Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Introduction: Despite being less common in recent years, recurrent pleomorphic adenoma still poses a surgical challenge, especially after improper surgery.

Methods: We retrospectively recruited all patients with recurrent pleomorphic adenoma and Carcinoma ex pleomorphic adenoma from February 2007 to April 2024 who were operated upon in a tertiary cancer center. Epidemiological, radiological, and pathological data, risk factors, details of surgical treatment, and surgical/oncological outcomes were analyzed.

Results: 35 patients with recurrent pleomorphic adenoma were recruited, 19 were women (54.3 %) with the parotid gland being the most affected site in 74.3 % followed by the submandibular gland in 20 %. Only 11 patients (31.4 %) underwent surgery for the primary tumor in our center, and of interest that 48.6 % of the total cohort underwent simple enucleation for their primary tumors. The interval between resection and recurrence was shortened with frequent recurrences. Again, 71.4 % of facial nerve injuries had a history of simple enucleation for their primaries. 3 cases of Carcinoma ex pleomorphic adenoma were reported, representing 1.4 % of the patients with parotid pleomorphic adenoma in the study period, and was associated with young age and long-standing recurrence.

Conclusions: Surgery is the cornerstone treatment for both primary and recurrent pleomorphic adenoma. Inadequate primary surgery, long-standing lesions, multiplicity, and fragmentation may be associated with facial nerve injury. Reconstructive flaps may be needed to cover the large resultant defects. Surgery for pleomorphic adenoma should be done by adequately trained surgeons. Radiation as an adjuvant treatment needs to be used frequently, especially through a multidisciplinary approach. Carcinoma ex pleomorphic adenoma, being rare, is demanding in its management with a poor prognosis.

Objective: The aim of this study is to evaluate the nasolacrimal canal dimensionally and volumetrically after treatment in patients who underwent rapid maxillary expansion.

Materials and methods: A total of 19 patients (12 females, 7 males) with maxillary transverse deficiency, who underwent rapid maxillary expansion were included in the study. Cone beam computed tomography images were analyzed to measure the volume, anteroposterior diameter, transverse diameter, length, and angle of the nasolacrimal duct before and after treatment.

Results: The average age of the patients was 13.8 ± 1.69 years. Statistically significant increases in the volume, anteroposterior diameter, transverse diameter, length, and angle of the nasolacrimal canal were observed after treatment for both the right and left sides. No significant difference was found nasolacrimal canal dimensionally and volumetrically except angle on the left and right side of male and female patients. No significant differences were found in the changes between male and female patients.

Conclusion: Rapid maxillary expansion resulted in significant dimensional and volumetric increases in the nasolacrimal canal. Although no prior studies have linked maxillary transverse deficiency to nasolacrimal canal obstruction, the findings suggest that RME may be a viable treatment for nasolacrimal canal obstruction under appropriate conditions.

Purpose: This study aims to assess the outcomes of free dermal fat graft (FDFG) reconstruction following parotidectomy, evaluating both clinical complications and patient satisfaction with the procedure.

Methods: We conducted a systematic review and meta-analysis according to PRISMA guidelines, searching MEDLINE (via PubMed), Scopus, and the Cochrane Library for studies reporting on FDFG outcomes post-parotidectomy. Eligible studies included single-arm studies with data on recipient and donor site complications as well as patient satisfaction. Pooled complication rates were analyzed using a random-effects model to account for study heterogeneity.

Results: A total of 20 studies, representing 922 reconstructions in 919 patients, were included in the analysis. The overall rates of recipient site complications were low, with hematoma observed in 1.31% (95% CI: 0.50-3.34) and infection in 1.84% (95% CI: 0.95-3.53) of cases. The incidence of Frey's syndrome was 1.95% (95% CI: 0.74-5.02), and fat necrosis was noted in 1.74% (95% CI: 0.57-5.23) of patients. Donor site complications were minimal, with hematoma, infection, and seroma rates each below 1%. While there was high variability in satisfaction measures, results indicated favorable patient satisfaction with FDFG outcomes.

