Journal of Stomatology Oral and Maxillofacial Surgery最新文献_第9页

An update in the new classification of levels in arthroscopic techniques of the TMJ 关节镜下TMJ关节水平新分类的最新进展

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-24 DOI: 10.1016/j.jormas.2025.102633

Rafael Martín-Granizo , Luis Vicente González , Daniel Jerez-Frederick , Luciano del Santo , Raúl González-García

Objective

To complete the new classification of procedures and techniques to be performed in TMJ arthroscopy, with new techniques that have recently appeared and to add a new separate level.

Material and methods

The authors propose a new level and new subclassifications in TMJ arthroscopy, in order to be able to use the same language between TMJ arthroscopists and obtain more consistent results in the studies and analyses performed.

Results

Category and level I (lysis and lavage) is maintained while levels II (operative) and level III (discopexy) of TMJ arthroscopy are modified. Level III is divided according to the discopexy technique used; in IIIa for non-rigid sutures, IIIb for semi-rigid sutures and IIIc for rigid techniques. Furthermore, level IV of arthroscopy is also proposed, which would be that one carried out specifically and with special technique in the lower joint space.

Conclusions

It is important that all specialists in arthroscopic treatment of TMJ use the same classification system for the different techniques to obtain homogeneous, consistent and valid results in the different studies. This classification is not exclusive by levels, nor is it based on surgical difficulty, or the instrumentation of the techniques used.

目的结合最近出现的新技术，完成TMJ关节镜手术技术的新分类，并增加一个新的独立水平。材料和方法作者提出了TMJ关节镜的一个新的水平和新的亚分类，以便能够在TMJ关节镜医师之间使用相同的语言，并在进行的研究和分析中获得更一致的结果。结果维持TMJ关节镜的分类和I级（溶解和灌洗），调整TMJ关节镜的II级（手术）和III级（骨折）。三级是根据使用的解剖技术划分的；IIIa用于非刚性缝合，IIIb用于半刚性缝合，IIIc用于刚性技术。此外，我们还提出了关节镜检查的第四级，即在下关节间隙进行专门的、采用特殊技术的检查。结论关节镜下治疗颞下颌关节的专家对不同的技术采用相同的分类系统，在不同的研究中获得均匀、一致和有效的结果是很重要的。这种分类不以水平为排他性，也不以手术难度或所用技术的工具为基础。

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引用次数: 0

Bilateral pre-expanded supraclavicular artery flap: a versatile solution for extensive faciocervical burn contractures 双侧预扩张锁骨上动脉瓣：广泛面颈烧伤挛缩的通用解决方案。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-21 DOI: 10.1016/j.jormas.2025.102632

Pingping Liu, Sen Chen, Ning Ma, Yilong Guo, Zhe Yang, Yong Tang, Yangqun Li

Background

Extensive postburn face and neck contractures, particularly extending bilaterally or to the chest, pose significant reconstructive challenges. This study aims to assess the efficacy and strategies of bilateral pre-expanded supraclavicular artery flaps (SCFs) in addressing these complex defects.

Methods

A retrospective study was conducted at our institution from January 1, 2015, to January 1, 2024, encompassing patients who underwent bilateral pre-expanded SCF reconstruction for faciocervical scar contractures. Data on patient demographics, flap characteristics, and postoperative outcomes were collected.

Results

Twenty-one patients (median age, 11 years) underwent reconstruction with 42 pre-expanded SCFs. Indications included bilateral faciocervical scars (n = 7), full-neck scars (n = 5), and combined face, neck, and chest scars (n = 9). All flaps survived completely, with dimensions ranging from 8 cm × 5 cm to 25 cm × 13 cm. At a mean follow-up of 5.85 years, 95.2% of patients (20/21) reported satisfaction with the appearance and texture of the flaps, and all demonstrated improved neck mobility. Complications occurred in 19.0% of flaps (one wound dehiscence, three distal venous congestions), all of which resolved with conservative management.

