P79 Acute haemorrhagic oedema of infancy: a case report

Posters / British Journal of Oral and Maxillofacial Surgery 48 (2010) S25–S55

and purchase more snow ploughs to clear our streets but the government may need to invest in a small awareness campaign to make the average person safer in the snow! P78 The contemporary management of cervicofacial necrotising fasciitis: the Southampton experience J. Blythe, N.J. Baker. Southampton General Hospital, UK Introduction and Aims: Necrotizing fasciitis is a rampant infection of the deep fascia resulting in subcutaneous necrosis. The synergistic destructive activity stemming from a plethora of anaerobic and aerobic pathogens leads to a widespread systemic toxic response and rapidly progressive loco-regional fascio-cutaneous destruction. There is limited data in the oral and maxillofacial literature on cervicofacial necrotizing fasciitis. Many articles empirically recommend early and aggressive management of the condition but there is no clear evidence on time-related rates of mortality and morbidity from diagnosis and the impact of delayed surgery on cervicofacial necrotising fasciitis. The initial clinical features are often similar to less serious skin conditions and this leads to a delay until pathognomic diagnostic clinical and radiological features surface. This article reviews the contemporary management and outcomes of cervicofacial necrotising fasciitis at Southampton University Hospital Trust over the last decade. In addition, current international literature is reviewed. Method: Retrospective review of the perio-operative management of two patients with necrotizing fasciitis and a review of the current literature. Results: Both patients survived but significant morbidity was experienced peri-operatively leading to prolonged hospital admission. The rapid commencement of empirical antibiotics with level 3 hospital care and aggressive surgical debridement was the mainstay of acute management. The second phase of management required extensive multiprofessional level 1 care. Conclusion: Despite the lack of a Cochrane Collaboration level I–III evidence into the management and outcomes of cervicofacial necrotising fasciitis the take home message from the available literature is urgent surgical intervention and polymicrobial therapy supported by level III care. P79 Acute haemorrhagic oedema of infancy: a case report M. Dhillon, D. Dhariwal. John Radcliffe Hospital, Oxford, UK A normally healthy 2 year old female presented with a 3 day history of fevers, anorexia, generalised rash and fleeting oedema of the limbs and face. She was admitted to the paediatric unit with a provisional diagnosis of Henoch-Schonlein Purpura and referred to the Maxillofacial team with rapidly progressive facial swelling. On examination, there was a generalised purpuric rash and swelling over the lower limbs and right knee swelling. Head and neck examination revealed diffuse swelling of the right periorbital region with right eye closure, right frontal and temporal swelling but no alteration of visual acuity and absence of erythema. All biochemical and haematological markers were within normal range apart from an isolated raised CRP of 160 with no proteinuria. A provisional diagnosis of Acute Haemorrhagic Oedema of Infancy (AHOI) was made. Supportive treatment with intravenous fluids and Ceftriaxone was commenced. The right periorbital oedema resolved in 24 hours but was followed by a similar swelling of the left periorbital tissues. The patient made an uneventful recovery over the following few days.

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Acute haemorrhagic oedema of infancy, thought to be a variant of HSP, is an uncommon, but benign condition which typically presents in children under the age of 2 years. It is rarely seen by Maxillofacial Surgeons as facial swelling is usually less dramatic than in our case. Head and neck surgeons should have an awareness of AHOI to avoid misdiagnosis and overtreatment of this selflimiting condition. P80 Orthognathic surgery: the veracity of online information accessible to the public R.J. Cobb, W.J. Scotton. King’s College, London, UK Purpose: The object of this study is to assess the quality of information regarding orthognathic surgery using common internet searches. Methods: Five common search engines were queried with the string “orthognathic surgery OR jaw osteotomy OR surgical orthodontics”. The first 30 sites revealed by each search engine were reviewed, and the content veracity of the following components was assessed: indications, surgical procedure, complications, post-operative healing and long term outcome. Components were scored 0 to 2 depending on whether topics were addressed and if in accordance with current accepted UK practice. Results: Of the 150 links, 138 were accessible. 52% were orientated for lay people. 66% had an affiliation with a medical institution or professional. Authors were mainly orthodontists, maxillofacial/plastic surgeons (62%) or unspecified (31%). High scoring components included indications and surgical procedure. Components that scored poorly included complications and long term outcome. Conclusions: Online information, when available to the public, is generally of good quality. However, many websites fail to adequately address all aspects of orthognathic surgery, most importantly the potential complications. P81 Surgically assisted rapid maxillary expansion with transpalatal distractors – initial surgical results N. Fanaras, S. Saraf, A. Majumdar. Luton & Dunstable Hospital and Milton Keynes General Hospital, UK Transverse maxillary discrepancies in adolescents and adults is treated by a combination of orthodontics and surgical procedures and provides dental arch space for alignment of teeth. Surgically assisted rapid maxillary expansion (SARME) was first described by Brown in 1938 and is indicated for transverse maxillary hypoplasia, anterior crowding and buccal corridors. Transpalatal distractors have been a relatively recent introduction to the field of orthognathic surgery as first described by Mommaerts in 1999. We illustrate our early surgical experience including techniques andcomplications with the combination of the two procedures, to correct maxillary transverse discrepancies in this group of six non syndromal adolescents. The results of the maxillary expansion achieved by the distractors as measured from the study models is analysed. Keywords: Maxillary expansion, complications. transpalatal distractors, orthognathic surgery