bluuebunny/crossref_metadata_2025 huggingface dataset:
1611 Significant Epistaxis Secondary To COVID-19 Nasopharyngeal Swab
Authors: Laycock J , Ahmed O , Wasson J
Published: October 2021

Aim

This case highlights the need for appropriate training when adopting new techniques, even for relatively simple procedures.

Method

we report a rare complication of the innovative COVID-19 nasopharyngeal swab which is a new skill for many healthcare professionals and frequently performed with little or no training.

Results

We describe a case of iatrogenic epistaxis after a diagnostic nasopharyngeal swab was taken during the COVID-19 pandemic. The epistaxis was significant, causing haemodynamic and respiratory compromise. In a frail patient who is susceptible to epistaxis, the potenial for further harm is significant. After initially presenting with shortness of breath, this patient (who had no previous nasal pathology) underwent routine naso- and oro- pharyngeal swabbing to test for COVID-19. He felt immediate discomfort in his nasopharynx and epistaxis ensued. The bleeding persisted for several hours; bilateral anterior and posterior nasal packing was required to eventually cease the bleed. He was compromised with a falling haemoglobin, and aspiration of blood compounded his shortness of breath.

Conclusions

Epistaxis is a potentially serious side effect of nasopharyngeal swabbing; a procedural skill dramatically increasing in prevalence during the COVID-19 pandemic. We advocate for formal training of this procedure for all healthcare staff required to undertake it. Presenting such a case report can help us in understanding the complications of this procedure, and better thus inform the patient consenting process.
1648 Is Telephone Triage Here to Stay? An Audit of The Impact of COVID 19 On A Head and Neck Cancer Clinic
Authors: Osuji J , Srinivasan V
Published: October 2021

Due to the COVID19 pandemic, NHS reported a 60% drop in suspected cancer referrals and a delay in treatment initiation. In a pandemic, cancer waiting time (WT) targets can prove difficult to achieve. ENT UK and NHS England recommended a senior-led telephone triage system to be put in place in response to the pandemic.

Aim of this audit was to assess the impact of the pandemic and evaluate the efficacy of tele-consults on the Head & Neck Cancer (H&N) Service at a District General Hospital.

A retrospective audit of patients referred to the H&N clinic from April - June 2020, comparing patients managed by teleconsultations to patients seen F2F. Medical records were analysed to assess compliance with NHS Cancer WT targets.

2020 saw a 1.4% drop in referrals compared to 2019. Of the 224 referrals received from April - June 2020, 96.9% were seen within 14 days. 98.7% were initially reviewed by telephone, 37% of which were triaged to a F2F appointment, 39% were followed up by telephone and 24% were discharged or given routine appointments. 11.2% were diagnosed with cancer. Comparing cancer patients managed by telephone to patients seen F2F, 80% v 57% received a diagnosis by 28 days from the referral, and 100% v 17% started treatment by 62 days.

The department did not have a significant drop in referrals due to the COVID pandemic. Cancer patients managed by telephone were more likely to start treatment within 62 days. Telephone consults should be a permanent feature of cancer clinics beyond the pandemic.
1597 Navigating the Morality of Postponing Urgent Cancer Surgery in The Covid-19 Pandemic
Authors: Tucker S
Published: October 2021

Introduction

The Covid-19 pandemic presents challenges of unparalleled magnitude to healthcare resource allocation. Many cancer operations have been postponed due to reduced staff, bed and ICU availability, potentially allowing incurable disease progression. The five-year survival rate for stage 1 bowel cancer is 91%; stage 2, 84%1, yet some studies suggest the mortality rate of ventilated Covid-19 patients is 50-88%2,3,4,5. Many ethical documents attempt to guide just resource allocation for ICU, however, Covid-19 presents a greater conundrum. If resource allocation occurs on the basis of acute medical need it is preferential to Covid-19 care, and at what cost is this to those with potentially curable cancer? How can we navigate pandemic pressures to be as just as we can?

Method

Literature review and application of ethical theories including utilitarianism, deontology and a Rawlsian approach.

Results

Utilitarianism argues that allocating scarce resources to those likely to gain minimal benefit, whilst removing benefit from those with a higher likelihood of survival would not be for the greater good. Doctors, however, tend to practise in a more deontological way; that is in the best interests of the patient in front of them. Rawl’s thought experiment allows us to wear a ‘veil of ignorance’ to consider the fairest decision for any undefined individual.

Conclusions

Covid-19 has forced unprecedented moral dilemmas; these do not just extend to patients requiring ventilators, but those in need of curative surgery. An understanding of ethical principles and a multidisciplinary approach to decision-making should encompass the consideration of outcomes of oncological surgical intervention.
1556 Does Surgical Intervention Improve Quality of Life for Patients with Chronic Ear Disease in Nepal?
Authors: Ahmed F , de Cates C , Bahadur Bohara R , Youngs R
Published: October 2021

Aim

To assess change in quality of life (QoL) pre- and post-surgery for patients with chronic ear disease (CED) in Nepal. Hearing loss is the fourth leading cause of disability world-wide with 90% of those affected living in low and middle-income countries. A huge yet treatable contributor to this is chronic suppurative otitis media (CSOM). The Chronic Ear Survey is a sensitive and disease specific QoL measurement tool in patients with CSOM exploring activity restriction, symptoms and utilisation of medical services.

