The WhatsApp Application as a Teledentistry Tool in Oral and Maxillofacial Surgery in Cameroon

Introduction: Technological advances have greatly influenced the healthcare sector. The ability to transmit information and deliver services using telecommunication tools continues to transform the way healthcare is delivered around the world. The aim of this study was to highlight the epidemiological, clinical and therapeutic profile of oral and maxillofacial surgery patients consulted using the WhatsApp application. Methodology: This was a three-year descriptive study with a retrospective data collection, from 2021 to 2023, of WhatsApp communications between our team and oral and maxillofacial surgeons in Cameroon. In this study, the type/content of messages received, the epidemiological data of practitioners and patients, the various pathologies diagnosed and the procedures performed were evaluated. Results: 319 communications were received for a total of 146 cases. Written messages associated with images (photographs and/or X-rays) were the most frequently received, at 85.62%. Hospitals in urban areas were the most represented at 93.84%. Oral health professionals in the private sector sent more messages (65.75%). In terms of diagnoses, tumour and cystic pathologies were the most common (28.08%), followed by impacted/retained teeth (22.6%). Patients were referred to our hospital for treatment in 62.33% of cases. Conclusion: The WhatsApp application is an easy-to-use telecommunications tool. It facilitates exchanges between practitioners and improves patient care in oral and maxillofacial surgery.

Application of machine learning in oral and maxillofacial surgery

Oral and maxillofacial anatomy is extremely complex,and medical imaging is critical in the diagnosis and treatment of soft and bone tissue lesions.Hence,there exists accumulating imaging data without being properly utilized over the last decades.As a result,problems are emerging regarding how to integrate and interpret a large amount of medical data and alleviate clinicians’workload.Recently,artificial intelligence has been developing rapidly to analyze complex medical data,and machine learning is one of the specific methods of achieving this goal,which is based on a set of algorithms and previous results.Machine learning has been considered useful in assisting early diagnosis,treatment planning,and prognostic estimation through extracting key features and building mathematical models by computers.Over the past decade,machine learning techniques have been applied to the field of oral and maxillofacial surgery and increasingly achieved expert-level performance.Thus,we hold a positive attitude towards developing machine learning for reducing the number of medical errors,improving the quality of patient care,and optimizing clinical decision-making in oral and maxillofacial surgery.In this review,we explore the clinical application of machine learning in maxillofacial cysts and tumors,maxillofacial defect reconstruction,orthognathic surgery,and dental implant and discuss its current problems and solutions.

450 nm diode laser:A new help in oral surgery

AIM To describe the performance of 450 nm diode laser in oral surgery procedures.METHODS The case described consisted of the removal of a lower lip fibroma through a blue diode laser(λ = 450 nm). RESULTS The efficacy of this device, even at very low power(1W, CW), allows us to obtain very high intra and postoperative comfort for the patient, even with just topical anaesthesia and without needing suture. The healing process was completed in one week and, during the follow-up, the patient did not report any problems, pain or discomfort even without the consumption of any kind of drugs, such as painkillers and antibiotics. The histological examination performed by the pathologist showed a large area of fibrous connective tissue with some portions of epithelium-connective detachments and a regular incision with very scanty areas of carbonization.CONCLUSION The 450 nm diode laser proved of being very efficient in the oral soft tissue surgical procedures, with no side effects for the patients.

Intragastric surgery using laparoscopy and oral endoscopy for gastric submucosal tumors

We review the techniques and outcomes of the intragastric resection for gastric submucosal tumors(GSTs) using laparoscope and oral endoscope. In the literature, the mean operation time, intraoperative blood loss, pathological size of the tumor and postoperative hospital stay were 134 min, minimal, 31 mm and 6.4 d, respectively. There were no particular perioperative complications during the follow-up period(mean: 121.3 mo). Intragastric surgery using laparoscopy and oral endoscopy can be considerably beneficial for patients with GSTs locating in the upper third of the stomach between 2-5 cm in diameter and < 8 cm2 in crosssectional area and located in the upper third of the stomach.

