Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Background: Orbital floor fractures are among the most frequent facial injuries, and precise reconstruction is essential to prevent both functional and aesthetic complications. Virtual Surgical Planning (VSP) combined with pre-shaped titanium mesh has transformed orbital reconstruction. This study aimed to evaluate whether VSP-assisted surgery with pre-modeled mesh provides greater accuracy and reduced operative times compared with conventional intraoperative mesh shaping.

Methods: A case-control study was performed on 52 patients treated at the "Federico II" University Hospital of Naples for large pure orbital floor fractures. Twenty-four patients (Group A) underwent VSP-assisted reconstruction using a preformed titanium mesh, while twenty-eight patients (Group B) received conventional intraoperative mesh modeling. Operative time, postoperative diplopia, infraorbital sensory disturbance, mesh malposition, screw loosening, and infection were compared in the two groups. Clinical and radiological follow-up was conducted at 12 months.

Results: Median operative time was significantly shorter in Group A compared with Group B (55 minutes [IQR 50-65] vs. 110 minutes [IQR 98-125]; p < 0.001). Persistent diplopia occurred in 4% of patients in Group A and 28.6% in Group B (p = 0.028). Implant malposition was observed exclusively in Group B (25% vs. 0%; p = 0.011). Other postoperative complications, including infraorbital nerve alterations, eyelid malposition, wound dehiscence, screw loss, and infection, were more frequent in Group B but did not reach statistical significance. No cases of postoperative ocular motility limitation or iatrogenic fracture were observed in either group.

Conclusions: VSP with pre-modeled titanium mesh significantly reduces operative time and postoperative complications, enhancing reconstructive precision and outcomes in orbital floor fracture management. This virtual protocol is useful for reducing the costs and waiting times of custom-made implants, manufactured by external companies.

Objective: To evaluate, through three-dimensional finite element analysis (FEA), the stress and strain distribution in reconstruction plates of different thicknesses used for fixation of bone-grafted segmental mandibular defects.

Method: A dentate mandibular model was obtained from computed tomography data and digitally processed for FEA using ANSYS 7.0. Three reconstruction plate models (2.0, 2.4, and 3.0 mm thick) were applied to simulate defects in the symphyseal, body, and angle regions of the mandible, each associated with block bone grafts and fixed using 2.4-mm locking screws. A 300-N vertical occlusal load and muscle vectors representing masticatory forces were simulated. Stress distribution was analyzed according to von Mises criteria across plates, screws, and bone graft blocks.

Results: Increasing plate thickness reduced stress concentration within the plates but significantly increased stress on the fixation screws, particularly those adjacent to osteotomy lines. The symphyseal defect exhibited the highest stress values, followed by the body and angle defects. Stress values within bone graft blocks remained low (<250 MPa), indicating minimal deformation.

Conclusion: Thicker reconstruction plates enhance mechanical resistance but increase stress concentration on fixation screws, especially near osteotomies, suggesting a higher risk of screw loosening or peri-implant bone resorption. The anterior mandible demonstrated the most unfavorable stress distribution. Locking fixation systems are recommended when rigid plates are used to mitigate screw-related complications.

Objective: Ultrasound imaging is gaining increasing relevance in facial aesthetic medicine due to its real-time, non-invasive, and radiation-free nature. The purpose of this scoping review was to explore the clinical applications of ultrasonography in aesthetic medicine.

Materials and methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science to identify clinical studies evaluating the use of ultrasonography in facial aesthetic medicine. The search strategy included the following terms: "aesthetic", "facial", "ultrasound". PRISMA Extension for Scoping Review guidelines were used.

Results: A total of 6 studies were included in this review. Ultrasonography has been used to guide injections in facial aesthetic procedures such as filler and botulinum injection and to assess the thickness of the masseter muscle to evaluate the efficacy of masseter muscle hypertrophy treatment.

Conclusions: Ultrasonography enhances the safety of facial aesthetic procedures by guiding injections into the correct tissue layers and minimizing vascular risks. Priority should be given to the development of standardized protocols and an increase in randomized clinical trials.

