John W. Ferguson

Antibiotic prophylaxis during dental treatment in patients with prosthetic joints

Since the early l960s the replacement of large joints, including hip, knee, elbow and shoulder, has become commonplace. A survey by Hon Ct al (1978) revealed that some 120 000 total hip and knee replacements were undertaken each year in the United States, and it may be assumed that numbers have increased every year since. In New Zealand, over 4000 total hip replacements are performed annually (NZ Orthopaedic Associationpersonal communication 1990). Many orthopaedic surgeons consider that antibiotic prophylaxis is necessary in patients with prosthetic joints before dental treatment which could produce a bacteraemia. A study conducted throughout the United States (Jaspers and Little 1985) revealed that 93% of the orthopaedic surgeons polled believed such prophylaxis was necessary to prevent late infection. Late deep infection is a serious complication sometimes leading to loss of the prosthetic joint and attended by significant morbidity and mortality(Ahlberg, Carlsson and Lindberg 1978; Surin, Sundholm and B#{228}ckman 1983). However, opposing views have also been expressed, mainly by authorities in the dental field. These authors believe that the transient bacteraemias usually associated with dental treatment are unlikely toproducejoint infection (Peterson 1980; McGowan and Hendrey 1985; Jacobson et al 1986). Late joint infections, after three months, are considered to arise either by haematogenous spread or secondary to intra-operative contamination (Ahlberg et al 1978;

Control of vertical dimension during maxillary orthognathic surgery: A clinical trial comparing internal and external fixed reference points

The accuracy of vertical control during maxillary orthognathic surgery was assessed in 45 patients, comparing the use of traditional internal measurements across the osteotomy lines (15 subjects) with measurements between the incisor teeth and an external reference point consisting of a bone screw placed at nasion (two groups of 15 subjects each). Although use of a fixed external reference point can significantly decrease positioning error (p < 0.001), considerable care is required during application of rigid fixation to maintain the correct vertical dimension.

Lateral displacement of the intact mandibular condyle. Review of literature and report of case with associated facial nerve palsy.

A rare injury is described, in which symphyseal fracture of the mandible was associated with lateral displacement of the intact mandibular condyle into the temporal fossa and damage to the ipsilateral facial nerve with unilateral facial paralysis. Management of the injury was associated with an episode of acute laryngeal obstruction, necessitating emergency tracheostomy.

Cephalometric interpretation and assessment of facial asymmetry secondary to congenital torticollis. The significance of cranial base reference lines

The anatomic basis of the facial asymmetry resulting from untreated congenital muscular torticollis is discussed, and an objective system for both clinical and cephalometric assessment and measurement is described. Symmetry is assessed by first defining a true midfacial line, which allows both measurement of existing asymmetry and planning for subsequent surgical correction, and which can be applied to clinical as well as radiologic analysis.

Sebaceous cell adenoma. rare intra-oral occurrence of a tumour which is a frequent marker of torre’s syndrome

&NA; A case of sebaceous cell adenoma of the buccal mucosa in a 65‐yr‐old woman is described. The patient exhibited no manifestations of Torres syndrome (cutaneous sebaceous neoplasms and visceral carcinomas). Only four sebaceous adenomas of the oral mucosa have been previously reported. The literature on neoplasms of sebaceous glands and Torres syndrome is reviewed. The tumour had not recurred 18 months after surgical excision.

Mandibular vascular leiomyoma

A 54-year-old man had a symptomless swelling on the buccal aspect of the right mandibular molar area, this was associated with a multilocular radiolucency. Histologic and ultrastructural examination of the lesion revealed a vascular leiomyoma. This is only the fourth intrabony leiomyoma of the jaws to be reported.

Surgical correction of the facial deformities secondary to untreated congenital muscular torticollis

The facial asymmetry which develops in association with untreated congenital muscular torticollis is principally the result of a subcranial torsional rotation of the face toward the affected side. Principles of management are therefore to firstly release the sternomastoid muscle and achieve maximal improvement in head posture, followed by surgical straightening of the face by bimaxillary surgery and septorhinoplasty. The results of this approach in three patients are discussed and illustrated.

Clinical presentation of acoustic nerve neuroma in the oral and maxillofacial region

The clinical features of acoustic nerve neuroma in the oral and maxillofacial region are described and exemplified by a case in which the initial symptom was burning tongue.

A potential role for costo-chondral grafting in adults with mandibular condylar destruction secondary to rheumatoid arthritis—a case report

Little attention has been directed towards reconstruction of the mandibular condyles in adult patients with rheumatoid arthritis, other than with allogenic implants which are now known to cause serious complications. There is a relatively high incidence of condylar erosion and breakdown in rheumatoid arthritis, often leading to anterior open bite and retrognathia. Costochondral grafting does not appear to have been considered as a logical option for reconstruction, despite its high success rate in many other situations. A case is described of rapid bilateral condylar destruction occurring in a young woman with rheumatoid arthritis, leading to anterior open bite. Reconstruction was undertaken using bilateral costochondral grafts, giving an excellent clinical result which has been maintained over the follow-up period of two-and-a-half years. Radiologically complete healing of severe glenoid fossa erosion has taken place.

The diagnosis and initial management of the fractured mandible

Mandibular fractures are the second most common facial fracture. The usual causes are interpersonal violence and motor vehicle accidents (MVA). Nearly all cases present to an emergency department for initial management. They are rarely life-threatening injuries and must assume low priority in the initial assessment and management of the severely traumatized patient. Following any resuscitation and exclusion of other significant injuries, a clinical and radiologic diagnosis of the facial injuries should be undertaken including assessment of the fractured mandible. Initial therapy should be directed at temporary immobilization and pharmacologic treatment, followed by referral for appropriate definitive care.