Graeme A. Zaki

Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review.

Many factors have been implicated in the development of bony ankylosis following trauma to the temporomandibular joint (TMJ) or ankylosis that recurs after surgical treatment for the condition. Although many reports have been published, to our knowledge very little has been written about the pathogenesis of the process and there are few scientific studies. Over the last 70 years various treatments have been described. Different methods have been used with perceived favourable outcomes although recurrence remains a problem in many cases, and ankylosis presents a major therapeutic challenge. We present a critical review of published papers and discuss the various hypotheses regarding the pathogenesis of the condition.

Communication of the anterior branch of the great auricular nerve with the marginal mandibular nerve: A prospective study of 25 neck dissections

The great auricular nerve originates from the cervical plexus (C2, 3) and supplies sensation to the lower part of the pinna and the skin overlying the angle of the mandible. We have previously reported an unusual anatomical variant where the anterior division of the great auricular nerve passed into the submandibular triangle and was joined on its deep surface by the marginal mandibular division of the facial nerve. We now report a prospective study of 25 neck dissections in which a meticulous search for this variant resulted in the same communication between the great auricular nerve and the marginal mandibular division of the facial nerve being found in one further patient (an incidence of 2/25 patients in our series). Although communications between the transverse cervical nerve and the cervical branch of the facial nerve are well known, we have found that the marginal mandibular nerve can also be joined by the cervical plexus. This may have clinical implications during operations on the neck, particularly as stimulation of a communicating nerve of the cervical plexus might result in depression of the lip, and could potentially cause the operating surgeon to think that it was a branch of the facial nerve. We think that this finding merits a cadaveric study to evaluate the relation more fully.

Controversies in third molar surgery — the national view on review strategies

A national survey was conducted to establish the current practice of postoperative review of third molar surgery by the 255 fellows of the British Association of Oral and Maxillofacial Surgeons. Of the 216 complete responses, 134 say that they routinely reviewed all patients, while 67 did not. A further 15 fellows (7%) are currently considering their practice. Five (2%) stated that routine review should be compulsory and failure to do so was medically negligent. We conclude that a policy of selective rather than routine review is safe for most patients, but if a patient is under age, mentally retarded, taking psychoactive drugs, or has any other associated condition, then routine follow-up should be undertaken.

Audiotaping consultations in a head and neck oncology clinic

Multidisciplinary clinics are busy and may not provide an ideal environment for conveying information to patients. In an attempt to overcome this problem we have used a dual headed audiocassette tape recorder to tape consultations. Although first suggested as long ago as 1977 by Butt,1 and investigated by several others in clinical settings,2–4 none seem to have focused on head and neck oncology clinics. The tape machine used in our clinic is the Uher double tape model obtained from Business Dictation (Oxted, Surrey, UK) (Fig. 1). From a legal point of view it is tamper-proof (in that the recording cannot be altered unless both tapes are inserted into the machine) and for this reason it is used widely during interviews by police. One tape is given to the patient; the other is stored in the medical records. The audio taping facility has been in use in our clinic for nearly 2 years, and over 130 patients have had their consultations taped.