T4b oral squamous cell carcinoma (OSCC) is a broad umbrella term for advanced oral cancers. Recent evidence points towards a subset of T4b tumours invading the masticator space (MS) that may be amenable to complete resec...T4b oral squamous cell carcinoma (OSCC) is a broad umbrella term for advanced oral cancers. Recent evidence points towards a subset of T4b tumours invading the masticator space (MS) that may be amenable to complete resection. Our aim was to evaluate the current evidence and present and discuss the arguments for and against re-classification. A systematic review was conducted of articles published between January 2000 and February 2025 to summarise prognostic factors that influence survival outcomes in MS T4b OSCC patients. Ten studies met the inclusion criteria. Only two reported statistically significant worse outcomes for supra-notch disease. Other established negative prognostic factors common to all OSCC subsites, such as pathological variables or nodal involvement, did not separate T4b disease into survival subgroups. Although several studies highlight the significance of vertical extension in T4b disease relative to the sigmoid notch, the data remain heterogeneous. Future research should adopt a unified system for classifying tumour extension before considering a subclassification of resectable cases, as current evidence is insufficient to justify changes to the staging criteria.
Radiation-induced xerostomia is a frequent and debilitating complication in patients undergoing radiotherapy for head and neck cancer. This study aimed to compare the effectiveness of available treatment modalities in pr...Radiation-induced xerostomia is a frequent and debilitating complication in patients undergoing radiotherapy for head and neck cancer. This study aimed to compare the effectiveness of available treatment modalities in preventing or managing radiation-induced xerostomia and associated complications in head and neck cancer patients. A detailed search of PubMed and Google Scholar was conducted. Only randomised controlled trials (RCTs) involving radiotherapy-treated head and neck cancer patients were included. The interventions that were analysed encompassed pharmacological agents (for example, pilocarpine, and amifostine), antioxidants, herbal formulations, acupuncture, low-level laser therapy (LLLT), and regenerative approaches. Primary outcomes included severity of xerostomia, rates of salivary flow, mucositis, oral pain, dysphagia, and fatigue. Thirty-one randomised clinical trials met the inclusion criteria. Pooled analysis showed no significant reduction in severity of xerostomia at weeks 3, 4, or 6, or 6 months. Stimulated salivary flow did not significantly improve (mean difference (MD): 0.22; p = 0.15), while unstimulated salivary flow showed a significant benefit (MD: 0.13; 95% CI: 0.09 to 0.17; p < 0.00001). A significant reduction in the severity of oral pain was also noted (MD: -2.25; p < 0.0001). No significant differences were found for the incidence or duration of mucositis, dysphagia, or fatigue. Considerable heterogeneity was observed across the studies and no single intervention demonstrated consistent efficacy in managing radiation-induced xerostomia. Some therapies have shown promise in improving unstimulated salivary flow and reducing oral pain; however, the overall evidence remains inconclusive. To address this persistent clinical challenge, future trials should adopt standardised outcome measures, assess combination therapies, and investigate novel regenerative strategies.
Handheld point-of-care ultrasound (HPOCUS) is a rapidly growing technology with an expanding range of medical applications. A new method to compare two-dimensional (2D) HPOCUS accuracy with three-dimensional (3D) cone-be...Handheld point-of-care ultrasound (HPOCUS) is a rapidly growing technology with an expanding range of medical applications. A new method to compare two-dimensional (2D) HPOCUS accuracy with three-dimensional (3D) cone-beam computed tomography (CBCT) was devised. Ten patients who had completed long-term follow up after surgical intervention to correct displaced zygomatic arch (ZA) fractures were included. The outer cortical outline of the 2D ZA was identified using HPOCUS and superimposed on to a 3D CBCT segmentation. A pointwise analysis of 100 discrete paired points was used to calculate the distance discrepancy between curves representing the ZA outlines derived from HPOCUS and CBCT. The mean (SD) distance between all patients' US and CBCT curves was 0.141 (0.087) mm. Given the minimal spatial discrepancy between the modalities, we recommend HPOCUS as the gold standard, first-line imaging follow-up modality for patients with ZA fractures.
