Identifying the Best Reduction Point for Zygomatic Arch Fractures Using Surface Markers.

This study aimed to describe a straightforward and efficient surgical technique for identifying the ideal point of reduction in isolated zygomatic arch fractures using preoperative radiopaque markers. In addition, a retrospective review of patient outcomes associated with this technique was conducted. The collected data encompassed demographics, injury side, mechanism of injury, time of injury, and classification of the isolated arch fracture. Measured outcomes included radiographic anatomic reduction, clinical facial symmetry, surgical operating time, and maximum interincisal mouth opening. Descriptive statistics were computed for each study variable. A total of 12 patients (10 males and 2 females) with an average age of 39.25 years (range: 26-60 y) were included in the study. The mechanisms of injury comprised road traffic accidents (6 patients, 50%), sports-related injuries (2 patients, 16.7%), occupational injuries (2 patients, 16.7%), and falls (2 patients, 16.7%). On average, patients presented 3 days after the injury (range: 1-14 d). The fracture classification according to Reyes and colleagues categorized 10 patients (83.3%) as type 4 and 2 patients (16.7%) as type 2. Coronoid impingement was observed in half of the patients (50%). The average surgical time was 15.4 minutes (range: 12-19 min). All patients exhibited optimal radiographic anatomic reduction, clinical facial symmetry, and maximum interincisal opening. In conclusion, this study demonstrates that the described technique is a simple and effective method for identifying the optimal reduction point in isolated zygomatic arch fractures.

Consensus Statement of the Saudi Society of Oral and Maxillofacial Surgery on practice during the COVID-19 pandemic in Saudi Arabia.

The coronavirus pandemic (COVID-19) has impacted essentially every country's healthcare system in extraordinary ways, fundamentally changing the way we deliver care. The practice of oral and maxillofacial surgery is no exception. In response to this global health crisis, the Saudi Society of Oral and Maxillofacial Surgery has prepared this consensus statement to inform our clinical and other medical colleagues and the public at large on proper procedures during this time. The statement is based on the best scientific evidence available and follows the guidelines put forth by the Saudi Ministry of Health on the COVID-19 response. It explains how to manage and triage oral and maxillofacial patients based on the level of care needed at the time of clinical presentation.

Photobiomodulation Therapy for Myofascial Pain in Temporomandibular Joint Dysfunction: A Double-Blinded Randomized Clinical Trial.

AIMS: Temporomandibular disorder (TMD) is a complex process that affects the temporomandibular joint (TMJ). The multifactorial process is of unknown etiology and has many manifestations and thus many management options. Photobiomodulation therapy has been suggested for management of TMD, despite the lack of understanding of its exact mechanism. The aim of this study is to examine the effectiveness of photobiomodulation in the treatment of myofascial type TMD. METHODS: Patients with unilateral TMJ and masticatory muscles pain during function were recruited and divided into two groups: a control group that received a sham laser treatment every 48 h for 10 days and a test group that received the same frequency of treatment to deliver a dose of 257 J per treatment and a total dose of 1285 J for the entire treatment. Pain was assessed using the visual analog scale (VAS). RESULTS: There was a significant difference in VAS scores between the test and control groups with the test group scoring lower. CONCLUSION: Photobiomodulation therapy proved to be an effective short-term therapeutic modality for myofascial TMD pain. It is non-invasive, easy to apply with no systemic side effects. Its long-term effect and its effect on different subtypes of TMD need further investigation.

Prevalence of Temporomandibular Joint Disorders in Adults in Jeddah, Kingdom of Saudi Arabia: A Cross-sectional Study.

