Journal of Oral and Maxillofacial Surgery最新文献

Background: Salivary duct carcinoma (SDC) is an aggressive malignancy with limited treatment options, and immune checkpoint inhibitors may offer novel therapeutic alternatives.

Purpose: The purpose of this study was to measure the association between immune checkpoint regulators and survival among patients with SDC.

Study design, setting, and sample: This retrospective cohort study was performed at Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital and Fudan University Shanghai Cancer Center between April 2006 and November 2016. Subjects were SDC patients meeting the inclusion/exclusion criteria.

Predictor variable: The predictor variable was the expression level of 5 immune checkpoint regulators (positive vs negative): programmed cell death protein-1 (PD-1), programmed death-ligand 1 (PD-L1), cytotoxic T-lymphocyte antigen 4 (CTLA-4), lymphocyte activation gene-3 (LAG-3), and T-cell immunoglobulin and mucin domain 3 (TIM-3).

Main outcome variable(s): The primary and secondary outcomes were disease-free survival (DFS) and overall survival.

Covariates: The covariates were subjects' demographics, tumor characteristics, and androgen receptor (AR) and human epidermal growth factor receptor 2 (HER2) status.

Analyses: Survival analysis was performed using Kaplan-Meier curves and Cox regression models. Subtype comparisons were made using Pearson χ² or Fisher's exact test. Statistical analyses were performed using SPSS v.26. Statistical significance was P < .05.

Results: The sample composed 54 subjects with a mean age of 59.39 years (SD 13.35) and 81% were male. PD-1, PD-L1, CTLA-4, LAG-3, TIM-3, AR, and HER2 positivity rates were 37, 31, 33, 15, 44, 67, and 24%, respectively (P < .001). The DFS was worse in subjects positive for HER2, PD-1, PD-L1, or CTLA-4 (all P < .05), whereas positivity for LAG-3 or TIM-3 was not associated with DFS. Multivariate analysis identified PD-1/PD-L1 co-positivity as an independent negative prognostic factor for DFS (HR = 2.69, P = .02). HER2 positivity was also an independent predictor of poorer overall survival (P = .003). No significant differences in immune checkpoint regulator expression were observed across subtypes.

Conclusions and relevance: PD-1, PD-L1, CTLA-4, and HER2 positivity are associated with unfavorable clinical outcomes in SDC. Immune checkpoint regulator expression was comparable among AR/HER2 subtypes. PD-1, PD-L1, and CTLA-4 are potential therapeutic targets for SDC, particularly for the HER2/AR double-negative subtype.

Background: Implant-retained auricular prostheses are a well-established reconstructive option for patients with facial defects resulting from congenital anomalies, trauma, or oncologic resections. Most temporal implants are 3.0 to 4.0 mm in length. Longer implants could result in improved implant survival, but risk mastoid cell perforation.

Purpose: The study purpose was to measure the association of implant mastoid cell perforation and implant survival.

Study design, setting, sample: A retrospective cohort study was conducted, including all patients treated with temporal endosseous implants at the University Hospital of Ghent between January 1, 1994, and July 31, 2024, with at least 1 postoperative computed tomography scan and minimal follow-up of 1 postoperative consultation. Patients were excluded if the available computed tomography scans were of insufficient quality or if patients were lost to follow-up.

Predictor variable: The predictor variable was temporal implant perforation into the mastoid air cells, coded as yes or no.

Outcome variable: The outcome variable was implant survival defined as the time between implant placement and implant loss, implant removal, or last consultation.

Covariates: The covariates were age, sex, smoking, diabetes, radiotherapy, and reason of deformity.

Analysis: Cox proportional hazards regression analyses were performed to assess the association between implant perforation into the mastoid air cells and implant survival, accounting for clustering of multiple implants within the same subject. A significance level of P ≤ .05 was considered statistically significant.

Results: The sample was composed of 22 subjects, with a mean age of 50 years (range 10 to 93, SD 24), of which 16 subjects were (73%) males. A total of 46 implants were placed, of which 10 (22%) implants failed, resulting in a 1-year survival rate of 87% (95% CI, 85 to 88%). The median follow-up was 21 months (interquartile range = 108.5). No association was found between mastoid cell perforation and implant survival (hazard ratio 0.31; 95% CI, 0.06 to 1.60; P = .2). Higher age was associated with an increased risk of implant failure over time (hazard ratio 1.10; 95% CI, 1.03 to 1.17; P = .006).

Conclusion: Mastoid air cell perforation showed no statistically significant association with implant survival. Larger prospective studies are needed to verify this result.

Background: Osteonecrosis of the jaw (ONJ) management remains challenging due to the lack of standardized surgical margin criteria. Bone autofluorescence (AF) has shown potential to distinguish necrotic from vital bone tissue intraoperatively.

Purpose: The study aimed to measure the association between bone AF intensity and histopathologic diagnosis to explore the potential of a new spectrophotometric method for real-time assessment of bone vitality.

Study design, setting, and sample: This was a prospective, multicentric, cross-sectional ex vivo study including 40 subjects treated for ONJ at 2 Italian university hospitals between 2023 and 2024. Exclusion criteria were age <18 years and inability to provide informed consent.

Predictor variable: The predictor variable was bone AF intensity coded as vital (CTRL) or necrotic (ONJ).

Outcome variable: The primary outcome variable was histologic tissue diagnosis coded as vital or necrotic. The secondary outcome was to assess whether systemic or pharmacological variables could influence the spectrophotometric measurements.

