Journal of Oral and Maxillofacial Surgery最新文献

Background: Sports injuries account for 11.3 to 42.1% of the facial fractures. Injuries from contact with a ball, a bat or stick, or another player raise safety concerns.

Purpose: The purpose of this study was to assess the patterns of sports-related maxillofacial injuries involving orbital bone fractures in children.

Study design, setting, and sample: This was a retrospective case series of children who presented to Children's Healthcare of Atlanta from 2015 to 2021, with orbital injuries resulting from sports.

Independent variable: None.

Outcome variable: The outcome variables, including the fracture location, pattern, and the management of injury.

Covariates: The medical record were reviewed for the following variables: 1) demographic information, 2) mechanism of injury, 3) type of sport, 4) symptoms, 5) length of inpatient stay, and 6) duration of follow-up.

Analysis: Data were collected using a standardized collection form. Descriptive statistics were calculated.

Results: Overall, 101 patients (92 males) with an age of 13 ± 3 met the inclusion criteria. The most common sport was baseball or softball (n = 78, 77.2%). The mechanisms of injuries were largely due to collision with the ball (n = 79, 78.2%) or with another player (n = 13, 12.9%). Orbital fractures occurred mostly in the floor (n = 87, 86.1%), followed by the medial wall (n = 22, 21.8%), with an average of 1 surface involved. Maxillary sinus (n = 23, 22.8%) and/or nasal bone (n = 17, 16.8%) were the other facial bones outside of orbit commonly injured. The fractures patterns are minimally/nondisplaced (n = 68, 67.3%), displaced (n = 30, 29.7%), or comminuted (n = 3, 3%). The managements include surgical and nonsurgical. Twenty-three patients (22.8%) underwent surgical intervention. Twelve of them had an emergent operation due to extraocular muscle entrapment.

Conclusion: Sports injuries are a common cause of orbital trauma in children. Most injuries are due to baseball/softball from collision with the ball. They were mostly managed without surgery, except for the individuals that presented with entrapment, oculocardiac reflex, and a large-size defect. The information from this project could be utilized in implementing safety equipment use for participants to further prevent such injuries.

Background: Whether postoperative nausea and vomiting (PONV) contributes to increased postoperative pain (POP) remains unclear, although POP is reported to cause PONV.

Purpose: This study aimed to determine whether PONV following minor oral and maxillofacial surgery (OMS) under general anesthesia increases POP.

Study design, setting, sample: The researchers implemented a retrospective cohort study. Patients who presented to Saitama Medical University Hospital between January 2021 and August 2022 and who required minor OMS under general anesthesia were identified from a review of electronic records. The inclusion criteria were patients aged between 16 and 65 years and nasal intubation via inhalational or propofol-based total intravenous general anesthesia. The exclusion criterion was patients who had diseases affecting POP or PONV.

Predictor variables: The primary predictor variable was the occurrence of PONV (yes/no) at 2 hours postoperatively.

Main outcome variables: The main outcome variable was POP measured on a 100 mm visual analog scale (VAS) at 2 hours postoperatively. The secondary outcome was the timing of POP, which was measured at 6 hours.

Covariates: Covariates included patient-related factors (age, body mass index, American Society of Anesthesiologists Physical Status, smoking status, and history of PONV or motion sickness), anesthesia-related factors (intraoperative analgesics, intraoperative antiemetics, duration of anesthesia, and anesthesia type), and surgery-related factors (surgery type and duration of surgery).

Analyses: Analyses were used for ordinal, categorical, and continuous variables. The POP VAS values were compared between each measurement time with repeated-measures analysis of variance. A P value < .05 indicated statistical significance.

Results: The sample included 148 patients with a mean age of 40 ± 16.5 years, 66 (44.6%) of whom were male. The incidence of PONV was 31 (20.9%) at 0 to 2 hours, 7 (4.7%) at 2 to 6 hours, and 0 (0%) at 6 to 24 hours. POP VAS scores were significantly higher in the PONV group than in the non-PONV group at 2 hours. The mean VAS score at 2 hours was 40.5 ± 29.2 (PONV group) versus 29.8 ± 23.7 (non-PONV group) (P = .03); the VAS score at 6 hours was 41.0 ± 29.4 (PONV group) compared with 25.4 ± 26.4 (non-PONV group) (P = .13).

Conclusion: Our present study revealed that PONV is associated with increased POP in patients undergoing minor OMS under general anesthesia.

