Head & Face Medicine最新文献

Radiotherapy is a crucial treatment for head and neck squamous cell carcinoma but is associated with several complications, particularly the onset of radiation-related caries (RRC), which severely compromises patients' oral health and quality of life. Most studies have focused on the direct effects of radiation on host organs. Such as radiotherapy/Concurrent Chemoradiotherapy (CCRT) contributing to RRC primarily by inducing salivary gland hypofunction and directly damaging tooth structure. However, emerging evidence implicates additional mechanisms including dietary modifications and oral microbial dysbiosis in driving pathogenic microbial shifts characterized by cariogenic bacterial/fungal proliferation, thereby exacerbating RRC progression. In particular, changes in common cariogenic bacteria/fungi after radiotherapy remain poorly understood. Furthermore, clinical translation of microbial ecology principles into effective RRC prevention strategies remains underexplored. This review centers on radiation-induced oral microbiota alterations, critically analyzing documented microbial shifts characterized by marked proliferation of cariogenic taxa including Streptococcus mutans, Lactobacillus, Prevotella melaninogenica, Veillonella, and Actinomyces, alongside fungal overgrowth of Candida albicans. We propose a dual-focused intervention protocol: initiating probiotic supplementation at radiotherapy commencement to stabilize microbial ecology and preserve salivary function, combined with standardized oral care encompassing mechanical plaque removal, fluoride therapy, and natural anticariogenic agents. While mechanistically plausible, this paradigm requires rigorous validation through multicenter randomized controlled trials assessing ecological stability maintenance and caries incidence reduction.

Objective: This study aimed to evaluate whether adjunctive vitamin D supplementation enhances the efficacy of conventional therapy in treating sudden sensorineural hearing loss (SSNHL) in patients with vitamin D deficiency, and to assess both short-term and long-term clinical outcomes.

Methods: In this prospective randomized controlled trial, 101 SSNHL inpatients with vitamin D deficiency (serum 25-hydroxyvitamin D < 75 nmol/L) were enrolled at Yinchuan First People's Hospital (January-December 2024). Participants were randomized into a control group (n = 51, receiving conventional therapy: methylprednisolone and ginkgo biloba extract) and an experimental group (n = 50, conventional therapy + oral vitamin D3 [1500-2000 IU/day] for 10 days). Hearing and tinnitus outcomes were assessed via pure tone audiometry (PTA) and the Tinnitus Handicap Inventory (THI) at baseline, 10 days, and 3 months.

Results: Baseline characteristics were comparable between groups (all P > 0.05). At 10 days, the experimental group demonstrated significantly higher total effective rates for hearing recovery (82.0% vs. 52.9%, P < 0.001) and tinnitus improvement (83.3% vs. 71.1%, P = 0.007) compared to the control group. Mean PTA improvement was 29.3 dB HL vs. 14.2 dB HL (P < 0.001). At 3 months, the experimental group maintained significantly better outcomes, with a mean PTA improvement of 25.1 dB HL versus 12.5 dB HL in the control group (P < 0.001) and a greater reduction in THI scores (27.5 vs. 13.9, P < 0.001). The total effective rate for hearing remained superior in the experimental group (76.0% vs. 47.1%, P = 0.002).

Conclusion: Vitamin D supplementation combined with conventional therapy significantly improves both short-term and sustained long-term hearing and tinnitus outcomes in SSNHL patients with vitamin D deficiency. These findings support its role as a safe and effective adjuvant treatment, warranting further validation through multicenter trials.

Background: In patients with medication-related osteonecrosis of the jaw (MRONJ), the use of nasogastric tubes (NGTs) after surgery is recommended to allow adequate nutrition without food interfering with oral wound healing. However, NGT therapy is often perceived as irritating and rejected by some patients. This study evaluates the effect of NGT feeding on oral wound healing and patients' oral health-related quality of life (OHRQoL) after surgical treatment of MRONJ.

Methods: We assessed early wound healing in 68 patients after Surgery for MRONJ. Postoperative comparison was made between patients with NGT feeding and a matched control group receiving an oral clear liquid diet. At 14 days postoperatively, the healing of the surgical site was morphologically classified as "complete" or "incomplete". The Early Healing Score (EHS) and the Inflammatory Proliferative Remodeling (IPR) Scale were examined on Days 1, 5 and 14 after surgery. The German version of the Oral Health Impact Profile-14 (OHIP-G 14) was used to assess OHRQoL.

