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Healthcare professionals are often confronted with children presenting to the emergency department with dento-facial infections. These infections may be associated with dental neglect and as such could be a marker for general neglect. The aim of this retrospective study was to ascertain whether dento-facial infections can be used as an indicator for general neglect.All children aged 16 years and under, who were admitted for surgical incision and drainage of dento-facial infection between January 2017 and January 2019 at King's College Hospital were examined retrospectively. All patients were discussed with the local safeguarding team/local authority to establish whether they were previously known to social services.This study showed that in our cohort, 48% of children admitted with dento-facial infection were already known to social services and one (2%) had been recently referred. The most commonly affected age group were 5-8-year-olds (50%) indicating that these children have an increased risk of neglect. An average of 5.6 teeth were extracted and four (10%) patients required extra-oral drainage. The average hospital stay was 2.26 days.Our retrospective study revealed that social services were already aware of 48% of patients under the age of 16, who were admitted to hospital with a dento-facial infection. This suggests a relationship between dental neglect and generalised neglect. Families of children presenting with dento-facial infection should be supported in accessing appropriate dental services for their children and clinicians should consider dento-facial infection a potential 'red flag' for generalised neglect.

Oral & Maxillofacial Surgery is unique specialty requiring dual qualification in medicine and dentistry. Since the inception of national recruitment a decade ago, only 70% of available posts have been filled. In a 2019 round, this was a worrying 30%. Questionnaires were sent to trainees at various levels via the Facebook JTG and Registrar groups. Data were collected on debt experience, and awareness of and access to financial assistance. We received 66 responses. The most important sources of funding were NHS work (46%), followed by student finance (25%). Of those surveyed, 79% were ‘concerned’ or ‘very concerned’ about debt. Respondents were interested in receiving more information on a range of sources of funding, such as non-NHS bursaries (81%), NHS bursaries (59%) and NHS work in OMFS (56%). Respondents identified the financial impact (44%), and the effect of personal and family life (41%) as the two biggest drawbacks to second-degree studies. In view of the persistent recruitment issues at the ST3 level in OMFS, it is important to address concerns surrounding second-degree study. Awareness of available support must be raised in order to safeguard the future of our specialty in its current format.

Paediatric orbital fractures are rare. Existing literature demonstrates wide variation in estimates of incidence, aetiology, management protocols and outcomes. Despite this, it is generally acknowledged that orbital fractures with entrapment of the extraocular muscles constitute a surgical emergency due to the potential for persistent diplopia secondary to muscle ischaemia and necrosis.This retrospective study was conducted to determine the characteristics and outcomes of management of orbital fractures amongst the paediatric population. It involved patients presenting to a major trauma unit in London between 2010 and 2020.Thirteen patients with isolated orbital fractures presented to our unit in this period. The average age was 13 years. Surprisingly the predominant aetiology was interpersonal violence. The most common fracture pattern involved the orbital floor and medial wall. One medial wall fracture case was missed in the emergency department. Eight patients required surgical intervention due to diplopia caused by muscular entrapment of extraocular muscles; the final patient had a large defect resulting in enophthalmos requiring a large titanium plate. A transconjuctival approach was preferred for surgical access and resorbable sheet was used in the remaining cases. Five patients had nausea, vomiting or bradycardia associated with the oculocardiac reflex. Surgical intervention occurred within 24-48 h of injury in 6 cases. Resolution of diplopia occurred in 7 patients within 6 months.Paediatric patients with orbital fractures should be assessed on the day of injury by a maxillofacial surgeon. Due to the risk of persistent diplopia, urgent surgical intervention in patients with entrapment of extraocular muscles should occur as soon as possible.

This study considers the confidence of dental core trainees (DCT’s) as they mature and progress through their first 6 months in an Oral and Maxillofacial Surgery (OMFS) training post. Trainees have different incentives for embarking on a year in OMFS; to develop additional skills before settling into general dental practice, as a step towards specialty training and for those who are uncertain about their career direction1. Traditionally, an OMFS year has been associated with creating well-rounded and confident clinicians2. We surveyed 123 DCT’s at 3 stages over a 6-month period to monitor their confidence towards 10 clinical domains: assessing dento-facial infection, mandible fractures, mid-face fractures, intra-oral/extra-oral swellings, airway risks, intra-oral/extra-oral lesions (benign/malignant), CT/MRI scans and performing intraoral/extra-oral suturing. This study demonstrates an increase in trainee confidence across all domains over the first 6 months of an OMFS post, with a particularly significant increase in the assessment of dento-facial infection, mandible/mid-face fracture and both intra/extra-oral lesions and swellings.

