Oral and Maxillofacial Surgery

Glomangioma: rare case of a painful lump in the upper lip Publication date: Available online 23 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): A.R. Hamilton, A. Paton, J.J. Downie Abstract Glomus tumours in the lip are extremely rare with only 13 cases, including this one, recorded in the English language that we know of. We report a 45-year-old woman with a firm, mildly painful lump in her upper lip. Excisional biopsy examination and histopathological analysis showed it to be a subtype of glomus tumour called a glomangioma.

Correlation study of increase of pharyngeal airway space after mandibular advancement, taking natural head position into consideration Publication date: Available online 23 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): Xiaozhen Lin Abstract The increase in the pharyngeal airway space after mandibular advancement has not been well explained, and in this study we aimed to show whether there is a correlation in the increase of pharyngeal airway space as a consequence of the mandibular advancement or of the relative change between the mandibular position and the natural head position (NHP). Fifteen patients who had bilateral sagittal split osteotomy for mandibular advancement with or without genioplasty were studied retrospectively. The primary variables of mandibular position, NHP, and pharyngeal airway space were measured in three dimensions using preoperative and postoperative cone-beam computed tomographic datasets and were compared using the paired t test. The secondary variable of pharyngeal airway space was defined as the square root of the mean cross-sectional area (CSA1/2) of the pharyngeal airway space. Pearson’s correlation coefficient was used to find out whether there was a correlation between the change in CSA1/2 and the change in mandibular position, or the relative change between the mandibular position and the NHP. Volumes and minimal cross-sectional areas were increased in the pharyngeal airway space, and lengths of airways decreased. Correlation existed only between the increase in CSA1/2 and the relative change between the mandibular position and NHP. The increase in pharyngeal airway space after mandibular advancement correlated with the relative changes between the mandibular position and the NHP.

McLaughlin’s legacy in the current treatment of facial palsy Publication date: Available online 23 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): A. Poker, E. Pescarini, C. Nduka, R.Y. Kannan Abstract Charles Redmond McLaughlin was a pioneer in both facial palsy surgery and in facial plastic surgery (East Grinstead, 1946-1969). Thanks to his work, the personalised treatment of facial palsy was begun.

Amniotic band syndrome with Tessier number 4 and 7 clefts: a case report Publication date: Available online 20 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): Z. Yang, Q. Liang, K. Ouyang, Z. Piao

Lightweight cast to support the upper limb after harvest of an osteocutaneous free flap from the radial forearm: a technical modification Publication date: Available online 14 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): N.I. Adam, J.V. Williams, M.W.S. Ho

Association between methylenetetrahydrofolate reductase polymorphisms and non-syndromic cleft lip with or without palate susceptibility: an updated systematic review and meta-analysis Publication date: Available online 12 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): X. Shu, S. Shu, L. Yang Abstract Methylenetetrahydrofolate reductase (MTHFR) polymorphisms are thought to be involved in the development of cleft lip with or without cleft palate (NSCL/P), but published results are contradictory. We therefore designed an updated meta-analysis to pool eligible studies and to evaluate further the possible relations between MTHFR polymorphisms (c.677C > T and c.1298A > C) and susceptibility to NSCL/P. A comprehensive search based on PubMed, Medline, Web of Science, and Embase databases was made up to February 2018. Twenty-three case-control and 10 case-parent trio studies (including 1149 cases and 1161 controls) were retrieved. Odds ratio (OR) with 95% CI were used to estimate the pooled strength of association under different genetic models. The Q test and I2 test were used to estimate heterogeneity among studies, the quality of which was assessed using the Newcastle-Ottawa scale. In the MTHFR c.677C > T polymorphism group, there were significant overall results for the recessive (OR 1.231, 95%CI 1.092 to 1.387) and homozygote (OR 1.252, 95%CI 1.078 to 1.456) models. Subgroup analysis by subjects and ethnicity identified only associations in European mothers for the recessive model and the homozygote model. For the c.1298A > C group, there were no significant results for either European or Asian patients for all genetic models. The MTHFR c.677C > T polymorphism might increase susceptibility to NSCL/P in European mothers, but was negatively associated in Asian patients, and the MTHFR c.1298A > C polymorphism is not involved in the development of NSCL/P in either European or Asian patients.

