Early Childhood (0 to 5 years) Presents the Greatest Risk for Facial Dog Bites.

PURPOSE: The purpose of the present study is to compare the characteristics of dog bite wounds to the face and that of the rest of the body among the pediatric population in the United States and to determine independent risk factors for dog bite wounds to the face. METHODS: A retrospective cohort study was conducted using the Kids' Inpatient Database. There were multiple, heterogenous predictor variables. The primary outcome variable was a facial dog bite. A multivariate logistic regression was employed to identify independent risk factors for the primary outcome variable. A P value less than .05 was the threshold for statistical significance. RESULTS: Our final sample consisted of 9,057 patients who suffered dog bite injuries, of which 2,913 (32.2%) occurred on the face. Relative to individuals aged 16-20 years, individuals aged 0-5 (odds ratio [OR] 5.7; confidence interval [CI] 4.0, 8.1), 6-10 (OR 3.8; CI 2.6, 5.5), and 11-15 years (OR 1.6; CI 1.1, 2.5) were all independently associated with increased odds of incurring a facial dog bite injury. Patients who were not admitted electively were 2.5 times (CI 1.4, 4.6) more likely to incur a facial dog bite injury relative to patients who were admitted electively. CONCLUSIONS: Young children (0-5 years) were at the greatest risk for facial dog bites relative to children aged 16-20 years. Dog bites that were admitted on emergency were more likely to occur on the face relative to those that were electively admitted to the hospital. To reduce the risk for facial dog bites and the host of chronic psychological ramifications that accompany them, established preventative strategies ought to be exercised.

What are the Risk Factors for Mortality Among Patients Who Suffer Le Fort III Fractures?

PURPOSE: Le Fort III fractures are the most severe subtype of the Le Fort fractures and are associated with adverse clinical outcomes. The purpose of this study was to identify risk factors for mortality among patients who suffer Le Fort III fractures. MATERIALS AND METHODS: A retrospective cohort study was completed using the 2016-2018 National Inpatient Sample. Patients with isolated Le Fort III fractures were selected. Patients who incurred bone fractures or organ injuries outside the head and neck were excluded. There were multiple, heterogenous predictor variables. The primary outcome variable was mortality. Relative risk was used to determine independent risk factors of mortality. Statistical significance was deemed for P values less than .05. RESULTS: The final sample consisted of 559 patients (mean age, 45.9 years) who suffered a Le Fort III fracture, of whom 15 patients (2.68%) died. Most patients were male (82.7%) middle-aged adults (42.9%) of White race (66.5%) within the lowest income quartile (31.7%) that lived in large metro areas (54.9%). Relative to males, females were nearly 62 times more likely to die (P < .01). Relative to privately insured subjects, uninsured subjects were 23 times (P < .05) more likely to die. Relative to weekday admissions, weekend admissions increased the risk of mortality by 8 times (P < .05). Cranial vault fractures (odds ratio, 7.24; P < .05) and upper cervical fractures (odds ratio, 63.27; P < .05) were risk factors for mortality. Relative to males, females were at an increased risk for mortality (relative risk [RR] 7.14, 95% confidence interval [CI] 2.60, 19.61). Skull base fracture (RR 2.99, 95 CI 1.04, 8.63), cranial vault fracture (RR 3.04, 95 CI 1.07, 8.65), subdural hemorrhage (RR 2.98, 95 CI 1.10, 8.05), subarachnoid hemorrhage (RR 6.73, 95 CI 2.34, 19.35), and injury of blood vessels at neck level (RR 13.24, 95 CI 2.46, 71.16) were each risk factors for mortality. CONCLUSIONS: Intracranial injury was not a risk factor for mortality. Instead, cranial vault fractures and skull base fractures increased the risk for mortality. In addition, uninsured patients and female patients were each at an increased risk for mortality.

Risk factors for increased length of hospital stay among young pediatric patients who suffer facial fractures.

