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1.
J Pak Med Assoc ; 71(4): 1197-1199, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34125771

RESUMEN

OBJECTIVE: To evaluate the existing practices of obtaining and documenting informed consent in cases of oral and maxillofacial surgery. METHODS: The cross-sectional study was conducted from April to June 2017 at the Oral and Maxillofacial Surgery departments of five teaching hospitals of Rawalpindi and Islamabad, Pakistan, and comprised patients who underwent surgery under general anaesthesia. Data was collected using questionnaire-based interviews a day after the surgery in each case regarding multiple aspects of the informed consent practices. Data was analysed using SPSS 21. RESULTS: Of the 100 patients, 58(58%) were males and 42(42%) were females, while 81(81%) were adults aged >18 years. In 42(42%) cases, the consent document was signed by the patient, and by a relative in 38(38%) cases. In the remaining 20(20%) cases, only verbal consent was taken. In 54(54%) cases nursing staff and in 46(46%) cases residents took the consent. Most patients were informed about nature of their disease 87(87%), proposed treatment 86(86%) and type of anaesthesia 100(100%). Fewer patients were informed about any alternative treatments 38(38%), and possible complications of the surgery 51(51%) or anaesthesia 26(26%). Overall, 44(44%) patients did not fully understand the written information, and 23(23%) said they were encouraged to ask questions. CONCLUSIONS: The quality of informed consent practices was found to be sub-optimal in oral and maxillofacial surgery setups.


Asunto(s)
Anestesiología , Cirugía Bucal , Adulto , Estudios Transversales , Femenino , Humanos , Consentimiento Informado , Masculino , Pakistán/epidemiología , Encuestas y Cuestionarios
2.
Shanghai Kou Qiang Yi Xue ; 30(2): 206-209, 2021 Apr.
Artículo en Chino | MEDLINE | ID: mdl-34109364

RESUMEN

PURPOSE: To evaluate the sedative effect of dexmedetomidine in awake intubation and its influence on swallowing function. METHODS: Fifty patients with awake intubation in oral and maxillofacial surgery were randomly divided into two groups: dexmedetomidine(DEX) group and midazolam+fentanyl(MF) group. 15 min before intubation, patients in DEX group were intravenously given 50 mL dexmedetomidine(1.0 µg/kg), and others in MF group were intravenously given 50 mL normal saline respectively. 5 min before intubation, 10 mL normal saline was given to DEX group, 0.02 mg/kg midazolam and 2.0 µg/kg fentanyl were given to MF group. HR, MAP, RR, SpO2, Ramsay sedation score and swallowing time were measured at different time points (before induction-T0, before intubation-T1 and after intubation-T2). SPSS 20.0 software package was used for data analysis. RESULTS: There was no significant difference in HR, RR, MAP, SpO2 and swallowing time between the two groups at T0 time point(P>0.05). Compared with MF group, HR significantly decreased and swallowing time significantly shortened(P<0.05). RR, MAP, SpO2 and Ramsay sedation score had no significant difference (P>0.05) in DEX group at T1 time point. Compared with MF group, HR significantly decreased and Ramsay sedation score significantly increased(P<0.05); RR, MAP and SpO2 had no significant difference (P>0.05) in DEX group at T2 time point. Compared with T0 time, HR significantly decreased and swallowing time significantly prolonged (P<0.05); RR, MAP and SpO2 had no significant difference(P>0.05) in DEX group at T1 time point. Compared with T1 time, Ramsay sedation score decreased with significant difference(P<0.05) at T2 time point. CONCLUSIONS: Dexmedetomidine can provide good sedative effect for patients with awaking intubation without obvious inhibitory effect on swallowing reflex of patients, improving the safety of intubation.


