Journal of Oral and Maxillofacial Surgery最新文献

Comparison of Lip Revision Rates in Traditional Versus Early Cleft Lip Repair: An Institutional Review.

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-05 DOI: 10.1016/j.joms.2025.01.015

Idean Roohani, Marvee Turk, Dylan G Choi, Collean Trotter, Sarah Alfeerawi, Naikhoba C O Munabi, William P Magee, Jeffrey A Hammoudeh

Background: Traditional cleft lip repair (TLR) is performed between 3 and 6 months of age. For over 10 years, our institution has transitioned from offering presurgical nasoalveolar molding (NAM) before cleft lip repair to performing early cleft lip repair (ECLR) within 2 to 5 weeks of life, circumventing the use of NAM.

Purpose: This study aimed to estimate and compare the lip revision rates between patients who underwent ECLR versus TLR ± NAM.

Study design, setting, sample: A retrospective cohort study was conducted. Patients with nonsyndromic unilateral cleft lip who underwent primary repair between 2004 and 2021 at Children's Hospital Los Angeles were included. Exclusion criteria were as follows: American Society of Anesthesiologists classification III or higher, syndromic or bilateral cases, gestational-corrected age of more than 6 months at lip repair, and less than 2 years of follow-up.

Predictor variable: The predictor variable was the timing of primary cleft lip repair. Subjects were allocated to 1 of 2 treatment cohorts: ECLR (<3 months) and TLR ± NAM (3 to 6 months).

Main outcome variable: The primary outcome was lip revision surgery at any time during the patient's cleft care. Secondary outcomes included the extent and timing of the revision surgeries.

Covariates: Data collection included presurgical NAM use, surgeon, cleft phenotype, and cleft width ratio.

Analyses: A 2-phased coarsened exact matching process was performed to match cohorts based on surgeon, cleft phenotype, and cleft width ratio at a 1:1 ratio. Kaplan-Meier analyses were used to estimate and compare the revision rates.

Results: A total of 1,101 patients underwent primary repair during the study period. After applying the exclusion criteria, 362 patients remained before matching. Among these, 154 patients (77 ECLR, 77 TLR ± NAM) were included after matching. Kaplan-Meier analysis estimated a lower 5-year revision rate for the ECLR cohort compared to the TLR ± NAM cohort (17.3 vs 32.6%, log-rank P < .05). Median follow-up time was 6.6 years [interquartile range 4.4 to 9.2].

Conclusions and relevance: ECLR resulted in approximately a 2-fold reduction in lip revision rates compared with TLR ± NAM. These findings suggest that cleft lip repair at approximately 1 month of age may decrease the burden of secondary procedures later in life.

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引用次数: 0

Is A Surgeon's Self-Perceived Level of Anxiety Associated With the Type of Surgical Procedure Being Performed?

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-04 DOI: 10.1016/j.joms.2025.01.016

Onur Odabaşi, Mehmet Emrah Polat

Background: Surgical procedures result in some level of anxiety for the surgeon. It is unclear if the type of surgical procedure being performed by oral and maxillofacial surgeons influences the self-perceive level of anxiety.

Purpose: The purpose of this study was to measure the association between different oral and maxillofacial surgical procedures and anxiety levels, and to identify procedures associated with the highest level of performance anxiety.

Study design, setting, sample: A retrospective cross-sectional survey was conducted among oral and maxillofacial surgeons in Turkey, distributing surveys electronically via social media platforms, including Instagram and WhatsApp.

Predictor variable: The primary predictor variable was surgical procedure. The procedures were 15 different operations, including simple and complex tooth extraction, impacted mandibular and maxillary canine-premolar extraction, impacted mandibular and maxillary third molar extraction, dental implant surgery, sinus lifting, grafting (simple and complex), cyst operations, Le Fort I surgery, sagittal split ramus osteotomy, genioplasty, and temporomandibular joint (TMJ) surgery.

Main outcome variable: The main outcome variable was self-reported anxiety level during various surgical procedures, assessed using an 11-point Likert scale ranging from 0 (no anxiety) to 10 (extreme anxiety).

