Leo Cheng

Orthognathic surgery: the patients' perspective

It is often thought that patients seek combined orthodontic and surgical treatment for predominantly aesthetic reasons, with functional concerns being secondary. To find out whether patients were more satisfied with appearance than function after treatment, all 165 patients who had orthognathic operations during the 11-year period 1983-94 were sent a questionnaire; 139 responded (84%). Rating on a visual analogue scale showed a high level of satisfaction for both appearance (mean score 6.78) and function (mean score 7.24) (Wilcoxon test, P = 0.046). This indicates that orthognathic surgery is not merely done for aesthetic reasons, but is important when combined with orthodontic treatment in correcting severe malocclusions, which appreciably improve the ability to chew.

A multidisciplinary approach to recurrent cervicothoracic cystic hygroma in an adult

Cystic hygroma is a benign congenital lymphatic malformation affecting mainly the head and neck region in children. Although mediastinal or multiorgan lymphangiomatosis is rare, it can present at any age. We report an unusual case of recurrent bilateral cystic hygroma in an adult affecting both neck and mediastinum. When the extensive lesion became symptomatic, a multidisciplinary approach was necessary to remove the expanding mass to achieve the optimal functional and cosmetic outcome.

Thyroid surgery in the UK and on board the Mercy Ships

Diseases of the thyroid are common in the developed and developing world. We retrospectively compared surgical pathologies, types of thyroidectomy, and postoperative complications between 2 case series, one from the Mercy Ships in West Africa with 87 patients, and the other from London in the United Kingdom with 120 patients. In both, the most common operation was hemithyroidectomy, and nodular hyperplasia was the most common disease. The postoperative complication rate of sero-haematoma was comparable with large international series.

Treatment of an enlarged uvula

We report a case of enlarged uvula (5.5cm) that caused difficulty in swallowing and speech after it had been damaged by intubation or suction of the throat. Medical treatment failed, so 4.5cm was resected by diathermy. The patient made an uneventful recovery.

Use of TissuePatch™ sealant film in the management of chyle leak in major neck surgery

Chylous fistula is rare, and operation is often required for high output fistulas after serious operations on the neck. TissuePatch™sealant film (Tissuemed Ltd., Leeds, UK) is a useful adjunct to ensure that potential sources of leakage are sealed effectively.

How to do a safe tracheostomy Technical note

A new technique of surgical tracheostomy is described. Prior to performing the tracheostomy, the endotracheal tube (ETT) is advanced further down the trachea so that the end of the tube is positioned just above the carina. Using the flexible endoscope within the ETT the positioning can be done with precision. This manoeuvre avoids the cuff of the ETT being perforated as it is well below the site of the tracheal window. Following the creation of an opening in the trachea, the patient continues to have a definitive airway. In this controlled environment, time is taken to obtain haemostasis at the tracheostomy site, place a rescue stitch and also suction above the cuff of the ETT. A study was carried out in a series of 15 patients by recording various measurements during the procedure to confirm the accuracy of this technique.

Detection and management of cervical tuberculosis through neck lump clinics

information can be difficult to find and time consuming to continuously research. To address this issue we created MaxFaxLink.org, an online resource for trainees in OMFS. MaxFaxLink provides trainees with a constant stream of up-to-date information about useful CPD events. We use a WordPress web platform to display information in an RSS feed format. The benefit of this approach is the ability to provide both home and on-thego access. By downloading the WordPress app, or any RSS feed viewing app, for tablet or smartphone, the OMFS trainee can sync the MaxFaxLink feed to their device and obtain real-time updates. All these services are free-of-charge and updated monthly by the MaxFaxLink team. We continue to receive positive feedback as we look to expand the website and its content. Our intention is to create a community-led resource open to all levels of trainee, encouraging trainees to email the website with recommendations for useful upcoming events. In an age where healthcare continues to embrace advances in technology, we demonstrate how OMFS continues to be at the forefront of utilising Internet and handheld computer technology for the educational benefit of its trainees.

Dentists’ awareness of sickle cell disease—the patients’ perspective

Introduction: Sickle cell disease SCD) is an autosomal recessive aemoglobinopathy. Although orofaial complications among SCD patients ave been reported, their prevalence emains undefined. We therefore invesigate the prevalence of jaw pain and lip umbness among SCD patients. Methods: 495 patients with SCD ere sent a questionnaire followed by reminder. Those non-respondents were ontacted by telephone. Results: 173 (34.9%) completed our uestionnaire with female to male ratio of :2, mean age of 36 years (3–76) and stanard deviation of 15.4 years. The frequency f their attack varied widely from more han once a week to less than once every 6 onths. 56 (32.4%) experienced facial or jaw ain. Of the 45 (26.0%) respondents who xperienced sensory deficits to their lips, ongues or chins during a sickle cell criis, 15% claimed to be permanent. Those atients who experienced jaw pain were ore likely to have experienced sensory hanges (Fisher’s exact test, p= 0.0001). here was significant difference in the revalence of jaw pain between the group ith “crisis occurred once or more a onth” and “crisis occurred less than once month” (Fisher’s exact test p= 0.0006) hile sensory deficits were not statistially significant between the two groups p= 0.368). Conclusion: In our survey, jaw pain and erioral sensory deficits affected over 40% f SCD patients. Perioral sensory changes ere more common in those who experinced jaw pain. The jaw pain was more revalent in those with frequent sickle cell risis. Conflict of interest: None declared.