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The surgical removal of impacted third molars can lead to various postoperative consequences, which can be influenced by modifiable factors such as flap design. The present study aimed to determine whether a minimal-invasive envelope flap (MIEF) can reduce surgical consequences and improve life quality compared to conventional envelope flap (CEF) after removing impacted mandibular third molars.This single-blinded, cross-over randomized clinical trial was conducted on adult patients with bilateral, symmetrically impacted mandibular third molars. The flap design for surgical removal of the third molar was the primary predictor variable. The primary outcome (pain) and secondary outcome variables (swelling, mouth opening limitation [MOL]) were recorded daily and on the second and seventh days after the surgery, respectively. Wound dehiscence and patients' postoperative quality-of-life scores (PPOQL) were recorded on the seventh day. The data were analyzed by Kolmogorov-Smirnov and paired sample t test using SPSS version 22. The P value.5 was considered significant.Sixty-eight impacted third molars of 34 subjects with a mean age of 22 ± 12.9 years (35% females) were followed. The postoperative pain level in the MIEF group at rest (0.80 ± 0.53) and chewing (2.10 ± 1.32) up to fifth day was significantly (P value.01) lower than CEF group (2.40 ± 1.12 and 3.05 ± 1.13, respectively). The difference did not reach a significant level at rest and chewing on the sixth and seventh days (P value.05). On the seventh day, the subjects in the MIEF group showed a significantly (P value.001) lower level of swelling (1.13 ± 0.11) and MOL (8.28 ± 4.17) than the CEF group (3.2 ± 2.1 and 12.67 ± 4.92, respectively). Based on the PPOQL scale, patients in the MIEF group (1.82 ± 1.31) expressed a better recovery period than the CEF group (3.5 ± 2.1) (P value.001).Considering the reduction of pain, swelling, MOL, and wound dehiscence in MIEF cases, the application of MIEF in surgical removal of impacted mandibular third molars can lead to a significant reduction in postoperative consequences and also a noticeable improvement in PPOQL compared to CEF.

Purpose The use of rigid versus semi-rigid intermaxillary fixation (IMF) following subcondylar fractures is controversial. This study aims to investigate whether the “dynamic” elastic fixation technique improves the outcomes, compared to the rigid fixation technique for the treatment of displaced subcondylar fractures in adults. Materials and Methods This nonblinded randomized clinical trial was performed on adult patients with unilateral displaced mandibular subcondylar fractures. Patients were randomly allocated into two groups (n = 17). The primary predictor variable was wire versus elastic IMF. Changes in primary (mouth opening) and secondary (other clinical and radiological) outcomes were recorded. Data were analyzed with the t test and Mann-Whitney test with SPSS software version 20. P-value Results In this study 34 patients (with mean age of 33.03 ± 1.79, 23.5% females & 76.5% males) in two groups (Elastics & Wire) followed up to 6 months. The Elastics group showed significant improvement in mouth opening (primary outcome) after 1 month of follow-up, but the differences were not significant at the end of the study. In terms of secondary outcomes, the ramus height shortening compared to the opposite side revealed favorable improvement in the Elastics group in the period of study. The differences between the two groups in the lateral movement and protrusive movement were significant in favor of the Elastics group. The differences in pain, fracture displacement, and midline deviation between study groups were not significant at the end of the study. Just 1 case with malocclusion was observed in the Wire group. Patients were more satisfied with dynamic nonrigid IMF with elastics. Conclusions The results of this study showed that using the dynamic IMF technique is more tolerable, and patients have better functional and clinical outcomes during and at the end treatment.

Objective Maxillary fracture is the most prevalent fractures of the face. The aim of this study is to evaluate efficiency and disadvantages of different types of plate fixation in maxillary Lefort l fracture by using finite element analysis. Methods Three-dimensional model was reconstructed from Cone-Beam-tomography (CBCT) for finite element analysis. Then the fracture fixed by 4 methods of using L-type mini-plates or two-hole mini-plates in the Piriform or Zygomatic buttress. Forces were applied to measure the stress on the plates, screws, adjacent bone and the movement in the bony segments in 2 patterns of Bite force; Incisal clenching (INC) and intercuspal position (ICP). Result The maximum amount of stress was seen on the screws, plate-bar and bone adjacent to fracture line. These amounts were measured 29Mpa & 33Mpa consequently in type B (four 4-hole L shape) plate fixation in ICP and in type A (four 2-hole) plate fixation in INC patterns of Bite forces. However, the maximum amount of movement was observed in type A of plate fixation and the most stable method was Four L- shape plate fixation, the differences between stresses and movements in different fields of evaluation were not significant. Conclusion It can be concluded that there were no significant differences in these 4 types of plate fixation to show any superiority in clinical application.

