Simple dentate area fractures of the mandible - can we prevent postoperative infections?

Objective To evaluate the occurrence of surgical site infections and predisposing factors for these in simple mandibular fractures. Material and Methods A retrospective study of patients with fractures of the dentate part of the mandible included patients with intraorally treated simple fractures of the mandibular body, symphysis, and parasymphysis. The primary outcome variable was postoperative surgical site infection. Use of antibiotics, injury mechanism, fracture and surgery-related explanatory variables, patient-related variables and level of oral hygiene according to the modified Total Dental Index were evaluated. Results Of 254 patients with mandibular fractures, 107 were included in the final analysis. The infection group consisted of 18 patients (16.8%). Despite the high infection occurrence, significant differences were not found between antibiotic use or other studied variables and infection occurrence. Infections occurred mainly in patients without any specific explanatory factor for infection. Conclusion The notably high occurrence of surgical site infections despite antibiotic use after simple mandibular fracture surgery highlights the importance of perioperative tissue handling and local oral circumstances. It is also necessary to consider whether we generally accept the high risk of infection associated with the intraorally treated simple mandibular fractures.Peer reviewe

Effect of social distancing during the COVID-19 pandemic on the occurrence of maxillofacial fractures in a Finnish Tertiary Trauma Centre

Objectives To evaluate the effects of the COVID-19 pandemic on the occurrence of facial fractures in a tertiary trauma centre. Materials and methods All facial fracture patients evaluated by an oral and maxillofacial surgeon during the first stage of the pandemic in spring 2020 were included in the study and compared to the corresponding periods in 2017 and 2018. Differences in age, sex, timespan from accident to diagnosis of facial fracture, injury mechanism, fracture type, treatment method, associated injuries (AIs), and alcohol consumption at the time of injury were analyzed between the forementioned time periods. Results The total number of patients (n = 107) during the COVID restriction period did not differ from the previous years (116 and 113 patients in 2017 and 2018, respectively, p=.368). Injury mechanism was less often assault during 2020 compared with previous years (14.0% in 2020 versus 31.8% in 2018 and 30.2% in 2017). Non-intracranial AIs were more common in the COVID period (28% in 2020 versus 14.2% in 2018 and 21.6%). The distribution was statistically significant (p=.041). Alcohol use prior to injury varied between years (p=.023). Alcohol was more often related to the injuries in 2020 compared to the previous years. Conclusions COVID restrictions did not affect the overall facial fracture occurrence, but there was a significant decrease in assaults. The proportion of alcohol-related injuries did not decrease despite restrictions.Peer reviewe

Kirurgisk vård av nedrekäkens låga kondylfrakturer : väljer kirurger optimal teknik? : en litteraturöversikt och internationell kartläggning

Surgical treatment of condylar fractures is a much-discussed topic and a number of different techniques are used. We sent out a survey to maxillofacial trauma surgeons in the Nordic countries to gather information about regional differences in surgical praxis and post-operative treatment. A review of the literature was also conducted regarding the success-rate of different fixation plates. The survey yielded significant differences in the primary choice of fixation plate for the case of a subcondylar fracture presented, the most popular choices being two straight four-hole miniplates (27.8 %), a seven-hole lambda plate (25.0 %) as well as one straight four-hole miniplate (22.1 %). There was also division between respondents regarding choice of mono- versus bicortical screws (52.8 % versus 47.2 %) and post-operative dietary recommendations (soft diet ranging from two to eight weeks). The literature shows ample evidence favouring the use of two straight four-hole titanium miniplates for internal fixation over the use of a single straight four-hole miniplate, however newer three-dimensional plate designs are constantly being developed and have thus far shown promising results. We conclude that for optimal prognosis the single straight plate should not be used, only evidence-based treatment methods should be implemented. While there is some evidence to support the use of different three-dimensional plate designs, further research should be conducted before these can be seen as a viable choice for the standard double plating system.Flera fixationsnstekniker används aktivt vid kirurgisk vård av nedrekäkens kondylfrakturer. Vi skickade ett frågeformulär till käkkirurger i Norden med ändamålet att samla data gällande kirurgisk praxis och användning av olika titanplattor för frakturfixation. En litteraturöversikt gjordes med fokus på olika fixationsmetoders prognos. I frågeformuläret framgick det stor varians gällande val av fixationssystem för det presenterade exemplet av en kondylfraktur med lång frakturlinje. Det populäraste alternativet var två raka titanplattor med fyra hål (27,8 %), en lambdaformad titanplatta med sju skruvhål (25,0 %), samt en rak titanplatta med fyra skruvhål (22,1 %). Det framgick även stor varians vid val av mono- versus bikortikala fixationsskruvar (52,8 % vs. 47,2 %) samt skillnader i postoperativa kostrekommendationer (mjuk kostrekommendation varierande från två till åtta veckor). I litteraturen finns omfattande data som understöder användningen av två raka titanplattor med fyra skruvhål över användningen av en enkel titanplatta. Nya tredimensionella titanplattor utvecklas konstant och har visat lovande resultat. Sammanfattningsvis bör enkel fixation med rak titanplatta undvikas för att uppnå optimal prognos, vi rekommenderar endast evidensbaserade vårdmetoder. Medan det finns en del data som understöder användningen av diverse tredimensionella fixationssystem, krävs vidare forskning innan dessa kan ses som ett verkligt alternativ för industristandarden av två raka titanplattor

