Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Purpose: The aim of this study was to investigate the biomechanical effects of mandibular deviation on the TMJ in patients with mandibular prognathism before and after orthognathic surgery using three-dimensional finite element analysis.

Methods: Eight patients with mandibular prognathism without deviation, eight patients with mandibular prognathism with deviation and sixteen normal subjects were recruited. Three-dimensional models of the maxillofacial were reconstructed using MIMICS. Nine muscle forces were used to simulate incisal occlusion and contact was used to simulate fossa-disc-condyle interactions.

Results: Before surgery, the stress in the TMJ was generally greater in the Pre-MD&MP group than in the Pre-MD group; it was much greater in both groups than in the control group, ranging from about 2 to 12 times as great in the Pre-MD group and from about 5 to 64 times as great in the Pre-MD&MP group. After orthognathic surgeries, the stresses in the Post-MP&MD were significantly reduced by approximately 21.7 % to 93.4 %. And in the Post-MP group, the stresses were reduced by approximately 1.4 % to 51.1 %.

Conclusion: Mandibular deviation exacerbated the abnormal stress distribution in the TMJ of patients with mandibular prognathism. Orthognathic surgeries could improve the stress distribution in patients with mandibular prognathism (with and without deviation). TMD was closely related to the stress levels of the TMJ.

Background: Hyperlipidemia is a risky condition that can lead to atherosclerosis and other cardiovascular problems. Statins are used to treat hyperlipidemia. The most recommended medicine to treat hyperlipidemia is atorvastatin. On the contrary, clinical trials validated statins' negative effects. Omega-3 fatty acids have antioxidant properties and have been shown to improve a variety of disease processes in the general population, including inflammatory and immunological pathways, various cardiovascular diseases, and lipid regulation. The present research aimed to determine how atorvastatin affected the submandibular salivary gland (SMG) and whether omega-3 may have a protective impact.

Methods: Thirty adult male albino rats were divided into three equal groups and received drugs orally as a single daily dose for one week. Control group (I): received normal saline. Atorvastatin group (II): received a dose of 80 mg Kg^-1 of Atorvastatin. Group III: received Omega-3 before Atorvastatin. All rats were sacrificed 2 h following the last dose, and blood samples were gathered for the biochemical study of fasting blood glucose level (FBGL). Specimens were obtained and processed for histological and histochemical studies.

Results: Atorvastatin-treated rats showed degeneration of SMG acini. The acinar cells showed cytoplasmic vacuoles with dilated RER. Histochemical results revealed a marked decrease in total proteins. The biochemical study revealed an elevation in FBGL. The administration of Omega-3 with Atorvastatin minimizes these changes.

Conclusion: Atorvastatin has been proven to induce histological changes in SMG, and these changes can be attenuated by Omega-3. However, Omega-3 has no effect on FBGL.

Introduction and importance: Salivary gland secretory carcinoma (SGSC) represents a rare malignant tumor of the salivary glands. Despite being regarded as low-grade tumors, they may manifest with metastases and a high-grade aggressive clinical behaviour. The literature on this subject is limited, and there is currently no standardized approach to treatment.

Case report: We report a rare case of SGSC in the palate of a 14-year-old female patient. The patient underwent excision, bilateral tonsillectomy and adjuvant radiotherapy.

Clinical discussion: A critical review of the literature was conducted with the objective of analysing the cases of intraoral SGSC that have been previously reported. A total of 23 articles, published between 2010 and 2024, were identified as being directly pertinent to the review, resulting in a total of 58 patients being included.

Conclusion: SGSC on the hard palate in a 14-year-old child is an exceedingly rare occurrence. These tumors can mimic other pathologies of the salivary glands clinically and microscopically, which can result in misdiagnosis and a delay in treatment.

Introduction: ChatGPT is an artificial intelligence based large language model with the ability to generate human-like response to text input, its performance has already been the subject of several studies in different fields. The aim of this study was to evaluate the performance of ChatGPT in the management of maxillofacial clinical cases.

Materials and methods: A total of 38 clinical cases consulting at the Stomatology-Maxillofacial Surgery Department were prospectively recruited and presented to ChatGPT, which was interrogated for diagnosis, differential diagnosis, management and treatment. The performance of trainees and ChatGPT was compared by three blinded board-certified maxillofacial surgeons using the AIPI score.

