Penetrating Orbital Trauma by Large Foreign Body: Case Series Study with Treatment Guidelines and Literature Review.

Purpose: The present study aims to describe a case study of large penetrating orbital trauma and treatment guidelines associated with a review of English-language literature of large foreign bodies impacting the orbit from 1997 to 2020. Patients and Methods: Five patients suffered large penetrating orbital trauma and required emergency surgical procedures. Results: Together with this present study, a total of 33 cases were selected. The present work has data similar to the literature, and emergency surgical treatment was required in the majority of the cases. Conclusion: Penetrating orbital trauma by large objects is a challenge. The initial assessment and treatment are fundamental to determine the case severity. The large foreign body should be surgically removed by a trained and experienced team in an advanced hospital unit as soon as possible to minimize visual, functional and aesthetic sequelae.

Ultrasound protocol in odontogenic infections: a new proposal

Background: Point-of-care-ultrasound can be applied to preview a difficult airway, detect the presence of fluid collection, and soft-tissue edema, and guide the drainage location, although is rarely used. The purpose of this study is to validate a protocol for the assessment of these clinical features on patients with severe odontogenic infections.Material and methods: This was a single-group prospective cohort study (n=20) including patients with the diagnosis of deep-neck propagation of odontogenic infection. A transcervical linear high-frequency probe transducer (13-6 MHz) was used to scan the structures of the upper airway and the infectious collections. The drainage was guided by ultrasound and the patients were daily evaluated, according to the protocol. The data were extracted and the airway volume, midline deviation, and other important data such as length of hospital stay, dysphagia, voice alteration, raised floor of the mouth, dyspnea, and neck swelling were registered.Results: The ultrasound examination was correlated with multiple clinical findings, such as dyslalia (p=0,069), dysphagia (p=0,028), dyspnea (p=0,001), among others. This protocol has an advantage as it can be used at bedside evaluation, allowing the assessment of severe and unstable patients, and predicting the increase of the hospitalization time (p=0,019).Conclusions: This protocol is reliable for the assessment of the upper airway, even in an emergency, predicting not only the severity of the clinical features but aids in the determination of the length of the hospitalization time. (AU)

Double blind randomized clinical trial comparing minimally- invasive envelope flap and conventional envelope flap on impacted lower third molar surgery

Background: The latest trend in surgery is to look for minimally invasive procedures, with fewer complications and a shorter recovery time. This study aims to compare the minimally- invasive envelope flap, with smaller incision and fewer dissection and the conventional envelope flap, with a 20mm incision, on impacted mandibular third molar surgery, focusing on the hypothesis that there were no differences in postoperative outcomes. Material and methods: A double-blind randomized clinical trial was designed to compare both incisions, focused on determining the approach with minor postoperative side-effects and minor impact on quality-of-life. A total of 60 patients were enrolled for the study if their presented impacted mandibular third molar and was 18-years-old or more. Both groups were evaluated from time elapsed on the surgery, maximum mouth opening, swelling and quality of life assessment. Results: The flap choice influenced facial swelling (p=0,03), pain on the first three days (p=0,037), interference with oral hygiene (p=0,019) and discomfort on speech (p=0,07). Chewing, swallowing, trismus, pain after seven days, postoperative complications and other quality-of-life arrangements were no different between groups. Conclusions: The minimally- invasive envelope flap could lead to a less painful experience for the patient, with fewer impact on the oral hygiene and speech discomfort. (AU)

Did physical aggression in women increase during the novel coronavirus 2019 (COVID-19) pandemic? A perspective of facial trauma.