The quality of the bone plays an important part in marginal bone loss (MBL) around dental implants. The aim of this study was to compare MBL around implants the sockets of which had been preserved with the bone around healed sites in the mandible after extraction of first molars. It was a prospective, cohort study in which subjects were divided into three groups (n=30 in each): dental implants were placed six months after preservation of the socket in the first group, eight weeks after tooth extraction in the second, and six months after tooth extraction in the third. The changes between the marginal bone level after loading of the implant and 12, 24, and 36 months later were considered to be the MBL. Age and sex were the variables studied, the condition of the bone (healed socket or preservation) was a predictive factor, and MBL was the outcome. Analysis of variance was used to compare MBL and age among groups. There were no differences in the mean MBL among the three groups 12, 24, and 36 months after loading (p=0.55, p=0.22, p=0.38, respectively). Preservation of the socket did not seem to affect MBL of the first molar of the mandible.

Objective The COVID-19 pandemic raises an urgent need for large-scale control through easier, cheaper, and safer diagnostic specimens, including saliva and sputum. We aimed to conduct a systemic review and meta-analysis on the reliability and sensitivity of SARS-CoV-2 detection in saliva and deep throat sputum (DTS) compared to nasopharyngeal, combined naso/oropharyngeal, and oropharyngeal swabs. Methods This systematic review and meta-analysis was performed according to the PRISMA statement. The inclusion criteria were studies that specifically assessed a sample of saliva or deep throat sputum (DTS) with at least one other respiratory specimen in patients with COVID-19 infection, based on RT-PCR tests. The DerSimonian-Laird bivariate random-effects model analysis performed using STATA software with the "metaprop" package. Results From 1598 studies, we retrieved 33 records, of which 26 studies were included for quantitative analysis. We found an overall sensitivity of 97%(95%CI,86-100) for bronchoalveolar lavage fluid, 92%(95%CI,80-99) for double naso/oropharyngeal swabs, 87%(95%CI,77-95) for nasopharyngeal swabs, 83% (95% CI 77-89) for saliva, 82% (95%CI,76-88) for DTS, and 44% (95%CI,35-52) for oropharyngeal swabs among symptomatic patients, respectively. Regardless of the type of specimens, the viral load and sensitivity in the severe patients were higher than mild and in the symptomatic patients higher than asymptomatic cases. Conclusion The present review provides evidence for the diagnostic value of different respiratory specimens and supports saliva and DTS as promising diagnostic tools for first-line screening of SARS-CoV-2 infection. However, sampling, storing, and laboratory assay needs to be optimized and validated before introducing a definite diagnosis tool. Saliva, DTS, nasopharyngeal, and even double naso/oropharyngeal swabs showed approximately similar results, and sensitivity was directly related to the disease severity. This review revealed a relationship between viral load, disease severity, and test sensitivity. None of the specimens showed appropriate diagnostic sensitivity for asymptomatic patients., Graphical Abstract Image, graphical abstract

Objective Bite force can be used as a clinical indicator of masticatory performance. As bite force is reduced with fractures and also, miniplate fixation has become the standard treatment, the aim of this study is to determine the optimal method for mini-plating in the fracture of the mandible angle to reach the best mastication power. Methods A three-dimensional model generated from CBCT (Cone-beam computed tomography) of human mandible for Finite Element Analysis. Four different fracture patterns were simulated on the models. Each fracture pattern was fixed by five different methods of miniplate fixation. Each compared to others after simulation and applying the force of the masticatory muscles and result reported in Newton unit. Results The highest mastication force belonged to a pattern in which a miniplate was placed on an outer oblique ridge and another miniplate in the lower border of the buccal mandibular cortex. The lowest mastication force also belonged to placing a mini plate on the upper side of the cortex. Conclusion Finite Element Analysis is an effective method for indirect measurement of mastication power. In order to biomechanically rebuild optimal mastication force in patients with fracture of the lower angle of the jaw, it is recommended to use two miniplates in two different planes.

