BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

OBJECTIVES

To determine and group the anthropometric norms of the zygomaticomaxillary (ZM) fixation points as a basis for optimizing the design of maxillary L-plates, from a sample population aged 19 to 59, in a tertiary government hospital in Central Luzon, Philippines.

METHODS

Design: Retrospective Review of CT scans

Setting: Tertiary Government Training Hospital

Participants: CT scan images of 110 surgical patients from the Department of ORL-HNS, obtained between January 2023 and December 2024 were measured

RESULTS

A total of 169 maxillae were analyzed, comprising 85 right and 84 left sides. The maxillary width (MW) of males (30.59 ± 2.86 mm) was found to be wider than the MW of females (29.68 ± 2.69 mm) by 0.91 mm. The zygomatic width (ZW) and its inclination angle (IA), on the other hand, were not significantly different. There were also no significant differences in the MW, ZW, and IA between the right and left sides; with the MW mean at 30.17 ± 2.81 mm and a range of 24.40 36.80 mm, the ZW mean at 20.22 ± 2.47 mm and a range of 15.40–28.30 mm, and the IA mean at 111.13 ± 11.29 degrees and a range of 78.50–131.70 degrees. To capture the range of maxillary sizes among patients, a quartile-based grouping was introduced. The MW, ZW, and IA of the L-plates were classified into small (27.80 mm, 18.30 mm, 104.15 degrees), medium (29.80 mm, 19.90 mm, 110.70 degrees), and large (32.35 mm, 22.05 mm, 120.20 degrees) sizes, respectively.

CONCLUSION

This study established reference values for the MW, ZW and IA to optimize the maxillary L-plate design for ZM fractures. The novel quartile-based grouping provided options for future L-plate measurements – potentially creating a better fit for patients, streamlining design in implant production, and improving the efficiency and outcomes of maxillofacial surgeons.

Human ; Maxillary Fractures ; Tomography ; Titanium ; Fracture Fixation

Prone position ventilation (PPV) has been widely used in the treatment strategy of patients with acute respiratory distress syndrome (ARDS). Patients undergoing PPV may develop facial edema and are at risk for pressure injuries due to prolonged prone positioning. In clinical practice, preventive measures such as repositioning, protective dressings, and pressure-relief cushions are commonly used to prevent pressure injuries. However, factors such as improper endotracheal tube placement, self-paid dressings, and delayed clearance of oral and nasal secretions have reduced the effectiveness of preventing facial pressure injuries. To address the above issues, a device for preventing pressure injuries on the faces of patients in the prone position was designed by healthcare workers in the nursing department of Dalian Friendship Hospital, and a National Utility Model Patent of China was obtained (ZL 2024 2 0340439.8). The device consists of a support plate and a circuit control system. The support plate is equipped with two support members. Support member 1 is directly fixed to the support plate, while support member 2 is connected to the support plate via a slide and a spiral rod, serving to support the patient's face and allowing for adjustment of the appropriate width according to the size of the patient's face. Inside the two support members, there are several telescopic rods, with the upper ends designed as spherical supports. The height and position of the telescopic components can be adjusted through a circuit control system, regularly changing the pressure distribution on the patient's face, thereby achieving the purpose of changing the pressure points on the face. The inner wall of support member 2 is equipped with a camera, allowing direct observation of the patient's facial condition through a monitor, avoiding compression of the eyes and nose, and promptly removing secretions from the mouth to keep the face clean, thereby reducing the risk of facial pressure-related injuries. The center of the two support members features a hollow slot, facilitating the placement of a tracheal tube. The circuit control system includes a random module, a time setting module, a control module, and a drive module. Parameters can be set as needed. When the shortest set time is reached, the random module and time setting module send instructions to the control module. Upon receiving the instructions from the time setting module and the random number from the random module, the control module transmits information to the drive module. The drive module, upon receiving the information, controls multiple telescopic rods to adjust their height and position, thereby changing the support points on the patient's face. The device features a simple structure and convenient operation, allowing for flexible adaptation to the patient's facial shape. It can be replaced with the patient's facial pressure area, providing an intuitive view of the patient's facial pressure situation. With automation and high safety, it helps reduce the risk of pressure-related injuries and lightens the workload of medical staff.
Humans ; Pressure Ulcer/prevention & control* ; Prone Position ; Equipment Design ; Facial Injuries/prevention & control* ; Respiration, Artificial/instrumentation* ; Respiratory Distress Syndrome/therapy*

