Oral Health

The surgical sequencing and techniques in the management of multiple mandibular fractures involving the condyle: A review of 121 surgical cases Abhay Taranath Kamath, Sunil S Nayak, Anand Deep Shukla, Abhirup Chatterjee Journal of International Oral Health 2019 11(2):55-60 Aims: Surgical management of patients presenting with multiple fractures of the mandible involving condylar segments can be a challenging proposition to the maxillofacial surgeon. These fractures can be double or triple mandibular fractures and may also be in association with panfacial fractures. Even though most authors suggest that the conventional approachof reduction and fixation of the mandibular symphysis/ parasymphysis fractures, prior to addressing the fractured condylar segment is appropriate, there exists another school of thought suggesting that the condylar segment must be reduced and fixed first. This article aims to review the outcomes of surgery when reduction and fixation of the fractured condyle is done prior to other associated mandibular fractures and looks into the various surgical approaches advocated for the same. Materials and Methods: 121 surgically treated patients with multiple (double/ triple) mandibular fractures including a condylar component were reviewed. The preauricular, periangular and the retromandibular (anterior parotid-transmasseteric) approaches were advocated to access the fractured condylar segments. Results: The fractured condyle was the first segment to be addressed during the sequencing of the surgical management, irrespective of the approach used. Good reduction and fixation with limited complications were achieved by addressing the condylar fracture first. Conclusion: Sequencing of multiple mandibular fractures, though the prerogative of the operating surgeon, addressing the condylar segment first, provides the operator with a viable alternative to the conventional technique.

Parental perceptions and drinking water source among pediatric population in the United Arab Emirates Tarun Walia, Carel Brigi, Ruba Odeh, Ban Hisham Maree, K Ruaa Yarub Journal of International Oral Health 2019 11(2):61-65 Aims: The aim of the study is to determine the water source used for drinking and cooking purpose by the pediatric population in the United Arab Emirates (UAE). To ascertain the underlying factors influencing the parental choice for selecting tap water or bottled water. The study was also done to evaluate whether demographic factors have an influence on the parental choice of water consumption source.Materials and Methods: A total of 200 parents who had children aged between 3- and 15-year-old were chosen for this randomized cross-sectional study. The parents of the selected children were given a prewritten questionnaire consisting of 12 questions in four different languages. The questionnaires documented sociodemographic characteristics, water consumption practices, and the rationale for choosing bottled water and tap water. The responses were analyzed using descriptive statistics and a Chi-square test for a single proportion. Results: Majority of the parents in this study preferred bottled water to tap water for drinking and cooking purposes. About 84% of the parents opted bottled water for drinking and 57% selected bottled water for cooking at home. The consumption of tap water for drinking purpose from school and home was only 13% and 16%, respectively. Parental educational background and household income did not affect their selected source of water. A Chi-square test of independence conducted to investigate possible association between source of water and its purpose for drinking and cooking revealed that the source of water (tap/bottled water) was dependent on its purpose. Conclusion: A greater percentage of the UAE pediatric population utilized bottled water for drinking at school and home. The perceptions about the quality and safety of tap water had a great effect on the caregiver's choice on children's water consumption habits. The demographic factors such as socioeconomic status and parental education had no influence on the source of water used for drinking purpose.

Role of the dentist in early detection of oral cancer Nasser Alqhtani, Adel Alenazi, Fazil Arshad Nasyam, Sultan A Almalki, Alshammari Mohammed Journal of International Oral Health 2019 11(2):66-69 Aims: The aim of the study is to appraise the awareness levels among dentists of the Kingdom of Saudi Arabia (KSA) regarding oral cancer. Materials and Methods: A survey based on questionnaire was done to evaluate the acquaintance levels regarding oral cancer among the dentists working in the governmental and private dental clinic, Riyadh city, KSA. Results: Majority of the patients were male (57.9%, n = 117), most were working in private clinics (57.4%, n = 116), graduated within 15 years (2003–2018) (89.1%, n = 180), and general practitioners (78.7%, n = 159). The variation between knowledge and age, gender, year of graduation, and specialty (P > 0.05) among dentists was insignificant. Conclusion: For early detection of oral cancers, dentists have a vital role as they are the persons who see and observe oral cavity during routine dental checkups and can help identify suspicious lesions before having any symptoms.

The incidence of enamel hypoplasia in children between 8 and 15 years in Anbar Governorate, Iraq Abdul Nasser H Warwar, Mohammed I Abdullah, Wesam A Sami Journal of International Oral Health 2019 11(2):70-74 Aims: Hereditary and environmental factors can lead to enamel hypoplasia (EH). This defect can affect the baby teeth (primary) or permanent teeth. The study has been performed to estimate the incidence of the enamel hypoplasia among children between the age group of 8 and 15 years in Al-Anbar Governorate, Iraq and to try to find some solutions to protect the enamel in these ages. Materials and Methods: A total of 2652 pupils were selected from schools of primary and medium. All samples were chosen according to the randomized stratified clustered manner. The pupils' populations were classified into 1–3 groups. In each group, there were 884 pupils (442 males and 442 females) examined. The procedures of diagnosis were in calm status with daylight, using general surgical instruments, for example, disposable mirror, and forceps that have been used to retract the lips and cheeks. Statistical Analysis: The data have been collected were analyzed using the Chi-square statistic test (SPSS version 22 software). Results: The enamel hypoplasia was the most common widespread in both genders, in the boys, it was 122 (9.2%), whereas in the girls, it was 117 (8.82%), and there were no statistically significant P value differences between both genders (P > 0.05). Results also showed that hypoplastic enamel was significantly seen on the maxillary incisors compared with the canines and the premolars. Conclusion: Several factors can cause enamel hypoplasia among children between the age group of 8 and 15 years in Al Anbar Governorate such as nutritional factors, illness, or the range of acquired genetic factors that are eventually lead to esthetics problems and dental hypersensitivity. Accordingly, enamel hypoplasia in teeth can increase the risk of dental caries and tooth wear; therefore, one of the best options was effective preventive care and monitoring are required that is the helping to protect the enamel.

Correlation of maxillary and mandibular arch form and tooth size ratio in ethnic Javanese malocclusion patient I Gusti Aju Wahju Ardani, Dhansha Kannayyah, Ari Triwardhani Journal of International Oral Health 2019 11(2):75-79 Aims: Arch form is one of the important components that can relapse after orthodontic treatment. The relationship is between arch form and tooth size ratio (TSR) need to be evaluated that could help to determine extraction or nonextraction treatment in malocclusion. The aim of this study was to analyze the correlation of maxillary and mandibular arch forms with TSR in ethnic Javanese Malocclusion Patient at Airlangga University Dental Hospital. Materials and Methods: This study was an observational, analytical study with cross-sectional and total sampling method. The samples consisted of 135 model study were chosen according to the inclusion criteria and distributed into malocclusion Class I, Class II, and Class III Angle's classification. All the samples were analyzed using Bolton's anterior and overall ratio, and the maxillary and mandibular arch forms were detected using mathematical ratio using (canine depth/molar depth (MD))/(canine width [CW]/molar width [MW]). Statistical Analysis: The correlation of maxillary and mandibular arch form with clinically significant TSR using Bolton's analysis is interpreted using Pearson correlation test (P < 0.05). Results: No significant correlation of maxillary and mandibular arch forms with TSR using Bolton's analysis among malocclusion of Angle Class I, Class II, and Class III in ethnic Javanese (P > 0.05) was found. While the anterior TSR in Class I Angle's malocclusion has a significant correlation with inter-CW in mandibular arch (P < 0.05). Conclusions: TSR was not affected by types of arch form either in maxillary or mandibular while the anterior TSR in Class I Angle's malocclusion did.

The influence of coping designs on labio-marginal towards fracture resistance of metal-porcelain restoration Chihargo , Haslinda Zainuddin Tamin, Indra Nasution Journal of International Oral Health 2019 11(2):80-85 Aims: Metal-porcelain restoration on esthetic zones often results in an umbrella effect due to metal collar coping on the labiomarginal area. Therefore, metal collarless design on metal-porcelain restoration was indicated, yet it may influence the fracture resistance of the restoration. This study aimed to determine the effect of metal coping designs on the labiomarginal area against fracture resistance of metal-porcelain restoration. Materials and Methods: A total of 24 samples of metal-porcelain restorations from four designs were fabricated and cemented on 24 metal dies. The study was divided into four groups; Group A with metal collar design, Group B with modified metal collar design, Group C with metal collarless design, and Group D with modified metal collarless design. The measurement of fracture resistance was carried out using universal testing machine (Torsee UTM AMU-10, Tokyo, Japan) at a crosshead speed of 0.05 mm/minute. Loading point was applied at an angle of 45° until the porcelain layer fractured. Results: The mean value and standard deviation of fracture resistance are 2237.56 ± 183.83 N in Group A, 1934.34 ± 152.81 N in Group B, 2049.62 ± 162.58 N in Group C, and 2146.15 ± 210.75 N in Group D. Significant influence of fracture resistance on metal-porcelain restorations was found in all experimental groups (P < 0.05), and there were significant differences between Groups A and B and between Groups B and D (P < 0.05). Conclusion: Metal-porcelain restoration with modified metal collarless design can be an alternative restoration on esthetic zone with high fracture resistance and may be able to prevent umbrella effect on the labiomarginal area.

