Pub Date : 2025-12-01DOI: 10.1016/j.jcms.2025.10.003
Katharina Theresa Obermeier , Ina Dewenter , Eva Maria Schnödt , Philipp Poxleitner , Ulla Stumpf , Riham Fliefel , Eric Hesse , Ralf Schmidmaier , Sven Otto
Antiresorptive drugs such as bisphosphonates and denosumab are vital medications in the therapy of osteoporosis and in the treatment of cancer with osseous metastases. A rare but clinically relevant adverse effect is medication-related osteonecrosis of the jaw (MRONJ). This review outlines epidemiology, clinical features, diagnosis, treatment, and prevention of MRONJ. In addition, antiresorptives show promise in rare bone diseases relevant to oral and maxillofacial surgery, such as aneurysmal bone cysts, central giant cell granuloma, and diffuse sclerosing osteomyelitis. While early evidence indicates therapeutic benefit, further studies are needed to define safety and standardized protocols. Preventive dental care, patient education, and close interdisciplinary collaboration remain essential for optimal outcomes.
{"title":"Bisphosphonates – Boon or bane for oral and maxillofacial surgery? Anti-resorptive drugs and their potential role in dentistry and oral and maxillofacial surgery","authors":"Katharina Theresa Obermeier , Ina Dewenter , Eva Maria Schnödt , Philipp Poxleitner , Ulla Stumpf , Riham Fliefel , Eric Hesse , Ralf Schmidmaier , Sven Otto","doi":"10.1016/j.jcms.2025.10.003","DOIUrl":"10.1016/j.jcms.2025.10.003","url":null,"abstract":"<div><div>Antiresorptive drugs such as bisphosphonates and denosumab are vital medications in the therapy of osteoporosis and in the treatment of cancer with osseous metastases. A rare but clinically relevant adverse effect is medication-related osteonecrosis of the jaw (MRONJ). This review outlines epidemiology, clinical features, diagnosis, treatment, and prevention of MRONJ. In addition, antiresorptives show promise in rare bone diseases relevant to oral and maxillofacial surgery, such as aneurysmal bone cysts, central giant cell granuloma, and diffuse sclerosing osteomyelitis. While early evidence indicates therapeutic benefit, further studies are needed to define safety and standardized protocols. Preventive dental care, patient education, and close interdisciplinary collaboration remain essential for optimal outcomes.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 12","pages":"Pages 2199-2209"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446600","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}
This study investigates the expression of immune checkpoint proteins (PD-L1 and PD-L2) and inflammasome components (NLRP3, ASC, and Caspase-1) in oral lesions, including squamous cell carcinoma (SCC), metastases, leukoplakia, and benign conditions. Immunohistochemical analysis was performed on tissue samples from 151 patients to evaluate expression patterns and assess their diagnostic and prognostic potential. PD-L1 and PD-L2 were significantly overexpressed in SCC and metastases compared to benign lesions with IRS factor (immunoreactive score) (p = 0.003) and (p = 0.000002), indicating their roles in immune evasion and tumor progression. NLRP3 and ASC demonstrated associations with inflammation-driven carcinogenesis, with variations linked to tumor localization. However, none of the biomarkers showed significant prognostic value for disease progression. These findings highlight the potential diagnostic utility of these proteins while underscoring the need for further research to establish reliable clinical biomarkers in oral SCC.
{"title":"Differential expression of PD-L1, PD-L2 and inflammasome related proteins (NLRP3, ASC, and Caspase-1) in oral squamous cell carcinoma, lymph node metastases, and benign lesions","authors":"Arijan Zubović , Gordana Zamolo , Leo Kovač , Marina Raguž , Lorena Zubović , Margita Belušić","doi":"10.1016/j.jcms.2025.10.002","DOIUrl":"10.1016/j.jcms.2025.10.002","url":null,"abstract":"<div><div>This study investigates the expression of immune checkpoint proteins (PD-L1 and PD-L2) and inflammasome components (NLRP3, ASC, and Caspase-1) in oral lesions, including squamous cell carcinoma (SCC), metastases, leukoplakia, and benign conditions. Immunohistochemical analysis was performed on tissue samples from 151 patients to evaluate expression patterns and assess their diagnostic and prognostic potential. PD-L1 and PD-L2 were significantly overexpressed in SCC and metastases compared to benign lesions with IRS factor (immunoreactive score) (p = 0.003) and (p = 0.000002), indicating their roles in immune evasion and tumor progression. NLRP3 and ASC demonstrated associations with inflammation-driven carcinogenesis, with variations linked to tumor localization. However, none of the biomarkers showed significant prognostic value for disease progression. These findings highlight the potential diagnostic utility of these proteins while underscoring the need for further research to establish reliable clinical biomarkers in oral SCC.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 12","pages":"Pages 2190-2198"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508154","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 : 2025-12-01DOI: 10.1016/j.jcms.2025.09.015
Mary Fanning, Mohamed SA. Elfar, Huay-Zong Law
Gnathodiaphyseal Dysplasia is a rare autosomal-dominant disease caused by a mutation in GDD1. Patients typically present with pathological fractures, muscle weakness, and jawbone deformities. This genetic disorder has long been misdiagnosed until 2004 when the genetic basis of this disorder was identified, differentiating it from Osteogenesis Imperfecta and Fibrous Dysplasia. However, clinicians are still largely unaware of this entity and continue to label and treat it as a variation of Osteogenesis Imperfecta.
