We analysed the feasibility of day-case treatment for orthognathic procedures including bimaxillary osteotomy. A retrospective analysis compared an initial overnight cohort with a default day-case protocol. In 2023 all 2...We analysed the feasibility of day-case treatment for orthognathic procedures including bimaxillary osteotomy. A retrospective analysis compared an initial overnight cohort with a default day-case protocol. In 2023 all 23 patients stayed in hospital overnight following surgery. In 2024/25 the default day-case protocol led to 12 of 18 patients electing to return home the day of surgery (p < 0.001). Postoperative complications presented in five patients after more than 48 hours. No complications were related to day-case care. This study suggests that day-case orthognathic procedures are feasible, safe, and preferred by most patients.
Facial aesthetics are an important factor in quality of life following cleft lip surgery with the appearance of the nasolabial region a key outcome measure for patients and their families. Analysing the aesthetic outcome...Facial aesthetics are an important factor in quality of life following cleft lip surgery with the appearance of the nasolabial region a key outcome measure for patients and their families. Analysing the aesthetic outcome is difficult as it encompasses personal evaluation and judgment. The aim of this study was to determine whether subjective assessment can differentiate aesthetic outcomes between two surgeons who use differing surgical techniques for primary bilateral cleft lip repair. Five-year postoperative frontal photographs of bilateral cleft lip and palate patients (cropped as per the Asher-McDade aesthetic index) were analysed by 35 blinded surgical and lay reviewers using a five-point Likert scale (1 = excellent, 5 = very poor). The repairs were carried out by two different surgeons. The assessments were repeated at a later date to assess intra-rater reliability. A total of 38 consecutive cases of bilateral cleft lip repairs carried out by two surgeons were assessed. Seventeen cases were carried out by Surgeon A and 21 by Surgeon B. The mean Likert score for surgical/lay assessors for Surgeon A was 2.67/2.69 and for Surgeon B 2.90/2.83. Inter-rater reliability was excellent and intra-rater reliability was found to be slight. Subjective assessment using clinical photography is a useful tool in assessing aesthetic outcomes in bilateral cleft lip repair.
The aim of this retrospective study was to assess the change in the alveolar bone height following sinus augmentation surgery utilising a combination of right anterior iliac crest bone marrow aspirates and allogeneic can...The aim of this retrospective study was to assess the change in the alveolar bone height following sinus augmentation surgery utilising a combination of right anterior iliac crest bone marrow aspirates and allogeneic cancellous bone, as observed through cone-beam computed tomography (CBCT). A total of 46 patients who underwent CBCT scans taken before and after sinus augmentation surgery were evaluated. The alveolar bone heights were compared over time. Average and frequency measures, as well as a Student's t test were performed to determine significant differences between the graft height between the preoperative and postoperative alveolar bone heights. Overall, a statistically significant increase in alveolar bone heights from a mean of 5.44 mm ± 2.9 m to 12.49 mm ± 4.8 m was observed on the postoperative CBCT scan. The mean postoperative CBCT was 23 months (range: 5-59), p < 0.01. In conclusion, the use of bone marrow aspirates from the right anterior iliac crest combined with allogeneic cancellous bone materials can be successfully used to create increased bone height for pre-implant site grafting.
The aim of this study was to explore the post-treatment physical function of head and neck cancer survivors (HNCS). A prospective cross-sectional study was conducted. Assessment included physical measures (The Short Phys...The aim of this study was to explore the post-treatment physical function of head and neck cancer survivors (HNCS). A prospective cross-sectional study was conducted. Assessment included physical measures (The Short Physical Performance Battery (SPPB), Strength (30 second Sit to Stand Test and Grip Strength)), patient reported outcome measures (Neck Disability Index (NDI), and the FACT- H&N) and self-reported recovery measures. Participants (n = 30) were 66.7% men. Most had undergone surgery (87%, n = 26) and were less than six months post treatment (80%, n = 25). In total 41% (n = 12) of participants had low physical performance, 72% (n = 21) scored below average strength scores and 67% (n = 20) of participants had neck disability. The FACT H&N found a moderate impairment in quality of life [mean (SD) Trial Outcome Index 60.4 (20.2)] and 24% (n = 7) of participants screened positive for lymphoedema. Seventeen percent (n = 5) have participants reported having a fall in the last 12 months. This study provides descriptive data from a pilot study which may service as a foundation for future research.
