Prevalence and Variation of Medical Comorbidities in Oral Surgery Patients: A Retrospective Study at Jazan University.

BACKGROUND An aged population is susceptible to chronic diseases, which impacts oral surgery treatment procedures. This retrospective study aimed to evaluate the incidence of medical comorbidities in 640 oral surgery patients treated at the College of Dentistry, Jazan University. MATERIAL AND METHODS This single-center observational study investigated medical records of outpatients who visited Jazan University Dental College Hospital in a 1-year period (2018-2019). Patients’ clinical and radiographic archives were screened to obtain relevant data. Categorical and continuous variables were expressed in terms of frequency and mean values, respectively. Differences in variables were statistically analyzed using the chi-square goodness of fit and proportional test, with a probability value P≤0.05 considered significant. RESULTS Analysis of 640 patient records included records of 300 men and 340 women who underwent oral surgery, of whom 176 patients (27.5%), including 97 men and 79 women, had medical comorbidities. The most common comorbidities were endocrine disease (7.03%), cardiovascular disease (6.71%), respiratory disease (4.53%), and hematological disorders (3.43%). Individual diseases that showed higher prevalence were diabetes mellitus (4.68%), hypertension (3.43%), bronchial asthma (2.65%), and anemia (1.4%). Differences by sex were observed in many individual disorders. CONCLUSIONS Outpatients in oral surgery clinics presented a significant variance in the incidence of medical comorbidities, among which diabetes and hypertension were most common. A proper case history is the best preventive measure that helps a surgeon avert medical emergencies and post-surgical complications.

Oral Cancer in the Indian Subcontinent-Survival Outcomes and Risk Factors with Primary Surgery.

OBJECTIVE: To assess the oncological outcome and prognostic factors for primary Oral Squamous Cell Cancer (OSCC) staged as per AJCC 8th pTNM, and treated by the contemporary standard of primary surgery and pathology directed adjuvant radiation-chemoradiation. METHODS: A single institution cohort from a tertiary care academic institution in North India. Case inclusion 2013 to 2016; n = 218, median follow-up 35 months. All patients were restaged as per the AJCC 8th pTNM classification. Analysis for Overall Survival (OS), Disease-free Survival(DFS), and factors impacting outcome (Cox proportionate model Multivariate analysis). RESULTS: AJCC pTNM 7th to 8th edition conversion led to upstaging in 16.5%. Stage-II demonstrated greatest stage migration and apparent improvement in OS and DFS (P < .09). Discordance was noted between the presurgical (clinico-radiologic) and postsurgical (pathological) nodal status in 40.3% (88/218; 54 pathologically upstaged;34 downstaged). Pathological downstaging was particularly significant with advanced stage Gingivo-Buccal Cancers (25/73-34.7%). Stage-I-II early cancers had 3 years. OS-86.7% and DFS-78.8%; Stage-III-IV advanced cancers had 3 years. OS-56.7% and DFS-46.6%. Multivariate analysis identified poorer OS and DFS for age < 40 years (HR-1.8; 2.0), skin involvement (HR-2.1; 2.6) and pN+ status (HR-2.4; 3.5). Bone involvement did not compromise survival in this surgically treated set of patients. CONCLUSION: Age < 45 is newly identified as significantly compromising DFS and OS in Oral Cancer. Established factors of skin involvement and pN+ are confirmed as impacting DFS-OS. An apparent improvement in survival in Stage II Cancers is noted as consequent to adoption of AJCC 8th edition staging. LEVEL OF EVIDENCE: 2 (OCEBM 2011-Inception Cohort Study for Prognosis) Laryngoscope, 131:2254-2261, 2021.

How has COVID-19 affected surgical practice in Oral and Maxillofacial Surgery in the East Midlands, UK?

The impact on the provision of care within the NHS due to COVID-19 can not be understated. It has created various challenges for Oral and Maxillofacial Surgeons due to the high-risk nature of working within this specialty. The aims of this study were to identify the ongoing clinical activities at the height of pandemic, the guidance issued to staff regarding the use of personal protective equipment and the changes to maxillofacial practice. A prospective analysis was commenced within six Oral and Maxillofacial Surgery units in the East Midlands, UK with data being collected by means of a 10-item questionnaire relating to changes in patient care during this time. The responses were analysed to identify compliance with the national guidance produced by the British Association of Oral and Maxillofacial Surgeons. An 87% response rate was obtained (26 respondents from 30 invitations). 73.1% of participants confirmed all surgical members of staff were offered fit tests for FFP3 masks. All units reported a continuation of Head and Neck cancer and emergency operations with a complete reduction in TMJ and orthognathic surgery. FFP3 masks were the most popular masks used for theatre activity whilst FFP2 and surgical masks were more widely used for examining patients and performing procedures in the emergency department. Changes in maxillofacial practice included the use of local flaps compared to free flaps, use of intermaxillary fixation (IMF) where appropriate for craniofacial trauma and routine COVID-19 testing for all inpatients.

