Dental emergencies presenting to maxillofacial units during the COVID-19 pandemic: a five-centre UK hospital study.

Introduction Coronavirus disease (COVID-19) represents an unprecedented challenge to healthcare. Provision of dental services was significantly affected, with limited provision for emergencies resulting in patients increasingly attending hospitals.Objectives and methods The aim of the study was to assess the provision of emergency dental services by the maxillofacial departments during the initial COVID-19 pandemic lockdown in the United Kingdom. At the outset of the first lockdown, we initiated a prospective study to monitor the presentation and management of dental emergencies at five hospital trusts. Data were collected onto an online live database until the lockdown relaxation.Results Of a total of 211 dental emergencies, 156 were infection-related, 42 were trauma-related and 12 were cases of post-operative complications. A proportion of patients (76%) could have been treated in primary care, with 52% of presentations having already been 'triaged' on several occasions by urgent dental hubs and given multiple antibiotic courses, rather than any direct treatment.Conclusion There is a need to restructure emergency dental service provision as well as planning for possible further COVID-19 spikes and future pandemics.

A rare case of a intraosseous arteriovenous malformation of the temporomandibular joint and mandible - Case report and literature review.

INTRODUCTION: This case report looks at a 47 year-old patient, presenting with a rapid onset mass of the left face. This report examines the case, the investigations undertaken, its management and undertakes a literature review of this uncommon condition and rare presentation. PRESENTATION OF CASE: This patient had experienced functional deterioration, restriction and an evident swelling of the left face. Having identified the mass to arise from the mandibular condyle, an incisional biopsy was undertaken. The histology was suggestive of an arteriovenous malformation. Surgery was undertaken to excise the entire left mandibular condyle along with the lesion and then replace the temporomandibular joint with a custom made prosthesis. DISCUSSION: Arteriovenous malformations, or Haemiangiomas, can arise in any part of the body and can often grow over time. Although benign, lesions can be locally invasive and distort anatomy, resulting in functional issues. Their risk for hemorrhage and potentially significant blood losses is also a risk factor in their presence. Rarely arteriovenous malformations can occur in hard tissue, as in this case distorting and obliterating the temporomandibular joint. One's only recourse is to remove and eliminate the lesion, however in cases such as this significant morbidity could ensue due to functional deficit. Hence consideration must be given to reconstruction. CONCLUSION: Having excised the mass and reconstructed the temporomandibular joint with a titanium prosthesis, the patient experienced a good recovery with a return to normality.

Penetrating retro-orbital foreign body - large glass shards: A maxillofacial surgery case report.

OBJECTIVES: This case report looks at a 53-year-old patient who had suffered a penetrating foreign body injury to the retro-orbital space and the surgical approach taken to remove the large glass fragments found and to correct the damage caused. Having fallen while holding a drinking glass, this patient suffered multiple laceration injuries to the maxillofacial region upon the glass shattering in contact with the face. However, unbeknownst to the patient, several glass fragments became embedded in the retro-orbital space, and this was only detected on presentation 2 days post-injury with unusual symptoms of sharp, sudden pain elicited on extreme gaze as well as ocular motility restriction. METHODS: This embedded foreign body required a creative surgical approach to remove it involving gaining access to the retro-orbital space via a superior approach and cautiously following the path the glass shards took upon entry, all the way to the posterior aspect of superior rectus. Intra-operative radiographic guidance was required due to the restriction of operating within this space and particularly when removing glass fragments distal to superior rectus. RESULTS AND CONCLUSION: The patient recovered well and experienced an immediate improvement in ocular motility with a return to relative normality over the next few months.