Journal of Oral and Maxillofacial Surgery最新文献_第3页

The Value of Orthognathic Surgery Fellowships 正颌外科奖学金的价值。

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-03-01 DOI: 10.1016/j.joms.2025.08.021

Collin A. Ritchie DMD, MD , Jeffery C. Posnick DMD, MD , Brian E. Kinard DMD, MD

引用次数: 0

Trends in Antibiotic Prescriptions by Oral and Maxillofacial Surgeons to Medicare Beneficiaries, 2013-2022 口腔颌面外科医生对医疗保险受益人抗生素处方的趋势，2013-2022。

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-11 DOI: 10.1016/j.joms.2025.11.002

Lang Liang BS , Tim T. Wang DMD, MD, MPH , Cameron C. Lee DMD, MD , Daniel D. Choi DDS, MD , Zachary S. Peacock DMD, MD

Background

Oral and maxillofacial surgeons frequently prescribe antibiotics, yet their prescribing patterns are not well studied on a national level.

Purpose

The purpose of this study was to quantify and characterize antibiotic prescriptions to Medicare beneficiaries by oral and maxillofacial surgeons in 2013-2022.

Study design, setting, and sample

This retrospective cohort study used the Medicare Part D Prescribers data sets, 2013-2022. Providers with a specialty description of oral and maxillofacial surgery (OMS) and had antibiotic prescription data available were included.

Predictor variable

The primary predictor variable was the year of prescription (2013-2022).

Outcome variable

The primary outcome variable was the number of antibiotic claims per 1,000 beneficiaries. Secondary outcome variables included total antibiotic claims and claims per provider.

Covariates

Covariates included provider sex and region of practice.

Analyses

Descriptive statistics were calculated. Linear regression was utilized to assess changes in outcome variables in 2013-2022. The top 10% of antibiotic prescribers were categorized based on total antibiotic claims. Bivariate analyses were used to evaluate which characteristics were associated with the top 10% of prescribers.

Results

The number of surgeons each year in 2013-2022 ranged from 6,070 to 6,538. The total number of antibiotic claims in 2013-2022 was 6,803,957. The total number of antibiotic claims in 2013 and 2022 were 475,201 and 931,803, respectively. The mean claims per 1,000 beneficiaries and claims per surgeon in 2013-2022 were 874.6 and 106.9, respectively. The mean claims per 1,000 beneficiaries were 806.4 in 2013 and 946.2 in 2022, with an estimated yearly increase of 16.1 (P < .001). The mean claims per surgeon significantly increased from 2013 (78.3) to 2022 (144.9) by approximately 6.5 each year (P < .001). Amoxicillin was the most prescribed antibiotic, with the claims per 1,000 beneficiaries also increasing from 2013 (511.8) to 2022 (662.7) by approximately 17.1 each year (P < .001). The top 10% of antibiotic prescribers accounted for 29.5 to 31.0% of the total antibiotic volume depending on the year.

Conclusions and relevance

These findings suggest that antibiotic prescribing is increasing among oral and maxillofacial surgeons. Antibiotic stewardship interventions, especially tailored toward high-volume prescribers, may be beneficial in reducing overall antibiotic prescription volume.

