R. Elledge

Craniofacial implants at a single centre 2005-2015: retrospective review of 451 implants

Craniofacial endosseous implants are regularly used to support prostheses in the rehabilitation of complex defects, but reported success rates vary. To review our own clinical practice over 10 years, and particularly to examine the impact of radiotherapy and the timing of placement on the survival of implants, we retrospectively audited the records for all patients who had endosseous implants for prosthetic rehabilitation in our unit between 2005 and 2015. We reviewed 167 records, which gave 451 implants, of which, 222 (49%) were auricular, 98 (22%) nasal, and 131 (29%) orbital. Most were placed after ablative operations for cutaneous malignancy (n=103 patients, 62%). The failure rate of implants placed in bone that was irradiated either before or after placement was significantly higher than that of those placed in non-irradiated bone (univariate analysis: 11% compared with 2%, p<0.001: Kaplan-Meier survival analysis: p<0.001). The timing of placement in relation to radiotherapy (before compared with after) seemed to have no impact on success (p=0.96). Our findings are in keeping with previous reports, and the principal observation is that radiotherapy adversely affects success. We work closely with our maxillofacial prosthetists and place implants at the time of ablation. Our findings seem to support this practice regardless of whether or not the patient will later require adjuvant radiotherapy.

UK temporomandibular joint replacement database: a report on one-year outcomes

Alloplastic temporomandibular joint (TMJ) replacements are increasingly subspecialised, and supraregional centres that treat sufficient numbers to ensure high standards are emerging. Having recently reported the introduction of a national TMJ joint replacement database that is endorsed by the British Association of TMJ Surgeons (BATS), we now present the first-year outcomes. This was a review of all data in the BATS National Case Registration of TMJ Replacement as of June 2014. A total of 252 one-year outcome records were available. Key outcomes were median (IQR) improvements in interincisal distance of 9 (4-15) mm (p<0.001) and worst-sided pain score of 6 (4-8) (p<0.001). Pain scores improved or remained static at one year in all but 3 (2%) patients. There was a significant improvement in the proportion of patients who reported a good, very good, or outstanding quality of life at one year (38% at baseline to 87% at one year; p<0.001). While outcome reports from single centres for alloplastic TMJ replacements have already been published in the United Kingdom, this is the first dedicated national database in this country that will yield valuable longitudinal follow-up data. Outcomes were comparable with smaller published series and showed improvements in pain, dietary intake, quality of life, and function, with few outliers. The database has recently moved to a new software system and we hope to publish three-year and five-year outcomes in due course.

Conservative Management Options for Dislocation of the Temporomandibular Joint

Dislocation of the TMJ affects a wide demographic (up to 5% of the population) and can be attributed to a wide variety of causes including excessive mouth opening (e.g. yawning, vomiting, seizure), trauma (e.g. flexion-extension injury to the mandible, intubation, endoscopy, dental extraction), connective tissue disorders (e.g. Ehlers-Danlos syndrome, Marfan’s syndrome) and psychogenic causes (e.g. habitual dislocation, tardive dyskinesia) as possibly the majority of cases [1]. Single episodes of TMJ dislocation are often managed by manual reduction techniques (discussed elsewhere in this text) and require no further intervention. The terms “chronic”, “chronic recurrent” and “habitual” are interchangeable and used for cases in which repeated episodes of dislocation occur [2]. Other authors distinguish “acute”, “chronic” (i.e. persistently dislocated) and “recurrent”. Recurrent dislocations can be particularly troublesome and are the subject of discussion in the current chapter, which deals with conservative interventions to address these problems.

Extended total temporomandibular joint replacements: a classification system

Prosthetic total temporomandibular joint (TMJ) replacement (TJR) is well established in the United Kingdom, with clear guidelines for indications and nationally published outcomes. CAD/CAM technology has made it possible to push the boundaries of custom-made TJR to include extended versions (eTJR), which may replace segmental mandibular defects or defects in the skull base with extended components for the ramus and fossa, respectively. Such prostheses are uncommon, and published reports are restricted to isolated cases and series of cases. We know of no previous attempts to classify such prostheses, and here we suggest a bipartite classification system for use in communications between surgeons and manufacturers based on a review of 19 prostheses provided by one manufacturer (TMJ Concepts, Ventura, CA).

Current thinking in medical education research: an overview

Medical education is fast becoming a separate focus, and together with their clinical commitments, many clinicians now seek higher qualifications and professional accreditation in the field. Research is also developing, and there is a need for evidence-based practice in education, just as in clinical work. This review gives an overview of research into medical education, and explains the fundamentals of educational theory and the specific considerations for the quantitative and qualitative research methods that pertain to it. It also explains the application of these methods to two growing areas of research: technology-enhanced learning (TEL) and normative ethics in training.

Oral Prosthodontic Rehabilitation of Head and Neck Cancer Patients

When patients are first diagnosed with head and neck (H&N) cancer, their main concern is with survival. However, following cancer treatment, their concerns can rapidly shift towards reobtaining and maintaining a good quality of life (QoL) [1]. Oral prosthodontic rehabilitation forms a major component of QoL improvement contributing not only functionally but also psychologically. H&N cancer treatment can leave the patient with significant disability and deformity. Oral prosthodontic rehabilitation aims to address the acquired functional and cosmetic deficits by providing treatment to restore the defect, re-establish oral function, improve cosmetic appearance and allow the patient to interact in society with confidence. Rehabilitation should be patient-centred aiming to meet each individual’s unique and specific needs.