Per-oral endoscopic myotomy:Major advance in achalasia treatment and in endoscopic surgery

Per-oral endoscopic myotomy(POEM)represents a natural orifice endoscopic surgery(NOTES)approach to laparoscopy Heller myotomy(LHM).POEM is arguably the most successful clinical application of NOTES.The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM.Initial efficacy,safety and acid reflux data suggest at least equivalence of POEM to LHM,the previous gold standard for achalasia therapy.Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM.The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis.

Protocol for the management of oral surgery patients on warfarin utilizing a Point-of-Care In-Office international normalized ratio monitoring device

Purpose: This study was performed to assess the utility and safety of an In-Office INR Monitoring Device and present a safe and efficient protocol for the management of patients on oral anticoagulants and/or antithrombolytics requiring routine office oral and maxillofacial surgery. Patients and Methods: Sixty-one patients requiring “minor” oral and maxillofacial surgery being treated chronically with oral anticoagulation (warfarin) were entered into the study and compared in 2 groups. The control group (n = 29) was managed by discontinuing warfarin and any anti-platelet medication(s) prior to surgery. In the study group (n = 30), the decision to continue or withhold warfarin was determined by a protocol in which patients are 1) stratified based on risk for thromboembolism, and 2) classified as requiring “major” or “minor” surgery. Procedures categorized as “minor” surgery included dental extraction(s), dental implants, soft tissue and bone biopsies, and preprosthetic bone surgery, and incision and drainage. Warfarin and antiplatelet medication were not withheld in these patients, and a Point-of-Care In-Office INR Monitoring Device was used to obtain INR levels on the day of consultation and surgery. Local measures including removal of granulation tissue, packing, suturing, etc. were utilized for hemostasis. Results: The 30 patients in the study group maintained on warfarin readily achieved hemostasis using intraoperative local measures. The mean INR measured by the In-Office INR Monitoring Device was 2.36 with a range from 1.3 to 3.2. Study group patients underwent a total of 131 separate procedures including 108 dental extractions (impactions), placement of dental implants, preprosthetic bony surgery, bone cyst removal, soft tissue biopsies, facial skin cancer repair, and incision and drainage. One patient (3%) required “minor” intervention with removal of a “liver clot” on postop day 2 with repacking and suturing. The 29 patients in the control group discontinued off of war farin underwent a total of 99 procedures. One patient (3%) also required a “minor” intervention (repacking of extraction site). There were no “major” complications in either group. Conclusions: This study supports previous studies that minor oral surgery procedures can be safely performed while maintaining patients on warfarin minimizing the risk of a potentially devastating thromboembolic event. When deciding whether or not to withhold warfarin, this study supports the use of the proposed protocol based on 1) risk stratification for thromboembolism, 2) the need for “minor” versus “major” surgery, 3) and utilization of an In-Office INR Monitoring Device. An In-Office Point-of-Care INR measuring device can be a very effective tool to safely simplify and make the perioperative management of the anticoagulated patient more efficient for the patient and oral and maxillo facial surgeon.

Benefits of post-operative oral protein supplementation in gastrointestinal surgery patients: A systematic review of clinical trials

AIM: To evaluate published trials examining oral postoperative protein supplementation in patients having undergone gastrointestinal surgery and assessment of reported results.METHODS: Database searches(MEDLINE, BIOSIS, EMBASE, Cochrane Trials, Cinahl, and CAB), searches of reference lists of relevant papers, and expert referral were used to identify prospective randomized controlled clinical trials. The following terms were used to locate articles: "oral'' or "enteral'' and "postoperative care'' or "post-surgical'' and "proteins' ' or "milk proteins' ' or "dietary proteins' ' or "dietary supplements' ' or "nutritional supplements' '. In databases that allowed added limitations, results were limited to clinical trials that studied humans, and publications between 1990 and 2014. Quality of collated studies was evaluated using a qualitative assessment tool and the collective results interpreted.RESULTS: Searches identified 629 papers of which, following review, 7 were deemed eligible for qualitative evaluation. Protein supplementation does not appear to affect mortality but does reduce weight loss, and improve nutritional status. Reduction in grip strength deterioration was observed in a majority of studies, and approximately half of the studies described reduced complication rates. No changes in duration of hospital stay or plasma protein levels were reported. There is evidence to suggest that protein supplementation should be routinely provided post-operatively to this population. However, despite comprehensive searches, clinical trials that varied only the amount of protein provided via oral nutritional supplements(discrete from other nutritionalcomponents) were not found. At present, there is some evidence to support routinely prescribed oral nutritional supplements that contain protein for gastrointestinal surgery patients in the immediate post-operative stage.CONCLUSION: The optimal level of protein supplementation required to maximise recovery in gastrointestinal surgery patients is effectively unknown, and may warrant further study.