Prevalence of malocclusion among female schoolchildren aged 12-15 years: Saudi Arabia Ameera Al Qahtani, Navin Anand Ingle, Mansour K Assery, Sultan S AIshamrani Journal of International Oral Health 2019 11(2):86-91 Aim: The aim of the study is to assess the prevalence of malocclusion and orthodontic treatment needs among 12–15-year-old female schoolchildren of Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional descriptive survey was conducted among 500 female students aged 12–15 years. The prevalence of malocclusion and orthodontic treatment needs was assessed using occlusal traits based on the FDI/World Health Organization objective method. General information on demographic data was also recorded. Descriptive statistics was done to check discrepancies and consistencies. Results: Malocclusion and orthodontic treatment need were reported in this study. Twenty-three percent of participants had 2 mm and more diastema. The majority of participants had Class 1 relation with molar, incisor, and canine. Around 18.8% of participants had over 1/3 overlap, 12.9% had anterior open bite, and 11.9% had posterior over bite (unilateral and bilateral). Posterior crossbite on the right and left sides was present in 19.6% and 16.1% of participants, respectively. Scissor bite on the right and left sides was present in 11.5% and 12.8% of participants, respectively. Around 8.4% of participants had maxillary overjet over 4 mm. Reverse overjet was present in 14.8% of participants. Conclusions: There is a prevalence of malocclusion among the age group of 12–15 years in the KSA. This study can be used as a standard to implement school-based oral health awareness programs which are needed in the KSA.

Evaluation of tumor necrosis factor: Alpha in the saliva of oral cancer, leukoplakia, and healthy controls – A comparative study M Ameena, R Rathy Journal of International Oral Health 2019 11(2):92-99 Aims: The survival of oral squamous-cell carcinoma (OSCC) patients remains poor despite recent treatment advances. A sensitive and specific biomarker is important in screening high-risk patients. The present study was undertaken to test a hypothesis whether salivary tumor necrosis factor-alpha (TNF-α) can be used as a biomarker for OSCC. The study aimed to assess salivary TNF-α in OSCC, leukoplakia, and whether it can be used as a biomarker for the early diagnosis of OSCC. The objectives are as follows: (1) To evaluate salivary TNF-α and compare with histological grades of OSCC. (2) To evaluate salivary TNF-α in leukoplakia and compare with different grades of dysplasia. (3) To compare TNF-α levels in the saliva of oral cancer patients with leukoplakia patients and with healthy control group. Materials and Methods: The study was conducted in 90 participants, of which 30 healthy individuals, 30 leukoplakia, and 30 OSCC patients. Whole unstimulated saliva was collected and analyzed using an ELISA test. Results: TNF-α was significantly elevated in leukoplakia, further elevated in OSCC as compared to controls. There was a significant difference in TNF-α between the different histopathological grades of OSCC and leukoplakia (P ≤ 0.01). There were also statistically significant differences in TNF-α level between different clinical stages in OSCC (P ≤ 0.05). ROC curve analysis and area under curve values showed high specificity and sensitivity in differentiating OSCC from leukoplakia and healthy controls. Conclusion: The present study shows that salivary TNF-α can be used as a marker for predicting leukoplakia and oral cancer. The study also showed a significant correlation between clinical staging and histopathological grading of OSCC and TNF-α level.

The difference in enamel surface hardness after immersion process with cocoa rind extract (Theobroma cacao) and fluoride Nirawati Pribadi, Anggun Citra, Mandojo Rukmo Journal of International Oral Health 2019 11(2):100-103 Aims: Enamel is the hardest tissue in the human body and possessing mechanical properties, such as physiological functions as chewing, while protecting the underlying structure. Fluoride increase and improve one of the mechanical properties which is tooth surface hardness, but the excessive use of fluoride has the risk of fluorosis. Theobromine in cacao rind extract could potentially be used as an alternative herbal ingredient. Theobromine increases tooth enamel surface hardness through interstitial reactions. The aim of this study is to analyze differences in the hardness of the enamel surface by immersing it in extract of cacao rind and fluoride. Materials and Methods: The dental crowns of 27 square-shaped bovine incisors were planted in a round-shaped resin mold and divided into three groups consisting of nine samples. The control group was immersed in artificial saliva, Group I was immersed in artificial saliva with 0.1% of theobromine cacao rind extract, while Group II was immersed in a combination of artificial saliva and 2% sodium fluoride (NaF). The measuring of surface hardness was performed using Wolpert Wilson Vickers Microhardness tester after the sample had been immersed in the incubator for 30 min at 37°C. Results: Those groups immersed in artificial saliva to which 0.1% theobromine cacao rind extract was added yielded the highest surface hardness. The surface hardness of groups immersed in artificial saliva with the addition of 2% NaF was higher than that of the artificial saliva group. Conclusions: There was significant difference in the tooth enamel surface hardness of the groups immersed in cacao rind extract compared with that of the fluoridated groups.

Dental and oral health education for elderly age group: Full and partial edentulous teeth brushing method Titiek Berniyanti, Aryo Dwipo Kusumo, Taufan Bramantoro, Gilang Rasuna Sabdho Wening, Retno Palupi Journal of International Oral Health 2019 11(2):104-106 Aims: The objective of this research is to form independent cadres and could provide counseling and training on how to brush full/partial edentulous teeth the right way to the elderly in nursing home. Materials and Methods: This descriptive study was conducted with 12 participants with posttest only group design. Participants are given the theory of toothbrushing method of edentulous teeth, practical demonstration, and evaluation. To measure the knowledge level, there is a posttest and socialization ability test for respondents.Results: The average achievement percentage of respondents about knowledge and application of the elderly toothbrushing method was 96.67%, and the achievement percentage of respondent's success about the socialization ability was 87.66%. Conclusions: Based on empowerment results, most cadres understood about how to brush elderly teeth properly and socialize it to their elderly friends about how to brush their teeth properly.

Critical Care

A systematized review aimed to identify the impact of basic electrocardiogram training courses on qualified nurses Fahad Zeed Alanezi Saudi Critical Care Journal 2018 2(4):51-65 Aims: A systematized review aimed to identify the impact of basic electrocardiogram (ECG) training courses on qualified nurses. Background: ECG plays a crucial role in helping to diagnose, follow-up, and detect any abnormalities in patients' conditions. Nurses often work on the frontline in hospitals and are the ones who initially assess patients' conditions. According to the British Heart Foundation (n. d), 26% of all mortality in the UK is attributable to heart and circulatory diseases. Methodology: A comprehensive, systematized review was undertaken using the AMED, EMBASE, CINAHL, and MEDLINE databases. Thematic analysis was then used to synthesis the findings from the studies selected. Ten papers were selected following the application of inclusion and exclusion criteria. Conclusion: Basic ECG training courses were found to improve nurses' knowledge, compared to those who did not possess ECG training, the quality of care was seen better among nurses who had received ECG courses, and even patient outcomes were improved in the total number of myocardial infarction events in hospital which was decreased compared to before the intervention. Cardiac care nurses had better ECG interpretation skills than other nurses regardless if they took ECG courses or not.

Assessment of knowledge, attitude, and practice of hand hygiene among medical and health profession students at King Saud Bin Abdulaziz University for Health Sciences in Saudi Arabia Mohammed Bin Humran, Khalid Alahmary Saudi Critical Care Journal 2018 2(4):66-72 Background: In recent years, patients' safety has become high priority for health-care organizations. It has been documented that poor knowledge and compliance of health-care providers toward hand hygiene have contributed to poor patient safety outcomes. College students of health sciences may not receive adequate education and training on hand hygiene best practices. Objectives: To assess the health profession students' knowledge, attitude, and practice toward hand hygiene and to investigate the factors associated with poor hand hygiene knowledge and practice. Methods: This cross-sectional, correlational, descriptive study was conducted at King Saud Bin Abdulaziz University for Health Sciences performing clinical rotations at King Abdulaziz Medical City in Riyadh, Saudi Arabia. A proportional sampling was used to calculate the required proportions that reflect the size of student population form each of the three colleges. A total of 270 students including 140 medical, 83 nursing, and 47 respiratory therapy students who were selected using a simple random sampling method were included in the study. An adapted and validated knowledge, attitude, and practice (KAP) questionnaire was used to assess four domains: general information, knowledge, self-reported compliance to the WHO 5 Moments of Hand Hygiene, and general satisfaction on received education. Results: The overall average of knowledge score was 81.13 points out of 100. The results revealed that the knowledge score of hand hygiene was higher for nursing school (84.22 ± 12.98), followed by medical school (81.71 ± 11.31) and then respiratory therapy program (75.53 ± 11.76). The results also showed that students who took courses covering hand hygiene scored higher in knowledge score (83.28 ± 11.3) as compared to students who did not take such courses (75.16 ± 12.89). In the compliance domain, the results showed that there were no significant differences in compliance of hand hygiene between students in all categories. In terms of overall student satisfaction with hand hygiene education and training, the results showed that nursing students have higher satisfaction score (72.7%) than their counterparts in medical school (48.3%) and respiratory therapy program (49.7%). Conclusion: Hand hygiene knowledge among students was generally good, and the highest was among nursing students and the lowest among respiratory therapy students. The compliance of students toward the WHO 5 Moments of Hand Hygiene did not vary across different colleges. Improved knowledge was found to be associated with improved compliance with hand hygiene best practices. Recommendations: Increasing the academic focus on hand hygiene in both the curriculum and clinical rotations with periodic standardized educational courses and focusing on hands-on workshops could have a positive impact on the knowledge and practice of hand hygiene for current health sciences students and future health-care providers. Future studies are needed to assess the hand hygiene KAP among students in hospital settings using observation of actual practice.

Role of point-of-care ultrasound to prevent dilatation of false passage in a critically ill patient with urethral stricture Devinder Midha, Arun Kumar, Amit Kumar Mandal Saudi Critical Care Journal 2018 2(4):73-75 Urethral strictures are fairly common in elderly males getting admitted to the intensive care unit. Urethral catheterization is mostly done as a blind procedure and often leads to urethral trauma and, sometimes, false channelization in a patient who is many a time sedated, intubated, and is unable to tell about extreme of pain occurring which could warn the handler. Fluoroscopy is utilized in difficult situations to aid insertion, but this is not always an option for patients in intensive care units. The scope of ultrasonography is expanding in the practice of critical care. We used point-of-care ultrasound to confirm the position of guidewire before dilatation, in order to prevent dilatation of false passage.

