International journal of oral and maxillofacial surgery最新文献

Evaluating masticatory behaviour before and after surgical orthodontic treatment is crucial for successful postoperative oral rehabilitation of patients with jaw deformities. In this study, masticatory function was evaluated by measuring masticatory behaviour quantitatively in patients with jaw deformities before and after surgical orthodontic treatment. The untreated group included 42 patients with jaw deformities. The post-treatment group included 55 patients whose jaw deformities had been corrected surgically at least 1 year previously. The control group included 53 adults with individual normal occlusion. Masticatory behaviour was measured using a Bitescan device, and the occlusal contact area and maximum occlusal force were measured using Dental Prescale II system. The post-treatment group had the longest eating time (P = 0.008 compared to the control group). There was no significant difference in the right-left imbalance among the groups (P = 0.078). Both occlusal contact area and maximum occlusal force of the untreated group and post-treatment group were significantly lower than those of the control group (all P < 0.001). This study revealed that postoperative masticatory behaviour was not sufficiently improved, suggesting the possibility of insufficient adaptation to postoperative occlusion, a state of recovery of masticatory muscles, and a reliance on habitual masticatory behaviour.

This retrospective cohort study was performed to investigate the long-term skeletal, dental, and aesthetic stability, and patient satisfaction, following mandibular advancement with bilateral sagittal split osteotomy (BSSO) in skeletal Class II malocclusion patients. The follow-up period ranged from 6 to 19 years (mean 11.9 years), longer than in many previous studies. Twenty-nine patients (18 female, 11 male) who underwent mandibular advancement with rigid internal fixation between 2004 and 2017 were included. Lateral cephalometric radiographs from four time points were analysed: pre-surgery (T1), post-surgery (T2), 6-12 months post-surgery (T3), and long-term follow-up (T4). Patient satisfaction with the treatment outcome was assessed using the Orthognathic Quality of Life Questionnaire (OQLQ, Swedish version). The mean mandibular advancement was 5.53 ± 1.91 mm. Long-term follow-up revealed stable skeletal and dental outcomes, with no significant relapse in SNB, ANB, overjet, or overbite between T3 and T4. Soft tissue changes (T3-T4) for lower lip to E-line distance (mean -3.86 mm to -4.74 mm) and N'-Sn-Pog' angle (mean 159.91-162.11°) were statistically significant (P < 0.001) but not clinically relevant. Neurosensory disturbances were present in 21 patients after the surgery (72%), and these persisted in 13 at long-term follow-up (45%). Despite this, OQLQ scores indicated high patient satisfaction (mean 12.6, range 0-70), with minimal functional problems and improved oral health-related quality of life. These findings demonstrate the long-term skeletal and dental stability of BSSO with rigid fixation, as well as its effectiveness in achieving high patient satisfaction in the correction of skeletal Class II malocclusion.

In the management of oral squamous cell carcinoma (OSCC), neck dissection is essential for achieving loco-regional control. The submandibular gland (SMG) is frequently removed during this procedure, which may result in xerostomia and negatively affect postoperative quality of life. Although preservation of SMG could be beneficial, its oncological safety in OSCC remains uncertain. This retrospective, cross-sectional, multicentre study aimed to determine the prevalence of SMG involvement in OSCC, identify associated risk factors, and evaluate its impact on survival. Clinical and pathological data of OSCC patients diagnosed between 2000 and 2021 were analysed. Patients who did not undergo neck dissection, received neoadjuvant therapy, or had incomplete records were excluded. Data were obtained from the Malaysian Oral Cancer Database and Tissue Bank System. Survival outcomes were analysed using Kaplan-Meier estimates and log-rank tests. Among 223 included patients, SMG involvement was uncommon (n = 7, 3.1%). Most affected cases involved buccal mucosa OSCC and presented with advanced disease (cTNM stage IVa). SMG involvement was significantly associated with level Ib lymph node metastasis (P < 0.001) and extranodal extension (P = 0.013). No significant association was observed between SMG involvement and overall or disease-free survival. SMG preservation appears feasible in selected OSCC patients.

