Staff Publication

Suture-assisted punctoplasty (2017)

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Type of publication:
Journal article

Author(s):
*Sachdev A.; *Sagili S.R.

Citation:
Digital journal of ophthalmology : DJO; 2017; vol. 23 (no. 3); p. 60-62

Abstract:
Purpose: To describe a surgical technique in which a suture, instead of forceps, is used to improve access for the introduction of scissors and more easily achieve an appropriately-sized punctoplasty.Materials and Methods: In this technique, a new modification of the 2-snip punctoplasty, a 6-0 polyglactin 910 suture is passed through the posterior wall of the punctum to apply traction. A video of the technique is provided.Results: This technique improves the surgical field of view and eases access for introduction of Vannas scissors into the punctum to perform the punctoplasty.Conclusions: This simple and practical modification of the 2-snip punctoplasty improves instrument access so that an appropriately-sized punctoplasty can be performed with ease.

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A rare mandibular presentation in multiple myeloma (2017)

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Type of publication:
Conference abstract

Author(s):
*Mihalache G.; *MacBean A.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2017; vol. 55 (no. 10)

Abstract:
Introduction: Multiple myeloma(MM)is a relatively rare malignant haematological disease, a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions in the vertebrae, ribs, pelvic bone, skull and jaw. This rare disease develops mainly in men aged 50 to 80 years (mean age, 60 years). Materials: We report on a clinical case of a 45-year-old female patient who presented with spinal and long bones pain to the hospital and she was diagnosed with multiple myeloma. In order to start her treatment (radiotherapy/ chemotherapy/ bisphosphonates) conform our hospital protocol, she came for a full oral and dental assessment. No intraorally abnormalities were seen. However the orthopantomogram showed multiple rounded lesions of various sizes which have little, if any, circumferential osteosclerotic bone reaction. Results: Patient was diagnosed with multiple myeloma with mandibular involvement. She will be followed up by our team and her dentist for monitoring the oral health. Conclusions: The clear and rare multilocular image of myeloma on the orthopantomogram makes our case unique. Knowledge about the maxillofacial manifestations of multiple myeloma is important for the diagnosis of the disease and treatment, also the follow up of these patients regarding their oral manifestations. In the clinical case presented here, we highlight the interdisciplinarity needed to obtain a diagnosis and treatment of multiple myeloma.

Recurrent laryngeal nerve function after central neck dissection (2017)

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Type of publication:
Conference abstract

Author(s):
*Fussey J.; *El-Shunnar S.; *Spinou C.; *Hughes R.; *Ahsan F.

Citation:
European Journal of Surgical Oncology; Dec 2017; vol. 43 (no. 12); p. 2388-2389

Abstract:
It is generally accepted that central compartment neck dissection (CCND) improves locoregional recurrence rates in cases of known central compartment lymph node involvement, however the practice of prophylactic CCND is somewhat more controversial. It is often quoted anecdotally that the risk of damage to the recurrent laryngeal nerve is higher during CND than in thyroidectomy only. The aim of this study was to evaluate recurrent laryngeal nerve injury rates following CND in thyroid cancer patients. Prospectively collected data from three head and neck cancer centres was retrospectively analysed to identify patients who underwent CND with or without concurrent thyroid surgery over a three-year period. Fifty-eight patients underwent CND, 35 of which were bilateral. There were therefore 92 recurrent laryngeal nerves at risk. The temporary recurrent laryngeal nerve palsy rate was 2.2%, and the permanent palsy rate was 3.3%. All cases of permanent recurrent laryngeal palsy occurred in patients undergoing CND and total thyroidectomy for pT4 disease. Many factors can affect recurrent laryngeal nerve palsy rate following CND, including surgeon experience, tumour characteristics and extent of dissection. Our experience suggests that the risk to the nerve in CND is no higher than in standard thyroid surgery.

Incidence of recurrent laryngeal nerve palsy and hypocalcaemia following thyroidectomy in a district general hospital setting by a single surgeon (2017)

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Type of publication:
Conference abstract

Author(s):
*McNamara K.; *Albuidair A.; *Ahsan F.

Citation:
European Journal of Surgical Oncology; Dec 2017; vol. 43 (no. 12); p. 2389

Abstract:
Background: The British Association of Endocrine and Thyroid Surgeons' (BAETS) set a standard of permanent recurrent laryngeal nerve (RLN) palsy of 1-2% and risk of permanent hypocalcaemia of 5-10%. Aim: To establish ates of permanent recurrent laryngeal nerve palsy and post-operative hypocalcaemia from thyroidectomy by a single surgeon in a District General Hospital Setting. Methods: Patient demographics, rates of permanent recurrent laryngeal nerve palsy and postoperative hypocalcaemia were obtained from all hemithyroidectomy, completion thyroidectomy and total thyroidectomy procedures performed between June 2012 and January 2017. Data was collected from the online Clinical Portal. All cases of RLN palsy and hypocalcaemia had been documented in patient's clinical letters. Results: 245 thyroidectomy procedures were performed during this time. This included 179 hemithyroidectomy, 41 completion thyroidectomy and 16 total thyroidectomy procedures. 1/245 (0.4%) patient suffered with permanent recurrent laryngeal nerve palsy in this patient group. 1/57 patients (2%) developed postoperative hypocalcaemia following completion or total thyroidectomy. Conclusion: This study reveals a lower incidence of RLN palsy and hypocalcaemia than is set by standards. Careful preoperative evaluation helps in achieving a satisfactory outcome in thyroid surgery. Thyroid surgery is safe to be done in a District General Hospital in the hands of a Head and Neck surgeon with a subspecialist fellowship training in thyroid.

