Journal of Oral and Maxillofacial Surgery最新文献_第9页

Is Palatal Transmucosal Osteotomy With Piezoelectric Device Associated With Favorable Pterygomaxillary Junction Separation in Le Fort I Osteotomy? 在Le Fort I型截骨术中，使用压电装置进行腭粘膜截骨是否有利于翼颌交界处分离？

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.07.005

Ilker Burgaz DDS , Emine Nur Kahraman DDM , Emrah Dilaver DDS

Background

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。

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引用次数: 0

Managing Patients on Blood Thinners 使用血液稀释剂管理患者

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.09.012

Tara Aghaloo DDS, MD, PhD (Associate Editor)

引用次数: 0

AAOMS Author Disclosure forms 作者披露表

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/S0278-2391(25)00816-X

引用次数: 0

RE: Does Pterygoid Hamulotomy During Palatoplasty Affect Hearing Outcomes in Nonsyndromic Cleft Palate Patients? 腭裂成形术中翼状胬肉吻合术是否影响非综合征性腭裂患者的听力？

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.09.005

Austin Gaal DDS, MPH

引用次数: 0

Bridging Innovation: Why Critical Size Defect Models Must Evolve 桥接创新：为什么临界尺寸缺陷模型必须发展

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.06.233

Pascal Eber MD , Yannick M. Sillmann DDS , Fernando P.S. Guastaldi DDS, MSc, PhD

引用次数: 0

Can Patient-Specific Titanium Meshes Achieve Predictable Bone Volume in Extensive Alveolar Defects? 针对患者的钛网能否在大面积牙槽缺损中实现可预测的骨体积？

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.07.006

Matthias Tröltzsch MD, DMD , Johanna Caca DMD , Sven Otto MD, DMD , Markus Tröltzsch MD, DMD

Background

Reconstructing alveolar defects with titanium meshes is challenging and prone to complications. The introduction of patient-specific titanium meshes was expected to overcome these drawbacks.

Purpose

The aim of this study was to evaluate the association between planned and achieved augmentation volumes using patient-specific titanium meshes (Yxoss Customized Bone Regeneration ; ReOss, Filderstadt, Germany) and to identify factors associated with the clinically achieved augmentation volumes.

Study Design, Setting, and Sample

A single-center, retrospective cohort study was performed in an outpatient clinic. Inclusion criteria were patients aged >18 who underwent jaw augmentation with custom titanium meshes and a complete follow-up (postoperative healing, implant placement, and loading) between 2018 and 2023. Exclusion criteria were objection or inability to submit informed consent, loss to follow-up, and incomplete documentation.

Predictor variable

The predictor was the planned augmentation volume (in mm³).

Outcome variable

The primary outcome variable was the achieved augmentation volume (in mm³) about 3 months after mesh placement, determined by cone beam computed tomography analysis using Slicer 3D software (Brigham and Women's Hospital, Boston, MA).

Covariates

The covariates were sex, wound healing disturbances, rigidity of mesh fixation (number of screws), and mesh exposure.

Analyses

Descriptive and inferential statistics were computed (P < .05).

Results

During the study interval, 82 patients were treated, and 53 (64%) were excluded due to incomplete radiological data or loss to follow-up. The sample was composed of 29 subjects with a mean age of 61.8 years (±12.75), in whom 33 augmentation procedures were performed. Eight (27.8%) subjects were male. The mean planned and achieved augmentation volumes were 1488.73 mm³ (±949.03 mm³) and 763.23 mm³ (±510.2 mm³), respectively (P < .001; Pearson correlation coefficient 0.73). A more rigid mesh fixation significantly increased the achieved bone volume (β = 0.34; P = .006). Wound healing disturbances occurred frequently (42%) but did not reduce the achieved bone volume. During the median follow-up period of 23 months (interquartile range: 14-31), none of the 60 implants placed in the augmented bone failed.

Conclusion and relevance

Despite a significant complication rate, adequate bone volume for implant placement can be attained with custom titanium meshes.

