Category: Statistics

J Craniofac Surg. 2022 Jun 1;33(4):1166-1169. doi: 10.1097/SCS.0000000000008444. Epub 2021 Dec 16.

ABSTRACT

BACKGROUND: Maxillofacial fractures require stable fixation for uneventful bony healing and optimal remodeling. Conventional titanium plates considered the gold standard of rigid internal fixation for many years, however due to the inherent drawbacks associated with metal devices biodegradable plates have been developed.

AIM OF THE STUDY: To evaluate the efficacy of biodegradable plates as a treatment modality of rigid internal fixation for facial fractures and to assess the perioperative complications experienced with their utilization.

PATIENTS AND METHODS: This prospective clinical study included 10 Iraqi patients, met the eligibility criteria and subjected to open reduction and internal fixation with biodegradable plates system. The data were analyzed according to the age, gender, etiology of the fracture, fracture site, surgical approach, plate application time, fracture reduction, screw holes ossification, and patient’s satisfaction. The patients were radiographically followed up with either computed tomography or CBCT at 3, 24, and 48 weeks with regular follow up intervals. The statistical analysis was performed using percentages, the mean ± standard deviation, Shapiro-Wilk test and Mann-Whitney U test.

RESULTS: The age of patients ranged from 9 to 65 years with an average of 26.1 years and a standard deviation of ± 12.9. Regarding gender, males showed a higher percentage than female (80% versus 20%), respectively. There was a significant difference between the mean time of plate application in midface and mandible (53 versus 32.9 minutes), respectively. All cases end up with complete screw holes ossification.

CONCLUSIONS: This study demonstrated that biodegradable plating system was a sensitive procedure and greatly depended upon surgeon’s experience and improvement of the learning curve.

PMID:36041110 | DOI:10.1097/SCS.0000000000008444

J Craniofac Surg. 2022 Jun 1;33(4):1108-1110. doi: 10.1097/SCS.0000000000008076. Epub 2021 Aug 10.

ABSTRACT

One of the methods applied to ensure the long-term continuity of the desired result in rhinoplasty is to detect it by placing columellar strut between the medial crus. Columellar strut helps to increase tip support and projection. However, the placement of the strut between the medial crus can disrupt the divergence angle and prevent the tip rotation to be at the desired level due to the interaction of the septum with the caudal. in this study, the data obtained by fixing the columellar strut to the lateral faces of the medial crus are shared. in 51 primary rhinoplasty patients who underwent open rhinoplasty, the medial crus was dissected and released. The distance between the footplates and the new domes was measured and the length of the columellar struts was determined. Grafts obtained from cartilage septum were shaped. After symmetry was achieved between the medial crus, the prepared grafts were fixed to the lateral face of the medial crus. Preoperative and postoperative 12th month images were transferred to computer- aided program and nasolabial angles were measured. The obtained data were transferred to SPSS 22.0 (IBM Corp., Armonk, New York, USA) program and statistical comparisons were made. Fifty one patients were included in the study. Thirty eight of the patients were female and 13 were male. The mean age of the patients included in the study was 29.2 years. The mean preoperative nasolabial angle was 90.2 degrees postoperatively, and the average nasolabial angle was 104.2 degrees at 6 months. A statistically significant difference was found between preoperative and postoperative measurements (P < 0.05). Lateral columellar strut is an effective and reliable and novel method for increasing the stability of medial crus, maintaining tip support in postoperative period and increasing tip rotation.

PMID:36041106 | DOI:10.1097/SCS.0000000000008076

J Craniofac Surg. 2022 Jun 1;33(4):1147-1149. doi: 10.1097/SCS.0000000000008314. Epub 2021 Oct 27.

ABSTRACT

PURPOSE: To determine factors influencing postoperative enophthalmos after reconstruction of orbital wall fracture.

METHOD: Data of consecutive patients who were diagnosed with unilateral medial or inferior orbital wall fracture from March 2013 to February 2020 were retrospectively reviewed. Forty-three patients were included in this study (24 with medial orbital wall fracture and 19 with inferior orbital wall fracture). Their medical records including Hertel exophthalmometry, preoperative computed tomography (CT) scan, and postoperative CT scan were reviewed. The degree of enophthalmos developed was calculated by measuring exophthalmos before surgery and at 6 months after surgery. Patients were classified into 2 groups depending on whether reduction was good after surgery or not. Data (eg, age, gender, onset, fracture size, and so on) were then compared between these 2 groups.

