Abstract
Introduction
In this review, we aim to assess the categorical distribution of publications in 3 leading general OMS journals, British Journal of Oral and Maxillofacial Surgery (BJOMS), International Journal of Oral and Maxillofacial Surgery (IJOMS), Journal of Oral and Maxillofacial Surgery (JOMS) over the span of 21-years.
Method
We examined all full-length publications between 1998 and 2018 in 3 OMS journals (IJOMS, BJOMS, JOMS) and categorised into 16 pre-determined categories. These included facial aesthetic, anatomical, craniofacial, implantology, pre-prosthetic, oncology, orthognathic, pathology, pharmacology, radiology, reconstruction, obstructive sleep apnoea (OSA), technical notes, third molar, temporomandibular joint, and trauma. Statistical analysis was conducted to analyse the proportional changes in these categories over 2 time periods.
Results
A total of 14,324 articles were analysed. This included 3745 articles in IJOMS, 7229 from JOMS, and 3745 from BJOMS. The areas of greatest change were seen with a statistically significant increase in the field of orthodontics, OSA, and implantology in 2 of the 3 journals. There was a marked reduction proportion of case reports/series over this period.
Conclusions
The subject areas where there has been a proportional increase in publications included orthognathics, implantology, and sleep-related studies. Most other subject areas remain unchanged with a decrease noted in pathology-related articles.
Keywords: Evidence-based medicine, EBM, Research, Publications
Introduction
Since its inception, the surgical speciality of Oral and Maxillofacial surgery (OMS) has continued to evolve; from a dental speciality involved in facial trauma management during war time efforts, to today, heading units in oncology, craniofacial, and aesthetics [1, 2]. Dimitroulis stated that “Our scope of practice as a specialty is largely defined by the knowledge and experience that is gained through the research efforts and subsequent publications produced by oral and maxillofacial surgeons” [3]. In a similar vein, Hupp has outlined the important role of research by arguing the need for greater engagement and endeavouring into newer areas of investigation to allow OMS to thrive [4].
In our previous review of the quality of evidence in 3 major OMS journals we found that there has been a concerted effort to produce higher quality research. Over a 21-year period a significant increase in the quantity and quality of publications was noted across all 3 journals reviewed. The broad scope of OMS includes sub-specialised areas of dentoalveolar surgery, implantology, head and neck surgery, oncology and pathology, with several academic journals specialising in these areas and providing avenues for researchers to reach a target audience. This leaves the general OMS publications to better reflect the research interests of OMS at large. Whilst it has been shown that in 3 major OMS journals there is a trend towards higher quality research, the areas of the specialty in which the research is taking place are not well defined [5].
In this review, we aim to assess the categorical distribution of publications in 3 leading general OMS journals, British Journal of Oral and Maxillofacial Surgery (BJOMS), International Journal of Oral and Maxillofacial Surgery (IJOMS), Journal of Oral and Maxillofacial Surgery (JOMS). The aim of the current review was to analyse the subject categories published across a 21-year period, identify any changes in the sub-categories of published research during this period, to determine if publications in these journals represent the changing scope of OMS, and to describe the research trend. To the authors knowledge no previous article as looked at each subject category of academic publication in major OMS journals. The information provided in this analysis serves to inform researchers and clinicians of emerging areas of research interest, and changing trends in the literature published in these three journals. The analysis of the publication categories should reflect the interplay of the various factors that define the scope of our speciality and how it has evolved over time.
Methods
All full-length publications between 1998 and 2018 in 3 OMS journals (IJOMS, BJOMS, JOMS) were identified via each journals online catalogue. All publications in the time period were screened. Included in the data collection were all full-length publications including online only publications. Excluded from the data collection were all abstracts, reflections, perspectives and letters to the editor. This timeframe was selected to allow comparisons between a long-time span that could capture shifts in surgical research interest.
A search of Medical Subject Headings (MeSH) terms was performed to determine a list of categories for grouping. After an extended search through the MeSH tree using the search terms including maxillofacial, craniofacial, and oral surgery as well as a review of general comprehensive OMS textbooks, a pre-determined list of 16 categories was constructed to encompass the full scope of subspecialties and research areas in OMS in a simplified manner. These categories are (1) facial aesthetic, (2) anatomical, (3) craniofacial, (4) implantology, (5) pre-prosthetic surgery, (6) oncology, (7) orthognathic, (8) pathology, (9) pharmacology, (10) radiology, (11) reconstruction, (12) obstructive sleep apnoea (OSA), (13) technical notes, (14) dentoalveolar, (15) temporomandibular joint (TMJ), and (16) trauma.
