Maxillofacial Surgery Procedures Research Articles

PROPHYLACTIC USE OF ANTIBIOTIC IN MANDIBULAR THIRD MOLAR EXTRACTION - A CLINICAL STUDY

NTRODUCTION Mandibular third molar is most commonly impacted tooth. Surgical removal of mandibular third molars is one of the most frequently performed procedures in oral and maxillofacial surgery. The most frequent complication which follows the removal of impacted mandibular third molars is ‘dry socket’. Some degree of swelling, trismus and pain, unless they are related to infection or excessive trauma, must be regarded as a normal response to surgery. 1

Accuracy of clinical coding for procedures in oral and maxillofacial surgery

Clinical coding has important financial implications, and discrepancies in the assigned codes can directly affect the funding of a department and hospital. Over the last few years, numerous oversights have been noticed in the coding of oral and maxillofacial (OMF) procedures. To establish the accuracy and completeness of coding, we retrospectively analysed the records of patients during two time periods: March to May 2009 (324 patients), and January to March 2014 (200 patients). Two investigators independently collected and analysed the data to ensure accuracy and remove bias. A large proportion of operations were not assigned all the relevant codes, and only 32% - 33% were correct in both cycles. To our knowledge, this is the first reported audit of clinical coding in OMFS, and it highlights serious shortcomings that have substantial financial implications. Better input by the surgical team and improved communication between the surgical and coding departments will improve accuracy.

Bone Flap Technique for Impacted Teeth Extraction and Bone Cysts Removal.

The treatment of cystic lesions and the extraction of impacted third molars are 2 of the most common procedures in oral and maxillofacial surgery. The surgical treatment of cysts of the jaws can consist of a cystectomy, a cystotomy, or a staged combination of the 2 procedures. The surgical techniques developed for the extraction of impacted third molars are: coronectomy, orthodontic extraction, and surgery using intraoral or extraoral methods. There are various complications related to both surgical treatments. With regards to these complications, authors' department has developed a new surgical technique based on a previously described technique, which provides better support to the mucoperiosteal flap and improves bone regeneration after healing. Additionally, authors' goal was to reduce the risk of nerve injury, which has been achieved thanks to a direct visualization of the inferior alveolar nerve as well as cystic lesion or the dental element. The surgical procedure described produces major advantages over the traditional alternatives, despite needing a longer operation. This technique is particularly useful in the treatment of cystic lesions that have caused considerable bone loss. It can also be utilized for cysts or impacted dental elements strictly linked to the inferior alveolar nerve.

Comparison of oral and sublingual piroxicam for management of postoperative pain after mandibular third molar surgery: A prospective, randomized study

Background and Objectives: Surgical extraction of the third molars has been one of the widely performed procedures of all the minor oral surgical procedures in oral and maxillofacial surgery. Inflammation is a critical part of the normal sequence of healing as well as is an important cause for postoperative sequelae. They include pain, restriction of mouth opening, and swelling which are a few reasons for discomfort to the patient. There are various measures for the management of these complications including administration of nonsteroidal anti-inflammatory drugs. This study was done to compare the clinical efficacy of oral and sublingual piroxicam in the management of postoperative pain after surgical removal of the lower third molars. Methodology: The study comprised thirty selected patients with bilaterally impacted mandibular third molars. Split-mouth study design was implicated such that the patients served as their own control. Group 1 consisted of patients who were given piroxicam orally, and Group 2 consisted of patients who were given sublingual preparation postoperatively. Subjective evaluation (visual analog scale) and objective evaluation (validated landmarks) were carried out for pain, swelling, and trismus for the postoperative days 1 st , 3 rd , and 7 th . Results: The results showed no significant differences with respect to postoperative pain, trismus, and swelling when the two routes of drug delivery, namely, oral and sublingual were compared. Furthermore, the amount of rescue analgesics taken was slightly higher in the oral group but not statistically significant. Conclusion: Within the limitations of the study, it can be concluded both oral and sublingual formulations of piroxicam show comparable results and that both are equally effective in the postoperative management of pain, trismus, and swelling after surgical removal of the third molar.

Incidence of gloves perforation during oral and maxillofacial procedures

Introduction: Surgeons are at high risk of exposure to blood-borne diseases from needle stick injuries during oral and maxillofacial surgery (OMFS) procedures.

Efficacy of platelet rich fibrin in the reduction of the pain and swelling after impacted third molar surgery: randomized multicenter split-mouth clinical trial.

