Journal of Oral and Maxillofacial Surgery最新文献_第5页

Assessment and Validation of a Predictive Model for Severe Ocular Injuries Associated With Orbital Wall Fractures. 严重眼外伤合并眶壁骨折预测模型的评估与验证。

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

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-01-02 DOI: 10.1016/j.joms.2025.12.016

Farhad Salari, Seyed Mohsen Rafizadeh, Mohammad Taher Rajabi, Keivan Khosravifard, Reza Fekrazad, Behzad Salari

Background: Severe ocular injuries (SOI) can occur in orbital wall fractures and may be overlooked in acute care. Recognition of factors associated with SOI may improve patient outcomes.

Purpose: This study aimed to create and validate a predictive model for SOI in orbital wall fractures.

Study design, setting, sample: This is a retrospective cohort study. To create the training predictive model, the investigators screened a study population composed of all patients who presented to Farabi Eye Hospital between 2016 and 2023 for the evaluation and management of orbital wall fractures. The exclusion criteria were the absence of an ophthalmologic examination or an orbital computed tomography report. The validation model was composed of an external dataset that included 97 subjects.

Predictor variables: The predictor variables were trauma details, uncorrected visual acuity (UCVA), lid laceration, conjunctival hemorrhage, computed tomography scan features, including the number of herniated extraocular muscles (EOMs).

Main outcome variable(s): The main outcome variable was the presence of SOI, including open globe injuries, optic nerve-related injuries, and severe closed globe injuries.

Covariates: The covariates were age and sex.

Analyses: Multivariable logistic regression was performed to identify factors associated with SOI. Model performance was assessed using the area under the receiver operating characteristic curve, specificity, and negative predictive value (NPV) in an external validation dataset. Statistical significance was set at P < .05.

Results: The sample consisted of 537 subjects, with a mean age of 29.8 ± 13.91 years, and 22.7% (124) were female. The multivariable regression analysis revealed that the 4 main variables associated with SOI were: trauma setting (odds ratio [OR] = 2.61, 95% CI 1.1 to 6.21), UCVA (OR = 4.45, 95% CI 2.65 to 6.27), conjunctival hemorrhage (OR = 4.07, 95% CI 1.21 to 3.49), and herniated EOMs (OR = 1.77, 95% CI 1.2 to 2.61). In the training set, the specificity and NPV were 76.8 and 85.5%, respectively. This model achieved an area under the receiver operating characteristic curve of 0.77 for the subset of closed-globe injuries. When applied to the validation set, the model achieved a specificity of 76.6% and an NPV of 86%.

Conclusions and relevance: We identified that trauma setting, reduced UCVA, conjunctival hemorrhage, and herniated EOMs are associated with SOI in orbital fractures.

背景：严重眼损伤（SOI）可发生于眶壁骨折，在急性护理中可能被忽视。识别与SOI相关的因素可能会改善患者的预后。目的：本研究旨在建立并验证眼眶壁骨折SOI的预测模型。研究设计、环境、样本：这是一项回顾性队列研究。为了建立训练预测模型，研究人员筛选了2016年至2023年在法拉比眼科医院就诊的所有患者，以评估和管理眶壁骨折。排除标准是没有眼科检查或眶部计算机断层扫描报告。验证模型由包括97名受试者的外部数据集组成。预测变量：预测变量为创伤细节，未矫正视力（UCVA），眼睑撕裂，结膜出血，计算机断层扫描特征，包括眼外肌疝（EOMs）的数量。主要转归变量：主要转归变量为SOI的存在，包括开放球损伤、视神经相关损伤和严重闭球损伤。协变量：协变量为年龄和性别。分析：采用多变量logistic回归来确定与SOI相关的因素。使用外部验证数据集中的受试者工作特征曲线下的面积、特异性和负预测值（NPV）来评估模型的性能。差异有统计学意义，P < 0.05。结果：537例患者，平均年龄29.8±13.91岁，其中女性124例，占22.7%。多变量回归分析显示，与SOI相关的4个主要变量为：创伤环境（比值比[OR] = 2.61, 95% CI 1.1 ~ 6.21）、UCVA （OR = 4.45, 95% CI 2.65 ~ 6.27）、结膜出血（OR = 4.07, 95% CI 1.21 ~ 3.49）和EOMs突出（OR = 1.77, 95% CI 1.2 ~ 2.61）。在训练集中，特异性为76.8，NPV为85.5%。对于闭球损伤子集，该模型的受者工作特征曲线下面积为0.77。当应用于验证集时，该模型的特异性为76.6%，NPV为86%。结论和相关性：我们发现创伤环境、UCVA降低、结膜出血和EOMs突出与眶内骨折的SOI相关。

