Maxillofacial Surgery Procedures Research Articles

Primary closure after surgical extraction of mandibular third molar with or without tube drain: A prospective study.

Introduction:The surgical removal of impacted third molars is considered one of the most frequent procedures in oral and maxillofacial surgery. The utilization of drain is suggested for the reduction of postoperative complications, because it permits the drainage of the fluids located in the tissue spaces.Material and Methods:A prospective randomized clinical study was conducted with 30 patients each in two groups undergoing surgical extraction of mandibular third molars with and without drain. For the group with drain, a small no. 8 size rubber drain was used. Patients were evaluated for postoperative pain, swelling, and trismus.Result:The trismus was greater (highly significant with P < 0.001) on the first, third, and seventh postoperative days in the control group. When swelling was being evaluated, highly significant statistical difference was observed between the two groups on the first and third postoperative days (P < 0.001), but on the seventh postoperative day, there was no statistically significance (P > 0.05). On comparison of postoperative pain, there was no statistically significant difference between any follow up days.Conclusion:Use of tube drain is effective in reducing the postoperative discomfort in terms of pain, swelling and trismus after surgical removal of impacted mandibular third molar.

The effect of triangular and reversed triangular flap designs to post third molar odontectomy complications (a pilot study).

BackgroundOdontectomy is one of the most common surgical procedures in oral and maxillofacial surgery. Flap design influences the post operative complications. Triangular flap is the most widely used flap design but it has many shortages such as dehiscence, alveolar osteitis, reactionary bleeding, and periodontal disruption distal of second molar. The aim of this study is to introduce an alternative flap design in the surgical removal of impacted mandibular third molars – reversed triangular flap – and to compare this flap design with the triangular flap in case of dehiscence, reactionary bleeding, and clinical attachment loss. Material and MethodsThis prospective, split-mouth study involved 15 patients with bilateral partially impacted mandibular third molars with similar impaction classification. One impacted tooth was removed using a triangular flap and the other using a reversed triangular flap. Post operative complications such as dehiscence, reactionary bleeding, and clinical attachment loss were recorded 1, 3, 7, 14, and 30 days post odontectomy. ResultsChi square test result shows that there were fewer incidences of dehiscence seven days post surgery using the reversed triangular flap (p=0.032). Mann Whitney-U test result shows that the reversed triangular flap exhibited less bleeding score on day 1 (p=0.002) and day 2 (p=0.035) post surgery. There were no statistically significant differences according to Mann Whitney-U test between the flap designs for the clinical attachment loss on distal of second molar on day 14 (p=0.512) and day 30 (p=0.902) post surgery. ConclusionsThe reversed triangular flap design is preferable to triangular flap for impacted third molar surgery, escpecially in terms of wound dehisence and reactionary bleeding. Key words:Flap design, third molar impaction, odontectomy, post odontectomy complications.

Emerging challenges and possible strategies in maxillo-facial and oral surgery during the COVID-19 pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic suddenly took the world by storm and Italy was one of the hardest hit countries. Maxillo-facial surgery and dentistry procedures had to be significantly reorganized, since they are considered high-risk procedures. Protocols had to be changed and interdepartmental cooperation was put in place to plan surgical interventions and maintain high standards. Various improvements have been made to prevent and reduce the risks of spreading the infection. Even if the situation seems to have improved, being unprepared is not an option. In this paper the experience gained during these months has been shared and possible future challenges has been highlighted, suggesting practical adjustments based also on new guidelines and recommendations.

Comparing Video and Direct Laryngoscopy for Nasotracheal Intubation.

This parallel group randomized controlled clinical trial compared intubation duration and success using video laryngoscopy (VL) versus direct laryngoscopy (DL) during routine nasotracheal intubation. Fifty patients undergoing oral and maxillofacial surgery under general anesthesia were randomly assigned into 2 groups receiving either VL or DL to facilitate nasotracheal intubation. The primary outcome was the amount of time required to complete nasotracheal intubation. The secondary outcomes included the success of first attempt at intubation and the use of Magill forceps. Results demonstrated a mean time to intubation of 142 seconds in the DL group and 94 seconds in the VL group (p = .011). First attempt intubation success was 92.0% in the VL group and 84.0% in the DL group (p = .34). The use of Magill forceps was significantly increased in the DL group (p = .007). VL for routine nasotracheal intubation in oral and maxillofacial surgery procedures results in significantly faster intubation times and decreased use of Magill forceps compared with traditional DL.

Optimising the management of concurrent symphyseal/parasymphyseal and bilateral extracapsular condylar fractures using three-dimensional printing.