Conclusion

Bilateral pre-expanded SCFs provide a reliable option for reconstructing extensive faciocervical contractures, including bilateral cervicofacial involvement, entire neck involvement, or with mentosternal adhesions, achieving both aesthetic and functional improvements.

背景：烧伤后面部和颈部的广泛挛缩，特别是向双侧或胸部延伸，给重建带来了重大挑战。本研究旨在评估双侧预扩张锁骨上动脉瓣（SCFs）治疗这些复杂缺损的疗效和策略。方法：2015年1月1日至2024年1月1日在我院进行回顾性研究，纳入了因面部颈部瘢痕挛缩而行双侧预扩张SCF重建的患者。收集了患者人口统计学、皮瓣特征和术后结果的数据。结果：21例患者（中位年龄11岁）接受42例预扩张SCFs重建。适应症包括双侧面部颈部疤痕（n = 7），全颈部疤痕（n = 5），面部、颈部和胸部合并疤痕（n = 9）。所有皮瓣完全存活，尺寸从8cm × 5cm到25cm × 13cm不等。在平均5.85年的随访中，95.2%的患者（20/21）报告对皮瓣的外观和质地满意，并且所有患者都表现出颈部活动能力的改善。19.0%的皮瓣出现并发症（1例创面裂开，3例远端静脉充血），均经保守处理解决。结论：双侧预扩张SCFs为重建广泛的面颈挛缩提供了可靠的选择，包括双侧颈面受累、整个颈部受累或伴有胸膜粘连，实现了美观和功能的改善。

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引用次数: 0

Biomechanical assessment and topological optimization of embedded polygonal bone reconstruction structures 嵌入式多边形骨重建结构的生物力学评估与拓扑优化。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-19 DOI: 10.1016/j.jormas.2025.102631

Shuntao Cui, Xinrong Liu, Yiqin Liu, Chun Liu, Yuhang Xue

Purpose

Conventional mandibular reconstruction frequently results in stress shielding, compromised osteotomy site healing, or bone resorption. This study introduces an Embedded Polygonal Bone Reconstruction Structure (EPBRS) that eliminates titanium plate dependency, enhanced through fillet-based topological optimization.

Materials and Methods

A computational model of the Embedded Polygonal Bone Reconstruction Structure (EPBRS) was developed from CT scans. Four variants with fillet radii (0.2, 0.4, 0.6, and 0.8 mm) were designed. Physiological masticatory loading was simulated under identical conditions. The values of the von Mises stress and peak displacements were calculated for all configurations.

Results

With increasing fillet radius: The Maximum von Mises stress in the fibula graft decreased from 87.21 MPa to 37.59 MPa. The Maximum von Mises stress in the mandible decreased from 100.73 MPa to 23.9 MPa. The Maximum von Mises stress in titanium screws remained statistically invariant (170–185 MPa). Peak displacement (fibula graft, screws, mandible) decreased by approximately 0.1 mm between 0 mm and 0.2 mm fillet radii, remaining stable with further increases

Conclusion

The embedded polygonal reconstruction demonstrates significant biomechanical safety and reliability. Fillet optimization substantially reduced the Maximum von Mises stress and improved deformation resistance.

目的：传统的下颌骨重建经常导致应力屏蔽、截骨部位愈合受损或骨吸收。本研究介绍了一种嵌入式多边形骨重建结构（EPBRS），该结构消除了对钛板的依赖，通过基于圆角的拓扑优化得到增强。材料和方法：基于CT扫描建立了嵌入式多边形骨重建结构（EPBRS）的计算模型。设计了四种圆角半径（0.2、0.4、0.6和0.8 mm）。在相同条件下模拟了生理咀嚼负荷。计算了所有构型的von Mises应力和峰值位移值。结果：随着骨内圆角半径的增大，骨内最大von Mises应力由87.21 MPa降至37.59 MPa。下颌骨最大von Mises应力由100.73 MPa降至23.9 MPa。钛螺钉的最大von Mises应力在170 ~ 185 MPa之间保持统计学不变。峰值位移（腓骨移植物、螺钉、下颌骨）在0 ~ 0.2 mm圆角半径范围内下降约0.1 mm，随着圆角半径的进一步增大而保持稳定。结论：内埋多边形重建具有显著的生物力学安全性和可靠性。圆角优化大大降低了最大von Mises应力，提高了变形抗力。