背景：钛网重建牙槽缺损具有挑战性，且容易出现并发症。患者专用钛网的引入有望克服这些缺点。目的：本研究的目的是评估使用患者特异性钛网(Yxoss定制骨再生；ReOss, Filderstadt，德国)，并确定与临床实现的增大体积相关的因素。研究设计、环境和样本：在门诊进行单中心、回顾性队列研究。纳入标准是在2018年至2023年期间接受定制钛网下颌增强术和完整随访（术后愈合、种植体放置和加载）的年龄在bb0 - 18岁的患者。排除标准为反对或不能提交知情同意、随访失败和文件不完整。预测变量：预测因子是计划的增大体积（单位为mm3）。结果变量：主要结果变量是在植入网片约3个月后，通过使用Slicer 3D软件（Brigham and Women's Hospital, Boston， MA）的锥形束计算机断层扫描分析确定的获得的增大体积（mm3）。协变量：共变量为性别、伤口愈合障碍、网片固定刚度（螺钉数量）和网片暴露。分析：进行描述性统计和推断性统计（P < 0.05）。结果：在研究期间，82例患者接受了治疗，53例（64%）因放射学资料不完整或随访缺失而被排除。样本由29名平均年龄为61.8岁（±12.75岁）的受试者组成，其中33人接受了隆胸手术。男性8例（27.8%）。平均计划和实现的增大体积分别为1488.73 mm3（±949.03 mm3）和763.23 mm3（±510.2 mm3） (P < 0.001；Pearson相关系数0.73)。更刚性的网片固定显著增加骨体积(β = 0.34；P = .006)。伤口愈合障碍经常发生（42%），但没有减少达到的骨体积。在中位23个月的随访期间（四分位数范围：14-31），60个植入增强骨的植入物无一失败。结论及意义：尽管并发症发生率很高，但使用定制钛网可以获得足够的骨体积用于种植体的放置。

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引用次数: 0

Can Occlusal Splint or Botulinum Toxin A Therapy Reduce Masseter Muscle Thickness in Patients With Bruxism? 咬合夹板或A型肉毒杆菌毒素治疗能减轻磨牙症患者咬肌厚度吗？

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.08.009

Emel Taşdemir DDS , Şükriye Ece Doğan DDS , Elif Aslı Gülşen DDS , Çiğdem Şeker DDS

Background

Bruxism can cause masseter hypertrophy, discomfort, and facial asymmetry. Occlusal splints are widely used to manage pain and improve mandibular function, while botulinum toxin A (BTX-A) has gained interest for directly reducing masseter muscle thickness. However, the comparative effectiveness of these treatments remains unclear.

Purpose

The study purpose was to measure and compare masseter muscle thickness among patients treated with occlusal splints, BTX-A, or combination, using ultrasonography.

Study design, setting, sample

This randomized, nonblind clinical trial was conducted at the Department of Prosthodontics, Zonguldak Bulent Ecevit University, between April to July 2023. Subjects presenting bruxism and masseter muscle hypertrophy were enrolled. Inclusion criteria included tooth wear, clenching or grinding, masticatory pain, morning stiffness in the temporomandibular joint, and masseter hypertrophy. Exclusion criteria included active caries, acute dental pain, history of temporomandibular joint surgery, systemic or psychiatric disorders, and psychoactive medication use.

Independent variable

Independent variable was treatment group; no treatment (C), occlusal splint (O), BTX-A (B), or combination splint and BTX-A (OB).

Main outcome variable(s)

Primary outcome was masseter thickness, measured using ultrasonography at baseline (T0), 1 (T1), 3 (T2) and 6 months (T3). Secondary outcomes included maximum incisal opening and pain intensity.

Covariates

Covariates were age and sex.

Analyses

Analyses conducted using SPSSv28.0 (P < .05). Two-way and repeated-measures analysis of variance were used for continuous variables; χ² test for categorical data. Post-hoc tests applied where appropriate.

Results

A total of 48 subjects (40 females [83%], mean age 30.3 ± 7.5 years) were included. At rest, masseter thickness significantly decreased at 1 month in B and OB groups (P < .001). This difference persisted at 3 months, with the control group showing the highest values. During contraction, significant reductions were observed at 1 month in Group O, B, and OB, while Group C remained stable. However, by 6 months, all group values had become similar in both positions, reflecting a decline in effects of treatment.