Risk of Complications in Primary Versus Revision-Type Cranioplasty.

INTRODUCTION: Cranioplasty (CP) is a multifaceted procedure in a heterogenous patient population, with a high risk for complication. However, no previous large-scale studies have compared outcomes in primary (ie, first attempt) CP versus revision CP (ie, following previous attempts). The authors, therefore, analyzed long-term outcomes of 506 consecutive primary and revision CPs, performed by a single surgeon. METHODS: All CPs performed between 2012 and 2019 were analyzed under IRB protocol approval. Surgeries were categorized as either primary (no previous CP; n = 279) or revision CP (at least one previous CP; n = 227). Complications were defined as either major or minor. Subgroup analyses investigated whether or not CP complication risk directly correlated with the number of previous neuro-cranial surgeries and/or CP attempts. RESULTS: The primary CP group experienced a major complication rate of 9% (26/279). In comparison, the revision CP group demonstrated a major complication rate of 32% (73/227). For the revision CP group, the rate of major complications rose with each additional surgery, from 4% (1 prior surgery) to 17% (2 prior surgeries) to 39% (3-4 prior surgeries) to 47% (≥5 prior surgeries). CONCLUSION: In a review of 506 consecutive cases, patients undergoing revision CP had a 3-fold increase in incidence of major complications, as compared to those undergoing primary CP. These results provide critical insight into overall CP risk stratification and may guide preoperative risk-benefit discussions. Furthermore, these findings may support a center-of-excellence care model, particularly for those patients with a history of previous neuro-cranial surgeries and/or CP attempts.

The Indian dental litigation landscape: An analysis of judgments on dental negligence claims in Indian Consumer Redressal Forums.

INTRODUCTION: Dental malpractice/negligence litigations against dentists in India is not widely studied. The aim of this study is to report the Indian dentist related litigation landscape in consumer redressal forum (CRF) and to understand more of the nature of the same. MATERIAL AND METHOD: 111 cases of judgments of dental malpractice in Indian CRF were collected. Useful information was extracted, reported in a grid and statistically analyzed. Data was compared by claim, specialty, treatment offered, days lapsed and compensation awarded. P ≤ 0.05 was taken as statistically significant. RESULTS: In all, 44 (39.63%) dentists were found guilty. Thirty dentists had produced at least one evidence in their favor. Among them, 23 outcomes were in dentist's favor.(P = 0.02) The mean wait for final judgment was 1945 ±â€¯1286(193-6762) days. The mean compensation claimed was INR 577287 ±â€¯905898. Presence of evidence (dentists/patients) had an impact on the days to reach a judgment as well as compensation. CONCLUSION: Indian dental litigation landscape CRF has been described for the first time. We identified that CRF litigation of dental malpractice are few, as compared to number of procedures performed in India. Oral surgical procedures were often involved and 40% of instances, dentists were guilty and mean compensation awarded was INR 103998 ±â€¯158976.

Evaluación de la saturación arterial de oxígeno durante procedimientos de cirugía bucal en pacientes fumadores / Evaluation of arterial oxygen saturation during oral surgery procedures in smoker patients

INTRODUCCIÓN: El manejo odontológico de pacientes médicamente comprometidos requiere un enfoque integral y multidisciplinario. La hipoxemia puede presentarse en pacientes odontológicos con enfermedades respiratorias durante y después de la intervención, por lo que se requiere la monitorización del porcentaje de saturación de oxígeno en sangre periférica (%SpO2) para identificar rápidamente aquellos trastornos que precisen intervención terapéutica. La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad que puede permanecer subdiagnosticada en pacientes fumadores asintomáticos, quienes pueden presentar estas alteraciones. OBJETIVO: Evaluar el %SpO2 durante procedimientos de cirugía bucal en pacientes fumadores. MATERIALES Y MÉTODOS: A los pacientes fumadores a quienes se realizaron procedimientos de cirugía bucal en los servicios del Postgrado de Cirugía Bucal de la Facultad de Odontología de la Universidad Central de Venezuela y aceptaron su inclusión en el estudio se les determinó el consumo tabáquico en índice paquetes/año (p/a) y se les aplicó el COPD Assesment Test (CAT), la escala de disnea modified Medical Research Council (mMRC) y la clasificación de la Global Initiative for Chronic Obstructive Lung Disease (GOLD); también se les realizó una espirometría forzada y se registró la %SpO2 mediante un pulsioxímetro antes de comenzar el procedimiento quirúrgico, al realizar el bloqueo anestésico, un minuto después de este y al finalizar la síntesis de los tejidos. Los datos fueron analizados utilizando las pruebas t de Student, Chi cuadrado, Mann-Whitney y rho de Spearman. Se consideró un contraste estadísticamente significativo si p < 0,05. RESULTADOS: Se incluyeron 33 individuos, distribuidos en dos grupos: G1, n = 16, índice tabáquico > 20 p/a; G2, n = 17, índice tabáquico ≤ 20 p/a. El G1 presentó mayor puntuación CAT (10 vs. 4) y mMRC (2 vs. 0) y una disminución en los parámetros espirométricos %VEF1/CVF 59 vs. 83 %, FEF25-75% 38 vs. 82 l/s (p = 0,001). Todos los pacientes del G1 fueron diagnosticados de EPOC y tuvieron una significante disminución en el %SpO2 durante los tiempos quirúrgicos evaluados (97 vs. 98, 96 vs. 98, 95 vs. 97, 93 vs. 97 %), así como desaturaciones %SpO2 < 90 % (75 vs. 0) y mayor porcentaje de desaturación (3,5 vs. 1). No se observó correlación entre la duración de la cirugía y el %SpO2. CONCLUSIONES: Los pacientes fumadores de más de 20 p/a y con diagnóstico de EPOC presentaron disminuciones significativas del %SpO2 durante la realización de procedimientos odontológicos independientemente de su duración total; sin embargo, no se evidenciaron manifestaciones clínicas de hipoxemia

