Journal of the Korean Association of Oral and Maxillofacial Surgeons最新文献

Fungal ball is a non-invasive accumulation of the fungal element within the paranasal sinuses, most commonly affecting the maxillary sinus. This lesion often remains asymptomatic and is typically identified incidentally during imaging. This case report described the unexpected discovery of a maxillary fungal ball during elective esthetic facial contouring surgery in a healthy, asymptomatic 37-year-old female. Preoperative cone-beam computed tomography imaging revealed a chronic sinusitis-like lesion, which intraoperatively was confirmed as a dark-brown, fluffy mass in the right maxillary sinus. Histopathological analysis identified septate fungal hyphae consistent with non-invasive aspergillosis. Postoperative follow-up demonstrated no recurrence or sinus-related symptoms. This case showed the importance of thorough preoperative imaging and intraoperative vigilance in esthetic surgeries involving facial bones adjacent to sinus structures. Recognizing the potential for undiagnosed sinus pathology, even in asymptomatic patients, is essential for minimizing surgical complications and optimizing patient outcomes.

Objectives: : This study aimed to investigate the distribution of Archer's Classification in impacted maxillary third molars in Korean adults, evaluate the effect of the buccopalatal inclination of the maxillary second molar on the position and angulation of the impacted maxillary third molar, and analyze the relationship between root involvement with the maxillary sinus.

Materials and methods: : Cone-beam computed tomography (CBCT) images of 384 impacted maxillary third molars from 277 patients who visited Dankook University Dental Hospital between March 2021 and February 2024 were analyzed. The teeth were classified according to Archer's Classification (depth and axis), and the long axis angles of the maxillary first, second, and third molars as well as root involvement with the maxillary sinus were measured. Statistical analyses were conducted using the Mann-Whitney U test, chi-square test, and logistic regression analysis, with a significance level set at 0.05.

Results: : Depth categories B and C, and axis categories mesial and vertical were the most prevalent, with no significant differences in distribution based on sex (P>0.05). A significant negative correlation was found, indicating that as the buccal inclination of the maxillary second molar increased, the impacted maxillary third molar tended to incline more palatally (Kendall's tau-b=-0.245, Spearman's rho=-0.353, P<0.001). Root involvement with the maxillary sinus was not significantly associated with depth in Archer's Classification but showed a statistically significant difference based on axis (P=0.002).

Conclusion: This study systematically evaluated the position and angulation of impacted maxillary third molars through Archer's Classification and CBCT analysis, providing a clinical predictive index for assessing extraction difficulty and determining the surgical approach. In particular, the buccopalatal inclination of the maxillary second molar was identified as an important factor in predicting the position and angulation of impacted maxillary third molars.

Objectives: Mandibular midline widening is a known technique to correct transverse deficit. The osteotomy can be combined with bimaxillary orthognathic surgery and genioplasty in patients who require surgical correction of mandibular transverse width. The purpose of this study was to assess postoperative stability in patients who underwent bilateral sagittal split ramus osteotomy (BSSRO) setback and widening of mandibular midline to reinstate ideal transverse width.

Patients and methods: This retrospective cohort study included patients wherein single stage Le Fort I, BSSRO setback with mandibular midline widening and genioplasty was performed within August 2020 to March 2024; 24 patients underwent surgery and a 6-month postoperative follow-up. Three patients requiring surgery first approach, two stage bimaxillary surgery and titanium osteosynthesis placement without genioplasty were excluded (n=21). Pre- and postoperative radiographs at specific timepoints were used to compare same landmarks at the first molar and gonial regions, representative of mandibular transverse width change. Condylar angulations were assessed once before and after surgery. Postoperative complications were assessed during follow-up. Statistical analysis was done using Friedman's test, Wilcoxon signed rank test, t-test and Spearman's correlation. P<0.05 indicated significance.

Results: Total sample consisted of 21 (10 male, 11 female) patients. Mean patient age was 27.9±10.8 years. Simulated preoperative widening mean was 3.23±0.76 mm. There was no statistical significance between postoperative immediate and 1-month, 3-months, 6-months widening at gonial region; molar widening showed significance at 6-months (P=0.03). Molar widening correlation to right and left condylar angulation had very weak relation to both condyles in the immediate postoperative period. One patient sustained gingival tear and plate exposure which healed eventually.

