Maxillofacial Surgery Patients Research Articles

Risks of Oral and Maxillofacial Surgery in Patients with Thyroid Dysfunction: Proper Management Strategies

Oral and maxillofacial surgery encompasses procedures for correcting mouth, jaw, and facial issues, posing challenges in patients with thyroid dysfunction due to its impact on the coagulation system. Many authors noted a rise in thyroid disease among younger adults, affecting surgeries traditionally performed in this demographic. Thyroid dysfunction alters hemostasis, with hyperthyroidism increasing thromboembolic risks and hypothyroidism impairing wound healing and causing bleeding tendencies. In OMF surgery, hyperthyroid patients face thromboembolic risks, requiring preoperative assessment, thyroid normalization, and anticoagulant prophylaxis. Hypothyroid patients need optimized hormone therapy, careful hemostasis, and postoperative monitoring. Multidisciplinary collaboration among endocrinologists, surgeons, and hematologists is crucial for tailored management strategies. In conclusion, understanding thyroid dysfunction's hemostatic impact is vital for safe OMF surgery, necessitating personalized perioperative care strategies.

Capnography-assisted airway management by awake blind nasal intubation in maxillofacial surgeries: An observational study

Background: Maxillofacial surgery patients frequently pose challenges to airway management due to anatomical and functional constraints. While fiber-optic-aided nasotracheal intubation is considered the gold standard, not all medical facilities have access to fiber-optic bronchoscopes, particularly in low-resource settings. In such situations, awake nasal tracheal intubation is often the safest approach for managing patients with known or suspected difficult airways. Aims and Objectives: (1) To assess the technique of capnography-assisted airway management by awake blind nasal intubation (ABNI) in maxillofacial surgeries. (2) To find out any complications encountered by the technique of capnography-assisted airway management by ABNI in maxillofacial surgeries. Materials and Methods: 40 patients undergoing various maxillofacial surgeries and in whom blind nasotracheal intubation was attempted were included in this study. The institutional ethical committee approved the study, and informed consent was obtained from all the patients. The number of attempts for ABNI, successful versus failed ABNI, and complications encountered were studied. SSPS 21.0 software was used for statistical analysis. Results: There were 23 (57.50%) males and 17 (42.50%) females. There was a male preponderance, with the M: F ratio being 1:0.73. The mean age of the patients was 40.97±8.92 years. In 36 (90%) of the patients, the intubation could be successfully done. In 19 (47.50%) patients, blind nasal intubation was successfully done in the first attempt; 2 attempts were required in 15 (37.50%) patients, and 3 attempts were required in 2 (5%) patients. Epistaxis (10%) and sore throats (7.5%) were the most common complications in the studied cases. Conclusion: Capnography-assisted ABNI is an effective technique for airway control in patients undergoing maxillofacial surgeries with an acceptable complication rate.

Magnitude, associated factors of difficult airway, and predictive value of airway examinations among maxillofacial surgery patients at public hospitals in public hospitals in Southern Ethiopia: A multicentre cross-sectional study

Background: “Difficult airway” is the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with mask ventilation, laryngoscopy, and difficulty with tracheal intubation, or both. Associated factors and predictive value difficult airways, maxillofacial surgery study setup is under studied Objective: To determine the magnitude and associated factors of difficult airways and predictive value of airway examinations among adult patients who underwent maxillofacial surgery at public hospitals in Southern Ethiopia 2022. Methods and Materials: An institutional-based multicenter cross-sectional study was conducted among 250 maxillofacial patients from March to June 30, 2022 at selected hospitals. The data were entered into Epi_Data software version 4.3 and analyzed by STATA software version 14. All variables that were statistically significant in bivariate analysis, at the P < 0.25, were included in the multivariate logistic regression analysis. The predictive value or the effectiveness of airway examinations in predicting difficult airways was analyzed by ROC. Results: In the current study, the magnitude of difficult airways was 21.2%( 95% CI = 16.3%-26.1%) and the magnitude of difficult intubation, difficult laryngoscopy, and difficult mask ventilation was 6.4% ( 95% CI3.3%-9.4%), 9.6% ( 95% CI6.1%-13%), and 13.6% ( 95% CI (9.1%-16.8%), respectively. History of head and neck surgery AOR=6.3, 95%CI (2.85-14.34), cervical collar AOR=4.9, 95%CI (1.96-12.49), and cervical spine injury AOR=2.4, 95%CI (1.07-5.38)] were independently and significantly associated with difficulty of airway. Modified Mallampati class and sternomental distance were identified as good preoperative tests to predict difficult laryngoscopy, intubation, and mask ventilation Conclusion and recommendation: The magnitude of difficult airways was maxillofacial surgery. Among various airway assessment tests, no single test was perfectly accurate. Anesthesia professionals are recommended to use a combination of pre-operative airway assessments.

