Timing of oral and maxillofacial surgery in infected COVID-19 subjects: A retrospective cohort study.

This study aims to investigate the association of time to oral and maxillofacial surgery after Covid-19 infection with the risk of postoperative complications in a population from China. In the current study, a total of 1342 consecutive patients underwent general anesthesia (GA) in the maxillofacial district of the Chinese Oral and Maxillofacial COVID Collaborative, which consists of 27 teaching hospitals. Pulmonary, cardiovascular and thrombotic complications were monitored for 1 month after GA surgery (GAS) and their incidence was reported for the first 30 days. Post-operative complications were observed in 4 of 1076 cases (0.37%) who had suffered from mild Omicron infection and in none of the controls. Results from the Quasi-Poisson multivariate regression models showed that Omicron infection was not associated with increased post-operative complications compared to controls. Among the infected patients, delays of >4 but not >6 weeks were associated with lower OR of complications (0.08, 95% CI 0.01-0.78 and 0.06, 95% CI 0.01-1.80, respectively). Findings of this study suggest that delaying surgery for a period of 4-6 weeks following infection can provide a protective effect.

Alveolar bone loss and tooth loss contribute to increase in cancer mortality among older patients.

BACKGROUND: Both cancer and periodontitis are more prevalent with age. Information on their relationship in older patients is limited. This study aims to examine whether periodontitis is associated with increased risk of cancer mortality with a ≥ 75-year age group cohort. METHODS: A retrospective cohort study was conducted on 1146 patients who had digital radiographic examinations. Alveolar bone loss and loss of teeth were measured as indicators of periodontitis. Hazard ratio (HR) with 95% confidence interval (CI) were taken as the effect size to summarize the associations between periodontitis and risks of cancer mortality using the multivariate adjusted cox proportional hazards model and competing risk hazard model. RESULTS: Totally, 104 total cancer, 28 lip, oral cavity and pharynx (LOP) cancer, 39 digestive cancer and 13 respiratory cancer cases were documented over 10 years of follow-up. Total cancer (HR 1.27, 95% CI 1.06-1.53) displayed statistically significant associations with alveolar bone loss and tooth loss after adjusting for relevant confounding variables. We also observed borderline significant association between alveolar bone loss and LOP cancer (HR 1.45, 95% CI 0.99-2.12). The above associations were consistent with the results observed from the competing risk hazard models. CONCLUSION: Our results indicate that older patients suffering from tooth loss or alveolar bone loss are at increased risks of cancer mortality, especially for total cancer and LOP cancer.

Mandibular stability and condylar changes following orthognathic surgery in mandibular hypoplasia patients associated with preoperative condylar resorption.

OBJECTIVES: To evaluate postoperative mandibular stability and condylar changes in patients with mandibular hypoplasia and preoperative condylar resorption (CR) undergoing orthognathic surgery. MATERIALS AND METHODS: Fifty-four patients were included in this retrospective study. Computed tomography (CT) scans were acquired preoperatively (T0), 2-7 days immediate postoperatively (T1), and at least 1 year postoperatively (T2). Three-dimensional (3D) cephalometric analysis and measurements of condylar angle, volume, and position (joint spaces) were performed. A 2-mm mandibular relapse was deemed clinically acceptable. We also analyzed the correlations between relapse and postoperative CR and susceptible factors using a multivariate logistic regression model. RESULTS: The results showed one year after the surgery, the average mandibular relapse was 1.0 mm (p < 0.05), and the average reduction of condylar volume was 152.4 mm3 (12.7%). Condyle-fossa relationships were improved immediately after the surgery, with a tendency of returning to their original state in the follow-up (p < 0.05). Anteroposterior advancement at point B (B-CP advancement) at T1 and superior joint space (SJS) at T0 were significantly correlated with mandibular relapse, and postoperative CR was mainly associated with vertical increasement at point B (B-AP increasement) at T1. The optimal cut-off values were as follows: 1.6 mm for SJS, 4.2 mm for B-CP advancement, and 1.8 mm for B-AP increasement. Concomitant advancement Genioplasty showed no significant correlation with relapse and postoperative CR. CONCLUSIONS: While patients with mandibular hypoplasia and preoperative CR were vulnerable to further condylar resorption after mandibular advancement, the treatment outcomes were generally clinically acceptable. Postoperative relapse was associated with a larger than 4.2 mm of mandibular advancement measured at B-CP and a larger than 1.6 mm of superior joint space measured at SJS, and postoperative CR was associated with a larger than 1.8 mm of mandibular vertical increasement measured at B-AP. CLINICAL RELEVANCE: The findings of this study suggested that the mandibular advancement might be limited to 5 mm for patients with preoperative CR. A concomitant advancement genioplasty might also be considered to achieve a better facial profile in these patients.

