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I. Hutchison

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Papers by I. Hutchison

COVID-19, domestic violence and abuse, and urgent dental and oral and maxillofacial surgery care

British Dental Journal, 2020

Household isolation measures to reduce coronavirus transmission during the COVID-19 pandemic have... more Household isolation measures to reduce coronavirus transmission during the COVID-19 pandemic have resulted in increased risk of domestic violence and abuse (DVA). DVA physical injury most frequently involves the face. Dentists, dental care professionals, oral surgeons and oral and maxillofacial surgeons all have a critical part to play in identifying patients experiencing DVA, who present with dental and facial injury, and in making referrals to specialist agencies. This paper describes how to ask questions about DVA sensitively and how to make an appropriate referral. Early intervention and referral to a DVA advocate can prevent an abusive situation becoming worse with more intense violence. It can save lives.

BAOMS QOMS: findings from the pilot phase and lessons learned in the feasibility evaluation of a national quality improvement initiative

The British journal of oral & maxillofacial surgery, 2021

The BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - Apri... more The BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent. The pilot included a series of six audits (oral and dentoalveolar [ODA], oncology, orthognathic, reconstruction, trauma, and skin). Data entry was clinician-led in five OMFS units and in one unit (EKHU), it was additionally supported by members of the clinical coding team. One hundred and twenty-eight REDCap account user details were issued and of these, 45 (35%) completed registration and 22 (17%) were active users who participated in the pilot data entry. Disproportionate focus on individual audits within QOMS was seen, though...

Systemic lupus erythematosus presenting with oral mucosal lesions: easily missed?

British Journal of Dermatology, 2001

Two caucasian patients are described in whom oral mucosal lesions were the first manifestation of... more Two caucasian patients are described in whom oral mucosal lesions were the first manifestation of systemic lupus erythematosus. In both cases the diagnosis was delayed despite histological examination of oral lesions. Treatment with antimalarials and azathioprine was of significant benefit. In the absence of cutaneous or systemic features, distinguishing oral lupus erythematosus from lichen planus and epidermal dysplasia can be difficult, both clinically and on histology, and requires a high index of suspicion.

2012 – The year when BAOMS and its officers prevented closure of all UK shortened medical and dental courses

British Journal of Oral and Maxillofacial Surgery, 2020

In Spring 2011 the Department of Health (DH) received a request to review European Union Directiv... more In Spring 2011 the Department of Health (DH) received a request to review European Union Directive 2005/36 EU-the directive relating to the recognition of professional qualifications. The Department of Health lawyer raised concerns that the existing shortened dental courses may be in breach of EU law. There were three shortened dental courses in the UK: 4 year graduate entry courses in Liverpool/Peninsula and 3-year Dental Programme for Medical Graduates (DPMG) in Kings, London. During the summer the General Dental Council (GDC) was made aware of these concerns. In autumn 2011 the Chief Dental Officer for England with the GDC, told the Dental Deans' Council (DDC) that shortened dental courses were illegal. On 12th Jan 2012 students on the DPMG were told that they would have to complete a full 5-year dental degree. The GDC said that this interpretation of EU law would also impact on shortened medical courses. In view of the potentially enormous impact that this would have on OMFS training, BAOMS engaged all the resources it could and by assembling legal opinions including written contributions from Sir David Edward, whose opinion was being misinterpreted by the GDC and DH, and by sharing these resources with all the stakeholders, BAOMS was able to preserve shortened dental and medical courses. Now that the UK has left the European Union, negotiations around mutual recognition of qualifications may mean this issue will resurface. We should remain vigilant.

qMIDS: A Digital Diagnostic Test for Oral Cancer

British Journal of Oral and Maxillofacial Surgery, 2019

Are facial injuries really different? An observational cohort study comparing appearance concern and psychological distress in facial trauma and non-facial trauma patients

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2017

Labiomental intertrigo

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 1995

Severe skeletal retrognathia may lead to a pronounced labiomental fold. When severe the labioment... more Severe skeletal retrognathia may lead to a pronounced labiomental fold. When severe the labiomental fold may result in intertrigo, which is chronic and symptomatic. This problem can be managed by orthodontics and orthodontic surgery to reposition the jaw at a more anterior direction, thus creating a normal lip posture and a normal labiomental fold.

