Thomas Handley - Academia.edu (original) (raw)
Papers by Thomas Handley
British Journal of Oral and Maxillofacial Surgery, 2017
British Journal of Oral & Maxillofacial Surgery, 2017
Journal of the Intensive Care Society, 2009
ABSTRACT
British Journal of Oral and Maxillofacial Surgery, 2010
In addition to the excellent suggestion of lingual stop cuts, ehanna et al.,1 in their technical ... more In addition to the excellent suggestion of lingual stop cuts, ehanna et al.,1 in their technical note, commendably advoate making the incision and division of muscle for the lip plit mandibulotomy in different planes. However, instead f their proposed modification, the curved skin incision indiated in Fig. 1 can be dissected towards the midline in a plane uperficial to the muscle, and the muscle and periosteum can hen be incised in the midline without dividing the depresor anguli oris muscle belly. This arguably achieves the same rotection for the muscle belly, and a greater separation of the lanes of incision in the skin and muscle (compared with the roposed modified incision in Fig. 2). It better respects the osmetic units of the face, and ends in a submental position at ts most inferior point. It is inevitable that some subperiosteal issection of the depressor anguli oris will be necessary to llow for the application of fixation plates for osteosyntheis. I agree with the fundamental point of the paper that preseration of an intact depressor anguli oris muscle belly along ith preservation of the marginal mandibular branch of the acial nerve allows for better postoperative functional recovry of the depressor anguli oris.
Journal of Craniofacial Surgery, 2020
Here the authors present the surgical management of a 78-year-old female with a superficial squam... more Here the authors present the surgical management of a 78-year-old female with a superficial squamous cell carcinoma of the mucosa overlying her edentulous mandibular alveolus with no evidence of bony invasion.Combining the superficial nature of the lesion, patient age and substantial medical comorbidities, a limited intra-oral resection was planned, to avoid the need for free flap reconstruction. The operation required a wide local excision with clear clinical margins and a mandibular rim resection.All of the currently available reconstructions would result in prolonged surgical time, donor site morbidity, and possible secondary procedures. To overcome these pitfalls, a sublingual gland and mylohyoid muscle advancement flap was designed and executed. By combining the mylohyoid muscle and sublingual gland tissue as an advancement flap in a tension-free manner, secured to the remaining circumferential mucosa, a watertight closure was achieved.After an uneventful recovery without complication the patient was discharged the following day. Complete epithelialization was observed on day 25. Adjuvant radiotherapy was offered to reduce the risk of recurrence and progression. To date, no bony exposure and no pathological fractures have occurred.In conclusion, the entire procedure is simple and innovative. There is minimal donor site morbidity, with an immediate return to oral diet and tolerable surgical risks. It requires a small amount of surgical time compared to other reconstructive options and an overall reduced inpatient stay.
Head and neck pathology, Jan 3, 2018
Salivary gland tumours constitute approximately 1-5% of all human neoplasms. Pleomorphic adenoma ... more Salivary gland tumours constitute approximately 1-5% of all human neoplasms. Pleomorphic adenoma (PA) is the commonest benign neoplasm affecting the parotid gland most often (> 75%), followed by the submandibular gland (13%), then the palate (9%). Metastasising pleomorphic adenoma (MPA) is extremely rare. The effects can be severe and a reported 40% of MPA patients die with disease. This case represents the first known case in English literature of an untreated minor salivary gland PSA of the palate metastasising to an ipsilateral cervical node. We report a 61 year old female who presented with a large tumour occupying the palatal vault, and cervical neck mass. The oral tumour was believed to have been growing over four decades. The patient died eight months following surgical resection. Of known cases, male: female ratio is 35:51 and the mean age at diagnosis is 49.2. Most commonly, MPA is detected in bone 33.3% (n = 29), lung 31% (n = 27) and cervical lymph nodes 20.7% (n = 18)...
British Journal of Oral and Maxillofacial Surgery
Dental update, 2016
Orofacial infections following dental extractions are a common referral to an oral and maxillofac... more Orofacial infections following dental extractions are a common referral to an oral and maxillofacial department as an emergency, especially when combined with swelling and limited mouth opening. The case presented demonstrates a rare complication of chronic suppurative osteomyelitis with bilateral pathological fractures of the mandible, which occurred following a staged dental clearance. CPD/Clinical Relevance: Dental extractions are one of the most common treatments carried out by oral surgeons and general dental practitioners. This case highlights a rare but encountered complication of routine oral surgery and demonstrates when it is necessary to make an immediate referral to the local oral and maxillofacial surgery unit.
