Orthognathic surgery is commonly performed in healthy young adults and is associated with a low baseline risk of venous thromboembolism (VTE). However, considerable variation exists in the United Kingdom regarding the routine administration of preoperative pharmacological thromboprophylaxis with low molecular weight heparin (LMWH). The aim of this article is to review the current evidence for preoperative LMWH in orthognathic surgery, focusing on the incidence of VTE and the potential risk of perioperative bleeding, and to report findings of a local audit. Published literature demonstrates that symptomatic VTE following orthognathic surgery is rare, with reported incidences below 0.2% even in centres not using routine chemoprophylaxis. In contrast, anticoagulation has been linked with increased rates of postoperative bleeding complications, including haemorrhage requiring return to theatre, which raises concerns that routine prophylaxis may confer more harm than benefit in low-risk patients. A retrospective audit of 313 patients undergoing orthognathic surgery at a tertiary UK unit between January 2022 and February 2025, all of whom received prophylactic preoperative LMWH, identified no VTE events within three months of the operation. Intraoperative bleeding complications occurred in 12 patients (3.8%). Overall, current evidence does not support routine preoperative LMWH in low-risk orthognathic patients. Risk-stratified approaches are recommended, and prospective multicentre studies are needed to establish clear guidelines. (c) 2026 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
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.
Patients contemplating orthognathic surgery are increasingly turning to online forums, such as Reddit, as a supplementary source of information prior to undertaking a surgical treatment pathway. This study was designed to profile the main topics pertaining to orthognathic surgery which patients were discussing online, using data analytics methodologies and machine learning algorithms. An Application Programming Interface (API) wrapper was used to identify posts relating to orthognathic surgery on Reddit, within the /jawsurgery subreddit. The information was exported for further analysis. Topic modelling was undertaken with the Latent Dirichlet Allocation (LDA) algorithm, Valence Aware Dictionary and sEntiment Reasoner (VADER) tool was used for sentiment analysis, and a machine learning tool was used to pinpoint language cues in the posts. A total of 10265 posts were included in the analysis. These posts were categorised into one often topic groups based on qualitative analysis by the authors. Overall, there was positive sentiment toward orthognathic surgery within each of the topic groups within the subreddit. The topic groups which carried the highest sentiment were aesthetic change, aesthetic preferences and disagreements and, postoperative experience. Patients are actively seeking alternative sources of information regarding orthognathic surgery, particularly pertaining to the experiences of other patients. Whilst overall there is a positive sentiment toward surgery, both positive and negative experiences are posted online. Crown Copyright (c) 2026 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
