Pub Date : 2026-02-06DOI: 10.1016/j.jcms.2026.104483
Siyong Gao, Zhuoga Baima, Xiang Li, Kan Li, Huanzhong Ji, Jingyuan Li, Xueying Mei, Guangsen Zheng
This study aimed to investigate the characteristics and potential etiological factors of maxillary non-union, a rare but serious complication following Le Fort I maxillary osteotomy (LF-I). From a cohort of 1618 patients who underwent the procedure performed by a single clinical team between January 2017 and December 2024, five cases (0.31 % incidence) of non-union were identified, predominantly in females with a mean age of 29.6 years. Analysis of these cases revealed several critical risk factors. The primary surgical movements associated with non-union were maxillary retraction and impaction, which often involved separation of the pterygoid processes. A notably consistent finding was the lack of paranasal bone grafting at the osteotomy sites in four out of the five patients. Furthermore, unreliable rigid internal fixation was also a significant factor, as three patients presented with loosened titanium screws that featured fewer thread turns, compromising stability. All five patients were successfully treated with revision surgery involving fibrous tissue debridement and free autologous bone grafting, primarily harvested from the mandible, resulting in complete healing of the osteotomy sites.
上颌骨不连是Le Fort I型上颌截骨术后罕见但严重的并发症，本研究旨在探讨上颌骨不连的特点及潜在的病因。在2017年1月至2024年12月期间，由一个临床团队进行手术的1618例患者中，发现5例（0.31%）不愈合，主要是女性，平均年龄为29.6岁。对这些病例的分析揭示了几个关键的危险因素。与骨不连相关的主要手术动作是上颌内缩和嵌塞，通常涉及翼状突分离。一个值得注意的一致发现是，在5名患者中，有4名患者在截骨部位缺乏鼻旁骨移植。此外，不可靠的刚性内固定也是一个重要因素，有3名患者出现钛螺钉松动，螺纹旋转较少，影响了稳定性。所有5例患者均成功接受了包括纤维组织清创和游离自体骨移植在内的翻修手术，主要来自下颌骨，导致截骨部位完全愈合。
{"title":"Clinical analysis and management of bone non-union after Le Fort I maxillary osteotomy: An 8-year retrospective study.","authors":"Siyong Gao, Zhuoga Baima, Xiang Li, Kan Li, Huanzhong Ji, Jingyuan Li, Xueying Mei, Guangsen Zheng","doi":"10.1016/j.jcms.2026.104483","DOIUrl":"https://doi.org/10.1016/j.jcms.2026.104483","url":null,"abstract":"<p><p>This study aimed to investigate the characteristics and potential etiological factors of maxillary non-union, a rare but serious complication following Le Fort I maxillary osteotomy (LF-I). From a cohort of 1618 patients who underwent the procedure performed by a single clinical team between January 2017 and December 2024, five cases (0.31 % incidence) of non-union were identified, predominantly in females with a mean age of 29.6 years. Analysis of these cases revealed several critical risk factors. The primary surgical movements associated with non-union were maxillary retraction and impaction, which often involved separation of the pterygoid processes. A notably consistent finding was the lack of paranasal bone grafting at the osteotomy sites in four out of the five patients. Furthermore, unreliable rigid internal fixation was also a significant factor, as three patients presented with loosened titanium screws that featured fewer thread turns, compromising stability. All five patients were successfully treated with revision surgery involving fibrous tissue debridement and free autologous bone grafting, primarily harvested from the mandible, resulting in complete healing of the osteotomy sites.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 5","pages":"104483"},"PeriodicalIF":2.1,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1016/j.jcms.2026.104476
Che Wang, Meilin Yao, Min Wu, Bing Shi, Qian Zheng, Chenghao Li
This study aimed to compare the outcomes of different muscle reconstruction techniques with or without primary rhinoplasty (PR) in unilateral incomplete cleft lip repair patients. The study included 73 patients, with 36 patients undergoing traditional reconstruction techniques and 37 patients receiving the novel reconstruction technique. All patients wore nasal molds for 1 year after the primary surgery. Nasal and labial symmetry was evaluated using 12 indicators, based on two-dimensional photographs taken preoperatively, at 7 days postoperatively, and at 3-year follow-ups. The results at 7 days postoperatively indicated that the novel reconstruction method showed superior nasal symmetry in terms of nostril width ratio (p < 0.001) and nasal base ratio (p = 0.010) compared with the traditional reconstruction method. The 3-year follow-up results demonstrated that the novel reconstruction method also achieved better nasal symmetry in terms of nostril height ratio (p = 0.045), nostril width ratio (p = 0.023), nasal base ratio (p = 0.012), and columellar angle (p = 0.038) than the traditional reconstruction method. Both techniques performed equally well in terms of labial symmetry. In conclusion, although without PR, the novel muscle reconstruction technique showed better long-term outcomes and more significant improvements in nasal symmetry compared with traditional repair using the Tajima technique.
