Maxillofacial Surgical Patients Research Articles

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.

Inpatient Acute Pain Management in the Opioid Epidemic Among Oral and Maxillofacial Surgical Patients

Inpatient Acute Pain Management in the Opioid Epidemic Among Oral and Maxillofacial Surgical Patients

TAScope, an Indian Jugad for Difficult Intubations in Oral and Maxillofacial Surgical Patients.

TAScope, an Indian Jugad for Difficult Intubations in Oral and Maxillofacial Surgical Patients.

Severe odontogenic infections: focus on more effective early treatment.

Our aim was to investigate delay in the treatment of patients with acute odontogenic infections. A prospective clinical study and a questionnaire survey were designed and implemented in the emergency maxillofacial surgical patients of Helsinki University Hospital, Finland, over a one-year period. Altogether 88 adult patients with odontogenic infections confirmed by hospital examination were included in the analysis. The outcome variable was admission to hospital. Two-thirds of the patients had had previous visits for health care for their current infection. Treatment was started in nearly half the patients before hospital admission, and half of the treatment provided was exclusively antibiotics. The focus of infection was detected in half the patients before admission. Patients who were required further hospitalisation were younger than who were discharged (p=0.021). Less well-educated patients were more likely to be hospitalised than patients in other education groups (p=0.033). Leucocytosis was more prevalent in patients with a mandibular focus (p=0.008), non-identified focus (p=0.010), and infection as a result of elective tooth extraction (p=0.026). The number of previous health care visits for the acute infection was notably high. Early treatment of infection may be overlooked, particularly in younger age groups and less well-educated patients. Challenges in making the correct diagnosis and prescribing effective treatment for such infections cause additional health care visits and unnecessary delay in care. More attention should be paid to the early detection and comprehensive primary treatment of odontogenic infections.

Managing the oral and maxillofacial surgical patient during the SARS-CoV-2 pandemic: A review of guidelines

Management of the oral and maxillofacial surgical patient during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is quite challenging. This paper assesses the impact of coronavirus disease-2019 (COVID-19) on oral and maxillofacial surgical practice and lays down various guidelines employed to counter the pandemic. Separate protocol and guidelines are formulated for examining the patients in the Outpatient Department (OPD), minor surgical procedures in the clinics, and for managing patients in the triage and operation theatres. Particular emphasis should be given to disinfection and infection control measures to minimize the risk of COVID-19. Infection control in the clinical, hospital, and operation theatre setup is the most essential factor in the prevention of spread of COVID-19 disease in the workplace. The use of Personal Protective Equipment (PPE), barrier techniques, proper hand wash practices, surface disinfection, and proper sterilization of instruments help in infection control. Providing effective treatment to patients with conditions that cannot be deferred or controlled by pharmacological management and taking care to minimize the risk of COVID-19 to the hospital personnel is the primary concern in the present scenario.

Desarrollo de un mapa de riesgos en una unidad de cirugía oral y maxilofacial

Introductionthe main aim of this study was to develop and implement a risk map in the Oral and Maxillofacial Surgery Service of the University Hospital «Virgen de las Nieves» of Granada to minimize the incidence of adverse effects (AE). Materials and methodsLongitudinal, prospective study carried out in the Oral and Maxillofacial Surgery Service of the Hospital Universitario Virgen de las Nieves of Granada, from June 2017 to May 2018, through the methodology of «Analysis and Failure Mode Effect». Management of the different AE was addressed. The following phases were considered as it follows: identification of the problem, identification of AE for within the practice of the oral and maxillofacial surgery that represents a problem in the assistive safety, creation of an interdisciplinary working group, analysis of the current situation in patient safety and risk management using 2analysis tools, SWOT and PITELO, preparation of the patient care process, development of a catalog of AE and preparation of a risk map. ResultsA total of 33 AE were identified. The risk map showed a higher incidence of AE in the Surgical Area (22) compared to the areas of Outpatient Clinic and Hospital Discharge (6). A total of 10 critical AE were identified. ConclusionsThe elaboration of a risk map allowed to determine the process of the oral and maxillofacial surgical patient, and to elaborate a catalog of AE.

Proceedings of the American Association of Oral and Maxillofacial Surgeon's 2017 Clinical and Scientific Innovations in Oral and Maxillofacial Surgery (CSIOMS)

The sixth biennial Clinical and Scientific Innovations in Oral and Maxillofacial Surgery, formerly the Research Summit, of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois from April 28 to 30, 2017. The goal of the symposium is to provide a forum for the latest clinical and scientific advances to be brought to the specialty. It also nurtures collaboration and the development of relationships between oral and maxillofacial surgeons and researchers to bridge the gap between clinical and basic science. The goal is to improve the care of oral and maxillofacial surgical patients through the advancement of translational and clinical research.

