Postgraduate exposure to oral and maxillofacial surgery (OMFS) for medical and dental graduates differs significantly. To our knowledge, the availability and opportunities provided by these single-qualification posts have not previously been explored. We investigated the number of OMFS posts available for foundation year (FY) doctors and dental core trainees (DCTs) by using information from UK foundation schools and analysing data from Health Education England (HEE) and the UK Foundation Programme Office (UKFPO). In 2023-24 there were over 11 times as many OMFS posts for DCTs compared with FY doctors. The implications are explored in this paper, including the impact on interprofessional working and team development. OMFS as a specialty, with teams consisting of dental and medical graduates, is distinctive for fostering interprofessional education (IPE) and collaboration (IPC). IPE/IPC has been shown to increase the knowledge of practitioners and can lead to benefits for both clinicians and patients. By understanding the national composition of single-qualification posts, we hope to establish the foundations for further research into this unique interdisciplinary learning environment.

Attaining degrees in both medicine and dentistry to forge a career in Oral and Maxillofacial Surgery (OMFS) comes at a considerable financial cost. To fund a second degree most must work alongside their full-time studies. This study aims to assess the current working roles and patterns of those qualified in dentistry, studying medicine to pursue a career in OMFS. An online survey was created following a comprehensive literature review. Sixteen questions were included to collect data regarding the working patterns and roles of dentally qualified medical students. Responses from 45 students in the UK were included. Working in OMFS was undertaken by 96%, with 49% working in an OMFS unit associated with their university. First on-call OMFS roles were worked by 78%, with 38% doing second on-call work. Night shifts were worked by 84%. Roles providing primary dental care were undertaken by 31%. The work undertaken had a positive or strong positive effect on the OMFS skill set of 62%, and 84% wished to gain more operative experience in theatre. Most second-degree trainees are working in on-call OMFS roles encompassing night shifts. Many feel they are advancing their clinical skills but wish to gain more operative experience in theatre.

This study of clinicians working in oral and maxillofacial surgery (OMFS) in the United Kingdom (UK) investigates the prevalence and character of surgical performance anxiety (SPA), a state of anxiety in response to negative evaluation by others concerning the performance of a surgical task. There is growing awareness of the impact of non-technical skills on patient outcomes with some research into SPA, but this is not OMFS-specific, and the understanding of performance anxiety in surgery falls behind comparable performance-driven professions. A prospective mixed-methods study was therefore conducted among UK OMFS clinicians using an electronic survey. Data captured included demographics, trait anxiety, wellbeing, trait perfectionism, and surgical perfectionism. A total of 79 responses were collected. The mean (range) age was 35.6 (24-68) years, and the mean (range) experience working in OMFS was 9.6 (0.25-43) years. Ninety per cent of respondents had experienced SPA during their career. Reduced SPA and trait perfectionism were linked to increased age and experience. Respondents experienced significantly lower wellbeing compared with population norms. The thematic analysis highlighted people and the working environment as triggers for SPA. Creating an open, blame-free environment was a frequently suggested support strategy. By acknowledging and addressing SPA, OMFS clinicians can potentially improve their performance and patient outcomes. Identifying people and the working environment as triggers and the recommendation to create an open, blame-free environment offer direction for further research.

The accelerated dental degree, pioneered by King's College London (KCL) to facilitate dual qualification training pathways for primary medical degree trainees, has graduated its fourteenth class. The authors present data to demonstrate and analyse the success of the course, which was accumulated through an online questionnaire, direct communication with the alumni, a freedom of information request from KCL, and review of the General Dental and Medical Council registers. To date 133 students have graduated with updated information collated for 132 (99.2%). Thirty seven percent of the students are female, which is comparable to the wider NHS consultant workforce. Over 70% (n = 95) of graduates work within a dual qualification specialty, with women more likely to take this up than men. Dentistry was the second most common career path at 16.8% (n = 23) and this is most likely to be due to the draws of primary dental care over the NHS secondary care. Attrition rates of the KCL students at each stage of the career pathway were equal to or fewer than other university undergraduate medical and dental degrees, the dentistry-first pathway, and other higher surgical training schemes. KCL alumni attest to 29% of the OMFS higher surgical trainees, with the average time between GMC provisional registration and specialist registration being 14.7 years (range 12-19). The authors strongly advocate the success of the accelerated dental degree in KCL and would encourage other institutions around the United Kingdom to accept the model to increase accessibility and build on the success of the primary medical degree OMFS surgical trainee programme.

