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Elevated Intracranial Pressure After Primary Surgical Correction of Sagittal Suture Craniosynostosis. 矢状缝颅骨发育不良初级手术矫正术后颅内压升高。
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2023-03-01 Epub Date: 2022-03-11 DOI: 10.1177/19433875211064680
Rami P Dibbs, Andrew M Ferry, Lesley Davies, David F Bauer, Edward P Buchanan, Han Zhuang Beh

Study Design: A Case Report. Objective: Craniosynostosis is a craniofacial condition defined by premature fusion of at least one cranial suture. Resynostosis or secondary craniosynostosis of a previously patent adjacent suture following primary repair is a relatively common complication. While studies have assessed the rates of secondary craniosynostosis and subsequent reoperation, extremely limited data regarding reoperation techniques is available. Methods: We present a unique case of a pediatric patient with sagittal craniosynostosis who previously underwent a modified pi procedure and later developed resynostosis of the sagittal suture and secondary synostosis of the bicoronal sutures. We subsequently performed total cranial vault reconstruction with virtual surgical planning (VSP). Results: At his 31-month postoperative follow-up, he displayed normal head shape and denied any clinical signs of elevated intracranial pressures with a normal ophthalmological exam. Conclusions: The reoperation was successful with no significant postoperative complications noted. Performing geometric expansion with VSP to manage fusion of a previously open suture following primary treatment of sagittal synostosis should be considered within the armamentarium of operative options.

研究设计:病例报告。研究目的颅合畸形是一种颅面疾病,定义为至少一条颅缝过早融合。原发性修复后,先前通畅的邻近缝线再融合或继发性颅骨融合是一种相对常见的并发症。虽然有研究评估了继发性颅骨合骨病和后续再次手术的发生率,但有关再次手术技术的数据却极为有限。方法:我们介绍了一例独特的矢状颅颅骨畸形儿科患者的病例,该患者曾接受过改良π手术,后来出现了矢状缝再挛缩和双顶缝继发性颅骨挛缩。随后,我们通过虚拟手术规划(VSP)进行了全颅穹隆重建。手术结果在术后31个月的随访中,他的头型正常,没有任何颅内压升高的临床表现,眼科检查正常。结论:再次手术非常成功:再次手术非常成功,术后未发现明显并发症。在对矢状突合进行初次治疗后,应考虑使用 VSP 进行几何扩张,以处理先前开放缝合的融合问题。
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引用次数: 0
Quantifying Aerosol Generation in Maxillofacial Trauma Repair Techniques. 颌面部创伤修复技术中气溶胶产生的定量分析。
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2021-12-29 DOI: 10.1177/19433875211059314
Adam McCann, Kyle Singerman, James Coxe, John Singletary, Jun Wang, Ryan Collar, Tsung-Yen Hsieh

Study design: Cadaveric simulation study.

Objective: The novel coronavirus (COVID-19), which can be transmitted via aerosolized viral particles, has directed focus on protection of healthcare workers during procedures involving the upper aerodigestive tract, including maxillofacial trauma repair. This study evaluates particle generation at different distances from open reduction and internal fixation (ORIF) of maxillofacial injuries in the intraoperative setting to reduce the risk of contracting airborne diseases such as COVID-19.

Methods: Two cadaveric specimens in a simulated operating room underwent ORIF of midface and mandible fractures via intraoral incisions as well as maxillomandibular fixation (MMF) using hybrid arch bars. ORIF was performed with both self-drilling screws and with the use of a power drill for creating guide holes. Real-time aerosol concentration was measured throughout each procedure using 3 particle counters placed 0.45, 1.68, and 3.81 m (1.5, 5.5, and 12.5 feet, respectively) from the operative site.

Results: There was a significant decrease in particle concentration in all procedures at 1.68 m compared to 0.45 m, but only 2 of the 5 procedures showed further significant decrease in particle concentration when going from 1.68 to 3.81 m from the operative site. There was significantly less particle concentration generated at all distances when using self-drilling techniques compared to power drilling for ORIF.

Conclusions: Consideration of using self-drilling screwing techniques as well as maintaining physical distancing protocols may decrease risk of transmission of airborne diseases such as COVID-19 while in the intraoperative setting.

