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The proceedings contain 109 papers. The topics discussed include: dose intensity of palbociclib and initial body weight dosage: implications on progression free survival in 220 patients with ER+/HER2-negative metastatic breast cancer;characteristics of Nirmatrelvir/Ritonavir (Paxlovid) recipients and clinical interventions by oncology pharmacists at a tertiary outpatient cancer center;safe handling of non-carcinogenic drugs in the Ghent University Hospital: development, implementation and communication of hospital-specific guidelines;case series: use of olaparib in uncommon locations in patients with impaired homologous recombination;real-world data evaluation of medicines used in special situations in oncohematology: a retrospective study from a comprehensive cancer institution;Dostarlimab in the treatment of recurrent endometrial cancer: real life experience;medication-related osteonecrosis of the jaws and CDK4/6 inhibitors in breast cancer;and efficacy and safety outcomes of generic imatinib in adults with chronic myeloid leukemia (CML) following the switch from branded imatinib.
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Introduction: Frimley Park Hospital criteria for referral to High-Risk Obstetric Anaesthetic Clinic (HROAC) included all parturients with BMI > 40. The COVID-19 pandemic necessitated HROAC becoming virtual. It was still possible to discuss risk and assess patients' airways, but not to reliably assess the likely ease of neuraxial techniques or cannulation. Observationally, little useful clinical information was gained, and airway problems rarely noted. An audit was planned to assess how often clinically useful information about the women's airways was gained during appointments. Method(s): HROAC database search for women referred with BMI > 40 with estimated date of delivery 20/04/20-03/04/21 to see whether any airway difficulties were predicted (Mallampati 3 or 4;limited neck movement;jaw slide B or C;limited mouth opening). Result(s): 82 women had BMI > 40, of which 3 were assessed as having a potentially difficult airway: two had BMI > 50 and one had retrognathism causing difficult airway prediction unrelated to her BMI of 41.7. One woman, BMI 58.7, was assessed as having a straightforward airway but her notes revealed her airway had been challenging to intubate in the past. One was assessed in video consultation as straightforward but an airway assessment during admission at the end of her previous pregnancy was Mallampti 3. Five women declined a video consultation. Discussion(s): In view of the minimal gain of clinically useful information and the routine presence of difficult airway kit for the obstetric emergency theatre, it was deemed safe and more relevant to make airway and neuraxial assessments on admission to labour ward rather than in the antenatal clinic for women with BMI<50. The assessment would therefore be made by the duty trainee anaesthetist who would be responsible for managing the patient, thus facilitating appropriate planning and communication if a woman with a challenging airway was identified. It is therefore also made at the very end of pregnancy when weight gain and its impact on airway is likely to be at its maximum. This approach, in conjunction with an antenatal information leaflet, and the ability of any obstetrician to refer to the HROAC, complies with the need for timely assessment of women as required by GPAS [1]. By formalising the assessment of women with high BMI on the labour ward it is hoped that patient safety and planning can be maximised.Copyright © 2023 Elsevier Ltd
