Division Of Maxillofacial Surgery Research Articles

A Comparative Study on the Shaping Ability and Cleaning Efficiency of Two Different Single-File Systems, Reciprocating Wave One Versus Continuous Rotation F360, Evaluated by Scanning Electron Microscope: An In Vitro Study.

Background: In endodontics, the three processes of biomechanical preparation, disinfection, and obturation are each essential. The electron microprobe and scanning electron microscope (SEM) allowed for the detection and identification of the smear layer and debris. The purpose of the current investigation was to use a scanning electron microscope to evaluate the relative merits of two single-file systems, the reciprocating WaveOne and the continuous motion F360 files, in the cleaning and contouring of root canals in removed teeth. Materials and method: The 50 central maxillary permanent teeth Data was gathered from the Oral and Maxillofacial Surgery Division at Sri Ganganagar's Maharaja Ganga Singh Dental College and Research Centre for a number of reasons. Group A followed the manufacturer's guidelines for using the WaveOne instrument, whereas Group B utilised the F360. Reciprocating motion WaveOne system (group A) and continuous motion F360 system (group B) root canals were scored at three levels: coronal third, middle third, and apical third (group B). SPSS version 22 was used for the data analysis. The data were examined using the chi-square test and the one-way analysis of variance. Results: A greater quantity of smear layer was found in the apical third, whereas better results were achieved in the coronal and middle thirds. When compared to the F360 file system, the WaveOne file system is subpar when it comes to clearing the canal of debris. While both groups showed a large amount of debris in the apical third, outcomes were somewhat better in the coronal and middle thirds. Conclusion: The WaveOne and F360 file systems were both more effective in removing trash from the coronal and middle thirds of the disc than they were from the apical thirds. In comparison to the continuous motion F360 file system, WaveOne files demonstrated a statistically significant reduction in the amount of debris cleared from root canals in all three root zone thirds (coronal, middle, and apical). The reciprocating action of the WaveOne file system, in contrast to the continuous motion of the F360 file system, resulted in more extensive cleaning of the root canal smear layer in the coronal and middle thirds and less thorough cleaning in the apical thirds of the canal.

Temporomandibular joint arthrocentesis: a single-center experience and review of the literature.

The aim of this paper was to report our experience and to review the literature of arthrocentesis focusing on protocols and results. Arthrocentesis with supplemental hyaluronic acid was performed in patients with TMDs between January 2017 and December 2020 at the Division of Maxillofacial Surgery. The maximum interincisal opening (MIO) and pain score were recorded preoperatively (T0), 2 months postoperatively (T1), and 6 months postoperatively (T2). A literature search was performed to analyze the same parameters in patients with TMDs. Patient demographic, characteristics and treatment protocols used were also recorded. This retrospective analysis enrolled 45 patients. Twenty-two patients (20 females, 2 males) with mean age of 37.13 years with internal derangement were included in study group A. Study group B included 23 patients with degenerative joint disease (19 females and 4 males) with mean age of 55.73 years. The outcomes trend of MIO and pain during the follow-up period showed a gradual improvement. Fifty articles meeting the proposed scientific criteria were selected for the literature revision. A range of clinical and procedural variables were analyzed by grouping the studies into two broad categories based on the diagnosis of TMD. Based on our experience and on the basis of the most accredited scientific studies in the literature, intra-articular injections of HA are beneficial for the improvement of the pain and/or functional symptoms of TMDs.

Diagnosis and Management of Parotid Gland Cancer with Focus on the Role of Preoperative Fine-Needle Aspiration Cytology: A 10-Year-Long Retrospective Study with 5-Year Follow-Up.

Salivary gland cancers represent a rare heterogeneous group of neoplasms with complex clinicopathological characteristics and distinct biological behaviour. The appropriate diagnosis and management of parotid gland cancer are challenging and should be based on the clinical, imaging, cytological, and histological features. The present study analysed the use of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen section (FS) to guide the appropriate surgical and postoperative treatment of parotid gland cancers. We selected 48 patients with primary malignancy of the parotid gland surgically treated between 1 January 2008 and 30 June 2017 at the Maxillo-Facial Surgery Division, University Hospital of Parma, Italy. The patients had postoperative histological diagnosis of malignant parotid cancer and were followed up for longer than 5years. The 48 patients included in this study had a mean age of 56.7years. The most frequent type of parotid gland cancer was carcinoma ex pleomorphic adenoma (22.9%), followed by mucoepidermoid carcinoma (16.7%) and acinic cell carcinoma (14.6%). All 48 patients underwent preoperative FNAC: 29 (60.4%) and 19 (39.6%) were suggestive of malignant and benign lesions, respectively. In 31 patients, intraoperative FS was performed. Compared to previous studies, the present study showed significantly lower diagnostic sensitivity of FNAC for parotid gland cancers. The preoperative diagnostic accuracy for suspected malignant cases may be improved by repeat analysis of the cytological specimen by experts, preoperative core needle biopsy, and/or intraoperative FS analysis of the suspected mass.