INTRODUCTION: Hypoxemia commonly arises in dental patients with lung diseases during and after surgery and requires monitoring patients' blood oxygenation to identify life-threatening problems. Chronic Obstructive Lung Disease (COPD) could remain underdiagnosis in smokers without symptoms. OBJECTIVE: The aim of this study was to evaluate the arterial oxygen saturation (%SpO2) during oral surgery procedures in smoker PATIENTS: MATERIALS AND METHODS: The study population consisted in thirty-three smoker patients undergoing oral surgery procedures using local anesthetic at the School of Dentistry in the Central University of Venezuela. A medical history, included information on smoking habits: pack/year, COPD Assessment Test (CAT), modified Medical Research Council (mMRC), all patients were classified by Global Initiative for Chronic Obstructive Lung Disease criteria (GOLD). Oxygen saturation was monitored by pulse oximetry, before the beginning of the surgery, during the anesthetic administration, one minute after and the end of the suture. Data were analyzed using Student's t test, chi-squared, Mann-Whitney test, Spearman's rho test. RESULTS: Subjects were divided in two groups according with the smoking history: group 1, n = 16, > 20 pack/year; group 2, n = 17, ≤ 20 pack/year. Group 1 have higher scores of CAT (10 vs. 4) mMRC (2 vs. 0) and lower spirometric values % FEV1/FVC 59 vs. 83 %, FEF25-75 of 38 vs. 82 lts/s (p = 0,001). All group 1 patients were diagnosis with COPD and lower oxygen saturation during times of surgery (97 vs. 98, 96 vs. 98, 95 vs. 97, 93 vs. 97 %), episodes of %SpO2 90 % (75 vs. 0 %) and times of desaturation below the baseline (3,5 vs. 1). There was not relation between time of surgery and oxygen saturation. CONCLUSIONS: Patients with a smoking history > 20 pack-years and COPD diagnosis have episodes of arterial oxygen desaturation during oral surgery procedures and it occurs in the absence of hemodynamic or other physiologic signs of hypoxemia

Osteoradionecrosis of the mandible after radiotherapy for head and neck cancer: risk factors and dose-volume correlations.

Background: The project aimed at determining the incidence of mandibular osteoradionecrosis (ORN) after radiotherapy, possible risk factors, and mandibular dose-volume effects in a large cohort of head and neck cancer patients (HNC). Methods: The cohort consisted of 1224 HNC patients treated with 66-68 Gy in 2007-2015 predominantly with IMRT. ORN cases were defined from clinical observations at follow-up and through hospital code diagnostics after oral-maxillofacial surgery and cross-checked with the national Danish Head and Neck Cancer database. In a nested case-control study, patients with ORN cases were matched with two controls (1:2) and pre-RT dental procedures including surgery to the mandible were documented. Multivariable Cox regression analysis was applied using demographic and treatment variables including dental procedures, smoking and tumor characteristics, and combined with dosimetric data. Mean mandibular dose (Dmean) was pre-selected for the multivariable model. Results: ORN was recorded in 56 cases (4.6%) with a median time to event of 10.9 months (range 1.8-89.7) after RT, 90% occurred within 37.4 months. Median follow-up time was 22 months (0.3-95). Average Dmean was significantly higher in the ORN event cohort and significant dose-volume differences were observed for population mean DVH doses between 30 Gy and 60 Gy. In univariable analysis, smoking (HR = 1.69; CI 1.14-2.5), pre-RT surgery/tooth extraction (HR = 2.76; 1.48-5.14), and several dosimetric parameters including Dmean (HR = 1.05, 1.02-1.08) were all significantly associated with ORN. Dmean and surgery/tooth extraction remained significant predictors of ORN in multivariable analysis, HR = 1.04 (CI 1.01-1.07) and HR = 2.09 (CI 1.1-3.98), respectively, while smoking only retained its significance in an interaction analysis with pre-RT dental procedures. Conclusion: The onset of ORN of the mandible was early (median 10.8 months) and the incidence low (4.6%) after IMRT in HNC cancer patients. Surgery to the mandible and pre-RT tooth extraction, tobacco smoking, and treatment dose were associated with the development of ORN.

