Does the use of low-level light therapy postoperatively reduce pain, oedema, and neurosensory disorders following orthognathic surgery? A systematic review.

The aim of this study was to evaluate the efficacy of low-level light therapy (LLLT) in improving pain, oedema, and neurosensory disorders of the inferior alveolar nerve (IAN) after orthognathic surgery. This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were conducted in the PubMed, Embase, and Web of Science databases for randomized clinical trials (RCTs) published up to September 2020. After evaluating eligibility, 15 RCTs were selected. None of the studies reported an evaluation of all of the outcomes within the same publication. It was possible to determine the effect of LLLT in controlling pain following orthognathic surgery. Of the three studies evaluating this outcome, all observed a positive effect. Of the four studies that evaluated oedema, two found a positive effect. Of the 11 studies that evaluated neurosensory disorders of the IAN, all of them observed a positive effect, at least in one of the sensory evaluation tests. A meta-analysis was not possible due to the heterogeneity across studies. Considering the limitations of this review, but given the fact that LLLT is a minimally invasive intervention, its use merits consideration in immediate postoperative orthognathic surgery.

Effects of throat packs during orthognathic surgery: a double-blind randomized controlled clinical trial.

Throat packs are commonly used in maxillofacial surgeries. However, the evidence to support the benefits of their use is controversial. The aim of this study was to evaluate the effectiveness of throat packs in preventing postoperative nausea and vomiting, and their influence on the incidence of sore throat and dysphagia in patients undergoing orthognathic surgery. This was a prospective double-blind randomized study with 54 patients, who were randomized to two groups: with throat pack (n=27) and without throat pack (n=27). Fifty patients (25 in each group) were included in the analysis; 66% female and 34% male, mean age 29.44±8.53 years. Postoperative nausea and vomiting (Kortilla scale), sore throat (visual analogue scale), and dysphagia were evaluated. Statistically significant differences in favour of the without-pack group were found for the variables throat pain at 24hours (P=0.002) and dysphagia at 2 hours (P=0.007) and 24 hours (P<0.001). There was no difference between the groups regarding postoperative nausea and vomiting (P=1.00). The results of this study indicate that throat packs as utilized here do not prevent postoperative nausea and vomiting and are associated with worse sore throats and postoperative dysphagia.

Effectiveness of nicotine patch for the control of pain, oedema, and trismus following third molar surgery: a randomized clinical trial.

The aim of this study was to evaluate the effectiveness of a nicotine patch for the control of pain, oedema, and trismus following lower third molar surgery. A prospective, randomized, triple-blind, split-mouth trial was performed involving 20 patients who underwent two surgical procedures at different times. A patch containing 14mg nicotine was used in the experimental group, whereas a patch without nicotine (placebo) was used in the control group. The nicotine patch was effective at controlling pain after 4hours and 8hours (P= 0.023 and P= 0.005, respectively). The nicotine patch also had a significant effect on the control of oedema at 24 hours (P= 0.002), 48 hours (P= 0.001), and 72 hours (P= 0.005) following the intervention. Postoperative mouth opening was significantly greater among the patients who received the nicotine patch after 72 hours and 7 days. The number of rescue analgesics required was lower (P= 0.026) and the level of satisfaction was significantly higher (P= 0.008) when the patch was used, although higher levels of nausea were found in the nicotine group (P= 0.031 at 30 minutes, P= 0.008 at 4 hours). The nicotine patch was effective at controlling pain, oedema, and trismus following third molar surgery.

Root contact with maxillomandibular fixation screws in orthognathic surgery: incidence and consequences.

The use of maxillomandibular fixation (MMF) screws in orthognathic surgery has become common in recent years. The risk of injury to adjacent roots with their placement in this population has not been studied extensively. The aim of this study was to review the incidence and consequences of root contact/injury in patients undergoing orthognathic surgery. A retrospective analysis of the treatment and radiographic records of patients who underwent orthognathic surgery between January 2013 and September 2014 at a university in Kentucky, USA was performed. The mean number of screws used was correlated to the mean number of roots affected using Spearman's test, set to a level of significance of 5%. Of 125 patients who underwent orthognathic surgery, 15 (12%) had evidence of root contact. Subsequent radiographs showed resolution of the bone defects. There was no clinical evidence of pulpal necrosis or pain during follow-up. The average number of screws used was 3.14±0.35 per patient, with an average of 0.17±0.52 root contacts per patient. There was no correlation between the number of screws used and the number of roots injured (P=0.279). Based on these results, MMF screws can safely be used to establish interim fixation during orthognathic surgery. Caution should be taken during placement to avoid direct injury to the roots of teeth.

