British Journal of Oral and Maxillofacial Surgery

Septal extension grafts (SEGs) are widely used to correct a short nose in Asians, but few studies have investigated the relationship between different graft materials and the stability of the aesthetic results in East Asians. In this review we discuss the performance of autologous cartilage grafts, with a focus on the critical factors for achieving a stable postoperative nose shape, and propose algorithms for graft material selection in treating Asian patients. Avoiding harvesting septal cartilage grafts and preserving the whole cartilage is helpful for maintaining tip support over the long term.

The main purpose of this study was to identify an algorithm for the surgical management of Fibrous Dysplasia in syndromic (McCune-Albright Syndrome) and non-syndromic patients (monostotic and polyostotic sub-types). The secondary objectives were to assess the prevalence of affected craniofacial bones and its main clinical presentation.The authors performed a systematic review and meta-analysis by conducting a comprehensive electronic search from 1st January 2000 to 31st December 2019. A total of 1260 patients were included.

To evaluate the relationship between preoperative primary tumour standardised uptake value (SUVmax) (tSUVmax) and clinicopathological features, including depth of tumour invasion (DOI), recurrence factors and survival outcomes, and compare the prognostic value of tSUVmax with that of the other factors associated with recurrence for early-stage oral squamous cell carcinoma (OSCC) of the tongue.Study design: We retrospectively analysed data from 155 patients with tongue OSCCs. All the samples were treated, and regularly monitored at the “Changhua Christian Hospital (CCH).” Only patients who had undergone 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) within 14 days before surgery were included.

Autogenous methods for reconstruction arthroplasty (RA) for surgical management of TMJ have been extensively reported. The present review aimed to systematically review and pool data on clinical outcomes of autogenous grafts for RA in subjects with TMJ ankylosis.

Despite a surge in interest in patient-centred outcomes (PROMs) in healthcare settings, they remain an underutilised resource in third molar surgery. Clinicians and researchers in the field of oral surgery interested in incorporating PROMs into their clinical practice may face challenges in instrument selection, with as yet no consensus registry available. PROMs have undoubtedly transcended their original brief as research instruments, with collection of PROMs data now a routine undertaking in many healthcare systems.

Mechanical stress induces a variety of biochemical and morphological reactions in bone cell biology. This study aimed to investigate appropriate pressures of osteogenesis on the biological responses of three-dimensional cultured human mandibular fracture hematoma-derived cells by compressive loading. A total of six patients with mandibular fractures who underwent open reduction internal fixation were included in the study. During the operation, fracture hematomas that formed fibrin clots were manually removed before irrigation.

This single centre retrospective study aimed to characterise the epidemiology, management and outcomes of mandibular trauma presenting to the same tertiary trauma centre 30 years apart, including key paradigm shifts in management and techniques. A total of 393 patients presenting with 665 mandibular fractures were managed by the Oral & Maxillofacial Surgery department at The Royal Melbourne Hospital (RMH), Australia, between 2011 and 2016. Data from a previous RMH paper of 205 patients presenting with 376 mandibular fractures between January 1985 and April 1990 was compared.

This is a story of a sincere, loyal, dedicated young surgeon who represents another immigrant success story. Young Kaveh was born in Tehran in 1971 to Zolikha and Jaffar, the parents of three boys and one younger daughter. He was the youngest of the boys. He led a comfortable life in Iran, then the Iranian revolution started in 1979 followed by the war with Iraq in 1982. This affected the children and the parents sent the thirteen year old Kaveh to the United Kingdom for safety and education. This resulted in him obtaining self-sufficiency and adulthood at an early age which probably was fundamental towards his success.

A recent technological breakthrough in implant surgery is the use of robotic guidance (Yomi®, Neocis Inc).1–3 The technique aims to mitigate human-based error and eliminate the use of static surgical guides by algorithmically directing surgeons according to their virtual treatment plan.2 The system’s spatial awareness algorithm fixes the surgeon’s handpiece prior to initiating surgery to ensure that the surgeon is at the correct angulation and depth, and can maintain an adequate safe distance from key anatomical structures.

To evaluate the association between “asymptomatic or mildly symptomatic”, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (AS/MS-COVID) and surgical site infection (SSI) after craniomaxillofacial injury (CMFI) repair.

