Tracheotomies in COVID-19 Patients: Protocols and Outcomes.

PURPOSE: Approximately 3-15% of COVID-19 patients will require prolonged mechanical ventilation thereby requiring consideration for tracheotomy. Guidelines for tracheotomy in this cohort of patients are therefore required with assessed outcomes of tracheotomies. PATIENTS AND METHODS: A retrospective chart review was performed of COVID-19 patients undergoing tracheotomy. Inclusion criteria were the performance of a tracheotomy in COVID-19 positive patients between March 11 and December 31, 2020. Exclusion criteria were lack of consent, extubation prior to the performance of a tracheotomy, death prior to the performance of the tracheotomy, and COVID-19 patients undergoing tracheotomy who tested negative twice after medical treatment. The primary predictor variable was the performance of a tracheotomy in COVID-19 positive patients and the primary outcome variable was the time to cessation of mechanical ventilation with the institution of supplemental oxygen via trach mask. RESULTS: Seventeen tracheotomies were performed between 4-25 days following intubation (mean = 17 days). Seven patients died between 4 and 16 days (mean = 8.7 days) following tracheotomy and 10 living patients realized cessation of mechanical ventilation from 4 hours to 61 days following tracheotomy (mean = 19.3 days). These patients underwent tracheotomy between 4 and 22 days following intubation (mean = 14 days). The 7 patients who died following tracheotomy underwent the procedure between 7 and 25 days following intubation (mean = 18.2 days). Seven patients underwent tracheotomy on or after 20 days of intubation and 3 survived (43%). Ten patients underwent tracheotomy before 20 days of intubation and 7 patients survived (70%). Significant differences between the mortality groups were detected for age (P = .006), and for P/F ratio at time of consult (P = .047) and the time of tracheotomy (P = .03). CONCLUSIONS: Tracheotomies are safely performed in COVID-19 patients with a standardized protocol. The timing of tracheotomy in COVID-19 patients is based on ventilator parameters, P/F ratio, patient prognosis, patient advanced directives, and family wishes.

Low-cost Method for Obtaining Medical Rapid Prototyping Using Desktop 3D printing: A Novel Technique for Mandibular Reconstruction Planning.

BACKGROUND: Three-dimensional (3D) printing is relatively a new technology with clinical applications, which enable us to create rapid accurate prototype of the selected anatomic region, making it possible to plan complex surgery and pre-bend hardware for individual surgical cases. This study aimed to express our experience with the use of medical rapid prototype (MRP) of the maxillofacial region created by desktop 3D printer and its application in maxillofacial reconstructive surgeries. MATERIAL AND METHODS: Three patients with benign mandible tumors were included in this study after obtaining informed consent. All patient's maxillofacial CT scan data was processed by segmentation and isolation software and mandible MRP was printed using our desktop 3D printer. These models were used for preoperative surgical planning and prebending of the reconstruction plate. CONCLUSIONS: MRP created by desktop 3D printer is a cost-efficient, quick and easily produced appliance for the planning of reconstructive surgery. It can contribute in patient orientation and helping them in a better understanding of their condition and proposed surgical treatment. It helps surgeons for pre-operative planning in the resection or reconstruction cases and represent an excellent tool in academic setting for residents training. The pre-bended reconstruction plate based on MRP, resulted in decreased surgery time, cost and anesthesia risks on the patients. Key words:3D printing, medical modeling, rapid prototype, mandibular reconstruction, ameloblastoma.

Manejo quirúrgico de tumor mandibular asistido con la tecnología de impresión tridimensional: nota técnica y reporte de caso / Surgical management of mandible tumor assisted with three-dimensional printing technology: a technical note and case report

Objetivo: Introducir la tecnología de impresión tridimensional para la creación de modelos anatómicos para asistir la planificación quirúrgica de tumores mandibulares. Caso clínico: Presentamos el caso de una paciente de 30 años con historial de tumoración en la mandíbula, sector anterior, con 2 años de evolución. La biopsia incisional confirmó que se trataba de un fibroma osificante. Con la asistencia de la tecnología de impresión tridimensional se realizó la planificación quirúrgica para establecer los márgenes de osteotomías y el predoblado de la placa de reconstrucción. Adicionalmente se describe en detalle el proceso de construcción del modelo de prototipado rápido con la tecnología de impresión tridimensional.

