Can aerosols-generating dental, oral and maxillofacial, and orthopedic surgical procedures lead to disease transmission? An implication on the current COVID-19 pandemic.

Various dental, maxillofacial, and orthopedic surgical procedures (DMOSP) have been known to produce bioaerosols, that can lead to the transmission of various infectious diseases. Hence, a systematic review (SR) aimed at generating evidence of aerosols generating DMOSP that can result in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), further investigating their infectivity and assessing the role of enhanced personal protective equipment (PPE) an essential to preventing the spreading of SARS-CoV-2 during aerosol-generating procedures (AGPs). This SR was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) guidelines based on a well-designed Population, Intervention, Comparison, Outcomes and Study (PICOS) framework, and various databases were searched to retrieve the studies which assessed potential aerosolization during DMOSP. This SR included 80 studies (59 dental and 21 orthopedic) with 7 SR, 47 humans, 5 cadaveric, 16 experimental, and 5 animal studies that confirmed the generation of small-sized < 5 µm particles in DMOSP. One study confirmed that HIV could be transmitted by aerosolized blood generated by an electric saw and bur. There is sufficient evidence that DMOSP generates an ample amount of bioaerosols, but the infectivity of these bioaerosols to transmit diseases like SARS-CoV-2 generates very weak evidence but still, this should be considered. Confirmation through isolation and culture of viable virus in the clinical environment should be pursued. An evidence provided by the current review was gathered by extrapolation from available experimental and empirical evidence not based on SARS-CoV-2. The results of the present review, therefore, should be interpreted with great caution.

Mucormycosis of the bones of the facial skull, nasal cavity and paranasal sinuses in patients with COVID-19.

Currently, the relevance of the issues of diagnosis and treatment of invasive fungal diseases has increased significantly due to the pandemic of a new coronavirus infection COVID-19 and the massive use of corticosteroids for the treatment. The key success factors in the outcome of invasive fungal diseases are early diagnosis and treatment, including the applying of an adequate systemic antifungal therapy and surgical treatment. Extensive areas of mycotic lesions of the facial bones and paranasal sinuses are life-threatening conditions due to anatomical proximity to brain structures and a high risk of dissemination of I invasive fungal diseases with a fatal outcome. The objective of this work was to study the risk factors, possible pathogenesis, diagnosis and treatment strategy of invasive fungal diseases of the orofacial region in convalescents of COVID-19. We present case-series data on six patients in the clinics of maxillofacial surgery and otorhinolaryngology of the Pavlov First Saint Petersburg State Medical University over the period of 2021-2022. Predisposing factors, clinical and radiological symptoms, features of diagnosis, therapy and surgical strategy were analyzed. The presented observations confirm the relevance and danger of complications after a COVID-19 in the form of the development of invasive fungal diseases with damage to the maxillofacial region caused by mucormycetes and Aspergillus spp., as well as importance of early diagnosis and treatment.Copyright © 2021, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.

Use of a webinar series to improve exposure to oral & maxillofacial surgery during a global pandemic

Exposure to OMFS at undergraduate level is rare. Students seeking such exposure often struggle to access important information that would help them decide about a future career in OMFS. The COVID-19 pandemic has made access to such information, for example career workshops and specialty conferences, more difficult. This paper discusses our experiences of setting up an online webinar series aimed at providing practical advice for undergraduates and early trainees interested in the field of OMFS. Clinicians were approached via email and/or social media to deliver a structured programme of key advice and guidance about OMFS. Individual undergraduate and surgical societies were emailed in order to advertise the series which included talks such as 'Week in the Life', 'Subspecialties' and 'Portfolio Building'. An interactive poster containing a Quick Response code was circulated to allow a streamlined registration process. The seminars were held via Zoom videoconferencing software and feedback collated via Typeform using a Likert-scale questionnaire. On average, the webinars were 60 minutes long and each attracted 53 attendees. The series attracted 183 unique participants. The majority of attendees were dental students and 85% were based in the UK. Overall, 94% felt their knowledge of the specialty had improved and 86% were more likely to consider pursuing OMFS as a career as result of the series. This paper shows that videoconferencing is a useful modality to engage with junior trainees and has a wide reach. These benefits must be harnessed going forward to improve access and exposure to OMFS in early trainees.Copyright © 2022 The Authors

