A recent Oral & Maxillofacial Surgery digest,
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Study Type: Single-centre retrospective cohort study

Key Question: How often do lateralised early (cT1-T2) oral SCC tumours drain to the contralateral neck on sentinel node biopsy, and how often is this nodal disease?

Key Findings:

• Of 64 patients analysable for drainage, 26 (40.6%) showed contralateral or bilateral drainage; this was 40.0% (20/50) in anterior two-thirds tongue tumours.
• 22 patients (34.4%) had a positive SNB, of whom 3 (4.7%) had contralateral metastases. These three would have been inadequately staged or treated by ipsilateral elective neck dissection.
• One false-negative SNB (1.5%). Mean follow-up 46.3 months; 3-year overall survival 77.8%, disease-free survival 80.0%.

Clinical Relevance: SNB reveals contralateral disease that an ipsilateral elective neck dissection would miss, which is relevant to individualised neck management in early OCSCC as SNB use grows in the UK.

Limitations: Retrospective single-centre design with a small sample (64 of 92 patients analysable) and few contralateral metastases limits the strength of any associations with tumour characteristics.

Study Type: Prospective comparative cohort study (non-randomised, n = 56)

Key Question: Do posterior-shortening and posterior-lengthening approaches to counterclockwise mandibular setback differ in stability and outcome in surgery-first bimaxillary surgery for skeletal class III high-angle malocclusion?

Key Findings:

• Both groups (posterior-shortening n = 25; posterior-lengthening n = 31) showed early relapse in mandibular vertical translation and pitch at 1 week, and significant sagittal mandibular relapse by post-treatment.
• Most post-treatment outcomes were similar between groups, but posterior-shortening had significantly smaller maxillary and mandibular projection and upper incisor angle.
• Baseline differed: the posterior-shortening group had more gummy smile and lower projection and overbite. Effect sizes and follow-up duration are not reported in the abstract.

Clinical Relevance: Suggests either approach is viable in high-angle class III cases, but surgeons should counsel on sagittal relapse and select the approach according to baseline skeletal and soft-tissue features.

Limitations: Groups were not randomised and differed at baseline, so approach selection and outcome differences are confounded.

Study Type: In-vitro comparative study (80 implants in 20 maxillary bone models, intra-model comparison).

Key Question: Is augmented reality (Hololens 2)-assisted implant placement as accurate as conventional template-guided placement?

Key Findings:

• Angular deviation was lower with AR: mean 1.48° (±1.45) versus 2.65° (±1.29) for templates (P < 0.001).
• Depth deviation did not differ: -0.07 mm (±0.59) AR versus -0.08 mm (±0.67) template (P = 0.6).
• Accuracy was assessed by superimposing postoperative CBCT on the preoperative plan. The authors concluded both methods were highly precise.

Clinical Relevance: AR may offer a template-free route to guided implant placement, but this is early-stage evidence with no clinical data yet relevant to NHS practice.

Limitations: In-vitro bone models without soft tissue, saliva, patient movement or restricted access, so findings cannot be extrapolated to clinical performance; the abstract also does not report operator experience or whether the analysis accounted for clustering of implants within models.

Study Type: Retrospective cohort study (n=17), CT-based 3D volumetric analysis.

Key Question: Does the contralateral natural condyle undergo remodeling after unilateral total TMJ replacement, and is the prosthetic condyle positionally stable?

Key Findings:

• Contralateral condylar volume fell by a mean 139 mm³ (SD 98.9; P<0.001), approximately 9.3%, at a mean follow-up of 13.2 months.
• Resorption was localised to the posterior and superior condylar surfaces; simultaneous orthognathic surgery did not alter the remodeling trend.
• Prosthetic condyle displacement was <1 mm in all directions, indicating good positional stability.

Clinical Relevance: Unilateral TMJR may impose altered loading on the remaining native joint, which is relevant to case selection, counselling and long-term surveillance of the contralateral side in NHS TMJR pathways.

Limitations: Small, young cohort with short follow-up (about 1 year), no control group and no reported clinical correlation (pain, function, occlusion), so the significance and progression of the resorption remain unclear.

Study Type: Structured scoping review (JBI methodology, PRISMA-ScR), narrative synthesis

Key Question: What is the evidence base for OMFS-led surgical management of syndromic craniofacial conditions within multidisciplinary teams?

