The Beneficial Effect of Preoperative Dexmedetomidine in Controlling Postoperative Pain, Nausea, and Vomiting After Orthognathic Surgery: A Triple-blind Randomized Clinical Trial.

PURPOSE: Controlling postoperative pain and nausea (PONV) following orthognathic surgery can be challenging. The aim of the study was to assess the efficacy of dexmedetomidine (DEX) in reducing pain and preventing nausea and vomiting in subjects undergoing orthognathic surgery. METHODS: The authors implemented a triple-blinded, randomized clinical trial. Healthy adults with class III jaw deformity scheduled for bimaxillary orthognathic surgery were included. Subjects were randomized to the DEX or placebo groups. The DEX group received premedication with DEX 1 µg/kg IV over 10 minutes followed by a maintenance dose (0.2 µg/kg/hour) while the placebo group received normal saline. The primary outcome variables were postoperative pain, postoperative nausea, and postoperative vomiting . Pain was assessed using a visual analog scale at 1, 3, 6, 12, 18, and 24 hours, postoperatively). Nausea and vomiting were recorded throughout the postoperative period. Statistical analysis was performed using χ2, t test, and repeated measures ANOVA with a P value < .05 considered significant. RESULTS: A total of 60 consecutive subjects with a mean age of 24.6 ± 3.5 years completed the study. There were 38 females (63.33%) and 22 males (36.66%). The mean visual analog scale was significantly lower in the DEX group at all time-points (P < .05). There was a significantly greater demand for rescue analgesics in the placebo group compared to the DEX group (P = .01). Fourteen subjects (46.7%) in the placebo group and one subject (3.3%) in the DEX group reported nausea (P < .001). Postoperative vomiting was not observed in any of the subjects. CONCLUSION: Premedication with DEX can be considered a viable treatment option for reducing postoperative pain and postoperative nausea after bimaxillary orthognathic surgery.

Is There an Increase in the Risk of Obstructive Sleep Apnea After Isolated Mandibular Setback Surgery? An Evaluation Using the STOP-BANG Questionnaire.

PURPOSE: The aim of this study was to assess the impact of isolated mandibular setback surgery on the risk of obstructive sleep apnea (OSA), using the STOP-BANG questionnaire (SBQ). PATIENTS AND METHODS: The authors implemented a double-blinded prospective quasi-experimental study. All healthy patients with skeletal Class III deformity older than 18 years were included in this study. They were candidates for isolated mandibular setback surgery. The SBQ was completed by the pulmonologist, 1 week preoperatively (T0), and 1 and 6 months postoperatively (T1 and T2, respectively). The mandibular setback displacement was the study intervention. The risk of OSA on the basis of the SBQ was the outcome variable. Descriptive and bivariate statistics were computed and the significance level was set at .05. RESULTS: The sample comprised 30 patients (15 females, 15 males) with the average age of 25.77 ± 4.76. The mean score of SBQ at T0 was 1.37 ± 0.85, which increased to 2.33 ± 1.52 at T1 interval. However, it decreased significantly to 1.47 ± 1.17 at T2 interval (P < .001). T0-T1 and T0-T2 score differences were observed to be higher in the group with a mandibular setback repositioning greater than or equal to 5 mm (P < .005). CONCLUSIONS: An isolated mandibular setback surgery less than 5 mm does not increase the risk for OSA in a young healthy nonsmoker Class III patient, according to the SBQ. Moreover, there was a significant increase in the risk for OSA when the setback was greater than or equal to 5 mm, measured at the mandibular incisor edge. Therefore, clinicians should be careful and discuss this potential increased risk with the patients, when this movement is required by the treatment plan. Further clinical trials are needed to support the relevancy.

Correlation Between Lower Third Molar Impaction Types and Mandibular Angle and Condylar Fractures: A Retrospective Study.

