Forensic facial reconstruction is the reproduction of a deceased person’s antemortem face, most commonly achieved using population-based data of facial soft tissue thickness. Facial soft tissue thickness (FSTT) data have been documented for many populations. However, there are no published data for Nigerian female adults. This study measured the facial soft tissue thickness of 32 subjects based on computed tomography scans. Measurements were taken from 50 facial soft tissue thickness points, including 12 mid-sagittal and 19 bilateral (right and left) points, across a diverse age range of 18 to 95 years. The Nigerian female adult consistently shows marginal increase in soft tissue thickness on the left side of the face when compared with the right, with the greatest relative difference at the zygomatic arch and mid-lateral orbit. When compared with the published data of populations in South Africa, Turkey, Korea, and Belgium, there were similarities at the midline but appreciable differences at the lip and chin regions. The right side of the face of the Nigerian female adults was also compared with other populations; the differences at the lateral side of the face were greater than the midline differences. These differences reflects the greater thickness of bilateral soft tissue. This study demonstrates that although the data between different populations are similar, there are still measurable differences at several points. This new dataset will be most applicable for forensic facial reconstruction in Nigerian female adults.

A total rhinectomy may be part of the treatment of nasal malignancy and can cause severe facial disfigurement and unwanted psychological repercussions. A technique is described for fabricating a skin-colored interim nasal profile dressing for immediate fitting after surgery without the need for either preoperative or postoperative impressions. The technique avoids patient discomfort, and the initial emotional trauma of facial disfigurement may be avoided. The fabrication process includes the use of a preoperative computerized tomography scan, a computer-aided design software program, 3-dimensional printing, and spectrophotometry.

Facial soft tissue thickness (FSTT) was measured from computer tomography scans of 55 Nigeria adult males. Forensic facial reconstruction (FFR) with own population FSTT values can be vital in recognition of skeletal remains and has been used as an adjunct in forensic science.There are no published FSTT values for this population. Measurements were obtained at 12 mid-sagittal and 19 bilateral points totalling 50 and by use of a software package called RadiAnt. In comparison to previous studies in Africa, measurements were taken from more points and with a diverse age of 18 to 100 years. Mean FSTT values were determined for these combined Nigerian male ethnicities. These values will suffice in FFR for this population and for the Hausa adult male. This population homogenously showed more soft tissue volumes on the left than the right side at all FSTT points with the most relative difference at the frontal eminence and the least at the mid-point of the masseter muscle. The low relative difference at the mid-masseters may relate with the soft floury diets of this population. These combined Nigerian male ethnicities midline FSTT values showed significant differences in the lower third of the face when compared with other population data. The values for the right side of the face shows even more substantial differences at multiple points when compared with published data of other populations. The change with age compares well with other studies. These data will be applicable for FFR in the CNME than data of other populations.

In the United Kingdom (UK) the estimated prevalence of dental infection involving the supporting bone is 2%, and from 2014-2015 there were 2281 admissions in England alone due to dental abscess. We undertook an analysis of 184 dental abscesses that required surgical drainage, as there is surprisingly little in the literature on the subject. This was a retrospective study of 184 consecutive patients with dental abscesses who were admitted between January 2016 and September 2019. On admission, all patients had orthopantomograms (OPG) and baseline blood tests. Surgical drainage was performed under a general or local anaesthetic and a pus swab sent for culture and sensitivity. The submandibular space was the most commonly involved site and paediatric patients most often presented with buccal space abscesses. A lower molar tooth was the cause in 132 patients. White blood cells (WBC) and C-reactive protein (CRP) were both raised in 63.6% (n = 117), but were normal in 4.9% (n = 9). The remaining patients had either raised WBC (2.7%) or CRP (28.8%). Streptococcus milleri was the most common organism isolated in 66.6% (n = 42). There was no association between CRP or WBC values and duration of hospital stay. Paediatric patients had a shorter duration of admission (1.96 days vs 2.81 days) and significantly lower CRP values (120.9 vs 45.7; p = 0.001). The submandibular space was the commonest site involved and mandibular molars the most frequent source of infection. An elevated CRP value appeared to be a more sensitive indicator of infection in this study population. Adult and paediatric patients present in a different manner. (c) 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

This is a case report of necrosis of more than two-third of the dorsal tongue in a 74-year-old male following prolonged oral intubation for vascular surgery. This necrosis progressed from the left tongue to involve much of the dorsal tongue bilaterally. A diagnosis of rhabdomyolysis was made evident by compartment syndrome of the legs with an elevated creatine kinase level of 89 789 u/l (units per litre). The literature also reveals that vasopressin has been linked with reported cases of tongue necrosis. Other possible aetiological factors were discussed in this finding.

