Oral and Maxillofacial Surgery-Heidelberg最新文献

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.

Purpose: The harmony between the lips and the chin is an essential parameter in facial esthetics, and the mentolabial sulcus (MLS) represents the level of this harmony. This study aimed to assess the effect of MLS depth on facial profile attractiveness in long-face, short-face, and normal-face Iranian female individuals.

Methods: An observational study with a questionnaire was conducted, and a profile photograph of an Iranian female with class I occlusion was altered to create long-face, normal-face and short-face profiles with MLS depth ranging from 1 to 12 mm. Sixty-five lay people and 24 orthodontists rated the attractiveness of images using a 7-point Likert scale. Data were analyzed by independent t-test and Spearman's correlation coefficient using IBM SPSS Ver. 22.

Results: The ideal depth of MLS ranged from 5 to 7 mm for normal-face and short-faced and 6-8 mm for long-face Iranian females. The acceptable MLS depth was found to be up to 8 mm in normal-face and up to 10 mm in long-face and short-face females. normal-face images acquired the maximum score of attractiveness, followed by short-face images, while long-face images were the least attractive according to both observer groups. There was general agreement amongst orthodontists and lay people scoring process; however, orthodontists gave significantly higher scores for normal face images than lay people.

Conclusion: The optimal MLS depth in different facial types should be considered in treatment planning for orthognathic surgery and genioplasty.

Purpose: Bone expansion is one of the quickest, simplest, and most reliable methods of alveolar ridge augmentation for implant placement. This systematic review is designed to investigate the outcomes of the bone expansion technique for horizontal ridge augmentation.

Methods: The protocol of study has been prospectively registered into PROSPERO (CRD42023414686). Pubmed, Embase, Web of Science, and Scopus databases were searched. Human original articles utilizing different bone expansion procedures for horizontal ridge augmentation without the use of bone materials or combined with vertical ridge augmentation techniques were included in the study. Qualitative and quantitative synthesis have been conducted. I-squared was used to assess heterogeneity. Meta-regression, forest plots random-effect model, and weighted mean difference were used for analysis. Leave-one-out influence analysis for finding outliers. Egger's publication bias test and Funnel plots were used to address publication bias.

Results: 3291 records were identified. Ten articles were included in this study after screening. The survival and complication rates of implants placed simultaneously with bone expansion was 100% 100% (95% CI: 99-100%) and 0% (95% CI: 0-1%), respectively. The meta-regression revealed that by each month passing from the implant placement the survival probability would be decreased significantly by 0.08% (95% CI: 0.009-0.15%; P = 0.03). The weighted mean ridge width difference before and after the osseodensification was 1.55 mm (95% CI: 0.92-2.17 mm).

Conclusion: Based on the study's limitations it can be concluded that the bone expansion procedure can be considered an efficient and safe method regarding the survival and complication rates of placed implants.

Trial registration number: N/A.

Purpose: This study aimed to analyze changes in anxiety and comfort levels at each perioperative stage during third molar extraction under single-agent intravenous midazolam sedation, and to clarify how these conditions at each perioperative stage affect postoperative satisfaction.

Patients and method: 115 who requested extraction of 1 ~ 4 third molars under single-agent intravenous midazolam sedation were targeted. These patients were administered a questionnaire survey one week after surgery. The questionnaire's five items (Anxiety before surgery, Comfort during surgery, Comfort after surgery, Amnesia, and Satisfaction) were evaluated using a visual analog scale (VAS). We investigated the correlation between each of the eight parameters which added age, operation time, and total amount of midazolam, to the VAS score. Furthermore, we compared each eight parameters according to the number of extracted wisdom teeth and sex differences.

Results: Regarding the correlation among each parameter, low preoperative anxiety were weak and positively correlated with reduced operation time reduced midazolam dosage, and an increase in postoperative comfort. All parameters influenced the patient's satisfaction level. Those levels were significantly affected by preoperative reassurance (r = 0.4402, p < 0.01), postoperative comfort (r = 0.5522, p < 0.01) amnesia (r = 0.5741, p < 0.01), and intraoperative comfort (r = 0.7578, p < 0.01). Each parameter had no significant difference depending on the number of teeth extracted. In comparison between men and women, only preoperative reassurance was significantly lower in women than in men (p<0.05).

Conclusion and relevance: This sedation effectively managed preoperative anxiety and improved postoperative satisfaction. To obtain good sedative condition, Preoperative anxiolytics are recommended. This sedation is considered particularly effective in women.

Objective: This systematic review and meta-analysis compares the efficacy and complication rate of absorbable versus non-absorbable 3D-printed, patient-customized, maxillofacial implants in facial trauma patients.

