Synthesis of Novel Antimicrobial CHX-CaCl2 Coatings on Maxillofacial Fixatures for Infection Prevention.

Maxillofacial surgery placement of fixatures (Leonard Buttons, LB) at close proximity to surgical incisions provides a potential reservoir as a secondary local factor to advanced periodontal disease, with bacterial formation around failed fixatures implicating plaque. To address infection rates, we aimed to surface coat LB and Titanium (Ti) discs using a novel form of chlorhexidine (CHX), CHX-CaCl2 and 0.2% CHX digluconate mouthwash as a comparison. CHX-CaCl2 coated, double-coated and mouthwash coated LB and Ti discs were transferred to 1 mL artificial saliva (AS) at specified time points, and UV-Visible spectroscopy (254 nm) was used to measure CHX release. The zone of inhibition (ZOI) was measured using collected aliquots against bacterial strains. Specimens were characterized using Energy Dispersive X-ray Spectroscopy (EDS), X-ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). SEM displayed copious dendritic crystals on LB/ Ti disc surfaces. Drug release from double-coated CHX-CaCl2 was 14 days (Ti discs) and 6 days (LB) above MIC, compared to the comparison group (20 min). The ZOI for the CHX-CaCl2 coated groups was significantly different within groups (p < 0.05). CHX-CaCl2 surface crystallization is a new drug technology for controlled and sustained CHX release; its antibacterial effectiveness makes this drug an ideal adjunct following clinical and surgical procedures to maintain oral hygiene and prevent surgical site infections.

The 100 Most Cited Articles in Facial Trauma: A Bibliometric Analysis.

PURPOSE: The number of citations an article receives has been used as a marker of its influence within a surgical specialty. Currently, there is limited citation analysis in oral and maxillofacial trauma surgery. The purpose of this study was to determine the 100 most cited articles in facial trauma surgery and their characteristics. MATERIALS AND METHODS: Articles were identified from the Science Citation Index of the Institute for Scientific Information using the Thomson Reuters Web of Science search engine. All articles until 2015 were included. Then, the 100 most cited articles were assessed for title, author, journal, country of origin, and number of citations. A citation index (number of citations received per year) also was calculated. RESULTS: The 100 most cited articles in facial trauma received 9,933 citations (range, 66 to 297). They were published from 1942 through 2008, with 1990 through 1999 being the commonest decade. Articles were cited on average 4.6 times per year. Articles were published in 28 different journals, with impact factors ranging from 0.94 to 35.3. Most articles were observational research studies. CONCLUSION: These findings reflect the attention that articles have received during the past half century in oral and maxillofacial trauma research, shedding light on often-read articles in this field. In addition to current bibliometric indices, it could provide a useful evidence base for facial surgeons, represent key educational material for aspiring trainees, and be used to help guide future research efforts.

How good is good enough? Lessons learned from review of outcomes of 50 patients following extraoral open reduction and internal fixation of condylar neck and base fractures at a regional major trauma centre.

The management of mandibular fractures is routine owing to their frequency, particularly those of the mandibular condyle, which are invariably common. Notwithstanding disparities in the literature, the international consensus towards which fractures of the mandibular condyle benefit from open surgical intervention is almost universally accepted. Closed reduction or non-operative management may be utilised in certain circumstances. Whilst outcome research has addressed complications with respect to operative side effects, outcomes related to the quality of bone repair and the setting in which this is delivered have not been universally addressed. The aim of this study was to determine the predictability of translating an indicated operative treatment plan into an acceptable functional result. We evaluated the outcomes of 59 extracapsular condylar fractures in 50 patients who were treated by extraoral open reduction and internal fixation (ORIF) between March 2021 and August 2022. We reviewed demographic data, surgical approach, and plating strategy, and critically evaluated the clinical and radiological outcomes. Whilst we found that the quality of reduction was not universally perfect, the majority were within tolerance, which we set according to the Strasbourg Osteosynthesis Research Group (SORG) definition for minimal displacement (<2 mm overlap and 10° angulation). The cohort had good functional occlusion and minimal long-term postoperative complications. Two patients required re-operation for non-union, and we discuss causality in these cases. In conclusion, we found that ORIF of condylar neck and base fractures is predictable in real-time surgical practice with respect to functional outcome. However, if imperfectly reduced, there is a small risk of non-union.

