British Journal of Oral & Maxillofacial Surgery最新文献

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.

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.