Oral and Maxillofacial Surgery-Heidelberg最新文献

Purpose: This study aims to analyze microvascular reconstruction in Oral and Maxillofacial Surgery (OMFS) in Europe.

Methods: Based on previous studies, a dynamic online questionnaire was developed and subjected to internal and external evaluation. The questionnaire comprised multiple-choice, rating, and open-ended questions, addressing general and specific aspects and the impacts of the COVID-19 pandemic on microvascular reconstruction in OMFS in Europe. It was implemented into SurveyMonkey's^® online survey software and emailed to OMFS departments registered with the European Association for Cranio-Maxillofacial Surgery (EACMFS).

Results: Seventy-five participants from 23 European countries participated. Among them, 89% perform between 1 and 70 microvascular free flaps (MFF) annually. 38% of the participants reported a reduction in MFF due to the COVID-19 pandemic. The radial forearm (41% of participants) and fibula free flap (31%) are the most reported MFF. In most cases (59%), MFF procedures are exclusively performed by OMFS for OMFS patients, while 43% of participants reported cooperations with plastic surgeons to perform MFF for OMFS patients. Many participants prefer arterial end-to-end anastomoses (54%) using the facial artery (54%) and, if available, two venous anastomoses (68%). Low molecular weight heparin is the most used postoperative anticoagulant, reported by 67% of participants. For flap monitoring, clinical assessment and Doppler ultrasound are preferred by most participants (95% and 78%, respectively). Many participants (66%) indicated that tracheotomy is only performed when necessary. Differences were observed in relation to CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) techniques, types of osteosynthesis, and dental implant treatment.

Conclusion: This study highlighted variability in microvascular reconstruction in OMFS in Europe. Further studies are needed to assess these aspects in detail.

Purpose: This large-scale retrospective study aimed to examine the long-term effect of antiplatelet and anticoagulant medications intake on dental implant treatment outcome.

Materials and methods: This study retrospectively examined data from patients who underwent dental implant procedures at several university dental clinics within the BigMouth network between 2011 and 2022. Patients' characteristics including age, gender, ethnicity, race, tobacco use, systemic medical conditions and intake of antiplatelets and anticoagulants were analyzed. Implant treatment outcome was the main outcome variable. Implant failure was defined as the removal of a dental implant for any reason. Time to failure (date of procedure to date of visit with failure) was recorded, while sites without a failure were censored at the last follow-up visit.

Results: A total of 50,333 dental implants in 20,842 patients over 12 years were analyzed and an implant failure rate of 1.4% at the implant level and 2.7% at the patient level were found. Asians, African-Americans, American Indians or Alaskan Natives, and White individuals were significantly more likely to receive antiplatelet medications than Hispanics or Latinos. Males and smokers exhibited significantly higher odds of being antiplatelet and anticoagulant users compared to females and non-smokers, respectively. When the implant survival rates between antiplatelet and anticoagulant users were compared to non-users, no significant differences were observed.

Conclusion: Within the limitations of this study, it appears that the use of anticoagulant and antiplatelet medications does not affect the risk of implant failure. Both anticoagulant and antiplatelet users and non-users exhibit similar high implant survival rates.

Introduction: Increasing emphasis has been placed on measurement of quality of life (QOL) as a central criterion for assessment of success of any medical treatment. The aim of our study was to assess the nutritional and quality of life of patient-reported outcomes among patients who have undergone laser resection of tongue cancer.

Materials and methods: A cross-sectional study was undertaken of patients treated with KTP laser resection of T1/T2 tongue squamous cell carcinoma (SCC) between 2011-2019. University of Washington Quality of life 4 questionnaire (UW-QOL) and the abridged scored patient-generated subjective global assessment (AB PG-SGA) were used. Scores were correlated to analyse the QOL and nutritional status.

Results: 20 patients participated and were categorised into three groups based on AB PG-SGA score. The physical and social-emotional QOL scores were higher for patients who had a better nutritional status. There was a linear negative correlation between the AB PG-SGA score, physical and social-emotional domains of the QOL. No association was found between histopathological differentiation, neck dissection surgeries and the AB PG-SGA score.

Conclusions: The use of the KTP laser to excise tongue T1 and T2 SCC yields acceptable results in terms of QOL and patient-reported nutritional outcomes. There is a significant trend identifying that as a patient's nutritional status improves quality of life is enhanced and vice versa. The QOL and the nutritional status of patients were not affected by the different histopathological grades of SCC or whether they had undergone a neck dissection or not.