Gastroesophageal reflux has long been suspected in children with orofacial clefts, but its presence has remained unproven due to the absence of reliable diagnostic methods. The aim of this study was to evaluate the preva...Gastroesophageal reflux has long been suspected in children with orofacial clefts, but its presence has remained unproven due to the absence of reliable diagnostic methods. The aim of this study was to evaluate the prevalence of acid reflux in children with isolated cleft lip (CL), cleft palate (CP), or cleft lip and palate (CLP), using pH-metry prior to primary surgery. A retrospective study that included patients evaluated between January 1988 and December 2017 was conducted at a tertiary academic centre. A total of 234 patients were included (52 with CL, 87 with CP, and 95 with CLP). The prevalence of acid gastroesophageal reflux disease (GERD) was 17.02% (95% CI: 6.80 to 27.23) in the CL group, 16.09% (95% CI: 8.36 to 23.81) in the CP group, and 19.38% (95% CI: 11.43 to 27.32) in the CLP group. No statistically significant differences were found between the groups in terms of reflux index or secondary pH-metry parameters. In conclusion, nearly one in five infants with an orofacial cleft is affected by acid GERD. Routine gastroenterological evaluation and follow up should be considered as part of the multidisciplinary management of this population.
The aim of this paper was to present an overview of the previous published classification and staging systems for osteoradionecrosis (ORN) of the jaws and propose a new classification system for ORN. An electronic search...The aim of this paper was to present an overview of the previous published classification and staging systems for osteoradionecrosis (ORN) of the jaws and propose a new classification system for ORN. An electronic search was conducted using Medical Subject Headings (MeSH) terms, 'osteoradionecrosis' and 'classification', and free text words, 'stage', 'staging', 'ORN', classification'. A total of 2053 manuscripts were identified, of which 21 were included, reviewed, and analysed by all authors. A total of 21 different classification and staging systems were identified. Objective findings, included exposed bone and/or fistula, as well as radiological evidence of pathological fracture, were the three most used factors in the existing classification and staging systems (57.1%, 38%, 52.4%). Nine classification and staging systems (42.9%) were treatment-dependent. Fourteen out of the 21 (66.7%) classification and staging systems only described changes in the mandible. Notably, only one article described changes in the maxilla. No standardised classification or staging system has to our knowledge addressed the complexity of ORN. There is a clear need for a new classification and staging system that enables the monitoring of disease progression, evaluation of treatment outcomes, restaging, and comparison of different treatment approaches. We propose a new classification system to address these unmet needs.
Sialocele is a rare but important complication that may follow facelift surgery, typically as a result of inadvertent injury to the parotid gland or its duct. It often presents as a painless, fluctuant swelling in the pr...Sialocele is a rare but important complication that may follow facelift surgery, typically as a result of inadvertent injury to the parotid gland or its duct. It often presents as a painless, fluctuant swelling in the preauricular region and, if not properly managed, can lead to patient distress and aesthetic dissatisfaction. We conducted a retrospective review of three female patients, aged 42-56, who developed sialocele 10-14 days after superficial musculoaponeurotic system (SMAS) plication rhytidectomy. Parameters recorded included time to presentation, swelling characteristics, treatment modality, and outcome. All patients were initially managed conservatively with aspiration and compressive dressings. One responded fully to conservative therapy, another required botulinum toxin type A injection (50 units), and the third underwent surgical drainage and parotid duct ligation. Outcomes were defined as complete resolution of swelling without recurrence. This case series highlights a stepwise approach to managing sialocele, beginning with conservative measures and escalating as clinically indicated.