Conclusions and relevance

BTX-A was more effective than splints in early masseter thickness reduction. Combination therapy offered no additional benefit. BTX-A may be minimally invasive, short-term option for managing bruxism-related hypertrophy, reducing pain and supporting individualized, cost-effective care strategies.

背景：磨牙症可引起咬肌肥大、不适和面部不对称。咬合夹板被广泛用于控制疼痛和改善下颌功能，而肉毒毒素A （BTX-A）直接减少咬肌厚度已引起人们的兴趣。然而，这些治疗方法的相对有效性仍不清楚。目的：研究目的是用超声测量和比较咬合夹板、BTX-A或两者联合治疗的患者的咬肌厚度。研究设计、环境、样本：这项随机、非盲临床试验于2023年4月至7月在宗乌尔达克布伦特埃杰维特大学口腔修复系进行。有磨牙和咬肌肥大症状的受试者被纳入研究。纳入标准包括牙齿磨损、紧咬或磨牙、咀嚼痛、颞下颌关节晨僵和咬肌肥大。排除标准包括活动性龋齿、急性牙痛、颞下颌关节手术史、全身性或精神疾病、精神活性药物使用。自变量：自变量为治疗组；无治疗(C)，咬合夹板(O), BTX-A (B)，或夹板联合BTX-A （OB）。主要结局变量：主要结局是咬肌厚度，在基线（T0）、1 （T1）、3 （T2）和6个月（T3）时用超声测量。次要结果包括最大切口开口和疼痛强度。协变量：协变量为年龄和性别。分析：采用SPSSv28.0进行分析（P < 0.05）。对连续变量采用双向和重复测量方差分析；χ2检验。适当时进行事后测试。结果：共纳入48例，其中女性40例（83%），平均年龄30.3±7.5岁。休息时，B组和OB组的咬肌厚度在1个月时显著降低（P < 0.001）。这种差异持续到3个月，对照组的数值最高。在收缩期间，O组、B组和OB组在1个月时观察到明显的减少，而C组保持稳定。然而，到6个月时，两个位置的所有组值都变得相似，反映了治疗效果的下降。结论及意义：BTX-A在早期咬肌减厚中比夹板更有效。联合治疗没有提供额外的好处。BTX-A可能是治疗磨牙相关肥厚、减轻疼痛和支持个性化、成本效益高的护理策略的微创短期选择。

{"title":"Can Occlusal Splint or Botulinum Toxin A Therapy Reduce Masseter Muscle Thickness in Patients With Bruxism?","authors":"Emel Taşdemir DDS , Şükriye Ece Doğan DDS , Elif Aslı Gülşen DDS , Çiğdem Şeker DDS","doi":"10.1016/j.joms.2025.08.009","DOIUrl":"10.1016/j.joms.2025.08.009","url":null,"abstract":"<div><h3>Background</h3><div>Bruxism can cause masseter hypertrophy, discomfort, and facial asymmetry. Occlusal splints are widely used to manage pain and improve mandibular function, while botulinum toxin A (BTX-A) has gained interest for directly reducing masseter muscle thickness. However, the comparative effectiveness of these treatments remains unclear.</div></div><div><h3>Purpose</h3><div>The study purpose was to measure and compare masseter muscle thickness among patients treated with occlusal splints, BTX-A, or combination, using ultrasonography.</div></div><div><h3>Study design, setting, sample</h3><div>This randomized, nonblind clinical trial was conducted at the Department of Prosthodontics, Zonguldak Bulent Ecevit University, between April to July 2023. Subjects presenting bruxism and masseter muscle hypertrophy were enrolled. Inclusion criteria included tooth wear, clenching or grinding, masticatory pain, morning stiffness in the temporomandibular joint, and masseter hypertrophy. Exclusion criteria included active caries, acute dental pain, history of temporomandibular joint surgery, systemic or psychiatric disorders, and psychoactive medication use.</div></div><div><h3>Independent variable</h3><div>Independent variable was treatment group; no treatment (C), occlusal splint (O), BTX-A (B), or combination splint and BTX-A (OB).</div></div><div><h3>Main outcome variable(s)</h3><div>Primary outcome was masseter thickness, measured using ultrasonography at baseline (T0), 1 (T1), 3 (T2) and 6 months (T3). Secondary outcomes included maximum incisal opening and pain intensity.</div></div><div><h3>Covariates</h3><div>Covariates were age and sex.</div></div><div><h3>Analyses</h3><div>Analyses conducted using SPSSv28.0 (<em>P</em> < .05). Two-way and repeated-measures analysis of variance were used for continuous variables; χ<sup>2</sup> test for categorical data. Post-hoc tests applied where appropriate.</div></div><div><h3>Results</h3><div>A total of 48 subjects (40 females [83%], mean age 30.3 ± 7.5 years) were included. At rest, masseter thickness significantly decreased at 1 month in B and OB groups (<em>P</em> < .001). This difference persisted at 3 months, with the control group showing the highest values. During contraction, significant reductions were observed at 1 month in Group O, B, and OB, while Group C remained stable. However, by 6 months, all group values had become similar in both positions, reflecting a decline in effects of treatment.</div></div><div><h3>Conclusions and relevance</h3><div>BTX-A was more effective than splints in early masseter thickness reduction. Combination therapy offered no additional benefit. BTX-A may be minimally invasive, short-term option for managing bruxism-related hypertrophy, reducing pain and supporting individualized, cost-effective care strategies.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 12","pages":"Pages 1453-1460"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040368","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}

