bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &lt;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 &lt; 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

Abstract

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.
1275 Machine Learning for Outcome Prediction in Epilepsy Surgery: A Systematic Review
Authors: Chia C W L , Bhatia S , Shastin D , Chamberland M 
Published: October 2021

Abstract

Aim
A third of epilepsy patients suffer from medically refractory seizures. In patients eligible for surgical treatment, seizure freedom rates remain variable. Machine learning (ML) utilises large datasets to detect patterns to make predictions. We systematically review studies employing ML models for prediction of outcome following resective epilepsy surgery to evaluate their efficacy, applicability and value in determining surgical candidacy.

Method
MEDLINE, Cochrane and EMBASE databases were searched for literature published between 2010 – 2020 according to PRISMA guidance. Non-refractory epilepsy, non-clinical outcome prediction, or non-human studies were excluded. Clinical and demographic data, ML features, discrimination and prediction accuracy metrics were extracted.

Results
15 studies were included. Median cohort size was 49 (range 16 – 4211). Heterogeneous input data sources were utilised: MRI (n = 10) , electrophysiology (n = 4), PET (n = 2), clinical data (n = 2), and neuropsychological testing (n = 1). The most common ML model used was support vector machines (n = 7). All studies had good discrimination (AUC &gt; 0.70, range: 0.79 [95% CI NR] - 0.94 [95% CI 0.92 – 0.96]), and good prediction accuracy (&gt; 0.70, range: 0.76 [95% CI NR] – 0.95 [95% CI NR]). Limitations included small sample sizes, limited external validation and lack of comparison with clinician-predicted outcomes.

Conclusions
Machine Learning for outcome prediction could enhance clinical decision-making for surgical candidacy in epilepsy, and lead to improved precision medicine delivery. Outcome reporting remains inconsistent, and further work is required to externally validate such models to implement these to large-scale clinical populations.
1679 An Unusual Case of Hypoplastic Internal Carotid Artery with Segmental Aplasia of The Anterior Cerebral Artery: A Case Report and Systematic Literature Review
Authors: Whitley H , Skalicky P , Malik J , Charvat F , Benes V , Bradac O 
Published: October 2021

Abstract

Aim
Hypoplasia of the internal carotid artery (ICA) is a rare morphological variant with potential implications in disease and clinical decision-making. We describe an unusual case of ICA hypoplasia in a 50-year-old female who presented with an acute episode of vertigo. CT angiogram showed an unusually short common carotid artery (CCA) on the right side, hypoplasia of the right ICA, and agenesis of the A1 segment of the right anterior cerebral artery (ACA). We provide a short review of the available literature.

Method
The literature review was performed according to PRISMA guidelines. Three databases (Pubmed, Web of Science, and Ovid) were searched using the terms “ICA” and “Hypoplasia”. Case reports published in English in the last 10 years were considered eligible for inclusion. Reports of acquired ICA hypoplasia or ICA agenesis were excluded.

Results
Our systematic literature search revealed that 19 cases of congenital ICA hypoplasia have been reported in the last 10 years. Of these, 14 were unilateral hypoplasia, including nine cases in which the anomaly was on the left, and five cases in which the anomaly was on the right. Two cases had additional aplasias; one with aplasia of the ACOM and another with aplasia of segment C6 of the ICA.

Conclusions
We conclude that ICA hypoplasia remains a rare anomaly, despite the increasing incidence due to the availability of imaging technology. Clinicians should be aware of these variations, as they are frequently associated with haemodynamic changes, aneurysms, and fenestrations. Such variations have important implications for planning angiographic and surgical approaches.
555 Should All Acutely Presenting Gallstone Disease Be Managed Surgically?
Authors: Rehman S , Khan A , Wunnava R 
Published: October 2021

Abstract

Aim
This audit aims to assess if gallstone complications can be prevented by performing an emergency cholecystectomy in acutely presenting gallstone disease. Factors taken into consideration include number of presentations to hospital before surgery, secondary admissions of pancreatitis or cholangitis, subsequent requirements of ERCP as well as complication rates of elective and emergency surgery.

Method
Retrospective audit looking at 387 cholecystectomies carried out, within a year, at Walsall Manor Hospital.

Results
Approximately 20% of patients had an emergency cholecystectomy. A total of 192 patients had at least one admission, with 17% having a minimum second. Seven patients went on to develop gallstone pancreatitis subsequently, as well as eight requiring at least a minimum of one ERCP. The complication rate in elective surgery was higher at 4.1% compared to 2.7% in emergency cases. Long waiting times for surgery put patients at greater risk of complications. 96% (26/27) of elective cholecystectomy patients, who suffered an attack of pancreatitis, had to wait more than four weeks. Furthermore, 39% (47/119) of those who had a minimum of one admission had to wait more than 20 weeks. On the other hand, three-quarters of patients who were operated in emergency went home within 48 hours, with the figures being not too dissimilar from elective cases with a history of admission (76%).

