bluuebunny/crossref_metadata_2025_split huggingface dataset:
518 A Comparison of Outcomes After Analgesic and Anti-Inflammatory Injections into The TMJ After Arthroscopy and Arthrocentesis
Authors: Goel A , Tahim A , Komath D 
Published: October 2021

Abstract

Introduction
Temporomandibular joint dysfunction (TMJD) affects 12% of the population, with up to 5% seeking help for their symptoms. Minimally invasive TMJ surgery techniques have been harnessed by Oral and Maxillofacial surgeons to directly visualise joint pathology, facilitate joint arthrocentesis and enable safe injection of analgesic and anti-inflammatory agents into the joint space. This study compares outcomes after injection of either morphine or protein-rich plasma (PRP) after TMJ arthroscopy and arthrocentesis.

Method
Consecutive patients between 2017-2020 undergoing either morphine or PRP injections after TMJ arthroscopy and arthrocentesis were retrospectively reviewed. Basic demographics and Wilkes score were noted. All patients underwent a trial of conservative management prior to any surgical intervention. Pre- and post-operative mouth opening was measured objectively (mm), while pre- and post-operative pain scores were noted using standard subjective pain scores (1-10).

Results
31 patients underwent TMJ injections with morphine (n = 18) or PRP (n = 13) after TMJ arthroscopy and arthrocentesis. Both groups showed a significant reduction in subjective pain scores post-operative ( p &lt; 0.05). Patients receiving PRP injections showed greater mouth opening scores (4.0mm change in MO for PRP vs 1.7mm change in MO for morphine) .

Conclusions
PRP shows to be as effective in pain management of patients with TMJD undergoing arthroscopy and arthrocentesis as morphine. The increase in mouth opening in patients receiving PRP injection could be attributed to the anti-inflammatory potential of PRP. These findings suggest that further evaluation of the benefits of PRP use in TMJD is warranted.
631 Designing an Oral and Maxillofacial Trauma Assessment Proforma for Dental Core Trainees in Northern Ireland
Authors: Harkness S M , Cullen A , McAuley D 
Published: October 2021

Abstract

Aim
The dental core training (DCT) scheme is an optional postgraduate training pathway for dental graduates who have completed their foundation training and wish to undergo further specialist training. The majority of posts available in Northern Ireland (NI) are within oral and maxillofacial surgery (OMFS) units and include on-call commitment. Dental core trainees (DCTs) are expected to examine and assess OMFS trauma patients and often have limited experience of this prior to post commencement. This project outlines the development of an OMFS trauma assessment proforma designed for DCTs working in NI.

Method
An initial OMFS trauma proforma was designed alongside senior staff. This was introduced to 6 DCTs and 2 trust SHOs within a tertiary OMFS unit. 34 proformas were recorded within month 1, following which a feedback survey was completed by the 8 trainees. A revised proforma was redistributed and 33 recorded over month 2, followed by a repeat feedback survey.

Results
The revised proforma was found to be successful amongst trainees within the unit to act as an aid memoir and provide systematic structure to trauma examination. 100% of trainees recorded the revised proforma as useful. As a result, the proforma was introduced as part of the national induction programme for new DCTs commencing training posts in NI.

Conclusions
Progressing from general practice dentistry to the role of an OMFS DCT can be a challenging transition for many trainees. The proforma aids to guide junior clinicians in how to structure and record oral and maxillofacial trauma whilst ensuring thorough and comprehensive examination.
748 Case Series: Experience of Using External Fixation as An Adjunct in The Management of MRONJ Affecting the Mandible
Authors: Shaw A , Pilkington R J J , Wilson A , Nugent M 
Published: October 2021

Abstract

Introduction
External fixation was first described by Malgaigne and Rigaud in 1870 for use on long bones, then adapted for OMFS in 1934 and used for treating comminuted fractures. In recent times, popularity of external fixators has decreased with the use of mini-plates, often only used in major trauma, for example gunshot wounds. This is a case series of patients who have been treated by external fixation for medication related osteonecrosis (MRONJ) of the jaw and could be a fairly simple alternative to major reconstructive surgery in such cases. This method of treatment has been particularly useful during the Covid-19 pandemic as a non-aerosol generating procedure.

