COVID-19 vaccine and non-syndromic orofacial clefts in five arab countries. A case-control study.

OBJECTIVES: Risk factors for non-syndromic orofacial cleft (NSOFCs) include genetic profile and environmental exposure to medication and illnesses during pregnancy. We assessed the association between the COVID-19 vaccination and the incidence of NSOFC across five Middle Eastern countries. MATERIALS AND METHODS: This multi-country, hospital-based, case-control study included infants with NSOFCs whose first 3 intrauterine months coincided with the time when pregnant women were allowed to receive COVID-19 vaccination in the countries participating in the study. Newborns with NSOFCs were examined for cleft type and their parents were interviewed for maternal exposures and COVID-19 vaccination. Controls were newborns matched to cases in gender and setting. RESULTS: The study recruited 977 (348 children with NSOFCs and 629 controls). Maternal use of nicotine (Adjusted Odds Ratio (AOR): 2.437; P = 0.044) and family history of NSOFC (AOR: 11.059; P < 0.001) increased significantly the AOR of having a child with NSOFC. On the other hand, COVID-19 vaccine administration to pregnant mothers have significantly decreased the AOR of having a child with NSOFC (AOR: 0.337; P = 0.006). CONCLUSION: This study suggests that COVID-19 vaccination is not related to NSOFC and might protect against having a child affected with such a congenital anomaly. CLINICAL RELEVANCE: The finding of this study is important for healthcare providers for considering COVID-19 vaccination for pregnant woman. Clear communication and education about the potential risks and benefits would be crucial for informed decision-making. The study's results would directly impact pregnant individuals, as they would need accurate information to make informed decisions about their health and the health of their infants.

Application of supraclavicular island flap in oral and maxillofacial reconstruction.

Several surgical modalities are available for maxillofacial reconstruction as locoregional or microvascular free flaps. PURPOSE: (a) Evaluate the reliability of the supraclavicular flap in cervico-orofacial region; (b) investigate the role of computed tomography angiography (CTA) in predicting the post-operative viability of the flap; (c) assess the speech, feeding, and esthetics after reconstruction using this flap. METHODS: Eleven patients included in this study underwent either conventional or delayed harvesting of the supraclavicular flap (SCF). All the patients had diagnostic computed tomography angiography (CTA) of the supraclavicular flap before the surgery. RESULTS: The mean harvesting time of the flap was 45.45 ± 4.16 min. The average length of the flap was 22.64 ± 1.12 cm, whereas the mean width of the flap was 6.14 ± 1.14 cm. The flap survived in 9 patients, while two patients had complete flap loss. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. Only two patients complained of weakness in the donor site. None of the patients reported that the weakness or pain at the donor site affected their daily activities or quality of life. CONCLUSION: The pedicled SCF represents a safe and feasible option that can be used to reconstruct a wide array of maxillofacial oncologic defects. However, a study with a larger sample size is recommended to achieve more reliable clinical results for the modified delayed technique modification in terms of their effect on the survival of the supraclavicular flap.

COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study.

BACKGROUND: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19. METHODS: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion. RESULTS: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC. CONCLUSIONS: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Pediatric Aggressive Benign Mandibular Tumors: Clinical Features and Management.

INTRODUCTION: Aggressive benign mandibular tumors are uncommon in the pediatric population, and there is few publishing in the literature specifically dealing with them. Aggressive tumors can be defined based on known biologic behavior and/or histologic type and/or clinical characteristics. AIM OF THE STUDY: To review the clinical features and management of lower jaw pediatric aggressive benign tumor. PATIENTS AND METHODS: Medical records review of pediatric patients presented with aggressive benign mandibular tumors to the Maxillofacial and Plastic Surgery Department, University of Alexandria, Egypt between 2011 and 2019. RESULTS: Fifty-eight patients were included in this study, aged between 2 and 16 years (average = 11.8). Ameloblastoma was the commonest pathological diagnosis (n = 18) followed by central giant cell granuloma (n = 11) and juvenile ossifying fibroma (n = 10). Patients with central giant cell granuloma were treated by en-block resection (n = 4) or curettage after interferon alfa injection (n = 7). All other benign tumors were treated by en-block resection. The length of follow-up ranged from 1 to 8 years. Successful reconstruction was accomplished in 45 patients (88.2%). CONCLUSIONS: Aggressive lesion should be treated in an aggressive manner and immediate reconstruction is advocated. However, pharmacotherapy combined with enucleation is a more conservative approach for management of aggressive central giant cell tumors.

