British Journal of Oral and Maxillofacial Surgery

Oral and maxillofacial surgery (OMFS) is often overlooked as a specialty that is suitable for a first-degree medical student. Although its popularity is increasing amongst undergraduate training, exposure to OMFS remains minimal. Often, first-degree medics are met with confusion from clinicians in other specialties when expressing an interest in OMFS, mainly due to what is described as a “tortuous” training program. Understandably, this only discourages undergraduate medics from further exploring what OMFS has to offer.

The stylohyoid ligament is an extension of the temporal styloid process1. In some, the central part, formed by cartilage, is calcified, ossified, and elongated2,3. These situations cited above could present with several symptoms, of a rare condition called Eagle's Syndrome4.

Surgeons used to be unaware of the facial nerve's position during parotid surgery. Now, with special MRI sequences, the nerve can be located and converted into a 3D model displayed on an AR device for surgeons to study and manipulate. This study explores the accuracy and usefulness of this technique in treating benign and malignant parotid tumours.

There is an accelerated demand for non-surgical facial aesthetics (NSFA), encompassing the use of botulinum toxin and dermal fillers. Healthcare professionals may either treat NSFA-related complications in the public sector or begin practising NSFA in the private sector. Currently, there is no standardised undergraduate teaching in the UK to educate healthcare professionals on NSFA. The aim of our study is to compare the perceptions and awareness between medical and dental undergraduate students on NSFA and understand its role if implemented into each curriculum in the UK.

Dear Editor,

Non-Surgical Facial Aesthetics (NSFA) are cosmetic procedures to reduce signs of ageing and provide facial rejuvenation. There is currently no recommendation for NSFA to be included in the undergraduate dental curriculum globally.This study aims to gain the views of final year dental students in pursuing a career in NSFA.

Evidence is limited on whether titanium-zirconium alloy narrow-diameter implants (Ti-Zr NDIs) supporting single crowns have promising clinical outcomes. The purpose of this systematic review and meta-analysis was to evaluate existing clinical evidence, including survival rates, success rates and marginal bone loss (MBL) on Ti-Zr NDIs supporting single crowns. An extensive search was performed in the database of PubMed/MEDLINE, Scopus, Embase and Cochrane Library for studies published in English up to April 2022.

The popularity of cosmetic surgery is on the increase with the face being one of the most common anatomical areas operated on. Pre-existing mental health conditions can be associated with adverse patient outcomes post cosmetic surgery and can result in deterioration of postoperative mental health and lack of patient satisfaction. Therefore, identifying the presence of psychiatric disorders through preoperative screening should be considered during consultation for facial cosmetic surgery.In this study, we reviewed the types of preoperative mental health screening tools used in cosmetic facial surgery and the prevalence of mental health conditions among patients undergoing cosmetic facial surgery.

To investigate the relationship between periodontal disease (PD) and oral squamous cell carcinoma (OSCC). The systematic search was performed for the records published up to August 2022. Odds ratios (OR) and relative risk (RR) with 95% confidence intervals (95% CI) were estimated to evaluate this relationship. Then, sensitivity analysis was performed accordingly. Begg’s test and Egger’s test were used to detect publication bias. Out of 970 papers from several databases, 13 studies concerning the association between PD and OSCC were included.

Iodoform formulations are used as packing material following surgical removal of the jaw lesions. The purpose of this review was to explore the evidence and efficacy of iodoform-based dressing. We have systematically reviewed the published articles according to PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library database for articles mentioning the use of iodoform as dressing material for jaw lesions from January 2000 to March 2022. Finally, 92 studies were included.

Secondary nasal deformities in unilateral cleft lip represent surgical challenges. Open rhinoplasty involving lower lateral cartilage repositioning has been shown to be a suitable technique for patients with cleft lip nose deformity. This study aimed to explore a particular rhinoplasty method and to assess the esthetic outcomes for secondary unilateral cleft lip nose deformities following its use.

Anterior maxillary distraction osteogenesis (AMDO) surgery involves a distraction segment made at the anterior part of the maxilla and advanced anteriorly using distractors. The posterior part of the maxilla is preserved and velopharyngeal function is not affected in patients with cleft lip and palate. The main advantage of AMDO compared with Le Fort I advancement is that the maxilla is advanced without affecting speech from lengthening the maxilla.1,2 Previously, we reported the method of the pre-bent distractors made from a 3D model for AMDO for precise fit and decreasing surgical time.

An evaluation was made of the impact of orthognathic surgery (OS) on speech, addressing in particular the effects of skeletal and airway changes on voice resonance characteristics and articulatory function. A prospective study was carried out involving 29 consecutive patientssubjected to OS. Preoperative, and short and long-term postoperative evaluations were made of anatomical changes (skeletal and airway measurements), speech evolution (assessed objectively by acoustic analysis: fundamental frequency, local jitter, local shimmer of each vowel, and formants F1 and F2 of vowel /a/), and articulatory function (use of compensatory musculature, point of articulation, and speech intelligibility).

