Maxillofacial Trauma Surgery Research Articles

Epidemiologic Trends in Maxillofacial Trauma Surgery in Germany-Insights from the National DRG Database 2005-2022.

Background: Maxillofacial trauma (MFT) caused by falls, interpersonal violence or traffic accidents leading to fractures of different facial regions, including the midface and the mandible, are common clinical conditions requiring open reduction and internal fixation. The aim of this study was to analyze the incidence and time trends in MFT-associated surgeries regarding different facial regions in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related group (DRG) inpatient billing system was received from the German Federal Statistical Office for the years 2005-2022. We estimated the age-gender standardized incidence of MFT-associated procedures classified by the Operation and Procedure Classification System (OPS) and evaluated age- and gender-adjusted time trends using Poisson regression analysis. Results: The total standardized incidence rate of MFT-associated procedures in the observational period 2005-2022 was 25.1 (♀13.3; ♂37.5) per 100,000 person-years within a slight significant annual decrease of 0.5%. A significant increase in the incidence of MFT-related procedures within the observational period was found in older adults from 60 to 79 years (+55.1%; ♀+54.8%; ♂+56.3%) and elderly patients over 80 years (+66.7%; ♀+59.1%; ♂+85.1%). Other significant trends are decreases in MFT-related procedures performed in children from 0-14 years (-28.1%; ♀-30.3%; ♂-27.3%) and young adults between 15 and 35 years (-20.4%; ♀-7.3%; ♂-22.5%). Conclusions: MFT-associated surgery is a persisting challenge in the German healthcare system. There is an ongoing transition in MFT-associated surgeries from younger to older patients beyond the scope of demographic change, highlighting the increasing importance of interdisciplinary treatment of patients with pre-existing conditions in maxillofacial surgery. Implementation of injury prevention measures might be beneficial in this population.

Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany - implications from the national DRG database

PurposeThe COVID-19 pandemic has affected the personal and social lives of millions of people and also impacted the etiological factors of midfacial trauma such as falls, interpersonal violence or traffic accidents. The aim of this study was to analyze the influence of the COVID-19 pandemic on maxillofacial trauma surgery in the German healthcare system.MethodsNationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system used in all German hospitals was received from the German Federal Statistical Office. Various trauma-associated procedures of the Operation and Procedure Classification System (OPS), a German modification of the International Classification of Medical Procedures (ICPM), were statistically associated with different epidemiological factors between 2012 and 2021.ResultsA statistically significant decrease (p < 0.05) in surgeries regarding maxillofacial fractures was registered during the years 2020 and 2021. Young male patients had the largest decline in maxillofacial trauma surgeries during this period (p < 0.05). In contrast. elderly patients 80 years and older showed a dramatic increase in the frequency of fractures in both the midface and the mandible (p < 0.05).ConclusionsDuring the COVID 19 pandemic there has been a shift in the number, composition and etiology of maxillofacial fracture surgeries. Measures of social distancing and personal risk avoidance had a societal positive effect on the frequency of facial injuries. This stands in contrast to the drastic increase in fractures of elderly people who should be protected primarily by the measures taken. These results can help to understand these influences better in future pandemics.Trial registrationGerman Clinical Trials Register No: DRKS00032778.

Correlation between Malocclusion and Mandibular Fractures: An Experimental Study Comparing Dynamic Finite Element Models and Clinical Case Studies.

