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Purpose This study compared piezoelectric (PE) and conventional drills (CD) for maxillary aesthetic zone implant insertion. Material and methods This was a prospective split-mouth study. Implants were divided into two groups. Beds were prepared with CDs in group I and PE in group II. The implant stability quotient (ISQ) of the mechanical implant stability (MIS) was measured intraoperatively. The ISQ of the biological implant stability (BIS) was recorded at postoperative second and fourth months. Marginal bone loss (MBL) and bone density (BMD) were measured in the first and second years after prosthetic loading. The osteotomy time was also documented for both techniques. P values Results Sixty implants in 30 patients were included. PE provided a significantly higher ISQ. All values were above 70 throughout the follow-up period. The mean of the ISQ for MIS was 63.78 ± 1.03 and 73.89 ± 1.05 in group I and group II, respectively (p = 0.003). PE needed significantly longer osteotomy time with a mean of 11.99 ± 0.839 min. The BIS quality had high stability in group II and medium stability in group I throughout the study period. Its values decreased in both groups. Group II had a lesser percentage of decrease. However, it was significant only at time intervals between intraoperative and two months' postoperative (p = 0.004). MBL and BMD demonstrated insignificant results. Conclusion The implant site preparation with PE devices should be preferred to CDs whenever possible, because they seem to enhance implant stability and osseointegration, especially at the initial stages of healing.

The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is activated. Material and methods: A retrospective study included patients who developed TVR during the surgical management of mandibular, midface, and orbital fractures. The reflex was divided into type I, II, III, and IV-TVR according to the following nerves: ophthalmic, maxillary, mandibular, and non-trigeminal nerves, respectively. The magnitude of hemodynamic drops was identified at the intraoperative baseline, during reflex, and postoperatively. The needed time to elicit the reflex, frequency and duration, need for medical intervention, and sequence of the drop were also recorded. P - values0.05 was considered significant. Out of 260 patients' files were reviewed, the TVR was observed in only 30 (11.55 %) patients. The ophthalmic nerve activation significantly caused the greatest intensity and magnitude of hemodynamic drop, followed by maxillary nerve, then mandibular division, and the lowest one was non-trigeminal nerves. The highest mean of drops in the mean arterial blood pressure (MABP) was 62.92 ± 2.39 with the type ITVR, whereas those of the type II, III, and IV were 75.5 ±3.98, 81.02±1.31, and 82.22±1.85, respectively. Also, the type I-TVR led to the greatest decrease in the heart rate (HR) with the mean equaled to 52.31± 3.91. The drop percentage in the MABP was -30.5, -17.5, -12, -10.08 for type I, II, III, and IV, whereas those of the HR were - 33.9, -27.13, -26.6, and -25 with type I, II, III, and IV, respectively. All results showed highly significant differences with p-values less than 0.001 when comparing between the baseline and intraoperative values of each TVR type. There is a positive correlation between the activated pathway of the TVR and the intensity of its efferent arc response due to the neural pathway of each division in the brainstem circuitry. Understanding of the pathophysiology and mechanism of the TVR, together with the rapid recognition and treatment could prevent serious negative outcomes, especially when the ophthalmic nerve is stimulated. 1Introduction.

Purpose The aim of this prospective study was to address the anthropometric changes in the morphology of the lower eyelid and esthetic outcomes after performing subciliary, subtarsal, and transconjunctival approaches in patients with orbital and periorbital fractures. Patients and methods A prospective randomized controlled clinical study was undertaken on patients with orbital floor and infraorbital rim fractures. These were equally divided into three groups: in group 1, the fractures were approached via a stepped subciliary approach; in group 2, they were approached via a subtarsal approach; in group 3, a retroseptal transconjunctival approach was performed. The patients were assessed for anthropometric changes in the morphology of the lower eyelid, esthetic outcomes, and postoperative lower eyelid complications (LLCs). A one-way ANOVA test was used to analyze differences between the operated and non-operated sides and the effect of the surgical approach on anthropometric measurements. Results A total of 45 patients were included in the study. All the surgical approaches provided adequate surgical exposure of the infraorbital rim and orbital floor. The subtarsal approach allowed rapid access to the field (10.5 ± 1.9 min). All incisions resulted in adequate postoperative esthetic outcomes. Anthropometric analysis revealed that there were no significant differences between the three approaches, except for measurements of the eye fissure index (EFI) and lower iris coverage (LIC). Mean EFI measurements increased on all operated sides. The subciliary approach showed the highest percentage of increased measurements of this variable (34.5 ± 4.6), followed by the subtarsal approach (32 ± 2.1), and then the transconjunctival approach (31.1 ± 3.7), with p = 0.046. Furthermore, the subciliary approach significantly decreased the measurements of LIC. This change was also bigger with the subciliary approach (1.09 ± 2.3) than with the subtarsal approach (2.1 ± 2.4) or transconjunctival approach (3.4 ± 2.6), with p = 0.048. Conclusion Based on the results of this study, the subtarsal approach is a minimally invasive incision that provides an adequate and direct approach to orbital floor and infraorbital rim fractures, with a favorable periorbital architecture and the lowest incidence of LLCs. Therefore, the subtarsal technique should be preferred over subciliary and transconjunctival approaches.

