Search

Background 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. Materials and Methods From April 1st 2020 until July 31st 2020, OMF Surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information gathered included clinical presentation, mechanism of injury, and how it was managed and whether or not treatment included surgery. Participants were also asked to compare the patient’s care with the treatment, which would have usually been given prior to the crisis. Results Twenty-nine units across the UK contributed with 2229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and mandible fractures (13%) for hard tissues. Of 876 facial fractures, 79 patients had treatment, which differed from that which would be normal pre-COVID and 33 had treatment deferred meaning 112 (14%) patients received care at variance to normal practice because of COVID restrictions. Conclusions The pattern of OMFS injuries changed during the first COVID-19 lockdown period. For the majority, best practice and delivery of quality trauma care continued in spite on-going operational challenges. Changes to treatment affected only a small proportion of patients. The lessons learnt from the first wave combined with adequate resources and pre-operative patient testing should allow those facial injuries in the second wave to receive best practice care.

Background The BAOMS QOMS pilot was developed and run in 6 England OMFS units between December 2019- April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent Patients and methods The pilot included a series of six audits(oral and dentoalveolar [ODA], oncology, orthognathic, reconstruction, trauma and skin). Data entry was clinician-led in five OMFS units and in one unit (EKHU), it was additionally supported by members of the clinical coding team. Results One hundred and twenty-eight REDCap account user details were issued and of these, 45(35%) completed registration and 22(17%) were active users who participated in the pilot data entry. Disproportionate focus on individual audits within QOMS was seen, though not all units offered the full range of service audited. Users suggest the skin and ODA audits were sufficiently clear, but improvement is required in the oncology and reconstruction questionnaire particularly. Conclusion The pilot was successful in aiding the project team identify areas of weaknesses and strength in the design of the REDCap registry and implementation of the next phase of the initiative. The information and experience gained has to date enabled a successful application for section 251 approval from the HRA and progress for the next phase of national data collection.

It is often said that medicine could learn a lot from aviation. Human and system errors affect all complex organisations including healthcare, and there is increasing awareness of the role of non-technical skills in the safe practice of surgery. Comparisons are often drawn between the way in which the aviation industry learns from errors and the paucity of learning from errors in situational judgement in medical practice. Although many of us travel on planes, very few of us fly them, but most surgeons drive regularly. We review a series of motoring incidents that demonstrate poor situational awareness and judgement, and discuss the incidents, predisposing causes, and their relevance to medical practice. These errors are transferrable to medical practice, and perhaps we can learn from them.

To find out if the devolution of some dentoalveolar services into primary care in 2007 was having an effect on the workload of oral and maxillofacial units, I reviewed the workload of two units in 2011-13.

Extensive blood loss can occur when patients have major operations for head and neck neoplasia. The risks and costs of allogeneic blood transfusion have been well documented. Acute perioperative normovolaemic haemodilution (APNH) is a method of saving blood and autologous transfusion. The purpose of this study was to compare a group of patients having major head and neck operations who had APNH, with a historical group, to assess the need for allogeneic transfusion. Of the 21 patients who had APNH only one patient required allogeneic blood. In the historical group of 24 patients, 15 patients had required allogeneic blood (p=0.0001). APNH is an economic, safe and practical way of saving blood.

Mucoepidermoid carcinoma is the most common malignant salivary gland tumour. Central mucoepidermoid carcinomas (CMC) are an exceedingly rare subgroup, representing 2-4% of all cases. The authors report on a case of CMC in a patient who presented with trigeminal neuropathy, trismus and distant metastasis. The possible pathogenesis of CMC and criteria for diagnosis are discussed.

The training of oral and maxillofacial surgeons varies considerably throughout the world and is reflected in the length of programme and scope of practice. The duration of training and workload for British and American trainees have long been topics of discussion and debate. The purpose of this paper was to compare the general training pathways of oral and maxillofacial surgeons in the UK and USA, as exemplified by the programme at the University of California in San Francisco, and in the UK by that at the East Lancashire Oral and Maxillofacial Unit.

Introduction:The objective of the study was to determine any clinical or patient perceived benefit to using a wide bore nasogastric (NG) tube following a head and neck oncological resection. (Ethical approval received). Fine bore tubes get blocked following use and sometimes require removal and replacing. Wide bore tubes have the advantage of minimal blockage they can be more uncomfortable. Variation exists between head and neck surgeons as to which NG is used. Materials/Methods: Patients assigned randomly to those having a wide bore NG tube or a fine bore tube. There are two treatment groups. Collection of information required the use of three forms. The first form was completed by surgeon/anaesthetist placing NG tube, the second by nursing staff on the ward and the third by patients on removal of the NG tube. Each form has a study reference number to allow the information to be collated. 32 patients were included in the study. 17 had a wide bore tube, 15 had narrow bore. Results/Statistics: Statistical analysis is ongoing, however the trend reveals that wide bore tubes never blocked and never needed to be replaced for this reason. Patients however found them more uncomfortable. Narrow bore tubes frequently blocked with increased time demands on nurses/team to unblock/replace, with increased radiographical exposure. Conclusion/relevance:Given the increased risk of blocking of narrow bore NG tubes it is our view that where tolerated a wide bore NG tube should be used for feeding purposes in the post operative period.