Head & Face Medicine最新文献

Background: Patients undergoing oral mucosa harvesting for urethroplasty may experience several challenges during recovery like scarring or changes in oral sensitivity, which can lead to long-term discomfort. In this retrospective study long-term donor site complications after harvesting of oral mucosa for urethroplasty were evaluated and a new measurement method for oral volume differences between the non-operated and operated sides was applied.

Methods: Thirty adult male patients who underwent urethroplasty with buccal mucosa grafting were included. At a median of 43 months after surgery, a standardized questionnaire was used, and clinical examinations were conducted to measure the postoperative elasticity of the buccal mucosa. This measurement compared the non-operated side with the operated side. Additionally, we examined descriptive statistics and the influence of smoking status, diabetes mellitus, immunosuppression, alcohol consumption, and graft size.

Results: In total, 36% of the patients reported persistent subjective postoperative impairments, such as tightness in the oral cavity or numbness. In all patients, a difference in buccal volume was observed between the operated side and the non-operated side. This volume difference ranged from 3 to 15 ml (mean 8.10 ml, SD ± 3.4; p < 0.001). As the size of the harvested transplant increased, the postoperative buccal volume difference also increased significantly (p < 0.001). In one patient, follow-up surgery was required due to the severity of scarring. The presence of diabetes mellitus, immunosuppressive medication, smoking status, and alcohol consumption had no statistically significant effect on postoperative buccal elasticity or mouth opening.

Conclusions: The use of buccal mucosa grafts for urethroplasty is an established procedure in urology, but the oral harvesting procedure can lead to scarring within the buccal area, which is associated with a statistically significant decrease in buccal volume compared with the non-operated site. The volume analysis was performed by applying a new measurement method, which enables, for the first time, the quantification of oral donor site morbidity.

Objective: This study aimed to evaluate the effects of various teething oral gels, containing lidocaine, hyaluronic acid, and herbal-based ingredients, on cell viability and to compare the antifungal properties.

Materials and methods: The effect of the six different teething oral gels (Gengigel Teething, Orajel Baby, Calgel, Hyland's Baby Organic Soothing Gel, Buccotherm Teething Gel and Aftamed Teething) on cell viability was evaluated through the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay on L-929 mouse fibroblast cells. The antifungal activity of teething oral gels against Candida albicans ATCC 90,028, C. tropicalis ATCC 750, C. glabrata ATCC 2001, C. parapsilosis ATCC 22,019, and C. krusei ATCC 6258 was assessed using the broth dilution method.

Results: The cell viability analysis revealed that Aftamed Teething exhibited the highest level of cytotoxicity among the tested teething oral gel products, whereas Buccotherm Teething Gel demonstrated the lowest cytotoxicity. The teething oral gels can be ordered based on their respective cytotoxicity profiles: Aftamed Teething (IC₅₀ 4.62 mg/ml) > Calgel (IC₅₀ 33.40 mg/ml) > Gengigel Teething (IC₅₀ 122.85 mg/ml) > Orajel Baby (IC₅₀ 137.13 mg/ml) > Hyland's Baby Organic Soothing Gel (IC₅₀ 229.20 mg/ml) > Buccotherm Teething Gel (IC₅₀ 284.38 mg/ml) (p < 0.05). The results indicate that Buccotherm Teething Gel, Hyland's Baby Organic Soothing Gel and Orajel Baby did not exhibit any antifungal activity against C. albicans, while Gengigel Teething and Aftamed Teething demonstrated marginal effects at the 100 mg/ml concentration threshold. The Calgel exhibited the highest efficacy against C. albicans, with a minimum inhibitory concentration of 12.5 mg/ml (p < 0.05). From non-albicans Candida species, it was ascertained that Gengigel exhibited a modest antifungal effect on C. tropicalis and C. parapsilosis, while Calgel demonstrated a modest antifungal effect on C. glabrata. Additionally, Calgel demonstrates antifungal activity against C.tropicalis and C.parapsilosis, with a minimum inhibitory concentration of 25 mg/ml (p < 0.05).

Conclusion: Teething oral gels containing lidocaine, hyaluronic acid, and herbal formulations demonstrated varying degrees of cytotoxicity and antifungal efficacy. Herbal-based teething oral gels may be a more suitable option for young children compared to products containing lidocaine or hyaluronic acids, as they exhibit reduced cytotoxicity and enhanced biocompatibility. Lidocaine-containing gel may be preferred for opportunistic fungal infections, considering their high cytotoxic properties, solely to leverage their antifungal capabilities on different species.

Clinical relevance: Lidocaine-containing teething oral gel has demonstrated potent antifungal properties on both C.

Background: Temporomandibular disorders (TMD) are multifactorial conditions that involve pain, dysfunction, and impaired jaw movement, significantly impacting patients' quality of life. Emerging evidence suggests that psychological factors, including anxiety, depression, and stress, play a crucial role in the onset and progression of TMD. However, the exact nature of this relationship remains unclear. This study aims to systematically analyze and quantify the association between psychological factors and TMD, providing clinically relevant insights to improve patient management and therapeutic strategies.