Role of Lasers in Orthognathic Surgery- A Review

A huge revolution that has taken place in the field of surgery is the application of lasers. In recent decades the application of lasers in medical and surgical fields has significantly raised. Orthognathic surgery is a division of oral and maxillofacial surgery wherein a patient's facial and occlusal function is altered and improved to increase the patient's confidence and self-esteem. The laser can be abbreviated as "Light amplification by stimulated emission of radiation". A laser is a device that emits a high-intensity light beam that converts electrical energy into a focused high-energy beam. Lasers have various uses in Oral and maxillofacial surgery, including removing oral mucosal lesions like leukoplakia, oral lichen planus, Fordyce granules, and precancerous lesions. It also helps in removing oral benign lesions, Hemostasis during any surgical procedures, Frenectomy and treatment of ankyloglossia. Apart from these, low-level lasers are also effective in Orthognathic surgeries. Low-level lasers have been used in orthognathic surgery to reduce pain post-operatively, for effective wound healing, and reduce inflammation and trismus. This study aims to search for scientific evidence regarding the effectiveness of lasers in the above-mentioned aspects

Progressively enlarging midline cystic mass of the floor of the mouth in an infant

A 6-month-old infant arrived with parents for evaluation of an anterior floor of mouth swelling. The birth history was unremarkable, and the parents stated that the swelling had been present since birth. During the past few months, the oral swelling had enlarged progressively; however, the parents denied observing any difficulties with feeding or breathing. The parents noted no other medical abnormalities. On examination, a large, distensible mass was palpated at the anterior floor of the mouth. The overlying mucosa had a bluish tinge, and both submandibular duct orifices were present, patent, and laterally displaced by the lesion. There were no palpable neck masses. Magnetic resonance imaging of the face was performed 1 month before at an outside hospital and revealed a 1.5- × 1.7- × 1.8-cm, well-defined, predominantly cystic, lesion located within the root of the tongue (Figure 1). There was a small, enhancing, soft-tissue nodule ventrally. Dr. Trinh is a resident, Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY. Dr. Lee is a resident, Division of Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, New York, NY. Dr. Eisig is the chairman, Division of Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, New York, NY. Dr. Peters is an assistant professor, Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, New York, NY.

What is the Incidence of Oral Cancer Recurrence in Patients Reconstructed With a Microvascular Free Flap, Endosseous Implants, and an Oral Prosthesis and How Does the Timing of Implant Placement Influence Recurrence?

In patients with malignant oral disease, there is concern that immediate implant placement at the time of ablative and microvascular free flap surgery can contribute to tumor recurrence or delay the diagnosis of recurrence. The purpose of this study is to 1) estimate the incidence of recurrence in patients with malignant disease treated with immediate microvascular free flap reconstruction, endosseous implants, and an oral prosthesis, 2) measure and compare the timing of implant placement, immediate versus delayed, and the time to complete oral rehabilitation, and 3) measure the association between the timing of implant placement and tumor recurrence. This is a retrospective cohort study utilizing medical record analysis involving patients with malignant oral cancer undergoing tumor resection and immediate microvascular reconstruction from 1996 to 2019 at the Mayo Clinic, Rochester, MN by the Division of Oral and Maxillofacial Surgery. Additional inclusion criteria comprised of immediate or delayed endosseous implant placement, the fabrication of an oral prosthesis, and a minimum of 2-year follow-up. Data on patient demographics, tumor characteristics, timing of implant placement and prosthesis loading, type of prosthesis, tumor recurrence, or second primary tumor events were analyzed. Thirty-three patients with a mean follow-up of 6.4years were included. Twenty-four patients (72.7%) were diagnosed with squamous cell carcinoma with 3 patients experiencing tumor recurrence. Fifteen patients had immediate implant placement while 18 patients had delayed implant placement. The mean number of days to prosthetic loading of the implants was 680.4days and 330.1days for the delayed implant group and immediate implant group, respectively, which was statistically significant (P=.004). The timing of implant placement and the event of a recurrence were not statistically significant (P=.075). The incidence of recurrence in patients with malignant oral cancer treated with microvascular reconstruction, endosseous implants, and an oral prosthesis was 12.5% with one recurrence occurring beneath the oral prosthesis. Delayed implant placement resulted in a statistically significant delay in the completion of oral rehabilitation compared to immediate implant placement. There was no difference in the incidence of recurrence in the immediate implant group compared to the delayed implant group.

