Biomedical subjects
Publications and source records attributed to D W Patton.
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.
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Ballistics is the science of thrown or projected objects. The consequences of ballistic injuries to the face may be devastating and lead to considerable disability and disfigurement. Reconstructive techniques for maxillofacial injuries have improved greatly since World War II; however, the basic principles for the initial, early and reconstructive phases of treatment have stood the test of time. This paper gives an overview of the management of ballistic injuries to the face and jaws.
We prospectively studied 49 patients with oral squamous cell carcinoma (SCC) who had their cervical regional lymph nodes examined by ultrasound (US), with or without fine needle aspiration cytology (FNAC), for the detection of metastatic spread. They were screened over a two-year period (1993-1995) by computed tomography (CT) and magnetic resonance imaging (MRI) or both to measure the primary tumour. US, with or without FNAC, was used to stage the neck. All tumours were biopsied preoperatively and the diagnosis of SCC conformed by histological examination. Management of the neck was based on US staging. Thirty-five patients had neck dissections and 14 were managed conservatively. Mean follow-up was 30 months (range 24-48). All patients were alive at one year, but one died at 14 months from recurrence of disease in the neck. There were 3 false negatives (6%). We find that US, with or without FNAC, is an accurate (86%), sensitive (92%) and specific (83%) technique for the preoperative assessment of lymph node metastases in patients with SCC.
PURPOSE: The aims of this article are to study how variations in the anatomy of the neck may influence the success of percutaneous dilatational tracheostomy (PDT). PATIENTS AND METHODS: Four hundred and ninety-seven patients were included in this study. Patients with a short neck and altered tracheal anatomy were evaluated on the basis of difficulty with PDT, use of long shank tracheostomy tubes, and need for open surgical tracheostomy. RESULTS: 33 (6.6%) patients had an apparently reduced cricoid ring to sternum distance and a deeply lying trachea. Nine of these patients were referred for open surgical tracheostomy. A further five patients had altered tracheal anatomy secondary to disease or surgery. Two of these patients were also referred for open surgical tracheostomy. Thus, unfavourable neck anatomy was responsible for 2.2% (11/497) of patients being referred for open surgical tracheostomy. CONCLUSION: Variations in the anatomy of the neck can make PDT both difficult and hazardous. Patients with a deeply lying trachea may need a long shank tube. Open surgical tracheostomy is indicated in some patients with a deeply lying trachea and conditions producing secondary deformity of the trachea. All patients should have a detailed history and thorough clinical examination of the neck and thorax prior to PDT. The selective use of chest radiography, MRI, and ultrasound assessment prior to PDT can assist in the identification of patients unsuitable for this technique.
In a series of 497 PDT procedures done in the intensive therapy unit at Morriston Hospital between 1992 and 1999, PDT was abandoned because of bleeding in 6 patients and was noted to be a problem in a further 18 cases (overall incidence 4.8%). In all cases, haemorrhage was successfully arrested. Surgical tracheostomy was necessary in 6 of these 24 cases. The source of bleeding in 4 of these patients was attributed to the inferior thyroid vein (2 cases), high brachiocephalic vein, and possibly an aberrant anterior jugular communicating vein, respectively. In one patient, the vessel presumed injured could not be identified and in another patient, bleeding was related to multi-system disease. We conclude that the risk of bleeding, although low, can be minimised if the operator maintains a high index of suspicion for aberrant vascular anatomy and investigates possible abnormalities with diagnostic ultrasound. Injury to vessels low in the neck can be reduced by not fully extending the neck and siting the stoma at the upper tracheal rings. The possibility of developing a tracheoarterial fistula is reduced if the stoma is situated above the 4th tracheal ring and fibreoptic endoscopy is used to confirm correct tracheostomy tube placement.
Diagnostic ultrasound may be used to assess the suitability of patients for percutaneous dilatational tracheostomy (PDT) in the intensive care unit (ICU). It may identify patients unsuitable for PDT, prevent puncture of aberrant vessels, estimate the distance from the surface of the skin to the trachea, and ensure accurate placement of the needle in the trachea. We conclude that diagnostic ultrasound permits careful evaluation of patients for whom PDT is being considered, and adds to the safety of the procedure.