A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery.

PURPOSE: Especially in oral and maxillofacial surgery, where procedures involving the aero-digestive tract considered clean contaminated, surgical site infections (SSI) represent a severe health care burden. To improve implementation and methodological standard, an upgrade of the existing S1 guideline to a consensus-guided S3 guideline was initiated by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF, register number 067/009) and 25 collaborating medical societies. METHODS: A systematic literature search based on the Scottish Intercollegiate GL Network (SIGN)-search string for the guideline "Antibiotic prophylaxis in surgery" from 2014 was performed and equivalent exclusion/inclusion criteria were applied. An additional hand search provided latest evidence. RESULTS: In total, 80 clinical trials, retrospective studies, reviews, and meta-analysis were analyzed. For orthognathic surgery, prolonged antibiotic regimen may reduce risk for SSI but there is lack of evidence for the effects of short- vs. long-term therapy. For maxillofacial traumatology, antibiotic prophylaxis might reduce SSI but prolonged postoperative dosing shows no benefit. For clean-contaminated oncological interventions, anti-infectious therapy for 24 h only can reduce SSI; patients may not benefit from prolonged regimen. In contrast, for dentoalveolar procedures such as implantology or third molar removal, literature reveals ambivalent results. CONCLUSION: In summary, consensus process of the planned S3 guideline is much in need to transfer the indecisive results for antibiotic prophylaxis in dentoalveolar surgery in clinical praxis and encourage adherence to guidelines.

Optimal timing of endoscopic sinus surgery for odontogenic sinusitis.

OBJECTIVES: Odontogenic sinusitis (ODS) is more common than historically reported, and management recommendations are limited in the literature. Although ODS case series have shown successful outcomes with dental treatment and endoscopic sinus surgery (ESS), no studies have considered the optimal timing of these treatments. The purpose of this study was to analyze times to ODS resolution after primary dental treatment and ESS based on symptom, 22-item sinonasal outcome test (SNOT-22), and endoscopic outcomes. STUDY DESIGN: Prospective cohort study. METHODS: Thirty-seven symptomatic ODS patients who failed medical management were offered primary dental treatment or ESS. Eleven patients selected primary dental treatment, and 26 patients selected ESS. The following variables were collected prospectively at every office visit before and after dental treatment or ESS: SNOT-22, presence or absence of cardinal sinusitis symptoms, and presence or absence of middle meatal endoscopy findings (edema, polyps, purulence). Times to resolution of these clinical variables were analyzed with t test, chi-square test, Fisher exact test, McNemar test, and Kaplan-Meier survival analysis. RESULTS: Patients in the dental treatment and ESS groups showed no significant differences in preoperative sinusitis disease burdens based on symptoms, SNOT-22, endoscopy, and computed tomography. The ESS group experienced faster and more significant improvement in nearly all symptom, SNOT-22, and endoscopic outcomes. CONCLUSIONS: For symptomatic ODS, primary ESS resulted in faster resolution of SNOT-22, sinusitis symptoms, and endoscopic findings in ODS patients compared with primary dental treatment. ESS can be considered first-line therapy for symptomatic ODS, followed by dental treatment when necessary. LEVEL OF EVIDENCE: 2b Laryngoscope, 129:1976-1983, 2019.

Prospective Clinical and Histologic Evaluation of Alveolar Socket Healing Following Ridge Preservation Using a Combination of Hydroxyapatite and Collagen Biomimetic Xenograft Versus Demineralized Bovine Bone.

PURPOSE: This prospective study is aimed at investigating clinically and histologically the effectiveness of a biomimetic magnesium-enriched-hydroxyapatite (MgHA)/collagen-based bone substitute for alveolar socket preservation. MATERIALS: Patients scheduled for posterior single tooth extraction were included. The alveolar socket was filled either with MgHA or deproteinized bovine bone matrix (DBBM). In DBBM group, a punch of mucosa was taken from the palate and used to cover the graft. Vertical and horizontal dimensional changes of the alveolar process were assessed clinically with a periodontal probe and with 3-dimensional (3D) analysis of a cast model. Postoperative quality of life was assessed through a questionnaire. After 6 months of healing, an alveolar tissue biopsy was taken for histologic and histomorphometric analysis of the newly formed tissue. After checking normality of the distributions, parametric or nonparametric tests were used for statistical comparisons. RESULTS: Twenty patients (12 males, 8 females, mean age 42.8 ±â€Š5.1 years, range 33-50 years) were treated. After 6 months, vertical and horizontal alveolar ridge resorption was similar in the 2 groups. The 3D analysis of the models showed a significantly higher resorption at the buccal side than at the palatal/lingual side. Histomorphometric analysis showed similar new bone formation for MgHA group (23.07 ±â€Š10.3%) and DBBM (22.77 ±â€Š6.95%), and a significantly higher residual material% for DBBM (15.77 ±â€Š1.95%) than MgHA (5.01 ±â€Š1.04%). Significantly less pain was reported in the first 3 days after surgery in patients of the MgHA group. CONCLUSION: The MgHA was as safe and effective as DBBM and may represent a feasible bone substitute for alveolar socket preservation.