Lingual lymph nodes (LLN) are aberrant nodes located in the floor of mouth. Neither are metastases to these nodes routinely investigated nor are they included in the guidelines for management of tongue cancers. This arti...Lingual lymph nodes (LLN) are aberrant nodes located in the floor of mouth. Neither are metastases to these nodes routinely investigated nor are they included in the guidelines for management of tongue cancers. This article systematically collates published literature along with a meta-analysis to address clinically relevant questions pertaining to the lingual nodes. A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Databases were searched to identify all articles on LLN in English until December 2024. A total of 24 articles were included. Proportional analysis showed an overall incidence of 8.98% (LLN metastasis). Pooled sensitivity of cross-sectional imaging to detect these nodes was 34%. Patients presenting with advanced tumour stage and/or nodal positivity have a higher risk of LLN metastasis. The analysis also showed a higher chance of recurrencein patients with metastatic LLN resulting in poorer outcomes in these tongue cancers.
This case report discusses the long-term management of a patient's left zygomatic fracture with an associated orbital floor injury. The initial treatment involved open reduction and internal fixation (ORIF), followed by...This case report discusses the long-term management of a patient's left zygomatic fracture with an associated orbital floor injury. The initial treatment involved open reduction and internal fixation (ORIF), followed by the placement of a polyetheretherketone (PEEK) implant for globe dystopia. Despite this intervention, the patient developed progressive secondary enophthalmos and globe dystopia. To correct this, a second PEEK implant was used to improve the position of the eye. The aim of this report is to present a novel technique of PEEK-on-PEEK implants to restore globe alignment. This case underscores the importance of a multidisciplinary approach in the management of complex orbital floor fracture.
Temporomandibular joint dysfunction (TMD) is a common condition, yet multifactorial in nature. Our understanding of the interplay between clinical symptoms in relation to magnetic resonance imaging (MRI) findings and qua...Temporomandibular joint dysfunction (TMD) is a common condition, yet multifactorial in nature. Our understanding of the interplay between clinical symptoms in relation to magnetic resonance imaging (MRI) findings and quality of life is limited. Our primary objective therefore was to identify features of TMD that contribute to anxiety and depression. Our secondary objective was to determine whether clinical symptoms, baseline characteristics, and mental health outcomes are associated with underlying disease severity, as determined by MRI. A retrospective analysis of 202 TMD patients was performed. Mental health outcomes were quantified using the Integrating Mental and Physical Healthcare: Research, Training and Services (IMPARTS) questionnaires, Generalised Anxiety Disorder Assessment (GAD-7), and Patient Health Questionnaire (PHQ-9), and pain was judged by the Brief Pain Inventory (BPI). Patients were categorised based on the severity of temporomandibular joint pathology (normal, anterior disc displacement with reduction, anterior disc displacement without reduction, and severe degeneration). On multivariate analyses, both higher anxiety (GAD-7) (p < 0.001) and depression (PHQ-9) (p < 0.001) scores on the IMPARTS assessment were associated with worst perceived pain on a visual analogue scale (VAS). Unilateral joint involvement (OR 2.48; 95% CI 1.20 to 5.46; p = 0.018), locking (OR 4.28; 95% CI 1.63 to 13.63; p = 0.006), and clicking (OR 2.14; 95% CI 1.05 to 4.60; p = 0.006) were significantly associated with increased odds of an abnormal TMJ on MRI, whereas higher anxiety scores (OR 0.93; 95% CI 0.88 to 0.99; p = 0.006) and male gender (OR 0.35; 95% CI 0.15 to 0.79; p = 0.012) were statistically significantly indicative of a normal joint morphology on MRI. Our findings support a complex interplay between patient symptomatology, mental health outcomes, and objective radiologically-defined joint pathology in the TMD patient population.
