Surgeons currently operate blind to the facial nerve and can encounter unexpected events during surgery. The ability to track the facial nerve through the parotid gland prior to surgery would aid surgical planning and id...Surgeons currently operate blind to the facial nerve and can encounter unexpected events during surgery. The ability to track the facial nerve through the parotid gland prior to surgery would aid surgical planning and ideally improve outcomes. An audit was undertaken of 100 patients with parotid tumours. Each had a 3 Tesla magnetic resonance imaging (MRI) scan, with the DICOM data segmented into three-dimensional (3D) models of the facial nerve, tumour, and surrounding anatomy. The objective was to assess the value of 3D models in the management of parotid tumours. Of the 86/100 patients who proceeded to surgery, the 3D models were accurate in 98% of cases. The scale of surgical complexity predicted by the models correlated with operative duration and complications (p = 0.01). There was concordance (p = 0.01) between surgeons on the value of 3D models in different patients. 3D images from 3T MRI scans provide accurate visualisation of the facial nerve in parotid surgery. This novel technique facilitates improved preoperative planning, the prospect of improved outcomes, and a personalised approach to parotid surgery.
Many consider the consumption of smokeless tobacco (SLT) a risk to oral health. Snus is being increasingly used, and the aim of this systematic review was to determine the oral health effects of this. Medline, Web of Sci...Many consider the consumption of smokeless tobacco (SLT) a risk to oral health. Snus is being increasingly used, and the aim of this systematic review was to determine the oral health effects of this. Medline, Web of Science, and Scopus were searched using oral health related terms and the term snus. Studies concerning SLT products other than snus were excluded. The literature search identified 47 studies suitable for inclusion. Five out of six epidemiological studies did not report an elevated risk of oral cancer in users of snus. However, three observational studies presented cases of oral cancer at the site of snus placement. Snus was consistently associated with the development of oral mucosal lesions, or snuff dipper's lesions (SDLs). Studies indicate that quitting the habit leads to rapid SDL regression, and that taking up the habit leads to its rapid initiation. Evidence in this review suggests that snus may not increase the risk of oral cancer. Further research is required to supplement the current evidence in this area, and to investigate the range of snus products now available.
Non-syndromic cleft lip and palate (NSCL/P) is a prevalent congenital anomaly influenced by genetic and environmental factors. The role of the MSX1 gene in NSCL/P has been explored in various populations, with conflictin...Non-syndromic cleft lip and palate (NSCL/P) is a prevalent congenital anomaly influenced by genetic and environmental factors. The role of the MSX1 gene in NSCL/P has been explored in various populations, with conflicting results. This study investigates the association between MSX1 single nucleotide polymorphisms (SNPs) rs11726039 and rs3821949 and NSCL/P in a sub-Himalayan population of India. A total of 395 subjects, including 216 patients and 179 controls, were genotyped using TaqMan assays. The study also considered environmental factors, such as maternal smoking and folic acid intake. Statistical analysis, including odds ratios (OR), Fisher's exact test, and Hardy-Weinberg equilibrium, was used to assess the association between the SNPs (single nuclear polymorphisms) and NSCL/P. While rs11726039 showed no significant association in either patient or parental samples, rs3821949 indicated a protective effect in fathers (OR = 0.44, p = 0.001) but not in patients. The findings highlight population-specific variations in the genetic aetiology of NSCL/P and the need for larger studies to confirm the role of MSX1 SNPs in the sub-Himalayan region. Despite being located in the same country, differences in genetic associations were noted between the sub-Himalayan and South Indian populations, underscoring the complexity of genetic interactions in NSCL/P.
