Maxillofacial Plastic and Reconstructive Surgery最新文献

Background: Non-surgical method is a treatment option for mandibular condylar fracture; however, it is questionable whether bone fragments are adequately reduced and remodeled. The purpose of this study was to identify three-dimensional positional changes in the mandibular condyles in patients treated non-surgically, analyze factors influencing the extent of positional changes, and evaluate clinical prognosis.

Methods: This retrospective study included 31 patients with unilateral mandibular condylar fractures treated non-surgically at the Ajou University Dental Hospital between 2005 and 2023. Computed tomography was performed at the time of the fracture (T ₀) and > 6 months after non-surgical treatment (T ₁). The extent of recovery of the highest point of the condyle head was measured in three-dimensional x-, y-, and z-axes. At the last follow-up > 6 months after remodeling (T ₁), the prognosis was evaluated by clinical examination of mouth opening limitation, malocclusion, deviation on opening, temporomandibular joint disorder (TMD), and facial asymmetry.

Results: Position differences were statistically significant between T₀ and T₁ (paired Student's t-test, P < 0.05), and between the x-, y-, and z-axes (Welch's ANOVA, P < 0.05). The degree of positional recovery in the superior and lateral directions showed a statistically significant negative correlation with age (Pearson's correlation analysis, P < 0.05). The average amount of recovery between two age groups of over and under 19 years old was statistically significant (independent t-test, P < 0.05). Complications included TMD (6.4%), malocclusion (3.2%) and facial asymmetry (3.2%).

Conclusion: After non-surgical treatment, the condyle head of the fractured mandible recovered significantly laterally and superiorly in under 19-year-olds. The functional prognosis was favorable in all age groups. Non-surgical treatment can be an applicable treatment option for patients with mandibular condylar fractures.

Background: Although more than 200 techniques have been reported for the reconstruction of the upper and lower lip defects since 1000 BC, none of them is ideal. Local flaps may result in extra skin incisions and in some cases, the surgeon may be confronted with the lack of sufficient tissues for the reconstruction of large defects. Several techniques have been described for near-total lip reconstruction. The two major available techniques are local flap reconstruction (Bernard-von Burrow-Webster technique) and free micro-vascular tissue transfer. In this study, we are going to evaluate the functional results of using local muscles transposition-assisted dermal fat flap and muco-buccal flap in the treatment of large upper or lower lip defects.

Materials and methods: This study was carried out on 128 patients, who presented to us with malignant tumors affecting the lips.

Results: Lip defect sizes ranged from 4 to 6 cm in diameter. No flap failure was seen and desirable function and accepted esthetic results were obtained. The flap survival was 100%, and healing was eventful in all cases. No cases of microstomia were reported.

Conclusion: The use of local muscle transposition-assisted dermal fat flap and muco-buccal flap technique, showed excellent results in regaining oral competence and lip mobility, and as much as possible, increased the aesthetic outcome.

Level of evidence: IV therapeutic study.

Background: Titanium (Ti-6Al-4 V) is used for fixation in LeFort I osteotomy, a procedure for treating midface deformities. This study assessed the biomechanical stabilities of two Mg alloys (WE43 and ZK60) as biodegradable alternatives and compared them against Ti using finite element analyses. The LeFort I osteotomy procedure was simulated, and various plate and screw configurations were tested. The maximum principal and peak von Mises stresses in the metal plates and bone screws were measured under four load conditions, and the stability was evaluated.

Results: The holes in the Mg screws, as compared with the Ti counterparts, exhibited higher and lower stress levels in the cortical and cancellous bones, respectively. The Mg screws also exhibited a higher fracture risk. The ZK60 plate, as compared with the Ti and WE43 plates, exhibited a lower fracture risk under all load conditions. ZK60 exhibited higher biomechanical stability in terms of maintaining the gap between osteotomy surfaces and lower fracture risk; the osteotomy surfaces with Ti im-plants underwent bone impaction, resulting in gap closure.

Conclusions: Although the Mg implants exhibited better stress distribution, their screw strength requires improvement. Appropriate improvements can promote the use of Mg alloys in bone fixation applications.

Background: The shift from traditional two-dimensional (2D) planning to three-dimensional (3D) virtual surgical planning (VSP) has revolutionized orthognathic surgery, offering new levels of precision and control. VSP, combined with computer-aided design/computer-aided manufacturing (CAD/CAM) technology, enables the creation of patient-specific surgical guides and implants that translate preoperative plans into more precise surgical outcomes. This review examines the comparative accuracy and operative efficiency of VSP, especially when used with custom surgical guides, against conventional 2D planning in orthognathic surgery.

