Penetrating neck injury (PNI) describes an injury, typically with a sharp object, resulting in a wound that crosses platysma. These injuries often require surgical exploration and may result in significant morbidity and...Penetrating neck injury (PNI) describes an injury, typically with a sharp object, resulting in a wound that crosses platysma. These injuries often require surgical exploration and may result in significant morbidity and mortality. We undertook, to our knowledge, the first systematic analysis of the literature exploring the psychological impact of PNI, and carried out a thematic analysis. An electronic search of five databases and four registers was performed in March 2025 according to PRISMA guidelines. Quality of the studies was assessed using Critical Appraisal Skills Programme (CASP) checklists. Thematic analysis was conducted using NVivo software (Lumivero). Of 974 identified studies, 30 met the inclusion criteria, in which 651 patients with PNI were described. Three key themes were identified: aetiology of PNI drives treatment need; psychiatric care is central to multidisciplinary management; and PNI occurs in a socioeconomic context. Patients who self-injure typically receive psychiatric treatment and/or medication, and those with traumatic injuries may receive psychotherapy. Quality of the studies was moderate, with an absence of targeted or prospective research. Current treatment for the psychological impact of PNI is classified by aetiology, though the literature remains heterogeneous and incomplete. Studies note a strong association with socioeconomic deprivation. Psychiatric care is a central component of multidisciplinary management, particularly due to the risk of serious self-harm or suicide following PNI. Presentation with acute injuries offers oral and maxillofacial (OMFS) surgeons an opportunity to prevent further injury and death with timely referral to psychiatric teams. Targeted prospective research would enable optimal assessment and support for recovery in these patients.
The pursuit of the supposed best, 'ideal', or 'gold standard' solution, which often involves greater complexity, risks and/or costs, and/or morbidity, is coined 'maximising'. For several reasons addressed in this article...The pursuit of the supposed best, 'ideal', or 'gold standard' solution, which often involves greater complexity, risks and/or costs, and/or morbidity, is coined 'maximising'. For several reasons addressed in this article 'maximising' suffuses many surgical cultures. The polar opposite is 'satisficing'. The concept of 'satisficing' was articulated by Herbert Simon in 1956 and earned him the Nobel Prize. He advocated a pragmatic approach in which solutions are sought that are 'sufficient to be satisfactory for that situation' rather than relentlessly pursuing the 'single perfect solution'. The tension between these philosophies in maxillofacial surgery is exposed, with clinical examples and the legal responsibility to the patient highlighted.
This study aims to provide an overview of patient characteristics, treatment modalities, and associated complications following microvascular free flap reconstructions in maxillofacial surgery, based on data from a large...This study aims to provide an overview of patient characteristics, treatment modalities, and associated complications following microvascular free flap reconstructions in maxillofacial surgery, based on data from a large national tertiary care centre. Adult patients who received a microvascular free flap between April 2017 and December 2024 were analysed in this descriptive retrospective single-centre study. Follow up was recorded until February 2025. Fibular (FFF), scapular (SFF), deep circumflex artery (DCIA), radial forearm (RFF), anterolateral thigh (ALT) and latissimus dorsi (LDF) free flaps were included. Variables were stratified by flap type and the N-1 χ-test used to test for statistical significance of complication rates across years. A total of 1373 cases met the inclusion criteria. DCIA flaps suffered the highest rates of early flap loss (8.7%; x¯ = 3.6%) and wound infection (39.1%; x¯ = 13.5%). SFFs had the highest rate of anastomotic revision (25.0%; x¯ = 6.9%) and longest mean (SD) surgery duration: 715 ± 181 min. Donor site complications were most common among RFFs (36.0%) and FFFs (34.5%). Overall, wound infection rates were higher among bony rather than soft tissue flaps (23.0% vs. 7.8%). FFFs were associated with fewer recipient-site complications than SFFs and DCIA flaps, but donor site complications were higher. Among soft tissue flaps, complication rates did not differ significantly. Overall, complications at the recipient site were more frequent among bony compared to soft tissue flaps.
CAD-CAM subperiosteal implants (SPIs) offer a therapeutic solution for edentulous patients with severe bone atrophy. However, scientific evidence of their clinical performance for fixed partial restorations (FPRs) is sca...CAD-CAM subperiosteal implants (SPIs) offer a therapeutic solution for edentulous patients with severe bone atrophy. However, scientific evidence of their clinical performance for fixed partial restorations (FPRs) is scarce. The purpose of this review was to evaluate the clinical performance of SPIs supporting FPRs, focusing on survival rates and associated biological and mechanical complications. A scoping review using PRISMA-ScR methodology was conducted, searching the online databases MEDLINE/PubMed, Web of Science, Cochrane Library, and Scopus. Studies that evaluated clinical performance of CAD-CAM SPIs supporting FPRs with at least three patients and follow up of at least one year were included. The search yielded seven articles, which included 96 patients with a total of 121 SPIs. The weighted mean survival rate was 99.17%, with one failure reported in an anterior maxillary restoration. The complication rate was 4.13% for biological complications (wound dehiscence, bone loss, and implant exposure), and 7.44% for mechanical complications (provisional restoration fracture, implant instability, and re-cementing of crowns) over follow-up periods ranging from one to four years. SPIs supporting FPRs may offer a reliable alternative for the restoration of severe bone atrophy, achieving a high survival rate. The complication rate obtained was relatively low. However, the results of this review should be treated with caution, as data were drawn from a small, heterogeneous sample. Studies comparing SPIs supporting FPRs with other techniques are needed to determine their viability in different clinical scenarios.