This retrospective study assessed the long-term outcomes of extraoral craniofacial implants used to support auricular, nasal, and orbital prosthesis in 138 patients treated at Morriston Hospital, Swansea, from 2004 to 20...This retrospective study assessed the long-term outcomes of extraoral craniofacial implants used to support auricular, nasal, and orbital prosthesis in 138 patients treated at Morriston Hospital, Swansea, from 2004 to 2024. A total of 346 implants were reviewed, showing an overall implant survival rate of 91.9% and prosthesis survival rate of 89.6%. Long-term survival rates at 5, 10, and 20 years were highest for ear implants (100%, 90%, and 80%), respectively, followed by nasal (95.2%, 91.8%, and 91.8%) and orbital implants (89%, 86.6%, and 77%), respectively. Radiotherapy was associated with poorer implant survival, with a survival rate of 89.3% in irradiated implants compared with 97% in non-irradiated implants (p = 0.0219). Amongst the irradiated implants, those placed during ablative surgery showed a significantly improved survival rate (92.49%) than those placed following radiotherapy (68.42%, p = 0.0069). Emerging plating systems such as Epitek show promise in providing alternative nasal prosthesis retention but require further long-term follow up. The above findings underscore the necessity for careful planning alongside experienced lab technicians to optimise implant placement and enhance the long-term success of craniofacial prosthesis.
van Oorschot HD, Hardillo JA, van Es RJJ
… +19 more, van den Broek GB, Takes RP, Halmos GB, de Jel DVC, Dirven R, Lacko M, Vaassen LAA, Hendrickx JJ, Oomens MAE, Ghaeminia H, Jansen JC, Vesseur A, Bun R, Schwandt LQ, Krabbe CA, Klein Nulent TJW, van Bemmel AJM, Klijn RJ, de Jong RJB
The main goal of surgery for oral squamous cell carcinoma (OSCC) is to obtain adequate resection margins as inadequate margins are associated with a worse prognosis and treatment intensification. However, reported rates...The main goal of surgery for oral squamous cell carcinoma (OSCC) is to obtain adequate resection margins as inadequate margins are associated with a worse prognosis and treatment intensification. However, reported rates of inadequate resections vary from 30%-85%. Clinical auditing is an upcoming tool to improve margin status. This study investigates resection margins after OSCC surgery and differences in hospital results, disease-free, and overall survival for <1 and ≤5 mm cut-offs. This Dutch nationwide registry-based cohort study includes all patients who underwent surgery for first primary OSCC between 2018 and 2021. Resection margins were categorised as <1, 1-5, and >5 mm. Hospital variation was visualised in funnel plots and corrected for case-mix and treatment variables. Two-year overall and disease-free survival were determined. A total of 2,085 patients from 14 hospitals could be included for analysis. Nationally, margins <1 mm were present in 16.4% which varied from 6.5%-31.6% at hospital level. For margins ≤5 mm, the national average was 61.3%, with hospital outcomes ranging from 50.0%-78.6%. Significant outliers remained after correction for case-mix and treatment variables. Two year overall and disease-free survival was worse in the <1 mm group. Obtaining negative or adequate margins during the resection of invasive OSCC is challenging. Significant hospital differences in resection margin outcomes remained after correction for case-mix characteristics. By identifying best practices in OSCC, surgical and survival outcomes can be improved.