BACKGROUND/AIM: It is not known whether the mechanism of facial trauma influences the associated length of hospitalization. The aim of this study was to determine whether the mechanism of injury influenced the length of hospital stay (LOS) among pediatric patients who sustained facial fractures. MATERIALS AND METHODS: This retrospective cohort study was completed using the Kids' Inpatient Database (KID). The primary predictor variable was the mechanism of injury. The primary outcome variable was LOS. Linear regression was used to determine independent predictors of increased/decreased length of stay. A p-value of less than .05 was considered statistically significant. RESULTS: The final sample consisted of 2865 subjects aged 12 years or younger who had suffered facial fractures. The most common mechanism of injury was motor vehicle accidents (MVA) (58.6%). Facial fractures due to MVA added 1.20 days (95% CI, 0.02, 2.38; p < .05) when compared to those due to a fall. CONCLUSIONS: MVA significantly prolonged the LOS among young pediatric patients who sustained facial fractures, reflecting the exceptional amount of force involved. Having a chronic condition was also a significant factor for longer LOS. Four or more fractures also led to a longer LOS.

Patterns of craniomaxillofacial trauma among helmeted cyclists.

BACKGROUND/AIM: The head and face are prone to injury in bicycle accidents and helmets are proven to be helpful in decreasing injuries to some extent. The aim of this study was to determine whether certain craniomaxillofacial regions are at increased risk of injury (fracture) during bicycle accidents among helmeted cyclists. MATERIALS AND METHODS: This retrospective cohort study was conducted using data from the National Electronic Injury Surveillance System (NEISS). Data concerning craniomaxillofacial injuries as a result of cycling accidents between 2019 and 2020 were reviewed. The primary predictor variables were the craniomaxillofacial region and a craniofacial bone. The co-variates included patient characteristics (age, gender, race) and injury characteristics (location, season). The primary outcome variable was a fracture. Logistic regression was used to determine any independent risk factors for a fracture. RESULTS: Five hundred patients reported helmet use at the time of injury. Fractures of the face region were 75 times (p < .01) more likely than the head region. No particular craniofacial bone was at greater risk of fracture relative to the maxilla. Adults (OR 24.0, p < .01) and seniors (OR 38.6, p < .01) were each at greater risk for fracture relative to children. CONCLUSIONS: The facial region was at increased risk of fracture relative to the head during a bicycle accident. Adults and seniors were at increased risk of suffering craniofacial fractures relative to children.

Relapsing Polychondritis Concomitant With Synovial Chondromatosis of the Temporomandibular Joint.

Relapsing polychondritis (RP) is a rare, multisystem autoimmune disease characterized by inflammation, structural damage, and impaired function of cartilaginous tissues throughout the body. In the craniofacial region, this rare disease has been reported to affect structures of the ear and nose; however, reports of temporomandibular joint (TMJ) involvement are scarce. A second uncommon disorder of cartilage is synovial chondromatosis (SC), a progressive and proliferative disorder of the synovial membrane associated with the formation of variably sized cartilaginous and calcified loose bodies, often causing dysfunction of the joints and enlargement of the joint capsule. It commonly affects the larger joints; TMJ involvement is uncommon. We present the case of a 45-year-old woman with previously diagnosed RP in whom right TMJ pathology subsequently developed, undergoing arthroscopy and biopsy followed by arthroplasty, which was proved to be SC, likely due to her autoimmune disease. To our knowledge, this is the first case describing concomitant SC of the TMJ presumably from pre-existing RP.

Three Synchronous Atypical Metastases of Clear Cell Renal Carcinoma to the Maxillary Gingiva, Scalp and the Distal Phalanx of the Fifth Digit: A Case Report.

Oral cavity metastasis of malignant tumors is extremely rare and accounts for only 1% of all malignant oral tumors. Renal cell carcinoma (RCC) can metastasize to any part of the body, with a 15% risk of metastasis to the head and neck region when the disease is disseminated and a 1% risk when it is not. RCC also is the third most common infraclavicular neoplasm that metastasizes to the oral cavity, after lung carcinoma in men and breast carcinoma in women. In the maxillofacial region, the nasal cavity and paranasal sinuses are the most commonly affected sites, followed by the oral cavity. This report describes the case of a 51-year-old man with a history of clear RCC presenting with 3 synchronous atypical metastases of this tumor to the maxillary gingiva, scalp, and distal phalanx of the fifth digit. Clinical findings, diagnosis, pathology, and treatment of these lesions are discussed. Metastasis of RCC should always be included in the differential diagnosis when a new oral and maxillofacial lesion appears in a patient with a history of RCC because the metastatic lesions can often present in a broad spectrum of forms. The rapid growth of these lesions should alert clinicians to avoid any delays in biopsy examination and subsequent treatment, which is usually palliative, because prognosis is usually poor.