PURPOSE: The purpose of this study was to investigate and determine the relations between mandibular third molar (M3) impaction types and mandibular angle and condylar fractures. MATERIALS AND METHODS: A retrospective study was conducted in patients with mandibular angle and condylar fractures referred to the Oral and Maxillofacial Surgery Department of the Shahid Kamyab Hospital (Mashhad, Iran) from 2013 to 2018. Data sources were patients' hospital documents and panoramic radiographs. Predictor variables were the presence and position of impacted M3s. The Pell-Gregory classification was used to identify the horizontal and vertical positions of impaction. The impaction angulation was determined using the Schiller classification. Outcome variables were the presence of angle and condylar fractures. Data were analyzed using SPSS 16 (IBM Corp, Armonk, NY) and χ2 and Fisher exact tests. RESULTS: The study sample consisted of 117 patients (63.2% with condylar fractures, 30.8% with angle fractures, and 6% with concomitant fractures of the condyle and angle). Most patients (88.9%) with angle fracture had impacted M3s; however, impacted M3s were absent in 59.5% of condylar fracture cases. Mesioangular and vertical positions were the most prevalent impaction angulation types in patients with mandibular angle fracture. Classes II and B were the most frequent horizontal and vertical impaction types, respectively, according to the Pell-Gregory classification. There was a statistically significant difference between fracture site and the presence or absence of impacted M3s (P < .001). Moreover, a significant relation was observed between horizontal impaction type and fracture site in patients with impacted M3s (P = .001). CONCLUSIONS: The presence of impacted M3s increased the risk of angle fractures and simultaneously decreased the risk of condylar fractures. Fractures of the angle region were more commonly seen in patients with superficially impacted (vs deeply impacted) M3s.

Propofol Versus Remifentanil: Which One Is More Effective in Reducing Blood Loss During Orthognathic Surgery? A Randomized Clinical Trial.

PURPOSE: Propofol and remifentanil are 2 useful drugs used in induced hypotensive anesthesia. The purpose of this study was to compare the effects of these drugs on intraoperative blood loss, transfusion requirements, and hemodynamic status during standardized orthognathic surgical procedures. MATERIALS AND METHODS: In this double-blind randomized clinical trial, 50 consecutive healthy patients with Class III skeletal deformity were candidates for bimaxillary orthognathic surgery at Qaem Hospital, Mashhad University of Medical Sciences (Mashhad, Iran), from November 2016 until December 2017. These patients were randomly assigned to 2 equal-number groups to receive hypotensive anesthesia with propofol or remifentanil. Neither the surgeon nor the patients were aware of the study groups, whereas both the student and anesthesiologist were not blinded. Age and gender were recorded, and mean blood loss, mean arterial pressure, and mean heart rate, as well as duration of surgery and duration of general anesthesia, were monitored intraoperatively. The hypotensive anesthetic drugs were the primary predictor variables and the mean blood loss volume was the main outcome in this research. The independent t test and χ2 test were performed for data analysis using SPSS software (version 16; SPSS, Chicago, IL). RESULTS: In this study, 25 patients with a mean age of 22.25 ± 3.31 years were investigated in each group. The mean blood loss volume was 578.26 ± 95.14 mL and 366.67 ± 64.92 mL in the propofol and remifentanil groups, respectively. The independent-samples t test showed that mean blood loss was significantly lower in the remifentanil group than in the propofol group (P = .001). Furthermore, the mean arterial blood pressure was significantly lower in the remifentanil group than in the propofol group (85 ± 20 mm Hg vs 95 ± 15 mm Hg, P < .001). CONCLUSIONS: Hypotensive anesthesia with remifentanil, in comparison with propofol, significantly reduces mean blood loss during orthognathic surgery, which decreases the transfusion requirements and disadvantages of transfusion and blood loss.

An Unusual Case of Deep Vein Thrombosis After Orthognathic Surgery: A Case Report and Review of the Literature.