Covariates: Covariates included demographics (age and sex), experience (years) and institution type (public universities, private universities, private clinics, private health institutions, and Ministry of Health-affiliated hospitals.) ANALYSES: Normality was tested with the Shapiro-Wilks test. Anxiety scores were compared among categorical variables with more than 2 categories using the Kruskal-Wallis test, and by sex using the Mann-Whitney U test. Statistical significance was indicated by P value < .05.

Results: A total of 154 surveys were distributed, and 96 responses (62.3%) were received and analyzed. Among the respondents, 34 (35.4%) were female and 62 (64.6%) were male. Anxiety levels differed significantly by surgical procedure (P < .001), with the highest mean in TMJ surgery (8.10 ± 2.23) and the lowest mean in simple tooth extraction (1.44 ± 1.86).

Conclusions and relevance: The anxiety levels associated with different oral and maxillofacial surgical procedures vary for surgeons. Developing targeted anxiety management strategies is important, especially for procedures with high anxiety levels, such as TMJ surgery and bilateral sagittal split ramus osteotomy.

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引用次数: 0

Dumbbell-Shaped Bipaddled Pectoralis Major Myocutaneous Flap for Composite Commissural Defects: A Defect-Driven Modification 哑铃形双鞍胸大肌肌皮瓣治疗复合下颌缺损：缺陷驱动的改良。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.joms.2024.10.016

Subrat Kumar Padhiary MDS , Gunjan Srivastava MDS , Pratikshya Kothia MDS , Rupsa Das MDS

Pectoralis major myocutaneous flap (PMMF) has been a workhorse in orofacial reconstruction. Although microvascular tissue transfer has gained popularity in major tertiary centers, several infrastructural factors limit its use in many facilities, particularly in developing countries with high caseloads. Numerous modifications have been made to the PMMF since its inception. Here, we present a novel technique for reconstructing composite commissural defects with PMMF by modifying the skin paddle design to a dumbbell shape. Both ends of the paddle are used to line intraoral and extraoral defects, while the constricted middle portion recreates the commissure. We report the outcomes of a cohort of 7 patients treated at our institution, describing the modified PMMF design, harvesting, and in-setting techniques used in oral carcinoma cases involving the commissure. We have detailed the study outcomes for each patient, including the various complications related to the flap, donor, and recipient sites.

胸大肌肌皮瓣（PMMF）一直是口面部重建的主力。虽然微血管组织转移在大型三级医疗中心很受欢迎，但一些基础设施因素限制了它在许多医疗机构的使用，尤其是在病例量大的发展中国家。自 PMMF 诞生以来，已对其进行了多次改良。在此，我们介绍一种新技术，通过将皮瓣设计成哑铃状，用 PMMF 重建复合神经瓣膜缺损。皮瓣的两端用来衬托口内和口外的缺损，而中间的收缩部分则再造了咬合面。我们报告了在本机构接受治疗的 7 例患者的治疗结果，描述了在涉及会阴的口腔癌病例中使用的改良 PMMF 设计、采集和内置技术。我们详细介绍了每位患者的研究结果，包括与皮瓣、供体和受体部位相关的各种并发症。

引用次数: 0

Is Advanced Arthroscopic Debridement in Patients With End-Stage Temporomandibular Joint Degenerative Joint Disease Associated With Improved Quality of Life and Pain Reduction? 晚期颞下颌关节退行性关节病患者的晚期关节镜清创与改善生活质量和减轻疼痛有关吗？

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.joms.2024.11.003

Johnson Cheung DDS, MD, MSc, MSc , Sharon Aronovich DMD , Jonathan P. Troost PhD , Mohamed Hakim DDS, MBA

Background

Temporomandibular joint (TMJ) advanced arthroscopic debridement (level II arthroscopy) is a minimally invasive procedure involving microsurgical debridement of degenerated tissues with aid of a fiber-optic camera. Its use for treating intra-articular pain and dysfunction (IPD) in advanced TMJ degenerative disease remains debated.

Purpose

The primary purpose was to evaluate if level II arthroscopy was associated with improvement in pain and quality of life in subjects with advanced TMJ degenerative disease, and to identify clinical factors that influence outcomes.

