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Take a closer look at the faces that are at the heart of our profession – now on display at RCS England, the home of surgery. [ABSTRACT FROM AUTHOR]

Objective: This study reviewed all rhinology clinical negligence claims in the National Health Service in England between 2013 and 2018. Method: All clinical negligence claims held by National Health Service Resolution relating to rhinology in England between 1 April 2013 and 1 April 2018 were reviewed. Results: There were 171 rhinology related claims with a total estimated potential cost of £13.6 million. There were 119 closed claims (70 per cent) with a total cost of £2.3 million, of which 55 claims resulted in payment of damages. Over three quarters of all rhinology claims were associated with surgery (n = 132). Claims associated with endoscopic sinus surgery had the highest mean cost per claim (£172 978). Unnecessary pain (33.9 per cent) and unnecessary operation (28.1 per cent) were the most commonly cited patient injuries. Conclusion: Patient education and consent have been highlighted as key areas for improvement from this review of rhinology related clinical negligence claims. A shift in clinical practice towards shared decision making could reduce litigation in rhinology. [ABSTRACT FROM AUTHOR]

Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Correction to: A 10-year study of penetrating head and neck injury by assault in the North East of England The original article can be found online at https://doi.org/10.1007/s10006-021-00980-w B Correction to: Oral and Maxillofacial Surgery (2021) b https://doi.org/10.1007/s10006-021-00980-w The above article was published online with error. [Extracted from the article]

Abstract: Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a well-established relationship in the literature. We present a retrospective audit comparing the role of alcohol in maxillofacial trauma between Selly Oak Hospital in Birmingham, United Kingdom and Westmead Hospital in Sydney, Australia, and the association between alcohol involvement and patient demographics, including age, sex, marital status, and employment status. Also presented are the differences between the two centers in terms of mechanisms and types of injuries and the locations where these injuries were sustained. Alcohol was involved in 34.78 and 30.77% of patients at Westmead and Birmingham, respectively. A multiple logistic regression analysis revealed a reduced likelihood of alcohol involvement in episodes of maxillofacial trauma where patients were unemployed (P =.04), and where injuries were sustained secondary to mechanisms other than assault (P <.001) and in locations other than pubs and nightclubs (P =.024). There appeared to be no statistically significant contribution to the likelihood of alcohol involvement by treating center, marital status, patient sex, or age. Alcohol continues to be a strong driving factor in cases of maxillofacial trauma, particularly those due to alleged assault, with a typical patient demographic of the gainfully employed frequenting drinking establishments being most at risk for alcohol-related trauma, most commonly sustaining their injuries secondary to assault. Identifying patient groups most at risk is a key step in developing public health strategies aimed at prevention, and our findings would appear to suggest this group of patients as being the most worthwhile to target with measures aimed at reducing alcohol-fueled maxillofacial trauma. [Copyright &y& Elsevier]

The general features of Neurofibromatosis-1 are outlined and the oral and maxillofacial features described. Two case reports of patients treated in the Department of Sedation and Special Care Dentistry at King's College London Dental Institute are presented, and the dental management of patients with Neurofibromatosis discussed. Clinical Relevance: Neurofibromatosis-1 is a neurocutaneous genetic disease with a prevalence of one in 4000-5000. Dentists may be presented with these patients in their surgery and this article will help them to understand the condition and explain how to manage these patients. [ABSTRACT FROM AUTHOR]

This short article will present an overview of the contents of the Odontological Collection based at The Royal College of Surgeons of England, London. This dentally relevant research source has been accrued over the past two centuries and contains both human and animal cranial material that place a focus on the development of the teeth and jaws. Currently used by a range of researchers in a variety of fields, it is hoped that this brief review will encourage those with a palaeodontological interest to consider the Odontological Collection in data collection or for more general dental investigation. [ABSTRACT FROM AUTHOR]

