British Journal of Oral and Maxillofacial Surgery

Outcomes remain poor for patients presenting with locally-advanced oral cancers and it remains imperative to re-evaluate adjuvant therapies to provide improved outcomes, ideally without compromising on long-term quality of life. We present current available evidence that supports the use of immune checkpoint inhibitors (ICI) in squamous cell carcinoma (SCC) of the head and neck and discuss trials examining the integration of ICI into the locoregional management of such lesions that are resectable.

Schwannomas are benign tumours originating from the Schwann cells of the nerve. Despite the frequency of their occurrence in head and neck locations, data relating to their clinicopathological features in the oral maxillofacial region are limited. This study reviews the clinicopathological characteristics and specific pathology of ancient (degenerative) change in 40 cases of oral maxillofacial region schwannoma.Study DesignMedical records were reviewed for 40 cases of schwannoma in the oral maxillofacial region identified at Tokyo Medical and Dental University Hospital Faculty of Dentistry between 2000 and 2020.

The aim of this systematic review was to evaluate if manual intraoperative control of occlusion is adequate for mandibular fracture reduction, compared to intermaxillary fixation (IMF). We searched PubMed, Embase, Cochrane library and Clinical trial registry as well as references of included trials. Our primary outcome of interest was the reduction of fracture anatomically and radiographically, occlusal disturbances and incidence of revision procedures due to poor occlusion or reduction. Our secondary outcomes of interest were operative time and infective complications.

Dear Dr. Shakib,

The aim of the present study was to develop measurement methods to evaluate occlusal differences in digitally articulated and hand articulated models in final occlusal planning for orthognathic surgery.

This study aimed to examine the effectiveness of self-irrigation following the extraction of mandibular third molars.

This study aimed to evaluate the palatal surface area in children with different oral clefts after primary surgeries and at 5 years of age. This is a longitudinal study was composed by 216 digital models: unilateral complete cleft lip (UCL), unilateral complete cleft lip and palate (UCLP), and complete cleft palate (CP). The models were analyzed at four periods: T1 (before cheiloplasty), T2 (before palatoplasty), T3 (after palatoplasty); and T4 – 5 years. Area of dental arches was measured through stereophotogrammetry software.

Various anaesthetic agents have been used in dentistry for the extraction of teeth. The most commonly used local anaesthetic agent is lidocaine hydrochloride. Recently, articaine hydrochloride came into existence because of its versatile properties and longer duration of action. Due to lack of study of effects of articaine on various systems, the present study is aimed to compare the anaesthetic efficacy of articaine and lidocaine with adrenaline during the extraction of mandibular molars. A total of 100 patients was randomly divided into two groups (50 each) and clinical variables such onset and duration of anaesthesia, blood pressure, oxygen saturation, pulse rate, and pain perception were recorded at different time intervals using a visual analogue scale.

The mandible is the most common bone to develop complications following treatment of facial fractures. This is due to a complex interaction of both fracture specific and patient factors. Our aim was to identify those patient factors, with a specific focus on those that may be potentially modifiable to reduce the incidence of complications.

Management of zygomaticomaxillary complex (ZMC) fractures can be challenging. Consequently, there is a difference in treatment amongst clinicians. In literature it remains unclear if the number of fixation points affects the quality of the anatomical reduction, stability through time, and the potential complications. Therefore, the objective was to assess the outcome of no fixation, one-point fixation and multiple point fixation of ZMC fractures. MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials were searched to identify eligible studies.

We read with interest the paper by Smit et al.[1] regarding their New Zealand experiences of e- scooter trauma. We detail, to our knowledge, the first United Kingdom (UK) report in the medical literature of facial injuries from an e-scooter accident.

Multiple mucoceles of the minor salivary glands are a rare condition in the mouth. Typically, the minor salivary glands of the soft palate are affected. We report two cases which responded entirely following systemic therapy with evening primrose oil. No recurrence was reported over a two- year follow-up period. The response to evening primrose oil is postulated by having an effect on the composition and/or viscosity of minor salivary gland secretions.

To evaluate the reliability of three-dimensional (3D) cephalometric landmark identification in 3D images and to propose an improved protocol for determining the landmarks in 3D images.

Despite the ubiquitous use of N95 filtering facepiece respirators (N95 FFR), published literature on the topic remains scarce especially in relation to dental professionals. This study was performed to assess the impact of N95 FFRs on blood oxygen saturation and heart rate of dental health professionals while performing procedures requiring varying degrees of physical exertion in an aerosol-rich environment.

