World Journal of Plastic Surgery
Volume:12 Issue: 2, May 2023

We aimed to investigate the pharmacological and non-pharmacological interventions used for mitigating pain.

We integrated randomized controlled trials (RCTs) chosen from PubMed, Google scholar, and Scopus and aimed at assessing the effectiveness of one or multiple variants of Non-steroidal anti-inflammatory drugs (NSAIDs), as well as Narcotic analgesics, compared to corticosteroids, curcumin, hyaluronic acid, and antibiotics. In addition, trials utilizing NSAIDs, including Rofecoxib, which have been withdrawn from market circulation, were deemed ineligible for inclusion.

A total of 9 RCTs were evaluated in this study, and the patients' postoperative pain was assessed using the visual analog scale (VAS) and the time measurement. Moreover, there were various approaches to alleviating pain and discomfort.

The administration of ibuprofen prior to surgery leads to a marked reduction in pain. Pharmacological interventions, such as the administration of dexamethasone and oxycodone, alongside non-pharmacological interventions, such as laser therapy, have been shown to effectively alleviate the discomfort resulting from surgical procedures on the jaw and face.

The aim of this study was to evaluate the prevalence of bifid mandibular canal (BMC) using cone-beam computed tomography (CBCT) and panoramic images through meta-analysis.

Databases of Scopus, PubMed, and Web of Science were searched to find the relevant studies. Studies the met the inclusion criteria were selected. Variables of prevalence, side, length and diameter of BMC and sex were assessed. Data was analyzed using STATA software version 17.

Of the 1164 articles initially selected, 36 were enrolled. A total of 38077 patients were considered. The overall prevalence of BMC was 18.0%. Studies that evaluated CBCT images reported higher prevalence of BMC compared to panoramic images (25.0% vs 3.0%). The prevalence of BMC was higher in men than women and slightly higher in right side than the left side of the jaw, but none of those differences were significant.

The results have shown a total prevalence of 18.0% for BMC. Detection power of CBCT images were higher than panoramics. There was no significant relation between prevalence of BMC with sex or side of the jaw.

The aim of this study was to systematically review the literature on the treatment options of maxillofacial fractures in Iran, complementing a previous article regarding causes and the overall prevalence.

A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify the relevant articles published up to January 2023. Studies reporting the treatment option of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed.

This systematic review included 13 articles with a total of 19,147 treated patients for maxillofacial fractures. ORIF was the most common type of treatment, but complications occurred in approximately 5% of cases. Mandible fractures were not statistically more treated by ORIF than closed reduction or conservative treatment, and no type of treatment was considered statistically preferable depending on the anatomical region affected by Iranian maxillofacial surgeons. The included studies were considered to have a low risk of bias, but many were not clear in reporting cross-referenced data regarding the type of treatment, which could be considered a major flaw.

Overall, this study provides valuable insights into the types of treatment used for maxillofacial fractures by Iranian surgeons and highlights the importance of clear reporting of data in research articles.

Early or delayed mobilization of limb after flexor tendon rupture repairing has an effect on postoperative outcomes, however it is not yet clear whether early or late organ mobilization leads to more likelihood of recovery. We aimed to assess the effects of early and late active limb mobilization through rehabilitation after surgery on the range of motion and hand recovery.

This randomized clinical study was performed in Sina Hospital, Tehran, Iran in 2022 on 80 patients with flexor tendon damage in the zone II, who underwent reconstructive surgery of superficial and deep tendons. Patients were randomly (using random number table) divided into two groups that for one group, rehabilitation was done early (starting after three days, n = 53) and for the other group, rehabilitation was done late (starting after three weeks, n = 27). The patients were examined postoperatively and following occupational therapy and the range of motion of their involved joints was calculated.

The means PIP extension Lag, PIP active flexion, DIP extension Lag, DIP active flexion and total active motion were all significantly higher in those patients planned for early mobilization as compared to those who considered for late mobilization(P=0.031). Such a significant difference was also revealed adjusting baseline parameters.

Compared to the delayed start of hand flexor tendon mobility, the early start of these activities is associated with a much greater improvement in the movement function of this tendon.

Hand zone II flexor tendon repair had been associated with many complications thereby it was previously called no man's land. Although there is some agreement on the primary repair of flexor tendons in this area, it is challenging due to certain complications. We compared the six and four-strand techniques in the repair of flexor digitorum profundus (FDP) tendons of zone II.