背景：口腔颌面外科医生经常开抗生素，但其处方模式在全国范围内尚未得到很好的研究。目的：本研究的目的是量化和表征2013-2022年口腔颌面外科医生给医疗保险受益人开的抗生素处方。研究设计、设置和样本：本回顾性队列研究使用2013-2022年医疗保险D部分处方者数据集。具有口腔颌面外科（OMS）专业描述并具有抗生素处方数据的提供者被纳入研究。预测变量：主要预测变量为处方年份（2013-2022）。结果变量：主要结果变量是每1000名受益人使用抗生素的数量。次要结果变量包括总抗生素索赔和每个提供者索赔。协变量：协变量包括医生性别和执业地区。分析：进行描述性统计。采用线性回归评估2013-2022年结局变量的变化。前10%的抗生素处方者是根据总抗生素声明进行分类的。使用双变量分析来评估哪些特征与前10%的处方者相关。结果：2013-2022年，每年的外科医生数量为6070 ~ 6538人。2013-2022年抗生素索赔总数为6,803,957。2013年和2022年抗生素索赔总数分别为475201件和931803件。2013-2022年，每1000名受益人和每名外科医生的平均索赔分别为874.6和106.9。2013年每1000名受益人的平均索赔额为806.4,2022年为946.2，预计每年增加16.1 （P < 0.001）。从2013年（78.3）到2022年（144.9），每位外科医生的平均索赔要求每年显著增加约6.5次（P < 0.001）。阿莫西林是处方最多的抗生素，每1000名受益人的索赔也从2013年（511.8）增加到2022年（662.7），每年约增加17.1 （P < .001）。前10%的抗生素处方者占抗生素总量的29.5%至31.0%，具体年份不同。结论和相关性：这些发现提示抗生素处方在口腔颌面外科医生中正在增加。抗生素管理干预措施，特别是针对大量处方者量身定制的干预措施，可能有利于减少抗生素的总体处方量。

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引用次数: 0

Does Injection of Dexamethasone Into the Pterygopalatine Fossa Reduce the Side Effects of Third Molar Surgery? 翼状腭窝注射地塞米松能减少第三磨牙手术的副作用吗？

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-11 DOI: 10.1016/j.joms.2025.11.003

Thongnard Kumchai DDS , Atapol Yongvikul DDS , Manop Khanijou DDS, MSc , Natthamet Wongsirichat DDS, BSc

Background

Sequelae of third molar impaction (TMI) surgery, including pain, limited jaw movement, and edema, may be mitigated by dexamethasone injected into the pterygopalatine fossa (PPF).

Purpose

This study's purpose was to measure and compare pain, maximum interincisal distance (MID), and edema between dexamethasone and saline injected into the PPF.

Study design, setting, sample

A split-mouth, randomized, triple-blinded study was carried out at our institution from 2023 to 2024. Patients with 4-quadrant TMI of the same classification were included. Subjects were excluded for drug allergies, recent medication use, inability to complete the protocol, or medical contraindications. Split-mouth procedures were performed with a minimum interval of 4 weeks.

Predictor variables

The sides of the mouth were assigned randomly to study and control groups. The study group was injected with 8 mg dexamethasone and the control group with normal saline solution.

Main outcome variable(s)

Therapeutic response was assessed using 3 facial swelling indices, MID, and pain scores on postoperative days 1 (D-1), 3 (D-3), 5 (D-5), and 7 (D-7).

Covariates

The covariates were operative duration and TMI classifications.

Analysis

Wilcoxon signed-rank test, χ² and paired t-test analyses were used to compare the 2 groups at P < .05 with the SPSS statistic program.

Results

Nineteen subjects (mean age 21.38 ± 3.11 years; 47.36% male) completed the study. The dexamethasone group showed significantly lower facial swelling indices than controls on D-3 and D-7. On D-3, all 3 facial measurements (Ex-Go, Tr-Ch, and Tr-Pg ratios) were lower in the study group (P = .001, P = .001, and P = .002, respectively). On D-7, Ex-Go and Tr-Pg ratios remained significantly lower (P = .001 and P = .002). Swelling reduction was consistent across all measurements. MID and pain scores also showed significant reductions. The MID difference was 5.53 ± 2.16 mm on D-3 (P = .001), and the D-1 pain score was 4.21 ± 2.55 in the study group versus 6.68 ± 2.19 in controls (P = .001).

Conclusions

This study demonstrated a novel, clinician-friendly technique which PPF-administered dexamethasone significantly reduces post-TMI facial swelling and pain compared to placebo.

