Current practice of British oral and maxillofacial surgeons: advice regarding length of time to refrain from contact sports after treatment of zygomatic fractures

OBJECTIVE

To find out the current practice of consultant maxillofacial surgeons in the United Kingdom regarding the advice that they give to patients after the treatment of zygomatic fractures.

MATERIALS AND METHODS

We sent a postal questionnaire to 261 consultant maxillofacial surgeons in the United Kingdom. They were asked what advice they gave to patients about the length of time that they should refrain from contact sports after a zygomatic fracture.

RESULTS

A total of 184 replies were received (70%). Advice about the length of time to refrain from contact sports ranged from none to 13 weeks; 165 (90%) of respondents based their advice on common sense and traditional practice.

CONCLUSIONS

Advice given to the patients after the treatment of zygomatic fractures varies widely. Most consultants base their advice on traditional practice and common sense. No widely accepted evidence-based guidelines exist about post-operative advice concerning duration of avoidance of contact sports after zygomatic fractures.

FRCSEd (Oral and Maxillofacial Surgery): a milestone in the history of Oral and Maxillofacial Surgery in the United Kingdom

The British Association of Oral and Maxillofacial Surgeons (BAOMS) and the Royal College of Surgeons of Edinburgh (RCSEd) have had leading roles in organisation, assessment and improvement of surgical training in the United Kingdom. This was particularly well illustrated by the establishment of the fellowship examination in Oral and Maxillofacial Surgery (FRCSEd, OMFS).

Senior registrars' views on training in oral and maxillofacial surgery

Fifty-three British senior registrars in oral and maxillofacial surgery (OMS) were sent a questionnaire designed to determine their views on some of the main aspects of training in the specialty. Thirty-seven returns were received (70%), 36 completed. This paper reports and discusses the results of the survey.

Surgical correction of temporomandibular joint ankylosis

The correction of temporomandibular joint ankylosis is frequently followed by re-ankylosis, occlusal disturbance and alteration of functional masticatory movements. A multitude of surgical procedures have been devised in an attempt to overcome the complication of re-ankylosis in particular, and to create a functioning pseudoarthrosis where distance between resected bone surfaces and/or interpositional autogenous, homologous or alloplastic material is relied upon to prevent re-ankylosis and facilitate functional joint activity. Success in preventing re-ankylosis is said also to depend on long-term patient compliance in undertaking frequent and usually painful mandibular movement exercises. Achieving a functioning joint often precludes the maintenance of the occlusion and depends on resection of large amounts of bone and the use of alloplastic implants. A surgical technique is presented whereby a minimal gap arthroplasty in the region of the obliterated temporomandibular joint is completed. This minimizes deviation of the mandible to the operated side with the formation of an anterior open bite. Separation of the resected bone surfaces is accomplished using a composite free auricular skin and cartilage graft in order to prevent re-ankylosis as efficaciously as possible, while allowing for the promotion of immediate postoperative mandibular function, continued growth and the construction of a joint similar in broad terms to the pre-existing joint. A two-stage correction of temporomandibular joint ankylosis and concomitant secondary maxillofacial deformity is recommended. The results in 13 patients (17 joints) with a follow-up range of 1.5 to 5.5 years show that in all but one instance (of fibrous re-ankylosis following postoperative joint infection), satisfactory postoperative mandibular function and mouth opening was achieved.

The surgical correction of fronto-ethmoidal meningo-encephaloceles

One-stage correction of fronto-ethmoidal meningo-encephaloceles and related stigmata, via an orbito-cranial approach, is recommended. A bifrontal craniotomy is only required when simultaneous correction of hypertelorism is to be undertaken. A combined intra- and extracranial approach is essential. The possibility of a high relapse rate for repaired fronto-ethmoidal meningo-encephaloceles, together with the possibility of prolonged postsurgical cerebrospinal fluid leakage, meningitis and other complications is invited when either a transcranial bifrontal craniotomy surgical approach, or an extracranial approach via the facial lesion, is undertaken alone. Modification of existing craniofacial surgical approaches in order to avoid a frontal craniotomy, allowed for good repair of the encephalocele together with significant benefits in terms of simplification of the surgical procedure, operating time, blood loss, frontal lobe retraction and complications.

Hodgkin's disease presenting in the maxilla. A case report

A rare case of intra-oral, extra nodal, maxillary Hodgkin's disease (Stage I), with no other discernible tissue involvement is described and discussed. The pertinent literature is reviewed.

Multiple myeloma presenting as localized expansile jaw tumour

Myelomatous involvement of the maxilla is an exceptionally rare occurrence, and the presentation of the lesion as an expansile jaw bone tumour has not been reported. 2 cases, one with a maxillary lesion, the other with a mandibular lesion are presented, both of which illustrate gross bone expansions. Additionally, 1 case presented with a rare biclonal IgG kappa and IgG lambda light chain secreting myeloma. Relevant clinical, immunological, histological, biochemical and histochemical features are presented and discussed, and suggestions pertaining to surgical management made.