Method
A single centre, retrospective study of 5 cases between December 2018 - December 2020. The MRONJ cases were graded using the AAOMS classification. All cases treated with external fixation of mandible were included. Pre-operative condition, medical history, treatment complications, pain management, length of treatment and follow-up results were recorded.

Results
Of the 5 cases treated for MRONJ, 4 of these had pathological fractures. All were AAOMS stage 3. The mean duration of treatment was 78 days, with regular clinical reviews monitoring progress. Of these cases, 4 cases healed well with significant improvement or closure of intraoral and extra-oral wounds.

Conclusions
In this small case series the technique has shown positive results; being well received by patients and allowing function while in situ. It allows treatment of pathological fractures as well as stabilising the mandible as a preventative measure whilst debriding severely atrophic mandibles.
782 Evaluation of Ketamine Sedation as An Alternative to General Anaesthetic for The Management of Paediatric Soft Tissue Facial Injuries During the Covid-19 Pandemic
Authors: Nijamudeen A , Cole-Healy Z , Clark Stuart 
Published: October 2021

Abstract

Introduction
Standard surgical practice of paediatric soft tissue facial injuries requires general anaesthetic (GA) if treatment with local anaesthetic is not tolerated. However, the Covid-19 pandemic has increased the risk of hospital admission for GA to patients and pre-operative Covid-19 testing can delay surgical treatment. In response, a service was established to facilitate short surgical procedures by the Oral and Maxillofacial surgical (OMFS) team with ketamine sedation (KS) at a tertiary level paediatric emergency department. Evaluation of this service demonstrates that KS is a suitable alternative to GA with reduced waiting times, low complications and equivalent surgical outcomes.

Method
20 patients treated under KS from May- September 2020 were identified and compared to a control group of 20 patients treated under GA during the same time period. Data including patient demographics, surgical treatment and the KS/GA procedure was collected from the medical records and was analysed using Microsoft excel.

Results
The KS patients had shorter waits for treatment with 85% of patients waiting 1 day or less, compared with 55% for the GA group. Using the local KS protocol 1 or 2 doses of ketamine was sufficient in 79% of cases and adverse effects were minimal with 21% of KS patients suffering mild nausea and vomiting.

Conclusions
KS is an acceptable alternative to GA for the management of paediatric soft tissue injuries. KS reduces inpatient admission for GA which is of increased importance during the Covid-19 pandemic. Other OMFS units would benefit from access to a similar service.
803 Management of An Intra-Oral Resection with Integra® Dermal Regeneration Template – Worth A Bite?
Authors: McParland E , Dua R , Smith G 
Published: October 2021

Abstract

Introduction
There are a spectrum of treatment options available for reconstruction of oral mucosal defects including secondary healing, skin grafts, local flaps and microvascular free flaps. We present the use of an alternative intra-oral reconstruction with Integra® Dermal Regeneration Template.

Case Report
An 85-year-old patient with a severe gag reflex and history of oral cancer presented with biopsy proven severe dysplasia of the right palate extending to the hamular notch. She was treated with wide local excision, extraction of teeth, buccal fat pad advancement for closure of an oral-antral communication and placement of Integra® Dermal Regeneration Template. Discharge was possible the same day as the patient was able to eat and had minimal pain.

Discussion
Integra® Dermal Regeneration Template is a bilayer wound matrix consisting of silicone in the outer layer with bovine collagen and glycosaminoglycan from shark cartilage in the inner layer. Oral cancer predominantly affects the older population, and this method can reduce surgical time, remove donor site pain, reduce post-operative pain and avoid use of a cover plate where a strong gag reflex was present. The area heals quickly and aids quick restoration of oral function.

