A 21-year analysis of the publication patterns and level of scientific evidence in three major oral and maxillofacial surgery journals.

High-quality research in surgical sciences is constrained by a number of barriers including funding, blinding, adjusting for surgical experience, and inability to recruit sufficient numbers. As a result, surgeons have been reported to accept lower levels of scientific evidence to validate procedures. Our study analysed the quantity and quality of publications in three journals in Oral and Maxillofacial Surgery over a 21-year period. A retrospective analysis of all issues published between 1998 and 2018 in the International Journal of Oral and Maxillofacial Surgery, the British Journal of Oral and Maxillofacial Surgery and the Journal of Oral and Maxillofacial Surgery was conducted. A total of 14,324 articles were analysed and grouped according to their National Health and Medical Research Council of evidence. The analysis revealed that there has been a promising increase in both the quantity and quality of publications with statistically significant increases in each of the variables analysed. We found a statistically significant increase in the number of articles published in the most recent decade compared with the previous decade across the three journals. The level of evidence also increased during the study period, with greater numbers of level I and II studies being published in more recent years. These findings were found to be statistically significant (P˂0.001).

The contemporary management of third molars.

The management of third molars requires a significant assessment and decision process both for the patient and the clinician. The clinician must always identify the indication for third molar surgery, assess the risks of the proposed procedure, and then modify their plan to account for the patient's current and future health, their social and financial setting, and the patient's tolerance of risk. In doing this, the clinician can tailor a solution to meet the individual patient's needs. This decision to remove a third molar is made in the fluid setting of the patient's quality of life and requires regular review. This article gives the clinician the tools, the matrix, and the confidence to guide patients through this process, and outlines some of the pitfalls and common points of bias within the process.

Referral patterns of general dental practitioners for bone grafting and implant placement.

BACKGROUND: Dental implant rehabilitation is a well-established procedure often conducted in the general dental practise setting. The outcomes for implant placement are reliable when the recipient site is favourable. The goal of this study was to assess the accuracy with which general dental practitioners (GDP) assess the bone volume available for implant placement and their referral patterns for implant sites, which may require bone grafting. METHODS: Fifty-three GDP were surveyed and asked to assess five different scenarios and cone-beam scans for difficulty (0, 'no difficulty'; 5, 'the most difficult'), and bone grafting requirements ('yes'/'no' and 'who to perform'), prior to implant placement. RESULTS: The GDP assessment of difficulty for the cases was: no graft required, 1.88; aesthetic zone involvement, 3.25; vertical deficiency, 2.8; sinus lift required, 3.68; and horizontal deficiency, 4.4. GDP seemed to have some difficulty identifying which cases required a bone graft, occasionally grafting a site with sufficient bone (12.5%), or not grafting a site with insufficient bone (45-75%). CONCLUSIONS: These results show that GDP are accurate in assessing the difficulty of an implant case and conservative when it comes to attempting these complex cases. GDP are less confident when it comes to recognizing cases that require bone grafting, and what options are available.

Facial fractures in football: incidence, site, and mechanism of injury.

Football injuries are responsible for many of the maxillofacial injuries sustained during sporting activities. In the Australian Capital Territory (ACT), the four major types of Australian football are played in large numbers and up to a high standard. Our objective was to analyse maxillofacial fractures that were sustained during rugby league, rugby union, Australian rules, and soccer matches. We retrospectively studied 134 patients with maxillofacial fractures during the five-year period 2010-14. All patients were assessed and treated at Canberra Hospital, the major trauma centre in the ACT. Data collected from patients' records included type of football, age, sex, mechanism of injury, site of injury, and treatment. The number of people registered to play was obtained from each football governing body to find out the incidence of fractures. League had the highest incidence of facial fractures, followed by union, Australian rules, and soccer. High speed and high collision football (league and union) had a higher rate of mandibular fractures than high speed and low contact football (Australian rules and soccer) (n=43, 45% compared with n=7, 21%). Australian rules and soccer had a higher incidence of midface fractures than league and union (n=26, 79%, compared with n=52, 55%). Clash of heads was the leading cause of fractures. Collisions against other players' shoulders and forearms were more likely to cause mandible fractures. Ninety-four patients (70%) required surgical intervention. Football-related maxillofacial fractures occur regularly, and different types of football have predictable patterns of injury. Padding of the heads and elbows of players may reduce the number and seriousness of facial fractures.

