Advances in assistive technologies for orthognathic surgery have increased the prevalence of guided surgeries. In this study, we developed and evaluated a novel system utilising electromagnetic (EM) navigation for maxill...Advances in assistive technologies for orthognathic surgery have increased the prevalence of guided surgeries. In this study, we developed and evaluated a novel system utilising electromagnetic (EM) navigation for maxillary positioning. Le Fort I osteotomies were performed on three skull models. The three-dimensional position of two sensors, facilitated by an EM tracking system, was used to move and fix the maxilla into its planned position, shifted 3 mm forward. The first sensor was placed on the lateral border of the pyriform aperture on the cranial side, while the second sensor was affixed as a splint on the maxillary dentition. Surface data from scans of the experimental skull bone were obtained using an optical scanner and superimposed on the pre-planned data to assess accuracy. The discrepancy between the maxilla positioned with EM navigation and the planned position was within 1.0 mm in the vertical, horizontal, and anteroposterior directions. Error at the A and ANS measurement points was 0.44 and 0.54 mm mean, 0.32 and 0.38 SD, 0.38 and 0.47 mm median, respectively This experimental study represents a paradigm shift from guided to navigation surgery. Meticulous maxillary repositioning achieved through EM navigation enhances the reproducibility of preoperative simulations during surgery.
Head and neck sarcomas are rare and diverse tumours with limited published literature. Choosing a precise biopsy technique is vital for accurate diagnosis and therapeutic decisions. This study aimed to compare the accura...Head and neck sarcomas are rare and diverse tumours with limited published literature. Choosing a precise biopsy technique is vital for accurate diagnosis and therapeutic decisions. This study aimed to compare the accuracy of two commonly used techniques, core needle biopsy (CNB) and open biopsy (OB), in histological diagnosis (benign versus malignant), subtyping, and grading of bone and soft tissue sarcomas. In this retrospective study, sarcoma cases discussed at head and neck multidisciplinary team (MDT) meetings between January 2018 and April 2024 were reviewed. Inclusion criteria were cases performed with either CNB or OB, with available diagnostic and final histopathology reports. Ninety cases were included in the study. The accuracy of OB in determining benign versus malignant diagnosis, histological type, and subtype was 95%, 90%, and 85%, respectively. There was no statistically significant difference when compared with CNB, with results of 86%, 76 % and 76%, respectively. OB was significantly superior to CNB in terms of tumour grading (87% vs 62%) and this was statistically significant (p = 0.007). While OB may be preferable for bone sarcoma due to sampling challenges, CNB is a feasible, less invasive first-line option for soft tissue sarcomas. Biopsy tract excision or targeted radiotherapy is recommended to minimise the risk of tumour cell seeding. Optimal sample quality and sarcoma specialist histopathology opinion further enhances diagnostic accuracy. CNB is an accurate, minimally invasive, and safe diagnostic modality in cases of head and neck bone and soft tissue sarcoma. The authors recommend a non-inferiority trial to definitively establish this in comparison with OB.
Head and neck surgery with free-flap reconstruction (FFR) is associated with postoperative complications (PCs), which may affect the short and long-term prognosis of patients. This study aimed to propose a new model to p...Head and neck surgery with free-flap reconstruction (FFR) is associated with postoperative complications (PCs), which may affect the short and long-term prognosis of patients. This study aimed to propose a new model to predict the risk of PCs after head and neck surgery with FFR. A retrospective analysis was performed on 528 patients undergoing head and neck surgery with FFR between March 2020 and June 2022 in a tertiary head and neck centre. All information assessed included patient characteristics, tumour, laboratory, and surgical and anaesthetic factors. The primary outcome was a composite of severe non-surgical PCs during hospitalisation. All patients were grouped into those with PCs and those without PCs. Based on univariate and multivariate logistic regression analysis, a model to predict the risk of PCs was constructed and validated with bootstrap resampling. The incidence of PCs was 23.30% (123/528). Five predictors of PCs were identified: age, flap size, blood loss, maximum lactic acid value, and type of airway. The model incorporating these variables had moderate predictive discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.74 (95% CI: 0.69 to 0.79) for PCs, and maintained satisfactory calibration performance (Brier score of 0.157). Meanwhile, the model demonstrated satisfactory clinical significance. We propose a new simple PCs prediction model that shows promise for the guiding of perioperative management after head and neck surgery with FFR.
