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Patient-specific, additively manufactured (printed) titanium reconstruction plates have been widely used to improve accuracy and efficiency of fibular flap reconstruction of the mandible. Miniplates possess some potential advantages over single-piece reconstruction plates, however multiple-miniplate fixation can be more technically demanding and may lengthen the duration of surgery. Furthermore, incremental angulation errors in screw placement for each miniplate could compromise overall dimensional accuracy of the neomandibular reconstruction. This preliminary article reports the first clinical use of a new patient-specific, printed titanium miniplate-jig system in a patient undergoing hemimandibulectomy for osteoradionecrosis of the mandible withfibular flap reconstruction. Our initial experience with the new deviceand technique demonstratesa quick, user friendly, and precise method for the placement and fixation of multiple miniplates in fibular-flap reconstruction of the mandible.

Facial trauma accounts for 5%-10% of all presentations to emergency departments (ED) in the UK, and it is often referred to the oral and maxillofacial surgery (OMFS) department by ED physicians. Undergraduate medical students often have limited exposure to OMFS, and this is likely to translate to reduced exposure to facial trauma. We investigated the exposure of undergraduate clinical medical students to facial trauma teaching and asked about their confidence to manage facial lacerations and their ability to diagnose common facial fractures. An online survey was completed by 237 medical students across two English universities, 154 (65%) from University A and 83 (35%) from University B. Of the students, 68% reported no exposure to any teaching in facial trauma up to their current year of medical school; no statistically significant differences were found among the year groups (p0.05). The majority of facial fractures within our cohort were referred to ear, nose and throat (ENT) (43%), followed by OMFS (31%), and plastic surgery (12%). In total, 84% of students did not feel competent to manage facial lacerations, and 95% were not confident to present a facial injuries examination to a senior colleague. Exposure to facial trauma teaching remains poor. Future work should aim to devise a clear OMFS curriculum with objective teaching on facial trauma.

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 20% likelihood of nodal metastases was only apparent in primary tumours greater than 6 mm thick. The length of inpatient stay was increased from 3.7 to 16.5 days with free vascularised transfer. There were complications including cranial nerve damage. There were two peri-operative deaths. No ipsilateral neck failures occurred, median follow up was 937 days. To reduce unnecessary END, resection can be undertaken as a prior procedure, subsequently only carrying out END on tumours greater than 6 mm, or with unfavourable tumour characteristics.

Females are under-represented in surgery, including in leadership roles within academia. The Royal College of Surgeons of England and British Association of Oral and Maxillofacial Surgery (BAOMS) have both initiated programmes aiming to promote equality, diversity and inclusion in gender representation. This article quantifies the gender representation amongst editorial boards of oral and maxillofacial journals and further reinforces that there is more work to be done to promote gender parity.

In 2008, to create a rapid route for information transfer in relation training and recruitment for OMFS trainees, the British Association of Oral and Maxillofacial Surgeons (BAOMS) created a website to "Register Your Interest in OMFS" (RYIO). From 2011 a Mentoring and Support Programme (MSP) was created to provide focussed guidance for trainees aiming for specialty training. This paper reviews the effectiveness and cost of these programmes. Between 2008 and 2020, 1744 individuals used RYIO on 2715 occasions. Of these registrations, 1772 were by dentists, 193 dental students, 589 doctors and 161 medical students. 2354 were from UK and Ireland and 351 from the rest of the world. 188 registrants subsequently became UK OMFS trainees or specialists. All registrants valued the information provided. In response to RYIO trainee feedback the new ‘Taste of OMFS 2020’ programme was created. The MSP was originally called the Junior Trainee Programme (JTP). The MSP scheme provides a layer of mentorship/support which runs parallel to the medical/dental training post or period of study. Of 180 members of MSP, 72 have obtained specialty training posts in OMFS. There are 88 current members. Full information is available on the BAOMS website www.baoms.org.uk . Reviewing both programmes, participant feedback is excellent with tangible results whilst cost effectiveness is high.

