Comprehensive facial injury (CFI) score as a predictor of surgical time, length of hospital stay, and head injury? Our experience at level I trauma center.

Purpose: The present study aimed to evaluate the statistical significance of comprehensive facial injury (CFI) score concerning total surgical time (ST), length of hospital stay (LHS), and head injury in maxillofacial trauma patients. Methods: This retrospective observational study included 288 patients having maxillofacial injuries with or without associated head injury. CFI score was calculated for each of them. One-way ANOVA and Kruskal-Wallis H-test were used to compare ST (minutes), LHS (days), and Glasgow Coma Scale (GCS) score among the CFI score clusters. Head injury among the CFI score clusters was compared using Fisher's exact test. The level of statistical significance was set at P < 0.05. Results: Of total 288 cases (males: 83.68%, females: 16.31%, mean age: 30 ± 15.92 years), road traffic accidents accounted for 76.0% of admissions. A definitive approach (open reduction and internal fixation) was used in 26.38% of cases. Statistically significant association of CFI score was obtained with ST and LHS in high-dependency unit (P < 0.001). Posttraumatic head injury was seen in 21.25% of cases. A significant association of CFI score with GCS score (P = 0.032) and with head injury (P = 0.019) was found. Conclusion: CFI score is a comprehensive yet simple scale to assess ST and LHS. A strong correlation established between CFI score and these variables further validate its reliability as a perfect tool for communication of the maxillofacial morbidity and in making a treatment protocol, although its predictive ability for associated head injuries needs to be studied further.

Impact of COVID-19 on oral and maxillofacial surgery practice in India: A national survey.

STUDY DESIGN: The Coronavirus disease-19 (COVID-19) pandemic has disrupted oral and maxillofacial (OMF) surgeons' practice globally. We implemented a cross-sectional, questionnaire-based survey among the OMF surgeons of India. OBJECTIVE: The objectives of the study were (1) gathering data among the maxillofacial surgeons in terms of their occupational exposure and access to adequate personal protective equipment (PPE) and (2) to estimate how the COVID-19 pandemic has affected the practice of OMF surgeons in India. MATERIALS AND METHODS: Complete responses of 178 OMF surgeons were included in the study. Descriptive and analytic statistics were computed. The level of statistical significance was set at P < 0.05. Binary logistic regression models were created to assess the predictors of the impact of the COVID-19. RESULTS: Out of the 178 respondents of the study, most (37.1%) were following their hospital's guidelines. Most had access to adequate PPE (89.9%), whereas 93.8% had COVID-19 testing available. One hundred and thirty-three (74.7%) surgeons were involved in teleconsultation. Ninety-two (51.7%) and 166 (93.3%) were involved in elective surgery and emergency surgeries, respectively. Median outpatient department cases and number of surgeries done per week reduced by 73.9% and 66.7% (P < 0.001), respectively. Most surgeons (86%) experienced that cost of treatment had increased during the COVID. Over 75% were afraid to get infected with COVID, whereas 44.9% were anxious to lose the income. More than 56% of the OMF surgeons reported a fall in income and 94% reported decreased productivity in academic research. Most surgeons (93.8%) believed that COVID had a positive impact on human behavior in terms of hand hygiene. CONCLUSION: The impact of COVID-19 among OMF surgeons has adversely affected clinical practice, personal lives, and academic productivity and has catalyzed an exponential increase of telemedicine. Future surveys should capture the long-term impact of COVID-19.

Is Coronoidectomy Superior to Coronoidotomy for Improving Maximum Incisal Opening in Patients With Oral Submucous Fibrosis?

PURPOSE: In the management protocol of the oral submucous fibrosis (OSMF), multiple studies have advocated that an additional step of coronoidectomy or coronoidotomy helps achieve better and more consistent postoperative results. But, there are no studies that validate if one has an advantage over the other. This study aimed to compare the outcome of the coronoidectomy with coronoidotomy for OSMF cases. METHODS: A randomized controlled trial was designed in patients with OSMF requiring operative intervention. Patients were randomized into 2 groups based on a computer-generated randomization table: group I coronoidectomy and group II coronoidotomy. The primary predictor variables were the 2 different adjunct surgical steps - coronoidectomy and coronoidotomy. The primary outcome variable was the postoperative maximum incisal opening (MIO). Secondary outcome variables were duration of surgery and blood loss. RESULTS: The study sample was composed of 32 patients (16 each group). Both the groups were comparable in terms of demographic profile. The MIO after surgery was comparable throughout the study between the groups. Repeated measures analysis of variance for comparison of mouth opening within the group showed that there was a significant improvement in postoperative MIO in both the groups (group I P value <.001 and group II P value 0.004). A statistically significant difference was found in the duration of the surgery (3.5 ± 0.73 hours vs 2.06 ± 0.87 hours) and blood loss (393 .75 ± 278.6 mL vs 90.62 ± 58.36 mL) with the shorter time and less blood loss in coronoidotomy compared with coronoidectomy. All these cases were followed for 1 year. CONCLUSIONS: Coronoidotomy as an adjunctive treatment in OSMF provides comparable treatment outcome in terms of MIO compared with coronoidectomy with the added advantage of shorter operating time and less blood loss.

Re-Assessment of Coronoid as a Graft for Condylar Reconstruction in TMJ Ankylosis Patients: A Prospective Study and Literature Review.

INTRODUCTION: Treatment for TMJ ankylosis aims at restoring joint function, improving the patient's aesthetic appearance and quality of life and preventing re-ankylosis. To rebuild a structurally and functionally satisfactory neocondyle is a challenging problem. Aim of this study is to re-assess the coronoid as a graft for condyle reconstruction. MATERIALS AND METHODS: Twenty patients of TMJ ankylosis without involvement of the coronoid process in ankylotic mass, coming in age group elder than 14 years were selected for the study over a period 3 years from 2011 to 2014. Clinical examination, radiographs, and photographs were used postoperatively to evaluate the grafts and TMJ function. After osteoarthrectomy coronoid process was detached and fixed with a 4 hole L-shaped titanium miniplate to form neo condyle. RESULT: No donor site morbidity was observed as reported with other autogenous grafts. Satisfactory mouth opening was observed during follow up period with mean mouth opening 37.33 ± 4.20 mm except one case which required graft removal due to postoperative infection. Radiographically moderate amount of resorption of grafted coronoid process was observed in nearly all the cases however satisfactory mandibular function and occlusion was observed.