Mandibular fractures are a common injury managed by oral and maxillofacial surgeons. Current open reduction and internal fixation (ORIF) treatment strategies are based on Champy's ideal line of osteosynthesis with the use of miniplate and load-sharing fixation techniques. Postoperative instructions for the duration of a soft diet have varied. This prospective, randomised study reviewed the outcomes of a patient led return to diet at 2 weeks and 4 weeks compared with 6 weeks (control group) following an ORIF of mandibular fractures. There was no significant difference in the incidence of complications between a graduated return to diet at 2, 4, or 6 weeks following an ORIF of the mandible, nor was there a difference in the quality of life during the postoperative period. Smoking has a notable risk factor for complications. The findings of this study suggest that strict adherence to a softened diet may not be necessary, and that patients identified at being of low risk of complications may be able to return to a normal diet from as early as two weeks.

Fractures of the facial skeleton place a burden on healthcare systems at the individual and population level. It is suggested that a high proportion of such patients are non-compliant with various aspects of their care. It stands to reason that non-compliance would contribute to adverse outcomes and increased costs in general. The intent of this study was two-fold: to determine factors associated with poor compliance in the studied population of 215 patients with 359 mandible fractures, and to determine whether poor compliance is associated with an increased incidence of treatment complications. Being male, an illicit drug user, non-employed, and living furthest from care were the factors associated with non-compliance in the studied population. Compliance with soft diet, mouthwash, oral antibiotics, cigarette cessation, and review appointment attendance was 74%, 96%, 96%, 16%, and 58%, respectively. Global compliance scores of low, medium, and high were assigned to 27%, 59%, and 14% of participants, respectively. None of the individual postoperative compliance variables was found to be significantly associated with outcomes of treatment at the 5% level. Borderline associations were found. Globally non-compliant patients were significantly more likely to experience wound dehiscence. The utility of the current postoperative regimen should be further elicited.

The ideal timing for treatment of mandible fractures has not been well established. The objective of this study was to analyse the effects of treatment timing in the surgical management of mandible fractures. A prospective evaluation of 215 continuous patients with a total of 359 mandible fractures was undertaken. Nine outcome variables were analysed in relation to treatment delay by logistic regression modelling: wound dehiscence, hardware exposure, local postoperative infection, malocclusion, trismus, nerve damage, fracture non-union, return to theatre, and radiographic outcome. Nineteen additional variables were included in the analysis to adjust for potential confounding. Delay was measured in days and ranged from 0 to 41days, with a mean delay of 4.6days. The incidence of wound dehiscence, hardware exposure, local postoperative infection, trismus, nerve damage, fracture non-union and return to theatre was 6%, 4%, 11%, 8.5%, 47%, 2% and 8%, respectively. Objective malocclusion and poor radiographic outcomes were evident in 13% and 4.5% of cases, respectively. No statistically significant association was found between treatment delay and treatment outcomes. The findings of this study suggest it may be safe to delay the definitive treatment of mandible fractures. Treatment delay may allow for improved resource distribution and prioritization of more time-dependent interventions.

OBJECTIVETo investigate the efficacy of exercise interventions and factors associated with changes in work ability for people with chronic whiplash-associated disorders.DESIGNSecondary analysis of a single-blind, randomized multi-centre controlled trial.SETTINGInterventions were conducted in Swedish primary care settings.PATIENTSA total of 165 individuals with chronic whiplash-associated disorders grade II-III.METHODSParticipants were randomly allocated to neck-specific exercise, neck-specific exercise with a behavioural approach, or prescribed physical activity interventions. Work ability was evaluated with the Work Ability Index at baseline, 3, 6 and 12 months.RESULTSThe neck-specific exercise with a behavioural approach intervention significantly improved work ability compared with the prescribed physical activity intervention (3 months, p = 0.03; 6 months, p = 0.01; 12 months, p = 0.01), and neck-specific exercise at 12 months (p = 0.01). Neck-specific exercise was better than the prescribed physical activity intervention at 6 months (p = 0.05). An increase in work ability from baseline to one year for the neck-specific exercise with a behavioural approach group (p< 0.01) was the only significant within-group difference. Higher self-rated physical demands at work, greater disability, greater depression and poorer financial situation were associated with poorer work ability (p<0.01).CONCLUSIONThis study found that neck-specific exercise with a behavioural approach intervention was better at improving self-reported work ability than neck-specific exercise or prescribed physical activity. Improvement in work ability is associated with a variety of factors.

