Although socioeconomic status partly explains ethnic disparities seen with covid-19, cultural and structural racism also adversely affect health, argue Mohammad Razai and colleagues

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Breast cancer is the most common global malignancy and the leading cause of cancer deaths. Despite this, undergraduate and postgraduate exposure to breast cancer is limited, impacting on the ability of clinicians to accurately recognise, assess and refer appropriate patients. This article provides a comprehensive review of the pathology, epidemiology, clinical presentation, referral pathways and management of breast cancer in the UK. It also describes how to conduct a thorough clinical breast examination.

In published trials, good compliance with compression is reported in around two thirds of patients, with inferior compliance in those given higher degrees of compression. Further studies are required to identify predictors of non-compliance, to help inform the clinical management of these patients. Complications of compression are not documented in many studies and should be given more consideration in the future.

Purpose: Orthognathic surgery for dentofacial deformities is typically preceded and followed by orthodontic treatment. Traditionally, orthodontic hardware is secured to the dentition to allow dental movement and stabilization. Clear-aligner therapy (eg, Invisalign) provides an aesthetic alternative, consisting of a series of transparent trays. Its use has not been described in complex triple-jaw orthognathic surgery. The purpose of this study is to evaluate perioperative outcomes and 3-dimensionally quantify postoperative edema in Invisalign patients undergoing triple-jaw orthognathic procedures, comparing this to patients treated with conventional fixed appliances. The surgical approach to patients with clear-aligners is also outlined. Methods: The authors conducted a retrospective chart review and 3-dimensional morphometric study of Invisalign patients undergoing triple-jaw surgery (LeFort I osteotomy, bilateral sagittal split osteotomy, and genioplasty). An identical assessment of demographically matched patients treated with conventional fixed appliances was performed and compared with the Invisalign group. Results: Thirty-three patients, with a mean age of 19.99 years, were included: 13 with Invisalign and 20 with conventional fixed appliances. No significant difference was observed in operating time, concurrent extraction of teeth, fat grafting, duration of hospital stay, diet advancement, and use of narcotic analgesics between the 2 groups. Nine patients had sufficient 3-dimensional images for volumetric analysis (4 with Invisalign and 5 with conventional fixed appliances). Postoperative edema was not significantly different (P = 0.712) when comparing conventional fixed appliances (44.29 ± 23.16 cm3) to Invisalign (37.36 ± 31.19 cm3). Conclusion: The present study demonstrates that complex multiple-jaw orthognathic procedures can be successfully performed in Invisalign patients. Perioperative and short-term clinical outcomes are not compromised.

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Segmental Le Fort I osteotomy, a complex procedure with many mobile parts, has traditionally required presurgical orthodontics with conventional braces, composed of metal brackets, bands, and archwires. These appliances are not always accepted by patients, particularly older teenagers and professional adults who previously endured traditional orthodontia during adolescence, and now require retreatment because of jaw growth differences necessitating orthognathic surgery. Less obtrusive orthodontic therapies, involving clear aligners (e.g., Invisalign), are becoming increasingly popular, as they are less noticeable and less aesthetically objectionable. They are typically indicated for milder occlusal discrepancies, such as crowding and minor rotations, without significant vertical or transverse problems. Clear aligners in conjunction with orthognathic surgery for severe dentofacial problems are progressive and not widely used. Moreover, the most complicated of orthognathic sequences, segmental double-jaw surgery, has never before been described to be performed using Invisalign. Several potential challenges exist when performing segmental double-jaw surgery with Invisalign (i.e., no bonded or banded appliances, and no archwire). The purpose of this article is to review the feasibility of segmental double-jaw surgery without orthodontia (Invisalign only), report a series of cases, and review the technical steps involved.

This study showed that since ADM introduction to our centre, more breast reconstructions have been of the implant-only type with consequent reductions in the more complex and expensive autologous techniques. Implant-only procedures that incorporated ADM use had similar complication rates to those that did not.