Journal of Maxillofacial & Oral Surgery最新文献

Purpose: The stability of mandibular advancement is critical for successful treatment. This study aimed to assess the stability of the mandible following bilateral sagittal split osteotomy (BSSO) with two modifications, namely, the Epker and Dal Point techniques.

Materials and methods: This pre-protocol prospective cohort study evaluated patients with retrognathia. Two BSSO modifications were studied: the Epker modification (group 1) and the Dal Pont modification (group 2). The primary outcome of this study was mandibular stability following advancement. The Epker and Dal Pont BSSO techniques were predictive variables. All measurements were performed before, immediately after, and 24 months after surgery.

Results: Sixty-seven of 92 patients who underwent BSSO for the correction of retrognathia met the inclusion criteria to participate in the study. There were 33 patients in Group 1 and 34 in Group 2. The mean relapse in the sagittal plane at the B point was 0.51 ± 1.12 mm in group 1 and 0.68 ± 0.81 mm in group 2. The two groups had no significant difference in the mean amount of sagittal relapse (p = 0.21). The mean vertical relapse at B point was 0.49 ± 0.57 mm in group 1 and 0.56 ± 0.10 mm in group 2. The results showed no significant differences between the two groups (p = 0.56).

Conclusion: The stability of mandibular advancement using the Epker and Dal Pont techniques was the same. The amount of relapse was closely correlated with the magnitude of advancement in both techniques.

Vascular malformations are congenital lesions from embryonic vascular disruptions, classified by the International Society for the Study of Vascular Anomalies (ISSVA) into low- and high-flow types with normal endothelial turnover. Phleboliths are calcified thrombi formed by stasis, which is rare in head and neck regions and exceptionally uncommon in pediatric lip lesions. This case report presents a rare manifestation of multiple phleboliths in a 10-year-old patient with a congenital venous malformation, while delineating the key diagnostic modalities and therapeutic interventions.

Background: Mandibular fractures constitute 57% of all maxillofacial trauma cases, particularly in developing countries such as India. The treatment of mandibular fractures involves either open reduction and internal fixation (ORIF), or closed reduction which is intermaxillary fixation (IMF). These fractures diminish the mandible's load-bearing capacity and compromise the functional ability of the patient. Masticatory efficiency, which measures the effectiveness of chewing, is a key indicator of the functionality of a remodeled mandible.

Aim: This study evaluates the masticatory efficiency and mandibular function as affected by open or closed reduction of mandibular fractures.

Materials and methods: In this study, 14 cases of mandibular fractures were divided into two groups, Group 1-open reduction; and Group 2-closed reduction. The following outcomes were evaluated; subjective evaluation of masticatory efficiency of chewing function questionnaire, occlusion was assessed clinically, and mandibular function was assessed by maximal interincisal opening, maximal protrusion, maximal lateral excursion, and maximal retrusion.

Result: Group 1 consisted of nine patients (64.29%), while Group 2 had five patients (35.71%). A significant difference was achieved in masticatory efficiency between Group 1 and Group 2 in Week 3 (0.025) and Week 6 (0.003). Mean values of Maximal Interincisal Opening (MOI) and their comparison at different intervals revealed that in Group 1, MIO values significantly improved from preoperative 19.69±6.60 to postoperative 33.11 ± 5.25 with p-value <.001.

Conclusions: The study concluded that mandibular function, as measured by mouth opening and occlusion, is similar in ORIF and IMF. Although both groups'masticatory efficiency improved significantly subjectively and objectively as compared to their preoperative efficiency, significant differences were observed. However masticatory efficiency is higher in ORIF patients than in IMF patients after 6 weeks.

Aim: This study aims to compare the volumetric changes of the orbit after using conventional technique or virtual navigation endoscopically integrated and virtual planning in orbital trauma.

