Craniomaxillofacial Trauma and Reconstruction, Jun 1, 2015
Fractures of the mandibular subcondylar area are common. 1,2 Although the techniques of open redu... more Fractures of the mandibular subcondylar area are common. 1,2 Although the techniques of open reduction and internal fixation (ORIF) for most fractures of the facial skeleton are widely accepted as best practice, the discussion over the optimal management of mandibular subcondylar fractures persists. 3-6 Upon electing to treat mandibular subcondylar fractures by ORIF, the surgeon must then make a reasoned decision on the type of implant to be used to reduce the fracture. 1,3,7-12 The most stable fracture reduction is achieved by using the largest plate possible; however, due to anatomical and clinical restraints, it is desirable to minimize the size of any implant placed. Thus, there are two opposing influences in the design of bone plates with the optimal design balancing the need to minimize the degree of surgical insult by using small plates, with the requirement to bestow sufficient stability to permit fracture healing to occur. Patient-specific implants (PSIs) have theoretical and practical advantages including a superior fit compared with generic Keywords ► patient-specific implant ► finite element analysis ► condylar fractures ► ORIF
Background: A case of Crohn's disease (CD) was diagnosed following recognition of oral and system... more Background: A case of Crohn's disease (CD) was diagnosed following recognition of oral and systemic signs and symptoms in a 19-year-old male patient. Methods: Clinical investigation utilized included blood tests (full blood count, electrolytes, urea, creatinine, liver function tests), computed tomogrphy scans, magnetic resonance imaging scans, oral biopsies, colonoscopy and biopsies of the terminal ileum and colon. Results: A diagnosis of CD was made which then allowed appropriate medical treatment to be initiated. Conclusion: The importance of a thorough medical history and full physical examination with appropriate investigations as dictated by clinical findings is demonstrated.
Craniomaxillofacial Trauma and Reconstruction, Sep 1, 2014
Facial fractures are a common injury often resulting from interpersonal violence or motor vehicul... more Facial fractures are a common injury often resulting from interpersonal violence or motor vehicular accident. 1 In modern surgical practice, the management of most facial fractures using the techniques of open reduction and internal fixation (ORIF) as espoused by the AO, is widely accepted as best practice; however, debate over the treatment of fractures of the mandibular condylar process continues. 2-5 The use of ORIF to treat mandibular condyle fractures is becoming
Background: Head and neck cancer is a significant cause of morbidity and mortality worldwide and ... more Background: Head and neck cancer is a significant cause of morbidity and mortality worldwide and in Australia. Early diagnosis of this group of diseases has been shown to improve both survival and decrease morbidity. Unfortunately, a significant number of patients still present at a late stage of disease. The purpose of this study was to identify factors which may be associated with diagnostic delay in head and neck cancers. Methods: a retrospective chart review of patients who had been referred to the Multidisciplinary Head & Neck Clinic at the Newcastle Mater Misericordiae Hospital in 2004 was performed. Patients with the following disease classifications were included in the study; ID9 codes 140-149 and 173. Forty five patients were included in the study. Patient delay and professional delay were calculated from the data. In addition referral delay (the time from the date of the referral letter to being assessed in the clinic), the biopsy delay (the period from presentation to the initial clinician to the date of biopsy) and the delay to assessment at the Head & Neck Clinic (the period from initial consultation to being seen in the clinic) were determined. Non-parametric statistical tests were used to detect an association between these five types of diagnostic delay and the following potential predictor variables; age, gender, ECOG score, presence of chronic disease(s), marital status, occupation, family history of cancer, previous diagnosis of cancer, stage of tumour at diagnosis and smoking history. Results: Disease stage at diagnosis was not associated with any of the five types of diagnostic delay examined. None of the other variables examined reached statistical significance. Conclusions: No association between 10 predictor variables and diagnostic delay in head and neck cancer were demonstrated. List of abbreviations viii HCP Health Care Professional ECOG Eastern Cooperative Oncology Group viii An Investigation into Patient & Professional Delays in the Diagnosis of Head & Neck Cancer. Introduction & Literature Review Malignant disease of the head and neck region is a significant cause of morbidity and mortality both in Australia and throughout the world. 1, 2 During 2002, globally there were 274,000 new cases of oral cancer alone. 3 This figure does not include the extraoral cancers which also comprise head and neck cancers. In New South Wales in 2002, there were 785 new cases of head and neck cancer (575 male, 210 female) representing 3.5% and 1.5% of new cancers in males and females respectively. 2 This corresponds to a crude incidence rate of 17.4 per 100,000 for men and 6.3 per 100,000 in women. 2 Head and neck cancer incidence in NSW ranked seventh for males and 16 th for females, and the mortality rates were 7.7 and 2.9 in males and females respectively. 2 It has been estimated that globally in 1990 there were 66,000 and 34,100 deaths due to oral cancer in men and women respectively. 4 The combined
Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a w... more Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a well-established relationship in the literature. We present a retrospective audit comparing the role of alcohol in maxillofacial trauma between Selly Oak Hospital in Birmingham, United Kingdom and Westmead Hospital in Sydney, Australia, and the association between alcohol involvement and patient demographics, including age, sex, marital status, and employment status. Also presented are the differences between the two centers in terms of mechanisms and types of injuries and the locations where these injuries were sustained. Alcohol was involved in 34.78 and 30.77% of patients at Westmead and Birmingham, respectively. A multiple logistic regression analysis revealed a reduced likelihood of alcohol involvement in episodes of maxillofacial trauma where patients were unemployed (P 5 .04), and where injuries were sustained secondary to mechanisms other than assault (P ! .001) and in locations other than pubs and nightclubs (P 5 .024). There appeared to be no statistically significant contribution to the likelihood of alcohol involvement by treating center, marital status, patient sex, or age. Alcohol continues to be a strong driving factor in cases of maxillofacial trauma, particularly those due to alleged assault, with a typical patient demographic of the gainfully employed frequenting drinking establishments being most at risk for alcohol-related trauma, most commonly sustaining their injuries secondary to assault. Identifying patient groups most at risk is a key step in developing public health strategies aimed at prevention, and our findings would appear to suggest this group of patients as being the most worthwhile to target with measures aimed at reducing alcohol-fueled maxillofacial trauma.
We present a patient with extensive surgical emphysema following the dental restoration the upper... more We present a patient with extensive surgical emphysema following the dental restoration the upper left first molar (tooth 26) with a high speed turbine handpiece. The clinical findings and management of subcutaneous cervical emphysema are discussed.
The most stable pattern of internal fixation for mandibular condyle fractures is an area of ongoi... more The most stable pattern of internal fixation for mandibular condyle fractures is an area of ongoing discussion. This study investigates the stability of three patterns of plate fixation using readily available, commercially pure titanium implants. Finite element models of a simulated mandibular condyle fracture were constructed. The completed models were heterogeneous in bone material properties, contained approximately 1.2 million elements and incorporated simulated jaw adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. No human subjects were involved in this investigation. The stability of the simulated condylar fracture reduced with the different implant configurations, and the von Mises stresses of a 1.5-mm X-shaped plate, a 1.5-mm rectangular plate, and a 1.5-mm square plate (all Synthes (Synthes GmbH, Zuchwil, Switzerland) were compared. The 1.5-mm X plate was the most stable of the three 1.5-mm profile plate configura...
Background: Head and neck cancer is a significant cause of morbidity and mortality worldwide and ... more Background: Head and neck cancer is a significant cause of morbidity and mortality worldwide and in Australia. Early diagnosis of this group of diseases has been shown to improve both survival and decrease morbidity. Unfortunately, a significant number of patients still present at a late stage of disease. The purpose of this study was to identify factors which may be associated with diagnostic delay in head and neck cancers. Methods: a retrospective chart review of patients who had been referred to the Multidisciplinary Head & Neck Clinic at the Newcastle Mater Misericordiae Hospital in 2004 was performed. Patients with the following disease classifications were included in the study; ID9 codes 140 -149 and 173. Forty five patients were included in the study. Patient delay and professional delay were calculated from the data. In addition referral delay (the time from the date of the referral letter to being assessed in the clinic), the biopsy delay (the period from presentation to t...
Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a w... more Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a well-established relationship in the literature. We present a retrospective audit comparing the role of alcohol in maxillofacial trauma between Selly Oak Hospital in Birmingham, United Kingdom and Westmead Hospital in Sydney, Australia, and the association between alcohol involvement and patient demographics, including age, sex, marital status, and
Craniomaxillofacial Trauma and Reconstruction, Jun 1, 2015
Fractures of the mandibular subcondylar area are common. 1,2 Although the techniques of open redu... more Fractures of the mandibular subcondylar area are common. 1,2 Although the techniques of open reduction and internal fixation (ORIF) for most fractures of the facial skeleton are widely accepted as best practice, the discussion over the optimal management of mandibular subcondylar fractures persists. 3-6 Upon electing to treat mandibular subcondylar fractures by ORIF, the surgeon must then make a reasoned decision on the type of implant to be used to reduce the fracture. 1,3,7-12 The most stable fracture reduction is achieved by using the largest plate possible; however, due to anatomical and clinical restraints, it is desirable to minimize the size of any implant placed. Thus, there are two opposing influences in the design of bone plates with the optimal design balancing the need to minimize the degree of surgical insult by using small plates, with the requirement to bestow sufficient stability to permit fracture healing to occur. Patient-specific implants (PSIs) have theoretical and practical advantages including a superior fit compared with generic Keywords ► patient-specific implant ► finite element analysis ► condylar fractures ► ORIF
Background: A case of Crohn's disease (CD) was diagnosed following recognition of oral and system... more Background: A case of Crohn's disease (CD) was diagnosed following recognition of oral and systemic signs and symptoms in a 19-year-old male patient. Methods: Clinical investigation utilized included blood tests (full blood count, electrolytes, urea, creatinine, liver function tests), computed tomogrphy scans, magnetic resonance imaging scans, oral biopsies, colonoscopy and biopsies of the terminal ileum and colon. Results: A diagnosis of CD was made which then allowed appropriate medical treatment to be initiated. Conclusion: The importance of a thorough medical history and full physical examination with appropriate investigations as dictated by clinical findings is demonstrated.
Craniomaxillofacial Trauma and Reconstruction, Sep 1, 2014
Facial fractures are a common injury often resulting from interpersonal violence or motor vehicul... more Facial fractures are a common injury often resulting from interpersonal violence or motor vehicular accident. 1 In modern surgical practice, the management of most facial fractures using the techniques of open reduction and internal fixation (ORIF) as espoused by the AO, is widely accepted as best practice; however, debate over the treatment of fractures of the mandibular condylar process continues. 2-5 The use of ORIF to treat mandibular condyle fractures is becoming
Background: Head and neck cancer is a significant cause of morbidity and mortality worldwide and ... more Background: Head and neck cancer is a significant cause of morbidity and mortality worldwide and in Australia. Early diagnosis of this group of diseases has been shown to improve both survival and decrease morbidity. Unfortunately, a significant number of patients still present at a late stage of disease. The purpose of this study was to identify factors which may be associated with diagnostic delay in head and neck cancers. Methods: a retrospective chart review of patients who had been referred to the Multidisciplinary Head & Neck Clinic at the Newcastle Mater Misericordiae Hospital in 2004 was performed. Patients with the following disease classifications were included in the study; ID9 codes 140-149 and 173. Forty five patients were included in the study. Patient delay and professional delay were calculated from the data. In addition referral delay (the time from the date of the referral letter to being assessed in the clinic), the biopsy delay (the period from presentation to the initial clinician to the date of biopsy) and the delay to assessment at the Head & Neck Clinic (the period from initial consultation to being seen in the clinic) were determined. Non-parametric statistical tests were used to detect an association between these five types of diagnostic delay and the following potential predictor variables; age, gender, ECOG score, presence of chronic disease(s), marital status, occupation, family history of cancer, previous diagnosis of cancer, stage of tumour at diagnosis and smoking history. Results: Disease stage at diagnosis was not associated with any of the five types of diagnostic delay examined. None of the other variables examined reached statistical significance. Conclusions: No association between 10 predictor variables and diagnostic delay in head and neck cancer were demonstrated. List of abbreviations viii HCP Health Care Professional ECOG Eastern Cooperative Oncology Group viii An Investigation into Patient & Professional Delays in the Diagnosis of Head & Neck Cancer. Introduction & Literature Review Malignant disease of the head and neck region is a significant cause of morbidity and mortality both in Australia and throughout the world. 1, 2 During 2002, globally there were 274,000 new cases of oral cancer alone. 3 This figure does not include the extraoral cancers which also comprise head and neck cancers. In New South Wales in 2002, there were 785 new cases of head and neck cancer (575 male, 210 female) representing 3.5% and 1.5% of new cancers in males and females respectively. 2 This corresponds to a crude incidence rate of 17.4 per 100,000 for men and 6.3 per 100,000 in women. 2 Head and neck cancer incidence in NSW ranked seventh for males and 16 th for females, and the mortality rates were 7.7 and 2.9 in males and females respectively. 2 It has been estimated that globally in 1990 there were 66,000 and 34,100 deaths due to oral cancer in men and women respectively. 4 The combined
Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a w... more Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a well-established relationship in the literature. We present a retrospective audit comparing the role of alcohol in maxillofacial trauma between Selly Oak Hospital in Birmingham, United Kingdom and Westmead Hospital in Sydney, Australia, and the association between alcohol involvement and patient demographics, including age, sex, marital status, and employment status. Also presented are the differences between the two centers in terms of mechanisms and types of injuries and the locations where these injuries were sustained. Alcohol was involved in 34.78 and 30.77% of patients at Westmead and Birmingham, respectively. A multiple logistic regression analysis revealed a reduced likelihood of alcohol involvement in episodes of maxillofacial trauma where patients were unemployed (P 5 .04), and where injuries were sustained secondary to mechanisms other than assault (P ! .001) and in locations other than pubs and nightclubs (P 5 .024). There appeared to be no statistically significant contribution to the likelihood of alcohol involvement by treating center, marital status, patient sex, or age. Alcohol continues to be a strong driving factor in cases of maxillofacial trauma, particularly those due to alleged assault, with a typical patient demographic of the gainfully employed frequenting drinking establishments being most at risk for alcohol-related trauma, most commonly sustaining their injuries secondary to assault. Identifying patient groups most at risk is a key step in developing public health strategies aimed at prevention, and our findings would appear to suggest this group of patients as being the most worthwhile to target with measures aimed at reducing alcohol-fueled maxillofacial trauma.
We present a patient with extensive surgical emphysema following the dental restoration the upper... more We present a patient with extensive surgical emphysema following the dental restoration the upper left first molar (tooth 26) with a high speed turbine handpiece. The clinical findings and management of subcutaneous cervical emphysema are discussed.
The most stable pattern of internal fixation for mandibular condyle fractures is an area of ongoi... more The most stable pattern of internal fixation for mandibular condyle fractures is an area of ongoing discussion. This study investigates the stability of three patterns of plate fixation using readily available, commercially pure titanium implants. Finite element models of a simulated mandibular condyle fracture were constructed. The completed models were heterogeneous in bone material properties, contained approximately 1.2 million elements and incorporated simulated jaw adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. No human subjects were involved in this investigation. The stability of the simulated condylar fracture reduced with the different implant configurations, and the von Mises stresses of a 1.5-mm X-shaped plate, a 1.5-mm rectangular plate, and a 1.5-mm square plate (all Synthes (Synthes GmbH, Zuchwil, Switzerland) were compared. The 1.5-mm X plate was the most stable of the three 1.5-mm profile plate configura...
Background: Head and neck cancer is a significant cause of morbidity and mortality worldwide and ... more Background: Head and neck cancer is a significant cause of morbidity and mortality worldwide and in Australia. Early diagnosis of this group of diseases has been shown to improve both survival and decrease morbidity. Unfortunately, a significant number of patients still present at a late stage of disease. The purpose of this study was to identify factors which may be associated with diagnostic delay in head and neck cancers. Methods: a retrospective chart review of patients who had been referred to the Multidisciplinary Head & Neck Clinic at the Newcastle Mater Misericordiae Hospital in 2004 was performed. Patients with the following disease classifications were included in the study; ID9 codes 140 -149 and 173. Forty five patients were included in the study. Patient delay and professional delay were calculated from the data. In addition referral delay (the time from the date of the referral letter to being assessed in the clinic), the biopsy delay (the period from presentation to t...
Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a w... more Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a well-established relationship in the literature. We present a retrospective audit comparing the role of alcohol in maxillofacial trauma between Selly Oak Hospital in Birmingham, United Kingdom and Westmead Hospital in Sydney, Australia, and the association between alcohol involvement and patient demographics, including age, sex, marital status, and
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