Journal of Cranio-Maxillofacial Surgery最新文献

{"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 ,&nbsp;Francesco Maffia ,&nbsp;David Sanz ,&nbsp;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 (&gt;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}

{"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 ,&nbsp;Mehmet Melih Omezli ,&nbsp;Damla Torul ,&nbsp;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 &gt; 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}

{"title":"Association between cranial morphology and dysgnathias in adolescents and adults: A prospective case–control study","authors":"Jan-Falco Wilbrand ,&nbsp;Elisa Heep ,&nbsp;Hans-Peter Howaldt ,&nbsp;Martina Wilbrand","doi":"10.1016/j.jcms.2026.104446","DOIUrl":"10.1016/j.jcms.2026.104446","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;div&gt;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.&lt;/div&gt;&lt;div&gt;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.&lt;/div&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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 &gt; 81) was significantly more common in Angle Class III malocclusions compared with controls (p = 0.0085). In addition, an ear axis offset (EO &gt; 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}

{"title":"Atypical intramuscular arterio-venous malformations and intramuscular capillary type hemangiomas (ICTH) of the head and neck: considerations on a case series of 13 patients.","authors":"Giacomo Colletti, Sara Negrello, Linda Rozell-Shannon, Alexandre Anesi, Benedetta Mattei, Stefano Vallone, Laura Moneghini, Riccardo Nocini","doi":"10.1016/j.jcms.2026.104444","DOIUrl":"https://doi.org/10.1016/j.jcms.2026.104444","url":null,"abstract":"<p><p>Vascular anomalies can be harbored within a muscle. Slow-flow ones (venous malformations, fibro adipose vascular malformations, etc.) are frequent. However, high-flow intramuscular vascular anomalies (IFVA) are rare and poorly understood. A retrospective study was conducted on a case series of 13 patients suffering from IFVA of the head and neck area. For each case, the following were examined: clinical course, treatment, histological features and prognosis. Two distinct entities were revealed: intramuscular arteriovenous malformations (AVM) and intramuscular capillary-type hemangioma (ICTH). They were similar in many aspects. Both presented as slowly-growing, pulsating and warm tumefactions. They involved the masseter muscle in nine cases, the masseter and the temporalis in one, the sternocleidomastoid in one, the anterior and middle scalene in 1, and the frontalis in 1. On imaging, both showed the presence of a mass-like tissue with vessels within it. This appeared as T1 isointense and T2 hyperintense, and had vivid contrast enhancement. However, AVM had bigger and more prevalent vessels, while ICTH had smaller and fewer ones. On ultrasound imaging, AVM presented the typical features of shunting (low resistance index) whereas ICTH did not. AVM and ICTH were histologically different. Patients who were managed with accurate and complete resection did not relapse, whereas partial or subtotal removal resulted in disease recurrence. Intramuscular fast-flow vascular anomalies comprise AVM and ICTH. They share common features, but are different diseases. Complete surgical removal appears to be an effective method of treating both.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 5","pages":"104444"},"PeriodicalIF":2.1,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151341","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}

{"title":"Comparative analysis of soft tissue response after orthognathic surgery in patients with and without cleft using 3D imaging: A preliminary study","authors":"Chi Hyun Lee ,&nbsp;Yong Chan Bae ,&nbsp;Youn-Kyung Choi ,&nbsp;Rafael Denadai ,&nbsp;Hyung Joon Seo","doi":"10.1016/j.jcms.2025.11.008","DOIUrl":"10.1016/j.jcms.2025.11.008","url":null,"abstract":"<div><div>This study investigated differences in upper lip soft tissue response to skeletal movement between patients with and without cleft following orthognathic surgery. Twelve patients with Class III dentofacial deformities underwent orthognathic surgery: six with complete unilateral cleft lip and palate and six age- and sex-matched non-cleft controls. Hard tissue movement was measured using 3D surgical simulation, and soft tissue changes were assessed with 3D photogrammetry.</div><div>The cleft group showed significantly greater advancement across all hard tissue landmarks compared to the non-cleft group (p &lt; 0.01). However, soft tissue advancement at the subnasale was only moderately greater in the cleft group (p &lt; 0.05), with no significant differences observed at other midline points. Soft-to-hard tissue movement ratios were consistently lower in the cleft group, although these differences did not reach statistical significance. The ratio of soft tissue volume change to A-point displacement was higher in the non-cleft group than in the cleft group (p &lt; 0.05), indicating a reduced soft tissue response in the cleft group.</div><div>These findings suggest that patients with cleft may require greater skeletal advancement to achieve favorable soft tissue outcomes, highlighting the importance of individualized surgical planning to balance aesthetic goals with complications such as velopharyngeal insufficiency.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 3","pages":"Article 104405"},"PeriodicalIF":2.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980128","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}