There is limited knowledge on masticatory function after release of temporomandibular joint (TMJ) ankylosis. In this study, masticatory function was evaluated by measuring maximum voluntary bite force (MVBF) and chewing efficiency in thirty unilateral TMJ ankylosis patients who were treated with buccal pad of fat (BFP) interpositional arthroplasty. Eighteen subjects of age more than 12 years were included in study Group A and twelve subjects below 12 years of age were included in study Group B. The study groups had completed minimum follow of one year after surgery.

Development of new lymphatic tracers and advancement of hybrid tracers, such as Indocyanine Green (ICG)-Nanocoll, represent an exciting step in the future of sentinel lymph node biopsy (SLNB). These tracers aim to improve our ability to detect sentinel lymph nodes by enhancing their localisation. The aim of this study was to assess the performance of a novel dual tracer, double injection technique of ICG-“cold”-Nanocoll and radiolabeled Nanocoll, in SLNB for early stage oral cancer.

Analysing morbidity and using this to improve the quality of patient care is an important component of clinical governance. Several methods of data collection and clinical analysis have been suggested, but to date none have been widely adopted.

This study considers the confidence of dental core trainees (DCT’s) as they mature and progress through their first 6 months in an Oral and Maxillofacial Surgery (OMFS) training post. Trainees have different incentives for embarking on a year in OMFS; to develop additional skills before settling into general dental practice, as a step towards specialty training and for those who are uncertain about their career direction1.Traditionally, an OMFS year has been associated with creating well-rounded and confident clinicians2.

Together with the ongoing serious Covid-19 second wave in India, a serious fungal infection, mucormycosis has been increasingly found in Covid-19 recovered patients. Colloquially known as “black fungus”, mucormycosis commonly causes necrosis in the head and neck region including the nose, paranasal sinuses, orbits, facial bones, with possible intracranial spread. The disease causes high morbidity and mortality given that diagnosis is often delayed, and that is progresses rapidly. Given the sheer magnitude of the outbreak, the Indian Health Ministry has advised all states to declare mucormycosis an epidemic.

To compare outcomes of patients with sialorrhea who had a submandibular excision only (SE) and submandibular excision with parotid duct ligation (SE + PL)

Sir, we read with interest the recent article regarding the prevalence of e-scooter related injuries that presented to the oral and maxillofacial surgical team in New Zealand by Smit et al.1 The article has highlighted the increasing problem in e-scooter related accidents currently especially in this modern day and age.

Considerable progress in microvascular free flap has become a cornerstone in the management of head and neck cancer. An important determinant of the success of free flap reconstruction is the proper choice of vessels. The available literature shows that donor-recipient diameter mismatch in arterial anastomosis is common and can increase the thrombosis rate and flap loss.1 The invagination technique and the oblique cut method are commonly used for the management of arteries with a large-to-small diameter ratio of 1.5:1 or less.

Any change in the maxillary position can affect the vocal tract length. This study aimed to assess the vocal acoustic parameters in patients who underwent Lefort I osteotomy for maxillary advancement.This cross-sectional study evaluated class III skeletal patients who underwent LeFort I osteotomy for maxillary advancement. The vocal acoustic parameters (fundamental frequency and perturbation indexes: Jitter and Shimmer) were studied before and at 3, 7, and 10 months after maxillary advancement. The age and gender of patients were the variables of the study.

COVID-19 is a new disease which mainly presents with respiratory symptoms, however can present with a multitude of signs and symptoms affecting various body systems. Several oral manifestations related to COVID-19 have also been reported. We carried out a systematic review to explore the types of oral mucosal lesions that have been reported in COVID-19 related literature up to the date of 25th of March 2021.A structured electronic databases search using Medline, Embase and CINAHL as well as gray literature search using Google Scholar revealed a total of 322 studies.

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignancy of the skin. The incidence of MCC is increasing with half of cases involving the head and neck. Few large studies have been published in the UK and to date this is the largest reported series of head and neck MCC.

The recent 8th AJCC staging system has introduced depth of invasion(DOI) as one of its important component. DOI is also important for deciding neck management in superficial tongue cancers. MRI is mainly used to access the DOI and in this study, we have evaluated the efficacy of MRI in detecting DOI.

Radiofrequency coblation (RFC) is a relatively new device that has been used in several transoral procedures. Currently, clinical data on its use for excising lingual thyroglossal duct cyst (LTGDC) are lacking. Herein, we conducted this retrospective case series to explore the feasibility and efficacy of RFC-assisted transoral surgery (RFC-TOS) in excising LTGDC. A total of 12 LTGDC patients between 2013 and 2020 were retrospectively studied. The cysts of these patients were all fully removed along the boundary to the depth of the hyoid using RFC wands.

