Knowledge and attitudes of emergency medicine physicians and nurses regarding emergency management of dentofacial trauma in pediatric patients.

OBJECTIVES: Considering that the first visit for dentofacial trauma is generally in emergency departments, the awareness and knowledge of the emergency medicine staff regarding the treatment of dentofacial injuries is very important for the prognosis. The aim of this study was to investigate the knowledge, education, and self-confidence levels of emergency medicine physicians and nurses concerning the diagnosis and treatment of dentofacial traumatic injuries in pediatric patients. METHODS: This questionnaire-based, cross-sectional study included emergency medicine physicians and emergency medicine nurses. The survey contained questions and three sections on participants' general data, attitudes, basic knowledge, and confidence levels in managing dentofacial trauma. RESULTS: A total of 407 participants (250 emergency medicine physicians and 157 emergency medicine nurses) were included in this study. There was a significant difference between the groups regarding the correct answers to the questions about trauma management and emergency management of crown fractures and avulsed permanent teeth (p <0.05). CONCLUSION: Our findings show that there is a lack of information on dentofacial trauma for emergency medicine physicians and nurses. In order to increase knowledge in this area and to improve the diagnosis and management of dentofacial trauma, interdisciplinary seminars, case discussions, and continuing education programs should be held for emergency medicine staff.

Initial radiological signs of dentofacial deformity in juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood and the temporomandibular joint (TMJ) is often involved. TMJ arthritis in growing individuals can cause deformation of facial skeleton (dentofacial deformity) and TMJ components (TMJ deformity). Treatment outcome hinges on early initiation of anti-inflammatory treatment and orthopaedic treatment with dental splints. The aim of the present study was to characterize the radiological signs of dentofacial deformity in patients with a JIA-induced need for orthopaedic treatment. We retrospectively studied 96 patients with JIA and 20 non-JIA controls to identify the initial radiological signs of JIA-induced dentofacial deformity leading to initiation of orthopaedic treatment. We found that initial radiological signs of dentofacial deformities were subtle and characterized by minor mandibular asymmetry and occlusal plane steepening. Radiological findings of TMJ deformity associated with initial dentofacial deformity were frequent and characterized by condylar articular surface flattening (OR 8.42), condylar subcortical cyst (OR 5.94), condylar surface erosion (OR 5.38) and condylar deviation in form (OR 25.39). Radiological signs of TMJ deformity were also documented in TMJs considered "healthy" during initial clinical and radiological examination. This study presents new knowledge of importance for early diagnosis of dentofacial deformity in JIA. Early diagnosis of dentofacial deformity is important as treatment outcome is greatly influenced by timely initiation.

Decision-making in awake fibre optic intubation for patients with severe dentofacial infection: which patients will require fibre optic intubation?

BACKGROUND: Risk factors for advanced airway intervention among patients with dentofacial infection (DFI) are poorly understood. The appropriate delivery of clinical care to this patient group raises challenging anaesthetic service provision issues. The purpose of this study was to identify factors which may predict a requirement for an awake fibre optic intubation (AFOI) technique for airway management in this patient population. METHODS: A retrospective analysis of data for consecutive patients admitted with DFI were analysed at the Oral & Maxillofacial department at St James's Hospital, Dublin from July 2014-July 2015 was carried out. Receiver operating characteristic analysis determined optimal cut-off values predictive of AFOI, and multivariate logistic regression determined independent risk factors for AFOI. RESULTS: One hundred and twenty-five patients (64 male, 61 female) were admitted with DFI. The mean age was 35.9 years (range 16-91). AFOI was carried out in 58 (67.4%) patients who required GA. Increasing age was associated with an increase likelihood of AFOI (P = 0.047 95% CI 1.07(1.00-1.14). Reduced mouth opening was significantly associated with requirement for AFOI (28.8 ± 8.6 vs. 14.8 ± 8.6 mm, P < 0.0001). On receiver operating characteristic (ROC) analysis, mouth opening predicted requirement for AFOI with 87% accuracy (AUC 0.87 [95% CI 0.80-0.95], P < 0.0001). Using a cut-off value of 16.5 mm predicted subsequent AFOI with 96.7% (95% CI 78.1-100.0%) specificity and 65.6% (95% CI 51.4-77.8%) sensitivity. Initial C-reactive protein (CRP) was significantly associated with requirement for AFOI (60.1 ± 40.0 vs. 121.3 ± 89.8, P = 0.002). A CRP value of over 110 mg/L predicted subsequent AFOI with 95.8% (95% CI 78.9-100.0%) specificity. CONCLUSION: Increasing age, reduced mouth opening < 16.5 mm, and an increased serum admission CRP > 100 mg/L on admission significantly increase the requirement for AFOI on multivariate and univariate regression analysis. The availability of anaesthetists experienced in AFOI is essential for safe management of these patients.

