British Journal of Oral and Maxillofacial Surgery

Mandibular fractures are a common injury managed by Oral and Maxillofacial Surgeons. Current open reduction and internal fixation (ORIF) treatment strategies are based on Champy’s ideal line of osteosynthesis with the use of miniplate and loadsharing fixation techniques. Post-operative instructions for the duration of a soft diet has varied. This prospective, randomised study reviewed the outcomes of a patient led return to diet at 2 weeks and 4 weeks compared with 6 weeks (control group) following an ORIF of mandibular fractures.

The treatment of mandibular fractures by gunshot ranges from late conservative repair to more aggressive early repair in a single stage. Treatments that preserve bony architecture as much as possible should be used, minimising patient morbidity and the complexity of future surgeries. The purpose of this study was to use a systematic review to determine which method of treatment was most effective for mandibular fractures by gunshot. Searches were conducted on Medline via PubMed, Scopus, Central Cochrane, and Sigle via Open Grey up to August 2019.

Never events relevant to OMFS include wrong site procedures (including tooth extraction), and retained instruments and swabs. In February 2021, the list of never events was updated to exclude wrong tooth extraction as the systemic barriers to prevent these incidents are not considered ‘strong enough.’We discuss the matter, and provide some recommendations to minimise risk for wrong tooth extraction, which to date has been the commonest never event in the NHS.

Oral epithelial dysplasia (OED) is often diagnosed in oral potentially malignant disorders (OPMD) and caries an increased malignant transformation risk (MTR). Currently, there is variation in reported MTR for OED. Here we present the MTR for a cohort of 150 patients with OED at a specialist centre. 2.6%, 4.1% and 29.2% of mild, moderate and severe OED in our cohort progressed to oral squamous cell carcinoma at the dysplastic site, while a small number developed a malignant lesion elsewhere. Moreover, 17 patients experienced an increase in dysplasia grade and two patients showed histological resolution of their lesions.

Recruitment to specialist training in all 10 surgical specialities has been in decline in recent years. There have, in recent years, been perceived difficulties in recruiting dentists into DCT or SHO roles in Maxillofacial Surgery units with posts going unfilled. This survey examines the reasons behind this recruitment issue.

During my final year student selected component (SSC) in Oral & Maxillofacial Surgery, I noticed that clinicians frequently made reference to skin cancer patient information posters (PIP) when communicating with patients. These posters were extremely beneficial in easing patient concerns and were good learning resources for students and trainees. Research has shown that patients value health information materials and perceive them as being helpful in improving patient-physician interaction, health-related knowledge and self-management.

The BAOMS QOMS pilot was developed and run in 6 England OMFS units between December 2019- April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent

The COVID-19 pandemic resulted in an unprecedented reduction in the delivery of surgical services worldwide, especially in non-urgent, non-cancer procedures. A prolonged period without operating (or ‘layoff period’) can result in surgeons experiencing skill fade (both technical and non-technical) and a loss of confidence. While senior surgeons in the UK may be General Medical Council (GMC) validated and capable of performing a procedure, a loss of ‘currency’ may increase the risk of error and intraoperative patient harm, particularly if unexpected or adverse events are encountered.

The number of patients presenting with osteoradionecrosis (ORN) is likely to increase in future and health related quality of life (HRQOL) is a key outcome.This study aimed to report patient concerns and HRQOL in an osteoradionecrosis cohort over 12 years. Patients attended routine follow-up clinics between 2008 to 2020, where patient reported outcome (PRO) assessment was used before consultations as standard practice. The two PROs were the Patient Concerns Inventory (PCI) and the University of Washington quality of life questionnaire (UW-QOL v4).

Historically, patients who received bilateral sagittal split osteotomies (BSSO) required an inpatient admission for at least one night. Since March 2015, the Oral and Maxillofacial Department at the Royal Gwent Hospital has performed bilateral sagittal split osteotomies (BSSO) as a day case procedure for their medically and socially fit patients. Our team’s service evaluation by Davies et al 2018 for this procedure, demonstrated that this could be done both routinely and successfully, whilst conforming to national day case procedural standards.

Osteoradionecrosis of the mandible present a cohort of patients posing additional challenges to the attending clinician when it comes to major reconstructive head and neck surgery.We present a novel technique to assist in the virtual surgical planning of mandibular osteoradionecrosis, which involves deforming previously delivered radiation dosimetry data onto the virtual mandible to aid in the assessment of surgical resection margins.This is a retrospective case-series of osteoradionecrosis patients who were treated either with a traditional virtual surgical planning approach or dosimetry guided virtual surgical planning.

