Maxillofacial Unit Research Articles

Prognostic determinants in severe odontogenic space infections: a single-center retrospective analysis.

Odontogenic space infections are a common presentation in oral and maxillofacial surgery units worldwide. Multiple patient and treatment dependent variables may be used predict the outcomes of the disease process. This study was aimed at a retrospective evaluation of significant predictors of prognosis in terms of length of hospital stay and the need for re-exploration in cases of odontogenic space infections. Patients who underwent incision and drainage of odontogenic space infections were identified from the hospital records of the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, Karnataka, India. The variables assessed included Diabetic status, pyrexia on admission, topical rubefacient agent application, hot fomentation, recent tooth extraction, trismus, dysphagia or dyspnea on presentation, white blood cell count, number of spaces involved, antibiotics used, organisms isolated, severity of the infection and the anesthesia technique used (local anesthesia [LA], conscious sedation or general anesthesia). The sample consisted of 259 patients (110 male, 159 female) with a mean age of 41±16.9 years. Space infections were preceded by tooth extractions in 53 (20%) cases, rubefacient balm application in 130 (40%) and hot fomentation in 58 (22%) cases. Trismus was noted in 140 patients with an average mouth opening of 21±10.3 mm. Dyspnea and dysphagia were noted in 55 (21%) and 96 (37%) patients each. Sixty-six patients were diabetic. The average length of hospital stay was 5.8±3 days and re-exploration was required in 75 (29%) patients. Significant predictors of hospital stay were severity (P<0.001), number of spaces affected (P<0.001), hot fomentation (P=0.04), trismus (P<0.001), dysphagia (P<0.001) and dyspnea (P<0.001). Predictors of re-exploration are an increased primary surgery under LA (P<0.001), white blood cell count (P<0.001), rubefacient balm application (P=0.045), dysphagia (P<0.001), dyspnea (P=0.018), and reduced mouth opening (P<0.001). No significant correlation between diabetes and length of hospital stay or the need for re-exploration were found in this study. Poorer outcomes can be predicted based on the severity of the infection, the number of spaces involved, an increased white blood cell count as well as clinical signs and symptoms like trismus, dysphagia and dyspnea. Hot fomentation and Rubefacient agent application were identified as significant determinants of poor prognosis in this study. The presence of these indicators warrants a more aggressive approach towards management of space infections.

Evaluation of soft tissue prediction accuracy for orthognathic surgery with skeletal class III malocclusion using maxillofacial regional aesthetic units.

This study aimed to evaluate the soft tissue prediction accuracy of patients undergoing orthognathic surgery to correct skeletal class III malocclusion using maxillofacial regional aesthetic units. Pre- and postoperative cone-beam computed tomography (CBCT) and 3D facial scans were taken for 58 patients who had undergone orthognathic surgery. The preoperative 3D facial scan was integrated with the preoperative CBCT using ProPlan CMF software. The software simulated the surgery and generated postoperative soft tissue prediction. The simulated 3D facial scan was then compared with the actual 3D facial scan obtained at least 6months after the surgery by the maxillofacial regional aesthetic units and the facial soft tissue landmark points. The anatomical regions of the upper lip, lower lip, chin, right external buccal and left external buccal prediction were above 2.0mm. As for the soft tissue landmarks, at chl, chr, ls, stm and li, the position of predicted scan was higher than that of the actual postoperative scan. The accuracy of 3D soft tissue predictions using ProPlan CMF software in Skeletal III patients was clinically satisfactory according to maxillofacial regional aesthetic units combined with facial soft tissue landmark points. However, the accuracy of prediction still needed improvement in some areas. The accuracy of soft tissue prediction can be analyzed more clearly through maxillofacial regional aesthetic units so that clinicians have a deeper understanding of the use of the software to predict soft tissue change after orthognathic surgery.

Effect of COVID-19 Italian Lockdown on Maxillofacial Trauma Related to Domestic Violence: A Retrospective Cohort Study.

