Pub Date : 2024-08-28DOI: 10.1016/j.jcms.2024.08.023
Brianne B Roby,Avery Schnell,Tara L Johnson,Melissa Scholes,Andrew R Scott
The goal of this study was to investigate the relationship between mandibular distraction osteogenesis (MDO) and rates of postoperative gastrostomy tube (G-tube) placement among patients with isolated and syndromic Robin sequence (RS). This study was a multi-institutional retrospective chart review of patients with RS who underwent MDO at one of three different pediatric tertiary medical centers. The primary aim of the study was to compare rates of G-tube placement following MDO among the three institutions. The primary outcome was analyzed using Fischer's exact test. The secondary aim of the study was to assess for other contributing factors to G-tube placement such as demographic differences, length of hospital stay, and age at MDO. Analysis of secondary outcomes was assessed using multiple logistic regression models. A total of 125 patients met the inclusion criteria, which required RS diagnosis, completion of MDO between 2004 and 2019, and adequate medical record availability. Sixty percent (n = 75) of subjects were categorized as isolated RS (iRS) and forty percent (n = 50) as syndromic RS (sRS). After MDO, 20% (n = 25) of all patients had G-tubes placed. Of the iRS group, 14.7% (n = 11) required a G-tube, while 28% (n = 14) of the sRS group required a G-tube. The post-operative G-tube rate was similar between institutions when considering all patients. When considering only those patients with iRS, the post-MDO G-tube rate at one center was significantly higher than the other two. Overall, most patients with RS did not require a G-tube after MDO, regardless of diagnosis. However, the significant differences in rates of G-tube placement among patients with iRS may indicate differing practice philosophies, surgical protocols, thresholds for G-tube placement, or regional influences between institutions.
本研究的目的是调查下颌骨牵引成骨术（MDO）与孤立性和综合征罗宾序列（RS）患者术后胃造瘘管（G管）置入率之间的关系。这项研究是一项多机构回顾性病历审查，对象是在三家不同的儿科三级医疗中心之一接受下颌骨牵引成骨术（MDO）的罗宾序列（RS）患者。研究的主要目的是比较三家机构在 MDO 后放置 G 管的比例。主要结果采用费舍尔精确检验进行分析。研究的次要目的是评估导致放置 G 管的其他因素，如人口统计学差异、住院时间和 MDO 时的年龄。次要结果的分析采用多元逻辑回归模型进行评估。共有 125 名患者符合纳入标准，其中包括 RS 诊断、在 2004 年至 2019 年期间完成 MDO 以及有足够的医疗记录。60%（n = 75）的受试者被归类为孤立RS（iRS），40%（n = 50）的受试者被归类为综合RS（sRS）。MDO 后，20% 的患者（n = 25）置入了 G 管。在 iRS 组中，14.7%（n = 11）的患者需要置入 G 型管，而在 sRS 组中，28%（n = 14）的患者需要置入 G 型管。在考虑所有患者的情况下，各机构的术后 G 管使用率相似。如果只考虑 iRS 患者，一个中心的术后 G 管率明显高于另外两个中心。总体而言，无论诊断结果如何，大多数 RS 患者在 MDO 后都不需要 G 管。然而，iRS 患者的 G 管置入率存在显著差异，这可能表明不同机构的实践理念、手术方案、G 管置入阈值或地区影响存在差异。
{"title":"G-tube placement in patients with robin sequence undergoing mandibular distraction osteogenesis: A multi-institutional review.","authors":"Brianne B Roby,Avery Schnell,Tara L Johnson,Melissa Scholes,Andrew R Scott","doi":"10.1016/j.jcms.2024.08.023","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.023","url":null,"abstract":"The goal of this study was to investigate the relationship between mandibular distraction osteogenesis (MDO) and rates of postoperative gastrostomy tube (G-tube) placement among patients with isolated and syndromic Robin sequence (RS). This study was a multi-institutional retrospective chart review of patients with RS who underwent MDO at one of three different pediatric tertiary medical centers. The primary aim of the study was to compare rates of G-tube placement following MDO among the three institutions. The primary outcome was analyzed using Fischer's exact test. The secondary aim of the study was to assess for other contributing factors to G-tube placement such as demographic differences, length of hospital stay, and age at MDO. Analysis of secondary outcomes was assessed using multiple logistic regression models. A total of 125 patients met the inclusion criteria, which required RS diagnosis, completion of MDO between 2004 and 2019, and adequate medical record availability. Sixty percent (n = 75) of subjects were categorized as isolated RS (iRS) and forty percent (n = 50) as syndromic RS (sRS). After MDO, 20% (n = 25) of all patients had G-tubes placed. Of the iRS group, 14.7% (n = 11) required a G-tube, while 28% (n = 14) of the sRS group required a G-tube. The post-operative G-tube rate was similar between institutions when considering all patients. When considering only those patients with iRS, the post-MDO G-tube rate at one center was significantly higher than the other two. Overall, most patients with RS did not require a G-tube after MDO, regardless of diagnosis. However, the significant differences in rates of G-tube placement among patients with iRS may indicate differing practice philosophies, surgical protocols, thresholds for G-tube placement, or regional influences between institutions.","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"36 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193728","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 : 2024-08-28DOI: 10.1016/j.jcms.2024.08.022
