Policy of fourteen maxillofacial divisions towards titanium plates removal after internal fixation of paediatric maxillofacial fractures: A World Oral Maxillofacial Trauma (WORMAT) project.

INTRODUCTION: The aim of this 11-year retrospective multicentric study is to evaluate the policy of 14 maxillofacial surgery divisions in terms of titanium plate removal from paediatric patients who had undergone open reduction and internal fixation (ORIF) to treat maxillofacial fractures. MATERIAL AND METHODS: Patients ≤ 16 years undergoing surgical treatment for fractures of middle and lower third of the face between January 2011 and December 2022, with a minimum follow-up of 6 months, were included. Age (group A: ≤ 6 years, B: 7-12 years, C: 13-16 years), sex, fracture location and type, surgical approach, number, and location of positioned and removed plates, timing and indications for removal were recorded. RESULTS: 191/383 (50 %) patients (median age, 10 years; M:F ratio 2.1:1) underwent removal of 319/708 (45 %) plates. Maxillary dentoalveolar process (91 %), angle/ramus (63 %) and mandibular body (61 %) had a significantly higher removal rate than other fracture sites (p < 0.001). A significant decreasing trend in removal with increasing age was observed, from 83 % in Group A to 24 % in Group C (p < 0.001). On the total of positioned plates, 11 % were removed for symptomatic reasons (5 % infections, 6 % discomfort/pain) and 34 % for other reasons (28 % scheduled removal). DISCUSSION: This multicentric study showed that plate removal was not performed routinely in the paediatric population. The incidence and causes of symptomatic plates removal were consistent with the literature, while the plate removal rate from asymptomatic patients was lower. A correlation was found between increasing age and a reduction in the frequency of plate removal procedures.

Open reduction and internal fixation of paediatric maxillozygomatic complex fractures: An 11-year multicentric retrospective study.

BACKGROUND/AIM: Paediatric maxillozygomatic complex (MZC) fractures are uncommon, and there is a scarcity of data regarding their surgical treatment. The aim of this study was to analyse choices and outcomes of open reduction and internal fixation (ORIF) for MZC fractures among 14 maxillofacial centers around the world. MATERIALS AND METHODS: This multicentric retrospective observational study included patients ≤16 years of age with quadripod MZC fractures treated with ORIF from January 2011 and December 2022. The following data were collected: age, gender, dentition stage (deciduous, mixed, and permanent), cause of injury, type of fracture, surgical approach, site of osteosynthesis (infraorbital rim, zygomaticomaxillary buttress, frontozygomatic, and zygomaticotemporal sutures), material (titanium or resorbable) and number of plates used, and outcome. The minimum follow-up was 6 months. Statistical analyses were performed with Fisher's exact test or chi-squared test, as appropriate. RESULTS: Sixty-four patients (mean age, 12.3 years) with quadripod MZC fractures were included. Seventy-two percent of patients received a single-point fixation. The zygomaticomaxillary buttress was the most common site for fixation, both in single-point and two-point fixation schemes, especially in combination with the frontozygomatic suture. Increasing age was associated with a higher rate of plate removal (p < .001). Postoperative complications included 5 (7.8%) cases of wound infections, 2 (3.1%) infraorbital paraesthesia, 1 (1.6%) ectropion. Residual facial asymmetry was found in 5 (7.8%) patients and was not associated with the type of fixation (p > .05). CONCLUSIONS: This study highlights the possibility of using ORIF, even with a single point of fixation, for the treatment of displaced quadripod MZC fractures in the paediatric population. The zygomaticomaxillary buttress was the preferred site of fixation and allowed for adequate stabilization with no external scars and a low risk of tooth damage. Future prospective studies with long-term follow-up are needed to establish definitive surgical protocols and clarify the surgical decision-making.

Two Cases of COVID-Related Osteonecrosis of the Jaws: A New and Worrying Entity Is Emerging.