Aim: Cancelled operations are a major drain on hospital resources. The maxillofacial department at the Leicester Royal Infirmary (LRI) performs at least 14 elective operating sessions each week. A study reported that our cancellation rate or performance indicator (PI) was 0.3% at LR1. The most common reasons for cancellation of procedures at that time were lack of post-operative beds and insufficient operating time. This study aimed to continue to develop a methodology for looking at this complex issue and to further investigate the reasons for delay to assess whether the system could be managed more efficiently. Material and Methods: In this study, the computerised theatre records system has been utilised to investigate the reasons for theatre delays. A retrospective analysis of data for 1212 patients treated in the 1 year period between December 2006 and December 2007 was performed. Results and Conclusions: Eight hundred and forty-nine patients were treated on a day-surgery basis, of which 710 were dentoalveolar procedures and 139 were other operations. The remaining 363 patients were treated as in-patients of which 97 were oncological patients, 84 orthognathic, 35 salivary gland surgery, 65 traumas, and 82 other operations. Sixty-four (5.28%) of these treatment episodes were logged as delayed. The main reasons for delays were related to the ward (17%) or anaesthetist (22%).The operating time consumed 74% of the overall time in theatre complex. The utilisation of operating time was much better for in-patient operations (81%) than day-surgery procedures (64%). Suggestions have been made to reduce theatre delays. [ABSTRACT FROM AUTHOR]

Summary: Introduction: We present a retrospective analysis of 106 radial forearm free flaps (RFFFs) using double venous anastomoses as performed at Northampton General Hospital over an 11-year period. The aim was to assess the failure rate and salvage rate for venous thrombosis of these flaps. Methods: RFFFs were raised with the cephalic vein where possible. The cephalic vein and 1 venae commitantes or 2 venae commitantes (VC) were anastomosed using microscope assistance. The veins were anastomosed end to side on to the internal jugular vein (IJV). Data was collected from patient notes using a proforma and entered onto an Access™ database. Results: Of the 106 RFFFs there was 1 (0.94%) failure at day 9, a presumed arterial failure. None of the 106 RFFFs were returned to theatre for salvage for venous thrombosis. Conclusion: Our results compare favourably with similar published data. Comparable studies gave a mean failure rate of 4% (range of 0–10%) and 7% (range 3–12.5%). We believe our results are due to: 1 – Double venous anastomosis, 2 – end to side anastomosis to the IJV using deep and superficial systems, 3 – initial anastomosis of the cephalic vein low in the neck to shorten ischaemic time. 4 – overnight sedation and ventilation of the patient on the intensive care unit. [Copyright &y& Elsevier]

Abstract: On 7 July 2005 there were four explosions in central London, three almost synchronously and a fourth within an hour. The Royal London Hospital received 208 casualties and the Hospital Major Incident Plan was put into action. We report on the events of that day and the role of the maxillofacial surgeons immediately and in the subsequent 48h. [Copyright &y& Elsevier]

Abstract: 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. [ABSTRACT FROM AUTHOR]

Aim: To analyse the detection rate of oral cancer from referrals to our department and if our department policy of triaging referrals was appropriate. Material and methods: The authors reviewed all oral cancer referrals and urgent oral lesion referrals to the Department of Oral and Maxillofacial Surgery at Peterborough and Stamford National Health Service Foundation Trust Hospitals during 2006. Results: Sixty-three patients were referred in 2006 for lesions that consultant triage suspected may be malignant or referred to be seen urgently. Thirty-three patients were referred by general practitioners and all were subsequently seen within the 2-week rule. Consultant triage of referral letters allocated a further 17 to been seen under the 2-week rule timescale. An additional 13 urgent referrals were classified as not meeting the 2-week rule criteria by the consultant that graded the letter but to be seen within 4 weeks. Conclusion: Our study shows that with consultant triaging of referral letters, a malignancy detection rate of 24% can be achieved. [ABSTRACT FROM AUTHOR]

Third molar surgery is the most frequent procedure carried out by the departments of oral and maxillofacial surgery all over the world. The procedure is accompanied by significant risks, with possible damage to the inferior alveolar and/or lingual nerve being of special concern. Considering these risks of morbidity, it is essential to establish the need of removal. National Institute of Clinical Excellence (NICE) in the United Kingdom introduced guidelines for removal of third molars in 2000, advocating that only pathological third molars should be removed. The following article makes reference to a study carried out in England where third molars are extracted in accordance with NICE guidelines. This study was carried out to assess the compliance of general dental practitioners to the NICE guidelines. It was noted that 95% of the patients referred for third molars extraction fulfilled the criteria set forth by NICE. 11% (15) patients who fulfilled the NICE guidelines criteria refused to undergo removal of third molars. Only 5% (7) patients did not meet referral criteria set by NICE guidelines. These guidelines cut down lot of unnecessary referrals and allowed for organization of the patient load by the secondary referral center, as well as limiting unnecessary surgeries and postoperative complications. There is a dire need to define similar guidelines in Pakistan pertaining to the local needs. [ABSTRACT FROM AUTHOR]

