Assessing the Compliance of Randomized Controlled Trials Published in Craniofacial Surgery Journals With the CONSORT Statement.

BACKGROUND: Randomized controlled trials (RCTs) are gold standard assessments for healthcare interventions. The Consolidated Standards of Reporting Trials (CONSORT) statement was published to maximize RCT reporting transparency. The authors conducted a systematic review to assess current compliance of RCTs published within craniofacial surgery with the CONSORT statement. METHODS: The Thomson Reuters Impact Factor Report 2016 was consulted to identify craniofacial surgery journals. PubMed was used to search for recent RCTs published within the 5 journals identified. Two independent researchers assessed each study for inclusion and performed data extraction. The primary outcome was compliance of each RCT with the CONSORT statement. Secondary outcomes were the pathology and interventions examined, impact factor, multi-versus-single center, number of authors, and publication date. RESULTS: Eighty-six studies met the inclusion criteria, across which a median of 56% (range 33%-94%) applicable CONSORT items were reported. The 5 least reported items were: trial design (3a); registration number and name of trial registry (23); who generated random allocation sequences, enrolled participants, and assigned participants to interventions (10); sample size determination (7a); mentioning "randomized trial" in the title (1a). CONCLUSION: The compliance of craniofacial surgery RCTs with the CONSORT statement requires improvement. Areas in need are identified, and methods to improve reporting transparency, are discussed.

Improving Burns and Plastic Surgery Induction Programmes: A Departmental Quality Improvement Project.

BACKGROUND: Changes to the undergraduate medical curriculum now offer a greater focus on community-based teaching, communication skills and medical humanities. Unfortunately, this has been at the expense of surgical teaching. The senior house officer is usually the first port of call when a patient is being referred to a plastic surgery department. Therefore, a reasonable level of knowledge is required with regard to emergency presentations, examination skills, and clinical skills to appropriately manage the injury. The primary aims of this quality improvement project are to firstly improve the newly starting doctor's confidence in undertaking an on-calls in either trauma or burns following the induction programme and to also improve their level of satisfaction. METHODS: The Quality Improvement Project (QIP) team consisted of a Foundation Year 2 doctor, a core surgical trainee, and a registrar. Three Plan, Do, Study, Act (PDSA) cycles were completed to improve the quality of the induction programme. In the first PDSA cycle, junior doctors were provided with a handbook that covered necessary topics regarding burns and plastic surgery. In the second cycle, a structured presentation which included case-based discussions, was incorporated into the trauma aspect of the induction. Finally, in the third cycle, a structured presentation which included case-based discussions, was incorporated into the burns aspect of the induction. Data was collected in the form of a questionnaire one month following the departmental induction for each cycle. The questionnaire assessed the doctor's confidence levels and degree of satisfaction with the induction programme. Students were also given the opportunity to complete written descriptive feedback at the end of the questionnaire. Furthermore, pre- and post-induction questionnaires on the day of induction for the December and April cohort of doctors were also obtained.  Results: A total of 16 doctors completed the questionnaires. Overall satisfaction, confidence in undertaking trauma on-calls, and confidence in undertaking burns on-calls improved from 3.84/5, 1.83/5, and 2.67/5 in the first cycle to 4.6/5, 3.6/5, and 3.6/5 in the third cycle, respectively. Satisfaction with the clinical emergencies and case discussions aspect of the induction programme improved from 2.17/5 in the first cycle, to 4.6/5 in the third cycle. With regards to the pre- and post-induction questionnaire on the day of induction, the December cohort's correct answer percentage improved from 58.3% to 94.4%, and the April cohort improved from 47.2% to 93.3%. CONCLUSION: Whilst it is unlikely to completely prepare new junior doctors for the transition into clinical practice in a unique speciality such as burns and plastic surgery, our study highlights the value of a thorough, multi-stage induction in ensuring junior doctors feel confident to deliver high quality and safe patient care.

A systematic literature review and narrative synthesis on the use of autologous cartilage in the repair of orbital fractures.

Introduction: Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if herniation of globe content occurs. Various studies have demonstrated the use of autologous cartilage grafts in the reconstruction of orbital fractures. Methods: A systematic review protocol was registered with PROSPERO, and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. Results: Seven thousand one hundred seventy-one articles were identified following a comprehensive literature search. These articles were filtered for relevance and duplication, which reduced the number of articles to 16. A total of 259 patients underwent orbital reconstruction with the use of autologous cartilage. Conchal cartilage was harvested in 148 patients, auricular cartilage in 22 patients, nasoseptal cartilage in 72 patients, and costal cartilage in 17 patients. Thirty, seven, twelve, and four complications were observed in patients where cartilage was harvested from the concha, auricle, nasoseptum and rib, respectively. Most common complications included diplopia (n=23), infra-orbital para/anaesthesia (n=27), and enophthalmos (n=7). No failure of graft or donor site morbidity were observed in the studies. Conclusion: Autogenous materials such as cartilage can be used as an alternative for orbital reconstruction. Cartilage was considered by the authors to provide adequate structural support to the orbital contents, and that it was easy to harvest, shape, and position.

Bisphosphonate therapy in the management of diffuse sclerosing osteomyelitis of the mandible: a systematic review and narrative synthesis.