引用次数: 0

Can Chatbots Provide Accurate and Readable Information for Patients With Temporomandibular Disorders? 聊天机器人能为颞下颌疾病患者提供准确可读的信息吗？

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.08.012

Luís Eduardo Charles Pagotto DDS, MSc, PhD , Dennys Ramon de Melo Fernandes Almeida DDS, MSc, PhD , Thiago de Santana Santos DDS, MSc, PhD , Everton Freitas de Morais DDS, MSc, PhD

<div><h3>Background</h3><div>Temporomandibular disorders (TMDs) are common musculoskeletal and neuromuscular conditions that impair jaw function and quality of life. Patients often lack access to reliable health information. Large language models (LLMs) have introduced chatbots as potential educational tools, yet concerns remain regarding accuracy, readability, empathy, and citation integrity.</div></div><div><h3>Purpose</h3><div>This study evaluated whether LLM-based chatbots can provide clinically accurate, empathic, and readable responses to patient-friendly questions about TMDs and whether their cited references are authentic.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This cross-sectional in silico study was conducted in March 2025. Twenty-three standardized TMD-related questions were used as prompts for each chatbot.</div></div><div><h3>Predictor/Exposure/Independent Variable</h3><div>The predictor variable was the chatbot platform, reflecting distinct LLM architectures: GPT-4 (transformer-based autoregressive model, OpenAI), Gemini Pro (multimodal transformer, Google), and DeepSeek-V3 (mixture-of-experts transformer, DeepSeek).</div></div><div><h3>Main Outcome Variables</h3><div>Accuracy was defined as the proportion of responses judged clinically correct by two board-certified oral medicine specialists. Empathy was assessed by expert scoring of tone. Readability was determined with Flesch–Kincaid Reading Ease and Grade Level. Citation reliability was assessed by verifying whether references were authentic and retrievable in PubMed or other authoritative databases.</div></div><div><h3>Covariates</h3><div>No formal covariates were included; exploratory correlations between variables were performed.</div></div><div><h3>Analyses</h3><div>Descriptive statistics, 1-way analysis of variance with Tukey's post hoc tests, Pearson correlation, and χ<sup>2</sup> tests were performed. Statistical significance was set at <em>P</em> < .05.</div></div><div><h3>Results</h3><div>No statistically significant differences were observed in accuracy (<em>P</em> = .2) or empathy (<em>P</em> = .2). The mixture-of-experts transformer provided the most readable content (Flesch–Kincaid Reading Ease = 28.47; Flesch–Kincaid Grade Level = 12.19; <em>P</em> < .001). The transformer-based autoregressive model produced the highest proportion of hallucinated references (47.2%), compared with the multimodal transformer (18.8%) and the mixture-of-experts transformer (10.1%) (<em>P</em> < .001). A weak positive correlation was found between accuracy and readability (r = 0.27; <em>P</em> = .03), with no correlation between accuracy and empathy.</div></div><div><h3>Conclusions and Relevance</h3><div>While all LLM-based chatbots delivered generally accurate and empathetic responses, the mixture-of-experts transformer outperformed others in readability and citation reliability. The high rate of hallucinated references in the transformer-based autoregressi