{"title":"EACMFS Prizes & Awards","authors":"","doi":"10.1016/S1010-5182(26)00018-1","DOIUrl":"10.1016/S1010-5182(26)00018-1","url":null,"abstract":"","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 2","pages":"Article 104461"},"PeriodicalIF":2.1,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978684","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}

{"title":"Management of postoperative pain associated with sleep disordered breathing surgery: A systematic review","authors":"Mengmeng Li ,&nbsp;Qinglai Tang ,&nbsp;Qian Yang ,&nbsp;Shiying Zeng ,&nbsp;Haibo Ou ,&nbsp;Xinying Tong ,&nbsp;Danhui Yin ,&nbsp;Shisheng Li","doi":"10.1016/j.jcms.2026.104452","DOIUrl":"10.1016/j.jcms.2026.104452","url":null,"abstract":"<div><div>Postoperative pain is one of the most common and significant complications in patients undergoing surgery for sleep-disordered breathing (SDB), and inadequate pain control may precipitate adverse events and impair postoperative recovery. This systematic review evaluated the effects of various pharmacological and non-pharmacological analgesic interventions on pain following SDB-related surgery, with the aim of identifying potentially optimal postoperative analgesic strategies. A comprehensive search of PubMed, EMBASE, Scopus, Web of Science, CINAHL, the Cochrane Library, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, supplemented by manual screening of reference lists, identified 28 randomized controlled trials eligible for inclusion. Across the available evidence, multiple pharmacological approaches-including local anesthetics, non-steroidal anti-inflammatory drugs, corticosteroids, sucralfate, and vitamin C demonstrated varying degrees of analgesic benefit. Non-pharmacological interventions, such as enhanced recovery after surgery protocols, surgical wound cooling, glossopharyngeal nerve block, and patient-controlled analgesia, were also reported to reduce postoperative pain. When opioids were required, intranasal butorphanol appeared to offer a potentially safer alternative based on reported outcomes. Notably, substantial variability in postoperative pain severity among studies was attributable in part to differences in surgical techniques and surgical instruments. These findings underscore the need to integrate postoperative pain considerations into preoperative evaluation and surgical planning for patients with SDB. Collectively, the current evidence supports the use of multimodal analgesia that combines pharmacological and non-pharmacological measures; however, further high-quality trials are warranted to refine postoperative analgesic strategies and to strengthen the evidence base for this patient population.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 3","pages":"Article 104452"},"PeriodicalIF":2.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980127","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}

{"title":"Can OMFS experts distinguish AI from human manuscripts? A double-blind evaluation using ChatGPT-4","authors":"Anuj Jain","doi":"10.1016/j.jcms.2026.104468","DOIUrl":"10.1016/j.jcms.2026.104468","url":null,"abstract":"<div><h3>Objective</h3><div>As generative AI tools like ChatGPT-4 gain traction in academic writing, questions arise regarding their credibility, scientific depth, and detectability. This study aimed to evaluate whether experienced oral and maxillofacial surgeons (OMFS) can reliably distinguish between AI- and human-authored manuscripts, and to compare both in terms of coherence, scientific rigor, citation accuracy, and overall quality.</div></div><div><h3>Materials and methods</h3><div>Three core OMFS topics—impacted third molar surgery, cyst enucleation, and TMJ arthroscopy—were selected. For each topic, two manuscripts (∼2500 words each) were independently written: one by ChatGPT-4 and one by senior OMFS clinicians. Twenty board-certified OMFS reviewers, blinded to authorship, evaluated these manuscripts using a validated 25-item questionnaire assessing five domains: readability, scientific depth, reference accuracy, writing quality, and methodological rigor. Reviewers also attempted to identify the authorship source. Citation accuracy was verified through manual PubMed cross-checking. Statistical analysis included paired t-tests, chi-square tests, and ANOVA.</div></div><div><h3>Results</h3><div>Human-authored manuscripts outperformed AI-generated ones in scientific depth (4.5 ± 0.4 vs. 3.9 ± 0.6, p &lt; 0.01), reference accuracy (4.9 ± 0.1 vs. 4.4 ± 0.7, p &lt; 0.001), and overall writing quality (4.7 ± 0.4 vs. 4.1 ± 0.5, p &lt; 0.01). Coherence and readability scores were comparable (human: 4.8 ± 0.4; AI: 4.6 ± 0.5; p = 0.07). Reviewers correctly identified manuscript authorship only 54 % of the time (p = 0.68), suggesting AI-generated texts are often indistinguishable from human ones in surface fluency.</div></div><div><h3>Conclusion</h3><div>ChatGPT-4 is capable of producing readable and structurally sound OMFS manuscripts. However, deficiencies in scientific reasoning and citation fidelity underscore the need for expert oversight. As AI tools integrate into academic workflows, transparent disclosure and editorial safeguards are imperative to uphold scientific integrity.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 3","pages":"Article 104468"},"PeriodicalIF":2.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980130","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}