背景：第三磨牙嵌塞（TMI）手术的后遗症，包括疼痛、下颌活动受限和水肿，可以通过向翼腭窝（PPF）注射地塞米松来缓解。目的：本研究的目的是测量和比较地塞米松和生理盐水注射PPF的疼痛、最大内切距离（MID）和水肿。研究设计、环境、样本：本研究于2023年至2024年在我院开展了一项分口、随机、三盲研究。纳入同一分类的四象限TMI患者。受试者因药物过敏、近期用药、无法完成方案或医学禁忌症而被排除。裂口手术的最短间隔为4周。预测变量：口腔两侧被随机分配到研究组和对照组。研究组注射地塞米松8mg，对照组注射生理盐水。主要结局变量：术后第1天（D-1）、第3天（D-3）、第5天（D-5）和第7天（D-7），采用3种面部肿胀指数、MID和疼痛评分来评估治疗效果。协变量：共变量为手术时间和TMI分类。分析：采用SPSS统计程序，采用Wilcoxon sign -rank检验、χ2和配对t检验分析，P < 0.05。结果：19例受试者完成研究，平均年龄21.38±3.11岁，男性47.36%。地塞米松组D-3、D-7面部肿胀指数明显低于对照组。在D-3时，研究组的所有3项面部测量（Ex-Go， Tr-Ch和Tr-Pg比率）均较低（P = 0.001, P = 0.001和P = 0.002）。在D-7时，Ex-Go和Tr-Pg比值仍显著降低（P = 0.001和P = 0.002）。所有测量结果均显示消肿效果一致。MID和疼痛评分也有显著降低。D-3的MID差异为5.53±2.16 mm (P = .001)， D-1疼痛评分实验组为4.21±2.55，对照组为6.68±2.19 （P = .001）。结论：本研究证明了一种新颖的，临床友好的技术，ppf给药地塞米松与安慰剂相比，可显著减少tmi后面部肿胀和疼痛。

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引用次数: 0

Are Persistent Post-traumatic Complications Associated With Orbital Volume Variation After Orbital Reconstruction? A Prospective Cohort Study 持久的创伤后并发症与眼眶重建后眼眶体积变化有关吗？前瞻性队列研究。

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-29 DOI: 10.1016/j.joms.2025.10.016

Bruno Coelho Mendes DDS, MSc, PhD , Fabrizio Albieri DDS, MSc , Thaysa Barbosa dos Santos Queiroz DDS, MSc , Eduardo Hochuli-Vieira DDS, MSc, PhD , Rodrigo dos Santos Pereira DDS, MSc, PhD

Background

Orbital fractures are common facial injuries that may cause lasting functional and esthetic complications, but the link between orbital volume variation and persistent postoperative outcomes remains unclear.

Purpose

The study purpose was to measure the association between postoperative orbital volume and persistent postoperative complications.

Study Design, Setting, and Sample

This prospective cohort study was conducted between 2022 and 2024 at the General Hospital of Nova Iguaçu, Brazil. It included patients who underwent surgical treatment of unilateral orbital fractures with orbital wall repair using titanium mesh; those with prior orbital surgery, neurological disorders, facial syndromes, or unsatisfactory reconstruction were excluded.

Predictor Variable

The predictor variable was postoperative orbital volume variation defined as the difference between the reconstructed and the contralateral orbit.

Outcome Variables

The primary outcome was the persistence of postoperative complications, defined as the presence of enophthalmos, diplopia, ocular dystopia, hypoglobus, superior orbital fissure syndrome, ophthalmoplegia, or retrobulbar hematoma at postoperative follow-up. The secondary outcome was orbital volume variation over time measured at 3 distinct time points.

Covariates

The Covariates analized were age, sex, race, mechanism of injury, fracture side, associated fractures, preoperative complications, orbital defect classification, and follow-up duration.

Analyses

Continuous data were analyzed with Student's t-test or Mann–Whitney U test, and categorical data with Fisher's exact test. Logistic regression identified predictors of persistent complications (odds ratio, 95% CI). Repeated-measures analysis of variance evaluated orbital volume changes over time. Statistical significance was set at P < .05.

Results

This study included 28 subjects, with a mean age of 30.4 years (±10.7), of whom 20 (71.4%) were male. No significant associations were found between orbital volume variation and the analyzed covariates. A statistically significant association was observed only for fracture side (P < .01). Fracture side was the only significant predictor (odds ratio = 6.0; 95% CI, 1.1 to 33.2; P < .01). Repeated-measures analysis of variance showed a significant decrease in orbital volume over time (P < .01).

