The objective of this paper was to evaluate intraoperative and postoperative complications associated with maxillary segmentation in Le Fort I osteotomy and compare them with conventional one-piece Le Fort I. A meta-anal...The objective of this paper was to evaluate intraoperative and postoperative complications associated with maxillary segmentation in Le Fort I osteotomy and compare them with conventional one-piece Le Fort I. A meta-analysis was performed using studies published in the last 15 years from PubMed, Cochrane, and SciELO databases. Observational human studies reporting complications of segmented and conventional Le Fort I osteotomies were included. A random effects model was used to calculate pooled complication rates and relative risks. Seven studies comprising 3307 patients were included; 873 underwent segmented Le Fort I osteotomy. The complication rate was higher in segmented surgery (11.6%) than in one-piece procedures (6.8%). Removal of osteosynthesis material and dental injury were the most common complications. Oronasal fistula and segmental necrosis occurred exclusively in segmented cases. Segmented Le Fort I osteotomy increases the risk of postoperative complications, particularly those related to vascular compromise and intersegmental stability. These findings support careful case selection and meticulous technique when performing maxillary segmentation.
Follow up of maxillofacial mandible patients imposes a significant burden on clinic utility. We aimed to investigate whether a more efficient manner of follow up was possible. We retrospectively reviewed all patients wit...Follow up of maxillofacial mandible patients imposes a significant burden on clinic utility. We aimed to investigate whether a more efficient manner of follow up was possible. We retrospectively reviewed all patients with non-condylar fractures of the mandible who had been treated surgically in our supra-regional major trauma centre between 01 January 2022 and 31 December 2023. We examined the difference in the time it took to detect complications between Cohort 1 (scheduled follow up) and Cohort 2 (patient-initiated follow up). We identified 338 surgically-treated mandibular fractures in 223 patients, of whom 204 (91.8%) attended booked follow-up appointments. A total of 26/204 (12.7%) patients developed postoperative complications. In Cohort 1 (scheduled follow up), 14/15 (93.3%) complications were detected early (within 6 weeks). In Cohort 2 (patient-initiated follow up), 9/11 (81.8%) complications were detected late (after 6 weeks), with the patients having no symptoms during previous visits. The timing of the detection of these complications differed significantly between cohorts (p = 0.00098, Fisher's exact test). This study highlights the importance of timely follow-up appointments for non-condylar fractures of the mandible, with complications more likely to be detected within 6 weeks post-surgery. With an average of 2.5 appointments booked per patient in our supra-regional major trauma centre and a did-not-attend rate of up to 23.7%, there is an argument for reducing the number of postoperative follow-up appointments. Consideration needs to be given to the investigation of whether other regimes may be more efficient, such as including patient-initiated follow up.
Most head and neck cancers (HNC) are diagnosed at advanced stages, highlighting the need for strategies to enhance early recognition. Since 2009, urgent suspected cancer (USC) referrals have increased by 377%, but HNC co...Most head and neck cancers (HNC) are diagnosed at advanced stages, highlighting the need for strategies to enhance early recognition. Since 2009, urgent suspected cancer (USC) referrals have increased by 377%, but HNC conversion rates have declined to 2.2%, straining resources and reducing efficiency. Predictive tools aim to support clinicians to identify high-risk patients. This study evaluates the predictive capability of HaNC-RC-v.2 compared with a restructured Wakefield Model and assesses the impact of HNC risk-based stratification on service organisation. Retrospective analysis of 1183 USC referrals collected data surrounding demographics, social history, 16 signs/symptoms, and diagnoses. Univariate and multivariate regression identified significant HNC predictors. Performance of the Wakefield Model was evaluated through sensitivity, specificity, area under the receiver operator curve (AUC), Akaike information criterion, and Hosmer-Lemeshow tests. DeLong tests compared model predictive capabilities. The Wakefield Model incorporated age, gender, smoking, alcohol, and seven HNC predictors, achieving an AUC of 82.70%. HNC-risk thresholds defined high-risk (≥7.35%; sensitivity: 75.71%; specificity: 80.41%) and low-risk (≤1.70%; sensitivity: 76.47%; specificity: 58.21%) groups. The model's predictive capability was significantly greater than that of the HaNC-RC-v.2 (AUC: 77.70%). Stratifying patients by HNC-risk thresholds ensured that >95% of HNC cases were assessed within 14 days, whilst reallocating 26.20% - 32.12% of USC assessments, improving service efficiency. HNC predictive models help clinicians to identify high-risk individuals, prioritise assessments, and optimise service provision. Implementing models at the point of referral could potentially stratify referrals into suitable assessment pathways.
