Maxillofacial Emergencies Research Articles

Analysis of Telehealth Coverage Amongst Maxillofacial Emergency Services during the COVID-19 Pandemic: A Comparison of Three Academic Institutions

Analysis of Telehealth Coverage Amongst Maxillofacial Emergency Services during the COVID-19 Pandemic: A Comparison of Three Academic Institutions

Will our aging population affect maxillofacial emergency attendance? A 5-year analysis (2017-2022)

Will our aging population affect maxillofacial emergency attendance? A 5-year analysis (2017-2022)

Macroglossia Revealing a Neuroleptic Malignant Syndrome: a Clinical Images

Neuroleptic malignant syndrome is a rare and potentially fatal side effect that can occur in response to treatment with antipsychotic drugs. It is characterized by four main symptoms: Impaired mental function, fever, muscle rigidity and autonomic dysfunction. We report the case of a 20-year-old patient, followed for psychosis, in whom a new therapeutic line was adapted 3 days ago: Largactil (chlorpromazine) and Haldol (Haloperidol), who presented to the maxillofacial emergency department with tongue laceration. Clinical examination revealed in an agitated, uncooperative tachycardic and apyretic patient, revealed a generalized muscular spasm associated with trismus attacks, causing tongue injuries due to the installed macroglossia.

Radiographic grid for locating foreign bodies in maxillofacial emergency trauma

ObjectivesThe accurate localization of the foreign bodies (FBs) is essential. This work presents a new noninvasive technique for subcutaneous metallic FBs under a radiographic grid, a system that simplifies the localization of facial FBs removal using a grid with embedded reference points.MethodsThis work designed a retrospective study to evaluate the effect of a radiographic grid on FBs removal surgery. All patients who met the inclusion criteria and attended the Hospital of Stomatology of China Medical University from January 2022 to June 2023 were enrolled and randomly divided into grid and non-grid groups. The assessment of facial swelling, the primary indicator, was conducted on days 2 and 7 post-surgery. The variables were analyzed using the Student t test and a repeated-measures general linear model.ResultsThe study sample consisted of 20 patients, with 14 males (70%) and 6 females (30%), who had an average age of 30.30 ± 5.38. The average time of operation was 1.85 ± 0.66 h (range 0.7 to 3.2). In the present cases in this report, of the 20 patients’ FBs, 14 were metal, 5 were glass, and 1 was residual root. And the FBs were surgically removed with no postoperative complications. Through comparison, it was found that the degree of swelling on day 2 postoperatively was significantly different between the grid group and the non-grid group (P < 0.05).ConclusionsThis study demonstrates that a radiographic grid with mark points is a more efficient approach compared with traditional methods for FBs removal, and this surgical method is more accurate, fast and noninvasive.

Impact of the Sanitary Confinement Resulting From COVID 19 on Pediatric Emergencies in Maxillofacial Surgery

The pediatric population constitutes a large part of the admissions to maxillofacial emergencies, the health confinement following the declaration of the state of alert as a consequence of the COVID 19 pandemic has modified the behavior of the Moroccan population. In order to study the impact of the lockdown on pediatric maxillofacial emergencies, we conducted a retrospective descriptive and comparative study over a period of 2 months from February 16, 2020 to April 16, 2020: one month before and during the lockdown following the COVID 19 pandemic of pediatric maxillofacial surgery emergency admissions at the MOHAMMED the 6th University Hospital of MARRAKECH. We included the entire pediatric population admitted to the maxillofacial surgery emergency room, ranging from 0 to 15 years of age. The data were collected from the registers of maxillofacial surgery emergencies for two consecutive years.

Dental and Maxillofacial Emergency Algorithms in Swiss Emergency Departments.

