Factors predictive of the intensity of local anesthesia in mandibular third-molar surgery: A cross-sectional study.

INTRODUCTION: Primarily, the intensity of local anesthesia (LA) in mandibular third-molar (M3) surgery is governed directly by lipid solubility of the local anesthetic drug and indirectly by other physical characteristics. However, a patient's demographic, anthropometric, behavioral, and surgical factors may affect these physical characteristics and, therefore, indirectly influence the clinical actions of the local anesthetic drug used. The aim of this study was to investigate patients' demographic, anthropometric, behavioral, and surgical variables that may predict for the intensity of LA in mandibular M3 surgery among healthy adult patients. MATERIAL AND METHODS: This cross-sectional study included 141 patients with unilateral mandibular M3 teeth indicated for surgical extraction under LA. Patients' demographic, anthropometric, behavioral, and surgical potential predictor variables were recorded. Lidocaine (2%) with epinephrine (1:100,000) was administered to provide block anesthesia for mandibular M3 surgery. The overall intra-operative pain (intensity of LA) was the outcome variable and was evaluated by the patient after surgery, using a visual analogue scale (VAS). Data were analyzed using univariate analysis and multivariate regression analysis. RESULTS: The final study population comprised 126 participants: 80 women and 46 men (mean age±SD=29.2±12.3 year). With multivariate regression analysis, age, smoking quantity, and "amount of local anesthetic used" were the only significant (P<0.001) predictors of the intensity of LA in mandibular M3 surgery. CONCLUSIONS: This study suggested that an increase in age, smoking quantity and "amount of local anesthetic used" would predict an increase in the intensity of LA in mandibular M3 surgery.

Age and gender variations in the cone-beam computed tomographic location of mandibular canal: Implications for mandibular sagittal split osteotomy.

BACKGROUND: Mandibular sagittal split osteotomy (MSSO) may incur unfavorable split and sensorineural injuries. Knowledge of the anatomic location of the mandibular canal (MC) and bone thickness in the region of interest for MSSO, and the possible variations by age and gender can assist in avoiding such complications. Purpose, to study the location of the MC and bone thickness in the region of MSSO by cone-beam computed tomography (CBCT) radiographs and to evaluate the possible variations by age and gender in a Jordanian population. MATERIAL AND METHODS: This retrospective radio-anatomical study examined all CBCT radiographs for patients treated over three years at the University of Jordan Hospital, Amman, Jordan. Distances from the MC to the cortical external surfaces and MC diameter (MCD) were measured by a reliable observer at three predetermined regions for MSSO: region (A) [mandibular foramen area], region (B) [mandibular angle area] and region (C) [directly mesial to the second molar]. Gender and age differences in all measurements were then compared using non-parametric Mann-Whitney U test. RESULTS: The final study radiographs comprised a total of 202 CBCT belonged to a cohort of 202 subjects; 91 males (45.1%) and 111 (54.9%) females, with mean age (± SD) of 42.94 ± 18.54 years (range 18-90 years). Whereas only the bone thickness superior, buccal and inferior to MC in regions (B) and (C), and MCD in the three regions exhibited significant (p < 0.05) gender differences, all measured distances exhibited statistically significant (p < 0.05) differences between young and adult patients. CONCLUSION: The location of MC and bone thickness in the region of MSSO were significantly variable according to age, but exhibited sexual diamorphism only in regions (B) and (C). This fundamental knowledge should be considered during MSSO planning.

Social factors as career obstacles for female oral and maxillofacial surgeons in three Middle Eastern countries.

Despite the feminization of dentistry in many areas of the world, female representation in the field of oral and maxillofacial surgery (OMFS) is poor. The purpose of this study was to identify factors perceived by female oral and maxillofacial surgeons in Egypt, Jordan, and Saudi Arabia as being obstacles to their career progression and to compare them to factors identified by their male colleagues. This was a cross-sectional questionnaire-based study. A Google Forms questionnaire was designed to collect data on socio-demographics and perceived career obstacles in OMFS. This was distributed to oral and maxillofacial surgeons in Egypt, Jordan, and Saudi Arabia. Statistically significant differences between the genders were evident in terms of marital status (P=0.001), spouse's education (P=0.005), and spouse's occupation (P<0.001). When compared to male surgeons, female surgeons more often considered that their spouse's occupation hindered their career progression (P<0.001). Female surgeons, but not male surgeons, perceived sexism and social factors such as marriage, children, and the attitudes of society to be major career obstacles (P<0.005). In conclusion, female maxillofacial surgeons in some Middle Eastern countries were found to have different socio-demographic characteristics compared to their male colleagues and they considered sexism, marriage, children, and the attitudes of society to be major career obstacles.

Leukocytosis is common after orthognathic surgery: A retrospective study.

INTRODUCTION: In the absence of infection-specific clinical signs and symptoms, it is often difficult for the maxillofacial surgeon to decide whether leukocytosis after orthognathic surgery is part of the normal postoperative response, as suggested for a variety of non-maxillofacial surgeries, or a sign of a developing infection. The aim was to determine the trends and factors predictive of postoperative WBC (white blood cell) values after orthognathic surgery that may provide the surgeon appropriate guidance for decision making. MATERIALS AND METHODS: This retrospective cohort study included a total of 83 consecutive patients who underwent 93 orthognathic surgical cases over six years. The natural history of postoperative WBC values and incidence of leukocytosis were characterized, and their differences across potential predictor variables were then analyzed using univariate analysis and multivariate regression analysis. RESULTS: On post-operative day (POD) 1, the mean post-operative WBC count reached the peak level, with an increase of 11.4 × 106 cells/µL. By POD 2, it declined slightly to a level approximately two times more than the preoperative level. Over the first two post-operative days, the incidence of leukocytosis was 93.5%. Multivariate regression analyses revealed that gender, duration of surgery and pre-operative WBC count were the only significant predictors of the post-operative WBC value, whereas the pre-operative WBC count was the only significant (OR: 2.61, P < 0.05) predictor of post-operative leukocytosis. CONCLUSION: Post-operative leukocytosis after orthognathic surgery is significantly influenced by the pre-operative WBC count, and has similar trends with a much higher incidence, compared to non-maxillofacial surgeries.