National waiting time targets demand that patients referred to oral and maxillofacial surgery (OMFS) via an urgent suspicion of cancer (USOC) referral are appointed and investigated quickly, which puts strain on secondar...National waiting time targets demand that patients referred to oral and maxillofacial surgery (OMFS) via an urgent suspicion of cancer (USOC) referral are appointed and investigated quickly, which puts strain on secondary care resources. Despite National Institute for Health and Care Excellence (NICE) referral guidance, many USOC referrals are received for low-risk patients with benign disease, while some patients with head and neck cancer (HNC) are referred via potentially slower pathways. The Head and Neck Cancer Risk Calculator version 2 (HaNC-RC-v2) may be used by primary care referrers to inform referral priority. This tool has been validated mainly in ear, nose, and throat (ENT) settings, with limited evidence for its use in OMFS. This study retrospectively applied the HaNC-RC-v2 and the NICE USOC referral criteria to 476 OMFS patients, using information from electronic medical records and referral letters, to determine the referral priority each tool would have recommended. The sample comprised 200 USOC and 276 non-USOC referrals. HNC was diagnosed in 28 patients (5.9%). The referral priority selected by the primary care clinician accurately reflected the patient's eventual diagnosis in 62.2% of cases. In comparison, the NICE criteria and the HaNC-RC-v2 achieved significantly higher accuracies of 75.5% and 81.9%, respectively (p < 0.05). Both tools also showed significantly greater specificity compared with the clinical judgement of the initial referrer (p < 0.05). If the HaNC-RC-v2 is used by referrers, a significant reduction in USOC referrals of around 50% would be expected (p < 0.0001), with no significant change in cancer detection rates.
The emphasis laid on quality of life (QoL) in patients treated with head and neck cancer treatment has challenged surgeons to refine their resection techniques and improve on reconstruction and rehabilitation. Whilst the...The emphasis laid on quality of life (QoL) in patients treated with head and neck cancer treatment has challenged surgeons to refine their resection techniques and improve on reconstruction and rehabilitation. Whilst the importance laid on the technical refinement has been of great importance; one needs to be aware of the significance of perioperative preparation of a patient prior to the commencement of any strategy of cancer treatment. The Enhanced Recovery After Surgery (ERAS) pathway provides the platform for this perioperative package of care. In this paper we offer special emphasis on the giving of information, to improve patients' expectations and overall QoL. The authors would like to lay emphasis on the advantages of the ERAS clinic, which offers a wide range of services. One aim of the service is to provide detailed information to patients and help manage their expectations. It is our opinion that management of expectations results in a better quality of life. We attribute our QoL outcomes to this improvement in surgical planning and execution alongside a robust ERAS pathway in managing patients' expectations.
The objective of this systematic review is to outline the current landscape and applications of predictive artificial intelligence (AI) in maxillofacial surgery. Studies on predictive AI models used in maxillofacial surg...The objective of this systematic review is to outline the current landscape and applications of predictive artificial intelligence (AI) in maxillofacial surgery. Studies on predictive AI models used in maxillofacial surgery were reviewed to understand how predictive AI is used and to identify emerging trends in its research. Of the studies identified, 25 were included in the review. The results show that predictive AI in the field of maxillofacial surgery has strong applications in the prediction of postoperative results from preoperative medical imaging modalities, and has generally shown high accuracy. It is also used for treatment and surgical planning, identifying which treatment is necessary and if surgery may be indicated in the future. It has the potential to cut down clinical time, improve workflow, and reduce the strain on clinicians. Predicting the future need for surgery allows for timely intervention and risk management, and ultimately enables early and effective patient communication. Overall, the studies show that AI has the potential to work alongside clinicians to improve clinical workflow and decision-making.
