This retrospective study examines the factors influencing bone thickness buccal to the implant (BTFU) and alveolar width at follow up (AW1) in immediate implant placement procedures in the upper aesthetic zone. After reviewing university records, thirty patients who underwent immediate implant placement before 2020 were recruited for cone-beam computed tomographic (CBCT) scans. Variables such as buccal gap, alveolar width, and buccal bone plate thickness were measured at T0 (pre-extraction) and T1 (study follow up). The results indicated significant effects of the type of bone graft used, buccal gap, alveolar width, and thickness of the buccal plate on BTFU and AW1. The study also showed non-linear relationships between the ratio of buccal gap to thickness of buccal plate (BG/TBP) and the outcome variables. This research provides insights into the complex interplay of these factors, which may guide clinicians in optimising immediate implant placement procedures for better aesthetic and functional outcomes.
Follow up of maxillofacial mandible patients imposes a significant burden on clinic utility. We aimed to investigate whether a more efficient manner of follow up was possible. We retrospectively reviewed all patients with non-condylar fractures of the mandible who had been treated surgically in our supra-regional major trauma centre between 01 January 2022 and 31 December 2023. We examined the difference in the time it took to detect complications between Cohort 1 (scheduled follow up) and Cohort 2 (patient-initiated follow up). We identified 338 surgically-treated mandibular fractures in 223 patients, of whom 204 (91.8%) attended booked follow-up appointments. A total of 26/204 (12.7%) patients developed postoperative complications. In Cohort 1 (scheduled follow up), 14/15 (93.3%) complications were detected early (within 6 weeks). In Cohort 2 (patient-initiated follow up), 9/11 (81.8%) complications were detected late (after 6 weeks), with the patients having no symptoms during previous visits. The timing of the detection of these complications differed significantly between cohorts (p = 0.00098, Fisher's exact test). This study highlights the importance of timely follow-up appointments for non-condylar fractures of the mandible, with complications more likely to be detected within 6 weeks post-surgery. With an average of 2.5 appointments booked per patient in our supra-regional major trauma centre and a did-not-attend rate of up to 23.7%, there is an argument for reducing the number of postoperative follow-up appointments. Consideration needs to be given to the investigation of whether other regimes may be more efficient, such as including patient-initiated follow up.
National waiting time targets demand that patients referred to oral and maxillofacial surgery (OMFS) via an urgent suspicion of cancer (USOC) referral are appointed and investigated quickly, which puts strain on secondary care resources. Despite National Institute for Health and Care Excellence (NICE) referral guidance, many USOC referrals are received for low-risk patients with benign disease, while some patients with head and neck cancer (HNC) are referred via potentially slower pathways. The Head and Neck Cancer Risk Calculator version 2 (HaNC-RC-v2) may be used by primary care referrers to inform referral priority. This tool has been validated mainly in ear, nose, and throat (ENT) settings, with limited evidence for its use in OMFS. This study retrospectively applied the HaNC-RC-v2 and the NICE USOC referral criteria to 476 OMFS patients, using information from electronic medical records and referral letters, to determine the referral priority each tool would have recommended. The sample comprised 200 USOC and 276 non-USOC referrals. HNC was diagnosed in 28 patients (5.9%). The referral priority selected by the primary care clinician accurately reflected the patient's eventual diagnosis in 62.2% of cases. In comparison, the NICE criteria and the HaNC-RC-v2 achieved significantly higher accuracies of 75.5% and 81.9%, respectively (p < 0.05). Both tools also showed significantly greater specificity compared with the clinical judgement of the initial referrer (p < 0.05). If the HaNC-RC-v2 is used by referrers, a significant reduction in USOC referrals of around 50% would be expected (p < 0.0001), with no significant change in cancer detection rates.