Background: The ideal timing for treatment of mandible fractures has not been well established. Objectives: The objective of this study was to analyse the effects of definitive treatment timing in the management of all mandible fractures. Methods: A prospective case series of 215 continuous patients with a total of 360 mandible fractures was undertaken. Nine outcome measures were analysed in relation to treatment delay by logistic regression modelling: wound dehiscence, hardware exposure, local postoperative infection, malocclusion, trismus, nerve damage, fracture non-union, return to theatre, and radiographic reduction adequacy. 19 additional covariates were included in the analysis to adjust for potential confounding: age, gender, fracture aetiology, dental status, ASA, alcohol use, cigarette use, illicit drug use, prior mandible fracture, number of fractures, location of fractures, fracture comminution, tooth in line of fracture, local preoperative infection, associated maxillofacial injury, significant other injury, operation type, length of surgery, operator experience. Delay was measured in days and ranged from 0–41 days, with a mean delay of 4.6 days. Findings: A statistically significant association was only found between delay and trismus. For each additional day of delay, the odds of trismus being present, compared to absent, increased by 9% (odds ratio [OR], 1.10; 95% CI, 1.02–1.16). Conclusions: Definitive treatment of mandible fractures can be safely delayed. Treatment delay may allow for improved resource distribution and prioritisation of more time dependant interventions. Where practical, mandible fractures should be treated promptly to minimise trismus and other unstudied consequences of injury, such as pain and delayed return to work.

The purpose of this study was to compare regional elastic properties between anterior and posterior regions of the patellar tendon, and individual quadriceps muscles, over a range of knee flexion angles.

The purpose of this study was to determine if there is a difference in postoperative sequelae (facial swelling, trismus, pain and neurological complications) and operation time when osteotomy for surgical extraction of mandibular third molars is performed with a piezoelectric device rather than a convention rotary drill. A search for clinical trials was conducted on the PubMed, EMBASE, CENTRAL and Google Scholar databases. Studies were assessed for study type/design, participant characteristics, sample size, surgical method, cointerventions, outcome variables, risk of bias and findings. Confidence in the effect estimates was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Meta-analyses of results were performed where possible. There were 15 eligible clinical trials. Patients in the piezoelectric group had less facial swelling (SMD, −1.15; 95% CI, −2.02 to −0.27; P = 0.01), trismus (greater maximum mouth opening, SMD, 0.78; 95% CI, 0.56 to 1.00; P < 0.0001) and pain (SMD, −0.81; 95% CI, −1.56 to −0.06; P = 0.04) at day one, less facial swelling at day seven (SMD, −0.98; 95% CI, −1.52 to −0.44; P < 0.0001), and less neurological complications (OR, 0.28; 95% CI, 0.09 to 0.89; P = 0.03). Swelling and trismus at day seven and pain at day five did not significantly differ between the two methods. Operation time was longer with the piezoelectric device (SMD, 0.83; 95% CI, 0.57 to 1.09; P < 0.0001). The confidence in the effect estimates was low or very low across all outcomes.

BACKGROUND:Invasive squamous cell carcinomas (SCCs) presents with different grades of differentiation and depths of invasion.AIM:To compare the grade of differentiation, tumour diameter and tumour depth by anatomical site in invasive SCC.METHODS:Retrospective clinical and histopathological data on consecutive cases of SCC came from a clinic in Sydney, Australia were assessed. A multinomial logistic regression model was applied to compare grades of differentiation by age, sex, anatomical sites, and histological tumour maximum diameter and depth.RESULTS:In total, 1666 SCCs were identified, including 82.1% (n = 1367) well-differentiated, 13.3% (n = 222), moderately differentiated and 4.6% (n = 77) poorly differentiated SCCs. Patients with poorly differentiated tumours were more likely to be older and male (both P < 0.001). The most common site for poor differentiation was the scalp in men (n = 12; 15.6%) and the cheek or chin in women (n = 7; 9.1%). In the multivariate model, compared with well-differentiated SCC, older age was significantly associated with poorly and moderately differentiated SCC (P < 0.01 and P = 0.02, respectively). Larger tumour diameters were related to poor differentiation (P = 0.03). Ear, forehead and chest sites had increased tumour depth and poor differentiation.CONCLUSIONS:This study found increased rates of poorly differentiated SCC on the forehead and cheek for both sexes, while men displayed increased rates of poorly differentiated SCC on the bald scalp and the ears. Tumour diameter and depth increased as tumours varied from well-differentiated to moderately differentiated and from moderately differentiated to poorly differentiated. An increase in depth and increased prevalence of poorly differentiated tumours were found on the ears for men and on various facial sites for both sexes.

