Journal of Oral and Maxillofacial Surgery最新文献

Purpose: Coronectomy is an alternative approach to the complete removal of an impacted mandibular third molar. The present study conducted a systematic review and meta-analysis to compare coronectomy with extraction concerning complications associated with the inferior alveolar nerve injury (IANI).

Methods: This review followed the principles of systematic reviews and meta-analyses. We conducted a comprehensive literature search of 5 databases according to PRISMA guidelines. Research articles published in English before April 30, 2024 were reviewed. The keywords consisted of "coronectomy and lower third molar." In this study, Rayyan online software was used to identify and eliminate duplicate articles, and another reviewer was invited to screen the articles independently. The included articles' data were extracted, and conclusions were drawn after cross-comparison. The forest plot was drawn after analysis by the R program (JJ Allaire, Boston, Massachusetts, USA). The primary outcome variable of the present study was evaluating the incidence of IANI, and secondly, the lingual nerve injury (LNI), dry socket, postoperative infection, the necessity for surgical reintervention, root migration, root extraction, and coronectomy failure rate. These assessments were made concerning patients' chosen operative technique for managing third molars, either coronectomy or extraction, as predictor variables.

Results: After applying inclusion and exclusion criteria, 34 of the 564 articles were included in this study (24 cohort studies and 10 case‒control studies), with 7,115 wisdom teeth from 4,477 patients in different countries. Meta-analysis showed that coronectomy reduced the risk of IANI: relative risk (RR): 0.1; 95% confidence interval (CI): 0.0-0.2; I² (inconsistency index) = 0%; P < .0001, the risk of LNI (RR: 0.2; 95% CI: 0.0-0.7; I² = 0%; P = .01), dry socket (RR: 0.4; 95% CI: 0.3-0.7; I² = 0%; P = .002), and postoperative infection (RR: 1.0; 95% CI: 0.5-2.1; I² = 27%; P = .9). However, coronectomy exhibited a higher risk of surgical reintervention of 3.63% (111 of 3,055), root exposure of 2.66% (61 of 2,290), and a specific failure rate of 2.79% (119 of 4,261).

Conclusion: When the mandibular third molar with a higher risk of IANI needs to be removed, coronectomy can reduce the risk of IANI and LNI and the incidence of dry socket compared with traditional extraction. There was no significant difference in postoperative infection between the 2 groups. However, coronectomy exhibited a specific failure rate and higher odds of secondary surgical intervention. Guided bone regeneration can slow down the movement of residual roots and reduce the incidence of secondary surgery.

Background: Intraoperative cone-beam computed tomography (CBCT) during open reduction and internal fixation of zygomaticomaxillary complex (ZMC) fractures may facilitate the re-establishment of a complex 3-dimensional anatomy.

Purpose: This study was conducted to measure the occurrence of malpositions after ZMC fracture reduction and intraoperative revision rates after conducting intraoperative CBCT.

Study design, setting, sample: This retrospective case series included subjects treated for ZMC fractures with intraoperative CBCT at the Department of Maxillofacial Surgery of the University Hospital Zurich (Switzerland) over a 5-year period (January 2015 to December 2019). The exclusion criteria were a history of facial fracture and incomplete data.

Predictor variable: Not applicable.

Main outcome variables: The primary outcome variable was malpositioning after ZMC fracture reduction on intraoperative 3-dimensional imaging. Further variables-including intraoperative revisions of ZMC malpositions, osteosynthesis material revisions, and intraoperative assessments of orbital reconstruction-were analyzed.

Covariates: Demographic (age and sex) and clinical (associated with facial fractures) characteristics were assessed.

Analyses: The analyses included Spearman's rank correlations, mosaic plots, χ² tests, and Fisher's exact tests. The confidence level for hypothesis testing was set at P < .05.

Results: The sample included 337 subjects, and 589 intraoperative CBCT scans were obtained. ZMC malposition after reduction was observed in 154 (45.7%) subjects; the most common malpositions were caudal displacement, underprojection, and inward rotation of the ZMC. Intraoperative revisions were conducted in 150 (44.5%) subjects: 105 (31.2%) subjects exhibited a ZMC malposition, 13 (3.9%) subjects needed revisions of the osteosynthesis material placement, and 32 (9.5%) subjects required intraoperative orbital floor reconstruction. No secondary revision surgeries were required, excluding 25 secondary orbital floor reconstructions. Preoperative and intraoperative CBCT findings did not correlate regarding indications for orbital floor reconstruction.