Achieving a prolonged analgesic effect from an inferior alveolar nerve block (IANB) following mandibular third molar (MTM) surgery remains a challenge. This study aimed to investigate the analgesic efficacy of adding mag...Achieving a prolonged analgesic effect from an inferior alveolar nerve block (IANB) following mandibular third molar (MTM) surgery remains a challenge. This study aimed to investigate the analgesic efficacy of adding magnesium sulphate to an IANB on postoperative pain within 24 h following MTM surgery. The eligible participants were randomly assigned to receive articaine with either 150 mg or 250 mg magnesium sulphate, or articaine alone. The primary outcomes were pain intensity at 6 and 24 h postoperatively, using the Heft-Parker visual analogue scale (VAS). Secondary outcomes included the success rate of IANB, characteristics of analgesic consumption, and occurrence of adverse events. Multivariate analysis including multivariate linear regression was performed with a significance level of 0.05. A total of 72 MTMs were included. At 6 h postoperatively, the estimated treatment differences in pain at rest were -42.02 (95% CI: -61.50 to -22.54) for the 150 mg magnesium group, and -42.76 (95% CI: -62.42 to -23.11) for the 250 mg magnesium group. For pain on movement, the differences were -38.07 (95% CI: -60.22 to -15.92) and -29.07 (95% CI: -51.42 to -6.72), respectively. By 24 h, pain intensity did not differ significantly among the groups. First analgesic use was significantly delayed in both magnesium groups. The addition of 150 mg magnesium sulphate to articaine for IANB significantly reduced pain intensity at 6 h following surgery with no adverse events.
This study reviews the clinical presentation, investigation, and management of deep neck infections in our department. We aimed to identify predisposing factors for serious complications, with a view to improving prognos...This study reviews the clinical presentation, investigation, and management of deep neck infections in our department. We aimed to identify predisposing factors for serious complications, with a view to improving prognostication. This was a single-centre analysis of patients presenting to the OMFS department at Queen Elizabeth University Hospital (Glasgow) with head and neck abscesses who underwent surgery between February 2021 and January 2022. The following clinical data were analysed and compared: age, gender, Scottish Index of Multiple Deprivation (SIMD) rank, admission duration, infection source/ aetiology, treatment modality, signs and symptoms at presentation, complications (return to theatre, airway compromise, necrotising fasciitis, or mediastinitis), imaging modality, microbiology results, inflammatory markers, and antibiotic therapy. Of the 100 patients included, the average SIMD rank was 3.6, with most patients in decile 1. Eighty-seven infections (87%) were odontogenic, with over half of the patients having no signs of systemic inflammatory response syndrome (SIRS) at admission. We demonstrate that C-reactive protein (CRP) level at presentation, even in the absence of SIRS, is indicative of prolonged admission, the need for repeat multiaxis imaging, and repeated surgeries. We also demonstrate that the incidence of deep neck infections (DNI) is strongly correlated with SIMD rank.
Advances in surgical techniques and materials have improved midface fracture management, with miniplate fixation replacing traditional intermaxillary fixation (IMF). This study evaluates whether IMF remains necessary, fo...Advances in surgical techniques and materials have improved midface fracture management, with miniplate fixation replacing traditional intermaxillary fixation (IMF). This study evaluates whether IMF remains necessary, focusing on postoperative malocclusion and the impact of fracture complexity, demographics, and operative techniques on patient outcomes. A retrospective observational analysis of 100 midface trauma cases requiring surgical fixation was conducted at a major trauma centre in London. Patient demographics, injury parameters, and operative details, including IMF use, were assessed. Statistical analysis was performed to evaluate associations between fracture complexity, operative factors, and postoperative malocclusion. Postoperative malocclusion was documented in 8% of cases, with IMF usage showing a statistically significant association with malocclusion (p = 0.027). However, fracture complexity and injury patterns were not significant predictors of occlusal outcomes. IMF was primarily used in more complex cases, often involving a higher number of fractured buttresses requiring fixation. Our study shows that accurate anatomical reduction and fixation of complex midface fractures ensures predictable functional and aesthetic outcomes. Intermaxillary fixation (IMF) remains an essential tool in supporting the reconstruction of deranged occlusion in midface trauma. While useful as an adjunct, our findings suggest that IMF is not always necessary in less complex cases, and its use should be considered judiciously, as a very low rate of postoperative malocclusion can be achieved with more selective application.