Results: The average total AIPI score assigned to the practitioners was 18.71 and 16.39 to ChatGPT, significantly lower (p < 0.001). According to the experts, ChatGPT was significantly less effective for diagnosis and treatment (p < 0.001). Following two of the three experts, ChatGPT was significantly less effective in considering patient data (p = 0.001) and suggesting additional examinations (p < 0.0001). The primary diagnosis proposed by ChatGPT was judged by the experts as not plausible and /or incomplete in 2.63 % to 18 % of the cases, the additional examinations were associated with inadequate examinations in 2.63 %, to 21.05 % of the cases and proposed an association of pertinent, but incomplete therapeutic findings in 18.42 % to 47.37 % of the cases, while the therapeutic findings were considered pertinent, necessary and inadequate in 18.42 % of cases.

Conclusions: ChatGPT appears less efficient in diagnosis, the selection of the most adequate additional examination and the proposition of pertinent and necessary therapeutic approaches.

Purpose: To determine whether odontogenic maxillary sinusitis, either alone (OMSw/oFB) or in combination with fungus ball (OMSwFB), is associated with specific clinical characteristics and treatment outcomes compared to non-odontogenic maxillary sinusitis.

Materials and methods: A retrospective cohort study was performed on patients who underwent surgical treatment for chronic maxillary sinusitis between 2013 and 2021. OMSw/oFB and OMSwFB patients, were selected as the study group, while patients diagnosed with non-odontogenic maxillary sinusitis (non-OMS) were enrolled as the control group. Predictor variables were OMSw/oFB and OMSwFB. Outcomes were clinical presentation, postoperative complications, and treatment outcome. Descriptive, bivariate, and multiple logistic regression statistics were calculated, and the significance level was set at P ≤ 0.05.

Results: The sample included 200 patients with a mean age of 49.6 ± 20.1 years and 57.5 % were men. Of the 200 patients, 123 (61.5 %) had non-OMS, 55 (27.5 %) had OMSw/oFB, and 22 (11 %) had OMSwFB. Multivariate analysis showed that OMSw/oFB was associated with more successful treatment rates (OR = 8.19, p < 0.01), whereas OMSwFB was associated with a less favorable outcome (OR = 0.27, p = 0.03). Age was associated with an unfavorable outcome in both OMS groups (OR: 0.98, p = 0.03 and p = 0.03, respectively), but no significant associations with other outcomes were found.

Conclusion: This study suggests that OMSwFB is a recalcitrant form of OMS associated with a higher risk of persistent symptoms and less favorable outcome. These patients should be informed about the challenging nature of the disease and closely monitored.

Introduction: The objectives of this study are to establish normative nasalance values in European French for children aged 8-10 years, to study the factors likely to influence nasalance values, and to ensure that the nasometer allows the differentiation of control subjects from subjects with velopharyngeal insufficiency.

Methods: Nasal balance scores were calculated using the Nasometer II 6450 (KayPENTAX) for 50 control subjects producing 31 verbal stimuli specifically designed for the French language. Nasalance scores were analyzed and compared with 7 subjects with velopharyngeal insufficiency.

Results: This study provided nasalance norms for each verbal stimulus. The phonetic content of the stimuli (nasality, vowel height, voicing) was a major factor influencing the nasalance score. However, the characteristics of the speaker (gender and age) had a non-significant effect, with the major exception of the presence or absence of velopharyngeal insufficiency.

Conclusion: This study confirmed the need to use established normative values in the patient's language and for each verbal stimulus. Although the effect of vowel height on the nasalance score has been demonstrated, this study is the first to show an effect of voicing. Once normative nasalance scores are established, a validation study with a larger pathological population will be necessary. This study establishes normative nasalance scores in European French in children.

Purpose: This study aimed to investigate the linear and angular differences in the nasolabial soft tissue in patients who underwent bimaxillary orthognathic surgery using two different three-dimensional imaging methods. Furthermore, the advantages, disadvantages, and limitations of these methods were determined after comparing the data obtained from the imaging methods used in the study.

Materials and methods: Preoperative (T0) and 6-months postoperative (T1) cone-beam computed tomography (CBCT) and three-dimensional facial scanning (3DFS) data from 22 patients who underwent maxillary advancement surgery were examined. The DICOM (Digital Imaging and Communications in Medicine) data (CBCT group) and ".obj" format images (3DFS group) of the patients were analyzed using Dolphin software (Dolphin Imaging®, Version 12, Chatsworth, CA, USA). The linear and angular soft tissue measurements were calculated after determining the reference anatomical landmarks for both groups.