Method

This study was conducted at the Brinos Ear Care Centre in Nepalgunj, Nepal. A modified Chronic Ear Survey (mCES) was translated into Nepali and administered to patients before surgery and at post-operative follow up by community ear care assistants. The Mann-Whitney U test was used for statistical analysis.

Results

The mCES was administered to 64 patients pre-operatively and 28 patients post-operatively. Disease specific QOL in patients with CSOM was demonstrated to be better overall in patients post-surgery and specifically in the domains of activity limitation and symptoms. No significant change was demonstrated in utilisation of medical services (p < 0.1)

Conclusions

Surgical intervention for patients with CSOM in Nepal improves ear specific QOL. This manifests specifically in a reduction in severity of symptoms and fewer restrictions on activity. Surgery in this population does not significantly change healthcare seeking behaviour and this must be explored further in the context of access to surgery and attitudes towards healthcare in this population.
173 Long Term Analysis of The Evolution of Practice and Results of Abdominal Wall Reconstruction by A Single Surgeon
Authors: Woffenden H , Vijayan D , Stevens E , Ghini F , Cunha M , Suggett N
Published: October 2021

Background

It is estimated that at least 12-15% of abdominal operations lead to incisional hernias, and Worldwide, evidence shows high rates of recurrence after surgical repair ranging from 12.7% in the Danish hernia registry to 23% in the Swedish registry.

Method

This is a retrospective analysis of the practice of a single surgeon at a tertiary centre. An electronic database provided all hernia surgeries done by the surgeon. A total of 185 patients with complete data were included who had open hernia repair. Electronic patient records were analysed to collect the data.

Results

185 patients, with a median age of 57 years (IQR 68 – 49), and BMI of 31.14 (IQR 36.02 – 27.52), had a hernia recurrence rate of 15.6% (29/185). More than 80% of the cases were complex hernias with a European Hernia classification of M3 and/ or W3, with dense intestinal adhesions and multiple previous repairs. Variability in techniques and mesh evolved over this period, from anterior component separation to transversus abdominis release to achieve closure of the abdomen. Polypropylene meshes were used for non-contaminated or less complex cases. The use of biologics in the early years has been superseded by biosynthetic.

Conclusions

The creation of the abdominal wall unit and subsequent MDT at this centre resulted in a rise of total procedures, complexity of cases and patients with significant co-morbidities. Specialised abdominal wall surgeons are associated with better results when performing complex abdominal wall reconstructions.
516 Does the Use of Adjuvant Chemotherapy Increase Incisional Hernia Rates in Colorectal Cancer Patients – A Retrospective Single Centre Cohort Study
Authors: Singh N , Gupta K , Khan T , Rahman E , Singh-Ranger D
Published: October 2021

Aim

Incisional hernias (IH) are a known complication of any major abdominal surgery. It is known that chemotherapy impairs healing processes via delayed inflammation, impaired collagen synthesis and reduced fibrin deposition and wound contraction. There are currently, to our knowledge, no trials examining the effect of adjuvant chemotherapy on incidence of IH in patients with colorectal cancer. This study aims to assess the same by comparing IH rates between chemotherapy and non-chemotherapy patient groups.

Method

All the patients who had major surgery for colorectal cancer between January 2009 and January 2014 were divided into two groups of chemotherapy (A) and non-chemotherapy (B). Records of first 160 patients from each group were retrospectively analysed.

Results

There were non-significant differences between groups for sex, tumour location, primary operation, and type of procedure (emergency or elective). Significant differences were observed for age (more elder patients in group B, p = 0.000011), method of access (more open procedures in group B and more laparoscopic procedures in group A, p = 0.0007) and Charlson co-morbidity scores (more advanced score in group B, p = 0.029). We found that 21/120 (21.21%) patients in the chemotherapy group and 12/99 (13.79%) patients in non-chemotherapy group developed Incisional hernias. Although there was a higher rate of IH in the chemotherapy group, this was not statistically significant (p = 0.27).

Conclusions

Although this study fails to demonstrate any statistically significant difference in IH incidence between two groups, but this study can act as a pilot in order to fuel further high-quality research to draw more valid conclusions.
832 Groin Hernia Should Remain A Clinical Diagnosis -- An Evidence-Based Study
Authors: Abu Elgasim M , Conroy A , Cartland M R , Sridhar P
Published: October 2021

Introduction

British Hernia Society (BHS) 2013 guidelines1 suggest that groin hernia diagnostic investigation should not be done at the primary care level. Nevertheless, General Practitioners refer patients with a positive ultrasound finding of groin hernia to secondary care. As a result, patients have false hopes that their symptoms would resolve if the ultrasound finding is addressed. The study aims to find the positive predictive value (PPV) for groin ultrasound for hernia and should the primary care physicians request the scan before referral to secondary care.