Abstracts were screened and if further information was required to allow accurate classification, the full-length articles were accessed and reviewed. Data collection was standardised between 3 authors (AS, AS, DB) by independent review of the first 2 years (1998–1999) of each journal and comparing for inter-reviewer variability. The final data collection was performed by one author (DB) after this training was completed and separated by year of publication for further analysis.
The number of articles was tabulated and grouped into 2 time periods from 1998 to 2008 and 2009 to 2018. As there was a significant increase in the total output in the period between 2009 and 2018, the total number in each category was calculated as a percentage of the total articles in each respective time period to appropriately compare the two groups.
The type of article (meta-analyses, randomised controlled trials, observational, laboratory, review, and case reports) was also collected.
Statistical analysis was conducted with Jamovi (The jamovi project (2021). jamovi. (Version 2.0) [Computer Software]. Retrieved from https://www.jamovi.org).
Results
A total of 14,324 articles were analysed over the 21-year period between 1998 and 2008. This included 3745 articles in IJOMS, 7229 from JOMS, and 3745 from BJOMS. There was a significant increase in the number of publications in the most recent decade between 2009 and 2018 compared to the period between 1998 and 2008; 2044 versus 1306 in BJOMS, 2271 versus 1474 in IJOMS, and 4061 versus 3168 in JOMS. As a result, the number of publications in each category was represented as a percentage of the total number of publications over the 2 respective periods that were compared. The increasing number of publications over the 21-year period is represented in Fig. 1.
Fig. 1.
Number of publications per year in BJOMS, IJOMS, and JOMS
The most significant changes were noted in a large absolute proportional decrease in the category of pathology-related publications across all 3 journals down 5.39%, 7.62%, and 5.77% across BJOMS, IJOMS, and JOMS, respectively. Despite this, pathology was still the most popular publication category in both time periods representing more than 15–20% of publications in all 3 journals. The most significant increases were seen in technical notes in BJOMS (5.99% absolute increase), and orthognathics in IJOMS (6.95% absolute increase).
The 3 most common categories of publication in BJOMS were oncology, pathology, and technical notes in both timeframes. In IJOMS only oncology remained in the top 3 category across the decades with pathology and reconstruction being replaced by orthognathics and temporomandibular joint (TMJ) articles overtaking in popularity in the more recent decade. JOMS maintained pathology across the 2 decades but trauma and TMJ from the previous decade were replaced by orthognathics and reconstruction.
A full summary of the percentage of publications in each respective category and journal is demonstrated in Table 1.
Table 1.
Percentage of the total publications in each subject category during 1998–2008 and 2009–2018
The type of research revealed significant proportionate decreases in case reports across all 3 journals in the 2009–2018 period compared 1998–2008: 17.22% versus 27.34%, 13.12% versus 23.27%, 20.09% versus 29.10%, for BJOMS, IJOMS, and JOMS, respectively. Concurrently, there was an increase in the proportion of systematic reviews/meta-analyses and RCTs during this time. This information is summarised in Table 2.
Table 2.