The Intercollegiate Membership of the Royal College of Surgeons (MRCS, parts A and B) is a mandatory examination for entry into higher surgical training in the UK. We investigated which factors predict success in both the written (Part A) and clinical (Part B) parts of the examination, and provide a summary for oral and maxillofacial surgeons (OMFS). All UK graduates who attempted both parts between 2007 and 2016 were included. There was a positive correlation between the scores in parts A and B (r=0.41, p

Noise in the operating theatre has an adverse impact on healthcare professionals, both physically and psychologically. It can be distracting, make communication difficult, and contribute to a perceived increase in stress. Staff in theatre must deliver high quality care, and overlook noise as a potentially damaging influence. The aim of this survey was to obtain further information about the perspective of healthcare professionals on how noise can affect their practice and whether it affects their work in theatre. We distributed six closed-ended questions in the form of a Survey Monkey® questionnaire to about 50 hospitals across the UK and target groups such as medical students, the Leeds Advanced Trauma Life Support faculty group, the Court of Examiners of the Royal College of Surgeons of England, and surgical trainees sitting the Member of the Royal College of Surgeons examination. We received 519 responses of which 415 respondents (83%) thought that noise contributed to human errors. A total of 282 participants (57%) thought that the theatre was the noisiest area within the theatre suite. Both communication among staff (n=400, 80%) and concentration (n=384, 77%) were thought to be adversely affected by noise. However, 385 (78%) did not feel that music adversely affected their performance. The results provide insights into the interplay of noise and its effect on people. Although the role of music remains contentious, our results suggest that it might have a calming influence.

This review summarises all orthognathic and related papers published between January 2011 and December 2012 in the British Journal of Oral and Maxillofacial Surgery (BJOMS). A total of 36 articles were published, a high proportion of which (78%) were full-length papers. The remainder consisted of short communications and technical notes. The topics included operative planning and postoperative outcomes, and there was a strong focus on distraction osteogenesis. There were fewer orthognathic articles published in BJOMS than articles on other subspecialties such as trauma or head and neck oncology. Only 8 (29%) of the full-length articles were prospective studies or randomised trials, which highlights a need for well-designed clinical studies in orthognathic research.

Carcinoid tumours are usually slow-growing, neuroendocrine neoplasms that primarily affect the gastrointestinal tract and bronchial tree. Although relatively rare, isolated, single metastasis to the head and neck has been reported. We present a unique case of 6 metachronous carcinoid metastases to both parotid glands, the left submandibular gland, upper lip, and thyroid, over 3 years. To our knowledge, this widespread presentation in the head and neck has not previously been reported.

Anatomical variants that affect both the anterior and posterior digastric muscles are well described, and include duplications and variable origin or sites of insertion. Although agenesis or atrophy of the anterior digastric occurs in up to 40% of patients with hemifacial microsomia, to our knowledge, it has been reported only rarely in those without this syndrome. To minimise observer bias and to establish the incidence of anomalies and atrophy of this muscle, a prospective 6-year study was conducted by an experienced consultant radiologist in all patients referred for ultrasound of the head and neck. Unilateral atrophy or absence of the anterior digastric muscle was seen in 3 of 1484 patients (0.2%). All 3 were female, and they had no symptoms or clinical signs related to the finding. One subsequently had a magnetic resonance scan. Non-syndromic absence or atrophy of the anterior digastric muscle is rare, and seems to be a unilateral phenomenon. Recognition of this variant could be important before operations in which it may be used as a landmark, or during procedures in which it is used, for example, for reanimation of a static lip or during reconstruction with a submental island flap.

We review papers on diseases of the salivary glands published in journals relating to the head and neck, which are commonly read by members of our specialty. Most of the papers focus on the investigation and treatment of diseases of the parotid gland, which reflects the relative prevalence of parotid lesions among salivary gland diseases. Minimally invasive surgery is increasingly of interest. There is a lack of clinical trials that address the many controversies concerning salivary gland surgery, and much of the evidence for treatment is based on small case series and expert opinion, partly because of the relative rarity of salivary disease and the disparate groups that treat it. This problem could be addressed if regional and national oral and maxillofacial surgery (OMFS) units, and possibly other specialties, could collaborate more closely and combine data.