Surgical management of TMJ ankylosis involves various techniques from which interpositional arthroplasty involves using several materials.

Mandibular fractures are frequently diagnosed in trauma centres. Tympanic plate and mandibular fossa fractures can be associated with those fractures and can pass unnoticed if a careful evaluation and adequate imaging exam are not performed. This descriptive study was made to evaluate the incidence of condylar fractures associated with mandibular fossa and/or tympanic plate fractures in a large trauma hospital. Twenty-nine patients were diagnosed with such fractures between July/2019 and July/2020.

Patient-specific, additively manufactured (printed) titanium reconstruction plates have been widely used to improve accuracy and efficiency of fibular flap reconstruction of the mandible. Miniplates possess some potential advantages over single-piece reconstruction plates, however multiple-miniplate fixation can be more technically demanding and may lengthen the duration of surgery. Furthermore, incremental angulation errors in screw placement for each miniplate could compromise overall dimensional accuracy of the neomandibular reconstruction.

This study evaluated, by mechanical testing, the strength of four-hole grid plates used for mandibular angle fracture fixation. Much has been discussed about the treatment of mandibular fractures with straight or curved plates. However, there are few studies about the use of grid plates. The geometry of such plates provides three-dimensional stability, resistance against torque associated with a low profile. Ninety polyurethane hemimandibles were used as substratum. The hemimandibles were divided into nine groups and fixation of the fractures was performed varying the type and position of plate and type of screw.

A variety of corticosteroids are available as an alternative to reduce inflammatory complications after mandibular third molar surgery (3MS). However, it is unclear which are the best preoperative drugs, doses, and routes of administration. A frequentist network meta-analysis was performed to assess the comparative effectiveness of corticosteroids to reduce inflammatory complications after 3MS. We searched Embase, PubMed, and the Cochrane Library without language restrictions. Only randomised clinical trials (RCTs) were included.

Surgery for head and neck malignancy may be complex with postoperative admission to critical care units (CCUs) often required. There are, however, increasing demands on this resource. We examined a national intensive care database to assess patterns of admission and outcomes for patients following surgery for malignancies of the oral cavity and oropharynx. An analysis was performed of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database. Data were extracted on case mix and outcomes for patients coded as ‘malignant neoplasm of the oropharynx requiring surgery’ admitted to critical care between 2010 and 2019.

The purpose of this study was to determine which factors are associated with increased hospital charges and length of stay among pediatric patients who incurred dog bites to the face.

The surgery-first concept is becoming increasingly popular in orthognathic surgery since it offers major advantages like a reduction of treatment duration and an increase in patient satisfaction by eliminating phases of presurgical orthodontic decompensation. Here, we present a novel interdisciplinary pathway of a fully virtual orthodontic-surgical planning concept in a surgery-first setting using a 3D-printed cutting guide and a customised maxillary implant for the Le-Fort-I osteotomy as well as a CAD/CAM-based stereolithographic final splint.

We read with interest the recent systematic review by Monaghan et al. regarding whether a surgery first approach to the orthognathic treatment of patients with a Class III skeletal relationship results in a shorter treatment duration. Although all of the surgery first studies included in this review showed relatively short treatment times, the authors concluded that there is no quality evidence that surgery first does result in shorter durations of treatment, due to bias in these studies. However, the authors also stated that their review concentrated on the ‘physiological’ aspects of the surgery first approach, and it may be that some ‘logistical differences’ inherent in this approach, are more important to treatment duration.

The objective of this study was to update and redefine some concepts of the surgery-first (SF) approach, regarding its indications and contraindications, virtual planning work-up, surgical tips, and postoperative orthodontic benefits, after 10 years of experience. A retrospective analysis was made of orthognathic surgical procedures following the SF protocol between January 2010 and December 2019 to review inclusion and exclusion criteria, diagnostic workflow, surgical tips, and postoperative outcomes.

An increasing number of elderly patients requires dental care. The data concerning the medical risk profile of seniors consulting dentists are scarce. In this context, the comorbidity-polypharmacy-score (CPS) could be an effective clinical tool to quickly assess the medical status of elderly patients. The medical data from 648 patients (60 years and older) of two cohorts (Fulda group [Fg] and Marburg group [Mg]) from two maxillofacial surgical units were recorded using a standardised questionnaire and compared concerning the number of the regular medications and the CPS.

