Restrictions to traditional face-to-face meetings were mandated by many government authorities during the COVID-19 pandemic, impacting the delivery of educational training sessions for maxillofacial surgery trainees in the traditional group manner. An online survey was designed to review what effect the pandemic had on the use and uptake of online educational sources amongst a representative cohort of maxillofacial surgery trainees in higher specialist training. Their attitudes and satisfaction with online resources were considered. The use of live sources such as webinars and pre-recorded materials (e.g. YouTube videos) was investigated. Engagement with online sources was considered prior to, and then during the pandemic. Alterations in the behaviour of trainees were demonstrated, with increasing online resource use seen once the COVID-19 pandemic took hold. Online pre-recorded resource use increased by 26% during the pandemic, with the median number of hours watched per month increasing from 1-5 h to 5-10 h (p < 0.001). Engagement with live online sources (webinars) increased by 52% and median time watched increased from 15 h per month to 10-20 h per month (p < 0.001). Trainees expressed satisfaction with the quality and flexibility of the resources. There was a firmly positive response to live webinars with regard to teaching quality, audio and video quality, ease of access and relevance to training needs. Pre-recorded and live online resources may prove a useful alternative or adjunct to face-to-face teaching when regulations limit or restrict social interactions.

On social media it has been claimed that while surgical scrubs are purported to be unisex, they are simply male scrubs with a 'unisex' label. The aim of this study was to investigate staff perceptions of scrub fit and understand its impact on female and male employees.

To assess the number of patients and types of pathology booked for review in the SHO-led ‘trauma clinic’ and compare this to the departmental standard operating procedure (SOP), with the intention of optimising use of resources and the patient journey.

The COVID-19 pandemic increased the demands on nursing staff and resulted in many calls to our OMFS service regarding complaints related to basic mouth care. The aim of this audit was to assess the knowledge of nursing staff in relation to oral hygiene and mouthcare in COVID-19 inpatients.

Study Design Observational. Objective To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. Methods Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations – neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer. Results In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4–C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1–2) joints. Conclusions Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.

PURPOSE:Neck dissection is often performed in patients with oral cancer to both treat and reduce the risk of subsequent neck metastases. Injury to the hypoglossal nerve may result in dysarthria, dysphagia, and profound difficulty with upper airway control. Although surgical landmarks facilitate intra-operative identification of vital structures to be preserved, they should not be an absolute measure, due to anatomical variants. We present a rare case of unilateral aberrant anatomy of the hypoglossal nerve, passing superficial to the internal jugular vein.METHODS:A 70-year-old female presented to the emergency department with an indurated and ulcerated floor of mouth lesion, later confirmed to be a squamous cell carcinoma. She was treated with wide local excision, bilateral selective neck dissection of levels I to III, surgical tracheostomy, anterior mandibulectomy and reconstruction with a left composite radial forearm free flap.RESULTS:A nerve-like structure was identified crossing superficially and perpendicular to the internal jugular vein within the left neck, which was later determined to be an anatomical variant of the hypoglossal nerve. This was carefully dissected and preserved, and the remainder of the surgery completed uneventfully. On the right, the hypoglossal nerve followed its normal anatomical course. The patient made a good recovery and suffered no neurological complications.CONCLUSION:Identification, meticulous dissection and preservation of the hypoglossal nerve is essential in lymphadenectomy involving levels I and II. Detailed knowledge of both normal and variant anatomy is fundamental for surgeons, which will allow for identification and protection of important neurovascular structures, thereby minimising surgical morbidity.

More than a fifth of major trauma patients have concomitant maxillofacial injuries, the prevalence of which is increasing. Patient outcomes may be optimised by early treatment, particularly for time-critical diagnoses, but management of maxillofacial injuries must be appropriately prioritised in the context of whole patient care. Development of standard operating procedures (SOPs) fosters a high standard of uniform care across a range of clinicians and specialties. SOPs for the management of maxillofacial trauma by the Air Ambulance Kent, Surrey, Sussex (AAKSS) were developed and updated. Four maxillofacial diagnoses warranted inclusion for initiation of management in the pre-hospital setting: midfacial haemorrhage, isolated epistaxis, penetrating neck injury, and retrobulbar haemorrhage. Development of the document was complemented by an in-person presentation to the Helicopter Emergency Medical Service (HEMS). The resulting SOPs and underlying evidence are presented.

The Breast JournalVolume 25, Issue 6 p. 1328-1329 COMMENTARY The role of nipple punch biopsy Georgina Hicks MBBS, BSc, MRCS, Corresponding Author Georgina Hicks MBBS, BSc, MRCS georginahicks@doctors.org.uk orcid.org/0000-0002-7518-8947 West Middlesex University Hospital, London, UK Correspondence Georgina Hicks, Department of Breast Surgery, West Middlesex University Hospital, Twickenham Road, TW7 6AF, Isleworth, London, UK. Email: georginahicks@doctors.org.ukSearch for more papers by this authorSarah Brown MBBS, BSc, Sarah Brown MBBS, BSc West Middlesex University Hospital, London, UKSearch for more papers by this authorThomas Pepper MBBS, BDS, MRCS, Thomas Pepper MBBS, BDS, MRCS King's College Hospital, London, UKSearch for more papers by this authorRazick Sait MBBS, MS, Razick Sait MBBS, MS West Middlesex University Hospital, London, UKSearch for more papers by this authorMusa Barkeji MBBS, FRCSI, Musa Barkeji MBBS, FRCSI West Middlesex University Hospital, London, UKSearch for more papers by this author Georgina Hicks MBBS, BSc, MRCS, Corresponding Author Georgina Hicks MBBS, BSc, MRCS georginahicks@doctors.org.uk orcid.org/0000-0002-7518-8947 West Middlesex University Hospital, London, UK Correspondence Georgina Hicks, Department of Breast Surgery, West Middlesex University Hospital, Twickenham Road, TW7 6AF, Isleworth, London, UK. Email: georginahicks@doctors.org.ukSearch for more papers by this authorSarah Brown MBBS, BSc, Sarah Brown MBBS, BSc West Middlesex University Hospital, London, UKSearch for more papers by this authorThomas Pepper MBBS, BDS, MRCS, Thomas Pepper MBBS, BDS, MRCS King's College Hospital, London, UKSearch for more papers by this authorRazick Sait MBBS, MS, Razick Sait MBBS, MS West Middlesex University Hospital, London, UKSearch for more papers by this authorMusa Barkeji MBBS, FRCSI, Musa Barkeji MBBS, FRCSI West Middlesex University Hospital, London, UKSearch for more papers by this author First published: 23 July 2019 https://doi.org/10.1111/tbj.13468Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume25, Issue6November/December 2019Pages 1328-1329 RelatedInformation

Robert Lutz spoke regarding his concerns of the construction project at 214 N. Main Street. Mr. Lutz owns the rental property to the east of the project and he has experienced many difficulties regarding a large tree removed from his lot, flooding of his basement due to drain pipes being damaged, and safety issues due to exposed metal rods and trenching along his property border. He recognizes that the DDA may not have any ability to correct the situation and he has spoken previously to the Almont Village Manager and wanted to make sure that all parties are communicating. He stated that Joe Israel has been very helpful throughout the process in addressing his concerns. As an owner of a rental property he has to comply with the property maintenance codes and hopes that the project owner is being held accountable as well. T. Roach acknowledged the concerns and asked that DDA Director N. Boxey perhaps draft a letter to the Village Council stating that the DDA is frustrated with the lack of progress in correction of this community eyesore. N. Boxey assured Mr. Lutz that she is in close contact with the Village Manager regarding this project and that several citations have been issued per the property maintenance code.