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Oral presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S1–S25   S23

effects of infections to healing time or final outcomes, pro-

phylactic antibiotics are not indicated for any elective skin

cancer surgery.

doi:10.1016/j.bjoms.2011.04.058

58

Facial lacerations—what makes for less painful local

anaesthetic infiltration?

N. Vig∗, A. Ujam, J. Haq, S. Holmes

 Barts and The London, United Kingdom

Introduction: This paper asks whether administration of 

local anaesthetic infiltration within a wound is more comfort-

able than administration dermally (through intact skin) in the

treatment of facial lacerations.

The vast majority of lacerations presenting in the emer-

gency setting are sutured under local anaesthetic and

infiltrationcan be very uncomfortable. Currently, no evidenceexists to support this as in-wound infiltration as less painful

than through-skin for facial wounds, and so practice varies.

Methods: A prospective, single-blind, randomised study

was conducted at a busy London teaching hospital. Exclu-

sions included patients aged below 16, and patients with

heavily contaminated wounds. Subjects received local anaes-

thetic within the wound on one side, and dermally on the

other, and visual analogue pain scale was used to measure

pain after each injection. They were also asked to report

which was more painful.

Results: Preliminary results of the study are based on 36

patients to date (total dataset to include 70 patients). Median

pain scoreswerehigher in those infiltrated dermally versus in-

wound (40 mmvs 16mm; p < 0.001). Order of infiltration has

no bearing on the result. There was also significant difference

in patients reporting the dermal injection as more painful than

the subcutaneous ( p < 0.001).

Conclusion:  Early results of this study demonstrate in-

wound infiltration as a more comfortable option in achieving

anaesthesia for facial lacerations and should be used where

clinically indicated.

doi:10.1016/j.bjoms.2011.04.059

59

Mortality and morbidity from combat neck injury

J. Breeze∗, L.S. Allanson-Bailey, N.C. Hunt, R.J. Delaney,

A.E. Hepper, J. Clasper

 Academic Department of Military Surgery and Trauma,

 Royal Centre for Defence Medicine, United Kingdom

Introduction:   Neck injury represents 11% of battle

injuries in UK forces in comparison to 2–5% in US forces.

The aim of this study was to determine the causes of 

death and long-term morbidity from combat neck injury in

an attempt to recommend new methods of protecting the

neck.

Method: Hospital and post mortemrecords for all UK ser-

vicemen sustaining battle injuries to the face or eye between

01 January 2006 and 31 October 2010 were analysed.

Results: Neck wounds were found in 152/1528 (10%) of 

battle injured service personnel. 79% of neck wounds weredue to explosions and were associated with a mortality rate

of 41% compared to 78% from gunshot wounds. Current UK

neck collars can potentially protect zone I from explosive

fragments but all service personnel in this series chose not to

wear them. The most common cause of death from explosive

fragments was vascular injury (85%). 14% of survivors sus-

tained permanentcomplications from theirneck wound. Zone

II was the most commonly affected area overall by explosive

fragments (57%) but Zone I was associated with the highest

morbidity in survivors.

Conclusions: Nape protectors, that cover zone III of the

neck posteriorly, would only have potentially prevented 3%

of injuries and therefore this study does not support their

use. Had current neck collars been worn, potentially 22% of 

wounds could have been prevented. Modifications to neck 

collar design have been implemented that maintain exist-

ing surface area coverage but will reduce load and thermal

burden.

doi:10.1016/j.bjoms.2011.04.060

60

OMFS referral: an audit of standard practice and pilot

of a novel web-based referral system

N. Cronin∗, S. Dev, J. Coombes, K. Fan

Kings College Hospital, London, United Kingdom

Introduction:   Oral and Maxillofacial surgery (OMFS)

telephone referrals can be a protracted process. As King’s

moves to electronic records, a web referral system may

improve delivery of maxillofacial services.

Aim:  To review the traditional inter-hospital telephone

referral pathway, implement a web-based referral pathway,

and compare their effectiveness.

Methods: Both pathways were audited using a proforma

by the referring and receiving teams. The ease and speed of 

referral, availability of information, accessibility of OMFSon-call and educational value were assessed.

Results: The appraisal of the telephone pathway demon-

strated a good service by the OMFS on-call team: speed

and accessibility of referrals were very satisfactory, as evi-

dence by respective average scores of 7.5/10 and 9/10 on

Likert scales of user satisfaction. However, the traditional

telephone referral pathway was of limited educational value

(3.1/10). The OMFS team scored the traditional telephone

referral 4.6/10 for adequacy of information provided by the

referrer, improving to 9/10 with web-referrals.

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