This report describes a 21-year-old male with GDD presenting with numerous fractures and Angle Class III malocclusion. He was treated with LeFort 1 advancement and Bilateral Sagittal Split Osteotomy of the mandible with setback procedures. No complications were seen and 2-year follow-up showed stable dental occlusion.
This is the first report describing orthognathic surgery safely performed on a patient with GDD1. Other procedures are possible, but more research is needed to develop best practices for this disorder.
Consent authorization
The patient provided written consent for publication of the clinical photos.
{"title":"Double jaw surgery for a patient with Gnathodiaphyseal dysplasia (GDD): A case report and literature review","authors":"Mary Fanning, Mohamed SA. Elfar, Huay-Zong Law","doi":"10.1016/j.jcms.2025.09.015","DOIUrl":"10.1016/j.jcms.2025.09.015","url":null,"abstract":"<div><div>Gnathodiaphyseal Dysplasia is a rare autosomal-dominant disease caused by a mutation in GDD1. Patients typically present with pathological fractures, muscle weakness, and jawbone deformities. This genetic disorder has long been misdiagnosed until 2004 when the genetic basis of this disorder was identified, differentiating it from Osteogenesis Imperfecta and Fibrous Dysplasia. However, clinicians are still largely unaware of this entity and continue to label and treat it as a variation of Osteogenesis Imperfecta.</div><div>This report describes a 21-year-old male with GDD presenting with numerous fractures and Angle Class III malocclusion. He was treated with LeFort 1 advancement and Bilateral Sagittal Split Osteotomy of the mandible with setback procedures. No complications were seen and 2-year follow-up showed stable dental occlusion.</div><div>This is the first report describing orthognathic surgery safely performed on a patient with GDD1. Other procedures are possible, but more research is needed to develop best practices for this disorder.</div></div><div><h3>Consent authorization</h3><div>The patient provided written consent for publication of the clinical photos.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 12","pages":"Pages 2155-2161"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454012","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 : 2025-12-01DOI: 10.1016/j.jcms.2025.09.007
Jonas Schäfer , Annemarie Fritz , Annika Schönfeld , Alexander Hemprich , Katie Elisabeth Anne Poser , Maximilian Poser , Bernd Lethaus , Anita Kloss-Brandstätter , Dirk Halama , Andreas Maximilian Fichter , Niels Christian Pausch , Sebastian Gaus
Objective
This study explored the impact of lip reconstruction during the perioperative phase on maternal bonding with children affected by cleft lip.
Background
Visible facial deformities like cleft lip can distress caregivers and strain the mother-child bond. Lip reconstructive surgery drastically alters a child's appearance and expression within hours, potentially impacting maternal attachment. However, research on how the perioperative phase affects maternal-infant attachment and its vulnerabilities remains limited.
Design
Forty-four mothers of children with cleft lip participated in two interviews: one before surgery and another during the postoperative inpatient stay. An online survey, conducted at least three months post-surgery, assessed maternal bonding, psychosocial challenges, daily difficulties related to the cleft, and satisfaction with surgical outcomes. Maternal attachment style and mother-infant bonding were evaluated using validated questionnaires.
Results
The perioperative phase of lip reconstruction did not affect the overall mother-infant bond. However, mothers who struggled to interpret their child's needs faced more challenges during the inpatient stay. Single mothers and those with a secure attachment style showed a stronger, more resilient bond. Post-discharge, mothers reported an improved bond, better understanding of their child's needs, and greater social comfort.