Characteristics and surgical management of pure trapdoor fracture of the orbital floor in adults: a 15-year review

PurposeThis retrospective study aims to define the optimal timing of the surgical treatment of orbital floor trapdoor fractures (OFTFs) in adults according to clinical and radiological findings.MethodsFrom January 2006 to December 2020, 382 patients with isolated orbital floor fracture were admitted to the Division of Maxillofacial Surgery of Turin, Italy. The criteria for inclusion were age ≥ 16 years, preoperative computed tomography showing a linear (1a) or medial hinge fracture (1b), diplopia, and 6 months of follow-up data. Aetiology and mechanism of injury, presence of post-traumatic enophthalmos and oculocardiac reflex, time between trauma occurrence and surgery [stratified as < 24 h (urgent treatment), 24–96 h (early treatment), and > 96 h (late treatment)], days of hospitalisation, and clinical outcomes were examinated.ResultsTwenty-four patients (18 males; mean age, 23.2 years) presented with OFTFs. The most common cause was sport injury (50%). Type 1a fracture was observed in eight patients (mean age, 19.5 years), type 1b fracture in 16 patients (mean age, 23.6 years). Urgent, early, and late treatments were performed in eight patients each. The mean time between trauma occurrence and surgery was 3,8 days (range: 0–17 days). Resolution of diplopia was observed 1 week after surgery in 10 patients, 1 month in 12. Diplopia persisted in 2 patient, both treated > 96 h after trauma.ConclusionAlthough the number of patients was too small to define a standard protocol, the authors recommend early treatment of adult OFTFs to promote complete resolution of diplopia.

The Influence of Dental Rehabilitation on the Detection and Rate of Cancer Recurrence after Oral Cavity Malignant Tumor Ablation

Immediate microvascular tissue reconstruction is the reconstructive modality of choice after head and neck malignant tumor ablation. Although delayed reconstruction allows for definitive analysis of pathologic margins, studies have shown that immediate reconstruction does not yield higher rates of recurrence.1 Immediate reconstruction is associated with less financial burden, decrease in treatment time, and improved quality of life.1 The use of an implant-retained or -supported prosthetics furthers this improvement in quality of life. Although the previously discussed benefits also apply when endosseous implants are placed immediately at the time of reconstruction, there are concerns of their impact on recurrence in the treatment of malignant tumors. It has been hypothesized that immediate implant placement can result in seeding, interference with the efficacy of adjuvant radiation therapy, and delay in the diagnosis of recurrent disease secondary to radiographic artifact and lack of clinical visibility.2 The primary aim of this study was to assess the impact of dental rehabilitation in the diagnosis of disease recurrence in patients with oral cavity malignancies that underwent free flap reconstruction with endosseous implant placement. The secondary aim was to determine the rate of osteoradionecrosis in patients who underwent adjuvant radiation treatment.This is a retrospective study from a sample of subjects who underwent immediate reconstruction with a free tissue transfer and either immediate or delayed implant placement for treatment of oral cavity malignancies by the Division of Oral and Maxillofacial Surgery at the Mayo Clinic, MN. Descriptive data were collected on patient demographics, diagnosis, number of implants, history of radiation therapy, and type of prosthesis utilized. The tumors were staged according to the AJCC eighth edition tumor-node-metastasis classification. All subjects received an implant-retained or -supported prosthesis and had a minimum follow-up of 24 months. Recurrence was confirmed by incisional biopsy.A total of 29 patients with an average age of 54.6 years old, including 12 females (41.4%) and 17 males (58.6%), with an oral cavity malignancy met inclusion criteria. Squamous cell carcinoma was the most common malignancy, occurring in 20 patients (69%), followed by 5 subjects (17.2%) with osteosarcoma. Seven patients (24.1%) experienced a local recurrence and, of these, and 5 had an initial pathologic T4a squamous cell carcinoma. Six of the 24 subjects (25.0%) restored with a fixed prosthesis experienced a recurrence. Fifteen patients (51.7%) had implants placed at the time of reconstruction. Of those, 5 (33.3%) experienced recurrence with the average number of days from reconstruction to diagnosis of recurrence being 810.8 days. Two (14.3%) subjects in the delayed implant group experienced recurrence with the average number of days from reconstruction to the diagnosis of recurrence being 4550 days. Fourteen subjects received adjuvant radiation therapy, of which 4 (28.6%) experienced osteoradionecrosis. Timing of implant placement was equally distributed in patients who experienced osteoradionecrosis.In conclusion, subjects who underwent immediate implant placement had a higher rate of recurrence (33.3%) when compared to those with delayed implant placement (14.3%). None of the recurrences were directly adjacent to the endosseous implants and the clinical diagnosis of local recurrence was not affected by the presence of a prosthesis. The timing of implant placement was not associated with a higher risk of osteoradionecrosis.

