British Journal of Oral and Maxillofacial Surgery

Pathology reports often contain elements of uncertainty and communication between clinicians and pathologists is paramount for providing the best patient care. Surveys were given to pathology service-users and pathologists in order to ascertain confidence levels regarding certain phrases used in pathology reports. A focus group was then held with pathologists, to gain insight into why certain language is used and the challenges they face in presenting an uncertain diagnosis. Whilst most of the phrases were interpreted similarly between service-users and pathologists, certain phrases elicited more variation in confidence than others, suggesting that message conveyed in pathology reports is not always interpreted the way it is intended to be.

Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse side effect of antiresorptive agents. However, withdrawal of antiresorptive agents in patients with osteoporosis may increase the risk of fractures. The treatment of MRONJ is challenging and standard treatment guidelines have yet to be established. In this study, the aim was to examined whether adjunct daily or weekly teriparatide (TPTD) injections are beneficial for the bone exposure of MRONJ lesions compared to standard conservative management.

The purpose of this systematic review was to critically analyze the recent literature to present the state of the art in customized reconstruction of orbital fractures. Three electronic databases and manual search approaches were used to identify relevant articles. Only studies with a controlled clinical study design were included. Primary outcome was defined as the status of recovery (complete/partial functional and esthetic disturbances). The benefit of intra-surgical navigation should be described.

Dear Sir,

We report a summary of developmental work to explore, develop and establish clinical applications of real-time magnetic resonance imaging (rtMRI) with a temporal resolution of 70 frames per second in oral and maxillofacial surgery. rtMRI can contribute to procedure planning, diagnostics, rehabilitation, monitoring and patient education. At present, conventional MRI is used extensively in diagnosis, staging and follow-up of head and neck cancer patients, with scanning durations of typically several minutes and a temporal resolution of up to 0.5 frames per second.

Maxillofacial injuries sustained playing sport are becoming increasingly common. In the UK, where football is the most popular team sport, associated maxillofacial injuries are a regular occurrence. This study retrospectively examined data for patients referred between 2007 and 2019 with facial injuries sustained playing football (n=265). Demographics, mechanism of injury, diagnosis and treatment received were analysed. The mean (SD) age was 25 (± 11.0) years (range: 3-85 years) and there was a strong male predominance (n=256, 96.6% male).

Head and neck cancer remains one of the most common cancers in the UK, with a sixteen percent increase in incidence over the last decade.[1] Head and neck surgery, including tracheostomy placement, leads to the acute loss of voice for a patient. The breakdown in communication between the patient and the medical team, often causes a challenging post- operative journey, with the patients feeling unheard, isolated and receiving a lack of individualised care.[2] This additionally provides a challenge to nursing staff, with many of the difficulties arising due to a lack of effective communication aids.

Lip filling mostly involves cosmetic aspects and is basically aimed at increasing the labial volume and beautifying the patient’s facial features. It can positively effect the patient’s self-perception of dental-facial aesthetics and attractiveness.[1]

The maxilla-first approach has been the standard orthognathic sequence for many years, however with the evolution of rigid internal fixation and to eliminate any errors that could be encountered during pre-operative bite registration, the mandible-first approach has become an effective treatment modality for bimaxillary orthognathic surgery

To ensure that dental implants remain functional in the long-term, adequate thickness and width of keratinised tissue at the cervical collars are essential.[1] Once a tooth is lost, the height of the alveolar bone is reduced, and the keratinised tissue of the edentulous area recedes.[2] There are two techniques currently used to obtain the desired keratinised tissue augmentation: the apically positioned flap surgery and the free gingival graft surgery.[2] The apically positioned flap surgery, the existing keratinised tissue is incised at the mucosal or mucoperiosteal flap to enable natural extension of the incised end.

Preoperative assessment is essential to prevent inferior alveolar nerve (IAN) injury during surgical extraction of the lower third molar (LM3). Here, we aimed to establish an assessment system to predict IAN injury during surgical extraction of the LM3.