AIM: Assess the prevalence of temporomandibular dysfunction (TMD) in adults in Jeddah, Kingdom of Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional study of adults aged 18 years and above during their routine visit to primary care dental centers in the city in 2018. Five-hundred participants enrolled in this study. Primary healthcare centers are clustered geographically in five areas of the city (north, south, west, east, and center) by the ministry of health. One-hundred participants were recruited from each area. The TMD/pain screener questionnaire was completed by participants. The first item used a scoring mechanism of 0-2 (a = 0, b = 1, c = 2), and the second and third items were scored 0-1 (a = 0, b = 1). A total score of 3 or more indicates the presence of TMD. t test was used to evaluate gender differences in TMD prevalence with a significance level of p < 0.05. RESULTS: There were 250 females and 250 males participants. The mean age was 40.6 years (range: 18-89 years; standard deviation: 13.7 years). Answers to the first question showed that 52% of participants had no pain in the temple area, or jaw in the last 30 days, 46% of participants had intermittent pain, and 2% had persistent pain. Twenty-seven percent of participants had pain or stiffness in the jaw upon waking up, whereas 39% of participants had pain while chewing food, 29% experienced pain from opening the mouth or moving the jaw, 34% during jaw habits such as holding the teeth together, clenching, or chewing gum, and 18% during other jaw activities such as talking, kissing, or yawning. A total score of 3 or more was found in 175 participants, indicating a prevalence of 35%. TMD was significantly more prevalent in females (105 participants, 42%) than in males (70 participants, 28%) with p = 0.0008. CONCLUSION: The prevalence of TMD in adult population in Jeddah is considered high. It is significantly more prevalent in females than in males. CLINICAL SIGNIFICANCE: TMD prevalence is relatively high in adults of Jeddah, Kingdom of Saudi Arabia. Public health efforts should be directed at increasing TMD awareness in patients and healthcare professionals.

Effect of Advanced Platelet-rich Fibrin on Wound Healing after Third Molar Extraction: A Split-mouth Randomized Double-blind Study.

AIM: To evaluate the potential of advanced platelet-rich fibrin (A-PRF) as a regenerative biomaterial for bone regeneration and postoperative sequelae after impacted third molar extractions. MATERIALS AND METHODS: This was a split-mouth, randomized, double-blind clinical trial. A total of 10 female patients in King Abdulaziz University Dental Hospital with bilateral impacted third molars were recruited into the study. Surgical extractions were performed on both sides of the mandible. Randomization was done by a coin toss; A-PRF was placed on the one side while the other side did not receive any intervention. Each patient acted as their own control. Both the patients and the investigators were blinded about the A-PRF side. The outcome on periodontal regeneration was made measuring pocket depth (PD), gum recession (GR), and clinical attachment level (CAL) before and at 1- and 3-months postoperatively. Pain, swelling, and healing were assessed on the 7th postoperative day. p value less than 0.05 was considered statistically significant. RESULTS: An estimated 10 patients completed the study. There were no significant differences in PD, CAL, and GR between the two groups at any time point, although the data obtained were slightly favoring the A-PRF. However, a statistically significant reduction in pain and swelling was observed in the A-PRF group compared to the controls (p < 0.05). CONCLUSION: The findings of this study demonstrate A-PRF as a potential biomaterial for lessening the severity of pain and swelling after third molar surgery. Long-term trials with a larger sample size and more methodically sound assessment tools are needed to obtain more meaningful results on periodontal regeneration. CLINICAL SIGNIFICANCE: Placement of A-PRF clot in the extraction socket could lessen postoperative pain and increase patient comfort after third molar extraction. TRIAL REGISTRATION: NCT03703479. Registered 8 October 2018 How to cite this article: Zahid TM, Nadershah M. Effect of Advanced Platelet-rich Fibrin on Wound Healing after Third Molar Extraction: A Split-mouth Randomized Double-blind Study. J Contemp Dent Pract 2019;20(10):1164-1170.

Is Alloplastic Temporomandibular Joint Reconstruction a Viable Option in the Surgical Management of Adult Patients With Idiopathic Condylar Resorption?

