Maxillofacial Trauma Patterns in Bare-Knuckle Fighting.

PURPOSE: The purpose of this study is to analyze patterns and trends of maxillofacial injuries in bare-knuckle fighting. Results comparisons with other combat sports are provided in the Discussion section. MATERIALS AND METHODS: The study design is a retrospective cohort study. Data were collected by a single ringside physician who participated in all bouts. Predictor variables were number of rounds and final fight result (ie, knockout, technical knockout, and decision). The primary outcome variable was the frequency of maxillofacial injury, and secondary outcome variables were type of injury (laceration/fracture) and traumatic brain injury. The chi-square test was used to determine if there was any statistical significance between the predictor variables. RESULTS: Study sample consisted in fighters who suffered maxillofacial injuries during the matches from June 2018 to March 2022 (n = 177). A total of 177 fighters sustained maxillofacial trauma in 301 matches, and a total of 211 maxillofacial injuries were identified. Of the 211 injuries, 184 were lacerations and 27 were fractures. Proportionally more injuries occurred in matches that lasted 5 rounds (33%), and a significant association was found between the number of rounds fought and the frequency of injury (P < .00001). From a total of 107 technical knockouts, 74% of them caused at least 1 injury; from 96 knockouts, 60% caused at least 1 injury; and from 89 fights that ended in decision, 83% of them caused at least 1 injury. A statistically significant association was found between final fight result and frequency of injury (P < .00001). P value less than 0.05 (95% confidence interval) was considered statistically significant. CONCLUSIONS: Maxillofacial injuries were predominantly associated with longer fights and fights which result were knockout/technical knockout. Traumatic brain injury was associated with knockout results, which mostly occurred in the first and second rounds.

Atrophic Mandible Fractures: Are Bone Grafts Necessary? An Update.

PURPOSE: The management of atrophic mandibular fractures poses a challenge because of anatomic variations and medical comorbidities associated with elderly patients. The purpose of this article is to review and update the literature regarding the management of atrophic mandible fractures using load-bearing reconstruction plates placed without bone grafts. MATERIALS AND METHODS: We performed a review of the English-language literature looking for atrophic mandibular fractures with or without continuity defects and reconstruction without bone grafts. Included are 2 new patients from our institution who presented with fractures of their atrophic mandibles and had continuity defects and infections. Both patients underwent reconstruction with a combination of a reconstruction plate, recombinant human bone morphogenetic protein 2, and tricalcium phosphate. This study was approved as an "exempt study" by the Institutional Review Board at the University of Kentucky. This investigation observed the Declaration of Helsinki on medical protocol and ethics. RESULTS: Currently, the standard of care to manage atrophic mandibular fractures with or without a continuity defect is a combination of a reconstruction plate plus autogenous bone graft. However, there is a need for an alternative option for patients with substantial comorbidities. Bone morphogenetic proteins, with or without additional substances, appear to be a choice. In our experience, successful healing occurred in patients with a combination of a reconstruction plate, recombinant human bone morphogenetic protein 2, and tricalcium phosphate. CONCLUSIONS: Whereas primary reconstruction of atrophic mandibular fractures with reconstruction plates supplemented with autogenous bone graft is the standard of care, in selected cases in which multiple comorbidities may influence local and/or systemic outcomes, bone morphogenetic proteins and tricalcium phosphate can be used as a predictable alternative to autogenous grafts.

Decision making in third molar surgery: a survey of Brazilian oral and maxillofacial surgeons.

This study was designed to evaluate the variations in decision making among Brazilian oral and maxillofacial surgeons (OMFS) and trainees in relation to third molar surgery. A survey on 18 diverse clinical situations related to the assessment and treatment of the third molar surgeries was conducted during the 20th Brazilian National OMFS meeting. Participants were divided into three groups according to their level of training. Another variable studied was length of experience. Correlation between the question answers and the variables was analysed using the chi-square test and the f test. The mean age of participants was 32.68 years, and their mean length of experience was 5.24 years. There were no statistical differences between the level of training and number of years of experience and the responses to 15 of the 18 questions on clinical situations. However, differences were found in responses to prophylactic extraction of asymptomatic third molars, use of non-steriodal anti-inflammatory drugs (NSAIDs) during the preoperative surgical period and the use of additional imaging to plan extractions. The group with shorter time of experience (3.8 ± 3.94 years) tended to recommend extractions of asymptomatic third molars more frequently compared with the more experienced surgeons (P = 0.041). More experienced surgeons used NSAIDs in the preoperative surgical period, whereas the majority of the youngest surgeons (4.1 ± 5.96 years of experience) did not (P = 0.0042). The certificated trained and in practice group tended to treat deep lower third molar impactions based on the findings of a panoramic radiograph, without obtaining additional imaging [cone beam computed tomography (CBCT)] before treatment (P = 0.0132). Decision making regarding third molar treatment differs according to the level of training and is influenced by the number of years of experience. Therefore, further continuous education programmes in this area are warranted to make recommendations regarding third molars consistent with the current literature.

