麻醉学教学在口腔颌面外科毕业后医学教育中的实施与体会

口腔颌面外科住院医师和专科医师需通过麻醉科轮转以获得必要的麻醉基本知识和急救技能。通过开展针对口腔颌面外科医生的麻醉学教学，应用具有麻醉专科特色的教学查房和模拟教学手段来提高口腔颌面外科毕业后医学教育的质量。     

How useful is intraoperative cone beam computed tomography in maxillofacial surgery? An overview of the current literature

Intraoperative imaging is increasingly used by surgeons and has become an integral part of many surgical procedures. This study was performed to provide an overview of the current literature on the intraoperative use of cone beam computed tomography (CBCT) imaging in maxillofacial surgery. A bibliographic search of PubMed was conducted in March 2020, without time limitation, using “intraoperative imaging” AND “maxillofacial surgery” AND “cone beam computed tomography” as key words. Ninety-one articles were found; after complete reading, 16 articles met the eligibility criteria and were analysed. The results showed that the majority of the indications were related to maxillofacial trauma, particularly zygomaticomaxillary complex fractures. Final verification with intraoperative CBCT before wound closure was the most common use of this device. However, innovative uses of intraoperative CBCT are expanding, such as CBCT coupling with mirror computational planning, and even the combined use of initial intraoperative CBCT acquisition with navigation. Immediate, fast, and easy evaluation of bone repositioning to avoid the need for further surgical revision is the main advantage of this technique. Imaging quality is comparable to that of multi-slice computed tomography, but with lower radiation exposure. Nevertheless, CBCT is still not widely available in maxillofacial centres, probably because of its cost, and perhaps because not everyone is aware of its advantages and versatility, which are reported in this review.     

Lasers in oral and maxillofacial surgery

Because of their many advantages, lasers have become indispensable in OMS as a modality for soft tissue surgery. Based on manufacturer estimates, approximately 10% to 20% of all oral and maxillofacial surgeons have one or more lasers in their offices, and most surgeons have access to lasers in the hospital. Lasers not only enhance the current surgical options for treatment, but also have expanded the scope of practice. There are many uses for lasers in OMS, and the advent of new wavelengths will undoubtedly lead to new procedures that can be performed with them. One [figure: see text] elusive use is hard tissue surgery. Although the Er:YAG has been approved for hard tissue use in the United States and currently is being used in general dentistry, it is still not yet practical or proven for large-volume osseous or extraction surgery, in which the greatest opportunity for innovation and clinical use exists. With future research, it is possible that the right wavelength laser will be developed for this purpose, allowing an increased base of procedures performed with lasers in OMS.     

Simulation-based training in maxillofacial surgery: are we going to be left behind?

Simulation is an important way both to optimise a trainee’s learning time and reduce morbidity and operating time for patients. We have reviewed the current use of simulation in training for maxillofacial surgery, and provide an overview of areas of practice where it may be useful. A web-based survey of trainees’ opinions of it was made in February 2018, and disseminated using the Junior and Fellows in Training group mailing lists. We also reviewed popular current simulation courses that are available. A total of 45 of the 57 trainees who replied agreed that simulation-based training would be beneficial in maxillofacial surgery, particularly with regard to maxillofacial surgical emergencies. A total of 54 of the 57 also agreed that simulation-based training would be a useful adjunct to their clinical training. However, most of the simulation-based courses available were priced beyond the budgets available to UK-based trainees for study, although funding changed in April 2018. While other surgical disciplines have adopted simulated clinical teaching and its benefits, maxillofacial surgery has limited the use of all types of formal simulation. Surgical simulation training is increasingly being used to complement the traditional surgical apprenticeship in other specialties, and ours needs to consider ways in which we can use it, given that trainees within the specialty think that it would be useful. Other specialties have shown that there is good transfer of skills from simulation to the actual clinical operating environment, and this increases satisfaction, decreases morbidity, and reduces the time required for intraoperative teaching.     

持续发展,与时俱进——我国口腔颌面外科发展之前瞻

2006年伊始,传来阵阵喜讯：2006是“十一五”规划起始之年：是强调以自主创新为主的第6次全国科技大会胜利召开之年；也是《国家中长期科学和技术发展规划纲要(2006～2020年)》正式公布之年……,这一切一切,给我国科技界、生命科学和医学界,给我国口腔颌面外科事业的发展带来了新的挑战和新的机遇。1当前生命科学及医学的发展趋势1．1生命科学的内涵和在科技领域中的地位     

The landscape of international oral and maxillofacial surgery collaborations from 1996 to 2020: a scoping review of the published literature