Despite the wide uses of mandibular distraction osteogenesis (MDO), no study appears to have evaluated the use of MDO and subsequent advancement genioplasty. This study addressed lower facial third aesthetics in a consecutive series of subjects with micrognathia who underwent MDO and subsequent advancement genioplasty. Standard cephalometric measurements were performed pre-MDO, at the end of consolidation, and at 1 week, 6 months, and 12 months after genioplasty. At the end of follow-up, questionnaires were given to measure patient satisfaction. Forty patients were included, 33 of whom underwent genioplasty. The mean patient age was 22.35 ± 1.12 years. Pre-genioplasty cephalometric measurements showed that all patients had a deficient chin position and projection; they were dissatisfied with their facial aesthetics. Post-genioplasty cephalometric measurements showed that the hard and soft tissue pogonion had moved significantly: 8.4 ± 2.3 mm and 11.0 ± 2.11 mm, respectively. According to the questionnaire, the patients were satisfied with the final results. The MDO reduced the amount of chin advancement and minimized relapses; the soft tissue response of the lower facial third was more sensitive to genioplasty than isolated MDO. MDO and genioplasty lead to a modest horizontal chin movement that achieves the preferred pogonion position and projection.

Purpose The aim of this clinical study was to prospectively measure the incremental changes in the maximum interincisal opening (MIO) after 1 cm gap arthroplasty, compare these changes between unilateral and bilateral cases, and emphasize the importance of the monitoring of the MIO for at least 24 months. Materials and methods This prospective study enrolled 26 patients with TMJ ankylosis either unilateral or bilateral. The fingers assessment method was used to measure the MIO preoperatively, intraoperatively, and monthly postoperatively up to 24 months. All the patients had undergone 1 cm gap arthroplasty to release the ankylosis. The changes in MIO measurements of unilateral and bilateral cases were statistically compared. The physiotherapy was performed until the measurements had normal stable values. Results All the cases showed a significant decrease in MIO at the first three months. At 6 months, the MIO continuously increased up to 1 year. There was no difference between the unilateral and bilateral cases. At the end of the follow-up, all measurements showed normal stable values. Conclusion The monitoring of MIO is important to detect the early signs of re-ankylosis. It is the only way that can be used in which the early signs cannot be detected in radiographs.

Objectives Pediatric maxillofacial fractures are less common as compared to adults, however, they may lead to serious complications. Methods The study aimed to retrospectively correlate demographic data, facial fractures characteristics, and patterns among pediatric patients who were managed at 3 of the governmental Egyptian Hospitals from 2008 to 2016, and discussing the treatment protocols. The study included 104 patients presented with maxillofacial traumas. Those with dentoalveolar and/or dental injuries were excluded. All the patients were treated by conservative approaches, except those in whom surgical interventions were mandatory. Results The mean age of 104 patients was 10.94 ± 3.92 years. The female/male ratio was 1:1.4. Females’ fractures were mainly due to falls (17.31%). Road traffic accidents (RTAs) were the most common cause in males, followed by sports injuries (17.31.8%), then assault (10.58%). The most prevalent site of fractures was the mandible (67.31%) in particular condylar fractures. All the fractures were healed successfully, but restricted mouth openings were the most common sequela. Conclusion The RTAs were the main cause. Males and condylar fractures have the highest predominance. The conservative treatment is still the treatment of choice in pediatric fractures. Pediatric fractures must be followed longitudinally to avoid post-traumatic sequelae.

