International journal of oral and maxillofacial surgery最新文献

Cranial fasciitis is a rare fibroproliferative condition predominantly affecting children. An unusual case of cranial fasciitis in a full-term male newborn presenting with significant right malar swelling is reported. Initial imaging revealed a large frontal extra-axial mass displacing both frontal lobes and extending to the right infratemporal fossa and orbit, subsequently diagnosed via a transoral biopsy. Two-stage surgery involving a multidisciplinary team was performed to completely remove both the intracranial and extracranial components of the lesion. Long-term follow-up MRI indicated no recurrence of the disease at 16 months post-resection. Multidisciplinary collaboration is crucial in managing complex craniofacial conditions, especially in newborns and infants.

Patient-specific implants (PSIs) have demonstrated improved outcomes and have reduced the complexity of surgery in orthognathic surgery. However, the design process for PSIs is time-consuming and complicated, leading to high costs that hinder its widespread adoption. The aim of this study was to develop a novel workflow for designing PSIs using generative design (GD) techniques to streamline the process. The proposed workflow was implemented using GD-embedded software, Fusion (Autodesk Inc.), and tested by designing PSIs for one Le Fort I osteotomy case and one genioplasty case. The performance of the GD workflow was assessed through the time required for design and the basic properties of the GD PSIs. The hands-on time for the design was 94 min for the Le Fort I fixation plate and 45 min for the genioplasty plate. The maximum von Mises stress was 227.63 MPa for the Le Fort I fixation plate and 237.31 MPa for the genioplasty fixation plate. The GD-based workflow simplified and accelerated the design of PSIs for orthognathic surgery. Biomechanical analysis indicated the feasibility of generative designed patient-specific implants for clinical practice.

The primary aim of this study was to assess the accuracy and predictability of a splintless treatment protocol for edentulous patients with moderate to severe obstructive sleep apnoea (OSA) undergoing maxillomandibular advancement (MMA). Ten consecutive edentulous patients treated with MMA were enrolled in this retrospective study. All cases were virtually planned, followed by computer-aided design of individual osteotomy cutting guides and patient-specific implants. For the maxilla, the mean discrepancy between the planned and achieved right to left, posterior to anterior, and cranial to caudal translations was 0.3 ± 0.2 mm, 1.0 ± 0.6 mm, and 0.8 ± 0.6 mm, respectively. There was a mean discrepancy of 0.5° ± 0.5°, 2.5° ± 2.0°, and 0.3° ± 0.4° for roll, pitch, and yaw of the maxilla, respectively. The mean discrepancy of the mandible osteotomy gap was 1.2 ± 1.0 mm on the right side and 0.8 ± 0.5 mm on the left. Surgical success was achieved in nine patients, one of whom met the criteria for surgical cure. On average, the apnoea-hypopnea index was reduced by 72%. The results of this study indicate that the splintless treatment protocol for MMA applied in edentulous OSA patients is highly accurate, predictable, and effective in the treatment of OSA.

Currently, internal mandibular distraction osteogenesis is performed with stock distractors that are either linear or circular. However, a recent in silico study showed that linear and circular distractions resulted in bone deformity, malocclusion, and condylar displacement, while custom helical distractors produced excellent outcomes. A system to design and manufacture custom helical distractors has recently been developed. An unpublished in vitro study showed excellent outcomes with custom helical devices manufactured using this system. However, it is unknown whether these appliances will work in human tissues. Hence, the current study was performed to determine first, in a cadaver model, whether the new system of custom helical distraction can produce appropriate clinical outcomes; and second, to contrast the performance of the custom helical distractors with those of stock and hybrid (i.e., linear appliances that feature patient-specific footplates) devices. The results demonstrated that the new system of custom helical distraction could produce appropriate clinical outcomes in the cadaver model. Also, the new custom helical distractors operated as intended. Interpreted as trends, the best results of this study were seen with the helical distractors, followed by the hybrid devices and lastly the stock appliances.

A retrospective review was performed to evaluate the prognostic factors and survival of patients with submandibular gland adenoid cystic carcinomas (ACCs), covering the period January 2006-December 2022. Thirty-eight patients were identified, 25 female and 13 male (age range 25-83 years, median 54.5 years). Surgical excision was performed in all patients, and the occult node metastasis rate was 17.1%. The median follow-up time was 61.5 months (range 13-169 months). Ten patients (26.3%) developed recurrent disease after initial surgery. Nine patients died during follow-up. The 5-year overall survival and disease-free survival rates were 81.1% and 75.4%, respectively. AJCC T-classification 3/4 (vs 1/2), AJCC TNM stage III/IV (vs I/II), positive surgical margin, presence of extra-glandular extension, and histological grade III (vs I/II) had a significant negative impact on both overall survival and disease-free survival. The findings of this study confirm the important impact of several clinicopathological factors on an unfavourable prognosis. Furthermore, radical surgery with tumour-free margins is recommended for patients with localized submandibular gland ACCs. Elective neck treatment is indicated for patients with advanced stage submandibular gland ACCs. Moreover, improvements in disease detection in the early stage and multicentre studies should be encouraged.