Oral and maxillofacial surgery in China: Past, present and future

China is the most highly populated developing country. As with other scientific disciplines, dentistry (stomatology) is progressively growing since 1949 when the new China was founded. Due to the closing of the country to international discourse for several decades, international counterparts know very little about dentistry or stomatology, including the sub-discipline oral and maxillofacial surgery. This paper is aimed to introduce the scope, give a brief history, update clinical and basic research, and discuss the future of oral and maxillofacial surgery in China. It will hopefully help international colleagues to have an insight into the developmental history, education system, clinical and basic research achievements, as well as the prospective future of oral and maxillofacial surgery in

Effectiveness of Disinfection of Anesthetics Tubes in Oral Surgery -An in Vitro Study

Context： Anesthetic tubes are always on the surgical table, for this reason, it＇s necessary to perform its disinfection, generally by chemicals. Aim： Was to analyze the effectiveness of tubes decontamination made by disinfectant substances used in a clinical setting and to identify the microorganisms found on their surface. Materials and Methods： 14 anesthetic tubes were collected from dental clinic, on 5 groups. 01 plastic and 01 glass tubes that were not submitted to any disinfection process composed the control group and they had been sown in Agar Blood. Experimental groups underwent immersion and fixation with the proposed chemicals for 1 minute, laminar flow hood was used to seed it in Agar Blood and then it was transferred to incubator for 24 hours at 37℃. Tests were used to identify the main Gram positive pathogenic genera. Gram-negative pathogenic colonies isolated were seeded in biochemical means of identification. Results： It was possible to identify the presence of Staphylococcus coagulase negative, Staphylococcus aureus, Streptococcus viridans, Staphylococcus saprophyticus, Escherichia coli and Acinetobacter spp, as well as the effectiveness of chemical solutions proposed in this study. Conclusions： All chemical solutions proposed in this study were effective for the surface disinfection process of anesthetic tubes.

Management of Coagulation＇s Disorders in Oral Surgery： State of Art

Understanding and managing the bleeding＇s causes is essential for a good surgical practice in general. In fact, it is crucial to know how to manage and control this problem （sometimes simply annoying, but that may be able to cause even dangerous consequences） with a comprehensive and multidisciplinary approach, trying to use all the means is available today. The goal of this paper is to describe, even through a brief review of the literature--the State of Art about the bleeding control in oral surgery, the proper use of surgical devices and the NOACs （new oral anticoagulants） appearance.

Oral Health and Masticatory Performance in Adults Submitted to Bariatric Surgery: A Pilot Study

Background: Obesity has reached epidemic patterns and constitutes a serious public health problem due to comorbidities and the impact on life quality of affected individuals. Bariatric surgery appears as one of the most recommended treatments;however much has been known about the effects of this intervention on the functional performance of the organism as a whole. Objective: To characterize the oral health of adults submitted to bariatric surgery, before and after the intervention, with emphasis on the performance of masticatory function. Methods: A prospective observational cohort study conducted in a public reference service to the treatment of obesity in the city of Recife, State of Pernambuco. The data were obtained during the first half of 2011, through interview, intraoral physical examination and evaluation of masticatory function. Statistical treatment adopted was a CI of 95% and the chi-square test. The collection was conducted in three stages, with initial assessment in the preoperative and follow-up at 60 and 180 days. Results: The sample consisted of 20 volunteers, aged between 23 and 58 years and mean BMI of 43.2 ± 2.8. When compared the pre-operative to the control periods, there were significant differences for variables with decreased tendency towards spontaneous gingival bleeding and increased tooth hypersensitivity and tooth mobility (p < 0.05). Regarding the masticatory function, we found significant differences for most of the variables investigated, except in the coordination of movements and breathing during this function. Conclusion: The performance of masticatory function shows differences in pre- and postoperative periods for bariatric surgery.