Oral rehabilitation of severe dentoalveolar trauma: a clinical report.

This clinical report describes the oral rehabilitation of an adult male who suffered severe dentoalveolar trauma as a result of a motor vehicle accident. The specific objectives of this treatment were to restore esthetics and masticatory function. Treatment included removal of fractured roots, placement of multiple endosseous implants, and placement of anterior and posterior metal-ceramic crowns and fixed partial dentures. Three year clinical examination revealed no pathology associated with the rehabilitation. The patient's esthetic and functional expectations were successfully achieved.

Dental Trauma and Alveolar Fractures.

A dentoalveolar fracture requires thorough clinical and radiographic examination for an accurate diagnosis to guide appropriate treatment. Dentoalveolar fractures can be classified into the following 4 groups: (1) crown/root fractures, (2) luxation/displacement of teeth, (3) avulsion, and (4) alveolar fractures. Treatment can be divided into nonrigid fixation (splinting with wires and composite) and/or rigid fixation (Erich arch bars, Risdon cable wires) depending on the extent of dentoalveolar fractures. Special considerations must be made for primary teeth and mixed dentition to avoid injuring tooth buds and arising permanent dentition.

Certification by the American Board of Oral and Maxillofacial Surgery: Residency to Retirement.

The American Board of Oral and Maxillofacial Surgery (ABOMS) has been serving the specialty since 1946. The ABOMS frequently reviews its strategic plan, mission, and vision. The board administers 4 examinations (the Oral and Maxillofacial Surgery In-service Training Examination, the Qualifying Examination, the Oral Certifying Examination, and Certificates of Added Qualifications in Head and Neck Oncologic and Reconstructive Surgery and Pediatric Craniomaxillofacial Surgery) and also oversees the Certification Maintenance process for diplomates. The members of the Examination Committee and directors are volunteers who create, validate, and deliver examination content for the various examinations by the ABOMS.

Historical evolution of surgical approaches to the face-part III: lower face.

Surgical approaches to the head and maxillofacial area have been described and modified by many authors throughout history. It was, however, during the nineteenth and twentieth centuries when most of the techniques were described, mainly thanks to the advent of anesthesia and antibiotic therapy. Currently, a myriad of surgical techniques are employed to access the maxillofacial complex, with each of them having advantages and disadvantages. Although the approaches are the subject of textbooks and articles, most do not describe the circumstances or the historical context under which they were designed. In a series of three articles, we will provide a historical perspective of the most common surgical approaches to the head and face employed today. Descriptions contain advantages and disadvantages and modifications are provided. The purpose of the present article (3/3) is to review the approaches to the lower face.

Historical evolution of surgical approaches to the face-part I: head and upper face.

Surgical approaches to the head and maxillofacial area have been described and modified by many authors throughout history. It was, however, during the nineteenth and twentieth centuries due in large part to improvements in the delivery of anesthesia and antibiotic therapy when most of the techniques were described. Currently, a myriad of surgical techniques are employed to access the maxillofacial complex with advantages and disadvantages for each one. Although each approach is described in many text and articles, few describe the circumstances or the historical context under which they were designed. In a series of three articles, a historical perspective will be provided on the evolution of some of the most commonly employed today. Descriptions will enumerate the advantages and disadvantages of as well as later modifications. The purpose of the present article (1/3) is to review the approaches to the head and upper face.

Historical evolution of surgical approaches to the face-part II: midface.

Surgical approaches to the head and maxillofacial area have been described and modified by multiple authors throughout history. It was during nineteenth and twentieth century when most of the techniques evolved due to advances in anesthesia and antibiotic therapy. Currently, a myriad of surgical approaches are employed to gain access to the maxillofacial complex, with each of them having advantages and disadvantages. Although the approaches are presented in numerous textbooks and articles, few texts describe the circumstances or historical context under which they were developed. In a series of three articles, we will provide a historical perspective of the evolution of the most common surgical approaches to the head and face employed today. Descriptions contain advantages and disadvantages of the approaches and modifications are also provided. The purpose of the present article (2/3) is to review the approaches to the midface.

Management of facial soft tissue injuries in children.

Pediatric facial trauma can present a challenge to even the more experienced plastic surgeon. Injuries to the head and neck may involve bone and soft tissues with an assortment of specialized organs and tissue elements involved. Because of the active nature of children, facial soft tissue injuries can be diverse and extensive as well as some of the more common injuries a plastic surgeon is asked to treat. In 2007, approximately 800,000 patients younger than 15 years presented to emergency departments around the country with significant open wounds of the head that required treatment.In this review, we present the different types and regions of pediatric soft tissue facial trauma, as well as treatment options and goals of plastic surgery wound management. Special aspects, such as bite wounds, burns, pediatric analgesia, and antibiotic therapy, are also discussed.