The transconjunctival approach (TCA) is popular to gain access to the walls of the orbit, despite some unfavourable outcomes, such as entropion and damage to the lacrimal apparatus. Access to the medial wall is also chal...The transconjunctival approach (TCA) is popular to gain access to the walls of the orbit, despite some unfavourable outcomes, such as entropion and damage to the lacrimal apparatus. Access to the medial wall is also challenging because of the position of the inferior oblique muscle (IOM), which can lead to iatrogenic palsy of the IOM and diplopia after its detachment. As an alternative, it is possible to use a subtarsal (STA) or subciliary approach (SCA) to avoid IOM injury. The present paper reports 361 orbits treated through a single SCA or STA for bone decompression and fixation of complex fractures. The IOM has been preserved and used as safety guide to reach the medial wall. From 2000 to 2024, we used SCA/STA to gain access to the floor, lateral, and medial walls of the orbit in 361 procedures involving the medial wall. The IO muscle was not divided in any case and one patient had clinical mild diplopia that lasted about two months. The rate of ectropion was 5.5%, with six cases (1.8%) corrected under local anaesthesia. We report that SCA/STA is a simple, reliable and fast approach to the orbit, preserving the IOM to get the medial wall.
The British Journal of Oral and Maxillofacial Surgery (BJOMS) is a leading platform for clinical research. We analysed 1416 BJOMS clinical articles indexed on Scopus to map global research patterns, collaboration network...The British Journal of Oral and Maxillofacial Surgery (BJOMS) is a leading platform for clinical research. We analysed 1416 BJOMS clinical articles indexed on Scopus to map global research patterns, collaboration networks, and thematic focus. Bibliometric data were extracted using Bibliometrix™ and VOS viewer™. The UK contributed most articles (n = 642), with strong international collaborations. Top institutions included NHS Greater Glasgow and Clyde (UK) and Liverpool University Hospitals NHS Foundation Trust (UK), and leading authors were Rogers SN, Lowe D, and Brennan PA. Keyword analyses revealed clusters in oncology, surgical innovation, trauma management, patient quality of life, regenerative medicine, education, infection, and epidemiology. This Scopus-based evaluation highlights the global research impact and thematic breadth of the journal.
Patients with cleft lip and palate (CLP) exhibit complex maxillary morphology, including hypoplasia, making Le Fort I osteotomy challenging and prone to complications. The aim of this retrospective, comparative study was...Patients with cleft lip and palate (CLP) exhibit complex maxillary morphology, including hypoplasia, making Le Fort I osteotomy challenging and prone to complications. The aim of this retrospective, comparative study was to improve the safety of Le Fort I osteotomy by analysing the maxillary structure of patients with CLP. Fifteen unilateral CLP cases with maxillary hypoplasia (six males, nine females) and 15 non-CLP cases undergoing mandibular setback for prognathism (four males, 11 females) were evaluated. Axial computed tomographic (CT) images at 2.5 and 5 mm above the nasal floor were analysed. Ten parameters were measured, focusing on the distances between key anatomical landmarks including lateral and medial pterygoid plates and posterior maxillary sinus wall to pterygoid fossa. In the CLP group, the distance between the lateral and medial pterygoid plates was 4.8 ± 1.2 mm (healthy side) and 5.4 ± 1.3 mm (afflicted side), compared with 6.4 ± 1.2 mm in the non-CLP group. The shortest distance between the posterior maxillary sinus wall and pterygoid fossa was 2.7 ± 1.1 mm (healthy side) and 2.9 ± 1.3 mm (afflicted side) in CLP group, significantly greater than 1.9 ± 0.3 mm in non-CLP group. These findings indicate a thicker pterygomaxillary junction in patients with CLP, which highlights key anatomical differences. Understanding these features may help reduce surgical complications during Le Fort I osteotomy in patients with CLP.