Effect of Perioperative Systemic Dexamethasone on Pain, Edema, and Trismus in Mandibular Fracture Surgery : A Randomized Trial

The authors' aim was to evaluate the effect of perioperative systemic dexamethasone (DXM) administration on postoperative pain, edema, and trismus in mandibular fracture patients. The authors conducted a prospective randomized study of 45 patients with one or 2 noncomminuted fractures of the dentate part of the mandible. All patients underwent surgery for intraoral miniplate fixation. Patients in the study group were given a total of 30 mg DXM, while patients in the control group received neither DXM nor placebo. Only paracetamol and opioids were served as analgesics. Pain severity was assessed using the visual analog scale. The effect in facial swelling was measured in centimeters and analyzed as percentage change. Trismus was evaluated as the difference in maximal mouth opening by measuring interincisal distance in millimeters. The Mann-Whitney U test was applied to determine the statistical significance of differences between the groups. Thirty-four patients were included in the statistical analysis. The visual analog scale score was significantly lower in the study group than in the control group at 18 hours postoperatively (P = 0.033). Significant differences in edema or trismus were not found postoperatively between the DXM and control groups. In conclusion, perioperative DXM decreases postoperative pain in mandibular fracture patients when nonsteroidal anti-inflammatory drugs are not used, but it does not seem to be effective in reducing edema or trismus.Peer reviewe

Effect of COVID-19 pandemic on orofacial and respiratory infections in ear, nose, and throat and oral and maxillofacial surgery emergency departments : a retrospective study of 7900 patients

Objectives The study purpose was to evaluate the effects of the COVID-19 pandemic on the rate and disease profile of orofacial and respiratory infections in oral and maxillofacial surgery (OMFS) and ear, nose, and throat (ENT) emergency units. Materials and methods Records of patients with orofacial or respiratory infection, or infectious symptoms, diagnosed in the OMFS or ENT Emergency Departments of the Helsinki University Hospital, Helsinki, Finland between 1st March and 30th October 2020 and the corresponding periods in 2018 and 2019 were reviewed. The main outcome variable was the occurrence of studied infections during the evaluated periods. Other study variables were age, gender, residence area, speciality, specific cause for the emergency department visit and admission to ward. Results There was a significant 37% decrease in the number of infection patients in 2020 compared to the years 2019 and 2018 (1894 vs. 2929 and 3077, respectively, p < .001). A mean decrease of 51% (from 1319 and 1249 patients in 2018 and 2019, respectively, to 592 patients in 2020) was seen in the "Other ENT respiratory infection" category. ENT patients were 51% less likely to be admitted to the ward in 2020 compared to 2019 and 2018 (p = .013). Conclusion A significant decrease was observed in the volume of emergency department visits for orofacial and respiratory infections during the COVID-19-pandemic in 2020 compared to the non-COVID periods.Peer reviewe

Yritystoiminnan kehittäminen hankintojen avulla

Työ toteutettiin tutkimalla aiheeseen liittyvää kirjallisuutta sekä tutkimalla sähköisiä informaatiolähteitä. Työssä hyödynnettiin yksityiseen hankintasektoriin kohdentuvaa materiaalia. Idea työhön sai alkunsa opinnäytetyöntekijän työpaikan hankintojen kehittämisprosessin aloittamisesta. Aihe herätti mielenkiintoa ja halun alkaa tutkia kehittämisen eri mahdollisuuksia. Opinnäytetyön teoriaosuudessa yksityisen sektorin hankinnan sisältö jaettiin osiin, jolloin hankinnan eri vaiheet saatiin selostettua mahdollisimman selkeästi. Työssä avataan lukijalle hankintaa kehittäviä metodeja kuten työkaluja, toimittajasuhteidenhallintaa, toiminnanohjausjärjestelmiä ja riskienhallintaa. Työ on teoriapainotteinen, ja sen tarkoituksena on saada lukija innostumaan yritystoimintansa kehittämisestä hankintojen avulla ja antamaan uusia näkökulmia ja ideoita sekä antamaan varmuutta ja uskallusta lähteä kehittämään liiketoimintaansa. Kesken työtä oli selvästi huomattavissa, että aihe on yhtä laaja kuin kehittämisen mahdollisuudetkin, eli lähes rajaton. Oli hankalaa miettiä mitä jätetään pois ja mitä halutaan tuoda opinnäytetyön sisältöön. Työkaluja ja analyysimenetelmiä on olemassa hyvin paljon, ja niistä joitakin hyödyllisempiä ja yleisimpiä on esitelty tässä opinnäytetyössä. Opinnäytetyön laatiminen on syventänyt tekijän omaa ammatillista osaamista; Sen avulla on pystynyt yhdistämään opitun teorian ja käytännön keskenään