This study compares the internal fixation of mandibular fractures using either rigid 2.7 mm AO/ASIF plates or mini-plates. In the rigid plate group, 88 fractures were fixed with 88 plates. In the mini-plate group, 116 fractures were fixed with 170 plates. All the cases were consecutive and were treated in two South Wales hospitals during a 3-year period from 1988 to 1991. The aetiology of injury, timing of surgery, site of fracture, antibiotic policy and demographic features were evenly distributed between the two groups but there was a higher incidence of females in the mini-plate group. Both plating systems were successful in restoring functional occlusion. Rigid plates avoided the use of postoperative elastics better than mini-plates but the difference was not significant. There was a significantly higher incidence (P = 0.013) of infection in the mini-plate (12.9%) compared with the rigid plate (2.3%) group but 7.9% of the rigid group developed facial nerve weakness. A significantly higher proportion of mini-plates needed to be removed (P = 0.00019). A better treatment outcome for angle and comminuted fractures was noted with rigid plates.
Post-maxillectomy defects may be restored either by surgical reconstruction or by prostheses and there is continuing controversy about the most appropriate method of rehabilitation in any particular case. A questionnaire was designed to assess the current practices of oral and maxillofacial surgeons in the UK after resection of the maxilla for malignant disease. Maxillectomies were carried out by 83% of surgeons; most surgeons do 1-5 cases a year; 38% of surgeons do reconstruct surgically, but only in 10% of cases. Only 65% of surgeons have access to the services of a restorative dentist; this did influence 19% of surgeons' decision about whether to reconstruct surgically or restore by prosthetic means.
Trigeminal neuralgia remains a difficult condition to manage. Surgery aimed at peripheral nerve branches continues to be used extensively by oral and maxillofacial surgeons. The efficacy of 68 peripheral alcohol injections (retrospective study) and 22 peripheral glycerol injections (prospective study) were assessed in comparison with peripheral cryotherapy. The results indicate that the median time for total pain control after the first alcohol block was 13 months. When individual branches were assessed it was 13 months for the infra-orbital nerve and 19 months for the inferior alveolar nerve. These results compare with the published results on cryotherapy. The results for glycerol were disappointing with a mean time of pain relief of 7 months. The results suggest that peripheral alcohol nerve blocks do still have a role to play in the management of trigeminal neuralgia, particularly in the elderly, medically compromised and those unwilling to undergo more extensive surgery. They also provide a means of temporary relief.
A retrospective study was carried out on 82 patients whose symptoms of trigeminal neuralgia were controlled by repeated peripheral alcohol nerve blocks in order to assess the associated complications. Peripheral alcohol nerve blocks were invariably associated with swelling and discomfort lasting several days. Significant complications occurred in 3 out of 413 nerve blocks administered over a 20-year period.
This is the second in a two-part series on oral cancer. Part 1 focused on the surgical aspects of treatment and morbidity associated with oral cancer. In this article aspects of prosthodontic management of patients with maxillary tumours are considered, with emphasis on promoting optimal rehabilitation.
Three cases are presented in which calculi appear to have reformed in the submandibular duct many years after the total removal of the submandibular gland. The basis for this is presumed to be the existence of communications between the sublingual glandular complex and the remaining submandibular duct.
The hard and soft tissue changes brought about by Le Fort II osteotomies on 13 non-cleft patients were studied using pre-operative, immediate post-operative and follow up lateral cephalograms. The cephalometric analysis was carried out using a digitizer linked to a microcomputer. The results are compared with a similar study previously reported for cleft patients.
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Food or flavouring intolerance has been demonstrated in 14 out of 80 patients with oro-facial granulomatosis. Provoking molecules include cinnamaldehyde, carvone and piperitone, although a wide range of food or flavourings may be implicated. The nature of the reaction is not understood but does not seem to involve an IgE mediated response. At present the only reliable way of detecting specific provoking factors is by the use of an elimination diet.
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