Accepted Abstracts

Primary Author: Arunkumar Kamalakaran

Abstract:

ACCESS THE INACCESIBLE-   LATERAL ORBITOTOMY- A CASE SERIES Abstract: Introduction:            Access osteotomies have made access to the lesions in the cranial base, orbit and deep spaces of neck less complex and have ensured complete removal of the lesion without any damage to the vital structures. Orbital tumors can occur in any part of the orbit.The safest and the most direct approach should be chosen based on the location and the extension of the tumor. The lateral orbitotomy was first described by Kronlein in 1889. The purpose of this paper is to present a case series wherein a  lateral orbitotomy have been used to access the orbital tumors and to discuss the  modifications and advantages and disadvantages of this approach. Materials and Methods:  This is a retrospective non interventional descriptive case series of patients who underwent lateral orbitotomy to  access pathologies within the lateral orbit, Results:   10 patients with pathologies lateral to or within the optic nerve were included in this case series. The chief complaints were protrusion of the eyeball, swelling or blurred vision. The histopathological diagnoses of the lesions were Orbital lymphoma, hemangioma, neuro-fibroma, angular dermoid, cavernous hemangioma,adenocarcinoma. The mean follow up period ranged from 2-3 years.Seven patients had reduced proptosis immediately and patients with restricted extra-ocular movement had improved, ocular mobility and diplopia resolved in patients with complaint of double vision. Complications that occurred post operatively were unchanged visual acuity in one patient and ophthalmoplegia in one patient.Definitive surgical outcomes were graded as good when the visual acuity, ocular movements were normal and disappearance or decreased proptosis,fair where even though the visual function was unchanged, the proptosis reduced significantly and poor when there was permanent visual impairment, irreversible ptosis. Good surgical outcome was seen in eight patients, fair in one patient and poor in one patient. Discussion and Conclusion: Lateral orbitotomy is a good choice of approach for accessing lesionsin the lateral and superolateral compartment of the orbital cavity without involving the orbital apex. The extent of the lateral orbitotomy depends on the size, consistency and nature of the lesion. This approach has good esthetic outcome with minimal morbidities compared to the trans-cranial approach.   

Primary Author: Rocio Lopez Chermulas

Coauthor(s): Jorge Zancarini Suárez, Gonzalo Herrera

Abstract:

Cranial base tumors are a big challenge to treat, as they may compromise many structures and could leave functional impairments. Seeking for the safest approaches with low morbidities as good functional results, the use of transfacial approaches is the gold standard.  Purpose: To stand out the importance of transdisciplinary work between neurosurgery and oral and maxillofacial surgery to achieve high standards results in esthetic and functional outcomes. Methods: Presentation of a case of a young woman with an ossifying fibroma at the roof of the nasal cavity that occupies the ethmoidal and sphenoidal sinus as well as the clivus and the orbits.  Results: Achievement of good esthetic and functional results. Improved of quality of life and facial scar almost imperceptible. She experienced cacosmia due to the non-functional cavity left by the tumor alongside the nasal cavity. Conclusions: Maxillofacial surgery by nature of training and expertise, is in a position to provide surgical access as well as functional reconstruction, always in the transdisciplinary approach of these complex patients. So, efforts as a team should rely on good communication to establish clear goals of treatment and to coordinate the best strategies to apply in the operating room. As in any other surgery plan it should be clear from the beginning, aims and limitations of each one, to give the patient the best care possible. Transfacial approaches are the first line choose treatment option for midline skull base tumors, and to achieve high standard resolution the integration of a transdisciplinary team is mandatory.

Primary Author: Carine Tabarani

Abstract:

Bisphosphonates are agents used for the prevention and treatment of cancer-induced bone diseases, corticosteroid-induced bone loss and Paget's disease. For years surgeons have routinely performed surgical procedures and dental implant placement in patient receiving bisphosphonates therapy without knowing the inevitable side effects of these drugs on bone. Osteochemonecrosis of the jaw was defined by the American Association as the presence of unhealed exposed bone in the jaws that has persisted for more than 8 weeks in a patient who has received a systemic bisphosphonate treatment but not received local radiation therapy. Oral bisphosphonates induced osteochemonecrosis is a rare but real entity that is less frequent  less severe and more predictable than intravenous bisphosphonates induced osteochemonecrosis of the jaws. Guidelines for treatment of dental patients receiving intravenous bisphosphonates treatments, should be different than those for patients taking oral formulations of these medications. In the following presentation we will go through many studies conducted on the given subject and we will be displaying clinical cases along recent recommendations used in patient treated with both routes of bisphosphonates and are to undergo implant surgery rehabilitation.   

Primary Author: Jose Golaszewski

Coauthor(s): Ruben Munoz Sr., Dionelys Barazarte, Andrea Maldonado

Abstract:

Introduction: The aim of this study was to present our clinical experience in using transport DO technique (TDO) for treating mandibular bony defects following tumor ablation in benign tumor cases combined with a free fibula flap. Materials and Methods: Eigth patients (5 females and 3 male) ages 27 to 45 years old (average 32) underwent tetrafocal distraction osteogenesis after major mandibular resection including the complete symphyseal area, 2 ameloblastomas (pleomorphic and follicular), 1 giant cell granuloma, and 1 odontogenic myxoma. All patients underwent partial mandibulectomy and reconstruction plate placement through the intraoral route, a fibular flap segment was used to reconstructed the symphyseal area. The internal distraction devices were 45 mm long and were cut, and fixed over the reconstruction plate;. Once the transported disc or bullet reached the parasymphyseal area.. A 12 months latter, transmandibular zigomatic implants were inserted and dental rehabilitation was completed Results: All mandibles were reconstructed by intraoral bone transport, creating 70.5 to 100.3 mm of new bone to finally allow dental implants placement and dental rehabilitation. No infections, fractures, or nonunions were seen. The patients were seen on a weekly basis for 3 months and then every 30 days until completion of the treatment and rehabilitation. Conclusions: This multiple bone transport system permits mandibular reconstruction for the very difficult clinical situation, with excellent results. Advantages and goals of this technique are excellent biological response, feasibility for implant placement, complete functional and esthetic rehabilitation, and no need for extraoral  appliances.

Primary Author: Soo-Keun Kim

Coauthor(s): Stephanie Drew

Abstract

Introduction: Intraosseous vascular anomalies (IVA) of the craniofaciall bones are not well documented. We report a single institutional series of craniofacial IVA with a focus on clinical and radiographic findings. Methods: The Emory University archives were retrospectively reviewed for patients with a craniofacial IVA between 1/1/2010 and 12/31/2020. Results: Twenty-one patients (7 male, 14 female) were identified, ranging in age from 29 to 84 years. The anatomic distribution included cranial bones (14), mandible (3), orbits (2), nasal bone (1) and zygoma (1). Clinically, 7 lesions were incidentally found, with 14 patients exhibiting various symptoms. Three patients underwent preoperative embolization. Surgical resection was completed for 19 patients, with debridement and enucleation in one case each.  Conclusion: IVA is uncommonly encountered, leading to the possibility of a management dilemma. In our cohort, craniofacial IVA most commonly affects middle aged female patients, is associated with symptoms and most commonly affects the cranial bones. Biopsying is uncommon, and in most cases the diagnosis was suspected on clinical and radiographic grounds. Resection appears to be the surgical management of choice.

Primary Author: Sujata Mohanty

Coauthor(s): ANJALI VERMA

Abstract:

Purpose: Nasolabial flap is a versatile and robust flap which satisfies many requirements for oro-facial reconstruction. Despite the numerous studies referring colour Doppler sonography as a preoperative imaging modality in the planning of local flap, no comparative studies exist validating outcomes, or any other end point with respect to use of conventional axial and Doppler guided nasolabial flaps. Methods:A total of 26 flap reconstructions were carried out in patients who were alternately divided into two groups using simple randomisation method. In Group I patients, the conventional axial flap was marked 1 cm lateral to commissure of the mouth keeping it parallel to nasolabial fold. In Group II, blood flow evaluation of feeding vessels for the USG guided flap was performed with the help of Colour Doppler ultrasound, one day prior to surgery. Patients were assessed for a minimum of 6 months and the post-operative flap outcome was quantified using an indigenous composite scoring system including flap pliability, vascularity, loss of flap, height, wound dehiscence and hair growth. Results: The mean post-operative flap outcome score was significantly higher in Group II patients than Group I, both at the beginning (1st post-operative week; p=0.04*) and at the conclusion of the study (6th post-operative month; p=0.003*). Additionally, reconstruction of the oro-facial defects with the conventional nasolabial flap was associated with greater morbidity (61.9%) as compared to Group II (38.1%) Conclusions: Flap selection based on known dominant perforators could achieve superior outcomes resulting in minimal postoperative morbidity while allowing complex surgical reconstructions.

Primary Author: Atsumu Kouketsu

Coauthor(s): Tetsu TAKAHASHI

Abstract:

Objectives To evaluate the ability of different imaging modalities to accurately detect bone invasion in oral squamous cell carcinomas. Patients and methods Patients with oral squamous cell carcinoma, who were scheduled for mandibulectomy or maxillectomy, underwent clinical evaluation using five preoperative imaging diagnosis methods-contrast-enhanced MRI, CT, 99mTc scintigraphy (Tc scan), FDG-PET CT (PET/CT), and panoramic radiography. The sensitivity and specificity of each modality in detecting bone invasion were calculated by comparing the findings on the images with postoperative histopathological findings. In a subgroup of patients, we further assessed the ability of MRI and CT to detect the accurate extent of bone invasion, including the height, width, and depth in patients with pathological mandibular invasion. Results Overall, 50 patients were enrolled in this study, and nine patients with pathological mandibular invasion were included in our subgroup analysis. MRI was found to be the most useful method in detecting bone invasion, showing the highest sensitivity (88.9%) and negative predictive values (92.3%). CT (87.5% specificity and 77.8% sensitivity) was more specific than MRI, though less sensitive. Combined PET/CT was more sensitive (83.3%) and less specific (71.9%) than CT. Tc scan had high sensitivity (88.9%); however, the specificity was relatively low (71.9%). Conclusion MRI was the most useful method in detecting bone invasion. A negative MRI result definitively excludes bone marrow invasion. In patients with positive MRI findings, a negative CT may be useful in ruling out bone marrow invasion.

Primary Author: Jing-Ya Jane PU

Coauthor(s): Yu-Xiong Richard Su

Abstract:

Background Computer-assisted surgeries (CAS) are increasingly being adopted as the treatment of choice for jaw reconstructions. Although unexpected change of surgical plans remains a major concern of CAS, there is no study focusing on this unfavorable clinical scenario. This study aimed to analyze and classify different clinical scenarios of unexpected change of surgical plans and rationalize the management strategies.   Methods A retrospective study was performed to evaluate all the patients who underwent computer-assisted jaw resections and free flap reconstructions by the same chief surgeon in our department. The postoperative radiographs were reviewed and compared. Operating records were examined to analyze the reasons for unexpected change of plans and the management.   Results From Nov 2014 to May 2021, a total of 89 consecutive computer-assisted jaw reconstruction cases with osseous free flaps were included in this study. Our experience showed that 5.6% of the patients (five cases) needed intra-operative change of the surgical plans.  We suggested a clinical classification to record unexpected change of surgical plans and the contingency strategies: type I (extended resection and reconstruction), type II (shortened resection and reconstruction), type III (modified resection without changing reconstruction), and type IV (modified reconstruction without changed resection). Conclusion A clinical classification was proposed to record unexpected change of surgical plans and rationalize contingency strategies in computer-assisted jaw reconstruction. This practical classification will help standardize medical record, facilitate comparison among different studies, and most importantly provide management strategies for the beginners in computer-assisted jaw reconstruction. Future studies are warranted to verify this new clinical classification.

