Antibiotic susceptibility of orofacial infections in Bratislava: a 10-year retrospective study.

OBJECTIVES: Aim of this study was to analyse causal microbiological agents and their bacterial resistance in orofacial infections requiring hospital admission. MATERIALS AND METHODS: Presented is a 10-year retrospective study of patients hospitalised at a single department in 2014-2023. 744 patients were involved. In the statistical analysis, following data was evaluated: causal microbes and their resistance to Penicillin, Amoxicillin-Clavulanate, Clindamycin and Metronidazole. RESULTS: Most frequent aetiology was odontogenic with causal tooth in socket (n = 468; 62,9%), followed by odontogenic - post extraction (n = 152; 20.4%), jaw fracture (n = 41; 5.5%), sialadenitis n = 31 (4.2%), osteonecrosis n = 22 (3.0%), oncological diagnosis in head and neck (n = 17; 2.3%), unknown (n = 10; 1.3%) and multiple factors (n = 3; 0.4%). 408 patients (54.8%) underwent extraoral abscess revision, 336 patients (45.2%) patients were treated locally without extraoral revision. In odontogenic group with tooth still present, superior CRP (m = 145.8 mg/l; SD = 117.7) and leukocyte values (m = 13.6*109l; SD = 6.6) were observed in comparison to other groups. There were 698 cultivated bacteria in 362 patients. Most frequent bacteria were Streptococci (n = 162; 23.2%), Prevotella (n = 83; 11.2%) and Parvimonas (n = 65; 9.3%). Clindamycin resistance was highest (n = 180 resistant bacteria; 25.8%), followed by Metronidazole (n = 178; 25.5%), Penicillin (n = 107; 15.3%) and Amoxicillin-Clavulanate (n = 34; 4.9%). CONCLUSIONS: Orofacial infections in head and neck region are mostly of odontogenic origin with causal tooth still in socket. Causal bacteria show a high antibiotic resistance rate, especially to Clindamycin and Metronidazole. CLINICAL RELEVANCE: Acquired data will be used to determine guidelines for empirical antibiotic prescription in cases of orofacial infections.

Advantages of virtual planning in reconstructive surgery of bone defects in the maxillofacial region.

OBJECTIVES: Our analysis focuses on the advantages of virtual surgical planning (VSP) compared to a conventional treatment method as well as on a wider range of parameters influencing the surgical procedure, postoperative care, morbidity and lastly, the survival rate of these patients. BACKGROUND: Patients with extensive bone defects of different etiologies of the upper or lower jaw who underwent complex reconstructive surgery with a free fibula flap (FFF). METHODS: We retrospectively analyzed data from a total of 34 patients (12 female and 22 male) whose defects were reconstructed with an osteomyocutaneus FFF. The data were collected over a period of 6 years from 2017 to 2023. We divided the patients into two groups, namely those who underwent conventional surgical treatment (5 patients) and those who underwent computer­planned surgical treatment (29 patients). RESULTS: The duration of surgery showed a significant difference between the VSP group and the conventional group (t(32) = 3.316; p < 0.01), with the VSP group having a significantly shorter surgery time (M= 8:10; SD = 1:18) compared to the conventional group (M = 10:52; SD = 2:41). The independent t-test revealed significant differences between the VSP group (M = 45.967; SD 14.548) and conventional group (M = 17.61; SD = 24.996) for the dose of unfractionated heparin per kilogram administrated immediately after vascular micro anastomosis (t(32) = -3.609; p < 0.001). CONCLUSION: Among all the risk factors, administering a higher unfractionated dosage of heparin administered immediately after completing the anastomosis was identified as a significant predictor of postoperative complications. Using VSP in cases of advanced stage head and neck malignancy for salvage surgery is highly recommended. Shorter duration of these comprehensive surgeries in the VSP group leads to a significantly favorable outcome (Tab. 2, Fig. 2, Ref. 19). Text in PDF www.elis.sk Keywords: virtual planning, microvascular flap, maxillofacial, free fibula flap, reconstructive surgery.

Near infrared spectroscopy in monitoring of head and neck microvascular free flaps.

