Changing patterns of penetrating neck injuries at a London-based level 1 major trauma centre: a five-year review.

Penetrating neck trauma is becoming a more frequently encountered presentation in UK emergency departments. Although largely attributable to violent crime, other aetiologies are on the rise. This study aimed to review changes in the pattern of penetrating neck injury (PNI) over a five-year period at our level 1 major trauma centre. Data were retrospectively collected on all patients presenting to the emergency department with PNIs between 2016 and 2021. The number of these injuries doubled between 2016 and 2021, accounting for 11% of all penetrating trauma in 2021. The majority of patients were male (87%). Violence remained the predominant aetiology but numbers of self-harm-related PNIs trebled between 2018 and 2021. PNIs are on the rise. These injuries remain complex to manage and require a multidisciplinary approach. Tackling violent crime remains essential in combating PNIs, but focus must also be placed on identifying and supporting individuals most at risk of deliberate self-harm from a deterioration in mental health.

Choosing Juvéderm Volux™ to chin augmentation: Case report and flowchart for clinical evaluation.

INTRODUCTION: The development of filler biomaterials with high hyaluronic acid concentrations, cohesiveness, and elastic modulus has become an option for chin augmentation, as the balance of these rheological properties promotes high lifting capacity, providing minimally invasive perceptible improvements in patient appearance. PRESENTATION OF CASE: The present study reviewed clinical and anatomical aspects of patients referred for chin augmentation and created a flowchart to assertively diagnose patients with an indication of Juvéderm® Volux™ for defining the lower third of the face. DISCUSSION: The chin is vital for facial proportions and attractiveness perception. Its relevance to facial appearance is noticed the most when chin size is less than ideal, making other facial areas seem larger or smaller. The adjacent soft tissues of the neck and jaw appear prematurely aged when chin projection or width is inadequate. Hyaluronic acid-based fillers have a confirmed history of safe and effective use for treating facial volume loss or deficiency. CONCLUSION: Juvéderm® Volux™ is a safe, effective, and long-lasting alternative for restoring and creating facial volume and sculpting, shaping, and contouring the chin and jaw.

Attitudes and perceptions of medical and dental students on the implementation of non-surgical facial aesthetics in their curricula.

There is an accelerated demand for non-surgical facial aesthetics (NSFA) encompassing the use of botulinum toxin and dermal fillers. Healthcare professionals may either treat NSFA-related complications in the public sector or practise in the private sector. Currently, there is no standardised undergraduate teaching in the UK to educate healthcare professionals on NSFA. The aim of our study was to compare medical and dental undergraduate students' perceptions and awareness of NSFA, and to understand its role if implemented in each curriculum in the UK. An online questionnaire was devised and distributed via social media platforms to medical and dental students across the UK. Student responses were anonymised and collated as quantitative data, and subsequently analysed. Of the 146 respondents, 89% had no previous teaching on NSFA. Ninety-three per cent of medics and 75% of dentists agreed or strongly agreed that non-surgical aestheticians require dental or medical knowledge to deliver NSFA, and 66% of medics and 75% of dentists agreed or strongly agreed that NSFA should be incorporated into the undergraduate curriculum. Only 7% of medics and 8% of dentists were aware of the steps required to practise NSFA. Incoming doctors and dentists are showing interest in the field yet have no formal teaching in the area. Requiring healthcare professionals to have some baseline understanding of NSFA and its associated complications means that implementing formal education on the subject in the medical and dental curricula is an important consideration.

Debt experience and sources of funding in OMFS training: A survey of current and aspirant OMFS trainees.

Oral and Maxillofacial Surgery is unique specialty requiring dual qualification in medicine and dentistry. Since the inception of national recruitment a decade ago, only 70% of available posts have been filled. In a 2019 round, this was a worrying 30%. Questionnaires were sent to trainees at various levels via the Facebook JTG and Registrar groups. Data were collected on debt experience, and awareness of and access to financial assistance. We received 66 responses. The most important sources of funding were NHS work (46%), followed by student finance (25%). Of those surveyed, 79% were 'concerned' or 'very concerned' about debt. Respondents were interested in receiving more information on a range of sources of funding, such as non-NHS bursaries (81%), NHS bursaries (59%) and NHS work in OMFS (56%). Respondents identified the financial impact (44%), and the effect of personal and family life (41%) as the two biggest drawbacks to second-degree studies. In view of the persistent recruitment issues at the ST3 level in OMFS, it is important to address concerns surrounding second-degree study. Awareness of available support must be raised in order to safeguard the future of our specialty in its current format.

Penetrating trauma during a global pandemic: Changing patterns in interpersonal violence, self-harm and domestic violence in the Covid-19 outbreak.

INTRODUCTION: The restrictions imposed on social activity in response to the Covid-19 pandemic have had a profound impact globally. In the UK, the NHS was placed on a war-footing, with elective surgery, face-to-face outpatient clinics, and community care facilities all scaled back as a temporary measure to redistribute scarce resources. There has been concern during this period over increasing levels of violence in the domestic setting, as well as self-harm. METHODS: Data was collected on all patients presenting with traumatic penetrating injuries during the 'lockdown' period of 23rd March to 29th April 2020. Demographics and injury details were compared with the same period in the two preceding years. RESULTS: Overall trauma fell by 35% compared with the previous year. Over one in four penetrating injuries seen were a result of self-harm, which was significantly higher than in previous years (11% in 2019, 2% in 2018). There were two cases of injuries due to domestic violence, while a total of 4 cases of injury arose in separate violent domestic incidents. Self-harm commonly involved penetrating injury to the neck. DISCUSSION: Our centre has seen an increase in the proportion of penetrating injuries as a result of both self-harm and violence in the domestic setting. The number of penetrating neck injury cases, which can represent suicidal intent or a major presentation of psychiatric illness, is of particular concern. We must further investigate the effect of social restrictions on violent injury, and how home confinement may influence a changing demographic picture of victims.

Penetrating head & neck trauma - Epidemiology and injury characteristics in terror-related violence, interpersonal violence and deliberate self-harm at a level 1 trauma centre.

INTRODUCTION: Penetrating trauma to the head and neck presents specific clinical challenges. Aetiologies include interpersonal violence, deliberate self-harm and terror-related violence. King's College Hospital is a Major Trauma Centre serving inner-city London boroughs with a high incidence of knife and gun crime. It also received victims of the terrorist attack at London Bridge in June 2017. METHODS: Data was collected prospectively on all patients presenting with penetrating trauma to the head and neck over a one-year period (August 2016-July 2017). RESULTS: Overall figures for penetrating trauma are the highest since comparable records began with 478 cases (2016/17) compared with 172 (2010/11). Most patients had injuries resulting from interpersonal violence (83%); a group consisting mostly in males (88%) under the age of 30 (69%). The sole fatality among all patients was a result of repeat deliberate self-harm. Terror-related violence victims were equally gender split and older; all patients in this group required surgical intervention and had longer lengths of stay (16.3 days) compared with interpersonal violence (6.3 days) and deliberate self-harm (3 days). CONCLUSION: Violent crime is increasing. Overall penetrating injury has more than doubled in 6 years. The injury characteristics observed are distinct depending on the assailants and motives. Head and neck trauma requires a multidisciplinary approach, with an understanding of the care needs of patients. Interpersonal violence is the most common aetiology and as such efforts to tackle rising violent crime must involve police and the community. In addition, terror-related violence is evolving in the United Kingdom and globally, and as such healthcare professionals must understand differences in aetiologies to promote optimal patient care.