Study Design, Setting, Sample

This was a retrospective cohort study conducted on subjects who presented to the University of Michigan oral and maxillofacial surgery clinic between November 2020 and July 2023 who required arthroscopy for IPD. Inclusion criteria were unilateral or bilateral IPD, Wilkes V disease, arthroscopically verified disc perforation, and 3-month minimum follow-up. Subjects with level I/III arthroscopy or with Wilkes I-IV disease were excluded.

Covariates

The covariates included demographics (age, sex), preoperative variables (body mass index, allergies, environmental sensitivities, condylar degeneration, systemic arthropathy, serology, prior arthrocentesis, preoperative jaw functional limitation scale (JFLS) and pain), and operative variables (synovitis, chondromalacia, adhesions, laterality, debridement, and injections).

Main Outcome Variables

Primary outcomes were changes in quality of life and pain measured via the JFLS and visual analog pain scale, respectively, at minimum 3-month post-arthroscopy.

Analyses

Linear regression analyzed JFLS with covariates, and linear-mixed effects models adjusted for nonindependent pain from bilateral TMJ sides. Paired t-tests compared mean JFLS and pain scores with significance set at P < .05.

Results

A total of 240 subjects were screened and 40 subjects completed the study with mean age of 49.33 (±13.62) years, 95% subjects were female, and median follow-up of 7 months (interquartile range 6 to 8). Mean JFLS decreased from 73.3 (±34.94) to 43.8 (±35.35) postoperatively (P < .0001). Mean pain scores decreased from 60.0 (±21.2) to 38.0 (±28.5) postoperatively (P < .0001). Environmental sensitivity was the only covariate significantly associated with higher postoperative JFLS (P = .002). Three subjects (7.5%) required total arthroplasty post–level II arthroscopy.

Conclusion and Relevance

Advanced arthroscopic debridement (level II arthroscopy) is associated with reduced pain and improved quality of life in subjects with Wilkes V degenerative joint disease.

背景：颞下颌关节（TMJ）晚期关节镜清创（II级关节镜）是一种微创手术，包括在光纤相机的帮助下对变性组织进行显微外科清创。它用于治疗晚期TMJ退行性疾病的关节内疼痛和功能障碍（IPD）仍有争议。目的：主要目的是评估II级关节镜是否与晚期TMJ退行性疾病患者疼痛和生活质量的改善有关，并确定影响结果的临床因素。研究设计、环境、样本：这是一项回顾性队列研究，研究对象是2020年11月至2023年7月期间在密歇根大学口腔颌面外科诊所就诊的需要关节镜治疗IPD的患者。纳入标准为单侧或双侧IPD， Wilkes V型疾病，关节镜下证实的椎间盘穿孔，至少随访3个月。排除I/III级关节镜检查或Wilkes I- iv级疾病的受试者。协变量：协变量包括人口统计学（年龄、性别）、术前变量（体重指数、过敏、环境敏感性、髁退变、全身性关节病、血清学、既往关节穿刺、术前颌功能限制量表（JFLS）和疼痛）和手术变量（滑膜炎、软骨软化、粘连、侧边、清创和注射）。主要结局变量：主要结局是关节镜术后至少3个月的生活质量和疼痛变化，分别通过JFLS和视觉模拟疼痛量表测量。分析：线性回归分析JFLS与协变量，线性混合效应模型调整非独立的疼痛从双侧TMJ。配对t检验比较平均JFLS和疼痛评分，P值为显著性。结果：共筛选240例患者，40例患者完成研究，平均年龄49.33（±13.62）岁，95%为女性，中位随访7个月（四分位间距6 ~ 8），术后平均JFLS从73.3（±34.94）下降到43.8（±35.35）(P)。晚期关节镜清创（II级关节镜）与Wilkes V型退行性关节疾病患者疼痛减轻和生活质量改善相关。

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引用次数: 0

A Reliable Protocol for Fiberoptic Nasal Intubation 一种可靠的纤维鼻插管方案。

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.joms.2024.11.004

Mary Katherine Spinella DMD, MD , Hamsini Nathan BS , Travis Wilson MD , Daniel E. Perez DDS, MS

