OMFS Units Research Articles

29. Project management and efficacy of data collection within various OMFS units - the QOMS experience to date

29. Project management and efficacy of data collection within various OMFS units - the QOMS experience to date

10. Audit Reviewing the Accuracy of Coding for Temporal Artery Biopsies at a Large Teaching Hospital

North Manchester General Hospital (NMGH) has recently undergone a change in parent trust from the Pennine Acute Hospitals NHS Trust (PAT) to Manchester University NHS Foundation Trust (MFT). Temporal Artery Biopsy (TABx), a procedure not infrequently performed at the OMFS unit, follows urgent referral from Rheumatology colleagues for suspected Giant Cell Arteritis (GCA). A review of coding applied to these procedures is performed, aiming to establish whether payments been appropriate. The gold standard is met if the the correct code/correct payment are applied.

74. See and Treat for non-melanoma skin cancers in an OMFS unit: A successful change of practice and service improvement as a result of the COVID-19 pandemic

During the COVID-19 pandemic, our unit converted to a see and treat model for the treatment of non-melanoma skin cancers (NMSCs), aiming to undertake complete excision at the first review. The intention was to reduce patient contact, to reduce the risk of virus transmission, whilst keeping waiting times to a minimum. This audit aimed to assess whether “See and treat” is an effective strategy and to determine whether it should continue following easing of lockdown restrictions.

1616 Antibiotic Use in The Management of Mandibular Fractures: A Survey of Current Practice in the UK

Abstract Aim Traumatic mandibular fractures account for a significant proportion of UK oral and maxillofacial trauma. Prophylactic antibiotics is standard practice for management of these patients, however evidence for this is weak and relevant RCTs are insufficiently powered or poorly designed. The Maxillofacial Trainee Research Collaborative (MTReC) aims to survey current antibiotic regimens in UK OMFS units treating mandibular trauma, Method A multicentre online survey was shared via email and social media. Questions focused on current practices regarding management of mandibular fractures during pre-, peri-, and post-operative phases. Results 89 responses from 50 UK OMFS units including 76 trainees and 4 consultants were collated over 2.5-months. 45 units routinely admitted patients; 88% clinicians starting pre-operative IV antibiotics;11 different pre-operative antibiotic regimens were identified across all surveyed clinicians, with 65% prescribing Augmentin, and remaining 35% using variable combinations of penicillins with 4 other antibiotic classifications. 5 different protocols were identified in use across the 88.8 % of respondents who chose to prescribe post-operative antibiotics. Conclusions There is inter-unit and inter-clinician variability in prophylactic antibiotic prescription in UK patients undergoing ORIF mandibles. Given antimicrobial resistance has been declared a WHO public health threat, efforts must be made to reduce antibiotic overuse and understand regional situation specific sensitivities. The survey highlights need for nationalised protocols for antibiotics use in mandibular fractures, if at all. This survey of clinician reported practice will be used to inform a prospective observational study on 30-day outcomes of ORIF mandibles taking into account patient factors, fracture pattern, fixation type and antibiotic use.

1153 “To FNA Or to Not FNA, That Is the Question.” A 5-Year Retrospective Epidemiological Study Of 238 Surgical Parotid Cases Treated at An East Yorkshire OMFS Unit

Abstract Introduction Fine needle aspiration (FNA) is a surgical procedure used to aid with diagnosis and subsequent treatment planning. This study compares FNA histology with final histology (gold standard) for diagnostic accuracy in parotid surgery patients. Method A retrospective investigation of patient records from January 2014-January 2019 was performed to find eligible patients that underwent parotid surgery. Histology reports of the ultrasound (US) FNA and final parotid sample were compared for diagnostic accuracy and ability to differentiate between malignant & benign tumours. Results 240 parotid surgeries on 238 patients were undertaken between 2014-2019 under OMFS and ENT specialities. 137 US FNA’s were performed, of these, there was an 85% diagnostic rate. Of the diagnostic FNA’s 79% reach gold standard, with the histology matching that of the final histology. Of the 24 without diagnostic accuracy, 2/3 were still able to differentiate between malignant and benign lesions. Overall, the US FNA’s were able to differentiate malignant and benign parotid lesions in 93% of cases. Conclusions The audit has proven US FNA to be an accurate diagnostic test, it gives extra data to aid in the decision making and planning for parotid surgeries. Although US FNA has shown to be more accurate in diagnosing benign parotid tumours; it is useful in detecting cellular change which could be indicative of malignancy.