Method

A retrospective audit of outcome of patients referred to a general surgical department for groin hernia treatment. The study looked at elective groin hernia referrals for the period between June and August 2019.

Results

127 patients were electively treated for groin hernia in secondary care. 40% of the patients had ultrasounds before treatment. The GP requested 78% of the ultrasounds. A positive finding was the reason for the referral. Two patients (5%) in this group had negative operative findings. 24 herniograms over 57 months for patients referred with positive ultrasound and negative clinical findings showed only 2 had positive findings (8%). None of the negative patients returned to the same hospital for groin hernia treatment until date.

Conclusions

It is recommended that the diagnostic tests for groin hernia be requested by the operating surgeon as per the BHS guidelines. Patients should not be subjected to hernia operations based on ultrasound findings as the PPV for this investigation is very low for patients who have negative clinical findings.2
1225 How Are Acutely Symptomatic Hernias Repaired in The UK? Surgical Techniques from The MASH Study
Authors: Spence O ,   MASH Steering group,   MASH Collaborators
Published: October 2021

Aim

Minimal evidence exists guiding the emergency management of acutely symptomatic abdominal wall and groin hernias (ASH) and there is a lack of consensus on optimal surgical technique. The aim of this study was to explore surgical techniques used in the repair of ASH.

Method

A prospective 12-week cohort study (NCT04197271) recruited adult patients with ASH across 23 UK sites. Baseline characteristics, quality of life, management strategy and 30/90-day outcomes were collected. For those undergoing surgery, detailed information was recorded on: time to surgery, anaesthetic technique, grade of surgeon, intraoperative findings, antibiotic use, operative approach, repair technique (mesh vs suture), mesh/suture type and position, and whether bowel resection/stoma formation was required.

Results

Of the 264 patients recruited, 214 (82%) underwent acute repair within 48 hours of admission. 95% of patients underwent open repair, 93% under general anaesthetic. Mesh was used in 89% of inguinal hernia repair vs 29% umbilical hernia repair. The majority (86%) used a synthetic non-absorbable mesh (94% inguinal, 84% umbilical). Mesh placement varied widely for epigastric and umbilical hernia, with onlay used most commonly (24%). Similar variation was seen in suture choice. 8% of patients developed an SSI by 30 days, the majority which were in umbilical repairs. One patient developed early hernia recurrence (umbilical) requiring surgery.

Conclusions

This data demonstrates variation in the surgical management of ASH, especially with the use of mesh. Laparoscopic surgery was uncommon. Further studies are required to clarify optimal technique strategies in the emergency setting.
155 A Machine Learning-Based Approach for Predicting Surgeons’ Subjective Experience and Skill Levels: Neuroimaging Study
Authors: Keles H O , Cengiz C , Demiral I , Ozmen M M , Omurtag A
Published: October 2021

Aim

Measuring cognitive load is important for surgical education and patient safety. Traditional approaches of measuring cognitive load of surgeons utilise behavioural metrics to measure performance and surveys and questionnaires to collect reports of subjective experience. There is a need for more automated, more accurate and objective evaluation methods.

Method

Functional neuroimaging data was collected using wireless NIRS device from sixteen surgeons (11 attending surgeons and 5 surgery resident) and 17 students while they performed two laparoscopic tasks (Peg transfer and String pass). Participant’s subjective mental load was assessed using NASA-TLX survey. Machine learning approaches were used for predicting the subjective experience and skill levels.

Results

The Prefrontal cortex (PFC) activations were greater in students who reported higher-than-median task load, as measured by the NASA-TLX survey. However, in the case of attending surgeons the opposite tendency was observed, namely higher activations in lower v higher task loaded subjects. We found response was greater in the left PFC of students particularly near dorso- and ventrolateral areas. We quantified the ability of PFC activation to predict differences in skill and task load using machine learning while focusing on the effects of NIRS channel separation distance on the results. Our results showed that the classification of skill level and subjective task load could be predicted based on PFC activation with an accuracy of nearly 90%.

Conclusions

The high accuracy of results is encouraging and suggest the integration of the strategy developed in this study as a promising approach to design automated, more accurate and objective evaluation methods.
1006 Impact of The Human Factor on Student Interest in Orthopaedic Surgery: A Randomised Control Trial
Authors: Feeley A , Feeley I , Lee M , Merghani K , Sheehan E
Published: October 2021

Aim

The positive learning experiences of students on surgical rotations which subsequently influence career choice may be delineated into practical and interpersonal themed factors. It remains unclear the relative impact each component has on the student experience and subsequent specialisation. We evaluated the influence of having senior resident mentor during practical simulation in orthopaedic surgery has on medical student interest in surgery; their comfort in theatre; and its role in enhancing knowledge acquisition within the rotation

Method

Medical students undergoing clinical rotations in a Regional University Hospital were randomised to undertaking a a virtual reality simulated operation independently or performing under the guidance of an experienced resident. Baseline levels of interest in surgery, comfort in theatre, perceived barriers to surgical learning and entry to surgery were established and compared to answers following completion of the tutorial. Qualitative feedback was collected regarding the benefits and limitations to the experience. Presented according to CONSORT guidelines.