PURPOSE: Idiopathic condylar resorption (ICR) presents diagnostic and therapeutic challenges to practitioners because of the rarity of the condition, progressive deformity, and simultaneous involvement of skeletal, occlusal, and articular disorders. The objective of this study was to report clinical outcomes after prosthetic replacement of the temporomandibular joint (TMJ) for the management of ICR. PATIENTS AND METHODS: A retrospective analysis of patients with ICR managed by bilateral total TMJ replacement and concomitant mandibular advancement with or without maxillary surgery was performed using data gathered from medical records. The primary treatment outcomes of interest were 1) correction of anterior open bite malocclusion, 2) mandibular advancement, and 3) increase in posterior facial height. Secondary outcomes included subjective assessment of pain, dietary restrictions, and functional disability and objective evaluations of TMJ sounds, occlusal relation, mandibular range of motion, cranial nerve VII injury, and objectionable scarring. Radiographs were used to measure surgical change and relapse. RESULTS: Twenty-one patients met the inclusion criteria for this retrospective study. The average patient age was 25.6 years (range, 22 to 32 yr) and mean follow-up was 6.2 years (range, 5 to 12 yr). Mean mandibular advancement at the B point was 24.3 mm and mean change in occlusal plane was -10.2°. Sixteen patients (76%) underwent maxillary orthognathic surgery for posterior downgrafting with rigid fixation and grafting. Long-term follow-up showed excellent stability of surgical movements with a decrease in TMJ and myofascial pain, headaches, and dietary restrictions. CONCLUSIONS: Patients with ICR can be effectively treated using total TMJ prostheses with maxillary orthognathic surgery when indicated for the correction of an associated dentofacial deformity. Use of alloplastic joint prostheses allows for the execution of large mandibular advancements in a predictable and accurate manner with a meaningful decrease in symptoms of TMJ dysfunction.

Therapeutic applications of botulinum neurotoxins in head and neck disorders.

OBJECTIVE: The aim of this article is to review the mechanism of action, physiological effects, and therapeutic applications of botulinum neurotoxins in the head and neck area. STUDY DESIGN: An extensive literature search was performed using keywords. The resulting articles were analyzed for relevance in four areas: overview on botulinum neurotoxins, the role of botulinum neurotoxins in the management of salivary secretory disorders, the role of botulinum neurotoxins in the management of facial pain, and the role of botulinum neurotoxins in head and neck movement disorders. Institutional review board approval was not needed due the nature of the study. RESULTS: Botulinum neurotoxin therapy was demonstrated to be a valuable alternative to conventional medical therapy for many conditions affecting the head and neck area in terms of morbidly, mortality, and patient satisfaction with treatment outcomes. CONCLUSION: Botulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.

Orthognathic surgery in the presence of temporomandibular dysfunction: what happens next?

One of the most well-known yet perhaps controversial conditions affecting temporomandibular dysfunction (TMD) and the signs and symptoms of facial pain and clinical outcomes after orthognathic surgery procedures is temporomandibular joint internal derangement. This article provides an overview of the mutual relationship between orthognathic surgery and TMD, with especial consideration to internal derangement. The existing literature is reviewed and analyzed and the pertinent findings are summarized. The objective is to guide oral and maxillofacial surgeons in their clinical decision making when contemplating orthognathic surgery in patients with preexisting TMD.

Langerhans cell histocytosis of the mandible in a pediatric patient.

Langerhans cell histiocytosis (LCH) is a rare, proliferative disorder in which the accumulation of pathologic Langerhans cells leads to local tissue infiltration and destruction. In this article, a review of LCH is presented and a case of a single LCH lesion affecting the mandible of healthy infant is discussed. The history, radiological appearance, histopathology and treatment options are discussed.

Nutritional considerations for head and neck cancer patients: a review of the literature.