Robotic surgical systems in maxillofacial surgery:a review

Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.

Clinical significance of computed tomography assessment for third molar surgery

Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery.Third molar surgery is warranted when there is inadequate space for eruption,malpositioning,or risk for cyst or odontogenic tumor formation.Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues.Due to developments in medical engineering technology,computed tomography(CT)now plays a critical role in providing the clear images required for adequate assessment prior to third molar surgery.Removal of the maxillary third molar is associated with a risk for maxillary sinus perforation,whereas removal of the mandibular third molar can put patients at risk for a neurosensory deficit from damage to the lingual nerve or inferior alveolar nerve.Multiple factors,including demographic,anatomic,and treatment-related factors,influence the incidence of nerve injury during or following removal of the third molar.CT assessment of the third molar prior to surgery can identify some of these risk factors,such as the absence of cortication between themandibular third molar and the inferior alveolar canal,prior to surgery to reduce the risk for nerve damage.This topic highlight presents an overview of the clinical significance of CT assessment in third molar surgery.

Anesthetic Management of a Patient with Sick Sinus Syndrome during General Anesthesia for Maxillofacial Surgery

Sick sinus syndrome (SSS) is a generalized abnormality of cardiac impulse formation. Patients with SSS occasionally need temporary pacing during general anesthesia. The most common issue arising in the perioperative period is electromagnetic interference with device function. We report a case of a 66-year-old man who required temporary cardiac pacing during maxillary cyst extirpation using electrocautery.

Relevance of Predictors in Difficult Intubation for Patients Undergoing Maxillofacial Surgery

Objective: To determine a clinically useful variable for predicting difficult tracheal intubation in patients with seemingly normal airways. Material and Methods: In our study we had included 68 patients from September 2011 to September 2013 who needed tracheal intubation for elective maxillofacial surgery. An airway assessment test was conducted on each patient prior to general anaesthesia, with respect to mouth opening, sternomental distance, thyromental distance, oropharyngeal (Mallampati) classification and ability to protrude the mandible. After induction of anaesthesia, the laryngeal view during laryngoscopy was graded and then the ability to intubate was assessed. Results: Incidence of difficult intubation occurred in 8 (11.76%) cases out of 68 patients. Airway test that was significant for predicting difficult tracheal intubation was SMD of less than 12.5 cm, TMD of less than 6 cm, a score according to Mallampati et al. of greater than III, protrusion of mandible position B and position C and IIG less than 3 cm with sensitivity of 87.5%, 62.5%, 62.5%, 25% and 50%, respectively. Conclusion: Our study concluded that sternomental distance had the highest sensitivity of 87.5% which was statistically significant

Effect of orthognathic surgery on temporomandibular joint

AIM:To investigate the effect of temporomandibular joint position and remolding process and the signs and symptoms of temporomandibular joint in patients undergoing orthognathic surgery.METHODS:The standard Schuller’s position radiographs were used to examine the position temporomandibular joint form and condylar position change of 32 case after orthognathic surgery.Helkimo index was used to analyze the anamnestic and clinical data.RESULTS:Changes of condylar position had happened after the operation, but within one year the conlylar had resumed the same position as the preoperative.The change of temporomandibular joint symptoms and signs after orthognathic surgery was not significant.CONCLUSION:The effect of orthognathic surgery on the condylar position and TMJ form is not significant,and most of the changes are within the normal adaptability of temporomandibular joint.