This cohort study focuses on establishing volumes and subclassifications of extended temporomandibular joint replacement (eTMJR) prostheses that are presently being produced compared to the production of standard TMJR de...This cohort study focuses on establishing volumes and subclassifications of extended temporomandibular joint replacement (eTMJR) prostheses that are presently being produced compared to the production of standard TMJR devices. The reports of the use of eTMJR devices in the management of large segmental mandibular defects that also involve the temporomandibular joint (TMJ) are increasing in the literature. Data received from Stryker/TMJ Concepts reveals that eTMJR prostheses account for 13.5% of TMJR devices produced. The literature reports eTMJR adverse event issues such as infection, mechanical failures, and heterotopic bone formation. The aim of this study is to provide insights into the use of eTMJR prostheses to guide clinicians and researchers in advancing their use as a management option for complex mandibular reconstructions. Future research directions, focusing on the elements of device embodiments (materials, design, manufacturing), regenerative medicine, and predictive tools to enhance eTMJR longevity and success, are discussed.
Chyle leak following injury to the thoracic duct (TD) is an uncommon but serious complication of cervicothoracic procedures, including neck dissection and oesophagectomy, and has significant morbidity and mortality. We a...Chyle leak following injury to the thoracic duct (TD) is an uncommon but serious complication of cervicothoracic procedures, including neck dissection and oesophagectomy, and has significant morbidity and mortality. We aimed to investigate the efficacy of indocyanine green (ICG) fluorescence in facilitating intraoperative TD visualisation and preventing chyle leaks. A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards for studies that assessed ICG for TD visualisation in cervicothoracic procedures. The primary outcome measure was TD visualisation using ICG. Secondary outcomes included rates of chyle leak detection, visualisation rate in white light, and time from injection to visualisation. Twelve studies enrolling 475 subjects met the inclusion criteria. The TD visualisation rate with ICG was 93.3% (SE 0.013, p < 0.001) compared with 54.3% (SE 0.065, p < 0.001) in white light. Detection rates for intraoperative chyle leak were higher using ICG compared with no ICG use: 74% (SE 0.047, p < 0.001) vs 17.5% (SE 0.086, p = 0.043), respectively. ICG reduced rates of postoperative chyle leak from 10.1% (untransformed proportion metric: 0.101 (0.045, 0.157), p < 0.001) to 3.9% (SE 0.021, p = 0.061). Mean time from ICG injection to TD visualisation was 83.94 minutes (p < 0.001). ICG offers an effective method of TD visualisation in cervicothoracic surgery. It can reduce rates of chyle leak and mitigate adverse sequelae from inadvertent duct injury. High-quality randomised controlled trials are required to improve the evidence base.
Historically, Le Fort I bimaxillary osteotomy (BMO) in the UK has generally been regarded as a surgical procedure requiring a full day of operating with subsequent hospital stay for several days, including potential inte...Historically, Le Fort I bimaxillary osteotomy (BMO) in the UK has generally been regarded as a surgical procedure requiring a full day of operating with subsequent hospital stay for several days, including potential intensive care admission and blood transfusions. Following the introduction of the national standards on day case surgery in the UK in 2011, the authors have routinely and successfully performed bilateral sagittal split osteotomy surgery (BSSO) as a day-case procedure, whilst achieving excellent patient satisfaction since 2015. The desire to improve efficiency in the management of patients requiring short-term surgical admission, was also applied to BMO procedures, with aims for a short, less than 24 h (<24-hour) stay admission, for patients with appropriate medical and social circumstances. With day surgery and short stay admission considered fundamental to modern care, this presents multiple benefits for both patients and the National Health Service (NHS). Our aim was to demonstrate that our BMOs conform to current national standards, and could be carried out both successfully and safely, as a <24-hour stay procedure. All patients undergoing BMOs (n = 165) were planned as a <24-hour stay procedure between 2012 and 2023 by the same consultant. Demographic details, operative time, length of stay, and re-admittance rates were reviewed retrospectively. Of these patients, 96.4% (n = 159) were discharged within 24 h of the procedure. Four patients (2.4%) were discharged within 24-48 h, and two (1.2%) within 48-72 h. There were no re-admissions within 48 h of discharge. We concluded that BMOs, along with concurrent wisdom tooth removal, can be carried out successfully and routinely as a single, short stay procedure. However, to reduce the rate of prolonged admission, it is recommended that a strict perioperative protocol be followed.
