The New Zealand oral and maxillofacial surgeon workforce in 2017-18: characteristics, practice and prospects.

AIM: To describe and consider the findings of a workforce survey of New Zealand Oral and Maxillofacial Surgeons (OMS) which was conducted in 2017-18, and to compare those to findings from a similar survey undertaken in 2001. METHODS: A questionnaire was used to obtain information on the qualifications, sociodemographic characteristics and and practising circumstances of all practising OMS in New Zealand. Data were analysed using SPSS (version 24). After the computation of descriptive statistics, cross-tabulations were used to identify differences in proportions (with those tested for statistical significance using Chi-squared tests), and analysis of variance was used to examine differences in means. RESULTS: All 39 OMS took part. There were 17 medically qualified surgeons who also held a surgical fellowship, comprising just under half of the workforce. Overall, one in eight surgeons worked solely in the public sector, while just under one-quarter worked solely in private; the remainder worked in both sectors. Dentoalveolar procedures were by far the most common undertaken (with considerably more done by older surgeons than younger ones), followed by implants, the treatment of facial trauma, skin lesions and surgery for malignancy. Orthognathic surgery and dentoalveolar trauma procedures were the least commonly reported. Only two-thirds of surgeons participated in public on-call work. While 95% of surgeons were indeed satisfied with their work, the lowest rate was observed among those working solely in the public sector, where it was 80%; among those working exclusively in private, it was 100%. Between 2001 and 2017-18, the proportion of medically qualified surgeons rose from just over one-quarter to more than two-thirds. The proportion of surgeons working solely in private practice rose from one in seven to almost one-quarter. There were marked increases in the mean number of malignancies dealt with and implants provided. CONCLUSION: The findings highlight a number of problems-some long-standing, others emerging-in New Zealand's OMS system. Fewer surgeons are participating in public sector provision and there is stress on those who remain. Workforce planners should be aware that more resources need to be put into training surgeons who will take up hospital appointments and provide essential after-hours emergency services.

The variable position of the inferior alveolar nerve (IAN) in the mandibular ramus: a computed tomography (CT) study.

INTRODUCTION: This study was designed to quantify the important anatomical landmarks and the path of the inferior alveolar nerve (IAN) within the human mandibular body and ramus, in particular with reference to the bilateral sagittal split osteotomy (BSSO). MATERIALS AND METHODS: Four hundred and eleven CT scans were studied, 299 of these were involved in determining the position of lingula; and 230 were involved in determining the course of IAN in the mandibular molar region, namely from the mesial of the mandibular first molar to the distal of the mandibular second molar; 118 were involved with both measurements. RESULTS: On average, the lingula was located 17.0 ± 2.2 mm from the external oblique ridge; 11.6 ± 2.0 mm from the internal oblique ridge; 17.2 ± 2.7 mm from the sigmoid notch; and 15.6 ± 1.9 mm from the posterior border of the mandible. The course of the IAN in the mandibular molar region was found to descend vertically from the distal of the mandibular second molar (7) to reach its lowest point between the first and second molars (6 and 7), and then ascend towards the mesial of the first molar (6). Horizontally, the IAN was found to traverse medially between the distal of the 7 and the middle of the 7, and then changes its path laterally towards the mesial of the 6. CONCLUSION: Precise knowledge of the individual's position of the IAN will help surgical planning.

Surgically-assisted rapid maxillary expansion of narrowed maxillae: a case-cohort study.

AIMS: The aim of this study was to investigate a consecutive cohort of surgically-assisted rapid maxillary expansion cases to determine the indications, results and relapse associated with the procedure. METHODS: The records of 21 cases of SARME treated by the Oral and Maxillofacial Surgery and Orthodontic units at the University of Adelaide were examined. Overall expansion and subsequent relapse were compared on study models and posteroanterior cephalometric radiographs against the variables of age, gender, surgeon, surgical technique, final occlusion and the retention period. Statistical analysis was performed on paired variables. RESULTS: Maximum expansion was gained across the intermolar width and the most relapse identified across the canines. Male patients showed statistically greater stability across the intercanine width. There were otherwise no significant relationships between the treatment variables, stability or relapse. CONCLUSIONS: SARME is a safe surgical technique for narrowed maxillae requiring intermolar expansion of 6 mm or more. Overexpansion of up to 60% is required to compensate for relapse.