Share the Airway: An Interdisciplinary Course for Management of the Unexpected Difficult Airway

IntroductionWithin the scope of practice of oral and maxillofacial surgery, the unexpected difficult airway may occur in the trauma bay, operating theater, postoperative, or office-based setting. Oral and maxillofacial surgeons must be trained to diagnose and intervene in anatomically or anesthetically compromised airways. An interdisciplinary training course hosted by an anesthesiology airway expert and oral and maxillofacial surgeon is a novel resident training opportunity. Materials and methodsIn August 2019 and October 2020, the department of anesthesiology and the division of oral and maxillofacial surgery at Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, co-hosted interdisciplinary educational sessions focused on management of the unexpected difficult airway, taught to residents and faculty. A SurveyMonkey (San Mateo, CA) questionnaire was taken 2 weeks before and after the course, with 10 questions assessing fund of knowledge in airway anatomy and physiology, etiology of difficult airway scenarios, difficult airway algorithm, and performance of emergency surgical airways. An interactive lecture on likely scenarios, airway algorithms, relevant surgical anatomy, routine and emergency airway management, airway devices, and emergency surgical airway techniques was conducted. A hands-on cricothyroidotomy tutorial using Crico-Trainer “Pig” (VBM, Sulz, DE) anatomic models with fresh porcine tracheas to simulate human airway anatomy were used. A post-course test consisted of a timed, filmed performance followed by a debriefing session. ResultsIncreased fund of knowledge and comfort with airway anatomy, difficult airway diagnosis and management, and emergency surgical airway techniques was evident between pre-and post-course surveys and was clearly demonstrated across multiple years. The sample size (n = 10, 2019; n = 7, 2020) was insufficient for statistical analysis. ConclusionInterdisciplinary didactic and clinical training in emergency airway management are of paramount importance to the oral and maxillofacial surgeon. Between years, a drop-off in knowledge base and technical skills occurred, even among senior staff, and all attendees agreed that periodic repetition is worthwhile. This course is now offered as part of the core curriculum on an annual basis and may be expanded to additional specialties for whom airway management is important.

Characteristics of Skeletal Archial Analysis Facial Patterns in Adult Obstructive Sleep Apnea