RESULTS: A total of 43 patients were included in the study. Their mean age was 40.1 years. There were 34 (79.1%) males. The mean onset from trauma to surgery was 8.1 days. Insufficient soft tissue reduction was found in 9 patients through postoperative CT scan. Preoperative mean enophthalmos was – 1.70 mm. Postoperative mean enophthalmos was -0.45 mm after 6 months. The mean fracture size was 213.74 mm2. There was no statistically significant difference in enophthalmos at 6 months after surgery regardless whether the reduction was good or not. Enophthalmos at 6 months after surgery was associated with preoperative fracture size and onset.

CONCLUSIONS: Postoperative enophthalmos development might be associated with preoperative fracture size and onset. Delayed operation in case of large orbital wall fracture might lead to undesired result. Thus, surgeons should keep that in mind.

PMID:36041108 | DOI:10.1097/SCS.0000000000008314

J Craniofac Surg. 2022 Jun 1;33(4):1057-1062. doi: 10.1097/SCS.0000000000008440. Epub 2021 Dec 16.

ABSTRACT

The purpose of this prospective multicenter study was to analyze the epidemiology, patterns, and management of maxillofacial fractures due to road traffic accidents (RTAs) worldwide.Between Monday September 30, 2019 and Sunday October 4, 2020,1066 patients with RTAs related fractures were admitted to 14 maxillofacial surgery departments. The following data were analyzed: age, gender, mechanism of injury, alcohol or drug abuse at the time of trauma, maxillofacial fracture site, facial injury severity scale (FISS) score, associated injuries, day and month of trauma, time of treatment, type of treatment and length of hospital stay. Data were analyzed using bivaried and multivaried statistical analysis.Eight hundred seventy patients were male, and 196 were female. The most common mechanism of injury was motorcycle accidents (48%). More than half of the patients had fractures of the middle third of the maxillofacial skeleton. In total, 59% of the study sample underwent open reduction internal fixation. The median facial injury severity scale (3 points) and the medial hospital stay (3 days) were significantly lower in patients with seatbelts and helmet (P < 0.001).This first prospective, multicenter epidemiological study shows that motorcycle accidents are the leading cause of RTAs related fractures, mostly in young males. Particularly in Australia and Europe, the incidence of RTAs was significantly lower. Moreover, this study found that the severity of maxillofacial lesions was significantly higher in patients without safety devices, with consequent longer hospital stay demonstrating the efficacy of road safety policies in preventing maxillofacial injury.

PMID:36041104 | DOI:10.1097/SCS.0000000000008440

J Craniofac Surg. 2022 Jun 1;33(4):e398-e401. doi: 10.1097/SCS.0000000000008256. Epub 2021 Oct 12.

ABSTRACT

OBJECTIVE: To evaluate whether the maxillary complex would be sagittally, vertically, or mutually displaced after the transverse maxillary correction by surgically assisted rapid maxillary expansion and how the facial profile would be affected.

MATERIALS AND METHODS: The sample comprised 28 adult patients (mean age 25.8 [age range 19-39 years]; 50% women) with transverse maxillary deficiency greater than 7 mm who underwent the surgical rapid maxillary expansion. Cephalometric analysis (n = 112), intra- and extra-oral registries, and radiographic records were taken before treatment (T1), right after the end of the expansion (T2), 4 months after the expansion (T3), and 10 months after the end of the expansion (T4). Dental and skeletal cephalometric measurements were evaluated at each time-point, whereas soft tissue cephalometric analyses were determined at 2 time points (T1 and T4).

RESULTS: The results indicated that no sagittal, vertical, skeletal, or soft tissue variation was found after the surgical expansion. However, statistically significant dental changes (P < 0.05) were observed in dental angles (1.NA/1.SN/1.PoOR/1.PP) throughout the different time-points. The authors found statistically relevant posterior inclination of the incisors from T2 to T3 based on multiple comparisons.

