新型交叉颊面管对磨牙支抗保护作用的临床研究

目的探讨新型交叉颊面管对磨牙支抗的保护作用。方法选取11名全程使用新型交义颊面管（XBuccal Tube,XBT）进行矫治的病例,在矫治前、后取上颌研究模型,进行三维数字模型测量,并和传统的治疗前后X线片重叠测量相对比,观察矫治前后上颌第一磨牙的位移变化。结果三维数字化模型测量显示矫治后22颗上颌第一磨牙平均远中倾斜1.81°,近中移动2．38mm,伸长0．73mm,颊向倾斜0．46°,与相应的头颅侧位片重叠测量结果进行配对t检验,结果显示二者间无显著性差异（P〉0．05）,达到强支抗的要求。结论在不使用任何额外口内或口外装置加强支抗的情况下,新型交叉颊面管能对磨牙支抗起到良好的保护作用。     

Admission patterns and outcomes of patients admitted to critical care in the UK with surgically treated facial infection: an analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database

Facial infections are common and can occasionally be severe. A small number of patients may develop severe sepsis or airway compromise requiring critical care admission. We examined a national intensive care database to assess patterns of admission and outcomes for patients in this cohort. An analysis was performed of the Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme database. Data were extracted on case mix and outcomes for patients coded as ‘mandible, facial bones, dental, and salivary infection’ admitted to critical care between 2010 and 2019. Data included admission numbers, demographics, comorbidities, physiology scores, and outcomes including length of stay and mortality. There were 2820 admissions for patients with facial infections from 212 CCUs over the ten-year period. Admissions increased from 194 in 2010 to 368 in 2019. These admissions accounted for 0.16% of overall admissions in 2010 and 0.21% in 2019, a statistically significant increase in the rate of admissions, p < 0.001. The median age of patients was 48 years and 62.7% were male. Sepsis was present in 77.6% of patients. The median length of stay in critical care was 49 hours (IQR 23.2, 100.3 hours). The median total hospital stay was 7 days (IQR 4, 16 days). The rate of admissions to CCUs for facial infection remains low overall but has significantly increased over the last decade. With increasing demand for this resource ongoing monitoring of utilisation is important.     

Oral and maxillofacial dental care professionals in critical care during the COVID-19 pandemic

At the peak of the COVID-19 pandemic there was a ‘call to arms’ across the oral and maxillofacial staff. This article reports on the extended role of the department's dental care professionals (DCPs) and the tremendous opportunity and value that temporary redeployment presented.     

腭裂患儿咽鼓管功能障碍与中耳疾病的研究

目的 :探讨不同年龄组腭裂患儿咽鼓管功能障碍与中耳疾病的发病情况。方法 :对 121例腭裂患儿 ,242耳 ,分为早期腭帆修复组 (手术时平均年龄为 3 2个月 )与延迟腭帆修复组 (手术时平均年龄为 15个月 ) ,在术前、术后 1年进行耳镜 ,耳显微镜检查和鼓膜穿刺术或鼓膜切开术。结果 :两组患儿均有 90 %以上的中耳有病理性渗出 ,但延迟手术组患儿的中耳渗出向粘稠化 ,感染化转变 ,两组患儿中耳渗出情况在术后 1年明显好转。结论 :腭裂患儿应尽早作耳科相关检查 ,对病理性渗出的中耳 ,应置放鼓室平衡管 ,以消除负压和引流 ,早期的腭帆修复术对咽鼓管及中耳功能的恢复有明显的改善。     

Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 10⁹/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.     

口腔颌面外科术后呼吸机相关性肺炎患者血清铁调素和铁蛋白临床分析

目的:研究口腔颌面外科术后呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者血清铁调素和铁蛋白的含量及临床意义.方法:选择2017年1月-2019年12月上海交通大学医学院附属第九人民医院收治的口腔颌面外科手术后行呼吸机治疗的患者196例,依据是否发生呼吸机相关肺炎分为VAP...     

Did the March 2020 lockdown cause an increase in patients presenting to the emergency department with odontogenic pain and infection? A single centre,retrospective analysis

On the 25 March 2020 the Chief Dental Officer (CDO) published guidance to restrict the provision of routine dental care in England due to the rapid spread of the severe acute respiratory syndrome Coronavirus 2 (COVID-19). We analysed the impact of the pandemic on the number of patients presenting with odontogenic pain and infection to the emergency department (ED) of an urban-based teaching hospital, the Bristol Royal Infirmary (BRI). Furthermore, we investigated the severity of infection at first presentation to the ED. The study period encompassed three phases that represented the stages of pandemic restrictions: phase 1 prior to lockdown measures, with no restrictions to dental practice; phase 2 during the government lockdown, with the severest restrictions on dental practices; and phase 3 following the ease of lockdown measures, with return to limited dental services. Data were collected retrospectively from electronic patient records (EPR) regarding adult patients presenting to the ED with dental pain. The rate of presentations (per week) was calculated for each timepoint and compared. A severity score was assigned to each patient using a grading system based on signs of clinical infection and treatment modality. Patients' presentations were analysed at each phase of the pandemic. There was a 42.8% increase in attendance with oral facial pain and infection to ED from phases 1 to 3. The COVID-19 pandemic resulted in restrictions to routine primary dental care services, which were deemed necessary to reduce the spread of the virus. However, this increased demand on secondary care services, as patients increasingly struggled to access primary dental care to manage dental pain.     