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BackgroundGCA is a critically ischemic large vessel vasculitis, varying in extent, severity and outcomes, hence requires disease stratification using clinical, laboratory and imaging parameters, for targeted management. Although DMARDs are used, the effectiveness in real life, such adjuvants remain un-elucidated. We performed a prospective, multi centre cohort study of new GCA stratified into remitting, relapsing, refractory, ischemic disease.ObjectivesWe assessed prognostic factors and compared critical outcomes such as remission with glucocorticoid (GC) monotherapy versus GC plus DMARDs in the first 12 months.MethodsHAS GCA study (1) recruited consecutive patients with new onset GCA from 7 centres (UK, Italy, Spain, Netherlands). diagnosis was confirmed used a modified GiACTA criteria at 6 months follow up. All underwent ultrasound (bilateral common, parietal, frontal temporal arteries, and axillary arteries) using accepted standard cut-off values [2]. GCA patients had US at baseline,1,3,6,12 months and halo count (HC) and Halo score (Temporal TAHS, axillary AAHS, total THS) assessed [3]. The primary outcome- remission at 12 months (absence of signs/symptoms, CRP<5 mg/dl, prednisolone < 5 mg daily). Results are reported as descriptive statistics.Results229 participants included in the study (GCA- 84 (36.68 %) (Figure 1). Study recruited during Covid pandemic,73 completed,11 lost to follow-up (died -7, withdrawn-4). The deceased/withdrawn patients (compared to completers) were older (80 v74 yrs, p=0.018), preponderantly male (73% v 36%, p=0.043) with visual symptoms (91% v 49%, p=0.010) partial/total sight loss (55% v 21%, p=0.024), lower CRP (21 v 68, p=0.061) and ESR (42 v 62, p= 0.317).Of 73 completers 36 required early DMARDs (<12 weeks) for refractory/relapsing/ischemic/GC related AEs. This group had more LV involvement (50% v 11%, p=0.0003), Remission attained at 12 months 32/36 (89%) in DMARD group was comparable to the remitting GC monotherapy group 33/37 (89%) with comparable cumulative GC doses (Figure 1, Table 1).At 12-months follow up, median TAHS, AAHS and THS reduced from 13 to 3, 12 to 9 and 21.5 to 12, respectively.ConclusionOur study suggests, elderly males with visual symptoms, sight loss, lower CRP are a high-risk group with increased mortality within GCA. Difficult to treat disease is seen in half of all patients especially with LV involvement. This group responds well to early DMARD use achieving remission comparable to the remitting group at 12 months. Current therapies fail to achieve remission in 9.5 % of cases. HS and HC show significant improvement mirroring clinical outcomes during first 12 months of therapy.References[1]Sebastian A et al. BMC Rheum. 2020[2]Schafer VS et al. Rheumatology 2017[3]van der Geest KSM et al. ARD 2020Table 1.comparison between the DMARD-used group and only GC group in all the GCA completed the 12 months follow upPatients' characteristicsGCA with completed follow-up (n=73)GCA treated with DMARD=36GCA not treated with DMARD=37Age, median (range) years73.5 (60-89)76 (60-89)Sex, Females, n (%)23 (64)24 (65)US halo score (HS)/IMT median (range)Temporal artery HS11 (0-23)13 (1-22)Axillary artery HS12 (0-21)12 (0-18)Axillary artery IMT (mm)0.77 (0.33-2.6)0.82 (0.39-1.21)Total HS22.5 (2-41)21 (5-40)Clinical features, n (%)Temporal headache25(69)30 (81)Scalp tenderness17 (47)19 (51)Jaw & Tongue claudication22 (61)24 (65)Polymyalgic symptoms21 (58)13 (35)Constitutional symptoms21 (58)18 (49)Any visual disturbance15 (42)21 (57)Partial or complete vision loss8 (22)7 (19)History of PMR6 (17)3 (8)Exam findings, n (%)Temporal artery abnormality24 (67)30 (81)AION/ CRAO8 (22)6 (16)Ocular nerve palsy1 (3)3 (8)Lab markers at baseline, median (range)CRP mg/dL,72.2 (6.4-292)59 (6-206)ESR mm/hr67 (9-130)57 (2-120)GC treatment, median (range)GC starting dose, (baseline)45 (0-60)50 (0-60)GC dose at 12m,5 (0-25)2.5 (0-10)Cumulative GC dose at 12m4627.5 (2600-10260.5)4622.5 (944-10737.5)Remission with prednisolone dose ≤5 mg at 12m, n (%)32 (89)33 (89)Acknowledgements:NIL.Disclosure of InterestsBhaskar Dasgupta Consultant of: Roche, Chugai, Sanofi, Grant/research support from: Roche, Sanofi, AbbVie, and GlaxoSmithKline, Kornelis van der Geest Speakers bureau: Roche, Grant/research support from: AbbVie, Alessandro Tomelleri: None declared, Pierluigi Macchioni: None declared, Giulia Klinowski: None declared, Carlo Salvarani: None declared, Abdul Kayani: None declared, Mohammad Tariq: None declared, Diana Prieto-Peña: None declared, Edoardo Conticini: None declared, Muhammad Khurshid: None declared, Sue Inness: None declared, Jo Jackson: None declared, Alwin Sebastian: None declared.
