Nadeem Saeed

Birth Prevalence of Cleft Lip and Palate in Sucre, Bolivia

Objective To determine the birth prevalence of cleft lip and palate (CL ± P) in the municipality of Sucre, Bolivia. To ascertain whether the birth prevalence in this region differs significantly from birth prevalence reported in similar populations and other racial groups. Results Twenty-eight clefts were identified among 22,746 live births between the years 1995 and 2001 in three maternity hospitals in the city. The total birth prevalence of CL ± P was 1.23/1000 live births per year. There were 12 clefts of the lip alone (birth prevalence 0.53/1000 per year), 15 cleft lip and palate (0.66/1000 per year), and one cleft palate only (0.04/1000 per year). Conclusions The birth prevalence was not significantly different from birth prevalence published previously in South American populations, although it is lower than previously published data from Bolivia. The birth prevalence of CL ± P in this South American population was similar to published data in white subjects and between those found in black and oriental groups. The sex ratio and birth prevalence of simultaneous congenital malformations also did not differ from previously published figures.

Chronic pain related to first bite syndrome: report of two cases

First bite syndrome is the classic symptomatology of pain in the parotid region that occurs in response to the first bite of a meal. We report two cases of this syndrome in patients after operations to the parapharyngeal space.

Acute bilateral tongue necrosis – a case report

We report the case of an 88-year-old lady who presented with acute necrosis of the whole tongue. Giant cell arteritis was suspected, and early treatment with corticosteroids led to complete resolution and no need for further intervention. We emphasise the importance of early diagnosis of giant cell arteritis and treatment with corticosteroids to stabilise the condition and to avoid serious ocular complications.

A Novel Approach to Chondrosarcoma of the Glenoid Fossa of the Temporomandibular Joint: A Case Report

Chondrosarcoma (CS) is a rare malignant tumor of cartilaginous tissue, with an incidence of 5% to 12% in the head and neck region. The maxilla and nasal and paranasal sinuses are most commonly affected. CS of the temporomandibular joint (TMJ) is extremely rare. Surgery remains the mainstay of treatment options. To our knowledge, this is the first report in the literature on CS arising from the glenoid fossa. We describe our surgical technique that allows immediate joint reconstruction and restoration of joint function.

Delays in emergency oral and maxillofacial operations: 5 years later.

Delays in emergency oral and maxillofacial operations lead to prolonged discomfort for patients and increase the burden on acute hospital services. A published prospective study in our unit in 2003-2004 identified appreciable delays, which were primarily attributed to general surgical cases taking priority (system delay). Our aim in the present study was to assess progress since then by making a prospective audit of delays in emergency oral and maxillofacial operations over a 6-month period. Data collected included duration and reason for delays, and these were correlated with type of operation, and compared to the performance in the same hospital 5 years previously.A total of 222 patients were booked on to the emergency list, which indicated that the workload had doubled during the 5 years. Mean delay had also increased, with 60% of patients waiting more than 12h, and 29% more than 24h. Fractured mandibles were most likely to be left. System delay accounted for 83% of delays. There had been no lessening of the delays in emergency operating, despite increased use of elective lists for emergencies. This may be attributed to the large increase in workload without matching increases in the number of staff or availability of theatres. In addition, problems with communication between specialties, the number of staff in theatre and recovery, and over-running of elective lists, contributed to the use of theatres that did not match their capacity. Since the end of the audited period there have been signs of improvement as a result of an interspecialty initiative to improve the productivity of emergency theatres, and the addition of a dedicated trauma list for oral and maxillofacial surgery.

Use of reciprocating rasp in articular eminectomy

We use a modified Al-Kayat and Bramley incision with extension through the temporalis fascia to allow adequate minectomy was first described by Myrhaug1 in 1951 for he treatment of habitual dislocation of the mandible. It s now a well established technique for recurrent disloation or subluxation and has been described for internal erangement.2 Baumstark et al. suggested that eminoplasty lone is sufficient for hypermobility cases,3 but if the disc equires decompression then eminectomy is better to reduce mpingement.4 Traditionally eminectomy is done using drills and chisels. ccess to the medial aspect of the eminence can be hazrdous because of the close proximity of the great vessels s they enter the base of the skull. For this reason we use micro reciprocator rasp (ConMed Linvatec, Largo, USA) s a saw attachment (Fig. 1). The smooth, rounded edge can e safely used deep in the infratemporal fossa to remove the uperomedial bone and achieve a good reduction of the entire minence without the risk of damaging vital structures. The elatively broad and flat working surface also prevents the isk of intracranial perforation. We have used this technique or a number of years and surgeons now familiar with the otal Biomet Microfixation TMJ replacement system (Biomet icrofixation—Europe, Dordrecht, The Netherlands) will be ware of a similar procedure they advise for preparation of he fossa.5

Dental foundation year 2 training in oral and maxillofacial surgery units – the trainees’ perspective

Most dental foundation year 2 (DF2) training takes place in oral and maxillofacial surgery (OMFS) units. We did a survey of DF2 trainees in these units by telephone interviews and an online questionnaire to find out about their experience of training and their career aspirations. A total of 123 responded, which is roughly 41% of the total estimated number of trainees. Trainees applied for these posts mainly to improve their dentoalveolar skills (50%), and this was cited as the best aspect of the training. Most (81%) were on-call at night and this was generally thought to be a valuable training experience (77%), but 20% thought that it was the worst aspect of the job. Most did not regret taking up the post although the experience had caused 75% to alter their intentions about their future career; general dental practice was the commonest choice. In conclusion, trainees are generally satisfied with their training and these positions have guided their choices about future careers.

Ankylosis of the temperomandibular joint secondary to neonatal group B streptococcal sepsis

Ankylosis of the temporomandibular joint (TMJ) in children can result in significant morbidity including severe airway obstruction, swallowing and feeding difficulties, speech impairment, facial asymmetry and mandibular and facial growth deficiency. Recognised causes of ankylosis include forceps delivery or paediatric trauma, inflammatory arthropathies or local infection (middle ear/mastoid). Early recognition and treatment may improve outcomes and reduce the number of surgical interventions required, which are often multiple each with further impact on facial growth and development. We present three cases of TMJ ankylosis secondary to group B streptococcal (GBS) neonatal septicaemia and discuss the consequences and management.