Although deliberate hypotension during surgery may potentially cause organ ischaemia, in particular of the myocardium and cerebrum, it is widely used as an adjuvant technique in oral and maxillofacial surgery aimed at reducing blood loss and improving the surgical field. Deliberate hypotension was reported as the fourth commonest cause...

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the incidence of squamous carcinoma of the cervix but indeed in the last 10 to 15 years has halved the mortality rate from this disease. In...

It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness with either radical hysterectomy or radical radiotherapy. However a proportion of patients treated with surgery may be classified as having a significant risk of relapse...

Flexible fibreoptic bronchoscopy (FFB) has become an indispensable tool in the optimal management of intensive care unit (ICU) patients with both diagnostic and therapeutic goals. Its safety and usefulness, in well-trained hands with appropriate precautions, have led to its increasing use even in unstable and mechanically ventilated patients. This article...

Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique for percutaneous insertion of central venous lines. In 1973, Shaw invented a technique of cannulating peripheral veins with silastic catheters, as an alternative approach to...

Pyogenic granulomas are common benign fibrovascular growths of the oral cavity that are non-neoplastic in nature. They may also present as skin lesions. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Compound tibial fractures are high-energy traumatic injuries, which are frequently associated with high incidence of complications like infection and failure of bony union leading to amputation. The extent of injury is proportional to the magnitude of trauma. This article is available only as a PDF. Please click on “Download PDF”...

Rheumatoid arthritis (RA) is a chronic inflammatory arthritis which is occasionally associated with extraarticular manifestations. Although the first good clinical description was by Landre-Beauvais in 1800, the term rheumatoid arthritis was first used only in 1878 by Alfred Garrod. This article is available only as a PDF. Please click on...

Tooth avulsion, frequently of the maxillary central incisors, occurs most often in children from 7 to 9 years of age, when the periodontium surrounding the immature erupting teeth is loosely structured, providing minimal resistance to extrusive forces. Falls against hard objects, including those incurred during sports activities, are one...

Ameloblastoma is a benign but locally invasive tumour that affects the jaws. Although it is commonly regarded as a homogeneous group of tumours, detailed investigations have proven its clinicopathologic diversity. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Schimmelpenning syndrome (SS) is characterised by specific skin manifestations, skeletal defects, and central nervous system abnormalities, such as mental deficiency and seizures. Happle has shown that a clinical entity known as “epidermal nevus syndrome”, formerly used as an alternative term to SS, does not exist. This article is available only...

Secondary alveolar bone grafting, which was pioneered in Europe, was reported in the German literature at the beginning of this century. However, it was not until the 1970s that secondary or delayed bone grafting became popular in the United States. This article is available only as a PDF. Please click...

The current explosion of molecular biology encompassing genetics, morphogenesis, teratogenesis and pharmacogenomics for targeted drug therapy is about to have a profound impact upon the practice of medicine in the next century. A new discipline of molecular medicine is becoming a feature of clinical practice. This article is available only...

Most of the mucocutaneous diseases are confined to the stratified squamous epithelia and thus may involve oral, genital and other mucosae and skin. Most of these conditions are acquired and have an immunological basis but there is often a hereditary predisposition. This article is available only as a PDF. Please...

Form follows function and adaptation to physiologic demands dictates skeletal form. In the oro-facial region, tooth loss leads to atrophy of the alveolar arches in all planes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Cranial bone defects can be a result of trauma, congenital defects, infection or iatrogenically induced by surgery. Even for patients with sufficient hair to cover the affected site, hair styling may not be sufficient to mask off the deficient external cranial contour. This article is available only as a PDF....

There are a variety of pathological conditions that present in the oral cavity. While clinical and radiographic examination will suggest a provisional diagnosis, histological examination is often required to confirm or exclude a suspected diagnosis. This article is available only as a PDF. Please click on “Download PDF” on top...

Multiple segment osteotomy (MSO) orthognathic surgery serves to combine total or segmental maxillary and mandibular correction of dentofacial deformities with concurrent diastematic procedures to provide immediate repositioning of dental-osseous elements. In addition, splitting the palate may often be necessary to correct a functionally poor relationship of the maxilla to...

Craniofacial development is a complex multidimensional process that depends in large part on growth in the cranial base at several growth centres posteriorly and a suture anteriorly. Coordinated development of these sites produces the normal shape of the skull. This article is available only as a PDF. Please click on...