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引用次数: 0

Management of a fractured pterygomaxillary implant in full-arch maxillary rehabilitation: A case report 上颌全弓康复治疗翼颌种植体骨折1例。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-17 DOI: 10.1016/j.jormas.2025.102627

Jie Ren , XiaoMao Lin

We describe the management and 3-year outcome of a fractured pterygomaxillary implant in a full-arch maxillary rehabilitation. A 48-year-old man with severe periodontitis and bruxism received a six implant full-arch prosthesis, including two pterygomaxillary implants. One year post-delivery, the prosthesis fractured. Radiographic examination revealed fracture at the apical third of the right pterygomaxillary implant. Coronal fragment and prosthesis were removed, apical fragment was retained because of its anatomical position. To restore posterior support, a short implant was placed using trans-alveolar sinus lift. After 4 months, a new prosthesis was delivered. At the 3-year follow-up, the outcome was successful. This is the first report of a fractured pterygomaxillary implant managed by retaining the apical fragment. We demonstrate that conservative retention of a fractured pterygomaxillary implant can be safe when surgical retrieval carries risks. We emphasize the importance of managing risk factors, like bruxism, in full-arch reconstructions involving pterygomaxillary implants.

我们描述了在全弓上颌康复中翼状颌种植体骨折的处理和3年的结果。一名患有严重牙周炎和磨牙的48岁男性接受了六种植体全弓假体，包括两颗翼状颌种植体。分娩一年后，假体骨折。x线检查显示右侧翼颌种植体顶端三分之一处骨折。冠状碎片和假体切除，根尖碎片因其解剖位置保留。为了恢复后路的支持，使用经牙槽窦提升术放置一个短种植体。4个月后，移植了一个新的假体。在3年的随访中，结果很成功。这是第一份报告的骨折翼状颌种植体管理保留根尖碎片。我们证明，当手术复位有风险时，保守保留骨折的翼颌种植体是安全的。我们强调管理风险因素的重要性，如磨牙，在全弓重建涉及翼状颌种植体。

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引用次数: 0

First report of recurrent bilateral temporomandibular joint dislocation treated with personalized porous bioceramic medical devices 个体化多孔生物陶瓷医疗器械治疗复发性双侧颞下颌关节脱位的首次报道。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-17 DOI: 10.1016/j.jormas.2025.102619

Pierre-Etienne Tissot Serrée , Camille Coussens , Aude Barrabé , Aurélien Louvrier , Eugénie Bertin

Various surgical techniques have been proposed to prevent recurrent temporomandibular joint (TMJ) dislocations, with inconsistent results regarding recurrence and preservation of mandibular mobility. We report the innovative use of a custom-made porous bioceramic medical device for the treatment of recurrent bilateral TMJ dislocations. The implants were computer-designed from the patient's preoperative CT scan and manufactured by the Cerhum company. Implantation and fixation were performed through preauricular approaches. At one-year follow-up, no recurrence or surgical complications were observed. Mandibular mobility was within normal limits, and the aesthetic outcome was satisfactory. This is the first reported use of porous bioceramic in the management of recurrent TMJ dislocations. The technique combines the osseointegrative properties of the material with the precision of a patient-specific design. However, the intrinsic fragility of bioceramic requires limiting implant thickness. Additional cases and longer follow-up are mandatory to confirm the efficacy and safety of this novel technique.