Conclusion
This study suggests that cleft lip reconstruction plays a crucial role in strengthening the mother-child bond. Cleft malformations can adversely affect maternal well-being by complicating the interpretation of a child's needs. A secure maternal attachment style appears to offer protective benefits during the cleft repair hospitalization period. Preoperative consultations are essential for addressing concerns and providing reassurance to caregivers.
{"title":"The influence of lip reconstruction on mother-infant bonding during the perioperative phase","authors":"Jonas Schäfer , Annemarie Fritz , Annika Schönfeld , Alexander Hemprich , Katie Elisabeth Anne Poser , Maximilian Poser , Bernd Lethaus , Anita Kloss-Brandstätter , Dirk Halama , Andreas Maximilian Fichter , Niels Christian Pausch , Sebastian Gaus","doi":"10.1016/j.jcms.2025.09.007","DOIUrl":"10.1016/j.jcms.2025.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study explored the impact of lip reconstruction during the perioperative phase on maternal bonding with children affected by cleft lip.</div></div><div><h3>Background</h3><div>Visible facial deformities like cleft lip can distress caregivers and strain the mother-child bond. Lip reconstructive surgery drastically alters a child's appearance and expression within hours, potentially impacting maternal attachment. However, research on how the perioperative phase affects maternal-infant attachment and its vulnerabilities remains limited.</div></div><div><h3>Design</h3><div>Forty-four mothers of children with cleft lip participated in two interviews: one before surgery and another during the postoperative inpatient stay. An online survey, conducted at least three months post-surgery, assessed maternal bonding, psychosocial challenges, daily difficulties related to the cleft, and satisfaction with surgical outcomes. Maternal attachment style and mother-infant bonding were evaluated using validated questionnaires.</div></div><div><h3>Results</h3><div>The perioperative phase of lip reconstruction did not affect the overall mother-infant bond. However, mothers who struggled to interpret their child's needs faced more challenges during the inpatient stay. Single mothers and those with a secure attachment style showed a stronger, more resilient bond. Post-discharge, mothers reported an improved bond, better understanding of their child's needs, and greater social comfort.</div></div><div><h3>Conclusion</h3><div>This study suggests that cleft lip reconstruction plays a crucial role in strengthening the mother-child bond. Cleft malformations can adversely affect maternal well-being by complicating the interpretation of a child's needs. A secure maternal attachment style appears to offer protective benefits during the cleft repair hospitalization period. Preoperative consultations are essential for addressing concerns and providing reassurance to caregivers.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 12","pages":"Pages 2089-2097"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380049","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 : 2025-12-01DOI: 10.1016/j.jcms.2025.10.009
Xiaofeng Xu , Kaijin Lin , Bowei Zhou , Dongsheng Peng , Siyi Wang , Wei Zhao , Minqian Zheng , Jin Yang , Jianbin Guo
Background
Demineralized dentin matrix (DDM) is a bioactive tissue known to promote bone regeneration by enhancing osteoblast proliferation and osteogenic differentiation. Recent studies suggest that DDM may also stimulate fibroblast proliferation, adhesion, and migration. However, the inductive capacity of DDM on human gingival fibroblasts (HGFs) and its underlying mechanisms remain largely unexplored. This study aims to investigate the effects of DDM on HGFs and to elucidate the potential molecular mechanisms involved.
Methods
The effects of DDM on HGFs migration and adhesion were investigated using a multi-step approach. First, the optimal DDM concentration for co-culture with HGFs was determined using a cell migration assay. Next, Transwell migration assays and scanning electron microscopy were employed to evaluate the impact of DDM on HGFs migration and adhesion. Subsequently, high-throughput sequencing was performed on co-cultured HGFs and a control group to analyze and identify differentially expressed genes (DEGs). Finally, the expression of three DEGs was validated using RT-qPCR.
Results
The optimal concentration of DDM for promoting HGFs migration was determined to be 10 mg/mL. The Transwell assay revealed a significantly higher number of migrating HGFs in the DDM-treated group compared to the control group. Scanning electron microscopy imaging showed that HGFs adhered to and spread on the DDM surface. Transcriptome analysis identified 64 DEGs between the HGFs monoculture group and the DDM co-culture group, with 6 genes upregulated and 57 downregulated. GO functional enrichment analysis and KEGG pathway enrichment analysis indicated that these DEGs were primarily enriched in biological processes related to immune and inflammatory responses. The expression levels of three key DEGs were further validated using qRT-PCR, and the results were consistent with the RNA-Seq data.
