To determine the prevalence of preoperative frailty among oral cancer patients and identify its risk factors, a thorough review of observational studies published until 30 August 2025 was performed in various databases,...To determine the prevalence of preoperative frailty among oral cancer patients and identify its risk factors, a thorough review of observational studies published until 30 August 2025 was performed in various databases, including PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, CBM, and Wanfang. The primary outcome was the prevalence of preoperative frailty or associated factors. Risk of bias and methodological quality were independently evaluated by two authors using both the Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ) criteria. The meta-analysis included 18 articles. The results indicated that the prevalence of preoperative frailty in oral cancer patients was 42.2%. The risk factors included age, cognitive impairment, American Society of Anesthesiologists' (ASA) score of ≥3, more than five medications, Charlson comorbidity index (CCI) score of ≥2, and a low skeletal muscle index (SMI). Body mass index (BMI) was identified as a protective factor. The findings can enable healthcare providers to implement effective interventions to prevent, reverse, or delay the progression of frailty.
This meta-analysis compares the safety and efficacy of outpatient or day case parotidectomy versus inpatient therapy. The objective of this study is to integrate current information on postoperative complications, readmi...This meta-analysis compares the safety and efficacy of outpatient or day case parotidectomy versus inpatient therapy. The objective of this study is to integrate current information on postoperative complications, readmission rates, and reoperation rates, as well as to assess the methodological quality of existing studies and provide selection criteria for outpatient surgery. We searched PUBMED, SCOPUS, and Google Scholar from January 1980 to January 2025. Search terms included "parotidectomy", "parotid gland surgery", "outpatient", "ambulatory", and "same-day discharge". We considered studies that compared outpatient and inpatient parotidectomy. The primary outcomes studied were postoperative complications, haematoma, seroma, infection, facial nerve injury, readmission, and reoperation rates. Two reviewers extracted data separately and used the ROBINS-I tool to determine bias. The analysis included 13 trials with a total of 5040 patients (2365 outpatients and 2674 inpatients). Outpatient parotidectomy had a similar complication risk as inpatient surgery (Odds Ratio 0.69, 95% Confidence Interval: 0.49 to 0.98, p = 0.04). Haematoma and permanent facial nerve injury were much lower in outpatients. However, most research showed considerable selection and confounding biases. Outpatient parotidectomy is a safe and effective option for carefully chosen individuals. Standardised selection criteria can help enhance patient outcomes and surgical decision making.
Head and neck cancer (HANC) patients' health-related quality of life and concerns shape the patient-clinician interaction. Allowing patients to raise concerns that might otherwise be missed affords an opportunity for int...Head and neck cancer (HANC) patients' health-related quality of life and concerns shape the patient-clinician interaction. Allowing patients to raise concerns that might otherwise be missed affords an opportunity for intervention and signposting to multiprofessional rehabilitation services. The Patient Concerns Inventory (PCI-HN) is a simple, condition-specific tool that promotes holistic, patient-centred consultation. This paper aims to summarise the findings from PCI use in routine clinics in Nottingham and report PCI profiles based on cancer site, surgical treatment, adjuvant radiotherapy (RT), time since surgery, and Speech and language therapy (SALT) frequency of follow up. From October 2020 to March 2022, 102 HANC patients undergoing curative surgery attended follow ups at Queen's Medical Centre, Nottingham. A total of 242 PCI-HN forms were completed, as some had multiple consultations. The cohort included 38 females and 64 males (aged 31-93). Most had oral cancer (83%), followed by oropharyngeal (12%) and other HANC (5%). The most common concerns were dental health/teeth (26%), chewing/eating (21%), fear of recurrence (21%) and dry mouth (21%). Concern patterns varied, notably, oral and oropharyngeal cancer patients prioritised dental health, free flap (FF) reconstruction patients focused on physical/functional wellbeing, and RT patients cited chewing/eating (36%) versus non-RT patients who feared recurrence (20%). FF and RT patients required more frequent SALT rehabilitation. PCI-HN captured diverse patient concerns, varying by site, surgery type, adjuvant RT, and time since surgery. Findings support targeted, stratified follow-up care.
