Advances in Oral and Maxillofacial Surgery最新文献

Background

After the global pandemic of COVID-19 in March 2020, restrictions were implemented on all aspects of routine dental-care with a primary focus to urgent care only.

Aim

To investigate the impact on secondary care medical facilities and Emergency Department (ED) admissions for the management of severe dental infections as a result of restricted access to routine primary dental-care during the period of COVID-19 restrictions.

Design

National level Hospital Episode Statistics was used to describe the number of inpatient admissions for the drainage of a dental abscess and the attendance for dental related to ED. Data was stratified across ethnicity, sex and deprivation.

Results

There was a decrease in admission to secondary care for dental infection and total admissions during the initial period of national lockdown due to COVID-19. Incidence of dental abscess drainage equalled 4.51 per100,000 person years from 2018 to 2021. There was a 209 % increase in admissions in patients with greatest deprivation. This was much more exaggerated compared to that of non-dental comparison conditions and total inpatient admissions. Using subsequent inpatient admission as a marker of severity, 4.2 % dentally related ED attendance required onward admission.

Conclusion

A large proportion of ED attendances with dental related conditions did not require inpatient admission, therefore a large proportion of ED attendances could be managed more appropriately in specific dental services. Dental infections requiring surgical admission disproportionality affects the most deprived communities of the population which is much more exaggerated compared to peri-anal and total inpatient admissions. This highlights the inequalities and links with deprivation that exist in oral and dental health in England, which is much greater than that of general health if total admissions are used as maker for this. This research highlights the need to improve access to primary dental-care services.

A 34-year-old healthy woman was referred to our department for extraction of the right maxillary third molar. A rare complication happened during the procedure and management options were discussed with the patient; the agreement was to extract the tooth under general anaesthesia. Tooth extraction is a routine procedure performed in oral and maxillofacial surgery. However, complications may occur even with an experienced surgeon. Herein, we present a rare complication of the maxillary third molar displacement into the infratemporal fossa during extraction and its management.

Physicians are used to having complementary studies that help us in all phases of our work. In the maxillofacial surgery field the most commonly used tests are radiological tests (CT and NMR) and digital clinical photographs.

In recent years, the concept of 3D surgery has been developed and consists of the use of 3D technology applied to surgery. 3D surgery allows us to move from on-site planning of the surgery to pre-surgical planning, with a simulation and preview of the result at the bone and soft tissue level.

Radiological studies are of very limited use in soft tissue planning and digital photography is two-dimensional and dependent on patient positioning. The use of the surface scanner solves these limitations as it computes the spatial coordinates of the patient's anatomical surface in order to create a 3D digital model.

Introduction

The identification of the Facial nerve in parotid surgery stands as a stiff challenge till date. Various different pointers with numerical measurements have been identified. But these landmarks can differ between various race, sex or the presence of a tumour. Tracking the branch to posterior belly of digastric, which is not an expressive branch is the only surgical step where the surgeon can reach the facial nerve trunk without doing any surgical maneuver on facial nerve trunk.

Materials and methods

The study was conducted on 15 patients presenting with disease of the parotid gland. Surgery was done by following appropriate surgical steps and the nerve to posterior belly of digastric was searched for. Signs of Facial nerve palsy post-surgery was looked for and noted.

Results

In all our patients we could find the PDBFN confidently in continuation of the surgery. We observed the PDBFN is a thicker nerve then the marginal mandibular and it's easier to identify if it is intended as it is a constant anatomical landmark. Use of this branch help us to track the nerve which is definitive.

Conclusion

We found the digastric branch of the facial nerve is a reliable, consistent landmark to get the facial nerve trunk. Moreover, it was identified without any manouvere over the facial nerve trunk and as it is a non-expressive branch, it guards the possibility of inducing morbidity.

The reconstruction of large mandibular deficits involving the temporomandibular joint (TMJ) can be challenging. Extended alloplastic total temporomandibular joint reconstruction (eTMJR) is one treatment option.