Oral Surgery, 2008
Canalicular adenoma is a benign minor salivary gland neoplasm, which most commonly occurs in or n... more Canalicular adenoma is a benign minor salivary gland neoplasm, which most commonly occurs in or near the upper lip. We present three cases of palatal canalicular adenoma that presented with mucosal ulceration, highlighting diagnosis, treatment and follow up, with a review of the current literature.
Journal of Oral Pathology and Medicine, 2006
Dyskeratosis congenita is an inherited disorder that usually presents in males, consisting of a t... more Dyskeratosis congenita is an inherited disorder that usually presents in males, consisting of a triad of leukoplakia of the mucous membranes, nail dystrophy and skin pigmentation. Whilst most cases are X-linked, autosomal dominant and recessive forms have also been reported. The significance of the condition lies in premature mortality arising from either bone marrow failure or malignant change within the areas of mucosal leukoplakia. We present a case (X-linked recessive form) where the classic triad of signs were present, along with the development of lichenoid reaction in the buccal and labial mucosa. This is believed to be the first case in which such a reaction has been noted together with the oral hyperkeratosis. The identification of a white patch within the mouth of a child, in the absence of any other obvious cause must arouse suspicion of this rare condition. All clinicians should be aware of this rare genetic disorder so that early referral can be made and appropriate management instigated.
Journal of the Intensive Care Society
International Journal of Otolaryngology, 2010
British Journal of Oral and Maxillofacial Surgery, 2013
This study aims to give a better understanding of the prevalence, patterns, and determinants of p... more This study aims to give a better understanding of the prevalence, patterns, and determinants of postoperative complications, to evaluate the Clavien-Dindo classification of surgical complications, and to set out a protocol to improve postoperative recovery. Over a period of 27 months we studied 192 patients who had had major head and neck operations with free flaps. Data on complications were gathered prospectively along with patients' details, comorbidities, factors indicative of the magnitude of the surgical insult, and variations in perioperative care. Complications were classified according to the Clavien-Dindo system. Outcomes analysed comprised any complication, major complications (Clavien-Dindo III and above), wound complications, and pulmonary complications. A total of 64% of patients had complications, and in around one third they were serious; wound and pulmonary complications were the most common. Factors significantly associated with complications reflected an interaction between coexisting conditions of the patient at operation and the magnitude of the surgery. Perioperative interventions to ensure preoperative optimisation of patients, and to lessen the systemic inflammatory response that results from operation offer the best prospect of reducing the burden of surgical complications. A protocol to improve recovery after operation would be appropriate. The Clavien-Dindo classification of surgical complications is useful in this group.
British Journal of Oral and Maxillofacial Surgery, 2013
Facial lacerations in children are common emergencies that often require debridement and closure ... more Facial lacerations in children are common emergencies that often require debridement and closure under general anaesthesia because of poor cooperation by the patient. General anaesthesia in children is not without risk so any technique that avoids its use is beneficial. LAT gel (lidocaine, adrenaline, and tetracaine) is a topical anaesthetic, which is ideal for suturing facial lacerations in children. In our experience its use has resulted in the effective treatment of these injuries, and has reduced distress and discomfort, and the need for hospital admission and general anaesthesia.
British Journal of Oral and Maxillofacial Surgery, 2005
We describe a simple and cost effective technique for the insertion of calverial bone grafts for ... more We describe a simple and cost effective technique for the insertion of calverial bone grafts for augmentation rhinoplasty.
British Journal of Oral and Maxillofacial Surgery, 2014
Oral Oncology, 2006
ABSTRACT Dyskeratosis congenita is an inherited disorder that usually presents in males, consisti... more ABSTRACT Dyskeratosis congenita is an inherited disorder that usually presents in males, consisting of the triad of leukoplakia of the mucous membranes, nail dystrophy and skin pigmentation. Whilst most cases are X-linked, autosomal dominant and recessive forms have been reported. The significance of the condition lies in premature mortality arising from either bone marrow failure or malignant change within the areas of leukoplakia. Various mucocutaneous and non-mucocutaneous manifestations have been reported. The syndrome arises from an inherited defect within the DKC1 gene that codes for the protein dyskerin in the X-linked recessive form of the disorder, whereas mutations in the RNA component of telomerase (TERC) result in the autosomal dominant form of the condition. The identification of a white patch within the mouth of a child in the absence of any other obvious cause should arouse suspicion of this rare condition. Greater understanding of the molecular biology surrounding this syndrome should lead to improvements in diagnosis, monitoring of disease progression and therapy.
