Head & Face Medicine最新文献

Objective: This study aimed to assess the thickness and ultrasonographic pattern of the masticatory and suprahyoid muscles in OSA patients and compare the effects of mono-bloc (MB) and bibloc (BB) mandibular advancement devices (MADs) via ultrasonographic measurements.

Methods: This pilot study of 20 patients with mild-to-moderate OSA who were diagnosed by full-night polysomnography (manually scored by the American Academy of Standards and Methods (AASM) manual, version 2.4) and treated randomly with mono-bloc or bibloc MAD (n = 10). The baseline thickness and pattern (types I, II, and III) of the masticatory and suprahyoid muscles were assessed by an oral radiologist. The same procedure was repeated at the 3-month and 6-month follow-up time points for participants after appliance use.

Results: Both types of MAD devices significantly increased the thickness of all muscles (p < 0.05). The changes in ultrasonographic muscle patterns were significant only in the BB group for the SCM muscle (p = 0.006). no other significant changes were observed in the studied ultrasonographic muscle patterns in the MB and BB devices up to 6 months (P > 0.05). No significant differences in muscle thickness or patterns were detected between the MB and BB modalities (P > 0.05).

Conclusion: The results of the present study indicate that MAD treatments do not have contraindications based on changes in muscle thickness and ultrasonographic muscle patterns. However, the BB group showed significant changes in the SCM ultrasonographic muscle pattern. Nevertheless, further studies are required to validate these findings.

Background: Active Facial nerve (FN) management, including decompression, end-to-end or rerouting anastomosis, and grafting consistently plays an important role in the surgical management of petrous bone cholesteatoma (PBC), and postoperative FN function is also a major concern for surgeons. The aim of this study is to analyze the long-term FN function outcomes in PBC patients with FN paralysis who have underwent different managements and to explore the prognostic factors.

Methods: A retrospective analysis of 160 PBC patients with preoperative FN paralysis was conducted, and long-term FN function outcome was evaluated. Multivariate ordinal logistic regression models were used to determine the prognostic factors.

Results: 160 patients were collected. 102 males (63.75%) and 58 females (36.25%) with mean age 34.09 ± 13.54 years (range: 5.58-77 years). Mean FN paralysis duration preoperatively was 62.5 ± 90.80 months (range: 4 days-46 years). The preoperative/postoperative House-Brackmann (H-B) grade are as follows: H-B (I-II): 0/38 cases, H-B III: 11/37 cases, H-B IV: 22/38 cases, H-B V: 21/14 cases.

H-b vi: 106/33 cases. The poorer preoperative FN function, the poorer postoperative FN function (r_s=0.745, P < 0.001). Among 160 PBC patients, 127 patients underwent active FN management, 94/127 (74.0%) with preoperative H-B (V-VI) improved postoperatively. 33 patients were not eligible for FN repair, due to prolonged period of complete FN paralysis. FN decompression achieved H-B (I-II) recovery in 100% of H-B (III-IV) patients (22/22) within 12 months of paralysis and 88.9% (8/9) of H-B (V-VI) patients operated within 2 months of paralysis. End-to-end/rerouting anastomosis achieved H-B III recovery in 77.8% (14/18) of patients treated within 12 months. Greater auricular nerve graft within 12 months of paralysis achieved H-B III recovery in 75% of patients. Hypoglossal-FN anastomosis yielded H-B IV recovery in 7/12 patients (58.3%). Multivariate analysis identified worse preoperative FN function and prolonged FN paralysis duration (P < 0.05) as independent risk factors for poor prognosis.

Conclusions: Patients with FN paralysis can undergo active FN management to reconstruct FN function, depending on the preoperative FN function and the duration of FN paralysis. Worse preoperative FN function and longer duration of FN paralysis (P < 0.05) are risk factors for poorer prognosis.