1537 Squamous Cell Carcinoma Arising in A Maxillary Odontogenic Keratocyst in Gorlin Goltz Syndrome - A Rare Case Report

Abstract Introduction Gorlin Goltz syndrome (GGS) is a rare, hereditary, AD condition with multiple BCCs, odontogenic keratocysts (Jaw cysts), calcification of falx cerebri, skeletal anomalies & a predisposition to neoplasms like medulloblastomas, fibromas and rhabdomyosarcomas. Aim We present a rare case of a Squamous cell carcinoma (SCC) developing in a Maxillary odontogenic keratocyst in a 32-year male with GGS. Discussion This patient was referred to the OMFS unit with a non-healing UL3 extraction socket and exophytic growth. Initial biopsies suggested an atypical squamo-proliferative lesion, however a repeat biopsy demonstrated an invasive SCC arising from a background odontogenic keratocyst of the maxilla. He was initially reluctant to undergo a staging CT scan to avoid risks of developing further BCCs due to IR exposure. This was eventually performed as per H&N MDT recommendation & showed a T4aN0M0 SCC of the left maxilla and bilateral multiple mandibular odontogenic keratocysts. He underwent a left maxillectomy, left neck dissection & reconstruction with a DCIA free flap, but did not want his mandibular keratocysts treated at the same time. Complete tumour clearance was achieved with no involved neck nodes & he remains disease-free at 4 months postoperatively. Although for a T4 tumour he would have needed postoperative radiotherapy, in view of the GGS, no adjuvant treatment was indicated. Conclusions SCC developing in a maxillary OKC is exceedingly rare with only two previous cases reported in GG syndrome. This is the first reported case of a GGS patient with oral SCC undergoing a complex free flap reconstruction.

Comparison of oral and maxillofacial trauma during the first and third lockdown of the COVID-19 pandemic in the United Kingdom

The incidence and management of maxillofacial trauma was compared between the first and third lockdowns in the United Kingdom due to the COVID-19 pandemic. From 6 January, 2021 to 8 March 2021, the units that had participated in the collection of data during the first lockdown were asked to update their information into the same database for the third. Nine units participated with 929 entries. Compared to the first lockdown, the number of patients whose treatment had been changed due to the pandemic reduced from 7.6% to 0.4% in the third lockdown. In the UK during the third lockdown there were higher numbers infected with COVID-19 and admitted to hospital than in the first lockdown. Despite this OMFS units that participated in the second study were able to continue the management of maxillofacial trauma without the pandemic affecting care.

BAOMS QOMS: findings from the pilot phase and lessons learned in the feasibility evaluation of a national quality improvement initiative

The BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent. The pilot included a series of six audits (oral and dentoalveolar [ODA], oncology, orthognathic, reconstruction, trauma, and skin). Data entry was clinician-led in five OMFS units and in one unit (EKHU), it was additionally supported by members of the clinical coding team. One hundred and twenty-eight REDCap account user details were issued and of these, 45 (35%) completed registration and 22 (17%) were active users who participated in the pilot data entry. Disproportionate focus on individual audits within QOMS was seen, though not all units offered the full range of service audited. Users suggest the skin and ODA audits were sufficiently clear, but improvement is required in the oncology and reconstruction questionnaire particularly. The pilot was successful in aiding the project team identify areas of weaknesses and strength in the design of the REDCap registry and implementation of the next phase of the initiative. The information and experience gained has to date enabled a successful application for section 251 approval from the HRA and progress for the next phase of national data collection.

How has COVID-19 affected surgical practice in Oral and Maxillofacial Surgery in the East Midlands, UK?

The impact on the provision of care within the NHS due to COVID-19 can not be understated. It has created various challenges for Oral and Maxillofacial Surgeons due to the high-risk nature of working within this specialty. The aims of this study were to identify the ongoing clinical activities at the height of pandemic, the guidance issued to staff regarding the use of personal protective equipment and the changes to maxillofacial practice. A prospective analysis was commenced within six Oral and Maxillofacial Surgery units in the East Midlands, UK with data being collected by means of a 10-item questionnaire relating to changes in patient care during this time. The responses were analysed to identify compliance with the national guidance produced by the British Association of Oral and Maxillofacial Surgeons.An 87% response rate was obtained (26 respondents from 30 invitations). 73.1% of participants confirmed all surgical members of staff were offered fit tests for FFP3 masks. All units reported a continuation of Head and Neck cancer and emergency operations with a complete reduction in TMJ and orthognathic surgery. FFP3 masks were the most popular masks used for theatre activity whilst FFP2 and surgical masks were more widely used for examining patients and performing procedures in the emergency department. Changes in maxillofacial practice included the use of local flaps compared to free flaps, use of intermaxillary fixation (IMF) where appropriate for craniofacial trauma and routine COVID-19 testing for all inpatients.

