Is there any benefit in surgery for potentially malignant disorders of the oral cavity?

Oral epithelial dysplasia grading is currently recognised as the most useful prognostic indicator for predicting conversion of potentially malignant disorders of the oral cavity to squamous cell carcinoma. It is also used as a basis for deciding management options. However, the diagnosis of oral epithelial dysplasia is subjective and thus unreliable. Surgery is currently recommended for removal of high-risk lesions; however, the evidence for its success is lacking, and in some cases, there have been reports of increased recurrence of malignancy following surgical excision. Molecular and genetic markers have been identified and show promising results in identifying which potential malignant disorders are at risk of malignant transformation. The current evidence available for prognosis of potential malignant disorders and its treatment is based on observational and retrospective data. No randomised control trials have been conducted to date to assess the efficacy of surgery in oral epithelial dysplasia. Until good quality evidence is available from well-designed randomised control trials, experts still recommend the surgical removal of potential malignant disorders which are regarded as high risk.

Can I be a student again? How medical graduates make the decision to return to dental school prior to a career in oral and maxillofacial surgery.

INTRODUCTION: Oral and maxillofacial surgery (OMFS) trainees in the UK have traditionally completed their dental undergraduate studies prior to returning to medical school. Recently, there have been increasing numbers of medical graduates who return to dental school before embarking on OMFS specialist training. There is limited research into the career motivation within this group and little guidance on how they may integrate the dental undergraduate course into their postgraduate training path. This study aims to evaluate these factors in more detail. METHODS: Questionnaires and focus groups were used to evaluate prior surgical experience of qualified medics who return to dental school with the intention of pursuing a career in OMFS, along with the factors that affect the timing of their return to dental school. RESULTS: The average age of medical graduates entering dental school decreased during the study period. The average number of months each cohort of students spent as a practicing doctor prior to starting dentistry also reduced. Postgraduate experience in OMFS was highly variable, but the numbers of students who received alternative exposure to OMFS, such as undergraduate special study modules, medical school elective or taster weeks, increased. The key barriers that were carefully considered by these trainees before returning to university included the perceived increase in the length of training, trainees' prior surgical experience, financial implications and the impact on quality of life. CONCLUSIONS: A trainee's decision to return to study dentistry is a multifactorial process. Understanding when trainees decide to return to sit their dental degree is vital not only to provide guidance for future trainees but also to assist future workforce planning, thus aiding training, education and development within OMFS.

Medical students' understanding of oral and maxillofacial surgery: an Irish perspective.

Oral and Maxillofacial Surgery (OMFS) remains an enigmatic specialty in Irish medicine and many students are unaware of its scope and the unique career pathway involved. We completed a multicentre cross-sectional study to identify their ability to identify the requirements for entry to specialty training year 3 (ST3) in OMFS, to assess their awareness of OMFS surgeons, and their general awareness of, and exposure to, the specialty. Data were collected through an electronic questionnaire. Participants were asked to select the most suitable surgical specialty to treat a number of common conditions in the head and neck, and to choose the requirements they deemed essential for specialist training. Knowledge was measured by the number of correct responses. A total of 443 medical students participated (University College Cork (UCC) n=328, 74%; Royal College of Surgeons in Ireland (RCSI) n=113, 26%). A total of 318/374 (85%) had had no previous experience of OMFS, 38/374 (10%) had had theoretical teaching only, and 18/374 (5%) had had clinical experience. A total of 212/329 (64%) wished for greater exposure as a student, but only 34/329 (9%) would consider a career in the specialty. The median (IQR) number of correct responses for OMFS procedures was 3.0/10 (2.0), with women, direct entrants, and RCSI students scoring highest. Only 11/367 (3%) could identify the minimum entry requirements for a post of specialist registrar. This study has identified a potential gap in the undergraduate curriculum. Although medical students are rarely taught about OMFS, they show an interest in learning more.

The role of diffusion-weighted magnetic resonance imaging in the diagnosis, lymph node staging and assessment of treatment response of head and neck cancer.

Standard magnetic resonance imaging (MRI) and computed tomography continue to be the imaging modalities of choice in staging and reviewing patients with head and neck cancer. Diffusion-weighted MRI (DW-MRI) is an advanced imaging modality that records the molecular diffusion of protons and thus provides an opportunity to further assess tissue character. Interest in DW-MRI of the head and neck continues to grow, especially its application to the assessment and treatment of head and neck cancer. We highlight the potential role of DW-MRI in the delineation, characterization, and lymph node staging of head and neck tumours. Furthermore, we discuss the ability of DW-MRI to provide a real opportunity to differentiate post-treatment tumour recurrence from chemoradiotherapy-induced local tissue changes. The future impact of these findings upon the clinical practice of the head and neck surgeon is discussed.

A review of TMJ-related papers published in the British Journal of Oral and Maxillofacial Surgery in 2011 and 2012.

This review summarises the articles relating to the temporomandibular joint (TMJ) that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) between January 2011 and December 2012. In total 24 papers were published. Of these, 16 (67%) were full-length articles, which included prospective, retrospective, and laboratory-based studies as well as reviews. The remaining 8 papers were short communications, technical notes, and letters to the editor, which report on, amongst other things, unusual cases, rare complications, and novel surgical techniques.

A review of oral surgery-related papers published in the British Journal of Oral and Maxillofacial Surgery during 2011 and 2012.

This paper is a synopsis of all articles relating to oral surgery that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) between January 2011 and December 2012. Of the 57 published, 40 (70%) were full-length articles that predominantly focused on implantology, dentoalveolar surgery, and bisphosphonate osteonecrosis of the jaws (BONJs). In addition, a number of short communications, technical notes, and letters to the editor described rare cases, unusual complications, and novel surgical techniques.

Minimally invasive treatment of oral ranulae: adaption to an old technique.

Oral ranulas are cysts in the floor of the mouth that result from the extravasation of mucous. Historically there has been little consensus on the ideal first-line treatment, but currently, definitive treatment involves excision of the sublingual gland, which can injure the lingual nerve and submandibular duct. Minimally invasive surgical alternatives such as marsupialisation have been proposed, but so far have been associated with a high rate of recurrence. The aim of this pilot study was to evaluate the success of a simple, modified suture technique for the treatment of oral ranulas that can be done in the outpatient department. We retrospectively analysed outcomes after the technique was used as a first-line treatment in 15 consecutive patients between 2011 and 2013. Although 2 attempts were needed in 4 patients, complete resolution of the ranula was seen in 13. Other than the need for a second attempt, and recurrent failure in 2 cases, there were no complications. This minimally invasive and quick procedure is a suitable first-line alternative to other less successful or higher risk options.