Quantifying Aerosol Generation in Maxillofacial Trauma Repair Techniques

Study Design Cadaveric simulation study. Objective The novel coronavirus (COVID-19), which can be transmitted via aerosolized viral particles, has directed focus on protection of healthcare workers during procedures involving the upper aerodigestive tract, including maxillofacial trauma repair. This study evaluates particle generation at different distances from open reduction and internal fixation (ORIF) of maxillofacial injuries in the intraoperative setting to reduce the risk of contracting airborne diseases such as COVID-19. Methods Two cadaveric specimens in a simulated operating room underwent ORIF of midface and mandible fractures via intraoral incisions as well as maxillomandibular fixation (MMF) using hybrid arch bars. ORIF was performed with both self-drilling screws and with the use of a power drill for creating guide holes. Real-time aerosol concentration was measured throughout each procedure using 3 particle counters placed 0.45, 1.68, and 3.81 m (1.5, 5.5, and 12.5 feet, respectively) from the operative site. Results There was a significant decrease in particle concentration in all procedures at 1.68 m compared to 0.45 m, but only 2 of the 5 procedures showed further significant decrease in particle concentration when going from 1.68 to 3.81 m from the operative site. There was significantly less particle concentration generated at all distances when using self-drilling techniques compared to power drilling for ORIF. Conclusion Consideration of using self-drilling screwing techniques as well as maintaining physical distancing protocols may decrease risk of transmission of airborne diseases such as COVID-19 while in the intraoperative setting.

The Impact of COVID 19 on Oral Surgery Post-Operative Patient Complications and Communications Within the Oral Surgery Department at the Eastman Dental Hospital

Introduction: A rise in post-operative complications (POCs) was observed following the second national lockdown due to the ongoing Coronavirus 2019 (COVID-19) pandemic. This prompted our Oral Surgery Department to investigate this to understand why this increase had occurred. Aim: To evaluate the rise in POCs at The Eastman Dental Hospital Oral Surgery Department during and after the COVID-19 pandemic lockdown. Materials and methods: A two cycle audit to assess the effect of the restrictions and ease imposed by lockdown on the number of POCs reported within the department. Results: A spike in POCs was observed during the second lockdown. Following the ease of these restrictions, POCs reduced by half. Discussion: As lockdown eased, the number of patient’s contacting the department following surgical procedures significantly reduced. Did the pandemic cause patients to become more observant with regards to their post-operative site? Conclusions: COVID-19 has had a lasting effect amongst our society and healthcare professionals are seeing not only the physical detriment but also the mental effects on our patients. We must ask if the increase in our POCs be caused by underlying “health anxiety” amongst members of the general public and if so, how can it be overcome?

Schwannoma of the Supraglottis

Hoarseness lasting greater than 2 weeks should be thoroughly evaluated. Here, a case is presented of a 38-year-old female with a 10-year history of dysphonia. Endoscopic examination confirmed the presence of a supraglottic mass, for which operative biopsy and imaging were performed. Pathology confirmed the diagnosis of supraglottic schwannoma. This was excised endoscopically with close management postoperatively to monitor for rapid recurrence and airway compromise. At one month postoperatively, the patient is still mildly dysphonic but vocally improved and the operative site continues to heal well.

ECOLOGY OF NOSOCOMIAL INFECTIONS IN THE ENVIRONMENT OF RESUSCITATION OF SURGICAL EMERGENCIESABOUT 332

Nosocomial infection is any infection contracted in a healthcare establishment by any patient whose symptoms appear after 48 hours of hospitalization, 30 days for the operative site and one year in the case of an intervention. surgical Their high frequency, cost and severity make nosocomial infections a major health problem. Its surveillance is not an end in itself, it is designed as a means of guiding prevention, from which it must therefore gather the necessary information.

CSF Oculorrhea Presenting as “Tearing” following the Repair of Fronto-Ethmoidal Encephalocele

<b><i>Introduction:</i></b> Cerebrospinal fluid (CSF) oculorrhea is extremely rare, and very few cases have been reported mostly following trauma. There is only 1 case in the published literature where oculorrhea occurred following the repair of fronto-nasal encephalocele. <b><i>Case Description:</i></b> A six-year-old girl presented with gradually increasing fronto-ethmoidal encephalocele with secondary papulo-nodular changes. She underwent bi-frontal craniotomy with excision of encephalocele sac and herniated gliotic brain followed by dural closure using peri-cranial graft. One month later, she presented again with swelling over the operative site and “tearing” from both her eyes. She was diagnosed with CSF oculorrhea. After failing conservative management, lumbar drain was inserted and kept on continuous drainage. Oculorrhea stopped with lumbar drain but restarted with its removal. Therefore, theco-peritoneal shunt was placed, following which oculorrhea stopped. She is doing well at 5 months’ follow-up. <b><i>Conclusion:</i></b> CSF oculorrhea must be considered by the pediatric neurosurgeons in any patient who presents with “tearing” following the repair of an anterior encephalocele.

Role of Radiology in the Diagnosis of an Uncommon Site of a Common Gossypiboma

A 53 year old man presented with right sided neck swelling which was tender on palpation along with symptoms such as high grade fever and sweating since 4 days. No significant and relevant personal and family history was present. Patient had a successful operative history for a benign neurogenic tumour in right infratemporal fossa 1.5 months back. Patient was relatively asymptomatic before 10 days. He then gradually developed a swelling at the operative site which sooner became tender and was accompanied with high grade fever 4 days back. Patient also complained of mild restriction of neck movements as well. He then came for detailed examination and then was referred for MRI examination as a part of protocol. Radiological Features Routine MRI examination showed a well-defined circumscribed lesion at operative site in right infra temporal fossa which appeared to be peripherally thick walled hypo intense in T1W images (green arrow Fig. 1) and hyper intense in T2W images (green arrow Fig. 2). On further sequences it was noted that a diffuse hypo intense central part is noted in all sequences which was prominent in GRE (Gradient Recalled Echo) images showing again hyper intense thick wall (pink arrow in Fig 3) and central hypo intensity (blue arrow in Fig. 3) suggesting multiple air foci. Haemorrhage was excluded in view of lack of T1W hyper intensity. On STIR (Short Tau Inversion Recovery) images no significant other information was gained about the lesion (green arrow in Fig. 4). Observing the whole examination at first it looked like an abscess but due to lack of diffusion restriction and surrounding soft tissue swelling, this differential is ruled out