Simulation-based training in maxillofacial surgery: are we going to be left behind?

Simulating A Subcondylar Mandibular Fracture With Intraoral Open Reduction and Internal Fixation: A Novel Education Tool for Residents

Study Design

Face and content validation of a surgical simulation model.

Objective

Open reduction and internal fixation in displaced subcondylar mandibular fractures is standard care. This requires an extraoral (eg: retromandibular, transparotideal) or intraoral approach. An intraoral approach requires further training since specialized instrumentation such as the 90° screwdriver system and endoscopes might be needed. Currently, no simulation models are available for training residents in intraoral reduction and fixation of subcondylar mandibular fractures. Therefore, we present a validated simulation model for intraoral treatment of subcondylar mandibular fractures.

Methods

Based on a computer tomography data set, we designed and printed a 3D model of a mandible with a unilateral subcondylar fracture. To simulate intraoral work depth, it was positioned inside a dental phantom. We tested the model by a group of experts (n = 8), simulating intraoral reduction and fixation of a unilateral subcondylar fracture, using a 90° screwdriver system, a 1.0 subcondylar plate (lambda), and 5-6 mm screws.We assessed Face and Content validity by survey.

Results

We provided an open-source printable fracture model. Printing costs were approximately US $10. Experts "Agreed" the model resembling the real scenario and its use for training intraoral reduction and fixation of subcondylar mandibular fractures.

Conclusions

We developed a low cost, reproducible, open-source simulator for subcondylar mandibular fractures. Face and Content validity was achieved through evaluation by a group of experts.

MaxSim: a novel simulation-based education course for OMFS emergencies

For oral and maxillofacial surgery (OMFS) senior house officers (SHOs) with no formal medical training, the first exposure to emergency scenarios will be the first time they have to manage them, usually alone. Simulation-based education (SBE) has been demonstrated to increase experience and confidence when used in medical education, so an OMFS SBE course was created to facilitate this. The course was centred on scenarios that necessitate a rapid response, including sepsis, retrobulbar haemorrhage, and carotid artery blowout. A questionnaire with a 10-point numerical score was given to assess the change in confidence when managing these scenarios. Learner numbers were limited due to the COVID-19 pandemic, but all 10 completed both questionnaires. There was an even distribution between first and second-year SHOs. Two had received simulation training before, but it was very limited. In all stations every learner felt an increase in confidence, on average by 45% (range 38%-56%, p<0.05) on the 10-point scale. Positive feedback was also given by them all. SBE has been shown to be an invaluable method of training for clinical scenarios and needs to become common in OMFS. The course is to be expanded post COVID-19 to become available nationally.

Comparisons of orthodontic residents' performance and attitudes using 2D, 3D, and virtual reality surgical simulation methods

PURPOSE

Advances in virtual reality technology for surgical simulation methods may improve diagnosis and treatment planning of complex orthognathic surgery cases. The objectives were to assess orthodontic residents' performance and attitudes when treatment planning orthognathic surgery cases using two-dimensional (2D) digital, three-dimensional (3D) digital, and virtual reality (VR) surgical simulations.

METHODS

The study had a mixed methods study design involving 20 graduate orthodontic residents. Their previous experiences, confidence, and competence with orthodontic diagnosis and surgical treatment planning were assessed with a baseline survey. Each resident completed 2D, 3D, and VR treatment planning and simulation tasks in a randomized order and recorded their diagnosis, objectives, treatment plan, and special surgical concerns for each case using a treatment planning worksheet. The worksheets were scored and quantitative data were analyzed. Attitudinal responses to the simulation experience were captured with a post-survey and interview.

RESULTS

The number of total prescribed surgical movements was greater for 3D and VR simulation methods (p = 0.001). There were no differences in the overall total written treatment plan analysis score among the three surgical simulation tasks. Participants took longer to complete the VR and 3D tasks (p < 0.001) and asked more questions regarding manipulation (p < 0.001) and software features (p < 0.002) for higher fidelity tools. Analysis of qualitative feedback showed positive attitudes toward higher fidelity tools with regard to visualization, manipulation, and enjoyment of the task.

CONCLUSIONS

The results demonstrate that simulation methods of increased fidelity (3D and VR) are appropriate alternatives to 2D conventional orthognathic surgical simulation methods when combined with traditional records. Qualitative feedback confirms residents' readiness to adopt VR simulation. However, comprehensive training is needed to increase familiarity and comfort with using the new technology.

UK Oral and Maxillofacial Surgery Trainee Perceptions of Flexible Nasal Endoscopy

INTRODUCTION AND AIM

Flexible nasal endoscopy (FNE) is a useful adjunct in diagnosis and follow-up of oncology patients as well as in airway assessment. Proficiency in this technique is also listed as part of the Oral and Maxillofacial Surgery (OMFS) curriculum. We aimed to explore OMFS trainee perceptions of training and confidence in this technique.