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Objective The purpose of this study was to ascertain the correlation between COVID-19 infection and jaw osteonecrosis, along with the identification of risk factors that could be associated with the development of the condition. Another aim of our study is to establish whether maxillofacial osteonecrosis is an early or late complication seen in COVID-19 patients. Material and method This was a retrospective study conducted over a period of two years. Case records of patients with a history of severe COVID and steroid treatment who later developed jaw osteonecrosis were evaluated. Result 13 patients with an age range from 8 years to 70 years were identified. Osteonecrosis was seen as late as 21 months after COVID-19. The majority of the cases involved maxilla, one case was of bi-jaw involvement, and one case presented with isolated mandibular involvement. 6 patients were diabetic and 11 patients gave a history of provocative dental treatment like extraction. Conclusion A triad of post-COVID coagulopathy, steroid administration, and a provocative dental treatment may contribute to jaw osteonecrosis which may be seen in patients without pre-existing systemic illness and may present as late as 21 months after COVID-19.
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Background/Aims GCA is a systemic vasculitis predominantly affecting the large vessels that requires prompt diagnosis and management. This clinical audit aims to study the impacts of COVID-19 pandemic on our GCA service and to identify areas for improvement to ensure good and safe practice amid healthcare crisis. Methods We audited referrals for suspected GCA from February 2021 until September 2022 and measured our patient care against the BSR quality standards. We performed retrospective data collection from digital care record systems and analysed our data using the IBM SPSS Statistics version 29. Results 106 patients with suspected GCA were included, 73% were female and the mean age was 70 years. 75% of the referrals were from primary care. Main presenting symptoms were headaches (95.7%), scalp tenderness (69.6%), tongue/jaw claudication (52.2%), visual symptoms (47.8%), constitutional symptoms (43.5%) and polymyalgic symptoms (21.7%). 33% of patients were diagnosed and treated as GCA. Mean CRP was 23.9mg/L and mean plasma viscosity was 1.89mPA. The mean referral-to-specialist review time has reduced to 1.6 days, compared with 2.7 days pre-pandemic. All patients had vascular ultrasound but only 7.5% had a temporal artery biopsy (TAB), compared with 41% pre-pandemic. Table 1 compares expected and achieved BSR quality standards. Conclusion Changes in work pattern during the pandemic meant that the time from referral to specialist review was significantly reduced, by implementing twice weekly registrar-led 'Hot' clinics and reserving ad hoc slot(s) in on-call consultant's clinics for GCA referrals. We have ramped up our vascular imaging capacity for vascular ultrasound during the pandemic in response to reduced surgical operating capacity for TAB. Strategies to address areas for improvement identified in this audit include: (1) clear and timely communication with referrer about steroid initiation and dosage, at the time of referral;(2) improving communication with primary care, emphasising need for urgent Ophthalmology input in patients with suspected GCA-related visual symptoms, through updating our regional GCA guideline for primary care;(3) standardising and implementing a GCA review proforma or checklist in our department to ensure that the BSR GCA care bundle is being implemented and addressed at the earliest opportunity. (Table Presented).