Head and neck cancer is neurotrophic and nearly 30% of cases appear to have nerve involvement.1 Segmental mandibulectomy is the treatment of choice in head and neck cancer cases that have evident or possible involvement of the inferior alveolar nerve.2 We suggest that the posterior osteotomy in this procedure should be performed as a unilateral sagittal split osteotomy. This technique allows the surgeon to not only follow the nerve to the base of the skull but also to cut with the handpiece away from the nerve.

Pain management in orthognathic surgery is essential to enhance recovery, reduce hospital stay, and improve the whole experience of the patient. The aim of this systematic review was to evaluate current evidence on pain management in orthognathic surgery.A systematic review of the literature was performed following PRISMA guidelines, and PubMed, EMBASE, and the Cochrane Controlled Trials Registry were searched to retrieve randomised clinical trials (RCTs) published until July 2020. RCTs that compared different pre-emptive analgesia and low-level laser therapy (LLLT) with placebo after orthognathic surgery were included.

The free deep circumflex iliac artery (DCIA) osteocutaneous flap has been one of the common options for mandibular reconstruction since its description by Taylor in 1979.1,2 In the traditional design a skin paddle and bone components are nourished by the same several small osteomusculocutaneous perforators, while the deep circumflex iliac artery perforator flap (DCIAPF) is nourished by the terminal musculocutaneous perforator of the DCIA. The perforator is usually 1–2 cm above the iliac crest and 5 cm posterior to the anterior superior iliac spine (Fig.

Head and neck cancer, a disease of the elderly, is now becoming more common in the young due to their lifestyle and habits. With an increasing concern for cosmesis, it has become essential for clinicians to make use of the best technology and surgical skills. With minimal-access surgery reaching new heights, robot-assisted neck dissections (RAND), which allow superior visualisation and fine-motor movements in inaccessible anatomical spaces, are becoming a reality, and surgeons are reworking approaches to achieve the best outcomes.

The aim of this systematic review and network meta-analysis was to comprehensively evaluate and compare the effectiveness of diverse therapies for disc displacement of temporomandibular joint. An electronic search of PubMed, Embase, the Cochrane Library, CNKI and Wanfang databases was performed to identify relevant studies available up to July 31, 2021. Study selection, data extraction and quality assessment were performed for all included studies, while the outcomes of interest contained post-therapeutic maximum mouth opening and pain intensity.

To our knowledge this is the first systematic review of the immediate application of negative pressure wound therapy (NPWT) to the head and neck in free flap reconstruction. We conducted a systematic search of the PubMed and Cochrane databases in October 2021 using the MeSH terms ‘negative pressure wound therapy’, ‘free flaps’, ‘microsurgery’, and ‘vacuum-assisted closure’. Included studies evaluated the use of immediate NPWT in head and neck free flap reconstruction. Outcomes, indications, monitoring, and reported complications were retrieved.

The aim of this study was to compare the changes in the oral flora of Sprague-Dawley rats before intraperitoneal injection of zoledronic acid, 6 weeks and 12 weeks after injection. Clinically, some antibiotics effectively treat patients with medicine-related osteonecrosis of the jaws (MRONJ), but the effect of broad-spectrum antibiotics for osteomyelitis of the jaw is not obvious. We therefore speculated that MRONJ may have some dominant bacteria. We used 12 healthy rats for the experiment. One rat was used for haematoxylin and eosin staining, three were used for gene analysis, three for signal molecule research, and five for 16SrDNA high-pass sequencing to compare the changes of flora before intraperitoneal injection of zoledronic acid, and 6 and 12 weeks after injection once every three days.

The aim of this study was to assess the occurrence of neurosensory disturbance of the inferior alveolar nerve (IAN) following modified mandibular bilateral sagittal split osteotomy (BSSO) that preserves the mandibular inferior border. All patients undergoing BSSO, associated or not with a Le Fort I osteotomy (performed by the same senior operator) between January 2018 and December 2019, were eligible. The modified BSSO consists of a modification of the technique described by Epker: the bony section of the buccal cortex stops 3-4 mm above the basal mandibular edge.