Investigation of the risk factors associated with the survival rate of dental implants.

PURPOSE: The propose of this article was to evaluate the risk factors associated with the survival rate of the dental implants. MATERIAL AND METHODS: This retrospective study evaluated the survival rate of 940 implants placed at the Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, from January 2003 to January 2011. The potential risk factors associated with the survival rate of the implants were investigated. RESULTS: Fifteen (1.5%) of the 940 implants failed during the follow-up period. Smoking did not affect the survival rate of the implants (log-rank, 1.5; P = 0.219). The survival rate of the implants placed in the maxilla was lower than that of the implants placed in the mandible (log-rank, 4.81; P = 0.028). The 5-year survival rate of the dental implants was 98.5%. CONCLUSIONS: There are still conflicting results about the risk factors associated with the survival rate of the implants. According to the results of this study, it is concluded that only the location of the implants is associated with the survival rates of the implants. All implant systems showed high survival rates.

A Review of 13,470 Head and Neck Injuries from Trampoline Jumping.

Study Design: The authors designed a 20-year cross-sectional study using the National Electronic Injury Surveillance System (NEISS) database. Objective: The purpose of the study is to determine the risk factors for hospital admission among individuals who suffer head and neck injuries secondary to trampoline use. Methods: The primary predictor variables were a set of heterogenous variables that were categorized into the forementioned study variable groups (patient characteristics and injury characteristics). The primary outcome variable was hospital admission. Multivariate logistic regression was used to determine independent risk factors for hospital admission. Results: The final sample consisted of 13,474 reports of trampoline injuries to the head and neck. Relative to females, males (OR 1.66, P < .05) were at an increased risk for hospital admissions. Fractures (OR 35.23, P < .05) increased the risk for hospital admissions relative to dental injuries. Concerning anatomical region of injury, neck injuries (OR 30.53, P < .05) were at an increased risk for hospital admissions. Conclusions: Injuries to the neck from trampoline jumping significantly increased the risk for admission. The severity of neck injuries from trampoline jumping is well established in the literature. Additionally, male sex and fractures were each risk factors for hospital admission. Given the rising prevalence of trampoline-related head and neck injuries over the past 2 decades, it is crucial for individuals to take the necessary precautions when jumping on a trampoline.

Surgical treatment of hereditary gingival fibromatosis by diode laser: Report of five rare cases in the same family.

The pathogenesis of hereditary gingival fibromatosis (HGF) is largely unknown; however, the removal of excess tissue may often be necessary as it often causes aesthetic and functional problems. Gingivectomy is usually a treatment option that can be performed using a scalpel, cryotherapy, electrosurgery, or laser. This paper aims to evaluate the results of HGF treatments using a diode laser of five people from the same family. Three members of a family of five (two females and three males; 9-36 years old) underwent gingivectomy with a 3 W 300-micron fiber-tipped diode laser (Doctor Smile, Vicenza, Italy) at 810 nm wavelength. While all teeth of one member were extracted, the other member refused treatment. Relapse occurred in three members due to poor oral hygiene. The diode laser was reapplied and oral hygiene instructions were repeated. Patients were followed during the postoperative period for up to two years. HGF is a rare condition that clinicians should pay attention to in the diagnosis, treatment, and follow-ups. Since recurrences are due to dental plaque, oral hygiene instructions are essential and compliance is mandatory. Although there are many treatment approaches, the diode laser is the most indicated method due to many advantages such as providing a bloodless and more sterile operation field, performing an atraumatic surgery, ensuring earlier and ideal recovery, and minimizing postoperative pain.

Characterization of head and neck pain symptoms of patients presenting to a tertiary care pain clinic.

