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PURPOSE: To determine the most appropriate stress distribution in fixation with resorbable screws and plates after bilateral sagittal split ramus osteotomy using the finite-element method. MATERIALS AND METHODS: This experimental study was performed on simulated human mandibles using computer software. The osteotomy line was applied to the simulated model and experimental loads of 75, 135, and 600 N were exerted on the model in accordance with the vector of occlusal force. The distribution pattern of stress was assessed and compared in 8 fixation methods: 1 resorbable screw, 2 resorbable screws in a vertical pattern, 2 resorbable screws in a horizontal pattern, 3 resorbable screws in an L pattern, 3 resorbable screws in a backward-L pattern, 1 miniplate with 2 screws, 1 miniplate with 4 screws, and 2 parallel miniplates with 4 screws each. RESULTS: Among the simulated fixations, 2 parallel miniplates showed the greatest primary stability and the single screw and the 2-hole miniplate showed the least tolerance to posterior forces. CONCLUSIONS: This study showed the 2-miniplate/4-hole plate pattern was the strongest and the single-screw and 2-hole plate patterns were the weakest of fixations in this bilateral sagittal split ramus osteotomy model. The finite-element method showed that polymer-based resorbable screws and plates (polyglycolic acid and d,l-polylactide acid) provide satisfactory primary stability in this model. [ABSTRACT FROM AUTHOR]

Immediate implantation after extraction is advantageous when clinical circumstances allow it. However, it is often problematic. The most common problem in such cases is confronting bone loss after tooth extraction because of long-standing periodontitis. Although there are many techniques designed to manage these complications, autogenous grafts are considered to be the gold standard in grafting procedures because of their osteoinductive properties. There are many sites from which to harvest bone for grafting procedures, each possessing advantages and disadvantages. We present a new site for bone harvesting and a new graft design for osseous reconstruction in implant dentistry. Copyright © 2009 by the American Association of Oral and Maxillofacial Surgeons. [ABSTRACT FROM AUTHOR]

PURPOSE: This study evaluates 2 surgical methods used at our center for the treatment of mandibular arteriovenous malformations (AVMs): resection with immediate replantation and curettage via proximal transmandibular osteotomy. PATIENTS AND METHODS: Patients with AVMs of the mandible who were treated during a 17-year period between 1992 and 2008 at our department were assessed. Two surgical techniques were used for treatment: 1) resection of the segment, curettage of the intrabony lesion, extraction of involved teeth, and immediate replantation and 2) proximal osteotomy curettage of the lesion within the bone and extraction of involved teeth. In the replantation group the resected segment of the mandible was replanted after the contents were scraped out and the involved teeth removed. In contrast, in the proximal osteotomy group this was done without removal of the bone segment. In both techniques the cortical bone of the mandible was maintained. However, in the transmandibular curettage group the periosteum was not entirely stripped off because curettage was done via proximal osteotomy without removal of the segment. The entire intrabony lesion and a margin of cancellous bone related to the lesion were excised in both groups. The bone was fixed with titanium plates in all cases. All patients were followed up annually for a period of 1 to 17 years (mean, 9.5 years). RESULTS: We treated 12 patients with mandibular AVMs (2 male and 10 female patients). Their ages ranged from 7 to 17 years. Preoperative angiography showed high-flow central vascular lesions in all patients. Of the lesions, 7 (58%) were treated via resection with immediate replantation and 5 (42%) were treated via transmandibular curettage. Embolization was performed in 4 cases 48 hours before surgery. However, blood loss was not significantly decreased by embolization. The lesions were categorized as multilocular (58.3%) or unicystic (41.7%) based on the radiographic findings and were located in the mandibular body (66.7%) or ramus (33.3%). Blood loss averaged 1.60 L in the group undergoing resection and immediate replantation and 1.30 L in the transmandibular curettage group. During the follow-up period, no recurrences were encountered in either group via clinical, radiographic, or computed tomography scan assessment, and none of the patients had facial deformities develop. CONCLUSIONS: The results suggest that transmandibular curettage via proximal osteotomy without complete resection is an effective less invasive method with which to treat AVMs of the mandible provided that the lesion is small, is confined within the bone, and has not invaded the soft tissues. Less blood loss, preservation of the bone, more favorable postoperative esthetics, and better function are among the advantages of this technique. In more extensive cases and those involving both hard and soft tissues, resection with immediate replantation is recommended. Both techniques obviated the need for bone graft reconstruction. This technique is better than resection and discarding of the segment. [ABSTRACT FROM AUTHOR]