Post-traumatic stress disorder (PTSD) is a distressing consequence of a traumatic event associated with an increased suicide risk and reduced quality of life. Surgeons often have low confidence in identifying psychological problems. The prevalence of PTSD following facial trauma ranges from 23% to 41%. This highlights the importance of identifying and managing at-risk patients to optimize both mental and physical recovery. IMPARTS (Integrating Mental and Physical healthcare: Research, Training and Services) provides electronic screening tools to guide the non-mental health clinician in the ‘real-time’ identification, documentation, and management of potential mental health problems. The bespoke IMPARTS facial trauma screening tool was piloted in a UK oral and maxillofacial surgery trauma clinic from July 2015 to November 2017. A total of 199 patients completed screening, with 48 (24%) screening positive for possible PTSD. Further analysis of these 48 patients revealed that four (8%) had PTSD symptoms alone; three (6%) also screened positive for depression, 17 (35%) for co-existing symptoms of anxiety, and 24 (50%) for PTSD, anxiety, and depression. IMPARTS was found to be a highly effective tool aiding the non-mental health clinician to screen for PTSD and initiate prompt management. The data captured informs planning of the psychological support service.

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.

Introduction Electric scooters (e-scooters) are rife but are yet to be legalised in the UK. The aim of this paper was to investigate whether there had been an increase in the number of e-scooter injuries referred to the oral and maxillofacial surgery (OMFS) service at our unit. We present here what is, to our knowledge, the largest dataset regarding e-scooter-related injuries in the UK.Method A double cohort study in which details of patients sustaining e-scooter-related injuries that were referred to the OMFS department were collected, prospectively, for a 16-week period in 2020 (investigation period). This was compared with data collected, retrospectively, from the emergency department (ED) referral database for the same date range in 2019 (control period).Results In the investigation period, 12/649 referrals to OMFS from the ED were for e-scooter-related injuries. There were eight male patients and four female patients with a mean age of 35 years (interquartile range 24-48). Of these, only one patient was wearing a helmet and 8/12 had consumed alcohol. Head and neck injuries sustained included avulsed teeth, mandibular and midface fractures, skull fractures, facial lacerations and cervical spine injuries. One patient died as a result of their injuries. During the control period, 2/997 ED referrals to OMFS were for e-scooter-related injuries (12/649 versus 2/997; Fisher's exact test p0.001).Conclusion There was a significant rise in e-scooter-related injuries seen at our major trauma unit compared with 2019. We recommend that e-scooters are subject to at least the same requirements in safety equipment and sobriety as bicycles and that their top speed is limited to 12.5 mph. We hope that these measures will allow the benefits of this technology to be enjoyed while reducing associated morbidity and mortality.

Background Intraoral bleeding complications in implant surgery are infrequent; nevertheless, serious and life-threatening complications have been described, generally related to mandibular implants. Purpose This article presents the exceptional case of a 24-year-old woman who underwent repeated delayed life-threatening episodes of intraoral bleeding following uncovering of a maxillary dental implant. Local measures afforded only temporary control. Results The episodes were successfully managed by embolising the greater descending palatine artery, and the patient remains now under close follow-up. Conclusions Early recognition of shock secondary to hemorrhage following intraoral surgery is of paramount importance.