Results

Participants in the resident guided group achieved significantly higher simulated performance scores compared to the control (p < 0001), with an increase in orthopaedic surgery from baseline expressed to a statistically significant degree (p = 0.04). 100% participants strongly agreed it was a beneficial learning experience which would be useful in surgical curricula.

Conclusions

Surgical trainee guided simulation led to improved performance and interest in orthopaedic surgery, while virtual practical experience was felt to be a useful learning tool independent of supervision. Further research is needed to establish the role of interpersonal interactions in student surgical experience.
1515 A Survey on The Perceived Effect of Background Music on Intra-Operative Stress, Anxiety and Surgical Task Load On the Operating Surgeon
Authors: Pearson L , Narayanan A , Fisher J , Khashram M
Published: October 2021

Introduction

Music is commonly played in operating theatres throughout the world though its use remains controversial. There is growing literature supporting the notion that playing background music can improve a surgeon’s task performance and reduce performance stress. We present findings from our survey of surgeons about their perceptions of the effect of intra-operative music on their stress levels.

Method

Surgeons and registrars from three different specialties – general, vascular, and paediatric surgery – in a single tertiary centre were surveyed on their views on the effect of music in theatre. Two instruments were used to assess parameters of stress: the modified 6-point state trait anxiety inventory (STAI-6) and the surgical task load index (SURG-TLX).

Results

There were 35 respondents across the three surgical specialties (78% response rate). Pop and “easy listening” were the most popular genres. A majority felt music improved their temperament (75%) and perceived stress (63%). 59% of respondents reported no to low perceived anxiety with music, compared with 31% reporting moderate and 9% high anxiety based on STAI-6 parameters. Regarding SURG-TLX parameters and music, respondents overall perceived feeling less anxious, rushed and mentally fatigued though more distracted.

Conclusions

Music is generally thought to have positive subjective effects on the theatre environment with regards to anxiety levels, temperament, perceived stress, and parameters within the surgical task load index. This is counterbalanced by a smaller group of respondents who felt that music can impair communication and increase distraction within theatre. Music used appropriately may reduce perceptions of stress in theatre.
1636 Improving Plastics SHO Induction: A Three-Cycle QI Project and National Survey
Authors: Leong S , Vijayasurej K , Faderani R , Sin-Hidge C , Gibson J , Jessop Z
Published: October 2021

Aim

Burns and Plastic Surgery is a wide-ranging exciting field that is rarely taught well in undergraduate medical curriculums. As such, it is imperative that we design and deliver a safe and effective induction programme for Foundation doctors and core trainees who are new to this specialty.

Method

Plastics SHOs rotating to our unit from December 2019 to December 2021 completed quantitative and qualitative questionnaires on the departmental induction they received. Statistical analysis and thematic analysis of their quantitative and qualitative responses were performed respectively. We aimed to describe the process of modifying our induction programme to the modern learner's learning needs. In addition, we surveyed Plastics SHOs in all Plastics units in the UK to compare and assimilate best practice.

Results

A combination of didactic and practical workshops resulted in significantly improved learner satisfaction, SHO preparedness for oncalls and knowledge of departmental policies in our unit. SHO shadowing was the most preferred and effective method of SHO induction nationally but rarely used. SHO handbooks were useful but employed by less than 40% of Plastics units nationally.

Conclusions

Through a multi-cycle QI project and national survey, we look forward to presenting the ideal design of an SHO induction programme for a specialty that requires structured clinical assessment and procedural skills. In summary, the ideal SHO induction programme consists of a combination of didactic tutorials, practical workshops, and peer shadowing. This is crucial in maintaining patient safety and junior doctor well-being when tackling the often-busy plastic surgery oncalls.
98 Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: Meta-Analysis of Randomised Controlled Trials
Authors: Qayum M , Nawaz G , Hajibandeh S , Hajibandeh S
Published: October 2021

Aim

To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy.

Method

We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models.

Results

We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P < 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups.

Conclusions

The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length.
353 AIR Score Based Management of Appendicitis
Authors: Carlile A
Published: October 2021

Introduction

Appendicitis is the most common cause of an acute abdomen. Approximately 7% of the population will be affected at some point. The development of AIR has been developed to aid diagnosis and decreasing the number of negative appendectomies while also safely identifying those who have developed appendicitis.

Aim

This retrospective audit, which aims to assess the effects of the introduction of AIR score risk on the negative appendicectomy rate of patients admitted to Taranaki Base Hospital.