Deep vein thrombosis (DVT) is caused primarily by obstruction of blood flow in the deep veins in the lower limbs. It is a form of thrombophlebitis and can be a major cause of morbidity and mortality in hospitalized patients. This report describes an unusual case of DVT in a 21-year-old woman with Class III malocclusion who underwent bimaxillary orthognathic surgery (bilateral sagittal split osteotomy and Le Fort I osteotomy) under general anesthesia. She developed DVT unexpectedly 1 week after surgery, with episodes of sweating and chills in addition to lower limb edema, tenderness, and rigidity. D-dimer laboratory testing and venous Doppler sonography were performed and the DVT diagnosis was confirmed; therefore, the patient was admitted to the intensive care unit for anticoagulant and supportive therapy. Although the incidence rate of thromboembolism in hospitalized patients undergoing oral and maxillofacial surgery is low, it is not an operation without risk of DVT. This complication can cause fatal acute pulmonary thromboembolism and death. This case study illustrates that pharmacologic treatment of menorrhagia with mefenamic acid combined with intraoperative use of tranexamic acid for control of blood loss might put the patient at increased risk of DVT. Hence, maxillofacial surgeons should assess all their patients preoperatively for thromboembolism risk; if they suspect any risk factors in the patient, prompt diagnostic tests and management should be ordered.

Does Intra-Alveolar Application of Chlorhexidine Gel in Combination With Platelet-Rich Fibrin Have an Advantage Over Application of Platelet-Rich Fibrin in Decreasing Alveolar Osteitis After Mandibular Third Molar Surgery? A Double-Blinded Randomized Clinical Trial.

PURPOSE: To evaluate the effectiveness of chlorhexidine (CHX) gel and platelet-rich fibrin (PRF) compared with PRF alone in preventing the development of alveolar osteitis (AO). MATERIALS AND METHODS: In a double-blinded trial, patients undergoing surgical management of bilateral impacted mandibular third molars were randomly divided into 2 groups; 1 group received PRF in 1 extraction socket with the other socket as its control and the other group received 0.2% CHX gel plus PRF in 1 socket with the other socket serving as its control. The study and control sides were unknown to the surgeon and the patient. The predictor variables were PRF application (PRF vs non-PRF) and PRF plus CHX application (PRF-CHX vs non-PRF-CHX). The outcome variable was the development of AO during the first week after surgery. Age, gender, surgical difficulty score, surgeon's experience, number of anesthesia cartridges injected, and irrigation volume were other variables. Data were analyzed in SPSS 11.5 using the t test and χ2 test, with the confidence interval set at 95%. RESULTS: In total, 482 surgeries were performed on 241 patients (mean age, 24 yr). The overall frequencies of AO in all surgeries, the PRF group, and the PRF-CHX group were 15.14, 17.37, and 13%, respectively. The frequency of AO in the PRF and PRF-CHX sockets was significantly lower than in the non-PRF (relative risk = 0.46) and non-PRF-CHX (relative risk = 0.18) sockets, respectively (P < .05). Moreover, the risk of developing AO in the PRF-CHX sockets was significantly lower than in the PRF sockets (relative risk = 0.37; P < .05). CONCLUSION: According to the present findings, the application of CHX gel with PRF increases the efficiency of PRF in lowering the risk of developing AO after surgical removal of impacted mandibular third molars.

Intra- and Postoperative Complications of Le Fort I Maxillary Osteotomy.

