[Features of medical care provision in the profile «Maxillofacial surgery¼ in the Southern Federal District of the Russian Federation]. / Osobennosti okazaniya meditsinskoi pomoshchi po profilyu «chelyustno-litsevaya khirurgiya¼ v Yuzhnom federal'nom okruge Rossiiskoi Federatsii.

OBJECTIVE: To study the actual state of the organization of medical care for patients with the profile of «maxillofacial surgery¼ in the Southern Federal District of the Russian Federation in order to develop proposals for its optimization within the framework of a three-level system of medical care. MATERIAL AND METHODS: We analyzed accounting and reporting materials characterizing the organization of medical care in the field of «Oral and maxillofacial surgery¼ to the population in the Southern Federal District of the Russian Federation. RESULTS: The population of the Southern Federal District of the Russian Federation is currently provided with accessible round-the-clock medical care in the field of maxillofacial surgery. The forces and means at the disposal of the district government allow this to be implemented. However, the article describes a number of obstacles to the provision of high-quality medical care in the field of maxillofacial surgery and suggests ways to eliminate them. CONCLUSION: Preparation of an Order defining the functioning of a three-level system of medical care for adults and children with maxillofacial pathology in the Southern Federal District of the Russian Federation, as well as more effective use of telemedicine consultations will significantly improve the availability and quality of medical care.

How has COVID-19 affected surgical practice in Oral and Maxillofacial Surgery in the East Midlands, UK?

The impact on the provision of care within the NHS due to COVID-19 can not be understated. It has created various challenges for Oral and Maxillofacial Surgeons due to the high-risk nature of working within this specialty. The aims of this study were to identify the ongoing clinical activities at the height of pandemic, the guidance issued to staff regarding the use of personal protective equipment and the changes to maxillofacial practice. A prospective analysis was commenced within six Oral and Maxillofacial Surgery units in the East Midlands, UK with data being collected by means of a 10-item questionnaire relating to changes in patient care during this time. The responses were analysed to identify compliance with the national guidance produced by the British Association of Oral and Maxillofacial Surgeons. An 87% response rate was obtained (26 respondents from 30 invitations). 73.1% of participants confirmed all surgical members of staff were offered fit tests for FFP3 masks. All units reported a continuation of Head and Neck cancer and emergency operations with a complete reduction in TMJ and orthognathic surgery. FFP3 masks were the most popular masks used for theatre activity whilst FFP2 and surgical masks were more widely used for examining patients and performing procedures in the emergency department. Changes in maxillofacial practice included the use of local flaps compared to free flaps, use of intermaxillary fixation (IMF) where appropriate for craniofacial trauma and routine COVID-19 testing for all inpatients.

Redesigning the Paradigms of Clinical Practice for Oral and Maxillofacial Surgery in the Era of Lockdown for COVID-19: From Tradition to Telesemeiology.

The rise of the COVID-19 pandemic has posed new challenges for health care institutions. Restrictions imposed by local governments worldwide have compromised the mobility of patients and decreased the number of physicians in hospitals. Additional requirements in terms of medical staff security further limited the physical contact of doctors with their patients, thereby questioning the traditional methods of clinical examination. Our institution has developed an organization model to translate the essential clinical services into virtual consultation rooms using a telemedicine interface which is commonly available to patients. We provide examples of clinical activity for a maxillofacial surgery department based on teleconsultation. Our experience is summarized and an organization model is drafted in which outpatient consultation offices are translated into virtual room environments. Clinical examples are provided, demonstrating how each subspecialty of oral and maxillofacial surgery can benefit from virtual examinations. The concept of "telesemeiology" is introduced and a checklist is presented to guide clinicians to perform teleconsultations. This paper is intended to provide an organization model based on telemedicine for maxillofacial surgeons and aims to represent an aid for colleagues who are facing the pandemic in areas where lockdown limits the possibility of a physical examination.

Considerations for Oral and Maxillofacial Surgeons in COVID-19 Era: Can We Sustain the Solutions to Keep Our Patients and Healthcare Personnel Safe?

Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care.

Evolution of COVID-19 Guidelines for University of Washington Oral and Maxillofacial Surgery Patient Care.

The emergence of coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 (SC2) virus, in late December 2019 has placed an overwhelming strain on healthcare institutions nationwide. The modern healthcare system has never managed a pandemic of this magnitude, the ramifications of which will undoubtedly lead to lasting changes in policy and protocol development for viral testing guidelines, personal protective equipment (PPE), surgical scheduling, and residency education and training. The State of Washington had the first reported case and death related to COVID-19 in the United States. Oral and maxillofacial surgeons have a unique risk of exposure to SC2 and developing COVID-19 because of our proximity of working in and around the oropharynx and nasopharynx. The present report has summarized the evolution of COVID-19 guidelines in 4 key areas: 1) preoperative SC2 testing; 2) PPE stewardship; 3) surgical scheduling guidelines; and 4) resident education and training for oral and maxillofacial surgery at the University of Washington, Seattle, Washington.