This study aimed to evaluate the effectiveness of early active mandibular exercise (AME) to address mouth-opening limitation following orthognathic surgery in patients with skeletal Class III malocclusion. This was a sin...This study aimed to evaluate the effectiveness of early active mandibular exercise (AME) to address mouth-opening limitation following orthognathic surgery in patients with skeletal Class III malocclusion. This was a single-centre, randomised, controlled, and double-blinded experimental study. In 44 subjects, the experimental group (n = 21) performed AME 10 times daily and were asked to self-assess the degree of opening by counting the number of tongue depressors they could fit in, whereas the control group (n = 23) performed only basic finger exercises. Efficacy was assessed by the range of mandibular movement in four directions (maximum opening, and right lateral, left lateral, and anterior movements), and pain was assessed using a visual analogue scale. Opening-related quality of life (QoL) was assessed using a questionnaire. All variables were measured immediately (T0), and at one week (T1), two weeks (T2), four weeks (T3), and 12 weeks (T4) after the removal of intermaxillary fixation. Statistical analyses were performed using the Mann-Whitney U, Friedman, and chi-squared tests. The experimental group demonstrated earlier recovery of mandibular range of motion in all directions compared with the control group during T0-T1 (p < 0.05). The control group gradually recovered from T0-T4. At T1 the opening recovery rate was 56-68% in the experimental group and 18-39% in the control group. Pain scores were significantly lower in the experimental group than in the control group at T1 (p < 0.05). The experimental group also showed an earlier positive response to all daily living activities at T3 compared with T4 in the control group. AME not only effectively recovers mouth-opening limitation after orthognathic surgery, but also promotes early improvements in range of motion and pain scores. Furthermore, it is an effective intervention to facilitate an early return to the opening-related activities of daily living.
Sentinel lymph nodes are often the first nodes to be involved in early oral cancer. The aim of this review was to assess the relation of clinicopathological factors in patients with positive sentinel lymph nodes. We prop...Sentinel lymph nodes are often the first nodes to be involved in early oral cancer. The aim of this review was to assess the relation of clinicopathological factors in patients with positive sentinel lymph nodes. We propose formulating a risk prediction model that could elucidate the individual risk of nodal metastases and prognosis in early oral squamous cell carcinoma (SCC). A systematic review was undertaken in accordance with the PRISMA protocol. Study quality was assessed using STROBE, and bias was assessed using the ROBINS-I tool. Meta-analysis was carried out using the Mantel-Haenszel method for calculating the weighted pooled odds ratio under the fixed effects model. Thirty studies published between 2004 and 2023 were included. Pooled sentinel lymph node positivity from 27 studies averaged 26.7%. On meta-analysis 26% of T1N0 and 35% of T2N0 patients were sentinel-node positive. On pooled meta-analysis, there was an increased odds ratio for sentinel node positivity that was statistically significant for pT2 status, a non-cohesive tumour front, moderate differentiation, and the tongue subsite. We believe that these findings not only add to the current evidence but will also contribute to a future risk model for management of the neck in patients with early oral SCC.
This study evaluates the impact of genioplasty combined with bilateral sagittal split osteotomy (BSSO) on patient-reported outcomes within the UK's National Health Service (NHS). As the first study of its kind in the UK...This study evaluates the impact of genioplasty combined with bilateral sagittal split osteotomy (BSSO) on patient-reported outcomes within the UK's National Health Service (NHS). As the first study of its kind in the UK that we know of, it aims to provide evidence to support the continued commissioning of these procedures. A retrospective, multi-site cohort study was conducted using validated patient-reported outcome measures (PROMs) through postoperative telephone consultations. Outcomes assessed included satisfaction with facial appearance, self-confidence, and quality of life before and after surgery. Of 30 eligible patients, 21 completed follow up at a minimum of six months. Results showed high overall satisfaction rates of 90% and significant improvements in psychological wellbeing (40%), quality of life (32%), and social confidence (42%). Additionally, satisfaction with lower jaw appearance and chin aesthetics improved by 60% and 61%, respectively. These findings highlight the significant benefits of genioplasty with BSSO and support its continued commissioning in the NHS.