Principles of management for patients with oral cancer during the COVID-19 pandemic

The outbreak of coronavirus disease 2019 (COVID-19) affects the world. It is highly contagious and spreads quickly. COVID-19 severely increases the medical burden and interferes with our normal work. This article introduces our experience on treat oral cancer patients during the epidemic. The negative impact can be minimized through reasonable and orderly arrangement.Copyright © 2021 The Authors

Impact of COVID-19 pandemic on oral and maxillofacial surgery in Japan: A report from a questionnaire survey during the different phases of the pandemic

COVID-19 pandemic has provided a new challenge to healthcare systems and medical care providers. In the current study, we describe the challenges faced and actions taken to provide optimum healthcare in Japan during the COVID-19 pandemic based on the results of a questionnaire survey that was conducted by oral and maxillofacial surgeons. A total of 24 Japanese institutions participated in the study. The first survey was conducted between June 22, 2020 and June 26, 2020, and the second survey was conducted between October 23, 2020 and November 8, 2020. The questionnaire focused on the practical situation in the respondent's hospital, personal protective equipment (PPE) availability, and what alterations had occurred compared to the situation before the COVID-19 pandemic. The commonest reported duration of restrictions to the outpatient clinic was 1-2 months. All of the institutions had lifted their restrictions on outpatient services by September 2020. Surgical procedures in the operating room were restricted in 74% of hospitals in the first wave of the pandemic;however, 88% lifted their restrictions and restarted their regular surgical services by November 2020. Although, non-urgent or elective procedures were delayed, surgeries for malignant tumors, maxillofacial infections, and trauma were performed at almost all hospitals during the pandemic. Health care institutions will require a new approach to maintain patient volume and recover from the pandemic. Going forward, it is also necessary to minimize the risk of exposure and transmission to health care personnel as well as patients.Copyright © 2021 The Authors

POSTCOVID NECROSIS OF THE MAXILLOFACIAL REGION.

The analysis of a clinical case with osteonecrosis of the maxillofacial region, which was a manifestation of a complication of a COVID-19 coronavirus infection, to show the diagnostic capabilities of computed tomography followed by multiplanar and 3D reconstructions. Materials and methods. Clinical observation of patient R. 53 years old is presented, with complaints of pain, painful swelling of the soft tissues of the right suborbital area, painfulness during chewing, which appeared in the early period after COVID-19. The patient was referred to the Department of Oral and Maxillofacial Surgery where she underwent comprehensive radiological examination to determine the nature of the changes and comprehensive treatment. Results. The diagnosis of osteonecrosis with the progression to the soft tissue suppuration and upper jaw destruction was verified by CT scan and confirmed by surgical intervention. Detection and detailed diagnosis of these changes was facilitated by multispiral computed tomography and 3D reconstructions during the follow-up. Discussion. COVID-19 coronavirus infection can be complicated by necrosis of the skeletal bones, including the jaw, which can be diagnosed with radiology methods. Various radiological methods can be used to diagnose this pathology, but CT scan of the maxillofacial region is the most informative. Conclusion. CT of the skull bones and facial skeleton in patients with osteonecrosis of the maxillofacial region provides complete diagnostic information about the localization and distribution of the lesion, which determines the further tactics of patient management taking into account the detected changes. As a result, timely initiated adequate treatment helped to cope with the progressing protracted pathological process of the maxillofacial region, which was a manifestation of a complication of the recent COVID-19 coronavirus infection.Copyright © 2022 Russian Electronic Journal of Radiology. All rights reserved.