The emerging field of global oral and maxillofacial surgery (OMS) aims to improve worldwide access to safe, timely, and affordable OMS care. However, there exists a dearth of literature thoroughly detailing the scope of academic global OMS collaborations between high-income countries (HICs) and low- and/or lower middle-income countries (LICs/LMICs). This scoping review was performed to characterize the landscape of global academic OMS collaborations between HICs and LICs/LMICs. A five-stage methodological framework was used. Academic global OMS collaborations from 1996 to 2020 were identified via an electronic database and grey literature review. A total 1318 articles were identified on December 17, 2020. Following the application of inclusion and exclusion criteria, 71 articles describing 81 unique global OMS academic collaborations were included in the final analysis. The most common HIC was the United States (44.4%); the majority of LIC/LMICs were within Africa (45.8%). Of the total interventions, 89.6% improved LIC/LMIC capacity development, and surgical (43.8%) interventions were the most common. By serving as a central report on current and past academic collaborations in global OMS, this review helps identify areas in need of surgical capacity building, lays the foundation for future research efforts on the topic, and serves as a resource for individuals aiming to become involved in global OMS.     

网络平台在口腔颌面外科专科医师培训的初步应用

网络平台是口腔颌面外科专科培训的重要途径,具有极大容量的教学空间,且无时空地域限制,资源丰富。网络平台可打破传统上口腔颌面外科医师通过教材或书籍获取知识的局限,大大提高了获取信息医学资源的速度,为专科医师培训提供了一个更广阔、便捷的方式。因此,加速推广网络平台在口腔颌面外科专科医师培训的应用,有利于保障专科医师规范化培训工作的顺利实施,提高培训质量。     

美国口腔颌面外科专业发展历史和现状

本文通过对美国德克萨斯大学健康科学中心·圣安东尼奥分部口腔颌面外科主任和住院医师培训项目主任Edward Ellis教授的采访,详细介绍了美国口腔颌面外科教育的发展历史和现状,为我国口腔颌面外科专科教育提供参考。     

Transitioning from residency to private practice

A resident in oral and maxillofacial surgery must prepare for the inevitable transition from residency training to practice as a private practitioner, an officer in the military, an academician, or as a fellow in a postresidency training program. Each career path offers distinct challenges and rewards. This article reviews the issues that face a chief resident embarking on a career in private practice in oral and maxillofacial surgery.     

Senior registrars' views on training in oral and maxillofacial surgery

Fifty-three British senior registrars in oral and maxillofacial surgery (OMS) were sent a questionnaire designed to determine their views on some of the main aspects of training in the specialty. Thirty-seven returns were received (70%), 36 completed. This paper reports and discusses the results of the survey.     

Minimally invasive orthognathic surgery: a systematic review

Minimally invasive techniques are currently applied in many oral and maxillofacial surgical procedures, including orthognathic surgery. A systematic review on the application of potentially minimally invasive procedures in orthognathic surgery was performed to provide a clear overview of the relevant published data. Articles in English on minimally invasive orthognathic procedures, published in the scientific literature, were obtained from the PubMed, Embase, and Cochrane Library databases, and an additional manual search (revised 31 December 2016). After screening the abstracts and applying the eligibility criteria, 403 articles were identified. All articles reporting the potential for minimally invasive orthognathic surgery were included (n = 44). The full papers were evaluated in detail and categorized as articles on a minimally invasive surgical approach (n = 4), endoscopically assisted orthognathic procedures (n = 17), or the use of a piezoelectric device in orthognathic surgery (n = 25); two articles were each included in two categories. Although a small incision and minimal dissection is the basic principle of a minimally invasive technique, most articles (90.9%) reported the endoscope and piezoelectric instrument as important tools in minimally invasive orthognathic surgery. Evidence from available studies suggests that patients undergoing minimally invasive orthognathic surgery have less morbidity and make a faster recovery. Further research should aim to obtain higher levels of evidence.     

Implant survival rates for oral and maxillofacial surgery residents: a retrospective clinical review with analysis of resident level of training on implant survival.

PURPOSE: This study evaluates dental implant survival rates in cases where surgery was performed by oral and maxillofacial residents and determines whether the level of resident training influenced the outcome of dental implant treatment. PATIENTS AND METHODS: Retrospective review of all 2-stage implants placed between July 1, 2002 and June 30, 2004 by oral and maxillofacial surgery residents-in-training at the Washington Hospital Center was carried out. Patients were seen for follow-up at 1-week, 1-month, and 6-month intervals after implant surgery. The criteria for implant success in this study were based on clinical and radiographic evidence of implant osseointegration during the follow-up period. We evaluated implant survival rates and used Cox proportional hazards modeling to analyze whether level of resident training or location of implant placement influenced implant survival. RESULTS: This study included 175 implants placed in 54 patients. The overall survival rate of implants placed by oral and maxillofacial surgery residents at all levels of training was 91%. No statistically significant difference in implant survival rates was observed as a function of the level of training of the resident surgeon (P = .89) or location of implant placement (P = .93). CONCLUSION: Survival rates for implants placed by surgeons in training are comparable to rates reported in the literature. There was no statistically significant difference in survival rates when a comparison of level of training was taken into consideration. To our knowledge, this study is the first to examine implant survival rates as a function of surgeon experience in the setting of an oral and maxillofacial residency program and suggests that predictable outcomes in implant treatment are attainable by surgeons in training.     

