f p s t l t s h d e s q l l w b r s g r e d t t ne of the factors that limits an informed discussion n the management of ranulas is the relative rarity ot only of this condition but salivary gland disease in eneral. For example, the incidence of salivary stones, eported as the commonest salivary condition, only ccurs in 6 cases per 100,000 population. Benign alivary gland tumors have an incidence of 8 per 00,000 and malignant salivary tumors as little as 0.7 nnually. Salivary ranulas occur much less frequently han salivary stones. In our salivary gland clinic, 570 f the 2,200 patients seen in the last 10 years had alivary stones. In this period only 11 patients preented with ranulas (2 of which were consequent to urgery for stones). The situation is compounded by he fact that mucoceles present to more than 1 surgial discipline, which further dilutes clinical experince. No one individual has enough experience to evelop new ideas and techniques that would chalenge current accepted norms. De facto the manageent of many salivary gland conditions has been froen in time. But this situation is slowly changing. A umber of centers in Europe have specialized in surical management of salivary gland disease. In these enters patients presenting with salivary stones in the iddle or posterior duct have greater than a 75% hance of stone clearance and only 2% of cases subequently undergo gland excision. Despite these dvances a consensus on the appropriate manageent of ranulas has not evolved. Over time, however, spects of this condition have been clarified. It would seem the vast majority of ranulas are exravasation cysts (approximately 90%). This fact has mportant clinical applications because it means that he connective tissue capsule of the cyst need not be emoved at the time of surgery. This is not particularly mportant in small lesions but in plunging ranulas it eans that wide exposure through both the mouth

Management of the Ranula

If you would like to submit a book to the Annals for review, please send two copies to: Publications Department, The Royal College of Surgeons of England, 35–43 Lincoln’s Inn Fields, London WC2A 3PE. Book reviews are published at the discretion of the editor.

Schein's Common Sense-Prevention and Management of Surgical Complications

Oral and Maxillofacial Surgery – An Objective Based Textbook

Abstract Objectives The purpose of this study was to do a retrospective analysis of patients with zygomatic fractures who were treated at the Department of Maxillofacial Surgery, Regional University Hospital of Perugia, Italy, between 2016 and 2023. Materials and Methods Patients were evaluated based on various parameters including age, sex, aetiology, symptoms, comorbidity, clinical findings, zygomatic fracture type, other facial fractures, treatment, waiting time before the operation, complications and sequelae. In the period described, we had 123 cases of zygomatic fractures requiring surgical intervention. Results Among the patients, 101 were male (82.1%) and 22 were female (17.9%). The average age of the patients was 48.65 years (ranging from 7 to 94 years). The leading cause of these fractures was sports‐related injury ( n = 32; 26.01%), and isolated zygomatic bone fractures were the most frequent (72.43%). The most common clinical signs and symptoms were pain, depression of the facial profile, difficulty in chewing, limitation of the buccal opening, difficulty in protrusion movements and mandibular lateralization. Ninety‐six per cent of patients underwent surgery under general anaesthesia, with open reduction and internal fixation. Conclusions The successful and effective management of zygomatic fractures requires a solid understanding of its anatomy, pathophysiology and related biomechanical structures and forces. The continuous research in epidemiology, aetiology, materials and techniques will further refine our treatments which are nowadays more and more customized according to the type of trauma. 

Retrospective epidemiological study over 8‐year period on zygomatic complex fractures: A single centre experience

Abstract A 31-year-old male with a history of right zygomaticomaxillary complex (ZMC) fracture presented with aesthetic concerns, continuous tearing, and double vision. The patient had undergone multiple surgeries post accident, resulting in an asymmetrical cheek bulge, persistent diplopia, and epiphora. Investigations revealed abnormal placement of an orbital mesh and damage to the lacrimal sac. A surgical plan was devised to remove the plates, reposition the muscles, secure the floor, correct the epiphora, and provide the desired aesthetics. The surgery involved removal of the mesh and a long plate, refracturing of the zygoma, approximation and securing of the fractured zygoma with plates, and creation of an osteum on the lateral wall of the nose. Post-operatively, the patient’s healing was uneventful and he was satisfied with the outcome. This case underscores the importance of a proper surgical technique and patient-centered care in managing complex facial fractures. 

Management of Persistent Diplopia and Epiphora in Mismanaged Orbital Blowout Fracture – A Case Report

Minor oral soft tissue surgery for the general dental practitioner

Retrospective study. To evaluate patient demographics, surgical management, and complications of orbital and orbitozygomaticomaxillary complex (OZMC) fractures treated at a district hospital in Norway. The medical records of patients with orbital fractures treated at Aalesund hospital between January 2002 and July 2017 were reviewed. Data on demographics, signs and symptoms, cause of injury, fracture type, associated fractures, surgical management, and complications were collected. A total of 36 patients were reviewed. Males predominated (1:4.1), and fractures occurred mostly in patients 40–59 years (mean 41.8 years). Interpersonal violence was the leading cause of injury, followed by falls. Alcohol was significantly associated with assault caused fractures ( P = .001). Orbitozygomaticomaxillary fractures were the most frequent, followed by pure orbital fractures. Clinical findings included periorbital ecchymosis (72%), swelling (56%), sensory nerve dysfunction (53%), diplopia (22%), and restricted eye motility (22%). Commotio cerebri was observed in more than half of our sample and 47% had other facial bone fractures. Referral to tertiary hospitals was done in 19% of the cases. The main treatment done was open reduction and internal fixation (ORIF) (45%). Infection was diagnosed in 17% and managed with antibiotics. The incidence of orbital and OZMC fractures in Moere and Romsdal county in western Norway was low, occurring mainly in males over 40 years. The mechanism of injury was predominantly interpersonal violence and falls. A high proportion of the sample had minor traumatic brain injury (mTBI).

Retrospective Study of Orbital and Orbitozygomaticomaxillary Complex Factures Treated at Aalesund Hospital Between 2002 and 2017

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Minor oral soft tissue surgery for the general dental practitioner

Retrospective Study of Orbital and Orbitozygomaticomaxillary Complex Factures Treated at Aalesund Hospital Between 2002 and 2017