British Journal of Oral and Maxillofacial Surgery

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.

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.

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.

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 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.

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.

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.

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.

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.

Any procedure aimed at management of maxillofacial fracture is incomplete without a meticulous maxillomandibular fixation (MMF). Since decades, Erich Arch Bars (EABs) are being used for this purpose. But with advent of Bone supported Arch Bars (BSABs), more surgeons are preferring them over conventional EABs. The present study is designed to identify which among the aforementioned two MMF modalities is a better one.

Sagittal split ramus osteotomy (SSRO) with large mandibular advancements is a common surgical procedure and could be indicated for patients with sleep apnoea. As a large variety of fixation methods is used for the stabilisation of SSRO, a biomechanical test model was used to analyse which fixation technique was most stable. For this in vitro study, 80 polyurethane hemimandibles with a prefabricated SSRO were used as substrates. Loads in Newtons were recorded at displacements of the mandibular incisive edge at 1mm, 3mm and 5mm.

To report the incidence of orbital hematoma formation following orbital fracture repair with silicone, polytetrafluorethylene (PTFE), and poly-L-lactic acid/hydroxyapatite (PLLA/HA) implants.

Metastatic cutaneous SCC carries a poor prognosis with 5-year survival of 25-57%. The aim of this study is to examine the outcomes following surgery with adjuvant therapy for management of metastatic cSCC in a UK based population.

The surgical working environment has changed considerably since the World Health Organisation (WHO) declared the coronavirus outbreak, COVID-19 (SARS-CoV-2), a pandemic on 11 March 2020. Measures remain in place to reduce the risk of spread from patients to surgeons, nosocomial infection and amongst healthcare workers. However, despite these protective measures, healthcare staff are at risk with the number of health workforce deaths increasing worldwide.This article sets out to explore the roles and responsibilities of the surgeon during these extraordinary times and discuss how we can improve our practice to reduce the risk of harm to patients, surgical staff and ourselves.

We recently read the above mentioned article by von Wilmowsky et al, an interesting study which aimed to demonstrate how the use of CAD-based pre-bent custom orbital floor plates could reduce theatre time1.

This study aimed to evaluate the effectiveness and long-term outcomes of free and pedicled expanded deltopectoral flaps with perforation of the internal thoracic artery in repairing facial scars.

To explore patients’ experiences of orthognathic treatment for facial asymmetry and their adaptation to facial changes after surgery, we did a qualitative, cross-sectional study of patients after treatment for non-cleft asymmetry at two UK sites. A total of 15 patients aged 19-40 years were approached after being identified using patient databases and clinical notes. Individual and photo-elicitation interviews were conducted covering experiences prior to treatment, during treatment, and after surgery.

Pleomorphic dermal sarcoma (PDS) is a rare mesenchymal neoplasm that shares histopathological features with atypical fibroxanthoma (AFX), but has additional features of deep invasion of the superficial subcutis, tumour necrosis, and vascular and perineural invasion, which confers a risk of local recurrence and metastases. To study the clinical and pathological spectrum more comprehensively, we retrieved 49 cases of pleomorphic dermal sarcoma from our departmental files. There was a strong male predominance (n=45).

To investigate the prognostic significance of the stratification of extranodal extension (ENE) into ENE minor (ENEmi, up to 2mm) and ENE major (ENEma, over 2mm) in non-HPV-related squamous cell cancers of the head and neck, we retrospectively reviewed microscopic slides from neck dissection specimens of ENE-positive patients and subcategorised them into ENEmi and ENEma. We then compared the two groups in terms of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS).

The objective of this systematic review was to evaluate the stability and complications of tooth-borne (TB), bone-borne (BB) and hybrid (TB-BB) appliances in surgically assisted rapid maxillary expansion (SARME). Database searches were conducted (PubMed, Embase, Cochrane Library and SciELO), as well as a grey literature search (Google Scholar) and hand searches of reference lists. Forty-six articles were included after study selection (κ=0.854). After eligibility assessment, 16 articles and one article from the grey literature were processed (κ=0.866) and six articles were selected by hand searching, for a total of 23 articles included.

Carnoy’s solution (CS) is routinely used as adjuvant therapy in the management of odontogenic keratocyst (OKC) and a few other benign lesions. The purpose of this study was to explore the evidence of application and efficacy in benign lesions other than OKC. We have systematically reviewed published articles to identify the evidence of CS in benign jaw lesions other than OKC following the PRISMA guidelines. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library database, to find relevant articles from 1980 to March 2020.