Method

All patients under General Surgery receiving open appendicectomy, laparoscopic appendicectomy or diagnostic laparoscopy for evaluation or treatment of appendicitis from January 1st 2017 – December 31st 2018.

Results

The negative appendicectomy rate dropped 11.1% after introduction of the AIR score, we also noted a decrease in CT scan use.

Discussion

Our results suggest that the Air score could be used as an adjunct to the clinical diagnosis of acute appendicitis.
856 Mortality and Morbidity Meetings in Oral and Maxillofacial Surgery: Hindsight is 20/20
Authors: Ahmed A , McMillan K
Published: October 2021

Aim

Mortality and Morbidity (M&M) meetings form a critical part of clinical governance however they often suffer from hindsight bias and lack objectivity. To combat this, Kahoot surveys were disseminated to senior clinicians prior to M&M meetings. Each case to be discussed is presented as a survey item with the clinical and radiographic information that was available to the performing surgeon pre-operatively and participants are asked to detail their ideal treatment. The aims of this study were to determine if the introduction of Kahoot surveys prior to M&M meetings improves the objectivity of the discussions and reduces the effects of hindsight bias.

Method

A 12-item questionnaire relating to the introduction and utility of Kahoot surveys prior to M&M discussions was distributed to all registrars and consultants within our department.

Result

An 80% response rate was obtained (16/20 responses). Prior to the introduction of Kahoot surveys, 62.6% of surgeons felt case discussions were clouded by the benefit of hindsight. Comparatively, 68.8% indicated the use of pre-M&M surveys reduced the effects of hindsight bias. 56.3% of participants expressed the objectivity of case discussions improved and 50% felt the quality of feedback improved.

Conclusions

The use of Kahoot surveys prior to M&M meetings demonstrates that withholding the case outcome until each clinician has given their own opinion reduces the effect of hindsight bias. The surveys utilise the Bolam Test, thereby enabling us to determine the correct error classifications with greater objectivity. Furthermore, they facilitate a higher quality of discussion and feedback.
1153 “To FNA Or to Not FNA, That Is the Question.” A 5-Year Retrospective Epidemiological Study Of 238 Surgical Parotid Cases Treated at An East Yorkshire OMFS Unit
Authors: Townend G , Moussa A , Akoush Y , Dhanjal G , O'Higgins C , Gladwin L , Taha A , Mizen K , Crank S , Philip J
Published: October 2021

Introduction

Fine needle aspiration (FNA) is a surgical procedure used to aid with diagnosis and subsequent treatment planning. This study compares FNA histology with final histology (gold standard) for diagnostic accuracy in parotid surgery patients.

Method

A retrospective investigation of patient records from January 2014-January 2019 was performed to find eligible patients that underwent parotid surgery. Histology reports of the ultrasound (US) FNA and final parotid sample were compared for diagnostic accuracy and ability to differentiate between malignant & benign tumours.

Results

240 parotid surgeries on 238 patients were undertaken between 2014-2019 under OMFS and ENT specialities. 137 US FNA’s were performed, of these, there was an 85% diagnostic rate. Of the diagnostic FNA’s 79% reach gold standard, with the histology matching that of the final histology. Of the 24 without diagnostic accuracy, 2/3 were still able to differentiate between malignant and benign lesions. Overall, the US FNA’s were able to differentiate malignant and benign parotid lesions in 93% of cases.

Conclusions

The audit has proven US FNA to be an accurate diagnostic test, it gives extra data to aid in the decision making and planning for parotid surgeries. Although US FNA has shown to be more accurate in diagnosing benign parotid tumours; it is useful in detecting cellular change which could be indicative of malignancy.
1203 Sialendoscopy In Non-Stone Sialadenitis Is an Effective Therapeutic Approach
Authors: Karia R , Pepper T , Ryba F
Published: October 2021

Introduction

The aim of this retrospective case series was to investigate the therapeutic effectiveness of salivary endoscopy for non-stone related sialadenitis and obstructive symptoms.

Method

The records of 46 patients who underwent salivary endoscopy between September 2018 and December 2019 were reviewed. Included cases presented with at least one symptomatic major salivary gland, with no history or evidence of stone disease on clinical or radiologic examinations.

Results

A total of 22 patients (48%) and 26 glands were identified. These patients had a mean age of 50.8 years (range 27–74) and 73% were female. Most cases (19/26) involved the parotid gland. The primary imaging modality used was ultrasound, with sialography reserved for suspected strictures. The most common sonographic finding was ductal dilation (50%). Dexamethasone was instilled at completion of sialendoscopy in 23/26 cases. Outcomes included symptomatic improvement in 15/18 patients (4 patients have follow-up pending) with 5/15 experiencing complete symptom resolution. 2/18 patients did not have any symptomatic improvement, and 1/18 experienced acute infection that was treated with antibiotics. No patients required gland excision.