Background: In anticipation of third molar surgery, patients may experience increased anxiety. Patients frequently access social media platforms and view content about surgical treatments.

Purpose: The study purpose was to measure the level of perioperative anxiety of patients scheduled for third molar surgery exposed to social media and identify factors associated with patient anxiety.

Study design, setting, sample: This is a prospective cohort study of patients undergoing impacted mandibular third molar surgery from September 2021 to August 2022 at the outpatient clinic of Cukurova University School of Dentistry.

Predictor variable: The predictor variable was level of exposure to viewing third molar surgery-related social media before the surgery. Subjects were divided into 2 groups based on social media viewing preferences at their own discretion: the control group involved patients who did not view social media and study group involved patients who viewed social media before the surgery.

Main outcome variables: The outcome variables were patients' anxiety levels assessed using Modified Dental Anxiety Scale and Spielberger State Anxiety Inventory.

Covariates: Covariates were age, sex, education level, history of previous dentist visit, and impacted third molar surgery.

Analyses: Student t-test, Mann-Whitney U test, χ² test, Kruskal-Wallis test, one-way analysis of variance, and post hoc tests were used according to data. Level of significance was set at P < .05.

Results: The study sample comprised 162 patients; 82 (50.6%) patients were in the control group and 80 (49.4%) were in the social media group. The Modified Dental Anxiety Scale scores of the social media group (11.95 ± 4.50) were statistically higher than the control group (9.66 ± 4.28) (P = .001). The Spielberger State Anxiety Inventory scores of the social media group (46.43 ± 5.80) were statistically higher than the control group (44.52 ± 5.53) (P = .03). There were statistical differences in anxiety levels considering some covariates. In social media group, there were some statistical differences in anxiety levels of patients who viewed different social media type and content.

Conclusion and relevance: Patients who viewed social media on their own preferences before the surgery had higher perioperative anxiety compared to those who did not. The effects of demographic variables, different social media types and content on perioperative anxiety should be taken into account during stress management of the patients.

Background: Photobiomodulation therapy (PBMT) has been showed to have beneficial effects on the healing and control of inflammation associated with oral surgical wounds. However, different PBMT protocols have been proposed and it is not clear if different protocols impact the hard and soft tissues healing equally.

Purpose: To compare the tissue repair of postextraction alveoli of third molars between treated with dual-wavelength PBMT (red and infrared) or PBMT with infrared laser (IRL) alone.

Study design, setting, sample: This split mouth randomized controlled trial enrolled 20 patients, who were submitted to the extraction of the 4 partially erupted or fully impacted third molars between August 2023 and December 2023 at the clinic of the INPES postgraduate school (Institute for Clinical Health Research), and at the Federal University of Uberlândia. Adult with all the 4 molars were included in this study, while patients with systemic diseases/conditions, with less than 4 third molars were excluded of this study.

Exposure variable: The exposure variable is PBMT treatment. Treatment side was randomly allocated to according to the PBMT protocol applied on the postextraction sockets: IRL-PBMT: irradiation with PBMT with an IRL (808 nm) and IRL-RL-PBMT: irradiation with dual-wavelength PBMT (660 and 808 nm).

Main outcome variable(s): The primary outcome variable was the bone tissue healing that was measured using the fractal analysis and bone tissue density assessed using the radiographic images. The secondary outcome variable was soft tissue healing measured assessing the facial dimensions variations and a healing index that assessed the tissue consistence, color, exudation, bleeding, and edema. Additionally, the analyses centered on the patients' perceptions was assessed by the application of a visual analogic scale to assess pain, bleeding, edema, difficulty in chewing, and mouth opening conditions. Subjects were clinically evaluated at 3, 7, 14, 30, and 90 days after the surgical procedure.

Covariates: The covariates are the tooth position, and the demographic data (age and sex).

Analyses: The evaluation of the effects of the independent variables (Treatment and period of evaluation) on the primary and secondary outcomes was performed through the application of the repeated measures ANOVA (P < .05).

Results: The sample was composed of 20 subjects with a mean age of 28.58 ± 8.94 years, and 12 (60%) were females. There were no statistically significant differences between the 2 treatments for any outcome variables (P > .10).

Conclusion and relevance: It can be concluded that PBMT with dual wavelengths (red and infrared) and an IRL alone induced similar postoperative clinical results after third molar extraction surgeries.

Background: Arthroscopy is regarded as a minimally invasive surgical procedure, with complication rates ranging from 1.7 to 4.4%. It remains unclear whether the complexity of the arthroscopic procedure is associated with the frequency of complications.