Bilateral sagittal split osteotomy (BSSO) and its numerous modifications remain the cornerstone of mandibular orthognathic surgery. Despite extensive literature describing individual techniques, we know of no comprehensi...Bilateral sagittal split osteotomy (BSSO) and its numerous modifications remain the cornerstone of mandibular orthognathic surgery. Despite extensive literature describing individual techniques, we know of no comprehensive comparison of their properties, indications, and clinical outcomes. This review proposes a novel classification of the BSSO technique based on the position of the buccal cut relative to the mandibular notch and angle: pre-notch, post-notch, and post-gonial. Their technical characteristics and clinical implications are described and compared, providing a straightforward guide to the optimal approach in each scenario. A narrative review of key publications on BSSO techniques was conducted and combined with the authors' clinical experience. Using this foundation, an original classification was formulated, organising established osteotomy designs according to the position of the buccal cut relative to the mandibular notch. Pre-notch approaches provide broad bony contact and stable outcomes for standard procedures with a thick soft tissue; post-notch techniques reduce inferior border notching and help protect the inferior alveolar nerve, and are therefore indicated for large mandibular movements and thin soft tissues; post-gonial strategies facilitate ramus lengthening and the correction of complex vertical asymmetry. The proposed classification offers a simple, clinically oriented framework that aligns existing BSSO modifications with surgical objectives, and supports more precise and individualised treatment planning.
Oral and maxillofacial surgery (OMFS) is a specialty that is under-represented in medical school teaching, leading to poor awareness and low confidence among doctors when managing and diagnosing OMFS conditions. This stu...Oral and maxillofacial surgery (OMFS) is a specialty that is under-represented in medical school teaching, leading to poor awareness and low confidence among doctors when managing and diagnosing OMFS conditions. This study aims to evaluate an online teaching programme designed to improve knowledge and the confidence of doctors to assess and manage common OMFS presentations. A three-part webinar series was developed and delivered online through the free open access medical education platform Mind the Bleep. The topics covered were facial trauma, orofacial infection, and other important OMFS presentations. The sessions were available to all doctors around the world and were presented live and made available on demand. Participants completed surveys before and after the course where quantitative and qualitative data were gathered. Statistical analysis was then performed using Wilcoxon signed-rank tests, and qualitative data were analysed. A total of 229 doctors attended both live and on demand. Of the 84 participants who provided feedback there was significant improvement in confidence across all topics (p < 0.05). Positive feedback was received on the content, format, and helpfulness of the topics. Constructive comments were received through qualitative feedback. This targeted OMFS teaching programme effectively improved the confidence to manage common OMFS conditions. It provided an accessible, flexible, and cost-effective solution to addressing gaps in OMFS education for doctors and could be adapted for other medical specialties.
Large language models (LLMs) are increasingly used in healthcare, but their role in aesthetic surgical procedures remains unexplored. These interventions present unique challenges, marked by high patient expectations, em...Large language models (LLMs) are increasingly used in healthcare, but their role in aesthetic surgical procedures remains unexplored. These interventions present unique challenges, marked by high patient expectations, emotionally charged decision-making, and subtle yet impactful outcomes on self-perception and psychosocial health. This cross-sectional in silico study evaluated the performance of ChatGPT-4 (OpenAI, 2025), DeepSeek V3 (DeepSeek AI/High-Flyer, 2025), and Gemini 2.5 Pro Experimental (Google, 2025) in preoperative and postoperative counselling for aesthetic facial surgery. Twenty-six standardised patient-oriented questions were submitted, and the anonymised responses of the chatbots were independently assessed by two calibrated oral and maxillofacial surgeons across four domains: accuracy, empathy, readability (Flesch-Kincaid Reading Ease (FKRE) and Grade Level (FKGL)), and referencing reliability (including the identification of fabricated or non-verifiable citations, a phenomenon referred to as "hallucination" in LLM outputs). Statistical tests included Kruskal-Wallis, Mann-Whitney U with Bonferroni correction, Spearman correlation, and chi-squared. DeepSeek achieved the highest accuracy (4.77 (0.51), p = 0.0078) and readability (FKRE 2.92 (0.27), p < 0.00001), while Gemini outperformed in empathy (4.08 (0.89), p < 0.001). GPT-4 produced the most hallucinated citations (36%) compared with Gemini (14%) and DeepSeek (8.8%) (p < 0.00001). A negative correlation between empathy and readability (r = -0.34, p = 0.002) suggested a trade-off between affective tone and accessibility. Overall, LLMs generated satisfactory counselling responses with distinct performance profiles, supporting their potential in patient-centred communication while reinforcing the need for human oversight.