Background: This retrospective study aims to identify the potential reasons for the increase in maxillofacial trauma from domestic violence in the first COVID-19 lockdown and propose some strategies that could be effective in fighting it during any future pandemic events. Materials and Methods: The study was conducted on patients with maxillofacial trauma who arrived at the Maxillofacial Unit of the Magna Graecia University of Catanzaro from 9 March to 3 May 2020, who were compared with those registered in the same period in 2019. Inclusion criteria were: patients of both sexes and admission diagnosed with maxillofacial trauma with or without bone fracture. Exclusion criteria were: patients less than 7 years of age, maxillofacial trauma that occurred outside the established period, and patients unconscious or with unclear clinical history. Patients were divided into two groups according to the mechanism of injury (MOI): “domestic” and “non-domestic” trauma. Both descriptive and regressive statistical analysis was conducted using a Student’s t-test with a significance level set at p < 0.05. Results: The total number of maxillofacial fractures in 2020 was similar to 2019 (31 pcs in 2020 vs. 38 pcs in 2019). Before the lockdown, most of the trauma occurred in non-domestic settings (25% in 2020 vs. 76.67% in 2019), especially in road accidents (4.17% in 2020 vs. 20% in 2019). During the lockdown, most of the trauma occurred in a domestic setting (75% in 2020 vs. 23.33% in 2019), especially interpersonal violence (31.58% in 2020 vs. 14.28% in 2019). There were 7 cases of interpersonal violence recorded in 2020 (1 male and 6 female), compared to only one case (female) recorded in 2019, with a statistically significant p-Value (0.0475). Conclusions: The first COVID-19 lockdown has provided the opportunity to study the aetiology of domestic trauma due to interpersonal violence attributable to economic and social problems, all of which were aggravated by the impediment to requesting help due to the difficulty of contacting the services and the general slowdown in the ways out of violence. The analysis conducted and compared with data in the literature suggests the adoption of a proactive (and non-reactive) approach to combat domestic violence during pandemic events.

Machete-Cut Maxillofacial Injuries in Civilian Setting: Case Series from a Tertiary Health Care Facility in Sokoto, Northwestern Nigeria.

Machete-cut injuries are not uncommon and are usually associated with severe soft tissue disruption and unusual bone fractures. This could result into a potentially life-threatening injuries that could pose challenges in management. Six patients seen and managed for machete-cut injuries over a period of 2years (From July 2020 to August 2022) at the Dental and Maxillofacial surgery unit of Usmanu Danfodiyo University Teaching Hospital Sokoto were presented. All the victims were males sustaining varying degrees of soft and hard tissue injuries, with no tissue avulsion. Four (4) cases of the series were treated under local anaesthesia and conscious sedation while the remaining two (2) cases were done under general anaesthesia. Open reduction and internal fixation were done in four (4) of the cases, splinting in one (1) case and only soft tissue repair in one (1) case. Facial nerve palsy, mental and buccal nerve anaesthesia were the observed nerve injuries. Early presentation, careful assessment of the injuries and meticulous planning will reduce morbidity and mortality associated with such injuries. There is need for preventive mechanisms such as providing education as well as reducing rate of unemployment in our society.

Rhinocerebral Form of Invasive Mycosis in COVID-19 Patients: Clinical Course, Diagnosis, Treatment Experience

