Current recommendations for the elimination of canine-mediated human rabies focus on mass dog vaccination as the most feasible and cost-effective strategy. However, attempts to control rabies are often combined with canine surgical sterilisation programmes. The added value of sterilisation is widely debated. A systematic review was undertaken to compare the outcomes and impact of vaccination and sterilisation programmes with vaccination only programmes. A systematic search of three electronic databases (CAB Abstracts, Medline and Global Health) and grey literature was performed. From 8696 abstracts found, 5554 unique studies were identified, and 16 studies met the inclusion criteria. Eight described vaccination only programmes and eight described vaccination and sterilisation programmes. Indicators of impact measured were dog bites and/or doses of post-exposure prophylaxis administered; numbers of dog and/or human rabies cases; dog population demographic changes; changes in health and welfare of dogs, and indicators related to human behaviour change. The studies were contextually very diverse, programmes being implemented were complex, and there was variation in measurement and reporting of key indicators. Therefore, it was difficult to compare the two types of intervention, and impossible to make an evaluation of the role of sterilisation, using this evidence. Given the large number of vaccination and sterilisation programmes conducted globally, the lack of studies available for review highlights a gap in data collection or reporting, essential for impact assessment. There are several knowledge gaps concerning the impact of the sterilisation component alone, as well as subsequent effects on rabies transmission and control. Prospective studies comparing the outcomes and impact of the two interventions would be required in order to establish any additional contribution of sterilisation, as well as the underlying mechanisms driving any changes. In the absence of such evidence, the priority for rabies control objectives should be implementation of mass vaccination, as currently recommended by the World Health Organisation.

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Background: Impaction of the maxilla during orthognathic surgery results in sliding along the anterior cranial base. Considering the inclination of anterior cranial base, superior repositioning should also result in an anterior movement of the maxilla. The surgical anteroposterior movement of the facial bones implies secondary positional and tensional changes in the attached soft tissues that introduce significant changes in the facial appearance and in the pharyngeal airway space. Objective: To evaluate changes in cephalometric measurements of the PSAS before and after superior impaction of the maxilla. Methods: Pre-and postoperative cephalometric analysis was performed on five patients who underwent superior impaction of the maxilla by Le Fort I osteotomy. The linear cephalometric measurements in the retropalatal region were done to examine changes in the posterior pharyngeal airway. Findings: The results show an advancement of 3 mm, 2.5 mm, 2 mm, 3 mm and 3 mm in the retropalatal region for a superior impaction of 5 mm, 5 mm, 4 mm, 5 mm and 5 mm in patients one, two, three, four and five respectively. The mean advancement was found to be 1 mm for every 1.6 mm superior impaction of the maxilla Conclusion: It is of the authors' opinion that superior repositioning of the maxilla results in predictable advancement of the maxilla and concurrently of the posterosuperior airway space.

• There is no clear evidence that a flank incision is more or less painful than a midline incision when spaying cats. However, the surgeon's preference and individual patient circumstances should be considered when choosing which approach to take. Clinical scenario Dr Perry brings her ive-month-old female domestic shorthair kitten, Kylie, in to be spayed. She has read on the internet that cats can be spayed using either a midline or a lank incision. She is very concerned about Kylie being in pain and asks you which is the least painful surgical option for Kylie. You wonder if one approach is less painful than the other.