Use of Integra® on avascular tissue

Integra® (Integra LifeSciences) is a well-known dermal regeneration template used in partial and full-thickness wound reconstruction. It can be applied directly on to vascular tissue to create a bed for a skin graft, which is often placed in a second surgery. We present our experience of its novel use in oral and maxillofacial surgery patients, using it directly on bone and cartilage (avascular tissue) without further skin grafting. Patients who required full-thickness excision of lesions down to bone or cartilage and who were treated using Integra® were included. After scalp or ear lesion resection, the collagenous dermal layer of Integra® was placed directly on to bone or cartilage and, along with its outer silicone epidermal layer, secured to the defect with absorbable sutures and a bolster dressing. The wounds were kept dry for 14 days, at which point the dressing and silicone were removed and patients continued regular wound care. Seventeen patients were included, 15 of whom had squamous cell carcinoma. One was lost to follow up. The rest achieved complete healing of the defect. Histology showed epidermis developing on the Integra® surface and at one year, the appearance of normal scarred skin. This novel approach could redefine the uses of Integra®, avoiding the need for free-flap surgery or skin grafting when reconstructing large defects. Further resection of close margins or recurrence is easier after reconstruction using dermal regeneration material than after reconstruction with a local or free flap.

Design and Simulate Intracranial Support to Guide Maxillo Surgery: A Study Based on Bioengineering.

Intraoperative navigation allows for the creation of a real-time relationship between the anatomy imagined during diagnosis/planning and the site of surgical interest. This procedure takes place by identifying and registering trustworthy anatomical markers on planning images and using a point locator during the operation. The locator is calibrated in the workspace by placing a Dynamic Reference Frame (DRF) sensor. This study aims to calculate the localization accuracy of an electromagnetic locator of neuro-maxillofacial surgery, moving the standard sensor position to a different position more suitable for maxillofacial surgery. The upper dental arch was chosen as an alternative fixed point for the positioning of the sensor. The prototype of a bite support device was designed and generated via 3D printing. CT images of a skull phantom with 10 anatomical landmarks were acquired. The testing procedure consisted of 10 measurements for each position of the sensor: precisely 10 measurements with the sensor placed on the forehead and 10 measurements with the sensor placed on the bite support device. It also evaluated the localization error by comparing the two procedures. The localization error, when the sensor was placed on the bite support device, was lower in the sphere located on the temporal bone. It was the same in the spheres located on the maxillary bone. The test analysis of the data of the new device showed that it is reliable; the tests are reproducible and can be considered as accurate as the traditional ones. In addition, the sensor mounted on this device has proven to be slightly superior in terms of accuracy and accuracy in areas such as the middle third of the face and jaw. The realization of the bite support device allowed the sensor to change position concerning its natural site. This procedure allows us to explore structures, such as the frontal site, which were initially difficult to approach with neuronavigation and improves the approach to midface structures, already studied with neuronavigation. The new calibration, with the position of the sensor on the support device in the same reference points sphere, highlighted the reduction in the location error. We can say that the support proposed in this study lays the foundations for a new navigation approach for patients in maxillofacial surgery, by changing the position of the sensor. It has strong points in improving the localization error for some reference points without determining disadvantages both in the calibration and in the surgical impediment.

Perioperative Optimization and Management of the Oral and Maxillofacial Surgical Patient: A Narrative Review on Updates in Anticoagulation, Hypertension and Diabetes Medications

PurposeThe preoperative management guidelines of surgical patients are constantly evolving as newer evidence-based research is published. Oral and maxillofacial surgeons need to be current with the increasingly more complex new drug therapies and updated national association(s) guidelines. This narrative review provides a synopsis with important reference tables for updated preoperative optimization guidelines for anticoagulation, antiplatelet therapy, antihypertensive management, and glycemic control in the preoperative period for the oral and maxillofacial surgery patient. It also includes the most current anesthesia guidelines on glucagon-like peptide (GLP-1) receptor agonists. MethodsThe search strategy utilized pubmed.gov to identify the most recent national society guidelines and review articles pertinent to perioperative anticoagulation, antiplatelet therapy, antihypertensive management, and glycemic control. ResultsThe search identified 75 articles from the American College of Surgeons, American Heart Association, American Society of Anesthesiologists, American College of Cardiologists, in addition to recent reviews discussing the standard of care for optimization of patients in the perioperative period. ConclusionMedical optimization prior to surgery is important for safe and efficient surgical practice and has been shown to improve overall mortality. This narrative review provides a summary of the current data with recommendations focusing on four key points.