Many people were affected by COVID-19 in its severe form. Some intercurrences are still emerging. We here report two cases of COVID-related osteonecrosis of the jaws (CRONJ). Two retrospective cases were admitted into Imam Reza Hospital, Mashhad, Iran with suspected CRONJ. One patient escaped from hospital while the other showed a positive result after our proposed treatment. A new aftermath to COVID-19 infections is emerging. Maxillofacial and orthopedic surgeons should be aware of this situation. CRONJ should be on the suspect list in patients with COVID-19. Measures that are useful in the treatment carried out, as well as some measures recommended in the literature, were discussed. Surgical treatment of CRONJ appears to be an effective alternative, especially in the more aggressive cases.

Assessing the Utility of Oral and Maxillofacial Surgery Posters as Educational Aids in Dental Education for Undergraduate Students: Is it Useless or Helpful?

Background: Educational posters play a crucial role in education, information dissemination, and awareness. Their visual appeal efficiently communicates condensed yet vital information on significant topics, making them valuable for teaching sequential concepts. We aimed to assess the effectiveness of educational posters in the oral and maxillofacial surgery department for student education. Methods: The study was carried out during the fall semester of 2022 at Mashhad Dental School, Mashhad, Iran utilizing a questionnaire-based approach. The questionnaire gathered demographic information and assessed students' perspectives on educational posters. Statistical analysis was performed using SPSS version 23 with a significance level set at 0.05. Results: This study was conducted on 70 students (35 females and 35 males). Gender-based analysis demonstrated significant differences in beauty, adaptability, and learning, with male students scoring lower than females (P values = 0.036 and 0.031, respectively). Further analysis by academic year unveiled higher beauty and adaptability scores among third-year students compared to second-year students, showing statistical significance (P value = 0.035). A two-by-two comparison highlighted that the average beauty score of third and fifth-year students surpassed that of second-year students (P values = 0.041 and 0.038, respectively). In summary, higher academic years correlated with superior performance, emphasizing the potential impact of educational posters on academic outcomes. Conclusion: Posters in the oral and maxillofacial surgery department received commendable ratings in various areas, positively impacting the teaching and learning process.

Postoperative nausea and vomiting in orthognathic surgery: systematic review and meta-analysis.

PURPOSE: Postoperative nausea and vomiting (PONV) is a frequently reported adverse event following orthognathic surgery. The aim of this work is to conduct a systematic review of the literature on the subject, and to discuss the role of maxillofacial surgeons and the steps that can be taken to prevent or control PONV in orthognathic surgery. METHODS: A systematic review was conducted according to the PRISMA guidelines, using the search strategy: (orthognathic AND (nausea OR vomiting)). The authors searched PubMed, Embase, Dimensions, Web of Science and Google Scholar databases, without any language restrictions. RevMan 5.4 was used to create a risk of bias graph and a forest plot. RESULTS: The included articles were classified as having a low risk of bias, despite the limited literature on the subject. Various measures have been reported to be beneficial in preventing or managing PONV, such as the use of dexamethasone, antiemetic drugs, gastric aspiration, and anesthetic blocks. Effective bleeding control and faster surgeries can also be helpful. CONCLUSIONS: Throat packs have not been found to be effective in preventing PONV. Although no definitive protocol has been established in the literature, the Enhanced Recovery After Surgery (ERAS) protocol could be a useful approach. Overall, a multimodal approach may be taken to prevent PONV, and further research is needed to establish definitive protocols.

The online attention analysis on orthognathic surgery research.

OBJECTIVES: Altmetrics is one of the fields of bibliometrics that seeks to assess the impact and interest of a given subject through Internet users. The aim of this study is to make an altmetric analysis of the orthognathic surgery literature. METHODS: A literature search was conducted using Dimensions app up to December 2023. A list of the 100 most mentioned articles on the topic was compiled. A Google Trends search was performed with same strategy to visualize important data regarding internet search. Charts and tables were created using Microsoft Excel and VOSviewer software to allow bibliometric visualization. RESULTS: There was a very poor correlation between the number of mentions and the number of citations (r = 0.0202). Most articles discussed on technical innovations associated to orthognathic surgery, majority related to virtual planning (n = 26). Other topics considered interesting to internet readers were complications (n = 18), surgical technique (n = 14), and psychological aspects/quality of life (n = 13). CONCLUSION: Online interest in orthognathic surgery closely aligns with the level of academic interest but is also influenced by factors such as location and economic status. The internet is a powerful tool for disseminating scientific research to a broad audience, making it more accessible and engaging than traditional academic channels.