新型口腔局部麻醉仿真训练设备的设计与研发

目的 虚拟现实技术和模拟仿真技术的出现极大地丰富了口腔医学教育领域的教学形式,但是两者联合在口腔教学中的应用较少.口腔局部麻醉的教学一直是口腔医学实验课的重难点,为增强学生兴趣、强化临床技能、提高实验教学安全性,本研究联合应用上述技术设计并研发了一种新的口腔局部麻醉仿真模拟训练设备.方法 基于口腔颌面外科学实验教学大纲,利用仿真软件技术、仿真头模技术、空间定位技术及智能化考核技术,设计研发设备.结果 设计开发的"安麻施"训练系统可提供练习模式、示教模式、考核模式及用户设置等功能模块,通过虚拟软件实现流程化教学,通过头模和空间定位系统进行操作与实时反馈.结论 "安麻施"训练系统有望优化口腔颌面外科实验教学模式,提高教学质量,为课程改革提供新的方向.     

Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications,limitations, and future possibilities

Objectives

A narrative review on the potential use of low-dose protocols for cone beam computed tomography (CBCT) was conducted to identify indications and their relevance for various dental disciplines.

Materials and methods

Google Scholar was searched using the words “low-dose CBCT”. Reviews, consensus papers, clinical studies, and experimental studies were eligible for the initial screening process, but for data extraction only original articles were selected. Similar search procedures were then performed with the additional search words “pedo,” “ortho,” “endo,” “implant,” “perio,” and “oral surgery.” Furthermore, references of included articles were examined to identify further relevant articles.

Results

After screening, 27 publications remained for the data extraction process. Low-dose protocols have been reported for specialties such as pediatric dentistry (evaluating orofacial clefts, periapical lesions, impacted teeth, and autotransplantation), orthodontics (cephalometric analysis and interim assessment of treatment results), endodontics (detecting root fractures, resorptions and periapical bone loss), implant dentistry (planning implant insertion, evaluating peri-implant fenestration and dehiscence), periodontology (assessing periodontal structures), and oral and maxillofacial surgery (assessing mandibular third molars and TMJs). Nevertheless, most of the literature available is related to non-clinical studies. Furthermore, there is a lack of position statements or guidelines from authoritative bodies regarding the use of low-dose protocols in dental medicine.

Conclusions

Low-dose protocols for CBCT imaging seem to have potential in various disciplines in dental medicine ranging from pediatric dentistry to oral and maxillofacial surgery. Dose reduction is usually achieved by mAs reduction, use of partial rotations, reduced number of projections, and larger voxel sizes, but seldom by kV reduction.

Clinical relevance

Albeit low-dose protocols have potential to result in a reduction of dose exposure for 3D imaging due to dental indications, there is a need to more clearly specify indications and limitations to avoid indiscriminate use of standard and high-dose CBCT scans in the future on the lines of ALARA/ALADA principles.

     

Survey of TMJ arthroscopy in oral and maxillofacial surgery residency programs

A questionnaire was mailed to oral and maxillofacial surgery residency programs in February 1988 regarding their indications for arthroscopy, number of patients treated, acquisition of skills, success of therapy, and several other questions about arthroscopy. Of the 56 questionnaires returned, 38 (68%) reported experience with TMJ arthroscopy. Pain and decreased range of jaw motion were the most frequently listed indications for surgery. Neural injuries were the most frequently seen complication. Four auditory canal perforations were reported. The operation was deemed successful in 64.8% of the patients. The most frequent criteria given for success were pain relief and increased range of motion. The main sources chosen by the respondents of this survey for acquiring skill in a residency program were information from the literature and hands-on training.     