Purpose Chronic oroantral fistulas (OAFs) are a challenging problem in oral and maxillofacial surgery, and the treatment success rate of OAFs is as low as 67%. Thus, the double-layered closure has been described. The purpose of this study was to evaluate the simplicity and effectiveness of using a palatal rotational flap and suturing of the sinus membrane perforation as a new technique for double-layered closure. Materials and Methods A prospective case series study was performed in patients who had chronic OAFs and were treated at Al-Zahraa Hospital from 2010 to 2013. The following demographic and clinical data were collected: age, gender, location of defect, size, etiology, signs and symptoms, postoperative healing, and complications. Under local anesthesia, fistulectomy and sinus irrigation were performed to control sinusitis. Under general anesthesia, the oral side of the fistulous tract was sutured with a purse suture. A palatal flap was reflected and sutured to the buccal tissue. Results Twelve patients 19 to 51 years old were enrolled in this study. All patients tolerated the surgical procedures; all surgical wounds healed uneventfully without recurrence. Conclusion Double-layered closure of OAFs is a straightforward, convenient, and successful technique that provides stable, strong, and double-sealed closure of chronic OAFs.

Purpose A restricted mouth opening (MO) is predominantly a complication of maxillofacial trauma in pediatric patients and develops in 4 to 26.2% of cases. The purpose of the present study was to quantitatively investigate the influence of patient demographic data, fracture characteristics, and regular vigorous physiotherapy, with either voluntary or forcible MO exercises, on the recovery of a post-traumatic restricted MO in pediatric patients. Patients and Methods A prospective cohort study was performed of pediatric patients with maxillofacial injuries who had been referred to Al-Zahraa and El-Fayoum Hospitals from 2013 to 2015. The predictive variables were patient demographic data, fracture characteristics, and regular vigorous physiotherapy. The patients were treated with a closed technique. The MO measurements were the clinical outcome variables and were recorded at the first week and then monthly for 12 months. Regular vigorous physiotherapy was performed until the patients had returned to their preoperative MO. The data were tabulated and statistically analyzed. Results Eighty-six patients were enrolled in the present study. Males predominated. Falls were the most common cause of fracture. Condylar fractures had the greatest incidence. A restricted MO occurred in 81 patients. The results showed no interaction between MO recovery and age, gender, etiology, or fracture site. After physiotherapy, the patients had returned to their preoperative MO at the fourth month, with the measurements fixed at normal values at the sixth month. The recovery rate was nonlinear, with faster improvement in the months closest to the injury. Conclusion Physiotherapy is more critical in the recovery of the MO and prevention of bony ankylosis than patient data or fracture characteristics in pediatric trauma. We highly advocate the performance of voluntary mouth exercises, even in the absence of fracture. Forcible MO exercises are mandatory to recover a restricted MO. These exercises should be performed under close supervision of the patient's surgeon with the parents motivated to cooperate for at least 6 months.

Purpose The aim of this study was to compare segmental mirroring with mirroring of the entire unaffected side to determine which method obviates intraoperative readjustment of virtually planned pre-bent plates and to evaluate the effect on costs. Materials and Methods Patients eligible for inclusion in this prospective study had unilateral mandibular discontinuity defects. Patients were randomly divided into 2 groups. In group I, models were constructed by mirroring the entire unaffected side of the mandible at the midsagittal plane. In group II, only the resected segments were cut and replaced by the corresponding mirrored healthy segments. The lesions were resected, and their sites were reconstructed using pre-bent reconstruction plates. The need for intraoperative plate readjustment, plate placement time, operation time, and operation costs were reviewed. Results Fifty patients were enrolled in this study. All but 5 plates in group I required readjustment. In group II, plates were placed without intraoperative handling. Average operating times were 4.20 ± 0.56 hours in group I and 3.186 ± 0.28 hours in group II (P = .00002). Mean times for plate placement were 33.36 ± 8.20 and 21.88 ± 5.73 minutes in groups I and II, respectively. The difference resulted in an average time gain of 11.48 minutes. Average personal costs per minute were US$740.77 for group I and US$560.87 for group II. The difference resulted in an average saving of approximately US$179.90. Conclusion Segmental mirroring is superior in reflecting the bone anatomy in 3-dimensional models, thus eliminating intraoperative plate readjustment and providing better plate adaptation with better contour. It decreases operating time and costs and thus can be recommended for lesions that do not cross the midline.