Conclusion
Integra® Dermal Regeneration Template has been used for head and neck defects with good outcomes. It is being increasingly used intra-orally with good outcomes, suggesting a further application of the material with advantages over traditional techniques in specific patient groups.
1119 Readdressing Consent in Head & Neck Free Flap Surgery: The Nottingham Experience
Authors: Jivraj A , Evans K , Aga H , Al-Qamachi L 
Published: October 2021

Abstract

Aim
The Montgomery vs NHS Lanarkshire case in 2015 led to a paradigm shift in the consent process within surgery. It became incumbent upon clinicians to outline all “material risks” prior to a procedure. Within head and neck surgery, the Enhanced Recovery After Surgery (ERAS) pathway addresses this obligation through a multi-disciplinary approach. The aim of this audit was to assess the effect of the existing ERAS pathway on the consent process.

Method
35 head and neck oncology cases involving free flap reconstruction were identified across two audit cycles. Cases pre- and post-introduction of the ERAS pathway were analysed to assess whether the existing pathway led to improvement in consent quality.
8 key consent elements were identified based on a review of current literature and guidelines. This was our gold standard. A tick-box system was devised, and each case assigned a percentage score based on compliance with these criteria. A consent checklist was introduced within the ERAS pathway file alongside multi-disciplinary documentation which would follow the patient from the pre-operative environment through to discharge.

Results
Prior to the introduction of the ERAS pathway, there was a 58% compliance with the gold standard. Upon implementation of the ERAS protocol, compliance rose to 65%. Following introduction of the checklist, compliance rose further to 85%. This resulted in an overall increase in compliance of 27%.

Conclusions
We recommend the introduction of a focused consent checklist within any unit providing major head and neck reconstruction procedures in order to ensure informed consent, mitigating medico-legal risks post-operatively.
1173 Airway and Breathing Problems in Pierre Robin Sequence: A Systematic Review Protocol
Authors: Ramjeeawon A , van der Plas P , van de Lande L , Ong J , Wyatt M , Abel F , Kangesu L , Sommerlad B , Navaratnarajah J , Wolvius E , Laverty A , Bulstrode N 
Published: October 2021

Abstract

Aim
The primary aim is to systematically review the specific airway and/or breathing problems which have been reported in Pierre Robin Sequence (PRS). Secondary aims are to understand the prevalence and severity of these airway and breathing problems, and options for screening, assessment, and monitoring.

Method
A search strategy will be designed to search the following databases: MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials(CENTRAL) including a grey literature search, to identify publications on airway and/or breathing problems in Pierre Robin Sequence patients. Airway or breathing problems to be included are defined upper airway conditions (e.g., sleep apnoea) or clinically or objectively defined airway/breathing problems (e.g., increased respiratory rate, polysomnography). Screening will exclude non-English articles, abstracts, letters, editorials, expert opinions and breathing problems not anatomically related to craniofacial underdevelopment.

Results
This systematic review has been successfully registered on the PROSPERO International Prospective Register of Systematic Reviews (CRD42020210572)

Conclusions
PRS is a rare craniofacial condition which presents at birth, consisting of micrognathia, glossoptosis and airway problems, and is usually, but not always, associated with a cleft palate. There is no consensus on the type of airway problems that affect patients with PRS. The findings of this systematic review will help to develop a consensus on the airway and breathing problems in PRS and options for assessment and monitoring of the airway and breathing problem. This data may also contribute to development of a standardized guideline for management of airway and breathing problems in PRS.
1196 Sonographic Assessment Versus Direct Clinical Measurement of Sialolith Size and Its Influence on Modality of Endoscopic Removal
Authors: Pepper T , Karia R , Ryba F 
Published: October 2021

Abstract

Aim
The aim of this retrospective case series was to investigate the influence of sialolith size on the potential for endoscopic stone removal.

