Journal of Cranio-Maxillofacial Surgery最新文献

Boxing is a popular combat sport in which participants frequently experience head trauma. The neurological impact of boxing has been widely discussed, but the impact on the bone and soft tissue of the head has been less investigated. For this study, a national emergency department database was used to investigate the impact of a 2013 rule change - removing the requirement for amateurs to wear head protection - on the frequency and type of facial injuries sustained by amateur boxers. Over the study period (2006-2021) there were 11 760 injuries, with 6261 occurring before the change and 5499 occurring after (p < 0.001). The number of contusions, fractures, hematomas, and hemorrhages all significantly decreased after the rule change, while the number of lacerations did not. Additionally, the number of septal deviations increased from 16 to 97 (p < 0.001). According to age-group-specific analysis, injuries decreased in both the 0-17 and 24-29 cohorts, but increased in the 18-23 group. The results suggest that the rule change may have had a protective effect on the risk of craniofacial trauma in amateur boxers, potentially due to increased risk-averse behavior by the boxers, who may feel less protected during sparring because of the lack of head protection.

This case series aimed to assess the clinical outcomes of oncologic patients rehabilitated with a zygomatic implant-supported prosthesis. Ten oncologic patients who underwent upper jaw resections due to cancer were enrolled in the study. Zygomatic implants were utilized for rehabilitation according to specified inclusion criteria. Surgical and prosthetic procedures were standardized, and implant and prosthetic survival rates, along with complications, were evaluated. The study cohort comprised 10 patients with a mean age of 66.5 years. A total of 35 implants were placed, with a survival rate of 94.29% at the mean follow-up of 5.78 years. Biological complications affected 40% of patients, while prosthetic complications occurred in 40% of patients, necessitating modifications but with no outright failures. Zygomatic implants offer a viable solution for oncologic patient rehabilitation, particularly in cases where bone grafting is contraindicated or impractical. However, they present medium-to long-term complications that warrant careful consideration. Future research should focus on larger studies and meta-analyses to provide more robust evidence.

This study evaluates the quality and readability of informed consent documents generated by AI platforms ChatGPT-4 and Bard Gemini Advanced compared to those written by a first-year oral surgery resident for common oral surgery procedures. The evaluation, conducted by 18 experienced oral and maxillofacial surgeons, assessed consents for accuracy, completeness, readability, and overall quality. ChatGPT-4 consistently outperformed both Bard and human-written consents. ChatGPT-4 consents had a median accuracy score of 4 [IQR 4-4], compared to Bard's 3 [IQR 3-4] and human's 4 [IQR 3-4]. Completeness scores were higher for ChatGPT-4 (4 [IQR 4-5]) than Bard (3 [IQR 3-4]) and human (4 [IQR 3-4]). Readability was also superior for ChatGPT-4, with a median score of 4 [IQR 4-5] compared to Bard and human consents, both at 4 [IQR 4-4] and 4 [IQR 3-4], respectively. The Gunning Fog Index for ChatGPT-4 was 17.2 [IQR 16.5-18.2], better than Bard's 23.1 [IQR 20.5-24.7] and the human consents' 20 [IQR 19.2-20.9]. Overall, ChatGPT-4's consents received the highest quality ratings, underscoring AI's potential in enhancing patient communication and the informed consent process. The study suggests AI can reduce misinformation risks and improve patient understanding, but continuous evaluation, oversight, and patient feedback integration are crucial to ensure the effectiveness and appropriateness of AI-generated content in clinical practice.

Epithelioid osteoblastoma (EOB) is a rare, benign bone tumor characterized by the proliferation of atypical epithelioid osteoblasts within a vascular stroma. It typically presents as a slow-growing painful mass and requires careful differentiation from more aggressive lesions like osteosarcoma for appropriate management. We present a case of an otherwise healthy 30-year-old man who presented with a mandibular EOB measuring 23 cm × 17 cm x 19 cm, causing significant disfigurement and functional impairment. Surgical management involved radical resection and immediate reconstruction using an osteocutaneous fibula free flap. The case emphasizes the importance of multidisciplinary care, advanced surgical planning, and the impact of socioeconomic factors on healthcare access and outcomes.