Abstract: A consensus conference organised by the Association of Surgeons of Great Britain and Ireland (ASGBI) and the Association of Surgeons of Training (ASIT) was held at the Royal College of Surgeons of England on 2 September 2005. All Specialist Advisory Committees and specialist associations were represented, except for orthopaedic surgery. The future of both academic surgery and training were discussed. We concluded that the European Working Time Directive, and Modernising Medical Careers are likely to have an adverse effect on future of research in oral and maxillofacial surgery. Most surgeons were concerned about the future of training and the development of surgery in general. [Copyright &y& Elsevier]

An interview with Naimesha Patel, first student on MSc course in Maxillofacial Technology offered at King's College dental school in London, England, is presented. Patel shares her reason for doing the course. She mentions her motivation for applying to do the course. She also describes her career highlights since 1984 when she started her training at King's.

Following the amalgamation on one site of inpatient oral and maxillofacial surgical (OMFS) services serving four towns, patients attending accident and emergency (A&E) departments in Bolton, Burnley and Bury who required specialist OMFS care were transferred to Blackburn. This sometimes led to inappropriate transfer, with inconvenience for patients, sub-standard care and wasted resources. To reduce these problems, a videoconferencing system was established, linking the A&E departments of three peripheral hospitals to the central site. This allowed realtime visualization of patients and their radiographs, discussion between clinicians and transfer of a summary data-sheet. The aim was to improve remote diagnosis and to deliver a cost-effective, high-quality specialist service. In the first 12 months, there were an average of 25 remote consultations per month, with favourable feedback from both patients and clinicians. [ABSTRACT FROM AUTHOR]

We retrospectively analysed the incidence of symptomatic venous thromboembolism (VTE) and associated risk factors in operations under general anaesthesia for cancer of the oral cavity. To identify symptoms related to deep venous thrombosis (DVT) and pulmonary embolism (PE), together with associated risk factors, we reviewed medical records of patients operated on in the department of oral and maxillofacial surgery at the Queen Elizabeth Hospital, Birmingham, United Kingdom, between June 2007 and October 2012. All patients were categorised according to their level of risk of VTE. The incidence of VTE was calculated with univariate associations and odds ratios with related 95% confidence intervals, where possible. In total, 233 patients were included, comprising 244 operations (mean (SD) age at operation 60.9 (13) years). Almost all patients (97%) were classified as having the highest risk of VTE. Swelling of an extremity, expectoration of blood, and tightness of the chest were the most common symptoms for suspected cases. An incidence of 0.41% was found for symptomatic VTE; one man developed a PE 2 days after operation. Associations between the analysed factors and symptomatic VTE were not significant. The development of the complication in oncological oral and maxillofacial operations seems to be rare, even in patients with a high risk. We cannot recommend the use of routine thromboprophylaxis, but it could be advocated in patients with obvious serious risk factors., (Copyright © 2015. Published by Elsevier Ltd.)

The author reflects on the assessment of the Medical Education England (MEE) on the services and training related to oral surgery (OS) offered in the country. He quotes the statement of MEE on the need of OS to be distinguished from oral and maxillofacial surgery's (OMFS) medical specialty. He also elaborates the importance of sufficient training for undergraduate OS studies.

The article reports that professor Bernard Devauchelle has told participants at the British Dental Association (BDA) hospitals group conference held in Cambridge, England in September 2008 that the potential of face transplants for burns and injury patients may be limited by the difficulties of finding suitable donors. He added that a successful transplant depended on the donor and recipient having the same shaped face, being of similar age and having skin of the same color and consistency.