Nasotracheal intubation is crucial for many oral and maxillofacial surgery procedures; however, it presents more challenges than orotracheal intubation and requires a higher level of training, along with various execution options. The routine use of an endotracheal tube (ETT)-first nasal fiberoptic intubation protocol is recommended, specifically in cases where orotracheal intubation is not possible or feasible. In this proposed technique, 137 randomly selected patients underwent fiberoptic nasotracheal intubation for general anesthesia utilizing a strict ETT first protocol. The mean preintubation ETT depth was 14 cm from the nares, correlating this distance with the patient's height, weight, and gender, proposing a formula for depth selection. Inserting the nasal ETT to a mean depth of 14 cm prior to insertion of the fiberoptic scope resulted in excellent visualization of the glottis with a first pass success rate for intubation of 97.8% and a mean intubation time of 68.5 seconds, regardless of the expertise of the provider.

鼻气管插管是许多口腔颌面外科手术的关键；然而，它比口气管插管更具挑战性，需要更高水平的培训，以及各种执行方案。建议常规使用气管内插管(ETT)-鼻纤维插管方案，特别是在不可能或不可行的情况下。在这项技术中，137名随机选择的患者采用严格的ETT第一方案接受纤维鼻气管插管进行全身麻醉。插管前ETT平均深度为14cm，将此距离与患者的身高、体重和性别相关联，提出了深度选择的公式。在插入光纤镜之前，将鼻ETT插入到平均深度14厘米处，可以很好地看到声门，插管的一次通过成功率为97.8%，平均插管时间为68.5秒，无论提供者的专业知识如何。

引用次数: 0

Mandibular Reconstruction Utilizing the Reamer-Irrigator-Aspirator to Obtain Nonvascularized Femur Grafts 利用绞刀-灌注器-呼吸器获取无血管股骨移植物的下颌骨重建术

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.joms.2024.10.019

Alec Bankhead DMD , Yotom Rabinowitz DDS , Hether Khosa DDS , T. Toan Le MD , James A. Phero DDS, MD

Between July 2021 and February 2024, 6 patients with biopsy-confirmed benign pathologic lesions had mandibular defects reconstructed using a reamer-irrigator-aspirator at the University of Cincinnati Medical Center. Patients' ages ranged from 34 to 73, 5 of which were males and one female. Primary end points were bony continuity of the mandible, recovery time, and ability of the graft to receive implants. The reamer-irrigator-aspirator obtained 40 to 100 cm³ of uncompressed bone from donor sites. All patients ambulated on the day of surgery or postoperative day one. No neurosensory disturbances were reported at the donor site. Five patients achieved radiographic continuity of the mandible postoperatively. Of the patients with continuity, 4 received implants, and one received a removable prosthesis. The patient without mandibular continuity declined further intervention and received a removable prosthesis. The findings lend support to the possibility of harvesting medullary bone from the femur for mandibular defect reconstruction.

2021 年 7 月至 2024 年 2 月期间，辛辛那提大学医学中心对 6 名经活检证实为良性病变的患者进行了下颌骨缺损重建手术，手术中使用了铰刀-irrigator-aspirator。患者年龄从 34 岁到 73 岁不等，其中 5 人为男性，1 人为女性。主要终点是下颌骨的骨性连续性、恢复时间以及移植体接受植入物的能力。铰刀-灌注器-抽吸器从供体部位获取 40 至 100 立方厘米的未压缩骨。所有患者都能在手术当天或术后第一天行走。供骨部位未出现神经感觉障碍。五名患者术后下颌骨在影像学上实现了连续性。在获得下颌连续性的患者中，4 人接受了种植体，1 人接受了活动假体。没有下颌骨连续性的患者拒绝接受进一步干预，并接受了活动假体。研究结果支持从股骨中获取髓质骨用于下颌骨缺损重建的可能性。

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引用次数: 0

Too Busy to Research! Too Busy to Publish! A Surgeon's Justification

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.joms.2024.10.017

Elavenil Panneerselvam MDS, MBA , Anantanarayanan Parameswaran MDS, DNB

引用次数: 0

The Modified Caldwell-Luc Approach for Treating Odontogenic Maxillary Sinusitis Without Need for Functional Endoscopic Sinus Surgery: A Retrospective Study 无需功能性内窥镜鼻窦手术治疗牙源性上颌窦炎的改良 Caldwell-Luc 法：回顾性研究

