Pub Date : 2025-12-01DOI: 10.1016/j.joms.2025.07.011
Matthew Watt BS , Camila Tussie DMD , Samat Borbiev BS , Fernando Guastaldi DDS, MSc, PhD
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Pub Date : 2025-12-01DOI: 10.1016/j.joms.2025.09.007
Anuj Jain MDS
{"title":"REPLY: Does Pterygoid Hamulotomy During Palatoplasty Affect Hearing Outcomes in Non-Syndromic Cleft Palate Patients?","authors":"Anuj Jain MDS","doi":"10.1016/j.joms.2025.09.007","DOIUrl":"10.1016/j.joms.2025.09.007","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 12","pages":"Pages 1451-1452"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cleft palate repair aims to achieve tension-free closure without compromising Eustachian tube function and hearing outcomes. The effect of pterygoid hamulotomy on postoperative hearing remains inconclusive.
Purpose
This study evaluated the effect of pterygoid hamulotomy during palatoplasty on hearing thresholds and middle ear status in nonsyndromic cleft palate patients.
Study Design, Setting, Sample
This prospective double-blind study was conducted at the Department of Oral and Maxillofacial Surgery at a tertiary care hospital. Eighty nonsyndromic cleft palate patients aged 10 to 60 months were included and allocated alternately to 2 groups: Group I (palatoplasty with hamulotomy, n = 40) and Group II (palatoplasty without hamulotomy, n = 40). Those with prior palatal or ear surgery, syndromic conditions, or congenital hearing loss were excluded.
Predictor Variable
The predictor variable was operative technique (with or without pterygoid hamulotomy), and patients were alternately allocated to 2 groups upon enrollment.
Main Outcome Variable(s)
The primary outcome variable was hearing threshold measured using brainstem-evoked response audiometry preoperatively, and at 1 and 6 months postoperatively. The secondary outcome was middle ear status assessed by otoscopic examination at the same time points.
Covariates
Covariates included age, sex, and cleft type (complete or incomplete).
Analyses
Data were analyzed using a mixed-effects repeated measures analysis of variance (ANOVA) to evaluate changes in brainstem-evoked response audiometry hearing thresholds over time and between groups. χ2 tests were used for comparing categorical outcomes such as otoscopic findings. A significance level of P < .05 was considered statistically significant.
Results
The final sample included 80 patients (mean age 32.7 ± 12.4 months; 53% male). At 6 months postoperatively, mean hearing thresholds improved in both groups (group I: 32.5 ± 6.4 dB to 22.8 ± 4.9 dB; group II: 33.1 ± 6.2 dB to 23.4 ± 5.1 dB), with no statistically significant difference between groups (mean difference: 0.6 dB, 95% CI: −1.3 to 2.5, P = .6). Normal middle ear status improved at 6 months in both groups (group I: 75.0%, group II: 72.5%), with no significant intergroup difference (P = .8).
Conclusions and Relevance
Hearing thresholds and middle ear status improved following palatoplasty in both groups. Pterygoid hamulotomy did not adversely affect hearing outcomes, suggesting it may be used without impacting auditory function.
