R. Anand

An audit of 405 temporomandibular joint arthrocentesis with intra-articular morphine infusion

The management of refractory pain in the temporomandibular joint (TMJ) is both challenging and controversial. Arthrocentesis is a simple technique that can be used instead of more invasive procedures in patients with pain that fails to respond to conventional conservative measures. We undertook an audit of 405 arthrocenteses in 298 patients over a 10-year period who had refractory pain in the TMJ. The pain was assessed subjectively by a visual analogue scale, both before arthrocentesis and at 1 and 6 months, and 1 year afterwards. A significant reduction in pain score was found after arthrocentesis (P < 0.001) and 269 patients (90%) found the procedure beneficial. We recommend arthrocentesis as an effective, minimally invasive technique in patients with continuing pain in the TMJ that is unresponsive to conservative management.

Reconstruction of maxillary defects with serratus anterior muscle and angle of the scapula

Large maxillary defects ideally require reconstruction with a free flap. Varied classifications have been reported to describe maxillary/orbital defects. We describe our experience of free flaps in large maxillary defects using composite tissue of serratus anterior muscle and the angle of the scapula. Eleven patients (6 men and 5 women, age range 42-69 years) were studied retrospectively and the outcome was recorded. We conclude that the composite flap is versatile enough to reconstruct maxillary defects of various sizes.

Stabilising the leg to harvest a fibular flap: a new device

A simple stabilisation device is described that facilitates easy harvesting of a fibular free flap.

Nasopharyngeal tube facilitates endoscopic monitoring of pharyngeal flaps.

rhinoscopy and otoendoscopy. The brightness of the light was satisfactory. The image of the Xenon light seemed to have a bluish colour, but when we white balanced the image manually and lowered the colour temperature of our monitor, the bluish effect improved. We believe that a portable, low-cost endoscopy system is an ideal teaching and diagnostic tool that may be widely used both in outpatient clinics as well as in anatomy dissection laboratories.