Primary Author: PRISCILA CHABOT

Coauthor(s): Sarah Reis, Mariana Granucci, Sarah Sales, Felipe Campos

Abstract:

Introduction: Odontogenic myxoma (OM) is a benign neoplasm originated from odontogenic ectomesenchyma, locally aggressive and with high recurrence rate. The treatment of OM ranges from curettage to segmental resection, with or without adjuvant therapy. Case report: A 28-year-old male patient attended the Service when he was 13 years old with an asymptomatic swelling in the maxilla, firm to the touch and covered by normal mucosa, discovered by other professional in the radiography. A Computed Tomography showed an extensive mixed image on maxilla, multilocular, extending from upper left deciduous canine to first right upper molar. After incisional biopsy, the diagnosis was OM. Despite the size of the lesion, a conservative treatment was performed, with curettage associated with adjuvant treatment. After 8 years follow up, the patient had no signs of recurrence. Then, a free autogenous bone graft from anterior iliac crest was performed and subsequent oral implant-supported rehabilitation. Adequate speech, mastication and esthetic were observed. Discussion: Despite the aggressive treatment leads to a lower recurrence rate, it provides a poorly quality of life with function, esthetic, and psychological sequels.  Conservative curative surgery must be the better choice for the patient when it is possible. It is therefore imperative to include the maxilla reconstruction in the treatment plan. The autogenous bone graft from iliac crest is often used for large defects, and implant rehabilitation promote suitable volumetric stability and osteogenic potential. Conclusion: The patient is on his fourteenth year of follow up, without recurrence and with better quality of life. References: http://dx.doi.org/10.1016/j.ajoms.2019.03.005.

Primary Author: Gursimrat Brar

Coauthor(s): Mehak Malhotra, Sodhi Surender

Abstract:

Introduction: Covid Associated Mucormycosis(CAM), also called Black Fungus, is another deadly and challenging epidemic in pandemic Covid-19. Previously seen rarely, CAM has become prevalent after the second wave of Covid-19. Early diagnosis and management is required to combat this deadly fungus. Purpose: Inter-disciplinary approach is mandatory for CAM’s early diagnosis and management. Methods: A series of ten cases of post-covid fungal infection involving maxilla and orbit presented. Diagnosis was confirmed by relevant history, clinical and radiological examination, including contrast MRI PNS with orbital cuts, histopathological and microbiological examination. Management included thorough debulking and debridement of soft tissue and removal of necrotic bone(maxillectomy), if required. In case of involvement of orbit, exenteration is mandatory. Supportive antifungal drug regime was given for three weeks. Post-debridement defect was then rehabilitated by soft tissue and hard tissue reconstruction or with an obturator. Results: Out of the ten cases of post-covid-19 fungal infections, one patient each reported on histopathological examination as Aspergillosis and Candidiasis and eight patients reported as mucormycetes fungal infection. They have been successfully treated and are on regular follow-up. Conclusion: The foremost cause for opportunistic fungal infection in post-Covid-19 patients is ideal environment of low oxygen(hypoxia), high glucose(diabetes, new-onset hyperglycemia, steroid-induced hyperglycemia), acidic medium(metabolic acidosis, diabetic ketoacidosis[DKA]), high iron levels(increased ferritins) and decreased phagocytic activity of white blood cells(WBC) due to immunosuppression(SARS-CoV-2 mediated, steroid-mediated or background comorbidities) alongwith risk factors including prolonged hospitalization with or without mechanical ventilators. Accurate and timely diagnosis and multidisciplinary approach is the key to Covid Associated Mucormycosis(CAM) management.

Primary Author: Kevin Zhou

Coauthor(s): Moulik Patel, Michael Sho Shimzu, Trevor Thang

Abstract:

Purpose: Bilateral maxillary defects (whether traumatic, surgical, or congenital in origin) challenge fibula free flap (FFF) reconstruction surgery due to limitations in virtual surgery planning (VSP) workflows. While segmented 3D meshes of unilateral maxillary defects can be mirrored to virtually reconstruct missing anatomy, bilateral defects (Brown class c and d) lack a contralateral reference and associated anatomical landmarks. This often results in poor placement of osteotomized fibula segments. The current study improves the VSP workflow for FFF reconstructions using statistical shape modelling (SSM) – a form of unsupervised machine learning – to virtually reconstruct premorbid anatomy in an automated, reproducible, and patient-specific manner.  Methods: The SSM training set was sourced from the New Mexico Decedent Image Database via stratified random sampling to ensure even age and sex distributions. Skulls from 104 computed tomography scans were segmented and rigidly aligned, after which principal component (PC) analysis was applied to construct a discrete Gaussian process (GP). Defect reconstruction was accomplished on a validation set of 8 skulls via an iterative closest point algorithm with GP regression.  Results: Preliminary analysis shows that Brown class 2c maxillectomy defects can be virtually reconstructed with promising accuracy [Hausdorff distance = 7.89±1.63 mm, volumetric Dice coefficient = 99.1±0.01 %, compactness = 7.22×105 mm2 (over the first 97 PC), specificity = 1.18 mm, and generality = 1.06×10−5 mm].  Conclusion: SSM-guided VSP will allow surgeons to create patient-centric treatment plans, increasing reconstruction accuracy and reducing the risk of complications. This is expected to improve post-operative outcomes.

Primary Author: Zainab Chaudhary

Abstract:

Purpose: Unicystic ameloblastoma (UA) is a distinguishable entity of ameloblastomas, characterized by slow growth and being relatively locally aggressive. The aim of this study is to establish the efficacy of the two treatment modalities viz conservative and radical method, when applied based on the histological variant, age and location of the UA. Methods: A retrospective study was conducted using patients’ data with the diagnosis of UA. Ackermann classified UA into luminal, intraluminal and mural, which has a direct bearing on their biological behaviour, treatment, and prognosis. Luminal and intraluminal cases (group A) were treated with enucleation with chemical cauterization and open packing whereas mural variant (group B) was treated by resection and reconstruction. Post operatively, the patients were radiographically assessed with digital OPG every 6 months in the first 2 years, every year in the next 5 years and every two years in the next 10 years. Results: A total of 17 patients (group A: 9 patients; Group B: 8 patients) were enrolled in the study because of the rarity of occurrence of UA. The mean follow-up of the patients were 4.9 years (Range 1.4 years – 11.8 years). The success of treatment is judged by the absence of recurrence: none of the patients showed recurrence. Conclusion: It has been well established by this study that luminal and intraluminal variant in young individuals can be successfully treated with conservative approach, whereas mural variant being more aggressive should undergo radical treatment.

Primary Author: Alveena Shabbir

Coauthor(s): haheen Ahmed, humera waheed

Abstract:

PURPOSE: Oral squamous cell carcinoma is one of the common malignant tumour worldwide. Currently the diagnosis of OSCC is based on histopathological examination, which results in delayed diagnosis and leads to low survival rates. Cathepsin B is a lysosomal cysteine protein, which is found in abundant quantities in lysosomes of cells and tissues and in different biological fluids. By demonstrating the salivary levels of Cathepsin B in OSCC patients is an optimistic approach for early detection of OSCC by using non-invasive tool. MATERIALS AND METHODS: In total 80 research participants were included which were divided into 20 in each group. (well differentiated OSCC, moderately differentiated OSCC, poorly differentiated OSCC and control group). Enzyme linked immunosorbent assay was used to determine Cathepsin B levels in saliva in all the four study groups. RESULTS: The results of our study showed that in all three grades of OSCC i.e. well, moderate and poorly differentiated OSCC  Cathepsin B levels in saliva were significantly increased with p-value< 0.001 as compared to control group. We observed highest mean Cathepsin B levels in well differentiates OSCC followed by poorly differentiated and moderately differentiated OSCC. CONCLUSION: The results of the present study suggests that Cathepsin B levels in saliva in OSCC can be used as a non-invasive tool for early detection of OSCC.  

Primary Author: John Le

Coauthor(s): Kelly Sayre, Chaitra Seri, Rae Sesanto, Yedeh Ying, Anthony Morlandt

Abstract:

Currently no consensus exists regarding the role of elective neck dissection (END) to improve regional disease control for pT1-T3 and cN0 gingival squamous cell carcinoma (GSCC).  This study explores whether T-classification and histopathological features (i.e., depth of invasion, grade, perineural invasion, and lymphovascular invasion) are predictive of occult cervical metastasis. This study compared occult cervical metastasis and disease-free survival between patients treated with END or expectant management for primary pT1-T3 and cN0 GSCC.  Sixty-two patients (25 receiving END, and 37 managed expectantly) were analyzed. Mean follow-up period was 27 months. cT-classification was greater in the END group compared to the expectant management group (P=0.04); however, pT-classification was comparable (P=0.65). Depth of invasion was greater in the END group (4.26 mm) compared to the observation group (3.22 mm) but did not reach statistical significance. Alcohol status and advanced cT-classification were independent predictors for END. Local and regional recurrence were comparable between groups. Occult cervical metastasis was observed in 9.7% of the cohort with 8.6% and 11% observed in maxillary and mandibular GSCC, respectively. Only lymphovascular invasion was predictive of occult cervical metastasis in all cases.  In this study, the overall rate of occult nodal metastasis for pT1-T3 cN0 GSCC is lower than the reported literature (~20%). Both END and expectant management had comparable regional disease control and disease-free survival. An END should be considered in the presence of lymphovascular invasion and advanced cT4 GSCC. It should be noted that END did not improve disease-free survival in the cT1-T2 cohort. 

Primary Author: Ana Carolina Silva

Coauthor(s): Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: Endonasal tooth are rare, prevalent in up to 1% of the population, asymptomatic and with uncertain etiology. The usual treatment is the surgical removal, to prevent future complications. The most common methods are with direct vision by open approaches with mucosal incisions and endoscopic approaches. The purpose of this study was to evaluate which approach was related with the fewer rate of complications. Methods: A systematic review of the literature was performed in accordance with the PRISMA protocol , focused on the clinical question of the open approach is more related with postoperative complications than the endoscopic one? Results: A total of 49 studies with 73 patients were retrieved. A Homogeneous sample between the technique performed was observed (52% endoscopic vs 48% open). The choice of the approach for the exposure and removal of endonasal tooth presented no relationship with postoperative complications (p=0,867). Conclusion: The results of this study suggest that the surgeon experience and the dental location are the determinant factors on decision of the approach that is going to be performed and both techniques are safe and reliable for the exposure of the surgical site.

Primary Author: Jose Golaszewski

Coauthor(s): Ruben Muñoz

Abstract:

Introduction: The Purpose of this study is described the approach as a surgical technique to gain access to regions of the upper and middle face for craniofacial surgery and the functional results of this technique. Experimental methods: we reports five patient (1 females and 4 males), with a mean of age 40,26 years old (range 22 to 58 years), with various diagnosesl.  In all the cases we considered use this approach with different treatment for reconstruction. We evaluated facial superficial sensitivity was performed using 2 neurological tests, namely the Semmes-Weinstein pressure and thermal sensitivity tests. Permanent neurosensory and neuromotor disturbance was defined as abnormal clinical test results obtained at least 12 months after surgery, persistence of lagoftalmus was evaluated in all cases.  Results: The prevalence of the patients who showed normal results for sensitivity to pressure/touch and thermal sensitivity (warm and cold; P<0.05) was significantly high. The analysis of the data of the patients with craniofacial syndrome revealed that most of the patients had normal pressure sensitivity test results (P<0.003). Results from the thermal sensitivity tests showed no significant difference between these patients (P=0.317). Sensitive disturbances was seen in V1. The result was not evidence that functionally compromise of facial expression in all cases. Not infections and Lagoftalmus was seen in all patient the frits three months with recovery of total function.  Conclusion: Dismasking flap approach is a useful tool in the management of craniofacial fractures, reconstruction craniofacial resection of tumors of the anterior cranial fossa, microvascular surgery and facial transplant.