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Purpose. To demonstrate possibilities of multispiral computed tomography in the detection of fungal osteomyelitis in two patients with second type of diabetes mellitus two and six months after COVID-19 associated pneumonia. Material and methods. We present two clinical observations of patients with second type of diabetes mellitus who complained about pain in the upper jaw, nasal purulent discharge, difficulty in nasal breathing which appeared two and six months after COVID-19 associated pneumonia. To identify pathological changes, patients were directed to the department of radiology for the purpose of performing MSCT of the skull. Results. In the presented clinical cases, using MSCT, the features of the radiological semiotics of skull bone changes were studied in patients with fungal infection on the background of type 2 diabetes mellitus, the use of corticosteroids and after the viral COVID-19 associated pneumonia. The diagnosis was verified by histological and cytological studies of biopsy (surgical) material. Discussion. Recently, there has been an increase in the number of cases of fungal osteomyelitis of the jaws and paranasal sinuses in patients after viral pneumonia caused by SARS-CoV-2. The most common fungal infection is mucormycosis, caused by fungi belonging to the order Mucorales. The rhinocerebral form of mucormycosis is common in patients with diabetes mellitus after treatment with corticosteroids with the background of immunosuppression. This form of mucormycosis contributes to the appearance of extensive bone-destructive changes in the middle and upper zones of the maxillofacial region, requiring further surgical treatment. Conclusion. The 2019 coronavirus infection (COVID-19) caused by SARS-CoV-2 and type 2 diabetes remain urgent healthcare problems worldwide. This combination in a patient after treatment of COVID-19 associated pneumonia with corticosteroids leads to immunosuppression and the development of concomitant infections, including fungal ones. Fungal osteomyelitis in such patients, as a rule, affects the skull and is characterized by an aggressive course and requires surgical treatment. The use of modern and high-tech methods of radiation imaging, such as MSCT, allows to obtain complete diagnostic information about the localization and prevalence of the lesion, which, in the future, determines the management tactics and surgical treatment of patients of this category.Copyright © 2022 Chinese Journal of Pediatric Surgery. All rights reserved.
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Background: Hyaluronic acid fillers (HAF) are a versatile tool in esthetic medicine. They also have a potential for medical indications including facial rehabilitation. Materials and methods: We performed a literature search on PUBMED and Google Scholar until December 2022. Clinical trials, clinical studies, review articles, systematic reviews, meta-analyses, case series, and case reports were considered for review. Keywords "facial rehabilitation”, "acne scars”, "traumatic scars”, "oral restoration”, "facial lipoatrophy”, "facial asymmetry”, "periocular correction”, "nasal obstruction”, "ear lobe restoration”, "morphea”, AND "hyaluronic acid filler” were used to select articles. Results: We prepared a narrative review on the use of HAF for correction of facial asymmetry and asymmetric lips, improvement of different types of scars, improvement of the jaw line, improvement of ear lobes, periocular and oral restoration, and the treatment of nasal obstruction and morphea en coub de sabre. The amount of HA used in these indications is often less than 1 mL. The bolus technique, fanning, and dual-plane injections can be utilized for treatment. Duration of clinical effects depends upon the anatomical region and is usually maintained between 2 months and 2 years. Adverse events are often mild and temporary. Vascular occlusion is a severe adverse event, but it has not been reported yet for these medical indications. Repeated injections are recommended to obtain a longer-lasting improvement. In cases of morphea, only stable and non-inflammatory plaques should be treated. The advantage of HAF compared to permanent and semipermanent fillers is the availability of hyaluronidase for rapid removal of filler material and to revise overcorrection. Conclusions: HAF play an auxiliary role in facial rehabilitation. Knowledge of filler qualities, anatomy, and underlying diagnoses is important for their safe application. More prospective controlled trials are necessary to improve evidence.