Types/methodology of publications compared between 1998 and 2008 and 2009 and 2018
| BJOMS | IJOMS | JOMS | |||||||
|---|---|---|---|---|---|---|---|---|---|
| 1998–2008 | 2009–2018 | Total | 1998–2008 | 2009–2018 | Total | 1998–2008 | 2009–2018 | Total | |
| Systematic reviews/meta analyses | 1 (0.08%) | 11 (0.54%) | 12 (0.36%) | 1 (0.07%) | 64 (2.82%) | 65 (1.74%) | 4 (0.13%) | 44 (1.08%) | 48 (0.66%) |
| RCTs | 30 (2.30%) | 49 (2.40%) | 79 (2.36%) | 41 (2.78%) | 130 (5.72%) | 171 (4.57%) | 50 (1.58%) | 165 (4.06%) | 215 (2.97%) |
| Prospective observational | 124 (9.49%) | 205 (10.03%) | 329 (9.82%) | 244 (16.55%) | 470 (20.70%) | 714 (19.07%) | 506 (15.97%) | 388 (9.55%) | 894 (12.37%) |
| Retrospective observational | 353 (27.03%) | 560 (27.40%) | 913 (27.25%) | 403 (27.34%) | 693 (30.52%) | 1096 (29.27%) | 831 (26.23%) | 1662 (40.93%) | 2493 (34.49%) |
| Case reports | 357 (27.34%) | 352 (17.22%) | 709 (21.16%) | 343 (23.27%) | 298 (13.12%) | 641 (17.12%) | 922 (29.10%) | 816 (20.09%) | 1738 (24.04%) |
| Animal/laboratory/surveys | 174 (13.32%) | 288 (14.09%) | 462 (13.79%) | 315 (21.37%) | 375 (16.51%) | 690 (18.42%) | 400 (12.63%) | 536 (13.20%) | 936 (12.95%) |
| Review articles and technical notes | 267 (20.44%) | 579 (28.33%) | 827 (25.25%) | 127 (8.62%) | 241 (10.61%) | 368 (9.83%) | 455 (14.36%) | 450 (11.08%) | 905 (12.52%) |
Table 3 summarises the proportional change across the different subject categories across the decades and journals. The mean difference represents the percentage (proportional to the total number of publications in that journal over that time period) of articles published per year within that time period. A negative mean difference represents a decrease in the 2009–2018 time period compared to 1998–2008. The statistically significant (p-value < 0.05) changes are highlighted.
Table 3.
Proportional change in publications between 1998 and 2008 and 2009 and 2018
| Journal | p-value | Mean difference | 95% confidence interval | |
|---|---|---|---|---|
| Aesthetic | BJOMS | 0.643 | 0.0141 | − 0.0486–0.0769 |
| IJOMS | 0.275 | 0.0229 | − 0.0198–0.0655 | |
| JOMS | 0.532 | 0.0198 | − 0.0453–0.0849 | |
| Anatomical | BJOMS | 0.039 | 0.1186 | 0.0065–0.2307 |
| IJOMS | 0.502 | 0.0466 | − 0.0959–0.1890 | |
| JOMS | 0.369 | 0.0277 | − 0.0352–0.0905 | |
| Craniofacial | BJOMS | 0.678 | 0.0283 | − 0.1123–0.1688 |
| IJOMS | 0.101 | 0.1768 | − 0.0377–0.3914 | |
| JOMS | 0.019 | 0.1394 | 0.0260–0.2528 | |
| Implantology | BJOMS | 0.008 | 0.1507 | 0.0443–0.2572 |
| IJOMS | < 0.001 | 0.4472 | 0.2226–0.6719 | |
| JOMS | 0.158 | 0.1819 | − 0.0772–0.4409 | |
| Pre-prosthetic | BJOMS | 0.305 | 0.0380 | − 0.0375–0.1135 |
| IJOMS | 0.001 | 0.2324 | 0.1063–0.3585 | |
| JOMS | 0.214 | 0.0852 | − 0.0536–.2240 | |
| Dentoalveolar | BJOMS | 0.369 | − 0.0684 | − 0.2241–0.0873 |
| IJOMS | 0.361 | 0.0870 | − 0.1075–0.2816 | |
| JOMS | 0.047 | 0.2961 | 0.0046–0.5875 | |
| Oncology | BJOMS | 0.368 | 0.1161 | − 0.1476–0.3799 |
| IJOMS | 0.176 | − 0.3036 | − 0.7554–0.1481 | |
| JOMS | 0.083 | 0.1646 | − 0.0237–0.3530 | |
| Orthognathics | BJOMS | 0.156 | 0.1269 | − 0.0528–0.3066 |
| IJOMS | < 0.001 | 0.7897 | 0.3876–1.1919 | |
| JOMS | < 0.001 | 0.3672 | 0.1830–0.5515 | |
| Pathology | BJOMS | 0.296 | − 0.3443 | − 1.0155–0.3268 |
| IJOMS | 0.003 | − 0.5802 | − 0.9380– − 0.2224 | |
| JOMS | 0.091 | − 0.3579 | − 0.7783–0.0626 | |
| Pharmacology | BJOMS | 0.506 | 0.0610 | − 0.127–0.2493 |
| IJOMS | 0.005 | 0.1329 | 0.0452–0.2206 | |
| JOMS | 0.315 | − 0.0726 | − 0.2200–0.0748 | |