Khalid Ayidh Alqahtani,Eman Shaheen,Oliver Da Costa Senior,Constantinus Politis,Reinhilde Jacobs
The primary purpose of this study was to accurately assess linear, volumetric and morphological changes of maxillary teeth roots following multi-segments Le Fort I osteotomy. A secondary objective was to assess whether patient- and/or treatment-related factors might influence root remodeling. A total of 60 patients (590 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The multi-segments group included 30 patients who had either 2-segments or 3-segments Le Fort I osteotomy. The other 30 patients underwent one-segment Le Fort I osteotomy. Preoperative, 1 year, and 2 years postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and fully automated method for evaluating root changes in three dimensions (3D) was applied. No statistical significant differences were found between multi-segments and one-segment Le Fort I for linear, volumetric and morphological measurements. The Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement leading to more root remodeling. This research may allow surgeons to properly assess root remodeling after combined treatment of orthodontics and the different Le Fort I osteotomies.
本研究的主要目的是准确评估多段勒堡I型截骨术后上颌牙根的线性、体积和形态变化。次要目的是评估患者和/或治疗相关因素是否会影响牙根重塑。研究人员对接受正畸和正颌联合手术的 60 名患者（590 颗牙齿）进行了回顾性研究。多段组中有 30 名患者接受了 2 段或 3 段 Le Fort I 截骨术。另外 30 名患者接受了单段 Le Fort I 型截骨术。对患者进行术前、术后一年和两年的锥形束计算机断层扫描（CBCT）。采用经过验证的全自动方法评估牙根的三维变化。在线性、体积和形态测量方面，多节段和单节段 Le Fort I 之间没有发现明显的统计学差异。斯皮尔曼相关系数显示，上颌前突与牙根重塑之间存在正相关关系，前突越大，牙根重塑越多。这项研究可以让外科医生正确评估正畸和不同 Le Fort I 截骨联合治疗后的牙根重塑情况。
{"title":"Three dimensional assessment of root changes after multi-segments Le Fort I osteotomy.","authors":"Khalid Ayidh Alqahtani,Eman Shaheen,Oliver Da Costa Senior,Constantinus Politis,Reinhilde Jacobs","doi":"10.1016/j.jcms.2024.08.022","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.022","url":null,"abstract":"The primary purpose of this study was to accurately assess linear, volumetric and morphological changes of maxillary teeth roots following multi-segments Le Fort I osteotomy. A secondary objective was to assess whether patient- and/or treatment-related factors might influence root remodeling. A total of 60 patients (590 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The multi-segments group included 30 patients who had either 2-segments or 3-segments Le Fort I osteotomy. The other 30 patients underwent one-segment Le Fort I osteotomy. Preoperative, 1 year, and 2 years postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and fully automated method for evaluating root changes in three dimensions (3D) was applied. No statistical significant differences were found between multi-segments and one-segment Le Fort I for linear, volumetric and morphological measurements. The Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement leading to more root remodeling. This research may allow surgeons to properly assess root remodeling after combined treatment of orthodontics and the different Le Fort I osteotomies.","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"15 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249950","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}
Pleomorphic adenoma (PA) is the most prevalent benign salivary gland tumor. Although rare, among the minor salivary glands, palatal PA exhibits the highest incidence. Unlike other benign tumors, PA infiltrates the surrounding tissues, posing challenges for complete removal through conservative measures. Surgeons often resort to aggressive surgical procedures involving resection of adjacent tissue to ensure clear margins and prevent recurrence. This study aims to analyze diverse histological characteristics of palatal PA, seeking statistical correlations for early prediction of tumor aggressiveness. The goal is to facilitate the preservation of the periosteum during surgical resection and attain conservative surgical margins. A retrospective histopathological investigation encompassed 18 patients diagnosed with palatal PA who underwent surgical