Conclusion and relevance: The 44.5% intraoperative revision rate underscores the challenges of ZMC fracture surgery. Clinical evaluation of fracture reduction at the latero-orbital rim is recommended to identify caudal displacements, and intraoperative CBCT helps identify candidates for primary orbital floor reconstruction. This technique may enhance quality control and precision, thereby potentially improving patient outcomes.

Purpose: Maxillomandibular advancement (MMA) surgery for obstructive sleep apnea (OSA) has shown to be effective according to objective measures; however, patient-reported outcome measurements (PROMs), especially health-related quality of life (HRQoL), are also crucial but have not been systematically assessed in relation to MMA surgery for OSA yet. Therefore, this study aims to conduct a systematic review on the effect of MMA surgery on PROMs focusing on HRQoL in patients with OSA.

Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines with a literature search performed in PubMed and Medline to identify relevant studies from database inception to May 2024 evaluating PROMs focusing on HRQoL in adult OSA patients treated with MMA surgery. The primary variables are the PROMs outcomes. Screening and eligibility assessments were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework, and study quality was evaluated using the ROBINS-I tool. The data extraction for the meta-analysis included PROMs outcomes and was carried out in SPSS using a fixed-effects model to report effect sizes as mean differences.

Results: Thirty-three studies were screened of which 12 were included in this systematic review encompassing 317 patients. The studies reported PROMs in a heterogeneous manner, but MMA consistently showed an improvement postoperatively in mean differences. In the most used PROMs instruments MMA surgery was associated with a 5.35-point improvement in the Epworth Sleepiness Scale (95% CI -6.57 to -4.14; Z = -8.62; P < .001), a 3.96-point improvement on the Functional Outcomes of Sleep Questionnaire (95% CI 3.11, 4.80; Z = 11.60; P < .001) and an improvement in all domains of the Short Form 36 Health Survey.

Conclusion: MMA surgery for patients with OSA shows significant improvements in PROMs related to quality of life. The PROMs are positive, demonstrating satisfaction across various domains. This indicates that MMA surgery is well received by patients and results in clinically meaningful improvements in PROMs related to HRQoL.

Background: Orthognathic surgery significantly influences psychosocial well-being. Individuals with dentofacial deformities may experience psychological distress, characterized by negative affectivity (NA) and social inhibition (SI). When these 2 traits coexist, they define Type D personality.

Purpose: The aim of this study was to estimate the prevalence of Type D personality traits in patients with Class III dentofacial deformities and assess changes in these traits, which inherently reflect variations in Type D personality, following orthognathic surgery.

Study design, setting, sample: This prospective cohort study was conducted at Başkent University Department of Oral and Maxillofacial Surgery between November 2022 and March 2024. Sociodemographic data and psychological assessments were collected using the Type D Scale-14 preoperatively and 3 months postoperatively.

Predictor: The predictor variable was the preoperative personality trait, measured using the validated Type D Scale-14 questionnaire. This questionnaire comprises the following 2 subscales: NA and SI, each consisting of 7 items. Responses are scored from 0 to 4, resulting in scores ranging from 0 to 28. A score of ≥10 on both NA and SI subscales indicates a Type D personality.

Outcome variable: The primary outcome variable was the postoperative personality trait, specifically changes in NA and SI, measured using the Type D Scale-14. The secondary outcomes were the prevalence of Type D personality traits before and after surgery.

Covariates: The covariates were age, sex, marital status, and employment status.

Analyses: Descriptive statistics and paired t-tests were performed to assess the differences between preoperative and postoperative results. A P value of <.05 was considered statistically significant.

Results: The study sample comprised 41 participants (mean age: 22.24 ± 4.72 years), 65.9% (n = 27) of whom were female. The prevalence of Type D personality traits significantly decreased from 42.9% (n = 18) preoperatively to 17.1% (n = 7) postoperatively (P < .05). When the subscales of NA and SI were examined, both scores showed statistically significant reductions (P < .05).