This systematic review aims to evaluate the possible time benefits when using three-dimensional planning prior to orthognathic surgery when compared to a conventional method only. The databases utilised were PubMed, MEDLINE, Web of Science and the Cochrane Library. Studies were selected based on eligibility criteria and reviewed independently by two authors. A total of 8 studies were included in the systematic review. The review concludes that there are limited studies with the appropriate experimental protocols in place.

To review the evidence relating to treatment duration and the surgery first approach (SFA) in managing class III skeletal discrepancies. To determine whether there is sufficient evidence to show that a SFA results in a shorter duration of treatment compared to a conventional orthodontics first approach (OFA).

A systematic review and network meta-analysis was conducted to compare different commercially available xenograft materials used in maxillary sinus floor elevation surgery (MSFES). The electronic search was carried out on Embase, PubMed, Cochrane Library, Web of Science, Scopus, LILACS, and grey literature up to July 13, 2020. Only randomized controlled trials were included. A frequentist network meta-analysis using a random effect model compared different commercially available xenograft materials.

The importance of teams’ and individuals’ non-technical skills in reducing adverse events is well-recognised. We undertook a systematic review of the published literature to assess the research undertaken to date in assessing non-technical skills and behaviours within oral maxillofacial-head and neck (OMFS-H&N) surgery. The aim was to assess the applicability of published studies to current practice, how these studies could guide future research and to assess for areas where further development could be undertaken.

The purpose of the study was to define a protocol for prevention of re-ankylosis after surgical management of temporomandibular joint ankylosis (TMJA). The investigators designed a retrospective study on all TMJA patients treated with different treatment modalities from 2013-2019. The investigators observed that complete removal of ankylotic mass particularly on medial side, use of piezoelectric scalpel for clean and smooth osteotomy with copious irrigation to remove bone chips and slurry, less trauma to the local tissue, osteotomy design parallel and inferior osteotomy at narrowest part which mostly corresponds to condylar neck, perform coronoidectomy (if mouth opening is <30 mm), fat interposition, no-intraoperative correction of pre-existing chin deviation when treated with costochondral graft, patient motivation and aggressive physiotherapy, and use of vacuum drain are important to prevent re-ankylosis, irrespective of treatment modality.

The first COVID-19 vaccination was given in December 2020 and there is an effort to vaccinate the international population on a massive scale. Common side effects from the vaccine include headache and tiredness. Regional lymphadenopathy has been described in relation to other vaccines. We describe two cases of supraclavicular reactive lymphadenopathy presenting in patients who had the COVID vaccination in the ipsilateral arm. Awareness of this diagnosis is important for patients presenting to the neck lump clinic.

Cephalic malposition is an anatomical variant, particularly found in Middle Eastern people. The alar cartilage malposition may cause both functional and aesthetic problems. This study aimed to investigate and compare the functional and aesthetic outcomes of the two lower lateral cartilage cephalic malposition correctional techniques, including lateral crural overlay (LCO) and lateral crural transposition techniques.

Cardiopulmonary exercise testing (CPET) is used as a risk stratification tool for patients undergoing major surgery. In this study, we investigated the role of CPET in predicting day five cardiopulmonary morbidity in patients undergoing head and neck surgery. This observational cohort study included 230 adults. We recorded preoperative CPET variables and day five postoperative cardiopulmonary morbidity. Full data from 187 patients were analysed; 43 patients either had incomplete data sets or declined surgery/CPET.

With this research, we aimed to evaluate the effect of condylar osteochondroma (OC) resection through an intraoral approach on the masticatory functions. Resection of condylar OC was carried out via an intraoral approach with the help of three-dimensional (3D) design, endoscope, and navigation system. The T-Scan III computerised occlusal analysis system was used to evaluate the occlusal force distribution, recorded at pre-treatment (T1) and post-treatment (T2) intervals. Records of the clinical examination of the temporomandibular joint (TMJ), including maximal interincisal opening, mandibular lateral and forward movements, were also collected.

To investigate the bone regeneration effect of autologous adipose tissue mesenchymal stem cells (ATMSC) in a small animal model.

The treatment of pediatric mandibular condylar fracture (PMCF) is typically non-operative. The purpose of this study was to determine if non-operative management of PMCF, results in a new condylar process of normal morphology to regenerate after closed treatment (restitutional remodeling). The specific aim of the study was to observe restitutional remodeling (RM) in PMCF and review the literature. The investigators designed and implemented a retrospective study on pediatric patients (age<12) with unilateral or bilateral condyle fractures treated with non-operative treatment between January 2005 and July 2015.