Clinical coding of ICD-10 and OPCS in elective local anaesthetic and IV sedation cases

Treatments facilitated by healthcare trusts are transformed into codes through which payments are organised. Accurate coding is essential for correct payment, inaccurate clinical coding results in significant loss of income. Our OMFS unit performs regular day-case procedures with data recorded in a standardised proforma. An audit was performed to determine the accuracy of ICD and OPCS codes generated by the OMFS department to identify factors contributing to inaccuracies leading to loss of income. All local anaesthetic and IV sedation cases were reviewed at two separate 3 monthly time frames within the OMFS department with 100 cases per cycle. A gold standard of 100% coding information recorded and accuracy were set. The first data cycle demonstrated a number of factors to improve the clinical coding process including implementing a new clinical coding form. This was utilised in the second audit cycle. Regarding ICD-10 the first audit cycle yielded a 65% accuracy of primary diagnoses. Following recommendations this improved to 72%. Coding accuracy in the first cycle was recorded as 62% with improvement to 78% in the second cycle. OPCS data accuracy was 80% in the first cycle improving to 90% in the second cycle. Secondary or bilateral procedures also showed improvement from 83% to 89% accuracy in the second cycle. Across the audit cycle £20,000 of revenue was generated. Inaccuracies in clinical coding reduces income, improved understanding of error sources can ensure income is commensurate with clinical activity.

Midface trauma: outpatient follow-up and surgical treatment times

Introduction/aims: Surgical treatment of midface fractures should ideally occur within two weeks of injury, after which bony healing and consolidation makes repair more difficult for the operating surgeon. The OMFS unit at the Royal Surrey County Hospital is the tertiary referral centre for maxillofacial trauma from five regional hospitals. We present a completed audit cycle of midface trauma referrals managed over a one year period. Our standard was that clinical assessment of the midface fracture would take place in a consultant led outpatient clinic within 7 days, and when indicated, surgical fixation would occur within 10 days of referral.

Junior Trainees Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) conference 2018: overview of the conference and analysis of delegates’ feedback

The Junior Trainees Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) and the JTG Annual Conference aim to support pre-registrar trainees interested in OMFS. The theme of the 2018 conference, "Research and Innovation" was disseminated through a diversity of expert speakers and interactive workshops. This paper provides an overview of the conference and analysis of the delegates' feedback to show how it represented their interests and influenced their decisions to pursue OMFS. Online questionnaires assessed demographics and the impact of the conference on numerous aspects of the decisions made about careers by delegates at different levels of training. A Kruskal Wallis test with post-hoc pairwise comparisons was done to assess the significance of differences between groups. A total of 135 delegates completed the questionnaires (13% dual-qualified; 13% second-degree medics; 18% second-degree dentists; 6% singly-qualified medics; 41% singly-qualified dentists; 5% first-degree medics; and 4% first-degree dentists), and 141 submitted abstracts of which 32 poster and 12 oral presentations were accepted. A total of 79/135 (59%) were members of the BAOMS. Word-of-mouth was the commonest way by which delegates became aware of the conference. As the stage of training advanced, they agreed more that it represented their training level and influenced them to pursue research and attend the BAOMS 2018 conference. The JTG conference is the only national meeting for pre-registrar trainees, and this year there were record numbers of delegates and abstracts. As the JTG grows, we continue to assist juniors to pursue their involvement in OMFS units and to participate in research and collaborative projects. Our goals are to expand as a national platform to represent junior trainees who are interested in OMFS, and to support them as they progress towards registrar training.

Antimicrobial regimens used in the treatment of mandibular fractures in UK maxillofacial units: changes over 12 years.