{"title":"Comparison of muscle reconstruction techniques with versus without primary rhinoplasty in unilateral incomplete cleft lip repair.","authors":"Che Wang, Meilin Yao, Min Wu, Bing Shi, Qian Zheng, Chenghao Li","doi":"10.1016/j.jcms.2026.104476","DOIUrl":"https://doi.org/10.1016/j.jcms.2026.104476","url":null,"abstract":"<p><p>This study aimed to compare the outcomes of different muscle reconstruction techniques with or without primary rhinoplasty (PR) in unilateral incomplete cleft lip repair patients. The study included 73 patients, with 36 patients undergoing traditional reconstruction techniques and 37 patients receiving the novel reconstruction technique. All patients wore nasal molds for 1 year after the primary surgery. Nasal and labial symmetry was evaluated using 12 indicators, based on two-dimensional photographs taken preoperatively, at 7 days postoperatively, and at 3-year follow-ups. The results at 7 days postoperatively indicated that the novel reconstruction method showed superior nasal symmetry in terms of nostril width ratio (p < 0.001) and nasal base ratio (p = 0.010) compared with the traditional reconstruction method. The 3-year follow-up results demonstrated that the novel reconstruction method also achieved better nasal symmetry in terms of nostril height ratio (p = 0.045), nostril width ratio (p = 0.023), nasal base ratio (p = 0.012), and columellar angle (p = 0.038) than the traditional reconstruction method. Both techniques performed equally well in terms of labial symmetry. In conclusion, although without PR, the novel muscle reconstruction technique showed better long-term outcomes and more significant improvements in nasal symmetry compared with traditional repair using the Tajima technique.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 4","pages":"104476"},"PeriodicalIF":2.1,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-04DOI: 10.1016/j.jcms.2026.104486
Menghao Deng, Yongqian Wang
Secondary cleft lip nasal deformity presents a persistent challenge in reconstructive surgery, with fundamental differences existing between unilateral and bilateral presentations that dictate distinct management approaches. This systematic review delineates the contrasting anatomical underpinnings of these deformities, where unilateral cases are characterized by marked asymmetry and bilateral cases by a symmetric deficiency marked by severe columellar shortening. It further synthesizes the evolution of assessment methodologies, from traditional anthropometry to advanced three-dimensional (3D) technologies like stereophotogrammetry and CT reconstruction, which enable precise preoperative planning. The review elaborates on differentiated repair strategies, emphasizing symmetry restoration in unilateral deformities versus midline structural reconstruction in bilateral cases, often necessitating substantial costal cartilage grafts. Despite advancements, challenges remain in achieving long-term stability and managing soft tissue limitations. The integration of computational modeling, artificial intelligence (AI), and tissue engineering represents the future direction for progressing toward personalized and predictable reconstruction. This synthesis provides a comprehensive framework to guide clinical decision-making and future research.