IntroductionSkeletal archial analysis in adult OSA has not been characterized. The specific aim of this study was to characterize archial analyses of adult subjects with known OSA. The primary research question of this study was: “What is the frequency of skeletal patterns from archial analysis in adult OSA subjects?” The authors hypothesized that adult subjects with OSA will follow a retrusive pattern skeletal archial analysis with high correlation with OSA severity. Materials and methodsA retrospective cohort study of adult polysomnogram (PSG)-confirmed OSA subjects’ charts was designed from subjects who presented to Allegheny General Hospital Division of Oral and Maxillofacial Surgery between January 1, 1992, and December 31, 2017. Inclusion criteria included PSG-confirmed OSA (AHI > 5), diagnostic lateral cephalometric radiographs, and demographic and diagnostic data. Exclusion criteria included subjects with a history of maxillofacial trauma or tumor surgery, craniofacial syndromes, and inadequate chart records. Independent predictor variables were age, sex, body-mass index (BMI), anterior arc independent (continuous data), and combined horizontal and vertical analyses (categorical data). Lateral cephalometric radiographs were analyzed with Dolphin software (v. 11.8) for Sassouni Plus archial analysis. Anterior arc analysis was recorded for maxillary incisor position to ANS (U1 - ANS arc), Point B to Point A arc (B - A arc), and pogonion to ANS arc (Pg - ANS arc). Skeletal facial types were categorized into 27 distinct facial types. Statistical analysisStandard descriptive and Spearman correlation (□) analysis was used with Excel. Results were reported as mean, standard deviation, and percentages. Standard error of measurement (SEM) and post-hoc power analysis were completed. Statistical significance was set at the P < .05 level. ResultsA total of 171 subject charts that met the inclusion criteria were included in this study. The cohort consisted of 124 females (73%). The cohort mean for age was 47 years (Standard deviation [SD] 11), for BMI 31 (6.5), for AHI 42 (30.5), for ESS 13 (4.9), and for nO2 81% (11). All ICC were greater than or equal to 0.90. Skeletal archial analyses revealed that the most frequent skeletal patterns were Class III at 44.7% (77/171), bimaxillary retrusion at 27% (46/171), Class II at 21.1% (36/171), Class I at 6.6% (11/152), and bimaxillary prognathism at 0.6% (1/171). Relative to the anterior arc, maxillary position was retrusive in 82.2% (141/171), ideal in 11.2% (19/171), and protrusive in 6.6% (11/171) of subjects. Also, relative the anterior arc, the mandible was in an ideal position in 45.3% (78/171), retrognathic in 33.6% (57/171), and prognathic in 21.1% (36/171) of subjects. Long vertical skeletal pattern was most frequent at 81.6% (140/171), normal at 14.5% (25/171), and short at 3.9% (7/171) of subjects. The most frequent skeletal patterns were Maxilla Retro, Mand Ideal AP; Long Vertical (49/171, 28.9%), Bi-Skeletal Retro AP; Short Vertical (41/171, 23.7%), and Maxilla Retro, Mand Prog AP; Long Vertical (26/171, 15.1%). There were only weak correlations between all independent and dependent variables (range P = .05 to .19). ConclusionWithin the limitations of this study, maxillary and bimaxillary retrusion patterns were frequent horizontal archial analysis skeletal positions as was long lower facial height. Most skeletal patterns involved maxillary retrusion, generally with long vertical lower face. All of the horizontal archial skeletal positions had weak correlations with severity of adult OSA. Additional research may be required to fully analyze the full diagnostic potential of skeletal archial analysis in diagnosis and treatment planning of subjects with OSAS.

Archial Skeletal Analysis is not a Significant Predictor of Adult OSA Syndrome Severity

IntroductionArchial analyses may be a useful tool in the diagnosis and treatment planning of adult OSA. The purpose of this study was to evaluate the association of vertical and horizontal archial analyses on predictors of the severity of OSA. The primary research question of this study was: “Does facial skeletal archial analysis predict severity of OSA?” The authors hypothesize that archial analyses will predict severity of adult OSA. Subjects and methodsA retrospective cohort study of adult polysomnogram (PSG)-confirmed OSA subjects’ charts was designed from subjects who presented to Allegheny General Hospital Division of Oral and Maxillofacial Surgery between January 1, 1992, and December 31, 2017. Inclusion criteria included PSG-confirmed OSA (AHI > 5), diagnostic lateral cephalometric radiographs, and demographic data. Exclusion criteria included subjects with a history of maxillofacial trauma or tumor surgery, craniofacial syndromes, and inadequate chart records. Independent predictor variables were age, sex, body-mass index (BMI), anterior arc independent (continuous data), and combined horizontal and vertical analyses (categorical data). Skeletal facial types were categorized into 27 distinct facial types based on combined anterior horizontal and vertical arcs. Primary outcome variable was severity of OSA as defined by apnea-hypopnea index (AHI). Secondary outcome variables included Epworth sleepiness scale (ESS) and lowest oxygen saturation (nO2). Lateral cephalometric radiographs were analyzed with Dolphin software (v. 11.8) for Sassouni Plus archial analysis. Anterior arc analysis was recorded for maxillary incisor position to ANS (U1 - ANS arc), Point B to Point A arc (B - A arc), and pogonion to ANS arc (Pg - ANS arc). Statistical analysisStandard descriptive analysis, multiple linear regression on continuous variables, and multinomial logistic regression on categorical and dummy variables were performed using XLSTAT. Stratified by sex, multilinear regression was performed on anterior arc analyses. Continuous variables (median values) and categorical data were transformed to dummy variables for multinomial logistic regression. Results were reported as mean, standard deviation, and odds ratio (OR). Standard error of measurement (SEM) was completed on repeated cephalometric analyses of 20 randomly selected radiographs. Statistical significance was set at P < .05 level. ResultsA total of 171 subject charts that met the inclusion criteria were included in this study. The cohort consisted of 124 females (72.5%). The cohort mean for age was 47 years (Standard deviation [SD] 11), for BMI 31 (6.5), for AHI 42 (30.5), for ESS 13 (4.9), and for nO2 81% (11). All SEM were greater than or equal to 0.90. Stratified by sex, and controlling for age and BMI, no statistically significant associations for anterior archial analyses (U1 - ANS arc, B - A arc, or Pg - ANS arc) and severity of adult OSAS were found. Multinomial logistic regression revealed that none of the archial skeletal classifications were significant predictors of the severity of OSAS (AHI OR = 1.0, P = .89; ESS OR = 0.99, P = .70; nO2 OR = 1.0, P = .81). ConclusionWithin the limitations of this study, when controlling for age, sex, and BMI, anterior horizontal archial analyses were not significantly associated with, and archial skeletal facial types were not significant predictors for, OSAS severity as defined by AHI, ESS, or nO2. Additional research may be required to fully analyze the full diagnostic potential of skeletal archial analysis in diagnosis and treatment planning of subjects with OSAS.