The aim of this study was to assess the long-term clinical outcomes of patients with temporomandibular joint (TMJ) ankylosis treated by interpositional arthroplasty using buccal fat pad (BFP). Fifty patients who had undergone the procedure and completed at least 1 year of follow-up were evaluated. no case of reankylosis was noted after a mean follow-up of 51.1 ± 23.7 months. Significant improvements were observed in postoperative mouth opening (35.36 ± 9.25 mm) and lateral excursion movements; ipsilateral excursion increased to 6.56 ± 2.99 mm and contralateral excursion improved to 2.78 ± 2.49 mm (all P < 0.001). Additionally, the study assessed patient quality of life using the Temporomandibular Joint Ankylosis Quality of Life (TMJAQoL) questionnaire, which includes 12 questions in four domains and two global ratings. The patients were divided into two age groups for this analysis: ≥12 years (n = 36) and <12 years (n = 14). Both groups showed significant improvements in the two global ratings and in the total TMJAQoL score. In conclusion, the use of BFP in interpositional arthroplasty for TMJ ankylosis was associated with no recurrence, improved mouth opening and jaw movements, and a significant improvement in patient quality of life.

This study was performed to investigate whether preoperative disc perforation is associated with postoperative condylar resorption (assessed as the 1-year change in mandibular ramus height) in skeletal Class II patients, and to analyse the preoperative temporomandibular joint (TMJ) morphology and synovial biomarkers in Class II and III patients. Orthognathic surgery patients treated between 2020 and 2022, who had undergone preoperative arthroscopy, MRI, CT, and synovial fluid analysis, were included. Three groups of patients were investigated: Class II with disc perforation (Class II/Pf(+); nine patients), Class II without disc perforation (Class II/Pf(-); eight patients), and Class III (seven patients). None of the Class III patients had disc perforation. Anterior disc displacement without reduction was significantly more common in Class II/Pf(+) than in Class II/Pf(-) (P = 0.033) and Class III (P = 0.017), suggesting that progressive disc displacement may lead to disc perforation. Moreover, TMJ osteoarthritis was significantly more frequent in Class II/Pf(+) than in Class II/Pf(-) (P = 0.037) and Class III (P = 0.005). Levels of IL-6 in the synovial fluid were significantly elevated in Class II/Pf(+) compared to Class III (P = 0.011), indicating an association between this inflammatory cytokine and the pathogenesis of TMJ deformities. Postoperative condylar resorption was significantly greater in Class II/Pf(+) (6.5%) than in Class II/Pf(-) (1.7%) (P = 0.019). These findings suggest that disc perforation in preoperative Class II patients is an important factor promoting postoperative condylar resorption. This study highlights the importance of preoperative evaluation of disc perforation in orthognathic surgery planning.

Orthognathic surgery is performed to correct dentoskeletal deformities and restore maxillomandibular symmetry. These changes may affect biometric identification and verification. The aim of this study was to assess the facial recognition capability of a commercially available software application in patients who had undergone orthognathic surgery. This retrospective study included 24 patients, of both sexes, who were treated for dentofacial deformities: 12 skeletal Class II and 12 Class III. Images of these patients taken in neutral expression and in smiling expression, acquired preoperatively and at 6 months postoperative, were analysed using the software via a machine-learning tool through two neural network models. The software identified similarities between the preoperative and postoperative images based on Euclidian distances (ED). Regarding recognition in neutral facial expression, there was no significant difference in the mean ED between classes II and III (P = 0.50). However, in smiling facial expression, a significant difference was observed, with a higher mean ED in Class III (P = 0.009). Moreover, a significant difference between neutral and smiling facial expressions was observed for Class III patients (P = 0.023), but not for Class II patients (P = 0.65). Although orthognathic surgery can result in considerable changes to the face, the program under evaluation demonstrated excellent performance in recognizing patient facial similarities.

