Oral and Maxillofacial Surgery-Heidelberg最新文献

Purpose: The increasing use of direct oral anticoagulants (DOACs) in patients undergoing oral surgery highlights the need for well-defined, evidence-based recommendations on perioperative and postoperative bleeding management. This review aims to evaluate bleeding risks and strategies to optimize the management of patients treated with DOACs undergoing oral surgical procedures.

Methods: A systematic review identified 628 articles, of which 17 met the inclusion criteria. These studies focused exclusively on patients treated with DOACs-Dabigatran, Rivaroxaban, Apixaban, and Edoxaban-undergoing oral surgical procedures, such as tooth extractions, dental implants, and soft tissue surgical procedures. Articles involving other anticoagulants or combined therapies were excluded to ensure precision in evaluating DOAC-specific outcomes.

Results: The findings revealed that minor to moderate bleeding events were relatively common, while severe bleeding requiring hospitalization was rare. Bleeding events were effectively managed using standard local hemostatic measures in most cases. This review highlights the importance of scheduling procedures when DOAC levels are at their lowest, as this minimizes the risk of excessive bleeding. Furthermore, the continuation of DOAC therapy during oral surgery was deemed safe, with effective local management strategies mitigating bleeding risks.

Conclusion: This review offers practical, evidence-based recommendations for the management of patients on DOAC therapy undergoing oral surgical procedures. The findings simplify clinical decision-making and improve patient safety by emphasizing the importance of timing and perioperative strategies. The exclusive focus on DOACs underscores the clinical significance of this work in guiding oral and maxillofacial surgeons.

Objectives: Considering the increase in regenerative dental treatments, autologous fibrin membranes (ARMs) have been widely used in tissue engineering, favoring the regeneration of hard and soft tissues, accelerating angiogenesis and promoting cell differentiation and migration. This study proposed evaluate the differences in clinical characteristics and levels of the growth factors BMP-2, IGF, PDGF and VEGF between smokers and nonsmokers were evaluated according to the guidelines of the US Preventive Service Task Force (USPSTF).

Materials and methods: Fourteen smokers and 14 nonsmokers were selected. After processing, the samples were allowed to rest in tubes for 5 min for the organization of the matrix and completion of the fibrin clot. Only the yellow portion and the buffy coat were removed and stored. Four clots were obtained from each donor and used to quantify the release of the growth factors BMP2, PDGF, IGF and VEGF. In addition, histological analyses were performed, and clinical characteristics were evaluated.

Results: The data were tabulated and subjected to statistical analysis with a significance level of 5%. In both groups, the membranes remained intact throughout the analysis period, indicating similar structural behavior. Histological evaluation of the membranes obtained from the participants revealed the presence of more homogeneous fibrin membranes in the nonsmoker group and many leukocytes bordering the entire fibrin clot. In the smoker group, heterogeneous fibrin clots, sometimes malformed, and fewer leukocytes in the region of the buffy coat and bordering the entire fibrin were observed.

Conclusions: Smokers had significantly lower levels of VEGF, PDGF and BMP-2 (pg/ml in 1 µg total protein) than smokers did (p < 0.05), and there was no significant difference in IGF levels (p > 0.05) between the groups. There was also no statistically significant difference in membrane size between smokers and nonsmokers (mm, p > 0.05).

Clinical relevance: Smoking may interfere with the formation of the fibrin mesh and consequently affects the quality and regenerative capacity in in smoking patients.

Purpose: To assess the clinical utility of the 3D 4K exoscope for reconstructive head and neck surgery.

Methods: This retrospective study analyzed surgical details and complications with the use of the 3D 4K exoscope for microvascular reconstruction at a high-volume Department of Oral and Maxillofacial Surgery, compared to the use of a 2D microscope. Patients with oral cancer undergoing microvascular reconstruction were categorized into two cohorts based on the intraoperative use of the 3D 4K exoscope (Orbeye™, Olympus, Tokyo, Japan) or a conventional microscope (ZEISS S8 - OPMI Vario, Carl Zeiss AG, Oberkochen, Germany; Leica M680, Leica Mikrosysteme Vertrieb GmbH, Wetzlar, Germany) during a six-month study period, respectively. Outcomes were also compared between two time periods of the exoscope use to assess the learning curve over time.