{"title":"Does Pterygoid Hamulotomy During Palatoplasty Affect Hearing Outcomes in Nonsyndromic Cleft Palate Patients?","authors":"Anuj Jain MDS , Abhilasha Yadav MDS, PhD , Amit Rao MDS , Pratap Jadhav MDS , Yash Merchant MDS , Pranali Nimonkar MDS","doi":"10.1016/j.joms.2025.08.006","DOIUrl":"10.1016/j.joms.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Cleft palate repair aims to achieve tension-free closure without compromising Eustachian tube function and hearing outcomes. The effect of pterygoid hamulotomy on postoperative hearing remains inconclusive.</div></div><div><h3>Purpose</h3><div>This study evaluated the effect of pterygoid hamulotomy during palatoplasty on hearing thresholds and middle ear status in nonsyndromic cleft palate patients.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This prospective double-blind study was conducted at the Department of Oral and Maxillofacial Surgery at a tertiary care hospital. Eighty nonsyndromic cleft palate patients aged 10 to 60 months were included and allocated alternately to 2 groups: Group I (palatoplasty with hamulotomy, n = 40) and Group II (palatoplasty without hamulotomy, n = 40). Those with prior palatal or ear surgery, syndromic conditions, or congenital hearing loss were excluded.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was operative technique (with or without pterygoid hamulotomy), and patients were alternately allocated to 2 groups upon enrollment.</div></div><div><h3>Main Outcome Variable(s)</h3><div>The primary outcome variable was hearing threshold measured using brainstem-evoked response audiometry preoperatively, and at 1 and 6 months postoperatively. The secondary outcome was middle ear status assessed by otoscopic examination at the same time points.</div></div><div><h3>Covariates</h3><div>Covariates included age, sex, and cleft type (complete or incomplete).</div></div><div><h3>Analyses</h3><div>Data were analyzed using a mixed-effects repeated measures analysis of variance (ANOVA) to evaluate changes in brainstem-evoked response audiometry hearing thresholds over time and between groups. χ<sup>2</sup> tests were used for comparing categorical outcomes such as otoscopic findings. A significance level of <em>P</em> < .05 was considered statistically significant.</div></div><div><h3>Results</h3><div>The final sample included 80 patients (mean age 32.7 ± 12.4 months; 53% male). At 6 months postoperatively, mean hearing thresholds improved in both groups (group I: 32.5 ± 6.4 dB to 22.8 ± 4.9 dB; group II: 33.1 ± 6.2 dB to 23.4 ± 5.1 dB), with no statistically significant difference between groups (mean difference: 0.6 dB, 95% CI: −1.3 to 2.5, <em>P</em> = .6). Normal middle ear status improved at 6 months in both groups (group I: 75.0%, group II: 72.5%), with no significant intergroup difference (<em>P</em> = .8).</div></div><div><h3>Conclusions and Relevance</h3><div>Hearing thresholds and middle ear status improved following palatoplasty in both groups. Pterygoid hamulotomy did not adversely affect hearing outcomes, suggesting it may be used without impacting auditory function.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 12","pages":"Pages 1487-1495"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.joms.2025.08.016
Vicky Yau DDS , Boyu Ma DMD, MD , Shanshan Lin ScM , Shaoshi Zhu BS , Michael D. Turner DDS, MD, MSc
<div><h3>Background</h3><div>Orbital fractures are common midfacial injuries that present complex challenges due to the anatomical and functional intricacies of the orbit. Understanding the evolution of surgical approaches and academic perspectives is essential to guide future research and multidisciplinary management.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to describe the evolution of management of orbital fractures, highlighting scholarly focus to inform future research and multidisciplinary care.</div></div><div><h3>Study design, setting, sample</h3><div>This bibliometric study was conducted in January 2025. An electronic literature search was conducted on Web of Science Core Collection with search keys of orbital fracture and associated terms. Articles published between 1950 and 2024 were eligible for screening. Inclusion criteria were full-length, English-language articles, and ranking among the top 100 most-cited articles in the search results. Any literature not in English, editorial materials, letters, book chapters, meeting abstracts, notes, and reprints were excluded. The identified literature was analyzed using bibliometric and sentiment analysis.</div></div><div><h3>Outcome variables</h3><div>Information on the title, abstract, authors, year of publication, country of origin, primary institution, keywords, citation count, and number of references was retrieved from all identified articles. For the top 100 most-cited articles, additional data were collected, including journal, corresponding author's specialty, and research topics.