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引用次数: 0

No Evidence of Reduction in Mouth Opening After Biopsy in Oral Submucous Fibrosis—A Prospective Cohort Study 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 : 2026-01-01 DOI: 10.1016/j.joms.2025.09.009

Sampurna Raha MDS , Rajiv S. Desai MDS , Shivani P. Bansal MDS , Pankaj M. Shirsat MDS , Pooja S. Prasad MDS

Background

Reluctancy to perform biopsy in oral submucous fibrosis (OSF) is usually observed among clinicians due to the common assumption that maximum mouth opening (MMO) is reduced after biopsy as wound healing occurs by an exaggerated pathological fibrotic response.

Purpose

The study purpose was to evaluate and compare MMO in OSF subjects before and after biopsy against baseline MMO of healthy controls.

Study Design, Setting, Sample

This was a prospective institutional cohort study including subjects with OSF and healthy controls reporting at Nair Hospital Dental College, Mumbai, India from January to December 2023. Subjects less than 12 years of age, edentulous subjects, missing permanent incisors, subjects having temporomandibular joint disorders like ankylosis, OSF undergoing malignant transformation and previously treated OSF were excluded.

Predictor Variable

The predictor variable was disease status, and subjects were grouped into healthy controls and OSF subjects.

Main Outcome Variable(s)

The outcome variable was jaw function measured using MMO. In healthy controls, baseline MMO was assessed. In study group MMO was evaluated at 4 intervals: 1) before biopsy and 2) after biopsy at (a) 15th day, (b) 1-month, and (c) 6-month follow-up.

Covariates

The covariates were age and sex.

Analyses

A repeated measures analysis of variance test was employed to find statistical differences between MMO recorded in both groups. P < .05 was considered as statistically significant.

Results

The study composed of 200 (100%) subjects with mean age of 45.94 ± 17.29 years and 100 (50%) males. Each group comprised of 100 subjects with healthy controls having mean age of 47.49 ± 21.45 years and OSF group 44.39 ± 11.67 years. A statistically significant difference (P < .001) was observed between MMO in healthy controls (mean = 47.49 ± 4.87 mm, range 35 to 56 mm), and OSF subjects before biopsy (mean = 20.73 ± 5.79 mm, range 9 to 29 mm). MMO of OSF subjects at 4 intervals were 20.73 ± 5.78 mm, 20.92 ± 5.52 mm, 20.98 ± 5.51 mm and 21.01 ± 5.52 mm respectively, showing no statistical significance (P = .3).

Conclusion and Relevance

No decrease in MMO in OSF subjects after biopsy was observed thus encouraging clinicians to take biopsy to rule out epithelial dysplasia and malignancy.

背景：在口腔黏膜下纤维化（OSF）患者中，临床医生通常不愿进行活检，因为他们普遍认为，由于病理性纤维化反应过度导致伤口愈合，活检后最大开口（MMO）会减少。目的：研究目的是评估和比较OSF患者活检前后的MMO与健康对照者的基线MMO。研究设计、环境、样本：这是一项前瞻性机构队列研究，包括2023年1月至12月在印度孟买Nair医院牙科学院报告的OSF患者和健康对照者。排除年龄小于12岁、无牙、缺恒门牙、有颞下颌关节疾病如强直、OSF恶性转化及既往治疗过OSF的受试者。预测变量：预测变量为疾病状态，受试者分为健康对照组和OSF组。主要结局变量：结局变量为使用MMO测量的下颌功能。在健康对照中，评估基线MMO。研究组在4个时间间隔评估MMO: 1)活检前和2)活检后(a)第15天，(b) 1个月和(c) 6个月随访。协变量：协变量为年龄和性别。分析：采用重复测量方差检验分析两组间MMO记录的统计学差异。P < 0.05为差异有统计学意义。结果：研究对象200人（100%），平均年龄45.94±17.29岁，男性100人（50%）。各组健康对照100例，平均年龄47.49±21.45岁，OSF组平均年龄44.39±11.67岁。活检前健康对照组（平均47.49±4.87 mm，范围35 ~ 56 mm）与OSF组（平均20.73±5.79 mm，范围9 ~ 29 mm）的MMO差异有统计学意义（P < 0.001）。OSF受试者在4个时间间隔的MMO分别为20.73±5.78 mm、20.92±5.52 mm、20.98±5.51 mm和21.01±5.52 mm，差异无统计学意义（P = .3）。结论及相关性：OSF患者活检后未观察到MMO减少，因此鼓励临床医生进行活检以排除上皮异常增生和恶性肿瘤。

