Journal of Maxillofacial & Oral Surgery最新文献

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.

Aim: The purpose of the present study was to compare the clinical outcomes between two different types of open joint procedures in Wilkes Grade III TMJ internal derangement patients after failure of conservative (nonsurgical) treatment and arthrocentesis.

Methods: Patients were retrospectively reviewed from an institutional database. Subjects were divided into two groups and were followed up at four different time points. The primary outcome variable was change in TMJ pain. A 10 cm standard visual analogue scale (VAS) assessment was used to evaluate outcomes. Individual time points were compared to baseline pain scores using a student t test. Significance was determined at an alpha level of 0.05.

Results: Sample included 18 patients in group 1 for discectomy and 15 in group 2 for disc repositioning. Improved postoperative pain score was noted at all recorded time points for both groups 1 and 2 (p < 0.001). Most significant pain improvement was noted after subsequent intervention at T4. Mild decrease in MIO was noted in both groups; however, no significant difference was noted between groups (p = 0.66).

Conclusion: Both disc repositioning and discectomy lead to improved postoperative pain control in this select cohort of patients. More than a third of these patients required a subsequent surgical intervention for more optimal pain control.

Introduction: Surgery for early-stage lower gingiva-buccal sulcus (GBS) complex lesions results in small to medium size defects. There are a variety of techniques for reconstruction; however, primary closure with hyoglossus release provides a primary mucosal cover while maximally preserving form and function. This study aims to assess long-term results of hyoglossal release method of reconstruction.

Material and methods: This is a longitudinal prospective study of oral squamous cell carcinoma of lower GBS complex lesions who underwent resection with primary closure with hyoglossus release. All demographic, clinical, surgical resection, flap viability and flap complication data were collected and recorded prospectively. On follow-up, all patients underwent functional outcome and form assessment including speech and swallowing assessment, mouth opening, tongue range of motion and cheek distortion.

Results: Thirty-six patients underwent primary closure with hyoglossus release after lower GBS composite resection. Marginal mandibulectomy was done in 80.6% (n = 29) and segmental mandibulectomy in 19.4% (n = 7). On functional assessment, 77.8% (n = 28) had normal functional swallow, 69.4% (n = 25) had normal tongue protusion while the mouth opening was more than 3.5 cm in 41.7% (n = 15).

Conclusion: Primary closure by hyoglossus release is well suited for anterior, lateral and posterior lower GBS complex defects with maximal preservation of form and function. The technique is simple, intuitive and is an useful alternative to local, pedicled or free flaps.

Introduction: Large language models (LLMs) offer remarkable potential in assisting healthcare professionals with diagnostic and therapeutic decision-making processes. However, the integration of LLMs into healthcare decision-making processes also introduces several doubts in the field of usefulness, reliability and ethical implications.

Materials and methods: To assess the potential of LLMs in managing intricate surgical situations, a cross-sectional study with 30 real-world cases of maxillofacial traumatology was designed. The cases were presented to ChatGPT-4, Google Bard, and maxillofacial surgery residents in a standardized manner, and the results of the subjects were evaluated by an expert surgeon panel of reviewers using the AIPI and QAMAI tools.

Results: ChatGPT-4 and Bard showed comparable performances in patient feature consideration but differed significantly in their ability to suggest differential diagnoses. ChatGPT-4 outperformed Bard in proposing additional examinations and treatment plans. Compared to LLMs, human surgery residents consistently scored higher across all parameters of the QAMAI tool, indicating superior accuracy, clarity, relevance, completeness, quality of references, and overall usefulness.

Discussion: Both LLMs demonstrated their potential to support clinical decision-making in facial traumatology, but they require further development to be sufficiently reliable for real-world clinical use.

Conclusions: AIPI and QAMAI proved their utility as evaluation tools but highlighted the need for standardization in LLM-generated responses assessment.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-025-02556-7.

Background and objectives: Virtual Reality (VR) technology has gained significant attention in surgical education and training. This systematic review and meta-analysis aim to evaluate the impact of VR on intraoperative surgical performance across various domains in the operating room (OR).

Methods: A comprehensive search of electronic databases (PubMed, MEDLINE, Cochrane Library Central Register of Controlled Trials, and Web of Science) was conducted to identify relevant studies published from 2010 to 2024. All the randomized controlled studies that assessed the effect of VR training on surgical performance in the OR were included in the study. The risk of bias was assessed using the Cochrane Collaboration's tool, evaluating domains such as random sequence generation, allocation concealment, and blinding. The inverse variance method was used to calculate the pooled mean difference for continuous outcomes, and a random-effects model was applied to account for heterogeneity.

Results: The literature search identified 1284 potential articles, of which 11 studies met the inclusion criteria for quantitative synthesis. The meta-analysis revealed a significant positive effect of VR training on surgical outcomes, despite substantial heterogeneity (I ² = 95%). Eight of the eleven studies demonstrated that VR training significantly improved surgical performance, with mean differences ranging from 1.30 to 14.00 compared to the control group. Notably, two studies reported substantial positive effects with mean differences of 9.30 and 14.00, indicating marked enhancements in surgical skills. Conversely, no significant improvement in surgical performance was observed in three studies, which reported mean differences of 0.13 and -0.90 between the two groups.