Effectiveness Of Computed Tomography-Guided Nasotracheal Intubation Procedure On Predicting Tube Advancement Difficulty And Preventing Epistaxis: A Prospective Case-Control Study.

To evaluate the effectiveness of computed tomography-guided nasotracheal intubation procedure in predicting tube advancement difficulty and preventing epistaxis. The prospective study was conducted at Erciyes University Faculty of Dentistry from April 2018 to June 2019 and comprised maxillofacial surgery patients of either gender aged 18-50 years who were due to undergo bimaxillary orthognathic surgery, which was defined as American Society of Anaesthesiology grade I or II. The space where the tube was to be passed in the internal nasal valve region was measured horizontally and vertically using computed tomography. A single experienced anaesthesiologists intubated all the patients who were later divided into 'easy' group A and 'difficult' group B on the basis of the effort required to advance the tube through the nasal passage. Data was analysed using JASP version 0.14.1.0). Of the 60 patients, 42(70%) were females and 18(30%) were males. The overall mean age was 29.0±10.5 years and the mean body mass index value was 23.6±4.0 kg/m 2 (p>0.05). There were 28(46.6%) patients in group A, and 32(53.3%) in group B. Median distances were significantly shorter and epistaxis was significantly higher in group B compared to group A (p<0.001). The cut-off values to reveal the distance at which difficulty may be experienced while advancing the tube, determined through receiver operating characteristic analysis, were 1.09 cm for vertical and 0.39cm for horizontal distances. The nasotracheal intubation procedure under the guidance of computed tomography could help predict the difficulty of tube advancement, and could thus prevent epistaxis and other related nasal intubation complications. Clinical trial number: NCT05525754.

Can a Social Media Application be a Valid Educational Tool for Oral and Maxillofacial Surgery Patients?

TikTok (ByteDance, Beijing, China) is the fastest growing social media application (SMA) to date and has become a major source of information for medicine. The rising use of media platforms by patients and practitioners alike plays a significant role in the perception of healthcare. The purpose of this study is to identify the presence and popularity of oral and maxillofacial surgery content on the SMA, to measure whether the information shared is useful for viewers, and whether there are differences in quality of the videos between video content producer groups. A cross-sectional study was used to evaluate oral and maxillofacial surgery content on the SMA. Included videos were published during a 3-month period (November 16, 2021 to February 17, 2022) and mentioned "oral surgery" or "wisdom teeth" in the video description, title, or hashtag. The independent variable was video content producer-content created by health professionals versus laypersons. Quality of each video was determined by the information in the video and its usefulness, using the Global Quality Scale (GQS) criteria. Topic was categorized as educational or anecdotal. Popularity was measured by the number of likes accumulated. Statistical analysis was performed using 2-sample t-tests. Statistical significance was achieved with a P value < .05 with 95% confidence interval. Of 558 videos searched, 426 videos met study criteria. GQS score was greater in health professional videos (MHP=3.30) versus layperson videos (ML=2.05) (P<.05). Most video content producers were laypersons (69%) and videos were mostly anecdotal (87%). Health professional videos had greater popularity than layperson videos (P<.05). Health professionals and laypersons averaged 25,148 likes and 2,109 likes, respectively. All videos combined totaled 3,939,685 likes. By analyzing GQS and the popularity of videos, it has shown that health professionals produced higher quality videos along with greater number of likes. With 39% of videos by health professionals being educational, it shows that we are using the SMA to instruct patients. However, there is still room to produce more educational rather than anecdotal videos with the goal to provide accurate information to patients.

Accuracy of on-site teleoperated milling with haptic assistance

PurposeIn bone surgery specialties, like orthopedics, neurosurgery, and oral and maxillofacial surgery patient safety and treatment success depends on the accurate implementation of computer-based surgical plans. Unintentional plan deviations can result in long-term functional damage to the patient. With on-site teleoperation, the surgeon operates a slave robot with a physically-decoupled master device, while being directly present at the operation site. This allows the surgeon to perform surgical tasks with robotic accuracy, while always remaining in the control loop.MethodsIn this study the master- and slave-side accuracy of an on-site teleoperated miniature cooperative robot (minaroHD) is evaluated. Master-side accuracy is investigated in a user study regarding scale factor, target feed rate, movement direction and haptic guidance stiffness. Scale factors are chosen to correspond to primarily finger, hand, and arm movements. Slave-side accuracy is investigated in autonomous milling trials regarding stepover, feed rate, movement direction, and material density.ResultsMaster-side user input errors increase with increasing target feed rate and scale factor, and decrease with increasing haptic guidance stiffness. Resulting slave-side errors decrease with increasing scale factor and are < 0.07 mm for optimal guidance parameters. Slave-side robot position errors correlate with the feed rate but show little correlation with stepover distance. For optimal milling parameters, the 95th percentile of tracked slave-side position error is 0.086 mm with a maximal error of 0.16 mm.ConclusionFor optimal guidance and milling parameters, the combined error of 0.23 mm is in the range of the dura mater thickness (< 0.27 mm) or mandibular canal wall (~ 0.85 mm). This corresponds to safety margins in high-demand surgical procedures like craniotomies, laminectomies, or decortication of the jaw. However, for further clinical translation, the performance and usability of on-site teleoperated milling must be further evaluated for real-life clinical application examples with consideration of all error sources in a computer-assisted surgery workflow.