CONCLUSIONS: Surgically assisted rapid maxillary expansion does not promote anterior and vertical displacement of the maxilla. Notwithstanding, the surgical intervention causes upper incisor palatal inclination.

PMID:36041096 | DOI:10.1097/SCS.0000000000008256

J Craniofac Surg. 2022 Jun 1;33(4):e382-e384. doi: 10.1097/SCS.0000000000008210. Epub 2021 Sep 21.

ABSTRACT

Facial trauma is now considered an epidemic due to its high incidence. This type of injury represents an impact on the social, psychological and professional life of the victim. It may be associated with poor protection and exposure of this region of the body, as well as with the attempt to disfigure the face of victims of aggression, to affect their identity and self-image. This study aims to carry out an epidemiological survey on the profile of facial trauma related to violence at the First Aid Hospital of Porto Alegre from November 2015 to July 2016. In this retrospective descriptive cross-sectional study, data such as age and sex of the patient, type of trauma, anatomical region, etiology, and reasons for the aggression of patients’ records were analyzed using the Chi-Square test in Paws Statistics 18 software, evaluating P < 0.05. During the period evaluated, 1224 cases were recorded. The most prevalent sex was male. The age group with the most injuries varied from 21 to 40. The most affected type of lesion was soft tissue injury. Scalp regions (parietal, occipital, temporal) and multiple regions were the most affected in males, differing from females, where the frontal and nasal regions were the most predominant. Violence is a major risk factor for facial trauma in adult patients and it is from epidemiological studies like this that we have the possibility to know the magnitude and severity of the results of violence, allowing the definition of public policies for coping.

PMID:36041094 | DOI:10.1097/SCS.0000000000008210

J Craniofac Surg. 2022 Jun 1;33(4):e376-e382. doi: 10.1097/SCS.0000000000008174. Epub 2021 Oct 26.

ABSTRACT

OBJECTIVE: To evaluate the accuracy of intentional change of the frontal ramal inclination (FRI) from virtual to actual orthognathic surgery.

MATERIALS AND METHODS: A total of 16 patients who underwent orthognathic surgery for correction of facial asymmetry and took cone-beam computed tomography 2 to 3 weeks before surgery (T0) and 3 days after surgery (T1A) were selected. After reorientation of cone-beam computed tomography, the digital imaging and communications in medicine data was converted to StereoLithography format for the merging with dental cast scan using R2GATE software (MegaGen Implant, Daegu, Republic of Korea). During virtual surgery using Geomagic Freeform Plus software (3D Systems, Rock Hill, SC), bilateral FRI discrepancy was corrected (T1V) and 3D-printed surgical wafers and customized metal plates were manufactured using 3D printer (Meg-printer II, MegaGen Implant, Daegu, Republic of Korea) and computer numerical control milling machine (ARDEN, TPS Korea Ltd., Gwangju, Republic of Korea) accordingly. During surgery, FRI correction was done using surgical guide and customized plates. The difference between preoperative and virtually corrected FRI (Δ T1V – T0) and the difference between preoperative and actually surgically corrected FRI (Δ T1A – T0) were measured, and the achieved FRI correction in percentage ([Δ T1A – T0]/[Δ T1V – T0] × 100) was calculated.

RESULTS: The mean absolute value of virtual FRI correction (Δ T1V – T0) and actual FRI correction (Δ T1A – T0) were 3.0° and 2.9°, respectively (n = 32). In the increased (medial rotation) FRI group, mean virtual and actual correction amount were 3.2° and 2.8° (n = 17), whereas in the decreased (lateral rotation) group, mean virtual and actual correction amount were -2.7° and -3.1°, respectively (n = 15). No statistically significant difference between virtual and actual measurements were present in either group. The mean achievement rate was 102.8%. Tendency of undercorrection (91.2%) in the increased FRI group and overcorrection (116.0%) in the decreased FRI group were noted.

DISCUSSION: With virtual planning and computer-aided design and computer-aided manufacturing-made customized plates, it is possible to correct FRI during orthognathic surgery of patients with facial asymmetry.

