Journal of Maxillofacial & Oral Surgery最新文献

Introduction: Chronic suppurative osteomylities (CSO) in maxillofacial region most commonly affects mandible and involvement of condyle and coronoid is uncommon. CSO in children is usually misdiagnosed and not treated properly.

Case report: We present a girl child reported with swelling and pus discharge near preauricular region. She had history of extraction in mandible and recurrent swelling and trismus in the past.

Treatment: The case was diagnosed as chronic suppurative osteomyelitis and sequestrectomy was done under general anaesthesia.

Outcome: CSO involving condyle and coronoid is uncommon in children which makes it a unique case. Awareness regarding osteomyelitis in children should be encouraged more in rural areas so that diagnosis and prompt treatment can be given at the earliest.

Background: Orbital contents need to be retracted delicately and effectively during complex orbital floor repairs.

Innovation: We employed gentle retraction of orbital contents during a complex floor repair with the Leyla^TM retractor used to retract brain parenchyma in neurosurgery. This autoclavable retractor is self-retaining and consists of two flexible tension arms as well as a fixation base and spatula supports. This is available in the neurosurgery sets of most Level I Trauma Centres.

Advantage: The advantage of this technique is that it facilitates gentle and controlled retraction of the orbital contents without requiring assistance. The exposure till the posterior floor of the orbit is excellent and enables a precise and thorough assessment of the defect without being concerned about damaging orbital contents. Since it is self-retaining, the retractor remains in place till the end of reconstruction enabling visualisation with conservative incisions. The design of the flexible arms allows for retraction from multiple angles, crucial for navigating complex orbital floor repair. The smooth edges and precision design of the spatula minimize tissue damage during retraction.

Aim: To determine, summarize, assess and compare one-stage with two-stage ridge split procedures by systematically reviewing the existing scientific literature in adults with a novel meta-analysis.

Methods: This review was performed in accordance with Preferred Reporting Items for the Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The PubMed, Google Scholar and EBSCO Host databases were searched from January 2000 to December 2021 for prospective and follow-up studies that compared one-stage and two-stage ridge split procedures and reported the outcome in terms of mean and standard deviation (SD). Quality assessment of included studies was done using Newcastle Ottawa Scale through its domains and that of included case reports was done using the critical checklist recommended by the Joanna Briggs Institute (JBI). The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value < 0.05 as statistically significant.

Results: Eleven studies fulfilling the eligibility criteria were included in qualitative synthesis, of which, three studies were suitable for meta-analysis. All the included studies had moderate to high risk of bias. The pooled estimate through the Standardized Mean Difference (SMD) on an average favours 0.89 times more to one-stage ridge split compared to two-stage ridge split. In addition, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating presence of possible publication bias.

Conclusion: The results of our meta-analysis suggests that one-stage ridge split is superior to two-stage ridge split on a comparative analysis.

Introduction: Fixation of bifocal fractures of the mandible remains an enigma for surgeons as to how much fixation would be able to provide adequate stability. Increasing number of miniplates could lead to more complications. Thus, the aim of the study was to evaluate to minimum amount of fixation required to achieve adequate stability in bifocal fracturees of the mandible.

Materials and methods: The study was carried out in the Department of Oral & Maxillofacial Surgery and the Department of Mechanical Engineering using a finite element analysis. The Von Mises stresses and deformation distribution was analyzed when the mandibular subcondylar fracture and the contralateral parasymphysis or body fracture was fixed using a single or two miniplates. Forces were applied on the incisors, left and right molars.

Results: The results revealed that the mandibular parasymphysis or body fracture with a contralateral mandibular subcondyle fracture showed adequate stability when fixed using a single four-hole with gap titanium miniplate for fixation of both fractures in combination with an arch bar (Von Mises stress on mandible = 555.59 MPa, 558.62 MPa on 150 N incisor load; 545.98 MPa, 545.24 MPa on 300 N left molar load; and 612.99 MPa, 652.85 MPa on 300 N right molar load).

Conclusion: Non-rigid fixation is sufficient to provide adequate stability for bifocal fractures of the mandible involving unilateral mandibular subcondyle with associated contralateral mandibular dentate fracture.

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.