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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.

The use of synthetic materials to repair craniofacial defects is increasing today and will increase further in the future. Because of the complexity of the anatomy in the head and neck region, reconstruction and augmentation of this area pose a challenge to the surgeon. This review discusses key facts and applications of traditional reconstruction bone substitutes, also offering comparative information. It then describes the properties and clinical applications of bioactive-glass (B-G) and its variants in oral and maxillofacial surgery, and provides clinical findings. The discussion of each compound includes a description of its composition and structure, the advantages and shortcomings of the material, and its current uses in the field of osteoplastic and reconstructive surgery. With a better understanding of the available alloplastic implants, the surgeon can make a more informed decision as to which implant would be most suitable in a particular patient.

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.

Surgical cleft repair aims to restore function of the oro-nasal sphincter and oro-nasal soft tissues and re-establish the complex relationship between perioral and perinasal muscle rings without compromising subsequent mid-facial growth and development. Here we review the surgical anatomy of this region, optimal timing for surgical repair and current thinking on the use of surgical adjuncts. In addition, an overview of current surgical techniques available for the repair of cleft lip, cleft palate and velopharyngeal insufficiency is presented. Finally, we briefly discuss nasal revision surgery and the use of osteotomy, including distraction osteogenesis in the cleft patient.

Surgical cleft repair aims to restore function of the oro-nasal sphincter and oro-nasal soft tissues and re-establish the complex relationship between perioral and perinasal muscle rings without compromising subsequent mid-facial growth and development. Here we review the surgical anatomy of this region, optimal timing for surgical repair and current thinking on the use of surgical adjuncts. In addition, an overview of current surgical techniques available for the repair of cleft lip, cleft palate and velopharyngeal insufficiency is presented. Finally, we briefly discuss nasal revision surgery and the use of osteotomy, including distraction osteogenesis in the cleft patient.

Improvement in appearance is an important motivation for orthodontic treatment and orthognathic surgery, and two possible underlying causes are objective physical abnormalities, or the patient's personality type that leads them to concentrate on their appearance and request unnecessary interventions. Questionnaires that measure personality traits were given to 30 women who required orthognathic operations, and a control group of 30 other women. Traits measured were: satisfaction with the appearance of the face, head, and body; tendency to compare their appearance with that of others; the extent to which they are aware of their appearance and how they thought they should look; sense of self identity; depression; anxiety; and self-esteem. The only difference between patients and controls was that patients were more dissatisfied with their facial appearance than the others. Orthognathic patients were psychologically normal except that they had more dissatisfaction with their facial appearance. As this was the only difference, it is likely that their desire for operation was caused by a genuine physical abnormality rather than a perceived exaggerated aesthetic problem. It seems, therefore, that any patient who seeks orthognathic treatment because they have a personality that causes them to dwell on their appearance (which may lead them to hold unrealistic expectations of intervention) are screened out of the process before they begin treatment.

Objectives Recent work has demonstrated that female orthognathic patients display more dissatisfaction with their facial appearance after viewing idealised images of facial photographs, than do controls. Patients may request orthognathic surgery because they hope to improve their appearance to conform with ideals portrayed in the mass media, and these hopes may not be realistic. Patients who demonstrate certain personality traits are more likely to hold such hopes. The current study sought to identify the role of dental status (orthognathic patient versus control), personality traits and media images in dissatisfaction with facial appearance. Methods Female patients and controls completed a bank of personality measures and then gave repeated measures of satisfaction with their facial appearance after viewing images of ‘ideal’ and ‘average’ women. Results Neither group showed any change in satisfaction with appearance after viewing either set of images. Patients showed lower satisfaction with facial appearance than controls, but did not differ on other personality measures. Conclusions Viewing ‘ideal’ images of other women has no significant impact on satisfaction with appearance compared to viewing images of ‘average’ women. These results may help inform the development of a psycho-educational intervention to protect women against the negative effects of viewing idealised images in the media.

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.