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引用次数: 0

Naloxone Coprescribing in Oral and Maxillofacial Surgery: An Opportunity for Harm Reduction? 纳洛酮在口腔颌面外科的共同处方：减少危害的机会？

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

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.joms.2025.07.015

Kihan E. Sung , Tim T. Wang DMD, MD, MPH , David A. Keith BDS, DMD , Jeffrey T. Hajibandeh DDS, MD

引用次数: 0

The 50 Most-Cited Publications on Mandibular Condyle Fractures: A Bibliometric Study 下颌骨髁骨折50篇被引用最多的出版物：文献计量学研究。

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

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.joms.2025.09.006

Liam Costello MB BCh, BDS , Éanna O'Kelly-Lynch BDS , Mark Wilson MCh, BDS , Akinsola Ogunbowale MB BCh, BDS

Background

Mandibular condyle fractures represent 16.5 to 56% of mandibular injuries and remain controversial in management. This bibliometric analysis evaluates the top 50 most-cited studies to identify research trends and gaps. We systematically searched the Web of Science for mandibular condyle fracture studies, analyzing the top most-cited 50 articles by citation counts, authorship, institutions, journals, and keywords using the VOSviewer for bibliometric coupling.

Findings

Studies (citations: 42 to 243) peaked in the 1990s to 2000s, declining after 2015. Germany 22% and the USA 12% led contributions, with the Journal of Oral and Maxillofacial Surgery publishing most articles (17 of 50). Dominant keywords included "open reduction" and "osteosynthesis," yet 84% of studies were low-level evidence (levels III to IV). Key contributors were Eckelt U and Lindqvist C, with the Technical University of Dresden as the top institution.

Conclusion and relevance

The field relies on older, lower-quality studies with stagnant high-impact research since 2015. Future work should prioritize prospective studies to resolve management controversies.

背景：下颌髁骨折占下颌损伤的16.5%至56%，在处理上仍有争议。这个文献计量分析评估了前50个被引用最多的研究，以确定研究趋势和差距。我们系统地检索了Web of Science关于下颌髁骨折的研究，使用VOSviewer进行文献计量耦合，通过引用次数、作者、机构、期刊和关键词分析了被引次数最多的50篇文章。研究结果：研究（引用：42至243）在20世纪90年代至21世纪初达到顶峰，2015年后下降。德国22%，美国12%，其中《口腔颌面外科杂志》发表的文章最多（50篇中有17篇）。主要关键词包括“切开复位”和“骨合成”，但84%的研究是低水平证据（III至IV级）。主要贡献者是Eckelt U和Lindqvist C，其中德累斯顿工业大学（Technical University of Dresden）位居榜首。结论和相关性：自2015年以来，该领域依赖于较老、质量较低、高影响力研究停滞不前的研究。未来的工作应优先考虑前瞻性研究，以解决管理争议。

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引用次数: 0

Does Intra-Operative IV Dexamethasone Reduce Postoperative Pain More Effectively With Nonopioids or Opioids? 术中静脉注射地塞米松是否与非阿片类药物或阿片类药物一起更有效地减轻术后疼痛？

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

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.joms.2025.09.022

Ryan Look DMD , Vincent B. Ziccardi DDS, MD , Tracy Andrews MS , Patricia Greenberg MS , Janine Fredericks-Younger DMD

Background

Corticosteroids reduce postoperative swelling and trismus. However, their role in pain management, particularly when combined with opioid versus nonopioid analgesics, is less understood.

Purpose

The purpose of the study was to determine whether intra-operative corticosteroids reduce postoperative pain following third molar surgery and compare its effect on pain relief within nonopioid (NSAIDs and acetaminophen) and opioid analgesic treatment arms.

Study Design, Setting, and Sample

This retrospective cohort study is based on the multicenter Opioid Analgesic Reduction Study (OARS) (n = 1,815). Participants who received oral corticosteroids (n = 41) were excluded.

Predictor Variable

The primary predictor was the therapeutic treatment (opioid, nonopioid). Within each treatment arm, participants were grouped based on intra-operative steroid use (steroid, no steroid).

Main Outcome Variable(s)

Average pain (numeric rating scale: 0 to 10) was measured on postoperative days 1, 2, and 3 and entire postoperative period. Secondary outcomes included satisfaction with pain medication, unused analgesic tablets, use of rescue opioids, and emergency clinic visits.