Suture needles can break when they are used to suture the oral mucosa, especially if they have been bent or if excessive force is applied. Several retrieval modalities have been discussed in the literature; these have focused mainly on locating the needle. Although the segment often is found and removed by the surgeon during the procedure, more extensive procedures and paraclinical diagnostics may be necessary. This article presents a case in which a lost suture needle was located using a cone beam computed tomography scan and retrieved via surgery. [ABSTRACT FROM AUTHOR]

PURPOSE: The present retrospective study assessed the outcome and effectiveness of the buccal fat pad flap for closure of postoperative midpalatal fistulas and fistulas of the posterior palate in patients previously treated for cleft palate. PATIENTS AND METHODS: The charts of 29 patients with residual midpalatal and posterior palatal fistulas treated using buccal fat pad flaps were assessed. Of the 29 patients, 18 were males and 11 were females, aged 2.5 to 19 years. The fistula size was 10 to 20 mm. RESULTS: Full epithelialization of the flap had occurred within 4 weeks in all 29 patients. The fistulas had completely closed in 28 patients. In 1 patient, a 2-mm defect was noted in the anterior part of the fistula repair that had healed after 2 months without intervention. CONCLUSION: The buccal fat pad flap can be used to repair any remaining postoperative palatal fistulas that are 10 to 20 mm in size. [ABSTRACT FROM AUTHOR]

Background and Purpose. Fixed orthodontics may be associated with accumulation of Mutans Streptococci (MS), enamel demineralization, and an increased number of carious lesions, predominantly in sites adjacent to brackets. This study was undertaken to assess the effectiveness of Listerine, Oral-B, and Ortho-kin on the accumulation of MS in plaque around orthodontic brackets. Materials and Methods A double-blind randomized cross-over clinical trial on 25 orthodontic patients, classified into 6 groups was done to assess MS in plaque and saliva with the side specific modified Strip-Mutans technique and the plaque (PI) was measured before and after rinsing using 3 types of commercial mouth-rinses. A washout period (3 weeks) was awaited between using each mouth-rinse and the data was analyzed via Wilcoxon and Kruskal Wallis statistical tests. Results. This study of 25 patients, 5 men and 20 women, with an average age of 19 ± 6/3 assessed the effectiveness of mouth-rinses on MS. Our results showed that Ortho-kin had a better effect than Oral-B and Listerine (P < 0/09). Ortho-kin also had better effects than Oral-B and Listerine on plaque accumulation (P < 0/001). Conclusion. Ortho-kin showed better effects on decreasing MS and PI because it contained chlorhexidine. [ABSTRACT FROM AUTHOR]

This 18-year retrospective multi-center study analyzed data from patients diagnosed and treated for peripheral giant cell granuloma (PGCG) and central giant cell granuloma (CGCG) of the jaws from 1991-2009. Data included age, gender, the jaw involved, the area of the lesion, the type of surgical treatment, and recurrence. Thorough curettage or partial resection was used to treat CGCG (96.39% success rate) and PGCG (98.71% success rate) in this group of patients documented during the follow-up period (1-18 years). [ABSTRACT FROM AUTHOR]

Leishmaniasis is a parasitic disease prevalent throughout the world. According to the geographic region in which different Leishmania species are found it can present variably. Because of the increase in both international travel and immigrant populations, the numbers of reported cases of leishmaniasis is on the increase. It is important that clinicians are able to recognize the cutaneous lesions and unusual presentations of leishmaniasis (CL). Our case was an incidental finding during treatment of a gunshot wound. The lesions were mistaken for facial pimples because they were numerous and the patient was a teenager. The patient was treated with sodium stibogluconate. [ABSTRACT FROM AUTHOR]

Background: Iranian people celebrate the last Wednesday of the year also known as Chahar Shambeh Soori (CSS) using low explosive pyrotechnics classified as fireworks. Mishaps and accidents are common and maxillofacial fractures may occur which have a negative impact on the quality of life. This study aimed to assess maxillofacial fractures (fx) caused by explosive agents., Methods: This cross-sectional descriptive study assessed 283 patients suffering maxillofacial fxs caused by explosive agents during CSS ceremonies between 2009 and 2019 referred to our craniomaxillofacial (CMF) surgery center. The data assessed included age, sex, cause, type, site, and severity of injury, fracture patterns, treatment modalities, and complications. All maxillofacial injuries were evaluated and treated by Craniomaxillofacial staff surgeons., Results: Among 283 patients, 72.8% (206) and 27.2% (77) were men and women, respectively. The mean age of patients was 17.35 years. The most common maxillofacial fracture was in the mid-face; with the distribution of fractures being: 39.9% zygomatic fractures, 32.1% nasal bone fractures, 63.2% dentoalveolar fracture, 43.1% Le Fort (Le Fort I, Le Fort II, Le Fort III), 31.4% orbital, and 43.1% mandible fractures. The most frequent type of treatment was Open Reduction and Internal Fixation (ORIF) (77.4%)., Conclusion: The most common site of maxillofacial fractures and most frequent treatment used were similar to military or ballistic injuries. ORIF was common treatment., Competing Interests: The authors declare that there is no conflict of interests.

