Introduction

Within the literature there are well established risk factors implicated in  the most severe cervicofacial infections - of which obesity is included. However, to date, no one has considered how a larger body habitus may change clinicians investigative decision making and management strategies.

Method

We conducted a retrospective analysis of all cervico-facial infections over the last 6 years who underwent incision and drainage at QEUH in Glasgow. We calculated each patient's body mass index (BMI), and compared those within a ‘healthy BMI’ with those considered to be ‘obese’ and ‘morbidly obese’ to determine if patients with higher BMI:

Undergo more three-dimensional imaging pre/post-operatively
Experience more returns to theatre
Have a longer length of hospital stay
Are more likely to require a tracheostomy or intensive care stay

Results

We have shown that patients with higher BMI are subject to more investigations and operative intervention than their ‘healthy BMI’ counterparts. We attribute this to difficulties differentiating between excess adipose tissue and true oedema when assessing those patients with high BMI.

Conclusion

Between 2005-2006, the average annual cost of running a single operating theatre for 27 hours per week was £1.1 million. Furthermore, the cost of expensive three-dimensional imaging modalities and long hospital stays is significant. One can appreciate the significant cost-savings and decreased morbidity for patients with high BMI if unnecessary investigations and interventions could be avoided.

Abstract

Title: Recurrent Facial cellulitis due to MRSA : a case report.

Introduction

Cellulitis is a common bacterial skin infection that typically responds well to empirical antibiotic therapy. However, recurrent or non-responsive cases may signal underlying resistance, particularly due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA). This report highlights the importance of microbiological diagnosis in guiding effective treatment.



Case Report

A 41-year-old male with a history of recurrent cellulitis presented with spreading erythema over the right perioral region following manipulation of a pimple. His general practitioner prescribed oral co-amoxiclav, but symptoms worsened, prompting hospital admission for intravenous flucloxacillin. The infection initially improved, but a small abscess developed and was surgically drained.


Ten days later, the patient reported significant improvement with only residual scarring. However, erythema recurred in the same area one week later. Oral metronidazole was initiated, resulting in partial improvement, but symptoms returned before the course was completed. Microbiological analysis of the drained abscess revealed MRSA, resistant to beta-lactam antibiotics and sensitive only to cotrimoxazole and vancomycin. The patient was transitioned to oral cotrimoxazole, leading to marked and sustained improvement at one-week follow-up.



Discussion

This case underscores the diagnostic challenges in managing recurrent cellulitis. Initial empirical therapy may be ineffective against resistant organisms such as MRSA, delaying recovery and increasing the risk of complications. Early microbiological sampling and sensitivity testing are essential in guiding targeted antibiotic therapy. Clinicians should maintain a high index of suspicion for MRSA in recurrent or non-responsive skin infections and consider culture-directed treatment to optimize outcomes and prevent recurrence.

Introduction:
Accurate triage of OMFS referrals is essential for appropriate care. However, increasing volume and often poor referral quality place strain on consultant time. Large language models (LLMs), such as GPT-3.5 and GPT-4, are emerging as potential decision-support tools. This project combined a scoping review and pilot study to evaluate the effectiveness of LLMs in OMFS referral triage compared to clinicians.

Method:
A scoping review was conducted using the PRISMA-ScR framework to identify literature on LLMs in triage, diagnosis, and referral optimisation. Findings informed a pilot study. Fifty synthetic referrals were constructed using anonymised real-patient case summaries. Original referrals lacked sufficient detail, so synthetic versions were designed to reflect plausible clinical scenarios with adequate information for assessment. Each referral was input into GPT-3.5 and GPT-4 using a standardised prompt requesting: (1) suggested investigations, (2) likely diagnosis, and (3) initial management. Outputs were compared to actual clinical decisions for those cases.

Results:
The review found limited but growing evidence for LLMs in referral triage, with sparse coverage in surgical specialties. In the pilot, GPT-4 showed better clinical alignment than GPT-3.5 across all domains. Both models produced more appropriate suggestions with structured information, but struggled with vague inputs, mirroring challenges in human triage.

Conclusion:
LLMs, particularly GPT-4, show promise as triage adjuncts in OMFS. While not a replacement for clinician judgement, they may help streamline decision-making when referral detail is sufficient. Further validation is needed before clinical implementation.

Background: 70-year-old female previously treated for Squamous Cell Carcinoma (SCC) of the right mandible and right labial commissure represents with a non-healing ulcer on the right labial mucosa extending to the maxillary alveolus. Reconstruction following resection of the SCC poses a significant challenge due to previous radiotherapy associated with treatment of the SCC on the right labial commissure, a field needed in reconstruction of the resected site. The aim of the patient’s treatment being tumour resection, restoration of function and a level of aesthetic restoration.
Methods: Careful consideration of reconstructive flap in this case was needed due to the compromised vascularity of the previously irradiated tissue.  A modified Karapandzic flap along with a V-Y flap and placement of Integra intraorally was the treatment modality of choice, conserving nerves, enhancing blood supply as well as providing adequate adaptation and functional restoration.
Results: The selected flaps provided majority stable wound healing, restored oral competence, and preserved speech and oral intake. The patient recovered without major complications.
Conclusion: Oral commissure reconstruction in previously irradiated patients requires meticulous flap selection to optimise vascularity and function. A tailored approach is essential to achieving functional and aesthetic outcomes while satisfying the primary objective of complete tumour excision.

An incidental finding of a Complex Odontoma – A reminder regarding the importance of routine investigations

Maria-Alexandra Barbu1, Cristina Frezzini1, Iain Varley1
1-Department of Oral and Maxillofacial Surgery Department
Sheffield Teaching Hospitals NHS Foundation Trust


Abstract

Introduction:
Complex odontomas are rare odontogenic tumors composed of a disorganized mass of dental tissues, typically detected during routine radiographic examinations. They represent a developmental anomaly rather than a true neoplasm and are most often diagnosed in the first two decades of life. Although usually asymptomatic, complex odontomas may impede eruption of permanent teeth or alter the normal development of adjacent anatomical structures, warranting early recognition and appropriate management.