Key Findings:

• 40 studies (1975-2026) were included from 274 screened records, covering syndromic craniosynostosis, Pierre Robin sequence, Treacher Collins syndrome and hemifacial microsomia.
• Outcomes were generally favourable, but evidence was mostly retrospective case series and case reports, with inconsistent outcome measures and little long-term or patient-reported data.
• Timing of intervention and distraction osteogenesis versus conventional osteotomy remain unresolved, with conflicting comparative data.

Clinical Relevance: Offers a mapped overview of OMFS contributions, particularly skeletal reconstruction and airway management, but gives no comparative evidence to guide technique or timing in UK craniofacial networks, where OMFS roles and team leadership vary.

Limitations: Evidence is predominantly low-level observational data, and no quality appraisal or quantitative synthesis is described, so conclusions on effectiveness are limited.

Study Type: Single-centre retrospective comparative study (n = 19 bimaxillary cases; comparator group size not stated in abstract).

Key Question: Can a semi-guided workflow (3D-printed cutting guides plus pre-bent plates) transfer virtual surgical planning for Le Fort I maxillary positioning as accurately as conventional splint-based surgery?

Key Findings:

• Osteotomy deviation ranged 0.09–1.34 mm (mean 0.56 mm).
• No significant differences in maxillary positioning versus the splint workflow, apart from greater absolute vertical deviation in the semi-guided group, judged of limited clinical relevance (magnitude not reported).
• Mean operative time was 28.8 minutes shorter with the semi-guided approach, but this was not statistically significant (p = 0.173).

Clinical Relevance: A hybrid approach may offer a cheaper, faster alternative to splints or full PSI, relevant to NHS units weighing planning and manufacturing costs, though no cost data were presented.

Limitations: Small, retrospective, single-centre sample with no randomisation, so allocation bias and underpowering (particularly for operative time) cannot be excluded.

Study Type: Finite element analysis (computational biomechanical study); no clinical or in vivo data.

Key Question: How do Voronoi lattice filling ratio (25–75% vs solid) and ramus length (mini, standard, extended) affect stress distribution and fatigue life in a porous titanium total TMJ prosthesis?

Key Findings:

• Ramus von Mises stress fell with increasing filling ratio, from 363.5 MPa (standard, 25% lattice) to 71.3 MPa (extended, solid); all designs showed infinite fatigue life (safety factors 1.5–7.8).
• Lower filling ratios transferred more load to bone, potentially reducing stress shielding; bone stress stayed within physiological limits.
• Fossa and UHMWPE stresses rose with filling ratio, and UHMWPE stress exceeded polyethylene yield strength in every model.

Clinical Relevance: Lattice-structured, potentially patient-specific TMJ ramus components may support bone-sparing designs, but this remains a bench-level observation with no bearing yet on current NHS practice.

Limitations: Single-load simulation (unilateral molar clenching) using one anatomical dataset, with no experimental, biological, or clinical validation; the UHMWPE yield exceedance is unresolved.

Study Type: Retrospective national database analysis (aggregate procedure-count data, Japan), with comparative context from Germany.

Key Question: How did oral cancer resection volumes and case mix change across Japan's pre-, during- and post-COVID-19 periods, stratified by operating specialty (OMS vs otolaryngology/head-and-neck surgery)?

Key Findings:

• 72,135 resections captured over 2016-2023 (mean ~9,017/year); OMS performed 53-58%. Volume fell 12.8% between 2019 and 2021, almost entirely within OMS, and fully recovered by 2023.
• OMS performed most partial glossectomies (57%), marginal mandibulectomies (81%) and partial maxillectomies (66%); OHNS performed most subtotal and en bloc resections. The partial-to-subtotal glossectomy ratio was 28 for OMS vs 3.5 for OHNS.
• No post-pandemic shift toward more extensive resection was seen, broadly consistent with Germany.

Clinical Relevance: Reassuringly, no signal of pandemic-related disease progression in resection extent, though UK services should interpret this cautiously given differing healthcare structures and pandemic disruption.

Limitations: Aggregate procedure counts lack patient-level staging, so stage migration cannot be assessed directly.