Conclusions: Significant differences were observed in NA and SI before and after orthognathic surgery. This study represents the first application of the Type D Scale-14 in the context of orthognathic surgery. Observed psychological improvement highlights the importance of preoperatively assessing patients' psychosocial conditions.

Background: The endoscope-assisted pterygomandibular ligament approach for the resection of parapharyngeal space (PPS) tumors has been reported in a limited number of cases, with insufficiently detailed procedural descriptions.

Purpose: The study purpose was to report clinically relevant outcomes among patients who underwent endoscopy-assisted pterygomandibular ligament resection for PPS tumors.

Study design, setting, and sample: This study was a retrospective case series analyzing patients treated between January 2018 and July 2021 at the Department of Otolaryngology, Second Affiliated Hospital of Wenzhou Medical University. The sample consisted of patients who underwent endoscopy-assisted pterygomandibular ligament resection for PPS tumors. Patients with incomplete medical records or loss of follow-up were excluded.

Main outcome variable: The primary outcomes included successful tumor resection, intraoperative blood loss, operation duration, hospital stay, complications, recurrence, and follow-up duration.

Covariates: Demographic characteristics, tumor size, pathology, postoperative pain score were collected and analyzed.

Analyses: Data were summarized using descriptive statistics.

Results: The sample was composed of 9 patients (4 males, 5 females). The operation time ranged from 30 to 240 minutes, with operation blood loss between 5 and 200 mL. The average length of hospital stay was 8.45 days. The average pain score at the first postoperative day was 3.5. No complications, such as infection, bleeding, or nerve damage, were observed. No tumor recurrence was detected over a median follow-up of 53 months (interquartile range: 32.5).

Conclusion: The endoscope-assisted pterygomandibular ligament internal approach appears to be a good strategy for PPS tumor resection.

Background: In the evaluation of isolated zygomatic arch (ZA) fractures, a standardized guideline for recommending operative intervention is lacking.

Purpose: The study purpose was to measure the association between fracture displacement and operative treatment following isolated ZA fractures.

Study design, setting, sample: This is a retrospective cohort study identifying adult subjects with isolated ZA fractures presenting to the emergency department between September 2011 and October 2022. Subjects with non-ZA zygomaticomaxillary complex fractures or concurrent facial fractures were excluded.

Predictor/exposure/independent variable: The predictor is maximal fracture displacement in centimeters measured on axial computed tomography imaging.

Main outcome variable(s): The main outcome variable is operative management defined as recommendation of operative versus nonoperative intervention.

Covariates: Covariates collected include patient demographics; consisting of age, sex, past medical history (hypertension and diabetes); injury mechanism; social history (tobacco and alcohol use); presenting signs and symptoms (trismus, facial swelling, paresthesias, malar depression, and bony-step offs). Native overlying soft-tissue thickness was also measured on computed tomography imaging.

Analyses: Bivariate and multivariate statistical analyses were used to investigate differences between nonoperative and operative groups. Receiver operating characteristic curve was utilized to determine the discriminative fracture displacement for operative intervention. All statistical tests were performed with a significance level set at P < .05.

Results: The sample was composed of 86 subjects with an average age of 47.0 ± 19.1 years old. The mean fracture displacement was 0.29 ± 0.21 cm. Overall, 22 (25.6%) subjects were recommended operative intervention while 64 (74.4%) were managed nonoperatively. On bivariate analysis, mean fracture displacement was higher in the operative (0.51 ± 0.14 cm) versus nonoperative groups (0.21 ± 0.18 cm, P < .001). A significantly greater number of patients in the operative cohort presented with trismus, facial swelling and malar depression. Native soft-tissue thickness was not associated with operative intervention. On receiver operating characteristic curve analysis, the displacement that discriminated operative intervention was 0.36 cm with a sensitivity of 86.4% and specificity of 81.3% (area under the curve 0.9).

Conclusions and relevance: Isolated ZA fractures with a displacement of 0.36 cm or greater are associated with operative intervention. Measurement of fracture displacement may aid in clinical decision-making.