A random forest algorithm predicting model combining intraoperative frozen section analysis and clinical features guides surgical strategy for peripheral solitary pulmonary nodules.

Background: Intraoperative frozen section (FS) analysis has been used to guide the extent of resection in patients with solitary pulmonary nodules (SPNs), but its accuracy varies greatly among different hospitals. Artificial intelligence (AI) and multidimensional data technology are developing rapidly these years, meanwhile, surgeons need better methods to guide the surgical strategy of SPNs. We established predicting models combining FS results with multidimensional perioperative clinical features using logistic regression analysis and the random forest (RF) algorithm to get more accurate extent of SPN resection. Methods: Patients with peripheral SPNs who underwent FS-guided surgical resection at the Shanghai Chest Hospital (January 2017-December 2018) were retrospectively examined (N=3,089). The accuracy of intraoperative FS-guided resection extent was analyzed and used as Model 1. The clinical features (sex, age, CT features, tumor markers, smoking history, lesion size and nodule location) of patients were collected, and Models 2 and 3 were established using logistic regression and RF algorithms to combine the FS with clinical features. We confirmed the performance of these models in an external validation cohort of 117 patients from Hwa Mei Hospital, University of Chinese Academy of Science (Ningbo No. 2 Hospital). We compared the effectiveness in classifying low/high-risk groups of SPN among them. Results: The accuracy of FS analysis was 61.3%. Model 3 exhibited the best diagnostic accuracy and had an area under the curve of 0.903 in n the internal validation cohort and 0.919 in the external validation cohort. The calibration plots and net reclassification index (NRI) of Model 3 also exhibited significantly better performance than the other models. Improved diagnostic accuracy was observed in in both internal and external validation cohort. Conclusions: Using an RF algorithm, clinical characteristics can be combined with intraoperative FS analysis to significantly improve intraoperative judgment accuracy for low- and high-risk tumors, and may serve as a reliable complementary method when FS evaluation is equivocal, improving the accuracy of the extent of surgical resection.

Evaluation of Related Factors of Maxillary Sinusitis After Le Fort I Osteotomy Based on Computed Tomography: A Retrospective Case-Control Study.

ABSTRACT: Maxillary sinusitis is 1 of the postoperative complications of the Le Fort I osteotomy, this study investigated the related factors of maxillary sinusitis after Le Fort I osteotomy. A total of 23 cases, 92 controls, and 11 related factors were included in this case-control study with a 1:4 case-control ratio. The risk factors for maxillary sinusitis after Le Fort I were examined by least absolute shrinkage and selection operator multivariate conditional logistic regression and least absolute shrinkage and selection operator multivariate linear regression. The patency of maxillary sinus ostium at 6 months after surgery was significantly associated with maxillary sinusitis after Le Fort I osteotomy. Compared with the obstructed maxillary sinus ostium, the percentage of the volume of the healthy air cavity in the complete sinus cavity increased 70.7% when the maxillary sinus ostium was unobstructed, and 95% confidence interval was 0.610 to 0.805. Similarly, when the maxillary sinus ostium was wide, the percentage increased 6.0% compared with the narrow 1, and 95% confidence interval was 0.013 to 0.107. This study indicated that the patency of maxillary sinus ostium has an important impact on maxillary sinusitis after Le Fort I osteotomy. Close attention should be paid to maintain the maxillary sinus ostium and the drainage of maxillary sinuses unobstructed in a clinical setting.

