Educational paper: research in oral and maxillofacial surgery

Training in oral and maxillofacial surgery (OMFS) requires undergraduate degrees in both medicine and dentistry. When trainees in other surgical specialties may be pursuing a higher degree in research or education, OMFS trainees will be studying for their second undergraduate degree. It is possibly therefore that the specialty is weak in terms of doubly qualified university academics who have been trained in the full and extended curriculum OMFS. Research is recognised in all applications to United Kingdom and Ireland specialist training programmes, and points are awarded, though many juniors who enter these will have found it difficult to do any research during their careers to date. With changes in specialist training it may become even more difficult to obtain a research degree, although with the introduction of the National Institute for Health Research Integrated Academic Training (academic clinical fellowships/clinical lectureships) there is renewed hope that enthusiasm for academic OMFS will be reignited. In this paper we try to provide an idea of the opportunities available to OMFS trainees in academia and research.     

The role of qualitative research in oral and maxillofacial surgery

Oral and maxillofacial research has utilised predominantly quantitative research approaches and qualitative methodologies have been applied with very narrow scope. Although qualitative surgical research is increasing in popularity there is a lack of patient voice within extant research and important aspects of patients’ experiences including preparation, perceptions of well-being, and functional outcomes are potentially overlooked. This provides researchers with significant opportunities to devise approaches that expand our understanding of the social contexts surrounding surgical interventions and associated outcomes and to develop better-informed approaches to research and practice. Reflecting on a novel research project involving OMFS patients this paper seeks to outline some distinct advantages of qualitative research based on researcher reflections. Firstly, we contend that understanding patients as collaborators within the research process helps to establish a research design that reflects the context and complexities of the phenomenon under investigation and increases the precision of the concepts being addressed. Secondly, interactive group-based data collection approaches create a space in which patients are able to explore aspects relating to OMFS. Thirdly, we suggest that patient interaction optimises the quality of data by providing participants with the opportunity to engage in conversation with those who understand the treatment processes. The final advantage concerns the intentional involvement of patients within the data analysis phase. We contend that interactive approaches to data collection and analysis where data are collected, analysed, compared and refined as new data are acquired helps to develop a conceptual explanation for the phenomenon in question that is both significant and relevant to the setting being studied. We conclude with recommendations for future research.     

Piezosurgery in oral and maxillofacial surgery

This review summarizes current knowledge and experience with piezosurgery, a promising, meticulous and soft tissue-sparing system for bone cutting, based on ultrasonic microvibrations. The main advantages of piezosurgery include soft tissue protection, optimal visibility in the surgical field, decreased blood loss, less vibration and noise, increased comfort for the patient and protection of tooth structure. To date it has been indicationed for use in oral and maxillofacial surgery, otorhinolaryngology, neurosurgery, ophthalmology, traumatology and orthopaedics. The main indications in oral surgery are sinus lift, bone graft harvesting, osteogenic distraction, ridge expansion, endodontic surgery, periodontal surgery, inferior alveolar nerve decompression, cyst removal, dental extraction and impacted tooth removal. In conclusion, piezosurgery is a promising technical modality for different aspects of bone surgery with a rapidly increasing number of indications throughout the whole field of surgery.     

透明质酸及其在口腔颌面外科领域的研究应用

透明质酸是一种酸性粘多糖,有独特的分子结构和理化性质,生理功能多样,可润滑关节,调节血管壁的通透性,调节蛋白质、水电解质扩散及运转,促进创伤愈合等。目前,透明质酸已广泛应用于临床各科室,该文将对透明质酸的结构、合成与代谢、在口腔颌面外科中的应用作一综述。     

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.     

Cosmetic oral and maxillofacial surgery

The dental specialty of oral and maxillofacial surgery over the last fifteen years has been intimately involved in not only altering the bony facial skeleton, but also the esthetic defects of the facial soft tissue drape. These procedures are currently being taught, in many of our residency programs, along side the art and science of dentoalveolar surgery. When one combines the modification of both the skeletal and soft tissues, the resultant effect can be greater than the sum of its parts. Should one take this a step further and add to the list, proper arch form as prepared by the orthodontist along with cosmetic shape and appearance of the dentition by the restorative dentist using the latest in cosmetic dental techniques, what transforms is a result that has never been seen heretofore in the annals of dentofacial care. To follow are a number of case reports illustrating some salient points.     

Amniotic membrane in oral and maxillofacial surgery

Purpose

Following its renaissance in ophthalmology during the 1990s, preserved human amniotic membrane (HAM) has become an attractive biomaterial for all surgical disciplines. This article reviews the current and potential use of HAM in oral and maxillofacial surgery, its postulated properties and common preservation techniques.

Methods

Literature was identified by an electronic search of PubMed in July 2012; this was supplemented from the reference lists of the consulted papers.

Results

HAM has been used in the field of oral and maxillofacial surgery from 1969 onwards because of its immunological preference and its pain-reducing, antimicrobial, mechanical and side-dependent adhesive or anti-adhesive properties. The effects of HAM on dermal and mucosal re-epithelialisation have been highlighted. Typically, HAM is applied after being banked in a glycerol-preserved, DMSO-preserved or freeze-dried and irradiated state. Whereas the use of HAM in flap surgery and in intra-oral and extra-oral lining is reported frequently, novel HAM applications in post-traumatic orbital surgery and temporomandibular joint surgery have been added since 2010. Tissue engineering with HAM is a fast-expanding field with a high variety of future options.

Conclusions

Preserved HAM is considered to be a safe and sufficient biomaterial in all fields of oral and maxillofacial wound healing. Recently published novel indications for HAM application lack a high level of evidence and need to be studied further.     

Computed tomography in oral and maxillofacial surgery

The use of computed tomography (CT) in oral and maxillofacial surgery is discussed. The CT scan delineates lesions in the oral and maxillofacial complex to aid in planning of surgical treatment. Case examples are presented, and the indications for the use of CT scanning are discussed.     

Arteriography in oral and maxillofacial surgery.

A brief review of the methodology of selective external carotid arteriography is presented together with its risks, complications, and contraindications. The indications for this procedure are described with illustrative case material to demonstrate its usefulness in both diagnosis and preoperative evaluation of various types of lesions of the head and neck that may be encountered in the practice of oral and maxillofacial surgery.