In the case of most mandibular fractures, the prescription of antimicrobials for more than 24 hours postoperatively confers no clinical benefit. To establish the prescribing patterns for mandibular fractures in UK OMFS units, and to compare them with those used 12 years ago, we did a telephone and email survey of OMFS units in the UK. Antimicrobials were prescribed for more than 24 hours postoperatively by 76 units (65%) (considerably fewer than the 82 (87%) in 2005). The most commonly prescribed first-line antimicrobial was co-amoxiclav (75%). Although there has been some improvement since 2005, most units still prescribe antimicrobials for periods longer than 24 hours. National collaboration may improve their appropriate prescription.

Treatment of lip dysplasia with imiquimod 5%: Results from a single OMFS unit

Treatment of lip dysplasia with imiquimod 5%: Results from a single OMFS unit

The novel use of dental suction tubing in the decompression of large dental cysts

Introduction: Dental suction tubing is widely available in OMFS Units. It has a metal radiopaque marker and can easily be cut to the desired length with scissors. It is relatively inexpensive and has a reinforced lumen that makes easy access for saline irrigation. We have used this tubing now in 3 large odontogenic cysts of the jaws and present this as an aid to effective and simple cyst decompression.

Admission for cervicofacial infection after exodontia: a data comparison study

Aims: Warning of the risk of post extraction infection is commonplace. The aim of this audit was to compare the admissions for cervicofacial infections following dental extractions at an OMFS unit over two 18 month periods between January 2008 and December 2016.

Association of traumatic head injuries and maxillofacial fractures: A retrospective study.

The association of traumatic head injury (THI) with maxillofacial fractures (MFF) is a major health concern worldwide. In spite of the close anatomical proximity of maxillofacial bones to the cranium, the association of THI with MFF is controversial. The aim of this study was to assess the association between THI and MFF. Other factors associated with THI in patients with MFF were also investigated. A hospital-based retrospective study was conducted at the OMFS Unit, Hospital USM, Kelantan, Malaysia. From 12 June 2013 to 31 December 2015, 473 patient records with MFF were reviewed to evaluate the association of THI and MFF. A total of 331 patients (69.98%) presented with concomitant THI. The most common associated THI were cranial bone fractures (68.6%) followed by intracranial injuries and concussion. A significant association existed between the Glasgow coma scale (GCS) score and the presence of THI concomitant MFF with P-value <.001. The univariable logistic regression analysis revealed that age group (31-40years), cause of injury (road traffic accident-RTA), all midface fracture types and most of the mandibular fracture types were statistically associated with the presence of THI. The multivariable logistic regression analysis revealed that the cause of the injury (RTA) and MFF types (nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and the alveolar process of mandible fractures) were statistically significantly associated with THI in patients with MFF. There was a high prevalence of THI among patients with MFF (69.98%). RTA, nasal bone, zygomatic complex, zygomatic arch, orbital wall, maxillary sinus wall and mandibular alveolar process fractures were significantly associated with THI in patients who sustained a MFF.

Clinicopathological study of epithelial salivary gland tumours-a retrospective study

Introducton: Tumours of the salivary glands are infrequent, yet they represent an extensive variety of both benign and malignat tumours. Objective: The aim of this study was to evaluate clinicopathological data to determine the distribution of epithelial salivary gland tumours(SGT) in patients who were diagnosed at OMFS unit , TH-Karapitiya, Sri Lanka from 2004 to 2014. Material and methods: Total of 77 SGT were diagnosed in the period of 11 years were reviewed using biopsy reports. Results: Out of 77 epithelial SGTs 35 were benign , 42 were malignat. Indicating a benign to malignat ratio of 1: 1.2. Malignat tumours were more common in minor salivary glands indicating a percentage of 59.52% of total malignat tumours.When considering minor SGT, 73.52% were malignat. Conclusion: There was a higher occurrence of malignat tumours in minor salivary glands in this study.

A survey of self-reported clinical practice of Dental Core Trainees relating to radiographic investigations and service provision in OMFS units across the UK

A survey of self-reported clinical practice of Dental Core Trainees relating to radiographic investigations and service provision in OMFS units across the UK

An audit of returns to theatre in a regional Oral and Maxillofacial Surgery Unit: what is returning to theatre and can we improve?

Introduction: In current guidance, it is recommended returns to theatre and surgical outcomes should be monitored and audited on a regular basis. It can highlight areas for improvement and direct surgical services to ensure unnecessary readmissions or returns are avoided. There was no official record of the return rate within the OMFS unit and an audit was carried out to identify the current level of return.