Surgical Treatment of Dentofacial Deformities Caused by Juvenile Idiopathic Arthritis.

The purpose of our retrospective study was to evaluate the results of orthognathic treatment, distraction osteogenesis, and/or prosthetic reconstruction of the temporomandibular joints in patients with juvenile idiopathic arthritis (JIA).Twelve patients with severely affected temporomandibular joints (TMJs) and reduced ramus height were treated with mandibular advancement with orthognathic surgery (11) and additional bilateral or unilateral mandibular ramus distraction (3) or additional bilateral or unilateral prosthetic reconstruction of the TMJ (3). One patient was treated surgically with bilateral TMJ prosthetic reconstruction only. The patients were followed up clinically and radiologically with emphasis on healing, TMJ function, stability of the occlusion, skeletal stability, and facial appearance for an average of 2.3 years after the final surgery. The mean mandibular advancement was 10.1 mm. The mean relapse at pogonion was 2.1 mm, which represents 20.8% of the surgical advancement. The occlusion was stable in 11/12 patients. The TMJ function was good and the facial esthetics improved in all patients. Orthognathic treatment and mandibular ramus distraction osteogenesis provide beneficial lengthening of the mandibular body in JIA patients with asymptomatic and stabile condyles. In adult patients with relapse of the disease or postoperative condylar relapse prosthetic total joint replacement is a reliable and safe alternative.

Guideline for the Treatment of Condylar Osteochondroma Combined With Secondary Dentofacial Deformities.

OBJECTIVE: Surgical treatment of condylar osteochondroma combined with secondary dentofacial deformities is a significant clinical challenge. The authors present this review article to provide some guidelines for the surgical treatment for this severely complex condition. MATERIALS AND METHODS: Diagnosis and treatment protocol of condylar osteochondroma patients combined with secondary dentofacial deformities are discussed at the basis of published literatures and the authors' own clinical experiences. Proper treatment protocol was designed according to features of tumor and dentofacial deformities. Follow-up and radiographic examination was performed to evaluate recurrence of tumor, occlusion, joint function, and facial appearance after surgery. RESULTS: The patients received 1 or several methods of resection of tumor, condylar reconstruction, correction of skeletal deformities, and treatment of malocclusion. The condylar ostechondroma and secondary dentofacial deformities were treated satisfactorily. Temporomandibular joint function, occlusion, and facial appearance were improved obviously after operation evidenced by radiographic examination and follow-up. CONCLUSION: Surgical management of condylar osteochondroma with secondary dentofacial deformities requires careful patient selection, treatment planning, and precise execution. This article has reviewed the current status of surgical treatment options and provided practical guidelines for oral and maxillofacial surgeons to consider their clinical practice.

Treatment of Dentofacial Deformities Secondary to Osteochondroma of the Mandibular Condyle Using Virtual Surgical Planning and 3-Dimensional Printed Surgical Templates.