Primary Author: Altaf Hussain Malik

Abstract:

Aims and Objective To evaluate clinical features, prevalence, biochemical findings  and treatment modality of giant cell lesions associated with primary hyperparathyroidism  in  maxillofacial region. Materials and methods  All histopathologically diagnosed cases of giant cell lesions in  maxillofacial region were evaluated retrospectively from 8 year old data base in the department of oral and maxillofacial surgery at Govt Dental College Srinagar. Giant cell lesions associated with primary hyperparathyroidism were studied with respect to serum calcium, phosphate, alkaline phosphate and parathormone and other clinical features. The cases were studied and co -related after the correction of primary hyperparathyroidism. Result     Histopathologically 51  proven giant cell lesions were evaluated  and 7 cases were  found associated with primary hyperparathyroidism . Two cases had simultaneous maxillary and mandibular involvement  . The  patients had  high values of alkaline phosphate and parathormone on follow up.All the 7 patients of primary hyperparathyroidism  had significant reduction of lytic bone lesions after parathyroidectomy eliminating the need for surgical intervention for bony lesions. Conclusion The prevalence of primary hyperparathyroidism associated giant cell lesions is 5.9 %. and is  therefore rare. Sometimes the giant cell lesions associated with  primary hyperparathyroidism may be the only manifestion and so appropriate work up of patients clinically,rdiographically and biochemically is important to  rule out such lesions which are otherwise simiar to other giant cell lesions like central giant cell granuloma.. Keywords: Primary hyperparathyroidism, Alkaline phosphatase, Giant cell lesion,

Primary Author: Toshiaki Numajiri

Abstract:

Introduction In the field of head and neck reconstruction, microvascular anastomosis is usually performed using an operative microscope. This use of operating microscope is considered the gold standard. On the other hand, in the field of gastrointestinal surgery, laparoscopic and robot-assisted surgeries have become the standard. The procedure is mainly performed on a video monitor. Will vascular anastomosis really be replaced by surgery using video monitors? Patients and methods A 67-year-old male patient with hypopharyngeal cancer underwent total pharyngo-laryngo-esophagectomy, and neck lymph node dissection. Immediately free jejunum was transferred. Two arteries and veins (superior thyroid artery, lingual artery, and two branches of internal jugular vein) were anastomosed using a new 3D-video monitor system, called Hawksight (Mitaka Kohki, Tokyo, Japan). The anastomosis was performed as usual as under the microscope using 9-0, 10-0 nylon, or anastomotic couplers. Vascular patency was maintained. Tissue viability was also confirmed using indocyanine green fluorescence. Result Transferred tissue were completely survived without any complication. Conclusion Magnification, maneuverability, and 3D-operability through 4K-Video monitor are equivalent to those of microscopic surgeries. The large monitor (55 inch) and magnification was considered to be advantageous in terms of reliability and comprehension not only for the surgeons but also co-medical staff. In the next era, procedures using a 3D monitor may become an option.

Primary Author: Shradha Tiwari

Abstract:

INTRODUCTION: Oral anticoagulant therapy was used to reduce the risk of thromboembolism. There is an increased risk of bleeding during dental treatment in such cases. As a result, anticoagulant therapy is advised to be discontinued.TXA (tranexamic acid) or chitosan plug is an antifibrinolitic agent.This study looked at the hemostatic impact of TXA pressure packs or chitosan plugs on post-extraction bleeding in individuals on anticoagulant therapy. AIM: The purpose of the study was to clinically evaluate and compare the effectiveness of tranexamic acid-soaked pressure pack v/s chitosan plug for controlling the post-extraction bleeding in patients on aspirin therapy. Materials and Methods: This was a double-blind study in which patients were chosen randomly and divided into two groups. Group A: Tranexamic acid-soaked pressure pack, and Group B: Chitosan plug (axiostat), each having a minimum of 15 patients. Pre-operatively, PT and INR were done, and extraction was performed without interruption of anticoagulant therapy. Clinical evaluations were done after 10 minutes, 30 minutes, and 24 hours to see whether the bleeding had ceased, and after 7 days to determine whether healing had occurred. Results: The results revealed that there was no statistically significant difference between the two groups. There was no evidence of TXA or chitosan allergy. In all cases, postoperative hemorrhage management was acceptable. Conclusion: Using TXA or Chitosan, extraction may be performed safely without interrupting anticoagulant and antiplatelet medication in a susceptible group of patients.

Primary Author: Vivekanand Kattimani

Abstract:

Purpose: Various bone regenerative materials have been used for the healing of bone defects with varying success rates. Recently, our team has developed nanohydroxyapatite (nHAp) as a novel bone graft substitute. The material has been compared for its bone regeneration efficacy in calvarial defects of Wistar rats. Methodology: A total of 40 adult male Wistar rats were included and grouped into two. Group A with collagen membrane and Group B without collagen membrane. Both the groups received commercially available Synthetic (G-bone from G-Surgiware, India.) and nHAp ( from eggshell calcium-carbonate using indigenous Microwave-synthesis ) graft material randomly to fill the bilateral calvarial bone defects of 6mm each. The animals were followed up to observe healing and sacrificed on the 10th,30th, 60th, 90th, and 120th days post-surgery to evaluate the nature of bone regeneration using histomorphometry & MicroCT. Results: The wound was well healed in both groups. New bone formation was observed from the periphery in both groups filled with nHAp. Bone growth was statistically significant, and the thickness of bone, density of the matrix was increased progressively with a decrease in fibrous connective tissue throughout the healing process in nHAp compared to the Synthetic group. Micro CT observations were consistent with histomorphometry. Conclusion: Both materials showed the osteoconductive property. Irrespective of the presence of collagen membrane, nHAp group showed better bone regeneration compared to the Synthetic group. The thickness of the matured bone was more in nHAp on the 120th day and was consistent compared to Synthetic group at all timelines.

Primary Author: Anastasia Depounti

Coauthor(s): Theodore Goff

Abstract:

Trigeminal Neuralgia (TN) is a rare chronic condition that affects the 5th cranial nerve. TN manifests as a paroxysmal, unilateral, stabbing,and burning sensation triggered by any mild stimulation to the face such as shaving or make up application. TN is a type of neuropathic pain due to injury of the protective coating (myelin sheath) around the nerve axon. When the myelin sheath is damaged (demylination) nerves do not conduct electrical impulses normally. Careful history of typical symptoms is crucial for diagnosis as it is often misdiagnosed for an ear or toothache. Current treatments target the symptoms rather than the etiology of TN and have many unwanted side effects such as sedation, dizziness, nausea, diploma, vomiting, memory loss, ataxia, and hypernatremia. DA is traditionally used to treat Attention Deficit Disorder. DA promotes norepinephrine and dopamine reupake into the presynaptic neurons therefore increasing the release of dopamine and norepinephrine into extraneuronal spaces which in turn increases the oligodendrocyte progenitor cells. Oligodendrocytes are important because they produce myelin. Our study shows that DA promotes remylination of the sensory fibers and hence treat the underlying cause of TN. A small group of patients (10) diagnosed with TN half were treated with 20mgDA two dose level for 3 periods of 30days each and the other half with 20mgDA three dose for 3 periods of 30 days each. There was a positive correlation between the frequency of doses and time to alleviate pain making DA a promising pharmaceutical that could actually treat nerve injury causing TN.

Primary Author: Júlia Silva

Coauthor(s): Bruna Campos Ribeiro, Thaís Resende, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: The effect of Leukocyte- and platelet-rich fibrin (L-PRF) in enhancing the healing after oral surgical interventions is still a matter of debate. The effectiveness of PRF in postoperative soft tissue healing is well described known, however published studies present a high risk of bias. The present study evaluated the risk of bias of randomized clinical trials on the influence of L-PRF on third molar surgeries. Methods: This study used a Cochrane risk-of-bias tool for randomized trials (RoB 2) to evaluate the studies on the L-PRF on third molar surgery topic. Results: Eighteen studies were included in the sample. All studies underwent the risk of bias assessment, and in the randomization of the sample, 50% had low risk and 50% had some concerns. In the allocation of groups, 11% low risk, 78% some concerns and 11% high risk. In blinding, 68% low risk, 11% some concerns and 22% righ risk. In the lost data, 100% had low risk. In choosing the data, 100% had some concerns and in other bias 100% had low risk. So, 48% studies had low risk, 26% some concerns and 26% high risk. Conclusions: More studies should be carried out, with lower risk of bias, to confirm the results of previous studies, since the studies presented a high rate of risk of bias.

Primary Author: Priyanka Ganesan

Abstract:

Background: The extraction of impacted lower third molar is one of the common oral surgical procedures associated with high levels of patient anxiety. The yoga therapy (YT) is reported in medical literature as an effective modality in bringing down anxiety in clinical scenarios, nevertheless the report of the same for dental settings are fewer. The current study is aimed to evaluate the effect of pranayama on psycho-physiological indicators of anxiety in patients of impacted lower third molar extraction. Materials and method: A Randomised Control trial study was conducted on 50 participants who underwent surgical extraction of impacted lower third molar. The sample was divided into two groups, Yoga group (group A; n=25) who received YT and control group (group B; n=25) who were subjected to self-relaxation during oral surgical procedure. The state of anxiety was measured by a five point single item Likert scale and the cardiovascular (CV) parameters [ systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) ] were derived and compared between both the groups. Results: The intergroup comparison showed significant differences in anxiety score(p<0.001), SBP(p<0.001), HR(p<0.029), DBP(p<0.003) Conclusion: A significant reduction was recorded in terms of anxiety and CV parameters in yoga group. The YT can be adopted as interventional tool for anxiety management in patients indicated for surgical extraction of impacted lower third molars.

Primary Author: Alexandar Stamatoski

Abstract:

Purpose Mouth and oropharyngeal cancer accounts for 85 % of malignant lesions of oral cavity which have increased by almost 55 per cent in the last 12years. The etiology is multifactorial and has been studied extensively. Diagnosis of oral cancers depends on the medical and dental history following clinical examination which depends on investigatons. Given the clinical importance according to early diagnosis of this entity, Cyfra21-1 was notable as non-invasive method who determinate as useful tumor marker clinically and also is useful in the prognostication and monitoring followed by verification of saliva matrix metalloproteinase. The purpose of the study, was to determinate the levels of both salivary biomarkers in healthy non-smokers persons. Methods The prospective analysis of small-group data of 8 patients (3 with diagnosed oral cancer and 5 healthy persons) were included. Unstimulated saliva samples were collected and salivary specimen of CYFRA 21-1 and matrix metalloproteinase levels were measured using expression system. Differences in salivary levels between groups were tested using statistical test for small groups. Results The difference expression of Cyfra21-1 and MMP-was observed as compared in healthy croup. The best cut-off value to detect a significant association should be done in large groups of patients Conclusion Further study investigation is encouraged and in our original proposal we emphasized our desire to include much more clinical cases to reveal the diagnostic and prognostic value of both methods in oral-mouth cancer comparing the clinical and pathological grade of established tumor.

Primary Author: Alvaro Ranz Colio

Coauthor(s): Fernando ALMEIDA, Alberto Haddad Riesgo, ANGELA Bueno-deVicente, Patricia de Leyva, Julio Acero Sanz

Abstract:

Introduction: The surgical treatment of midface tumours is often highly complex. The three-dimensional anatomy of the midface and advanced maxillary tumours make anatomical orientation difficult, which increases the risk of affected surgical margins. The main objective is to answer the question: Does intraoperative navigation improve oncological results in complex midface resections? Material and Methods: Thirty-two patients with malignant midface advanced tumours were included.16 patients were prospectively selected and surgery was performed with intraoperative navigation (ION). A control group of 16 patients was retrospectively selected and surgery was performed without ION. A systematic margin analysis was performed selecting 6 surgical margins for each surgical piece and 192 surgical margins in total were analysed. Results: Squamous carcinoma was the most frequent histological type (56.25% in study group and 68.75% in control group).Complex maxillectomies (types IV-V-VI Brown and Shaw) were performed in 9 of 16 patients in study group (56.25%) and in 2 of 16 (12.5%) in control group. There were 11 of 96 margins affected in study group (11.5%) and 16 of 96 affected margins in control group (16.7%). Chi square test was not statistically significative (p 0.299). The most affected surgical margin was the deep margin in both groups, 9 of 16 (56.25%) in control group and 6 of 11 (54.5%) in the study group. Conclusion: The use of intraoperative navigation facilitates the resection of advanced midface malignancies and it seems to improve tumour-free margin status with less intraoperative complications.However, further prospective trials with a larger cohort are required to confirm these preliminary results.