Conclusion: BSSRO setback with mandibular midline widening and genioplasty is ideal for correction of mild to moderate (≤5 mm) transverse mandibular discrepancies with good stability and fewer postoperative complications.

Transcrestal sinus floor elevation (tSFE) is a useful method for vertical bone augmentation in the posterior maxilla at the time of implant placement. However, this is a blind surgical technique with a risk of perforating the Schneiderian membrane. In this article, we present a simple technique to perform tSFEs using ridge spreaders. With this technique, the tSFE is performed in a slow and controlled manner without the entry of instruments into the maxillary sinus. Furthermore, many clinicians may find they already have the necessary surgical tools within their armamentarium. This precludes the need for rotary drills that spin at high revolutions per minute in the sinus cavity or osteotomes which may result in an uncomfortable patient experience. In order to fully exemplify its clinical utility in performing successful tSFE without membrane perforation, we present this surgical technique in a case with limited residual bone height and a steeply oblique sinus floor.

Objectives: An oroantral fistula (OAF) is an abnormal connection between the oral cavity and the maxillary sinus. The buccal fat pad (BFP) has been used as a pedicle graft for the repair of oral cavity defects, including OAF defects. In the present study, we evaluated the effectiveness of the BFP technique for closing OAFs resulting from dental implant removal.

Patients and methods: BFP grafting was performed in patients with OAFs after dental implant removal, and the results were retrospectively analyzed. Nine patients were included, and the BFP was grafted onto the posterior maxilla for closure of the OAF.

Results: In seven patients (82%), the OAF was successfully closed only in the first surgery, but in two patients, the OAF was not closed; therefore, additional surgery was performed. All patients with OAF after dental implant removal were successfully treated with the BFP graft without other serious complications.

Conclusion: Overall, this study highlights the clinical significance of BFP grafting for the management of OAFs following dental implant failure and suggests that BFP grafting can be considered a primary treatment option for patients presenting with OAFs.

Isolated bilateral temporalis muscle hypertrophy (IBTMH) is a rare clinical condition characterized by symmetrical enlargement of the temporalis muscles without masseter involvement. This case report presents a 47-year-old male with progressive bilateral temporal swelling and discomfort during mastication, significantly affecting his quality of life. Clinical examination and magnetic resonance imaging (MRI) confirmed homogenous enlargement of the temporalis muscles with no underlying pathology. The patient was treated with botulinum toxin type A (BTxA) injections in two sessions, following anatomical landmarks and established guidelines to ensure safety and efficacy. Post-treatment follow-ups revealed significant improvement in symptoms and normalization of temporal contours, with MRI confirming muscle volume reduction. This case contributes to the limited literature on IBTMH and supports BTxA as a safe, non-invasive, and effective treatment modality. It also underscores the need for standardized injection techniques to minimize complications in the anatomically complex temporal region. Further case reports and research are essential to improve clinical understanding and guide best practices for diagnosis and management of this rare entity.

Objectives: This case series aims to describe the virtual surgical planning process and report the surgical outcomes of in-house-designed patientspecific implants (PSIs) combined with navigation systems in orthognathic surgery.

Patients and methods: Three patients undergoing two-jaw surgery were assessed across pre-surgical planning, surgical execution, and post-surgical evaluation phases. The accuracy was evaluated between the surgical plan (T0) and immediate post-operative three-dimensional (3D) radiographic image (T1) using 2 methods: bone surface comparison and dental landmark comparison. The stability was assessed between T1 and 3D radiographic image at 9 months after surgery (T2) by Bone surface comparison method.

Results: The accuracy assessed by Bone surface comparison shows that green areas (deviation between 0.0-0.4 mm) were mostly observed in the anterior region of the Le Fort I segment. The average deviations of dental landmark comparison are as follows: in the left-right direction, 0.28±0.41 to the right; in the anterior-posterior direction, 0.13±0.48 to the posterior; and in the superior-inferior direction, 0.37±0.39 to the inferior. The stability assessed by bone surface comparison shows the green area in two of three patients, indicating minimal post-surgical changes.

