Management Of Maxillofacial Trauma Research Articles

Comparison of Patterns and Demographics of Isolated Traumatic Mandibular Fracture Between Incarcerated and General Populations.

Introduction The management of maxillofacial trauma can be challenging in different unique clinical presentations. While maxillofacial fractures vary in location based on the mechanism of injury, the mandibular fracture is noted to be one of the most common facial fractures. The objective of this study was to explore the differences in injury patterns, outcomes, and demographics of isolated traumatic mandibular fractures between incarcerated and general populations. Methods This retrospective study analyzed consecutive patients presenting for trauma care from January 1, 2010, to December 31, 2020, at the Arrowhead Regional Medical Center (ARMC).Patients 18 years and older were included in this study. Patients diagnosed with mandibular fracture as the primary diagnosis at admission and discharge were identified using the International Classification of Disease, Ninth and Tenth Revision (ICD-9, ICD-10) Code. Patient demographics were extracted from their electronic medical records and included race, marital status, and insurance status. Results A total of 1080 patients with confirmed mandibular fractures were included in the final analysis. Among these patients, 87.5% (n=945) were males, 40% (n=432) of the patients were Hispanic, and the average age was 31.55 years old. The most common mechanism of injury was blunt trauma secondary to assault. Compared to the general population with mandibular fracture, the incarcerated patients with mandibular fracture were more likely to be males (96.1% vs 86.1% for incarcerated population vs. general population respectively, p=0.0005). No other variables were statistically different between these two groups. Conclusion The evidence from this study suggests that the patterns, outcomes, and demographicsof mandibular fracture in both incarcerated and general populations are similar.

Efficacy of Pre-emptive Infiltration of Dexmedetomidine with a Local Anaesthetic on Postoperative Pain in Maxillofacial Trauma Management under General Anaesthesia: A Prospective Study

Abstract Introduction: Pre-emptive analgesia aims to reduce post-operative pain and the need for analgesics. Dexmedetomidine (DEX) is an alpha-2 adrenergic agonist with sedative and analgesic properties. The aim of this study was to compare the effectiveness of pre-emptive infiltration of DEX combined with local anaesthetic (2% lignocaine with adrenaline) in managing post-operative pain in maxillofacial trauma patients undergoing open reduction and internal fixation procedures, as compared to pre-emptive infiltration of placebo (saline) with the same local anaesthetic. Materials and Methods: Forty-two participants of maxillofacial trauma with a Visual Analogue Scale (VAS) score of more than 4 were included in this double-blinded randomised controlled trial. Group DL (Dexmedetomidine with local anaesthetic) received dexmedetomidine (DEX) with local anaesthesia while group PL (placebo with local anaesthetic) received placebo with local anaesthesia. Participants were evaluated for the time taken for the first rescue analgesic, total doses of fentanyl taken by the patient in the first 24 h, post-operative pain (VAS) at 6, 12, 16 and 24 h, post-operative side effects and analysed. Results: The DL group had a significantly longer time to first rescue analgesic compared to the PL group. Surgeons in the DL group reported higher satisfaction and better surgical field visibility. Post-operative VAS scores were lower in the DL group at 6 and 12 h, with a median score of 1 at 16 and 24 h. Discussion: Pre-emptive DEX infiltration is effective in reducing post-operative pain and opioid consumption in maxillofacial trauma cases undergoing open reduction and internal fixation. This approach can enhance patient comfort and improve surgical outcomes without significant risks.