This single center, prospective, long-term observational study evaluates the objective and subjective outcomes of 21 eTMJR subjects followed >5 years postoperatively. The long-term stability of the eTMJR was determined by collecting objective data (mandibular kinematics, contralateral surface electromyography (sEMG), maximum voluntary clenching (MVC)) and subjective oral health related quality of life (oHrQoL).

Except for mandibular deviation on opening, the objective variables markedly improved. A statistically significant decrease was found for ipsilateral condylar hypermobility (P = 0.001), and an increase in bilateral MVC (ipsilateral P = 0.029, contralateral P = 0.015). The subjective outcomes 'diet consistency’ (P = 0.001) and 'physical distress' (P = 0.043) improved significantly.

Based on the stability of the eTMJR devices over the study period, improved objective and subjective variables, eTMJR appears to be a safe and effective predictable management option for patients with large mandibular deficits including the TMJ.

The purpose of the present study was to compare the precision and reliability of voxel- and surface-based registration for computer-assisted assessment of the surgical accuracy and postoperative stability of segmental bimaxillary surgery. Three-dimensional translational and rotational measurements were performed by two observers using voxel- and surface-based registration. The precision and reliability of the measurements were calculated by the mean absolute differences (MAD) and intraclass correlation coefficients (ICC) at 95 % confidence intervals. A paired t-test or the non-parametric equivalent, Wilcoxon signed-rank test, was applied to statistically evaluate whether the precision of voxel- and surface-based registration was statistically significantly different (p < 0.05). Voxel-based registration had high precision (MAD <0.44 mm/0.92°) and excellent reliability, ICC [0.82–1.00]. The precision of surface-based registration was lower (MAD <0.56 mm/1.45°) and the reliability ranged from poor to excellent for the different bone segments, ICC [0.33–1.00]. Both registration techniques had high precision and excellent reliability for the assessment of the surgical accuracy, and the error margin of both techniques was clinical irrelevant. However, the increased precision of voxel-based registration was statistically significant (p < 0.05) for the maxillary segments and the chin, and the stability measurement error (ranging up to 1.58 mm and 4.46°) introduced by surface-based registration may be considered clinical relevant for these bone segments. Within the limitations of the present comparative study, voxel-based registration generally exhibited higher precision and reliability than surface-based registration for the surgical accuracy and postoperative stability assessment of segmental bimaxillary surgery.

Background

Human papilloma virus (HPV) infection is an important risk factor in oropharyngeal cancer. Several studies have analyzed the association of tumoral HPV status and different imaging parameters in FDG-PET/CT and magnetic resonance (MR) diffusion-weighted imaging (DWI), with contradictory findings. In this retrospective study, the influence of HPV-status on different parameters in FDG-imaging and MR DWI is investigated.

Methods

In this retrospective, single-center study we analyzed patients diagnosed with oropharyngeal cancer between January 2018 and December 2020 at a tertiary center in Switzerland. HPV status was assessed via p16 immunohistochemistry and/or PCR. Standardized uptake value (SUV), total lesion glycolysis (TLG) and apparent diffusion coefficient (ADC) were measured in pretreatment imaging (FDG-PET/CT, FDG-PET/MR, DWI MR). Statistical analysis was performed using Mann-Whitney-U tests. All p values reported are two-sided, and p values < 0.05 were considered statistically significant.

Results

142 patients were included. 67% of tumors were HPV-positive. Mean SUV_max in FDG-PET was 15.0+/-5.9 for HPV-positive tumors and 18.6+/-9.7 for HPV-negative tumors (p = 0.15). Mean ADC was 1109 x 10⁶ mm²/s+/-326.8 for HPV-positive tumors and 1045.8 x 10⁶ mm²/s+/-467.0 for HPV-negative tumors (p = 0.76).

Conclusion

and Relevance: We found no correlation between oropharyngeal carcinoma HPV status and any of the analyzed imaging parameters.

