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Introduction The invasion of Ukraine by Russian troops on February 24, 2022, and the beginning of the full-scale war had huge humanitarian consequences. The major challenges facing the Ukrainian health care system included the disruption of medical infrastructure and logistics, the termination of the supply of expendable materials, significant migration, and a dramatic increase in high-velocity blast and gunshot injuries among combatants and civilians. The aim of the present study was to analyze the challenges and solutions in patient care faced by the Ukrainian system of maxillofacial surgery during the war in different regions of the country. Materials and Methods A cross-sectional study was designed and implemented as an online survey to collect national data concerning maxillofacial surgeons' experiences and professional activities. The study was initiated and supported by Bogomolets National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF (Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the University of Helsinki (Finland). The questionnaire was developed by specialists in maxillofacial surgery and sociologists and contained 65 close-ended questions. Surgeons who had not worked in this specialty in inpatient departments of hospitals since at least the beginning of the full-scale war were excluded from the study. We received and analyzed 97 responses that met the abovementioned criteria. The geography of respondents covered all the regions and the main cities of Ukraine, expect for the occupied territories. Results After a year of warfare, the percentage of surgeons who treated patients with blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher in military hospitals and in regions located in the vicinity of the front line. We found that, during the war, 78.6% of respondents performed osteosynthesis in cases of high-velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly followed AO CMF recommendations, while 41.7% performed the fixation based on available hardware, existing technical possibilities and their own preferences). We found that 70.2% of respondents had the opportunity to apply Computer-Aided Design/Computer-Aided Manufacture technology and patient-specific implants for the treatment of gunshot injuries, 38.1% reported that their hospitals were able to perform microsurgical reconstructions for facial defects, 79.4% of respondents reported that their departments received humanitarian aid and support from volunteer organizations (either Ukrainian or international), which significantly facilitated the treatment process. Conclusions According to this nationwide survey of Ukrainian maxillofacial surgeons during a year of the full-scale war, 86.6% of respondents were involved in the treatment of gunshot and ballistic injuries in civilians and combatants. The main problems reported by the respondents were (1) a lack of experience and knowledge related to the treatment of severe wounds, especially by secondary reconstruction, and (2) a deficit of resources (equipment, materials, and medications) under conditions of disrupted logistics and changes in the numbers and nosological distribution of patients. There were the opportunity to transfer the patients to European clinics (29.9%), online consultations (45.4%), collaboration with foreign surgeons who come to Ukraine asvolunteers (32%). [ABSTRACT FROM AUTHOR]

Background: Odontogenic maxillary sinusitis (OMS) is widely acknowledged in both the dentistry and otolaryngology fields. Recently, iatrogenic odontogenic maxillary sinusitis cases can be encountered frequently. The purpose of this study was to evaluate the effect of intraoral sinus irrigation using the small lateral window approach in patients with odontogenic maxillary sinusitis by comparing pre- and postoperative volumetric measurement of CBCT and symptoms. We surveyed 21 patients who visited the Oral and Maxillofacial Surgery Department at PNUDH from 2016 to 2022. All the patients' information was extracted from an electronic database. The patients with a follow-up period of 2 months or more were included. The three-dimensional volumetric measurement was performed using the ImageJ program (National Institute of Health, University of Wisconsin). Results: Among 21 patients, 16 (76.1%) were male, and 5 (23%) were female. The most common type of surgery was general anesthesia (16 cases) in which oroantral fistula was present in 7 cases. In the causes of maxillary sinusitis, there were seven implant-related patients, five patients of tooth extraction, seven patients of bone grafting, and two patients in other groups. Radiographic opacity decreased by 40.15% after sinus irrigation especially in bone graft and tooth extraction cases. Clinically, symptoms improved in 17 patients (80.9%). Conclusion: By this study, it can be concluded that maxillary sinus irrigation using the small lateral window approach is a clinically and radiologically effective treatment method for odontogenic maxillary sinusitis. [ABSTRACT FROM AUTHOR]

Background: This study aims to conduct a bibliometric analysis of the current literature related to facial feminization surgery (FFS) and facial masculinization surgery (FMS) to understand the patterns, trends, and evolution of research topics. In addition, it aims to objectively identify the important articles that constitute the primary backbone of the FFS/FMS literature and provide a resource for education and new studies in this emerging field. Results: Using the principles of the Leiden Manifesto, 384 publications from the Web of Science from 1987 to 2023 were analyzed. The analysis included cross-country collaboration, keyword trends, affiliations, co-citation networks, and clustering. The results showed an increasing trend in FFS/FMS publications, with the USA leading in both publications (n = 238) and citations (n = 2420). The most cited journal was the Journal of Plastic and Reconstructive Surgery. The results indicate a high growth rate, with an H-index of 34 and an average citation of 11.41 per article. Co-occurrence analysis revealed evolving keywords such as "forehead" (n = 52) and "quality of life" (n = 44). The timeline view illustrated the terms reflecting current areas of interest such as #patient satisfaction and #gender-affirming care. Conclusion: The study reveals the influence of countries, institutions, authors, and emerging trends, supporting the anticipation that FFS/FMS will be a critical field of study in the future. The findings contribute to understanding the global landscape of FFS/FMS research, facilitating informed decision-making for researchers, and clinicians in the field of maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Selective outcome reporting (SOR) can threaten the validity of results found in clinical trials. Some studies in the literature have analyzed SOR in dentistry, but there is no study that has observed SOR in clinical trials in oral and maxillofacial surgery. Impacted third molar surgery is one of the most used models in clinical trials to study mainly analgesic and anti-inflammatory drug interventions. Our study aimed to evaluate the prevalence of SOR in publications employing the third molar extraction clinical trial model, and to verify whether there was an association between the statistical significance of outcomes and other characteristics that could lead to SOR. A systematic search was performed on the ClinicialTrials.gov platform for randomized clinical trial protocols, using the condition of third molar extraction. The corresponding published articles were sourced in PubMed, Scopus, and Embase databases, and compared with the registered protocols regarding the methodological data, in terms of: sample calculation, primary outcome identification, end-point periods, insertion of new outcomes in the publication, and results of outcomes. 358 protocol records were retrieved; 87 presented their corresponding articles. SOR was identified in 28.74% of the publications, and had a significant relationship with changes in the protocol, insertions of new outcomes, and discrepancies in the types of study. General risk of bias was found to be low. There were associations between SOR and the discrepancies in terms of the type of study, the choice of new outcome, and changes in the history of protocol records. The prevalence of SOR in clinical research using the third molar extraction surgery model is moderate. The quality of the scientific reporting of the results and, consequently, the certainty of evidence relating to the intervention tested can be overstated, increasing the chances of misinterpretation by health professionals. [Display omitted] • Selective outcome reporting (SOR) can threaten the validity of results found in clinical trials. • The prevalence of SOR in clinical research using the third molar extraction surgery model is moderate. • Certainty of evidence of an intervention with SOR can be overstated increasing misinterpretation by health professionals. [ABSTRACT FROM AUTHOR]