Data sources: A comprehensive search of four databases (PubMed, Scopus, Web of Science, and Cochrane) was conducted.

Methods: A systematic review and single-proportion meta-analysis was conducted employing PRISMA guidelines. A comprehensive search of four databases (PubMed, Scopus, Web of Science, and Cochrane) yielded a total of 4087 results. After removing duplicates, 16 articles underwent full-text analysis, with 13 meeting the inclusion criteria. The inclusion focused on primary clinical data involving 3D-printed, patient-specific implants for facial bone fracture restorations. Exclusion criteria removed studies without full text, ongoing studies, animal studies, and studies not utilizing CAD/CAM for their implants.

Results: A total of 114 patients underwent insertion of 3D-printed implants. Patients receiving non-absorbable implants had a success rate of 84% (95% CI: 74-91), with complications in 12 patients. Patients receiving absorbable implants achieved a 100% success rate (95% CI: 0-100), with zero complications.

Conclusion: The study suggests absorbable 3D-printed implants provide superior results with fewer complications compared to non-absorbable 3D-printed implants for the treatment of facial fractures.

Clinical trial number: Not applicable.

Purpose: It has been suggested that dentofacial deformities (DFD) can impair sleep quality. This pilot study aimed at evaluating sleep disorders in individuals with DFD before orthognathic surgery, correlating the clinical findings with salivary biomarker levels.

Methods: This cross-sectional study enrolled ten males and ten females with DFD diagnoses under orthodontic treatment preceding orthognathic surgery. The participants responded to the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Fletcher and Luckett Sleep Questionnaire (FLSQ). Obstructive sleep apnea (OSA) was examined by the Home Sleep Apnea Test (HSAT). The salivary levels of interleukin-1β (IL-1β), glutamate, and serotonin were measured.

Results: 85% of individuals presented PSQI and FLSQ scores indicative of sleep alterations. Females had higher scores in part 2 of the FLSQ instrument, referring to sleepiness-associated complaints. HSAT analysis revealed a low number of symptomatic OSA individuals, with three males demonstrating altered oxygen desaturation rates. There was a significant negative correlation between the salivary levels of serotonin and the FLSQ results.

Conclusions: Individuals with DFD diagnosis showed poorer sleep quality, which is likely independent of sex and OSA diagnosis, and negatively correlated with salivary levels of serotonin.

Purpose: This study aimed to clarify the applicability of smartphone-based three-dimensional (3D) surface imaging for clinical use in oral and maxillofacial surgery, comparing two smartphone-based approaches to the gold standard.

Methods: Facial surface models (SMs) were generated for 30 volunteers (15 men, 15 women) using the Vectra M5 (Canfield Scientific, USA), the TrueDepth camera of the iPhone 14 Pro (Apple Inc., USA), and the iPhone 14 Pro with photogrammetry. Smartphone-based SMs were superimposed onto Vectra-based SMs. Linear measurements and volumetric evaluations were performed to evaluate surface-to-surface deviation. To assess inter-observer reliability, all measurements were performed independently by a second observer. Statistical analyses included Bland-Altman analyses, the Wilcoxon signed-rank test for paired samples, and Intraclass correlation coefficients.

Results: Photogrammetry-based SMs exhibited an overall landmark-to-landmark deviation of M = 0.8 mm (SD =  ± 0.58 mm, n = 450), while TrueDepth-based SMs displayed a deviation of M = 1.1 mm (SD =  ± 0.72 mm, n = 450). The mean volumetric difference for photogrammetry-based SMs was M = 1.8 cc (SD =  ± 2.12 cc, n = 90), and M = 3.1 cc (SD =  ± 2.64 cc, n = 90) for TrueDepth-based SMs. When comparing the two approaches, most landmark-to-landmark measurements demonstrated 95% Bland-Altman limits of agreement (LoA) of ≤ 2 mm. Volumetric measurements revealed LoA > 2 cc. Photogrammetry-based measurements demonstrated higher inter-observer reliability for overall landmark-to-landmark deviation.

Conclusion: Both approaches for smartphone-based 3D surface imaging exhibit potential in capturing the face. Photogrammetry-based SMs demonstrated superior alignment and volumetric accuracy with Vectra-based SMs than TrueDepth-based SMs.

Background: The primary objective of this study was to assess the benefit of cancer-directed surgery (CDS) on both overall survival (OS) and cancer-specific survival (CSS) of patients with malignant major salivary gland cancers (MMSGCs). The secondary objective was to explore the benefits of adjuvant therapy on the survival outcomes of these patients.