This study compared the performance of four serology assays for Coronavirus Disease 2019 (COVID-19) and investigated whether COVID-19 disease history correlates with assay performance. Samples were tested at Northshore using the Elecsys Anti-SARS-CoV-2 (Roche Diagnostics), Access SARS-CoV-2 IgG anti-RBD (Beckman Coulter), and LIAISON SARS-CoV-2 S1/S2 IgG (DiaSorin) as well as at Genalyte using Maverick Multi-Antigen Serology Panel. The study included one hundred clinical samples collected before December 2019 and ninety-seven samples collected from convalescent plasma donors originally diagnosed with COVID-19 by PCR. COVID-19 disease history was self-reported by the plasma donors. There was no difference in specificity between the assays tested. Clinical sensitivity of these four tests was 98% (Genalyte), 96% (Roche), 92% (DiaSorin), and 87% (Beckman). The only statistically significant differences in clinical sensitivity was between the Beckman assay and both Genalyte and Roche assays. Convalescent plasma donor characteristics and disease symptoms did not correlate with false negative results from the Beckman and DiaSorin assays. All four tests showed high specificity (100%) and varying sensitivities (89-98%). No correlations between disease history and serology results were observed. The Genalyte Multiplex assay showed as good or better sensitivity to three other previously validated assays with FDA Emergency Use Authorizations., Competing Interests: The authors have read the journal’s policy and have the following competing interests: Procurement and testing of samples collected prior to the year 2020 was paid for by Genalyte, Inc. NorthShore University HealthSystem paid for testing of convalescent plasma donor samples on the three in-house assays, however it was not charged for testing on Genalyte’s assay. Hossein Fakhrai-Rad, Rick Hockett, and Mohammad H. Motamedi are employees of Genalyte, the commercial manufacturer of Genalyte’s SARS-CoV-2 Multi-Antigen Serology Panel. Sean David owns equity in Genalyte. Thomas J. Gniadek, Hong Kee Lee, Jason Kang, Robert C. Benirschke, and Sean David are paid employees of NorthShore University HealthSystem. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Purpose: Morbidity and death after facial trauma are substantial issues of concern both in civilians and in military personnel. This cross-sectional retrospective study sought to assess the prevalence, pattern, treatment, and complications of soft and hard tissue injuries of the face in military personnel from 2012 to 2018., Patients and Methods: This cross-sectional, retrospective, chart study analyzed the descriptive statistics of 591 patients by use of Microsoft Excel software (version 2013; Microsoft, Redmond, WA); we assessed military casualties treated at our hospital from 2012 to 2018. All military personnel were documented in our trauma registry. The patient records were studied, and information relating to patients' injuries was documented and assessed after compilation of patient data. This study was approved by our local institutional review board; the causes and complications of maxillofacial (MF) trauma were assessed. Statistical analysis was done. This study used descriptive statistics based on a total of 591 patients and Microsoft Excel software (version 2013)., Results: Among maxillofacial (MF) fractures, midface fractures (49%) were most prevalent, followed by lower face fractures (43%) and upper face fractures (24%). The most common cause of injury was explosives (58%). The most frequent site of fracture in the mandible was the angle region, followed by the mandibular body and condyle. Nasal fractures were seen in 44% of midface fractures. The most commonly used technique for treatment was open reduction-internal fixation, which was used in 89% of patients., Conclusions: The pattern of MF injuries and the treatment modalities used to treat these patients showed that the most frequent type of injury was midface fracture and most patients were treated by open reduction-internal fixation., (Copyright © 2019. Published by Elsevier Inc.)

