Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Background: Adenoid cystic carcinoma (ACC) of the oral cavity is a rare head and neck cancer. This rarity contributes to the paucity of comprehensive research on this cancer thereby complicating the development of evidence-based treatment strategies. This study aims to use machine learning (ML) techniques to analyze survival outcomes and optimize treatment approaches of ACC.

Methods: The SEER database (2000-2020) was used in this study. Cox regression analysis was used to identify the prognostic variables; prognostic models using five ML algorithms were constructed to predict the 5-year survival rates. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of ML models. Also, Kaplan-Meier survival analysis was performed.

Results: This study's sample included 645 patients. The most common primary site for ACC was the hard palate, followed by the cheek mucosa. Survival rates varied across treatment groups, with the highest rates observed in patients who underwent surgery only. ML models revealed that the most significant prognostic factors were age, metastasis, and surgery.

Conclusions: This study contributes evidence and knowledge to the limited literature on ACC and emphasizes the importance of adjuvant radiotherapy. This study highlights that metastasis and age are key prognostic factors. Furthermore, the developed ML-based web tool offers a novel approach for the personalized prognosis of these rare cancer types.

Background: Contralateral elective neck dissection in human papillomavirus (HPV)- associated tonsil cancer is a matter of debate.

Objectives: The aim of this study was to analyze rates of contralateral lymph node (LN) metastasis and their prognostic effects on HPV-associated tonsil cancer. We also assessed the necessity of elective contralateral neck dissection.

Methods: To investigate the pathologic incidence of and risk factors for contralateral nodal disease in HPV-associated tonsil cancer treated with upfront primary surgery and bilateral neck dissection, the records of 68 patients were reviewed.

Results: Six (8.8%) patients displayed pathologic contralateral nodal disease; four of the patients had LN metastasis confirmed in contralateral level II, one patient had LN metastasis in level III, and one patient had multi-level metastasis in contralateral levels II and III. Contralateral LN metastasis showed a significant association with greater depth of invasion (DOI) in primary tumor (p = 0.032), count of positive LN (p = 0.008), and positive LN ratio of the ipsilateral neck (p = 0.01). Patients with contralateral LN metastasis showed a significantly worse five-year overall survival but no significant difference in disease-free survival.

Conclusion: HPV-associated tonsil cancer has exceedingly low rates of occult contralateral LN metastasis. However, in cases of ipsilateral multiple node metastases and higher DOI, it may be worth considering elective contralateral neck dissection based on the risk of occult metastasis.

Introduction: Burning Mouth Syndrome (BMS) can present with a variety of oral mucosal symptoms such as burning, discomfort, xerostomia, dysgeusia, involving part or all of the mouth and lips but without visible lesions. This study assesses the patients' understanding of the pathophysiology of their condition and that influence on their outcome.

Material and methods: A single-center, observational, retrospective study was conducted. 136 patients diagnosed with BMS between February 2019 and September 2023 were recruited with follow-up in October 2023.

Results: Patients' understanding of their diagnosis and symptom improvement were statistically associated in both univariate (OR 7.25; CI 2.26-32.5) and multivariate analyses (OR 4.94; CI 1.31-24.6). A significant association was also found between a shorter history of symptoms and improvement.

Conclusion: A patient's understanding of their condition appears to benefit their outcome.

Objectives: Impacted third molars(3 M), commonly known as wisdom teeth, are prone to caries and pathological formations depending on their position in the jaw. This study aimed to determine and compare the incidence of caries, pathological formations, and the superposition of the roots of the mandibular impacted third molar over the mandibular canal in different positions of impacted 3Ms.

Meterials and methods: This retrospective study was conducted on orthopantomographs of patients who presented with 3 M complaints at the Tokat Gaziosmanpaşa University Oral and Maxillofacial Surgery Department between 2019 and 2023. The 3 M were classified according to their position by two researchers independently and were evaluated for caries, pathology, and nerve superposition. The position of the 3Ms classified using Pell and Gregory and Winter's classifications. The primary outcome variable was the presence of caries in the 3 M The secondary outcome variable was the presence of pathological formations around the 3 M The tertiary outcome variable was the superposition of the roots of the mandibular 3 M over the mandibular canal.

