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Introduction
Skills and Expertise
Current institution
Publications
Publications (95)
A year after publication of the Breaking the Silence report, the authors share the progress made and discuss what still needs to be done by us all.
NMSC UK Head and Neck Guidelines, Chapter 28
Background:
This observational study, paired with National Health Service (NHS) workforce population data, examined gender differences in surgical workforce members' experiences with sexual misconduct (sexual harassment, sexual assault, rape) among colleagues in the past 5 years, and their views of the adequacy of accountable organizations in deal...
The incidence of skin cancer is increasing and surgery is the mainstay of management. The James Lind Alliance (JLA) priority setting partnership (PSP) was designed to address research uncertainties in skin cancer surgery. We report the outcome and top ten research priorities from the JLA PSP in skin cancer surgery.
Introduction/Aims
Skin grafts are commonly used for reconstruction of defects following excision of facial skin cancers. Tie-over bolster dressings are routinely placed to secure these grafts, but are they necessary for healing or graft success?
Methods
96 patients treated from 2013-2019 who underwent full thickness skin graft (FTSG) reconstructio...
DOI: 10.1111/bjd.20649
In this guideline by Keohane et al., the wording for recommendation R26, especially the portion "very high-risk lesions, such aspT2 or greater lip cSCC" was insufficiently clear, opening it to interpretations and has caused some confusion. To clarify, advanced cSCC of the lip may overlap into the oral cavity and fall into the...
COVID-19 has resulted in an expansion of webinar-based teaching globally. Socially distanced e-learning is the new normal. The delivery of regional OMFS teaching programmes in the UK and the Republic of Ireland, for Specialty Trainees (ST’s) under the Joint Committee on Surgical Training (JCST) and Intercollegiate Surgical Curriculum Programme (ISC...
The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of cutaneous squamous cell carcinoma (cSCC). The document aims to
• offer an appraisal of all relevant literature up to 30 January 2020, focusing on any key developments,
• address important, practical clinical questions relating to th...
Introduction
Process mapping in industry is a well-established tool to improve efficiency. It is defined as a quality improvement technique that breaks down a process, or task, into its individual components, or steps, then analyses it. Lean principles are used to reduce waste and produce consistently good outcomes.
Improving the operative efficien...
Introduction
Orthognathic surgery improves quality of life in terms of oral function and facial aesthetics. Our aim was to establish and compare operative time and length of inpatient stay for orthognathic procedures, and to assess the re-operation rate.
Methods
Departmental electronic data base was used to identify all patients undergoing orthogn...
Covers all aspects of oral and maxillofacial surgery, providing the core information in a succinct and clear fashion
Explains the diagnosis and treatment of a wider range of congenital and acquired conditions that affect the mouth, jaw, face, and neck
Provides updated and complete coverage of the exit FRCS (OMFS) syllabus and also remains relevant...
The overall objective of the guideline is to provide up-to-date,
evidence-based recommendations for the management of cutaneous
squamous cell carcinoma (cSCC). The document aims
to
• offer an appraisal of all relevant literature up to 30 January
2020, focusing on any key developments,
• address important, practical clinical questions relating to
th...
This is the third of three articles that give an overview of the current evidence for management of the neck and parotid in patients with cutaneous cancers of the head and neck. In this paper we discuss Merkel cell carcinoma (MCC) and review the latest evidence for management of the regional nodes.
Sentinel lymph node biopsy (SLNB) is an accurate staging procedure for malignant melanoma but its use in patients with melanoma of the head and neck has been questioned in the past because of a perceived record of poor safety and accuracy. Technical improvements have sought to redress this. Vital structures and variable lymphatic pathways can make...
A feasibility study before a national randomised controlled trial (RCT) of radiotherapy (RT) in the treatment of patients with pT2 and pT3 ('high risk') head and neck primary cutaneous squamous cell carcinoma (H&N pcSCC). Introduction: The incidence of cutaneous squamous cell carcinoma (cSCC) continues to rise at a rate higher than any other human...
Accurate staging of a skin cancer is essential in order to properly plan its management. Staging takes account of the tumour itself (T), whether it has spread to lymph glands (nodes – N) and whether it has spread to distant organs (metastases – M). The TNM classification system is constantly being revised in the light of new research. The latest ed...
The 8th edition of TNM (tumour, node and metastasis) has numerous and important changes compared with the 7th edition. Public Health England and the Royal College of Pathologists, U.K., have adopted the 8th edition of TNM (TNM8) published by the Union for International Cancer Control for skin cancer staging. These changes will have an impact on the...
Intraoral extranodal Hodgkin's lymphoma is rare. We present the case of a 66-year-old gentleman who was treated for necrotizing ulcerative gingivitis of the UR6 tooth by his dentist which failed to resolve. Biopsy and histopathology revealed that this was, in fact, a rare presentation of primary (Stage I) extranodal oral Hodgkin's lymphoma. We pres...
Background
Leiomyosarcoma (LMS) is a malignant tumour formed of cells with distinct smooth muscle features. Leiomyosarcomas rarely metastasise to the oral cavity and this literature review details all reported cases of metastasis to the mandible found in the literature. This offers a unique perspective by specifying mandible as the site of metastas...
