Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Introduction: Alveolar cleft grafting is crucial in cleft lip and palate rehabilitation, promoting maxillary continuity and facilitating dental development. While autologous bone grafts are the gold standard, combining them with platelet-rich plasma (PRP) and xenografts like Bio-Oss has the potential to enhance bone regeneration and long-term stability. This study aimed to evaluate the synergistic effects of combining autologous cortico-cancellous bone grafts, PRP, and Bio-Oss in alveolar cleft repair.

Materials and methods: Twenty patients (aged 8-25 years) with unilateral cleft lip and palate were randomly divided into two groups. Group A received autologous cortico-cancellous bone grafts combined with PRP, while Group B received the same grafts with PRP and Bio-Oss. Bone density, pain, and wound healing were assessed at various intervals up to one year postoperatively. Data were analysed using repeated measures ANOVA and Bonferroni post hoc tests.

Results: Group B demonstrated significantly higher bone density (1028.5 ± 45.2 HU) at six months and one year compared to Group A (P < 0.05). Bone resorption occurred in both groups within the first three months, but Group B showed greater bone regeneration. No significant differences were noted in wound healing between the groups, though two patients in Group B experienced secondary healing due to infection.

Conclusion: The combination of autologous bone grafts, PRP, and Bio-Oss may enhance bone regeneration and stability in alveolar cleft repair. Further studies are needed to validate these findings and optimize clinical protocols.

Background: Extensive cervicofacial defects often lead to functional and aesthetic impairments. The pre-expanded cervico-acromial flap technique is reliable and cost-effective for addressing such defects.

Objective: To introduce our 34 years' experience on pre-expanded cervico-acromial flap technique, emphasizing key surgical techniques.

Method: The supraclavicular artery and its main branches were evaluated with Doppler ultrasound preoperatively. Pre-expansion was performed in most cases to optimize flap dimensions, with the tissue expander placed at the subfascial level to preserve adequate blood supply. Once fully expanded, the cervico-acromial flap was raised and rotated to cover the cervicofacial defects. The pedicle was divided three weeks postoperatively.

Results: A total of 19 patients (5-57 years) were finally included in this retrospective study. They all accepted the above-mentioned technique by the same senior surgeon from October 1990 to October 2024. The expanded flap sizes ranged from 15 × 7 cm to 35 × 15 cm. The follow-up lasted from 6 months to 9 years. All flaps survived without necrosis or infection. Patients expressed high satisfaction with functional and cosmetic outcomes in both donor and recipient areas.

Conclusions: The pre-expanded cervico-acromial flap is safe and effective for repairing the extensive cervicofacial defects. Thorough understanding of this flap's blood supply and careful design based on the vascular anatomy help to improve the flap's survival rate.

Objective: This systematic review and meta-analysis aimed to determine the optimal timing for mandibular distraction osteogenesis in children with craniofacial microsomia based on long-term outcomes and relapse rates.

Methods: A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for studies published up to September 2024. Eligible studies included children aged ≤16 years with CFM who underwent MDO, with follow-up duration exceeding one year. The included population was divided into two groups based on age: children younger than 6 years and those aged 6-16 years. The primary outcome was the relapse rate measured by ramus height ratio, and secondary outcome was occlusal cant. Statistical analyses included heterogeneity assessment, random-effects modeling, and subgroup analysis based on follow-up duration.

Results: Ten studies, comprising 175 patients, were included. The pooled relapse rate based on ramus height ratio was 67.8% (CI: 35.8-93.4%) for children under 6 years and 72.5% (CI: 10.5-94.4%) for those aged 6 years or older, with no statistically significant difference. Subgroup analysis showed that relapse rates increased significantly after five years of follow-up, suggesting progressive asymmetry due to slower growth on the affected side. When occlusal cant was used as a metric, higher relapse rates were observed in children over 6 years 95.6% (CI: 28.9-65.1%) compared to younger patients 46.8% (CI: 83.9-100%).

Conclusions: Despite early MDO providing psychosocial and developmental benefits, relapse rates remain high across all age groups, complicating the determination of an optimal timing. Long-term monitoring, individualized treatment plans, and refined severity grading systems are essential for improving outcomes in CFM patients. Future research should include standardized methodologies, larger groups, and advanced imaging techniques to optimize treatment strategies.