Method
The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease.

Results
A total of 25 patients (48%) and 27 stones were identified. These patients had a mean age of 45.2 years (range 16–72); 52% were female. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. The overall success rate of sialendoscopic retrieval was 23/27 (85%), with 17/27 stones removed intact and 6/27 undergoing fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Median (sonographic) stone size in the largest dimension for those stones removed intact was 4mm (range 3-12mm), while for those undergoing fragmentation it was 7mm (range 3-11mm). Ultrasound provided an accurate assessment of stone size in most cases, but underestimated diameter by an average of 1mm in 6/27 cases, and overestimated size by 1mm in a single case.

Conclusions
Sialendoscopic stone retrieval is a minimally invasive and effective treatment for sialolithiasis. It is possible to remove most stones using a basket, with intraoral lithotripsy employed for larger stones. Ultrasound is a reliable diagnostic tool for predicting stone size but may underestimate size in a small proportion of cases.
1239 Postoperative Complication Rate of Facial Injury Repairs Treated by Maxillofacial On-Call Team: Surgical Audit
Authors: Dhanjal G. , Ghouri M. , Crank S. , Philip J. 
Published: October 2021

Abstract

Introduction
A significant aspect of Oral and Maxillofacial Surgery workload relates to trauma, particularly soft-tissue injuries. Contingent on the aetiology of injury, facial wounds require debridement and rapid closure to reduce risk of infection and degree of scarring. The aim was to identify possible risks and frequency of postoperative complications, including problems identified by patients following treatment of facial injuries by the Maxillofacial on-call team.

Method
Data was retrospectively collected from patients who sustained soft-tissue facial injuries treated by the Maxillofacial team and provided with follow-up appointments from January to August 2020. Computerised clinical notes were accessed to determine patient demographics, mechanism and site of injury, location and time of repair, operator grade and postoperative complications (if any).

Results
153 patients required debridement and suturing of a facial injury under local or general anaesthetic. Among these, the male to female ratio was 65:35. 47% of facial injuries resulted from mechanical fall. Lips were found to be the most common site (31%) of injury. Postoperative complication rate was 8% within the 8-month period, with reports of infection, wound dehiscence and haematoma requiring further treatment. 58% of complications resulted from treatment carried out between 5pm-5am with a sole operator (DCT/SHO). 83% of complications followed treatment carried out within the Emergency Department rather than Maxillofacial clinical setting.

Conclusion
Following facial injury repair, just less than 8% of patients experienced complications, which required corrective treatment. Although facial injuries require immediate care, careful planning and performing treatment in a specialised setup may improve perioperative care, thus clinical outcomes.
1249 A 3D Morphable Model of the Apert Mandible
Authors: Ramjeeawon A , van de Lande L , O'Sullivan E , Bloch K , Khonsari R , Schievano S , Dunaway D , Bulstrode N 
Published: October 2021

Abstract

Aim
Assess the three-dimensional Morphable Model (3DMM) of the Apert mandible, investigate differences between sex and age, and characterise growth by age. Additionally, compare with a healthy mandible 3DMM.

Method
High-quality CT scans of children with Apert’s Syndrome (without previous mandibular surgery) between November1987-January2020 were sourced from Great Ormond Street (GOSH) and Necker Hospitals. DICOM files were constructed to 3D meshes through isolation of mandibles and artifact removal (MeshMixer, Mimics) and annotation using standardized landmarks (Wrapped). A 3DMM was constructed using an existing pipeline, and experiments performed to compare with the healthy mandible 3DMM, investigating differences between sex and age, and to characterise growth by age. A healthy mandible 3DMM has been created by our team using healthy mandible CT scans sourced from a GOSH database.

Results
A 3DMM of the unoperated Apert mandible was successfully constructed from 276 Apert CT scans, male=137 (aged0-20), female=139 (aged0-23), and the first components of the morphable model identified.