Conclusion: VR training in the OR enhances surgical performance, reduces operative times, and potentially improves patient outcomes. The study supports the integration of VR into surgical education and training programs. Further research with larger sample sizes and long-term follow-up is warranted to confirm these benefits and explore the cost-effectiveness of VR training in surgery.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-025-02449-9.

Background: Facial Appearance as Core Expression Scales (FACES) was designed to assess maxillofacial surgery patients' perceptions of their faces. We used FACES to study ratings of non-patient participant's own faces, and faces produced by the generative AI application DALL·E.

Materials and methods: DALL·E was used to generate 16 photo-realistic faces of males and females aged 20, 30, 40, and 50 of differing apparent ethnicities. Four stem descriptions were used for four sets of four images, for example "The face of a 40-year-old male (or female) of mixed South American and African ancestry wearing something dark in the style of a professional photo portrait." This was followed by descriptions taken from all seven FACES items, such as "the face is (not) like I want others to see me." Image generation instructions differed only in "not" being used for half of the images.

Results: Participants (n = 333) rated images using FACES to test the hypothesis that FACES can distinguish between faces generated by positively and negatively worded instructions. That hypothesis was confirmed for all 8 image pairs.

Conclusion: We also found that Rosenberg Self-Esteem and State Self Esteem Scale scores predicted FACES ratings of participants' own faces. However, DALL·E was unable to depict realistic maxillofacial anomalies.

Background: Voice is the critical component of communication, and impairment in voice quality tends to affect the overall health status of an individual. Voice quality tends to impair significantly in head and neck cancer patients because the tumors are usually present near the structures which were responsible for the production of voice.

Objective: The present study aimed to analyze the voice quality in head and neck cancer patients using three instruments including VHI, EORTC-QLQ-H&N35 and SSS. The objective of the study includes analysis of voice quality impairment in different domains including functional, physical, emotional impairment. We also aim to correlate the impartment in voice quality with the gender, cancer stage and site of the tumor. At last, our objective was to analyze the correlation of VHI with the EORTC-QLQ-H&N35 and SSS.

Methods: Totally, 205 adult head and neck cancer patients were recruited from the outpatient department. Sociodemographic and clinical data were collected using a predesigned proforma. Voice quality among patients was analyzed using the Hindi version of the VHI, EORTC-QLQ-H&N35 and SSS.

Results: The mean age of 205 patients was 52.79 ± 13.11 years, with a male predominance. Majority of patients presented with stage IV cancer. The most common cancer site was the oral cavity, including the tongue, buccal mucosa and alveolus. The functional and physical states of voice were found to be affected more than the emotional state among all patients. Voice quality was affected more in males compared to the female. Patients with the advanced stage of cancer have more impaired voices. Patients having cancer in the tongue, buccal mucosa, alveolus, larynx and palate tend to have more severely impaired voice quality. A strong correlation of VHI was observed with the SSS and EORTC-QLQ-HN35.

Conclusion: Voice quality was found to impair at a severe level in head and neck cancer patients. Further studies are required to validate the findings of this study to design treatment protocol that take voice quality of head and neck under consideration.

Remote anchorage in implantology refers to the strategic engagement of distant cortical bone to enhance primary stability and load distribution, particularly in severely atrophic jaws. This approach is necessary because conventional implants require sufficient alveolar bone volume for osseointegration, which is often lacking in patients with severe bone loss due to atrophy, trauma, or resection. By utilizing remote- anchorage sites such as the zygomatic bone, pterygoid region, pyriform region, and nasal floor, these implants provide a stable foundation for prosthetic rehabilitation. Advances in placement techniques and immediate loading protocols have improved their predictability. As surgical techniques continue to evolve, remote-anchorage implants will play an increasingly vital role in treating complex maxillary atrophy cases. Despite their numerous advantages, remote-anchorage implants have certain drawbacks that need to be addressed. Ultimately, the success of these implants relies on precise surgical execution, thorough prosthetic planning, and continuous follow-up to ensure long-term stability and patient satisfaction. This article reviews remote anchorage implants in terms of their indications, survival rate and complications.

Introduction: Ultrasonography (USG) is a radiation-free imaging modality that provides real-time visualization of internal structures. This systematic review evaluates the role of USG in the management of zygomatic fractures.

Methods: A systematic review was conducted following PRISMA guidelines. The literature searches in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library (inception to October 2024) identified studies using intraoperative USG for zygomatic fracture reduction and fixation. Data on study characteristics, USG protocols, outcomes, and challenges were extracted. Risk of bias was assessed using the Joanna Briggs Institute (JBI) tool.

Results: Twelve studies (246 patients) were analyzed. USG was mainly used for fracture reduction of zygomaticomaxillary complex (ZMC) (N = 7) and isolated zygomatic arch(N = 5), with some applications in reduction and fixation. Linear probes with frequencies between 5 and 12 MHz were commonly used. Challenges included limited visibility due to patient-related factors (swelling, tissue edema), USG-related limitations (low resolution, incorrect transducer frequency) and surgeon-related factors (learning curve, over-reduction errors). Post-operative CT/CBCT served as a reference to confirm USG's accuracy.

Conclusion: USG shows potential as intraoperative imaging for reduction and fixation of ZMC fracture despite challenges such as limited visualization in cases of soft tissue swelling or deeply located fracture sites.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-025-02775-y.