The novel use of dental suction tubing in the decompression of large dental cysts (2017)

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Type of publication:
Conference abstract

Author(s):
*Otukoya R.; *Mihalache G.; *Castling B.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2017; vol. 55 (no. 10)

Abstract:
Introduction: Dental suction tubing is widely available in OMFS Units. It has a metal radiopaque marker and can easily be cut to the desired length with scissors. It is relatively inexpensive and has a reinforced lumen that makes easy access for saline irrigation.We have used this tubing now in 3 large odontogenic cysts of the jaws and present this as an aid to effective and simple cyst decompression. Materials/Methods: Large odontogenic cysts present a surgical challenge in terms of recurrence prevention, protection of the inferior dental nerve and teeth and avoidance of mandibular fracture. We have effectively managed 3 such cases with the insertion of a segment of dental suction tubing as a decompression grommet at the same time as local anaesthetic biopsy of the cyst lining. The tube rigidity maintains patency and it is robust enough to allow easy self-irrigation by the patient. The position of the tubing can be assessed radiographically. Results: We allowed decompression over a 3 to 6 month period prior to formal cyst enucleation. There were no complications or failures of the tube patency. The benefits of decompression were clear as a demonstrable bony infilling and reduction in cyst size. Additionally the cyst lining became markedly thicker and easier to enucleate intact, an advantage in odontogenic kearatocysts. Conclusions:We would like to commend this dental suction tube grommet technique as an effective way to manage large odontogenic cysts of the jaws.

Sex differences in the splenic flexure (2017)

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Type of publication:
Journal article

Author(s):
Brookes A.F.; Macano C.; Meecham L.; *Stone T.; *Cheetham M.

Citation:
Annals of the Royal College of Surgeons of England; Jul 2017; vol. 99 (no. 6); p. 456-458

Abstract:
INTRODUCTION Anecdotally, surgeons claim splenic flexure mobilisation is more difficult in male patients. There have been no scientific studies to confirm or disprove this hypothesis. The implications in colorectal surgery could be profound. The aim of this study was to assess quantitatively whether there is an anatomical difference in the position of the splenic flexure between men and women using computed tomography (CT). METHODS Portal venous phase CT performed for preoperative assessment of colorectal malignancy was analysed using the hospital picture archiving and communication system. The splenic flexure was compared between men and women using two variables: anatomical height corresponding to the adjacent vertebral level (converted to ordinal values between 1 and 17) and distance from the midline. RESULTS In total, 100 CT images were analysed. Sex distribution was even. The mean ages of the male and female patients were 68.1 years and 66.7 years respectively (p=0.630). The mean vertebral level for men was 8.88, equating to the inferior half of the T11 vertebral body (range: 1-17 [superior half of T9 to inferior half of L2]), and 11.36 for women, equating to the inferior half of the T12 vertebral body (range: 4-16 [superior half of T10 to superior half of L2]). This difference was statistically significant (p=0.0001) and is equivalent to one whole vertebra. The mean distance from the midline was 160.8mm (range: 124-203mm) for men and 138.2mm (range: 107-185mm) for women (p<0.0001). CONCLUSIONS The splenic flexure is both higher and further from the midline in men than in women. This provides one theory as to why mobilising the splenic flexure may be more difficult in male patients.

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Managing glycaemic trends in people with diabetes requiring enteral feeding support: The challenges in primary and secondary care (2017)

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Type of publication:
Journal article

Author(s):
*Richardson, Erica A.; Agbasi, Nneka

Citation:
Journal of Diabetes Nursing; Aug 2017; vol. 21 (no. 7); p. 241-246

Abstract:
Matching therapeutic treatments to manage glycaemic excursions in people with diabetes receiving enteral nutrition (e.g. nasogastric, gastrostomy or jejunostomy) can be difficult. There is evidence to suggest that there is an increased risk of complications and mortality, longer lengths of stay in hospital, higher risk of intensive care input and higher demands for transitional or nursing home care post discharge. Other intrinsic factors, such as illness, timing of medications, poly-pharmacy, types of feeding regimen chosen and history of diabetes, all need to be considered when choosing appropriate treatments. This article describes the challenges of supporting people with diabetes requiring enteral feeding and the implications for diabetes nurses.

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