Patients with cleft lip and palate (CLP) exhibit complex maxillary morphology, including hypoplasia, making Le Fort I osteotomy challenging and prone to complications. The aim of this retrospective, comparative study was to improve the safety of Le Fort I osteotomy by analysing the maxillary structure of patients with CLP. Fifteen unilateral CLP cases with maxillary hypoplasia (six males, nine females) and 15 non-CLP cases undergoing mandibular setback for prognathism (four males, 11 females) were evaluated. Axial computed tomographic (CT) images at 2.5 and 5 mm above the nasal floor were analysed. Ten parameters were measured, focusing on the distances between key anatomical landmarks including lateral and medial pterygoid plates and posterior maxillary sinus wall to pterygoid fossa. In the CLP group, the distance between the lateral and medial pterygoid plates was 4.8 ± 1.2 mm (healthy side) and 5.4 ± 1.3 mm (afflicted side), compared with 6.4 ± 1.2 mm in the non-CLP group. The shortest distance between the posterior maxillary sinus wall and pterygoid fossa was 2.7 ± 1.1 mm (healthy side) and 2.9 ± 1.3 mm (afflicted side) in CLP group, significantly greater than 1.9 ± 0.3 mm in non-CLP group. These findings indicate a thicker pterygomaxillary junction in patients with CLP, which highlights key anatomical differences. Understanding these features may help reduce surgical complications during Le Fort I osteotomy in patients with CLP.
Oral and maxillofacial surgery (OMFS) is a specialty that is under-represented in medical school teaching, leading to poor awareness and low confidence among doctors when managing and diagnosing OMFS conditions. This study aims to evaluate an online teaching programme designed to improve knowledge and the confidence of doctors to assess and manage common OMFS presentations. A three-part webinar series was developed and delivered online through the free open access medical education platform Mind the Bleep. The topics covered were facial trauma, orofacial infection, and other important OMFS presentations. The sessions were available to all doctors around the world and were presented live and made available on demand. Participants completed surveys before and after the course where quantitative and qualitative data were gathered. Statistical analysis was then performed using Wilcoxon signed-rank tests, and qualitative data were analysed. A total of 229 doctors attended both live and on demand. Of the 84 participants who provided feedback there was significant improvement in confidence across all topics (p < 0.05). Positive feedback was received on the content, format, and helpfulness of the topics. Constructive comments were received through qualitative feedback. This targeted OMFS teaching programme effectively improved the confidence to manage common OMFS conditions. It provided an accessible, flexible, and cost-effective solution to addressing gaps in OMFS education for doctors and could be adapted for other medical specialties.
Large language models (LLMs) are increasingly used in healthcare, but their role in aesthetic surgical procedures remains unexplored. These interventions present unique challenges, marked by high patient expectations, emotionally charged decision-making, and subtle yet impactful outcomes on self-perception and psychosocial health. This cross-sectional in silico study evaluated the performance of ChatGPT-4 (OpenAI, 2025), DeepSeek V3 (DeepSeek AI/High-Flyer, 2025), and Gemini 2.5 Pro Experimental (Google, 2025) in preoperative and postoperative counselling for aesthetic facial surgery. Twenty-six standardised patient-oriented questions were submitted, and the anonymised responses of the chatbots were independently assessed by two calibrated oral and maxillofacial surgeons across four domains: accuracy, empathy, readability (Flesch-Kincaid Reading Ease (FKRE) and Grade Level (FKGL)), and referencing reliability (including the identification of fabricated or non-verifiable citations, a phenomenon referred to as "hallucination" in LLM outputs). Statistical tests included Kruskal-Wallis, Mann-Whitney U with Bonferroni correction, Spearman correlation, and chi-squared. DeepSeek achieved the highest accuracy (4.77 (0.51), p = 0.0078) and readability (FKRE 2.92 (0.27), p < 0.00001), while Gemini outperformed in empathy (4.08 (0.89), p < 0.001). GPT-4 produced the most hallucinated citations (36%) compared with Gemini (14%) and DeepSeek (8.8%) (p < 0.00001). A negative correlation between empathy and readability (r = -0.34, p = 0.002) suggested a trade-off between affective tone and accessibility. Overall, LLMs generated satisfactory counselling responses with distinct performance profiles, supporting their potential in patient-centred communication while reinforcing the need for human oversight.