We report a case of venous leg ulceration in a Reconstructive Oral and Maxillofacial Surgeon. An online survey was created by the BAOMS Reconstruction SSIG primarily targeting head and neck surgeons to investigate the perceived risk and occurrence of venous leg disease. Two respondents had received treatment for lower limb venous disease thus compromising their ability to work, while 13 had symptoms of early venous disease. Our study shows an interesting area of concern for occupational health in surgeons, particularly those carrying out long operations as will be the case for Reconstruction SSIG members.

On 25th March 2020, the Chief Dental Officer issued national guidance restricting the provision of all routine, non-urgent dental services in response to the spread of COVID-19. We analysed odontogenic cervicofacial infections (CFI) presenting to Oral and Maxillofacial Surgery (OMFS) departments during the first wave of COVID-19 in the United Kingdom.

This work systematically reviews dental implant placement through impacted teeth or residual roots, as alternative to invasive extraction surgeries, evaluated in terms of survival rates, marginal bone loss, surgical and prosthetic complications

We assess the effect of Coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).

We previously published a study on the provision of emergency maxillofacial services during the first UK COVID-19 pandemic national lockdown. We have repeated the study during the second lockdown, and present our findings highlighting the main differences and learning issues as the services have evolved during the pandemic.

The objective of this study was to assess the efficacy of knotless barbed sutures in intraoral wound closure for maxillofacial trauma in comparison with conventional (vicryl) sutures. This was a randomised controlled clinical trial involving 40 patients with isolated mandibular angle fractures who required intraoral incisions for open reduction and internal fixation (ORIF). The sample was randomised into the study group (20 patients) and control group (20 patients). Following fracture fixation by a standardised surgical protocol, the wound closure was done with bidirectional knotless barbed suture and vicryl for the study and control groups, respectively.

We write to draw attention to muscle rigidity as an important adverse effect of remifentanil use in anaesthesia. Remifentanil is a short-acting synthetic opioid often used in combination with propofol as a form of TIVA (total intra-venous anaesthesia) or with inhalational agents. These drug combinations provide good equilibrium between depth of anaesthesia and recovery time and obtund noxious stimuli. Use of remifentanil in orthognathic surgery has been advocated to produce conditions of hypotensive anaesthesia, associated with reduced blood loss and haemodynamic stability intra-operatively.

Glycosamine is an amino-monosaccharide present in connective and cartilage tissues that contribute to the maintenance, resistance, flexibility, and elasticity of these tissues. This study aimed to determine the in vivo effects of glucosamine sulphate (GS) on the temporomandibular joint (TMJ) of ovariectomised rats (OVX).Thirty-two rats were distributed into four groups as follows: G1, sham-OVX+saline solution; G2, sham-OVX+glucosamine sulphate (80mg/kg) – oral administration; G3, OVX+saline solution; G4, OVX+glucosamine sulphate (80mg/kg) – oral administration.

We commend Turner et al1 for their hard work but would point out that to compare BJOMS publication rates without considering the number of trainees in each rotation risks misrepresenting their productivity.

Medication-related osteonecrosis of the jaw (MRONJ) is a severe condition, which affects the jaw in patients exposed to specific drugs. More often, it has been described in association with patients receiving primarily bisphosphonate (BP) therapy. However, nowadays it has been observed with the usage of other medications, such as RANK ligand inhibitor and monoclonal antibody agent (Denosumab) and antiangiogenic drugs. Managing this condition has unfortunately proven difficult and still remains a major challenge for clinicians and surgeons.

Thank you for your comments on our paper, as you rightly say (and this was also a feature of the original article In 20122) it would be useful to evaluate publication rates to BJOMS against number of trainees per deanery or percentage of trainees in each deanery. Such metrics may as a mathematical exercise give a more accurate representation of where trainees are being supported to write papers and engage in research or evidence based medicine. We shouldn’t forget however, that some trainees will submit papers to International and non specialty.

We read the paper by Shen et al with great interest.1 This paper retrospectively compared outcomes following the use of the submental island flap (SIF), submental artery perforator flap (SAPF), and the anterolateral thigh perforator flaps (ALTPF), and we commend the authors on their work. Of significance, they looked at the oncological safety associated with transferring the SIF with level 1 tissue versus SAPF not harbouring level 1 tissue.

After reading the review by Hardie et al,1 on aviation communication for use within the operation room (OR), I wish to share some lessons that I learned trying to adapt and implement communication strategies from high-risk organisations for surgical safety.

