Journal of Cranio-Maxillofacial Surgery最新文献

It remains uncertain whether replacing posterior zygomatic implants with pterygoid implants reduces the stress exerted on anterior zygomatic implants in the canine region. This three-dimensional finite element analysis (FEA) study aims to compare stress and strain patterns between two implant configurations under the influence of masticatory muscle forces. A 3D (FEM) model of an edentulous, atrophic maxilla was developed using data from a cone-beam computed tomography (CBCT) scan. Two configurations were examined: Model A, which included bilateral zygomatic implants, and Model B, featuring one zygomatic and one pterygoid implant. Virtual implant placement was carried out, and corresponding prosthetic superstructures were designed for each model. The simulation assessed stress distribution within the bone, implants, and prosthetic components under three loading conditions: a 150 N vertical force, a 50 N lateral force, and a 300 N distributed occlusal load applied at the masseter muscle's insertion on the zygomatic arch. Von Mises stress maps were used to visualize stress patterns in the peri-implant bone, abutments, and prosthetic framework. Additionally, maximum principal stress and micromotion were evaluated to assess implant stability and predict osseointegration potential. The FEA results revealed notable stress concentrations at the abutments of both posterior zygomatic and pterygoid implants in each model. However, Model B, which utilized a pterygoid implant, showed a more balanced distribution of occlusal forces at the anterior implant-abutment interface, maintaining stress levels within physiological limits. Moreover, Model A exhibited nearly twice the micromotion observed in Model B. These findings indicate that the abutment interface is a primary zone of stress concentration under simulated masticatory forces. Overall, the study concludes that incorporating pterygoid implants enhances load distribution and reduces cantilever effects due to a broader anteroposterior implant spread. Nonetheless, both implant types experienced peak stresses at the abutment interface, suggesting this region may be prone to mechanical complications over time.

Neoadjuvant immunochemotherapy (NICT) is an emerging strategy for locally advanced oral squamous cell carcinoma (OSCC), yet its impact on perioperative safety remains a significant concern. This study compared major surgical complication rates between patients receiving NICT followed by surgery and those undergoing upfront surgery (US). A retrospective, propensity score-matched cohort study was conducted at a tertiary center. Adults with locally advanced OSCC undergoing curative-intent resection (2016-2024) were included. The NICT group received ≥2 cycles of immune checkpoint inhibitors plus chemotherapy before surgery; the US group proceeded directly to surgery. The primary outcome was the incidence of Clavien-Dindo grade ≥Ⅲ complications within 30 days. After 1:1 matching, 166 pairs were analyzed. The incidence of major complications was 10.2% in the NICT group and 8.4% in the US group (odds ratio [OR] 1.24, 95% confidence interval [CI] 0.59-2.58; p = 0.6). Multivariable analysis confirmed no significant association between NICT and increased complication risk (adjusted OR 1.30, 95% CI 0.61-2.78; p = 0.5). Rates of specific surgical and medical morbidities, 30-day readmission, and hospital length of stay were comparable between groups. Subgroup and sensitivity analyses were consistent with the primary finding. In patients with locally advanced OSCC, NICT was not associated with a statistically significant increase in major postoperative complications compared to upfront surgery. These findings support the surgical safety of NICT and may facilitate its integration into multimodal treatment paradigms.

Limited data are available on oropharyngeal minor salivary gland carcinomas (OMSGCs). This study aimed to evaluate survival outcomes and identify independent prognostic factors for OMSGC patients in a long-term cohort. A total of 97 patients diagnosed with OMSGC between 1996 and 2018 were retrospectively analyzed from a single tertiary cancer center in Southern China, with final follow-up completed on December 31, 2023. The primary endpoint was overall survival (OS). The cohort included 57 males (58.8%), with a median age of 50. Several factors, including alcohol consumption, N stage, M stage, AJCC stage, and surgical treatment, were significantly associated with OS (all P < 0.05). Multivariate analysis identified age and surgery as independent prognostic factors. While postoperative radiation therapy did not significantly affect long-term OS (P = 0.76), patients who received it had a higher 5-year OS rate (0.86). This study offers valuable insight into OMSGCs in Southern China and highlights the importance of surgical intervention and younger age in predicting improved overall survival.

Background: Maxillofacial surgery frequently faces the permanent and catastrophic impacts of firearm injuries, an alarming scenario due to rising mortality and morbidity rates, representing both global and individual losses.

Objectives: The main objective of this study was to outline and synthesize the epidemiological profile and trends in the global incidence of firearm-related maxillofacial injuries.

Methods: A scoping systematic review was conducted, including observational studies, case series, and case reports published up to September 2025, retrieved from PubMed and Google Scholar, using the combination of the terms "maxillofacial injuries," "gunshot wounds," "firearms," "ballistic injuries," and "epidemiology."

Results: A total of 29 articles and mortality data from the World Health Organization (WHO) database were included. There were certain limitations in the global analysis of firearm-related mortality rates due to the scarcity of information. The average death rate from violence was higher in American countries compared to countries at war (p < 0.01), and it was not possible to establish significant correlations between firearm mortality and most demographic variables. A moderate negative correlation was observed between GDP and mortality rates in war contexts (ρ = -0.55, p < 0.05).

Conclusion: Greater transparency in national reporting is necessary to establish a more robust global epidemiological profile. Conversely, the negative impact of wars on national economies and violence in American countries is evident, and strict firearm access, control, and distribution laws are one potential strategy to combat this growing epidemic.

The use of an operating microscope in cleft palate repair offers improved visualization, enhanced illumination, and ergonomic advantages. However, its clinical adoption remains limited. This study compares surgical efficiency, intraoperative visualization, and complication rates between microscope and surgical loupe use. A prospective, quasi-randomized controlled study was conducted on 40 patients under the age of two years with isolated nonsyndromic secondary incomplete cleft palate. Patients were allocated to either surgical loupe magnification or operating microscope use in an alternating sequence, ensuring balanced distribution between groups. Operative time, intraoperative visualization scores from the surgical team, and postoperative complications were recorded. The mean operative time was significantly longer in the microscope group (76.75 ± 3.7 min) compared to the loupe group (60.91 ± 1.05 min), though this difference decreased over the study period. Visualization scores given by the anesthesiologist and scrub nurse were significantly higher in the microscope, while residents also rated the microscope group higher, though not statistically significant. Complication rates were similar among groups. The operating microscope Improves intraoperative visualization, enhances surgical ergonomics, and provides educational benefits. The initially increased operative time diminishes with experience, indicative of a learning curve. Despite minor limitations, its advantages may justify its routine use in cleft palate repair.