Telemedicine in oral surgery and maxillofacial trauma: a descriptive account.

Trauma patients presenting to emergency rooms (ER) in rural or remote locations have significantly less access to oral and maxillo-facial surgery (OMFS) specialists. In this case, OMFS services at four hospitals were rearranged to concentrate expertise, inpatients, and 24/7 cover on a single site. A Federation (managed clinical network) model was used that improved the management of inpatients and made better use of a small team of junior medical staff. New government standards limiting the on-call burden for U.K. junior doctors (The New deal) were met under this service model. Despite the success of the Federation, the loss of on-site OMFS support to the three peripheral ER departments was problematic. Sites that do not have OMFS support used a simple telephone referral to transfer patients to the OMFS center. The degree to which referrals were considered inappropriate led to operational and patient satisfaction difficulties. The introduction of an OMFS telemedicine system linking the three peripheral/"spoke" ER departments to the OMFS center/"hub" succeeded in increasing the appropriateness of patient transfers, developed the skills of the ER medical staff, and was believed to have led to an overall improvement in the early-stage management of this group of patients. The telemedicine system augmented the overall success of the Federation model. New uses for telemedicine within the OMFS service soon developed.

Accuracy of diagnosis of fractures by maxillofacial and accident and emergency doctors using plain radiography compared with a telemedicine system: a prospective study.

Ten facial radiographs with fractures and 10 without fractures were viewed by eight oral and maxillofacial surgery (OMFS) and eight accident and emergency (A&E) doctors who were each asked questions about the presence and site of any fractures as well as the quality of the images and diagnostic confidence. Each radiograph was then transmitted over a teleradiology link and viewed by the same OMFS doctors who answered the same questions. The position of the fracture was more accurately assessed using plain radiography. Diagnosis by OMFS doctors using telemedicine was broadly comparable with fracture diagnosis by A&E doctors using plain radiography. Poor quality radiographs and frontozygomatic and infraorbital rim fractures were poorly diagnosed by telemedicine. This telemedicine system was a useful tool to aid diagnosis of most facial fractures. The need for appropriate clinical information is vital. Diagnosis of frontozygomatic and infraorbital rim disruption using telemedicine is less reliable than plain radiography.

Impact of dedicated trauma lists on a maxillofacial surgical service.

In 1995, the maxillofacial surgical inpatient services in East Lancashire were centralized in Blackburn Royal Infirmary, and twice-weekly operating lists dedicated to maxillofacial trauma were established. We examined the non-elective workload for three-month periods before and after trauma lists became available to find out the proportion of non-elective operations done out of normal working hours. Although there was an increase in the total number of non-elective patients after centralization, day-time trauma lists allowed a reduction in the proportion of operations performed out of normal working hours. Fewer trauma cases were added to elective lists. Trauma lists allow the unit to comply with the recommendations of both NCEPOD and the Calman report, in that they maximize training opportunities for all staff and facilitate both audit and research.