Introduction: Mandibular condylar fractures are among the most common facial fractures and its incidence has been rising since the past few decades. Although various approaches for management of mandibular condylar fractures have been described in literature there is a gap in the published literature when it comes to comparison of these approaches. There have only been a handful of studies which have compared use of Retromandibular Transparotid against Retromandibular anteroparotid approach in management of mandibular condylar fractures with conflicting results. The aim of this study was to aid in decision making regarding the choice of approach between the Retromandibular Transparotid and Anteroparotid Transmasseteric approach based on the ease of surgical access and incidence of complications.

Materials and methods: A total of 24 patients were registered in the study under two treatment groups, Transparotid (Group A) and Anteroparotid (Group B). Data collection was done by a single blinded observer for measurement of exposure time, facial nerve weakness, facial oedema, presence of a sialocele, presence of a parotid fistula (and presence of various complications).

Results: The average time required for exposure of fracture site in group A was 11 min ± 2.73 min and in group B was 9 min ±1.91 min. Facial nerve injury (Grade III House Brackmann scale) was noted in one patient in group A. There was no significant difference in quality of reduction, occlusion and mandibular mobility.

Conclusion: The results of this study indicate that the rate of complications and time required to access the fracture site was comparable in both the approaches. It can be said that both the anteroparotid and transparotid approaches are reasonably safe and convenient in management of mandibular condylar fractures.

The anterolateral thigh (ALT) flap is a commonly used donor site for reconstructive surger, especially in head and neck reconstructions. The flap's success is primarily determined by the quality and quantity of its perforating vessels, which is why clinicians typically prefer harvesting from a healthy leg with intact vascular anatomy. Poliomyelitis typically causes unilateral lower limb paralysis, resulting in muscle atrophy and deformities. Harvesting the ALT flap from the paralyzed leg could preserve the function of the unaffected limb, but this approach is complicated by the atrophy and deformities present in the affected leg, creating substantial challenges. We here report the successful ALT flap harvesting from the polio-affected leg in a 55-year-old male patient for the reconstruction of a tongue defect. The patient diagnosed with Left tongue squamous cell carcinoma, and underwent tongue cancer excision and a modified radical neck dissection. The flap survived and healed well with the patient's tongue tissue. The wound at the donor site on the thigh also healed well. There were no complications observed in either the flap or the donor site. Our experience suggests that harvesting from the paralyzed leg is a safe and feasible procedure that preserves the function of the unaffected limb and may enhance the postoperative quality of life for polio survivors.

Background: Complex craniofacial trauma is defined as those traumatic injuries that are not responding to initial treatment and may involve chronic infection, tissue exposure, and soft tissue contusions. Typical reconstruction using a Y-shaped microvascular venous anastomotic free flap is labor intensive. Although free flap grafts have been used in many applications, their use for combined microvascular anastomotic therapy remains an unexplored but attractive possibility.

Purpose: Correcting facial contour trauma is challenging because it requires careful planning of flap design, composition, and ancillary procedures METHODS: This study analyzed a retrospective cohort of 28 craniofacial trauma patients (18 males; 10 females) who underwent Y-shaped microvascular venous anastomosis free flap grafting for treatment of the defects between January 2020 and January 2022, and were followed up for more than 6 months after the procedure.

Results: The causes of defects were high-voltage electrical injuries (n = 12), after excision of scalp malignant tumors (n = 8), grade III burns (n = 6), and trauma (n = 2). By adjusting the height of the tissue and the different tissue components, the flaps were designed in three dimensions by contour mapping so that they had different thicknesses depending on the defect. Custom-sized flaps with a reliable envelope were taken while minimizing the loss of overlying skin. 6 flaps were based on two perforators, and another 19 were based on one perforator. Nine flaps were harvested in an inlay fashion. All flaps were fully viable and no donor lesions were present in any case. Contour and symmetry were improved in all patients, and all grafted patients were evaluated for pre- and postoperative aesthetic restoration.

Conclusions: Our findings suggest that the Y-shaped microvascular venous anastomosis free flap approach may be a reliable alternative for aesthetic reconstruction of facial contour trauma.

Objective: Guided implant surgery using three-dimensional (3-D) planning software and 3-D printed surgical guides has become a critical tool for enhancing accuracy. This study aims to determine the minimum guide hole height necessary to maintain implant placement accuracy.