Assessing the implementation of guidelines surrounding aerosol generating procedures

This paper assesses the changing guidelines regarding Aerosol Generating Procedures and fallow time in Oral and Maxillofacial Surgery Departments in the UK. Many departments have variable local policies and protocols and this could be a contributing factor in increased waiting lists for patients during a time when patients have less access to primary and secondary care.Copyright © 2021

Effect of coronavirus pandemic on oral and maxillofacial surgical education and training: Developing standards for effective online training

Oral and maxillofacial surgery deals with the diagnosis and treatment of dentofacial problems and usually requires a four year specialized training after a bachelor's degree in dental surgery. The COVID 19 pandemic in early 2020 led to disruptions in the training programs worldwide and urged the supervisors and faculty to devise ways and means to continue the residents' learning experience utilizing different online teaching modalities. An account of some strategies for developing standards for effective online training to equip oral and maxillofacial training programs for similar future emergencies.Copyright © 2022 The Authors

The dental office: A safe place against COVID19 and other future pandemics

Background: The pandemic caused by the spread of COVID19 generated throughout the world great changes in all areas of life. Social distancing was carried out very drastically in some countries, and even in the field of dental care, some countries prohibited the practice of dentistry. Objective(s): To demonstrate that the dental office is safe regarding the possibility of contagion of Sars-Cov-2 as long as good biosecurity protocols are used. Method(s): A structured survey of 19 questions was applied to 103 patients who subsequently attended a periodontics and oral and maxillofacial surgery office in Mexico, to receive care from these specialties between April 2020 and July 2021. The questions posed in this survey were aimed at knowing the opinion of the patients regarding the measures that this establishment has for the prevention of the transmission of COVID19, as well as questions regarding the possible effects of attending this office in contagion of the disease from patients and their families. Result(s): A total of 18 (17.5%) patients reported having suffered COVID19, and none reported that they fell ill after the consultation. None of the clinic's specialists and assistants have fallen ill with COVID-19 during the pandemic. Conclusion(s): It is not necessary to suspend or condition dental care during times of pandemics such as what happened with COVID19, as long as strict safety protocols are observed within clinical facilities.Copyright © 2022 The Authors

Dental Student's Satisfaction with the Video-assisted Educational Approach in Teaching Oral and Maxillofacial Surgery Principles

BACKGROUND: Educating dental students in practical skills are a difficult task that has become increasingly demanding since the outbreak of COVID-19. Today, the use of digital media plays an essential role in teaching practical skills. AIM: This study investigated the effect of educational videos on oral and maxillofacial surgery basics on dental student's satisfaction. METHOD(S): Six subjects were chosen from the principles of oral and maxillofacial surgery, and according to the necessary standards, educational videos were made based on the needs assessment of students. Fellow attending evaluated and approved each video. Students were shown videos in six 2-h sessions. Students were given a researcher-created questionnaire with proven validity and reliability. Students filled out questionnaires to evaluate the impact of educational videos as well as the structure of educational videos. RESULT(S): Two hundred and three students participated in this study in their 4th-6th years. In this study, 203 students in their 4th to the 6th year participated. Most students were satisfied with the structure of educational videos (73.9%);in general, 84.7% of students expressed their satisfaction with this method. Half of the students preferred video training over face-to-face training in oral and maxillofacial surgery (50.4%). Many students suggested that these videos be included in the curriculum (80.7%). CONCLUSION(S): Students' overall satisfaction with the structure and impact of educational videos indicates that educational videos made and evaluated by dental professors can help teach practical topics as a part of the curriculum.Copyright © 2022 Maryam Hosseini, Anita Taheri, Farzad Nouri, Ashkan Badkoobeh, Kamyar Abbasi, Mohsen Golkar, Mostafa Alam.

SARS-CoV-2 Effects on Psychophysical Olfactory Scores: Prospective Study With Evaluation Before and 60-Days After Infection.