Results: A total of 7,038 patients were included in the study, with 53.74 % being female. The mean age was 32.15±7.2 years. The highest incidence of caries was associated with the vertical position in both maxillary and mandibular 3Ms (right maxillary: 9.98 %, P < 0.001; left maxillary: 12.74 %, P < 0.001; left mandibular: 11.66 %, p = 0.003; right mandibular: 11.69 %, p = 0.031). Pathological formations were most commonly observed in the vertical position, but the highest incidence was found in the horizontal or mesioangular positions (right maxillary: 36.84 %, p < 0.001; left maxillary: 40 %, p < 0.001; left mandibular: 62.04 %, p < 0.001; right mandibular: 62.25 %, p < 0.001). Nerve superposition was most common in the vertical position but was highest in the distoangular position (left mandibular: 74.69 %, p < 0.001; right mandibular: 76.66 %, p < 0.001).

Conclusions: The position of 3Ms plays a critical role in the development of complications such as caries and pathological formations. Prophylactic extraction may be considered more seriously in cases where the position of the tooth poses a higher risk of complications.

Objective: The study compared the effectiveness of radiofrequency and electrocautery techniques in TMJ arthroscopic surgeries by evaluating changes in pain levels and maximal incisal opening before surgery and throughout a 30-day postoperative period.

Materials and methods: This prospective, randomized controlled trial included 62 patients with bilateral TMJ disorders classified as Wilkes stages III and IV. Patients were randomly assigned to two groups: Group 1 (n = 31) underwent arthroscopy with electrocautery, and Group 2 (n = 31) received radiofrequency ablation. Inclusion criteria were patients with Wilkes stages III or IV TMJ disorders. Exclusion criteria included previous TMJ surgery, significant systemic disease, or contraindications to surgery. Pain levels were assessed using the McGill Pain Questionnaire, and maximal incisal opening was measured preoperatively and up to 30 days postoperatively.

Results: The sample included 62 subjects with a mean age of 33.5 years, 80.6% female. The electrocautery group showed significantly greater maximal incisal opening at 12 h, 7 days, and 14 days post-surgery compared to the radiofrequency ablation group. Pain levels did not differ significantly between groups, though the electrocautery group reported higher pain scores on postoperative day 14. Both groups showed similar pain improvement and maximal incisal opening changes over 30 days, with a trend towards more improvement in maximal incisal opening in the radiofrequency ablation group. No significant differences in complications or overall pain improvement were observed.

Conclusion: Electrocautery and radiofrequency did not differ in postoperative pain outcomes; however, electrocautery was more effective in improving maximal incisal opening up to postoperative day 14.

Background: Mandibular growth following distraction osteogenesis (DO) in patients with craniofacial microsomia (CFM) remains unclear. We aimed to investigate both the short- and long-term effects of DO on mandibular growth in children with Pruzansky-Kaban type IIA CFM based on skeletal units.

Materials and methods: We collected computed tomography data from 15 children with CFM preoperatively(T0), immediately after distractor removal(T1), and 4-6 years after distractor removal(T2). Measurements were taken to assess the size and orientation of the skeletal units. Linear and angular measurements were analyzed to evaluate the short- and long-term effects of DO. Bilateral differences in growth rates (GRs) for each unit between T1 and T2 were assessed.

Results: Preoperatively, the affected side exhibited smaller condylar and body units than the unaffected side. From T0 to T1, there was a significant increase in the body unit and normalization of the skeletal unit orientation on the affected side. However, from T1 to T2, the GRs of the units on the affected side were significantly slower than those on the unaffected side. Although the condylar and body unit length on the affected side did not show statistically significant increases, the angular unit length decreased. Relapses were also observed in the alignment of the units on the affected side.

Conclusions: Our findings suggest a potential long-term inhibitory effect of early DO on mandibular growth in children with CFM. This issue requires further attention as strategies to promote the growth of skeletal units following DO are critical for optimal long-term treatment outcomes.

