Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Objectives: Postoperative pulmonary complications (PPCs) are common after major head and neck cancer surgery. This trial evaluated whether adding daily lung ultrasonography (LUS) to the current diagnostic strategy (clinical evaluation with on-demand chest X-ray [CXR]) improves PPC detection.

Methods: In this randomized controlled trial, 196 adults at intermediate/high risk for PPCs undergoing head and neck cancer surgery with free-flap reconstruction were assigned to the current strategy alone or a routine strategy (daily LUS plus current strategy). The primary outcome was the detection rate of clinically relevant PPCs.

Results: The routine strategy identified significantly more clinically relevant PPCs than the current strategy (92.3% vs. 66.7%, p = 0.035) with higher diagnostic accuracy (AUC: 91.9% vs. 80.4%, p = 0.035). Detection occurred earlier with the routine strategy (median postoperative day 2 vs. 3, p = 0.042). No significant differences were observed in hospital stay or mortality.

Conclusions: Incorporating daily LUS into postoperative care enhances the detection of PPCs in patients on general wards after head and neck cancer surgery, without significantly altering short-term clinical outcomes.

Introduction: Pathological fractures of the mandible, often secondary to intraosseous lesions or post-enucleation bone loss, pose significant structural and clinical concerns. While miniplate fixation is routinely used for reinforcement, its mechanical reliability lacks standardized assessment. This study employs finite element analysis to model stress distribution across various mandibular defect scenarios, quantify the biomechanical performance of miniplates, and evaluate postoperative stability in structurally compromised regions.

Methods: This study involved 3D reconstruction of mandibular bone models from CT scans, followed by finite element analysis using ANSYS and LS-DYNA software. Cortical and trabecular structures were modeled with region-specific parameters, and Champy-style mini-plates with screws were applied to simulate post-enucleation reinforcement. Various defect scenarios were evaluated under 350 N occlusal loading, with boundary conditions ensuring model stability. A total of 16 simulations assessed stress distribution and mechanical performance.

Results: Titanium plate application reduced principal stresses in all models. In Model 3, maximum and minimum stresses (565 MPa and 472 MPa) decreased to 204 MPa and 105 MPa with force applied from the healthy side. With plate application, maximum stress decreased from 142 MPa to 37 MPa in Model 1, from 150 MPa to 66 MPa in Model 2, from 565 MPa to 74 MPa in Model 3, and from 140 MPa to 66 MPa in Model 4.

Conclusion: Miniplates can effectively reduce stress in mandibular defects post surgery, but their success depends on defect type, cortical bone quality, and anatomical factors. Unicortical defects carry lower fracture risk, and accurate screw placement is critical. In select cases, conservative management with dietary precautions may be sufficient. These results support individualized treatment planning and highlight the need for further clinical validation.

Context: Perineural invasion (PNI) and intraneural invasion (INI) are histopathological features associated with aggressive behaviour and local neural spread in salivary gland malignancies (SGMs). They facilitate tumour extension along nerve pathways.

Aims: This study aimed to evaluate their prognostic significance with respect to overall survival (OS) and disease-free survival (DFS).

Settings and design: This retrospective cohort study included 49 patients with histologically confirmed salivary gland malignancies diagnosed between 2007 and 2024.

Methods and material: Clinical data were retrieved from institutional records. Histopathological evaluation was done using H&E-stained slides and IHC procedure was done using S100 marker to document the presence of PNI and INI. Clinicopathological variables were evaluated.

Statistical analysis used: Survival analysis was performed using Kaplan-Meier curves with log-rank tests. Cox proportional hazards regression was used to assess the independent prognostic value of PNI, INI, age, and sex.

Results: PNI was identified in eight patients (16.3%) and INI in two patients (4%). Kaplan-Meier analysis revealed significantly poorer OS and DFS in PNI-positive patients (p < 0.001 for both) and INI-positive patients (p = 0.050 for OS; p = 0.009 for DFS). In multivariate Cox analysis, PNI showed increased risk of mortality (HR = 2.47, p = 0.275) and recurrence (HR = 3.34, p = 0.074). INI also showed an increased hazard trend. Age was significantly associated with DFS (HR = 1.044, p = 0.016), and male sex was significantly associated with OS (HR = 16.48, p = 0.013).

Conclusions: PNI and INI appear to be important indicators of adverse outcomes in SGMs, showing associations with reduced OS and DFS, with age and sex also influencing outcomes. Routine reporting of neural invasion may aid in risk stratification and clinical management.

