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The aim of surgical management of benign facial skin lumps is to remove the lesion in its entirety, with minimal damage to adjacent tissue structures, while maintaining facial aesthetics. A method to achieve these goals is to remove peri-oral lesions in the labial and buccal zones via an intra-oral approach. We report an extended cases series of facial skin lumps that were excised using an intra-oral approach. A retrospective analysis was performed on all patients who underwent excisions of benign cutaneous lesions on the face via an intra-oral approach. Patient demographics, indication for surgery and complications were noted. Forty-seven lesions were excised over a 15-year period. Indications for surgery included benign lesion with minimal skin involvement, risks of keloid/scar hypertrophy and cosmetic factors. Lesions were predominantly epidermoid cysts and lipomas. Mean follow-up was 2.9 years with a 6.4% recurrence rate and 2.1% rate of haematoma and transient facial nerve weakness. There are established techniques to remove facial skin lumps. We believe that in selected cases, an intra-oral approach to such lesions, particularly in cases with high risk of scar pathology or where there is strong patient preference, may be an important tool in the oral and maxillofacial surgeon’s armamentarium.

Oral and Maxillofacial Surgery (OMFS) remains an enigmatic specialty in Irish medicine and many students are unaware of its scope and the unique career pathway involved. We completed a multicentre cross-sectional study to identify their ability to identify the requirements for entry to specialty training year 3 (ST3) in OMFS, to assess their awareness of OMFS surgeons, and their general awareness of, and exposure to, the specialty. Data were collected through an electronic questionnaire. Participants were asked to select the most suitable surgical specialty to treat a number of common conditions in the head and neck, and to choose the requirements they deemed essential for specialist training. Knowledge was measured by the number of correct responses. A total of 443 medical students participated (University College Cork (UCC) n=328, 74%; Royal College of Surgeons in Ireland (RCSI) n=113, 26%). A total of 318/374 (85%) had had no previous experience of OMFS, 38/374 (10%) had had theoretical teaching only, and 18/374 (5%) had had clinical experience. A total of 212/329 (64%) wished for greater exposure as a student, but only 34/329 (9%) would consider a career in the specialty. The median (IQR) number of correct responses for OMFS procedures was 3.0/10 (2.0), with women, direct entrants, and RCSI students scoring highest. Only 11/367 (3%) could identify the minimum entry requirements for a post of specialist registrar. This study has identified a potential gap in the undergraduate curriculum. Although medical students are rarely taught about OMFS, they show an interest in learning more.

Introduction Transoral partial glossectomy procedures for small squamous cell carcinomas of the anterior tongue often leave significant defects which are challenging to reconstruct. Post-operative scarring leads to adhesions, reduced tongue mobility and limitations of function. We present a series of cases where a decalcified collagen scaffold was successfully used in this challenging reconstructive setting. Methods After standard oncological diagnostic and workup, five patients underwent transoral partial glossectomy procedures. Decalcified collagen scaffolds were used to reconstruct the surgical defect using a standard protocol. Demographic and outcome data were collected retrospectively. Results The median length of post-operative stay was 5 days. There was no reported post-operative bleeds or infection. Histological margins were clear. Scaffolds remained in situ at 1 week, and functional recovery was apparent at 6 weeks post-procedure. Discussion These results suggest such scaffolds could be used as an adjunct to help reconstruct the anterior tongue after oncological resection. Conclusion The study supports a call for further exploration and research into the use of these scaffolds as a potentially beneficial avenue for reconstructing the tongue.

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.

Spring-assisted cranioplasty has been proposed as an alternative to total calvarial remodeling for sagittal craniosynostosis. Advantages include its minimally invasive nature, and reduced morbidity and hospital stay. Potential drawbacks include the need for a second procedure for removal and the lack of published long-term follow-up. The authors present a single-institution experience of 100 consecutive cases using a novel spring design.All patients treated at the authors' institution between April of 2010 and September of 2014 were evaluated retrospectively. Patients with isolated nonsyndromic sagittal craniosynostosis were included. Data were collected for operative time, anesthetic time, hospital stay, transfusion requirement, and complications in addition to cephalic index preoperatively and at 1 day, 3 weeks, and 6 months postoperatively.One hundred patients were included. Mean cephalic index was 68 preoperatively, 71 at day 1, and 72 at 3 weeks and 6 months postoperatively. Nine patients required transfusion. Two patients developed a cerebrospinal fluid leak requiring intervention. One patient required early removal of springs because of infection. One patient had a wound dehiscence over the spring and one patient sustained a venous infarct with hemiplegia. Five patients required further calvarial remodeling surgery.The authors' modified spring design and protocol represents an effective strategy in the management of single-suture sagittal craniosynostosis with reduced total operative time and blood loss compared with alternative treatment strategies. In patients referred within the first 6 months of birth, this technique has become the authors' procedure of choice. In a minority of cases, especially in the older age groups, further remodeling surgery is required.Therapeutic, IV.

In this study we investigate the five most cited articles in the British Journal of Oral and Maxillofacial Surgery (BJOMS). Articles cited were usually published in other OMFS journals (40%) or dentistry journals (32%). The mean (SD) SCImago Journal and Country Rank, (SJR) (an interface to access the bibliometric database of journals) for cited papers was 0.64 (SD=0.56). Nearly one third of citations were of research in OMFS and dentistry, suggesting its relevance to the wider academic community.

