Journal of Maxillofacial & Oral Surgery最新文献

Oral cancer is a cancer type that is widely prevalent in low-and middle-income countries with a high mortality rate, and poor quality of life for patients after treatment. Early treatment of cancer increases patient survival, improves quality of life and results in less morbidity and a better prognosis. To reach this goal, early detection of malignancies using technologies that can be used in remote and low resource areas is desirable. Such technologies should be affordable, accurate, and easy to use and interpret. This review surveys different technologies that have the potentials of implementation in primary health and general dental practice, considering global perspectives and with a focus on the population in India, where oral cancer is highly prevalent. The technologies reviewed include both sample-based methods, such as saliva and blood analysis and brush biopsy, and more direct screening of the oral cavity including fluorescence, Raman techniques, and optical coherence tomography. Digitalisation, followed by automated artificial intelligence based analysis, are key elements in facilitating wide access to these technologies, to non-specialist personnel and in rural areas, increasing quality and objectivity of the analysis while simultaneously reducing the labour and need for highly trained specialists.

Background: Rhino-oculo-cerebral Mucormycosis (ROCM) is a well-known complication post-COVID-19 infection. The extension of this disease into the oral cavity is a grey area with no proper protocol for management of the same in the existing literature. Based on our experience in the management of oral extension, this study aims to propose a protocol to treat these cases.

Aim: To derive a classification for the surgeon from retrospectively collected data of 53 operated cases of oral Mucormycosis.

Settings and design: Hospital record-based cross-sectional study; evaluation of the previously treated 53 cases of oral extension of post-COVID-19 Rhino-oculo-cerebral Mucormycosis in the duration between May 2021 to August 2021. Follow-up for a period of 1 year.

Methods and material: Based on the preoperative data, 4 parameters were taken -Tooth tenderness, Tooth mobility, Palatal perforation, and Radiological findings. A clinical-radiological classification system was derived based on the intraoperative data from the OT notes and the preoperative findings corresponding to the 4 parameters.

Statistical analysis: The statistical analysis was done using SPSS for windows version 20 software (SPSS Inc., Chicago, IL, USA).

Results: Totally 220 cases of ROCM were recorded in our institute. Of this, 53 patients were treated for ROCM extending into the oral cavity. In 27 patients, we were able to achieve primary closure. In 26 patients, there was oro-antral communication after removal of the palate. Based on this data, we derived a protocol that may be used by the treating surgeon to manage oral cavity cases of ROCM, so that aggressive tissue resection may be avoided unnecessarily.

Conclusion: This protocol will help the treating surgeon to have a clearer outlook on treating this disease.

Tessier facial cleft is among the rarest facial clefts detailed in literary works and there are numerous issues contending around its multidisciplinary repairing methods. The authors describe a case of a 14-year-old girl with a neglected facial cleft associated with ADAM complex syndrome. The patient underwent soft tissue reconstruction using a combination of the forehead flap, bilateral mustardee flap, and Abbe flap. The results concerning the functional improvement for the soft tissue reconstruction are categorized as good in our terms. Surgical outcome analysis through a long-term follow-up becomes important to achieve the best possible results and patient satisfaction.

Medication-related osteonecrosis of the jaws (MRONJ) consists of an area of exposed intraoral or extraoral bone that affects patients with a history of use of antiresorptive and antiangiogenic medications, and who have not undergone head and neck radiotherapy. Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous material of great potential, used as an adjuvant in surgical treatments, especially where healing is compromised. The aim of this article is to report three cases of the use of L-PRF in the prevention of MRONJ in three female Caucasian under bisphosphonates therapy. Patient 1, 86 years old, with osteoporosis, complained of intense pain in tooth 33, which presented edema and periapical lesion and association with MRONJ. Patient 2, 61 years old, undergoing treatment for bone metastases due to breast cancer, reported pain symptoms in tooth 47, as well as suppuration in the dental element, grade I mobility, pain on periapical palpation and radiographically an endoperiodontal lesion was evidenced. Patient 3, 56 years old, also undergoing treatment for breast cancer, presented with severe pain in tooth 36. On clinical examination, she presented pain, mobility and suppuration, and radiographs indicated a furcation lesion on tooth 36. The treatment option in the three cases was the extraction of the affected teeth and the use of L-PRF to promote healing. All patients present a favorable outcome in follow-up. The use of L-PRF can be an adjuvant in the prevention of MRONJ; however, further studies are needed to prove its effectiveness.

Background: Obstructive Sleep Apnoea (OSA) is a common sleep disorder marked by partial or total obstruction of the upper airway while a person is asleep leading to breathing difficulty, reduced oxygenation and frequent awakenings. This condition affects the general health significantly compromising quality of life. The objective of this overview  is to thoroughly assess the systematic reviews on current surgical therapies for the management of OSA in terms of patient outcomes.

Methods: A thorough literature search was performed from inception till 31st December 2022 using PubMed, and Cochrane databases. Studies evaluating the effectiveness and safety of different surgical techniques for the management of OSA were considered. The quality of articles was assessed using AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and Glenny et al. checklist.

Results: Out of eighteen studies, only seven studies met the inclusion and exclusion criteria. Results showed that the majority of studies were in the pediatric age group except one systematic  review which assessed the adult age group.

