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Microvascular free flaps are considered the gold standard in head and neck reconstructive surgery. Myofascial flaps, in particular, are useful in certain oral and maxillofacial reconstruction cases, where mucosal regeneration over the transplanted tissue is planned. Despite high success rates, 1–6% of free flaps fail. A plethora of methods are available to assess transplanted tissue viability after reconstruction, including clinical observational monitoring, surface Doppler, implantable Doppler probe, colour Doppler sonography, laser Doppler flowmeter, surface temperature and indocyanine green angiography. However, no method has demonstrated adequate reliability or has proven to be cost-effective. The authors tested a technique called real-time optical vascular imaging to evaluate the microvascular circulation of myofascial free flaps. This technique was develop at Guy’s Hospital, London to observe the microvascular anatomy of the oral cavity in vivo, non-invasively and without the need for patient preparation, with the aim of detecting and monitoring oral diseases. This technology detects the red blood cells flowing inside the microvasculature at a depth of approximately 2 mm, allowing the microvascular architecture and blood flow to be determined. This study showed that RTOVI may prove to be beneficial for the early detection of vascular compromise due to its immediacy and the feasibility of assessing multiple graft tissue regions.

Numerous incisions around the ear have been described, and many have been used in oral and maxillofacial surgery for procedures involving the temporomandibular joint (TMJ), condylar neck, and parotid gland, as well as for rhytidectomy.1-5 Although the traditional preauricular and endaural incisions will frequently provide an excellent outcome, they will heal with a visible scar.1,4 The incision we have described aims to refine the incision to further improve this esthetic outcome. Additionally, surgical procedures around the ear have often resulted in the unpleasant and inconvenient collection of blood or surgical skin preparation in the ear canal. Although not recorded in reported studies, in our experience, patients have commonly complained of "blocked ears" for 1 to 2 weeks in the postoperative period. Although this complication represents minimal risk, it can often be difficult, once clotted or dried, to remove and will be bothersome to the patient. In addition, any packing placed in the external auditory canal (EAC) intraoperatively to mitigate the collection of blood will often and repeatedly dislodge from the EAC, requiring replacement multiple times during the procedure to the frustration of the surgeon. The techniques we have described are 2 straightforward, but innovative, surgical techniques that refine surgery around the ear to improve the esthetics and patient comfort, facilitate the surgical procedure, and increase reliable anatomic access. The modified incision we have described is predominately aimed at operations requiring access to the TMJ, condylar neck, or parotid gland. The techniques were, to the best of our knowledge, first used in our unit at the University of Maryland.

How trans-oral robotic surgery can treat cancer in the oropharyngyal space

300 cases of non-melanoma cutaneous lesion procedures carried out by the Oral and Maxillofacial Surgery and Dermatology departments in a North West London hospital over a 6 month period between September 2011 and February 2012 were included in a retrospective case control study. The results from each speciality were compared. The mean age of the OMFS group was 75.8 years compared to 69.9 years in the dermatology group. There was no statistically significant difference in gender between the 2 groups. The OMFS group treated a higher proportion of atypical (17%) and malignant (64.9%) cases compared to the dermatology group (11.3% and 50.5% respectively). This could also account for the fact that the OMFS group carried out a higher number of full excisions compared to dermatology. Both groups had a similar number of false positives (a benign lesion initially diagnosed as malignant) and a similar proportion of false negatives (a malignant lesion initially diagnosed as benign). Overall, the results show that both specialities had similar outcomes when managing non-melanoma cutaneous lesions. Both groups adhere to the guidelines set out by the British Association of Dermatologists and the National Institute of Clinical Excellence when managing such lesions.

Background Reconstruction of oral cavity defects requires a thin, pliable flap for optimal functional results. Traditional flap choices are imperfect: the anterolateral thigh flap is excessively thick, whereas the radial forearm flap has a poor donor site. The authors therefore favor calf perforator flaps such as the medial sural artery perforator flap to provide thin tissue with an acceptable donor site. This two-part study aims to demonstrate their suitability for intraoral reconstruction. Methods In the radiologic part of the study, the authors compared thigh and calf tissue thickness by examining lower limb computed tomographic scans of 100 legs. For their clinical study, they collected data prospectively on 20 cases of oral cavity reconstruction using calf perforator flaps. Results The mean thickness of the calf tissue envelope was significantly less than that of the thigh (8.4 mm compared with 17 mm) based on computed tomographic analysis. In the clinical study, a medial sural artery perforator was used in the majority of cases (17 of 20). The mean pedicle length was 10.2 cm and the mean time to raise a flap was 85 minutes. There were no flap losses. One patient was returned to the operating room for management of late hematoma and wound dehiscence. Conclusions Calf perforator flaps provide ideal tissue for intraoral reconstruction and are significantly thinner than anterolateral thigh flaps. In addition to medial sural artery perforator flaps, the authors raised both sural and soleal artery perforator flaps in this series. Opportunistic use of the calf donor site allows the harvest of thin tissue with minimal donor-site morbidity. Clinical question/level of evidence Therapeutic, IV.