Conclusions

Salivary endoscopy is a minimally invasive and effective treatment for patients with non-stone sialadenitis that is refractory to conservative measures. Our review demonstrated 83% therapeutic benefit with gland preservation in all patients.
1208 Silent Sinus Syndrome: Systematic Literature Review and Report of Case Treated with A Customised PEEK Orbital Floor Implant
Authors: Denholm K A , Pilkington R J J , Keith D J W
Published: October 2021

Aim

Silent sinus syndrome is a rare condition characterised by progressive, painless enophthalmos with subsequent development of hypoglobus due to orbital floor resorption. It is caused by hypoplasia of the ipsilateral maxillary sinus due to atelectasis. It may be associated with previous orbital floor surgery or trauma or may be idiopathic. We describe the case of a 33-year-old female treated with a customised orbital floor implant, and a review of the condition from available literature.

Method

A total of 53 patients with a diagnosis of silent sinus syndrome reported in 7 different papers from 2003-2020 were compared in age, presenting signs and symptoms, radiographic findings and the types of treatment provided.

Results

The patients ranged from ages 19 to 91, with an average age of 45.1 years, and a male to female split of 29:24. The most common presenting sign was progressive unilateral enophthalmos, usually in the absence of any ocular symptoms. Treatments included endoscopic maxillary antroscopy, orbital floor repair (prefabricated or customised) and septoplasty.

Conclusions

Silent sinus syndrome typically presents with unilateral enophthalmos which is often painless and not associated with any visual disturbance. It possesses characteristic clinical and radiographic signs. The management of choice is surgical and does not tend to recur in the years immediately following resolving treatment. Since the advent of 3D printing, accurate customised orbital plates can now be designed to correct the hypoglobus which is a major aesthetic component when it presents in this condition.
1211 An Ameloblastoma Or Intra-Oral Basal Cell Carcinoma? A Clinical Case Report
Authors: Crummey S , Amini A
Published: October 2021

A basal cell ameloblastoma is an uncommon benign neoplasm and has a similar histological appearance to basal cell carcinoma of the skin. This clinical case report will discuss an ameloblastoma originating in the maxilla and of the baseloid variant. The objective of report is to highlight the possibility of misdiagnosis from this challenging case.

A 34-year-old male was referred to the maxillofacial department with recurrent nasal regurgitation following dental extraction from the left maxilla 1 year previous. Clinically there was an oro-antral fistula visible and initial CT showed cystic lesion in the left maxilla likely to represent an odontogenic cyst. The patient underwent extraction and enucleation, where the diagnosis of the amelobalstoma was established with need of resection. Partial maxillectomy and primary closure with buccal fadpad was performed in the second stage and histological results showed a 6mm completely excised basal cell carcinoma within the oral mucosa and no bony invasion. Due to this extremely unusual results, secondary histological review was requested, and conclusion was a fully excised basal cell ameloblastoma. Following the procedure and subsequent reviews, the patient has no evidence of oro-antral fistula or recurrence of this rare type of neoplasm.

A basal cell ameloblastoma variant is a rare lesion and due to its’ similar histological appearance to a basal cell carcinoma, can lead to a misdiagnosis. The aim of the report is to show the unusual presentation and findings along the way to correct diagnosis in this case.
1327 Youtube As in Information Source for Microsurgical Training: A Systematic Review of Video Content
Authors: Ochuba P , Uppal J , Langan D , Chai A
Published: October 2021

Aim

The COVID-19 pandemic has resulted in fewer physical microsurgical training opportunities, forcing trainees to seek virtual alternatives. As one of the largest video-sharing platforms globally, YouTube is increasingly being used to provide educational content. With additional emphasis placed on these videos, there will likely have an impact on training progression further down the line. This research aims to evaluate YouTube video content as a microsurgical training information source.

Method

We searched Youtube.com for videos demonstrating and teaching microsurgical techniques. Search terms included “microsurgical”, “teaching”, “anastomosis” and “flap”. All videos of neurosurgical nature were excluded. Thirty-one videos were evaluated using nine criteria and using a modified GQS score. To reduce duplication, included videos were limited to two from one source.

Results

Initial results show 79% of the videos were GQS Score 4/5 and therefore of good quality, despite only 38.7% featuring human procedures. 82.8% of the videos found were from medical websites, with most generated from three independent sources. The highly-scoring YouTube videos tended to have an audio voice-over or subtitles and clearly described the instruments and materials used.

Conclusions

The results demonstrated that high-quality videos are easily accessible on YouTube and deemed useful as educational tools. However, trainees should be aware that varied sources provide videos that range in quality; and the learning acquired may not directly correspond to learning objectives set out by governing bodies and is unlikely to be comparable to real-life observation in theatre. Overall, evidence for the current educational value of YouTube for microsurgical techniques is somewhat limited.
1395 The Influence of Shortened Antimicrobial Courses in Surgical Management of Mid 1/3rd Facial Fractures
Authors: Lawrence M , Karia R , George K
Published: October 2021

Aim

Antimicrobial resistance (AMR) is an increasing issue posing a grave threat to global public health. A prospective pilot study within our OMFS unit investigated the effects a shortened course of perioperative antimicrobial cover had on infective post-operative complications in patients who had surgical management of mid 1/3rd facial fractures.

