Evaluation of the potential risk of benign paroxysmal positional vertigo due to traumatic effect of osteotomy in septorhinoplasty patients. Publication date: Available online 26 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Suha Ertugrul, Malik Abacı, Emre Soylemez Abstract Purpose To investigate the effect of osteotomy on the vestibular system in septorhinoplasty patients and to determine the potential risk of benign paroxysmal positional vertigo (BPPV) occurrence in these patients. Methods In this prospective study, 48 primary septorhinoplasty patients were evaluated as the study group and 50 septoplasty patients as the control group. Osteotomy was performed in all septorhinoplasty patients. No hammer and osteotomes were used in the control group. All patients underwent static balance tests (tandem stance test, one-leg standing test, and Romberg test), dynamic balance tests (tandem walking test and Fukuda test), positional balance tests (Dix-Hallpike test and supine roll test), head impulse test (HIT), and the adult dizziness handicap inventory (ADHI) preoperatively and during the first postoperative week. Results No significant differences were found between the two groups in terms of static balance tests, dynamic balance tests, positional balance tests, and head impulse test results. Postoperative ADHI scores were significantly worse in the septorhinoplasty patient group than in the control group. Posterior semicircular canal BPPV was observed in 2 patients in the septorhinoplasty patient group but no cases occurred in the control group. Conclusion BPPV is one of the possible early postoperative complications of rhinoplasty. In patients with vertigo after rhinoplasty, surgeons should evaluate the semicircular canals using the Dix-Hallpike test and supine roll test. In order to avoid the traumatic effect of osteotomy reflected on the inner ear, attention should be paid to the applied force and sharp osteotomes should be used.

Clinical effect of virtual reality to relieve anxiety during impacted mandibular third molar extraction under local anesthesia Publication date: Available online 26 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Yoshio Yamashita, Daiji Shimohira, Reona Aijima, Kesuke Mori, Atsushi Danjo Abstract Purpose Many patients undergoing dental treatment have experienced pain associated with treatment, and they are anxious or fearful of treatment. Anxiety and fear have conventionally been dealt with by the use of inhalation anesthesia or tranquilizers, but their physical effects must also be considered, and they are not suitable for all patients. The purpose of this study was to assess the clinical effect of virtual reality (VR) to relieve anxiety during impacted mandibular third molar extraction under local anesthesia Methods We used VR to alleviate anxiety concerning surgical treatment in 51 patients undergoing impacted mandibular third molar extraction under local anesthesia. Fear and anxiety before and after treatment were evaluated by a questionnaire that included a visual analog scale (VAS). The post-treatment questionnaire asked patients to evaluate their satisfaction on a five level Likert scale. Heart rate variability (HRV) was also analyzed in the VR group using an acceleration plethysmograph (APG) Results Anxiety improved among patients who used VR (VR group), with a difference of –13.3 ± 28.7 mm in anxiety measured using a visual analog scale between before and during treatment, whereas it increased by 4.0 ± 22.3 mm in 49 patients who did not use VR. Furthermore, a post-treatment questionnaire using a five-point evaluation scale was administered to the VR group, and 92% reported that their anxiety had decreased. Objective evaluation by HRV measurement also showed a sympathetic nerve-predominant state before treatment, but during VR use during treatment, parasympathetic nervous activity was predominant, with a stable balance between the two. No patient showed symptoms suggestive of cybersickness. Conclusions These results demonstrate that VR may be valuable in dental treatment, particularly extractions, and surgical treatment.