Case report:
We report the case of an 11-year-old fit and well female who presented with a complex odontoma of the LR7 region. This was an incidental finding following imaging taken for orthodontic treatment purposes.
We describe the investigation, diagnosis and management of this child’s condition.

Discussion:
This case highlights the incidental detection of a complex odontoma during orthodontic evaluation and underlines the potential implications for tooth eruption and mandibular growth. Multidisciplinary input involving orthodontics and oral and maxillofacial surgery is crucial for establishing an appropriate management plan, balancing surgical intervention with preservation of developing teeth and the inferior alveolar nerve. Early diagnosis allows timely intervention, preventing complications such as impaction, malocclusion, or pathological fracture. Recognition of odontomas as incidental findings on panoramic radiographs emphasizes their significance in orthodontic and pediatric dental practice.

Head and neck squamous cell carcinoma (HNSCC) is often treated with surgery followed by adjuvant radiotherapy or chemoradiotherapy in high-risk cases. While radiotherapy improves initial control, up to 20–30% of patients still develop recurrence. For many, salvage surgery is the only potentially curative option. Advances in microvascular reconstruction now make salvage more feasible, but operating in irradiated tissues carries higher risks and often leaves patients with significant functional difficulties.
Aim:
To review current evidence on how prior radiotherapy influences outcomes and complications of salvage surgery in HNSCC, and to consider the implications for both patients and clinical teams.
Findings:
Five-year overall survival after salvage typically ranges from 20–45%, with the best outcomes seen in solitary, late recurrences. Prognosis is worse with short disease-free intervals, nodal recurrence, or previous adjuvant treatment. Surgery in irradiated fields is associated with greater rates of wound breakdown, fistula and reconstructive failure, though flap survival exceeds 90% in experienced centres. Functionally, many patients remain gastrostomy-dependent and return to a normal diet is rare. Only about one-third of patients with recurrence are suitable candidates for salvage, but the overall number of operations is increasing due to rising cancer incidence, longer survivorship, and wider surgical feasibility.
Discussion:
For patients, salvage after radiotherapy offers a chance of cure but at the cost of higher morbidity and quality-of-life compromise. For clinical teams, these operations are complex, resource-intensive and require multidisciplinary planning.
Conclusion:
Salvage surgery in previously irradiated HNSCC provides hope for selected patients, but remains a demanding intervention with significant risks and functional consequences. Future strategies, including better patient selection, quality-of-life research, and novel systemic options such as immunotherapy, are needed to refine care.

Introduction

Within the literature there are well established risk factors implicated in  the most severe cervicofacial infections - of which obesity is included. However, to date, no one has considered how a larger body habitus may change clinicians investigative decision making and management strategies.

Method

We conducted a retrospective analysis of all cervico-facial infections over the last 6 years who underwent incision and drainage at QEUH in Glasgow. We calculated each patient's body mass index (BMI), and compared those within a ‘healthy BMI’ with those considered to be ‘obese’ and ‘morbidly obese’ to determine if patients with higher BMI:

Undergo more three-dimensional imaging pre/post-operatively
Experience more returns to theatre
Have a longer length of hospital stay
Are more likely to require a tracheostomy or intensive care stay

Results

We have shown that patients with higher BMI are subject to more investigations and operative intervention than their ‘healthy BMI’ counterparts. We attribute this to difficulties differentiating between excess adipose tissue and true oedema when assessing those patients with high BMI.

Conclusion

Between 2005-2006, the average annual cost of running a single operating theatre for 27 hours per week was £1.1 million. Furthermore, the cost of expensive three-dimensional imaging modalities and long hospital stays is significant. One can appreciate the significant cost-savings and decreased morbidity for patients with high BMI if unnecessary investigations and interventions could be avoided.

Introduction
 Head and neck cancers represent a significant public health concern in the UK, with rising incidence, mortality rates and late diagnoses. Despite national efforts to streamline diagnostic pathways, delays persist for OMFS referrals. This audit evaluates the efficiency of the diagnostic pathway for suspected malignancies under local anaesthetic procedures (LASP), focusing on adherence to NHS England’s 28-day best-practice timeline, implemented from June 2024.

Method 
A retrospective audit was conducted from August to October 2024, reviewing 46 patients referred under the two-week wait (2WW) pathway to OMFS across two sites (BGH and CF). Data was extracted from scheduled LASP lists, patient's documentation, assessing time intervals from referral to clinic, LASP appointments, histology, and follow-up. Comparisons were made with the previous audit cycle to identify trends and areas for improvement.

Results 
Only 1 out of 46 patients met the 28-day referral-to-diagnosis target. While 91% of referral forms were dated, just 43% met the recommended 3–6 day upload window. Weekend referrals and ENT triage contributed to delays. LASP was performed within 14 days for 48% of patients, and histology results were available within 21 days for 59%. Malignant diagnoses accounted for 6% of lesions, with a notable increase in dysplastic findings (22%) compared to the previous cycle (7%). Buccal mucosa remained the most commonly biopsied site.

Conclusion 
Despite some improvements, significant delays remain in achieving timely diagnosis for head and neck cancer referrals. Key bottlenecks include referral upload times, ENT triage, and limited adherence to the 28-day pathway. Enhanced education for referrers, dedicated LASP slots, and improved triage protocols are recommended to streamline the diagnostic process and improve patient outcomes. Further cycles will aim to include additional sites and refine data collection to support targeted interventions. This audit is targeted for improving patient clinical outcomes, safety and effectiveness of quality care.