This study aimed to evaluate the availability and use of dental and maxillofacial emergency algorithms in Swiss hospitals. A survey was performed among physicians at Swiss emergency departments (ED) and participants of the "36th Annual Meeting of the Society for Oral and Cranio-Maxillofacial Surgery". Eighty-nine EDs in Switzerland were questioned about the availability and use of electronic algorithms in their hospitals. Eighty-one (91%) participated in the study. In 75 (93%) of the EDs, electronic algorithms are used, mainly "medStandards". Six have no available algorithms. Fifty-two (64%) use algorithms daily. Eight (10%) Swiss EDs have maxillofacial and dental algorithms, and 73 (90%) have no access to or do not know about them. For dental algorithms, 28 (38%) of the respondents would like to have access, and 16 (22%) do not desire access. For maxillofacial algorithms, 23 (32%) want to have access and 21 (29%) do not want it. Most (74%) of the participating maxillofacial surgeons did not know about the existence of ED algorithms regarding their specialty. Our study shows that the existence of specific algorithms is often not known. Furthermore, there is a demand for dental and maxillofacial algorithms in Swiss EDs.

Protocol for management of pregnant patients requiring emergency minor oral surgical procedures: a prospective study in 52 patients.

Dental or maxillofacial emergencies are uncommon during pregnancy, but if they occur, they are challenging to treat due to potential risks. The mother should not be denied necessary medical or dental care because of pregnancy. The aim of the study is to observe outcomes of pregnancy in patients requiring emergency minor oral surgical procedures during gestation and to determine the safety of the pregnant woman undergoing the procedure and the fetus. The study was conducted on 52 pregnant women requiring emergency oral surgical procedures. A standard treatment protocol for treatment of specific entities was followed. Close monitoring and observation were the primary goal of treatment. All patients were followed postoperatively until complete recovery from the surgical procedures and then until birth of the baby. A control group of 52 healthy pregnant patients who did not require oral surgical procedures was considered for statistical analysis. The measurements to calculate observation were fetal loss (spontaneous abortion), preterm birth, low-birth weight, or incidence of any congenital anomalies in the baby and its association with surgical procedures. No fetal loss occurred in any of the cases. However, four patients experienced preterm birth and seven neonates exhibited low birth weights. No congenital abnormalities were discovered. In one instance, a patient who underwent surgery for a mandibular symphysis fracture under general anesthesia in the 31st week of pregnancy experienced labor pain on the fourth postoperative day, requiring an emergency Caesarean section. The results of our study demonstrate that, compared to the control group, minor emergency surgeries performed during pregnancy have no discernible negative effects on the fetus. These procedures can safely be performed by adhering to our described protocols.

65. Maxillofacial emergency simulation training for OMFS Dental Core Trainees – results from a new programme

Our aim was to initiate a training programme in OMFS emergencies for Dental Core Trainees (DCTs) using the resources in the Simulation Suite, in order to improve their competence and confidence in managing the emergencies they were likely to encounter during work as a maxillofacial SHO.

Oral and maxillofacial emergencies: A retrospective study of 5220 cases in West China.

There are no epidemiological reports focused on the oral and maxillofacial surgery emergency department in the West China Hospital of Stomatology. The aim of this study was to analyse the epidemiological characteristics of emergency patients admitted for Trauma and Plastic Surgery Department of the West China Hospital of Stomatology from 2016-2019. In this retrospective study, 5220 patients with complete medical records were evaluated. The following data were collected: gender, age, etiology, disease type distribution, anatomic injury site and treatment modality. There were 3046 males and 2174 females (ratio 1.40:1), with an average age of 16.2 years. The largest group was children aged between 3 and 6 years old (28.3%). Maxillofacial injuries were the most common condition (87.3%), which mostly occurred on the forehead (29.7%), followed by the lips (27.8%). A fall was the leading cause of injury (59.9%), especially in patients younger than 6 years old. There were 327 cases of maxillofacial space infections (MSI), and the mandibular third molars were the most common tooth associated with odontogenic infections (36.2%). Univariable analysis identified that multiple-space infection, visit time and systemic conditions were the risk factors for being admitted to the hospital for treatment. There were 116 patients (2.2%) with bleeding as the main complaint, and most of the maxillofacial bleeding patients could be stopped by compression (52.6%). Males and children aged younger than 6 years were the highest risk populations. Trauma accounted for the majority of emergency patients in maxillofacial surgery. Most maxillofacial injuries involved the forehead and were mainly caused by accidental falls. The proportion of MSI was not high, but serious cases may be life-threatening. The causes of bleeding were diverse, and the bleeding was easy to control.