The British Journal of Oral and Maxillofacial Surgery (BJOMS) accepts many types of papers that include leading articles, reviews, full length articles, and short communications. Many of the latter are isolated case reports of rare or interesting pathology, or personal experience of a difficult or unexpected complication. Case reports are considered to have a relatively low value in the advancement of medical knowledge, and with increasing pressure for space in paper publications, many journals now limit them to online publication only. We evaluated all 142 short communications published in BJOMS during 2008/2009. Most (87%) were single case reports, and they covered virtually the whole remit of the specialty. There were also 14 formal studies that included two laboratory-based research projects; these were excluded from the analysis. We used established criteria to assess the possible educational value of each publication, and found that 61/128 papers (48%), while interesting and informative, probably added little to existing knowledge. The remaining papers described new or unreported cases, rare or unexpected outcomes, and adverse effects or complications of treatment. We discuss the possible implications of this study for readers of BJOMS and for the journal itself.

Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. Extravasation of NaOCl into intra-oral and extra-oral tissues can lead to devastating outcomes leading to long-term functional and aesthetic deficits. Currently no clear guidelines are available which has caused confusion among the dental and oral and maxillofacial (OMFS) surgical community how best to manage these patients. Following a literature review and considering our own experience we have formulated clear and precise guidelines to manage patients with NaOCl injury.

Aim: To report a new intraoral manifestation of sarcoid disease and review the literature. Methods: We present a case of oronasal fistulation as a previously unreported complication of sarcoid disease. A review of the literature was carried out to find documented cases of the oral manifestations of sarcoid disease. The types of intraoral lesions identified were recorded. Results: Seventy-two documented cases of oral sarcoid disease were identified. Soft tissue lesions were the most common, described as nodular or ulcerative and having a predilection for the buccal mucosa. Bony lesions presented as asymptomatic swellings, non-healing tooth sockets or mobile teeth. As far as we are aware, there are no reported cases of an oronasal fistula occurring as a complication of sarcoid disease. Conclusion: Sarcoidosis is a multisystem non-caseating, granulomatous condition of unknown aetiology, most commonly presenting in young adults. Pulmonary and lymph node involvement are common and although oral lesions can occur, these are rare. This is a case report of a man in his 40s who presented with symptoms associated with an oronasal fistula through the hard palate, secondary to sarcoid disease. To our knowledge, this has not been reported previously in the literature.

Background We present the case of a fractured mandible due to a dog bite in a 9 month old female. Dog bites in this age group are rare as are fractured mandibles. There are only two reported cases of fractured mandibles due to dog bites in the literature. This is the youngest. The other reported cases were in a 1 year old and also in a 4 year old. Case Presentation A 9 month old female was brought by her parents to the Emergency Department after sustaining a dog bit to the face. This was assessed by the emergency physicians and deemed to be superficial. The patients wounds were irrigated, and she was given oral antibiotics. She was transferred to our department were she was assessed under anaesthetic. A fracture of her mandible was discovered and treated with open reduction and internal fixation. Conclusion The case presentation highlights the important of proper assessment of facial lacerations for not only neurovascular status and the parotid duct, but also the hard tissues. The case also highlights the difficulty of treating children and infants with fractures of the mandible and the importance of follow-up to monitor growth.

Our vocabulary grows as undergraduates, and continues to develop as we continue to grow as dental professionals. For many of us not learned in Latin or Greek, we are too busy learning what words mean rather than appreciating why a word means what it does. This article aims to clarify where words relating to the maxilla are derived from, why they are used and how they are related to other similar words in everyday use.

A 9-month-old infant was attacked by the family pet dog. The lacerations were obvious but the fractured jaw was not evident until …

Bilateral dislocation of the temperomandibular joints are rare in children. The classic signs of this condition, anterior open bite, protruded mandible, and drooling are …

A healthy 38 year old man finished the 2004 London marathon in just over five hours. During the evening celebrations, he had “two …