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The aim of this study was to assess the extent of cortical perforation in millimetres (mm) in inferior alveolar nerve (IAN) canal on coronal section of cone beam computed tomography (CBCT) to predict IAN injury in high risk patients. We also analysed relation of position of canal and number of roots with likelihood injury to IAN. We conducted a prospective clinical study of 100 high risk patients in which 78 patients had cortical perforation which was verified by CBCT. 13/78 of 3rd molars were associated with IAN injury at 1 month post extraction. Out of those, only 3 had a permanent decrease in sensation and remaining 10 had temporary paraesthesia. Owing to the large number of patients with cortical defects, we further sub-categorised them into five groups based on cortical perforation: Type 1 – No involvement, Type 2–1 - 3 mm, Type 3–4 - 6 mm, Type 4–7 - 9 mm, Type 5 – more than 9 mm. All of the 8 patients who had more than 6 mm (Type 4 and Type 5) had some sensory disturbance whereas no IAN injury was found in patients of type 1 and type 2. There were 5/23 who had nerve injury in type 3. The association between cortical perforation and IAN injury was statistically significant (p

To manage the soft and hard tissue injuries of the face, the surgeon requires to be comfortable with the surgical anatomy of the face and neck. This chapter will provide the reader a glimpse into the relevant anatomy which will help in the management of trauma. There are extensive texts written on this subject, and the reader is advised to refer to those for any further details. The head and neck area is divided into six zones, and an integrated relevant anatomy is provided to the reader.

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 global pandemic of Coronavirus disease (COVID-19) represents one of the greatest challenges to healthcare systems, and has forced medical specialties to rapidly adapt their approaches to patient care. Oral and Maxillofacial Surgery is considered particularly at risk of disease transmission due to aerosol generation during surgical interventions, patient proximity and operating environment. On day 2 (26th March, 2020) of when severe restrictions in population movement were instigated in the United Kingdom, we began a study to prospectively monitor the presentation and management of maxillofacial emergencies at five hospital trusts. Data was collected onto an online live database fed through a smartphone application. Of the total 529 patients over six weeks, 395 attended for face-to-face consultations and 134 patients received remote consultations via telephone or video link. There were 255 trauma related cases, 221 infection and 48 cases of postoperative complications. Most trauma cases were minor soft tissue injury related to slip, trip or fall at home. There were 44 cases of facial fractures with a tendency for conservative treatment. 19 cases were related to domestic violence or self-harm. Of the 216 dental related emergencies, 68% could have been managed in the primary care setting. A quarter of all emergency patients were satisfactorily managed by remote consultations. There was a significant change in the provision of emergency maxillofacial service during the pandemic lockdown. We discuss the study findings as well as the potential implications in relation to planning for possible further COVID- 19 spikes and future pandemics.

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.

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.

Many factors have been implicated in the development of bony ankylosis following trauma to the temporomandibular joint (TMJ) or ankylosis that recurs after surgical treatment for the condition. Although many reports have been published, to our knowledge very little has been written about the pathogenesis of the process and there are few scientific studies. Over the last 70 years various treatments have been described. Different methods have been used with perceived favourable outcomes although recurrence remains a problem in many cases, and ankylosis presents a major therapeutic challenge. We present a critical review of published papers and discuss the various hypotheses regarding the pathogenesis of the condition.

This paper provides a summary of the 49 trauma and related papers published in British Journal of Oral and Maxillofacial Surgery during the period January 2008 to December 2009. 16/49 (32%) of these publications were full length articles, which covered areas such as epidemiology, service provision, materials and operative surgery. In addition there were other articles including short communications, technical notes, letters to the editor and interesting cases. Whilst fewer full length articles were published compared to the other sub-specialties, it was reassuring to see that the studies represent all aspects of trauma. More basic science and randomized control studies relating to trauma need to be encouraged.

Many disease processes can present with facial swelling and multiple discharging sinuses. A differential diagnosis would include actinomycosis, tuberculosis and osteomyelitis, but tinea barbae is a relatively uncommon presentation.The following case report describes a 48-year-old jockey who was diagnosed with tinea barbae. It chronicles the investigations that were performed to determine the offending pathogen and the difficulty in achieving a diagnosis.The investigations and the pathophysiology of dermatophytic infections and their management in a maxillofacial/oral medicine environment are discussed.

Tongue tremor is commonly associated with essential tremor, but rarely presents as an initial finding. Essential tremor is the most common movement disorder and is characterised by 4-12 Hz postural and kinetic tremor, but there is no universally accepted diagnostic criterion. It commonly affects the arms, and to a lesser extent, other regions of the body, and signs and symptoms tend to worsen during emotional or physiological stress. We describe a rare isolated presentation of tongue tremor as a part of essential tremor, its management, and the diagnostic dilemma. To our knowledge isolated tongue tremor as a presentation of essential tremor has not previously been described in maxillofacial publications.

We describe a rare case of depressed skull fracture after a dog bite. To our knowledge only three such cases have been reported.

Introduction: A 79 year old Caucasian male underwent left sided extended hemi-maxillectomy and orbital excenteration for T4 N0 M0 poorly differentiated squamous cell carcinoma of the left maxillary antrum in 2003.He subsequently had left sided elective neck dissection for nodal disease and chemo radiotherapy. Initial rehabilitation included an adhesive retained orbital prosthesis with maxillary obturator and denture. He could not tolerate the eye prosthesis due to sensitivity over the bony ridges and elected to wear an eye patch instead. He only had two teeth in the right hemi-maxilla which were periodontally compromised and were therefore extracted. He had peri orbital implants for a bar retained orbital prosthesis. Due to his dementia he and his wife found it difficult to clean around the fixed prosthesis. Material and Methods: A removable connector was designed to incorporate a large multipurpose magnet (Technovent ®) for retention of obturator and the orbital prosthesis. This allows easy placement of orbital prosthesis followed by the obturator. The patient fondly calls this his “bottle opener”. Results: This has helped to solve both the defect obliteration and his dexterity issues for its maintenance. Conclusion: We describe and demonstrate a unique removable connector to make the hemi-facial prosthesis modular and removable. As far as our knowledge this modification is unique and not described in the literature