Methods: This is an analytical prospective cohort study. The sample was subjects that underwent primary reconstruction for unilateral orbital deformities secondary to trauma. The population was divided into three groups: A control group in order to establish in our patients a reference of the standard difference between both orbits (Group 1). The conventional technique (Group 2) and virtual navigation endoscopically integrated combined with virtual planning (Group 3). Both groups were compared separately with the control group.

Results: In total, 18 patients were divided into three groups. In Group 2, the differential between the orbits was 6.31. In Group 3, the differential between both orbits was 1.14 finding statistically significant differences between Group 1 and Group 2 (p = 0.02), and between Group 2 and Group 3 (p = 0.03). Additionally, between Group 1 and Group 3 no statistically significant differences were found (p = 0.10).

Conclusion: Combining these two techniques into the same instrument for orbital reconstruction can be a great alternative and can be useful to decrease the risk of complications associated with this procedure and improve the results and sequelae.

Introduction: The prevalence of maxillary mucormycosis has surged in the wake of the COVID-19 pandemic. This study assesses the effectiveness of zygomatic implants and patient-specific 3D-manufactured implants in maxillary reconstruction post-mucormycosis secondary to COVID-19.

Methodology: Ten patients underwent surgical and prosthetic maxillary reconstruction utilizing zygomatic implants and patient-specific implants. Parameters including pain, implant exposure, infection, wound dehiscence, implant fit, post-operative surgical rating scale, oro-antral communication, facial edema, and orbital status were evaluated at baseline, 6 months, and 12 months post-surgery.

Results: Statistical analysis revealed a positive association using SPSS version 20. Zygomatic implants combined with patient-specific implant systems demonstrated efficient therapeutic outcomes for maxillary reconstruction, within the limitations of the study.

Conclusion: The study concludes that the integration of patient-specific implant systems with zygomatic implants offers a promising therapeutic approach for maxillary reconstruction post-mucormycosis secondary to COVID-19. However, further research with larger sample sizes and extended follow-up periods is warranted to validate these findings.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-024-02177-6.

Background: The angle of the mandible acts as a transitional zone between dentate and edentulous areas. It is a distinct anatomical subcomponent, suspended within robust masticatory muscles. Angle fractures are predominantly caused by low-kinetic-energy etiological factors like assaults and falls, while they are less associated with high kinetic energies. Bilateral angle fracture resulting from the subsequent accidental strangulation in the agricultural field stands as a singularly unique event necessitating immediate action.

Material and methods: We present a rare event where the patient had a bizarre machinery mishap while farming in the agricultural field. A 16-year-old female presented with persistent pain, restricted mouth opening, and malocclusion following a farming accident where her scarf became entangled in a thresher, causing sudden neck strangulation. Radiographic imaging, including cone beam computed tomography (CBCT), confirmed bilateral angle fractures extending to the developing third molars. The patient underwent intraoral open reduction and internal fixation using miniplates along Champy's osteosynthetic lines.

Results: Postoperatively, the patient experienced significant pain relief, restored occlusion, and an uneventful recovery. The mechanism of injury was attributed to force transmission through the suprahyoid musculature, deviating from conventional mandibular angle fracture etiologies.

Conclusion: This case underscores the importance of considering strangulation injuries as potential causes of mandibular fractures and highlights the role of meticulous clinical and radiographic assessment in ensuring comprehensive management. Given the rarity of such cases, further research is needed to understand the biomechanics of force transmission in maxillofacial trauma.

Background: Oroantral fistulas are challenging complications that often require surgical intervention for successful closure and long-term healing.

Purpose: To present a modified submucosal connective tissue flap technique that enhances closure stability and healing predictability in oroantral fistulas.

Methods: Following excision of the fistula and sinus debridement, a standard buccal advancement flap was elevated. A subepithelial connective tissue graft was harvested from the palatal mucosa using a partial-thickness dissection and stabilized using resorbable sutures anchored to bone perforations. The overlying buccal flap was then advanced and sutured to complete a bilayered closure.