研究设计:尸体模拟研究。目的:新型冠状病毒(COVID-19)可通过雾化病毒颗粒传播,已成为医护人员在包括颌面创伤修复在内的上呼吸道消化道手术过程中的保护重点。本研究评估术中颌面部损伤在切开复位和内固定(ORIF)不同距离下产生的颗粒,以降低感染COVID-19等空气传播疾病的风险。方法:在模拟手术室对2例尸体标本进行中、下颌骨骨折经口内切开ORIF和混合弓棒固定(MMF)。ORIF采用自钻螺钉和电钻制造导向孔。在每次操作过程中,使用3个粒子计数器实时测量气溶胶浓度,分别放置在距离操作地点0.45、1.68和3.81 m(分别为1.5、5.5和12.5英尺)处。结果:与0.45 m相比,在1.68 m处,所有手术的颗粒浓度均显著降低,但在距离手术部位1.68 m至3.81 m处,5个手术中只有2个手术的颗粒浓度进一步显著降低。与ORIF的动力钻井相比,使用自钻技术在所有距离上产生的颗粒浓度都明显减少。结论:术中考虑使用自钻螺钉技术并保持身体距离可降低COVID-19等空气传播疾病的传播风险。
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引用次数: 0
Odontogenic Keratocyst: A Clinical Entity With Favorable Response to Active Decompression and Distraction Sugosteogenesis. 牙源性角化囊肿:一种对主动减压和牵张有良好反应的临床实体。
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2021-08-05 DOI: 10.1177/19433875211035237
Juan-Pablo Porte, Lidia M Guerrero, Bonifacio Rivera, Andres Wiscovitch, Jaime Castro-Núñez

Objective: The purpose of this study was to determine the usefulness of active decompression and distraction sugosteogenesis (ADDS) for the management of non-syndromic odontogenic keratocysts (OKC).

Materials and methods: A retrospective case series study was designed and implemented. The study observed the Declaration of Helsinki on medical protocol and ethics and it was approved by the university's Institutional Review Board (IRB). The medical files of all patients who underwent ADDS for OKCs of the jaws at the Department of Oral and Maxillofacial Surgery of a tertiary university-affiliated medical center were reviewed. Data were collected on patient's age, gender, presenting signs and symptoms, lesion location, locularity, pre-ADDS, size of the lesion, post-ADDS, pain, days with bloody discharge and/or proteinaceous fluid inside the system's external unit, days to achieve hermetic seal, size of the lesion 2 weeks after ADDS, percentage of reduction, patient's complaints/complications, and follow-up period. Pre- and post-ADDS panoramic radiographs were reviewed for reduction parameters.

Results: Six patients, 5 males and 1 female, with an average age of 45.16 years (range 16-74 years) were studied. ADDS was performed during 4 weeks in all patients. During the therapy, the extraoral unit collected blood during 2.83 days in average. In average, after the third day, the cystic cavity started to drain a proteinaceous fluid for about 9.33 days (range 6-15 days). The average pre-ADDS Standard Lesional Area Index (SLAI) was 18.17 cm2 (range 4.40 cm2-34.58 m2) and, after 2 weeks of ADDS, the average SLAI was 5.47 cm2 (range 0.49 cm2-15.39 cm2). The average percentage of reduction, after 2 weeks, was 73.93% (range 55.49%-97.51%), which yielded an overall good reaction of OKCs to ADDS. No significant reduction of the lesions was observed from week 2 to week 4, when ADDS ceased. All lesions were enucleated after 3 months. After an average of 14 months of follow-up (12 to 17 months), no signs of recurrence have been observed.