Conclusions and Relevance

Although orbital volume decreased significantly over time, it was not associated with persistent postoperative complications. Outcomes likely reflect multifactorial interactions of trauma severity, surgical treatment, and healing rather than isolated volumetric changes.

背景：眼眶骨折是常见的面部损伤，可引起持久的功能和美学并发症，但眼眶体积变化与持续的术后结果之间的联系尚不清楚。目的：研究目的是测量术后眶体积与术后持续并发症的关系。研究设计、环境和样本：这项前瞻性队列研究于2022年至2024年在巴西新伊瓜帕拉苏总医院进行。其中包括手术治疗单侧眶骨折并使用钛网修复眶壁的患者；既往有眼眶手术、神经系统疾病、面部综合征或重建不满意者排除在外。预测变量：预测变量为术后眶体积变化，定义为重建眶与对侧眶的差异。结果变量：主要结果是术后并发症的持续存在，定义为术后随访时出现眼内陷、复视、眼异位、球下、眶上裂综合征、眼麻痹或球后血肿。次要结果是在3个不同的时间点测量眼眶体积随时间的变化。协变量：分析的协变量包括年龄、性别、种族、损伤机制、骨折侧、相关骨折、术前并发症、眶缺损分类和随访时间。分析：连续资料采用Student's t检验或Mann-Whitney U检验，分类资料采用Fisher精确检验。Logistic回归确定了持续性并发症的预测因素（优势比，95% CI）。重复测量方差分析评估眼眶体积随时间的变化。差异有统计学意义，P < 0.05。结果：本研究纳入28例受试者，平均年龄30.4岁（±10.7），其中男性20例（71.4%）。眼眶体积变化和分析的协变量之间没有发现显著的关联。仅在骨折侧观察到有统计学意义的相关性（P < 0.01）。骨折侧是唯一有意义的预测因素（优势比= 6.0;95% CI, 1.1 ~ 33.2; P < 0.01）。重复测量方差分析显示眼眶体积随时间显著减少（P < 0.01）。结论及相关性：虽然眼眶体积随时间明显减小，但与术后持续并发症无关。结果可能反映创伤严重程度、手术治疗和愈合的多因素相互作用，而不是孤立的体积变化。

{"title":"Are Persistent Post-traumatic Complications Associated With Orbital Volume Variation After Orbital Reconstruction? A Prospective Cohort Study","authors":"Bruno Coelho Mendes DDS, MSc, PhD , Fabrizio Albieri DDS, MSc , Thaysa Barbosa dos Santos Queiroz DDS, MSc , Eduardo Hochuli-Vieira DDS, MSc, PhD , Rodrigo dos Santos Pereira DDS, MSc, PhD","doi":"10.1016/j.joms.2025.10.016","DOIUrl":"10.1016/j.joms.2025.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Orbital fractures are common facial injuries that may cause lasting functional and esthetic complications, but the link between orbital volume variation and persistent postoperative outcomes remains unclear.</div></div><div><h3>Purpose</h3><div>The study purpose was to measure the association between postoperative orbital volume and persistent postoperative complications.</div></div><div><h3>Study Design, Setting, and Sample</h3><div>This prospective cohort study was conducted between 2022 and 2024 at the General Hospital of Nova Iguaçu, Brazil. It included patients who underwent surgical treatment of unilateral orbital fractures with orbital wall repair using titanium mesh; those with prior orbital surgery, neurological disorders, facial syndromes, or unsatisfactory reconstruction were excluded.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was postoperative orbital volume variation defined as the difference between the reconstructed and the contralateral orbit.</div></div><div><h3>Outcome Variables</h3><div>The primary outcome was the persistence of postoperative complications, defined as the presence of enophthalmos, diplopia, ocular dystopia, hypoglobus, superior orbital fissure syndrome, ophthalmoplegia, or retrobulbar hematoma at postoperative follow-up. The secondary outcome was orbital volume variation over time measured at 3 distinct time points.</div></div><div><h3>Covariates</h3><div>The Covariates analized were age, sex, race, mechanism of injury, fracture side, associated fractures, preoperative complications, orbital defect classification, and follow-up duration.</div></div><div><h3>Analyses</h3><div>Continuous data were analyzed with Student's t-test or Mann–Whitney U test, and categorical data with Fisher's exact test. Logistic regression identified predictors of persistent complications (odds ratio, 95% CI). Repeated-measures analysis of variance evaluated orbital volume changes over time. Statistical significance was set at <em>P</em> < .05.</div></div><div><h3>Results</h3><div>This study included 28 subjects, with a mean age of 30.4 years (±10.7), of whom 20 (71.4%) were male. No significant associations were found between orbital volume variation and the analyzed covariates. A statistically significant association was observed only for fracture side (<em>P</em> < .01). Fracture side was the only significant predictor (odds ratio = 6.0; 95% CI, 1.1 to 33.2; <em>P</em> < .01). Repeated-measures analysis of variance showed a significant decrease in orbital volume over time (<em>P</em> < .01).</div></div><div><h3>Conclusions and Relevance</h3><div>Although orbital volume decreased significantly over time, it was not associated with persistent postoperative complications. Outcomes likely reflect multifactorial interactions of trauma severity, surgical treatment, and healing rather than isolated volumetric changes.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"84 3","pages":"Pages 331-343"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

