Oral and Maxillofacial Surgery-Heidelberg最新文献

Purpose: Perioperative bleeding is a serious concern during orthognathic surgery. Tranexamic acid (TXA), a synthetic lysine analog with antifibrinolytic properties, reduces blood loss across various surgical fields. This study aimed to investigate the effectiveness of preoperative TXA administration in reducing intraoperative and postoperative blood loss following combined Le Fort I and sagittal split ramus osteotomies at our hospital.

Methods: This single-center, retrospective cohort study included patients who underwent combined Le Fort I and sagittal split ramus osteotomies between November 2017 and October 2022. The primary outcome was the volume of intraoperative blood loss.

Results: Among 1,329 eligible patients, 87 were included in the analysis (32 in the TXA group and 55 in the control group, where no TXA was administered). The median (interquartile range) intraoperative blood loss was 200.0 (157.5-237.5) mL in the TXA group and 260.0 (180.0-350.0) mL in the control group, showing a significant difference between the groups (p = 0.0365). However, postoperative blood drainage within 24 h and 24-48 h did not differ significantly between the two groups.

Conclusion: A single intravenous administration of TXA was associated with a decrease in intraoperative bleeding without severe adverse events during combined Le Fort I and sagittal split ramus osteotomies. However, postoperative blood loss, nausea, vomiting, and autologous blood transfusion were not significantly associated with this administration.

Purpose: To evaluate the effectiveness of CO₃Ap granules in the mandibular bone defects by using computed tomography (CT) images.

Methods: This study was retrospective case series of mandibular bone defect reconstruction using CO₃Ap granules. Six patients with jawbone cysts treated by simultaneous grafting CO₃Ap granules after cyst enucleation were enrolled. Patients without grafting CO₃Ap granules were excluded. Mandibular bone height including buccolingual bone height, the change of perpendicular distance between the buccolingual line to the alveolar ridge, and the three-dimensional volume of remaining CO₃Ap granules were analyzed using CT images obtained at 3, 6, 12, 18, and 24 months postoperatively.

Results: Postoperative CT images showed that cortical and cancellous bone-like structures were formed on the grafting area periphery and inside the defect, respectively, with gradual resorption of the CO₃Ap granules. Furthermore, there was no evidence of leaving bone defect even at the center of the lesion when the defect was successfully reconstructed by filling it with CO₃Ap granules. The percentage volume of remaining CO₃Ap granules to the volume at 3 months postoperatively were 76.1 ± 13.1%, 35.8 ± 22.5%, 25.0 ± 13.0%, and 9.9 ± 6.4% at 6, 12, 18, and 24 months postoperatively, and the volume reduction rate increased significantly within 12 months postoperatively.

Conclusion: Grafting CO₃Ap granules after the enucleation of a jawbone cyst is a good reconstructive treatment option for postoperative prosthetic treatment because CO₃Ap granules are gradually replaced by new bone while preserving the contour of the mandibular bone.

Clinical trial number: Not applicable.

Purpose: The objective of this study is to present the largest personal series of oral teratomas already published in English literature and discuss the diagnosis, neonatal management, and surgical treatment of this disorder.

Method: The study included patients treated by the senior author (RSF) between 2004 and 2023. Data were collected regarding prenatal evaluation, perinatal approach, surgical management, evolution, and treatment of secondary deformities. In addition, we performed a literature review on the topic.

Results: Twelve patients with oral teratoma were included in this study. Seven cases did not have been submitted to any previous treatment, and five cases had already undergone some treatment in another institution. Four cases were diagnosed as epignathus (33.3%), two as true teratomas (16.6%), four as teratoid teratomas (33.3%), one as dermoid teratoma (8.3%) and one as fetus in fetus (8.3%). All patients, except for one, had the tumor surgically removed with good evolution. There was one case of recurrence, successfully operated. The most frequently associated comorbidity was 0-14 fissure, present in 66% of the cases.

Conclusion: The experience of our twelve cases indicates that prenatal diagnosis, associated with good multidisciplinary planning of the delivery care, and complete resection of the masses reveal high success rates in the treatment of this pathology.

Clinical trial number: This study was performed in line with the principles of the declaration of Helsinki. Approval was granted by the Ethics Committee of Federal University of Paraná - 47102421.2.0000.5225.