BackgroundImpacted third molar removal is a routine procedure in oral and maxillofacial surgery. Platelet-rich fibrin (PRF) is a second generation platelet concentration which is produced by simplified protocol. The aim of this study was to assess the effectiveness of PRF in the healing process by evaluating the changes in pain and swelling after third molar surgery.MethodsFifty-six patients (23 male, 33 female) who provide the inclusion criteria were selected to participate in this study. The evaluation of the facial swelling was performed by using a horizontal and vertical guide. The pain was evaluated in the postoperative period using a visual analog scale (VAS) of 100 mm.ResultsHorizontal and vertical measurements showed more swelling at the control side (without PRF) in 3th day postoperatively (p < 0.05). There were no statistically significant differences regarding pain among the groups.ConclusionAs a conclusion, PRF seems to be effectiveness on postoperative horizontal swelling after third molar surgery. PRF could be used on a routine basis after third molar extraction surgery.

Rhabdomyolysis After Prolonged Operations

Postoperative rhabdomyolysis is a rare event, particularly in oral and maxillofacial surgery (OMS) procedures and is rarely discussed in OMS literature. Rhabdomyolysis occurs when damaged muscle breaks down, releasing intracellular contents, including myoglobin and creatinine kinase (CK), into circulation. This produces a non-specific clinical syndrome including electrolyte disturbances, hypovolemia, metabolic acidosis, coagulopathies, and risk for acute kidney injury (AKI).

A multivariate statistical analysis on variables affecting inferior alveolar nerve damage during third molar surgery.

The risk factors associated with inferior alveolar nerve damage during third molar surgery were investigated. Surgeries performed during a period of 50 months by a single expert surgeon were reviewed. Only those surgeries that met the selected inclusion criteria were considered for this study. The following tests were applied for the statistical analysis: the Kolmogorov-Smirnov test, the principal components analysis, the Mann-Whitney U test, the two-tailed exact Fisher test and the Bonferroni sequential correction. The surgical difficulty index, multi-rooted third molars and changes in the inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage. Computed tomography is mandatory when the nerve is superimposed on the tooth root on the ortopantomography. SCIENTIFIC RATIONALE FOR STUDY: Lower third molar extraction is one of the most common procedures in oral and maxillofacial surgery, and it is burdened by the risk of inferior alveolar nerve damage. Understanding which factors are able to predict this complication is therefore essential in correctly programming surgery. Surgical difficulty index, multi-rooted third molars and changes in inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage. If, on the orthopantomography, the nerve is superimposed on the tooth root, a computed tomography is mandatory to define all of these variables.

Safety of adjunct pre-emptive intravenous tramadol with midazolam sedation for third molar surgery.

The purpose of this study was to evaluate patient safety, in terms of adverse events, alterations in blood pressure or oxygen saturation (SpO2) in two routine sedation procedures, with and without intravenous analgesia. Patients referred for surgical removal of mandibular third molars were treated in a randomized, controlled, single-blinded procedure. Eighty-seven men and women, aged 18 to 44years, were allotted to either of two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S) or to a control group (C), given no sedation. Tramadol at 1mg/kg body weight resulted in a higher frequency of oxygen desaturation (SpO2 < 90%) than a placebo (p = 0.002) but had no effect on mean SpO2 at the end point or at the end of surgery. In both the test groups, there was a significant decrease in diastolic blood pressure (p < 0.001) from baseline to the end of surgery. The results confirm that pre-emptive intravenous tramadol, administered at 1mg/kg body weight as an adjunct to midazolam sedation for third molar surgery, offers a safe method. But, it should be noted that our previous study shows that it is not a particularly effective analgesic. Further testing is therefore warranted, using other doses or other drugs, to find a better intravenous protocol for postoperative analgesia, with maximum effect and minimal risk, in outpatient oral and maxillofacial surgery procedures.

Benefits of Prophylactic Antibiotics in Third Molar Impaction

Aim: To do a review on the benefits of prophylactic antibiotics in the impaction of third molar. Objective: Prophylactic antibiotics are used to treat preoperative infections. This review is on the role of antibiotics in third molar extraction. Background: The removal of impacted third molars is a common procedure in oral and maxillofacial surgery. There is controversy about the use of antibiotics as prophylaxis to prevent complications after third molar removal. Antibiotic prophylaxis for preventing postoperative wound infections accounts for >30% of antibiotic prescriptions in general hospitals. They concluded that systemic antibiotic prophylaxis given before surgery is effective in reducing the frequencies of alveolar osteitis and wound infection. Reason: To know the benefits of prophylactic antibiotics in the surgical treatment of third molar impaction.