AAOMS Author Disclosure forms 作者披露表

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-03-01 DOI: 10.1016/S0278-2391(26)00006-6

引用次数: 0

Is Preoperative Serum Albumin Associated With Medication Related Osteonecrosis of the Jaw Severity and Surgical Outcomes? 术前血清白蛋白与MRONJ严重程度和手术结果相关吗？

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-15 DOI: 10.1016/j.joms.2025.10.002

Adam Fuller BA , Srighana Nadella BA , Georgios Hatzipetrou DMD , Puhan He DMD, MD , Katherine N. Theken PharmD, PhD , Neeraj Panchal DDS, MD, MA

Background

Preoperative serum albumin is a widely recognized marker of postoperative outcomes across various surgical conditions, with lower levels associated with worse outcomes. However, its prognostic value in medication-related osteonecrosis of the jaw (MRONJ) remains unexplored.

Purpose

The purpose of the study was to evaluate the association between preoperative albumin levels and both surgical outcomes and MRONJ severity at presentation.

Study Design, Setting, Sample

A retrospective cohort study was conducted on subjects treated for MRONJ under the Oral and Maxillofacial Surgery service at the University of Pennsylvania Health System between January 1, 2013, and September 12, 2022. Inclusion criteria were a confirmed MRONJ diagnosis, surgical management, and preoperative serum albumin level measured within 3 months of surgery. Subjects without at least one postoperative follow-up were excluded.

Predictor Variable

The primary predictor variable was preoperative serum albumin within 3 months of surgery.

Main Outcome Variables

The primary outcome variable was surgical outcome in MRONJ, characterized as improved (resolved or downstaged) versus not improved (same stage, upstaged, and/or with complications).

Covariates

Covariates included demographic variables (age, sex, race) and clinical factors (MRONJ stage, history of osteoporosis, cancer, penicillin allergy, diabetes, smoking) for MRONJ.

Analysis

Multiple logistic regression and analysis of variance models were used to assess associations between serum albumin and surgical outcomes. Statistical significance was defined at P < .05.

Results

The sample was composed of 94 subjects with a mean age of 68.1 ± 10.3 years; 31 (33.0%) were male. The mean preoperative albumin level was 3.84 ± .43 g/dl. The unadjusted associated albumin levels were statistically significantly lower in the group with poor surgical outcomes (3.51 ± 0.457 g/dl) compared to the improved group (3.90 ± 0.394 g/dl; P < .05). After adjusting for all the covariates, albumin was statistically significantly associated with improved outcomes (OR: 0.0928; 95% CI: 0.0138 to 0.489; P < .05).