The aim of the present study was to perform a systematic review of the need for the latency period in distraction osteogenesis to obtain adequate bone formation. Searches were performed in the Web of Science, Pubmed/MEDLINE, Scopus and Cochrane electronic databases. Nine articles were selected for qualitative analysis. Quality assessment was performed using the 10-item SYRCLE tool. Clinical stability was evaluated in two articles. Histology was analyzed in seven articles. Histomorphometry was analyzed in three articles and mechanical testing was used in two articles.

We investigated the value of the weighted lymph node ratio (WLNR), a new marker that incorporates prognostic information regarding the number of metastatic lymph nodes (LNs) with the extranodal extension (ENE) and the lymph node yield (LNY) of pN0 patients, in the prognosis and postsurgical management of oral squamous cell carcinoma (OSCC). We designed a retrospective study and enrolled patients who were diagnosed with OSCC and treated with neck dissection (ND). The predictor variable was WLNR, and the outcome variable was overall survival (OS).

The aims of this study were to externally validate the OroGrams (oropharyngeal cancer survival calculator) nomogram in a Scottish cohort with high endemic smoking rates, and to compare survival rates with the original validation cohort. A retrospective cohort study in Greater Glasgow and Clyde ENT and OMFS surgery departments was performed to investigate survival outcomes of patients with oropharyngeal squamous cell carcinoma (OPSCC) from January 2012 - December 2017. The main outcome measures were progression-free (PFS) and overall survival (OS), and Kaplan Meier curves.

We used finite element analysis to assess stress on the cortical bone and plate fixation system, as well as mandibular resistance after sagittal split ramus osteotomy with different mandibular advancements and rotations of the occlusal plane. Three-dimensional mandibular models were obtained, and 6mm and 12mm advancements were planned associated with linear, clockwise, and counter-clockwise rotation of the angle of the occlusal plane. Each model was then fixed with one or two 2.0mm system plates and secured with four monocortical screws.

Our aims were to determine the prevalence and association of postoperative delirium (POD) in head and neck (H&N) cancer patients undergoing free flap reconstruction at the oral and maxillofacial surgery (OMFS) unit, Queen Elizabeth University Hospital (QEUH) Glasgow, and to assess whether these determinants can be modified to optimise patient care and reduce the occurrence of POD. Delirium remains an important problem in the postoperative care of patients undergoing major H&N surgery, and early detection and management improve overall outcomes.

Head and neck cancer patients present unique airway challenges, and oropharyngeal, laryngeal, and hypopharyngeal tumours considerably distort and narrow the anatomy of the airway. We describe the use of 3D augmented reality software combined with 3D printed models to assess the anatomy of difficult airways and to assist in the formulation of the most optimal airway management strategy in such patients. The reported patients had computed tomograms (CT) of the neck prior to their anaesthetic and surgical management.

The COVID-19 pandemic has changed the landscape of surgical practice. It has limited access to the operating theatre due to the redeployment of theatres, staff, and equipment to support critically ill patients, and only emergency and cancer surgeries have been performed because of the risk posed by the COVID-19 infection to both patients and staff. The reduction in operating has had an adverse effect on surgical training. Opportunities for surgical trainees will remain limited and it is essential to optimise the training experience.

Oral and Maxillofacial Surgery has learnt much from the world of aviation. Mostly this has been about improving patient safety, for example by reducing stress in the operating theatre and/or reducing the rigid confines of the traditional heirachical structure in surgical teams, especially when problems arise during surgery.

The COVID-19 pandemic has catalysed the computerisation and online delivery of postgraduate examinations. Social distancing regulations and lockdown measures resulted in many written and clinical examinations being cancelled during the initial surge of the virus. In an effort to reinstate the assessment of trainees and enable career progression, the UK medical regulator, the General Medical Council (GMC) has approved unprecedented changes to clinical examinations, including virtual assessment. We outline the changes made and the advantages and disadvantages of these new examination formats.

We describe a novel technique for the insertion of a vacuum drain, in an outpatient setting, for persistent seroma post-parotidectomy. This is a retrospective case series of a single academic centre. The complete medical records of all patients who underwent parotidectomy between 2014 and 2019 were reviewed. Data regarding demographics, comorbidities, and intraoperative and postoperative courses were extracted for patients for whom a vacuum drain was inserted due to persistent seroma. A size 8 Fr drain was inserted using a novel approach through the parotidectomy incision using ‘Biovac’ (Biometrix) 50ml, Trocar kit, that had been adjusted and modified for this purpose.