Actinomycosis of the tongue is rare. It may be difficult to differentiate this infection clinically and radiologically from other tongue pathology especially neoplasia. We report a substantial tongue lesion which mimicked malignancy at presentation. The patient was treated successfully with 4 weeks of oral antibiotic therapy. It is also important that clinicians are aware of the radiological differential diagnosis of lingual actinomycosis.

Changes to guidance about the two-week wait referrals for suspected cancer of the head and neck have created a new recommendation for a general medical practitioner to refer any patients to a dentist under certain criteria. The potential effect of this was assessed based on 91 referrals to an oral and maxillofacial unit. A total of 33 met the criteria for initial referral to a dentist; of these, one was later diagnosed with cancer. We outline the potential deleterious effects the new guidance might have on the rapid diagnosis of oral lesions.

Background: Complete local excision of tongue squamous cell carcinoma (SCC) is the primary surgical aim in disease control. Method: A retrospective analysis was performed among those who underwent resection of tongue cancer between 1 September 2010 and 8 July 2015. Results: The population mean age is 63.9 (SD, 14.5) years, 53 were female. SCC was localised on the ventral aspect in 18 cases, 5 on the dorsum, 40 and 37 on the left and right lateral tongue. Postoperative staging were 54 T1, 30 T2, 8 T3 and 9 T4. Neck dissection was performed in 63 instances and found 9 N1, 12 N2b and 4 N2c with 38 N0 disease negative necks. Two investigated ordinal type primary outcome measures were used: closest radial and closest deep margin. Over 30 pre-, intra- or postoperative factors impact was analysed. Conclusion: At least four factors for each outcome measures were identified which can predict close not sufficient excision margins. Using the coefficient and confidence intervals to be provided correction of techniques is possible. Independently the publication would also suggest some baselines for certain measures as to avoid incomplete excisions. Control over the identified statistically significant predictors can eliminate incomplete excisions potentially. Incomplete or narrow margin excision of tongue tumour is still rare possible. Control over the margins however mostly possible for good outcomes this is a must criteria. All possible steps should be followed to prevent incomplete excisions.

Introduction: The authors have previously published a comprehensive 10 year analysis showing significant trends in presentations at this meeting: CME Avery et al. British Journal of Oral and Maxillofacial Surgery 51 (2013) 453–456. The presentation of work at the annual scientific meeting of the British Association of Oral and Maxillofacial Surgeons is important for raising the profile of surgical trainees and surgical units as well as contributing to the development of our specialty. In this paper the authors have undertaken a comprehensive update to include data from the most recent meetings (2012 - 2015).

Introduction: It is well recognised that undertaking any form of surgical procedure frequently provokes a sympathetic nervous response which must be managed well by the surgeon to prevent poor performance. This response is often greater in members of the team with less experience in undertaking procedures that they may be expected to perform or assist with. This study measures recordable aspects of the sympathetic response to assess anxiety inDCT1 trainees whilst undertaking clinical procedures in Oral and Maxillofacial Surgery.

Introduction: The National Institute for Health and Care Excellence (NICE) publish referral guidance for two week wait (2WW) suspected cancer referrals (CG27 2005, NG12 2015). NG12 updated CG27 and now recommends certain presentations, if identified by a GP, should be referred to a dentist for assessment (criterion 1.8.4). We compared NG12 to CG27 in a cohort of patients referred to an Oral and Maxillofacial Surgery department to assess likely impact on outcomes.