This randomized controlled clinical trial was registered with the Iranian Registry of Clinical Trials (IRCT20130812014333N139). Fifty patients with damaged FDP in zone II of the hand who were referred to Taleghani Hospital, Kermanshah, Iran in 2020 were included and divided into two groups (n=25). In group 1, the damaged tendons were repaired using the four-strand technique and prolene suture while in group 2, the six-strand technique was used. Postoperatively, the patients were examined every week for the first three weeks. In the second and third weeks, sutures were removed. At the end of 3rd month, the outcomes of surgery were compared in the groups.

Fifty patients (74% male) with 85 damaged fingers were investigated. Based on Buck-Gramcko criteria, the outcomes of surgery were excellent in 78%, good in 16%, fair in 4%, and bad in 2%. Complications after surgery were adhesion (8%) and 2 cases of rupture. There was no significant difference between 4 and 6-strand sutures regarding tendon adhesion and range of motion. 

Both 4 and 6-strand sutures were associated with favorable outcomes in patients with damaged FDP in zone II of the hand.

In recent years, special attention has been paid to minimally invasive and conservative methods in addition to conventional surgical methods to repair tendon damage. In this regard, the effect of fat injection and graft has been of great interest due to its potential in accelerating tissue repair. We aimed to assess the clinical efficacy of fat injection along with conventional approach in patients with flexor tendon injury.

In this randomized clinical trial, 64 patients were randomly scheduled for tendon repair using the usual modified Kessler four-strand method alone or tendon repair using four-strand method and fat injection on the proximal and distal sides of the repair site in the Hazrat Fatemeh Hospital, Tehran Province, Iran in 2022 (IRCT20221206056723N1). Patients were followed-up for eight weeks regarding the function status of the repaired tendon (using Strickland grading test), range of motion (by physical examination) and flexion and extension gaps (by imaging).

In the eighth weeks after the treatment, the average Strickland score was significantly higher in the group receiving fat injection (P: 0.009 ). In the two pointed times, the mean range of motion was significantly higher and the mean flexion and extension gaps were significantly lower in those who received fat injection. None of the procedural side effects were observed in the fifth and eighth weeks after the treatment.

Fat injection along with usual surgical treatment for tendon repair accelerates and improves tendon function and range of motion.

Treating burn scar contractures remains challenging for reconstructive surgeons; no clear guidelines declare the optimal and most effective technique. We evaluated the efficacy of local flaps in treating patients with post-burn contractures.

This retrospective study included 243 patients with post-burn contractures referred to Taleghani Hospital (Khuzestan, southwest Iran) for local flap reconstruction from 2011 to 2020. Patients' demographic data, detailed descriptions of scars, surgical procedures, and flap outcomes were assessed. A plastic surgeon conducted all surgical procedures, the goals of which were to release the scar and cover the defect. Joint range of motion (ROM) (according to goniometric measurements), complications, need for second-stage surgery, and patient satisfaction were assessed.

After scar release, 70.4% of joints were covered with a Z-plasty and similar local flaps, 26.1% with a Z-plasty plus skin grafts, and 3.5% with only skin grafts. The outcome after one year revealed a significant improvement in mean ROM (by 45.80% of the normal ROM; P< 0.001). The mean functional and aesthetic satisfaction scores were 9.45 and 7.61 out of 10, respectively. The complication rate was 10.82%: re-contracture occurred in 3.82%, flap tip necrosis in 1.27%, and partial flap necrosis in 0.31%.

Simple local flaps such as the Z-plasty are safe and effective in covering the joint following post-burn contracture release. Due to the feasibility, minimal need for facilities, steep learning curve, acceptable functional and aesthetic outcomes, and low complication rate, we strongly recommend the Z-plasty for reconstructing burn contractures, particularly in LMICs.

Pericoronitis is a common pathological condition related to mandibular third molar teeth (wisdom teeth). It is an inflammation of the soft tissue surrounding the crown of an erupted or partially erupted tooth that causes pain and discomfort. We aimed to investigate the relation between third molar impaction types and pericoronitis.