What is the best method for prevention of postparotidectomy Frey syndrome? Network meta-analysis.

BACKGROUND: Prevention of Frey syndrome (FS) after parotidectomy using an interposition barrier has long been gaining a wide popularity; however, there is no clear evidence regarding which preventive technique is more effective. The aim of this network meta-analysis (NMA) is to answer the question: What is the best method for prevention of FS after parotidectomy? METHODS: A comprehensive search of the PubMed, Embase, SCOPUS, and Cochrane library was conducted to identify the eligible studies. The outcome was the incidence of subjective Frey syndrome (SFS) and objective Frey syndrome (OFS). The Bayesian NMA accompanied with a random effects model and 95% credible intervals (CrIs) were calculated using GeMTC R package. RESULTS: Thirty-four studies (n = 2987 patients) with five interventions, namely Alloderm (ADM), temporoparietal fascia (TPF), sternocleidomastoid muscle (SCM), superficial musculoaponeurotic system (SMAS), and free fat graft (FFG), were compared together and with no interposition barrier (NB). The results of NMA showed a statistically significant reduction in both SFS and OFS when ADM, TPF, SMAS, FFG, and SCM were compared with NB. No statistical differences were observed when comparing ADM, SCM, SMAS, FFG, and TPF. TPF ranked the best of all treatments (59.4%) and was associated with the least incidence of SFS; whereas ADM ranked the best of all treatments (61.1%) and was associated with the least incidence of OFS. CONCLUSIONS: All interventions (TPF flap, ADM, FFG, SMAS, and SCM) were associated with a significant reduction in the incidence of FS when compared with NB. TPF and ADM showed the best outcome with the least incidence of SFS and OFS, respectively.

Panfacial Fractures Management.

INTRODUCTION: Panfacial fracture represent a challenge for maxillofacial surgeons due to paucity of useful landmark and stable bone that can be used for fixation. Nowadays, with the availability of rigid and semi rigid fixations, understanding of the importance of the facial buttresses, bone grafting, and early intervention, the functional and cosmetic outcomes showed a significant improvement. Many treatment sequences exist in the literature including top to bottom, bottom to top, lateral to medial, and medial to lateral approach. AIM OF THE STUDY: To evaluate the outcome of "bottom to top, lateral to medial" sequence that we used in the management of panfacial fractures in term of function and cosmesis. PATIENTS AND METHODS: This study included 73 patients with panfacial fractures admitted to the Maxillofacial and Plastic Surgery Department, Alexandria University. RESULTS: Most of the patients (n = 52, 71.23%) were aged between 21 and 40 years old. 83.56% (n = 61) of patients were male. Road traffic accidents was the most common cause of trauma (n = 57). The most common site involved in panfacial fracture was the middle and lower third (58%). The common complication observed was malocclusion (n = 6). Of these, 5 patients had minor malocclusion that was corrected orthodontically and only one patient required surgical intervention. CONCLUSION: The "bottom to top, lateral to medial' sequence for reduction and fixation of panfacial fractures is reliable with satisfactory results in term of function and cosmesis.

Widespread metachronous carcinoid tumour metastases to the head and neck: a unique presentation.

Carcinoid tumours are usually slow-growing, neuroendocrine neoplasms that primarily affect the gastrointestinal tract and bronchial tree. Although relatively rare, isolated, single metastasis to the head and neck has been reported. We present a unique case of 6 metachronous carcinoid metastases to both parotid glands, the left submandibular gland, upper lip, and thyroid, over 3 years. To our knowledge, this widespread presentation in the head and neck has not previously been reported.

Metastatic squamous cell carcinoma in the neck presenting with Horner syndrome - a cause of the condition not previously described.

Horner syndrome, a combination of pupillary miosis, ptosis and facial anhidrosis, results from damage to the oculosympathetic nerve pathways. It can occur anywhere from the hypothalamus to the eye, but to our knowledge, metastatic disease to a node in the neck from a mucosal squamous cell carcinoma (SCC) of the head and neck has not previously been reported as a primary cause in humans. It is surprising that it does not present more often given the frequency of metastatic disease in the neck. We discuss how it may have occurred, and highlight the importance of a thorough examination and investigation of the head and neck in patients who present with unusual neurological signs.