Fever After Maxillofacial Surgery: A Critical Review

Purpose

The aim of this paper is to review the pathophysiology of thermoregulation mechanism, various causes of fever after maxillofacial surgery and the different treatment protocols advised in the literature.

Discussion

Fever is one of the most common complaints after major surgery and is also considered to be an important clinical sign which indicates developing pathology that may go unnoticed by the clinician during post operative period. Several factors are responsible for fever after the maxillofacial surgery, inflammation and infection being the commonest. However, other rare causes such as drug allergy, dehydration, malignancy and endocrinological disorders, etc. should be ruled out prior to any definite diagnosis and initiate the treatment. Proper history and clinical examination is an essential tool to predict the causative factors for fever. Common cooling methods like tepid sponging are usually effective alone or in conjunction with analgesics to reduce the temperature.

Conclusion

Fever is a common postoperative complaint and should not be underestimated as it may indicate a more serious underlying pathology. A specific guideline towards the management of such patients is necessary in every hospital setting to ensure optimal care towards the patients during post operative period.     

Analysis of the Pattern of Maxillofacial Fracture by Five Departments in Tokyo: A Review of 674 Cases

We studied maxillofacial fractures treated by departments of oral and maxillofacial surgery in Tokyo. A retrospective review of records and radiographs for patients admitted during the 5-year period from 2000 to 2004 was conducted at five departments in Tokyo. Date, age, gender, cause of injury, fracture site, concomitant injury, domestic violence against women, and treatment were reviewed. 674 patients with maxillofacial fractures were admitted. Male-to-female ratio was 3.6 : 1. The most frequent age group was 21–25 years. Fractures of the mandible were most frequent (87%), followed by the maxilla (14%) and the zygomatic bone (12%). Thirty-one percent of fractures were due to traffic accidents, 29% to accidental falls, 23% to violence and 14% to sports. The incidence of maxillofacial fractures caused by traffic accidents was lower, and that caused by falls and violence were higher than in other countries. Seventeen percent of the maxillofacial fracture patients had concomitant injuries. The incidence of domestic violence-related maxillofacial fracture was 1.6% of all cases. These cases were mainly caused by a husband (55%) or a sexual partner (36%). Most patients (67%) were treated by open reduction surgery. However, condylar fracture alone was usually treated by closed reduction surgery.     

Management and Treatment Outcomes of Maxillofacial Fibro-osseous Lesions: A Retrospective Study

Introduction

Fibro-osseous lesions are a diverse group of bone disorders and include developmental, reactive or dysplastic diseases and neoplasms. They share overlapping clinical, radiographic and histopathologic features and demonstrate a wide range of biological behaviour.

Aim

To evaluate the characteristics, treatment and outcome of benign fibro-osseous lesions of the jaws.

Patients and Method

All patients with fibro-osseous lesions of the jaws treated at the department of Oral and Maxillofacial Surgery of the Kamineni Institute of Dental Sciences from 2007 to 2013 were included in this study.

Results

Six males and four females were treated. Juvenile ossifying fibroma was most often encountered (40 %), and the mandible was the most frequent location (70 %). Main clinical feature in most of the cases was a painless expansile swelling with facial asymmetry, and radiologically mixed (radiolucent and radiopaque lesions) were seen in majority of cases. All cases were surgically treated and histopathologically confirmed. Segmental ostectomy was performed in six cases; maxillectomy was done in one case and excision along with margin in three cases. Mean follow-up was of 3.3 years with no recurrence.

Conclusions

Fibro-osseous lesions, although sharing similar microscopic features, exhibit a variety of clinical behavior rendering their treatment highly individualized. Radical treatment is the choice to achieve an outcome without recurrence.     

颌面部恶性淋巴瘤15例早期临床诊断

目的:探讨颌面部恶性淋巴瘤的早期临床诊断方法及注意点。方法:总结近年来我科收治的15例早期颌面部恶性淋巴瘤的诊断方法和经验。结果:对临床高度怀疑恶性淋巴瘤的患者,全面分析临床表现,结合CT、B超等各种全身辅助和特殊检查,最终通过针吸活检和病理明确诊断。结论:肿块针吸或切取活检辅以全身系统性检查是诊断颌面部早期恶性淋巴瘤的有效手段。     