Three-dimensional (3D) printing plays an important role in the diagnosis and treatment planning of many elective procedures in oral and maxillofacial surgery (OMFS). 3D printers and the associated print materials are now within the price range of most maxillofacial units, requiring less work to be sent out to commercial printers. Whilst their use in the planning of elective procedures is commonplace, acute trauma is an area where 3D printing remains underutilised. The successful management of complex fracture patterns such as concomitant symphyseal/parasymphyseal and bilateral condylar fractures often warrants this approach. Freeware digital processing and manipulation software packages were used to view and segment structures from computed tomography (CT) data. Thereafter, fractures were digitally reduced. 3D printed models were produced from the digitally reduced models, allowing preoperative custom adaptation of osteosynthesis plates, facilitating accurate fracture fixation intraoperatively. For less than one hundred pounds sterling (STG), a 3D printer (with print material) capable of producing a model of sufficient quality can be purchased. The use of freeware digital processing software allows digital manipulation of CT data. Production of 3D models and plate adaptation can be carried out within hours after CT examination. The construction of digitally reduced 3D models and custom adapted plates enables the surgeon to achieve accurate fixation of complex fracture patterns in theatre which is clearly of benefit to patients. The potential for reduced theatre time also renders this approach more desirable, making this a worthwhile investment despite the additional non-clinical time associated with training and initial expenditure.

Comparison of naproxen and Gelofen for Pain relief in lower third molar surgery: A single-blinded randomized clinical trial

Abstract Objectives: Third molar surgeries are a routine procedure in oral and maxillofacial surgery and its associated pain is bothersome to patients. The purpose of this study was to compare the analgesic effect of Gelofen and naproxen in lower third molar surgery. Materials and Methods: A single-blinded randomized clinical trial was designed, and patients were randomly allocated into four groups (n = 20 cases in each group): pre-Gelofen group: 400 mg Gelofen 30 min preoperative and continuing every 6 h, Gelofen group: 400 mg Gelofen immediately postoperative and continuing every 6 h, pre-naproxen group: 500 mg naproxen 30 min preoperative and every 8 h, and naproxen group: 500 mg naproxen immediately postoperative and every 8 h. The pain intensity was recorded using the visual analog scale at 2, 6, 12, and 24 h after surgery. Results: Pain intensity decreased in a linear pattern in all groups after 2, 6, 12, and 24 h. In pre-naproxen group, pain decreased suddenly between 2 and 6 h, but after 6 h, pain relief was slower than other groups. The mean pain intensity at 2 h postoperative for the pre-naproxen group was significantly lower than Gelofen group, and at 6 h, it was less than all other groups. At 12 and 24 h after surgery, pain intensity in all groups was similar except for the Gelofen group. Conclusion: Under limitation of the present study, preoperative intake of naproxen showed more effective pain relief than other groups.

Audit on the Accuracy of Clinical Coding for Oral and Maxillofacial Surgery Procedures

Background: Recently numerous oversights have been noticed in the coding of oral and maxillofacial (OMF) procedures2. Clinical coding has important financial implications with discrepancies directly affecting the funding of the department and hospital1.

Rhabdomyolysis after the free fibular flap operation for mandibular reconstruction: a case report

BackgroundFree fibular flap is one of the most useful methods in the hard tissue reconstruction of the maxilla-mandible. Free fibular flap presents some advantages in which the reconstruction of both soft and hard tissues can be done at the same time. It also provides a safe and successful bone graft for the reconstruction, along with a low rate of complications. Despite these advantages and the rarity of a postoperative complication, particularly in oral and maxillofacial surgery procedures, a prolonged operation might exhibit some complications related with rhabdomyolysis. We experienced the rare event of rhabdomyolysis after oral cancer surgery.Case presentationIn this article, we report the case of a patient who developed rhabdomyolysis after undergoing free fibular flap surgery.ConclusionsDespite the advantages of the free fibular flap operation, clinicians must be aware of the risk of complications because there are multiple factors that could result in rhabdomyolysis, such as duration of operation, position of the subject, and pre-existing conditions of diabetes and hypertension. Once the diagnosis of rhabdomyolysis is confirmed, a prompt treatment plan should be made and applied as soon as possible. This will increase the chance of a full recovery for the patient who is exhibiting symptoms of rhabdomyolysis.

Does Low-Level Laser Therapy Affect Recovery of Lingual and Inferior Alveolar Nerve Injuries?