{"title":"A comparative analysis of secondary unilateral and bilateral cleft lip nasal deformities: From anatomical characteristics to repair strategies","authors":"Menghao Deng, Yongqian Wang","doi":"10.1016/j.jcms.2026.104486","DOIUrl":"10.1016/j.jcms.2026.104486","url":null,"abstract":"<div><div>Secondary cleft lip nasal deformity presents a persistent challenge in reconstructive surgery, with fundamental differences existing between unilateral and bilateral presentations that dictate distinct management approaches. This systematic review delineates the contrasting anatomical underpinnings of these deformities, where unilateral cases are characterized by marked asymmetry and bilateral cases by a symmetric deficiency marked by severe columellar shortening. It further synthesizes the evolution of assessment methodologies, from traditional anthropometry to advanced three-dimensional (3D) technologies like stereophotogrammetry and CT reconstruction, which enable precise preoperative planning. The review elaborates on differentiated repair strategies, emphasizing symmetry restoration in unilateral deformities versus midline structural reconstruction in bilateral cases, often necessitating substantial costal cartilage grafts. Despite advancements, challenges remain in achieving long-term stability and managing soft tissue limitations. The integration of computational modeling, artificial intelligence (AI), and tissue engineering represents the future direction for progressing toward personalized and predictable reconstruction. This synthesis provides a comprehensive framework to guide clinical decision-making and future research.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 5","pages":"Article 104486"},"PeriodicalIF":2.1,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-04DOI: 10.1016/j.jcms.2026.104478
Philipp Becker , Jan-Dirk Raguse , Andrea Rau , Kai Wermker , Benedicta Beck-Broichsitter , Manuel Weber , Frederic Bouffleur , Alexander-N. Zeller , Andreas Pabst
Evidence for de-escalating oral squamous cell carcinoma (OSCC) treatment is growing, but real-world adoption remains unclear in German-speaking countries. A nationwide web-based survey (SurveyMonkey®), developed by the German–Austrian–Swiss Working Group on Tumors of the Maxillofacial Region (DÖSAK) and distributed to department heads of oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland, assessed surgical and adjuvant de-escalation practices across 33 items. Participation was voluntary and anonymous; data were analyzed descriptively. Forty-two of 92 OMFS departments participated in the study (45.7 %). Sentinel lymph node biopsy (SLNB) was used by 38.1 % and planned by 26.2 %, yet fewer than half regard it as a future standard. For strictly lateral tongue cT1/2 cN0 carcinoma, unilateral elective neck dissection (ND) was reported by 73.5 %, although a minority reported more extensive procedures. Bone management shows a shift toward function preservation. Many centers favor marginal resection when cortical/medullary invasion is not demonstrated, though segmental resections persist in borderline scenarios. For maxillary OSCC, early-stage strategies varied; elective ND was widely supported in cT3/4 OSCC. Adjuvant therapy patterns are heterogeneous: most recommend radiotherapy (RT) for advanced primary or nodal disease (e.g., >pT2: 71 %; pN1: 74 %; >pN1: 68 %) and radiochemotherapy (RCT) for high-risk features (pR2: 94 %; pR1: 81 %; extranodal extension (ENE+): 81 %). Notably, ∼20 % would not recommend RCT despite pR1 or ENE+. In contrast, more than 40 % would escalate to RCT for isolated intermediate-risk factors (e.g., perineural (Pn1), lymphatic (L1), or venous invasion (V1)). Nearly half support individualized omission of adjuvant RT in pN1 when no additional adverse pathological features are present, such as Pn1, L1, or V1.
De-escalation in OSCC is gaining traction but remains inconsistently implemented, with signals of both under- and overtreatment. Standardized definitions (e.g., bone invasion), more precise risk-adapted adjuvant algorithms, and prospective multicenter studies are needed to balance oncologic safety with functional outcomes and patient preferences.
{"title":"De-escalation strategies in the treatment of oral squamous cell carcinoma: A cross-sectional study in oral and maxillofacial surgery in Germany, Austria, and Switzerland","authors":"Philipp Becker , Jan-Dirk Raguse , Andrea Rau , Kai Wermker , Benedicta Beck-Broichsitter , Manuel Weber , Frederic Bouffleur , Alexander-N. Zeller , Andreas Pabst","doi":"10.1016/j.jcms.2026.104478","DOIUrl":"10.1016/j.jcms.2026.104478","url":null,"abstract":"<div><div>Evidence for de-escalating oral squamous cell carcinoma (OSCC) treatment is growing, but real-world adoption remains unclear in German-speaking countries. A nationwide web-based survey (SurveyMonkey®), developed by the German–Austrian–Swiss Working Group on Tumors of the Maxillofacial Region (DÖSAK) and distributed to department heads of oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland, assessed surgical and adjuvant de-escalation practices