OBJECTIVE: To characterize the presentation and symptomatology of individuals presenting with pain in head and neck regions. METHODS: A retrospective chart-review was performed on patients with pain in the HFN presenting to a tertiary pain center in Turkey between January 2016 and January 2017. Information regarding the characteristics of pain and medical and treatment history were extracted and reviewed. RESULTS: Among 197 subjects, 135 (68.5%) were females. The average duration of pain was 60.13 ± 92.32 months. The pain was continuous in presentation and severe in intensity in 43.1% and 51.8% of the subjects, respectively. The pain was associated with at least one somatosensory symptom in 12.1% of subjects. Common diagnoses were trigeminal neuralgia, persistent idiopathic facial pain, and migraine headaches. CONCLUSION: Painful disorders of the HFN are associated with varying and perplexing signs and symptoms. Such patients should undergo a comprehensive clinical assessment with a multidisciplinary team.

What factors influence the cost of orthognathic surgery among patients in the US?

OBJECTIVE: The purpose of our study was to analyze what factors influence the cost of orthognathic surgery performed within the US. STUDY DESIGN: This retrospective cohort study was completed using the Kids' Inpatient Database (KID) from 2000 to 2012 on all patients aged 14 to 20 years who had undergone orthognathic surgery. The predictor variables included patient and hospitalization characteristics. The primary outcome variable was hospital charge ($). Multivariate linear regression was conducted to determine independent predictors for increased/decreased hospital charge. RESULTS: The final sample consisted of 14 191 patients (mean age, 17.4 ± 1.6 years; females, 59.2%). Each additional day in the hospital added $8123 in hospital charges (P < .01). Relative to mandibular osteotomy, maxillary osteotomy (+$5703, P < .01) and bimaxillary osteotomy (+$9419, P < .01) were each associated with increased hospital charges. Genioplasty (+$3499, P < .01), transfusion of packed cells (TPC) (+$11 719, P < .01), continuous invasive mechanical ventilation (CIMV) <96 hours (+$23 502, P < .01), and CIMV ≥96 hours (+$30 901, P < .01) were each associated with significantly increased hospital charges. Obstructive sleep apnea (OSA) added $6560 in hospital charges (P < .01). CONCLUSIONS: Maxillary osteotomy and bimaxillary surgery were each associated with significantly increased charges relative to mandibular osteotomy. Concomitant genioplasty, TPC, CIMV, and OSA each significantly increased the charges. Each additional day to the length of stay significantly increased the charges.

Motorcycle Accidents are the Strongest Risk Factor for Panfacial Fractures Among Pediatric Patients.

Study Design: A retrospective cohort study was conducted using the Kids' Inpatient Database from 2000 to 2014. Subjects were included if they were 18 years and younger and suffered any type of facial fracture. Objective: The purpose this study was to determine the risk factors for incurring panfacial fractures among the pediatric population. Methods: The primary predictor variables were a set of heterogenous variables that included patient characteristics, injury characteristics, hospitalization outcomes. The primary outcome variable was panfacial fracture. Logistic regression was used to determine the independent risk factors for panfacial fractures. Results: Relative to infants and toddlers, teenagers were nearly three times more likely to sustain panfacial fractures (P < .01). Relative to no chronic conditions, patients with one or more chronic conditions were more likely to incur panfacial fractures. Motorcycle accidents were over three times more likely (P < .01) to result in panfacial fractures while car accidents were over two times more likely (P < .01) to result in panfacial fractures. Falls were less likely (OR, .39; P < .01) to result in panfacial fractures. Conclusions: Motor vehicle accidents was a major risk factor for panfacial fractures. Teenagers are also found to have an increased risk for panfacial fractures relative to infants and toddlers. Each additional chronic condition was a significant risk factor for suffering panfacial fractures relative to not having any chronic condition at all. In contrast, falls independently decreased the risk of incurring a panfacial fractures. Special attention should be given to safety precautions when occupying a motor vehicle.

Keratocystic odontogenic tumors: predictive factors of recurrence by Ki-67 and AgNOR labelling.