Introduction

The Oral and Maxillofacial Surgery (OMFS) department is unique in its composition of both medical and dental professionals, with the dental team often unfamiliar with the principles of venous thromboembolism (VTE) prophylaxis prior to commencing their  placements. NICE guidelines state all patients should be assessed for VTE risk on admission to hospital. The aims of the QIP involved assessing adherence to this standard in the OMFS department and the extent to which both pharmacological (Enoxaparin) and non-pharmacological prophylaxis (TED stockings) is being prescribed on inpatient drug charts where indicated.

Methods

Baseline data collection was performed to identify areas for performance improvement. 2 PDSA (‘Plan, Do, Study, Act’) cycles were subsequently completed. The intervention in Cycle 1 consisted of a VTE teaching session delivered to the OMFS juniors. The Cycle 2 intervention consisted of the design and display of posters as visual prompts to complete the relevant assessments and prescriptions.

Results

The baseline data collection demonstrated a VTE risk assessment completion rate of 72.5% (29/40). Of the patients assessed to require enoxaparin prophylaxis, this was prescribed on the inpatient drug chart in 85.7% (18/21). Of the patients assessed to be suitable for TED stockings, these were only prescribed on the drug chart in 76% (22/29). Positive change was subsequently demonstrated in Cycle 1 with a risk assessment completion rate of 88% (23/26), enoxaparin prescription completion rate of 95% (19/20) and TEDS prescription rate of 82.6% (19/23). Cycle 2 demonstrated sustained change; risk assessment completion rate of 90% (15/20), enoxaparin prescription rate of 100% (15/15), and TEDS prescription rate of 86.7% (13/15).

Conclusion

Positive change demonstrated across both cycles with improvements across all
parameters. Plan for future FY2 doctors rotating through the department to continue the QIP in order to assess for and implement sustained change over a longer-term period.

Approximately 20% of patients treated for head and neck cancer develop loco-regional recurrence. National guidance, which forms the basis of local guidance, exists on how clinicians should follow-up patients following radical surgical treatment for head and neck cancer. The aim of the quality improvement project was to assess whether patients were being adequately followed up following radical management of sino-nasal cancers based upon local guidance.

Patients who underwent radical management of sino-nasal and nasopharyngeal cancers between 2020-2023 at one South West Trust were assessed using available online databases. Compliance to local guidance regarding follow up was assessed. Patients were excluded if they were palliated or if the patient died during treatment. Following the first cycle, the data was presented at the local departmental teaching and a poster reminding clinicians of the follow up criteria was implanted within clinic rooms. Data was then recollected 3 months later.

40 patients were coded as having new sino-nasal cancers. 22 patients were assessed after exclusion. There was improvement in the percentage of patients who had clinical review arranged within the correct timeframe from 54% to 97%. Percentage of patients who had an MRI arranged improved from 74% to 93%. Percentage of patients who had a biopsy arranged improved from 30% to 60%.

Although improvement was achieved within this audit, there were limitations within the study. Namely, the leading clinician was able to identify the patients who did not have correct follow up arranged from the initial audit cycle and arranged this himself, thus not demonstrating a direct link between intervention and change. There were also small sample sizes, however, this reflects the nature of the cohort of patients with sino-nasal cancers. Recommendations would include re-auditing at 1-2years to assess for continued improvement and to obtain more data.

Introduction: Oral and Maxillofacial Surgery (OMFS) in the UK is a dual degree specialty facing ongoing recruitment challenges. For dentistry first trainees, the Human Disease/Clinical Medical Sciences in Dentistry (HD/CMSD) module in the undergraduate degree often represents their initial encounter with medicine and OMFS. This module may therefore play a role in shaping early interest in the speciality and this study aims to explore its structure, delivery and define possible influence on career choice.

Methods: A 16-item survey was distributed via Jotform© to eligible dual qualified or second-degree OMFS trainees through BAOMS JTG and WhatsApp©. Responses were collected anonymously between July 2024 and February 2025 from a potential pool of 455 trainees.

Results: 52 trainees responded (response rate 11.4%) with 46/52 being dental-first graduates. 45/52 completed an HD/CMSD module, typically delivered a summative assessment. 21/52 completed a medical placement in a hospital setting as part of the module with only 12 participants reporting OMFS exposure within the placement. Leadership of the module varied with specialists in OMFS and Oral Medicine (OM) being the most common. 16/36 participants reported OMFS exposure within their medical school curriculum. 27/52 participants reported the module as having some influence in their decision to pursue OMFS as a career.

Conclusion: The HD/CMSD module offers valuable early exposure to medicine within undergraduate dentistry, although its impact on OMFS career choice appears limited. Enhancing OMFS representation and structured clinical exposure within the module may improve awareness and support future recruitment into the specialty.

Introduction:
The Scottish Dental Clinical Effectiveness Programme (SDCEP) published updated guidance in 2022 regarding the management of patients taking oral anticoagulant and antiplatelets for dental treatment including biopsies.
The aim of this audit is to investigate the outpatient clinic’s current compliance with SDCEP 2022 guidance. This involves reviewing the documentation of dictated letters and communication of pre-operative advice related to anticoagulant and anti-platelet therapy. All patients should be receiving appropriate and documented advice regarding their medications prior to surgery.
Method:
20 consecutive patients were selected between 25/01/25 and 28/02/25 from the MOS clinics. Inclusion criteria comprised patients having a planned local anaesthetic dentoalveolar procedure, such as a dental extraction or intra-oral biopsy, and take anticoagulant and/or antiplatelet.
Results:
Of the 20 patients, 8 received correct and documented pre-operative information regarding their medication. However,12 patients had no documented medication advice. Assuming patients continued their medications as usual, 7 patients would have managed their medications appropriately, while 5 would have done so incorrectly.
The primary issue identified among patients not receiving correct advice was the failure to instruct patient to withhold their morning doses of DOACs for high-risk bleeding procedures, such as intra-oral biopsies. To address these gaps, a teaching session will be delivered for all clinicians.
Conclusions:
Accurate documentation of pre-operative instructions regarding anticoagulants and anti-platelets is essential to minimise risk of post-operative complications and to mitigate potential medico-legal risks. This audit has highlighted key areas for improvement.
To ensure sustained improvement, a third cycle audit is recommended in six months to reassess compliance with SDCEP guidelines and evaluate the effectiveness of implemented changes.

