British Journal of Oral and Maxillofacial Surgery

Major salivary gland malignancies are rare, constituting 1%-3% of head-neck tumours. The surgical management of the clinically negative neck (cN0) does not have a univocal consensus yet. We have carried out a retrospective study on 119 cases of malignant parotid tumours that were surgically treated between January 1999 and January 2014. Our aim was to analyse preoperative findings (cytotype, cTNM) and to correlate these with postoperative results (grading, histotype, occult neck metastasis) in patients with parotid tumours to obtain an appropriate indication for neck management.

This study was a systematic review with meta-analysis to evaluate the influence of hyperbaric oxygen therapy (HBOT) on the survival of dental implants placed in patients who had had radiotherapy for cancer of the head and neck. A systematic literature search was conducted using the PubMed/Medline, Science Direct, Embase and the Cochrane Library, between January 1985 and July 2018. The study observed the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) declaration and norms, and the systematic review was duly recorded in the PROSPERO (International prospective register of systematic reviews) database.

To identify the potential risk factors for bad splits, we calculated the incidence of bad splits from 484 patients with 964 cases of sagittal split ramus osteotomy (SSRO) and investigated the association between the occurrence of bad splits and risk factors such as gender, patients’ age, class of occlusion, unimaxillary or bimaxillary surgery, presence of the lower third molar, thickness of the ascending ramus, and the distance from the mandibular canal to the buccal cortical bone. The results showed that 40 sides (4.149%) with bad splits occurred in 36 patients (7.438%).

Niall Mark Hamilton McLeod was born in Hamburg, Germany on 8 June 1971 to Ian and Marion McLeod. Ian’s pursuit of career opportunities led the McLeod family to relocate several times and by the age of 5, Niall had lived in Germany, France, Zaire (now the Democratic Republic of Congo), and Canada. After attending local primary schools, Niall boarded with his brother, Euan, at Rannoch School in Perthshire, Scotland. Being in the middle of nowhere, weekends were spent trekking across the highlands, or playing sports, most notably cross-country skiing where he came 3rd at Scottish schools under 16 s.

The Royal College of Surgeons of England stipulates that to hold a substantive specialty or associate specialist (SAS) grade post a person must be a minimum of 4 years post-graduation and have at least 2 years’ experience in their chosen speciality. We have noticed an increasing number of excellent applications for specialty doctor adverts posted by our trust without the necessary 4 years of post-graduate experience. Many of these applicants who do not comply with the RCS stipulations may be forced to take a job outside of their chosen career path.

Autotransplantation is a surgical technique where a donor tooth belonging to the same individual is re-positioned into a surgically prepared socket or a site of a previous tooth extraction. This procedure is beneficial in patients with teeth affected by agenesis, trauma, significant caries, non-restorable condition or are prognostically poor due to other pathology. Autotransplantation is particularly useful in paediatric patients as properly transplanted teeth have a vital periodontium that allow for continuous growth and functional adaptation leading to preservation of the alveolar ridge.

We would like to thank you for our interest in our paper. We would agree that surgery at one month post-injury would be rarely indicated, as a significant proportion of injuries may recover either fully, or to a level where surgery would not be beneficial to a patient. Our suggested management protocol, suggests that if ‘limited or no recovery’ is seen one month post-injury, referral should be made for assessment to a specialist centre such as ours. As highlighted in our paper, in the United Kingdom, many patients have seen significant delay in referral, assessment, and surgery and earlier referrals for poorly recovering injuries would allow for any indicated surgery to be undertaken at an earlier stage (3-6 months).

An area critical to safety in an organization is the perceived and actual culture. National Air Traffic Services (NATS) work closely with large safety-critical industries including various aviation companies to enable them to identify strengths and vulnerabilities with an aim to improving safe practice. NATS have developed a simple free downloadable self-assessment App that individuals can use to assess their own culture perception in their organization. The App has 16 questions arranged in four domains but to our knowledge it has not been used to date in healthcare.

Short-term glucocorticoids have been advocated for decades to reduce postoperative swelling, pain, trismus, nausea, and vomiting in patients experiencing maxillofacial surgeries. The purpose of this systematic overview is to identify and assess the best evidence regarding efficacy of glucocorticoid administration in patients who undergo orthognathic surgery. Five databases Medline, Embase, The Cochrane Library, Web of Science, and Epistemonikos were searched from their inception to October 2020.

Perioral rejuvenation is carried out by surgical and non-surgical tools. The common procedures are laser resurfacing and volumanisation using alloplastic fillers or autogenous fat. Nonetheless, any such procedures are associated with complications.