This study aimed to evaluate the utility of ultrasound elastography for assessing postoperative recovery of the masseter muscle, and its potential role in predicting functional outcomes in patients undergoing orthognathic surgery. Fifteen patients with dentofacial deformities (30 masseter muscles) underwent ultrasound strain elastography at rest, during mouth opening, and during clenching, at four time points: preoperatively, and at seven days, one month, and three months postoperatively. Strain values (SVs), cross-sectional muscle area, and maximal mouth opening (MMO) were measured. Statistical analyses included Friedman and Wilcoxon signed-rank tests, with correlations assessed using Pearson's or Spearman's coefficients, as appropriate. SVs significantly decreased at seven days postoperatively and recovered to baseline by one month, remaining stable at three months. The cross-sectional area increased significantly at seven days and one month in the rest and mouth opening conditions, returning to baseline at three months, while no significant changes were observed during clenching. Significant positive correlations were observed between SVs and muscle area at rest and during mouth opening. In addition, higher preoperative SVs were associated with greater postoperative improvement in MMO. Ultrasound elastography provides objective, non-invasive information on postoperative changes in the masseter muscle. This modality may serve as a useful tool for predicting functional recovery after orthognathic surgery in patients with dentofacial deformities.
Surgeons in the United Kingdom and the United States often perform identical oral and maxillofacial operations with strikingly different instrument sets. The extent and practical significance of this divergence have not, to our knowledge, been previously reported. We conducted a descriptive comparative review of contemporary UK and US practice (2023-2024), cataloguing instruments through clinical observation and discussions with peers and scrub teams, then verifying nomenclature, design, and provenance against reference texts and manufacturers' catalogues. Functionally equivalent but non-identical instruments were paired and profiled for origin, form, and typical use. Findings show a small common core (Freer elevator, Minnesota retractor, Austin retractor, DeBakey forceps, Adson forceps, Metzenbaum scissors, and Mayo scissors) with nearly all other instruments differing, illustrating parallel solutions to the same operative tasks. British instruments and their American counterparts (for example, Molt #9, Woodson #1, Seldin elevator, Molt #4, Dean scissors, Army-Navy retractor, Sweetheart retractor, Sistrunk retractor, Hargis retractor, 301 elevator, and Cogswell elevators) were assembled into a practical compendium, with the aim of encouraging cross-pollination of surgical practice. Awareness of transatlantic instrument choices presents an opportunity to refine one's armamentarium. Through selective adoption of unfamiliar but potentially advantageous instruments, the open-minded surgeon can discover new ways to enhance operative precision, efficiency, or ergonomics.
Chronic pain is an under-recognised but common and significant complication following temporomandibular joint (TMJ) surgery. This study aimed to investigate how oral and maxillofacial (OMF) surgeons diagnose and manage persistent post-operative pain and to assess collaboration with pain specialists. A 21-item anonymous online questionnaire was distributed to 130 OMF surgeons with expertise in TMJ surgery. The survey addressed clinical practice demographics, diagnostic and management strategies for persistent post-operative pain, awareness of risk factors for chronic pain, and interdisciplinary collaboration. Descriptive statistics were used to analyse responses. Of 39 responses, 30 complete responses were analysed (response rate: 23%). Respondents reported that 30% of their patients with TMD underwent minimally invasive procedures and 24% underwent open joint surgery. Although 24 surgeons routinely discussed the risk of chronic pain, six did not or only did so selectively. Common diagnoses of pain following TMJ surgery included persistent myofascial pain, neuropathic pain, and progression of arthropathy. Only 14 surgeons reported referring patients with persistent pain to a pain specialist. Barriers to referral included limited access, difficulty coordinating care, and perceptions of unnecessary use of resources. Although all respondents were aware of the orofacial pain (OFP) specialty, eight indicated that it was not recognised in their country. Persistent post-operative pain remains a complex, multifactorial issue in TMJ surgery. While most surgeons recognise its prevalence and approach management conservatively, gaps remain in interdisciplinary collaboration and risk factor awareness. Improved integration of OFP specialists and broader adoption of the biopsychosocial model of pain may enhance patient outcomes.