Oral squamous cell carcinoma (OSCC) is a prevalent malignancy with a propensity for lymphatic spread, particularly to the neck. There are current inconsistencies in the treatment paradigm for cT3/4 OSCC with negative nod...Oral squamous cell carcinoma (OSCC) is a prevalent malignancy with a propensity for lymphatic spread, particularly to the neck. There are current inconsistencies in the treatment paradigm for cT3/4 OSCC with negative nodal status. The American Society of Clinical Oncology (ASCO) recent guidelines advocate for contralateral neck treatment with neck dissection or radiotherapy, but this approach remains debated and has not been adopted within UK clinical guidance. This study aims to evaluate the recurrence rates and survival outcomes of patients with well lateralised pT3/4N0 OSCC managed with or without contralateral neck interventions. A retrospective cohort study was conducted across five UK Oral and Maxillofacial Surgery (OMFS) units. We included patients with biopsy-proven pT3/T4 OSCC treated between 2012 and 2017. The study compared outcomes between two groups: the standard care group (SC) and the extended neck management group (ENM), which additionally received contralateral neck dissection (CLND) or neck radiotherapy (NRT). The primary outcome measure was the recurrence rate (RR), with secondary outcome measures including overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). Of 583 patients, 210 met the inclusion criteria. The mean follow up was 44 months. The SC group, compared with ENM demonstrated similar overall recurrence rate (24.8% vs 24.6%), higher regional recurrence (7.4% vs. 1.6%) and lower distant recurrence rates (4% vs 6.6%) respectively, however, none of these results reached significance. No significant differences in OS, DFS, or RFS were demonstrated (p > 0.05) between groups, and this was maintained with confounding variables controlled for. Findings suggest that well lateralised T3/4N0 OSCC patients managed more conservatively, without contralateral neck intervention, may have comparable outcomes to those receiving additional neck management. Further research into this area of research paucity may assist in further refinement of management guidelines for this subset of OSCC patients.
The submucous cleft palate is a known entity. The two most common techniques are intravelar veloplasty and Furlow palatoplasty. However, a standard technique has not yet been defined and, to our knowledge, there are no s...The submucous cleft palate is a known entity. The two most common techniques are intravelar veloplasty and Furlow palatoplasty. However, a standard technique has not yet been defined and, to our knowledge, there are no systematic reviews on the topic. This study therefore was undertaken to compare these two surgical techniques in terms of improvements in speech and velopharyngeal closure. We used Google Scholar, PubMed Central, Medline, and Cochrane databases. Reference checking and citation searching was done to identify studies to be included. Outcomes measured were speech improvement, objective improvement in velopharyngeal insufficiency, and adverse effects (wound dehiscence, palatal fistula, sleep apnoea, or hyponasal speech).Results were synthesised for each outcome using meta-analysis where possible (inverse variance with random effects analysis model). Four studies were included in the meta-analysis with a total of 170 participants. The comparison between intravelar veloplasty and Furlow palatoplasty in terms of speech was in favour of Furlow palatoplasty (odds ratio: 1.32; 95% confidence interval (CI): 0.55 to 3.18). For velopharyngeal closure, the result was in favour of Furlow palatoplasty (odds ratio: 2.11; 95% CI: 0.54 to 8.23). The rate of fistula formation was lower with intravelar veloplasty (odds ratio: 0.54; 95% CI: 0.11 to 2.71). Furlow palatoplasty may reduce the risk of incomprehensible speech and velopharyngeal insufficiency in comparison with intravelar veloplasty. There is less risk of fistula formation after intravelar veloplasty.
Cases of oral squamous cell carcinoma (OSCC) are becoming more prevalent with an increasing population requiring surgical management. In cases where clinical staging indicates that there is no spread to the neck, surgica...Cases of oral squamous cell carcinoma (OSCC) are becoming more prevalent with an increasing population requiring surgical management. In cases where clinical staging indicates that there is no spread to the neck, surgical treatment options such as an elective neck dissection (END) may be considered. This audit aims to assess the recurrence rate in North London and Bristol Hospitals over a five-to-six-year period and to our knowledge is the first UK published study reporting isolated regional recurrence rate following END of OSCC. Regional MDT databases were used to identify patients given a pathological staging of pN0 following END in the same theatre session from 01.01.2017 to 01.01.2023 in London Northwest NHS Healthcare Trust and 01.01.2019 to 01.01.2024 in University Hospitals Bristol NHS Trust. Medical records were interrogated to retrospectively collect data on histopathology, staging, adjuvant treatments, recurrences, and follow up. A total of 232 patients were identified in total, with a minimum follow up of six months. The isolated regional recurrence rate was 2.2% with the locoregional recurrence rate being 3.9%. When categorising cases as pT1-T2 and pT3-4, the isolated regional recurrence rates were 3.3% and 0.9%, respectively. Overall, isolated neck recurrences were identified in five cases and locoregional recurrences were identified in nine. The findings of this audit show a lower recurrence rate in comparison to other international centres where similar studies have been performed. This supports the evidence that offering END in these trusts to patients with a pN0 staging continues to be an effective treatment option and should always be considered along with effective and consistent follow-up protocols and surveillance measures.