Within the UK, Oral and Maxillofacial Surgery (OMFS) is a competitive surgical speciality with a rigorous training programme which currently requires dual degrees in both medicine and dentistry. Training in OMFS can present various challenges to finances, length of training and work life balance. The current study explored the concerns of second-degree dental students in trying to obtain an OMFS speciality training post, as well as views on the second degree curriculum.

The aim of this study is to comparatively analyze osseointegration after self-tapping screws (STS) and self-drilling screws (SDS) implantation. Thus, 24 Wistar male rats, 6-month old, received SDS and STS screws in left and right tibias, respectively. Sample collection was performed at 0h (immediate), 2, 7 and 21 days post implantation. Samples from immediate and 21 days were analyzed by micro computed tomography (MicroCT). All time points were evaluated by histology (HE and Goldner's Trichrome) and immunohistochemistry for tartrate-acid resistant phosphatase positive (TRAP+) osteoclasts.

We report a novel technique of robot-assisted harvesting of the internal mammary vessels to provide effective recipient vessels in a patient with bilateral vessel depleted neck (VDN). A 44-year-old with a Notani grade III osteoradionecrosis (ORN) of the anterior mandible underwent robot-assisted (Da Vinci® Surgical System, Intuitive Surgical) harvesting of the left internal mammary vessels (LIMA, LIMV). Reconstruction of the mandibular defect was done with a virtually planned composite fibular free flap and microvascular anastomosis of the peroneal vessels to the LIMA and LIMV.

The aim of this audit was to identify the magnitude of on-the-day elective surgery cancellations within the oral and maxillofacial department at East Kent Hospital University Foundation Trust, and then to be able to evaluate the reasons for them and suggest any necessary improvements to alleviate the situation.

The odontogenic keratocyst (OKC) is a common cystic lesion in the jaw. Its management, however, is highly debated with no consensus on the best treatment option. Clinicians base their approach on treatment efficacy and associated morbidity. Management often consists of enucleation with peripheral ostectomy and adjunctive therapy to prevent recurrence. The aim of our systematic review was to evaluate the safety and efficacy of these different modalities. Embase, Medline, and Cochrane were searched according to the PRISMA guidelines for articles that presented non-syndromic patients with histopathologically confirmed OKC treated with 5-fluorouracil (5FU), Carnoy’s solution (CS), or modified Carnoy’s solution (MCS) as adjunctive therapy after enucleation and peripheral ostectomy.

The objective of this study was to compare the effectiveness of buffered and non-buffered local anaesthetic (LA) following inferior alveolar nerve block (IANB). This study was conducted at Usmanu Danfodiyo University Teaching Hospital Sokoto from June 2020 to January 2021. Subjects were randomised into Groups A and B. Group A received 2 ml of freshly prepared 2% lignocaine with 1:100,000 adrenaline buffered with 0.18 ml of 8.4% sodium bicarbonate solution while those in Group B received non-buffered 2% lignocaine with 1:100,000 adrenaline LA solutions.

The OMFS urgent suspicion of cancer (USOC) referral pathway for head and neck cancer is costly in terms of time and resources, and despite NICE referral guidance, it has a low conversion rate with many inappropriate referrals. The Head and Neck Cancer Risk Calculator version 2 (HaNC-RC-v2) gives recommendations to primary care referrers on appropriate referral priority. To our knowledge, this is the first study to investigate the accuracy of the HaNC-RC-v2 in a cohort of maxillofacial referrals.

Nasal complex injuries are the most common facial fracture encountered in the trauma population. Multiple surgical techniques for treatment of these fractures have been described with varying results. The goal of this study was to review the efficacy of closed reduction of nasal and septal fractures using a technique based upon several key concepts. We reviewed the records of patients who had undergone isolated nasal and/or septal fractures with closed reduction at our institution between January 2013 and November 2021.

We aim to summarise the latest evidence to better inform OMFS practitioners about the deleterious effects of vaping on oral health and the risks of oral cancer, so they can better inform their patients. Current evidence suggests that e-cigarette use is not risk-free.

The immune checkpoint inhibitor (ICI), nivolumab, has revolutionised the treatment of recurrent and metastatic oral cancer. However, the response rate to ICIs remains low, and identifying predictors of nivolumab response is critical. Although the neutrophil-to-lymphocyte ratio (NLR) has been suggested as a predictive marker of nivolumab response in patients with various types of cancer, its utility in oral squamous cell carcinoma (OSCC) has not been elucidated. In this retrospective multicentre cohort study, we evaluated the association between NLR and outcome of nivolumab treatment in 64 patients with OSCC treated between 2017 and 2020.

Intraoperative CT scanning is the international standard for treating midface fractures as it allows intraoperative assessment of reduction and fixation. To our knowledge, no NHS hospital in the UK has this facility yet due to the financial and logistical burden of its implementation. The aim of this study was to determine if complications including the requirement for a return to theatre (RTT) could have been predicted from the post-fixation CT scan. All treated midface fractures that had presented to a regionalised major trauma centre within two years (01 January 2020 - 31 December 2021) were identified.