The aim of this study was to prospectively evaluate the olfactory function in a series of individuals infected with SARS-CoV-2 and who had undergone psychophysical olfactory assessment prior to infection. Individuals unexposed to SARS-CoV-2 infection underwent a psychophysical evaluation of smell with the Sniffin' Sticks test. The subjects were followed prospectively and included in the study if they developed SARS-CoV-2 infection with a second test 60 days after recovery. At the 60-day follow-up of the 41 included subjects, 2 (4.9%) self-reported persistent olfactory dysfunction (OD). The differences between TDI scores before and after infection were statistically significant (37 [interquartile range (IQR), 34.25-39.25] vs 34.75 [IQR, 32.25-38]; p = .021). Analyzing the individual olfactory domains, the differences were significant for threshold (T) (9.75 [IQR, 9-11.25] vs 8.25 [IQR, 7.25-10.25]; p = .009) but not for odor discrimination (D) (p = .443) and identification (I) (p = .159). SARS-CoV-2 causes a significant reduction in the olfactory function, in particular affecting the olfactory threshold, even in subjects who do not self-report an OD.

Microvascular reconstructions in oral and maxillofacial surgery - Results of a survey among oral and maxillofacial surgeons in Germany, Austria, and Switzerland.

This study aimed to evaluate the use of microvascular free flaps (MFF) in oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland. A dynamic online questionnaire, using 42-46 questions, was sent to OMF surgeons based in hospitals in Germany, Austria, and Switzerland. The questionnaire was evaluated internally and externally. Aside from general information, data were collected on organizational aspects, approaches, MFF types and frequency, presurgical planning, intraoperative procedures, perioperative medications, flap monitoring, and patient management. Participants mostly performed 30-40 MFF each year (11/53). Most stated that the COVID-19 pandemic did influence MFF frequency (25/53) to varying extents. Radial forearm flap was most frequently used (37/53), followed by ALT (5/53), and fibula flap (5/53). Primary reconstruction was performed by most participants (35/48). Irradiated bony transplants were mostly used for implant placement after 12 months (23/48). Most participants (38/48) used reconstruction plates, followed by miniplates (36/48), PSI reconstruction (31/48), and PSI miniplates (10/48). Regarding the postoperative use of anticoagulants, low-molecular-weight (37/48) and unfractioned heparins (15/48) were widely used, most often for 3-7 days (26/48). Clinical evaluation was mostly preferred for flap monitoring (47/48), usually every 2 h (34/48), for at least 48 h (19/48). Strong heterogeneity in MFF reconstructions in OMFS was found, especially regarding the timepoints of reconstruction, types of osteosynthesis, and postoperative MFF management. These findings provide the chance to further compare the different treatment algorithms regarding relevant MFF aspects, such as postoperative management. This could create evidence-based treatment algorithms that will further improve the clinical outcomes in MFF reconstructions.

Universal COVID-19 pre-procedural swabs in children in a developing country: A comparison of findings over two transmission waves

Aim: The Coronavirus disease (COVID-19) pandemic has strained healthcare systems worldwide. Some institutions have implemented additional precautionary measures such as pre-procedural swabbing (PPS) to reduce transmission in patients and healthcare workers. We evaluate our experience with universal pre-procedural screening for COVID-19 in low-risk pediatric patients. Method(s): We performed a retrospective review of patients aged 18 years and below who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay swabs in our center over two waves (1st May 2020 to 31st July 2020 and 1st April 2021 to 30th June 2021). We included patients who underwent rRT-PCR for SARS-CoV-2 prior to any procedures requiring general anesthesia and were deemed low risk for COVID-19 according to our institutional screening criteria. All study patients were followed up for 14 days post-procedure. Result(s): Of 2065 swabs done for patients aged 18 years and below during the study period, 645 (31.2%) were pre-procedural swabs. Patients were aged 4.2 years (median, interquartile range: 1.6 years-9.8 years). Two patients (0.3%) tested positive for COVID-19 by PPS, detected during Period 2 - both had risk criteria which were overlooked by healthcare workers. Within 14 days post-procedure, 10 patients had unscheduled readmissions and 15 required repeat rRT-PCR, all of which were negative. Conclusion(s): In patients deemed low risk for COVID-19 infection according to our screening criteria, routine pre-procedural swabbing returns a low positive rate. Our findings can guide screening protocols at institutions that provide surgical services during the COVID-19 pandemic. Copyright © The Author(s) 2022.