The aim was to investigate the effects of botulinum toxin type A (BTX-A) treatment on sleep quality in patients diagnosed with probable sleep bruxism and awake bruxism. A prospective observational study was conducted on 40 female patients. All participants received standardized BTX-A injections (30 units in the masseter muscles, 20 units in the temporalis muscles). Sleep quality was assessed pre- and post-treatment using the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses compared pre- and post-treatment PSQI scores and included subgroup analyses. Significant improvements were observed in subjective sleep quality and in sleep latency, efficiency, duration, and disturbance (all P < 0.05). The proportion of patients with good sleep quality (PSQI ≤5) increased from 17.5% pre-treatment to 60% post-treatment (P < 0.001). Daytime function also improved significantly (P = 0.002). BTX-A treatment was associated with improved sleep quality in patients with probable bruxism, including reductions in sleep latency and disturbances, along with enhanced sleep duration and efficiency. Although the lack of a control group limits causal inference and the placebo effect remains unknown, the study findings suggest BTX-A injections may be an effective therapeutic approach for bruxism-related sleep impairments, highlighting the relationship between awake bruxism and sleep quality.

Acute airway obstruction in patients with head and neck conditions often results in a 'can't intubate, can't oxygenate' (CICO) situation, which requires a different management approach than the airway emergency guidelines in the context of anaesthesiology. This systematic review and meta-analysis synthesized and analysed the patient demographics, causes, presentations, complications, operators, and outcomes of emergent surgical airways performed in patients with head and neck conditions, and proposed a targeted management pathway. A total of 1011 emergent surgical airways reported in 14 studies were identified, including 961 tracheostomies and 50 cricothyrotomies. The analysis of patient demographics showed that 79% of the patients were male (95% confidence interval (CI) 73.3-84.1%), and mean age was 56.0 years (95% CI 51.5-60.5 years). The most common underlying cause was neoplasm (56.0%, 95% CI 37.4-73.7%). The most common preceding symptom was dyspnoea (66.6%, 95% CI 44.3-85.7%). The pooled mean complication rate was 16.8% (95% CI 8.8-26.6%). The airway-related mortality rate was 0.2% (95% CI 0.0-0.8%). The odds of successful decannulation were significantly increased in non-malignant tumour cases compared to malignant cases. The odds of complications were significantly increased for emergent surgical airways performed in locations other than the operating room.

Head orientation is a key component of orthognathic surgical planning, and sets the reference frame on which clinical assessment and surgical planning are performed. Hard tissue-based (HT) and soft tissue-based (ST) head orientation methods are commonly used, but their impact on symmetry is unclear. The purpose of this study was to analyze the impact of head orientation technique on symmetry assessment. Patients who underwent orthognathic surgery at a single center over 13 months were studied retrospectively. Preoperative computed tomography were oriented using HT and ST methods, and the roll and mediolateral positions of the maxillary dental midline (U1) and pogonion (Pog) were compared. In fifty-seven eligible subjects, the median roll difference was 0.64° (range 0-2.85°; P = 0.003), and the median absolute mediolateral position difference was 0.9 mm at U1 and 1.2 mm at Pog (both P = 0.003). The reliability of the both methods was excellent (intra-class correlation coefficient > 0.974; both P < 0.001). Use of HT and ST head orientation methods resulted in differing symmetry assessments, which could result in clinically significant deviations. Clinicians must balance the advantages and disadvantages of the HT and ST methods to properly apply each to their surgical workup protocols.

Accurate anatomical segmentation in computed tomography (CT) imaging is vital for diagnostics and virtual surgical planning in head and neck surgery, yet manual methods remain time-consuming and inconsistent. This study presents a dual-model artificial intelligence (AI) system that automates the segmentation of key craniofacial structures. A total of 388 clinical CT scans were processed using a two-stage nnU-Net-based approach: a coarse global model (3.0 mm resolution) followed by a fine local model (0.5 mm resolution). Ground truth segmentations of the skull, mandible, teeth, sinuses, and soft tissue were created by a single annotator and compared to the AI-based segmentation results using the Dice similarity coefficient (DSC), mean surface distance (MSD), and Hausdorff distance (HD) . High accuracy was achieved: mean DSC of 0.963 for mandible and skull, and 0.986 for soft tissue. Mean MSD values were lowest for maxillary sinus (0.134 mm) and mandible (0.150 mm). While HD remained low overall, soft tissue showed high variability (mean 25.138 mm). The AI system proved robust across varied imaging protocols, including low-resolution scans. By significantly reducing manual segmentation efforts while ensuring clinical precision, this open-access dual-model framework offers a scalable solution for diagnostic, surgical, and educational applications in craniofacial care.