Background

An intramuscular (IM) injection into gluteal muscle can lead to iatrogenic trauma to sciatic nerve. The drugs can be injected directly into sciatic or into the tissue adjacent to the nerve. Besides the direct damage to nerve due to needle and drug entrance to nerve tissue, the chemical nature of each drug activates immune system near healthy peripheral nerves in order to remove damaged tissues and start healing process. This immune system response has a great role in creating pathological pain and it makes functional recovery as a major challenge.

Material method

In this study, 25 adults male Fischer- Wistar rats were used. An analgesic drug (diclofenac) was injected in the muscles near sciatic nerve (4 groups) and also in sciatic nerve (1 group, nerve control group). For clinical assessment of sciatic nerves integrity, sciatic functional index test (SFI test) was done before, 1 day and 7 days after surgery. Treatments with meloxicam, dexamethasone and extract of Salvia Officinalis were started for 3 muscle groups and 1 group remained as a control muscle group. After 1 week, all the animals were euthanized under deep anesthesia and the sciatic nerves with surrounding muscles were removed and sent to histopathological examination.

Results

all three treatment groups showed decreased inflammatory process and increased repair regeneration in compare to control group. Although, the amount recovery in the dexamethasone group was significantly higher in compared to the control and other treatment groups.

Conclusion

This study showed That IM injection of analgesic drug (Diclofenac), without direct damage to sciatic nerve, causes activation of the immune system and iatrogenic sciatic neuropathy. This study also showed therapeutic effects of two common drugs (NSAID and corticosteroids) and an extract of Salvia Officinalis. Treatment with all three drugs, decreased inflammatory response at injury site and increased recovery but Long-term usage of corticosteroids and NSAIDs can be challenging. The Salvia extract also have showed acceptable improvement effects with minimal side effects.

Introduction

The aspiration and ingestion of a molar during its extraction is a rare accident, so there is not enough information about the reported cases. The objective of this study is to carry out a systematic review, analyze the articles on intraoperative dental aspiration and intake, and propose an algorithm for the management of this complication.

Materials and methods

A systematic review was carried out following the PRISMA criteria in the PubMed database in January 2023 with the following limitations: studies conducted in humans; English language; reports of aspiration and swallowing of teeth during dental extraction, age was not limited. Exclusion criteria: studies of aspiration and ingestion of foreign bodies that do not involve teeth.

Results

A total of 5 articles were obtained with 5 reported cases of aspiration. There were no reports associated with the ingestion of a tooth. The most prevalent sex was male, with all cases reported in men, the average age was 24.4 years. The imaging studies of choice were chest radiography and computed tomography. The right bronchus was the most prevalent location site. The first line treatment was bronchoscopy, followed by tracheotomy and thoracotomy.

Conclusion

Tooth extraction is a common surgical procedure, so it is essential to be careful in the event of possible complications such as intraoperative aspiration or tooth ingestion. Tooth aspiration can be a life-threatening complication, so prompt management is important. The proposed algorithm allows adequate management for aspiration and swallowing of teeth.

Microvascular free flap tissue transfer is a reliable technique for the reconstruction of orofacial defects, success rates have been cited as being between 96 and 98%, with vascular compromise requiring early return to theatre reported in 5–20% of cases across the literature. It has been described that the majority of free flap compromise occurs within the first 48 h post anastomosis, and that salvage rates are proportional with the timing of the vascular insult. Strategies adopted to identify early signs of compromise and hence improve the chances of flap survival are many, and protocols vary between units. On review of the literature, diligent bedside clinical monitoring of free flaps in the early post-operative period, seemed to facilitate detection of vascular compromise, allowing for early salvage, and hence better outcomes. Monitoring adjuncts such implantable doppler devices may prove helpful in such cases but false positives and negatives should be kept in mind. It would seem appropriate that future research should centre on evaluating adjunctive techniques to close bedside monitoring with a focus on clinically relevant outcome measures as well as cost/benefit analyses.