Objectives: English dominates scientific communication, yet non-native speakers face significant barriers in publishing. Artificial intelligence (AI) translation tools offer a potential solution, but their efficacy requires systematic evaluation. The aim of this paper is to evaluate the performance of generative AI tools with a focus on their suitability for non-native English-speaking researchers.

Materials and methods: Thirty Non-English texts (150-300 words) across technical, academic, and descriptive genres were translated by six AI tools (ChatGPT-4.0, Claude 3.7, Copilot, Gemini 2.0, DeepSeek-V3, Perplexity) using standardized prompts. Translations were assessed via Grammarly® for correctness, clarity, engagement, and delivery. Statistical analysis (ANOVA, Kruskal-Wallis) compared performance.

Results: DeepSeek achieved the highest overall score (mean=92.9, p<0.001), significantly outperforming Claude (p=0.006) and Copilot (p=0.048), while matching Gemini (p=0.989). Gemini ranked second but frequently declined revisions, citing "already perfect" texts. Correctness varied significantly (p=0.0078), with Copilot excelling, while DeepSeek led in clarity, engagement, and delivery (p<0.01).

Conclusion: DeepSeek emerged as the most robust translator, with Gemini as a close second. AI translation can help reduce barriers but requires transparency and ongoing refinement to balance efficiency with academic rigor.

Purposes: The aim of this retrospective cohort study was to evaluate the accuracy of pterygoid implant placement using static guides based on mucosa-tooth-supported titanium templates in fully edentulous patients. In addition, the study assessed whether deviations at the neck and apex tended to compensate or amplify along the implant axis by introducing the differential parameters.

Methods: Thirty-four patients (mean age 63.7 ± 9.0 years) received 62 pterygoid implants between September 2022 and July 2023. Virtual implant planning was performed on cone-beam computed tomography (CBCT)-derived datasets, and 3D printed resin surgical guides were fabricated to transfer the plan to the surgical field. Postoperative CBCT scans were superimposed onto the virtual plan using voxel-based registration, allowing vertical and horizontal measurement of deviations at the implant neck (v³, h₃) and apex (v₄, h₄), as well as angular discrepancies (θ). Compensation and amplification effects were analyzed by computing vertical and horizontal differentials Δv and Δh. Data were expressed as medians and interquartile ranges (iqr).

Results: At the neck level, median vertical deviation was -0.54(0.59) mm and horizontal deviation 0.78(0.60) mm. At the apex, median vertical deviation was -0.41(0.61) mm, while horizontal deviation increased to 1.06(0.48) mm. The difference between h₃ and h₄ was significant (p < 0.0001), reflecting systematic amplification of horizontal misalignment. Angular deviation was low, with a median of 1.37(1.18) degrees. Analysis of Δv, about 0(0.31) mm, and Δh, +0.30(0.52) mm revealed that vertical errors were variably compensated apically, whereas horizontal errors tended to amplify. Quadrant analysis showed that while most implants displayed amplification, a subset exhibited partial or even double compensation when both vertical and horizontal deviations decreased apically.

Conclusion: Pterygoid implant placement with static guides based on mucosa-tooth-supported titanium templates demonstrated high accuracy, with deviations lower than those reported in meta-analyses and angular discrepancies markedly reduced. The introduction of Δv and Δh provided a novel insight into error propagation, highlighting compensatory versus amplifying trajectories.

Background: Case reports play a critical role in Oral and Maxillofacial Surgery (OMFS) by documenting rare presentations, unexpected complications, and complex intraoperative events. However, contemporary publication patterns suggest a bias toward reporting "ideal" outcomes, potentially limiting opportunities for complication-based learning.

Methods: A narrative review of bibliometric studies and large-scale clinical reports published between 2008 and 2025 was conducted using journal archives and database searches (PubMed, Scopus). The review synthesised trends in case report publication across major OMFS journals and compared these with real-world complication rates reported in high-volume clinical studies.