Chronic pain is an under-recognised but common and significant complication following temporomandibular joint (TMJ) surgery. This study aimed to investigate how oral and maxillofacial (OMF) surgeons diagnose and manage p...Chronic pain is an under-recognised but common and significant complication following temporomandibular joint (TMJ) surgery. This study aimed to investigate how oral and maxillofacial (OMF) surgeons diagnose and manage persistent post-operative pain and to assess collaboration with pain specialists. A 21-item anonymous online questionnaire was distributed to 130 OMF surgeons with expertise in TMJ surgery. The survey addressed clinical practice demographics, diagnostic and management strategies for persistent post-operative pain, awareness of risk factors for chronic pain, and interdisciplinary collaboration. Descriptive statistics were used to analyse responses. Of 39 responses, 30 complete responses were analysed (response rate: 23%). Respondents reported that 30% of their patients with TMD underwent minimally invasive procedures and 24% underwent open joint surgery. Although 24 surgeons routinely discussed the risk of chronic pain, six did not or only did so selectively. Common diagnoses of pain following TMJ surgery included persistent myofascial pain, neuropathic pain, and progression of arthropathy. Only 14 surgeons reported referring patients with persistent pain to a pain specialist. Barriers to referral included limited access, difficulty coordinating care, and perceptions of unnecessary use of resources. Although all respondents were aware of the orofacial pain (OFP) specialty, eight indicated that it was not recognised in their country. Persistent post-operative pain remains a complex, multifactorial issue in TMJ surgery. While most surgeons recognise its prevalence and approach management conservatively, gaps remain in interdisciplinary collaboration and risk factor awareness. Improved integration of OFP specialists and broader adoption of the biopsychosocial model of pain may enhance patient outcomes.
Sentinel lymph node biopsy (SLNB) is a well-established method for managing primary oral squamous cell carcinoma (OSCC), but its role in recurrent or secondary carcinomas, particularly following previous neck dissection,...Sentinel lymph node biopsy (SLNB) is a well-established method for managing primary oral squamous cell carcinoma (OSCC), but its role in recurrent or secondary carcinomas, particularly following previous neck dissection, remains insufficiently studied. This study explores the utility of SLNB in these challenging cases, focusing on reliability, sentinel lymph node (SLN) localisation trends, and clinicopathological factors, comparing results between primary and secondary/recurrent carcinomas. A retrospective analysis was conducted on patients with primary and recurrent or secondary OSCCs treated at a German tertiary medical centre. Chi squared tests were used to analyse correlations between clinicopathological characteristics and SLN localisation. The negative predictive value (NPV) was calculated, and the timing of recurrence was also evaluated. We found an NPV of 93.75% for SLNB in primary carcinomas, whereas it was 88.89% for secondary and recurrent carcinomas. While most SLNs were localised ipsilaterally across both groups, recurrent/secondary cancers showed a higher prevalence of contralateral SLNs (22.2%) and bilateral localisation patterns (11.1%) compared to primary carcinomas (8.3% contralateral; 8.3% bilateral). Despite observed trends, no statistically significant associations were found between SLN localisation and clinicopathological factors. The mean (SD) time to recurrence was significantly shorter for primary carcinomas with 9.20 (3.49) months compared to recurrent or secondary cases 32.00 (8.54) months). SLNB in recurrent or secondary OSCC shows distinct SLN localisation patterns, including more contralateral and mixed foci. In terms of NPV, SLNB is reliable in both primary and secondary/recurrent OSCC. Furthermore, a longer recurrence time reinforces the potential of SLNB as a viable alternative to neck dissection in managing these complex cases.