The role of salvage surgery in oral squamous cell carcinoma

Aim:To select and analyze the most representative papers published in the literature concerning oral squamous cell carcinoma(OSCC),specifically dealing with salvage surgery following primary treatment by surgery with or without by postoperative radiotherapy,specifically focusing in the oral cavity and oropharynx locations.Methods:A bibliography search on MEDLINE and EMBASE databases for studies published from March 2000 to March 2016 was conducted.The authors only included studies published in the English language and those dealing with“squamous cell carcinoma of the oral cavity and/or oropharynx”.The following technical bibliographic exclusion criteria were applied:(1)case reports;(2)technical report;(3)animal or in vitro studies;(4)review articles;(5)uncontrolled clinical studies;and(6)publications in which the same data were published by the same group of researchers.The abstracts of yielded results were reviewed and the full text of those with apparent relevance was obtained.Results:A total amount of 188 studies were found using the above reported searching parameters.Thirteen original papers were finally selected according to the inclusion and exclusion criteria.From 1,692 analyzed patients,overall recurrence rate was 26%(range:15-41.7%),with a mean 47.3%,35.1%and 10.9%local,regional and loco-regional recurrence,respectively.Mean 5-year overall survival rate was 40.2%(range:37.5-42.9%).Conclusion:Salvage surgery is the best option for the treatment of recurrent OSCC,either local,regional or loco-regional,with the highest rates in terms of survival and with an acceptable morbidity.

Investigation of Maxillary Preprosthetic Situations after Oral Tumor Treatment

In order to investigate the maxillary preprosthetic situation after oral tumor treatment and/or reconstructive surgery, based on the review of case history and the clinical records 47 cases were analyzed after oral tumor treatment and/or reconstruction, including residual maxillary bone, intermaxillary relationships, defection of maxilla and oral situation after radiation therapy. The results showed that the residual maxillary bone was useful for implantation in the front alveolar bone and zygoma area. The maxillary preprosthetic situation after tumor treatment and/or reconstructive surgery was difficult due to maxillary resection, intermaxillary relationships, unsuitable soft and hard tissue transfer and the irradiation. It is suggested that the maxillary preprosthetic situation after oral tumor treatment is getting worse not only due to maxillary resection and/or irradiation, but surprisingly also due to mandibular resection and/or irradiation.

Effects of early oral feeding after radical total gastrectomy in gastric cancer patients

BACKGROUND Gastric cancer(GC)is a heavy burden in China.Nutritional support for GC patients is closely related to postoperative rehabilitation.However,the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.AIM To prospectively explore the safety,feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.METHODS This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China.A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled.Of which,105 patients were given early oral feeding(EOF group)after surgery,and the other 101 patients were given the traditional feeding strategy(control group)after surgery.Perioperative clinical data were recorded and analyzed.The primary endpoints were gastrointestinal function recovery time and postoperative complications,and the secondary endpoints were postoperative nutritional status,length of hospital stay and expenses,etc.RESULTS Compared with the control group,patients in the EOF group had a significantly shorter postoperative first exhaust time(2.48±1.17 d vs 3.37±1.42 d,P=0.001)and first defecation time(3.83±2.41 d vs 5.32±2.70 d,P=0.004).In addition,the EOF group had a significant shorter postoperative hospitalization duration(5.85±1.53 d vs 7.71±1.56 d,P<0.001)and lower postoperative hospitalization expenses(16.60±5.10 K¥vs 21.00±7.50 K¥,P=0.014).On the 5th day after surgery,serum prealbumin level(214.52±22.47 mg/L vs 204.17±20.62 mg/L,P=0.018),serum gastrin level(246.30±57.10 ng/L vs 223.60±55.70 ng/L,P=0.001)and serum motilin level(424.60±68.30 ng/L vs 409.30±61.70 ng/L,P=0.002)were higher in the EOF group.However,there was no significant difference in the incidence of total postoperative complications between the two groups(P=0.507).CONCLUSION Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function,improve postoperative nutritional status,reduce length of hospital stay and expenses while not increasing the incidence of related complications,which indicates its safety,feasibility and potential benefits for gastric cancer patients.