A retrospective cohort study of risk factors for descending necrotizing mediastinitis caused by multi-spaces infection in the maxillofacial region Publication date: Available online 26 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Luyao Qu, Hongyuan Xu, Xiang Liang, Xieyi Cai, Weijie Zhang, Wentao Qian Abstract: PURPOSE Descending necrotizing mediastinitis (DNM) was the most common life threatening complication of multi-space infection (MSI)in the maxillofacial region due to a lack of timely diagnosis and treatment. We assessed the clinical characteristics and diagnosis of odontogenic MSI and evaluated the risk factors for DNM caused by MSI. METHODS We performed a retrospective cohort study, of inpatients with MSI in the maxillofacial region, from January 2012 to October 2016. Patients were classified into a non-DNM group and a secondary DNM group. The information collected included sex, age, systemic comorbidities, source of maxillofacial infection, the computed tomography imaging data, and laboratory tests. Univariate analysis(test or t’ test and χ2 test, or Fisher’s exact test) and logistic regression analysis were applied. RESULTS A total of 296 patients were included. The mortality was 6.3%. In univariate analysis , sex (p = 0.001); age (p = 0.003); source of infection (p = 0.004); number of affected spaces (p < 0.001); parotid space (p < 0.001), submandibular space (p <0 .001), subgingival space (p < 0.001), pterygomandibular space (p < 0.001), parapharyngeal space (p < 0.001), retropharyngeal space (p < 0.001) involvement; and percentage of neutrophils (p < 0.001) significant. In multivariate analysis, parapharyngeal space (p = 0.008), source of infection (p = 0.037), and number of affected spaces (p<0.001) were statistically significant. CONCLUSIONS Glandular infection, parapharyngeal space involvement, and multiple affected spaces were risk for DNM. Clinicians should vigilantly watch for these factors in clinical treatment, and effective measures should be taken to prevent the occurrence of DNM as soon as possible.

Augmented reality technology could be an alternative method to treat craniomaxillofacial foreign bodies: A comparative study between augmented reality technology and navigation technology Publication date: Available online 26 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Jie Yao, Wei Zeng, Shanluo Zhou, Jie Cheng, Chenyu Huang, Wei Tang Abstract Purpose Removal of foreign bodies in the craniomaxillofacial region is challenging. The purpose of this study was to explore the feasibility of using augmented reality (AR) technology to treat craniomaxillofacial foreign bodies. Methods A prospective study in patients with granular metal foreign bodies retained in the craniomaxillofacial region from March 2017 to March 2019 was performed. AR technology and navigation technology were both employed to localize foreign bodies. The face was divided into the upper and lower part by the ala-tragus line. In group A, navigation technology was used to locate foreign bodies in the upper face; it was used in the lower face in group B. Similarly, AR technology group was used in the upper face in group C, in the lower face in group D. The primary predictor variable was technology type. The primary outcome variables were positioning deviation and the time used for surface positioning. Paired T test and independent-samples T test were used for statistical analysis. Results Five patients with 24 craniomaxillofacial foreign bodies were included. The positioning deviation of navigation technology (1.42±0.49 mm) did not differ from that of AR technology (1.52±0.58 mm) (p=0.116). The positioning deviation of the groups were 1.01±0.37 mm (A), 1.73±0.29 mm (B), 1.02±0.44 mm (C), and 1.89±0.36 mm (D). Groups A and B were significant different (p<0.01), as were groups C and D (p<0.01). The time used to position the two technologies was significantly different (10.04±2.88 s for navigation technology and 3.46±0.83 s for AR technology) (p<0.01). Conclusion AR technology positioning is similar to that of navigation technology, but it does not need an invasive registration device and provides real-time dynamic image guidance. AR technology could be an alternative method for treating foreign bodies in the craniomaxillofacial region.

Improving accuracy of jaw reconstruction based on gender differences Publication date: Available online 21 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Xiangyang Zhu, Jing Han, Zijie Zhou, Xiongkuo Min, Qiaoyu Zhang, Jiannan liu, Guangtao Zhai Abstract Purpose The aim of this study was to re-determine the position of the key points (skeletal marker points) in severely damaged female and male jaw, thus improving the accuracy of jaw reconstruction. Materials and Methods In order to develop a personalized jaw reconstruction guidance program for each patient, we first made 3 statistics to compare the gender differences of jaw, and then we proposed and compared 3 methods to restore key skeletal marker points of the damaged jaw according to our statistics. Results 111 groups of CT data of the jaw were collected from normal people as experimental materials. Depending on our statistics, gender differences existed in the shape of the jaw. In addition, some key angles and distances of jaw satisfied Gaussian distribution. The reconstruction results showed that our methods had a better effect than the widely used method. Conclusion In order to reduce errors, gender differences should be considered when designing a reconstruction approach of the jaw. In addition, our methods can improve the accuracy of reconstruction of the jaw.

