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Purpose: The inferior alveolar nerve block (IANB) is a necessary and frequent local anesthetic injection in dental practice in which the conventional technique is generally applied. However, multiple studies reported that the failure rate of IANB is high, whereupon our study aimed to assess the modified and conventional IANB techniques, concerning the success rate. Methods: A split-mouth single-blind randomized clinical trial study was conducted on 42 patients (84 cases) as paired analyzing, between 18 to 55 years-old, who needed bilateral IANB for posterior mandibular teeth extraction. To apply the modified technique, the barrel of the syringe was located in the corner of the mouth; while mouth is open wide and the needle-penetrated mucosa exactly lateral (anterior) to the pterygomandibular fold (PMF). The needlepoint was 5–15 mm above the occlusal plane (OP) according to the digital panoramic radiography and parallel to OP. The outcomes were analyzed using the Cochran-Mantel-Haenszel test. Results: The success rates were 97.6% in the modified IANB and 83.3% in the conventional technique, evaluating in the first 10 minutes.Conclusion: The clinician can operate IANB by modified technique with fewer anatomical landmarks, clear injection points and the higher success rate upon which the performance will be easy by the beginners. Trial registration IRCT20150924024167N2, on 07.03.2020, was retrospectively registered.

This research introduces a green/novel route for preparation of an epoxy system with bi-functional active/passive anti-corrosion properties via inclusion of modified/reduced graphene nanoparticles. For the first time, the reduced nanosheet (RGO) with the barrier-inhibitive activities was prepared using bioactive reductant based on histamine. Also, zinc cations were loaded onto RGO sheets by two sequence based (RGO-Hist-Zn-I nanosheet) and in-situ based (RGO-Hist-Zn-II nanosheet) approaches. Characterization of the synthesized RGOs using X-ray photoelectron spectroscopy, field emission-scanning electron microscopy, transmittance electron microscopy, ultraviolet-visible and inductively coupled plasma techniques approved the precision of graphene oxide reduction via histamine and zinc cation's chemical adsorption. The performance of the RGO nanosheets was investigated by electrochemical impedance spectroscopy, potentiodynamic polarization, salt spray, pull off adhesion, cathodic disbondment (CD) and energy dispersive X-ray spectroscopy analyses. The results clarified that the epoxy coating reinforced with RGO-Hist-Zn-I provided the best anti-corrosion performance (log |Z|10 mHz = 9.73 Ω cm2 after 60 days immersion in NaCl solution), self-healing property (liberation of histamine and zinc cations from the nanocomposite bulk to the scratch region after 8 h immersion), adhesion to steel surface (lowest adhesion loss, i.e. 14.2% after 38 days of immersion and CD resistance (ca. 4.7 mm).

The main aim of this research is studying the corrosion inhibition properties of the combination of praseodymium nitrate (PrN) and Urtica Dioica (UrDi) on mild steel in sodium chloride solution. Fourier transform infrared (FT-IR), ultraviolet-visible (UV-Vis), thermogravimetric analysis/differential thermogravimetry (TGA/DTG) and X-ray photoelectron spectroscopy (XPS) results confirmed complex formation between Pr cations and UrDi (Pr-UrDi). Electrochemical results revealed that the Pr-UrDi hybrid complex had significant influence on the mild steel corrosion protection (by inhibition efficiency of ca. 94%) in NaCl solution.

Introduction: In recent years, the prevalence of attacks perpetrated by humans against other humans has increased worldwide. The injuries suffered by attack victims are severe and multi-organ. Iran’s neighboring countries have been the scenes of attacks in the recent past. This study assessed the type and severity of injuries sustained by victims transferred to Iran during the time period 2005-2007. Methods: This study was conducted on injured civilians transferred to hospitals in Iran. Data regarding cause of injury, type and severity of injuries, diagnostic-therapeutic interventions, and patient outcomes was collected and statistically analyzed using SPSS version 14 software. Results: In the studied time period, 214 attack victims were transferred to 3 Level 1 trauma centers in Iran. The mechanisms of injury were explosion in 130 cases, gunshot in 48, and other causes in the remaining victims. The mean Injury Severity Score (ISS) was 5.91 ± 4.54 (range = 1-34), and the median was 4; 109 cases (51%) had an ISS between 1 and 8, 73 cases (34%) were scored between 9 and 14, 15 cases (7%) were scored from 16 to 24, and 17 cases (8%) had an ISS ≥25. In terms of the number of injured organs, 42 patients (20%) had one, 124 (58%) had 2, 36 (17%) had 3, and 12 patients (5%) had 4 or more injured organs. Procedures included 86 orthopedic, 25 general surgical, 21 ear, nose, and throat (ENT), 18 plastic, 15 neurosurgical, and 10 ophthalmic operations; 25 patients received psychiatric counseling. The mean (±SD) hospital stay was 13.43 (±19.76) days (range = 1-230). Conclusion: The injury pattern in attacks is more severe and differs from other traumas. The medical team should have adequate knowledge in this respect to provide comprehensive healthcare.