A reasoned argument as to why the status quo for Oral and Maxillofacial Surgery training is not sustainable and an alternative is suggested. It is argued that the current financial burden, future pension provision and unacceptable work/life balance must immediately be addressed to ensure uptake of training posts for preservation of the specialty.

This study aims to compare socket repair after tooth extraction and suture using Nylon 5-0 versus closure using cyanoacrylate biologic glue. Twenty male Wistar rats were used, with each animal weighing approximately 200 g. They were submitted to the extraction of the right and left first molar teeth. On the right side, the alveolus closure was performed with a 2 ethyl-cyanoacrylate, whereas on the left side a single interrupted suture was performed with Nylon 5-0. The animals were sacrificed after 3, 7, 15, and 30 postoperative days, and images of histological sections of the alveolus were captured for analysis.

We designed this study to determine the efficiency and stability of anterior segmental osteotomies (ASO) without orthodontics for various dentofacial deformities. Records of patients treated with maxillary or mandibular ASO, or both, without orthodontics in the past 15 years were analysed. The assessment included postoperative analysis of patients’ aesthetics and functional satisfaction using a questionnaire and grading (score 0 - 4) system, and the amount of relapse calculated from 12-month postoperative cephalograms.

In spite of the development of modern injection techniques, palatal injection is still a painful experience for patients. A plethora of techniques have been tested to reduce this. One such technique that has been claimed to work is administering articaine on the buccal side alone for the extraction of maxillary teeth due to its ability to diffuse through soft and hard tissues more reliably than other local anaesthetics. This split mouth study evaluated the efficacy of 4% articaine with 1:100000 adrenaline to avoid the painful palatal injection for bilateral permanent maxillary tooth extraction in 50 patients.

The aim of this experimental study was to evaluate the reliability of two plate fixations applied to the anterior region of the maxilla after Le Fort I osteotomy, in terms of stability. Twenty polyurethane-based skull models were used to evaluate two fixation techniques. Two groups, consisting of four and two L-shaped titanium miniplates, respectively, were tested. Each group was tested applying vertical forces in the anteroposterior direction using a servo-hydraulic testing unit. The displacement values in each group at each stage, from 10 N up to 120 N were compared using the Mann-Whitney U-test.

Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap.

The aim of this study was to evaluate the impact of orthognathic surgery on the quality of life (QoL) of patients with dentofacial deformity. This systematic review was performed through the survey of observational studies that had evaluated the impact of orthognathic surgery on the QoL of patients with dentofacial deformity. The article databases included PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and grey literature. The risk of bias was analysed according to the Newcastle-Ottawa Scale for quality assessment.

Aggressive therapy of oral cancers is associated with significant post-operative morbidity. Patients with feeding issues may require nutritional support. In our unit, patients identified as developing feeding issues are reactively referred for specialist input through a feeding issues multidisciplinary team meeting (FiMDT). Reactive feeding increases length of patient stay (LOS) and may contribute to patient morbidity. We aimed to develop a model to pre-emptively identify patients likely to develop feeding issues post-operatively, to facilitate the establishment of a pre-operative referral pathway to increase patient flow.

Equality, inclusivity and diversity remain pertinent topics in healthcare not only for the benefit of patients but also of the workforce. Schemes have existed for many years and, despite progress being made, it remains necessary to reverberate the importance of these terms and conscious effort to enforce them.This paper describes prejudices and stereotypes as a function of the Bayesian brain, beyond human control, and suggests that a Higher Function is needed to recognise and over-ride these innate thought process.

Trismus is one of the most debilitating and treatment-resistant complications resulting from head and neck oncologic treatments. The objective of this study was to assess how primary tumour variables could assist in predicting chronic trismus.

The training pathway for oral and maxillofacial surgery (OMFS) has remained relatively stable for around 30 years. Circumstances surrounding the training pathway have changed including the priorities of individuals considering entering OMFS training. Run-through Specialty Training (ST1) OMFS posts (which include core surgical training) are oversubscribed while direct entry to Specialty Training (ST3) OMFS specialty recruitment rounds have unfilled posts, including places declined by appointable candidates.

We thank the authors for their article “Evidence based algorithm for the management of acute traumatic retrobulbar haemorrhage (RBH)”.1 In our experience, the management of RBH can be exceedingly challenging, beginning with a correct, timely diagnosis. Furthermore it is often the case that the “odds are stacked against us” from the outset, with inherent delays in presentation, difficulty in confirming diagnosis, coexisting ocular trauma and delays to theatre. Bearing in mind that 60 - 90 min. is the recognised timeframe from onset of symptoms (often at the scene of the injury) it is perhaps not surprising that in this cohort of patients (as opposed to iatrogenic cases), even in true cases of RBH, (as opposed to oedematous OCS), most patients do not recover vision.

