Journal of Maxillofacial & Oral Surgery最新文献

Introduction: Complications in patients post-COVID 19 viral infection are many and include maxillary mucormycosis. Mucormycosis is usually treated with radical maxillary resection and debridement of involved structures along with the use of anti-fungal agents. The extensive removal of hard and soft tissue results in severe functional and cosmetic defects. Rehabilitation of these patients requires implant-supported prosthesis for adequate retention. However, the lack of adequate bone in the maxilla precludes the use of conventional dental implants alone for dental rehabilitation and often requires additional zygomatic implants. These implants can usually support a removable over denture prosthesis.

Case reports: This article describes two cases, wherein patients had had an extensive resection and their removable obturator prosthesis were not retentive enough. These patients were successfully rehabilitated using zygomatic implants supported removable prosthesis. Both the patients were satisfied with the cosmetic and functional rehabilitation. At the end of one year follow up, the implants and prosthesis were stable.

Conclusion: Zygomatic implants are a useful tool to rehabilitate patients who have undergone maxillary resection for management of post-COVID maxillary mucormycosis defect (PCMMD).

Objective: To comprehensively assess and describe the three-dimensional changes in nasal morphology following Le Fort I osteotomy.

Method: Search of PubMed, Google scholar and institutional library database. In addition, bibliographies of included studies were hand searched to identify potentially eligible studies that were not captured by electronic search.

Results: A total of 574 participants were investigated who underwent Le fort I osteotomy surgery. The participants were assessed on alar base width, nasolabial soft tissue, nasal septum deviation post le fort I orthognathic surgery. Mean age 18 - 30 years of age. 10 out of 11 articles in the review have established a strong correlation between le fort I osteotomy and nasal soft and hard tissue changes.

Conclusions: Le fort I osteotomy has pronounced consequences on nasal morphology. This review provides an inventory of pre-surgical and post-surgical nasal soft and hard tissue alterations in le fort I osteotomy surgery. Surgeons must thus carefully evaluate the patient's nasal anatomy and plan the surgical approach accordingly.

Introduction: Pterygoid implants offer a reliable alternative for rehabilitating the atrophic posterior maxilla by avoiding complex grafting procedures. Despite their increasing use, there is no standardized framework for assessing their clinical success. This study introduces the Pterygoid Implant Placement Success Index (PIPSI), a comprehensive scoring system to evaluate pterygoid implants across preoperative, intraoperative, and postoperative parameters.

Materials and methods: PIPSI was developed using eight critical parameters: bone density, implant length, angulation accuracy, primary stability, loading protocol, bone resorption, postoperative complications, and prosthetic success. Each parameter was weighted based on clinical relevance, culminating in a total score of 80. Scores were stratified into four outcome categories: Excellent (70-80), Good (55-69), Moderate (40-54), and Poor (< 40). Validation involved inter-observer reliability, internal consistency (Cronbach's alpha), and predictive validity using logistic regression and ROC curve analysis.

Results: PIPSI scores demonstrated strong internal consistency and significant correlation with implant survival and prosthetic outcomes. Higher scores were associated with fewer complications and better long-term stability. Stratification revealed distinct survival curves across outcome groups, confirmed by Kaplan-Meier analysis and log-rank testing (p < 0.05). ROC analysis yielded high discriminative accuracy for predicting implant success.

Discussion: The PIPSI offers a robust, objective method for assessing pterygoid implant success, integrating anatomical, surgical, and prosthetic dimensions. It facilitates clinical decision-making and standardized reporting. Limitations include the need for prospective validation, standardization of imaging metrics, and incorporation of patient-reported outcomes. Future enhancements may include digital integration and AI-driven predictive modelling.

Objective: This study is envisioned to appraisal the existing data pertaining to the feasibility and efficacy of intralesional platelet-rich plasma (PRP) over other existing modalities in the medical management of oral submucous fibrosis (OSMF) through a systematic literature survey.

Methods and materials: For this study, a comprehensive literature search was undertaken electronically Medline, EMBASE, and CENTRAL databases to identify papers published until the end of December 2023 in dental, oral, and maxillofacial surgery, plastic surgery, and otolaryngology journals containing the terms "oral submucous fibrosis", "intralesional injections", "platelet rich plasma", "Corticosteroids", "Hyaluronidase", "Placentrix" in their titles, abstracts, and/or keywords with only English being the preferred language. The data were extracted from the included papers and carefully reviewed to extract and code the data. Descriptive data from all the carefully chosen articles were selected and analysed.