已经提出了各种手术技术来预防复发性颞下颌关节（TMJ）脱位，但关于复发和保留下颌活动能力的结果不一致。我们报告了一种定制的多孔生物陶瓷医疗装置的创新使用，用于治疗复发性双侧TMJ脱位。植入物是由Cerhum公司根据患者术前CT扫描设计并制造的。植入和固定通过耳前入路进行。随访1年，无复发及手术并发症。下颌活动在正常范围内，美观效果令人满意。这是首次报道使用多孔生物陶瓷治疗复发性颞下颌关节脱位。该技术将材料的骨整合特性与患者特定设计的精度相结合。然而，生物陶瓷固有的脆弱性要求限制植入物的厚度。更多的病例和更长时间的随访是必要的，以确认这种新技术的有效性和安全性。

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引用次数: 0

Biomechanical study on the stability of mini-implants in the infrazygomatic crest region 颧骨下嵴微型植入物稳定性的生物力学研究。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-16 DOI: 10.1016/j.jormas.2025.102623

Qian Lin , Yanling Chen , Tingxu Lin , Fuhai Zhao

Objective

To determine insertion angles and force directions that minimize micromotion of infrazygomatic crest (IZC) mini-implants while accounting for the curved lateral wall and the non-parallel bicortical anatomy.

Methods

We built 20 three-dimensional finite element models that preserved full thread geometry and the true IZC bicortical relationship. Two force directions (horizontal vs. vertical), five insertion angles (15°–70°), and single vs. double cortical engagement were tested under a 2 N load. Outcomes included implant displacement and von Mises stress in the screw and surrounding bone.

Results

Vertical loading consistently halved displacement compared with horizontal loading (mean 7.3 ± 2.9 μm vs. 14.7 ± 6.2 μm). Under horizontal forces, 45° minimized displacement (8.1 μm) and cortical stress (92 MPa); under vertical forces, 15° performed best (4.6 μm). Effect sizes were substantial: vertical vs. horizontal displacement ratio ≈ 0.50; 45° vs. 70° cortical stress reduction ≈ 33–40 % under horizontal loading. Penetrating the thin sinus floor (∼0.45 mm) did not improve stability.

Conclusion

For IZC anchorage, 15–45° insertion with predominantly vertical force reduces stress and micromotion; thin bicortical engagement provides no additional benefit. These anatomy-aware rules are readily applicable chairside.

目的：考虑到颧下嵴弯曲的外侧壁和非平行的双皮质解剖结构，确定使颧下嵴微型植入物微动最小化的植入角度和受力方向。方法：建立20个三维有限元模型，保留完整的螺纹几何形状和真正的IZC双皮质关系。在2n载荷下，测试了两种力方向（水平与垂直），五个插入角度（15°-70°），单皮质与双皮质接合。结果包括种植体移位和螺钉及周围骨的von Mises应力。结果：与水平加载相比，垂直加载始终使位移减半（平均7.3±2.9 μm比14.7±6.2 μm）。水平力作用下，45°位移最小（8.1 μm），皮质应力最小（92 MPa）；在垂直力作用下，15°角（4.6 μm）效果最佳。效应量很大：垂直与水平位移比≈0.50；水平加载条件下，45°vs 70°的皮质应力降低≈33-40%。穿透薄窦底（~ 0.45 mm）不能提高稳定性。结论：对于IZC支具，以垂直力为主的15-45°插入可减少应力和微动；薄的双皮质接触不会带来额外的好处。这些与解剖学相关的规则在椅子旁很容易适用。

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引用次数: 0

Analysis of perioperative mortality in 66 patients with head and neck cancer: A retrospective study 66例头颈部肿瘤围手术期死亡率的回顾性分析。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-16 DOI: 10.1016/j.jormas.2025.102624

Pengfei Zhao , Xinyi Lin , Wei Li , Yiming Chen

Background

To investigate the characteristics, causes, and risk factors of perioperative mortality (POM) in patients undergoing surgery for head and neck cancer (HNC).