Identification of FOXM1-induced epigenetic markers for head and neck squamous cell carcinomas

Cancer, 2013

BACKGROUND: Epigenetic reprogramming of the methylome has been implicated in all stages of cancer... more BACKGROUND: Epigenetic reprogramming of the methylome has been implicated in all stages of cancer evolution. It is now well accepted that cancer cells exploit epigenetic reprogramming, a mechanism that regulates stem/progenitor cell renewal and differentiation, to promote cancer initiation and progression. The oncogene FOXM1 has been implicated in all major forms of human cancer. METHODS: We have recently shown that aberrant upregulation of FOXM1 orchestrated a DNA methylation signature that mimics the cancer methylome landscape, from which we have identified a number of FOXM1-induced epigenetic markers. Differential promoter methylation and gene expression in clinical specimens were measured using commercially available bisulfite conversion kits and absolute quantitative PCR, respectively. RESULTS: Here, we investigated 8 FOXM1-induced differentially methylated genes, SPCS1, FLNA, CHPF, GLT8D1, C6orf136, MGAT1, NDUFA10, and PAFAH1B3, using human head and neck tissue specimens donated by 2 geographically independent patient cohorts from Norway and the United Kingdom. Two genes (GLT8D1 and C6orf136) were found to be differentially expressed in head and neck squamous cell carcinomas (HNSCCs). Using methylationspecific quantitative PCR, we confirmed that the promoters of GLT8D1 and C6orf136 were hypo-and hypermethylated, respectively, in HNSCC tissues. CONCLUSIONS: Given that epigenetic change precedes gene expression, methylation status of candidate genes identified from this study may represent a signature of premalignancy, rendering them potentially useful predictive biomarkers for precancer screening and/or therapeutic targets for cancer prevention.

Interrelationship of depression, stress and inflammation in cancer patients: A preliminary study

Journal of Affective Disorders, 2012

La depressione è un disturbo molto comune tra le persone affette da cancro e ne compromette notev... more

BAOMS QOMS (Quality and Outcomes in Oral and Maxillofacial Surgery), a specialty-wide quality improvement initiative: progress since conception

The British journal of oral & maxillofacial surgery, 2021

European OMFS in the time of Brexit – where did the UK fit and how might the future look?

British Journal of Oral and Maxillofacial Surgery, 2020

INTRODUCTION The specialty of OMFS in the UK is a dual degree specialty which was recognised in E... more INTRODUCTION The specialty of OMFS in the UK is a dual degree specialty which was recognised in Europe within Annex V of Directive 2005/36/EU. Currently UK law matches that of the EU. Brexit may change this. DIRECTIVE 2005/36/EU: Defines two specialties within European nations, Dental, Oro-Maxillo-Facial Training DOMFS (Basic dental & medical training) and Maxillofacial Surgery (basic medical training). The UK sat within DOMFS and so specialists from DOMFS nations could travel and work in the UK. Specialists from all other nations were required to use the Certificate of Eligibility for Specialist Registration (CESR) route. DIRECTIVE 2013/55/EU: This directive updated 2005/36/EU regarding Mutually Recognised Professional Qualifications (MRPQ) including creating an international alert system for doctors in difficult Entry onto the UK OMFS Specialist List by CESR Route CESR application is a large and complex portfolio of evidence to demonstrate knowledge, skills and experience are equivalent to a Certificate of Completion of Training (CCT) holder. To date, no EU applicants have successfully completed a CESR application. UNION OF EUROPEAN MEDICAL SPECIALISTS (UEMS) Even after Brexit, the UK will remain a full member of UEMS. The OMFS Section of UEMS is a source of information and support for specialists wishing to work in other nations and for nations wishing to develop an OMFS specialty in their nation. ACCESS TO UK OMFS TRAINING FOR NON-UK TRAINEES Applicants meeting the person specifications for approved OMFS specialty training (ST) posts in the UK are welcome to apply to the national selection process for OMFS specialty training in the UK. Many have done so successfully. Fixed term appointments and Fellowships are advertised and represent a useful route to gain support for application for training or through the CESR Route. CONCLUSIONS The UK remains part of the diverse OMFS community in Europe. There is support from within the UK and from UEMS for trainees and specialists interested in coming to the UK to train or to work.