Out-of-hours maxillofacial trauma surgery: a risk factor for complications?

Recent literature from general and orthopaedic surgery as well as anaesthetic viewpoints has identified that operations performed outside normal work hours pose potential risks for both patients and healthcare workers. This is in contrast to the increasing pressure for 24h surgical availability for the public and the desire to reduce waiting times for patients. Further, there is evidence of the effects of fatigue on reducing performance. The authors aim to compare outcomes of maxillofacial trauma surgery performed in and out of normal work hours. Retrospective analysis was carried out on all maxillofacial trauma surgery under general anaesthesia at a tertiary referral hospital over a 14-month period. Outcomes of patient mortality, injury severity, patient demographics and operation duration were analysed with reference to two groups: in-hours (0800-1700 Monday to Friday) and out-of-hours (1700-0800 Monday to Friday as well as all operations performed Saturday and Sunday). 134 patients/procedures met the inclusion criteria, 53 out-of-hours and 81 in-hours. A statistically significant (p=0.05) higher complication rate (13%) was found in the out-of-hours cases compared to the in-hours cases (4%). The potential implications for this result on the need for increased availability of dedicated in-hours maxillofacial trauma operating lists at major hospitals are discussed.

Tennis racquets in the jaw: eosinophilic granuloma.

A healthy 4-year-old boy presented with a 4 month history of episodic pain and swelling of his left jaw which appeared to respond to antibiotics. An ultrasound, orthopantomogram (OPG), CT scan and MRI revealed a 3 cm well circumscribed lesion in the left mandible near, but not related to, his posterior molar teeth. The radiological differential diagnosis included a mandibular abscess or neoplasm such as Ewing's sarcoma, or Langerhans cell histiocytosis (LCH). A fine needle aspirate (FNA) was performed. The cytology, in conjunction with the immunohistochemistry (S100 protein and CD1a expression by the histiocyte-like cells) and electron microscopy (demonstrating Birbeck bodies) showed features characteristic of LCH. The boy was treated with an intra-lesional injection of methyl prednisolone with radiological and clinical evidence of regression of the lesion. Localised LCH is also known as eosinophilic granuloma (EG). Its pathogenesis is unknown, although recent studies suggest it is a disease that results from mononuclear phagocyte dysregulation that may be infective, autoimmune or neoplastic in origin. EG is rare, usually affecting children 5-15 years. The jaws are affected in 10-20% of cases with mandible involvement more common in adults. No consensus exists for the optimal therapy which includes curettage, intra-lesional prednisolone and chemotherapy.

Mandible fracture severity may be increased by alcohol and interpersonal violence.

BACKGROUND: Alcohol as a cofactor in interpersonal violence (IPV) has been established by studies from a number of countries. This study aimed to determine if alcohol was a cofactor in the incidence or severity of mandible fracture. METHODS: A prospective study of mandible fracture patients presenting for oral maxillofacial review over 16 months was completed. Injury severity was assessed utilizing the Mandible Injury Severity Score (MISS). RESULTS: A total of 252 facial trauma cases presented to our tertiary referral centre, 83 with fractures of the mandible. The majority of presentations were secondary to IPV (n = 54, 65.06%), 49 (90.74%) of these cases involved alcohol. Overall, alcohol was involved in 63.85% of cases (n = 53). The relative risk of requiring surgical intervention with alcohol involvement was 2.68 (CI = 1.11-9.47). Alcohol significantly increased facial fracture severity for MISS: alcohol (n = 53) 13.07 ± 5.01, no alcohol (n = 30) 11.03 ± 4.87 (p < 0.05). IPV also increased facial fracture severity for MISS: IPV (n = 54) 13.09 ± 4.90, non-IPV (n = 29) 11.00 ± 4.81 (p < 0.05). The angle of the mandible was most commonly fractured (40.5% of cases). CONCLUSIONS: Mandible fracture patients, whose injury is a result of IPV, have more severe fractures and a higher likelihood of requiring surgery if alcohol is involved. This correlates to a higher surgical workload, economic and social burden to the community. Primary alcohol and IPV prevention strategies will play an important role in reducing mandible fracture.