Outcomes of Dental Implants in Osteoporotic Patients. A Literature Review

Purpose: This article reviews available data on the outcome of dental implants in osteoporotic patients.
Materials and Methods: A search was performed in PubMed and completed in July 2007. The keywords "dental AND implants AND osteoporosis,""dental AND implants AND age,""dental AND implants AND gender," and "dental AND implants AND bone AND quality," with no limitations for language or year of publication, resulted in 82, 598, 94, and 541 articles, respectively. After abstract scanning (in case of doubt the article was read), 39 nonreview articles studying dental implant outcomes in osteoporotic/osteopenic subjects remained for our review. The bibliographies of the 39 articles were also inspected, but no additional studies were identified.
Results: Thirteen of 16 animal studies found lower osseointegration rates in osteoporotic/osteopenic bone than in normal bone. Six in nine clinical reports mention success. Eight of 12 studies in humans support the applicability of dental implants in osteoporotic patients.
Conclusions: There are no data to contraindicate the use of dental implants in osteoporotic patients; however, a proper adjustment of the surgical technique and a longer healing period may be considered in order to achieve osseointegration. Data on the use of biphosphonates in osteoporotic patients and implant outcomes are very limited, and no conclusions can be drawn. In addition, large prospective studies investigating the long-term success of dental implants in osteoporotic individuals are required.     

Cervical Spine Injuries and Maxillofacial Trauma: A Systematic Review

ObjectivesIdentify specific maxillofacial trauma patterns associated with cervical spine injuries.MethodsThe protocol was developed according to (PRISMA-P) and was admitted to PROSPERO under accreditation code #CRD42020177816. Furthermore, the reporting of the present SR was conducted based on the PRISMA checklist.ResultsOf the 1,407,750 patients recorded, a total of 115,997 patients (12.13%) had MFF with an associated CSI with a gender proportion (M:F) of 3.63:1 respectively. Motor vehicle accident was the most common cause of the combined Maxillofacial Trauma (MFT) and CSI. The most common CSI location was at the C2, followed by the C5 cervical spines. The most common location of a maxillofacial fracture resulting in a CSI was the mandible.ConclusionThe incidence of the association of CSIs with MFT has been low (12.13%). Nevertheless, in cases of an isolated mandibular trauma due to a severe blow presenting with a low Glasgow Coma Scale, maxillofacial surgeons should be at a high alert of an associated CSI.     

颌面部损伤——附284例临床分析

对２８４例面部损的伤的伤员，就其致伤原因，颌面部软、硬组织损伤和异物存留的特点及主要的并发症等进行临床分析，并在急救和处理体会方面也进行了和讨论。     

A Retrospective Study on Endodontic Treatment Outcomes in Patients With Special Needs

IntroductionOutcomes of endodontic treatment in patients with special needs are not fully understood, leading to reluctance in performing endodontic treatment.MethodsThis retrospective cohort study evaluated the periapical healing and tooth survival in patients with special needs who had permanent teeth endodontically treated in a hospital setting between 1998 and 2019. Data characterization was performed using univariate analyses. Logistic and Cox regression analyses (P < .05) were performed to identify the odds ratio (OR) and hazard ratio (HR) of the potential prognostic factors, respectively. These predictors were chosen from previous outcome studies in the general population and patients with special needs.ResultsA total of 61 patients (108 teeth) met the inclusion criteria. The most common treatment modality was initial therapy with 81.5% of cases being managed without a need for general anesthesia. Healing rate for initial endodontic treatment was 89.9% and was affected by no restoration at follow-up (OR = 0.15; 95% confidence interval [CI], 0.12–0.71; P = .02). After a mean follow-up of 79.36 ± 59.6 months, the survival rate was 73% and was correlated with gender (HR for males = 0.3; 95% CI, 0.1–0.6; P < .05) and age (HR for patients >45 years = 3.7; 95% CI, 1.7–8.2; P < .05). The most common reason for tooth extraction was unrestorable tooth fracture.ConclusionsEndodontic therapy without a need for general anesthesia is a viable treatment option for patients with special needs. If the overall patient condition permits, then treatment can be administered by community dentists rather than waiting for a patient to be seen in a hospital setting.     

颌面部肉瘤临床疗效分析

目的:探讨颌面部肉瘤的临床病理特点及其治疗效果。方法:对44例颌面部肉瘤患者的临床、病理、随访资料进行整理分析。结果:好发年龄为19～49岁,平均36岁,男女比例1.2∶1,病理分型以骨肉瘤居多,多发生在下颌骨,总生存率59%左右。结论:颌面部肉瘤病理类型多样,恶性程度高,易复发,淋巴转移罕见,晚期可有肺及多脏器转移。首次治疗时根治性切除是关键,如果切缘不足,或者有远处转移时,则须考虑放、化疗。