Asunto(s)
Dexmedetomidina , Cirugía Bucal , Deglución , Humanos , Hipnóticos y Sedantes , Intubación Intratraqueal
3.
Int J Comput Dent ; 24(1): 65-76, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-34006064

RESUMEN

INTRODUCTION: Mixed reality (MR) represents a new evolution in technological development that combines both virtual reality (VR) and augmented reality (AR) to create a blend of the physical and digital worlds. However, the potential role of MR in preoperative diagnostics in oral and maxillofacial surgery has not been scientifically investigated and remains generally unclear. This article presents a workflow that integrated MR in its scheme. It also evaluates the potential benefit of MR compared with its predecessors, VR and AR. MATERIAL AND METHODS: MR technology was used to plan the surgical treatment of a clinical case with an extensive tumor of the left maxilla. A workflow proposal incorporating both the surgeon and radiation oncologist is presented based on this experience. A total of 10 examiners rated the usability and applicability of MR for daily routines. RESULTS: MR showed good results during preoperative planning for a surgically extensive case in terms of displaying 3D structures and enhancing the physical and virtual interactions among the examiners. Previously described drawbacks of other VR/AR applications such as nausea and motion sickness were not observed with MR. However, MR seems to lack intraoperative usability, which is a drawback. CONCLUSION: MR shows great potential in improving the preoperative assessment of 3D DICOM datasets and thus facilitating diagnostic measures. However, further improvements should be made to implement an MR workflow and incorporate it into the clinical treatment planning tree.


Asunto(s)
Realidad Aumentada , Cirugía Bucal , Realidad Virtual , Humanos , Simbiosis , Tecnología
4.
BMC Med Educ ; 21(1): 198, 2021 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-33827549

RESUMEN

BACKGROUND: To evaluate the self-confidence of undergraduate dental students in relation to oral and maxillofacial surgery (OMFS) to assess the teaching curriculum at Kuwait University using a validated questionnaire originally developed by the Association of British Academic Oral Maxillofacial Surgeons (ABAOMS). METHODS: A cross-sectional survey of sixth year (n = 20) and seventh year (n = 19) dentistry students was conducted by Kuwait University Faculty of Dentistry between the 1st and 15th of May 2020. The ABAOMS questionnaire is composed of 17 questions assessing various areas of the undergraduate OMFS curriculum. The response options to the questionnaire utilised a Likert scale. Independent sample t-tests were performed to assess the difference in responses between the 2 year groups. Spearman's rho correlations were calculated to measure the strength of association between confidence in all aspects of surgical and forceps exodontia. RESULTS: A total of 39 questionnaires were completed by the students. The majority of students expressed feelings of confidence that they have enough knowledge to undertake independent practice (61%). General aspects of the questionnaire were answered favourably except for surgical extraction of teeth, in which both classes reported a lower level of self-confidence. CONCLUSIONS: The ABAOMS survey revealed the students' self-confidence in undertaking independent practice and preforming basic oral surgery procedures. Students felt comfortable with exodontia using forceps and elevators, root removal, managing acute pericoronitis, managing haemorrhage from a socket, assessing impacted teeth, and recognising the clinical features of potentially malignant and malignant lesions of the oral cavity. They reported a lower level of confidence in performing surgical procedures.


Asunto(s)
Estudiantes de Odontología , Cirugía Bucal , Estudios Transversales , Curriculum , Humanos , Kuwait , Encuestas y Cuestionarios , Universidades
5.
Br Dent J ; 230(7): 477-482, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33837348

RESUMEN

The specialist cadre of the Royal Army Dental Corps (RADC) came to fruition at the start of World War II, with the speciality of maxillofacial surgery being born during World War I. The cadre has followed developments within the speciality, and building on the experience of forebears, has become capable of not only providing a secondary care service to the RADC but also being competent in the management of complex war injuries.