BACKGROUND: The Le Fort I maxillary osteotomy is a versatile and simple procedure, which has gained popularity nowadays, to correct a wide range of malocclusion and maxillofacial deformities. This procedure is often associated with significant but rare postoperative complications. The aim of this study was to evaluate the types and frequencies of intra- and perioperative complications related to Le Fort I osteotomies in noncleft Iranian patients. MATERIALS AND METHODS: In this prospective study, all the healthy systemic patients, (ASA I, II) with the age range of 18 to 30 years from both genders, who had the skeletal class II or III deformities and required only isolated 1-piece maxillary Le Fort I osteotomy, were included in this study. These patients had no craniofacial cleft history and were candidates for orthognathic surgery in Maxillofacial Surgery Department of Qaem Hospital of Mashhad (Iran), 2015 to 2017. All of the operations were carried out or supervised by a single surgeon and anesthesiologist using the same protocol. The patients were monitored for occurrence of intra- or postoperative complications till 6 months. The t-test, Chi-squared test, and Fisher exact test were performed for data analysis using SPSS version 16 (SPSS Inc, Chicago, IL). RESULTS: In the present study, a total of 114 consecutive patients with the average age of 22 ±â€Š5 years from October 2015 to November 2017 were recruited. About 77 (67.54%) patients were presented skeletal class III deformity and 37 (32.46%) were class II. The most prevalent maxillary movement after Le Fort I osteotomy was identified to be isolated maxillary advancement in 51 (44.75%) patients. Only 10 (8.77%) of all 114 patients confronted surgical complications. Hemorrhagic complication (arterial bleeding from descending palatine artery and epistaxis) and anatomic complications (septal deviation and bad fracture) would be the most prevalent complications with the frequency of 5.25% and 3.5% in total. Maxillary setback with impaction presented the highest rate (36.4%) of complications compared to other maxillary movement types. On balance, there was a significant association between Le Fort I surgery complications and maxillary movement types in our research (P = 0.002). CONCLUSION: The rate of intra- and postoperative complications following Le Fort I osteotomy for healthy noncleft adults in our center was low. Therefore, it can be concluded that this technique is safe and reliable. The maxillofacial surgeon should pay more attention for prevention or even management of the risk of intra- and perioperative complications in patients with anatomic irregularities (previous craniofacial cleft or trauma history) and those who required maxillary setback concomitant with impaction movements.

Is Low-Level Laser Therapy Effective for Treatment of Neurosensory Deficits Arising From Sagittal Split Ramus Osteotomy?

PURPOSE: This study investigated the effectiveness of low-level laser therapy (LLLT) for treating neurosensory impairment after bilateral sagittal split osteotomy (BSSO). MATERIALS AND METHODS: This randomized, double-blinded, split-mouth trial included patients requiring BSSO. After surgery, 1 side of each patient was randomly assigned to laser therapy and the other side served as the control. At 24, 48, and 72 hours after surgery, LLLT was accomplished by intraoral application of a 660-nm laser around the surgical site (200 mW, 10 seconds, 2 J, 1.5 J/cm2) followed by extraoral irradiation by an 810-nm laser (200 mW, 10 seconds, 2 J, 7 J/cm2) along the distribution of the inferior alveolar nerve. Subsequently, extraoral irradiation was repeated 2 times per week for 3 weeks along the path of the inferior alveolar nerve, lower lip, and chin. On the control side, the treatment was similar to the laser side but with laser simulation. The main outcome was assessing nerve damage by a "2-point discrimination test" before and up to 60 days after surgery. RESULTS: The sample consisted of 16 patients. No significant difference was found between the laser and control sides before and after surgery and on postoperative days 15 and 30 (P > .05). The 2-point discrimination distance was significantly shorter on the laser side than on the control side on postoperative days 45 and 60 (P < .05). CONCLUSION: LLLT was effective in the treatment of neurosensory disturbances arising from BSSO. Therefore, LLLT can be recommended to accelerate the recovery of sensory aberrations in patients undergoing BSSO.

Is Low-Level Laser Therapy Effective in the Management of Pain and Swelling After Mandibular Third Molar Surgery?

PURPOSE: This study evaluated the effect of low-level laser therapy (LLLT) on decreasing pain and swelling after removal of impacted third molars. PATIENTS AND METHODS: This randomized, double-blinded, split-mouth study included patients presenting 2 symmetrically impacted mandibular third molars. In each participant, one side was randomly assigned to laser treatment and the other side received placebo. LLLT was performed by intraoral application of a 660-nm laser (200 mW, 6 J per point at 4 points) followed by extraoral application of an 810-nm laser (200 mW, 6 J per point at 3 points). Irradiation at the 810-nm wavelength was repeated on days 2 and 4 after surgery. On the control side, the treatment protocol was similar to the experimental side, but with laser simulation. The main outcomes were the degree of pain during the next 7 days and the edema coefficients on days 2, 4, and 7 after surgery. Data were analyzed using generalized linear models to determine the effect of group and time on pain level and edema coefficients. RESULTS: The final sample consisted of 40 patients. Pain level was significantly lower in the laser than in the placebo side at all time points during the experiment (P < .05). Swelling was significantly lower in the laser than in the placebo group on days 2, 4, and 7 after surgery (P < .05). CONCLUSION: LLLT proved effective in decreasing the intensity of pain and swelling after removal of impacted third molars and can be recommended to alleviate patients' symptoms after surgery.