Effects of long-term soft contact lens wear on corneal epithelial thickness after small incision lenticule extraction.

The present study investigated changes in corneal epithelial thickness after small incision lenticule extraction (SMILE) in patients with long-term preoperative soft contact lens (SCL) wear, the impact of SCL wear on the efficacy of surgical outcomes and the effects of long-term SCL wear on postoperative corneal aberrations. Patients were assigned to three groups according to the duration of SCL wear: Group A, the non-SCL-wearing group; group B, those with SCL wear ≤1 year; and group C, those with SCL wear >1 year. Epithelial thickness was recorded in nine zones by anterior segment optical coherence tomography across a 5-mm diameter before surgery and at 1 week, and 1, 3 and 6 months post-surgery. Corneal epithelial thickness and corneal aberrations among the three groups were compared, as well as the effects of changes in corneal epithelial thickness on postoperative visual acuity and manifest refraction. No significant differences were noted with regard to age or preoperative spherical equivalent among groups A (22 eyes), B (17 eyes) and C (18 eyes). Preoperative corneal epithelial thickness in the inferonasal, inferior and inferotemporal zones was thinner in group B compared with that in group A, and corneal epithelial thickness was thinner in all nine zones in group C compared with that in group A (P<0.05). At all follow-up time points, in the central, nasal, inferonasal, inferior, inferotemporal and temporal areas, the epithelial thickness was thinner in group C compared with that in group A (P<0.05). At 3 months postoperatively, the epithelial thickness was thinner in the inferonasal and inferior sectors in group C compared with that in group B (P<0.05), and at 6 months postoperatively, the epithelial thickness in the inferior region was thinner in group C compared with that in group B (P<0.05). There were no significant differences in visual acuity or manifest refraction among the three groups at all postoperative time points. The total higher-order aberrations were greater in group C compared with those in group A for all time points (P<0.05) and were greater in group C at 1 and 3 months postoperatively compared with those in group B (P<0.05). The spherical aberrations at 3 and 6 months postoperatively were greater in group C compared with those in group A (P<0.05). The coma aberrations were greater in group C compared with those in groups A and B for all time points (P<0.05). In conclusion, long-term SCL wear will result in corneal epithelial thinning, which does not impact visual acuity or manifest refraction after SMILE.

Effects of autologous concentrated growth factor on gingival thickness in periodontal accelerated osteogenic orthodontics: a 6-month randomized controlled trial.

BACKGROUND: Earlier studies have not given clear results of concentrated growth factor (CGF) on gingival thickness (GT) in periodontal accelerated osteogenic orthodontics (PAOO). This randomized controlled trial aimed to evaluate the effects of CGF on GT in patients with thin gingival phenotype undergoing PAOO. METHODS: Forty four patients presenting 264 anterior mandibular teeth were recruited and randomly allocated to one of the groups: test-positioning of autologous CGF after PAOO or control-positioning of a collagen membrane after PAOO. GT, gingival height (GH), buccal alveolar bone thickness (BT), and buccal alveolar bone height (BH) were evaluated depending on cross-sectional CBCT images at t0 (before surgery) and t1(6 months after surgery). RESULTS: GT were increased in both groups at t1 compared to t0. Yet, higher values were observed in the test group (from 0.94 ± 0.23 to 1.31 ± 0.33 mm) compared to the control group (from 0.94 ± 0.19 to 1.02 ± 0.16 mm) (p < 0.05). Moreover, in the intergroup comparison, GT at t1 in the test group was significantly higher compared to the control group (p < 0.01). Furthermore, the GT of central incisors, lateral incisors and canine teeth all showed significantly changes compared with baseline and the test group showed higher increase (p < 0.01). No statistically significant difference were found in GH, BT, BH and all clinical parameters between two groups at t1 (p > 0.05). CONCLUSIONS: Within the limitation of this study, gingival thickness could be increased by using CGF in PAOO for the patients with thin gingival phenotype. Trial registration The study was registered in Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ) under the number ChiCTRINR17013346, Registered 11 November 2017.

