International journal of oral and maxillofacial surgery最新文献

The aim of this study was to provide an overview of food texture modification to address dysphagia in patients with head and neck cancer, and the current application of these methods. A comprehensive search strategy was developed across five databases: PubMed, Embase, Web of Science Core Collection, CINAHL, and the Cochrane Library. The JBI guidance for scoping reviews was used to conduct a descriptive analysis of the literature and extract data. Thirteen studies were included; 11 evaluated swallowing function in patients undergoing treatment for HNC, while two directly investigated modified food in relation to swallowing function in patients treated for HNC. Most of the studies used thin liquids for assessment, and the evaluation process often transitioned from thin or thick liquids to solids/semi-solids. Adverse outcomes occurred regardless of the treatment. However, dysphagia seemed to get worse in the short term after surgery. In terms of interventions, thickeners might have a positive effect on the patient's swallowing function. In the studies investigating food texture modification, there was an increased incidence of adverse swallowing outcomes after therapeutic treatment. Further intervention with thickener could be considered in this patient population, and a comprehensive approach needs to be taken throughout the treatment process.

Evidence was reviewed to assess the decrease in compressive strength postoperatively. The PRISMA guidelines were followed. PubMed, Embase, Web of Science, Google Scholar, and ProQuest were searched. Five cadaver studies met the inclusion criteria (49 cadavers). Three reported force leading to fracture (FLF), which ranged between 1034 N and 9962 N consistently higher than three times cadaver body weight. Only one reported statistically significant lower FLF in decancellated tibias compared to the contralateral tibias (mean 3766.9 N vs 5126.4; stability reduction 26.5%). The overall estimate of FLF in decancellated tibias was 4321.6 N (95% confidence interval 3434.4-5208.8 N. Meta-analysis estimated a significant difference in force leading to fracture (ΔFLF) 1098.1 N, 95% confidence interval 547.8-1648.5 N. While mean FLF in all studies and the pooled data was above a force three times the body weight of an average adult (70 kg x 3 = 2100 N), three cadavers showed FLF values below this threshold. Increasing the threshold to 2400 N (roughly relating to a body weight of 80 kg, increased this number to six. Normal weight-bearing after decancellation seems to be statistically safe. Clinically, however, the authors are not able to generalize this assumption.

Malignant tumors of the nasal and paranasal cavities account for only 3-5% of all head and neck neoplasms. Among these tumors, rare instances of human papillomavirus (HPV)-positive multiphenotypic carcinomas and biphenotypic sarcomas have been documented. Two such cases are reported here, along with the respective treatment approaches. The first involved a 39-year-old male patient diagnosed with HPV-positive multiphenotypic carcinoma. Surgical treatment was performed through a craniofacial and transfacial approach, en bloc resection, and reconstruction of the anterior cranial base with a fascia lata graft and pericranial flap. The second involved a 41-year-old female patient diagnosed with biphenotypic sarcoma. Surgical treatment was performed through centripetal endoscopic tumour resection. In both cases, adjuvant radiotherapy was performed after obtaining the histopathological result and negative margins. Both patients were free of disease during postoperative follow-up. Given the rarity of these cases, there are no established guidelines outlining specific treatments. It is recommended that such tumours are assessed in interdisciplinary committees to determine the optimal treatment options. Typically, this will involve surgical resection via craniofacial and transfacial approaches or endoscopic surgery, depending on the diagnosis, extent of anatomical involvement, and tumour aggressiveness. Additionally, the potential benefits of adjuvant radiotherapy should be evaluated, as it has demonstrated promising outcomes, even in cases with positive margins.

The chin is a major functional and aesthetic anatomical unit of the face. The correction of bony abnormalities is common in orthognathic surgery, but the management of the soft tissues is complex. This article describes a genioplasty technique focused on the soft tissue. The procedure improves the chin morphology in patients with a sharp lower lip-chin prominence angle or sagittal prominence of the chin soft tissue, with or without correction for bone malposition. Furthermore, this procedure can be performed on an outpatient basis. It can also be combined with conventional osteotomy.

The aim of this study was to assess the value of the use of software for the preoperative evaluation of cranial bone thickness in syndromic patients undergoing Le Fort III osteotomy. Four patients were evaluated preoperatively to determine whether they were eligible for distraction osteogenesis. Data from the computed tomography scans was evaluated using advanced reverse engineering tools to determine the temporal bone thickness. Three patients showed adequate values for the positioning of a rigid external distractor device (average thickness values >3.5 mm), while one patient showed insufficient bone thickness (average value <2.5 mm) and therefore underwent midface advancement according to the traditional technique. Adequate midface advancement was obtained in the three patients who underwent distraction osteogenesis. No complications related to the rigid external distractor were observed. A shorter skeletal advancement was obtained in the patient who underwent Le Fort III osteotomy according to the traditional technique. A cerebrospinal fluid fistula was observed after the removal of the plates, requiring surgical repair. Software evaluation of the cranial bone thickness is a useful tool in the surgical planning of Le Fort III osteotomy in patients affected by syndromic craniosynostosis.

The aim of this study was to evaluate dental and periodontal injuries and radiological bone healing at vertical osteotomies in patients treated with segmental Le Fort I (LFI) osteotomy, using cone beam computed tomography (CBCT) scans. This retrospective study analyzed 105 patients who underwent segmental LFI osteotomy. Vertical osteotomies were performed between the lateral incisor and canine using a bur and osteotome. CBCT scans were taken preoperatively and at 1-week and 1-year follow-ups. Measurements at 1-week included interdental distances, root injuries, and periodontal detachment, while 1-year follow-up assessed endodontic treatment and osteotomy healing. Results showed no damage to the 420 roots at risk, though 38 roots had osteotomy extensions into the periodontal ligament. The mean preoperative minimum distance between roots was significantly different between sites with intact and detached periodontal ligaments (P < 0.001). One tooth required endodontic treatment at 1-year follow-up. Incomplete healing of vertical osteotomies was more frequent in female patients (P = 0.012). The findings suggest that segmental LFI osteotomy is safe when performed with a bur and osteotome, provided a minimum distance of 2.5 mm between roots is maintained.

