National journal of maxillofacial surgery最新文献

Background: Diagnosis and treatment of Carcinoma Buccal Mucosa is dependent on imaging techniques such as contrast-enhanced computed tomography (CECT), which is primarily used to stage the disease and predict resectability. Recent studies have identified a 'Borderline Resectable' subgroup in these patients who benefit with induction chemotherapy prior to surgery.

Materials and methods: This prospective observational pilot study, from April 2022 to March 2024, curated a dataset of 256 preoperative CECT scans of patients with stage IVA and IVB squamous cell carcinomas of the buccal mucosa, which were integrated into a novel artificial intelligence-based machine learning model designed to predict resectability for upfront surgery. We developed a Convolutional Neural Network-based predictive model to distinguish between "Borderline Resectable" and "Resectable Upfront" disease.

Results: The model displayed high performance with an overall F1 score of 0.8, efficiently stratifying tumors based on resectability. Integration with Gradio allowed access to run the model on a local server, which allowed real-time execution of the model. The area under the curve (AUC) for the training set was 0.9652, with 50.39% sensitivity, 96.65% specificity, 65.75% negative predictive value, and 94.20% positive predictive value. The validation set had an AUC of 0.9735, along with 98.40% specificity, 67.96% negative predictive value, 55.73% sensitivity, and 97.33% positive predictive value.

Conclusion: This study represents a first step toward the use of artificial intelligence to aid in the treatment to of patients with carcinoma buccal mucosa, allowing us to avoid the possibility of margin positive resection with upfront surgery.

Background: Third molar surgery, and more especially mandibular third molar surgery, is among the most often performed and popular operations in oral surgery. This is well known to have major postoperative adverse effects, including limited jaw opening, edema, and pain. Several approaches and biomaterials have been developed to reduce these complications, like osseous grafts, growth factors (PRF, CGF), stem-cell therapy, and osteopromotive substances like statins. Sticky bone, in recent years, has gained popularity due to its osseous and soft tissue healing potential.

Methods: The purpose of this clinical trial was to examine the effects of simvastatin and xenograft (sticky bone) on the region around the socket. In this study, 22 patients (representing 44 surgery sites) participated. The indicators of pain, edema, mouth opening, and gingival healing were evaluated in both groups on the third, seventh, and one-month marks. Regeneration of bone and density of bone were compared at the one-month and three-month marks.

Results: Patient's postoperative pain significantly reduced in both groups from third day to seventh day till one month with better outcome in group A (sticky bone) in comparison with group B (simvastatin). Swelling decreased postoperatively from third day till one month in both groups, with significant reduction in group A than group B at one month owing to the better soft tissue healing tendency of xenograft (sticky bone). Postoperative mouth opening showed improved outcome in group A in comparison with group B. Gingival healing was not significant when compared in both the groups. The overall comparison of the two groups revealed that there was increased bone regeneration and bone density in group A than in group B at the end of the third month.

Conclusion: Xenograft (sticky bone) was more effective in osseous regeneration of the extraction socket as well as more effective in reducing the postoperative complications in comparison with simvastatin (10 mg). Therefore, placement of sticky bone in the extraction socket is justified due to its excellent soft and hard tissue healing potential.

Introduction: Dentoalveolar fracture involves injuries to the dentition, periodontium and alveolar bone, which may occur individually or concurrently. The International Association of Dental Traumatology (IADT) guidelines recommend the use of flexible splints for a shorter duration in cases of dentoalveolar trauma.

Objectives: To compare and evaluate the intraoperative and postoperative outcome of the arch bar splinting and wire composite splinting in the management of Clark's Class II dentoalveolar fractures.

Materials and methods: Patients were randomized by Envelope method of randomization. Equal number of patients were randomly allocated to two groups, irrespective of age, gender, type, and severity of fractures. The study population was divided equally into two groups. Group A- Patients in whom dentoalveolar fractures were managed by arch bar splinting. Group B- Patients in whom dentoalveolar fractures were managed by wire composite splinting. All patients were managed by a single maxillofacial surgeon.

Results: The mean time for splinting in group B was 7.52±0.76 min. No glove perforation or intraoperative blood loss was observed in group B. No soft tissue injury in terms of mucosal ulcerations and gingival trauma was noted in patients of group B. The pain intensity recorded was mild on the VAS scale on postoperative day 1. This resulted in better patient comfort/acceptance of the treatment in patients of group B. Oral hygiene status evaluated by using Modified Turesky Gilmore Plaque Index was significantly better in group b as compared to group A(p=0.018).