Conclusions
Apert’s Syndrome is a rare genetic condition, with characteristic extremity (syndactyly) and craniofacial features (craniosynostosis), however breathing problems, sleep apnoea, relative prognathism and Angle class III malocclusion have been reported. Few studies have analysed the potential role of the Apert mandible. 3DMMs are statistical tools used to represent 3D shapes and have been used to create shape and texture parameters for anatomical areas. The 3DMM of the unoperated Apert mandible has potential applications for further understanding of Apert’s Syndrome, diagnostic purposes and may be used to develop further management of these patients, such as surgical planning.
1264 A Cross-Sectional Study of Psychological Expectations of Orthognathic Surgery Patients Based on Their Typology
Authors: Falinda D , Tahim A , Cronin A , Komath D , Pabla R , Mistry P , Lee S 
Published: October 2021

Abstract

Aim
Orthognathic surgery corrects craniofacial deformity which compromises breathing or masticatory function. Patients typology influences their expectations for physical and psychological transformation before and after surgery and is an emerging area of research. This study aims to evaluate: 1) subjective expectations and/or perceived outcomes and 2) whether orthognathic surgery meets patients’ expectations.

Method
A questionnaire-based cross-sectional survey was administered pre- and post-operatively. Patients were classified according to typology, namely metamorphosizers - patients with high expectation of psychological and physical changes, evolvers - opposite of metamorphosizers, pragmatists - low expectation of psychological and high expectation of physical changes, and shedders - opposite of pragmatists. A chi-square test was used to examine whether orthognathic surgery met patients’ expectations.

Results
A total of 27 patients consisting of 19 pre-operative and 8 post-operative completed the survey over an 11-month study period (females = 11; males = 16; mean age= 22.5 years; range = 17-52). Typologically, metamorphosizers dominated, 48%, followed by shedders, 30%, evolvers, 13% and pragmatists, 9%. This indicates that most patients, 78% (metamorphosizers and shedders) had high expectations of psychological change pre-operatively [X2 (2, N = 90) = 43.9, p &lt; .0001)] and perceptions of psychological change post-operatively [X2 (2, N = 90) = 48.8, p &lt; .0001)].

Conclusions
Most patients in this study anticipated and perceived psychological changes after orthognathic surgery. Understanding patient typology may help the orthognathic surgeon understand, address and improve post-operative psychological outcomes in their patients.
1307 Linking Pre-ST Trainees into The Surgical Profession - An Example from OMFS Of A Structured Introduction to The Speciality
Authors: McLean A , Rapaport B 
Published: October 2021

Abstract

Introduction
Inspiration and support are two of the key principles that enthuse junior trainees to pursue a career in surgery. Exposure to Oral and Maxillofacial Surgery (OMFS) is minimal at undergraduate level and can present a challenge for those postgraduate individuals who wish to gain more experience before applying to further training. This has prompted the formation of a support programme comprised of two stages: Taste of OMFS and Mentoring and Support Programme (MSP).

Method
Feedback was captured from OMFS junior trainees and educational supervisors on the existing junior trainee programme. It was concluded that a new programme was required to create a more structured system to help support trainees achieve their goals within OMFS. Taste in OMFS aims to provoke intrigue in the specialty. Individuals who are inspired to experience more can advance on to the MSP which consists of checklists, carefully designed to help the trainee obtain adequate exposure and achieve the recommended requirements for second-degree and specialty training applications.

Results
The new programme was trialed by existing junior trainee programme members over a six-month period. The results were encouraging with positive feedback on the structure of both sections. This, in combination with ideas generated from a focus group has helped create the final version, now published and accessible on the British Association of Oral and Maxillofacial Surgeons website.

Conclusions
We hope to raise awareness of this dynamic programme which can be tailored to each individual, in the hope that more junior trainees pursue a career within OMFS.