British Journal of Oral & Maxillofacial Surgery最新文献

To determine the prevalence of preoperative frailty among oral cancer patients and identify its risk factors, a thorough review of observational studies published until 30 August 2025 was performed in various databases, including PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, CBM, and Wanfang. The primary outcome was the prevalence of preoperative frailty or associated factors. Risk of bias and methodological quality were independently evaluated by two authors using both the Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ) criteria. The meta-analysis included 18 articles. The results indicated that the prevalence of preoperative frailty in oral cancer patients was 42.2%. The risk factors included age, cognitive impairment, American Society of Anesthesiologists' (ASA) score of ≥3, more than five medications, Charlson comorbidity index (CCI) score of ≥2, and a low skeletal muscle index (SMI). Body mass index (BMI) was identified as a protective factor. The findings can enable healthcare providers to implement effective interventions to prevent, reverse, or delay the progression of frailty.

Oral and maxillofacial surgery (OMFS) is a specialty that is under-represented in medical school teaching, leading to poor awareness and low confidence among doctors when managing and diagnosing OMFS conditions. This study aims to evaluate an online teaching programme designed to improve knowledge and the confidence of doctors to assess and manage common OMFS presentations. A three-part webinar series was developed and delivered online through the free open access medical education platform Mind the Bleep. The topics covered were facial trauma, orofacial infection, and other important OMFS presentations. The sessions were available to all doctors around the world and were presented live and made available on demand. Participants completed surveys before and after the course where quantitative and qualitative data were gathered. Statistical analysis was then performed using Wilcoxon signed-rank tests, and qualitative data were analysed. A total of 229 doctors attended both live and on demand. Of the 84 participants who provided feedback there was significant improvement in confidence across all topics (p < 0.05). Positive feedback was received on the content, format, and helpfulness of the topics. Constructive comments were received through qualitative feedback. This targeted OMFS teaching programme effectively improved the confidence to manage common OMFS conditions. It provided an accessible, flexible, and cost-effective solution to addressing gaps in OMFS education for doctors and could be adapted for other medical specialties.

Bilateral sagittal split osteotomy (BSSO) and its numerous modifications remain the cornerstone of mandibular orthognathic surgery. Despite extensive literature describing individual techniques, we know of no comprehensive comparison of their properties, indications, and clinical outcomes. This review proposes a novel classification of the BSSO technique based on the position of the buccal cut relative to the mandibular notch and angle: pre-notch, post-notch, and post-gonial. Their technical characteristics and clinical implications are described and compared, providing a straightforward guide to the optimal approach in each scenario. A narrative review of key publications on BSSO techniques was conducted and combined with the authors' clinical experience. Using this foundation, an original classification was formulated, organising established osteotomy designs according to the position of the buccal cut relative to the mandibular notch. Pre-notch approaches provide broad bony contact and stable outcomes for standard procedures with a thick soft tissue; post-notch techniques reduce inferior border notching and help protect the inferior alveolar nerve, and are therefore indicated for large mandibular movements and thin soft tissues; post-gonial strategies facilitate ramus lengthening and the correction of complex vertical asymmetry. The proposed classification offers a simple, clinically oriented framework that aligns existing BSSO modifications with surgical objectives, and supports more precise and individualised treatment planning.

Large language models (LLMs) are increasingly used in healthcare, but their role in aesthetic surgical procedures remains unexplored. These interventions present unique challenges, marked by high patient expectations, emotionally charged decision-making, and subtle yet impactful outcomes on self-perception and psychosocial health. This cross-sectional in silico study evaluated the performance of ChatGPT-4 (OpenAI, 2025), DeepSeek V3 (DeepSeek AI/High-Flyer, 2025), and Gemini 2.5 Pro Experimental (Google, 2025) in preoperative and postoperative counselling for aesthetic facial surgery. Twenty-six standardised patient-oriented questions were submitted, and the anonymised responses of the chatbots were independently assessed by two calibrated oral and maxillofacial surgeons across four domains: accuracy, empathy, readability (Flesch-Kincaid Reading Ease (FKRE) and Grade Level (FKGL)), and referencing reliability (including the identification of fabricated or non-verifiable citations, a phenomenon referred to as "hallucination" in LLM outputs). Statistical tests included Kruskal-Wallis, Mann-Whitney U with Bonferroni correction, Spearman correlation, and chi-squared. DeepSeek achieved the highest accuracy (4.77 (0.51), p = 0.0078) and readability (FKRE 2.92 (0.27), p < 0.00001), while Gemini outperformed in empathy (4.08 (0.89), p < 0.001). GPT-4 produced the most hallucinated citations (36%) compared with Gemini (14%) and DeepSeek (8.8%) (p < 0.00001). A negative correlation between empathy and readability (r = -0.34, p = 0.002) suggested a trade-off between affective tone and accessibility. Overall, LLMs generated satisfactory counselling responses with distinct performance profiles, supporting their potential in patient-centred communication while reinforcing the need for human oversight.

This systematic review and meta-analysis evaluated the effectiveness of resorbable versus titanium plating systems in the management of paediatric maxillofacial fractures. A comprehensive search of PubMed, Embase, Scopus, and specialty journals up to December 2024 identified six retrospective studies published between 2010 and 2024, involving 1,584 patients aged ≤18 years. Both resorbable and titanium systems provided satisfactory fracture stability and healing. Titanium fixation was consistently associated with higher complication rates, ranging from 8%-12% whereas resorbable systems demonstrated rates of 0%-11%, mostly minor complications. Titanium fixation was frequently associated with hardware removal, with reported rates ranging from 15%-95%, reflecting both complication-related and protocol-driven removals, whereas none of the resorbable systems required secondary surgery for hardware removal. Meta-analysis demonstrated a non-significant reduction in complication odds with resorbables compared with titanium (odds ratio 0.42; 95% confidence interval 0.12 to 1.48; p = 0.18; I² = 52%). These findings indicate that resorbable plating systems offer comparable stability to titanium, with fewer complications and the significant advantage of eliminating the need for removal. Titanium remains the preferred option for load-bearing mandibular fractures due to its superior mechanical strength, while resorbables appear effective for non-load-bearing and growth-sensitive sites. Further prospective trials with long-term follow up are required to confirm their impact on craniofacial growth and cost-effectiveness.