British Journal of Oral and Maxillofacial Surgery, 2017
British Journal of Oral & Maxillofacial Surgery, 2017
Journal of the Intensive Care Society, 2009
ABSTRACT
British Journal of Oral and Maxillofacial Surgery, 2010
In addition to the excellent suggestion of lingual stop cuts, ehanna et al.,1 in their technical ... more In addition to the excellent suggestion of lingual stop cuts, ehanna et al.,1 in their technical note, commendably advoate making the incision and division of muscle for the lip plit mandibulotomy in different planes. However, instead f their proposed modification, the curved skin incision indiated in Fig. 1 can be dissected towards the midline in a plane uperficial to the muscle, and the muscle and periosteum can hen be incised in the midline without dividing the depresor anguli oris muscle belly. This arguably achieves the same rotection for the muscle belly, and a greater separation of the lanes of incision in the skin and muscle (compared with the roposed modified incision in Fig. 2). It better respects the osmetic units of the face, and ends in a submental position at ts most inferior point. It is inevitable that some subperiosteal issection of the depressor anguli oris will be necessary to llow for the application of fixation plates for osteosyntheis. I agree with the fundamental point of the paper that preseration of an intact depressor anguli oris muscle belly along ith preservation of the marginal mandibular branch of the acial nerve allows for better postoperative functional recovry of the depressor anguli oris.
Journal of Craniofacial Surgery, 2020
Here the authors present the surgical management of a 78-year-old female with a superficial squam... more Here the authors present the surgical management of a 78-year-old female with a superficial squamous cell carcinoma of the mucosa overlying her edentulous mandibular alveolus with no evidence of bony invasion.Combining the superficial nature of the lesion, patient age and substantial medical comorbidities, a limited intra-oral resection was planned, to avoid the need for free flap reconstruction. The operation required a wide local excision with clear clinical margins and a mandibular rim resection.All of the currently available reconstructions would result in prolonged surgical time, donor site morbidity, and possible secondary procedures. To overcome these pitfalls, a sublingual gland and mylohyoid muscle advancement flap was designed and executed. By combining the mylohyoid muscle and sublingual gland tissue as an advancement flap in a tension-free manner, secured to the remaining circumferential mucosa, a watertight closure was achieved.After an uneventful recovery without complication the patient was discharged the following day. Complete epithelialization was observed on day 25. Adjuvant radiotherapy was offered to reduce the risk of recurrence and progression. To date, no bony exposure and no pathological fractures have occurred.In conclusion, the entire procedure is simple and innovative. There is minimal donor site morbidity, with an immediate return to oral diet and tolerable surgical risks. It requires a small amount of surgical time compared to other reconstructive options and an overall reduced inpatient stay.
Head and neck pathology, Jan 3, 2018
Salivary gland tumours constitute approximately 1-5% of all human neoplasms. Pleomorphic adenoma ... more Salivary gland tumours constitute approximately 1-5% of all human neoplasms. Pleomorphic adenoma (PA) is the commonest benign neoplasm affecting the parotid gland most often (> 75%), followed by the submandibular gland (13%), then the palate (9%). Metastasising pleomorphic adenoma (MPA) is extremely rare. The effects can be severe and a reported 40% of MPA patients die with disease. This case represents the first known case in English literature of an untreated minor salivary gland PSA of the palate metastasising to an ipsilateral cervical node. We report a 61 year old female who presented with a large tumour occupying the palatal vault, and cervical neck mass. The oral tumour was believed to have been growing over four decades. The patient died eight months following surgical resection. Of known cases, male: female ratio is 35:51 and the mean age at diagnosis is 49.2. Most commonly, MPA is detected in bone 33.3% (n = 29), lung 31% (n = 27) and cervical lymph nodes 20.7% (n = 18)...
British Journal of Oral and Maxillofacial Surgery
Dental update, 2016
Orofacial infections following dental extractions are a common referral to an oral and maxillofac... more Orofacial infections following dental extractions are a common referral to an oral and maxillofacial department as an emergency, especially when combined with swelling and limited mouth opening. The case presented demonstrates a rare complication of chronic suppurative osteomyelitis with bilateral pathological fractures of the mandible, which occurred following a staged dental clearance. CPD/Clinical Relevance: Dental extractions are one of the most common treatments carried out by oral surgeons and general dental practitioners. This case highlights a rare but encountered complication of routine oral surgery and demonstrates when it is necessary to make an immediate referral to the local oral and maxillofacial surgery unit.