Family and Community Medicine

Review of literature on disseminated tuberculosis with emphasis on the focused diagnostic workup Fahmi Y Khan Journal of Family and Community Medicine 2019 26(2):83-91 Disseminated tuberculosis (TB) is a life-threatening disease resulting from the hematogenous spread of Mycobacterium tuberculosis. The diagnosis is challenging owing to its subtle nonspecific clinical presentation, which usually reflects the underlying organ involved. Besides, tools for confirmatory laboratory diagnosis are limited. Therefore, a high index of suspicion is required for early diagnosis. Miliary pattern on chest radiography is a common finding that has an important role in the early detection of the disease. Nevertheless, approximately 10%–15% of patients have normal chest radiography. Although abnormalities are present, basic hematologic and biochemical tests as well as tuberculin skin test are nonspecific for the diagnosis. Imaging studies are helpful adjunct tools for disseminated TB as they can help determine the involved sites and guide technicians to obtain appropriate specimens for diagnosis. Clinical confirmation of the diagnosis of disseminated TB is usually based on bacteriological or histological evidence. Response to first-line anti-TB drugs is good as evidenced by many reports. This review aims to present a current update on disseminated TB with emphasis on the diagnostic workup of this devastating condition.

Stroke in atrial fibrillation: Review of risk stratification and preventive therapy Abdullah M Alshehri Journal of Family and Community Medicine 2019 26(2):92-97 Atrial fibrillation (AF) is a leading preventable cause of ischemic stroke for which early detection and treatment are critical. The risk of stroke in people with AF can be stratified by the use of such validated prediction instruments such as CHADS2 or CHA2 DS2–VASc. The CHA2 DS2–VASc adds to the evaluation of the risk of stroke by reliably identifying patients at very low risk. Additional points are assigned for an additional age category of 65–74 years (1 point), female sex (1 point), and vascular disease other than cerebrovascular disease (1 point). Two points are awarded for age ≥75 years. The risk of stroke increases according to point score: 0.5% per year (0 points), 1.5% per year (1 point), 2.5% per year (2 points), 5% per year (3 points), 6% per year (4 points), and 7% per year (5–6 points). For decades, Vitamin K antagonists were the only class of oral anticoagulants available to clinicians for the prevention of stroke in AF. However, new oral anticoagulants (NOACs), such as apixaban, dabigatran, and rivaroxaban, are currently available and have proved to be safe and effective in preventing stroke in patients with nonvalvular AF. In addition, a nonpharmacologic procedure like left atrial appendage occlusion is a possible option in selected patients. In this article, we have reviewed the stratification of stroke risk in AF, prevention of stroke in nonvalvular AF, warfarin versus NOACs, weighting risk of bleeding versus stroke risk when deciding on the anticoagulation protocol in patients with AF, and the use of nonpharmacologic therapy for stroke prevention.

Quality of life assessment of breast cancer patients in Saudi Arabia Tahani H Nageeti, Huda R Elzahrany, Aisha O Gabra, Arwa A Obaid, Raid A Jastania Journal of Family and Community Medicine 2019 26(2):98-102 BACKGROUND: To assess the quality of life (QOL) of females with breast cancer in Saudi Arabia and its association with patients' demographic, social, and clinical data. MATERIALS AND METHODS: This analytical cross-sectional study was conducted among breast cancer patients attending King Abdullah Medical City, Makkah. Participants were asked to complete a self-administered structured questionnaire. We utilized the validated Arabic version of the European Organization for Research and Treatment of Cancer QOL-C30 (EORTC-QOL-C30) and breast cancer module QLQ-BR23 (EORTC-QOL-BR-23). Data were analysed using SPSS; mean and standard deviation computed for continuous variables, and percentages for categorical variables. Student's t-test performed to compare mean scores for various groups. RESULTS: Eighty-eight women participated in the study. The participants had a mean global health score of 64.0, standard deviation (SD) = 27.7. Of the functional scales, role functioning scored the highest (mean 71.2, SD = 31), while social and emotional functioning scored the lowest, (mean 57 SD = 35.8) and (mean 59.5 SD = 32), respectively. On the symptom scales, the most troubling symptoms were fatigue and insomnia, (mean 48.86 SD = 29.4) and (mean = 48, SD = 35), respectively. On the disease-specific tool (QLQ-BR23), body image and future perspective scored the lowest with a mean of 60.2 SD = 35 and 42.0 SD = 39.6, respectively. The most distressing symptom was hair loss (mean 61.56 SD = 41). CONCLUSIONS: Our population showed an acceptable overall global health score. However, they scored low on the important functional and symptoms domains. This study implies that patient age, social, and physical factors were possible determinants of global health and QOL scores. The healthcare system of Saudi Arabia should, therefore, address all these different aspects of QOL of breast cancer survivors.

Knowledge and attitude of Saudi female university students about first aid skills Lubna M Halawani, Shahad D Alghamdy, Manal M Alwazae, Wafa A Alkhayal Journal of Family and Community Medicine 2019 26(2):103-107 BACKGROUND: First aid is the first and most essential life saving care that can reduce the morbidity of an individual in a health-threatening circumstance. The aim of this study was to assess the knowledge and attitude toward the provision of first aid among students attending Princess Norah University (PNU). MATERIALS AND METHODS: A cross-sectional study was conducted at PNU in Riyadh, Saudi Arabia, from October 2017 to December 2017. A total of 1000 female students from 15 different colleges completed a self-administered questionnaire. RESULTS: The mean age was 21 years (range 18-26); 36% study participants were from health colleges and remaining from other colleges. Only 34.7% had good knowledge, 57.5% had moderate knowledge, and 7.8% had poor knowledge on first aid skills. Analysis of knowledge in specific emergency situations showed that the students were more knowledgeable in cases of epistaxis, ingestion of toxins, burns, hypoglycemia, and loss of consciousness. However, they were found to be less knowledgeable in handling situations of seizures, choking, and snake bite. About 20.2% of the students had encountered situations where cardiopulmonary resuscitation was required and 65.3% of these students had not provided first aid because of the lack of knowledge, nervousness, and other issues. Good knowledge was associated with previous first aid training and being a student in a health college. CONCLUSION: Overall, students had a positive attitude toward first aid; however, they still did not have the knowledge necessary to be able to act in emergency situations. There is a need for increased public health awareness. It is also advisable to introduce first aid courses in all universities and secondary schools.

Internet addiction and its relationships with depression, anxiety, and stress in urban adolescents of Kamrup District, Assam Anku M Saikia, Jahnabi Das, Pavel Barman, Mintu D Bharali Journal of Family and Community Medicine 2019 26(2):108-112 BACKGROUND: In these modern times of digitization, the use of Internet has become an integral part of everyday life, especially the lives of adolescents. At the same time, Internet addiction has emerged as a serious affliction. However, the impact of Internet addiction on these crucial years of life has not been well studied in India. The objective of this study was to determine the prevalence of Internet addiction in adolescents of the urban areas of Kamrup district and assess its association with depression, anxiety, and stress. MATERIALS AND METHODS: A cross-sectional study was conducted among students of higher secondary schools/colleges in the urban areas of Kamrup district in Assam. Out of 103 government and private higher secondary school/colleges of Kamrup district, Assam, 10 colleges were selected randomly, and a total of 440 students were enrolled in the study. A pretested, predesigned questionnaire, Young's Internet Addiction Scale, and Depression Anxiety Stress Scales 21 (DASS21) were used in the study. Chi-square test and Fisher's exact test were used to assess the association between Internet addiction and depression, stress, and anxiety. RESULTS: Majority (73.1%) of the respondents were females, and mean age was 17.21 years. The prevalence of Internet addiction was 80.7%. The main purpose of using Internet was social networking (71.4%) followed by study (42.1%), and majority (42.1%) reported spending 3-6 hours a day on internet. There was a significant association between Internet addiction and stress (odds ratio=12), depression (odds ratio=14), and anxiety (odds ratio=3.3). CONCLUSION: Internet addiction is a serious problem with a profound impact on mental health. Therefore, early intervention is crucial.

May we improve vaccine timeliness among children? A cross sectional survey in northern Saudi Arabia Ghada Z.R. Alrowaili, Umar F Dar, Altaf H Bandy Journal of Family and Community Medicine 2019 26(2):113-117 BACKGROUND: The timeliness of vaccinating children is the pillar of the cost-effective strategy of decreasing the burden of many infectious diseases. Delayed immunization creates the risk of failure. There is regional variation in the rate of delayed vaccination. The purpose of present study was to determine the timeliness of vaccination and reasons for delay in vaccinating children under the age of 2 years in Sakakah, Northern Saudi Arabia. MATERIALS AND METHODS: This study included 195 children under 2 years of age consecutively taken from four randomly selected primary health centers in Sakaka, Al Jouf province. A pretested proforma was used to screen the vaccination cards of the children for any delays in vaccination. Parents of children whose vaccinations had been delayed for more than 4 weeks were interviewed to determine the reasons for the delay. The reasons for delay were grouped under three different themes, i.e., child related, facility related and social issues. RESULTS: The mean age of the children was 8.6 ± 5 months; 45% were girls and 38% were first or second order babies. In our sampled population, 23% children had delayed vaccinations of more than 4 weeks. The delay was similar for both male and female children (21.5% of males and 25% of females). High education of parents, working mothers and low birth order were positively associated with timeliness of vaccine uptake (P < 0.05). Of those with delayed vaccination, only 15.6% mentioned facility or appointment related reasons; illness of the child was reported by 46.7%. CONCLUSION: There is considerable delay in vaccination of children in Sakakah, Northern Saudi Arabia. A third or more birth order of the child, parents having less than university education, and child's mother being home maker are related with increased risk of delayed vaccination.