Conclusions
DDM exhibits biocompatibility and enhances HGFs migration. This suggests that DDM may play a crucial role in promoting gingival soft tissue healing by regulating biological processes and gene expression related to immune and inflammatory responses.
{"title":"Study on the biological effects and mechanisms of demineralized dentin matrix on human gingival fibroblasts","authors":"Xiaofeng Xu , Kaijin Lin , Bowei Zhou , Dongsheng Peng , Siyi Wang , Wei Zhao , Minqian Zheng , Jin Yang , Jianbin Guo","doi":"10.1016/j.jcms.2025.10.009","DOIUrl":"10.1016/j.jcms.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Demineralized dentin matrix (DDM) is a bioactive tissue known to promote bone regeneration by enhancing osteoblast proliferation and osteogenic differentiation. Recent studies suggest that DDM may also stimulate fibroblast proliferation, adhesion, and migration. However, the inductive capacity of DDM on human gingival fibroblasts (HGFs) and its underlying mechanisms remain largely unexplored. This study aims to investigate the effects of DDM on HGFs and to elucidate the potential molecular mechanisms involved.</div></div><div><h3>Methods</h3><div>The effects of DDM on HGFs migration and adhesion were investigated using a multi-step approach. First, the optimal DDM concentration for co-culture with HGFs was determined using a cell migration assay. Next, Transwell migration assays and scanning electron microscopy were employed to evaluate the impact of DDM on HGFs migration and adhesion. Subsequently, high-throughput sequencing was performed on co-cultured HGFs and a control group to analyze and identify differentially expressed genes (DEGs). Finally, the expression of three DEGs was validated using RT-qPCR.</div></div><div><h3>Results</h3><div>The optimal concentration of DDM for promoting HGFs migration was determined to be 10 mg/mL. The Transwell assay revealed a significantly higher number of migrating HGFs in the DDM-treated group compared to the control group. Scanning electron microscopy imaging showed that HGFs adhered to and spread on the DDM surface. Transcriptome analysis identified 64 DEGs between the HGFs monoculture group and the DDM co-culture group, with 6 genes upregulated and 57 downregulated. GO functional enrichment analysis and KEGG pathway enrichment analysis indicated that these DEGs were primarily enriched in biological processes related to immune and inflammatory responses. The expression levels of three key DEGs were further validated using qRT-PCR, and the results were consistent with the RNA-Seq data.</div></div><div><h3>Conclusions</h3><div>DDM exhibits biocompatibility and enhances HGFs migration. This suggests that DDM may play a crucial role in promoting gingival soft tissue healing by regulating biological processes and gene expression related to immune and inflammatory responses.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 12","pages":"Pages 2245-2254"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410914","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 : 2025-12-01DOI: 10.1016/j.jcms.2025.09.009
Zhengrui Zhu , Jie Wang , Jing-Rui Yi , Yinfu Che , Qiwen Man
Objective
This study aimed to evaluate the pro-apoptotic effects of 5-fluorouracil (5-FU) on ameloblastoma (AM) through in vitro experiments and to explore its potential as a topical adjunctive therapy following surgery.
Methods
Primary AM cells and freshly resected tumor tissues were treated with 5 μM 5-FU for 48 h. Apoptotic changes were assessed via transmission electron microscopy (TEM), TUNEL staining, and flow cytometry. Cell proliferation and viability were evaluated using EdU incorporation and CCK-8 assays. Transcriptomic profiling and Gene Ontology (GO) enrichment analyses were conducted to investigate underlying mechanisms.
Results
5-FU treatment markedly induced apoptosis in AM tissues and cells. TEM revealed abundant apoptotic bodies, with a mean count 2.01-fold higher than controls (p < 0.05). TUNEL staining demonstrated a 2.66-fold increase in apoptotic area (p < 0.01). Flow cytometry showed a 4.70-fold rise in early apoptotic cells (Annexin V+/PI−) and a 25.5 % decrease in viable cells (Annexin V−/PI−) (p < 0.01 and p < 0.05, respectively). EdU incorporation decreased by 35.0 %, and CCK-8 assays indicated a 34.5 % reduction in cell viability (p < 0.01). Transcriptomic analysis revealed downregulation of cell cycle-related genes (CCNB1, CCNB2) and enrichment of pathways involved in cell cycle arrest and apoptosis.