Effectiveness of patients’ knowledge about perioperative information prior to third molar removal

Many patients feel anxious before dental treatment on the presumption that the procedure will cause them pain and discomfort. Among other procedures, oral surgery has been reported to induce highest level of anxiety. The surgical removal of mandibular third molars is one of the most commonly performed dent alveolar procedures in oral and maxillofacial surgery. Individuals of lower socioeconomic status, with less education and lack of knowledge about the procedure are one major factor to preoperative anxiety. Provide preoperative information about the procedure significantly reduces patient anxiety. Several preoperative variables were recorded (during preoperative, intraoperative and postoperative phases) and patient anxiety was assessed through the use of various questionnaires.

Accessory mental foramen: an anatomical study on dry mandibles and review of the literature.

Since numerous surgical procedures in oral and maxillofacial surgery as well as several aspects of dental practice involve the mental region, the knowledge of its anatomical variations is essential for the clinician. Therefore, the aim of the present study was to evaluate the incidence and the anatomical features of the accessory mental foramen, which is occasionally traced additionally to the main mental foramen. Ninety-six dry human mandibles of a Greek population and of unknown sex and age were examined in order to notice the presence of possible accessory mental foramina. The frequency of the accessory mental foramen was calculated, and its dimensions and its topographical relationship to the teeth of the mandible and the mental foramen were determined as well. A single accessory mental foramen was identified in 4.17% of the sample, while its mean transverse diameter was measured to be 1.09 mm and its mean distance from the mental foramen was 5.24 mm. The present study revealed an appreciable incidence of the accessory mental foramen in the Greek population, recognizably higher than the discovered incidence of past studies involving the Greek population. Consequently, the clinician should always be prepared to deal with an accessory mental foramen during surgical procedures.

YIM-O20. Standardization and performance of cone beam ct scan for the evaluation of linear scleroderma of the face

Up to now, standardized and validated methods for monitoring linear scleroderma of the face are still lacking. Therefore, it is difficult to assess, in these patients, the disease progression both for therapeutic purposes and maxillofacial surgery procedures. The Cone Beam Computed Tomography (CBCT) is an imaging technique that has good sensitivity for both soft and the bony tissues, is fast to be performed, does not require sedation and the irradiation is 50 times lower than traditional CT scan.

Comparison of the Safety of Anesthetic Agents in Ambulatory Procedures for Pediatric Population in Oral and Maxillofacial Surgery

Intravenous sedation during ambulatory oral and maxillofacial surgery procedures is often a necessary component in the practices of oral and maxillofacial surgeons (OMS). The purpose of the study was to compare the safety and anesthetic outcomes of propofol and methohexital in pediatric patients aged 20 years old or younger. Additionally, the study compared the safety and adverse effects of the two agents when administered by an OMS or a non-OMS provider.

CT scans as a tool for planning difficult airway intubation

CT scans as a tool for planning difficult airway intubation

Getting to the bottom of MRI defeacating proctograms

Getting to the bottom of MRI defeacating proctograms

Vettransplantatie in de cosmetische aangezichtschirurgie

Loss of volume in the soft tissues of the face is considered to be an important cause of facial ageing. This volume loss can be compensated by microfattransfer. This technique offers a natural and long-lasting effect. Fat is harvested with liposuction and after centrifugation it is injected into the target areas in the face using small blunt cannulas. The goal is to place the fat in the desired place in such a way that the fat will survive and become integrated in the acceptor tissue. Microfattransfer can be combined with other cosmetic facial procedures such as blepharoplasties and facelifts. Although fatgrafting is a safe technique, complications may occur. These are mostly related to technique and amount of fat injected. Microfattransfer is a useful adjunctive procedure in maxillofacial surgery. Because only 40-50% of the result of microfattransfer is permanent touching up is often necessary. Microfattransfer should be considered as a staged treatment modality.

Interventions for iatrogenic inferior alveolar and lingual nerve injury.