Primary Author: Fausto Risploi

Abstract:

To Be Determined

Primary Author:Ricardo Grillo

Coauthor(s): Cláudio Jodas

Abstract:

Purpose: Third molar surgery is a very common procedure. Some patients experience pain associated with this situation. The aim of this article is to discuss non-conventional therapies for the management of postoperative pain associated with third molar surgery. Methods: An extensive literature search was carried out with the keywords “third molar” + “pain” and all articles that excluded already established drugs as analgesics, anti-inflammatories, or therapies such as laser therapy and ozone therapy while non-conventional drugs and therapies were retained. Results: The article rated bromelain, honey, hyaluronic acid, nicotine patches, Kinesio tape, TENS, anticonvulsants, curcumin, and melatonin. Some therapies are efficient and safe, while others have not shown promising results. Conclusions: Bromelain and Kinesio tape are considered the be the most effective non-conventional therapies for controlling postoperative pain, and even with few studies on them, they are therapies with promising results.

Primary Author: Saravanan Kandasamy

Abstract:

Purpose: Research on various biomaterials being pursued for the purpose of promoting bone to implant osseo integration. To obtain enough stable biological activity on the surface of implants guaranteeing the retention of their excellent inherent chemical and mechanical properties, recent studies have focussed to use bioactive materials including functional proteins, growth factors, peptides, and stem cells, including chemical ones. Therefore, the aim of this conceptual literature review is to enumerate the bio materials available for rapid osseo integration. Method: Electronic Search was conducted in a direct scientific article, Google Scholar, Wiley online library, PubMed with keywords for biomaterials, rapid osseo integration in implants, that varied from substances for bone induction from autogenous to alloplastic substrates, growth factors between 2010 and 2021 and selected articles that are more relevant to this topic/ subject. Result: Implant healing is a complex process involving osteogenic cellular proliferation and differentiation, angiogenesis, functional remodeling and cross communication between the two. Calcium deposition, namely mineralization, is an important marker of late differentiation of osteoblast-like cells. These biomaterials seem to be a promising and high-effective modified strategy to obtain better angiogenesis and osseointegration for bone regeneration and remodelling in vivo. Conclusion: Successful osseointegration between implant surface and surrounding host tissue is of critical importance for effective long-term fixation of dental implants. The present promising results indicate that these biomaterials could be used as crosslinking substrates for rapid implant to bone osseo integration thus opening new avenues for research to apply even in compromised clinical situations.

Primary Author: Sujata Mohanty

Coauthor(s): ANJALI VERMA

Abstract:

PURPOSE: This randomized control trial was aimed at comparing the efficiency of buccal fat-pad (BFP) and platelet rich-fibrin (PRF) with control group of spontaneous regeneration for achieving bone regenerate after enucleation/ablation of pathologic lesions. METHODS: 36 patients were included and were randomly selected as test or control group consisting of 12 patients in each group. Obliteration of defect was done using BFP and PRF in Group 1 and 2 respectively. Group 3 included spontaneous regeneration of the defect. Patients were examined clinically and radiographically. Postoperative radiographs were taken at 3 and 6 months to evaluate reduction in size of the residual cavity and the change in bone density was compared using cone-beam computed tomography. RESULTS: Males (66.7%; n=24/36) in the third to fourth decade were more commonly affected involving mandibular posterior region (73.3%). All patients showed progressive and predictable healing with significant radiographic osseous regeneration in defects treated with PRF and BFP as compared with control group. The mean volume of the defect was noted to change from 32.32±11.7 mm3 to 7.07±6.7 mm3 (p=0.000*) in Group 1; 36.38±12.6 mm3 to 8.76±5.9 mm3 (p=0.002*) in Group 2 and 34.91±14.6 mm3 to 19.58±9.3 mm3 (p=0.080) in Group 3 from the preoperative period to the last follow-up. CONCLUSIONS: Spontaneous regeneration remains an effective and reliable method for the repair of small defects. However, larger defects may end up with dehiscence and delayed healing. These defects with doubtful outcome can be successfully treated with PRF / BFP without any postoperative complications and a good bone fill.

Primary Author: Charudatta Naik

Coauthor(s): Sanjay Joshi

Abstract:

Purpose: The study aimed to investigate the characteristics of the mesenchymal stem cells (MSCs) isolated from different tissues for craniofacial bone regeneration. Methods Human Mesenchymal Stem Cells MSCs (MSCs) were obtained from nine tissue samples, three each from adult iliac bone marrow (BMMSC), mandibular periosteum (PdMSC), and buccal fat pad (BFPMSC). MSCs were isolated and expanded. Stem cells were assessed for the surface markers expression, proliferation capacity, and senescence. The cells were further assessed for their osteogenic potential using alkaline phosphatase (ALP) expression and osteogenic markers such as DLX5, RUNX2, and BGLAP. Results The results showed that all cells expressed differentiation markers CD73, CD90, and CD105 markers. These cells could differentiate into osteogenic lineages in vitro. Proliferation capacity was highest in BFPMSC. There was no significant difference in cell senescence in the three groups. PdMSC showed the highest ALP expression followed by BFPMSC and BMMSC. Gene expression analysis showed significant upregulation of DLX5, RUNX2, and BGLAP. Conclusion Within the limitations of the study, we can conclude that buccal fat pad, periosteum, and iliac bone marrow are good sources of MSCs which have osteogenic potential. Mandibular periosteum is a promising source of MSCs which have been little investigated in the literature so far. Studies with a larger sample size and study of in vivo behaviour of different MSCs would give more assenting results.

Primary Author: Ifueko Patience Osaghae

Abstract:

Purpose: Attempt to use strangling to stop severe hemorrhage of acutely bleeding highly vascular intraoral soft tissue lesions by occluding of feeder vessel and for excision, as resulting necrosis would lead to separation. Method: Prospectively maintained data of patients that presented with acutely bleeding exophytic gingiva lesions due to truma. Initially controlled by application of pressure gauze pack for 2- thirty minutes period; infiltration of up to 4mls 2% lidocaine with 1:100,000 adrenaline; intra-muscular vitamin k1, 5-10mls then strangulation of lesion was undertaken. Non-resorbable 2/0 sutures (silk) placed at junction of the lesion to gingiva: passed from mid- buccal to palato/lingual, 2 ends of sutures were taken at 180° of lesion and ligated mesially. Another suture passed at the same point from buccal to palato/lingual and tied off distally. Gauze pack was placed, patients observed at 30-minutes interval until bleeding stopped; observed further and sent home. Results: Three patients: two females 11 and 22 years and one male 34 years. Older female in 3rd trimester. Two pedunculated lesions- palatally and bucally placed and third, sessile lingually. Patients revealed no bleeding on getting home. Lesion fell off whole second day for pregnant woman; part fell off 3rd then 7th day for male patient. For 11 year old, did not fall off even after one week review: part was observed to be greenish-black and other part red. Conclusion: Ligating stalk can lead to stoppage of severely bleeding soft tissue lesions of traumatic origin. Resulting separation of lesion more favourable when pedunculated.

Primary Author: Prashant Punde

Abstract:

Purpose- For retromolar intubation, conventional endotracheal tube needs to bend in retromolar region leading to compresion of the inner diameter of the tube which in turn reduces airflow through the tube. There is no tube specially designed for retromolar intubation. Currently endotracheal tubes are stabilized in position using tracheal cuff inflation and elastic stretchable tape around it's exit. Manipulation of maxillofacial bones has may lead to compression, damage or accidental extubation during the surgery. Thus, we have developed a novel tube dedicated to Retromolar intubation with additional means of tube stabilization. Methods- PUNTUBE has curvature in axial plane adapting the tube well behind the last erupted molar with no need of bending the tube. This prevents reduction in airflow due to bending of the tube. This tube is made of PVC as conventional tubes are made of. PUNSTAB wires provide firm stabilization with teeth & can be checked easily during the procedure. Results Peak pressure within the tube was compared. There was only 0.8% of change in PUNTUBE compared to 6% of change in conventional tube when bent. Stabilization of tube was satisfactory with PUNSTAB wires.Conclusion: PUNTUBE is a novel innovation for retromolar intubation, can be used in all cases with risk free intubation. Note: PUNTUBE & PUNSTAB are the trademarks named after the inventor Punde's RETROMOLAR tube & Punde's stabilisation method. These are PATENTED DESIGN WITH PATENT NUMBER 345662-001 with Patent office India.

Primary Author: Fernando ALMEIDA

Coauthor(s):ANGELA Bueno-deVicente, Alvaro Ranz Colio, Patricia de Leyva, Julio Acero Sanz

Abstract:

Keywords: sialoendoscopy, salivary glands, litectomy, inflammatory salivary gland disease Objetives: The inflammatory pathology of the salivary glands constitutes one of the most frequent pathologies in maxillofacial diseases. In most cases it has an obstructive origin due to the presence of lithiasis in the path of the excretory duct. Another cases are due to not lithiasis inflammatory disease (recurrent sialadenitis). The emergence and development of sialoendoscopy allows the minimally invasive treatment of these patients with promising results, reducing morbidity, lowering health costs and accelerating the recovery of patients with this pathology. We present our experience in the implementation of this technique in an oral and maxillofacial surgery department and the results obtained. Results: We present 31 cases of inflammatory glandular disease from September 2018 to September 2021 , 25 cases of lithiasis origin, treated by endoscopic lithectomy and 6 cases of chronic non lithiasis sialadenitis treated by means of washes with serum and dilators. In 23 of the 25 cases of lithiasis origin, the lithectomy was achieved with no complications.The cases of failure of the procedure were a lithiasis of 10 mm of diameter. The range value of lithiasis diameter was from 3,4 to 8,7 mm, and the mean value was 6,3 mm.The cases of not lithiasis origin the procedure allowed an improvement of its symptomatology.The complications were temporal glandular swelling in 23 cases and post surgical ductal stenosis in 1 case. Conclusion: Sialoendoscopy can be served as an organ-preserving approach for diagnosis and treatment of inflammatory (obstructive and not obstructive) salivary diseases.

Primary Author: Anand Gupta

Coauthor(s):Shyam Popat

Abstract:

PURPOSE In advance staged Oral squamous cell carcinoma (OSCC), use of Neoadjuvant chemotherapy (NACT) plays an important role in down staging of the tumor. Frequently at the completion of NACT there is considerable regression in tumor size and this obscures its original limit. So, it becomes imperative to accurately demarcate the limit of the tumor before NACT. We use a newer method of tattooing for both skin and oral mucosa marking in OSCC patients. METHODS A prospective cohort study was conducted to assess the feasibility and advantages of this newer technique in cases of advance staged OSCC who were offered NACT before surgery from July 2020 to June 2021. RESULTS The total of 12 patients (8 male, 4 female) were enrolled in this study and marked with wireless tattooing pen using sterile tattooing needle and ink. In seven patients, the marking was done both at skin and oral mucosa and 5 patients underwent only oral mucosa marking depnding on the skin involvement by tumor. The procedure was found to be quick and comfortable to the patients. There was no complain of any infection or pain by any of the patient after this procedure. The marking was very much stable and clear which helped in easy assessment of tumor regression and also gave confidence to the surgeon in taking proper margins during the surgery. CONCLUSIONS This newer technique of tattooing using wireless pen system provides an easy and quick method of marking skin as well as mucosa. This gave high confidence to the surgeon in deciding resection margins.

