Risk of frontal sinus anterior table fractures after craniofacial trauma and the role of anatomic variations in frontal sinus size: A retrospective case-control study

Introduction: Purpose of this study was to evaluate a probable risk of frontal sinus size for traumatic depressed anterior table fractures in patients with similar forehead trauma. Methods: We conducted a retrospective case-control study with a case group of consecutive treated patients with displaced frontal sinus anterior table fractures. The control group was randomly sampled from patients who presented with a blunt forehead trauma in our institution's emergency unit. In computed tomography data sets, all patients' frontal sinus size was categorized by Guerram's classification that is defined as aplasia, hypoplasia, medium-size and hyperplasia. Odds for prevalence of the sinus types as well as sinus total width and height were compared between both groups. Results: In total, 47 cases and 93 controls were identified. Hyperplasia in the case group had an odds ratio of 46: 1 (p < 0.001) compared to the controls. Mean sinus width (73 mm vs. 46 mm; p < 0.001) and sinus height (30 mm vs. 15 mm; p < 0.001) were larger in the case group. Conclusion: Depressed traumatic fractures of the anterior table are an injury with a high risk specific for enlarged frontal sinus sizes. Anatomy is the predictive factor for this mode of craniofacial trauma. (C) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved

Intraoperative Ultrasound Control of Zygomatic Arch Fractures: Does Additional Imaging Improve Reduction Quality?

Purpose: Intraoperative navigation to assess anatomic reduction is the general trend in maxillofacial trauma surgery. The aim of this study was to evaluate the closed reduction outcome of isolated zygomatic arch fractures using ultrasound compared with palpation control. Materials and Methods: In this case-and-control study, the authors identified consecutively treated patients who underwent closed reduction of isolated zygomatic arch fractures using the Volkmann reposition hook with intraoperative ultrasound. Controls were patients with the same diagnosis and surgical procedure without ultrasound imaging. Pre- and postoperative radiographic datasets were geometrically analyzed. The outcome variables postoperative cortical step, persistent postoperative displacement, and overall grade of reduction were compared in the 2 study groups. Subgroups of fracture patterns were classified as M-shaped or variable. Statistical analysis was performed using t test for continuous variables and 2-sided chi(2) test for categorical variables, with a P value less than .05 defined as significant. Results: Sixteen cases with intraoperative ultrasound and 60 controls were identified from the institution's database. The angle of postoperative displacement was significantly decreased in the ultrasound group for all fractures (2.4 degrees vs 5.3 degrees; P = .004) and the variable fracture type (1.6 degrees vs 8.1 degrees; P = .005). Overall grade of reduction was improved in the ultrasound group for all fractures (P = .03) but with no difference solely for M-shaped fractures (P = .37). Conclusions: Although reduction control using palpation and probing using the Volkmann hook showed satisfactory results for M-shaped fractures, additional intraoperative ultrasound imaging showed promise for increasing success rates for the variable type of zygomatic arch fracture. (C) 2018 American Association of Oral and Maxillofacial Surgeon

Laterocaudal approach to the inferior rim of the orbit

Purpose: Fractures of the orbital floor and orbital rim are frequently treated in maxillofacial departments. Various approaches to the orbital floor are described in the literature. We present an investigation of a modified subciliary approach (laterocaudal approach) with respect to its feasibility and clinical outcome. Materials and methods: Our retrospective study investigated 130 well-documented cases of patients with orbital floor fractures who received surgical reconstruction using a laterocaudal approach, and compared the results with the current literature, with a focus on subciliary and transconjunctival approaches. Results: 111 patients (85.4%) presented a Vancouver scar scale (VSS) of 0.14 patients (10.8%) had a VSS score of 1. No patients had a VSS of 2. Just five patients (3.8%) had a slight ectropium and therefore a VSS score of 3. Conclusion: The laterocaudal approach can be safely performed and presents advantages over comparable techniques such as the subciliary and transconjunctival approaches if performed correctly. (c) 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved

Oral health-related quality of life and implant therapy: A prospective multicenter study of preoperative, intermediate, and posttreatment assessment

Purpose: Loss of teeth is associated with a significant reduction in quality of life. The aim of this prospective multicenter study was to assess the impact of dental implants on oral health-related quality of life (OHRQoL). Material and methods: Patients with various kinds of indications for dental implants ranging from single tooth loss to edentulous jaws were included. Quality of life related to dental implants was assessed through the Oral Health Impact Profile (OHIP-G 21), which has a score from 0 to 20 in healthy patients. Results: In total, 8689 patients from 17 centers from 2009 to 2014 were enrolled in the study. The sex distribution was almost even (53.3% men, 46.7% women). The most frequent indications for the insertion of dental implants were free-end gaps (30.6%) and posterior single-tooth gaps (27%). In all, 12.4% of patients had an edentulous jaw. For all indications, patients reported significant changes in mean OHIP scores after prosthetic reconstruction. The most significant improvements in the OHIP score occurred in the groups of patients with edentulous jaws (pretreatment score: 42.3) after prosthodontic reconstruction (score: 24.8) and in the patient group with an anterior single-tooth gap (pretreatment score: 36.4) after prosthodontic reconstruction (score: 24.8). Conclusion: The insertion of dental implants and prosthodontic rehabilitation led to an improved OHRQoL for patients with all indications for dental implants, with the most significant improvements in patients with edentulous jaws and anterior single-tooth gaps. (c) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved

Oral recipient site infections in reconstructive surgery - impact of the graft itself and the perioperative antibiosis

ObjectivesThis study was designed to assess the influence of peri/post-operative antibiotic prophylaxis (POABP) and the reconstructive graft itself on recipient sites infections in head and neck surgery.Materials and Methods:In this retrospective cohort study, 322 consecutive patients with reconstructive surgery were investigated. The primary objective was to analyze the differences of commonly applied reconstructive grafts on the occurrence of oral recipient site infections. Moreover, differences of POABP regimes (namely: ampicillin/sulbactam, 2(nd) generation cephalosporins, clindamycin) and antibiotic alternatives were investigated. In addition, patients' length of in-hospital stay was analyzed in regard to reconstructive graft and POABP regime.ResultsThe free radial forearm flap and split-thickness skin graft presented significantly less recipient site infections and shorter length of in-hospital stays (LOS) in comparison to further six reconstructive technique with pedicled tissue transfer or bone transfers. LOS was significantly shorter for patients with ampicillin/sulbactam than with 2(nd) generation cephalosporins as POABP. 91% of the harvested pathogens (n=193) were susceptible to the combination of 2(nd) and 3(rd) generation cephalosporins. Secondly, 92 out 113 (81%) harvested pathogens presented susceptibility to moxifloxacin.ConclusionSmaller tissue transfers are less prone to infections of the recipient site and present low LOS. For an POABP regime, the combination of 2(nd) and 3(rd) generation cephalosporins presents substantial results in recipient site infections. In cases of allergy, potential pathogens show adequate susceptibility to moxifloxacin.Clinical relevanceA combination of 2(nd) and 3(rd) generation cephalosporins may be used to prevent recipient sites in head and neck surgery

Frontal Sinus Morphology: A Reliable Factor for Classification of Frontal Bone Fractures?