背景：颞下颌紊乱（TMDs）是一种常见的肌肉骨骼和神经肌肉疾病，会损害颌骨功能和生活质量。患者往往无法获得可靠的健康信息。大型语言模型（llm）已经将聊天机器人作为潜在的教育工具引入，但在准确性、可读性、同理心和引用完整性方面仍然存在担忧。目的：本研究评估了基于法学硕士的聊天机器人是否能够对患者友好的tmd问题提供临床准确、共情和可读的回答，以及它们引用的参考文献是否真实。研究设计、设置、样本：这项横断面的计算机研究于2025年3月进行。23个标准化的tmd相关问题被用作每个聊天机器人的提示。预测变量/暴露变量/自变量：预测变量是聊天机器人平台，反映了不同的LLM架构：GPT-4（基于变压器的自回归模型，OpenAI）， Gemini Pro（多模态变压器，谷歌）和DeepSeek- v3（混合专家变压器，DeepSeek）。主要结局变量：准确性定义为由两名委员会认证的口腔医学专家判定临床正确的应答比例。同理心通过语调专家评分进行评估。可读性用Flesch-Kincaid Reading Ease和Grade Level测定。通过验证参考文献是否真实并可在PubMed或其他权威数据库中检索来评估引文可靠性。协变量：未纳入正式协变量；进行变量间的探索性相关性分析。分析：采用描述性统计、单因素方差分析及事后检验、Pearson相关和χ2检验。差异有统计学意义，P < 0.05。结果：准确性（P = 0.2）和共情性（P = 0.2）差异无统计学意义。混合专家变压器提供了最易读的内容（Flesch-Kincaid Reading Ease = 28.47; Flesch-Kincaid Grade Level = 12.19; P < .001）。与多模态变压器（18.8%）和混合专家变压器（10.1%）相比，基于变压器的自回归模型产生的幻觉参考比例最高（47.2%）（P < 0.001）。准确性与可读性呈弱正相关（r = 0.27; P = 0.03），准确性与共情无相关。结论和相关性：虽然所有基于法学硕士的聊天机器人都提供了普遍准确和同理心的回应，但专家混合转换器在可读性和引用可靠性方面优于其他机器人。在基于变压器的自回归模型中，高幻觉参考率强调了在临床应用中人类监督的必要性。

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引用次数: 0

Bridging Medicine and Dentistry: The University of Alabama at Birmingham OMS Reverse-Track Residency Program—A Path Forward in a Changing Residency Recruitment World 衔接医学和牙科：阿拉巴马大学伯明翰OMS反向住院医师项目——在不断变化的住院医师招聘世界中前进的道路

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.06.232

Kirav Patel MD , Timothy M. Weber Jr. MD, DMD , Kathlyn K. Powell DMD, MD , Brian E. Kinard DMD, MD

引用次数: 0

What is the Role of Depth of Invasion With Site Specificity in Managing the Clinically Negative Neck for Patients With Stage I Oral Cavity Squamous Cell Carcinoma? (cT1N0) 浸润深度和部位特异性在处理I期口腔鳞状细胞癌临床阴性颈部患者中的作用是什么？(cT1N0)”。

IF 2.6 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Oral and Maxillofacial Surgery

Pub Date : 2025-12-01 DOI: 10.1016/j.joms.2025.09.001

Paul L. Shivers DMD, MD , Jonathan Troost PhD , Brent B. Ward DDS, MD

Background

Guidelines for elective neck dissection (END) in oral cavity squamous cell carcinoma (OSCC) remain controversial with observation, sentinel lymph node biopsy or END in all subjects inconsistently proposed. The current study evaluated the performance of the (D)OI (depth of invasion) and (S)site to determine (E)lective (N)eck (D)issection (DSEND) algorithm in recommending END for cT1N0 OSCC subjects.