Purpose Hemorrhage is one of the significant factors that cause adverse reactions and complications during trauma management. This study aimed to investigate the effectiveness of preoperative tranexamic acid (TXA) administration on intraoperative blood loss in mandibular fracture surgeries. Materials and Methods The authors implemented a triple blinded randomized clinical trial. All healthy young patients who suffered from bilateral displaced mandibular angle and body fractures were included in this study. All operations were performed using open reduction and internal fixation by the same surgical team. The eligible subjects were randomly divided into 2 equal groups. The anesthesiology staff administered the intravenous TXA (20 mg/kg) to the intervention group and 20 mL of intravenous normal saline (0.09%) in the control group, 30 minutes preoperatively. The study outcome variables included intraoperative blood loss and hemoglobin loss. The data were statistically analyzed in SPSS, version 20 (SPSS Inc, Chicago, IL). Results Fifty patients, including 31 males (62%) and 19 females (38%), with the mean age of 28 ± 5.6 years were studied. The mean blood loss was 360.57 ± 173.5 mL and 560.9 ± 248.07 mL in the TXA and control groups, respectively. This difference was statistically significant (P = .008). In addition, the mean drop in hemoglobin value was 0.91 ± 0.33 mg/dL in the intervention group and 1.44 ± 0.45 mg/dL in the control group, with a significant difference (P = .001). No adverse effect was observed in the TXA cases. Conclusions TXA is a safe and effective drug for reducing intraoperative blood loss in patients who underwent mandibular fracture open reduction and internal fixation surgeries.

Introduction: The aim of this study was to assess the effect of low-level laser therapy (LLLT) on pain, swelling and maximum mouth opening in patients undergoing third molar surgery. Methods: A prospective, randomized double-blind study was undertaken on 44 patients at the Dental School, Ahvaz Jundishapur University of Medical Sciences, in 2015. A low-level laser was randomly applied on one of the two sides after surgery of 15 patients. The experimental side received 18 J/cm2 of energy density, wavelength of 980 nm, and output power of 1.8 W. On the control side, a hand-piece was applied intra-orally, but laser was not activated. In addition, in order to evaluate trismus, 13 patients were treated by unilateral laser therapy and 16 patients did not receive laser therapy at all. The laser was administered intraorally on two points of vestibular and lingual sides at 1 cm from the surgery site, and extraorally at the emergence of the masseter muscle, immediately after surgery, and repeated 24 hours later. The pain, swelling and maximum mouth opening (MMO) were compared between the two groups at 24 hours and a week after surgery. Results: The mean score of pain 24 hours after surgery in the laser therapy group (2.3 ± 3.5) was significantly lower than the mean score of pain in the drug therapy (4.19 ± 3.09) ( P = 0.036). Moreover, the mean score of pain at one week after surgery in the laser therapy group (0.13 ± 2.33) was significantly lower than the drug therapy group (1.43 ± 2.45) ( P = 0.046). The amount of swelling according to different measurements did not significantly differ between the two groups neither at 24 hours nor at 1 week after surgery. Conclusion: Our findings showed that LLLT was useful in reducing pain and could slightly reduce swelling compared to drug therapy in impacted third molar surgery.

Background This study was aimed to compare the efficacy of customized patient-specific titanium mesh based on 3D printed model with intra-operative bending of titanium mesh for reconstructing of orbital floor fracture. Methods This study was prospectively conducted on 10 patients with unilateral orbital floor fractures caused by accident or falls. In intervention group (n=5), the CT-scan slices were used for generating 3D reconstruction of both affected and unaffected orbits. Then, a 3D printed template of mirrored unaffected orbit was produced to mold the titanium mesh. The titanium mesh in conventional group (n=5) was bended only manually and intraoperatively by surgeon and positioned over the bony defect. All patients were followed-up within 1 week, 1 month and 4 months after surgery for assessing enophthalmos, diplopia and other complications. Results Of 10 patients of the study only two patients in intervention group had preoperative vertical dystopia or diplopia which had been resolved after intervention. The mean enophthalmos at baseline and 1 week, 1 month and 4 months after surgery in control group were 3.8±0.7, 2.4±0.8, 2.4±0.8, and 2.4±0.8 mm, respectively, and in intervention group were 2.6±0.8, 0.35 ± 0.4, 0.35 ± 0.4 and 0.35 ± 0.4 mm, respectively. The mean enophthalmos did not differ significantly at baseline between two groups, while two groups showed significant difference after surgery. Conclusion Finally, we concluded that the placement of patient-specific titanium implant for reconstructing of orbital bone fracture led to better outcomes when compared to manual bending in terms of enophthalmos and other complications.