Purpose: The frontal sinus shows a wide range of morphologic variations. The aim of this study was to evaluate the influence of frontal sinus size on fracture characteristics in frontal bone trauma. Materials and Methods: In this cross-sectional study, data from patients with traumatic fractures of the frontal bone were retrospectively collected from the institution's database. Radiometric analysis of computed tomography and cone-beam computed tomography datasets was performed. Frontal sinus size was measured as variables of height, width, and depth. The secondary predictor was morphologic sinus type according to Guerram's classification: hyperplasia, medium size, hypoplasia, or aplasia of the frontal sinus. To determine outcomes, we classified fractures into the following categories: fracture isolated to the anterior table, combined fractures of the anterior and posterior tables, fracture isolated to the posterior table, and frontal bone fracture without sinus involvement. Further study variables were patients' demographic characteristics, combined midfacial fractures, orbital rim involvement, fracture displacement, and surgical approach. For statistical analysis, fracture types were assessed for frontal sinus metric size and morphologic type using bivariate tests with P < .05 defined as significant. Results: We enrolled 53 consecutive patients with a mean age of 35 years; male patients comprised 91%. Fracture types differed significantly in sinus width and height (both P < .001), as well as depth (P = .002). Frontal sinus morphology was hyperplastic in 66%, medium in 30.2%, and hypoplastic in 3.8%. Patients with a hyperplastic frontal sinus had an increased likelihood of isolated anterior table fractures (odds ratio, 6.0; P = .007) compared with medium-sized types. Fractures without sinus involvement were more likely in hypoplastic and medium types (P < .001). Conclusions: The morphology of the frontal sinus determines the probability of fracture types from craniofacial trauma. Thus the frontal sinus size appears to be a major factor for frontal bone resistance to traumatic force impingement. (C) 2018 American Association of Oral and Maxillofacial Surgeon

Osteotomy speed, heat development, and bone structure influence by various piezoelectric systems-an in vitro study

Objectives The aim of this in vitro study was to evaluate osteotomy speed, heat development, and bone structure influence from osteotomies performed by various piezoelectric devices and insert tips. These devices and tips were compared among each other with regard to conventional rotatory and oscillating systems with special focus on the insert tip design and thickness. Material and methods The osteotomies were conducted on porcine ribs utilizing 12 different insert tips (straight and angulated) and three conventional systems. After time and temperature measurements, histological analysis was carried out. Light microscopy was used to evaluate the roughness of the osteotomic surface and to search for indications of thermal bone necrosis. A special software analyzing tool was employed to determine cutting width (mm) and debris (%). Results All piezoelectric tips created smooth cuts. Cutting widths in general were wider than the actual insert tip size with a tendency for narrow straight insert tips producing relatively wide osteotomies, whereas narrow angulated inserts produced relatively small osteotomies. None of the samples demonstrated distinct indication of necrosis. Overall, there was only a small amount of debris in all osteotomy gaps. Conventional rotatory saws were faster and created less heat compared to all tested piezoelectric systems. Straight tips proved faster osteotomy speed than angulated tips. Thin insert tips indicated to have a positive correlation to osteotomy time and performed faster than conventional microsaw. The average temperature rise was lower when using conventional systems, but critical exceeding temperatures were only observed in short-time exceptional cases. In general, temperature rise was less when using angulated inserts. Conclusion All tested tips are appropriate for bone surgery. Only small differences were found among the piezoelectric insert tips. Although conventional rotatory systems in general performed faster osteotomies, special designed and thin piezoelectric insert tips seem to have a positive influence on osteotomy speed. Ultimately, none of the tested devices or inserts combined all best features of speed, heat development, bone structure influence, and safety

Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions

Purpose The purpose of this retrospective study was to evaluate perioperative risk factors concerning difficult airway management, primary tracheostomy, and need for intensive care unit (ICU) admission in severe odontogenic space infections. Methods Perioperative risk factors were retrospectively analyzed in 499 cases. Fisher's exact test and analysis of variance were performed to analyze associations between categorical and continuous variables. Univariate regression analysis was used for estimating predictors for ICU admission. A risk model for ICU admission was performed using multivariate regression analysis. Area-under-the-curve (AUC) was calculated by receiver-operating-characteristic (ROC) curve. Results Airway securing in patients with restricted mouth opening led to significant use of the video laryngoscope (p < 0.001) or fiberoptic bronchoscope (p < 0.001). The use of fiberoptic bronchoscopy was significantly increased in patients with dysphagia (p = 0.005) and dyspnea (p = 0.04). Four patients (0.8%) needed primary tracheostomy. ICU admission was significantly associated with higher levels of C-reactive protein (CRP, p = 2.78 x 10(-5)), white blood cell count (WBC, p = 0.003), dyspnea (p = 9.95 x 10(-6)), and higher body mass index (BMI, p = 0.0003). American Society of Anesthesiologists physical status (ASA PS) class III patients (p = 0.04) and the need for the use of a video laryngoscopy (p = 0.003) or fiberoptic bronchoscopy (p = 6.58 x 10(-5)) resulted in a more frequent ICU admission. The AUC of the model was 0.897. Conclusion Difficult airway management was mainly dependent on limited mouth opening and elevated CRP. Elevated CRP, BMI, ASA PS III, and dyspnea were important risk factors for ICU admission. These predictors should be considered preoperatively for proper planning and preparation

