A. Omar Abubaker

Use of the coronal surgical incision for reconstruction of severe craniomaxillofacial injuries

The coronal approach is a versatile surgical technique to expose the craniofacial skeleton. A retrospective clinical study on the use of this approach in treatment of craniomaxillofacial trauma in 28 patients was carried out. The study showed that this technique provides optimum exposure of the fracture sites, allowing for accurate anatomic reduction and fixation of the fractured segments and good cosmetic results in the incision site. The surgical technique, indications, and management and prevention of potential complications of the coronal approach are discussed.

Telemedicine consultations in oral and maxillofacial surgery

PURPOSE The purpose of this study was to evaluate the efficiency of telemedicine consultation for preoperative assessment of patients. PATIENTS AND METHODS A retrospective study of 43 patients was done to evaluate the efficiency of telemedicine consultation in adequately assessing patients for dentoalveolar surgery with general anesthesia and nasotracheal intubation. Efficiency was defined as the ability to conduct surgery with general anesthesia at the immediately following clinic appointment without the need for further preoperative testing, evaluation, or consultation. Thirty-five of these patients were subsequently treated. RESULTS Ninety-five percent (33) of patients were able to undergo surgery with general anesthesia at the immediate appointment, and 100% of patients were assessed correctly, using telemedicine consultation. Two of the patients were assessed as American Society of Anesthesiologists Class III during telemedicine consultation and required further evaluation before surgery could be scheduled. No surgical procedure was canceled, and there were no anesthetic complications attributable to inadequate preoperative assessment of patients during telemedicine consultation. CONCLUSIONS This study confirms that telemedicine consultations are as reliable as those conducted by traditional methods. Because of the reorganization of health care and the ways it is financed, it may be more economical to move data from place to place than to move doctors from place to place. Telecommunication is an efficient and cost-effective mechanism to provide preoperative evaluation in situations in which patient transport is difficult or costly.

Narcotic Prescribing Habits and Other Methods of Pain Control by Oral and Maxillofacial Surgeons After Impacted Third Molar Removal

PURPOSE It has been suggested that a source of narcotics used for nonmedical purposes by young adults is the unused opioids prescribed for the management of pain after the removal of impacted third molars. The purpose of the present study was to determine whether oral and maxillofacial surgeons routinely prescribe larger amounts of a narcotic than would generally be needed for adequate postoperative pain control. A secondary goal was to determine whether they use methods other than analgesic drugs to minimize postoperative pain and thereby reduce the amount of narcotic that might be needed. PATIENTS AND METHODS An 8-question survey was sent to 100 randomly selected oral and maxillofacial surgeon members of the American Association of Oral and Maxillofacial Surgeons in each of the 6 association districts. The questions asked were related to whether a narcotic was routinely prescribed for patients who have had impacted teeth removed, the most common drug used, and the dosage and number of tablets prescribed. The participants were also asked whether they had pretreated patients with a nonsteroidal anti-inflammatory drug or had prescribed one along with the narcotic, had injected a steroid, or had used a long-lasting local anesthetic postoperatively. RESULTS Only 2 of the 384 respondents stated that they did not prescribe a narcotic for patients who had had impacted teeth removed. Hydrocodone (5 mg) was the most frequently prescribed narcotic. The number of tablets varied from 10 to 40, but the most common number was 20 tablets. However, 80 respondents (22%) prescribed more, with 40 prescribing 30 tablets. Also, 80% of the respondents injected their patients with a steroid, and 62% injected a long-lasting local anesthetic postoperatively. Only 34% pretreated their patients with a nonsteroidal anti-inflammatory drug, but 66% recommended such use postoperatively. CONCLUSIONS Most oral and maxillofacial surgeons prescribe analgesic drugs of an appropriate type and dosage and use proper adjunctive pain control measures to supplement these drugs. However, our findings also indicated that more than 20% prescribe more tablets than would generally be necessary to control the postoperative pain after the removal of impacted third molars. This could be a source of drug diversion and nonmedical use by young adults and should be avoided.

Management of Mandibular Angle Fracture

Fractures through the angle of the mandible are one of the most common facial fractures. The management of such fractures has been controversial, however. This controversy is related to the anatomic relations and complex biomechanical aspects of the mandibular angle. The debate has become even more heated since the evolution of rigid fixation and the ability to provide adequate stability of the fractured segments. This article provides an overview of the special anatomic and biomechanical features of the mandibular angle and their impact on the management of these fractures.