目的:本研究的目的是确定主动减压和牵张促骨成形术(添加)对治疗非综合征性牙源性角化囊肿(OKC)的有效性。材料和方法:设计并实施回顾性病例系列研究。该研究遵循了《赫尔辛基医疗礼仪和伦理宣言》,并得到了该大学机构审查委员会(IRB)的批准。本文回顾了某高等专科大学附属医学中心口腔颌面外科所有因颌骨OKCs而接受手术的患者的医疗档案。收集患者的年龄、性别、表现的体征和症状、病变位置、局限性、病变前、病变大小、病变后、疼痛、系统外部单元内出血和/或蛋白液体天数、达到密封的天数、病变2周后的大小、缩小的百分比、患者的投诉/并发症以及随访时间。回顾了术前和术后的全景x线片的复位参数。结果:6例患者,男5例,女1例,平均年龄45.16岁(16 ~ 74岁)。所有患者均在4周内进行了add。治疗期间,口外单位采血时间平均为2.83天。平均而言,第三天之后,囊腔开始排出蛋白液体约9.33天(范围6-15天)。add前的平均标准病变面积指数(SLAI)为18.17 cm2(范围4.40 cm2-34.58 cm2), add 2周后的平均SLAI为5.47 cm2(范围0.49 cm2-15.39 cm2)。2周后,平均减少率为73.93%(55.49% ~ 97.51%),表明OKCs对添加物的总体反应良好。从第2周到第4周,当add停止时,没有观察到明显的病变减少。3个月后所有病变均去核。经过平均14个月的随访(12 ~ 17个月),未观察到复发迹象。
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引用次数: 1
The Role of Bone Grafts in Preventing Medication-Related Osteonecrosis of the Jaw: Histomorphometric, Immunohistochemical, and Clinical Evaluation in Animal Model. 骨移植在预防颌骨药物相关性骨坏死中的作用:组织形态学、免疫组织化学和动物模型的临床评价。
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2021-10-30 DOI: 10.1177/19433875211048367
Jonathan Ribeiro da Silva, Maria Cristina de Moraes Balbas, Caroline Águeda Corrêa, Manuella Zanela, Roberta Okamoto, Rodrigo Dos Santos Pereira, Nicolas Homsi, Eduardo Hochuli-Vieira

Objective: To evaluate the effects of inorganic bovine bone graft (Lumina Bone, Criteria, Brazil) and beta-tricalcium phosphate (β-TCP) graft (ChronOS, Synthes, Brazil) in rats with the risk of developing post-extraction medication-related osteonecrosis of the jaw (MRONJ).

Methods: Eighteen male Wistar rats weighing 350 to 450 g were induced to develop MRONJ using zoledronic acid for 5 weeks. In the sixth week, the right maxillary first molar was extracted. The animals in Group I (G1) did not receive bone grafts after tooth extraction, while Group II (G2) animals received inorganic bovine bone grafts, and Group III (G3) animals received beta-tricalcium phosphate (β-TCP) grafts. Clinical evaluation and histomorphometric and immunohistochemical analyses were performed. ANOVA and Tukey's statistical tests were used and a level of significance was considered to be 5%.

Results: In the clinical evaluation, animals from G2 and G3 did not present clinical manifestations of osteonecrosis, unlike the control group (G1) animals, which presented necrotic bone tissue exposure in all samples. In the histomorphometric evaluation, animals in G3 showed greater formation of bone tissue (66%) and less formation of bone lacuna (18%) than animals in G1 (58%/32%) and in G2 (59%/27%) (P < 0.05). Moderate (++) immunostaining was observed in G2 and G3 for RANKL, TRAP, and OC, while G1 showed moderate (++) labeling for OC and mild (+) immunostaining for TRAP and RANKL.

Conclusions: Greater formation of bone tissue and fewer bone lacunae were found in animals treated with β-TCP. In clinical evaluation, bone graft groups presented with the clinical manifestation of MRONJ and showed higher intensity of immunostaining for TRAP and RANKL. Despite the limitations of experimental animal studies, the results of this work may assist in the development of future clinical research for the prevention of MRONJ.