Covariates

Covariates included age, sex, race/ethnicity, preoperative pain and swelling, number of teeth extracted, impaction level, anesthesia type, use of antibiotics, and the administration of 0.5% bupivacaine with 1:200,000 epinephrine.

Analyses

Mixed-effects models estimated the interaction of analgesics by steroid use by time with random effects for study sites and participants. Differences were assessed using P < .00625 to account for multiple comparisons.

Results

The sample included 1,774 subjects with a mean age (SD) of 25.7(6.2) and 893(50.3%) were female. Analgesics by steroid groups were distributed as follows: nonopioid + no-steroid (626(35.3%)), opioid + no-steroid (635(35.8%)), nonopioid + steroid (265(14.9%)), and opioid + steroid (248(14.0%)). Steroid exposure was associated with lower day 1 postoperative pain in both the nonopioid group (mean difference 0.78; 99.375% CI 0.25 to 1.30; P < .001) and the opioid group (1.22; 0.68 to 1.77; P < .001). Across all days, the nonopioid + steroid group had the lowest pain scores, with a mean difference of 0.55 (−0.04 to 1.14; P = .026) compared with the nonopioid+ no steroid group.

Conclusion

Intra-operative IV dexamethasone was associated with reduced pain for the first 24 hours following third molar surgery. Adding dexamethasone to either analgesic group improved pain control. Providers should consider incorporating intra-operative IV dexamethasone with postoperative nonsteroidal anti-inflammatory drugs and acetaminophen.

背景：皮质类固醇可减少术后肿胀和牙关紧闭。然而，它们在疼痛管理中的作用，特别是当与阿片类镇痛药或非阿片类镇痛药联合使用时，尚不清楚。目的：本研究的目的是确定术中皮质类固醇是否能减轻第三磨牙手术后的疼痛，并比较其在非阿片类药物（非甾体抗炎药和对乙酰氨基酚）和阿片类镇痛治疗组中的疼痛缓解效果。研究设计、环境和样本：本回顾性队列研究基于多中心阿片类镇痛减少研究（OARS）（n = 1815）。接受口服皮质类固醇治疗的参与者（n = 41）被排除在外。预测变量：主要预测因子是治疗性治疗（阿片类药物，非阿片类药物）。在每个治疗组中，参与者根据术中使用类固醇（类固醇，不使用类固醇）进行分组。主要结局变量：在术后第1、2、3天和整个术后期间测量平均疼痛（数值评定量表：0 - 10）。次要结局包括对止痛药、未使用的镇痛片、使用阿片类救援药物和急诊就诊的满意度。协变量：协变量包括年龄、性别、种族/民族、术前疼痛和肿胀、拔牙数量、嵌塞程度、麻醉类型、抗生素使用、0.5%布比卡因与1:20万肾上腺素联合使用。分析：混合效应模型估计了镇痛药与类固醇使用时间的相互作用与研究地点和参与者的随机效应。采用P < 0.00625来评估差异，以解释多重比较。结果：共纳入1774例患者，平均年龄25.7岁（6.2%），女性893例（50.3%）。类固醇组镇痛药分布为：非阿片类+非类固醇626种（35.3%）、阿片类+非类固醇635种（35.8%）、非阿片类+类固醇265种（14.9%）、阿片类+类固醇248种（14.0%）。类固醇暴露与非阿片类药物组和阿片类药物组术后第1天疼痛均较低相关（平均差异0.78;99.375% CI 0.25至1.30;P < 0.001）。全天，非阿片类药物+类固醇组的疼痛评分最低，与非阿片类药物+非类固醇组相比，平均差异为0.55（-0.04至1.14;P = 0.026）。结论：术中静脉注射地塞米松与第三磨牙术后24小时疼痛减轻有关。两组加用地塞米松均可改善疼痛控制。提供者应考虑将术中静脉注射地塞米松与术后非甾体抗炎药和对乙酰氨基酚联合使用。

