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Background: The purpose of the present study was to evaluate the changes in maxillofacial fracture epidemiology and etiology regarding Covid-19-related social distancing restrictions in an Iranian population. Methods: A retrospective cross-sectional study was undertaken in six major trauma center hospitals in Iran in a period of two years (March 2018 until March 2020). The primary outcome variable was the maxillofacial fractures incidence. Patients' demographic data, date of injury as well as fracture characteristics, fracture etiology, type, and site were all recorded, compared, and analyzed in the control and experimental groups. Results: The patients consisted of 520 (83.6%) males and 102 (16.4%) females. Patients sustaining maxillofacial fractures over this two-year period displayed a mean age of 31.24±14.44, with an age range of 2 to 88 years. The incidence of maxillofacial fractures significantly decreased in all age groups (p<0.001). After social distancing restrictions were placed; there was a significant drop in the number of subjects attending due to motorcycle collisions and road traffic accidents, whereas the number of fractures caused by assaults and domestic violence significantly increased (p<0.001 for each). Conclusion: The investigators realized that social distancing restrictions were able to change the trends and patterns in maxillofacial fracture incidence and etiology.

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BACKGROUND: The possibility of mandibular bad spilt might happen during bilateral sagittal split osteotomy (BSSO). This study investigated the effect of impacted mandibular third molars on bad spilt incidence during BSSO. METHODS: Totally, 140 patients under 40 years old who were candidates for BSSO surgery due to class 3 skeletal discrepancy were divided randomly into two equal groups. The impacted mandibular third molars were presented in one group during BSSO (Exposed), and the third molars were removed at least six months before surgery for the other group (Unexposed). All cases underwent BSSO using the same technique by a single surgeon. A bad split was diagnosed by inter-operative clinical examination and postoperative panoramic radiography. RESULTS: Four bad split occurrences were observed including three patients in the group which impacted mandibular third molars were presented and one patient in the group without impacted mandibular third molars. The incidence of bad fracture in the exposed group was 3.7 times more than the unexposed group. The incidence of the bad fracture in exposed group was 3.7 times more than unexposed group. The chance of fractures in females was 1.7 times higher than males. With one year addition to the patient's age, chance of fracture increased 0.985 times more. CONCLUSION: Overall incidence of bad split fracture in presence of mandibular third molars in females and at older ages increased during BSSO. The extraction of impacted mandibular third molars, six months before the BSSO is recommended to prevent the bad split incidence during the operation.

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INTRODUCTION AND AIM: The aim of this study was to evaluate the effect of two concentrations of caffeine (1.5% and 3%) powder added to Bio-Oss xenograft on bone healing rate of iatrogenic mandibular defects in dogs. MATERIALS AND METHOD: The researchers implemented a pilot study on ten male adult mongrel dogs. Two 4-mm circular critical-sized defects were trephined on each side of the mandibular body (a total of 4 defects for each dog). One of the defects remained empty as a control group. The other three defects in each case were randomly filled with 1.5% or 3% caffeinated Bio-Oss or pure Bio-Oss. The mandible specimens were sent for histological and histomorphometric assessments, 4 months postoperatively. Our predictor variable was the type of bone substitute. The study outcomes were new bone formation, angiogenesis, and fibrosis. The p value was set at 0.05 using SPSS 16. RESULTS: The histological assessment showed that the administration of 1.5% caffeinated Bio-Oss to mandibular defects caused more angiogenesis and more new bone formation as well as less fibrosis compared to the other groups (p < 0.05). CONCLUSION: This study suggested that the application of 1.5% caffeinated Bio-Oss in bone defects of dogs resulted in the higher new bone formation. However, further clinical trials are needed to support its relevancy.

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PURPOSE: Because no study has evaluated the postoperative pain caused by the shape of dental implants, this study compared the level of postoperative pain between tapered and cylindrical implants inserted in the posterior region of the maxilla. MATERIALS AND METHODS: The study was designed as a double-blinded randomized clinical trial and conducted in 50 healthy patients 20 to 60 years old who were edentulous in the posterior maxilla and were candidates for single implantation. All patients had the same surgical difficulty with appropriate bone width and height. BioHorizons (Birmingham, AL) implants (tapered vs cylindrical) with 4.5-mm platform diameter were randomly selected for each group. The visual analog scale was used to evaluate the level of pain. Pain severity in each group was measured at 30-minute, 3-hour, 6-hour, 12-hour, 24-hour, 2-day, 3-day, and 1-week intervals. The predictor variable was implant shape and the outcome was postoperative pain severity. Data were statistically analyzed with SPPS 16 (SPSS, Inc, Chicago, IL) at the significance level of a P value less than .05. RESULTS: Fifty patients (n = 25 per group) with the mean age of 43.7 ± 10.9 years were included in this study. The pain level in the 2 groups reached its maximum at the 6-hour postoperative interval. Pain severity decreased significantly over time in the 2 implant groups (P < .001). Severities of postoperative pain in the tapered group at 3-, 6-, 12-, and 24-hour intervals were statistically lower than those in the cylindrical group (P < .05). CONCLUSIONS: Implant shape had an impact on postoperative pain. It can be concluded that tapered implants lead to less postoperative pain compared with cylindrical ones.

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BACKGROUND: The aim of this randomized controlled triple blind trial was to compare the efficacy of clonidine with dexamethasone versus ondansetron with dexamethasone for postoperative pain, nausea and vomiting prevention in orthognathic surgery patients. MATERIAL AND METHODS: In this clinical trial study, 30 consecutive patients with skeletal class III deformities were candidates for orthognathic surgery in Qaem hospital, Mashhad University of medical sciences, Mashhad, Iran from March to November 2017. These subjects were randomly assigned to two equal number groups, ondansetron or clonidine. Patients received either oral ondansetron 8 mg or oral clonidine 150 μg as premedication, 1 hour before the surgery (both dissolved in 20 cc of water). Also both groups received intravenous dexamethasone 8 mg (1 hour preoperatively and every 4 hours intraoperatively). RESULTS: In this study, a total of 30 patients (14 males and 16 females) with a mean age of 23.9 ± 3.9 were investigated. The incidence of postoperative nausea in women was more than men (p = 0.003), also the correlation between the incidence of PON and the surgery duration ≥ 3 hours was statistically significant (p = 0.050). The frequency of postoperative nausea (PON) in the ondansetron group was less than clonidine (53.3% vs 73.3% respectively). There was no postoperative vomiting (POV) in the ondansetron group, but 6.7% of cases in clonidine group suffered POV. Post-operative nausea in ondansetron group occurred significantly later than clonidine (525.0 ± 233.2 vs 100.0 ± 34.0 min; p < 0.001). On the other hand, the incidence time of post-operative severe pain or in other word the analgesia time in clonidine group was significantly more than ondansetron one (875/0 ± 68/5 vs 614.3 ± 159.1 min; p < 0.001). CONCLUSION: Ondansetron with dexamethasone premedication was more effective in controlling PONV after orthognathic surgery compared to clonidine with dexamethasone group

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INTRODUCTION: A 32-year-old woman was admitted to our hospital following a motor vehicle accident. Her chief complaint was severe limited mouth opening and unilateral open bite on the left. METHODS: Axial and coronal CT scans showed penetration of right condyle into the middle cranium through the fractured roof of glenoid fossa. A craniotomy exactly above the glenoid fossa was done. RESULTS: The condyle was reduced and the glenoid fossa was reconstructed. CONCLUSION: On postoperative follow-up at 6 months, the patient had no complaint, but there was a small deviation to the affected side on opening.

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