Results: No significant difference was observed in the rate of complete wound healing in patients receiving NGT feeding (61.1%) compared to patients receiving an oral clear liquid diet (62.5%) at 14 days postoperatively. The mean total EHS and the IPR Scale were not significantly different between patients on NGT feeding (EHS: 18.08 ± 5.35, IPR Scale: 14.36 ± 3.08) and patients on an oral clear liquid diet (EHS: 18.03 ± 5.26, IPR Scale: 14.66 ± 3.24). Furthermore, there was no significant difference in the mean OHIP-G 14 total score regardless of NGT therapy or consumption of an oral clear liquid diet.

Conclusions: The results indicate that postoperative NGT feeding has no beneficial effect on wound healing after surgical treatment of MRONJ. It can be assumed that NGT feeding can be replaced by an oral clear liquid diet after surgery for MRONJ without compromising oral wound healing. Additionally, our data suggest that there is no difference in OHRQoL between patients treated with an NGT and those treated with an oral clear liquid diet. Therefore, patients' negative perceptions of NGTs do not appear to affect OHRQoL.

Trial registration: The trial was retrospectively registered with the German Clinical Trials Register on February 26, 2024 (DRKS00033706).

Objective: To evaluate the efficacy and safety of endoscopic navigation-guided 3D printing combined with absorbable materials for individualized minimally invasive reconstruction of orbital blowout fractures, comparing outcomes to preformed titanium mesh controls to validate clinical value in achieving anatomical reduction, improving visual function, and reducing complications.

Methods: This retrospective study enrolled 87 patients receiving absorbable implants (Trial Group) and 19 patients treated with preformed titanium mesh (Control Group). Preoperative CT scans were processed using Mimics 21.0 and Geomagic Studio 12.0 for 3D reconstruction, generating patient-specific guides and 3D-printed orbital models based on mirror-imaged healthy orbits. In the Trial Group, absorbable plates were thermo-molded using surgical guides and implanted; controls underwent titanium mesh trimming followed by screw fixation. Statistical analyses employed SPSS 26.0 with Python-automated covariate control: propensity score weighting (PSW) balanced baseline covariates (gender, age, fracture extent; SMD < 0.1 confirmed balance). Longitudinal continuous data (exophthalmos difference, logMAR BCVA) were analyzed via generalized estimating equations (GEE) modeling time-group interactions, while ordinal outcomes (diplopia severity, ocular motility restriction) used weighted ordinal logistic regression to compute marginal effects. All analyses controlled for timepoint interactions with statistical significance defined at α = 0.05.

Results: The absorbable material group demonstrated superior diplopia resolution (residual rate: 9.2% vs. 31.6%, P = 0.018) with significant long-term recovery interaction (β = 1.59, P = 0.039). Both groups showed significant time-dependent improvements in ocular motility and exophthalmos (P < 0.001), though intergroup differences were non-significant. Trial group BCVA improved an additional 42% at 6 months (interaction β = 0.05, P = 0.028). No implant-related complications (infection/displacement) occurred in the absorbable group.

Conclusion: Endoscopic navigation-guided 3D printing with absorbable materials enables precise, individualized orbital reconstruction, significantly improving diplopia and visual acuity with superior safety, strongly supporting clinical adoption.

Objective: The goal of this paper is to explore the value of choroidal vascular and oropharyngeal morphological indicators in predicting the efficacy of Continuous Positive Airway Pressure (CPAP) treatment in patients with severe Obstructive Sleep Apnea Syndrome (OSAS).

Methods: A total of 245 patients with severe OSAS between January 2022 and June 2024 from a hospital, treated with CPAP, were enrolled. Patients were divided into two groups based on treatment efficacy: the Good response group and the Poor response group. Choroidal vascular indicators [subfoveal choroidal thickness (SF-CT), choriocapillaris vessel density (CC-VD), choroidal vascularity index (CVI)] and oropharyngeal morphological indicators [posterior nasal spine to menton distance (PNS-Me), hyoid-mental distance (HMD), soft palate length (posterior nasal spine to uvular tip point, PNS-P1)] were compared between the two groups. Receiver Operating Characteristic (ROC) curves were drawn to analyze the predictive efficacy of these indicators for CPAP treatment in severe OSAS patients. A nomogram and calibration curve were created to develop a prediction model for CPAP treatment efficacy in severe OSAS patients.

