The purpose of this study was to identify the aetiology and management of facial fractures in patients over 60 years old and to identify potential trends in caseload to assist with planning of resources for maxillofacial services in the coming decades. We made a prospective study over 2 years (2009-2010), during which all injured patients referred to the oral and maxillofacial surgery unit at The Canberra Hospital, Australia were recruited. The patients were classified into two groups: less than 60 years old (younger group); or 60 years old or more (older group). Factors studied included sex, age, aetiology, site of fractures, severity scored using the Maxillofacial Injury Severity Score (MFISS), and management. Based on current trends, the expected workload was extrapolated. A total of 470 patients were recruited (younger: n=430 and older: n=40). Falls were the most common cause of fracture in the older group (85%) and the zygoma (40%) was the bone most commonly fractured. The mean (SD) MFISS for the older group was 3.8 (2.2) (17% of these maxillofacial injuries were operated on) and 6.0 (5.0) for the younger group (72% of these were operated on). In Australia, population trends suggest that older people as a proportion of the total population will rise from about 20% of 22 million to 26% of 30 million by 2034. As the older group increases there will be a corresponding increase in the number of older people who present with trauma to maxillofacial units. The overall maxillofacial surgical workload will probably not increase much because the injuries tend to be less severe and are less likely to require operation.

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Background: Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection. Methods: Patients referred to the multidisciplinary head and neck clinic at Westmead Hospital between 1980-2002 with a diagnosis of minor salivary gland carcinoma of the oral cavity or oropharynx were retrospectively identified. Data were collected on histology, treatment, outcome and the referring practitioner. Results: A total of 30 patients diagnosed with a malignant minor salivary gland carcinoma were identified. Many patients, 16/30 (53 per cent), were referred by dentists. There were 15 males and 15 females with a mean age of 62 years (range, 22-86 yrs). Most (73 per cent) presented with early stage disease (stage 1/11). Adenoid cystic carcinoma was the most common histological subtype (40 per cent) followed by mucoepidermoid carcinoma (30 per cent) and polymorphous low-grade adenocarcinoma (20 per cent). All but two patients underwent surgery with 12/30 (40 per cent) also receiving adjuvant radiotherapy usually in the setting of an incomplete/close margin. One patient developed local recurrence and one developed widespread metastatic disease. At last follow-up 83 per cent of patients were alive and disease free. Conclusions: Early diagnosis and treatment of minor salivary gland carcinoma is likely to lead to a better outcome. In our study dentists were responsible for half of all referrals to our multidisciplinary head and neck clinic. Awareness of this uncommon entity is important for dental practitioners.

Background: Debate continues as to whether being young confers a worse prognosis for patients with squamous cell carcinoma of the tongue. Recent papers have provided conflicting views in this debate. In this study we aimed to investigate if young age at the time of diagnosis of squamous cell carcinoma of the tongue confers a worse prognosis. Methods: Eligible patients were identified through the computer database of the Department of Radiation Oncology, Westmead Hospital, Sydney. All eligible patients were treated with radical intent. Using age 40 as a cut off multivariate and survival analysis was undertaken to compare age groups. Results: Median age at diagnosis was 60 years (range, 19-86 years) in 84 males (65 per cent) and 45 females (35 per cent). Median follow-up time was 43 months (range, 2.3-203 months). Fifteen patients (12 per cent) were aged <40 years. On univariate analysis stage and age were significant determinants of disease-specific survival. There was no difference in overall survival between the young (<40 years) and middle-aged groups (40-60 years). However, the young and the middle aged were both more likely to survive than the older age group (>60 years). On multivariate analysis age remained a significant factor for determining disease-specific survival, with the older age group 2.9 times more likely to die than the younger groups. Conclusion: Young age (<40 years) did not portend to worse survival in comparison to older tongue cancer patients.

We add our experience of 30 cases of SCF repair to the international literature. We experienced a complication rate lower than the reported average, and maintain that the SCF is an excellent reconstructive option in patients with previously irradiated necks or comorbidities that affect microvasculature and anaesthetic resilience.