</div></div><div><h3>Analyses</h3><div>Sentiment analysis was performed on the top 100 most-cited articles using a natural language processing model to classify abstracts as positive, neutral, or negative, reflecting the overall tone of orbital fracture research. Bibliometric analyses and graphical presentations were generated using VOSviewer (Leiden University, The Netherlands).</div></div><div><h3>Results</h3><div>A total of 981 articles were identified, representing 66 countries. The United States was the top publishing country with a total of 326 (33.2%) articles, followed by South Korea and China. The top 5 institutions were Shanghai Jiaotong University, Harvard University, University of Maryland, Johns Hopkins University, and Helsinki University Hospital. Articles from Baylor College of Medicine were the most-cited, with a total of 460 citations. For the 100 most-cited articles, the United States remained the leading country; however, our overlay map demonstrated a subtle shift toward other countries in recent years. Four clusters of keywords were identified, including “Epidemiology,” “Management,” “Complications,” and “Fracture Types,” suggesting research trends from diagnosis and management to materials and surgical planning. These articles most frequently appeared in the <em>Plastic and Reconstructive Surgery</em> (n = 9, 9%), the <em>International Journal of Oral & Max
背景：眶骨折是一种常见的面中损伤，由于眶解剖和功能的复杂性，它提出了复杂的挑战。了解手术入路和学术观点的演变对指导未来的研究和多学科管理至关重要。目的：本研究的目的是描述眼眶骨折治疗的发展，突出学术焦点，为未来的研究和多学科护理提供信息。研究设计、环境、样本：本文献计量学研究于2025年1月进行。以眶骨折及相关术语为检索键，对Web of Science核心馆藏进行电子文献检索。1950年至2024年间发表的文章符合筛选条件。入选标准是完整的英文文章，并且在搜索结果中排名前100位。任何非英文文献、编辑材料、信件、书籍章节、会议摘要、笔记和重印都被排除在外。使用文献计量学和情感分析对已识别的文献进行分析。结果变量：从所有确定的文章中检索标题、摘要、作者、出版年份、原产国、主要机构、关键词、引文计数和参考文献数量等信息。对于被引用次数最多的前100篇文章，还收集了其他数据，包括期刊、通讯作者的专业和研究主题。分析：使用自然语言处理模型对引用次数最多的前100篇文章进行情感分析，将摘要分为积极、中性或消极，反映了眶骨折研究的整体基调。使用VOSviewer（荷兰莱顿大学）进行文献计量分析和图形展示。结果：共确定981篇文章，代表66个国家。美国以326篇（33.2%）位居第一，韩国和中国紧随其后。前5名分别是上海交通大学、哈佛大学、马里兰大学、约翰霍普金斯大学和赫尔辛基大学附属医院。贝勒医学院（Baylor College of Medicine）的文章被引用次数最多，共计460次。在被引用最多的100篇文章中，美国仍然是领先的国家；然而，我们的覆盖地图显示了近年来向其他国家的微妙转变。我们确定了四组关键词，包括“流行病学”、“管理”、“并发症”和“骨折类型”，提示了从诊断和管理到材料和手术计划的研究趋势。这些文章最常出现在《Plastic and Reconstructive Surgery》（n = 9,9%）、《International Journal of Oral & Maxillofacial Surgery》（n = 7,7%）和《Journal of Craniofacial Surgery》（n = 7,7%）等共46种期刊中。通讯作者的专业显示，最多的是眼科（n = 36, 36%），其次是口腔颌面外科（n = 24, 24%），然后是耳鼻喉头颈外科（n = 15, 15%）。结论和相关性：文献计量学分析显示，随着时间的推移，对眶骨折研究的兴趣越来越大，出版物和引用也越来越多。研究重点已经从诊断和管理发展到外科创新，在高被引文献中积极情绪占主导地位。这些发现为未来的跨学科合作和研究重点提供了有价值的见解。
{"title":"Insights From the 100 Most-Cited Articles on Orbital Fractures: A Bibliometric and Sentiment Analysis","authors":"Vicky Yau DDS , Boyu Ma DMD, MD , Shanshan Lin ScM , Shaoshi Zhu BS , Michael D. Turner DDS, MD, MSc","doi":"10.1016/j.joms.2025.08.016","DOIUrl":"10.1016/j.joms.2025.08.016","url":null,"abstract":"<div><h3>Background</h3><div>Orbital fractures are common midfacial injuries that present complex challenges due to the anatomical and functional intricacies of the orbit. Understanding the evolution of surgical approaches and academic perspectives is essential to guide future research and multidisciplinary management.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to describe the evolution of management of orbital fractures, highlighting scholarly focus to inform future research and multidisciplinary care.</div></div><div><h3>Study design, setting, sample</h3><div>This bibliometric study was conducted in January 2025. An electronic literature search was conducted on Web of Science Core Collection with search keys of orbital fracture and associated terms. Articles published between 1950 and 2024 were eligible for screening. Inclusion criteria were full-length, English-language articles, and ranking among the top 100 most-cited articles in the search results. Any literature not in English, editorial materials, letters, book chapters, meeting abstracts, notes, and reprints were excluded. The identified literature was analyzed using bibliometric and sentiment analysis.</div></div><div><h3>Outcome variables</h3><div>Information on the title, abstract, authors, year of publication, country of origin, primary institution, keywords, citation count, and number of references was retrieved from all identified articles. For the top 100 most-cited articles, additional data were collected, including journal, corresponding author's specialty, and research topics.</div></div><div><h3>Analyses</h3><div>Sentiment analysis was performed on the top 100 most-cited articles using a natural language processing model to classify abstracts as positive, neutral, or negative, reflecting the overall tone of orbital fracture research. Bibliometric analyses and graphical presentations were generated using VOSviewer (Leiden University, The Netherlands).