Primary Author: Elisabetta Lucchi

Coauthor(s):ACHILLE TARSITANO, Claudio Marchetti, Francesco Ricotta

Abstract:

PURPOSE We analyzed the prognostic impact of 3D tumor characteristics, tumor volume and tumor sphericity, on the survival of patients with primary oral cancer. METHODS We identified 73 patients from our database that underwent a surgical treatment from 2006 to 2021. The pre-operatory CT were uploaded in an appropriate software to segment the tumor mass with threshold tools. Afterwards we obtained the corresponding volume and sphericity (numeric index of the regularity of the tumor surface). The average follow-up was 22 months. RESULTS In the subgroup of tongue mean tumor volume was significantly lower in patients without recurrence of disease (4.48 vs 18.10cm3 with p=0.009), whereas mean tumor sphericity was significantly different in the subgroup of adherent gingiva in relation to recurrence or death tumor-related (respectively 0.62 vs 0.51 with p=0.025; 0.63 vs 0.54 with p=0.006). Survival was significantly greater for patients with a tumor volume inferior to cut-off value (recurrence-free survival 78.0% vs 28.6% with p< 0.01; overall survival 88.3% vs 46.2% with p=0.001). We obtained a similar result for the subgroup of tongue (recurrence-free survival 78.9% vs 0.0% with p=0.028; overall survival 92.3% vs 41.7% with p=0,022), whereas for the subgroup of adherent gingiva survival was worse in patients with a sphericity index inferior to cut-off (recurrence-free survival 88.2% vs 30.0 with p<0.01; overall survival 96.6% vs 73.3% with p=0,014). CONCLUSIONS Three-dimensional parameters, tumor volume and tumor sphericity, characterize better the size and shape of each case, adding information that could be useful to delineate the prognosis for oral cancer.

Primary Author: Sher Ali Khan

Coauthor(s): Mohamed El Sayed Abd El Had

Abstract:

Sub-condylar fractures of mandible are a common occurrence in the trauma of maxillofacial region both in children and adults. These fractures are treated by open reduction and internal fixation or by closed reduction according to the patient's age, his general condition and the facilities available in a particular healthcare setting.Using the antero-parotid trans-massetric approach for treating mandibular subcondylar fractures, it has the least postoperative complications among other approaches for treating mandibular subcondylar fractures. Data was collected over seven years with a total of 245 fractures operated on 205 patients. Only minor complications were noticed during the 10 days post operative period with mild temporary weakness of the buccal branches of facial nerve in 3.4% of cases while post operative unusual edema and trismus in 8.7 % which resolved during the first ten days post operatively.No parotid leak/sialocele was found in any of these cases.Our aim is to give some clinical tricks after seven years experience in using this approach to treat subcondylar fractures, to achieve the best results with the least complications. The tricks include; the type of fractures which can be treated with this approach, to identify the access site, to deal with facial nerve branches in surgical site , the needsd for perfect retraction and how to aid in reduction of fractures. We recommend this approach as it is rapid ,easy, safe and effective for treating low subcondylar fractures .We suggest to take in concern those clinical tricks to achieve the least complications and minimize surgical time.

Primary Author: Samuel Costa

Coauthor(s): Bruna Campos Ribeiro, Alessandro Oliveira de Jesus, Marcio Bruno Figueiredo Amaral

Abstract:

Purpose: The primary care proposed on the ATLS protocol is considered the gold-standard for life-threatening situations, and the maxillofacial surgeons should be familiar with the protocol as the trauma surgery is considered a consistent field of the speciality. Methods: A nationwide survey with maxillofacial residents was promoted in Brazil. The aim of the study was to evaluate the knowledge of this group on the ALTS protocol. Results: A total of 149 maxillofacial residents responded the survey and 91% of the participants were aware of the protocol and its features. In only 42% of the residency programs the trauma practice was performed at least once a week and fewer responded to apply the protocol on daily basis (35%). Conclusion: The trauma surgery is an important field of the maxillofacial surgery. It is concerning that the majority of the residency programs are not preparing the residents on trauma surgeries and emergencial events.

Primary Author: isabella vilella

Coauthor(s): Bruna Campos Ribeiro, Samuel Costa

Abstract:

Purpose: Airway maintenance is fundamental for neurological and pulmonary reasons.For patients with middle-face trauma, the usual nasal intubation has its limitation. Together with that, the need for transoperative dental occlusion contraindicates the useof orotracheal intubation. So both tracheostomy and submental intubation should beconsidered, each one with its indications. This study describes the complications of thesubmental intubation, over a large case series. Methods: All the data from patients with maxillofacial trauma that required the use ofsubmental intubation, Over a ten-year was retrieved. Results: 219 patients were enrolled in this study, 26 cases of complications wereobserved (12%), being the skin infection the most common. The mean follow-up was6.2 months.Conclusion: When the indications for submental intubation were respected, is simple technique without major complications. The technique allows the establishmentof transoperative maxillomandibular fixation. Therefore submental-tracheal intubation isa useful safe and rapid alternative for the airways with a low complication rate asshown in the present study.

Primary Author: Yaseer Arafat

Abstract:

Purpose: To demonstrate a case report of comprehensive management of LMN type Facial Nerve injury and Avulsion of External Ear Lobe after sustaining RTA. Methods: The postulated management protocol. Stage 1: Facial Nerve Trunk exploration and cooptation with ipsilateral Massetric Nerve. Stage 2: Soft Tissue volume expansion using soft tissue expanders. Stage 3: External Ear Reconstruction using careful carved costochondral graft. Stage 4: Ear lobe sulcus and creases recreation. Results: The 4 stage approach was planned and executed successfully by our surgical team and restored form, function and aesthetics to near normal. Conclusion: Our proposed protocol in managing Facial Nerve trunk LMN type injury with External Ear Lobe Avulsion gives very good functional and aesthetic outcomes. Thus we recommend this proposed management protocol when similar situation arises.

Primary Author: Michael Theiss

Coauthor(s): Shravan Renapurkar, Daniel Laskin

Abstract:

Purpose: The purpose of this study was to evaluate outcomes for patients who sustained concomitant symphysis/parasymphysis (S/PS) and condylar/subcondylar (C/SC) mandible fractures and were treated with different approaches. Methods: This is a retrospective cohort study on patients who underwent treatment for concomitant S/PS and C/SC fractures between 2010-2020 at a single institution. Forty-seven patients met inclusion criteria and data were analyzed for the development of major complications such as malocclusion, malunion and infection that needed additional surgery. The subjects were grouped based on open (intra-oral vs. extra-oral) or closed approaches for initial treatment. The C/SC fracture group treated with a closed approach was further subcategorized into unilateral and bilateral fractures. Results: Major complications were not significantly associated with treatment method and approach (P = 0.27). Similarly, there was no significant difference in major complication rate with the concomitant treatment of S/PS fractures with unilateral or bilateral C/SC fractures (P > 0.99). Conclusions: The results of this study suggest that the major complication rate associated with concomitant treatment of S/PS and C/SC mandible fractures is low (9%). The treatment method and approach for each fracture type when analyzed separately also does not differ significantly in complication rate. There was no significant difference in the complication rate for the closed treatment of unilateral and bilateral C/SC fractures with concomitantly treated S/PS fractures.

Primary Author: Wanderson Ferreira da Silva Junior

Coauthor(s): Alice Goncalves, Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: Fractures of the anterior skull base could lead to several complications and the CSF leakage is not uncommon, being hard to diagnose, which can mislead the treatment. This clinical feature is characterized by a dura-mater lesion and the leakage could drain to the naso-orbito-ethmoid complex. Methods: The present study presents considerations about CSF leakage after NOE fractures in patients over a retrospective 10-year period. Results: 209 patients with NOE fractures underwent diagnosis of the condition by different tests: 99,52% by CT; 5,26% by cisternography; 73,20% for glucose test and 90,43% for paper filtration. In 58,37% of patients, surgical fistula closure was necessary, while in 41,62%, the closure was spontaneous, although the literature indicates that conservative treatment can be effective in most cases. Conclusions: The difficult diagnosis is also due to the little or absent bone volume in the skull base as a normal anatomical variation. Combinations of radiological and biochemical tests are effective. CT can be essential as a first exam and follow-up of cases is necessary to reduce the risk of complications such as meningitis..

Primary Author: Laura Silva

Coauthor(s): Samuel Costa, Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Guilherme Lacerda De Toled

Abstract:

Purpose: Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication and have few cases described in the literature, to this reason, there are some questions about witch treatment protocol to follow. To date, no study compared the protocols and compared the pearls and pitfalls for each one. Methods: A systematic literature review was carried to establish the best treatment method for the mandibular condyle dislocation to the medial cranial fossa. The conservative and surgical treatments were evaluated. Results: Fifty patients were included on the study. The most common gender was female (70%), followed by male (30%), with mean age of 25 years old. The M.V.A. was the most common cause for the trauma (60%), followed by falls and assaults. The studies included in this review suggested that the surgical treatment was predominant (92%) and the conservative treatment was performed in only 8% of the sample. However, 60% of the patients treated without surgery referred postoperative complications versus 10% on the surgical protocol. Conclusion: This study suggest that the surgical protocol should be performed when dealing with condyle displacement to medial cranial fossa, avoiding complications such limited mouth opening, aesthetical asymmetry and malocclusion.

Primary Author: Anand Gupta

Coauthor(s): Shyam Popat

Abstract:

PURPOSE Extraoral approaches are commonly used for the open reduction and internal fixation (ORIF) of subcondylar fractures, although sialocele, transient facial nerve injury, infection and facial scar are some of the important complications. The intraoral approach for the ORIF avoids these potential complications, however technical difficulty is the major concern. The objectives were to compare complication rated and average duration of post-operative hospital stay between these two approaches. METHODS A case-control study was conducted to compare the retrospective data of the patients who had subcondylar fracture and managed with either intraoral (Group A) or extraoral (Group B) ORIF in our department from February 2015 to January 2021. The statistical analysis was done using SPSS ver 21.0. RESULTS The total of 40 patients (35 male, 5 female) having subcondylar fracture were treated with ORIF. Out of these, 16 were treated using intraoral approach and 24 using extraoral approach. The mean + S.D. post-operative hospital stay for intraoral group was 3.31 + 0.87 days and 3.70 + 0.7 days for extraoral. This difference was found to be statistically significant (p = 0.02). None of the patients of intraoral group developed post-operative complications. While, in extraoral group 2 patients developed sialocele, 1 transient facial nerve palsy, and 1 post-operative infection. The rate of complications was significantly lower in patient treated intraorally (p=0.05). CONCLUSIONS Intraoral approach for ORIF of subcondylar fractures significantly reduce the rate of post-operative complications and post-operative hospital stay. Although technically difficult, a steep learning provides improved and early rehabilitation of patients with mandibular subcondylar fractures.

Primary Author: Elavenil Panneerselvam

Abstract:

Background and purpose: Literature supporting use of intra-operative navigation (ION) in orbital reconstruction is abundant. However, evidence on the role of ION in improving orbital implant position is sparse. Our objective was to determine if ION influenced implant position accuracy in secondary orbital reconstruction. Methods: This was designed as a prospective observational study comparing two groups of patients requiring secondary orbital reconstruction; the test group received intra-operative guidance with ION, while the control did not. The groups were matched for age and defect size. Primary outcome variables included assessment of deviations between the ideal implant position and achieved implant position in six degrees of freedom; horizontal, vertical and transverse (linear), pitch, roll and yaw (angular). Secondary outcome variables included assessment of procedural time. Descriptive and inferential statistics were used to compare means and variance. Results: A total of 24 patients were recruited into the study with a mean age of 27.79 years. Results demonstrated that implant position accuracy was significantly superior in the transverse plane (medio-lateral) for the test group (p=0.03). The total duration of the procedure was longer by 8 minutes (p=0.047), while surgery time was 15 minutes shorter when using ION (p<0.001). This was due to the additional equipment setup time for the test group (mean 23 mins, p<0.001). Conclusion: The study demonstrated that ION may be a useful intra-operative guide to improve implant position in infero-medial orbital defects requiring reconstruction. ION also reduced the time required for intra-orbital dissection and positioning of the implant.

