Incidence and features of maxillofacial fractures at Jordanian tertiary hospital before, during and after the COVID-19 period.

BACKGROUND: The purpose of this retrospective cohort study is to investigate the incidence and treatment of maxillofacial fractures before, during, and after the COVID-19 pandemic. MATERIAL AND METHODS: This single-center study was conducted at King Abdullah University Hospital (KAUH). The required data was obtained from the electronic clinical records of all patients in whom maxillofacial fractures were confirmed by plain radiography and computed tomography (CT) between January 2019 and December 2021, allowing for a 12-month period before, during and after the COVID-19 pandemic. RESULTS: During the study period, 595 maxillofacial fractures in 311 patients (234 males and 77 females, mean age 27.28 years) were treated. The most frequent affected age was 21-30 years old in the before and after COvid- 19 period (92 patients, 29.58.%), while in during-COVID-19 period it was 11-20 years old (22 patients, 7.07%). There was similarity in male predominance, RTA cause, anatomical site was the mandible, the type anatomical complexity was single, treatment procedure was ORIF in all three periods. CONCLUSIONS: The incidence of maxillofacial fractures during the COVID-19 pandemic period was lower compared to the periods before and after the pandemic. Given that most fractures were caused by RTAs, these findings are expected, as movement was restricted during lockdown.

Pattern and management of maxillofacial fractures in Jordanian children and adolescents.

BACKGROUND: The aim of this study was to analyze the characteristics, etiology and treatment of maxillofacial fractures among children and adolescents in northern part of Jordan. MATERIAL AND METHODS: A retrospective cohort study which included 91 children and adolescents patients who were treated for maxillofacial fractures during a period of three years between January 2019 and December 2021 at a tertiary hospital in Jordan. RESULTS: Over a period of three years, a total of 91 children between the age of 0 and 19 years were treated with 156 total maxillofacial fractures. Of these, 68 (74.73%) were males and 23 (25.27%) were females. One tenth of patients (10 (10.99%) were children of the preschool group and 55 patients (60.44%) were adolescents. Road traffic accident (RTA) was the most common cause of maxillofacial fractures, accounting for 57 (62.64%) of cases. Mandibular fractures were the most common and accounted for 82 (90.2%) of all fractures, followed by the zygomatic bone fractures 40 (44%). The most common treatment was intermaxillary fixation (IMF) with 53 (33.97%) fractures. CONCLUSIONS: Maxillofacial fractures are predominant among adolescents in comparison to children. RTA was the most common cause of maxillofacial fractures, mandibular fractures were the most common fractures, and intermaxillary fixation (IMF) was the most common treatment modality.

Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya.

BACKGROUND: The purpose of the present study was to evaluate changing pattern in characteristics of maxillofacial fractures and concomitant injuries in Western Libya During revolution and to assess the association between mechanism of injury and fracture patterns. MATERIAL AND METHODS: A retrospective review of medical records and radiographs of 187 patients treated for maxillofacial fractures from January 2010 to December 2012 was performed, there were 326 fractures in 187 patients. RESULTS: The male: female ratio was 6:1. Most fractures occurred in patients aged 11 to 40 years, and few injuries occurred in patients aged > 50 years. Most fractures occurred from motor vehicle accidents, and other most frequent causes included assault, gunshot, and fall injuries. Most maxillofacial fractures involved the mandible, zygomatic complex, or maxilla. Most mandibular fractures occurred at the parasymphysis, angle, or condyle. Associated injuries most frequently involved the head, chest, and extremities. Most patients were treated with open reduction (132 patients [71%]), and 26 patients (14%) were treated nonoperatively. There were 21 complications (11%). CONCLUSIONS: In summary, motor vehicle accidents were the most frequent cause of maxillofacial fracture in western Libya, possibly because of the lack of seat belt legislation. Interpersonal violence was a less frequent cause of maxillofacial fracture, possibly because of the religious restriction on alcohol consumption.

The effect of full-mouth tooth extraction on glycemic control among patients with type 2 diabetes requiring extraction of all remaining teeth: a randomized clinical trial.

