Maxillofacial Service Research Articles

Interfacility Emergency Department Transfer for Mandibular Fractures in the United States

Interfacility hospital transfer for isolated mandibular fractures is common but rarely clinically necessary. The purpose of this study was to generate nationally representative estimates regarding the incidence, risk factors, and cost of transfer for isolated mandibular fractures. This was a retrospective cohort study using the Nationwide Emergency Department Sample 2018 to identify patients with isolated mandibular fractures. The primary predictor variable was hospital trauma center designation (Level I, Level II, Level III, and nontrauma center). The primary outcome variablewas hospital transfer. Total emergency department (ED) charges were also assessed. Covariates were demographic, medical, injury-related, and hospital characteristics. Descriptive, bivariate, and multiplelogistic regression statistics were used to evaluate the incidence and predictors of interfacility transfer. A total of 28,357 encounters with mandibular fracture as the primary diagnosis were included. Within this cohort there were 2,893 hospital transfers (10.2%). In unadjusted analysis, evaluation at a nontraumacenter, level III trauma center, metropolitan nonteaching hospital, nonmetropolitan nonteaching hospital, micropolitan region, and history of cerebrovascular event was associated with hospitaltransfer (P≤.001). In the adjusted model, independent predictors (risk factors) for hospital transfer were evaluation at a nontrauma center (P≤.001, odds ratio [OR]=12.8, 95% confidence interval [CI]=6.43 to 25.4), level III trauma center (P≤.001, OR=10.7, 95% CI=5.25 to 21.7), nonmetropolitan nonteaching hospital (P≤.001, OR=2.45, 95% CI=1.73 to 3.46), metropolitan nonteaching hospital (P≤.001, OR=1.57, 95% CI=1.20 to 2.06), cervical spine injury (P=.002, OR=3.53, 95% CI=1.61 to 7.75), fractures of the mandibular body (P=.007, OR=1.33, 95% CI=1.08 to 1.64), and unspecified mandibular fractures (P=.006, OR=1.49, 95% CI=1.12 to 1.99). The average ED charge per encounter was $7,482±565 for a total nationwide charge of $212,172,264. Transferred subjects had total ED charges of $25,632,974, not including additional charges incurred at the recipient hospital. Isolated mandibular fractures are common injuries that are frequently transferred and cost the healthcare system millions of dollars annually. Hospital characteristics rather than medical or injury-related variables were the strongest predictors of transfer, suggesting that transfers are primarily driven by need to access maxillofacial surgical services. Programs evaluating necessity of transfer and facilitating specialist evaluation in the outpatient setting may reduce healthcare expenditures for this injury.

Osteoradionecrosis: Experience from the Oral and Maxillofacial Surgery Unit at Christchurch Hospital, New Zealand

Background and objectives: Osteoradionecrosis of the jaws (ORN) is a debilitating complication of radiotherapy among head and neck cancer patients. Dentists are critical to the management of patients at risk and may be the first clinicians to encounter new onset ORN. Oral and Maxillofacial Surgical teams are commonly involved in the surgical management of such patients. To the best of our knowledge there have been no studies examining the referral pathways of patients with ORN to Oral and Maxillofacial Surgical Services in New Zealand. Methods: A retrospective study was conducted and included all patients with ORN referred to the Oral and Maxillofacial Surgical Service at Christchurch Hospital, New Zealand in the 3-year period 1st January 2018 to 31st December 2020. Clinical records were accessed to collect data endpoints. To illustrate the potential severity of ORN we also present a case report of a patient with mandibular ORN and pathologic fracture that was managed. Results: Thirteen patients with ORN were referred to the Oral and Maxillofacial Surgical Service at Christchurch Hospital over the study period. The majority of patients were referred by internal Christchurch Hospital colleagues (Otorhinolaryngology and Hospital Dentists). A wide range of presenting signs/symptoms were found. All patients presented with exposed necrotic bone however no other symptoms were found to be of high sensitivity for ORN. Patients required a range of treatment modalities, from conservative management to resection and fibula free-flap reconstruction. Conclusions: Most patients at risk of ORN are being maintained on long-term Hospital based recall lists for clinical review. Given the wide range of presenting signs/symptoms of ORN, oral health practitioners must exercise a high degree of clinical suspicion when encountering these in irradiated patients.

Epidemiological Study of Frontal Sinus Fractures: Evaluation of 16 Years of Care at the Faculty of Dentistry of Ribeirão Preto/Brazil.

Aiming to evaluate and study the epidemiological profile of frontal sinus fractures treated in the region of Ribeirão Preto-Brazil. Sixteen years of activity in the Oral and Maxillofacial service of the Faculty of Dentistry of Ribeirão Preto/SP (FORP/USP), totaling 9,736 consultations, 4,524 with facial fractures, those diagnosed with frontal sinus fracture (113) were evaluated and selected for the study. Frontal sinus fractures accounted for 2.5% of facial fractures, the majority occurring in men (89.4%), concentrated in the age group 21-30years old, with 52.2% of cases being caused by road traffic accidents (RTA). Associations with other facial fractures are common and appeared in 75.2% of cases. Treatment was followed either surgically, by open reduction internal fixation (52.2%) or conservatively (35.4%). Analyzing only the 28 isolated frontal sinus fractures, the most common treatment was conservative (46.4%). surgical treatment dropped to 25%. The most common postoperative complications were temporal branch paralysis and supraorbital nerve paresthesia, both occurring in 30.5% of surgical cases. The frequency of frontal sinus fractures may be decreasing, but the pattern of occurrence in young men due to road traffic accidents does not seem to change, fortunately the appearance of serious complications is not common and it is usually associated with more severe trauma.

Titanium miniplate removal after joint orthodontic-orthognathic surgery treatment: a 10-year retrospective hospital-based audit.

The reported incidence of titanium miniplate removal after orthognathic surgery varies widely, making delivery of risk information to patients problematic. This variation relates to potential biases introduced during the study design, for example, with the pooling of different patient types, creating heterogeneous study samples. This study reduces sampling bias by limiting the cohort to only consecutive orthognathic cases. The primary aim of the study was to identify the incidence of miniplate removal following orthognathic surgery. The secondary aim was to assess the indications and any risk factors for miniplate removal. Data from the clinical records of 907 orthognathic surgery cases treated within a centralised oral and maxillofacial hospital service over a 10-year period were collected by two operators and analysed. Every identified case qualified for inclusion. Patient demographics (age, sex, medical comorbidity, smoking), operations (type of surgery, duration, third molar removal, complications) and the indication, timing and site of miniplate removal were analysed. Only 19 patients required postoperative miniplate removal, with the most common indication being infection (63%). There was no significant difference in any of the factors assessed except that significantly more miniplates were removed from female patients (68%) (p<0.001) and from mandibular sites (84.2%) (p=0.003). The incidence of miniplate removal for this sample was 2.1%. Female sex and miniplate location in the mandible were the only statistically significant risk factors for miniplate removal.

How Accurate Are Surgeons at Calculating Orbital Volumes?

Bilateral orbital volume (OV) symmetry is imperative for successful orbital reconstruction to prevent complications such as enophthalmos, diplopia, and orbital dystopia. The purpose of this study was to determine the accuracy of surgeon-led in-house OV calculation for reconstructed orbits after orbital floor fracture. This is a retrospective cross-sectional observational study of maxillofacial computed tomography scans for patients undergone orbital fracture repair by Emory Oral and Maxillofacial service at Grady Memorial Hospital (Atlanta, Georgia) from 2018 to 2020.The primary predictor variable was OV calculation approach (outsourced vs surgeon-led in-house approach). The primary outcome variable was OV. Secondary variables were age, gender, and race. Interobserver reliability was calculated with a 2-way mixed-effects model, intraclass correlation coefficients, 95% confidence intervals, and Pvalues. Differences between OV (in-house and outsourced) were calculated using student t-test. Statistical significance was determined at P<.05. During the study period, 172 patients sustained orbital floor fracture. Of them, 49 patients (31 male, 18 females; 98 orbits) with the mean age of 41.3years (range, 19 to 89 years) met inclusion criteria. Subjects with incomplete medical records and inadequate computed tomography scans were excluded from the study. The racial distribution in descending order was 87.8% African American, 8.2% Caucasian, 2% Hispanic, and 2% Asian. There was excellent inter-rater reliability for calculating uninjured OV (OV-U, P<.0001) and reconstructed OV (OV-R, P<.0001). The mean OV difference of outsourced approach was 0.8cm3and for surgeon-led in-house approach was 0.07cm3. There was no significant difference in OV difference between outsourced and in-house approach (P=.16). In conclusion, using open-source 3-dimensional imaging software is a reliable and a predictable method at calculating reconstructed OV in patients who underwent open reduction and internal fixation of orbital fractures. By having this software in our personal computers and laptops, one can easily calculate OVs in an efficient manner.

Glandular odontogenic cysts: A collaborative investigation of 22 cases and proteins related to invasiveness.

A glandular odontogenic cyst (GOC) has an intriguing, aggressive behaviour whose mechanisms have not yet been clarified. To conduct a collaborative cross-sectional study on the clinical, demographic, microscopic and immunohistochemical characteristics of GOCs, emphasizing the histopathological characteristics and expression of proteins related to invasiveness. Twenty-two cases of GOC from three oral and maxillofacial pathology services in Brazil were selected from 1988 to 2018. Clinical and demographic data were collected. Histopathological features were evaluated in detail. Sixteen cases of GOC were also submitted to immunohistochemistry to detect MT1-MMP, TKS4, TKS5 and cortactin, the key regulators of invadopodia formation. Glandular odontogenic cysts were primarily seen in men over 40years of age, in the posterior mandible and the anterior maxilla as a unilocular, radiolucent lesion. All cases presented hobnail cells, clear cells and variable thickness of the lining epithelium, 3 of the 10key histopathological parameters to be evaluated in GOCs. Immunohistochemistry revealed a greater expression of the studied proteins in the GOCs than in the controls (p<0.0001). Overexpression of proteins that regulate cell invasiveness was identified, and the present study's findings suggest that invadopodia activity is a possible mechanism used by GOCs to promote local invasion, which could partly explain its intriguing biological behaviour.

The impact of covid-19 lockdown on maxillofacial related services at tertiary dental institution

In the wake of the devastating COVID-19 pandemic, many countries in the world instituted various protocols to limit the spread of the disease and to reduce the burden on health care facilities. However, the unintended consequences of these restrictions included the reduction of human mobility, limited access to health care services, resulting in delayed or missed medical treatment. Aims The aim of the study was to assess the impact of the COVID-19 lockdown restriction on maxillofacial services. Methodology This retrospective and descriptive study of patient’s clinical records, spanned from October 2019 to August 2020.This period included the pre-lockdown (October –December 2019) and the different lockdown (levels 5,4, and 3) periods. Complete clinical patient records were included for analysis. Results The study revealed a 88%, 86%, and 45% decline in maxillofacial and oral surgery consultations during levels 5, 4 and 3 respectively. Third molar impaction related complaints such as pericoronitis, pain and sepsis werethe predominant consultation motives during all levels of lockdown periods. Gender and age of patients had no impact on the consultation rates during the course of the study. Conclusion The Covid-19 pandemic related lockdown restrictions affected the service provision for maxillofacial patients seen at this institution.

The referral system for specialist dental services at Sefako Makgatho Oral Health Centre: a cross-sectional study

The functioning of various referral systems in service delivery at district level have been described. Aims and Objectives To examine the functioning of referral system for specialist dental services at Sefako Makgatho Oral Health Centre. The prevalence of self-referrals and emergency patients and reasons for referrals were determined. The pattern of referrals for elective treatment at the clinical units was described. Design This was a cross-sectional study Method A structured closed questionnaire was used to collect data related to demographic characteristics, reasons for referrals to the clinic and whether patients were referred by healthcare workers or self-referred. Patients themselves or with the assistance of the research team completed the questionnaire. Data required for classifying patients into emergency and non-emergency was gathered from the service register. The classification was made based on the referral preferences of attending clinicians. Results A substantial proportion of visitors to the hospital were self-referred (71.3%), emergency patients (69.7%). Among referred patients, the most common reason for referrals was for specialist oral and maxillofacial surgical services. The majority (64.7%) of hospital visitors received elective treatment referrals, 48.9% of which were for general dentistry.Conclusion The prevalence of self-referrals by emergency patients is extremely high.

Comparative evaluation of vegetable matter involved lesions with oral parasitic infections in the oral cavity.

The current research aims to perform a comparative evaluation of vegetable matter involved lesions with oral parasitic infections found in oral mucosa, presenting histochemical methods to differentiate their microscopic similarities. Eight cases were selected out of a sample of 1.975 reports from a single Oral and Maxillofacial Pathology Service of the author's institution from 2012 to 2019. Specimens were examined by hematoxylin and eosin staining (HE), periodic acid-Schiff (PAS) staining, Gomori-Grocott staining, Ziehl-Neelsen staining, Giemsa, and mucicarmine staining. Microscopic analysis included fluorescence, polarized light, and confocal microscopy. Microscopically, in HE coloration, hookworm eggs showed as eosinophilic. Inflammatory multinucleated giant cells and lymphocytes, were usually related to the nematode eggs, forming an intense inflammatory infiltrate. Biofluorescent properties of eggs and larvae revealed to be sensitive in the detection of parasitic structures contrasting with the inflamed connective tissue. Vegetable presence was confirmed by polarized light microscopy and it was found to be associated with microbial biofilms. Confocal microscopy has showed to be an excellent method for morphotype differentiation of parasitic eggs. Parasitic infection and vegetable matter displayed similarities in the inflammatory response, but the latter can rot and agglomerate biofilms. The microscopic diagnosis of such infections requires the interpretation of challenging morphological features since the parasites are usually sectioned and mixed with an inflammatory reaction. These histochemical approaches proved to be excellent to distinguish both lesions.

Maintaining the maxillofacial service under cyber-attack: The Waikato experience.

ANZ Journal of SurgeryVolume 91, Issue 12 p. 2566-2568 PERSPECTIVE Maintaining the maxillofacial service under cyber-attack: The Waikato experience Ming Yap BDS, Corresponding Author Ming Yap BDS mingjinn.yap@gmail.com orcid.org/0000-0002-9203-0025 Department of Oral and Maxillofacial Surgery, Waikato Hospital, Hamilton, New ZealandSearch for more papers by this authorAlastair Luo BBioMedSci, BDS, Alastair Luo BBioMedSci, BDS orcid.org/0000-0002-9480-6958 Department of Oral and Maxillofacial Surgery, Waikato Hospital, Hamilton, New ZealandSearch for more papers by this authorArun Majumdar MBChB, FDSRCS, FRCS(OMFS), Arun Majumdar MBChB, FDSRCS, FRCS(OMFS) Department of Oral and Maxillofacial Surgery, Waikato Hospital, Hamilton, New ZealandSearch for more papers by this authorThasvir Singh BDS, MBChB, MPhil, FRACDS(OMS), Thasvir Singh BDS, MBChB, MPhil, FRACDS(OMS) Department of Oral and Maxillofacial Surgery, Waikato Hospital, Hamilton, New ZealandSearch for more papers by this author Ming Yap BDS, Corresponding Author Ming Yap BDS mingjinn.yap@gmail.com orcid.org/0000-0002-9203-0025 Department of Oral and Maxillofacial Surgery, Waikato Hospital, Hamilton, New ZealandSearch for more papers by this authorAlastair Luo BBioMedSci, BDS, Alastair Luo BBioMedSci, BDS orcid.org/0000-0002-9480-6958 Department of Oral and Maxillofacial Surgery, Waikato Hospital, Hamilton, New ZealandSearch for more papers by this authorArun Majumdar MBChB, FDSRCS, FRCS(OMFS), Arun Majumdar MBChB, FDSRCS, FRCS(OMFS) Department of Oral and Maxillofacial Surgery, Waikato Hospital, Hamilton, New ZealandSearch for more papers by this authorThasvir Singh BDS, MBChB, MPhil, FRACDS(OMS), Thasvir Singh BDS, MBChB, MPhil, FRACDS(OMS) Department of Oral and Maxillofacial Surgery, Waikato Hospital, Hamilton, New ZealandSearch for more papers by this author First published: 16 December 2021 https://doi.org/10.1111/ans.17177Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume91, Issue12December 2021Pages 2566-2568 RelatedInformation

The effect of the SARS-CoV-2 pandemic on suspected cancer referrals at a regional head and neck unit

The novel coronavirus SARS-CoV-2, initially identified in late 2019 as a small case cluster, has rapidly become a global pandemic. Government restrictions, closure of primary care services, interruption of cancer screening programmes, and fear of contracting the virus have demonstrably led to a reduction in referrals for suspected cancer and delays to treatment across the United Kingdom. A retrospective analysis was carried out on suspected cancer referrals to the maxillofacial service at Aberdeen Royal Infirmary during the 12 months from March 2020, and compared with the 12 months prior. Suspected cancer referrals reduced by 38.6% (p < 0.001) during this period, with a reduction in the percentage referred by General Dental Practitioners. Further analysis shows a proportionate reduction in squamous cell carcinoma diagnoses, with other diagnoses remaining stable. Time from referral to first appointment, biopsy, and treatment showed no change. Stage at diagnosis and treatment modality was also unaffected. Assuming no change to the incidence of head and neck malignancies, over a third of new malignancies may have been undiagnosed during the 12 months from March 2020. Evidence for the impact of the pandemic is likely to become apparent as services return to pre-pandemic levels and these patients begin to present.

1370 Classifying Morbidity and Error in Oral and Maxillofacial Trauma Using the Clavien-Dindo Classification: A Prospective Pilot Study

Abstract Introduction The collection of morbidity outcomes following surgery was recommended by the Royal College of Surgeons of England in 2014. They suggest a structure to stratify complications into groupings but do not include a classification this limits comparison. Our unit, a regionalised maxillofacial trauma service, introduced a standardised morbidity and error classification to be applied at M&amp;M meetings. Method Prospective collection of data from March 2019 to February 2020. All patients discussed at our M&amp;M meeting were then classified according to the Clavien-Dindo Classification (2004), assigned an error type and recommended action determined through a panel of between 5-10 consultants. Results 301 surgical procedures were carried out with a 7% complication rate. 26 cases were discussed at M&amp;M. The commonest error type was ‘nature of the disease’ (48%) followed by ‘error in judgement’ (37%). Clavien-Dindo Classification IIIb (intervention under GA) was the most frequent morbidity (74%) Conclusions Standardised national data collection of morbidity and error can be used to analyse a single institution or between institutions to improve patient care. To our knowledge, this is the first standardised classification of morbidity in maxillofacial trauma and was of educational and service benefit. However, there was discussion of the appropriateness of the classification systems to facial fractures. We would therefore recommend further development of both a morbidity classification and an error type classification specific to treatment of facial fractures so that it can be used to improve outcomes for our patients in the future.

1619 Evaluation of Referrals to The Maxillofacial on Call Service Over A Seven-Year Period in A Busy Tertiary Trauma Centre and Teaching Hospital

Abstract Aim University Hospitals Plymouth is the only designated adult major trauma centre for the south west of England, also serving secondary care to a catchment of 450,000 patients. The on call maxillofacial service receives numerous referrals daily, which began to be recorded in a trauma database populated on a daily basis. Our study aims to evaluate these referrals with a view to classifying them and identifying service provision needs; improve support and training of the junior team; and understand patient demographics. Method There were 3717 referrals recorded between 7th January 2014 and 7th January 2021. All referrals were taken into account; from the emergency department; from primary care providers; from other hospital departments; and directly from patients themselves. Both adult and paediatric cases were included. Results Of these 3717 referrals, 2122 (57%) were pertaining to male patients. Adult patients accounted for 85% of the referrals and 1200 (32%) of all patients were referred for soft tissue injury. Around 20% of patients attended with facial swellings. 1090 (29%) patients were able to have treatment under a local anaesthetic, whilst 959 (26%) required admission. Most common fractures were nasal (8%), followed by orbital wall (6%) and mandibular fractures (4%). Conclusions Evaluation of the database shows a slight prevalence of male attenders, particularly in cases involving trauma. Management of soft tissue injuries under local anaesthetic is an important topic during the induction of new junior trainees to the department, in accordance with the expected service provision. Furthermore, the large sample has allowed for epidemiologic analysis and interventions.