Osteoradionecrosis (ORN) is potentially a debilitating and serious consequence of radiotherapy to the head and neck. Although it is often defined as an area of exposed bone that does not heal, it can also exist without breaching the mucosa or the skin. Currently, 3 classifications of ORN are in use, but they depend on the use of hyperbaric oxygen or are too complicated to be used as a simple aide-mémoire, and include features that do not necessarily influence its clinical management. We propose a new classification to cover these shortcomings and to take into account the increasingly widespread use of antifibrotic medical treatment. We classified a series of 85 patients with varying severities of ORN into 4 groups. An analysis of the outcomes of the series showed that the classification staged the severity of the condition simply and that the stage was relevant to both treatment and outcome. The new classification was therefore verified by the series presented.

We aimed to investigate the concentration of copper ions in drinking water and to assess whether copper has a role in the pathogenesis of oral submucous fibrosis (OSMF). We studied 50 patients with clinically and histologically diagnosed OSMF from the Yadgir district of Karnataka in India. Fifty healthy people matched for age and sex were used as controls. In both groups concentrations of copper ions in serum, saliva, and home drinking water were measured using atomic absorption spectroscopy and intelligent nephelometry technology. Serum ceruloplasmin concentrations were also estimated in both groups. The mean (SD) concentration of copper in the home drinking water of patients with OSMF was significantly higher (764.3 (445.9)μmol/L) than in the controls (305.7 (318.5)μmol/L) (p

The role that human factors have in contributing to air crashes is well known and is included as an essential part of training. Awareness of human factors in surgery is increasingly being recognised but surprisingly few papers have come from head and neck specialties. We circulated a questionnaire on human factors based on an aviation model to 140 head and neck medical and ancillary staff who work in operating theatres in 3 large UK hospitals. Most positive responses were found in the consultant group followed by trainee doctors and support staff. A significant difference was found in the subcategories of Unsafe Supervision ( p = 0.002) and Preconditions to Unsafe Acts ( p = 0.001). This work will help to identify multi-system deficiencies that can be corrected, and highlights aspects that may yield the greatest reduction in surgical errors.

Facial paralysis can have a profound effect on the patient from both an aesthetic and functional point of view. The symptoms depend on which branch of the nerve has been damaged and the severity of the injury. The purpose of this paper is to review currently available treatments for dynamic reanimation of a damaged facial nerve, and the goals are a symmetrical and coordinated smile. Careful selection of patients and use of the appropriate surgical technique can have excellent results.

Suspicious malignant supraclavicular lymphadenopathy provides a challenge for diagnosis and treatment. The wide variety of primary tumours that metastasise to this region should alert the clinician to look beyond the head and neck, particularly if it is the only site in the neck with suspected disease. As metastatic spread to these nodes from primaries not in the head and neck often indicates wide spread disease, neck dissection is controversial. In this article we review the lymphatic anatomy and discuss the investigation of supraclavicular lymphadenopathy. We discuss the evidence for the management of the neck in patients with subclavicular primary cancers (excluding lymphoma and melanoma) and the role of neck dissection.

Full length articles such as prospective and retrospective studies, case series, laboratory-based research and reviews form the majority of papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS). We were interested to evaluate the breakdown of these types of articles both by sub-specialty and the type of study as well as the proportion that are written by UK colleagues compared to overseas authors over a 2 year period (2010-11). A total of 191 full length articles across all sub-specialties of our discipline were published, with 107 papers (56%) coming from UK authors. There were proportionately more oncology papers arising from the UK than overseas (60 and 30% of total respectively) while the opposite was found for cleft/deformity studies (10% and 22%). There was only one laboratory-based study published from the UK compared with 27 papers from overseas. The number of quality papers being submitted to the Journal continues to increase, and the type of article being published between UK and overseas probably reflects different practices and case-loads amongst colleagues. The relatively few UK laboratory based studies published in BJOMS compared to overseas authors are most likely due to authors seeking the most prestigious journals possible for their work.

