Recomendaciones en la Atención de Pacientes en Cirugía Maxilofacial Durante la Pandemia de COVID-19 (SARS-CoV-2) / Recommendations in the Care of Patients in Maxillofacial Surgery During the COVID-19 Pandemic (SARS-CoV-2)

RESUMEN: La nueva enfermedad por coronavirus 2019 (COVID-19) es la última patología de preocupación internacional. Originada en Wuhan, China, se extendió rápidamente a nivel mundial, razón por la cual fue declarada una emergencia de salud pública. Sus síntomas principales son fiebre, tos, dolor de garganta, dificultad respiratoria, fatiga, malestar general y la anosmia, que ha sido incorporada recientemente. Sin embargo, también se han descrito múltiples casos asintomáticos que han alarmado a la población general. Esta enfermedad, se caracteriza por su alta tasa de contagio y su mecanismo de propagación es el contacto cercano entre personas y a través de fluidos corporales como la saliva y secreciones de las vías aéreas. El personal de salud es especialmente vulnerable a la infección debido a su gran exposición a las secreciones oronasales de los pacientes, sobre todo, aquellas especialidades médicas y odontológicas cuyo campo de acción se centra en estas áreas, siendo la cirugía oral y maxilofacial una de ellas, teniendo un alto riesgo de transmisión de SARS-CoV-2. Por lo tanto, es fundamental para este personal, seguir protocolos de prevención y control de infecciones, junto con una correcta anamnesis, examen y diagnóstico de los pacientes que permita establecer una priorización en las atenciones quirúrgicas, disminuyendo la propagación del virus. El objetivo de esta revisión es conocer las recomendaciones básicas para la priorización de pacientes y el cuidado en los procedimientos quirúrgicos por parte del equipo de cirugía maxilofacial durante la pandemia por COVID-19.

ABSTRACT: The new coronavirus disease 2019 (COVID-19) is the latest pathology of international concern. Originating in Wuhan, China, it spread rapidly worldwide, which is why it was declared a public health emergency. Its main symptoms are fever, cough, sore throat, shortness of breath, fatigue, general discomfort, and anosmia, which has been recently incorporated. However, multiple asymptomatic cases have also been described that have alarmed the general population. This disease is characterized by its high contagion rate and its propagation mechanism is close contact between people and through bodily fluids such as saliva and airway secretions. Health personnel are especially vulnerable to infection due to their high exposure to patients' oronasal secretions, especially those medical and dental specialties whose field of action focuses on these areas, oral and maxillofacial surgery being one of them, having a high risk of transmission of SARS-CoV-2. Therefore, it is essential for these personnel to follow infection prevention and control protocols, together with a correct anamnesis, examination, and diagnosis of patients, which allows prioritizing surgical care, reducing the spread of the virus. The objective of this review is to know the basic recommendations for patient prioritization and care in surgical procedures by the maxillofacial surgery team during the COVID-19 pandemic.

Advantages and disadvantages of implant navigation surgery. A systematic review.

This review elucidates the advantages and disadvantages of the different implant navigation methods to assist the precise surgical placement of dental implants. Implant navigation surgery can be classified into: dynamic and static navigation, and static navigation can further be divided into full (FG)- and half-guided (HG) implant surgery. The HG implant placement includes the drilling-guided, pilot-drill guided, and the non-computed guided approaches. In dynamic navigation, the bone drilling and the implant placement are completely tracked with a specific software; while the static navigation refers to the use of static surgical templates. The FG associated with flapless surgery and teeth/crown supported guides has demonstrated the highest accuracy, followed by the drilling and pilot HG surgery that may provide comparable results, while the non-computer HG and FH implant placement provide the least accuracy in transmitting the implant positioning from the pre-surgical planning to the patient. Additionally, flapless implant surgery is related to reduced pain, less analgesic consumption, less swelling, shorter chair-time, and reduced risk of hemorrhage while achieving greater patient satisfaction. Nevertheless, other methods such as non-computer HG and FH implant surgery procedures require more surgical experience to overcome their limitations. There is still limited evidence to support dynamic surgery, and further investigations are needed.

Laser de baixa intensidade no reparo tecidual do segundo molar após cirurgia de terceiro molar: ensaio clínico randomizado duplo cego / Low intensity laser on second molar tissue repair after hird molar surgery: double blind randomized clinical trial