Objectives: This study aimed to examine the relationship between computed tomography (CT) values of the condylar surface in the coronal plane, condylar morphology and the disc positions in the temporomandibular joint (TMJs) in patients with deformities before and after orthognathic surgery.  MATERIALS AND METHODS: The maximum CT values (pixel values) on the condylar surface, condylar thickness, condylar width, condylar angle, condylar height, and joint space were measured. TMJ disc position was classified into five types (anterior type, fully covered type, posterior type, anterior disc displacement with [AW] and without reduction [AWO]), using magnetic resonance imaging (MRI), before and 1 year after surgery. Statistical analysis was performed to assess differences between groups and between the pre- and postoperative values.  RESULTS: We enrolled 142 TMJs from 71 female patients diagnosed with jaw deformities. Disc position classification did not change after surgery in all TMJ. Significant differences were observed between anterior displacement (AW and AWO) and other types (fully covered type and posterior type) in the lateral CT value and condylar angle before and 1 year after surgery (P < 0.05).  CONCLUSIONS: This study demonstrated a strong relationship between condylar surface CT values in the coronal plane and condylar angle with TMJ disc position classification.

Purpose: The SARS-CoV2 pandemic introduced a new problem in postoperative outpatient care: If I set a follow-up appointment at the clinic, will I endanger my patient? This study presents a different way to identify problems in the postoperative setting after outpatient procedures in our field- the telephone interview.

Methods: A study nurse conducted the telephone interview using a structured questionnaire within one week of minor outpatient oral and maxillofacial surgery. She asked about pain, swelling, numbness, and mouth opening limitations. Certain red flag answers (numbness, increasing pain, increasing swelling, pain keeping patient from sleeping, pain on swallowing) caused her to book an appointment for the patient in our clinic within the following 24 hours.

Results: 52 Patients completed the telephone questionnaire. Of those 3 (5.7%) had red flag answers that resulted in an appointment at the hospital within 24 hours. 2 (3.8%) of them were due to numbness. 24 (46.2%) patients reported no pain. On the numerical rating scale from 0 (no pain) to 10 (worst pain), the average reported pain was 2.24 (SE 0.30). Swelling was reported by 39 (75%) patients. 22 (42.3%) reported the swelling to be mild, 10 (19.2%) moderate, and 7 (13.5%) to be severe. 13 (25%) patients reported a limitation to mouth opening. None reported the interincisal distance to be smaller than one finger.

Conclusion: A structured telephone questionnaire can be a useful tool to discern postoperative complications and initiate necessary treatment. At the same time, it minimizes overtreatment. It can be used as a standard tool in the ambulatory treatment. It can be delegated to a secretary or ambulatory nurse with a standardized questionnaire to optimize resource use for selected patients. Moreover, patients describe it as a service to be called at home and they avoid unnecessary travel.

Purpose: This study aims to compare the efficacy of two non-steroidal anti-inflammatory agents (NSAIDs), namely lornoxicam and etodolac for controlling pain, edema and trismus after removal of lower impacted third molars.

Materials and methods: A total of 20 patients comprised of both genders with bilateral impacted lower impacted third molars (in similar positions) was included in the present study. Patients were randomly assigned either to the lornoxicam group (8 mg of lornoxicam) or to the etodolac group (400 mg of etodolac). The drugs prescribed were handed out immediately after tooth extraction. Postoperative pain was assessed using visual analog scale (VAS). Edema was evaluated using reference lines on the face. Trismus was assessed using a caliper at maximum mouth opening (mm).

Results: There was no significant difference in postoperative pain, trismus, and edema between lornoxicam and etodolac group (p > 0.05).

Conclusions: Based on the results obtained in the present study, ıt has been verified that both lornoxicam and etodolac were adequately effective in the management of pain following third molar surgery. Lornoxicam and etodolac had similar impacts on pain, edema and trismus after impacted lower third molar surgical extractions.

Purpose: This study was performed to investigate the association of dental dysplasia with childhood cancer. We examined the occurrence of agenesis, microdontia, and enamel changes of permanent teeth in pediatric cancer survivors.

Methods: Seventy-six patients with pediatric cancer and hematologic diseases were referred to our department for the first time from October 2005 to December 2019. Of these, 17 patients who presented for a checkup in our department fulfilled the study criteria and were analyzed. Clinical examinations and panoramic radiographs were performed to investigate dental dysplasia of permanent teeth. A total of 34 developmental abnormalities (18 missing teeth, 16 cases of microdontia) occurred in 5 patients. The patients' medical records were also analyzed to assess the relationships of specific types of dysplasia with the treatment duration and cumulative drug dose administered.

Results: All five pediatric cancer survivors had dental dysplasia; all five had tooth agenesis, and four had microdontia. All five patients were < 4 years of age and had undergone high-dose chemotherapy.