{"title":"Does Intra-Operative IV Dexamethasone Reduce Postoperative Pain More Effectively With Nonopioids or Opioids?","authors":"Ryan Look DMD , Vincent B. Ziccardi DDS, MD , Tracy Andrews MS , Patricia Greenberg MS , Janine Fredericks-Younger DMD","doi":"10.1016/j.joms.2025.09.022","DOIUrl":"10.1016/j.joms.2025.09.022","url":null,"abstract":"<div><h3>Background</h3><div>Corticosteroids reduce postoperative swelling and trismus. However, their role in pain management, particularly when combined with opioid versus nonopioid analgesics, is less understood.</div></div><div><h3>Purpose</h3><div>The purpose of the study was to determine whether intra-operative corticosteroids reduce postoperative pain following third molar surgery and compare its effect on pain relief within nonopioid (NSAIDs and acetaminophen) and opioid analgesic treatment arms.</div></div><div><h3>Study Design, Setting, and Sample</h3><div>This retrospective cohort study is based on the multicenter Opioid Analgesic Reduction Study (OARS) (n = 1,815). Participants who received oral corticosteroids (n = 41) were excluded.</div></div><div><h3>Predictor Variable</h3><div>The primary predictor was the therapeutic treatment (opioid, nonopioid). Within each treatment arm, participants were grouped based on intra-operative steroid use (steroid, no steroid).</div></div><div><h3>Main Outcome Variable(s)</h3><div>Average pain (numeric rating scale: 0 to 10) was measured on postoperative days 1, 2, and 3 and entire postoperative period. Secondary outcomes included satisfaction with pain medication, unused analgesic tablets, use of rescue opioids, and emergency clinic visits.</div></div><div><h3>Covariates</h3><div>Covariates included age, sex, race/ethnicity, preoperative pain and swelling, number of teeth extracted, impaction level, anesthesia type, use of antibiotics, and the administration of 0.5% bupivacaine with 1:200,000 epinephrine.</div></div><div><h3>Analyses</h3><div>Mixed-effects models estimated the interaction of analgesics by steroid use by time with random effects for study sites and participants. Differences were assessed using <em>P</em> < .00625 to account for multiple comparisons.</div></div><div><h3>Results</h3><div>The sample included 1,774 subjects with a mean age (SD) of 25.7(6.2) and 893(50.3%) were female. Analgesics by steroid groups were distributed as follows: nonopioid + no-steroid (626(35.3%)), opioid + no-steroid (635(35.8%)), nonopioid + steroid (265(14.9%)), and opioid + steroid (248(14.0%)). Steroid exposure was associated with lower day 1 postoperative pain in both the nonopioid group (mean difference 0.78; 99.375% CI 0.25 to 1.30; <em>P</em> < .001) and the opioid group (1.22; 0.68 to 1.77; <em>P</em> < .001). Across all days, the nonopioid + steroid group had the lowest pain scores, with a mean difference of 0.55 (−0.04 to 1.14; <em>P</em> = .026) compared with the nonopioid+ no steroid group.</div></div><div><h3>Conclusion</h3><div>Intra-operative IV dexamethasone was associated with reduced pain for the first 24 hours following third molar surgery. Adding dexamethasone to either analgesic group improved pain control. Providers should consider incorporating intra-operative IV dexamethasone with postoperative nonsteroidal anti-inflammatory drugs and acetaminophen.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"84 1","pages":"Pages 87-100"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459110","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

Distinguishing Postoperative Pain Development Trajectory After Orthognathic Surgery 鉴别正颌手术后疼痛发展轨迹。

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

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.joms.2025.09.010

Li-Kuan Wang MD , Xu-Dong Yang MD, PHD , Hai-Yin Wu MD, PHD , Dan Zhou MD

Background

The lack of understanding of postoperative pain patterns makes it challenging to adopt refined pain management for orthognathic patients.

Purpose

The purpose was to characterize pain trajectories for the first 5 days following orthognathic surgery and identify factors associated with the trajectories.

Study design, setting, and sample

This retrospective cohort study was conducted at Peking University Hospital of Stomatology and included individuals aged ≥18 years who underwent orthognathic surgery. Patients with neuropsychiatric disorders or missing postoperative pain data were excluded.

Predictor variables

The predictor variable was postoperative pain intensity, assessed daily from days 1 to 5 after surgery using numerical rating scale.

Main outcome variables

The outcome variable was pain trajectory, determined by group modeling of self-reported pain over the first 5 postoperative days.

Covariates

Covariates comprised demographic, psychological, surgical, and perioperative variables.

Analyses

Descriptive statistics were calculated for each variable. Group-based modeling determined and clustered pain trajectories, and logistic regression identified independent factors. A P value of < .05 was considered significant.