Background The United Kingdom entered ‘lockdown’ on the 23 March 2020 due to the COVID‐19 pandemic. This resulted in school closures forcing children to remain at home. Dental‐facial trauma was still likely to be common place due to falls and injuries exercising. The aim of this study was to explore the impact of the COVID‐19 pandemic on clinical practice in a paediatric population in a tertiary care hospital and a linked Dental Institute. Method A proforma was designed to capture the demographics, presenting complaints, type of dental‐facial injury, treatment need and the treatment received for all paediatric patients presenting face to face with dental‐facial trauma to King's College Hospital during the ‘lockdown’ period (23 March‐ 14 June 2020). Results Four hundred and twenty calls were triaged, converting to 102 patients seen face‐to‐face for dental‐facial trauma. The remainder were able to be triaged ‘virtually’. Injuries seen included 56 (54.9%) dentoalveolar injuries, 37 (36.2%) lacerations, five (4.9%) suspected facial fractures and four (3.9%) dog bites. Males and females were equally affected. The majority of incidents occurred in the home environment (n = 60, 58.8%), with the remainder (n = 42, 41.2%) occurring outside the home environment. The main causes of dental‐facial trauma were falls (n = 47, 46.1%) and bicycles/scooters (n = 29, 28.4%). The most common type of dentoalveolar injury was lateral luxation (n = 15, 26.7%), followed by avulsion (n = 12, 21.4%). Only one child required treatment under general anaesthesia (GA). Conclusion The demographic, presenting complaints and treatment needs of patients who presented during the lockdown period with dental‐facial trauma were unusual. The overwhelming majority were able to be treated without the use of GA. The attendance protocol in a tertiary care setting and the use of ‘teledentistry’ ensured only the most severe trauma cases were seen. This highlights how more complex trauma can still occur during ‘lockdown’ and requires immediate management.

The purpose of this study is to execute an evidence-based review answering the following question (PICO): “Do patient-specific implants (PSI), manufactured or designed using computer-assisted technology, improve outcomes (orbital volume change, enophthalmos, diplopia, and operative duration) compared to conventional methods in orbital reconstruction following traumatic orbital injury in the adult patient population?” We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. Inclusion criteria included any comparative paper whereby computer-assisted technology was used in the prefabrication or design process of implants for use in post-traumatic orbital reconstruction. Paediatric patient populations were excluded. Eight databases were systematically searched for relevant studies. Risk of bias was assessed through the NOS and RoB2 tools. Random-effects models were used to identify differences in outcomes between groups where possible. Analysis was performed using R 4.0.0. Eleven of 4784 identified studies were included, comprising 628 adult patients, with 302 and 326 patients in the patient-specific and conventional groups, respectively. Weighted mean difference between unaffected and post-operative orbital volume was 0.32 ml (SD 0.75) and 0.95 ml (SD 1.03) for patient-specific and conventional groups, respectively. Significant improvement was identified in post-operative orbital volume reconstitution with the use of PSI, compared to conventional implants, in 3 of the 5 reporting studies. Equally, post-operative enophthalmos trended towards lower severity in the patient-specific group, with 11.2% of patients affected in the patient-specific group and 19.2% in the conventional group, and operative duration was significantly reduced with the use of PSI in 3 of the 6 reporting studies. Despite a tendency to favour PSI, no statistically significant differences in key outcomes were identified on meta-analysis. Although there is some encouraging data to support improved outcomes with the use of patient-specific orbital implants in post-traumatic reconstruction, there is, at present, no statistically significant evidence to objectively support their use over conventional implants based on the currently available comparative studies. Based on the results of this study, the choice of implant used should, thus, be left to the discretion of the surgeon.

Aim In the U.K, Dental Core Training (DCT) is an elective postgraduate training programme. There are over 700 DCT jobs with the majority in Oral and Maxillofacial Surgery (OMFS). Our focus was to measure the confidence and skills of 103 DCTs, as they mature during a year in OMFS. Method OMFS DCTs answered questionnaires in month 1, 3 and 6 of their training post, regarding confidence and proficiency in assessment of dental infections, facial fractures, swellings, pathology, airway risk, imaging and performing suturing. Results In month 1, 55% of DCTs were ‘somewhat confident’ in performing intra-oral suturing and assessing dento-facial infection out of the skills assessed. Only 22% of DCTs were ‘extremely confident’ in any competencies. Specifically, DCTs felt ‘not at all confident’ with interpretation of scans (78%) and assessment of facial fractures (35%). Between month 1 and month 6 there has been an increase in confidence across all competencies. Notably, a 42% confidence increase in extra-oral suturing and 61% increase in assessing mandibular fractures. Conclusions We demonstrate that an OMFS training year improves confidence in clinical skills and that an adequate time in a post is required to attain that. Our results highlight areas where DCTs lack confidence early in their posts. These could be targeted at dental school, during the hospital induction process or through guided support and training in the initial phase of their jobs. This study adds clarity to both dentists and doctors contemplating a training year in OMFS and gives insight into how to support and train them.