A retrospective analysis of social media posts pertaining to COVID-19 vaccination side effects

Objectives: With an uprising influence of social media platforms like Twitter and Instagram a multitude of worldwide accessible information is available. Since the beginning of COVID-19 pandemic the exchange of medical information about several topics related to this infectious disease and its vaccination has increased rapidly. The purpose of this investigation was to assess the content associated with COVID-19 vaccination and its side effects and evaluate its educational quality. Methods: We conducted this retrospective study to investigate 600 Twitter and Instagram posts by #covidvaccinesideeffects due to number of 'likes', comments, type of post, language, its purpose and source. In addition, posts were evaluated due to educational quality by three examiners of different edu-cational levels. Results: The majority of posts showed 0 to 50 likes and 0 to 5 comments in English language. A com-parison between Twitter and Instagram by the influence of application showed significant differences in number of posts and likes or comments (p < 0.05). The major post type were texts for Twitter (251; 83.7%) and videos for Instagram (104; 34.7%). While a majority of posts by #covidvaccinesideeffects report about the occurrence of side effects, the majority of them were mild and general COVID-19 vacci-nation feedback during the first 4 months was positive. But, only 3 to 7% were rated by excellent edu-cational and validatable content. Interrater reliability between all three examiners presented a high concordance with 89% (p = 0.001). Conclusions: This study presents an analysis of quantity and quality of social media content according to COVID-19 vaccinations and its side effects. It supports the deduction that most of the content on Twitter and Instagram is shared by patients and unclear sources and thus is limited informative. Nevertheless, influence of social media on medical information especially during COVID-19 pandemic is increasing and practitioners have to face its effect on their patients. (c) 2021 Elsevier Ltd. All rights reserved

#facialtraumasurgery: Educational Content of Instagram as a Social Media Source for Facial Trauma Surgery

With an uprising influence of social media platforms like Instagram during the last decade, medical and healthcare related posts have accumulated majorly. In particular the head and face characterizes and signifies each individual's human character, which may be the reason why numerous posts are shared on social media platforms. The purpose of this investigation was to assess the content associated with facial trauma surgery and evaluate its educational quality. The authors performed a retrospective investigation on 550 Instagram posts by #facialtraumasurgery due to number of likes, comments, type of post, language, its purpose, and source. Furthermore, posts were evaluated due to their educational quality by 3 examiners of different educational levels. The majority of posts showed 0 to 50 likes and 0 to 5 comments in English language. The major post type were single photographs (289; 52.5%), multiple photographs (188; 34.2%), videos (73; 13.3%) and predominantly case reports (233; 42.4%). The source was 322 (58.5%) posts by surgeons, followed by 185 (33.6%) clinic posts. Only 10% to 18% of the posts were rated excellent. Interrater reliability between all 3 examiners presented a high concordance with 89% (P = 0.000). Our study presents an analysis of quantity and quality of social media content according to facial trauma surgery. It supports the deduction that most of the content on Instagram is shared by patients and unclear sources and thus is limited informative. Nevertheless, influence of social media on medical information is increasing and practitioners have to face its effect on their patients