Aim: Introduction of three-dimensional printing technology for the generation of medical rapid prototyping models, an assistant tool in surgical planning of mandibular tumors. Clinical case: We report the case of a 30-years-old female patient who presented an anterior mandible mass with 2 years of evolution. Incisional biopsy confirmed ossifying fibroma. With the assistance of three-dimensional printing technology, 3D model was created and surgical planning was performed with the design of osteotomy sites for mandibular resection. Furthermore, prebending of reconstruction plate based on 3D model was accomplished. The protocol for rapid prototyping models creation in details is described in this article.

Retrograde submental intubation assisted with direct video laryngoscopy in maxillofacial trauma: technical note and case report / Intubación submentoniana retrógrada asistida con videolaringoscopía en trauma maxilofacial: nota técnica y reporte de caso

The management of a difficult airway is one of the biggest challenges of perioperative anesthesia management. The maxillofacial trauma can cause serious disturbances of the soft and hard tissues of the anatomical components of the upper airway and often with little external evidence of deformity. The submental intubation is a procedure that was reported to avoid tracheostomy and allow for the concomitant restoration of occlusion and reduction of facial fractures in patients with craniomaxillofacial trauma ineligibles for nasotracheal intubation. We described a modification of the original technique by performing a retrograde submental intubation assisted by direct laryngoscope video in a maxillofacial trauma patient with restricted mouth opening. In addition, the surgical anatomy of the technique is detailed described.

El manejo de una vía aérea difícil es uno de los mayores desafíos del manejo anestésico perioperatorio. El trauma maxilofacial puede causar serias alteraciones a los tejidos blandos y duros de la vía aérea superior, y muchas veces con pequeña evidencia externa de deformidad. La intubación submentoniana es un procedimiento que fue reportado para evitar la traqueostomía y permitir la concomitante restauración de la oclusión para la reducción de fracturas faciales en pacientes donde la intubación nasotraqueal está contraindicada. Describimos una modificación de la técnica original, realizando una intubación submentoniana retrógrada asistida con videolaringoscopio en un paciente de trauma maxilofacial con apertura de la cavidad disminuida. Adicionalmente se describe detalladamente la anatomía quirúrgica de la técnica.

Large recurrent radicular cyst in maxillary sinus: a case report / Gran quiste radicular recurrente en seno maxilar: reporte de caso

Radicular cyst is the most common inflammatory jaw cystic lesion that occurs in necrotic teeth. They account for more than 50 % of all odontogenic cysts. Radicular cysts cause slowly progressive painless swelling and there are no symptoms until they become large. Enucleating the cyst with endodontic therapy of the affected tooth is recommended as the primary treatment. Here we describe a patient with a large recurrent radicular cyst with maxillary sinus involvement who underwent a midfacial degloving approach for complete enucleation. In conclusion, radicular cyst should be considered in the differential diagnosis of large maxillary sinus lesions and never be discarded until histopathology is available.

El quiste radicular es la lesión inflamatoria quística más común que ocurre en los dientes necróticos. Su presentación abarca más del 50 % de los quistes odontogénicos. Los quistes radiculares se presentan como una inflamación indolora de crecimiento lento y progresivo y se hacen sintomáticas una vez que alcanzan un gran tamaño. El tratamiento primario recomendado para este quiste es la enucleación junto al tratamiento endodóntico de los dientes afectados. Presentamos un reporte de caso de un paciente que presentaba un gran quiste radicular recurrente con envolvimiento de todo el seno maxilar y que fue tratado con un acceso intraoral extendido para lograr la completa enucleación de la lesión. En conclusión, el quiste radicular debe ser siempre considerado en el diagnóstico diferencial de lesiones de gran tamaño que involucren el seno maxilar y nunca ser descartado hasta tener el resultado de histopatología.