PURPOSE: Road traffic accidents (RTA), assaults, falls, and sports-related injuries are the leading causes of maxillofacial trauma. Due to quite different geographical environment and fast urbanization, the use of various protective equipment is restricted in India. Thus, compared to other countries, there might be a significant difference in the pattern and frequency of associated injuries among subjects with maxillofacial trauma. The present study was conducted to identify the causes and pattern of various maxillofacial fractures and the frequency of other related injuries among subjects with maxillofacial trauma. METHODS: This is a cross-sectional retrospective study recording 2617 subjects with maxillofacial trauma from October 2017 to October 2022. The patient demographics, causes of trauma, types of maxillofacial injury, and associated soft and hard tissue injuries were recorded. The types of maxillofacial and associated injuries were diagnosed from details of clinical examinations and the interpretation of various radiographs available in the file. The associated injuries were divided into head injury, other bony injuries, and soft tissue and vital structure injuries. Descriptive statistics and the test of proportion were used. A p value < 0.05 was considered as a level of significance. RESULTS: The maxillofacial injuries were significantly common in patients aged 16 - 45 years (66.7%) than in patients aged ≤ 15 and > 46 years (33.3%) (p < 0.001). The RTA was the most common cause of maxillofacial injury (n = 2139, 81.7%), followed by fall (n = 206, 7.9%), other causes of injury (n = 178, 6.8%), and assaults (n = 94, 3.6%). The maxillofacial injury by 2-wheel vehicle accidents was significantly higher than that by 4-wheel vehicle and other vehicle accidents (p < 0.001). There was a significant correlation between alcohol and RTA (p < 0.001). The head injury (n = 931, 61.1%) was the most common associated injury, followed by soft tissue and vital structures injuries (n = 328, 21.5%) and other bone injuries (n = 264, 17.3%). DISCUSSION Head injury was the most common associated injury followed by soft tissue and vital structures and bone injuries among subjects with maxillofacial trauma. Clavicle fracture and injury to the lower extremities were the most common hard and soft tissue-associated injuries.
Humans ; Maxillofacial Injuries/etiology* ; Retrospective Studies ; Adult ; India/epidemiology* ; Male ; Female ; Cross-Sectional Studies ; Middle Aged ; Adolescent ; Young Adult ; Tertiary Care Centers ; Accidents, Traffic/statistics & numerical data* ; Child ; Aged ; Multiple Trauma/epidemiology* ; Child, Preschool

OBJECTIVES: This study aims to evaluate the clinical effect of low-energy semiconductor laser treatment on the promotion of wound healing after maxillofacial fracture surgery. METHODS: A prospective randomized controlled study was conducted. Patients with maxillofacial fractures who were hospitalized in the Department of Trauma and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, from August 2021 to June 2023 were selected as the study subjects and randomly divided into experimental and control groups. The experimental group was treated with a low-energy semiconductor laser once a day for six consecutive days after daily routine dressing change on the first day after surgery. The control group only underwent routine dressing change treatment and did not receive low-energy semiconductor laser treatment. Wound healing times, wound healing conditions, modified Stony Brook scar evaluation scale (mSBSES) scores, pain indices, and wound infection rates were compared between the two groups. RESULTS: A total of 211 patients were included in this study. A total of 104 and 107 cases comprised the experimental and control groups, respectively. A total of 128 males and 83 females were included. After low-energy semiconductor laser treatment, the facial skin wound healing time of the experimental group was found to be significantly shorter than that of the control group (P<0.05). Moreover, the wound grade A healing rate of the experimental group was higher than that of the control group on the seventh day after surgery (P<0.05). Among postoperative facial skin wound evaluation indices, the mSBSES scores of the experimental group at all observation points were higher than those of the control group (P<0.05), and the scores of the experimental group were higher than those of the control group in terms of wound width reduction, height reduction, color lightening, and incision line loss (P<0.05). In postoperative wound pain evaluation, the pain index of the experimental group after low-energy semiconductor laser treatment was significantly lower than that of the control group (P<0.05). No significant difference in wound infection rates was found between the two groups (P>0.05). CONCLUSIONS For facial skin wounds in maxillofacial fracture surgery, low-energy semiconductor laser treatment can effectively promote wound healing, improve wound healing quality, fade scars, and relieve wound pain.
Humans ; Wound Healing/radiation effects* ; Male ; Female ; Lasers, Semiconductor/therapeutic use* ; Prospective Studies ; Adult ; Middle Aged ; Low-Level Light Therapy ; Maxillofacial Injuries/surgery* ; Young Adult

