Journal of Oral and Maxillofacial Surgery最新文献

Background: Local recurrence is common in mandibular squamous cell carcinoma (MSCC). Fluorescence visualization is a noninvasive technology that can detect oral epithelial dysplasia around MSCC, and it can potentially reduce local recurrence.

Purpose: The purpose of this study was to measure and compare local control (LC) between fluorescence visualization-guided surgery (FVS) and conventional surgery for patients with Stages I or II MSCC.

Study design, setting, sample: This retrospective cohort study was conducted at Tokyo Dental College, Chiba Hospital, or Chiba Dental Center. The medical records of MSCC patients from 2000 to 2021 were analyzed. Patients from any sex and 18 years of age or older with complete records who received surgery for mandibular SCC in the early stages were included in this study.

Predictor variable: The predictor variable was operative treatment and was divided into 2 groups, conventional or FVS.

Main outcome variables: The outcome variable is 5-year LC defined as no recurrence at or within 20 mm of the surgical site.

Covariates: Covariates included demographic variables of age, sex, clinical and pathological characteristics, forms of resection, lifestyle, and quality of life.

Analyses: Data analysis was performed by carrying out χ² tests. Survival outcome was performed by the Kaplan-Meier method, which was used to calculate and stratify the log-rank test; P values <.05 indicated statistical significance.

Results: This study sample was composed of 56 subjects with a mean age of 68.5 years old (standard deviation 13.7), and 33 (58.9%) were female. There were 36 (64.3%) and 20 (35.7%) subjects in the conventional and FVS groups. The characteristics and quality of life did not differ significantly between the 2 groups. Five-year LC with FVS was statistically significantly higher than conventional surgery (P = .04, 94.4 vs 77.2%). Multivariate analysis for LC rate only identified FVS (P = .004; hazard ratio = 0.11, 95% confidence interval = 0.46, 0.88).

Conclusion and relevance: On MSCC, LC was 94.4% in FVS versus 77.2% in conventional surgery. For MSCC at stages I and II, FVS was associated with improved LC.

Background: Idiopathic condylar resorption (ICR) is a rare condition of unknown etiology characterized by progressive decrease in volume and pathologic remodeling of a previously normal mandibular condyle. Juvenile idiopathic arthritis (JIA) affecting only the temporomandibular joint (TMJ-only JIA) is characterized by synovitis and destruction of TMJ tissues without involvement of other joints. It is often difficult to differentiate the 2 conditions because they exhibit similar phenotypes.

Purpose: To compare histology of resected condylar specimens from patients with ICR and TMJ-only JIA. Specific aims were as follows: 1) to correlate longitudinal clinical data with histopathology of resected condyle specimens and 2) to compare resorption patterns between the 2 disease processes.

Study design, setting, sample: This was a retrospective cohort study of patients treated at the Massachusetts General Hospital from 1999 through 2023.

Predictor/exposure/independent variable: Primary predictor variable was the diagnosis (ICR or JIA). Secondary predictor variables included age, gender, race, putative contributing factors, and laboratory studies.

Main outcome variable(s): Primary outcome variable was presence or absence of inflammatory infiltrates in bone and synovial specimens. Secondary outcome variables were structural integrity and morphologic characteristics of the condylar cartilage and bone.

Analyses: Spearman correlation was used to assess the relationship between histological scores and age, gender, and possible associated contributing factors. A P value < .05 was considered statistically significant.

Results: Thirty-five subjects (67 specimens) were included in group 1 (ICR). Eight subjects (15 specimens) were included in group 2 (TMJ-only JIA). The histopathologic findings in ICR consisted of severe and irregular cartilage surface disruption, fibrocartilage degeneration, and subchondral bone with no inflammatory infiltrate. Degeneration was observed to begin at the anterior pole of the condyle and progress eventually to total resorption to the sigmoid notch. TMJ-only JIA was notable for more severe condylar degeneration and inflammation in the bone and synovia. There was no specific pattern of degeneration. For both groups, the subject's age, gender, or putative contributing factors did not correlate with the histopathologic scores.

