This study aims to determine which of the main arthroscopic discopexy techniques yields the best outcomes. A systematic review was conducted following the PRISMA guidelines. The inclusion criteria comprised studies repor...This study aims to determine which of the main arthroscopic discopexy techniques yields the best outcomes. A systematic review was conducted following the PRISMA guidelines. The inclusion criteria comprised studies reporting Visual Analogue Scale (VAS) scores and maximum interincisal opening (MIO) in patients who underwent temporomandibular joint (TMJ) discopexy. A Bayesian linear regression analysis was performed, considering pain reduction and increased mouth opening as dependent variables. The three primary technique groups were classified as rigid, semi-rigid, and non-rigid. A total of 1.400 discopexies performed were assessed on 849 female and 204 male patients. The most common diagnosis was Wilkes stage III, observed in 257 joints. The rigid technique resulted in a pain reduction of -56.07 (VAS), the semi-rigid technique reduced pain by -41.17 (VAS) and the non-rigid technique by -51.47 (VAS). Regarding MIO improvement, the semi-rigid technique showed the greatest increase, with a mean gain of 9.84 mm (7.06 ± 2.78 mm), followed by the non-rigid technique with 8.41 mm (7.06 ± 1.35 mm), and the rigid technique with 7.06 mm. All techniques demonstrated improvements in both pain reduction and mouth opening. However, the rigid technique achieved the best pain reduction, while the semi-rigid technique resulted in the most significant improvement in MIO.
Temporomandibular joint dysfunction (TMD) can lead to jaw hypomobility and trismus. There are several treatment options depending on diagnosis, however, where possible, conservative measures are preferred to surgical int...Temporomandibular joint dysfunction (TMD) can lead to jaw hypomobility and trismus. There are several treatment options depending on diagnosis, however, where possible, conservative measures are preferred to surgical intervention. This paper investigates the safety and efficacy of using Restorabite (Integrated Prosthetics & Reconstruction, Chris O'Brien Lifehouse), a new jaw-stretching device with regulated and incremental levels of force, to treat trismus in patients with chronic closed lock of the temporomandibular joint. Fifteen consecutively recruited participants used Restorabite as their primary treatment modality. Maximum incisal opening and trismus, swallowing, and speech-related quality of life outcome measures were measured at baseline (time of diagnosis), after 10 weeks of therapy, and at 6 and 12-month follow up. At completion of the intervention mouth opening improved on average by 15.1 mm (p < 0.001). This was maintained at 6 months (average gain of 16.7 mm, p < 0.001) and 12 months (15.5 mm, p < 0.001). Trismus-related quality-of-life scores also significantly improved by 23.6 (p = 0.01). There were no treatment-related adverse events. Restorabite is a safe option for the conservative management of TMD-related trismus. Restorabite™ offers a safe and effective treatment for trismus resulting from chronic TMJ closed lock in patients with TMD.
Assessing the health-related quality of life (HRQOL) in maxillofacial trauma patients is essential for understanding the holistic impact of injury. Whilst validated tools exist for oral cancer, trauma-specific HRQOL ques...Assessing the health-related quality of life (HRQOL) in maxillofacial trauma patients is essential for understanding the holistic impact of injury. Whilst validated tools exist for oral cancer, trauma-specific HRQOL questionnaires are lacking. The University of Washington Quality of Life (UOW-QOL) questionnaire for oral cancer was adapted to evaluate maxillofacial patients as a pilot study. The aim was to capture functional and psychosocial challenges unique to trauma, thereby improving patient care. Thirty-five patients who sustained facial injuries then underwent surgery at the Royal London Hospital were recruited. They were routinely followed up in clinic one to six months postoperatively and completed the adapted QOL questionnaire, tailored for maxillofacial trauma. Version 28 IBM SPSS statistics software was used for data analysis. There was a statistically significant association between the dentoalveolar region and QOL (p < 0.001), indicating a lower QOL, potentially reflecting current NHS dental care deficiencies. The total severity of complications was significantly correlated with QOL (p < 0.047), meaning an increase in the number and severity of complications led to QOL deterioration. Among the complications, appearance and scarring were significant (p < 0.03 and p < 0.029, respectively), with a negative self-perception of appearance and more severe scarring contributing to a lower QOL. A validated QOL questionnaire is needed to assess maxillofacial patients postoperatively for more standardised comparisons of outcomes. The researchers found this tool effective in evaluating the QOL of these patients, and believe that if future studies adopt it, more consistent and comparable data can be generated.
Injuries to the face, mouth and jaws are common presentations to UK hospitals. Understanding the current volume of work and the recent changes can yield important lessons for the teams that deal with facial injuries. We...Injuries to the face, mouth and jaws are common presentations to UK hospitals. Understanding the current volume of work and the recent changes can yield important lessons for the teams that deal with facial injuries. We examined the Hospital Episode Statistics (HES) covering England for the financial reporting years ending in 2015-2024 for relevant diagnoses and procedures undertaken during hospital admissions. A significant reduction in activity in many areas due to COIVD-19 was found. We report on the change between average volumes of activity in the years ending 2015-17, compared with the years ending 2022-24. For soft tissue trauma there was an 11.3% reduction in recorded repairs between these time periods. There were also reductions in orbital (-20.7%), nasoethmoidal (-22.2%), zygomatic complex (-32.4%), nasal (-52.9%), and mandibular (-18.5%) fracture repairs. In many areas this was found in contrast to increased diagnosis of these fracture types. In conclusion, for many types of facial trauma, there has been a reduction in clinically significant events over the last decade. Improved diagnosis and changes in coding behaviour may account for increased recognition of injuries with less clinical relevance.
