The use of teleradiology for triaging of maxillofacial trauma Brucoli, Matteo; Boffano, Paolo; Franchi, Stefano ...
Journal of cranio-maxillo-facial surgery,
October 2019, 2019-Oct, 2019-10-00, 20191001, Letnik:
47, Številka:
10
Journal Article
Recenzirano
The aim of this study was to assess and discuss our experience with a teleradiology technique applied to facial trauma patients referred to an oral and maxillofacial surgery hub center.
All trauma ...patients with maxillofacial fractures from the hospitals of Vercelli, Biella, Borgosesia, Borgomanero, Verbania, and Domodossola who were referred between July 2014 and September 2018 to the hub maxillofacial center of Novara were reviewed. The following data were recorded for each patient: sex, age, referral hospital, etiology, etiology mechanisms, site of facial fractures, date of injury, indications for surgery according to teleradiology consultation, indications for surgery following clinical maxillofacial assessment, date of eventual surgery, timing of surgery from trauma, type of surgical intervention.
A total of 467 patients with a total of 605 fractures were triaged and managed by the Tempore telemedicine system. The most frequent cause of maxillofacial injury was fall. The most frequently observed fracture involved the zygoma. Following remote computed tomography assessment, surgical indications were suggested in 68 patients; 223 patients were not considered suitable candidates for surgery; and 176 patients needed a clinical assessment for the establishment of definitive eventual indications for surgery. Following clinical assessment, the absence and presence of surgical indications was confirmed in all 223 and 68 patients, respectively. Within the 176 patients with “possible” surgical indications, only 27 patients were referred for surgery.
Teleradiology may be helpful for an appropriate triaging of trauma patients from peripheral hospitals for the correct referral to a maxillofacial trauma hub center.
Introduction
Maxillectomy following tumors or, more rarely, traumatic injuries may result in maxillary defects that may determine physical dysfunctions and functional impairment of speech and ...swallowing. The aim of our study was to present our experience in the management of post-maxillectomy patients by the use of obturator prostheses that were obtained by 3D digital casts via an intraoral scanner.
Methods
Patients with maxillary defects following maxillary and/or palatal resection or maxillary traumatic avulsion were selected for this clinical study between 2015 and 2018. Five to 6 months after surgery, a definitive obturator prosthesis was fabricated thanks to an intraoral scanner. The following parameters of clinical outcome were considered: the absence of fluid leakage, the recovery of phonation, the recovery of swallowing, and personal satisfaction.
Results
Twenty-eight patients (20 males, 8 females) fulfilled the inclusion criteria and were included in the study. Most patients had a maxillary and/or palatal defect because of a malignant tumor. On the whole, 93% of patients reported a complete absence of fluid leakage between maxillary sinuses or nasal fossa and oral cavity; most patients reported a good or complete recovery of phonation and swallowing.
Conclusions
Digital technology for the fabrication of maxillary obturator prosthesis may be effective and useful. The reduced laboratory working time, the avoidance of the risk of aspiration of impression materials, and the overcome of the difficulties associated with whole tissue undercut impression are just some of the most important advantages that have been encountered thanks to this promising technology.
Introduction
The aim of this study was to assess the relationship between the status and position of third molars, and the presence of mandibular angle and/or condylar fractures, in a group of ...patients treated for mandibular fractures, thus hoping to contribute to the knowledge of potential predictors of these fractures.
Methods
A retrospective study was designated to include all the patients who were diagnosed and treated with open reduction and internal fixation for isolated mandibular angle fractures or isolated mandibular condylar fractures between 1st of January 2012 and 31st of December 2018. The following data were collected for each included patient: gender, age, etiology, site and side of the fracture, and presence and eruption state of third molars in the fracture side.
Results
Seventy patients were diagnosed with a condylar fracture, 48 with an angle fracture. No statistically significant difference was observed as for etiology and gender distribution between angle fracture and condyle fracture patients (
p
> 0.05). Angle fractures were statistically associated with the presence of third molars, whereas condylar fractures with the absence of third molars (
p
< 0.000005). The presence of completely erupted 3Ms was associated with condylar fractures (
p
< 0.05), and partially impacted 3Ms were associated with angle fractures (
p
< 0.0005).
Conclusions
Mandibular angle fractures and third molar presence are associated in patients who present with mandibular fractures, especially if the third molar is incompletely erupted. This information should be kept in consideration as for the diagnosis and management of patients with mandibular fractures.