The specialist management of non-temporomandibular orofacial pain: maxillofacial surgery’s known unknown? Publication date: Available online 12 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): D.H. Awal, K. Amin, C. Venda-Nova, A. Naqvi, J. Zakrzewska Abstract The management of orofacial pain is considered to be within the remit of oral and maxillofacial surgery (OMFS). In this study we aimed to provide an overview of the healthcare “journey” of a group of patients referred to a specialist unit with “complex” non-temporomandibular orofacial pain. We retrospectively reviewed all those who were referred over a six-month period and followed for up to three years. A total of 133 were included, 69% were female, and the mean (SD) duration of symptoms before assessment was 66.4 (88.8) months. Patients were treated for seven different conditions by a mean (SD) of 2.6 (1.2) specialties, and 3.2 (2.5) medications had been tried before assessment at the unit. A mean (SD) of 3.9 (3.3) appointments were attended over the three years, and 80% of patients were prescribed at least one medication. Patients were under the care of the unit for a mean (SD) of 11.9 (14.0) months, and 38% were still being seen at three years. Those with trigeminal neuralgia were most likely to remain in care at three years (p = <0.001), and those with burning mouth syndrome (p = <0.001) or persistent idiopathic facial pain (p = 0.005) were most likely to be discharged. In the current NHS climate, the lack of resources to treat facial pain and the focus on a mix of skills, mean that OMF surgeons are likely to have an increasing role in the treatment of these patients. This paper provides an important insight into these conditions.

Outcome of sentinel lymph node biopsy in early-stage squamous cell carcinoma of the oral cavity with methylene blue dye alone: a prospective validation study Publication date: Available online 11 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): J.R. Vishnoi, V. Kumar, S. Gupta, A. Chaturvedi, S. Misra, N. Akhtar, P. Agarwal, N. Jamal, P. Pareek Abstract Our aim was to evaluate the feasibility and role of sentinel lymph node (SLN) biopsy using methylene blue dye alone in identifying occult lymph node metastases in early oral cancer (cT1, T2, and cN0). The study was done from 2013–15 in 94 patients in a large cancer centre. The blue nodes were dissected and sent for frozen section, routine histopathological examination, and immunohistochemical testing for cytokeratin, and was followed by elective neck dissection in all patients. The identification rate was 93.61%. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for frozen section and haematoxylin and eosin (H&E) staining were 84.6%, 100%, 100%, 93.9% and 95.5%, respectively. Occult lymph node metastasis was seen in 27.6% cases. Biopsy of SLN with blue dye alone might be used successfully with good sensitivity and negative predictive value in countries with limited resources in the developing world. Immunohistochemistry contributes to it by increasing the sensitivity and NPV, and thereby improves the diagnostic value.

Economic analysis of a low-cost virtual surgical planning protocol for mandibular reconstruction: a case series Publication date: Available online 11 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): C. Spaas, O. Lenssen Abstract The aim of this study was to make an economic analysis and evaluation of a low-cost virtual surgical planning (VSP) protocol that was developed in house, and based on open-source software and a desktop 3-dimensional printer. All eight patients between April 2014 and 2015 who had been treated by mandibular reconstructions with microvascular fibular flaps that had been planned using the protocol were retrospectively analysed for accuracy, time, and cost. Median differences for planned compared with postoperative intercondylar distance, intergonial distance, and gonial angle did not differ significantly. A median (range) labour time of 85 (€57-124) minutes was needed. An evaluation of cost, including labour, showed an additional median (range) cost/patient of € 276 (€257.50-297.25). With the acquisition cost of the 3-dimensional printer omitted, there was a negligible additional cost/patient of €44.75 (€26.25-66). All planning was done by the junior surgeon and there was a steep learning curve. Our new VSP protocol is cost-effective, easy to use, and has an accuracy comparable with that of a standard VSP protocol. To the best of our knowledge this is the first report of an open-source software protocol in which the labour costs of the planning by a surgeon are included.

New surgical treatment for a ruptured carotid artery near the skull base Publication date: Available online 9 July 2019 Source: British Journal of Oral and Maxillofacial Surgery Author(s): L.k. Li, J. Liu, F. Chen, D. Lv, D. Deng