Discussions of orthognathic planning are often dogmatic, however, it is a subjective science. The aim of this study was to quantify the variation in orthognathic surgery planning in a group of experienced orthognathic su...Discussions of orthognathic planning are often dogmatic, however, it is a subjective science. The aim of this study was to quantify the variation in orthognathic surgery planning in a group of experienced orthognathic surgeons. A cross-sectional study was designed, and an identical presurgical orthognathic case provided to 13 surgeons. Statistical analysis was performed using descriptive statistics, Fisher's exact test, and MANOVA with p < 0.05 considered significant. The mean (SD) anterior-posterior (AP) movement of the upper incisors was 5.8 (1.5) mm anterior (range 3.0-7.0 mm), and 0.7 mm (-0.7 (1.9) mm; range -2.9 to 4.0 mm). The mean (SD) AP movement of pogonion was 0.6 mm posterior (-0.6 (2.2) mm; range 5.5 mm posterior to 2.1 mm anterior). The standard deviations in movement (AP and superior-inferior) were greatest at pogonion (2.3 mm and 1.9 mm), followed by B-point (1.9 mm and 2.0 mm), maxillary incisor (1.5 mm and 1.9 mm), then A-point (1.4 mm and 1.8 mm). This study shows that significant variation exists in surgical planning among a group of experienced orthognathic surgeons at the level of pogonion and B-point, with less variation at the maxillary central incisor and A-point. Future studies may compare these results with surgeons with less orthognathic expertise, or non-OMS trained surgeons.
This study examines the impact of residual bone inclination on the accuracy of implant placement. In this in vitro study, ten replica models with inclined surfaces were fabricated using three-dimensional (3D) modelling s...This study examines the impact of residual bone inclination on the accuracy of implant placement. In this in vitro study, ten replica models with inclined surfaces were fabricated using three-dimensional (3D) modelling software to assess implant placement accuracy on varying inclinations (90°, 15°, 30°, 45°, 60°). Implants were placed using two drilling protocols: a standard sequence (Group A) and a sequence beginning with a pointed drill to prevent slippage (Group B). Drill slippage and binding were recorded, and placement accuracy was measured by superimposing pre- and post-placement scans to calculate 3D positional errors. In total, 50 implants were placed across ten blocks, categorised by drill type (Group A: without sharp twist drill; Group B: with sharp twist drill) and angle (90°, 15°, 30°, 45°, 60°). Drill binding occurred more frequently at smaller angles, especially at 15° (100% in Group A; 80% in Group B). The Jonckheere-Terpstra test confirmed a significant trend of increased binding with smaller angles (p = 0.001 for Group A; p = 0.028 for Group B). The largest x-axis deviations occurred at 15°, with errors primarily to the left, which reflected expected slippage on inclined surfaces in both groups. While significant differences in anteroposterior (y-axis) and vertical (z-axis) deviations were observed at certain angles between Group A and Group B, the overall placement accuracy between the groups remained comparable. This study highlights the challenges of guided implant placement on inclined surfaces, where decreased drill angles lead to significant x-axis deviations.
Head and neck cancers and their respective treatments have a profound impact on quality of life. Many oropharyngeal and oral cancers are likely to have implications for oral health-related quality of life (OHRQoL), but r...Head and neck cancers and their respective treatments have a profound impact on quality of life. Many oropharyngeal and oral cancers are likely to have implications for oral health-related quality of life (OHRQoL), but research investigating tools to measure this are lacking. We conducted a scoping review to ascertain the available tools for measuring OHRQoL in head and neck cancer patients. The primary objective was to compile a summary of the existing tools and determine their completeness, validity, and reliability. The literature search yielded 1239 articles. Thirty-one studies were included in the review and multiple tools were identified. None of the tools assessed all potential OHRQoL impacts, and none had undergone comprehensive testing using a range of assessments. Most of the tools did not adhere to published guidance, with only the European Organisation for Research and Treatment of Cancer (EORTC) citing methodological guidance in their survey tool development protocols. All tools achieved recommended readability scores in English. Due to methodological flaws in the evidence base, it was not possible to definitively establish the completeness of any available tool. There was discordance between tools regarding the relevant OHRQoL impacts. Several tools failed to assess accepted domains of OHRQoL, calling into question their concordance with the construct of OHRQoL. In addition, there was a lack of adherence to published standards regarding both the construction and testing methods for quality-of-life instruments. Studies reporting on OHRQoL in head and neck cancer may, therefore, not comprehensively assess the actual impacts of the disease and its treatment.