PURPOSE: The present study aimed to assess whether there was an increase in physical aggression in women treated in Belo Horizonte, Minas Gerais, through the mandatory quarantine. METHODS: Data from a cross-sectional study were collected and analyzed, from March 1 to December 31, 2020. Additionally, data from the same period the previous year were collected for comparison. RESULTS: Of the etiologies reviewed for 2020, physical aggression had the highest percentage increase (+ 4.9%) and was the only etiology that showed a significant difference (p = 0.045). The mean age of the included patients was 34.05 years in 2019 and 33.97 in 2020, and most of the women had facial fractures, with nasal fractures being the most frequent, followed by jaw fractures. There was a significant increase (p = 0.34) in the conservative treatment of fractures from 2019 (48.6%) to 2020 (71.7%) and a minor (p = 0.088) increase in aggression toward intimate partners (2019, 40.9%; 2020, 63.9%). CONCLUSION: Physical aggression against women increased during the period of mandatory social isolation that resulted from the COVID-19 pandemic. Health professionals, including emergency services professionals, must be trained to identify victims and refer them to specialized care.

New Device for Submental Endotracheal Intubation: A Prospective Cohort Study.

PURPOSE: Silveira et al (2020) described a new device that aims to facilitate submental intubation. This study aimed to verify the clinical complications from using this new device for submental endotracheal compared to the conventional technique. MATERIAL AND METHODS: Patients who underwent submental intubation with the orotracheal tube transposition device were compared to those who underwent the conventional technique in a prospective cohort study. The primary predictor variable was intubation technique: conventional versus device-assisted. The primary outcome was total complications (all complications trans and postoperative, were recorded). Secondary variables were 1) age, 2) sex, 3) etiology, 4) race/ethnicity, 5) fracture types, and 6) intubation procedure time. The data were analyzed using descriptive and inferential statistics. Differences were considered statistically significant at P < .05. RESULTS: Forty-two cases are described, including 24 cases with the device and 18 cases using the conventional technique. The mean age was 30.5 ± 11.228 years. The majority of patients were of male sex (88%), non-white (64%), and victims of motorcycle accidents (33%). The mean time to perform submental intubation was 9.9 minutes (±2.1293). Nine complications were recorded, including 2 intraoperative (2 tube dislocations) and 7 postoperative (5 unesthetic scars, one localized hematoma, and one skin infection). The technique used did not affect the time to submental intubation (P = .610). There was no association between technique and occurrence of intraoperative (P = .679; RR = 0.75; confidence interval [CI], 0.05-11.2), postoperative (P = .656; RR = 1.000; CI, 0.255-3.922), or total complications (P = .602; RR = 0.938; CI, 0.293-3.003). CONCLUSION: The new device proposed seems to be a good option with similar complication rates as compared to conventional submental intubation.

Profile of patients with TMJ dislocation in a level-1 emergency hospital: A cross-sectional study.

OBJECTIVE: To describe a cross-sectional study of TMJ dislocation in a Brazilian level-one trauma center. METHODS: The data were collected and analyzed from electronic medical records in a period from 2013 to 2020. RESULTS: Bilateral TMJ dislocation occurred in the majority of cases, being reduced by the Nélaton maneuver associated with Barton's bandage. The average time between the dislocation and specialist appointment was 30.69 hours. Elderly patients were associated with an increased number of recurrent dislocations (p = 0.03). Furthermore, a longer dislocation time was associated with the reduction under intravenous (IV) sedation (p < 0.05). CONCLUSION: The literature is still scarce concerning demographic data, treatment modalities, and follow-up. More studies are necessary to better understand TMJ dislocation management.

Assessment of condylar fractures associated with mandibular fossa and/or tympanic plate fractures.

Mandibular fractures are frequently diagnosed in trauma centres. Tympanic plate and mandibular fossa fractures can be associated with those fractures and can pass unnoticed if a careful evaluation and adequate imaging exam are not performed. This descriptive study was made to evaluate the incidence of condylar fractures associated with mandibular fossa and/or tympanic plate fractures in a large trauma hospital. Twenty-nine patients were diagnosed with such fractures between July/2019 and July/2020. A total of 81.5% of the patients were diagnosed with condylar fracture associated with tympanic plate fracture, 11.1% with a condylar fracture with mandibular fossa fracture, and 7.4% with condylar fracture associated with both tympanic plate and mandibular fossa fracture. Otorrhagia, trismus, malocclusion, and mouth opening deviation were the most observed clinical signs. Treatments performed were speech therapy, open reduction, and closed reduction. A total of 7.4% of the patients evolved with complications after the treatment. This study suggests that fractures of the tympanic plate and mandibular fossa may go unnoticed if an adequate imaging exam is not performed and rated by the surgeon. The early and corrected treatment prevents future sequelae, and a long-term follow up is essential.