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.joms.2024.09.006

Aysar Nashef DMD, PhD , Michael V. Joachim DMD, MSc , Nina Liubin DMD , Murad Abdel Raziq DMD, MD , Imad Abu El-Naaj DMD , Amir Laviv DMD, MPH

<div><h3>Background</h3><div>Odontogenic maxillary sinusitis is a common inflammatory condition resulting from the violation of the Schneiderian membrane by conditions arising from the dentoalveolar unit, which includes teeth, their supporting structures, and adjacent tissues. This study aims to evaluate a modified surgical approach for treating this condition.</div></div><div><h3>Purpose</h3><div>The purpose of this study is to measure the frequency of retreatment of maxillary sinusitis of odontogenic origin following treatment with a modified Caldwell-Luc approach, which involves accessing the maxillary sinus through the canine fossa without creating a counter-opening in the inferior nasal meatus.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This retrospective cohort study included 82 cases (83 sinuses) with odontogenic sinusitis treated surgically with the modified Caldwell-Luc technique at the Department of Oral and Maxillofacial Surgery, Poriya Medical Center, between 2014 and 2021. Patients with nonodontogenic sinusitis were excluded.</div></div><div><h3>Predictor Variable</h3><div>Anatomic findings defined as the presence or absence of ostiomeatal complex abnormalities and oroantral communication, as identified through clinical examination and computed tomography imaging.</div></div><div><h3>Main Outcome Variables</h3><div>The need for retreatment, defined as the requirement for functional endoscopic sinus surgery (FESS) due to persistent signs and symptoms of maxillary sinusitis after the modified Caldwell-Luc procedure, including facial pain/pressure, nasal congestion, purulent nasal discharge, or radiographic evidence of persistent sinus opacification on computed tomography scan, lasting more than 4 weeks despite appropriate medical management.</div></div><div><h3>Covariates</h3><div>Covariates included demographic data (age, sex [male/female as identified at birth]), smoking status, etiologies of odontogenic sinusitis, and surgical conditions.</div></div><div><h3>Analyses</h3><div>Descriptive statistics, Cox proportional hazards regression was used to compute hazard ratios (HRs). Kaplan-Meier survival analysis was performed to estimate the probability of remaining FESS-free over time. The level of statistical significance was set at <em>P</em> < .05.</div></div><div><h3>Results</h3><div>The sample was composed of 82 patients (83 sinuses) with a mean age of 52.3 years (SD 13.5), and 47 (56.6%) were male. Dental implantation and sinus augmentation procedures were the most common etiologies of odontogenic sinusitis (50.6%). The median follow-up time was 6.03 months (interquartile range: 2.57 to 10.93 months). The incidence rate of FESS requirement was 2.64 per 100 person-months of follow-up. The FESS-free frequency was 89.2% (95% CI: 80.4 to 94.4%). The Kaplan-Meier analysis estimated the probability of remaining FESS-free at 12 months to be 89.1% (95% CI: 79.8 to 94.4%). Patients with ostiomeatal complex abnormalities ha