</div></div><div><h3>Results</h3><div>A total of 981 articles were identified, representing 66 countries. The United States was the top publishing country with a total of 326 (33.2%) articles, followed by South Korea and China. The top 5 institutions were Shanghai Jiaotong University, Harvard University, University of Maryland, Johns Hopkins University, and Helsinki University Hospital. Articles from Baylor College of Medicine were the most-cited, with a total of 460 citations. For the 100 most-cited articles, the United States remained the leading country; however, our overlay map demonstrated a subtle shift toward other countries in recent years. Four clusters of keywords were identified, including “Epidemiology,” “Management,” “Complications,” and “Fracture Types,” suggesting research trends from diagnosis and management to materials and surgical planning. These articles most frequently appeared in the <em>Plastic and Reconstructive Surgery</em> (n = 9, 9%), the <em>International Journal of Oral & Max","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 12","pages":"Pages 1496-1518"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.joms.2025.08.011
Pascal Grün DMD , Florian Pfaffeneder-Mantai DMD , Tim Schiepek , Richard Mosch DMD , Flora Turhani , Constantin von See DMD, DDS, PhD , Dritan Turhani MD, PhD
Accurate dental implant fixture placement is critical for optimal restorative functional and esthetic outcomes. Computer-assisted implant surgery, including static computer-assisted implant surgery and dynamic computer-assisted implant surgery systems, improves accuracy compared to freehand techniques. Augmented reality (AR) offers further benefits by integrating preoperative planning with real-time intraoperative visualization, enhancing surgical results and providing valuable tools for training future implantologists. However, high costs and technological complexity have limited its widespread adoption.
This technical note presents the first clinical application of a mobile-visualized AR navigation system. While the intraoperative interface operates on a smartphone, the system is built upon a comprehensive digital workflow involving cone-beam computed tomography imaging, intraoral scanning, photographic data, and bite registration for dynamic implant navigation in the anterior maxilla. Postoperative analysis showed maximum deviations of 2.0 mm in implant apex position and 9.15° in angulation from the planned trajectory. These results confirm accurate implant placement and support the feasibility of smartphone-based AR as a cost-effective, accessible solution for digital navigation in implantology. Further research with larger sample sizes is warranted to validate these preliminary findings.
{"title":"Smartphone-Based Augmented Reality Application for Dental Implant Placement: A Technical Innovation","authors":"Pascal Grün DMD , Florian Pfaffeneder-Mantai DMD , Tim Schiepek , Richard Mosch DMD , Flora Turhani , Constantin von See DMD, DDS, PhD , Dritan Turhani MD, PhD","doi":"10.1016/j.joms.2025.08.011","DOIUrl":"10.1016/j.joms.2025.08.011","url":null,"abstract":"<div><div>Accurate dental implant fixture placement is critical for optimal restorative functional and esthetic outcomes. Computer-assisted implant surgery, including static computer-assisted implant surgery and dynamic computer-assisted implant surgery systems, improves accuracy compared to freehand techniques. Augmented reality (AR) offers further benefits by integrating preoperative planning with real-time intraoperative visualization, enhancing surgical results and providing valuable tools for training future implantologists. However, high costs and technological complexity have limited its widespread adoption.</div><div>This technical note presents the first clinical application of a mobile-visualized AR navigation system. While the intraoperative interface operates on a smartphone, the system is built upon a comprehensive digital workflow involving cone-beam computed tomography imaging, intraoral scanning, photographic data, and bite registration for dynamic implant navigation in the anterior maxilla. Postoperative analysis showed maximum deviations of 2.0 mm in implant apex position and 9.15° in angulation from the planned trajectory. These results confirm accurate implant placement and support the feasibility of smartphone-based AR as a cost-effective, accessible solution for digital navigation in implantology. Further research with larger sample sizes is warranted to validate these preliminary findings.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 12","pages":"Pages 1519-1525"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unfavorable separation of the pterygomaxillary junction (PMJ) during Le Fort I osteotomy can cause complications, such as hemorrhage and pterygoid plate fractures. Achieving favorable PMJ fracture patterns is critical to minimize surgical risks.