Length of post-operative stay is an important factor in improving cost-effectiveness of total hip arthroplasty (THA). Short stem femoral components may reduce soft tissue and bone damage, permitting earlier mobilization and earlier safe discharge from hospital. This study compares the length of stay of patients undergoing THA using a short stem femoral component compared to an age matched group undergoing standard THA. The mean age in the standard stem group was 52.7 years and 50.4 years in the short femoral stem group (p=0.57). Total theatre time, blood loss and post-operative Oxford hip scores in the groups were not statistically different (p=0.11, p=0.91, p=0.16). Mean post-operative stay for the short stem group was shorter (3 vs 5 days, p=0.010), resulting in 10% cost saving per patient episode.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a chronic condition of the oral cavity resulting in mucosal ulceration and exposure of underlying necrotic bone, and the ensuing secondary complications. As a relatively newly recognised condition, the epidemiology of BRONJ is poorly described. In a 2012 position statement by the UK Faculty of General Dental Practice, an estimated incidence of 10 patients per year per million population was stated.1 This would indeed classify it as a rare condition, with a GP expecting to see only a handful of cases in their career. However, with increased numbers of patients on bisphosphonate (BP) therapy, all GPs should be aware of the risk factors for BRONJ and the pre-assessment advice they give to patients commencing BP therapy. BPs inhibit the action of osteoclast cells, decreasing bone turnover and increasing bone density.2 The mechanism by which BPs cause osteonecrosis is not proven but is probably due to a combination of decreased bone remodelling, poor wound healing, and an antiangiogenic effect leading to ischaemic changes and subsequent necrosis in response to a local traumatic insult.2 The main indications for the use of BPs are for the treatment of post-menopausal osteoporosis, steroid-induced osteoporosis, Paget’s disease, and the complications of metastatic bone lesions and multiple myeloma, namely, hypercalcaemia and bony pain. It is outside the scope of this article to discuss BP …

Purpose The number of citations an article receives has been used as a marker of its influence within a surgical specialty. Currently, there is limited citation analysis in oral and maxillofacial trauma surgery. The purpose of this study was to determine the 100 most cited articles in facial trauma surgery and their characteristics. Materials and Methods Articles were identified from the Science Citation Index of the Institute for Scientific Information using the Thomson Reuters Web of Science search engine. All articles until 2015 were included. Then, the 100 most cited articles were assessed for title, author, journal, country of origin, and number of citations. A citation index (number of citations received per year) also was calculated. Results The 100 most cited articles in facial trauma received 9,933 citations (range, 66 to 297). They were published from 1942 through 2008, with 1990 through 1999 being the commonest decade. Articles were cited on average 4.6 times per year. Articles were published in 28 different journals, with impact factors ranging from 0.94 to 35.3. Most articles were observational research studies. Conclusion These findings reflect the attention that articles have received during the past half century in oral and maxillofacial trauma research, shedding light on often-read articles in this field. In addition to current bibliometric indices, it could provide a useful evidence base for facial surgeons, represent key educational material for aspiring trainees, and be used to help guide future research efforts.

Development of professional identity is becoming increasingly important in medical education, and has been found to be beneficial in a surgeon's training. However, despite the complex, demanding nature of early training in oral and maxillofacial surgery (OMFS), we know of little research on how it develops during this time. We therefore used qualitative research methodology based on a grounded theory approach to investigate how trainees gain a sense of identity as they progress through their 2 undergraduate degrees. Data from in-depth, semi-structured interviews with OMFS specialist trainees were transcribed and coded to allow for thematic analysis and subsequent theory construction. We propose a model of how professional identity develops in early OMFS training. Of note, professional experience gained during the second degree was found to be of great importance in the development of a strong professional identity. We look at reasons for this in terms of "cognitive space" and use the concept to discuss potential improvements to the training pathway.

Background and purpose of the study Although traditionally a "dentistry first, medicine second" training route, UK Oral and Maxillofacial surgery is increasingly populated with medicine-first trainees at ST3 level. Despite this, there is little evidence suggesting any increase in exposure at medical undergraduate level. We sought to evaluate the current level of awareness of OMFS as a medical specialty and potential career pathway amongst ‘first-degree' medical undergraduates. Method We distributed an on-line survey amongst 253 medical undergraduates divided between two UK universities. Findings A total of 72.3% of undergraduates received no exposure to OMFS in any form. Those with exposure had an improved understanding of the scope of the specialty. Regardless of previous exposure to the specialty, only 27.7% correctly identified the essential requirements for entry in OMFS specialty training. Nevertheless, a vast majority (76.7%) wanted more guidance on the possibility of pursuing a career in OMFS. Conclusions Undergraduate exposure to OMFS in UK medical schools is limited. Even a small degree of exposure to OMFS improves understanding of the scope of the specialty. Although medical students do not fully understand the career pathway, they wish to explore OMFS as a career option. It is therefore important that UK undergraduate surgical curricula offer greater exposure to the specialty, the career pathway and the clinical opportunities it can provide.

Oral and maxillofacial surgery has the longest training pathway of any medical specialty in the UK. Peter Brennan and colleagues look at ways to shorten this

Introduction Professional identity is becoming increasingly important in medical education in terms of developing appropriately trained and safely practising doctors. Oral and maxillofacial surgery (OMFS) is a unique surgical speciality that requires dual qualification in medicine and dentistry. Its junior trainees move between the various roles of student, doctor and dentist, and at certain times these roles may overlap. This heterogeneous early training may raise significant barriers for them in terms of understanding their professional identity and developing their own sustainable sense of belonging. This study looks to understand current trainees’ perceptions of the professional identity of an oral and maxillofacial surgeon. Method A qualitative research methodology based on a grounded theory approach was used in this study. Data were collected using in-depth, semi-structured interviews with OMFS specialist trainees. Subsequent theories were constructed after thematic analysis. Results A model of the professional identity of an oral and maxillofacial surgeon is proposed. Discussion This study represents the first attempt to understand professional identity in OMFS trainees. It will provide insight into what trainees understand by the term in this speciality, as well as outlining what trainees feel are important elements to develop a sense of belonging within the speciality.