Evaluating Content, Quality, and Adequacy of Maxillofacial Trauma Videos on YouTube

Aim: The study aimed to analyze the content, quality and adequacy of information on YouTube videos regarding maxillofacial trauma. Material and Methods: The keyword “maxillofacial trauma” was obtained from Google Trends, YouTube was then searched, and 200 videos were selected to be analyzed for the study. Of the 200 videos, 108 were found eligible and then rated for quality and adequacy. After evaluating the demographic features of the videos, the viewing rates of the videos were determined. The quality of the videos was assessed by the Information Quality Index (VIQI) and the Global Quality Scale (GQS). The videos were categorized as low and high-content groups using a 16-point score system. Shapiro-Wilk test, Mann-Whitney U test, Pearson chi-square test and Fisher-Freeman-Halton were used for statistical analysis. Results: The vast majority of YouTube videos were uploaded by healthcare professionals (55.6%). The low content videos were classified as 88 videos (81.5%) and 20 videos (18.5%) as high content. The anatomic structures were the most covered topic (43.5%), followed by trauma area (40.7%), treatment procedure (32.4%), intraoral complications (31.5%), and definition of maxillofacial trauma (30.6%). A lower percentage of videos (13.9%) mentioned post-operative. Prognosis and survival (17.6%) were another low finding. The high-content video group had a significantly higher median value of GQS and VIQI score. A positive correlation was obtained from the total content score along with the total VIQI (r=0.792, p<0.001) and GQS (r=0.778, p<0.001) score and also it was determined that there was a statistically significant positive correlation between VIQI and GQS scores (r=0.930, p<0.001). Conclusions: The findings of this study highlight the need for improved content quality and accuracy of YouTube videos on maxillofacial trauma, particularly for layperson audiences. This could be achieved through collaboration between healthcare professionals, commercial entities, laypersons and YouTube to create, review, and promote reliable educational content. By doing so, YouTube can become a more valuable resource for patient education and awareness regarding maxillofacial trauma management and treatment.

Management of Maxillofacial Trauma in Pregnant Women.

Trauma during pregnancy deserves special attention as management must be directed towards both the mother and the fetus. Management of maxillofacial fractures in pregnancy can adversely affect the well-being of the fetus by impinging on normal functions such as respiration, mastication, and nutrition. Pregnancy complicates the management of facial injury due to the maintenance of the patent airway, anesthesia considerations, and imaging restraints. The purpose of this study is to use three illustrative from our own institution to further elucidate education on the management of mandible fracture in pregnancy with a focus on multidisciplinary treatment and outcomes. A retrospective chart review was performed for all cases of facial fractures admitted to Ryder Trauma Center from 2012 to 2022. During this time, 4,910 patients presented with facial fractures 1319 patients were female. Three of the patients were pregnant at the time of admission. Demographics, mechanism of injury, associated injuries, and management information were collected. Patient 1 was a 20-year-old female presented to Ryder Trauma Center following a motor vehicle collision. She was 17 weeks pregnant at the time of admission and was found to have a left mandibular angle fracture. Patient 2 was a 14-year-old female who presented to Ryder Trauma Center status post gunshot wound to the mandible after she and her brother were unknowingly playing with a loaded gun. She was 18 weeks pregnant at the time of admission, with a past medical history of domestic violence, suicidal ideation, and major depressive disorder. Patient 3 was a 20-year-old female 36 weeks pregnant at the time of admission. She presented with a right paraymphyseal fracture and left mandibular angle fracture as a result of falling on the stairs. Patients all underwent surgical repair of fractures.

The Application of Cone Beam Computed Tomography (CBCT) on the Diagnosis and Management of Maxillofacial Trauma.

The assessment and management of facial trauma in an acute setting is one of the core services provided by oral and maxillofacial units in the United Kingdom. Imaging is a pre-requisite for appropriate diagnosis and treatment planning, with a combination of plain radiographs and medical-grade CT being the mainstay. However, the emergence of cone beam CT in recent years has led to its wider applications, including facial trauma assessment. It can offer multi-planar reformats and three-dimensional reconstruction at a much lower radiation dose and financial cost than conventional CT. The purpose of this review is to appraise its potential indications in all anatomical areas of maxillofacial trauma and provide our experience at a level 1 trauma centre.