Conclusion: Dentoalveolar fractures are mostly managed by closed treatment. The type and time of splinting depends on the type of injury and the amount of stabilization needed for the specific injury. The use of wire composite splint proved to be an ideal treatment option for Clark's Class II dentoalveolar fractures.

Post traumatic partial amputation of tongue is a rare but life-threatening condition as it may lead to active intraoral bleeding. In this article, we present a case in which successful surgical repair with appropriate functional and esthetic results. The patient presented to emergency department with tongue injury due to road traffic accident. On examination patient had laceration in which its distal fragment was attached to proximal with bands of soft tissue. Attempt was made to repair it but no revascularization signs were seen. So dissection was done repair using rotational flap. The tongue was repaired layer wise.

Bilateral masseteric hypertrophy is a rare entity affecting the lower third of the face. An uncommon idiopathic condition is related to increased volume bulk of masseter muscles. Several treatment modalities are employed for its management and surgical and conservative treatments. Surgical treatment aims at angle ostectomy along with muscle debulking. The purpose of this case report is to present a new precise technique applied for the angle resection of the mandible along with muscle debulking. A 17-year-old female visited our Department of Oral and Maxillofacial Surgery with a major esthetic complaint of wide asymmetrical angles of the jaw associated with mild tenderness on palpation and occasional reduced mouth opening. To reduce the unpleasant lower facial third appearance, intraoral incisions were placed on both sides and bilateral angle resection was accomplished using a planned ostectomy using the fabricated splint for precise cuts. Patient satisfaction was achieved esthetically and functionally too. Six months of postoperative follow-up produced uneventful outcomes. Prominent square-shaped appearance of the lower face was precisely converted to an optimal oval face with the use of stereolithographic model fabrication and a surgical splint guide.

Context: Panchavalkala extract has anti-inflammatory properties and has been tested in gynecological wounds, especially in cesearian wounds. The study aims at the extract being used for maxillofacial wounds, especially in lateral eyebrow incisions, which is the approach for the reduction of frontozygomatic fractures.

Aim: The study aims at evaluating the soft tissue wound healing in lateral eyebrow incisions with 5% w/v Panchavalkala water extract, 5% w/v Panchavalkala alcohol extract, and 5% w/v Panchavalkalahydroalcohol extract.

Settings and design: The randomized interventional study according to consort guidelines and ethical clearance, parallel-group design, and allocation groups (1:1:1) with four groups. Group 1: 11 patients having frontozygomatic fractures was applied with 5% w/v Panchavalkala water extract. Group 2: 11 patients with frontozygomatic fractures were applied with 5% w/v Panchavalkala alcohol extract. Group 3: 11 patients with frontozygomatic fractures were applied with 5% w/v Panchavalkala hydroalcohol extract. Group 4: 11 patients with frontozygomatic fractures were applied with Neosporin ointment (control).

Materials and methods: The Panchavalkala quath and its various group preparations were used, and preparation was applied in the lateral eyebrow incisions of isolated frontozygomatic fractures and evaluated. Evaluation involved measuring various parameters such as slough, swelling, redness, pain, discharge, tenderness, and malodor at specific intervals postoperatively (day 1, day 7, day 15, and day 30).

Statistical design: The groups were evaluated with Kruskal-Wallis analysis of variance (ANOVA) tests. Group 3, which received the 5% w/v panchavalkahydroalcohol extract, exhibited the highest level of improvement, followed by group 2 (5% w/v panchavalka alcohol extract), group 1 (5% w/v panchavalka water extract), and finally group 4 (Neosporin ointment).

Results: These findings strongly support the superior healing properties of the 5% w/v panchavalkahydroalcohol extract for soft tissue wound healing.

Conclusion: The 5% v/w hydroxyalcohol extract of Panchavalkala gave excellent results in terms of all parameters of healing compared to the other two groups and hence can be the future for many studies.

Purpose: Enucleation of the maxillo-mandibular cysts will create post-surgical bone defects, which may take more than a year for complete bone healing. Bone grafts are common to aid bone regeneration in large defects. The aim was to evaluate the clinical and radiographical healing and bone formation capabilities of polymer of i-PRF and hydroxyapatite in maxilla-mandibular defects compared to hydroxyapatite (HA) alone. The primary objective was to do a clinical assessment of healing at postoperative days 1, 3, and 7; and a radiological evaluation of bone formation postoperatively at the 2^nd month and 4^th month. A secondary objective was to identify if any, local or systemic side/ill effects of polymer of i-PRF with HA.

