Journal of Maxillofacial & Oral Surgery最新文献

Background: Odontogenic infections (OIs) pose a significant public health burden in low- and middle-income countries (LMICs) due to socioeconomic barriers and limited dental care access. This study characterizes OIs in an Indian tertiary care setting, evaluating clinical features, management, and outcomes.

Methods: A retrospective cohort study of 278 patients with OIs (July 2022-July 2025) was conducted at a government tertiary care center in Western India. Data on demographics, clinical characteristics, comorbidities (e.g., diabetes mellitus [DM], malnutrition), risk factors (e.g., smoking, gutka chewing), diagnostics, management (e.g., incision and drainage [I&D], antibiotics), and outcomes were analyzed using chisquare tests, logistic regression, and Kaplan-Meier survival analysis.

Results: Periapical abscesses (45.0%) and Ludwig's angina (18.0%) were predominant, driven by poor oral hygiene (70.1%), smoking (39.9%), and uncontrolled DM (34.9%). Aggressive I&D (71.9%), modified incisions for Ludwig's angina, and antibiotic sensitivity testing (ABST)-guided therapy (25.2%) achieved a 99.3% resolution rate. Complications (15.1%) included osteomyelitis (6.1%) and sepsis (6.1%), with a 0.7% mortality rate. DM (OR 3.5, 95% CI 2.0-6.1) and smoking (OR 2.8, 95% CI 1.5-4.9) predicted complications.

Conclusions: OIs in LMICs are exacerbated by socioeconomic and clinical factors. Costeffective interventions (e.g., sanitary pads, suction drains) and early management improve outcomes. Recommendations include enhanced oral health education, diagnostic access, and antibiotic stewardship.

Background: Patients undergoing rhinectomy often experience significant functional and psychological distress due to facial disfigurement. An immediate provisional nasal prosthesis can provide aesthetic restoration during the healing period before definitive reconstruction or prosthesis fabrication.

Materials and methods: A presurgical facial impression was obtained prior to rhinectomy. Necessary trimming of the nasal profile was carried out on the facial moulage. A wax sculpture replicating the desired nasal form and profile was created on the model. This wax sculpture was duplicated using an elastomeric impression material to prepare a master cast, from which a vacuum-formed provisional nasal prosthesis was fabricated. The prosthesis was placed intraoperatively and secured to the surrounding skin using stay sutures. A second mold of the wax sculpture was prepared for fabrication of a definitive interim prosthesis. Preoperative skin color matching was performed, and medical-grade room temperature vulcanizing (RTV) silicone was processed using this mold.

Results: The initial vacuum-formed prosthesis was worn by the patient for 72-h postoperatively. After this period, a silicone interim nasal prosthesis was delivered, which could be worn daily and retained using adhesive tapes. This approach provided an immediate cosmetic solution and allowed for easy remaking of the prosthesis during the healing phase.

Conclusion: The described protocol enables the fabrication of an immediate provisional nasal prosthesis using preoperative facial impressions. This method offers psychological support, facilitates social reintegration, and improves the patient's quality of life during the postoperative healing period following rhinectomy.

Background: Mandibular condylar fractures, particularly condylar head fractures (CHFs), pose significant challenges due to their location within the temporomandibular joint (TMJ). The optimal management of CHFs remains controversial, with various treatment modalities available.

Aim: To evaluate the efficacy of open reduction and internal fixation (ORIF) for CHFs using an inviscision approach and fixation with one bicortical screw, two bicortical screws, and miniplates to assess post-operative outcomes and complications.

Materials and methods: According to He et al., Type A, B 67 cases (76 joints) of condylar head fractures were treated for ORIF. The parameters like exposure and fixation times, types of fixations, disc repositioning/repair, mouth opening, bite force, occlusion, excursive movements, chin deviation, pain, fracture reduction and complications were monitored. Patient satisfaction score and scar formation were also evaluated.

Results: Road traffic accidents were the primary cause of CHFs (46.27%). Average surgical exposure time was 13.12 min. Post-operative outcomes demonstrated significant improvements in mouth opening, bite force, and occlusal derangement. Radiographic evaluation revealed successful anatomical reduction in 76.32% of cases, with minimal complications like post-operative infection (9.21%) and transient facial nerve injury (22.37%). Overall, patient satisfaction score was 4 and the average score of 2 on Patient and Observer Scar Assessment Scale. Top of FormTop of Form.