Asunto(s)
Personal Militar , Cirugía Bucal , Historia del Siglo XX , Humanos , Primera Guerra Mundial , Segunda Guerra Mundial
6.
J Craniomaxillofac Surg ; 49(5): 415-421, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33648814

RESUMEN

The aim of this study was to analyze the current situation of trainees in OMFS in a nationwide survey at German universities and teaching hospitals. A questionnaire about their training in OMFS and discrimination, gender (in-)equality, and reconcilability of work and family life was sent to many OMFS residents in Germany. Seventy-five questionnaires were included. The average age of the participants was 32.15 years (± 0.75 years); 47 participants were male, 22 female, and 3 "diverse". The participants' overall satisfaction rate was good. Training concepts existed in most of the teaching hospitals (54.67%). 8.11% of the participants stated discrimination existed against men while, 24.32% agreed that discrimination existed against women. Stating that discrimination against women exists, it was associated with female gender (p < 0.001), being married (p = 0.042), and not aiming for further academic degrees (p = 0.009). Overall, the training situation in Germany seems structured in most teaching hospitals. Apart from the residents' general satisfaction with the training concepts, there seems to be a matter of concern regarding discrimination especially against women and the reconcilability of work and family life in OMFS training. Furthering the establishment of structured training concepts might be useful to overcome these issues in the course of training in OMFS.


Asunto(s)
Internado y Residencia , Cirugía Bucal , Adulto , Femenino , Alemania , Humanos , Masculino , Satisfacción Personal , Encuestas y Cuestionarios
7.
Clin Oral Investig ; 25(5): 3007-3019, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33779814

RESUMEN

INTRODUCTION: Neck dissection (ND) is a surgical procedure addressing cervical lymph nodes and metastases in patients with oral squamous cell carcinoma (OSCC). The aim of this study was to analyze clinical decisions regarding indications and variations of ND in Oral and Maxillofacial Surgery (OMFS) in Germany. MATERIAL AND METHODS: A nationwide survey of the German Association of Oral and Maxillofacial Surgery was performed using dynamic online questionnaires including 38 questions. Data about oncological centers, case numbers, and staging procedures were collected. Relevant aspects, such as inclusion of level IIb and levels IV and V to ND, uni- vs. bilateral ND, and the influence of extra-nodal extension (ENE) of metastases on extension of ND were evaluated. RESULTS: Eighty-four OMFS of university and non-university hospitals participated in the study (responding rate 21.4%). Sixty-six (78.57%) stated to work at certified cancer centers and 53.57% of the hospitals treated between 50 and 100 OSCC cases per year. CT and/or MRI of the head and neck was performed in most of the staging procedures. Level IIb was included by 71 (93.42%) of the participants in selective ND. Levels IV and V were included by 53 (69.74%) in node-positive neck. In solitary ipsilateral metastases (ENE-), 49 participants (62.82%) stated to perform exclusively an ipsilateral ND and 40 (51.95%) stated to perform only an ipsilateral ND in ENE+. CONCLUSION: This study demonstrated a high rate of certified cancer centers in Germany showing differences regarding staging procedures, indications, and extension of ND, especially in increasingly complex cases. CLINICAL RELEVANCE: Clinical decisions regarding ND are dependent on case-individual aspects and must be decided individually.


Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de la Boca , Cirugía Bucal , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Alemania/epidemiología , Humanos , Ganglios Linfáticos , Metástasis Linfática , Neoplasias de la Boca/patología , Neoplasias de la Boca/cirugía , Disección del Cuello , Estadificación de Neoplasias , Estudios Retrospectivos , Encuestas y Cuestionarios , Universidades
8.
Oral Maxillofac Surg Clin North Am ; 33(2): 249-262, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33685787

RESUMEN

Oroantral communication and fistula are commonly seen complications in the field of oral and maxillofacial surgery. Oral surgeons must be familiar with the diagnosis and proper management including multiple soft and hard tissue approaches to this surgical dilemma.