Effect of maternal anemia on the status of iron stores in infants: A cohort study Arvind K Shukla, Shitanshu Srivastava, Garima Verma Journal of Family and Community Medicine 2019 26(2):118-122 BACKGROUND: Iron deficiency anemia in pregnant women may affect the iron reserves of their infants and lead to anemia later. The objective of the study was to compare hemoglobin and iron store status of infants born to anemic and non-anemic mothers and to determine any correlation. MATERIALS AND METHODS: A cohort study was conducted in the Department of Pediatrics of a Teaching hospital after obtaining ethical approval and written informed consent from all participants. Total 180 mother-infant pairs were enrolled in the study were divided into two groups; Group I: 90 term infants born to anemic mothers (Hb <11 g/dl), Group II: 90 term infants born to non-anemic mothers (Hb >11 g/dl). Hemoglobin and ferritin levels were assessed in cord blood at birth and at 14 weeks after birth in the infants of both groups. Data was analyzed using SPSS 20.0; Chi-square test and t-test were applied to test for statistical significance. RESULTS: The final sample size was 85 for Group I and 78 for Group II. For Group I, mean hemoglobin and ferritin levels in the cord blood of infants at birth were 16.33 ± 1.19 and 135.40 ± 25.94, respectively. For Group II, Mean hemoglobin and ferritin levels in the cord blood of infants at birth were 17.62 ± 1.35 and 160.45 ± 28.50, respectively; differences were statistically significant. At 14 weeks, the mean Hb and ferritin was 11.24 ± 1.03 and 55.92 ± 10.44 in Group I and 13.18 ± 0.82 and 63.56 ± 10.15 in Group II; the differences were statistically significant. A significant correlation between maternal and infant hemoglobin and ferritin levels was observed at birth and 14 weeks after birth. CONCLUSION: Maternal iron deficiency may have an effect on the iron status of their infants. Thus, timely appropriate interventions are necessary.

Forecasting Indian infant mortality rate: An application of autoregressive integrated moving average model Amit K Mishra, Chandar Sahanaa, Mani Manikandan Journal of Family and Community Medicine 2019 26(2):123-126 BACKGROUND: The Infant Mortality Rate (IMR) reflects the socioeconomic development of a nation. The IMR was reduced by 28% between 2015 and 2016 (National Family Health Survey-4 [NFHS-4]) as compared to 2005–2006 (NFHS-3), from 57/1000 to 41/1000 live births. The target fixed by the Government of India for IMR in 2019 is 28/1000 live births (National Health Policy, 2017). One of the most common methods of forecasting this is the autoregressive integrated moving average (ARIMA) model. A forecast of IMR can help implementation of interventions to reduce the burden of infant mortality within the target range. MATERIALS AND METHODS: The objective of the study was to give a detailed explanation of ARIMA model to forecast the IMR (2017–2025). Secondary data analysis and forecast were done for the available year and IMR data extracted from “open government data platform India” website. RESULTS: The forecast of the sample period (1971–2016) showed accuracy by the selected ARIMA (2, 1, 1) model. The postsample forecast with ARIMA (2, 1, 1) showed a decreasing trend of IMR (2017–2025). The forecast IMR for 2025 is 15/1000 live births. CONCLUSION: In the current study, long-time series IMR data were used to forecast the IMR for 9 years. The data showed that IMR would decline from 33/1000 live births in 2017 to 15/1000 live births in 2025. When the actual data for another year (2017) are available, the model can be checked for validity and a more accurate forecast can be performed.

Pattern and severity of sleep apnea in a Saudi sleep center: The impact of obesity Khalid A Alshehri, Lujain F Bashamakh, Hussein M Alshamrani, Ibtihal O Alghamdi, Bsmah A Mahin, Ahmed A Alharbi, Waleed M Alqulyti, Hisham Z Alshehri, Mohannad T Alghamdi, Faris F Alhejaili Journal of Family and Community Medicine 2019 26(2):127-132 AIM: The aim of this study was to estimate the effect of obesity on the severity of obstructive sleep apnea (OSA) by assessing the relationship between OSA and body mass index (BMI). MATERIALS AND METHODS: A cross-sectional study was conducted in 2017 among patients who had been referred to the sleep center at King Abdulaziz University Hospital (KAUH, Jeddah, Saudi Arabia) for polysomnography between January 2012 and September 2017. The data were abstracted from the medical records of these patients at KAUH. Initial data analysis included descriptive statistics; Chi-square test, t-test, and one-way ANOVA as appropriate were used to assess the associations between the variables. RESULTS: The study included 803 patients; the average age of the patients was 45.9 years and 56.5% were male. About 70.4% were obese, 54% of whom were classified as having Class 3 obesity. Approximately, 75% patients had OSA. The prevalence of OSA was higher among obese patients (77.7%) compared to nonobese patients (22.3%). Moreover, the severity of OSA was higher in obese patients, with 85.3% of obese patients considered as having severe OSA. CONCLUSION: Obesity is a considerable risk factor for developing OSA and could play a major role in increasing the severity of the disease. We encourage further studies on the impact of sedentary lifestyle and its association with OSA in Saudi Arabia, with an emphasis on the evaluation of the cost-effectiveness and burden of the disease.

Perceptions and attitudes of family medicine residency program directors regarding ranking applicants for residency programs using their social media accounts: A national study in Saudi Arabia Amani M Al Qarni, Shaher Z Al Shehri, Moataza M.A. Wahab Journal of Family and Community Medicine 2019 26(2):133-140 BACKGROUND: In contemporary times, employers use information available on the social media (SM) to assess attitudes before interviews and recruitment of potential employees. It is used as one of the criteria to rank applicants for acceptance as residents in the Middle East. In this study, an evaluation was done of this new practice in which program directors (PDs) take into account e-professionalism for the acceptance of applicants. It was a national study of all 41 hospitals in the Kingdom of Saudi Arabia involved in Saudi board family medicine training programs. MATERIALS AND METHODS: A 36-item questionnaire was administered to PDs. Next, a focus group discussion (FGD) was held, after which there was social listening. We recorded the FGD. There was verbatim transcription and coding of the qualitative data. We held social listening using Keyhole. The percentage of positive attitudes (PPAs) was normally distributed; we tested its relationship with different factors by comparing the mean score values among categories using the Student's t-test and one-way analysis of variance. RESULTS: The average PPA toward the ranking of applicants by using their SM was 55.5% ± 17.3% (median: 56.6%). The average PPA was higher in those who used SM to communicate with residents (60.2% ±19.5%) than those who did not (49.4% ±12%; P = 0.04), even after adjusting for familiarity with Internet use. Directors in hospitals of the Ministry of Education had higher percentages; these figures, however, are not statistically significant. PDs considered the importance of establishing culturally acceptable guidelines for the assessment of e-professionalism and social reputation. CONCLUSIONS: Culturally appropriate, bioethical regulations that meet the needs of modern times should be designed. We need to solve ethical dilemmas, especially with regard to privacy in SM.

Gynecology and Minimally Invasive Therapy

The role of laparoscopy and the value of peritoneal carcinomatosis index in patients with intra-abdominal malignancies who are scheduled to laparotomy Peng-Hui Wang Gynecology and Minimally Invasive Therapy 2019 8(2):51-52

Surgical and oncological outcome of total laparoscopic radical hysterectomy versus radical abdominal hysterectomy in early cervical cancer in Singapore Timothy Yong Kuei Lim, Krystal Koh Miao Lin, Wai Loong Wong, Ieera Madan Aggarwal, Philip Kwai Lam Yam Gynecology and Minimally Invasive Therapy 2019 8(2):53-58 Introduction: The Wertheim's radical abdominal hysterectomy (RAH) has been the traditional surgical approach for operable Stage IB cervical cancer in Singapore whereas total laparoscopic radical hysterectomy (TLRH) was introduced only in 2009. In this study, we aimed to compare the long-term surgical outcome between the two routes of surgery in our center. Methods: This is a prospective study performed in a single large tertiary institution in Singapore. Inclusion criteria included surgically fit patients with early cervical cancer and no radiological evidence of regional or distant metastases. Results: From November 2009 to December 2014, 51 TLRHs and 85 RAHs were performed. Median blood loss in the TLRH group was significantly lower than in the RAH group (300 vs. 500 mL; P = 0.002) as was median hospital stay (5 vs. 6 days; P = 0.001). Operative time was significantly higher in the TLRH group (262 vs. 228 min; P < 0.001). There was no significant difference in bladder recovery. Intraoperative complications were encountered in 2 (3.9%) TLRH patients and 1 (1.2%) RAH patient. Postoperative complications occurred in 3 (5.9%) TLRH patients and 8 (9.4%) RAH patients. With a median follow-up of 117 (range 1.6–314.6) weeks in the TLRH group and 143.3 (range 0.4–304.7) weeks in the RAH group, 9 (17.6%) TLRH patients and 7 (8.2%) RAH patients had recurrence. There was no significant difference in the overall 3-year survival between the TLRH group and the RAH group for tumor size ≤2 cm (100.0% vs. 97.0%; P = 0.37). However, there was a trend toward lower survival for the TLRH group for tumor size >2 cm (61.9% vs. 85.4%; P = 0.06). Conclusion: The results of our study suggest that with appropriate patient selection, TLRH can be a safe and effective procedure for the management of early cervical cancer in Singapore, especially in women with small tumors ≤2 cm but should be used with caution in women with larger tumors.