Mandibular fractures are very common in maxillofacial trauma surgery. While previous studies have focused on possible risk factors related to post-operative complications, none have tried to identify pre-existing conditions that may increase the risk of mandibular fractures. We hypothesized, through clinical observation, that anatomical conditions involving poor dental contacts, such as malocclusions, may increase the risk of mandibular fractures. This work was subdivided into two parts. In the first part, Digital Imaging and Communications in Medicine (DICOM) data of four healthy patients characterized by different dentoskeletal occlusions (class I, class II, class III, and anterior open bite) have been used to develop four finite element models (FEMs) that accurately reproduce human bone structure. A vertical and lateral impact have been simulated at increasing speed on each model, analyzing the force distribution within the mandibular bone. Both vertical and lateral impact showed higher level of stress at the impact point and in the condylar area in models characterized by malocclusion. Specifically, the class III and the open bite models, at the same speed of impact, had higher values for a longer period, reaching critical stress levels that are correlated with mandibular fracture, while normal occlusion seems to be a protective condition. In the second part of this study, the engineering results were validated through the comparison with a sample of patients previously treated for mandibular fracture. Data from 223 mandibular fractures, due to low-energy injuries, were retrospectively collected to evaluate a possible correlation between pre-existing malocclusion and fracture patterns, considering grade of displacement, numbers of foci, and associated CFI score. Patients were classified, according to their occlusion, into Class I, Class II, Class III, and anterior open bite or poor occlusal contact (POC). Class I patients showed lower frequencies of fracture than class II, III, and open bite or POC patients. Class I was associated with displaced fractures in 16.1% of cases, class II in 47.1%, class III in 48.8% and open bite/POC in 65.2% of cases (p-value < 0.0001). In class I patients we observed a single non-displaced fracture in 51.6% of cases, compared to 12.9% of Class II, 19.5% of Class III and 22.7% of the open bite/POC group. Our analysis shows that class I appears to better dissipate forces applied on the mandible in low-energy injuries. A higher number of dental contacts showed a lower rate of multifocal and displaced fractures, mitigating the effect of direct forces onto the bone. The correlation between clinical data and virtual simulation on FEM models seems to point out that virtual simulation successfully predicts fracture patterns and risk of association with different type of occlusion. Better knowledge of biomechanics and force dissipation on the human body may lead to the development of more effective safety devices, and help select patients to plan medical, orthodontic/dental, and/or surgical intervention to prevent injuries.

Minutes of the 3rd Annual Meeting of Society of Oral and Maxillofacial Trauma and Orthognathic Surgery, Chinese Stomatological Association

Minutes of the 3rd Annual Meeting of Society of Oral and Maxillofacial Trauma and Orthognathic Surgery, Chinese Stomatological Association

Stability of Nasoendotracheal Tube with Transeptal Flower Stitch versus Simple Surgical Knot in Patients undergoing Maxillofacial Trauma Surgery: A Cross-sectional Study

Stability of Nasoendotracheal Tube with Transeptal Flower Stitch versus Simple Surgical Knot in Patients undergoing Maxillofacial Trauma Surgery: A Cross-sectional Study

Evaluation of Surface Changes of Stainless Steel Miniplates and Screws Following Retrieval from Maxillofacial Trauma and Orthognathic Surgery Patients: A Comparative Study.

This study examines the surface changes of stainless steel miniplates and screws after their retrieval from patients who underwent maxillofacial trauma and orthognathic surgery. The assessment focuses on comparing the alterations in these materials, aiming to contribute to our understanding of their durability and performance in clinical settings. A total of 60 stainless steel miniplates and screws were collected from 30 patients who had previously undergone either maxillofacial trauma or orthognathic surgery. The retrieved miniplates and screws were carefully removed from the patients and cleaned to remove any organic debris. Each specimen was then examined for surface changes. Surface changes were evaluated using visual inspection, scanning electron microscopy (SEM), and roughness measurements. Visual inspection provided a qualitative assessment, while SEM allowed for a more detailed examination of the surfaces. Roughness measurements were conducted using a profilometer. Visual inspection revealed varying degrees of surface changes in the retrieved miniplates and screws. These changes included scratches, corrosion, and discoloration. SEM analysis confirmed the presence of surface alterations, with some specimens showing more significant damage, such as pitting and cracks. Roughness measurements indicated an increase in surface roughness for both miniplates and screws, suggesting that the surfaces had become less smooth. This comparative study of stainless steel miniplates and screws retrieved from maxillofacial trauma and orthognathic surgery patients demonstrated that these materials undergo surface changes over time.

A retrospective controlled study on the treatment effect of distraction osteogenesis and maxillomandibular advancement for severe obstructive sleep apnea hypopnea syndrome patients