Iatrogenic injury of the inferior alveolar or lingual nerve or both is a known complication of oral and maxillofacial surgery procedures. Injury to these two branches of the mandibular division of the trigeminal nerve may result in altered sensation associated with the ipsilateral lower lip or tongue or both and may include anaesthesia, paraesthesia, dysaesthesia, hyperalgesia, allodynia, hypoaesthesia and hyperaesthesia. Injury to the lingual nerve may also affect taste perception on the affected side of the tongue. The vast majority (approximately 90%) of these injuries are temporary in nature and resolve within eight weeks. However, if the injury persists beyond six months it is deemed to be permanent. Surgical, medical and psychological techniques have been used as a treatment for such injuries, though at present there is no consensus on the preferred intervention, or the timing of the intervention. To evaluate the effects of different interventions and timings of interventions to treat iatrogenic injury of the inferior alveolar or lingual nerves. We searched the following electronic databases: the Cochrane Oral Health Group's Trial Register (to 9 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 9 October 2013) and EMBASE via OVID (1980 to 9 October 2013). No language restrictions were placed on the language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) involving interventions to treat patients with neurosensory defect of the inferior alveolar or lingual nerve or both as a sequela of iatrogenic injury. We used the standard methodological procedures expected by The Cochrane Collaboration. We performed data extraction and assessment of the risk of bias independently and in duplicate. We contacted authors to clarify the inclusion criteria of the studies. Two studies assessed as at high risk of bias, reporting data from 26 analysed participants were included in this review. The age range of participants was from 17 to 55 years. Both trials investigated the effectiveness of low-level laser treatment compared to placebo laser therapy on inferior alveolar sensory deficit as a result of iatrogenic injury.Patient-reported altered sensation was partially reported in one study and fully reported in another. Following treatment with laser therapy, there was some evidence of an improvement in the subjective assessment of neurosensory deficit in the lip and chin areas compared to placebo, though the estimates were imprecise: a difference in mean change in neurosensory deficit of the chin of 8.40 cm (95% confidence interval (CI) 3.67 to 13.13) and a difference in mean change in neurosensory deficit of the lip of 21.79 cm (95% CI 5.29 to 38.29). The overall quality of the evidence for this outcome was very low; the outcome data were fully reported in one small study of 13 patients, with differential drop-out in the control group, and patients suffered only partial loss of sensation. No studies reported on the effects of the intervention on the remaining primary outcomes of pain, difficulty eating or speaking or taste. No studies reported on quality of life or adverse events.The overall quality of the evidence was very low as a result of limitations in the conduct and reporting of the studies, indirectness of the evidence and the imprecision of the results. There is clearly a need for randomised controlled clinical trials to investigate the effectiveness of surgical, medical and psychological interventions for iatrogenic inferior alveolar and lingual nerve injuries. Primary outcomes of this research should include: patient-focused morbidity measures including altered sensation and pain, pain, quantitative sensory testing and the effects of delayed treatment.

Applications of Coronoid Process as a Bone Graft in Maxillofacial Surgery

The coronoid process can be easily harvested as a donor bone by an intraoral approach during many maxillofacial surgery procedures. The purpose of this study was to evaluate the utility of autogenous coronoid process bone grafts for maxillofacial reconstructive surgery. Twelve patients, who underwent coronoid process grafts for reconstruction of maxillofacial deformities due to trauma, alveolar atrophy, or temporomandibular joint ankylosis, were included in the study. There were 3 orbital defects after extended maxillectomy, 1 blowout fracture of the orbit, 2 cases of reconstruction after temporomandibular joint ankylosis surgery, 1 case of additional chin augmentation following horizontal flip genioplasty, 1 defect of anterior wall of maxilla due to trauma, 2 mandibular defects, and 2 cases of bone augmentation for implants.We recommend the use of coronoid process of the mandible as a source for autogenous bone graft as it can provide sufficient bone in quantity and quality for selected maxillofacial reconstructions.

Prophylactic Antibiotics for Third Molar Surgery: An Enigma or Panacea?

The removal of impacted third molars is a common procedure in oral and maxillofacial surgery. There is controversy about use of antibiotics as prophylaxis to prevent complications after third molar removal. Several authors claim that prophylactic antibiotics are useful in preventing postoperative complications and infections after third molar removal. Decreased pain, swelling and trismus are reported. Quality of life is stated to be higher when antibiotics are prescribed. On the other hand, additional studies were not able to demonstrate the effectiveness of antibiotic prophylaxis. The purpose of this study is to review the literature regarding the appropriateness of the routine use of antibiotics for third molar surgery.