Mohs micrographic surgery (MMS) is the most precise surgery regarding margin control and total excision of tumours. The advantages of MMS include precise margin control, one-stop operation, and better patient satisfaction. The files of patients undergoing MMS between January 2013 and March 2023 were retrieved. Patients were referred for MMS as a result of having non-melanoma skin cancer (NMSC) on the face. A single surgeon operated on all patients. A total of 3812 MMS were performed. Fifty-eight percent of patients were male, and 41.92% were female (p < 0.001). Most lesions were midface (54%, p < 0.001), with 24% of lesions presenting in the left face and 21% in the right face (p = 0.012). Average MMS had 2.4 stages. Nose lesions and lesions with scar morphology required the most stages. Fair-skinned patients (Fitzpatrick Grade 2) required more stages than others in our cohort (p = 0.002). Eyelids, nose, and ear lesions were the areas that needed local flap coverage most often. This is a retrospective study, which could be seen as a limitation. To our knowledge, this is the first report in English in the literature that confirms the lateralisation of NMSC in the face. While most studies found a higher prevalence among females, this cohort is predominantly male. Previous operations in the same lesion have increased the number of stages needed to reach free margins.
This study aims to provide an overview of patient characteristics, treatment modalities, and associated complications following microvascular free flap reconstructions in maxillofacial surgery, based on data from a large national tertiary care centre. Adult patients who received a microvascular free flap between April 2017 and December 2024 were analysed in this descriptive retrospective single-centre study. Follow up was recorded until February 2025. Fibular (FFF), scapular (SFF), deep circumflex artery (DCIA), radial forearm (RFF), anterolateral thigh (ALT) and latissimus dorsi (LDF) free flaps were included. Variables were stratified by flap type and the N-1 χ2-test used to test for statistical significance of complication rates across years. A total of 1373 cases met the inclusion criteria. DCIA flaps suffered the highest rates of early flap loss (8.7%; x¯ = 3.6%) and wound infection (39.1%; x¯ = 13.5%). SFFs had the highest rate of anastomotic revision (25.0%; x¯ = 6.9%) and longest mean (SD) surgery duration: 715 ± 181 min. Donor site complications were most common among RFFs (36.0%) and FFFs (34.5%). Overall, wound infection rates were higher among bony rather than soft tissue flaps (23.0% vs. 7.8%). FFFs were associated with fewer recipient-site complications than SFFs and DCIA flaps, but donor site complications were higher. Among soft tissue flaps, complication rates did not differ significantly. Overall, complications at the recipient site were more frequent among bony compared to soft tissue flaps.
The emphasis laid on quality of life (QoL) in patients treated with head and neck cancer treatment has challenged surgeons to refine their resection techniques and improve on reconstruction and rehabilitation. Whilst the importance laid on the technical refinement has been of great importance; one needs to be aware of the significance of perioperative preparation of a patient prior to the commencement of any strategy of cancer treatment. The Enhanced Recovery After Surgery (ERAS) pathway provides the platform for this perioperative package of care. In this paper we offer special emphasis on the giving of information, to improve patients' expectations and overall QoL. The authors would like to lay emphasis on the advantages of the ERAS clinic, which offers a wide range of services. One aim of the service is to provide detailed information to patients and help manage their expectations. It is our opinion that management of expectations results in a better quality of life. We attribute our QoL outcomes to this improvement in surgical planning and execution alongside a robust ERAS pathway in managing patients' expectations.