WhatsApp messaging improves communication in an oral and maxillofacial surgery team.

OBJECTIVE: Smartphones have become very popular among oral and maxillofacial surgeons. WhatsApp is an application that enables users to send voice, text, and multimedia messages using the group communication feature. The purpose of this study was to evaluate the efficiency of WhatsApp messaging as a mode of consultation within an oral and maxillofacial surgery team. MATERIALS AND METHODS: A retrospective study on WhatsApp group conversations amongst oral and maxillofacial surgeons was performed between July 2015 and July 2016. A WhatsApp group consisting of senior and junior surgeons was created, and many consultations were recorded. Seven hundred fifty-six consultations were included in the study. In this study, the arrival and response times of messages, types of cases, timing of consultation's end, consultant locations, contents of multimedia messages, and the categories/types of messages were evaluated. During consultations, some cases were discussed with text messages via WhatsApp, and some cases with voice and image messages via WhatsApp, with or without WhatsApp text messages. In addition, several cases were discussed with video messages via WhatsApp. Thus, a total of 1747 messages reflecting four different message types were included in this study: 754 (43%) were text messages, 752 (43%) were photographic images, 213 (12%) were videos, and 28 (nearly 2%) were voice messages. RESULTS: The most frequent consultations concerned impacted teeth (n = 363, 48.01%). Most consultations were resolved using WhatsApp (n = 306, 64.4%), and consultants were often not in the hospital during these consultations (n = 411, 54.3%). Most messages sent by consultants were conclusive (n = 306, 74.4%). CONCLUSION: We conclude that WhatsApp is a simple, free, and practical application, which allows efficient consultation when consultants are not in the hospital.

Practice Management in Oral and Maxillofacial Surgery.

Managing an oral and maxillofacial surgery (OMS) practice has undergone dramatic changes. Electronic health records, privacy laws, revenue cycle management, online marketing, and the rise of dental service organizations (DSOs) present increased daily complexity for oral and maxillofacial surgeons in private practice, hospital-based employees, and academic surgeons. This article is structured to discuss the role of DSOs, private equity in OMS, online practice marketing, accounting and tax considerations, and modern essentials of practice management.

Early experience of a nurse-led clinic in a tertiary centre.

A busy head and neck or oral and maxillofacial (OMFS) National Health Service (NHS) clinic treats patients with many different conditions. A large proportion will have cancer of the head and neck, and they will be at different stages of their treatment. Their clinical needs may be different from a larger group of patients who have been referred through the "two-week wait" referral pathway, and who are present in the same clinic for their biopsy results. We present our early experience of "fast-track" referrals and their potential effect on the overall volume of work. They are only a small number of the patients who are typically seen in a nurse-led clinic.

[Oral and maxillofacial surgery residency training in the United States: what can we learn].

China is currently in the process of establishing formal residency training programs in oral and maxillofacial surgery and other medical and dental specialties. Regulatory agencies, and educational and academic institutions in China are exploring mechanisms, goals and standards of residency training that meet the needs of the Chinese healthcare system. This article provides an introduction of residency training in oral and maxillofacial surgery in the United States, with emphasis on the accreditation standard by the Commission on Dental Accreditation. As there are fundamental differences in the medical and dental education systems between China and United States, the training standards in the United States may not be entirely applicable in China. A competency-based training model that focus on overall competencies in medical knowledge, clinical skills and values at the time of graduation should be taken into consideration in a Chinese residency training program in oral and maxillofacial surgery.

Clinical Pathway Implementation Improves Efficiency of Care in a Maxillofacial Head and Neck Surgery Unit.

PURPOSE: Clinical pathways have become an important and simple method of improving patient outcomes and decreasing health care resource usage. The purpose of this study was to evaluate early outcomes associated with the implementation of a clinical pathway in a maxillofacial head and neck surgery unit. MATERIALS AND METHODS: This investigation is a retrospective cohort study of patients who underwent microvascular reconstruction of the head and neck from January 1, 2014 through December 31, 2014. Continuous variables were compared among 4 groups using analysis of variance or Kruskal-Wallis test, and categorical variables were compared using χ2 test or Fisher exact test where appropriate. The primary predictor variable was use of the clinical pathway. Groups included patients treated by surgeon A during periods before and after implementation of a postoperative clinical pathway. Two groups treated by surgeon B also were evaluated during the same periods and served as external controls. Each period covered a span of 6 months. Outcome variables across groups were evaluated, including length-of-stay metrics, infection rates, transfers to the intensive care unit, and unplanned return to the operating room. RESULTS: Sixty-six patients who underwent microvascular head and neck reconstruction were included. There was a significant decrease in the average length of stay (P = .0364) and an increase in the rate of discharge within 7 days (P = .0416) in the group treated with the clinical pathway. Other outcomes, including infection rate, transfer to the intensive care unit, and unanticipated return to the operating room, showed no relevant difference among groups. CONCLUSIONS: The results of this study suggest that implementation of a clinical pathway can be beneficial for efficient management of postoperative care in the setting of microvascular head and neck reconstruction. More predictable and shorter lengths of stay are achievable and the clinical pathway serves as a valuable means of improving communication of the clinical care team.