across 33 items. Participation was voluntary and anonymous; data were analyzed descriptively. Forty-two of 92 OMFS departments participated in the study (45.7 %). Sentinel lymph node biopsy (SLNB) was used by 38.1 % and planned by 26.2 %, yet fewer than half regard it as a future standard. For strictly lateral tongue cT1/2 cN0 carcinoma, unilateral elective neck dissection (ND) was reported by 73.5 %, although a minority reported more extensive procedures. Bone management shows a shift toward function preservation. Many centers favor marginal resection when cortical/medullary invasion is not demonstrated, though segmental resections persist in borderline scenarios. For maxillary OSCC, early-stage strategies varied; elective ND was widely supported in cT3/4 OSCC. Adjuvant therapy patterns are heterogeneous: most recommend radiotherapy (RT) for advanced primary or nodal disease (e.g., >pT2: 71 %; pN1: 74 %; >pN1: 68 %) and radiochemotherapy (RCT) for high-risk features (pR2: 94 %; pR1: 81 %; extranodal extension (ENE+): 81 %). Notably, ∼20 % would not recommend RCT despite pR1 or ENE+. In contrast, more than 40 % would escalate to RCT for isolated intermediate-risk factors (e.g., perineural (Pn1), lymphatic (L1), or venous invasion (V1)). Nearly half support individualized omission of adjuvant RT in pN1 when no additional adverse pathological features are present, such as Pn1, L1, or V1.</div><div>De-escalation in OSCC is gaining traction but remains inconsistently implemented, with signals of both under- and overtreatment. Standardized definitions (e.g., bone invasion), more precise risk-adapted adjuvant algorithms, and prospective multicenter studies are needed to balance oncologic safety with functional outcomes and patient preferences.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 5","pages":"Article 104478"},"PeriodicalIF":2.1,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-03DOI: 10.1016/j.jcms.2026.104475
Rosie Abdulqahar Othman , Mohamed Shebl Abdelghany Elbrol , Ibrahim Mohamed Nowair , Ahmed Gamal Abu-shahba
Anterior disc displacement with reduction (ADDwR) is a common temporomandibular joint disorder associated with pain, joint sounds, and limited jaw movement. Conservative treatments are considered first-line but often yield unsatisfactory results. Botulinum toxin type A (BTX-A) injection into the lateral pterygoid muscle (LPM) offers a minimally invasive alternative, and ultrasonography enhances safety and accuracy through real-time, radiation-free guidance. This single-arm clinical trial included ten patients (20 TMJs), aged 19–38 years, diagnosed with ADDwR. Each patient received 25 units of BTX-A into the LPM under ultrasound guidance. Clinical outcomes, including pain (NPRS), clicking sound, maximum interincisal opening (MIO), and lateral excursion of the mandible, were assessed at 2, 6, 12, and 24 weeks. MRI was performed at baseline and 12 weeks to evaluate disc position, while Fonseca's questionnaire was applied preoperatively and at 24 weeks. Significant improvements were observed in pain, clicking, MIO, and lateral excursion, with MRI confirming improved disc position at 12 weeks and Fonseca scores demonstrating marked improvement at 24 weeks. The findings suggest that ultrasound-guided BTX-A injection into the LPM is a safe and effective treatment for ADDwR, enhancing joint function and symptom relief, although larger randomized studies are recommended.
{"title":"Evaluation of the ultrasonography-guidance for botulinum toxin type a injection into lateral pterygoid muscle in patients with TMJ anterior disc displacement with reduction","authors":"Rosie Abdulqahar Othman , Mohamed Shebl Abdelghany Elbrol , Ibrahim Mohamed Nowair , Ahmed Gamal Abu-shahba","doi":"10.1016/j.jcms.2026.104475","DOIUrl":"10.1016/j.jcms.2026.104475","url":null,"abstract":"<div><div>Anterior disc displacement with reduction (ADDwR) is a common temporomandibular joint disorder associated with pain, joint sounds, and limited jaw movement. Conservative treatments are considered first-line but often yield unsatisfactory results. Botulinum toxin type A (BTX-A) injection into the lateral pterygoid muscle (LPM) offers a minimally invasive alternative, and ultrasonography enhances safety and accuracy through real-time, radiation-free guidance. This single-arm clinical trial included ten patients (20 TMJs), aged 19–38 years, diagnosed with ADDwR. Each patient received 25 units of BTX-A into the LPM under ultrasound guidance. Clinical outcomes, including pain (NPRS), clicking sound, maximum interincisal opening (MIO), and lateral excursion of the mandible, were assessed at 2, 6, 12, and 24 weeks. MRI was performed at baseline and 12 weeks to evaluate disc position, while Fonseca's questionnaire was applied preoperatively and at 24 weeks. Significant improvements were observed in pain, clicking, MIO, and lateral excursion, with MRI confirming improved disc position at 12 weeks and Fonseca scores demonstrating marked improvement at 24 weeks. The findings suggest that ultrasound-guided BTX-A injection into the LPM is a safe and effective treatment for ADDwR, enhancing joint function and symptom relief, although larger randomized studies are recommended.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 5","pages":"Article 104475"},"PeriodicalIF":2.1,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-02DOI: 10.1016/j.jcms.2026.104465