Conclusion and relevance: These results support the hypothesis that ICR and TMJ-only JIA are distinct clinical entities and can be distinguished by histopathologic findings in the mandibular condyles and synovia.

Background: Cone-beam computed tomography (CBCT) provides additional 3-dimensional information on the relationship between the mandibular third molar (M3M) and the inferior alveolar nerve (IAN). As such, CBCT is being increasingly utilized in preoperative M3M assessment.

Purpose: The purpose of the study was to compare the radiographic findings on panoramic and CBCT and their association with postoperative IAN paresthesia.

Study design, setting, sample: We conducted a retrospective cohort study in a sample of patients referred to the Department of Oral and Maxillofacial Surgery at the Royal Dental Hospital of Melbourne, for management of impacted M3Ms. Patients were included in this study if they had 1 or more high-risk findings on orthopantomogram (OPG), had both OPG and CBCT imaging taken and if at least 1 M3M had been extracted. Subjects were excluded from this study if their M3Ms were not extracted or if a CBCT was not indicated.

Independent variable: The independent variable was radiographic features identified on OPG (Rood and Shehab's radiographic signs, root morphology, impaction type, Pell and Gregory classification) and CBCT (number and location of roots, severity of IAN compression and the presence of ankylosis).

Main outcome variable: The outcome variable was postoperative neurosensory function defined as any reported paresthesia at 2-week postprocedural review.

Covariates: The covariates were patient demographic information (age, sex).

Analyses: Variables were initially assessed with univariate logistic regression analysis to determine factors related to developing postoperative paresthesia. Multivariate logistic regression analysis was then used to assess the association between positive univariate study variables and postoperative paresthesia, while adjusting for potential confounders. Covariates were assessed using an omnibus likelihood ratio test and included if they were statistically significant at the P < .05 level.

Results: The study sample consisted of 257 subjects who underwent surgical removal of n = 386 M3Ms. The mean age was 25.9 (standard deviation = 7.05). The panoramic features of narrowing of canal, diversion of canal and dark and bifid roots were identified as statistically significant associations of postoperative paresthesia. No CBCT features were significantly associated of postoperative paresthesia.

Conclusion and relevance: Certain panoramic features, along with patient age, are significant predictors of IAN paresthesia. CBCT findings were not significant predictors upon multivariate analysis, thus additional CBCT imaging did not significantly improve ability to predict paresthesia.

Computed tomography (CT) is the standard of care imaging in craniomaxillofacial (CMF) trauma. Despite the clear advantages of high-resolution multiplanar and three-dimensional reconstructions, which facilitate accurate diagnosis and provide intraoperative (IO) real-time visual feedback, CT's main drawbacks remain availability, cost, and high radiation exposure. The decision to perform a CT scan is based on the integration of the patient's trauma mechanism, clinical examination, subjective judgment of the CMF surgeon, and the complexity of the surgery if used IO. Handheld point-of-care ultrasound is a small, portable device that can provide valuable additional data directing clinical decisions for CT referral in minor trauma cases and assist IO maneuvers. We describe a novel handheld point-of-care ultrasound application concept as a clinical supplementary tool in CMF trauma diagnosis and surgery.

Background: Complications of open reduction and internal fixation (ORIF) of mandibular fractures are influenced by several patient factors. A postoperative surgeon phone call could modify these factors through education and reinforcement of instructions, but its effect has not been studied.

Purpose: The purpose of this study was to measure and compare the frequencies of postoperative inflammatory complications (POICs) following ORIF of mandibular fractures in patients who did and did not receive a postoperative surgeon phone call.

Study design, setting, sample: The authors conducted an ambispective cohort study consisting of patients with mandibular fractures treated with ORIF at a large urban trauma hospital with the prospective cohort from January 1, 2021 to March 31, 2022 and a retrospective cohort from April 1, 2020 to December 31, 2020. Prisoners and patients with gunshot wounds were excluded.