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Background. SARS-CoV-2 infection can be accompanied by neuromuscular disorders. Rhabdomyolysis and Guillain-Barre syndrome have been described repeatedly. There are case reports of inflammatory myopathies manifesting during COVID-19, presenting as dermatomyositis, polymyositis or immune-mediated necrotizing myopathy, with dermatomyositis-like presentations most commonly reported. Larger cases series are from postmortem examinations of COVID-19 patients, where variable inflammatory pathology of the skeletal muscle has been found frequently but without local detection of the actual virus. Thus, autoimmune mechanisms or the systemic interferon response are discussed as causes. We report a case of focal inflammatory myopathy with perimysial pathology of the temporalis muscle occurring with acute, but mild COVID-19. Methods. Case report of clinical observations, cranial MRI, histopathological, and laboratory findings. 3T cranial MRI was performed with gadolinium contrast. Open temporalis muscle biopsy was performed. The sample underwent standard cryohistological studies as well as immunohistochemistry with antibodies against MHC-I and II, CD3, CD4, CD19, CD68, anti-MAC, p62 and MxA. Testing for auto-antibodies was based on immunoblots or ELISA. RT-PCR for SARS-CoV-2 was run with RNA extracted from cryopreserved muscle. Results. A Caucasian woman in her 60s with no history of autoimmune or muscle complaints developed swelling and pain of the right jaw musculature five days after testing positive for SARS-CoV-2 due to respiratory tract symptoms. In addition, she experienced trismus, but no further neuromuscular complaints. The course of respiratory tract symptoms stayed mild. She had been vaccinated previously with single shot SARS-CoV-2 vector vaccine. Due to persistent swelling and complaints, giant cells arteritis was excluded by unresponsiveness to five days oral steroids and sonography of the temporal artery. Cranial MRI was performed nearly four weeks after the SARS-CoV-2 infection and showed marked swelling and oedema of the temporalis muscle. Its biopsy showed numerous CD68 and acid phosphatase positive cells infiltrating from perimysial perivascular foci towards the endomysium with perimysial damage but little damage of adjacent, perifascicular muscle fibres. Muscle fibres did not react with anti-MHC-II, anti-MAC or -MxA. Capillaries did not react with anti-MAC or -MxA. SARS-CoV-2 RNA was not detected in muscle tissue. Serum creatine kinase was not elevated in the subacute phase. Slightly elevated ANA titre led to detection of autoantibodies against proliferating cell nuclear antigen (PCNA). No pathological results for other autoantibodies, including myositis-specific antibodies and anti-ds-DNA, were found in blood. Neither were antibodies against hepatitis C and B viruses. Retesting 15 weeks after infection, anti-PCNA immunoblot was still positive, but ELISA did not indicate a pathologic titre. The swelling, myalgia and trismus regressed spontaneously a month after onset, yet the latter still persists at the time of reporting. Conclusion. Our case diverges from the majority of COVID-19 associated my-ositis reports in the unusual location of the focal myositis and the histopathological pattern of predominantly perimysial damage and histiocytic infiltration. It concurs with the literature as no SARS-CoV2 RNA could be detected in the muscle. Anti-PCNA is associated very rarely with myositis. Other associated disorder (systemic lupus erythematosus, chronic viral hepatitis B or C) were not found. Increased levels of autoantibodies are reported in COVID-19 and mostly attributed to loss of self-tolerance during the acute disease phase. Interestingly, the structural protein M of SARS-CoV-2 appears to interact notably with PCNA in infected cells. Still, the causal connection between the myositis and COVID-19 in this case is based on the close temporal association in the absence of alternative, competing explanations from the medical history and findings.