Raffaele Aguglia, Brice Blanc, Pierre Descols, Lucas Ungerer, Antoine Moya-Plana, Nadia Benmoussa
Extensive orbital exenteration requires complex reconstructive strategies to restore both function and aesthetic form while allowing for durable prosthetic rehabilitation. This retrospective study analyzed reconstructive outcomes following orbital exenteration at the Gustave Roussy Institute, while emphasizing the importance of prosthesis-driven surgical planning through close collaboration between surgeons and prosthetists. Seventy-eight patients who underwent orbital exenteration between 2000 and 2023 were included. Demographic characteristics, oncological data, reconstructive techniques, complications, and surgical and prosthetic outcomes were collected and analyzed descriptively. The cohort had a mean age of 58 years (female/male ratio 30/48). Squamous cell carcinoma was the most frequent diagnosis (36 %). Neoadjuvant or adjuvant radiotherapy was administered in 61.5 % of patients, and 41 % underwent extended exenterations associated with maxillectomy. Free flaps were the predominant reconstructive method (73 %). Twenty-five patients (32 %) were rehabilitated with an epithesis, including 12 implant-supported prostheses. Based on long-term institutional experience and representative clinical cases, five reconstructive principles were identified to optimize outcomes: selection of the thinnest feasible flap according to defect extent and radiotherapy status; prioritization of orbital concavity and malar projection over anatomic reconstruction of the orbital frame; strategic timing and positioning of osseointegrated implants; avoidance of eyelid preservation in extensive defects with loss of bony support; and proactive management of dyschromia. An epithesis-first approach to reconstruction may improve functional, aesthetic, and patient-reported outcomes following extensive orbital exenteration.
{"title":"Management of extended oncologic orbital exenteration reconstruction: a collaboration between surgeons and prosthetists for optimized results.","authors":"Raffaele Aguglia, Brice Blanc, Pierre Descols, Lucas Ungerer, Antoine Moya-Plana, Nadia Benmoussa","doi":"10.1016/j.jcms.2026.104465","DOIUrl":"https://doi.org/10.1016/j.jcms.2026.104465","url":null,"abstract":"<p><p>Extensive orbital exenteration requires complex reconstructive strategies to restore both function and aesthetic form while allowing for durable prosthetic rehabilitation. This retrospective study analyzed reconstructive outcomes following orbital exenteration at the Gustave Roussy Institute, while emphasizing the importance of prosthesis-driven surgical planning through close collaboration between surgeons and prosthetists. Seventy-eight patients who underwent orbital exenteration between 2000 and 2023 were included. Demographic characteristics, oncological data, reconstructive techniques, complications, and surgical and prosthetic outcomes were collected and analyzed descriptively. The cohort had a mean age of 58 years (female/male ratio 30/48). Squamous cell carcinoma was the most frequent diagnosis (36 %). Neoadjuvant or adjuvant radiotherapy was administered in 61.5 % of patients, and 41 % underwent extended exenterations associated with maxillectomy. Free flaps were the predominant reconstructive method (73 %). Twenty-five patients (32 %) were rehabilitated with an epithesis, including 12 implant-supported prostheses. Based on long-term institutional experience and representative clinical cases, five reconstructive principles were identified to optimize outcomes: selection of the thinnest feasible flap according to defect extent and radiotherapy status; prioritization of orbital concavity and malar projection over anatomic reconstruction of the orbital frame; strategic timing and positioning of osseointegrated implants; avoidance of eyelid preservation in extensive defects with loss of bony support; and proactive management of dyschromia. An epithesis-first approach to reconstruction may improve functional, aesthetic, and patient-reported outcomes following extensive orbital exenteration.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 4","pages":"104465"},"PeriodicalIF":2.1,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1016/j.jcms.2026.104474
David Faustino Ângelo , Francesco Maffia , David Sanz , Henrique José Cardoso