PMID:36041093 | DOI:10.1097/SCS.0000000000008174

J Craniofac Surg. 2022 Jun 1;33(4):e350-e355. doi: 10.1097/SCS.0000000000008059. Epub 2021 Aug 3.

ABSTRACT

Dacryocystitis diagnosis is important for preventing rapid blurring and vision loss. Existing state-of-the-art methods focus on routine clinical examinations and objective scattering index-based statistical analysis. Such approaches are invasive operations or lack quantitative indicators, and their application is limited. in addition, little attention has been paid to the explainability and clinical utility of models. This paper proposes an explainable dacryocystitis prediction model from noninvasive ocular indicators. The proposed model is based on an deep stacked network with 4 improvements: a multivariable feature extraction module, obtaining comprehensive predictive factors including the quantitative ocular indictors, conventional texture features, and deep learning features from shallow to deep convolutional layers; a multifeature fusion and attribute selection module based on the ReliefF method, guiding the network to focus on useful information at variables; Decision curve analysis the model is introduced into the model to evaluates the risks and benefits; and appending a SHapley Additive exPlanations (SHAP) module to the framework to automatically and efficiently interpret the prediction of the models. By integrating the above improvements in series, the models’ performances are gradually enhanced. Real labeled data samples are used to train and test the model, and our model achieves high accuracy and reliability.

PMID:36041091 | DOI:10.1097/SCS.0000000000008059

J Craniofac Surg. 2022 Jun 1;33(4):1255-1259. doi: 10.1097/SCS.0000000000008110. Epub 2021 Sep 13.

ABSTRACT

OBJECTIVE: This study aimed to evaluate 4 methods of osteosynthesis in the maxilla after a linear advance of 11 mm.

METHODOLOGY: Le Fort I osteotomies were performed on 24 resin models and different osteosynthesis were applied in the anterior region. Group I received Lindorf plates; group II, modified Lindorf plates; group III, inverted “T” plates; and group IV, “L” plates. All groups received “L” plates in the posterior region. Analysis were performed through universal mechanical testing machine with an axial linear load until 5-mm displacement. The data obtained about the force and the amount of deformation were computed, thus the energy required for displacement and stiffness was calculated. Statistical analysis was performed using 2-way analysis (Shapiro-Wilk, followed by Holm-Sidak) (P < 0.05).

RESULTS: Groups I and II showed greater resistance to displacement (P < 0.05) than the other groups. The largest amount of maximum force exerted for the 5-mm displacement was in group II (91.73 N), followed by group I (87.46 N), presenting the best values in comparison with the other groups (P < 0.001). Group III had less stiffness (P < 0.001) than the other groups.

CONCLUSIONS: The use of preclinical methodologies to verify the mechanical stability of fixation models allows a prediction in the choice of greater resistance systems. The fixation type with greater resistance to deformation was achieved with modified Linford plates followed by Linford plates in the anterior region and plate “L” bilaterally in the posterior region.

PMID:36041090 | DOI:10.1097/SCS.0000000000008110

J Homosex. 2022 Aug 30:1-25. doi: 10.1080/00918369.2022.2111536. Online ahead of print.

ABSTRACT

This study focuses on the relations between minority stressors, protective factors and psychological wellbeing among lesbian, gay and bisexual (LGB) people. Experimental data based on a sample of 156 showed that participants asked to recall a negative coming out experience to somebody significant reported more identity threat and distress and less positive affect compared to those recalling a neutral coming out experience. In the negative recall condition, the effects of the stressors of discrimination and rejection on the variance of distress through the mediation of identity threat were statistically significant but not in the neutral recall condition and the two conditions statistically significantly differed in regards to the relationship between discrimination and distress. Identity resilience-continuity was associated with less identity threat and distress in the negative recall condition only, while social support was negatively associated and LGB stigma sensitivity was positively associated with distress in both conditions. Degree of outness (operating as a coping strategy) was associated with increased positive affect in both the neutral and negative recall conditions. When recalling a negative coming out experience, LGB people may be more susceptible to distress associated with minority stressors but also capitalize on available coping strategies.

PMID:36041082 | DOI:10.1080/00918369.2022.2111536