Caracterización de los casos de fracturas maxilofaciales operados en el Hospital Carlos van Buren, Chile, entre los años 2010-2014 / Characterization of the cases of maxillofacial fractures operated in Carlos van Buren Hospital, Chile, between the years 2010 and 2014

Objetivos: El objetivo de esta investigación fue describir demográficamente la población estudiada, la etiología y los tratamientos quirúrgicos utilizados en el Hospital Carlos van Buren en Chile entre los años 2010 y 2014. Método: Recolección de datos mediante revisión retrospectiva de fichas médicas de los pacientes operados por trauma maxilofacial entre el 1 de enero de 2010 y 31 de diciembre de 2014. Resultados: Se encontró una preponderancia de pacientes varones (83%), y la relación hombre a mujer fue de 5: 1. Aproximadamente la mitad de los casos tenían entre 20 y 39 años de edad, con una edad promedio de 34 años. El diagnóstico maxilofacial más frecuente fue la fractura mandibular (47%). Las lesiones no maxilofaciales asociadas ocurrieron en el 38% de los casos, el 37,5% de los pacientes sufrió un traumatismo encéfalo-craneano. El traumatismo maxilofacial fue causado por agresiones en el 45,5%, seguido por accidentes de tránsito en el 19,6%. Reducción abierta y osteosíntesis múltiple se realizó en la mayoría de los casos. Cuanto mayor fue el número de fracturas, mayor fue el tiempo de hospitalización, siendo la media de 11,8 días. Conclusión: Los resultados obtenidos son en general coincidentes con la literatura

Objectives: The aim of this study was to demographically describe the population studied, the aetiology, and surgical treatments used in the Carlos van Buren Hospital in Chile between 2010 and 2014. Method: Data collection was by retrospective review of medical records of patients operated on due to maxillofacial trauma between 1 January 2010 and 31 December 2014. Results: The large majority of patients were male (83%), with a male to female ratio of 5: 1. Approximately half of the cases were between 20 and 39 years of age, with a mean age of 34 years. The most frequent maxillofacial diagnosis was mandibular fracture (47%). Associated non-maxillofacial lesions occurred in 38% of the cases, and 37.5% of the patients suffered traumatic brain injury. Maxillofacial trauma was caused by assaults in 45.5%, followed by traffic accidents in 19.6%. Open reduction and multiple osteosynthesis was performed in most cases. The higher the number of fractures, the longer the hospitalisation time, with a mean of 11.8 days. Conclusion: The results obtained are generally coincident with the literature

An Evaluation of a Practice-Based Minor Oral Surgery Service.

AIM To report the findings of a service evaluation of an NHS practice-based minor oral surgery service. METHOD A service evaluation including a retrospective analysis of activity and outcome data and assessment of patient and practitioner satisfaction. RESULTS 623 appointments were arranged, with a mean waiting time of 43 days. Treatment provided included: surgical removal of third molars and non-third molars, surgical endodontics and other surgical and oral medicine cases (29.7%, 44.1%, 3.0% and 23.4% of cases respectively). Antibiotics were prescribed at 16.1% of treatment appointments and 1.9% required appointments for post-operative complications. All participants reported overall satisfaction with their care and strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding and acceptance; 77.5% were seen on time and none were seen more than 15 minutes late; 87.5% felt the standard of the service was better than expected than at a hospital and none felt it was worse. Over 80 of practitioners agreed that waiting times were better than expected at a hospital, urgent problems were seen quickly and the referral process was easy and understandable. All practitioners strongly agreed/agreed they that they were happy with the service provided. CONCLUSIONS A range of minor oral surgery procedures can be provided with low complication rates, acceptable waiting times and accessibility, and high patient and referring practitioner satisfaction from a practice-based specialist oral surgery service.