目的:评价无机牛骨移植物(Lumina bone, Criteria, Brazil)和β-磷酸三钙(β-TCP)移植物(ChronOS, Synthes, Brazil)对拔牙后药物相关性颌骨坏死(MRONJ)风险大鼠的影响。方法:用唑来膦酸诱导18只体重350 ~ 450 g的雄性Wistar大鼠发生MRONJ,持续5周。第六周拔除右侧上颌第一磨牙。ⅰ组(G1)拔牙后不接受骨移植,ⅱ组(G2)接受无机牛骨移植,ⅲ组(G3)接受β-磷酸三钙(β-TCP)移植。进行临床评价、组织形态学和免疫组织化学分析。采用方差分析和Tukey统计检验,认为显著性水平为5%。结果:在临床评价中,G2和G3组动物未出现骨坏死的临床表现,而对照组(G1组)动物在所有样本中均出现坏死骨组织暴露。在组织形态学评价中,G3组骨组织形成率(66%)高于G1组(58%/32%)和G2组(59%/27%),骨陷窝形成率(18%)低于G1组(59%/27%)(P < 0.05)。G2和G3中RANKL、TRAP和OC呈中等(++)免疫染色,G1中OC呈中等(++)标记,TRAP和RANKL呈轻度(+)免疫染色。结论:β-TCP治疗小鼠骨组织形成增多,骨陷窝减少。在临床评价中,骨移植组表现出MRONJ的临床表现,TRAP和RANKL的免疫染色强度更高。尽管实验动物研究存在局限性,但这项工作的结果可能有助于未来MRONJ预防的临床研究的发展。
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引用次数: 2
Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury - Is It Safe? Radiological Simulation in a Healthy Volunteer. 颌面外伤合并颈椎损伤患者术中定位安全吗?健康志愿者的放射模拟
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2022-01-03 DOI: 10.1177/19433875211053091
Thomas Pepper, Harry Spiers, Alex Weller, Clare Schilling

Study design: Observational.

Objective: To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures.

Methods: Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations - neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer.

Results: In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4-C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1-2) joints.

Conclusions: Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.

研究设计:观察性研究。目的:通过模拟普通颌面手术术中体位,探讨颌面手术体位对患者颈椎的影响。方法:采用磁共振成像技术评估了一名健康志愿者在常见的术中体位——中立(前下颌骨体位)、伸展(气管造口体位)和侧向旋转(下颌髁体位)对c -脊柱的影响。结果:在气管造口位置,最大运动发生在颈枕交界处和C4-C5之间的矢状面以及颈胸交界处。最小的运动发生在C2(在C3上),C5(在C6上)和C6(在C7上)。在下颌髁位,颈椎在旋转面和矢状面均发生运动。最大活动发生在C4水平以上,集中在寰枕关节和寰枢关节(C1-2)。结论:对于屈伸稳定的损伤,如齿状突钉骨折和C5 - C7骨折,颈部伸展可能是相对安全的。对于C4以下的骨折,以及椎体骨折和无椎间盘破坏的椎板骨折,头部旋转可能相对安全。与神经外科团队的早期对话仍然是颌面部和颈椎合并损伤患者安全管理的核心原则。
{"title":"Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury - Is It Safe? Radiological Simulation in a Healthy Volunteer.","authors":"Thomas Pepper, Harry Spiers, Alex Weller, Clare Schilling","doi":"10.1177/19433875211053091","DOIUrl":"10.1177/19433875211053091","url":null,"abstract":"<p><strong>Study design: </strong>Observational.</p><p><strong>Objective: </strong>To investigate the effects on the cervical spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures.</p><p><strong>Methods: </strong>Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations - neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer.</p><p><strong>Results: </strong>In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4-C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1-2) joints.</p><p><strong>Conclusions: </strong>Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":"15 4","pages":"312-317"},"PeriodicalIF":0.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40690901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Facial Trauma During the COVID-19 Pandemic. COVID-19大流行期间的面部创伤。
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2021-12-27 DOI: 10.1177/19433875211053760
Kiranya E Tipirneni, Amanda Gemmiti, Mark A Arnold, Amar Suryadevara

Study design: Retrospective cohort study.

Objective: The purpose of this study is to evaluate the impact of the COVID-19 global pandemic on the regional trends in facial trauma at a tertiary care, level 1 trauma center in Central New York.

Methods: The study sample was derived from the population of patients who presented with facial trauma to the emergency department at the Downtown and/or Community Campuses of SUNY Upstate University Hospital between March 1, 2020, and May 15, 2020, and compared to two historical controls in 2018 and 2019. Descriptive and bivariate statistics were calculated for study variables in each cohort. Poisson regression was used to compare incident rate ratios (IRR) with 95% confidence intervals with significance set at P < .05.