Results: Measurements with CBCT and 3DFS imaging methods were compared at T0, T1, and all measurements (T0+T1). No statistically significant difference was observed between the CBCT and 3DFS groups for five measurements performed at T0 and T0+T1, but statistically significant differences were observed between the groups for the other seven measurements. There was no statistically significant difference between the CBCT and 3DFS groups for six measurements at T1, but there were statistically significant differences between the groups for the other six measurements. After reviewing the postoperative differences in the nasolabial soft tissue, a statistically significant increase in four linear and one angular measurement in the 3DFS group was observed, and there was a statistically significant increase in two linear and two angular measurements in the CBCT group. Upon comparison of postoperative differences in soft tissue alterations, no statistically significant difference between the 3DFS group and the CBCT group were observed in any of the soft tissue measurements.

Conclusion: Orthognathic surgery has significant effects on nose width and upper lip morphology. Although both 3DFS and CBCT methods can be used to evaluate such effects, the results of the present study revealed differences in sensitivity and limitations between the two methods. Thus, surgical outcomes should be evaluated in consideration of the abovementioned parameters.

This study aims to present a novel technique for reconstructing complex facial nerve defects using the masseteric nerve and descending hypoglossal nerve. Here, we report a case involving a patient with locally advanced parotid malignancy who underwent extended parotidectomy with resection of the invaded facial nerve. Following tumor resection, the proximal end of the facial nerve was inaccessible, leading to the formation of multiple distal branch defects. Subsequently, we performed reconstruction of the complex facial nerve defect using the masseteric nerve for the zygomatic and upper buccal branches and the descending hypoglossal nerve for the lower buccal and submandibular branches. There were no significant operative or post-operative complications observed. Upon 18 months of follow-up, the facial function of the patient had been restored to House-Brackmann-III grade. In conclusion, this dual nerve transposition approach proves to be an effective method for reconstructing complex facial nerve defects subsequent to extended parotidectomy.

Background: The character of Asian nose usually presents low projection of tip, short columellar, and short nose, necessitating the construction of a cartilage framework to achieve optimal results. The objective of this study was to evaluate the structural characteristics, stability, and postoperative outcomes of the integrated fixed framework, 1+1 framework, 2+1 framework, 4+1 framework, and Y-shaped framework.

Methods: A retrospective analysis was conducted on a cohort of 612 patients who underwent rhinoplasty and were admitted between February 2017 and December 2022. According to rhinoplasty framework, the patients were categorized into fixed frameworks (integrated fixed framework group, 1+1 framework group, 2+1 framework group) or elastic frameworks(4+1 framework group, Y-shaped framework group). The stability of rhinoplasty frameworks was assessed by measuring nasal tip projection and nasolabial angle at both one and twelve months post-surgery. Postoperative follow-up included monitoring complications occurrence and evaluating patient satisfaction.

Results: The mean duration of follow-up was 25.23 months (rang from 24 to 54 months). The overall satisfaction rate reached 89.37 %(547/612), with the highest satisfaction rate observed in 2+1 framework group.Compared with the integrated fixed, 1+1, 2+1 framework group, the nasolabial angle and nasal tip projection of 4+1, and Y-shaped framework group decreased more obviously(P < 0.001).

Conclusions: Nasal frameworks in Asians are generally classified as fixed frameworks or elastic frameworks. The stability of the fixed frameworks surpasses that of the elastic frameworks. The secure fixation of the strut to the anterior nasal spine can enhance the overall stability of the framework.

Level of evidence statement: IV.

Background: France is ranked 6th in Europe in terms of oral cancer incidence. Dental surgeons are on the front line in examining the oral mucosa, but little is known about the knowledge, attitudes and practices of French dental surgeons with respect to lesions suspected of malignancy.

Methods: An online survey including 18 self-administered questions was widely shared on social media using major networks of French dentists. Items included socio-demographic characteristics of the respondents, their self-assessed knowledge, screening practices and training on oral cancer detection and care.

Results: A total of 676 dental surgeons participated in this survey. The vast majority, 92.8 %, were general dental surgeons, 83.9 % had a private practice and 49.1 % had less than 5 years of dental experience. Almost 55 % declared that they did not conduct systematic examinations of the oral mucosa and 45 % reported that they did conduct such examinations. In-hospital practice, lower patient age, dental surgeon experience, and specialty were all positively associated with systematic examination of the oral mucosa. Conversely, absence of a patient complaint, absence of an obvious lesion, lack of time, and lack of training/skills were all negatively associated.

Discussion: This is the first survey to analyze the practices of French dental surgeons in oral cancer screening. Only half of the respondents, the best trained, performed systematic oral mucosa examinations which objectively help to early detect mucosal cancer lesions. To improve oral cancer early detection, we recommend mandatory screening training programs for all dental students and dental surgeons.