Primary Author: Joao Vitor Gonçalves

Coauthor(s): Adriano Augusto Souza, Bruna Campos Ribeiro, Roger Lanes Silveira, Samuel Costa

Abstract:

Purpose: 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. The authors developed a device for the tube transposition and a study was necessary to evaluate if the gadget would perform in a larger sample. Methods: A prospective study was carried to observe if the device would perform in a larger sample of patients with indication of submental intubation. Bleeding, tube damage, cuff damage, skin infection, hypertrophic cicatrization and unwanted extubation were observed. Results: A total of 18 patients were enrolled by this study, all with indication of submental endotracheal intubation. The male gender was the most prevalent (88%), followed by the female (12%). Hypertrophic cicatrization of the incision was the only complication observed (11%). None bleeding, tube damage, cuff damage, skin infection and unwanted extubation were observed. Conclusion: This proposed device in this present study is reliable and should be used to aid unexperienced professionals with the submental endotracheal intubation technique.

Primary Author: Sathesh Kumar Ramamoorthy

Abstract:

Purpose: This study was done to evaluate the efficacy of Ropivacaine which belongs to pipecoloxylidide group , long acting local anaesthetic in comparison with Lignocaine for inferior alveolar nerve block in bilaterally impacted mandibular third molars. Method: This study involved 20 healthy patients (ASA 1) with bilaterally impacted mandibular third molar.The patients wererandomly selected of both Sexes between age group of 20-40 years.A total of 40 procedures were performed. Patients received 2ml of 2% Lignocaine with adrenaline on one side and 2ml of 0.75 % plain Ropivacaine on the other side at two different appointments. The time of onset of anaesthesia, duration of anaesthesia, analgesia and postoperative requirement of analgesics were measured. Pain experiences were measured by Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). Results:In Ropivacaine group, the means of onset of anaesthesia, duration of anaesthesia, duration of post-operative analgesia and requirement of post-operative analgesicswere 5.8±2.33 min, 533.3±142.2 min,539.6±114.7 min and 4.2±0.8 respectively and there was a significant difference between these group (<0.001). Conclusion: The efficacy of plain Ropivacaine 0.75% is superior to 2% lignocaine with adrenaline 1:1,00,000 in terms of duration of anaesthesia and analgesia, intraoperative and post-operative pain control but the onset of action of plain Ropivacaine is slightly higher. We conclude that Plain Ropivacaine 0.75% can be used as an alternative to lignocaine in third molar surgeries and other minor surgical procedures which necessitates longer duration of anaesthesia and analgesia in oral and maxillofacial region.

Primary Author: Kurdi Salah

Abstract:

Management of facial gunshot wounds poses a challenge not only for the oral and maxillofacial surgeons but also for the reconstructive surgeons. Aim -- To determine pattern and presentation in terms of site of injury, airway, associated injuries; and early management of facial gunshot wounds occurred in Tripoli-Libya from 2011-2019 Materials and methods -- A total of 612 patients were treated during 1st January 2011 to 31st December 2019 have been included. Results -- Age ranged from 15 to 42 years with mean of 28+4.98 years. There were 695 bullet different calibers (7.62x39 mm, 9 mm, 12.5 mm, and 14.5 mm) & 20 land mine. All patients are males. 342 (55.8%) patients required airway management. The most frequent site involved was mandible in 387 (63.2%) patients while midface was involved in 227 (37.1%) patients. Open reduction and internal fixation (ORIF) was performed in 367 (60.0%) . 127 (20.7%) patients had some complications; trismus, sinusitis and infection. Conclusion -- All patient in this series required surgical intervention for treatment of their facial gunshot wounds. Primary treatment of soft and skeletal facial structures at the time of surgical debridement was possible in the majority of our patients. Early management and operative intervention for repair of the soft and skeletal facial structures leads to satisfactory results. Facial gunshot wounds frequently involve mandible with more likely requirement of establishment of emergency airway and ( ORIF).

Primary Author: Shivya Chopra

Abstract:

BACKGROUND-Communited fractures of face especially the regions of the anterior maxillary sinus wall and frontonasal suture are often difficult to stabilize with plates and screws because of the presence of multiple thin bony fragments which are prone to disintegrate due to the drilling or screw tapping pressures.If the hardware in this region is not properly stabilized then it can eventually result in secondary problems like infection and loosening of hardware.Such clinically non severe ,asymptomatic and undisplaced fracture segments are usually treated conservatively but there is a possibility of these segments being displaced after reduction of the entire fracture complex resulting in long term discomfort to patient.The purpose of this study is to evaluate fixation efficacy of comminuted fracture fragments using resorbable suture in order to avoid complications. METHOD-Patients with comminuted fractures of anterior maxillary wall fracture, fronto nasal fracture were planned for open reduction and internal fixation under general anaesthesia.Thin fracture segments were stabilized using 2-0 vicryl plus along with the fixation of large fragments by bone plating .Patients were evaluated post operatively for complications and efficacy of bone fixation . RESULTS-According to post operative radiological evaluation there were no evidence of collapsed reduction fragments or any other associated complications such as infection,rhinitis,sinusitis,chronic purulent secretion and unstable fixation at fracture site . CONCLUSION -This minimally invasive technique of fixation of thin fragments with resorbable sutures ensures adequate blood supply for osseointegration and stability for precision fixation of fractured fragments.This technique consumes less time with minimal instrumentation, easy to master with minimal secondary complications.

Primary Author: Patrick Harrison

Coauthor(s): Alex Green, Anthony Chellappah, Kathleen Fan

Abstract:

Purpose: Paediatric orbital fractures are rare. The existing literature demonstrates wide variation in estimates of incidence, aetiology, management protocols and outcomes. Despite this, it is generally acknowledged that orbital fractures with entrapment of the extraocular muscles constitute a surgical emergency due to the potential for persistent diplopia secondary to muscle ischaemia and necrosis. Methods: This was a retrospective study, conducted to determine the characteristics and outcomes of management of orbital fractures amongst the paediatric population. It involved patients presenting to King’s College Hospital, London between 2010-2020. Results: 20 patients with pure orbital fractures presented to our Unit in this period. The average age of the patients was 11 years with a male preponderance. The predominant aetiology was road traffic accidents, but in surgical patients aged 13 to 16 this was interpersonal violence. The most common fracture pattern involved the orbital floor and medial wall. 9 patients required surgical intervention due to diplopia caused by entrapment of extraocular muscles. 5 patients had nausea, vomiting or bradycardia associated with the occulocardiac reflex. Surgical intervention occurred within 24 - 48 hours of the patient sustaining their injury in 6 cases. Resorbable sheet was used to reconstruct the orbit. Resolution of diplopia occurred in 7 patients within 6 months. Length of follow up ranged from 1 to 18 months. Conclusions: Paediatric patients with orbital fractures should be assessed on the day of injury by a Maxillofacial Surgeon. Due to the risk of persistent diplopia, urgent surgical intervention in patients with entrapment of extraocular muscles should occur as soon as possible.

Primary Author: Thaís Resende

Coauthor(s): Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Júlia Silva, Samuel Costa

Abstract:

Purpose: The complications related to the treatment of upper facial fractures are difficult to treat, such as contour deformity, adherence and palpability of the fixation material due to skin thinning. The coverage of the fixation material is an important method to mitigate the majority of these complications and the pericranium could be repositioned to increase the tissue thickness. Methods A case series of patients with upper facial fractures treated with internal fixation and covered with a lateral pericranium flap was performed. Results A total of nine patients were enrolled by this study. All the patients had frontal and naso-orbito-ethmoidal fractures. Open reduction and fixation of the fractures was followed by the coverage of the material using a lateral based pericranium flap. On the postoperative care, the flap prevented the palpability of the fixation material and the skin thinning. No exposure of fixation material, no surgical site infections and non palpable plate were observed. Conclusion The pericranium flap is widely used in surgeries of reconstruction, obliteration of paranasal sinuses and bone restoration. The technique described in this study proved to be reliable and costless, with good functional and cosmetic results. Furthermore the morbidity, the complications and the side effects of this technique are not common.

Primary Author: Ana Carolina Silva

Coauthor(s): Samuel Costa, Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Alice Goncalves

Abstract:

Purpose: The main challenge in mandibular fractures caused by firearms is restore the anatomy in the fracture areas, due to the severe destruction of the bone and tooth borne structures. To reestablish these areas, load sharing devices usually lacks support, leading to non-union and infections. Strong systems, with load-bearing pattern are the gold-standard for the treatment of complex mandibular fractures. Methods: A series of patients with mandibular fracture caused by firearms injuries was treated with load-bearing devices and followed to observe the complications and outcomes. Results: A total of 22 patients were enrolled by this study, 19 male and 3 females. All the patients were treated with transcutaneous approach and rigid fixation with a 2.4mm titanium plate, a total load-bearing device. The complication rate was considered low, being infection of the surgical site (13%) and material fatigue (9%) the most prevalent. Conclusion Open reduction and internal fixation of mandibular fractures with load-bearing devices is a reliable procedure. The use of these materials in cases of caused by firearms projectiles is fundamental to promote the correct for bone support in long term.

Primary Author: JUNYOUNG JEONG

Abstract:

Introduction: Treatment for fractures of the edentulous mandible is a special therapeutic challenge and controversy exists regarding the method of management. The purpose of this study is to compare and discuss the treatment options for the fractures in the edentulous mandible. Patients and Methods: We conducted a retrospective study of edentulous patients who had mandibular fractures that were surgically treated and observed for more than 1 month at the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital between January 2011 and December 2019. Those patients were investigated about the following data: age, gender, fracture site, fracture pattern, fracture site vertical height, intermaxillary fixation period, postoperative follow-up period, complications and those management methods, etc. Results: The mean follow-up period for 25 enrolled patients was 6 months. Three out of all patients had condylar fracture and 10 patients had concomitant mandibular fracture. Mandibular fractures were mostly located in the body area, followed by angle and symphysis area. Twelve patients who had isolated fracture in edentulous mandible were treated by open reduction and internal fixation (ORIF) without intermaxillary fixation (IMF) in 10 cases and with IMF using gunning splint in two cases. Complications occurred in eight of 10 cases, including malocclusion (n=3), transient nerve injury (n=3), infection (n=1), plate exposure (n=1). Conclusion: It seems that several considerations are needed for the management of edentulous mandibular fractures differently from the dentate patient.

Primary Author: Júlia Ferreira

Coauthor(s): úlia Silva, Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: Mandibular fractures are usually caused by direct trauma. The need for surgical intervention depends on the location and type of fractures, always aiming to avoid complications. Missiles lesion on the maxillofacial region are uncommon. Methods: Report the case of a patient victim of an accident with a spear gun impacted in the anterior mandibular region. Results: 38-years-old male patient, presented with spear gun impacted on the anterior aspect of the mandibular symphysis. After immaginological examination, it was confirmed that no vascular and hypopharynx lesion was observed.The patient underwent removal of the object under direct vision. The mandibular fracture was fixated with 2 titaniumminiplates. The patient was followed by 12 months without any know complication. Conclusion: Missile objects should be removed on the first opportunity, however the correct diagnose and propedeutics should not be put under position. A strict follow-up is mandatory to assess if any complication could arise.