Results: Sixty five patients presented during the COVID-19 pandemic, while 83 presented in 2019 and 95 in 2018. For the study period, the most common mechanism was assault in 47.7%. IRR was significantly lower than in 2018 (IRR = 1.46, P = .018), but not significantly different from 2019 (IRR = 1.28, P = .14). During lockdown, IRR was significantly decreased compared to 2019 (IRR = 1.84, P = .0029) and 2018 (IRR = 2.16, P < .001).

Conclusions: The volume of facial trauma seen in Central New York appears undeterred in the absence of "shelter in place" orders. Analysis of pandemic and regional trauma variations can offer valuable insight for improved resource allocation to better prepare for potentially high-risk procedures.

研究设计:回顾性队列研究。目的:本研究的目的是评估COVID-19全球大流行对纽约中部三级护理一级创伤中心面部创伤区域趋势的影响。方法:研究样本来自2020年3月1日至2020年5月15日期间在纽约州立大学上州立大学医院市中心和/或社区校区急诊科就诊的面部创伤患者,并与2018年和2019年的两个历史对照进行比较。对每个队列的研究变量进行描述性和双变量统计。用泊松回归比较事故率比(IRR), 95%置信区间P < 0.05。结果:新冠肺炎大流行期间确诊65例,2019年确诊83例,2018年确诊95例。在研究期间,最常见的机制是攻击,占47.7%。IRR显著低于2018年(IRR = 1.46, P = 0.018),但与2019年无显著差异(IRR = 1.28, P = 0.14)。在封锁期间,IRR与2019年(IRR = 1.84, P = 0.0029)和2018年(IRR = 2.16, P < 0.001)相比显著下降。结论:在没有“就地避难”命令的情况下,纽约中部的面部外伤数量似乎没有受到影响。对流行病和区域创伤差异的分析可以为改进资源分配提供有价值的见解,以便更好地为可能高风险的程序做好准备。
{"title":"Facial Trauma During the COVID-19 Pandemic.","authors":"Kiranya E Tipirneni, Amanda Gemmiti, Mark A Arnold, Amar Suryadevara","doi":"10.1177/19433875211053760","DOIUrl":"10.1177/19433875211053760","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>The purpose of this study is to evaluate the impact of the COVID-19 global pandemic on the regional trends in facial trauma at a tertiary care, level 1 trauma center in Central New York.</p><p><strong>Methods: </strong>The study sample was derived from the population of patients who presented with facial trauma to the emergency department at the Downtown and/or Community Campuses of SUNY Upstate University Hospital between March 1, 2020, and May 15, 2020, and compared to two historical controls in 2018 and 2019. Descriptive and bivariate statistics were calculated for study variables in each cohort. Poisson regression was used to compare incident rate ratios (IRR) with 95% confidence intervals with significance set at <i>P</i> < .05.</p><p><strong>Results: </strong>Sixty five patients presented during the COVID-19 pandemic, while 83 presented in 2019 and 95 in 2018. For the study period, the most common mechanism was assault in 47.7%. IRR was significantly lower than in 2018 (IRR = 1.46, <i>P</i> = .018), but not significantly different from 2019 (IRR = 1.28, <i>P</i> = .14). During lockdown, IRR was significantly decreased compared to 2019 (IRR = 1.84, <i>P</i> = .0029) and 2018 (IRR = 2.16, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>The volume of facial trauma seen in Central New York appears undeterred in the absence of \"shelter in place\" orders. Analysis of pandemic and regional trauma variations can offer valuable insight for improved resource allocation to better prepare for potentially high-risk procedures.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":"15 4","pages":"318-324"},"PeriodicalIF":0.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40690904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Can an App-Based Maxillofacial Trauma Score Predict the Operative Time, ICU Need and Length of Stay? 基于app的颌面外伤评分能否预测手术时间、ICU需求和住院时间?