Results

The sample was composed of 371 subjects with a median age of 25 years [21 to 29] and 272 (73.3%) were female. We identified three pain trajectories, and there were 208 (56.1%), 111 (29.9%), 52 (14%) subjects in Trajectories 1, 2, and 3 groups, respectively. Trajectory 1 showed gradually decreasing pain. Trajectory 2 showed mild pain that decreased until day 3 and then increased slightly on days 4 to 5. Trajectory 3 showed moderate pain decreasing until day 3, increasing to moderate on day 4 and severe on day 5. Increased Pain Catastrophizing Scale score (adjusted odds ratio (OR), 1.033, 95% confidence interval (CI), 1.006 to 1.060, P = .015), American Society of Anesthesiologists classification I (adjusted OR, 2.593, 95% CI, 1.102 to 6.100, P = .029), increased remifentanil dose (adjusted OR, 1.301, 95% CI, 1.038 to 1.632, P = .023), and dezocine used in the analgesia pump (adjusted OR, 4.883, 95% CI, 1.953 to 12.209, P = .001) were associated with increased likelihood of Trajectory 3. Male had significantly lower risk of Trajectory 2 (adjusted OR, 0.424, 95% CI, 0.264 to 0.680, P < .001) and Trajectory 3 (adjusted OR, 0.489, 95% CI, 0.287 to 0.834, P = .009).

Conclusion

Distinct pain trajectories were exhibited after orthognathic surgery. It recommends patient-specific management across different trajectories.

背景：缺乏对术后疼痛模式的了解使得对正颌患者采用精细的疼痛管理具有挑战性。目的：目的是描述正颌手术后前5天的疼痛轨迹，并确定与疼痛轨迹相关的因素。研究设计、环境和样本：本回顾性队列研究在北京大学口腔医院进行，纳入年龄≥18岁且接受正颌手术的患者。排除有神经精神障碍或术后疼痛数据缺失的患者。预测变量：预测变量为术后疼痛强度，从术后第1天到第5天每天使用数值评定量表进行评估。主要结局变量：结局变量为疼痛轨迹，通过术后前5天自我报告疼痛的组建模确定。协变量：协变量包括人口统计学、心理学、外科和围手术期变量。分析：对各变量进行描述性统计。基于组的建模确定和聚集疼痛轨迹，逻辑回归确定独立因素。P值< 0.05被认为是显著的。结果：样本共371例，年龄中位数为25岁[21 ~ 29岁]，其中女性272例，占73.3%。我们确定了三种疼痛轨迹，分别有208人（56.1%）、111人（29.9%）、52人（14%）被分为轨迹1、2和3组。轨迹1显示疼痛逐渐减轻。轨迹2显示轻度疼痛，直到第3天减轻，然后在第4至5天略有增加。轨迹3显示中度疼痛缓解至第3天，第4天加重至中度，第5天加重。剧烈疼痛量表分数增加(调整后的优势比(或)1.033,95%可信区间(CI), 1.006 - 1.060, P = .015),美国麻醉医师学会分类我(调整或者2.593,95%可信区间,1.102 - 6.100,P = .029),增加remifentanil剂量(调整或者1.301,95%可信区间,1.038 - 1.632,P = 0),和地佐辛用于镇痛泵(或调整,4.883,95% CI, 1.953 - 12.209, P =措施)是与轨迹3的可能性增加。男性患轨迹2（校正OR， 0.424, 95% CI, 0.264 ~ 0.680, P < 0.001）和轨迹3（校正OR， 0.489, 95% CI, 0.287 ~ 0.834, P = 0.009）的风险显著降低。结论：正颌手术后有明显的疼痛轨迹。它建议对不同的患者进行针对性的管理。

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引用次数: 0

Is Same Day Discharge Associated With Readmission After Orthognathic Surgery? 正颌手术后同日出院是否与再入院有关？

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

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.joms.2025.09.017

Tim T. Wang DMD, MD, MPH , Lang Liang BS , Nicholas Wilken DDS, MD , Gary Warburton DDS, MD , John Caccamese DMD, MD , Cameron Lee DMD, MD

Background

Same day discharge pathways have the potential to reduce health care expenditures and improve access to care for patients undergoing orthognathic surgery. However, the effect of same day discharge on safety and postoperative outcomes is poorly understood.

Purpose

The purpose of this study was to measure the association between discharge pathway and 30-day hospital readmission, as well as evaluate trends in same day discharge over time in patients undergoing orthognathic surgery.

Study design, setting sample

This was a retrospective cohort study using the 2011 to 2023 American College of Surgeons National Surgical Quality Improvement Program databases. Patients undergoing orthognathic surgery were included. Patients with missing data or undergoing concurrent temporomandibular joint or facial cosmetic procedures were excluded.

Predictor variable

The predictor was discharge pathway, categorized as either same day discharge from the hospital or inpatient admission.

Main outcome variable

The primary outcome was hospital readmission within 30 days of surgery.

