Journal of Maxillofacial & Oral Surgery最新文献

Purpose: Management of comminuted mandible fracture can be either conservative or open reduction and internal fixation (ORIF). The purpose of the present case series is to reinforce ORIF for extensive comminuted mandible (ECM) fractures. The specific aim is to present a stepwise approach to manage these fractures.

Material and methods: The investigators designed a retrospective study in a tertiary care hospital in India. The study sample consisted of patients of extensive comminuted mandible fracture managed with ORIF. The patients having an extensive comminuted fracture of mandible with complete records were included as study subjects, irrespective of age and gender. The data collected were age, gender, mode of injury, type of fractures, concomitant injuries, timing of treatment, the outcomes and complications, if any. The authors have described a stepwise approach to convert a complex task into easy task to achieve better results.

Results: In these retrospective case series, the authors have presented 5 cases of severely comminuted mandible fracture managed with ORIF from January 2022 to March 2023. All patients were young with age range was 17-27 years. The male to female ratio was 1.5:1. The mode of injury was fall from height in 3 cases and road traffic accident in 2 cases. Out of 5 patients, 4 had concomitant orthopedic injury and rest 1 had isolated maxillofacial injury. The follow-up ranged from 48 days to 15 months. No major complication was seen in any of the patient.

Conclusion: Open reduction and internal fixation provide promising results for extensive comminuted mandible fractures with minimal complication rate. Sequential stepwise approach should be followed in these fractures.

Aim: Autologous blood injections (ABI) have shown promise in treating temporomandibular joint (TMJ) dislocation, but the underlying mechanism of action remains unclear. This study aimed to investigate the histological changes in the TMJ of rabbits after ABI at various time points.

Methods: Eighteen white New Zealand rabbits were allocated into a control group (n = 4) and a study group (n = 14). The study group underwent ABI in the TMJ superior joint space and peri-capsular area; while, the control group received no interventions. The rabbits were euthanized at different time intervals: 2 weeks (n = 2), 4 weeks (n = 2), 6 weeks (n = 6), and 10 weeks (n = 4) post-injections. Histological examination was conducted to assess the TMJ for changes in articular cartilage, chondrocyte appearance, osteochondral junction, subchondral bone structure, inflammation, and fibrosis.

Results: During the early weeks (2 and 4), cartilage thickening, chondrocyte clustering, and signs of inflammation were observed. Conversely, in the late weeks (6 and 10), cartilage thinning, hypocellular chondrocytes, disruptions in the osteochondral junction, and increased subchondral bone trabeculation were evident. No fibrosis was noted in any group.

Conclusion: The histological changes occurring in the TMJ of rabbits following ABI is dynamic and changing at different time points. We reported early cartilage thickening and late thinning. Fibrosis was not noted to play a role in our sample.

Background: Oral squamous cell carcinoma (OSCC) comprises a significant proportion of head and neck cancers, with alarming incidence rates in India. Despite tobacco's known role, a concerning rise in OSCC among non-tobacco users poses an intriguing challenge.

Objective: This ten-year retrospective study aimed to compare the clinicopathological features of OSCC in patients with and without habits, focusing on the unique characteristics of OSCC in non-tobacco users.

Methods: Reviewing clinical records from 2012 to 2022, we gathered demographic and histopathological data, conducting statistical analyses using SPSS version 19.

Results: 83% of the subjects with OSCC had a known history of tobacco use, and 17% were non-tobacco users. Non-tobacco users exhibited distinct features, including a higher prevalence of well-differentiated SCC, more females, and an increased incidence of tongue cancers-statistically significant findings.

Conclusion: This study highlights the unique clinicopathological features of OSCC in non-tobacco users, challenging conventional notions. Despite limitations in survival analysis, our findings underscore the need for targeted research into OSCC among non-tobacco users for improved preventive and therapeutic strategies. The study successfully confirmed the clinical distinctiveness of non-tobacco-induced oral cancers, setting the stage for future prospective research into the survival and prognosis of these two distinct groups.

Purpose: This systematic review and meta-analysis evaluated the role of 3D virtual surgical planning (VSP) in orthognathic surgery compared to traditional surgical planning (TSP).

Methods: Studies were identified from databases, including PubMed, Scopus, The Cochrane Library, Google Scholar, and ScienceDirect, using PICO eligibility criteria. Thirteen studies met the inclusion criteria, with four included in the meta-analysis. The quality of the studies was assessed using RoB-2 for RCTs and ROBINS-I for non-RCTs, and the certainty of the evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Inter-reviewer agreement was assessed with a kappa statistic of 0.82.

Results: According to the meta-analysis, in the SNA and SNB subgroups, no significant differences were observed between 3D VSP and TSP (p = 0.85, p = 0.81) with 0% heterogeneity. Similarly, no significant differences were found in the horizontal and vertical skeletal component subgroups (p = 0.52, p = 0.47) with 0% heterogeneity. These findings suggest comparable accuracy between VSP and TSP in key cephalometric measurements. RCTs were generally of good quality, while non-RCTs showed varying bias levels. The GRADE assessment indicated high certainty in outcomes.

Conclusion: The differences between VSP and TSP were not statistically significant, and both had the same outcomes. VSP is recommended for complex cases requiring enhanced visualization and interdisciplinary collaboration. Future research should aim to standardize variables for improved study comparability.