Primary Author: Ianca Batista

Coauthor(s): Bruna Campos Ribeiro, Samuel Costa, Marcio Bruno Figueiredo Amaral

Abstract:

Purpose: Oronasal hemorrhage is severe and, if left untreated, can lead to death. The source of bleeding may be the maxillary artery and its branches, as well as intracranial vessels, which are difficult to expose during an emergency. Thus, oronasal tamponade may be an option for temporary bleeding control when the patient has the airway secured. Methods: This study reports a case series on the use of massive oronasal tamponade to control emergencial severe bleeding. Results: 16 patients, 14 males, and 2 females, had major oronasal bleeding. After orotracheal intubation, the patients underwent posterior nasal packing with a foley catheter, anterior packing with a hemostatic agent, and gauzes. Oronasal bleeding was temporarily controlled in all patients, however, in eleven of them, a subsequent surgical approach was necessary to control the bleeding and the super-selective embolization was the technique of choice . Conclusion: In this context, it is important to emphasize that there are several treatment possibilities for the condition. A massive oronasal tamponade is a viable approach that presents low complication rates and achieves the objective of stabilizing the condition.

Primary Author: Júlia Silva

Coauthor(s): Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: Naso-orbital-ethmoid fractures are complex to be treated, as they require in-depth knowledge of the central anatomy of the face, one of the most challenging areas of facial reconstruction, as well as precise surgical techniques, availability of tools and patient characteristics to obtain an ideal restoration of the aesthetics and function. The present study describe a case series of the treatment of naso-orbital ethmoidal fractures using the medial canthopexy technique supported by a cantilever plate. Methods: A prospective case series of patients with naso-orbital ethmoidal fractures were treated using the medial canthopexy technique supported by a contra-lateral cantilever plate. All the patients were closely followed for twelve months. Results: A total of 15 patients (4 female and 11 male) were enrolled by this study, in a Level 1 Brazilian public hospital with multiple type III naso-orbito-ethmoidal fractures were found. 94% of the patients presented no complications, however a persistent traumatic telecanthus was observed in one patient (6%). Conclusion: Fractures of the naso-orbito-ethmoidal region are difficult to treat. One of the methods available for treatment is medial canthopexy with a contralateral cantlever plate, which can be an easily feasible and reliable technique, with minimal complication rates.

Primary Author: Alice Goncalves

Coauthor(s): Wanderson Ferreira da Silva Junior, Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: Severe injury to the nasal bones and structures may lead to a depressed nasal dorsum, so-called “saddle-nose deformity”, which is generally caused by medium and high-intensity impacts to this area, resulting in aesthetic and functional complaints. The present study aims to describe a case series of strut plates implementation to restore nasal projection. Methods: A case series of patients with naso-orbital-ethmoid fractures associated with panfacial fractures and severe saddle-nose deformity with comminuted nasal dorsum were followed for 36 months after the correction of the nasal projection with a nasal dorsum strut plate, coated by a pericranium flap. Results: Nine male patients victims of M.V.A. were enrolled by the study. In all cases, a strut titanium plate was applied vertically at the nasal root to reconstruct its dorsum. No signs of infection or plate exposure were observed; in other words, the complication rate was 0% in all nine cases. The nose dorsum projection was re-gained for all the patients. Conclusion: The main goal of the treatment is to obtain restoration of aesthetic form and function. The 3-years follow-up, alongside the satisfactory outcomes, indicate that the use of a strut plate for dorsal nasal height restoration, associated with pericranium flap coating. is an excellent corrective technique to saddle-nose deformity and can be performed by the maxillofacial surgeon during the surgical intervention.

Primary Author: Fausto Rispoli

Abstract:

Background: Nonsurgical rhinoplasty with injectable dermal fillers has emerged in recent years as one of the most performed facial cosmetic procedure. Increase in demand to the to social media boost, relative low cost, convenience and rapid recovery low risk profile, has quickly become in popular imagination an alternative to surgical procedures for patients. Thus, proper patient selection with clear clinical indications, a methodological approach, knowledge of possible complications and management need to be clear.. This study reports the experience of a single oral & maxillofacial surgeon (FR, Gemelli Molise) performing nonsurgical rhinoplasty over the last 5 years. Methods: Patient demographics, indications, technique details, outcomes of patients treated between September 2017 and September 2021 were reviewed. The author describes his personal approach to nonsurgical rhinoplasty defining 3 key nasal subunits: dorsal hump, nasal tip, anterior nasal spine of maxilla. He describes indications for 2 types of hyaluronic acid fillers: VYC-20 or VYC-17.5. Patients received a maximum of 1 mL of filler. Minimum follow up length was 6 months. Results: Nonsurgical rhinoplasty was performed in 40 patients. Common indications were: dorsal hump (75%), dropping tip (15%) saddle nose deformity (10%). Swelling and erythema were self-limiting side effects encountered in 2 patients. No infection, skin necrosis, supratroclear paresthesia were observed. Conclusions: Nonsurgical rhinoplasty is a safe procedure with positive aesthetic results and meaningful changes in key nasal angles. Knowledge of nasal anatomy, comprehensive training, and use of appropriate materials are key in ensuring safety and stable results over time.

Primary Author: Louis Mercuri

Abstract:

Are All Alloplastic Total TMJ Replacement Devices the Same? The purpose of this study was to demonstrate that the manufacturing process and the metallic component microstructure of a temporomandibular joint replacement (TMJR) device have a direct effect on that material’s physical and mechanical properties in the body after implantation. A total of 26 wrought titanium alloy (Ti6Al4V) and cobalt chrome molybdenum (CoCrMo) alloy TMJR devices were analyzed using scanning electron microscope equipped with an electron backscatter and energy dispersive x-ray spectroscopy detectors. Electrochemical studies were performed in simulated joint fluid utilizing a three-electrode cell. The results of this study showed that wrought Ti6Al4V alloys were superior with respect to the corrosion rate, repassivation potential, and the capacitance values compared to 3D printed Ti6Al4V alloys. This study also demonstrated that TMJR implant CoCrMo alloys can vary with respect to microstructure within ASTM specifications. One important conclusion from this study was that with the introduction of additively manufactured joint replacement components, critical evaluation of 3D printed Ti6Al4V implant alloy microstructure is essential to prevent potential premature implant failures. Further, just as with the medications prescribed, it behooves the surgeon to understand the differences in biologic and physiologic responses to these materials when prescribing which device to implant in a specific case.

Primary Author: Shintaro Sukegawa

Abstract:

In recent years, clinical application of three-dimensional treatment planning using computer simulation constructed from image data and patient biometric information has been progressing. Computer-assisted surgery (CAS) using simulation-based navigation systems and surgical guides has been introduced for oral and maxillofacial surgery. The 3D model created based on the preoperative image data can determine the preoperative surgical plan and the reduction site of the bone, and is very useful for the treatment of maxillofacial fractures. In addition, the intraoperative navigation system captures the three-dimensional anatomical position by linking the surgical site on the CT or MRI image and displaying the positional relationship between the position seen by the operator and the target on the monitor in real time. It is a computer surgery support system that is widely used in many oral and maxillofacial surgeries. However, the problem with conventional navigation systems is that the intraoperative display image cannot be updated. This is because the navigation system is based on preoperative image data. In recent years, it has become possible to use CT images taken during surgery by using a hybrid operating room, and even in maxillofacial fracture surgery involving bone movement, intraoperative evaluation is possible by using a navigation system with images taken after movement. Yes, its usefulness is increasing. In this presentation, we would like to examine the usefulness and future prospects of computer-assisted surgery in oral and maxillofacial trauma surgery together with cases.

Primary Author: Joao Vitor Gonçalves

Coauthor(s): Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: Panfacial fractures are a challenge for maxillofacial surgeons, mainly due to the lack of reference points for reduction and bone borne structures for fixation. Usually these fractures are the one the involves ate least two thirds of the face, being severe and often related with trauma in other regions. The complications of the treatment of the panfacial fractures are usually related to the intervention time and modality of the treatment. Methods: 10-years retrospective study on a Level 1 trauma hospital in Brazil. All the patients with diagnose of panfacial fractures were evaluated. The treatment plan and the postoperative complications were retrieved. Results: A total of fifty-two patients were enrolled on the study and the complications were considered uncommon with a 11% rate. The most prevalent were malocclusion, followed by persistent traumatic telecanthus and facial enlargement. In all the patients, was observed that conservative or delayed treatment was observed. Conclusion: The panfacial fractures treatment is usually complex and should be carefully performed by an experienced surgeon. The delayed treatment and the conservative treatment are usually performed due to the severity of the trauma and life-treating situations, however the complications could be more common and severe.

Primary Author: FARAH HANAN ABD WAHID

Coauthor(s): Sharifah Tahirah Aljunid

Abstract:

Introduction: Mucormycosis is a serious fungal infection caused by a group of molds called mucormycete. Post traumatic mucormycosis presenting as a complication is a rare occurrence. Here we present a case of mucormycosis post trauma with extensive craniofacial involvement and its management. Case report: A young and immunocompetent gentleman was involved in a motor vehicle accident and sustained extensive soft tissue injuries with multiple facial bone fractures. The wound was heavily contaminated as he landed in a muddy swamp. On examination he had degloving injury over the right scalp region exposing the frontal bone. His right globe had dislodged into the right antrum due to the orbital floor fracture. Surgery was done to reposition the globe and the orbital floor was reconstructed with titanium mesh and microporous high-density polyethylene. Post-operatively, he developed infection to the right eye which eventually had to be exenterated. Microscopic examination of the pus specimen revealed mucormycosis. Computed tomography scan showed widespread infection into rhinocerebral region with orbital wall involvement. A series of debridement was done and course of amphotericin B was completed. The case was managed by a multidisciplinary team as it continued to extends towards craniofacial region. Conclusion: The key to successful management of mucormycosis is early diagnosis while aggressive surgical debridement is the most important component of treatment as well as administration of amphotericin B is a useful adjunct. Skin grafting as a method of repairing defects left by extensive debridement is an advantageous option

Primary Author: Shintaro Sukegawa

Abstract:

In recent years, the clinical application of three-dimensional treatment planning using computer simulation constructed from image data and patient biometric information has been progressing. Computer-assisted surgery (CAS) using a navigation system and surgical guide based on computer simulation has been introduced into oral and maxillofacial surgery. In the treatment of maxillofacial fractures, a three-dimensional realistic model based on preoperative image data is very useful for preoperative surgical planning and determining the correct position of the restoration. An intraoperative navigation system is a computerized surgical support system that links images such as CT and MRI to the surgical site, and displays the position of the target and the surgeon on a monitor in real time to help the surgeon understand the three-dimensional anatomical location. However, conventional navigation systems have the problem of not being able to update the displayed images during the operation. This is because the navigation system is based on image data taken preoperatively. In recent years, the use of hybrid operating rooms has made it possible to use CT images taken during surgery. In recent years, the use of hybrid operating rooms has made it possible to use CT images taken intraoperatively, which has increased the usefulness of intraoperative evaluation in maxillofacial fracture surgery involving bone movement by using images taken after the movement for navigation. In this presentation, I would like to show the usefulness and future prospects of computer-assisted surgery in oral and maxillofacial trauma surgery with a case study performed in our department.

Primary Author: Ianca Batista

Coauthor(s): Bruna Campos Ribeiro, Samuel Costa, Marcio Bruno Figueiredo Amaral

Abstract:

Purpose: The load-bearing fixation plates are an excellent material for mandibular reconstruction. However, due to its more robust size and shape, the system has particularities that must be observed. It is well described that the larger material is vulnerable to fatigue when inadequate bone support, due to material stress. Methods: This study describes a 10-year retrospective study evaluating reconstructive plaque fatigue in an emergency department. Results: A total of 23 patients (21M, 2F) were enrolled in this study due to material failure., The main etiology was firearm injury (56%), followed by M.V.A and other minor causes. In all patients, it was necessary to re-approach to replace the fixation material. It was observed that adequate bone support to the plate had not been provided. In 82,6% of patients, infection and fatigue occurred less than six months after the first approach. Conclusion: The load-bearing fixation plate is an excellent material when well indicated, being the gold standard for the treatment of comminuted fractures, infected areas, fractures with bony loss, atrophic jaw, and treatment delayed fractures with nonunion ensuring an adequate facial contour. However, when there is inadequate bone support, the plate can generate torque, which leads to fatigue and event fracture.