Results: The exoscope was applied for microvascular anastomosis in 55 surgical cases (cohort 1), and the conventional microscope was employed in 56 cases (cohort 2). The rates of postoperative complications within 14 days following the use of the exoscope were 14.5% (N = 8), compared to 16.1% (N = 9) in cohort 2. Analysis over time demonstrated a learning curve with the exoscope, reflected in a decrease in postoperative complications within 14 days from 22.7 to 9.1%.

Conclusion: The three-dimensional camera system provides excellent and reliable intraoperative visualization in reconstructive head and neck surgery. Transitioning to this new technology did not lead to an increase in intra- or postoperative complications, but the successful implementation requires some experience with the device.

Purpose: To investigate the anatomical variations and measure the distances between surgically relevant structures in the maxilla associated with Le Fort I osteotomy in patients with maxillary canting using cone beam computed tomography (CBCT).

Methods: CBCT scans of 63 patients (21 males and 42 females) with maxillary canting who were indicated for orthognathic surgical planning were retrospectively investigated and analyzed. The distances of the relevant anatomical structures, including the descending palatine artery, pterygomaxillary junction, infraorbital foramen, and nasolacrimal duct opening, were measured with the key anatomical landmarks to evaluate their variations. The independent correlations of measurements with magnitude of canting were examined, considering a 5% significance level.

Results: Among the 63 patients, the mean vertical difference of maxillary canting was 3.26 ± 0.98 mm and 3.62° ± 1.09°. The descending palatine artery differed significantly in distance between the longer and shorter sides (P < 0.001). Similar significant differences were found in the pterygomaxillary junction distance (P < 0.001), pterygomaxillary junction height (P < 0.001), and infraorbital foramen distance (P = 0.009). Every 1 mm of maxillary canting increases the pterygomaxillary junction distance by 0.1721 mm, pterygomaxillary junction height by 0.2773 mm, infraorbital foramen by 0.3301 mm, and nasolacrimal duct in 0.2255 mm.

Conclusion: Maxillary canting significantly affects the morphometrics of pterygomaxillary junction distance and height, infraorbital foramen, and nasolacrimal duct on the longer and shorter sides. Therefore, these surgical anatomies should be of concern when performing Le Fort I osteotomy in patients with maxillary canting.

Clinical trial number: Not applicable.

Purpose: Alcohol use has been shown to affect injury patterns and risk of trauma. This study aims to characterize the epidemiologic characteristics of alcohol involved facial injuries presenting to US emergency departments.

Methods: This study reports a cross-sectional analysis of patients with facial injuries within the National Electronic Injury Surveillance System (NEISS). Demographics, disposition, and mechanism of injury were compared between facial injury patients with reported/suspected alcohol consumption prior to or during the time of injury (AIFI+) and facial injury patients with no alcohol consumption (AIFI-).

Results: A total of 37,777 facial injuries were reported within the NEISS. Out if these, 3,336 patients experienced an alcohol involved facial injury (AIFI+). AIFI + patients were younger than AIFI- patients (47 vs. 57, p < 0.001), more likely to be male (68.5% vs. 31.5%, p < 0.001), and more likely to be White (51.6% vs. 53.6%, p = 0.03). Patients with AIFI were less likely to be injured at home (41.5% vs. 45.5%, p < 0.001) and more likely to be injured in the street (8.5% vs. 4.5%, p < 0.001). Disposition differed with AIFI + patients less likely to be treated and released (78.8% vs. 83.3%, p < 0.001) and more likely to leave without being seen (3.8% vs. 1.8%, p < 0.001).

Conclusions: Our study reports that AIFI + patients are younger, more likely to be injured on the street, and more likely to be injured by stairs than AIFI- patients. Additionally, patients with an AIFI + are more likely to leave the hospital without being seen.