Asunto(s)
Cirugía Bucal , Colgajos Quirúrgicos , Humanos , Cirujanos Oromaxilofaciales , Fístula Oroantral/cirugía
9.
Artículo en Inglés | MEDLINE | ID: mdl-33668506

RESUMEN

Computer-aided simulations have long been of great importance in university teaching; however, to date, there is limited use of such simulations in the dental surgical sector. For this purpose, an oral surgery simulator, "Kobra", was implemented in student training and was evaluated for dental education. Dental students (group 1, third-year and group 2, fourth-year) and dentists of the faculty (control group) were trained to use the simulator. The outcomes for group 1 (apicoectomy of an upper lateral incisor with Kobra), group 2 (removal of an impacted lower wisdom tooth with Kobra) and the control group (both procedures with Kobra) were evaluated. For evaluation purposes, subjective parameters (improvement of practical skills, comparison between conventional training and Kobra simulation, and implementation of simulation-based teaching) and objective parameters (removal of bone, tooth substance and soft tissue measured while performing the Kobra simulation) were assessed using questionnaires with a scale ranging from 1-5. A total of 49 students (third-year n = 29, with 22 women and 7 men; fourth-year n = 20, with 17 women and 3 men) and 10 dentists (women n = 5 and men n = 5) participated. Compared to the Kobra simulation, the conventional training method with plastic models was still favored (the difference was non-significant). Compared to the dentists, the simulation data showed a less precise surgical performance of the students (the difference was not significant). The Kobra simulation may offer an additional method to conventional surgery training using plastic models, with benefits for students and faculty staff.


Asunto(s)
Competencia Clínica , Entrenamiento Simulado , Cirugía Bucal/educación , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Estudiantes de Medicina , Enseñanza
10.
Rev. cuba. estomatol ; 58(1): e2919, ene.-mar. 2021. graf
Artículo en Español | LILACS, CUMED | ID: biblio-1156427

RESUMEN

Introducción: La osteomielitis mandibular crónica es considerada como una infección odontogénica que cursa con tumefacción de la cara, limitación de la abertura bucal y dolor. Pocas veces es tratada a través de gammagrafías con fijación a ciprofloxacino con la consiguiente obtención de resultados efectivos. Objetivo: Describir un caso clínico de osteomielitis mandibular crónica tratada con terapia antibiótica y quirúrgica. Presentación de caso: Paciente femenina de 63 años de edad que acudió al servicio de estomatología del Hospital María Auxiliadora, Lima, Perú; con un historial de tres meses de hinchazón creciente a nivel del borde inferior izquierdo de la mandíbula desde que le realizaron una extracción dentaria. Los exámenes tomográficos, gammagrafía, biopsia y antibiograma confirmaron la osteomielitis y la susceptibilidad bacteriana. La decorticación, debridamiento, exodoncia y la administración de metronidazol más vancomicina por dos meses permitió la remisión del cuadro. Conclusiones: El seguimiento clínico de dos años y las gammagrafías de evaluación permitieron verificar la presencia de regeneración ósea y ausencia de focos de reactivación. La osteomielitis crónica puede ser provocada por restos de exodoncias dentarias. Su diagnóstico y seguimiento clínico requiere de múltiples exámenes y controles a largo plazo(AU)


Introduction: Chronic mandibular osteomyelitis is considered to be an odontogenic infection manifesting as facial tumefaction, limited mouth opening and pain. It is not often enough treated with ciprofloxacin fixation gammagraphies with the consequent achievement of effective results. Objective: Describe a clinical case of chronic mandibular osteomyelitis treated with antibiotic and surgical therapy. Case presentation: A female 63-year-old patient attends the dental service at María Auxiliadora Hospital in Lima, Peru, with a history of three-months' swelling of the lower left edge of her mandible upon performance of a dental extraction. Tomographic examination, gammagraphy, biopsy and antibiograms confirmed the presence of osteomyelitis and bacterial susceptibility. Decortication, debridement, exodontia and administration of metronidazole plus vancomycin for two months led to remission of the patient's status. Conclusions: Two-year clinical follow-up and evaluation gammagraphies made it possible to verify the presence of bone regeneration and the absence of reactivation foci. Chronic osteomyelitis may be caused by remains of dental exodontias. Its diagnosis and clinical follow-up require a large number of long-term tests and controls(AU)


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Cirugía Bucal/métodos , Vancomicina/uso terapéutico , Antibacterianos/administración & dosificación , Metronidazol/uso terapéutico
14.
J Craniomaxillofac Surg ; 49(4): 323-328, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33581957

