International journal of oral and maxillofacial surgery最新文献

The aims of the study were: to estimate the risk of recurrence of ameloblastoma and the factors associated with this risk; to determine the factors that should suggest ameloblastic carcinoma (AC) at diagnosis; and to estimate the rate of metastases or malignant transformation, as well as their risk factors. Records for all patients from our centre followed with ameloblastoma between January 2007 and May 2024 were exhaustively retrieved. Cox survival analysis for an ameloblastoma recurrence was then performed, and logistic models to study the risk of AC at the time of diagnosis and occurrence of metastases or of transformation into AC. A total of 175 patients with histologically proven benign ameloblastoma were included. In multivariate analyses, a radical surgical treatment appeared to be a strong protective factor against recurrence (hazard ratio (HR) 0.048 (0.006-0.365), P = 0.003). The metastases rate and transformation rate into AC at 5 years were 1% (0-2%) and 3% (0-7%), respectively. A histologically confirmed extraosseous extension of the initial ameloblastoma should be considered at risk of metastases or AC during the follow-up (HR 3.939 (1.089-25.06), P = 0.043). Closer follow-up is recommended, including thoracic imaging, in cases of ameloblastoma with extraosseous extension on histological sections.

This study aimed to analyse the spectrum of unsatisfactory outcomes requiring secondary surgery, the technical challenges involved, and the results achieved in a cohort of patients undergoing reoperative orthognathic surgery. A retrospective, single-centre study was conducted on all patients who underwent secondary orthognathic surgery at the Face Surgery Center (Parma, Italy) between January 2014 and June 2024. All patients had previously undergone orthognathic procedures by other surgeons abroad and were dissatisfied with the aesthetic outcomes. The final sample included 72 patients (50 women, 22 men), with a mean age of 25.8 years (range 18-43) at reoperation. All patients were treated by revision bimaxillary surgery; it was combined with: septorhinoplasty (52 patients, 72.2%); genioplasty (36 patients, 50%); mandibular remodelling (nine patients, 12.5%); mandibular angle prostheses (three patients, 4.1%); eyelid surgery (two patients, 2.7%). The main defects after primary surgery were (each individual case may incorporate several defects): enlargement or deformation of the nose (86%); facial asymmetry (57%); chin projection deficiency (50%); irregular mandibular borders (48%); and malocclusion (42%). No skeletal relapses occurred postoperatively; after surgery Class I occlusion was achieved in all patients. Bimaxillary procedures combined with facial lipofilling led to improved aesthetic outcomes in most patients.

The success of complete-arch implant-supported prostheses in edentulous patients relies heavily on accurate implant placement using surgical guides. The aim of this study was to assess and compare the accuracy of bone-supported and mucosa-supported guides in dental implant surgery. A comprehensive literature search following the PRISMA guidelines was conducted across PubMed, OVID, MEDLINE, and Scopus for studies published between January 2000 and August 2025. Thirteen articles meeting the inclusion criteria were selected, encompassing a total of 1092 implants-952 placed using mucosa-supported guides and 140 using bone-supported guides. Meta-analysis revealed no significant differences between bone-supported and mucosa-supported guides in angular deviation (4.41° vs 5.43°, P = 0.45), linear deviation at entry (1.46 mm vs 1.64 mm, P = 0.42), or linear deviation at apex (1.59 mm vs 2.13 mm, P = 0.16). Depth deviation was reported only for mucosa-supported guides, with an overall pooled estimate of 1.12 mm. These findings indicate no significant difference in linear deviation (at entry or apex) or angular deviation between bone-supported guides and mucosa-supported guides.

The effectiveness of computer-aided design and computer-aided manufacturing (CAD/CAM) and three-dimensional (3D) printed surgical guides in mandibular reconstruction has been widely demonstrated. Nevertheless, there are few reports on innovations in 3D-printed surgical guide for maxillectomy reconstruction. Although the scapula flap is valuable for maxillectomy reconstruction, its design and harvesting process are technically demanding and time-consuming. This technical note describes our new 3D-printed surgical guide for harvesting the scapula flap that was applied in a 50-year-old man after a left total maxillectomy. By incorporating a handle into the surgical guide to stabilize the scapula, more controlled and stable osteotomy of the scapula was achieved. By using our new surgical guide, 89.7% of the reconstructed bone was identified within a tolerance range of 3 mm relative to the preoperative plan. Optical 3D surface scanning of the facial surface demonstrated that the contour of the cheek in the frontal view and the height of the malar eminence were maintained relative to the preoperative state. This technical note demonstrates the potential of our 3D-printed surgical guide to enable precise maxillectomy reconstruction. Further application of the new surgical guide in a larger number of cases is required to evaluate its accuracy and clinical utility.