The effect of an epoxy resin modifier was studied on the performance of an oxidized bitumen binder. Four types of analysis were conducted including physical, mechanical, viscoelastic and thermal properties in order to study the impact of the epoxy resin on the bitumen performance. Fourier transform infrared (FTIR) and differential scanning calorimetry (DSC) studies revealed the reaction of the epoxy functional groups with the oxidized bitumen at elevated temperature. The DSC results of the epoxy-modified bitumen showed two glass transition temperature (T g ), which are related to the maltene part of the bitumen (T g1 ) and the physical adsorption and/or chemical interactions between epoxy resin and asphaltenes of the bitumen (T g2 ). 5% (w/w) of epoxy resin addition to the bitumen leads to the highest increase in softening point temperature of the bitumen (about 11 °C). Evaluation of the epoxy-modified bitumen showed an increase in hardness compared to the neat bitumen using shore ‘A’ test. Different epoxy-modified bitumens demonstrated an enhancement of storage modulus and also decrease in tan δ using dynamic mechanical thermal analysis (DMTA). Improvement in tensile strength and decrease in toughness and also elongation at break were observed for the oxidized bitumen modified with the epoxy resin. Thermogravimetric analysis (TGA) proved that the epoxy resin improved thermal stability of the bitumen.

Context: The face is the most exposed part of the body; therefore, the maxillofacial region is vulnerable to trauma. The evaluation of the incidence and etiology of maxillofacial traumas is necessary to disclose the pattern of fractures. Objectives: The study aimed to evaluate the pattern of maxillofacial fractures (MFs) and associated injuries by a literature review. Data Sources: Original papers investigating the pattern of MFs and associated injuries published before November 2018 were examined. Online sources including PubMed, Scopus, Medline, Wiley, ISI Web of Knowledge, and EMBASE were searched for these papers. The extracted data included study characteristics, participants’ characteristics, MFs causes, and distribution of various MFs. Results: In total, 17,055 patients (men: 83.61%; women: 16.38%) were examined. The age range was 21 - 30 years in 40.89% of the patients with MFs. The most common risk factor of fractures was road traffic accidents (45.33%). Mandibular fractures were more frequent than other injuries. Condyle was the most common mandibular fracture (25.89%). Le Fort II was the most common site in the middle-third fractures (30.29%). Conclusions: The results showed that maxillofacial fractures were more frequent in men, in the age of 21 to 30 years, in the site of the mandible, and mainly caused by road traffic accidents.

The location of the mandibular foramen (MF) on digital panoramic radiographs can be an important guide for clinicians when administering the inferior alveolar nerve block (IANB) for dental anesthesia of the mandible. This study, aimed to assess the location of the MF relative to the anterior border (AB) of the ramus and the occlusal plane (OP) from digital panoramic radiographs. An observational case series study was conducted on digital panoramic radiographs from the oral and maxillofacial radiology department archives of patients at least 18 years of age with a 1:1 scale (100%). The samples had to have at least 2 lower molar teeth on both sides without any blurring, previous fracture of the ramus or other artifacts. The distance of the MF to the OP and the AB of the ramus was measured using a caliper. The role of age and gender were also analyzed statistically using the 2-way analysis of variance test. One hundred ninety-four digital panoramic radiographs were included in the analysis. The findings showed that the vertical distance of the MF to the OP was a maximum of 14.52 mm and a minimum of −3.0 mm (mean 4.32 ± 2.34 mm). The distance of the MF to the AB of the ramus was a maximum of 25.52 and a minimum 9.68 mm (mean 16.48 ± 3.28 mm). Based on these findings, the IANB target site for injection should be approximately 5 mm above the OP and approximately 16.5 mm beyond the AB of the ramus to achieve successful anesthesia of the mandible via standard IANB in an Iranian population.