To CT2 or not to CT2. Should this be a question? A pilot study

Introduction/Aims: The pathway to Oral and Maxillofacial Surgery isn't a short one and there are opportunities to shorten it. Dual-qualified trainees may progress from CT1/ST1 to CT3 /ST3 bypassing CT2/ST2 providing certain requirements are met. Not all choose or are able to do this and the reasons for this need to be explored. These are the results of a pilot study to explore the reasons as to why trainees include an extra year on their pathway to becoming an Oral and Maxillofacial Surgeon. Material(s) and Method(s): A Google Forms survey containing three sections was distributed to a group of six dual-qualified individuals, half of whom had progressed from CT1/ST1 to CT3/ST3 and half who undertook CT2/ST2. After a common stem of questions, the two groups were divided down separate arms to explore the reasons for their individual decisions and identify collective themes. Results/Statistics: Out of the six individuals surveyed, four were in OMFS Higher Speciality Training. 5/6 were Dentist first. Information regarding progression was obtained from the Junior Trainee Group, BAOMS, GMC and other trainees. 100% were aware that they could bypass CT2/ST2 and 50% were contacted by their TPD regarding this. Reasons for bypassing included having sufficient experience and limited training opportunities. Reasons for undertaking CT2/ST2 included geographic, COVID-19 redeployments and MRCS delays. All three also felt that whilst providing further exposure the CT2 year was of limited benefit. Conclusions/Clinical Relevance: This pilot study has identified themes requiring further assessment and study. Addressing barriers may improve progression, recruitment and retention in Oral and Maxillofacial Surgery. Copyright © 2022

Review of a regional paediatric trauma service

Introduction/Aims: Sheffield Children's NHS Foundation Trust (SCH) is a paediatric major trauma centre, covered by a regional on-call oral and maxillofacial surgery (OMFS) team. Referrals are taken from across South Yorkshire and North Derbyshire. We carried out a retrospective review of all emergency referrals to OMFS to establish indications for referral and review management. Material(s) and Method(s): We reviewed all on-call data from October 2018 - July 2020 to evaluate date assessed, referral source, diagnosis, admission, surgical intervention, follow up and demographic data. This was then compiled in a dataset and analysed. Results/Statistics: Over the period evaluated, 669 patients were referred to OMFS at SCH. Of all referrals, 68.6% were from SCH and other emergency departments accounted for 3.7%. Reasons for referral included lacerations (59.6%), dental infections (13.8%), dental trauma (13.9%) and facial fractures (3.9%). Of patients assessed, 24% required admission and at least 65.6% needed surgical intervention. 43% patients required follow-up of their injuries. Since the onset of the Covid-19 pandemic, there has been an increase in the number of phone reviews, accounting for 2.7% of follow-up appointments over the total time period. Conclusions/Clinical Relevance: The majority of referrals to paediatric OMFS are related to soft tissue trauma, and a majority require surgical intervention. A significant proportion of patients required follow up after discharge. The data gathered supports the need for OMFS access to emergency theatres and day-case facilities, in order to enable the effective running of a regional paediatric trauma service. Copyright © 2022

'Fellowship of the Ring' - My Waikato Experience - Hamilton, New Zealand

Introduction/Aims: The conventional route to being a Maxillofacial surgeon is a training programme of five years, undertaking the 'exit' exam and being awarded a certificate of completion of training (CCT). Whilst for many the next stage would be attaining and undertaking a consultant post immediately or whilst utilising their grace period, some trainees consider the opportunities afforded by a fellowship. This can be both a formal and informal opportunity to address training deficiencies or to consolidate and acquire new skills prior to a definitive consultant post. Material(s) and Method(s): As part of my fellowship I chose to go to Waikato Hospital, Hamilton, New Zealand during the COVID-19 pandemic. I was afforded the opportunity to consolidate skills I had acquired since gaining my CCT and provide general and specialist maxillofacial services in the Waikato region which covers a population of 425k over 21,000km2. This fellowship provided me with an amazing opportunity to practice maxillofacial surgery in an area with a breadth of trauma by virtue of being a major trauma centre. Results/Statistics: I would strongly recommend the opportunity to engage in a fellowship overseas as it exposed me to a healthcare service model I had not previously encountered. New Zealand has a strong public system which is well supported by their Accident Compensation Corporation scheme. This covers all healthcare costs associated with injury from an accident, irrespective of the mechanism. Conclusions/Clinical Relevance: My experience was superb both clinically, professionally and socially and it definitely supported me up for my consultant practice on returning to the UK. Copyright © 2022