BackgroundSquamous cell carcinoma (SCC) may present with or without the feature of acantholysis.MethodsInvestigate invasive acantholytic SCC by microscopic maximum tumor surface diameter, depth of invasion, grade of differentiation, perineural invasion (PNI) and percentage of acantholysis. Assess recurrence following excision.ResultsA total of 1658 consecutive invasive SCC cases were examined, comprising 4.9% acantholytic SCC. Median tumor microscopic maximum diameter was 8 mm for acantholytic SCC and 7.3 mm for non‐acantholytic SCC. Median tumor invasion depth was 1.0 mm for acantholytic SCC and 1.5 mm for non‐acantholytic SCC. Well, moderate and poor differentiation were not significantly different between acantholytic SCC and non‐acantholytic SCC. One PNI case was found in 82 acantholytic SCC cases. A total of 77 acantholytic SCC cases were followed up over a median 25 months finding histologic proven recurrence at three acantholytic SCC excision sites.ConclusionsAcantholytic SCC were more likely to be located on head sites with less median depth than non‐acantholytic SCC. Increasing percentage of acantholysis within acantholytic SCC was not associated with a shift towards poor differentiation. Histologic margins of 1.2 mm may adequately excise small acantholytic SCC. No recorded deaths, low PNI and low recurrence rates suggests acantholytic SCC is low‐risk.

HaemophiliaVolume 22, Issue 4 p. e335-e337 Letter to the Editor Haemophilia and age-related comorbidities: do men with haemophilia consult a general practitioner for men's preventative health checks? O. Hollingdrake, Corresponding Author O. Hollingdrake orcid.org/0000-0002-1108-4567 Queensland Haemophilia Centre, Royal Brisbane & Women's Hospital, Herston, QLD, Australia Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, Australia Correspondence: Olivia Hollingdrake, RN, MPH, Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Herston, 4029 QLD, Australia. Tel.: +61 432 872 505; fax: +61 7 3365 5442; e-mail: o.hollingdrake@uq.edu.auSearch for more papers by this authorA. Mutch, A. Mutch Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, AustraliaSearch for more papers by this authorB. Zeissink, B. Zeissink Queensland Haemophilia Centre, Royal Brisbane & Women's Hospital, Herston, QLD, AustraliaSearch for more papers by this authorS. P. Lawler, S. P. Lawler Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, AustraliaSearch for more papers by this authorM. David, M. David Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, AustraliaSearch for more papers by this authorL. Fitzgerald, L. Fitzgerald Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, AustraliaSearch for more papers by this author O. Hollingdrake, Corresponding Author O. Hollingdrake orcid.org/0000-0002-1108-4567 Queensland Haemophilia Centre, Royal Brisbane & Women's Hospital, Herston, QLD, Australia Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, Australia Correspondence: Olivia Hollingdrake, RN, MPH, Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Herston, 4029 QLD, Australia. Tel.: +61 432 872 505; fax: +61 7 3365 5442; e-mail: o.hollingdrake@uq.edu.auSearch for more papers by this authorA. Mutch, A. Mutch Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, AustraliaSearch for more papers by this authorB. Zeissink, B. Zeissink Queensland Haemophilia Centre, Royal Brisbane & Women's Hospital, Herston, QLD, AustraliaSearch for more papers by this authorS. P. Lawler, S. P. Lawler Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, AustraliaSearch for more papers by this authorM. David, M. David Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, AustraliaSearch for more papers by this authorL. Fitzgerald, L. Fitzgerald Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, QLD, AustraliaSearch for more papers by this author First published: 13 June 2016 https://doi.org/10.1111/hae.12968Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue4July 2016Pages e335-e337 RelatedInformation