Randomized Clinical Trial of the Accuracy of Patient-Specific Implants versus CAD/CAM Splints in Orthognathic Surgery.

BACKGROUND: The maxilla position is essential for the aesthetic and functional outcomes of orthognathic surgery. Previous studies demonstrated the advantages of patient-specific implants in orthognathic surgery. However, more data are needed to confirm the superiority of patient-specific implants over surgical splints created with computer-aided design/computer-aided manufacturing (CAD/CAM). This randomized controlled trial aimed to compare the accuracy of patient-specific implants and CAD/CAM splints for maxilla repositioning in orthognathic surgery. METHODS: Patients (n = 64) who required orthognathic surgery were randomly assigned to use either patient-specific implants (patient-specific implant group) or CAD/CAM surgical splints (splint group) to reposition the maxilla. The outcome evaluation was completed by comparing virtual plans with actual results. The primary outcome was the discrepancies of the centroid position of the maxilla. Other translation and orientation discrepancies of the maxilla were also assessed. RESULTS: The authors analyzed 27 patients in the patient-specific implant group and 31 in the splint group. The maxilla position discrepancy was 1.41 ± 0.58 mm in the patient-specific implant group and 2.20 ± 0.94 mm in the splint group; the between-group difference was significant (p < 0.001). For the patient-specific implant group, the largest translation discrepancy was 1.02 ± 0.66 mm in the anteroposterior direction, and the largest orientation discrepancy was 1.85 ± 1.42 degrees in pitch. For the splint group, the largest translation discrepancy was 1.23 ± 0.93 mm in the mediolateral direction, and the largest orientation discrepancy was 1.72 ± 1.56 degrees in pitch. CONCLUSION: The result showed that using patient-specific implants in orthognathic surgery resulted in a more accurate maxilla position than CAD/CAM surgical splints. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Alveolar Bone Loss, Tooth Loss and Oral Cancer Mortality in Older Patients: A Retrospective Cohort Study.

PURPOSE: There has been growing interest in the association between periodontitis and systemic disease. In recent years, however, inconsistent results have also been found by case-control studies for the role of periodontitis in the development of oral cancer. This study aimed to examine whether periodontitis was an independent risk factor for oral cancer with a ≥75-year age group cohort. MATERIALS AND METHODS: Between January 2010 and December 2014, 1385 patients aged ≥75 years who underwent radiographic examination were included in this retrospective cohort study. We collected demographic information and comorbid health conditions from local health authorities. Participants were followed up until either the occurrence of mortality, or the end of the study on December 31, 2018. Cox proportional hazards regression and competing risk hazard models were used to examine the association between periodontitis and oral cancer mortality. RESULTS: Periodontitis and loss of teeth were significantly associated with oral cancer mortality. Compared to oral cancer mortality in healthy subjects, the HR and 95% CI in patients with mild, moderate, and severe periodontitis were 4.46 (0.94-21.06), 5.16 (1.14-23.39), and 6.65 (1.51-29.36), respectively. The HR (95% CI) was 1.05 (1.01-1.09) for tooth loss after controlling for potential confounding factors. All the increases in risk persisted in patients aged ≥80 years. CONCLUSION: The present study provides substantial evidence that poor periodontal health is associated with oral cancer mortality. It is necessary to underline the importance of considering periodontitis in the prevention of oral cancer, particularly in the older patients.

Association between incidence of fatal intracerebral hemorrhagic stroke and fine particulate air pollution.