Heuristics and predictor rules are a mainstay in the field of emergency medicine where the breadth of knowledge required of frontline staff can be significant. The Birmingham mandible and midface (BruMM) rules were previ...Heuristics and predictor rules are a mainstay in the field of emergency medicine where the breadth of knowledge required of frontline staff can be significant. The Birmingham mandible and midface (BruMM) rules were previously developed to streamline decision making concerning plain film radiography in suspected facial fractures. Frontline clinicians within a large NHS foundation trust were asked to apply the BruMM rules to any suspected mandibular or zygomatic fracture, prompting them to consider plain film radiographs as the investigation of choice. Radiographs were then reviewed by members of the BruMM Rules Study Group to determine the presence or absence of fractures. Discriminant analysis was performed whereby binomial fracture outcomes were modelled using cross-validated least absolute shrinkage and selection operator (LASSO) regression. Custom analysis was then performed using a forward stepwise procedure, maximising the Jaccard index of a predictor against the target outcome. A total of 116 patients were recruited, of whom 28 (24.1%) demonstrated a fracture. Combining the results from the LASSO regression analysis and forward stepwise Jaccard procedure yielded a predictor rule with three mandibular and six zygomatic predictors. This composite BruMM-rules score demonstrated maximal sensitivity and specificity of 96.4% and 56.5%, respectively.Implementation of the BruMM rules in the current cohort would have avoided 49 plain film radiograph studies (43.4%), translating into potential cost savings of £8,356.86-£15,440.76 per annum.
The objective of this paper was to evaluate the long-term efficacy of temporomandibular joint (TMJ) arthroscopy regarding functional outcomes and quality of life, and to identify factors influencing these results. A coho...The objective of this paper was to evaluate the long-term efficacy of temporomandibular joint (TMJ) arthroscopy regarding functional outcomes and quality of life, and to identify factors influencing these results. A cohort of 74 patients (99 TMJs) treated by level II/III arthroscopy were followed for ≥five years. Pain (100-mm visual analogue scale [VAS]), maximum inter-incisal opening (MIO), protrusion, and lateral excursions were recorded preoperatively and at one, six, 12 months, and ≥five years postoperatively. Quality of life was assessed with OHIP-14. Arthroscopic findings (synovitis, adhesions, chondromalacia, disc perforation, anterior space obliteration) were graded intraoperatively. Bruxism was clinically recorded. Outcomes were classified as: success, re-arthroscopy <five years, re-arthroscopy ≥five years, or open surgery. Mean (SD) VAS significantly decreased from 56 (22) to 18 (21) mm (p < 0.001), and MIO increased from 32.3 (8.8) to 38.9 (5.9) mm (p < 0.001), surpassing established Minimal Clinically Important Differences (MCID). A total of 82% of joints met all AAOMS-2024 functional goals. Grade III-IV chondromalacia (24%) and anterior space obliteration (29%) correlated significantly with higher pain (+12 mm) and lower MIO (-4 mm) throughout follow up (p < 0.05). Disc perforation had no significant impact. Re-intervention rates were 12% (early) and 5% (late), with 4% progressing to open surgery. Bruxism (55%) did not increase postoperative condylar tenderness but predicted poorer outcomes: higher VAS at five years (30 [31] vs 19 [21] mm; p = 0.032), lower MIO (35.7 (7.0) vs 38.7 (4.3) mm; p = 0.012), lower surgical success (58% vs 68%), and worse OHIP-14 scores. TMJ arthroscopy provides durable pain relief and functional improvement beyond five years. Chondromalacia, anterior obliteration, and bruxism negatively affect outcomes and should inform patient selection and counselling.
Medication-related osteonecrosis (MRONJ) and osteoradionecrosis (ORN) present a significant reconstructive challenge. Assessing the suitability of pedicled flap (PF) reconstruction in the context of a compromised tissue...Medication-related osteonecrosis (MRONJ) and osteoradionecrosis (ORN) present a significant reconstructive challenge. Assessing the suitability of pedicled flap (PF) reconstruction in the context of a compromised tissue bed is essential for effective surgical management. This systematic review evaluates the outcomes of PF reconstruction in MRONJ and ORN. PubMed, Ovid (MEDLINE ALL, Embase), and Cochrane CENTRAL were searched for outcomes of PF reconstruction from inception through to November 2024. A total of 48 studies met inclusion criteria (32 MRONJ, 16 ORN). Analysis included 575 patients (MRONJ: n = 478; ORN: n = 97) receiving 607 flaps (MRONJ: n = 509; ORN: n = 98). The pooled success rate was 90% (95% CI: 87% to 92%) for MRONJ and 98% (95% CI: 94 to 100%) for ORN. Both conditions showed an 18% pooled complication rate (MRONJ: 95% CI, 14% to 23%; ORN: 95% CI: 11% to 28%). In MRONJ, buccal fat pad flap was most common (n = 189, 37.13%), while submental island flap with mylohyoid muscle showed the highest success rate (94%, 95% CI: 67% to 99%). There were significant differences in complication rates across flap types (p < 0.0001), with the mylohyoid flap showing the lowest rate (9%, 95% CI: 2% to 36%). For ORN, pectoralis major musculofascial flap was most common (n = 36, 36.73%). Pedicled flaps demonstrate high success rates (>90%) in MRONJ and ORN reconstruction, supporting their use as a reliable option in compromised tissue beds. Flap selection should be individualised based on defect characteristics and patient factors. Further research is needed to better define indications and optimise patient selection.