Minimally invasive orthognathic surgery (MIOS) offers numerous advantages, including reduced morbidity, faster recovery, and better aesthetic outcomes compared to conventional methods. However, the learning curve associa...Minimally invasive orthognathic surgery (MIOS) offers numerous advantages, including reduced morbidity, faster recovery, and better aesthetic outcomes compared to conventional methods. However, the learning curve associated with MIOS has not been well studied. This study aims to evaluate the learning curve associated with MIOS. A consecutive series of 30 bimaxillary orthognathic surgeries (30 patients), including genioplasty, was performed by a single surgeon, using the minimally invasive approach. Surgical time, intraoperative blood loss, and incision sizes were measured. All surgeries followed the described MIOS protocol. The learning curve for MIOS was evident in the first 12 cases, where surgical time, bleeding, and incision sizes improved significantly. Incision lengths in the maxillary approach increased significantly (*p < 0.05), while a significant (*p < 0.05) reduction in genioplasty incision size was observed. Four reoperations were required. Six major complications were reported, with most occurring during the initial 10 cases. Complications decreased after the initial cases, reflecting the surgeon's increasing proficiency. Compared with conventional surgery, MIOS showed a significant reduction in blood loss and duration of hospital stay, therefore, MIOS appears to be a safe, feasible and effective technique. However, further research is needed to confirm these findings and establish standardised MIOS protocols.
Orthognathic surgery is one of the modalities used to treat dentofacial deformities which cannot be corrected with an acceptable outcome by conventional orthodontic treatment. In certain circumstances, orthodontic camouf...Orthognathic surgery is one of the modalities used to treat dentofacial deformities which cannot be corrected with an acceptable outcome by conventional orthodontic treatment. In certain circumstances, orthodontic camouflage can be a viable treatment alternative and involves orthodontic appliances to correct the malocclusion with a view to disguising the underlying skeletal discrepancy. The decision-making process is multi-faceted and can often pose a challenge to the clinical team in borderline cases. This article outlines the rationale behind both orthodontic and orthognathic treatment along with a discussion of the factors to consider when deciding between each treatment modality.
Leadership is increasingly recognised as an essential non-technical skill for effective surgical practice, particularly in oral and maxillofacial surgery (OMFS) due to its multidisciplinary nature and clinical scope. The...Leadership is increasingly recognised as an essential non-technical skill for effective surgical practice, particularly in oral and maxillofacial surgery (OMFS) due to its multidisciplinary nature and clinical scope. The aim of this review is to identify current leadership development opportunities available to UK OMFS specialty trainees, evaluate their sufficiency, and propose areas for improvement. A comprehensive search of published and grey literature was conducted, screening 2796 articles, with 18 meeting the inclusion criteria. Fourteen leadership opportunities were identified; however, most were generic rather than OMFS-specific, comprising formal programmes, committee roles, and e-learning modules. In comparison, allied surgical specialties such as ENT, Plastic Surgery, and Orthopaedics offer more targeted leadership programmes supported by dedicated funding and structured mentorship. To improve OMFS training, this review recommends the development of specialty-specific leadership programmes that are integrated into clinical practice and complemented by formal mentorship initiatives through organisations such as BAOMS. These steps are vital for cultivating future OMFS leaders, ensuring the specialty's continued growth, and ultimately enhancing patient care.
This study aimed to evaluate the long-term effectiveness of arthroscopic discopexy using resorbable pins in the treatment of temporomandibular joint (TMJ) disc displacement over a 10-year follow-up period. A retrospectiv...This study aimed to evaluate the long-term effectiveness of arthroscopic discopexy using resorbable pins in the treatment of temporomandibular joint (TMJ) disc displacement over a 10-year follow-up period. A retrospective analysis was conducted on thirty-three patients who underwent arthroscopic discopexy with resorbable pins between January 2007 and November 2013. Clinical outcomes, including maximal interincisal opening (MIO), lateral movements (LM), protrusive movement (PM), joint pain with the visual analogue scale (VAS), joint locking, and clicking; were assessed at one, three, and six months and at 1.5 and 10 years postoperatively. The results showed significant improvements in MIO, increasing from 31.66 mm preoperatively to 45.50 mm at 10 years (p < 0.05). LM and PM also increased significantly, with PM improving from 3.63 mm to 6.21 mm (p < 0.001). Joint pain decreased substantially, with a mean improvement of 66.02 points on the VAS scale (p < 0.001). Joint locking and clicking were significantly reduced, with no locking observed at five and 10 years postoperatively (p < 0.001). These findings confirm that arthroscopic discopexy with resorbable pins provides durable clinical improvements in pain relief, mandibular function, and joint stability, over 10 years.