This cross-sectional study assessed 60 patients referred to the Oral and Maxillofacial Surgery Department of Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran in 2022 for totally and partially impacted mandibular third molar tooth surgery with pericoronitis. Their demographic data, including age and gender, was recorded. The impacted tooth's side and the symptoms of pericoronitis were identified using clinical examination and panoramic radiography imaging, based on the Pell & Gregory criteria and Peterson's classification. Third-molar tooth surgery was performed according to standard protocol. Patients' data were recorded and were analyzed using Excel 2019 and SPSS ver 21.

The prevalence of pericoronitis symptoms in women was higher than in men (P< 0.001).The Class B type of third molar teeth impaction had a relation with the majority of pericoronitis cases (P< 0.001). Pericoronitis and systemic symptoms were more likely to occur in Class II than in Class I type of third molar teeth impaction (P< 0.001). The most frequent kind of impaction linked to pericoronitis and systemic symptoms such as malaise was mesio-angular (P< 0.001). The symptoms of pericoronitis were substantially correlated with smoking (P< 0.001).

Class B, Class II, and mesio-angular types of third molar impaction are linked with a higher risk of pericoronitis. This information might help in the early diagnosis and management of pericoronitis in patients with impacted third molar teeth.

In Flexor Pollicis Longus (FPL) injuries, primary repair with end-to-end suture is the treatment of choice. In cases where primary repair is not possible, tendon transfer or tendon grafting is used, each of which has its strengths and weaknesses. We aimed to investigate the effectiveness of each of the above two methods in patients.

Patients with FPL injury who referred to Hazrat Fatemeh Hospital, Tehran, Iran late in 2020 to 2021, if primary tendon repair was not possible, were randomly repaired with tendon transfer or tendon graft. After the appropriate time, the splint was opened and physiotherapy was performed for the patients. Then, at least three months after the repair, the range of motion of the IP and MP joints of the patients thumb was measured and compared in two groups.

Ten patients in the tendon transfer group and 10 patients in the tendon graft group were studied. In the secondary repair of FPL with tendon grafting, the range of motion of both IP and MP joints of the thumb was not significantly different compared to repair with tendon transfer.

The findings of this research confirm controversies in this field. In order to obtain more accurate results, it is suggested to carry out a research with a larger number of patients and with strict control over the surgical technique and post-operative care, as well as taking into account the morbidities caused by donor tendon removal and examining the overall satisfaction of the patients.

Burn injuries are amongst the most devastating causes of trauma worldwide. Preventive measures can be of great value in decreasing burn incidents. Increasing the knowledge and education of patients is a crucial step in this process.   

 In this prospective cross-sectional study, we evaluated 82 patients with burn injuries who were divided into two groups randomly during the 2018 to 2019 at Shahid Motahari Hospital, Tehran, Iran.  The first group received an e-Book, and the second group a paperback booklet to read before visiting their primary care. Besides, both groups received a questionnaire on their knowledge of burn injuries and prevention before and after the visit. The e-Book and paperback booklet included basic information about burn injuries and preventive measures. We compared the questionnaire results in both groups before and after reading the e-book and booklet using a paired t-test analysis.

There was a significant improvement in self-reported knowledge of burn prevention (P < 0.05; CI: 95%). Subjects receiving the eBook performed significantly had better post-survey (P < .01, 95% CI), despite equivalent pre-survey scores compared to those receiving the booklet.

Increased use of interactive educational modalities, such as an e-book, can benefit patients with knowledge of their disease and improve the quality of care. These modalities may increase compliance with the physician's recommendations regarding their disease states and treatments.

We aimed to compare the diagnostic quality of multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) in high (HR) and low (LR) resolution modes for assessment of the nasal cavity and paranasal sinuses.

This in vitro study was conducted on 5 dry human skulls by using a CBCT and a MDCT scanner in HR and LR modes to assess their diagnostic quality for 21 anatomical landmarks of the nose. The quality of images was evaluated by two oral and maxillofacial radiologists and a dentist using a four-point Likert scale of (I) poor, (II) decreased, (III) good, and (IV) excellent. Data were analyzed by STATA at 95% confidence interval. The Chi-square test was applied to compare the quality of visualization of landmarks based on the type of scanner.

The diagnostic quality of HR CBCT and CT for the majority of landmarks was higher than that of LR CBCT and CT (P<0.05). The diagnostic quality of HR CBCT for agger nasi cells (P=0.010), olfactory cleft (P=0.032), sphenoethmoidal recess (P=0.032), and nasolacrimal duct (P=0.014) and LR CBCT for the middle turbinate (P=0.046) and middle meatus (P=0.031) was significantly higher than that of MDCT.