Patients and Methods

Medical records of HNC patients treated between 1999 and 2024 were reviewed. Sixty-six patients who experienced POM were identified and compared with 132 matched controls (matched for tumor site, stage, and type of surgery). Data included demographics, comorbidities, tumor features, treatment history, perioperative management, and causes of death. POM causes were categorized as surgical, medical, mixed, or personal. Risk factors were assessed using univariate and multivariate logistic regression.

Results

Among 198 patients (66 POM, 132 controls), those with POM were older, had more comorbidities, advanced disease, and prior radiotherapy. They also showed higher ASA grades, longer operations, greater blood loss, and more frequent tracheotomy (all p < 0.05). Most deaths occurred postoperatively, with medical complications predominating. Independent predictors of POM were comorbidities, advanced stage, ASA grade <III, blood loss >600 ml, and tracheotomy.

Conclusion

Perioperative mortality in HNC surgery results from multifactorial causes, with both surgical and medical complications contributing significantly. Identifying high-risk patients based on preoperative status and operative parameters may help optimize perioperative care and reduce mortality.

背景：探讨头颈癌（HNC）手术患者围手术期死亡率（POM）的特点、原因及危险因素。患者与方法：回顾1999 ~ 2024年收治的HNC患者的医疗记录。66例经历POM的患者被确定并与132例匹配对照（匹配肿瘤部位、分期和手术类型）进行比较。数据包括人口统计学、合并症、肿瘤特征、治疗史、围手术期管理和死亡原因。POM的原因分为手术、医疗、混合和个人原因。采用单因素和多因素logistic回归评估危险因素。结果：198例患者（66例POM， 132例对照）中，POM患者年龄较大，合并症较多，病情进展，既往放疗较多。ASA分级高，手术时间长，出血量大，气管切开次数多（p < 0.05）。大多数死亡发生在术后，以医学并发症为主。POM的独立预测因子为合并症、晚期、ASA分级600 ml和气管切开术。结论：HNC手术围手术期死亡率是由多因素引起的，手术并发症和内科并发症均有显著影响。根据术前状态和手术参数识别高危患者有助于优化围手术期护理和降低死亡率。

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引用次数: 0

Additively manufactured titanium subperiosteal implants: A long-term retrospective clinical evaluation of 10 patients with severe mandibular atrophy 增材制造的钛骨膜下种植体：10例严重下颌萎缩患者的长期回顾性临床评价。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-16 DOI: 10.1016/j.jormas.2025.102621

Jan Łoginoff, Agata Majos, Marcin Elgalal

Background

Severe mandibular atrophy often precludes the use of conventional endosseous implants. Recent advances in 3D imaging, CAD/CAM design, and direct metal laser sintering (DMLS) of titanium alloys have improved the clinical viability of custom-made subperiosteal implants.

Methods

This retrospective study included 10 patients with Cawood and Howell Class IV–VI mandibular atrophy who received additively manufactured, patient-specific titanium subperiosteal implants. Designs were based on CT scans and fabricated via DMLS. Clinical and radiological assessments were conducted postoperatively to evaluate implant survival, complications, and bone stability over a follow-up period of up to 12 years.

Results

Seven implants (70 %) remained functional and clinically stable. Three were removed due to late complications, including bone resorption and granulation tissue formation. Early postoperative complications included oedema and pain in all cases, all of which were effectively managed with conservative treatment. These complications did not compromise implant functionality. Late complications were observed in three patients that ultimately led to implant removal. The overall implant survival rate in this cohort was 70 %.

Conclusion

DMLS-fabricated, custom-designed subperiosteal implants offer a promising solution for patients with severe mandibular atrophy. Despite some late complications, the technology demonstrates favorable long-term outcomes, especially when conventional implants are contraindicated.