Method

As per the World Health Organisation (WHO) global action plan on antimicrobial resistance, with our microbiology team we developed and implemented a shortened antimicrobial protocol for use in the surgical management of mid 1/3rd facial fractures. Following protocol implementation, the records of 55 patients who underwent surgery for their mid 1/3 facial fractures between May 2019 and May 2020 were reviewed.

Results

Of 55 patients who underwent surgical management of mid 1/3rd facial fractures 28/55 (50.9%) were prescribed a shortened course of perioperative antimicrobials depending on whether an intra or extra oral surgical approach was used, whilst 27/55 (49.1%) were prescribed a longer course of antimicrobials. Of those given a shortened course of antimicrobials 1/28 (3.6%) experienced infective post-operative complications. Conversely 4/27 (14.8%) of those given a longer course of antibiotics experienced infective post-operative complications.

Conclusions

This data supports growing evidence that shorter courses of antimicrobials are appropriate in the surgical management of facial fractures. As OMFS surgeons we can utilise evidence-based medicine to provide optimal surgical care whilst simultaneously contributing to healthcare professionals’ obligations to tackle the increasing challenge of antimicrobial resistance.
1425 Surgical Management of a Long-Standing Temporomandibular Joint Dislocation: A Case Report
Authors: Dunphy B , Quach H , Ghaly G A
Published: October 2021

Background

Temporomandibular joint (TMJ) dislocation is a common presentation to Oral & Maxillofacial Surgery. In most cases, the condylar head is displaced anterior to the articular eminence and can be relocated by closed reduction. Severe dislocation into the infratemporal fossa is uncommon. Long-standing dislocation is rare and makes closed reduction difficult to achieve.

Presentation

A 60-year-old female presented to the outpatient clinic with long-standing bilateral TMJ dislocation which onset months prior following a seizure. Both condylar heads could be palpated superior to the zygomatic arches and could not be reduced under local anaesthetic. Mandibular range of movement was severely limited and creating an oral seal was not possible, affecting speech function. There was a history of discomfort and declining oral intake. Computed tomography revealed both condyles were displaced into the infratemporal fossa.

Management

The patient and family expressed a desire to avoid risk of damage to the facial nerve and therefore surgery was limited to an intra-oral approach only. Closed reduction was impossible due to the degree of muscle fibrosis present. Bilateral coronoidectomies were performed under a short general anaesthetic which immediately improved range of movement. Full articulation and occlusion were achieved by performing bilateral condylotomies.

Outcome

The patient was reviewed by video consultation 2 weeks later and had recovered well. They reported good masticatory function and improved dietary intake. No additional physiotherapy or surgical input was required, and they have been discharged from further review.
1592 An Audit on Prophylactic Prescribing for Third Molar Surgery
Authors: Nandhra K , Shah P , Ubhi A
Published: October 2021

Introduction

Over-prescription of antibiotics gives rise to problems including increased risk of adverse antimicrobial reaction and antimicrobial resistance. Despite this, the ‘routine’ prescription of prophylactic antibiotics following lower third molar removal (LTMR) remains common practice. The current body of evidence shows minimal to no statistically significant difference in the incidence of postoperative infection between prescribing and withholding prophylactic antibiotics for LTMR in healthy individuals. There is currently no published guidance on appropriate antibiotic usage following LTMR.

Method

A single centred, retrospective review of 100 successive patients undergoing LTMR. In the absence of current guidance, standards of specific criteria to justify antibiotic prophylaxis were formed. Primary outcome measures included appropriate prescription of prophylactic antibiotics, and record of clinical indication for antibiotic prescription. Following dissemination of results and implementation of suggested improvements, a 2nd audit cycle has commenced.

Results

Cycle 1 (n = 100) (Nov 2019 - April 2020) 52% of patients received prophylactic antibiotics following LTMR. Only 9% had a clear appropriate justification for use. 27% of antibiotics were not prescribed in accordance with BNF or SDCEP guidance. There were 0 postoperative infections within this cohort.

Conclusions

Over-prescription of antibiotic prophylaxis with inadequate documented justification for use is clear. All clinicians have a duty to consider the rising incidence of antimicrobial resistance and reflect this in their practice. The use of prophylactic systemic antibiotics in LTMR should be limited to cases where it may be deemed to show clinical benefit in patient best interest on both an individual and community scale.
1616 Antibiotic Use in The Management of Mandibular Fractures: A Survey of Current Practice in the UK
Authors: Kumar D , Kent S , Dawoud B , Kysas P ,   Maxillofacial Trainee Collaborative
Published: October 2021

Aim

Traumatic mandibular fractures account for a significant proportion of UK oral and maxillofacial trauma. Prophylactic antibiotics is standard practice for management of these patients, however evidence for this is weak and relevant RCTs are insufficiently powered or poorly designed. The Maxillofacial Trainee Research Collaborative (MTReC) aims to survey current antibiotic regimens in UK OMFS units treating mandibular trauma,

Method

A multicentre online survey was shared via email and social media. Questions focused on current practices regarding management of mandibular fractures during pre-, peri-, and post-operative phases.