In-House Surgeon-lead Virtual Surgical Planning for Maxillofacial Reconstruction Publication date: Available online 21 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Haider Abo Sharkh, Nicholas Makhoul Abstract Purpose Virtual surgical planning (VSP) and custom fabricated cutting guides for maxillofacial reconstruction have been demonstrated to improve the accuracy of bony reconstruction, overall surgical efficiency, and decrease ischemia time. Our aim is to demonstrate an in-house VSP technique for maxillofacial reconstructive procedures. Methods We used two free software applications. 3DSlicer © was used to extract the bones of interest for the recipient and the donor sites from the CT scan DICOM (Digital Imaging and Communication in Medicine) data. Autodesk Meshmixer © was used to perform the virtual surgical planning and fabrication of the cutting guides. A reconstructed jaw model was printed in-house using commercially available fused deposition modeling (FDM) based desktop 3D printer (Qidi Technology ©) and used to pre-bend the reconstruction plate. The cutting guides were printed using commercially available resin based stereolithography apparatus (SLA) desktop 3D printer (Form 2, Formlabs ©; Dental SG Resin) to allow for sterilization of the guides. We performed this technique on 19 consecutive patients with maxillofacial benign and/or malignant tumours requiring microvascular bony reconstruction. We calculated the average time and associated costs using this in-house VSP technique. Results The technique was found to be simple and repeatable. The average time for VSP is 158 minutes (2 hours and 38 minutes). The average cost for printing the reconstructed model per case is $5.21 CAD (Canadian Dollars), and the average cost for printing the cutting guides per case is $12.80 CAD. Conclusion Using this technique, in-house VSP and 3D printing can be performed by the treating surgeon, without prior engineering background, in a reasonable amount of time.

Factors associated with low and high article citations in the oral and maxillofacial surgery literature Publication date: Available online 20 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Victor T. Warren, K. Tuck Borie, Timothy C. Kreger, Kimberly D. Martin, Carter J. Boyd Abstract Objective To assess factors in published oral and maxillofacial surgery (OMS) articles that are associated with number of citations. Methods We identified all primary research articles published between 1998-2008 in the International Journal of Oral and Maxillofacial Surgery, Journal of Oral Maxillofacial Surgery, British Journal of Oral Maxillofacial Surgery, and Journal of Craniomaxillofacial Surgery. 66 articles obtained only 0-3 citations in the 10 years following publication. We compared these lowest-cited articles to the 66 highest-cited articles. Characteristics of the lowest and highest cited articles were compared using bivariate analysis. Logistic regression analysis using generalized estimating equations was conducted to examine the association between selected article-, author- and journal-level characteristics and being highly-cited. Results In initial bivariate analysis, highly-cited articles were associated with greater abstract and manuscript word counts (p<0.0001), manuscript pages (p<0.0001), figures (p=0.0482), sample sizes (p=0.0149), and references (p<0.0001). They were more likely to report a significant result (p=0.0202), be published in JOMS (p=0.0405) and cover topics such as Dentoalveolar/Implantology and Trauma/Reconstruction (p=0.0002). Lowly-cited articles were more likely to be published in BJOMS (p=0.0405) and address topics unrelated to core OMS procedures (p=0.0002). H-indexes of first and corresponding authors were greater in the high citations group (p<0.0001). Following multivariate analysis, greater number of manuscript pages (p=0.0015) and paper classification as Dentoalveolar/Implantology (p=0.0017) or Trauma/Reconstruction (p=0.0368) had higher odds of being highly-cited. In addition, higher H-index of the first author also made it more likely to be found in the high citations group (p=0.0397). Conclusions There are relatively few articles in the OMS literature that fail to produce citations in the 10 years following publication indicating that most articles accepted for publication provide meaningful contributions. There are significant differences between the highest and lowest cited publications suggesting that study design and article structure may influence its audience and impact.

Expanded Transoral Microvascular Mandibular Reconstruction: A Scar-free Approach Publication date: Available online 20 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Jian Sun, Jun Li, Ming-ming Lv, Liang Wang, Anand Gupta, Yi Shen Abstract Background We present our experience with transoral segmental mandibulectomy, in conjunction with vascularized osseous mandibular reconstruction, utilizing an intraoral anastomosis and free of extraoral incisions. Virtual surgical planning (VSP) and intra-operative navigation were used to help achieve this minimally invasive and scar-free approach. Additionally, we performed a cadaver dissection to highlight relevant anatomic details of the facial artery and vein. Methods Between January 2018 and October 2018, transoral segmental mandibulectomy followed by vascularized osseous reconstruction using an intraoral anastomosis was performed on 9 patients. Pre-operative VSP and intra-operative navigation were used in all cases. The anastomotic recipient vessels were the facial artery and vein. Postoperative panoramic radiographs and CT images were obtained for assessment of the neo-mandible. Results Successful transoral segmental mandibulectomy was achieved in 9 patients, with an intraoral anastomosis successfully achieved in 8 patients. In one patient, an extraoral anastomosis was required because of challenging facial vein anatomy. Both recipient and donor sites healed uneventfully. In all cases, a well positioned neo-mandible with good occlusion was demonstrated on postoperative imaging and exam. A symmetric facial appearance with no restrictions in mouth opening was also achieved in each case. Conclusions Transoral segmental mandibulectomy combined with intraoral microvascular mandibular reconstruction is a surgically achievable technique with the benefit of being scar free. In our cadaver dissection, we describe the anatomical course of the facial artery and vein. An average angle of 30 degrees between these vessels is identified.

