Prof. Ghada A M I N Khalifa | Al-Azhar University (original) (raw)

Papers by Prof. Ghada A M I N Khalifa

Journal of Cranio-Maxillofacial Surgery

Introduction: The radiographic images play a major role in detecting the position of the impacted... more Introduction: The radiographic images play a major role in detecting the position of the impacted teeth, shape, orientation, and their relation to the adjacent vital structure. Thus, they facilitate their surgical removal with minimal trauma and minimize the postoperative complications. Plain radiographs provide two-dimensional images that have certain drawbacks. In complex impactions, the missing of certain data may lead to postoperative complications. Objectives: The aim of this study is to compare between the radiographic results of three-dimensional computed tomography (3DCT) which inserted into Simplant software and that of two-dimensional orthopantomograms(OPGs). Material & Methods: A total of 50 abnormally positioned impacted teeth were studied. The shape, position, orientation, and the relation to the adjacent vital structures were studied by using OPGS and 3DCT scans. The correlation between the surgical findings during surgeries and radiographic results was also done. The dataset of the 3DCT scans was inserted and manipulated by Simplant technology to virtually visualize the impacted teeth. Results: Thirty cases were lower impacted wisdom molars, 10 cases were upper impacted third molar, while the impacted upper canine found in 5 cases, and the other 5 cases were impacted lower second premolar. There were no differences between the OPGs and 3DCT scans regarding the orientation of impactions. 3DCT scans were much more precise in determination of the exact location of the teeth in the jaw. The buccal, palatal, or lingual position of the teeth were difficult to be determined in OPGs. The configuration of the roots was better seen by using 3DCT scans. The results of 3DCT scans were also correlated with the surgical findings, during surgeries, more than those of OPGs. Conclusion: It could be concluded that the data which is obtained from 3DCT scans can meet the objectives of the diagnostic images much more than OPGs in diagnosis and determination of the surgical panning for the removal of the complex impacted teeth. Thus, they facilitate their surgical removal with minimal complications, and amplify the documentations that provided to the patient in the consent.

Al-Azhar Dental Journal for Girls, 2018

Purpose: To compare the outcomes after rigid intermaxillary fixation (IMF) versus functional ther... more Purpose: To compare the outcomes after rigid intermaxillary fixation (IMF) versus functional therapy (FT) in patients with mandibular condylar fractures (CFs). Patients and Methods: A prospective comparative study with 3 follow-ups (FU) at 1, 3 and 6 months was undertaken in 2 groups, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from Group1 (GI) received IMF for 10 days, followed by physiotherapy, whereas those in Group2 (GII) had undergone FT for 21 days via guiding elastics. In both groups, all concomitant fractures (if present) were treated by open reduction and internal fixation (ORIF). Patients with unilateral CFs, with or without concomitant mandibular fractures showing one or more of the following conditions were included: adult patients (>18 years of age) indicated for closed treatment, and sufficient dentition for arch bars application. Previous history of tempromandibular joint (TMJ) dysfunction, severe pre-traumatic skeletal dysgnathia, and mid face fractures was excluded. Results: 12 patients (6 in GI and 6 in GII) were included. The clinical TMJ Dysfunction Index of Helkimo (CTDI-H) was equal in both groups at 1 month FU, it became worse in GI than in the GII at 3 month FU, corresponding to better function on the short-term. At the 6 month FU, there were better values in the GII. The Magnetic Resonance Imaging (MRI) scans revealed that the trauma caused disc displacement for 33.3% of GI and 66.7 % of GII. At 6 months FU, 33.3% of GI had improvement in the degree of the disc displacement, but they still had internal derangement with reduction. In GII, 2 out of 4 retained the normal position of the disc and the others had improvement in the disc displacement degree only. Conclusion: Both treatment options may yield acceptable results, however, FT seems to be the appropriate treatment for rapid recovery of range of mandibular motion (ROMM), relief of pain during palpation of masticatory muscles, and recovery of disc position during FU. Its success depends on the passive maneuver of physiotherapy if there is no restricted maximum interincisal opening (MIO) and it should be in a forcible manner in case of restricted MIO.

Journal of Cranio-Maxillofacial Surgery, 2017

The aim of this clinical study was to prospectively measure the incremental changes in the MIO af... more The aim of this clinical study was to prospectively measure the incremental changes in the MIO after 1 cm gap arthroplasty, compare these changes between unilateral and bilateral cases, and emphasize the importance of the monitoring of the MIO for at least 24 months. Materials and Methods: This prospective study enrolled 26 patients with TMJ ankylosis either unilateral or bilateral. The fingers assessment method was used to measure the maximum interincisal opening (MIO) preoperatively, intraoperatively, and monthly postoperatively up to 24 months. All the patients had undergone 1 cm gap arthroplasty to release the ankylosis. The changes in MIO measurements of unilateral and bilateral cases were statistically compared. The physiotherapy was performed until the measurements had normal stable values. Results: All the cases showed a significant decrease in MIO at the first three months. At 6 months, the MIO continuously increased up to 1 year. There was no difference between the unilateral and bilateral cases. At the end of the follow-up, all measurements showed normal stable values. Conclusion: The monitoring of MIO is important to detect the early signs of re-ankylosis. It is the only way that can be used in which the early signs cannot be detected in radiographs.