PURPOSE: The purpose of the present study was to investigate the possible role of Ki-67 and argyrophilic nucleolar organizing regions (AgNOR) between the recurrent and nonrecurrent keratocystic odontogenic tumors (KCOTs). Another aim was to compare the correlation between these two markers. MATERIALS AND METHODS: 22 KCOTs were evaluated retrospectively. The actual proliferative activity of the KCOT was measured by Ki-67 labelling index and argyrophilic nucleolar organizing regions AgNOR count per nucleus. RESULTS: Recurrence occurred in 3 patients (13.6%) during the follow-up period (mean follow-up, 37.8 months) The Ki-67 and AgNOR counts were significantly higher in the recurrent lesions comparing to the non-recurrent lesions. (p=0,045; p=0,049) The correlation between Ki-67 and AgNOR counts was found to be positive (r=0,853 p=0,0001). CONCLUSION: Within the limit of the present study, it is thought that Ki-67 and AgNOR might be helpful as a prognostic marker for the recurrences of KCOTs. These markers reinforced the meaning of the new classification of the lesion as an odontogenic tumor. Enucleation with curettage or decompression following enucleation with curettage is a simple and appropriate surgical model for the treatment of KCOT despite the relative high recurrence rate. On the other hand, the conservative treatment can be chosen only if there is no coronoid invasion, no interruptive cortical lysis and no tissular invasion.

Incidentally detected asymptomatic metal foreign bodies (two nails) in shoemaker's maxillary sinus.

The diagnosis metal foreign bodies of maxillary sinus cannot be usually made in an acute setting and patients may present with chronic symptoms due to drainage and chronic irritation of the mucosa years later. Metal foreign bodies can be generally displaced to the maxillary sinus at the time of dental intervention. In this article, we report a very interesting case of 23-year-old male shoemaker with two metal foreign bodies (nails) which were non-related with any surgical intervention or trauma and found incidentally in the right maxillary sinus.

The importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws: Study of 276 cases.

PURPOSE: Benign fibro-osseous lesions (BFOLs) are heterogeneous intraosseous disease processes sharing overlapping histopathologic features and demonstrate a wide range of biological behavior. The aim of this study is to highlight the importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws. MATERIALS AND METHODS: This is a cross-sectional retrospective study evaluating the three main groups of BFOLs: Cemento-osseous dysplasia, ossifying fibromas, and fibrous dysplasia. Previously diagnosed BFOL cases were searched for thoroughly from the archives of Istanbul University, Institute of Oncology, Department of Tumor Pathology in between 2005 and 2015. Clinical and radiological data of these cases were identified and recorded. The histopathologic features were reevaluated from the H&E-stained slides. RESULTS: A total of 276 BFOL cases were identified and reevaluated for the study. The most common BFOL type was cemento-osseous dysplasia (n = 135), followed by cemento-ossifying fibroma (n = 77), fibrous dysplasia (n = 53) and juvenile ossifying fibroma (n = 11). The female/male ratio was 3.4:1 with a strong predilection for the 4th decade (n = 102). The mandible (n = 209) was the predominantly affected jaw. Prominent osteoblastic rimming around the bony lesion was commonly observed for cemento-ossifying fibroma (n = 60/77), followed by cemento-osseous dysplasia (n = 23/135). Predominant ossification patterns showed some differences among the groups. The most common radiological feature was the mixed radiolucent/radiopaque internal structure. CONCLUSION: Our results document various clinical, radiological and histopathologic findings of BFOLs. Even some histopathologic differences are observed, clinical and radiographic correlation is mandatory prior to the definitive histopathologic diagnosis of BFOLs for the prevention of possible misdiagnoses or inappropriate treatments.

The effect of irrigation temperature on bone healing.

OBJECTIVE: Osteotomies, performed by rotational instruments, can cause temperature rise on the bone and elevated temperature can disrupt the bone healing. When the osteotomies are performed for the insertion of miniscrews, the bone healing disruption may cause stability loosening or failures. Saline irrigation is mostly used for the prevention of the heat generation during osteotomy. PURPOSE: The purpose of this study was to evaluate the effect of the saline irrigation temperature on bone healing. MATERIAL AND METHOD: Standardized drilling and miniscrew placement was performed in the tibias of 18 Sprague Dawley rats with rotating bur uncooled, cooled with 25°C and 4°C saline irrigations. After the 21 days, the difference in healing was observed between the uncooled and cooled groups. RESULTS: Although there was no statistically significant difference between the group irrigated with 25°C and 4°C saline for newly bone formation, osteoblasts were seen more active and bone marrow was more dynamic in group 4°C than group 25°C. There is no disadvantage to use 25°C, but it may be better to use 4°C for rapid healing.