Comparison of the effect of low level laser therapy with alvogyl on the management of alveolar osteitis.

BACKGROUND: This study investigated the efficacy of low level laser therapy (LLLT) for managing alveolar osteitis (AO). MATERIAL AND METHODS: Sixty patients with alveolar osteitis of mandibular third molars were randomly divided into three groups. In group 1, socket irrigation was followed by alvogyl placement, and the treatment was repeated 48 hours later. In group 2, socket was irradiated with a low power red laser for 3 consecutive days (200 mW, 30 seconds on each of the buccal and lingual surfaces and 30 seconds at the middle of the socket, 6 J per area). The subjects in group 3 underwent treatment with a low power infrared laser with the same parameters as group 2. A visual analogue scale (VAS) was used to record the degree of pain at the morning (T0, before intervention) and at 6 (T1) and 12 (T2) hours later for 3 days. RESULTS: Pain was significantly lower in the alvogyl group than the other groups at T1 and T2 points on day 1 and at T0 and T1 points on day 2 (p<0.05). At T2 point on day 2 and on day 3, VAS became significantly lower in the red laser group compared to the other groups (p<0.05). The infrared laser was not more efficacious than the other groups at any of the treatment intervals, but it reduced VAS to an acceptable level. CONCLUSIONS: LLLT displayed good results in this study for treatment of alveolar osteitis and should be further investigated as an alternative to alvogyl for AO management.

Effect of platelet-rich fibrin on frequency of alveolar osteitis following mandibular third molar surgery: a double-blinded randomized clinical trial.

PURPOSE: To evaluate the effectiveness of platelet-rich fibrin (PRF) in preventing the development of alveolar osteitis (AO). MATERIALS AND METHODS: In a double-blinded study, patients with bilateral impacted mandibular third molars underwent surgical extractions, with one socket receiving PRF and the other one serving as a control. The surgeon and patient were unaware of the study or control side. The predictor variable was the PRF application and was categorized as PRF and non-PRF. The outcome variable was the development of AO during the first postoperative week. Other study variables included age, gender, smoking status, irrigation volume, extraction difficulty, surgeon experience, and number of anesthetic cartridges. Data were analyzed using χ(2) and t tests, with the significance level set at a P value less than .05. RESULTS: Seventy-eight patients (mean age, 25 yr) underwent 156 impacted third molar surgeries. The overall frequency of AO was 14.74% for all surgeries. The frequency of AO in the PRF group was significantly lower than in the non-PRF group (odds ratio = 0.44; P < .05). CONCLUSION: Based on the results of the present study, PRF application may decrease the risk of AO development after mandibular third molar surgery.

Assessment of Benign Paroxysmal Positional Vertigo (BPPV) Incidence Following Closed Sinus Lift and Ridge Splitting Surgeries: A Cohort Study.

Background: With a notable increase in demand for implant placement in atrophic cases, this study aimed to evaluate the occurrence of benign paroxysmal positional vertigo (BPPV) following closed sinus lift and ridge splitting surgeries. Materials and Methods: Healthy patients requiring posterior maxillary closed sinus lift or ridge split surgeries at Mashhad Dental School from September 2021 to September 2022 were enrolled in this cohort study. A single surgeon performed all surgeries under standard protocols. The intervention groups consisted of closed sinus lift and ridge splitting procedures. The primary outcome variable was BPPV, and the Dix-Hallpike maneuver was used before and after the operation to diagnose BPPV. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05. Results: A total of 112 patients (51 women and 61 men) with a mean age of 48.4 ± 9.5 years participated in the study. The average BMI was 21.5 ± 2.4, and the mean duration of surgery was 31.9 ± 6.6 min. Of the patients, 10.7, 36.6, 27.7, 12.5, and 1.8% presented with hypertension, headache, dizziness, nausea, and BPPV, respectively. Two patients (3.1%) in the closed sinus lift group were diagnosed with BPPV, whereas no patients in the ridge split group were diagnosed. However, there was no significant difference (P = 0.509). No statistically significant difference in the occurrence of certain symptoms between two groups was found. There was a significant association between certain health conditions and the onset of BPPV. Conclusion: The study suggests closed sinus lift surgery may have a higher risk of BPPV than ridge split surgery, but further studies with larger sample are needed to confirm this association.