OBJECTIVE: Few studies investigating associations between fine particulate air pollution and hemorrhagic stroke have considered subtypes. Additionally, less is known about the modification of such association by factors measured at the individual level. We aimed to investigate the risk of fatal intracerebral hemorrhage (ICH) incidence in case of PM2.5 (particles ≤ 2.5 µm in aerodynamic diameter) exposure. METHODS: Data on incidence of fatal ICH from 1 June 2012 to 31 May 2014 were extracted from the acute stroke mortality database in Shanghai Municipal Center for Disease Control and Prevention (SCDC). We used the time-stratified case-crossover approach to assess the association between daily concentrations of PM2.5 and fatal ICH incidence in Shanghai, China. RESULTS: A total of 5286 fatal ICH cases occurred during our study period. The averaged concentration of PM2.5 was 77.45 µg/m3. The incidence of fatal ICH was significantly associated with PM2.5 concentration. Substantial differences were observed among subjects with diabetes compared with those without; following the increase of PM2.5 in lag2, the OR (95% CI) for subjects with diabetes was 1.26 (1.09-1.46) versus 1.05 (0.98-1.12) for those without. We did not find evidence of effect modification by hypertension and cigarette smoking. CONCLUSIONS: Fatal ICH incidence was associated with PM2.5 exposure. Our results also suggested that diabetes may increase the risk for ICH incidence in relation to PM2.5.

Course of the mandibular canal in hemifacial microsomia: a retrospective computed tomography study.

OBJECTIVE: The aim of this study was to evaluate the anatomic course of the mandibular canal in patients with hemifacial microsomia (HM). STUDY DESIGN: In this retrospective study, 77 patients were included and stratified according to the Pruzansky-Kaban classification. The mandibular canal and the mandible were reconstructed on the basis of computed tomography data. The entrance, route, and exit of the mandibular canal (representing the entrance, route, and exit of the inferior alveolar nerve [IAN], respectively), and the antilingula were analyzed in different types of mandibular deformities in patients with HM. RESULTS: No significant difference in the course of the mandibular canal was detected between the affected and unaffected sides in patients with type I and type IIa HM. Abnormalities were observed in some patients with type IIb and type III HM. Significant differences were found between patients with type IIb and type III HM in the entrance (P = .015) and route (P = .001) of the canals. The antilingula was identified only in patients with type IIb and type III HM and was more common in patients with type III HM than in those with type IIb HM. CONCLUSIONS: Variation of the anatomic course of mandibular canal exists in patients with Pruzansky-Kaban type IIb and type III HM. Evaluation of the course of the canal in patients with HM is recommended before surgical intervention to avoid IAN damage.

Impact of long-term soft contact lens wear on epithelial flap production and postoperative recovery in laser-assisted subepithelial keratomileusis.

PURPOSE: To investigate the impact and postoperative clinical recovery of long-term soft contact lens wear on the epithelial flap made during laser-assisted subepithelial keratomileusis (LASEK). METHODS: In a prospective study, 371 patients (589 eyes) who underwent LASEK were divided into four groups (G1, G2, G3, G4) according to their length of soft contact lens wear. After the contact lens (CL) was removed 1 week after surgery, various symptoms - uncorrected visual acuity (UCVA), oedema of the corneal epithelium, spherical equivalent (SE) and haze degree - were recorded on day 1, and at 1 and 3 months postoperatively. RESULTS: There were no significant differences in corneal flap production among the first three groups that wore CLs, but various symptoms and UCVA were all different from the fourth group that did not wear CLs. There were statistically significant differences in oedema of corneal epithelium among the first three groups, and the degree of oedema was positively correlated with the CL wearing time. There were no significant differences in postoperative SE and haze in all four groups. CONCLUSIONS: Long-term soft CL wear can affect production of the epithelial flap and postoperative recovery, including various symptoms, oedema of the central corneal epithelium and visual acuity. In contrast, there was no effect of long-term CL wear on postoperative mean refractive spherical equivalent (MRSE) and haze.

Meta-analysis of methylprednisolone pulse therapy for Graves' ophthalmopathy.