Objective: The aim of this comparative case report is to evaluate the skeletal, dental, and airway effects of two CAD-CAM-designed maxillary expansion protocols using the Keles Keyless Expander (KKE): a Hyrax-type expander with Er:YAG laser-assisted corticotomy(LAC), and a MARPE appliance stabilized with four palatal miniscrews. To our knowledge, this is the first report describing the use of LAC techniques in SARPE, underscoring its novelty and clinical significance.

Methods: Two female patients, both 18 years of age, were included. In the first case, a Hyrax-type expander with a 12-mm keyless screw was used, and LAC was performed with an Er:YAG laser. In the second case, a MARPE appliance with four mini-screws and an 8-mm keyless screw was applied. Pre-post-expansion cone-beam computed tomography(CBCT) scans were obtained for both patients, measurements were analyzed and compared.

Results: The KKE with corticotomy produced marked more dental effects, while the MARPE appliance showed a distinct skeletal expansion pattern. Molar inclination increased buccally by 7.8° in the laser case but decreased lingually by 1.8° in the MARPE case. The midpalatal suture opening was more parallel in the MARPE group.

Conclusion: Both expansion protocols demonstrated measurable skeletal, dental, and airway changes, yet with different patterns of response. LAC provided pronounced skeletal and dental effects, whereas the MARPE appliance achieved a more parallel midpalatal suture opening without buccal tipping of molars. These differences highlight the importance of appliance selection and adjunctive techniques in treatment planning. Larger prospective studies are needed to confirm long-term stability and clinical applicability.

The temporomandibular joint (TMJ) is a common cause of orofacial pain. Several imaging techniques can be used to aid diagnosis and management of patients. Ultrasound (US) is a non-ionising, inexpensive and widely available technique. This pictorial review aims to demonstrate the US changes associated with various TMJ disorders. Ultrasound examinations should be standardised and include static and dynamic evaluations of the joint. Several abnormalities can be detected in cases of osteoarthritis, inflammatory arthritis, or disc disorders, such as cortical irregularity, effusion, or disc displacement. Ultrasound also enables joint aspiration, intra-articular injection and synovial biopsy with real-time control. This review also discusses the limitations of this imaging modality, with MRI remaining the gold standard for diagnosis in most cases. Nevertheless, ultrasound can still be considered an extension of clinical examination. It provides rapid and cost-effective diagnostic information and serves as a valuable complement to CBCT and MRI within a multimodal TMJ imaging strategy.

Objective: The nodal spreading of oral cavity and oropharynx squamous cell carcinoma (OCSCC/OSCC) remains a critical challenge. The pathological nature of lymph nodes adjacent to the tumor is sometimes difficult to interpret on PET/CT during the initial assessment. The primary objective of this study was to evaluate the impact of contralateral node PET/CT hyperfixation on disease-free survival (DFS) in lateralized OCSCC or OSCC.

Methods: From our database, all patients who had a PET/CT during their management for a lateralized SCC were selected between 2018 and 2021. Clinical, histological and radiological data between patients with and without contralateral nodes on the initial PET/CT were compared, as well as the survival of these patients. The Inselspital, Bern University Hospital (ISB) publicly available dataset was then used, to estimate the positive predictive value (PPV) of a contralateral fixation.

Results: Of 48 patients who had a PET/CT for lateralized OCSCC or OSCC, 16 (33%) had contralateral lymph node hyperfixation on PET/CT (PET/CT CLN+). In this group, 4 had a bilateral lymph node dissection (27%), and only one had lymph node metastasis. Using the ISB dataset, we found a PPV of only 35% for these contralateral hyperfixation. There was no significant difference in a multivariate Cox model in terms of DFS between the two subgroups in the case of lateralized tumors.

Conclusion: There was no difference in survival between patients with or without contralateral lymph nodes on the initial PET/CT.

Oral squamous cell carcinoma (OSCC) remains a major global health challenge due to its high recurrence rate and poor prognosis. Perineural invasion (PNI), characterized by tumor cells infiltrating nerves, has been frequently reported in OSCC; however, its precise prognostic significance remains debated. To comprehensively clarify this, we performed a systematic review and meta-analysis assessing the prognostic impact of PNI on clinical outcomes in OSCC. Relevant studies published between 2015 and 2025 were systematically searched and selected, extracting hazard ratios (HR) for overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and local recurrence (LR) from multivariate analyses. Fifty-seven eligible studies, encompassing 23,580 patients, were included. Meta-analysis demonstrated that the presence of PNI significantly correlated with worse OS (HR = 1.67; 95% CI: 1.49-1.87), DFS (HR = 1.71; 95% CI: 1.59-1.84), DSS (HR = 1.52; 95% CI: 1.35-1.72), and increased risk of LR (HR = 2.68; 95% CI: 1.70-4.24). Subgroup and sensitivity analyses confirmed robust and consistent prognostic associations, despite moderate publication bias in OS, DFS, and DSS outcomes. These findings provide strong evidence that PNI independently predicts adverse clinical outcomes in OSCC. Our results underscore the critical importance of incorporating PNI status into clinical risk stratification, guiding decisions on surgical management and adjuvant therapies. Future studies should focus on standardizing diagnostic methods and further elucidating underlying molecular mechanisms to optimize patient care.