Conclusion: FDFG reconstruction following parotidectomy is a safe and effective method for correcting contour deformities, showing minimal complications and high patient satisfaction. The low incidence of complications, including Frey's syndrome, underscores FDFG as a viable option for facial contour restoration in parotid surgery, providing favorable aesthetic and functional outcomes.

Objectives: The nasometer is the most widely used tool for objective assessment of phonation in both research and clinical practice. French standards have been validated in cases of total cleft lip and palate. The objective of this research is to propose a second validation study on velopalatal clefts. The 15 most sensitive and specific items from the initial validation were selected to create a test that is suitable for use in a clinical setting. A secondary objective is to ascertain the impact of cleft type on nasometry.

Methods: A total of 39 participants with an isolated or non-isolated velopalatal cleft were recruited for the study. A speech therapist conducted a blinded subjective evaluation of phonation. The nasometric assessment was based on a corpus developed in collaboration with the CNRS Phonetics and Phonology Laboratory. The corpus is composed of items that are phonetically balanced.

Results: The obtained nasalance threshold values ranged from 11 to 40%. The study corroborated the existence of a voicing effect, whereby the articulation of voiced consonants was associated with a higher nasalance score. This effect, not previously observed in other studies, is specific to French phonetics. Participants with a velopalatal cleft exhibited higher nasalance scores compared to those with a total cleft.

Conclusion: By validating the most relevant stimuli, a French Nasalance Test can be established. With a view to harmonising assessment protocols, it would be appropriate to use the items from this test in subjective assessment.

Despite technological advancements, maxillary rehabilitation remains a significant challenge in Oral and Maxillofacial Surgery. This paper presents the case of a patient who underwent multiple previous procedures for prosthetic rehabilitation without achieving the desired results. The most recent intervention, which resulted in some sequelae, involved the placement of bilateral zygomatic implants. After unsuccessful attempts to maintain these implants, the decision was made to remove them and place a custom subperiosteal implant, produced via additive manufacturing. The patient has now been successfully rehabilitated with these implants for over a year, with no complaints and a notable improvement in her quality of life. The rehabilitation of severely atrophic maxillae using custom subperiosteal implants has proven to be an excellent alternative, offering predictability, the possibility of virtual planning and simulation, and the ability to rehabilitate extensive bone defects.

Introduction: Teeth movement or rotation is one of the complications of mandibular defect repair using transport disk distraction osteogenesis (TDDO). However, the mechanical reasons are not clearly understood.

Material and methods: To evaluate the biomechanical factors associated with teeth movements during mandibular defect repair with TDDO, a finite element model created from computed tomographic images of the human mandible was adopted to evaluate teeth displacement and the Von Mises stress distribution on the periodontal ligament resulting from the transport disk for teeth subjected to TDDO loading.

Results: Under a displacement of 0.5 mm to the fixed arm of the transport disk, the teeth on the disk moved away from the distraction. The stress on the periodontal ligament was highest (60 KPa) around the distal neck. Upon the application of 150 g of resistance, the entire tooth moved in the same direction and the isoline gradient was almost parallel to the long axis of the tooth. Although the stress was distributed similarly; it decreased to 0.117 KPa geometrically.

Discussion: When mandibular defects are repaired with TDDO, the transport disk and anti-distraction forces contribute to the reversal movement or rotation of the teeth, which may become immobility when antagonistic forces are applied in the same direction.

Objective: Oral potentially malignant disorders (OPMDs) are oral mucosal conditions that may progress to oral squamous cell carcinoma (OSCC). Although autoimmunity has linked to the malignant transformation potential of various precancerous conditions, its role in OPMD remains unclear. This review aimed to identify the role of systemic autoimmunity on OPMD development and their progression to OSCC.

Methods: A comprehensive literature search was conducted using PubMed, Cochrane CENTRAL, and SCOPUS database for articles published up to January 2024. The key questions addressed by this review were "Is autoimmunity associated with the development of OPMD" and "How does systemic autoimmunity influence the potential for malignant transformation of OPMD?". This review followed the PRISMA guidelines for scoping reviews (PRISMA-ScR).