Background: Diffuse sclerosing osteomyelitis (DSO) affecting the mandible is an uncommon condition characterised by recurrent pain and functional disturbances. Traditional treatments involving antibiotics, steroids, and analgesics have generally yielded unsatisfactory results. Numerous articles have proposed the utilisation of bisphosphonate therapy as an alternative approach to achieve sustained symptom relief. This study aims to consolidate the available evidence on the effectiveness of bisphosphonate therapy in managing DSO. Methods: A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies were devised, and studies were screened based on predefined inclusion and exclusion criteria. Results: Ten articles met the eligibility criteria, encompassing a total of 135 patients diagnosed with DSO who received bisphosphonate treatment. All included studies consistently reported a reduction in pain levels and swelling, along with a decrease in the cumulative use of analgesics. The majority of patients reported long-lasting symptom improvement with bisphosphonate therapy. Notably, four studies documented improvements in maximal mouth opening, with one study reporting a mean increase of 9.6mm. Furthermore, six studies observed improvements in panoramic radiographs and cone beam computed tomography scans, with one publication describing two patients exhibiting near-normal bone architecture. Importantly, all studies reported the absence of long-term complications. Conclusions: Bisphosphonate therapy emerges as a promising treatment modality for DSO, exhibiting efficacy in symptom alleviation and radiological enhancement while conferring lasting benefits. Nevertheless, further prospective studies are warranted to refine treatment protocols and substantiate these findings.

Exploring Aesthetic Outcomes and Complications in Auricular Reconstruction Utilising Autologous Cartilage: A Systematic Review and Narrative Synthesis.

Auricular reconstruction remains a challenging procedure, requiring a high degree of manual dexterity and attention to detail in order to reconstruct the complex three-dimensional geometry of the ear successfully. Most techniques will rely on autologous cartilage for auricular framework fabrication, carrying a risk of donor and recipient site morbidity. The aim of this report is to investigate the complications and aesthetic outcomes associated with autologous cartilage harvest in auricular reconstruction. A systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies for four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. The literature search identified 7171 articles. Filtering for relevance and duplication reduced the number of articles to 52. A total of 12,215 patients underwent auricular reconstruction utilising autologous cartilage. Indications included 11,696 patients due to microtia, 334 patients due to burns or trauma, 70 patients due to constricted ears, and 115 patients due to prominent ears. The most commonly reported donor site complications included chest wall deformities (n = 159). The most commonly reported recipient site complications included hypertrophic or keloid scars (n = 279), haematoma (n = 155), tissue expander exposure (n = 111), cartilage or framework exposure (n = 122), and cartilage framework deformation or resorption (n = 50). Although a challenging procedure, auricular reconstruction utilising autologous cartilage is possible. Exceptional aesthetic results can be achieved when performed by a skilled surgeon on appropriately selected individuals. However, the potential risks and complications associated with the procedure should be discussed with the patient and family beforehand.

A retrospective cohort study on the aetiology and characteristics of maxillofacial fractures presenting to a tertiary centre in the UK.

Introduction: Approximately 3 million facial injuries occur annually, some of which result in maxillofacial fractures. The aim of our study was to evaluate the aetiology and characteristics of maxillofacial fractures presenting to the Queen Elizabeth Hospital in Birmingham. Methods: The medical records for 809 patients treated for maxillofacial fractures were retrospectively reviewed between the dates of 01/01/2016 to 30/06/2017. Results: A total of 1381 maxillofacial fractures were recorded. The majority of patients were males (n = 682, 84.3%) with a male:female ratio of 5.59:1. The age group with the highest number of admissions was the 26-50 years age group (n = 395, 48.8%). Assaults was found to be most frequent aetiological factor for maxillofacial fractures in the male cohort and falls was the leading cause of maxillofacial fractures in the female cohort. The most common fractured site in our study was the mandible (n = 599, 43.3%) with the angle and symphysis/parasymphysis regions of the mandible being the most susceptible to injury. Teams that were more frequently involved in the care of these patients included ophthalmology (n = 86) trauma and orthopaedics (n = 53), neurosurgery/neurology (n = 95) teams. Conclusion: Socioeconomic status plays a significant role in the aetiology of facial fractures. Furthermore, assaults and falls were found to be the leading aetiological factors for maxillofacial fractures in the male and female cohorts respectively. There is a need to develop strategies in preventing falls in care homes, and addressing violence in young people through public awareness campaigns via the public health sector to reduce the incidence of such fractures.

A systematic literature review and narrative synthesis on the risk factors for developing affective disorders in open lower-limb fracture patients.

Background: Despite the advancements made in the management of the physical complications of open lower-limb fractures, few studies have been performed which investigate the association of such injuries with affective disorders. The complications resulting from this injury may result in significant psychological distress. Aim: To evaluate the risk factors associated with the development of affective disorders, in patients with open lower-limb fractures. Methods: A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. A comprehensive literature search was performed to gather relevant papers. Two independent reviewers screened titles and abstracts according to the inclusion and exclusion criteria. Results: 2488 were screened according to the inclusion and exclusion criteria resulting in seven articles eligible for inclusion. Of the seven articles, two assessed for PTSD, one assessed for depression and PTSD concurrently, two assessed for anxiety and depression concurrently, and two assessed for psychological distress. With the exception of two studies, open lower limb fracture patients were included with other lower-limb injuries in their analysis. Furthermore, not all variables were available in all included studies. Risk factors identified included post-operative pain, mechanism and severity of injury, age of patient, social support and social deprivation. Conclusions: Further studies are required within this area. However, addressing risk factors such as pain management, poor social support and inappropriate coping mechanisms, may reduce the incidence of affective disorders by equipping patients with necessary psychosocial resources.

Spontaneous retropharyngeal haematoma with direct oral anticoagulant medication.

A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery.