Division Of Maxillofacial Surgery Research Articles

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

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

Teardrop-shaped radiolucency of the mandible

An 18-year-old man in good overall health was seen by his general dentist with an expansile, radiolucent lesion of the right posterior mandible. The patient stated that he noticed a right-sided facial swelling, which he described as “growing rapidly,” over the past week (although the exact duration of the lesion was unknown). He was unaware of any facial asymmetry or fullness before the past week, and he denied any associated pain or discomfort. Intraorally, the mandibular right gingiva showed buccal and lingual cortical expansion in the area of the first and second premolars (teeth nos. 28 and 29). Dr. Lee is a resident, Department of Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, New York, NY. Dr. Chen is a resident, the Department of Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, New York, NY. Dr. Furmanek is a resident, the Department of Oral and Maxillofacial Surgery, Columbia University Irving Medical Center, New York, NY. Dr. Eisig is the chair, Section of Hospital Dentistry; director, Division of Oral and Maxillofacial Surgery; and the chief, Hospital Dental Service, New York Presbyterian/Columbia University Medical Center, New York, NY. Dr. Peters is an assistant professor, Division of Oral and Maxillofacial Pathology, Columbia University Irving Medical Center, 630 West 168th St, PH15-1562W, New York, NY 10032.

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

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

Clinico-statistical Study of 338 Cases with Maxillofacial Fractures in the Last Five Years at the Division of Oral and Maxillofacial Surgery, Kishiwada Tokushukai Hospital

Clinico-statistical Study of 338 Cases with Maxillofacial Fractures in the Last Five Years at the Division of Oral and Maxillofacial Surgery, Kishiwada Tokushukai Hospital

Functional analysis of chondroitin 4 sulfate constituting osseointegration

Osseointegration can be defined as a direct connection, both structural and functional, between living bone and the surface of an artificial implant. Indeed, the word comes from the Greek term for 'bone' and 'to make whole'. In dentistry, once dental implants are placed, the body will react with osseointegration, enabling the implants to become a permanent part of the jaw. There are many benefits to this type of implant, compared with traditional tooth replacement options, not least that dental implants mimic the strength and functionality of a natural tooth. Dr Shuhei Tsuchiya is a researcher based in the Division of Oral and Maxillofacial Surgery at Nagoya University, Japan, who is interested in a range of areas, including regenerative medicine and the extracellular matrix. One of his key preoccupations, though, is shedding light on osseointegration. He and his team are working to unravel the mysteries of the mechanism.

Maxillofacial Injuries Due to Traffic Accidents.

The purpose of this retrospective study was to analyze the epidemiology, patterns, and management of maxillofacial due to road traffic accidents over a 17-year period. Between January 2001 and December 2017, 2924 patients with maxillofacial fractures were admitted to the Division of Maxillofacial Surgery, Turin, Italy.The following data were analyzed: age, gender, data of the trauma, alcohol and drug abuse, mechanism of injury, fracture site, facial injury severity scale, associated injuries, type of treatment, and length of hospital stay. Of the 605 patients included in the study, 419 were male and 186 were female (ratio, 2.2:1). The most common mechanism of injury was car accidents (62.6%).More than half of the patients had fractures of the middle third of the maxillofacial skeleton.Associated injuries were detected in 172 (45.5%) patients. In total 5.3% of patients did not undergo surgery. The average hospital stay was 7.3 days. This study shows an important reduction in maxillofacial fractures following road traffic accidents since the turn of the new millennium. At least in north-western Italy, road safety policies implemented in the last 30 years seem to have affected the behavior of motorists and motorcyclists.

Dental consultations requests to the maxillofacial surgery division in a brazilian hospital

Background: Dental consultations refer to the evaluation of an inpatient by a dentist, to guide the medical team's conduct. They contribute to a comprehensive inpatient healthcare and are a valuable educational element.

Facial paralysis of unknown etiology

A 71-year-old woman was seen at the Columbia University College of Dental Medicine owing to a 1-year history of progressive right facial paralysis and pain involving the area of the right parotid gland (PG) and ear. The pain had preceded the paralysis by 6 months and was described as a constant, burning sensation of moderate intensity. The woman had received care for this problem from several medical specialists, including prescriptions for an antiviral agent (acyclovir), anti-inflammatory medications (ibuprofen and prednisone), and acupuncture, to no avail. The patient had no other medical problems, and she denied use of medications other than those prescribed for the facial nerve palsy (FP). She was referred to the Salivary Gland Center at the Columbia University College of Dental Medicine after seeing her general dentist, who excluded an odontogenic cause for her facial discomfort. Dr. Kevin C. Lee is a resident, Division of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, New York, NY. Mr. Jason J. Lee is a research assistant, Salivary Gland Center, and a third-year dental student, 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, New York, NY. Dr. Mandel is the director, Salivary Gland Center, and an associate dean and a clinical professor, Division of Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, 630 W 168 St, New York, NY 10032.

Is Surgical Treatment Based on a 1-Step or 2-Step Protocol Effective in Managing the Odontogenic Keratocyst?

The literature does not present any consensus on a uniform treatment plan for odontogenic keratocysts (OKCs) and does not provide adequate evidence for determining which modality is most effective in lowering morbidity or preventing recurrence. The purpose of this study was to compare the effectiveness of surgical treatment based on a 1- versus 2-step protocol. The authors designed and implemented a retrospective cohort study and enrolled a sample of patients diagnosed with OKC from 1991 through 2018. The medical records of all cases were retrieved from files of the Oral and Maxillofacial Surgery Division of the Piracicaba Dental School (Piracicaba, Brazil). The predictor variable was treatment group (1- vs 2-step protocol). Statistical analysis was performed using Kaplan-Meier analysis, Mantel-Cox log-rank test, and proportional hazard regression analysis. The sample was composed of 72 patients (38 male) with a mean age of 40.72years. Thirteen patients received 1-step treatment and 59 received 2-step treatment. The complex composed of the body, angle, and mandibular ramus was the site most frequently affected. In the individual Kaplan-Meier analysis for each presented variable only involved tooth was significant (P = .0128 by log-rank test), with the risk of relapse 4.23 times higher for the involved tooth than for the non-involved tooth. The 1- and 2-step protocols for treatment of OKCs are safe and appropriate as the first treatment option, offering a conservative and effective option with low morbidity. Treatment protocols associated with systematic monitoring promote a better quality of life for patients with low potential for complications.

Clinical investigation of gustatory and neurosensory alterations following mandibular third molar surgery: an observational prospective study.

This study aimed to prospectively observe gustatory and neurosensory alterations following surgical removal of mandibular third molars. A prospective clinical study was conducted with patients who required mandibular third molar extraction, recruited from the Division of Oral and Maxillofacial Surgery at the Federal University of Ceará (Brazil). Age, sex, and radiographic signs were recorded. The outcome variables were the presence or absence of gustatory and neurosensory alterations. The patients were observed preoperatively and at 7, 30, 90, and 180days postoperatively by using gustatory and neurosensory tests. The response to sweet (p = 0.509) and sour (p = 0.078) stimulus did not alter significantly over time. The salty threshold significantly increased from the preoperative to 7- and 30-day postoperative periods, returning to baseline values at 90days postoperatively (p = 0.038). The bitter threshold increased significantly from the preoperative to 7-day postoperative period, returning to baseline values at 30days after surgery (p < 0.001). Regarding neurosensory evaluation, there was an altered response to stimulus at 7days postoperatively in specific studied areas, returning to baseline values 30days after surgery (p < 0.05). The present study shows that mandibular third molar removal was associated with slight sensory disturbances related to mechanical, tactile, and gustatory perception. Regarding the recovery period, all patients returned to normal function without intervention, over a period ranging from 30 to 90days. This study highlighted the importance of a sensory evaluation following removal of third molars, notably regarding mechanical perception and gustatory threshold assessment.

Investigation of an Opioid Prescribing Protocol After Third Molar Extraction Procedures

The United States is experiencing an epidemic of opioid overdoses and deaths. The relation between prescription opioids and opioid abuse is well documented. Oral and maxillofacial surgeons and other dentists are proportionately among the most prevalent prescribers of opioids. Practitioners are looking for evidence-based ways to decrease excess opioid prescriptions and adequately manage postoperative pain. The authors recently analyzed the impact of a mandated nonopioid prescribing protocol at their institution. Although broad guidelines have been useful for treating postoperative pain, there are no procedure-specific guidelines for managing pain after third molar extraction. The purpose of this study was to determine whether an opioid prescribing protocol was sufficient to decrease opioid prescribing after third molar extractions. This retrospective study compared the use of opioids prescribed for patients undergoing third molar extraction before introducing and after implementing a postoperative opioid prescribing protocol. The inclusion criterion was third molar extraction performed at the Division of Oral and Maxillofacial Surgery at the University of Minnesota (Minneapolis, MN) during the fourth quarters of 2015 and 2017 with complete records. The number of opioid prescriptions decreased and the number of nonopioid analgesics prescribed increased for all procedure codes after implementation of the protocol. Higher Current Dental Terminology (CDT) codes were associated with increased opioid prescriptions, indicating increased surgical difficulty was a rationale for opioid prescriptions. The mean number of opioid tablets per prescription was 15.9 in 2015 and decreased to 11.5 in 2017. No statistical difference was observed for average tablets for various CDT codes. Data from this study suggest an acute postoperative pain opioid prescribing protocol leads to fewer opioid prescriptions after third molar extraction procedures, less variance in opioid prescribing among practitioners, a decreased number of opioid tablets prescribed per patient, and safe and effective management of acute postoperative pain.

Molar Position and Surgical Time in Lower Third Molar Extraction

The aim of this research was to find the influence of lower third molar position in surgical time required for extraction of this molar. A prospective study was designed in patients at the Division of Oral and Maxillofacial Surgery at Universidad de La Frontera. Patients with ASA I and II and without oral diseases as aggressive periodontitis and oral infections were included. The third molar position was established in relation to Pedersen scale, Winter scale and Pell and Gregory scale, considering surgical time between the start of surgery and finalization of the procedure; data analyses was carried out with t test with statisticaldifferences when p&lt;0.05. Surgical time of 12±9 minutes was registered, and this was statistically associated to dental position and difficulty observed. It is therefore concluded that the position of the molar has an influence on surgical time.

Comparative evaluation of autofluorescence imaging and histopathological investigation for oral potentially malignant disorders in Taiwan

ObjectivesAutofluorescence imaging is gaining popularity as an adjunctive test for oral potentially malignant disorders (OPMD). This study evaluated the efficacy of autofluorescence imaging based on the current standard oral mucosal disorder checklist in Taiwan.Materials and methodsIn total, 126 patients suspected to have mucosal disorders at the Division of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei, Taiwan, were enrolled. Following a conventional oral examination by using the oral mucosal disorder checklist and an autofluorescence imaging examination, all participants underwent histopathological examination to access epithelial dysplasia.ResultsAmong 126 patients, 68 patients were diagnosis as having an OPMD and 63 having epithelial dysplasia. Autofluorescence imaging exhibited a sensitivity, specificity, positivity predictive value (PPV), negative predictive value (NPV), and accuracy of 77.94%, 35.42%, 63.10%, 53.13%, and 60.34%, respectively, for OPMD and of 88.89%, 43.86%, 63.64%, 78.13%, and 67.50%, respectively, for epithelial dysplasia. After the exclusion of 48 non-OPMD cases according to the checklist, the sensitivity, specificity, PPV, NPV, and accuracy of autofluorescence imaging became 87.50%, 72.73%, 94.23%, 53.33%, and 85.07%, respectively, for epithelial dysplasia.ConclusionThe efficacy of epithelial dysplasia identification and OPMD risk assessment can be increased after the exclusion of the non-OPMD cases through autofluorescence imaging.Clinical relevanceAutofluorescence imaging is a useful adjunct that can assist specialists in assessing OPMD patients prone to dysplasia without compromising patient care.

Is the removal of osteosynthesis plates after orthognathic surgery necessary? Retrospective long-term follow-up study

The removal of titanium miniplates is a controversial topic in oral and maxillofacial surgery. This retrospective study examined the timing of and reasons for titanium plate removal after orthognathic surgery. The study included 240 orthognathic surgery patients (71 male, 169 female; age range 16–55 years, mean 25.0±8.8 years) who had maxillofacial osteosynthesis plates inserted or inserted and then removed at the Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, between April 2003 and March 2017. During the study period, a total of 717 miniplates were inserted in the 240 patients, and 71 of the patients (29.6%) had 236 plates (32.9%) removed. Ten patients (14.1%) had their plates removed within a year due to early complications. Although no patient had their plate removed due to complications at 1–5 years postoperative, a further 14 patients (19.7%) had their plates removed after more than 5 years of long-term follow-up due to plate-related complications. Complications requiring plate removal were evidently biphasic, occurring within 1 year after the operation and at ≥5 years after the operation. Therefore, after confirming postoperative bone healing, it is necessary to explain to patients the risks of plate removal and the importance of long-term follow-up.

2004 年から2017 年までの岩手医科大学歯学部口腔顎顔面再建学講座口腔外科分野（旧・口腔外科第二講座，歯科口腔外科学講座） の基礎研究について

2004 年から2017 年までの岩手医科大学歯学部口腔顎顔面再建学講座口腔外科分野（旧・口腔外科第二講座，歯科口腔外科学講座） の基礎研究について

Occupational group, educational level, marital status and deleterious habits among individuals with maxillofacial fractures: retrospective study.

BackgroundTo investigate the occupational profile, educational level, marital status and deleterious habits to the health of patients with maxillofacial fractures of a population of northeastern Brazil.Material and MethodsA retrospective study of patients records admitted to the Division of Oral and Maxillofacial Surgery at the Walter Cantídio University Hospital (Fortaleza, Brazil) who sustained maxillofacial fractures was conducted in the period between 2006 and 2015.ResultsA total of 338 patients rendered 355 fractures. Males were the most affected (p<0.001), with prevalence in the third decade of life (p<0.001). There was a predominance of motorcycle accidents (p<0.001), home workers (p<0.001), low educational status (p = 0.032), and no cigarette use (p<0.001) or alcohol (p = 0.023). Fractures of the zygomatic-orbital complex were the most prevalent in the sample (p<0.001).ConclusionsThe sociodemographic profile exerted a significant influence on the epidemiological profile of maxillofacial fractures in a Brazilian population during the study period. Key words:Epidemiological studies, trauma, facial bones.

石心会さやま総合クリニック歯科口腔外科における病理組織学的検査の検討（第1報）

石心会さやま総合クリニック歯科口腔外科における病理組織学的検査の検討（第1報）

Abstract: Utility of Postoperative Mandibulomaxillary Fixation after Rigid Internal Fixation of Isolated Mandibular Fractures

INTRODUCTION: The goal of treating mandibular fracture centers on re-establishing continuity of the mandible for bony union and occlusion. Many maxillofacial surgeons feel unnecessary to place the patients on post-surgical mandibulomaxillary fixation (MMF) after open reduction and stable internal fixation (ORIF). However, many feel necessary to add MMF after rigid internal fixation for improved follow up visit, and ‘soft tissue rest’ which may be associated with decreased wound complications.1,2 The purpose of this study is to retrospectively analyze if patients undergoing ORIF with post-operative MMF have improved outcome compared with those treated with ORIF alone at a major trauma center. MATERIALS AND METHODS: A two-year retrospective review was performed on mandibular fractures which were treated by Division of Plastic, Reconstructive & Maxillofacial Surgery at R. Adams Cowley Shock Trauma Center / University of Maryland Medical Center, and Department of Oral & Maxillofacial Surgery. Patients who underwent ORIF of one or more mandibular fractures were included. Edentulous patients, and those who underwent non-rigid fixation or suffered other facial fractures were excluded. Two groups of patients were analyzed: one group was placed on MMF post-operatively after ORIF (‘ORIF+MMF’); the other group had MMF removed intra-operatively after ORIF (‘ORIF only’). Post-operative complications and follow up compliance were compared between these two groups. RESULTS: A total of 100 patients were analyzed; 54 patients were in the ORIF+MMF group, and 46 patients were in the ORIF only group. Average follow up was 3.8 months. Average duration of MMF in ORIF+MMF group was 4.2 weeks (range 1 – 13.3wks). The difference between the two groups was compared using an unpaired t test and p<0.05 for significance. The two groups were similar in terms of age, sex, weight, number or fractures, and smoking status (P<0.05). There was no significant difference in post-operative complications between the two groups (P=0.45); with 22 complications in ORIF+MMF group and 13 complications in ORIF only group. Follow-up compliance was higher in the ORIF+MMF group with 3 patients lost to follow-up compared to 9 in the ORIF only group (P<0.05). CONCLUSION: This study showed that post-operative MMF does not improve clinical outcome after ORIF in dentate patients with isolated mandible fractures. However, the use of post-operative MMF may improve follow-up rates. DISCLOSURE/FINANCIAL SUPPORT:No financial support. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Shenoy NA, Shah N, Shah J. A questionnaire survey on postoperative intermaxillary fixation in mandibular trauma: Is its use based on evidence? Natl J Maxillofac Surg. 2011;2(2):141–146. 2. Saman M, Kadakia S, Ducic Y. Postoperative maxillomandibular fixation after open reduction of mandible fractures. JAMA Facial Plast Surg. 2014;16(6):410–413.

An analysis of 711 victims of interpersonal violence to the face, Turin, Italy.

The aim of this work is to analyze the risk factors in interpersonal violence and to describe the epidemiology, patterns and management of maxillofacial fractures in high volume trauma center of the northern Italy. This retrospective study recorded patients hospitalized with maxillofacial fractures, at the division of maxillofacial surgery, Città della Scienza e della Salute University Hospital, Torino, Italy, since January 2001. Only patients who presented with "violence" in the database field for "cause of injury" and with "interpersonal violence" as a subtype of etiology were considered. Statistical analysis was determined using the χ(2) or Fisher's exact test. 2567 patients were admitted. 711 patients (27.7%) had undergone interpersonal violence that has increased from 20% to 35% in the study period. The male-to-female ratio was 11:1; the mean age was 32.7. 247 patients were foreigners (34.7%). 107 patients were enrolled in that study, referred alcohol or drugs abuse. IPV episodes account for 953 maxillofacial fractures localized in 55.3% of the cases in the midface, 43.1% in the lower third. Particularly the trauma involved the orbital region and the maxillo-orbito-zygomatic region. 4.4% of patients had combined trauma. IPV maxillofacial fractures in Europe such as in Italy are becoming one of the first cause of injuries. This study shows that young males and foreigners are involved in violence mostly during the weekend. These fractures occur due to fists frequently involving the maxillo-zygomatic-orbital complex.

Arthroscopy of the Temporomandibular Joint in Patients With Juvenile Idiopathic Arthritis

The early diagnosis of temporomandibular joint (TMJ) involvement in patients with juvenile idiopathic arthritis (JIA) before joint destruction and growth disturbances could allow for interceptive treatment. The purpose of this article is to report early TMJ arthroscopic findings in patients with JIA. This was a case series of 3 patients with JIA treated at the Emory University Division of Oral and Maxillofacial Surgery from July 2011 through December 2012. Patients were included if they had a confirmed diagnosis of JIA, did not respond to anti-rheumatologic medication, and had TMJ pain or limited mouth opening. All patients underwent TMJ arthroscopy with an injection of triamcinolone hexacetonide. Demographics, medical history, magnetic resonance imaging findings, arthroscopic findings, and postoperative course were reported. Three female patients (mean age, 12.5yr; 5 joints) underwent arthroscopy. Arthroscopic findings consisted of mild to moderate synovitis and grade 2 to 4 chondromalacia with or without fibrosis. Postoperatively, all patients had improvement in pain and mouth opening. There was a positive correlation between duration of JIA activity in the TMJ and severity of arthroscopic findings. Arthroscopic lysis and lavage combined with triamcinolone hexacetonide injection resulted in improvement in pain and range of motion.