A fellowship in craniofacial surgery.
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Craniocerebral Trauma↗
Biomedical subjects
D K Dhariwal
Publications and source records attributed to D K Dhariwal.
Use of interventional radiology in the management of mediastinitis of odontogenic origin.
Descending necrotising mediastinitis is a rare complication of odontogenic infection. The key to diagnosis is to maintain a high index of suspicion when antibiotics and adequate surgical drainage do not lead to resolution of symptoms. Open thoracic operation to drain mediastinal collections is potentially lethal and interventional radiological techniques are thought to reduce mortality. We report the use of interventional radiology in the diagnosis, monitoring and treatment of this condition and illustrate our experience with three case reports.
Abscess↗
Blood transfusion requirements in bimaxillary osteotomies.
The over-ordering of cross-matched blood to cover operations can result in blood shortages and is costly; it can never be free of risk. Current published guidelines recommend cross-matching 2 units of blood for bimaxillary orthognathic procedures with an additional 2 units if combined with a genioplasty. We reviewed the records of 115 consecutive cases of simultaneous bimaxillary osteotomies at Morriston Hospital over a 5-year period (January 1996 to December 2000). Ordering and use of blood were investigated and the cost analysed. Blood loss was minimised using a strategy of controlled moderate hypotension and meticulous haemostasis. Nine patients were given transfusions of blood but five of these were deemed inappropriate. No predisposing factors for transfusion were identified. We recommend that the tariff for ordering blood for bimaxillary osteotomies should be revised to a "group and save" with antibody screen, providing that a 30-min indirect antibody cross-match is available.
Adolescent↗
The CRABEL score--setting standards in maxillofacial medical note-keeping.
The CRABEL score (developed by Crawford, Beresford and Lafferty) was introduced for auditing medical note-keeping at Morriston Hospital in June 2001. Guidelines detailing the scoring system were issued to all clinicians in the maxillofacial unit. An auditor selected two sets of medical notes from each consultant's firm, giving an initial allocation of 100points/firm (50 points for each set of notes). The notes of the most recent in-patient admission were analysed using the CRABEL marking sheet to give a score out of 100 for each firm. The audit was repeated at 3-month-intervals. CRABEL scores within the maxillofacial unit improved from 70 to 97. The CRABEL score is simple, reliable and repeatable. It is a successful and objective measure for audit and for improvement in the quality of note-keeping. We propose that it be adopted in maxillofacial units throughout the United Kingdom.
Humans↗
Titanium plate reconstruction of the osseous defect after harvest of a composite free flap using the deep circumflex iliac artery.
Hernia formation following harvest of bicortical iliac crest bone occurs infrequently as a late complication and may lead to chronic pain at the donor site and rarely to obstruction and strangulation of bowel. We describe the use of a custom-made titanium plate used to reconstruct the iliac donor site following harvest of a DCIA composite free flap. A pre-operative 3D CT and stereolithography model of the ilium are used to fabricate a titanium plate of the desired shape and size. This plate is used to reconstruct the donor site defect at the time of primary surgery. This technique may reduce late complications following DCIA composite free flap harvest.
Bone Plates↗
A form for referral of injured patients between maxillofacial and ophthalmology units.
We have designed a form to facilitate referral of injured patients between maxillofacial and ophthalmology units. This form improves communication, gives a written record of referral, and can be used for audit.
Eye Injuries↗
Ecstasy related periodontitis and mucosal ulceration -- a case report.
Methylenedioxymethamphetamine (MDMA) more commonly known as 'Ecstasy' is a widely used recreational drug. The oral and systemic effects associated with its use have been well documented. This paper highlights a previously unreported complication of MDMA use on the oral mucosa. MDMA periodontitis is illustrated with a case report and the local oral and systemic effects of MDMA use outlined.
Adolescent↗
Epidural spinal abscess following dental extraction--a rare and potentially fatal complication.
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Adult↗
Post-traumatic orbital cellulitis.
Orbital cellulitis is uncommon. It may arise as a sequel to eyelid infection, or from direct spread of infection from the paranasal sinuses; it may be of odontogenic origin and has been reported after meningitis and after nasoorbital fractures with pre-existing sinusitis. Clinically, orbital cellulitis is of great importance, as it is a severe disease with potentially disastrous consequences. It may lead to optic neuritis, optic atrophy, blindness, cavernous sinus thrombosis, superior orbital fissure syndrome, meningitis, subdural empyema, and even death. We report two cases of severe post-traumatic orbital cellulitis with subperiosteal abscesses. These were managed surgically and vision was preserved. We describe the anatomy, a classification of orbital infection, and the importance of multidisciplinary management of these cases.
Adult↗
A drill-free bone screw for intermaxillary fixation in military casualties.
Drill-free bone screws are a simple and quick method of establishing intermaxillary fixation requiring a minimum amount of specialist training or equipment. These screws offer significant advantages over other methods of intermaxillary fixation and are well suited for use in military casualties.
Bone Screws↗
Trends in oral surgery in England and Wales 1991-2000.
OBJECTIVE: To investigate trends in oral surgery in England and Wales 1991-2000. METHODS: Oral surgery procedure data were derived from Dental Practice Board and Department of Health Hospital Episode Statistics. RESULTS: There was a 6% increase in minor oral surgery (MOS) procedures, including ordinary extractions, extractions of special difficulty, apicectomies and third molar removals, carried out in the General Dental Services (GDS) but the number of third molars removed fell by 32% after 1997. General anaesthetics (GA) administered in the GDS fell by 77% and the number of sedations rose 54% after 1998. There was concentration of minor oral surgery in practices: in the year 2000, 88% of practitioners carried out less than five third molar removals. In the Hospital Dental Service (HDS) there was a 98% increase in day surgery, and a 53% decrease in ordinary admissions for minor oral surgery. HDS waiting times remained constant over the ten year period. CONCLUSIONS: The principal trends were substantial decreases in apicectomies, third molar removals after 1997 and GAs after 1998; increases in extractions of special difficulty and concentration of MOS in the GODS. Numbers of ordinary extractions did not change. In the HDS there was a large shift from in-patient to daycase provision which has facilitated expansion of maxillofacial surgery. This is an important example of NHS reconfiguration. Perhaps the most important implication of these changes concerns the place of MOS in vocational training.
Anesthesia, Dental↗
A two year review of the treatment and complications of mandibular angle fractures.
A review of all patients with treated mandibular angle fractures at a district general hospital, over a two year period, was undertaken. Forty one consecutive patients with 43 mandibular angle fractures were identified. Thirty eight fractures were treated by open reduction and internal fixation with miniplates and 5 by intermaxillary fixation (IMF). Fractures treated with miniplates were reduced under direct vision to give an anatomical reduction without using temporary intermaxillary fixation. The shortened operative time together with the prompt administration of intravenous antibiotics following injury and rapid treatment of fractures after admission resulted in a low complication rate of 7.3% of patients requiring a subsequent surgical procedure. Although IMF has an important role to play in the general treatment of facial fractures, we suggest that there is a place for single miniplate fracture fixation without the use of temporary IMF when treating simple angle fractures. As this technique is quick and has a low complication rate its use in military situations should be considered.
Adolescent↗