In 2008 the Postgraduate Medical Education and Training Board (PMETB) Review of Oral and Maxillofacial Surgery (OMFS) recommended that OMFS specialty training should start with second-degree studies. This recommendation has not yet happened. Currently, no OMFS controlled places at medical/dental schools are directly linked to OMFS Specialty Training (ST) posts. 'OMFS controlled' in this paper refers to dedicated places on shortened second degree courses to which OMFS specialists/trainers have the key role in selection. Freedom of Information requests were sent to 14 medical schools known to have OMFS 'controlled' second-degree MB places: Aberdeen, Birmingham, Bristol, Cambridge, Cardiff, Glasgow, Leeds, Liverpool, Manchester, London-Kings, London-QMUL, Newcastle, Plymouth and York/Hull. Information was also requested from the London-Kings BDS Dental Programme for Medical Graduates (DPMG). These data were supplemented by information from consultants and trainees with experience of the processes. Replies were received from six medical schools in Birmingham, Cambridge, Glasgow, Liverpool, London-Kings, and London-QMUL, plus the dental school of London - Kings DPMG. These seven programmes provide approximately 30 OMFS controlled places per year. The application ratios, between 5:1 and 29:1, are significantly more competitive than selection to ST1 and ST3 places. There are more OMFS controlled second degree places than presented in this paper which only details universities from whom replies were received. If all students in OMFS controlled second-degree places progressed to ST without loss, there are more than sufficient to fill all available OMFS ST places. Linking OMFS controlled second degree places through to OMFS ST posts would deliver the key PMETB recommendation in a process which would be more competitive than current ST selection. For OMFS trainees whose first degree was medicine, OMFS selected places at shortened dental courses are needed outside London.

In the UK Oral and Maxillofacial Surgery (OMFS) and Oral Surgery (OS) are distinct specialties governed respectively by the General Medical Council (GMC) and General Dental Council (GDC) respectively. There has always been overlap of training and care between both specialties. The OMFS curriculum was updated in 2021 and the Oral Surgery Curriculum in 2023. This paper quantitatively compares the two documents. The generic professional elements of both curricula are extensive and similar in content. The specialty specific elements of the OS and OMFS curricula, with focus on knowledge domains and competencies including index procedures and critical conditions, were compared with the level of coincidence colour coded: green (matching), amber (some overlap) and red (not present). OMFS curriculum contains all components of the new UK OS curriculum with the exception of formal documented competence in conscious sedation for dentistry. This overlap between OMFS and OS has been recognised by the General Dental Council who give OMFS specialists direct access to the Oral Surgery specialist list by Route 4. In contrast, the OS overlap with OMFS is limited, particularly in the important critical/emergency conditions where 'competence' has been replaced by 'experience of' in the 2023 OS curriculum in the domains of trauma and acute infections. This change will preclude OS specialists trained on the new curriculum being able to share on-call with OMFS specialists without significant additional training. We hope this comparison will be useful to those commissioning services and also for young dentists/doctors considering their future careers.

This study aims to evaluate the post-surgical stability of patients with cleft lip and palate that underwent maxillary advancement surgery. The study was conducted by means of cephalometric analysis of the soft tissues in digital radiographs acquired preoperatively, immediate postoperatively and six months after surgery using Dolphin Imaging 11.5 software. The effective sample consisted of 87 patients, among whom 50 (57.4%) were male and 37 (42.6%) were female. The mean age of the patients was 23.1 years, the minimum age was 17 years, and the maximum age was 37 years. Patients underwent maxillary advancement with cephalometric analysis during the preoperative and postoperative period, which was around six months. The results revealed a significant tendency for relapse in the vertical direction with instability of the occlusal plane. In the postoperative period, counterclockwise movement of the maxillomandibular complex was observed, leading to height reduction of the lower third of the face and increased facial angle. The observed changes were not correlated with the extent of the sagittal advancement.