Covariates

Covariates were categorized into demographic (age, sex), medical (hypertension, diabetes), and perioperative (type of surgery, operative time).

Analyses

Descriptive and bivariate statistics were performed to evaluate the association between discharge pathway and readmission. Linear regression was utilized to analyze trends in discharge pathway over time.

Results

The cohort was composed of 2,056 subjects with a mean age of 28.8 ± 10.8 years, and 1,035 were male (50.3%). Of these, 468 (22.8%) were discharged the same day and 1,588 (77.2%) were admitted. Readmission rates were 0.40% (n = 2) for same day discharge and 1.10% (n = 17) for inpatient admission (relative risk 0.4, 95% CI 0.09 to 1.72, P = .3). In bivariate analysis, no study covariates including discharge pathway were associated with readmission. The mean time between discharge and readmission for the same day discharge and inpatient admission groups were 7.5 ± 6.4 days and 12.2 ± 9.0 days, respectively (P = .4). The frequency of same day discharge increased during the study period from 10.7% in 2011 to 23.1% in 2023 (P = .03).

Conclusions and relevance

Same day discharge was not associated with an increased risk of 30-day readmission in appropriately selected patients.

背景：当天出院路径有可能减少医疗保健支出，并改善接受正颌手术的患者获得护理的机会。然而，当天出院对安全性和术后结果的影响尚不清楚。目的：本研究的目的是测量出院途径与30天住院再入院之间的关系，并评估接受正颌手术的患者当天出院的趋势。研究设计，设置样本：这是一项回顾性队列研究，使用2011年至2023年美国外科医师学会国家手术质量改进计划数据库。包括接受正颌手术的患者。数据缺失或同时进行颞下颌关节或面部美容手术的患者被排除在外。预测变量：预测因子为出院途径，分类为当日出院或住院。主要结局变量：主要结局是手术后30天内再入院。协变量：协变量分为人口学（年龄、性别）、医学（高血压、糖尿病）和围手术期（手术类型、手术时间）。分析：采用描述性和双变量统计来评估出院途径与再入院之间的关系。利用线性回归分析了排放路径随时间的变化趋势。结果：该队列由2056名受试者组成，平均年龄28.8±10.8岁，其中男性1035名（50.3%）。其中当日出院468例（22.8%），入院1588例（77.2%）。当日出院患者再入院率为0.40% (n = 2)，住院患者再入院率为1.10% (n = 17)（相对危险度0.4,95% CI 0.09 ~ 1.72, P = 0.3）。在双变量分析中，没有包括出院途径在内的研究协变量与再入院相关。当日出院组和住院组出院至再入院的平均时间分别为7.5±6.4天和12.2±9.0天（P = 0.4）。同日出院频率从2011年的10.7%上升到2023年的23.1% （P = 0.03）。结论和相关性：在适当选择的患者中，同一天出院与30天再入院风险增加无关。

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引用次数: 0

Contemplating One’s Novel 沉思小说

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

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.joms.2025.09.004

Thomas B. Dodson DMD, MPH (Editor-in-Chief)

引用次数: 0

Evaluating the Effectiveness of Large Language Models in Addressing Patient Queries Regarding Maxillomandibular Fixation for Maxillofacial Fractures 评估大型语言模型在解决颌面部骨折患者上颌下颌固定问题中的有效性。

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

Journal of Oral and Maxillofacial Surgery

Pub Date : 2026-01-01 DOI: 10.1016/j.joms.2025.09.016

Ragavi Alagarsamy MDS , Babu Lal MDS , Jitendra Chawla MDS , Ramya Arangaraju MDS , Sujata Mohanty MDS , Kaleem Fatima MDS , Arivarasan Barathi MD