Background. The incidence of invasive mycoses is reported to increase among patients with a history of new coronavirus infection COVID-19. Adhesion and damage of endothelial cells by zygomycetes lead to fungus angioinvasion, release of a large number of fungal proteases, lipases and mycotoxins, as well as vascular thrombosis, subsequent necrosis of tissues.Objectives. Improvement of the diagnosis and treatment for COVID-19 associated invasive mycosis.Methods. Examination and treatment of 143 patients with invasive mycosis of the maxillofacial area in the period from August 2021 to May 2022 at the Maxillofacial Unit of Regional Clinical Hospital of Emergency Medical Care, Krasnodar Krai, Russia. The diagnosis was confi rmed by cytological, culture-based methods, as well as pathomorphological study of surgical specimen. Follow-up monitoring was carried out in 1, 3, 6 months, with repeated CT and MRI investigations. The group under follow-up monitoring included 91 patients. The incidence of signs was determined via descriptive statistics methods in proportion of the total number of observations and expressed as a percentage. Statistika 12.5 and Excel 2010 (Windows 10) were used in the study, the graphical representation of the material was made in the same programs.Results. Manifestation of invasive mycoses of the maxillofacial area occurred during the early convalescent period of coronavirus infection in specialized infectious hospitals or within two weeks after discharge from the hospital. A typical clinical picture includes rhinocerebral zygomycosis with the development of fungal osteomyelitis of the upper jaw, nasal bones, zygomatic bone, ethmoidal labyrinth bones, sphenoid bone, frontal bone. 17 cases (11.9%) had a lethal outcome as a result of disseminated form of fungal infection caused by Mucorales (14 patients), Aspergillus (3 patients) with damage to the brain, lungs, kidneys and fatal massive necrotic lesions of the craniofacial area. An integrated approach embraced early antifungal therapy (Amphotericin B) as well as surgical debridement of the lesions and provided a positive effect in treatment.Conclusion. Invasive fungal infections require prompt diagnosis and early prescription of antifungal therapy (prior to histological confi rmation of diagnosis) to minimize consequences and prevent fatal outcome. Due to the nonspecifi c nature of clinical symptoms and diffi culties of early diagnosis of invasive zygomycosis and aspergillosis, it is necessary to be alert to potential invasive aggressive mycoses in immunocompromised patients who have a history of a new coronavirus infection COVID-19.

Analysis of the High Submandibular Approach: A Critical Reapprasail of a Transfacial Access to the Mandibular Skeleton.

In 2006 following the development of dedicated osteosynthesis plates, Meyer and colleagues reported a successful clinical study of condylar fractures treated by a modified submandibular approach; it was called high submandibular approach or "Strasbourg approach." The aim of this study is to describe the high submandibular approach step by step. Between January 2010 and December 2015 at the Maxillofacial Unit of the Hospital "Policlinico San Martino" 13 patients affected by subcondylar fracture underwent open reduction and internal with high submandibular approach. Surgery was uneventful in all patients; no infections occurred in any of the cases; the mean procedure duration was 89 minutes, ranging from 66 to 125 minutes. The mean hospital stay was 2.9 days, ranging from 2 to 6 days. At the 1-year follow-up, all patients had stable occlusion with a natural, well-balanced morphology of the face and adequate dynamic excursion of the mandible. The morbidity is negligible in terms of damage to the facial nerve, vascular injuries, and aesthetic deformity. The authors think that further prospective clinical trials are necessary to assess and eventually develop this approach.

SEGMENTAL MANDIBULECTOMY WITH MICROVASCULARIZED FIBULAR GRAFT FOR MULTICYSTIC AMELOBLASTOMA TREATMENT: A CASE REPORT

Ameloblastomas are benign tumors of the jaws and account for 80% of odontogenic tumors. Ameloblastomas can be very aggressive and lead to dysfunction, such as facial asymmetry. To minimize recurrence, segmental mandibulectomy is more efficient, but it carries high morbidity. We present a case of a 12-year-old male patient who was referred to the Oral and Maxillofacial Surgery unit with swelling of the left mandible. Histologic examination confirmed the diagnosis of multicystic ameloblastoma. Computed tomography showed a multilocular radiolucent lesion, 5.99 cm long and 4.52 cm wide on sagittal view. The patient underwent a segmental mandible resection with a microvascularized fibula graft fixed by a 2.7-mm reconstruction plate. At 6-month follow-up, the patient has good mouth opening, a satisfactory lower jaw shape, and no pain. Microvascularized grafts are the gold standard for rehabilitation after ameloblastoma resection because they restore function and aesthetics.

Personalized Surgery Service in a Tertiary Hospital: A Method to Increase Effectiveness, Precision, Safety and Quality in Maxillofacial Surgery Using Custom-Made 3D Prostheses and Implants.