Trends in emergency room visits of oral and maxillofacial surgery patients in a tertiary hospital in South-East Nigeria

Trends in emergency room visits of oral and maxillofacial surgery patients in a tertiary hospital in South-East Nigeria

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.

Construction and application of virtual patients in prosthodontics

In recent years, with the rapid development of digital technology, the application of oral virtual patients in prosthodontics, orthodontics, oral and maxillofacial surgery, and other disciplines has gradually increased. Although the focus on oral virtual patients varies in different disciplines, the application of oral virtual patients in assisting the prediction of treatment effects and the formulation of treatment plans will have good prospects. The construction accuracy and presentation effects of oral virtual patients can be influenced by the source of three-dimensional (3D) image, and methods of registration. Based on the studies and clinical experiences of our team, researches of other teams, the source of 3D images, the construction methods, and the clinical applications of virtual patients in prosthodontics will be presented, so as to provide a reference for normalized application and development of oral virtual patients and to offer a future development direction of oral virtual patients.

Evaluation of Anxiety and Experience of patients presented with Maxillofacial Trauma in Nishtar Institute of Dentistry

Aim: To evaluate the anxiety in patients of maxillofacial trauma using HAM-A scale presenting in emergency department and compare it with elective maxillofacial surgery patients Study design: Analytical cross sectional study. Place and duration of study: Study was conducted from May 2021 to Apr 2022 at Dental unit of Nishtar Institute of Dentistry. Methodology: 80 patients who met the inclusion criteria were included. Inclusion criteria was any patient aged between 12-80 years irrespective of gender who got isolated facial trauma, patients with no previous history of psychological disorder. Hamilton anxiety scale was used to make a proforma which was filled by on duty post graduate trainee. p-value of ≤0.05 was significant. Results: There were 61 males (76.2%) and 19(23.8%) females. Mean age of patients in group A (facial trauma) was 40.5±15.20 years and in group B (elective surgery) was 50.2±10.47 years. HAM-A score in group A was 25.15±9.74 (moderate to severe anxiety) and in group B it was 12.12±4.44 (mild anxiety) which was statistically significant. (p value 0.00). Conclusion: Maxillofacial injuries may pose a heavy impact psychological lives of patients and patients may suffer from anxiety and depression. A multidisciplinary team approach with surgeon and psychiatrist be included to reduce physical damage and psychological impact on patients. Keywords: Anxiety, depression, maxillofacial trauma

ПАТОГЕНЕТИЧЕСКИЕ ПАРАЛЛЕЛИ ОСТЕОПОРОЗА И ХРОНИЧЕСКОГО ПАРОДОНТИТА. ЛИТЕРАТУРНЫЙ ОБЗОР

Subject. Parallels in the pathogenesis of two severe diseases of the modern era, osteoporosis and periodontitis.&#x0D; Objectives. To review domestic and international research on pathogenetic relationship between osteoporosis and periodontal pathology.&#x0D; Methodology. In topic generalization, the review of publications (since 2016) available on PubMed, eLIBRARY, Web of Science, Scopus by keywords is made.&#x0D; Conclusion. Research studies have shown that bone tissue in the orofacial region, though lesser than bones of axial skeleton, tends to develop osteoporosis. That is why patients with osteoporosis are recommended regular periodontal maintenance visits, especially when periodontal disease is diagnosed at the appointment or during the complex rehabilitation program for patients in osteoplastic and maxillofacial reconstructive surgery. Future controlled longitudinal studies may be useful in research of this relationship based on the features of osteogenesis in the both diseases. This literature review helps to develop modern views of pathogenetic relationship between osteoporosis and periodontitis, evaluate general risk factors, promote understanding of tools in the diagnostic process and interpretation of results. Moreover, with the help of this paper by knowing the cell and molecular structure of bone tissue and mechanisms of bone remodeling a dental practitioner can arrange a personalized follow-up strategy for patients in the risk group for the above two diseases timely engaging general practitioners in interdisciplinary and complex therapy of patients with periodontal pathology.