胃肠减压在口腔癌根治同期修复重建患者中的应用

目的探讨口腔癌根治同期修复重建术应用胃肠减压的临床效果。 方法选择中山大学附属口腔医院口腔颌面外科行口腔癌根治同期修复重建术患者230例。2010年12月至2013年2月住院手术患者115例为非胃肠减压组,术后未行胃肠减压,于术后第1天予留置胃管并进行鼻饲流质。2013年3月至2014年8月住院手术患者115例为持续胃肠减压组,于术中进行留置胃管,术后即予持续胃肠减压,术后第1天予鼻饲流质。统计持续胃肠减压组与非胃肠减压组术后恶心呃逆、呕吐、返流误吸及吸入性肺炎的发生率,采用卡方检验或Fisher确切概率法比较分析即刻持续胃肠减压在口腔癌根治同期修复重建患者中的作用。 结果非胃肠减压组术后出现恶心呃逆17例（14.78%）、呕吐26例（22.61%）、吸入性肺炎2例（1.74%）。持续胃肠减压组术后出现恶心呃逆5例（4.35%）、呕吐2例（1.74%）,未出现吸入性肺炎。持续胃肠减压组采用即刻持续胃肠减压方法后,其术后呕吐（χ² = 23.410,P = 0.003）,恶心呃逆（χ² = 7.238,P = 0.008）与胃肠反应发生率（χ² = 33.120,P = 0.005）均低于非胃肠减压组,差异有统计学意义。 结论口腔癌根治和修复重建手术患者术后给予持续胃肠减压可减少患者术后恶心呃逆、呕吐的发生,预防术后创口感染,利于皮瓣成活,并可通过引流液性质和引流量动态观察患者术后口内创口渗血情况,及时发现病情的变化,有利于患者安全。     

Correlation between a patient-centred outcome score and surgical skill in oral surgery

Our aim was to find out whether scores derived from a patient-centred outcome questionnaire correlated with the skill of the surgeon as assessed by a trainer. We found a relatively poor correlation after removal of a third mandibular molar, probably because outcome scores incorporate other measures, including patients' perceptions, anaesthesia, clarity of explanations and instructions, apart from surgical skill. The experience of the surgeon and the length of operation also influenced the results. The correlation was closest (i.e. higher levels of skill produced milder symptoms) when the operation was under local anaesthesia, probably because the surgeon's skill, behaviour, and attitude were visible to the patient throughout, and other team members had a less prominent role. In future, it may be more appropriate to assess the performance of the whole surgical team, rather than the surgeon alone.     

Hospital-based emergency department visits involving dental conditions: Profile and predictors of poor outcomes and resource utilization

BackgroundUntreated dental conditions may progress to lesions that are severe enough to necessitate emergency visits to hospitals. The authors conducted a study to investigate nationally representative trends in U.S. hospital-based emergency department (ED) visits involving dental conditions and to examine patient-related characteristics associated with ED charges.MethodsThe authors used the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, for the years 2008 through 2010. They selected all ED visits involving patients with a diagnosis of either dental caries, pulpal or periapical lesions, gingival or periodontal conditions, or mouth cellulitis or abscess. Outcomes examined included post-ED disposition status and hospital ED charges.ResultsDuring the study period, 4,049,361 ED visits involved diagnosis of a dental condition, which is about 1 percent of all ED visits occurring in the entire United States. Uninsured patients made about 40.5 percent of all dental condition–related ED visits. One hundred one patients in the study died in EDs. The mean hospital ED charge per visit was approximately $760 (adjusted to 2010 dollars), and the total ED charges across the entire United States during the three-year study period was $2.7 billion.ConclusionsPatients without insurance are a cohort at high risk of seeking dental care in hospital-based ED settings. A substantial amount of hospital resources are used to treat dental conditions in ED settings. Patients with mouth cellulitis, periodontal conditions and numerous comorbidities are likely to incur higher ED charges.Practical ImplicationsDental conditions can be treated more effectively in a dental office setting than in hospital-based settings.     

Emergency department revisits for nontraumatic dental conditions in Massachusetts

BackgroundInadequate access to oral health care and palliative care provided in the emergency department (ED) creates a pattern of repeat nontraumatic dental condition (NTDC) ED visits. The authors examined NTDC ED revisits and assessed the determinants associated with these visits in Massachusetts.MethodsThe authors examined NTDC ED revisits in Massachusetts during 2013 using the Massachusetts All-Payer Claims Database. The authors report patient characteristics of those who made a single NTDC ED visit and of those who made NTDC ED revisits within 30 days of the index NTDC ED visit. The authors used a multilevel logistic regression model to examine the determinants associated with NTDC ED repeat visits.ResultsIn 2013, 21.5% of NTDC ED visits were revisits. Men from 26 through 35 years of age who were enrolled in Medicaid and who did not make an outpatient dental office visit within 30 days of the index NTDC ED visit had increased odds of repeat visits.ConclusionsThe sizable proportion of NTDC ED repeat visits indicates that certain patients in Massachusetts experience consistent and systematic barriers in accessing appropriate and timely oral health care.Practical ImplicationsPrioritizing young adults and Medicaid enrollees for ED diversion programs and setting up a formal referral process via connecting patients to dental offices and community health centers after an NTDC ED visit may reduce NTDC ED revisits and provide appropriate oral health care to these patients.