Zygomaticomaxillary complex (ZMC) fractures are common facial injuries that often require surgical intervention to restore both function and aesthetics. A variety of surgical approaches, including traditional open reduct...Zygomaticomaxillary complex (ZMC) fractures are common facial injuries that often require surgical intervention to restore both function and aesthetics. A variety of surgical approaches, including traditional open reduction and more minimally invasive techniques, have been proposed. This review aims to evaluate the functional, aesthetic, and postoperative outcomes associated with these surgical treatments, based on studies conducted from 2014 to 2024. A systematic search of MEDLINE, EMBASE, and Cochrane databases was conducted until October 2024. Twelve studies, published between 2014 and 2024, focusing on ZMC fractures and using open or minimally invasive approaches, were included. These studies, both retrospective and prospective, provided data on patient demographics, surgical approaches, complications, recovery times, and functional and aesthetic outcomes, which were extracted and analysed. The review found that surgical approaches for ZMC fractures generally led to favourable functional and aesthetic outcomes, with no major complications such as infections or malunion. Both open and minimally invasive approaches effectively restored facial function, including ocular motility and nerve recovery, with minimal recovery times. Minimally invasive procedures showed better aesthetic outcomes, with less scarring and faster recovery. Functional outcomes, including sensory recovery, were similar across techniques, with minimally invasive methods having a slight advantage in recovery time. Both traditional open reduction and minimally invasive techniques are effective for managing ZMC fractures, with minimal complications and favourable functional and aesthetic outcomes. Endoscopically-assisted techniques in particular offer superior cosmetic results and shorter recovery times. Future studies with standardised protocols and long-term follow up are needed to assess the durability of these outcomes and better understand factors affecting nerve recovery and facial aesthetics.
Skin cancer, particularly non-melanoma skin cancer (NMSC), represents a significant healthcare burden globally. Correct clinical diagnosis can be challenging with patients being misdiagnosed and having unnecessary surger...Skin cancer, particularly non-melanoma skin cancer (NMSC), represents a significant healthcare burden globally. Correct clinical diagnosis can be challenging with patients being misdiagnosed and having unnecessary surgery or delays in treatment. Punch biopsies offer a minimally invasive method to establish the diagnosis prior to treatment. This study correlates clinical appearance with histological diagnosis post punch biopsy and reflects on its value in the patient pathway. This single-unit study evaluated 200 consecutive punch biopsies of 137 suspected NMSC patients. Data were analysed for demographic factors, clinical appearances, histopathological results, subsequent management, and time between these events. The clinical diagnoses were 124 basal cell carcinoma (BCC), 36 squamous cell carcinoma (SCC), one lentigo maligna, one Merkel cell tumour, and 38 benign lesions. Overall clinical diagnosis and punch biopsy histology were the same in 86 cases (43%). In 89 of 162 NMSC cases (55.6%) the punch biopsy diagnosis avoided further surgery. In 10 cases (5%) it was necessary to expedite surgical intervention where SCC or BCC were unexpectedly diagnosed. Correct clinical diagnosis for BCC and SCC was 41.9% and 30.6%, respectively, underscoring the importance of histological confirmation in cases where clinical diagnosis is uncertain. Twenty-five punch biopsies were for dermatology referrals, and concordance was 12 (48%). Punch biopsy did not delay treatment as time from clinical assessment to biopsy result was mean (SD) 19.1 (16.3) days. This study highlights that the benefit of punch biopsies, which helped clarify the diagnosis for both the patient and surgeon, improved diagnostic accuracy, and avoided inappropriate use of theatre time with associated patient burden and morbidity.
This systematic review and meta-analysis aimed to evaluate the association between orthognathic surgery and temporomandibular disorder (TMD) symptoms in patients with dentofacial disharmony (DFD) during different postope...This systematic review and meta-analysis aimed to evaluate the association between orthognathic surgery and temporomandibular disorder (TMD) symptoms in patients with dentofacial disharmony (DFD) during different postoperative time periods. The study protocol was prospectively registered on PROSPERO (CRD42024609472). PubMed, Embase, CENTRAL, SIGLE, CNKI, WANFANG, and VIPC databases were searched from 2000 to 2025 for studies assessing the efficacy of orthognathic surgery in DFD patients, focusing on changes in TMD symptoms during different postoperative time periods. Random-effects meta-analysis was utilised to pool risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) calculated. This review included 21 studies comprising 2070 participants. There was a reduction in TMD signs during different postoperative time periods but no significant intergroup differences (p = 0.68). Temporomandibular joint (TMJ) pain (RR 0.57, 95% CI 0.35 to 0.93, p = 0.02) and TMJ clicking status (RR 0.31, 95% CI 0.14 to 0.68, p = 0.004) were significantly alleviated at six months postoperatively. However, when compared with six months, a significant recurrence of symptoms was noted at one or two years postoperatively. Notably, the intergroup difference concerning TMJ clicking (p = 0.04) was more significant than it was for TMJ pain (p = 0.64) during different postoperative time periods. Furthermore, maximal mouth opening (MMO) gradually increased over time. Orthognathic surgery primarily aims to correct DFD, and after improving the occlusion there is a possibility that TMD symptoms may subsequently improve. However, certain symptoms may recur to varying degrees during different postoperative periods. Further research is necessary to expand the sample size and investigate the different effects of various factors such as type of DFD, surgical procedure, condylar resorption, and articular disc condition, on the alleviation of TMD symptoms.