Predictor variable: The primary predictor variable was the surgeon call group. After January 2021, a postoperative call was implemented 1-3 days following fracture repair to review instructions, such as nonchew diet and oral hygiene, and provide education, such as reviewing expectations. Prior to January 2021, patients were not called. This resulted in 3 categories: Not Called, Called and Answered, and No Answer.

Main outcome variables: The primary outcome variable was POICs, defined as the occurrence of exposed or infected hardware, abscess formation, recurrent swelling/pain, nonunion, osteomyelitis, or fistula formation.

Covariates: Demographic variables, injury-related variables, and treatment-related variables were also measured.

Analyses: Statistical analysis was performed using Fisher's exact and Wilcoxon rank-sum tests, as well as multivariable logistic regression. A P value was considered significant if < .05.

Results: Of the 178 patients in the study, 137 (77%) were male and the average age was 39.9 ± 12.6 years. Sixty-five patients (36.5%) were not called. Of the patients called, 79 (44.4%) answered and 34 (19.1%) did not answer. POICs occurred in 9.2% of the Not Called group and 8.9% of the Called and Answered group (P = .99). In the No Answer group, 29.4% had POICs, which was higher than the other 2 groups (P = .01).

Conclusion and relevance: A surgeon phone call was not associated with complication rates; however, patients in the No Answer group were significantly more likely to experience a POIC.

Background: Finding a protocol that could prevent bone resorption and be implemented in clinical practice would be crucial in providing sufficient bone to replace missing teeth with implants.

Purpose: The study aimed to determine the effectiveness of different centrifugation platelet-rich fibrin (PRF) protocols in new bone formation and bone regenerative markers.

Study design, setting and sample: This randomized clinical trial was conducted at Izmir Katip Çelebi Research Hospital, a population-based facility in Izmir, Turkey. Study subjects were composed of patients who required extraction of anterior teeth. Exclusion criteria included periodontal disease, resorption of alveolar bone, defects, smoking, alcoholism, and systemic diseases.

Independent variable: The independent variable was the PRF protocol. The subjects were randomly assigned to one of three groups: leukocyte platelet-rich fibrin (L-PRF), advanced platelet-rich fibrin (A-PRF) and control groups (healing naturally).

Main outcome variable: The primary outcome of interest was the percentage of new bone formation, determined by analyzing the staining intensity in histomorphometric assessments of bone samples collected 8 weeks after extraction. The secondary outcomes were regenerative effects measured by the immunohistochemical expression of markers such as osteocalcin, alkaline phosphatase, and proliferating cell nuclear antigen. Potential benefits were evaluated by clinical observations of pain, swelling, membrane visibility and healing.

Covariates: The covariates were age, sex and health conditions.

Analyses: Histologic comparative staining intensities and biomarkers expression between groups were evaluated by one way analysis of variance. A difference of P < .05 was considered statistically significant.

Results: The study included 57 subjects, with a mean age of 45 years (±5.6); 30 were male (53%) and 27 female (47%). The control group had a mean new bone formation of 32.68% (±2.5), the A-PRF group 61.37% (±3.0), and the L-PRF group 70.74% (±3.5) (P < .001). The A-PRF group showed significantly higher osteocalcin expression than the control group (P = .013). Alkaline phosphatase and proliferating cell nuclear antigen expression scores for PRF groups were significantly higher than the control group's (P = .001). Both groups demonstrated significantly lower pain scores, reduced gingival swelling, better membrane visibility, and healing compared to the control group.

Conclusion and relevance: PRF enhanced bone formation rates, with L-PRF showing the most significant effect.

Background: Custom-designed and patient-fitted temporomandibular joint replacement (TMJR) devices are used to manage end-stage temporomandibular joint (TMJ) pathology, distorted bony TMJ architecture, or in patients who have undergone multiple prior failed TMJ surgeries.

Purpose: This study aimed to measure the frequency of revision or replacement over time, estimate the 1-, 2-, and 3-year survival rate of implants, and determine what demographic, anatomical, or operative variables may be associated with a device adverse event (AE).

