Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Background: Tooth agenesis, particularly the absence of upper lateral incisors, presents substantial challenges for clinicians due to the associated bone atrophy, which limits the use of traditional implant solutions. Current options, such as endosseous implants combined with guided bone regeneration (GBR), often fail due to insufficient osseointegration in atrophic bone. This study aims to evaluate the effectiveness of custom-made, additively manufactured subperiosteal implants in addressing these challenges METHODS: This retrospective study assessed 16 custom-made subperiosteal implants used in 12 patients (10 females, 2 males; mean age 25 ± 2.3 years) with lateral incisor agenesis who had previously experienced early implant failure with conventional endosseous implants. The protocol included subperiosteal implants combined with bovine bone grafts and PRF membranes, allowing for immediate loading and correct prosthetic alignment. Clinical evaluations focused on implant stability, peri-implant tissue health and esthetic (including probing depths and bleeding on probing), and prosthetic success over time.

Results: During a follow-up period of 18 to 64 months (mean 48 ± 6.7 months), all patients maintained stable implants, with no implant failures reported. Biological outcomes demonstrated stable peri-implant health, with probing depths averaging 3 mm and minimal signs of inflammation. The mean pink esthetic score was 12.3 ± 1.1 (range: 10 to 14). Prosthetic complications were limited to minor adjustments, with two cases requiring recementing of crowns after three years.

Conclusions: The results indicate that this new protocol provides a reliable, single-procedure solution for the rehabilitation of lateral incisor agenesis in patients with significant bone atrophy, achieving a 100 % success rate in this study. Despite promising outcomes, the study is limited by a small sample size and the need for longer follow-up to assess durability. This approach offers a viable alternative for patients where traditional implants are not feasible due to bone deficiencies.

Background: Oral cancer is a common head and neck cancer malignancy that seriously affects patients' quality of life and increases the health care burden. Moreover, there is a lack of comprehensive reviews of previous research on factors associated with oral cancer. The aim of the current umbrella review was to provide a comprehensive and systematic summary of relevant studies, to grade the quality of evidence of relevant studies, and to provide guidance for the prevention of oral cancer.

Methods: The PubMed, Web of Science, Medline, Cochrane Library, Embase and CNKI databases were searched for relevant meta-analyses and systematic reviews. Two authors extracted the data separately and assessed the quality of the studies using the AMSTAR-2(A Measurement Tool to Assess Systematic Reviews-2) scale.

Results: A total of 28 meta-analyses were included in this review:13 meta-analyses of dietary factors and 8 meta-analyses of behavioural habits and 7 meta-analyses of factors that were difficult to categorise as dietary and behavioural. Alcohol, tobacco (chewing tobacco/secondhand smoke exposure), betel quid , processed meat, periodontal disease, HPV (especially HPV16 and HR-HPV) infection, and chronic mechanical irritation were positively correlated with the risk of oral cancer. Vitamin C-rich citrus fruits were negatively associated with the risk of oral cancer . Fish, milk and dairy products except butter, coffee and tea intake may be negatively associated with the risk of oral cancer, but subgroup analyses of studies of fish and milk revealed significant effects only for European populations. Additionally, green tea showed the strongest protective effect among teas. High and moderate coffee intake was negatively associated with the risk of oral cancer. Oral hygiene maintenance was also negatively associated with the risk of oral cancer.

Conclusion: Reducing or eliminating alcohol consumption, refraining from direct or indirect exposure to tobacco products, and reducing betel quid chewing may lead to a reduced risk of oral cancer. Reducing the intake of processed meat, moderate intake of coffee, the consumption of green tea of appropriate temperature and strength, fish and citrus fruit intake, and oral hygiene, preventing periodontal diseases and HPV infections, and reducing mechanical stimulation of the oral mucosa caused by various reasons can exert protective effects against oral cancer.

Background: This review aimed to emphasize the implications of DNA content in head and neck squamous cell carcinoma (HNSCC), focusing on its predictive value, role in patient stratification, and potential as a therapeutic target for this malignancy.

Methods: A narrative review of the literature was conducted through electronic database searches.

Results: In conventional HNSCC, aneuploid tumors are associated with increased lymph node metastasis, locoregional recurrences, poor response to radiotherapy and chemotherapy, and worse prognosis. Few studies specifically address the role of DNA content in young HNSCC patients. These studies reveal that young patients exhibit high DNA content abnormalities, suggesting significant genomic instability and potential genetic differences compared to older patients. Regarding HPV and DNA content, no difference was found between HPV-associated and HPV-independent tumors. More research is needed to understand the role of DNA content in histological subtypes, surgical margins, and targeted therapy.

Conclusion: This review highlights the findings related to DNA content in HNSCC, suggesting its usefulness in patient stratification and outcome prediction.

Objective: The focus of this study was to assess the diagnostic effectiveness of ^99mTc-MDP single-photon emission computed tomography/computed tomography (SPECT/CT) in pinpointing medication-related osteonecrosis of the jaw (MRONJ).

Methods: We gathered a total of 39 patients who were suspected of having MRONJ and displayed radionuclide concentration in the jaws on whole-body bone scans. These patients were subjected to simultaneous SPECT/CT fusion imaging of the jaws during delayed imaging. A consistent team of nuclear medicine physicians and oral and maxillofacial surgeons carried out diagnostic evaluations using SPECT/CT image analysis and dental specialist examinations, and the diagnoses were documented.

Results: Based on the SPECT/CT image analysis and dental specialist examination outcomes, we calculated the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ^99mTc-MDP SPECT/CT in diagnosing suspected MRONJ. Further, we enumerated the number and proportion of patients at each stage.

Conclusion: Our findings suggest that ^99mTc-MDP SPECT/CT demonstrates high diagnostic precision in patients suspected of MRONJ who display radionuclide concentration in the jaw on whole-body bone scans. Moreover, it proves beneficial in identifying the early stages of MRONJ.

Purpose: This study aimed to evaluate a chimeric flap comprising a nasolabial flap and a buccal artery myomucosal flap used to reconstruct a large defect of the lower lip.

Materials and methods: From November 2019 to August 2022, seven patients with lower lip carcinoma underwent radical resection and reconstruction. A chimeric flap comprising a nasolabial flap and a buccal artery myomucosal flap was used to reconstruct the large defect of the lower lip. Postoperative observations included flap healing, mouth opening, and lip competence.

Results: Seven patients with lower lip carcinomas underwent radical resection and reconstruction. The flap survived without complications in 6 patients; 1 patient showed marginal necrosis of the skin paddle. The reconstructed lower lip had an adequate lip length and height, and its appearance was acceptable. The mouth opening ranged from 2.5 cm to 3.5 cm. All patients were able to intake oral diet in a public setting.

Conclusions: The chimeric flap, comprising a nasolabial flap and a buccal artery myomucosal flap, offers a method for reconstructing near-total and total defects of the lower lip.

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.