Results: The technique allowed tension-free closure with improved flap stability and reduced donorsite morbidity. Postoperative healing was uneventful, and complete mucosal regeneration was observed within one month.

Conclusions: This bilayered closure technique, combining mechanical anchorage of a palatal graft with a buccal advancement flap, provides a reliable and predictable solution for oroantral fistula closure, particularly in edentulous or anatomically compromised cases.

Background: Temporomandibular joint reconstruction (TMJR) with standard alloplastic prosthesis is a reliable treatment for TMJ ankylosis, especially for recurrent cases.

Purpose: Long-standing TMJ ankylosis causes morphological changes in the mandible, resulting in ill adaptation of stock TMJ prosthesis over the ramus of the mandible with mediolateral and anteroposterior discrepancy. It makes it cumbersome for the surgeon to adapt the stock prosthesis to an ideal position during the procedure. In unilateral TMJ replacement surgery, the mediolateral inclination of the mandibular component cannot be appreciated under direct vision.

Technique: An intraoperative C-arm was used to visualize, compare and confirm the accurate mediolateral and anteroposterior position of stock TMJ prosthesis in unilateral total TMJ replacement, thereby placing the condylar unit in a near-ideal position. Various positions of C-arm were discussed.

Conclusion: The practice of intraoperative C-arm usage has helped the operating surgeon's ambiguity concerning the near-accurate three-dimensional position of the new condyle within the fossa.

Introduction: Central odontogenic fibroma (COF) manifests as a rare neoplasm of odontogenic ectomesenchyme. It establishes clinically as a progressively growing mass that eventually causes cortical expansion. On a radiograph, it appears as a single or multiple locular radiolucent lesion with occasional root resorption or displacement of adjacent teeth.

Case report: We put forth a case report of a 15-year-old girl who presented with the complaint of a swelling in the lower jaw. Radiographically, a multilocular radiolucency was noticed in relation to the root of the left lower premolar teeth.

Treatment: Surgical excision was performed under general anaesthesia. The lesion appeared to be firm on palpation with appreciable interface between the lesion and the bone. The lesion could be easily enucleated from the osseous com ponent.

Outcome: Painless gingival enlargement could potentially be a clinical manifestation of an COF which usually resembles any other odontogenic cyst or tumor.

Objective: This randomized controlled clinical trial evaluated the efficacy of 980 nm diode laser therapy as an adjunct to conventional treatment for acute pericoronitis.

Materials and methods: Ninety-two patients with acute pericoronitis were divided into a control group (n = 44) receiving standard treatment and a laser group (n = 48) receiving additional 980 nm diode laser therapy (7.07W/cm², pulsed wave mode, 30 s/site, once daily for 3 days). Outcomes including Modified Gingival Index (MGI), Visual Analog Scale (VAS) pain scores, maximum mouth opening (MMO), lymphadenopathy, and body temperature were assessed at baseline and day 4 post-treatment.

Results: The laser group exhibited significantly greater reductions in VAS pain scores (5.62 ± 1.71 to 0.92 ± 0.81 vs. 5.59 ± 1.57 to 1.73 ± 2.4; p < 0.05) and MGI scores (p < 0.05) compared to controls. Both groups showed comparable improvements in MMO (p > 0.05). Lymphadenopathy resolved in 58% of laser patients vs. 64% of controls, though not statistically significant(p > 0.05). All patients achieved normalized body temperature by day 4. Stratified reanalysis by type of impacted tooth revealed that the laser-treated mesially impacted group experienced significant improvements in postoperative pain (VAS; p < 0.001) and gingival inflammation (MGI; p = 0.005) in laser-treated Mesial impactions compared to the control group.

Conclusion: Adjunctive 980 nm diode laser therapy significantly enhances pain relief and reduces gingival inflammation in acute pericoronitis compared to conventional treatment alone, supporting its role as a non-invasive therapeutic adjunct.