Introduction:
Student finance provisions for the second degree can be complex, with some finance agencies having specific policies for graduate-entry students who have previously studied medicine or dentistry. Second-degree students may take up part time employment during their studies to maintain clinical skills or to allow for the financing of their course in addition to other living costs. Doctors and dentists have several employment options available to them although these may be during unsocial hours owing to the full-time nature of medicine and dentistry courses.
Methods:
This qualitative research study investigated the impact of employment on medical education during the second degree. In addition to educational impact, also explored were the reasons for taking on employment and what advice participants may have for prospective students on minimising impact. In total, 7 participants were interviewed over Microsoft Teams, following recruitment via a social media post. Those recruited were all dentistry-first and studied medicine as the second-degree. Participants were interviewed using a standardised interview schedule.
Results:
Participants reported both positive and negative impacts of work on medical education and the primary reason for working was financial. Positive impacts included maintenance and development of clinical skills, building of professional relationships and improved teaching skills. The predominant negative impact was that of tiredness, with additional negative impacts being loss of study time and poor academic performance.
Conclusion:
Second-degree students reported positive and negative impacts to their medical education as a result of part-time work during studies. Many expressed a desire for greater financial support during the second degree. Incidental findings also revealed other impacts to the student experience unrelated to medical education.

Introduction

Brown’s tumour (osteitis fibrosa cystica) is a rare, non-neoplastic condition resulting from hyperparathyroidism. It is characterized by increased osteoclastic activity and bone turnover, which subsequently leads to the deposition of fibrous tissue. It generally affects long bones of the body, however it can affect facial bones, particularly the mandible. It can mimic other fibro-osseous, infective or malignant conditions.

Case Report

We report the case of a 67-year-old female with primary hyperparathyroidism. The initial swelling was found incidentally during an extraction. Radiographic appearance reported root resorption to adjacent teeth, whilst histological findings consisted of the typical multi-nucleated giant cells. Increased blood calcium and parathyroid hormone levels have confirmed primary impression.

Discussion

Brown's tumour is often a diagnostic challenge as it is misdiagnosed, particularly as a malignant lesion. Early detection is key in order to provide the appropriate treatment not only for the lesions but also for the underlying HPT.

Background:
Bony invasion in oral squamous cell carcinoma (SCC) is a poor prognostic factor. It is diagnosed preoperatively utilising staging scans and periosteal stripping. Tumours with invasion into the medulla typically require segmental mandibulectomy (SM) to ensure oncological clearance. A more conservative rim/marginal mandibulectomy (RM) may be performed in cases of close tumour proximity to bone or cortical erosion. However, this procedure may risk under-treatment if the preoperative assessments underestimate the extent of bone invasion.
This retrospective cohort study explores the suitability of RM as a conservative alternative to SM in select patients.
Methods:
Patients undergoing mandibulectomy for SCC at a UK OMFS centre between 2018-2023, with >24months follow-up, were identified. Primary outcomes are survival and recurrence, analysed using multivariate regression. Subgroup analysis will be performed on RM patients who subsequently demonstrate histological medullary involvement.
Results:
RM (n=26) and SM (n=30) patients met inclusion criteria. Regression modelling did not identify RM or SM procedures as a significant factor in patient outcomes (p>0.9). Histological medullary involvement was found in 6 RM patients (23%). Survival outcomes and recurrences in these patients were not significantly different to the wider RM group. Presence of bone margin clearance of 5mm was significantly related to survival outcomes.
Conclusions:
Findings continue to support RM as a safe surgical option, even with inherent risk of under-staging. However, preoperative diagnostic accuracy is key to reducing the risks. A further 10 patients have been identified for analysis and will also be presented in the dataset.

Introduction: Efficient referral pathways are crucial for prompt and exceptional paediatric surgical care. This audit evaluates the trend, demography and outcomes of paediatric referrals to Royal Hallamshire Hospital’s Oral and Maxillofacial Surgery department (OMFS). The understanding of referral patterns allows for strategic resource allocation, enforces evidence-based planning and streamlines patient centred care by developing data-driven referral pathways.

Methods: A retrospective audit was conducted involving 649 paediatric patients referred to our institution over a 12-month period (August 2024 to July 2025). The data was categorised according to referral source, date, clinical indication and subsequent management. The data was analysed using descriptive statistic and graphical representation for ease of interpretation.

Results: Preliminary analysis revealed a sizeable variation in referral sources and clinical indications. A notable portion of referrals originate from Sheffield Children’s Hospital (65%) with laceration (49%) being the major indication of referral. Majority of paediatric patients underwent admission and surgery at 39% followed by treatment under local anaesthesia (LA) at 19%. This audit also indicates the highest frequency of referrals are in the month of May at 86, inversely February reported the lowest frequency at 29.

Conclusion: The trend demonstrates significant seasonal variation and potential over-referral in certain categories. This audit emphasizes the need for closer cooperation and clear communication channels between primary care providers, district hospitals and other tertiary centres. The findings provide actionable insights to guide resource allocation, informed decision making and infrastructure development. Enhanced triage protocols, appropriate staff education, and adequate manpower could mitigate unnecessary hospital referrals and encourages timely interventions of high priority cases.