The aims of this paper were to validate a modification of an extended total temporomandibular joint replacement (eTMJR) classification system and develop a classification schematic for ease of reference. High-volume TMJ surgeons were asked to score 20 separate eTMJR devices using the updated classification system, and inter-rater variability was calculated. Using the modified classification system developed, a Conger’s kappa (κ) coefficient of 0.53 was returned, suggesting moderate to good levels of agreement.

Facial infections are common and can occasionally be severe. A small number of patients may develop severe sepsis or airway compromise requiring critical care admission. We examined a national intensive care database to assess patterns of admission and outcomes for patients in this cohort. An analysis was performed of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database. Data were extracted on case mix and outcomes for patients coded as ‘mandible, facial bones, dental, and salivary infection’ admitted to critical care between 2010 and 2019.

This study aimed to evaluate the clinical efficacy and histological outcomes of autogenous demineralised dentin matrix (ADDM) as bone graft material compared with Bio-Oss® in bone augmentation for the treatment of patients with oral bone deficits. Eight databases (PubMed, EMBASE, Cochrane Library, Science Direct, Scopus, Web of Science, CNKI, and WFPD) were searched for randomised controlled trials (RCT) performed from the date of inception of each database to July 2021. The Cochrane Collaboration’s risk assessment tool was used to conduct the methodological quality assessment.

Despite forming the majority in undergraduate medicine and dentistry programmes, females remain under-represented in all surgical specialties, including oral and maxillofacial surgery (OMFS). Efforts are ongoing to promote female uptake in surgery. Research output is a key metric in measuring leadership and academic advancement within a specialty. The aim of this study was to assess female authorship in research published in the British Journal of Oral and Maxillofacial Surgery from 2000-2020 with a retrospective cohort study of original articles and reviews published in the journal from five different volumes of the journal (2000, 2005, 2010, 2015, 2020 as representative time points).

Maxillomandibular advancement (MMA) is an effective treatment for obstructive sleep apnoea syndrome (OSAS) that is refractory to conventional treatment. However, it is a highly invasive procedure with several recognised side effects, and we know of few data on its effect on important patient-reported outcome measures (PROMS). Here we describe a case series of patients selected for MMA through our joint respiratory/maxillofacial surgery clinic, detailing the effect of MMA on objective physiological measurements and important PROMS.

Fracture of the nasal bone is the most common facial fracture because the nose is the most protruding part of the facial skeleton. Standard treatment is nasal reduction, which may cause patients significant pain and stress. Closed nasal reduction may be unsuccessful because of old fractures, despite physical examination being compatible with a new fracture. This study aimed to investigate factors influencing the success of closed nasal reduction. A total of 80 patients with isolated nasal bone fractures who opted for closed reduction under local anaesthesia were included.

Surgical navigation is a technique that has evolved greatly in recent years. It allows surgeons to navigate through the surgical field in real time, and helps to locate anatomical structures or lesions and to place devices in complex anatomical regions with relatively high accuracy. In this article, we describe the application of surgical navigation in temporomandibular joint (TMJ) arthroscopy using an optical surgical navigator for a more precise diagnosis and to accurately place instruments in the desired position, especially in lateral pterygoid myotomy.

Currently, free flaps and pedicled flaps are assessed for reperfusion in postoperative care using colour, capillary refill, temperature, texture, and Doppler signal (if available). While these techniques are effective, they are prone to error due to their qualitative nature. In this research, different wavelengths of light were used to quantify the response of ischaemic tissue. The assessment provides indicators that are key to developing a point-of-care diagnostic device that is capable of observing reduced perfusion quantitatively.

Active pull of the suprahyoid muscle complex (SMC) was thought to be the main contributor of relapse in mandibular or chin advancement, but literature evidence lacks human studies that assess the role of the SMC following genial advancement (GeA). This study therefore aimed to analyse the influence of SMC pull on relapse following GeA by distraction osteogenesis based on electromyographic (EMG) changes. EMG was recorded and analysed preoperatively (T0), at four months (T1), and at one-year follow up (T2) at three submental regions during two different activities.

Skin grafts are commonly used for reconstruction of defects following excision of facial skin cancers. Tie-over bolster dressings are routinely placed to secure these grafts, but are they necessary for healing or graft success?A total of 96 patients was treated from 2013-2019 who underwent full thickness skin graft (FTSG) reconstruction following facial skin cancer excision were retrospectively analysed. All patients were treated by one consultant with non-fenestrated FTSG’s placed on defects varying from 10 to 55mm in maximum diameter.