Sclerosing microcystic adenocarcinoma (SMA) is a rare, low-grade salivary gland tumor primarily affecting mucosal sites of the head and neck. We present the case of a 53-year-old woman with an 18-month history of a painless submucosal mass on the anterior tongue. MRI revealed a 14 × 15 × 10 mm ill-defined lesion with isosignal intensity to muscle on T2 weighted images and vivid contrast enhancement. Histopathological analysis following surgical excision confirmed SMA, characterized by perineural and muscular invasion, and a close surgical margin necessitated re excision. The patient remains disease-free at twelfth months postoperatively. A review of 25 previously reported cases highlights the tumor's indolent clinical course despite locally aggressive features. No recurrence or metastasis has been reported to date. Excisional biopsy is recommended due to the diagnostic limitations of small samples. While further studies are needed, based on the current evidence conservative surgical management could be justified. Decision regarding routine neck dissection or adjuvant therapy should be individualized, taking into account tumor extent and patient related factors.

Objective: To evaluate the effectiveness of alveolar ridge preservation (ARP) in periodontally compromised extraction sockets with simultaneous periodontal regeneration (PR) in adjacent teeth.

Materials and methods: A total of 69 extraction sites were retrospectively evaluated and allocated into two groups according to the presence of interdental bone defects at adjacent teeth. The test group received ARP combined with simultaneous PR of adjacent teeth, whereas the control group underwent ARP alone. All sites were managed using an open wound healing protocol. Linear dimensional changes were assessed on superimposed cone-beam computed tomography (CBCT) images obtained preoperatively, immediately postoperatively, and after 6 months of healing. Soft tissue healing was evaluated at the time of suture removal using a standardized open wound healing scoring system.

Results: ARP combined with PR was associated with statistically significant improvements in radiographic interdental bone height over the 6-month healing period. Horizontal ridge width was better preserved in the test group at the crestal and shallow subcrestal levels, with significant intergroup differences observed at 1 mm and 3 mm below the ridge crest. A significant gain in buccal ridge height was observed exclusively in the test group, while vertical ridge height at the lingual/palatal aspect remained basically stable in both groups. Soft tissue healing outcomes were acceptable in both groups; however, the test group presented slightly lower scores in tissue color and total score.

Conclusions: ARP with simultaneous PR in adjacent teeth was associated with improved radiographic interdental bone height and enhanced ridge dimensional stability in defect sockets.

Context: Self-reported penicillin allergy frequently limits optimal antibiotic prescribing in maxillofacial surgery. The PEN-FAST score (Penicillin allergy, within the last five years, Anaphylaxis/angioedema, Severe cutaneous adverse reaction, Treatment required for allergy episode) is a validated clinical decision rule used to identify patients at low risk of true penicillin allergy and to guide safe penicillin reintroduction.

Methods: We conducted a prospective, interventional, single-center study including adult patients with a self-reported penicillin allergy undergoing maxillofacial surgery. A PEN-FAST score was calculated for each patient. Penicillins were reintroduced in patients classified as very low risk (PEN-FAST = 0). Primary outcomes were adverse reactions and infectious complications. Secondary outcomes included surgical site infection (SSI), severe infectious complications (SIC), length of hospital stay, and number of surgical interventions.

Results: Seventy-four patients were included, of whom 41 (55%) had a PEN-FAST score of 0. Penicillins were reintroduced in 29 of these patients (71%), with no adverse reactions observed. In multivariate analysis, penicillin non-use was independently associated with a higher risk of SSI or SIC (odds ratio [OR] = 31.54, 95% CI [5.422-611.72]; p = 0.002). Penicillin non-use was also associated with prolonged hospital stay (incidence rate ratio [IRR] = 1.86, 95% CI [1.13-3.00]; p = 0.012) and an increased number of surgical interventions (IRR = 1.41, 95% CI [1.08-1.88]; p = 0.018) after stratification by type of surgery.

Conclusions: Penicillin reintroduction guided by the PEN-FAST score is safe in very low-risk patients and is associated with improved clinical outcomes. Routine implementation of this tool in maxillofacial surgery may reduce infectious complications and healthcare utilization.