Objective: To compare the treatment effect of distraction osteogenesis (DO) and maxillomandibular advancement (MMA) for severe obstructive sleep apnea hypopnea syndrome (OSAHS) patients and to guide clinical decisions about treatment of OSAHS. Methods: Thirty-seven OSAHS patients which accepted maxillomandibular advancement (MMA) or distraction osteogenesis (DO) in Stomatological Hospital of the Department of Maxillofacial Trauma and Orthognathic Surgery, School of Stomatology, The Forth Military Medical University from June 2017 to June 2019 were collected. Their preoperative and postoperative data of cephalometry, polysomnography (PSG), Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale (ESS) scores were collected and analyzed. With propensity score matching method, the treatment effect of MMA and DO was analyzed and compared. Results: According to the statistics of MMA group, only AHI was correlated with operative successful rate and cure rate. With the increase of AHI, the treatment effect of MMA on OSAHS patients gradually decreased. The cut-off point of AHI as a predictor of MMA treatment failure was 78.2 n/h. All the matched cases were severe OSAHS patients. Statistical analysis showed that the mandibular elongation of DO patients[(24.00±4.39) mm] was significantly more than that of MMA group [(11.20±1.37) mm] (t=-6.11, P<0.001), the improvement of PSG index [including lowest oxygen saturation (LSpO2), longest apnea (LA) and longest hypopnea (LH)] in DO group [LSpO2=(93.40±1.82)%; LA=(18.28±8.32) s; LH=(61.84±32.94) s] was significantly higher than that in the MMA group [LSpO2=(86.00±4.06)%, LA=(64.08±21.78) s, LH=(172.40±30.70) s](t=-3.72, P=0.005; t=4.39, P=0.003; t=5.49, P=0.004). The PSQI and the ESS scores of DO group (PSQI=4.20±0.83; ESS=3.40±1.52) were also significantly better than that of MMA group (PSQI=8.80±2.39, ESS=9.40±2.88)(t=4.07, P=0.001; t=4.12, P=0.002). Conclusions: For severe OSAHS patients, the objective and subjective indicators of DO treatment group showed a better therapeutic effect than that of MMA.

P-36666249-244 - Oral maxillofacial trauma treatment using computer assisted surgery.

In recent years, clinical application of three-dimensional treatment planning using computer simulation constructed from image data and patient biometric information has been progressing. Computer-assisted surgery (CAS) using simulation-based navigation systems and surgical guides has been introduced for oral and maxillofacial surgery. The 3D model created based on the preoperative image data can determine the preoperative surgical plan and the reduction site of the bone and is very useful for the treatment of maxillofacial fractures. In addition, the intraoperative navigation system captures the three-dimensional anatomical position by linking the surgical site on the CT or MRI image and displaying the positional relationship between the position seen by the operator and the target on the monitor in real time. It is a computer surgery support system that is widely used in many oral and maxillofacial surgeries. However, the problem with conventional navigation systems is that the intraoperative display image cannot be updated. This is because the navigation system is based on preoperative image data. In recent years, it has become possible to use CT images taken during surgery by using a hybrid operating room, and even in maxillofacial fracture surgery involving bone movement, intraoperative evaluation is possible by using a navigation system with images taken after movement. Yes, its usefulness is increasing. In this presentation, we would like to examine the usefulness and future prospects of computer-assisted surgery in oral and maxillofacial trauma surgery together with cases.

Application of Virtual Surgical Planning and Rapid Prototyping in Maxillofacial Trauma Surgery: A Case Series

Application of Virtual Surgical Planning and Rapid Prototyping in Maxillofacial Trauma Surgery: A Case Series

A randomized controlled trial on cross infection control in maxillofacial trauma surgery a comparison of intermaxillary fixation techniques

Aim: The purpose of the present research was to evaluate the intermaxillary fixation techniques in maxillofacial trauma surgery in terms of cross infection control. Methodology: A randomized controlled trial which included 120 patients with fractures of the mandible requiring open reduction and fixation. The participants were allocated either to the study group and treated with intraoperative Rapid IMF or to the control group and managed with intraoperative eyelet wire ties. Results: Rapid IMF group had significantly fewer glove perforations than the traditional method (0.67 per operation compared with 1.5), (P &lt; 0.0001). The incidence of skin-penetrating injuries was the same in both groups (rate 0.02/ procedure). The application of Rapid IMF was significantly faster than wiring (P &lt; 0.0001). Minor intraoperative complications were noted in both groups, but more in the Rapid IMF group. Most concerned loosening or fracture of the anchorage ties but the surgical outcome was not affected. Conclusion: Rapid IMF is a safer alternative to wiring methods with significant reduction in glove perforation rates and is quicker to apply than conventional wiring techniques.

