The pattern of maxillofacial fractures associated with rollover accidents: A 7-year retrospective study.

BACKGROUND/AIM: This study aimed to assess the incidence and pattern of maxillofacial fractures and related demographic data in the victims of rollover crashes. PATIENTS AND METHODS: This retrospective study was based on medical records of patients who sustained maxillofacial injuries following rollover accidents. Investigated data included age, gender, accident date and time, accident cause, seat belt usage, airbag deployment, road type, anatomical location of the facial fracture, and treatment approach. RESULTS: Among the 147 patients who met the inclusion criteria, the most prevalent age groups were 20-30 (36.7%) and 30-40 (32.7%) years, with a mean age of 33.6 ± 9.7 years. The male-to-female ratio was 6:1. Most crashes occurred in March, August, and July. These accidents involved 69.4% light vehicles and 39.6% heavy vehicles. The leading causes of rollover crashes were speeding (58.5%) followed by distracted driving (21.1%) and traffic rule violations (13.6%). The most prevalent injuries were fractures of the maxillary sinus wall (40.8%), nasal bones (39.5%), zygomaticomaxillary complex (36.1%), and the mandible (32.6%). Surgical intervention was necessary for 44.2% of patients, while 12.9% of cases underwent close reduction, and 42.9% did not require any surgical intervention. The occurrence of nasal bone fractures was significantly lower in cases where seat belts were worn and zygomatic arch fractures were less frequent in incidents with airbag deployment. CONCLUSIONS: In rollover crashes, the midface is the most vulnerable anatomical location. Utilization of seat belts and airbag deployment has the potential to prevent nasal bone and zygomatic arch fractures.

Accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery.

PURPOSE: The aim of this study was to assess the accuracy of maxillary repositioning surgery in teaching hospitals using conventional model surgery. MATERIALS AND METHODS: A total of 73 patients undergoing single-piece LeFort I osteotomies in the maxilla and bilateral sagittal split osteotomies in the mandible were included in the study. Preoperative and immediate postoperative cone-beam CT were compared in computer software (Dolphin3D©). Maxillary landmarks relative to the vertical and horizontal reference lines were evaluated. The difference between the planned and achieved maxillary positions was measured. Distance error in millimeters and achievement ratio (achieved displacement/planned displacement*100) were calculated for different maxillary movements. RESULTS: Midline correction and advancement were the most accurate movements with an overall mean distance error of 0.53 mm and 0.63 mm respectively while posterior impaction and setback were the least accurate movements with 1.38 mm and 1.76 mm mean discrepancies, respectively. A significant difference was observed only in setback movement regarding the discrepancy value (P < .05). Although setback and down-graft movements tended to under-correction, all other movements were overcorrected. As the magnitude of maxillary movements increases, the accuracy decreases. In severe displacements (≥ 8 mm), the accuracy declines significantly (P < .05). CONCLUSION: Classic cast surgery and manually fabricated intermediate splints in teaching hospitals yield accurate and acceptable results in the majority of cases (84.6%). The accuracy of maxillary repositioning decreases as the magnitude of displacement increases.

Fibrous dysplasia associated with peripheral giant cell granoluma in maxilla in a young patient, a case report of rare hybrid lesion.

Benign fibro-osseous lesions are a diverse range of entities that have distinct clinical and radiographic features. They can occur as solitary lesions or concomitant with other pathologies as hybrid lesions. Fibrous dysplasia (FD) accompanied by central giant cell granuloma (CGCG), peripheral giant cell granuloma (PGCG) or peripheral ossifying fibroma (POF) as hybrid lesions, is reported very rarely in the literature. Although we were unable to find any reports of FD with PGCG as a hybrid lesion. Fibro-osseous lesions have certain histopathological features in common with PGCG including multinucleated giant cells. Here we report a 28 year old female with a painless, slow growing and pedunculated swelling of the maxilla for 18 months. Differential diagnosis consisted of FD, cemento-ossifying fibroma (COF), chondrosarcoma and probable PGCG considering radiographic and clinical investigations. Histopathologic findings revealed PGCG and FD as a hybrid lesion. The combination of PGCG and FD has not been reported in the literature so far.

Multiple maxillary periodontal abscesses as a manifestation of post-coronavirus disease 2019 mucormycosis: a case report.

BACKGROUND: Coronavirus disease 2019 makes patients more susceptible to superinfection of fungal disease as a consequence of immunological system impairment. Mucormycosis is a fungal infection that is rare but has a high mortality rate and mostly affects patients with poorly controlled diabetes mellitus or those receiving corticosteroids. CASE PRESENTATION: Here, we present a case of post-coronavirus disease 2019 mucormycosis in a 37-year-old Persian male presenting with multiple periodontal abscess with purulent discharge and necrosis of maxillary bone (without oroantral communication). Surgical debridement following antifungal therapy was the treatment of choice. CONCLUSION: Early diagnosis and immediate referral are the cornerstone of comprehensive treatment.

COVID-19-associated mucormycosis involving the maxilla.

It is important to increase the awareness and knowledge of head and neck surgeons about the recent surge of craniofacial mucormycosis in COVID-19 patients because early diagnosis and appropriate treatment are essential to improve the outcomes. Here, we describe clinical features, treatment protocols, and outcomes of treatment in eight patients with COVID-19-associated mucormycosis in the maxilla. Consistent with the findings of previous studies, our experience in the management of these eight patients shows that early administration of amphotericin B and prompt aggressive surgery are essential for optimal control of the disease.