Introduction: Labial tipping of the incisors, observed during levelling and alignment in orthodontic treatment with multibracket-appliances, can be an undesired side effect due to its association with relapse and attachment loss in excessive cases. Therefore, its pre-treatment prediction is useful to individualise treatment plans correspondingly. This retrospective cross-sectional study aimed to establish regression equations predicting incisors' inclination changes during levelling and alignment with fixed appliances in orthodontic patients using lateral cephalograms. Potential predictors analysed included clinical and cephalometric parameters.

Methods: Patients of any age and malocclusion were screened for inclusion, and the upper and lower arches were evaluated separately. Lateral cephalograms taken at T0 and T1, initial plaster models and patient records were analysed. Multiple linear regression models were performed to establish regression equations, identifying predictors of incisors' inclination changes.

Results: The final study population was comprised of 216 female (n = 123, 56.9%) and male (n = 93, 43.1%) orthodontic patients (147 upper, 151 lower arches) aged between 9.3 and 30.0 years with a mean age of 13.1 years ± 2.1. Interrater- and intrarater-reliability showed perfect measurement concordance for all cephalometric parameters and moderate to perfect concordance for categorical variables. Sagittal changes of the upper incisors' inclination (Δ1-NL) were dependent on initial anterior crowding, initial incisor inclination and intermaxillary elastics (corrected R² = 0.375, n = 147). In the lower jaw, incisors' proclination (Δ1-ML) was predicted by anterior crowding, incisor inclination, growth pattern, skeletal class and bracket type (corrected R² = 0.468, n = 151). Changes in the interincisal angle (Δ1-1) were significantly predicted by mandibular anterior crowding and initial inclination of the upper and lower incisors (corrected R² = 0.440, n = 82).

Conclusions: Regression equations with specific clinical and cephalometric parameters are suitable to predict the degree of incisors' inclination changes during alignment with fixed appliances. The amount of anterior crowding and the initial incisors' inclination of the respective jaw were relevant in all three formulas. Using the predictors may reduce undesired excessive inclination changes and help in individualised treatment planning. However, as more than 50% of the variance are explained by other factors, they act as an adjunctive method to the remaining procedures of treatment planning.

Introduction: In the German-speaking community of surgeons addressing the oral cavity, there has long been a prevailing opinion that dairy products could be harmful to oral wound healing, but is this true? This study sheds light on this issue based on clinical data of wound healing impairment rates.

Methods: A patient questionnaire, clinical examination prior to surgery of the oral cavity and a postoperative examination at suture removal were used to assess whether altered wound healing impairment rates occurred because of dairy product consumption. This was done in the setting of a prospective, randomized, controlled, single-blinded, bicenter study in outpatient and inpatient settings.

Results: Among the 257 patients participating 228 were included in the study, 227 had complete data sets and were used for our statistical analysis. The cohort was randomly divided into 105 dairy product consumers (intervention group) and 123 without dairy products (control group). In total, 45 wound healing impairments out of 227 patients (19.82%) were noted, including 20 (19.05%) in the group of dairy product consumers (intervention group) and 25 (20.33%) in the control group. The logistic regression model was unable to show a statistically significant association between dairy product consumption and wound healing impairment. (p = 0.26), (OR = 0.65). The study found no statistically significant associations that dairy product consumption has either a negative or positive effect on wound healing. (p = 0.26), (OR = 0.65).

Background: After surgical procedures involving bone and soft tissue, such as impacted tooth extraction, profen and diclofenac derivatives are commonly prescribed. Diclofenac sodium (DS) and dexketoprofen trometamol (DT), derivatives of diclofenac and profen, exhibit clinical differences from their parent compounds. Despite their widespread use, comparative studies of their effects on postoperative complications remain limited. This randomized controlled trial was performed to compare the analgesic and anti-inflammatory effects of DS and DT following impacted tooth extraction.

Methods: This split-mouth, randomized clinical study included healthy individuals aged 18 to 40 years with bilaterally impacted third molars. Left and right teeth were randomly assigned to either the DT or DS group. Participants took 25 mg of DS or 36.9 mg of DT twice daily for 7 days, beginning 1 h before extraction. Postoperative pain was assessed using a visual analogue scale at 4, 8, 12, and 24 h postoperatively, as well as on days 2 through 7. Trismus was evaluated by the interincisal distance, and edema was anatomically measured preoperatively and on postoperative days 2 and 7. The surgical duration and rescue analgesic use were also recorded.