Current perspectives on the surgical management of mandibular third molars in the United Kingdom: the need for further research

British Journal of Oral and Maxillofacial Surgery, 2020

This survey of expert opinion regarding the management of mandibular third molar (M3M) impaction ... more This survey of expert opinion regarding the management of mandibular third molar (M3M) impaction and its clinical sequelae was circulated to all members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). It was completed by 289 clinicians who reported treating 60003 patients annually. Respondents included 199 (69%) specialists and 58 (20%) primary care clinicians. Most (99%) of the clinicians treated at least one M3M with complete surgical removal (CSR) annually. Only 69% performed one or more coronectomies (COR). Advocates of coronectomy reported lower rates of inferior alveolar nerve (IAN) injury, but IAN, lingual nerve, and adjacent second molar damage were rare, occurring in less than 0.5% of cases, with small differences between the COR and CSR groups. Although these differences are not statistically significant, they are likely to be clinically important. Also, the COR group would have comprised mainly high-risk teeth, while the CSR group would include many teeth at low risk of complications. This might have skewed the results. Those clinicians performing no coronectomies cited three main reasons for being low adopters of COR: the lack of irrefutable evidence to support its benefit, the increased need for a second operation, and more non-IAN complications. Although COR may prevent permanent IAN damage in high-risk cases, this paper highlights clinicians' views that there is a gap in evidence and knowledge to support COR. As a result, 47% of the clinicians surveyed recommended, and were prepared to participate in, further studies to determine the effectiveness and safety of COR.

British Association of Oral and Maxillofacial Surgeons’ National Facial Injury Surveys: hard tissue facial injuries presenting to UK emergency departments

British Journal of Oral and Maxillofacial Surgery, 2019

The British Association of Oral and Maxillofacial Surgeons (BAOMS) and Saving Faces undertook two... more The British Association of Oral and Maxillofacial Surgeons (BAOMS) and Saving Faces undertook two national prospective surveys 11 years apart. They recorded the facial injuries treated in UK emergency departments and collected data on 14872 patients. In this paper, which aims to act as a feasibility study for a third national survey of facial injuries, we have reviewed hard-tissue injuries and specifically focused on temporal changes in their morphology. The two sets of directly comparable, categorical, unpaired, cross-sectional data were evaluated independently for statistical significance. In 1997, there were 1977 hard-tissue facial injuries (33%) but in 2008 this had decreased to 1899 (22%) (p<0.05). In 1997, there were 1315 fractures (22%) and 662 dental injuries (11%) compared with 1462 (17%) fractures and 438 (5%) dental injuries in 2008 (p<0.05). There were proportional increases in orbital (21%), nasal (139%), and cranial fractures (340%) (p<0.05). The data showed a small reduction in the total number of hard-tissue injuries, but this was a considerable reduction as a proportion of the total injuries. Analysis of the type and subtype of injury generally pointed towards a reduction in their energy and severity, and to likely changes in mechanism. The project has proved the feasibility of a third national survey of facial injury.

Health risks information reaches secondary school smokers

Health Education Research, 2007

This cross-sectional study aimed to assess smoking prevention and cessation education delivered a... more This cross-sectional study aimed to assess smoking prevention and cessation education delivered as part of the UK National Curriculum and to evaluate the relative effectiveness of health, social influence and other/non-health components. In all, 1789 students aged 11-15 from 12 secondary schools completed online surveys assessing smoking status, factors known to be related to smoking and experience of smoking education. A total of 1421 of 1722 (83%) students remembered some school-based education. Of these, 803 (57%) said that the lessons changed their ideas about smoking. Multinomial logistic regression was used to assess whether lesson recall was associated with smoking status in a model adjusting for age, gender, ethnicity, family and best friend smoking status, socioeconomic status, and school. Quitters were more likely than smokers to report having changed their ideas about smoking as a result of a lesson (OR 5.78, 95% CI 2.44-13.72). The relative effectiveness of 16 lesson themes was assessed. Significantly more students changed their ideas about smoking as a result of 'health' compared with 'social influence' (v 2 (1) 124.0, P < 0.001) or 'other/ non-health' (v 2 (1) 63.16, P < 0.001) topics. Mouth cancer was the most effective health topic and may provide a suitable model for both smoking and risky drinking prevention.