Conclusion: A comprehensive approach incorporating aesthetic surgical techniques, precise fracture management, and disc repositioning is crucial for successful management of CHFs. ORIF using inviscision techniques, long bicortical screws, and miniplates presents a promising treatment modality for restoring TMJ function and achieving high patient satisfaction rates.

Background: Distress is a multifactorial emotional experience which many cancer patients experience. Increased distress levels, as measured by the NCCN distress thermometer, are associated with poor treatment compliance and reduced survival. It has also been shown to be associated with poor wound healing.

Methodology: This prospective observational was done to assess the incidence of preoperative distress levels in head and neck squamous cell carcinoma patients and its impact on postoperative complications.

Results: A total of 350 patients were enrolled in the study. The majority of the patients had oral squamous cell carcinoma (n = 333, 95.1%). The incidence of postoperative complications was 14.3% (n = 50/350). The incidence of preoperative distress levels of ≥ 4 was only 5.14% (n = 18/350), and it did not have any influence on the postoperative complications. The factors that predisposed to the development of postoperative complications were the need for tracheostomy (p < 0.001 [5.844(3.060 - 11.160)]), duration of surgery > 4 h (p = 0.012 [3.753(1.833 - 4.807)]), and patient belonging to the lower socioeconomic strata (p = 0.003[2.711(1.407 - 5.224)]).

Conclusions: The incidence of significant preoperative distress levels was low in our cohort, and it did not influence the development of postoperative complications. The findings from this study may well need further confirmation. The low distress scores reported in our study should not deter from routinely checking for preoperative distress levels in head and neck cancer patients.

Background: One of the most common dental surgeries is third molar extraction which often leads to pain and swelling after surgery. In recent years, the prophylactic antibiotics before or after surgeries have been used to reduce the risk of injuries and infection. Various researches conducted in this field have yielded contradictory results. The aim of prophylactic antibiotic treatment is to prevent possible infections and complications after surgery, while antibiotic prescription after surgeries reduces clinical symptoms such as pain. The aim of the present review study is to determine and compare the effect of antibiotic drugs before and after third molar extraction in order to reducing surgical complications.

Material and methods: The research was conducted using electronic databases provided by PubMed, Scopus, Web of Science and Google Scholar, with applying inclusion and exclusion criteria. Accordingly, all the clinical trials published since 2000 focused on the antibiotic treatments in third molar extraction surgery were included in this review.

Results: The obtained results from 18 selected studies demonstrated that there is no statistically significant document to confirm the efficacy of antibiotics to prevent post-surgery complications such as swelling and pain after third molar extraction.

Conclusion: Dentists should carefully consider the potential increase in bacteria's resistance to antibiotics and the possibility of side effects when prescribing them. This is because in some cases, the disadvantages may outweigh the benefits for the patient.

Background: Angiogenesis is the process of new vessels formation. Vascular endothelial growth factor (VEGF) is the most involved growth factor in endothelial cell proliferation. Many viruses are implicated in this process, directly through membrane receptors or indirectly by stimulating VEGF production. In particular, hepatitis B virus (HBV) can stimulate proliferation of endothelial cells, contributing to the development of vascular malformations and tumors, benign as hemangiomas or malignant as hepatocarcinoma or cholangiocarcinoma.

Objective: Starting from these assumptions, the authors of this observation paper questioned the possibility that chronic HBV infection could determine vascular malformations/tumors also in other areas, in particular head and neck.

Case description: To answer this question, a case of a 52-year-old woman with chronic HBV infection, who developed a vascular malformation of the upper lip, was described.

Conclusion: This hypothesis of correlation between chronic viral infections, with a blood viral load 0, and vascular malformations/tumors can lay the foundations for carrying out molecular studies.

Objective: This study aims to present surgical experience and clinical outcomes regarding the reconstruction for malignancy-induced midfacial skin defects using varying patterns of cervicofacial advancement-rotational flaps (CARFs).

Methods: This is a descriptive study, and 25 patients with midfacial skin defect participated in this study. Defect repair was performed using CARF and descriptive statistics were used in data analysis.

Results: The CARF was designed over perforators arising from branches of the anterior-based external carotid artery in all patients. 48% of the patients developed midfacial skin defects due to basal cell carcinoma, and 40% due to squamous cell carcinoma. Two patients developed ectropion, one patient developed base positivity, and one patient developed necrosis distal to the flap.

Discussion: The CARF has a good pattern and minimal tension, thus closing midface skin defects without bunching. The reconstruction for midfacial skin defects with CARF decreases both functional and aesthetic morbidity and improves patient outcomes.