With the increasing influence of social media in medicine and dentistry, it now serves as a tool of communication and research amongst patients. This study aimed to evaluate the influence of social media on patient choic...With the increasing influence of social media in medicine and dentistry, it now serves as a tool of communication and research amongst patients. This study aimed to evaluate the influence of social media on patient choice of oral and maxillofacial surgeon. This cross-sectional study used a self-administered online survey to form an anonymous cohort of volunteer participants who had undergone, or were planning to undergo, temporomandibular joint replacement (TMJR) surgery. Of the 209 respondents, 35.9% chose their surgeon through social media, and the most significant factor affecting their choice was successful postoperative photographs (60.4%). A negative t-statistic of -2.032 was found between increased social media usage and surgeon choice through social media platforms, suggesting that patients who spend more time on social media have an increased tendency to choose their surgeon through online research compared with those who spend one hour/day or less on social media. A statistically significant relation between age and the likelihood of choosing a surgeon through social media was observed (p = 0.0001), which suggests that as age decreases, the likelihood of choosing a surgeon through social media increases. The findings of this study underscore the growing impact of digital presence on patient decision-making, emphasising the need for healthcare professionals to consider social media as a key platform for patient engagement and outreach. Maxillofacial surgeons should therefore consider maintaining an active and professional presence on social media platforms, with careful attention not to use the platforms for inappropriate practice marketing, but for patient education.
The zygomatic implant perforated (ZIP) flap is an alternative to the fibular free flap (FFF) for maxillary reconstruction with dental rehabilitation. The aim of this study was to compare facial contour and patient-report...The zygomatic implant perforated (ZIP) flap is an alternative to the fibular free flap (FFF) for maxillary reconstruction with dental rehabilitation. The aim of this study was to compare facial contour and patient-reported outcomes in matched cases of ZIP flap or FFF maxillary reconstruction. Inclusion criteria were patients who underwent ZIP flap reconstruction between February 2017 and April 2023 with high-resolution preoperative and postoperative computed tomography (CT) imaging, and who had completed the FACE-Q questionnaire, matched with patients who had undergone maxillary FFF reconstruction. Accuracy of facial contour restoration was assessed in CloudCompare® by comparing preoperative and postoperative segmentations of the complete facial mask and midface subsites. Associations with patient-reported outcomes were assessed using linear regression. Twenty patients (10 ZIP, 10 FFF) were included. Mean difference between preoperative and postoperative facial contour did not differ significantly between groups for complete facial mask (1.0 mm ZIP vs 1.1 mm FFF, p = 0.30), or subsite analysis (malar eminence p = 0.49, nose p = 0.29, upper lip p = 0.31). Patient-reported outcomes were similar between groups except for saliva function, which was superior in the FFF group (p = 0.043). ZIP flaps are a valuable option for maxillary reconstruction in carefully-selected patients.