Electric scooters (e-scooters) provide a potentially attractive means of private transportation in the pandemic era, during which use of public transport is discouraged. E-scooter use has become widespread recently, and we have noticed a concomitant rise in related craniomaxillofacial injuries, often associated with alcohol consumption and lack of protective equipment. We present here the first-published UK data on electric scooter injuries which, in the post-lockdown period, included facial lacerations, mandibular and midface fractures, avulsed teeth, and cervical spine injury. We urge that forthcoming legislation make e-scooters subject to at least the same requirements in lighting, helmet wear, and sobriety as bicycles and that, in this way, their benefits can be enjoyed while reducing associated morbidity and mortality.

Background During the coronavirus pandemic, paediatric patients will still likely present with dental pain and infection. In order to streamline care at King's College Hospital (KCH), Paediatric Dentistry and Oral and Maxillofacial Surgery (OMFS) have developed a collaborative working approach allowing patients to be treated effectively and to streamline patient care in the absence of easy access to general anaesthetic facilities. Method Presenting complaints, treatment need and the treatment received were recorded for all paediatric patients presenting with dental pain and infection in the “lockdown” period (23rd March- 14th June) during “normal” working hours and “out of hours” to either paediatric dentistry or OMFS. Results 420 calls were triaged which converted to 67 patients seen face-to-face for oro-facial pain and infection. 41% of children were treated successfully under Local anaesthetic alone, only 13% required a general anaesthetic (GA) in the “lockdown” period. The vast majority of patients had antibiotics prescribed prior to attendance (80%). Conclusion We have demonstrated the demographic, presenting complaints and treatment need of patients who presented to KCH during the lockdown period with dental pain and infection. The majority were able to be treated without needing for GA facilities. This paper highlights how a collaborative approach between paediatric dentistry and OMFS can help streamline patient care and is a model which can be adopted by other units in the event of further “lockdowns”.

Introduction The restrictions imposed on social activity in response to the Covid-19 pandemic have had a profound impact globally. In the UK, the NHS was placed on a war-footing, with elective surgery, face-to-face outpatient clinics, and community care facilities all scaled back as a temporary measure to redistribute scarce resources. There has been concern during this period over increasing levels of violence in the domestic setting, as well as self-harm. Methods Data was collected on all patients presenting with traumatic penetrating injuries during the ‘lockdown’ period of 23rd March to 29th April 2020. Demographics and injury details were compared with the same period in the two preceding years. Results Overall trauma fell by 35% compared with the previous year. Over one in four penetrating injuries seen were a result of self-harm, which was significantly higher than in previous years (11% in 2019, 2% in 2018). There were two cases of injuries due to domestic violence, while a total of 4 cases of injury arose in separate violent domestic incidents. Self-harm commonly involved penetrating injury to the neck. Discussion Our centre has seen an increase in the proportion of penetrating injuries as a result of both self-harm and violence in the domestic setting. The number of penetrating neck injury cases, which can represent suicidal intent or a major presentation of psychiatric illness, is of particular concern. We must further investigate the effect of social restrictions on violent injury, and how home confinement may influence a changing demographic picture of victims., Highlights - Overall penetrating trauma figures fall during Covid-19 ‘lockdown’ - Injuries resulting from self-harm and domestic violence rise - Over one in four penetrating injuries a result of self-harm - Changing demographic with older males presenting with self-inflicted injuries - Violence of all aetiologies in the domestic setting rises

Provide an update on the diagnosis and management of the recurrent aphthous stomatitis (RAS). It is worth noting that the papers included were on RAS and not oral ulceration secondary to other causes. Although the diagnosis of RAS is discussed, it was beyond the scope of the article to discuss the features of all other conditions associated with recurrent oral ulceration; therefore, the onus was placed on the clinician to ensure that they can distinguish RAS from ulceration related to systemic conditions. A genetic basis for the RAS was suggested, and precipitating factors included trauma, stress, foods, hormonal imbalance, and tobacco smoking. Diagnosis is made on the basis of the history and clinical findings, as there are no specific diagnostic tests. There are many papers available on RAS, but as the exact aetiology remains unknown, curative treatment currently remains elusive.