Emergency Management of Multiple Maxillofacial Trauma Patients with Head Injury: A Case Report

Trauma to the face has the potential to be life-threatening and cause facial deformities. Head injuries are usually a more severe consequence of such incidents and must be addressed earlier. Here we present a case of a 24year old male patient with history fell from motorcycle three hours before the patient was admitted to the hospital, the patient fell with the mechanism of his face hitting the asphalt first. He was diagnosed with panfacial fracture of facial bones and mild head injury. Emergency treatment need to be done for his general condition improvement, transfusion of red blood cell, admister of elecltrolyte, oxygenation and observation of consciousness, primary suture of laceration, placing erich bar wire for maxilla mandible, placing skin traction was done in the emergency room. The patient then was scheduled for open reduction internal fixation of the facial fracture after the condition was optimal enough. Maintaining the airway and limiting bleeding are fundamental concepts in the emergency department's management of maxillofacial trauma.

Epidemiology Of Motorcycle-Related Maxillofacial Injuries Presenting To The 37 Military Hospital, Ghana

Objective: The study examined the epidemiology of motorcycle-related maxillofacial injuries to provide data to guide the prevention and management of maxillofacial trauma. Methodology: The research was a one-year prospective cross-sectional study of patients presenting with motorcycle crash-related maxillofacial injuries. The variables recorded include the demographic data, type of motorcycle collision, day and time of motorcycle crash, location of the crash, role of injured patient, maxillofacial and concomitant injuries sustained. Descriptive statistics were used to ascertain the epidemiology of maxillofacial injuries sustained. Results: A total of 148 patients aged between 15 and 65 years were involved in the study. There was a high male dominance (96%) among patients who sustained maxillofacial injuries secondary to motorcycle-related road traffic crashes (RTC). The median age of the participants was 30.9 +/- 9.1 years. Most (55.6%) of the motorcycle crashes resulted from collisions with cars. Maxillofacial injuries were mostly soft tissue injuries with the midface sustaining the most. Skeletal injuries often occurred in the mandible with parasymphyseal fractures constituting the majority of the mandibular fractures. Conclusion: There is a male predominance in patients with motorcycle-related maxillofacial injuries with a peak age of 21-30 years. Victims of motorcycles crashes often sustain soft tissue injuries with aesthetic and functional implications. Motorcycle crashes contribute significantly to the public health burden of RTC, especially in developing countries like Ghana. Healthcare professionals ought to be conversant with the epidemiology of maxillofacial injuries in motorcycle crash victims to ensure prompt and comprehensive management.

Efficacy of lidocaine vs combination of lidocaine and bupivacaine in management of maxillofacial trauma: a clinical comparative study.

The COVID-19 pandemic has created an unprecedented situation which the treatment of maxillofacial trauma, especially mandibular fractures that were previously managed using general anaesthesia had to be performed under local anaesthesia. In these cases, there was a requirement for an anaesthetic agent that would have a rapid onset but also provide a prolonged effect. The aim of the study was to evaluate the onset, duration, depth, required volume of anaesthesia of lidocaine with epinephrine versus combination of lidocaine and bupivacaine with epinephrine anaesthetic agents in surgical management of isolated mandibular fracture patients. A total of 30 patients with isolated mandibular fractures reported to our hospital included the study group. Patients were randomly distributed to two groups, Group A and Group B. Group A received local anaesthesia using 2% Lidocaine with 1:80,000 adrenaline and Group B received 0.5% Bupivacaine with 1:2,00,000 adrenaline combined with 2% Lidocaine with 1:80,000 adrenaline at a ratio of 1:1. The outcome variables were recorded and the data was tabulated and analysed using un-paired students t test. The combination of anaesthetic agents had longer duration of action (mean: 182.47min, P-value: 0.001) and required lesser volume of anaesthetic solutions (mean: 5.38mL, P-value: 0.001) as compared to usage of lidocaine alone. Although combination group showed quicker onset (mean: 4min 8s), the result was insignificant (p-value: 0.345). The study found that the combination of lidocaine and bupivacaine could serve as a potential anaesthetic cocktail in effective surgical management of isolated mandibular fractures. Maxillofacial injuries can be managed efficiently under local anaesthesia using combination of lidocaine and bupivacaine.