USE OF THE RING‑ADAIR‑ELWYN (RAE) TUBE AS AN ALTERNATIVE FOR FLEXIBLE REINFORCED ARMORED TUBE FOR SUBMANDIBULAR APPROACH FOR ENDOTRACHEAL INTUBATION TO AVOID SURGICAL INTERRUPTION IN PATIENTS WITH PANFACIAL FRACTURES

Background: Maxillofacil and dental surgery are challenges for the anesthetist, because the surgical procedures are just around the upper airway. So, the corner stone in the maxillofacial surgical patients is the patient safety during and after operation. Previous studies recommended the use of reinforced armored tube for submandibular tracheal intubation in maxillofacial surgical patients. The current study tested the RAE tube as an alternative technique to armored tube in the submandibular route for tracheal intubation in maxillofacial surgical patients. Objectives: The study aimed to compare the RAE tube as an alternative to flexible reinforced armored tube in submental endotracheal intubation in maxillofacial surgery. Methods: A total of thirty patients had undergone submental intubation for management of maxillofacial surgical procedures. The submandibular intubation by RAE tube was chosen in 15 patients as an alternative for flexible armored tube in another 15 patients when the oral and nasal intubation was not suitable and not safe for the surgical procedure. We excluded from the start the patient that required prolonged assisted ventilation because the tracheostomy is the preferred choice for all. Results: From November 2013 to November 2014, thirty patients with traumatic panfacial fractures were admitted to the Plastic Surgery and Burn Department at Al-Azhar University Hospitals within the subspeciality of Maxillofacial Surgery. Endotracheal oral intubation by laryngoscope was successful in all patients of the studied groups. No statistical difference was recorded between the studied groups as regard the time of intubation (9-13min), and no recorded intraoperative or postoperative major complications. Both types of the tube provided secured airway and an uninterrupted surgical access to the oral and nasal cavity. Also, it carried an access for good hemostasis and allowed intraoperative control of dental occlusion. The technique was found to be easy and convenient with uneventful intraoperative and postoperative periods. The technique was satisfactory to the surgeon, the anesthetist, the patients and the relatives. Conclusions: Submandibular tracheal intubation by RAE tube is an effective and useful technique for airway control in maxillofacial surgery. It can be used as a good alternative to reinforced armored tube in maxillofacial surgical patients.

Sickle Cell Disease and Perioperative Considerations: Review and Retrospective Report

To review the current literature on sickle cell disease (SCD) and patient management in the perioperative setting and to retrospectively evaluate the treatment and complications of oral and maxillofacial surgical patients with SCD treated in the Regional Medical Center at Memphis. A literature review was performed, with the main search criteria of SCD, anesthesia, and oral and maxillofacial surgery. In addition, a retrospective record analysis was performed of patients with SCD seen at the Regional Medical Center over 9 years. Criteria recorded included the procedure, type of anesthesia, use of intravenous fluids, thermoregulation (use of warm fluids and blankets covering the patient), supplemental oxygen, antibiotic prophylaxis, and postoperative complications. In total, 33 clinic visits were reviewed, with 29 patients and 21 procedures performed. Patients were managed quite differently each time, with no consistent protocol. Intravenous fluids were used in only 9 of 21 procedures, supplemental oxygen was recorded for 11 of 21 patients, and preoperative antibiotics were given to 14 of 21 patients. A small sample and the lack of an established protocol did not provide significant statistics. Patients with SCD are at risk for various perioperative complications, and it is imperative that the surgeons be educated and prepared so they can effectively manage these patients. No significant complications were found through the outpatient treatment of patients with SCD in this analysis. It may be concluded that treating patients with SCD in the outpatient setting is not contraindicated and may be a safe alternative to inpatient treatment or no treatment at all.

Proceedings From the 2011 American Association of Oral and Maxillofacial Surgeons Research Summit

In 2011 the American Association of Oral and Maxillofacial Surgeons and its Advisory Committee on Research Planning and Technology Assessment held the fourth research summit in Rosemont, IL. The biannual symposium, cosponsored by the American Association of Oral and Maxillofacial Surgeons, the Oral and Maxillofacial Surgery Foundation, and the National Institute of Dental and Craniofacial Research, aimed at fostering the collaboration of oral and maxillofacial surgeons and experts from different disciplines and basic science researchers. The ultimate goal is to improve the care of the oral and maxillofacial surgical patients through the advancement of translational and clinical research. The major themes of head and neck cancer, obstructive sleep apnea (OSA), and craniofacial development reflect areas in which oral and maxillofacial surgeons have opportunities to lead advances in diagnosis and directed care.

Performance enhancing drug use and the oral and maxillofacial surgical patient—a literature review

Performance enhancing drug use and the oral and maxillofacial surgical patient—a literature review

Difficult intubation in ENT and maxillofacial surgical patients: a prospective survey.

Difficult intubation in ENT and maxillofacial surgical patients: a prospective survey.

Predicting and preventing catastrophic deterioration in post-operative oral and maxillofacial surgical patients: would a modified early warning score help?

Predicting and preventing catastrophic deterioration in post-operative oral and maxillofacial surgical patients: would a modified early warning score help?