Background Closure of facial lacerations in young children can be difficult under local anaesthetic in an emergency department setting. Sedation or general anaesthetic are often required to close lacerations safely and to a good surgical standard. Our hospital introduced the use of local anaesthetic gel (LAT) following an audit, to reduce the need for paediatric admissions. In light of the current COVID-19 pandemic, this can be a valuable tool to help avoid admissions. Objectives To ascertain the usefulness of LAT gel in reducing paediatric admissions. Methods Data was collected prospectively of all children presenting to the paediatric emergency department for input by the oral and maxillofacial team after the introduction of LAT gel. Data collected included age, aetiology, length and position of laceration, associated injuries and management. Use of LAT gel and other anaesthetics was recorded. Findings Over a 12 month period, 536 children attended the paediatric ED. Paediatric lacerations accounted for 45% of the reasons for attendance. LAT gel was used in management of 33% of patients with facial lacerations. The use of the gel was successful in 76% of occasions. Ninety children (16.8% of all attendances) were admitted to hospital during this time, of which 49 were paediatric lacerations. Conclusion LAT gel is an effective adjunct to management of laceration in the paediatric population.

The general assessment and extra oral examination of the dental patient can identify undiagnosed or undisclosed medical conditions, such as malignancies, endocrine conditions and signs indicating raised cardiovascular or cerebral vascular risk. This knowledge may influence dental treatment, and could impact the morbidity and mortality of the patient. This article gives an overview of the general and extra oral examination of the dental patient.

Background Communication between patients and clinicians plays an important role in improving quality of healthcare and clinical outcomes and ensuring that patients understand medical terminology used by their physicians is a core aspect of this. The aim of this study is to evaluate the degree of patient understanding with respect to commonly used terms in a joint orthodontic-maxillofacial clinic in the context of preparing for combined orthodontic/orthognathic treatment. Methods Patients were recruited to partake in a short two-part questionnaire. Demographic data collected included participants’ age, sex, level of education, fluency of English and whether English was their first language. In the second part of the questionnaire, participants were asked to identify the correct definition of 11 commonly used terms from a series of multiple-choice answers. Results 51 patients participated in this study ranging between ages 15 to 52. 86% of patients selected English as their first language and 37% reported having a university education. The overall mean score for the questionnaire was 44%, with the best understood term being ‘retainers’ at 80% correct and ‘decalcification’ the worst understood at 14% correct. An association between level of education and understanding of specific terms was detected. Conclusion This study highlights the overall sub-optimal patient understanding of medical terminology used by clinicians on a joint orthodontic-maxillofacial orthognathic clinic. The authors of this study recommend further consideration to the terminology currently used as well as adapting the mode and frequency of information delivery, serving to improve patients’ understanding and retention of medical conversations.

Minimally invasive surgical procedures aiming to repair damaged maxillofacial tissues are hampered by its small, complex structures and difficult surgical access. Indeed, while arthroscopic procedures that deliver regenerative materials and/or cells are common in articulating joints such as the knee, there are currently no treatments that surgically place cells, regenerative factors or materials into maxillofacial tissues to foster bone, cartilage or muscle repair. Here, hyaluronic acid (HA)-based hydrogels are developed, which are suitable for use in minimally invasive procedures, that can adhere to the surrounding tissue, and deliver cells and potentially drugs. By modifying HA with both methacrylate (MA) and 3,4-dihydroxyphenylalanine (Dopa) groups using a completely aqueous synthesis route, it is shown that MA-HA-Dopa hydrogels can be applied under aqueous conditions, gel quickly using a standard surgical light, and adhere to tissue. Moreover, upon oxidation of the Dopa, human marrow stromal cells attach to hydrogels and survive when encapsulated within them. These observations show that when incorporated into HA-based hydrogels, Dopa moieties can foster cell and tissue interactions, ensuring surgical placement and potentially enabling delivery/recruitment of regenerative cells. The findings suggest that MA-HA-Dopa hydrogels may find use in minimally invasive procedures to foster maxillofacial tissue repair.