Background: Liposomal bupivacaine (LB) is a long-lasting local anesthetic providing analgesia for several days. The current literature examining the efficacy of LB in pain management following third molar extractions remains unclear.

Purpose: The purpose of this study was to compare postoperative pain management between LB and standard bupivacaine (SB) in mandibular third molar extractions.

Study design: A double-blinded randomized controlled trial of subjects undergoing bilateral mandibular third molar extractions at our institution from 2022 to 2024 was conducted using a split-mouth study design. Subjects were excluded if they received additional mandibular teeth extractions, were unable to complete the questionnaire, or had medical contraindications.

Predictor variable: The predictor variable was postsurgical local anesthetic agent, and the sides of mouth were randomly assigned to LB or SB.

Main outcome variable(s): Primary outcome was postoperative pain on a 10-point numerical rating scale (NRS), and the mean cumulative pain rating via area under the curve (AUC) analysis. Secondary outcomes were adverse events and ibuprofen or acetaminophen consumption.

Covariates: Demographics, procedure time, preoperative and perioperative local anesthetics used, and procedural difficulty coded as nonsurgical or surgical were collected.

Analyses: We used mixed-effects models to compare the NRS scores during each time period and paired t-tests to compare AUC values. Statistical tests included 95% CIs with alpha = 0.05.

Results: The study sample included 72 subjects (mean age 25.8, SD: 9). Pain was lower in the LB versus SB group on surgery day (NRS difference -0.75; P = .002) until the morning of postoperative day 2 (-0.68, P = .003). When limiting the analysis to bilateral surgical extractions, it was statistically significant until the morning of postoperative day 3 (-0.61, P = .02). AUC analysis showed cumulative pain reduction for the LB group in comparison to the SB group through all 4 postoperative days for the overall cohort (average AUC_0-96 difference 93.5, P = .005), with a similar effect for bilateral surgical extractions (101.88, P = .006).

Conclusion: LB modestly reduces pain following third molar extractions, with this difference more pronounced following surgical extractions. This suggests that LB may be more beneficial in complex extractions and greater pain-inducing surgeries.

Background: Minimally invasive orthognathic surgery (MIOS) involves smaller incisions and minimal tissue dissection. Most MIOS is done using interim splints to position the first jaw. The application of patient-specific implants in MIOS is difficult due to the size of traditional cutting/drill guides, which require larger incisions. As a result, MIOS guides were redesigned for this study to fit into smaller incisions.

Purpose: The study purpose was to estimate and compare the accuracy of the smaller and redesigned bone-borne (BB) versus bone/tooth-borne (BTB) cutting/drilling guides used in minimally invasive bimaxillary orthognathic surgery.

Study design, setting, sample: This retrospective cohort study included consecutive MIOS patients treated by a single surgeon at the University of Texas Health San Antonio from June 2023 to September 2024. It included patients that underwent bimaxillary MIOS with complete preoperative and postoperative cone-beam computed tomographic records. Exclusion criteria included craniofacial syndromes, severe medical comorbidities, or single-jaw surgery.

Predictor variable: The primary predictor variable was the type of cutting/drilling guide (BB vs BTB) used to perform maxillary osteotomy.

Main outcome variable(s): The primary outcome variable was accuracy, defined as mean linear discrepancy that is closest to 0 mm. Linear discrepancies between planned and actual maxillary movements were measured.

Covariates: Demographics and malocclusion type.

Analyses: χ² tests compared categorical variables, and Student's t-tests assessed accuracy differences. A P value < .05 was considered significant, with a Bonferroni correction applied for multiple comparisons.

Results: The sample consisted of 20 patients (15 females, 75%; 5 males, 25%; mean age 24 ± 11.3 years) evenly divided into BB (n = 10) and BTB (n = 10) guide groups. The BTB guide demonstrated superior vertical accuracy for the upper incisor (mean difference: 0.67 mm, standard deviation = 0.33, P = .02) and the upper left canine (mean difference: 0.11 mm, standard deviation = 0.04, P = .03) when comparing means. However, no significant differences were found in root mean square discrepancies (P > .2) or other measurements (P > .06).

Conclusions and relevance: Both guides achieved acceptable accuracy overall, with the BTB guide showing superior precision for 2 of the 11 landmarks.