Methods: This study was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY202420084) to ensure methodological transparency and adherence to systematic review standards. The study design and protocol followed the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The National Institutes of Health (NIH) Quality Assessment Tool was used to assess the methodological quality of the included studies. The data were systematically extracted and analyzed.

Results: The literature search yielded 2392 potential articles, of which 21 were included in this study. A significant correlation was found between TMD and anxiety, depression, stress, and somatization. Statistically significant differences in anxiety and depression scores were observed between patients with TMD and the controls (p < 0.00001). Stress increased TMD development and severity. In addition, subgroup analyses revealed gender differences, with depression significantly correlating with TMD in males. Similarly, students showed significant correlations between TMD and anxiety, while adults demonstrated strong associations with both anxiety and depression. Adolescents showed correlations between TMD development and somatization and obsessive-compulsiveness.

Conclusion: Anxiety, depression, and stress are significant risk factors for the development and progression of TMD. Subgroup analyses demonstrated significant correlations between particular psychological factors and TMD in different sub-populations.

Background: Cone beam computed tomography (CBCT) is an established diagnostic tool for impacted wisdom teeth (third molars (3 M)) in proximity of the mandibular nerve canal. This study aims to define the minimum field-of-view (FOV) size and its localization to reduce radiation exposure. As reference, the chin rest of the CBCT device was used.

Methods: Three-dimensional CBCT data sets were used to analyze the bilateral positions and dimensions of the wisdom teeth. A total of 215 wisdom teeth from a study population with a mean age of 21 years, including data from 82 male and 58 female patients, were mapped. By transformation into a common coordinate space using the device's chin rest as a joint denominator, the optimal size and location for uni- and bilateral capture of the wisdom teeth were determined, for both best-case and worst-case scenarios with regard to patient positioning.

Results: The minimal FOVs for the lower 3 M capture were H 23.5 mm × R 35.4 mm in the best-case scenario assuming optimal patient positioning and H 35.4 mm × R 36.6 mm in the worst-case scenario with rotational deviation along the transversal axis. For the upper 3 M, the minimal FOVs were H 29.9 mm × R 29.2 mm in the best-case scenario and H 38.6 mm × R 35.6 mm in the worst-case scenario. Unilateral capture of both the upper and lower 3 M required FOV dimensions of H 51.7 mm × R 39.8 mm and H 44.8 mm × R 36.8 mm, respectively. For bilateral capture of all four 3 M, the best-case FOV was H 44.8 mm × R 84.8 mm and the worst-case FOV was H 51.7 mm × R 85.6 mm.

Discussion: This research provides indication-specific FOVs for uni- and bilateral imaging of the upper and lower 3 M. Taking into account optimal clinical practices for CBCT imaging, this study aims to propose clinically feasible FOV dimensions while meeting the technical specifications of commonly used CBCT devices. Clinical application of the results may help reduce radiation exposure of patients receiving CBCT imaging of the wisdom teeth. Transfer of the present results to other CBCT devices requires further research.

Trial registration: The study is registered in the German Trial Register with the number DRKS00026149, 2024/02/21.

Background: We aimed to comprehensively analyze the application of machine learning (ML) in dentistry and oral surgery using bibliometric methods to identify research trends, hotspots, and future directions.

Methods: Publications related to ML in dentistry and oral surgery published between 2010 and 2024 were retrieved from the Science Citation Index Expanded by the Web of Science Core Collection (WoSCC). A total of 2234 unique publications were identified after screening. Bibliometric analysis was performed using the VOSviewer and CiteSpace software, focusing on parameters such as the number of publications, countries, institutions, journals, co-cited references, and keyword bursts.

Results: The number of publications increased significantly from 2018 to 2024. China and the United States were the leading countries in terms of number of publications and citation counts. Prominent institutions include Seoul National University, Sichuan University, and Charite Universitätsmedizin Berlin. Journals such as BMC Oral Health and the Journal of Dentistry have a large number of publications. Analysis of the co-cited references revealed clusters related to disease diagnosis and risk prediction, treatment planning, clinical decision support systems, and dental education. Keyword bursts indicate the evolution of research focus from traditional machine learning algorithms to deep learning algorithms and the emerging importance of multimodal data and foundation models.

Conclusion: ML has made remarkable progress in dentistry and oral surgery. Although clinicians can benefit from the application of ML models in their practice, they should conduct comprehensive clinical validations to ensure the accuracy and reliability of these models. Moreover, challenges, such as data availability and security, algorithmic biases, and "black-box models", must be addressed. Future research should focus on integrating multimodal data and leveraging foundation models to improve the accuracy of diagnosis, treatment planning, and educational tools in dentistry and oral surgery.

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.