OBJECTIVES: Microvascular free­flap monitoring is crucial to the early detection of flap failure and increases the chance of early intervention in case of disruption of perfusion to a flap. Many clinical alternatives to classical clinical flap monitoring have been proposed, such as color duplex ultrasonography, handheld Doppler, flap thermometry, or implantable Doppler flowmetry. Early detection of critical changes in tissue oxygenation can lead to successful surgical intervention when problems with flap nutrition arise. METHODS: Our clinical study seeks to investigate dynamic monitoring of free flaps with near­infrared spectroscopy (NIRS). NIRS is a non-invasive instrumental technique used for continuous monitoring of peripheral tissue oxygenation (StO2) and microcirculation. All patients were included prospectively from one clinical center. RESULTS: During the clinical research period, 18 patients underwent extraoral head and neck reconstruction with one of three types of free flap, namely with radial forearm free flap (RFFF), anterolateral thigh flap (ALT) or fibula free flap (FFF). Measurements of flap perfusion were taken using NIRS during intraoperative and postoperative phases for 71 hours on average. A total of 6 perfusion disorders were recorded, of which three originated from microanastomoses and three from postoperative bleeding and compression of pedicle. NIRS showed characteristic changes in all 6 cases that were returned to the operating theatre owing to pedicle compromise. In these cases, NIRS had detected the pedicle compromise before it was clinically identified. A single StO2 monitoring was able to detect the vascular compromise with 100% sensitivity and 95.65% specificity. None of the cases were falsely positive. In our study, all compromised flaps were accurately identified by means of NIRS. In most cases, the changes in oxygen saturation became evident on NIRS prior to being clinically observed. CONCLUSION: In our study, the continuous NIRS monitoring securely detected the early stages of arterial and venous thromboses or pedicle compression. The most important aspects of monitoring the flaps´ microvascular perfusion and vitality by means of NIRS lie in its function of recording the dynamics of changes in the values ​​of absolute oxygen saturation (StO2> 50%) alongside with detecting a 30% decrease in tissue saturation over a 60­minute interval (60 min StO2 >30%) before the clinical changes in the microvascular flap become observable. In cases of pedicle compression, the average time of appearance of signs of StO2 values dropping below the reference interval (as detected by NIRS) was 1:29:02 hour (SD= 0:58:42 h) prior to the occurrence of any clinical signs, while in cases of microvascular anastomosis complications, it was 0:35:23 hour (SD=0:08:30 h)  (SD = 0:08:30 h) (Tab. 3, Fig. 7, Ref. 42).

Three-dimensional navigation in maxillofacial surgery - the way to minimize surgical stress and improve accuracy in fibula free flap and Eagles syndrome surgical procedures.

BACKGROUND: Surgical navigation with three-dimensional (3D) printing techniques presents two major advantages: First, from a technical aspect, it facilitates orientation in target anatomical structures resulting in improvement of the accuracy of surgery. Moreover, it shortens the time of complex surgical interventions by preparing the exact position of customized autologous grafts with fixation devices. Second, from a clinical point of view, it also lessens the impact of surgical stress to adjacent tissues by decreasing the duration of surgery. MATERIAL AND METHODS: Two maxillofacial procedures were evaluated in this study using 3D navigation and planning approach - resection of the styloid process due to Eagles syndrome and microvascular mandibular reconstruction with the fibula free flap. All patients who underwent these procedures were divided into two groups (with or without 3D navigation). RESULTS: In the Eagles syndrome group procedure independent t-test showed  significant difference in the operating time between group 1 (M = 148; SD = 0) and group 2 (M = 78; SD = 4.24) t (1) = 13.472; P = 0.047. There was no significant difference in the duration of postoperative hospitalization (2 days), which was equal in all patient groups. Regarding the fibula free flap procedure, the independent t-test revealed significant difference in operating time with (M = 8: 40 : 25; SD = 0 : 58 : 07) and without 3D printing guides (M = 10 : 43 : 15; SD = 3 : 04 : 32) t (14)=2.133, P = 0.051. Similarly, there was no significant difference between groups (group 1 M = 15.5; SD = 0,71; group 2 M = 13; SD = 1,63) in the duration of postoperative hospitalization time t (4) =1,98; P = 0.119. CONCLUSION: In summary, reduction in operation time in Eagles syndrome and in microvascular mandibular reconstruction with the fibula free flap group mitigates the surgical stress on target tissues enabling faster tissue healing and quicker recovery.