Material and methods: After surgical enucleation of 19 maxillo-mandibular cysts/tumors, either HA or HA + i-PRF graft was adapted to the defect. Clinical outcome variables such as Pain (VAS score), edema, and mucosal color were evaluated on postoperative days 01, 03, and 07 while radiological outcome variables such as volume of the defect (cc), and Density of new bone (HU) on Computed Tomography were evaluated at 2^nd and 4^th month. The results obtained were tabulated and compared with the inferential analysis.

Results: Clinical parameters are better in the HA + i-PRF group but the result was non-significant. Radiologically, the mean healing ratios were significantly greater in the HA + i-PRF group (63.5 ± 2.34 at 2^nd month, 90.3 ± 7.32 at 4^th month) compared to the HA group (57.2 ± 5.21at 2^nd month, 80.8 ± 5.33 at 4^th month). When comparing the mean density of new bone, there was a statistically significant difference with a mean difference of 95.2 HU more in the HA + i-PRF (623 HU ± 42.9) compared to the HA group (528 HU ± 96.5) in 2^nd month.

Conclusion: The polymer of i-PRF and HA prepared as the sticky bone yields faster and better bone healing in post-enucleation maxilla-mandibular bony defects as compared to hydroxyapatite alone based on radiological findings till 4 months.

Residual ridge resorption (RRR) is an inevitable physiological process occurring after the extraction of teeth. The annual rate of resorption is thought to be more in the mandible as compared to the maxilla leading to loss of support and retention in the mandibular conventional prosthesis. The compromised retention and stability of conventional dentures in the mandible lead to the denial of a patient to wear the prosthesis. Rehabilitation of resorbed ridges using implant-supported prosthesis has led to enhanced retention and an increase in chewing efficiency, leading to better acceptance of prosthesis by the patient. This case series describes the rehabilitation of mandibular resorbed ridges using various approaches for implant-retained prosthesis utilizing both conventional and digital means.

Introduction: Oral submucous fibrosis (OSMF) is a prevalent disease in India, mainly caused by tobacco chewing (areca nut, pan masala, and betel quid). Its treatment is still under debate, as none of the treatment modalities have been statistically superior to one another, may it be medical or surgical.

Aim and objective: Clinical and interleukin-6 (IL-6) assessment in patients of submucous fibrosis at baseline and 3 months of follow-up, after intervening their usual treatment with the herbal extract.

Methodology: Sixty patients were randomly divided into two groups. Group 1 was given the standard treatment, while group 2 was given herbal extract along with the standard treatment.

Results: A significant reduction (P < 0.05) in burning sensation and pain upon mouth opening was observed in group 2 patients. Also, comparatively more decrease in the level of IL-6 was noted in group 1.

Discussion: Sphaeranthus, Ocimum, and honey are already being used, separately or together, in many diseases as anti-inflammatory, antimicrobial, and antioxidant.

Conclusion: The herbal extract, used in this study, can be used as an adjunct in OSMF for alleviating the painful symptoms at an early stage.

There are currently conflicting views on the value of using antimicrobial prophylaxis in dental procedures, including extractions and implants. This review intended to highlight the common use and misuse of antibiotic treatment regimens in a dental setting, particularly in third molar surgery. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study has been reported accordingly. The purpose of the present systematic review was to evaluate the use of antibiotics during therapeutic orthodontic treatment involving third molar extractions, with the aim of reducing the likelihood of postoperative complications. The systematic review was conducted using online databases such as the Cochrane Central Register of Controlled Trials, PubMed, and Scopus. A set of inclusion and exclusion criteria was applied, focusing on randomized controlled trials (RCTs) that investigated antibiotic treatment for third molar surgery and were published up to 2021. The total 20 RCTs were included. The findings indicated that amoxicillin, both with and without clavulanic acid, was frequently used as an antibacterial agent in various doses and durations. However, there were no statistically significant differences in postoperative complication rates between the treatment groups. There is currently insufficient evidence to recommend standard antibiotic prophylaxis for healthy young individuals undergoing third molar extraction surgery. Additionally, antibiotic-related adverse events were not statistically different from those observed in placebo groups. Based on our findings, the risk of allergic reactions and the potential for developing antimicrobial resistance necessitate a careful and judicious use of antibiotics in mandibular third molar extraction procedures, even if cost is not a limiting factor.