Sagittal split ramus osteotomy (SSRO) is a reliable surgical procedure for the correction of maxillofacial deformities. However, the most common complication that occurs after the procedure is a neurosensorial disturbanc...Sagittal split ramus osteotomy (SSRO) is a reliable surgical procedure for the correction of maxillofacial deformities. However, the most common complication that occurs after the procedure is a neurosensorial disturbance of the inferior alveolar nerve (IAN). Especially in individuals with retrognathic mandible or sleep apnoea, it may be necessary to perform a large amount of mandibular advancement and counter-clockwise (CCW) rotation depending on the angle of the mandibular plane. The likelihood of prolonged neurosensorial disturbance is increased in such patients. The objective of this experimental study was to evaluate the accumulation of stress on the IAN caused by different amounts of advancement and CCW rotation using finite element analysis. The mandibular models with SSRO were advanced 6, 9, and 12 mm and rotated 10 degrees CCW. According to the data obtained, a slight increase in stress values was observed when 10 degrees CCW rotation was applied. However, it was found that significant increases in stress values were directly proportional to the amount of advancement. This experimental study showed that the main cause of stresses on the inferior alveolar nerve after SSRO is the amount of advancement rather than the amount of CCW rotation.
Alveolar bone grafting (ABG) is an essential procedure for the treatment of cleft alveolus and palate defects, promoting maxillary continuity, dental eruption, functional rehabilitation, and symmetrical facial developmen...Alveolar bone grafting (ABG) is an essential procedure for the treatment of cleft alveolus and palate defects, promoting maxillary continuity, dental eruption, functional rehabilitation, and symmetrical facial development. Traditionally performed as an inpatient procedure due to pain management concerns, recent efforts have explored its feasibility as day-case surgery. A two-phase study was conducted. First, a retrospective analysis of 12 ABG cases (July 2023-February 2024) evaluated postoperative pain management and feasibility. This was followed by a prospective pilot study involving 17 patients (March-August 2024), who underwent ABG as day cases under a structured protocol. Pain scores, analgesic requirements, and patient/parent feedback were recorded and analysed. The retrospective analysis concluded that effective pain control was achieved with oral analgesia within six hours postoperatively. In the prospective cohort, mean pain scores were 2.2/10 for the oral site and 2.5/10 for the hip donor site, managed with oral paracetamol and ibuprofen, with minimal opioid use (<30%). No significant complications were reported. Transitioning to day-case ABG reduced bed shortage-related cancellations and was preferred by patients. Day-case ABG is a feasible and safe alternative to inpatient care when strict selection criteria and structured protocols are implemented. This approach optimises resource utilisation, minimises cancellations, and enhances patient satisfaction. Larger studies are warranted to confirm these findings and facilitate broader implementation.
Searches of the literature and current guidelines have revealed inconsistent recommendations regarding dental optimisation prior to alloplastic temporomandibular joint replacement (TMJR). Furthermore, current literature...Searches of the literature and current guidelines have revealed inconsistent recommendations regarding dental optimisation prior to alloplastic temporomandibular joint replacement (TMJR). Furthermore, current literature suggests there is no consensus on antibiotic prophylaxis (AP) for dental procedures following TMJR. A 12-question survey was emailed to Professor Mercuri's TMJ Internetwork Group (144 members) and The European Society of Temporomandibular Joint Surgeons (ESTMJS) (49 members), totalling 177 survey recipients, accounting for those who are members of both groups. Respondents were asked whether routine dental assessments were performed prior to TMJR, if they recommended AP following TMJR, the timeframes and types of procedures for which this was recommended, and the types of antibiotics prescribed. The survey had 50 respondents, as of 15 November 2024, giving an overall response rate of 28.2%, however, the question specific response rate ranged from 29 to 50 respondents. No consensus was reached regarding the types of AP recommended, with 54.2% (n = 26) of respondents offering no prophylaxis for dental treatment following TMJR. The majority of respondents who did provide prophylaxis preferred amoxicillin or co-amoxiclav (n = 25/37), and clindamycin for penicillin allergic patients (n = 13/46). The timeframe for which respondents felt that antibiotics should be offered for dental procedures post-TMJR varied from one month (n = 3/37) to lifelong (n = 6/37), with a modal response of two years (n = 9/35). This survey reflected the lack of consensus seen across available literature and highlights the need for unified guidance to ensure safe and consistent patient care for TMJR patients.