treatment at Hadassah Medical Centre, Jerusalem, Israel. Evaluated parameters included tumor size, pseudocapsule thickness, tumor-periosteum distance, and the presence of pseudopodia and satellite nodules indicating tumor penetration. Statistical significance was set at P < 0.05. Tumors of varying sizes, whether large or small, lack consistent features. Neither tumor size, pseudocapsule thickness, nor tumor-periosteum distance displayed correlations with tumor penetration features. Palatal PA exhibits varied histological attributes impacting surgical technique. The absence of correlations among these attributes impedes early prediction of tumor aggressiveness, casting doubt on periosteum preservation. The periosteum is sufficiently robust to contain the tumor and should be excised. There is no data to support either ostectomy or a through-and-through surgical resection as part of the treatment.
多形性腺瘤（PA）是最常见的良性唾液腺肿瘤。虽然罕见，但在小唾液腺中，腭腺瘤的发病率最高。与其他良性肿瘤不同的是，PA 会浸润周围组织，这给保守治疗带来了挑战。外科医生通常会采取积极的外科手术，切除邻近组织，以确保边缘清晰，防止复发。本研究旨在分析腭PA的不同组织学特征，寻求早期预测肿瘤侵袭性的统计学相关性。目的是在手术切除过程中保留骨膜，实现保守的手术切缘。一项回顾性组织病理学调查涵盖了在以色列耶路撒冷哈大沙医疗中心接受手术治疗的 18 名确诊为腭PA的患者。评估参数包括肿瘤大小、假囊厚度、肿瘤与骨膜的距离、假栓和表明肿瘤穿透的卫星结节的存在情况。统计学意义以 P < 0.05 为标准。不同大小的肿瘤，无论大小，都缺乏一致的特征。肿瘤大小、假囊厚度和肿瘤与骨膜的距离均与肿瘤穿透特征无关。腭PA表现出不同的组织学特征，对手术技术产生影响。这些属性之间缺乏相关性，妨碍了对肿瘤侵袭性的早期预测，使人对骨膜的保留产生怀疑。骨膜的坚固程度足以容纳肿瘤，因此应予以切除。目前还没有数据支持将骨膜切除术或贯穿性手术切除作为治疗的一部分。
{"title":"\"The correlation between histopathological pattern and surgical treatment for palatal pleomorphic adenoma. Can we choose a more conservative approach?\"","authors":"Keidar Zar,Rami Tabib,Heli Rushinek,Itay Madmon,Tal Keidar Haran,Michael Alterman","doi":"10.1016/j.jcms.2024.08.015","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.015","url":null,"abstract":"Pleomorphic adenoma (PA) is the most prevalent benign salivary gland tumor. Although rare, among the minor salivary glands, palatal PA exhibits the highest incidence. Unlike other benign tumors, PA infiltrates the surrounding tissues, posing challenges for complete removal through conservative measures. Surgeons often resort to aggressive surgical procedures involving resection of adjacent tissue to ensure clear margins and prevent recurrence. This study aims to analyze diverse histological characteristics of palatal PA, seeking statistical correlations for early prediction of tumor aggressiveness. The goal is to facilitate the preservation of the periosteum during surgical resection and attain conservative surgical margins. A retrospective histopathological investigation encompassed 18 patients diagnosed with palatal PA who underwent surgical treatment at Hadassah Medical Centre, Jerusalem, Israel. Evaluated parameters included tumor size, pseudocapsule thickness, tumor-periosteum distance, and the presence of pseudopodia and satellite nodules indicating tumor penetration. Statistical significance was set at P < 0.05. Tumors of varying sizes, whether large or small, lack consistent features. Neither tumor size, pseudocapsule thickness, nor tumor-periosteum distance displayed correlations with tumor penetration features. Palatal PA exhibits varied histological attributes impacting surgical technique. The absence of correlations among these attributes impedes early prediction of tumor aggressiveness, casting doubt on periosteum preservation. The periosteum is sufficiently robust to contain the tumor and should be excised. There is no data to support either ostectomy or a through-and-through surgical resection as part of the treatment.","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"200 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249951","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 : 2024-08-22DOI: 10.1016/j.jcms.2024.08.012
Christian Doll,Jonas Wüster,Steffen Koerdt,Felix Thiele,Kilian Kreutzer,Carsten Rendenbach,Holger Amthauer,Max Heiland,Claudius Steffen