BACKGROUND AND OBJECTIVE: Several studies have shown that periodontitis can complicate the severity of diabetes by worsening the degree of glycemic control. The purpose of this study was to determine the effect of full-mouth tooth extraction on glycemic control among type 2 diabetic patients. MATERIAL AND METHODS: A total of 58 patients with type 2 diabetes mellitus and advanced periodontitis who were requiring extraction of all remaining teeth were randomized consecutively into treatment (full-mouth tooth extraction) and control groups (no treatment). Eight patients were lost to follow-up or reported use of antibiotics, leaving 50 patients to be included in the analysis. All patients had all their remaining teeth in a hopeless condition. Relevant data were collected, and glycosylated hemoglobin (HbA(1c) ) and fasting blood glucose levels were measured at baseline and at follow-up times of 3 and 6 mo. RESULTS: At baseline, the mean (SD) HbA(1c) level was 8.6% (1.24) in the treatment group and 7.7% (0.87) in the control group. In the treatment group, the mean HbA(1c) level decreased significantly from 8.6% at baseline to 7.4% after 3 mo of denture treatment, and continued to decrease to 7.3% after 6 mo. In the control group, the mean HbA(1c) decreased from 7.7% at baseline to 7.5% after 3 mo, and remained almost the same after 6 mo. After adjusting for the baseline HbA(1c) , the mean reduction in HbA(1c) after 3 mo in the treatment group [1.23% (0.79)] was significantly higher than the mean reduction in the control group [0.28% (0.87)]. CONCLUSION: Full-mouth tooth extraction resulted in an improvement in glycemic control among diabetic patients. Large-scale multicentre clinical trials are needed to confirm the current evidence.

Long-term clinical and radiological outcomes of surgical management of central giant cell granuloma of the maxilla.

The aim of this study was to report the results of long-term clinical and radiological follow up of the surgical management of central giant cell granuloma of the maxilla. A retrospective analysis was conducted on 12 patients--5 male and 7 female whose ages ranged from 9 to 41 years, with central giant cell granuloma of the maxilla treated between 1991 and 2000. The anterior maxilla was involved in five cases, seven cases were in the posterior region, and none crossed the midline. Four patients were asymptomatic and eight patients presented with pain, mobility of teeth, and rapidly enlarging facial swelling. Radiographically, all lesions were radiolucent; 58.3% were unilocular, and the borders were well-defined in 33.3%. Roots were commonly displaced by the lesion, but no root resorption was observed. Cortical perforation was seen clinically and on CT scan in four patients. All cases were treated with thorough curettage until healthy bone was encountered. In cases with cortical perforation the affected buccal and/or palatal mucosa was excised. When the maxillary sinus was affected or the lesion was bulging into the nose, the nasal mucosa was also removed. All patients were reviewed annually for a follow-up period of 2-9 years; the condition recurred in two patients. It is concluded that thorough curettage is a satisfactory method for the treatment of non-aggressive and aggressive central giant cell granuloma of the maxilla, with a low recurrence rate and favorable postoperative outcome.

Sensory nerve impairment following mandibular third molar surgery.

PURPOSE: This prospective study reports the rate and factors influencing sensory impairment of the inferior alveolar and lingual nerves after the removal of impacted mandibular third molars under local anesthesia. PATIENTS AND METHODS: There were 741 patients with 741 mandibular third molars removed under local anesthesia during a 3-year period from 1994 to 1997. Standardized data collection included the patient's name, age and gender, side of operation, angulation of the tooth, lingual flap elevation, use of vertical or horizontal tooth division, the experience of the operator, and the occurrence of lingual and/or inferior alveolar nerve paresthesia. RESULTS: Postoperative lingual nerve paresthesia occurred in 19 patients (2.6%). There was a highly significant increase in the incidence associated with raising of a lingual flap (P <.001). The incidence of inferior alveolar nerve paresthesia was (3.9%). It was highest in the under 20-year-old age group (9.8%), and there was a highly significant relationship to the experience of the operator (P <.001). Statistical analyses revealed that both lingual and inferior alveolar nerve paresthesia were unrelated to the other variables. CONCLUSIONS: The elevation of lingual flaps and the experience of the operator are significant factors contributing to lingual and inferior alveolar nerve paresthesia, respectively.

Effect of preservation of the inferior and posterior borders on recurrence of ameloblastomas of the mandible.