Le Fort I and nasal fracture, primary reduction, and secondary revision saddle nose: A case report

Maxillofacial trauma is a common clinical situation in emergency rooms. Lesions involving the maxillofacial complex pose a significant public health challenge, not only due to their costs but also because of the potential functional and aesthetic issues that patients may experience. While some fractures are more suitable for delayed treatment, others necessitate immediate attention, requiring intervention within 24 hours of the trauma occurrence. Different types of reduction and fixation exist depending on the patient’s age, location, type of fracture, and the surgeon’s preferences. We reported a case of a 20-year-old female patient diagnosed with Le Fort I bilateral fracture and closed nasal fracture followed by saddle nose. The patient was managed with open reduction internal fixation and closed reduction nasal bone. The saddle nose in the patient was managed four months later by augmentation rhinoplasty with rib cartilage and pearl fat graft. Proper management of Le Fort I fracture and nasal fracture accompanied with saddle nose by open reduction internal fixation and augmentation rhinoplasty with rib cartilage and pearl fat graft can restore occlusion and improve symmetrical, proportional facial aesthetics, which is the indicators of a successful holistic maxillofacial trauma management.

Cross-Sectional Study of Serum Metal Ions in Patients With Metal Implants in the Maxillofacial Region.

The purpose of the present study was to measure the serum metal ion levels (titanium, cobalt, chromium) in patients who have metal implants in the maxillofacial region. The investigators implemented a cross sectional study on patients treated with procedures requiring metal implants for management of maxillofacial trauma, fixation for orthognathic surgery, and total temporomandibular joint replacement (TJR). Inductively coupled plasma mass spectrometry was used as an analytical method to detect metal ions in serum samples. The study comprised of 50 patients who were divided into 4 groups- group I- total TJR (n = 18), group II- orthognathic (n = 8), group III- trauma (n = 8), and group IV- control (n = 16). The mean values of metal ions level were raised than the control group. The present study's results suggest a rise in serum metal ion levels after the metal implantation in maxillofacial region. None of the patients had any abnormal signs and symptoms due to raised metal levels. Further studies are warranted to correlate the serum metal ion levels and their clinical relevance.

Changing trends in central midface fracture – A proposal for revised classification and holistic management

BackgroundMidface fractures are one of the common facial fractures encountered in the current era. High energy impact injuries that lead to gross comminution of the midface warranting modification of the standard treatment plan, often cannot be categorized by existing classification systems. The aim of the current paper is to describe the changing trends in midface fracture patterns and propose a modification for the current classification system and describe the holistic approach for management. Materials and methodsA retrospective study was conducted at our center to include all the patients who reported to us for the management of maxillofacial trauma between 2020 and 2022. The details of the cause of facial trauma and pattern of injury, clinical presentation, diagnosis were retrieved from the medical records and the radiographic details including computed tomography details of the fracture pattern were tabulated for evaluation. The Fractures which could not be classified based on the classical Le fort fracture lines were isolated and were classified based on the current classification system and the modifications in the treatment plan and management were recorded. ResultsA total of 673 trauma cases reported between the given time frame. Out of which 205 were midface fractures. 109 patients from the foresaid group had central mid face fracture. 62 fractures of these cases could not be classified based on conventional Le fort classification due to fragmentation, bone loss and combination with other Le fort level injury of the opposite side of the midface and involvement of orbit/ anterior cranial fossa. The modified Le fort classification (Table 1) was used to reclassify these fractures and according to the same 12 cases of Le fort IA, 9 cases of le fort IB, 4 cases of Le fort IIA, 20 cases of Le fort IIB, 4 cases of Le fort IIIA, 9 cases of Le fort IIIB and 4 cases of Le fort IV fracture.The details of the management strategy along with the timing of repair are discussed. ConclusionWith continual rise in the high impact injuries, the pattern of midface fracture presentation is changing. Advanced fixation modalities that are currently available can be applied only when a precise diagnosis and planning can be performed. The current modification of the midface fractures provides a better insight in defining the fracture patterns which will enable the surgeon to plan the midface reconstruction adequately.