Management of the neck in oral cavity squamous carcinoma is debatable. The role of selective neck dissection (SND) in node positive neck in oral SCC is controversial. The aim of this study was to determine the efficacy o...Management of the neck in oral cavity squamous carcinoma is debatable. The role of selective neck dissection (SND) in node positive neck in oral SCC is controversial. The aim of this study was to determine the efficacy of SND for the node positive neck in patients with oral cancer. A retrospective chart review was done of 424 oral cancer patients undergoing SND, who had pathologically node positive disease on histopathology treated from January 2017 to September 2024. A total of 424 patients were analysed with 82% male predominance. The median age was 49 years. The commonest primary site was the bucco-alveolar complex (60%). A total of 520 SNDs were done in 424 patients. At median follow up of 29 months, 59 patients (13.9%) had neck recurrence among which 15 patients had recurrence at level V, along with recurrence at other nodal levels. Three-year regional control was 82%, while DFS and OS were 65% and 81%, respectively. For oral cancer with a pathologically node positive neck, SND is an effective and oncologically safe treatment. Outcomes are similar to modified neck dissection, as reported in the literature.
The aim of this study was to investigate the features of temporomandibular disorder (TMD) and non-TMD subjects on electroencephalogram (EEG) the jaw resting, biting, and opening states. A total of 34 participants were re...The aim of this study was to investigate the features of temporomandibular disorder (TMD) and non-TMD subjects on electroencephalogram (EEG) the jaw resting, biting, and opening states. A total of 34 participants were recruited into the study. Participants with TMD were evaluated using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the Protocol for Multi-Professional Centres for the Determination of TMD Signs and Symptoms (ProTMDMulti). EEG was recorded using the NeuroSky biosensor at jaw resting, biting, and opening states for the non-TMD subjects, TMD patients before therapy, and TMD patients after therapy. The EEG energy of the TMD patients was significantly greater than that of the non-TMD subjects at the jaw resting, opening and biting states (p < 0.05), except the EEG Beta wave at the jaw biting state. After conventional therapy for TMD, the EEG energy of TMD patients significantly decreased at the jaw resting state (p < 0.01). During the jaw opening state, the EEG energy of TMD patients also significantly decreased after therapy at the low frequency waves but increased at the high frequency waves (p < 0.01). EEG features were significantly different between the non-TMD and TMD participants as well as in the TMD patients before and after therapy. EEG may serve as an objective biomarker and a quantitative diagnostic tool for TMD.
Wierzbicka M, Gazinska P, Chen HC
… +14 more, Burduk P, Bartkowiak E, Pietruszewska W, Stodulski D, Leduchowska A, Markowski J, Piernicka-Dybich A, Wierzchowska M, Czech J, Amernik K, Chańko A, Majszyk D, Bruzgielewicz A, Mikaszewski B
Salivary gland tumours comprise one of the most complex and rare groups of heterogeneous lesions encountered in oral pathology. Large clinical and population-based epidemiological studies are inherently limited. This mul...Salivary gland tumours comprise one of the most complex and rare groups of heterogeneous lesions encountered in oral pathology. Large clinical and population-based epidemiological studies are inherently limited. This multicentre prospective study was conducted between 2017 and 2021 using the Polish Salivary Network Database (PSND). A dataset of 2653 cases of salivary gland tumours was analysed, focusing on the submandibular gland (n = 173), accessory parotid gland (n = 100), and parotid gland (n = 2375). Epidemiological and pathological factors were considered to identify the risk of malignancy and differences between tumours of the submandibular, parotid, and accessory parotid glands. A significant difference was observed in the median age of patients with tumours of the submandibular (50.5 years) and accessory parotid glands (51.5 years) compared with that of patients with parotid gland tumours (60.0 years) (p < 0.001). Factors such as tobacco usage (p < 0.001) and place of residence (p = 0.015) were associated with these differences. Sex was not a differentiating factor in the risk of malignancy. In females, 106/173 patients had tumours in the submandibular gland, 61/100 had tumours in the accessory parotid, and 1282/2375 had tumours in the parotid. In males, 67/173 had tumours in the submandibular gland, 39/100 had tumours in the accessory parotid, and 1093/2375 had tumours in the parotid. Significant differences were found in submandibular and parotid tumour locations between village and city inhabitants (p = 0.016). The nature of tumours located in the parotid, comprising the superficial and deep lobes, was distinct in relation to accessory parotid tumours. Accessory parotid tumours exhibited more similarities to those originating in the submandibular region. These findings have the potential to impact future clinical approaches. However, additional validation studies are needed.