Aspiration of dental items: Case report with literature review and proposed management algorithm.

The aim of this present study is to describe a case of a screwdriver implant aspiration removed with flexible bronchoscopy. This study reviewed the current literature and the authors also proposed an airway management algorithm in case of suspected foreign body aspiration during dental procedures. A review of English-language literature of aspiration of objects after clinical dental practice from 1984 to 2021 was performed. The bronchoscopy was the main method for dental items removal. A total of 57 cases from the literature were enrolled in this study. Aspiration of dental crown and prostheses (43.85%) followed by implant material (19.29%) and tooth (15.78%) were the main aspirated items. Prevention is the better way to avoid this type of complication. Early diagnosis facilitates the removal of foreign body and bronchoscopy is considered the treatment of choice for removal of foreign body aspiration. Also, regular professional training in basic life support is required.

Ultrasonography on the Early Postoperative Control of Severe Odontogenic Infections.

The management of odontogenic infections remains an important segment of the oral-maxillofacial surgical practice. The implementation of ultrasonography (US) imaging for the diagnosis of head and neck infections increases the possibility of visualizing the abscess collections in the deep neck spaces of lateral pharyngeal, masticator, and submandibular areas. The US imaging can detect the presence of fluid collections and edema, which may indicate local inflammation. Signs of deeper infections, such as subcutaneous emphysema and perifascial fluid, may also be apparent via US imaging. We present a new technique that uses US imaging to evaluate the deep neck infections after drainage from the early postoperative time to determine the locations of the drains inside the collection area and the edema of adjacent tissues. This technique is less costly than computed tomography or magnetic resonance imaging and allows for early assessment of adjacent tissues, leading to an earlier extubation and reduced hospitalization time and costs.

Does the Lockdown Influence the Oral and Maxillofacial Surgery Service in a Level 1 Trauma Hospital During the COVID-19 Pandemic?

ABSTRACT: The pandemic status of the Novel Coronavirus 2019 has affected many countries around the world, due to the high virulence of the SARS-CoV-2, the recommended protocol to prevent infection is social isolation. The purpose of this study was to compare the number of patients admitted and their epidemiological data on a Level 1 Trauma Hospital after the declaration of the pandemic status and the first week of mandatory lockdown, with the same period of time in the last year. This was a retrospective study of medical records from the patients admitted in the Oral and Maxillofacial Surgery of the João XXIII Hospital, between the March 24 and March 31 of 2020 and the same period of the last year. There was a 52.27% decrease in the total number of patients and 76.34% decrease in the total consultations of the service of oral and maxillofacial surgery during the lockdown. All the groups presented a decrease in significance with motor vehicle accidents events, the group 11 to 20 years old presented an increase on the correlation with violence (P = 0.019) and falls (P = 0.002). When comparing both sex with the etiologies, the male one presented an increase in the correlation with violence and falls. The female sex presented correlations only with the minor causes. No valid significance was observed when comparing females with violence events. The lockdown is an effective way to reduce the transmission of the COVID-19, the hospital usage and occupation.

What Do We Know About COVID-19?: Maxillofacial Surgeons Survey.