Open temporomandibular joint (TMJ) surgery must balance exposure, facial nerve preservation, and cosmesis. The Root of Helix Inter Tragus Notch Incision (RHITNI), an endaural modification with promising aesthetics and low morbidity, lacks systematic outcome data. A single-center retrospective cohort study of consecutive primary open TMJ procedures using RHITNI over five years was performed. Primary endpoint: branch-specific facial nerve dysfunction (temporary or permanent). Secondary endpoints: auriculotemporal sensory change, salivary complications, hematoma, infection, wound problems, and scar concerns. Outcomes were stratified by procedure type and calculated per surgical site (joint). Thirty-seven patients underwent surgery, for a total of 46 operated joints. Follow-up was completed for all patients over a five-year period. Temporary complications occurred in 6/46 joints (13.0 %). Specific events included: transient facial nerve weakness in 2/46 (4.3 %); auriculotemporal hypoesthesia/paresthesia in 2/46 (4.3 %); ear canal blood clot in 1/46 (2.2 %); and preauricular edema in 1/46 (2.2 %). All transient events resolved (median facial nerve recovery 322 days, range 300–344). No infections, salivary issues, dehiscence, or scar-related complaints were recorded. No permanent complications (>12 months persistence) were observed (0 %). RHITNI provided safe access for open TMJ surgery, with 4.3 %transient facial nerve weakness, no permanent deficits, and minimal locoregional morbidity regardless of the intra-articular procedure performed. Findings compare favorably with benchmarks and support RHITNI as an aesthetic, nerve-sparing option.
{"title":"Root of Helix Inter Tragus Notch Incision (RHITNI) for open temporomandibular joint surgery: A five-year retrospective cohort study on safety and complications","authors":"David Faustino Ângelo , Francesco Maffia , David Sanz , Henrique José Cardoso","doi":"10.1016/j.jcms.2026.104474","DOIUrl":"10.1016/j.jcms.2026.104474","url":null,"abstract":"<div><div>Open temporomandibular joint (TMJ) surgery must balance exposure, facial nerve preservation, and cosmesis. The Root of Helix Inter Tragus Notch Incision (RHITNI), an endaural modification with promising aesthetics and low morbidity, lacks systematic outcome data. A single-center retrospective cohort study of consecutive primary open TMJ procedures using RHITNI over five years was performed. Primary endpoint: branch-specific facial nerve dysfunction (temporary or permanent). Secondary endpoints: auriculotemporal sensory change, salivary complications, hematoma, infection, wound problems, and scar concerns. Outcomes were stratified by procedure type and calculated per surgical site (joint). Thirty-seven patients underwent surgery, for a total of 46 operated joints. Follow-up was completed for all patients over a five-year period. Temporary complications occurred in 6/46 joints (13.0 %). Specific events included: transient facial nerve weakness in 2/46 (4.3 %); auriculotemporal hypoesthesia/paresthesia in 2/46 (4.3 %); ear canal blood clot in 1/46 (2.2 %); and preauricular edema in 1/46 (2.2 %). All transient events resolved (median facial nerve recovery 322 days, range 300–344). No infections, salivary issues, dehiscence, or scar-related complaints were recorded. No permanent complications (>12 months persistence) were observed (0 %). RHITNI provided safe access for open TMJ surgery, with 4.3 %transient facial nerve weakness, no permanent deficits, and minimal locoregional morbidity regardless of the intra-articular procedure performed. Findings compare favorably with benchmarks and support RHITNI as an aesthetic, nerve-sparing option.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 4","pages":"Article 104474"},"PeriodicalIF":2.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.jcms.2026.104447
Muhammed Furkan Yilmaz , Mehmet Melih Omezli , Damla Torul , Richard J. Miron
This study aims to explore the effectiveness of injectable platelet-rich fibrin (I-PRF) and concentrated platelet-rich fibrin (C-PRF) in temporomandibular joint (TMJ) internal derangements. Patients with TMJ complaints were randomly divided into three groups in which arthrocentesis alone, arthrocentesis and I-PRF injections, or arthrocentesis and C-PRF injections were applied. Pain levels, maximum mouth opening (MMO), TMJ movements, and sounds were recorded preoperatively, postoperatively, at the 1st week, 1st month, and 3rd month; Oral health-related quality of life (OHRQoL) and mandibular dysfunction were evaluated preoperatively and at 3 months. 30 patients (mean age 41 ± 12.19) were included. Although I-PRF and C-PRF groups were found more effective clinically, no statistically significant differences were observed between the groups regarding pain level, MMO, and TMJ movements except for differences at postoperative-1st week (p = 0.023) for MMO and preoperative-1st month (p = 0.043), preoperative-3rd month (p = 0.005) and 1st week-3rd month (p = 0.007) for left lateral movement. No statistically significant differences were observed between the groups in terms of the Oral Health Impact Scale-14 (OHIP-14) and Mandibular Function Impairment Questionnaire (MFIQ) (p > 0.05). Although not significant, slightly improved values in the I-PRF group for pain and in the C-PRF group during the acute phase for pain and MMO suggest that I-PRF and, during the acute phase, C-PRF may be preferred after arthrocentesis to enhance clinical outcomes. However, these results still require more research on larger samples to be validated.