Use of Power Screwdrivers and Power Driven Wire Twisters in Maxillofacial Trauma Management for Screw Placement and Intermaxillary Fixation – An Innovative Technique

Use of Power Screwdrivers and Power Driven Wire Twisters in Maxillofacial Trauma Management for Screw Placement and Intermaxillary Fixation – An Innovative Technique

The Impact of 3D Printing on Oral and Maxillofacial Surgery

3D printing technology has driven major medical, dental, engineering, and education innovations. In oral and maxillofacial surgery (OMFS), 3D printing technology has been implemented to improve precision in treatment planning, increase surgical predictability, reduce operation times, and lower overall costs. Furthermore, 3D printing has opened access to surgical training, facilitated patient-physician relationships, and generated greater surgical outcomes. The aim of this review is to summarize the impact of 3D printing technology in the field of OMFS. We discuss its many applications in the management of maxillofacial trauma and reconstruction, orthognathic surgery, maxillofacial prosthodontics, temporomandibular joint (TMJ) reconstruction, dental implants (3D-printed surgical guides and 3D-printed dental implants), bone tissue engineering for maxillofacial regeneration, clinical education, and patient communication.

A Retrospective Study of Maxillofacial Fractures at a Tertiary Care Centre in North India: A Review of 1674 Cases.

To examine the pattern of maxillofacial fractures in patients treated at the SMS Hospital in Jaipur, India, over a two-year period. A retrospective study was conducted from October 2019 to September 2021, which recorded various data of patients with maxillofacial fractures, including age, sex, site distribution, cause of injury, type of facial bone fractures, soft tissue injuries, dentoalveolar trauma, and type of treatment. The days spent in the hospital before and after surgery were also recorded. The study included 1674 patients, with a male-to-female ratio of 4.07:1 and males being the most affected at 80.3%. The most common cause of injury was road traffic accidents (53.5%), followed by falls (18.6%) and assaults (16.1%). Mandibular fractures accounted for 38% of all fractures, with the parasymphysis being the most common site for fractures. Open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) were the most common treatment options for mandibular fractures. The study highlights the need for strict enforcement of traffic rules and road safety laws, along with education and preventive measures to reduce the incidence of maxillofacial trauma. The pattern of maxillofacial injuries can provide useful information for designing programs towards the prevention and management of maxillofacial trauma.

Efficiency of virtual surgical planning in management of maxillofacial trauma

Background: Craniomaxillofacial (CMF) injuries has different patterns from simple to complicated ones. Surgeons usually spend time and effort planning the optimal surgical approach to avoid damage to vital structures that could otherwise lead to functional deficits. It is also imperative to optimize the skin incisions to avoid unfavourable scarring. The aim of this work is to assess the effectiveness and efficiency of virtual surgical planning (VSP) application in management of different types of CMF traumas, the advantages, and disadvantages of VSP, and the accuracy of three dimensional (3D) measures as a preoperative planning tool.Methods: This prospective consecutive series study enrolled 30 patients presented with different types of CMF trauma. All patients were subjected to CT scans. The obtained Digital imaging and communications in Medicine (DICOM) files were imported into the software for virtual planning.Results: The actual operative time (OT) after VSP was significantly lower than the expected time by traditional methods (p=0.008). There was no significant difference between the actual and expected number of incisions. The accuracy measures of preoperative VSP were very close postoperatively. The functional, anatomic reduction and patient satisfaction outcomes were very satisfying to the surgeon and the patient respectively. Conclusions: VSP can be a valuable tool for optimizing functional and aesthetic outcomes of the CMF trauma surgery. The accurate measurements obtained pre-operatively helped in reducing surgical time and minimizing the need for subsequent revision surgeries.