Effect of menstrual cycle on frequency of alveolar osteitis in women undergoing surgical removal of mandibular third molar: a single-blind randomized clinical trial.

PURPOSE: To measure the association between the menstrual cycle and the frequency of alveolar osteitis (AO). MATERIALS AND METHODS: In a study with a single-blind design, patients with bilateral impacted third molar teeth underwent randomized surgical extraction: one tooth during the menstrual period and one during the middle of the cycle. The postoperative examiner was unaware of the menstrual cycle status of the patients. The predictor variable was the timing of the menstrual cycle and was grouped as mid-cycle and menstrual period. The outcome variable was AO, which was measured (without knowledge of the menstrual cycle timing) at 2 to 7 days postoperatively. Other study variables included oral contraceptive (OC) use, smoking status, irrigation used during surgery, extraction difficulty, surgeon experience, number of local anesthetic cartridges used, and patient age. Appropriate bi- and multivariate statistics were computed, and the level of statistical significance was set at P < .05. RESULTS: A total of 145 female patients, with a mean age of 24 years, underwent 290 third molar extractions. The overall frequency of AO was 23.45%. The frequency of AO was significantly greater in the middle of the cycle than during the menstrual period inboth the OC users and nonusers (P < .05). Although OC users revealed a significantly greater frequency of AO compared with nonusers (P < .05), no statistically significant differences were found between the 2 groups during the menstrual period (P > .05). CONCLUSIONS: According to the results of the present study, the menstrual cycle could be a determinant risk factor in the frequency of AO. We recommend that elective procedures be performed during the menstrual period in both OC users and nonusers to eliminate the effect of cycle-related hormonal changes on the development of AO.

Effectiveness of green tea mouthwash in postoperative pain control following surgical removal of impacted third molars: double blind randomized clinical trial.

BACKGROUND: Pain following surgical removal of impacted molars has remained an important concern among practitioners. Various protocols have been proposed to reduce postoperative pain. However, each one has special side effects and limitations. As green tea possesses anti-inflammatory and antibacterial properties, the aim of the current study was to evaluate the effectiveness of green tea mouthwash in controlling postoperative pain. MATERIALS AND METHODS: In a study with split-mouth and double blind design, 44 patients in need of bilateral removal of impacted third molars underwent randomized surgical extraction; following one surgery patients rinsed with a green tea mouthwash from the first to seventh postoperative day and after other extraction rinsed with placebo mouthwash in the same duration. Both patients and surgeon were blinded to the type of mouthwash. The predictor variable was type of mouthwash and primary outcome variable was postoperative pain measured by visual analogue scale (VAS) during first week after surgery. In addition, number of analgesics patients used after surgery recorded. To measure the effect of green tea mouthwash, repeated measures test with confidence interval of 95% was performed. RESULTS: Total of 43 patients with mean age of 24 years underwent total of 86 surgeries. VAS value had no statistically difference prior rinsing among groups (P-value > 0.05). However, the mean value of VAS following rinsing with green tea was statistically lower than placebo in postoperative days of 3-7 (P-value < 0.05). In addition, while rinsing with green tea, patients took significantly lower number of analgesics after surgery (P-value < 0.05). No side effects reported. CONCLUSION: Green tea mouthwash could be an appropriate and safe choice to control postoperative pain after third molar surgery.

Three Different Fixation Modalities following Mandibular Setback Surgery with Sagittal Split Ramus Osteotomy: A Comparative Study using Three-dimensional Finite Elements Analysis.