Third molar surgery: Past, present, and the future.

Third molar surgery is the most common ambulatory procedure done by oral and maxillofacial surgeons. Surgical approaches for the removal of third molars have been published since the 20th century. This article reviews the history and development of extraction techniques through a literature review. The literature was selected through a search of an electronic database. Key words for the Medline search were "mandibular/maxillary third molar," "impacted mandibular/maxillary third molar," "mandibular/maxillary third molar flap design," and "mandibular/maxillary third molar incision." The search was restricted to English-language articles. Additionally, a manual search in the major oral surgery journals and books was performed. The aim of this article is to examine the evolution of third molar surgery, recognize pioneering techniques, and compare these techniques to current approaches. Common approaches employed today are discussed and treatment philosophies with thoughts for future therapies are provided.

Complications of frontal sinus fractures with emphasis on chronic craniofacial pain and its treatment: a review of 43 cases.

PURPOSE: Frontal sinus fractures constitute 5% to 12% of all facial fractures. The optimal management of frontal sinus fractures is controversial but involves preserving the function of the nasofrontal ducts when feasible. We reviewed the postoperative complications of a series of 43 patients treated surgically for frontal sinus fractures. MATERIALS AND METHODS: The data from 43 patients treated from 2000 to 2006 were reviewed. The information reviewed included patient age and gender, mechanism of injury, type of frontal sinus injury, associated facial injuries, treatment method, and complications. The institutional review board approved the present study. RESULTS: The average patient age was 32.5 years; 36 were men and 7 were women. Of the 43 patients, 23 (53.5%) had had anterior table fractures and 20 (46.5%) had had both anterior and posterior table fractures. Postoperative complications occurred in 7 patients (16.3%). Of these 7 patients, 2 experienced continued headache and pain and required surgical removal of infected hardware, 3 also experienced frequent headaches and pain in the frontal-temporal region, 1 had a post-traumatic deformity, and 1 developed periorbital cellulitis and abscess formation within the frontal sinus. CONCLUSION: Frequent headaches and complaints of continued pain were the most common complications experienced by our series of patients. We also reviewed treatment strategies for postoperative follow-up and treatment of chronic pain.

Oculocardiac reflex in an adult with a trapdoor orbital floor fracture: case report, literature review, and differential diagnosis.

Orbital floor blowout fractures can result in a variety of signs and symptoms depending on the severity of the bone defect. Large defects often result in enophthalmos and restriction of ocular movement; yet the timing of surgery can be delayed up to two weeks with good functional outcomes. In contrast, an orbital trapdoor defect with entrapment of the inferior rectus muscle usually elicits pain with marked restriction of the upward gaze and activation of the oculocardiac reflex without significant dystopia or enophthalmos. When autonomic cardiac derangement is diagnosed along with an orbital floor fracture, it has been suggested that the fracture should be treated immediately. Otherwise, it will result in continued hemodynamic instability and muscular injury and may require a second surgery. This article reports the management of an unusual presentation of a trapdoor blowout orbital floor fracture surgery with oculocardiac response in an adult, with emphasis on its pathophysiology, management, and differential diagnosis.

Biodegradable polymerized simvastatin stimulates bone formation.

Previous research from our labs demonstrated the synthesis of polymerized simvastatin by ring-opening polymerization and slow degradation with controlled release of simvastatin in vitro. The objective of the present study was to evaluate the degradation and intramembranous bone-forming potential of simvastatin-containing polyprodrugs in vivo using a rat calvarial onlay model. Poly(ethylene glycol)-block-poly(simvastatin) and poly(ethylene glycol)-block-poly(simvastatin)-ran-poly(glycolide) were compared with simvastatin conventionally encapsulated in poly(lactic-co-glycolic acid) (PLGA) and pure PLGA. The rate of degradation was higher for PLGA with and without simvastatin relative to the simvastatin polyprodrugs. Significant new bone growth at the circumference of poly(ethylene glycol)-block-poly(simvastatin) disks was observed beginning at 4 weeks, whereas severe bone resorption (4 weeks) and bone loss (8 weeks) were observed for PLGA loaded with simvastatin. No significant systemic effects were observed for serum total cholesterol and body weight. Increased expression of osteogenic (BMP-2, Runx2, and ALP), angiogenic (VEGF), and inflammatory cytokines (IL-6 and NF-ĸB) genes was seen with all polymers at the end of 8 weeks. Poly(ethylene glycol)-block-poly(simvastatin), with slow degradation and drug release, controlled inflammation, and significant osteogenic effect, is a candidate for use in bone regeneration applications. STATEMENT OF SIGNIFICANCE: Traditional drug delivery systems, e.g., drug encapsulated in poly(lactic-co-glycolic acid) (PLGA), are typically passive and have limited drug payload. As an alternative, we polymerized the drug simvastatin, which has multiple physiological effects, into macromolecules ("polysimvastatin") via ring-opening polymerization. We previously demonstrated that the rate of degradation and drug (simvastatin) release can be adjusted by copolymerizing it with other monomers. The present results demonstrate significant new bone growth around polysimvastatin, whereas severe bone loss occurred for PLGA loaded with simvastatin. This degradable biomaterial with biofunctionality integrated into the polymeric backbone is a useful candidate for bone regeneration applications.