To determine the prevalence of temporary and permanent facial nerve injury in total TMJ replacement surgery and to identify potential predictive risk factors.

It is with great enthusiasm we read the article written by Atkins and Kyriakidou, 20201 regarding the promising clinical outcomes of lingual nerve repair among a case series of 114 patients. As substantiated by the evidence, authors concluded that lingual nerve repair contributed to good sensory outcomes and significant improvements in the incidence and degree of neuropathic pain among patients of all ages despite being delayed. However, in our practice, we found patients who regained a reasonable degree of sensation were willing to accept and did not suffer neurological pain.

Deep head and neck space lesions can present a number of diagnostic challenges due to their deep anatomical position and difficult access for diagnostic tissue sampling.We describe a series of percutaneous 'transfacial' buccal space CT guided core biopsy of deep head and neck space lesions and subsequent histological findings.

The UK COVID vaccination programme has progressed at an astonishing rate since the first patients received their doses in December 2020. It is well known that other vaccines including influenza and human papilloma virus (HPV) can result in reactive lymphadenopathy in the axilla and/or neck. Patients are now presenting via the two week wait neck lump clinic with supraclavicular fossa and low neck lymphadenopathy related to COVID vaccination, and to similar one stop breast clinics with axillary lymph nodes.

Facial Feminisation Surgery (FFS) is integral to the management of transgender adult females. Literature detailing the conduct and outcomes of FFS is lacking. The aim of this project was to review surgical practices in NHS Scotland.

Up until now, only a limited number of evidence-based studies with different results has evaluated traumatic nerve injury after maxillofacial surgery using piezoelectric devices versus rotary instruments. The present experiment was performed to evaluate damage to the inferior alveolar nerve (IAN), histologically, after osteotomy of the buccal cortex of the mandible using piezoelectric devices versus surgical handpieces. Forty rabbits underwent bilateral osteotomy of the mandibular buccal cortex.

Vitamin D (VD) levels and several variants in the vitamin D receptor (VDR) gene are associated with the occurrence of diseases of the bones and cartilage. The aim of this research was to study and compare the association of the BsmI variant in the VDR gene as well as VD levels in disc displacement with reduction (DDR) between patients and healthy controls. This was a case-control study, in which 104 patients of DDR and 102 healthy individuals were studied. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) was used to diagnose temporomandibular diseases.

To assess the safety and efficacy of endoscopic-assisted maxillary sinus elevation, a systematic review of the literature was conducted. PubMed, Embase, Web of Science and Cochrane database were searched for articles in English. Published studies involving patients undergone endoscopic-assisted maxillary sinus floor augmentation were selected. The validity of the included articles was evaluated. After going through full text, a total of 12 studies met the eligibility criteria and were included. It was concluded that endoscopic-controlled maxillary sinus floor elevation was a viable and beneficial method, providing direct visualization of the integrity of the mucosa and place of bone graft material.

Lateral crura cut and overlap (LCC) or medial crura cut and overlap (MCC) are two of the many techniques applied to ensure an adequate nasal tip projection and rotation; however, little evidence supports the long-term efficacy of these techniques.

The object of this paper was to explore the feasibility and advantages of endoscope-assisted parotid tumour resection. Three databases (PubMed, Web of Science, and Cochrane) were used to search for all related randomised controlled trials or controlled trials (up to November 2019). The key parameters for assessment included ‘Endoscope’, ‘Endoscopes’, ‘Cancer of Parotid’, and ‘Parotid Cancer’. To evaluate the feasibility and advantages of endoscope-assisted resection of parotid tumours, the data for each parameter were pooled, based on patients who received endoscope-assisted surgery and those who received conventional surgery.

In scientific fields, various statistical analysis methods such as bibliometric analysis have been used to determine the effectiveness of journals, researches and articles. The aim of this study is to conduct a bibliometric analysis to systematically and understandably characterize publications on impacted third molar surgery (ITMS) from 2000 to 2020. The articles were retrieved on the same day from the Web of Science Core Collection (WoSCC) database of the Web of Science (WoS) on January 01, 2021, to prevent biases due to the daily databases updates.

The techniques used to repair bilateral cleft lip have evolved over time, yet little data exists to compare outcomes using the various techniques. The aim of this study was to retrospectively evaluate and compare aesthetic outcomes in two types of complete bilateral cleft repair: the advancement rotation and a historic cohort repaired with a Manchester technique.