Caution in Use of Bicortical Intermaxillary Fixation Screws

British Journal of Oral and Maxillofacial Surgery, 2000

Numb chin syndrome: an ominous clinical sign

BDJ, 2010

A 58-year-old man was referred by his general dental practitioner (GDP) with a threemonth history... more A 58-year-old man was referred by his general dental practitioner (GDP) with a threemonth history of unilateral anaesthesia of his left chin and lip and a ten-week history of dull, throbbing pain from his left jaw radiating to his ear. He described a sudden onset of paraesthesia over a small area of the left side of his chin. This had progressively increased to involve his entire chin, lip and the oral mucosa overlying the left mandible.

Synovial sarcoma presenting as a parotid mass: Case report and review of literature

Head & Neck, 2008

Background. Synovial sarcoma is an unusual neoplasm of mesenchymal derivation, which is uncommon ... more Background. Synovial sarcoma is an unusual neoplasm of mesenchymal derivation, which is uncommon in the head and neck sites. In the parotid gland, it is most likely to be misdiagnosed as a myoepithelial, primary mesenchymal, or metastatic neoplasm. Methods. We report a case of synovial sarcoma in a young woman who was seen with temporomandibular joint symptoms with a 10-year history. A review of the literature was undertaken to highlight the radiologic and histologic features that help in diagnosis as well as the suggested therapeutic protocols most likely to ensure better survival. Results. Radiologic and histologic studies of the parotid mass led to a diagnosis of synovial sarcoma. A total parotidectomy was performed, and the individual remains tumor free at 36 months. Conclusions. Review of the literature suggests an aggressive long-term outcome for synovial sarcoma and advocates early diagnosis and radical surgical excision for a favorable prognosis.

Quality of life (QoL) and patient reported outcome measures (PROMS) in radiologically N0 (rN0) necks treated by Sentinel Node Biopsy (SNB) or Elective Neck Dissection (END)

British Journal of Oral and Maxillofacial Surgery, 2015

First degree hotspots for OMFS recruitment 1967–2010: dental and medical schools where OMFS specialists and trainees were more likely to start their careers

British Journal of Oral and Maxillofacial Surgery

Broken jaws in the COVID era

British Dental Journal, Apr 1, 2020

COVID-19, domestic violence and abuse, and urgent dental and oral and maxillofacial surgery care

British Dental Journal, 2020

Household isolation measures to reduce coronavirus transmission during the COVID-19 pandemic have... more Household isolation measures to reduce coronavirus transmission during the COVID-19 pandemic have resulted in increased risk of domestic violence and abuse (DVA). DVA physical injury most frequently involves the face. Dentists, dental care professionals, oral surgeons and oral and maxillofacial surgeons all have a critical part to play in identifying patients experiencing DVA, who present with dental and facial injury, and in making referrals to specialist agencies. This paper describes how to ask questions about DVA sensitively and how to make an appropriate referral. Early intervention and referral to a DVA advocate can prevent an abusive situation becoming worse with more intense violence. It can save lives.

BAOMS QOMS: findings from the pilot phase and lessons learned in the feasibility evaluation of a national quality improvement initiative

The British journal of oral & maxillofacial surgery, 2021

The BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - Apri... more The BAOMS QOMS pilot was developed and run in six England OMFS units between December 2019 - April 2020. The aims of this pilot project were: to evaluate feasibility of the questionnaires developed for the audit and how effective they were with regards to quality improvement, to test the processes associated with the data collection system and finally, to provide baseline data to support patient data collection without the requirement of prospective consent. The pilot included a series of six audits (oral and dentoalveolar [ODA], oncology, orthognathic, reconstruction, trauma, and skin). Data entry was clinician-led in five OMFS units and in one unit (EKHU), it was additionally supported by members of the clinical coding team. One hundred and twenty-eight REDCap account user details were issued and of these, 45 (35%) completed registration and 22 (17%) were active users who participated in the pilot data entry. Disproportionate focus on individual audits within QOMS was seen, though...

Systemic lupus erythematosus presenting with oral mucosal lesions: easily missed?

British Journal of Dermatology, 2001

Two caucasian patients are described in whom oral mucosal lesions were the first manifestation of... more Two caucasian patients are described in whom oral mucosal lesions were the first manifestation of systemic lupus erythematosus. In both cases the diagnosis was delayed despite histological examination of oral lesions. Treatment with antimalarials and azathioprine was of significant benefit. In the absence of cutaneous or systemic features, distinguishing oral lupus erythematosus from lichen planus and epidermal dysplasia can be difficult, both clinically and on histology, and requires a high index of suspicion.