Personalized surgery (PS) involves virtual planning (VP) and the use of 3D printing technology to design and manufacture custom-made elements to be used during surgery. The widespread use of PS has fostered a paradigm shift in the surgical process. A recent analysis performed in our hospital—along with several studies published in the literature—showed that the extensive use of PS does not preclude the lack of standardization in the process. This means that despite the widely accepted use of this technology, standard individual roles and responsibilities have not been properly defined, and this could hinder the logistics and cost savings in the PS process. The aim of our study was to describe the method followed and the outcomes obtained for the creation of a PS service for the Oral and Maxillofacial Surgery Unit that resolves the current absence of internal structure, allows for the integration of all professionals involved and improves the efficiency and quality of the PS process. We performed a literature search on the implementation of PS techniques in tertiary hospitals and observed a lack of studies on the creation of PS units or services in such hospitals. Therefore, we believe that our work is innovative and has the potential to contribute to the implementation of PS units in other hospitals.

INFLAMMATORY PSEUDOTUMOR MAXILLARY SINUS: CASE REPORT

A 52-year-old White male patient was referred to the Oral and Maxillofacial Surgery Unit of tertiary hospital in São Paulo due to recurrent nasal polyps. Despite the absence of neoplastic aspects, a recurrent lesion with an aggressive aspect was observed on clinical and imaging evaluation, mimicking a malignant neoplasm, with destruction of the floor of the right orbit. The right maxillary sinus lesion was excised with nasal and external endoscopic access by lateral rhinotomy and CaldWell-Luc access with right orbit reconstruction. The anatomopathologic evaluation showed a lymphoplasmacytic inflammatory process, with no evidence of malignancy, confirming the diagnosis of inflammatory pseudotumor maxillary sinus. After 1 year of postoperative follow-up, there are no signs of recurrence. The aggressivity of the inflammatory pseudotumor of the paranasal sinuses constitutes a diagnostic challenge, and the treatment must guarantee the complete excision of the lesion, preventing its recurrence.

Osteoradionecrosis: Experience from the Oral and Maxillofacial Surgery Unit at Christchurch Hospital, New Zealand

Background and objectives: Osteoradionecrosis of the jaws (ORN) is a debilitating complication of radiotherapy among head and neck cancer patients. Dentists are critical to the management of patients at risk and may be the first clinicians to encounter new onset ORN. Oral and Maxillofacial Surgical teams are commonly involved in the surgical management of such patients. To the best of our knowledge there have been no studies examining the referral pathways of patients with ORN to Oral and Maxillofacial Surgical Services in New Zealand. Methods: A retrospective study was conducted and included all patients with ORN referred to the Oral and Maxillofacial Surgical Service at Christchurch Hospital, New Zealand in the 3-year period 1st January 2018 to 31st December 2020. Clinical records were accessed to collect data endpoints. To illustrate the potential severity of ORN we also present a case report of a patient with mandibular ORN and pathologic fracture that was managed. Results: Thirteen patients with ORN were referred to the Oral and Maxillofacial Surgical Service at Christchurch Hospital over the study period. The majority of patients were referred by internal Christchurch Hospital colleagues (Otorhinolaryngology and Hospital Dentists). A wide range of presenting signs/symptoms were found. All patients presented with exposed necrotic bone however no other symptoms were found to be of high sensitivity for ORN. Patients required a range of treatment modalities, from conservative management to resection and fibula free-flap reconstruction. Conclusions: Most patients at risk of ORN are being maintained on long-term Hospital based recall lists for clinical review. Given the wide range of presenting signs/symptoms of ORN, oral health practitioners must exercise a high degree of clinical suspicion when encountering these in irradiated patients.