Iatrogenic damage to the inferior alveolar nerve (IAN) and lingual nerve (LN) may occur during routine oral and maxillofacial surgery procedures. The primary aim of this study was to determine, using a prospective, double-blind, randomized controlled clinical trial, whether the proportion of nerve-injured patients with postoperative neurosensory improvement over a 3-month period differed significantly between a control group and a low-level laser therapy (LLLT) group. The study sample consisted of 35 patients with iatrogenic nerve injury due to third molar odontectomy, dental implant placement, or local anesthetic injection. The investigators used a randomized, double-blind laser delivery system to administer either placebo or LLLT to patients who met the inclusion criteria. The outcome variable of neurosensory improvement was defined as a minimum 1-unit increase from baseline in visual analog scale rating and was based on standard objective clinical neurosensory testing. Study variables included the affected nerve (IAN or LN) and time from injury to treatment (3 to 12months or >12months). Univariate statistical analysis (χ2 test) was performed to determine significance between the groups. Neurosensory improvement was observed in 46.7% of the LLLT patients, who showed at least a 1-unit improvement at 3months, compared with 38.5% improvement for controls (P=.66), regardless of the specific nerve involved (IAN or LN). In addition, no observed difference was noted between the study groups based on time from injury to treatment. This study failed to provide sufficient evidence to conclude that a difference in neurosensory improvement exists between the LLLT and placebo groups with IAN or LN injuries. However, this study is unique in the prospective double-blind study design and comprehensive neurosensory testing protocols. There is a continued need for further clinical studies on LLLT in oral and maxillofacial surgery nerve injuries.

Impaction of lower third molars and their association with age: radiological perspectives

BackgroundThird molars are the most commonly impacted teeth, and their extraction is the most commonly performed procedure in oral and maxillofacial surgery. The aim of the present study is to describe the pattern of mandibular third molar impaction and to define the most appropriate age for prophylactic extraction of mandibular third molar teeth.MethodsA total of 1198 orthopantomographs (OPGs) with 1810 impacted lower third molars were reviewed by two authors. The pattern of eruption in relation to patient’s age was examined using standard radiographic points and angles. Statistical analysis was performed using SPSS for Windows release 16.0 (SPSS Inc., Chicago, IL, USA).ResultsIn patients older than 20 years, vertical pattern of impaction was the most common (21.4%); while in young patients; horizontal impaction was more common (21.3%). Furthermore, there was a constant pattern of increase in Pell-Gregory ramus class 1 with increasing age, as the prevalence of class 1 was 0% at age 18 years compared to 54.9% at the age of 26 years.ConclusionFrequency of vertical impaction of lower third molars was seen more at an older age (> 20 years) in this study, with an increase in the retromolar space. Late extraction of mandibular third molar teeth (i.e. after the age of 20) is therefore recommended when prophylactic extraction is considered.

Pterygoid process fracture during dental extraction – an unusual complication

INTRODUCTION: The extraction of the upper third molar is a simple and common procedure in Oral and Maxillofacial Surgery daily practice. Infection, facial swelling, trismus, wound dehiscence, root fracture, oroantral fistula, iatrogenic displacement, fracture of the maxillary tuberosity are some of the complications that can occur during third molar extraction.CASE DESCRIPTION: In this article, an unusual fracture of the pterygoid process during upper third molar extraction and a minimally invasive technique for treatment are described.CONCLUSION: It is important to recognize the fracture and not remove the fragment before a complementary image exam, it will guide the type of treatment that should be use.

Effects of Inferior Alveolar Nerve Neurosensory Deficits on Quality of Life.

The purpose of this study was to investigate the effect of temporary or persistent neurosensory disturbance of the inferior alveolar nerve (IAN) on the quality of life using Oral Health Impact Profile (OHIP-14) questionnaire. The patients with the neurosensory deficit of the IAN that was confirmed by subjective and objective neurosensory tests formed the study group. The patients who had dental or oral and maxillofacial surgery procedures in the same unit and did not present neurosensory deficit were matched with the study group according to their gender and age and were presented as the control group. Both groups filled OHIP-14 questionnaire. This study included 200 patients (122 female and 78 male), aged between 18 and 75 years. Kolmogrov-Smirnov, Levene, Mann-Whitney U, and Kruskal Wallis tests were used for statistical analysis. In study group, the average OHIP-14 scores were higher in women than in men in physical pain and handicap subgroups. There were significant differences between study and control groups in functional limitation, psychological discomfort, psychological disability, and handicap subgroups. The OHIP-14 scores were higher in study group compared with the control group. It was concluded that the patients with the neurosensory deficit of the IAN have a poorer quality of life than those without neurosensory deficits.