Results: In the Poor response group, the longest apnea duration (LAD), percentage of time with oxygen saturation < 90% (TS90%), and apnea-hypopnea index (AHI) were all significantly higher than those in the Good response group. The lowest arterial oxygen saturation (LSaO2) was notably lower in the Poor response group compared to the other one (P < 0.05). The area under the curve (AUC) values of SF-CT, CC-VD, and CVI for predicting the outcome of IBD patients were 0.835, 0.805, and 0.910, respectively. The AUC values of PNS-Me, HMD, and PNS-P1 were 0.897, 0.937, and 0.898, respectively. In addition, the nomogram prediction model constructed with choroidal vascular and oropharyngeal morphology indicators had high accuracy.  CONCLUSION: Choroidal vascular and oropharyngeal morphological indicators have a good predictive effect on CPAP treatment efficacy in patients with severe OSAS.

Background: The treatment of mandibular angle fractures remains controversial, particularly regarding the method of fixation. The primary aim of this study was to compare surgical outcomes following treatment with 1-plate versus 2-plate fixation across two oral and maxillofacial surgery clinics. The secondary aim was to evaluate associations between patient-, trauma-, and procedure-specific factors with postoperative complications and to identify high-risk patients for secondary osteosynthesis.

Methods: In this retrospective two-center cohort study, patients who underwent surgical treatment for mandibular angle fractures via a transoral approach using either 1-plate or 2-plate fixation over a 10-year period were included. Clinic A exclusively performed 1-plate fixation, while clinic B used 2-plate fixation. Demographic, clinical, radiological, and treatment data were analysed. Multivariable analyses were conducted to identify predictors of postoperative complications and secondary osteosynthesis.

Results: A total of 253 patients with 264 mandibular angle fractures were included. Violence was the most common mechanism of injury (n = 131; 49.6%). Postoperative complications occurred in 34.6% of the cases at clinic A and 26.8% at clinic B (p < 0.0001). Secondary osteosynthesis was required in 9.4% at clinic A and 7.6% of the cases at clinic B, respectively (p = 0.6547). Multinomial regression analysis identified smoking, diabetes mellitus, patient noncompliance, left-sided mandibular angle fractures, presence of a third molar (M3), partial M3 eruption, vertical depth A of M3 and horizontal impaction class II (Pell and Gregory) as significant predictors of postoperative complications. Logistic regression analysis identified smoking, diabetes mellitus, patient noncompliance, left mandibular angle fractures, mandibular angle und body fractures and presence of third molars as significant predictors of secondary osteosynthesis. As patient age there is an increased tendency for wound infection and plate/screw loosening (p = 0.06). A longer interval between trauma and surgery was associated with a higher risk of postoperative occlusal disturbances (p = 0.06). Patients with a longer duration of postoperative IMF were significantly associated with a higher rate of wound infection and secondary osteosynthesis (p < 0.05).

Conclusions: Both 1-plate and 2-plate fixation techniques demonstrated acceptable outcomes. Single-plate fixation offers sufficient stability for most mandibular angle fractures with fewer complications, supporting its use in uncomplicated cases. Double-plate fixation may be reserved for complex cases. Higher complication rates were associated with patient-related and anatomical risk factors. Individualized treatment and further prospective studies are needed to refine surgical strategies.

Purpose: This study aimed to identify predictors of diplopia following orbital fractures.

Methods: We retrospectively analyzed clinical and imaging data from 155 patients who experienced orbital fractures at our center between 2021 and 2023. Orbital fracture sites were classified as C/S/A according to imaging: the lacrimal bone was named as A1, the bony structure behind lamina papyracea as A2 and the lateral wall of the orbit (including the zygomatic bone and the greater wing of sphenoid) was appointed as A3 in the axial view; the orbital floor was divided into three equal parts as S1-S3 in the sagittal view; the frontal process of maxilla was designated as C1, the intermediate central midface between frontal process of maxilla and zygomaticomaxillary suture as C2 and the structure between the zygomaticofrontal suture and the zygomaticomaxillary suture was named as C3. First, we examined clinical characteristics, including age, gender, fracture position, as well as follow-up data on fracture location and diplopia duration. Next, we assessed the correlation between orbital fracture location (C/S/A) and diplopia occurrence. Lastly, we used a multivariable logistic regression model to evaluate predictors associated with the occurrence and location of diplopia in orbital fractures.