Coronavírus disease 2019 (COVID-19) is a virus of mass dissemination, with an impact on international public health, leading to hospitalizations and death. The main symptoms of COVID-19 are fever, fatigue, dry cough; however, myalgia and dyspnea and the transmission routes include direct transmission by cough, sneeze, droplet inhalation, or contact transmission with the oral, nasal, or eye mucous membranes. The dental professionals are the main risk group to COVID-19 due to the transmission routes that are directly related to the dental practice. In addition, the oral and maxillofacial surgeons (OMFS) are even more exposed, due to increased contact with the population in hospitals and emergency services. OMFS should be able to identify a suspected case of COVID-19, its symptoms, risk groups, disease severity, laboratorial and computed tomography alterations, and treatment guidelines. In the present study, the authors performed a nationwide survey with Brazilian OMFS to evaluate the knowledge of these professionals about the pandemic status of the COVID-19. A total of 142 OMFS replied the survey and the results brings light to an incomparable health public problem that the OMFS in Brazil are no able to protect itself, diagnose the suspicious and probable cases, request and interpret the correct laboratorial examinations for the treatment of the COVID-19 patients.

New Device For Submental Endotracheal Intubation.

The submental intubation is a well-described technique as an alternative for the tracheostomy in the airway management in patients with contraindications for the nasotracheal and cannot remain in the orotracheal position due to the need to maintain the intermaxillary fixation. Residents and young oral and maxillofacial surgeons could have experienced some difficulty performing the technique first described by Altemir (1986). This report aims to describe a new device designed to facilitate and simplify the technique helping surgeons on the submental endotracheal intubation.

Efficacy and safety of diode laser during circumvestibular incision for Le Fort I osteotomy in orthognathic surgery: a triple-blind randomized clinical trial.

The aim of this triple-blind randomized clinical trial was to evaluate the efficacy and safety of diode laser during circumvestibular incisions for Le Fort I osteotomy in orthognathic surgeries in comparison with conventional techniques using electrocautery and scalpel. Patients were randomly allocated to one of three groups based on the technique employed to perform incisions: diode laser, electrocautery, and scalpel. The parameters used to evaluate the efficacy and safety of diode laser were incision velocity, duration of surgery, bleeding rate, alterations in postoperative functions, pain, edema, wound clinical healing, and infection. Thirty patients were enrolled in the study (10 per group). Regarding bleeding, the incisions performed with diode laser promoted a lower bleeding rate compared with scalpel and electrocautery (p = 0.00). The diode surgical laser was effective during the incision procedure, but required a longer time to perform the incisions compared with the other techniques evaluated (p < 0.05). No statistically significant difference was detected between groups regarding total surgical time or other safety parameters (p > 0.05). Thus, diode laser proved to be effective and safer during circumvestibular incisions for Le Fort I osteotomy than conventional devices.

Intraosseous xanthoma of the mandible: A multi-institutional case series with a literature review.

BACKGROUND: The aim of the present study was to report the clinicopathologic, radiographic and immunohistochemical features of five South American cases of intraosseous xanthomas of the mandible and to compare them to those detected in a literature review. METHODS: Clinical data were collected from the records of three Oral and Maxillofacial Pathology services in South America and compared with those compiled from a literature review based on a search of three electronic databases (PubMed, Web of Science and Scopus). All cases were evaluated by haematoxylin and eosin staining and immunohistochemistry for CD68 and S-100. RESULTS: The series comprised four females (80%) and one male (20%) with a mean age of 23.3 ± 10.9 years (range: 13-45 years). In four cases, there was involvement of the posterior region of the mandible (80%). The lesions presented radiographically as unilocular (60%) radiolucencies with punched-out margin (80%). All cases predominantly consisted of CD68-positive and S-100-negative xanthomatous cells. No recurrences were observed after curettage, with a median follow-up of 27 months. CONCLUSION: Intraosseous xanthoma of the jaws is a rare benign disorder. We report here five additional cases affecting the mandible, for a total of 36 cases of the jaws reported in the literature. Overall, this lesion has predilection for posterior sites of the mandible of asymptomatic young adults.