背景：牙源性上颌窦炎是一种常见的炎症，是由于牙槽单位（包括牙齿、其支持结构和邻近组织）的病变侵犯了施奈德膜而引起的。本研究旨在评估治疗这种病症的改良手术方法。目的：本研究的目的是测量采用改良的 Caldwell-Luc 方法治疗牙源性上颌窦炎后再治疗的频率，这种方法是通过犬窝进入上颌窦，而不在下鼻孔开一个对口：这项回顾性队列研究纳入了波利亚医疗中心口腔颌面外科在 2014 年至 2021 年间采用改良 Caldwell-Luc 技术手术治疗的 82 例（83 个鼻窦）牙源性鼻窦炎患者。不包括非牙源性鼻窦炎患者：主要结果变量：再治疗需求，即在改良 Caldwell-Luc 手术后，由于上颌窦炎的症状和体征持续存在，包括面部疼痛/压迫感、鼻塞、脓性鼻涕，或计算机断层扫描显示持续性鼻窦不通畅，且在适当的药物治疗后仍持续 4 周以上，则需要进行功能性内窥镜鼻窦手术（FESS）：协变量包括人口统计学数据（年龄、性别[出生时确定的男性/女性]）、吸烟状况、牙源性鼻窦炎的病因和手术条件：描述性统计、考克斯比例危险回归用于计算危险比（HRs）。卡普兰-梅耶尔生存分析用于估算随时间推移保持无FESS的概率。统计显著性水平设定为 P 结果：样本由 82 名患者（83 个鼻窦）组成，平均年龄为 52.3 岁（SD 13.5），其中 47 名（56.6%）为男性。种植牙和鼻窦增生手术是牙源性鼻窦炎最常见的病因（50.6%）。中位随访时间为 6.03 个月（IQR：2.57 至 10.93 个月）。每 100 人月的随访中，需要进行 FESS 的发生率为 2.64。无 FESS 频率为 89.2%（95% CI：80.4% 至 94.4%）。卡普兰-梅耶尔分析估计，12个月后仍无FESS的概率为89.1%（95% CI：79.8%至94.4%）。有骨盆复杂异常的患者需要进行 FESS 的 HR 为 2.25（95% CI：0.47 至 10.84，P = .31），而有口腔交流的患者 HR 为 1.85（95% CI：0.46 至 7.39，P = .38）：结论与意义：改良 Caldwell-Luc 手术能有效治疗大多数牙源性鼻窦炎病例。对于一小部分症状持续存在的病例，可能需要进行鼻窦成形术。需要进一步研究以确定是否需要进行 FESS 的预测因素。值得注意的是，我们建议口腔颌面外科医生在实施改良 Caldwell-Luc 手术之前，与 FESS 外科医生一起对鼻窦炎病例进行复查，以便在必要时同时或密切配合手术。

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引用次数: 0

Does Cannabis Affect Your Oral and Maxillofacial Surgery Practice?

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.joms.2024.11.005

Tara Aghaloo DDS, MD, PhD

引用次数: 0

Does a Modified Endaural Incision Reduce Facial Nerve Injury and Improve Cosmesis When Compared to the Modified Pre-Auricular Incision for Management of Temporomandibular Joint Ankylosis? 在治疗颞下颌关节强直时，改良耳内切口（Inviscision）与 Alkayat-Bramely 切口相比是否能减少面神经损伤并改善外观？

IF 2.3 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.joms.2024.10.010

Saurabh S. Simre BDS, MDS , Sameer Pandey BDS, MDS, MCh , Ram Sundar Chaulagain BDS, MDS , Akansha Vyas BDS, MDS , Abiskar Basnet BDS, MDS , Ashi Chug BDS, MDS, PhD

<div><h3>Background</h3><div>Facial nerve injury (FNI) and unesthetic scar are distressing complications of temporomandibular joint (TMJ) surgery. Insufficient evidence on whether a modified endaural incision can reduce FNI and serve as an aesthetic alternative is a concern.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to compare the postoperative FNI and surgical scar cosmesis using modified endaural incision (Inviscision approach [IA]) and modified preauricular incision (Alkayat-Bramley approach [ABA]) in TMJ ankylosis.</div></div><div><h3>Study design, Setting, Sample</h3><div>The authors implemented a single-centre, retrospective, cohort study. Subjects presenting to the Division of Craniomaxillofacial surgery at All India Institute of Medical Sciences, Rishikesh with TMJ ankylosis who underwent ankylosis release between January 2021 and December 2023 were identified through electronic medical record review. Inclusion criteria were the presence of unilateral or bilateral, Sawhney's type III or IV ankylosis. Exclusion criteria were pre-existing FNI, reankylosis cases.</div></div><div><h3>Predictor/Exposure/Independent Variable</h3><div>The primary predictor variable was surgical approach (IA vs ABA).</div></div><div><h3>Main Outcome Variables</h3><div>The primary outcome variables were FNI at 1 month and 6 months, measured using House-Brackmann scale, and scar cosmesis at 6 months using the Patient and Observer Scar Assessment Scale. Secondary outcome variables were dissection time for surgical exposure (minutes), intraoperative blood loss (milliliters), and other complications of infection, dehiscence, and hypertrophic scar.</div></div><div><h3>Covariates</h3><div>Covariates included demographics (age, sex), preoperative (side, location and Sawhney's type of ankylosis).</div></div><div><h3>Analyses</h3><div>The data were analyzed using descriptive statistics, student t-test, Mann-Whitney U test and regression analysis, with the level of statistical significance at <em>P</em> < .05.</div></div><div><h3>Results</h3><div>The study included 30 patients (40 joints: 20 in each group) with mean age of 22.45 ± 7.09 years in IA and 19.25 ± 7.06 years in ABA (<em>P</em> = .99). IA included 8 men (53.33%), 7 women (46.6%) and ABA had 5 men (33.3%), 10 women (66.6%) (<em>P</em> = .87). Postoperative FNI at 1 month accounted 45% in IA (n = 9) and 95% in ABA (n = 19), which was statistically significant (<em>P</em> = .001). At 6 months, FNI was 15% in IA (n = 3) and 70% in ABA (n = 14) that showed statistical difference (<em>P</em> = .003). For scar assessment at 6 months, the mean Patient and Observer Scar Assessment Scale score was 40.7 ± 17.2 for IA and 61.75 ± 17 for ABA, which was statistically significant (<em>P</em> = .001). IA had statistically significant shorter dissection time (IA = 25.45 ± 2.48 mins, ABA = 35.45 ± 3.97 mins; <em>P</em> = .0001) and lower amount of blood loss (IA = 52.15 ± 9.12 mL, ABA = 80.05 ± 8.91 mL;