{"title":"Efficacy of injectable platelet-rich fibrin and concentrated platelet-rich fibrin injections combined with arthrocentesis in the management of temporomandibular joint internal disorders: Randomized clinical trial","authors":"Muhammed Furkan Yilmaz , Mehmet Melih Omezli , Damla Torul , Richard J. Miron","doi":"10.1016/j.jcms.2026.104447","DOIUrl":"10.1016/j.jcms.2026.104447","url":null,"abstract":"<div><div>This study aims to explore the effectiveness of injectable platelet-rich fibrin (I-PRF) and concentrated platelet-rich fibrin (C-PRF) in temporomandibular joint (TMJ) internal derangements. Patients with TMJ complaints were randomly divided into three groups in which arthrocentesis alone, arthrocentesis and I-PRF injections, or arthrocentesis and C-PRF injections were applied. Pain levels, maximum mouth opening (MMO), TMJ movements, and sounds were recorded preoperatively, postoperatively, at the 1st week, 1st month, and 3rd month; Oral health-related quality of life (OHRQoL) and mandibular dysfunction were evaluated preoperatively and at 3 months. 30 patients (mean age 41 ± 12.19) were included. Although I-PRF and C-PRF groups were found more effective clinically, no statistically significant differences were observed between the groups regarding pain level, MMO, and TMJ movements except for differences at postoperative-1st week (p = 0.023) for MMO and preoperative-1st month (p = 0.043), preoperative-3rd month (p = 0.005) and 1st week-3rd month (p = 0.007) for left lateral movement. No statistically significant differences were observed between the groups in terms of the Oral Health Impact Scale-14 (OHIP-14) and Mandibular Function Impairment Questionnaire (MFIQ) (p > 0.05). Although not significant, slightly improved values in the I-PRF group for pain and in the C-PRF group during the acute phase for pain and MMO suggest that I-PRF and, during the acute phase, C-PRF may be preferred after arthrocentesis to enhance clinical outcomes. However, these results still require more research on larger samples to be validated.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 3","pages":"Article 104447"},"PeriodicalIF":2.1,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Cranial deformities in infancy, such as positional plagiocephaly and brachycephaly, have been suggested to influence the development of jaw malpositions. However, the long-term relationship between cranial shape and dysgnathia remains unclear.</div></div><div><h3>Objective</h3><div>This prospective case–control study investigates whether differences in cranial morphology, measured by the Cranial Index (CI), Cranial Vault Asymmetry Index (CVAI), Diagonal Difference (DD), and ear axis offset (EO), are associated with malocclusions classified according to the Angle system in adolescents and adults.</div></div><div><h3>Materials and methods</h3><div>A total of 146 participants (113 dysgnathia patients and 33 controls with neutral occlusion) were recruited from the Dysgnathia Clinic at the University Hospital Giessen between October 2018 and February 2020. Cranial morphology was assessed using an automated three-dimensional photogrammetric system (VECTRA®), and occlusion was documented with dental impression models. Participants were grouped by Angle classification (Class I [control], Class II, and Class III) as well as by the presence/absence of laterognathia. Statistical associations between head shape parameters and malocclusion types were analyzed using Fisher's exact test and the Kruskal–Wallis H-test (α = 0.05).</div><div>Only non-syndromal adolescents and adults were included; patients with previous cranial surgery, severe head trauma, or jaw fractures were excluded; controls had Angle Class I occlusion and no history of orthodontic treatment.</div><div>Cranial morphology was acquired using the VECTRA® 3D stereophotogrammetry system (Canfield Scientific Inc., Fairfield, NJ, USA). Landmarking and analysis were performed in Cranioform Analytics 4.0. We report CI, CVAI, DD and EO as continuous variables; infant-derived thresholds are cited for descriptive context only and are not used for inferential testing in this adult cohort.</div><div>Angle Class I–III was determined on three-dimensionally oriented plaster models. Models were oriented using standard craniofacial planes to ensure reproducible assessment of molar relationships.