The incidence and patterns of maxillofacial fractures and associated head and neck injuries.

The aim of this study was to evaluate the incidence and patterns of maxillofacial fractures and the demographic characteristics of associated head and neck injuries. This single-center retrospective cohort study was conducted at the Department of Oral and Maxillofacial Surgery of King Abdullah University Hospital (KAUH) in Irbid, northern Jordan. The data was obtained from the electronic clinical records of all patients in whom maxillofacial fractures and associated head and neck injuries were confirmed. During the five-year period captured by this retrospective study, 481 patients with 1026 maxillofacial fractures (equivalent to 2.13 fractures per patient) were treated. The sample comprised of 369 (76.7%) males and 112 (23.3%) females, resulting in a male/female ratio of 3.3:1. Majority of the patients were in the 21-30 age group and RTA was the most common cause of maxillofacial fractures, accounting for 299 (62.1%) of the analyzed cases. In 316 cases, maxillary fractures were accompanied by associated injuries, 132 (41.77%) of which were intracranial lesions, 80 (25.32%) were skull fractures, and 59 (18.67%) were cervical spine injuries. Based on the obtained data, it can be concluded that the high occurrence of RTA emphasizes the significance of adhering to traffic laws and regulations, as individuals who have suffered serious head and neck injuries as a result of maxillofacial trauma may experience potentially fatal consequences. Thus, management for patients with maxillofacial fractures and concomitant traumas should be multidisciplinary and coordinated.

The pattern of orbital walls fractures in north of Jordan.

Background: The aim of this study was to examine the incidence and demographic characteristics of patients with orbital walls fractures who were treated in the department of oral and maxillofacial surgery of a tertiary hospital in Jordan. Material and Methods: A retrospective cohort study of patients with a diagnosis of with selected orbital walls fracture was designed and implemented, during a two-year period between January 2020 and December 2021. Information on patients treated for orbital walls fractures were retrieved and analyzed regarding age, sex, etiology, anatomical site, and treatment modality. Descriptive data presented as simple frequencies and percentages. Results: A total of 76 patients with 100 orbital wall fractures, age range was 4-68 years old with a mean age 28 (SD±12), of whom were 53 (69.7%) were male and 23(30.3%) were female, with male:female ratio was 2:1. The most common etiology of all orbital walls fractures was RTA in 47 patients (61.8%; P ≤0.021), followed by violence in male patients. The most prevalent age-group was 21-30 years old with 16 patients (21.05%; P ≤0.235), and single orbital wall fractures 56 (56%) were more common than combined orbital wall fractures. Conclusions: In conclusion, this study will contribute to identifying the best clinical therapy and protective techniques for individuals with orbital fractures. Key words:Orbital fracture, Etiology, Orbital trauma, Road traffic accidents, Trauma.

The Pattern of Midface Fractures in Jordan: A Retrospective Review of Medical Records.

Introduction: Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018-2021. Methods: This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021. Results: During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures. Conclusions: Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality.

The effect of modified surgical flap design for removal of lower third molars on lingual nerve injury.

AIM: The objective of this study was to evaluate a modified flap design for removal of lower third molars with avoidance of lingual flap elevation and its effect on postsurgical lingual nerve sensory impairment. MATERIALS AND METHODS: The patients included in this prospective study were those referred for removal of symptomatic lower third molars at two Oral and Maxillofacial Surgery clinics. Different patterns of impaction were included regarding the angulation and depth of the lower third molar. Patients were reviewed 1 day after surgery, then after 1 week. Each patient was examined at each recall visit for any sensory alterations of the lingual nerve. The data collected was correlated to several variables including the age, gender, side of operation, state of eruption, angulation, depth of impaction, and tooth division. RESULTS: A number of 53 patients (23 males and 30 females), at ages ranging from 16 to 43 years, underwent surgical removal of 66 fully or partially impacted lower third molars under local anesthesia using a modified flap design. The modified flap design provided adequate exposure for removal of the lower third molar for all patterns of impactions included, regarding the state of eruption, angulation, and depth of the tooth. CONCLUSION: This study showed that the investigated flap design can be safely used to remove lower third molars for different patterns of impaction without jeopardizing the lingual tissues thus providing optimum protection for the lingual nerve since it provided adequate exposure to remove the tooth without the reflection of a lingual flap.

Extraction of Maxillary Teeth Using Articaine Without a Palatal Injection: A Comparison Between the Anterior and Posterior Regions of the Maxilla.