Rash associated with pregabalin use.

OBJECTIVE: To report a case of extensive rash induced by orally administered pregabalin in a patient with neuropathic pain. CASE SUMMARY: A 35-year-old white female with a diffuse, erythematous, maculopapular rash localized to her back and extremities presented to the preoperative holding area for planned exploratory nerve surgery. Prior to presentation, she had been receiving oral pregabalin 50 mg 3 times a day for approximately 2 weeks to treat her neuropathy. Prior to pregabalin therapy, the patient indicated that she had taken gabapentin for approximately 3 weeks for the pain, but had discontinued it due to adverse effects and perceived lack of efficacy. Pregabalin was discontinued and diphenhydramine and methylprednisolone were given to treat the rash. The rash almost completely resolved one week after pregabalin was discontinued. DISCUSSION: Pregabalin-induced rash was rarely reported in Phase 3 trials, and a clinical description of such events has not been published. Pregabalin exhibits pharmacokinetics different from those of most other antiepileptic agents. Presently, there are no clear mechanisms known for rash associated with pregabalin. The Naranjo probability scale indicates a probable relationship between the development of rash and use of pregabalin by our patient. CONCLUSIONS: There are currently no other available reports of the development of a rash coinciding with the use of pregabalin. As both Food and Drug Administration-approved and off-label use of this drug increases, further consideration of risk factors associated with the development of rash is needed.

Evaluation of orthodontic mini-implant anchorage in premolar extraction therapy in adolescents.

INTRODUCTION: The purpose of this study was to determine the success rate, positional stability, and patient evaluation of orthodontic mini-implants (OMIs). METHODS: Thirteen patients (8 girls, 5 boys; average age, 14 years 10 months) were treated with 82 OMIs measuring 1.6 mm in diameter and 6 mm in length placed in the buccal alveoli (1 unloaded OMI and 1 loaded OMI per quadrant). The right or left side of each arch was randomly selected for immediate loading with up to 250 g of direct force; the contralateral side was loaded 3 to 5 weeks later. Serial impressions, clinical observations, and orthodontic maintenance were performed until adequate space closure was achieved. RESULTS: The overall OMI success rate was 70.73%. As calculated with a mixed-model analysis, there was no statistically significant difference between the success rates of immediately loaded OMIs (80.0%) and delayed loaded OMIs (80.95%). The combined success rate for loaded OMIs (80.49%) was significantly higher than that of unloaded OMIs (60.98%). Patients' motivation for OMI treatment was primarily the desire to avoid headgear. Using a 100-mm visual analog scale, the patients indicated average scores of 54.77 for the amount of pain during OMI placement and 27.10 for the amount of pain during OMI removal. CONCLUSIONS: OMIs are a predictable, effective, and well-tolerated anchorage source for adolescents. Neither the timing of force application nor the force itself precipitated failure of the OMIs. Orthodontic forces can be applied immediately to OMIs. Various anatomic and behavioral conditions unique to adolescents and a clinical learning curve can affect the success rate of OMIs.

Testing of a bioactive, moldable bone graft substitute in an infected, critically sized segmental defect model.

Large infected bone defects, often resulting from high energy traumas, are difficult to treat due to their variability in complexity and location. Standard treatment for infected bone defects begins with a protocol that includes a series of debridements in conjunction with an extended course of systemic antibiotics. Only after the infection has been eliminated will repair of the defect commence, typically with implantation of autologous bone. To address some of the shortcomings of the standard treatment methods, such as serial procedures, limited grafting material, and the need for a second surgical site for autologous bone, a sequential, dual drug-releasing, moldable, calcium sulfate-based bone graft substitute was developed previously. In the present studies, the effectiveness of the material for treating both the infection with vancomycin and bone defect with simvastatin was evaluated in vivo using a critically sized, infected segmental defect model in rat femurs. Although the infection was not fully eliminated, the local release of vancomycin increased survivorship of infected animals by 464% compared to nontreated controls. Infected animals receiving antimicrobial treatment showed comparable amounts of new bone formation within the defect site when compared to noninfected controls. Incorporating agents capable of disrupting established biofilms into bone graft substitutes may enhance effectiveness in treating a biofilm infection within a bone defect. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1878-1886, 2018.