Journal of Lasers in Medical Sciences, 2016

Introduction: Temporomandibular disorders (TMD) lead to masticatory muscle pain, jaw movement dis... more Introduction: Temporomandibular disorders (TMD) lead to masticatory muscle pain, jaw movement disability and limitation in mouth opening. Pain is the chief complaint in 90% of the TMD patients which leads to disability and severe socioeconomic costs. The purpose of this study was to evaluate the therapeutic effects of low level laser therapy (LLLT) compared to pharmacotherapy with NSAIDs (naproxen) in myofascial pain disorder syndrome (MPDS). Methods: In this randomized controlled clinical trial, 40 MPDS patients were divided into two groups. One group received naproxen 500 mg bid for 3 weeks as treatment modality and also had placebo laser sessions. The other group received active laser (diode 810 nm CW) as treatment and placebo drug. Pain intensity was measured by visual analogue scale (VAS) and maximum painless mouth opening was also measured as a functional index every session and at 2 months follow up. Data was collected and analyzed with SPSS software. Independent t test was used to analyze the data. A P < 0.05 was considered significant. Results: Low level laser caused significant reduction in pain intensity (P < 0.05) and a significant increase in mouth opening. In naproxen group neither pain intensity nor maximum mouth opening had significant improvement. Pain relief, in subjective VAS was observed in third session in LLLT group, but did not occur in naproxen group. Maximum mouth opening increased significantly in laser group compared to the naproxen group from the eighth session. Conclusion: Treatment with LLLT caused a significant improvement in mouth opening and pain intensity in patients with MPDS. Similar improvement was not observed in naproxen group.

Journal of American …, 2010

1 Associate Professor of Oral and Maxillofacial Surgery, Research Institute of Ophthalmology. 2Le... more 1 Associate Professor of Oral and Maxillofacial Surgery, Research Institute of Ophthalmology. 2Lecturer of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Azhar University, Girl Branch. 3Associate Professor of Radiology, Faculty of ...

Al-Azhar Dental Journal for Girls, 2020

Purpose: The intent of the study was to compare the periodontal and bony changes of piezocision c... more Purpose: The intent of the study was to compare the periodontal and bony changes of piezocision corticotomy with bone graft guided by 3D-surgical template in maxillary protrusion versus non grafted one. Patients and Methods: Prospective study included 20 maxillary protrusive female patients with age group ranging between 20 and 50 years. Patients were divided in to group I: treated with piezocision corticotomy without bone graft guided by 3D surgical template. Group II: treated with piezocision corticotomy with bone graft guided by 3D surgical template. CBCT scan was performed of all the patients. Gingival index (GI), probing depth (PD) and CBCT images were performed at baseline and 6months then collected data were analyzed using SPSS statistical analysis program. Results: There were significant reductions in GI, and PD of Group I and Group II from baseline to 3 months. Radiographic analysis of group II showed a statistically significant increase of labial bone thickness (LBT) after 6 months. Conclusion: The uses of guided bone regeneration during cortioctomy improve the clinical parameter and augment the labial bone with minimal loss of bone thickness during en-mass movement.

Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2021

The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TV... more The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is activated. Material and methods: A retrospective study included patients who developed TVR during the surgical management of mandibular, midface, and orbital fractures. The reflex was divided into type I, II, III, and IV-TVR according to the following nerves: ophthalmic, maxillary, mandibular, and non-trigeminal nerves, respectively. The magnitude of hemodynamic drops was identified at the intraoperative baseline, during reflex, and postoperatively. The needed time to elicit the reflex, frequency and duration, need for medical intervention, and sequence of the drop were also recorded. P - values < 0.05 was considered significant. Out of 260 patients' files were reviewed, the TVR was observed in only 30 (11.55 %) patients. The ophthalmic nerve activation significantly caused the greatest intensity and magnitude of...

Journal of Cranio-Maxillofacial Surgery, 2020

PURPOSE The aim of this prospective study was to address the anthropometric changes in the morpho... more PURPOSE The aim of this prospective study was to address the anthropometric changes in the morphology of the lower eyelid and esthetic outcomes after performing subciliary, subtarsal, and transconjunctival approaches in patients with orbital and periorbital fractures. PATIENTS AND METHODS A prospective randomized controlled clinical study was undertaken on patients with orbital floor and infraorbital rim fractures. These were equally divided into three groups: in group 1, the fractures were approached via a stepped subciliary approach; in group 2, they were approached via a subtarsal approach; in group 3, a retroseptal transconjunctival approach was performed. The patients were assessed for anthropometric changes in the morphology of the lower eyelid, esthetic outcomes, and postoperative lower eyelid complications (LLCs). A one-way ANOVA test was used to analyze differences between the operated and non-operated sides and the effect of the surgical approach on anthropometric measurements. RESULTS A total of 45 patients were included in the study. All the surgical approaches provided adequate surgical exposure of the infraorbital rim and orbital floor. The subtarsal approach allowed rapid access to the field (10.5 ± 1.9 min). All incisions resulted in adequate postoperative esthetic outcomes. Anthropometric analysis revealed that there were no significant differences between the three approaches, except for measurements of the eye fissure index (EFI) and lower iris coverage (LIC). Mean EFI measurements increased on all operated sides. The subciliary approach showed the highest percentage of increased measurements of this variable (34.5 ± 4.6), followed by the subtarsal approach (32 ± 2.1), and then the transconjunctival approach (31.1 ± 3.7), with p = 0.046. Furthermore, the subciliary approach significantly decreased the measurements of LIC. This change was also bigger with the subciliary approach (1.09 ± 2.3) than with the subtarsal approach (2.1 ± 2.4) or transconjunctival approach (3.4 ± 2.6), with p = 0.048. CONCLUSION Based on the results of this study, the subtarsal approach is a minimally invasive incision that provides an adequate and direct approach to orbital floor and infraorbital rim fractures, with a favorable periorbital architecture and the lowest incidence of LLCs. Therefore, the subtarsal technique should be preferred over subciliary and transconjunctival approaches.