Sentinel lymph node biopsy (SLNB) is increasingly incorporated in European national guidelines for the management of the clinically node-negative neck (cN0) in early-stage oral squamous cell carcinoma (OSCC). In Germany, SLNB in OSCCs is not yet routinely performed. This study aimed to evaluate the clinical outcome of SLNB in a German cohort. Patients with primary early-stage OSCC who underwent tumor resection and SLNB were retrospectively analyzed. Clinical-pathological characteristics were documented. Primary endpoints were sensitivity and the negative predictive value (NPV). A total of 46 patients with a mean age of 62.3 (±14.5) years met the inclusion criteria. Most tumors were located in the tongue (63.0%). Bilateral drainage from a lateral tumor was observed in three cases (6.5%), and sentinel lymph node metastasis was detected in three patients (6.5%). Mean follow-up for all patients was 13.8 months (±9.6). One patient developed regional recurrence following a negative SLNB during the observation period, leading to an NPV of 0.98 and a sensitivity of 75.0%. The 2-year neck-specific relapse-free survival was 92.8%. SLNB in early-stage OSCC is a reliable diagnostic tool of the cN0 neck, ensuring a high NPV and RFS. SLNB can be advantageous in comparison to elective neck dissection due to the detection of contralateral lymph drainage.
{"title":"Sentinel lymph node biopsy in early-stage oral squamous cell carcinoma: A retrospective single-center analysis.","authors":"Christian Doll,Jonas Wüster,Steffen Koerdt,Felix Thiele,Kilian Kreutzer,Carsten Rendenbach,Holger Amthauer,Max Heiland,Claudius Steffen","doi":"10.1016/j.jcms.2024.08.012","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.012","url":null,"abstract":"Sentinel lymph node biopsy (SLNB) is increasingly incorporated in European national guidelines for the management of the clinically node-negative neck (cN0) in early-stage oral squamous cell carcinoma (OSCC). In Germany, SLNB in OSCCs is not yet routinely performed. This study aimed to evaluate the clinical outcome of SLNB in a German cohort. Patients with primary early-stage OSCC who underwent tumor resection and SLNB were retrospectively analyzed. Clinical-pathological characteristics were documented. Primary endpoints were sensitivity and the negative predictive value (NPV). A total of 46 patients with a mean age of 62.3 (±14.5) years met the inclusion criteria. Most tumors were located in the tongue (63.0%). Bilateral drainage from a lateral tumor was observed in three cases (6.5%), and sentinel lymph node metastasis was detected in three patients (6.5%). Mean follow-up for all patients was 13.8 months (±9.6). One patient developed regional recurrence following a negative SLNB during the observation period, leading to an NPV of 0.98 and a sensitivity of 75.0%. The 2-year neck-specific relapse-free survival was 92.8%. SLNB in early-stage OSCC is a reliable diagnostic tool of the cN0 neck, ensuring a high NPV and RFS. SLNB can be advantageous in comparison to elective neck dissection due to the detection of contralateral lymph drainage.","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"41 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193727","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}
The aim of this study is to evaluate the changes in nasolabial soft tissues following Le Fort I osteotomies, focusing on the impact of maxillary vertical repositioning. This retrospective study included 39 patients with a history of Le Fort 1 osteotomy between 2013 and 2021. Patients were grouped based on their maxillary movement into three categories: pure advancement (group A), advancement with impaction (group B), and advancement with downward repositioning (group C). Preoperative and postoperative CBCT (Cone Beam Computed Tomography) data were analyzed to measure the changes in nasolabial soft tissues. The current study utilized Mimics Suite 20.0 for measuring linear and angular variables. The evaluated variables included intercanthal distance, nasal dorsal length, tip protrusion, mouth width, alar width, upper lip height, nostril dimensions, and angles of nasolabial, alar base, and upper lip. Among them intercanthal distance, nasal dorsal length, or tip protrusion showed no statistical difference (p > 0,05). Mouth width, alar width, alar base angle were increased and upper lip angle was decreased significantly (p < 0.001). Changes in upper lip height and nasolabial angle differed among the groups of the study. While upper lip height increased significantly in groups A and C (p < 0.05), there was a slight decrease in Group B with no significance (p > 0.05). Nasolabial angle decrased significantly on Groups A and B (p < 0.05). The results of this study revealed changes in several soft tissue parameters, some of which occurred regardless of vertical repositioning of the maxilla. Within the limitations of the study, maxillary advancement surgery can affect the aesthetics of the nasolabial region and cause specific changes in related soft tissues. Understanding these changes is essential to establish realistic patient expectations and achieve optimal functional and aesthetic outcomes.