A exodontia de terceiros molares inferiores é uma prática comum nas clínicas odontológicas, porém o pós-operatório inerente a esta cirurgia apresenta dor, edema e trismo. Algumas das posições de inclusão do terceiro molar podem acarretar comprometimento periodontal nos segundos molares adjacentes. Com isso o presente trabalho buscou desenvolver através deste estudo clínico controlado, um protocolo com o laser de baixa intensidade para aplicação no pós-operatório das exodontias de terceiros molares mandibulares, de modo a minimizar os sinais e sintomas e melhorar os parâmetros periodontais dos segundos molares adjacentes. O laser empregado foi o Photon Laser III ­ DMC, São Carlos, SP/Brasil ­ como meio de condução o vermelho, com comprimento de onda 660 nm, potência útil de 30 mW, meio ativo AsGaAl. Sessenta pacientes de ambos os gêneros, com necessidade de exodontia dos terceiros molares, em classificações padrões de posição, foram randomizados em três grupos para análise ­ Grupo I: 10J/cm2 , Grupo II: 30J/cm2 e Grupo III: Sham, e acompanhados pelo período de 6 meses. A análise do trismo e edema facial no pós-operatório e do nível clínico de inserção encontraram diferenças estatísticas significantes entre os grupos que receberam a terapia laser quando comparado ao grupo sham. Portanto, a utilização do laser de baixa intensidade como terapia adjuvante após a exodontia de terceiros molares demonstrou efetividade. Sendo que o Grupo I se destacou, após seis meses de avaliação(AU)

The extraction of lower third molars is a common practice in dental clinics, but the postoperative period inherent to this surgery presents pain, edema and trismus. Some of the inclusion positions of the third molar can lead to periodontal involvement in the adjacent second molars. The aim of this study was to develop a low-intensity laser protocol for the post-operative treatment of mandibular third molar extractions in order to minimize the signs and symptoms and to improve the periodontal parameters of the second molars adjacent. The laser used was Photon Laser III - DMC, São Carlos, SP / Brazil - as red conduction medium, with wavelength 660 nm, useful power of 30 mW, active medium AsGaAl. Sixty patients of both genders, in need of third molar extraction in standard position classification, were randomized into three groups for analysis - Group I: 10J / cm2, Group II: 30J / cm2 and Group III: Sham, and monitored for the period of 6 months. The analysis of trismus and facial edema in the postoperative and the clinical level of insertion found significant statistical differences between the groups that received the laser therapy when compared to the sham group. Therefore, the use of the low intensity laser as an adjuvant therapy after third molar extraction was effective. As Group I stood out after six months of evaluation(AU)

[Current Nomina Anatomica for oral and maxillofacial surgery]. / Nomenclature anatomique utile en chirurgie orale et maxillo-faciale.

Using the international organonymy is mandatory as well for daily clinical practice as for research and teaching our students. The international organonymy, Nomina Anatomica, is in Latin. A rather unsuccessful attempt at using a French version of the international organonymy in clinical practice has been made in France. Eponyms have been systematically contraindicated; the definitions of general anatomy are applied, as well as a systematic Gallicization of the Latin terminology. Despite a stringent observance of these rules, some terms remain inappropriate because they are misleading or inaccurate. Furthermore, using this language used worldwide remains uneasy in daily clinical practice. We had for objective to focus on the main anatomical terms used routinely in oral and maxillofacial surgery, and to justify their use in clinical practice, research, and education.

Oral and maxillofacial surgery: what are the French specificities?

PURPOSE: Oral and maxillofacial surgery has expanded rapidly over the past century. Recognition in France has grown since the first face transplantation in the world performed by Professor Bernard Devauchelle. This speciality, which seems to correspond to a narrow scope of services, actually involves oral, plastic, reconstructive, and cosmetic surgeries of the face. French training for maxillofacial surgeons differs from the Anglo-Saxon course of study. After examining surveys carried out in Great Britain, the United States, and Brazil, the perception of this speciality in the general public and among regular correspondents (general practitioners and dental practitioners) was ascertained. MATERIALS AND METHODS: More than 4,000 questionnaires were sent to health care workers and patients attending dental practices. The returned questionnaires concerning recognition of this profession in France were analyzed. Evaluating awareness of maxillofacial surgery among practitioners and the public was of particular interest because it can overlap with several other specialities (ear, nose, and throat; plastic surgery; odontology). The questionnaire included the 20 items used in other similar studies so the results could be compared. RESULTS: Several fields of expertise were identified in maxillofacial surgery, in particular traumatology, surgery for facial birth defects, and orthognathic surgery. Moreover, dental practitioners were found to be the most regular correspondents of maxillofacial surgeons compared with general practitioners. Compared with Anglo-Saxon and Brazilian peers, French recognition of maxillofacial surgery was better. CONCLUSION: Despite encouraging results, maxillofacial surgery remains a somewhat obscure speciality for health care workers and the general public. Better awareness is necessary for this speciality to become the reference in facial surgery.

Oral and maxillofacial surgery - a case of mistaken identity?

There are international grumbles from those perturbed by an impending identity crisis within oral and maxillofacial surgery (OMFS). This unrest is further compounded by scattered suggestions that a name change may prove beneficial in raising the profile of OMFS. The purpose of this paper is to consider novel methods of increasing awareness of the specialty amongst the public, primary and secondary care colleagues by collecting a consensus of thoughts and opinions regarding the specialty's identity and the appropriate and holistic nomenclature of OMFS. Approximately 300 eight-point questionnaires were distributed internationally with a response rate, via both email and post, of approximately 25% (72). Thirty-two percent of respondents considered there to be an identity crisis within OMFS although just 18% felt that a specialty name change would be beneficial. The results suggest that the problem with identity relates more to incapacity to convey the message of OMFS rather than nomenclature.

