Evaluating the impact of recombinant human epidermal growth factor on scar formation in oral and maxillofacial traumatic wound healing.

Scarring following oral and maxillofacial trauma can have significant aesthetic and functional repercussions. Recombinant human epidermal growth factor (rhEGF) has emerged as a potential therapeutic agent to enhance wound healing and minimise scar formation. This retrospective study analysed data from March 2020 to June 2023 at a single institution. A total of 105 patients were divided into a control group (n = 70) receiving standard treatment and an observation group (n = 35) receiving standard treatment plus rhEGF. The primary outcomes were the incidence of scar hyperplasia and infection rates, with the secondary outcome being scar aesthetics measured by the visual analogue scale (VAS). No significant differences were found in baseline characteristics between the two groups. The observation group showed a significant reduction in scar hyperplasia (14.3% vs. 57.1%, χ2 = 20.98, p < 0.01) and infection rates (5.7% vs. 21.4%, χ2 = 4.246, p < 0.05) compared to the control group. VAS scores indicated a superior aesthetic outcome in the observation group at all post-treatment timepoints (p < 0.01). rhEGF treatment in oral and maxillofacial trauma patients resulted in favourable healing outcomes and reduced scar formation, improving aesthetic results. These findings highlight the therapeutic potential of rhEGF and underscore the need for larger-scale trials to further investigate its benefits.

Postoperative leukocyte changes in facial fracture patients: a randomized prospective study with short-term dexamethasone.

PURPOSE: We investigated leukocyte changes in facial fracture patients undergoing surgery. Of specific interest was the effect of perioperative dexamethasone on leukocyte changes. METHODS: Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone, whereas patients in the control group received no glucocorticoid. All patients received antibiotics until postoperative days 7-10. Leukocyte count was measured on postoperative days 1 and 2. Clinical infections were observed during the follow-up. RESULTS: A total of 110 adult patients were included in the study. Postoperative leukocytosis was found in 91.2% of patients receiving dexamethasone and in 67.9% of controls. Dexamethasone was associated strongly with leukocyte rise (p < 0.001) on both postoperative days. Transoral surgery and younger age (≤40 years) showed significant associations with leukocytosis on the first postoperative day (p = 0.002). In regression analyses, dexamethasone associated with leukocytosis most significantly (p < 0.001). No association was found with infections. CONCLUSIONS: Dexamethasone use was the most significant predictor of leukocyte rise. As a drug response, perioperative dexamethasone caused sixfold postoperative leukocytosis. High-dose dexamethasone-induced leukocytosis may confuse the clinical decision-making especially in assessment of early infections.

The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in maxillofacial trauma.

In recent years, recombinant human bone morphogenetic protein-2 (rhBMP-2) has been introduced as a therapeutic option in the treatment of several congenital and acquired craniofacial defects. Although there have been promising clinical results, the international literature still lacks complete guidelines, including limits and indications for the use of rhBMP-2. The possible indications for rhBMP-2 in patients undergoing facial trauma are discussed in this article.

INTRA-ARTERIAL INFUSIONS AND DOPLEROGRAPIC CONTROL FOR COMPLEX TREATMENT OF UPPER AND MIDDLE FACIAL ZONES, CONCOMITANT WITH TRAUMATIC CRANIOCEREBRAL INJURIES.