Introduction: Current management of oral potentially malignant disorders (OPMDs) based on dysplasia grading is controversial. The malignant transformation rate of OPMDs does not correlate well with dysplasia grading, resulting in non-standardized treatment for patients. A quantitative biomarker-based risk score (qBRS; trade name StraticyteTM) was previously developed to address shortcomings related to the current standard of care. A multicenter, retrospective cohort study consisting of biopsied OPMDs was used to validate qBRS for predicting transformation of OPMDs to OSCC.

Materials & methods: Three hundred and two cases were immunostained, imaged, and analyzed via qBRS. A binary prognostic risk was determined using a receiver operating characteristic curve optimizing sensitivity and specificity. Kaplan-Meier analysis was used to estimate the cumulative probability of lack of malignant transformation for patients with elevated or normal biomarker-based risk.

Results: The results demonstrated very high sensitivity (96.2%) and negative predictive value (96.2%) for qBRS. Elevated risk scores had higher predicted probabilities of transformation to cancer, independent of dysplasia grade.

Conclusions: qBRS can be a useful clinical adjunct tool to dysplasia grading for the assessment of malignant transformation potential, providing a quantitative metric in OPMDs. The addition of qBRS to current histological techniques should improve early detection rates of OSCC, enhancing the effectiveness of treatment.

Objective: To systematically review the effect of applying mesenchymal stem cells (MSCs) and gene-therapy approach on the bone formation of the distracted area in the maxillofacial region.

Study design: Studies that delivered genetically modified or unmodified MSCs or used gene-therapy methods without MSCs delivery for the mandibular or maxillary distraction osteogenesis (DO) treatment in both human and animal models were included.

Results: From a total of 720, 32 animal studies and one human study were included. Results of human study showed that the injection of bone marrow MSCs has no significant complications and can induce significant bone formation. Results of animal studies showed that applying of MSCs as the study group results in higher values of bone formation variables, namely new bone formation and volume, bone volume/total tissue volume, bone mineral density and thickness of the new trabeculae compared to control group. Meta-analysis revealed that in rabbit models, significant increase was observed in the bone formation percentage after MSCs injection. In the goat models, stem cell injection showed significant increase in trabecular thickness.

Conclusion: In animal models, the use of MSCs in distraction osteogenesis (DO) treatment of the maxillofacial region did not result in significant complications and showed potential positive outcomes on bone formation. However, more clinical and animal studies with a lower risk of bias are required to fully establish the efficacy and safety of this approach.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-025-02434-2.

Introduction: A good anesthetic and analgesic effect is crucial for any minor surgical treatment to be successful. 2% Lignocaine hydrochloride with Adrenaline (1:80,000) is the most commonly used local anesthetic. However, it is not recommended for long procedures or in patients with cardiovascular diseases, where adrenaline is not desirable. Hence, need arises for a local anesthetic which has longer duration of action and adequate analgesic effect with minimal adverse reaction. 0.5% Ropivacaine is a long-acting amide local anesthetic with vasoconstrictive properties. It is considered to have superior properties compared to lignocaine in terms of duration of action and need for analgesics. This study compared the efficacy of 0.5% Ropivacaine versus 2% Lignocaine Hydrochloride with Adrenaline (1:80,000) in the surgical removal of impacted mandibular third molars.

Materials and method: A prospective, randomized, split mouth, cross over study was conducted amount 33 patients indicated for surgical extraction of impacted mandibular third molar. Extraction of one side was done using 2% Lignocaine with Adrenaline (1:80,000) and the opposite side was extracted one week later using 0.5% Ropivacaine. Parameters assessed were, pain on injection, time of onset of the local anesthetic, the depth and duration of anesthesia, intensity of pain and need for analgesics postoperatively.

Results: There was no statistically significant difference between the two groups in terms of pain on injection. Time of onset was noted to be faster in the Lignocaine group. Ropivacaine was found to be superior to Lignocaine in terms of depth and duration of anesthesia and the postoperative analgesic effect. No adverse effect were noted in either of the two study groups.

Conclusion: 0.5% Ropivacaine can be a suitable alternative to 2% Lignocaine in minor surgical procedures of long duration and in conditions, where the use of vasoconstrictor is contraindicated. It also provides an added benefit of greater depth of penetration into the bone along with a postoperative analgesic effect, thereby increasing the patient comfort. However, further study on a larger sample size is necessary to determine the overall effectiveness and practicality of using Ropivacine as an alternative to lignocaine in minor oral surgical procedures.