Purpose: Several forms of autogenous tooth graft have been presented. However, it is still unclear which form provides better bone formation and is the best to use clinically. This network meta-analysis aimed to thoroughly evaluate the available literature on the ability of different forms of the autogenous tooth graft to promote bone regeneration, in order to explore if any specific type or method of processing would result in better overall outcomes.

Methods: MEDLINE/PubMed, Cochrane library, and Scopus databases were searched, to find randomized clinical trials, published up to November 29, 2023, which compared two forms of autogenous tooth graft or any form of this material with other bone grafts or with empty sockets and reported the percentage of bone formation in the grafted sites.

Results: Of 1129 articles found, nine were included. The outcomes of this meta-analysis indicated that demineralized dentin, demineralized root with BMP-2 and undemineralized tooth all showed significantly higher bone formation, compared to xenograft; Mean difference (MD) = 23.25, 95% Confidence interval (CI) = 7.42 to 39.08, MD = 17.09, 95% CI = 4.03 to 30.15, and MD = 12.40, 95% CI = 5.64 to 19.16, respectively. Following the GRADE system, the level of evidence was judged to be low/very low.

Conclusion: Choosing the undemineralized tooth could be a better option than other forms of this material, considering the complexity, time, and cost of the other forms of autogenous tooth graft. Nevertheless, future investigations with more direct comparisons are highly needed, considering the small number of included studies and the low level of evidence obtained from this meta-analysis.

Purpose: Carcinogenesis is characterized by the transformation of normal cells into malignant cells. Concerning the lower lip, exposure to UV radiation is the main etiological factor associated with the development of epidermoid carcinomas and actinic cheilitis. According to the hierarchical model theory, cancer development is driven by populations of cancer stem cells. In this context, this study aimed to compare the expression of octamer-binding transcription factor 4 (OCT4) and CD44 in 40 lower lip epidermoid carcinoma (LLEC) and 40 actinic cheilitis (AC) cases.

Methods: OCT4 and CD44 expressions were assessed semi-quantitatively according to the percentage of positive epithelial cells (PP) and intensity of expression (IE), resulting in a total immunolabeling score (PIT).

Results: No statistically significant differences were detected between OCT4 and CD44 immunoexpression and clinicopathological parameters, except for lymph node metastasis, in which a decrease in CD44 expression in the core tumor of cases with lymph node metastasis was observed. Furthermore, decreased CD44 expression was observed in LLEC cases when compared to AC cases.

Conclusions: The findings reported herein suggest a higher participation of CD44 in early carcinogenesis stages. In addition, the imbalance between OCT4 and CD44 immunoexpressions suggests the presence of different neoplastic cell subpopulations.

Objective: A nanometer-sized vesicles originating from bone marrow mesenchymal stem cells (BMMSCs), called exosomes, have been extensively recognized. This study defines the impact of BMMSCs and their derived exosomes on proliferation, apoptosis and oxidative stress (OS) levels of CP-induced parotid salivary gland damage.

Methods: BMMSCs were isolated from the tibia of four white albino rats and further characterized by flowcytometric analysis. BMMSCs-derived exosomes were harvested and underwent characterization using transmission electron microscopy (TEM), western blot analysis and BCA assay. Fifty-six healthy white albino male rats weighting from 200 to 250 g were allocated into 4 groups (n = 14); Group I, rats received phosphate buffered saline (PBS), group II, rats were intraperitoneally injected with CP, group III& IV received CP and after 3 days they were intravenously injected with either BMMSCs (group III) or BMMSCs-exosomes (group IV). Histological, and immunohistochemical studies using proliferating cell nuclear antigen (PCNA) were done after 7 and 14 days. The OS was measured using malondialdehyde (MDA) and apoptosis was measured by annexin V-FITC/PI.

Results: BMMSCs and exosomes treated groups showed better histological features approximating the normal architecture of the control group. The percentage of PCNA positively stained cells were significantly higher in the exosomes treated group in comparison to all other groups. MDA assay test revealed that the exosomes were able to reduce the OS when compared to the cell-based therapy using BMMSCs. Annexin V revealed that BMMSCs-exosomes significantly reduced the percentage of apoptotic cells compared to other treated groups.

Conclusions: BMMSCs-exosomes could improve the CP-induced cytotoxicity in rats' parotid salivary gland.

Objective: This narrative review aims to explore the current applications and future prospects of AI within the subfields of oral and maxillofacial surgery (OMS), emphasizing its potential benefits and anticipated challenges.

Methods: A detailed review of the literature was conducted to evaluate the role of AI in oral and maxillofacial surgery. All domains within OMS were reviewed with a focus on diagnostic, therapeutic and prognostic interventions.