Purpose: The orbital cavity can be affected in zygomaticomaxillary complex (ZMC) fractures. The aim of this study was to assess the relation between orbital volume changes and enophthalmos in patients with ZMC fractures., Materials and Methods: A descriptive study of consecutive adult patients with recent isolated unilateral ZMC fractures who were otherwise healthy was performed from 2016 through 2017. Multislice computed tomographic (CT) scans were taken of all patients and enophthalmos was measured clinically using a Hertel exophthalmometer. In the axial plane, enophthalmos was measured on CT scan using Mimics software. Three-dimensional reconstruction and volume measurement of the orbital cavity also were performed using Mimics software. The correlation between clinical and radiographic amounts of enophthalmos was measured by Pearson correlation coefficient analysis. The association among radiographic enophthalmos, clinical enophthalmos, and volume changes of the orbital cavity was assessed by linear regression. The P value was set at .01., Results: Ninety-six patients (77 men, 19 women; mean age, 28.48 ± 8.29 yr) were assessed. Mean volumes of control and fractured bony orbits measured on CT scan were 29.02 ± 1.71 and 32.05 ± 2.22 cm 3 , respectively (P < .001). There was a strong positive correlation between clinically and radiographically measured amounts of enophthalmos (correlation coefficient = 0.97; P < .001). Based on the linear regression model, for each 1-cm 3 orbital volume change, clinical and radiographic enophthalmos amounts changed by 0.68 and 0.71 mm, respectively (P < .0001)., Conclusion: ZMC fractures commonly increase orbital volume and the degree of change is strongly correlated with enophthalmos., (Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: This study was aimed to determine the prevalence, predictors and cost of CAM practitioner use among traumatic patients in Iran., Methods: This cross-sectional household survey of a nationally representative sample of Iranians 15 to 64 yr old was conducted in 2011, using a three-stage cluster sampling. Short Form Injury Questionnaire 7 (SFIQ7) was utilized through face-to-face interviews and data on demographics, history of injuries, mechanism, site and type of injury, type and place of the treatment were attained. Via telephone calls, service use and costs of treatment were also collected., Results: The prevalence of CAM practitioner use in injured people and victims seeking medical care was 0.7% and 4.1%, respectively in 3-month interval in 2011. There were no significant sociodemographic differences between victims who seek unconventional settings and those who seek conventional treatment. The most common injury description treated by CAM providers was as follows: fracture (type of injury), upper limb (site of injury), fall (mechanism of injury) and cast, splint, and physiotherapy (type of treatment). The average medical cost of CAM practitioner was US$14.7 while this amount in the conventional setting was US$195.5., Conclusion: Use of CAM is not very common among injured people in Iran. However, due to lack of formal training, CAM usage has possible side effects., Competing Interests: Conflict of Interest All of authors declare that they have no conflict of interest.

Background: Although bone grafts are commonly used in reconstructive surgeries, they are sensitive to local perfusion and are thus prone to severe resorption. Biphosphonates can inactivate osteoclasts and can be used to control the undesirable bone resorption., Objective: To assess the effect of administration of biphosphonates on bone resorption., Methods: 20 patients with bony defects who were candidates for free autogenous grafts were randomized into "pamidronate" and "control" groups. Bone segments were soaked in either pamidronate solution or normal saline and were inserted into the area of the surgery. Bone densities were measured post-surgery and in 6-month follow-up. Data were obtained via Digora software and analyzed., Results: The mean±SD bone density in pamidronate group changed from 93.4±14.6 to 93.6±17.5 (p<0.05); in the control group the density decreased from 89.7±13.2 to 78.9±11.4 (p<0.05). The mean difference of bone density in anterior areas of the jaws showed higher DXA in comparison to posterior regions (p=0.002)., Conclusion: Locally administered pamidronate affects reduction in bone resorption.

Objective: A variety of nasal skin reconstruction methods are available to meet the esthetic patient's needs. In this article, we review some of modifications of these procedures and share our experience in reconstruction of different parts of the nasal skin following skin tumor ablation., Patients and Methods: From January 2010 to January 2014, 171 patients underwent nasal skin reconstruction after excising cancerous lesions of the involved nasal skin. The patient's history, pre- and post-operation photographs, and the surgery data were collected and assessed. Demographic data related to the type of cancer, defect size and location, type of reconstruction were collected., Results: A variety of local flaps were used based on location and defect features. Nearly all flaps healed primarily without postsurgical significant complications., Conclusion: According to the results and the outcomes of the operations, we concluded that a certain flaps are more effective than others in nasal skin reconstruction. Local flap reconstruction of the nose has good esthetic result with low complication rate.

Background: Hospital readmission places a high burden on both health care systems and patients. Most readmissions are thought to be related to the quality of the health care system., Objectives: The aim of this study was to examine the causes and rates of early readmission in emergency department in a Tehran hospital., Patients and Methods: A cross-sectional investigation was performed to study readmission of inpatients at a large academic hospital in Tehran, Iran. Patients admitted to hospital from July 1, 2014 to December 30, 2014 via the emergency department were enrolled. Descriptive statistics were used to summarize the distribution demographics in the sample. Data was analyzed by chi2 test using SPSS 20 software., Results: The main cause of readmission was complications related to surgical procedures (31.0%). Discharge from hospital based on patient request at the patient's own risk was a risk factor for emergency readmission in 8.5%, a very small number were readmitted after complete treatment (0.6%). The only direct complication of treatment was infection (17%)., Conclusions: Postoperative complications increase the probability of patients returning to hospital. Physicians, nurses, etc., should focus on these specific patient populations to minimize the risk of postoperative complications. Future studies should assess the relative connections of various types of patient information (e.g., social and psychosocial factors) to readmission risk prediction by comparing the performance of models with and without this information in a specific population.