PURPOSE: One-stage treatment for condylar osteochondroma and secondary facial deformities by resection and reconstruction of the mandibular condyle, orthognathic surgery, and mandibular contouring has been reported recently. This study investigated the clinical feasibility of treating osteochondroma of the mandibular condyle and secondary dento-maxillofacial deformities by virtual surgical planning and 3-dimensional (3D) printed surgical templates. MATERIALS AND METHODS: A composite skull model with accurate dentition was obtained with data from spiral computed tomography (CT) and surface scanning of the dental arch. Virtual surgical simulation was performed using Dolphin Imaging 11.7 Premium and Mimics software after a comprehensive 3D diagnosis and surgery planning. Surgical templates were fabricated by 3D printing using data from virtual surgical simulation for guidance of excision of the mandibular condyle with osteochondroma, reconstruction of the mandibular condyle, mandibular contouring, and reconstruction of a normal occlusion. Le Fort I osteotomy of the upper jaw and genioplasty were performed when indicated. The linear difference between virtually simulated and postoperative skull models was evaluated. RESULTS: All surgeries were successfully simulated using virtual surgical planning, and the guiding templates were successfully applied for all patients. Successful reconstruction of condylar function, normal occlusion, and symmetry of the facial profile was achieved. Postoperative CT scans and quantitative analysis showed that virtual surgical plans provided acceptable accuracy in the operating room. The linear difference of the incisors and first molars was no more than 1.4 mm, and the greatest difference was found for the menton landmark, which was up to 2.4 mm. CONCLUSIONS: Results from this study suggested that virtual surgical planning and guiding templates facilitated accurate diagnosis, treatment planning, accurate osteotomy, repositioning of bony segments, and contouring of the mandibular border in the treatment of condylar osteochondroma and secondary facial asymmetry.

Oro-facial characteristics and the surgical correction of patients affected by beta-thalassaemia: a review of the literature and report of a case.

Despite the fact that recent medical advances have improved the quality of life and increased the life expectancy of patients suffering from thalassaemia, no standard strategy or clinical guidelines are available for the correction of the presenting craniofacial anomalies. The aim of the present study is to review the craniofacial features of affected patients, and to discuss the orthodontic and orthognathic surgical treatment options available to manage the associated and characteristic facial deformity.

Orthodontic-surgical management of a case of severe mandibular deficiency due to condylar ankylosis.

Dentofacial deformities involve deviations from the normal facial proportions and dental relationships and can range from mild to being severe enough to be severely handicapping.The term handicapping malocclusions though not a term commonly used, involves a fortunately small section (2-4%) of patients who can suffer from esthetic,psychological and functional problems. Craniofacial Orthodontics is the area of orthodontics that treats patients with congenital and acquired deformities of the integument and it's underlying musculoskeletal system within the craniofacial area and associated structures.This case report of a young woman with severe mandibular deficiency and facial asymmetry due to condylar ankylosis highlights the importance of team work in rehabilitation of such severe craniofacial deformities.

Treatment management of children with juvenile idiopathic arthritis with temporomandibular joint involvement: a systematic review.

OBJECTIVE: This study aimed to systematically review the available literature on the treatment of patients with juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement. STUDY DESIGN: According to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, studies were included until August 2012. RESULTS: A total of 40 articles were identified. TMJ involvement in patients with JIA varies between 17% and 87%. The mean age at diagnosis of JIA is 7.2 years. TMJ treatment can be divided into 2 main groups, an arthritis group and a dentofacial deformity group. The main treatment modalities are counseling, pharmaceutical interventions, physiotherapy, orthodontic treatment, surgery, or a combination of the aforementioned therapies. CONCLUSIONS: TMJ involvement in patients with JIA has a high incidence. There is no consensus on the treatment of TMJ pathology and dentofacial deformities in patients with JIA, and treatment varies from counseling to surgery. Treatment to improve aesthetics and function and to obtain pain reduction can be effective. However, the articles are heterogeneous, and the level of evidence is low (level IV).

A review of 156 odontogenic tumours in Calabar, Nigeria.

BACKGROUND: Odontogenic tumours occur in our environment and because of late treatment, cause considerable disabilities. OBJECTIVE: To review cases of odontogenic tumours in our centre in order to obtain a baseline data and subsequently compare the results with that obtained elsewhere. PATIENTS AND METHODS: Using hospital case files and register, we carried out a 15-year retrospective study of odontogenic tumours at the Dental and Maxillofacial Clinic, University of Calabar Teaching Hospital, Nigeria. The data documented include age, gender, duration of lesion, type of tumour, socio-economic class, type of surgery, and complaints during follow-up reviews. RESULTS: Majority of the patients (n=49, 31.4%) were in the third decade of life. There were 85 (54.5%) males and 71 (45.5%) females, giving male to female ratio of 1.2:1. There was a significant association between the type of odontogenic tumour and the age of occurrence (p=0.000). The longer the duration of symptoms before presentation, the larger the tumours (p=0.000). The benign odontogenic tumours were 151 (96.8%), ameloblastoma (n=74, 47.4%) being the commonest. Jaw resection (54.5%) was the predominant treatment. Majority (58.0%) of the complications following treatment were Facial deformity, malocclusion and impaired mastication. CONCLUSION: Majority of the patients was in the lower socio-economic class, presented late for treatment and a few with aesthetic and functional impairment returned for secondary surgery. The intervention of agencies of government and non-governmental organizations is required to assist these patients if we are to accomplish the core healthcare system values in our environment.