The transconjunctival approach (TCA) is popular to gain access to the walls of the orbit, despite some unfavourable outcomes, such as entropion and damage to the lacrimal apparatus. Access to the medial wall is also challenging because of the position of the inferior oblique muscle (IOM), which can lead to iatrogenic palsy of the IOM and diplopia after its detachment. As an alternative, it is possible to use a subtarsal (STA) or subciliary approach (SCA) to avoid IOM injury. The present paper reports 361 orbits treated through a single SCA or STA for bone decompression and fixation of complex fractures. The IOM has been preserved and used as safety guide to reach the medial wall. From 2000 to 2024, we used SCA/STA to gain access to the floor, lateral, and medial walls of the orbit in 361 procedures involving the medial wall. The IO muscle was not divided in any case and one patient had clinical mild diplopia that lasted about two months. The rate of ectropion was 5.5%, with six cases (1.8%) corrected under local anaesthesia. We report that SCA/STA is a simple, reliable and fast approach to the orbit, preserving the IOM to get the medial wall.
Head and neck cancer (HANC) patients' health-related quality of life and concerns shape the patient-clinician interaction. Allowing patients to raise concerns that might otherwise be missed affords an opportunity for intervention and signposting to multiprofessional rehabilitation services. The Patient Concerns Inventory (PCI-HN) is a simple, condition-specific tool that promotes holistic, patient-centred consultation. This paper aims to summarise the findings from PCI use in routine clinics in Nottingham and report PCI profiles based on cancer site, surgical treatment, adjuvant radiotherapy (RT), time since surgery, and Speech and language therapy (SALT) frequency of follow up. From October 2020 to March 2022, 102 HANC patients undergoing curative surgery attended follow ups at Queen's Medical Centre, Nottingham. A total of 242 PCI-HN forms were completed, as some had multiple consultations. The cohort included 38 females and 64 males (aged 31-93). Most had oral cancer (83%), followed by oropharyngeal (12%) and other HANC (5%). The most common concerns were dental health/teeth (26%), chewing/eating (21%), fear of recurrence (21%) and dry mouth (21%). Concern patterns varied, notably, oral and oropharyngeal cancer patients prioritised dental health, free flap (FF) reconstruction patients focused on physical/functional wellbeing, and RT patients cited chewing/eating (36%) versus non-RT patients who feared recurrence (20%). FF and RT patients required more frequent SALT rehabilitation. PCI-HN captured diverse patient concerns, varying by site, surgery type, adjuvant RT, and time since surgery. Findings support targeted, stratified follow-up care.
The British Journal of Oral and Maxillofacial Surgery (BJOMS) is a leading platform for clinical research. We analysed 1416 BJOMS clinical articles indexed on Scopus to map global research patterns, collaboration networks, and thematic focus. Bibliometric data were extracted using Bibliometrix™ and VOS viewer™. The UK contributed most articles (n = 642), with strong international collaborations. Top institutions included NHS Greater Glasgow and Clyde (UK) and Liverpool University Hospitals NHS Foundation Trust (UK), and leading authors were Rogers SN, Lowe D, and Brennan PA. Keyword analyses revealed clusters in oncology, surgical innovation, trauma management, patient quality of life, regenerative medicine, education, infection, and epidemiology. This Scopus-based evaluation highlights the global research impact and thematic breadth of the journal.