The diagnostic quality of HR CBCT and CT for the majority of the landmarks in the nasal cavity and paranasal sinuses was higher than that of LR CBCT and CT. For the majority of landmarks, the diagnostic quality of CBCT and CT was the same; while for some landmarks, the diagnostic quality of HR and LR CBCT was higher than HR and LR CT. In general, CBCT has high efficacy for evaluation of the paranasal sinuses and the nasal cavity, and provides diagnostic information comparable to those provided by CT, but with a much lower radiation dose.

Peripheral nerve damage is a major cause of disability, which can lead to serious limitations in daily and occupational activities. Although primary repair can restore the function of the damaged organ remarkably, factors predicting the prognosis of nerve repair are a topic of constant debate. We aimed to investigate the factors affecting the outcomes of primary nerve repair in patients afflicted by upper extremity nerve injuries following penetrating trauma.

This cross-sectional study was conducted on 51 patients referred to Shohada-ye Ashayer Hospital in Khorramabad, Iran, from 2016 to 2021. Data including the patient’s age, gender, education, type, severity, and mechanism of injury, the damaged nerve, time and of method repair, the surgeon’s specialty, as well as the electrodiagnostic findings, were collected and analyzed using SPSS software version 22.

The mean age of the patients was 30.41 ± 12.63 years, and the majority of them (84.3%) were men. A significant relationship was found between the sensory amplitude with education (P=0.002), the type of damaged nerve (P=0.048), and the severity of injury (P=0.012). The positive sharp wave was significantly associated with the surgeon’s specialty (P=0.034). Besides, the motor amplitude was considerably related to the patient’s age (P=0.040) and the surgeon’s specialty (P=0.035).

Factors determining the outcome of peripheral nerve repair following penetrating trauma to the upper extremity include age, education, the type of damaged nerve, the severity of the injury, and the surgeon’s specialty.

Clinical educational environments play a substantial role in the teaching of medical residents and fellows. In order to improve the quality of clinical education, its status should be evaluated. Therefore, we aimed to inquire about the educational environment of Plastic Surgery fellows in two teaching hospitals in Tehran, Iran using the Postgraduate Hospital Educational Environment Measure (PHEEM).

In this descriptive cross-sectional study, Plastic Surgery fellows studying in two teaching hospitals in Tehran, Iran, in 2022 were included. The Persian version of the PHEEM questionnaire was applied for assessing the clinical educational environment. The collected data were analyzed by SPSS software version 22.

Twenty six Plastic Surgery fellows were studied, 15.4% of whom were women (n=4) and 84.6% were men (n=22). The mean total score of the PHEEM questionnaire was 89.68±26.02. The highest mean score was in the teaching dimension (35.08), while the lowest mean score was in the social support dimension (25.42).

Most dissatisfaction among Plastic Surgery fellows were in the field of social support. It is necessary to adopt proper educational policies to improve the supportive resources for Plastic Surgery fellows.

Mucocele is a benign soft tissue mass that could occur in all accessory glands. Mucocele can also occur in paranasal sinuses. It is mostly placed in the frontal sinus and barely grows larger than 1.5 centimeters(cm). Based on the affected site, it could cause facial pain and headache. Analgesics like opioids could relieve and potentially make patients ignore the headache and cause giant frontal mucocele. This article discusses a patient with giant frontal sinus mucocele (7×8×8 cm) and opium addiction that presented with severe and intolerable pain. A 32 yr old man came to Rajaee Trauma Hospital, Shiraz, Iran with a severe headache and a large swelling of the face frontal region that developed gradually. In physical examination, the mass was non-tender, non-pulsatile, and free from the overlying normal skin. Computed tomography (CT) scan and magnetic resonance imaging (MRI) demonstrated a frontal sinus mucocele. The operation was planned, and the patient was discharged after two days. Subsequently, the 6-month follow-up of the patient was normal. Two different hypotheses are declared in this article. First, the potential role of opium addiction as a risk factor for giant mucoceles was noted, then the analgesic non-responsiveness of sinus mucoceles was described. The latter hypothesis is more likely. So, we should consider that if the patient had an analgesic-resistant headache, one differential diagnosis could be sinus mucocele. Moreover, the possible psychological effect of addiction on discounting face beauty was acknowledged.