RESUMO
Background: The zygomaticomaxillary complex (ZMC) functions as the main buttress for the lateral portion of the middle third of the facial skeleton and because of its prominent position & convex shape, it is frequently fractured, alone or along with other bones of the midface. The management of the ZMC fractures is debatable as the literature is saturated with various theories. A number of techniques, from closed reduction to open reduction and internal fixation can be effectively used to manage these fractures. Controversies lie right from the amount of fixation (mostly 2-, 3-point fixation) required to the ideal approach, and there is no conclusive view on its ideal line of management. Aim: To systematically review the existing scientific literature to determine whether two-point or three-point fixation is a better treatment alternative for the patients with zygomaticomaxillary fractures through a meta-analysis. Methods: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, Google scholar and Ebsco Host were searched from January 2000 to November 2023 for studies reporting treatment of zygomaticomaxillary fractures through two-point and three-point fixation and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included was evaluated using Cochrane risk of bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value < 0.05 as statistically significant. Results: Eleven studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only eight studies were suitable for meta-analysis. The pooled estimate through the standardized mean difference (SMD) of - 0.21 (- 0.83-0.41) favors two-point fixation employing random effect model with I2 (heterogeneity) value of 89% and p value 0.51. Publication bias through the funnel plot showed asymmetric distribution with systematic heterogeneity. Conclusion: In our systematic review, we aimed to evaluate which method of fixation is more effective in the treatment of zygomaticomaxillary complex fractures. Our pooled estimate using quantitative synthesis indicates that both two- and three-point fixation procedures are equally effective in the treatment of zygomaticomaxillary fractures. As a result, two-point fixation is as efficient as three-point fixation in treating zygomaticomaxillary complex fractures.
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Background: Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial. Aim: The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis. Methods: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle-Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant. Results: Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias. Conclusion: The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.
RESUMO
BACKGROUND: The COVID-19 pandemic has created an unprecedented situation which the treatment of maxillofacial trauma, especially mandibular fractures that were previously managed using general anaesthesia had to be performed under local anaesthesia. In these cases, there was a requirement for an anaesthetic agent that would have a rapid onset but also provide a prolonged effect. The aim of the study was to evaluate the onset, duration, depth, required volume of anaesthesia of lidocaine with epinephrine versus combination of lidocaine and bupivacaine with epinephrine anaesthetic agents in surgical management of isolated mandibular fracture patients. METHODS: A total of 30 patients with isolated mandibular fractures reported to our hospital included the study group. Patients were randomly distributed to two groups, Group A and Group B. Group A received local anaesthesia using 2% Lidocaine with 1:80,000 adrenaline and Group B received 0.5% Bupivacaine with 1:2,00,000 adrenaline combined with 2% Lidocaine with 1:80,000 adrenaline at a ratio of 1:1. The outcome variables were recorded and the data was tabulated and analysed using un-paired students t test. RESULTS: The combination of anaesthetic agents had longer duration of action (mean: 182.47 min, P-value: 0.001) and required lesser volume of anaesthetic solutions (mean: 5.38 mL, P-value: 0.001) as compared to usage of lidocaine alone. Although combination group showed quicker onset (mean: 4 min 8 s), the result was insignificant (p-value: 0.345). CONCLUSION: The study found that the combination of lidocaine and bupivacaine could serve as a potential anaesthetic cocktail in effective surgical management of isolated mandibular fractures. CLINICAL RELEVANCE: Maxillofacial injuries can be managed efficiently under local anaesthesia using combination of lidocaine and bupivacaine.
Assuntos
Lidocaína , Fraturas Mandibulares , Humanos , Anestésicos Locais , Bupivacaína , Método Duplo-Cego , Epinefrina , PandemiasRESUMO
Aim: To systematically review the existing scientific literature, to summarize and assess the efficacy of the nasal floor augmentation on the survival rate of dental implants by systematically reviewing the available literature. Methodology: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO-CRD42027289143. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting efficacy of nasal floor augmentation and reporting outcomes in terms of survival rates of dental implants. Quality assessment of included comparative follow-up studies was done using the critical checklist put forward by the Joanna Briggs Institute (JBI) was used. Results: Only nine studies fulfilled the eligibility criteria and were included in the qualitative synthesis. Of those nine studies, five were case reports and four comparative follow-up studies. A total of 14 implants were placed in five patients with a survival rate of 100% in included case reports, while a total of 408 implants were placed in 130 patients with survival rates ranging from 89% to 100% in included comparative follow-up studies. No complications were observed during follow-ups, and the patients were satisfied with the functional and aesthetic results of the treatment. Quality assessment of included studies showed moderate to low risk of bias with overall high quality of studies. Conclusion: The results of this systematic review indicate that implant placement by nasal floor augmentation techniques can be considered as a predictable treatment modality. However, due to the scarcity of literature, more studies should be carried out on proving the efficacy of nasal floor augmentation on survival rate or success of dental Implants.
RESUMO
Purpose: The aim of the study is to compare the functional and esthetic results of two lip splitting approaches-McGregor incision and stepladder Z plasty for surgical resection of primary Oral Squamous cell carcinoma (OSCC). Method: Prospective study involved 24 patients who had modified radical neck dissection for OSCC between 2018 and 2020. Predictor variables were drawn from demographic characteristics (age and gender), primary site, extent of the primary lesion. Patients were divided into two groups randomly with group I McGregor lip splitting incision and group II step ladder Z plasty, with subjective and objective assessment. Results: In the overall comparison of the oral incontinence between the two groups, there was no statistically significant results. Z plasty group had better outcome with lesser degree of drooling and good cosmesis. There was no difference between the speech efficiency between the two groups. Subjective assessment of the appearance of lips and face was better in Z plasty group. Subjective assessment of inversion and eversion was better in McGregor group. Cosmesis was assessed objectively by Stony Brook Scar Evaluation Scale (SBSES). Group 1 had a mean score of 2.92 out of 5 and Group II mean score of 4.08 out of 5. Cosmesis was better in Z plasty group. Conclusion: Z plasty was found as a superior option when it comes to cosmesis due to its geometric nature which allows accurate approximation. McGregor offers better functional outcome in terms of lip movement and oral incontinence.