Journal of Cranio-Maxillofacial Surgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Al-Azhar Dental Journal for Girls, 2019

Purpose this study was conducted between 2015 and 2017 at the faculty of Veterinary Medicine Cair... more Purpose this study was conducted between 2015 and 2017 at the faculty of Veterinary Medicine Cairo University and aimed to histologically compare between the effect of processed and unprocessed bone marrow aspirate on the quantity and quality of the newly formed bone. Material and methods 72 Adult male white New Zealand rabbits were used in this study and were divided equally into 2 groups A and B. Bone defects were created at the medial upper extremity of right and left tibia of all rabbits down to bone using trephine bur measuring 4 mm diameter to 5 mm depth. The bone defects were treated with whole bone marrow loaded on gel foam in group A right tibias and using mononuclear cell layer obtained through centrifuging bone marrow loaded on gel foam in group B right tibias. Bone defects in the left tibias in all rabbits treated with gel foam only. Scarification was done 3,6,12 weeks postoperative. Histological evaluation was done using H and E and Masson's trichrome stain. results the results showed that group A right tibial defects had better healing results than group B right tibial defects all over the follow-up period, but the differences were not statically significant. Conclusion the study findings indicate that the centrifugal concentration techniques provide better therapeutic outcomes over the whole BMA, but it is statistically insignificant. IntroduCtIon The limitations of autogenous allogenic and synthetic bone substitutes in augmenting critical size defects (1) necessitate the development of other treatment modality. The field of biotechnology and tissue

Egyptian Dental Journal, 2017

Statement of problem: Management of subcondylar fracture with proper reduction of temporomandibul... more Statement of problem: Management of subcondylar fracture with proper reduction of temporomandibular joint position and function is a challenge, different osteosynthesis devices are used with great diversity in their types, numbers, positions, and results. Purpose: Comparative study between the efficiency of single miniplate and single minidynamic compression plate in restoration of ramus height, condylar angulation, and tempromandibular joint function in subcondylar fracture cases. Material and Method: 14 patients indicated for open reduction and fixation of subcondylar fractures were divided into two groups each of 7 patients. Group A: subcondylar fractures were fixed using 2.0 single miniplate along posterior border of ramus. Group B: a single 2.0-mm minidynamic compression plates (DCP), were applied along posterior border of ascending ramus for fracture fixation in the other seven patients. Intermaxillary fixation for 10 days was applied for both groups. Clinical and radiograhic follow up were performed at 1, 3, 6 months using panorama and CT. Results: At 6 months postoperatively, there was an improvement of mandibular functions with improvement of inter-incisal opening from 19.1mm and 20.1 mm in group A and B respectively to 35.6mm and 30.8 mm. Which was significantly different (P value =0.04). The shortening in ramus height improved from 3.2mm and 5.2mm in group A and B to 0.8 mm and 0.6 mm, also sagittal angulation of condyle improved from 1.6º and 4.7º in both group respectively to 0.2º and 0.3º with no significant difference between two types of mini-plate. There were no signs of infection, malunion, nonunion or device failure in both groups. except for one case of group A, that suffered from malocclusion with displacements of the fractured segments immediately after the operations, that responded to elastic traction within 15 days. Conclusion: Single 0.2mm miniplate or mini DCP aided by intermaxillary fixation are successful devices in fixation of subcondylar fracture without complication, with superiority of mini DCP in proper condylar reduction and stable fixation.

Al-Azhar Dental Journal for Girls, 2019

Purpose: The aim of the study was to compare between computer guided surgery and the traditional ... more Purpose: The aim of the study was to compare between computer guided surgery and the traditional method in preserving vertical ramus height (VRH) and the skull base thickness during gap arthroplasty in patients with the TMJ bony ankylosis. Material and methods: Twelve patients with 15 joints suffering from true bony TMJ ankylosis were included in this study. The patients were divided into 2 groups: Group A (8 joints); The ankylosis was released by computer-assisted 1cm gap arthroplasty. Group B (7 joints); The ankylosis was released by traditional 1cm gap arthroplasty. Pre and postoperative clinical examinations included: measurements of maximum interincisal opening, midline deviations or deflections during mouth opening or closing, presence of open bite, recording any sign/symptoms of infection, facial nerve function evaluation. Preoperative radiograph were measure the preoperative VRH, and aid in construction of the surgical guide for group A, while, postoperative radiograph performed for measure the VRH and skull base thickness. Result: Clinically improvement in the midline shift and occlusion during physiotherapy period postoperatively for all cases in group A except in one patient. While, clinical result in group B revealed increase in the midline shift, and change in occlusion postoperatively. Radiographically: there was no statistical significant difference between the 2 groups in postoperative VRH loss measurements. There was statistical significant difference between the 2 groups in postoperative skull base thickness. Conclusion: Computer assisted surgical simulation could help the surgeon to preserve the VRH and the skull base that reflects positively on the postoperative clinical outcomes.

International Journal of Oral and Maxillofacial Surgery, 2018

Despite the wide uses of mandibular distraction osteogenesis (MDO), no study appears to have eval... more Despite the wide uses of mandibular distraction osteogenesis (MDO), no study appears to have evaluated the use of MDO and subsequent advancement genioplasty. This study addressed lower facial third aesthetics in a consecutive series of subjects with micrognathia who underwent MDO and subsequent advancement genioplasty. Standard cephalometric measurements were performed pre-MDO, at the end of consolidation, and at 1 week, 6 months, and 12 months after genioplasty. At the end of follow-up, questionnaires were given to measure patient satisfaction. Forty patients were included, 33 of whom underwent genioplasty. The mean patient age was 22.35 AE 1.12 years. Pre-genioplasty cephalometric measurements showed that all patients had a deficient chin position and projection; they were dissatisfied with their facial aesthetics. Post-genioplasty cephalometric measurements showed that the hard and soft tissue pogonion had moved significantly: 8.4 AE 2.3 mm and 11.0 AE 2.11 mm, respectively. According to the questionnaire, the patients were satisfied with the final results. The MDO reduced the amount of chin advancement and minimized relapses; the soft tissue response of the lower facial third was more sensitive to genioplasty than isolated MDO. MDO and genioplasty lead to a modest horizontal chin movement that achieves the preferred pogonion position and projection.

Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2017

Objectives: Pediatric maxillofacial fractures are less common as compared to adults, however, the... more Objectives: Pediatric maxillofacial fractures are less common as compared to adults, however, they may lead to serious complications. Methods: The study aimed to retrospectively correlate demographic data, facial fractures characteristics, and patterns among pediatric patients who were managed at 3 of the governmental Egyptian Hospitals from 2008 to 2016, and discussing the treatment protocols. The study included 104 patients presented with maxillofacial traumas. Those with dentoalveolar and/or dental injuries were excluded. All the patients were treated by conservative approaches, except those in whom surgical interventions were mandatory. Results: The mean age of 104 patients was 10.94 ± 3.92 years. The female/male ratio was 1:1.4. Females' fractures were mainly due to falls (17.31%). Road traffic accidents (RTAs) were the most common cause in males, followed by sports injuries (17.31.8%), then assault (10.58%). The most prevalent site of fractures was the mandible (67.31%) in particular condylar fractures. All the fractures were healed successfully, but restricted mouth openings were the most common sequela. Conclusion: The RTAs were the main cause. Males and condylar fractures have the highest predominance. The conservative treatment is still the treatment of choice in pediatric fractures. Pediatric fractures must be followed longitudinally to avoid post-traumatic sequelae.

Journal of Oral and Maxillofacial Surgery, 2016

PURPOSE A restricted mouth opening (MO) is predominantly a complication of maxillofacial trauma i... more PURPOSE A restricted mouth opening (MO) is predominantly a complication of maxillofacial trauma in pediatric patients and develops in 4 to 26.2% of cases. The purpose of the present study was to quantitatively investigate the influence of patient demographic data, fracture characteristics, and regular vigorous physiotherapy, with either voluntary or forcible MO exercises, on the recovery of a post-traumatic restricted MO in pediatric patients. PATIENTS AND METHODS A prospective cohort study was performed of pediatric patients with maxillofacial injuries who had been referred to Al-Zahraa and El-Fayoum Hospitals from 2013 to 2015. The predictive variables were patient demographic data, fracture characteristics, and regular vigorous physiotherapy. The patients were treated with a closed technique. The MO measurements were the clinical outcome variables and were recorded at the first week and then monthly for 12 months. Regular vigorous physiotherapy was performed until the patients had returned to their preoperative MO. The data were tabulated and statistically analyzed. RESULTS Eighty-six patients were enrolled in the present study. Males predominated. Falls were the most common cause of fracture. Condylar fractures had the greatest incidence. A restricted MO occurred in 81 patients. The results showed no interaction between MO recovery and age, gender, etiology, or fracture site. After physiotherapy, the patients had returned to their preoperative MO at the fourth month, with the measurements fixed at normal values at the sixth month. The recovery rate was nonlinear, with faster improvement in the months closest to the injury. CONCLUSION Physiotherapy is more critical in the recovery of the MO and prevention of bony ankylosis than patient data or fracture characteristics in pediatric trauma. We highly advocate the performance of voluntary mouth exercises, even in the absence of fracture. Forcible MO exercises are mandatory to recover a restricted MO. These exercises should be performed under close supervision of the patient's surgeon with the parents motivated to cooperate for at least 6 months.

International journal of oral and maxillofacial surgery, 2015

A retrospective study was conducted to compare the clinical outcomes of three different types of ... more A retrospective study was conducted to compare the clinical outcomes of three different types of hardware that are used in mandibular angle fracture fixation. Thirty patients were selected from the hospital database. The patients were categorized into the following groups: group A, in which a single 2.0-mm locking miniplate was used; group B, in which a single rigid 2.3-mm plate was used; and group C, in which a single lag screw was inserted. All patients were followed for 6 months. With regard to intraoperative variables, significant differences were found among the groups in the duration of surgery and cost. Group C had the shortest surgical time, followed by group A and then group B. Two patients, one in group A and one in group B, suffered an occlusal discrepancy after surgery. Of the group A patients, two exhibited wound dehiscence and one had an infection. One patient in group B had an exposed plate. Sensory nerve involvement was noted in three group C patients and one group B...

Australian Journal of Basic …, 2010

Lecturer of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Azhar 1 Universi... more Lecturer of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Azhar 1 University, Girl Branch. Lecturer of Oral and Maxillofacial Surgery, Abo El Reesh,Cairo University Hospitals. 2 Assistant Professor of Oral and Maxillofacial Surgery, Research Institute of ...

Background: The study aimed to determining the magnitude of the power of the aromatherapy at whic... more Background: The study aimed to determining the magnitude of the power of the aromatherapy at which it reduces the intensity of dental pain and level of dental anxiety. Also, it aimed to correlate between olfactory aromatherapy, phases of dental visits, and different dental procedures. Methods: A randomized controlled study was enrolled on female patients. The olfaction was stimulated via lavender oils. Patients were randomly divided into a lavender group in which patients inhaled 2 % of lavender vapors and control group where the patients inhaled water vapors. The variables included pain score, anxiety score, and changes in vital signs. Modified Dental Anxiety Scale (MDAS) and Speilberger State-Trait Anxiety Inventory (STAI) questionnaires and visual analog scales (VAS) were used to assess anxiety and pain. Vital signs included systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and oxygen saturation (Spo2). Variables were assessed before inha...

Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2015

Journal of Cranio-Maxillofacial Surgery

Introduction: The radiographic images play a major role in detecting the position of the impacted... more Introduction: The radiographic images play a major role in detecting the position of the impacted teeth, shape, orientation, and their relation to the adjacent vital structure. Thus, they facilitate their surgical removal with minimal trauma and minimize the postoperative complications. Plain radiographs provide two-dimensional images that have certain drawbacks. In complex impactions, the missing of certain data may lead to postoperative complications. Objectives: The aim of this study is to compare between the radiographic results of three-dimensional computed tomography (3DCT) which inserted into Simplant software and that of two-dimensional orthopantomograms(OPGs). Material & Methods: A total of 50 abnormally positioned impacted teeth were studied. The shape, position, orientation, and the relation to the adjacent vital structures were studied by using OPGS and 3DCT scans. The correlation between the surgical findings during surgeries and radiographic results was also done. The dataset of the 3DCT scans was inserted and manipulated by Simplant technology to virtually visualize the impacted teeth. Results: Thirty cases were lower impacted wisdom molars, 10 cases were upper impacted third molar, while the impacted upper canine found in 5 cases, and the other 5 cases were impacted lower second premolar. There were no differences between the OPGs and 3DCT scans regarding the orientation of impactions. 3DCT scans were much more precise in determination of the exact location of the teeth in the jaw. The buccal, palatal, or lingual position of the teeth were difficult to be determined in OPGs. The configuration of the roots was better seen by using 3DCT scans. The results of 3DCT scans were also correlated with the surgical findings, during surgeries, more than those of OPGs. Conclusion: It could be concluded that the data which is obtained from 3DCT scans can meet the objectives of the diagnostic images much more than OPGs in diagnosis and determination of the surgical panning for the removal of the complex impacted teeth. Thus, they facilitate their surgical removal with minimal complications, and amplify the documentations that provided to the patient in the consent.

Al-Azhar Dental Journal for Girls, 2018

Purpose: To compare the outcomes after rigid intermaxillary fixation (IMF) versus functional ther... more Purpose: To compare the outcomes after rigid intermaxillary fixation (IMF) versus functional therapy (FT) in patients with mandibular condylar fractures (CFs). Patients and Methods: A prospective comparative study with 3 follow-ups (FU) at 1, 3 and 6 months was undertaken in 2 groups, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from Group1 (GI) received IMF for 10 days, followed by physiotherapy, whereas those in Group2 (GII) had undergone FT for 21 days via guiding elastics. In both groups, all concomitant fractures (if present) were treated by open reduction and internal fixation (ORIF). Patients with unilateral CFs, with or without concomitant mandibular fractures showing one or more of the following conditions were included: adult patients (>18 years of age) indicated for closed treatment, and sufficient dentition for arch bars application. Previous history of tempromandibular joint (TMJ) dysfunction, severe pre-traumatic skeletal dysgnathia, and mid face fractures was excluded. Results: 12 patients (6 in GI and 6 in GII) were included. The clinical TMJ Dysfunction Index of Helkimo (CTDI-H) was equal in both groups at 1 month FU, it became worse in GI than in the GII at 3 month FU, corresponding to better function on the short-term. At the 6 month FU, there were better values in the GII. The Magnetic Resonance Imaging (MRI) scans revealed that the trauma caused disc displacement for 33.3% of GI and 66.7 % of GII. At 6 months FU, 33.3% of GI had improvement in the degree of the disc displacement, but they still had internal derangement with reduction. In GII, 2 out of 4 retained the normal position of the disc and the others had improvement in the disc displacement degree only. Conclusion: Both treatment options may yield acceptable results, however, FT seems to be the appropriate treatment for rapid recovery of range of mandibular motion (ROMM), relief of pain during palpation of masticatory muscles, and recovery of disc position during FU. Its success depends on the passive maneuver of physiotherapy if there is no restricted maximum interincisal opening (MIO) and it should be in a forcible manner in case of restricted MIO.

Journal of Cranio-Maxillofacial Surgery, 2017

The aim of this clinical study was to prospectively measure the incremental changes in the MIO af... more The aim of this clinical study was to prospectively measure the incremental changes in the MIO after 1 cm gap arthroplasty, compare these changes between unilateral and bilateral cases, and emphasize the importance of the monitoring of the MIO for at least 24 months. Materials and Methods: This prospective study enrolled 26 patients with TMJ ankylosis either unilateral or bilateral. The fingers assessment method was used to measure the maximum interincisal opening (MIO) preoperatively, intraoperatively, and monthly postoperatively up to 24 months. All the patients had undergone 1 cm gap arthroplasty to release the ankylosis. The changes in MIO measurements of unilateral and bilateral cases were statistically compared. The physiotherapy was performed until the measurements had normal stable values. Results: All the cases showed a significant decrease in MIO at the first three months. At 6 months, the MIO continuously increased up to 1 year. There was no difference between the unilateral and bilateral cases. At the end of the follow-up, all measurements showed normal stable values. Conclusion: The monitoring of MIO is important to detect the early signs of re-ankylosis. It is the only way that can be used in which the early signs cannot be detected in radiographs.