The role of the BDJ is to inform its readers of ideas, opinions, developments and key issues in dentistry - clinical, practical and scientific - stimulating interest, debate and discussion amongst dentists of all disciplines.
We retrospectively reviewed the management at our centre of 25 patients with Merkel cell carcinoma (MCC) of the head and neck. We obtained details of the operation, including wide local excision, sentinel lymph node biopsy (SNB), neck dissection, postoperative radiotherapy, and clinical outcomes, from patients’ records. All patients were white, 11...
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides consensus recommendations on the management of cutaneous basal cell carcinoma and squamous cell carcinoma in the head and neck region on the basis of current evidence.
Recommendations
• Royal Co...
Oral and Maxillofacial Surgery Second Edition gives a concise and structured overview of current maxillofacial practice in a user friendly format. The handbook covers all specifics concerned with the diagnosis and surgical treatment of diseases affecting the mouth, jaws, face and neck. It is particularly useful to trainees in maxillofacial surgery...
The new edition of this online guide gives a concise and structured overview of current maxillofacial practice in a user friendly format. It covers all specifics concerned with the diagnosis and surgical treatment of diseases affecting the mouth, jaws, face and neck, and is particularly useful to trainees in maxillofacial surgery at both junior and...
This overview is the first of 2 articles on the current evidence for management of the neck and parotid in cutaneous cancers of the head and neck. In this paper we discuss cutaneous squamous cell carcinoma (SCC) and review the latest evidence for management of the regional nodes.
This is the second of 2 articles giving an overview of the current evidence for management of the neck and parotid in cutaneous cancers of the head and neck. We discuss cutaneous malignant melanoma and review the latest evidence for management of the regional nodes.
Introduction: The incidence of cutaneous malignancy is rising, and OMFS surgeons are increasingly involved in management, particularly as the majority of lesions are found on the head and neck. It is important to ensure adequate histological excision rates remain high within departments of multiple OMFS surgeons performing excisional surgery. Natio...
Skin cancer is increasing in incidence and the face is the
commonest site for skin cancers to occur. Patients who
are at risk from skin cancers include those who have fair
skin and who have had long-term exposure to sunshine.1
While facial skin cancers are more common in the
older population, greater numbers of younger people
are developing these c...
Desmoplastic fibromas are rare, benign bone tumours, which often behave in a locally aggressive manner. In the head and neck region they are most commonly seen in the mandible and have been treated in various ways. We present an unusual presentation of the lesion, which was subsequently treated by the less commonly used technique of enucleation, wi...
Tuberculosis (TB) of the temporomandibular joint (TMJ) is rare and misdiagnosis is common. We describe an unusual case of the disease in a 27-year-old Zimbabwean woman.
Effective surgical training is under pressure on a number of fronts. There are growing demands from the nHs to increase service commitment and targets. The European Working time regulations (EWTR) and the introduction of modernising medical careers have both decreased surgical training time and surgical exposure. Wade and Henderson looked at the vi...
Multidisciplinary Management Guidelines
Although patients are commonly reviewed after primary treatment for squamous cell carcinoma (SCC) of the oral cavity, there is little evidence about the frequency and duration of such a review. To try and obtain further information about current practice within the United Kingdom we used a structured telephone questionnaire to contact 50 units. Mos...
Although several studies have reported the use of reinnervated microvascular free flaps for oro-pharyngeal reconstruction, it has been known for some time that non-innervated flaps demonstrate spontaneous sensory recovery. This study sought to evaluate the degree of such spontaneous recovery in 50 radial forearm flaps used for mucosal reconstructio...
A 33-year-old female patient developed an ipsilateral sixth nerve palsy and partial third nerve palsy following a Le Fort 1 osteotomy. Complete resolution occurred at 10 weeks. The likely mechanism of injury secondary to pterygo-maxillary dysjunction is highlighted, with description of the relevant anatomy. Previous cases of ocular motility complic...
The use of iodinated contrast material in radiography is contraindicated in patients with known iodine sensitivity and such patients may present a management dilemma. The successful use of gadolinium in contrast sialography is described.
A simple method using a staple was successfully used to treat a 74-year-old lady with a fractured frontozygomatic suture.
The case records of 72 patients in Northern Ireland who had secondary bone grafting of 94 alveolar clefts between 1987 and 1997 were examined. Details were recorded of age, sex, laterality of cleft, preoperative orthodontic treatment, whether grafting was combined with soft tissue revision, method of harvesting the graft, complications, eruption of...
We report a case of adenosquamous carcinoma that arose in the maxillary alveolus of a 61-year-old woman, metastasized rapidly to submandibular and deep cervical lymph nodes, and caused death in spite of surgery and radiotherapy. Our case highlights the aggressive behavior associated with this tumor when it occurs in the oral cavity and at most othe...
Two cases of benign lymphoid hyperplasia (BLH) of the palate are reported. The histologic appearances are those of a benign or reactive lymphoid aggregate and correlate well with other published accounts of this lesion. Using a battery of antileukocyte antibodies suitable for formalin-fixed tissue, analysis of the antigenic profile of oral BLH has...