Oral Surgery, 2008
Canalicular adenoma is a benign minor salivary gland neoplasm, which most commonly occurs in or n... more Canalicular adenoma is a benign minor salivary gland neoplasm, which most commonly occurs in or near the upper lip. We present three cases of palatal canalicular adenoma that presented with mucosal ulceration, highlighting diagnosis, treatment and follow up, with a review of the current literature.
Journal of Oral Pathology and Medicine, 2006
Dyskeratosis congenita is an inherited disorder that usually presents in males, consisting of a t... more Dyskeratosis congenita is an inherited disorder that usually presents in males, consisting of a triad of leukoplakia of the mucous membranes, nail dystrophy and skin pigmentation. Whilst most cases are X-linked, autosomal dominant and recessive forms have also been reported. The significance of the condition lies in premature mortality arising from either bone marrow failure or malignant change within the areas of mucosal leukoplakia. We present a case (X-linked recessive form) where the classic triad of signs were present, along with the development of lichenoid reaction in the buccal and labial mucosa. This is believed to be the first case in which such a reaction has been noted together with the oral hyperkeratosis. The identification of a white patch within the mouth of a child, in the absence of any other obvious cause must arouse suspicion of this rare condition. All clinicians should be aware of this rare genetic disorder so that early referral can be made and appropriate management instigated.
Journal of the Intensive Care Society
International Journal of Otolaryngology, 2010
British Journal of Oral and Maxillofacial Surgery, 2013
This study aims to give a better understanding of the prevalence, patterns, and determinants of p... more This study aims to give a better understanding of the prevalence, patterns, and determinants of postoperative complications, to evaluate the Clavien-Dindo classification of surgical complications, and to set out a protocol to improve postoperative recovery. Over a period of 27 months we studied 192 patients who had had major head and neck operations with free flaps. Data on complications were gathered prospectively along with patients' details, comorbidities, factors indicative of the magnitude of the surgical insult, and variations in perioperative care. Complications were classified according to the Clavien-Dindo system. Outcomes analysed comprised any complication, major complications (Clavien-Dindo III and above), wound complications, and pulmonary complications. A total of 64% of patients had complications, and in around one third they were serious; wound and pulmonary complications were the most common. Factors significantly associated with complications reflected an interaction between coexisting conditions of the patient at operation and the magnitude of the surgery. Perioperative interventions to ensure preoperative optimisation of patients, and to lessen the systemic inflammatory response that results from operation offer the best prospect of reducing the burden of surgical complications. A protocol to improve recovery after operation would be appropriate. The Clavien-Dindo classification of surgical complications is useful in this group.
British Journal of Oral and Maxillofacial Surgery, 2013
Facial lacerations in children are common emergencies that often require debridement and closure ... more Facial lacerations in children are common emergencies that often require debridement and closure under general anaesthesia because of poor cooperation by the patient. General anaesthesia in children is not without risk so any technique that avoids its use is beneficial. LAT gel (lidocaine, adrenaline, and tetracaine) is a topical anaesthetic, which is ideal for suturing facial lacerations in children. In our experience its use has resulted in the effective treatment of these injuries, and has reduced distress and discomfort, and the need for hospital admission and general anaesthesia.
British Journal of Oral and Maxillofacial Surgery, 2005
We describe a simple and cost effective technique for the insertion of calverial bone grafts for ... more We describe a simple and cost effective technique for the insertion of calverial bone grafts for augmentation rhinoplasty.
British Journal of Oral and Maxillofacial Surgery, 2014
Oral Oncology, 2006
ABSTRACT Dyskeratosis congenita is an inherited disorder that usually presents in males, consisti... more ABSTRACT Dyskeratosis congenita is an inherited disorder that usually presents in males, consisting of the triad of leukoplakia of the mucous membranes, nail dystrophy and skin pigmentation. Whilst most cases are X-linked, autosomal dominant and recessive forms have been reported. The significance of the condition lies in premature mortality arising from either bone marrow failure or malignant change within the areas of leukoplakia. Various mucocutaneous and non-mucocutaneous manifestations have been reported. The syndrome arises from an inherited defect within the DKC1 gene that codes for the protein dyskerin in the X-linked recessive form of the disorder, whereas mutations in the RNA component of telomerase (TERC) result in the autosomal dominant form of the condition. The identification of a white patch within the mouth of a child in the absence of any other obvious cause should arouse suspicion of this rare condition. Greater understanding of the molecular biology surrounding this syndrome should lead to improvements in diagnosis, monitoring of disease progression and therapy.