Journal of Maxillofacial & Oral Surgery最新文献

Aim: To understand the current status of arthrocentesis in India.

Materials and methods: A questionnaire was designed and validated by the authors. Questionnaires were circulated by e-mail to oral and maxillofacial practitioners in India. 363 questionnaires were sent out vie e-mail. 48.48% of those who responded claimed to practice arthrocentesis. The majority had been practicing arthrocentesis only for the last 1-3 years. 94.6% of them found arthrocentesis to be helpful in resolving symptoms of temporomandibular disorders.

Conclusion: Arthrocentesis enjoys popularity among Indian surgeons. Most surgeons appear to be following the guidelines recommended by current literature in most cases and find it to be an effective procedure.

The short face has been challenging in orthodontic and surgical management due to unfavorable aesthetic results. More surgical alternatives should be described in the literature. The objective of this report is to propose a novel surgical technique complementary to orthognathic surgery for the management of the short face. To this end, a retrospective series of 10 cases analyzes and describes a novel method using autologous mandibular angle grafts after mandibular angle recontouring. The autologous mandibular angle graft technique is a simple, minimally invasive technique that allows mandibular angle ostectomies as interposition grafts for chin and maxilla descents, improving aesthetic results and bone stability.

Aim: This systematic review and meta analysis rigorously examines the effectiveness of botulinum toxin type A (BTX-A) injections into the lateral pterygoid (LP) muscle for treating temporomandibular disorders (TMDs).

Methodology: Adhering to PRISMA guidelines, the review analyzes studies from 2000 to 2022, identified through various databases and manual searches. Following the PICO framework, the inclusion criteria focus on clinical trials investigating BTX-A injections in the LP muscle to manage TMDs symptoms. The Cochrane risk of bias tool assessed study quality.

Results: Out of 124 reports, five studies with 117 participants met the criteria. Most trials reported symptom improvements, particularly in reducing pain and clicking sounds. However, discrepancies in study design, assessment methods, and participant characteristics led to moderate to high bias, resulting in an overall assessment of moderate to poor quality evidence. While results are promising, consensus on the therapeutic efficacy of BTX-A for TMDs is lacking due to inconsistencies among studies. The proposed mechanisms include chemical denervation and analgesic effects, but further research is necessary to determine optimal dosages and injection sites. Adverse effects were typically temporary and manageable, though considerations about the cost-effectiveness of BTX-A therapy compared to alternatives are needed.

Conclusion: BTX-A injections in the LP muscle show potential for alleviating TMDs symptoms, but rigorous randomized controlled trials with larger sample sizes and extended follow-up periods are necessary for definitive evidence. Patients should be aware of possible transient effects and the need for repeated injections, which may complement other treatments for improved outcomes.

Background: Dislocation of the temporomandibular joint (TMJ) is the dislodgement of the head of the condyle from its normal position in the glenoid fossa. At its worst, the condition limits the patient in his day to day life by causing frequent and uncontrolled locking episodes. Hypermobility and habitual luxation of the TMJ may cause injury to the disk, the capsule, and the ligaments, leading to progressive internal derangement. Conservative approaches should be considered as first line treatment for such disorders. In this study, we establish the versatility and virtually negligible complication rate associated with one such treatment modality, the use of Injectable Platelet Rich Fibrin injections (I-PRF) into the joint space which has yielded favorable outcomes.

Materials and methods: 26 patients diagnosed clinically with hypermobility of the TMJ were selected after fulfilling the inclusion criteria. All the patients underwent single injection I-PRF being injected into the superior joint space (SJS) and periarticular tissues under local anesthesia (LA). Postoperatively, patients were assessed at 1st and 3rd months for reduction in maximal interincisal mouth opening, TMJ pain, reduction in locking episodes and clicking sounds.

Results: In terms of parameters assessed post injection, the mouth opening showed significant reduction from the baseline up to the 3 months follow up period. Similarly, the locking episodes, pain score and joint sounds too showed significant reduction from the baseline values to 3 months follow up period.

Conclusion: I-PRF is a simple, minimally invasive and cost effective procedure that can be tried prior to other joint injections or invasive surgical procedures.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-024-02389-w.

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.