Alcohol-related violence and the role of oral and maxillofacial surgeons in multi-agency prevention

The maxillofacial region is by far the most frequently selected target in assaults on adults. There is a causal link between alcohol intoxication and injury. Therefore, oral and maxillofacial surgery is, in effect, the lead speciality for those injured in violence and has a responsibility to orchestrate holistic care that takes into account mental health needs. Recent years have also seen a determined effort by oral and maxillofacial surgeons to get involved in wider issues of prevention, exemplified by the national UK BAOMS Facial Injuries Awareness Week. Multi-agency prevention, not just with mental health professionals in the case of individual patients, but also with emergency medicine, public health, local government, the police and the voluntary sector is key to success. Given the potential complexity of collaborations like this, it is important to understand what works in multi-agency prevention. This paper reviews successful interventions: their rationale and how oral and maxillofacial surgeons can contribute to local injury prevention.     

Low burnout risk and high engagement levels among oral and maxillofacial surgeons

Little is known about the well-being of oral and maxillofacial surgeons. The aim of this study was to measure the levels of burnout risk and the demanding work aspects of Dutch oral and maxillofacial surgeons, as well as the levels of positive work engagement and stimulating aspects of the work environment. The Maslach Burnout Inventory, Dutch version (UBOS), and inventories on positive engagement, work demands, and stimulating aspects of work, were sent to all 179 Dutch oral and maxillofacial surgeons currently in clinical practices. With a 70% response, UBOS mean scores on Emotional Exhaustion and Depersonalization appeared lower, and on Personal Accomplishment appeared higher, when compared with relevant reference scores. Engagement scores appeared to be relatively high. Mean scores on the work demands subscales were all well below the scale midpoint, whereas work resources were all well above. Dutch oral and maxillofacial surgeons showed relatively favorable burnout and engagement levels. The aspects of the work environment that best explain differences in burnout are 'Practice demands and organization' and 'Lack of variation and perspective in work'. Differences in engagement are best explained by 'Variety in work' and 'Positive effect upon patients'. It is remarkable that all work demands show relatively low levels and all stimulating work aspects show relatively high levels.     

Could exercise improve mental health and cognitive skills for surgeons and other healthcare professionals?

Workplace-related illness is common in the UK, and in healthcare more than five million working days over 10 years have been lost as a result. Occupational stress is well known and can affect clinicians at any stage, yet many healthcare professionals continue to work with this or other psychological problems (including anxiety, chronic fatigue, and burnout) as they do not wish to let their colleagues down. Mental health issues might be dismissed, particularly in surgery, because there is a misconception that surgeons can cope better with stress than those working in other specialties, and are better protected from clinical burnout. The benefit of exercise on physical health is clear, but its role in the maintenance of good mental health and well-being should not be underestimated. As society adopts an increasingly sedentary lifestyle, exercise for many has a lower priority than other activities. In this article we give an overview of the mental health issues that might affect doctors and surgeons, and explore how exercise can benefit our well-being and clinical performance.     

The successful oral and maxillofacial surgery practice

Oral and maxillofacial surgery has been and will continue to be one of the premiere health care specialties in the United States. Incomes of oral and maxillofacial surgeons are among the highest of any profession in the country. With efficient scheduling, organized business systems, efficient fee schedules, and appropriate use of consultants, oral and maxillofacial surgery can lead to a lifestyle that is relatively stress free, allows a direct route to financial independence, and provides a great public service.     

The psychological impact of maxillofacial trauma: an overview of reactions to trauma

We provide an overview of the current understanding of posttraumatic psychological problems, such as posttraumatic stress disorder, and the implications for maxillofacial surgeons and allied professionals. Posttraumatic stress disorder is not confined to combat veterans; it is common after all traumatic events-including maxillofacial injury-and can become chronic unless recognized and treated. The neurobiologic underpinnings of and the known vulnerability factors for posttraumatic stress disorder are increasingly understood, assisting the nursing and surgical staff in their assessments. Both psychological and pharmacologic treatments have been shown to have efficacy; nevertheless, intervention by mental health professionals will not be required by all.     

国内外口腔颌面外科教育培训体系对比

口腔颌面外科的范围除了基础的牙及牙槽外科之外,还包括各种复杂的颅颌面手术,因此对口腔颌面外科医生的知识背景要求就不仅限于牙科。虽然其在世界范围的很多地方被归为牙科专业,但也有许多国家会要求从业者获得临床医学和牙科学的双重学位。不同国家和地区的口腔颌面外科教育培训路径各有不同,文章将进行对比分析,并浅谈对于口腔颌面外科医师培养的一些思考。     

Changing Guidelines of Cardiopulmonary Resuscitation and Basic Life Support for General Dental Practitioners and Oral and Maxillofacial Surgeons

Introduction

Every general dental practitioner and oral and maxillofacial surgeon needs a thorough knowledge of the diagnosis and management of medical emergencies. Cardiopulmonary arrest is the most urgent of emergencies and diagnosis must be done as soon as possible.