Temporomandibular joint replacement is performed in patients with severe disorders of the temporomandibular joint with the aim of improving quality of life, function and pain. Traditionally, this has been carried out usi...Temporomandibular joint replacement is performed in patients with severe disorders of the temporomandibular joint with the aim of improving quality of life, function and pain. Traditionally, this has been carried out using a preauricular or endaural incision in addition to a submandibular incision. In this study, a novel technique was used wherein a total temporomandibular joint replacement was performed through an endaural incision with endoscopic assistance. This negated the need for a submandibular incision, with the aim of minimising the complications of open joint surgery. This is a retrospective cohort study of 104 joint replacements in 82 patients using this technique for the treatment of pathology or end-stage joint disease. The primary outcome variable was improvement in pain and quality of life measurements, whilst secondary outcome variables were facial nerve function and mouth opening. Pain intensity (/10) decreased postoperatively for worst pain score (8.4 to 4.5, p < 0.001) and average pain score (6.1 to 3.0, p < 0.001). The average Graded Chronic Pain Scale score decreased postoperatively from 67.7 to 32.7 (p < 0.001). The Jaw Function Limitation Scale had an overall reduction from 4.29 to 1.55 postoperatively (p < 0.001). There were 20 cases (19.4%) of temporary facial nerve weakness, all of which had resolved by six months. Mouth opening increased from 31.6mm preoperatively to 36.5 mm postoperatively (p < 0.01). This study shows similar or reduced rates of temporary facial nerve weakness compared to other studies whilst still significantly improving patients' quality of life postoperatively, demonstrating that good clinical outcomes can be achieved through an endaural incision with endoscopic assistance.
This study aimed to evaluate the clinical efficacy of indocyanine green angiography (ICGA) in optimising anterolateral thigh (ALT) flap reconstruction for oral and maxillofacial defects. Fifteen consecutive patients (10...This study aimed to evaluate the clinical efficacy of indocyanine green angiography (ICGA) in optimising anterolateral thigh (ALT) flap reconstruction for oral and maxillofacial defects. Fifteen consecutive patients (10 males, mean (SD) age 53.8 (14.5) years) undergoing ALT flap reconstruction following tumour resection were prospectively enrolled. Intravenous indocyanine green (ICG) (2.5 mg/ml) administration combined with hand-held Doppler ultrasound (DUS) enabled preoperative mapping of the descending branch of the lateral circumflex femoral artery and localisation of the perforator. Intraoperative real-time ICGA guidance facilitated precise flap trimming, while postoperative monitoring incorporated both DUS and ICGA assessments. Preoperative imaging revealed comparable perforator detection rates between modalities (DUS: 35/42 confirmed vs ICGA: 33/39 confirmed; accuracy 83.3% vs 84.6%, Z = 0.096, p = 0.081, kappa = 0.82, p = 0.026). ICGA-guided intraoperative modifications proved critical in seven cases, all achieving marginal flap viability. Four high-risk patients avoided reoperation through ICGA-guided perfusion monitoring. Notably, ICGA detected salvageable perfusion in two cases with absent DUS signals, and confirmed arterial patency following re-anastomosis in one case. ICGA enhances surgical precision in ALT flap reconstruction through perfusion mapping, enabling real-time intraoperative decision-making and improved postoperative monitoring sensitivity.
Healthcare systems are significant contributors to the growing climate crisis. The NHS has pledged a net zero target by 2040. This pilot investigated the environmental and financial impact of leaving computer monitors on...Healthcare systems are significant contributors to the growing climate crisis. The NHS has pledged a net zero target by 2040. This pilot investigated the environmental and financial impact of leaving computer monitors on during out-of-hours service within the oral and maxillofacial surgery (OMFS) departments. A total of 151 monitors were surveyed over a varied period, revealing that on average, 92.7% remained on overnight. Each monitor left in active mode costs approximately £14.47 annually compared to £0.47 in energy-saving mode. Extrapolating these results across the Trust, switching off monitors could save an estimated £150,000 and reduce emissions by 121.69 tonnes of CO-equivalent emissions (COe) per year, equivalent to 6000 planted trees. These findings emphasise the need for targeted strategies to support the NHS's goal, with OMFS departments leading the way in sustainability initiatives.