背景：面神经损伤（FNI）和不美观的疤痕是颞下颌关节（TMJ）手术令人苦恼的并发症。目的：本研究的目的是比较在颞下颌关节强直中使用改良硬膜内切口（inviscision approach [IA]）和改良耳前切口（Alkayat-Bramley approach [ABA]）的术后 FNI 和手术瘢痕外观：作者实施了一项单中心、回顾性、队列研究。作者通过查阅电子病历，确定了在 2021 年 1 月至 2023 年 12 月期间因颞下颌关节强直向瑞诗凯诗印度医学科学研究所颅颌面外科就诊并接受强直松解术的受试者。纳入标准为单侧或双侧、索尼氏 III 型或 IV 型强直。排除标准为已存在 FNI 和再强直病例：主要预测变量为手术方法（IA vs ABA）：主要结果变量：1 个月和 6 个月时的 FNI（使用 House-Brackmann 量表测量）以及 6 个月时的疤痕外观（使用患者观察员疤痕评估量表测量）。次要结果变量为手术暴露的剥离时间（分钟）、术中失血量（毫升）以及感染、开裂和增生性瘢痕等其他并发症：协变量包括人口统计学（年龄、性别）、术前（侧、位置和 Sawhney 强直类型）：数据分析采用描述性统计、学生 t 检验、Mann-Whitney U 检验和回归分析，统计显著性水平为 P 结果：研究共纳入 30 名患者（40 个关节：每组 20 个），IA 患者的平均年龄为（22.45 ± 7.09）岁，ABA 患者的平均年龄为（19.25 ± 7.06）岁（P = .99）。IA 组有 8 名男性（53.33%）、7 名女性（46.6%），ABA 组有 5 名男性（33.3%）、10 名女性（66.6%）（P = .87）。术后 1 个月的 FNI 在 IA（9 人）中占 45%，在 ABA（19 人）中占 95%，具有统计学意义（P = .001）。6 个月时，IA（3 人）的 FNI 为 15%，ABA（14 人）的 FNI 为 70%，差异有统计学意义（P = .003）。在 6 个月时的疤痕评估中，患者观察者疤痕评估量表的平均评分为：IA 40.7 ± 17.2 分，ABA 61.75 ± 17 分，差异有统计学意义（P = .001）。IA的剥离时间更短（IA-25.45 ± 2.48 mins，ABA-35.45 ± 3.97 mins；P = .0001），失血量更少（IA-52.15 ± 9.12 mL，ABA-80.05 ± 8.91 mL；P = .0001），具有统计学意义。未观察到有统计学意义的并发症：总之，IA 显示出更好的结果，如更短的剥离时间、更少的 FNI、更好的疤痕外观，可作为颞下颌关节强直手术中传统 ABA 的合适替代方案。

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引用次数: 0