The present study examined the possible use of autologous human plasma (AHP) to improve the in vitro culture for cytogenetics of benign and malignant oral tumor cells. The effect of AHP on the growth of a variety of benign and malignant head and neck tumor cells was studied by inverted microscope and cytogenetic analysis. Minced tumor biopsies of cases of hemangioma (HM), lipoma (LP), central giant cell granuloma (GC), pleomorphic adenoma (PA), schwannoma (SW), oral squamous cell carcinoma (SCC), Ewing sarcoma (ES), Merkel cell carcinoma (MCC) and adenoid cystic carcinoma (ACC), were cultured in medium supplemented with either AHP, allogeneic pooled human plasma (PHP), or fetal calf serum (FCS). More fibroblasts were seen in the FCS supplemented cultures, while in HP or PHP culture medium, more epithelial-like tumor cells were noted. The karyotypes of HM, LP, GC and PA were normal in all 3 different mediums. Cytogenetic analysis of SW and SCC revealed random numerical changes in all cultures. However, in AHP cultures a clone bearing translocation was found in SW t(2;13). In the SCC cultures one tumor had t(12;14) and the other t(3;21) translocations. Complex karyotype was found in all kinds of cultures in ES, MCC and ACC. AHP by itself does not cause chromosomal aberrations but may improve the ability to find chromosomal aberrations in some tumors over medium containing FCS. The spectrum of oral tumors where AHP can improve the cytogenetic analyses should be further studied on a greater number of tumors.

With the 2012 Olympics being held in London, we explored pre-requisites for success in sport, and the comparative efficacy of employing these when performing under intense pressure in the clinical setting. We asked members of the Great Britain Olympic rowing team and OMFS surgeons to complete a validated questionnaire on how they performed under pressure. 89 questionnaires were completed by 43 surgeons and 46 rowers (81% response). We compared the results in terms of mental toughness and technical skill. The importance of training to be a winner was evident in athletes. While emphasising the multidimensional nature of talent, we recognise the essential role of psychology in the ability of individuals to fulfil their sporting potential. We discuss the possible implications for surgeons.

Narrow band imaging (NBI) is a novel method of imaging that increases the diagnostic potential of conventional endoscopy. It highlights abnormalities in the superficial vasculature of mucosal lesions so that precancerous or cancerous lesions can be identified more easily. Initially developed for the gastrointestinal tract, and widely used in other branches of medicine, it is now being used for the assessment of patients with malignancy in the head and neck. We review current published papers relating to NBI and discuss its benefits for early detection of cancer of the head and neck.

Fracture of the mandible during exodontia is fortunately rare, but is under-reported. A review identified 189 documented cases of iatrogenic fractures of the mandible (IFM) associated with the removal of teeth. The reasons for its occurrence are thought to be multifactorial and include age, sex, degree of tooth impaction, relative volume of the tooth in the jaw, pre-existing infection or bony lesions, failure to maintain a soft diet in the early postoperative period, and the surgical technique. The clinical experience of the surgeon does not seem to have an important role. We review the aetiology of iatrogenic mandibular fracture and summarise the ways of minimising this complication.

Despite the increasing number of cases of osteonecrosis of the jaws related to bisphosphonate therapy described in the literature there is a paucity of evidence-based treatment for the condition. In this second article on bisphosphonate-related jaw complications we discuss the different treatment strategies for the condition, review current literature, particularly in relation to the recommendations that have been published, and discuss the evidence behind them.

The Intercollegiate Committee for Basic Surgical Examinations (ICBSE) is responsible for the standard, quality assurance, and continued development of both the MRCS and the Diploma in Otolaryngology and Head and Neck Surgery (DOHNS). It is accountable to the 4 Royal Colleges of Surgeons in the U.K. and Ireland, and the General Medical Council (GMC). This article gives information and an update (including pass rates) for candidates and trainers on the 2013 MRCS format, and summarises the most recent changes to the examination made by the ICBSE with the approval of the GMC.

Paralysis of the hypoglossal nerve, the twelfth (XII) cranial nerve, leads to atrophy, deviation of the tongue to the affected side, and varying degrees of fasciculation. The injury to the nerve can occur from its origin to the tongue itself. The causes of hypoglossal nerve palsy are well documented, but idiopathic, isolated nerve palsy that does not recover, is rare. To our knowledge we describe the first case that failed to resolve, and discuss the importance of meticulous investigation to make a diagnosis and rule out sinister disease.