Introduction
T3 oral cavity squamous cell carcinoma (OCSCC; AJCC-8: tumour > 4 cm or depth of invasion > 10 mm) is managed with primary surgery and risk-adapted adjuvant therapy. The UK delivers guideline-driven multidisciplinary care, while Pakistan applies the same oncologic principles within more heterogeneous resource settings. We compared published guidance and real-world practice to identify convergences, gaps, and opportunities for pathway improvement.

Method
PRISMA-guided scoping review (MEDLINE, Embase, Cochrane, and grey literature, 2000–Aug 2025). We included: (i) UK guidelines/standards for oral cavity cancer; (ii) Pakistan institutional series and practice statements for T3 OCSCC; (iii) health-system reports on multidisciplinary team (MDT) availability and radiotherapy capacity. Outcomes: resection and neck-dissection strategy, reconstruction modality, positive margins, time to post-operative radiotherapy (PORT), complications, recurrence, and survival. Data were charted narratively due to heterogeneity.

Results
UK sources consistently recommend upfront resection with appropriate ipsi/contralateral neck dissection, microvascular reconstruction when indicated, and adjuvant RT/CRT for adverse features, delivered through MDT pathways with staging, dental, and nutritional optimisation. Pakistan tertiary centres report adherence to core surgical principles with growing microvascular capability; regional flaps are used where resources are constrained. Across Pakistan reports, later stage at presentation is common; MDT access and radiotherapy capacity vary, contributing to PORT delays. Broader head-and-neck literature links delayed PORT (>6 weeks) with inferior outcomes. No head-to-head UK–Pakistan comparative cohort specific to T3 OCSCC outcomes was found.

Conclusion
Oncologic intent is aligned, but system-level factors—MDT coverage, reconstructive resources, and timely access to PORT—likely drive differences in delivered care and outcomes. Standardised, context-adapted pathways (routine MDT triage, clear neck algorithms, reconstruction choice matched to resources, and fast-tracked PORT) and a bi-national registry focused on T3 OCSCC are warranted to benchmark timing, treatment patterns, and outcomes.

Reducing Delays to PEG Insertion in Postoperative Head and Neck Cancer Patients: A Quality Improvement Project

Introduction:
Patients undergoing major head and neck cancer surgery can experience postoperative dysphagia requiring percutaneous endoscopic gastrostomy (PEG) for nutrition. For those not pre-emptively fitted with PEGs, delays in post-operative PEG insertion can prolong hospitalisation, recovery, and initiation of adjuvant treatment. This quality improvement project aimed to quantify these delays, assess their impact, and implement interventions to streamline care.

Methods:
A retrospective review of all postoperative head and neck cancer patients admitted to a specialist ward, in a single centre, between January 2024, and June 2025, requiring inpatient PEG insertion was done. Data included demographics, surgical details, PEG indication, time from PEG request to insertion, and length of hospital stay. Financial impact was calculated using standard NHS bed day costs.

Results:
Five patients met inclusion criteria. All had extensive surgical procedures including bilateral neck dissections and tracheostomy. Median time from PEG request to insertion was 33 days (range: 12–37 days). Qualitative review revealed scheduling delays, with “next available booking date” as the most common justification. These delays accounted for 138 excess bed days, equating to an estimated cost of £47,610.

Discussion:
Prolonged waits for PEG placement in otherwise medically fit patients increased hospital bed occupancy and healthcare costs. Delays were logistical, rather than clinical. A targeted intervention involving early PEG referral, streamlined multidisciplinary communication, and onsite PEG insertion by the Upper GI team was introduced.

Conclusion:
Delayed PEG insertion in postoperative head and neck cancer patients leads to avoidable hospitalisation, financial burden, and may delay adjuvant treatment. Reasons for delay were specific to logistical factors within the unit. Results were presented and led to the implementation of an onsite referral pathway and improved interdepartmental coordination in order to offer a sustainable solution.

Introduction
Oral and Maxillofacial Surgery (OMFS) is a unique specialty requiring dual qualification in medicine and dentistry. Exposure during medical training is often limited, potentially impacting knowledge, confidence, and recruitment. This study assessed OMFS awareness, teaching exposure, and basic clinical knowledge among UK foundation doctors.
Methods
A cross-sectional survey was conducted in August 2025 among 58 foundation doctors (F1–F2) at a District General Hospital. The survey collected demographic details, prior OMFS teaching and placement exposure, and career intentions. Basic OMFS knowledge was assessed using questions on adult dentition count, identification of an orthopantomogram, and knowledge of training requirements. Confidence in recognising and escalating three OMFS emergencies (Ludwig’s angina, retrobulbar haemorrhage, and facial trauma) was recorded.
Results
Most respondents (86%) reported no undergraduate OMFS placement, with 14% having ≤1 day to a few weeks’ exposure. Undergraduate OMFS teaching was absent in 57%, with 38% receiving only 1–2 sessions and 5% more than this. Postgraduate OMFS teaching was almost universally absent. Only 59% correctly identified the usual adult dentition as 32 teeth. Most (76%) recognised that OMFS specialty training requires both medical and dental qualifications, with 24% unsure or incorrect. Confidence in recognising Ludwig’s angina was low, with 52% “not confident” and 31% “not heard of condition”. For retrobulbar haemorrhage, 47% “not confident” and 33% “not heard of condition”. Facial trauma recognition had slightly higher confidence (45% “somewhat confident” or above), but more than half of respondents (53%) remained “not confident”. A majority (81%) had not fully decided on their future specialty.
Conclusions
Foundation doctors demonstrated limited knowledge and confidence in OMFS-related topics, reflecting minimal teaching exposure during training. The large undecided group at this career stage presents an opportunity to raise awareness and promote OMFS through targeted teaching and clinical exposure. Increasing early-stage engagement may improve understanding and attract future trainees to the specialty.

Introduction
Discharge summaries provide an essential overview of admission and post-operative care. Clear discharge instructions are critical for patient safety, recovery, and overall healthcare experience, while also reducing administrative burden on clinical teams.