Conclusion
5-FU effectively induces apoptosis and inhibits proliferation in AM cells, likely through disruption of cell cycle progression. These findings support the potential use of topical 5-FU as an adjunctive pharmacologic strategy in the post-surgical management of ameloblastoma.
{"title":"Pro-apoptotic effects of 5-fluorouracil on ameloblastoma in vitro: Exploring the potential of topical 5-FU ointment in adjunctive therapy","authors":"Zhengrui Zhu , Jie Wang , Jing-Rui Yi , Yinfu Che , Qiwen Man","doi":"10.1016/j.jcms.2025.09.009","DOIUrl":"10.1016/j.jcms.2025.09.009","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the pro-apoptotic effects of 5-fluorouracil (5-FU) on ameloblastoma (AM) through in vitro experiments and to explore its potential as a topical adjunctive therapy following surgery.</div></div><div><h3>Methods</h3><div>Primary AM cells and freshly resected tumor tissues were treated with 5 μM 5-FU for 48 h. Apoptotic changes were assessed via transmission electron microscopy (TEM), TUNEL staining, and flow cytometry. Cell proliferation and viability were evaluated using EdU incorporation and CCK-8 assays. Transcriptomic profiling and Gene Ontology (GO) enrichment analyses were conducted to investigate underlying mechanisms.</div></div><div><h3>Results</h3><div>5-FU treatment markedly induced apoptosis in AM tissues and cells. TEM revealed abundant apoptotic bodies, with a mean count 2.01-fold higher than controls (p < 0.05). TUNEL staining demonstrated a 2.66-fold increase in apoptotic area (p < 0.01). Flow cytometry showed a 4.70-fold rise in early apoptotic cells (Annexin V<sup>+</sup>/PI<sup>−</sup>) and a 25.5 % decrease in viable cells (Annexin V<sup>−</sup>/PI<sup>−</sup>) (p < 0.01 and p < 0.05, respectively). EdU incorporation decreased by 35.0 %, and CCK-8 assays indicated a 34.5 % reduction in cell viability (p < 0.01). Transcriptomic analysis revealed downregulation of cell cycle-related genes (<em>CCNB1, CCNB2</em>) and enrichment of pathways involved in cell cycle arrest and apoptosis.</div></div><div><h3>Conclusion</h3><div>5-FU effectively induces apoptosis and inhibits proliferation in AM cells, likely through disruption of cell cycle progression. These findings support the potential use of topical 5-FU as an adjunctive pharmacologic strategy in the post-surgical management of ameloblastoma.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 12","pages":"Pages 2106-2111"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132709","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 : 2025-12-01DOI: 10.1016/j.jcms.2025.10.011
Michael Maurer , Katharina Ritzinger , Maximilian Gottsauner , Amer Haj , Karl-Michael Schebesch , Thomas Kühnel , Torsten Reichert , Tobias Ettl
There are various treatment options for frontal sinus fractures. They mainly depend on whether the anterior or posterior table and the frontal sinus outflow tract (FSOT) are affected. Our study retrospectively assessed the surgical management of 116 frontal sinus fractures in terms of the different surgical treatment options as well as the resulting complications. In our cohort, all cases of displaced anterior table fractures (n = 73) were treated by open reduction and fixation (ORIF). In cases of posterior table fractures (n = 43), cranialization, obliteration, sinus preserving measures, or no treatment were carried out. Pyomucocele was the most common complication, occurring in 8.6 % of cases. It was significantly more frequent with dislocation of the posterior table without treatment (p = 0.003). Cerebrospinal fluid (CSF) leakage was especially observed in combined anterior and posterior table fractures (p = 0.012) and in cases of accompanying centrolateral midfacial fractures (p < 0.001). Poor aesthetic outcome was significantly more frequent with concomitant nasoethmoidal fracture (p < 0.001). CSF leakage and cosmetic defects seem to depend mainly on the severity of the trauma and the accompanying injuries. Reconstruction of the posterior wall and sealing it with autologous grafts appears to be an effective method of preventing CSF leakage and pyomucocele in most cases.
