Peter J. Revington

Surgical Management of Temporomandibular Joint Ankylosis in Ankylosing Spondylitis

Relatively few patients develop such severe degenerative temporomandibular joint (TMJ) disease that they require total joint replacement. Current indications include those conditions involving condylar bone loss such as degenerative (osteoarthritis) or inflammatory joint disease (ankylosing spondylitis, rheumatoid, and psoriatic). Ankylosis of the temporomandibular joint (TMJ) secondary to ankylosing spondylitis remains an under investigated entity. We aim to provide an overview of treatment objectives, surgical procedures, and our experience with total TMJ replacement for this condition.

Amaurosis, ophthalmoplegia, ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anaesthesia.

BackgroundOphthalmic complications following inferior alveolar nerve anaesthesia are rare. They include transient blindness (amaurosis), ophthalmoplegia, ptosis, mydriasis and diplopia. These events may occur following the intravascular administration of anaesthetic solution and are distressing to both patient and operator alike.Case reportWe report the unusual case of a young patient who experienced amaurosis, total ophthalmoplegia, complete upper eyelid ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anaesthesia. Similar but less profound signs were observed in the same patient on a subsequent occasion. This was following general anaesthesia, during which she had received local anaesthetic prior to mandibular wisdom tooth removal.ConclusionsOphthalmic complications following inferior alveolar nerve anaesthesia are rare but distressing events. In particular, amaurosis is an extremely rare event and usually heralds a more sinister pathology such as stroke. Clinicians should be aware of these complications to minimise anxiety and reassure their patients appropriately.

The Outcome for Secondary Alveolar Bone Grafting in the South West UK Region Post-CSAG

Objective In 1998 the delivery of cleft care in the United Kingdom was examined by the Clinical Standards Advisory Group, the outcomes of which led to the wide restructuring of cleft services in the United Kingdom. We present a retrospective study evaluating the radiographic outcome of 53 consecutively performed alveolar bone grafts following the regional centralization of secondary alveolar bone grafting to the South West Cleft Centre between 2004 and 2006. Methods A retrospective audit of one surgeons outcome of 53 consecutively performed alveolar bone grafts, assessed radiographically using the Kindelan method. Results That 94% of bone-grafted sites achieved a successful radiographic outcome compares favorably with the previously published Clinical Standards Advisory Group data of 58% with Bergland scores. Conclusion The radiographic outcome for alveolar bone grafting has improved with centralization. A small number of patients are being grafted after the ideal chronological age, and this needs to be addressed throughout the region. The Kindelan assessment provides a reliable method of early assessment for alveolar bone grafting.

Eagle's Syndrome: A Novel Surgical Approach to the Styloid Process Using a Preauricular Incision

Structural anomalies of the styloid chain were described more than 300 years ago by anatomists. In 1937, the American otolaryngologist Watt W. Eagle 1 wrote a series of reports on this subject and its clinical significance. Because of his interest, the symptoms related to the anomalies of the stylohyoid chain became known as Eagle’s syndrome. Eagle himself acknowledged 3 other surgeons who identified these anomalies and treated them surgically to alleviate the symptoms. The first of these predated Eagle by 65 years. The present report refers to the anomalies of the stylohyoid chain as Eagle’s syndrome.

Impact of Secondary Alveolar Bone Grafting on the Symptoms of Reflux in Oronasal Fistulas: A Patient-Related Outcome Study

Objective To establish for the first time the prevalence of fistula symptoms and the effectiveness of secondary alveolar bone grafting to treat these symptoms in a single surgeon cohort in Bristol, United Kingdom. Design Direct questioning of 233 consecutive patients with cleft before and after secondary alveolar bone grafting as to the presence of fistula symptoms. Setting Southwest and South Wales Cleft Centre, Frenchay Hospital, Bristol, United Kingdom. Participants Consecutive patients with cleft who were being treated for secondary alveolar bone grafting. Outcome Measure Patients reporting presence of fistula symptoms. Data collection on cleft type (unilateral, bilateral), date of birth, and age at secondary alveolar bone grafting. Results Of the 167 unilateral patients with cleft lip and palate and 66 patients with bilateral cleft lip and palate, 45% had symptoms of a fistula before alveolar bone grafting and 10% had symptoms of a fistula after surgery. There were no statistically significant differences between the presence of symptoms before or after secondary alveolar bone grafting between cleft types or by age at secondary alveolar bone grafting. Conclusion This is the first study examining the rates of fistula symptoms before and after secondary alveolar bone grafting in the United Kingdom. This study used the patient-centered outcome of the presence of symptoms as a way of measuring the presence of fistulas in this group. Secondary alveolar bone grafting reduces the incidence of symptomatic fistula in this setting.

Initial surgical management of a gunshot wound to the lower face – a stepwise approach

Facial gunshot wounds are rarely encountered in the UK, but not to such an extent that emergency departments should not be prepared to deal with them. We describe the management of a self-inflicted shotgun wound to the lower face using a step-wise approach. The primary reconstruction of such injuries should be performed soon after stabilisation of the patient. Simple yet careful surgical techniques are often effective in cases of severe facial trauma that might initially appear to require tissue transfer techniques, as soft tissue loss is often less than initially estimated. Preservation and closure of remaining tissue should aim to reconstruct oro-facial units while leaving options for more advanced reconstructive techniques open for future procedures if necessary.

Hyperglobus, do not forget the sinister.

Hyperglobus is an elevation of the ocular globe with the majority of the orbit remaining intact. We present a case of hyperglobus caused by a metastatic mass from a prostate carcinoma. There are no other reported cases in the literature.

Sudden hypotensive syncope and significant iatrogenic maxillofacial trauma following administration of oral sodium phosphate purgative solution.

Oral sodium phosphate (NaP) solution is used globally as a bowel preparation for colonoscopy, surgery and medical-imaging (Balaban 2008). We present a case of a patient who suffered sudden hypotensive syncope and iatrogenic mandibular fractures within an hour of ingesting a NaP solution. We discuss the uses of these medicines and highlight the need to warn patients of possible adverse side effects to avoid patient harm and subsequent litigation.

Facial basal cell carcinoma in a young patient with Crohn disease.

A 26-year-old man with Crohn disease developed a 10-mm-diameter facial basal cell carcinoma. He was referred to our department, and the tumor was excised with a clear margin. The wound was closed by primary closure, and he made an uneventful postoperative recovery with a satisfactory cosmetic result. Although the increased risk of nonmelanoma skin cancer in immunosuppressed solid organ transplant patients is well known, the association with inflammatory bowel disease remains unclear. There are few articles in the literature on this topic, and the authors believe this to be the first documented case of facial basal cell carcinoma occurring in the context of Crohn disease. Of particular interest is the very young age at presentation.