Current thinking about the effects of e-cigarettes on oral cancer risk.

In the last decade there has been a significant increase in the appeal and popularity of e-cigarettes. Recent national news headlines outline that one million smokers will be given a free vaping starter kit to encourage them to give up tobacco products. An independent report commissioned by the UK Government has cited promotion of vaping as a critical recommendation to ensuring England is smoke-free by 2030. Undoubtedly, the dental team will now encounter many more questions from patients keen to know more regarding the safety of electronic nicotine delivery systems and their effects on the oral cavity. However, it is often difficult to answer these questions due to a lack of evidence regarding their impact. Although there are some preliminary animal and in vitro data, additional well-designed, long-term studies are required to investigate oral health outcomes of e-cigarette use.We aim to summarise the latest evidence to better inform clinicians about the effects of vaping on oral health, particularly regarding the risks of oral cancer, so they can better inform their patients.

Video-based online learning - a fast and easy way to teach your team about the oral surgery armamentarium.

Dental trainees and scrub teams are often unfamiliar with the oral surgery armamentarium. After research of the subject, no appropriate simple training resources were found. We created a simple video vital to facilitate i-training, promote effectiveness of the surgical team, and minimise patient risks. We share our QR code for our free, simple reproducible educational video and a 'test yourself' style questionnaire.

Can we do it better? Consent in dentoalveolar surgery.

Obtaining informed consent is essential for any medical or dental procedure. Dentoalveolar surgery poses numerous risks due to the complex environment and anatomy of the oral cavity. Failure to seek and correctly document consent may lead to claims in negligence, as demonstrated by the increasing litigation in OMFS. We audited dentoalveolar surgery consent forms at two different UK OMFS units and found that many forms failed to document important material risks associated with procedures. In an attempt to improve the consent process, we developed a standardised form containing a list of risks for dentoalveolar surgery that can be affixed to the consent form. We suggest other OMFS units adopt this form to standardise the consent process and optimise patient care while protecting clinicians from medico-legal claims.

e-Cigarettes and Oral Cancer: what do we know so far?

We aim to summarise the latest evidence to better inform OMFS practitioners about the deleterious effects of vaping on oral health and the risks of oral cancer, so they can better inform their patients. Current evidence suggests that e-cigarette use is not risk-free.

Centralised pathology service for sentinel node biopsy in oral cavity cancer: The Southeast England Consortium experience.

BACKGROUND: Sentinel lymph node biopsy is an increasingly recognised option for accurate staging and subsequent management of the clinically negative neck in early stage oral cavity squamous cell carcinoma. However, the technique is currently underused due to several logistic constraints including increased burden on pathology services. Here, we describe the feasibility of an outsourced centralised pathology processing and reporting service for sentinel lymph node biopsies in oral cavity squamous cell carcinoma. PATIENTS AND METHODS: The Southeast England Consortium comprises four surgical centres utilising a central pathology service. Consecutive cases between January 2016 and February 2020 were retrospectively evaluated for survival outcomes and laboratory turnaround times. RESULTS: Twenty-eight per cent from a cohort of 139 patients had positive sentinel nodes. There was a trend towards greater overall, disease-free and disease-specific survival (OS, DFS and DSS, respectively) in sentinel node negative compared to sentinel node positive patients, but these differences were not statistically significant. The sensitivity, negative predictive value and false negative rate were 92.8%, 97.0% and 6.8%, respectively. The mean and mode laboratory TAT were 5 and 4 working days, respectively. CONCLUSION: An outsourced centralised pathology service is a feasible option to widen the availability of sentinel node biopsy in oral cavity squamous cell carcinoma.

Providing national level teaching to OMFS specialty trainees in a virtual classroom setting using learning theories of education.