(1) Introduction and Aim: Surgical navigation has evolved as a vital tool in maxillofacial surgery, offering precise and patient-specific data. This study explores the clinical applications and accuracy of intraoperative tool tracking in maxillofacial surgery. (2) Materials and Methods: The research includes 42 patients with various pathologies who underwent surgeries assisted by a surgical navigation system using tracked instruments. Four representative cases are exhibited in the study: the first case involving coronoid hyperplasia with mouth opening deficit, the second case addressing naso-orbital-ethmoidal-frontal ossifying fibroma resection, the third case showcasing a subapical osteotomy (Köle) for a class III dentoskeletal malocclusion, and the fourth one exposing the treatment of a recurrent ameloblastoma. (3) Results: The results indicate that surgical navigation with tracked instruments provides high precision (

Background: The utilization of three-dimensional (3D) surface imaging for facial anthropometry is a significant asset for patients undergoing maxillofacial surgery. Notably, there have been recent advancements in smartphone technology that enable 3D surface imaging.In this study, anthropometric assessments of the face were performed using a smartphone and a sophisticated 3D surface imaging system. Methods: 30 healthy volunteers (15 females and 15 males) were included in the study. An iPhone 14 Pro (Apple Inc., USA) using the application 3D Scanner App (Laan Consulting Corp., USA) and the Vectra M5 (Canfield Scientific, USA) were employed to create 3D surface models. For each participant, 19 anthropometric measurements were conducted on the 3D surface models. Subsequently, the anthropometric measurements generated by the two approaches were compared. The statistical techniques employed included the paired t-test, paired Wilcoxon signed-rank test, Bland–Altman analysis, and calculation of the intraclass correlation coefficient (ICC). Results: All measurements showed excellent agreement between smartphone-based and Vectra M5-based measurements (ICC between 0.85 and 0.97). Statistical analysis revealed no statistically significant differences in the central tendencies for 17 of the 19 linear measurements. Despite the excellent agreement found, Bland–Altman analysis revealed that the 95% limits of agreement between the two methods exceeded ±3 mm for the majority of measurements. Conclusion: Digital facial anthropometry using smartphones can serve as a valuable supplementary tool for surgeons, enhancing their communication with patients. However, the proposed data suggest that digital facial anthropometry using smartphones may not yet be suitable for certain diagnostic purposes that require high accuracy.

Background Plastic surgery has developed to benefit in a variety of challenging areas formerly handled by other disciplines. Medical students do not have a clear picture of plastic surgery as a career due to lacking scope, clinical practice, and understanding of plastic surgery as a clinical area of expertise, including general practitioners, nursing staff, medical trainees, and the general public, and misconceptions about the extent of reconstructive and plastic surgery.

Restrictions to traditional face-to-face meetings were mandated by many government authorities during the COVID-19 pandemic, impacting the delivery of educational training sessions for maxillofacial surgery trainees in the traditional group manner. An online survey was designed to review what effect the pandemic had on the use and uptake of online educational sources amongst a representative cohort of maxillofacial surgery trainees in higher specialist training. Their attitudes and satisfaction with online resources were considered. The use of live sources such as webinars and pre-recorded materials (e.g. YouTube videos) was investigated. Engagement with online sources was considered prior to, and then during the pandemic. Alterations in the behaviour of trainees were demonstrated, with increasing online resource use seen once the COVID-19 pandemic took hold. Online pre-recorded resource use increased by 26% during the pandemic, with the median number of hours watched per month increasing from 1-5 h to 5–10 h (p < 0.001). Engagement with live online sources (webinars) increased by 52% and median time watched increased from 15 h per month to 10–20 h per month (p < 0.001). Trainees expressed satisfaction with the quality and flexibility of the resources. There was a firmly positive response to live webinars with regard to teaching quality, audio and video quality, ease of access and relevance to training needs. Pre-recorded and live online resources may prove a useful alternative or adjunct to face-to-face teaching when regulations limit or restrict social interactions. [ABSTRACT FROM AUTHOR]

Purpose Bar charts of numerical data, often known as dynamite plots, are unnecessary and misleading. Their tendency to alter the perception of mean's position through the within-the-bar bias and their lack of information on the distribution of the data are two of numerous reasons. The machine learning tool, Barzooka, can be used to rapidly screen for different graph types in journal articles. We aim to determine the proportion of original research articles using dynamite plots to visualize data, and whether there has been a change in their use over time. Methods Original research articles in nine surgical fields of research were sampled based on MeSH terms and then harvested using the Python-based biblio-glutton-harvester tool. After harvesting, they were analysed using Barzooka. Over 40 000 original research articles were included in the final analysis. The results were adjusted based on previous validation data with 95% confidence bounds. Kendall τ coefficient with the Mann–Kendall test for significance was used to determine the trend of dynamite plot use over time. Results Eight surgical fields of research showed a statistically significant decrease in use of dynamite plots over 10 years. Oral and maxillofacial surgery showed no significant trend in either direction. In 2022, use of dynamite plots, dependent on field and 95% confidence bounds, ranges from ~30% to 70%. Conclusion Our results show that the use of dynamite plots in surgical research has decreased over time; however, use remains high. More must be done to understand this phenomenon and educate surgical researchers on data visualization practices.   What is already known on this topic   Although it is well established that dynamite plots are misleading data visualizations for numerical data, the frequency of their use in surgical research is yet to be investigated. What this study adds   Following this study, we now know that dynamite plots are frequently used in most fields of surgical research. Use over time is decreasing; however, more must be done. How this study might affect research, practice or policy   This study further reiterates the importance of good data visualizations in research. It also emphasizes the need for educational initiatives for surgeons involved in research, as well as the need for journal policies that encourage better data visualization practices. [ABSTRACT FROM AUTHOR]

BACKGROUND: Oral and Maxillofacial region is an area that is prone to multitude of disease conditions of developmental nature or acquired which require surgical intervention on many occasions. The aim of this study was to assess the pattern, indications, and types of major oral and maxillofacial surgical procedures carried out at Addis Ababa university Maxillofacial Surgery affiliate hospitals. METHODS: A retrospective study was conducted on all patients who had undergone oral and maxillofacial surgeries under general anesthesia at Yekatit 12 Hospital Medical College and Saint Peter Specialized Hospital in a period of 3 years from January 2017 to December 2019. Descriptive statistics such as biodata, indication and type of surgery were recorded and analyzed using the Epi info version 7 software. RESULTS: A total of 689 patients with oral and maxillofacial conditions were managed during the study period. The male to female ratio was 2.48:1, and the mean age of patients was 29.05 years with standard deviation of ±15.5. The predominant indications for surgery were traumatic conditions (50.71%, n=354), followed by neoplastic conditions (18.7%, n=129)). Open reduction and internal fixation were the most common (43.7%, n=313) surgical procedure performed. CONCLUSIONS: The field of oral and maxillofacial surgery in our climes is a relatively new one. However, it is evolving, and its relevance is growing. With the observed relatively high frequency of traumatic conditions, especially among younger populations, efforts geared at prevention and adequate preparedness for proper surgical management of such patients should be commenced. [ABSTRACT FROM AUTHOR]

The epithelial-myoepithelial carcinoma (EMC) is a rare neoplasm of the salivary glands with an incidence

