Journal of Maxillofacial & Oral Surgery最新文献

Introduction: The ZMC complex is crucial for orbital integrity as it forms most of the lateral wall and the floor of the orbit. Therefore, the fracture of the zygomaticomaxillary complex destroys the orbital skeleton causing various types of ophthalmic injuries in about 2.7 to 96% of cases. The variability of clinical features is due to differences in the amount of energy delivered, the impact vector, and the duration of the impact of energy.

Aim: To study the demographic distribution and clinical manifestation of different types of ophthalmic injuries in patients associated with ZMC fractures and to understand the need for evaluation by an ophthalmologist.

Objectives: To study the common fracture patterns, sex and age demographics, and etiology of ZMC fractures. To study the presence of various types of clinical manifestation in ZMC fractures.

Materials & methods: A retrospective study was conducted by the Manipal College of Dental Sciences, Manipal, Karnataka, India, by the Department of Oral and Maxillofacial Surgery studying ophthalmic consideration and clinical manifestation of patients having zygomaticomaxillary complex fracture from February 2019 to December 2022. Data collection was done from patient files and subjected to descriptive statistics.

Results: It was found that the affected population is mainly Indian males in the second decade of their life mostly due to road traffic accidents. A variety of ophthalmic injuries was noted. Periorbital oedema and ecchymosis are the most common ones.

Objective: To examine the effect of Kinesio taping on postoperative trismus, and soft tissue oedema and pain after surgical removal of impacted mandibular third molars.

Materials and methods: Forty patients with impacted mandibular third molars who required surgical extraction were randomly selected and allotted into two groups, a control and a study, and the patients in the study group were applied Kinesio Tape 2m*5m for 3 days postoperatively. In both groups, pain, trismus, and swelling preoperatively and postoperatively on day 3 and day 7 were measured. Facial swelling was measured using a flexible scale, using a five-point measurement, trismus using Vernier callipers, and pain using visual analogue scale.

Results: Forty patients were followed up for 7 days, and swelling, pain, and trismus were measured. Results showed significant improvement in trismus and swelling on postoperative day 3 and 7 in the study group.

Conclusion: The application of Kinesio tape is a non-invasive, easy economical, and medically relevant approach.

Introduction: Sagittal split osteotomy is a standard procedure performed by maxillofacial surgeons. Patients usually present with either aesthetic or functional concerns. Surgical landmark identification is crucial to a successful surgical procedure. Various diagnostic preoperative tools have been used to identify these landmarks, such as imaging studies or cadaveric dissections. The cone-beam computed tomography (CBCT) is currently the most common preoperative tool used.

Aim: This study aims to identify whether the deepest part of the ascending ramus (coronoid notch) distance to the mandibular lingula can be used as a safe reference prior to performing medial horizontal osteotomies.

Materials & methods: Data were extracted from a database of patients who underwent CBCT scanning for various reasons. A total of 313 CBCT scans were included in this study. Patients younger than 18 years, with a history of mandibular pathology, or whose scans were suboptimal were excluded. Statistical analysis was performed via IBM SPSS v29 (IBM Corp., Armonk, NY, U.S.), and the predetermined p-value was < 0.05. Statistical significance was present in both the right and left measurements.

Results: A total of 313 (626 sides) CBCT were included in this study. Most patients were of the female gender, with 171 scans (54.6%) and 142 scans (45.4%) from males. Our study focused on the distance from the specific reference point, the coronoid notch (the most concave point at the ascending ramus in the retromolar area), to the anterior part of the mandibular lingula. For the total sample, the standard deviations for each side were 2.25 (p-value = < 0.001) and 2.07 (p-value = 0.003), left and right, respectively. This finding indicated that the distances on each side were statistically significant.

Conclusion: The authors suggest that the anterior aspect of the ramus can be used as a reference point for horizontal medial osteotomy, as both distances were statistically significant. This finding has important implications for the safety and efficiency of bilateral sagittal split osteotomy procedures, as it provides a reliable reference point for surgeons to use during the procedure, potentially reducing the risk of complications, surgical time, and improving patient outcomes.

Introduction: The preservation of the alveolar ridge following tooth extraction is important for maintaining optimal dental health and ensuring successful future dental interventions. Various techniques for alveolar ridge preservation are done, including socket grafting and the use of biomaterials, membranes, and growth factors, which have a plenty of clinical benefits, such as improved aesthetics and stability for dental implants along with potential cost-effectiveness compared to more invasive procedures, thus optimizing treatment outcomes and promoting long-term dental health.

Aim: To assess the effectiveness of bone graft material and collagen membrane for ridge preservation following tooth extraction compared to tooth extraction alone group.

Materials and method: Ninety patients presenting with the need for extraction were included in this study.They were divided into three groups. In group A, the socket was filled with bone allograft and protected with a fish derived collagen membrane without buccal thickness flap. In group B, buccal/labial thickness flap was elevated, socket was filled with bone allograft and protected with a fish derived collagen membrane barrier, and in group C, no bone graft and collagen membranes were placed.

Results: Showed that group A is much more beneficial and simpler than the group B procedures.

Conclusion: Bone regeneration using collagen membranes and inorganic bovine bone combination seems promising. But, there is obviously a need for long-term studies to confirm the success rate of ridge preservation procedures using buccal full thickness flap and without buccal full thickness flap.

A schwannoma is a benign, slow-growing peripheral nerve sheath tumour that originates from Schwann cells. Orbital schwannomas are rare, accounting for only 1% of all orbital neoplasms. Preoperative diagnosis of schwannoma is difficult because of its variable presentation and location. Appropriate early assessment of orbital tumours by CT or MRI and prompt management is warranted to prevent the development of severe complications. Authors would like to present here one such case of orbital schwannoma and management of the same.