Study design, setting, sample: A prospective cohort study was conducted on consenting adults who could read English, implanted with the TMJ Concepts TMJR prostheses between 2013 and 2015 by private or academic surgeons. Patients under the age of 18 and those who were incapable, unwilling, or unable to complete the perioperative forms were excluded.

Main outcome variable: The primary outcome variable was the frequency of AEs, which is defined as device revision or replacement. The secondary outcome variable was the survival rate for the TMJ Concepts devices.

Analyses: Device survival at 1, 2, and 3 years was estimated using the Kaplan-Meier methodology. Cox proportional hazards regression was used to analyze the effects of the predictor variables for the device survival rate. A P value of <.05 was considered significant.

Results: A total of 738 subjects (1,098 joints) were enrolled in the study with 102 (14%) males and 636 (86%) females. The mean age was 45.4 (+14.8) years. The median follow-up period was 36.2 months (95% CI: 36.1 to 36.2 months). A total of 187 subjects (25.3%) were lost to follow-up during; the study period. Forty-nine devices (4.46%) were associated with an AE at 3 years. The; 3-year device survival was 95.1% (95% CI: 93.6 to 96.3%). The only significant risk factor for an AE was the asymmetry of the mandible (hazard rate ratio = 1.989, P = .03). The primary diagnosis was not associated with the time to an AE (P value = .8685). Infection (44.7%, 21 joints) and material sensitivity (12.8%, 6 joints) were the most common reasons specifically for device removal/replacement in the study cohort.

Conclusion and relevance: Infection was the primary reason reported for device revision or replacement followed by material sensitivity. In the study cohort, the device survival following implantation of the TMJ Concepts prosthesis was not significantly different than reported by the TMJR stock device.

Background: There is variability in the literature on the role of the depth of invasion (DOI) for recommending an elective neck dissection (END).

Purpose: The purpose of the study is to estimate the DOI threshold for recommending an END.

Study design, setting, sample: A retrospective cohort study was performed at McGill University Health Centre from 2008 to 2018 with 5 years of follow-up. The sample was subjects with clinical T1/T2 oral squamous cell carcinoma and clinically negative neck. Subjects with previous head and neck cancer were excluded.

Predictor variable: The primary predictor variable was DOI measured from the basement membrane of the adjacent normal mucosa on final pathology, coded as <4 mm or ≥4 mm. DOI is a continuous variable converted to a binary variable.

Main outcome variable: The main outcome variable was time to development of neck disease (RD+) defined as the time from surgery to development of pathologic nodes. Time to RD+ for pathologic nodes discovered from the END was considered 0 months. The secondary outcome variable was overall survival.

Covariates: Demographics (age, sex, and smoking/alcohol history) and tumor characteristics (tumor location, clinical T, tumor differentiation, perineural invasion, and lymphovascular invasion) were analyzed.

Analyses: Time to RD+ and survival were analyzed using Cox hazard ratio, Kaplan-Meier curves, and log-rank test. Student's t-test and χ² test were used for bivariate analyses; P ≤ .05 was statistically significant.

Results: The final sample were 64 subjects (average age 65.25 [standard deviation 13.06] years and 36 [56.2%] males). Twenty-nine subjects had DOI < 4 mm, and the 5-year RD+ was 3.4% (the 1 occurrence of RD+ was at 5.3 months). Thirty-five subjects had DOI ≥ 4 mm, and the 5-year RD+ was 45.7% (15 subjects had RD+ discovered from the END, and 1 subject had RD+ at 7.6 months). DOI ≥ 4 mm had significantly higher risk of RD+ than DOI < 4 mm (hazard ratio 17.91; 95% confidence interval 2.37 to 135.3; P = .01), which remained significant after adjusting for clinical T, tumor differentiation, perineural invasion, and lymphovascular invasion (hazard ratio 9.53; 95% confidence interval 1.12 to 81.44; P < .05). The shallowest DOI with >20% risk of RD+ was in the DOI 4 mm to 4.9 mm group.

Conclusion and relevance: Among patients with oral squamous cell carcinoma of T1 or T2 and clinically negative necks, END should be considered with DOI ≥ 4 mm.