This study assessed whether pre-operative class III patients could recreate their facial difference based on a profile photograph. Twenty class III pre-surgery bimaxillary orthognathic patients used CASSOS (SoftEnable Technology Ltd.) to manipulate a distorted soft tissue image of them until they felt it resembled their current soft tissue profile. Patients were able to move their upper lip and lower chin backward and forwards, as well as the lower chin up and down. Differences in the mean absolute distance between the patient-perceived position of the upper lip (Labrale superious) and chin (Pogonion) and the actual position of their upper lip and chin were measured on two occasions.

The aim of this study was to carry out a retrospective multicenter study comparing the morphological outcome of 8 techniques used for the management of sagittal synostosis versus a large cohort of control patients. Computed tomography (CT) images were obtained from children CT-scanned for non-craniosynostosis related events (n=241) and SS patients at pre-operative and post-operative follow-up stages (n=101). No significant difference in morphological outcomes was observed between the techniques considered in this study.

The purpose of this study is to explore the patterns of head and neck injuries secondary to boxing.

The principal authors decide which contributors deserve inclusion on the title page based on the quantum of work done. Although many follow ethics in research, few engage in gift authorships for different reasons.[1–3] It is highly challenging for journals to police this.

Maxillary repositioning in orthognathic surgery to a planned position requires vertical, antero-posterior and transverse measurements. The latter two are obtained from the intermediate wafer in bimaxillary osteotomy and the final wafer in single jaw osteotomy. The techniques to ensure reproducibility of the vertical dimensions are varied. Also, retaining the dental midline accuracy is an important task in maxillary osteotomy.

Traditionally, surgical management of zygomatic maxillary-complex (ZMC) and orbital fractures occurs within two to three weeks of the injury followed by an overnight admission to allow for extended eye observations. This is due to the risk of post-operative retrobulbar haemorrhage (RBH) or orbital compartment syndrome (OCS), a rapidly progressive and sight threatening emergency which requires immediate intervention.In September 2016 the Oral and Maxillofacial Surgery (OMFS) department at Leeds Teaching Hospitals redesigned their trauma service with a full-time trauma consultant, dedicated clinic and a weekly morning elective trauma theatre list.

The purpose of this research was to evaluate virtual planning accuracy in bimaxillary orthognathic surgery, in bone tissue, by analyzing the mean linear and angular differences, through comparison between planning and surgical result. Electronic databases, MEDLINE via PubMed, Web of Science, SCOPUS, Cochrane Library database, Gray Literature, and the American clinical trial registry (www.clinicaltrials .gov), were accessed as search engines. The studied population consisted of publications related to the assessment of accuracy in virtual planning in bimaxillary orthognathic surgery, between 2010 to 2020.

For Oral and Maxillofacial Surgery (OMFS) Senior House Officers (SHOs), with no formal medical training, the first exposure to emergency scenarios will be the first time they are having to manage them, usually alone. Simulation based education (SBE) has been demonstrated to increased experience and confidence when used in medical education [1], therefore an OMFS SBE course was created to facilitate this learning.

Surgical approaches to orbital retrobulbar tumours involve the medial and lateral corridors, including medial or lateral decompression, as well as the transcranial approach.[1,2]

Orthognathic surgery is a treatment modality indicated to correct dentofacial deformities. Postoperative vomiting can be associated with multifactorial origin mainly correlated to patient-related symptoms, anesthetic and surgical factors. Swallowed blood has been related with one of those multifactorial vomiting causes. Objective: This present study was to compare the efficacy of gastric aspiration after bimaxillary orthognathic surgery. Study design: A double blind randomized clinical trial was carried out and patients were divided in two groups (n = 44 / 39 respectively).

Beauty has been linked to the mathematics and described as a numerical ratio by “The Pythagorean Theorem”[1]We too perceive symmetry and proportions as a guideline and framework for beauty. The Aesthetic Surgeons who recommend treatment also describe proportions vertically as one third of upper, middle, lower face and transversely from the mid-face to the chin aiming to create a triangular projection to achieve a pleasing outcome.