Primary Author: Walid Ghanem

Coauthor(s):Amany Khalifa

Abstract:

Aim of the study : Evaluate the role of PRF in osteogenesis of critical bone defect associated with mandibular fractures. Material &Methods: The study was involved eighteen mature male Mongrel dogs (ranged from 1-2 years old) average weight about 15 kg & divided into two equal groups. Unilateral mandibular body fracture was induced by segmental body resection 6.5x1x1.5 cm dimensions .The mandibular body fracture was fixed by reconstruction bone plate 2.3mm . Group Ι: act as a control group. Group II (study group): the gap filled with platelet rich fibrin (PRF). All surgical sites were closed by interrupted suture with black silk. Three animals from both groups were sacrificed with an overdose of anesthesia at 2, 4,6months. CBCT were done for the fracture sites at 2, 4,6months. The fracture site was sectioned and preparing for histological process and histomorphometric analysis were done. Result: All dogs were completed the study without missing of any dog or loss of their body weight. Clinically soft tissue healing proceeded normally with no sign of inflammation, wound dehiscence or infection. CBCT showing increase bone density measures for group II but significantly increased after 6months. Histomorphometric examinations showed that the rate of bone formation gradually increased for group II but significantly increased more than group I after 4,6months. Conclusions: Platelet Rich Fibrin (PRF) significantly increase bony formation rate provided that rigid fixation of fracture site is done.

Primary Author:Leh Chaun Lim

Abstract:

Introduction: The Sheffield joint orbital trauma clinic, led by a maxillofacial consultant and ophthalmology consultant, has been running monthly for the last 7.5 years. It provides a specialised and bespoke service for a range of patients presenting with orbital pathologies but mainly periorbital trauma and post-traumatic periorbital deformities. Other than maxillofacial and ophthalmology/orbital clinic consultation and assessment, there is access to same-day ophthalmology imaging and photography, in-house same day orthoptics assessment and 3D surgical planning. There is also pathway for quick referrals for patients who require further oculoplastics or strabismus surgery. Methods Patient attendance records from May 2012 to May 2019 were obtained from hospital database. Data was collected from patient notes, clinic letters and operation notes. Results A total of 154 new patients have been seen jointly in the clinic. 108 were male, and 46 were female. 91 referrals were from OMFS, 54 from ophthalmology and 9 from other specialities (GP, ENT). The main presenting complaints were late-onset enophthalmos and diplopia. 70 of the patients had previous orbital surgeries: 55 were open reduction internal fixation of zygomatic complex +/- orbital floor exploration and repair. 56 patients were listed for operations following consultation, of which 30 were joint operations between ophthalmology and OMFS. The most common joint procedure was orbital floor exploration + insertion of a customised polyetheretherketone(PEEK) implant +/- surgical navigation. Conclusion The joint orbital clinic is a useful and valuable service which combines the expertise of two surgical specialities for specialist care of patients with complex sequalae from orbital trauma.

Primary Author: Wanderson Ferreira da Silva Junior

Coauthor(s): Alice Goncalves, Bruna Campos Ribeiro, Marcio Bruno Figueredo Amaral, Samuel Costa

Abstract:

Purpose: The oculocardiac reflex is the result of a response to the stimulus of the vagus nerve after trigeminal nerve excitation by ocular compression, which can cause bradycardia by inhibiting the heart rhythm. This is a severe intraoperative complication, that should be carefully carried to prevent further cardiac arrest. The present abstract proposes to report a case of severe bradycardia due to the oculocardiac reflex in a patient victim of a zygomatic fracture. Methods: The present abstract study reports a case of severe bradycardia due to the oculocardiac reflex in a patient victim of a zygomatic fracture, during the bone reduction. Results: A 43-year-old male patient, with past medical health unknown, victim of a left zygomatic fracture after trauma during sports practice undergoes open reduction and internal fracture fixation. During the reduction, the patient presented a severe oculocardiac reflex, followed by bradycardia, 22 heart beats per minute. Atropine was used for the correction of the heart function and the procedure was resumed and the patient presented no further complications. At the follow-up, the patient was accompanied by a cardiologist, without any cardiac diseases or alterations. Conclusions: All craniomaxillofacial procedures in the orbital region, middle third or orthognathic surgeries could lead to life-threatening conditions, such as oculocardiac reflex. The surgeons must be prepared for intervention and treatment.

Primary Author: Wanderson Ferreira da Silva Junior

Coauthor(s):Alice Goncalves, Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: Firearms injuries are usually severe, destructing bone structures, in addition to that the soft tissue usually suffers from an enormous amount of energy transfer. Usually vascular lesions could arise due to this trauma. Pseudo-aneurisms are usually severe due to the amount of blood loss. Methods: An unique case of super-selective embolization of pseudo-aneurism of the sphenopalatine artery is presented. Results: 26-years-old military presented with a facial firearm injury due to an accidental shot. The primary care was taken without any alteration and after two weeks from trauma the patient presented severe nasal bleeding. Immaginological exams presented a sphenopalatine artery pseudo-aneurism. Together with the Vascular Surgery Team, a super-selective embolization with a spring prosthesis. The patient did not presented any epistaxis at the 12-month follow-up. Conclusion: The trauma surgery is an important field of the maxillofacial surgery. The super-selective embolization is a safe and reliable procedure for the control of vascular lesions on the vessels of the face.

Primary Author: Samuel Costa

Coauthor(s):Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral

Abstract:

Purpose: Frontal fractures are not rare and their treatment is usually open surgery. The risk of material exposure increases when there are skin injuries. Many materials could be used to cover the implants, aiming to avoid the exposure and infection. Some pearls and pitfalls could alternate the post-operative outcomes and complications. Methods:This study report a unique case of cranioplasty with titanium mesh for the anterior vault reconstruction, using a temporal fascia flap for the soft tissue adjustment. Results: 22-years-old male patient victim of motorcycle accident presented with open frontal fracture, with an extensive soft tissue laceration with loss of substance. A bicoronal flap was performed to expose the fractures, that were repositioned and fixated with miniplates. An extensive titanium mesh was used to reconstruct the anterior vault. A temporal fascia flap was rotated to cover the material. After a 12-month follow-up no exposure or infection occurred. Conclusion: The temporal fascia flap is a reliable and cost-free procedure to adjust the soft tissue and to avoid the exposure of the material, specially in cases if there are loss of soft tissue substance.

Primary Author: Victor-Vlad Costan

Coauthor(s):Mihai-Liviu Ciofu, Daniela Sulea, Andrei Nicolau, Eugenia Popescu

Abstract:

Purpose The aim of this study is to investigate the contribution of soft tissue adjustment surgery in reestablishing contour, volume, and function in cases with different posttraumatic midface defects. Materials and methods We reviewed 19 patients with deformities of the midface following trauma in which soft tissue surgery was performed. We documented the type of posttraumatic sequelae and the surgical results. The surgical outcomes were evaluated clinically and by photographic measurements and were related to the type of residual posttraumatic defect. Results Considering the defect’s structure, in 8 of the patients the sequelae involved strictly the soft tissues, in 5 cases strictly the skeletal frame, while in the other 6 cases both the soft tissues and bone were affected. 14 of the patients had primary surgery in the acute trauma setting. The other 5 cases presented late due to associated lesions that delayed primary repair. The procedures consisted of lipostructure in 9 patients, silicone implant placement in 3 patients, suture suspension in 7 cases, canthoplasty in 5 cases, scar revision in 7 patients. Eight patients had multiple corrective procedures. From the total, 5 cases had purely aesthetic complaints, while in 14 of them, there were associated functional disturbances. Following corrective surgery there were aesthetic improvements in all the included cases. Twelve of the patients also noticed an important benefit regarding functional improvement. Conclusion The results of this study underline the importance of modelling the soft tissues for optimal functional and aesthetic outcomes in the management of midface trauma sequelae.

Primary Author: Chee-Hon Ng

Abstract:

The effect of Covid 19 safe distancing measures on facial fractures – a metaanalysis NG CH and STASSEN LFA National Maxillofacial Unit, St James’s Hospital, Ireland Abstract Introduction Safe distancing is a community mitigation measure used to mitigate the burden and spread of an infectious disease during the pandemic. Safe distancing measure can have healthy effect on other human diseases as well. The purpose of this study was to understand the impact of social distancing enacted during the pandemic on the epidemiology of facial fracture. Material and methods An electronic literature search was undertaken on “Covid 19” and/or “Facial trauma” and “Facial fracture” in Pubmed. The other search terms used included “Coronavirus”. The included studies for analysis contained measurable outcomes for calculation. Results Eleven studies were found that included measurables for Covid 19 and patients presented with facial trauma during the current pandemic and pre pandemic era. Actual number of patients presenting with trauma fell during the pandemic as reported in all the included 11 studies. The forest plot obtained favoured Covid 19 intervention over Control with odd ratio of 0.48 [0.46, 0.50] at 95% Cl. Conclusion The Covid-19 safe distancing measure during the pandemic is an effective Public Health measure that has a positive effect on the presenting number for facial trauma and fractures. References Allareddy V (2011) Epidemiology of facial fracture injuries. J Oral Maxillofac Surg 69: 2613-2618. Zhu N (2020) A novel coronavirus from patients with pneumonia in China. N Engl J Med 382: 727-733

Primary Author: Alice Goncalves

Coauthor(s): Wanderson Ferreira da Silva Junior, Bruna Ribeiro, Marcio Bruno Figueiredo Amaral, Samuel Costa

Abstract:

Purpose: Orbital floor is composed by the maxillary, zygomatic and palatine bones, being frequently involved in orbital fractures. Different types of approaches are available to the exposure, however, the transconjunctival approach has been prevalent due to its benefits, as aesthetic outcome and lower complications incidence, when compared to transcutaneous ones. The purpose of this study is to report the transconjunctival approach for the orbital floor reconstruction. Methods: A case series of patients with blow-out orbital floor fractures was followed for 36 months after surgical procedure to correct the fractures, under the exposure provided by the preseptal transconjunctival approach. Results: A total of 13 patients were enrolled by the study. All selected cases were indicated for open surgery with titanium mesh to reconstruct the inferior orbital wall. 77% of the patients were male, followed by 23% female, and the mean age was 32 years. The main etiology was M.V.A. and assaults, with 46,1% each. Thereby, ocular motility and vision acuity were preserved for all patients, without any aesthetic concern. Conclusion: Transconjunctival approach is a good method for the exposure of the orbital floor, due to the lack of external skin scar and low rate of complications. Titanium mesh is the predominant material used in orbital floor fracture cases for its easy adaption and adequate restore of this wall.

Primary Author: Samuel Costa

Coauthor(s):Bruna Campos Ribeiro, Marcio Bruno Figueiredo Amaral

Abstract:

Purpose: Mandibular condyle fractures presents different classifications and treatment modalities. It is controversial if the open surgery presents a more effective recover of the mandibular function than the closed treatment. Methods: A prospective cohort was performed aiming to measure the bite force and maximum mouth opening in two groups, surgical and closed treatment, in seven to ninety days after the procedure. The bite force was measured using an specific designed dynamometer. Results: A total of twelve patients were included in this study, six on each group. The maximum mouth opening was recovered after the day 30 on patients on the surgical group, on the closed treatment group it occurred on the sixty day, an statistical significant difference, p=0,003 . The bite force was regained on both groups with a mean time of thirty days and there was no difference between the groups, p=0,766. Conclusion: Both techniques are reliable on the long term and no differences were observed in the 2-plates AO/ASIF technique and the closed treatment for the subcondylar fractures on the bite force, however the surgery recover the patient mouth opening in a fewer time.