PURPOSE: The injection of a local anesthetic before tooth extraction is always associated with pain, and palatal anesthesia is the most painful type of injection for the patient. The specific aims of the study were to evaluate "pain control" using 4% articaine without palatal injection and to compare adequate anesthesia and pain control in the anterior and posterior regions of the maxilla. MATERIALS AND METHODS: This prospective controlled study followed a split-mouth protocol, in which patients served as their own control. Forty-eight patients who needed routine extraction of permanent maxillary anterior and posterior teeth were referred. After an injection of 4% articaine and a 5-minute wait, 1 posterior tooth and 1 anterior tooth were extracted using standard techniques. The patient's perception of pain was assessed using a visual analog scale and a verbal rating scale after each injection and extraction. Statistical analysis consisted of descriptive statistics, paired-sample t test, and independent-samples t test to determine whether differences were statistically significant (P < .05). RESULTS: In total, 48 anterior and 48 posterior teeth were extracted from 48 patients. Extraction of maxillary teeth was possible without an additional palatal injection for 87 teeth (90.6%), whereas only 9 teeth (9.4%) needed an additional palatal injection to complete the extraction. Of the total number of patients, 90% reported that the pain caused by tooth extraction in the anterior and posterior regions of the maxilla was mild. None of the patients rated the pain of extraction in the maxilla as severe. CONCLUSION: There was no difference in pain perception when extracting anterior and posterior teeth. Of the total number of teeth, 90.6% were extracted without the need for palatal injection. In this study, extraction of erupted maxillary teeth using 4% articaine without manipulation of the palatal mucosa obviated palatal infiltration during extraction. Articaine anesthesia provides adequate palatal anesthesia for maxillary teeth extraction in the anterior and posterior regions without the need for a palatal block.

Pathology associated with impacted mandibular third molars in a group of Jordanians.

PURPOSE: The aim of this study was to determine the frequency and type of a group of radiographically detectable pathologic conditions around impacted mandibular third molars in Jordanians. PATIENTS AND METHODS: A retrospective study of patients referred to the Oral and Maxillofacial Surgery unit for surgical removal of impacted mandibular molars. The analysis outcome measures were the patients' age and gender, and any radiographic lesions associated with the impacted mandibular third molars. The following radiographic lesions were recorded in relation to the impacted third molar: caries, pericoronal radiolucent areas, and periapical radiolucent areas, in addition to odontomes, caries in the adjacent second molars, and external resorption of the roots of adjacent mandibular second molars. Bony radiolucent areas were all verified histopathologically. RESULTS: Impacted mandibular third molars (N = 2,432) from 1,398 patients were examined; 46.4% of third molars showed associated radiographically detected lesions. The most common lesion seen on panoramic radiographs was dental caries. Others included pericoronal radiolucent and periapical radiolucent areas. The majority of periapical radiolucent areas were histologically proven to be chronic periapical inflammation. All pericoronal radiolucent areas were histologically found to be either cysts or tumors. The most common cyst was dentigerous cyst; the most common tumor was ameloblastoma. CONCLUSION: A high ratio of impacted mandibular third molars in this group of Jordanians had an associated pathologic lesion.

Mandibular fractures in Jordanians: a comparative study between young and adult patients.

BACKGROUND: There are very few reports directly comparing mandibular fractures between young and adult patients in Middle Eastern countries. AIM: To review and compare the frequency and aetiology of mandibular fractures in young and adult Jordanian patients. STUDY DESIGN: A retrospective review was made of patients' records and radiographs seen at two university-based maxillofacial units during a 10-year period between 1993 and 2002. Age, gender, aetiology, and site were analysed and compared between young and adult patients. RESULTS: In total, 703 patients (502 (71%) male and 201 (29%) female) were found with 892 mandibular fractures altogether. There were 497 (71%) adults with 676 fractures, and 206 (29%) young patients with 216 fractures. The mean age of the adults was 30 years with a male-to-female ratio of 2.5:1. The mean age of the young patients was 13 years with a male-to-female ratio of 1.5:1. The most common fracture site in adult patients was the mandibular body, whereas the condyle predominated in young patients. The most common causative factor in adults was road traffic accidents, and falls in the young. CONCLUSION: There was a similar gender distribution in both groups of Jordanian young and adult patients. However, there were differences regarding aetiology and site of fracture. The differences found in this study between adult and young patients are similar to those from other countries.

The prevalence of inflammatory and developmental odontogenic cysts in a Jordanian population: a clinicopathologic study.