Cleft palate morphology and palatal dimensional changes due to growth and treatment have been analysed by numerous quantitative techniques. Many of these methods, however, produce two-dimensional measurements of the three-dimensional cleft palate deformity. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Distraction osteogenesis is rapidly becoming a mainstream treatment modality for the early management of the patient with mandibular hypoplasia. Following early clinical experience with external distracters, intraoral buried internal distracters have been developed that offer specific advantages over the external device. This article is available only as a PDF. Please...

Apart from the nasal bone, the mandible is the most commonly fractured bone in the face. It is also the 10th most often broken bone in the body. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior release approach and posterior instrumentation. Preoperative assessment revealed good effort tolerance. This article is available only as a PDF. Please click on “Download PDF” on top...

A 16-year-old boy, with a background history of beta-thalassaemia intermedia, splenectomy and hypogonadotrophic hypogonadism, was referred to our otolaryngological clinic for right otalgia following an episode of upper respiratory tract infection (URTI). He had hearing loss with tinnitus in the right ear, nasal obstruction with greenish nasal discharge and...

Diabetes mellitus affects some 9% of Singaporeans. Studies had shown that virtually all insulin dependent diabetes mellitus (Type 1) and 85% of non-insulin dependent diabetes mellitus (Type 2) patients would develop retinopathy after 20 years of disease. This article is available only as a PDF. Please click on “Download PDF”...

The mandible is a unique bone in the human skeleton and occupies a prominent position in the craniofacial region. Traumatic injury to the face, especially in the lower third, may result in fractures of the mandible. This article is available only as a PDF. Please click on “Download PDF” on...

Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1 Goldman et al2 formulated the “cardiac risk index”, implicating previous myocardial infarction (MI), heart failure and unstable angina as major determinants of postoperative cardiac events. This...

The spread of human immunodeficiency virus (HIV) disease has pursued a relentless course since it was first recognised in the early 1980s and if current trend continues, it is most likely to carry on well into the 21st century. Asia and South Asia are expected to shoulder the greatest...

In the last decades, the exponential growth in the sophistication of the medical/dental knowledge and technologies has made the current dental curriculum more cramped and inevitably compartmentalised. This paradigm shift has caused, globally and regionally, a great demand on dental schools to produce dentists who can differentiate the quality...

The phenotypic sex of an individual is usually male if that person’s genotype is 46, XY since the SRY gene on the Y chromosome, being the putative testicular determining factor (TDF) governs testicular gonadogenesis. Yet, there are distinct situations where sexual differentiation proceeds along a female phenotype despite the...

BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in Lille, France. In Singapore, all newborn babies are given the vaccination at birth, and until recently, a second vaccination was given to children at the...

Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of 6.9 per 100,000 per year for men and 1.7 per 100,000 per year for women in Singapore. This article is available only as a PDF. Please...

There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an epidural gone astray, and the lowest reported volume of local anaesthetic used was 3.5 mL. This article is available only as a PDF. Please click on...

Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with epidural analgesia; and effective postoperative pain relief is a prerequisite to attain improved postoperative outcome. This article is available only as a PDF. Please click on...

Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to simple starvation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Pre-eclampsia is a major cause of adverse obstetric outcome. It remains one of the leading causes of maternal mortality1 and continues to contribute significantly to perinatal morbidity and mortality. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Cleidocranial dysplasia is an autosomal dominant skeletal disorder characterized by short stature, brachycephaly, delayed closure of the fontanelles and sutures, Wormian bones, midface hypoplasia, unerupted teeth, supernumerary permanent teeth, aplasia or hypoplasia of the clavicles, and other skeletal anomalies, such as hypoplastic iliac wings and brachydactyly. This article is available...

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent and future adult health and well being. Adolescent substance use and abuse is an example of this. This article is available only as a PDF. Please...

A 19-year-old Indian male with a past history of “Ludwig’s angina” was seen at the Accident and Emergency Department of National University Hospital complaining of an acute swelling at the floor of the mouth for 2 days. The patient was seen the day before in an outpatient clinic and...

The floor of the mouth takes form as early as in the fourth week of gestation with the downward growth and subsequent degeneration of the ectoderm surrounding the peripheral of the tongue, forming the lingual sulcus separating the tongue and the floor of the mouth. The anterior boundary is...

Ameloblastoma is a true neoplasm of enamel organ type tissue which does not undergo differentiation to the point of enamel organ. This type of tumour occurs mostly in the mandible and grows slowly with variable clinical and histological characteristics, but it is histologically benign. This article is available only as...

Six patients with unusual presentations of head and neck disease were presented for diagnosis by discussants at the conference. Images were accompanied by brief details and the differential diagnosis was explored by the discussants. This article is available only as a PDF. Please click on “Download PDF” on top to...