Aims
1. To evaluate whether discharge instructions for patients undergoing orthognathic surgery and mandibular open reduction and internal fixation (ORIF) at a single centre met consultant consensus guidelines.
2. To implement a discharge summary proforma with targeted education.
3. To re-audit performance following intervention.

Methods
Twenty consecutive cases of orthognathic surgery (bilateral sagittal split osteotomy, bimaxillary osteotomy, Le Fort I osteotomy) and mandibular ORIF between July–October 2024 at the John Radcliffe Hospital were retrospectively reviewed. Consultant consensus defined optimal discharge instructions for each group. Proforma-based discharge summary templates were developed and disseminated to resident doctors and dental core trainees alongside in-person teaching. A further twenty cases between April–June 2025 were re-audited. Completeness of discharge instructions was compared using the Mann-Whitney U test.

Results
In the second cycle, templates were used in 70% of orthognathic cases and 60% of mandibular fracture cases. There was a significant improvement in the total number of relevant discharge instructions included for both orthognathic surgery (p = 0.0000006) and mandibular fractures (p = 0.0001).

Discussion
The introduction of discharge summary templates and in-person education for resident doctors and dental core trainees significantly improved the quality of written discharge instructions. Although patient safety outcomes and patient satisfaction were not directly assessed, it is likely that clearer, standardised advice contributes to improved recovery and continuity of care. This approach could be readily adapted for other OMFS procedures and surgical specialties to standardise practice.

Conclusion
Standardised discharge templates combined with structured education improved post-operative documentation quality. Wider adoption of standardised proformas may enhance patient safety and clinical efficiency.

Dentigerous cysts are one of the most common cysts of the mandible. They are frequently seen surrounding lower third molars which have seen chronic inflammation and extraction has been avoided. We report a case of a 59-year-old male with an intraosseous squamous cell carcinoma from a lesion which clinically looked like a dentigerous cyst.

He was referred by his General Dental Practitioner to our oral surgery department for extraction of a symptomatic LL8 in June 2023. His initial CBCT scan showed abnormalities including destruction of the buccal and lingual plate and was referred urgently to our local oral and maxillofacial unit due to risk of mandible fracture. He had no paraesthesia.

His referral was then upgraded to a 2 week wait pathway by our oral and maxillofacial consultant after the patient saw him privately in October 2023 and was planned for a biopsy under General anaesthetic in November 2023. However, he sustained a pathological fracture of his mandible 4 days prior to his surgery. An OPG was taken at this point showing significant increase in size of the lesion.

A biopsy was taken from the mucosa around the LL7 and a separate biopsy from the intraosseous lesion. The histology from the central lesion biopsy confirmed it was a moderately differentiated squamous cell carcinoma, but the mucosal biopsy showed no signs of dysplasia.

This patient subsequently had a segmental mandibulectomy and fibular free flap reconstruction in January 2024, 2 weeks after his biopsy. The histology of the resection was now a poorly differentiated squamous cell carcinoma.

This highlights an unusual case of an aggressive malignant tumour where there was no mucosal ulceration or dysplastic features. It emphasises the importance of reassessing the patient’s clinical picture and to be aware of the potential malignant change of odontogenic cysts.

Introduction:
Orbital fractures and the following reconstructive surgery carries a risk of sight-threatening complications, including retrobulbar haemorrhage (~0.3%).1 The Getting It Right First time (GIRFT) guidance2 and our regional protocol recommends mandatory postoperative eye observations to allow for early recognition and therefore intervention in case of developing sight‐threatening complications. This service evaluation assessed compliance of a regional Oral and Maxillofacial trauma service with requesting and documenting eye observations following orbital fracture surgery.
Method:
A retrospective review of 44 consecutive patients undergoing orbital fracture repair between 2020 and 2024 was conducted at University Hospitals of Liverpool Group. Information was recorded using an electronic data collection tool. The primary outcome was whether post-operative eye observations were requested and documented, with secondary outcomes including whether eye observation charts were completed fully and any complications identified.
Results:
Of the 44 patients, post-operative eye observations were requested in operative notes in 95.5% of cases. Majority (93.2%) of patients had eye observation charts initiated, with complete documentation recorded in 90.9%. One case displayed an immediate post-operative complication. Variation in practice between surgeons was noted, with some prescribing eye observations ‘as per protocol’ and others outlining specific recommendation.
Conclusion:
Compliance with requesting and initiating documentation of post-operative eye observations was high but full completion was inconsistent. National guidance and local protocol have been reinforced to optimise patient safety.

References:
1. Safdar, Yasser et al., Postoperative observations for orbital and zygomatic repairs – A 5-year review, British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 10, e69.
2. British Association of Oral & Maxillofacial Surgeons. Isolated Fractured Zygomatic Complex/Orbit Pathway, 2022. Online information available at https://www.baoms.org.uk/professionals/girft.aspx (accessed 26/08/25). 

Introduction:

All ZMC fractures involve orbital fractures, with orbital floor fracture severity varying depending on the mechanism and energy of injury. Disruption of the orbital floor changes the orbital volume, increasing the risk of ocular signs/symptoms (e.g. enophthalmos, diplopia). This must be assessed at primary presentation to decide if primary orbital surgery should be performed alongside ZMC repair.

There is currently no standardised set of criteria to guide the decision-making process for orbital exploration in ZMC fractures. This study will evaluate whether the absence of ocular signs/symptoms pre-operatively can safely exclude the need for orbital exploration.

Method:

Data was retrospectively collected from a consecutive series of 98 patients who had ZMC fractures requiring ORIF intervention at the QEUH between 2021-2024. The presence/absence of ocular signs/symptoms at initial assessment was recorded. The cohort was then assessed to determine which patients underwent primary orbital exploration. Post-operative outcomes were reviewed, including whether any patients subsequently required secondary orbital surgery.