Background: The provision of sufficient stability after maxillofacial surgery is essential for the reduction of complications and disease recurrence. The stabilization of osteotomized pieces results in rapid restoration of normal masticatory function, reduction of skeletal relapse, and uneventful healing at the osteotomy site. We aimed to compare qualitatively stress distribution patterns over a virtual mandible model after bilateral sagittal split osteotomy (BSSO) bridged with three different intraoral fixation techniques. Methods: This study was conducted in the Oral and Maxillofacial Surgery Department of Mashhad School of Dentistry, Mashhad, Iran, from March 2021-March 2022. The mandible computed tomography scan of a healthy adult was used to generate a 3D model; thereafter, BSSO with a 3mm setback was simulated. The three following fixation techniques were applied to the model: 1) two bicortical screws, 2) three bicortical screws, and 3) a miniplate. The bilateral second premolars and first molars were placed under mechanical loads of 75, 135, and 600N in order to simulate symmetric occlusal forces. Finite element analysis (FEA) was carried out in Ansys software, and the mechanical strain, stress, and displacement calculations were recorded. Results: The FEA contours revealed that stress was mainly concentrated in the fixation units. Although bicortical screws presented better rigidity than miniplates, they were associated with higher stress and displacement readings. Conclusion: Miniplate fixation demonstrated the most favorable biomechanical performance, followed by fixation with two and three bicortical screws, respectively. Intraoral fixation with miniplates in combination with monocortical screws can serve as an appropriate fixation arrangement and treatment option for skeletal stabilization after BSSO setback surgery.

Pharmacological and Non-Pharmacological Methods of Postoperative Pain Control Following Oral and Maxillofacial Surgery: A Systematic Review.

Background: We aimed to investigate the pharmacological and non-pharmacological interventions used for mitigating pain. Methods: We integrated randomized controlled trials (RCTs) chosen from PubMed, Google scholar, and Scopus and aimed at assessing the effectiveness of one or multiple variants of Non-steroidal anti-inflammatory drugs (NSAIDs), as well as Narcotic analgesics, compared to corticosteroids, curcumin, hyaluronic acid, and antibiotics. In addition, trials utilizing NSAIDs, including Rofecoxib, which have been withdrawn from market circulation, were deemed ineligible for inclusion. Result: A total of 9 RCTs were evaluated in this study, and the patients' postoperative pain was assessed using the visual analog scale (VAS) and the time measurement. Moreover, there were various approaches to alleviating pain and discomfort. Conclusion: The administration of ibuprofen prior to surgery leads to a marked reduction in pain. Pharmacological interventions, such as the administration of dexamethasone and oxycodone, alongside non-pharmacological interventions, such as laser therapy, have been shown to effectively alleviate the discomfort resulting from surgical procedures on the jaw and face.

Oral and maxillofacial literature from Middle East: a bibliometric analysis and list of top-100 most cited articles.

OBJECTIVES: The aim of this work is to perform a bibliometric analysis on Middle Eastern oral and maxillofacial surgery through years and to compare the data with previous studies. A list of the top 100 most cited articles was generated. METHODS: A Pubmed bibliographic search for literature journals specialized in oral and maxillofacial surgery in the Middle East was performed. A graphic representation of authorship and keywords was created with VOSviewer. Mendeley and Microsoft Excel were used for tabulation and data visualization. A list of the top 100 most cited articles was created using Web of Science. Some statistical tests were performed with a 95% confidence interval, which was considered significant. RESULTS: A total of 6,536 articles were retrieved in fifteen selected oral and maxillofacial journals. A moderate correlation between number of publications and total population (R = 0.6052), low correlation with area (R = 0.302291), and a negligible correlation with the Human Development Index (HDI) were found (R = 0.1747). A disparity can be seen in the number of publications by country, leaded by Turkey (46.30%), Israel and Iran (13.68% each). The more common studied topic was oral surgery (25.77%), maxillofacial trauma (16.13%) and oral pathology (10.25%). CONCLUSIONS: A useful list of the top 100 most cited articles on oral and maxillofacial surgery from Middle East has been created. Middle East publications on oral and maxillofacial surgery can be considered high quality (IF = 1.879). Some issues on performing an adequate selecting of MeSH keywords were discussed.

