Introduction:Gynaecomastia is a common problem in the male population with a reported prevalence of up to 36%. Various treatment techniques have been described but none have gained universal acceptance. We reviewed all gynaecomastia patients operated on by one consultant over a 7-year period to assess the morbidity and complication rates associated with the procedure.Materials and Methods:Clinical notes and outpatient records of all patients who underwent gynaecomastia correction at University Hospital North Staffordshire between 01/10/2001 to 01/10/2009 were retrospectively reviewed. A modified version of the Breast Evaluation Questionnaire was used to assess patients satisfaction with the procedure.Results:Twenty-nine patients and a total of 53 breasts were operated on during the study period. Patients underwent either liposuction alone (6 breasts - 11.3%), excision alone (37 breasts - 69.8%) or both excision and liposuction (10 breasts - 18.9%). Twelve operated breasts (22.6%) experienced some form of complication. Minor complications included seroma (2 patients), superficial wound dehiscence (2 patients) and minor bleeding not requiring theatre (3 patients). Two patients developed haematomas requiring evacuation in theatre. No cases of wound infection, major wound dehiscence or revision surgery were encountered. Twenty-six patients (89.7%) returned the patient satisfaction questionnaire. Patients scored an average 4.12 with regards comfort of their chest in different settings, 3.98 with regards chest appearance in different settings, and 4.22 with regards satisfaction levels for themselves and their partner/family. Overall complication rate was 22.6%. Grade III patients experienced the highest complication rate (35.7%), followed by grade II (22.7%) and grade I (17.6%). Overall complication rates among the excision only group was the highest (29.8%) followed by the liposuction only group (16.7%) and the liposuction and excision group (10.0%). There were high satisfaction rates amongst both patients and surgeon. Eleven patients (37.9%) had their outcome classified as ‘excellent’ by the operating surgeon, 16 patients (55.2%) as ‘good’, 1 (3.4%) as ‘satisfactory’ and 1(3.4%) as ‘poor’.Conclusion:Gynaecomastia is a complex condition which poses a significant challenge to the plastic surgeon. Despite the possible complications our case series demonstrates that outcomes of operative correction can be favourable and yield high levels of satisfaction from both patient and surgeon.

BACKGROUND Temporomandibular joint disorders are characterised by disturbance of mouth opening, TMJ pain and noise (clicking). The involvement of dislocation and deformation of the disc and the formation of adhesive lesions in the temporomandibular joint cavity are characteristic of this disease. With the development of the small endoscope, arthroscopy is now used for both examination and treatment of temporomandibular joint disorders. The objective of this study was primarily aimed at investigating the efficacy of arthroscopic lysis and lavage and examination of the temporomandibular joint in patients having pain and clicking sound in temporomandibular joint. MATERIALS AND METHODS In this pilot, non-randomised study patients with symptoms of TMJ disease were included. Preoperative evaluation including complete history with physical examination of patients along with relevant radiograph and/or CT scan/MRI was done. Routine investigations were done. The treatment plan was carried out through Arthroscopic examination and lysis and lavage of temporomandibular joint. Patients were operated either under general anaesthesia (nasotracheal intubations) or local anaesthesia. Proper medication, physical therapy and diet were advised to patients. Outcomes were measured using pain reduction in preauricular region, reduction in clicking/grating joint sound, maximal interincisal opening, deviation of mandible and disability improvement. Patients were followed at post-operative day-1, week-1, week-2, week-4, week-8 and week-12. RESULTS Out of a total of six patients, arthroscopic lysis and lavage reduced pain and increasing mandibular range of motion in approximately 83% of patients. Patients aged between 20-30 years were the predominant age group presenting with complaints of pain clicking sound in temporomandibular joint. Females (66.6%) were most commonly affected with pain clicking sound in temporomandibular joint. CONCLUSION Arthroscopic lysis and lavage is efficacious treatment modality for patients suffering and from pain clicking sound in temporomandibular joint. However, studies with larger sample size are necessary to corroborate the findings of the present study for their wider use in clinical practice.