The effect of interdental continuous loop wire splinting and intermaxillary fixation on the marginal gingiva

To study the influence of interdental loop-wire splinting and intermaxillary fixation on the marginal gingiva, 30 patients were evaluated clinically using different periodontal parameters, at 5 examination times. It was shown that despite a standardized oral hygiene regime including the use of a mouthrinse, gingival inflammation occurred for the duration of the splinting period. Factors other than the presence of limited plaque, such as gingival trauma due to splint application and subsequent mechanical irritation should be considered as possible aetiological factors. All investigated marginal gingival changes had totally reversed 2 weeks following loop-wire splint removal, apart from tooth mobility which did not re-attain pre-operative levels, the difference, however, being statistically insignificant.

Skeletal open bite correction by combined Le Fort I osteotomy and bilateral sagittal split of the mandibular ramus

Of over 300 surgically-treated skeletal open bite cases, 10 were corrected by simultaneous repositioning of the maxilla and mandible by means of a Le Fort I osteotomy and bilateral sagittal splitting of the mandibular ramus. The paucity of cases does not permit detailed statistical evaluation; however of the many parameters investigated, certain appeared to be associated with relapse in this series: short intermaxillary fixation period, skeletal class II, and the surgeon. Despite skeletal relapse in 3 cases, dental compensation precluded the need to re-operate on any of these relapsed cases. This surgical approach to the correction of a skeletal open bite, when indicated on aesthetic and occlusal grounds, is a particularly suitable method, and gives stable results.

Ameloblastoma with multiple delayed recurrences: a case report

The ameloblastoma is a tumor arising predominantly in the mandible from odontogenic epithelium, and is locally invasive. It is rarely malignant; but even when benign, it causes gross local destruction and expansion of tissue. Growth is persistent, and recurrence may occur more than a decade after presumed total resection. Surgical resection should include a reasonable margin of healthy tissue whenever possible. Late patient presentation due to a paucity of symptoms, and insiduous tumor growth patterns render complete removal of the ameloblastoma difficult. Follow-up examinations should span a prolonged period, exceeding 10-15 years.

Intraoral reconstruction of mandibular defects after tumor resection

The intraoral reconstruction of mandibular defects resulting from tumor resection with autogeneic iliac bone is described. Large pieces of pelvis can be harvested and split sagittally for lengthening or altering the direction and shape of the body or angle of the reconstructed mandible. A graft taken from the iliac tubercle region can be used for satisfactory reshaping of the chin area. Delays in reconstruction, if necessary, should be of short duration, and a fabricated Kirschner wire splint with fixation screws, or a Kirschner wire and acrylic condyle may serve to counteract scar retraction prior to grafting. Esthetic and functional results have been good, and postoperative complications have been minimal.

Calcifying odontogenic cyst

The literature pertinent to calcifying odontogenic cysts is reviewed, and an additional case is described. Relevant clinical, radiological and histological features, as well as methods of treatment are considered, and an unusual method of treatment with good results is described in detail.

Traumatic myositis ossificans in masticatory muscles

3 cases of traumatic myositis ossificans circumscripta, located within the masticatory muscles are presented. Two of the lesions involved the masseter muscle, and exceptionally, 1 involved the temporalis muscle. Three pathognomonic histological zones, permitting the differential diagnosis of myositis ossificans from sarcomatous lesions, are described, and treatment incorporating ideally early surgical intervention with wide excisional biopsy of the lesion is stressed.

Stomal sepsis and fatal haemorrhage following tracheostomy

A case of stomal sepsis and fatal haemorrhage following an emergency tracheostomy in a 28-year-old woman is presented. It is proposed that major haemorrhage can occur in the absence of a large vessel lesion as a result of local sepsis and inflammation. Infection in this setting can be predicted to be polymicrobial in origin and attention is therefore drawn to the need for early prophylactic antimicrobial therapy as well as the need for meticulous care of the stomal site.

Focal osteoporotic bone marrow defects of the jaws

Twenty focal osteoporotic bone marrow defects of the jaws were analyzed clinically, histologically, and radiographically; the findings were compared with those from all known published cases. Radiologic and clinical criteria that are useful for making a definitive diagnosis are discussed, and five radiologic categories are proposed.

Craniofacial polyostotic fibrous dysplasia

Three cases of gross craniofacial polyostotic fibrous dysplasia are presented, together with a brief review of the condition, and pertinent points regarding the cases are discussed. As complete excision of the lesion and immediate reconstruction is rarely feasible or possible, and partial excision may result in accelerated growth of the lesion during the patient's active growth phase, resection only to protect, maintain or restore certain important functions (e.g. vision) during this period are advocated, after which close follow-up is mandatory until the lesion becomes quiescent, when further surgical procedures may be undertaken.

Submucosal nodular chondrometaplasia in denture wearers

In 39 denture-wearing patients in whom anterior maxillary flabby ridge tissue (prosthesis fibroma) was excised, 15.4% contained cartilaginous nodules within this tissue. The chondrometaplasia may arise due to mechanical irritation activating pluripotential mesenchymal cells; but the possibility that the cartilaginous nodules represent remnant embryologic tissue cannot be excluded.

Stafne's mandibular lingual cortical defect. Discussion of aetiology

The literature relevant to Stafne's mandibular lingual cortical defect is reviewed. Four case descriptions are added. Aetiological theories are discussed and an alternative hypothesis of circumscribed, localized bone atrophy due to relative ischaemia is proposed.