The article discusses the highlights of the "ADA Summer Scientific Meeting" conducted in Sheffield, England on June 14, 2007. It addresses the need to realign the American Dental Association (ADA) and the concept of closer cooperation with the Dental Sedation Teachers Group (DSTG). The development of major oro-maxillofacial surgery was demonstrated by R. Croscher and J. McDonough of Rotherham.

The article reports on the launch of a masters degree in Maxillofacial & Craniofacial Technology at King's College London Dental Institute in England. According to program coordinator Trevor Coward, the program provides opportunities for students to develop and demonstrate extended knowledge and understanding and advanced skills including anatomy, histology and pathology of the dental, oral and facial tissues. The four main components of the course are described.

The article reports the opening of the craniofacial care facility at Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust. The hospital provides complete care of craniofacial deformities in children after they attain the age of 16 years. The article also discusses about various departments available at the facility including oral and maxillofacial surgery and orthodontics.

The author reports that the Royal College of Surgeons of England has decided to allow doctors to carry out face transplants. Despite many reservations, the College has declared physicians may proceed with face transplants with caution if certain minimum requirements are met. The requirements involve physician skills, social issues and psychological considerations.

The article reports that Sachin Sedani, a graduate of London Dental Institute of King's College in London, England, has been awarded the Poplett Prize for distance learning for his outstanding work in his five year study at Kings College in London. Sedani has studied maxillofacial surgery during his elective period in Johannesburg, with a perspective about the treatment of HIV/AIDS patients.

The article presents the position paper of the Royal College of Surgeons of England on facial transplantation. The association stressed that psychological impact on the recipient and on the donor's family, and the ethical concerns must be weighed in dealing with this procedure. To proceed with the operation, further research should be made and the prospect of better control of the complications brought should be first settled down.

Presents various developments in the field of dentistry as published in the November 2000 issue of the 'British Dental Journal.' Availability of government funding for the development of an Oral and Maxillo-facial surgery project in Morecambe Bay, England; Receipt of Kevan Wong, a general dental practitioner, of the Doctorate of Philosophy in Implant Dentistry from the University of London in March 2000.

In the United Kingdom, maxillofacial techniques are underused in the treatment of obstructive sleep apnoea (OSA). We retrospectively analysed the details and relevant clinical data of consecutive patients who had operations for OSA at the maxillofacial unit in Leicester between 2002 and 2012. They had been referred from the local sleep clinic after investigation and diagnosis, and in all cases treatment with continuous positive airway pressure (CPAP) had failed. We compared preoperative and postoperative apnoea/hypopnoea indices (AHI), scores for the Epworth sleepiness scale (ESS), and lowest oxygen saturation to measure surgical success (AHI of less than 15 and a 50% reduction in the number of apnoeas or hypopnoea/hour) and surgical cure (AHI of less than 5). We identified 51 patients (mean age 44 years, range 21-60) with a mean (SD) body mass index (BMI) of 29 (3.4). Most patients had bimaxillary advancement with genioplasty (n=42). Differences in mean (SD) preoperative and postoperative values were significant for all 3 outcome measures (AHI: 42 (17) to 8 (7) p<0.001; ESS: 14 (4) to 5 (4) p<0.001; lowest oxygen saturation: 76% (11%) to 83% (7%); p=0.006). On the postoperative sleep study 85% of patients met the criteria for surgical success. Our experience has confirmed that bimaxillary advancement results in a high rate of success in patients with OSA. The operation has a role in the management of selected patients in the UK who do not adhere to CPAP., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Presents an abstract of the paper 'Autologous Transfusion in Maxillofacial Surgery; recent experience in Southampton,' by N.J. Baker, B.T. Evans and F. Boulton, presented at the Royal College of Physicians of Edinburgh Consensus conference on autologous transfusion in November 1998. Effectiveness of administering pre-deposited autologous blood in adults requiring elective maxillofacial surgery.

The article presents a calendar of events to be held across the world in the fall of 1991. The "Spring Meeting of the British Association of Oral and Maxillofacial Surgeons," will be held on April 12 in Brighton. A conference entitled "24th Annual Advances and Controversies in Clinical Pediatrics," will take place during May 16-18 in San Francisco, California. The "Eighth International Symposium on Radionuclides in Nephrourology," will be held during May 6-8 in Chester, Engalnd.