{"title":"Buccinator myomucosal flap with rotational flap in repair of midline and distal palatal Fistulas: A comparative study of 30 cases with speech outcome evaluation","authors":"Ahmed Samy Saad ,&nbsp;Mahmoud Elsayed Gouda ,&nbsp;Mostafa Elhadidy ,&nbsp;Ahmed Arafa","doi":"10.1016/j.jcms.2026.104450","DOIUrl":"10.1016/j.jcms.2026.104450","url":null,"abstract":"<div><h3>Background</h3><div>Midline distal palatal fistulas are challenging complications of cleft palate repair, often resulting in velopharyngeal incompetence (VPI) and speech difficulties. This study evaluates the effectiveness of rotational palatal flaps with or without buccinator myo-mucosal flap inclusion in 30 patients.</div></div><div><h3>Methods</h3><div>A retrospective review of 30 patients treated for midline and distal palatal fistulas was conducted. Group A (n = 15) underwent rotational flaps with buccinator myo-mucosal flap, while Group B (n = 15) underwent flaps without muscle. Outcome measures included fistula closure, VPI improvement, and speech outcomes.</div></div><div><h3>Results</h3><div>Group A achieved 100 % closure and 87 % speech improvement; Group B had 86.7 % closure and 60 % speech improvement. VPI improvement was significantly higher in Group A.</div></div><div><h3>Conclusion</h3><div>Incorporation of the buccinator myo-mucosal flap with rotational flaps significantly reduced fistula recurrence and improved speech outcomes in midline distal palatal fistula repair.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 3","pages":"Article 104450"},"PeriodicalIF":2.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980185","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}

{"title":"Radio-anatomopathological discrepancies in lymphonodal staging of squamous cell carcinoma of the upper aerodigestive tract","authors":"Caillouey Alan ,&nbsp;Bettoni Jérémie ,&nbsp;Laborde Sullivan ,&nbsp;Borel Justine ,&nbsp;Cordier Nina ,&nbsp;Costes Raphael ,&nbsp;Testelin Sylvie","doi":"10.1016/j.jcms.2026.104451","DOIUrl":"10.1016/j.jcms.2026.104451","url":null,"abstract":"<div><h3>Objectives</h3><div>The therapeutic strategy for squamous cell carcinomas of the upper aerodigestive tract (SCC-UADT) relies, in part, on the histopathological study of the neck dissection. Currently, several studies aim to limit the use of lymph node neck dissection based on a radioclinical cTNM evaluation. The objective of this study was therefore to assess the accuracy of clinical and radiological examination in nodal analysis of SCC-UADT compared with the histopathological assessment of neck dissection, in order to evaluate the risk of inadequate oncological management in the absence of decision-making based on the histopathological gold standard.</div></div><div><h3>Methods</h3><div>A retrospective single-centre study was carried out between 2010 and 2024, including patients who had undergone excision and neck dissection for a primary SCC-UADT. The primary endpoint was the number of cases in which cN and pN differed during lymph node assessment of SCC-UADT. In addition, the number of lymph node metastases in level IIB in patients classified as cTXN0, as well as the number of metastases bypassing the theoretical first lymphatic drainage level in patients classified as cT1/T2N0, were collected.</div></div><div><h3>Results</h3><div>A total of 1167 patients were identified. 457 patients (164 women and 293 men) with a mean age of 58.3 years were included. 194 patients showed a discrepancy between cN (clinical–radiological CT scan examination) and pN. 41 patients classified as cTxN0 presented a metastasis in level IIB. 16 patients classified as cT1/T2N0 had an occult metastasis bypassing the theoretical first lymph node drainage level.</div></div><div><h3>Conclusions</h3><div>Clinical and radiological examination is not yet sufficiently reliable to serve as the sole basis for an oncological strategy concerning SCC-UADT. It is therefore necessary to pursue further investigations into the safety and reliability of therapeutic de-escalation measures.</div></div><div><h3>Contribution to the literature</h3><div>Although there is currently a desire to place imaging at the centre of oncological strategy, this publication highlights the limitations of such an approach and the importance of histopathological assessment in the management of lymph node metastases in squamous cell carcinomas of the upper aerodigestive tract.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"54 3","pages":"Article 104451"},"PeriodicalIF":2.1,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967801","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}