Lower Impacted Third Molar Surgery - Small Things, Big Improvements

Lower, impacted third molar surgery (ITMS) is a common procedure in oral & maxillofacial surgery around the world. By its nature, it often results in pain, swelling, trismus, bleeding, nerve dysfunction and postoperative infection. The author presents clinical study on 18 patients where ITMS were performed. Modified incision as a minimally invasive approach to lower impacted third molars jointly with suitable preoperative and surgical management significantly reduce postoperative symptoms usually accompanied with this type of surgery.

Influence of a strictly perioperative antibiotic prophylaxis vs a prolonged postoperative prophylaxis on surgical site infections in maxillofacial surgery.

The adequate perioperative antibiotic prophylaxis in maxillofacial surgery is still under discussion due to the wide range of hard and soft tissue procedures as well as contaminated, semi-contaminated and clean surgical sides. Perioperative antibiosis is an easy applicable tool that can be used to decrease nosocomial morbidity and mortality by reducing the rate of infections. We compared strictly perioperative antibiosis with an extended postoperative prophylactic antibiosis. In this study, 901 consecutive patients, from a tertiary care maxillofacial surgery department were included and distributed into two groups: The first group received peri- and postoperative antibiotic prophylaxis (PP; n=365) from the day of operation until the fifth day postoperatively. The second group was treated with single shot prophylaxis with intraoperative repetition as needed (SSP; n=536) only. Furthermore, the patients were grouped according to their main diagnosis and surgical procedure. For comparison, general anamnestic data, cultured bacteria and resistances, number of surgical site infections and duration of hospitalization were compared. There were no statistically significant differences in general diseases or extent of surgery between the groups. There was no statistical difference in the surgical site infections between the groups regardless of their diagnosis. There were significant correlations between tracheotomised patients (p<0.001) as well as patients with a higher BMI (p=0.009) and the incidence of surgical site infections. Most common cultured bacteria were staphylococci. Based on the findings of the study, we believe that a perioperative antibiosis delivers a sufficient prophylaxis for patients undergoing maxillofacial surgery procedures.

Intentional partial odontectomy\u2014a long-term follow-up study

BackgroundThe surgical extraction of the third molar is the most frequently encountered procedure in oral and maxillofacial surgery and is related with a variety of complications. This study examined the efficacy of intentional partial odontectomy (IPO) in the third molars which have no periapical lesions and are located near important anatomical structures such as inferior alveolar nerve.MethodsSeven patients (four males, three females, 39.1 ± 11.6 years), who received IPO to reduce the risk of inferior alveolar nerve injury (IANI), were followed long-term. The treated teeth were horizontally impacted third molars in the mandibular left (n = 5) or mandibular right (n = 4) areas and were all ankylosed with the surrounding alveolar bone. During the IPO, the bone around the crown was removed to expose the crown, and then the tooth was resected at cement-enamel junction (CEJ). Any secondary trauma to the healthy root was minimized and remained intact after primary suture.ResultsThe mean follow-up time was 63.2 ± 29.8 months, and all sites showed good bone healing after the crown removal. Also, sensory abnormality was not found in any patients after IPO. In one patient, the bone fragments erupted 4 months after IPO. In other patient, an implant placed on second molar site adjacent to the third molar that received IPO was explanted about 2 years after the patient’s persistent discomfort.ConclusionsIn case where high risk of IANI exists, IPO may be chosen alternatively to surgical extraction to reduce the risk of nerve damage.

Prise en charge des patients atteints d’angiœdèmes bradykiniques en chirurgie orale et maxillo-faciale

Bradykinin-mediated angioedema (AE) is a rare disease characterized by recurrent cutaneous or mucosal angioedema. This hereditary or acquired disease is of rapid installation, non-pruritic, usually painless and can affect the face, lips, larynx, gastrointestinal tract or extremities. When the affected area involves the upper respiratory tract, laryngeal angioedema can lead to imminent death by asphyxia. This is the reason for the high mortality rate (30 %) in undiagnosed or improperly managed patients. High-risk situations in oral and maxillofacial surgery procedures should be identified preoperatively. Short-term prophylaxis must be carried-out prior to any procedure that may trigger an attack. A multi-site reference center (CREAK) has been created to help clinicians to manage this disease. This article reviews the pathophysiologic mechanisms, the clinical presentations, the possible treatments, the acute strategies for attacks and different prophylactic possibilities in oral and maxillofacial surgery.