Global oral and maxillofacial surgery, as a component of global surgery, strives to provide worldwide access to safe, timely and economical oral surgical care. [ABSTRACT FROM AUTHOR]

Introduction & objective: Oral and maxillofacial surgeries commonly require nasotracheal intubation (NTI) to overcome difficulty of work in the oropharyngeal space. Several variables affect intubation difficulty and complications and include tube type or design, topical vasoconstrictors, lubricating the endotracheal tube (ETT), selecting smaller diameter ETT, using urethral catheter to assist NTI, using some catheters etc. We aimed to explore the effectiveness of nasopharyngeal airway (NPA) as a factor facilitating the passage of ETT in the nasopharynx and diminishing trauma and bleeding during NTI. Methodology: One hundred-forty patients undergoing surgery in the oral and maxillofacial area were divided into groups of 70 each; NPA group, in which an NPA was used as an assist device, and non-NPA group with non-NPA use. Before intubation, the more patent nostril was identified, topical nasal vasoconstrictor was used, lubricant jelly applied and thermo softening of the ETT achieved. In NPA group, nasal cavity dilatation was done with an NPA before NTI. The ease of ETT passage and any nasopharyngeal bleeding were assessed by a scale of four grades. Results: About 95.71% patients had easy (grade 0 or 1) passage of ETT in the NPA group compared to 81.43% in the non-NPA group (P < 0.0001, P = 0.006), and the remaining grades also showing significant differences between groups. About 98.57% patients had grade 0 to 1 bleeding (no or traces of blood) in the NPA group, compared to 97.14% in the non-NPA group (P = 0.001) and the remaining grades also showed significant differences between the groups. NPA minimized difficulties in passage of the ETT and complications. Conclusion: Application of nasopharyngeal airway in patients undergoing nasotracheal intubation for general anesthesia proved to be effective in increasing nasal cavity space and minimizing difficulties faced in the passage of the endotracheal tube through the nasal passages and diminishing the resulting complications. [ABSTRACT FROM AUTHOR]

Purpose: Chronic flaccid paralysis of the facial nerve leads to permanent dysfunction of eye closure, problems with drinking and eating, and lack of emotional expression. Modern facial surgery can help those affected. An analysis of the development of facial surgery in Germany over time is presented. Methods: Nation-wide population-baes diagnosis-related case group (DRG) data of virtually all inpatients who underwent facial surgery for facial palsy between 2005 and 2019 were included. Binomial regression models for changes in surgery rates over time were calculated in relation to gender and treating specialty. Results: Between 2005 and 2019, there were 28,622 inpatient stays for facial surgery. Most surgeries were provided by otolaryngology (39%) and ophthalmology or dentistry, oral and maxillofacial surgery (20% each). The mean treatment rate was 2.33 ± 0.53 surgeries per 100,000 person-years. The surgery rate was highest for nerve reconstruction surgery (0.46 ± 0.15) and static sling surgery (0.44 ± 0.0.16). The greatest increase was seen in men for nerve surgery (3.9-fold; relative risk [RR] = 3.68; confidence interval [CI] = 3.18–4.26) and sling surgery (5.0-fold; RR = 4.25; CI = 3.38–5.33). Conclusions: While nerve and sling surgery increased significantly over time, this was less true or not true at all for surgical techniques. Surgical rates and their change over time were greater in men, without explanation from the data. [ABSTRACT FROM AUTHOR]

Oral and Maxillofacial Surgery was among the Interests of many physicians and surgeons having practiced in Ancient Greece and the Ancient Greek world in general, from antiquity to the fall of Byzantium. The scope of their experience regarding Oral and Maxillofacial Surgery included dentoalveolar surgery, oral and cervicofacial Infections, cranio- maxillofacial injuries, head and neck oncologic and reconstructive surgery, surgical pathology of salivary glands, temporomandibular joint disorders, preprosthetic surgery, craniofacial surgery, but also more broadly oral and maxillofacial pathology. Their surgical work and writings exerted great impact on the development of Surgery in general and particularly of Oral and Maxillofacial Surgery, which is shown from their introduction as textbooks in the curriculum of many Medical Faculties in Europe, such as the Medical School of the University of Paris, even in the 17th century A.D.. Especially regarding Byzantium, Oral and Maxillofacial Surgery was practiced in the Surgical Departments of the Byzantine "Xenons" (Hospitals), at least from the 6th century A.D. and afterwards, whereas the role of the Orthodox Christian Church in taking care and treating patients suffering from diseases and traumatic injuries of the oral and maxillofacial region was decisive, since the famous "Xenons were attached mainly to Monasteries, where there was a possibility of providing systematic and organized medical care. [ABSTRACT FROM AUTHOR]

Background: The options of (neo-)adjuvant immunotherapy in addition to surgery in the treatment of oral squamous cell carcinoma (OSCC) are steadily increasing, but patients do not always respond to therapy as intended. The objectives of this study were to investigate the systemic perioperative course of the biomarkers CD45RO, TGF-β, and IL-8 in non-tumor-related minor and tumor-related major maxillofacial surgery and to perform association analyses with demographic and histomorphologic parameters. A deeper understanding of surgery-related changes in various of different immune biomarkers could help to better understand the immunologic consequences of surgery which could influence immunotherapeutic protocols. Methods: Peripheral whole blood from 38 patients was analyzed by real-time quantitative polymerase chain reaction (RT-qPCR) at five different timepoints before and after maxillofacial surgery to detect changes in mRNA expression of the biomarkers TGF-β, IL-8 and CD45RO. All patients underwent general anesthesia to undergo either resection and free flap reconstruction for OSCC or minor maxillofacial surgery (controls). Statistical analysis was done using Mann-Whitney-U test, Wilcoxon test, and Spearman’s correlation. Results: Compared to the preoperative expression, there was a significant postoperative downregulation of CD45RO, TGF-β and IL-8 until the 4th postoperative day (p ≤ 0.003) in OSCC patients. For TGF-β and IL-8, the reduction in expression was significant (p ≤ 0.004) compared to controls. By postoperative day 10, all analyzed parameters converged to baseline levels. Only CD45RO still showed a significant downregulation (p=0.024). Spearman analysis revealed a significant correlation between increased duration of surgery and perioperative reduction in peripheral blood expression of CD45RO, TGF-β and IL-8 (p ≤ 0.004). Perioperative changes in TGF-β and PD-L1 expression were shown to be not correlated. Preoperative TGF-β expression was significantly lower in patients with lymph node metastases (p=0.014). Conclusion: With regard to the analyzed parameters, major oncologic head-and-neck surgery does not seem to have long-lasting systemic immunologic effects. Reduced CD45RO might be an expression of transient systemic immunosuppression in response to major surgery. The association of duration of surgery with expression changes of immunologic markers supports efforts to keep the duration of surgery as short as possible. As perioperative TGF-β and PD-L1 expression changes are not associated, these results support further investigation of a combined perioperative anti-PD-1 and anti-TGF-β immunotherapy. [ABSTRACT FROM AUTHOR]

