Qualitative comparison of curricula in oral and maxillofacial surgery training. Part 1: dental foundation training

Dental foundation training (DFT) is a two-year programme being introduced for new dental graduates. It is not currently compulsory but there are plans to make it so. Those studying oral and maxillofacial surgery (OMFS) must complete both medical and dental degrees, and training, and if DFT becomes a requirement for dental registration, the process could be lengthened. We aimed to examine the overlap between DFT and medical foundation and core surgical training, to highlight areas of potential duplication for those who completed their surgical training before graduating from dental school. Relevant curricula for OMFS trainees were identified and compared with the DFT curriculum, and a qualitative assessment tool was developed to measure overlap between non-analogous curricula. Depending on previous experience, an OMFS trainee who completed core training in surgery before studying dentistry may already have covered 76% of the DFT curriculum. Areas with the least duplication in clinical skills (53%) were notably those related to restorative dentistry, prosthodontics, and periodontology, but there was considerable overlap in non-clinical areas such as communication skills (100%) and professionalism (90%). A method of standardised assessment of previous experience may allow for DFT to be shortened for OMFS trainees.     

Qualitative comparison of curricula in oral and maxillofacial surgery training. Part 2: oral surgery

A comparison between the curricula for specialist training in oral surgery (OS), and oral and maxillofacial surgery (OMFS) illustrates the overlap between the two specialties. We identified and compared relevant curricula for OMFS with competencies in the OS specialist-training curriculum using a qualitative assessment to establish the degree of overlap. All competencies within the OS curriculum are covered by OMFS curricula, and 21 of 96 OMFS clinical competencies are covered by OS core competencies. The majority of OMFS competencies are unique and are not directly comparable with those in the OS curriculum. Knowledge of this overlap may help to avoid unnecessary duplication in the training of those who wish to transfer specialty.     

Bilateral procedures in maxillofacial surgery in the United Kingdom: survey of higher trainees' performance and experience

We conducted a survey targeting all higher surgical trainees in oral and maxillofacial surgery in the United Kingdom to find out their dominant hand, ability and confidence using powered instruments, and any trends in the likelihood of operating on one or other side of an index bilateral operation: the bilateral sagittal split mandibular osteotomy. We also explored the attitudes of trainees and trainers towards non-dominant manual dexterity, and whether senior consultants were more likely to adopt certain rehearsed routines and approaches when supervising trainees.     

Endoscopic treatment of mandibular condylar fractures in live minipigs: benefits of the operative learning curve

Endoscopic treatment of mandibular condyle fractures is a minimally invasive technique that avoids the complications of open reduction and internal fixation. We have used live minipigs as an animal model for learning and training the technique. Fourteen condylar fractures were created, reduced, and internally plated in 7 minipigs using an endoscopic approach by a surgeon with no previous experience of the technique. The mandibles were reduced and fixed successfully in each animal. Operating time was reduced as the surgeon became more familiar with the technique. Minipigs are useful as a model for the endoscopic approach to the treatment of mandibular condylar fractures. Surgeons have the opportunity to train and gain surgical endoscopic experience before treating patients.     

Impact of Modernising Medical Careers on basic surgical training and experience of oral and maxillofacial higher surgical trainees

Modernising Medical Careers (MMC) is a programme for change that aims to improve the quality of patients’ care through improvement in postgraduate medical education and training. Its introduction had far reaching affects and many shortcoming due to its failure to take into account the craft specialties. The aim of this paper is to illustrate the impact of MMC on oral and maxillofacial surgical (OMFS) training. An online questionnaire was distributed to OMFS trainees, and data were gathered about current position, year of training, duration and specialties worked during basic surgical training, stage of completion of examinations and courses, and overall satisfaction with training. Comparisons were made between those who had been trained before and after MMC was introduced. Ninety-five trainees (68%) responded. Of these 66 (69%) had basic surgical training before the introduction of MMC and 29 (31%) afterwards. MMC shortened overall time spent on basic surgical training of OMFS trainees by half, to only 1 year. There were similarities between the two groups in terms of the range of specialties experienced. MMC also resulted in more trainees starting higher surgical training without their Membership of the Royal College of Surgeons. There was greater satisfaction with BST for the pre-MMC group than the post-MMC group. It is hoped that the recent changes to training that were implemented after this study will address some of the shortcomings that we have identified.     

