British Journal of Oral & Maxillofacial Surgery最新文献

This meta-analysis compares the safety and efficacy of outpatient or day case parotidectomy versus inpatient therapy. The objective of this study is to integrate current information on postoperative complications, readmission rates, and reoperation rates, as well as to assess the methodological quality of existing studies and provide selection criteria for outpatient surgery. We searched PUBMED, SCOPUS, and Google Scholar from January 1980 to January 2025. Search terms included "parotidectomy", "parotid gland surgery", "outpatient", "ambulatory", and "same-day discharge". We considered studies that compared outpatient and inpatient parotidectomy. The primary outcomes studied were postoperative complications, haematoma, seroma, infection, facial nerve injury, readmission, and reoperation rates. Two reviewers extracted data separately and used the ROBINS-I tool to determine bias. The analysis included 13 trials with a total of 5040 patients (2365 outpatients and 2674 inpatients). Outpatient parotidectomy had a similar complication risk as inpatient surgery (Odds Ratio 0.69, 95% Confidence Interval: 0.49 to 0.98, p = 0.04). Haematoma and permanent facial nerve injury were much lower in outpatients. However, most research showed considerable selection and confounding biases. Outpatient parotidectomy is a safe and effective option for carefully chosen individuals. Standardised selection criteria can help enhance patient outcomes and surgical decision making.

Surgeons in the United Kingdom and the United States often perform identical oral and maxillofacial operations with strikingly different instrument sets. The extent and practical significance of this divergence have not, to our knowledge, been previously reported. We conducted a descriptive comparative review of contemporary UK and US practice (2023-2024), cataloguing instruments through clinical observation and discussions with peers and scrub teams, then verifying nomenclature, design, and provenance against reference texts and manufacturers' catalogues. Functionally equivalent but non-identical instruments were paired and profiled for origin, form, and typical use. Findings show a small common core (Freer elevator, Minnesota retractor, Austin retractor, DeBakey forceps, Adson forceps, Metzenbaum scissors, and Mayo scissors) with nearly all other instruments differing, illustrating parallel solutions to the same operative tasks. British instruments and their American counterparts (for example, Molt #9, Woodson #1, Seldin elevator, Molt #4, Dean scissors, Army-Navy retractor, Sweetheart retractor, Sistrunk retractor, Hargis retractor, 301 elevator, and Cogswell elevators) were assembled into a practical compendium, with the aim of encouraging cross-pollination of surgical practice. Awareness of transatlantic instrument choices presents an opportunity to refine one's armamentarium. Through selective adoption of unfamiliar but potentially advantageous instruments, the open-minded surgeon can discover new ways to enhance operative precision, efficiency, or ergonomics.

Penetrating neck injury (PNI) describes an injury, typically with a sharp object, resulting in a wound that crosses platysma. These injuries often require surgical exploration and may result in significant morbidity and mortality. We undertook, to our knowledge, the first systematic analysis of the literature exploring the psychological impact of PNI, and carried out a thematic analysis. An electronic search of five databases and four registers was performed in March 2025 according to PRISMA guidelines. Quality of the studies was assessed using Critical Appraisal Skills Programme (CASP) checklists. Thematic analysis was conducted using NVivo software (Lumivero). Of 974 identified studies, 30 met the inclusion criteria, in which 651 patients with PNI were described. Three key themes were identified: aetiology of PNI drives treatment need; psychiatric care is central to multidisciplinary management; and PNI occurs in a socioeconomic context. Patients who self-injure typically receive psychiatric treatment and/or medication, and those with traumatic injuries may receive psychotherapy. Quality of the studies was moderate, with an absence of targeted or prospective research. Current treatment for the psychological impact of PNI is classified by aetiology, though the literature remains heterogeneous and incomplete. Studies note a strong association with socioeconomic deprivation. Psychiatric care is a central component of multidisciplinary management, particularly due to the risk of serious self-harm or suicide following PNI. Presentation with acute injuries offers oral and maxillofacial (OMFS) surgeons an opportunity to prevent further injury and death with timely referral to psychiatric teams. Targeted prospective research would enable optimal assessment and support for recovery in these patients.

Mohs micrographic surgery (MMS) is the most precise surgery regarding margin control and total excision of tumours. The advantages of MMS include precise margin control, one-stop operation, and better patient satisfaction. The files of patients undergoing MMS between January 2013 and March 2023 were retrieved. Patients were referred for MMS as a result of having non-melanoma skin cancer (NMSC) on the face. A single surgeon operated on all patients. A total of 3812 MMS were performed. Fifty-eight percent of patients were male, and 41.92% were female (p < 0.001). Most lesions were midface (54%, p < 0.001), with 24% of lesions presenting in the left face and 21% in the right face (p = 0.012). Average MMS had 2.4 stages. Nose lesions and lesions with scar morphology required the most stages. Fair-skinned patients (Fitzpatrick Grade 2) required more stages than others in our cohort (p = 0.002). Eyelids, nose, and ear lesions were the areas that needed local flap coverage most often. This is a retrospective study, which could be seen as a limitation. To our knowledge, this is the first report in English in the literature that confirms the lateralisation of NMSC in the face. While most studies found a higher prevalence among females, this cohort is predominantly male. Previous operations in the same lesion have increased the number of stages needed to reach free margins.

CAD-CAM subperiosteal implants (SPIs) offer a therapeutic solution for edentulous patients with severe bone atrophy. However, scientific evidence of their clinical performance for fixed partial restorations (FPRs) is scarce. The purpose of this review was to evaluate the clinical performance of SPIs supporting FPRs, focusing on survival rates and associated biological and mechanical complications. A scoping review using PRISMA-ScR methodology was conducted, searching the online databases MEDLINE/PubMed, Web of Science, Cochrane Library, and Scopus. Studies that evaluated clinical performance of CAD-CAM SPIs supporting FPRs with at least three patients and follow up of at least one year were included. The search yielded seven articles, which included 96 patients with a total of 121 SPIs. The weighted mean survival rate was 99.17%, with one failure reported in an anterior maxillary restoration. The complication rate was 4.13% for biological complications (wound dehiscence, bone loss, and implant exposure), and 7.44% for mechanical complications (provisional restoration fracture, implant instability, and re-cementing of crowns) over follow-up periods ranging from one to four years. SPIs supporting FPRs may offer a reliable alternative for the restoration of severe bone atrophy, achieving a high survival rate. The complication rate obtained was relatively low. However, the results of this review should be treated with caution, as data were drawn from a small, heterogeneous sample. Studies comparing SPIs supporting FPRs with other techniques are needed to determine their viability in different clinical scenarios.

The pursuit of the supposed best, 'ideal', or 'gold standard' solution, which often involves greater complexity, risks and/or costs, and/or morbidity, is coined 'maximising'. For several reasons addressed in this article 'maximising' suffuses many surgical cultures. The polar opposite is 'satisficing'. The concept of 'satisficing' was articulated by Herbert Simon in 1956 and earned him the Nobel Prize. He advocated a pragmatic approach in which solutions are sought that are 'sufficient to be satisfactory for that situation' rather than relentlessly pursuing the 'single perfect solution'. The tension between these philosophies in maxillofacial surgery is exposed, with clinical examples and the legal responsibility to the patient highlighted.