In cancers and chronic conditions, peer support (PS) has been shown to improve quality of life (QOL) and provide an important coping mechanism for patients, however there is little evidence for this intervention in Head and Neck cancer (HNC). Peer support allows individuals to come together and share information, encouragement, and experiences. It is delivered in a variety of ways including one-to-one, online, and support groups. There is limited literature regarding the timing, barriers, and types of PS available for individuals with HNC across the United Kingdom (UK).

We read with interest the report by Raoet al.on COVID-associated mucormycosis, dubbed “Black Fungus” in popular media.[1] We take this opportunity to respond to the views presented in their paper.

Dear Editor,

The effects of head and neck cancer treatment with adjuvant radiotherapy can be devastating for patients. There is frequently loss of function due to tooth loss, pain and discomfort from xerostomia and mucositis, and a significant psycho-social impact. Dental implants provide an effective means of rehabilitation for many; however, irradiation poses a unique set of challenges that can affect the outcome of treatment. The aim of this review is to evaluate whether radiotherapy in head and neck cancer patients affects dental implant survival and discuss the details of pertinent influencing factors.

The two surgical approaches to access orbital fractures are transconjunctival and transcutaneous. The aim of this study was to assess the outcomes of orbital repairs with a focus on lid-related complications and their management. A retrospective analysis was carried out over a 5-year period, from January 2015 to January 2020, assessing all consecutive orbital repairs in our unit. Data was collected for variables including demographics, fracture pattern, surgical approach, and details of any post-operative complications.

Malnutrition is associated with the prognosis of malignant diseases. The geriatric nutritional risk index (GNRI), based on serum albumin (ALB) levels and the present and ideal body weight, is a simple screening tool to predict the risk of malnutrition and mortality in patients. We hypothesized that nutritional markers could predict the prognosis of patients with oral squamous cell carcinoma (OSCC). The primary predictor variable was the GNRI score and the primary outcome variable was overall survival (OS).

What is “a teachable moment”? Think of it as an unplanned occasion to provide insights on a topic, a procedure, or an issue that is occupying the attention of a person(s) you are engaged with at that moment. It requires an opportunity, a recipient (student, trainee, colleague) and a willing teacher (mentor). Teachable moments are unplanned, so they must be sensed and acted upon by the teacher or mentor. The concept was popularized by Robert Havighurst in his 1952 publication: “When the time is right, the ability to learn a particular task will be possible.” This is “a teachable moment.”[1] During daily interactions, it can be difficult to seize the attention of a student or trainee.

To reconstruct the envelope surface of the condyle and the four-dimensional trajectory model in mandibular border movement in normal adults.

The incidence and management of maxillofacial trauma was compared betweenthe first and third lockdown in the United Kingdom due to the COVID-19 pandemic.

This timely article by Wilson et al 1 demonstrated that the trend in the maxillofacial literature is towards higher quality research. However, the paper clearly showed, but did not discuss, the very low number of audits published in the British Journal of Oral and Maxillofacial Surgery and the complete absence of published audits in the International Journal of Oral and Maxillofacial Surgery.

The aim of the study is to investigate and compare the short and long-term effects of the occlusal splint(OS), ultrasound(US), and high-intensity laser therapy(HILT) in patients with painful temporomandibular joint(TMJ) disc displacement with reduction(DDWR).

The COVID-19 pandemic resulted in sudden changes to the established practice of using high dependency (HDU) for the first night of postoperative care following microvascular free tissue transfer. Patients were managed instead on the head and neck ward. This retrospective case-note review aimed to report outcomes in consecutive patients treated before and during the pandemic and to reflect on the implications of ward-based care rather than HDU.235 patients had free tissue transfer between 3rd January 2019 and 25th February 2021, 125 before the pandemic (lockdown 23rd March 2020), and 110 during the pandemic (52 ward managed and 58 HDU managed).

The authors previously published positive peer-reviewed (21 raters using the Terzis scale) and photogrammetric (Emotrics) outcomes in patients who had undergone two-stage lower lip reanimations up to 2018. Other series have published surgeon and peer-rated results but only two series (n=12) assessed patient’s views using patient satisfaction surveys.

found interest in the article by Harazono et al. that raised 40 cases of schwannoma in the oral and maxillofacial region. [1] First of all, I should congratulate Harazono et al. on their article for the great number of cases regarding a rare pathology: however, some critical aspects in the text should be pointed out.

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The incidence of metastases following neck dissection in the apparent lymph node negative neck in oral cancer is between 7% and 33%; early resection of cervical metastases may well increase survival. Modern imaging techniques can reduce the yield of previously undiagnosed metastatic nodes in elective neck dissection (END). An audit of 112 consecutive cases was conducted to determine the proportion of undiagnosed nodal metastases, after END. There were neck metastases in 10 cases (9%), which were mainly (but not all) micrometastic.

The intraoral vertical ramus osteotomy (IVRO) is an orthognathic procedure that is used to correct dentofacial abnormalities, and is performed by approaching the lateral aspect of the mandibular ramus. This approach, however, precludes visualisation of the inferior alveolar nerve (IAN) on the medial side, thereby placing it at risk of iatrogenic damage. The antilingula, a bony prominence on the lateral mandibular ramus, has been proposed as a landmark for prediction of the IAN’s location during IVRO.

The aim of this paper was to clinically evaluate the efficacy of the greater palatine pedicled flap (GPPF) for the correction of trismus in oral submucous fibrosis (OSMF). This retrospective study was designed from the patients diagnosed with OSMF who underwent transection of fibrous bands and coverage of the defect in the retromolar trigone (RMT) region using GPPF from 2008-2019. Cases were analysed for preoperative (MOpre-op), and postoperative mouth opening (MOpost-op), secondary healing of the palate, and complications of the procedure.

To evaluate the clinical effect and feasibility of immediate implant placement combined with flap surgery, no bone grafting and non-submerged healing, in the maxillary molar area.

Oral and Maxillofacial Surgery (OMFS) has been increasing in popularity amongst medicine first trainees. Despite this, there is still limited exposure at the undergraduate level. This study aimed to: evaluate the experience of medical students in the field of OMFS, the awareness of medical students to OMFS resources/societies and to determine the greatest motivators and deterrents for students in pursuing a career in OMFS.

Unicystic ameloblastoma is a distinct pathological variant with varying evidence published about its behaviour and surgical management. Due to paucity of large studies in the literature with long-term follow-up, the aim of this study was to analyse its surgical management and identify clinico-pathological features associated with recurrences.All histopathologically confirmed lesions diagnosed at two referral centres between 1995 and 2020 were retrospectively analysed. Demographic, clinical, radiological and histopathological features were analysed along with surgical methods and follow-up data.

Sarcopenia is increasingly recognised as a poor prognostic factor in older patients undergoing cancer treatment. Recently, masseter muscle cross sectional area (MMCSA) has been shown to accurately identify sarcopenic patients. We aimed to apply this novel technique to a head and neck cohort to identify any potential relationship with survival.

The main components of the medical management of osteoradionecrosis (ORN) are combinations of clodronate, pentoxifylline, tocopherol, sometimes with antibiotics or chlorhexidine rinses. Anecdotally in the Cheshire and Merseyside network, patients report having difficulties getting and taking their prescription, hence the aim was to survey patient experience of obtaining prescriptions, administration of the medications, and side effects.Patients prescribed tocopherol and pentoxifylline from the pharmacy department’s record database from the period of January 2019 to June 2020 were invited to take part in a semi-structured telephone survey.

The removal of lower third molar teeth is one of the most common surgical procedures performed worldwide. Many concepts in this surgery have been unclear and engendered different opinions. This paper aims to review current thinking in certain pertinent aspects of this surgery, to update the reader on the most current research and synthesise it to make clinical recommendations. Topics covered include pre-operative imaging, timing of removal, flap design, lingual retraction, coronectomy, lingual split, closure techniques, antibiotics and steroid use and drains.

We read the above article with great interest, not only because it is a topic of relevance but also to reminisce on our own experiences in the UK.1

To assess the level of evidence for genetic, biologic, and functional predictive and predisposing factors for end-stage temporomandibular joint arthritis within published literature.