本研究旨在评估 Le Fort I 截骨术后鼻唇软组织的变化，重点关注上颌骨垂直复位的影响。这项回顾性研究纳入了 39 名在 2013 年至 2021 年间接受过 Le Fort 1 型截骨术的患者。根据患者的上颌骨移动情况将其分为三组：单纯上颌前移（A组）、上颌前移伴阻抗（B组）和上颌前移伴向下复位（C组）。对术前和术后的 CBCT（锥形束计算机断层扫描）数据进行分析，以测量鼻唇软组织的变化。本研究使用 Mimics Suite 20.0 测量线性和角度变量。评估的变量包括鼻翼间距、鼻背长度、鼻尖前突、口腔宽度、鼻翼宽度、上唇高度、鼻孔尺寸以及鼻唇角、鼻翼基底角和上唇角。其中，鼻间距、鼻背长度和鼻尖前突无统计学差异（P>0.05）。口宽、腭宽、腭底角明显增加，上唇角明显减少（P 0.05）。A 组和 B 组的鼻唇角明显减小（p
{"title":"Maxillary advancement surgery with vertical component: Impact on the nasolabial aesthetics.","authors":"Turhan Bıçkı, Emre Tosun, Salih Eren Meral, Hakan Hıfzı Tüz, Hanife Avcı","doi":"10.1016/j.jcms.2024.08.011","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.011","url":null,"abstract":"<p><p>The aim of this study is to evaluate the changes in nasolabial soft tissues following Le Fort I osteotomies, focusing on the impact of maxillary vertical repositioning. This retrospective study included 39 patients with a history of Le Fort 1 osteotomy between 2013 and 2021. Patients were grouped based on their maxillary movement into three categories: pure advancement (group A), advancement with impaction (group B), and advancement with downward repositioning (group C). Preoperative and postoperative CBCT (Cone Beam Computed Tomography) data were analyzed to measure the changes in nasolabial soft tissues. The current study utilized Mimics Suite 20.0 for measuring linear and angular variables. The evaluated variables included intercanthal distance, nasal dorsal length, tip protrusion, mouth width, alar width, upper lip height, nostril dimensions, and angles of nasolabial, alar base, and upper lip. Among them intercanthal distance, nasal dorsal length, or tip protrusion showed no statistical difference (p > 0,05). Mouth width, alar width, alar base angle were increased and upper lip angle was decreased significantly (p < 0.001). Changes in upper lip height and nasolabial angle differed among the groups of the study. While upper lip height increased significantly in groups A and C (p < 0.05), there was a slight decrease in Group B with no significance (p > 0.05). Nasolabial angle decrased significantly on Groups A and B (p < 0.05). The results of this study revealed changes in several soft tissue parameters, some of which occurred regardless of vertical repositioning of the maxilla. Within the limitations of the study, maxillary advancement surgery can affect the aesthetics of the nasolabial region and cause specific changes in related soft tissues. Understanding these changes is essential to establish realistic patient expectations and achieve optimal functional and aesthetic outcomes.</p>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146897","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 : 2024-08-22DOI: 10.1016/j.jcms.2024.08.017
Siyu Wu,Simo Xia,Shijing Yue,Guo Bai,Minjie Chen,Chi Yang
The aim of this retrospective observational study was to introduce a comprehensive MRI evaluation criterion for the clinical management of synovial chondromatosis of the temporomandibular joint (TMJ-SC). Patients received different treatments according to the MRI evaluation system: bone erosion, extent, articular disc condition, location, maturity, and size of loose body. At least a 2-year follow-up was completed to assess tumor recurrence, visual analogue scale score for pain (VAS) and maximum interincisal opening (MIO). Of the 195 patients included for TMJ-SC, 34 received arthroscopy and 161 received open surgery. Among the patients with significant extent of SC, 32 received temporary resection of the condylar neck or zygomatic arch and 2 received treatment combined with ear, nose and throat(ENT). 28 received articular disc reconstruction and 56 received disc repositioning. Patients showed good recovery of joint function with only two cases of tumor recurrence at an average follow-up of 75.1 months after surgery. The MIO had improved from 30.2 mm to 40.0 mm(P < 0.0001) and VAS had decreased from 5.1 to 0.78(P < 0.0001).The preoperative MRI evaluation principles has been effective in selecting appropriate surgical options.