Assessment of Benign Paroxysmal Positional Vertigo (BPPV) Incidence Following Closed Sinus Lift and Ridge Splitting Surgeries: A Cohort Study.

Background: With a notable increase in demand for implant placement in atrophic cases, this study aimed to evaluate the occurrence of benign paroxysmal positional vertigo (BPPV) following closed sinus lift and ridge splitting surgeries. Materials and Methods: Healthy patients requiring posterior maxillary closed sinus lift or ridge split surgeries at Mashhad Dental School from September 2021 to September 2022 were enrolled in this cohort study. A single surgeon performed all surgeries under standard protocols. The intervention groups consisted of closed sinus lift and ridge splitting procedures. The primary outcome variable was BPPV, and the Dix-Hallpike maneuver was used before and after the operation to diagnose BPPV. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05. Results: A total of 112 patients (51 women and 61 men) with a mean age of 48.4 ± 9.5 years participated in the study. The average BMI was 21.5 ± 2.4, and the mean duration of surgery was 31.9 ± 6.6 min. Of the patients, 10.7, 36.6, 27.7, 12.5, and 1.8% presented with hypertension, headache, dizziness, nausea, and BPPV, respectively. Two patients (3.1%) in the closed sinus lift group were diagnosed with BPPV, whereas no patients in the ridge split group were diagnosed. However, there was no significant difference (P = 0.509). No statistically significant difference in the occurrence of certain symptoms between two groups was found. There was a significant association between certain health conditions and the onset of BPPV. Conclusion: The study suggests closed sinus lift surgery may have a higher risk of BPPV than ridge split surgery, but further studies with larger sample are needed to confirm this association.

A global landscape analysis of the impact, trends, and dissemination in oral and maxillofacial surgery research.

OBJECTIVE: This study aims to comprehensively analyze the global landscape of oral and maxillofacial surgery (OMFS) literature through bibliometrics. The research focuses on evaluating publication trends, influential topics, and the impact of scholarly works within the field. METHODS: Following the principles of the Leiden Manifesto, a literature search was conducted using the Web of Science database, encompassing seven OMFS journals. A total of 18,218 publications were analyzed, with indicators such as publication language, geographic location, specialty, year, citation, and authorship examined. Statistical analyses, including Pearson correlation tests and angular coefficient calculations, were performed in RStudio. RESULTS: The study revealed a strong upward trend in publications related to orthognathic surgery, trauma, and infections. Geographic analysis indicated a dominance of European and Asian contributions, with the USA leading in overall publications. The impact of self-citations was explored, emphasizing nuanced perspectives on their role in scholarly impact metrics. The data provided insights into the scholarly impact of OMFS publications, including the H-index, number of citations, and citing articles. CONCLUSION: The findings underscored potential global discrepancies in OMFS research, both geographically and in terms of topics covered. The study discussed the influence of language and journal impact on citation counts, emphasizing the role of English publications. Specific topics, such as trauma and infections, exhibited high scholarly interest and citation rates. Recommendations were made to encourage submissions on specific topics, such as cosmetic surgery and pathology, to enhance the diversity of OMFS literature. The study aims to foster international collaboration and leverage bibliometrics for evidence-based decision-making, educational strategies, and advancements in the dynamic field of oral and maxillofacial surgery.

Treatment Options of Maxillofacial Fractures in Iran: A Comprehensive Systematic Review.

Background: The aim of this study was to systematically review the literature on the treatment options of maxillofacial fractures in Iran, complementing a previous article regarding causes and the overall prevalence. Methods: A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify the relevant articles published up to January 2023. Studies reporting the treatment option of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed. Results: This systematic review included 13 articles with a total of 19,147 treated patients for maxillofacial fractures. ORIF was the most common type of treatment, but complications occurred in approximately 5% of cases. Mandible fractures were not statistically more treated by ORIF than closed reduction or conservative treatment, and no type of treatment was considered statistically preferable depending on the anatomical region affected by Iranian maxillofacial surgeons. The included studies were considered to have a low risk of bias, but many were not clear in reporting cross-referenced data regarding the type of treatment, which could be considered a major flaw. Conclusion: Overall, this study provides valuable insights into the types of treatment used for maxillofacial fractures by Iranian surgeons and highlights the importance of clear reporting of data in research articles.