Study design, setting, sample

This is a retrospective case series of subjects treated between 2017 and 2023. All cT1N0 subjects treated with the DSEND algorithm were included. Exclusion criteria included subjects with recurrent disease, prior radiation therapy of the head and neck, or follow-up less than 1 year.

Predictor

The predictor variable was management of the neck—observation versus END per DSEND algorithm. Subjects who reached the site-specific threshold were treated with END. A secondary analysis compared preoperative depth and intraoperative depth to evaluate if one was more accurate compared to final pathology depth.

Outcome variable

The outcome variable was isolated neck recurrence (yes/no) during the follow-up period. The secondary analysis outcome variable was depth of invasion measured preoperative, intraoperative and on final pathology.

Covariates

The covariates were age, sex (male/female), smoking and alcohol status (yes/no), tumor size (cm), nodal status (positive/negative), anatomical subsite and final pathology depth of invasion (mm).

Analyses

We report descriptive statistics, accuracy of DSEND, comparison of preoperative versus intraoperative frozen section to final pathology depth of invasion using Student's t-test, setting P < .05 as statistically significant.

Results

The sample was composed of 88 subjects with a mean age of 63.7 (standard deviation 13.2). Females represented 51% (45 of 88) of the subjects. DSEND protocol was used for 80 subjects. Observation of the neck was recommended in 57.5% (46 of 80) of subjects with only 1 developing isolated neck recurrence (false negative 2% (1 of 46)). In patients managed with END 6% (2 of 33) experienced isolated neck recurrence. The difference between final pathology and intraoperative depth was significantly smaller than final pathology compared to preoperative depth.

Conclusions and Relevance

The DSEND algorithm applied to cT1N0 OSCC allowed for nonsurgical management of the neck in 57.5% (46 of 80) of subjects with a 2% (1 of 46) false negative. Frozen section analysis was more accurate than preoperative depth of invasion from biopsy.

背景：口腔鳞状细胞癌（OSCC）择期颈部清扫（END）的指导方针仍然存在争议，所有受试者的观察、前哨淋巴结活检或END的建议不一致。目前的研究评估了(D)OI（侵袭深度）和(S)部位的性能，以确定(E)选择性(N)eck (D)issection （DSEND）算法在推荐cT1N0 OSCC受试者的END时的效果。研究设计、环境、样本：这是2017年至2023年期间接受治疗的回顾性病例系列。所有采用DSEND算法治疗的cT1N0受试者均被纳入。排除标准包括疾病复发、既往头颈部放射治疗或随访少于1年的受试者。预测变量：预测变量是颈部观察的管理与每个DSEND算法的END。达到特定部位阈值的受试者接受END治疗。第二次分析比较术前深度和术中深度，以评估是否比最终病理深度更准确。结局变量：结局变量为随访期间孤立性颈部复发（是/否）。次要分析结果变量是术前、术中和最终病理测量的侵袭深度。协变量：年龄、性别（男/女）、吸烟和酒精状况（是/否）、肿瘤大小（cm）、淋巴结状态（阳性/阴性）、解剖亚位点和最终病理浸润深度（mm）。分析：我们采用学生t检验报告描述性统计、DSEND的准确性、术前与术中冷冻切片与最终病理浸润深度的比较，P < 0.05为有统计学意义。结果：样本由88名受试者组成，平均年龄63.7岁（标准差13.2）。女性占51%（88人中有45人）。80例受试者采用DSEND方案。建议对57.5%（80人中46人）的受试者进行颈部观察，只有1人出现孤立性颈部复发（假阴性2%（46人中1人））。在接受END治疗的患者中，6%（33例中的2例）出现孤立性颈部复发。最终病理与术中深度的差异明显小于最终病理与术前深度的差异。结论和相关性：应用于cT1N0 OSCC的DSEND算法允许57.5%（80 / 46）的受试者进行颈部非手术治疗，假阴性率为2%（46 / 1）。冰冻切片分析比术前活检浸润深度更准确。

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引用次数: 0