The endoscopic-assisted technique for the treatment of subcondylar fractures has been used successfully and its acceptance develops as more surgeons gain experience. We present the short term results of this technique in a randomized prospective clinical trial.A total of 40 patients with mandibular subcondylar fracture were included in our study in two groups randomly. Patients of first group were treated by closed treatment technique and patients of second group by transoral endoscopic-assisted open reduction. All patients were followed for minimum of 12 weeks and occlusion, Mandibular Anterior Opening (MAO), mandibular deviation, and posterior ramal height were assessed.In the endoscopic group the MAO was significantly greater and mandibular deviation was lesser at 2nd and 4th week of follow up. Posterior ramal height showed significant increase in the endoscopic group rather than closed treatment group.The transoral endoscopic-assisted technique is a reliable and successful technique to address subcondylar fractures. The patients who were treated by this technique showed better results in the fields of mandibular function and patient satisfaction and comfort, although it is time consuming and needs expensive instruments.

Introduction: Our primary intention is to review the literature that has been published in this field and to report some cases of surgical correction of facial and skeletal deformities in patients with thalassemia. Thalassemia is widespread, and about 5% of the world population is affected. Management of facial and skeletal deformity is a major concern in patients with thalassemia, and numerous surgical approaches have been advocated to correct facial deformities, although the type of treatment remains in dispute. Materials and Methods: We report the cases of 3 specific patients who were treated with uncommon surgical procedures after the hematologic condition was corrected. Results: No signs of relapse or maxillary bony overgrowth have occurred in these patients. No massive bleeding occurred during the procedures, and the patients tolerated the surgical approach very well. Complicated surgical procedures, such as bimaxillary segmental osteotomies with 2 or more pieces have been done in patients who had proper systemic conditions without any complications. Conclusions: Maintaining a hemoglobin level of approximately 10 g/dL decreases the risk of preoperative hemorrhage and complications of anesthesia. A complicated surgical approach and more instability during surgery is expected in patients with higher degree of systemic problems. We found that preoperative facial analysis was important in guiding our surgical planning and would benefit the cosmetic outcome as well. Attention to cardiac dysfunction, osteoporosis, vitamin D deficiency, and type of hemoglobin deficiency must be kept in mind, though more surgical cases must be treated before reaching a definitive conclusion.

Tapia syndrome is known as a rare complication of airway manipulation, which can occur after any type of surgery under endotracheal general anesthesia. This syndrome is characterized by neurologic deficits involving the hypoglossal (XII) and recurrent laryngeal branch of the vagal nerve (X) that result in the tongue muscle's unilateral paralysis associated with the vocal cord's unilateral palsy. This article describes the first case of Tapia syndrome, which occurred after repair of a fractured zygomatic complex. In this article, we discuss the diagnosis, possible causes, clinical manifestations, treatment methods, and preventive strategies as described in 10 case reports in the literature that have been attributed to manipulation of the airway.

Introduction:The purpose of our study was to evaluate patients and technique and complete a review of the literature related to Zigzag genioplasty.Materials and Methods:To address the research purpose, the investigators designed and implemented a prospective clinical trial study. Seven osteotomy types (I–VII) are proposed for genioplasty that will permit one to decrease the 3-dimensions of the chin. These osteotomy designs are based on the displacement of bone fragments on the slopes of an inclined plane with a superior-medial direction.Results:All of the patients were satisfied with the esthetic results of their osteotomy. Based on presurgical and post-surgical facial analysis and clinical evaluations, no patients who received a Zigzag osteotomy suffered from permanent neurosensory deficiency, infection, hardware failure, severe pain, asymmetry, necrosis, massive hematoma, relapse, or suprahyoid muscle dysfunction.Conclusions:As a result, on the basis of our experience with 23 patients and after at least 1 year of follow-up with each one, the authors concluded that this technique is simple and easy to implement.