The Syndrome of Elongated Styloid Process, the Eagle's Syndrome-From Anatomical, Evolutionary and Embryological Backgrounds to 3D Printing and Personalized Surgery Planning. Report of Five Cases.

Background and Objectives: The symptoms of Eagle's syndrome are associated with the elongated styloid process of the temporal bone or calcification of the stylohyoid ligament. The first mention of pain syndrome associated with the elongated styloid process dates back to 1937, when it was described by Watt Weems Eagle. Over the last decade, experts in the field have shown a lively interest in the issue of the relationship between the elongated styloid process and various symptoms. This article presents the correlation between the clinical signs of Eagle's syndrome and alterations in surrounding anatomical structures. It includes a brief review of the evolutionary, embryological and clinical anatomical background of the elongated styloid process. Materials and Methods: Between 2018 and 2019, five patients were admitted to our workplace with 1-3-year history of bilateral or unilateral throat pain, otalgia and pharyngeal foreign body sensation. As a therapeutic novelty in the surgical approach to this condition, we used individual 3D printed models to measure and identify the exact location of the resection of the styloid process without damaging the surrounding anatomical structures, such as the facial, accessory, hypoglossal, and vagal nerves; the internal jugular vein; and the internal carotid artery. Results: Compared to traditional surgical methods without 3D models, 3D models helped to better identify cutting edges and major landmarks used in surgical treatment of Eagle's syndrome. Printed models provided assistance with the exact location of the styloid process resection position without damaging the surrounding anatomical structures such as the facial, accessory, hypoglossal, and vagal nerves; the internal jugular vein; and the internal carotid artery. Conclusion: In our clinical report, we used 3D printed models for navigation and planning during surgical procedures involving resections of the elongated styloid process. Additionally, we can formulate a new hypothesis: the elongated styloid process is a form of atavism of the bony hyoid apparatus in our evolutionary ancestors that is evolutionarily encoded or arises from disrupted degeneration of the middle portion of embryonal Reichert´s cartilage of the second pharyngeal arch. Under normal conditions, this portion does not ossify but degenerates and transforms into a connective tissue band, the future stylohyoid ligament.

Exploring the Practical Applications of Artificial Intelligence, Deep Learning, and Machine Learning in Maxillofacial Surgery: A Comprehensive Analysis of Published Works.

Artificial intelligence (AI), deep learning (DL), and machine learning (ML) are computer, machine, and engineering systems that mimic human intelligence to devise procedures. These technologies also provide opportunities to advance diagnostics and planning in human medicine and dentistry. The purpose of this literature review was to ascertain the applicability and significance of AI and to highlight its uses in maxillofacial surgery. Our primary inclusion criterion was an original paper written in English focusing on the use of AI, DL, or ML in maxillofacial surgery. The sources were PubMed, Scopus, and Web of Science, and the queries were made on the 31 December 2023. The search strings used were "artificial intelligence maxillofacial surgery", "machine learning maxillofacial surgery", and "deep learning maxillofacial surgery". Following the removal of duplicates, the remaining search results were screened by three independent operators to minimize the risk of bias. A total of 324 publications from 1992 to 2023 were finally selected. These were calculated according to the year of publication with a continuous increase (excluding 2012 and 2013) and R2 = 0.9295. Generally, in orthognathic dentistry and maxillofacial surgery, AI and ML have gained popularity over the past few decades. When we included the keywords "planning in maxillofacial surgery" and "planning in orthognathic surgery", the number significantly increased to 7535 publications. The first publication appeared in 1965, with an increasing trend (excluding 2014-2018), with an R2 value of 0.8642. These technologies have been found to be useful in diagnosis and treatment planning in head and neck surgical oncology, cosmetic and aesthetic surgery, and oral pathology. In orthognathic surgery, they have been utilized for diagnosis, treatment planning, assessment of treatment needs, and cephalometric analyses, among other applications. This review confirms that the current use of AI and ML in maxillofacial surgery is focused mainly on evaluating digital diagnostic methods, especially radiology, treatment plans, and postoperative results. However, as these technologies become integrated into maxillofacial surgery and robotic surgery in the head and neck region, it is expected that they will be gradually utilized to plan and comprehensively evaluate the success of maxillofacial surgeries.