Results

89 responses from 50 UK OMFS units including 76 trainees and 4 consultants were collated over 2.5-months. 45 units routinely admitted patients; 88% clinicians starting pre-operative IV antibiotics;11 different pre-operative antibiotic regimens were identified across all surveyed clinicians, with 65% prescribing Augmentin, and remaining 35% using variable combinations of penicillins with 4 other antibiotic classifications. 5 different protocols were identified in use across the 88.8 % of respondents who chose to prescribe post-operative antibiotics.

Conclusions

There is inter-unit and inter-clinician variability in prophylactic antibiotic prescription in UK patients undergoing ORIF mandibles. Given antimicrobial resistance has been declared a WHO public health threat, efforts must be made to reduce antibiotic overuse and understand regional situation specific sensitivities. The survey highlights need for nationalised protocols for antibiotics use in mandibular fractures, if at all. This survey of clinician reported practice will be used to inform a prospective observational study on 30-day outcomes of ORIF mandibles taking into account patient factors, fracture pattern, fixation type and antibiotic use.
778 A Systematic Review of Surgery for Optic Pathway Glioma
Authors: Momin S M B , Hill C S
Published: October 2021

Aim

Optic pathway gliomas (OPG) are a rare group of primary CNS malignancies usually found in children. The contemporary role of surgery in managing OPG is unclear. This review aimed to systematically assess the contemporary role for surgery in managing OPGs with respect to survival and functional outcomes.

Method

A systematic review was conducted in accordance with the PRISMA guidelines. A broad search strategy was employed in the literature search of the major medical databases. Articles describing OPG patients (stratified by modified Dodge classification (mDC) location) undergoing tumour-directed surgery were included, whilst articles with <10 patients, published before 2000 and describing individual case reports, opinions or secondary research were excluded. Primary outcomes were overall survival (OS), progression-free survival (PFS), visual outcome and endocrine outcome.

Results

1221 articles were originally identified, with 21 included in the qualitative synthesis. There were 13 Level II and 8 Level IV articles. 5-year OS and PFS was 94.6% and 57.8% respectively (n = 2139). Total resection of mDC I OPG was curative, with no other surgical strategy being associated with survival benefit. Surgery was not significantly associated with visual or endocrine outcome, aside from preservation of contralateral vision (p < 0.001) in one series and predicting posterior pituitary dysfunction and GH deficiency (both p = 0.05) in one cohort.

Conclusions

Patients undergoing surgery for OPG have excellent overall survival, but a significant proportion have disease progression and associated endocrinopathy. Although total resection of mDC I OPG appears curative, more robust evidence is required to ascertain the surgical role in OPG.
898 Awareness Regarding the Use of Topical Vancomycin in Cranial and Spinal Surgeries in Developing Countries
Authors: Garg K , Wellington J , Mishra S
Published: October 2021

Introduction

Surgical site infections (SSI’s) remain a worrisome complication of any procedure requiring invasive intervention, consequences varying from suture abscesses to sepsis. Topical vancomycin administration has become popular in developed countries for SSI prevention, subsequent publications, and clinical experience supporting the practice as an effective strategy against SSI development. Yet, little information is available regarding the current practices and awareness of surgeons working in developing countries topically applying vancomycin for SSI prevention.

Method

An online anonymous validated survey comprising a structured questionnaire targeted at gaining an insight into current surgical practice and awareness in developing countries regarding topical administration of vancomycin for SSI prevention was conducted.

Results

243 responses were recorded, with respondents from publicly and privately funded institutions evenly distributed. Increased awareness concerning topical administration of vancomycin was apparent amongst orthopaedic surgeons compared to neurosurgeons (p-value = 0.59) and South American respondents compared to Asia and Africa (p-value = 0.04). No difference in topical vancomycin usage awareness was found as per annual number of surgeries performed or respondents’ experience. Neurosurgeons administered topical vancomycin less frequently than orthopaedic respondents (p-value = 0.014), most frequent usage found in South America compared to Africa, which had the least (p-value = 0.051). Neurosurgeon respondents obtained information regarding topical vancomycin administration during residency, while orthopaedic respondents from journal articles.

Conclusions

75% of respondents were aware topical vancomycin administration led to postoperative SSI risk reduction. Neurosurgeons were less familiar than orthopaedic surgeons, with South American respondents more likely to administer topical vancomycin than respondents practicing in other continents.