Oral Lesion as the first Clinical Presentation in Sarcoidosis: A Case Report.

Sarcoidosis is a common multi-system disease characterized histolopathologically by the formation of non-caseating granulomas in the affected tissues. The oral involvement of sarcoidosis is relatively rare with less than 70 reported cases in literature while an oral lesion as the initial presenting sign is even less common. Oral lesions of sarcoidosis may mimic the lesions of other serious systemic diseases including Crohn's disease and tuberculosis as well as lesions localized to the orofacial region such as orofacial granulomatosis. This report presents a case of non-progressive sarcoidosis where the initial presenting symptom was a lesion in the buccal vestibule attached to the gingivae. A brief review of the pathology and clinical features is also presented.

A sheep model of intracapsular condylar fracture.

PURPOSE: An animal model of a condylar head fracture similar to a type B intracapsular fracture in humans was created. The effect of this model on mandibular function and morphological changes of temporomandibular joint (TMJ) structure was evaluated. MATERIALS AND METHODS: Ten sheep were divided into 3 groups, sacrificed at 1 week (2 sheep), 4 weeks (4 sheep), and 12 weeks (4 sheep) after surgery. The right side of the TMJ was considered the surgical group; the left side, the control group. The anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. The condyle fragment was pushed together with the disc anteriorly, inferiorly, and medially. The lateral side of the condylar stump was sutured to the capsule to limit movement. Preoperative and postoperative body weight, maximum mouth opening, lateral excursions, and x-ray and computed tomography (CT) findings in the 3 surgical groups and the control group were recorded. The SPSS software program was used for all statistical analyses. RESULTS: There were no significant differences in weight loss and left lateral movement among the 3 surgical groups, but maximum mouth opening and the right lateral movement decreased significantly in the 4-week and 12-week surgical groups. X-rays demonstrated severe bone erosion and new bony outgrowth in the lateral side of the condylar stump and a narrowed, indistinct joint space in these 2 groups. Three-dimensional reconstruction of CT images showed changed contours of the condylar stump, condylar fragment and articular eminence in all 3 surgical groups. CONCLUSIONS: This study demonstrates progressive changes toward ankylosis and pathological changes in sheep TMJ over time consistent with what has been found in humans.

Effect of auricular cartilage graft in the surgical treatment of temporomandibular joint ankylosis: An animal study using sheep.

PURPOSE: The purpose of this study was to test the functional and histologic fate of an auricular cartilage graft used in reconstruction of an ankylosed sheep temporomandibular joint (TMJ). MATERIALS AND METHODS: Five sheep were used in this study. TMJ ankylosis was induced in the right joints and the left joints were used as controls. The ankylosed TMJ was released by gap arthroplasty with an interposed auricular cartilage graft at 3 months. The sheep were sacrificed at 3 months after the arthroplasty. The maximal mouth opening was measured pre- and postoperatively. The joints were evaluated radiologically and histologically. RESULTS: Maximal mouth opening was maintained after placement of an auricular graft into the gap arthroplasty. Radiographically the surfaces of the temporal bone and ramus stumps were irregular, but radiolucent gaps were formed between them. Histologically, the auricular cartilage graft was alive and well attached to the mandibular ramus stump. In all operated joints, there was joint space between the grafted cartilage and temporal bone, with the space filled with fibrous connective tissue, which was oriented parallel to the temporal surface. CONCLUSION: Auricular cartilage graft with gap arthroplasty is useful in preventing reankylosis after TMJ gap arthroplasty for ankylosis.