PURPOSE: Approximately 35% to 60% of all patients with head and neck cancer are malnourished at the time of their diagnosis because of tumor burden and obstruction of intake or the anorexia and cachexia associated with their cancer. The purpose of this article is to provide a contemporary review of the nutritional aspects of care for patients with head and neck cancer. MATERIALS AND METHODS: A literature search was performed in Medline, Cochrane, and other available databases from 1990 through 2012 for the clinical effectiveness of nutritional support, treatment modalities, and methods of delivery in relation to patients with head and neck malignancies. Human studies published in English and having nutritional status and head and neck cancer as a predictor variable were included. Randomized controlled trials, meta-analyses, prospective clinical studies, and systemic reviews were selected based on their relevance to the abovementioned subtitles. The resultant articles were analyzed and summarized into the definition, impact, assessment, treatment, and modes of administration of nutrition on the outcome of patients with head and neck cancer. RESULTS: Articles were reviewed that focused on the etiology and assessment of malnutrition and current nutritional treatments for cancer-induced anorexia and cachexia. Two hundred forty-eight articles were found: 2 clinical trials, 10 meta-analyses, 210 review studies, and 26 systematic reviews. Because of the lack of prospective data, a summative review of the conclusions of the studies is presented. CONCLUSION: Nutritional interventions should be initiated before cancer treatment begins and these interventions need to be ongoing after completion of treatment to ensure optimal outcomes for patients. A nutritional assessment must be part of all comprehensive treatment plans for patients with head and neck cancer. Alternative medical interventions, such as immune-enhancing nutrients or anticytokine pharmaceutical agents, also may be effective as adjuvant therapies, but more research is needed to quantify their clinical effect.

Recurrent giant pilomatrixoma of the face: a case report and review of the literature.

Pilomatrixoma, also known as pilomatricoma, is a benign tumor that originates from the matrix of the hair root. It usually presents as a single, slow-growing subcutaneous or intradermal firm nodule with a general size of less than 3 centimeters (cm) in diameter. However, giant pilomatrixomas (more than 5 cm) have been reported infrequently. It is more common in females and usually presents during the first two decades of life (60%) as an asymptomatic, mobile, hard, elastic mass. Most of the cases are benign and affect the face. The authors report a rare case of a giant pilomatricoma of the cheek and discuss the surgical management of these lesions, histopathological findings, and review of the literature.

Removal of parotid, submandibular, and sublingual glands.

Surgical removal of the major salivary glands is a common task for the oral and maxillofacial surgeon. The major salivary glands have complex anatomic relationships with the surrounding neurovascular structures, and a thorough understanding of the surgical anatomy is essential for any surgeon involved in the management of salivary gland disease. This article reviews the indications, surgical anatomy, diagnostic evaluation, and surgical techniques for removal of the major salivary glands.

Use of 3-d stereolithographic models in oral and maxillofacial surgery.

OBJECTIVE: To assess the feasibility of the use of 3-dimensional (3-D) stereolithographic (SLA) technology in complex maxillofacial reconstructive surgery. MATERIALS AND METHODS: 3-D SLA technology was used in the treatment planning of complex maxillofacial procedures performed by the Department of Oral and Maxillofacial Surgery at Boston University. Specialized 3-D models were ordered and utilized for surgical treatment of a variety of indications including trauma surgery, temporomandibular joint surgery, orthognathic surgery, secondary correction of facial and skull deformities, and extensive jaw pathology. This technology was also used in one patient for jaw reconstruction using novel bone and tissue engineering techniques. RESULTS: The use of 3-D models in Oral and Maxillofacial Surgery significantly improved predictability of clinical outcomes when compared to similar treatments without its use. Total operating time was reduced which had the benefit of decreasing the duration of general anesthesia and reducing wound exposure time. They allowed for assessment of extensive traumatic and pathologic defects in three-dimensions prior to surgical reconstruction. The models were also useful in the design and fabrication of custom prostheses, sizing of bone grafts and allowed for manufacturing of scaffolds for bone regeneration. CONCLUSIONS: 3-D SLA models can be very effectively used in oral and maxillofacial surgery for multiple indications and diverse clinical scenarios. Successful incorporation of this technology for jaw bone regeneration using tissue engineering techniques offers exciting new prospects for the future.