Communities with Bikeshare Programs may have a Lower Risk for Bicycle-Related Maxillofacial Injuries: Results from an Early Adopter of Bikeshare Programs Publication date: Available online 20 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Marcus J. Hwang, Thomas B. Dodson, Jasjit K. Dillon Abstract Purpose While bikeshare programs may relieve traffic congestion, concerns for cyclist safety have been reported secondarily to low frequency of helmet use observed among bikeshare users. The purpose of this study is to measure and compare the risk of cycling-related maxillofacial injuries in communities with and without bikeshare programs. Materials and methods The investigators designed a retrospective cohort study and enrolled a sample of patients presenting to a level 1 trauma center for evaluation of bicycle-related injuries. The primary predictor variable was a community’s status regarding bikeshare programs, coded as present or absent. The primary outcome variable was the presence of a facial injury, coded as present or absent. Other study variables include demographic and injury-related parameters. Uni-, bi-, and multivariate statistics were computed, and statistical significance was set at p < 0.05. Results The study sample was composed of 1346 subjects. There were 507 (37.7%) subjects injured in communities with bikeshare systems, and facial injuries were present in 305 (22.7%) subjects. Facial injuries were less common in subjects injured in communities with bikeshare than among subjects injured in communities without bikeshare, 18.1 versus 25.4% (relative risk = 0.7; p = 0.002). Conclusion Contrary to expectations, bicyclists injured in communities with bikeshare programs had a 30% decreased risk for maxillofacial injuries when compared to communities without bikeshare programs.This finding may be partially explained by the low performance associated with current bikeshare bicycles.

Regeneration of the neocondyle following fibular free flap reconstruction of the mandibular condyle Publication date: Available online 20 November 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Yao Yu, Wen-Bo Zhang, Xiao-Jing Liu, Chuan-Bin Guo, Guang-Yan Yu, Xin Peng Abstract Purpose Shifting of the flap position after condylar reconstruction with free fibular flaps is known to occur, but its long-term effects on postoperative esthetic outcomes have not been sufficiently reported. Therefore, in this study, we evaluated the long-term morphological stability of the free fibula flap neocondyle. Methods This is a retrospective cohort study. The primary outcome variables were neocondyle regeneration and neocondyle position including Fo-Co (distance between the glenoid fossa and the initial neocondyle), Fo-Co’ (distance between the glenoid fossa and the stable neocondyle) and shifting of the neocondyle (distance between the stable neocondyle and the initial neocondyle). The primary predictor variable was time. The other variables were age, sex, diagnosis and fibula segments. Correlation analysis between the predictor variables and outcome variables was performed. Results The sample was composed of 26 subjects with a mean age of 31 years (11 males and 15 females). Diagnosis and number of fibular segments were significantly associated with Fo-Co and Fo-Co’ (P < 0.05). Among the 26 patients, only 11 showed neocondyle regeneration on follow-up (Group A), whereas 15 did not (Group B). Neocondyle regeneration was significantly associated with patient age (P < 0.01). Stable Fo-Co and stable time were significantly associated with neocondyle regeneration (P < 0.05). The stable time was significantly shorter in group A (3.64 ± 1.12 months) than in group B (6.67 ± 3.85 months) (P < 0.05), and the mean Fo-Co’ was significantly shorter in group A (13.65 ± 3.94 mm) than in group B (20.68 ± 8.87 mm) (P < 0.05). Conclusion The possibility of neocondyle regeneration is higher in pediatric patients than in adults. Neocondyle regeneration could result in the movement of the neocondyle toward the glenoid fossa with shorter stable time, which could improve neocondyle repositioning. Repositioning of the neocondyle with free fibula flap for mandibular condyle defects is a self-adaption process for TMJ function.