OBJECTIVES: This study aims to analyze the biomechanics of three kinds of rigid internal fixation methods for condylar head fractures. METHODS: A three dimensional finite element model of the normal mandible was constructed. It was then used to prepare condylar head fracture finite element model and three kinds of rigid internal fixation finite element model (unilateral tension screw, bilateral tension screw, tension screw+titanium plate). The mechanical characteristics and changes of the mandible condyle under the same mechanical conditions were compared among the three different rigid internal fixation methods. RESULTS: The maximum equivalent stress and displacement of the non-free end of condyle under the rigid internal fixation method of unilateral tension screw were 71.03 MPa and 4.72 mm, respectively. The maximum equivalent stress and displacement of the free end of condyle were 78.45 MPa and 4.50 mm, respectively. The maximum stress of fracture suture was 3.27 MPa. The maximum equivalent stress and displacement of the non-free end of condyle under the rigid internal fixation method of bilateral tension screw were 70.52 MPa and 4.00 mm, respectively. The maximum equivalent stress and displacement of the free end of condyle were 72.49 MPa and 3.85 mm, respectively. The maximum stress of fracture suture was 2.33 MPa. The maximum equivalent stress and maximum displacement of the non-free end of condyle under the rigid internal fixation method of tension screw+titanium plate were 67.26 MPa and 2.66 mm, respectively. The maximum equivalent stress and maximum displacement of the free end of condyle were 69.66 MPa and 2.50 mm, respectively. The maximum stress of fracture suture was 2.18 MPa. CONCLUSIONS The tension screw+titanium plate rigid internal fixation method is the most conducive to biomechanical distribution for condylar head fractures.
Fracture Fixation, Internal/instrumentation* ; Mandibular Condyle/surgery* ; Biomechanical Phenomena ; Bone Screws ; Finite Element Analysis ; Humans ; Mandibular Fractures/surgery* ; Bone Plates ; Titanium ; Stress, Mechanical

Pathological fractures after jaw cyst surgery are rare clinically but are a serious complication. Once a pathological fracture occurs, treatment time and economic costs increase, and doctors face difficulty in handling it. This article reports a case of a patient with mandibular pathological fractures after multiple odontogenic keratocyst surgery of the jaw. Mandibular lesions were located in the bilateral mandibular angles and had macrocystic changes. We adopted a conservative treatment plan, and the treatment effect was good. We also discussed and analyzed relevant literature to provide a reference for clinicians.
Humans ; Odontogenic Cysts/surgery* ; Conservative Treatment ; Postoperative Complications/therapy* ; Mandibular Fractures/etiology* ; Fractures, Spontaneous/etiology* ; Male ; Female

The accidental displacement of tooth roots into the mandibular canal is a serious complication during tooth extractions in oral and maxillofacial surgery, often resulting in direct damage to the structural and functional integrity of the inferior alveolar neurovascular bundle (IANB). This article reviews the anatomical features of the mandibular canal, the IANB, and adjacent tooth roots; identifies high-risk factors and anatomically vulnerable sites for root displacement; and outlines the clinical manifestations and radiographic characteristics of intraoperative root intrusion into the mandibular canal. Furthermore, management principles, surgical approaches and techniques, inferior alveolar nerve injury treatment, and prognostic considerations are discussed. The aim of this review is to provide a comprehensive clinical reference for improving surgical outcomes, and reducing postoperative complications.
Humans ; Tooth Extraction/adverse effects* ; Mandible/surgery* ; Tooth Root ; Mandibular Nerve/anatomy & histology* ; Postoperative Complications/prevention & control* ; Intraoperative Complications ; Mandibular Nerve Injuries/etiology*

