Objectives To evaluate the clinical utility of intraoperative indocyanine green fluorescence angiography (ICG-FA) for perfusion assessment in head and neck oncological flap reconstruction and its association with outcomes and intraoperative decision-making. Materials and Methods A PRISMA-compliant systematic review, searched MEDLINE, Embase, and CENTRAL from inception to 19 February 2026. Eligible studies included adults undergoing head and neck oncological resection with free or pedicled flap reconstruction using intraoperative ICG-FA. Primary outcomes were return to theatre, partial flap necrosis, total flap loss, and flap salvage. Secondary outcomes included fistula, wound dehiscence, infection, and intraoperative decision impact. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Owing to heterogeneity, findings were synthesised narratively. Results Ten observational studies were included, comprising 469 ICG-assessed flaps in 463 patients; two comparative studies also contributed 306 non-ICG comparator flaps. Most reconstructions were free flaps (90.6%). Re-exploration occurred in 12.4% (56/450) of ICG-assessed flaps, partial flap necrosis in 4.8% (4/83), and total flap loss in 3.8% (16/424). Salvage was achieved in 73.3% (33/45) of compromised flaps. Intraoperative management changed in 12.8% (12/94) of flaps. Risk of bias was significant in both comparative studies and moderate across the non-comparative series. Conclusion ICG-FA appears to be a useful adjunct to intraoperative perfusion assessment, with the clearest potential benefit in flap salvage, flap loss, and operative decision-making. However, the evidence base is limited by observational study design, heterogeneity, and risk of bias. Prospective comparative studies using standardised protocols are needed before routine adoption can be recommended.
Introduction Sentinel lymph node biopsy (SNB) maps tumour draining lymph nodes on an individual basis, identifying locations outside typical neck dissection levels including the contralateral neck. We report contralateral drainage and positivity rates in lateralised early oral cavity squamous cell carcinoma (OCSCC) and assess associations with tumour characteristics. Methods Single-centre retrospective study of patients with lateralised cT1-T2 OCSCC treated with wide local excision and SNB between February 2016 and January 2022. Data included tumour depth, distance to midline, lymphatic drainage, sentinel node number/location and SNB status. Variables were analysed using two-tailed Student t-tests and Fisher’s exact test, with Holm-Bonferroni correction where appropriate. Results Ninety-two patients underwent SNB; sixty-four met criteria for lymphatic drainage analysis. Contralateral or bilateral drainage occurred in twenty-six (40.6%) cases. Fifty (78.1%) tumours involved the anterior 2/3 tongue, with contralateral or bilateral drainage in twenty (40.0%).Twenty-two patients (34.4%) had positive SNB, including three (4.7%) with contralateral metastases. Mean follow-up was 46.3 months. One- and three-year overall survival were 93.7% and 77.8%; disease-free survival was 91.7% and 80.0%. One patient (1.5%) had a false-negative SNB, and three (4.7%) would have been inadequately staged or treated by ipsilateral elective neck dissection. Discussion Contralateral drainage was common in lateralised early OCSCC, although contralateral positivity was uncommon. SNB may improve individualised staging by identifying clinically relevant contralateral drainage not addressed by ipsilateral elective neck dissection. Prospective multicentre studies are needed to define anatomical and tumour-related predictive factors for contralateral drainage.