Conclusion: The in-house-designed PSIs combined with navigation systems can achieve accuracy and stability in orthognathic surgery.

Objectives: To compare the clinical and radiographic results of three approaches-involving particulate bone graft, recombinant human bone morphogenetic protein-2 (rhBMP-2)+absorbable collagen sponge (ACS), and no graft material-for lateral maxillary sinus augmentation with simultaneous dental implant placement.

Materials and methods: From January 2015 to June 2021, a retrospective analysis was performed on 63 patients (a total of 122 implants) who underwent lateral maxillary sinus augmentation with simultaneous implant placement at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital. The patients were classified into three groups: no bone graft (n=46), particulate bone graft (n=44), and rhBMP-2+ACS graft material (n=32) groups. Panoramic and cone-beam computed tomography images taken before and after surgery were used to evaluate the residual bone height (RBH), postoperative bone height (POBH), bone density, and type of bone formation at the apex of the implant (BT). Additionally, the implant survival rates and postoperative complications were analyzed.

Results: The 1-year implant survival rate was similar across all three groups, exceeding 95%. The particulate bone graft group demonstrated the best clinical outcomes in terms of POBH and bone density, as well as the most active bone formation at the BT. The incidence of complications did not differ significantly among the three groups.

Conclusion: Although particulate bone graft was effective for bone formation and space maintenance, no significant differences were observed in the implant survival rate or complications compared with the other methods. The sinus augmentation outcomes did not vary considerably regardless of the type of bone graft material used.

Untreated mandibular condyle fractures in childhood can result in significant jaw deformities, such as mandibular retrognathism, open bite, and facial asymmetry, which may necessitate surgical intervention in later years. Surgical approaches vary depending on the severity of the condition, including mandibular surgery alone, maxillomandibular surgery, or mandibular distraction osteogenesis (MDO). This report highlights a case involving mandibular retrognathism and open bite with condylar dislocation and malunion caused by untreated pediatric condyle fractures. Key challenges in this case included excessive anterior mandibular movement, irregular morphology of the mandibular ramus caused by malunion from fracture healing, and anteromedial dislocation of both condyles, all of which posed significant surgical complexities. The surgical approach combined Le Fort I osteotomy with MDO to perform maxillary impaction and mandibular advancement, followed by a secondary genioplasty. Notably, the dislocated temporomandibular joints were left untreated. Two years postoperatively, no relapse or recurrence of open bite was observed, and the dislocated condyles showed no positional and morphological changes, reflecting favorable outcomes. To our knowledge, this is the first reported case of orthognathic surgery combined with MDO for bilateral dislocated mandibular condyles, making it a valuable contribution to clinical practice.

Objectives: : Autotransplantation of third molars with complete root formation is a well-established surgical approach for replacing missing teeth, offering biological advantages over conventional prosthetic or implant therapies. The severity of third molar impaction may significantly influence autotransplantation prognosis, yet its clinical significance has not been thoroughly investigated.

Materials and methods: : This retrospective cohort analysis assessed for autotransplantation of the third molar. Patients were categorized based on impaction severity, and Kaplan-Meier survival analysis was conducted to estimate cumulative Survival rates. Differences in survival according to impaction severity were assessed using the log-rank test, with further evaluation of associated factors.

Results: : A total 227 autotransplantation patients (118 males, 109 females, 45.4±14.4 years) and the mean follow-up duration was 26.8 months, achieving an overall 5-year cumulative survival rate of 72.0%. Fully impacted teeth exhibited significantly superior survival outcomes (93.3%) compared to fully erupted (62.9%) and partially impacted teeth (82.9%) (P<0.001). Lower patient age was also significantly associated with better survival (P=0.002). Younger age (≤30 years) was also significantly associated with better survival outcomes (P=0.002). No significant survival differences were found regarding sex, splinting period, extra-socket time, or healing period.

Conclusion: Impaction severity is a critical prognostic factor influencing the prognosis of autotransplantation by using the third molars. Comprehensive preoperative evaluation of donor tooth condition, particularly regarding impaction severity, is essential to maximize transplantation outcomes.