<div><h3>Background</h3><div>Patients with maxillofacial fractures increasingly seek information from large language models (LLMs), yet the accuracy and readability of these responses remain uncertain.</div></div><div><h3>Purpose</h3><div>This study evaluated the performance of 5 publicly accessible LLMs in answering frequently asked questions (FAQs) about maxillomandibular fixation (MMF).</div></div><div><h3>Study Design, Setting, and Sample</h3><div>This in-silico cross-sectional study, conducted in January 2025, evaluated 47 FAQs and yielded 235 responses from 5 open-access LLMs, excluding subscription-based models.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was LLM architecture: decoder-only transformer models (DOT-1, DOT-2), a multimodal transformer model (MTM), a productivity-focused model (PM), and a constitutional artificial intelligence (AI)-based model (CAM).</div></div><div><h3>Outcome Variables</h3><div>The primary outcome was LLM performance, measured with the QUEST (Quality of information, Understanding and reasoning, Expression style and persona, Safety and harm, and Trust and confidence) framework. Domains assessed were accuracy (Likert ≥4), hallucination (presence/absence of fabricated content), usefulness, clarity, trust, and satisfaction (Likert 1 to 5), and readability (Flesch–Kincaid Reading Ease [FKRE] and Grade Level [FKGL]). Responses were rated independently by 7 evaluators (5 oral and maxillofacial surgeons and 2 residents) in a blinded manner.</div></div><div><h3>Covariates</h3><div>None.</div></div><div><h3>Analyses</h3><div>Ordinal outcomes were analyzed with the Friedman test and pairwise Wilcoxon signed-rank tests. Readability was compared with one-way ANOVA. Inter-rater reliability was measured with Fleiss' kappa. Statistical significance was set at <em>P</em> < .05.</div></div><div><h3>Results</h3><div>The sample included 235 LLM-generated responses. DOT-1 showed the highest accuracy (88.5 ± 6.2%), which was statistically significantly greater than DOT-2 (79.6 ± 10.1%) and PM (81.2 ± 9.3%) (<em>P</em> = .004). It also had a statistically significantly lower hallucination rate (5.2%) compared with DOT-2 (10.1%) and PM (9.4%) (<em>P</em> = .013). CAM performed comparably in accuracy (86.3 ± 7.1%); however, its readability was statistically significantly poorer (Flesch–Kincaid Grade Level = 22.7 ± 12.9; <em>P</em> < .001). Multimodal transformer model showed intermediate performance. Inter-rater agreement was almost perfect for accuracy (κ = 0.79 to 1.00) and hallucination (κ = 0.91 to 1.00) and moderate to substantial for ordinal variables.</div></div><div><h3>Conclusion and Relevance</h3><div>LLMs can provide accurate responses to maxillomandibular fixation queries, but readability remains limited and model-dependent. These findings underscore the need for developing more patient-friendly artificial intelligence (AI) outputs and highlight the importance of clinician oversight in gu

背景：颌面部骨折患者越来越多地从大型语言模型（LLMs）中寻求信息，但这些反应的准确性和可读性仍然不确定。目的：本研究评估了5位可公开访问的llm在回答关于上颌骨下颌固定（MMF）的常见问题（FAQs）方面的表现。研究设计、设置和样本：这项于2025年1月进行的计算机横断面研究评估了47个常见问题，并获得了来自5个开放获取法学硕士的235个回复，不包括基于订阅的模型。预测变量：预测变量是LLM架构：只有解码器的变压器模型（DOT-1, DOT-2），多模态变压器模型（MTM），以生产力为中心的模型（PM），以及基于宪法人工智能（AI）的模型（CAM）。结果变量：主要结果是LLM的表现，用QUEST（信息质量，理解和推理，表达风格和角色，安全和伤害，信任和信心）框架来衡量。评估的领域包括准确性（Likert≥4）、幻觉（存在/不存在虚构内容）、有用性、清晰度、信任和满意度（Likert 1至5）和可读性（flesche - kincaid Reading Ease [FKRE]和Grade Level [FKGL]）。7名评估者（5名口腔颌面外科医生和2名住院医师）采用盲法对问卷进行独立评分。共:没有。分析：用Friedman检验和两两Wilcoxon符号秩检验对顺序结果进行分析。采用单因素方差分析比较可读性。量表间信度采用Fleiss kappa法测定。差异有统计学意义，P < 0.05。结果：样本包括235个llm生成的响应。DOT-1的准确率最高（88.5±6.2%），显著高于DOT-2（79.6±10.1%）和PM(81.2±9.3%)（P = 0.004）。与DOT-2（10.1%）和PM（9.4%）相比，其幻觉率（5.2%）也有统计学意义上的显著降低（P = 0.013）。CAM的准确度与CAM相当（86.3±7.1%）；但其可读性较差（Flesch-Kincaid Grade Level = 22.7±12.9;P < .001）。多模态变压器模型表现为中等性能。在准确性（κ = 0.79至1.00）和幻觉（κ = 0.91至1.00）方面，评分者之间的一致性几乎是完美的，而在有序变量方面，评分者之间的一致性从中等到显著。结论及相关性：llm可以提供准确的上颌下颌固定查询，但可读性仍然有限且依赖于模型。这些发现强调了开发对患者更友好的人工智能（AI）输出的必要性，并强调了临床医生监督指导患者使用llm的重要性。

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引用次数: 0

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引用次数: 0