Background: The management of maxillofacial injuries is one of the most common challenges in the healthcare field as surgeons, who treat these patients have additional responsibilities in terms of esthetic reconstruction as well as restoration of the patient’s appearance and function.Objectives: The aim of the present studywas to evaluate the epidemiology and etiology of trauma at BualiHospital of Tehran during 2008 to 2016.Methods: In this retrospective study, the files of all the trauma patients (n = 293) that had referred to Buali Hospital were investigated, and demographic data and etiologic factors were extracted. Radiographs were analyzed with regards to fracture patterns. The results were statistically analyzed using the SPSS 22 software.Results: The mean age was 29.18 ± 14.74 years in males and 34.48 ± 19.81 years in females. Fractures were more frequent at ages between 21 and 30 years (39.9%) and less common among 71- to 84-year-olds (2.4%). Most patients were males (78.8%). Of all 474 fractures in 293 patients, zygomatic fractures were the most common fractures (18.6%), while Lefort III in the maxilla was the least common type (1.3%). The main cause of fracture was motor vehicle accidents (51.5%), whereas workplace injuries were uncommon (11.4%).Conclusions: According to the results, fractures often occur in males in the third decade of life due to their roles in the community. In the current study, similar to other studies carried out in developing countries, the main cause of fractures was motor vehicle accidents. Most of the patients were treated by open reduction. The most frequent side effect was sensory disorders.

The bath pH, vanadia solution concentration and immersion time as reaction parameters of vanadium-based conversion coating (VCC) for chemical surface treatment of ST12 mild steel are optimized. The improvement process was evaluated by utilizing linear polarization resistance (LPR) method on the V-treated samples submerged in 3.5% NaCl electrolyte. The LPR measurements provided an optimum anti-corrosion behavior with highest polarization resistance (Rp) for a steel surface treated in 50 mg L−1 V2O5 aqueous solution for 60 s at pH = 3. The formation process of optimized VCC on mild steel was inspected in situ by electrochemical noise measurement (ENM). Through the inverse of noise resistance (1/Rn) interpretation, three distinctive steps of VCC formation on the steel surface were deduced. The impact of optimized VCC on the metal surface chemistry was investigated with static water contact angle (CA) measurements, which showed a ca. 6.5° CA decrease along with enhancement of the mild steel surface free energy. Field emission-scanning electron microscopy (FE-SEM), elemental mapping of energy dispersive X-ray (EDX) and atomic force microscopy (AFM) studies of treated surfaces revealed a VCC thin layer that consisted of very small nano-sized particles as vanadium oxides/hydroxides compounds. Electrochemical impedance spectroscopy (EIS) and open circuit potential (OCP) methods were applied to study the anti-corrosive behavior of VCC treated mild steel during degradation in 3.5% NaCl corrosive media.

Purpose Morbidity and death after facial trauma are substantial issues of concern both in civilians and in military personnel. This cross-sectional retrospective study sought to assess the prevalence, pattern, treatment, and complications of soft and hard tissue injuries of the face in military personnel from 2012 to 2018. Patients and Methods This cross-sectional, retrospective, chart study analyzed the descriptive statistics of 591 patients by use of Microsoft Excel software (version 2013; Microsoft, Redmond, WA); we assessed military casualties treated at our hospital from 2012 to 2018. All military personnel were documented in our trauma registry. The patient records were studied, and information relating to patients' injuries was documented and assessed after compilation of patient data. This study was approved by our local institutional review board; the causes and complications of maxillofacial (MF) trauma were assessed. Statistical analysis was done. This study used descriptive statistics based on a total of 591 patients and Microsoft Excel software (version 2013). Results Among maxillofacial (MF) fractures, midface fractures (49%) were most prevalent, followed by lower face fractures (43%) and upper face fractures (24%). The most common cause of injury was explosives (58%). The most frequent site of fracture in the mandible was the angle region, followed by the mandibular body and condyle. Nasal fractures were seen in 44% of midface fractures. The most commonly used technique for treatment was open reduction–internal fixation, which was used in 89% of patients. Conclusions The pattern of MF injuries and the treatment modalities used to treat these patients showed that the most frequent type of injury was midface fracture and most patients were treated by open reduction–internal fixation.