Journal of Lasers in Medical Sciences, 2016

Introduction: Temporomandibular disorders (TMD) lead to masticatory muscle pain, jaw movement dis... more Introduction: Temporomandibular disorders (TMD) lead to masticatory muscle pain, jaw movement disability and limitation in mouth opening. Pain is the chief complaint in 90% of the TMD patients which leads to disability and severe socioeconomic costs. The purpose of this study was to evaluate the therapeutic effects of low level laser therapy (LLLT) compared to pharmacotherapy with NSAIDs (naproxen) in myofascial pain disorder syndrome (MPDS). Methods: In this randomized controlled clinical trial, 40 MPDS patients were divided into two groups. One group received naproxen 500 mg bid for 3 weeks as treatment modality and also had placebo laser sessions. The other group received active laser (diode 810 nm CW) as treatment and placebo drug. Pain intensity was measured by visual analogue scale (VAS) and maximum painless mouth opening was also measured as a functional index every session and at 2 months follow up. Data was collected and analyzed with SPSS software. Independent t test was used to analyze the data. A P < 0.05 was considered significant. Results: Low level laser caused significant reduction in pain intensity (P < 0.05) and a significant increase in mouth opening. In naproxen group neither pain intensity nor maximum mouth opening had significant improvement. Pain relief, in subjective VAS was observed in third session in LLLT group, but did not occur in naproxen group. Maximum mouth opening increased significantly in laser group compared to the naproxen group from the eighth session. Conclusion: Treatment with LLLT caused a significant improvement in mouth opening and pain intensity in patients with MPDS. Similar improvement was not observed in naproxen group.

Journal of American …, 2010

1 Associate Professor of Oral and Maxillofacial Surgery, Research Institute of Ophthalmology. 2Le... more 1 Associate Professor of Oral and Maxillofacial Surgery, Research Institute of Ophthalmology. 2Lecturer of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Azhar University, Girl Branch. 3Associate Professor of Radiology, Faculty of ...

Al-Azhar Dental Journal for Girls, 2020

Purpose: The intent of the study was to compare the periodontal and bony changes of piezocision c... more Purpose: The intent of the study was to compare the periodontal and bony changes of piezocision corticotomy with bone graft guided by 3D-surgical template in maxillary protrusion versus non grafted one. Patients and Methods: Prospective study included 20 maxillary protrusive female patients with age group ranging between 20 and 50 years. Patients were divided in to group I: treated with piezocision corticotomy without bone graft guided by 3D surgical template. Group II: treated with piezocision corticotomy with bone graft guided by 3D surgical template. CBCT scan was performed of all the patients. Gingival index (GI), probing depth (PD) and CBCT images were performed at baseline and 6months then collected data were analyzed using SPSS statistical analysis program. Results: There were significant reductions in GI, and PD of Group I and Group II from baseline to 3 months. Radiographic analysis of group II showed a statistically significant increase of labial bone thickness (LBT) after 6 months. Conclusion: The uses of guided bone regeneration during cortioctomy improve the clinical parameter and augment the labial bone with minimal loss of bone thickness during en-mass movement.

Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 2021

The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TV... more The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is activated. Material and methods: A retrospective study included patients who developed TVR during the surgical management of mandibular, midface, and orbital fractures. The reflex was divided into type I, II, III, and IV-TVR according to the following nerves: ophthalmic, maxillary, mandibular, and non-trigeminal nerves, respectively. The magnitude of hemodynamic drops was identified at the intraoperative baseline, during reflex, and postoperatively. The needed time to elicit the reflex, frequency and duration, need for medical intervention, and sequence of the drop were also recorded. P - values < 0.05 was considered significant. Out of 260 patients' files were reviewed, the TVR was observed in only 30 (11.55 %) patients. The ophthalmic nerve activation significantly caused the greatest intensity and magnitude of...

Journal of Cranio-Maxillofacial Surgery, 2020

PURPOSE The aim of this prospective study was to address the anthropometric changes in the morpho... more PURPOSE The aim of this prospective study was to address the anthropometric changes in the morphology of the lower eyelid and esthetic outcomes after performing subciliary, subtarsal, and transconjunctival approaches in patients with orbital and periorbital fractures. PATIENTS AND METHODS A prospective randomized controlled clinical study was undertaken on patients with orbital floor and infraorbital rim fractures. These were equally divided into three groups: in group 1, the fractures were approached via a stepped subciliary approach; in group 2, they were approached via a subtarsal approach; in group 3, a retroseptal transconjunctival approach was performed. The patients were assessed for anthropometric changes in the morphology of the lower eyelid, esthetic outcomes, and postoperative lower eyelid complications (LLCs). A one-way ANOVA test was used to analyze differences between the operated and non-operated sides and the effect of the surgical approach on anthropometric measurements. RESULTS A total of 45 patients were included in the study. All the surgical approaches provided adequate surgical exposure of the infraorbital rim and orbital floor. The subtarsal approach allowed rapid access to the field (10.5 ± 1.9 min). All incisions resulted in adequate postoperative esthetic outcomes. Anthropometric analysis revealed that there were no significant differences between the three approaches, except for measurements of the eye fissure index (EFI) and lower iris coverage (LIC). Mean EFI measurements increased on all operated sides. The subciliary approach showed the highest percentage of increased measurements of this variable (34.5 ± 4.6), followed by the subtarsal approach (32 ± 2.1), and then the transconjunctival approach (31.1 ± 3.7), with p = 0.046. Furthermore, the subciliary approach significantly decreased the measurements of LIC. This change was also bigger with the subciliary approach (1.09 ± 2.3) than with the subtarsal approach (2.1 ± 2.4) or transconjunctival approach (3.4 ± 2.6), with p = 0.048. CONCLUSION Based on the results of this study, the subtarsal approach is a minimally invasive incision that provides an adequate and direct approach to orbital floor and infraorbital rim fractures, with a favorable periorbital architecture and the lowest incidence of LLCs. Therefore, the subtarsal technique should be preferred over subciliary and transconjunctival approaches.

