Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Septal obturators and buttons for nasal septal perforations are often poorly tolerated. We describe a new method of obturator construction using three-dimensional imaging which more closely replicates the true anatomy of the defect. Patients were assessed using a questionnaire relating to how symptoms had changed between having no obturator, a conventional obturator and the new CT obturator. Eight of nine patients had an improvement in total symptom scores comparing old obturators to new CT obturators and this was significant with a P-value of 0.018 using Student's paired t-test. The majority of patients were satisfied with the new obturators and reported an overall improvement of symptoms.

NICE guidance for mandibular third molars has been available since 2000. This was set up to limit the surgical treatment of these teeth to symptomatic patients. There are numerous risks involved with surgical treatment of mandibular third molars and these should be explained in detail to the patient. Common and serious complications of mandibular third molar surgery are damage to the inferior alveolar and lingual nerve. Predicting the risk of inferior alveolar nerve injury is useful for treatment planning. The orthopantomogram (OPT) is the baseline special test for assessing this and numerous signs on an OPT can predict an increased risk of injury to the nerve. Cone beam computed tomography (CBCT) is being more frequently used to assess this relationship further and can influence treatment planning. Coronectomy is a technique whereby the crown of the tooth is sectioned and removed leaving the roots in situ. This has proven to be a useful technique in high risk cases, but is not without its own complications. The increase in availability of CBCT imaging and the recent resurgence of coronectomy as a treatment modality can increase the number of treatment options available to patients. We have proposed an algorithm to aid the treatment planning and informed consent processes associated with mandibular third molar surgery. Clinical relevance: This article is relevant to primary and secondary care dental practitioners as it will aid the investigation, treatment planning, correct referral and management of patients with problematic mandibular third molars.

A 56-year-old man developed left heart failure secondary to left to right shunt due to acquired aorto-pulmonary artery (PA) fistula. He had previously undergone aortic root replacement for streptococcal aortic valve endocarditis. A modified strategy involving interventional radiology and surgical technique was employed to deal with this complex surgical challenge. A balloon catheter was placed in the right PA to enable fistula occlusion during cardiopulmonary bypass followed by repair using cardiopulmonary bypass and circulatory arrest.

The disparity between parental satisfaction rates and published clinical efficacy can be explained by a lack of parent/child outcome measures specific to tonsillectomy for recurrent sore throats. A more parent/child-centered approach may establish what tonsillectomy could offer this group of children.