Purpose

This paper discusses the importance of the International Liaison Committee on Resuscitation which forms the guidelines for cardiopulmonary resuscitation (CPR), highlighting the important changes in the guidelines of CPR from the year 2000 to 2010, the basic sequence of performing CPR and also the role of defibrillation and the use of automated external defibrillators. Finally the five part chain of survival which is of utmost importance to dental health care professionals and oral and maxillofacial surgeons.

Conclusion

All dental health care personnel and oral & maxillofacial surgeons should recognize the importance of the changes in the guidelines of CPR, be trained and allowed to use a properly maintained defibrillator, to respond to cardiac arrest victims.     

Fever work-up and management in postsurgical oral and maxillofacial surgery patients

This article focuses on the etiology, diagnosis, and management of fever in postoperative oral and maxillofacial surgery patients. A list of the causes of postoperative fever can be exhaustive. This article focuses on the more common presentations relevant to oral and maxillofacial surgeons. Some rare but important causes also are discussed. To be comprehensive in covering this topic, a definition of fever and an overview of its pathophysiology are included.     

我国口腔颌面外科面临的挑战及应对浅见

口腔颌面外科对口腔医学的发展具有不可磨灭的贡献,但进入21世纪后,我国口腔颌面外科的发展遇到了不少困难．面临着巨大的挑战。本文结合本地实际和个人体会,从3个方面分析了口腔颌面外科面临的挑战及应该采取的应对措施。相信随着学科的发展和广大口腔颌面外科工作者的不懈努力,口腔颌面外科必将迎来新的辉煌时期。     

Autologous versus prosthetic nasal and auricular reconstruction – patient,professional and layperson perceptions

The aim of this study was to retrospectively evaluate the perceptions of aesthetic outcome following the autologous and prosthetic reconstruction of nasal and auricular defects among patients, professionals (oral and maxillofacial surgeons and ear, nose and throat surgeons) and people unfamiliar with reconstructive surgery. The influence of anatomical subunits on the overall perception of nasal and auricular reconstructions was also determined. A total of 119 patients treated for nasal and auricular defects between 1997 and 2016, with a minimum follow-up period of 6 months, were selected, and photographs of 77 of these patients (65%) were presented in a digital survey and reviewed using a standardized questionnaire. No clinically relevant correlations were found between the age or gender of patients (as well as those of the respondents) and their scores. Prosthetic reconstructions of nasal and auricular defects were considered advantageous over autologous reconstructions in terms of the subjective aesthetic outcome in the view of the professionals, in particular oral and maxillofacial surgeons; however, the patients judged both techniques to be equally effective in terms of aesthetics. No anatomical subunits were found to have a significant impact on the overall match of a nasal or auricular reconstruction with the patient’s face.     

中华口腔医学会口腔颌面外科专业委员会20周年发展回顾

历史值得铭记,未来需要开拓。1986年,在中华医学会口腔学会之下,正式建立了口腔颌面外科学组；并相继于1986、1990、1994年在上海、西安、武汉召开了第二、三、四次全国性口腔颌面外科学术交流会。自此,我国的口腔颌面外科专业队伍初步形成,并且不断壮大。经过几代人的不懈努力,中国的口腔颌面外科发展迅速,日臻成熟,涌现出了一大批卓有建树的专家学者,诞生了中国口腔医学界第一位工     

华西口腔医院口腔颌面创伤专科医师规范化培训的实践探索

专科医师规范化培训是我国毕业后医学教育的重要组成部分,已经从局部试点转入了全面实施阶段。口腔颌面创伤是口腔颌面外科重要亚专业,目前我国口腔颌面创伤外科专科医师数量较少,主要集中在大城市的少数专科医院中,尚缺乏全面系统的规范化培训。文章通过分析我国口腔颌面创伤专科医师规范化培训现状,介绍华西口腔医院口腔颌面创伤专科医师规范化培训体系方面的经验,为培养能够独立规范地承担口腔颌面创伤专科常见多发疾病、疑难重症诊疗工作且具备良好执业道德的高素质口腔颌面创伤专科人才提供参考。     

Fine-needle aspiration biopsy in oral and maxillofacial surgery

Fine-needle aspiration biopsy is a technique that is gaining great popularity in both surgical and nonsurgical specialties. Its accuracy, safety, and usefulness have been demonstrated repeatedly; however, its usefulness seems to have been overlooked by oral and maxillofacial surgeons. This technique has many advantages in the diagnosis of mass lesions, including ease of use, cost effectiveness, convenience, and accuracy. It lends itself well to oral and maxillofacial surgery.     

Oral and maxillofacial injuries experienced in support of Operation Iraqi Freedom I and II

Penetrating, perforating, and avulsive fragmentation injuries present a unique surgical challenge for oral and maxillofacial surgeons in the Iraqi theater of operation. Maxillofacial injuries encountered in Operation Iraqi Freedom I and Operation Iraqi Freedom II have presented injury patterns not encountered previously in other large-scale armed conflicts. Current literature in the field of oral and maxillofacial surgery does not cover adequately the concerns that are inherent to care and treatment planning at an echelon III facility. This article addresses clinical and surgical practice guidelines that were developed by oral surgeons in theater and from feedback they received from higher echelons of care.     