The British Association of Oral and Maxillofacial Surgeons (BAOMS) funded Maxillofacial Academic Practice (MAP) study aims to define the current state of research and academic training within UK Oral and Maxillofacial Surgery (OMFS). Phase One of the study, the OMFS Trainee Research Engagement Survey, explores levels of research involvement, barriers, and facilitators among trainees. An online cross-sectional survey was developed comprising multiple-choice, free-text, and 10-point Likert scale items. It was distributed to OMFS trainees across the UK. The primary outcome was the level of research interest and current engagement, while secondary outcomes included identifying barriers, facilitators, and proposed interventions to be explored in Phase Two. A total of 82 OMFS trainees responded, representing all UK training regions and levels. Of these, 30/82 were specialist trainees and 45/82 were pre-ST3 trainees. A total of 58/82 expressed clear research interest, and 46/82 were actively involved in projects. However, only 19/82 reported working in departments with OMFS-led research, and 51/82 were unaware of local research contacts. Research interest was significantly higher among trainees in research-affiliated units. Despite the high level of interest, 25/82 reported having no opportunity to participate. Mean self-rated exposure to research was 5/10. OMFS trainees demonstrate strong academic interest, yet access to research opportunities remains limited. Trainees with greater exposure are more likely to pursue academic careers. Targeted recommendations include clearer national guidance, improved access to mentorship, and the development of cross-Deanery academic networks to support future OMFS clinical academics - as will be explored in Phase 2 of the MAP study.
Recognising how human factors shape workplace behaviour and patient safety, as well as appreciating their medicolegal consequences, is essential for the modern medical graduate. This study examines medical students' and resident doctors' practices, attitudes, and experiences in relation to patient safety and human factors. A UK-wide convenience survey of UK medical students and resident doctors was done between April and June 2025. Results were compared with a pilot group of students from under-represented backgrounds who participated in a tailored human factors and medicolegal workshop. Of 1274 survey respondents, 942 (74.0%) were medical students and 332 (26.0%) resident doctors. Human factors frequently reported were time pressures (57.0%), fatigue (56.2%), and ineffective handover (43.8%). Preparedness to manage human factors (median 3/5) and confidence to speak up (median 3/5) were significantly lower among comprehensive/state-educated respondents (confidence-adjusted odds ratio 0.70, 95% confidence interval 0.57 to 0.87, vs grammar/private/international schools). Most respondents lacked clear institutional guidance on the legal implications of error (62.2%), and nearly half did not know where to seek support. Workshop participants (n = 21) reported greater preparedness to recognise and manage human factors and more confidence to raise concerns (p < 0.001). Despite frequently encountering patient safety-related human factors, UK resident doctors and medical students are only moderately prepared and supported to address them. In a healthcare environment with increasing workloads, resource limitations, and errors, greater training and exposure to key concepts is required. Educational interventions could be drawn from other high-reliability organisations such as aviation to reduce the incidence of patient safety and medical errors.
Head and neck sarcomas (HNS) are rare, heterogeneous malignancies representing less than 1% of head and neck cancers. Their complex anatomy and overlapping morphologies pose significant challenges for traditional diagnosis. We aimed to evaluate the clinical utility of next-generation sequencing (NGS) within a tertiary referral centre and synthesise these findings with current global molecular standards. We conducted a retrospective review of an original, previously unpublished, cohort of 12 patients with histologically verified HNS treated at University College London Hospital (UCLH) between 2023 and 2024. Molecular profiling included targeted DNA (RMH200) and RNA-fusion panels. This was supplemented by a qualitative synthesis of 16 key studies (2010-2026) identified through a systematic search strategy. In the institutional cohort, NGS provided definitive diagnostic or therapeutic clarification in 66% of cases (8/12). Key findings included the identification of pathognomonic fusions (such as EWSR1::FLI1, PAX3::MAML3), a novel MAMLD1::VGLL3 fusion, and actionable variants such as BRAF V600E and MYOD1. Furthermore, the formal exclusion of Neurotrophic tropomyosin receptor kinase (NTRK) fusions in some cases allowed for therapeutic streamlining. Literature synthesis aligned these results and emphasised the need for NGS for more accurate diagnosis and adequate treatment. NGS is a clinical necessity in the management of ultra-rare HNS. By transitioning from traditional morphology to high-resolution molecular interrogation, clinicians can resolve diagnostic ambiguity and identify targeted therapeutic pathways. Integration with emerging 2026 standards, including epigenetic classification and liquid biopsy monitoring, represents the future of precision surgery in head and neck sarcoma.