Conclusions and Relevance

In one of the largest surgical MRONJ cohorts to date, there was a statistically significant association between lower preoperative serum albumin levels and poorer surgical outcomes.

背景：术前血清白蛋白被广泛认为是各种手术条件下的术后预后指标，其水平越低，预后越差。然而，其在药物相关性颌骨骨坏死（MRONJ）中的预后价值仍未被探索。目的：本研究的目的是评估术前白蛋白水平与手术结果和出现时MRONJ严重程度之间的关系。研究设计、环境、样本：在2013年1月1日至2022年9月12日期间，在宾夕法尼亚大学卫生系统口腔颌面外科服务下进行MRONJ治疗的受试者进行了一项回顾性队列研究。纳入标准为确诊的MRONJ诊断、手术处理和术前3个月内测定的血清白蛋白水平。没有至少一次术后随访的受试者被排除在外。预测变量：主要预测变量为术前3个月内的血清白蛋白。主要结果变量：主要结果变量为MRONJ的手术结果，特征为改善（缓解或降级）与未改善（相同阶段，降级和/或合并并发症）。协变量：协变量包括人口统计学变量（年龄、性别、种族）和MRONJ的临床因素（MRONJ分期、骨质疏松史、癌症、青霉素过敏史、糖尿病、吸烟史）。分析：采用多元logistic回归和方差分析模型评估血清白蛋白与手术结果之间的关系。P < 0.05为差异有统计学意义。结果：本组共94例，平均年龄68.1±10.3岁；男性31例（33.0%）。术前平均白蛋白水平为3.84±。43 g / dl。手术预后不良组的未校正相关白蛋白水平（3.51±0.457 g/dl）明显低于手术预后改善组（3.90±0.394 g/dl, P < 0.05）。在对所有协变量进行调整后，白蛋白与改善的预后有统计学显著相关（OR: 0.0928; 95% CI: 0.0138 ~ 0.489; P < 0.05）。结论和相关性：在迄今为止最大的外科MRONJ队列之一中，较低的术前血清白蛋白水平与较差的手术结果之间存在统计学上显著的关联。

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引用次数: 0

REPLY: Cost-Effectiveness Analysis of Immediate Tissue Engineering Bone Graft Versus Fibula-Free Flap Reconstruction for Mandibular Continuity Defects Secondary to Benign Pathology 回复：即刻组织工程骨移植与无腓骨瓣重建治疗继发性下颌骨连续性缺损的成本-效果分析。

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-03-01 DOI: 10.1016/j.joms.2025.10.014

Sam M. Anton DDS, Andrew Gayed DMD, Paul Addamo DDS, MD, Julian N. Holland PhD, Mark E. Wong DDS, James C. Melville DDS

引用次数: 0

RE: No Evidence of Reduction in Mouth Opening After Biopsy in Oral Submucous Fibrosis—A Prospective Cohort Study RE：没有证据表明口腔黏膜下纤维化活检后开口减少-一项前瞻性队列研究。

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-03-01 DOI: 10.1016/j.joms.2025.10.020

Anuj Jain MDS

引用次数: 0

Prosthodontic Rehabilitation After Fibula-Free Flap Reconstruction of the Jaws. 颌骨无腓骨皮瓣重建后修复康复相关因素：一项回顾性队列研究。

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-02-26 DOI: 10.1016/j.joms.2026.02.017

John M Le, Myra Rana, Henry S Kendrick, Michael T Kase, Yedeh P Ying, Anthony B Morlandt

Background: Prosthodontic rehabilitation (PR) after fibula-free flap (FFF) reconstruction of maxillomandibular defects remains clinically challenging, and understanding factors that enhance or detract from achieving PR is critical to improving outcomes.

Purpose: The purpose of this study was to estimate the incidence of PRand identify clinical factors that facilitate or impede completion of PR in subjects undergoing FFF reconstruction of the maxilla or mandible.

Study design, setting, and sample: This retrospective cohort study was conducted at the University of Alabama at Birmingham and included subjects who underwent FFF reconstruction between January 2014 and July 2021, with at least 12 months of follow-up. The exclusion criteria included unresectable tumors, defects outside the oral cavity, and insufficient follow-up.