Maxillofacial traumatic injuries concomitant with craniocerebral trauma are still considered as an actual problem in emergency medicine. For this category of patients one of the dangerous and severe complications is development of inflammatory process in the injured areas. Fracture lines of upper and middle facial zones pass through the accessory sinuses of the nose, maxillary/upper dental arch area and are considered to be open and infected fractures. Combination of these fractures with craniocerebral injuries and especially, with open traumas creates predisposition for development of inflammatory processes in CNS that can result in heavy outcome. 29 patients (among them 5-females and 24 -males) with severe and open craniofacial fractures were observed by the authors. For prevention of inflammatory complications in complex treatment of the patients, intra-arterial infusions of therapeutic agents (wide spectrum of antibiotics, Heparin) were used for stimulation of reparative regeneration in fractured fragments of facial bones. After the main surgical interventions (neurosurgery, surgery of facial bones) sanitation of infected centers (accessory sinuses of the nose, oral cavity) and catheterization of external carotid arteries through the temporal arteries were performed. According to the severity of the trauma and its preferential localization, catheterization of carotid arteries was conducted unilaterally (12 cases) or bilaterally (17 cases). Insertion depth through femoral artery was 6-8 cm. Catheter was stayed in the artery for 7-8 days. Intra-arterial infusions were carried out in the morning and evening. Therapeutic agents for arterial infusion included: antibiotic (Rocephin and its analogues), Heparin. To determine the effectiveness of vascular therapy dopplerography of external carotid artery, its branches and supratrochlear artery was performed. Dopplerography of supratrochlear artery, which is the branch of internal carotid artery, was conducted to detect the impact of therapeutic agents, administered in external carotid artery, on the internal carotid artery. During the treatment of complicated concomitant craniofacial injuries in a sequential order, development of inflammatory processes was not observed even in the patients with basic inflammatory processes in accessory sinuses of the nose. After infusion of therapeutic agents to external carotid artery, dopplerographically, sharp increase in blood flow in main artery and its branches, indicates to the stimulation of microcirculation that serves as a guarantee for osteogenic type healing of fractured fragments.

Modulação do processo inflamatório agudo: terapia medicamentosa e laser não ablativo: revisão de literatura / Modulation of acute inflammatory process

Os traumatismos, os mais diversos, poderão dar origem a processos inflamatórios exacerbados nas regiões anatõmicas tratadas na especialidade de cirurgia e traumatologia bucomaxilofacial. A modulação desse processo ocorre quando as manifestações inflámatórias iniciais superam o benefício da regeneração tecidual. O objetivo deste trabalho é realizar uma revisão sobre a modulação do processo inflamatório agudo por meio de terapia medicamentosa de rotina e sobre a efetividade do uso do laser não ablativo neste processo

[Animal experiment of the ketamine effects on traumatic brain injury resulting from impact maxillofacial injury].

OBJECTIVE: To test the effects of ketamine (KET) on traumatic brain injury resulting from impact maxillofacial injury. METHODS: The rat models with middle serious traumatic brain injury were obtained by falling impaction at maxillofacial region of the rats, then the animals were treated with KET in the early stage, and the alteration of the neural function in those rats was observed at the same time. RESULTS: There was obvious difference between the rats in the KET-treating groups and the control group. It took about 2 days fewer than that of the control group for rats in the KET-treating group to recover. CONCLUSION: KET can shorten the recovery time of rats with brain injury resulting from impact maxillofacial injury.

[Maxillofacial trauma. How to treat?]. / Maxillofaciale traumata. Hoe te handelen?

Fractures of the maxillofacial skeleton, often accompanied by dentoalveolar injuries, are no exception. Dentists may become primarily involved in the diagnosis of such a trauma and the treatment of dentoalveolar injuries. More often they will play an important role in the aftercare of such a patient (endodontics, prosthodontics). This paper describes the general principles of the treatment of such patients. The specific treatment of maxillofacial trauma will be described in the contributions of other authors in this special issue.

[Efficacy and tolerability 80 mg granulated ketoprofen lysine salt in posttraumatic orodental pain: double blind vs placebo study]. / Efficacia e tollerabilità di ketoprofene sale di lisina 80 mg granulato in bustine nel dolore post-traumatico in odontostomalogia: studio in doppio cieco vs placebo.