Is there a role for perioperative use of dexamethasone in facial fracture surgery? : Aspects in postoperative nausea and peripheral nerve recovery

Background and purpose: Glucocorticoids (GCs) are used in various medical indications. One generally accepted and well-known indication is perioperative administration to reduce postoperative nausea and vomiting. GCs are also used with mixed results in promoting nerve recovery after an injury. However, these two potential indications have not been extensively investigated in facial trauma populations. The aim of this study was to determine whether dexamethasone could reduce the incidence of postoperative nausea and vomiting (PONV) and promote nerve recovery in the trigeminal nerve area after a facial trauma. Patients and methods: The study was based on a randomized controlled trial where patients were randomized to either receive dexamethasone or serve as a control. Study I included patients with different types of facial fractures (n=119), Study II patients with isolated zygomatic complex (ZC) fractures (n=64), Study III patients with isolated orbital fractures (n=18), and Study IV patients with one or two fractures in the dentate part of the mandible (n=27). In Study I, the outcome variable was PONV and the primary predictor variable was the administration of perioperative dexamethasone. In Studies II-IV, the outcome variable was neurosensory disturbance (NSD) at 6 months and the primary predictor variable was the use of perioperative dexamethasone. Results: The overall PONV incidence (Study I) was 16.8%. Dexamethasone did not reduce PONV incidence. In Studies II-IV, dexamethasone did not reduce long-term NSD. PONV was significantly more common in patients who received postoperative opioids. In Study III, a significant predictor for prolonged NSD was treatment delay. Conclusions: The role of short-term dexamethasone in the indications studied remained insignificant. The findings therefore do not support the use of perioperative dexamethasone in reducing PONV or postoperative NSD in facial fracture patients. The low number of study subjects excluded the possibility for subgroup analysis.Tausta ja tutkimuksen tarkoitus: Glukokortikoideilla on useita eri käyttötarkoituksia lääketieteessä. Yksi tunnettu käyttöindikaatio on pahoinvoinnin ehkäisy ja lisäksi useita tutkimuksia on tehty glukokortikoidien käytöstä muun muassa vaurioituneen hermon paranemisen nopeuttamiseksi. Runsaista tutkimuksista huolimatta näitä kahta edellä mainittua mahdollista käyttöindikaatiota ei ole laajalti tutkittu kasvomurtumapopulaatiossa. Tutkimuksen tarkoituksena oli selvittää yhden yleisesti käytössä olevan glukokortikoidin (deksametasoni) vaikutusta leikkauksen jälkeiseen pahoinvointiin ja kasvojen alueen tuntohermon paranemiseen kasvomurtumapotilailla. Aineisto ja metodit: Tutkimuksen aineisto koostui deksametasonin käytön suhteen randomoidusta potilasaineistosta. Osajulkaisussa I sisälsi kaikki tutkimukseen randomoidut potilaat (n=119), osajulkaisu II koostui poskiluumurtumapotilaista (n=64), osajulkaisu III silmäkuopan pohjan murtumapotilaista (n=18) ja viimeinen osajulkaisu IV koostui alaleuan hampaallisen alueen murtumapotilaista (n=27). Selitettävä muuttuja oli ensimmäisessä osajulkaisussa leikkauksenjälkeinen pahoinvointi (postoperative nausea and vomiting, PONV) ja muissa osajulkaisuissa alentunut tuntohermon toiminta 6 kuukauden kohdalla leikkauksesta (neurosensory disturbance, NSD). Selittävänä muuttujana oli kaikissa deksametasonin käyttö leikkauksen yhteydessä. Tulokset: Leikkauksen jälkeisen pahoinvoinnin esiintyvyys aineistossa oli 16.8%. Deksametasonilla ei ollut vaikutusta pahoinvoinnin esiintyvyyteen. Opiaatteja saaneilla potilailla esiintyi merkittävästi enemmän pahoinvointia. Deksametasoni ei vähentänyt potilaiden tuntohäiriöitä 6 kuukauden seurannassa. Leikkausviive oli silmäkuopan pohjan murtumapotilailla merkityksellinen. Yhteenveto: Deksametasonilla ei tämän tutkimuksen perusteella ollut vaikutusta potilaiden leikkauksenjälkeiseen pahoinvointiin tai tunnon palautumiseen, eikä tämän käyttöä voida tämän tutkimuksen perusteella suositella kasvomurtumapotilailla edellä mainittuihin käyttötarkoituksiin. Aineiston pieni otoskoko rajoitti tarkempien alaryhmäanalyysien tekoa