Results: In total, 35 patients (28 women, 7 men) aged 18 to 31 years (mean, 21.31 ± 3.19 years) participated. The mean operation duration was 12.94 ± 2.26 min for the DT group and 13.26 ± 2.19 min for the DS group (p > 0.05). No statistically significant difference was observed between the groups regarding pain, edema, or trismus development (p > 0.05). However, from days 2 to 7, the DS group exhibited a greater reduction in edema than did the DT group (p < 0.05). Additionally, the DS group required 10% more frequent use of rescue analgesics than the DT group.

Conclusion: Following impacted tooth extraction, administering DT during the initial days-when pain is more intense and the inflammatory response is developing-followed by DS in the later recovery phase may enhance postoperative comfort.

Trial registration: This clinical trial was retrospectively registered on 03.10.2023 with the number TCTR20231003006.

Background: The aim of this study was to compare the accuracy of 3D-printed intermediate wafers (3DW) with conventionally made intermediate wafers (CW) fabricated through manual model surgery (MMS). This study was designed as an in vitro experiment focused on the Le Fort I osteotomy and maxillary repositioning process. It aims to achieve maxillary repositioning outcomes mediated by intermediate wafers while eliminating intraoperative errors.

Materials and methods: Both MMS and virtual model surgery (VMS) were performed for each patient to fabricate CW and 3DW. Subsequently, the maxillomandibular dental casts were remounted on the articulator using the fabricated CW and 3DW, followed by digital scanning and superimposition. The midpoint of the right maxillary central incisor edge, the uppermost points of the right and left maxillary canines, and the mesiobuccal cusps of the right and left maxillary molars were used as measurement points. The points in VMS were set as references for comparison. Paired t-tests were conducted to compare the outcomes between CW and 3DW. Independent t-tests were used to analyze differences between groups with and without rotational movements. Additionally, Spearman's correlation analysis was performed to examine the relationship between the rotational movement of the maxilla and the corresponding coordinate differences.

Results: Significant differences were observed in the transverse (p = 0.005), anteroposterior (p = 0.016), and vertical (p = 0.003) coordinates between the maxillary positions derived from CW and VMS. In MMS, the presence of roll movement significantly influenced transverse position (p = 0.002), pitch affected vertical position (p < 0.001), and yaw impacted transverse (p = 0.005) and vertical (p = 0.019) positions.

Conclusion: 3DW demonstrated greater accuracy than MMS with CW. Especially in cases involving rotational maxillary movements such as roll, yaw, and pitch, it resulted in fewer errors compared to MMS with CW. Consequently, 3DW offers more precise recording of maxillary repositioning plan and contributes to the successful transfer of this plan into the surgical outcome in orthognathic surgery.

Objectives: To compare the effects of mandibular setback surgery on the upper airway and sleep quality using two approaches: the surgery-first approach (SFA) and the conventional orthognathic approach (COA).

Materials and methods: A prospective, comparative clinical study was conducted in 20 patients, with 10 in each group undergoing isolated mandibular setback surgery. Three-dimensional upper airway analysis using cone-beam computed tomography and sleep quality assessments through questionnaires and sleep studies were performed preoperatively (T0), within 1 month postoperatively (T1), and six months postoperatively (T2).

Results: The SFA group demonstrated greater mandibular setback and rotational changes compared to the COA group. Both groups exhibited postoperative reductions in airway volume and minimum cross-sectional area, with no significant intergroup differences. Significant differences in the change in airway length in the upper airway segment (0.9 ± 1.0 mm for SFA vs. -1.2 ± 3.4 mm for COA, P = 0.002) and total airway length (3.3 ± 1.8 mm for SFA vs. -0.1 ± 2.3 mm for COA, P < 0.001) were observed at T2 compared to the preoperative period. Subjective and objective sleep parameters were comparable between the groups. Objective sleep quality initially worsened but improved over time.