Background: Genioplasty as an isolated surgical technique is a highly demanded procedure in the maxillofacial surgery area. Advances in facial reconstructive surgery have been associated with less morbidity and more predictable results. In this paper, "conventional" genioplasty and genioplasty by means of virtual surgical planning (VSP), CAD-CAM cutting guides, and patient custom-made plates are compared. Methods: A descriptive observational study was designed and implemented, and 43 patients were treated, differentiating two groups according to the technique: 18 patients were treated by conventional surgery, and 25 patients were treated through virtual surgical planning (VSP), CAD-CAM cutting guides, STL models, and titanium patient-specific plates. Results: The operation time ranged from 35 to 107 min. The mean operative time in the conventional group was 60.06 + 3.74 min.; in the custom treatment group it was 42.24 + 1.29 min (p < 0.001). The difference between planned and obtained chin changes in cases of advancement or retrusion was not statistically significant (p = 0.125; p = 0.216). In cases of chin rotation due to asymmetry, guided and personalized surgery was superior to conventional surgery (p < 0.01). The mean hospital stay was equal in both groups. A decrease in surgical complications was observed in the group undergoing VSP and customized treatment. Conclusions: Multi-stage implementation of VSP with CAD-CAM cutting guides, STL models, and patient-specific plates increased the accuracy of the genioplasty surgery, particularly in cases of chin asymmetry, reducing operation time and potential complications. [ABSTRACT FROM AUTHOR]

Background/Aim: Centrofacial fractures resulting from high-impact violence can be considered mild traumatic brain injuries. Given the complexities and associated risks, a comprehensive examination of these fractures is warranted. These fractures are increasingly prevalent among young adult patients and are commonly associated with road traffic accidents. In the literature, only a few studies have focused on this particular type of facial bone lesion. In Ivory Coast, no studies have been conducted on these fractures, which highlights the importance of our research aimed at describing the epidemiological and anatomicalclinical characteristics of centrofacial fractures in the stomatology and maxillofacial surgery department of the Cocody Teaching Hospital. Methods: This descriptive cross-sectional study was conducted in the Stomatology and Maxillofacial Surgery Department of the Cocody University Hospital Center from January 2016 to December 2020. Results: The prevalence of these fractures was 24.20%, with a predominance of male subjects. The age group most affected was 20 to 40 years old, accounting for 70.96% of cases, and most patients resided in Abidjan (59%). All socio-economic categories were represented, with a higher proportion of individuals in liberal professions (91.4%). Road traffic accidents involving two-wheeled vehicles were the primary cause of these fractures (76.8%), with the most common injury site being the naso-ethmoido-maxillo-frontoorbital complex (NEMFOC) (32.5%). Conclusion: The epidemiological characteristics of centrofacial fractures associated with two-wheeled vehicles in the Abidjan metropolis of Côte d'Ivoire suggest the need for increased accountability among motor vehicle drivers and stricter enforcement of traffic laws. [ABSTRACT FROM AUTHOR]

Professor Michael Höllwarth, a renowned pediatric surgeon, passed away on March 12, 2024. He was a dynamic and visionary leader who made significant contributions to the field of pediatric surgery. Professor Höllwarth played a major role in advancing pediatric surgery in Europe and internationally, particularly through his work in Graz, Austria. He was also instrumental in establishing the European Paediatric Surgeons' Association (EUPSA) and the journal "Paediatric Surgery International." Professor Höllwarth's leadership, passion, and dedication to providing quality surgical care to children will be remembered and appreciated by all who knew him. [Extracted from the article]

Constant advances in treatment methods in all medical specialties have led to the development and introduction of new drugs into therapy. Antithrombotic drugs are increasingly prescribed in the chronic treatment of numerous medical conditions. This is a large group of medications that act on components of the clotting process. We can categorize the vast majority of antithrombotic drugs used in chronic therapy into antiplatelet drugs - which are inhibiting platelet activity, or into anticoagulants - which are affecting various factors of the clotting cascade. In recent years, thanks to advances in the prevention and treatment of various cardiovascular diseases, in daily clinical practice we can see patients taking a combination therapy of two such drugs chronically. Even triple antithrombotic therapy is used in secondary prevention and in patients with high thromboembolic risk. The use of the above-mentioned medications prevents the formation of embolisms, but may pose a risk of an excessive bleeding that threatens the life or health of the patient. Hemorrhagic complications of chronically used anticoagulants are a problem of particular importance in patients preparing for maxillofacial surgery. Within this field, we can distinguish, according to the recommendations of the International Society of Thrombosis and Hemostasis, procedures with a low or moderate risk of bleeding and those with a high risk of bleeding. For operations with a high risk of bleeding, careful preparation of the patient is necessary. The authors discuss the drugs most commonly used in antithrombotic therapy. They describe their types and their mode of action and pharmacological properties. In the following review paper, based on the current literature, recommendations relating to each of the above-mentioned groups of treatments are presented. The guidelines discussed in the paper will help safely prepare patients who chronically take antithrombotic drugs for various types of maxillofacial surgical procedures.

During the last few years, the superior eyelid endoscopic transorbital approach has been proposed as a new minimally invasive pathway to access skull base lesions, mostly in ophthalmologic, otolaryngologic, and maxillofacial surgeries. However, most neurosurgeons performing minimally invasive endoscopic neurosurgery do not usually employ the orbit as a surgical corridor. The authors undertook this technical and anatomical study to contribute a neurosurgical perspective, exploring the different possibilities of this novel route. Ten dissections were performed on ten formalin-fixed specimens to further refine the transorbital technique. As part of the study, the authors also report an illustrative transorbital surgery case to further detail key surgical landmarks. Herein, we would like to discuss equipment, key anatomical landmarks, and surgical skills and stress the steps and details to ensure a safe and successful procedure. We believe it could be critical to promote and encourage the neurosurgical community to overcome difficulties and ensure a successful surgery by following these key recommendations. [ABSTRACT FROM AUTHOR]

Background and Aims: Mandibular resection during maxillofacial cancer surgery evokes a strong sympathetic response requiring high doses of opioids. We studied the effect of the inferior alveolar nerve block (IANB) for analgesia in maxillofacial cancer surgeries. Methods: This randomised controlled study was conducted over five months in a tertiary care cancer hospital following Institutional Ethics approval and trial registration. Fifty consenting adult patients belonging to the American Society of Anesthesiologists (ASA) physical status I and II requiring maxillofacial cancer surgery with unilateral mandibular resection were recruited. Twenty-five patients in the study arm received ipsilateral IANB; a mock injection was given to the control group. Fentanyl requirement and haemodynamic parameters during primary tumour excision were the primary and secondary endpoints. Student's t-test was applied to compare primary and secondary endpoints. Results: Forty-nine patients completed the study. Both arms were comparable with respect to age, gender distribution, ASA physical status and baseline heart rate (HR) and blood pressure (BP). The mean (standard deviation) intravenous fentanyl requirement during primary tumour excision in the IANB arm was 70(32) μg, significantly lower than 183(48) μg in the control arm, P < 0.001. The mean maximum HR during primary tumour excision was 82 and 99 per minute in the IANB and control arms, respectively (P < 0.001) whereas the maximum mean BP was 88 and 101 mm Hg, respectively (P < 0.001). Conclusion: IANB significantly reduced intraoperative fentanyl requirement and caused fewer haemodynamic changes during maxillofacial cancer surgery requiring unilateral mandibular excision. [ABSTRACT FROM AUTHOR]

