Journal of Oral and Maxillofacial Surgery最新文献

Normative reference models are essential for assessing facial form, yet existing databases, stratified by ethnicity, age, and sex, have significant limitations, including incompleteness and lack of applicability for mixed-heritage patients. We propose a new paradigm, the Kindred Reference Form, which derives personalized reference morphology from a patient's nondeformed relatives. This framework provides an individualized normative standard overcoming the limitations of population datasets and proposing a new direction for patient-specific surgical planning in facial deformities.

Background: Symptomatic disc displacement (SDD) is a common temporomandibular joint disorder, with arthroscopic discopexy being one of the treatment options that offers the advantages of a minimally invasive approach.

Purpose: The purpose was to evaluate factors associated with favorable outcomes after mattress-loop technique (Yang's technique) for arthroscopic discopexy in subjects with SDD.

Study design, setting, and sample: This prospective cohort study was conducted at a tertiary care center (Clínica Bupa Santiago). Patients presenting between 2022 and 2024 with SDD who required arthroscopic discopexy were enrolled. Exclusion criteria included missing preoperative data or unavailable preoperative magnetic resonance imaging (MRI).

Predictor variable: The predictor variable was a set of heterogenous variables categorized as demographic, perioperative, or imaging.

Main outcome variables: The main outcome variable was therapeutic effect measured using (1) visual analog scale to assess pain and (2) maximal incisal opening (MIO). The secondary outcome was radiographic, measured using disc stability assessed on 6-month MRI based on disc position. All variables were measured at baseline and at 6 months postoperatively.

Covariates: Not applicable.

Analyses: Data were analyzed using descriptive and inferential statistics, a statistical significance was set at P value < .05. Mixed-effects regression models with a random intercept for patient to account for correlation between joints within the same individual were performed for changes in pain, MIO, and disc position stability.

Results: A total of 218 joints from 141 subjects were included. At 6 months, pain decreased from a mean of 5.53 ± 2.42 to 0.81 ± 1.60 (Δ = 4.72, P < .05) and MIO increased from 31.29 ± 9.13 mm to 38.52 ± 4.61 mm (Δ = 7.23 mm, P < .05). MRI follow-up showed disc stability in 120 joints (89.5%). Female sex, younger age, and the presence of clicking were significantly associated with greater improvements in pain and MIO. After adjusting for males experienced significantly less pain reduction (β = -1.56, P = .03), and younger subjects (β = -0.17 mm/year, P = .002) had better pain relief and improved MIO respespectively.

Conclusion (and relevance): The results suggest that mattress-loop technique was associated with reducing pain, increasing MIO, and preserving short-term disc stability at 6 months. Younger age was the strongest predictor of favorable outcomes, supporting early intervention in this population.

Background: Artificial intelligence (AI) and machine learning (ML) (AI/ML) has grown exponentially over the past several years. However, oral and maxillofacial surgeons have limited education and exposure to AI in the clinical and administrative setting. The purpose of this review is to provide an introduction of core concepts in commonly used AI models while providing relevant context in oral and maxillofacial surgery (OMS). Challenges and potential solutions to development of AI in OMS are also discussed.

Findings: Preliminary studies using AI/ML in OMS have demonstrated high performance in metrics including sensitivity, specificity, Dice coefficient, intersection over union, and residual error.

Conclusions and relevance: Oral and maxillofacial surgeons should have a functional knowledge of AI technologies to guide development, testing, and adoption into OMS. With surgeon guidance, AI/ML has the potential for meaningful application across multiple clinical and administrative domains of OMS.

Background: Joint space dimensions influence maxillomandibular relationships by altering condylar position. Although disc displacement (DD) is the most common temporomandibular joint (TMJ) disorder, its effect on joint space dimensions and associated morphology remains unclear.

Purpose: This study aimed to determine whether DD status and sex are associated with differences in joint space dimensions and related bony morphology, based on combined TMJ magnetic resonance imaging and computed tomography (CT) evaluations.

Study design, setting, sample: This retrospective cross-sectional study included patients who underwent paired magnetic resonance imaging and CT scans at Seoul National University Dental Hospital between 2008 and 2023. Exclusion criteria were congenital anomalies, systemic diseases, previous TMJ, orthodontic or orthognathic treatment, and trauma involving the TMJ.

Predictor variable: The predictor variables were 1) DD status, categorized as normal disc position (NR), DD with reduction, and DD without reduction and 2) sex, coded as male or female.

Main outcome variable: The main outcome variable was joint space dimensions, selected for their influence on condylar position, including sagittal (anterior, superior, and posterior) and coronal (medial, central, and lateral) joint space distances (mm), and anterior, superior, posterior, and total joint space volumes (mm³).

Covariates: Age, CT modality (cone-beam CT vs multidetector CT), and laterality (right vs left) were considered as potential covariates.

Analyses: Linear mixed-effects models with a subject-level random intercept were applied, with Bonferroni and false discovery rate adjustments. Statistical significance was set at P < .05.

Results: The sample consisted of 85 subjects (24.6 ± 6.8 years), including 41 males (48.2%) and 44 females (51.8%). Age, CT modality, and laterality did not affect outcomes (P > .05). Compared with NR joints, DD joints exhibited a smaller condyle within a larger fossa (P < .05) and significantly greater anterior joint space distance in the sagittal plane, without differences in superior or posterior distances (P = .108 and P = 0.913, respectively). Coronal joint space distances did not show differences (P > .40). Anterior joint space volume was larger in DD joints than in NR joints (P < .001). Sex did not significantly influence these associations (P > .05).

Conclusions and relevance: DD is associated with smaller condyles and enlarged fossa, contributing to increased anterior joint space dimensions. These findings may aid diagnosis and treatment planning in patients with TMJ DD.