{"title":"Clinical guidance based on MRI for the management of temporomandibular joint synovial chondromatosis: One institution's experience.","authors":"Siyu Wu,Simo Xia,Shijing Yue,Guo Bai,Minjie Chen,Chi Yang","doi":"10.1016/j.jcms.2024.08.017","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.017","url":null,"abstract":"The aim of this retrospective observational study was to introduce a comprehensive MRI evaluation criterion for the clinical management of synovial chondromatosis of the temporomandibular joint (TMJ-SC). Patients received different treatments according to the MRI evaluation system: bone erosion, extent, articular disc condition, location, maturity, and size of loose body. At least a 2-year follow-up was completed to assess tumor recurrence, visual analogue scale score for pain (VAS) and maximum interincisal opening (MIO). Of the 195 patients included for TMJ-SC, 34 received arthroscopy and 161 received open surgery. Among the patients with significant extent of SC, 32 received temporary resection of the condylar neck or zygomatic arch and 2 received treatment combined with ear, nose and throat(ENT). 28 received articular disc reconstruction and 56 received disc repositioning. Patients showed good recovery of joint function with only two cases of tumor recurrence at an average follow-up of 75.1 months after surgery. The MIO had improved from 30.2 mm to 40.0 mm(P < 0.0001) and VAS had decreased from 5.1 to 0.78(P < 0.0001).The preoperative MRI evaluation principles has been effective in selecting appropriate surgical options.","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"24 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193732","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 : 2024-08-22DOI: 10.1016/j.jcms.2024.08.021
Shirley van de Velde,Merel M Smit,Robrecht J H Logjes,Enrico Martin,Maartje Haasnoot,Aebele B Mink van der Molen,Emma C Paes
The study aimed to: (1) compare the occurrence of postoperative respiratory difficulties (PRD) following primary cleft palate repair (CPR) in infants with an isolated cleft palate (iCP) and infants with Robin sequence (RS), and (2) describe the possible benefit of preoperative analysis with palatal plate in infants with RS. All consecutive infants with an iCP and infants with RS who underwent CPR between January 2009 and June 2022 in the Wilhelmina Children's Hospital were retrospectively reviewed. A total of 127 infants were included of which 74 infants with an iCP and 53 infants with RS. The group of infants with RS consisted of 35 infants with non-isolated RS (niRS) and 18 infants with isolated RS (iRS). Significant more PRD were seen in infants with RS compared to infants with an iCP (14/53 versus 9/74; p = 0.04). Especially infants with niRS have a significant higher risk of developing PRD in comparison with infants with an iCP (OR = 4.16, 95% CI [1.17-15.99], p = 0.031). The preoperative palatal plate screening in infants with RS (n = 25) did not show abnormalities and had no effect on the perioperative policy. Within the limitations of this study it seems that infants with niRS are more prone to develop PRD following primary CPR when compared to infants with iRS or an iCP. No clear benefit was found in postponing surgery until 12 months or later in infants with RS to avoid PRD. The preoperative palatal plate screening did not demonstrate signs of UAO in infants with RS that developed PRD. These findings suggest that preoperative analysis with palatal plate has a low predictive value.