Background: Conventional analgesia using non-steroidal anti-inflammatory drugs not only provides inadequate pain relief but also can produce a multitude of systemic adverse effects. During oral and maxillofacial surgeries, inhibition of central sensitization by pre-incision nerve blocks with local anesthetic can reduce postoperative pain, may curtail analgesic requirement, and thereby can provide better patient comfort. Aims and Objectives: This study aimed to evaluate the effectiveness of pre-incisional peripheral nerve block using 0.25% bupivacaine over placebo for postoperative pain relief in patients undergoing oral and maxillofacial surgery under general anesthesia. Materials and Methods: One hundred and twenty patients of 18–35 years of either sex, American Society of Anesthesiologists physical status class I and II had undergone oral and maxillofacial surgeries were divided into two groups to receive bupivacaine 0.25% (Study group, n=60) normal saline (Control group, n=60) for nerve block before surgical incision. Postoperative pain was assessed by Visual Analog Scale (VAS) score and verbal response scale (VRS) score. The number of rescue analgesia was required in the first 24 h and the incidence of any complications associated with this agent was documented. Results: The VAS score was found considerably lower in the bupivacaine group compared with the control group in the first 24 h of postoperative period (P<0.05). A similar trend was observed with VRS score in the first 16 h of postoperative period (P<0.05). The number of rescue analgesia required in the control group was much higher in comparison with the study group. There was no serious adverse event in both the groups. Conclusion: Bupivacaine 0.25% as pre-emptive analgesia can be used to reduce postoperative pain and analgesic requirements in maxillofacial surgeries. [ABSTRACT FROM AUTHOR]

Introduction: Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.S. Naval Ship Mercy (T-AH 19). This study describes trends in overall and surgical specialty operative volumes to better understand the burden of surgical disease treated during these humanitarian and civic assistance (HCA) operations. This information can assist medical planners and surgical leaders involved in future humanitarian missions. Materials and Methods: Following approval from the Naval Medical Center San Diego Institutional Review Board, a retrospective review of surgical case data was performed for the six PP missions from 2006 to 2018. Data collected included patient demographics, Current Procedural Terminology codes, and surgical specialty. The primary outcome was surgical case volume per specialty. Secondary outcomes included surgical staffing per mission and overall trends in operative volume. Results: A total of 3,826 operative procedures were performed during the study period. Mission years in which case volume for both general surgery and ophthalmology were below their respective medians were associated with the least total surgical services to host nations (HNs). The number of active duty Navy surgeons varied with each mission; however, the staffing for a PP mission generally included at least two general surgeons, one ophthalmologist, one plastic surgeon, one pediatric surgeon, one orthopedic surgeon, one otolaryngologist, one oral surgeon, one urologist, and one obstetrician–gynecologist. Case volume per surgeon was highest in 2006 (50 cases per surgeon) and decreased after 2006, reaching an all-time low during the 2018 PP mission (10 cases per surgeon). Pediatric surgery and plastic surgery had the highest average case volumes per surgeon at 58 and 46 cases per surgeon, respectively, while oromaxillofacial surgery and neurosurgery had the lowest average case volumes per surgeon at 9 and 14 cases per surgeon, respectively. Conclusions: Operative volume on military HCA missions is greatly influenced by the priorities of the HN, the mission focus, the number of individuals from the HN that present for screening, and the availability of personnel and resources available on the hospital ship. Future mission planning should optimize general surgery and ophthalmology staffing and essential equipment, as total mission case volumes were highly dependent upon the productivity of these two specialties. Careful determination of the surgical needs of HNs should serve as a guide for the selection of subspecialists to maximize effectiveness in future military HCA missions. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to explore the respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors. Methodology: A total of 494 patients receiving oral and maxillofacial surgery under general anesthesia with tracheal intubation were assigned to a non-infection group (n = 469) and an infection group (n = 25). Another 494 healthy people undergoing physical examination in the same period were enrolled to establish a classification tree model. The distribution of pathogens, drug resistance of main pathogens, and related influencing factors of postoperative respiratory tract infection were analyzed. The influencing factors of respiratory tract infection were screened by logistic regression analysis. After construction of the classification and regression tree (CART) model based on the influencing factors, the accuracy was evaluated by plotting receiver operating characteristic (ROC) curve. Results: Pseudomonas aeruginosa was highly resistant to cefazolin and more sensitive to cefoperazone, ciprofloxacin, norfloxacin and imipenem. Staphylococcus aureus was highly resistant to gentamicin and more sensitive to vancomycin. Age = 60 years old, history of lung diseases, operation time = 4 h, anesthesia ventilation time = 120 min, and orotracheal intubation were independent influencing factors of respiratory tract infection (p < 0.05). The results of the gain chart, index map, and Risk value indicated a high predictive value of the CART model for the risk of postoperative respiratory tract infection. The area under the ROC curve was 0.869 [95% confidence interval: 0.795-0.947]. Conclusions: The CART model has a high predictive value and may reduce the risk of postoperative infection. [ABSTRACT FROM AUTHOR]

Background: This overview aimed to characterize the type, development, and use of haptic technologies for maxillofacial surgical purposes. The work aim is to summarize and evaluate current advantages, drawbacks, and design choices of presented technologies for each field of application in order to address and promote future research as well as to provide a global view of the issue. Methods: Relevant manuscripts were searched electronically through Scopus, MEDLINE/PubMed, and Cochrane Library databases until 1 November 2022. Results: After analyzing the available literature, 31 articles regarding tactile sensors and interfaces, sensorized tools, haptic technologies, and integrated platforms in oral and maxillofacial surgery have been included. Moreover, a quality rating is provided for each article following appropriate evaluation metrics. Discussion: Many efforts have been made to overcome the technological limits of computed assistant diagnosis, surgery, and teaching. Nonetheless, a research gap is evident between dental/maxillofacial surgery and other specialties such as endovascular, laparoscopic, and microsurgery; especially for what concerns electrical and optical-based sensors for instrumented tools and sensorized tools for contact forces detection. The application of existing technologies is mainly focused on digital simulation purposes, and the integration into Computer Assisted Surgery (CAS) is far from being widely actuated. Virtual reality, increasingly adopted in various fields of surgery (e.g., sino-nasal, traumatology, implantology) showed interesting results and has the potential to revolutionize teaching and learning. A major concern regarding the actual state of the art is the absence of randomized control trials and the prevalence of case reports, retrospective cohorts, and experimental studies. Nonetheless, as the research is fast growing, we can expect to see many developments be incorporated into maxillofacial surgery practice, after adequate evaluation by the scientific community. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve blocks are being utilized more often, either as a part of multimodal analgesia or even as a substitute for drugs that treat systemic pain. Primary headache problems and secondary headaches have both been successfully treated with peripheral nerve blocks. Objectives: This study aimed to assess safety of ultrasound-guided trigeminal nerve block (USGTNB) in individuals who are receiving general anesthesia and are undergoing unilateral maxillofacial surgery. Methods: This cross-sectional study enrolled 25 adult patients aged more than 18 years, who had American Society of Anesthesiologists physical status I or II and were scheduled for elective unilateral maxillofacial surgery under general anesthesia. Patients received USGTNB using 5 ml of bupivacaine 0.25%. The intraoperative hemodynamic parameters were assessed. Results: More than half of patients were males (64%) with a mean age of 37.28 ± 11.54 years old. Patients had mean duration of surgery of 2.96 ± 0.69 hours, most of them had ASA grade I. Patients had significantly lower HR compared to their baseline values. Patients had significantly lower MAP relative to their initial levels. The total fentanyl consumption was 0.36 ± 0.55 µ/kg. Regarding complications, 12% of patients had headache, 8% had paraesthesia and 4% had nausea\vomiting. Conclusion: ultrasound-guided nerve block is a safe and reliable method for controlling pain in adult patients undergoing maxillofacial surgery with fewer side effects. [ABSTRACT FROM AUTHOR]