OBJECTIVE: The purpose of this study was to evaluate the experience and results of using a rational radical conservative approach in the surgical treatment of mandibular ameloblastomas. STUDY DESIGN: A retrospective analysis of every patient with an ameloblastoma of the mandible treated in the Department of Oral Medicine and Oral Surgery at the Jordan University of Science and Technology between 1989 and 1999 was conducted. All were operated on by the author, who used a uniform surgical protocol in every case. All soft tissues in contact or overlying the lesion and a wide margin of cancellous bone related to the tumor were destroyed. The compact bone comprising the lower border of the mandible and the posterior border of the ascending ramus together with the nutrient periosteum attached to them were preserved, thus maintaining the continuity of the mandible and the facial contours. When teeth, soft tissues, or both were involved, they were destroyed. All patients were reviewed annually for a follow-up period of 3 to 10 years (mean, 6.5 years) by the same clinician. RESULTS: All ameloblastomas were located in the mandible; 21 were in the angle/molar region and the ascending ramus, and 2 cases were in the anterior region. There was no clinical or radiographic evidence of recurrence observed during the follow-up period. CONCLUSION: Ameloblastoma has a high rate of local recurrence if it is not adequately removed. The findings of this study to date suggest that the technique of rational radical conservative resection may have a place in the treatment of ameloblastoma of the mandible and is worthy of further trial.

Angiotensin II, nitric oxide, and end-organ damage in hypertension.

The adaptive changes that accompany hypertension and involve the kidney, heart, and vessels, namely, muscle hypertrophy/hyperplasia, endothelial dysfunction and extracellular matrix increase can, in fact, be maladaptive and eventually lead to end-organ disease, such as renal failure, heart failure, and coronary disease. However, these changes vary markedly between individuals with similar levels of hypertension. Nitric oxide (NO), an endogenous vasodilator and inhibitor of vascular smooth muscle and mesangial cell growth, is synthesized in the endothelium by a constitutive NO synthase (NOS). NO antagonizes the effects of angiotensin II on vascular tone and growth and also down-regulates the synthesis of angiotensin converting enzyme (ACE) and angiotensin II type 1 (AT-1) receptors. In hypertension, the physiologic response to the increased shear stress and cyclic strain is to upregulate NOS activity in endothelial cells. Upregulation of vascular NOS activity is a homeostatic adaptation to the increased hemodynamic workload that may help in preventing end-organ damage. Indeed, hypertension-prone salt-sensitive rats manifest a decrease (instead of an increase) in vascular NOS activity when hypertensive; these rats develop severe vascular hypertrophy, left ventricular hypertrophy, and renal injury. Studies in hypertensive humans suggest that, independent of the effects of salt on blood pressure, salt sensitivity may be a marker for susceptibility to the development of endothelial dysfunction as well as cardiovascular and renal injury. We hypothesize that in hypertension, recognition of markers of cardiovascular susceptibility to injury and the understanding of the pathophysiological mechanisms involved may open new opportunities for therapeutic intervention. In this context, only those antihypertensive agents that lower blood pressure and concomitantly restore the homeostatic balance of vasoactive agents such as angiotensin II and NO within the vessel wall would be effective in preventing or arresting end-organ disease.

Etiology and incidence of maxillofacial fractures in the north of Jordan.

OBJECTIVE: The objective of this investigation was to determine the causes and incidence of maxillofacial fractures in the country of Jordan. DESIGN: A retrospective review of patient records and radiographs for the 5-year period from 1992 to 1997 was conducted. Data regarding age, gender, cause of fracture, anatomic site, and treatment modalities were reviewed. RESULTS: During the 5-year period, 563 patients with 756 maxillofacial fractures were treated. The age range was 5 to 73 years (mean, 28.8 years). Of the 563 patients, 75.3% were male, with the peak incidence occurring in the age group 20 to 29 years. The bone of fracture was most frequently the mandible (seen in 419 cases, or 74.4% of the total), followed by the maxilla (76 cases; 13.5%), the zygomatic arch (60 cases; 10.7%), and the alveolar process (8 cases; 1.4%). Of the fractures, 55.2% were due to traffic accidents, 19.7% to accidental falls, and 16.9% to assaults. Most patients (82.3%) were treated by closed reduction surgery (45.2% with eyelet wiring; 54.8% with arch bars and intermaxillary fixation). Only 17.7% of patients were treated by open reduction surgery. All maxillary fractures were treated by orbital and circumzygomatic suspension with interdental wiring and intermaxillary fixation. Of the zygomatic complex fractures, 26 cases were treated with Gillies' temporal approach, 20 with percutaneous hook elevation, and 14 with observation alone. CONCLUSION: The findings support the view that both the causes and the incidence of maxillofacial fractures vary from one country to another.