Impact of COVID-19 lockdown on incidence of maxillofacial fractures: A retrospective analysis

COVID-19 lockdown restrictions greatly influenced people's behaviour and movements, and therefore patient presentation may differ in maxillofacial trauma surgery during lockdown. The aim of this study is to evaluate the impact of a lockdown on the incidence, types and mechanisms of injury of maxillofacial fractures. In this single-centre retrospective cohort study patients who visited the maxillofacial surgeon after traumatic injury between 15 March and 1 June in the years 2018, 2019, 2020 and 2021 were included. The primary outcome is the incidence of maxillofacial fractures during the lockdown in 2020 compared to the pre-lockdown and post-lockdown periods. Secondary outcomes are type of fracture and mechanism of injury. A total of 130 patients with maxillofacial fractures were identified. During the lockdown 0.51 (95% CI 0.32–0.84) times less maxillofacial fractures were reported. A significant association was found between mechanism of injury and lockdown compared to the post-lockdown period. No further associations were found between a lockdown and type of fracture or mechanism of injury. In conclusion, the incidence of maxillofacial fractures was significantly lower compared to equivalent time periods in other years, but recovered after lockdown.

The clinical utility of steroids in facial trauma: A retrospective study of 638 patients

AbstractGlucocorticosteroids reduce post‐operative swelling, trismus and pain after third molar extraction, maxillofacial trauma and orthognathic surgery. Steroids may affect immune system and retard wound healing. However, the use of steroids may or may not lead to infection. Patients were divided into two groups based on steroid therapy. The minimum follow‐up was for 6 months. Independent t‐test and chi‐square statistics were used for quantitative and categorical data respectively. A p &lt; 0.05 was considered significant at 95% confidence interval. A total of 638 patient records were divided into two groups; group A (steroid group) and group B (non‐steroid group). After 6 months 45% of group A patients and 2% of group B patients had infection (p value‐0.077). The mean duration of analgesic requirement in group A was 3.9 ± 1.5 days compared to 4.4 ± 2.1 days in group B (p = 0.01). Oedema was present in 9% of patients in group A compared to 12.5% in group B after 1 week (p &lt; 0.0001). The mean VAS score at 1 week was 0.03 ± 0.18 in group B compared to 0 in group A (p &lt; 0.001). Use of steroids does not increase the risk of infection. It significantly reduces the duration of analgesic requirement with the reduction in oedema and pain.

Evaluation of HMDs by QFD for Augmented Reality Applications in the Maxillofacial Surgery Domain

Today, surgical operations are less invasive than they were a few decades ago and, in medicine, there is a growing trend towards precision surgery. Among many technological advancements, augmented reality (AR) can be a powerful tool for improving the surgery practice through its ability to superimpose the 3D geometrical information of the pre-planned operation over the surgical field as well as medical and instrumental information gathered from operating room equipment. AR is fundamental to reach new standards in maxillofacial surgery. The surgeons will be able to not shift their focus from the patients while looking to the monitors. Osteotomies will not require physical tools to be fixed on patient bones as guides to make resections. Handling grafts and 3D models directly in the operating room will permit a fine tuning of the procedure before harvesting the implant. This article aims to study the application of AR head-mounted displays (HMD) in three operative scenarios (oncological and reconstructive surgery, orthognathic surgery, and maxillofacial trauma surgery) by the means of quantitative logic using the Quality Function Deployment (QFD) tool to determine their requirements. The article provides an evaluation of the readiness degree of HMD currently on market and highlights the lacking features.

An Epidemiological Analysis of Maxillofacial Fractures in the Inner Aegean Region: A Retrospective Evaluation of 343 Cases

Objective: The focus of this study was the sociocultural, economic, educational, and geographical factors that influence the incidence and types of fractures in maxillofacial trauma (MFT). The aim of this study was to identify the etiology and demographic characteristics of MFT cases in the inner (eastern) Aegean region. Materials and Methods: The records of patients treated at the Kütahya Health Sciences University Evliya Çelebi Education and Research Hospital for MFT from January 1, 2017 to March 1, 2020 were analyzed retrospectively. Results: A total of 476 bone fractures in 343 patients were analyzed. The sample comprised 239 male patients and 104 female patients. The average age was 35.19±17.79 years. Traffic accidents were found to be the most common cause (42%) of MFT. Of the isolated non-nasal bone fractures, 19 were in the maxilla, 17 in the zygoma, 14 in the mandible, and 7 in the frontal sinus. Nasal fractures (42.6%) were found to be the most frequently occurring breakages. Surgery was performed in 35.27% of the patients who agreed to have surgery for MFT. Conclusion: The etiology and incidence of MFT can vary not only by country but also by geographical region within countries. The results of this study support this view. A review of the literature indicated that MFT in the inner (eastern) Aegean region in Turkey has not yet been studied. Societal differences must be considered in the recommendation of measures to reduce the incidence of MFT and thus morbidity and mortality.