It is the aim of the study to discuss litigation related to facial cosmetic surgery with a particular focus on written consent, in order to prevent unfortunate outcomes for the surgeon and patient alike. A 10-year online search for facial cosmetic surgery litigation in Brazil was conducted from 2012 to 2022. Statistical analyzes were performed using RStudio, and the results were considered significant with a 95% confidence interval. A total of 992 litigations were identified through the search. Of these, 122 articles met our inclusion criteria. The number of legal disputes on this subject has been increasing for years. Female patients are more prone to litigation. Financial damage ranged from $75 to $500,000 (mean: $59,536). Many of the lawsuits that had appropriate written consent have had a favorable outcome for the defendant. The primary specialty was the most common plastic surgery (67%), followed by maxillofacial surgery (9%). Surgeons engaged in facial cosmetic surgery should protect themselves legally from litigation. Written consent significantly reduces both litigation losses and financial damage. Some details on the preparation of this consent form have been discussed. [ABSTRACT FROM AUTHOR]

Craniomaxillofacial surgery has been experiencing a deep conceptual change in surgical planning over the last decade, with virtual reality technologies becoming widely adopted. The high demand has led to an exponential increase in available software. The aim of this review was to outline the current literature and provide evidence on the most used software for virtual surgical planning (VSP), and also to define contemporary knowledge on which procedures are more ready candidates for VSP. A search was performed in the major databases, and screening of the results according to the PRISMA statement identified 535 articles reporting the implementation of preoperative VSP during the years 2010–2020. A total of 77 different software programs were identified. The surgical procedures were assigned a standardized nomenclature and further simplified into 10 categories for analysis: temporomandibular joint (TMJ), implants (IMPL), malformations (MALF), reconstruction (REC), oncology (ONCO), oral surgery (ORAL), orthognathic surgery (ORTH), cranial surgery (CRANIO), trauma (TRAUMA), miscellaneous (OTHER). The journals they were reported in and the sample size of each study were also investigated. The results showed that the Materialise suite was the most widespread tool for VSP, with a prevalence of 36.3%, followed by the Geomagic family. Several packages were found to be associated with a specific type of surgical procedure. This review offers a synopsis of the array of VSP software reported in the literature and sets the basis for an informed, evidence-based use of this software in craniomaxillofacial surgery. [ABSTRACT FROM AUTHOR]

Background: Odontogenic infections are common and self-limiting in most cases; however, they can lead to severe consequences, considerable morbidity and can even be fatal despite modern medical therapy. Patients and Methods: This retrospective study included patients with severe deep fascial space infections treated in the Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag Governorate, Egypt, and the Department of Oral and Maxillofacial Surgery, King Fahd Specialist Hospital (tertiary referral center), Burayda City, Qassim Province, Saudi Arabia, from June 2017 to June 2022. Results: This study included 296 patients, 161 (54.4%) males, 135 (45.6%) females. The fifth decade of life was the most common vulnerable age group. Forty-three percent of patients had diabetes mellitus, 26.6% were hypertensive, and 13.3% were on long-term steroid therapy. In 83% of patients, the offending tooth was identified but in 17% of patients no dental cause was identified. The lower third molar tooth was most commonly involved. Sixty-nine (23.3%) patients had submandibular space infections. Fifty-three (17.9%) patients had canine space infections. Thirty (10.1%) patients had submasseteric space infection. Twenty-eight (9.5%) patients had submental space infections. Twenty-three (7.8%) patients had combined infection of the submasseteric, submandibular, and pterygomandibular spaces, whereas 19 (6.4%) patients presented with Ludwig's angina. Conclusions: Odontogenic infections are common. The submandibular space is the most commonly affected single space. These infections could lead to lethal complications in immunocompromised patients, especially patients with diabetes mellitus. These infections require urgent surgical intervention to decrease hospital stays and avoid potentially lethal complications. [ABSTRACT FROM AUTHOR]

Over the past 5 years, The University of Alabama at Birmingham (UAB) Department of Surgery has taken a keen interest in the practice of surgery in rural Alabama and has established the UAB surgery community network. Our goal is to improve the delivery of surgical care in rural areas through active recruitment of rural surgeons, the development of research around rural surgery practice, and the expansion of a surgery network throughout the state. Here, we will present the challenges faced by rural surgery, our early work to address these challenges, and offer a plan for moving forward. [ABSTRACT FROM AUTHOR]

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder characterized by neurological symptoms and distinctive neuroimaging findings. There are a few cases reported in the literature in which PRES can occur after surgery, and there is no clear direct relationship between a procedure and its debut. Methods: We performed a review of the literature by analyzing all reported cases of PRES syndrome which debuted after a surgical procedure with the aim of identifying the clinical features, the timing of the symptoms' onset and the therapy of patients suffering from this unusual surgical complication. Results: The total number of patients collected was 47, with a mean age of 40.9 years. Postoperative PRES can occur in either pediatric or adult patients (ages 4–82 years). The most frequent form of comorbidity reported was cardiovascular disease (fourteen patients, 29.78%). Sixteen patients (36%) had no relevant risk factors or comorbidities at the time of the surgical procedure. The types of surgery most correlated were cranial neuro and maxillofacial surgery (twenty-one patients, 44.68%) followed by transplant surgery (eight patients, 17%). The time of onset of PRES after surgery occurred within the first 3 weeks (mean time of onset 4.7 days), and when rapidly treated with antihypertensive and antiepileptic drugs appeared to have a reversible and benign course. Conclusion: PRES syndrome can be considered a rare complication of procedures and can occur following a wide range of surgeries, especially cranial and transplant surgery. Being able to recognize it in time and treat it ensures a full reversibility of symptoms in most cases. [ABSTRACT FROM AUTHOR]