Introduction Child neglect has a significant impact on children's physical and emotional health and development with lifelong consequences. Dental decay can lead to maxillofacial space infections which can have life-threatening complications and may indicate that a child has suffered dental neglect. Aims and method In this retrospective audit, we reviewed children below sixteen years who were admitted under oral and maxillofacial surgery for incision and drainage of a dental/facial abscess, under general anaesthesia, between January 2015 and January 2017, to understand if they had experienced dental neglect. We also assessed if they were or had been known to Children's Social Services (SS) before hospital admission. Results Twenty-seven children were included in the study, eleven children (40%), were known to social services (SS). On average 3.2 teeth were extracted with an average hospital stay of 2.5 days. Discussion Our data indicate that a significant number of children admitted for maxillofacial space infection are already known to social services. Conclusion Our recommendation is that all children admitted with dental/maxillofacial space infections, where dental neglect may be present, should be discussed with the local safeguarding team.

Introduction Communication within the doctor-patient relationship is complex due to a variety of reasons; a patient's understanding may not correspond with the clinician's vocabulary, resulting in misunderstanding, anxiety and ill-informed decision making. We investigated the understanding of terminology commonly used in oral and maxillofacial surgery and oral medicine clinics. Methods We investigated patients' understanding using a questionnaire-based study in the out-patient setting. Age, gender, first language and highest educational level were recorded. The questionnaire included multiple choice questions regarding patients' understanding of words as well as asking patients to define certain terms. Vocabulary included 'ulcer', 'blister', 'cancer', 'malignant' and 'benign'. Results and conclusions Many patients have difficulty in understanding and explaining commonly used terminology. 'Blister' was the most commonly understood term, while 'benign' and 'lesion' were the least well understood. 'Tumour' was mistakenly thought of as synonymous with 'malignancy' by over a third of patients. Understanding was better among those for whom English was their first language. It is essential that all clinicians modify their language appropriately during consultations in order to deliver information in a comprehensive manner, to educate patients on their condition thus enabling informed decision making by patients.

Psychiatric illness is extremely common and the general dental practitioner (GDP) will inevitably encounter patients with such an illness. This article outlines common psychiatric conditions that the GDP should be familiar with alongside its impact on oral health. It also gives a systematic approach to dealing with a patient who presents to practice with an undiagnosed psychiatric illness, whereby the illness interferes with delivery of suitable dental care.

BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of death by disease worldwide and has a 30-day readmission rate of 22.6%. In 2015, COPD was added to the Medicare Hospital Readmission Reductions Program. OBJECTIVE The objective of this paper was to survey the current medical technologies for remote patient monitoring (RPM) tools that forecast COPD exacerbations in order to reduce COPD readmissions. METHODS We searched literature and digital health news to find commercially available RPM devices focused on predicting COPD exacerbations. These technologies were reviewed and compared according to four criteria: forecasting ability, cost, ease of use, and appearance. A rating system was developed to facilitate the evaluation process. RESULTS As of June 2019, a list of handheld and hands-free devices was compiled. We compared features and found substantial variations. Devices that ranked higher on all criteria tended to have a high or unlisted price. Commonly mass-marketed devices like the pulse oximeter and spirometer surprisingly fulfilled the least criteria. CONCLUSIONS The COPD RPM technologies with most technological promise and compatibility with daily living appear to have high or unlisted prices. Consumers and providers need better access to product information to make informed decisions.

A 48-year-old blacksmith presented to A&E after sustaining facial injuries while operating a metal punch press. Radiographs revealed the presence of a metallic foreign body within the cheek, but this was clinically impalpable. By using a neodymium rare earth magnet extraorally, it was possible to identify the position of the fragment several centimetres lateral to the entry wound. Triangulation of the fragment's position allowed retrieval under local anaesthetic through the original penetration wound, without need for cross sectional imaging or extensive exploration under general anaesthetic. This case highlights an application for magnets in detection and removal of impalpable metallic foreign bodies embedded in superficial soft tissues.