8/10/2019 British Journal of Oral and Maxillofacial Surgery Volume 33 Issue 6 1995 [Doi 10.1016%2F0266-4356%2895%2990

1/2

Letters to the Editor

CLEFT LIP AND PALATE SURGERY IN INDIA

Sir,

May I, through your correspondence column, bring to theattention of higher trainees the exception al training whichcan be obtained in Mang alore, India in cleft lip andpalate surgery.

I have just returned, having spent 2 weeks a t a workshopthere. In a total of 8 days operating we performed 42operations, mos t of which were primary cleft repairs, Imyself com pleting 15 primary lip repairs and 3 primarypalate repairs. There are still over 140 cleft case s requiringprimary surgery on the waiting list and the only limitationon the number of cases that can be treated, is the timetaken to complete the surgery.

Unlike other un its in which it may be only possible toobserve , or the report of a previous course in India inwhich there was said to be little teaching, this unit provideshands-on training which is closely supervised and instructedby a very experienced maxillofacial cleft surgeon, the sur-gery being pe rformed to a very high standard using prin-ciples developed by Delaire.2-4 A fundamentalunderstanding of these concepts is essential though, beforevisiting this unit if the trainee is to obtain the most from avisit. Further workshops can be arranged on an individualbasis for interested trainees (or consultants) who wish toincrease their experience. It would also be possible to

arrange workshops in the managemen t of oral.malignancyor aesth etic facial surgery, tailored to the training require-ments of individual surgeons.

If any trainees who are interested in travelling toMangalore will contact me, I can initiate the arrangementsfor them.

Andrew FordyceSenior RegistrarOral and Maxillofac ial UnitMiddlesbroug h General Hosp italAyresome Green LaneMiddlesbroughClevelandTS5 5AZ

References

1. Smith WP. Clinical attachment to the Dharwad Cleft Unit,SCM College of Dental Sciences and Hospital, Dhanvad, IndiaNovember-Decem ber 1993. Supplement to Ann R Co11 SurgEngll994; 76: 296-297.

2. Markus AF, Smith WP, Delaire J. Primary closure of cleftpalate: a functional approach. Br J Oral Maxillofac Surg 1993;31: 71-77.

3. Markus AF, Delaire J. Functionalprimary closure of cleft lip.Br J Oral Ma xillofac Surg; 1993; 31: 281-291.

4. Sm ith W P, Markus AF, Delaire J. Primary closure of the cleftalveolus: a functional approach. Br J Oral Ma xillofac Surg;1995; 33: 156-165.

MIDDLE THIRD INJURIES

Sir,

As part of audit all the records and radigraphs of a 5-year-old child who w as hit in face by a playground swing, andwho subseq uently died of neurosurgical injuries werereviewed. The CT scan revealed a complex, cornminutedmaxillary fracture, which had been suspected clinically, butdue to the severi ty of the neurosurgical injury had not beenreferred fo r specia list opinion.

Further scrutiny of the cases transferred for neurosurgicalcare revealed a 9-year-old child with a com plex middle thirdinjury sustained as the result of a road traffic accident 4months prior to this case.

This finding of two cases of complex middle third injuriesoccurring in children in a hospital which has few cases oftrauma in 4 months is surprising. This is because thereported incidence of these injuries in the UK is very low,and this confirms earlier studies in the USA2 and Australia.3Howeve r, it is well recognised that when these complexmiddle third injuries are present in children, it is often inassocia tion with cranial, a nd more rarely, visceral injuries.

This unexpected cluster o f cases suggests that the trueincidence of these injuries may be higher than the currentpublished studies suggests, but because of the severity o fthe associated injuries they are not seen by maxillofacialsurgeons.

P. J. AndersonFellow in Craniofacial Surgery

W.J. Harkness F.R.C .S.Consultant NeurosurgeonHospital for Sick ChildrenOrmond StreetLondon

References

1. Anderson PJ. Fractures of the facial skeleton in Children.Injury 1995; 26: 47-50.

2. Kaban LB, Mulliken JB, Murray JB. Facial fractures inChildren. Plas Reconstructr Surg 1977; 59: 15-21.

3. Hall RK. Injuries to the face and Jaws in Children. Int J OralSurg 1972; 1: 65-82.

THIRD MOLAR SURGERY

Sir,

In response to the letter in your journal of August 1995 byJ V Townend concerning our paper on third molar surgeryfrom earlier in the year, I would like to thank Mr Townendfor his obvious careful appraisal of the paper. How ever, Ifeel he has failed to appreciate the key points of thepublication.

The thrust of this paper was to highlight the fact that5 1 of patients who actually underwent third molar surgeryhad no clinical indication for this. The authors considerthis to be the most important take home message from thispaper, wh ereas the data relating to nerve injury probablyonly reflect s a minor contribution to the already v ast litera-ture on this subject.

395

8/10/2019 British Journal of Oral and Maxillofacial Surgery Volume 33 Issue 6 1995 [Doi 10.1016%2F0266-4356%2895%2990

2/2