What is the Most Prevalent Type of Third Molar Impaction in Patients with Pericoronitis?

Background: Pericoronitis is a common pathological condition related to mandibular third molar teeth (wisdom teeth). It is an inflammation of the soft tissue surrounding the crown of an erupted or partially erupted tooth that causes pain and discomfort. We aimed to investigate the relation between third molar impaction types and pericoronitis. Methods: This cross-sectional study assessed 60 patients referred to the Oral and Maxillofacial Surgery Department of Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran in 2022 for totally and partially impacted mandibular third molar tooth surgery with pericoronitis. Their demographic data, including age and gender, was recorded. The impacted tooth's side and the symptoms of pericoronitis were identified using clinical examination and panoramic radiography imaging, based on the Pell & Gregory criteria and Peterson's classification. Third-molar tooth surgery was performed according to standard protocol. Patients' data were recorded and were analyzed using Excel 2019 and SPSS ver 21. Results: The prevalence of pericoronitis symptoms in women was higher than in men (P< 0.001). The Class B type of third molar teeth impaction had a relation with the majority of pericoronitis cases (P< 0.001). Pericoronitis and systemic symptoms were more likely to occur in Class II than in Class I type of third molar teeth impaction (P< 0.001). The most frequent kind of impaction linked to pericoronitis and systemic symptoms such as malaise was mesio-angular (P< 0.001). The symptoms of pericoronitis were substantially correlated with smoking (P< 0.001). Conclusion: Class B, Class II, and mesio-angular types of third molar impaction are linked with a higher risk of pericoronitis. This information might help in the early diagnosis and management of pericoronitis in patients with impacted third molar teeth.

Prevalence of Bifid Mandibular Canal: A Systematic Review and Meta-analysis.

Objectives: The aim of this study was to evaluate the prevalence of bifid mandibular canal (BMC) using cone-beam computed tomography (CBCT) and panoramic images through meta-analysis. Methods: Databases of Scopus, PubMed, and Web of Science were searched to find the relevant studies. Studies the met the inclusion criteria were selected. Variables of prevalence, side, length and diameter of BMC and sex were assessed. Data was analyzed using STATA software version 17. Results: Of the 1164 articles initially selected, 36 were enrolled. A total of 38077 patients were considered. The overall prevalence of BMC was 18.0%. Studies that evaluated CBCT images reported higher prevalence of BMC compared to panoramic images (25.0% vs 3.0%). The prevalence of BMC was higher in men than women and slightly higher in right side than the left side of the jaw, but none of those differences were significant. Conclusion: The results have shown a total prevalence of 18.0% for BMC. Detection power of CBCT images were higher than panoramics. There was no significant relation between prevalence of BMC with sex or side of the jaw.

Assessment of Maxillary Sinus Variations Post-LeFort: A Systematic Review.

Background: The purpose of this article was to systematically review maxillary sinus changes after LeFort. We examined and analyzed the anatomical abnormalities that occurred following LeFort I osteotomy, as well as the abnormalities of maxillary sinus volume (MSV) before and after the operation. Methods: A systematic search was conducted on various databases, such as Google Scholar, PubMed, and Scopus. The articles used were in English and original. This study was conducted until September 2023, and after reviewing the articles, several keywords, such as "Maxillary sinus" and "LeFort I osteotomy", were employed. The obtained data were evaluated based on the PICO framework. Results: Findings from 15 studies showed that the amount of MSV decreased before and after the operation (considering the three dimensions of the sinus, the measurement was performed linearly). These reduction values differed between men and women, with men having a greater reduction. As is the case with other operations, there were some side effects associated with this type of operation that some patients experienced postoperatively. Conclusion: In both male and female patients, the MSV was reduced after one-piece and multi-segment osteotomies. Nonetheless, one-piece LeFort I osteotomy showed a higher reduction in MSV than the multi-segment osteotomy method, according to this systematic review and meta-analysis.

Etiology, Epidemiology, and Treatment Type of Maxillofacial Traumas in Razavi Khorasan Province with Certain Insurance between 2016 and 2021.