Results: Of the 1265 articles initially identified, 21 fulfilled the search criteria. Three themes were emerged; 1) the prevalence and prognosis of oral cancers in patients with systemic autoimmune diseases, 2) circulating autoantibodies in OPMD patients, and 3) autoimmune-related markers linked to malignant transformation in OPMD patients. This review indicated that systemic autoimmunity may contribute to chronic inflammatory conditions, disruption of oral mucosal integrity, and interference with the DNA damage repair process, thus influencing malignant transformation in the oral epithelium of patients with OPMD.

Conclusion: The co-occurrence of OPMD with circulating autoantibodies or systemic autoimmune diseases underscores the importance of understanding these interactions for improved management of OPMD and early detection of OSCC.

Background: Treatment for head and neck squamous cell carcinoma (HNSCC) is often associated with various adverse effects, including changes in salivary parameters and complaints of halitosis. This study aimed to investigate changes in volatile sulfur compound (VSC) levels and salivary parameters in patients undergoing treatment for HNSCC.

Methods: This prospective longitudinal study was conducted at a Brazilian oncology center, where a convenience sample of 24 HNSCC patients undergoing radiotherapy or chemoradiotherapy were evaluated for VSC levels, salivary flow, pH, viscosity, dry mouth, and tongue coating. Assessments were performed at the beginning and end of antineoplastic therapy. VSC levels were measured using an Oral Chroma™ gas chromatograph. Data were analyzed descriptively and analytically.

Results: No significant changes were found in overall VSC levels. However, a statistically significant reduction in salivary flow (p < 0.001) and pH (p = 0.017) and an increase in salivary viscosity (p = 0.037) were noted post-treatment. Patients who reported halitosis after treatment exhibited significantly higher hydrogen sulfide levels (p = 0.045). Tongue coating and VSC levels showed no significant changes.

Conclusion: Treatment for HNSCC results in reduced salivary flow, altered pH, and increased salivary viscosity. Although self-reported halitosis correlates with elevated hydrogen sulfide levels post-treatment, no significant changes in overall VSC concentrations were observed.

Introduction: The present study aimed to provide and evaluate the efficiency of an artificial intelligence mechanism for detecting cystic lesions on cone beam computed tomography (CBCT) scans.

Method and materials: The CBCT image dataset consisted of 150 samples, including 50 cases without lesions, 50 dentigerous cysts (DC), and 50 periapical cysts (PC) based on both radiographic and histopathological diagnosis. The dataset was divided into a development set with 70 % of samples for training and validation and a final test set with the other 30 % of samples. Four images were obtained for each case, including panoramic, manually segmented panoramic, axial, and manually segmented axial images. A deep convolutional neural network (CNN) architecture was used for automatic lesion detection and diagnosing the type of cystic lesion. To increase the number of image samples and avoid overfitting, a data augmentation procedure was applied. Recall, precision, F1-score, and average precision (AP) values were measured for lesion detection performance, and sensitivity, specificity, and accuracy indicators from the confusion matrix were calculated for the lesion classification performance of the CNN model.

Results: Mean average precision, recall, and F1-score for the detection of DCs and PCs were respectively, 0.87, 0.92, and 0.89 before data augmentation, and 0.93, 0.95, and 0.93, after the augmentation process. For the classification of DCs with data augmentation, sensitivity, specificity, accuracy, and AUC values were 96.4 %, 99.5 %, 97.3 %, and 0.98, respectively, and for PCs with augmentation, these values were 89.6 %, 98.9 %, 98.1 %, and 0.94, respectively. Lastly, for no lesion samples, sensitivity, specificity, accuracy, and AUC values were 100 %, 99.1 %, 99.4 %, and 0.99, respectively, by application of data augmentation.

Conclusion: Our developed deep learning-based CNN algorithm showed high accuracy, sensitivity, and precision values (more than 90 %) for detecting and classifying dentigerous and periapical cysts on CBCT images using data augmentation.