UHCW publication: Success rates and complications of eminectomies

Success rates and complications of eminectomies: a retrospective case series
Rahman, Z; Chand, M; Breeze, J; Stocker, J. Oral Surgery; Edinburgh Vol. 11, Iss. 1, (Feb 2018): 28-32.

Abstract
Introduction
Eminectomy is the physical removal of the articular eminence to enable free movement of the condyle. The primary indication is to treat recurrent dislocation, although in the past it has been used for non-reducing disc displacement without reduction (NDDR). The established contraindication to the procedure is pneumatisation of the articular eminence or tubercle. Determining the success rates of eminectomies from previous papers are hampered by the lack of baseline objective measures needed to improve assessment of treatment outcomes.

Methodology
A retrospective case series was conducted, in which written and computerised hospital records and images were analysed from 2007 to 2014, using a minimum data set developed by our unit to assess outcomes. These included indication for procedure, frequency of dislocation, interincisal distance, pre-operative imaging and objective pain scoring.

Results
Twenty of twenty-eight (71%) patients receiving an eminectomy conformed to the minimum data set. Pain improvement was demonstrated in 60% of patients with both recurrent dislocation and NDDR. Complications occurred in 24% of eminectomies, all of which were temporary.

Conclusions
Eminectomy is a safe and effective procedure for management of chronic temporomandibular joint dislocation in well-selected cases. However, the results were less predictable with NDDR. The recording of specific clinical information is required to improve comparing outcomes and we would recommend the use of a proforma such as one utilised in our study. There was no evidence that pneumatisation of the eminence was related to an adverse clinical outcome but further evidence is required to question this as a contraindication to eminectomy.

Culture and sensitivity reporting in odontogenic infections: do microbiology swabs change antibiotic prescribing practice?

British Journal of Oral and Maxillofacial Surgery , Volume 55 , Issue 10 , e94 - e95 

Odontogenic infections are commonly polymicrobial. Effective treatment depends on definitive drainage of abscesses and empirical antimicrobial therapy based on likely organisms.

UHCW Research: Jasdeep Singh Saggu, Jean Medard Croos, Ross Elledge and Gary Walton

The impact of fixation method selection on neurosensory disturbance following bilateral sagittal split osteotomy

British Journal of Oral and Maxillofacial Surgery , Volume 55 , Issue 10 , e174 

The bilateral sagittal split osteotomy is a commonly performed procedure to correct dentofacial deformities such as retrognathia and prognathia. Fixation choices available to the surgeon include bicortical screws and monocortical fixation plates. Whilst there is evidence in the literature to support both methods in terms of stability, there is little about comparative rates of sensory deficit in the distribution of the inferior alveolar nerve.

UHCW Research: Naren Thanabalan, Ross Elledge, Hayley Kyte and Peter Stockton

Should we consider devolution of “head and neck” surgery from the specialties of oral and maxillofacial surgery; ear, nose, and throat surgery; and plastic surgery?

Br J Oral Maxillofac Surg. 2017 Jun;55(5):566. doi: 10.1016/j.bjoms.2016.12.019. Epub 2017 Feb 14.
Editorial published in the British Journal of Oral and Maxillofacial Surgery

In the United Kingdom the practice of vascular surgery has now become recognised as the tenth independent surgical specialty by the Royal College of Surgeons of England and the General Medical Council (GMC). Traditionally, surgical trainees developed their subspecialty vascular interest within the parameters of obtaining a certificate of completion of training (CCT) in General Surgery. The process of devolution of areas of subspecialty may also apply to other surgical specialties.

 

UHCW Research: Elledge R, Walton G, Sandhu R, Prasad S, Howe D

The provision of surgical tracheostomies by maxillofacial surgeons in the UK: time for a dedicated tracheostomy team?

The Annals of The Royal College of Surgeons of England 0 0:0, 1-4                     

Surgical tracheostomy is a commonly provided service by surgical teams for patients in intensive care where percutaneous dilatational tracheostomy is contraindicated. A number of factors may interfere with its provision on shared emergency operating lists, potentially prolonging the stay in intensive care. We undertook a two-part project to examine the factors that might delay provision of surgical tracheostomy in the intensive care unit. The first part was a prospective audit of practice within the University Hospital Coventry. This was followed by a telephone survey of oral and maxillofacial surgery units throughout the UK.

UHCW Research: P Chohan, Elledge R, Virdi MK and GM Walton

Thyrolingual trunk: aberrant branches of the external carotid artery

British Journal of Oral and Maxillofacial Surgery May 2017 Volume 55, Issue 4, Pages 437–438 

We recently encountered an anatomical variation of the superior thyroid and lingual branches of the external carotid artery during a modified radical neck dissection. It was a common trunk, arising below the level of bifurcation of the common carotid artery, and we anecdotally named it the thyrolingual trunk (Fig. 1). This subsequently branched into the respective superior thyroid and lingual arteries.

UHCW Research: Al-Ali, S., Elledge, R., Esmil, T. and Walton, G.

Re: Should we consider devolution of "head and neck" surgery from the specialties of oral and maxillofacial surgery; ear, nose and throat surgery; and plastic surgery?

Br J Oral Maxillofac Surg. 2017 Feb 14. pii: S0266-4356(17)30042-6. doi: 10.1016/j.bjoms.2016.12.019. [Epub ahead of print]

We were interested in Islam’s editorial regarding the devolution of head and neck surgery from the parent specialties that feed into it.1 We have had a devolved arrangement of practice at University Hospitals Coventry and Warwickshire Hospitals NHS Trust since 2003. To the best of our knowledge this is the only service in the country in which this is the case, and it is recognised as such within the clinical and management structure of the hospital. The service has a separate clinical lead, QIPS (Quality, Improvement, and Patient Safety), business, and departmental meetings

UHCW Research: Elledge R, Walton G, Sandhu R, Prasad S and Howe D.

When the cows come home: occupational tinea barbae in a cattle farmer

British Journal of Oral and Maxillofacial Surgery. ePub ahead of Print 13/1/2017. http://dx.doi.org/10.1016/j.bjoms.2017.01.001

We recently treated a man with an unusual facial infection who had been admitted under the maxillofacial team. He was 29 years old, otherwise healthy, and presented with pyrexia and a severe, spreading, facial folliculitis, which had worsened over two weeks. He had initially been treated for suspected folliculitis with amoxicillin orally, but to no effect.

UHCW Research: S. Al-Ali , R. Elledge, A. Ilchyshyn and P. Stockton