Surgeons of oral cancer and leaders of a young specialty: the role of 3 oral and maxillofacial surgeons.

The treatment of oral and related cancer has evolved greatly since the early part of the 20th century. Today, some oral and maxillofacial surgeons include oral cancer surgery as a normal part of their practice. This article will discuss 3 pioneers, Elmer C. Hume, Fred Henny, and Claude La Dow, who shared a career-long commitment to oral cancer surgery, trained future leaders of the specialty, and retained their professional identity within dentistry and oral surgery. Their lives and contributions are profiled within the context of the political climate of oral surgery at the time. Oral cancer surgery within the discipline of oral and maxillofacial surgery declined later in the 20th century as this activity increased among head and neck surgeons based in general surgery and later, otolaryngology. Simultaneously, the interest of American oral surgeons was drawn toward orthognathic surgery and the landmark presentation by Hugo Obwegeser at Walter Reed Army Medical Center in June 1966 signaled the beginning of a shift in the focus of the specialty. The close of the 20th century has witnessed a renaissance of interest in oral cancer surgery within American oral and maxillofacial surgery.     

Cosmetic oral and maxillofacial surgery options

BACKGROUND: Dentistry and its related specialties have made exponential increases in the functional and cosmetic treatment of the maxillofacial region. Oral and maxillofacial surgeons historically have been involved in functional and cosmetic rejuvenation of the face, and newer technologies have enhanced the ability to make patients look and feel better. METHODS: Cosmetic oral and maxillofacial surgery is being taught in residency programs, is included in the oral and maxillofacial surgery board examinations and represents a part of contemporary oral and maxillofacial surgery. The author discusses common facial rejuvenation procedures with an emphasis on newer treatment technologies. RESULTS: Many oral and maxillofacial surgeons have the ability to improve the esthetics of the maxillofacial area and related structures. The large number of aging baby boomers and technological advances in cosmetic facial surgery have made these procedures easier to perform and more popular than ever. CONCLUSION: A global diagnosis and treatment plan to include facial esthetics can enhance cosmetic dentistry and serve to frame the work of the restorative dentist. The oral and maxillofacial surgeon can help the dentist and patient pursue both functional and cosmetic improvement with safe and effective procedures. CLINICAL IMPORTANCE: All dentists should be aware and abreast of advances in all areas of dentistry and have a basic understanding of available procedures that can benefit their patients. Cosmetic oral and maxillofacial surgery can enhance the work of the restorative dentist and improve facial esthetics, as well as enhance the well-being of the patient.     

A self-supporting hospital dental service

This article focuses on the business aspects of dentistry in a hospital. However, there is another aspect of hospital dentistry—the relationship of dentistry to medicine in a hospital and the tertiary dental services that can be developed with a strong dental program. A strong dental service has benefits for a hospital in addition to its service to an indigent dental community and the teaching of general practice dental residents. A strong dental service will attract oral surgeons and potentially an oral surgery residency program. Oral surgeons can fill beds, use the operating room, and interact with other medical disciplines. Having oral surgery residents will attract the more difficult oral surgery patients (oral carcinoma or maxillofacial surgery), and these residents will be available for 24-hour coverage, thereby encouraging major cases to be admitted to the hospital. Oral surgeons will also refer dental emergencies to the emergency room, which will also be a potential source of admissions. The relationship of medicine and dentistry can also be found in the following programs: cleft palate teams, head and neck surgery, temporomandibular joint (TMJ) problems, maxillofacial surgery, and mandibular fractures. These programs will encourage physicians to admit patients with these health care needs to the hospital as the full range of services are available. There are many reasons for a hospital to evaluate all possible alternatives for survival of hospital ambulatory dentistry or to evaluate the start of a program.     

Indicating analgesics in oral health care

A representative survey amongst Dutch dentists and oral and maxillofacial surgeons showed that almost all of them indicated analgesics regularly. Thirty-five% of the dentists advised their patients in case of one or several tooth extractions to use analgesics. Forty-seven % of these dentists advised using the analgesics before the pain starts. After similar treatments, 89% of the oral and maxillofacial surgeons indicated analgesics and 73% advised taking the analgesic preventatively. Also in the case of other treatments oral and maxillofacial surgeons advised more often than dentists using analgesics preventatively. Dentists usually advised paracetamol and oral and maxillofacial surgeons a non-steroidal anti-inflammatory drug. Most dentists and all oral and maxillofacial surgeons thought that they had enough knowledge about the side-effects and interactions of analgesics. The majority of the dentists and oral and maxillofacial surgeons indicated that they would like to be updated on analgesia by post-graduate education occasionally     

头颈肿瘤患者加速康复外科方案

本项目经过历时6个月的一系列建设性会议完成。利益相关者包括口腔颌面外科医师、耳鼻咽喉科医师、麻醉师、营养师、物理治疗师、言语和语言治疗师以及护理人员。基于目前的文献证据和本团队共识,制定了一个针对头颈肿瘤患者的加速康复外科方案,本方案可供国内相关专业人员参考实施。