The retromolar foramen, retromolar canal, and retromolar nerve constitute a variation of the inferior alveolar nerve (IAN) with a prevalence of 12-75%; this represents type 1 bifidity of the IAN. The aim of this study was to assess the prevalence of the retromolar nerve in our population and to obtain related data. One hundred and thirty-six mandibles of fresh cadavers aged 20-75 years were dissected. The buccolingual location, diameter, and distance from the third molar, and their associations with sex, were measured. The area of innervation and demographic data were also documented and analysed statistically. The retromolar foramen and retromolar nerve were observed in 55 cases (40.4%). The mean diameter of the retromolar foramen was 1.7 mm (range 1.1-2.1 mm); the mean diameter was 1.8 mm in males and 1.5mm in females. Histological findings showed that the retromolar nerve extended from the anterior border of the ramus, innervating the retromolar pad and continuing to the buccal gingiva of up to two teeth anteriorly (first molar region). This high percentage of IAN type 1 bifidity (40.4%) suggests it to be a normal anatomical variation of the IAN rather than an anomaly., (Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Approximately 25% of all oral cavity carcinomas involve the lips, and the primary management of these lesions is complete surgical resection. Loss of tissue in the lips after resection is treated with a variety of techniques, depending on the extension and location of the defect. Here we review highly accepted techniques of lip reconstruction and some of new trials with significant clinical results. Reconstruction choice is primarily depend to size of the defect, localization of defect, elasticity of tissues. But patient's age, comorbidities, and motivation are also important. According to the defect location and size, different reconstruction methods can be used. For defects involved less than 30% of lips, primary closures are sufficient. In defects with 35-70% lip involvement, the Karapandzic, Abbe, Estlander, McGregor or Gillies' fan flaps or their modifications can be used. When lip remaining tissues are insufficient, cheek tissue can be used in Webster and Bernard advancement flaps and their various modifications. Deltopectoral or radial forearm free flaps can be options for large defects of the lip extending to the Jaws. To achieve best functional and esthetic results, surgeons should be able to choose most appropriate reconstruction method. Considering defects' size and location, patients' expects and surgeon's ability and knowledge, a variety of flaps are presented in order to reconstruct defects resulted from tumor ablation. It's necessary for surgeons to trace the recent innovations in lip reconstruction to offer best choices to patients.

Context: Despite the ongoing advances in surgical procedures and promising progress in bioengineering techniques, auricular reconstruction remains a significant challenge in plastic surgery. There are different causes for acquired auricular defects, including trauma, tumor ablation and burns. The management options for upper, middle and lower third auricular defects are briefly reviewed in the current paper., Evidence Acquisition: Original research papers investigating the plastic surgeons, otolaryngologists and maxillofacial surgeons in approaching the complicated issue of auricular reconstruction published from January 1995 to December 2014 were aggregated and used in the current study., Results: Utilizing autologous stem cell populations to treat craniofacial defects is a promising field of ongoing investigations. Studies show that cartilage stem/progenitor cells (CSPCs) are highly chondrogenic and can produce elastic reconstructive material with long-term tissue restoration., Conclusions: Auricular reconstruction surgery is a challenging plastic procedure that requires great expertise and expert knowledge of the various techniques available. Novel techniques in the fields of reconstructive bioengineering and regenerative medicine are promising but further research is required before widespread clinical application.

Background: Providing health services is described as an important moral measure, since its major aim is to ensure the welfare of the people who need treatment and care. Moral sensitivity is the ability to identify the existing moral problem and understand the moral consequences of the decisions made on the patient's part. Physicians are always exposed to moral distress due to various circumstances., Objectives: In this survey, we evaluated moral sensitivity and moral distress among physicians and the relationship of these ethical factors on them. Hence, we assessed y relationship between moral sensitivity and moral distress in physicians will facilitate their sound management so as to provide high-quality and safe health services. Moreover it will confirm proposed theories regarding this subject., Materials and Methods: This cross-sectional descriptive-analytic study aimed at investigating the relationship between moral sensitivity and moral distress among 321 specialist physicians working in hospitals affiliated to Tehran Medical Universities in Tehran. The samples were selected through two-stage random cluster sampling method. A three-partite questionnaire comprising of demographic characteristics, moral distress, and moral sensitivity was used for collecting data which then were analyzed using SPSS-20., Results: There was a negative significant relationship between moral sensitivity and moral distress frequency; there was a positive significant relationship between moral sensitivity and moral distress intensity. Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress., Conclusions: Participating in medical ethics courses increased moral sensitivity and decreased the frequency of moral distress.