Head and neck cancer presentations in the emergency department during the COVID-19 pandemic.

Introduction It is not uncommon to note patients with painful orofacial lesions presenting via the emergency department to the on-call team. However, during the COVID-19 pandemic, we saw a surge in these attendances, prompting a review of our emergency database.Methods The maxillofacial emergency database was retrospectively reviewed in the period between March 2020 and October 2021 (19 months). Data including relevant variables were collected in a standard spreadsheet database and analysed by two clinicians.Results Between March 2020 and October 2021, 34 patients attended with oral ulceration and non-odontogenic neck swellings, out of which nine patients had subsequent diagnosis of oral/oropharyngeal cancer (mean age: 64.2 years). All patients were grouped as stage IV cancers and only one patient was deemed suitable for ablative surgery, which is the primary mode of treatment in oral cancers. Three patients were deemed to have progressive/recurrent disease despite active treatment and two patients unfortunately passed away due to the disease.Conclusion The impact of the COVID-19 pandemic on head and neck cancer diagnoses and management suffered significantly. We present our experience dealing with this vulnerable cohort in the emergency department and their subsequent journey.

Analysis of 256 pediatric oral and maxillofacial emergency in-patients during the outbreak of COVID-19.

Background/AimsPediatric oral and maxillofacial surgeons have faced severe challenges in ward management due to their high risk of exposure during the COVID‐19 epidemic. The aim of this study was to analyze and summarize the treatment methods and infection prevention and control measures applied in emergency cases in the Department of Pediatric Oral and Maxillofacial Surgery, Children's Hospital of Chongqing Medical University, during the COVID‐19 epidemic.MethodsIn this retrospective study, information was collected from 256 pediatric emergency patients who were treated from January 23, 2020 to August 9, 2021. The patients' data were statistically analyzed according to age, gender, disease and pathogenesis, operation time, and the main treatment applied in pediatric oral and maxillofacial emergency cases during the COVID‐19 epidemic.ResultsDuring the epidemic period, 256 pediatric emergency patients were successfully treated. Among them, there were 170 boys and 86 girls. In all, 182 patients were diagnosed with oral or facial lacerations; 43 had jaw fractures; 26 had maxillofacial infections; and five had dento‐alveolar fractures. A total of 246 patients underwent surgery under negative pressure with level 3 protection standards. No doctors or patients infected with COVID‐19 were found throughout the stury period.ConclusionsPediatric oral and maxillofacial emergency in‐patients mainly experienced maxillofacial trauma during the COVID‐19 epidemic, followed by infection. Effective diagnosis and treatment, and avoidance of COVID‐19 infection can be achieved by strictly following epidemic prevention and treatment procedures.

87 Maxsim, A Novel Simulation-Based Education Course for Oral and Maxillofacial Surgical Emergencies

For Oral and Maxillofacial Surgery (OMFS) Senior House Officers (SHOs), with no formal medical training, the first exposure to inpatient medical or OMFS emergencies will be the first time they are having to manage them, usually alone.Simulation-based education has been demonstrated to increase experience and confidence when used in medical education; therefore, an OMFS simulation-based education (SBE) course was created to facilitate this learning in a safe environment.The course included implementation of training on SBAR, A to E Assessment, stations on medical emergencies such as sepsis, and OMFS emergencies centred around scenarios that necessitate rapid response including retrobulbar haemorrhage and carotid artery blowout. Pre- and post-course questionnaires were given to all delegates to assess their change in confidence when managing the scenarios. Each was asked to score their confidence in managing the scenarios numerically from 1 to 10.Delegate numbers were limited due to the COVID-19 pandemic with all 10 completing both questionnaires. There was an even distribution between first- and second-year SHOs. Two had received simulation training before, however very limited. In all 10 simulation stations, every delegate felt an increase in confidence on average by 45% (range: 38–56%, p &lt; 0.05) on the 10-point scale. Positive feedback was received, with all delegates finding the day useful, it achieving what they hoped and stating they would recommend the course to a colleague. Both the SBAR and A to E tools were unknown to all of the SHO’s, highlighting their lack of medical training as they are well-known tools within the medical community. SBE was demonstrated to increase the experience and confidence of SHO’s managing and escalating common OMFS situations. This will increase the quality of patient care of these specific scenarios but the translatable skills will also enable more comprehensive care and handover in all aspects of the delegates roles. Simulation-based education is an invaluable method of training for clinical scenarios and needs to become more common place in Oral and Maxillofacial Surgery. Furthermore, Health Education England has commissioned the course to run on 3 days annually, providing simulation-based education for 40 SHOs in the Southwest Deanery undertaking a rotation within OMFS.