Late revision or correction of facial trauma-related soft-tissue deformities.

Surgical approaches used in accessing the facial skeleton for fracture repair are often the same as or similar to those used for cosmetic enhancement of the face. Rarely does facial trauma result in injuries that do not in some way affect the facial soft-tissue envelope either directly or as sequelae of the surgical repair. Knowledge of both skeletal and facial soft-tissue anatomy is paramount to successful clinical outcomes. Facial soft-tissue deformities can arise that require specific evaluation and management for correction. This article focuses on revision and correction of these soft-tissue-related injuries secondary to facial trauma.

Late reconstruction of orbital and naso-orbital deformities.

Acute orbital fractures and naso-orbital ethmoid fractures can result in chronic orbital and naso-orbital deformities. Understanding the acute injury is the first step in reconstructing the established late deformity. The best management strategy for reconstruction of orbital hypertelorism is to avoid late complications by repairing these deformities early near the time of the original fractures. New technologies from computer-guided surgical planning and additive manufacturing technology produce passive fitting implants tailored for patient-specific needs.

Treatment guidelines for temporomandibular joint ankylosis with secondary dentofacial deformities in adults.

Temporomandibular joint (TMJ) ankylosis with secondary dentofacial deformities in adult patients is a severely disfiguring condition and surgical treatment of this disease remains a great clinical challenge. Treatment goals are to restore the joint function, to improve facial appearances and to correct malocclusion, as well as to re-establishing harmony among them. Currently, various surgical techniques, such as arthroplasty with or without interpositional material, orthognathic surgery, distraction osteogenesis, autologous bone or bone replacement materials graft and plastic surgery, have been described in the literature. In most cases these techniques should be used in combination to achieve satisfactory outcomes. The biggest difficulty for most clinicians is to determine the proper sequence of these procedures because no uniform treatment protocol has been established. Based on the published literature and our own clinical experiences, we have prepared this review article to provide some guidelines for the surgical management of TMJ ankylosis with dentofacial deformities in adults, which will be modified and updated periodically to provide the best treatment options to benefit our patients.

Intervención educativa en escolares de 5 y 6 años con hábitos bucales deformantes / Educative intervention in children aged 5-6 with deforming oral habits

Debido a que las maloclusiones constituyen un problema de salud en la población y por la estrecha relación que existe entre estas y la persistencia de hábitos bucales deformantes, nos dimos a la tarea de realizar una intervención educativa en niños de 5 y 6 años afectados por estos. Se efectuó un estudio del tipo longitudinal prospectivo descriptivo en una escuela primaria del área de salud de Santa Martha, Municipio Varadero, provincia de Matanzas, en el período comprendido por el curso escolar 2005-2006. El universo estuvo constituido por 120 niños de preescolar y primer grado de esta escuela, de donde se obtuvo una muestra representativa de 87 escolares que presentaban hábitos bucales deformantes. Se observó el predominio del uso del biberón en los niños de estas edades (65,6 por ciento) en relación con el reto de los hábitos estudiados, así como el hecho de que al finalizar la intervención disminuyó la presencia de dichos hábitos(AU)

As malocclusions are a health problem in the population and as there is a close relationship between them and the persistence of deforming oral habits, an educative intervention was carried out in children aged 5-6 affected by them. A longitudinal, prospective and descriptive study was undertaken in a primary school of the health area of Santa Martha, Varadero municipality, province of Matanzas, during the academic course 2005-2006. The study group was composed of 120 children of kindergarten and first grade. A sample of 87 school children with oral deforming habits was obtained. The use of nursing bottle prevailed in children at these ages (65.6 percent) compared with the rest of the studied habits. It was observed a reduction of these habits at the end of the intervention(AU)