Staged reconstruction of hemimaxillectomy defect: Application of buccal fat pad flap, iliac bone graft and implant-supported dental prostheses.

In order to achieve a fixed implant-supported prosthesis in a posthemimaxilectomy patient, ideal soft and hard tissue rehabilitation is necessary. Here, we present a staged approach for soft tissue reconstruction with local flaps followed by anterior iliac crest bone graft which resulted in a predictable and satisfactory outcome.

Self-regeneration of an extensive bony defect following mandibular resection.

Spontaneous bone regeneration is a rapid and uncommon formation of new bone in a previous bone defect. Preservation of periosteum as the main source of osteogenesis, young age, and genetics are possible important factors related to this phenomenon.

Metastasis of a prostate adenocarcinoma to mandible: A case report and review of literature.

Dentists and physicians should include oral metastases originating from prostate adenocarcinoma as a rare differential diagnosis of jaw lesions that can produce periosteal reactions in the radiographic features such as osteosarcoma.

Hybrid Odontogenic Tumor of Calcifying Odontogenic Cyst and Ameloblastic Fibroma: a Case Report and Review of Literature.

Calcifying odontogenic cyst is an uncommon odontogenic lesion that represents less than 2% of all odontogenic cysts and tumors. It usually occurs in incisor and canine areas during the second to fourth decades of life. It can be associated with other lesions like odontoma, ameloblastic fibroma, ameloblastoma, adenomatoid odontogenic tumors, odontoameloblastoma, and odontogenic myxoma. Ameloblastic fibroma is a truly mixed tumor usually diagnosed within the posterior mandible during the first two decades of life. In the present article, a hybrid odontogenic tumor composed of calcifying odontogenic cyst and ameloblastic fibroma in a 14-year-old white Persian female is described.

Cervical Necrotizing Fasciitis After Surgery of a Mandibular Fracture.

INTRODUCTION: Cervical necrotizing fasciitis (CNF) is a rapid progressing and potentially fatal infection of connective tissues that spreads along the fascial planes. It commonly develops from odontogenic sources. In this article, the authors present a case of CNF which was developed after open reduction and internal fixation (ORIF) of a mandibular fracture. CLINICAL CASE: A 19-year-old male patient with no past medical history was admitted due to a mandibular fracture. Following ORIF surgery, on third post-operative day, Physical examination revealed extensive cervical swelling extending from submandibular to suprasternal area, with tender and erythematous skin. Soon after confirmation of CNF diagnosis, surgical debridement and wide spectrum antibiotic therapy was performed. The residual soft tissue defect was reconstructed following infection subsidence. CONCLUSION: Our study aims to highlight the risk of CNF development during postoperative period of a simple mandibular fracture ORIF surgery which is considered a routine maxillofacial procedure. Early detection and adequate emergency treatment including immediate surgical intervention are critical in the management of these patients.

Inferior Alveolar Nerve Medialization for Dental Implant Placement: Case Report with the Introduction of a New Technique.

Inferior alveolar nerve repositioning is an option for treating the edentulous posterior mandible with insufficient bone height above the inferior alveolar canal. This report presents a case in which inferior alveolar nerve medialization was performed for placing dental implants. In the second postoperative week, mandibular fracture occurred after biting on a relatively solid piece of food, which was treated conservatively.

The Conservative Treatment of Pediatric Mandible Fracture With External Nasal Splint.

INTRODUCTION: The frequency of mandible fractures is relatively less in children compared with adults, but their treatment is significantly more challenging due to the concerns regarding mandible growth and the developing dentition. The authors have introduced a new way of closed reduction by using external nasal splints. METHODS: In 3 patients aged between 4 and 6-year old with parasymphyseal and body fractures of mandible, fractures were reduced under general anesthesia and thermoplastic nasal splints were directly formed and trimmed to fit the lingual surface of mandible.Splints were fixed to mandible with circummandibular wiring and were retained in place for 3 weeks. RESULTS: All fractures healed uneventfully and the occlusion in all patients was satisfactory. All patients gained good masticatory efficiency. There was no need to use the intermaxillary fixation in any of the patients. CONCLUSION: Using thermoplastic external nasal splint for fracture stabilization in children is an easy, rapid, nonexpensive, and conservative way to treat mandible fractures in pediatric patients.

Effect of low-concentration povidone iodine on postoperative complications after third molar surgery: a pilot split-mouth study.

PURPOSE: Povidone iodine is used primarily as an antiseptic to decrease surgical site infection. Its hemostatic and antiedematous properties in oral surgery also have been investigated recently. PATIENTS AND METHODS: A randomized controlled clinical trial was performed in 30 patients undergoing mandibular third molar removal in a split-mouth design. In the study group, a povidone iodine solution with a concentration of 0.5 mg/mL was used as the coolant and irrigant solution, whereas normal saline was used in the control group. Swelling (orotragus and mentotragus distances), trismus (maximum interincisal opening), and pain (visual analog scale score) were evaluated on postoperative days 2 and 7. RESULTS: In the study group, a significant decrease in swelling and trismus was observed at the 2 postoperative visits (P = .00) compared with the control group. The decrease of pain in the study group was not statistically significant at either postoperative visit (P > .05). More patients (63%) were subjectively satisfied with the side treated with povidone iodine. CONCLUSION: Povidone iodine irrigation is an inexpensive and safe method to lessen the postoperative sequelae of third molar surgery.