Journal of Maxillofacial & Oral Surgery最新文献

Background: The anterolateral thigh flap is a versatile flap that offers many advantages. These include a long and reliable pedicle that enables a wide arc of rotation, the possibility to harvest a large skin area, raising the flap with underlying fascia and minimal donor site morbidity. The purpose of this study is to show better esthetics and function with the use of ALT perforator flap in head and neck region. It is a large prospective case study done in our institute with regular follow-up which shows the outcomes of ALT flap.

Materials and method: From 2020 to 2022, hundred patients were reconstructed with anterolateral thigh flap. The flap was used for reconstruction in head and neck region. The patient group consisted of 53 males and 47 females. The age range was 30-90 years with a mean age of 61 years. Patients who had extensive soft tissue defect in the head and neck and had been reconstructed by free ALT flap have been reported. Flap data (type, length, and width), duration of flap elevation, donor-site morbidity, post-operative complications, and follow-up data including aesthetic and functional outcome were recorded.

Results: We experienced no flap loss. The donor site was closed directly in twenty-eight out of eighty patients, and the remaining twenty patients were closed by split thickness skin grafting. Satisfactory aesthetic and functional outcome were achieved in all patients.

Conclusion: Our experience illustrates the versatility in the clinical application of the anterolateral thigh flap. The many advantages of the flap, such as the long and reliable pedicle, a large area of skin that can be harvested, the potential to supercharge the flap and the minimal donor site morbidity, highlight the diversity of defects that can be reconstructed using this flap.

Aim: The aim of our study is to compare two plating techniques (delta plate and two miniplates) biomechanically, and to conclude which one is the more stable in the treatment of subcondylar fractures.

Materials and methods: 3D model of human mandible was constructed on work bench solid works program and manipulated to mimic true subcondylar fracture with proximal and distal parts fully separated, three designs of plating techniques was constructed and wrapped on the mandible model, the final two models was exported to FEM software as solid models with masticatory muscles molded bilaterally in addition to contralateral molar clenching task, linear elastic solution was constructed for each model and results was assigned according to von misses stresses upon hardware, jaw bone and total model deformation in each configuration.

Result: Double plating 2.0 design showed optimal results compared to delta plate.

Conclusion: Double plating 2.0 design is the gold standard and the best method of fixation for the mandibular subcondylar fractures provided that available space is enough for the application of the two plates.

Oral chemical burns result due to ingestion of a chemical accidentally into the mouth, causing burns in the oral mucosa, esophagus, stomach, and upper digestive tract if swallowed. Oral chemical burns mainly happen in children. The current case report describes a rare case of a child who ingested POTASH (potassium hydroxide (KOH) (a caustic chemical used as a detergent in clothes washing in law socioeconomic standard Egyptian places) at home and developed chemical burns that resulted in total ankyloglossia. This case was further complicated through mishandling by a general dentist. This case report describes a detailed protocol for the management of such cases.

Aim: To assess, compare and evaluate the better effectiveness of metronidazole compared to conventional therapy for dry socket through a meta-analysis.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used and registered in PROSPERO-CRD42023440597. Electronic databases were searched until April 2023 for studies evaluating the effectiveness of metronidazole compared to placebo and other conventional therapy and evaluating outcome in terms of reduction of incidence of dry socket, swelling and impact on healing. Quality assessment was evaluated using Cochrane risk of bias (ROB)-2 tool for randomized controlled trials (RCT) through its domains using RevMan software version 5.3. The risk ratio (RR) was used as summary statistic measure with random effect model (p < 0.05).

Results: Twelve studies were included in review and eleven studies for meta-analysis. Quality assessment revealed a moderate to low ROB. It was observed that pooled estimate favoured metronidazole in reducing dry socket incidence-RR - 0.57 (95% CI - 0.24-1.33), reduction in swelling with RR - 0.62 (95% CI 0.12-3.25) and a greater impact on healing with RR - 0.25 (95% CI 0.12-0.52) were seen. Metronidazole was found to be superior compared to the placebo or conventional therapy. Funnel plot did reveal the presence of heterogeneity indicating the presence of publication bias.

Clinical significance: Since, dry socket is the most common complication following third molar surgery, it is important for a clinician to take adequate precautions and consider regimes that can aid in reducing this incidence.

Aim: Analyzing quality of Randomized Controlled trials (RCTs) published in the Journal of Maxillofacial and Oral Surgery (MAOS) since inception using Cochrane Risk of Bias tool version 2.0.

Methodology: Three authors independently screened and evaluated the RCTs according to Cochrane Risk of Bias tool version 2.0 based on the exclusion and inclusion criteria. All six domains of the RoB 2.0 tool were analyzed. The assessment of each judgment can be "Low" or "High" risk of bias, or can express "Some concerns."

Results: "Some concerns" were found in the randomization process (57%), and "low ROB" was evaluated in the second domain (57%), third domain (96%) and fourth domain (53%).In fifth domain, maximum of the articles had shown either some concerns in ROB (49%) or low ROB (45%).Analysis of the overall ROB in the included articles, maximum of the articles (50%) of the articles had shown high ROB followed by articles with some concerns in the ROB assessment (36%) and only 14% of the included article shad shown the low ROB in the RCT methodology.