Methods: Patients diagnosed with MMSGC were extracted from the SEER database and subsequently categorized into two cohorts: CDS and non-CDS. Propensity score matching (PSM) was used to mitigate confounding variables. The survival benefit associated with CDS was evaluated using Kaplan-Meier analysis, log-rank tests, and Cox proportional hazard models. Furthermore, the impact of adjuvant radiotherapy and chemotherapy was explored within the CDS subgroup.

Results: A total of 7,029 patients with MMSGC were included. PSM was performed and resulted in a matched cohort between both groups, including 595 patients in each group. Multivariable Cox proportional hazard indicated that patients who received CDS had better OS (HR: 0.45, 95% CI [0.39 to 0.52], P < 0.001) and CSS (HR: 0.46, 95% CI [0.40 to 0.52], P < 0.001). The 5- and 10-year OS for the CDS group was 42% (95% CI, 38 - 46%), and 25% (95% CI, 21 - 29%) consecutively, while the 5- and 10-year OS for the non-CDS group was 20% (95% CI, 17 - 24%), and 12% (95% CI, 9.7 - 16%) consecutively. Moreover, patients with younger age, localized tumors, and lower TNM stage could benefit more from CDS. Radiotherapy as adjuvant therapy was found to be beneficial (HR: 0.69, 95% CI [0.55-0.85], p < 0.001), while chemotherapy could not significantly benefit these patients.

Conclusion: CDS improved the OS and CSS survival in MMSGC patients. Specific patient subgroups seemed to have a superior benefit from CDS. Adjuvant radiotherapy could help enhance the survival outcomes of these patients while chemotherapy could not.

Purpose: Current scapular free flap (SFF) harvest in mandibular reconstruction often requires repositioning, hindering simultaneous harvest and resection and potentially increasing ischemic time. This study evaluated the efficacy of the pull-through technique (PTT) for SFF harvest, aiming to reduce ischemic time during mandibular segmental resection.

Methods: A retrospective analysis was conducted on 24 patients who underwent mandibular reconstruction using SFF at two maxillofacial surgery departments between January 2015 and May 2022. In total, 13 patients received PTT, while the remaining 11 underwent non-PTT. Demographic and clinical data were collected, including age, sex, diagnosis, resected mandibular segments, operative time, and ischemic time. Statistical analysis was performed to compare these variables between the PTT and non-PTT groups.

Results: The study found no significant differences between the groups in terms of age, sex, diagnosis, number of resected segments, or total operative time. However, ischemic time was significantly shorter in the PTT group than in the non-PTT group. PTT also allowed for minimal position changes during surgery compared with non-PTT.

Conclusion: Our study investigated the impact of the PTT on SFF reconstruction during mandibular segmental resection. We found that utilizing PTT-SFF significantly reduced ischemic time compared with the traditional method. This technique offers a potential advantage by facilitating stable blood flow visualization and potentially improving flap viability.

Clinical trial number: Not applicable.

Background: It has been outlined that LTM (Lower third molar) extracted from patients in which grinding, cleaning, sterilization & demineralization prove to be highly effective as graft material for filling the alveolar socket of the very same patient. These investigations aim to assess the efficiency of ADDM (Autogenous Demineralized Dentin Matrix) graft in third molar extraction sockets.

Purpose: To check the effectiveness of ADDM as graft material in extraction socket by evaluating pain, swelling, trismus, PD (Probing Depth) and bone density.

Study design, setting, sample: A prospective, randomized control trial was conducted at our institute. The patients were haphazardly, non-blindly alienated into two groups. Group A (45 patients) on the test side after LTM impaction surgery will receive ADDM graft material with bio-collagen membrane and Group B (45 patients) on the control side underwent LTM removal, with the alveolus left to heal conventionally by forming a blood clot.

Results: Swelling showed significant difference between CG (Control Group) and TG (Test Group), the intergroup comparison of change in the swelling scores at seventh post-operative day (from pre-op level) was significantly higher in the TG (117.35) as compared to the CGs (115.92) (p = 0.001). A statistically significant difference in probing depth was also noted between the two groups, CG 4.46 ± 1.252 & TG 2.52 ± 0.641 in the post-operative examination at three months. In our study radiographical evaluation revealed progressive increase in bone density in TG (135.81 ± 8.73) when compared to CG (121.59 ± 13.83) over a period of three months. Pain and trismus evaluation did not reveal any significant difference between TG & CG.

Conclusion: The clinical results of the ADDM graft procedure demonstrate satisfactory outcomes in extraction sockets. The findings of this study highlight the importance of preservation methods in maintaining the periodontal pocket depth distal to the second molar and the remaining alveolar ridge following extraction.