Dimples are small visible indentations on the surfaceof the skin; they may appear on various parts of thebody, such as the abdomen, back, shoulder, or limbs.When dimples occur on the face, they are highlyprized because the face is highly visible, and it is animportant outlet for expressing thoughts and emo-tions beyond words. Dimples tend to accentuate asmile, thus increasing the perception of attractive-ness, sociability, and facial beauty.

In the 1st phase of this study, thirty patients were investigated. Five milliliter stimulated saliva was collected just before and after MRI. The magnetic flux density was 0.23 T and the duration of exposure of patients to magnetic field was 30 minutes. In the 2nd phase, fourteen female healthy University students who had not used mobile phones before the study and did not have any previous amalgam restorations were investigated. Dental amalgam restoration was performed for all 14 students. Their urine samples were collected before amalgam restoration and at days 1, 2, 3 and 4 after restoration. The mean +/- SD saliva Hg concentrations of the patients before and after MRI were 8.6 +/- 3.0 and 11.3 +/- 5.3 microg L(-1), respectively (p < 0.01). A statistical significant (p < 0.05) higher concentration was observed in the students used mobile phone. The mean +/- SE urinary Hg concentrations of the students who used mobile phones were 2.43 +/- 0.25, 2.71 +/- 0.27, 3.79 +/- 0.25, 4.8 +/- 0.27 and 4.5 +/- 0.32 microg L(-1) before the amalgam restoration and at days 1, 2, 3 and 4, respectively. Whereas the respective Hg concentrations in the controls, were 2.07 +/- 0.22, 2.34 +/- 0.30, 2.51 +/- 0.25, 2.66 +/- 0.24 and 2.76 +/- 0.32 microg L(-1). It appears that MRI and microwave radiation emitted from mobile phones significantly release mercury from dental amalgam restoration. Further research is needed to clarify whether other common sources of electromagnetic field exposure may cause alterations in dental amalgam and accelerate the release of mercury.

Introduction Pathologic changes may occur in dental follicle of impacted teeth, which makes the microscopic evaluation of enlarged follicle an important issue. One of the exceedingly rare conditions seen in dental follicles is multiple calcifying hyperplastic dental follicles, which has microscopical appearance similar to central odontogenic fibroma (WHO type). Case Presentation A 13-year-old boy, in the case presented in this article, had 15 unerupted teeth, each associated with hyperplastic pericoronal tissue. Conclusions The purpose of this article is to report an example of this entity and describe the histopathologic characteristics that helps diagnose and treat such condition in the most appropriate manner.

Objective The aim of this study was to compare normal and hyperplastic mandibular condyles using two different histopathologic staining techniques. Study design Nine cases of condylar hyperplasia and 13 normal cases were studied after hematoxylin and eosin and silver staining. Results There was a significant difference between the two groups in the thickness of the hyperplastic cartilage layer of condylar soft tissue (P = 0.017). Also, the number of argyrophilic nucleolar organizer regions was significantly higher in the condylar hyperplasia case group (P = 0.0001). No significant differences could be demonstrated in cartilage island frequency, penetration depth, and distribution in the cancellous bone of condyles. Conclusion The thickness of the hyperplastic cartilage layer appears significantly increased in condylar hyperplasia. In addition, argyrophilic nucleolar organizer region count may be useful in histopathological identification of condylar hyperplasia.

Introduction: Unilateral mydriasis is a seriously significant finding in neurologic examinations indicating life-threatening conditions such as cerebral vascular injuries. Case Presentation: A 24 year old woman with mandibular trauma was referred to our center after five days for a reduction of the right mandibular angle fracture. The patient had no history of any loss of consciousness after the accident. Her physical examination showed no abnormalities, except those related to her mandibular fracture. The laboratory results were normal as well. At 8:30 am a general anesthesia was induced. The patient’s eyes were kept shut throughout the surgical procedure. The operation included an intraoral open reduction and fixation using two miniplates without any complications. After the operation, it was noticed that the left eye was completely dilated with no reaction to light, while the right eye was normal. The management and outcomes in this patient were described in the present case report. Conclusions: Evaluating the size of the patient’s pupils before, during and after the operation, careful history, consult, CT scan and MRI would help to diagnosis. Although no probable cause was found to explain the transient mydriasis in our patient.

