Kathleen Fan

Tissue engineering technology and its possible applications in oral and maxillofacial surgery

Tissue engineering is a rapidly advancing discipline that combines the attributes of biochemical and biomaterial engineering with cell transplantation to create bio-artificial tissues and organs. For the oral and maxillofacial surgeon, the reconstruction of maxillofacial defects in hard and soft tissues is an ongoing challenge. While autologous grafts and vascularised free flaps are the current gold standard, they are not without complications at both the donor and reconstructed sites. Tissue engineering, which aims to create tissue-matched, prefabricated, prevascularised bony or soft tissue composite grafts, or both, therefore has the potential to revolutionise practice in maxillofacial surgery. We review the technology of tissue engineering and its current and future applications within the specialty, and discuss contemporary obstacles yet to be overcome.

Incidence and patterns of mandibular fractures during a 5-year period in a London teaching hospital

We retrospectively evaluated mandibular fractures in patients who presented to a London teaching hospital between June 2005 and May 2010. A total of 1261 patients sustained 1994 mandibular fractures (mean 1.6, range 1-5). The incidence of mandibular fracture was higher in male patients (87%) than in females (13%) (male:female ratio 6.6:1), and the peak incidence was during the third decade for both genders. The most common site of fracture was the angle (30%), followed by the parasymphysis (27%), and condyle (27%). Overall, interpersonal violence was the most common cause (72%) followed by falls (18%). In male patients, the most common cause was interpersonal violence (77%); in females it was a fall (46%). The anatomical sites of fracture reflected their cause. Interpersonal violence typically resulted in fractures of the angle (36%) while road traffic accidents and falls resulted in condylar fractures (28% and 53%, respectively). A total of 66 (5%) patients sustained other maxillofacial fractures and 37 (3%) presented with non-maxillofacial fractures. Our findings are consistent with trends reported in other urban centres.

A Review Of Current Clinical Photography Guidelines In Relation To Smartphone Publishing Of Medical Images

The rise in popularity of smartphones has seen a surge in the number of smartphone-specific software applications (apps) available. Among these apps, many are medical and healthcare related, of benefit to both the general public and healthcare staff. With this improved technology comes the ability to display full-colour images and videos, for which medical images could be utilised. We reviewed current clinical photography guidelines in relation to the publishing of medical images in smartphone apps. Of the 5 relevant guidelines, none discussed hand-held electronic media or smartphone app publishing. This creates confusion for clinicians as to how to interpret current guidelines for this purpose. Medical illustrators, clinicians and NHS Trusts need to be aware of the changes in technology and the ethical considerations of allowing medical images to be published within smartphones. We discuss the issues surrounding consent and provide practical tips for obtaining informed consent from patients to publish medical images in smartphone apps.

Awareness of oral and maxillofacial surgery as a specialty and potential career pathway amongst UK medical undergraduates

BACKGROUND AND PURPOSE OF THE STUDYnAlthough traditionally a dentistry first, medicine second training route, UK Oral and Maxillofacial surgery is increasingly populated with medicine-first trainees at ST3 level. Despite this, there is little evidence suggesting any increase in exposure at medical undergraduate level. We sought to evaluate the current level of awareness of OMFS as a medical specialty and potential career pathway amongst first-degree medical undergraduates.nnnMETHODnWe distributed an on-line survey amongst 253 medical undergraduates divided between two UK universities.nnnFINDINGSnA total of 72.3% of undergraduates received no exposure to OMFS in any form. Those with exposure had an improved understanding of the scope of the specialty. Regardless of previous exposure to the specialty, only 27.7% correctly identified the essential requirements for entry in OMFS specialty training. Nevertheless, a vast majority (76.7%) wanted more guidance on the possibility of pursuing a career in OMFS.nnnCONCLUSIONSnUndergraduate exposure to OMFS in UK medical schools is limited. Even a small degree of exposure to OMFS improves understanding of the scope of the specialty. Although medical students do not fully understand the career pathway, they wish to explore OMFS as a career option. It is therefore important that UK undergraduate surgical curricula offer greater exposure to the specialty, the career pathway and the clinical opportunities it can provide.