Síndrome da fissura orbital superior associada a traumatismos craniomaxilofaciais / Superior orbital fissure syndrome associated with craniomaxillofacial traumatism

Introdução: A Síndrome da Fissura Orbital Superior (SFOS) é uma condição de ocorrência rara, inicialmente descrita por Hirchfield em 1858. Caracterizada pela presença de oftalmoplegia, ptose da pálpebra superior e midríase, podendo ocorrer parestesia da pálpebra superior e da região frontal, associada à lesão dos pares de nervos cranianos: oculomotor, troclear, abducente (III, IV e VI) e, por vezes, o nervo trigêmeo (V). A identificação da SFOS é importante, visto que sua incidência é rara no trauma, e sua identificação pode ajudar a direcionar o tratamento de forma mais adequada. Relato de caso: O presente trabalho descreve dois casos da SFOS associados a traumas craniofaciais, cita as possíveis etiologias relacionadas a essa síndrome e descreve a situação de trauma agudo. Considerações Finais: A avaliação das condições sistêmicas do paciente e de exames complementares, como tomografias computadorizadas, auxilia o diagnóstico diferencial entre patologias que acometem a região orbital e a base de crânio, fraturas e traumas craniofaciais. A identificação da SFOS no trauma agudo orienta a abordagem imediata ou precoce quando indicada, como nos casos de hematomas retrobulbares ou em grandes deslocamentos ósseos maxilofaciais com necessidade de redução cirúrgica. Nos casos com indicação de abordagem tardia, as fraturas craniofaciais são tratadas de forma conservadora, e o paciente é encaminhado para atendimento especializado... (AU)

Introduction: The superior orbital fissure syndrome (SOFS) is a rare condition and initially described by Hirchfield in 1858. Characterized by the presence of ophthalmoplegia, upper eyelid ptosis and mydriasis, and there may be paresthesia of the upper eyelid and forehead associated by the injury of the cranial nerves like: oculomotor, trochlear, abducens (III, IV and VI) and sometimes the trigeminal nerve (V). The identification of SOFS is important, since its incidence is rare in trauma, and its identification may help to target the treatment more adequately. Case report: The present study describes two cases of SFOS associated with craniofacial trauma, cites the possible etiologies related to this syndrome and describes the situation of acute trauma. Final considerations: The evaluation of the patient's systemic conditions and complementary exams, such as computed tomography, help the differential diagnosis between pathologies that affect the orbital region and the skull base, and fractures and traumatic head injuries. The identification of SFOS in acute trauma guides the immediate or early approach when indicated, as in cases of retrobulbar hematomas or large maxillofacial bone dislocations requiring surgical reduction. In cases with indication for late approach, craniofacial fractures are treated conservatively and the patient is referred for specialized care... (AU)

Supernumerary nasal tooth removed with a modified maxillary vestibular approach: case report and literature review.

PURPOSE: The aim of this present study is to describe a case of supernumerary nasal tooth removed with a modified maxillary vestibular approach with subperiosteal dissection. METHODS: Also, a review of English-language literature of supernumerary nasal teeth from 1959 to 2018 was performed. RESULTS: This study demonstrated that the modified maxillary approach with subperiosteal intranasal dissection is a useful approach for the exposure and removal of teeth impacted in the floor of the nasal cavity. The advantage of its use versus the other techniques is the lower risk of complications and postoperative morbidity. The use of computed tomography is essential to determinate the position of the tooth and to help in the surgical planning. CONCLUSIONS: The transoral approaches are more natural to the oral and maxillofacial surgeons than the transnasal or endoscopic ones.

Experience with 5% ethanolamine oleate for sclerotherapy of oral vascular anomalies: A cohort of 15 consecutive patients.

PURPOSE: To describe the effectiveness and safety of a sclerotherapy protocol with 5% ethanolamine oleate (EO) at 0.1 mL/3 mm for oral vascular anomalies (OVAs). Our hypothesis is that EO applied at a concentration of 5% may decrease the number of sessions necessary for clinical healing. MATERIALS AND METHODS: We describe a cohort of 15 consecutive patients. OVAs <20 mm were included. Clinical data of the OVAs were collected. Descriptive and bivariate statistical analyses were performed. RESULTS: Fifteen of the 19 OVAs were varicosities and the lower lip was the most affected site (n = 7). The median size was 6 mm, and one session was required in 89.5% of cases for clinical healing within 28 days. The pain/burning score was low (<2) for most lesions (63.1%) and the degree of satisfaction was high (>8) for all OVAs. The number of applications, final volume of drug and time to resolution differed significantly according to the size of the anomaly. CONCLUSION: The protocol with 5% EO was shown to be effective and safe to treat OVAs <20 mm, and with a decrease in the number of sessions, volume and time to resolution, without complications and with high patient satisfaction.