Results:

27 patients (28%) presented with ocular signs/symptoms, 6 of them underwent primary orbital surgery. Among the 71 patients (72%) who had no ocular findings at initial presentation, none required orbital surgery. Only 1 patient in the cohort required secondary orbital surgery, and this patient had also undergone primary orbital surgery.

Conclusion:

The absence of pre-operative ocular signs/symptoms may be a reliable indicator for excluding the need for orbital exploration. No patients who did not receive primary orbital exploration needed secondary orbital exploration, proving there were no late ocular complications from this approach.

Approximately 25% of patients treated for head and neck cancer develop loco-regional recurrence. Therefore, ensuring that we are following up these patients appropriately is a necessity. With large multidisciplinary team input during clinical surveillance, it is easy for information to get lost within a large volume of paper notes. Therefore, the aim of this project was to develop a clinical surveillance booklet which outlined the patients’ cancer and treatment, along with pages for clinical imaging and MDT follow-up.

A clinical surveillance booklet was created outlining the patients’ diagnosis and management to date. Inserts surrounding clinical follow-up and scans were also created. Before printing, five ENT registrars ranging from ST3-8 and two head and neck consultants were consulted for advice on whether this would be beneficial.

The main positive themes from interview were surrounding improved documentation, improved junior trainee experience, reduction in admin time to find patient information and safer clinical surveillance.
Main positive themes were surrounding admin time to fill out the booklet and use once the trust has transitioned to electronic notes.

Overall, the clinical team feel as though a clinical surveillance booklet would be beneficial for patient safety and experience. Other specialties, such as obstetrics, have benefitted from an adapted version of our proposed booklet. There will likely be a learning curve when getting used to completing the proforma for follow-up patients. The booklet can be easily downloaded to the electronic notes system, once it has been introduced. 

Introduction
Pre-operative anaemia is a modifiable risk factor that increases complications after head & neck (H&N) surgery. UK primary-care data show a higher burden of anaemia among women of Asian heritage than White women. We reviewed the evidence on pre-operative anaemia and H&N/OMFS surgical outcomes and summarised UK epidemiology by ethnicity to inform equity-focused peri-operative pathways.

Method
PRISMA-guided review (MEDLINE/Embase/Cochrane, 2000–Aug 2025). Inclusion: studies of H&N/OMFS surgery reporting pre-operative haemoglobin/iron indices vs peri-operative outcomes (transfusion, surgical-site infection, return to theatre, flap failure, length of stay, readmission, mortality, oncological endpoints). We additionally summarised UK population/primary-care studies reporting anaemia prevalence in women by ethnicity and current UK peri-operative anaemia guidance.

Results
Across H&N cohorts and syntheses, lower pre-operative haemoglobin independently associates with higher peri-operative transfusion and adverse outcomes; a high-risk transfusion threshold is consistently observed around ~120 g/L. UK guidance recommends routine pre-operative screening and optimisation (including intravenous iron) for major surgery. UK primary-care datasets demonstrate higher anaemia prevalence and lower mean haemoglobin/MCV among Asian compared with White patients, indicating that women of South Asian heritage are more likely to present anaemic before surgery. No UK H&N/OMFS study has yet quantified outcome differences by both anaemia status and ethnicity.

Conclusion
Robust evidence links pre-operative anaemia with worse H&N surgical outcomes, and UK datasets show higher anaemia prevalence in Asian women. These findings support a standardised OMFS/H&N anaemia optimisation pathway—early case-finding, iron studies, rapid IV iron, and transfusion-sparing strategies—with particular attention to access and uptake among South Asian women. Future UK multicentre analyses should test whether ethnicity modifies anaemia-related surgical risk and evaluate pathway impact on complications and treatment delays.

Introduction
The Royal College of Anaesthetists (RCA) highlights key considerations when selecting anaesthetic modalities, including operator experience, diagnosis severity, and peri-operative compliance. This Quality Improvement Project (QIP) aimed to assess anaesthetic use in secondary care against RCA guidance and develop a long-term strategy to reduce reliance on CEPOD where possible. Benefits include minimising risks of GA-associated mortality, enabling immediate management, reducing anticipatory stress for children and parents, and optimising resource allocation by alleviating CEPOD pressures.
Method
A retrospective pilot cycle was conducted at University Hospital Wales, followed by two prospective cycles at Dudley Group Hospitals and Royal Wolverhampton Trusts. Each cycle included 20 paediatric OMFS presentations from the emergency department. Data collected comprised age, gender, diagnosis, mechanism of injury, pre-operative compliance, management, anaesthetic modality, and peri-operative compliance. Between the second and third cycle, an action plan was presented to paediatric and OMFS teams.
Results
In the first cycle (mean age 4.75; 70% male), 90% were managed with GA, 5% with inhalation sedation, and 5% with LA. The second cycle (mean age 9.7; 75% male) showed 25% GA, 5% inhalation sedation, and 70% LA. In the third cycle (mean age 8; 70% male), 40% were managed with GA, 5% inhalation sedation, 5% ketamine sedation, and 50% with LA.
Conclusion
The QIP demonstrated varied anaesthetic modalities with increasing uptake of sedation between the second and third cycles. Future improvements include implementing a proforma for children undergoing GA to evaluate alternative modalities, ensuring safer, more efficient decision-making. Incorporating Patient Reported Outcomes from parents and children could further inform service development, providing insights into waiting times, cosmetic results, and anxiolysis during treatment.

Introduction
Temporomandibular dysfunction (TMD) is increasingly managed with botulinum toxin injections. However, current practice at the Royal Free London NHS Foundation Trust involves providing only verbal aftercare instructions, which may be insufficient for optimal patient understanding and recovery. This quality improvement project aimed to enhance patient aftercare by introducing written resources to supplement verbal guidance.