OBJECTIVE: To determine the prevalence of odontogenic jaw cysts in a Jordanian population and to compare these data with previously published reports from other geographic areas. METHOD AND MATERIALS: The files on odontogenic jaw cysts treated between 1989 and 2001 in the Oral and Maxillofacial Pathology Diagnosis Service at the Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, were reviewed. Clinical and radiographic data were recorded and microscopic slides evaluated according to the most recent World Health Organization classification. Cases were analyzed with regard to age, sex, and anatomic site. RESULTS: A diagnosis of odontogenic jaw cyst was established in 654 patients, with a male-to-female ratio of 1.7:1. Radicular cyst was the most common type of odontogenic cyst found (41.7%), followed by dentigerous cysts (24.8%). The peak age affected was between the third and fifth decades. Both jaws were almost equally affected. The most common anatomic site of incidence was the maxillary incisor/canine region, followed by the mandibular molar region. CONCLUSION: This study indicates that there are some geographic differences with regard to the relative frequency, sex, and anatomic distributions of odontogenic cysts.

The predisposing factors of pericoronitis of mandibular third molars in a Jordanian population.

OBJECTIVES: The purpose of this study was to identify the most frequently encountered predisposing factors in relation to the etiology of pericoronitis in young adults and to compare these findings with similar studies. METHOD AND MATERIALS: The patients included in this prospective study were those presenting for treatment of signs and symptoms of pericoronitis in the mandibular third molar area during an 8-year period from 1994 to 2001. A standard check sheet of subjective and objective observations was completed, and female patients were asked about menstruation or pregnancy. Each patient with a diagnosis of pericoronitis was interviewed and observations were recorded. Patients were asked about the symptoms relating to the pericoronitis. Patients were divided into five 5-year age groups ranging from 16 to 40 years. RESULTS: During the 8-year period, 2,151 patients presented diagnosed cases of pericoronitis; 932 (43.3%) patients were male and 1,219 (56.7%) were female. The peak age of occurrence of pericoronitis varied from 21 to 25 years (55.2% of the patients). The incidence of pericoronitis was highest in September (207 [9.6%]), followed by April (181 [8.4%]); for subacute pericoronitis, the highest was in February (128 [5.95%]) and April (112 [5.2%]), followed by October (97 [4.5%]). The most frequently seen predisposing factor was upper respiratory tract infection in 815 (37.9%) patients, followed by stress in 473 (22%) patients. CONCLUSION: It was concluded that the upper respiratory tract infection was the most frequently predisposing factor, which could precipitate pericoronitis.

The surgical removal of mandibular third molars: a study in decision making.

OBJECTIVE: The aim of this study was to investigate and analyze the angulation of and the various indications for removal of mandibular third molars in Jordanians as a representative Arab sample. METHOD AND MATERIALS: The data included in this retrospective study were obtained from the clinical and radiographic records of 1,282 patients undergoing mandibular third molar surgery during a 5-year period from 1994 to 1999. The indications for removal of the mandibular third molars were classified in accordance with age and gender. The angular position of mandibular third molars was registered. RESULTS: A total of 2,252 mandibular third molars were removed from 740 male patients (57.7%) and 542 female patients (42.3%) aged 14 to 67 years. Pericoronitis was the most common indication for surgery, affecting 1,055 teeth (46.8%). Caries was observed in 519 third molars (23.0%). The vertical angular position was most commonly found (1,383 teeth; 61.4%) followed by the mesioangular position (407 teeth; 18.1%). CONCLUSION: The results obtained in this study are similar to those reported in earlier studies carried out elsewhere, although the incidence of periodontitis among Jordanians was significantly higher and occurred in older patients, and prophylactic removal was performed less frequently than has been reported in other countries.

A retrospective study of selected oral and maxillofacial fractures in a group of Jordanian children.

Objective. The purpose of this study was to review the etiology, incidence, and treatment of selected oral and maxillofacial fractures in children in Jordan. Study Design. This retrospective review of patient records and radiographs was conducted during the 5-year period between 1996 and 2001. Age, gender, etiology, anatomic site, and treatment methods were reviewed. Results. During the 5-year period, 227 patients with 274 maxillofacial fractures were treated. The age range was from 1 to 15 years (mean age, 11.2 years). Of the patients, 70% were male, with the peak incidence rate occurring in the 10-year-old to 12-year-old age group. The mandible was the most frequent bone of fracture, with 169 cases (74.5%), followed by the alveolar process in 28 cases (12.3%), the maxilla in 27 cases (11.9%), and the zygomatic complex in 3 cases (1.3%). Of the fractures, 52% were from accidental falls, 20% from road traffic accidents, 17% from assaults, 8% from sport injuries, and 3% from other causes, such as horse kick. Most patients (82.3%) were treated with closed reduction (45.2% with eyelet wiring and 54.8% with arch bars and intermaxillary fixation). Only 17.7% of patients were treated with open reduction and fixation. All maxillary fractures were treated with orbital and circumzygomatic suspension with interdental wiring and intermaxillary fixation. The 3 cases of zygomatic complex fractures were kept under observation without the necessity of surgical intervention. Conclusion. Accidental falls were found to be the leading cause of maxillofacial fractures in our environment, and males were 3 times more affected than females.