Journal of Cranio-Maxillofacial Surgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Al-Azhar Dental Journal for Girls, 2019

Purpose this study was conducted between 2015 and 2017 at the faculty of Veterinary Medicine Cair... more Purpose this study was conducted between 2015 and 2017 at the faculty of Veterinary Medicine Cairo University and aimed to histologically compare between the effect of processed and unprocessed bone marrow aspirate on the quantity and quality of the newly formed bone. Material and methods 72 Adult male white New Zealand rabbits were used in this study and were divided equally into 2 groups A and B. Bone defects were created at the medial upper extremity of right and left tibia of all rabbits down to bone using trephine bur measuring 4 mm diameter to 5 mm depth. The bone defects were treated with whole bone marrow loaded on gel foam in group A right tibias and using mononuclear cell layer obtained through centrifuging bone marrow loaded on gel foam in group B right tibias. Bone defects in the left tibias in all rabbits treated with gel foam only. Scarification was done 3,6,12 weeks postoperative. Histological evaluation was done using H and E and Masson's trichrome stain. results the results showed that group A right tibial defects had better healing results than group B right tibial defects all over the follow-up period, but the differences were not statically significant. Conclusion the study findings indicate that the centrifugal concentration techniques provide better therapeutic outcomes over the whole BMA, but it is statistically insignificant. IntroduCtIon The limitations of autogenous allogenic and synthetic bone substitutes in augmenting critical size defects (1) necessitate the development of other treatment modality. The field of biotechnology and tissue

Egyptian Dental Journal, 2017

Statement of problem: Management of subcondylar fracture with proper reduction of temporomandibul... more Statement of problem: Management of subcondylar fracture with proper reduction of temporomandibular joint position and function is a challenge, different osteosynthesis devices are used with great diversity in their types, numbers, positions, and results. Purpose: Comparative study between the efficiency of single miniplate and single minidynamic compression plate in restoration of ramus height, condylar angulation, and tempromandibular joint function in subcondylar fracture cases. Material and Method: 14 patients indicated for open reduction and fixation of subcondylar fractures were divided into two groups each of 7 patients. Group A: subcondylar fractures were fixed using 2.0 single miniplate along posterior border of ramus. Group B: a single 2.0-mm minidynamic compression plates (DCP), were applied along posterior border of ascending ramus for fracture fixation in the other seven patients. Intermaxillary fixation for 10 days was applied for both groups. Clinical and radiograhic follow up were performed at 1, 3, 6 months using panorama and CT. Results: At 6 months postoperatively, there was an improvement of mandibular functions with improvement of inter-incisal opening from 19.1mm and 20.1 mm in group A and B respectively to 35.6mm and 30.8 mm. Which was significantly different (P value =0.04). The shortening in ramus height improved from 3.2mm and 5.2mm in group A and B to 0.8 mm and 0.6 mm, also sagittal angulation of condyle improved from 1.6º and 4.7º in both group respectively to 0.2º and 0.3º with no significant difference between two types of mini-plate. There were no signs of infection, malunion, nonunion or device failure in both groups. except for one case of group A, that suffered from malocclusion with displacements of the fractured segments immediately after the operations, that responded to elastic traction within 15 days. Conclusion: Single 0.2mm miniplate or mini DCP aided by intermaxillary fixation are successful devices in fixation of subcondylar fracture without complication, with superiority of mini DCP in proper condylar reduction and stable fixation.

Al-Azhar Dental Journal for Girls, 2019

Purpose: The aim of the study was to compare between computer guided surgery and the traditional ... more Purpose: The aim of the study was to compare between computer guided surgery and the traditional method in preserving vertical ramus height (VRH) and the skull base thickness during gap arthroplasty in patients with the TMJ bony ankylosis. Material and methods: Twelve patients with 15 joints suffering from true bony TMJ ankylosis were included in this study. The patients were divided into 2 groups: Group A (8 joints); The ankylosis was released by computer-assisted 1cm gap arthroplasty. Group B (7 joints); The ankylosis was released by traditional 1cm gap arthroplasty. Pre and postoperative clinical examinations included: measurements of maximum interincisal opening, midline deviations or deflections during mouth opening or closing, presence of open bite, recording any sign/symptoms of infection, facial nerve function evaluation. Preoperative radiograph were measure the preoperative VRH, and aid in construction of the surgical guide for group A, while, postoperative radiograph performed for measure the VRH and skull base thickness. Result: Clinically improvement in the midline shift and occlusion during physiotherapy period postoperatively for all cases in group A except in one patient. While, clinical result in group B revealed increase in the midline shift, and change in occlusion postoperatively. Radiographically: there was no statistical significant difference between the 2 groups in postoperative VRH loss measurements. There was statistical significant difference between the 2 groups in postoperative skull base thickness. Conclusion: Computer assisted surgical simulation could help the surgeon to preserve the VRH and the skull base that reflects positively on the postoperative clinical outcomes.

International Journal of Oral and Maxillofacial Surgery, 2018

Despite the wide uses of mandibular distraction osteogenesis (MDO), no study appears to have eval... more Despite the wide uses of mandibular distraction osteogenesis (MDO), no study appears to have evaluated the use of MDO and subsequent advancement genioplasty. This study addressed lower facial third aesthetics in a consecutive series of subjects with micrognathia who underwent MDO and subsequent advancement genioplasty. Standard cephalometric measurements were performed pre-MDO, at the end of consolidation, and at 1 week, 6 months, and 12 months after genioplasty. At the end of follow-up, questionnaires were given to measure patient satisfaction. Forty patients were included, 33 of whom underwent genioplasty. The mean patient age was 22.35 AE 1.12 years. Pre-genioplasty cephalometric measurements showed that all patients had a deficient chin position and projection; they were dissatisfied with their facial aesthetics. Post-genioplasty cephalometric measurements showed that the hard and soft tissue pogonion had moved significantly: 8.4 AE 2.3 mm and 11.0 AE 2.11 mm, respectively. According to the questionnaire, the patients were satisfied with the final results. The MDO reduced the amount of chin advancement and minimized relapses; the soft tissue response of the lower facial third was more sensitive to genioplasty than isolated MDO. MDO and genioplasty lead to a modest horizontal chin movement that achieves the preferred pogonion position and projection.

Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 2017

Objectives: Pediatric maxillofacial fractures are less common as compared to adults, however, the... more Objectives: Pediatric maxillofacial fractures are less common as compared to adults, however, they may lead to serious complications. Methods: The study aimed to retrospectively correlate demographic data, facial fractures characteristics, and patterns among pediatric patients who were managed at 3 of the governmental Egyptian Hospitals from 2008 to 2016, and discussing the treatment protocols. The study included 104 patients presented with maxillofacial traumas. Those with dentoalveolar and/or dental injuries were excluded. All the patients were treated by conservative approaches, except those in whom surgical interventions were mandatory. Results: The mean age of 104 patients was 10.94 ± 3.92 years. The female/male ratio was 1:1.4. Females' fractures were mainly due to falls (17.31%). Road traffic accidents (RTAs) were the most common cause in males, followed by sports injuries (17.31.8%), then assault (10.58%). The most prevalent site of fractures was the mandible (67.31%) in particular condylar fractures. All the fractures were healed successfully, but restricted mouth openings were the most common sequela. Conclusion: The RTAs were the main cause. Males and condylar fractures have the highest predominance. The conservative treatment is still the treatment of choice in pediatric fractures. Pediatric fractures must be followed longitudinally to avoid post-traumatic sequelae.

Journal of Oral and Maxillofacial Surgery, 2016

PURPOSE A restricted mouth opening (MO) is predominantly a complication of maxillofacial trauma i... more PURPOSE A restricted mouth opening (MO) is predominantly a complication of maxillofacial trauma in pediatric patients and develops in 4 to 26.2% of cases. The purpose of the present study was to quantitatively investigate the influence of patient demographic data, fracture characteristics, and regular vigorous physiotherapy, with either voluntary or forcible MO exercises, on the recovery of a post-traumatic restricted MO in pediatric patients. PATIENTS AND METHODS A prospective cohort study was performed of pediatric patients with maxillofacial injuries who had been referred to Al-Zahraa and El-Fayoum Hospitals from 2013 to 2015. The predictive variables were patient demographic data, fracture characteristics, and regular vigorous physiotherapy. The patients were treated with a closed technique. The MO measurements were the clinical outcome variables and were recorded at the first week and then monthly for 12 months. Regular vigorous physiotherapy was performed until the patients had returned to their preoperative MO. The data were tabulated and statistically analyzed. RESULTS Eighty-six patients were enrolled in the present study. Males predominated. Falls were the most common cause of fracture. Condylar fractures had the greatest incidence. A restricted MO occurred in 81 patients. The results showed no interaction between MO recovery and age, gender, etiology, or fracture site. After physiotherapy, the patients had returned to their preoperative MO at the fourth month, with the measurements fixed at normal values at the sixth month. The recovery rate was nonlinear, with faster improvement in the months closest to the injury. CONCLUSION Physiotherapy is more critical in the recovery of the MO and prevention of bony ankylosis than patient data or fracture characteristics in pediatric trauma. We highly advocate the performance of voluntary mouth exercises, even in the absence of fracture. Forcible MO exercises are mandatory to recover a restricted MO. These exercises should be performed under close supervision of the patient's surgeon with the parents motivated to cooperate for at least 6 months.

International journal of oral and maxillofacial surgery, 2015

A retrospective study was conducted to compare the clinical outcomes of three different types of ... more A retrospective study was conducted to compare the clinical outcomes of three different types of hardware that are used in mandibular angle fracture fixation. Thirty patients were selected from the hospital database. The patients were categorized into the following groups: group A, in which a single 2.0-mm locking miniplate was used; group B, in which a single rigid 2.3-mm plate was used; and group C, in which a single lag screw was inserted. All patients were followed for 6 months. With regard to intraoperative variables, significant differences were found among the groups in the duration of surgery and cost. Group C had the shortest surgical time, followed by group A and then group B. Two patients, one in group A and one in group B, suffered an occlusal discrepancy after surgery. Of the group A patients, two exhibited wound dehiscence and one had an infection. One patient in group B had an exposed plate. Sensory nerve involvement was noted in three group C patients and one group B...

Australian Journal of Basic …, 2010

Lecturer of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Azhar 1 Universi... more Lecturer of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Azhar 1 University, Girl Branch. Lecturer of Oral and Maxillofacial Surgery, Abo El Reesh,Cairo University Hospitals. 2 Assistant Professor of Oral and Maxillofacial Surgery, Research Institute of ...

Background: The study aimed to determining the magnitude of the power of the aromatherapy at whic... more Background: The study aimed to determining the magnitude of the power of the aromatherapy at which it reduces the intensity of dental pain and level of dental anxiety. Also, it aimed to correlate between olfactory aromatherapy, phases of dental visits, and different dental procedures. Methods: A randomized controlled study was enrolled on female patients. The olfaction was stimulated via lavender oils. Patients were randomly divided into a lavender group in which patients inhaled 2 % of lavender vapors and control group where the patients inhaled water vapors. The variables included pain score, anxiety score, and changes in vital signs. Modified Dental Anxiety Scale (MDAS) and Speilberger State-Trait Anxiety Inventory (STAI) questionnaires and visual analog scales (VAS) were used to assess anxiety and pain. Vital signs included systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and oxygen saturation (Spo2). Variables were assessed before inha...

Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2015