Kimura's disease: an uncommon cause of head and neck masses with potentially serious sequelae

Kimura's disease (KD) typically presents as a mass in the head and neck region in association with eosinophilia and elevated serum IgE. Excisional biopsy is often required in order to obtain an adequate sample for histological diagnosis and exclude malignancy. If suspected, patients should also be investigated for renal involvement as this may complicate KD. Treatment options include surgical excision and medical therapies such as corticosteroids depending on the extent and severity of disease.

Review article: Maxillofacial emergencies: oral pain and odontogenic infections

Oral pain and odontogenic infections are common reasons for patients to present to EDs and general medical practice in Australia. Although most odontogenic infections can be managed on an outpatient basis, because of their proximity to the airway, infections in this region can be life threatening, requiring urgent surgical intervention and ICU management. This article focuses on the emergency assessment, triage and non-specialist management of oral pain and odontogenic infections.

Orbital Roof Fractures: A Clinically Based Classification and Treatment Algorithm

Orbital roof fractures are relatively uncommon in craniofacial surgery but present a management challenge due to their anatomy and potential associated injuries. Currently, neither a classification system nor treatment algorithm exists for orbital roof fractures, which this article aims to provide. This article provides a literature review and clinical experience of a tertiary trauma center in Australia. All cases admitted to the Royal Melbourne Hospital with orbital roof fractures between January 2011 and July 2013 were reviewed regarding patient characteristics, mechanism, imaging (computed tomography), and management. Forty-seven patients with orbital roof fractures were treated. Three of these were isolated cases. Forty were male and seven were female. Assault (14) and falls (13) were the most common causes of injury. Forty-two patients were treated conservatively and five had orbital roof repairs. On the basis of the literature and local experience, we propose a four-point system, with subcategories allowing for different fracture characteristics to impact management. Despite the infrequency of orbital roof fractures, their potential ophthalmological, neurological, and functional sequelae can carry a significant morbidity. As such, an algorithm for management of orbital roof fractures may help to ensure appropriate and successful management of these patients.

Review article: Maxillofacial emergencies: Maxillofacial trauma

Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non-specialist management of traumatic injuries of the orbit and facial skeleton.

Selected midfacial access procedures to the skull base

The indications and operative technique of various procedures commonly used to provide or increase access to the central skull base, anterior and middle cranial fossae, nasopharynx, infratemporal fossa and retromaxillary space are discussed with illustrative cases.

Survey of Australian and New Zealand Oral and Maxillofacial Surgery trainees and recent specialists--education and experience

This study examined the demographic characteristics, educational background and attitudes toward training of all recent OMS specialists and all current trainees in Australia and New Zealand in 1996. The early nineties is a key period as it marks the transition from an essentially dentally based speciality (85% dental degree in 1990); to recent specialists with an increasing number with both medical and dental degrees (33% dual degree 1990-1996); to predominantly dual degree training (84.4% dual in 1996). Current trainees had more extensive experience in pathology, preprosthetic and reconstructive surgery. They were also strongly critical of the length and cost of training.

Survey of Australian and New Zealand Oral and Maxillofacial Surgery trainees and recent specialists--workforce issues

This study examined Oral and Maxillofacial Surgeon (OMS) workforce issues in relation to current training in Australia and New Zealand. Earlier findings identified that there was a requirement of approximately 6 additional OMS specialists per year in Australia and one per year in New Zealand to maintain an adequate level of supply in the profession. It was found in this study that through to the early part of the next decade the number of OMS entering the Australian workforce is appropriate (5.9 per annum), but there would appear to be concerns about the sufficiency of the number entering the New Zealand workforce (0.7 per annum). In addition, the study also found possible maldistribution in the location of intended future practices, with possible shortages outside of the metropolitan areas.

Guided osteogenesis using synthetic membranes: an experimental pilot study

The aim of this pilot study was to develop an experimental model for the assessment of bone augmentation, and in doing so compare the use of various synthetic membranes by relating osteogenesis to their microstructural and physical properties. Calvarial sites in nine Sprague Dawley rats were prepared for bone augmentation and three different membranes were used to cover the healing sites. Specimens were retrieved at sequenced intervals and subjected to macroscopic, histologic and histomorphometric analysis. The results obtained suggest that while current membranes are adequate for the regeneration of bone they may not be ideal for bone augmentation.

The nasal tooth. Case report

A case of supernumerary tooth presenting in the nasal cavity is reported. The literature is reviewed for nasal and other unusual ectopic sites of tooth eruption and other possible diagnoses for calcified intranasal masses are discussed.

Maxillary ameloblastoma: a retrospective study of 13 cases

Ameloblastoma is uncommon in the maxilla, comprising about 15% of all reported ameloblastomas. Ameloblastomas are locally aggressive and, when involving the maxilla, potentially lethal. The long term outcome of 13 patients with ameloblastoma in the maxilla for whom surgery was the primary treatment between 1951-1990 was studied. Patient records from both private and public practices in Melbourne, Australia were examined as were those cases reported to the Bone Tumour Registry at the University of Bristol, England. The study showed that control of disease was achieved in all patients where the tumour was limited to the confines of the maxilla (10 cases). The mean follow-up period in this group was 7 years (range 2-20 years). In the three cases that recurred all had preoperative radiological evidence of posterior maxillary sinus wall destruction and/or pterygoid plate erosion. Two patients died of extensive local recurrence and one has persistence of the disease. Histopathological examination confirmed the diagnosis of ameloblastoma in each case with a variety of histological patterns being noted. It is concluded that notwithstanding histological type, the extent of the tumour at presentation and the adequacy of the surgical approach and removal were the main factors in successfully managing the disease.

Respiratory epithelium in a mandibular cyst after grafting of autogenous bone

The case of an interesting mandibular cyst is presented. The pathogenesis of this cyst may be related to implantation of epithelial remnants in an autogenous graft to the recipient tissues during previous cosmetic surgery. With the proliferation of methods involving tissue transfer to the maxillofacial region, the possibility of the transfer of potentially pathogenic material needs to be considered.