Journal of Oral and Maxillofacial Surgery最新文献

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.

Background: Leech therapy has been used in medicine since ancient times for varying indications. More recently, it has come back into favor for treating venous congestion of surgical sites; however, there is limited data on the number of leeches and application techniques for the head and neck region compared with other anatomical subsites.

Purpose: This study's purpose was to assess the response to leech therapy in a series of patients with venous congestion, review the literature to determine association between leech therapy use and venous congestion, and provide guidelines for leech therapy for use in the head and neck region.

Study design: A retrospective case series of patients treated by the Department of Oral and Maxillofacial Surgery for venous congestion with leech therapy at Harborview Medical Center, Seattle, WA, was analyzed from 2016 to 2019. All nonleech cases were excluded. Literature review articles were gathered from PubMed and Scopus using the search terms leeching and venous congestion using the Boolean operator and.

Main outcome variable: The main outcome variable in this study was tissue loss in reconstructive sites of the head and neck, defined as no tissue loss, partial tissue loss, or complete loss of tissue.

Covariates: Covariates included age, gender, medical comorbidities, type of operation required, and chief complaint. Number of leeches used, duration, and antibiotic prophylaxis agents were also gathered. Data gathered from articles included in the literature review included study design, population, number of leeches used, duration, complications, and amount of tissue lost or salvaged.

Analyses: Descriptive statistics were calculated for data gathered from patient cases.

Results: Seven cases were reviewed with a mean age of 60.86 years. Five (71%) subjects experienced venous congestion resulting from resection or reconstruction of malignancy and 2 (29%) after laceration repair. Three subjects (43%) had complete recovery from venous congestion following leech therapy. Four subjects (57%) had partial (minor) tissue loss secondary to necrosis. No subject had complete loss of tissue. From the article review, 16 articles were identified, consisting of 3 systematic reviews, one literature review, and 13 retrospective case series ranging from 6 to 277 cases.

Conclusions and relevance: Leech therapy is a viable treatment option for venous congestion. Patients should be screened for coagulopathy, use of blood thinners, and psychological acceptance to therapy prior to initiating leech therapy; antibiotic prophylaxis is essential for preventing infection with Aeromonas hydrophila.

Background: In the Netherlands, more than 15,000 children visit the emergency department (ED) after bicycle or scooter accidents annually, frequently presenting with maxillofacial injuries. Despite evidence that helmet use reduces injuries in the general population, research focusing on maxillofacial injuries in children is still limited.

Purpose: The study purpose was to estimate and compare the frequencies of bicycle- or scooter-related maxillofacial injuries between helmeted and unhelmeted pediatric riders.

Study design, setting, sample: This single-center retrospective cohort study was conducted at the Erasmus Medical Center in Rotterdam, the Netherlands. Patients aged <18 years who visited the ED after a bicycle or scooter accident between June 2017 and December 2023 were included. Bicycle spoke injuries were excluded.

Independent variable: The independent variable was helmet use, coded as helmeted or unhelmeted.

Main outcome variable: Maxillofacial injury status (present or absent) was the primary outcome. The secondary outcome was the type of maxillofacial injury (soft tissue, fracture or dentoalveolar).

Covariates: Subject characteristics (age, sex) and accident characteristics (type of vehicle, type of rider) were determined as covariates.

Analyses: Descriptive and analytical statistics were calculated with the threshold for statistical significance set at P < .05. Multiple logistic regression analysis was used to compare pediatric subjects with and without maxillofacial injuries.

Results: Overall, 56,000 trauma patients were screened. 210 (100%) subjects were included in the study sample with a median age of 16 (interquartile range 13 to 17) and 144 (68.6%) were male. 100 (47.6%) subjects wore a helmet. The frequency of maxillofacial injuries was 28 (28.0%) in the helmeted and 51 (46.4%) in the unhelmeted group with a relative risk (RR) of 0.60 (95% CI 0.42 to 0.89, P = .008). The odds ratio for maxillofacial injuries was 0.52 (95% CI 0.28 to 0.97, P = .041) for helmeted subjects after regression analysis. Additionally, helmet use was associated with a lower risk for soft tissue injury (RR 0.56; 95% CI 0.38 to 0.82; P = .003) and maxillofacial fractures (RR 0.38 95% CI 0.16 to 0.95; P = .037).