The aim of this study was to analyze the demographic variables and causes and characteristics of mandibular angle fractures managed at several European departments of maxillofacial surgery.
This ...study was based on a multicenter systematic database that allowed the recording of data from all patients with mandibular angle fractures between January 1, 2013, and December 31, 2017. The following data were recorded: gender, age, etiology, side of angle fracture, associated mandibular fractures, presence of third molar, intermaxillary fixation, and osteosynthesis.
The study included 1,162 patients (1,045 male and 117 female patients). A significant association was found between the presence of a third molar and the diagnosis of an isolated angle fracture (P < .0000005). Furthermore, assaults were associated with the presence of voluptuary habits (P < .00005), a younger mean age (P < .00000005), male gender (P < .00000005), and left-sided angle fractures (P < .00000005).
Assaults and falls actually represent the most frequent causes of angle fractures. The presence of a third molar may let the force completely disperse during the determination of the angle fracture, finding a point of weakness.
Introduction
The understanding of anatomy of head and neck region and of the relative pathological conditions may be challenging for most medical students. Furthermore, patients may encounter great ...difficulties to understand their pathology, the proposed surgical technique, as well as the anatomy of this body district. The purpose of the present study was to present and discuss the use of the Anatomage Table for the assessment of several benign and malignant conditions of head and neck district.
Materials and methods
The hospital database of Novara University Hospital, Novara, Italy, was searched for odontogenic keratocysts, thyroglossal duct cysts, and oral squamous cell carcinomas. A case for each pathology was randomly chosen, and preoperative computed tomography (CT) scans (in DICOM files) were retrieved. The DICOM data of preoperative CT examinations were uploaded in the Anatomage Table device, and an immediate 3-D reconstruction image was obtained from the Anatomage Table. Then, a workstation was used to obtain images of the body surface, “dissection cuts,” or “vascular reconstructions,” by the variations of the filters.
Results
The “dissection,” “vascular,” and “bony” images of three cases of odontogenic keratocyst, thyroglossal duct cyst, and mandibular oral squamous cell carcinoma were produced and presented.
Discussion
The examination of the different slices and the application of different filters represent a promising tool both for the education of students/residents and for an improved informed consent by the patients.
Different alcoholic beverages can have different effects on blood alcohol concentration (BAC) and neurotoxicity, even when equalized for alcohol content by volume. Anecdotal evidence suggested that ...natural wine is metabolized differently from conventional wines. This triple-blind study compared the BAC of 55 healthy male subjects after consuming the equivalent of 2 units of alcohol of a natural or conventional wine over 3 min in two separate sessions, one week apart. BAC was measured using a professional breathalyzer every 20 min after consumption for 2 h. The BAC curves in response to the two wines diverged significantly at twenty minutes (interval T20) and forty minutes (interval T40), and also at their maximum concentrations (peaks), with the natural wine inducing a lower BAC than the conventional wine T20 = 0.40 versus 0.46 (
< 0.0002); T40 = 0.49 versus 0.53 (
< 0.0015); peak = 0.52 versus 0.56 (
< 0.0002). These differences are likely related to the development of different amino acids and antioxidants in the two wines during their production. This may in turn affect the kinetics of alcohol absorption and metabolism. Other contributing factors could include pesticide residues, differences in dry extract content, and the use of indigenous or selected yeasts. The study shows that with the same quantity and conditions of intake, natural wine has lower pharmacokinetic and metabolic effects than conventional wine, which can be assumed due to the different agronomic and oenological practices with which they are produced. It can therefore be hypothesized that the consumption of natural wine may have a different impact on human health from that of conventional wine.
Since the beginning of the pandemic, we have been involved in the nutritional management of patients with severe acute respiratory syndrome coronavirus (SARS-CoV-2) and, like our colleagues with ...nutritional expertise, we have been committed to building a nutritional protocol, with indications delineated differently depending on the severity of the clinical conditions and the intervention setting. Considering the length of time needed to obtain the blood dosage of vitamin D, we opted for early supplementation in all hospitalized patients with 30 000 IU of 25-hydroxycholecalciferol. Patients weaned from CPAP have been systematically supplemented with high-calorie, high-protein oral nutritional supplements in the amount of two to four or five daily whenever there was a possibility of stopping ventilation, often for a short period of time, thus requiring an easily accessible and usable energy source.