2012 – The year when BAOMS and its officers prevented closure of all UK shortened medical and dental courses

British Journal of Oral and Maxillofacial Surgery, 2020

In Spring 2011 the Department of Health (DH) received a request to review European Union Directiv... more In Spring 2011 the Department of Health (DH) received a request to review European Union Directive 2005/36 EU-the directive relating to the recognition of professional qualifications. The Department of Health lawyer raised concerns that the existing shortened dental courses may be in breach of EU law. There were three shortened dental courses in the UK: 4 year graduate entry courses in Liverpool/Peninsula and 3-year Dental Programme for Medical Graduates (DPMG) in Kings, London. During the summer the General Dental Council (GDC) was made aware of these concerns. In autumn 2011 the Chief Dental Officer for England with the GDC, told the Dental Deans' Council (DDC) that shortened dental courses were illegal. On 12th Jan 2012 students on the DPMG were told that they would have to complete a full 5-year dental degree. The GDC said that this interpretation of EU law would also impact on shortened medical courses. In view of the potentially enormous impact that this would have on OMFS training, BAOMS engaged all the resources it could and by assembling legal opinions including written contributions from Sir David Edward, whose opinion was being misinterpreted by the GDC and DH, and by sharing these resources with all the stakeholders, BAOMS was able to preserve shortened dental and medical courses. Now that the UK has left the European Union, negotiations around mutual recognition of qualifications may mean this issue will resurface. We should remain vigilant.

qMIDS: A Digital Diagnostic Test for Oral Cancer

British Journal of Oral and Maxillofacial Surgery, 2019

Are facial injuries really different? An observational cohort study comparing appearance concern and psychological distress in facial trauma and non-facial trauma patients

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2017

Labiomental intertrigo

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 1995

Severe skeletal retrognathia may lead to a pronounced labiomental fold. When severe the labioment... more Severe skeletal retrognathia may lead to a pronounced labiomental fold. When severe the labiomental fold may result in intertrigo, which is chronic and symptomatic. This problem can be managed by orthodontics and orthodontic surgery to reposition the jaw at a more anterior direction, thus creating a normal lip posture and a normal labiomental fold.

Identification of FOXM1-induced epigenetic markers for head and neck squamous cell carcinomas

Cancer, 2013

BACKGROUND: Epigenetic reprogramming of the methylome has been implicated in all stages of cancer... more BACKGROUND: Epigenetic reprogramming of the methylome has been implicated in all stages of cancer evolution. It is now well accepted that cancer cells exploit epigenetic reprogramming, a mechanism that regulates stem/progenitor cell renewal and differentiation, to promote cancer initiation and progression. The oncogene FOXM1 has been implicated in all major forms of human cancer. METHODS: We have recently shown that aberrant upregulation of FOXM1 orchestrated a DNA methylation signature that mimics the cancer methylome landscape, from which we have identified a number of FOXM1-induced epigenetic markers. Differential promoter methylation and gene expression in clinical specimens were measured using commercially available bisulfite conversion kits and absolute quantitative PCR, respectively. RESULTS: Here, we investigated 8 FOXM1-induced differentially methylated genes, SPCS1, FLNA, CHPF, GLT8D1, C6orf136, MGAT1, NDUFA10, and PAFAH1B3, using human head and neck tissue specimens donated by 2 geographically independent patient cohorts from Norway and the United Kingdom. Two genes (GLT8D1 and C6orf136) were found to be differentially expressed in head and neck squamous cell carcinomas (HNSCCs). Using methylationspecific quantitative PCR, we confirmed that the promoters of GLT8D1 and C6orf136 were hypo-and hypermethylated, respectively, in HNSCC tissues. CONCLUSIONS: Given that epigenetic change precedes gene expression, methylation status of candidate genes identified from this study may represent a signature of premalignancy, rendering them potentially useful predictive biomarkers for precancer screening and/or therapeutic targets for cancer prevention.

Interrelationship of depression, stress and inflammation in cancer patients: A preliminary study

Journal of Affective Disorders, 2012

La depressione è un disturbo molto comune tra le persone affette da cancro e ne compromette notev... more

BAOMS QOMS (Quality and Outcomes in Oral and Maxillofacial Surgery), a specialty-wide quality improvement initiative: progress since conception

The British journal of oral & maxillofacial surgery, 2021

European OMFS in the time of Brexit – where did the UK fit and how might the future look?