Salivary human chorionic gonadotropin as a novel biomarker for early detection of pregnancy: A pilot study Madhura Mahajan, Uzma Iqbal Belgaumi, Rajendra Baad, Nupura Vibhute, Vidya Kadashetti, Sushma Bommanavar, Wasim Kamate Gynecology and Minimally Invasive Therapy 2019 8(2):59-61 Context: The role of saliva in detection of pregnancy has not received the due importance it deserves. Aims: The present paper aims at determining the role of saliva in detection of pregnancy using home-based pregnancy detection kits to provide an alternative biofluid that is more user friendly, acceptable, noninvasive, rapid, and easy for home use. Settings and Design: The study was conducted among 35 women visiting a gynecology clinic for confirmation of pregnancy, who gave a history of a missed menstrual cycle not more than 4 weeks. Subjects and Methods: A home-based pregnancy detection kit meant for urinary human chorionic gonadotropin (hCG) detection with 20 mIU specification was used in the study for estimation of salivary hCG. Routine test that was prescribed to the patient such as laboratory-based urine hCG and/or ultrasound examination was used for confirmation of pregnancy status and correlation with the saliva-based result. Results: A positive test was obtained in 74% participants, with a dark band in 43% participants and a light band in 31% participants. A negative result was noted in 26% participants. We observed that salivary hCG estimation showed a 77% accuracy and 23% false-negative results. Conclusions: An astounding 74% of participants showed a positive result with an existing pregnancy kit which indicates a strong plausibility of using salivary hCG as a biomarker for detection of pregnancy. With the findings obtained from our study, we could positively affirm that salivary hCG can be used as a potential, user friendly, and more acceptable biomarker for early detection of pregnancy.

The Use of ulipristal acetate (Esmya) prior to laparoscopic myomectomy: Help or hindrance? Rebecca Mallick, Sam Oxley, Funlayo Odejinmi Gynecology and Minimally Invasive Therapy 2019 8(2):62-66 Introduction: The aim of this study was to assess the operative effects, both positive and negative, of pretreatment with ulipristal acetate (UPA) on laparoscopic myomectomy. Materials and Methods: We conducted a retrospective analysis of prospectively collected data from patients who underwent a laparoscopic myomectomy over a 2-year period. Results: A total of 62 patients were included, of which 10 received a 3-month preoperative course of UPA, and 52 patients received no pretreatment. There was no statistically significant difference between the two groups (no pretreatment vs. UPA pretreatment) with regard to blood loss (214.4 [±214.96] vs. 160 [±51.64], P = 0.432), operating time (111.64 [±41.8] vs. 117.5 [±50.4], P = 0.694), and duration of inpatient stay (1.27 [±0.56] vs. 1.11 [±0.33], P = 0.419). There were no complications in either group. In 100% of cases with UPA pretreatment, a distortion of the fibroid capsule with a more technically challenging dissection was noted, compared to 0% in the no pretreatment group. This anatomical distortion may result in more cases of incomplete resection and a potentially higher risk of recurrence. Conclusion: We conclude that UPA confers no operative benefits and should be used with caution in the presurgical treatment of fibroids. The use of UPA may indeed result in a more technically difficult myomectomy with distorted cleavage planes and carry a potential risk of incomplete resection.

The comparison of outcomes between the "skeleton uterus technique" and conventional techniques in laparoscopic hysterectomies Adnan Orhan, Isil Kasapoglu, Gokhan Ocakoglu, Oguzhan Yuruk, Gurkan Uncu, Kemal Ozerkan Gynecology and Minimally Invasive Therapy 2019 8(2):67-72 Aim: The aim of this study is to compare demographic characteristics, operative data, and complication rates of women who underwent total laparoscopic hysterectomy by the skeleton uterus technique (Skeleton-TLH) with those of women who underwent TLH by the standard technique (Standard-TLH) in a university teaching and research hospital. Materials and Methods: This retrospective study included 932 laparoscopic hysterectomies in a university teaching and research hospital between January 1, 2013 and December 31, 2017. Clinical characteristics, operative outcomes, and complications were recorded and compared for the two techniques. Results: In total, 932 laparoscopic hysterectomies were performed, 454 by Skeleton-TLH and 478 by Standard-TLH. The general demographic characteristics of the patients were similar; only gravida and parity were statistically significantly different between the groups (P < 0.001). Based on the primary outcomes (the operative data), total anesthesia time and main operation time were similar in the two groups. Estimated blood loss was statistically significantly lower in the Skeleton-TLH group than in the Standard-TLH group. Hospital stay was longer for the Skeleton-TLH group, and specimen weight was heavier. The secondary outcome was the complication rate. There were no differences between the Skeleton-TLH and Standard-TLH groups in the rates of all minor and major complications. Conclusion: TLH with the skeleton uterus technique is feasible and safe, especially for advanced pelvic surgeons. This technique not only provides retroperitoneal access to the pelvic spaces and good anatomical visibility; but it also delivers a safer laparoscopic hysterectomy by clamping the uterine arteries and monitoring the ureter throughout the operation.

Isolated incisional recurrence in a patient with early-stage endometrial cancer: A case report and review of the literature Takashi Hirayama, Soshi Kusunoki, Kazunari Fujino, Yasuhisa Terao, Atsuo Itakura Gynecology and Minimally Invasive Therapy 2019 8(2):73-75 Isolated incisional recurrence in a patient with early-stage endometrioid carcinoma is extremely rare. The mechanism of this recurrence also remains unclear. We describe a case of an isolated incisional recurrence of endometrioid carcinoma from the uterine corpus 4 years after the primary surgery. We review the previous literature and discuss the possible mechanism of isolated incisional recurrence. A 56-year-old woman diagnosed with the International Federation of Gynecology and Obstetrics Stage IA and Grade 2 endometrioid carcinoma in the uterine corpus showed an isolated cystic mass in the abdominal wall 4 years after the primary surgery. She underwent resection of the abdominal tumor, and the pathological findings showed endometrioid carcinoma, which was the same as the primary tumor. She received chemotherapy and remained disease free 8 months after chemotherapy. Long-term follow-up is required to detect recurrence, even in patients with early-stage uterine corpus carcinoma.

Successful surgical treatment for congenital vaginal agenesis accompanied by functional uterus: A report of two cases Chihiro Minami, Ryosuke Tsunematsu, Kana Hiasa, Katsuko Egashira, Kiyoko Kato Gynecology and Minimally Invasive Therapy 2019 8(2):76-79 We present two cases of congenital vaginal agenesis with functional uterine corpus, manifesting with periodic lower abdominal pain and hematometra in adolescence. Both patients were successfully treated with the creation of neovagina and neocanal structures to discharge menstrual blood; this may also facilitate the preservation of fertility. Both cases were characterized by degrees of congenital vaginal agenesis, whether short or completely absent, with no communication between the uterine cavity and external genitalia, as confirmed by physical examination and imaging. We surgically reconstructed a neovagina with the modified McIndoe's procedure, using an artificial skin graft, and canalized to the caudal portion of the uterine cavity. Although redilatation of the neocanal was required, no patient suffered severe infection in postoperative course and both now exhibit regular menstruation. Although hysterectomy has classically been the preferred treatment for such cases, recent technical progression enables treatment of such diseases with conservative and minimally invasive surgery, in a safe manner.

Immunotherapy with subcutaneous injection of immunomodulatory agent (OK-432) elicits durable response in locally advanced or relapsed cervical cancer Quenny Michelle Dyan A. Alas, Cheng Tao Lin Gynecology and Minimally Invasive Therapy 2019 8(2):80-82 Immunotherapy (IT) has been studied as a new and alternative treatment option for locally advanced, persistent, recurrent, or relapsed cervical cancer in an effort to extend the life and possibly cure patients with advanced stage disease. Targeted immune checkpoint inhibitors augment anticancer immunity and prolong patient's life span without immune-related adverse events (irAEs). Here, we present a case of a 56-year-old woman, gravida 2 para 0, diagnosed with squamous cell carcinoma of the cervix stage IVB who received IT coupled with subcutaneous injection of immunomodulatory agent (OK-432) during her standard treatment of concurrent chemoradiation therapy (CCRT) and as a maintenance therapy after CCRT due to relapsed cervical cancer. This form of treatment strategy showed good response as reflected by a decrease in tumor biomarker with no notable serious irAEs.

Intrauterine contraceptive device perforating the cecum, a pregnancy complication? Luay Ibrahim Abu Atileh, Mohammad Anas Mourad, Dania Haj-Yasin, Laith Shlash, Laith Zaid Kaylani, Nardin Fadila Gynecology and Minimally Invasive Therapy 2019 8(2):83-85 Intrauterine contraceptive device (IUCD) is a widely used method of contraception worldwide. Displacement of the IUCD extrauterine, by perforating the uterus and migration, is a serious complication following its insertion. We reported an extremely rare case of a 24-year-old female patient found to have a copper T 380A IUCD displaced from its normal site to be embedded into the cecum, suggested to have occurred during pregnancy, and being successfully removed laparoscopically.

Removal of a retroperitoneal foreign body by laparoscopic surgery Saeki Shinichiro, Yu Wakimoto, Hidetake Kamei, Atsushi Fukui, Hiroaki Shibahara Gynecology and Minimally Invasive Therapy 2019 8(2):86-88 Migration of intrauterine devices (IUDs) into the abdominal cavity is rare. In this report, we describe a patient in whom a levonorgestrel intrauterine system (LNG-IUS) device was initially misplaced outside of the uterus, likely due to stenosis of the cervix following a conization procedure for carcinoma in situ. The patient presented with persistent abdominal pain and vaginal bleeding. The LNG-IUS was not visible on physical examination and ultrasound imaging, requiring intraoperative abdominal radiography and postoperative computed tomography for localization. Once localized, we proceeded with the removal of the foreign body in the retroperitoneal space by laparoscopy. Misplacement of an IUD such as LNG-IUS outside of the uterus after a conization procedure should be suspected in women with persisting symptoms, and this possibility should be diligently assessed.