Covariates: Covariates included clinical history, pharmacologic treatments, and ONJ characteristics.

Analyses: Descriptive statistics were computed for all variables. Normality was assessed with the Shapiro-Wilk test, and group differences were analyzed using parametric and nonparametric tests. A mixed-effects modeling framework was applied to account for repeated measures, including a linear mixed-effects model for fluorescence ratios and a mixed-effects logistic regression to assess the association between AF and histology; diagnostic accuracy was derived from model-based probability thresholds.

Results: The sample included 33 females (82.5%) and seven males (17.5%) with a mean age of 68.4 ± 11.9 years. A total of 294 spectral points were analyzed (147 necrotic, 147 vital). The mean photon count at 500 nm for the areas with ONJ was 7,886 ± 4,452, while the mean photon count at 500 nm for the healthy areas was 33,825 ± 10,791. The mean loss of fluorescence intensity (LoFI) ratio was 5.2 ± 2.4. Fluorescence did not differ by oncologic status (P = .8) but was significantly reduced in patients treated with new antiresorptive drugs (P = .004).

Conclusions and relevance: Quantitative bone AF was directly correlated with histopathologic vitality. This objective, real-time method may improve the precision of surgical margin identification in ONJ management.

Background: Concentrated growth factors (CGFs) are autologous biomaterials with notable regenerative potential, particularly relevant in oral surgical applications. Optimizing postoperative recovery after third molar extraction is a clinically significant concern.

Purpose: This systematic review evaluates the effectiveness of CGFs in reducing postoperative sequelae and complications and in improving healing after third molar extraction in healthy adults. The primary outcomes assessed were pain and analgesic use, swelling, hemostasis, trismus, infection and dry socket, inferior alveolar nerve injury and paresthesia, fever, patient-reported outcomes, and satisfaction. Secondary outcomes included surgical duration, overall healing time, soft tissue recovery, radiographic bone fill, and periodontal parameters.

Study selection: A comprehensive literature search was conducted across 11 databases up to April 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251031885). Clinical studies involving healthy adults undergoing third molar extraction with or without CGF application were considered eligible based on population, intervention, comparison, outcomes, and study design framework. Of the 380 studies initially identified, 11 studies (2.9%) met eligibility; all were randomized clinical trials. Study quality was assessed using a modified Cochrane tool.

Results: Among the 11 included randomized clinical trials, 5 were rated as having unclear risk of bias, while the remainder demonstrated low risk, supporting the reliability of the findings. Due to high heterogeneity in study designs, methodologies, and outcomes, quantitative synthesis was not feasible. Pain improved in 6 of 8 (75%) studies, swelling in 4 of 7 (57%), and trismus in 2 of 4 (50%). Analgesic consumption decreased in 2 of 2 (100%) studies. Dry socket incidence was reduced in 1 of 3 (33%) of studies, while 2 showed no or nonsignificant differences. Soft-tissue healing improved in 2 of 2 studies, radiographic bone outcomes in 4 of 5 (80%), and periodontal parameters in 4 of 4 studies. Patient-reported outcomes improved in at least 1 domain in 2 of 2 studies.

Conclusions and relevance: Within the limits of the current evidence, CGF appears to reduce postoperative pain and analgesic use, enhance soft-tissue healing, and show potential benefits in radiographic bone fill and periodontal outcomes distal to the second molar after third molar surgery. Its effects on swelling, trismus, and alveolar osteitis remain uncertain. Further well-designed, large-scale trials are needed to confirm these findings and clarify the role of CGF in routine practice.

Registration: PROSPERO registration number: CRD420251031885.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication associated with antiresorptive therapies commonly prescribed for conditions such as osteoporosis. While MRONJ is extensively studied in adult populations, its occurrence and characteristics in pediatric patients remain underexplored. Dental clearance, defined as evaluation by a dental provider prior to initiation of certain medications or surgical interventions to ensure dental and oral health, has been extensively studied in the adult population. Its utility, however, in the setting of MRONJ in the pediatric population, remains to be assessed extensively.

Purpose: The primary goal of this systematic review is to assess the prevalence of MRONJ in the pediatric and young adult populations. The secondary aims include an overview of pathophysiology, clinical presentation, and clinical guidelines for management strategies of MRONJ in this population.

Study selection: A comprehensive literature search was conducted, focusing on studies published between 2015 and 2024, that addressed MRONJ in children and adolescents. The pediatric population was defined as individuals with age <18 years old and young adults being 18 to 25.

Results: A total of 6 publications were analyzed for the study. From the 1,284 pediatric patients identified, only 1 case of pediatric MRONJ has been identified. Exposure duration was calculated as a median of 4.6 years (interquartile range 2.3 to 6.3), corresponding to an approximate mean ± SD of 4.2 ± 2.1 years.

Conclusion and relevance: Currently, limited evidence regarding the incidence of pediatric MRONJ exists. Risk factors for MRONJ in pediatric patients include long-term use of bisphosphonates and poor oral hygiene. Management strategies vary, with an initial phase including conservative treatments, followed by surgical intervention as needed in advanced cases. Based on the current literature, in the reported case the condition did not develop prior to eruption of permanent dentition. While common in the adult population, the benefit in conducting a dental clearance prior to eruption of permanent dentition seems to be unclear; Thus, describing the need for further investigation and data collection is needed.