</div></div><div><h3>Results</h3><div>Mean age was 26.3 ± 8.9 years; sex distribution is reported descriptively in the Results tables (female/male proportions). The overall analysis revealed a significant association between CI classes and dysgnathia (p = 0.0042). In particular, a brachycephalic head shape (CI > 81) was significantly more common in Angle Class III malocclusions compared with controls (p = 0.0085). In addition, an ear axis offset (EO > 0.31 cm) was significantly associated with both Angle Class II (p = 0.0027) and Class III (p = 0.0274) malocclusions. No statistically significant associations were found between the indices of cranial asymmetry (CVAI and DD) and either dysgnathia or laterognathia. Notably, only 11.5 % of participants exhibited pathological CVAI values and
{"title":"Association between cranial morphology and dysgnathias in adolescents and adults: A prospective case–control study","authors":"Jan-Falco Wilbrand , Elisa Heep , Hans-Peter Howaldt , Martina Wilbrand","doi":"10.1016/j.jcms.2026.104446","DOIUrl":"10.1016/j.jcms.2026.104446","url":null,"abstract":"<div><h3>Background</h3><div>Cranial deformities in infancy, such as positional plagiocephaly and brachycephaly, have been suggested to influence the development of jaw malpositions. However, the long-term relationship between cranial shape and dysgnathia remains unclear.</div></div><div><h3>Objective</h3><div>This prospective case–control study investigates whether differences in cranial morphology, measured by the Cranial Index (CI), Cranial Vault Asymmetry Index (CVAI), Diagonal Difference (DD), and ear axis offset (EO), are associated with malocclusions classified according to the Angle system in adolescents and adults.</div></div><div><h3>Materials and methods</h3><div>A total of 146 participants (113 dysgnathia patients and 33 controls with neutral occlusion) were recruited from the Dysgnathia Clinic at the University Hospital Giessen between October 2018 and February 2020. Cranial morphology was assessed using an automated three-dimensional photogrammetric system (VECTRA®), and occlusion was documented with dental impression models. Participants were grouped by Angle classification (Class I [control], Class II, and Class III) as well as by the presence/absence of laterognathia. Statistical associations between head shape parameters and malocclusion types were analyzed using Fisher's exact test and the Kruskal–Wallis H-test (α = 0.05).</div><div>Only non-syndromal adolescents and adults were included; patients with previous cranial surgery, severe head trauma, or jaw fractures were excluded; controls had Angle Class I occlusion and no history of orthodontic treatment.</div><div>Cranial morphology was acquired using the VECTRA® 3D stereophotogrammetry system (Canfield Scientific Inc., Fairfield, NJ, USA). Landmarking and analysis were performed in Cranioform Analytics 4.0. We report CI, CVAI, DD and EO as continuous variables; infant-derived thresholds are cited for descriptive context only and are not used for inferential testing in this adult cohort.</div><div>Angle Class I–III was determined on three-dimensionally oriented plaster models. Models were oriented using standard craniofacial planes to ensure reproducible assessment of molar relationships.</div></div><div><h3>Results</h3><div>Mean age was 26.3 ± 8.9 years; sex distribution is reported descriptively in the Results tables (female/male proportions). The overall analysis revealed a significant association between CI classes and dysgnathia (p = 0.0042). In particular, a brachycephalic head shape (CI > 81) was significantly more common in Angle Class III malocclusions compared with controls (p = 0.0085). In addition, an ear axis offset (EO > 0.31 cm) was significantly associated with both Angle Class II (p = 0.0027) and Class III (p = 0.0274) malocclusions. No statistically significant associations were found between the indices of cranial asymmetry (CVAI and DD) and either dysgnathia or laterognathia. Notably, only 11.5 % of participants exhibited pathological CVAI values and ","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 3","pages":"Article 104446"},"PeriodicalIF":2.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号