maxillofacial trauma
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Study Design Cadaveric simulation study. Objective The novel coronavirus (COVID-19), which can be transmitted via aerosolized viral particles, has directed focus on protection of healthcare workers during procedures involving the upper aerodigestive tract, including maxillofacial trauma repair. This study evaluates particle generation at different distances from open reduction and internal fixation (ORIF) of maxillofacial injuries in the intraoperative setting to reduce the risk of contracting airborne diseases such as COVID-19. Methods Two cadaveric specimens in a simulated operating room underwent ORIF of midface and mandible fractures via intraoral incisions as well as maxillomandibular fixation (MMF) using hybrid arch bars. ORIF was performed with both self-drilling screws and with the use of a power drill for creating guide holes. Real-time aerosol concentration was measured throughout each procedure using 3 particle counters placed 0.45, 1.68, and 3.81 m (1.5, 5.5, and 12.5 feet, respectively) from the operative site. Results There was a significant decrease in particle concentration in all procedures at 1.68 m compared to 0.45 m, but only 2 of the 5 procedures showed further significant decrease in particle concentration when going from 1.68 to 3.81 m from the operative site. There was significantly less particle concentration generated at all distances when using self-drilling techniques compared to power drilling for ORIF. Conclusion Consideration of using self-drilling screwing techniques as well as maintaining physical distancing protocols may decrease risk of transmission of airborne diseases such as COVID-19 while in the intraoperative setting.

Malocclusion is one of the most common and often difficult-to-manage complications associated with post-traumatic maxillofacial injury. Maxillofacial injury is considered an important health problem worldwide. Such injuries most often have significant financial consequences and result in deformity of facial aesthetics, loss of function, and increased incidence of other health problems. Many common treatment approaches are extraction of teeth, occlusal adjustments, functional therapy, or a combination of these. An appropriate treatment plan should typically involve orthodontic treatment because it can prevent multi-segment upper jaw operations and stabilize the arches by coordinating and aligning them. The most common and important form of post traumatic malocclusion is malocclusion secondary to condylar fractures. Patient may complain of an open bite with functional disturbances, facial asymmetry. There is also improper alignment of teeth, frequent biting of the inner cheeks or tongue, discomfort when chewing or biting. Management approach of secondary malocclusion after maxillofacial trauma should include prosthetic treatment, orthodontic treatment, and implant-supported rehabilitation.

Study design Retrospective chart review Objective Injury and trauma scores are the mainstay of predicting outcomes of trauma patients. ZS (Zeeshan and Simon) maxillofacial trauma score is based on 4 previous facial trauma scores and is user friendly, app-based visually coded facial trauma scoring system. Our study was designed to seek the application of an app-based ZS maxillofacial trauma score to predict the operative time, intensive care unit (ICU) need and length of stay. Methods We performed a retrospective chart review of patients who presented to a university medical college teaching hospital with maxillofacial fractures from October 2018 until October 2019. ZS maxillofacial trauma scoring app was used to calculate the ZS maxillofacial trauma severity score, which was our primary predictor variable. Our primary outcome of interest was operative time. Our secondary outcome of interest was ICU need and length of stay. Correlation analysis, linear regression and logistic regression were performed for statistical analysis. A statistical P-value of .05 was considered significant at a 95% confidence interval. Results There were 95 male and 5 female patients included in the study. The age ranged from 3 to 84 years with a mean of 30.76 (SD = 14.04). A statistically significant correlation between the ZS score and operative time ( r = 0.67, P < .001) was observed. ZS score predicted operative time ( b 1 = 7.67, P < .001) in our study sample . Increasing ZS trauma score was also significantly associated with ICU requirement ( X 2(3) = 13.682, P = .003), but the length of stay could not be predicted based on ZS score. Conclusion: ZS maxillofacial trauma score can predict the operative time, and an association was seen with the need for ICU with increasing ZS score, but could not predict the length of stay or the ICU need. It has potential for future integration with electronic health record systems.