Background: Trauma is a leading cause of death and disability in developing countries, with maxillofacial fractures being a significant part of such cases. This study focuses on maxillofacial traumas among insured patients in Razavi Khorasan province (2016-2021), exploring the impact of gender, age, and trauma causes on injury prevalence and treatment approaches. Methods: This retrospective cross-sectional study utilized the records of the patients who were treated for maxillofacial fractures in Mashhad Shahid Kamyab Hospital or a Private Trauma Center, from 2016 to 2021. Demographic characteristics of the patients (age and gender), educational backgrounds of surgeons, accident causes, year and location of the fractures, and reasons for referrals were recorded. The data were statistically analyzed using SPSS 20, and the significance level was set at 0.05. Results: We examined the records of 60 patients (44 males, 16 females). Males (73.4%) exhibited a significantly higher prevalence of maxillofacial traumas compared to females (26%) (P Value < 0.05). Falling was identified as the most common cause of fractures (51.7%), followed by impacts from hard objects and motor vehicle accidents (MVA) (P Value = 0.63). Mandible fractures were observed in 48% of patients, followed by zygomaticomaxillary and panfacial fractures, subsequently (P Value < 0.05). Conclusion: The study findings highlight the impact of age, gender, and trauma causes on maxillofacial fractures and treatments among patients with certain insurance. Understanding the origins and patterns of these fractures offers crucial insights for shaping effective health policies, providing valuable guidance for addressing such injuries in this population.

What Is the Effect of Maxillary Impaction Orthognathic Surgery on Voice Characteristics? A Quasi-Experimental Study.

Background: Regarding the impact of orthognathic surgery on the airway and voice, this study was carried out to investigate the effects of maxillary impaction surgery on patients' voices through acoustic analysis and articulation assessment. Methods: This quasi-experimental, before-and-after, double-blind study aimed at examining the effects of maxillary impaction surgery on the voice of orthognathic surgery patients. Before the surgery, a speech therapist conducted acoustic analysis, which included fundament frequency (F0), Jitter, Shimmer, and the harmonic-to-noise ratio (HNR), as well as first, second, and third formants (F1, F2, and F3). The patient's age, sex, degree of maxillary deformity, and impaction were documented in a checklist. Voice analysis was repeated during follow-up appointments at one and six months after the surgery in a blinded manner. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05. Results: Twenty two patients (18 females, 4 males) were examined, with ages ranging from 18 to 40 years and an average age of 25.54 years. F2, F3, HNR, and Shimmer demonstrated a significant increase over the investigation period compared to the initial phase of the study (P <0.001 for each). Conversely, the Jitter variable exhibited a significant decrease during the follow-up assessments in comparison to the initial phase of the study (P< 0.001). Conclusion: Following maxillary impaction surgery, improvements in voice quality were observed compared to the preoperative condition. However, further studies with larger samples are needed to confirm the relevancy.

The Effect of Covid-19-Related Social Distancing Restrictions on Maxillofacial Fractures Epidemiology.

Background: The purpose of the present study was to evaluate the changes in maxillofacial fracture epidemiology and etiology regarding Covid-19-related social distancing restrictions in an Iranian population. Methods: A retrospective cross-sectional study was undertaken in six major trauma center hospitals in Iran in a period of two years (March 2018 until March 2020). The primary outcome variable was the maxillofacial fractures incidence. Patients' demographic data, date of injury as well as fracture characteristics, fracture etiology, type, and site were all recorded, compared, and analyzed in the control and experimental groups. Results: The patients consisted of 520 (83.6%) males and 102 (16.4%) females. Patients sustaining maxillofacial fractures over this two-year period displayed a mean age of 31.24±14.44, with an age range of 2 to 88 years. The incidence of maxillofacial fractures significantly decreased in all age groups (p<0.001). After social distancing restrictions were placed; there was a significant drop in the number of subjects attending due to motorcycle collisions and road traffic accidents, whereas the number of fractures caused by assaults and domestic violence significantly increased (p<0.001 for each). Conclusion: The investigators realized that social distancing restrictions were able to change the trends and patterns in maxillofacial fracture incidence and etiology.