COVID-19 has resulted in an expansion of webinar-based teaching globally. Socially distanced e-learning is the new normal. The delivery of regional OMFS teaching programmes in the UK and the Republic of Ireland, for Specialty Trainees (ST's) under the Joint Committee on Surgical Training (JCST) and Intercollegiate Surgical Curriculum Programme (ISCP) umbrellas is variable. We recognised the need to provide additional teaching to supplement this teaching, at a time of crisis in our countries and healthcare systems, which had jointly led to a significant impact on the progression of training. The membership category of Specialty Trainees within the national specialty association-the British Association of Oral and Maxillofacial Surgeons (BAOMS) is Fellows in Training abbreviated to FiT. We designed an OMFS FiT (Fellows in Training) webinar series based on the current Oral and Maxillofacial Surgery (OMFS) curriculum. Senior trainers delivered weekly national web-based teaching using learning theories of education. Thirteen webinars were conducted between the 14th of May and the 4th of August 2020. Webinars were attended by 40-75 ST's with 98 percent of trainees rating the webinars as 'excellent' or 'very good', and 99% found the content 'extremely useful' or 'very useful'. We discuss the learning theories used for this teaching which include - Bloom's taxonomy, Bruner's spiral model, Vygotsky's zone of proximal development, the flipped classroom model, and Knowles' andragogy model. This pilot national teaching programme has been extremely well received by OMFS trainees and is here to stay!

Cystic Squamous Cell Carcinomas of the Jaws: Twelve Cases Highlighting Histopathological Pitfalls.

Cystic squamous cell carcinomas (SCCs) of the jaws, including carcinoma cuniculatum, are rare, slow growing, and relentlessly invasive. The aim of this article is to present 12 cases, 4 of which were designated as carcinoma cuniculatum on the basis of deeply endophytic, anastomosing channels of cystic stratified squamous epithelium and keratin microabscesses. The other 8 were also cystic, but more heterogeneous morphologically and were diagnosed as well differentiated SCCs. Six patients were female, 6 were male (mean age = 74.0 years, range = 50-94 years). Six tumors affected the mandible, 6 the maxillary alveolus with or without extension into the hard palate. All patients underwent primary resection with neck dissection and were staged as T4a N0 M0. In 4 patients, diagnosis was delayed as a result of superficial biopsies and/or confusing histopathology. Cystic SCCs of the jaws can be difficult to diagnose and clinicoradiological correlation is essential. Long-term follow-up is mandatory.

Current thinking in the management of adenoid cystic carcinoma of the head and neck.

Adenoid cystic carcinoma (ACC) is an aggressive, rare, malignant tumour that accounts for about 1% of all head and neck neoplasms and 10% of all salivary gland tumours. It is characterised by frequent local recurrences and distant metastases. Growth is slow but relentless, and progression poses a challenge to head and neck clinicians. Many small retrospective studies have described its clinical management, but the lack of multicentre, randomised, controlled trials has resulted in inconsistencies in management globally. We have focused on three key management-related controversies: the role of elective neck dissection (END) for the N0 neck; the role of adjuvant treatment or radiotherapy; and finally, the follow-up protocol, particularly cross-sectional surveillance imaging of the full body or chest computed tomography (CT) alone, and options for treatment if metastases are found. The paucity of published studies may reflect the inconsistencies that exist in the management of ACC of the head and neck in the UK. The collaboration of head and neck centres would, we think, help to correct the imbalance in these three domains of care.

Current thinking in management of the neck (including contralateral neck) in ipsilateral recurrent or second primary oral squamous cell carcinoma.

Metastasis to the neck in patients with oral squamous cell carcinoma (SCC) has a huge impact on long-term survival and prognosis, and its incidence varies. Due consideration therefore should be given to management of the neck in each individual case. The pathways in patients with primary oral SCC are well-established, but there is a paucity of published papers on management of the neck in those with ipsilateral recurrent or second primary oral SCC whose necks have previously been operated on with or without radiotherapy or chemoradiotherapy, or treated with radiotherapy or chemoradiotherapy alone. These patients may be under treated because of failure to stage the most likely drainage site, and are likely to have a worse outcome if there is macroscopic recurrence in the neck after independent treatment of the recurrent or second primary tumour. Based on the current review, we think there is a need for a multicentre, collaborative, retrospective review of the outcomes of patients with ipsilateral second primaries or recurrent oral SCC in the previously treated neck. Our recommendations include consideration of positron emission tomography-computed tomography in all patients with recurrent or second primary oral SCC (if "hot" - neck dissection, if "cold" - sentinel node biopsy); consideration of sentinel node biopsy in all patients with recurrent or second primary oral SCC who have previously had treatment to the neck; and finally, consideration of definitive management of the sentinel biopsy zone or region if the node is invaded.