Sir,

The naturally occurring Cannabis plant has played an established role in pain management throughout recorded history. However, in recent years, both natural and synthetic cannabis-based products for medicinal use (CBPMs) have gained increasing worldwide attention due to growing evidence supporting their use in alleviating chronic inflammatory and neuropathic pain associated with an array of conditions. In view of these products’ growing popularity in both the medical and commercial fields, we carried out a systematic review to ascertain the effects of cannabis and its synthetically derived products on orofacial pain and inflammation.

Brush cytology and telemedicine platforms are used with proven benefits in remote diagnosis of malignancies like cervical cancer. In low-resource settings access to the current standard of care, biopsy and histopathology grading of oral lesions, can be unfeasible. Risk stratifying early malignant and oral potentially malignant lesions can help instigate therapeutic treatment and improve prognosis. Therefore, a tele-cytology platform enabling remote connectivity to specialist centres may aid early detection of oral cancer.

This study aimed to evaluate long-term condylar remodeling in skeletal Class III patients who underwent bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT). 23 patients were studied retrospectively, and a total of 4 CBCT scans were obtained for each subject: 1 month before surgery (T0), immediately after the surgery (T1), 6 months after the surgery (T2), and 6.1 ± 2.1 years after the surgery (T3). Condylar remodeling was measured using the condylar volume, height, width, and depth.

In this study, we aimed to describe a classification method (position and displacement (PD) classification) and the corresponding treatment strategies for condylar fractures in children, based on the anatomical position and displacement of the fractures. Moreover, we aimed to explore the effect of the treatment strategies for condylar fractures in children. Such fractures were classified into the following three types by PD classification: condylar head fracture (type A), mildly displaced condylar neck and base fracture (type B), and severely displaced condylar neck and base fracture (type C).

The British Association of Oral and Maxillofacial Surgery is soon to implement the Quality Outcomes in Oral in Maxillofacial Surgery (QOMS) to provide a platform for quality management across the specialty in the UK. The initial oncology and reconstruction audits for QOMS involves data collection on specific procedures and metrics. The aim of this report is to determine their appropriateness using extant audit datasets in our institution that overlap substantially with the QOMS audits. Pre-existing datasets comprising information on patients treated for oral cavity SCC with curative intent were analysed.

Harvest of scapular free flaps for head and neck reconstruction has previously been described in the supine position,1 avoiding the need for turning the patient part way through the procedure, with the additional advantage of early identification of the vascular pedicle, and the possibility of two teams operating simultaneously to allow reduced operative time. Alternatives include putting the patient in a semi-decubitus position2 allowing rotation of the operating table.3 Harvest of a true scapular soft tissue flap based upon the transverse cutaneous branch can be challenging in the supine position, particularly as classical dissection of this component from medial to lateral is not possible,4 and origin of the circumflex scapular artery can be variable.

Metastasis to retropharyngeal lymph nodes (RPLN) from oral squamous cell carcinoma is rare and associated with poor outcomes. The poor prognosis of RPLN is multifactorial and includes the clinicopathological aggressiveness of the primary disease and the late presentation. The aim of this systematic review is to assess the evidence on RPLN in patients diagnosed with oral squamous cell carcinoma (OSCC), the quality of the diagnostic modalities and the available treatment options. We aimed to analyse the overall survival of these patients diagnosed with RPLN.

We read with interest the short communication by Broderick et al.1 They detailed their experience of a single case of head and neck free tissue transfer, performed in a vessel depleted neck, in which the subclavian artery and vein were used as recipient vessels. In response to their article, we would like to raise a number of points of interest and gently suggest a safe, historical alternative for such a challenging case.

We read with great interest the study published by Maharaj et al entitled ‘Reverse umbrella technique – percutaneous reduction of frontal bone fracture using an intermaxillary fixation screw device’ in your journal.1 In this technical note, the authors have described their percutaneous screw reduction technique for the treatment of noncomminuted isolated anterior table fracture of the frontal sinus with the use of intermaxillary fixation (IMF) screws. We agree that percutaneous reduction techniques should be used for the treatment of these type of fractures whenever possible, in order to avoid complications related to the coronal approach or the complexity of endoscopic approaches.

Non-melanoma skin cancer (NMSC) is the most common type of cancer in the UK and Ireland, accounting for approximately 20% of all new malignancies recorded, with evidence of increasing incidence. Surgical excision is regarded as the gold standard treatment for such lesions; however, incomplete excision incurs both physical and financial strain on patients and the healthcare service. Our aim is to identify which anatomical regions of the head and neck pose greater risk of incomplete excision and raise awareness for future surgical practice.