{"title":"Postoperative respiratory difficulties following primary cleft palate repair in infants with Robin sequence versus isolated cleft palate: A retrospective study.","authors":"Shirley van de Velde,Merel M Smit,Robrecht J H Logjes,Enrico Martin,Maartje Haasnoot,Aebele B Mink van der Molen,Emma C Paes","doi":"10.1016/j.jcms.2024.08.021","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.021","url":null,"abstract":"The study aimed to: (1) compare the occurrence of postoperative respiratory difficulties (PRD) following primary cleft palate repair (CPR) in infants with an isolated cleft palate (iCP) and infants with Robin sequence (RS), and (2) describe the possible benefit of preoperative analysis with palatal plate in infants with RS. All consecutive infants with an iCP and infants with RS who underwent CPR between January 2009 and June 2022 in the Wilhelmina Children's Hospital were retrospectively reviewed. A total of 127 infants were included of which 74 infants with an iCP and 53 infants with RS. The group of infants with RS consisted of 35 infants with non-isolated RS (niRS) and 18 infants with isolated RS (iRS). Significant more PRD were seen in infants with RS compared to infants with an iCP (14/53 versus 9/74; p = 0.04). Especially infants with niRS have a significant higher risk of developing PRD in comparison with infants with an iCP (OR = 4.16, 95% CI [1.17-15.99], p = 0.031). The preoperative palatal plate screening in infants with RS (n = 25) did not show abnormalities and had no effect on the perioperative policy. Within the limitations of this study it seems that infants with niRS are more prone to develop PRD following primary CPR when compared to infants with iRS or an iCP. No clear benefit was found in postponing surgery until 12 months or later in infants with RS to avoid PRD. The preoperative palatal plate screening did not demonstrate signs of UAO in infants with RS that developed PRD. These findings suggest that preoperative analysis with palatal plate has a low predictive value.","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"15 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193729","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}
The management of Condylar Head fractures (CHFs) has historically been with closed treatments(CTR); however, contemporary studies suggest that Open Reduction and Internal Fixation(ORIF) may produce better clinical and radiographic results. Our primary aim was to review the literature on the clinical and radiological outcomes of open and closed management of CHFs. A systematic literature search was undertaken using EMBASE, MEDLINE and PubMed, using PRISMA guidelines, for all studies relating to outcomes following CHF. The inclusion criteria include 1) studies focused on CHF in adult patients that included at least 20 cases 2) published in English language. ROBINS-1 tool was used for risk assessment. Data extracted was analysed and compared using the relative risks. A total of 29 studies reporting on 1550 ORIF and 798 CTR were included. ORIF resulted in significantly less trismus (RR 9.5), chin deviation (RR 7.3), malocclusion (RR 6.5), TMJ clicking (RR 4.3) and pain(RR 12.6) than CTR. Due to the substantial heterogeneity of studies, firm conclusions are difficult but there does appear to be objective benefits in outcomes following ORIF than CTR. Satisfactory results may however be achieved with CTR. Further large studies using standardised outcome measurements will be required to help elucidate exactly which CHF are best served by ORIF.