Fractures of the mandibular condyle are common and include diacapitular fractures that affect the condylar head. The medial part of the condylar head is least commonly fractured, possibly due to decreased propensity for lines of force to run in the region. Micro-computed tomography (X-ray microtomography) of five temporomandibular joint specimens was conducted to explore whether trabecular bone structure correlates positively with fracture prevalence, which could reflect adaptation in response to lower exposure to physiological loads throughout life.

This paper presents the results of a retrospective case-controlled cohort study to investigate the effectiveness of a donor site local anaesthetic infusion protocol in reducing opioid requirements, length of Intensive Therapy Unit (ITU) stay and the incidence of post-operative delirium. Adult free flap head and neck patients were identified from a prospective database. Eighty-six patients were included. There was a significant reduction in mean opioid requirement (p <  0.001). Post-operative delirium was observed in 12 out of 35 patients before introduction of the protocol, and 10 out of 51 patients after introduction (p  = 0.139).

We read with interest a structured review by Twigg et al.1 evaluating the prevalence of suicide in head and neck cancer (HNC) survivor and appropriate interventions in reducing the suicide risk in head and neck cancer patients, and commend the authors on this review. Here, we offer some discussion points regarding this structured review.

We thank the authors for their interest in our review paper “Best practice in reducing the suicide risk in head and neck cancer patients: a structured review”1 and for their constructive and insightful comments. While there are multiple observational studies evaluating suicide risk among HNC patients, there is a conspicuous dearth of evidence relating to suicidal ideation or demonstrating the utility of specific interventions to reduce the frequency or intensity of suicidal thoughts, or indeed reduce risk of suicide attempts or completion in this high-risk population.

COVID-19 has impacted the provision of orthognathic surgery globally. Uncertainty around its effects and transmission in aerosol generating procedures (AGP’s) has led to disagreement within maxillofacial surgeons into the safety of orthognathic surgery during the pandemic. We present a local case series of orthognathic surgery undertaken during the COVID-19 pandemic. To our knowledge no such similar study has been reported worldwide. Data was collected from the 1st June to 30th November 2020 for all patients undergoing orthognathic surgery by a single consultant.

The aim of this study was to determine the course of marginal mandibular nerve (MMN) in relation to the inferior border of the mandible from the gonion until its terminal insertion to the depressor anguli oris, relating the position to a palpable anatomical landmark with emphasis on the depth of the nerve in relation to platysma and the deep cervical fascia. Twelve fresh adult cadavers were dissected and the mandibular base was contoured using needles with 5mm gaps, starting from the mandibular angle to the muscular termination point of the nerve bilaterally.

We undertook this study to assess the analgesic and anti-inflammatory properties of ibuprofen when administered through two drug delivery systems after mandibular third molar surgery. The study was conducted on 100 patients who required the surgical removal of impacted mandibular third molars under local anaesthesia. The study subjects were divided into two groups of 50 patients each. Patients in the study group were given ibuprofen-incorporated chitosan-based microspheres, which were packed into the third molar sockets after removal of impacted teeth.

To assess the impact, if any, of L-PRF application in an implant bed prior to implant placement focusing on implant stability. by means of implant stability quotient (ISQ) values.

We are writing in reply to the comments regarding our recent publication entitled “In-vitro Assessment of Bone viability with different Implant Drill Speeds”.1 We would like to thank the authors for their great interest in our article. We enclosed a point-by-point response to their questions.

It’s significant for clinicians to reduce the impact of heat produced during drilling procedure. The conclusion that drilling with higher speed produces less heat and maintains more viability than lower speed interests us greatly. After reading the article by Hamdy A. M. Marzooka et al (In-vitro assessment of bone viability with different implant drill speeds.)1, we have several questions to ask.

The long-term sustainability of providing oral and maxillofacial care in the NHS relies on the specialty’s ability to demonstrate the cost-effectiveness of its treatment and the clear health benefits in line with best evidence-based practice, both in terms of objective outcomes and meeting patient expectations. However, the specialty lags behind other surgical specialties in terms of publication of clinical outcomes across the UK e.g. Vascular Services Quality Improvement Programme, Perioperative Quality Improvement Project (PQIP)1 and Trauma Audit and Research Network (TARN)2.