Dental preoperative anxiety poses significant challenges in healthcare, leading to treatment avoidance and prolonged recovery times. Despite the plethora of pharmacological and psychotherapeutic interventions employed fo...Dental preoperative anxiety poses significant challenges in healthcare, leading to treatment avoidance and prolonged recovery times. Despite the plethora of pharmacological and psychotherapeutic interventions employed for anxiety management, their relative efficacy remains unclear. This study aims to compare the effectiveness of oral melatonin (6 mg) and music therapy in preoperative anxiety management among patients undergoing surgical extraction of impacted mandibular third molars. A total of 78 patients aged 18-40 years undergoing surgical extraction were selected and randomly assigned into three groups: nil intervention (Group NI) with no intervention, Group ML administered oral melatonin, and Group MT administered 20 min of relaxing music (n = 26). Physiological parameters (pulse rate, blood pressure) and subjective assessments (visual analogue scale for anxiety) were measured on arrival (T1), after the intervention (T2), and after surgical extraction (T3). Salivary cortisol levels, recorded preoperatively and postoperatively, were analysed using ELISA. Results showed significant improvement in physiological parameters for both ML and MT compared with NI (p < 0.05). However, postoperative cortisol levels increased significantly in the NI (0.55 (0.15) - 0.88 (0.32) pmol/ml) and MT groups (from 0.33 (0.15) - 0.62 (0.2) pmol/ml) but decreased in the ML group (from 0.42 (0.19) - 0.3 (0.14) pmol/ml). This indicated a delayed action of melatonin as compared with the immediate impact of music therapy. Understanding the mechanisms and insights obtained can aid in developing advanced anxiety management methods for dental practitioners, thereby enhancing patient care and outcomes in dental practice.
This systematic review evaluates the impact of the large language model (LLM) ChatGPT in oral and maxillofacial surgery. Following PRISMA guidelines and registered in PROSPERO (CRD42024625882), the study involved a compr...This systematic review evaluates the impact of the large language model (LLM) ChatGPT in oral and maxillofacial surgery. Following PRISMA guidelines and registered in PROSPERO (CRD42024625882), the study involved a comprehensive search across PubMed/Medline, Embase, Scopus, and Science Direct. Inclusion criteria focused on ChatGPT's use in clinical decision-making, surgical planning, patient education, and research. Ten studies were reviewed, assessing ChatGPT's performance in diagnostic accuracy, surgical efficiency, and patient satisfaction. GPT-4 achieved the highest accuracy (76.8%) in multiple-choice questions but showed variability, with lower performance in pharmacology and complex clinical scenarios. It excelled in generating informed consent documents, outperforming other AI models and human residents in accuracy, completeness, and readability. It also provided accurate and supportive responses in postoperative follow up. However, limitations were noted in handling complex clinical decisions and providing personalised advice for cases such as oral cancer and orthognathic surgery. While ChatGPT shows potential in improving patient communication, reducing healthcare workloads, and providing up-to-date information, its current limitations in accuracy and personalisation underscore the need for human supervision and integration with clinical databases. AI tools like ChatGPT can complement, but should not replace, human judgment in specialised fields such as oral and maxillofacial surgery.