Surgery is the treatment of choice for tumors in the parotid gland. We evaluate complications following parotid surgery.

The aim of this prospective study was to analyse if a delay in the time from injury to definitive surgical intervention of open reduction and internal fixation (ORIF) of compound mandibular fractures predisposed to an increase in postoperative infectious complications. ORIF beyond 72 hours from injury was considered to be delayed intervention. Postoperative surgical site infections (SSI) and non-infectious complications (NIC) were recorded. The Mann-Whitney U test was used to compare the delay in ORIF with SSI.

This study examines the effect of the lateral bone cut end (LBCE) on the pattern of lingual split during bilateral sagittal split osteotomy (BSSO) in patients with skeletal class III malocclusion. A case-control study according to the pattern of the sagittal split osteotomy (SSO) lingual split line was conducted in patients who underwent BSSO. The primary predictor variable was the ratio of the LBCE. The primary outcome variable was the type of lingual fracture line classified according to the lingual split scale (LSS).

Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients treated with TMJR regardless of the indication for the operation. A prospective, single-centre study was performed. Data on 36 patients (56 TMJR) were collected preoperatively and at follow up two to three years postoperatively. The primary outcome variable was subjective TMJ pain (none/mild, moderate/severe) at follow up.

Salivary gland malignant tumours are a complex and highly variable pathological group. Their diagnosis can be challenging, and management is guided by multidisciplinary teams. This project aimed to establish clinicopathological and sociodemographic features that significantly impacted overall disease-free or progression-free survival in patients diagnosed with malignant salivary gland disease between 2010 and 2019 in a tertiary referral centre. In total, 86 patients were included for analysis, with a female:male gender ratio of 1.3:1.

The decision about the choice of load-sharing (LS) or load-bearing (LB) osteosynthesis is determined by an interplay of fracture-related and patient-related factors. In some situations a similar fracture in two different patients may be treated successfully by either of these methods. Our aim was to identify preoperative patient-related factors that may assist in deciding which form of osteosynthesis is employed. All adult patients who underwent open reduction and internal fixation of mandibular fractures (excluding condyle) between 1 October 2018 and 1 June 2021 were retrospectively identified.

Reconstruction of the bony orbit in patients with combined midface injuries is frequently discussed in the current literature. Two main concepts can be distinguished: single-stage reconstruction, usually with a hand-bent titanium orbital mesh, and two-stage reconstruction, in which osteosynthesis of the zygomaticomaxillary complex (ZMC) is followed by orbital reconstruction with a virtually-planned, patient-specific titanium implant in a second surgery. This study aimed to compare one-stage and two-stage surgical approaches on combined midface fractures regarding postoperative diplopia.

The field of dental implants is a huge market. The worldwide implant dentistry market is estimates at $US 4.2 billion (1 CHF/1.12 $US). Straumann Inc. is a major dental implant player and defines the USA as its major target market with an estimated 2.5 million dental implants placed each year representing a market share of 24%.1

The aim of this study was to review current literature regarding the speech outcome of different techniques of surgical treatment of VPD in cleft patients, in an attempt to reach a treatment algorithm. A systematic review was done, by searching Pubmed, Scopus, and Web of Science electronic databases, following the PRISMA guidelines. Articles reporting speech assessment results of secondary VPI surgeries on non-syndromic patients with CP. Surgical techniques were categorised into two groups; palatal and pharyngeal surgeries.

The authors must be commended for highlighting lessons and best practices from the world of aviation and other high reliability organisations with an intent to improve patient safety and team dynamics in surgical setting.1 As attendings, working in a high volume outpatient oral surgery clinic staffed by residents and students (in the USA), we are constantly trying to establish a workflow to ensure optimum teaching, reduce errors, and yet best serve our patients in an efficient manner. Here we present a case and possible workflow that draws on and illustrates the implementation of ideas presented in the article.

In this study, we aim to evaluate the quality of life in patients with Class III deformities after orthognathic surgery. A total of the 40 patients (26 female and 14 male) were included. The mean age of the patients was 24.85. Patients' ages ranged from 20 to 36 years. All patients received orthodontic treatment before surgery. Sagittal split ramus osteotomy was performed for single jaw patients. Le Fort I osteotomy and sagittal split ramus osteotomy was performed for double jaw patients. Patients completed the Oral Health Impact Profile 14 (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ) three times.

Anterior disc displacement is one of the most frequent temporomandibular joint (TMJ) disorders. Disc displacement can incite inflammatory changes that cause osteoarthritis and progressive degenerative joint disease.1

The maxillary artery (MA) is a key structure at risk of injury in numerous oral and maxillofacial surgical (OMS) procedures. Knowledge of safe distances from this vessel to surgically familiar bony landmarks could improve patient safety and prevent catastrophic haemorrhage. Distances between the MA and bony landmarks on the maxilla and mandible were measured using CT angiograms on 100 patients (200 facial halves). The vertical height of the pterygomaxillary junction (PMJ) was mean (SD) measurement of 16 (3) mm.

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.