Produção especializada no SUS em capitais brasileiras com centros de especialidades odontológicas: uma análise descritiva / Specialized production in the unified health system in Brazilian capitals with dental specialty centers: a descriptive analysis

Centros de especialidades odontológicos (CEOs) são estabelecimentos de saúde de âmbito especializado que devem realizar uma quantidade mínima de procedimentos. Objetivos: descrever a produção odontológica especializada e reportar o cumprimento das metas nas capitais brasileiras com CEOs. Materiais e método: foi conduzido um estudo do tipo longitudinal retrospectivo, sendo realizada uma busca por CEOs cadastrados no Cadastro Nacional de Estabelecimentos de Saúde (CNES). A produção odontológica foi pesquisada no Sistema de Informações Ambulatoriais do Sistema Único de Saúde (SIASUS), de maio de 2015 a abril de 2016. Resultados: foram encontrados e considerados elegíveis para o presente estudo 59 CEOs, localizados em 19 capitais brasileiras e no Distrito Federal, sendo 48% CEOs tipo II. Cerca de 730 mil procedimentos especializados foram realizados durante os 12 meses avaliados. Uma taxa de 86% das metas foi cumprida, sendo que cirurgia foi à área com maior cumprimento (92%), seguida de periodontia (89%) e endodontia (76%). Uma das capitais apresentou apenas 33% das metas cumpridas. Três capitais não atingiram nenhuma das metas estabelecidas em procedimentos de endodontia. Conclusão: foi observada uma grande variação no cumprimento das metas entre as capitais com CEOs. Enquanto algumas capitais apresentaram elevado cumprimento das metas, outras exibiram dados preocupantes, principalmente nos procedimentos de endodontia. (AU)

Dental Specialty Centers (Centros de Especialidades Odontológicas ­ CEOs) are specialized health facilities that should perform a minimum number of procedures. Objectives: this study aimed to describe the specialized dental production and report the achievement of goals in Brazilian capitals with CEOs. Materials and method: a retrospective longitudinal study was performed with a search for the CEOs listed in the National Registry of Health Establishments. The dental production was searched in the Outpatient Information System of the Brazilian Unified Health System for the period from May 2015 to April 2016. Results: fifty-nine CEOs were found and considered eligible for the present study. They were located in 19 Brazilian capitals and in the Federal District, whereas 48% were CEOs Type II. Approximately 730 thousand specialized procedures were performed during the 12 months evaluated. A rate of 86% of goals was met and surgery presented the highest achievement (92%), followed by periodontics (89%) and endodontics (76%). One of the capitals achieved only 33% of the goals. Three capitals did not achieve any of the goals set for endodontic procedures. Conclusion: there was a great variation in the achievement of goals among capitals with CEOs. While some capitals showed high achievement of goals, others presented concerning data, especially for endodontic procedures. (AU)

Speech and language characteristics in individuals with nonsyndromic submucous cleft palate-A systematic review.

BACKGROUND: Up to 80% of individuals with unrepaired submucous cleft palate (SMCP) experience speech difficulties secondary to velopharyngeal insufficiency. Language delays are reported in the broader cleft lip and/or palate population, suggesting that individuals with SMCP may also be at risk. However, contemporary understanding of this population remains limited as there has been no systematic examination of the literature. This review aims to systematically review and document the speech and language characteristics of individuals with nonsyndromic SMCP and, in addition, to identify factors reported to impact speech and language outcomes. METHOD: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five databases were comprehensively searched using keywords and indexed headings. Included studies had to report speech or language outcomes of individuals with nonsyndromic SMCP. Risk of bias and methodological design quality were examined using tools from the Scottish Intercollegiate Guidelines Network. Relevant data were extracted for analysis. RESULTS: Eighteen studies met inclusion criteria, yielding 598 participants. Study results showed that individuals with unrepaired nonsyndromic SMCP may have speech difficulties secondary to velopharyngeal insufficiency including increased nasal resonance and palatalized or glottal articulation. Lower age at primary surgical repair led to better postsurgical speech outcomes. There is a paucity of literature outlining motor or phonological aspects of speech and receptive or expressive language abilities of this population. CONCLUSION: Individuals with nonsyndromic SMCP present with speech difficulties similar to those experienced by individuals with overt cleft palate. Health care professionals should be aware of possible presenting symptoms and consider early SMCP diagnoses where appropriate. Further research is needed to specify the broader communication profile in this population.

Challenges to achieving low palatal fistula rates following primary cleft palate repair: experience of an institution in Uganda.

OBJECTIVE: To determine frequency of palatal fistula following primary cleft palate repair and the associated factors as a measure of cleft palate repair outcome and its challenges at a cleft centre in Uganda. RESULTS: Between May and December 2016, 54 children with cleft palate were followed up at Comprehensive Rehabilitation services of Uganda (CoRSU) hospital, from time of primary cleft palate repair until at least 3 months postoperative to determine whether they developed palatal fistula or not. Frequency of palatal fistula was 35%. Factors associated with increased fistula formation were cleft width wider than 12 mm (p = 0.006), palatal index greater than 0.4 (p = 0.046), presence of malnutrition at initial outpatient assessment (p = 0.0057) and at time of surgery (p = 0.008), two-stage palate repair (p = 0.005) and postoperative infection (p = 0.003). Severe clefting (palatal index greater than 0.4) was seen in 74% of patients and malnutrition (Low weight for age) seen in 48% of patients. Palatal fistula rates at our institution were high compared to reports in literature. The high proportions of severe clefting and malnutrition observed in our population that was also poor and unable to afford feeding supplements increased likelihood of fistula formation and posed challenges to achieving low fistula rates in our setting.