Effect of the use of combination uridine triphosphate, cytidine monophosphate, and hydroxycobalamin on the recovery of neurosensory disturbance after bilateral sagittal split osteotomy: a randomized, double-blind trial.

The change in neurosensory lesions that develop after bilateral sagittal split osteotomy (BSSO) was explored, and the influence of the application of combination uridine triphosphate (UTP), cytidine monophosphate (CMP), and hydroxycobalamin (vitamin B12) on patient outcomes was assessed. This was a randomized, controlled, double-blind trial. The study sample comprised 12 patients, each evaluated on both sides (thus 24 sides). All patients fulfilled defined selection criteria. Changes in the lesions were measured both subjectively and objectively. The sample was divided into two patient groups: an experimental group receiving medication and a control group receiving placebo. The statistical analysis was performed using SPSS software. Lesions in both groups improved and no statistically significant difference between the groups was observed at any time. 'Severe' injuries in the experimental group were more likely to exhibit a significant improvement after 6 months. Based on the results of the present study, it is concluded that the combination UTP, CMP, and hydroxycobalamin did not influence recovery from neurosensory disorders.

Extensive oral lesion colonized with 601 myiasis larvae.

Myiasis is a type of infection caused by the larvae of flying insects. This paper reports a case of a 72-year-old Caucasian man who was referred to the Infectology Department of Oswaldo Cruz University Hospital (Pernambuco-Brazil) for urgent treatment as he was malnourished and dehydrated. He had a facial and buccal lesion colonized with larvae and was extremely debilitated. The surgical and clinical treatment indicated at the first moment was the surgical removal of the larvae. But, after two days, some larvae were still present and therefore 12 mg of ivermectin was administered. At the end of the treatment, 601 larvae had been removed and the therapeutics established were suitable.

Dentofacial characteristics as indicator of obstructive sleep apnoea-hypopnoea syndrome in patients with severe obesity.

Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a complex disease with a multifactor aetiology. OSAHS is strongly associated with obesity, but there are many other clinical risk factors, such as the dentofacial characteristics of hard and soft tissues, hyoid bone position, neck circumference, upper airway spaces and nasal respiration. A descriptive cross-sectional study was carried out involving 13 patients (one man and 12 women) with severe obesity in order to evaluate specific physical dentofacial characteristics through a cephalometric examination. Cephalometry was analysed using 29 measurements of the hard and soft tissues of the craniofacial structures and dimensions of the upper airways. The demographic data revealed a mean body mass index of 48 ± 6.26 kg m(-2) and cervical circumference of 43 ± 3.69 cm. No patient exhibited important facial asymmetry and facial types 1 (normal) and 3 (mandible forward) were the most prevalent. Septal deviation was observed in 46% of patients. The most prevalent modified Mallampati index score was between 3 and 4, while grade 1 was the most prevalent tonsillar hypertrophy index score (46%). Cephalometry revealed angular and linear measurements with normally acceptable values for the hard tissues. Obese patients seem to have a normal craniofacial structure and the risk of developing OSAHS is especially related to obesity.

Perception of oral maxillofacial surgery by health-care professionals.

Oral and Maxillofacial Surgery (OMFS), a dentistry specialty recognized by the Federal Dentistry Board in the mid-1960s, is responsible for the diagnosis, and clinical and surgical treatment of traumatic, congenital, developmental and iatrogenic lesions in the maxillofacial complex. Even today, difficulties are experienced owing to the lack of knowledge of the general public and health professionals concerning the scope of OMFS. To investigate recognition of the scope of OMFS, 400 questionnaires were sent to dentistry students, medical students, dentists and doctors, in 4 equal groups. The questionnaire covered 26 clinical situations in four different specialties (OMFS, Plastic Surgery, Ear Nose and Throat Surgery, Head and Neck Surgery) and an option with no specialty specified. Each interviewee had to correlate the clinical situation with the respective specialist. For facial trauma, dento-facial deformities, mandibular reconstruction and temporomandibular joint surgery, most respondents would consult the OMF surgeon for treatment (mean, 90%). In cases of oral biopsy and treatment of benign mandibular tumours the mean referral rate to OMFS was low (48%). On the basis of the questionnaire responses, a good level of knowledge of the scope of OMFS was found. In order to ensure the correct referral of all patients, the specialty needs to broaden its horizons.