The influence of the COVID-19 pandemic on the work of the Department of Ear, Nose, Throat and Head and Neck Surgery in University Hospital Centre Zagreb

Aim: The aim of this study was to show changes in the work of the Ear, Nose, Throat and Head and Neck Surgery Department, UHC Zagreb, during the COVID-19 pandemic. Methods: We retrospectively extracted and compared the data on the procedures and diagnoses of the Department during the period from January 1st to April 30th in 2019, 2020 and 2021. Results:The total number of cases was lower by 34.2% in 2020, and by 13.19% in 2021, compared to 2019 (p<0.001). The Head and Neck Surgery Division recorded a decrease of 31.9%, Division of Children's Otolaryngology 41.9%, Otology Division 66.7%, and Rhinosinusology Division 82.5%. Maxillofacial Surgery Division and Head and Neck Tumours Divisions recorded an increase of 71.1% and 31.1%, respectively. The review of diagnoses revealed a decrease in the number of thyroid disorders (-57.1%), nasal septum deviations (-85.1%), middle ear and mastoid process diseases (-75.35%), and diseases of the tonsils (-52.6%). There was an increase in the number of head and neck tumours (165.4%), facial bones fractures (95%), and cleft lip and palate (19 in 2021, none in 2019 and 2020). There were 35% more newly diagnosed laryngeal cancers in 2021 than in 2019. The number of T1 laryngeal cancers was lower by 22.2%, while the number of T2 increased by 133%. Conclusions: This study showed the decrease in the overall number of procedures since the start of the pandemic, but also an incremental increase in the complexity and the number of oncological surgical procedures. Our results demonstrated that managing the increased number of complex head and neck surgery patients is possible even in the extraordinary conditions in the well organised and equipped institution. This points to the importance of developing centres of excellence, which can provide the high standards of treatment even when the health care system is under increased pressure. © 2021 Hrvatski Lijecnicki Zbor. All rights reserved.

Free flap surgery in osteoradionecrosis of the head and neck

: Osteoradionecrosis (ORN) following radiation therapy is a much-feared complication of the treatment of head and neck cancer. Free flap reconstruction in the ORN patient has specific challenges for the surgeon. From 2014 to 2020 the Head and Neck Microvascular unit of the Oral and Maxillofacial Surgery Division at Jackson Health/University of Miami treated 149 ORN patients with free flap reconstruction. The fibula free flap (n=65) and anterior lateral thigh free flap (6n=1) were the workhorse flaps in our series comprising 44% and 41% of the total flap surgeries. A total of 13 cases (8.7%) involved performing 2 flaps in the same operation. Thirty cases had recorded complications with one flap loss (0.7%) and one case of partial necrosis (0.7%) of the flap. The most common complications encountered were flap congestion with 8 cases (5%), 5 cases of flap dehiscence,4 cases of neck hematoma (2.6%) and 3 cases of infection of the flap reconstruction site (3%). The average length of stay was 8.2 days. In this paper we present our approach to reconstruction in these patients and the lessons we have learned. Though this surgery is complex and has greater risks than free flap surgery in the “virgin” neck, our experience demonstrates that good outcomes can be achieved consistently with a structured approach.

The activity of an Oral and Maxillofacial Surgery Division during the pandemic diffusion of COVID-19

The recent pandemic diffusion of COVID-19 has dramatically changed the routine activity of entire hospitals all over the world. in some regions such as Northern Italy both outpatient and surgical activity of hospitals had to be completely modified to support the enormous quantity of COVID-19 patients' admissions and to limit the diffusion of the novel Coronavirus. As for maxillofacial surgery departments, in such regions the routine activity may have been reduced to manage urgencies. The aim of this article was to present the changed activity of an Italian Oral and Maxillofacial Surgery Division, due to the current world emergency. © 2020 edizioni minerva medica.