High-quality healthcare aims to deliver a patient-centred service that adapts to the clinical needs of the patient. The aim of this study was to evaluate the association between Patient-Reported Outcome Measures (PROMS) and Quality and Outcomes in oral and Maxillofacial Surgery (QOMS) and assess the impact and quality of orthognathic surgery, as reported by patients and surgeons, respectively. This prospective study was conducted in patients who received orthognathic treatment, according to the surgery-first approach, between 2023 and 2025. Two questionnaires were used in the study; the validated PROMS and the nationally approved surgeon-reported QOMS for orthognathic surgery. PROMS was completed pre-surgery, and at 4-8 weeks and 1-year post-surgery. QOMS was completed by the clinicians pre-surgery, and at 6 months and 1-year post-surgery. It was hypothesised that a large effect would be found, and a minimal sample size of 31 patients would ensure that the study was powered appropriately at 80%, and to account for dropouts, 33 patients were recruited. Chi-squared and Fisher's exact tests were applied to assess associations between PROMS and QOMS. Thirty-three patients with a mean (SD) age of 26.6 (9.0) years were included in the study. Surgery improved patients' reported quality of life, facial aesthetics, and oral function. Preoperatively, 25 patients out of 31 reported that they were 'very dissatisfied' or 'dissatisfied' with their facial appearance. At 1-year post-surgery, all patients reported being 'satisfied' or 'very satisfied' with their facial appearance, and the total Orthognathic Quality of Life Questionnaire (OQOL) scores improved substantially, reducing from 40.4 pre-treatment to 20.0, which indicates considerable long-term improvement in function, aesthetics, psychological status, and overall quality of life. Two patients required a return to theatre but, within 30 days, both demonstrated reductions in their OQOL scores from the baseline to postoperative assessments, indicating that Return to Theatre (RTT) did not negatively affect overall quality of life outcomes. A statistically significant association was observed between clinicians' and patients' perceptions regarding facial aesthetic improvement as a primary indication for surgery (p = 0.007). However, this was less evident concerning the improvement of function as an indication for surgery (p = 0.078). Both patients and clinicians reported agreement on improved function (p = 0.017), but the association concerning improved aesthetics did not reach statistical significance (p = 0.069). The surgery-first approach to orthognathic treatment yields measurable improvements in patient-reported and clinician-assessed outcomes. The PROMS and QOMS questionnaires are useful tools for the evaluation of the quality of the delivery of orthognathic services.
Zygomatic implant perforated (ZIP) flaps have emerged as a novel technique in maxillary reconstruction following surgical resection. ZIP flaps consist of a microvascular soft tissue free flap perforated by immediate zygomatic implants to separate oral and nasal cavities while enabling early fixed dental rehabilitation. This study aimed to evaluate the viability of the technique by examining the failure and complication rates of ZIP flaps in maxillary reconstruction. A systematic review of major biomedical databases was conducted. Included studies involved patients with a maxillary pathology that required surgical resection followed by reconstruction with a ZIP flap reconstruction and for whom follow up data was available. Patient demographics and outcomes relating to flap or implant complications were extracted. Outcomes were summarised descriptively, and pooled complication rates were calculated using 95% confidence intervals. Four studies met the inclusion criteria out of the 77 identified. A total of 50 patients had 50 ZIP flap reconstruction procedures with a total of 185 zygomatic implants placed. The mean follow-up time was 14.3 months (IQR 12-12). The total flap failure rate was 4.0% (95% CI: 0.5-13.7), while the flap complication rate was 32.0% (95% CI: 19.5-46.7). The implant failure and complication rates were 2.3% (95% CI: 0.6-5.8) and 6.9% (95% CI: 3.6-11.7), respectively. ZIP flaps demonstrate high overall success, with failure and complication rates comparable to conventional free flaps. Complications related to prostheses and necrosis of the flap margins are specific additional risks. These results should be interpreted with caution due to the lack of long-term high-quality studies available.