This study aimed to evaluate the utility of ultrasound elastography for assessing postoperative recovery of the masseter muscle, and its potential role in predicting functional outcomes in patients undergoing orthognathi...This study aimed to evaluate the utility of ultrasound elastography for assessing postoperative recovery of the masseter muscle, and its potential role in predicting functional outcomes in patients undergoing orthognathic surgery. Fifteen patients with dentofacial deformities (30 masseter muscles) underwent ultrasound strain elastography at rest, during mouth opening, and during clenching, at four time points: preoperatively, and at seven days, one month, and three months postoperatively. Strain values (SVs), cross-sectional muscle area, and maximal mouth opening (MMO) were measured. Statistical analyses included Friedman and Wilcoxon signed-rank tests, with correlations assessed using Pearson's or Spearman's coefficients, as appropriate. SVs significantly decreased at seven days postoperatively and recovered to baseline by one month, remaining stable at three months. The cross-sectional area increased significantly at seven days and one month in the rest and mouth opening conditions, returning to baseline at three months, while no significant changes were observed during clenching. Significant positive correlations were observed between SVs and muscle area at rest and during mouth opening. In addition, higher preoperative SVs were associated with greater postoperative improvement in MMO. Ultrasound elastography provides objective, non-invasive information on postoperative changes in the masseter muscle. This modality may serve as a useful tool for predicting functional recovery after orthognathic surgery in patients with dentofacial deformities.
Surgeons in the United Kingdom and the United States often perform identical oral and maxillofacial operations with strikingly different instrument sets. The extent and practical significance of this divergence have not,...Surgeons in the United Kingdom and the United States often perform identical oral and maxillofacial operations with strikingly different instrument sets. The extent and practical significance of this divergence have not, to our knowledge, been previously reported. We conducted a descriptive comparative review of contemporary UK and US practice (2023-2024), cataloguing instruments through clinical observation and discussions with peers and scrub teams, then verifying nomenclature, design, and provenance against reference texts and manufacturers' catalogues. Functionally equivalent but non-identical instruments were paired and profiled for origin, form, and typical use. Findings show a small common core (Freer elevator, Minnesota retractor, Austin retractor, DeBakey forceps, Adson forceps, Metzenbaum scissors, and Mayo scissors) with nearly all other instruments differing, illustrating parallel solutions to the same operative tasks. British instruments and their American counterparts (for example, Molt #9, Woodson #1, Seldin elevator, Molt #4, Dean scissors, Army-Navy retractor, Sweetheart retractor, Sistrunk retractor, Hargis retractor, 301 elevator, and Cogswell elevators) were assembled into a practical compendium, with the aim of encouraging cross-pollination of surgical practice. Awareness of transatlantic instrument choices presents an opportunity to refine one's armamentarium. Through selective adoption of unfamiliar but potentially advantageous instruments, the open-minded surgeon can discover new ways to enhance operative precision, efficiency, or ergonomics.