Instagram as a Marketing Tool for Oral and Maxillofacial Surgery Residencies: Overcoming Resident Recruitment Challenges in the Year of COVID-19

Instagram as a Marketing Tool for Oral and Maxillofacial Surgery Residencies: Overcoming Resident Recruitment Challenges in the Year of COVID-19

Analysis of incident and accident reports of the last five years in division of oral and maxillofacial surgery at Iwate Medical University

Analysis of incident and accident reports of the last five years in division of oral and maxillofacial surgery at Iwate Medical University

Safety of Outpatient Procedural Sedation Administered by Oral and Maxillofacial Surgeons: The Mayo Clinic Experience in 17,634 Sedations (2004 to 2019)

The safety of the team anesthesia model routinely used by the specialty of oral and maxillofacial surgery has recently been called into question. The purpose of this article is to measure the frequency of adverse anesthetic events related to ambulatory surgical procedures performed under intravenous (IV) sedation by the Division of Oral and Maxillofacial Surgery at the Mayo Clinic during a 15-year period using the team anesthesia model. A retrospective cohort study was designed, and a sample of subjects identified undergoing IV sedation at Mayo Clinic from 2004 to 2019. The primary outcome variable of interest was the presence of anesthetic-related adverse events (AEs) consistent with the World Society of Intravenous Anesthesia International Sedation Task Force's intervention-based definitions of adverse anesthetic events. Additional covariates included patient age, gender, American Society of Anesthesiologists (ASA) score, type of surgical procedure performed, and the type/dosage of medications administered periprocedurally. Univariate logistic regression analysis was used to assess for associations between AEs and covariates. The study identified 17,634 sedations administered to 16,609 unique subjects. In 17,634 sedations, 16 (0.1%) AEs and no subject deaths (0%) were identified. There were no statistically significant associations between AEs and age (hazard ratio [HR], 0.4; 95% confidence interval [95% CI], 0.2 to 1.3; P=.13); gender (HR, 0.9; 95% CI, 0.3 to 2.5; P=.87); ASA 2 classification (HR, 1.6; 95% CI, 0.6 to 4.5; P=.33); ASA 3 classification (HR, 1.3; 95% CI, 0.1 to 22.0; P=.86), or types of IV sedation medications administered during the procedure: fentanyl (HR, 0.4; 95% CI, 0.02 to 6.3; P=.5); midazolam (HR, 1.0; 95% CI, 0.2 to 4.3; P=.98); propofol (HR, 1.0; 95% CI, 0.3 to 3.5; P=.99); or ketamine (HR, 1.0; 95% CI, 0.1 to 7.3; P=.97). The frequency of AEs (0.1%) and 0% mortality rate reported in this study demonstrate that the anesthesia team model used by oral and maxillofacial surgeons compares favorably to standardized intervention-based adverse anesthetic event outcomes reported by other nonanesthesiology specialties routinely performing outpatient procedural sedation.

In-hospital 3D Printing to Aid Maxillofacial Surgery during the COVID-19 Pandemic.

Surgeons around the world share the same goal: providing the best care to their patients. In recent years, the complexity of procedures has increased, and so has the need for enhanced planning, training, and education. A growing number of interventionists and surgeons are using 3D-printed patient-specific models in their practice to prepare for procedures with more confidence. In 2018 we considered to implement 3D printing in our hospital, and we have created a virtual planning and 3D printing LAB within the maxillofacial surgery department at Città della Salute e della Scienza Hospital, University of Torino, Italy. (See Video [online], which displays the planning, printing and intraoperative cutting guides.) The laboratory is equipped with a CAD station and two 3D printers (Ultimaker 3 Extended and Formlabs Form 3). {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"Video 1 from “In-Hospital 3d Printing in Maxillofacial Surgery during the Covid-19 Pandemic”","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_wgikhelf"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Fig. 1.: Protective visor 3D model to print.3D-printing and advanced visualization techniques have been proved to assist clinicians develop tailored surgical approaches for patients. Hospitals, clinicians, and patients can all benefit from 3D printing regardless of whether the process is handled in-hospital or outsourced. Nevertheless, having a dedicated facility in-house can cut days off the process, support innovation initiatives, and lower the overall costs incurred by the hospital. From the beginning of 2019 until the period before the start of the COVID-19 pandemic, the laboratory within the department worked at full capacity for the virtual planning of selected cases and for the printing of models. According to Jacobs and Lin,1 3D-printing technologies in cranio-maxillofacial surgery were divided into 4 categories: Type 1 contour models, Type 2 guides, Type 3 splints, and Type 4 implants. In the period between January 2019 and the start of the pandemic, we printed a total of 331 models. In 79 cases, only type 1 models were printed; in 68 cases, type 1 models were printed together with type 2 and 3 models.2 At the start of the lockdown, elective surgical activity was drastically reduced, as well as hospital resources. Surgical activity was therefore limited only to handling trauma and tumors. However, the activity of the 3D laboratory has not suffered a limitation: in addition to the planning and realization of the surgical models, the production of protective visors has been started to support the surgical departments of the entire hospital (Fig. 1). During the period of the lockdown, 650 pieces of personal protective equipment were produced in our 3D laboratory at the Division of Maxillofacial Surgery. The creation of an in-hospital 3D lab has been shown to be an effective tool both for routine surgery and during the pandemic. The ability to customize devices and surgeries proved to be a possibility for the immediate production of emergency devices within the department.

