Maxillofacial education in the time of COVID-19: the West Midlands experience

COVID-19 has accelerated a reliance on virtual technology for the delivery of postgraduate surgical education. We sought to develop a regional teaching programme with robust quality assurance. Webinars were delivered on a weekly basis by subspecialty experts using Zoom™ augmented with interactive polling software. Trainee feedback comprised Likert item rating on content and delivery, free text comments and self-assessed confidence levels using visual analogue scale (VAS) scores. A focus group was also convened and transcripts assessed with grounded theory analysis. Likert items revealed 442 (93.2%) positive responses regarding content and 642 (96.7%) positive responses regarding trainer delivery. There were statistically significant improvements in VAS scores across all programme content. Key themes from the focus group analysis were the pragmatics of delivering online education, issues surrounding trainer interactivity in the virtual world, the identification of the FRCS as a driving factor and a desire for case-based content and pre-learning of information (the ‘flipped classroom’). We are continuing to be reactive to trainee feedback in developing our online learning programme which will also include a regional Moodle-based virtual learning environment (VLE), the subject of future educational research in our region.

Venous malformations of the head and neck: current concepts in management

Low-flow venous malformations are congenital lesions and they are the third most common vascular anomaly in the head and neck. In this paper, the third in a series of three educational reviews, we discuss current trends in their management, and include a summary of common sclerosant agents used in their control.

The clinical relevance of microbiology specimens in orofacial abscesses of dental origin

INTRODUCTION

It is common surgical practice to take a specimen for microbial culture and susceptibility (MC&S) when draining an orofacial abscess. The aim of this study was to determine if routine MC&S has any therapeutic value in the care of these patients.

METHODS

A retrospective study was undertaken of records of patients admitted for surgical management of orofacial abscesses between January 2010 and December 2011. Records were reviewed for bacteriology specimen and result, admission details, antimicrobial treatment and outcome.

RESULTS

A total of 79 patients were included in the study and specimens sent from 62 patients (78.4%). Samples were positive in 86.2% of cases, of which Streptococcus viridans was the most commonly isolated organism (54.7%). Interim reports were published on average after 3.25 days, with 89.9% of patients having been discharged within 2 post-operative days. According to clinical records, no patients in the cohort required further intervention or alteration of prescribed antimicrobial treatments following discharge.

CONCLUSIONS

Almost 90% of patients were discharged before bacteriology results were available, without complication. This study suggests bacteriology culture has no therapeutic value in these patients. Omission of this practice in the case of uncomplicated orofacial abscesses could improve efficiency in the National Health Service without affecting patient care.

Giant salivary calculi of the submandibular gland

Sialolithasis is the most common salivary gland disease. A case of an unusually large sialolith arising in the submandibular gland is presented, along with a review of the management of giant salivary gland calculi.

Intra-operative internal jugular vein thrombosis complicating microvascular free flap transfer

Internal jugular vein thrombosis is rare. It is often secondary to prolonged central venous cannulation and associated with local or distant malignancy. The authors present a case of intra-operative thrombosis of the internal jugular vein which complicated subsequent microvascular anastomosis of a radial forearm free flap. The management of the intra-operatively thrombosed internal jugular vein and alternative anastamotic options for the free flap are discussed.