Choosing the best method to utilise single positron emission computed tomography (SPECT) scans in the management of unilateral condylar hyperplasia.

Facial asymmetry secondary to unilateral condylar hyperplasia can be a diagnostic challenge to oral and maxillofacial surgeons. Single positron emission computed tomography (SPECT) scans provide a useful adjunct. We report a brief summary of the evidence describing the effectiveness of different methods of analysing SPECT scans and compare it with the results of a 10-year study at Sunderland Royal Hospital. Overall, both the evidence base and our study strongly favour use of the condyle:condyle ratio over the condyle:reference bone ratio, suggesting that no further comparisons are needed.

Changing the Oral and Maxillofacial Surgery (OMFS) training pathway in the United Kingdom - an illustrative retrospective.

OMFS training is perceived as a long and expensive pathway although papers have shown it compares favourably with other surgical specialties. Every OMFS clinician has a vested interest and duty continually to improve the quality of training and minimise costs, especially to trainees at junior levels. Any serious proposal to fundamentally change the format of training, must be given due consideration by all stakeholders. In 2016, a British Medical Journal article whose authors included the BAOMS President of that year and OMFS Specialty Advisory Committee (SAC) Chair, posed the question - should the future of OMFS training revert to single dental degree, change to single medical degree - or continue as a dual degree specialty? The BMJ publication was discussed at the British Association of Oral and Maxillofacial Surgeons (BAOMS) Council in March 2016 and all present unanimously supported the dual degree pathway. Later that year a formal proposal was made by the BAOMS immediate past President that training in the UK change to single medical degree 'Maxillofacial Surgery' similar to the training in Spain, France or Italy. Evidence around the risks and benefits of making this change to OMFS training was assembled and reviewed by BAOMS Council in March 2017. BAOMS Council once again unanimously supported continuing OMFS as a dual degree specialty with the observation that the quality of patient care which this training provided was the specialty's Unique Selling Point or USP. The requirement for both degrees to provide care for OMFS patients had been confirmed by external scrutiny on two separate occasions by the responsible regulators. In this paper, we outline the key steps to be considered when making major changes in the OMFS training pathways using this event as an example and the suggestion that those proposing changes should assemble and present evidence to support their proposal using the template provided.

Condylar hyperplasia: current thinking.

Unilateral condylar hyperplasia is a rare disease that causes facial asymmetry as a result of excessive vertical or horizontal growth, or both, of the mandibular condyle. Investigation should address the patient's concerns, and establish whether the disease is active with the use of single positron emission tomography (PET). Proportional reduction of the condyle arrests active disease and restores mandibular height, and any residual asymmetry can be corrected according to conventional orthognathic principles. We recommend the use of 3-dimensional virtual planning for such complex movements. The rarity of the disease means that, to our knowledge, high-quality evidence is lacking and further research is needed.

The role of thoracic computed tomography in staging newly-diagnosed oral squamous cell carcinoma.

Patients who present with squamous cell carcinoma (SCC) in the head and neck have a serious risk of coincident thoracic malignancy. The aim of this study was to identify the incidence of thoracic malignancy in newly diagnosed, previously untreated, oral and oro-pharyngeal SCC, and to evaluate the role of thoracic computed tomography (CT) in its management. Of 116 consecutive patients who were identified prospectively 81(70%) had oral and 35 (30%) oropharyngeal SCC. Ten patients (9%) had suspicious thoracic CT findings. After investigation or follow up, four (3.5%) of these patients were shown to have coincident thoracic malignancies. This large prospective series of newly diagnosed oral and oropharyngeal SCC had a lower incidence of coincident thoracic malignancy than had previously been shown.

Senior house officer training in oral and maxillofacial surgery: a national survey.

Service commitments have often taken priority over training for many senior house officers. There have been changes, with more planned to make this truly a training grade. We conducted a national postal survey of senior house officers (SHO) in oral and maxillofacial surgery (OMFS) in 2001/2002. A total of 229 replies were received with an estimated response rate around 70%. Almost 60% of these respondents (57.2%) had been a SHO in OMFS for over 3 years. Only 39% had a weekly bleep-free teaching session. Forty-eight per cent did not think undergraduate BDS training was adequate for their job. This 48% of SHOs were significantly less likely to have out patient clinic sessions with a designated trainer undertaking teaching (chi 2 = 6.127, P = 0.013) or have a bleep-free teaching session (chi 2 = 6.896, P = 0.009). Sixty-four per cent had received formal training in medical examination of patients. Twenty-nine per cent had not been appraised during their present post. Forty-two per cent of SHOs in OMFS are in band 3 posts. Improvements have been made, but there is a case for further change.

Current practice of British oral and maxillofacial surgeons: advice regarding length of time to refrain from contact sports after treatment of zygomatic fractures.

OBJECTIVE: To find out the current practice of consultant maxillofacial surgeons in the United Kingdom regarding the advice that they give to patients after the treatment of zygomatic fractures. MATERIALS AND METHODS: We sent a postal questionnaire to 261 consultant maxillofacial surgeons in the United Kingdom. They were asked what advice they gave to patients about the length of time that they should refrain from contact sports after a zygomatic fracture. RESULTS: A total of 184 replies were received (70%). Advice about the length of time to refrain from contact sports ranged from none to 13 weeks; 165 (90%) of respondents based their advice on common sense and traditional practice. CONCLUSIONS: Advice given to the patients after the treatment of zygomatic fractures varies widely. Most consultants base their advice on traditional practice and common sense. No widely accepted evidence-based guidelines exist about post-operative advice concerning duration of avoidance of contact sports after zygomatic fractures.