The aim of this study was to evaluate whether an A-PRF + membrane can lower the fistula rate in patients undergoing primary palatoplasty. A total of 20 children were included: 10 were randomized and included in the platelet-rich fibrin (PRF) group, and 10 were assigned to the control group. Before two-flap palatoplasty was performed, the cleft's width was measured. The patients in the PRF group underwent an intraoperative collection of 5 ml venous blood, which was centrifugated and pressed onto an A-PRF + membrane. Subsequently, the membrane was placed between the oral and nasal mucosal layers. The control group underwent the same procedure without the addition of A-PRF+. The need for transfusions or postoperative intensive care was registered. All children were followed up at 10 days, 1, 2, 3, and 6 months, and after more than 6 months and the occurrence of fistulae and need for a second palatal operation was then evaluated. After more than six months postoperatively, only two fistulae (10%) remained and had to undergo secondary palatoplasty (p = 1.00). Moreover, the blood transfusion rate did not differ significantly (p = 1.00). A-PRF + might be beneficial in cleft closure, but further randomized studies with larger patient cohort are needed.

This retrospective study aimed to investigate the impact of orthognathic surgery with maxillary advancement (MA) on the velopharyngeal function (VF) in individuals with cleft lip and palate (CLP). The study included 651 patients with repaired CLP, both sexes, aged over 18 years who underwent MA alone or in combination with nasal procedures and/or mandibular osteotomy, operated between 2000 and 2019. The main outcome measures were nasalance (nasal text-NT and oral text-OT) and velopharyngeal orifice area measurement (VA), determined by nasometry and pressure-flow technique, respectively. Preoperatively, mean nasalance scores for NT and OT indicated normality, and VA demonstrated borderline-inadequate velopharyngeal closure in all patients. Following MA, a significant increase in nasalance scores for NT and OT occurred (p < 0.001), revealing hypernasality in those undergoing MA combined with nasal procedure (MAN, N = 191), bimaxillary orthognathic surgery with nasal procedure (BON, N = 227) and bimaxillary orthognathic surgery (BO, N = 151). Conversely, nasalance scores remained within the normal range for those undergoing isolated maxillary advancement (IMA, N = 82). VA exhibited a significant increase leading to the classification of VF as inadequate in the BON and MAN groups. Overall, MA contributed to VF deterioration, resulting in the appearance of hypernasality and increased VA, particularly when combined with nasal procedures.

The existing literature provides little insight into the efficacy of transoral endoscopy in exposing benign tumors originating from salivary glands in the parapharyngeal space at the parotid gland base and resecting part of the deep lobe with a safe margin. This study aims to investigate the efficacy of the endoscopic transoral approach for the visualization and resection of such tumors. Through transoral endoscopic cadaveric dissections and surgical procedures, we examined the anatomical structures of the parapharyngeal space and the deep lobe of the parotid gland, identifying key anatomical landmarks. We conducted a retrospective analysis of 19 patients with benign salivary gland-derived tumors in the parapharyngeal space who underwent transoral endoscopic resection. Intraoperative visualization of the tumor pedicle and the deep lobe of the parotid gland was successfully achieved in all cases, allowing for resection with safe margins. During a median follow-up period of 54.0 months, imaging revealed no signs of recurrence. Endoscopic transoral approach provides effective visualization of the deep lobe of the parotid gland and the medial portion of the parotid bed from the parapharyngeal space. Benign tumors of salivary gland-derived in this area can be well exposed and safely resected with adequate margins.

Orbital floor (OF) fractures present a dilemma, with controversies surrounding surgical indication, approach, and ideal material for reconstruction. Our study was conducted on cases of (OF) fracture admitted to a tertiary referral centre. Cases of (OF) associated with zygomaticomaxillary complex (ZMC) fracture were managed as follows: those with ophthalmological problems were subjected to endoscopically assisted transorbital reconstruction of the floor; cases without ophthalmological problems were subjected to reduction and fixation of the ZMC fracture only. The recently developed endoscopic endonasal transmaxillary approach was used to manage cases with pure OF fracture, while the same approach with added endoscopic transethmoidal reconstruction of the medial orbital wall (MOW) was applied to cases with associated MOW fracture. Outcome measurements were the correction of diplopia and enophthalmos, along with the restoration of normal globe function. The study included 80 patients, who were divided into four groups according to the proposed algorithm. OF reconstruction was performed in 32 cases with either septal cartilage (n = 4), titanium plate (n = 11), or porous polyethylene mesh (n = 17). Our study presents the novel role of minimally invasive endoscopic surgery in the management of (OF) fracture, together with a recently developed management plan that could maximize positive outcomes and decrease morbidity.