Purpose
The purpose of the study was to measure the association between the Le Fort I osteotomy technique—either a palatal transmucosal osteotomy using a piezoelectric device (PTOPD) or a buccal approach with a curved osteotome (BACO)—and favorable PMJ fracture patterns.
Study design, setting, and sample
A retrospective cohort study was conducted at a tertiary hospital between January 2022 and June 2024. Subjects undergoing Le Fort I osteotomy for maxillary hypoplasia were included. Exclusion criteria were insufficient imaging, prior maxillofacial surgery or trauma, systemic bone disease, or syndromic maxillary hypoplasia.
Predictor variable
The primary predictor variable was the surgical technique: 1) PTOPD group and 2) BACO group. The primary outcome was the PMJ fracture pattern, classified as favorable (clean separation without fracture of the pterygoid plates or sinus wall), anterior (fracture into the posterior maxillary sinus wall), or posterior (fracture into the pterygoid plates). Unfavorable fractures were defined as anterior or posterior types. Bilateral patterns were recorded as combinations of both sides (eg, favorable/favorable, favorable/anterior, anterior/posterior, posterior/posterior). For subject-level analysis, fracture patterns were also dichotomized as favorable (clean separation on both sides) or unfavorable (at least one side with an anterior or posterior fracture).
Covariates
Age, sex, PMJ thickness (PMJT), and length (PMJL) measured on preoperative scans.
Analyses
Statistical analyses included independent samples t-test, Mann–Whitney U test, Pearson χ2 test, and Kruskal–Wallis test. A significance level of P ≤ .05 was used for all comparisons.
Results
The study sample included 34 subjects (22 [64.7%] female, 12 [35.3%] male; mean age: 29.0 ± 8.4 years). Favorable/favorable fracture patterns were more frequent in the PTOPD group than BACO (70.6% [12] vs 23.5% [4], P = .008). Unfavorable combinations, especially involving posterior components, were more common in BACO (76.5% [13] vs 11.8% [2], P = .006).
Conclusions and Relevance
These findings suggest that PTOPD, compared to BACO, may result in more favorable PMJ fracture patterns.