Dual surgeon operating to improve patient safety

The COVID-19 pandemic resulted in an unprecedented reduction in the delivery of surgical services worldwide, especially in non-urgent, non-cancer procedures. A prolonged period without operating (or ‘layoff period’) can result in surgeons experiencing skill fade (both technical and non-technical) and a loss of confidence. While senior surgeons in the UK may be General Medical Council (GMC) validated and capable of performing a procedure, a loss of ‘currency’ may increase the risk of error and intraoperative patient harm, particularly if unexpected or adverse events are encountered.Dual surgeon operating may mitigate risks to patient safety as surgeons regain currency while returning to non-urgent operating and may also be beneficial after the greatly reduced activity observed during the COVID-19 pandemic for low-volume complex operations. In addition, it could be a useful tool for annual appraisal, sharing updated surgical techniques and helping team cohesion.This paper explores lessons from aviation, a leading industry in human factors principles, for regaining surgical skills currency. We discuss real and perceived barriers to dual surgeon operating including finance, training, substantial patient waiting lists, and intraoperative power dynamics.     

Outcome of microvascular free flaps in a high-volume training centre

PurposeMicrovascular free tissue transfer allows major ablative defects following oncologic surgical and traumatic reasons to be reliably reconstructed in the head and neck region. A retrospective analysis of the microvascular flap procedures which were performed within one year in a high volume training centre was performed.Patients and methodsThe microvascular free flap procedures of the year 2011 were reviewed and followed up until the 31st December 2012. The type and indication of the reconstructive procedure, operation time, operating team, experience and level of training of the surgeons involved, postoperative IMC (intermediate care unit) and/or ICU (intensive care unit) time, inpatient time, flap revisions, further postoperative complications, preoperative and postoperative radiation of the patients, the placement of dental implants were studied.ResultsFrom 1st of January 2011 to 31st of December, 2011, the data of 101 patients with 103 microvascular free flap procedures were analysed of which 72% (84 flaps) were harvested by residents. The patients ranged in age from 14 to 89 years (mean age 59 years, 71 males and 40 females). The mean operation time was 591 min with the longest operation times for scapular flaps (744 min) and the shortest operation times for ALT flaps (455 min). Mean inpatient time was 34.2 days with a minimal time for the fibular flaps of 27.2 days and a maximum of 45.7 days for the latissimus dorsi flaps. 24 flaps (23.3%) in total had to be revised with bleeding being the main cause of immediate revisions (41.7% of all revisions). 5 flaps (4.85% of all flaps) were lost despite a revision procedure meaning a successful revision rate in 79.2% of all revisions.ConclusionMicrovascular reconstruction procedures are safe and should be considered as standard procedures for reconstruction of large defects especially in high volume training centres. Intensive flap monitoring and early revisions maximize the flap outcome.     

改良耳颞切口在颞下颌关节手术中的应用

目的:评价改良耳颞切口在颞下颌关节手术中的效果。方法:回顾分析1998年7月～2002年11月间收治的72例颞下颌关节病患者,男性35例,女性38例,年龄4～72岁,平均年龄36.1岁。所有患者均采用改良耳颞切口及进路术式,于耳颞部行美容切口设计,先翻开耳前皮瓣,暴露颞浅血管分支,然后沿耳颞神经血管束前缘进入,向前下翻开颞深筋膜瓣,倒“L”形切开关节囊后暴露髁突。结果:72例患者中获得随访38例(49侧),随访期4～45个月,平均17.7个月。仅1侧右颞区皮肤麻木,3侧额纹消失,总体对手术切口满意度为97.4%(37/38),不满意1例为髁突骨折患者,术后8个月术区瘢痕仍很明显,伴有颞区皮肤麻木和额纹消失。结论:改良耳颞切口及进路是目前治疗颞下颌关节疾病的理想术式之一。     