Minor salivary gland carcinoma involving the oral cavity or oropharynx.

BACKGROUND: Minor salivary gland carcinomas are uncommon but most often occur in the oral cavity, particularly the hard palate. Dental examination may provide an opportunity for early detection. METHODS: Patients referred to the multidisciplinary head and neck clinic at Westmead Hospital between 1980-2002 with a diagnosis of minor salivary gland carcinoma of the oral cavity or oropharynx were retrospectively identified. Data were collected on histology, treatment, outcome and the referring practitioner. RESULTS: A total of 30 patients diagnosed with a malignant minor salivary gland carcinoma were identified. Many patients, 16/30 (53 per cent), were referred by dentists. There were 15 males and 15 females with a mean age of 62 years (range, 22-86 yrs). Most (73 per cent) presented with early stage disease (stage 1/11). Adenoid cystic carcinoma was the most common histological subtype (40 per cent) followed by mucoepidermoid carcinoma (30 per cent) and polymorphous low-grade adenocarcinoma (20 per cent). All but two patients underwent surgery with 12/30 (40 per cent) also receiving adjuvant radiotherapy usually in the setting of an incomplete/close margin. One patient developed local recurrence and one developed widespread metastatic disease. At last follow-up 83 per cent of patients were alive and disease free. CONCLUSIONS: Early diagnosis and treatment of minor salivary gland carcinoma is likely to lead to a better outcome. In our study dentists were responsible for half of all referrals to our multidisciplinary head and neck clinic. Awareness of this uncommon entity is important for dental practitioners.

Tongue cancer: do patients younger than 40 do worse?

BACKGROUND: Debate continues as to whether being young confers a worse prognosis for patients with squamous cell carcinoma of the tongue. Recent papers have provided conflicting views in this debate. In this study we aimed to investigate if young age at the time of diagnosis of squamous cell carcinoma of the tongue confers a worse prognosis. METHODS: Eligible patients were identified through the computer database of the Department of Radiation Oncology, Westmead Hospital, Sydney. All eligible patients were treated with radical intent. Using age 40 as a cut off multivariate and survival analysis was undertaken to compare age groups. RESULTS: Median age at diagnosis was 60 years (range, 19-86 years) in 84 males (65 per cent) and 45 females (35 per cent). Median follow-up time was 43 months (range, 2.3-203 months). Fifteen patients (12 per cent) were aged <40 years. On univariate analysis stage and age were significant determinants of disease-specific survival. There was no difference in overall survival between the young (<40 years) and middle-aged groups (40-60 years). However, the young and the middle aged were both more likely to survive than the older age group (>60 years). On multivariate analysis age remained a significant factor for determining disease-specific survival, with the older age group 2.9 times more likely to die than the younger groups. CONCLUSION: Young age (<40 years) did not portend to worse survival in comparison to older tongue cancer patients.

Use of pituitary cells in primary culture to study the regulation of gonadotropin hormone (GtH) secretion in rainbow trout: setting up and validating the system as assessed by its responsiveness to mammalian and salmon gonadotropin releasing hormone.

To study the regulation of gonadotropin secretion in rainbow trout in vitro, a method for preparing primary cultures of dispersed pituitary cells is described. Cells were dispersed by collagenase 0.1% in Hank's saline solution for 20 hr at 12 degrees and a high yield of viable cells was obtained. Attempts to improve cell functioning were made by varying culture conditions (density of cells initially plated, age of the culture). Cell functioning was assessed by their ability to respond to increasing doses of mammalian and salmon GnRH. Pituitaries were collected from spermiating males whose pituitaries are known to be sensitive to mammalian GnRH in vivo. Using 96-well plates, optimal conditions for good biological activity, are initial plating with 6.2 X 10(4) cells, incubation with GnRH for 24 hr on the third day after plating. In these conditions mammalian analog and salmon GnRH induced an increase in GtH release for doses ranging from 10(-9) to 10(-6) M. The GtH released during the GnRH incubation period does not decrease the sensitivity of the system since addition of 20 ng of GtH at the beginning of incubation does not modify the response profile.