Comprehensive analyses of maxillofacial fractures due to non-professional sports activities in Italy.

Sports activities have become increasingly popular among amateurs and this has led to an increase in maxillofacial fractures. The aim of this study was to investigate the management of amateur sport-related maxillofacial fractures and appropriate preventive measures. A trauma database was used to analyze 3231 patients with maxillofacial fractures admitted to the Maxillofacial Surgery Division of Città della Salute e della Scienza Hospital, Turin, Italy, from January 2001 to December 2019. Only patients with non-professional sports-related maxillofacial fractures were included. The following data were collected: age, gender, type of sport, mechanisms of injury, sites of fracture, Facial Injury Severity Scale, associated injuries, month of trauma, time to treatment, treatment, length of stay, and interval before return to sport. There were 432 patients, 378 males and 54 females, with a mean age of 29.2 (5-76years). Sport-related maxillofacial fractures' relative percent ranged from 11.1% in 2001 to 17.5% in 2019. Soccer was the most common cause of sport-related maxillofacial fractures (54.2%), and impact with a player/opponent was the main mechanism of injury (72%). An intentional violent act (player hit by a fist) was the cause of fracture in 8.5% of the soccer-related injuries. Fractures of the middle third of the face occurred in 61.2% of patients. Maxillofacial fractures were treated within 24h in 25% of patients. There were 343 out of 412 patients who received open reduction and internal fixation (mean length of hospital stay: 3.7days). There was no contraindication to resuming sport activities at 30/40days after treatment, except for combat sports. This study provided further evidence of a relative increase in sports-related maxillofacial fractures. Soccer is related to the majority of sport maxillofacial fractures. Adherence to the rules is necessary to limit violent acts that cause such injuries. In non-professional players, resumption of the full activity is allowed after 40days for non-combat sports.

Dental consultations requested to the maxillofacial surgery division in a hospital in Brazil

Introduction: This study analyzed dental consultation requests to the division of oral and maxillofacial surgery in a Brazilian tertiary hospital. Methods: A cross-sectional study with data collected retrospectively from inpatients’ electronic medical records containing dental consultation requests made between January 2013 and December 2017. Results: 327 consultation requests were analyzed. Mean (SD) patient age was 38.71 (24.4) years; 164 (50.2%) were male and 267 (81.7%) were Caucasian. Regarding systemic conditions, 34 (10.4%) were classified as ASA I, 86 (26.3%) as ASA II, 182 (55.7%) as ASA III, and 25 (7.6%) as ASA IV. Dental consultations were mostly requested by the internal medicine team (n = 42, 12.8%). The most common reason for consultation was septic teeth (n = 131, 40.1%). Complementary tests were required in 188 (57.5%) cases. Surgical intervention was required in 82 (25.0%), with tooth extraction as the most prevalent procedure (20.2%). The most demanding service was inpatient care, with 276 (84.4%) requests. Cases were resolved in 249 (76.1%). Conclusions: The division of oral and maxillofacial surgery in our hospital deals with a great amount of consultations, contributing with surgical procedures to the adequacy of patients’ oral health with a high effectiveness rate. Our data illustrate the contribution of dentists in a hospital setting, assisting the medical team in providing comprehensive care for inpatients. Keywords: Dental consultations; inpatients; oral and maxillofacial surgery