OBJECTIVEDespite increases in Commonwealth funded general practice (GP) Registrar training positions, workforce trends continue to show geographical maldistribution. This study aimed to identify Registrar attributes which describe a cohort choosing to work in rural practice.DESIGNCross-sectional self-report questionnaire for socio-demographics, prior training, current training pathway, measures of personality and resilience.PARTICIPANTS AND SETTINGGP Registrars (N = 452) training in either the general or rural pathways of three Registered Training Providers in three states, or training through the Australian College of Rural and Remote Medicine's independent pathway.MAIN OUTCOME MEASUREOrdinal logistic regression tested the impact of key variables on the likelihood that Registrars would settle in rural practice. Univariate analysis explored differences between groups and effects of variables.RESULTSA significantly increased interest in rural practice was to found to exist among registrars who were male, identified themselves as being rural, had a partner who identified as being rural, were enrolled in a rural training pathway and had high levels of Cooperativeness.CONCLUSIONWe present a discriminating model combining socio-demographics, prior training and personality variables which challenges Australia to rethink Registrar attributes when training for rural general practice. With significant changes about to occur to GP training in Australia, this paper highlights the need for a more holistic approach which considers personal attributes such as Cooperativeness, rural identity and provision of geographically focused rural training pipelines to encourage Registrars to bond to individual rural communities and further develop their personal connectedness to country life and rural medical practice.

The aim of this study was to analyze the effects of surgical treatment delay in the management of zygomatic fractures. A retrospective case series of 99 patients was undertaken. Four outcome measures were analyzed in relation to delay: facial symmetry, facial scarring, trismus, and radiographic outcome. Five additional variables were subsequently analyzed: operation, diagnosis, primary operator, regular alcohol use, and regular cigarette use. Statistically significant associations were found between delay and facial scarring, and delay and radiographic outcome. For each additional delay of a day, the odds of facial scarring being present, compared to absent, decreased by 13% (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.76-0.98). For regular cigarette users, for each additional day of delay there was a 306-fold increased risk of having a radiographic outcome of major deviation from premorbid compared to equivalent to premorbid (OR 306.38, 95% CI 2.08-45, 161.49). For non-regular cigarette users/non-users, for each additional day of delay there was a 1.5-fold increased risk of having a radiographic outcome of major deviation from premorbid compared to equivalent to premorbid (OR 1.50, 95% CI 1.08-2.09). These findings correlate with commonly held beliefs and anecdotal evidence. Despite the limitations, this study allows for an evidence-based approach to the timing of treatment of zygomatic fractures.

Background: In the paediatric population careful attention needs to be made concerning techniques utilised for wound assessment to minimise discomfort and stress to the child.Aim: To investigate whether 3D photography is a valid measure of burn wound area in children compared to the current clinical gold standard method of digital planimetry using Visitrak (TM).Method: Twenty-five-children presenting to the Stuart Pegg Paediatric Burn Centre for burn dressing change following acute burn injury were included in the study. Burn wound area measurement was undertaken using both digital planimetry (Visitrak (TM) system) and 3D camera analysis. Inter-rater reliability of the 3D camera software was determined by three investigators independently assessing the burn wound area.Results: A comparison of wound area was assessed using intraclass correlation co-efficients (ICC) which demonstrated excellent agreement 0.994 (CI 0.986, 0.997). Inter-rater reliability measured using ICC 0.989(95% CI 0.979, 0.995) demonstrated excellent inter-rater reliability. Time taken to map the wound was significantly quicker using the camera at bedside compared to Visitrak (TM) 14.68 (7.00) s versus 36.84 (23.51) s (p < 0.001). In contrast, analysing wound area was significantly quicker using the Visitrak (TM) tablet compared to Dermapix (R) software for the 3D Images 31.36 (19.67) s versus 179.48 (56.86) s (p < 0.001).Conclusion: This study demonstrates that images taken with the 3D LifeViz (TM) camera and assessed with Dermapix (R) software is a reliable method for wound area assessment in the acute paediatric burn setting. (C) 2014 Elsevier Ltd and ISBI. All rights reserved.