Risks and possible complications in maxillofacial surgery patients during or after coronavirus infection

This review/prognostic article briefly shows the pandemic features of COVID-19, morphological changes in blood vessels in COVID-19, mainly related to endotheliitis and thrombosis of small vessel branches. Cases of COVID-19 complications occurring in the practice of maxillofacial surgeons are given. Regarding possible complications during invasive interventions on the head and neck, we believe it is possible to consider COVID-19 in the anamnesis of patients in the departments of maxillofacial surgery as a new risk factor, and in case of severe course and prognosis of possible complications, as a contraindication for manipulations in the head and neck area.

Is There a Weekend Effect in the Management of Maxillofacial Trauma Patients?

Many previous studies have shown that patients admitted to the hospital at weekends have a longer delay than those on weekdays. It has been proposed that the equality of specialist services throughout the week could mitigate the 'weekend effect.' This study aimed to determine whether or not a weekend effect is observed in Oral and Maxillofacial surgery patients at a medical college and teaching hospital. Our primary predictor variable was the day of admission. Our primary outcome of interest was the length of hospital stay from admission to operation. Descriptive analysis, correlation analysis, One way ANOVA, and post hoc comparison were performed for statistical analysis. Out of 1185, 1005 (84.8%) were male and 180 (15.2%) female, with a mean age of 30.3 (SD=14.1) years. There was a significantly higher admission on weekends, Friday, and Saturday, and the weekend admissions were associated with a longer delay from admission to operation. The night shift was also associated with a longer delay from admission to operation. The diagnosis based procedure had the most significant effect on delay from admission to operation. The patient's age and gender had no association with the primary outcome. There is a delay in the definitive treatment of maxillofacial surgery patients admitted on weekends. These findings have implications for adequate staffing and resource allocation on the weekends based on admission volume.

Update on Management of the Oral and Maxillofacial Surgery Patient on Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) have been the cornerstone for the treatment of depression, anxiety, obsessive-compulsive disorder, and panic disorder for a wide spectrum of age groups. Although the beneficial therapeutic properties are well recognized by the medical community, it also possesses many undesirable adverse effects with clinical manifestations. Some of the effects can be severe. This chapter highlights use of SSRIs, the mechanism of action, medication dosages, common drug to drug interactions, and recommendations on management of the oral and maxillofacial surgery patient on SSRIs.

Medication for Gravid and Nursing Oral and Maxillofacial Surgery Patients.

The purpose of this article is to clarify clinically impactful features of the perioperative and postoperative pharmacologic management of pregnant and lactating patients in the maxillofacial or dental setting. Before prescribing any drug to a nursing mother or pregnant patient, the maxillofacial surgeon and other dental and medical providers should consider the available evidence, benefits, and risk for that particular drug. There are many complex factors to consider when prescribing in order to maintain the safety of the pregnant individual, fetus, and infant. This article aims to provide concise, memorable, and actionable information to use in your clinical practice.

Use of primary screening tools as a pre-surgical evaluation protocol for obstructive sleep apnea in maxillofacial surgery patients

Obstructive Sleep Apnea (OSA) is implicated in the etiology of numerous serious health problems. The aim of this study is to screen suspected cases of OSA, create awareness amongst patients at risk and propose a cost effective and easy screening protocol for OSA. An observational study which included screening of patients posted for surgery, at department of Oral and Maxillofacial Surgery using detailed history and clinical examination, STOP BANG questionnaire, lateral cephalogram and overnight pulse oximetry in a step wise manner. The data obtained was analysed to determine the relationship of each test parameter to the final risk scoring and overnight Oxygen Desaturation Index (ODI). In this study, over a period of one year, out of 124 cases, 40 cases (32.3%) were categorized as intermediate or high-risk cases for presence OSA, according to the STOP-BANG questionnaire. 11 cases (26.2%) were screened as high-risk based on ODI value. There was a strong correlation between risk factors such as snoring, obesity, male gender, excessive daytime sleepiness, hypertension and OSA. We can categorize the patients as low, intermediate and high-risk cases and accordingly advise them for further polysomnography studies, lifestyle modifications or oral appliances and take the necessary peri-operative precautions for intermediate or high-risk cases where surgery is mandatory.

COVID 19 Pandemic - Present And Future recommendations/guidelines to manage the patients in oral and maxillofacial surgery.

COVID 19 Pandemic - Present And Future recommendations/guidelines to manage the patients in oral and maxillofacial surgery.