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2021-12-03 DOI: 10.1177/19433875211055598
Ashutosh Kumar Singh, Safal Dhungel, Zeeshan Ahmad, Simon Holmes
Study Design Retrospective chart review Objective Injury and trauma scores are the mainstay of predicting outcomes of trauma patients. ZS (Zeeshan and Simon) maxillofacial trauma score is based on 4 previous facial trauma scores and is user friendly, app-based visually coded facial trauma scoring system. Our study was designed to seek the application of an app-based ZS maxillofacial trauma score to predict the operative time, intensive care unit (ICU) need and length of stay. Methods We performed a retrospective chart review of patients who presented to a university medical college teaching hospital with maxillofacial fractures from October 2018 until October 2019. ZS maxillofacial trauma scoring app was used to calculate the ZS maxillofacial trauma severity score, which was our primary predictor variable. Our primary outcome of interest was operative time. Our secondary outcome of interest was ICU need and length of stay. Correlation analysis, linear regression and logistic regression were performed for statistical analysis. A statistical P-value of .05 was considered significant at a 95% confidence interval. Results There were 95 male and 5 female patients included in the study. The age ranged from 3 to 84 years with a mean of 30.76 (SD = 14.04). A statistically significant correlation between the ZS score and operative time (r = 0.67, P < .001) was observed. ZS score predicted operative time (b 1 = 7.67, P < .001) in our study sample. Increasing ZS trauma score was also significantly associated with ICU requirement (X 2 (3) = 13.682, P = .003), but the length of stay could not be predicted based on ZS score. Conclusions: ZS maxillofacial trauma score can predict the operative time, and an association was seen with the need for ICU with increasing ZS score, but could not predict the length of stay or the ICU need. It has potential for future integration with electronic health record systems.
研究设计:回顾性图表回顾。目的:损伤和创伤评分是预测创伤患者预后的主要依据。ZS (Zeeshan and Simon)颌面创伤评分基于先前的4个面部创伤评分,是一个用户友好的、基于应用程序的视觉编码面部创伤评分系统。我们的研究旨在寻求应用基于app的ZS颌面创伤评分来预测手术时间、重症监护病房(ICU)需求和住院时间。方法:对2018年10月至2019年10月在某大学医学院附属医院就诊的颌面部骨折患者进行回顾性分析。使用ZS颌面创伤评分应用程序计算ZS颌面创伤严重程度评分,这是我们的主要预测变量。我们关注的主要结果是手术时间。我们感兴趣的次要结局是ICU需求和住院时间。采用相关分析、线性回归和逻辑回归进行统计分析。在95%置信区间内,p值为0.05被认为是显著性的。结果:男性95例,女性5例。年龄3 ~ 84岁,平均30.76岁(SD = 14.04)。ZS评分与手术时间的相关性有统计学意义(r = 0.67, P .001)。ZS评分预测手术时间(b1 = 7.67, P .001)。ZS创伤评分升高与ICU需求也显著相关(x2 (3) = 13.682, P = 0.003),但ZS评分不能预测住院时间。结论:ZS颌面外伤评分可以预测手术时间,ZS评分的升高与患者是否需要ICU治疗有一定的相关性,但不能预测患者的住院时间和ICU治疗的需要。它有可能在未来与电子健康记录系统集成。
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引用次数: 0
Recreational Motorized Vehicle Use Under the Influence of Alcohol or Drugs Significantly Increases Odds of Craniofacial Injury. 在酒精或药物影响下使用娱乐性机动车辆显著增加颅面损伤的几率。
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2021-09-14 DOI: 10.1177/19433875211046721
Thomas J Sorenson, Matthew D Rich, Abhinav Lamba, Annika Deitermann, Ruth J Barta, Warren Schubert

