Author(s) Chandran A.; Bhanji A.; Rao J.
Source British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
Introduction/Aims A surgeon's experience undertaking larger case volumes is often linked to better performance. The aim was to assess a single surgeons performance in NMHNSC excisions over five years. We analysed time and case number to reach a consistent competency with regards to excision margins. Materials/Methods Skin pathology data sets were collected retrospectively from 2014 to 2018 The data collected involved a single surgeon operating in multiple hospitals and settings. Information regarding patient demographics, histological features of NMHNSC and excision margins were collected from pathology reports for each operation.

Results/Statistics The results showed from January 2014 to April 2014 there was a 6.8% involved margin rate and a 11.4% close margin rate. This improved with further case volume over the five years. By September2018 to December 2018it was noted that the involved margin rate had reduced to 3.8% and the close margin rate had increased slightly to 13.4%. We present the longitudinal statistics.

​Conclusions/Clinical relevance This study has shown that there appears to be improvement in performance of excisions of NMHNSC as the surgeon gains experience over time to reach a consistent performance. There was a clear initial learning curve to achieve this which took several cases. This likely differs from numbers presented in the literature believed to achieve competency in other bodily surgical procedures.Copyright © 2019

Author(s) Markose G.; Corsar K.; Graham R.M.
Source British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
With advances in CT scanning and 3D printing facilities the use of surgical models / stents in maxillofacial surgical planning for implants and oncological work is fairly routine. We present a case where the use of custom cutting guides aided 3D sculpting of a rather overgrown mandible in a young girl with a central giant cell granuloma. En bloc resection can be challenging due to the variable size and location of the tumours and their proximity to surrounding vital tissues. To overcome the challenge of precise resection, computer-aided models were used to assess vital structures, the extent of the affected area and plan surgery.

​The models were able to accurately identify the course of the mandibular canal. A mirror image of the normal side of the mandible was superimposed on the overgrown mandible and patient-specific guiding templates for resection were fabricated which allowed significant recontouring of the mandible with relative ease. The guiding templates provide significant advantages by guiding surgery, leading to more precise resection of the bone with less blood loss, shorter operation time and avoiding damage to the inferior alveolar nerve. We discuss the pre-operative and operative steps in the surgery and review the results.Copyright © 2019

Author(s): Hosni, Sara; Burnside, Girvan; Watkinson, Simon; Harrison, Jayne E.
Source: American Journal of Orthodontics & Dentofacial Orthopedics; Oct 2018; vol. 154 (no. 4); p. 545-553
Publication Date: Oct 2018
Publication Type(s): Academic Journal
Abstract:Introduction: Knowledge of a patient's stage of growth and development plays a vital role in diagnosis, treatment planning, results, and stability of the outcome. Cervical vertebral maturation (CVM) predicts the stage of growth and development, but its validity has only been investigated restrospectively, using historic samples. Our objective was to assess prospectively whether a correlation exists between CVM stage and statural height growth velocity.

Methods: Participants were aged between 8 and 18 years and of both sexes. Standing height was measured every 6 weeks with participants barefoot and in natural head position. CVM stage was assessed from lateral cephalograms taken at the start of treatment. Intraobserver and interobserver reliability of CVM staging and statural height measurements were assessed using the Cohen weighted kappa, percentage of agreement, intraclass correlation coefficient, and Bland-Altman plots, respectively. Analysis of variance was used to test for statistically significant differences between growth velocities at the CVM stages.Results: We analyzed 108 participants. The peak in statural height growth velocity occurred at CVM stage 3 (P = 0.001). There was a statistically significant difference in the mean annualized growth velocity between all CVM stages except stages 2 and 4. Girls had their peak pubertal growth spurt an average of 1.2 years earlier than did boys.

​Conclusions: This study suggests that there is a significant relationship between CVM stage and statural height velocity.
Database: CINAHL