British Journal of Oral and Maxillofacial Surgery, 2020

INTRODUCTION The specialty of OMFS in the UK is a dual degree specialty which was recognised in E... more INTRODUCTION The specialty of OMFS in the UK is a dual degree specialty which was recognised in Europe within Annex V of Directive 2005/36/EU. Currently UK law matches that of the EU. Brexit may change this. DIRECTIVE 2005/36/EU: Defines two specialties within European nations, Dental, Oro-Maxillo-Facial Training DOMFS (Basic dental & medical training) and Maxillofacial Surgery (basic medical training). The UK sat within DOMFS and so specialists from DOMFS nations could travel and work in the UK. Specialists from all other nations were required to use the Certificate of Eligibility for Specialist Registration (CESR) route. DIRECTIVE 2013/55/EU: This directive updated 2005/36/EU regarding Mutually Recognised Professional Qualifications (MRPQ) including creating an international alert system for doctors in difficult Entry onto the UK OMFS Specialist List by CESR Route CESR application is a large and complex portfolio of evidence to demonstrate knowledge, skills and experience are equivalent to a Certificate of Completion of Training (CCT) holder. To date, no EU applicants have successfully completed a CESR application. UNION OF EUROPEAN MEDICAL SPECIALISTS (UEMS) Even after Brexit, the UK will remain a full member of UEMS. The OMFS Section of UEMS is a source of information and support for specialists wishing to work in other nations and for nations wishing to develop an OMFS specialty in their nation. ACCESS TO UK OMFS TRAINING FOR NON-UK TRAINEES Applicants meeting the person specifications for approved OMFS specialty training (ST) posts in the UK are welcome to apply to the national selection process for OMFS specialty training in the UK. Many have done so successfully. Fixed term appointments and Fellowships are advertised and represent a useful route to gain support for application for training or through the CESR Route. CONCLUSIONS The UK remains part of the diverse OMFS community in Europe. There is support from within the UK and from UEMS for trainees and specialists interested in coming to the UK to train or to work.

Current perspectives on the surgical management of mandibular third molars in the United Kingdom: the need for further research

British Journal of Oral and Maxillofacial Surgery, 2020

This survey of expert opinion regarding the management of mandibular third molar (M3M) impaction ... more This survey of expert opinion regarding the management of mandibular third molar (M3M) impaction and its clinical sequelae was circulated to all members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). It was completed by 289 clinicians who reported treating 60003 patients annually. Respondents included 199 (69%) specialists and 58 (20%) primary care clinicians. Most (99%) of the clinicians treated at least one M3M with complete surgical removal (CSR) annually. Only 69% performed one or more coronectomies (COR). Advocates of coronectomy reported lower rates of inferior alveolar nerve (IAN) injury, but IAN, lingual nerve, and adjacent second molar damage were rare, occurring in less than 0.5% of cases, with small differences between the COR and CSR groups. Although these differences are not statistically significant, they are likely to be clinically important. Also, the COR group would have comprised mainly high-risk teeth, while the CSR group would include many teeth at low risk of complications. This might have skewed the results. Those clinicians performing no coronectomies cited three main reasons for being low adopters of COR: the lack of irrefutable evidence to support its benefit, the increased need for a second operation, and more non-IAN complications. Although COR may prevent permanent IAN damage in high-risk cases, this paper highlights clinicians' views that there is a gap in evidence and knowledge to support COR. As a result, 47% of the clinicians surveyed recommended, and were prepared to participate in, further studies to determine the effectiveness and safety of COR.

British Association of Oral and Maxillofacial Surgeons’ National Facial Injury Surveys: hard tissue facial injuries presenting to UK emergency departments