A state-of-the-art scaffold capable of efficiently reconstructing the temporomandibular joint (TMJ) disc after discectomy remains elusive. The major challenge has been to identify a degradable scaffold that remodels into TMJ disc-like tissue, and prevents increased joint pathology, among other significant complications. Tissue engineering research provides a foundation for promising approaches towards the creation of successful implants/scaffolds that aim to restore the disc. In light of improving the quality of life of patients who undergo TMJ disc removal, it is critical to establish a preclinical animal model to evaluate the properties of promising scaffolds implanted post-discectomy and to determine the most efficient implantation procedures to ensure a more reliable in-depth evaluation of the biomaterial replacing the articular disc. The present study evaluated the outcomes of two protocols for implantation of an acellular scaffold composed of an extracellular matrix (ECM) derived from the small intestinal submucosa (SIS) of the pig, as a regenerative template for the TMJ disc in a goat model. The outcomes suggest that leaving one-half of the disc medially will allow anchoring of the device to the medial aspect of the joint while avoiding lateral displacement of the ECM scaffold. The goat model is ideal to assess the longevity of tissue-engineered solutions for the TMJ disc, considering that goats chew for 12-16 hours a day. This study provides an important reference for the selection of a suitable scaffold implantation procedure and the goat model for the development of new strategies to assess TMJ disc regeneration.

For dental graduates transitioning into junior oral and maxillofacial surgery (OMFS) roles, the shift from general dental practice to the hospital environment presents unique challenges. This article reviews the key resources and training tools that are available and commonly used by these graduates to prepare for their roles. The findings are based on a survey of 61 junior OMFS practitioners, highlighting the most helpful resources and identifying gaps that could be addressed to better support new entrants into the field and enhance training satisfaction.

Temporomandibular disorders (TMD) are a group of common conditions that can have significant detrimental impact on patients functional, emotional and social wellbeing. The aim of this systematic review is to collate and summarise the literature reporting patients' experience of TMD. This helps put the condition into the context of the patient themselves and their interaction with healthcare professionals. The study was completed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. A systematic literature search was performed on 1 December 2023 using following databases: MEDLINE, Embase, Web of Science, PsychInfo (American Psychological Associated) and the Cochrane Library. Of these 439 articles, 13 met the inclusion criteria for the review. It was a heterogenous sample with relatively poor methodological quality. The cohorts ranged from nine to 44; totalling 280 participants. Two key themes and six subthemes illustrate the experience of patients with TMD: Impact (Physical, Psychological) and Coping (Understanding the disease, Experience of healthcare professionals, Seeking treatment, Adapting behaviours). Clinical care needs to reflect the experience of patients with better explanation of the condition, access to services and support. Further research should explore how to address patients' concerns more effectively. One method might be through the development of a PCI-TMD.

Palliative care strives to improve the quality of life of patients experiencing life-limiting conditions by providing personalised holistic care. Head and neck cancer patients may require palliation at different stages of their disease, thus timely recognition and management is vital when considering supportive care. This study assesses the awareness, perceived confidence, and knowledge of palliative care management of UK-based oral and maxillofacial surgery (OMFS) head and neck surgeons. The study comprised eight multiple-choice questions developed by five palliative care consultants via the Delphi method and distributed over three months. Alongside knowledge, perceived confidence, and exposure and training, shortfalls in palliative care management were assessed. A total of 50 eligible responses were collated from middle grade (n = 34, 68%) and consultant (n = 16, 32%) OMFS surgeons in the UK. The mean knowledge score was 3.2 out of 10, with only 28% stating they were confident with the palliative management of head and neck patients. Only 10% had had palliative care rotations during their postgraduate training and the majority (86%) felt that further palliative care training should be incorporated into the OMFS curriculum. Our findings suggest a need for focused palliative care training and education amongst UK-based OMFS surgeons. A greater understanding through curriculum integration and a collaborative multidisciplinary approach will ultimately enhance the quality of care delivered to these patients.

In their 2022 paper Newman et al compared gender diversity between UK surgical specialties. It omitted the specialty of oral and maxillofacial surgery (OMFS), which is one of the ten General Medical Council recognised surgical specialties. When challenged, the authors did not provide data for OMFS. This paper analyses OMFS using a similar statistical approach but using specialty data rather than that held by NHS Digital. Data returned from NHS Digital about OMFS in 2022 did not accurately reflect known data. Alternative data was obtained from the General Medical Council with a Freedom of Information request for the OMFS specialist list in January 2024. These data were combined with a database of current OMFS trainees and retired OMFS consultants. For OMFS specialists, their date of entry onto the OMFS specialist list was used. For current trainees the average duration of OMFS training was added to the start date of their training. For both groups the gender cited on the GMC listing was used. The dataset consisted of 862 UK surgeons: 114 retired OMFS consultants, 571 currently on the OMFS specialist list and 177 in OMFS specialty training. Of this group 734 (85%) were male and 128 (15%) female. By plotting year of entry onto the OMFS specialist list for specialists and estimated year of Completion of Surgical Training for specialty trainees using linear projection in Excel©, gender parity of those joining the OMFS specialist list could happen in 2048 (24 years).