Objective: To investigate indications, surgical and functional outcomes of robotic or endoscopic facelift thyroid surgery (FTS) and whether FTS reported comparable outcomes of other surgical approaches. Data sources: PubMed, Cochrane Library, and Scopus. Review methods: A literature search was conducted about indications, clinical and surgical outcomes of patients who underwent FTS using PICOTS and PRISMA Statements. Outcomes reviewed included age; gender; indications; pathology; functional evaluations; surgical outcomes and complications. Results: Fifteen papers met our inclusion criteria, accounting for 394 patients. Endoscopic or robotic FTS was carried out for benign and malignant thyroid lesions, with or without central neck dissection. Nodule size and thyroid lobe volume did not exceed 6, 10 cm, respectively. FTS reported comparable outcome with transaxillary or oral approaches about operative time, complication rates or drainage features. The mean operative time ranged from 88 to 220 min, depending on the type of surgery (endoscopic vs robotic hemi- or total thyroidectomy). Conversion to open surgery was rare, occurring in 0–6.3% of cases. The most common complications were earlobe hypoesthesia, hematoma, seroma, transient hypocalcemia and transient recurrent nerve palsy. There was an important disparity between studies about the inclusion/exclusion criteria, surgical and functional outcomes. Conclusion: FTS is a safe and effective approach for thyroid benign and malignant lesions. FTS reports similar complications to conventional thyroidectomy and excellent cosmetic satisfaction. [ABSTRACT FROM AUTHOR]

Background: Mandibular third molar (M3M) removal and management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. This potential quantitative study assessed the ability of two types of surgical sutures, Silk and polytetrafluoroethylene polymer (PTFE), to carry aerobic and anaerobic bacteria on wounds after mandibular third molar surgery, with a collection of the stitches at the suture removal and study in the laboratory on the basis of colony-forming units. Methods: This prospective quantitative study sampled a total of 10 consecutive healthy patients for mandibular third molar surgery at the Oral Surgery School, Dentistry and Dental Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy. The mean age of the patients was 31 years (range 25–40 years), seven patients were male and three patients were female. Inclusion criteria were: presence of a partially impacted mandibular third molar. Exclusion criteria were: smoking and diabetes mellitus. Extraction of the mandibular third molar was performed under local anesthesia: after the third molar surgery, two sutures were applied on the surgical site distally to the second mandibular molar: one single 3/0 silk stitch; one single 3/0 PTFE stitch. No sutures were applied on the release incision. Sutures were removed after 7 days and were immediately conserved and sent to the laboratory to be rated on the basis of colony-forming units (CFUs). CFUs were evaluated and reported on GraphPad Prism and transformed into its base 10 logarithm. Data were analyzed with a non-parametric Wilcoxon test, and p-values < 0.05 were evaluated as statistically significant. Results: All the patients attended the suture removal date, and all the sutures were present in the site. None of the surgical sites presented dehiscence. No stitch loss was reported, and no patient reported mouth washing or tooth brushing in the surgery site. All interventions were uneventful and no major complications were reported after M3M surgery. Bacterial retention resulted as statistically greater in silk sutures rather than PTFE sutures, both in Brain Heart Infusion samples (p = 0.003) and Wilkins-Chalgren anaerobe samples (p = 0.002). Conclusions: We found the PTFE suture to be superior to the silk suture in a reduction in the bacterial biofilm in both aerobic and anaerobic evaluations after M3M surgery. [ABSTRACT FROM AUTHOR]

Patients presenting to the emergency department (ED) with an Emergency General Surgery (EGS) problem often require transfer to a tertiary facility. Issues impacting EGS mirror the same issues trauma surgery faced prior to the implementation of current trauma guidelines. This study analyzed the cost, time, and transport resource utilization of EGS patients with acute appendicitis when transferred from network hospitals to a level II trauma center. This was a retrospective study. Patients were transferred by a critical or specialty care transport team 62% of the time, although no skills performed required a critical or specialty care provider. The median time from decision to transfer to incision was 254 minutes, with an average transport time of 27 minutes. This study suggests that there is an opportunity to improve access to the operating room and to decrease resource utilization of specialty care and critical care transport for patients. [ABSTRACT FROM AUTHOR]

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Chondroid Syringoma is a rare benign mixed tumor characterized by gland elements in a cartilaginous stroma. These tumors most commonly occur in the skin of the head and neck district, affecting only rarely the periorbital area.Below we present two cases of Chondroid Syringoma, the first on the upper lip, and the second in the orbital cavity. Both are characterized by an epithelial component in a cartilaginous stroma.

Purpose: Postoperative sore throat (POST) is a common complication. We compared postoperative nebulized furosemide, budesonide, and sodium chloride solution for POST in patients undergoing maxillofacial surgery. Methods: 75 patients were randomly divided into 3 groups. Anesthesia induction and intubation were routinely performed. Following emergence, the patients were randomized to one of three groups. Group F was treated with 40mg of aerosolized furosemide, group B received 2 mg of aerosolized budesonide and Group S was given aerosolized 0.9% sodium chloride solution. Patients were assessed for sore throat,hoarseness, foreign body sensation,dry mouth, cough，nausea and vomiting at 15 min, 1, 2, 4, 6, 8, 12, 24 and 48 h after extubation. Results: Patients all in three groups had comparable clinical and surgical data.Compared to Group S, POST at rest and during swallowing was significantly lower in Group F and Group B at 2, 4, 6, 8 and 12 h (P

Background: Stress is generally known as a silent killer which manifests as increased anxiety, pertaining to a particular event. Surgery of any kind leads to stress which is inevitable for the patient. The reduction of stress is vital for patient satisfaction and successful clinical practice. One of the ways to reduce presurgical stress is listening to music. The aim of the study was to compare the effectiveness of classical piano music (PM) and Gayatri mantra (GM) on presurgical vital parameters of patients undergoing major maxillofacial surgery under general anesthesia. Patients and Methods: Forty patients requiring maxillofacial surgery under general anesthesia were included. They were divided into two groups. In Group 1, patients listened to PM and in Group II to GM before being induced. Patients were chosen alternatively and connected to noninvasive blood pressure monitor. Readings of vital parameters, i.e., pulse rate, respiratory rate, and blood pressure, were recorded and statistically evaluated. Results: Pulse showed a 3%– 5% decrease in value for the PM group versus a 0.4%–3.3% decrease for the GM group. Systolic blood pressure showed a maximum decrease of up to 4.3% for PM group as against 3.8% decrease for GM group. PM showed a greater decrease in the vital parameters compared to GM. Conclusion: Listening to classical PM 30 min before induction of general anesthesia results in reduced patient anxiety and a smoother induction for the anesthetist. [ABSTRACT FROM AUTHOR]

The presence of stromal osteoclast-like giant cells is a distinctive feature of some rare breast tumors, accounting for less than 1% of all breast cancer cases. Although the presence of stromal osteoclast-like giant cells may be encountered in different breast tumors, some authors still describe them as a specific tumor type. Usually, a histological diagnosis of breast carcinoma is made by a pathologist through a biopsy, which is then confirmed through a surgical specimen: it is rare for the two to differ, particularly when there are pathognomonic morphological markers, such as osteoclast-like giant cells. Herein, we report a case of a 45-year-old pre-menopausal woman, who was found to have a single solid mass in her right breast on screening mammogram. She underwent a core biopsy, which showed a malignant epithelial lesion arranged in tubules, glands, and papillae, intermingled with numerous stromal osteoclast-like giant cells. Therefore, a diagnosis of breast cancer with osteoclast-like giant cells was rendered. Curiously, these cells were no longer detectable in the surgical specimen. [ABSTRACT FROM AUTHOR]

