Journal of Oral and Maxillofacial Surgery最新文献

Background: Orbital fractures commonly result in functional and esthetic deficits, demanding precise reconstruction of orbital volume and globe position. Patient-specific implants (PSIs) have emerged as promising solutions, yet their definitive clinical and cost-effectiveness benefits remain debated.

Purpose: The study purpose was to estimate and compare orbital volume restoration, globe position, functional outcomes, and complications between PSI versus conventional orbital reconstruction.

Study selection: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science from inception to May 2025 identified studies comparing PSIs with conventional orbital reconstruction techniques in adults with post-traumatic orbital defects. Studies exclusively reporting technical aspects, pediatric samples, or nontraumatic defects were excluded. Of 385 identified studies, 23 met the inclusion criteria.

Results: The included studies involved 1,222 subjects. PSIs demonstrated significantly better orbital volume restoration compared to conventional methods (mean volume difference: PSI, 0.73 ± 0.28 cm³; conventional, 1.54 ± 0.38 cm³, P < .05). Globe position outcomes were also consistently better in PSI groups, with significantly reduced persistent enophthalmos (PSI 7.3% vs conventional 18.2%, P = .03). Functional outcomes, specifically persistent diplopia, were significantly lower with PSI (PSI 11.7% vs conventional 30.1%, P = .01). Revision rates were also significantly reduced with PSI usage (PSI 5.9% vs conventional 13.7%, P = .01). Despite higher initial costs, PSI reduced operative times by an average of 15.7 minutes, which may offset overall treatment expenses.

Conclusions and relevance: PSIs offer superior outcomes in orbital volume restoration, globe positioning, and reduced complication and revision rates compared to conventional reconstruction. These findings strongly support PSI utilization in complex post-traumatic orbital reconstruction, particularly when integrated with intraoperative navigation systems. Further research, especially prospective randomized studies with long-term follow-up, is needed to strengthen these recommendations.

Background: Preoperative serum albumin is a widely recognized marker of postoperative outcomes across various surgical conditions, with lower levels associated with worse outcomes. However, its prognostic value in medication-related osteonecrosis of the jaw (MRONJ) remains unexplored.

Purpose: The purpose of the study was to evaluate the association between preoperative albumin levels and both surgical outcomes and MRONJ severity at presentation.

Study design, setting, sample: A retrospective cohort study was conducted on subjects treated for MRONJ under the Oral and Maxillofacial Surgery service at the University of Pennsylvania Health System between January 1, 2013, and September 12, 2022. Inclusion criteria were a confirmed MRONJ diagnosis, surgical management, and preoperative serum albumin level measured within 3 months of surgery. Subjects without at least one postoperative follow-up were excluded.

Predictor variable: The primary predictor variable was preoperative serum albumin within 3 months of surgery.

Main outcome variables: The primary outcome variable was surgical outcome in MRONJ, characterized as improved (resolved or downstaged) versus not improved (same stage, upstaged, and/or with complications).

Covariates: Covariates included demographic variables (age, sex, race) and clinical factors (MRONJ stage, history of osteoporosis, cancer, penicillin allergy, diabetes, smoking) for MRONJ.

Analysis: Multiple logistic regression and ANOVA models were used to assess associations between serum albumin and surgical outcomes. Statistical significance was defined at P < .05.

Results: The sample was composed of 94 subjects with a mean age of 68.1 ± 10.3 years; 31 (33.0%) were male. The mean preoperative albumin level was 3.84 ± .43 g/dl. The unadjusted associated albumin levels were statistically significantly lower in the group with poor surgical outcomes (3.51 ± 0.457 g/dl) compared to the improved group (3.90 ± 0.394 g/dl; P < .05). After adjusting for all the covariates, albumin was statistically significantly associated with improved outcomes (OR: 0.0928; 95% CI: 0.0138 to 0.489; P < .05).

Conclusions and relevance: In one of the largest surgical MRONJ cohorts to date, there was a statistically significant association between lower preoperative serum albumin levels and poorer surgical outcomes.

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.

Background: Facial nerve (FN) dysfunction is a potential postoperative complication of managing temporomandibular joint ankylosis (TMJa).

Purpose: The purpose of this study was to determine whether evoked electromyography (EEMG) detects postoperative FN function (FNF) recovery earlier than House-Brackmann scale (HBS) and Sunnybrook scale (SBS) following TMJa surgery.

Study design, setting, sample: A prospective, single tertiary-care center cohort study was conducted at All India Institute of Medical Sciences, Rishikesh from October 2022 to April 2024. Patients with unilateral TMJa aged above 12 years were included. Exclusion criteria were previous surgery of parotid/temporomandibular joint, preexisting FN palsy, neuromuscular disorders, syndromic patients.

Predictor variable: The primary predictor variable was FNF recovery monitoring tool (EEMG vs HBS vs SBS).

Main outcome variables: The primary outcome variable was FNF recovery time. This was recorded postoperatively at defined time-points (1 week-T1, 1 month-T2, 3 months-T3, 6 months-T4).

Covariates: Covariates included age, sex, and operative time.

Analysis: Data were analyzed using SPSSversion20. Frequencies (percentages) were compared using χ² and Fisher's exact tests. Kaplan-Meier survival analysis and Cox-regression were used to assess recovery hazards, adjusting for covariates with level of statistical significance set at P < .05.

Results: The sample composed of 65 subjects of unilateral TMJa undergoing surgery. The mean age was 20.13 ± 7.58 years and included 27 females (42%) and 38 males (58%). Iatrogenic FN injury occurred in 15 (23%) cases. The median time to detect FNF recovery by EEMG was 6 weeks (interquartile range [IQR] 3 to 12) versus HBS 15 weeks [IQR 11 to 19] versus SBS 18 weeks [IQR 13 to 20] which was statistically significant favoring EEMG (95% CI, P < .05). Complete recovery of FNF was noted in all 15 cases. The chance of early detection of recovery by EEMG was 32% greater than with HBS and SBS (hazard ratio: 1.32, 95% CI, 1.02 to 1.72, P < .05).

Conclusion and relevance: EEMG detects FNF recovery earlier than grading scales, and is a valid electrodiagnostic test for postoperative monitoring.

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.

Background: Patients with maxillofacial fractures increasingly seek information from large language models (LLMs), yet the accuracy and readability of these responses remain uncertain.

Purpose: This study evaluated the performance of 5 publicly accessible LLMs in answering frequently asked questions (FAQs) about maxillomandibular fixation (MMF).

Study design, setting, and sample: 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.

Predictor variable: 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).

Outcome variables: 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.

Covariates: None.

Analyses: 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 P < .05.

Results: 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%) (P = .004). It also had a statistically significantly lower hallucination rate (5.2%) compared with DOT-2 (10.1%) and PM (9.4%) (P = .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; P < .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.

Conclusion and relevance: 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 guiding patients' use of LLMs.