Are blood investigations, or group and save, required before orthognathic surgery?

Most patients who require orthognathic surgery are young patients of American Society of Anesthesiologists' (ASA) grade I, and current publications recommend a policy of group and save, with antibody screening for all such patients. We retrospectively studied 284 patients who had orthognathic procedures over a 5-year period at one hospital. We identified patients with a history of bleeding disorders, and those with abnormal coagulation. No blood transfusions were required for any patient, and abnormal coagulation screens in patients with no history of bleeding disorders made no difference to perioperative medical or surgical management. We therefore recommend that grouping and saving blood with antibody or coagulation screening are not necessary before orthognathic operations in ASA grade I patients who have no history of bleeding disorders or previous blood transfusion. However, a routine full blood count should still be done, in keeping with the current National Institute for Clinical Excellence (NICE) guidelines.

Osteomyelitis of the mandible secondary to pericoronitis of an impacted third molar.

UNLABELLED: Impacted third molars are a common reason for referral to the hospital dental service. Third molar impaction can be complicated by infection. We present two cases of osteomyelitis of the mandible developing secondary to pericoronitis of partially erupted lower third molars. One of the cases reported was recently diagnosed and treated while the other was diagnosed and treated 20 years ago. The most commonly reported pathology associated with impacted lower third molars is pericoronitis. Osteomyelitis of the mandible secondary to pericoronitis is rare. CLINICAL RELEVANCE: It is helpful if dental practitioners are able to distinguish between the cases of pericoronitis that need emergency referral to hospital and the cases that can be managed in practice and referred to an outpatient clinic.

Malakoplakia presenting as an enlarging neck mass: Case presentation and review of the literature.

BACKGROUND: Malakoplakia is a very rare chronic inflammatory disorder, first described in 1902. In 75% of cases, the condition affects the genitourinary tract. Five cases of malakoplakia affecting the neck were previously reported in the literature. METHODS AND RESULTS: An 83-year-old woman presented with an enlarging mass in the posterior triangle of the neck that was histologically confirmed as malakoplakia. Presenting features are often nonspecific, and the diagnosis is dependent on histological findings. The characteristic microscopic findings are of Michaelis-Gutmann (M-G) bodies that stain positive with periodic acid-Schiff reagent, von Kossa's reaction for calcium, and Perl's ferrocyanide reaction to ferric iron. CONCLUSION: Although rare, a diagnosis of malakoplakia should be considered in patients with an enlarging mass. This may mimic the presentation of malignancy, particularly in patients in whom erosion through skin occurs, and histological confirmation is advocated.

Multicentre study of operating time and inpatient stay for orthognathic surgery.

Orthognathic surgery has advanced considerably since its development in the mid-twentieth century, and in most maxillofacial units mandibular and maxillary osteotomies are routine procedures. However, to enable accurate health planning and costing, and to obtain meaningful consent, it is important to have reliable data for duration of operation and inpatient stay. Virtually every aspect of orthognathic surgery has been researched, but we know of no recent studies that have looked specifically at how long the procedures take and how long patients stay in hospital. We retrospectively studied a sample of patients who had had orthognathic operations at six maxillofacial units in the United Kingdom (UK) to assess these measures. We looked at 411 operations which included 139 bilateral sagittal split osteotomies, 53 Le Fort I osteotomies, and 219 bimaxillary osteotomies. The study showed that the mean (SD) operating time for bilateral sagittal split osteotomy is 2h 6min (46min), 1h 54min (45minutes) for Le Fort I osteotomy, and 3h 27min (60min) for bimaxillary osteotomy. The duration of postoperative hospital stay was also measured. Fifty percent of patients spent one night in hospital after bilateral sagittal split osteotomy, whereas 39% and 9% of patients spent two and three nights, respectively. Forty-five percent of patients spent one night in hospital after Le Fort I osteotomy, whereas 34%, 13%, and 2% spent two, three, and four nights, respectively. Forty-one percent of patients spent two nights in hospital after bimaxillary osteotomy, whereas 34%, 21%, and 3% spent one, three, and four nights, respectively. This data provides evidence for national benchmarks.