The influence of 2020 coronavirus lockdown on presentation of oral and maxillofacial trauma to a central London hospital.

The novel coronavirus COVID-19 was first identified in China in December 2019. Its spread resulted in a pandemic, with the United Kingdom entering a period of national lockdown on 23 March 2020 to reduce disease burden on the National Health Service (NHS). King's College Hospital is a Major Trauma Centre serving an inner-city population of 700,000 with 120,000 patients attending the emergency department (ED) annually. We aimed to determine the effect of lockdown on OMFS trauma presentations and lessons learned from emergency service provision during a pandemic. All referrals to the oral and maxillofacial surgical (OMFS) team from ED during the first six weeks of the lockdown period - 23 March 2020 - 3 May 2020 - were compared with the same six-week period in 2019. A total of 111 referrals were made to OMFS during the first six weeks of the lockdown period in 2020 compared with 380 referrals in 2019. Of these, 50.5%, (n=192) were related to facial trauma in 2019 vs (63.1%, n=70) in 2020. Fewer patients were admitted under OMFS: 17.4% (n=35) in 2019 vs 2.9% (n=2) in 2020, and a greater number of patients were discharged from OMFS care directly from the ED: 63.2% (n=127) in 2019 vs 82.9% (n=58) in 2020. There was profound effect of the lockdown on referrals to OMFS from the ED, in number and type of diagnosis. This is potentially reflective of the increased availability of acute/emergency dental services in South-East London during the lockdown period. This gives us valuable insight for service planning in the event of further restrictions.

Complications encountered in a prospective series of 182 patients treated surgically for mouth cancer.

Outcomes of surgical treatment for patients with mouth cancer can be limited by the risk of perioperative complications. This study identifies factors that predict for complications in such patients. Between 1992 and 2000, 182 patients had surgery for mouth cancer. The patient, their medical and surgical characteristics as well as perioperative complications were identified. Univariate analysis was carried out to determine which characteristics were associated with complications. Complications occurred in 85 patients (47%). Fifty-three percent of the complications were of intermediate severity and 15.6% were major. The operative death rate was 3.2%. Factors predicting complications included pre-existing cardiovascular (p<0.01) and respiratory disease (p=0.02), alcohol consumption (p<0.01), stage of disease, nature and scale of surgery, duration of surgery (p<0.01). Tracheostomies (p<0.01, OR 3.05), poor differentiation of tumour (p<0.05) and presence of extracapsular spread were predictive of complications. Patients with more complications are at increase risk of operative death or dying with head and neck cancer (p=0.04). Complications were also analysed into those that may be related to surgical technique and medical management. 113 (37%) complications were in this category. Factors influencing complications are multifactorial. Identification of risk factors allows individualised approach should improve outcome of treatment.

Endoscopically assisted operative retrieval of parotid stones.

The treatment of large parotid stones remains a problem. We describe a technique in which microendoscopy is used to locate the stone and facilitate its removal. Over a 12-month period, eight patients were treated and seven stones removed successfully. The remaining duct was obstructed by a stricture. In six instances, the parotid duct was repaired and in two ligated. The mean follow up was 10 months (range 6-18) and there have been no complications. Our initial experience suggests that microendoscopy to locate the stone and facilitate its removal is an option in the management of persistent parotid stones.

Perioperative complications and survival in patients with oral cancer.

This study identifies factors that predict for outcome and complications in patients with mouth cancer. Out of a total of 276 patients, one third received radiotherapy alone and the remainder surgery (182) of which 62 also received adjuvant radiotherapy. Factors predicting an adverse outcome at a univariate level were male gender, recurrent disease, no partner, co-existing systemic disease (abdomen and respiratory), alcohol intake, non Caucasian, stage of disease, scale of surgery, decreasing differentiation of tumour, increasing hospital stay and blood loss. On multivariate analysis, female gender, reduced scale of surgery, absence of recurrence, excess alcohol consumption, increased hospital stay and duration of surgery were predictive of improved survival. Complications occurred in 85 patients (47%). Predictive variables on univariate analysis were preexisting cardio-respiratory disease, alcohol consumption, stage of disease, nature and scale of surgery. The 5 year disease specific survival was 87% for stage I, 75% for stage II, 62% for stage III and 43% for stage IV with a 3.2% operative death rate.