Submandibular approach for tracheal intubation in patients with panfacial fractures

The oral route for tracheal intubation can interfere with some maxillofacial surgical procedures. At the same time, the nasal route can be contraindicated or impossible. Tracheostomy is the usual solution in these circumstances, but it carries a high incidence of complications. We tested the submandibular route for tracheal intubation as an alternative to tracheostomy in such situations. The procedure was performed in 13 patients suffering from panfacial fractures associated with a fracture of skull base or a displaced nasal fracture, and in one patient with post-caustic burn scar affecting most of the face including the nose and requiring a full thickness skin flap surrounding the mouth. The technique was found easy and satisfactory for both the surgeon and the anaesthetist. It allowed uninterrupted surgical techniques and a secure airway. In six of the 13 patients, the submandibular tracheal tube was left in place for up to 44 h in the intensive care unit after the operation without complications or difficulties. Accidental dislodgement of the tube to the right main bronchus occurred in two patients while carrying out the procedure; it was rapidly detected and corrected. In another two patients, postoperative superficial infection occurred that responded well to local treatment. No other complications were encountered. Submandibular tracheal intubation is a simple and effective technique for upper airway management in some maxillofacial surgical patients when both oral and nasal tracheal intubations are not convenient.

The Preventive Effect of Propofol on Postoperative Nausea and Vomiting (PONV) in Oral and Maxillofacial Surgical Patients

The Preventive Effect of Propofol on Postoperative Nausea and Vomiting (PONV) in Oral and Maxillofacial Surgical Patients

Pregnancy testing for the female oral & maxillofacial surgical patient undergoing deep sedation or general anesthesia

Statement of the Problem: Increased risks of congenital anomalies, spontaneous abortion, premature delivery, and thromboembolism are associated with intravenous sedation or general anesthesia for the pregnant patient. Knowing the pregnancy status of the female patient is essential with oral & maxillofacial surgical procedures. The purpose of this study was to assess the incidence of positive pregnancy testing despite a verbal confirmation of a nonpregnant state from the female patient prior to elective procedures with deep sedation or general anesthesia.

A three-dimensional computerized mesh diagram analysis and its application in soft tissue facial morphometry

A modified computerized mesh diagram analysis that allows rapid and independent quantifications of soft tissue facial size and shape in the three-dimensional space is presented. Normal references are provided, and the application of the method is also exemplified by the analysis of two maxillofacial surgical patients. The Three-Dimensional Facial Morphometry method has been used for the collection of the x, y, z coordinates of 22 soft tissue landmarks in 50 men and 50 women (all healthy young white adults). The method detects the three-dimensional coordinates of retroreflective, wireless markers positioned on selected facial landmarks with two charge-coupled device cameras, working in the infrared field. The midpoint between the right and left tragus landmarks served as the origin of the coordinate axes, and the landmark coordinates were rotated, setting the intercantheal line horizontal on both the frontal and the horizontal planes, and the Camper’s plane inclined at -7.5° on the sagittal plane. A standardized mesh of equidistant horizontal (dimension: half the upper face width), vertical (half the vertical projection of upper face height), and anteroposterior (half the horizontal projection of upper face depth) lines was consequently constructed. The lattice was replicated on the entire face and comprised 84 parallelepipeds. Both male and female reference meshes had a harmonious and symmetric appearance, with gender differences in facial size but not in facial shape. The standard normal reference was superimposed on the patient’s tracing, and the global (size plus shape) difference was then evaluated by the calculation of the relevant displacement vectors for each soft tissue landmark. A global difference factor was calculated as the sum of the modules of all the displacement vectors. Consequently, a size normalization was performed, and the shape difference (size-standardized) was then evaluated by the calculation of new relevant displacement vectors for each landmark, as well as a shape–global difference vectors. (Am J Orthod Dentofacial Orthop 1998;114:404-13)

Effects of Induced Hypotension with Labetalol on Blood Loss and Blood Pressure in Maxillofacial Surgical Patients

Effects of Induced Hypotension with Labetalol on Blood Loss and Blood Pressure in Maxillofacial Surgical Patients

Use of the laryngeal mask airway in oral and maxillofacial surgery

Purpose: General anesthesia for the nonintubated oral and maxillofacial surgical patient presents unique anesthetic conditions. The primary concern is the maintenance of an unobstructed airway and protection against aspiration, while minimizing both interference and interruption of the surgical procedure. The laryngeal mask airway is an alternative to the nasal hood for such airway management. The purpose of this article is to inform the oral and maxillofacial surgeon of the clinical relevant information pertaining to the use of the laryngeal mask airway in oral and maxillofacial surgery. Experience with clinical use is discussed.

An Evaluation of Pediatric Oral and Maxillofacial Surgical Patients in Dental Hospital of Seoul National University

An Evaluation of Pediatric Oral and Maxillofacial Surgical Patients in Dental Hospital of Seoul National University