Conclusion: The methodological and reporting quality in MAOS journal has a significant room for improvement.

Introduction: Surgical loupes and microscopes are the gold standard in microvascular surgery, but they have various pitfalls. Smartphones have recently bridged the gap and are able to provide a high-quality image in a cost effective manner. But is this enough to replace traditional methods? The objective of this study was to compare the time taken to perform end-to-end microvascular anastomosis, and the error rate in head and neck oncology, in which a free fibula graft was used for reconstruction using smartphones and standard operative microscopes.

Materials and methods: Twenty-four patients were divided into three groups of eight for each magnification method. Smartphone 1, Smartphone 2 and Microscope. Patients undergoing free fibula graft reconstruction in head and neck oncology were enrolled for this study. A single microvascular surgeon operated. Anastomosis time and error rate based on Anastomosis Lapse Index was recorded.

Results: Anastomosis time was increased in smartphone 1 and smartphone 2 compared to the microscope (p = 0.002) and (p = 0.001), respectively. Error rate was not statistically significant.

Conclusion: Microvascular anastomosis can be performed effectively with a smartphone with an experienced surgeon.

Purpose: Inferior alveolar nerve is commonly encountered by the dental and maxillofacial surgeons in their routine dental practice. This nerve usually gives off a mylohyoid branch before it enters the mandibular foramen. Though predominantly considered to be motor nerve, mylohyoid nerve has also sensory innervations to inferior part of chin and aids in speaking, chewing and swallowing. This paper attempts to throw an insight into the various anatomical patterns of inferior alveolar nerve in infratemporal fossa as observed in cadaveric dissection of 40 specimens.

Methods: The study involved bilateral dissection of 20 human heads comprising a total of 40 dissected sides of infratemporal fossa to observe the nerve pattern.

Results: The inferior alveolar nerve followed its regular anatomical pattern in 37 specimens. Anomalies in its branching pattern were noted with respect to mylohyoid nerve in 3 of 40 specimens-7.5%. Two specimens had mylohyoid nerve branching directly from mandibular nerve, and one specimen had medial branching pattern of mylohyoid nerve.

Conclusion: Anatomical variations are rare but can occur. Variations in relation to branching patterns of mylohyoid nerve have been described in this article with review of literature. Knowledge and understanding about these anatomical variations are essential for the dental surgeons to identify the cause of failure after local anesthetic injections, to recognize the signs and symptoms of nerve damage and for the preservation of nerve during major surgical procedures.

Purpose: To compare the effects of cryotherapy and LLLT in minimizing edema, post-operative pain, trismus and post-operative discomfort after surgical removal of impacted mandibular third molars under local anesthesia.

Material method: 80 patients between the ages 18-50 years of either gender fulfilling the inclusion criteria were selected for the randomized, prospective, single-blind clinical trial. Bilaterally symmetrical mandibular impacted third molars were selected for the study and randomly designated into two groups (Group 1- LLLT, Group 2- CRYOTHERAPY) each. Along with pain, trismus and swelling, POSSe (post-symptom severity scale) was used for assessment of postoperative discomfort throughout the 7 days.

Results: Pain and swelling scores were generally better in cryotherapy group when compared to LLLT Group, specifically in first 3 postoperative days. However, trismus in first 3 postoperative days was significantly less in LLLT group than in the cryotherapy group. Postoperative mouth opening exhibited a reduction of 3.60% in the laser group, where LLLT irradiation was done, whereas in the cryotherapy group, it was much larger, around 17.96%. On evaluating the POSSe, in LLLT group, mostly patients reported that they were affected in enjoyment of food, approximately 40% more than cryotherapy group.

Conclusion: The mechanism of action and result outcomes for cryotherapy and LLLT has the potential to improve the quality of patient care provided by vast majority of clinicians in third molar surgery but when compared pain and swelling were better controlled with cryotherapy and trismus was better dealt with LLLT.

Introduction: Transport distraction osteogenesis (TDO) is a novel reconstructive modality for mandibular ablative defects, precluding donor site morbidity. Assessing of TDO regenerate that could assist in modifying the distraction strategy for patient specific needs.

Materials and methods: Present study enrolled 17 patients with mandibular defects of size < 12 cm, divided in two groups ≤35 years (A) and > 35 years (B); and assessed the TDO regenerate by clinically examining intra as well as post operatively, using orthopantomogram (OPG), ultrasonography (USG), color Doppler (CD) and cone beam computed tomography (CBCT).

Results: Group B had a longer latency period (p = 0.001) and consolidation period (p = 0.002) than group A. Paired sample correlation study of clinical defect and TDO regenerate (p 0.004) indicate that a better length of regenerate is possible with TDO in mandibular defects. OPG, USG and CBCT shown a significant difference in bone mineralization observed within different age groups except for CD. USG representing earlier detection of mineralization than OPG over the consolidation period.

Conclusion: Use of TDO for reconstruction of mandibular defects is advantageous as the regenerated bone and soft tissues matches the existing anatomical tissues. Evaluation by USG, OPG and CBCT could aid in providing patient specific protocols for TDO in Maxillofacial region.