Association of Tobacco Smoking with Systemic Co-Morbidities among Patients Seeking for Dental Care Services: Across Section Study

Background: Smoking is a common risk factor for chronic diseases, including cancer, lung diseases and cardiovascular disease. The adverse effects of tobacco smoking on oral health are well documented. This includes common and rare conditions of benign to life-threatening diseases such as bad breath, discoloration of teeth and dental restorations, taste and smell disorders , periodontal disease , oral mucosal lesions such as smoker's melanosis and smoker's palate, potentially malignant lesions and oral cancer . Aim of the Study: To verify associated of the smoking with systemic dissase among patients seeking for dental health care Patients and methods: A cross-sectional study performed at the dental and maxillofacial unit in AL-Sader Teaching hospital, Al-Najaf city the data were collected during a period of four months, starting 1st March to the 1st June 2019. Target population: study participants were selected by systemic random sampling patients attended Al Sader Teaching hospital at maxillofacial unit according to special criteria. Results: A total of 400 participants were enrolled in this study , their age ranged 18 – 65 years, no significant difference had been found regarding the age distribution between smokers and non-smokers sub groups, (P&gt;0.05). No significant association was found between smoking and residence, (P&gt;0.05). A significant association was found between occupation and smoking status , where unemployed were the dominant among smokers, contributed for 52.9%, compared to other occupations, (P = 0.001). Conclusions: Significant associated with observed between oral disease and cigarette smoking among patient seeking oral health care.

Patterns and Treatment Modalities of Maxillofacial Fractures due to Motorcycle Accidents

Aim: Maxillofacial fractures due to motorbike accidents are common in Pakistan. The aim of current study was to evaluate the pattern of fractures in motorbike accidents and the common treatment modalities used to deal these fractures. Methodology: In this cross-sectional study 274 patients with facial fractures were recruited consecutively from Maxillofacial surgery unit of Khyber College of Dentistry, from April 2021 to December 2021. Patterns were classified broadly into midface, mandible and combined fractures while treatment modalities included close reduction and ORIF at 1, 2, 3 and 4 or more points. Simple descriptive statistics were used with SPSS version 20.0. Chi-Square and Fisher’s Exact tests were applied where required, with p&gt;0.05 kept as significant. Results: Out of 274 patients, 260 were male and 110 belonged to age group 21 to 30years. Mandible fracture (n=108) was the most common pattern followed by combined fractures (n=88). Symphysis/parasymphysis was the most common site of single mandibular fractures while most common single midfacial bone to fracture was ZMC (n=56). Overall 2 points fixation (n=88) was the most common treatment modality used followed by 1 point fixation (n=72). Mandibular fractures were treated mostly by single point fixation and combined fractures by ORIF at 3 or more points (p=0.000). Conclusion: Maxillofacial fractures due to motorbike accident are common in men of 21 to 30 years age. Mandibular fractures are the most common followed by combined fractures. Mandibular fractures require 1 point, midface fractures 2 points and combined fractures 3 or more points fixation for their optimal management. Key words: motorbike accidents, patterns, treatment modalities

AB126. SOH22ABS057. The coronavirus disease 2019 (COVID-19) pandemic effects on Maxillofacial Trauma at the National Maxillofacial Unit: evidence of a potential increase in domestic violence?—This study reviews maxillofacial trauma patients (MFT) during the COVID pandemic

AB126. SOH22ABS057. The coronavirus disease 2019 (COVID-19) pandemic effects on Maxillofacial Trauma at the National Maxillofacial Unit: evidence of a potential increase in domestic violence?—This study reviews maxillofacial trauma patients (MFT) during the COVID pandemic

Medical status of elderly patients consulting two oral and maxillofacial surgery departments in Germany