[Risk factors generally neglected in oral surgery and implantology: the high LDL-cholesterol and the insufficient level of vitamin D]. / Des facteurs de risque généralement négligés en chirurgie orale et en implantologie : le taux élevé de LDL-cholestérol et le taux insuffisant de la vitamine D.

INTRODUCTION: Vitamin D deficiency is widespread throughout the world. Vitamin D has an important role in the regulation of phosphocalcic metabolism as well as in a large number of biological and metabolic processes. According to some studies, there is a correlation between vitamin D and LDL-cholesterol levels. A deficiency of vitamin D and / or a high level of LDL-cholesterol could represent risk factors for bone healing and osteointegration of dental implants. The purpose of our study is to demonstrate the reality of the problem of deficiency or deprivation in vitamin D in a population of patients requiring oral and / or implant surgery. MATERIAL AND METHODS: 46 cases of patients having undergone oral surgery together with preoperative blood test were analyzed. The results of the dosages of 25-hydroxy-vitamin D (25-OH-D), total cholesterol, LDL-cholesterol, HDL-cholesterol were collected and compared with reference values. Statistical tests were performed to determine the possible correlations between the 25-OH-D level and other blood parameters. RESULTS: 38 patients out of 46 (82.6 %) are defective in vitamin D, and 7 patients out of 46 (15.2 %) are deficient. LDL-cholesterol levels were high in 15 patients out of 33 (45.5 %). There was a non-significant correlation between LDLcholesterol and vitamin D levels. Total cholesterol was high in 42 % of patients. We observed a significant correlation between total cholesterol and vitamin D levels. CONCLUSION: According to our study, it appears that a preoperative assessment including the dosage of vitamin D, total cholesterol and LDLcholesterol may be of interest in patients requiring oral and / or implant surgery by correcting if necessary blood parameters and promoting bone metabolism.

INTRODUCTION: La déficience en vitamine D est largement répandue dans le monde. Or la vitamine D a un rôle important dans la régulation du métabolisme phosphocalcique ainsi que dans un grand nombre de processus biologiques et métaboliques. Selon certaines études, il existerait une corrélation entre le taux de vitamine D et le taux de LDL-cholestérol. Une déficience en vitamine D et/ou un taux élevé de LDL-cholestérol pourraient représenter des facteurs de risques de cicatrisation osseuse et d'ostéointégration d'implants dentaires. Le but de notre étude est d'objectiver, dans une population de patients devant bénéficier d'une chirurgie orale et/ou implantaire, la réalité du problème de déficience ou de carence en vitamine D. Matériel et méthode : 46 dossiers de patients ayant bénéficié d'une intervention chirurgicale buccodentaire et d'une prise de sang ont été analysés. Les résultats du dosage de 25-hydroxyvitamine D (25-OH-D), cholestérol total, LDL-cholestérol, HDL-cholestérol ont été recueillis et comparés aux valeurs de références. Des tests statistiques ont été réalisés afin d'établir les corrélations éventuelles entre le taux de 25-OH-D et les autres paramètres sanguins. Résultats : 38 patients sur 46 (82,6 %) sont déficients en vitamine D, et 7 patients sur 46 (15,2 %) sont carencés. Le taux de LDLcholestérol est élevé chez 15 patients sur 33 (45,5 %). Il existe une corrélation non significative entre le taux de LDL-cholestérol et le taux de vitamine D. Le taux de cholestérol total est élevé chez 42 % des patients. Nous observons une corrélation significative entre le taux de cholestérol total et le taux de vitamine D. CONCLUSION: D'après notre étude, il apparaît qu'un bilan préopératoire incluant le dosage de la vitamine D, du cholestérol total et du LDLcholestérol pourrait s'avérer intéressant afin de corriger si nécessaire ces paramètres sanguins et favoriser le métabolisme osseux dans un contexte de chirurgie orale et/ou implantaire.

Influence of a strictly perioperative antibiotic prophylaxis vs a prolonged postoperative prophylaxis on surgical site infections in maxillofacial surgery.

PURPOSE: The adequate perioperative antibiotic prophylaxis in maxillofacial surgery is still under discussion due to the wide range of hard and soft tissue procedures as well as contaminated, semi-contaminated and clean surgical sides. Perioperative antibiosis is an easy applicable tool that can be used to decrease nosocomial morbidity and mortality by reducing the rate of infections. We compared strictly perioperative antibiosis with an extended postoperative prophylactic antibiosis. MATERIALS AND METHODS: In this study, 901 consecutive patients, from a tertiary care maxillofacial surgery department were included and distributed into two groups: The first group received peri- and postoperative antibiotic prophylaxis (PP; n = 365) from the day of operation until the fifth day postoperatively. The second group was treated with single shot prophylaxis with intraoperative repetition as needed (SSP; n = 536) only. Furthermore, the patients were grouped according to their main diagnosis and surgical procedure. For comparison, general anamnestic data, cultured bacteria and resistances, number of surgical site infections and duration of hospitalization were compared. RESULTS: There were no statistically significant differences in general diseases or extent of surgery between the groups. There was no statistical difference in the surgical site infections between the groups regardless of their diagnosis. There were significant correlations between tracheotomised patients (p < 0.001) as well as patients with a higher BMI (p = 0.009) and the incidence of surgical site infections. Most common cultured bacteria were staphylococci. CONCLUSION: Based on the findings of the study, we believe that a perioperative antibiosis delivers a sufficient prophylaxis for patients undergoing maxillofacial surgery procedures.