Epidemiology and management of maxillofacial trauma caused by stabbing weapon at the University Hospital of Bouake (Côte d'Ivoire)

IntroductionInjuries to the face caused by stabbing weapon are often severe and can constitute maxilla-facial emergencies. The aim of this study was to describe the epidemiological and clinical features and the difficulties in the management of these injuries caused by this trauma in a context of limited resources. Material and methodsThis was a, retrospective and descriptive study that took place from 1 January 2018 to 31 December 2021 in the Odontostomatology and Maxillofacial Surgery Department of the University Hospital of Bouaké. It concerned patients admitted to the department for maxillofacial trauma caused by stabbing weapon. Results38 cases were collected. The average age was 32.96 years (extremes 19 and 48 years). The male gender predominated with a sex ratio of 8.5. All patients were victims of intentional assault with stabbing weapon. The weapon used was the machete in all cases. The injuries caused by this trauma were all complex, sometimes involving bone and organ damage. The jugal location predominated (34, 21%). The delay in treatment was most often more than 3 days. DiscussionThe lesions caused by this trauma can be particular due to the complexity of the lesions caused. Their management is hampered by the economic difficulties of the patients and the lack of health infrastructure. ConclusionThe improvement of care will require the strengthening of infrastructural capacities and the establishment of an effective system to combat insecurity.

Single Institute Audit of Maxillofacial Trauma Cases Before and During COVID-19 Pandemic.

In the year 2020, we saw the emergence of severe acute respiratory syndrome coronavirus 2 causing COVID-19 into a full blown pandemic. This resulted in constraints on healthcare resources, and the attention was shifted to reduce cross contamination and prevent spreader events. Maxillofacial trauma care was also affected similarly, and most of the cases were managed by closed reduction whenever possible. A retrospective study was conducted to document our experience in treating maxillofacial trauma cases before and after nationwide lockdown due to COVID-19 pandemic in India. The objective of the study was to compare the effect of pandemic in reported pattern of mandibular trauma and the result of closed reduction procedures in the management of single or multiple fractures in mandible during this time period. The study was conducted in the Department of Oral and Maxillofacial Surgery, Maulana Azad institute of Dental Sciences, Delhi, for a period of 20 months, that is, 10 months before and after nationwide lock down which was effective from 23rd March 2020 due to COVID-19 pandemic. The cases were grouped into Group A (those reporting from 1st June 2019 to 31st March 2020) and Group B (those reporting from 1st April 2020 to 31st January 2021). Primary objectives were assessed and compared according to etiology, gender, location of the mandibular fractures, and treatment provided. Quality of life (QoL) associated with the treatment outcome by closed reduction was assessed after 2 months as a secondary objective using General Oral Health Assessment Index (GOHAI) in Group B. A total of 798 patients sought treatment for mandibular fractures and included 476 patients in Group A and 322 in Group B. The groups showed similar age and male: female ratio. Cases showed a steep fall during first wave of pandemic, and most of the cases occurred as result of RTA followed by fall and assault. The fractures due to fall and assault showed an obvious rise during the lockdown period. There were 718 (89.97%) patients having exclusive mandibular fractures and 80 (10.03%) patients having involvement of both mandible and maxilla. Single fractures of mandible constituted 110 (23.11%) and 58 (18.01%) in Group A and B, respectively. 324 patients (68.07%) and 226 patients (70.19%) had multiple fractures involving mandible in respective groups. Parasymphysis of mandible was most commonly involved (24.31%) followed closely by unilateral condyle (23.48%) then Angle and Ramus of mandible (20.71%) with coronoid being the least fractured. During the initial 6 months after lockdown, all the cases were treated successfully using closed reduction. GOHAI QoL assessment conducted in cases having exclusive mandibular fracture (210 Multiple, 48 Single) showed favorable results with significant (P < .05) difference between the single and multiple fractures. After one and half years and recovering from the second wave of pandemic that hit the country, we have come to understand COVID-19 better and embraced better management protocol. The study reveals that IMF remains the gold standard for the management of most of the facial fractures in pandemic situations. It was evident from the QoL data that most of the patients were able to carry out their day-to-day functions adequately. As the country prepares for a third wave of pandemic, management of maxillofacial trauma by closed reduction will remain the norm for most unless indicated otherwise.