Loading dose of Dexdor ® and optimal sedation during oral and maxillofacial ambulatory surgery procedures: An observational study

Loading dose of Dexdor ® and optimal sedation during oral and maxillofacial ambulatory surgery procedures: An observational study

Osteoinductive potential of bone scaffolds developed from FYR Bioceramic (a material of emitting high performance far-infrared ray irradiation)

Background: Autogenous bone has been considered the golden standard for bone replacement procedures in maxillofacial surgery. Synthetic inert bioceramics are currently used as an alternative to autogenous bone graft. New developed type of so called FYR type of Bioceramic (FYRTOB) is a material that emits high performance far-infrared rays (4–20 μm), and possess physical, chemical and biological characteristics on irradiation of water: reducing the size of water clusters and weakening of the hydrogen bonds of water molecules and other effects on physical and chemical properties of water). The use of FYRTOB bone substitutes is not noted in the literature. Objectives: The present study examined the osteoinductive potential of effects of FYRTOB using in vivo animal models. Methods: In this study, autogenous milled bone grafts harvested with a trephine from Wistar rats and a novel alloplastic FYRTOB were implanted into bilateral muscle pouches (25 mg per pouch) of 30 Wistar rats and analysed histologically (at three and six weeks postoperatively) for their ability to induce new ectopic bone formation around grafted material. A semi-quantitative osteoinductive score was used to quantify the osteoinductive ability of both bone grafts. Results: The results reveal that the FYRTOB bone graft possessed 2.1 times higher osteoinductive potential in comparison with autogenous bone. Conclusion: These findings suggest that FYRTOB bone grafts have potential for inducing ectopic bone formation. Future clinical testing is necessary to reveal their bone-inducing properties in different clinical scenarios.

Molecular, Cellular and Pharmaceutical Aspects of Synthetic Hydroxyapatite Bone Substitutes for Oral and Maxillofacial Grafting.

Bone grafts are widely used for augmentation procedures in oral and maxillofacial surgery, with autogenous bone being the gold standard. Recently, the focus of research has shifted towards synthetic bone substitutes, as no second surgery is needed and large quantities of graft can easily be provided. Within the broad range of bone substitutes, synthetic hydroxyapatite has drawn much attention, as they are considered to be biocompatible, non-immunogenic, osteoconductive and osteoinductive. Scope of this review is to summarize existing knowledge concerning the molecular, cellular and pharmaceutical aspects of synthetic bone substitutes for oral and maxillofacial grafting.

The effects of maxillomandibular fixation on ventilatory functions in adult Nigerians

Background: Maxillomandibular fixation (MMF) is a routine procedure in maxillofacial surgery in developing countries. Aim: The aim of this study was to determine the pulmonary functions (forced expiratory volume in 1 min [FEV1], forced vital capacity [FVC], and peak expiratory flow rate [PEFR]) of adult Nigerian patients who had MMF and to find the associated changes in pulmonary functions in the postoperative period vis-a -vis pulmonary function tests among healthy adult Nigerians. Settings and Design: The study setting was the Oral and Maxillofacial Surgery Department of a Teaching Hospital in Northern Nigeria, and the study design was prospective hospital based. Materials and Methods: One hundred and six patients and 106 controls were recruited between January 2011 and December 2012. Information was obtained using a questionnaire. All study participants had their baseline lung functions measured; the treatment group in addition had their postoperative daily lung function parameters measured for the 1st week and then weekly for the next 5 weeks. Statistical Analysis: Statistical analyses were performed using the Statistical Package for Social Sciences (version 16, SPSS Inc., Chicago, IL, USA). The mean and standard deviation values of physical characteristics and ventilatory functions were determined in both men and women. The mean values were compared using Student's t-test. Statistical significance was inferred at P ≤ 0.05. Results: One hundred and seventy males and 42 females participated in the study. The control group had a mean age of 30.25 ± 9.05, weight 64.08 ± 9.90, height 1.67 ± 0.10, body mass index (BMI) 23.32 ± 3.07, basal FVC 3.70 ± 0.71, basal FEV13.16 ± 0.54, and basal PEFR8.35 ± 1.62. For the treatment group, the mean age was 30.68 ± 8.23, weight 64.91 ± 9.96, height 1.66 ± 0.10, BMI 23.21 ± 3.14, basal FVC 3.72 ± 0.69, basal FEV13.14 ± 0.51, and the basal PEFR8.18 ± 1.61. Conclusion: The postoperative mean FVC, FEV1, and PEFRvalues drop significantly by more than 50% when compared to the preoperative values in the first postoperative week with the nadir on the second postoperative day in the patients with MMF.