PURPOSE: Retrospective studies on the types and causes of facial burns are important because the patterns might vary in different societies. Our aim was to assess the burn-related factors of significance that might be useful in healthcare planning and implementing preventive strategies, adding to the body of current data on the subject. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted to assess the data from a major burns referral center during a 5-year period (2009 to 2013). The data relevant to age, gender, cause, source, location, burn degree, extent (body surface area [BSA]) of the burns, and mortality were gathered from comprehensive patient medical records, recorded, and analyzed using SPSS, version 20, software (SPSS, Chicago, IL). RESULTS: Within the study period, we found 808 documented cases of second- and third-degree facial burns. These burns were more common in men (81.9%) and in the 16- to 35-year age group (42.3%). The mean hospitalization was 9.85 ± 8.94 days. In 443 patients (54.83%), 10 to 19% of their BSA was burned, and 3.06% had associated inhalation burns. The most common burn was scalding (19%), and the deadliest was burns from acid, with a mortality rate of 7.4%. Accidents accounted for 776 burns (96.03%). Other causes were attempted homicide (16 cases, 1.98%) and suicide attempts (16 cases, 1.98%). The overall mortality was 1.6%. CONCLUSIONS: The key findings were that second- and third-degree facial burns were more common in males aged 16 to 35 years with burns covering 10 to 19% of the BSA. Accidental scalding was commonly responsible for the second-degree burns, and electrical accidents were commonly responsible for third-degree facial burns. Burn accidents occurred more often at the patient's home. Language: en

Objectives: To investigate the level of bacterial contamination in ventilation devices after being connected to head trauma patients with confirmed ventilator-associated pneumonia. Methods: This prospective, cross sectional study was carried out at Shahid Mohammadi hospital, Bandar-e Abbas, Iran. Samples for assessing the contamination of ventilators were obtainedfromexpiratoryandinspiratory tube insertion sites before connecting the device to the patients. The patients were then observed for the development of ventilator-associated pneumonia and were enrolled in the study if considered eligible. Sampling was repeated after disconnecting the patient. The following variables were assessed in each patient: gender, age, Glasgow Coma Scale upon hospitalization, length of stay in the intensive care unit (ICU), and mortality. Results: A total of 33 patients, including 26 men and 7 women, were enrolled in the study. There was no significant association between ventilation contamination and time of sampling (before or after ventilation) in the evaluated sites (P > 0.05). However, based on McNemer’s test for equality of frequencies, the prevalence of positive culture after disconnecting the device from the patients (60.6%) was not the same as the prevalence before being connected to the patients (21.2%) at inspiratory tube insertion sites (P = 0.002). Also, at both sites, the variety and pathogenicity of microorganisms after disconnecting the device were higher than those of microorganisms, colonized from samples which were obtained before connecting the device. Conclusions: The findings of the present study showed that mechanical ventilation of patients with pulmonary infection leads to the contamination of ventilators. These findings suggest the need for designing and implementing new measures, which are easily available in developing and resource-deficient countries in order to reduce the contamination of ventilation devices and prevent cross-contamination.