High-power diode laser in the circumvestibular incision for Le Fort I osteotomy in orthognathic surgery: a prospective case series study.

The incisions during orthognathic surgery are classically performed with conventional scalpel or electrocautery. Considering that the high-power diode laser surgery may provide advantages when compared to conventional incision techniques, the current study aimed to present a prospective case series of patients submitted to circumvestibular incision for Le Fort I osteotomy. Ten patients with dentofacial deformities who underwent to rapid assisted maxillary expansion or bimaxillary orthognathic surgery were enrolled in the study. All incisions were performed by a single surgeon using an 808-nm diode laser, with an optical fiber of 600 µm, at a power of 2.5 W, in a continuous-wave mode. The performance of the incision was evaluated by incision velocity, bleeding, edema, secondary infection, clinical healing, and pain. The velocity of the incision ranged from 0.10 to 0.20 mm/s (mean 0.13 ± 0.03 mm/s). Considering bleeding during the soft tissue incision, all surgeries were classified as absent bleeding. All patients presented a clinical healing of the surgical wound in a period that range from 3 to 5 weeks and experienced swelling during the follow-up period. On average, approximately 50% of the swelling had resolved after the third postoperative week, and 28.8% of swelling remained after 2 months after the surgery. The pain decreased after 2 and 3 days, and 90.0% of the patients reported no pain after 7 postoperative days. High-power diode laser is effective and safety during circumvestibular incisions for Le Fort I osteotomy in orthognathic surgery decreasing bleeding, surgery time, pain, and edema after orthognathic surgery.

Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review.

PURPOSE: The present study aims to describe three cases of patients inflicted by rubber bullets with severe facial fractures. METHODS: In addition, a review of English-language literature involving facial fractures by rubber bullets from 1975 to 2016 was performed. RESULTS: This current study demonstrated that the use of the LLRBW is unsafety even when applied by police enforcements exclusively. CONCLUSIONS: Management of facial fractures caused by LLRBW is done in a usual manner with closed or open reduction associated with bone mini-plates or reconstruction plates when indicated. Special initial wound care should be done to avoid secondary infection and additional procedures.

Prevalence profile of odontogenic cysts and tumors on Brazilian sample after the reclassification of odontogenic keratocyst.

PURPOSE: The aim of this study was to evaluate the impact of the reclassification of odontogenic keratocyst (OKC) as a tumor on the prevalence profile of odontogenic cysts (OCs) and odontogenic tumors (OTs). STUDY DESIGN: Two referral Oral and Maxillofacial Pathology services in Brazil were evaluated. All cases diagnosed as OCs or OTs were selected and classified according to the 1992 WHO-classification (cases before 2005 WHO classification of tumors excluding OKC) and the 2005 WHO classification of tumors, going forward including cases of odontogenic keratocyst tumor (KCOT). The frequency and prevalence of OCs and OTs were compared before and after the reclassification. RESULTS: Among 27,854 oral biopsies, 4920 (17.66%) were OCs and 992 (3.56%) were OTs. The prevalence of OTs before 2005 WHO classification of tumors was 2.04%, while the prevalence after 2005 WHO classification was 11.51% (p < 0.0001). Before 2006, the most frequent tumor diagnosed was odontoma with 194 cases (39.67%), and after 2005 WHO classification of tumors the KCOT was the most frequent with 207 cases (41.07%). CONCLUSIONS: The increase in the prevalence of OTs after 2005 WHO is related to the improvement of pathology services and to the inclusion of KCOT in the OTs group.