Sentinel lymph node biopsy (SLNB) is a well-established method for managing primary oral squamous cell carcinoma (OSCC), but its role in recurrent or secondary carcinomas, particularly following previous neck dissection, remains insufficiently studied. This study explores the utility of SLNB in these challenging cases, focusing on reliability, sentinel lymph node (SLN) localisation trends, and clinicopathological factors, comparing results between primary and secondary/recurrent carcinomas. A retrospective analysis was conducted on patients with primary and recurrent or secondary OSCCs treated at a German tertiary medical centre. Chi squared tests were used to analyse correlations between clinicopathological characteristics and SLN localisation. The negative predictive value (NPV) was calculated, and the timing of recurrence was also evaluated. We found an NPV of 93.75% for SLNB in primary carcinomas, whereas it was 88.89% for secondary and recurrent carcinomas. While most SLNs were localised ipsilaterally across both groups, recurrent/secondary cancers showed a higher prevalence of contralateral SLNs (22.2%) and bilateral localisation patterns (11.1%) compared to primary carcinomas (8.3% contralateral; 8.3% bilateral). Despite observed trends, no statistically significant associations were found between SLN localisation and clinicopathological factors. The mean (SD) time to recurrence was significantly shorter for primary carcinomas with 9.20 (3.49) months compared to recurrent or secondary cases 32.00 (8.54) months). SLNB in recurrent or secondary OSCC shows distinct SLN localisation patterns, including more contralateral and mixed foci. In terms of NPV, SLNB is reliable in both primary and secondary/recurrent OSCC. Furthermore, a longer recurrence time reinforces the potential of SLNB as a viable alternative to neck dissection in managing these complex cases.
Most head and neck cancers (HNC) are diagnosed at advanced stages, highlighting the need for strategies to enhance early recognition. Since 2009, urgent suspected cancer (USC) referrals have increased by 377%, but HNC conversion rates have declined to 2.2%, straining resources and reducing efficiency. Predictive tools aim to support clinicians to identify high-risk patients. This study evaluates the predictive capability of HaNC-RC-v.2 compared with a restructured Wakefield Model and assesses the impact of HNC risk-based stratification on service organisation. Retrospective analysis of 1183 USC referrals collected data surrounding demographics, social history, 16 signs/symptoms, and diagnoses. Univariate and multivariate regression identified significant HNC predictors. Performance of the Wakefield Model was evaluated through sensitivity, specificity, area under the receiver operator curve (AUC), Akaike information criterion, and Hosmer-Lemeshow tests. DeLong tests compared model predictive capabilities. The Wakefield Model incorporated age, gender, smoking, alcohol, and seven HNC predictors, achieving an AUC of 82.70%. HNC-risk thresholds defined high-risk (≥7.35%; sensitivity: 75.71%; specificity: 80.41%) and low-risk (≤1.70%; sensitivity: 76.47%; specificity: 58.21%) groups. The model's predictive capability was significantly greater than that of the HaNC-RC-v.2 (AUC: 77.70%). Stratifying patients by HNC-risk thresholds ensured that >95% of HNC cases were assessed within 14 days, whilst reallocating 26.20% - 32.12% of USC assessments, improving service efficiency. HNC predictive models help clinicians to identify high-risk individuals, prioritise assessments, and optimise service provision. Implementing models at the point of referral could potentially stratify referrals into suitable assessment pathways.
Osteomyelitis of the mandible is uncommon in the current age of antimicrobials. When it occurs, the effects can be devastating, both functionally and aesthetically. The low volume of cases means clinicians are unlikely to gain significant experience in managing this condition.In this 15-year retrospective case series, all cases of osteomyelitis of the mandible treated at our tertiary referral centre were identified. Data on patient demographics, risk factors, treatment regimens, and outcomes were collected. The Zurich classification system was used to group cases into Acute (AO), Secondary Chronic (SCO) and Primary Chronic (PCO) osteomyelitis.A total of 60 patients were included for analysis. Mean age was 43 years (8-77), and males and females were equally affected. The commonest aetiology was odontogenic (76.7%), followed by trauma. The commonest organisms were mouth commensals, with a significant association of less virulent organisms in SCO compared with AO (p = 0.018). There was a significant difference in the prevalence of systemic factors between AO and SCO patients (p < 0.001). Six weeks of antibiotics was sufficient to treat most AO cases (n = 13). SCO cases (n = 43) treated with surgical debridement combined with antibiotics had better initial outcomes.To our knowledge, this represents one of the largest series of mandibular osteomyelitis to date. Osteomyelitis of the mandible is an uncommon and challenging condition, requiring a multidisciplinary approach. There are important differences between SCO and AO that surgeons must consider, including host factors, organisms and treatment strategies.