Main text: The study systematically reviewed and analyzed published literature comparing the accuracy and operative time between VSP and conventional planning methods. The meta-analysis included clinical trials, controlled trials, and observational studies on patients undergoing orthognathic surgery, focusing on the degree of alignment between planned and postoperative bone positions and total surgery time. Results indicate that VSP consistently reduces discrepancies between planned and actual surgical outcomes, particularly when integrated with custom surgical guides. Additionally, while VSP demonstrated potential time-saving advantages over conventional planning, these differences were not statistically significant across studies, likely due to high variability among study protocols and designs.

Conclusions: VSP with custom surgical guides enhances surgical accuracy in orthognathic procedures, marking a significant advancement over traditional methods. However, the reduction in operative time was not conclusively significant, underscoring the need for further studies to evaluate time efficiency. These findings emphasize VSP's role in improving surgical precision, which holds substantial implications for future orthognathic surgical practices.

Background: Oral squamous cell carcinoma (OSCC) is a prevalent malignancy in oral cancer. Approximately 26% of OSCC cases recur after initial curative treatment, with over 80% of these recurrences occurring within the first 2 years. Delayed local recurrence (DLR) occurring beyond the 2-year period in cases of OSCC is infrequent. The aim of this study is to investigate the histopathological characteristics associated with DLR.

Methods: This study included 197 patients diagnosed with OSCC who underwent primary surgery from 2006 to 2022. Epidemiological features, such as age and gender, and histopathological features, including primary tumor sites, TNM staging, histopathological grading, depth of invasion, the presence of lymphovascular or perineural invasion, and the utilization of radiation therapy (RT) and neck dissection (ND) were analyzed.

Results: The mean interval until local recurrence was 22 ± 27 months. There were 10 cases of DLR (20.83%) among 51 patients with local recurrence. The epidemiological and histopathological analysis of these cases is as follows: 10 patients (3 males and 7 females) aged 51-80 years (median, 56.5 years). Primary tumor sites were tongue (n = 3), maxillary gingiva (n = 1), mandibular gingiva (n = 3), retromolar trigone (n = 1), and buccal mucosa (n = 2). Tumor size was advanced (T3/T4) in 5 cases, while a smaller size (T1/T2) was observed in 5 cases. No lymph node metastasis was 80.0%. Histopathological grading was well differentiated in 9 cases and moderately differentiated in 1 case, with no cases of poorly differentiated tumors. Depth of invasion > 5 mm was 70.0% of the cases (n = 7). Lymphovascular invasion and perineural invasion were not present. Three patients received RT, and 8 patients underwent ND. There were 2 patients who consumed alcohol, and 2 patients who smoked tobacco. The results showed that histological differentiation had a significant relationship with the interval (p = 0.031).

Conclusions: DLR, occurring more than 2 years after the initial tumor resection surgery, is infrequent. Histological differentiation is associated with tumor recurrence intervals. Patients with a higher histological grading require more precise follow-up observation during the initial 2 years after surgery.

Background: The aim of the study was to evaluate the etiology, incidence, demographics, and characteristics of maxillofacial fractures treated at a university hospital over a seven-year period.

Methods: We performed a retrospective analysis of 1,757 patients with maxillofacial fractures who were referred to our department between May 2012 and March 2019. The patients' demographic and clinical characteristics were noted, as well as the fracture type, location, and etiology. The treatment modalities were also analyzed.

Results: A total of 2,173 maxillofacial fractures were seen in 1,757 patients. The male to female ratio was 3.9:1, and the mean patient age was 31.89 ± 17.70 years (range: 0-95 years). Maxillofacial injuries were most prevalent in the 19-28 years age group (23.9% of cases), with a general increase in injuries observed between 2013 and 2018 across all age groups. The most common etiological factor was assault (29.1%), followed by falls (26%). In male patients, assault was reported as the main cause, while in female patients, falls were identified as the main cause. The nasal bone was the most common site of fracture, followed by the maxilla. The average time from admission to surgery was 2.8 days, with local anesthesia being the most frequent surgical intervention. The average time from admission to surgery was 2.8 ± 2.5 days (range: 0-20 days), with surgeries performed under local anesthesia being more frequent than those carried out under general anesthesia. Among the surgical interventions, the most common general anesthesia technique for fracture reduction was open reduction and internal fixation with plates and screws. Plate exposure, wound-site infection, and temporomandibular joint ankylosis were the major complications encountered in the study population.

Conclusion: The study reveals significant variability in maxillofacial fractures based on gender, age, and etiology. Assault emerged as the leading cause of these fractures, followed by falls and road traffic accidents. Men were affected by maxillofacial trauma four times more often than women, with the highest incidence occurring in the 19-28 years age group. Nasal fractures were the most frequently observed (78.7%), while condylar-subcondylar process fractures were the most common type of mandibular fracture. Given these findings, a targeted, lifelong prevention strategy focused on high-risk groups could significantly reduce the burden of maxillofacial trauma.