Characteristics of Skeletal Archial Analysis Facial Patterns in Adult Obstructive Sleep Apnea

IntroductionSkeletal archial analysis in adult OSA has not been characterized. The specific aim of this study was to characterize archial analyses of adult subjects with known OSA. The primary research question of this study was: “What is the frequency of skeletal patterns from archial analysis in adult OSA subjects?” The authors hypothesized that adult subjects with OSA will follow a retrusive pattern skeletal archial analysis with high correlation with OSA severity. Materials and methodsA retrospective cohort study of adult polysomnogram (PSG)-confirmed OSA subjects’ charts was designed from subjects who presented to Allegheny General Hospital Division of Oral and Maxillofacial Surgery between January 1, 1992, and December 31, 2017. Inclusion criteria included PSG-confirmed OSA (AHI > 5), diagnostic lateral cephalometric radiographs, and demographic and diagnostic data. Exclusion criteria included subjects with a history of maxillofacial trauma or tumor surgery, craniofacial syndromes, and inadequate chart records. Independent predictor variables were age, sex, body-mass index (BMI), anterior arc independent (continuous data), and combined horizontal and vertical analyses (categorical data). Lateral cephalometric radiographs were analyzed with Dolphin software (v. 11.8) for Sassouni Plus archial analysis. Anterior arc analysis was recorded for maxillary incisor position to ANS (U1 - ANS arc), Point B to Point A arc (B - A arc), and pogonion to ANS arc (Pg - ANS arc). Skeletal facial types were categorized into 27 distinct facial types. Statistical analysisStandard descriptive and Spearman correlation (□) analysis was used with Excel. Results were reported as mean, standard deviation, and percentages. Standard error of measurement (SEM) and post-hoc power analysis were completed. Statistical significance was set at the P < .05 level. ResultsA total of 171 subject charts that met the inclusion criteria were included in this study. The cohort consisted of 124 females (73%). The cohort mean for age was 47 years (Standard deviation [SD] 11), for BMI 31 (6.5), for AHI 42 (30.5), for ESS 13 (4.9), and for nO2 81% (11). All ICC were greater than or equal to 0.90. Skeletal archial analyses revealed that the most frequent skeletal patterns were Class III at 44.7% (77/171), bimaxillary retrusion at 27% (46/171), Class II at 21.1% (36/171), Class I at 6.6% (11/152), and bimaxillary prognathism at 0.6% (1/171). Relative to the anterior arc, maxillary position was retrusive in 82.2% (141/171), ideal in 11.2% (19/171), and protrusive in 6.6% (11/171) of subjects. Also, relative the anterior arc, the mandible was in an ideal position in 45.3% (78/171), retrognathic in 33.6% (57/171), and prognathic in 21.1% (36/171) of subjects. Long vertical skeletal pattern was most frequent at 81.6% (140/171), normal at 14.5% (25/171), and short at 3.9% (7/171) of subjects. The most frequent skeletal patterns were Maxilla Retro, Mand Ideal AP; Long Vertical (49/171, 28.9%), Bi-Skeletal Retro AP; Short Vertical (41/171, 23.7%), and Maxilla Retro, Mand Prog AP; Long Vertical (26/171, 15.1%). There were only weak correlations between all independent and dependent variables (range P = .05 to .19). ConclusionWithin the limitations of this study, maxillary and bimaxillary retrusion patterns were frequent horizontal archial analysis skeletal positions as was long lower facial height. Most skeletal patterns involved maxillary retrusion, generally with long vertical lower face. All of the horizontal archial skeletal positions had weak correlations with severity of adult OSA. Additional research may be required to fully analyze the full diagnostic potential of skeletal archial analysis in diagnosis and treatment planning of subjects with OSAS.