Predictor variables: Predictor variables included demographic, medical, pathologic, and operative factors, including implant placement.

Outcome variable(s): The outcome variable was time-to-PR and was defined as the replacement of missing dentition with fixed or removable prostheses.

Covariates: Not applicable.

Analysis: Descriptive statistics, Student's t test, χ², Kaplan-Meier analysis, and Cox regression analyses were performed. Statistical significance was set at P < .05.

Results: The sample consisted of 167 subjects with a mean age of 54.2 years (SD, 15.9), 86 (51.5%) male, and the median duration of follow-up was 39 months (interquartile range [IQR], 31). The incidence of PR at 12 months was 20%. The median time to PR was 32.5 months (95% CI, 19.9 to 45.0) and was significantly longer among subjects with malignant pathology, mandibular reconstruction, no implant placement, postoperative radiotherapy, and limited occlusal support. On multivariable analysis, mandibular reconstruction (P < .01) and absence of implant placement (P < .01) were independently associated with delayed completion of PR. A cumulative proportion of subjects who completed PR was 53.3%.

Conclusions and relevance: PR following FFF reconstruction occurred in a minority of subjects, with a median time to completion of 32.5 months, and was independently associated with mandibular reconstruction and absence of dental implant placement.

背景：上颌下颌骨缺损无腓骨瓣（FFF）重建后的修复康复（PR）在临床上仍然具有挑战性，了解促进或阻碍实现PR的因素对改善结果至关重要。目的：本研究的目的是评估上颌或下颌骨FFF重建患者PR的发生率，并确定促进或阻碍PR完成的临床因素。研究设计、环境和样本：这项回顾性队列研究在阿拉巴马大学伯明翰分校进行，纳入了2014年1月至2021年7月期间接受FFF重建的受试者，随访至少12个月。排除标准包括不可切除的肿瘤、口腔外缺损、随访不足。预测变量：预测变量包括人口统计学、医学、病理和手术因素，包括种植体放置。结果变量：结果变量为修复时间，定义为用固定或可移动义齿替换缺失的牙列。协变量：不适用。分析：采用描述性统计、Student’st检验、χ2、Kaplan-Meier分析和Cox回归分析。差异有统计学意义，P < 0.05。结果167例受试者，平均年龄54.2岁（SD, 15.9），男性86例（51.5%），中位随访时间39个月（四分位间距[IQR]， 31）。12个月时PR的发生率为20%。到PR的中位时间为32.5个月（95% CI， 19.9至45.0），在恶性病理、下颌重建、未植入种植体、术后放疗和咬合支持有限的患者中，PR的时间明显更长。在多变量分析中，下颌骨重建（P < 0.01）和未植入种植体（P < 0.01）与PR延迟完成独立相关。完成PR的受试者累积比例为53.3%。结论和相关性：FFF重建后的PR发生在少数受试者中，平均完成时间为32.5个月，并且与下颌重建和未种植牙独立相关。

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引用次数: 0

Does Pain Localization in Patients With Temporomandibular Disorders Discriminate Between Myogenous and Arthrogenous Sources? 颞下颌疾病患者的疼痛定位能否区分肌源性和关节源性？

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-02-25 DOI: 10.1016/j.joms.2026.02.020

Sandro Prati, Stefano Pagano, Chiara Valenti, Thomas Buttaboni Lacchini, Nicola Falocci, Gianluca Martino Tartaglia, Aldo Bruno Gianni

Background: Temporomandibular disorders (TMDs) are common, yet distinguishing myogenous from arthrogenous pain remains challenging.

Purpose: The purpose of the study was to measure the association between 3 patient-reported pain characteristics (anatomical localization, laterality, and modality used to indicate the painful area), individually and in combination, and the diagnosis of myogenous or arthrogenous TMD.