Background: Controversy exists regarding the timing of rhinoplasty for patients with cleft lip as some surgeons shy away from primary correction for fear of causing harm to the growth of the nose and the maxilla. We present our favorable experience with primary rhinoplasty with repair of unilateral cleft lip in Ain Shams University plastic surgery department, providing insights into the specific management of patients of middle eastern descent.

Methods: Prospective study of 32 patients, ages 3 months- 1 year with unilateral CL presenting to Ain Shams University hospitals between January 2019 and July 2022. Primary rhinoplasty was performed at the time of lip repair. Lip repair was done by Tennison-Randall technique. Evaluation of results was done by expert analysis of photographs, anthropometric measurements, and parents' satisfaction.

Results: Over-all concordance rate was 93% and inter-observer concordance was 89%. Non-significant differences were found between cleft and noncleft sides regarding nostril dome height, columellar length, and alar width 6 months post-operatively. 81.25% of the parents were very satisfied with the results.

Conclusion: Our study targeted a cohort of Egyptian patients with unilateral cleft lip, who underwent primary rhinoplasty and the time of lip repair, showing favorable results, supporting the literature advocating for this timing, but limited by relatively short follow up period. To the best of the authors' knowledge, this is the first study in Egypt to highlight the outcomes and direct experience for primary rhinoplasty with cleft lip repair in an Egyptian population.

Background: The effects of unilateral submandibular gland excision on the size of the contralateral gland are not well understood, with no human studies reported to date. This study aims to investigate the impact of unilateral submandibular gland excision on the contralateral gland's size, providing insights into compensatory mechanisms and their clinical implications.

Method: This retrospective study involved patients with oral cancer who underwent unilateral submandibular gland excision and ipsilateral neck dissection at Gangneung-Wonju National University Dental Hospital between 2008 and 2023. Patients were included if they had preoperative and follow-up 3D radiological images. The contralateral submandibular gland volume was measured using 3D Slicer software on preoperative, post-operative, and follow-up radiographic data.

Results: The mean volume change of the contralateral submandibular gland was 1.35 ± 2.06 cm3, with a mean change ratio of 1.18 ± 0.24. These changes were statistically significant (p = 0.006). Other factors such as age, gender, and radiotherapy did not significantly affect the volume change ratio (p > 0.05).

Conclusion: The contralateral submandibular gland exhibits a statistically significant increase in volume following unilateral gland excision, indicating compensatory hypertrophy. This morphological adaptation should be considered in post-operative care and surgical planning for oral cancer patients to optimize outcomes.

Background: Xerostomia, or dry mouth, can be a temporary or persistent symptom resulting from various factors, such as medication use, therapeutic radiation, chemotherapy, autoimmune conditions (e.g., Sjögren's syndrome), and hormonal imbalances. Xerostomia often leads to associated mucositis, which significantly impacts patients' quality of life. The nano-bio-fusion (NBF) gingival gel, a gel-type functional toothpaste containing vitamins C, E, propolis, and herbal extracts in a nano-emulsion state, has shown potential in accelerating the healing of oral mucosal lesions.

Methods: A total of 127 patients (102 females, 25 males) with persistent xerostomia were treated from 2018 to 2023. Of these, 32 patients were treated exclusively with NBF Gel, while 95 patients received NBF Gel in combination with other medications, such as pilocarpine. The underlying causes of xerostomia included irradiation and chemotherapy (12 patients), medication (40 patients), hormonal imbalance (28 patients), and Sjögren's syndrome (47 patients). NBF Gel was applied 2-3 times daily to the tongue and oral mucosa. Treatment effectiveness was evaluated through physical examinations and a patient-reported scale ranging from 1 (no improvement) to 10 (complete improvement), focusing on the healing of mucosal lesions rather than saliva production.

Results: Both treatment groups showed significant improvements in the healing of xerostomia-associated mucositis, particularly in severe cases with visible lesions. Patients treated with NBF Gel reported improved symptoms related to mucosal health, while those who received combination therapy also experienced reduced side effects of pilocarpine due to dose reduction. The most substantial improvements were observed in patients with drug-induced and hormonally-caused xerostomia-related mucositis. No adverse side effects from NBF Gel were reported during the study.

Conclusion: NBF gingival gel proved to be beneficial in accelerating the healing of mucositis associated with xerostomia, regardless of the underlying cause, including medication use, radiotherapy, chemotherapy, hormonal imbalances, and Sjögren's syndrome. It presents a promising adjunctive treatment to improve mucosal health and quality of life for patients suffering from xerostomia-associated mucositis.