Introduction: The reconstruction of lip defects while maintaining its functional and esthetic properties serves a daunting challenge to the surgeon. Various surgeons have described variety of techniques, ranging from local composite flaps to free flaps. But not one single procedure has fulfilled all requirements. We describe a novel method of using bilaterally harvested subcutaneous naso-labial (NL) flaps sandwiched onto each other with a bucket handle mucosal transfer from upper lip to reconstruct full thickness lower lip and vermilion defects in 10 patients.

Materials and methods: A retrospective review of the data of 10 patients of carcinoma of the lower lip reconstructed with this technique between April 2019 and May 2022 was done. Patient- and disease-related factors along with flap-related complications were analyzed.

Results: The bilateral NL flaps were used for construction of lower lip defects in 10 male patients. Mean age of the study population was 49.7 years (41-60 years). Major or minor complications were seen in 5 patients (50%). Complete flap loss was seen in one patient; three patients suffered from partial necrosis of the distal end of the outer flap. Two patients developed oral incontinence and two patients were referred to a speech therapist for partially unintelligible speech.

Conclusion: Ease of harvest, short learning curve, similar skin color as of the lost skin, a versatile blood supply with minimal morbidity and satisfactory outcomes makes the bilateral subcutaneous NL flaps sandwiched onto each other a potentially acceptable method of reconstructing full thickness lower lip defects.

Background: Reconstruction with medial sural artery perforator flap is gaining popularity and is subject of study since a decade in oral squamous cell carcinoma cases. This flap is proving to have more benefits over other free flap reconstructive options. Our study presents an evaluation of functional and esthetic outcomes in a large number of OSCC patients reconstructed with MSAP flaps.

Material and methods: Total number of 120 patients from 2020 to 2022 with OSCCs underwent reconstruction using MSAPs. The carcinoma involved buccal mucosa, tongue, floor of mouth. Pre- and intra-operative parameters were evaluated along with complications. Functional evaluation in terms of speech and diet was carried out. Patient's visual analog scores (VAS) were recorded for esthetic evaluation.

Results: Only 10 cases showed failure due to venous and arterial congestion. Normal speech with unrestricted diet intake was achieved in majority of the patients. Primary closure was performed at the donor site in 98.3% of patients, which showed good esthetic results.

Conclusion: MSAP flap is a versatile reconstructive method for small to medium defects in oral and maxillofacial region. The flap is less bulky, has a longer vascular pedicle, is pliable and has minimum donor site morbidity.

Background: Understanding the impact of anatomical factors in mandibular third molar surgery is crucial for minimizing the risk of nerve damage and improving patient outcomes.

Materials and methods: Prospective studies published in English language and based on anatomical risk factors associated with inferior alveolar nerve injury during lower third molar surgery were incorporated. A comprehensive online and manual search of English language literature with no date restrictions was done in November 2023. Of the 101 studies, only 9 were included for the qualitative analysis. The variables assessed were as follows: type of preoperative assessment, duration of follow-up, incidence of temporary or permanent paresthesia, and criteria used to identify the type of impaction, proximity to inferior alveolar nerve canal (IAC), and IAC shape.

Results: Around 22.22% of the studies did a follow-up period of 2 years, radiographic techniques employed included intraoral periapical radiograph (IOPA), panoramic (PAN) radiographs, cone beam computed tomography (CBCT) and a combination of PAN and CBCT, IOPA and shift cone technique in 11% of the studies while in 22% of the studies radiographs type was unspecified; the type of impaction criteria was assessed in six studies using various criteria based on degree of impaction, Pell and Gregory classification and Ma'aita & Alwrikat classification; IAC shape evaluation was done in two studies; paresthesia incidence was observed in 89% of the studies and proximity of anatomical landmarks to the IAC was observed in all nine studies which employed different classifications based on Rood and Shehab, Maglione's, Felez-Guiterrez et al. and > 2 mm / < 2 mm theory. Additionally, studies have shown that the use of CBCT imaging can significantly improve the accuracy of preoperative risk assessment for inferior alveolar nerve injury.

Conclusion: Certain anatomical factors raise inferior alveolar nerve injury risk, but careful preoperative planning mitigates it while standardized assessments aid meta-analysis. Furthermore, the use of advanced imaging techniques like CBCT can enhance the precision of preoperative risk assessment, potentially leading to better surgical outcomes and reduced complications.

Background: Mandibular resections are essential for managing a range of jaw pathologies. These surgeries often lead to significant tissue deficits, impacting patients' functionality and quality of life. Achieving pre-operative mandibular functionality while minimizing surgical complications remains a major challenge, further compounded by the psychological distress experienced by patients due to potential disfigurement and loss of function.

Objectives: This surgical technique is designed to preserve the original condylar position of the mandible, thereby maintaining occlusion and aesthetic harmony postsurgery. The technique focuses on overcoming the challenges associated with three-dimensional control of mandibular segments post-resection, including segmental torquing, inter-segmental spacing, and condylar positioning.

Methods: The technique involves stabilizing the mandible in maximum intercuspation using intermaxillary fixation (IMF) or manual methods prior to resection. A miniplate is then affixed to the lateral aspect of the ramus or coronoid process and extended to the maxilla, ensuring mandibular stability throughout the procedure. This approach facilitates accurate resection and reconstruction, minimizing the risk of occlusal discrepancies and maintaining the temporomandibular joint (TMJ) relationship postoperatively.

Outcome: The application of this technique resulted in maintenance of TMJ relationship as confirmed by follow-up CT scans.