Effect of COVID-19 pandemic on orofacial and respiratory infections in ear, nose, and throat and oral and maxillofacial surgery emergency departments: a retrospective study of 7900 patients

ObjectivesThe study purpose was to evaluate the effects of the COVID-19 pandemic on the rate and disease profile of orofacial and respiratory infections in oral and maxillofacial surgery (OMFS) and ear, nose, and throat (ENT) emergency units.Materials and methodsRecords of patients with orofacial or respiratory infection, or infectious symptoms, diagnosed in the OMFS or ENT Emergency Departments of the Helsinki University Hospital, Helsinki, Finland between 1st March and 30th October 2020 and the corresponding periods in 2018 and 2019 were reviewed. The main outcome variable was the occurrence of studied infections during the evaluated periods. Other study variables were age, gender, residence area, speciality, specific cause for the emergency department visit and admission to ward.ResultsThere was a significant 37% decrease in the number of infection patients in 2020 compared to the years 2019 and 2018 (1894 vs. 2929 and 3077, respectively, p < .001). A mean decrease of 51% (from 1319 and 1249 patients in 2018 and 2019, respectively, to 592 patients in 2020) was seen in the “Other ENT respiratory infection” category. ENT patients were 51% less likely to be admitted to the ward in 2020 compared to 2019 and 2018 (p = .013).ConclusionA significant decrease was observed in the volume of emergency department visits for orofacial and respiratory infections during the COVID-19-pandemic in 2020 compared to the non-COVID periods.Clinical relevanceIt seems that social distancing, facial mask wearing, and other infection prevention precautions have changed the accustomed patient profile in orofacial and respiratory infections.

Cycling-Related Injuries During COVID-19 Lockdown: A North London Experience.

There has been a notable surge in cycling injuries during the COVID-19(SARS-CoV-2 virus) pandemic. Cycling in general increased during lockdown as a leisure & fitness activity along with reduction in the use of public transport for commuting. We investigated the bicycle-related maxillofacial injuries & associations presenting through our emergency department(ED) which covers more than 1.6 million of London population. A retrospective observational study was undertaken in the Barnet General Hospital ("hub") which receives all maxillofacial referrals from 6 "spoke" hospitals & other urgent primary/community care practices in North London area between 16 March 2020 & 16 July 2020. All data corresponding to cycling injuries during the lockdown period was analyzed with the aid of trauma database/trust-wide electronic patient records. Twenty-two patients (6.7%) with cycling-related injuries out of a total of 322 patients who attended during the 4 months study period with maxillofacial emergencies were identified. Average age of patient cohort was 35.4 years, mainly consisting of adult males (77%). Seven patients had minor head injury and 1 patient suffered traumatic brain injury. About 59% patients did not wear a protective helmet & 3 patients had heavy alcohol/recreational drug intoxication during the accidents. Four patients needed inpatient admission and treatment under general anesthesia. Based on our humble study, we advocate the need for robust road & personal safety measures with mandatory government legislations, policing of drug intoxication & encouragement of physical & mental health improvement measures during these unprecedented times & beyond.

Implementation of photographic triage in a paediatric dental, orthodontic, and maxillofacial department during COVID-19.