Thesis Submitted for the Degree of Doctor of Medicine by Published Work University of Leicester

High-output chyle leak is an uncommon complication of neck dissection. Management ranges from dietary modification to ligation of the thoracic duct via a VATS approach.

A bone plate is required to restore the load-bearing capacity of the mandible following a segmental resection. A good understanding of the underlying principles is crucial for developing a reliable reconstruction. A finite element analysis (FEA) technique has been developed to study the biomechanics of the clinical scenarios managed after surgical resection of a tumour or severe trauma to assist in choosing the optimal hardware elements. A computer aided design (CAD) model of an edentulous human mandible was created. Then 4 common segmental defects were simulated. A single reconstruction plate was designed to span the defects. The hardware variations studied were: monocortical or bicortical screw fixation and non-locking or locking plate design. A standardized load was applied to mimic the human bite. The von Mises stress and strain, spatial changes at the screw-bone interfaces were analysed. In general, the locking plate and monocortical screw fixation systems were most effective. Non-locking plating systems produced larger screw "pull-out" displacements, especially at the hemimandible (up to 5% strain). Three screws on either side of the defect were adequate for all scenarios except extensive unilateral defects when additional screws and an increased screw diameter are recommended. The simplification of screw geometry may underestimate stress levels and factors such as poor adaptation of the plate or reduced bone quality are likely to be indications for bicortical locking screw fixation. The current model provides a good basis for understanding the complex biomechanics and developing future refinements in plate or scaffold design.

A single Accessory Mental Foramina (AMF) and is an uncommon occurrence in range of 1.7-10%. Double AMF is less frequent with an incidence of 0.7 - 1.2% 1 Sumit Gupta Jagdish S. Soni STUDY OF ANATOMICAL VARIATIONS AND INCIDENCE OF MENTAL FORAMEN AND ACCESSORY MENTAL FORAMEN IN DRY HUMAN MANDIBLES. Natl J Med Res. 2012; 2: 28-30 Google Scholar . A prior awareness of this possibility can prevent the risk of nerve damage and help modifying the surgical approach to avoid this risk. Poster presentations for BAOMS Annual Scientific Meeting 2-4 July 2014, Edinburgh International Conference Centre, ScotlandBritish Journal of Oral and Maxillofacial SurgeryVol. 52Issue 8Preview Full-Text PDF

Pseudo-aneurysm at the anastomosis of the free flap following ablative head and neck surgery is uncommon with an incidence of 0.07% and associated mortality of up to 30%. We present a case of an external carotid artery pseudoaneurysm in a patient who had previously undergone a subtotal glossectomy, neck dissection and radial forearm free flap reconstruction. The traditional treatment for pseudoaneurym has been open surgical repair and ligation with or without bypass and arterial reconstruction. Our patient underwent successful treatment with an endovascular embolization utilising thrombin injection of the aneurysmal sac.

AbstractIn general, the pedicled pectoralis major (PPM) flap has become a secondary choice for reconstruction in the developed world while remaining popular within the developing world. The pectoralis major flap is utilised in varying proportions as either the preferred reconstruction or for salvage reconstruction following free flap failure, further disease or complications. Refinements in surgical technique and an experienced surgeon may yield high total flap success rates with modest levels of wound complications. The pectoralis major flap is particularly useful with serious or multiple comorbidities, advanced disease, and previous surgery and/or chemoradiotherapy. It has primarily been used for reconstruction of extended radical neck dissection, posterolateral mandible, large glossectomy and oropharyngeal defects, and occasionally together with a free flap. A second free flap has increasingly been used after initial failure, particularly in the larger centres, but the PPM flap probably remains the most commonly used salvage option. The needs of the local population vary, survival outcomes are improving and patient choice may become an increasing factor in flap selection.

The presence of accessory mental foramina (AMF) in mandible is a rare anatomical variation. Single accessory mental foramen is reported in a few studies, but double AMF (DAMF) is very uncommon. We present an unusual case of DAMF, with accessory nerves, which were identified during maxillofacial oncology surgery. The nerves were protected by a modified mandibulotomy. It is essential that surgeons to be aware of the possibility of AMF existence and are prepared to take appropriate actions to avoid iatrogenic nerve injury.