Conclusions
Performing emergency cholecystectomies in the same admission or on a dedicated hot list would not only decrease the risk, but also the potential risk of developing gallstone complications.
1134 Incidence of Bile Acid Diarrhoea Post-Cholecystectomy - A Single Centre Cohort
Authors: Sallam M , Patel R , Sun W , Ali R , Windle R , Shalaby S , Ward J , Bond-smith G 
Published: October 2021

Abstract

Aim
Bile acid diarrhoea (BAD) can occur as a result of enterohepatic circulation interruption following cholecystectomy. Although up to 57.2% of patients are reported to develop post-cholecystectomy diarrhoea, this is not always because of BAD. The aim of this study was to determine the incidence of post-cholecystectomy BAD diagnosis and evaluate the current practices.

Method
This study was conducted as part of BADCAP study. The electronic records of patients underwent cholecystectomy operation at Oxford University Hospitals between January 2013 and December 2017 were retrospectively analysed. Records were matched with patients who underwent 75SeHCAT testing during the same time period. A positive 75SeHCAT testing was defined as a seven-day retention time of &lt; 15%.

Results
A total of 4327 patients underwent cholecystectomy operation. 2.05% (N = 89) investigated for diarrhoea by 75SeHCAT. Alongside 75SeHCAT, 69.7% (N = 62) had colonoscopy, 37.1% (N = 33) had CT abdomen and pelvis and 3.4% (N = 3) had MRCP/MRE. Gender wise statistics revealed females were 74.5% (N = 73) and males were 19.1% (N = 17). Median time from cholecystectomy to 75SeHCAT test was 780 days (SD +/-510 days). 70.8% (N = 63) had a positive 75SeHCAT test for BAD. IBD was confirmed in 2.2% (N = 2).

Conclusions
A small number of patients were investigated and only 1.5% were diagnosed with post-cholecystectomy diarrhoea. There was a significant time delay from operation to diagnosis. The true prevalence of BAD after cholecystectomy may be much higher and clinicians need to have an increased awareness of this condition. 75SeHCAT is a useful tool for diagnosis of bile acid diarrhoea.
1438 The Past, Present and Future Management of Complex Chyle Fistulae
Authors: Temperley H , Waters C , Carey J , Donlon N E , Donohoe C L , Ravi N , Reynolds J V 
Published: October 2021

Abstract

Background
Chyle leak/fistula is a rare complication of oesophageal surgery, usually consequent on an unintended breach of the thoracic duct, its tributaries, or the cisterna chyli. For high volume persistent leaks further surgery has been the traditional approach, however two cases have resulted in a new management approach at this Centre.

Case Series
The first patient, a 49-year-old, developed high volume drain output post three stage oesophagectomy. His jejunostomy feeding was discontinued, total parenteral nutrition and a somatostatin analogue, were commenced. Despite these measures, the drain output remained &gt;1.5litres per day and an exploratory thoracotomy was performed. The second patient, an 81-year-old underwent a transhiatal-oesophagectomy. On postoperative day 10 he developed acute onset shortness of breath, CXR demonstrated a large left sided pleural effusion. CT thorax demonstrated multiloculated complex pleural effusions. US guided pig tail drain was placed in the largest targetable effusion. The fluid was chylous in appearance. In both cases, an interventional radiological approach, not previously performed at this centre, provided definitive management. Lymphangiography was performed via injection of 1mL of Lipoidol® every 5 minutes into the inguinal lymph nodes to identify the cisterna chyli. A guidewire was advanced via the cisterna chyli with coils and glue used to embolize the leaking tracts.

Discussion
The lessons from this experience provide an algorithm for the management of chyle leaks, that will change practice at this centre. Embolization or disruption of thoracic duct and cisterna chyli leaks will be first line therapy for complex chyle leaks, with surgery reserved for where this fails.
1622 Peri-Operative Blood Use in Upper GI Surgery
Authors: Mercer A 
Published: October 2021

Abstract

Aim
One group and hold sample costs approximately £18 to process while it costs £170 to prepare and administer 1 unit of cross matched blood. We aimed to quantify the amount of blood cross-matched for elective oesophagectomy and gastrectomy cases and compare this to the number of units transfused.

Method
Retrospective cohort study comparing number of crossmatched blood units requested. Baseline data collected over a 10-week period (08/07/19-16/09/19). A new blood ordering protocol made in agreement with oesophago-gastric and anaesthetic consultants with criteria for blood ordering. Blood was only to be requested if: antibodies on group and hold, pre-op Hb &lt; 120g/l, operative team concerns or previous radiotherapy. Data recollected using the same parameters post -intervention over a 10-week period (23/12/19-08/03/20).

Results
Pre-intervention 24 patients were included, mean age 67. 47 units were requested with only 1 transfused. Post intervention 27 patients were included, mean age 69. 36 units were ordered and 3 transfused. The new protocol was correctly implemented in 19 patients (70%) therefore saving a potential of 24 units and approximately £4080.

Conclusions
Patients were cross matched far in excess of their transfusion needs. There was significant reduction in the number of patients being cross-matched post intervention. Rationalising this is important to reduce waste, reduce cost and cut down on delays to maximise theatre time.