The Annual Scientific Conference of the British Association of Oral and Maxillofacial Surgeons (BAOMS) provides an opportunity for colleagues to present papers to their peers, which can be beneficial both for professional development and for trainees to enhance their future career prospects. Each year far more abstracts are submitted than slots are available for oral presentation. These abstracts are reviewed by a paper selection committee, made up of several BAOMS colleagues. To our knowledge, there have not been any previous studies that have evaluated whether the type of study submitted (retrospective study, audit, prospective and so on) or the surgical sub-specialty is more likely to be accepted for presentation. Of 237 abstracts submitted for oral presentation at the 2009 conference, 99 were accepted (42% overall acceptance rate). Oncology and salivary gland disease formed the greatest proportion of total submissions (23%) followed by miscellaneous clinical papers (19%). The commonest type of submissions were retrospective studies (19%) followed by case report/series (15%). The greatest acceptance rate in this series was for orthognathic and TMJ papers (P0.01) while for type of presentation, research/laboratory studies, technical procedures and randomised trials were most likely to be accepted (P0.01 for all). It is possible that there are a certain number of slots allocated for presentation in each sub-category, which may increase competition in certain areas, but further work is necessary in this area. We recommend some general points for the successful acceptance of abstracts.

We aimed to find out whether dental practitioners take specific measures to identify patients who are at risk of osteoradionecrosis (ORN) of the jawbones; how oral and maxillofacial surgery units in the United Kingdom manage patients who have had radiotherapy and require dental extractions, and the evidence behind current practice. We sent postal questionnaires to 60 dentists and 117 maxillofacial units. Dentists were questioned about measures used to identify radiotherapy patients, and use of antibiotic prophylaxis. Maxillofacial units were questioned about the existence of written protocols and the measures used to minimise the risk of ORN. Thirty-five percent of dentists questioned ask specifically about head and neck cancer or radiotherapy as part of their medical history, and 5% of maxillofacial units questioned had written protocols for the management of patients who had had radiotherapy or had previously been diagnosed with ORN. Prophylactic antibiotics are recommended for patients at risk of ORN by 16% of dentists and 81% of maxillofacial units. Preoperative mouthwash is recommended by 59% of maxillofacial units. Identification of patients at risk of ORN is the first step in prevention but it is not done efficiently at present. Recommendations include the use of preoperative mouthwash and prophylactic antibiotics. Operations should be atraumatic and should be done by experienced clinicians.

The management of salivary gland disease forms a considerable part of the work done by oral and maxillofacial surgeons. Fast track and one-stop head and neck lump clinics allow for early diagnosis of salivary gland tumours in most units, the emphasis being on outcome after operation for benign disease. There have been limited advances in salivary gland surgery in recent years. Most recent publications have compared outcome of new methods of treatment with conventional techniques. This article reviews papers related to diseases of the salivary glands published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) over a two-year period (2007-2008), and includes other relevant articles to bring readers up to date about salivary gland disease.

Erythroplakia is an epithelial lesion that holds the highest risk of showing severe dysplasia or microinvasive carcinoma. The gold standard treatment is total excision to obtain a complete histopathological diagnosis. Traditionally this has been done by illumination of the lesion with white light, and resection with adequate margins. The difficulty with erythroplakia is that margins can be hard to delineate precisely, and even severe dysplasia can be seen with only subtle changes in the surface mucosa. Narrow band imaging is a novel technique that enhances the diagnostic potential of endoscopy. It highlights abnormalities in the superficial vasculature, which means that lesions such as oral erythroplakia can be identified more easily. We report its use in the identification of the full extent of lesions, and show its intraoperative advantages in obtaining resection margins free from disease.

he formation of a salivary fistula after elective parotidecomy is rare, but it can cause both physical and psychosocial roblems. While most fistulas resolve with medical or surical management, for example, with the use of hyoscine,1 otulinum toxin,2 and cyanoacrylate glue, refractory fistulas an be difficult to treat, and completion parotidectomy can amage the facial nerve. We report the successful treatment f a persistent parotid fistula using an allogenic acelluar dermal matrix (AlloDerm®, LifeCellTM, BioHorizons, irmingham, USA) after several interventions had failed. To ur knowledge, this use of AlloDerm® has not previously een reported.