Compared with other maxillofacial lesions, oral and maxillofacial (OM) aneurysmal bone cysts (ABCs) are rare, and most studies have been case reports. Because the features or radiographic findings of 1 case could not be representative of the whole, conclusions cannot be drawn and data analyses will not be feasible. Our aim was to assess and describe the clinical and histopathologic characteristics of a large sample of subjects with ABCs. To our knowledge, the present case series of OM ABCs is the largest ever reported.To address our research purpose, we designed and implemented a retrospective case series. A multicenter retrospective cohort study of patient charts dated from 1967 to 2013 (46 years) at 10 major universities in 8 cities was undertaken to assess OM ABCs nationwide. Subjects were included if they had documented chart data and definitive histopathologic slides confirming the diagnosis and treatment of ABC. They were excluded if their histopathologic slides did not confirm the diagnosis of an ABC. Data were collected, and special forms were completed. Variables such as age, gender, site (ie, maxilla, mandible, anterior, posterior), histologic type (ie, solid, mixed, vascular), signs, symptoms, radiographic features (ie, radiolucency, unicystic or multilocular), and outcomes (ie, treatment modal, recurrence, complications) of the lesion were evaluated and documented by OM surgeons and confirmed by OM pathologists for assurance. Data analyses were performed using Statistical Package for Social Sciences, version 20, software (SPSS, Chicago, IL) (P.05).We assessed the medical records and histopathologic slides of 120 patients diagnosed and treated for OM ABCs nationwide. Of these patients, 69 were male (57.5%) and 51 were female (42.5%), with no predilection found. The key findings were as follows. The mean age of occurrence was 20.7 ± 2.5 years (range 4 to 78), and occurrence was significantly greater in the first 2 decades of life (P.001). The incidence was 2.6 cases/year. ABCs were significantly more common in the mandible (P.05) and posterior areas (P.05). The most common histopathologic type was the mixed type (P.05). Firm swelling was the most common clinical presentation (P.05); all cases were radiolucent and commonly unilateral (P.05). Most were treated by excision and curettage. Recurrence was reported in 11 patients (9.2%) during the follow-up period (1 to 45 years).The present retrospective cohort found ABCs with a variable presentation, disease course, and histopathologic type, with no gender predilection. ABCs were significantly more common in childhood and adolescence and in the mandible and posterior areas of the jaws. Of the cases reviewed, 90% were treated by excision and curettage. ABCs had a relatively low recurrence rate (10%), precluding the need to perform aggressive surgery primarily.

The subsequent effect of the use of monomeric cationic surfactants, dodecyltrimethylammonium bromide (DTAB) and its gemini counterpart, 12-4-12, in 1 M sulfamic acid cleaning solution on the corrosion resistance and adhesion strength of polyurethane coating on mild steel surface was studied by salt spray and pull off, respectively. The EIS (electrochemical impedance spectroscopy) was employed to evaluate the corrosion behavior of mild steel during the contact with sulfamic acid solutions. Inhibition performance of DTAB on mild steel at the initial period of immersion was somewhat higher than 12-4-12, while at prolonged immersion period 12-4-12 was more effective than DTAB. The higher protection and adhesion for the coating applied on the mild steel washed with DTAB solution was connected to more rapid adsorption for DTAB than 12-4-12 at short immersion period due to its small molecular weight which resulted in better mobility of DTAB molecules.

Purpose Perforation of the nasal septum is a frustrating problem frequently reported in the literature. Surprisingly, in most reports, iatrogenic perforation during septoplasty and electrocautery are the leading causes of this complication. This article presents the management of septal perforations and the indications for an extracorporeal approach. Materials and Methods Fourteen patients with septal perforations were referred for treatment. Treatment was chosen based on defect size. Flaps, extracorporeal repair, or no treatment was used as indicated. Results Two of 14 perforations were small and were repaired by local flaps, 5 cases were treated by extracorporeal repair, and the 7 remaining cases required no surgical procedure. Conclusions The extracorporeal technique, when indicated, can be used effectively for the repair of nasal septum perforations in selected cases.

Purpose The orbital cavity can be affected in zygomaticomaxillary complex (ZMC) fractures. The aim of this study was to assess the relation between orbital volume changes and enophthalmos in patients with ZMC fractures. Materials and Methods A descriptive study of consecutive adult patients with recent isolated unilateral ZMC fractures who were otherwise healthy was performed from 2016 through 2017. Multislice computed tomographic (CT) scans were taken of all patients and enophthalmos was measured clinically using a Hertel exophthalmometer. In the axial plane, enophthalmos was measured on CT scan using Mimics software. Three-dimensional reconstruction and volume measurement of the orbital cavity also were performed using Mimics software. The correlation between clinical and radiographic amounts of enophthalmos was measured by Pearson correlation coefficient analysis. The association among radiographic enophthalmos, clinical enophthalmos, and volume changes of the orbital cavity was assessed by linear regression. The P value was set at .01. Results Ninety-six patients (77 men, 19 women; mean age, 28.48 ± 8.29 yr) were assessed. Mean volumes of control and fractured bony orbits measured on CT scan were 29.02 ± 1.71 and 32.05 ± 2.22 cm3, respectively (P Conclusion ZMC fractures commonly increase orbital volume and the degree of change is strongly correlated with enophthalmos.

