was collected on score sheets and by regular contact by telephone. Of the 46 operated on, 31 were female and 15 male. Data were available one year postoperatively for 43 patients. Ten of the 92 sides were reported as feeling normal on day 1 postoperatively, three-quarters as feeling normal at six months, and 79 at one year. On multivariate analysis there was no significant difference in postoperative sensation at one year between sides operated on by the registrar (left) and consultant (right) operated (p = 0.76). Our results compared favourably with the limited data available in similarly designed studies.     

Oral trauma in children: a hospital survey

The purpose of this investigation was to determine the type and prevalence of dental injuries seen in a hospital emergency room. Of the 10,436 patients who were treated at the hospital emergency room as a result of a traumatic episode, 765 (7.3%) had sustained injuries to structures of the oral cavity. The leading cause of dental injury was falls, accounting for 55.8% of the injuries. The male-to-female ratio of dental injuries was 1.6:1. The peak age group of children with dental injuries was the 1-to-2-year-old age group. Laceration of the lip was the most predominant injury to structures of the oral cavity, accounting for 62.8% of the dental injuries. The peak month for dental injuries was June, and 61.2% of the dental injuries occurred in the home.     

Epidermoid cyst of the external auditory canal in children: diagnosis and management

Epidermoid cyst of the external auditory canal (EAC) is rarely encountered in the clinical practice, but when it occurs, it may cause obstruction of the meatus that necessitates surgical excision. The aims of this study were to present 9 pediatric patients with epidermoid cysts of the EAC and to evaluate the outcome of the surgical technique that has been used in excision. Surgical removal of the cyst was carried out through a simple transmeatal approach, a medially based rectangular skin flap was elevated and the cyst was completely removed. No complications or recurrence have been reported. Epidermoid cyst should be listed in the differential diagnosis of EAC masses; it appears on computed tomography as a cystic mass in the outer cartilaginous part of EAC that is usually limited to the soft tissue with no bone erosion. It can be removed easily through simple transmeatal approach with high success rate and no morbidity.     

General anaesthesia for exodontia in children: experience of a dental teaching hospital in relation to changes in national guidance

Summary. Objectives. To examine, in relation to changes in national guidance, trends in the provision of general anaesthesia for exodontia in children. Design. Retrospective analysis of hospital records. Setting. University Dental Hospital, Cardiff, UK. Methods. Data were drawn from records of services provided in each of four index months during 1989, 1991, 1997 and 1999 (the years immediately preceding/following the Poswillo Report of 1990 and the General Dental Council's revised guidance of 1998). Results. In the first year after publication of the Poswillo report, there was a 19·6% increase in use of ‘chair case’ general anaesthesia over the four index months. Subsequently, upon the emergence of additional providers, patient flow in 1997 had fallen to 65·8% of that seen at baseline. Following the General Dental Council's revised guidance of 1998, there was a further reduction in the provision of ‘chair case’ general anaesthesia (to 40·8% of that seen at baseline). Conclusions. In this unit, throughput of children receiving general anaesthesia for exodontia has fluctuated in periods marked by changing national guidance. However, it is not possible to attribute such fluctuations in patient flow solely to this factor.     

Gainsharing in a general practice residency: Report of an experience

Postgraduate general dentistry programs are facing critical problems with funding, resident recruitment and viability, Recent federal actions reduced and eliminated graduate medical education (GME) support for some programs, and rising student debt and increasingly lucrative private practice opportunities reduce the value of postgraduate general dentistry experiences. Faced with these complex and interlinked challenges, the University of Nebraska Medical Center College of Dentistry General Practice Residency implemented a gainshare plan. The first 12 months of the plan produced a 44% increase in production and a concomitant 42% increase in actual collections resulting in enough funds to provide remuneration over base salary for residents, staff and faculty. The plan also compensated the Dean, the host department and the College of Dentistry while also funding the development of a reserve account for program enhancement and future stipend support. Gainshare concepts, rationale and details of the pilot plan are presented along with a discussion of key outcomes and experiences.     

Dental fear in children and adolescents: a comparison of forms of anxiety management practised by general and paediatric dentists

International Journal of Paediatric Dentistry 2011; 22: 60–67 Background. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. Aim. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. Design. Eight hundred dentists in Germany were interviewed via e‐mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. Results. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. Conclusions. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety.     

Dental treatment for children under general anaesthesia in day care facilities at a London dental hospital

Day-stay facilities are gaining in popularity in general surgery, especially in surgery for children. In dentistry, day-stay care has been shown to be of great value for the treatment of specific groups of child patients, including handicapped and those too young to tolerate treatment with local anaesthetic alone. The present study considered the characteristics of 103 patients attending for treatment in the day-care facilities of the Eastman Dental Hospital, the morbidity of the technique and the acceptability of the service to those using it. Of the 103 patients, 46 were seen in the unit because they required minor oral surgery and 22 because of particular problems with management. Ninety-four patients had one or more symptoms following treatment. In at least 53 cases this related to the treatment and not to the anaesthetic. Despite a cost to the families in terms of money and time, the service proved acceptable to almost all of those who used it.