Conclusions and relevance: Helmet use among children is inversely associated with risk of maxillofacial injury following a bicycle or scooter accident. These findings are considered relevant in future helmet legislation for children.

Background: For symptomatic anterior disc displacement without reduction, articular disc repositioning aims to enhance clinical function. It's unclear if double anchorage (DA) is superior to single anchorage (SA) in this procedure.

Purpose: The purpose of this study was to compare the therapeutic effects of DA or SA in subjects with temporomandibular joint symptomatic disc displacement (SDD).

Study design, setting, sample: The authors implemented a single-center retrospective cohort study. Subjects with Wilkes III-V stage SDD who underwent open temporomandibular joint disc plication at the Affiliated Stomatological Hospital of Nanchang University were identified via electronic medical records. The exclusion criteria of this study were as follows: (1) severe systemic diseases; (2) mental disorders; and (3) inability to complete follow-up.

Predictor variable: The predictor variable was the disc anchorage technique, which was grouped into DA and SA.

Main outcome variable(s): The primary outcome variable was the therapeutic effect, including pain (assessed using the visual analog scale), maximal interincisal opening (MIO), and the craniomandibular index (CMI). The secondary outcomes were quality of life and postoperative disc position. Among these, visual analog scale, MIO, CMI, and quality of life were recorded at T0 (preoperation), T1 (1 month postoperation), T2 (3 months postoperation), and T3 (6 months postoperation); postoperative disc position was recorded between T2 and T3.

Covariates: The covariates included demographics (age, sex), perioperative variables (Wilkes stage,laterality (unilateral or bilateral), and presence or absence of perforation).

Analyses: Repeated measures analysis of variance (ANOVA) examined various effects. For primary outcomes, independent samples t-tests were used for between-group comparisons and paired t-tests for within-group comparisons, with significance set at P < .05.

Results: The sample included 137 subjects (DA: 70, 51%; SA: 67, 49%), with an overall mean age of 41.24 (±18.02) years and 19.0% female/81.0% male. For the DA and SA groups, mean pain reduction was from 6.30 (±1.34) to 0.73 (±0.92) and 6.00 (±1.60) to 1.33 (±1.16), mean MIO increase from 20.86 (±4.77) to 36.33 (±4.11) and 21.64 (±4.94) to 34.82 (±4.49), and mean CMI reduction from 0.51 (±0.10) to 0.13 (±0.11) and 0.47 (±0.14) to 0.18 (±0.12), respectively (all P < .05); all pairwise comparisons were significant (P < .05).

Conclusion: The results suggest that DA was associated with superior therapeutic effects compared to SA and is a suitable alternative in SDD surgery.

Background: Velopharyngeal insufficiency (VPI) is common in patients with repaired cleft palate. Speech surgery, which encompasses operative procedures to improve velopharyngeal function and speech resonance, has been associated with postoperative obstructive sleep apnea (OSA). However, the relative risk of OSA between different speech surgery procedures remains unclear.

Purpose: The purpose of this study was to compare the relative risk of OSA following pharyngeal flap versus nonpharyngeal flap procedures, which included dynamic sphincter pharyngoplasty (DSP), Furlow palatoplasty, and buccal myomucosal flaps (BMMF).

Data sources: An electronic literature search was conducted utilizing PubMed, Cochrane, Embase, and Web of Science databases.

Study selection: Eligible studies included patients with a history of repaired cleft palate and VPI requiring speech surgery, published between 1994 and 2024. Studies specifically included comparison data between pharyngeal flap and nonpharyngeal flap techniques. Exclusion criteria were case reports, abstracts, and reviews.