See and Treat for non-melanoma skin cancers in an OMFS unit: A successful change of practice and service improvement as a result of the COVID-19 pandemic

Introduction/Aims: During the COVID-19 pandemic, our unit converted to a see and treat model for the treatment of non-melanoma skin cancers (NMSCs), aiming to undertake complete excision at the first review. The intention was to reduce patient contact, to reduce the risk of virus transmission, whilst keeping waiting times to a minimum. This audit aimed to assess whether "See and treat" is an effective strategy and to determine whether it should continue following easing of lockdown restrictions. Material(s) and Method(s): 300 patients were seen in 'See and treat' clinics from February to December 2021. Results/Statistics: Initial analysis showed 81.9% of patients were treated during the first visit, with the main reason for treatment delay being anticoagulation. Average time from referral to treatment was 46.8 days. Of the lesions: 46.9% were BCCs, 21.2% were SCCs, 9.8% actinic keratosis, and 22.1% were a mixture of other types. 74.5% of the resultant defects were closed primarily, 12.3% were closed with local flaps, 7.1% left open to granulate, 2.5% grafted with Integra and 2.8% closed with FTSG. The complete excision rate was 98.8%. Conclusions/Clinical Relevance: This audit shows that the "See and treat" model is an effective and safe method for the management of NMSCs in an oral and maxillofacial surgery unit. Based on these results, we recommend that this strategy remains in place post-pandemic to reduce clinic appointments and waiting times. Pre-appointment screening could help to detect high risk patients (such as those on anticoagulation) and address these issues before the first visit, further increasing the efficiency of the system. Copyright © 2022

Same-day Cancellation by Blackpool Victoria Hospital Oral and Maxillofacial Surgery Department

Introduction/Aims: The aim of this audit is to investigate the reason for, and the frequency of same-day cancellations in the Oral and Maxillofacial Surgery department of the Blackpool Victoria Hospital. This will hopefully provide a greater understanding of why procedures are cancelled on the day and may allow the implementation of improvements to reduce waiting times for surgery. Material(s) and Method(s): Cancellation data was collected between 08/01/2020-10/04/2021. Results/Statistics: Clinic had a cancellation rate of 7% for this time period. The majority of clinic cancellations were due to "clinical" reasons (80%). Of these, "operation not necessary" was the most common cancellation reason (62%). The second most common reason for cancellation was due to "patient choice" (13%). Theatre had a cancellation rate of 5% for this timeframe. "Non-clinical" were the most common same-day cancellation reasons at 60%. COVID-19 cancellations contributed 24%, which were unavoidable. Conclusions/Clinical Relevance: Examining same-day cancellations provides important information which may lead to an improvement in clinical efficiency and patient satisfaction. Most cancellations in the Oral and Maxillofacial department were classified as "clinical" which cannot always be anticipated. Contacting the patient in advance to re-discuss requirements may be beneficial, particularly to reduce "pre-op guidance not followed", "patient choice", and "unfit for surgery" cancellations. "Non-clinical" cancellations are often administrative and strategies may be possible to reduce their impact, such as allowing more time for notes or equipment. Copyright © 2022

Covid-19 pandemic: the impact of Italian lockdown on maxillofacial trauma incidence in southern Tuscany

The outbreak of the Covid-19 pandemic has seriously affected our society. Governments have difficult situations by adopting strict and severe mitigation measures in order to contain the pandemic spreading. These decisions influenced significatively people's behavior changing their habits and routines. This study offers a statistical analysis of the incidence of the Maxillo-Facial traumas in Tuscany southern area, during the pandemic lockdown. The statistical analyzed has been obtained comparing the maxillo-facial trauma occurrence during the Italian lockdown between the 9th of March and the 18th of May 2020 in comparison with same period of the five previous years.