{"title":"Condyle head fracture management: A systematic review of outcomes.","authors":"Chiew Ying Chieng,Anika Patel,Hira Nazir,Sana Ali,Nabeel Bhatti,Niall Mcleod","doi":"10.1016/j.jcms.2024.08.019","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.019","url":null,"abstract":"The management of Condylar Head fractures (CHFs) has historically been with closed treatments(CTR); however, contemporary studies suggest that Open Reduction and Internal Fixation(ORIF) may produce better clinical and radiographic results. Our primary aim was to review the literature on the clinical and radiological outcomes of open and closed management of CHFs. A systematic literature search was undertaken using EMBASE, MEDLINE and PubMed, using PRISMA guidelines, for all studies relating to outcomes following CHF. The inclusion criteria include 1) studies focused on CHF in adult patients that included at least 20 cases 2) published in English language. ROBINS-1 tool was used for risk assessment. Data extracted was analysed and compared using the relative risks. A total of 29 studies reporting on 1550 ORIF and 798 CTR were included. ORIF resulted in significantly less trismus (RR 9.5), chin deviation (RR 7.3), malocclusion (RR 6.5), TMJ clicking (RR 4.3) and pain(RR 12.6) than CTR. Due to the substantial heterogeneity of studies, firm conclusions are difficult but there does appear to be objective benefits in outcomes following ORIF than CTR. Satisfactory results may however be achieved with CTR. Further large studies using standardised outcome measurements will be required to help elucidate exactly which CHF are best served by ORIF.","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"16 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142249952","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}
Pierre-Robin Sequence (PRS) is a sequence of micrognathia, glossoptosis, and airway obstruction. There is no standardized consensus on the management of respiratory distress for patients with PRS, and operative interventions have associated complications. The purpose of this study is to identify all modalities of non-operative airway intervention for PRS infants. Following PRISMA 2020 guidelines, Embase, Medline, Cochrane, EMCARE, and Web of Science electronic databases were searched from 1992 to 2022 reporting on PRS infants under one year of age who were managed non-operatively. Publications with non-original research designs, an exclusive focus on surgical interventions, case reports, and non-English language articles were excluded. Analysis was performed using non-pooled and pooled proportions (PP). 3280 abstracts were screened, and 88 articles included. Retrospective methodologies were most common. Of the 60 studies where both operative and non-operative interventions were included, 2924 of 4708 PRS infants were administered a non-operative intervention (PP 65.8 % [95%CI 58.5, 72.7]). Reported definitive non-operative interventions, either alone or in combination with another non-operative intervention, included infant positioning (n = 1664), orthodontic appliances (n = 1299), nasopharyngeal tube insertion (n = 983), supplemental oxygen (n = 306), non-invasive ventilation (n = 290), oral airway (n = 46), endotracheal intubation (n = 36), and other (n = 40). The mean MINORS risk of bias score was 6.3 (range 1-12), indicating that the present review was limited by moderate methodological quality for included studies. This is the largest systematic review of non-operative interventions for PRS infants thus far. Most infants are managed non-operatively, with positioning, orthodontic appliances, and nasopharyngeal tubes being the most commonly reported modalities.
{"title":"Non-operative interventions for Pierre-Robin sequence: A systematic review and meta-analysis.","authors":"Justin Haas,Kimberley Yuen,Forough Farrokhyar,Minoo Aminnejad,Connie Williams,Matthew Choi","doi":"10.1016/j.jcms.2024.08.008","DOIUrl":"https://doi.org/10.1016/j.jcms.2024.08.008","url":null,"abstract":"Pierre-Robin Sequence (PRS) is a sequence of micrognathia, glossoptosis, and airway obstruction. There is no standardized consensus on the management of respiratory distress for patients with PRS, and operative interventions have associated complications. The purpose of this study is to identify all modalities of non-operative airway intervention for PRS infants. Following PRISMA 2020 guidelines, Embase, Medline, Cochrane, EMCARE, and Web of Science electronic databases were searched from 1992 to 2022 reporting on PRS infants under one year of age who were managed non-operatively. Publications with non-original research designs, an exclusive focus on surgical interventions, case reports, and non-English language articles were excluded. Analysis was performed using non-pooled and pooled proportions (PP). 3280 abstracts were screened, and 88 articles included. Retrospective methodologies were most common. Of the 60 studies where both operative and non-operative interventions were included, 2924 of 4708 PRS infants were administered a non-operative intervention (PP 65.8 % [95%CI 58.5, 72.7]). Reported definitive non-operative interventions, either alone or in combination with another non-operative intervention, included infant positioning (n = 1664), orthodontic appliances (n = 1299), nasopharyngeal tube insertion (n = 983), supplemental oxygen (n = 306), non-invasive ventilation (n = 290), oral airway (n = 46), endotracheal intubation (n = 36), and other (n = 40). The mean MINORS risk of bias score was 6.3 (range 1-12), indicating that the present review was limited by moderate methodological quality for included studies. This is the largest systematic review of non-operative interventions for PRS infants thus far. Most infants are managed non-operatively, with positioning, orthodontic appliances, and nasopharyngeal tubes being the most commonly reported modalities.","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"11 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193731","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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