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Widely considered safe, effective, and essential for pathogenic immunity, vaccines have proven to be one of the most important discoveries to date in medicine. Adverse reactions to vaccines are typically trivial but there have been extremely rare reports of vaccine induced myocarditis, particularly with the Tdap vaccine. This is thought to be due to a hypersensitivity reaction. In efforts to combat the SARS-CoV-2, prompt response from Pfizer-BioNTech and Moderna lead to vaccine development with a novel method, synthesized from modified messenger RNA. Despite minimal side effects on initial trials, reports of vaccine induced myocarditis have resulted. A majority of these cases occurred following subsequent doses for those previously inoculated. A descriptive study published in JAMA in January 2022 reviewed the Vaccine Adverse Event Reporting System (VAERS) in collaboration with the CDC described only 1626 cases of myocarditis, of which the majority occurred within days of the second dose. This review was limited by reviewing a passive reporting syndrome with variable quality data and without follow up data post diagnosis of myocarditis. Here we present a case of myocarditis occurring less than 24 hours after the second dose of Pfizer-BioNTech vaccine with 3 month follow up. A 23 year old man received his second dose of the COVID-19 vaccine in the morning. Within a few hours he experienced chest pain, chills, weakness, and fatigue. These dissipated by 7pm. He is a member of the National Guard and during drills the next day experienced stabbing substernal chest pain for which he sought evaluation. The pain radiated into his left jaw, worse with deep inspiration and worse in the left lateral decubitus position. He is a 1 PPD smoker with no personal or family history or cardiac disease. A friction rub was heard on physical exam. His troponin I peaked at 2.6ng/mL. His EKG showed normal sinus rhythm, a TTE showed a normal EF with no pericardial effusion. He was given aspirin 81 mg and started on a heparin drip for possible NSTEMI. The next day his pain decreased and a cardiac MRI demonstrated no inflammation. His serum coxsackie and parvovirus titers were negative. He was instructed to continue the aspirin, limit exercise for 8 weeks, and stop smoking. Upon follow up 3 months later the patient denied any recurrent chest pain and was advised to continue the aspirin. But the original bout of myocarditis limited his participation in the National Guard. Our case illustrates that exposure to an immunological trigger, the COVID-19 vaccine, leading to myocarditis was extremely short compared to typical cases of viral induced or vaccine hypersensitivity reaction. A proposed mechanism is molecular mimicry between the spike protein and myocardial contraction proteins. It also demonstrates that the vaccine can cause morbidity in patients, especially younger males. It also exemplifies that this may be a short lived phenomenon, long term follow up is still needed. With the rate of vaccination increasing, there needs to be a low threshold to consider myocarditis in young adults who have new chest pain after receiving an mRNA based vaccine.Copyright © 2022
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Studies about headaches associated with acute ischemic stroke in patients suffering from migraine were limited, and therefore we present a clinical case of central post-stroke pain (CPSP) in a 47-year-old woman with migraine and lacunar infarcts in the medulla oblongata and also possible mechanisms of CPSP in patients with migraine. Magnetic resonance imaging of the brain revealed lacunar infarction in the medulla oblongata on the right (vertebral artery basin) and a single focus of gliosis in the parietal lobe on the right. Magnetic resonance angiography of cerebral vessels showed the fetal type of structure of both posterior cerebral arteries. This clinical case is a complex clinical situation of a combination of secondary headaches (post-stroke) in a patient with a primary headache (migraine), which was successfully treated by the combined administration of first-line drugs for the treatment of neuropathic pain in a patient with lacunar infarcts in the medulla oblongata. The treatment of CPSP is a difficult task due to the insufficiently unexplored mechanisms of development, the most effective approaches are those aimed at reducing the increased excitability of neurons.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.