Results: Among the 155 patients, the mean age was 40.4 ± 14.6 years. Diplopia was the most common ocular symptom after orbital fracture (n = 42, 27.1%). The majority of patients were male (n = 106, 68.4%), with traffic accidents being the leading cause of fractures (n = 107, 69%). Diplopia was observed in 42 patients post-injury. Within the C/S/A classification, only the S region was significantly associated with post-injury diplopia (p = 0.01). Patients with S2, S3, or A1 fractures on preoperative CT had odds ratios (OR) [95% CI] of 2.708 (1.289-5.688), 2.353 (1.141-4.850), and 2.275 (1.068-4.846) for developing diplopia compared to those without these findings. For multiple fracture sites, only sagittal fractures in the S2 + S3 region (p = 0.01) was significantly associated with diplopia. Preoperative A1 fracture was found to increase the likelihood of diplopia by 2.377 times, respectively, according to binary logistic regression analysis.

Conclusion: Among the three anatomical views, fractures in the S2, S3, and A1 regions were significantly associated with preoperative diplopia. For patients with multiple fractures, combined S2 and S3 fractures was linked to a higher probability of diplopia. Multivariate analysis indicated that A1 provided the best model for predicting the likelihood of preoperative diplopia.

Background: Recently, several techniques for immediate implant placement have gained popularity, offering numerous advantages. These include the preservation of bone around the tooth socket and enhanced aesthetics. Nonetheless, the biomechanical behavior of implants and peri-implant tissues under immediate loading with these techniques remains uncertain. This study examines stress distribution surrounding an immediately placed implant, using socket shield and bone graft techniques compared to a healed socket.

Materials and methods: Cone-beam computed tomography (CBCT) scans of the anterior maxilla were used to construct finite element analysis (FEA) models. The process of modeling the implant, abutment, and provisional crown used standard tessellation language (STL) files of the original components. The implant was modeled in three clinical scenarios: a healed socket (HS), an extraction socket with bone graft (BG), and a socket shield (SS). A frictional contact (µ = 0.3) was established to simulate immediate loading. An axial load of 25.5 N and a non-axial load of 178 N at a 30° angle were applied along the implant's long axis in a palatal direction. FEA was conducted for stress distribution analysis.

Results: In evaluating maximum principal, von Mises stress distribution within the cortical bone, the HS model exhibited the highest stress level, with a maximum of 125 MPa, 127 MPa, respectively. The SS model demonstrated the lowest stress, recording a maximum of 82 MPa, 90.7 MPa, respectively, while the BG model had a maximum value of 115 MPa, 116.84 MPa, respectively. When assessing the von Mises stress distribution associated with the implant, the HS model recorded the highest stress value of 385 MPa. In contrast, the BG and SS models recorded lower stress values of 252 MPa and 281 MPa, respectively.

Conclusions: The socket shield technique exhibits advantageous biomechanical performance under immediate loading conditions by reducing stress on peri-implant bone and implant components. These results endorse its clinical applicability but necessitate further in vivo validation.

Background: Unplanned asymmetric palatal expansion following Surgically Assisted Rapid Maxillary Expansion (SARME) can result in a poor esthetic outcome or an unstable occlusion. The purpose of this study was to analyze the association between expander design and asymmetric expansion.

Methods: In this retrospective cohort study, preoperative and postoperative cone beam computed tomography (CBCT) scans of patients treated with SARME were randomly selected from the Radboud University medical imaging database. Patients were divided into two groups according to the used expander: (1) bone-borne distractor (TPD); (2) tooth-borne expander (Hyrax). Transverse dental and skeletal maxillary expansion were quantified using landmark-based measurements. A left-right difference of more than one millimeter was considered as asymmetric. Paired and independent t-tests were performed to analyze the asymmetry within and between the groups. Linear regression analyses were used to identify predictor variables for asymmetric expansion.

Results: 60 patients were enrolled into the study (mean age 30.3 ± 9.1 years; 24 male and 36 female), 30 in the TPD group and 30 in the hyrax group. The mean anterior maxillary dental and skeletal expansion was 3.9 ± 2.7 mm and 2.2 ± 1.4 mm. The mean posterior maxillary dental and skeletal expansion was 5.2 ± 2.7 mm and 2.3 ± 1.6 mm. No differences in dental and skeletal expansion were found between the TPD and hyrax groups (p > 0.05). 18 patients in the TPD group and 21 patients in the hyrax group exhibited anterior dental asymmetry (p = 0.42) whereas 10 and 11 patients exhibited anterior skeletal asymmetry (p = 0.79). Linear regression analyses demonstrated that the type of expander does not appear to be a predictor variable for asymmetric expansion.

Conclusion: Asymmetric maxillary opening occurred frequently after SARME irrespective of the type of expander used. Considering the similar postoperative outcome of hyrax and TPD, SARME with a hyrax expander may be preferred as it is less surgically invasive and more cost effective.