British Journal of Oral & Maxillofacial Surgery最新文献

This study aims to provide an overview of patient characteristics, treatment modalities, and associated complications following microvascular free flap reconstructions in maxillofacial surgery, based on data from a large national tertiary care centre. Adult patients who received a microvascular free flap between April 2017 and December 2024 were analysed in this descriptive retrospective single-centre study. Follow up was recorded until February 2025. Fibular (FFF), scapular (SFF), deep circumflex artery (DCIA), radial forearm (RFF), anterolateral thigh (ALT) and latissimus dorsi (LDF) free flaps were included. Variables were stratified by flap type and the N-1 χ²-test used to test for statistical significance of complication rates across years. A total of 1373 cases met the inclusion criteria. DCIA flaps suffered the highest rates of early flap loss (8.7%; x¯ = 3.6%) and wound infection (39.1%; x¯ = 13.5%). SFFs had the highest rate of anastomotic revision (25.0%; x¯ = 6.9%) and longest mean (SD) surgery duration: 715 ± 181 min. Donor site complications were most common among RFFs (36.0%) and FFFs (34.5%). Overall, wound infection rates were higher among bony rather than soft tissue flaps (23.0% vs. 7.8%). FFFs were associated with fewer recipient-site complications than SFFs and DCIA flaps, but donor site complications were higher. Among soft tissue flaps, complication rates did not differ significantly. Overall, complications at the recipient site were more frequent among bony compared to soft tissue flaps.

Chronic pain is an under-recognised but common and significant complication following temporomandibular joint (TMJ) surgery. This study aimed to investigate how oral and maxillofacial (OMF) surgeons diagnose and manage persistent post-operative pain and to assess collaboration with pain specialists. A 21-item anonymous online questionnaire was distributed to 130 OMF surgeons with expertise in TMJ surgery. The survey addressed clinical practice demographics, diagnostic and management strategies for persistent post-operative pain, awareness of risk factors for chronic pain, and interdisciplinary collaboration. Descriptive statistics were used to analyse responses. Of 39 responses, 30 complete responses were analysed (response rate: 23%). Respondents reported that 30% of their patients with TMD underwent minimally invasive procedures and 24% underwent open joint surgery. Although 24 surgeons routinely discussed the risk of chronic pain, six did not or only did so selectively. Common diagnoses of pain following TMJ surgery included persistent myofascial pain, neuropathic pain, and progression of arthropathy. Only 14 surgeons reported referring patients with persistent pain to a pain specialist. Barriers to referral included limited access, difficulty coordinating care, and perceptions of unnecessary use of resources. Although all respondents were aware of the orofacial pain (OFP) specialty, eight indicated that it was not recognised in their country. Persistent post-operative pain remains a complex, multifactorial issue in TMJ surgery. While most surgeons recognise its prevalence and approach management conservatively, gaps remain in interdisciplinary collaboration and risk factor awareness. Improved integration of OFP specialists and broader adoption of the biopsychosocial model of pain may enhance patient outcomes.