Treatment Options of Maxillofacial Fractures in Iran: A Comprehensive Systematic Review.

Background: The aim of this study was to systematically review the literature on the treatment options of maxillofacial fractures in Iran, complementing a previous article regarding causes and the overall prevalence. Methods: A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify the relevant articles published up to January 2023. Studies reporting the treatment option of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed. Results: This systematic review included 13 articles with a total of 19,147 treated patients for maxillofacial fractures. ORIF was the most common type of treatment, but complications occurred in approximately 5% of cases. Mandible fractures were not statistically more treated by ORIF than closed reduction or conservative treatment, and no type of treatment was considered statistically preferable depending on the anatomical region affected by Iranian maxillofacial surgeons. The included studies were considered to have a low risk of bias, but many were not clear in reporting cross-referenced data regarding the type of treatment, which could be considered a major flaw. Conclusion: Overall, this study provides valuable insights into the types of treatment used for maxillofacial fractures by Iranian surgeons and highlights the importance of clear reporting of data in research articles.

Is There Any Differences in Dento-Skeletal Stability between One Vs. Three-Screw Fixation of Mandible Following Bilateral Sagittal Split Osteotomy (BSSO)?

Background: The aim of this study was to compare the dento-skeletal stability between one and three-screw fixation of mandible following bilateral sagittal split osteotomy (BSSO) in skeletal class 3 patients. Methods: Healthy patients with skeletal class 3 malocclusion in Mashhad, Iran, from August 2020 to May 2021 were undergone mandibular setback through bilateral sagittal split osteotomy. Rigid fixation was performed in one group with one-screw technique, and three-screw fixation was done in another group. Cephalogram x-rays were prepared and analyzed in three stages: before surgery (T0), one week after the surgery (T1), and six months postoperatively (T2). The linear and angular alterations of chosen multivariate skeletal and dental variables were evaluated and statistically compared in all three periods. Results: This study included a total of 20 patients, 12 of them were female (60%). Patients in the one-screw fixation group had a mean age of 20.6 ± 2.2 years old, whereas those in the three-screw fixation group were 21.5 ± 2.8 years old, with no statistically significant difference. Both groups had excellent mandibular stability six months following surgery. No statistically significant differences were observed in the postoperative skeletal and dental changes between the two techniques. Conclusion: Fixation of the mandible following the setback surgery by the BSSO technique with the one-screw fixation method may be accomplished effectively, and the therapeutic outcomes are comparable to those obtained with the traditional 3-screw fixation approach.

Emergence from Anesthesia: A Comparison between Isolated Mandibular Setback and Bimaxillary Orthognathic Surgeries in Skeletal Class III Patients.

Background: We aimed to compare the emergence from anesthesia between the isolated mandibular setback and bimaxillary orthognathic surgeries in Skeletal Class III Patients. Methods: All healthy patients with skeletal class III deformity admitted to Mashhad Dental School, Mashhad, Iran from the years 2017 to 2018 were included in this study. They were candidates for either bimaxillary orthognathic surgery (Bimax surgery) through a combination of mandibular setback surgery plus maxillary advancement or isolated mandibular setback (Monomax surgery). The predictor variable was the type of jaw displacement and anesthesia duration, while the outcome variable was the duration of emergence from general anesthesia. The duration of emergence from anesthesia was calculated from the time the patient was transported to the recovery room until the time of safely discharging from the recovery room. For statistical analysis, the significance level was set at 0.05 using SPSS 21. Results: A total of 81 consecutive patients, comprising 45 (55.6%) males and 36 (44.4%) females, with an average age of 23.15±4.58 years were recruited. Among the participating patients, 56 (69.1%) underwent bimaxillary surgery while the other 25 (30.9%) were treated with Monomax surgery. Regardless of the type of performed surgery, the duration of general anesthesia was the only factor to be significantly correlated to the length of emergence from anesthesia (P= 0.001). Conclusion: Increased exposure time to general anesthesia might result in a longer emergence from anesthesia, despite the type of performed orthognathic surgery. Further clinical trials are needed to support the relevancy.