Comparing Opioid Prescription Trends of Oral and Maxillofacial Surgeons Practicing in Rural and Urban Settings

BackgroundWhile opioid prescription behavior among oral and maxillofacial surgeons (OMSs) has become increasingly responsible in the past few years, the opioid misuse crisis remains a major public health challenge. There are many differences in the access to and delivery of oral and maxillofacial services in urban settings compared to rural settings. In other areas of medicine, such as primary care, opioids are more often prescribed in rural settings.1,2 This study aimed to compare opioid analgesic prescription patterns among OMSs practicing in urban and rural settings in an effort to identify avenues to further promote responsible opioid prescribing. MethodsThis cross-sectional study used publicly available Medicare Provider Utilization and Payment Data from 2014 to 2018, focusing on providers labeled as OMS. Rural-Urban Commuting Area Codes (RUCA) were used to categorize each OMS as urban or rural. The outcome variables included Total Claims of Opioids (Including Refills), Mean Opioid Prescriptions Per Beneficiary, and Number of Days Supply of Opioids Per Claim. Descriptive statistics were summarized, and Wilcoxon rank-sum tests were employed to compare continuous variable means with statistical significance at P-value < .05. ResultsThe study sample, from 2014-2018, consisted of mostly urban and male OMSs (Table 1). The mean number of beneficiaries per OMS varied widely, and the mean age of beneficiaries was around 70 years. The mean hierarchical condition category (HCC), used as a proxy for patient complexity, was similar between rural versus urban OMSs across all years. The mean opioid claims per provider was higher among rural OMSs across all years, with large standard deviations among both rural and urban OMSs (Table 2). However, there were no statistically significant differences in the mean opioid prescriptions per beneficiary (about 1.1-1.2). While in some years there were statistically significant differences between urban and rural OMSs in the number of days’ supply per claim, the magnitude of difference was small (all periods had about 3-4 days). Finally, there were no documented instances of any long-term opioid prescriptions by any OMSs in the dataset. ConclusionWhile rural OMSs prescribed a higher mean volume of opioid analgesics than their urban counterparts, there were no differences in mean amount of opioids prescriptions written per beneficiary. These results suggest similar opioid prescription behaviors among the majority of OMSs practicing in both rural and urban settings. However, the large standard deviation in the mean opioid claims per provider affirms previous work that have found extreme cases of opioid prescription volume among a subset of Medicare OMSs.3 Limitations of this study includes the relatively small number of rural OMSs in the dataset and its limited generalizability to prescription behaviors toward the non-elderly population.

Volumetric Analysis of the Articular Eminence Pneumatization Using Cone Beam Computed Tomography

Objective: To assess tomographic features of mastoid cell pneumatization (MCP) using cone beam computed tomography (CBCT). Materials and Methods: To evaluate 659 CBCTs (500 women and 159 men) of the Oral and Maxillofacial Radiology service of Universidad Peruana Cayetano Heredia Dental Clinic, between 2014 – 2015. The age group was between 7 to 79 years-old. The classification of Al Faleh and Ibrahim was also used to assess the degree of pneumatization, and the statistical analysis was performed using the chi-square test. Results: The frequency of MCP was 76.2 % (502 cases). The highest frequency was found for grade 0 and 2, the highest frequency was found in the 6th decade of life and great predominance was found for the female sex. However, no statically significant differences were found with respect to the gender. Conclusion: MCP prevalence was 76.2% and CBCT became the gold-standard that allows an adequate evaluation of this anatomical variant.

Slow to heal or slow to diagnose cancer?

There are around 8,500 new cases of oral squamous cell carcinoma (SCC) diagnosed in the UK each year and the incidence appears to be increasing. Although surgical and non-surgical treatment options have improved significantly in the last few decades, five-year survival has not, with an average five-year survival of 56% in the UK. Providing patients have access, there are frequent opportunities for oral cancer screening by their general dental practitioner. We present two cases of SCC managed in our department, both of whom were referred following a protracted period of review in general dental practice, where the initial 'benign diagnoses' were not re-evaluated during this time. This delay can considerably impact on patient outcomes, including survival. We outline each patient's clinical course, and key learning points to help dental practitioners detect lesions that require prompt referral to the oral and maxillofacial service for urgent investigation.