Archial Skeletal Analysis is not a Significant Predictor of Adult OSA Syndrome Severity

IntroductionArchial analyses may be a useful tool in the diagnosis and treatment planning of adult OSA. The purpose of this study was to evaluate the association of vertical and horizontal archial analyses on predictors of the severity of OSA. The primary research question of this study was: “Does facial skeletal archial analysis predict severity of OSA?” The authors hypothesize that archial analyses will predict severity of adult OSA. Subjects and methodsA retrospective cohort study of adult polysomnogram (PSG)-confirmed OSA subjects’ charts was designed from subjects who presented to Allegheny General Hospital Division of Oral and Maxillofacial Surgery between January 1, 1992, and December 31, 2017. Inclusion criteria included PSG-confirmed OSA (AHI > 5), diagnostic lateral cephalometric radiographs, and demographic data. Exclusion criteria included subjects with a history of maxillofacial trauma or tumor surgery, craniofacial syndromes, and inadequate chart records. Independent predictor variables were age, sex, body-mass index (BMI), anterior arc independent (continuous data), and combined horizontal and vertical analyses (categorical data). Skeletal facial types were categorized into 27 distinct facial types based on combined anterior horizontal and vertical arcs. Primary outcome variable was severity of OSA as defined by apnea-hypopnea index (AHI). Secondary outcome variables included Epworth sleepiness scale (ESS) and lowest oxygen saturation (nO2). Lateral cephalometric radiographs were analyzed with Dolphin software (v. 11.8) for Sassouni Plus archial analysis. Anterior arc analysis was recorded for maxillary incisor position to ANS (U1 - ANS arc), Point B to Point A arc (B - A arc), and pogonion to ANS arc (Pg - ANS arc). Statistical analysisStandard descriptive analysis, multiple linear regression on continuous variables, and multinomial logistic regression on categorical and dummy variables were performed using XLSTAT. Stratified by sex, multilinear regression was performed on anterior arc analyses. Continuous variables (median values) and categorical data were transformed to dummy variables for multinomial logistic regression. Results were reported as mean, standard deviation, and odds ratio (OR). Standard error of measurement (SEM) was completed on repeated cephalometric analyses of 20 randomly selected radiographs. Statistical significance was set at P < .05 level. ResultsA total of 171 subject charts that met the inclusion criteria were included in this study. The cohort consisted of 124 females (72.5%). The cohort mean for age was 47 years (Standard deviation [SD] 11), for BMI 31 (6.5), for AHI 42 (30.5), for ESS 13 (4.9), and for nO2 81% (11). All SEM were greater than or equal to 0.90. Stratified by sex, and controlling for age and BMI, no statistically significant associations for anterior archial analyses (U1 - ANS arc, B - A arc, or Pg - ANS arc) and severity of adult OSAS were found. Multinomial logistic regression revealed that none of the archial skeletal classifications were significant predictors of the severity of OSAS (AHI OR = 1.0, P = .89; ESS OR = 0.99, P = .70; nO2 OR = 1.0, P = .81). ConclusionWithin the limitations of this study, when controlling for age, sex, and BMI, anterior horizontal archial analyses were not significantly associated with, and archial skeletal facial types were not significant predictors for, OSAS severity as defined by AHI, ESS, or nO2. Additional research may be required to fully analyze the full diagnostic potential of skeletal archial analysis in diagnosis and treatment planning of subjects with OSAS.

Intra-Articular Condylar Fractures: Is Necessary Surgical Treament?

The surgical treatment of mandibular condylar fractures represents one of the most discussed topics in maxillofacial trauma surgery. Over the years the literature has documented an increasing attitude towards open reduction and internal fixation (ORIF) of these fractures. Some authors have recently increased the indications for ORIF to include intra-articular fractures, which have historically been managed conservatively1,2,3. The authors present their experience in the surgical treatment of intra-articular condylar fractures over a period of five years, from 2009 to 2014. Surgical techniques, early and delayed complica-tions, clinical and radiological outcomes and comparison with conservative treatment are discussed. Keywords: Mandibular Fracture, Condylar Fracture, Trauma.