Otorrinolaringológica

Resultados oncológicos de la laringectomía de rescate en pacientes con carcinomas escamosos de laringe Publication date: Available online 26 April 2019 Source: Acta Otorrinolaringológica Española Author(s): Xavier León, Victoria Montoro, Carlota Rovira, Eduard Neumann, Montserrat López, Jacinto García, Miquel Quer Resumen Objetivo Analizar los resultados oncológicos conseguidos con una laringectomía total como cirugía de rescate en pacientes con carcinomas escamosos de la laringe. Material y métodos Revisión retrospectiva de una cohorte de 241 pacientes tratados con una laringectomía total tras una recidiva local de la enfermedad. El tratamiento inicial recibido por los pacientes fue de radioterapia (n = 201; 83,4%), quimiorradioterapia (n = 19; 7,9%), o una cirugía parcial (n = 21; 8,7%). Resultados La laringectomía total como cirugía de rescate consiguió el control local de la enfermedad en el 81,3% de las ocasiones, con una supervivencia específica a los 5 años del 65,3%. Las variables relacionadas con la supervivencia específica en un estudio univariante fueron la localización del tumor, la extensión local del tumor inicial y de la recidiva, los márgenes de resección, y el estatus patológico de los vaciamientos cervicales. De acuerdo con los resultados de un análisis multivariante, las variables que se relacionaron con la supervivencia fueron el estatus de los márgenes de resección, la presencia de una recidiva regional simultánea y la extensión local de la recidiva. Conclusiones La supervivencia específica a los 5 años de los pacientes tratados con una laringectomía total de rescate fue del 65,3%. Las variables que se relacionaron con el control final de la enfermedad fueron el estatus de los márgenes de resección, la presencia de una recidiva regional simultánea y la extensión local de la recidiva. Abstract Objective To analyse the oncological results of a salvage total laryngectomy in patients with a laryngeal carcinoma. Material and methods Retrospective review of a cohort of 241 patients treated with a salvage laryngectomy after a local recurrence. The initial treatment received by these patients was radiotherapy (n = 201, 83.4%), chemoradiotherapy (n = 19, 7.9%), and partial surgery (n = 21, 8.7%), Results Total laryngectomy as salvage treatment achieved local control of the disease in 81.3% of cases, with a 5-year specific survival of 65.3%. The variables related with specific survival in a univariate analysis were the location of the primary tumour, the local extension of the initial tumour and of the recurrence, the resection margins, and the pathological status of the neck dissections. According to the results of a multivariate analysis, the variables related to specific survival were the status of the resection margins, the presence of simultaneous regional recurrence, and the local extension of the recurrence. Conclusion The 5-year specific survival of patients treated with a salvage laryngectomy was 65.3%. The variables related with the control of the disease were the status of the resection margins, the presence of simultaneous regional recurrence and the local extension of the recurrence.

Paediatric nasal dermoids: Our experience Publication date: Available online 24 April 2019 Source: Acta Otorrinolaringológica Española Author(s): Ravi Meher, Avani Jain, Ishwar Singh, Nivea Singh, Raman Sharma Abstract Objectives Nasal dermoids are rare developmental anomalies seen in children. This study reports our experience in a developing country of the clinical and radiological findings as well as the management of nasal dermoids. Methods A retrospective analysis was performed, from 2012 to 2017, for 10 patients admitted for the treatment of nasal dermoids at a tertiary care center. The clinical presentation, preoperative imaging (CT/MRI), surgical approach, intraoperative findings, complications and recurrence were reviewed. Results Ten patients were included in this study, 6 males and 4 females, with an average age of 10.2 years at the time of presentation. Three patients presented with a mass located on the nasal dorsum, 1 had a nasoglabellar mass, 2 patients had a mass located on the nasal dorsum with visible sinus, and 4 patients presented with a sinus on the nasal dorsum, in which 1 patient had a tuft of hair. CT was performed in all the cases. It was not suggestive of intracranial extension in 9 patients, and was non-diagnostic in one patient. Both CT and MRI were performed on 2 patients, with no evidence of intracranial extension. Surgical and radiological findings were concordant in 8 patients (80%). Conclusion Nasal dermoids require preoperative imaging and precise surgical planning to achieve complete removal. Resumen Objetivos Los dermoides nasales son anomalías del desarrollo poco frecuentes que se observan en niños. Este estudio informa de nuestra experiencia, en un país en desarrollo, de los hallazgos clínicos y radiológicos, así como el manejo de los dermoides nasales. Métodos Se realizó un análisis retrospectivo, desde 2012-2017, para 10 pacientes ingresados ??para el tratamiento de dermoide nasal en un instituto de nivel terciario. Se revisaron la presentación clínica, las imágenes preoperatorias (TC/RM), el abordaje quirúrgico, los hallazgos intraoperatorios, las complicaciones y la recurrencia. Resultados Se incluyeron 10 pacientes en este estudio, 6 varones y 4 mujeres, con una edad promedio de 10,2 años en el momento de la presentación. Tres pacientes presentaban una masa localizada en el dorso nasal, uno tenía una masa nasoglabellar, 2 pacientes presentaban una masa localizada en el dorso nasal con seno visible y 4 pacientes presentaban un seno en el dorso nasal, de los cuales un paciente tenía un mechón de pelo. La TC se realizó en todos los casos. No sugirió una extensión intracraneal en 9 pacientes y no fue diagnóstico en un paciente. Tanto la TC como la RM se realizaron en 2 pacientes, sin evidencia de extensión intracraneal. Los hallazgos quirúrgicos y radiológicos fueron concordantes en 8 pacientes (80%). Conclusión Los dermoides nasales requieren imágenes preoperatorias y una planificación quirúrgica precisa para lograr una extracción completa.

Trismus and oral haematoma, a rare presentation of tetanus Publication date: Available online 20 April 2019 Source: Acta Otorrinolaringológica Española Author(s): Miguel Mayo-Yáñez, Liliana Invencio-Da Costa

Chronic cough and pneumonitis secondary to cerebrospinal fluid leak: Resolution after repair Publication date: Available online 16 April 2019 Source: Acta Otorrinolaringológica Española Author(s): Daniel William Scholfield, Catherine Rennie, Hesham A. Saleh

Carcinoma de paratiroides, una causa inusual de hiperparatiroidismo primario Publication date: Available online 15 April 2019 Source: Acta Otorrinolaringológica Española Author(s): Liliana Filipa Invêncio da Costa, Fabian Alzate Amaya, Jesús Herranz González Botas

Músculo elevador de la clavícula Publication date: Available online 13 April 2019 Source: Acta Otorrinolaringológica Española Author(s): José Miguel Costa González, Rosa Delia Ramírez Ruíz, Anna Sumarroca Trouboul

Riesgo de aparición de segundas neoplasias y neoplasias sucesivas en pacientes con un tumor índice de cabeza y cuello Publication date: Available online 12 April 2019 Source: Acta Otorrinolaringológica Española Author(s): Xavier León, Jacinto García, Montserrat López, Camilo Rodriguez, Alfons Gutierrez, Miquel Quer Resumen Objetivo Analizar la incidencia de aparición de segundas neoplasias y neoplasias sucesivas en una cohorte de pacientes con un carcinoma escamoso de cabeza y cuello. Material y métodos Estudio retrospectivo realizado en 4.458 pacientes con un tumor índice localizado en cabeza y cuello diagnosticados durante el periodo 1985-2016. Se llevó a cabo una evaluación de la incidencia de aparición de segundas neoplasias y neoplasias sucesivas a lo largo de un periodo de 30 años. Resultados Durante el seguimiento, un total de 1.203 pacientes (27,0%) contaron con la aparición de una segunda neoplasia, 242 (5,4%) con una tercera neoplasia, 58 (1,3%) con una cuarta y 8 (0,2%) con 5 o más neoplasias. La incidencia de aparición de segundas neoplasias fue del 3,5% anual, manteniéndose prácticamente constante a lo largo del periodo de seguimiento. Los pacientes que experimentaron la aparición de una segunda neoplasia contaron con un riesgo aumentado de presentar una tercera neoplasia, y los pacientes con una tercera neoplasia, con un riesgo aumentado de presentar una cuarta. Un 78% de las segundas, un 88% de las terceras y un 89,6% de las cuartas neoplasias aparecieron en localizaciones epidemiológicamente relacionadas con los consumos de tabaco y alcohol. Conclusiones Tras el diagnóstico y tratamiento de un tumor índice de cabeza y cuello los pacientes cuentan con un riesgo de aparición de una segunda neoplasia del 3,5% anual, y este riesgo permanece constante a lo largo del periodo de seguimiento a largo plazo. Abstract Objective To analyse the incidence of appearance of second and successive neoplasms in a cohort of head and neck squamous carcinoma patients. Material and methods We conducted a retrospective study with 4,458 patients with an index tumour located in the head and neck diagnosed during the 1985-2016 period. We evaluated the incidence of appearance of second neoplasms and successive neoplasms over a period of 30 years. Results During the follow-up, 1,203 patients (27.0%) had a second neoplasm, 242 patients (5.4%) a third neoplasm, 58 patients (1.3%) a fourth neoplasm, and 8 patients (0.2%) 5 or more successive neoplasms. The incidence of appearance of second neoplasms was 3.5% per year, remaining relatively constant throughout the follow-up period. The patients with a second neoplasm had a higher risk of appearance of a third neoplasm, and those with a third neoplasm had a higher risk of a fourth. Seventy-eight percent of the second neoplasms, 88% of the third neoplasms, and 89.6% of the fourth neoplasms appeared in locations epidemiologically related to tobacco and alcohol use. Conclusions Second neoplasms after a head and neck index tumour appeared at a constant rate of 3.5% per year throughout the entire follow-up period.