HPV infection and the type of host microbiota play a role in the formation of HNCs. In contrast to other forms of OSCC, where the relationship between HPV and the cancer is less obvious, HPV-HNSCC is a particular type of oropharyngeal cancer. HPV has infected a stratified squamous epithelium, which includes the throat, mouth, anogenital tract, respiratory tract, and skin on the hands and feet. HPV DNA was found in high amounts in the saliva and gargle samples of patients with HPV-related HNSCC. It has been discovered that the specificity of oral mRNA (HPV) and HPV DNA identification varies from 23 % to 82 % in the identification of OPSCCs. The higher rate of HPV transmission through vaginal-oral compared to penile-oral sexual activity may be the reason for the difference in HPV-positive HNSCC patients between males and females. The researchers postulate that HPV-inactive tumours signify an advanced stage of HPV-positive HNSCC, which explains why there are racial disparities in gene expression that correspond to different disease progressions in Black and White patients. The increase of CD8+ T cells in the cancer microenvironment, linked to P16 activation, extends life expectancy in OSCC. tumour markers methylation caused by HPV and suggested using them as possible HNC biomarkers. Fusobacterium levels are much higher in patients with OSCC, while Actinobacteria phylum and Firmicutes are significantly lower. It also serves as a biomarker for notable variations found in Firmicutes, Actinobacteria, Fusobacteriales, Fusobacteriia, Fusobacterium, and Fusobacteriaceae. Therefore, based on this we evidence, we could investigate the role of oral microbiota as a maker for the HPV associated HNSCC.

Objective: The purpose of this study was to investigate the diagnostic performance of a neural network Artificial Intelligence model for the radiographic confirmation of Temporomandibular Joint Osteoarthritis in reference to an experienced radiologist.

Materials and methods: The diagnostic performance of an AI model in identifying radiographic features in patients with TMJ-OA was evaluated in a diagnostic accuracy cohort study. Adult patients elected for radiographic examination by the Diagnostic Criteria for Temporomandibular Disorders decision tree were included. Cone-beam computed Tomography images were evaluated by object detection YOLO deep learning model. The diagnostic performance was verified against examiner radiographic evaluation.

Results: The differences between the AI model and examiner were non-significant statistically, except in the subcortical cyst (P=0.049*). AI model showed substantial to near-perfect levels of agreement when compared to those of the examiner data. Regarding each radiographic phenotype, the AI model reported favorable sensitivity, specificity, accuracy, and highly statistically significant Receiver Operating Characteristic (ROC) analysis (p<0.001). Area Under Curve ranged from 0.872, for surface erosion, to 0.911 for subcortical cyst.

Conclusion: AI object detection model could open the horizon for a valid, automated, and convenient modality for TMJ-OA radiographic confirmation and radiomic features identification with a significant diagnostic power.

Condylar process fractures remain a matter of ongoing controversy in maxillofacial surgery because of variety of opinions and proposed treatment modalities offered in the literature. The trend is toward open reduction and internal fixation (ORIF) whenever there is displacement or dislocation combined with unstable occlusal conditions. The fundamental treatment goals are anatomical fixation and early return to function. However, ORIF of a fractured condyle carries significant risks, including facial nerve damage, and presents challenges in reducing and stabilizing the fractured segment in an area of limited access. We present here an innovative technique for ORIF of condylar head fractures. It consists in fracture reduction and stabilization with two Kirschner wires followed by osteosynthesis with two cannulated headless compression screws using the AUTOFIX 2.0® system (Stryker, Kalamazoo, USA). This new technique, combined with intraoperative CT scan, ensures satisfactory reduction and stabilization of the dislocated joint segment, thereby restoring the condyle to its physiologically normal position.

Hybrid carcinomas (HC) are the association of two or more malignant neoplasms arising within the same topographical area. The present study is a systematic review of HC of the salivary glands. This study aimed to assess HC clinicopathological features and molecular profile. Observational studies, case series, and case reports were included. PubMed, Scopus, EMBASE, Lilacs, Web of Science, and gray literature were searched until June 2024. A total of 18 articles including 34 patients were included. HC of the salivary glands is presented as a painless mass affecting mainly the parotid gland of adults with a preference for male patients. Histologically, adenoid cystic carcinoma and epithelial-myoepithelial carcinoma were the most prevalent association, being surgical excision with radiotherapy the most common treatment. The most aggressive component, even when representing only a small proportion of the tumor, should guide the patient's treatment. Further molecular studies are necessary to determine if HC are distinct entities or biologically identical to the individual neoplasms. In conclusion, this systematic review may contribute to a better understanding of this rare lesion, their biological behavior, treatments employed, and the outcome of these patients.