A randomized, double-blind parallel group, placebo-controlled study was carried out in order to evaluate the analgesic and antiin-flammatory activity of ketoprofen lysine salt as granular formulation. Sixty patients undergoing extraction of an impacted third molar were treated orally with 80 mg ketoprofen lysine salt sachet or placebo t.i.d. for 3 days. The inflammation related local signs (pain, flare, local heat and wheal) were evaluated by scores at 1th and 3th day of observation; to study the time-course of analgesic activity, pain intensity was evalauted by Visual Analogic-Scale (VAS) by Scott-Huskisson before and 0.30 minutes, 1, 2, 3, 4, 5, 6, 8 hours after the first administration. Ketoprofen lysine salt was significantly superior to placebo in reducing all inflmamtory signs and symptoms starting from the first day of treatment; the analgesic effect was evident already 30 minutes after administration. Investigator's and patient's global evaluations of efficacy resulted favourable for ketoprofen lysine salt in 96.6% and for placebo in 26.7%. The three adverse events reported were limited to gastric pyrosis (ketoprofen lysine salt, two patients; placebo one patient) and posed no problem to patient management. These data demonstrate the pronouced and rapid analgesic and antinflammatory activity of 80 mg ketoprofen lysine salt granular formulation in post-operative pain and inflammation associated with dental surgery.

La Antibioticoterapia en la cirugía bucal y maxilofacial / Antibiotic therapy in oral and maxilofacial surgery

Ha sido el propósito de los autores describir sus bases para el uso de los antibióticos, perfectamente aplicable en condiciones normales y anormales como en la que nos encontramos de "período especial" en nuestro país, que consideramos pueda ser de gran utilidad tanto para el paciente, como para nuestra economía, si valoramos en cada caso el uso racional y específico de los antibióticos de existencia en el momento actual, si es que realmente lo requiere el paciente o no. Esta valoración conservadora debe utilizarse para ofrecer atención adecuada a los enfermos y minimizar que en muchas ocasiones prevalece en la profesión estomatológica y médica

Microbiologic and antibiotic aspects of infections in the oral and maxillofacial region.

An overview of infection as it applies to the oral and maxillofacial region has been provided. The following conclusions are drawn: odontogenic infections are caused by microbes found in the host's oral flora; cultures of purulent material generally will yield three to six anaerobes and one aerobe, (the aerobe is usually a Streptococcus species); Gram stains of purulent material can aid in therapeutic strategies; anaerobic as well as aerobic cultures are necessary to isolate all pathogens; pathogens found in infections of bite wounds reflect the oral flora of the aggressor; early postoperative wound infections are caused by the host's own flora, whereas later infections may be caused by hospital-acquired bacteria; and hepatitis B and herpes simplex virus are occupational hazards. Recommendations have been made for antimicrobial prophylaxis and for treatment. We recognize that some of these selections may be controversial. For instance, the value of prophylactic antibiotics in orthognathic surgery is not well defined; recommendations were made only in certain instances. However, in severe penetrating maxillofacial injuries with devitalized tissue, recommendations for antibiotics were for broad and prolonged coverage. In this instance, use of antibiotics is considered therapeutic and not prophylactic. In each instance, we tried to validate the selection. Our rationale has been to choose the antibiotics most active against the likely pathogens; additionally, consideration was given to drug toxicity and adverse reactions. We regard penicillin as the preferred agent for prophylaxis and treatment of most odontogenic infections. Alternative drugs include cephalosporins, doxycycline, and clindamycin. Erythoromycin and tetracycline are considered less effective than the former agents. Finally, we believe that successful treatment of infection depends as much on changing the microenvironment of the infected tissue by debridement and drainage as on appropriate antimicrobial therapy.

[Glucocorticoids in dental surgery and maxillofacial surgery]. / Glukokortikoide in der chirurgischen Stomatologie und Kiefer-Gesichts-Chirurgie.

Indications for the use of glucocorticoids in surgical stomatology are: 1. emergencies, 2. bullous and allergic diseases of the oral mucosa and therapy-resistant cases of chronic recurrent aphthae, erosive lichen planus and sialoses (for systemic therapy), 3. therapy-resistant temporomandibular complaints and hyperplastic tissue responses and, in combination with an antibiotic, diseases of the maxillary sinus (for local therapy). Preliminary clinical examination, case controls at short intervals, and circadian or alternating prescription will help to reduce undesirable side-effects. In patients receiving sustained glucocorticoid therapy, dental-surgical procedures require special consideration of the change in reactivity.