No consensus has been reached on an ideal method to objectively measure facial palsy, especially for patients with synkinesis1,2. We previously reported the use of landmarks to photogrammetrically assess ocular synkinesis3 and smile excursion in healthy individuals4. These include: the angle between the commissure, contralateral commissure and ipsilateral endocanthion (CCE); eye surface area (ESA); and midline to commissure distance (MCD). The aim of this study was to compare affected and non-affected hemi-faces of patients with facial palsy using these landmarks and assess its correlation with Sunnybrook Facial Grading System scores.

To evaluate alveolar ridge resorption using the socket shield technique (SST) without immediate dental implant placement.

Due to the risk of occult cervical metastasis, elective neck dissection (END) is recommended in the management of patients with early oral cavity squamous cell carcinoma (OSCC) and a clinically node-negative (cN0) neck. This paper presents a systematic review and meta-analysis of studies that recorded isolated regional recurrence (RR) in the pathologically node-negative neck dissection (pN0) neck following END in order to quantify the failure rate.

Odontogenic Keratocysts are benign, developmental, locally aggressive odontogenic cystic lesions with a high risk of recurrence. As such, the most effective treatment modalities remain controversial. The mainstay of treatment remains enucleation with or without decompression. The use of adjunctive therapies is widely reported.

To apply an augmented reality (AR) navigation technique based on a head- mounted display in the treatment of craniofacial fibrous dysplasia and to explore the feasibility and the value of AR in craniofacial surgery. With preoperative planning and three-dimensional simulation, the normal anatomic contours of the deformed area were recreated by superimposing the unaffected side onto the affected side. We completed the recontouring procedures in real time with the aid of an AR navigation system. The surgical outcome was assessed by superimposing the post-operative computed tomography images onto the pre-operative virtual plan.

Having just completed a botched year of foundation training, myself and five of my OMFS DCT colleagues found ourselves on the highest floor of the hospital, away from all forms of life not compatible with a ventilator. Gone were the days of prescribing co-amoxiclav 625mg TDS 5/7; we had now entered the brave new world of the coronial. We did not know what we were getting ourselves in for, but it was an experience like no other.

Juvenile Idiopathic Arthritis (JIA) of the Temporomandibular Joint (TMJ) is a frequent occurrence in children, with an increasing awareness of the condition in all healthcare professionals. TMJ involvement presents a challenge in both diagnosis and treatment as late presentation can still occur as the disease often develops asymptomatically. This can result in facial deformity and/or functional difficulties including obstructive sleep apnoea. Early diagnosis is therefore essential, requiring a high index of clinical suspicion coupled with the judicious use of gadolinium contrast MRI.

Hemophilia is a recessive congenital hereditary hemorrhagic disorder characterized by the decrease in or absence of the functional activity of factor VIII (Hemophilia A) or factor IX (Hemophilia B). The hematological medical treatment for these patients is systemic replacement therapy with factor VIII or factor IX concentrates. Dental implants are considered the gold standard for the replacement of missing teeth. There is no evidence or safe protocol for their use in patients with hemophilia. The objective of this study was to evaluate the clinical osseointegration and the incidence of postoperative bleeding in patients with hemophilia.

To investigate the clinical and MRI features of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). Fourteen patients with SC of TMJ were included. Clinical and MRI features were analyzed and divided into three types based on MRI classification: type I with loose bodies, type II with homogeneous masses and type III with a mixture of loose bodies and homogeneous masses. All SCs occurred in the superior compartment of the TMJ. There were 2 patients (14%) categorized as type I, 5 patients (36%) as type II and 7 patients (50%) as type III.

Dermal metastasis (DM), by definition, is the involvement of the skin by cancer cells originating from cancer elsewhere in the body. They are considered as rare site of distant failure in head and neck cancers. They are bearers of poor outcomes. There is a limited literature available regarding dermal metastases. This study was undertaken to analyse the factors associated with incidence and outcomes.

Planning discharge from hospital following microvascular free-tissue surgery can be complex and challenging. Planning involves the patient, carers, and multiple health professionals. Poor communication and expectations can delay discharge or give a suboptimal discharge process. It was hypothesised that prompt-list modelled along the principals of the Patient Concerns Inventory (PCI) could be help in discharge planning. The aim of this study was to define the items and format of a PCI-Ward Discharge (PCI-WD) and undertake a small pilot.

Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition to treat. It has primarily been associated with anti-resorptive and anti-angiogenic drugs, which are increasingly being used to prevent adverse skeletally-related complications in patients with cancer and bone pathologies. Although these medications have been proven to cause osteonecrosis of the jaws (ONJ) there are also a number of other drugs that could potentially cause this condition. The aim of this systematic review is to ascertain whether there is an associated risk of osteonecrosis of the jaw (ONJ) in recreational drug users (RDU).

Medical graduates interested in pursuing a career in Oral and Maxillofacial Surgery require attainment of Bachelor of Dental Surgery. A common question facing this cohort of junior trainees is whether to start Dentistry before or after Core Surgical Training. Both routes have advantages and disadvantages, that must be considered. Here is provide our perspective into this common dilemma.

In head and cancer (HNC), osteoradionecrosis (ORN) is one of the most significant complications of radiotherapy (RT). With an absence of effective non-surgical treatment, prevention of the development of ORN is the best approach.

The article describes our exploration of the transfacial sialolithotomyapproach to intraparenchymal stones in the submandibular gland assisted with sialendoscopy and gland preservation. 5 patients with large intraparenchymal stones in submandibular gland were included. Ultrasonography and computer tomography (CT) scans were performed to locate the stones. As the large intraparenchymal stones failed to retrieve throughout endoscope, patients were treated by a transfacial lithotomy approach with sialendoscopy.

Adequate positioning of an orbital implant during orbital reconstruction surgery is mandatory for restoration of the pre-traumatised anatomy, but visual appraisal of the implant’s position is limited by the keyhole access and protruding soft-tissues. A positioning instrument, that attaches to the implant, was designed to provide feedback outside the orbit. The goal of this study was to evaluate the effect on implant positioning accuracy of the instrument workflow compared to visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow.

Osteonecrosis of the jaw is a severe adverse condition affecting patients exposed to specific types of medications. Previous studies have highlighted that osteonecrosis of the jaw is triggered by invasive dental procedures and can be very challenging to manage, especially in oncologic patients. The primary aim of this review is to analyse all available evidence on the management (surgical and/or conservative) of medication related-osteonecrosis of the jaws (MRONJ) in patients with a history of antiangiogenic drugs therapy and not previously exposed to any antiresorptive drug treatments.

The purpose of this study is to explore the treatment efficacy of botulinum-A (BTX-A) in nocturnal bruxism.

A controversy exists with regards to the influence of graft placement site in the mandible and the success of nonvascularized bone grafting. In this study, we examine the association between the compartment of mandibular defect and bone graft failure rate.

Firstly, we thank the reader for his/her interest in our article.

We thank Pérez-González et al for their article ‘Dental implant placement through impacted teeth or residual roots as an alternative to invasive extraction surgeries: a systematic literature review’.1

Diabetes mellitus (DM) is thought to be associated with poor outcomes in cervicofacial infections (CFI), yet little is known about the prevalence of DM in CFI. Stress hyperglycaemia (SHG), a normal physiological response to inflammation, is distinct from DM, though they overlap and may be conflated. We aimed to establish the prevalence of DM and SHG in CFI and determine the effect of each on severity of disease and outcome measures.

Pterygomaxillary (PTM) dysjunction is a technique-sensitive step in Le Fort I osteotomy. Various studies implicate improper osteotomy techniques and anatomical variations of the midface in ophthalmic/orbital complications. The aim of this study was to assess the stress distribution and its transmission to the orbit during PTM dysjunction while using different angulations of the osteotome. The study involved the generation of two virtual models from the computed tomographic images of a non-cleft and cleft patient.

The ethos of the Junior Trainees’ Group is to facilitate peer support, an important complement to pursuing our speciality of Oral and Maxillofacial Surgery. Launched in September 2020, the Buddy Scheme enables peer-led mentorship. Results demonstrate this scheme has successfully provided additional support for second-degree applicants. With further help from our senior colleagues, our ambition is to expand this scheme in 2021.

This study aimed to systematically review and critically appraise available literature concerning the effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions. The “Preferred Reporting Items for Systematic Reviews and Meta-Analysis” guidelines were followed and the study protocol was registered at the “International Prospective Register of Systematic Reviews” (CRD42019116099). Six main databases were searched: Embase, LILACS, PubMed, Scopus, The Cochrane Library, and Web of Science.

The aims of the present study were to comprehensively assess all the published cases on dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) in the literature in English and describe the clinical, imaging, and therapeutic variables for this condition. An electronic search was undertaken in March 2020 using PubMed/MEDLINE, Web of Science, ScienceDirect, Springer, and Scopus databases. Eligibility criteria included publications with sufficient information to confirm the diagnosis.