We aimed to assess whether patients with hemifacial microsomia can be quantitatively identified using bone mineral density information. Mandibular bone mineral density was studied using computer assisted analysis between the nonaffected (r) and the affected (l) sides with an orthopantomograph in a patient with hemifacial microsomia with median mandibular cleft, and four patients who suffered from hemifacial microsomia in the left side. Fifty controls without bone diseases were randomly selected. Bone mineral density r/l ratios in the controls ranged from 0.479 to 2.064, and those in two patients that were associated with and without median mandibular cleft were higher than those in the controls, with a maximum of 8.622 in a particular male with median mandibular cleft after bone graft, whereas the r/l ratios in the other three cases were similar to the controls. Our findings indicate that the quantitative character in the case with median mandibular cleft reveals a large discrepancy of bone mineral density between the nonaffected and the affected sides. This may suggest a compensatory mechanism for bone hypertrophy from regulated bone mineral density with underdevelopment in hemifacial microsomia.

Introduction : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.
Methods : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.
Results : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).
Conclusion : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”