Covid-19 and maxillo-facial fractures: A comprehensive retrospective cohort study on the analysis of costs in COVID-19 era

Background/Aim: Maxillofacial trauma management has also undergone a change starting from December 2019 due to the emergence of a new viral infection, later called COVID-19, and then a pandemic mandating new medical protocols. This retrospective cohort study aimed to explain the changes in medical costs and underlying causes of cases with maxillofacial bone fractures during the COVID-19 period, based on the lack of focus on cost analyses on this subject in previous studies. Methods: Patients who were operated on for maxillofacial trauma in our clinic before and during the COVID-19 outbreak were retrospectively analyzed in terms of sex, age, etiology, personal protective equipment (PPE) usage, treatment methods, and total costs. Statistical analyses were carried out for any significant changes. Results: A total of 78 patients of which 38 were operated on before whereas 40 were operated on during the COVID-19 outbreak, were included in this study. Accordingly, 24 patients of the pre-COVID-19 group and 37 patients of the post-COVID-19 group were admitted from Emergency Department (ED), which included all the first wave patients (n=21). In the pre-COVID-19 group, a total of 220 screws and 58 plates were used for 22 IRFs. The total LoH of the patients was 180 days. In the post-COVID-19 group, 274 screws and 70 plates were used for 24 IRFs. The total LoH of the patients was 185 days. A total of 156 PPE including N95 masks and extra operation shirts were used. The pre-COVID-19 group’s treatment costs were calculated as USD 320.3 per patient. Post-COVID-19 group’s treatment costs were calculated as USD 496.68 per patient. Conclusion: The statistical evaluations revealed that the COVID-19 pandemic resulted in differences due to the introduction of PCR tests applied for each patient and the PPE used for the precautions taken for the COVID-19 infections. On the other hand, there were no changes in the number of the use of plates, screws, and in the length of hospitalization. It can be argued that this outcome has led to no necessary changes in the treatment protocols in terms of costs.

Efficacy of palonosetron in the management of postoperative nausea vomiting in oral and maxillofacial surgery.

Objective:The objective is to evaluate the efficacy of prophylactic single intravenous dose of palonosetron in the management of postoperative nausea and vomiting (PONV) following oral and maxillofacial surgical interventions performed through an intraoral approach under general anesthesia (GA).Materials and Methods:A prospective study was conducted on 100 subjects who underwent intraoral surgical procedures for the management of maxillofacial trauma, pathology, dentofacial anomalies, and deformities under GA. All subjects received a prophylactic single intravenous dose of 0.075 mg palonosetron along with premedication. Predisposing factors for PONV such as patient age, gender, Apfel risk score, history of motion sickness, smoking, type of procedure, and administration of postoperative opioids were taken into consideration. All the patients were monitored for PONV for the 1st 24 h postoperatively (PO). First, at an interval of 30 min for 1st 4 h and then at every 2 h interval for next 8 h followed by monitoring every 6 h interval till 24 h. Time and frequency of rescue medication were noted.Results:Seventy-nine percentage subjects did not have PONV. 15% subjects had a single episode of vomiting PO which could be attributed to multiple intra oral surgical sites performed as well as longer duration of exposure to anesthetic agents in addition to providing opioid analgesics for the management of postoperative pain. Only 6% subjects needed rescue antiemetic drug. Palonosetron did not show any significant changes in cardiac status and serum profile.Conclusion:Palonosetron is effective in the management of PONV for maxillofacial surgical procedures performed through an intraoral approach under GA.

Use of bite force measurement as a clinical means for follow up of maxillofacial trauma management

Use of bite force measurement as a clinical means for follow up of maxillofacial trauma management