MATERIALS AND METHODS

An electronic survey was undertaken of OMFS higher surgical trainees in the UK. A 10-item questionnaire was formulated using online survey software (SurveyMonkey) and distributed to Specialty Registrars in all deaneries via their regional representatives. Questions on training, exposure to and confidence in FNE were asked.

RESULTS

A total of 43 responses were received which included all grades of higher surgical trainees. A large proportion had undertaken FNE in oncology rotations (78.6%) and as part of airway assessment (85.6%). Nearly half of trainees (47.6%) were confident in diagnosing pathology using FNE although 16.6% had low levels of confidence in the technique. Only 38% had received formal training, and the majority of this training was a teaching session from a senior. A very large proportion of trainees (90.5%) feel formal training should be available in FNE and 76% would undertake a formal OMFS training course in FNE if available.

CONCLUSIONS

Trainees have high levels of exposure to FNE but variable levels of confidence in the technique. Trainees appear to receive limited formal training in the technique, and the introduction of more formalised training could be explored.

The Impact of Coronavirus Disease 2019 on Maxillofacial Surgery Training in Portugal: The Resident’s Perspective

Introduction

Methods

Results

Discussion

Conclusion

Surgical Simulation Course for Facial Fracture Education

A hands-on facial fracture simulation course can be an important adjunct teaching modality in resident education and training, enhancing both resident confidence and competence in treatment of facial fractures. In this study, 11 plastic surgery residents participated in a surgical wet laboratory and lecture focusing on operative management of facial fractures. Pre- and post-course questionnaires were administered as clinical knowledge assessments. Pre-course, 40% of participating residents reported feeling comfortable with facial fracture management (>5 of 10) and 50% of residents achieved competence on clinical assessment (scoring >50%). Following the simulation course, these same assessments were re-administered. Post-course, comfortability with fracture management increased to 100% among participating residents, and 90% of residents scored >50%, demonstrating improvement in clinical competency.

Surgical Training 2.0: A systematic approach reviewing the literature focusing on oral maxillofacial surgery - Part II

PURPOSE

Many technologies are emerging in the medical field. Having an overview of the technological arsenal available to train new surgeons seems very interesting to guide subsequent surgical training protocols.

METHODS

This article is a systematic approach reviewing new technologies in surgical training, in particular in oral and maxillofacial surgery. This review explores what new technologies can do compared to traditional methods in the field of surgical education. A structured literature search of PubMed was performed in adherence to PRISMA guidelines. The articles were selected when they fell within predefined inclusion criteria while respecting the key objectives of this systematic review. We looked at medical students and more specifically in surgery and analysed whether exposure to new technologies improved their surgical skills compared to traditional methods. Each technology is reviewed by highlighting its advantages and disadvantages and studying the feasibility of integration into current practice.

RESULTS

The results are encouraging. Indeed, all of these technologies make it possible to reduce the learning time, the operating times, the operating complications and increase the enthusiasm of the students compared to more conventional methods. The start-up cost, the complexity to develop new models, and the openness of mind necessary for the integration of these technologies are all obstacles to immediate development. The main limitations of this review are that many of the studies have been carried out on small numbers, they are not interested in acquiring knowledge or skills over the long term and obviously there is a publication bias.

CONCLUSION

Surgical education methods will probably change in the years to come, integrating these new technologies into the curriculum seems essential so as not to remain on the side. This second part therefore reviews, social networks, serious games and virtual reality. This Systematic review is registered on PROSPERO (CRD42020181376).

Microsurgical simulation, a 'cheep' solution

There is a demand for simulation-themed courses within maxillofacial surgery, yet these are often expensive. With this in mind, we used a non-living chicken thigh model to simulate microsurgical procedures on a training day for specialty registrars. The advantages and limitations of the simulation were explored through participant feedback. This model was found to be a useful, cost-effective simulation which was valued by trainees within our specialty.

Training simulation for oral and maxillofacial surgeons based on the techniques of arthroscopy in the temporomandibular joint

Arthroscopy is a diagnostic-therapeutic technique used in the treatment of disorders of the temporomandibular joint (TMJ). The difficulties of arthroscopy lie in the manipulation of the tools, which is why training in the technique of triangulation in artificial models is essential. We developed a training system based on the techniques of arthroscopy in the TMJ, using simulators. The first simulator was a metal box containing three holes for insertion of the instruments, and the second was a human artificial model made of polymers. We found that they facilitated training in the techniques of arthroscopy, which subsequently reduced operating time and led to a better execution of skills in reality.