Results: Four studies met the inclusion criteria. The treatment outcomes in all the included studies were identical with all the studies suggesting an improvement in the subjective signs and symptoms of OSMF with intralesional injection of PRP. It was observed that PRP was more efficient than corticosteroid alone or in combination with hyaluronidase in reducing pain and burning sensation coupled with aiding in better mouth opening but less effective in improving cheek flexibility. Studies revealed that there was no adverse effects or recurrence of lesions at the side of its administration which was considered to be the major advantage of using intralesional PRP. Since PRP is obtained naturally from the patient's own blood and would be devoid of any adverse effects and is free from any immunological or allergic reactions, it can be considered superior to other drugs used for intralesional injections. Hence, intralesional injection of PRP would yield either a similar to or even better clinical outcome than that obtained with the intralesional injection of corticosteroids, placentrix, or hyaluronidase either alone or in combination.

Conclusion: Intralesional injection of platelet-rich plasma in the management of oral submucous fibrosis is a novel method and is considered to be more efficient than intralesional injection of corticosteroids, placentrix, or hyaluronidase either alone or in combination.

Objective: The term 'retaining ligament' was first given by Dr. Mar McGregor for the 'area of fibrous attachment'. A thorough knowledge of the layers, planes, and structures of facial anatomy is critical when performing aesthetic surgery. The retaining ligaments of the face are important in understanding concepts of facial aging and rejuvenation. In this article, the ligamentous structure found in the pre-auricular region anterior to helix of ear encountered during standard pre-auricular approach to the temporomandibular joint has been discussed.

Methods: A total of eight cases of the standard pre-auricular approach to the temporomandibular joint were studied, and an anatomically constant cutaneous ligament to anterior helix of the ear was observed.

Results: Amongst the cases studied, a constant cutaneous ligament to the anterior helix of the ear was observed. It was also noted that the above-mentioned retaining ligament was useful in separating the sub- and supra-zygomatic compartments, thereby helping to direct the beginning of pre-tragal dissection.

Conclusion: As the pre-auricular approach is common in maxillofacial surgeries, thorough knowledge about the various cutaneous ligamentous structures is crucial. The described cutaneous ligament can serve as important landmark in standard pre-auricular approach, and reorientation of this structure is also important to resuspend the pre-auricular skin after surgery.

Introduction: Since the debate about carcinogenic potential of Carnoy's solution (CS) in 2000s, many surgeons adopted the use of modified Carnoy's solution (MC). There are many studies comparing the effectiveness of MC with CS for treatment of odontogenic keratocyst (OKC). Seldom are the studies defining versatility of MC in treating maxillofacial cysts and tumors. This case series aims to present diverse use of MC for treatment of maxillofacial cysts and tumors.

Methodology: Patients who reported with maxillofacial cysts and tumors from February 2018 to February 2023, and for whom surgical enucleation/resection with chemical cauterization using MC was done, are included in the study. We treated 29 cases of maxillofacial cysts and tumors using MC as a chemical cauterizing agent. Among these, 14 cases were OKC, eight were ameloblastoma, four were odontogenic myxoma, and three were ossifying fibroma.

Results: A total of 29 patients (18 males and 11 females) were included in the study. All patients were followed up for 12 months. Of the 29 cases, three cases were of anterior maxilla, out of which lesion recurred in two cases. Other complication reported was of paresthesia in two cases which resolved in 12 months.

Conclusion: Various treatment modalities are available to treat maxillofacial cysts and tumors but use of MC is an effective modality which reduces risk of recurrence. However, as it poses a risk of damage to surrounding neurovascular structures, caution is needed.

Segmental resection of the mandible, often necessitated by benign and malignant pathologies, leads to significant functional and cosmetic deformities. Three-dimensional (3D) reconstruction of the mandible is essential to preserve the patient's quality of life. The advent of virtual surgical planning and 3D printing has significantly enhanced mandibular reconstruction techniques, yielding improved treatment outcomes. This report highlights the pros and cons of patient-specific 3D-printed titanium implants based on our experience of successfully treating three patients, who underwent segmental resection for benign mandibular tumors of the mandible.

Introduction: This study aimed to introduce a new, less morbid computer-aided design-computer-aided manufacture (CAD-CAM) protocol that limits the excessive anteromedial movement of the mandibular condyle in front of the eminence.