European control and prevention policies are focused to guarantee a high level of protection of consumers' health. Food-borne diseases as obesity, diabetes, food allergy, and food-borne outbreaks are ...increasing. To prevent food-borne diseases, it is fundamental to involve consumers, in particular children, in educational experiences aimed to learn the proper behaviours to be applied. In this context, we designed and performed 5 educational workshops about food safety, hidden allergens in food and nutrition aimed to involve children attending primary and summer school. These experiences let us collect observations about children knowledge and behaviours. From May to October 2015, a total of 1708 children aged 6 to 11 years joined our workshops. Children were involved in listening activities, laboratory experiments, handling games and sensory experiences. All participants were familiar with food allergy and were interested to know how to behave with allergic people. Children showed great curiosity in discovering that many foods normally contain live bacteria. Less than 25% of children reported to skip breakfast, to have it watching TV or to spend few minutes for it. Many of them (>75%) thought that fruits and vegetables are all year-round available and are not related to a specific period. Very few participants (<25%) knew that freezing is the treatment to be applied to make fresh fish safe from parasites. Children involved in food safety and nutrition educational experiences have the opportunity to increase their awareness about the correct behaviours to prevent food-borne diseases and to improve their own critical thinking about food consumption.
Purpose
The Mediterranean diet (MD) is a sustainable and healthy diet. However, compliance to the MD is still poor. Given this, the authors created a Web app to promote the MD. The purpose of this ...study was to evaluate the efficacy of the Web app YourPappa in terms of adherence to the MD.
Design/methodology/approach
The authors developed a Web app, YourPappa, with the aim of encouraging virtuous dietary habits through a reward mechanism. After that, a randomized controlled study was conducted. All participants were given written advice on correct nutrition. Moreover, the case group was trained on the use of the app. The MD adherence was evaluated by a validated questionnaire (Medi-Lite).
Findings
Cases found an average increase in the Medi-Lite scores of +7.1%, whereas controls showed an increase of +0.7% (p = 0.06; effect size 0.60). For most of the users, the Web app helped them to think about what they were buying and to promote the MD.
Research limitations/implications
Obesity and related diseases are a topical problem. New strategies are needed to counter it. This study showed interesting and encouraging results, which need further research and insight to be validated and supported.
Originality/value
To the best of the authors’ knowledge, this is the first study that has evaluated the use of a Web app to stimulate the adoption of the MD through a reward mechanism.
Adherence to the Mediterranean diet reduces the risk of all-cause and cardiovascular (CV) mortality and the incidence of CV events. However, most previous studies were performed in high-risk ...individuals. Our objective was to assess whether the adherence to the Mediterranean diet, evaluated by the MED score, was associated with all-cause and CV mortality and incidence of CV events in individuals at low CV risk from a population-based cohort, after a 12-year mean follow-up.
A cohort of 1658 individuals completed a validated food-frequency questionnaire in 2001-2003. The MED score was calculated by a 0-9 scale. Anthropometric, laboratory measurements, and the vital status were collected at baseline and during 2014. The baseline CV risk was estimated by the Framingham risk score. Participants were divided into two groups: individuals at low risk (CV < 10) and individuals with CV risk ≥ 10.
During a 12-year mean follow-up, 220 deaths, 84 due to CV diseases, and 125 incident CV events occurred. The adherence to the Mediterranean diet was low in 768 (score 0-2), medium in 685 (score 4-5) and high in 205 (score > 6) individuals. Values of BMI, waist circumference, fasting glucose and insulin significantly decreased from low to high diet adherence only in participants with CV risk ≥ 10. In a Cox-regression model, the hazard ratios (HRs) in low-risk individuals per unit of MED score were: HR = 0.83 (95 % CI 0.72-0.96) for all-cause mortality, HR = 0.75 (95 % CI 0.58-0.96) for CV mortality, and HR = 0.79 (95 % CI 0.65-0.97) for CV events, after multiple adjustments. In individuals with CV risk ≥ 10, the MED score predicted incident CV events (HR = 0.85; 95 % CI 0.72-0.99), while the associations with all-cause (HR = 1.02; 95 % CI 0.90-1.15) and CV mortality (0.94; 95 % CI 0.76-1.15) were not significant.
Greater adherence to the Mediterranean diet was associated with reduced fatal and non fatal CV events, especially in individuals at low CV risk, thus suggesting the usefulness of promoting this nutritional pattern in particular in healthier individuals.
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