Study design: Cross-sectional study.

Objective: Concurrent substance-use, including alcohol and drugs, increases the risks of many recreational activities. Our purpose was to determine the relationship between substance use and craniofacial injuries in a large population of patients experiencing trauma due to recreational motorized vehicle use.

Methods: We report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from January 1, 2019 to December 31, 2019, in the United States. Patients were included in our study if they were evaluated in the emergency department (ED) for a recreational motorized vehicle-related injury. Primary outcome was craniofacial injury.

Results: There were a total of 6,485 adult patients who experience an injury after recreational motorized vehicle trauma reported by NEISS-participating EDs during the study period. Of this, 1,416 (21.8%) patients had a craniofacial injury, and 201 patients with craniofacial injuries were under the influence of alcohol/drugs (201/1,416; 14.2%). Injured patients under the influence of alcohol/drugs experienced greater odds of sustaining a general craniofacial injury (OR 2.50, 95% CI: 2.07-3.01, P < .0001), including craniofacial fracture (OR: 2.98, 95% CI: 2.01-4.40, P < .0001), laceration (OR: 2.19, 95% CI: 1.51-3.16, P < .00001) and internal injury (OR: 2.33, 95% CI: 1.84-2.95, P < .00001) than injured patients not under the influence.

Conclusions: Using recreational motorized vehicles under the influence of alcohol or drugs is not safe and increases the likelihood of craniofacial injuries, including fractures, lacerations, and internal injuries. As operating these recreational motorized vehicles under the influence is illegal, the law should be strictly enforced to prevent the occurrence of these injuries. Additional undertakings to increase helmet usage would be valuable.

研究设计:横断面研究。目的:同时使用物质,包括酒精和毒品,增加了许多娱乐活动的风险。我们的目的是确定在大量因娱乐性机动车辆使用而遭受创伤的患者中物质使用与颅面损伤之间的关系。方法:我们报告了2019年1月1日至2019年12月31日在美国向国家电子伤害监测系统(NEISS)报告的患者的横断面研究。在急诊科(ED)对娱乐性机动车相关损伤进行评估的患者被纳入我们的研究。主要结局为颅面损伤。结果:在研究期间,共有6485名成人患者在参与neiss的急诊科报告的娱乐性机动车创伤后发生损伤。其中1,416例(21.8%)患者有颅面损伤,201例颅面损伤患者受到酒精/药物的影响(201/1,416;14.2%)。与未受酒精/药物影响的受伤患者相比,受酒精/药物影响的受伤患者发生一般性颅面损伤的几率更大(OR 2.50, 95% CI: 2.07-3.01, P < 0.0001),包括颅面骨折(OR: 2.98, 95% CI: 2.01-4.40, P < 0.0001)、撕裂伤(OR: 2.19, 95% CI: 1.51-3.16, P < 0.00001)和内伤(OR: 2.33, 95% CI: 1.84-2.95, P < 0.001)。结论:在酒精或药物的影响下使用娱乐性机动车辆是不安全的,并且增加了颅面损伤的可能性,包括骨折、撕裂伤和内伤。由于在影响下操作这些娱乐机动车辆是非法的,法律应该严格执行,以防止这些伤害的发生。增加头盔使用的额外承诺将是有价值的。
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引用次数: 0
Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review. 下颌角骨折的第三磨牙出牙程度是否影响手术治疗?系统评价。
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2021-12-09 DOI: 10.1177/19433875211059330
Vikas S Kotha, Brandon J de Ruiter, M Grace Knudsen, Marvin Nicoleau, Edward H Davidson

Study design: Systematic review.

Objective: There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation.

Methods: PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II).

Results: Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (P = .043).

Conclusions: For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.

研究设计:系统评价。目的:下颌角骨折(maff)骨折线上第三磨牙的循证治疗日益发展。本研究的目的是根据第三磨牙的萌出程度和拔牙策略来区分Champy固定患者的MAF固定并发症。方法:到2020年5月,在PubMed、EMBASE、OVID、SCOPUS、Cochrane图书馆和clinicaltrials.gov上查询涉及第三磨牙的MAFs的英文出版物。使用作者定义的标准评估偏倚。计算拔出未萌和保留部分萌的第三磨牙(第一组)术后并发症的相对风险(RR),对照保留未萌和拔出部分萌的第三磨牙(第二组)。结果:10项研究报告了拔出或拔出的并发症;然而,只有一项研究将出疹和拔牙并发症分层以满足纳入标准。偏倚风险为中等,因为只有符合规定随访的病例被纳入。纳入73例(N):ⅰ组34例,ⅱ组39例。个体病例数据的定量综合显示,I组的并发症发生率明显高于II组(23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1)。感染并发症、机械并发症、骨不连或骨裂在两组间无显著差异。第1组需要再次手术的次数明显增加(P = 0.043)。结论:对于涉及第三磨牙的maf,同时拔除未萌出的第三磨牙和保留部分萌出的第三磨牙会增加Champy固定技术并发症的风险。对于这些患者,应考虑其他固定策略。
{"title":"Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review.","authors":"Vikas S Kotha, Brandon J de Ruiter, M Grace Knudsen, Marvin Nicoleau, Edward H Davidson","doi":"10.1177/19433875211059330","DOIUrl":"10.1177/19433875211059330","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review.</p><p><strong>Objective: </strong>There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation.</p><p><strong>Methods: </strong>PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II).</p><p><strong>Results: </strong>Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (<i>P</i> = .043).</p><p><strong>Conclusions: </strong>For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":"15 4","pages":"379-386"},"PeriodicalIF":0.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9647372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40689891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Global Impact of COVID-19 on Craniomaxillofacial Surgeons: A Follow-Up Survey After One Year. COVID-19对颅颌面外科医生的全球影响:一年后的随访调查
IF 0.9 Q4 DENTISTRY, ORAL SURGERY & MEDICINE Pub Date : 2022-12-01 Epub Date: 2022-01-02 DOI: 10.1177/19433875211057877
Tevfik Cicek, Justin van der Tas, Thomas Dodson, Daniel Buchbinder, Stefano Fusetti, Michael Grant, Yiu Yan Leung, Erich Roethlisberger, Gregorio Sánchez Aniceto, Alexander Schramm, Edward Bradley Strong, Gerson Mast, Eppo Wolvius