Intellectual disability is a risk factor for delayed emergence from total intravenous anaesthesia.

BACKGROUND: Previous studies have suggested that ID influences the depth of general anaesthesia (GA) and delays emergence from GA. In this retrospective cohort study, we investigated whether ID affects the time taken to emerge from GA. METHODS: We selected dental patients who underwent GA at the Department of Dental Anaesthesiology, Okayama University Hospital, using predefined inclusion and exclusion criteria, before dividing the selected participants into ID and non-ID (control) groups. Relevant data were collected from electronic anaesthesia records. Emergence time, the time from the discontinuation of propofol and remifentanil to tracheal extubation, was recorded for each patient. We compared the data of the ID group and control group. The association between ID and the emergence time was tested for statistical significance. Multivariate linear regression analysis was used to control for confounders. RESULTS: A total of 97 cases (control = 50, ID = 47) were included in the study. The emergence time was significantly longer in the ID group (ID group: 15.8 ± 6.6 min, control group: 10.8 ± 3.6 min). The ID group included more men and lower propofol and remifentanil infusion rates. The treatment time was longer, and the mean bispectral index was lower in the ID group. Sevoflurane inhalation was used only for anaesthesia induction in the ID group. In the multivariate linear regression analysis, ID was found to be significantly associated with a longer emergence time. CONCLUSION: Our results suggest that ID is associated with a longer emergence time from GA.

Pattern of maxillofacial surgical conditions in North Central Nigeria: A 5-year experience of an indigenous surgical mission.

BACKGROUND: Several publications have presented pattern of maxillofacial surgical conditions based on data from hospital-based studies. The objective of this study is to present the spectrum of maxillofacial surgical conditions from the perspective of a community study. METHODS: This is a prospective study of all patients seen and treated from 2011 to 2016. The information obtained included the biodata, clinical history of the disease conditions, radiological result, histopathologic result, diagnosis, and treatment records. Data analysis was carried out using SPSS version 20.0. RESULTS: There was a total of 863 patients, male 464 (53.8%) and female 399 (46.2%). The male to female sex ratio was 1.16:1. The age range was 3 days to 76 years with a mean age (SD) 16.8 ± 15.8 years. The spectrum of surgical conditions: facial clefts 492(57.0%); tumor and tumor-like lesions 126(15.2%), trauma 6(0.7%), and others 48(5.5 %). The size of tumors ranged from 5 to 50.4 cm2 with a mean (SD) 21.6 ± 11.9 cm2 and the duration of lesion ranged from 1 to 20 years with mean (SD) 8.7 ± 6.0 years. A total of 622(77.4) cases were operated within the study period with immediate jaw reconstruction in 5(0.8%) patients. Minor complications were recorded but there was no mortality. CONCLUSION: The spectrum of maxillofacial surgery from community-based data was associated with higher percentage of facial cleft as compared to hospital-based study that is associated with higher traumatic injury cases. High level of poverty, ignorance, and poor access to maxillofacial service have been identified as shortcomings in the management of the diseases. There is a need for pragmatic move to improve facility, training, enlightenment, and more funding of outreach programs.

Dentoalveolar oral surgery in children and adolescents: organization and surgical treatment in a large, Danish municipal dental service.

OBJECTIVE: To describe a population-based organization of dentoalveolar surgical service for 0 to 18-year old subjects in a Danish municipal dental service, and analyze the type of dentoalveolar surgical interventions needed. MATERIAL AND METHODS: The study was conducted in the Municipality of Aarhus, Denmark during five consecutive school-years. An internal referral system was established within the municipality where patients could be referred to colleagues with a higher level of competencies and more experiences with paediatric dentoalveolar surgery. The analysis includes a total of 1812 children and a total of 2854 surgical interventions. RESULTS: Almost 80% of the patients, representing more than 80% of the dentoalveolar surgical interventions needed, were referred internally. Denudations were the most frequent treatment type (40.3%) carried out, followed by removal of third molars (18.0%). Furthermore, 22 odontomas and 100 supernumerary teeth were removed. CONCLUSIONS: The need of dentoalveolar surgery in children and adolescents is relatively low, but includes a wide range of interventions. An organizational system, where dentists can refer to colleagues who have developed special competencies in this field, results in most of these surgical patients being referred and treated internally.