Conclusions: Isolated mandibular setback surgery, whether performed using SFA or COA, resulted in comparable changes in upper airway dimensions and sleep quality.

Clinical relevance: The choice between SFA and COA for isolated mandibular setback surgery does not significantly influence surgical decision-making regarding upper airway changes and sleep quality.

Background: Plaster models have been considered the gold standard in traditional orthodontic model analysis. Modern imaging techniques and ever-advancing technologies have expanded the scope of digital diagnostic tools. These innovations allow the use of devices specifically designed for the diagnosis of 3D structures. The aim of this method comparison study was to determine the accuracy and efficiency of digital measurements compared to conventional manual measurements on plaster models.

Materials and methods: The present cohort constitutes the evaluation of pretherapeutic situation models of 247 orthodontically treated patients (129 females and 118 males, average age 16.76 +- 9.49 years) with mixed or permanent dentition who were treated at the University Hospital RWTH Aachen between January 2018 and December 2020. Plaster models were digitised using a model scanner, and an experienced examiner performed various measurements on blinded plaster models using a calliper and on digital models using the specially developed 'Tooth width analysis Aachen' patch in the OnyxCeph3TM-3D software. The intra-rater and inter-rater reliability were determined by a second, blinded assessor. Measurements included tooth width, crown height, arch width, arch length and arch circumference, as well as overjet and overbite. Differences between analogue and digital methods were calculated.

Results: Differences of up to 0.3 mm were observed between manual and partially automated digital measurements for sagittal, transversal and vertical parameters. Teeth with close proximal contact to adjacent teeth and teeth in jaws with a negative space analysis result showed an increased difference between manual and partially automated digital measurements, although this was not clinically relevant. The time required to perform digital measurements was statistically significantly reduced.

Conclusions: Partially automated digital impression analysis offers an accurate, highly efficient and time-saving alternative to traditional manual impression analysis.

Background: This study utilized MRI-based texture analysis to quantify structural alterations in the lateral pterygoid muscle (LPM) among MR images with unilateral anterior disc displacement (uADD) of the temporomandibular joint. Retrospective analysis of anonymized MR images from 232 uADD patients and 123 healthy individuals (January 2022- December 2024), approved by the Ethics Committee of Wenzhou Medical University Affiliated School of Stomatology (Ethics Number: WYKQ 2024008) with waived informed consent due to the use of de-identified retrospective data, was conducted to identify diagnostic markers and possible related pathological changes of disc displacement. According to the inclusion and exclusion criteria four groups of MR images were included in this study: the healthy temporomandibular joints (H-TMJ) of individuals with uADD, joints with anterior disc displacement with reduction (ADDwR), joints with anterior disc displacement without reduction (ADDwoR), and MR images from normal volunteers as the healthy group (HG). Four texture parameters were used for analysis: the angular second moment (ASM), Contrast, inverse difference moment (IDM) and Entropy.

Results: Statistically significant differences (P < 0.05) were found between groups for the ASM, Contrast, IDM, and Entropy variables, indicating their potential as diagnostic markers. Additionally, Entropy values differed significantly between the ADDwoR and ADDwR groups (P < 0.05), highlighting its diagnostic potential in distinguishing these two conditions. The severity of ADD disease showed varying degrees of correlation with specific texture parameters, with significant associations observed for ASM, Contrast, IDM, and Entropy (P < 0.05).

Conclusions: The texture parameters of the LPM exhibit significant changes in MR images with anterior disc displacement(ADD). Notably, the Entropy value of the LPM demonstrates high diagnostic utility in distinguishing ADDwoR from ADDwR, particularly in cases of complex disc displacement involving deformation or remodeling. Furthermore, the severity of ADD disease shows varying degrees of correlation with specific texture parameters. However, further research is required to validate the relationship between numerical texture changes in the LPM and their corresponding pathological alterations.

Clinical trial number: Not applicable.