The Internet is a global network of networks that connect computers all over the world, so that anyone from any point in the network can communicate with others on the network through a service provider. The Transmission Control Protocol/Internet Protocol (TCP/IP) and the World Wide Web (www) technology have...

Bisphosphonates are commonly prescribed for the treatment (and prevention) of postmenopausal and corticosteroid induced osteoporosis, Paget’s disease, hypercalcemia associated with malignancy and osteolysis (and bone pain) associated with metastatic bone disease (e.g. in metastatic breast and prostate cancers). This article is available only as a PDF. Please click on “Download...

Recurrent aphthous stomatitis (RAS) is a common condition of the oral mucosa of unknown aetiology. Several predisposing factors have been suggested including haematinic deficiencies, reactions to foodstuffs and local trauma. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Human immunodeficiency virus (HIV) infection is a major global health problem. It is estimated that the number of people living with HIV infection in India, by the end of 2002, is 4 to 5 million. This article is available only as a PDF. Please click on “Download PDF” on top...

Betel quid/areca nut use has been common in South and Southeast Asia and the Asia Pacific region for a long time and is common among migrated communities in Africa, Europe and North America. Because of its ancient history, its use is socially acceptable among all sections of society, including...

The primary function of the immune system of the mouth is to protect the teeth, jaws, gingivae and the rest of the oral mucosa against infection. The oral immune system is part of an extensive and specialised compartmentalised mucosa-associated lymphoid tissue (MALT). This article is available only as a PDF....

The practice of Dentistry in Singapore has advanced rapidly, with the development and recognition of several specialty practices, coupled with the support of established specialty training programmes abroad as well as locally. In this respect, the Academy of Medicine, Singapore (AMS) had led and played a pivotal role in...

Over the last 70 years, transurethral resection of prostate (TURP) has been used in the surgical treatment of benign prostatic hyperplasia (BPH) and is still considered the gold standard. With improvements in operative techniques, video endoscopy, anaesthetic care and intraoperative monitoring of fluid and electrolytes, rates of intraoperative and...

Isolated infection of the sphenoid sinus is uncommon. It usually occurs in conjunction with infection of the other paranasal sinuses. Acute isolated sphenoid sinusitis is seen in fewer than 3% of all cases of sinusitis. This article is available only as a PDF. Please click on “Download PDF” on top...

Catheter angiography has long been considered the diagnostic standard by which the accuracy of other vascular imaging modalities are compared, given its superior contrast and spatial resolution, as well its high selectivity and ability to show the full extent of vascular disease, presence of contralateral disease, patterns of collateral...

Delusional parasitosis (DP), or delusional infestation, is a condition in which a person has the unshakeable and mistaken belief of being infested with parasites. Originally described in 1894, it has been previously referred to as dermatophobia, parasitophobic neurodermatitis, parasitophobia or entomorphobia. This article is available only as a PDF. Please...

Atopic dermatitis (AD) is a chronic and pruritic inflammatory skin disorder that occurs worldwide. Several guidelines on the management of AD have been published in the literature. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Diabetes mellitus (DM) is a common and growing global health problem. It is highly prevalent in Asian communities. Hong Kong, Pakistan, and Singapore are among the countries with the highest prevalence of diabetes in the adult population. This article is available only as a PDF. Please click on “Download PDF”...

Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE atrophy that may represent sequelae of previous episodes. CSCR can arise secondary to chronic treatment with steroids. This article is available only as a PDF. Please...

Tuberculosis (TB) has been present since ancient times. Around 460 BC, Hippocrates identified phthisis, which is the Greek term for consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor and long relentless wasting) as the most widespread disease of the times, which...

Carbon monoxide (CO) is an odourless, tasteless and toxic gas and is the most abundant pollutant in the lower atmosphere. It is produced largely in industrial processes, internal combustion engines, malfunctioning home appliances and as a result of the incomplete combustion of wood and tobacco products This article is available...

Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating occasional immediate intervention to avoid serious complications. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Total knee arthroplasty (TKA) has been established as an effective treatment modality for patients with symptomatic knee arthritis. It provides predictable decrement in pain, correction of deformity and improved functional outcomes. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty. This article is available only as...

During the growth and development of a person, the facial structures are primarily dependent on the genetic makeup and secondarily on the environmental factors. If the facial structures grow abnormally or disproportionately, a dentofacial deformity occurs. This article is available only as a PDF. Please click on “Download PDF” on...

The mandibular advancement device (MAD) consists of upper and lower splints attached to the teeth and postures the mandible forward. The rationale for use of the MAD is that the forward movement of the mandible moves the tongue forward since the tongue is attached to the genial tubercles of...