This study evaluates the performance of six large language models (LLMs) in generating content relevant to oral and maxillofacial surgery (OMFS), focusing on their ability to provide accurate, comprehensive, and relevant...This study evaluates the performance of six large language models (LLMs) in generating content relevant to oral and maxillofacial surgery (OMFS), focusing on their ability to provide accurate, comprehensive, and relevant information across five specific tasks. Each LLM was assessed based on its responses to five prompts: (1) postoperative instructions for third molar surgery; (2) a list of best-selling books on orthognathic surgery; (3) the most cited articles in OMFS; (4) novel ideas for systematic reviews; and (5) emerging trends in OMFS. Responses were scored for relevance, comprehensiveness, and accuracy using predefined criteria. Statistical analysis was performed using the Kruskal-Wallis test to compare tool performance. The LLMs performed similarly overall, with varying strengths and weaknesses. For postoperative instructions, they all provided comparable recommendations, though Perplexity underperformed. In identifying best-selling books, Gemini and Perplexity excelled, while ChatGPT and Copilot struggled with retrieving highly cited articles. Copilot and Claude were more effective in suggesting novel systematic review topics, while ChatGPT, Claude, Copilot, and DeepSeek identified emerging trends most accurately. LLMs demonstrate significant potential in supporting OMFS-related tasks, but their performance varies depending on the specific application. While they excel at synthesising existing information and identifying trends, limitations in accuracy and occasional hallucinations highlight the need for human oversight. These findings underscore the importance of integrating artificial intelligence (AI) as a supplementary tool in clinical, academic, and research settings, ensuring its use complements, rather than replaces, human expertise.
Many dental core trainees (DCT) feel unprepared to manage unwell patients and emergent situations. Simulation-based education (SBE) is a widely used educational intervention that can facilitate learning without compromis...Many dental core trainees (DCT) feel unprepared to manage unwell patients and emergent situations. Simulation-based education (SBE) is a widely used educational intervention that can facilitate learning without compromising patient safety, and increase preparedness for emergencies. To supplement the predominantly positivist relevant literature, this study endeavoured to answer a research gap through in-depth, meaningful enquiry. The aim was to explore the perceptions of preparedness for practice of oral and maxillofacial surgery (OMFS) DCTs following a one-day, high-fidelity SBE course. The construct under study was preparedness for practice. The study was grounded in the conceptual frameworks of social cognitive theory, constructivist principles, and experiential learning theory. DCTs who had attended an SBE course underwent semi-structured interviews. Thematic analysis of the data generated four main themes: realism; safe learning environment; community of practice; and DCT as a unique experience. The results outlined the importance of physical and psychological fidelity within the SBE design, debrief facilitated by experienced, multidisciplinary faculty, and incorporation of learning through peer-observation, as important SBE features to advance DCT learning and subsequent preparedness. The conclusions reflected participants' positivity about SBE as an educational technique to increase their preparedness. Overall, the findings illustrate a wide range of benefits from SBE in this context, the concepts of which other educationalists could consider adopting as a medical education strategy to improve DCTs' preparedness for OMFS.
Temporomandibular disorders (TMD) are complex conditions that burden patients and healthcare systems. Disparities in health literacy may hinder patient comprehension of online educational materials, potentially influenci...Temporomandibular disorders (TMD) are complex conditions that burden patients and healthcare systems. Disparities in health literacy may hinder patient comprehension of online educational materials, potentially influencing outcomes. Artificial intelligence (AI)-driven chatbots offer a promising solution to improve the readability of patient information materials. We assessed the readability of available online materials on TMD in the United Kingdom (UK) and evaluate the ability of three AI-chatbots to improve readability. A search was done of all UK public hospital websites with Oral and Maxillofacial Surgery (OMFS) or Ear, Nose, and Throat (ENT) units for TMD-related patient information. Readability was assessed using five standard scoring systems. Three AI-chatbots (ChatGPT, Claude, and Google Gemini) were used to revise the content to an 11-year-old (sixth-grade) reading level. A total of 31 out of 122 of UK hospital Trusts provided online TMD materials. Of these, 12/31 and 1/31 met the target readability according to the Flesch-Kincaid Grade Level (FKGL), and the Gunning Fog Index/Coleman-Liau Index (GFI/CLI), respectively, with mean (SD) readability at 64.68 (6.79) for Flesch Reading Ease Score (FRES). After AI modification by Gemini, 96.8% met the target readability per FKGL, 54.8% per GFI, and 29.0% per CLI. Gemini improved the mean (SD) score significantly to 82.59 (5.73) (p < 0.001) for FRES, meeting the target readability level. Online patient information on TMD exceeds the recommended Year Six (sixth grade in the US) reading level. AI chatbots, particularly Gemini, can significantly enhance the readability of these materials, enabling them to meet health literacy standards according to certain readability tools.