Return to normal diet following mandibular fractures - how long is long enough?

Mandibular fractures are a common injury managed by oral and maxillofacial surgeons. Current open reduction and internal fixation (ORIF) treatment strategies are based on Champy's ideal line of osteosynthesis with the use of miniplate and load-sharing fixation techniques. Postoperative instructions for the duration of a soft diet have varied. This prospective, randomised study reviewed the outcomes of a patient led return to diet at 2 weeks and 4 weeks compared with 6 weeks (control group) following an ORIF of mandibular fractures. There was no significant difference in the incidence of complications between a graduated return to diet at 2, 4, or 6 weeks following an ORIF of the mandible, nor was there a difference in the quality of life during the postoperative period. Smoking has a notable risk factor for complications. The findings of this study suggest that strict adherence to a softened diet may not be necessary, and that patients identified at being of low risk of complications may be able to return to a normal diet from as early as two weeks.

Oral and Maxillofacial Surgery and Oral Surgery - what's the difference? A Western Australian dental student survey.

Confusion exists around the terms 'Oral Surgeon' and 'Oral and Maxillofacial Surgeon'. Historical terms and international differences have added to this confusion. Recently, the University of Sydney has begun to offer a Doctor of Clinical Dentistry in Oral Surgery to graduate dentists. With this new dental specialty entering the Australian workforce, distinction must be made between their role and the role of Oral and Maxillofacial Surgeons to facilitate effective referral pathways. A cross sectional survey of 3rd and 4th year dental students was distributed in June 2019. Students were queried with regards to their perception of the scope of practice of Oral Surgeons and Oral and Maxillofacial Surgeons as well as their knowledge of the training pathways and level of interest in pursuing either pathway. A total of 85% of students responded. Responses indicated a general awareness of the increased scope of practice of Oral and Maxillofacial Surgeons with some exceptions. No significant difference was seen between third and fourth year responses. Knowledge of both training pathways was lacking. Further education is required with regards to the scope of practice of both specialties. A lack of exposure to Oral and Maxillofacial Surgery during the undergraduate years may be partly to blame. Consideration should be given to the renaming of Oral Surgery to Surgical Dentistry.

Radiographic study to assess the reliability of the Gillies approach for biopsy of the superficial temporal artery.

Biopsy of the superficial temporal artery is often used in the diagnosis of giant cell arteritis, but at traditional sites there is a risk of injury to the facial nerve. Recently the Gillies incision has been suggested as an alternative means of access for the biopsy, but the anatomical basis of this has not been fully elucidated. We therefore undertook a radiographic review of 150 patients, and examining 300 vessels, to find out. Our results indicated that there is considerable variability in the position of the bifurcation of the superficial temporal artery, and so a Gillies approach may not be reliable, particularly if access to the bifurcation is required.

Postoperative complications after head and neck operations that require free tissue transfer - prevalent, morbid, and costly.

To understand and reduce the impact of postoperative complications, we studied 568 patients who had had operations over 72 months in our hospital. Multivariate analysis indicated that factors indicative of coexisting conditions (including activated systemic inflammation) and the complexity of the operation are primary determinants of postoperative complications. The enhanced recovery after surgery (ERAS) care pathway did not have an effect on their occurrence or severity. Systematic study of patients' toleration of major head and neck operations is required, as optimal perioperative care pathways remain elusive.

Survey of Australasian oral and maxillofacial surgeons 2011--scope and workforce issues.

This study examined the qualifications, training, and practice patterns of oral and maxillofacial surgeons in Australia in 2011. This information was compared to similar studies performed in 1986 and 1995. It was found that dentoalveolar surgery comprised the greatest proportion of practice. There had been major growth in dental implantology, orthognathic surgery, and management of pathology. These increases were directly related to the standardization and increase in qualifications and training. The workforce had increased at the highest rate predicted, but was only just keeping up with the increases in population and the number of general health practitioners.

Influence of the site of origin on the outcome of squamous cell carcinoma of the maxilla-oral versus sinus.

The maxilla may be affected by squamous cell carcinoma (SCC) from both oral and sinus sites. We sought to determine whether the site of origin of the maxillary tumour, oral as compared to sinus, influences survival. Univariate Kaplan-Meier and multivariate Cox proportional hazard models analysis of 58 patients with SCC involving the maxilla, treated with curative intent, was conducted. The overall 5-year disease-free survival for the group was 41.7%. Five-year disease-free survival for oral subsite SCC was 56.8%, while for sinus subsite was only 21.6%. Univariate analysis found SCC of sinus origin to be associated with a poorer prognosis, however this was not confirmed on multivariate analysis. T-stage and positive margins were found to be the only independent risk factors. For SCC of the maxilla, sinus origin of the tumour per se does not confer a poorer prognosis; however, as a result of the complex anatomy of the midface, these tumours can present at an advanced stage, while surgical control of the disease can be more difficult, especially posteriorly. Tumour size and positive margins were the determinants of a poor prognosis in this group of patients with maxillary SCC.