Background: Monocortical miniplate fixation is an accepted and reliable method for internal fixation of mandibular angle fractures. Although placement of a second miniplate may theoretically provide more stability; however, the clinical importance of this issue remains controversial. Objectives: The present study assessed the postoperative complications and outcomes associated with the fixation of mandibular angle fractures using 1 and 2 miniplates in patients with favorable mandibular angle fractures. Patients and Methods: A prospective study of 87 patients (73 males, 14 females) with favorable mandibular angle fractures was done. In the first group, a 4-hole miniplate was placed at the superior border through an intraoral approach. In group 2, patients were treated with 2 miniplates, one placed at the superior border (similar to group 1) and the other on the lateral aspect of the angle at the inferior border through an intraoral and transcutaneous approach using a trocar. Postoperative complications including malocclusion, malunion and sensory disturbances associated with surgery, additional maxillomandibular fixation (MMF) by means of an arch bar and wires for a longer period (for delayed union) and infection were assessed in patients of both groups up to 12 months postoperatively. The data were analyzed using the chi-square test. Results: In the single miniplate group, 25 patients showed lip numbness associated with surgery (55.6%), 22 patients required additional use of MMF (48.9%) and 3 patients developed infections (6.7%). In the double miniplate group 20 patients showed lip numbness associated with surgery (47.6%), 18 patients required additional use of MMF (42.9%) and 1 patient developed infection (2.4%). None of the patients in either group showed malocclusion or malunion. No significant difference was observed between the groups regarding overall complication rate. Conclusions: In this study, use of one miniplate or two miniplates for treatment of favorable mandibular angle fractures was associated with a similar incidence of complications. Thus, it seems that the use of two miniplates in this setting may not be warranted, nor cost-efficient.

The stability of the 1 M sulfamic acid solutions containing a gemini cationic surfactant (12-4-12) or its monomeric counterpart (DTAB) during 23 days of storage were studied by electrochemical impedance spectroscopy (EIS), X-ray diffraction (XRD) and surface tension measurements. The EIS studies indicated that in comparison to DTAB solution, 12-4-12 solution considerably retained the corrosion inhibition during the storage period. The surface tension of DTAB solution was increased around 10 mN/m during storage while the surface tension of 12-4-12 solution was almost unchanged. The higher stability of 12-4-12 acidic solution than that of DTAB was also depicted by XRD results.

Background: Hospital readmission places a high burden on both health care systems and patients. Most readmissions are thought to be related to the quality of the health care system. Objectives: The aim of this study was to examine the causes and rates of early readmission in emergency department in a Tehran hospital. Patients and Methods: A cross-sectional investigation was performed to study readmission of inpatients at a large academic hospital in Tehran, Iran. Patients admitted to hospital from July 1, 2014 to December 30, 2014 via the emergency department were enrolled. Descriptive statistics were used to summarize the distribution demographics in the sample. Data was analyzed by chi2 test using SPSS 20 software. Results: The main cause of readmission was complications related to surgical procedures (31.0%). Discharge from hospital based on patient request at the patient’s own risk was a risk factor for emergency readmission in 8.5%, a very small number were readmitted after complete treatment (0.6%). The only direct complication of treatment was infection (17%). Conclusions: Postoperative complications increase the probability of patients returning to hospital. Physicians, nurses, etc., should focus on these specific patient populations to minimize the risk of postoperative complications. Future studies should assess the relative connections of various types of patient information (e.g., social and psychosocial factors) to readmission risk prediction by comparing the performance of models with and without this information in a specific population.

Background: There is significant prevalence of physical injuries sustained by civilian recruits at military training garrisons. Civilian recruits sustain these injuries mostly during the intensive and rigorous military combat-training period. Objectives: We sought to determine the prevalence and causes of oral and maxillofacial injuries as the first step in reducing and preventing them in civilian recruits (males aged over18 years) during their 2-year mandatory military service. Materials and Methods: In this 2-year study, we referred to 11major military training garrisons in 8 provinces and collected data from available medical records of military clinics at each garrison. Injuries occurring in civilian recruits during the intense 2-month military combat training period were documented. Data regarding the number of civilian trainees, percentage of those injured, site where the injury was sustained, type of injury and its causes, etc. as well as demographic data were collected. Results: The number of civilians called to military service was 153, 886. The ratio of those injured was 4419/153,886. The percentage of maxillofacial injuries was 20.4% (903/4419). The majorities of maxillofacial injuries occurred during the first month (38%) and were due to nonmilitary (86%) rather than military (14%) causes. From among the military causes, bullets (66%) were the most common cause of injury, while falls (73%) were the major cause of nonmilitary injuries. Mountainous terrain was the main cause of falls (51%). The most common military incidents which led to injury were related to artillery fire and explosions (33%). Nasal bone fracture was the most common maxillofacial fracture (49%), and lacerations were the most common soft tissue injury (54%). Among dental injuries, tooth fracture was most common (66%). Conclusions: The large number of general and maxillofacial injuries in civilian recruits during the 2-month combat-training period at military garrisons is disconcerting. This issue warrants further research to implement methods for identifying, decreasing, and preventing injuries in civilians at military-training garrisons.