During the COVID-19 pandemic, limitations were placed on face-to-face encounters in dentistry and oral and maxillofacial surgery (OMFS) in order to promote physical distancing and reduce viral propagation. To facilitate continued assessment of dental, orthodontic, and maxillofacial emergencies, a photographic triage system was initiated at Alder Hey Children's Hospital (AHCH). We will discuss the benefits this system offers at a patient, clinician, departmental, and NHS service level. To share our experience of photographic triage during the first 3months of COVID-19 lockdown, lessons learned, and recommendations. Prospective data collection over 3months. 220 photographic referrals were received, and swelling (30%) and dental trauma (27%) were the most common presenting complaints. 57% of referrals were not seen, 23% were seen semi-urgently, and 20% booked for outpatient review. Of those seen, 7 children were seen elsewhere and 44 were seen face-to-face at AHCH, with 8 being admitted. Photographic triage reduced physical encounters and proved useful in training junior staff, assessment of new patient referrals, and first on-call from home. Implementation should be considered throughout dental, orthodontic, and OMFS departments nationwide. In the event of a COVID-19 resurgence or emergence of a new pandemic, photographic triage could facilitate physical distancing and service provision.

Characteristics of Odontogenic Infections that Extended to Maxillofacial Space in Oral and Maxillofacial Emergency Department of Dr. Hasan Sadikin Hospital in 2017 - 2019

Characteristics of Odontogenic Infections that Extended to Maxillofacial Space in Oral and Maxillofacial Emergency Department of Dr. Hasan Sadikin Hospital in 2017 - 2019

Evaluation of maxillofacial emergency admissions for 2018 in a busy regional maxillofacial unit: the East Grinstead experience

Surgical non-elective admissions vary from region to region and are often dependent on the socioeconomic situations of a populace. The Queen Victoria Hospital (QVH), East Grinstead, houses a maxillofacial regional referral centre catering to almost 2.5 million people. Our study is aimed at classifying non-elective admissions with a view to identifying areas for improvement.

Comparison of provision of maxillofacial emergency service during the two COVID-19 national lockdowns in the United Kingdom

We previously published a study on the provision of emergency maxillofacial services during the first UK COVID-19 pandemic national lockdown. We repeated the study during the second lockdown and now present our findings that highlight the main differences and learning issues as the services have evolved.

A survey assessing the early effects of COVID-19 pandemic on oral and maxillofacial surgery training programs

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has specific implications for oral and maxillofacial surgeons because of an increased risk of exposure to the virus during surgical procedures involving the aerodigestive tract. The objective of this survey was to evaluate how the COVID-19 pandemic affected oral and maxillofacial surgery (OMFS) training programs during the early phase of the pandemic.Study DesignDuring the period April 3 to May 6, 2020, a cross-sectional survey was sent to the program directors of 95 of the 101 accredited OMFS training programs in the United States. The 35-question survey, designed by using Qualtrics software, aimed to elicit information about the impact of the COVID-19 pandemic on OMFS residency programs and the resulting specific modifications made to clinical care, PPE, and resident training/wellness.ResultsThe survey response rate from OMFS program directors was 35% (33 of 95), with most responses from the states with a high incidence of COVID-19. All OMFS programs (100%) implemented guidelines to suspend elective and nonurgent surgical procedures and limited ambulatory clinic visits by third week of March, with the average date being March 16, 2020 (date range March 8–23). The programs used telemedicine (40%) and modified in-person visit (51%) protocols for dental and maxillofacial emergency triage to minimize the risk of exposure of HCP to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Shortage of personal protective equipment (PPE) was experienced by 51% of the programs. Almost two-thirds (63%) of the respondents recommended the use of a filtered respirator (i.e., N95 respirator) with full-face shield and stated that it was their preferred PPE, whereas 21% recommended the use of powered air-purifying respirators (PAPRs) during OMFS procedures. Only (73%) of the programs had resources for resident wellness and stress reduction. Virtual didactic training sessions conducted on digital platforms, most commonly Zoom, formed a major part of education for all programs.ConclusionsAll programs promptly responded to the pandemic by making appropriate changes, including suspending elective surgery and limiting patient care to emergent and urgent services. OMFS training programs should give more consideration to providing residents with adequate stress reduction resources to maintain their well-being and training and to minimize exposure risk during an evolving global epidemic.

King Vision videolaryngoscope for nasal intubation in predicted difficult airway due to maxillofacial emergencies: A retrospective cohort study.

King Vision videolaryngoscope for nasal intubation in predicted difficult airway due to maxillofacial emergencies: A retrospective cohort study.