Delayed removal of a maxillary third molar accidentally displaced into the infratemporal fossa.

The removal of an impacted maxillary third molar is an easy procedure for an oral and maxillofacial surgeon. The most commonly seen complications associated with this type of surgery are excessive hemorrhage, infection, pain, swelling, trismus, and root fractures. Although rarely encountered, unexpected complications may also arise during this procedure, such as the displacement of the tooth into an anatomic space. In this article, a case of a maxillary left third molar accidentally displaced into the infratemporal fossa is presented, and the delayed removal of the tooth after 3 weeks from the initial unsuccessful attempt is described, along with the correlating reasons. The role of the radiologic analysis in determining the localization of the tooth, including the routine panoramic radiographs and more importantly the volumetric computed tomographic scans, is stated. The different surgical treatment options are classified, and the potential for morbidity in the surgical removal of the tooth from the infratemporal fossa is presented by ranging the vital anatomic structures running through it.

Clinical management of microstomia due to the static treatment of facial paralysis and oral rehabilitation with dental implants.

Facial-nerve paralysis is seldom seen and may occur because of a broad spectrum of causes. The most commonly seen cause of facial paralysis is the Bell palsy; iatrogenic causes and tumors are relatively rare. Facial asymmetry, drooling, garbled speech, and difficulty in feeding: all adversely affect the psychosocial conditions of the patients. Fascial and tendon sling procedures may be performed for the static treatment of the unilateral permanent facial paralysis. These techniques are used both for the correction of the asymmetry of the face, especially by providing static support for the corner of the mouth, and to prevent drooling. Microstomia after a sling procedure is not a previously observed complication in the literature. A patient is presented with the surgical management of the complication of microstomia that had risen because of a static treatment of his unilateral facial paralysis via a tendon that passes circularly through his orbicularis oris muscle. Oral rehabilitation thereafter was maintained with the support of dental implants and fixed prosthodontics. The most efficient treatment protocol was decided with an interdisciplinary consultation of the oral and maxillofacial surgeon, the plastic surgeon, and the prosthodontist.

Decompression, enucleation, and implant placement in the management of a large dentigerous cyst.

The dentigerous cyst is a developmental odontogenic cyst, accounting for 10% of all cysts of the jaws. The treatment options are decompression, marsupialization, or enucleation regarding the features of the lesions. In this article, a case of a 17-year-old adolescent girl having a large mandibular dentigerous cyst associated with an unerupted third molar is presented. The treatment is composed of decompression for 6 months and enucleation. Decompression and enucleation are a predictable choice in the treatment of large cysts. Radiologic evaluation is mandatory to decide for the appropriate time for the removal of the decompression stents, the enucleation time, and also for the evaluation of the adequate new bone formation for implant placement. The present case emphasizes the success of a conservative approach in the management of a large dentigerous cyst in a young patient and also the maintenance of the new bone formation without using any graft materials for the placement of dental implants.

Biomechanical evaluation of stress distributions at the implant-abutment complex and peri-implant bone around mandibular dental implants with different neck geometries and inclinations.

This study aimed to investigate the effects of the different dental implant neck designs, diameters, and inclinations, on the stress distributions at the mandibular crestal bone and implant-abutment complex, using three-dimensional (3D) finite element stress analysis (FEA) method. Finite element models of three-unit fixed partial dentures supported with two same length implants (10 mm), placed on the second premolar and second molar regions, were designed. Eight different models were designed according to the implants' neck designs (platform switching/traditional), diameters (4.1 mm/4.8 mm) and the tilting angles of the posterior implants (0°/15°). The anterior implants' widths were 4.1 mm and the neck design of the anterior implants matched the posterior implants. Two types of 100-N loads in vertical and 30° oblique directions were applied separately onto each central fossae and functional cusps of the fixed partial dentures crowns. Algor Fempro Software was used for the simulation and evaluation of the stress levels at the implant-abutment complex and the crestal bone. Stress levels measured at the crestal bone were found to be lower for the platform switching models. However, the platform switching design generated higher stress magnitudes within the implant-abutment complex. Inclined placement of posterior implants increased the amount of stress at the crestal bone around both implants. Biomechanically, selection of the largest diameter possible when using tilted platform switched implants may be recommended at the posterior mandible.