Study design, setting, and sample: A retrospective cross-sectional study was implemented. Patients presenting to Studio Dentistico Prati (Goito, Mantova, Italy) between January 2020 and January 2024 with a TMD diagnosis were identified through medical record. Inclusion criteria are subjects of ≥18 years of both sexes with painful TMD. Exclusion criteria are myogenous-arthrogenous TMD; orthodontic therapy within 3 years; gnathological, physiotherapeutic, or pharmacological therapy; neurological disorders; and head and neck cancer.

Predictor variable: Subjects self-reported pain profile based on location (preauricular, intra-auricular, masseteric, temporal, and craniofacial mass), modality of indication (finger vs hand), and unilaterality versus bilaterality of pain.

Outcome variable: The outcome variable was the TMD diagnosis of myogenous or arthrogenous pain sources based on the Diagnostic Criteria for TMD.

Covariates: Demographic variables were available only in aggregated form and not linkable to individual records; additional clinical covariates were inconsistently documented and therefore not included in multivariable adjustment.

Analyses: Cross-classification of categorical pain characteristics, prevalence odds ratio (POR), χ² test, Fisher's exact test for small samples, and logistic regression models were performed with R software 4.5.0, considering a significant P value of < .05.

Results: The sample was composed of 600 subjects (mean age 40.6 ± 17.4), 121 men (20.2%) and 479 women (79.8%). A total of 356 subjects (59.3%) presented with arthrogenous TMD and 244 myogenous (40.7%). Myogenous TMD is statistically significant associated with masseteric or temporal pain (P < .001), while preauricular and intra-auricular pain have statistical association with arthrogenous TMD (P < .001). In all areas, arthrogenous patients report unilateral pain (P < .001), while bilateral pain is therefore indicative of myogenous TMD (P < .001). The association between localization and indication modality is also statistically significant; finger-pointing was more likely among arthrogenous patients (P < .001).

Conclusions and relevance: Self-reported unilateral pain with finger indication is more likely associated with arthrogenous pain, both on cranial or masticatory areas.

背景：颞下颌紊乱（TMDs）是常见的，但区分肌源性和关节源性疼痛仍然具有挑战性。目的：本研究的目的是测量患者报告的3种疼痛特征（解剖定位、侧边和用于指示疼痛区域的方式）单独或联合与肌源性或关节源性TMD诊断之间的关系。研究设计、设置和样本：采用回顾性横断面研究。通过医疗记录确定2020年1月至2024年1月期间就诊于Studio Dentistico Prati （Goito, Mantova, Italy）的TMD诊断患者。纳入标准为年龄≥18岁且伴有疼痛性TMD的男女受试者。排除标准为肌源性-关节源性TMD；3年内接受正畸治疗；病理、物理治疗或药理学治疗；神经障碍;以及头颈癌。预测变量：受试者自我报告的疼痛情况基于部位（耳前、耳内、咬肌、颞部和颅面肿块）、指型（手指vs手）以及单侧与双侧疼痛。结局变量：结局变量是根据TMD诊断标准对肌源性或关节源性疼痛的TMD诊断。协变量：人口统计变量仅以汇总形式提供，不能与个人记录链接；其他临床协变量的记录不一致，因此不包括在多变量调整中。分析：分类疼痛特征交叉分类、患病率优势比（POR）、χ2检验、小样本Fisher精确检验、logistic回归模型采用R软件4.5.0，考虑P值< 0.05显著性。结果：调查对象600人，平均年龄40.6±17.4岁，其中男性121人（20.2%），女性479人（79.8%）。共有356例（59.3%）为关节源性TMD， 244例（40.7%）为肌源性TMD。肌源性TMD与咬肌疼痛或颞痛有统计学意义（P < 0.001），耳前和耳内疼痛与关节源性TMD有统计学意义（P < 0.001）。在所有区域，关节源性患者报告单侧疼痛（P < 0.001），而双侧疼痛因此表明肌源性TMD （P < 0.001）。定位与指征方式之间的关联也具有统计学意义；关节源性患者更容易发生相互指责（P < 0.001）。结论和相关性：自我报告的单侧手指指征疼痛更可能与关节源性疼痛相关，无论是在颅区还是咀嚼区。

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