RESUMEN

The worldwide pandemic caused by the COVID-19 outbreak has led to an unprecedented burden on hospital structures, posing new challenges in terms of reshaping healthcare services. At the same time, the so-called 'lockdown' restrictions have decreased overall mobility, thereby challenging the traditional concept of clinical examination. Moreover, the need for security for both patients and healthcare personnel has posed a further limitation to face-to-face meeting. Telemedicine has provided a valuable solution for such issues, allowing the evaluation of oral and maxillofacial surgery patients through technological interfaces, restricting physical consultations to cases with high clinical priority, intercepting suspects, and maintaining contact with discharged patients. Thanks to the experience gained during the previous wave of infections, the purpose of this study was to present a reorganization of clinical services for oral and maxillofacial surgery in order to help cope with the latest COVID-19 resurgence. Using commonly available software for telecommunications and online meetings, the Oral and Maxillofacial Surgery Department of the University Hospital of Udine has reshaped the organization of healthcare services, with telemedicine central to the continuity of assistance, while at the same time minimizing the risk of exposure for both patients and operators. Additionally, the high number of patients evaluated through telemedicine improved our ability to define signs and symptoms of diseases using informatic tools, thus allowing the introduction of the concept of 'telesemiology'. During our previous lockdown experience, between March and April 2020, 78 patients were evaluated using teleconsultation. All outpatient examinations were rescheduled and translated into a virtual platform, allowing each patient to undergo evaluation in the most appropriate setting. Special attention was paid to the follow-up of oncological patients. The rehabilitation team represented a crucial element in maintaining contact with more complex patients in this crucial time. This study was based on our previous lockdown experience - a situation that many will be facing again over the coming months. Our hope is that the organizational structure that our department applied during the previous wave of infections may offer other colleagues a solution to facing the current COVID-19 recrudescence.


Asunto(s)
COVID-19 , Cirugía Bucal , Telemedicina , Control de Enfermedades Transmisibles , Humanos , SARS-CoV-2
15.
Clin Oral Investig ; 25(6): 3853-3860, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33409692

RESUMEN

OBJECTIVE: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has created hitherto unknown challenges for healthcare systems and patient care. This study aimed to analyze its influence on patient care and healthcare management in oral and maxillofacial surgery (OMFS) in Germany. MATERIALS AND METHODS: A nationwide survey of the German Association of Oral and Maxillofacial Surgery was performed. Individual questionnaires containing 10 questions for university as well as non-university hospitals and 15 questions for private practices (PPs) for OMFS were created to collect data for patient numbers and surgical procedures conducted, usage of personal protection equipment (PPE), SARS-CoV-2 tests, and economic aspects. RESULTS: Fifty-four hospitals and 240 PPs participated in the study. The reduction in ward capacities and number of surgical procedures ranged from 17 to 78%. PPE consisted of standard surgical masks (58% hospitals, 64% PPs) and FFP2/N95/KN95 respirators (45% hospitals, 48% PPs). Preoperative SARS-CoV-2 tests were more frequently performed in hospitals (34% vs 2%). At PPs, turnover for medical and dental procedures billed to the public insurance had reduced to 58.81% and 62.43%, respectively, of the corresponding values for 2019, and 58.75% of the PPs had applied for short-time allowances. CONCLUSION: With the exception of some elective procedures, primary patient care in OMFS has been assured during the pandemic. However, the immense economic burden on hospitals and PPs cannot be conclusively assessed at this point. CLINICAL RELEVANCE: For OMFS, the German healthcare system has shown the ability to adapt to emergency situations such as the SARS-CoV-2 pandemic. Adequate surgical capacities in OMFS are necessary even during pandemics.


Asunto(s)
COVID-19 , Cirugía Bucal , Alemania/epidemiología , Hospitales , Humanos , Pandemias , Práctica Privada , SARS-CoV-2 , Encuestas y Cuestionarios
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