An increasing number of elderly patients requires dental care. The data concerning the medical risk profile of seniors consulting dentists are scarce. In this context, the comorbidity-polypharmacy-score (CPS) could be an effective clinical tool to quickly assess the medical status of elderly patients. The medical data from 648 patients (60 years and older) of two cohorts (Fulda group [Fg] and Marburg group [Mg]) from two maxillofacial surgical units were recorded using a standardised questionnaire and compared concerning the number of the regular medications and the CPS. No medication was needed in 57 patients and 311 took 1 to 4 medications per day. Polypharmacy (5 or more medications per day) could be observed in 280 patients. The average medication was 4.28 in the Fg and 4.57 in the Mg groups (p = 0.249). Antihypertensives and antithrombotics were the most common medications. The CPS was subdivided into three groups (minor, moderate, severe). In total, 332 patients belonged to the minor group and 80 to the severe group. The average CPS was 7.49 in the Fg and 7.99 in the Mg groups (not significant). CPS was strongly correlated with age (p < 0.001) but not with sex. The prevalence of elderly patients with polypharmacy presenting for dental care is increasing. Scores like CPS may be a useful adjunct for quantifying the burden of disease in the context of dental treatment.

Need for tracheostomy in major head and neck ablative surgery: a paradigm shift during the COVID-19 pandemic.

Management of the airway in the perioperative period for patients requiring major head and neck ablative surgery has commonly included the performance of elective surgical tracheostomy. This has been standard practice in most maxillofacial units across the UK, including ours. However, the COVID-19 pandemic and emerging guidelines on aerosol-generating procedures required us to revisit the need for a perioperative tracheostomy. We present our series of 29 consecutive cases, cared for during the first wave of the COVID-19 pandemic, that were managed either using surgical tracheostomy or overnight tracheal intubation. Out of 29 patients 3 received a surgical tracheostomy. The average duration of tracheostomy use was 8 days. Twenty patients were managed using a period of overnight tracheal intubation. Average duration of tracheal intubation was 1.2 days, with an average intensive care unit stay of 1.7 days. The average duration of hospital stay was 15.8 days for patients managed with overnight tracheal intubation and 30.1 days for patients who received a surgical tracheostomy. The return to theatre rate was 13.8% for reasons including flap failure and neck space infection. There were no airway issues reported in this series of patients. Our findings suggest that overnight tracheal intubation can be a safe alternative to surgical tracheostomy in the majority of cases.

How London maxillofacial units faced the demands of COVID lockdown and lessons learnt

IntroductionIn the UK between the March 23, 2020 and May 10, 2020, the government enforced a lockdown. This, combined with COVID, caused OMFS hospitals across London to experience a change in staffing, resources and patient presentations. This study examines these changes, how patient care was adapted during this period and what can be learnt for the future. MethodData was collected from OMFS units attached to all 4 level 1 trauma centers in London. Prospective data was collected from March 23, 2020–May 10, 2020 (1st period). Retrospective data was collected from hospital coding records for 23rd of March - May 10, 2019 (2nd period). Data was collected on all referrals to the OMFS team including diagnosis, patient demographics and treatment received. ResultsThere was an 84% reduction in patients presenting with mandible fracture. 2 units with dental emergency services experienced no change in dental abscess presentations whilst the other 2 units saw a decrease of 70–75%.There was a trend towards reducing admission and general anaesthetic treatments. Most mandible fractures were treated in the outpatient setting with 1 unit discharging 100% of mandible fractures that presented to A&E. Only 13 of 72 paediatric lacerations were treated with general anaesthetic. ConclusionThe COVID lockdown period, like war time, posed great challenges to healthcare provision. This paper presents the changes experienced and how patients were managed. Aiming to allow reflection and learning to guide changes in management to be adopted for the future.

PATTERN OF MOTORCYCLE RELATED MAXILLOFACIAL INJURIES IN PATIENTS PRESENTING TO A TERTIARY CARE HOSPITAL IN PAKISTAN: A CROSS-SECTIONAL STUDY

Objectives: To analyze the pattern of maxillofacial injuries and associated concomitant injuries received by a motorcyclist.Methods and materials: This descriptive (cross-sectional) study carried out at the Oral and Maxillofacial Surgery Unit of Hayatabad Medical Complex, Peshawar from 4th December, 2019 to 20th February 2021. A total of 386 patients having road traffic accidents were included in the study regardless of age and gender. Every patient was examined both clinically and radiographically to confirm the site of maxillofacial fracture.Results: Majority of the patients were involved in motorbike accidents (79%) among the patients injured in road traffic accidents. More than two third of the patients were young males (76%) as compare to females (24%). Out of 304 patients who sustained maxillofacial trauma during motor bike accidents, only a minority of victims 38(12.5%) used helmets while the remaining did not. The most common fractured site was mandible (46.7%).Conclusion: Most of the patients encountered in the present study were young males without helmets and mandible being the most frequent site.