Intoxicación por monóxido de carbono: una causa rara de hipoacusia neurosensorial reversible Publication date: Available online 7 March 2019 Source: Acta Otorrinolaringológica Española Author(s): Martin Marcano Acuña, Iván Doménech Máñez, Francisco Llopis Llopis, Manuel Salvador Marín

Manejo del absceso de la glándula tiroides Publication date: March–April 2019 Source: Acta Otorrinolaringológica Española, Volume 70, Issue 2 Author(s): Javier García Callejo, Jaume Redondo Martínez, Miguel Civera, José Verdú Colomina, Verónica Pellicer Zoghbi, M. Paz Martínez Beneyto Resumen Introducción La enfermedad supurativa de la glándula tiroides-absceso de tiroides o tiroiditis supurativa aguda– supone una infrecuente situación clínica. Presentamos nuestra experiencia en los casos asistidos durante 41 años. Materiales y métodos Estudio longitudinal retrospectivo anotando características epidemiológicas, conducta diagnóstico-terapéutica y resultado clínico, detectando 14 casos –9 varones y 5 mujeres, entre 19 y 68 años, con una media de edad de 40,6 ± 15,4 años– con 22 episodios. En 2 pacientes la condición se había reproducido hasta en 4 ocasiones. Resultados Supusieron el 0,29% de todos los abscesos cervicales atendidos. La punción-aspiración fue efectuada en 13 de ellos para su tratamiento e identificación del agente causal. Los agentes más habitualmente implicados fueron Mycobacterium tuberculosis y Staphylococcus aureus. Se realizó un estudio de imagen mediante ecografía en 9 casos y de tomografía computarizada en 7. En 10 pacientes el tratamiento definitivo fue quirúrgico, efectuándose drenaje del absceso en 7 de ellos, tiroidectomía total en 4 y hemitiroidectomía en 2. Otros tratamientos admitidos fueron la antibioterapia sistémica o mediante irrigación intralesional y la esclerosis. Aunque en un caso la fase aguda comenzó con hipertiroidismo y tirotoxicosis, a los 6 meses del alta existió hipotiroidismo definitivo en 5 casos. Las opciones terapéuticas adoptadas consiguieron la curación en el 100% de los casos. Conclusión La supuración de la glándula tiroidea es una circunstancia extremadamente rara en el contexto de la enfermedad cervical, variando las opciones terapéuticas desde alternativas conservadoras al drenaje con tiroidectomía según los hallazgos microbiológicos y radiológicos. Abstract Background Thyroid abscess or acute suppurative thyroiditis is an unusual clinical condition. We present our experience with cases attended over 41 years. Materials and methods A retrospective study was performed on these patients reviewing their epidemiological characteristics and the diagnostic and therapeutic manoeuvres chosen for them all, as well as their clinical outcome. A group of 9 males and 5 females was studied, with ages ranging from 19 to 68 (mean of 40.6 ± 15.4). These patients suffered 22 acute episodes, and 2 patients each had 4 episodes. Results Suppurative thyroiditis comprised 0.29% of the neck abscesses. Fine needle aspiration was performed in 13 cases to evacuate the collection and isolate the aetiological agent. Mycobacterium tuberculosis and Staphylococcus aureus were the most frequently identified. Nine patients underwent ultrasound and 7 computed tomography imaging studies. Surgery was the option for 10 patients, including drainage for 7, thyroidectomy for 4 and hemithyroidectomy for the remaining 2. Systemic or intralesional antibiotics and sclerosis of the gland were also carried out. Although one case presented with hyperthyroidism and thyrotoxicosis in the acute phase, definitive hypothyroidism was observed in 5 patients at 6 months following discharge. The rate of success was 100%. Conclusion Thyroid gland suppuration is a very infrequent circumstance in neck pathology, and the options for its treatment are varied, from conservative to invasive techniques according to the microbial and radiologic findings.

Recidiva de carcinoma nasosinusal relacionado con el virus del papiloma humano con características similares al adenoide quístico Publication date: March–April 2019 Source: Acta Otorrinolaringológica Española, Volume 70, Issue 2 Author(s): Andrés Felipe Sáenz González, Eduardo Morera Serna, Adriana Marcela Quintero Duarte, Rafael Ramos Asensio

Oral and Maxillofacial Surgery

Opioid Prescription Following Third Molar Extractions Publication date: Available online 27 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Gayathri Subramanian, Samuel Y.P. Quek

Prolonged Dysphagia After Orthognathic Surgery Publication date: Available online 27 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Roger A. Meyer

Condylotomy To Reverse Temporomandibular Joint Osteoarthritis In Rabbits Publication date: Available online 26 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Edela Puricelli, Felipe Ernesto Artuzi, Deise Ponzoni, Alexandre Silva Quevedo Abstract Purpose Osteoarthritis of the temporomandibular joint (TMJ OA) is characterized by local tissue degeneration and pain. Treatments aim to reduce symptoms, and only some of them interfere with the progression of pathophysiological changes caused by osteoarthritis. Condylotomy is an alternative for the treatment of patients refractory to conventional treatments. The aim of this animal study was to investigate the influence of condylotomy on TMJ OA in New Zealand rabbits. Methods The animals (n=36) were divided into three groups: osteoarthritis group (OG, induced osteoarthritis), treatment group (TG, induced osteoarthritis + condylotomy), and control group (CG, with neither osteoarthritis nor surgery). Disease was induced using intra-articular monosodium iodoacetate injection for 40 days. Animals in the treatment group underwent condylotomy and were killed 20, 40 and 60 days after treatment. Animals in the control and osteoarthritis groups were killed at the same time points. Results Articular joint condition was better in TG animals on day 60 after surgery (p=0.032). Direct comparison revealed regression of TMJ OA over time among treated animals (p=0.008). Surgical treatment promoted mandibular condylar remodeling in animals in the treatment group, thus reversing tissue degeneration caused by osteoarthritis. Conclusion Therefore, our findings suggest that condylotomy may be an option for the treatment of osteoarthritis and prevent damage to TMJ structures. This may be particularly important for patients who do not respond satisfactorily to more conservative treatments.

Temporomandibular Joint Condyle-Disc Morphometric Sexual Dimorphisms Independent of Skull Scaling Publication date: Available online 25 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Matthew C. Coombs, Xin She, Truman R. Brown, Elizabeth H. Slate, Janice S. Lee, Hai Yao ABSTRACT Purpose Approximately 2-4% of the U.S. population are estimated to seek treatment for temporomandibular symptoms, predominately affecting women. The study purpose was to determine whether sex-specific differences in temporomandibular morphometry result from scaling with sex differences in skull size and shape, or intrinsic sex-specific differences. Materials and Methods Eleven male (74.5±9.1 years) and eleven female (73.6±12.8 years) human cadaveric heads with no history of temporomandibular disc derangement underwent CBCT and high-resolution MRI scanning to determine three-dimensional cephalometric parameters and temporomandibular morphometric outcomes. Regression models between morphometric outcomes and cephalometric parameters were developed, and intrinsic sex-specific differences in temporomandibular morphometry normalized by cephalometric parameters were determined. Subject-specific finite element (FE) models of the extreme male and extreme female conditions were developed to predict variations in articular disc stress-strain under a same joint loading. Results In some cases, sex differences in temporomandibular morphometric parameters could be explained by linear scaling with skull size and shape; however, scaling alone could not fully account for some differences between sexes, indicating intrinsic sex-specific differences. Intrinsic sex-specific differences in temporomandibular morphometry were increased condylar medial length and mediolateral disc lengths for males, and longer anteroposterior disc lengths in females. Considering the extreme male and female temporomandibular morphometry observed in this study, subject-specific FE models resulted in sex differences with the extreme male joint having a broadly distributed stress field and peak stress of 5.28MPa, while the extreme female joint had a concentrated stress field and peak stress of 7.37MPa. Conclusion Intrinsic sex-specific differences independent of scaling with donor skull size were identified in temporomandibular morphometry. Understanding intrinsic sex-specific morphometric differences is critical to determining temporomandibular biomechanics given the impact of anatomy on joint contact mechanics and stress-strain distributions, and requires further study as one potential factor for the increased predisposition of women to temporomandibular disc derangement.

Inferior alveolar nerve block by the anterior technique anesthetizes the buccal nerve and improves anesthesia success rate for third molar extraction: a randomized controlled trial and magnetic resonance imaging evaluation Publication date: Available online 25 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Shota Tsukimoto, Yoshihiro Takasugi, Risa Aoki, Motoshi Kimura, Tatsuo Konishi Abstract Purpose Lack of anesthesia of the buccal nerve and insufficient volume of anesthetic are reportedly responsible for failed inferior alveolar nerve blocks (IANB) by the Halsted approach (conventional IANB). This study aimed to determine the extent of anesthesia in the buccal nerve innervation area and to evaluate the anesthetic efficacy of injecting a larger volume of anesthetic during IANB by the anterior approach (anterior technique) in clinical settings and with magnetic resonance imaging (MRI) analysis. Patients and Methods The prospective randomized controlled trial was performed in patients scheduled for removal of a mandibular third molar. The primary predictor variables were the approach for IANB (anterior technique and conventional IANB) and anesthetic dose (1.8 and 2.7 mL). The primary outcome variables were extent of anesthesia and anesthesia success rate defined as unnecessary additional anesthesia. The secondary outcome variable was anesthetic drug distribution related to the pterygomandibular space measured on MRI-T2WIs. Statistical independence of anesthesia success rate among primary predictor variables was tested with statistical significance set at p ≤ 0.05. Results One hundred eight patients and 10 volunteers were enrolled in the clinical and MRI studies, respectively. Anesthesia of the buccal nerve was evident in patients receiving the anterior technique with 2.7 mL of anesthetic. The success rate of the anterior technique with 2.7 mL of anesthetic (96%) was higher than that with 1.8 mL of anesthetic (67%) (p=0.0113), while increasing dose had no effect on the efficacy of conventional IANB (78% and 81%, p=1.000). The MRI study revealed distribution of the anesthetic over the anterior surface of the temporalis tendon and in the pterygomandibular space following the anterior technique. Conclusion Anesthesia of the buccal nerve following the anterior technique with 2.7 mL of anesthetic solution might contribute to increasing the success rate of anesthesia for removal of mandibular third molars.