Results: Case report publications in OMFS journals have progressively declined over the past decade. In BJOMS, complication- or novelty-focused short communications decreased from 52% in 2008-2009 to 35% in 2010-2011. In contrast, large clinical cohorts document substantial adverse event rates, ranging from 3.6% in third molar surgery to 43.7% in orthognathic surgery. This discrepancy highlights a growing gap between clinical reality and published literature.

Conclusion: The underrepresentation of complication-focused case reports skews perceptions of OMFS practice and limits experiential learning. Transparent, structured reporting of complications can enhance patient safety, strengthen surgical education, and better align published evidence with real-world outcomes. Journals should adopt policies that encourage and normalize the publication of clinically meaningful adverse events.

Background: Cleft lip and/or palate (CL/P) is the most common congenital orofacial anomalies worldwide, with a multifactorial etiology involving both genetic and environmental factors. This study aimed to estimate the pooled prevalence of CL/P in Ethiopia and identify the associated risk factors.

Materials and methods: We systematically searched PubMed, Scopus, and Google Scholar for studies published between 1990 and 2023. We included observational studies (cross-sectional, cohort, case-control, descriptive, and prospective) that reported prevalence data for CL/P in Ethiopia. Data were extracted using a standardized Excel form, and statistical analyses were conducted using STATA version 18. The primary outcome was the pooled prevalence of CL/P. Heterogeneity was assessed using Cochrane's Q test and the I² statistic, and meta-analysis was performed using a random-effects model. The methodological quality of the studies was assessed using the STROBE checklist (version 2007).

Results: Across ten studies comprising 19,024,539 births, the pooled birth prevalence of CL/P in Ethiopia was 0.24 per 1,000 live births (95% CI: 0.12-0.36). Considerable heterogeneity was observed among studies (I² = 99.94%, τ² = 0.04, Q = 8546.85, p < 0.001), reflecting substantial variability in prevalence estimates.

Conclusion: Although the prevalence of CL/P in Ethiopia is lower than the global average, it represents a significant public health concern. This underscores the need for strengthen preventive measures, promoting early detection, and expanding access to timely and comprehensive treatment services are essential for reducing the burden of these congenital anomalies.

Lip amputations in children may require urgent microsurgical management. Here we report a salvage procedure with partial survival following lower lip and chin replantation after a trampoline accident. Total amputation was managed with inferior labial artery anastomosis; however, venous drainage was not reestablished, necessitating leech therapy. Despite arterial revisions, 75% of the lip and 25% of the chin were lost by post-operative day 14. Reconstruction with a combined right Karapandzic flap and left Camille Bernard flap was performed one month later, supplemented by mesotherapy and nanofat injections. The outcome was marked by residual microstomia. These injuries are rare in children, often caused by dog bites. Venous anastomosis is frequently unfeasible, with leech therapy critical for drainage. When replantation is partially successful, reconstruction may involve local flaps or free tissue transfers. Microsurgical expertise, access to leech therapy and close collaboration with intensivists are essential for optimizing outcomes.

Background: Osteopetrosis, characterized by impaired osteoclast function and increased bone density, poses significant clinical challenges when complications like mandibular osteomyelitis arise. This report elucidates the clinicoradiographic progression and management of such a case in ADO-II, driven by a novel de novo CLCN7 c.2227C>T (p.R743W) mutation.

Case presentation: A 57-year-old male presented with refractory mandibular osteomyelitis accompanied by facial swelling and trismus. Radiographs revealed mandibular osteolysis, "sandwich vertebrae," and "Erlenmeyer flask" deformities. He had anemia and thrombocytopenia. Sequencing analysis revealed a de novo CLCN7 c.2227C>T (p.R743W) mutation in the patient. Therapeutic measures involved partial splenic artery embolization, administration of intravenous cefuroxime and ornidazole combined with hyperbaric oxygen therapy and pleural drainage. The osteomyelitis persisted due to avascular necrosis in sclerotic bone, despite the adoption of multidisciplinary management.

Conclusions: This case highlights the aggressive phenotype associated with the CLCN7 c.2227C>T (p.R743W) mutation, the importance of early genetic testing and personalized therapeutic strategies.