Oral verrucous carcinoma (OVC) is a low-grade warty variant of oral squamous cell carcinoma. Although these verrucous lesions appear clinically malignant, biopsies often report them as benign, leading to repeat biopsies and diagnostic delay. A retrospective review of patients who underwent surgery for clinically suspicious oral verrucous growths between 2012 and 2022 was conducted. Overall, 228 patients were identified. Final histopathology confirmed OVC in 80 patients (35.1%). Biopsy showed very low sensitivity of 32.4% but high specificity of 93.5% for detecting malignancy in clinically suspicious verrucous growths. The positive predictive value (PPV), negative predictive value (NPV), and accuracy were 80.9%, 61.8%, and 65.3%. Frozen section similarly demonstrated low sensitivity of 39% with very high specificity of 98%. The PPV, NPV, and accuracy were 93.2%, 65.2%, and 70.6%. Univariate analysis identified tumour thickness (>5 mm vs ≤5 mm) (P < 0.001), pathological T stage (T3/T4 vs T1/T2) (P = 0.002), and neck dissection (modified vs selective) (P = 0.003) as significant prognostic factors in OVC. This study highlights the limitations of biopsy and frozen section in diagnosing OVC. Despite high specificity, their low sensitivity may result in misdiagnosis, emphasizing cautious interpretation and adjunctive diagnostic approaches to avoid treatment delay.

The clinical efficacy of injectable platelet-rich fibrin (i-PRF) in internal derangement of the temporomandibular joint (TMJ-ID) has not been sufficiently investigated. This retrospective study was performed to evaluate the effect of intra-articular i-PRF, alone and in combination with arthrocentesis, on pain, jaw movement, and masticatory efficiency in TMJ-ID. Forty-eight patients with TMJ-ID who had undergone arthrocentesis only (AC), i-PRF injection with arthrocentesis (AC+i-PRF), or single i-PRF injection (i-PRF) were included (16 per group). Pain (at rest and during function), maximum mouth opening (MMO; unassisted and assisted), lateral and protrusive movements, and chewing efficiency were evaluated pre-treatment and at 10 days, 1, 3, and 6 months post-treatment. All outcomes improved significantly over time in all three groups. Significant differences were observed in pain during function and at rest between the three groups at most post-treatment time-points (all P < 0.01). Post hoc pairwise comparisons revealed no significant difference in mean VAS scores between AC+i-PRF and i-PRF; however, significant differences were observed between AC and both AC+i-PRF and i-PRF, with significantly lower pain scores in the i-PRF groups (all P < 0.05). Similarly, significant differences were noted between AC and both AC+i-PRF and i-PRF for MMO, with post hoc testing revealing greater MMO values in the i-PRF groups. Chewing efficiency differed significantly between the groups only at 3 months (P = 0.006). Overall, i-PRF, alone or combined with arthrocentesis, significantly reduced pain and improved jaw function compared to arthrocentesis alone. The findings suggest that i-PRF alone may provide comparable clinical benefits to AC+i-PRF, offering a simplified and effective treatment approach for TMJ-ID.

Decompression is a conservative treatment approach, either definitive or adjuvant, to jaw cysts (of odontogenic and non-odontogenic origin). It relieves intracystic pressure, which allows size decrease of the pathology concomitant to bone neoformation. Several devices have been described with the purpose of decompressing a lesion, which attempted to fulfil ideal characteristics, but many have displayed disadvantages, such as the impossibility of use in edentulous patients, being prone to contamination, clinical discomfort, etc. Thus, the objective of this technical note is to present a new approach to cystic decompression, using a double-way device, made from two fragments of a no. 12 nasogastric tube, fixed to each other with a stainless-steel wire. The device can be anchored to the tooth or through a hole in the bone and is removed during the definitive surgical treatment of the lesion. Our device features low cost, simple manufacture and installation, a smooth and flexible surface that provides clinical comfort, and, being a double-lumen device, it allows simultaneous active irrigation and passive drainage during the treatment period.

Optical navigation is a rarely used technique for puncture of the temporomandibular joint (TMJ). The flexibility of the cannula used leads to a loss of accuracy in navigated TMJ punctures. The aim of this study was to determine the accuracy of navigation-guided TMJ punctures using a flexible cannula. A navigation cone-beam computed tomography (CBCT) scan was performed to outline the puncture plan and define the trajectory in the navigation system software. After the puncture, the position of the cannula tip was documented using a further CBCT scan, and deviation from the navigation plan was determined. Thirty punctures were performed on six TMJs from three human whole-body donors. The mean deviation from the planned position of the cannula tip was 2.83 mm. The joint space was punctured successfully in 100% of cases. These findings indicate that navigation-assisted puncture is a valid and practicable procedure for puncturing the TMJ. Nevertheless, due to its higher technical demands and higher costs compared with other TMJ puncture techniques, optical navigation puncture appears to be particularly suited as an extension for complex cases or training purposes.

The aim of this retrospective study was to examine the characteristics of patients sustaining maxillofacial fractures due to falls at ground level. The specific aims were to analyse the severity of the fractures and the time interval between the accident and diagnosis (delay of diagnosis) in alcohol-intoxicated vs non-intoxicated patients. A total of 1200 consecutive adult patients diagnosed with maxillofacial fractures at a tertiary trauma centre over a 7-year period were included. Outcome variables were the delay of diagnosis and severity of the fracture; the latter was determined based on a facial injury severity score (FISS). The primary predictor variable was alcohol intoxication at the time of injury (yes/no). Overall, 360 patients (30%) were identified as being intoxicated by alcohol at the time of the injury. In the adjusted model, no association was found between alcohol intoxication and the severity of the maxillofacial fractures. However, the adjusted model showed that non-intoxicated patients had 2.0 times greater odds of a delay of diagnosis ≥3 days (95% confidence interval 1.3-3.0 , P < 0.001). The high occurrence of alcohol intoxication in facial trauma patients in general emphasizes the importance of screening patients for alcohol use and intervening when appropriate.