There is growing evidence to suggest that the success of a team relies not just on its leader, but also on team members or followers. Effective leadership is a two-way relationship between a leader and their followers with problems on either side leading to potential safety issues as well as effects on morale and wellbeing. Assertive, or courageous, followership has been identified as a means to make a team safer. In this article we review the role of followers and discuss how assertive followership can make for a safer and more effective team.

Patients undergoing sentinel node biopsy (SLNB) for early oral squamous cell carcinoma (OSCC) who harbour occult metastases (pN+ve) may be at greater risk of mortality due to prolonged overall treatment times than those identified as pN+ve on elective neck dissection (ELND). A retrospective comparative survival analysis was therefore undertaken to test this hypothesis. Patients were identified from the South Glasgow multidisciplinary team (MDT) database. Group 1 comprised 38 patients identified as pN+ve, or who were false negative, on sentinel lymph node biopsy (SLNB).

This study was performed to evaluate the effect of teriparatide therapy on healing of mandibular condylar osteochondral defects. Ninety six rats underwent surgery to create a defect in condylar head on one side of the mandible, and were divided into two groups. One group received subcutaneous injection of 2 µg/kg/day teriparatide, and the other group received normal saline until sacrifice. On postoperative days 20, 40, and 60, 16 animals from each group were sacrificed and bone and cartilage healing was histologically evaluated and semiquantitatively scored (1-5).

Synovial sarcoma (SS) is a rare, high-grade, soft tissue malignancy that originates from pluripotent mesenchymal stem cells. Knox introduced the term ‘synovial sarcoma’, noting its histological similarity to synovial tissue. SS is seen most frequently in young and middle-aged adults with an equal sex distribution. Symptoms are non-specific and relate to the local effect of the mass. Currently, we know of no specific guidelines for the management of SS in the head and neck. We report a case of primary monophasic SS of the mandible in a 59-year-old male, and outline our diagnostic approach and management.

The aim of this study was to report the patient characteristics and radial fracture rates in a consecutive series of composite radial forearm free flap (CRFFF) for head and neck reconstruction over a 31-year period. The patients were identified from between 1990 to 2020 inclusive from theatre records and records from previous analyses at the Unit on free flap outcomes. Electronic case notes were accessed where available, to gather information on the operation, histopathology, and radiographs. Patients were categorized into three groups for analysis: (1) new oral cancers with a composite radial being the first choice of flap, (2) new oral cancers with a composite radial being the choice of flap following compromise of another bony flap, (3) osteoradionecrosis (ORN) cases.

Neck lumps are a common clinical presentation in both primary care, the emergency department and in specialist clinics. Foundation doctors and final year medical students are often not confident in the assessment of patients presenting with head and neck symptoms. We evaluated medical students confidence in performing a systematic neck lump examination, formulation of differential diagnosis and presentation to senior colleagues.

There is a surprising lack of evidence documenting the volumetric symmetry of the bony orbit. This paper establishes reference values for orbital volume (OV) and symmetry in the 25 - 40 year old Caucasian population. Secondarily, this paper sets a landmark for the tolerances in OV that can be expected when reconstructing the bony defects which may occur from trauma.A standardised method of quantitative OV measurement was developed using CT sinus examinations acquired for indications unrelated to orbital trauma.

Odontogenic keratocyst (OKC) is known for its benign but aggressive clinical behaviour, and presents a challenge in its management due to high recurrence rate following surgical intervention. The sourcing of Carnoy’s solution, the widely used adjunct in OKC treatment, has lately become difficult especially after its banning by the United States Food and Drugs Agency (FDA). This has generated interest in exploring alternative chemical agents such as 5-Fluorouracil (5-FU) and Modified Carnoy’s solution (MCS).

Anatomy is a pillar of medical knowledge and essential for safe medical and surgical practice. The literature highlights concerns regarding anatomy knowledge, and knowledge of the head and neck in particular, in medical students and newly qualified doctors. We investigated medical students’ confidence to be assessed on head and neck anatomy, the amount of teaching they received, and its mode of delivery, through an online survey completed by 185 medical students across two English Universities (122 (66%) students from University A and 63 (34%) from University B).