Data extraction and synthesis: Data were extracted per the the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographics, speech procedure data, OSA frequency, and follow-up data were recorded. The primary comparison was procedure type including pharyngeal flap versus nonpharyngeal flap procedures. Meta-analysis was performed using a random-effects model, with P values <.05 considered statistically significant.

Main outcomes and measure: The primary outcome was relative risk of postoperative OSA between procedure types.

Results: Four studies met inclusion criteria, which included 751 subjects. Pharyngeal flap was associated with a significantly greater risk of postoperative OSA compared to nonpharyngeal flap procedures (pooled risk ratio = 2.45, 95% CI: 1.20 to 5.01, P = .01). Subgroup analysis showed that palatal lengthening procedures had a significantly lower risk of OSA than pharyngeal flap (risk ratio = 0.39, P = .002); however, there was no difference in postoperative OSA between DSP and pharyngeal flap (P = .68) CONCLUSIONS AND RELEVANCE: Palatal lengthening procedures had a lower risk of postoperative OSA than pharyngeal flap. There was no difference in postoperative OSA between pharyngeal flap and DSP. As such, in patients with preoperative OSA or patients at high risk for developing OSA, it may be prudent to use palatal lengthening procedures as a first-line option for the correction of VPI.

This case series evaluates the clinical application of augmented reality (AR) in temporomandibular joint arthroscopy, with a focus on improving accuracy in initial and secondary portal placement. Five patients underwent AR-assisted arthroscopy using preoperative CT-based virtual planning and intraoperative holographic visualization with the Microsoft HoloLens 2 and Xironetic's IntraOpVSP system. The AR interface enabled real-time alignment of surgical instruments with planned trajectories, resulting in successful joint access and completion of all intended procedures. The first portal was consistently placed with high precision, while the second portal benefited from AR-guided triangulation despite variability in preoperative joint space estimation. Although AR was not used during advanced intra-articular maneuvers due to current technical limitations, the system enhanced spatial orientation and procedural confidence. These findings support the feasibility of integrating AR into temporomandibular joint arthroscopy and highlight its potential to improve surgical accuracy, streamline workflow, and serve as a valuable adjunct in minimally invasive joint procedures.

Buccal mucosa squamous cell carcinoma (BSCC) has a poor prognosis. In this study, a new classification system for BSCC and a corresponding surgical strategy are proposed. A total of 210 BSCC patients who underwent continuous tumor en bloc excision and neck lymph node dissection in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital were enrolled. In the new classification, anterior/posterior buccal divisions by the front boundary of the masseter and upper/lower divisions by the occlusion line are defined. The corresponding surgical strategies included through-and-through resection, subzygomatic region resection, anatomical unit resection, and mandibular resection. The 5-year local disease control rate, overall survival rate, and disease-free survival rate of BSCC patients were 87.76, 73.61, and 69.24%, respectively. The local disease control rates in the T1-T2 stage group, I-II clinical stage group, and lymph node-negative group were 94.17, 98.80, and 97.50%, respectively. Our proposed BSCC classification and surgical strategy offer another surgical procedure for treating BSCC.

Background: Preoperative identification of major salivary gland (MSG) cancers is crucial for determining appropriate treatment strategies. However, whether fine-needle aspiration cytology (FNAC) or core-needle biopsy (CNB) should be the preferred first-line diagnostic modality remains controversial.

Purpose: This study compared the diagnostic utility of FNAC and CNB and assessed their associations with treatment strategies and survival outcomes in patients with primary MSG cancer.

Study design, setting, samples: This retrospective cohort study was conducted at Kyungpook National University Hospital. Patients diagnosed with primary MSG cancer after surgery were included. Exclusion criteria were metastatic cancers, nonsalivary epithelial malignancies, absence of preoperative FNAC or CNB, or procedures performed over 1 year before surgery.

Predictor variable: The predictor variable was the biopsy technique: FNAC or CNB.

