United Kingdom immigration and emigration of oral and maxillofacial Surgery (OMFS) specialists 2000-2020: how might Brexit impact on OMFS?

The United Kingdom left the European Union (EU) in January 2020. As it is unclear how many of the rights of OMFS surgeons to travel and work will remain after the transition period, we have reviewed how these rights have been used in the past. The OMFS specialist list from the GMC was compared with a database of current OMFS colleagues. Data were analysed using WinStat® (R. Fitch Software). Of 494 active surgeons on the OMFS specialist list, 23 (5%) completed their OMFS training outside the UK. Of these, 22 were specialists from Europe of whom 12 were substantive NHS consultants with others working as Fellows or visiting the UK occasionally. Two per cent of UK OMFS consultants are -specialists from Europe, the majority from Greece. Of the OMFS specialists who completed training in the UK since 1995, 24 are currently working outside the UK, and of them, 16 left the UK to return to their nation of origin (all 11 of those working in the European Economic Area [EEA] were born there). Of the seven UK-born specialists working overseas, none was working in the EEA. Twenty per cent of UK trainees whose primary degree was known (n = 117) received their primary qualification outside the UK, 38 in from the EU, and 79 from further afield. The majority of these UK trained specialists with non-UK first degrees (n = 101) stayed in the UK to work after training. The most significant impact of Brexit on OMFS could be a restriction on the opportunity for non-UK doctors and dentists to come to the UK to train and stay to work.

European OMFS in the time of Brexit - where did the UK fit and how might the future look?

INTRODUCTION: The specialty of OMFS in the UK is a dual degree specialty which was recognised in Europe within Annex V of Directive 2005/36/EU. Currently UK law matches that of the EU. Brexit may change this. DIRECTIVE 2005/36/EU: Defines two specialties within European nations, Dental, Oro-Maxillo-Facial Training DOMFS (Basic dental & medical training) and Maxillofacial Surgery (basic medical training). The UK sat within DOMFS and so specialists from DOMFS nations could travel and work in the UK. Specialists from all other nations were required to use the Certificate of Eligibility for Specialist Registration (CESR) route. DIRECTIVE 2013/55/EU: This directive updated 2005/36/EU regarding Mutually Recognised Professional Qualifications (MRPQ) including creating an international alert system for doctors in difficult Entry onto the UK OMFS Specialist List by CESR Route CESR application is a large and complex portfolio of evidence to demonstrate knowledge, skills and experience are equivalent to a Certificate of Completion of Training (CCT) holder. To date, no EU applicants have successfully completed a CESR application. UNION OF EUROPEAN MEDICAL SPECIALISTS (UEMS): Even after Brexit, the UK will remain a full member of UEMS. The OMFS Section of UEMS is a source of information and support for specialists wishing to work in other nations and for nations wishing to develop an OMFS specialty in their nation. ACCESS TO UK OMFS TRAINING FOR NON-UK TRAINEES: Applicants meeting the person specifications for approved OMFS specialty training (ST) posts in the UK are welcome to apply to the national selection process for OMFS specialty training in the UK. Many have done so successfully. Fixed term appointments and Fellowships are advertised and represent a useful route to gain support for application for training or through the CESR Route. CONCLUSIONS: The UK remains part of the diverse OMFS community in Europe. There is support from within the UK and from UEMS for trainees and specialists interested in coming to the UK to train or to work.

[Inverted papilloma: implications for the oral and maxillofacial surgeon]. / Invertiertes Papillom: Konsequenzen für den Mund-Kiefer-Gesichtschirurgen.

7 patients with inverted papillomas of the maxillofacial area were subjected to a post-treatment evaluation. Inverted papillomas were found in maxillary and frontal sinuses, ethmoid cells, nasal septa and as isolated lesions in the mucosa of the mandibular alveolar process. Apart from an inverted papilloma, one patient also had a mucoepidermoid carcinoma. The tendency to recur correlated well with the surgical approach. Radical removal of the mucosa must be called for as primary therapy in the paranasal sinus area. In order to safely exclude a concurrent carcinoma, the entire resected material must be examined histologically.

[Aspects of systemic analgesia in patients with incurable oral cancer]. / Aspekte der systemischen Analgesie bei Patienten mit inkurablem Mundhöhlenkarzinom.

When pain occurs in the final stage of a tumor disease, the administration of analgetic drugs in effective dosages may often be the most important treatment measure. In the years 1982 to 1987 a total of 83 oral cancer patients from our clinic died, 16 of them during their last stay in hospital. These histories have been evaluated in retrospective. Central and peripheral analgesics and neuroleptics had been applied. 25% of the patients required no analgetic drugs. Prediction of the analgesic dosage required was impossible, because of the variables tumor expansion, localization, lymph node involvement and the treatment provided. Individual analgesia using low-dose oral morphine on a step by step scheme remains indispensable.

Degradation of even-numbered reduced and non-reduced hyaluronate oligosaccharides with D-glucuronic acid or N-acetyl-D-glucosamine as non-reducing terminal by chondroitin ABC and AC lyases.

Chondroitin ABC and AC lyases split hexosaminidic linkages in galactosaminoglycans and hyaluronic acid. Even-numbered oligosaccharides from hyaluronic acid with either D-glucuronic acid or N-acetylglucosamine in non-reducing position were used, prior to and after reduction with sodium borohydride, as substrates for chondroitin ABC and AC lyases. These substrates allowed elucidation of the effects of the nearest neighborhood of the bond to be split on the action of the enzymes. The results indicate that chondroitin ABC lyase acts strictly as an endolyase towards hyaluronate and requires the presence of a disaccharide in both reducing and non-reducing positions of the endohexosaminidic bond to be split. None of the hexosaminidic bonds of the tetrasaccharide GlcNAc-GlcUA-GlcNAc-GlcUA is split by chondroitin ABC lyase. In contrast chondroitin AC lyase acts also as an exoglycosidase towards hyaluronate and recognizes only the amino sugar and the uronic acid residue that are linked via the hexosaminidic bond which is split. Thus, the N-acetylglucosamine and glucuronic acid residues at both ends of a tetrasaccharide with the structure GlcNAc-GlcUA-GlcNAc-GlcUA are liberated.