Maxillofacial injuries are usually not life-threatening and do not get priority over other associated injuries. However, some maxillofacial injuries with active oral or nasal bleeding need immediate management due to threatened airway and blood loss. In the case of major active vascular bleeding, measures such as local pressure, anterior nasal packing, posterior nasal packing, and balloon tamponade are ineffective. In these cases, angiography and transcatheter arterial embolisation (TAE) are used to treat life-threatening haemorrhage caused by maxillofacial trauma.

I read with great interest the article by Al-Muharraqi1 recently published in this journal and would like to share some information on oral-maxillofacial surgery (OMFS) in 3 countries with different OMFS: dental-based (I was a lecturer/hospitalist in Thailand: 1999-2003), medical-based (I was a trainee and Master/PhD student in France: 2003-2008) and dual-qualified (I have been a staff-graded and later consultant surgeon in Germany: since 2008) (Table 1). Medical-based and double-degree OMFS curricula in France and Germany focus mainly on full-scope OMFS/head and neck surgery without other medical rotations.

Reconstruction of post traumatic orbital defects has undergone a stepwise evolution following developments in reconstructive materials and surgical techniques. Advances in communication between surgical teams and design technicians have allowed provision of bespoke surgical plates with a high degree of accuracy and surgical relevance in an appropriate timeframe.We present a case series of 41 consecutive patients treated in London and BernBern Switzer between March 2019 and September 2020 with extensive defects reconstructed with patient specific orbital plates.

Oral submucous fibrosis (OSMF) is an insidious chronic disease of the oral mucosa that is characterised by severely limited mouth opening, blanching of the oral mucosa, and a burning sensation in the oral cavity. Consumption of betel nut and/or gutka are the known risk factors. We undertook this study to correlate the frequency and duration of gutka intake with the severity of OSMF and to determine the predictors of severe OSMF (mouth opening <20mm). A cross sectional study was conducted on 300 participants (who were known gutka chewers) selected at the Baqai Dental College and Fatima Hospital, Karachi, Pakistan.

In our tertiary level centre the Oral and Maxillofacial (OMFS) rotas often change at short- notice due to service requirements and developing guidance relating to the Covid-19 pandemic. Consequently, we developed a novel teaching method for our Dental Core Trainees (DCTs) to accommodate hectic schedules and conflicting availability between junior and senior staff. Here, we describe the innovative teaching approach we have established using case- based discussions via Whatsapp©. Feedback has been excellent; respondents stated the most useful aspect is flexibility to participate in-between tasks and across multiple sites, and 87% stated they use the searchable summaries when managing patients.

This study aimed to compare platelet-rich fibrin (PRF) membranes obtained using a conventional method and those obtained using the tranexamic acid-mixed method at various concentrations in terms of appearance, weight, and degradation period. In this in vitro study, 20 PRF membranes were divided into four groups, including a conventional group manipulated using the conventional method. The remaining groups were prepared using tranexamic acid at concentrations of 50, 150, and 200 mg. The PRF membranes were evaluated for gross weight, degradation period, and daily remaining weight for 28 days.

The MDT is key in the management and decision-making process of Head and Neck Cancer. The sudden shift to virtual meetings due to the COVID pandemic has been arguably the most dramatic change since inception of the MDT. No studies have evaluated the Head and Neck MDT since this change in working.

The present study was designed to compare the efficiency of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 in providing adequate anaesthesia for maxillary molar extraction with buccal infiltration only. In this randomised, double-blind clinical trial, 139 patients who needed maxillary molars extracting were enrolled. Individuals were randomly divided into two groups of 2% lidocaine with epinephrine 1:100,000 treated by buccal infiltration without palatal injection and 4% articaine with epinephrine 1:100,000 treated with the same method.

Monitoring of microvascular free flaps is an influencing factor in the success or failure of the treatment. In this study, we aim to compare the accuracy of implantable Doppler and scintigraphy in the monitoring of a vascularised buried fibular graft for reconstruction of the mandible. In a prospective cohort study, an implantable Doppler was placed intraoperatively, and Single Photon Emission Computed Tomography (SPECT) was taken in patients when abnormal blood flow was detected via the implantable Doppler or 48 hours after operations in patients with normal signals on the Doppler.

I read with great interest the letter relating to our recent paper.1 I would like to thank the authors for their kind and interesting comments. There are some important distinctions between different staging systems for cutaneous squamous cell carcinoma (cSCC) and we are grateful for highlighting them, and we hope this has initiated some fruitful discussion.