Journal of Oral and Maxillofacial Surgery最新文献

Background: Transdermal buprenorphine is used for the management of postoperative pain. Its effectiveness for the postoperative pain management following mandibular resection and reconstruction has yet to be evaluated.

Purpose: To evaluate the efficacy of transdermal buprenorphine patch (TBP) in managing postoperative pain after mandibular resection and reconstruction with anterior iliac crest graft.

Study design, setting and sample: This triple-blinded, randomized controlled trial included 30 subjects in the age range of 18 to 60 years with benign mandibular pathologies. Subjects visiting the outpatient department of the Dept. of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, India, were included in the study. Subjects with known allergies to any drugs, using sedatives, alcohol, pregnant and lactating mothers, and with respiratory problems were excluded.

Predictor: The predictor variable was postoperative pain management and subjects were randomly assigned to TBP or a placebo patch group.

Main outcome variable: It was the postoperative pain, which was measured by visual analog scale (VAS) for 7 consecutive days. Secondary outcome variables were requirement of rescue analgesics and drug-related adverse effects.

Covariates: Age at surgery, sex, diagnosis, duration of the operation, and amount of fentanyl used during the operation were covariates.

Analyses: Descriptive statistics, Mann-Whitney U test, χ², repeated measures analysis of variance, and post-hoc analysis (Bonferroni test) were used. A P value <.05 was considered a level of statistical significance.

Results: Thirty subjects were randomly allocated to TBP and control group. The mean VAS score during the study period was 0.8 ± 2.37, and 3.49 ± 2.37 in TBP and control group subjects respectively (P < .001). Compared to control group, the mean VAS score in TBP group subjects were significantly less till the end of postoperative day 4 (P < .001). The mean rescue analgesic requirement during the postoperative period was 5.33 ± 15.8 mg and 47.6 ± 37.7 mg in the TBP and control group subjects, respectively (P < .001). Nausea was the most common drug-related adverse effect in both the group subjects (46.7%) (P > .9).

Conclusion and relevance: The highest VAS score in TBP group subjects was 1.53 ± 0.92 on the morning of postoperative day 1, whereas it was 6.47 ± 1.3 at 6 hours after operation in control group subjects. Thus, a TBP was adequate for the management of postoperative pain following mandibular resection and reconstruction.

Background: Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) is a genetic disorder, marked by bone lesions, often affecting the craniofacial skeleton. Pain is a prevalent yet heterogeneous symptom reported by patients with craniofacial FD. Effective treatments are currently lacking, posing a significant clinical challenge to patient care.

Purpose: This preliminary study examined pain profiles in craniofacial FD and aimed to identify subtypes of patients based on pain phenotypes and emotional health.

Study design, setting, sample: A prospective, cross-sectional study involving 15 patients with FD/MAS, conducted at Boston Children's Hospital and Massachusetts General Brigham's Hospitals.

Predictor/exposure/independent variable: Headache frequency, craniofacial pain severity, neuropathic pain quality, pain interference, allodynia, photophobia, depression, and anxiety were assessed using clinical questionnaires.

Main outcome variable(s): The primary outcome variable was the symptom profile derived from standardized clinical questionnaires and analyzed using principal component analysis and K-means clustering.

Covariates: Covariates included demographic data, diagnosis, and lesion location(s).

Analyses: Principal component analysis and K-means clustering of patient-reported measures of pain and emotional health were performed. Analysis of variance was conducted to determine significant differences among patient subtypes. Statistical significance was set at (P < .05).

Results: The study included 15 subjects with FD/MAS, with a mean age of 36.2 (13.9) years, including 1 male. Clustering analysis identified 3 subtypes of patients with distinct symptom profiles. Cluster 1 (n = 2) averaged 70 (28.3) headache days in a 90-day period, pain level of 7.5 (0.7) on a 0-10 scale, and severe anxiety, depression, allodynia, photophobia, and pain interference. Cluster 2 (n = 7) patients reported an average of 5.4 (7.5) headache days, an average pain level of 2.7 (2.6), mild or no anxiety, depression, allodynia, photophobia, and pain interference. Cluster 3 (n = 6) patients displayed a mixed symptom profile with an average of 47.3 (36.4) headache days and a pain level of 5.25 (1.4). Notably, patients with temporal and skull base lesions were predominantly found in Clusters 1 and 3, which exhibited the most severe symptomatology.

Conclusions and relevance: This study establishes a basis for future longitudinal research aimed at understanding underlying pain mechanisms and evaluating the response to personalized pain management strategies in subtypes of patients with craniofacial FD.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with the use of antiresorptive agents, impacting patient quality of life and treatment outcomes. Predictive modeling may aid in a better understanding of MRONJ development.

Purpose: The study aimed to evaluate machine learning (ML)-based models for predicting MRONJ in patients receiving antiresorptive therapy.

Study design, setting, sample: This retrospective in silico study analyzed electronic medical records from Thammasat University Hospital, covering the period from January 2012 to December 2022. The sample included subjects receiving antiresorptive therapy, excluding those with a history of radiation therapy or metastatic jaw disease.

Predictor variables: The primary predictor variable was the predicted probability of MRONJ development from the ML models.

Outcome variables: The outcome variable was MRONJ status coded as present or absent based on chart review.

Covariates: Covariates included demographic data, MRONJ occurrence, location and staging of MRONJ, comorbidities, diseases related to antiresorptive agents, types of antiresorptive agents, therapy duration, concurrent medications, blood calcium levels, and dental factors.

Analyses: Model performance was assessed via accuracy, sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve. Additionally, univariate and multivariate Cox regression analyses were conducted to identify factors significantly associated with MRONJ development. P ≤ .05 was statistically significant.

Results: The study analyzed data from 5,305 subjects with a mean age of 75 ± 11.1 years, predominantly female. MRONJ was observed in 81 cases (1.5%), with a median time to development of 33 months (interquartile range = 3). Among the 6 models tested, the best-performing model had an accuracy of 0.95 and an area under the receiver operating characteristic curve of 0.89-0.90. Significant predictors identified through Cox regression included metabolic syndrome (hazard ratio = 14.064, 95% confidence interval = 1.111-178.067, P = .041) and patients receiving intravenous pamidronate (hazard ratio = 5.932, 95% confidence interval = 1.755-20.051, P = .004), indicating their association with MRONJ development.

Conclusions and relevance: ML-based predictive and time-to-event models effectively predict MRONJ risk, aiding in the strategic prevention and management for patients undergoing antiresorptive therapy.