Use of Vascularized Myo-Osseous Fibula Free Flap to Reconstruct a Hemimandibular Defect With a Concomitant Skull Defect Arising From Stock Condylar Prosthesis Displacement Into the Middle Cranial Fossa.

Functional reconstruction of the temporomandibular joint (TMJ) is a controversial topic among oral and maxillofacial surgeons; this controversy becomes more complicated when one dives into the dilemma of the ideal reconstructive modality. TMJ defects might result from various etiologies, such as blunt or penetrating traumatic injuries, advanced degenerative joint disease, or various pathologic conditions, including benign and malignant conditions, that might arise from the TMJ or adjacent tissues. Reconstruction of the TMJ is vital because of its essential function in mastication, articulation, speech, and facial esthetics and symmetry. In the pediatric population, the TMJ acts as a growth center. TMJ reconstructive surgery might be influenced by various factors that can steer the surgeon toward adopting a specific reconstructive modality. These factors can be classified into preoperative factors that include the overall general health of the patient, expectations, and socioeconomic status that might be an obstacle in using custom-made solutions. The surgeon's experience, level of comfort, and training are crucial influencing factors. TMJ reconstructive options consist of autogenous grafts or alloplastic options. Autogenous grafts encompass 2 broad subcategories. The first is the vascularized option, and a good example is the vascularized fibula free flap. The second subcategory includes nonvascularized grafts, such as costochondral grafts and sternoclavicular grafts. Alloplastic grafts include various TMJ stock joints or custom-made patient-specific prostheses and stock condylar prostheses. The goals of TMJ reconstruction are to establish a pain-free normal range of mouth opening, stable occlusion, and absence of facial deformity. Complication rates in TMJ surgery are low and include surgical infection, nerve injury, failure or fracture of the prosthesis, or injury to adjacent structures. This report presents a case of a stock condylar prosthesis displaced into the middle cranial fossa, which was managed with a 2-stage approach of removing the displaced prosthesis and then reconstruction with a fibula vascularized free flap and a simultaneous contralateral sagittal split osteotomy.

Psychological Impact of the COVID-19 Pandemic on Students, Assistants, and Faculty of a Dental Institute of Saudi Arabia.

This study aimed to assess the perceived stress levels in students, assistants, and faculty members of the College of Dentistry, Imam Abdulrahman Bin Faisal, University (IAU), Kingdom of Saudi Arabia (KSA) during the novel coronavirus disease 2019 (COVID-19) pandemic. Using the Cohen's perceived stress scale (PSS) questionnaire (consisting of 14 items, hence called PSS-14), an online observational survey was conducted. The PSS 14 was rated on a 5-point Likert scale ranging from 0 (never) to 4 (very often). The scores ranging from 0-18 represented low stress, 19-37 represented moderate stress, and 38-56 represented high stress. The second-and third-year students were designated as junior year students, while fourth-year onwards were considered senior year students. Out of total 265 participants, 65% (173) were female, and the majority of the participants were dental students 70% (185) with a mean age of 26.71 ± 9.26 years. In the present study, the average PSS score for the participants was computed as 29.89 (range score: 0-56) which shows moderate stress levels among the respondents. The PSS score for the students was 31.03; for the faculty, it was 28, while for the assistants, it was 27.05. Among the three participant groups, the students were found more on the severe stress side (19%) (p-value = 0.002), and among them, the senior year students (6th year) showed significantly higher stress levels compared to the junior year students (p-value = 0.005). Age-wise, the participants below 20 years were most stressed (21%), followed by those 20-30 years old (18%). Female participants were more severely stressed than males (17% vs. 10%, respectively). It was concluded that the students experienced more stress, followed by the faculty members and dental assistants. In addition, younger participants, females, and senior year students were more stressed than their counterparts. Future studies directed at evaluating stress levels of these groups from different dental institutes could provide an opportunity for policymakers to offer various resources to improve their mental health.