Study design: Comparative cross-sectional.

Objective: To measure the impact that COrona VIrus Disease-19 (COVID-19) has had on craniomaxillofacial (CMF) surgeons after 1 year and compare it with 2020 data by (1) measuring access to adequate personal protective equipment (PPE), (2) performance of elective surgery, and (3) the vaccination status. This should be investigated because most CMF surgeons felt that hospitals did not provide them with adequate PPE.

Methods: The investigators surveyed the international AO CMF membership using a 30-item online questionnaire and compared it to a previous study. The primary predictor variable was year of survey administration. Primary outcome variables were availability of adequate personal protective equipment (adequate/inadequate), performance of elective surgery (yes/no), and vaccination status (fully vaccinated/partly vaccinated/not vaccinated). Descriptive and analytic statistics were computed. Binary logistic regression models were created to measure the association between year and PPE availability. Statistical significance level was set at P < .05.

Results: The sample was composed of 523 surgeons (2% response rate). Most surgeons reported access to adequate PPE (74.6%). The most adequate PPE was offered in Europe (87.8%) with the least offered in Africa (45.5%). Surgeons in 2021 were more likely to report adequate PPE compared to 2020 (OR 3.74, 95% CI [2.59-4.39]). Most of the respondents resumed elective surgery (79.5% vs 13.3% in 2020) and were fully vaccinated (59.1%).

Conclusions: Most CMF surgeons now have access to adequate PPE, resumed elective surgery, and are either fully or partly vaccinated. Future studies should investigate the long-term impact of the fast-evolving COVID-19 pandemic on CMF surgeons.

研究设计:比较横断面。目的:通过(1)测量获得足够的个人防护装备(PPE)的情况,(2)选择性手术的表现,(3)疫苗接种情况,衡量2019冠状病毒病(COVID-19)对颅颌面外科医生(CMF) 1年后的影响,并与2020年的数据进行比较。应该对此进行调查,因为大多数CMF外科医生认为医院没有向他们提供足够的个人防护装备。方法:采用30项在线问卷对国际AO CMF会员进行调查,并与之前的研究进行比较。主要预测变量是调查管理的年份。主要结局变量为是否有充足的个人防护装备(充足/不足)、是否进行选择性手术(是/否)和疫苗接种状况(完全接种/部分接种/未接种)。计算描述性统计和分析性统计。建立了二元逻辑回归模型来衡量年份与PPE可用性之间的关系。差异有统计学意义,P < 0.05。结果:本组共523名外科医生,有效率为2%。大多数外科医生报告获得了足够的个人防护装备(74.6%)。欧洲提供的个人防护装备最充足(87.8%),非洲提供的最少(45.5%)。与2020年相比,2021年的外科医生更有可能报告足够的PPE (OR 3.74, 95% CI[2.59-4.39])。大多数受访者恢复了择期手术(79.5%,2020年为13.3%),并充分接种了疫苗(59.1%)。结论:大多数CMF外科医生现在可以获得足够的个人防护装备,恢复选择性手术,并全部或部分接种疫苗。未来的研究应调查快速发展的COVID-19大流行对CMF外科医生的长期影响。
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引用次数: 0
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Craniomaxillofacial Trauma & Reconstruction
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