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Two case reports involving drugs suspected of causing toxic epidermal necrolysis, that have not been previously implicated in this rare cutaneous drug reaction, are presented.

In this time of fiscal restraint it is important to consider the costs and effectiveness of the treatments used whenever more than one treatment option is available. This paper presents an economic evaluation undertaken from a societal perspective to determine the cost effectiveness of using a modified hyperbaric oxygen (HBO) protocol to treat osteoradionecrosis of the mandible. Costs for the study group were obtained froma retrospective study of 21 patients who underwent a modified HBO protocol at the Hamilton Civic Hospitals, Hamilton, Ontario – a tertiary centre. A hypothetical control group was created and matched to the study group. Costs for this hypothetical conservative therapy group were calculated based on expected outcomes obtained from the literature. A sensitivity analysis was performed to determine the sensitivity to changes in the assumptions that were made and the data that were obtained from the literature. The modified HBO protocol was both less expensive and more effective than conservative therapy and, thus, demonstrated dominance. The number of days that each patient spends in the hospital is the key cost driver for conservative therapy treatment for osteoradionecrosis of the mandible. Patients who underwent the modified HBO protocol enjoyed greater pain reduction and increased sleep while requiring fewer narcotics.

A review of the Hamilton experience over a 10-year period, discussing treatment trends, etiology and outcomes is presented.

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