| Radiology | BJOMS | 0.120 | − 0.0884 | − 0.2019–0.0252 |
| IJOMS | 0.429 | 0.0466 | − 0.0740–0.1671 | |
| JOMS | 0.606 | − 0.0171 | − 0.0852–0.0510 | |
| Reconstruction | BJOMS | 0.931 | − 0.0111 | − 0.2766–0.2544 |
| IJOMS | 0.004 | − 0.5731 | − 0.9405– − 0.2056 | |
| JOMS | 0.055 | 0.1580 | − 0.0040–0.3200 | |
| Obstructive sleep apnoea | BJOMS | 0.057 | 0.0741 | − 0.0024–0.1507 |
| IJOMS | 0.037 | 0.0678 | 0.0045–0.1311 | |
| JOMS | 0.024 | 0.0777 | 0.0113–0.1441 | |
| Technical note | BJOMS | 0.017 | 0.7549 | 0.1514–1.3583 |
| IJOMS | 0.568 | 0.0966 | − 0.2517–0.4449 | |
| JOMS | 0.482 | − 0.1263 | − 0.4953–0.2426 | |
| TMJ | BJOMS | 0.196 | 0.1536 | − 0.0862–0.3935 |
| IJOMS | 0.010 | 0.3009 | 0.0808–0.5209 | |
| JOMS | 0.334 | − 0.0946 | − 0.2945–0.1052 | |
| Trauma | BJOMS | 0.218 | − 0.2151 | − 0.5688–0.1386 |
| IJOMS | 0.480 | − 0.0814 | − 0.3176–0.1549 | |
| JOMS | 0.582 | 0.0601 | − 0.1641–0.2843 |
Mean difference figures represent a percentage change in the proportion of publications (per year) in the period between 2009 and 2018 and 1998 and 2008. Negative mean difference represents a smaller proportion published in the most recent decade
p-values of < 0.05 are highlighted in bold
Discussion
Our 21-year analysis of the 3 journals recovered 14,324 articles eligible for analysis. There was a significant increase in the total number of articles in the period between 2008 and 2018 compared to the previous decade with the average number of articles per year increasing 72.2%, 69.5%, and 41.0% increase in BJOMS, IJOMS, and JOMS, respectively.
The types of publications also revealed an increase in quality of the research published with increased numbers of systematic reviews and RCTs and a decrease in case reports. Systematic reviews, metanalyses, and RCTs combined contributed 2.94%, 8.54%, and 5.14% of the articles published between 2009 and 2018 in BJOMS, IJOMS, and JOMS. This compared to 2.38%, 2.85%, and 1.71% in the previous decade across the respective journals. This increase in high quality research was inversely reflected in a decrease in case reports with an absolute decrease of 10.12%, 10.15%, and 9.01% in BJOMS, IJOMS, and JOMS, respectively. This is likely secondary to the creation of case report focused journals and an active effort by the journals to publish higher quality papers [6]. Similar findings were recently reported by Wilson et al. who reviewed meta-analysis in BJOMS and IJOMS between 2010 and 2019 and compared this data to the previous decade [5, 7, 8].
There was some difficulty in pre-determining a list of subject categories that would encompass the full scope of oral and maxillofacial surgery. Previous investigations by Aslam-Pervez and Wilson et al. have used various categories to group papers into subject areas but there was no consensus list available [5, 9]. We conducted a MeSH search of keywords in maxillofacial surgery and reviewed the contents pages of several general OMS textbooks to determine the list of 16 subject categories used in this paper. There was significant overlap between our categorisation and previous methods; however, an important change was to divide oncology and reconstruction. These categories are often separate chapters in textbooks and the literature treats these as different areas of investigation. In addition, we included the category of pharmacology to represent the large number of articles specifically investigating the use of drugs to modify the surgical and postoperative course.