Elective surgical cricothyroidotomy in oral and maxillofacial surgery

Surgical Cricothyroidotomy is regarded as an emergency procedure today even though it has a good evidential record as an elective surgical airway. A misunderstanding of Jackson's landmark paper in 1921 has made the simple and safe procedure unpopular because of the fear of subglottic stenosis. We present the incidence of subglottic stenosis after surgical cricothyroidotomy, discuss evidence for elective surgical cricothyroidotomy, and suggest potential applications in oral and maxillofacial surgery.     

On Factors Influencing the Absorption Capacity of Surgical Sponges

Background

Cotton balls and surgical gauzes (CSG) have been routinely used for mopping fluids and blood in surgeries. Polyurethane sheets (PUS) are increasingly used instead of CSG. The factors influencing the absorption of fluids by CSG and PUS have not been studied in detail. There are a variety of factors that could be modified by the manufacturer while a limited number of them could be manipulated by the operator.

Materials and Methods

Mathematical models and equations have been employed in this study. The impact of absorbency was performed by modulating various factors.

Results and Discussion

A variety of factors such as thickness, density of the web, radius of fiber, temperature, surface tension and viscosity of fluid, all influenced the absorption rate and capacity to varying degrees. The optimal variation by which the PUS can be effectively used is discussed. The suggested mathematical model will help the operator to choose the appropriate type of PUS based on the individual’s needs.

Conclusion

In an area of rapidly developing technology and change in biomaterials, where the choice of such materials are overwhelming, hopefully this basic knowledge will help the clinician to make a more educated and rational decision.     

“Run-through” training at specialist training year 1 and uncoupled core surgical training for oral and maxillofacial surgery in the United Kingdom: a snapshot survey

Training in oral and maxillofacial surgery (OMFS) in the UK has undergone considerable changes during the last 10 years, and “core” surgical training has replaced “basic” surgical training. In 2014 a pilot “run-through” training programme from specialist training year one (ST1)-ST7 was introduced to facilitate early entry into the speciality. Run-through training guarantees that a trainee, after a single competitive selection process and satisfactory progress, will be given training that covers the entire curriculum of the speciality, whereas uncoupled training requires a second stage of competitive recruitment after the first one (for OMFS only) or two years of “core” training to progress to higher specialty training.The first two years of run-through training (ST1-ST2) are the same as for core surgical training. Dual-qualified maxillofacial aspirants and those in their second degree course are curious to know whether they should go for the uncoupled core surgical training or the run-through programme in OMFS. The General Medical Council (GMC) has now agreed that run-through training can be rolled out nationally in OMFS. To assess the two pathways we used an online questionnaire to gain feedback about the experience from all OMFS ST3 and run-through trainees (ST3/ST4) in 2016–2017. We identified and contacted 21 trainees, and 17 responded, including seven run-through trainees. Eleven, including five of the run-through trainees, recommended the run-through training programme in OMFS. Six of the seven run-through trainees had studied dentistry first. The overall mean quality of training was rated as 5.5 on a scale 0–10 by the 17 respondents. This survey gives valuable feedback from the current higher surgical trainees in OMFS, which will be useful to the GMC, Health Education England, OMFS Specialist Advisory Committee, and those seeking to enter higher surgical training in OMFS.     