British Journal of Oral and Maxillofacial Surgery, 2019

The British Association of Oral and Maxillofacial Surgeons (BAOMS) and Saving Faces undertook two... more The British Association of Oral and Maxillofacial Surgeons (BAOMS) and Saving Faces undertook two national prospective surveys 11 years apart. They recorded the facial injuries treated in UK emergency departments and collected data on 14872 patients. In this paper, which aims to act as a feasibility study for a third national survey of facial injuries, we have reviewed hard-tissue injuries and specifically focused on temporal changes in their morphology. The two sets of directly comparable, categorical, unpaired, cross-sectional data were evaluated independently for statistical significance. In 1997, there were 1977 hard-tissue facial injuries (33%) but in 2008 this had decreased to 1899 (22%) (p<0.05). In 1997, there were 1315 fractures (22%) and 662 dental injuries (11%) compared with 1462 (17%) fractures and 438 (5%) dental injuries in 2008 (p<0.05). There were proportional increases in orbital (21%), nasal (139%), and cranial fractures (340%) (p<0.05). The data showed a small reduction in the total number of hard-tissue injuries, but this was a considerable reduction as a proportion of the total injuries. Analysis of the type and subtype of injury generally pointed towards a reduction in their energy and severity, and to likely changes in mechanism. The project has proved the feasibility of a third national survey of facial injury.

Health risks information reaches secondary school smokers

Health Education Research, 2007

This cross-sectional study aimed to assess smoking prevention and cessation education delivered a... more This cross-sectional study aimed to assess smoking prevention and cessation education delivered as part of the UK National Curriculum and to evaluate the relative effectiveness of health, social influence and other/non-health components. In all, 1789 students aged 11-15 from 12 secondary schools completed online surveys assessing smoking status, factors known to be related to smoking and experience of smoking education. A total of 1421 of 1722 (83%) students remembered some school-based education. Of these, 803 (57%) said that the lessons changed their ideas about smoking. Multinomial logistic regression was used to assess whether lesson recall was associated with smoking status in a model adjusting for age, gender, ethnicity, family and best friend smoking status, socioeconomic status, and school. Quitters were more likely than smokers to report having changed their ideas about smoking as a result of a lesson (OR 5.78, 95% CI 2.44-13.72). The relative effectiveness of 16 lesson themes was assessed. Significantly more students changed their ideas about smoking as a result of 'health' compared with 'social influence' (v 2 (1) 124.0, P < 0.001) or 'other/ non-health' (v 2 (1) 63.16, P < 0.001) topics. Mouth cancer was the most effective health topic and may provide a suitable model for both smoking and risky drinking prevention.

Caution in Use of Bicortical Intermaxillary Fixation Screws

British Journal of Oral and Maxillofacial Surgery, 2000

Numb chin syndrome: an ominous clinical sign

BDJ, 2010

A 58-year-old man was referred by his general dental practitioner (GDP) with a threemonth history... more A 58-year-old man was referred by his general dental practitioner (GDP) with a threemonth history of unilateral anaesthesia of his left chin and lip and a ten-week history of dull, throbbing pain from his left jaw radiating to his ear. He described a sudden onset of paraesthesia over a small area of the left side of his chin. This had progressively increased to involve his entire chin, lip and the oral mucosa overlying the left mandible.

Synovial sarcoma presenting as a parotid mass: Case report and review of literature

Head & Neck, 2008

Background. Synovial sarcoma is an unusual neoplasm of mesenchymal derivation, which is uncommon ... more Background. Synovial sarcoma is an unusual neoplasm of mesenchymal derivation, which is uncommon in the head and neck sites. In the parotid gland, it is most likely to be misdiagnosed as a myoepithelial, primary mesenchymal, or metastatic neoplasm. Methods. We report a case of synovial sarcoma in a young woman who was seen with temporomandibular joint symptoms with a 10-year history. A review of the literature was undertaken to highlight the radiologic and histologic features that help in diagnosis as well as the suggested therapeutic protocols most likely to ensure better survival. Results. Radiologic and histologic studies of the parotid mass led to a diagnosis of synovial sarcoma. A total parotidectomy was performed, and the individual remains tumor free at 36 months. Conclusions. Review of the literature suggests an aggressive long-term outcome for synovial sarcoma and advocates early diagnosis and radical surgical excision for a favorable prognosis.

Quality of life (QoL) and patient reported outcome measures (PROMS) in radiologically N0 (rN0) necks treated by Sentinel Node Biopsy (SNB) or Elective Neck Dissection (END)

British Journal of Oral and Maxillofacial Surgery, 2015

First degree hotspots for OMFS recruitment 1967–2010: dental and medical schools where OMFS specialists and trainees were more likely to start their careers

British Journal of Oral and Maxillofacial Surgery

Broken jaws in the COVID era

British Dental Journal, Apr 1, 2020