Oral and Maxillofacial Surgery-Heidelberg最新文献

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.

Background: Immunoglobulin G4 related disease (IgG4-RD) is an immune-mediated, multifocal, fibroinflammatory disease with varied clinical manifestations. The involvement of head and neck region is infrequent. The objective was to report a case of localized IgG4-RD of mandible that clinically mimicked a lytic lesion.

Case presentation: A 22 year old female presented with restricted mouth opening and swelling over right ramus and angle region of mandible. Radiographic imaging showed an ill-defined radiolucent lytic lesion infiltrating adjacent muscles. An incisional biopsy was performed and histopathological picture was suggestive of benign spindle cell neoplasm. Immunohistochemistry was suggestive of IgG4-RD involving mandible adjoining soft tissues. Elevated serum IgG4 levels were noted. Oral steroid therapy was initiated and tapered without maintenance dose. The patient progressed without any sequelae. Imaging 2 years after completion of treatment showed complete resolution of the radiolucent lesion.

Conclusion: The precise diagnosis of this lesion is challenging and depends on many different factors. A non-specific localized lesion should be investigated as a systemic condition. Early diagnosis and prompt initiation of steroid therapy should be favored. Continued follow up is critical due to the indolent nature of this disease. The future of management of this disease is the development of specific diagnostic criteria and targeted therapy of head & neck lesions.

Purpose: This study aimed to evaluate the dental and skeletal stability one year after Miniscrew-Assisted Rapid Palatal Expansion (MARPE) by using 3D image data.

Methods: Patients with transverse maxillary deficiency from the age of 16 onwards were enrolled consecutively in this prospective longitudinal cohort study. The MARPE appliance was digitally and individually designed and fabricated. Cone-beam computed tomography (CBCT) scans and intra-oral scans (IOS) were acquired before the start of MARPE treatment (T0), immediately after active expansion (T1) and one-year post-expansion (T2). Nasal floor width (NFW), palatal alveolar width at the first molar (M1) and first premolar (P1) (PAW), nasal cavity width (NCW), intermolar width (IMW) and interpremolar width (IPW) were measured to assess the immediate (ΔT0-T1) and net (ΔT0-T2) skeletal and dentoalveolar expansion and relapse (ΔT1-T2). Potential correlations with age, sex and midpalatal suture maturation (MSM) stage were also investigated.

Results: Thirty-one patients (6 men, 25 women, mean age: 26.2 years) were included. The mean follow-up time (T0-T2) was 12.2 months. The initial NFW increase demonstrated a relapse of 0.6 ± 1.2 mm, or 11.6% of the initial expansion (p < 0.01). Expansion at the alveolar level remained stable during the follow-up. IPW also remained stable during the follow-up (4.2 ± 1.3 mm at T1; 4.4 ± 2.6 mm at T2). IMW exhibited a relapse of 3.8 ± 2.1 mm, or 60.2% of the initial expansion (p < 0.001) during T1-T2. There was no statistically significant correlation between stability and age, sex and MSM stage.

Conclusions: MARPE is an effective therapy for the correction of transverse maxillary discrepancy in late adolescents and adults, achieving a clinically stable skeletal outcome one year after expansion.

Purpose: Ameloblastoma is a benign tumor originating from odontogenic epithelium with a global incidence of about 0.5 cases per million persons per year. The overall recurrence rate of ameloblastomas range from 55% -90%. In this retrospective study we have analyzed the factors associated with recurrence and recurrence free survival in ameloblastoma of the jaws.

Methods: Retrospective chart review of 10 years was done from records directory. All demographic data, data on diagnostic modalities, clinical presentations, radiology, management and histology were taken into consideration. Kaplan Meir estimator was used to evaluate recurrence rate and Cox regression analysis (univariate and multivariate) was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence and influence recurrence free survival. ROC curve (Receiver Operating Characteristic) was used to find out the optimal cut off point for size of the lesion in predicting recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval.

Results: A total of 75 patients had recurrence with a median follow up of 65 months. The overall 5 year RFS was 19.5%. Conventional ameloblastomas, cortical/ soft tissue invasion, conservative treatment and tumor size ≥ 4 cm were independent predictors of recurrence.

Conclusion: Aggressive treatment is preferred for conventional ameloblastomas ≥ 4 cm with cortical/ soft tissue invasion.