颧骨颧弓骨折的分类与治疗方法的选择

目的 研究颧骨颧弓骨折的临床分类与应用。方法 参照Ｋｎｉｇｈｔ和Ｎｏｒｔｈ分类方法,对１３０例颧骨颧弓骨折病例进行分类。结合不同类别、手术切口入路、治疗方法和治疗效果总结分析。结果 Ⅱ类骨折龈颊沟切口入路,Ⅲ－Ⅳ类附加冠状切口、眉弓外切口、眶下眶周切口入路。复杂或陈旧颧骨颧弓骨折应选用半冠状切口入路。结论 根据不同类型骨折的特点,选择正确的手术入路是达到完善解剖复位及精确内固定的保证。     

游离腓骨肌皮复合组织瓣一期修复下颌骨及软组织缺损

目的寻找一种既能满足下颌骨及软组织复合缺损重建需要，又不影响供区功能的新的修复材料。方法对１０例各种原因所致的下颌骨及周围软组织缺损患者，采用游离腓骨肌皮复合组织瓣进行修复重建。所切取的腓骨平均长度９１ｃｍ，肌皮瓣平均大小为４５ｃｍ×６２ｃｍ。结果术后２周经９９ｍＴｃＯ－４骨扫描等证实，９例（９／１０）骨肌皮瓣成活，患者下颌功能与外形良好，行走无障碍。结论腓骨肌皮复合组织瓣骨量充足，骨质坚硬，腓骨血供具二重性，利于塑形，可以用作下颌骨及软组织缺损的修复。     

颈动脉体瘤系统诊断与治疗

目的:总结颈动脉体瘤的系统诊断与治疗经验。方法:对1990年1月至2005年12月8例颈动脉体瘤患者进行了彩色多普勒(Dopp ler)超声、磁共振影像(MR I)、磁共振血管成像(MRA)、数字减影血管造影(DSA)的系统影像学特征比较及M atas试验与颈内动脉暂时性球囊阻断试验(TBO)围手术期准备,并进行了手术。结果:颈动脉体瘤影像学特征:位于颈总动脉分叉处并与其紧密相连单发性肿块,瘤体内血供丰富,瘤体使颈外动脉向前内移位、颈内动脉向后外移位,颈内外动脉分叉角度增大明显,MRA及DSA呈“Goldcup”征改变。M atas试验时间45~60 d,TBO及DSA W illis环交叉充盈检查侧支循环代偿良好,8例患者手术后痊愈出院。结论:彩色Dopp ler超声、DSA、MRA均能明确诊断颈动脉体瘤,M atas试验是颈动脉体瘤手术必要常规的术前准备,W illis环交叉充盈检查是显示大脑代偿性侧支循环建立的客观标准,TBO试验是判断颈动脉结扎的可靠方法,手术是目前治疗颈动脉体瘤的最好手段。     

Peripheral Osteoma of the Maxillofacial Region Diagnosis and Management: A Study of 06 Cases

Background

Osteomas are benign neoplasm often associated with facial asymmetry, pain and surface ulceration. Peripheral osteomas are more common in the cranio-maxillofacial region. It is prevalent at younger age but maximum seen in the sixth decade, with a female to male ratio is 1:2. The aim of this study was to review the clinical presentations and management protocol of such lesions in cranio-maxillofacial region.

Materials and Methods

The study was conducted at Command Military Dental Centre (EC) during May 2004 to May 2007. Six serving soldiers and their families (four males, two females), age group ranging between 13 and 56 years, mean age 34.5 years were recruited in this study. The tumors were excised using extra oral, intra oral and combined approaches; no complications were reported during post op period.

Results

All the cases were operated under GA through extra oral, intra oral and combined approaches with satisfactory results. HPE report was benign in all our cases with no post operative complications reported during follow up.

Conclusion

Cranio-maxillofacial osteomas are exclusively benign tumors and not very common entities. Proper diagnosis and precision management alleviates symptoms without any post surgical complications. In our series of six cases the tumors were diagnosed and managed as per standard surgical protocol with excellent result.     

上颌埋伏尖牙外科正畸联合治疗

目的：探讨上颌埋伏尖牙通过外科导萌和正畸联合治疗的临床效果。方法：对28颗上颌埋伏尖牙利用固定矫治器为其提供间隙，通过翻瓣去骨显露埋伏牙牙冠，再牵引入牙列。结果：26颗上颌埋伏尖牙排入牙列。结论：外科正畸联合方法是可靠的上颌埋伏尖牙治疗方法。