Intermaxillary fixation is not usually necessary to reduce mandibular fractures

We undertook a retrospective study of all isolated mandibular fractures which had required active management over a 1-year period at the Maxillofacial Unit at Newcastle General Hospital. Patients with single or multiple fractures of the mandible were included in the study, if there were other simultaneous fractures of the facial skeleton, those patients were excluded. All case notes and radiographs were reviewed by a single operator. A total of 202 cases of fractured mandible were identified of which 115 fulfilled the selection criteria of: isolated fracture, no previous facial fracture, treatment by open reduction and internal fixation using titanium osteosynthesis miniplates, and all case notes and radiographs available to study. Sixty-six patients had their fractures reduced manually to obtain anatomical reduction without the use of peroperative intermaxillary fixation (IMF). Forty-nine were treated conventionally using peroperative IMF. The two groups were broadly similar in severity and type of fracture, and the method of reduction seemed to be decided by the operator according to their preference. IMF was not used routinely postoperatively. Overall there were significantly fewer occlusal discrepancies in the early postoperative period in those patients treated by anatomical reduction (6/66 compared with 16/49, P = 0.002) but there was no difference in the final outcome of the occlusion between the two methods of reduction. Avoidance of the use of peroperative IMF is more economical in time and cost, is safer for the operator, and more comfortable for the patient. As this technique produces comparable results in the long term with fewer early complications, we conclude that IMF is not usually necessary to reduce fractures confined to the mandibular bone.     

Post-extraction bleeding—An aid to diagnosis? Case report

Haemophilia A, the most common of bleeding disorders is characterzed by bruishing and spontaneous bleeding into the joints but may remain undiagnosed if present in the mild form. A case is discussed where episodes of bruising and joint sweelling as a child were misdiagnosed as rheumatic fever and the bleeding disorder was diagnosed following recurrent episodes of bleeding after extraction of an upper molar tooth.     

Post-extraction bleeding—An aid to diagnosis? Case report

Haemophilia A, the most common of bleeding disorders is characterzed by bruishing and spontaneous bleeding into the joints but may remain undiagnosed if present in the mild form. A case is discussed where episodes of bruising and joint sweelling as a child were misdiagnosed as rheumatic fever and the bleeding disorder was diagnosed following recurrent episodes of bleeding after extraction of an upper molar tooth.     

Superficial femoral artery pseudo aneurysm: A rare vascular complication of exostoses

Osteochondroma or exostosis is the most frequent bone tumour which appears in adolescence and rarely can be responsible for vascular complications. It may present with thrombosis, embolism, arteriovenous fistulae, or the development of pseudo aneurysms. We report a case of a patient with multiple osteochondromas complicated by development of pseudo aneurysm. A simultaneous surgical treatment of both lesions was performed with favourable post operative outcome.     

Effects of single dose methylprednisolone on patient recovery after cardiopulmonary bypass

Background

Ischaemic reperfusion injury, systemic inflammatory response and multi-organ dysfunction are not infrequent following Cardiopulmonary Bypass (CPB). We investigated the role of methylprednisolone in minimizing this state.

Subject and Methods

Hundred consecutive patients undergoing elective single heart valve replacement surgery were randomized to receive methylprednisolone 30?mg/kg (M group) or placebo (P group) after induction of anaesthesia. Data were analyzed using the??t?? test and Fischer test.

Results

The cardiac indices in the M and P group were 2.79?±?0.13?L/min/m² and 2.52?±?0.26?L/min/m² respectively (p?<?0.0001). The amount of blood loss in the test versus control group was 268.3?±?65.78?ml/24 hours versus 318.7?±?55.5?ml/24?h respectively (p?<?0.0001) and the amount of blood transfused in the test versus control group was 1.26?±?0.57 units versus 1.76?±?0.8 units respectively (p?=?0.005). Patients in the test group had a lower incidence of early postoperative fever and new-onset atrial fibrillation during the first 3?days postoperatively. There was a statistically significant reduction in the intensive care unit stay (3.52?±?1.16?days versus 4.14?±?1.29?days in the M versus P group, p?=?0.01) but not in hospital length of stay (13.7?±?1.78?days versus 14.2?±?1.52?days in the M versus P group, p?=?0.13), or in overall morbidity and mortality.

Conclusions

The use of methylprednisolone prior to initiation of CPB is associated with a more stable postoperative course with a higher cardiac index, shorter duration of Intensive Care Unit (ICU) stay and fewer blood transfusions. Methylprednisolone use also appears to be associated with a lower incidence of early postoperative fever and new-onset atrial fibrillation.     

Rib Haemangioma: A Rare Differential for Rib Tumours

Haemangiomas account for approximately 1% of all bone tumours and commonly involve the skull and the vertebrae Dorfman et al. (Human Pathol 2:349–376, 1971). Rare costal originated haemangiomas have been reported as a case report in literature Clements et al. (Am Surgeon 64:1027–1029, 1998), Filosso et al. (J Cardiovasc Surg 36:97–98, 1995). We report a case of 26 years old female presenting with haemangioma of the eighth rib (right). And conclude that haemangiomas should be included in the differential diagnoses of an osteolytic and expansile lesion of the ribs on radiology, especially in asymptomatic or mildly symptomatic patients.     

Observation of tumour thickness and resection margin at surgical excision of primary oral squamous cell carcinoma--assessment by ultrasound

Tumour thickness and the status of resection margins are of prognostic significance in the treatment of oral cancer. In a single blind prospective study, 14 patients with biopsy proven oral squamous cell carcinoma had intraoral ultrasound imaging done preoperatively to measure tumour thickness, and intraoperatively to measure the deep surgical margin half way during resection. The cut surface was demonstrated on ultrasound by placing a metal, ultrasound-reflective, retractor into the surgical cut. The ultrasound measurements were compared to the subsequent histological measurements. Using the threshold of 5mm as indicator of margin clearance, there was agreement in 10 out of 14 cases between ultrasound and histology. Ultrasound detection of close surgical margins had a sensitivity of 83% and a specificity of 63%. For preoperative tumour thickness measurement, ultrasound imaging showed a high degree of correlation with histology (Pearson correlation coefficient=0.95, P<0.01). This original paper demonstrates that high resolution ultrasound imaging applied intraorally is a reliable tool in objectively assessing both the tumour thickness and the surgical margin clearance at the time of surgery.     

Intraoperative ultrasound imaging to aid abscess drainage--a technical note

Diagnostic ultrasound is used widely to identify the presence of fluid collections preoperatively. Although its role in other parts of the body is well established, this report describes the technique of using diagnostic ultrasound intraoperatively to aid drainage of a large fascial space abscess in the head and neck. Following previously inadequate drainage of a large superficial abscess from a blindly placed drain, a second procedure was carried out, using ultrasound imaging to locate the persisting abscess. Furthermore, ultrasound demonstrated the adequacy of drainage and helped the surgeon to position the drain in the correct tissue space. We consider that intraoperative use of ultrasound has a role as a guidance tool to drain superficial fascial space abscesses in the head and neck region.