Conclusion: In this study, childhood cancer survivors who received high-dose chemotherapy before age 4 years experienced the dental dysplasia, including tooth agenesis, microdontia. These findings highlight the need for careful dental monitoring and early intervention in pediatric patients undergoing high-dose chemotherapy.

Clinical trial number: This research was conducted in accordance with the Declaration of Helsinki and approved by the Medical Ethics Committee of the Medical University of Kobe (protocol code No. B230066, 1 September 2023).

Purpose: The aim of this study was to clarify the three-dimensional changes in maxillofacial morphology following orthognathic surgery using 3D-CT in patients with asymmetrical jaw deformities.

Methods: The subjects were 30 patients with asymmetrical jaw deformities. Three-dimensional images taken preoperatively and 6 months postoperatively were re-aligned using image processing software with the horizontal plane, coronal plane, and midsagittal plane as reference axes. Thirty-nine measurements including 28 distances, nine angles, and two volumes were recorded, and differences between preoperative and postoperative measurements and percentage differences between paired measurements on the deviated and unevolved sides were calculated.

Results: Translational and rotational movements of the maxillary dentition and mandibular body and the mandibular ramus internally rotating contributed to improved symmetry of the maxillofacial morphology, but the degree and proportion of these changes varied from case to case and mild asymmetry remained even after surgery.

Conclusions: 3D-CT analysis of maxillofacial morphology is essential to accurately evaluate the asymmetry of hard and soft tissue morphology in the maxillofacial region and the degree of improvement after orthognathic surgery, and the tooth movement during preoperative orthodontic treatment should be determined taking into account the movement of the upper and lower jaws during orthognathic surgery.

Purpose: To evaluate clinical presentations, computed tomography (CT) findings, and various prognostic factors affecting the surgical outcomes of trapdoor fractures.

Methods: This retrospective multi-center study reviewed medical records and orbital CT scans of patients under 21 years old, diagnosed with isolated trapdoor fractures. The study was conducted across multiple medical centers, including emergency and clinical departments in Isfahan, Shiraz, and Tehran-Iran. The characteristics and outcomes following surgical intervention were assessed.

Results: 45 patients with isolated trapdoor fractures were included in the study, with a mean age of 11.67 ± 4.69 years, predominantly male (84.4%). Vehicle accidents was the major cause of fractures (31.1%). 44 patients (97.8%) had orbital floor fracture, and one patient (2.2%) had medial wall involvement. Nausea/vomiting were reported in 41 patients (91.1%). Surgical intervention within 2 days, resulted in 85.0% of patients experiencing no postoperative diplopia. Delayed surgery beyond 2 days showed increased odds of diplopia, although not statistically significant. CT scan findings suggested a lower risk of diplopia in patients with soft tissue entrapment compared to muscle involvement (OR: 0.336, 95% CI: 0.077-1.462, p = 0.146). Shorter time to surgery (within 2 days) was significantly associated with normal postoperative eye movements (p = 0.002). Nausea/vomiting were more prevalent in patients with muscle entrapment (p < 0.05).

Conclusion: Surgical intervention within 48 h is crucial for improving ocular motility following trapdoor fractures. Extraocular symptoms, including nausea/vomiting, should raise suspicion for trapdoor fractures in cases of orbital trauma associated with ocular movement impairment.

Clinical trial number: Not applicable.

Objectives: In the present study, blends of polyvinyl alcohol (PVA), starch (SH), nanohydroxyapatite (Nano-HA), and reduced graphene oxide (r-GO) were used to fabricate an electrospun nano scaffold (ENS), via electrospinning for their potential application in oral and maxillofacial bone soft and hard tissue regeneration.

Materials and methods: The scaffold was characterized for its physicochemical and mechanical properties. An invitro study was carried out using human osteoblast MG-63 bone cells. Surface characterization, particularly the analysis of calcium content, was performed before and after immersion in the simulated body fluid (SBF). Additionally, the impact of surface treatment on antimicrobial activity was investigated.

Results: The results demonstrated that the tensile strength (18.12 ± 0.14 MPa), elongation at break (19.23 ± 0.11%), and flexing index (20.15 ± 0.13%) of the ENS were outstanding, indicating promising performance. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assays demonstrated the biocompatible nature of the ENS. The bioactivity test result of ENS showed excellent deposition of bone apatite crystals. The ENS exhibited antimicrobial properties against E. coli (3.41 ± 0.03 mm) and S. aureus (3.12 ± 0.08 mm).

Conclusions: The ENS, possessing the desired properties, has the potential to be tested in large animals for oral and maxillofacial bone and soft tissue regeneration after obtaining the necessary approvals. The developed ENS offers a promising solution for bone tissue regeneration in the oral and maxillofacial region.