OBJECTIVES: This study investigates independent risk factors for postoperative internal fixation device infection in patients with maxillofacial fractures and proposes an early warning model based on the synthetic minority over-sampling technique (SMOTE) algorithm. METHODS: A total of 1 104 patients who underwent surgical treatment for maxillofacial fractures at Oral and Maxillofacial Surgery Department, Affiliated Hospital of Nantong University from January 2021 to December 2024 were retrospectively analyzed. The patients were divided into two groups based on the presence of postoperative internal fixation device infection: the infection group (27 cases) and non-infection group (1 077 cases). Clinical data from both groups were collected and subjected to statistical analysis. Univariate and binary Logistic regression analysis were used to identify risk factors for postoperative internal fixation device infection in maxillofacial fractures. Subsequently, a Logistic regression model was established, and the dataset was improved based on the SMOTE algorithm to construct an early warning model with the improved dataset. The prediction performance of the models was compared and validated. RESULTS: Among the 1 104 patients who underwent surgical treatment for maxillofacial fractures, 27 cases of postoperative internal fixation device infections were identified, corresponding to an infection rate of 2.45% (27/1 104). Age, diabetes history, fracture severity, and oral hygiene status were all identified as risk factors for postoperative internal fixation device infections in maxillofacial fractures (all P<0.05). The prediction model based on the original data (P1). The prediction model based on the SMOTE algorithm (P2). Receiver operating characteristic (ROC) curve analysis shows that the area under curve (AUC) for the P2 model was 0.882, the P1 model was 0.861, indicating the superior predictive performance of the P2 model. The DeLong test results show that the difference in AUC between the two models was statistically significant (P<0.05). CONCLUSIONS Age, diabetes history, postoperative fracture severity, and oral hygiene status are all risk factors for infections associated with internal fixation devices after maxillofacial fracture surgery. The proposed early warning model demonstrated good predictive performance. Medical professionals can utilize this model to effectively intervene and anticipate infections related to internal fixation devices after maxillofacial fracture surgery.
Humans ; Algorithms ; Retrospective Studies ; Male ; Female ; Fracture Fixation, Internal/instrumentation* ; Risk Factors ; Middle Aged ; Adult ; Logistic Models ; Surgical Wound Infection/epidemiology* ; Aged ; Internal Fixators/adverse effects* ; Maxillofacial Injuries/surgery* ; Adolescent

OBJECTIVE: To explore the mechanism of electroacupuncture (EA) in promoting recovery of the facial function with the involvement of autophagy, glial cell line-derived neurotrophic factor (GDNF), and phosphatidylinositol-3-kinase (PI3K)/mammalian target of rapamycin (mTOR) signaling pathway. METHODS: Seventy-two male Sprague-Dawley rats were randomly allocated into the control, sham-operated, facial nerve injury (FNI), EA, EA+3-methyladenine (3-MA), and EA+GDNF antagonist groups using a random number table, with 12 rats in each group. An FNI rat model was established with facial nerve crushing method. EA intervention was conducted at Dicang (ST 4), Jiache (ST 6), Yifeng (SJ 17), and Hegu (LI 4) acupoints for 2 weeks. The Simone's 10-Point Scale was utilized to monitor the recovery of facial function. The histopathological evaluation of facial nerves was performed using hematoxylin-eosin (HE) staining. The levels of Beclin-1, light chain 3 (LC3), and P62 were detected by immunohistochemistry (IHC), immunofluorescence, and reverse transcription-polymerase chain reaction, respectively. Additionally, IHC was also used to detect the levels of GDNF, Rai, PI3K, and mTOR. RESULTS: The facial functional scores were significantly increased in the EA group than the FNI group (P<0.05 or P<0.01). HE staining showed nerve axons and myelin sheaths, which were destroyed immediately after the injury, were recovered with EA treatment. The expressions of Beclin-1 and LC3 were significantly elevated and the expression of P62 was markedly reduced in FNI rats (P<0.01); however, EA treatment reversed these abnormal changes (P<0.01). Meanwhile, EA stimulation significantly increased the levels of GDNF, Rai, PI3K, and mTOR (P<0.01). After exogenous administration with autophagy inhibitor 3-MA or GDNF antagonist, the repair effect of EA on facial function was attenuated (P<0.05 or P<0.01). CONCLUSIONS EA could promote the recovery of facial function and repair the facial nerve damages in a rat model of FNI. EA may exert this neuroreparative effect through mediating the release of GDNF, activating the PI3K/mTOR signaling pathway, and further regulating the autophagy of facial nerves.
Rats ; Male ; Animals ; Rats, Sprague-Dawley ; Electroacupuncture ; Phosphatidylinositol 3-Kinase/metabolism* ; Facial Nerve Injuries/therapy* ; Phosphatidylinositol 3-Kinases/metabolism* ; Beclin-1 ; Glial Cell Line-Derived Neurotrophic Factor ; Signal Transduction ; TOR Serine-Threonine Kinases/metabolism* ; Autophagy ; Mammals/metabolism*