Hip fractures constitute a major health concern for older persons and are associated with significant morbidity and mortality, with 1-year mortality rates ranging from 14% to 36% in spite of advancements in anaesthesia, surgical techniques and nursing care.1,2 In addition, epidemiological studies have shown that the incidence of hip...

Burkitt’s lymphoma (BL) is a high grade B-cell neoplasm under the umbrella of non-Hodgkin’s lymphomas. It is predominantly seen in children but may also present in adults. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Arteriovenous fistulae (AVF) are created for haemodialysis in patients with end-stage renal failure. While AVF is a lifeline for these patients, its creation is not without complications.1 One complication is that of aneurysmal dilatation, which can cause rupture and potentially fatal haemorrhage. This article is available only as a PDF....

The idea of having an Academy of Medicine in Singapore was first proposed by some 20 medical specialists on 19 July 1957 and was named then as “Academy of Physicians & Surgeons”. It was officially formed by 34 founding members (comprising Dental Surgeons, Physicians and Surgeons) and was renamed...

Pathologically adherent placenta occurs when there is a defect of the decidua basalis, resulting in abnormally invasive implantation of the placenta into the substance of the uterus. As a result, there is no clear plane between the placenta and the underlying uterus to which it is implanted. The extent...

Despite perforated appendicitis (PA) being a common surgical emergency in childhood, controversy still exists with regard to its management in this era of minimal access surgery. Open appendicectomy (OA) has been accepted as the standard procedure for PA. However, OA has been associated with prolonged hospitalisation and significant complications...

Incisional hernias are common complications following abdominal surgery with an incidence of 2% to 20% after midline laparotomy. Umbilical fluid discharge is, however, an unusual presenting complaint and may arise from structural abnormalities persisting from birth such as a patent urachus or secondary to instrumentation. This article is available only...

Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have more severe infections, a different spectrum of bacteriology and a worse outcome. In our experience, of all patients with upper limb infections, those with end-stage...

Osteomas are benign, slow-growing tumours of the bone which may be classified as solitary or multiple. Multiple osteomas are mainly associated with Gardner’s syndrome while solitary osteomas can be further classified as peripheral, central or extra skeletal depending on the origin. This article is available only as a PDF. Please...

The possible methods of reaching the coronary vasculature using a percutaneous technique are limitless: the radial, femoral, brachial, ulnar, subclavian and axillary arteries, and even direct puncture of the aorta from a translumbar approach, have been utilised in the past. This article is available only as a PDF. Please click...

Diabetes mellitus is one of the most challenging global health problems in the 21st century. It is associated with excess mortality and significant morbidity from complications, which lead to disability, poor quality of life and an enormous health cost. This article is available only as a PDF. Please click on...

Cancer is the leading cause of death and the second most common cause of hospitalisation in Singapore. Cancer rehabilitation aims to help the patient achieve maximum physical, social, psychological and vocational function within limits imposed by cancer and its therapy through a multi-disciplinary approach. This article is available only as...

Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. The traditional operation of choice was the open appendicectomy (OA) pioneered by McBurney in 1894. In 1981, the laparoscopic technique was introduced by Kurt Semm and since then, laparoscopic appendicectomy (LA) is increasingly...

Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting 0.3% to 0.8% of the population worldwide, and is the most common inflammatory arthritis in Singapore. Suboptimally treated RA may result in irreversible joint damage, serious extra-articular manifestations, and comorbidities including osteoporosis6 and cardiovascular disease, with substantial adverse impact on...

Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass technique (CPB) introduced by Bartlett in 1972, which provides life-saving support in patients with refractory yet reversible cardiorespiratory failure until organ recovery or organ transplantation. Since the first report of successful ECMO support in an adult was published by Hill in...

Human adenoviruses (HAdVs) are well known pathogens that cause a variety of human illnesses. They are non-enveloped, linear double-stranded deoxyribonucleic acid (DNA) viruses. More than 50 distinct serotypes have been identified since the early 1950s. The wide spectrum of symptoms includes upper respiratory tract illness, pneumonia, conjunctivitis, cystitis and...

Coronavirus disease 2019 (COVID-19) is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported to the World Health Organization (WHO) as pneumonia of unknown aetiology in the Chinese city of Wuhan on 31 December 2019. Since then, COVID-19 has spread across the globe and...

Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...

The process of delivery of health care is complex and includes aspects which concern the clinician, the patient and the treatment process itself. Training imparts skill and knowledge to the clinician. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Recurrent cornea1 erosion (RCE) syndrome is a commonly encountered clinical condition which may be difficult to treat. Hansen first described it in 1872. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.