Associação entre o tempo cirúrgico e infecção pós-operatória na exodontia de terceiros molares / Association between surgical time and postoperative infection in third molar surgery

Introdução: Os quadros de infecção constituem a principal complicação associada a exodontia de terceiros molares. Apesar da baixa incidência, em torno de 10%, tendo em vista o grande número de procedimentos realizados em todo o mundo, o número absoluto de casos de infecção também tende a ser elevado. Apesar disso, o uso rotineiro de antibiótico profilático tem sido questionado em função da sua eficácia, efeitos colaterais, custo e principalmente pela crescente emergência de microorganismos resistentes. Na tentativa de racionalizar o uso de antibióticos, diversos trabalhos tem procurado estimar o risco de infecção baseado em aspectos relacionados ao paciente, ao procedimento cirúrgico e às características anatômicas e radiográficos do dente porém, tendo em vista o grande número de variáveis envolvidas e à forte interação entre elas, não se conseguiu, ainda, um modelo capaz de ponderar de forma confiável e reprodutível todas essas variáveis. Supondo que o tempo cirúrgico possa fazer essa ponderação, o objetivo deste estudo foi tentar correlacionar o tempo cirúrgico

e o índice de infecção pós-operatória na exodontia de terceiros molares. Material e métodos: Foram realizadas 349 cirurgias em 197 pacientes saudáveis com indicação de exodontia de ao menos um terceiro molar. Todos os pacientes foram operados com a mesma técnica cirúrgica e dose única de antibiótico pré-operatório. A variável primária do estudo foi o tempo cirúrgico e o desfecho a presença ou ausência de infecção de acordo com os parâmetros clínicos definidos pelo "Center for Disease Control" (CDC). Também foram avaliados a interação entre idade, gênero, posição do dente e experiência do cirurgião com o tempo cirúrgico. Resultados: A incidência de infecção foi de 4,6% e houve uma clara associação entre tempo cirúrgico e infecção, inclusive na análise multivariada (OR=1,017, IC95% =[ 1,001; 1,034 ], p=0,043), sendo que todos os casos infectados tiveram tempo cirúrgico superior a 30 minutos. Conclusões: O tempo cirúrgico pode ser usado como indicador de risco para infecção na exodontia de terceiros molares podendo definir a conduta de antibioticoterapia pós-operatória.

Introduction: Postoperative infection is the most common complication associated with third molar extraction. Despite the low incidence, around 10%, considering the large number of surgerys performed around the world, the absolute number of postoperative infections also tends to be high. Nevertheless, the routine use of prophylactic antibiotics is controversy, due to its side effects, cost, and mainly by the increasing emergence of resistant microorganisms. In attempt to rationalize antibiotics prescription, several studies have tried to estimate the postoperative infection risk based on patient related aspects, surgical procedure and tooth anatomical and radiographic characteristics but with little succsess, because of the large number of variables involved and their strong interaction. The aim of this study is to correlate the surgical procedure time and the postoperative infection rate in third molar surgery. Methods: We performed 349 surgeries in 197 healthy

patients with at least one third molar to be removed. All patients were operated with the same surgical technique and single-dose preoperative antibiotic. The primary variable was the surgical time and the outcome, the presence or absence of infection according to the clinical parameters defined by the "Center for Disease Control" (CDC). We also assessed patients age, gender, tooth posítion and surgeon experience. Results: The incidence of infection was 4.6% and there was a clear association between operative time and infection, even in the multivariate analysis (OR = 1.017, 95% CI = [1.001, 1.034], p = 0.043), and all infected cases had surgeries lasting more than 30 minutes. Conclusions: Operating time can be used as an risk indicator for infection in third molar surgery and thus can define the postoperative antibiotic therapy.

The healthcare system and the provision of oral healthcare in European Union member states. Part 2: Spain.

Spain is the second largest EU Member State with an area of 504,645 km(2) and is the fifth most populated one with a total of 46.5 million inhabitants. The number of dentists working in Spain has grown rapidly in the last 20 years. In December 2014, there were 33,346 practising dentists with a ratio of one dentist for every 1394 inhabitants. Oral health of children has improved; with a fall in the national mean DMFT index (decayed, missing and filled permanent teeth) among 12-year-olds, from 4.20 in 1984 to 1.12 in 2010. The percentage of the population that has visited a dentist within the last three months has risen from 13.5% (1987) to 16.9% (2011-2012). Forty-three percent of the Spanish population visited a dentist in the last year in 2009. The Spanish National Health System (SNS) provides comprehensive cover for general health, but very little oral healthcare for adults. Only emergency care and oral surgery (dental extractions) for adults are provided in publicly funded clinics. The vast majority of oral health care is provided in the private sector and over 90% of dental professionals work in the private sector. Nevertherless, children aged 7-15 years are covered (with some restrictions) by publicly funded oral healthcare with different care models, depending on the local health authority, and some of them are funded by a capitation system which was introduced 25 years ago.