This systematic review and meta-analysis evaluated the effectiveness of resorbable versus titanium plating systems in the management of paediatric maxillofacial fractures. A comprehensive search of PubMed, Embase, Scopus...This systematic review and meta-analysis evaluated the effectiveness of resorbable versus titanium plating systems in the management of paediatric maxillofacial fractures. A comprehensive search of PubMed, Embase, Scopus, and specialty journals up to December 2024 identified six retrospective studies published between 2010 and 2024, involving 1,584 patients aged ≤18 years. Both resorbable and titanium systems provided satisfactory fracture stability and healing. Titanium fixation was consistently associated with higher complication rates, ranging from 8%-12% whereas resorbable systems demonstrated rates of 0%-11%, mostly minor complications. Titanium fixation was frequently associated with hardware removal, with reported rates ranging from 15%-95%, reflecting both complication-related and protocol-driven removals, whereas none of the resorbable systems required secondary surgery for hardware removal. Meta-analysis demonstrated a non-significant reduction in complication odds with resorbables compared with titanium (odds ratio 0.42; 95% confidence interval 0.12 to 1.48; p = 0.18; I = 52%). These findings indicate that resorbable plating systems offer comparable stability to titanium, with fewer complications and the significant advantage of eliminating the need for removal. Titanium remains the preferred option for load-bearing mandibular fractures due to its superior mechanical strength, while resorbables appear effective for non-load-bearing and growth-sensitive sites. Further prospective trials with long-term follow up are required to confirm their impact on craniofacial growth and cost-effectiveness.
Osteomyelitis of the mandible is uncommon in the current age of antimicrobials. When it occurs, the effects can be devastating, both functionally and aesthetically. The low volume of cases means clinicians are unlikely t...Osteomyelitis of the mandible is uncommon in the current age of antimicrobials. When it occurs, the effects can be devastating, both functionally and aesthetically. The low volume of cases means clinicians are unlikely to gain significant experience in managing this condition. In this 15-year retrospective case series, all cases of osteomyelitis of the mandible treated at our tertiary referral centre were identified. Data on patient demographics, risk factors, treatment regimens, and outcomes were collected. The Zurich classification system was used to group cases into Acute (AO), Secondary Chronic (SCO) and Primary Chronic (PCO) osteomyelitis. A total of 60 patients were included for analysis. Mean age was 43 years (8-77), and males and females were equally affected. The commonest aetiology was odontogenic (76.7%), followed by trauma. The commonest organisms were mouth commensals, with a significant association of less virulent organisms in SCO compared with AO (p = 0.018). There was a significant difference in the prevalence of systemic factors between AO and SCO patients (p < 0.001). Six weeks of antibiotics was sufficient to treat most AO cases (n = 13). SCO cases (n = 43) treated with surgical debridement combined with antibiotics had better initial outcomes. To our knowledge, this represents one of the largest series of mandibular osteomyelitis to date. Osteomyelitis of the mandible is an uncommon and challenging condition, requiring a multidisciplinary approach. There are important differences between SCO and AO that surgeons must consider, including host factors, organisms and treatment strategies.
Mohs micrographic surgery (MMS) is the most precise surgery regarding margin control and total excision of tumours. The advantages of MMS include precise margin control, one-stop operation, and better patient satisfactio...Mohs micrographic surgery (MMS) is the most precise surgery regarding margin control and total excision of tumours. The advantages of MMS include precise margin control, one-stop operation, and better patient satisfaction. The files of patients undergoing MMS between January 2013 and March 2023 were retrieved. Patients were referred for MMS as a result of having non-melanoma skin cancer (NMSC) on the face. A single surgeon operated on all patients. A total of 3812 MMS were performed. Fifty-eight percent of patients were male, and 41.92% were female (p < 0.001). Most lesions were midface (54%, p < 0.001), with 24% of lesions presenting in the left face and 21% in the right face (p = 0.012). Average MMS had 2.4 stages. Nose lesions and lesions with scar morphology required the most stages. Fair-skinned patients (Fitzpatrick Grade 2) required more stages than others in our cohort (p = 0.002). Eyelids, nose, and ear lesions were the areas that needed local flap coverage most often. This is a retrospective study, which could be seen as a limitation. To our knowledge, this is the first report in English in the literature that confirms the lateralisation of NMSC in the face. While most studies found a higher prevalence among females, this cohort is predominantly male. Previous operations in the same lesion have increased the number of stages needed to reach free margins.