Langerhans cell histiocytosis—An update and rare case presentation

AbstractLangerhans cell histiocytosis (LCH) is a rare condition caused by the abnormal proliferation of a type of dendritic cell of the immune system (Langerhans cells). Accumulation of the cells can take place in one or multiple organs of the body and results in localised tissue destruction. The most commonly affected site is the bones and 50% of these cases present in facial bones, meaning an awareness of the condition by dental specialists is important. Although debated, LCH is currently categorised as a cancerous process that is treated in some cases with chemotherapy. Its first mention in medical literature was in the mid‐1800s but it was not recognised as LCH until 1973. Here we present a case of LCH presenting in the mandibular condyle of a 27‐year‐old female with symptoms commonly associated with temporomandibular joint dysfunction. Failing to respond to simple conservative measures by her general dental practitioner, the patient was referred to her local oral and maxillofacial surgery unit for further management. Complicated by a pathological fracture of the mandible, the diagnosis of LCH required a multi‐disciplinary approach to management and subsequent surgical resection of the lesion and reconstruction with a costochondral rib graft.

Comparison between Modified Triangular Flap and Envelop Flap Techniques for Surgical Removal of Impacted Mandibular Third Molar

Objective: To compare postoperative outcomes in surgical extraction of mandibular third molar with envelop flap versus modified triangular flap.&#x0D; Setting &amp; Duration: Oral &amp; Maxillofacial Surgery Unit at Faculty of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro. Study period was from January 2021 to December 2021.&#x0D; Subject and Methods: A set of 60 individuals were sequentially assigned 30 to the Group A envelop flap and 30 to the Group B modified triangular flap for surgical removal of the mandibular third molar tooth. The demographic and clinical parameters was identified and recorded in proforma. The discomfort, swelling, and restricted mouth opening linked with an impacted mandibular third tooth are all assessed prior to surgery. The flap pattern employed for the extraction of the impacted lower third molar tooth, pain, and mouth opening was all reported on the proforma at the end of the procedure. On the seventh postoperative day, each patient was evaluated again.&#x0D; Results: - The average age of patients in group A was 29.77±7.17 years and 28.20±6.28 years in group B. Mean pain score was significantly low in group A as compare to group B [0.87±0.86 vs. 2.93±0.87 p=0.0005]. Mean mouth opening was significantly high in group A than group B [12.86±3.59 vs. 6.12±1.67; p=0.0005].&#x0D; Conclusion: In comparison to the envelope flap, the modified triangular flap was more effective when considering the postoperative periodontal state of the surrounding third molar and the dehiscence after wound recovery.

Endoscopic tooth extraction after intrusion into the maxillary sinus in a teenager: a clinical case

Relevance . One of the complications of maxillary tooth extraction is its intrusion into the maxillary sinus due to the peculiarities of the anatomy of the upper jaw and possible technical errors of the doctor. The extranasal approach is the most common treatment method of this pathology, namely the Caldwell-Luke surgery (radical antrostomy) or oroantral communication closure and removal of a foreign body from a maxillary sinus. Diagnosis . This article describes two clinical cases. Both patients were admitted to the Pediatric Maxillofacial Surgery Unit with a diagnosis of Foreign body in the maxillary sinus. The paper presents our experience on the endoscopic removal of a foreign body from the TMJ in these patients. Results . Endoscopic removal of foreign bodies from the maxillary sinus was the treatment method in these patients. The postoperative period was unremarkable and without complications. Conclusions . We currently believe that the endoscopic approach to tooth removal from the maxillary sinus is a solution that should be adhered to by all modern surgeons since this method is less invasive and has a short recovery period.