Causas de exodoncia registradas en el Servicio Gallego de Salud / Causes of tooth extraction recorded in the Galician Health Service

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Transitioning from residency to private practice.

A resident in oral and maxillofacial surgery must prepare for the inevitable transition from residency training to practice as a private practitioner, an officer in the military, an academician, or as a fellow in a postresidency training program. Each career path offers distinct challenges and rewards. This article reviews the issues that face a chief resident embarking on a career in private practice in oral and maxillofacial surgery.

"EXODONCIA CONTEMPORANEA" APUNTES

Historia de cirugía bucal - Normas de bioseguridad en odontología - Examenes complementarios en cirugía bucal - Nervio trigémino - Anestésicos locales en odontología - Instrumental quirúrgico en cirugía bucal - Indicaciones y contraindicaciones de las exodoncias - técnicas de exodoncia simple - Exodoncia de cada pieza en particular - Accidentes y complicaciones de las exodoncias

Efectividad del tratamiento con férulas oclusales duras versus eminectomía en disfunción temporomandibular, Hospital Roberto Calderón Gutiérrez / Effects of treatment with occlusal splints hard versus eminectomía temporomandibular dysfunction, Roberto Calderon Hospital Gutierrez

El presente estudio se evaluó la eficacia clínica de férulas oclusales duras (tratamiento conservador) versus eminectomía(tratamiento quirúrgico) en sujetos con disfunción temporomandibuylar. Es un ensayo clínico exsperimental con un universo de 250 sujetos, el tamaño de la muestra fue de 120 sujetos. Los sujetos fueron valorados en etapas pre tratamiento y pos tratamiento a los 10 días, 45 días y 6 meses a través de Escala Analoga del dolor. palpación y auscultación para constatar la presencia de ruidos articulares, la maniobra de Kroug- Paulsen para valorar los movimientos anormales mandibulares en apertura y cierre. Resultados: ambas técnicas fueron efectivas para desaperecer los ruidos articulares, los movimientos anormales en las excursiones máxima apertura bucal y excursón laterotrusiva, el dolor dismnuyó en un 55 por ciento con tratamiento quirúrgico y un 70 por ciento con tratamiento conservador a los 6 meses: mandibular, con el tratamiento quirúrgico se obtuvo en deflexión un 90 por ciento y en excursión protusiva un 97 por ciento...

Intra-operative pain perception in tooth extraction--possible causes.

OBJECTIVES: To elicit the perception of pain in patients undergoing dental extraction under local anaesthesia and also to identify factors that might contribute to this experience despite the administration of local anaesthesia. SETTING: Ile-Ife, Southwestern Nigeria. PARTICIPANTS: 122 randomly selected single-tooth extraction patients. METHODS: Informed consent was obtained from patients who subsequently completed a questionnaire on the Corah Dental Anxiety Scale prior to treatment. Details documented for each patient included the demographics, history of previous tooth extraction and the status of the operator. The extraction was timed from the application of instrument until tooth delivery. Immediately after extractions, patients were asked to indicate on a Visual Analogue Scale (VAS) scores graded 0-10, the level of pain perceived during extraction. The data were subjected to simple descriptive and statistical analysis using SPSS for Windows 11.0. RESULTS: Positive correlations were found between the VAS and the anxiety scores, the attending surgeons' status, patients' anxiety score and the duration of surgery. A significant difference was found between the anxiety and the VAS scores in the different occupational groups. CONCLUSIONS: These results suggest that the status of the attending surgeon may affect the level of anxiety in patients undergoing tooth extractions prior to surgery. While patient's occupational group and duration of surgery could contribute to patient's intraoperative pain perception despite the administration of local anaesthesia.

Utilización del colgajo de músculo temporal en cirugía reconstructiva maxilofacial. Discusión / Use oftemporalis muscle flap. Discussion

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Propuesta de protocolo de evaluación kinésica para el manejo de pacientes con sindromes dolorosos miofaciales de los músculos de la masticación ocasionados por el bruxismo en la unidad de estomatología y cirugía bucomaxilofacial del Hospital de Clinicas de la Ciudad de La Paz / Protocol proposal of kinetic avaluación for the management of patients with miofaciales painful syndromes of the mastication muscles caused by the bruxism in the unit of stomatology and buccomaxillofacial surgery of the Hospital of Clinics of the city of La Paz

En el presente trabajo se propone un protocolo de evaluación kinésica para el manejo de pacientes con sindromé doloroso miofaciales de los músculos de la masticación ocasionados por el Bruxismo como producto de experiencias de trabajo de la postulante durante un año en la Unidad de estomatologia y ciriugia Bucomaxilofacial del Hospital de Clinicas de la ciudad de La Paz. Se utilizo el método empirico porque se realizó una serie de encuestas a fisioterapeutas, Especialistas Maxilofaciales y Odontólogos para identificar si trabajan con protocolos de evaluación, el método estadistico de tipo descriptivo y retrospectivo por la revisión de una serie de historia clinicas de pacientes que adolecen de Bruxismo de la Unidad ya mencionada anteriormente...