High-quality healthcare aims to deliver patient-centred cost-effective treatment. The aim of this study was to assess the costs in British pound (£) of the orthodontics-first approach (OFA) and the surgery-first approach (SFA) for the management of dentofacial deformities. This study was based on the retrospective analysis of 55 patients who had undergone orthognathic treatment, with either the SFA or OFA, for correction of dentofacial deformities. The SFA was used for 24 patients and the OFA for 31. All were treated with a Le Fort I osteotomy. The number of appointments for the OFA group was 24, compared to 14 for the SFA group. We calculated the direct medical costs, which included the duration of treatment, the number of consultation clinics, the radiographic imaging, and the surgery and hospitalisation, as well as the indirect costs, which included the time needed to attend the outpatient appointments, any travelling expenses, and loss of income for both patient and carer. The total cost of the OFA (direct and indirect, medical and non-medical), including a discount of 3.5% after the first year, as recommended by the National Institute for Health and Care Excellence, was £16,194, compared to £12,605 for the SFA. The £3590 difference represents a financial efficiency of 22.17% per patient. The difference in the direct medical cost between the two approaches was about £2676, which is 16% of the total costs. The opportunity cost saved by reducing the number of appointments between the two approaches, the average hourly cost per consultant, and the number of consultants, was £517.14, which represented about 3% of the total cost of the OFA case. Therefore, the total cost saving for each SFA case was 25.36%, which included a 22.17% saving of the direct cost and 3.19% of the consultant capacity cost saving. The direct non-medical costs were £366.10 per SFA case and £627.60 per OFA case, which generated a saving of £261.70 for each SFA case. The achieved saving of the indirect cost was £674 per SFA case. The SFA was more cost-efficient than the OFA for delivering orthognathic treatment.
'Handle on QoL' is a unique, online, searchable database of all peer-reviewed papers, published since 1982, regarding health-related quality of life (HRQoL) in head and neck cancer. The aim of this paper is to benchmark our results on the Handle on QoL dataset, against four common bibliometric patterns - author productivity, journal concentration, team size, and the sequencing of growth and diffusion. In this paper, we performed a bibliometric analysis of the database to explore its contents and understand the development of research on HRQoL in head and neck cancer. Publication numbers were small in the 80s and 90s (<20 per year) showing a slow increase from the early 90s, before increasing rapidly from the early 2000s to the late 2010s. The number of authors per paper varied overall between one and 81, with a mean of 7.09 and median of six authors per paper. The top 10 journals, by volume of publications, accounted for 33.5% of all publications in the collected data. Integrating bibliometrics into the characterisation of Handle on QoL data transforms subjective patient reporting into objective and measurable insights. Researchers/clinicians may therefore define the field's scope, monitor real-time trends, and pinpoint critical gaps in knowledge.
Single-system Langerhans cell histiocytosis (LCH) involving the maxillomandibular complex is rare, and optimal management remains controversial. Intralesional corticosteroid injections have been proposed as a minimally invasive alternative to surgery, radiotherapy, or systemic therapy. The aim of this study is to systematically evaluate the effectiveness and safety of intralesional corticosteroid injections for treating LCH of the maxilla or the mandible. A systematic review was conducted according to the PRISMA guidelines, in which PubMed, Embase and Scopus were searched. Eligible studies included English language case reports and case series describing LCH of the mandible and/or maxilla that had been confirmed by biopsy and treated with intralesional corticosteroid injections. Outcomes assessed included the resolution of symptoms, regression of lesions confirmed by radiography, recurrence, and adverse effects. Fifteen studies comprising 28 patients were included. Thirteen patients were treated with triamcinolone acetonide, 13 with methylprednisolone, and two with dexamethasone. Lesions were predominantly unifocal and located in the body or ramus of the mandible. Intralesional corticosteroid therapy was effective in 27 patients. Recurrence was reported in one case 12 months post treatment. Adverse effects were limited to one localised abscess that resolved without sequelae. Intralesional corticosteroid injections are associated with high rates of clinical and radiological improvement in mandibular and maxillary LCH, with minimal morbidity. While the current evidence is limited to low level studies, this approach represents a promising conservative treatment option. Prospective studies with standardised protocols are needed to define its long-term efficacy and role within treatment algorithms.