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Clinical Information Patient Initials or Identifier Number: JS Relevant Clinical History and Physical Exam: A 55-year old woman was brought to emergency department complaining of sudden onset squeezing chest pain radiating to her arm and jaw and associated with giddiness. She had flu like illness a day prior to her presentation associated with malaise, arthralgia and dry cough. She had history of hypertension. Physical examination revealed dual heart sounds and clear lung fields to auscultation. Relevant Test Results Prior to Catheterization: Electrocardiogram (ECG) showed normal sinus rhythm and the cardiac enzymes were elevated;high sensitivity troponin-I, 23000 ng/L (range0-10 ng/L). RNA PCR was positive for SARS-CoV-2 (COVID-19). D-Dimer was 303microgram/L (normal <500). Transthoracic echocardiogram showed severe hypokinesis of the mid inferolateral wall with left ventricular ejection fraction (LVEF) 52%. Chest X-ray showed no focal consolidation. [Formula presented] [Formula presented] Relevant Catheterization Findings: Invasive coronary angiogram showed tortuous coronary arteries with abrupt narrowing of mid- distal Ramus Intermiedius and discrete lesion of mid PDA. SCAD (spontaneous Coronary dissection) of Ramus Intermedius and mid PDA (posterior descending artery) was suspected, and patient was treated conservatively. Repeat coronary angiography, few months later showed complete resolution of SCAD with normal appearance of affected vessels. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: After obtaining an informed consent right Radial access was achieved with 6F Terumo sheath using over the wire technique. 1% lignocaine was used as local anaesthetic. 5F JL 3.5 (Judkin's) and JR 4 catheters were used to engage left main stem (LMS) and right coronary artery (RCA) and selective coronary angiography was performed. No percutaneous coronary intervention was performed. After the procedure hemoband (TR band) was applied to access site. Patient remained hemodyanamically stable throughout the procedure. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): SCAD is a potential cause of type II myocardial infarction in patients with COVID-19, but more studies are needed to establish causality. Infection-related SCAD may occur at any time during index events and could be difficult to diagnose. Conservative management seems like a safe strategy.Copyright © 2023
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Objective: The COVID-19 pandemic-related restrictions on the public have led to changes in occupation status and societal behavior which may be linked with adverse effects on mental health. We hypothesized that elevated personal stress induced by COVID-19 may underlie pain exacerbation among individuals with chronic myofascial pain. Method(s): Comprehensive myofascial pain questionnaire among 319 patients registered in our pain clinic. In total, 78 patients with TMD-associated pain responded and 113 patients with pain in other orofacial regions responded. Result(s): Patients with chronic TMD pain reported a higher self-rated stress level, which correlated with significantly increased pain intensity, and analgesic consumption. In contrast, patients experiencing non-TMD pain did not report of any increase pain, regardless of their stress levels. Conclusion(s): Significant correlation between self-perceived psychosocial stress levels and chronic myofascial pain exacerbation. Patients may benefit from early education and conservative intervention, and avoid uncontrolled increases in consumption of pain relief medication.Copyright © 2021 The Authors
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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.
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The article focuses on the clinical manifestation of inflammatory and destructive lesions of the bones of the midface, nose and paranasal sinuses as a long-term complication of COVID-19 with clinical examples provided.
Subject(s)
COVID-19 , Osteonecrosis , Humans , COVID-19/complications , Face , Necrosis , Facial BonesABSTRACT
COVID-19 is a serious global infectious disease impairing the quality of life of people across the world. SARS-CoV-2 may reside in nasopharyngeal and salivary secretions of COVID-19-infected patients and spreads mainly through respiratory droplets and fomites. It has presented a challenge to dentistry, as many dental procedures generate aerosols that could lead to cross-contamination. It also presents many post-infection complications that may continue to debilitate patients, even after successful management of the virus. One such complication may be osteomyelitis of the jaw. Two cases of post-COVID-19 osteomyelitis of the jaw are presented that were determined to be unrelated to mucormycosis in otherwise healthy individuals with no prior dental complaints. An attempt is made to shed light on clinical signs in post-COVID cases that may point to a diagnosis of the condition. The pathophysiology is also discussed, which may help in formulating guidelines to prevent and manage post-COVID osteomyelitis of the jaw.