Method
Two audit cycles were conducted. In Cycle 1 (Feb 2025), patients who received botulinum toxin injections for TMD between Sept 2024 and Feb 2025 were surveyed via telephone using a structured questionnaire. Questions assessed consent quality, recall of verbal instructions, confidence in post-operative care, and interest in written materials. Following Cycle 1, a trust-approved patient leaflet was introduced. Cycle 2 (June 2025) repeated the audit for patients treated after April 2025, evaluating the impact of the leaflet.

Results
Cycle 1 included 16 patients (14 female, 2 male; average age 45). Of the 10 respondents, 90% strongly agreed they were adequately consented, 60% agreed they remembered the verbal instructions, and 100% expressed interest in written aftercare materials. In Cycle 2, patients were surveyed post-leaflet implementation. All respondents (100%) found the written instructions useful and agreed they improved their confidence in post-treatment care.

Conclusion
The introduction of written aftercare materials significantly improved patient satisfaction and confidence in managing post- injections care for TMD. The audit supports continued use of written leaflets as standard practice and highlights the importance of multimodal communication in clinical care. Future audits will monitor long-term outcomes and adherence to aftercare protocols.

Title: A Quality Improvement Project on the Use of Physiotherapy Referral as Part of First-Line Management for Myogenic TMD in an OMFS Department

Background:
Myogenic TMD is a common condition managed primarily with conservative treatment, including physiotherapy. National guidance from Getting It Right First Time (GIRFT) highlights physiotherapy as a key first-line intervention. However, referral practices can be inconsistent, risking suboptimal patient outcomes.

Aim:
To assess whether new patients diagnosed with myogenic TMD were appropriately being diagnosed and referred for physiotherapy in an Oral and Maxillofacial Surgery department, and to evaluate the impact of targeted interventions.
Standards:
100% of new myogenic TMD patients should be considered for physiotherapy referral, in line with GIRFT and departmental guidelines.

Methods:
Two audit cycles (n=50 each) were completed. Inclusion criteria: new patients diagnosed with myogenic TMD. Exclusion criteria: arthrogenic or trauma-related TMD, or those beyond initial management. Data were collected retrospectively from electronic records.
Between cycles, a structured intervention was implemented, including:
• Creation of a dedicated Cerner physiotherapy referral pathway
• Departmental teaching and governance presentations
• Visual prompts and email reminders

Results:
Referral rates improved from 14% in Cycle 1 to 70% in Cycle 2. Patient demographics were comparable across cycles, with no significant gender or age-related differences in referral patterns.

Conclusion:
Initial referral rates were significantly below expected standards. Following simple, targeted interventions, compliance improved fivefold. This highlights the effectiveness of education and system-based changes in improving adherence to evidence-based TMD management.

Recommendations:
Further efforts should focus on standardising diagnosis documentation, embedding referral prompts, and re-auditing to ensure sustained improvement. Consideration should also be given to evaluating patient outcomes and physiotherapy attendance in future cycles.

Reducing Delays to PEG Insertion in Postoperative Head and Neck Cancer Patients: A Quality Improvement Project

Introduction:
Patients undergoing major head and neck cancer surgery can experience postoperative dysphagia requiring percutaneous endoscopic gastrostomy (PEG) for nutrition. For those not pre-emptively fitted with PEGs, delays in post-operative PEG insertion can prolong hospitalisation, recovery, and initiation of adjuvant treatment. This quality improvement project aimed to quantify these delays, assess their impact, and implement interventions to streamline care.

Methods:
A retrospective review of all postoperative head and neck cancer patients admitted to a specialist ward, in a single centre, between January 2024, and June 2025, requiring inpatient PEG insertion was done. Data included demographics, surgical details, PEG indication, time from PEG request to insertion, and length of hospital stay. Financial impact was calculated using standard NHS bed day costs.

Results:
Five patients met inclusion criteria. All had extensive surgical procedures including bilateral neck dissections and tracheostomy. Median time from PEG request to insertion was 33 days (range: 12–37 days). Qualitative review revealed scheduling delays, with “next available booking date” as the most common justification. These delays accounted for 138 excess bed days, equating to an estimated cost of £47,610.

Discussion:
Prolonged waits for PEG placement in otherwise medically fit patients increased hospital bed occupancy and healthcare costs. Delays were logistical, rather than clinical. A targeted intervention involving early PEG referral, streamlined multidisciplinary communication, and onsite PEG insertion by the Upper GI team was introduced.

Conclusion:
Delayed PEG insertion in postoperative head and neck cancer patients leads to avoidable hospitalisation, financial burden, and may delay adjuvant treatment. Reasons for delay were specific to logistical factors within the unit. Results were presented and led to the implementation of an onsite referral pathway and improved interdepartmental coordination in order to offer a sustainable solution.

Second victim syndrome within surgery encompasses the psychological and physical symptoms surgeons can experience after an adverse event. Post-traumatic symptoms amongst surgeons equal those experienced by military personnel returning from conflict. These symptoms can lead to workplace errors, crises of self-confidence and, over time, complete cessation of operating.

The Royal College of Surgeons of England (RCS) recently developed guidance on supporting surgeons after adverse events and the “SUPPORT” collaborative to help those affected. At the time of writing, no work has been conducted into increasing awareness or evaluating the impacts of second victim syndrome within OMFS in the UK, nor how we as a specialty can best support those affected. 

Performed as part of the BAOMS student bursary, this research assesses the prevalence of second victim symptomatology within OMFS colleagues of all levels (junior trainees to consultant level) through the use of electronic surveys. These surveys gathered information including awareness of second victim syndrome, knowledge of support currently available, anonymous personal experiences, and what further support could be beneficial for those affected.

With the knowledge gained, this project aims to provide education and increase awareness of second victim syndrome, its symptoms, signpost to support currently available for OMFS surgeons and trainees, and highlight how clinical leads can improve post-trauma support within their own units.