Main outcome variables: The primary outcomes were (1) diagnostic utility (sensitivity and nondiagnostic rates); (2) treatment strategies, defined as surgical extent (partial vs subtotal/total gland excision; no vs elective vs therapeutic neck dissections); and (3) 5-year disease-free survival.

Covariates: Covariates included age, sex, smoking, alcohol, comorbidity, primary clinical presentation, and tumor characteristics based on imaging and pathological findings.

Analyses: Data were analyzed using t-tests, χ² or Fisher's exact tests, Kaplan-Meier method with log-rank tests, and Cox regression model. Diagnostic sensitivity was calculated using the final histopathological diagnosis from surgical resection as the reference standard.

Results: A total of 129 subjects were included (mean age, 57.2 ± 15.3 years; 82 [63.6%] male). Of those, 97 (75.2%) underwent FNAC and 32 (24.8%) underwent CNB. CNB showed higher sensitivity for diagnosis of malignancy than FNAC (86.7 vs 45.9%, P < .001) and fewer nondiagnostic results (0.0 vs 10.3%, P < .001). CNB was associated with shorter time to surgery (43.1 ± 28.2 vs 125.1 ± 107.6 days, P < .001), more frequent subtotal/total gland excision (90.6 vs 43.3%, P < .001), and elective neck dissection (53.1 vs 18.6%, P < .001). In advanced disease, CNB was associated with better 5-year disease-free survival (77.6 vs 53.4%, P = .041). FNAC was an independent prognostic factor for treatment failure (hazard ratio, 2.963; P = .040).

Conclusion and relevance: CNB was associated with superior diagnostic utility compared to FNAC, more appropriate surgical management, and improved outcomes for patients with MSG cancer.

Background: It has been determined that oxytocin (OT), a hormone primarily involved in childbirth and lactation, has anabolic effects on bone metabolism.

Purpose: The purpose of the study was to measure and compare radiographic and clinical fracture healing between the OT-treated and control groups.

Study design, setting, and sample: This is an in vivo animal study using a mandibular fracture model in 42, 6-month-old male Wistar rats. The fracture line was created and fixed using mini plates and screws.

Predictor variables: The predictor variable was OT exposure. The animals were randomly assigned to OT or control groups (C). The animals were sacrificed on days 10 (OT-10, C-10), 20 (OT-10, C-10), and 30, (OT-30, C-30) to evaluate the effect of OT on fracture healing at different stages. Thus, two groups and six subgroups were formed.

Outcome variables: The outcome variable was fracture healing measured using gray values (GV), fracture healing scores (FHS), and the ratio of new bone area to total fracture area (NB/TF.) For an objective assessment of radiographic images, the average GV of the region can be calculated. FHS is a scoring system that evaluates bone healing. NB/TF is the ratio used to evaluate new bone formation.

Covariates: None.

Analyses: The differences between groups were analyzed using the independent samples test or the Mann-Whitney U test, depending on the distributional characteristics of the data. Comparisons between the control and experimental groups at each time point were performed using the independent samples test. Additionally, Pearson's or Spearman's correlation tests were used according to the distribution of the variables (P < .05).

Results: Compared to the C groups, OT groups consistently showed higher recovery outcomes. Although no significant difference was observed on day 10, on day 20, OT-20 subgroup demonstrated significantly higher GV (OT-20 = 1.35 ± 0.39, C-20 = 0.77 ± 0.24) (P = .011 < 0.05), FHS values (OT-20 = 7.83 ± 0.75, C-20 = 5.67 ± 1.21) (P = .004 < 0.05), and NB/TF ratios (OT-20 = 80.19 ± 4.93, C-20 = 31.40 ± 3.87) (P = .001 < 0.05). On day 30, OT-30 maintained this superiority, showing significantly higher GV, FHS, and NB/TF values compared to C-30 (all P < .05).

Conclusions: In this study, the groups treated with OT showed higher mean healing scores. Oxytocin improved the healing of mandibular bone fractures.