Purpose: Retrospective studies on the types and causes of facial burns are important because the patterns might vary in different societies. Our aim was to assess the burn-related factors of significance that might be useful in healthcare planning and implementing preventive strategies, adding to the body of current data on the subject., Materials and Methods: A retrospective cross-sectional study was conducted to assess the data from a major burns referral center during a 5-year period (2009 to 2013). The data relevant to age, gender, cause, source, location, burn degree, extent (body surface area [BSA]) of the burns, and mortality were gathered from comprehensive patient medical records, recorded, and analyzed using SPSS, version 20, software (SPSS, Chicago, IL)., Results: Within the study period, we found 808 documented cases of second- and third-degree facial burns. These burns were more common in men (81.9%) and in the 16- to 35-year age group (42.3%). The mean hospitalization was 9.85 ± 8.94 days. In 443 patients (54.83%), 10 to 19% of their BSA was burned, and 3.06% had associated inhalation burns. The most common burn was scalding (19%), and the deadliest was burns from acid, with a mortality rate of 7.4%. Accidents accounted for 776 burns (96.03%). Other causes were attempted homicide (16 cases, 1.98%) and suicide attempts (16 cases, 1.98%). The overall mortality was 1.6%., Conclusions: The key findings were that second- and third-degree facial burns were more common in males aged 16 to 35 years with burns covering 10 to 19% of the BSA. Accidental scalding was commonly responsible for the second-degree burns, and electrical accidents were commonly responsible for third-degree facial burns. Burn accidents occurred more often at the patient's home., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: Bifid mandibular canals (BMCs) are variations of the normal anatomy, with a reported prevalence ranging from 0.08 to 65%. Aberrations of the mandibular canal can have important clinical implications. We therefore sought to assess the prevalence of BMCs and discuss several surgical implications that may be associated with this variation., Materials and Methods: A retrospective chart study of available digital panoramic images from our file archives from 2011 to 2013 was performed to search for the prevalence of BMCs; to this end, 5,000 consecutive panoramic radiographs of patients aged 18 to 80 years were studied. Detection of BMCs was based on visualization of 2 radiolucent lines and at least 3 radiopaque borders on the monitor and confirmed by 2 oral and maxillofacial surgeons and 2 dentists. The types of bifidity also were assessed and recorded. Data analysis was performed using the χ(2) test., Results: BMCs were observed in 61, or 1.2%, of 5,000 digital panoramic images. There were no statistically significant correlations found regarding age or gender. The most frequently encountered type of bifid canal was type 2 (82%)., Conclusions: The prevalence of BMCs seen on panoramic images in this study was 1.2% and was not correlated with age or gender., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Endoscopic carpal tunnel release (ECTR) has gained recognition as an alternative to the current gold standard, the open carpal tunnel release (OCTR). Detailed technical points for the ECTR have not been explained in the literature, especially for surgeons who are considering trying this technique., Objectives: In this paper, we present our 5-year experience with the ECTR and special emphasis will be placed on less frequently discussed technical points, such as the optimal site to make the skin incision and the signs to look for in a completely divided retinaculum., Patients and Methods: In this prospective nonrandomized clinical trial, 176 patients with carpal tunnel syndrome who underwent surgical operation using the Agee uni-portal endoscopic carpal tunnel release technique, over a period of 5 years, were included. The "Hand Questionnaire", a standard questionnaire for hand surgery, was used to evaluate the patients at one, three, six and twelve month post-operative time points. Pain and scar tenderness were measured using the visual analog scale system. We propose the 'most proximally present wrist crease' for the skin incision and the 'proximal to distal sequential division of the retinaculum' as our methods of choice. Two signs, named 'railroad' and 'drop in', are proposed and these will be discussed in detail as hallmarks of complete retinaculum release., Results: Of the 176 patients who underwent the ECTR operation, 164 cases (93.2%) had no or very little pain at the one year postoperative visit, and nearly all of the patients reported no relapse of symptoms at the previously mentioned postoperative time points. Patient satisfaction and functional recovery was comparable to other published ECTR studies, and showed better short-term results of this technique over the OCTR. One deep seated infection, three cases of transient index finger paresthesia due to scope pressure on the median nerve, and one case of median nerve branch transection, were observed. Scar complications, including; tenderness, redness and pain, were significantly lower in the proximally placed incision in comparison with the distally placed incision (P < 0.005)., Conclusions: The 'most proximally present wrist crease' and the 'distal to proximal division of the retinaculum' using the two signs of 'railroad' and 'drop in' to confirm a complete division of retinaculum are proposed techniques that should be considered in order to produce good outcomes in ECTR. The 'railroad' sign is the parallel standing of the retinaculum edges, and the 'drop in' sign is the dropping of the retinaculum edge into the scope denote a completely divided retinaculum.