Background and Objectives The ideal line of osteosynthesis in mandibular angle fractures indicates that a plate might be placed either along or just below the external oblique ridge. Some authors believe that using one miniplate at this line at the mandibular angle region provides sufficient strength to stabilize the fracture but others imply a second plate is required. Such controversies exist in the use of maxillomandibular fixation (MMF). The intention of the present study was to compare efficiency and complications of using one miniplate with and without MMF in mandibular angle fractures. Methods and Materials Forty patients with facial trauma with mandibular angle fractures including displaced and unfavorable fractures were categorized into two groups of 20 persons. In all patients, one miniplate was placed on the external oblique ridge. In the first group, patients had light maxillomandibular elastic bands just after surgery but no rigid MMF. In the second group, patients had rigid MMF for 2 weeks after surgery. Patients were followed to evaluate complications and treatment efficiency. Conclusions Our study showed that use of a single miniplate in the external oblique ridge is a functionally stable treatment for all types of angle fractures (including displaced and unfavorable fractures) except comminuted and long oblique fractures, which were not included in our study. Use of postoperative MMF did not improve the results.

Purpose Fat grafts have always represented a challenge in inducing the necessary neoangiogenesis, which results in significant resorption. This study was designed to compare the efficiency of first- and second-generation platelet-rich plasmas (PRPs) combined with a fat graft during facial lipostructure surgery. Methods and Materials To address the research purpose, the investigators designed and implemented a double-blinded prospective clinical trial. The patients underwent bilateral facial lipostructure, a natural long-lasting method of filling and supporting the face using intricate layers of infiltrated autologous fat. The method involved the use of PRP on 1 side and platelet-rich fibrin (PRF) on the other side. The study population was composed of all patients presenting to the authors' department for the evaluation and management of facial contouring in the cheek and cheekbone areas from June 2008 through December 2010. The primary predictor variable was the type of combination (PRP/fat or PRF/fat). The outcome variables were the amount of resorption, which was estimated by comparing pre- and postsurgical photographic views, pain, edema, and bruising. The statistical evaluation of the findings was performed using SPSS software. Parametric tests (t test and Levene test) were used to compare the treatment efficacy and complications between the groups. Results Twenty-five patients (8 men and 17 women) underwent bilateral facial lipostructure surgery in the cheek and cheekbone areas using PRP and PRF. One year after the operation, a slight esthetic asymmetry was noticeable, with greater average resorption on the PRP/fat side. Conclusions This first comparative clinical study highlights the value of using concentrated platelets for adipocyte grafts. The results suggest that the combination of fat and PRF is more effective than the combination of fat and PRP in the context of facial lipostructure surgery.

Purpose The purpose of the study was to introduce a novel technique for malar augmentation using buccal fat pad pedicle flaps and to evaluate the long-term results and complications of the technique. Materials and Methods The investigators designed and conducted a prospective clinical trial. Patients underwent unilateral malar augmentation surgery using buccal fat pad pedicle flaps from June 2011 through June 2012. Patients underwent surgery for esthetic reasons or for trauma with severely comminuted or old zygomaticomaxillary complex fractures that could not be reduced precisely. The primary predictor variable was the buccal fat pad pedicle flap technique. The primary outcome variables included the amount of augmentation and resorption (which was estimated by comparing pre- with postsurgical photographic views), pain, edema, bruising, and nerve and parotid duct injuries. Results Thirteen patients (8 men and 5 women) underwent malar augmentation in the cheekbone area using the buccal fat pad pedicle flap technique. One year after surgery, the average amount of resorption was 0.376 mm. Other major complications, such as prolonged bruising, massive hematoma, intense pain, asymmetry, and parotid duct injury, were not observed. Conclusion These results indicate that this new open-access technique should be considered an alternative method for the management of mild to moderate malar depression in patients undergoing esthetic and post-trauma surgery.