Abstract Background Maxillofacial surgery for free flap reconstructions is associated with many complications due to technical complexity and comorbidity of patients. With a focus on critical care, the authors studied the impact of complications to highlight predictors of poor postoperative outcomes in order to implement optimization protocols. Methods This case-control study analyzed the relationship between perioperative variables and postoperative medical and surgical complications of patients who underwent head and neck surgery using fibular and forearm free flaps. The primary objective was the incidence of prolonged intensive care unit (ICU) length of stay (LOS). Secondary objectives were the incidence of ICU readmissions, postoperative infections, and 1-year mortality. A univariable logistic regression model was used. A study of mortality was performed with survival analysis. Regarding our primary objective, we performed a Benjamini-Hochberg procedure and a multivariable Poisson regression with defined variables of interest. Results The data of 118 hospital stays were included. Prolonged ICU LOS was observed in 47% of cases and was associated with chronic obstructive pulmonary disease, pneumopathies, intraoperative blood transfusion, and surgical duration. Medical and surgical complications were associated with prolonged ICU LOS. After the Benjamini-Hochberg procedure, infectious complications, complications, major complications, total number of pneumopathies, and operative time remained significant. At least one complication was experienced by 71% of patients during the hospitalization, and 33% of patients suffered from major complications. Infectious complications were the most common (40% of patients) and were mainly caused by pneumonia (25% of patients); these complications were associated with low preoperative hemoglobin level, intraoperative blood transfusion, accumulation of reversible cardiovascular risk factors, chronic alcohol consumption, and duration of surgery. Pneumonia was specifically associated with chronic obstructive pulmonary disease. The ICU readmission rate was 10% and was associated with lower preoperative hemoglobin level, pneumopathies, surgical duration, and use of a fibular flap. The 1-year mortality was 12%, and the survival analysis showed no association with prolonged ICU LOS. Poisson regression showed that ICU LOS was prolonged by smoking history, lower preoperative hemoglobin level, intraoperative blood transfusion, major complication, and pneumopathies. Conclusions Practices such as blood management and respiratory prehabilitation could be beneficial and should be evaluated as a part of global improvement strategies.

Difficult laparoscopic cholecystectomy is a condition that every general surgeon has once faced during surgery. There have been various propositions regarding the aetiology and criteria for difficult cholecystectomy. As a whole, it has been associated with abnormal anatomy, frozen Calot’s triangle, difficult exposure, post endoscopic retrograde cholangio-pancreatography, requiring more than 90 min, need for open conversion, etc. There are various preoperative and intraoperative predictors of difficult cholecystectomy described in the literature. However, history of severe pelvic inflammatory disease preoperatively has not been described in the literature as a predictor of difficult cholecystectomy. In our case report, a 31-year-old lady presented to us with biliary colic. Ultrasonography revealed a normal wall gall bladder, with multiple calculi. Diagnosis of symptomatic cholelithiasis was made. Based on clinical history and intraoperative findings, a diagnosis of Fitz-Hugh-Curtis syndrome was made, which is a sequelae of pelvic inflammatory disease. [ABSTRACT FROM AUTHOR]

Despite forming the majority in undergraduate medicine and dentistry programmes, females remain under-represented in all surgical specialties, including oral and maxillofacial surgery (OMFS). Efforts are ongoing to promote female uptake in surgery. Research output is a key metric in measuring leadership and academic advancement within a specialty. The aim of this study was to assess female authorship in research published in the British Journal of Oral and Maxillofacial Surgery from 2000-2020 with a retrospective cohort study of original articles and reviews published in the journal from five different volumes of the journal (2000, 2005, 2010, 2015, 2020 as representative time points). The gender of the first and last authors were assessed for gender by first name recognition and verified with a web-search of the author using their stated institutional affiliation when this was not clear. Articles were excluded if the gender of one of the first or last author could not be determined. A total of 501 articles were included with the gender of 1002 authors analysed. 173 (17.3%) authors were female, and 828 (82.7%) were male. The most common author combination was male-male (70.3%) and the least common female-female (4.8%). The proportion of female authors increased over time from 9.3% in 2000 to 23.4% in 2020. Females remain under-represented within surgery, but female presence in academic output is increasing at a similar rate to the numbers of female uptake in the clinical workforce which is a promising sign and indicative of progress towards gender parity. [ABSTRACT FROM AUTHOR]

Personalized surgery (PS) involves virtual planning (VP) and the use of 3D printing technology to design and manufacture custom-made elements to be used during surgery. The widespread use of PS has fostered a paradigm shift in the surgical process. A recent analysis performed in our hospital—along with several studies published in the literature—showed that the extensive use of PS does not preclude the lack of standardization in the process. This means that despite the widely accepted use of this technology, standard individual roles and responsibilities have not been properly defined, and this could hinder the logistics and cost savings in the PS process. The aim of our study was to describe the method followed and the outcomes obtained for the creation of a PS service for the Oral and Maxillofacial Surgery Unit that resolves the current absence of internal structure, allows for the integration of all professionals involved and improves the efficiency and quality of the PS process. We performed a literature search on the implementation of PS techniques in tertiary hospitals and observed a lack of studies on the creation of PS units or services in such hospitals. Therefore, we believe that our work is innovative and has the potential to contribute to the implementation of PS units in other hospitals. [ABSTRACT FROM AUTHOR]

Augmented reality (AR) is an innovative system that enhances the real world by superimposing virtual objects on reality. The aim of this study was to analyze the application of AR in medicine and which of its technical solutions are the most used. We carried out a scoping review of the articles published between 2019 and February 2022. The initial search yielded a total of 2649 articles. After applying filters, removing duplicates and screening, we included 34 articles in our analysis. The analysis of the articles highlighted that AR has been traditionally and mainly used in orthopedics in addition to maxillofacial surgery and oncology. Regarding the display application in AR, the Microsoft HoloLens Optical Viewer is the most used method. Moreover, for the tracking and registration phases, the marker-based method with a rigid registration remains the most used system. Overall, the results of this study suggested that AR is an innovative technology with numerous advantages, finding applications in several new surgery domains. Considering the available data, it is not possible to clearly identify all the fields of application and the best technologies regarding AR. [ABSTRACT FROM AUTHOR]

Clinician-reported outcome measures (ClinRO measures) play a fundamental role in quality assurance throughout healthcare systems. With commissioners turning ever more frequently to ClinRO data to evaluate and compare individual hospital performance and casemix, and funding decisions increasingly relying on these data, agreed core outcome sets (COS) are essential for the collection of standardised specialty-specific outcomes. Beyond their role in service commissioning, COS enable standardisation of outcomes in clinical studies, allowing comparisons to be drawn between similar trials as well as pooling of data for systematic reviews and metaanalyses. This review explores those ClinRO measures most commonly reported in the third molar literature, highlighting inconsistencies in ClinRO selection, measurement and reporting among researchers. We recognise here a prime opportunity for the specialty to address this lag in COS relative to other surgical specialties. With the Quality Outcomes in Maxillofacial Surgery (QOMS) overseeing the institution of many subspecialty-specific national databases in recent years, OMFS is well placed to develop a series of COS for each subspecialty domain for the benefit of researchers, clinicians and ultimately, patients. [ABSTRACT FROM AUTHOR]