Treatment of mandibular odontogenic keratocysts.

OBJECTIVE: The purpose of this study was to report our experience with surgical treatment of 31 mandibular odontogenic keratocysts, with special reference to their recurrence, and to review the literature on this subject. STUDY DESIGN: A retrospective analysis was conducted of all odontogenic cysts treated in the Department of Oral Surgery and Oral Medicine at Jordan University of Science and Technology between 1989 and 1995. Of a total of 227 odontogenic cysts, 31 odontogenic keratocysts were histopathologically diagnosed preoperatively. They were surgically treated through an intraoral approach by resection without continuity defects. The lower border of the mandible and/or the posterior border of the ramus was left intact. In cases where teeth were in continuity with the lesion, they were extracted. In cases where cortical perforation occurred, any associated overlying mucoperiosteum was excised. All patients were reviewed annually for a follow-up period of 2 to 8 years. RESULTS: All odontogenic keratocysts were found in the mandible. Of these, 23 were in the ramus and angular region (74.2%) and 8 were located in the body of the mandible. No recurrences of the operated odontogenic keratocysts were observed during the follow-up period. CONCLUSION: Our findings indicate that removal of odontogenic keratocysts by resection without continuity defects is a satisfactory method of treatment.

Aneurysmal bone cysts of the maxilla: a clinicopathologic review.

PURPOSE: This study evaluated the significant differences in clinicopathologic features of aneurysmal bone cyst in the maxilla and mandible. MATERIALS AND METHODS: A search of the literature showed 30 recorded maxillary cases, and these together with one previously unrecorded case formed the basis of the study. RESULTS: There were no differences in the age and sex incidence. Only two patients complained of pain, and no patient complained of tenderness. No patient gave a history of trauma. Swelling was present in virtually every patient. In seven cases, there was tooth mobility or migration of teeth. Two patients complained of paresthesia. Four patients presented with proptosis, two of whom complained of diplopia. The radiographic appearance of the aneurysmal bone cyst is suggestive but not diagnostic. CONCLUSION: Although these differences do not enable the clinician to make a definitive diagnosis before biopsy, they have important implications for management.

Arsenical necrosis of the jaws.

After a brief historical review of the use of arsenic in dental practice two cases of arsenical necrosis of the jaws, affecting the maxilla and mandible respectively, are reported. Both patients were treated conservatively over an extended period with excellent results. It is concluded that there is no justification, whatsoever, for the use of arsenic in modern dental practice and that, although prolonged, conservative treatment of chemical necrosis of the jaws is preferable to more radical treatment.

Extraoral epidermoid cysts.

Three boys presented with extraoral epidermoid cysts at the ages of 21 months and 10 and 12 years respectively. These were excised satisfactorily. We suggest that submental or extraoral epidermoid cysts constitute a distinct clinical entity, may arise below the mylohyoid muscle and when small are best removed via an extraoral approach.

Oral infiltrating lipomas.

Infiltrating lipomas are unusual benign tumours of mesodermal origin which infiltrate adjacent skeletal muscle and tend to recur after excision. We report three previously unrecorded cases that developed about the mouth, and describe the clinical characteristics of these lesions, together with those of the seven previously reported cases. We have identified a number of differences from oral lipomas that could be of diagnostic value.

An unusual case of the Melkersson-Rosenthal syndrome. A case report.

A case of Melkersson-Rosenthal syndrome in a woman with a history of trauma and infection is presented. In addition to the classical triad of signs, the patient also exhibited several other features of rare occurrence associated with Melkersson-Rosenthal syndrome. Clinical diagnosis was confirmed by biopsy, which revealed the characteristic features of Melkersson-Rosenthal syndrome.