高职生口腔颌面外科临床实践教学总结与探讨

口腔临床实习阶段是口腔医学教育的重要阶段。高等职业教育的口腔医学生(以下简称高职生)与本科教育起点的口腔医学生,在教育背景、专业基础、自身素质等方面都有所不同。本文针对高职生在口腔颌面外科实习的特点,对构建适合专科层次口腔颌面外科教学内容与体系,加强实践前培训、全科医学培训、临床思维能力培养、重点内容专项培训等内容进行了探讨。以期培养适合基层工作的实用性口腔医学人才。     

Prototyping for surgical and prosthetic treatment

Techniques of rapid prototyping were introduced in the 1980s in the field of engineering for the fabrication of a solid model based on a computed file. After its introduction in the biomedical field, several applications were raised for the fabrication of models to ease surgical planning and simulation in implantology, neurosurgery, and orthopedics, as well as for the fabrication of maxillofacial prostheses. Hence, the literature has described the evolution of rapid prototyping technique in health care, which allowed easier technique, improved surgical results, and fabrication of maxillofacial prostheses. Accordingly, a literature review on MEDLINE (PubMed) database was conducted using the keywords rapid prototyping, surgical planning, and maxillofacial prostheses and based on articles published from 1981 to 2010. After reading the titles and abstracts of the articles, 50 studies were selected owing to their correlations with the aim of the current study. Several studies show that the prototypes have been used in different dental-medical areas such as maxillofacial and craniofacial surgery; implantology; neurosurgery; orthopedics; scaffolds of ceramic, polymeric, and metallic materials; and fabrication of personalized maxillofacial prostheses. Therefore, prototyping has been an indispensable tool in several studies and helpful for surgical planning and fabrication of prostheses and implants.     

A computerised third molar surgery simulator – results of supervision by different professionals

The purpose of the study was to investigate which supervisory approach afforded the most efficient learning method for undergraduate students in oral and maxillofacial surgery (OMS) using a computerised third molar surgery simulator. Fifth year dental students participated voluntarily in a randomised experimental study using the simulator. The amount of time required and the number of trials used by each student were evaluated as a measure of skills development. Students had the opportunity to practise the procedure until no further visible improvements were achieved. The study assessed four different types of supervision to guide the students. The first group was where they were supported by a teacher/specialist in OMS, the second by a teaching assistant, the third group practised without any supervision and the fourth received help from a simulator technician/engineer. A protocol describing assessment criteria was designed for this purpose, and a questionnaire was completed by all participating students after the study. The average number of attempts required to virtually remove a third molar tooth in the simulator was 1.44 times for the group supervised by an OMS teacher; 1.5 times for those supervised by a teaching assistant; 2.8 times for those who had no supervision; and 3.6 times when support was provided only by a simulator technician. The results showed that the most efficient experience of the students was when they were helped by an OMS teacher or a teaching assistant. In a time and cost‐effective perspective, supervision by a teaching assistant for a third molar surgery simulator would be the optimal choice.     

PBL结合SP教学模式在口腔颌面外科住院医师规范化培训中的应用

目的:探讨PBL结合SP教学模式在口腔颌面外科住院医师规范化培训中的应用效果及其可行性。方法:我科室于2011年开始采用PBL结合SP教学模式对45名住院医师进行规范化培训,在教学过程中,充分结合两种教学方法的优点,并根据口腔颌面外科的特点进行重新编排,将PBL及SP教学模式分别应用于门诊及病房的规范化培训中,培养和锻炼住院医生的临床操作能力及诊断水平。结果:95%的住院医师在培训结束后都能熟练进行口腔颌面外科的基本操作,并对典型的常见疾病能够做出正确的诊断。结论:PBL结合SP教学模式在口腔颌面外科住院医师规范化培训中的应用切实可行,收到了良好的培训效果。     

Reporting of ethical protection in recent oral and maxillofacial surgery research involving human subjects

This retrospective observational study investigated the frequency of reporting ethical approval and informed consent in recently published oral and maxillofacial surgery (OMS) research involving human subjects. All research involving human subjects published in the International Journal of Oral and Maxillofacial Surgery, Journal of Oral and Maxillofacial Surgery, British Journal of Oral and Maxillofacial Surgery, and Journal of Cranio-Maxillofacial Surgery during January to June 2005–2007 were analysed for disclosure of ethical approval by a local ethical committee and obtaining informed consent from the subjects. 534 articles were identified; ethical approval was documented in 118 (22%) and individual patient consent in 135 (25%). 355 reports (67%) did not include a statement on ethical approval or informed consent and only 74 reports (14%) disclosed statements of both. Ethical documentation in retrospective and observational studies was scant; 12% of randomised controlled trials and 38% of non-random trials did not report both of ethical protections. Most recent OMS publications involving humans failed to mention ethical review or subjects’ consent. Authors must adhere to the international research ethics guidelines and journal instructions, while editors should play a gatekeeper role to protect research participants, uphold scientific integrity and maintain public trust in the experimental process and OMS profession.