Functional and electron-microscopic changes after differential traction injury in the sciatic nerve of a rat

BackgroundDuring maxillofacial trauma or oral cancer surgery, peripheral nerve might be damaged by traction injury. The purpose of this study was to evaluate functional and histomorphometric changes after traction nerve injury in the sciatic nerve of a rat model.MethodsA total of 24 Sprague-Dawley rats were equally divided into three groups: unstretched (sham/control, group A), stretched with 0.7N (group B) and 1.5N (group C). Traction injury was performed for 10 min in B and C groups. Functional recovery of the sciatic nerve was evaluated by walking track analysis, toe spread test, and pinprick test 2 weeks after injury. The weight of gastrocnemius muscles of both sides was measured to evaluate weight ratio (ipsilateral/contralateral). Total number of axons, axon fiber size, myelin thickness, G-ratio, axon number/mm2, diameter of fiber, changes of longitudinal width, and formation of the edema and hematoma were evaluated by transmission electron microscopy.ResultsThe sciatic function indexes were −11.48±4.0, −15.11±14.84, and −49.12±35.42 for groups A, B, and C, respectively. Pinprick test showed 3.0, 2.86±0.38, and 1.38±0.52 for A, B, and group C. Muscle weight ratios were 0.98±0.13 for group A, 0.70±0.10 for group B, and 0.54±0.05 for group C. There were significant differences in toe spread test, pinprick test, and muscle weight ratio between control group and experimental group (p<0.001). In the experimental group, fiber number, fiber size, G-ratio, fiber number/mm2, myelin thickness, diameter of fiber, and longitudinal width were decreased with statistical significance.ConclusionThe present study demonstrated that the nerve traction injury in the rat sciatic nerve damaged the motor and sensory function and axonal integrity. The amount of functional nerve damage was proportional to the amount of traction power and dependent on the initial tensile strengths (0.7N and 1.5N).

Evaluation of surface changes of stainless steel miniplates and screws following retrieval from maxillofacial trauma and orthognathic surgery patients: A comparative study.

Background:Metal implants have the potential to degrade body fluids. Corrosive degradation has been demonstrated in laboratory tests, both under simulated clinical conditions and by electrochemical methods, as well as in studies of retrieved metal implants. The clinical importance of degradation of metal implants is evidenced by particulate corrosion and wear products in tissue surrounding the implant, which may ultimately lead to bone loss.Materials and Methods:The present study is to evaluate the surface changes such as corrosion, surface roughness, and microfractures and for the tensile strength of 18 stainless steel miniplates and 18 stainless steel screws which were used as rigid internal fixation in the management of maxillofacial fractures and orthognathic surgeries.Results:In this study, surface roughness and microfractures were found in all the miniplates and screws that is 100%. Corrosion degradation was found in 12 of 18 plates that is 66.66%.Conclusion:Our results through scanning electron microscopy and stereo electron microscopy showed surface roughness, microfractures, and corrosion. However, tensile strength was not affected when the plates were in situ. Through our study, we recommend their retrieval after the purposes of rigid fixation have been fulfilled.

Does Intraoperative Computed Tomography Scanning in Maxillofacial Trauma Surgery Affect the Revision Rate?

The purpose of this study was to determine how intraoperative computed tomography affects the intraoperative revision rate and consequently the post-operative, secondary corrective surgery in maxillofacial trauma surgeries. A retrospective study composed of patients with facial fractures was conducted in Prince Sultan Military Medical City in Riyadh, Saudi Arabia. The predictor variables were age, gender, site of facial fracture, type of treatment, number of scans per patient, and discharge time. The primary outcome variable was immediate intraoperative revision rate. Secondary outcome variable was total scanning time (recorded from the moment surgery was halted until it was resumed after image acquisition). Descriptive statistics were used; numerical data presented as mean±SD and categorical variables as frequency (%). A total of 22 patients underwent 25 intraoperative scans while undergoing different maxillofacial surgeries. Eleven (50%) required intraoperative revisions after the scans, and 3 (13.6%) cases had another intraoperative scan after revision. Eighteen were men and 4 were women. The mean age was 30years and age range was 19 to 76. Cases were categorized by fracture location and treatment preformed. The mean scanning time was 18.9±4.6minutes. The highest rate of revisions was seen in zygomaticomaxillary complex fractures (63.6%), they were also the only cases that required a second intraoperative scan after revision to confirm final reduction. No complications were seen postoperatively, and all patients recovered uneventfully. None of the patients required a secondary corrective surgery. All patients were discharged on the following day, except 1 case which was admitted under another service. The use of intraoperative computed tomography imaging in treating maxillofacial fractures results in a higher rate of intraoperative revisions, which in turn leads to more accurate fracture reduction and consequently reduces the possibility of a postoperative, secondary corrective surgery.