Subject(s)
COVID-19 , Osteomyelitis , Humans , SARS-CoV-2 , Quality of Life , Respiratory Aerosols and Droplets , Osteomyelitis/diagnostic imaging , Osteomyelitis/etiology , MandibleABSTRACT
PURPOSE: To compare the incidence, aetiology, and patterns of maxillofacial fracture presentations during the various stages of the 2020 Melbourne COVID-19 lockdown restrictions to periods outside lockdown in 2019 and 2020. METHODS: This is a retrospective study of 344 subjects. The patterns of facial trauma presentations to a tertiary hospital in metropolitan Melbourne during the 2020 COVID-19 restrictions were compared to periods with no restrictions over 22 months from March 2019 to December 2020. RESULTS: The incidence of maxillofacial fractures decreased by 28% during lockdown (0.41 vs. 0.57 injuries/day, P = 0.0003). Falls overtook interpersonal violence as the leading cause of fractures (44% of lockdown presentations vs. 25.7% of presentations outside lockdown, P = 0.002), while sporting injuries dropped drastically (4% vs. 17.1%, P = 0.005). Lockdowns saw an increase in the proportion of female patients (40% vs. 26.8%, P = 0.03) and a fivefold increase in proportion of domestic violence-related fractures (6.7% vs. 1.1%, P = 0.006). Alcohol-related injuries decreased significantly (11% vs. 21%, P = 0.03). CONCLUSIONS: While restrictions reduced rates of interpersonal violence and alcohol-related maxillofacial trauma, there was a higher proportion of injuries to females, increased falls, and domestic violence-related injuries.
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Introduction/Aims: Historically orthognathic patients have required overnight admission owing to airway risk, risk of bleeding, pain, nausea and vomiting. (1) More recently patient drivers, NHS pressures, improved anaesthesia and operator efficiency (2) have led us to look for ways to deliver the service on a daycare protocol.(3) Material(s) and Method(s): We proposed a single surgeon pilot study in line with governance and safety standards. Peri operative criteria were defined as ASA1/2, support at home, standardised pre, intra and post operative medication and a set anaesthetic technique. Surgical parameters were set as a Le Fort 1 or BSSO osteotomy with intra operative wafers and post operative orthodontic review available. A prospective study from August 2017 to August 2021 was carried out. Results/Statistics: 35 patients met the criteria, 15 were treated on the day case protocol. 4 patients were excluded for surgical complications and 3 reported they would not have coped at home. 8 were successfully managed on the pathway. Barriers to the study included covid-19 restrictions, mixed elective and emergency operating, delays to theatre and patient acceptance varied. Conclusions/Clinical Relevance: Single jaw day case orthognathic surgery may increase productivity and reduce cancellations on the day. A successful pathway depends on good nursing, anaesthetic and orthodontic support. We report our experience of a pilot pathway and present our written protocols for each discipline. Managing patient selection and expectations is critical. Copyright © 2022
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Introduction/Aims: The COVID19 pandemic caused a cessation in services during 2020/2021, resulting in long NHS waiting lists and the low availability of hospital beds for elective patients. Before the pandemic, all patients undergoing orthognathic surgery at a tertiary London hospital were managed with in-patient admission and overnight hospital stay. The difficulty with delivery of in-patient elective surgery encouraged review of this level of postoperative care. Previous studies have highlighted the safety of day case orthognathic surgery. Our Aim is to review peri-operative and post-operative complications following orthographic surgery and to determine the safe implementation of orthognathic surgery as a day case in our unit. Material(s) and Method(s): Retrospective 2 years study of all patients who underwent BSSO, Le Fort 1 and bimaxillary osteotomies during the covid-19 pandemic in 2020 to 2021. The electronic notes were reviewed to record complications and post-operative recovery. Data collated include time to mobilisation, analgesia and anti-emetics requirement. Results/Statistics: Out of the 89 patients in this study, no patients experienced emergency airway or haemorrhage concerns. 3 patients (3.37%) required intervention on the ward on the same day as the surgery. Majority of patients were discharged after overnight stay. 7 patients (7.86%) required morphine and 2 patients (2.25%) required anti-emetics. These were largely specific to bimaxillary osteotomy patients. 1 (1.12%) patient required more than 1 night as an inpatient. Conclusions/Clinical Relevance: We conclude that single jaw osteotomy can be safely undertaken as day case surgery, this may aid recovery in elective surgery and may be applied to more units in UK. Copyright © 2022