Background: Mandibular reconstruction after head and neck cancer surgery is mostly a complex procedure, especially when followed by radiotherapy. Although the fibular free flap remains a reliable option, radiotherapy can compromise soft tissue healing, increasing the risk of hardware exposure and osteoradionecrosis.

Purpose: This technical note explores the use of the flexor hallucis longus (FHL) muscle in mandibular reconstruction, specifically for improving soft tissue coverage over reconstruction plates and minimizing radiation-related complications.

Methods: The FHL muscle was harvested alongside the fibular flap and was positioned over the reconstruction plate to provide a vascularized, durable layer of soft tissue. Its strong blood supply from the posterior tibial artery, combined with its bulk and resilience, was intended to offer better protection and healing in patients undergoing postoperative radiotherapy.

Results: Clinical experience showed that the FHL muscle helped reduce the risk of plate exposure and radiation-induced damage. Its vascularity not only promoted healing, while its bulk acted as a cushion against shear forces and tissue breakdown, but also this muscle also contributed to maintaining tissue integrity and minimizing the risk of osteoradionecrosis, with no significant increase in donor site morbidity.

Conclusion: Incorporating the FHL muscle in fibular flap-based mandibular reconstruction adds meaningful protection for patients receiving radiotherapy. It supports healing, safeguards underlying hardware, and improves both functional and aesthetic outcomes.

Background: Reconstruction after tumor removal in the head and neck region presents a challenge for balancing functionality and aesthetics. The pectoralis major myocutaneous flap (PMMC) is a reliable option for post-tumor resection reconstruction. However, complications such as flap necrosis, detachment, donor site tumor recurrence, wound infections, and wound dehiscence have been encountered in 150 cases where PMMC was utilized. This retrospective study focuses on analyzing the complications and experiences associated with using PMMC in head and neck oncology.

Materials and methods: This analysis looks back at 150 cases of head and neck oncology that underwent PMMC flap reconstruction. Of these cases, 128 (85.3%) involved buccal mucosa reconstruction, while 22 (14.7%) focused on the tongue, floor of the mouth, and neck. Out of the total 150 cases, 141 cases (94%) were male, and 9 cases (6%) were female. We carefully documented any complications, paying specific attention to flap necrosis, detachment, donor site tumor recurrence, flap retraction, oro-cutaneous fistula, wound infections, and wound dehiscence.

Results: The study result concluded following complications were encountered, and there were instances of flap necrosis observed in 9 cases (6%). Additionally, 16 cases (10.7%) experienced flap detachment, which impacted postoperative recovery and necessitated further interventions, and 11 cases (7.3%) had flap retraction. Three cases (2%) exhibited tumor recurrence at the donor site following PMMC flap harvesting. Wound infections were prevalent, affecting 13 patients (8.6%). Two patients (1.3%) experienced donor site wound dehiscence postoperatively, and five patients (3.3%) had oro-cutaneous fistula.

Conclusion: The use of PMMC flaps in head and neck oncology requires careful consideration, surgical expertise, and postoperative care to minimize complications. Although it has been historically significant and useful, advanced surgical techniques and postoperative care protocols are necessary to optimize outcomes in PMMC flap reconstructions. Therefore, meticulous patient selection and vigilant postoperative care are essential for addressing and minimizing complications.

Background: Cemento-ossifying fibroma (COF) is a rare subtype of benign fibro-osseous lesions predominantly affecting the craniofacial region. But tumor with combination of COF and vascular malformation has not been described in literature.

Case: Following is the case of 14-year-old female patient with extensive COF of right maxilla encroaching orbit, maxillary antrum, nasal cavity, and zygoma. During course of careful investigations, embedded vascular malformation based on right maxillary and facial artery was diagnosed, in which aspiration cytology played crucial role. After confirmation by computed tomographic (CT) angiography, proper vascular control was gained by superselective embolization followed by surgical resection as definitive management.

Introduction: Oral squamous cell carcinoma with stage T3 and above constitutes locally advanced disease without distant metastasis. Even with multimodality treatment, the 5-year survival is less than 50%. In this retrospective study, we shared our experience from a single center of the utility of neoadjuvant chemotherapy in the outcome of cT4 oral cavity squamous cell carcinoma.

Methods: Patients who underwent surgery either in the form of upfront resection or induction chemotherapy followed by surgery were considered for evaluation. Patients in the induction group underwent three cycles of NACT prior to response assessment. Patients with complete response underwent surgery, and partial responders were given fourth cycle of NACT prior to surgery. Patients with stable disease or disease progression were subjected to nonsurgical therapy. The primary endpoint assessment of the study was overall survival and disease-free survival. Secondary outcomes assessed were the extent of resectability after NACT, frequency of marginal mandibulectomies, postoperative radiotherapy and response following NACT.

Results: A total of 285 patients were initially screened for the review; of which 164 patients (Group A) underwent upfront surgical resection and 121 patients received NACT. The median DFS and OS in our study were 28 months and 30 months, respectively. There was no difference in DFS and OS between upfront surgery and NACT surgery. On subset analysis, NACT improved survival only in T4b patients. Positive margin, nodal metastasis and presence of extracapsular spread were the risk factors effecting survival.

Discussion: Induction chemotherapy improved survival only in T4b patients. There was no difference in survival in T4a patients with the addition of NACT. Overall no difference was seen in survival with the use of induction chemotherapy.