Does Single Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain Following Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study Publication date: Available online 25 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Ahmet Emin Demirbas, Mustafa Karakaya, Suheyb Bilge, Dilek Gunay Canpolat, Nükhet Kütük, Alper Alkan Abstract Purpose The aim of this study is to identify the preemptive analgesic effect of intravenous (IV) ibuprofen in mandibular third molar surgery. Material and Method 75 patients were randomly divided into 3 groups; Group 1 received IV ibuprofen 60 min before surgery and IV placebo (100 mL saline) after surgery; group 2 received IV placebo (100 mL saline) before surgery and IV ibuprofen 60 min after surgery; group 3 received IV placebo (100 mL Saline) 60 min before and after surgery. Postoperative pain was recorded on a visual analogue scale (VAS) at 1, 2, 4, 6, 8, 12 and 24 h within the postoperative period. The total dose of rescue acetaminophen intake was recorded during first 24 h of the postoperative period. Results The efficacy of post-surgical analgesia was greater within the preoperative IV ibuprofen group when compared to the other groups (p<0.001). The placebo group received more rescue analgesia within the first hour, when compared to the others. The average dose of acetaminophen administered within group 1 was 640 mg, compared to 1240 mg within group 2 and 1840 mg within group 3, within the first 24 h after surgery (p<0.001). Conclusion According this study, the preemptive use of IV ibuprofen resulted in less pain and a decrease in the requirement for rescue analgesia during the first 24 h following third molar surgery.

Biomechanical evaluation of mandibular condyle fracture osteosynthesis using the rhombic 3D condylar fracture plate Publication date: Available online 25 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Anas Ben Achour, Heike Meißner, Uwe Teicher, Dominik Haim, Ursula Range, Alexander Brosius, Henry Leonhardt, Günter Lauer Purpose The aim of this study was to evaluate the biomechanical stability of osteosynthesis in mandibular condyle fractures using a newly designed rhombic 3D condylar fracture plate and to compare it with that using the standard two 4-hole miniplates and with that in non-fractured condyles. Material and Methods On 200 porcine mandibles, three different monocortical plating techniques were evaluated. The condyles were fractured along a defined line tangential through the sigmoid notch perpendicular to the posterior border. After anatomical reduction osteosynthesis was performed using either standard rhombic 3D condylar fracture plates and standard screws (A) or locking rhombic 3D condylar fracture plates which were fixed either with standard (B) or locking screws (C). For comparison, non-fractured condyles (D) and condyles fixed with the standard two 4-hole miniplates and 8 screws were included (E). In a universal mechanical testing machine TIRA Test 2720 each group was subjected to linear loading in the directions: lateral to medial, medial to lateral, anterior to posterior and posterior to anterior. Maximum axial force and displacement at maximum force were measured. Mean values were compared for statistical significance using analysis of variance (ANOVA) with Bonferroni correction (significance at p < 0.05). Results The main mode of failure in the plating techniques investigated was the pull-out of screws from the proximal fragment. There is no significant difference in the stability of osteosynthesis between the two 4-hole miniplates and the rhombic 3D condylar fracture plate when loading from posterior to anterior, lateral to medial and medial to lateral. However, when loading from anterior to posterior a statistically significant difference among the standard and locking system and the two 4-hole miniplates was observed, the latter being more stable. Conclusion The results of this biomechanical study suggest that the rhombic 3D condylar fracture plates are suitable for the treatment of condylar neck fractures. Both types of the plate are able to resist physiologic strains comparable to the two 4-hole miniplates.

Bibliometric analysis of Medication-Related Osteonecrosis of the Jaw: high citation rates but low evidence. Publication date: Available online 23 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Márcio Diniz-Freitas, Maite Pena-Cristobal, Daniel Pérez-López, Lucía Lago-Méndez, Javier Fernández-Feijoo, Jacobo Limeres Abstract Purpose Citation analysis is one of the most commonly employed bibliometric tools for measuring the academic importance of an article in a specific area of knowledge. The objective of this study was to identify the 100 most cited articles on medication related osteonecrosis of the jaw, determine their main bibliometric characteristics and identify the bibliometric variables that affect the citation rates. Methods We performed a literature search in the Scopus database to determine the number of MRONJ article citations up to September 30, 2018. We then selected the 100 most referenced articles and gathered the following information: ranking based on the number of citations; citation density; number and names of authors; language and year of publication; country and institution of origin; financial support; publishing journal's name, impact factor, category and quartile; type of research; evidence level; and area of study. Results The top 100 publications had a mean citation density of 21.7 ± 20.7 (range, 6.2–99.4) and an h-index of 96. The 100 most cited articles on MRONJ were published in 42 scientific journals, classified into 10 separate categories of the Journal Citation Reports; 56% of the articles were in the first quartile of their category. Most of the studies were classified with a level of evidence of 4 (n=45) or 5 (n=29). In the bivariate analyses, only conflict of interest (P= 0.002), was associated with citation density. After adjusting for numerous variables, conflict of interest (r=0.27; P=0.020) and country of first author (r=0.23; P=0.043) were significantly associated with citation density. Conclusions The 100 most cited articles on MRONJ had a large number of citations and were published in journals with a high impact factor; however, the articles had a generally low evidence level and lacked randomized clinical trials.

CTRead – A Revolutionary Approach to Training Residents in CT Facial Bones Interpretation Publication date: Available online 23 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Wendall Mascarenhas, Daniel Richmond, Chiasson Genevieve Abstract Purpose The purpose of our study was to create an online, web-based training module that would instruct a group of residents in the interpretation of a CT facial bones scan in a logical, step-wise manner to locate and identify all relevant facial fractures. The investigator's hypothesis was implementing the CTRead facial bones training module would improve residents' competency in the interpretation of CT facial bones scans. Methods The investigators designed and implemented a prospective quasi-experimental trial. The population for this study included medical and dental residents. The primary outcome variable was the difference between the pre and post-test scores of the participants, and the frequency of missing fractures before and after the course. Secondary outcomes of interest are subjective data gathered from the course, including participants feedback as well as subjective evaluation of the training module and perceived benefit. Another secondary outcome measured was the resident's self-reported confidence level in interpreting CT facial bones scans on their own before and after completion of the course. Descriptive and bivariate statistics were used. Results The population sample consisted of 38 residents from North America, aged 25-34 (M=28.2) years of age. When comparing the results pre and post-course, the overall frequency of missed fractures decreased from 20.7 to 6.4 (p <0.001), and the total score overall increased from 32.7 to 74.7% (p <0.001). Regarding secondary outcomes, the majority of participants indicated that they "Agree" or "Strongly Agree" with a number of positive subjective questions asked. In addition, there was a statistically significant increase in the participants' comfort levels in the interpretation of CT facial bones scans. Conclusion The results of this study confirm the hypothesis that completing the CTRead training module (www.CTRead.ca) improves competency among residents in the interpretation of CT facial bones scans and their identification of facial fractures correctly.

Helmets Decrease Risk for Bicyclist-related Maxillofacial Injuries, but not Severity Publication date: Available online 23 April 2019 Source: Journal of Oral and Maxillofacial Surgery Author(s): Marcus J. Hwang, Jasjit K. Dillon, Thomas B. Dodson ABSTRACT Purpose Given the increasing use of bicycles for local transportation and recreation, the purpose of this study is to measure the effects of bicycle helmets on frequency and severity of maxillofacial injuries. The specific aims were to measure and compare the frequencies and severity of maxillofacial injuries between injured bicyclists who did or did not wear helmets. Methods The authors implemented a retrospective cohort study and enrolled a sample of bicyclists injured between January 4, 2012 and March 31, 2018 who presented to Harborview Medical Center for evaluation and treatment. The primary predictor variable was helmet use (yes/no). The primary outcome variables were 1) presence of a maxillofacial injury (yes/no) and 2) injury severity measured using the Face Abbreviated Injury Scale (FAIS). Other study variables were grouped into demographic or injury-related variables. Appropriate uni-, bi-, and multiple logistic regressions statistics were computed, and statistical significance was set at p < 0.05. Results The sample was composed of 1379 subjects with a mean age of 39.6 ± 18.9 (1 - 91) years and 78.4% were male. The frequencies of facial injuries between helmeted and non-helmeted bicyclists were 17.3% and 30.6%, respectively (relative risk = 0.6, 95% CI = 0.5 - 0.7, p < 0.0001). The protective effect held after adjusting for age, sex, and alcohol exposure. The FAIS between helmeted and non-helmeted riders was 1.8 ± 0.5 versus 1.9 ± 0.6 (p = 0.8), respectively. Conclusions Helmeted bicyclists were 40% less likely to have a facial injury from bicycle accidents. For cyclists who did have a facial injury, however, injury severity was not different between helmet and non-helmeted wearers. This may be due to the fact that unlike American football helmets, standard bicycle helmets do not include a face mask to protect the face.