Background: Correction of digit deformities at or near the Joints is performed easily ; however, maintaining the result is often difficult either due to noncompliance of the patient to wear the postoperative splints or problems related to unequal growth of bones or normal tissues compared to the scarred or operated side. Objectives: The aim of this study was to overcome the above mentioned problems for which we propose the "Distal d Digit Syndactyly" technique. Materials and Method: This method is based on the concept of suturing the distal phalanx of the deformed digit to the normal adjoining finger to help prevent the recurrence of the anomaly during the child’s growth period or the very important three or four postoperative months of scar maturation in the adult. After the correction of deformity of the finger or toe, "Distal Syndactyly" is created by two flaps on the adjoining digits; one base is dorsally hinged and the other one volar and after elevating the flaps they are sutured together. During the three postoperative weeks care is taken that this attachment is not disrupted and after healing a "distal syndactyly" is created which is very durable and in children it stretches with growth and does not impede the digit’s growth. Results: Eleven patients with congenital and traumatic digit anomalies were treated. The recurrence of the problem was prevented in 9 patients; in 2 patients with intact Syndactyly the contracture recurred by stretching the Syndactyly skin. The period of the “Joining” ranged from 6 months to three years and cosmetic appearance was acceptable to the patient and parents. Conclusion: This technique by joining a deformed digit to a normally growing adjacent digit prevents the postoperative recurrence of the contracture or growth-induced deviation in the digits of noncompliant patients especially children.

Background: With the growing interest in long bone distraction several types of distractors have been introduced; all have the same principle of an outer structure which acts like a scaffold and the distracting mechanism is a separate device which is mounted on this outer structure. Objectives: We have used a simple and very light weight external fixator we designed and discuss the results of distraction and advantages of this device . Materials and Methods: We applied our distractor to treat 14 men and four women, with a mean age of 39 years. There were three thumbs and 23 fingers; 26 digits (18 patients) lengthened by distraction callotasis and second stage bone grafting evaluated accordingly. Results: All patients but one were satisfied with the results and a stable pinch and grip was obtained. After lengthening, all patients maintained sensation of the finger pulp, as assessed by the Semes - Weinstein test. Conclusions: The superiority of this device for manoplasty lies in its simplicity of construction in addition to being, lightweight and also eases of application.

Background Accessory cartilages are small nasal cartilages between the lateral crus and piriform aperture of the nose bilaterally. These cartilages are among the supporting structures of the nasal tip. Study Design This prospective cross-sectional study was conducted on Iranian fresh cadavers for evaluation of ethnic differences. Seventy-two sesamoid cartilages in 41 cadavers (mean age 42 years) were dissected to evaluate anatomy and anthropometry of the sesamoid cartilages. Elevation of the dorsal nasal flap after a collumellar incision was done. After the separation of the lower lateral cartilages and sesamoid cartilages on each side, the anatomy and anthropometry of the cartilages were assessed. Results In 12% (5) of the cadavers there were no sesamoid cartilages, and in 88% (36) of the cadavers there was 1 sesamoid on each side. The shape of the sesamoid cartilages was rectangular in 66% (27) and triangular in 22% (9). The mean length, width, and thickness were 3 mm, 2 mm, and 0.75 mm, respectively. Conclusions This cartilage was single on each side of the nose and its shape was an irregular rectangle or triangle and has an important role in preserving nasal alar contour and tip projection. These findings confirm ethnic variations in the sesamoid nasal cartilages when this Iranian population is compared with other populations assessed in earlier reports.

Necrotizing fasciitis of the upper extremity is reported.Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cas-es. In a significant proportion of patients, the extremities are involved as a result of trau-ma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and pre-sent our experience with this often lethal condition.