Louise Dunphy

Experiences in managing arteriovenous malformations of the head and neck.

Arteriovenous malformations of the head and neck are difficult to treat and require a multidisciplinary approach. Interventional radiology can now be used to downgrade previously inoperable lesions to enable ablation, and the use of Onyx® (Covidien, Irvine, CA, USA), which has revolutionised their management by allowing precise obliteration of the nidus, has enabled the aggressive management of lesions in compromised anatomical areas. We report a series of 31 patients with lesions on the head and neck. They all presented with serious symptoms (Schobinger grade 2-3) and had embolisation with Onyx®. Some had additional operations. We describe the outcome including complications, and offer some lessons learned from our experience.

Simple novel technique to accurately control the depth of drill holes during transbuccal osteosynthesis of mandibular fractures

Sensory complications often caused by internal fixation canrange from transient to permanent dysaesthesia.Sincethepreferredareaforplatefixationisgenerallycloseto the inferior dental neurovascular canal, roots of eruptedteeth, and impacted wisdom teeth, it is often difficult, evenforanexperiencedsurgeon,toavoidiatrogenicinjurytothesestructures. The cutting tip of a standard transbuccal drill islongerthanthatrequiredfor6or8mmscrewsandisnoteasilystopped before it damages deeper structures. We acknowl-edge that use of a 90 degree drill makes this complicationless likely, but they are not yet widely available in the routinesurgical armamentarium.We report the novel use of suction catheter tubing, whichis placed over the drill bit during ORIF of a fractured angle