背景：严重的下颌骨萎缩常常使传统的骨内种植体无法使用。最近在3D成像、CAD/CAM设计和钛合金直接金属激光烧结（DMLS）方面的进展提高了定制骨膜下种植体的临床可行性。方法：本回顾性研究包括10例Cawood和Howell IV-VI级下颌萎缩患者，他们接受了增材制造的患者特异性钛骨膜下种植体。设计基于CT扫描并通过DMLS制作。术后进行临床和放射学评估，以评估种植体的存活、并发症和骨稳定性，随访时间长达12年。结果：7个（70%）种植体保持功能和临床稳定。3例因后期并发症，包括骨吸收和肉芽组织形成而切除。术后早期并发症包括水肿和疼痛，所有病例均通过保守治疗得到有效控制。这些并发症不影响种植体的功能。在3例患者中观察到晚期并发症，最终导致种植体移除。在这个队列中，种植体的总体存活率为70%。结论：dmls制造的骨膜下种植体是治疗严重下颌骨萎缩的有效方法。尽管有一些后期并发症，但该技术显示出良好的长期效果，特别是在常规植入物禁忌的情况下。

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引用次数: 0

When authorship ethics falter: Lessons from South Korea and reflections for our journal and specialist community 当作者伦理动摇：来自韩国的教训和对我们期刊和专家社区的反思。

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-16 DOI: 10.1016/j.jormas.2025.102620

Poramate Pitak-Arnnop

引用次数: 0

Refractory oral manifestations of Crohn's disease 克罗恩病的难治性口腔表现

IF 2 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of Stomatology Oral and Maxillofacial Surgery

Pub Date : 2025-10-16 DOI: 10.1016/j.jormas.2025.102625

A. Khemis , R. Lan , F. Amatore , JM. Reimund , F. Campana , A. Falguière

Introduction

Persistent oral manifestations of Crohn's disease (CD), despite intestinal remission, remain a therapeutic challenge. This study aimed to describe two such cases and review available literature on management strategies.

Case reports

Despite infliximab and methotrexate, the first patient developed progressive oral lesions with only partial improvement under upadacitinib. The second achieved digestive remission under golimumab and successfully controlled oral lesions with intralesional corticosteroids.

Discussion

A literature review (Pubmed, ScienceDirect; up to January 2025) identified 17 articles involving 75 patients. Oral lesions appeared independently (54 %), concomitantly with digestive disease (20 %), or preceded it (26 %). Therapeutic responses were variable, with limited efficacy of anti-TNF antibodies, immunosuppressants, and corticosteroids. Anti-IL12/23 antibodies showed promising results in isolated cases, while data on anti-IL-23 antibodies and JAK inhibitors remain lacking.

Conclusion

Due to the absence of standardized therapeutic protocols, a personalized, multidisciplinary approach is essential. Further studies are needed to better define effective treatments.

克罗恩病（CD）的持续口腔表现，尽管肠道缓解，仍然是一个治疗挑战。本研究旨在描述两个这样的案例，并回顾有关管理策略的现有文献。病例报告：尽管使用英夫利昔单抗和甲氨蝶呤，第一位患者出现进行性口腔病变，在upadacitinib下只有部分改善。第二例患者在戈利姆单抗下获得消化缓解，并成功地使用皮质类固醇控制口腔病变。讨论：一篇文献综述（Pubmed, ScienceDirect；截至2025年1月）确定了17篇文章，涉及75名患者。口腔病变独立出现（54%），伴发消化系统疾病（20%），或先于口腔病变出现（26%）。治疗反应是可变的，抗肿瘤坏死因子抗体、免疫抑制剂和皮质类固醇的疗效有限。抗il - 12/23抗体在个别病例中显示出良好的结果，而抗il -23抗体和JAK抑制剂的数据仍然缺乏。结论：由于缺乏标准化的治疗方案，个性化，多学科的方法是必不可少的。需要进一步的研究来更好地确定有效的治疗方法。

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引用次数: 0