Management of posttraumatic soft tissue infections

Between 10 and 12 million traumatic wounds are treated annually in emergency departments in the United States [1,2]. More than 50% of these lacerations are caused by blunt trauma. The others are caused by sharp objects, such as metal, glass, and wood. Only a small percentage of these wounds is caused by mammalian and nonmammalian bites [3,4]. Most of these lacerations occur on the face, scalp, and arms, mostly in young men [2]. Because of these locations, an important goal of management of these wounds is to avoid infection, which can lead to cosmetically and functionally unacceptable scars [5]. The current management of traumatic soft tissue injuries incorporates many of the surgical principles developed over the past century. These principles include a thorough understanding of the pathophysiology of wounding, the risk factors for infection, the basic mechanisms by which posttraumatic sepsis develops, and the appropriate methods for treatment of these injuries and the prevention of complications. This article reviews the defense mechanisms involved in soft tissue wound healing, describes the risk factors for posttraumatic wound infections, and discusses the prevention and treatment of such infections.

Accuracy of Predicting the Duration of a Surgical Operation

PURPOSE The ability to predict how long a particular operation will take is important for maintaining operating room efficiency. The purpose of this study was to determine how accurate oral and maxillofacial surgeons (OMSs) can be in making this determination. MATERIALS AND METHODS Three experienced OMSs predicted their operating times for various operations; these predictions were compared with the actual times. The cases were then grouped into those with accurate predictions and those with overestimated and underestimated times, and the operative reports were reviewed for possible operation trends or other contributing factors. RESULTS In the 100 cases analyzed, the surgeons correctly estimated operating times 26% of the time, overestimated 42% of the time, and underestimated 32% of the time. In the 42 overestimated times, 10 cases involved multiple tooth extractions or removal of impacted third molars, and 8 cases involved orthognathic surgery. In the 32 underestimated cases, 7 involved orthognathic surgery and 8 involved the open reduction of fractures. The 26 accurately estimated cases involved 7 cases of multiple tooth extractions or impacted third molar removal and 5 cases of arthroscopic temporomandibular joint lysis and lavage. CONCLUSIONS Although operating times need to be used for scheduling purposes, they can be highly unpredictable. Surgeons need to constantly analyze their predictions for confounding factors in order to improve their accuracy.

Characteristics of Oral and Maxillofacial Surgery Residencies That Result in Graduating Residents Entering Academic Positions

According to surveys done by the American Dental Association over the last decade, there has been a decrease in the number of full-time faculty in US dental schools, an increase in the number of faculty vacancies, and a decrease in the number of graduates entering academia. All of these factors are leading to a critical shortage in faculty to teach tomorrow’s dentists, advance clinical research, and take care of patient’s needs. These issues ffect oral and maxillofacial surgery (OMS) as well. OMS is one of the most sought-after fields in dentistry. s a result, there are many applicants each year. Howver, despite the popularity of this discipline, few gradates are now pursuing academic careers. There are any reasons why a graduate might select private pracice as a career choice, including financial gain, more ree time, greater independence, and personality fit. The quality of candidates who pursue OMS is generally superb, including the top graduates of the nation’s dental schools. With strong academic backgrounds, it is surprising that so few pursue academics—a natural extension of their proven intellectual ability. In addition to

Odontogenic Infection Leading to Adult Respiratory Distress Syndrome

l o c Odontogenic infections causing life-threatening complications have been relatively infrequent since the advent of modern antibiotic therapy. However, such infections occasionally still spread into the deep fascial spaces and cause serious sequelae. The authors report an unusual case of an odontogenic infection that subsequently led to the development of adult respiratory distress syndrome (ARDS).

Masseteric artery: anatomic location and relationship to the temporomandibular joint area.

PURPOSE This study was performed to determine the precise location of the masseteric artery in relation to the temporomandibular joint region to reduce the risk of injury during surgery. MATERIALS AND METHODS A careful dissection of 16 intact human cadaveric head specimens was carried out to determine the course of the masseteric artery. The location of the masseteric artery was then determined in relation to 3 points in the anterior-posterior plane between the mandibular condyle and the coronoid process: 1) the anterior-superior aspect of the condylar neck, 2) the most inferior aspect of the articular tubercle, and 3) the inferior aspect of the sigmoid notch. RESULTS The mean distance of the masseteric artery to the most anterior-superior aspect of the condylar neck was 10.3 mm; to the most inferior aspect of the articular tubercle, 11.4 mm; and to the most inferior aspect of the sigmoid notch, 3 mm. CONCLUSIONS These results show that there is considerable variability in the location of the masseteric artery. Although it is generally closest to the depth of the sigmoid notch, which can explain why this vessel can be easily damaged during intraoral vertical ramus osteotomies, in some instances it can also be close to either the neck of the condylar process or the coronoid process. The data provided in this study can serve as a guide for locating the vessel when operating in these areas.