A meta-analysis was performed to evaluate the efficacy of methylprednisolone pulse therapy for Graves' ophthalmopathy. Eight studies involving 376 patients were included. A higher effective rate was found for patients treated with intravenous glucocorticoids (IVGC) over oral glucocorticoids (OGC) (risk ratio [RR] = 1.48; 95% confidence interval [CI] = 1.18-1.86). The combined IVGC and orbital radiotherapy (OR) was markedly more effective than OGC+OR (RR = 1.40; 95% CI = 1.11-1.77). IVGC resulted in an obvious reduction of clinical activity score (CAS) compared with OGC, with a weighted mean difference (WMD) of 0.86 (95% CI = 0.53-1.18). The WMD for the reduction of the CAS between IVGC+OR and OGC+OR was 0.66 (95% CI = 0.30-1.02). IVGC is an effective treatment and cause fewer adverse events. Limiting the total cumulative dose of methylprednisolone, careful patient selection and monitoring the condition of patients during treatment are necessary.

The efficacy and safety of modified Snyder-Thompson posterior scleral reinforcement in extensive high myopia of Chinese children.

BACKGROUND: To observe the efficacy and safety of modified Snyder-Thompson posterior scleral reinforcement in extensive high myopia of Chinese children. We had a retrospective design, and included a control group of children with natural progression of high myopia. METHODS: This study included 64 eyes in 41 Chinese children with extensive high myopia who underwent modified Snyder-Thompson posterior scleral reinforcement surgery (PSR group), and 17 eyes in 11 age- and myopia-matched children who wore spectacles (control group). The mean follow-up was 4.99 ± 1.3 years in the PSR group and 4.48 ± 1.3 years in the control group. Axial length, spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and fundus examinations were recorded before and after treatment, and complications were noted. RESULTS: The mean change in SE at the end of the follow-up period was 1.5 ± 1.44 diopters (D) and 3.02 ± 1.57D in the PSR and control groups respectively. These changes were equivalent to an increase in axial length of 1.27 ± 0.54 mm and 2.05 ± 0.91 mm respectively. The PSR group showed less myopic progression and less eye elongation (p < 0.001). A notable increase in UCVA was only found in the PSR group (p = 0.0001). The improvement in BCVA was significantly greater in the PSR group (p = 0.0354). There were no serious complications of PSR surgery. CONCLUSION: The modified Snyder-Thompson PSR surgery was effective and safe in controlling extensive high myopia of Chinese children.

Clinic study on silicone hydrogel contact lenses used as bandage contact lenses after LASEK surgery.

AIM: To compare the clinical performance of two types of silicon hydrogel contact lenses used as bandage lenses after LASEK surgery. METHODS: A prospective, double-masked study was conducted on 42 eyes of 21 patients who received binocular LASEK surgeries. The interocular difference in spherical equivalent power was less than -1.50D. Patients were randomly assigned to wear Galyfilcon A (Lens A) bandage contact lens in one eye and Balafilcon A (Lens B) in the fellow eye after the surgery. The responses to a subjective questionnaire on comfort of wearing, corneal epithelial status, conjunctival hyperemia, limbal neovascularization, lens fitting and contact lens debris were assessed 1 and 5 days postoperatively. Corneal endothelium was assessed before and 5 days after the surgery upon bandage lens removal. RESULTS: There was no difference between the two groups in terms of conjunctival hyperemia, limbal neovascularization, contact lens fitting, corneal epithelial status, corneal endothelium cell density (CD) and endothelium cell size (CS) at any postoperative visit. Complaints of discomfort, including foreign body sensation, pain and intolerance were statistically more among Lens B wearers at any postoperative visit (P<0.05). Lens B appeared to attract much more debris than Lens A at the 5-day post-operative follow-up visit (P<0.01). CONCLUSION: The two types of silicon hydrogel lenses investigated in this study demonstrated similar clinical performance in terms of corneal responses and lens fitting. However, Lens A showed a better performance in terms of comfort of wearing and deposit resistance.