The effect of autogenous costochondral grafts on temporomandibular joint fibrous and bony ankylosis: A preliminary experimental study.

PURPOSE: The purpose of this study was to test the functional and histologic fate of costochondral grafts (CG) in temporomandibular joint (TMJ) reconstruction for unilateral ankylosis in the sheep. MATERIALS AND METHODS: Five pure-bred adult Merino sheep were used. Ankylosis was induced by articular damage, disc removal, and placement of a bone graft. At 3 months, a gap arthroplasty was performed with a CG from the thirteenth rib. The sheep were sacrificed 3 months after CG reconstruction. The range of jaw movements were recorded at first operation, at lysis of ankylosis, and at sacrifice. The joints were examined radiologically, macroscopically, and histologically. RESULTS: All sheep showed a decrease in masticatory function, as shown by weight loss and decreased jaw opening, during the ankylosis period. On release, they regained weight and increased the range of jaw movement. Histologically, the joint space was filled with fibrous tissue. However, the partial spaces around the CG head were covered by fibrous tissue and/or fibrous cartilage. CONCLUSIONS: This study shows that, when CGs are used with a gap arthroplasty in a fibrous and bony ankylosed TMJ, masticatory function is restored.

Diagnostic evaluation of an ultrathin 15,000 fiberoptic arthroscope: comparison of arthroscopic and histologic findings in a sheep model.

PURPOSE: An ultrathin 15,000 fiberoptic-based arthroscope was evaluated for the detection of osteoarthritic intra-articular pathologies in sheep temporomandibular joints. MATERIALS AND METHODS: Osteoarthritis was bilaterally induced in the temporomandibular joints in sheep. Twenty osteoarthritic temporomandibular joints were arthroscopically examined and rated with use of the ultrathin arthroscope. The arthroscopic observation was then compared with the histologic findings. RESULTS: The arthroscope provided excellent vision of the osteoarthritic joints. Correlation between arthroscopic and histologic findings was 80%. CONCLUSION: The recently developed ultrathin (15,000) arthroscope was found to be a highly reliable and efficient tool to diagnose joint space pathologies of the osteoarthritic temporomandibular joint.

Practice activity trends among oral and maxillofacial surgeons in Australia.

BACKGROUND: The aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time. METHODS: All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. RESULTS: Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). The rate of provision of services per visit changed over time with increased rates observed overall (from 1.43 +/- 0.05 services per visit in 1990 to 1.66 +/- 0.06 services per visit in 2000), reflecting increases in pathology and reconstructive surgery. No change over time was observed in the provision of services per year (4,521 +/- 286 services per year in 1990 and 4,503 +/- 367 services per year in 2000). Time devoted to work showed no significant change over time (1,682 +/- 75 hours per year in 1990 and 1,681 +/- 94 hours per year in 2000), while the number of visits per week declined (70 +/- 4 visits per week in 1990 to 58 +/- 4 visits per week in 2000). CONCLUSIONS: The apparent stability in the volume of services provided per year reflected a counterbalancing of increased services provided per visit and a decrease in the number of visits supplied.

The transmandibular implant: a 5- and 15-year single-center study.

PURPOSE: Fifty-eight patients (average age, 60 years) with gross mandibular atrophy had transmandibular implants inserted between 1984 and 1988. This study reports on their progress at 5 and 15 years. PATIENTS AND METHODS: In both 1991 and 2000, 50 cases were reviewed, with the other 8 lost to follow-up. Detailed surveys, using exactly the same format, were conducted to determine the outcome of transmandibular implant treatment. The records were reviewed and surviving patients with transmandibular implants were examined. RESULTS: An overall success rate of 80% in 1991 had fallen to 56% by 2000, with a total of 22 implants being removed. CONCLUSION: Factors involved in failure were age and medical infirmity of the patients, gross mandibular atrophy, and the use of several surgeons, in particular, trainees. This survey shows that the TMI has a progressive long-term failure rate and that extreme care needs to be taken in both patient selection and implant placement.