Hospital-based clinicians have seen a progressive increase in complications following cosmetic treatments. A challenging late complication of soft tissue filler treatments is granuloma formation. Oral and maxillofacial s...Hospital-based clinicians have seen a progressive increase in complications following cosmetic treatments. A challenging late complication of soft tissue filler treatments is granuloma formation. Oral and maxillofacial surgeons have a key role in the discussion around this delayed-onset complication. We present a case of trismus arising from intramasseteric granulomas following soft-tissue filler injections. Collaboration between surgeons and aesthetic medicine clinicians is crucial to preventing and managing complications from treatments which remain largely unregulated.
Limited long-term 3-dimensional (3D) studies exist evaluating risk factors for condylar resorption following orthognathic surgery. Our aim was to evaluate patient demographics, clinical and radiographic characteristics,...Limited long-term 3-dimensional (3D) studies exist evaluating risk factors for condylar resorption following orthognathic surgery. Our aim was to evaluate patient demographics, clinical and radiographic characteristics, and orthognathic surgical effects on long-term postoperative condylar volume and height, and horizontal skeletal stability, using a 3D approach. Analysis of clinical data and cone-beam computed tomography before, and approximately two weeks and five years after surgery was carried out on 50 subjects (17 male, 33 female), mean (range) age 25.62 (18-51) years. Multiple significant predictive factors for horizontal skeletal relapse and loss of condylar volume and height were identified which, when combined, were indicative of progressive condylar resorption. The magnitude of mandibular advancement, vertical movement, and preoperative body mass index (BMI) explained 50% of the variance in horizontal skeletal relapse, with mandibular horizontal advancement being the most important factor (31%). Significant predictive factors for long-term loss of condylar volume comprised preoperative BMI and mandibular plane angle, mandibular horizontal advancement, and vertical movement. Loss of condylar height was significantly associated with preoperative condylar volume, condylar neck inclination, and horizontal mandibular advancement. In conclusion, horizontal skeletal relapse and loss of condylar volume and height were affected by multiple predictive factors indicating a multifactorial correlation. The magnitude of mandibular advancement had the largest effect on long-term horizontal skeletal relapse, however, it also had a significant impact on loss of condylar volume and height. Preoperative BMI, mandibular plane angle, condylar volume, condylar neck inclination, and surgical vertical movement were also identified as significant predictive factors for long-term horizontal skeletal relapse and loss of condylar volume and height.
Oral submucous fibrosis (OSMF) is a potentially malignant disorder with a risk of progressing to oral squamous cell carcinoma. A key indicator of malignant transformation is increased and uncontrolled cell proliferation,...Oral submucous fibrosis (OSMF) is a potentially malignant disorder with a risk of progressing to oral squamous cell carcinoma. A key indicator of malignant transformation is increased and uncontrolled cell proliferation, which can be evaluated using markers such as Ki67. This study aimed to assess Ki67 expression in OSMF, compare its levels across different associated habits, and correlate expression with clinical and histological grading. This prospective study included 180 histopathologically confirmed cases, divided into three groups: 60 each of oral submucous fibrosis, oral squamous cell carcinoma, and normal oral mucosa. Immunohistochemistry was performed on 3 µm thick formalin-fixed, paraffin-embedded tissue sections using a monoclonal Ki67 antibody (clone MIB-1). Statistical analysis was conducted using SPSS version 21, and chi squared tests were applied, with significance set at p < 0.05. High Ki67 expression was observed in 51 of 60 Oral submucous fibrosis cases, significantly greater than in normal oral mucosa and slightly lower than in oral squamous cell carcinoma, where 57 of 60 cases showed high expression. A statistically significant correlation was found between Ki67 expression and high-risk habits, clinical stages, and histological grades (p < 0.05). The progressive rise in Ki67 expression from normal oral mucosa to oral submucous fibrosis and oral squamous cell carcinoma underscores its role as a biomarker for malignant transformation. While not a direct cause, elevated Ki67 reflects increased proliferative activity and malignancy risk. These findings highlight the utility of Ki67 in early detection, prognosis, and monitoring of oral submucous fibrosis patients to prevent malignant progression.
Soft palate (velar) elevation closes the posterior nasopharynx and prevents the escape of nasal passage air in speech or food during swallowing. However, when the velum is not symmetrical, incomplete closure may occur on...Soft palate (velar) elevation closes the posterior nasopharynx and prevents the escape of nasal passage air in speech or food during swallowing. However, when the velum is not symmetrical, incomplete closure may occur on one side, which is important in the assessment of speech hypernasality, principally after previously repaired cleft palate. This may present as a short anteroposterior length on one side of the uvula that leaves a gap in closure behind the velum. In the absence of an anatomical term, we have defined the posterior velar apex as the most anterior point on the free edge of the posterior border of the soft palate. It is a paired point, with one on each side of the uvula, and is important in the assessment of unilateral anatomical causes of velopharyngeal dysfunction. Synonymous terms would be "left/right posterior velar apex," "posterior hemivelar apex," or even simply, "left/right velar apex".