ABSTRACT
OBJECTIVES: COVID-19 is considered one of the most serious pandemic in history and has posed major challenges to the world's health care. Dentistry and oral and maxillofacial surgery (CMFS) are particularly affected due to direct exposure to the respiratory tract, as the reservoir of SARS-CoV-2. In this study, the impact of the COVID-19-pandemic on a dental and CMFS emergency services in Germany in 2020 was first time investigated and correlated with governmental restriction measures in public life. MATERIALS AND METHODS: Epidemiological data of a German University Hospital were analysed from a total of 8386 patients in 2019 and 2020. Parameters included information on demographics, time, weekday and reason for presentation, as well as diagnosis and therapy performed. Data from 2020 were compared with those from 2019, taking into account the nationwide periods of public life restrictions. RESULTS: In 2020, 22% fewer patients presented via dental and CMFS emergency service. In a monthly comparison, there were negative peaks of up to - 41% in November, but also a plus of 26% in July. The largest decreases were recorded during the lockdown periods in spring (- 33%) and winter (- 39%). Further, a threefold increase in actual emergencies and inpatient admissions revealed during these time periods (p < 0.001). CONCLUSIONS: COVID-19 pandemic had a significant impact on the dental and CMFS emergency service in 2020 resulting in more severe cases. CLINICAL RELEVANCE: This study underlines the importance of maintaining an emergency service system and basic outpatient care in these specialities, which requires uniform recommendations from the medical-dental societies and politics.
Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Hospitals, University , Humans , SARS-CoV-2ABSTRACT
OBJECTIVES: In reconstructive surgery, flap monitoring is crucial for early identification of perfusion problems. Using hyperspectral imaging (HSI), this clinical study aimed to develop a non-invasive, objective approach for perfusion monitoring of free and pedicled flaps. MATERIAL AND METHODS: HSI of 22 free (FF) and 8 pedicled flaps (PF) in 30 patients was recorded over time. Parameters assessed were tissue oxygenation/superficial perfusion (0-1 mm) (StO2 (0-100%)), near-infrared perfusion/deep perfusion (0-4 mm) (NIR (0-100)), distribution of haemoglobin (THI (0-100)), and water (TWI (0-100)). Measurements up to 72 h were correlated to clinical assessment. RESULTS: Directly after flap inset, mean StO2 was significantly higher in FF (70.3 ± 13.6%) compared with PF 56.2 ± 14.2% (p = 0.05), whereas NIR, THI, and TWI were similar (NIR_p = 0.82, THI_p = 0.97, TWI_p = 0.27). After 24 h, StO2, NIR, THI, and TWI did not differ between FF and PF. After 48 h, StO2, NIR, and TWI did not differ between FF and PF whereas THI was significantly increased in FF compared with PF(p = 0.001). In three FF, perfusion decreased clinically and in HSI, 36(1), 40(2), 5(3), and 61(3) h after flap inset which was followed by prompt intervention. CONCLUSIONS: StO2 < 40%, NIR < 25/100, and THI < 40/100 indicated arterial occlusion, whereas venous problems revealed an increase of THI. In comparison with FF, perfusion parameters of PF were decreased after flap transfer but remained similar to FF later on. CLINICAL RELEVANCE: HSI provides objective and non-invasive perfusion monitoring after flap transplantation in accordance to the clinical situation. With HSI, signs of deterioration can be detected hours before clinical diagnosis.
Subject(s)
Hyperspectral Imaging , Plastic Surgery Procedures , Feasibility Studies , Humans , Perfusion , Surgical FlapsABSTRACT
BACKGROUND: When using digitalization and artificial intelligence (AI), large amounts of data (big data) are produced, which can be processed by computers and used in the field of microvascular-reconstructive craniomaxillofacial surgery (CMFS). OBJECTIVE: The aim of this article is to summarize current applications of digitalized medicine and AI in microvascular reconstructive CMFS. MATERIAL AND METHODS: Review of frequent applications of digital medicine for microvascular CMFS reconstruction, focusing on digital planning, navigation, robotics and potential applications with AI. RESULTS: The broadest utilization of medical digitalization is in the virtual planning of microvascular transplants, individualized implants and template-guided reconstruction. Navigation is commonly used for ablative tumor surgery but less frequently in reconstructions. Robotics are mainly employed in the transoral approach for tumor surgery of the hypopharynx, whereas the use of AI is still limited even if possible applications would be automated virtual planning and monitoring systems. CONCLUSION: The use of digitalized methods and AI are adjuncts to microvascular reconstruction. Automatization approaches and simplification of technologies will provide such applications to a broader clientele in the future; however, in CMFS, robotic-assisted resections and automated flap monitoring are not yet the standard of care.