The surgical treatment of central giant cell granuloma of the mandible.

PURPOSE: The objective of this study was to report and evaluate our experience in the surgical treatment of mandibular central giant cell granuloma by resection without continuity defect and peripheral ostectomy. METHODS: A retrospective analysis was conducted of patients with central giant cell granuloma of the mandible who were treated between 1991 and 2000, in the Oral and Maxillofacial Surgery Unit at Jordan University of Science and Technology. A uniform surgical technique was used in all cases. The compact bone composed of the lower border of the mandible and/or posterior border of the ascending ramus, together with the nutrient periosteum attached to it, was preserved. All soft tissues in contact with or overlying the lesion and a margin of cancellous bone related to the lesion were excised. All patients were reviewed annually for a follow-up period of 1 to 9 years (mean, 3.9 years). RESULTS: Eighteen patients with central giant cell granuloma were included, (9 males and 9 females). Their age ranged from 10 to 46 years, with 89% younger than 40 years. Five (28%) lesions were in the incisor-canine region, 2 (11%) were confined to the premolar region, 4 (22%) were in the premolar-molar region, and 7 (39%) were in the molar-ramus region. All patients had aggressive central giant cell granulomas with pain, tooth mobility, and rapidly enlarging swelling. The initial diameter of lesions ranged from 2.7 to 10 cm. During the follow-up period, there was 1 case of recurrence, 2 (11%) patients had permanent lower lip paraesthesia, and no patient had obvious facial deformity. CONCLUSION: Our results suggest that resection without a continuity defect and peripheral ostectomy is a satisfactory method in the treatment of central giant cell granuloma of the mandible, with no or a very low recurrence rate and favorable postoperative function.

Rhabdomyosarcoma of the oral and maxillofacial region in Jordanians: a retrospective analysis.

OBJECTIVE: The objective was to study the clinicopathologic features of rhabdomyosarcoma (RMS) of the oral and maxillofacial region in Jordanians. STUDY DESIGN: Data were collected from records of patients treated between 1989 and 2000 at the Maxillofacial Unit of Jordan University of Science and Technology. The main outcome measures were age, gender, location, stage of disease, histopathologic type, treatment received, follow-up period, and eventual outcome. RESULTS: Nine patients with RMS aged 4 to 17 years were found, with a male to female ratio of 2:1. Six (67%) bony sites and 7 (78%) soft tissue sites were involved. The extent of disease was locoregional in 8 (89%) cases, nodal in 3 (33%) cases, and distant metastatic in 2 (22%) cases. The Intergroup Rhabdomyosarcoma Study classification of clinical groups was as follows: 2 (22%) cases in stage II, 5 (56%) cases in stage III, and 2 (22%) cases in stage IV. The histopathologic types found were 6 (67%) embryonal, 2 (22%) alveolar, and 1 (11%) undifferentiated. Triple agent chemotherapy was used in the treatment of 8 cases, singly or in combination with surgery or radiotherapy. Two patients are still alive, and 5 patients have died of disease. CONCLUSIONS: The clinicopathologic features of maxillofacial RMS in this group of Jordanians are different from those of people from other countries. Further studies are needed to have a better understanding of the behavior of RMS in the oral and maxillofacial area.

Surgical management of pleomorphic adenoma of the palate.

OBJECTIVES: The purpose of this article is to present an intraoral technique, which allows a wide local excision of pleomorphic adenoma of the palate with adequate mucosal and periosteal margins. STUDY DESIGN: Between September 1992 and May 1994 ten patients with pleomorphic adenoma of the palate were treated by one surgeon at the Oral and Maxillofacial Surgery Unit of the Jordan University of Science and Technology. A surgical technique, which was particularly useful for tumours extending into the soft palate, is described. RESULTS: Nine patients were aged between 15 and 25 years (mean age 20.1 years) and one patient was aged 50 years. Six of the patients were males. The tumour was removed from all ten patients by wide local excision with adequate margins, and after a follow-up period from 5 to 7 years (mean 6.3 years) there were no recurrences. CONCLUSION: This study has shown that wide local excision used for the treatment of pleomorphic adenoma of the palate is to be recommended. A close follow-up is necessary postoperatively.