{"title":"Surgical treatment of frontal sinus fractures: a retrospective evaluation of 116 cases","authors":"Michael Maurer , Katharina Ritzinger , Maximilian Gottsauner , Amer Haj , Karl-Michael Schebesch , Thomas Kühnel , Torsten Reichert , Tobias Ettl","doi":"10.1016/j.jcms.2025.10.011","DOIUrl":"10.1016/j.jcms.2025.10.011","url":null,"abstract":"<div><div>There are various treatment options for frontal sinus fractures. They mainly depend on whether the anterior or posterior table and the frontal sinus outflow tract (FSOT) are affected. Our study retrospectively assessed the surgical management of 116 frontal sinus fractures in terms of the different surgical treatment options as well as the resulting complications. In our cohort, all cases of displaced anterior table fractures (<em>n</em> = 73) were treated by open reduction and fixation (ORIF). In cases of posterior table fractures (<em>n</em> = 43), cranialization, obliteration, sinus preserving measures, or no treatment were carried out. Pyomucocele was the most common complication, occurring in 8.6 % of cases. It was significantly more frequent with dislocation of the posterior table without treatment (<em>p</em> = 0.003). Cerebrospinal fluid (CSF) leakage was especially observed in combined anterior and posterior table fractures (<em>p</em> = 0.012) and in cases of accompanying centrolateral midfacial fractures (<em>p</em> < 0.001). Poor aesthetic outcome was significantly more frequent with concomitant nasoethmoidal fracture (<em>p</em> < 0.001). CSF leakage and cosmetic defects seem to depend mainly on the severity of the trauma and the accompanying injuries. Reconstruction of the posterior wall and sealing it with autologous grafts appears to be an effective method of preventing CSF leakage and pyomucocele in most cases.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 12","pages":"Pages 2270-2278"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410863","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 : 2025-12-01DOI: 10.1016/j.jcms.2025.09.010
Hanchen Zhou , Chuning Luo , Qiaoshi Xu , Chong Wang , Bo Li , Delong Li , Huan Liu , Hao Wang , Chang Liu , Jingrui Li , Teng Ma , Fen Liu , Zhien Feng
Head and neck squamous cell carcinoma (HNSCC) patients undergoing free flap reconstruction face a high risk of surgical site infection (SSI). Logistic regression (LR) models for SSI prediction are limited by linear assumptions, while machine learning (ML) approaches like random forest (RF) may offer superior performance by handling complex clinical data. This study aimed to identify SSI risk factors and compare the predictive performance of LR and RF models. This retrospective study included 442 HNSCC patients. Two predictive models were constructed based on LR and RF methods, respectively. The predictive performance of two models was assessed based on area under the receiver operator characteristic curves, calibration curve, and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) was applied in the RF model to analyze the impact of features on prediction results. The RF model outperformed LR, achieving higher accuracy, sensitivity, specificity, and AUC. Calibration curves indicated superior alignment of RF predictions with observed outcomes. DCA revealed higher net benefits for RF across a wide probability threshold range. SHAP analysis identified PNI, operation time, and NLR as top predictors. Novel systemic markers (PNI, NLR) and clinical factors are critical for risk stratification.
{"title":"Machine learning approach to predict surgical site infection in head and neck squamous cell carcinoma patients after free flap reconstruction","authors":"Hanchen Zhou , Chuning Luo , Qiaoshi Xu , Chong Wang , Bo Li , Delong Li , Huan Liu , Hao Wang , Chang Liu , Jingrui Li , Teng Ma , Fen Liu , Zhien Feng","doi":"10.1016/j.jcms.2025.09.010","DOIUrl":"10.1016/j.jcms.2025.09.010","url":null,"abstract":"<div><div>Head and neck squamous cell carcinoma (HNSCC) patients undergoing free flap reconstruction face a high risk of surgical site infection (SSI). Logistic regression (LR) models for SSI prediction are limited by linear assumptions, while machine learning (ML) approaches like random forest (RF) may offer superior performance by handling complex clinical data. This study aimed to identify SSI risk factors and compare the predictive performance of LR and RF models. This retrospective study included 442 HNSCC patients. Two predictive models were constructed based on LR and RF methods, respectively. The predictive performance of two models was assessed based on area under the receiver operator characteristic curves, calibration curve, and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) was applied in the RF model to analyze the impact of features on prediction results. The RF model outperformed LR, achieving higher accuracy, sensitivity, specificity, and AUC. Calibration curves indicated superior alignment of RF predictions with observed outcomes. DCA revealed higher net benefits for RF across a wide probability threshold range. SHAP analysis identified PNI, operation time, and NLR as top predictors. Novel systemic markers (PNI, NLR) and clinical factors are critical for risk stratification.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 12","pages":"Pages 2112-2117"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132714","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}
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