背景：Le Fort I型截骨术中翼颌交界处（PMJ）分离不良可引起并发症，如出血和翼状钢板骨折。获得良好的PMJ骨折模式是降低手术风险的关键。目的：本研究的目的是测量Le Fort I截骨技术-使用压电装置（PTOPD）的腭粘膜截骨术或使用弯曲截骨术（BACO）的颊入路-与有利的PMJ骨折模式之间的关系。研究设计、环境和样本：一项回顾性队列研究于2022年1月至2024年6月在一家三级医院进行。接受Le Fort I型截骨术治疗上颌发育不全的受试者包括在内。排除标准为影像学不全、既往颌面手术或创伤、全身性骨病或综合征性上颌发育不全。预测变量：主要预测变量为手术技术：1)PTOPD组和2)BACO组。主要结局是PMJ骨折类型，分为良好（翼状骨板或窦壁未骨折的完全分离）、前骨折（骨折进入上颌后窦壁）或后骨折（骨折进入翼状骨板）。不良骨折分为前型和后型。双侧模式被记录为两侧的组合（例如，有利/有利，有利/前，前/后，后/后）。对于受试者水平的分析，骨折模式也被分为有利（两侧完全分离）或不利（至少一侧有前方或后方骨折）。协变量：年龄，性别，术前扫描测量的PMJ厚度（PMJT）和长度（PMJL）。分析：统计分析包括独立样本t检验、Mann-Whitney U检验、Pearson χ2检验和Kruskal-Wallis检验。所有比较均采用P≤0.05的显著性水平。结果：共纳入34例受试者，其中女性22例（64.7%），男性12例（35.3%）；平均年龄：29.0±8.4岁)。PTOPD组的有利/有利裂缝模式比BACO组更常见（70.6% [4]vs 23.5% [4], P = 0.008）。不良组合，特别是涉及后路成分，在BACO中更为常见（76.5% [2]vs 11.8% [2], P = 0.006）。结论和相关性：这些发现表明，与BACO相比，PTOPD可能导致更有利的PMJ骨折模式。
{"title":"Is Palatal Transmucosal Osteotomy With Piezoelectric Device Associated With Favorable Pterygomaxillary Junction Separation in Le Fort I Osteotomy?","authors":"Ilker Burgaz DDS , Emine Nur Kahraman DDM , Emrah Dilaver DDS","doi":"10.1016/j.joms.2025.07.005","DOIUrl":"10.1016/j.joms.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Unfavorable separation of the pterygomaxillary junction (PMJ) during Le Fort I osteotomy can cause complications, such as hemorrhage and pterygoid plate fractures. Achieving favorable PMJ fracture patterns is critical to minimize surgical risks.</div></div><div><h3>Purpose</h3><div>The purpose of the study was to measure the association between the Le Fort I osteotomy technique—either a palatal transmucosal osteotomy using a piezoelectric device (PTOPD) or a buccal approach with a curved osteotome (BACO)—and favorable PMJ fracture patterns.</div></div><div><h3>Study design, setting, and sample</h3><div>A retrospective cohort study was conducted at a tertiary hospital between January 2022 and June 2024. Subjects undergoing Le Fort I osteotomy for maxillary hypoplasia were included. Exclusion criteria were insufficient imaging, prior maxillofacial surgery or trauma, systemic bone disease, or syndromic maxillary hypoplasia.</div></div><div><h3>Predictor variable</h3><div>The primary predictor variable was the surgical technique: <em>1)</em> PTOPD group and <em>2)</em> BACO group. The primary outcome was the PMJ fracture pattern, classified as favorable (clean separation without fracture of the pterygoid plates or sinus wall), anterior (fracture into the posterior maxillary sinus wall), or posterior (fracture into the pterygoid plates). Unfavorable fractures were defined as anterior or posterior types. Bilateral patterns were recorded as combinations of both sides (eg, favorable/favorable, favorable/anterior, anterior/posterior, posterior/posterior). For subject-level analysis, fracture patterns were also dichotomized as favorable (clean separation on both sides) or unfavorable (at least one side with an anterior or posterior fracture).</div></div><div><h3>Covariates</h3><div>Age, sex, PMJ thickness (PMJT), and length (PMJL) measured on preoperative scans.</div></div><div><h3>Analyses</h3><div>Statistical analyses included independent samples <em>t</em>-test, Mann–Whitney U test, Pearson χ<sup>2</sup> test, and Kruskal–Wallis test. A significance level of <em>P</em> ≤ .05 was used for all comparisons.</div></div><div><h3>Results</h3><div>The study sample included 34 subjects (22 [64.7%] female, 12 [35.3%] male; mean age: 29.0 ± 8.4 years). Favorable/favorable fracture patterns were more frequent in the PTOPD group than BACO (70.6% [12] vs 23.5% [4], <em>P</em> = .008). Unfavorable combinations, especially involving posterior components, were more common in BACO (76.5% [13] vs 11.8% [2], <em>P</em> = .006).</div></div><div><h3>Conclusions and Relevance</h3><div>These findings suggest that PTOPD, compared to BACO, may result in more favorable PMJ fracture patterns.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 12","pages":"Pages 1478-1486"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.joms.2025.09.005
Austin Gaal DDS, MPH
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