Using The iBook In Medical Education And Healthcare Settings - The iBook As A Reusable Learning Object; A Report Of The Author's Experience Using iBooks Author Software

The recently launched iBooks 2 from Apple has created a new genre of ‘interactive multimedia eBook’. This article aims to dscribe the benefit of the iBook in a medical education and healthcare setting. We discuss the attributes of an iBook as compared with the requirements of the conventional web-based Reusable Learning Object. The structure and user interface within an iBook is highlighted, and the iBook-creating software iBooks Author is discussed in detail. A report of personal experience developing and distributing an iBook for junior trainees in oral and maxillofacial surgery is provided, with discussion of the limitations of this approach and the need for further evidence-based studies.

Common maxillofacial terminology: Do our patients understand what we say?

UNLABELLEDnFor a patient to make appropriate, informed decisions regarding their medical care, it is vital that the information given to them is complete and comprehensible. We have investigated patients understanding of commonly used terms in an oral and maxillofacial clinic. To the authors knowledge, this pertinent subject has not previously been explored for this specialty.nnnMETHODnPatients were recruited for this questionnaire-based study in the oral and maxillofacial department out-patient clinics. The questionnaire includes multiple choice questions and free text answers.nnnRESULTSnAll patients were invited to participate and we have shown the results of the 100 consecutive patients who agreed to take part. The 100 patients recruited ranged between the ages of 16 and 75. English was the first language for 76 participants. The term mandible was correctly defined by 37 respondents. Sixty per cent of patients think that a fracture is a crack and less severe than a broken bone.nnnCONCLUSIONnCommon maxillofacial jargon can easily be misunderstood by patients. It is essential that all clinicians appropriately modify their language during consultations in order to deliver information in a comprehensive manner, to educate patients on their condition and to ensure sensible decision making by patients.

Oral and maxillofacial surgery: the importance of undergraduate training for junior doctors in accident and emergency

Although facial trauma is a common presentation at emergency departments,1 many aspects of oral and maxillofacial surgery (OMFS) such as the diagnosis and management of facial fractures are absent from the undergraduate medical curriculum. The ability to manage maxillofacial trauma, life-threatening airway compromise and basic dental pathology would be useful for any junior …

Patterns of cervicofacial infections: analysis of the use of computed tomography

ObjectiveThe aim of this study was to determine which clinical, microbiological and radiological factors contribute to the need for repeated computed tomography (CT) imaging and surgical drainage.MethodsIn this retrospective study, medical records of all patients who underwent surgical drainage of cervicofacial infections between January 2006 and August 2010 at a London tertiary referral centre were analysed. Patients who underwent CT due to a clinical suspicion of deep cervicofacial infection were divided into two groups: (1) single CT only and (2) repeated CT imaging. These groups were then compared using Fisher’s exact test. Patients requiring return to theatre for additional exploration and drainage of collection were also analysed.ResultsFour hundred and forty-five patients were admitted with cervicofacial infections, of whom 78 patients had a CT scan. The most frequent site of infection was the submandibular space, involving 54xa0% of patients. Among the patients who underwent repeated imaging compared to those who underwent a single CT scan, the parapharyngeal space was involved significantly more frequently (5/24 vs 2/54, pu2009=u20090.03), as was the presence of multiple-space infections (13/24 vs 15/54, pu2009=u20090.04) and osteomyelitis (4/24 vs 0/54, pu2009=u20090.007). Multiple-space infection was also more frequent in the group who required repeat visits to theatre as compared to those who had a single drainage (7/9 vs 23/69, pu2009=u20090.02).ConclusionsThe majority of cervicofacial infections are managed without the need for CT scanning. Presence of infection in multiple cervicofacial spaces and in the parapharyngeal space and presence of osteomyelitis result in persistent sepsis necessitating repeat imaging and drainage.

Sustained bilateral middle ear effusions post orthognathic surgery successfully treated with grommet insertion

We present the case of a patient who developed persistent bilateral middle ear effusions post Le Fort I maxillary osteotomy.