Purpose: The study purpose was to measure the association between the level of arthroscopic complexity and short-term postoperative complications.

Study design, setting, sample: The researchers implemented a prospective cohort study. Subjects presenting to Clinica Bupa Santiago, a tertiary care hospital in Chile between 2022 and 2023 who requires arthroscopy were enrolled. Inclusion criteria required subjects to have a history of joint disorder and a preoperative magnetic resonance imaging (MRI) to be scheduled for an arthroscopic surgery with a 6-month follow-up. Subjects lacking 6-month follow-up were excluded.

Predictor variable: The predictor variable was the arthroscopy complexity level: level I (single puncture diagnostic sweep), level II (double puncture with instrumentation or shaver), and level III (discopexy or discectomy).

Main outcome variable: The main outcome variable was intraoperative and postoperative complications, which were defined as any unwanted development resulting in lasting consequences, additional surgeries, or unresolved issues, and these were coded as either present or absent.

Covariates: The covariates included age, sex, duration of symptoms, prior conservative therapies, history of previous open joint surgery, and Wilkes stage.

Analyses: Data were analyzed using descriptive statistics with statistical significance set at P value <.05. χ² or Fisher's exact test was used depending on the variable type.

Results: A total of 165 subjects (285 joints) with a mean age of 28.9 years (SD 13.0) were included. Of these, 149 (90.3%) were female and 16 (9.7%) were male. Level I procedures were performed on 37 joints (13.0%) in 23 subjects (16.3%), level II on 53 joints (18.6%) in 27 subjects (16.3%), and level III on 195 joints (68.4%) in 116 subjects (69.9%). Complications occurred only in level III (7 procedures, 2.5%, P = .33), affecting 5 subjects (3.0%). Observed complications included transient frontal facial paresis, mouth floor edema, transient neuropathic pain, suture rejection, and emphysema.

Conclusion and relevance: The postoperative complication rate after arthroscopy was 2.5%, with no statistically significant association with operative complexity. Although more complications were observed in advanced arthroscopies, this increase was not significant.

Background: While artificial intelligence has significantly impacted medicine, the application of large language models (LLMs) in oral and maxillofacial surgery (OMS) remains underexplored.

Purpose: This study aimed to measure and compare the accuracy of 4 leading LLMs on OMS board examination questions and to identify specific areas for improvement.

Study design, setting, and sample: An in-silico cross-sectional study was conducted to evaluate 4 artificial intelligence chatbots on 714 OMS board examination questions.

Predictor variable: The predictor variable was the LLM used - LLM 1 (Generative Pretrained Transformer 4o [GPT-4o], OpenAI, San Francisco, CA), LLM 2 (Generative Pretrained Transformer 3.5 [GPT-3.5], OpenAI, San Francisco, CA), LLM 3 (Gemini, Google, Mountain View, CA), and LLM 4 (Copilot, Microsoft, Redmond, WA).

Main outcome variables: The primary outcome variable was accuracy, defined as the percentage of correct answers provided by each LLM. Secondary outcomes included the LLMs' ability to correct errors on subsequent attempts and their performance across 11 specific OMS subject domains: medicine and anesthesia, dentoalveolar and implant surgery, maxillofacial trauma, maxillofacial infections, maxillofacial pathology, salivary glands, oncology, maxillofacial reconstruction, temporomandibular joint anatomy and pathology, craniofacial and clefts, and orthognathic surgery.

Covariates: No additional covariates were considered.

Analyses: Statistical analysis included one-way ANOVA and post hoc Tukey honest significant difference (HSD) to compare performance across chatbots. χ² tests were used to assess response consistency and error correction, with statistical significance set at P < .05.

Results: LLM 1 achieved the highest accuracy with an average score of 83.69%, statistically significantly outperforming LLM 3 (66.85%, P = .002), LLM 2 (64.83%, P = .001), and LLM 4 (62.18%, P < .001). Across the 11 OMS subject domains, LLM 1 consistently had the highest accuracy rates. LLM 1 also corrected 98.2% of errors, while LLM 2 corrected 93.44%, both statistically significantly higher than LLM 4 (29.26%) and LLM 3 (70.71%) (P < .001).

Conclusion and relevance: LLM 1 (GPT-4o) significantly outperformed other models in both accuracy and error correction, indicating its strong potential as a tool for enhancing OMS education. However, the variability in performance across different domains highlights the need for ongoing refinement and continued evaluation to integrate these LLMs more effectively into the OMS field.