Results: AI has been successfully integrated into surgical specialties to enhance clinical outcomes. In OMS, AI demonstrates potential to improve clinical and administrative workflows in both ambulatory and hospital-based settings. Notable applications include more accurate risk prediction, minimally invasive surgical techniques, and optimized postoperative management.

Conclusion: OMS stands to benefit enormously from the integration of AI. However, significant roadblocks, such as ethical concerns, data security, and integration challenges, must be addressed to ensure effective adoption. Further research and innovation are needed to fully realize the potential of AI in this specialty.

Purpose: Precise implant placement is essential for optimal functional and aesthetic outcomes. Digital technologies, such as computer-assisted implant surgery (CAIS), have improved implant outcomes. However, conventional methods such as static and dynamic CAIS (dCAIS) require complex equipment. This study examined the usefulness of smartphone-based augmented reality (AR) for CAIS based on the value addition regarding angulation and positioning of pilot drillings and the potential for training dental students.

Methods: An in vitro model was created to mimic dental scenarios using three-dimensional datasets. Smartphone technology and AR application (app)-based intraoral tracking were used for dCAIS. The app allowed real-time visualization of implant planning, superimposition of three-dimensional models, and alignment of surgical instruments. Forty dental students performed four pilot drillings each; two were performed freehand, whereas two were performed using the app. The angulation and position of the prepared implant bed preparation were statistically analyzed.

Results: Implant angulation was significantly better in the AR-guided group than in the unguided group; however, no significant difference was observed in the implant position.

Conclusions: Smartphone-based AR techniques for dCAIS are easily accessible in dental implantology. This may be advantageous for training dental students and potentially improving clinical outcomes, particularly the angulation of dental implants.

Purpose: Carcinogenesis of oral squamous cell carcinoma (OSCC) has long been associated with exposure to tobacco smoke and alcohol consumption. Some centres have reported that non-smoking non-drinking (NSND) patients represent a significant and increasing proportion of OSCC cases with reports of poorer outcomes. Demographic characteristics are variably reported for this group and carcinogenesis is not fully understood. We present the largest cohort study to date in this subject area and sought to better understand demographics and survival.

Methods: We interrogated 541 OSCC patients by retrospective analysis to assess risk factor status, disease characteristics and survival. Patients were categorised according to smoking and alcohol exposure with non-smoker (NS) status defined as less than five cigarettes per week with no history of use greater than this. Non-drinker (ND) status was defined as less than three standard drinks per week with no history of alcohol consumption greater than this. Those both NS and ND were categorised as NSND. Subsite, tumour stage and treatment were recorded along with evidence of cervical nodal and distant metastasis.

Results: These patients were more likely to be female, older and present with early-stage disease. Tumour site was tongue, maxillary alveolus and buccal mucosa, at variance with the smoker drinker groups.

Conclusion: NSNDs comprise a significant proportion our OSCC population. These patients were more likely to be female, older and present with early-stage disease. Tumour site was tongue, maxillary alveolus and buccal mucosa, at variance with the smoker drinker groups. Thus, NSNDs are a clinically distinct and significant group in oral cavity cancer management.

Background: The aim of this study is to assess the outcome of the patients who required intensive care unit (ICU) admittance after surgical drainage of an odontogenic cervicofacial infection and identify the variables that are able to predict severe infection or a high possibility of complications.

Patients and methods: This is a retrospective cohort study including all adult patients admitted to our hospital over the period 2011-2020 due to odontogenic cervicofacial infection and required ICU admittance. The study was approved by the hospital's scientific committee (no 814-9/8/2021).

Results: 51 patients were included (mean age 43.2 years). 11.7% of the patients had major comorbidities, such as diabetes or immunosuppression. At presentation, fever was recorded in 55% patients and trismus in 92.8%, with a mean delay from symptoms to hospital admission at 3 days. 23% of patients had a post-extraction infection, 61% pericoronitis and 15% other odontogenic infections. The mean duration of hospitalization was 9.16 days whereas the mean ICU length of stay was 3.76 days. 84.3% of patients showed improvement, 13.7% deteriorated with a need of reoperation and one death was reported. ICU length of stay was associated with an 89% reduced rate when positive microbe identification was feasible, whereas rate of complications was 4-fold higher in patients with prolonged ICU length of stay.

Conclusions: Patients with deep cervicofacial odontogenic infections who require ICU management have a favourable clinical outcome. A minority of these patients will not improve in a short time frame or develop complications which require further management.