Conclusion: None of the published articles had compared all surgical procedures based on the standard evaluating procedure nor followed all reporting guidelines in the primary studies. For better implementation, further multi center studies are warranted with unique reporting criteria and guidelines about pre- as well as post-operative phases. Future research should concentrate on contrasting strategies, combination therapies, and evaluating long-term effects.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-023-02051-x.

Objective: This study aimed to compare the difference between analyzing skeletal stability after orthognathic surgery by lateral cephalogram measurement created from Dolphin software (version 11.95) compared with the manual technique.

Methods: Twenty-eight patients who underwent mandibular setback surgery (BSSRO) were randomly selected between 2015 and 2021. Serial lateral cephalograms were analyzed at four different time sets postoperatively, and a total of 112 cephalometric radiographs were obtained. Horizontal measurement (BX), vertical measurement (BY), and 3 angular measurements (SNB, ANB, and Gonial angle) were analyzed by manual tracing and Dolphin software by 2 examiners. The intraclass correlation coefficient determined the intra-rater reliability. Parameter differences between timelines were observed for skeletal stability, and mean values between methods were compared using the Student's t-test.

Results: Both examiners were generally consistent in the repeated measurements (ICCs of the manual method ranged from 0.926 to 0.994, and the digital method ranged from 0.719 to 0.956). All variables represented skeletal stability at T0-T1, T0-T2, and T0-T3 showed no statistically significant differences between methods except ANB (T0-T1; p value = 0.009).

Conclusions: Computerized cephalometric analysis software is relatively reproducible for assessing skeletal changes after orthognathic surgery and can be used routinely in follow-up.

Introduction: Mandibular osteotomies in facial asymmetry are complicated by the abnormal position and course of inferior alveolar nerve. This manuscript aims to evaluate the possible variations in the preoperative positions of mandibular canal and mandibular foramen in patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia.

Materials & methods: This study included 15 patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia for which bilateral sagittal split osteotomy (BSSO) was performed as a corrective procedure. The presence/absence and extent of postoperative neurosensory deficiency was recorded subjectively and objectively. The measurements were done using multiplanar reconstruction (MPR) of three-dimensional radiographic imaging and were compared to normal subjects.

Discussion: The results revealed that the mandibular canal was closer to the buccal cortex on the affected side and the inferior border on both sides in the region of second molar in condylar hyperplasia. In condylar hypoplasia, the canal was nearer to the inferior border and the alveolar crest in relation to second and third molars respectively on the affected and contralateral sides.The mandibular foramen was also more superior to the occlusal plane on both sides in both condylar hyperplasia and hypoplasia.

Conclusion: Based on the study outcomes, the authors propose that assessment of the positions of mandibular canal and mandibular foramen is crucial to avoid postoperative neurosensory deficiencies.

Introduction: The aim of this study was to evaluate the long-term success rate of combined surgical-orthodontic therapy of skeletal anterior open bite.

Materials and methods: A total of 11 patients with an anterior open bite treated with a combined surgical-orthodontic therapy were retrospectively analysed via lateral cephalometric radiographs and models before treatment, 7-10 days after surgery (T1), one year post-operatively (T2) and two years post-operatively (T3).

Results: Ten patients continued to experience a positive overbite at T2. This decreased to 8 at T3. Three patients experienced relapse and had a negative overbite at T3. The average pre-treatment overbite was greater in the positive overbite group compared to the relapse group. Spearman's correlation analysis revealed a correlation between preoperative maxilla-mandibular plane angle (MMPA) with the overall change in overbite. Friedman's test followed by Bonferroni post-hoc analysis was carried out to identify any statistical significance.

Conclusion: In conclusion, combined surgical-orthodontic treatment achieves good results for anterior open bite. Patients with a high pre-operative MMPA have a higher risk of relapse. Lower anterior facial height ratio to total anterior facial height (LAFH/TAFH) and the amount of impaction do not significantly contribute to the risk of relapse. Long-term stability of overbite for anterior open bite patients should be around 75%.

Introduction: In this retrospective study stabilities of 24 implants simultaneously placed at posterior maxillae with sinuses grafted by advanced platelet rich fibrin (A-PRF) and newly formed bone around them were evaluated.

Patient and methods: Fourteen augmented maxillary sinuses of 11 patients with a mean residual alveolar bone height of 4.55 mm were involved in this study. Maxillary sinus lifting via lateral window approach and implant site osteotomy were performed, and prepared A-PRF clots were used as sole graft material. Each of the implants was immediately placed with a good primary stability. Postoperative sixth month tomography images were compared with preoperative ones in order to calculate the gained bone height and implant stability quotient (ISQ) values were recorded.

Results: The new vertical mean bone height of 24 implant sites was 12.21 mm with an implant survival rate of 100%. ISQ values of the implants were ranging from 62 to 75 with a mean value of 68. Statistically the diameter of implant did not have any effect on new bone formation and the ISQ values, however the length of them did.

Conclusion: A-PRF as a graft material for sinus lifting with simultaneous implant placement is a reliable technique with its low cost and lack of immunogenic reaction risk.