The purpose of this study was to compare the effects of anterior releasing of the temporomandibular joint disc during arthroscopic discopexy surgery with a holmium laser versus manual instrumentation. A total of 80 patients (139 joints), divided into two groups. Anterior releasing surgery was performed using manual surgical instruments in 40 patients (70 joints) and with holmium laser assistance in the other 40 patients (69 joints). Statistical analyses, including χ² tests and multivariate analysis, assessed factors impacting surgical success. The results showed that discopexy success was significantly higher with holmium laser use compared to manual instruments (odds ratio 4.41, P = 0.003). In addition, a preoperative diagnosis of anterior disc displacement with reduction (ADDwR) was found to be significantly more likely to result in surgical success compared to anterior disc displacement without reduction (ADDwoR) or idiopathic condylar resorption (odds ratio 5.91, P = 0.001). This study found that the use of holmium laser assistance, as compared to manual surgical instruments, significantly enhanced the success rate of arthroscopic discopexy in the temporomandibular joint. Furthermore, patients classified as ADDwR exhibited a notably higher surgical success rate compared to those classified as ADDwoR or idiopathic condylar resorption.

The placement of a columellar cartilage strut graft (CSG) between the medial cartilage crura is an important step for providing tip projection and support in rhinoplasty. While the CSG is placed by direct observation in open rhinoplasty, it can be placed with different approaches in closed rhinoplasty: by dissection from the mucosal side, delivery technique, marginal or lateral incisions from the edge of the columella, direct skin incisions over the columella, or incisions made through the intraoral mucosa. This study suggests the placement of the CSG through a medial crus footplate crease incision as an alternative approach in closed rhinoplasty. A septal cartilage graft is harvested and fashioned into a 16-22 mm long CSG for later insertion. A 3-mm incision is made at the junction of the nasal floor and the lip, at the level of the lower end of the right medial crural footplate. A minimal dissection is performed between the medial crura to the tip using a blunt periosteal elevator, following which the CSG is inserted. This procedure is easy and provides adequate support for the columella and tip without prolonging the operation time. The scar is hidden in the natural fold and heals very well.

The aim of this study was to clinically validate an artificial intelligence (AI)-based tool for automatic segmentation of the mandibular incisive canal (MIC) on cone beam computed tomography (CBCT), enabling prevention and detection of iatrogenic implant-related nerve injuries. Patient records from University Hospitals Leuven were screened for CBCT related to implant surgery cases with nerve injuries. CBCT scans were imported into Virtual Patient Creator for canal segmentation and 3D model generation. Two oral radiologists compared the AI-segmented canals with respective CBCT images. Five observers then performed canal identification and injury detection (present/absent) and reported their confidence level on a five-point Likert scale. Ten patient cases were assessed (eight female, two male; age 49-81 years). The AI-based tool enabled clear visualization of bilateral MIC in both pre- and postoperative images, revealing implant-canal relationships consistent with recorded post-implant pain or neural disturbance. For preoperative assessment, the AI-based tool significantly improved incisive canal detection (by 25%; P = 0.025) and observer confidence (by 8%; P = 0.038). The AI-based tool proved to be clinically useful to enable bilateral MIC visualization on CBCT images. Through canal segmentation with integrated 3D modelling, preoperative canal detection and the experts' confidence level were significantly improved.

Ameloblastic fibroma is a rare, benign, biphasic odontogenic tumour that typically presents in young patients and is treated conservatively with an excellent prognosis. An important differential is ameloblastoma, a more common odontogenic neoplasm that shares many of the clinical, radiological, and histological features, but requires more extensive surgery due to its potentially destructive nature. Both tumours demonstrate BRAF V600E mutations. While epithelial staining with BRAF V600E-specific immunohistochemistry is considered a surrogate marker for mutation and is supportive of the diagnosis of ameloblastoma, the staining pattern in ameloblastic fibroma has not been defined previously because of the rarity of the lesion. This report describes a case of ameloblastic fibroma in a 13-year-old, in which BRAF V600E immunohistochemistry showed cytoplasmic staining in both the stromal and epithelial components of the tumour. On review of the literature, this was interpreted to be concordant with the biphasic nature of the lesion.

The aim of this study was to use machine learning (ML) to classify sagittal and vertical skeletal discrepancies in three-dimensional (3D) facial scans, as well as to evaluate shape variability. 3D facial scans from 435 pre-orthodontic patients were subjected to cephalometric analysis and 3D facial landmark identification. Three ML models were used for the discrimination of skeletal discrepancy: random forest, AdaBoost, and multi-layer perceptron. Each model was evaluated by receiver operating characteristic curve and calculating the area under the curve (AUC). Principal component analysis was conducted to evaluate shape variability. The AUCs for Class II and III patients ranged from 0.91 to 0.95. Random forest achieved the highest accuracy for sagittal classification (88.5% for Class II, 95.5% for Class III). Multi-layer perceptron exhibited the best performance for vertical classification (accuracy of 78.8% for hypodivergent, 86.2% for hyperdivergent). Six principal components explained 94.0% of facial morphology variation. ML methods show promise for assisting in the discrimination of sagittal and vertical skeletal discrepancies based on 3D facial scans. 3D facial soft tissue features appear to be suitable for the discrimination of skeletal discrepancies in most cases.