Analysing the pattern of changes in each subject category was conducted after adjusting for the proportional increase in publications over the time periods. The number of articles in each category was converted as a percentage of the total number of publications within each respective time period. Implantology, orthognathics, and sleep-related studies revealed a statistically significant increase in two out of three journals. The influences are likely multifactorial but contributing factors could include the significant technological advances with the use of virtual planning and custom solutions in the field of implantology and orthognathics [10–12]. In addition, these two categories remain core components of contemporary OMS practice and therefore would be expected to remain frequent areas of investigations in general OMS journals.
Regarding the category of obstructive sleep apnoea, there was a significant increase seen in IJOMS and JOMS; however the absolute numbers were still small. Again, this is multifactorial; however there has been an increase recognition and interest in the role of OMS in the management of these patients.
Numerous articles have been published in obesity and respiratory medicine journals investigating the benefit of maxillo-mandibular advancement (MMA) in the management of OSA [13, 14]. This role has recently been validated in the updated Stamford Protocol for the management of OSA. The original Riley–Powell Stamford protocol for the surgical management of obstructive sleep apnoea (OSA) relied on a graduated approach to avoid unnecessary surgery however had relapse rates of 42–75% with phase I therapies (uvulopalatopharyngoplasty and genioglossus advancement hyoid myotomy) [15]. Phase II therapies, which included maxillomandibular advancement (MMA), were only considered for failed phase I candidates, despite MMA having a documented success rate of 90% [15, 16]. The updated Stamford protocol recognises the utility of MMA and therefore provides a greater role for MMA in the management of these patients [17].
Arakeri reported that in the BJOMS, the subjects which predominated in 2010–2011 were head and neck oncology, trauma, and cleft/orthognathic surgery [18]. It was also noted that whilst head and neck oncology was the predominant subject matter for both UK (60%) and overseas authors (30%), cleft/orthognathic papers were more likely to come from overseas authors (26% vs. 9%). Our analysis did not include the regional variation regarding the authors institution; however Arakeri hypothesised these differences reflect the caseload mix been with the UK and other European countries.
The recent analysis by Wilson et al. of meta-analyses in BJOMS and IJOMS between 2010 and 2019 revealed similar results to our investigation [5]. There was a marked increase in meta-analyses over the 2010–2019 compared to the previous decade in the fields of implantology (30.4%), followed by dentoalveolar surgery (21.6%) and orthognathic (10.8%). They suggested the popularity of meta-analyses in the field of implantology is likely due to the abundance of implants placed both in public and private practice, funding available from implant companies, and the ability to control for confounding factors required in RCTs.
The scope of OMS has been described as comprising three components: areas of expertise, areas of competence, and areas of familiarity [19]. The areas of expertise include oral pathology, dentoalveolar surgery, pre-prosthetic surgery and implantology and maxillofacial trauma [19]. Areas of competence include orthognathic surgery, temporomandibular joint surgery and local reconstructive surgery [19]. Areas of familiarity are cleft lip and palate, regional reconstructive surgery, oncologic surgery, craniofacial and cosmetic surgery [19]. These areas do not define any individual OMS surgeon but can guide the minimum requirements that would be expected and would distinguish an OMS surgeon from our colleagues in plastic surgery or otolaryngology.
Our analysis maintains that these 3 components remain the framework for general contemporary OMS practice. As Table 1 displays, the proportions of articles that have been published over time have largely stayed the same with the notable increase in orthognathic surgery which suggests that it could be considered to becoming more of an area of expertise from previously being an area of competence. Small but significant changes noted in areas such as surgical OSA management may play a bigger role in general OMS practice but this is likely many years away as the absolute number of publications remains low.
Conclusions
The overall trend in publication in these 3 OMS journals is an increase in higher quality research with increases in systematic reviews, meta-analyses, and RCTs and a decrease in case reports/series. The subject areas where there has been a proportional increase in publications included orthognathics, implantology, and sleep-related studies. This research has identified an increased interest by the major OMS journals in subjects including orthognathic surgery, implantology, and sleep-related studies. There has been a decrease in the total proportion of publications on the subject of pathology. Each individual journal considered in this study had different changes in the publication trends over the 21-year period. The findings from this study help inform prospective researchers of the various research interests of the major OMS journals, as well as highlighting areas where there are increasing numbers of publications. In addition, researchers should be aware that these journals are increasingly publishing articles of a higher level of scientific evidence.
Funding
No funding.
Declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
Not required.
Informed Consent
Not applicable.
Footnotes
Publisher's Note
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