Assessment of online visibility of the British Association of Oral and Maxillofacial Surgeons (BAOMS): A strategic study

The Internet is a powerful method of acquiring and sharing information. In marketing and business, online visibility is vital for publicity and the reputation of an organisation. To our knowledge, the importance of such visibility in medicine in general, and in Oral and Maxillofacial Surgery (OMFS) services in the UK, has not previously been investigated. We aimed to provide a better understanding of the way that patients use the Internet by asking 450 patients to complete a questionnaire when they attended outpatient OMFS departments at 2 centres. We also assessed the online visibility of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and investigated the correlation between the strength of online visibility and professional reputation. Results from the self-administered, anonymous, validated questionnaires showed that 82% of patients agreed that the Internet was a powerful source of information, and two-thirds associated online visibility with a good reputation. However, the perceived online visibility of the BAOMS was poor (2%). This study mirrors findings in business publications, and confirms the link between online visibility and professional reputation. It also shows that there is a gap between patients’ perceptions and the level of uptake of professional resources. We propose various strategies to bridge this gap and to promote the online visibility and professional reputation of the BAOMS and of OMFS services in the UK.     

Osteodistraction of mandibles with a small bone defect at the planned osteotomy site: A histological pilot study in dogs

AimTo develop a treatment plan for cases in which a bone defect is located on the osteotomy line of mandibular osteodistraction (DO).Subjects and methodsBilateral DO was performed in 17 Mongrel dogs. Prior to surgery, the 34 hemi-mandibles were randomly allocated to three groups: C (n = 10; a standard DO was performed), D − G (n = 12; a bone defect was created on the DO osteotomy line), and D + G (n = 12; the bone defect on the osteotomy line was grafted). After one week of latency, 8 days of distraction, and 4 weeks of consolidation the animals were sacrificed, and the newly formed bone were examined.ResultsIn group C, two zones of immature trabecular bone originating from host bone margins were separated by a central fibrous zone. In group D + G uniform new bone formation of the entire distraction gap was observed. In group D − G the distraction gap was mainly filled with fibrous tissue. The values for the newly formed bone volume and trabecular thickness were not significantly different between groups D + G and C, but were higher than values in group D − G (p < 0.05).ConclusionWhen a mandibular defect is located at the site of distraction osteotomy, DO can be performed simultaneous with bone grafting of the defect.     

Redefining our protocol of the orthognathic surgery-first approach after 10 years of experience

The objective of this study was to update and redefine some concepts of the surgery-first (SF) approach, regarding its indications and contraindications, virtual planning work-up, surgical tips, and postoperative orthodontic benefits, after 10 years of experience. A retrospective analysis was made of orthognathic surgical procedures following the SF protocol between January 2010 and December 2019 to review inclusion and exclusion criteria, diagnostic workflow, surgical tips, and postoperative outcomes. A total of 148 SF procedures were performed during this period, which corresponded to only 9.2% of the total orthognathic surgeries performed, which means that we have broadened the exclusion criteria instead of reducing them. Surgical tips include interdental corticotomies solely in cases of anterior crowding and leaving the intermaxillary fixation miniscrews in place postoperatively for orthodontic skeletal anchorage. The mean duration of postoperative orthodontic treatment was reduced in comparison to conventional surgery (36.8 vs 87.5 weeks). The overall degree of satisfaction was high not only for the patients, but also for the orthodontists and surgeon. SF is especially indicated for patients who desire an immediate aesthetic result, with short-term orthodontics, or for treatment of sleep-related breathing disorders, if they meet the established criteria.     

Effectiveness of tranexamic acid on intraoperative blood loss in isolated Le Fort I osteotomies – A prospective,triple blinded randomized clinical trial

The aim of this triple blinded randomized clinical trial was to evaluate the efficacy of tranexamic acid when used in conjunction with hypotensive anaesthesia exclusively for Le Fort I osteotomies. 49 patients undergoing Le Fort I osteotomy for correction of dentofacial deformity were divided into two groups; Group 1 received a placebo of saline 5 ml and Group 2 received 10 mg/kg body weight of tranexamic acid. The operating surgeon, anaesthetist and investigator were blinded. The variables of interest recorded in this study included the change in Hb%, PCV, total blood loss, total operating time and quality of the surgical field using Fromme's Ordinal Scale. Statistically significant differences between the two groups were found between the following variables: post-operative Hb%, drop in Hb%, post-operative PCV, drop in PCV, total surgical blood loss, total operating time and quality of surgical field (P < 0.05). Group 2 patients exhibited a smaller drop in Hb% and PCV, with a lower Fromme's Ordinal Scale value and decreased total blood loss and operating time. In conclusion single preoperative administration of tranexamic acid in the dose of 10 mg/kg, when combined with hypotensive anaesthesia is effective in controlling blood loss with regards to single piece Le Fort I surgery.     

Head posture and pharyngeal airway volume changes after bimaxillary surgery for mandibular prognathism

PurposeThe purpose of this study was to evaluate head posture and the pharyngeal airway volume changes using 3D imaging after bimaxillary surgery in mandibular prognathism patients by null hypothesis.Materials and methodsCone-beam computed tomography (CBCT) scans were obtained for 25 mandibular prognathism patients before bimaxillary surgery (T1) and 6 months after surgery (T2). The head posture of each patient was assessed by measuring cranio-cervical angle on a midsagittal plane passing through the anterior nasal spine at T1 and T2. Additionally, the volume of each subject's pharyngeal airway was measured using InVivoDental 3D imaging software.ResultsThe cranio-cervical angle increased significantly 6 months after bimaxillary surgery (p < 0.01). The total volume of the pharyngeal airway slightly decreased (p > 0.05) at the same timepoints, while naso- and oro-pharyngeal airway volume decreased significantly (p < 0.05, p < 0.05). There was significant relationship between the changes of head posture and those of total airway volume (p < 0.05).ConclusionThe null hypothesis was rejected. Bimaxillary surgery resulted in significant head flexion and a slight decrease in total pharyngeal airway volume.     

Oral mucositis: Current knowledge and future directions

Oral mucositis secondary to head and neck chemoradiation displays a complex molecular pathogenesis involving epithelial and microvascular injury, release of pro-inflammatory cytokines, and host-microbiome communications. These processes lead to oxidative stress and the release of reactive oxygen species that stifle the structural integrity of the oral mucosa, with emergence of erosions and ulcers. The consequences are malnutrition, psychological/psychiatric symptoms, poor quality of life, and occurrence of opportunistic infections. The latter pose a major challenge due to the risk of interruption of anti-neoplastic therapy, tumour recurrence and, ultimately, death. This article aims to present the clinical characteristics, molecular pathogenesis, and an overview of the predisposing factors and current management of oral mucositis. It is anticipated that the future direction of the management of oral mucositis will focus on evidence-based prehabilitation and pre- and per-chemoradiation therapy monitoring.