ANTROSTOMIA MAXILAR MEDIANTE AO ACESSO DE CALDWELL-LUC: RELATO DE CASO

Although well reported in the literature, endoscopic antrostomy cannot provide full access to the maxillary sinus, a fact that raises some controversy about its extension. Caldwell-luc access antrostomy has been performed for more than 120 years, under general or local anesthesia, managing to ensure greater visibility of the area being explored. A 40-year-old female patient attended the maxillofacial service of the Hospital do Oeste - Barreiras (BA) for evaluation. She claims to be suffering from chronic sinusitis for approximately one year after undergoing endodontic treatment, with constant nasal obstruction on the right side and failing to reach a considerable improvement with the medication use. The proposed treatment was the maxillary antrostomy with Caldwell-luc approach, under general anesthesia, followed by the installation of a rigid drain for direct irrigation in the maxillary sinus through an opening in the lateral wall of the nasal cavity on the affected side. Caldwell-luc approach is a classic procedure in the literature and has remained as a hegemonic surgical technique for the treatment of sinusitis until functional endoscopic surgery has emerged, which has made a less invasive technique possible. However, the advances in endoscopic surgery find a barrier in the limitation of the area accessed by this type of procedure. Despite the possible complications regarding the technique, the Caldwell-luc approach remains as a plausible method for the treatment of maxillary sinus morbidities.

Covid-19 and its impact on Maxillofacial Services at University Hospitals of Morecambe Bay NHS Trust

At the time of submitting this article, we are entering our second week of the second national lockdown, due to the Coronavirus Pandemic. All our lives have been adversely affected by this insidious disease, both professionally and personally, and it is unlikely that our working environmentwill ever return to the ‘normal’ that we once knew. The first part of this article is intended to shed some light on our specialty of Oral and Maxillofacial Surgery and how this pandemic has impacted upon our services at University Hospitals of Morecambe Bay NHS Foundation Trust (UHMB). The second part will be a series of cases, to corroborate the difficulties encountered as a direct result of Covid-19.

Diffuse palatal pigmentation

A 47-year old Asian man was referred to the Columbia University oral and maxillofacial pathology service for evaluation of a pigmented lesion involving the palate. The lesion was found incidentally by the patient’s dental care provider. The patient’s medical history was significant for chronic myeloid leukemia, which was diagnosed in 2015. At the time of the consultation, the patient was considered to be in remission. The only reported medication being taken by the patient was imatinib (Gleevec, Novartis). There were no significant findings on extraoral examination. Intraoral examination revealed a diffuse, well-demarcated, flat, blue-gray pigmentation in the midline of the hard palate extending from the incisive papilla to the junction of the hard and soft palates (Figure). Mr. Stanbouly is a second year dental student, Columbia University College of Dental Medicine, New York, NY. Dr. Shackelford is a resident, Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY. Dr. Peters is an assistant professor, Division of Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, 630 W 168th St PH1562W, New York, NY 10032.

Sialolipomas of minor salivary glands: A multi-institutional study and literature review.

Sialolipoma is a rare histological variant of lipoma commonly misdiagnosed and composed of a proliferation of mature adipocytes with secondary entrapment of normal salivary gland tissue. The purpose of the present study is to report the clinicopathologic and immunohistochemical features of 10 new cases of sialolipomas in conjunction with a review of the literature. A retrospective descriptive cross-sectional study was performed. A total of 54,190 biopsy records of oral and maxillofacial lesions from four oral and maxillofacial pathology services in Brazil were analysed. All cases of lipomas were reviewed, and clinical, demographic and histopathological data were collected of all cases compatible with sialolipomas. In addition, immunohistochemistry stains (AE1/AE3, CK7, 34βE12, S-100, HHF35, α-SMA and Ki-67) and a literature review based on a search of three electronic databases (PubMed, Web of Science and Scopus) were performed. Among all lipomas reviewed, there were 10 cases of sialolipomas. The series comprised of 7 females (70.0%) and 3 males (30.0%), with a mean age of 46.1±21.5years (range: 11-71years) and a 2.3:1 female-to-male ratio. The lower lip (n=3, 30.0%) and tongue (n=2, 20.0%) were the most common locations, presenting clinically as a nodule of slow growth and normal colour. Conservative surgical excision was the treatment in all cases. No recurrence was observed. Sialolipomas are a rare histological variant of lipoma, affecting the salivary glands, mainly in the parotid gland and palate of female adults. Pathologists must recognise sialolipomas to avoid misdiagnoses with other lipomatous tumours that can affect salivary glands.