Scoping an interdisciplinary model of student dental therapists in maxillofacial trauma.

Introduction This paper outlines a short pilot programme to assess the feasibility of an interdisciplinary model of involving student dental therapists in the management of maxillofacial trauma patients. It involved dental therapy students attending an oral and maxillofacial surgery trauma review clinic at a major trauma hospital in London, UK.Approach The small cohort of 15 second-year dental hygiene and therapy (BSc in Oral Health) students attended the trauma clinic once a week in pairs, over a period of six weeks, after which they completed a survey questionnaire.Findings No students had previous experience of dealing with trauma patients. The majority (81.8%) had learnt something by attending the clinic. Almost all (91.7%) had not thought previously about the importance of oral hygiene in maxillofacial trauma patients. By the end of the pilot programme, ten students (83.3%) felt that they had a role to play in the care of these trauma patients and they felt valued as members of the wider team.Conclusion These initial findings suggest that the scheme has potential for incorporation of maxillofacial trauma experience within the formal dental therapy curriculum. This would prepare them for future involvement in the management of maxillofacial trauma patients to promote oral health benefits and more widely, to work as a team member in interprofessional health care.

Features and networks of the mandible on computed tomography.

The mandible or lower jaw is the largest and hardest bone in the human facial skeleton. Fractures of the mandible are reported to be a common facial trauma in emergency medicine and gaining insights into mandibular morphology in different facial types can be helpful for trauma treatment. Furthermore, features of the mandible play an important role in forensics and anthropology for identifying gender and individuals. Thus, discovering hidden information of the mandible can benefit interdisciplinary research. Here, for the first time, a method of artificial intelligence-based nonlinear dynamics and network analysis are used for discovering dissimilar and similar radiographic features of mandibles between male and female subjects. Using a public dataset of 10 computed tomography scans of mandibles, the results suggest a difference in the distribution of spatial autocorrelation between genders, uniqueness in network topologies among individuals and shared values in recurrence quantification.

Motor vehicle accidents-related maxillofacial injuries: a multicentre and prospective study.

OBJECTIVES: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures. STUDY DESIGN: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1. RESULTS: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures. CONCLUSIONS: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.

The role of the maxillofacial surgeon in the initial 48 h following a terrorist attack.

On 7 July 2005 there were four explosions in central London, three almost synchronously and a fourth within an hour. The Royal London Hospital received 208 casualties and the Hospital Major Incident Plan was put into action. We report on the events of that day and the role of the maxillofacial surgeons immediately and in the subsequent 48 h.

European Maxillofacial Trauma (EURMAT) in children: a multicenter and prospective study.

OBJECTIVE: The aim of this study is to present and discuss the results of a European multicentre prospective study about pediatric maxillofacial trauma epidemiology during a year. STUDY DESIGN: The following data were recorded: gender, age, etiology, site of fracture, date of injury. Of the 3396 patients with maxillofacial fractures admitted within the study period, 114 (3.3%) were children aged 15 years and younger, with a male/female ratio of 2.6:1. Mean age was 10.9 years. Most patients (63%) were aged 11-15 years. RESULTS: The most frequent cause of injury was fall (36 patients). Sport injuries and assaults were almost limited to the oldest group, whereas falls were more uniformly distributed in the 3 groups. The most frequently observed fracture involved the mandible with 47 fractures. In particular, 18 condylar fractures were recorded, followed by 12 body fractures. CONCLUSIONS: Falls can be acknowledged as the most important cause of facial trauma during the first years of life. The high incidence of sport accidents after 10 years may be a reason to increase the use of mouthguards and other protective equipment. Finally, the mandible (and in particular the condyle) was confirmed as the most frequent fracture site.