By spending 3-5 years in a single location studying for their second degree, OMFS trainees often put down domestic roots which they are reluctant to pull up to complete their training elsewhere. The universities at which OMFS specialists/trainees obtained their second degrees were assembled using the General Medical Council's OMFS specialist list, the General Dental Council's Dental Register and a database of OMFS trainees and consultants. The second degrees of 818 past and current OMFS specialists/trainees were analysed. The most common location for second degrees of either type was London 287 (35%) followed by Birmingham 67 (8%), then Cardiff 51 (6%) and Manchester 45 (6%). There is a trend, with time, to more OMFS trainees obtaining their second degree in London. For those 689 whose second degree was medicine, London was the top location with 206 (30%) followed by Birmingham 67 (10%) and Cardiff 50 (7%). For those 129 whose second degree was dentistry, London was the top location with 81 (63%) followed by Europe 11 (9%) and Ireland 7 (5%). The predominance of London as a source of their second-degree for both 'dentistry first' and 'medicine first' OMFS trainees impacts on recruitment. Many who study in London want to train/work in or near London. Understanding where OMFS trainees obtain their second degrees, may help those planning for the future workforce for example creating opportunities outside London.

The aim of this paper was to systematically review and compare the Apnoea-Hypopnoea Index (AHI), Lowest O Saturation (LSAT), Oxygen Desaturation Index (ODI), Epworth Sleep Scale (ESS), and Body Mass Index (BMI) between dentofacial (skeletal) classes I, II, and III before and after maxillomandibular advancement (MMA) for Obstructive Sleep Apnoea (OSA). The PubMed, Scopus, and CINAHL databases were searched from inception to 23 November 2022. Two reviewers screened for articles that reported occlusion/malocclusion class type as I, II, or III, and reported preoperative and postoperative AHI, LSAT, ODI, ESS, and/or BMI. Two reviewers independently screened title/abstracts and subsequently, full-text articles that met eligibility criteria. Preoperative ESS and ODI were significantly higher in Class II (13.77, 95% CI, 11.38% to 16.17% and 47.49, 95% CI, 33.04% to 61.95%) than in Class III (12.47, 95% CI, 9.95% to 14.99% and 32.47, 95% CI, -10.37% to 75.30%) (p < 0.0001). Postoperatively, class I showed the greatest percentage reduction of AHI, with a reduction of 89.61% (95% CI, 84.47% to 94.75%) compared with class II and III (p < 0.0001). Additionally, amongst all malocclusion classes and operative status, meta-regression showed positive correlations between ESS and AHI (r = 0.94, p < 0.001) and ESS and ODI (r = 0.90, p < 0.001). Class I subjects with no dentofacial discrepancy had the greatest improvement in AHI compared with Class II and III. Class II subjects may express more severe ODI and ESS preoperatively compared with Class III subjects. Additionally, subjective outcomes (ESS) may be a predictor for objective outcomes (AHI and ODI) for patients undergoing MMA.

Myofascial pain represents the largest subgroup of temporomandibular disorders (TMD) that account for a common cause of non-dental orofacial pain. The management of TMD is complex due to the chronic nature of the condition, alongside acute episodes presenting to the clinician. A fundamental part of TMD management is consideration of the biopsychosocial element in its aetiology. First-line treatment of myofascial TMD includes early diagnosis, explanation and education, and conservative self-care measures. Botulinum toxin A (BTX-A) is now being used increasingly as an adjunct to conservative management of muskuloskeletal pain disorders due to its muscle-relaxant and analgesic properties. However, the scientific evidence regarding this is conflicting and it has been suggested that there is insufficient evidence to support the efficacy of BTX-A. To assess the effectiveness of masseteric BTX-A, a mixed methods analysis of a TMD-myofascial pain cohort who underwent BTX-A injections was therefore carried out. A total of 149 patients completed one round of treatment, and 61 of them completed an additional round. In total, 398 masseter muscles were injected. The mean preoperative visual analogue scale (VAS) pain score was 8/10, compared with a postoperative mean score of 3/10 six weeks after treatment. The mean percentage reduction in pain was 50%. Pain scores and quality of life scores improved considerably more in the severe pain group than in the mild group. Complete resolution of symptoms was reported in 21% of patients (n = 31). The treatment significantly improved patients' reported pain and quality of life scores, highlighting key beneficial effects for the myofascial pain subgroup of TMD.