Methods: Five patients were treated by surgical implantation of bilateral patient-specific polyether-ether ketone (PEEK) onlay eminoplasties; each implant was virtually designed using specific software and milled from medical-grade PEEK blocks. Intraoperatively, each implant was fixed with three mini-screws at the lateral aspect of the zygomatic arch. The follow-up period ranged from six months to two years.

Results: The mean preoperative maximal incisal mouth opening was (48.8 mm) versus (36.8 mm) for the postoperative measurement, which was statistically significant.

Conclusion: Patient-specific PEEK eminoplasty is an effective alternative for surgical treatment of chronic recurrent TMJ dislocation.

Introduction: Zygomatic complex fractures are the second most common facial fractures. Neurosensory disturbances of the infraorbital nerve are common following zygomatic complex fractures. Fracture complexity and displacement of fracture segments can cause neurosensory disturbances of the infraorbital nerve following zygomatic complex fractures. Therefore, fractures of the zygomatic complex are characterized by sensory neuropathy in the area of innervations of the infraorbital nerve as a presenting symptom.

Aim and objectives: To evaluate the neurosensory disturbances of infraorbital nerve in zygomatic complex fractures and to evaluate whether the lag time between injury and treatment has an effect on the neurosensory disturbance of infraorbital nerve.

Materials and method: A total of thirty-one patients with unilateral zygomatic complex fractures who complained of neurosensory disturbance in the region of the infraorbital nerve innervation were included in the study. All the patients underwent open reduction and internal fixation and were evaluated for neurosensory disturbance of the infraorbital nerve by two-point discrimination test, brush stroke and self-report score of paraesthesia on the injured side as well as the contralateral side preoperatively and postoperatively.

Result: A total of thirty-one patients with unilateral zygomatic complex fracture were evaluated for neurosensory disturbance of the infraorbital nerve. Thirty patients could detect the true direction of the brush stroke, and 1 patient could not detect it postoperatively. The mean difference of two-point discrimination was 0.574 cm vertically and 0.523 cm horizontally, and with every one-day delay in treatment, there was an increase in the incidence of self-report paresthesia by 0.66 times.

Conclusion: Delay in the treatment of zygomatic complex fracture does have an effect on the neurosensory disturbance of the infraorbital nerve.

Introduction: The upper and lower lips represent the most important functional and aesthetic anatomical structures of the lower segment of the face. The reconstructive aims are to restore the oral lining, oral competence and function (i.e. articulation, speech and mastication). Functional and aesthetic restoration of lip and oral commissure defects can be achieved using the composite radial free forearm flap (RFFF) with Palmaris longus tendon.

Methodology: To present the technique, we have used our experience with this form of reconstruction in 30 consecutive patients with lip and oral commissure defects who were surgically treated between 2012 and 2018. Reconstruction of the lip defect was done with RFFF with Palmaris longus tendon. The ends of the Palmaris longus tendon were passed intraorally and anchored to the remnant orbicularis oris muscle of the upper lip to provide adequate tension so that oral competency could be achieved and sagging of the commissure could be prevented, and in cases, where adequate orbicularis oris was not present, the tendon was sutured to the zygomatic prominence. The patients were followed for 1 year.

Results: In our study of 30 cases of stage 3 and stage 4 oral cavity squamous cell carcinoma, we did RFFF with Palmaris longus and found that the graft uptake was excellent, i.e. 93.33%. Flap failure occurred in only 2 out of the total 30 cases. Re-exploration of the flap was done, and venous congestion was the cause of flap failure. Re-anastomosis of the vessels was done, but still the flap could not be salvaged. Donor site healed satisfactorily without any complications except for scarring. All patients had excellent oral competence during rest, speaking and eating. Good sphincteric function was obtained in early post-operative days. Drooling or air leakage was seen only in 6 out of 30 cases after 1 year of follow-up. The patients' articulation was near-normal. The aesthetic results were accepted by 24 patients. All patients were able to resume regular diet. No complications were observed such as dehiscence, fistula formation or abscess formation. The mouth opening was also adequate (2-3 finger width) in 24 out of 30 patients of oral commissure reconstruction.

Conclusion: The RFFF with Palmaris longus has excellent viability. It is a secure and reliable reconstructive option which produced satisfactory aesthetic and functional results.