Purpose: Preoperative virtual planning and osteosynthesis with patient-specific implants (PSIs) have become a quotidian approach to many maxillofacial elective surgery setups. When a process is well-organized, a similar approach can be harnessed to serve the needs of exact primary reconstructions, especially in midfacial trauma cases. PSI osteosynthesis of the mandible is, however, more challenging because a mirror technique of the facial sides is often unreliable due to inherent lack of symmetry, and movement of the mandible increases the risk of loosening of the osteosynthesis. The purpose of this study was to present clinical results of the Helsinki protocol concept of utilizing PSIs in the primary surgery of unilateral mandibular subcondylar fractures as the first publication on the subject.

Methods: A single-center study of a new Helsinki protocol is presented for surgical treatment of subcondylar mandibular fractures using patient-specific, titanium-milled repositator plates. Ten patients with dislocated subcondylar mandibular fractures received surgery and osteosynthesis with PSI via a retromandibular approach.

Results: Clinical and radiological outcomes were excellent; none of the patients had fixation-related major complications or developed postoperative malocclusion.

Conclusions: Study results show that the Helsinki protocol, treating mandibular condylar fractures primarily with PSI plates, is a viable treatment option.

Purpose: Coronectomy is a valuable treatment proven safe for non-pathological mandibular third molars with an increased risk of inferior alveolar nerve injury. Coronectomy may also be useful for mandibular third molars with dentigerous cysts and caries, but this is not commonly performed due to the lack of well-designed, evidence-based studies. Here, we aim to investigate the safety of coronectomy for mandibular third molars with caries and dentigerous cysts.

Methods: One hundred fifteen patients with an impacted mandibular third molar with a dentigerous cyst or caries underwent coronectomy or complete removal and received follow-up with clinical and radiographical examinations. We statistically compared the presence of postoperative complications after coronectomy versus complete removal.

Results: Data from 121 molars were available for analysis. The results revealed no significant difference in the occurrence of postoperative complications (including persistent pain, inferior alveolar nerve injury, infection, alveolar osteitis, excessive bleeding, and the need for retreatment) between coronectomy and complete removal. Additionally, the incidence of postoperative complications was not related to any analyzed patient- or molar-related factors, including age, gender, health status, smoking, caries, dentigerous cyst extent, and impaction degree.

Conclusion: For pathological impacted mandibular third molars with dentigerous cysts and caries, coronectomy exhibited both short-term and long-term safety, showing no significant difference in postoperative complications compared to total removal. Our results suggest that coronectomy can be indicated for pathological mandibular third molars with proximity to the inferior alveolar nerve.

Trial registration number: Not applicable.

Background: Hybrid Odontogenic Tumors (HOT) are defined by the presence of two or more independent odontogenic tumors that originate from and affect the same maxillofacial site.

Methods: The present study is the first case report of a mandibular HOT consisting of Ameloblastoma, Calcifying Epithelial Odontogenic Tumor, and Ameloblastic Fibroma.

Case report: A 37-year-old otherwise healthy male presented with the chief complaint of swelling in the right mandibular body. On extraoral examination, mild facial asymmetry and stable occlusion were observed. Intraoral examination was significant for an erythematous, sessile, and indurated swelling in the buccal gingiva and mucosa, with ulceration in the lower right cervical pre-molar region. The computed tomography scan indicated a mandibular osteolytic, multilocular, and expansile lesion with areas of bone fenestration extending from the lower left lateral incisor to the right second molar. The patient underwent resection of the lesion through an intraoral approach with a 1 cm safety margin. Reconstruction was performed with a microvascularized fibula flap to restore function and achieve an acceptable cosmetic result. The patient is currently at a ten-year follow-up without recurrence.

Conclusions: Understanding the pathogenesis and pathophysiology of these complex lesions is necessary to improve comprehension, treatment, and surgical outcomes. Despite the rarity of hybrid lesions, they should be considered in the differential diagnosis, especially in large odontogenic pathologies. Due to microscopic variability, they require multiple biopsies and a thorough examination of the specimens to confirm the co-existence of two or more entities.

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.

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.