Background: This multicenter study assessed the demographics, prevalence, causes, types, treatment, and complications of maxillofacial (MF) fractures managed by MF surgeons nationwide., Methods: This 5-year retrospective descriptive analytical chart study evaluated 8,818 patients treated for MF fractures from 2007 to 2012 at 11 medical centers. Parameters, including age, sex, cause of injury, site of injury, type of injury, fracture patterns, treatment modalities, and complications, were evaluated from patient charts and radiographs. Collected data were analyzed via t test or χ test using SPSS 20 (Chicago, IL). A p value of less than 0.05 was considered statistically significant. This retrospective chart study was exempt from institutional review board approval., Results: There were 7,369 male patients (83.6%), 1,376 female patients (15.7%), and 73 patients (0.8%) of unknown sex (aged 6 months to 112 years); 39.54% (3,457 patients) were in the 21-year to 30-year age group (mean, 28.18 years). We found 5,737 mandibular fractures (65.1%); mandible fracture was the most common (p < 0.05), followed by maxillary (1,641, 18.6%), zygomatic (3,240, 36.0%), orbital floor (743, 8.4%), naso-orbitoethmoidal (472, 5.4%), nasal (848, 9.6%), and frontal (344, 3.9%) fractures. Road traffic accidents were the most common cause. Posttreatment documented complications included remaining neurosensory disturbance of the inferior alveolar nerve (16.01%) and the infraorbital nerve (15.5%), remaining neuromotor disturbance of the facial nerve (2.3%), blurred vision (2.43%), diplopia (3.2%), limitation of eye movement (1.6%), exophthalmoses (1.88%), blindness (0.8%), as well as postoperative infection and chronic osteomyelitis (1.0%)., Conclusion: On the basis of our study, mandibular fractures, in males and resulting from road traffic accidents in the third decade of life, were significant findings. Although the prevalence of MF fractures, demographics, and causes vary from one country to another and awareness of these patterns can provide insight to prevention protocols, this study shows that, despite better law enforcement of traffic regulations, better roads, better automobiles, and the like, the pattern of MF fractures in Iran has not changed significantly during the past 10 years., Level of Evidence: Epidemiologic study, level IV.

Purposes: The aim of this study was to evaluate the role of opium in causing oral cancer., Patients and Methods: Eighty patients and 80 selected matched controls who were referred to the ear-nose-throat department of an academic hospital were included in this study between October 2008 and September 2010. In addition to demographic data, information regarding alcohol, tobacco, and opium use was documented in the subjects. Finally, the effect of each risk factor was assessed., Results: There was no significant difference in patient demographics between the 2 groups. Smoking (P = 0.042) and poor oral hygiene (P = 0.016) significantly correlated with cancer. Finally, opium addiction showed a significant relationship with oral cavity cancer with an odds ratio of 4 (95% confidence interval, 1.2-13.6)., Conclusion: Opium use is among the possible risk factors for oral cancer.

Purpose: Compared with other maxillofacial lesions, oral and maxillofacial (OM) aneurysmal bone cysts (ABCs) are rare, and most studies have been case reports. Because the features or radiographic findings of 1 case could not be representative of the whole, conclusions cannot be drawn and data analyses will not be feasible. Our aim was to assess and describe the clinical and histopathologic characteristics of a large sample of subjects with ABCs. To our knowledge, the present case series of OM ABCs is the largest ever reported., Materials and Methods: To address our research purpose, we designed and implemented a retrospective case series. A multicenter retrospective cohort study of patient charts dated from 1967 to 2013 (46 years) at 10 major universities in 8 cities was undertaken to assess OM ABCs nationwide. Subjects were included if they had documented chart data and definitive histopathologic slides confirming the diagnosis and treatment of ABC. They were excluded if their histopathologic slides did not confirm the diagnosis of an ABC. Data were collected, and special forms were completed. Variables such as age, gender, site (ie, maxilla, mandible, anterior, posterior), histologic type (ie, solid, mixed, vascular), signs, symptoms, radiographic features (ie, radiolucency, unicystic or multilocular), and outcomes (ie, treatment modal, recurrence, complications) of the lesion were evaluated and documented by OM surgeons and confirmed by OM pathologists for assurance. Data analyses were performed using Statistical Package for Social Sciences, version 20, software (SPSS, Chicago, IL) (P < .05)., Results: We assessed the medical records and histopathologic slides of 120 patients diagnosed and treated for OM ABCs nationwide. Of these patients, 69 were male (57.5%) and 51 were female (42.5%), with no predilection found. The key findings were as follows. The mean age of occurrence was 20.7 ± 2.5 years (range 4 to 78), and occurrence was significantly greater in the first 2 decades of life (P < .001). The incidence was 2.6 cases/year. ABCs were significantly more common in the mandible (P < .05) and posterior areas (P < .05). The most common histopathologic type was the mixed type (P < .05). Firm swelling was the most common clinical presentation (P < .05); all cases were radiolucent and commonly unilateral (P < .05). Most were treated by excision and curettage. Recurrence was reported in 11 patients (9.2%) during the follow-up period (1 to 45 years)., Conclusions: The present retrospective cohort found ABCs with a variable presentation, disease course, and histopathologic type, with no gender predilection. ABCs were significantly more common in childhood and adolescence and in the mandible and posterior areas of the jaws. Of the cases reviewed, 90% were treated by excision and curettage. ABCs had a relatively low recurrence rate (<10%), precluding the need to perform aggressive surgery primarily., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Hydatid disease is a cyclozoonotic infection caused by the cestode genus Echinococcus. It occurs throughout the world and is especially common in sheep- and cattle-raising regions of Africa, Australia, New Zealand, India, the Middle East, South America, and the Mediterranean. The incidence of humans infected with hydatid disease is approximately 1-2:1000. It is higher in rural areas. Infection occurs via ingestion of infected meat. Hydatidosis is caused by sheep and cattle ingesting tapeworm eggs in dog feces. These eggs hatch in the duodenum and invade the liver, lungs, or bones of sheep and cattle. Humans are infected by ingesting the infected meat from these animals. In the organs, the embryo transforms into a cyst, which develops the germinal epithelium that produces capsules, larval forms, and eventually the infectious scolices. Although hydatid cyst of the pancreas is rare, it must be considered in the differential diagnosis of pancreatic lesions. We present a rare case.