The aim of this study was to develop a model for predicting the risk of postoperative temporomandibular joint osteoarthritis (TMJOA) in patients receiving a segmental or marginal mandibulectomy for oral cavity cancer . A total of 371 patients with buccal or gingival cancer who underwent mandibulectomy were included in this retrospective cohort study. Demographic data, computed tomography, and magnetic resonance images were reviewed. Univariate and multivariate Cox regression analyses were performed to develop a nomogram to predict post-mandibulectomy TMJOA. TMJOA was identified in 81 of the 371 patients at 2 years and 107 at 4 years. The predictors of post-mandibulectomy TMJOA were segmental mandibulectomy (hazard ratio (HR) 2.51, 95% confidence interval (CI) 1.64-3.83, P < 0.001), age ≥ 62.5 years (HR 2.28, 95% CI 1.53-3.40, P < 0.001), BMI < 24.1 kg/m² (HR 2.13, 95% CI 1.45-3.13, P < 0.001), and American Joint Committee on Cancer stage IVa/IVb (HR 2.21, 95% CI 1.38-3.56, P = 0.001). The nomogram developed in this study exhibited good predictive capacity (area under the curve 0.742, 95% CI 0.679-0.804). The proposed model for predicting post-mandibulectomy TMJOA in patients with buccal or gingival cancer can identify high-risk individuals for early preventive oral rehabilitation.

Prostheses for extended total temporomandibular joint replacement (eTJR) include modifications to the traditional alloplastic fossa-condyle joint that extend to adjacent bone defects. The aim of this retrospective study was to assess the feasibility, postoperative complications, and functional and aesthetic outcomes after eTJR. Patients aged ≥18 years undergoing eTJR between 2013 and 2022 were included. Data recorded were age, sex, comorbidities, indication for eTJR, prosthesis brand, classification, concomitant surgical procedures, postoperative complications, maximum inter-incisal opening (MIO), pain, quality of life (QoL), and aesthetic outcome. Twenty-five patients (mean age 40 years), with a total of 30 joint prostheses, were included. Over a median follow-up of 42 months, there was a significant improvement in MIO in patients with reduced mouth opening at baseline (P = 0.003), as well as in pain (P = 0.007) and QoL (P = 0.004). Both patients and surgeons judged facial appearance as improved or unchanged in 88% of cases. Postoperative complications included permanent trigeminal nerve hypoesthesia (44%), permanent facial nerve dysfunction (35%), infection (8%), salivary leak (4%), and lingual nerve impairment (4%). The findings suggest that eTJR is a safe and effective treatment for temporomandibular joint deficits extending to adjacent structures, yielding satisfactory functional and aesthetic outcomes.

The aim of this retrospective study was to evaluate the morphological changes in the mandibular angle area after orthognathic surgery with or without mandibular counterclockwise rotation in Class II deformity patients, and to investigate the associated factors. Computed tomography scans obtained preoperatively (T0), within 1 month postoperatively (T1), and 6 months postoperatively (T2) were collected from 58 patients who underwent either bilateral sagittal split ramus osteotomy (group I), bimaxillary surgery with mandibular counterclockwise rotation (group II), or bimaxillary surgery without mandibular counterclockwise rotation (group III). The intergonial width increased after surgery, by 2.78 ± 2.02 mm in group I, 2.86 ± 2.81 mm in group II, and 2.53 ± 2.42 mm in group III (all P < 0.001). The mandibular angle (MA) increased in group I (ΔMA 4.76 ± 2.79°; P < 0.001) and group III (ΔMA 3.50 ± 2.58°; P < 0.001); however no significant increase was observed in group II. The increase in intergonial width was positively correlated with the lateral displacement of the proximal segment. Counterclockwise rotation of the proximal segment resulted in an increase in MA, while counterclockwise rotation resulted in a reduction in this increasing trend. The results indicate that reducing the displacement and rotation of the proximal segments is key to minimizing changes in the mandibular angle area.

The survival rate of implants placed at sites of previous failures including the best treatment strategies remain unclear. This systematic review was performed to assess implant survival and peri-implant health for such cases, including subgroup analyses of immediate versus delayed implant placement and augmentation. Four electronic databases were searched. Meta-analyses including subgroup analyses were performed (PROSPERO CRD42024548610). Out of 1798 records identified, 24 studies were included. The 1-year implant survival rate after replacement was 96.7% (95% confidence interval (CI) 92.8-99.3%), with no significant difference between immediate and delayed placement (P = 0.31) or immediate and delayed augmentation (P = 0.85). Immediate augmentation showed higher overall implant survival (97.6%, 95% CI 93.4-99.9%) compared to delayed augmentation (91.7%, 95% CI 83.4-97.5%), although not statistically significant (P = 0.26). Peri-implant health outcomes, including marginal bone loss, were similar across subgroups. Second implant replacements had lower survival rates than first replacements. Replacement of the failed implant is an appealing treatment option for failed implants, although the implant survival is lower compared to initially placed implants. Immediate implant placement can be done if sufficient bone is present. If insufficient bone remains after removal, immediate augmentation followed by delayed implant placement is recommended.