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There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits. Inpatients were assessed for day surgery using medical, social, and surgical criteria. Each patient’s suitability for discharge was assessed two, three, and five hours postoperatively. A financial feasibility study was made retrospectively on a larger sample of patients with mandibular fractures. The discharge criteria from the day-care unit were fully met by 26/40 patients at five hours postoperatively, mean (range) duration of operation was 145 (40–285) minutes, and mean (SD) Mandibular Injury Severity Score was 13 (3), range 7–20. When all the criteria were combined (n = 100), 12 of the patients were suitable for day care. With 24 bed-day savings/100 patients, potential earnings would increase to around £80 000/year at this hospital. In conclusion, we have identified a group of patients who were suitable for management of mandibular fractures in the day-care unit. Considerable cost savings are anticipated.

This retrospective observational cohort study evaluated effectiveness of combined orthodontic-orthognathic surgical treatment in a UK University Dental Institute.Patients were identified from a database maintained prospectively throughout a 5-year period of observation. Demographic and clinical data included age, malocclusion, Index of Treatment Need, Index of Orthognathic Functional Treatment Need, orthodontist, surgeon, surgical procedure and treatment-time. Peer Assessment Rating (PAR) scores were generated from pre- and post-treatment dental study casts by a single calibrated examiner.One hundred and sixty two subjects began treatment during the period of observation, 92 completed, 14 elected to discontinue before surgery and 56 remained in treatment. Outcome data were available for 73, 16 males and 57 females (mean age 23.28 [SD, 7.92] years). Within this sample, 33 (45.2%) presented with class II division 1, 6 (8.2%) with class II division 2 and 34 (46.6%) with class III malocclusion. Isolated maxillary and mandibular surgery was carried out in 3 (4.1%) and 24 cases (32.8%), respectively; bimaxillary surgery was performed in 46 (63.1%). Mean total treatment time in fixed appliances was 920.28 days (30.7 months). Mean pre-treatment PAR score was 39.09 [SD, 9.42] and post-treatment 5.86 [SD, 4.25] with a mean 83.7% PAR score reduction, representing a greatly improved occlusal result. Kruskal-Wallis testing found no evidence of any relationship between independent variables and percentage PAR reduction; however, surgeon identity did significantly influence treatment length (P = 0.007).This investigation demonstrates that in terms of static occlusion combined orthodontic-orthognathic surgery is effective in correcting severe malocclusion.

Gingival squamous cell carcinomas (SCC) are relatively rare and make up approximately 10% of oral squamous cell carcinomas. 1 The initial signs and symptoms of a gingival SCC can resemble common dental and periodontal infections and hence it is usually diagnosed late with a relatively poor prognosis. This report presents a case of a healthy 39-year-old patient who attended for routine wisdom teeth extractions, and returned to the emergency department complaining of progressive trismus and paraesthesia of the lower lip. A provisional diagnosis of osteomyelitis was made. However, further clinical, radiographic and histopathological investigations resulted in the diagnosis of poorly-differentiated SCC. CPD/Clinical Relevance: A series of misdiagnoses were made by specialists and by general dental and medical practitioners; this case highlights the importance of recognizing the signs and symptoms of oral carcinoma and appropriate subsequent management.

Orbital cellulitis is a rare but serious sequel of infection from a dental origin. Without prompt treatment, further spread of infection is likely to occur, resulting in loss of vision and possibly death. We report a case of orbital cellulitis secondary to infection originating in a recently endodontically-treated upper first molar tooth. The case was successfully treated by intravenous antibiotics.Odontogenic causes of orbital cellulitis and sinusitis should always be considered in the differential diagnosis. The importance of aggressive treatment of infections in maxillary teeth cannot be over emphasized. Correct diagnosis is vital to the success of therapy.