Assault-related maxillofacial injuries: the results from the European Maxillofacial Trauma (EURMAT) multicenter and prospective collaboration.

OBJECTIVE: The aim of this study is to present and discuss the demographic characteristics and patterns of assault-related maxillofacial fractures as reported by a European multicenter prospective study. STUDY DESIGN: Demographic and injury data were recorded for each patient who was a victim of an assault. RESULTS: Assaults represented the most frequent etiology of maxillofacial trauma with an overall rate of 39% and the values ranging between 60.8% (Kiev, Ukraine) and 15.4% (Bergen, Norway). The most frequent mechanisms of assault-related maxillofacial fractures were fists in 730 cases, followed by kicks and fists. The most frequently observed fracture involved the mandible (814 fractures), followed by orbito-zygomatic-maxillary complex fractures and orbital fractures. CONCLUSIONS: Our data confirmed the strong possibility that patients with maxillofacial fractures may be victims of physical aggression. The crucial role of alcohol in assault-related fractures was also confirmed by our study.

European Maxillofacial Trauma (EURMAT) project: a multicentre and prospective study.

The purpose of this study was to analyse the demographics, causes and characteristics of maxillofacial fractures managed at several European departments of oral and maxillofacial surgery over one year. The following data were recorded: gender, age, aetiology, site of facial fractures, facial injury severity score, timing of intervention, length of hospital stay. Data for a total of 3396 patients (2655 males and 741 females) with 4155 fractures were recorded. The mean age differed from country to country, ranging between 29.9 and 43.9 years. Overall, the most frequent cause of injury was assault, which accounted for the injuries of 1309 patients; assaults and falls alternated as the most important aetiological factor in the various centres. The most frequently observed fracture involved the mandible with 1743 fractures, followed by orbital-zygomatic-maxillary (OZM) fractures. Condylar fractures were the most commonly observed mandibular fracture. The results of the EURMAT collaboration confirm the changing trend in maxillofacial trauma epidemiology in Europe, with trauma cases caused by assaults and falls now outnumbering those due to road traffic accidents. The progressive ageing of the European population, in addition to strict road and work legislation may have been responsible for this change. Men are still the most frequent victims of maxillofacial injuries.

Reoperative orbital trauma: management of posttraumatic enophthalmos and aberrant eye position.

Enophthalmos is a complex and unpredictable condition to treat secondarily, and this is likely to remain a difficult challenge. Modern imaging technology and the aggressive stance taken on appropriate primary repair make it likely that surgeons will see fewer minor cases and increased numbers of major cases. The choice of reconstructive material should be evidence-based rather than based on surgical preference. Of crucial importance to the management of all traumas, particularly in revisional surgery, is attention to the soft tissue envelope, which adds to the postoperative result, and may camouflage minor degrees of enophthalmos.

Facial trauma--who should provide care?

The management of facial trauma is key to the development and longevity of the specialty of Oral and Maxillofacial Surgery. Advances in material technology and surgical evolution have kept pace with increasingly complex fracture configurations. Soft tissue components of major craniofacial injuries are best managed in a multidisciplinary environment. This may be facilitated by a nominated team within specific trauma centres. Trauma management of the face is a continuum with both training implications and clinical governance issues. There is no uniformly accepted staging of severity, and no accepted quantifiable outcome measures. Until there are, craniofacial trauma management will remain anecdotal.

Simplified transfer of intraoral bone grafts in ridge-augmentation procedures.

The use of mandibular symphyseal bone in bony reconstruction of limited anterior defects is common. This communication suggests the use of a template to ensure accurate sizing of the graft. A technique is also suggested where the screw hole in the grafted bone is made prior to the removal from the donor site. These modifications greatly simplify the transfer of bone grafts in these cases.