Aims: In Iranian traditional medicine Anbarnesa (derived from smoke from burning female donkey's stool) has been used to treat ulcers and inflammatory conditions like stomatitis and ear infections (otitis). We assess the properties of Anbarnesa as an alternative mouthwash., Materials and Methods: In this experimental study, Anbarnesa smoke was analyzed using aGC-mass device. The smoke collected was dissolved at different densities in propylene glycol and incubated in Dulbecco's modified Eagle's medium in direct contact with fibroblast cells. Assessment of cytotoxicity was done at 1, 24 and 72 h. Cell viability was measured by methyl thiazolyl tetrazolium test, and ELISA Reader machine was used to read the results. Data were analyzed using one-way ANOVA test., Results: The findings of this study showed Anbarnesa was nontoxic in 1/64, 1/128 and 1/256 dilutions. In 1/32 dilution, toxicity was seen after 72 h. In dilutions, 1/8 and 1/16 toxicity were seen in the 1(st) h., Conclusion: According to the initial results of Anbarnesa may be used as an alternative mouthwash with fewer side-effects for plaque control and prevention of periodontal disease.

Background: Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a well-known challenging entity warranting management. Platelet-Rich Plasma (PRP) plays an important role in bone biology by enhancing bone repair and regeneration., Objectives: The aim of this animal study was to evaluate the effects of PRP on zoledronic acid-induced BRONJ., Materials and Methods: Seven rats were given 0.04 mg Zoledronic acid intravenously once a week for five weeks. Two weeks later, the animals underwent extraction of their first lower molars, bilaterally. After clinical confirmation of the osteonecrosis, PRP was injected randomly into one of the extraction sockets of each rat. Three weeks later, all rats were sacrificed in order to obtain histological sections. The analysis of epithelialization was performed by McNamar's test, and the analysis of osteogenesis and angiogenesis was performed by the Wilcoxon Sign Rank test. P value was set at 0.05., Results: We found no significant differences between the two groups regarding the amount of epithelialization, angiogenesis or sequestrum formation (P > 0.05), but a significant difference was seen between the two groups regarding the amount of existing vital bone (P < 0.05)., Conclusions: Our study demonstrates positive results (preservation or regeneration of bone) using PRP in treatment of BRONJ. Although PRP may enhance osseous regeneration, long-term follow-ups are required to confirm its benefits.

Purpose: Perforation of the nasal septum is a frustrating problem frequently reported in the literature. Surprisingly, in most reports, iatrogenic perforation during septoplasty and electrocautery are the leading causes of this complication. This article presents the management of septal perforations and the indications for an extracorporeal approach., Materials and Methods: Fourteen patients with septal perforations were referred for treatment. Treatment was chosen based on defect size. Flaps, extracorporeal repair, or no treatment was used as indicated., Results: Two of 14 perforations were small and were repaired by local flaps, 5 cases were treated by extracorporeal repair, and the 7 remaining cases required no surgical procedure., Conclusions: The extracorporeal technique, when indicated, can be used effectively for the repair of nasal septum perforations in selected cases., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)