Materials and methods: Ten maxillary models with edentulous areas were created using CT and optical scan data. Six sites (for each model) were prepared for implant placement with surgical guides fabricated using a 3-D printer. Sixty implants were placed using these guides and divided into five groups according to the guide hole height (1 to 5 mm). After the placement, digital impressions were taken to assess the accuracy of implant positioning. Deviations between planned and actual implant positions were investigated using computer software, and data were statistically analyzed using ANOVA and Kruskal-Wallis tests.

Results: Guide holes with 1 mm height (Group Ⅰ) resulted in the highest 3-D deviations (1.12 ± 0.36 and 1.99 ± 0.74 mm at the coronal and apical positions, respectively), with significant errors at the implant apical position compared to groups with taller guide holes (Groups Ⅳ and Ⅴ) (p = 0.005). There were no significant deviations between the 3 mm and 5 mm guide hole heights, with no statistical differences between groups at the x, y, and z-axis in the implant position.

Conclusion: A comparison between the group with a guide hole height of 5 mm on one side and the group with a height of 1 mm on both sides revealed a significant difference in implant placement accuracy.

Introduction: Arterialized venous flap, like any other flap, will undergo an ischemic reperfusion injury during its transfer process. To overcome this, ischemic preconditioning can be done to provide protection and enhanced flap survival. One of the reliable parameters of flap survival is its temperature. However, there was no recorded data regarding AVF's temperature or its monitoring. This research aimed to demonstrate the temperature effect of ischemic preconditioning on arterialized venous flap.

Method: Male Wistar Rats were randomly divided into 4 groups, consisting of 6 negative control groups, 8 positive control group (PS) rats that underwent an anastomosis of the superficial epigastric artery to the superficial epigastric vein, 8 experimental rat group 1 (EX1) that underwent 3 cycles of 5 minutes pre-anastomosis clamping with 3 cycles of 5 minutes each, and 8 experimental rats' group 2 (EX2) with 3 cycles of 10 minutes. Flap's temperature was observed preoperatively and postoperatively from day 1 to day 7, day 14, and day 21 with an android-based thermal camera and recorded in Celsius degrees.

Results: All the flaps (N= 26) were vital. The temperature drop was seen in all anastomosed flaps compared to the negative control (30.37 vs. 25.08 vs. 23.77 vs. 25.27, p<0.05). A significant increase in temperature occurred on days 4 to 6 in Ex1 (33.62±1.820, 33.62±1.820, 32.40±1.627; p<0.05). As in the temperature trend, Ex2 is shown to have a stable temperature from day 2 until 21.

Conclusion: This study has recorded an increase in temperature in the early days of the creation of the arterialized venous flap at various timings of ischemic preconditioning. The flap's monitoring was easily observed with a thermal camera that can be implemented in humans.

Introduction: Orbital fractures are common among maxillofacial injuries. The primary objective of this study was to investigate the clinical and radiographic characteristics of pure orbital blowout fractures (OBFs) and their association with post-traumatic diplopia. The secondary objective was to identify predictors of diplopia in pure OBFs.

Method: This retrospective cross-sectional study analysed the clinical records and computed tomography (CT) data of patients with pure OBFs, treated between 1st January 2008 and 28th February 2022 at a single tertiary trauma centre in Klang Valley, Kuala Lumpur, Malaysia. Data collected included demographic characteristics and the aetiology of OBFs. Specific factors such as fracture site, size, type, and soft tissue involvement were assessed using CT images, which were converted to DICOM format and analysed with the OsiriX v4.1.2 software. Diplopia was measured using the Hess area ratio percentage (HAR%).

Results: The analysis included records of 70 patients. Motor vehicle accidents (MVAs) accounted for 61.4 % of pure OBFs. The largest fracture observed involved both the orbital floor and the medial wall, with a mean size of 6.40 ± 3.05 cm². Among the patients, 41.6 % had Type 3 fractures, and 50 % (n = 35) had 2-point muscle-soft tissue contact. Fracture size, site, type, and muscle contact were all significantly associated with HAR92 % (p < 0.05). Logistic regression revealed that Type 3 fracture was the significant predictor of diplopia (HAR < 92 %), with an odds ratio of 19.80 (95 % CI: 5.76-68.07, p < 0.001).

Conclusion: Fracture site, size, type, and muscle involvement were important factors associated with diplopia. Among these, Type 3 fractures were identified as the primary predictor of HAR < 92 %.