International journal of oral and maxillofacial surgery最新文献

While magnetic resonance imaging (MRI) is the reference standard for diagnosing temporomandibular joint disc displacement, limited accessibility necessitates alternative approaches. This systematic review and meta-analysis evaluated whether osseous markers on conventional or cone-beam computed tomography (CT/CBCT) accurately detect disc displacement compared to MRI. PubMed, Cochrane Library, and Google Scholar were searched through May 31, 2025. Study quality was assessed using QUADAS-2. Twenty studies were included, categorized into pathological changes, morphology, and joint space measurements. Bivariate random-effects meta-analyses showed the pathological changes group (seven studies) had a pooled sensitivity of 74%, specificity of 83%, and diagnostic odds ratio (DOR) of 7.77. The morphology subgroup (10 studies) demonstrated sensitivity of 73%, specificity of 79%, and DOR of 9.77. The joint space subgroup (eight studies) revealed sensitivity of 72%, specificity of 81%, and DOR of 11.41. Limitations include heterogeneity and varying imaging protocols. Findings support CBCT or CT as a valuable alternative diagnostic tool when MRI is unavailable. A clinical decision-making algorithm was developed to guide diagnostic confidence.

The fibula free flap (FFF) is commonly used in mandible reconstruction due to its good bone length and volume, and availability of a long vascular pedicle - the fibular artery (FA). In this study, digital subtraction angiography (DSA) was utilized to evaluate the lower leg arteries in 130 patients (48 female, 82 male). The mean distance from the fibula head to the fibular artery (FA) origin was 72.8 mm, with significant differences between sexes (P=0.019) and sides in males (P=0.033). FA diameters were significantly larger in males (P=0.042); in females, right-side FA diameters were larger than left (P=0.002). While stenosis grades varied significantly by side for popliteal and tibial arteries, the FA remained consistent. However, females showed higher popliteal stenosis (P=0.028). Notably, the FA was the primary foot supply in 20% of cases (24.0% females, 17.7% males). DSA provides valuable information for preoperative planning and for safe and effective FFF transfer. This study adds to our understanding of the lower leg vessel anatomy, supporting surgeons in selecting the most suitable flap.

Three-dimensional imaging, 3D printing, and computer-assisted planning have revolutionized craniofacial surgery, allowing surgeons to fabricate surgical splints in-house. While this shift enhances efficiency and data security, research comparing the quality of in-house versus industry-produced splints remains limited. This study evaluated 20 orthognathic surgery cases to compare industry-generated splints (IND) with in-house-fabricated splints (IHS). Using 3D-printed dental models and a modified American Board of Orthodontics Objective Grading System, two blinded orthodontists assessed the resulting occlusions. Higher scores indicated superior occlusal quality. The results demonstrated that in-house splints (mean score 29.70) yielded significantly better occlusal outcomes than industry splints (mean score 27.28) (P = 0.013). This suggests that, following an initial learning curve, oral and maxillofacial surgeons can produce in-house splints that meet or exceed the quality of third-party industry standards. In-house fabrication serves as a highly effective, viable alternative for orthognathic surgical planning, offering clinical advantages alongside logistical benefits.

Osimertinib, an epidermal growth factor receptor tyrosine kinase inhibitor, improves the progression-free and overall survival of patients with inoperable or recurrent non-small cell lung cancer. However, it is reportedly associated with osteonecrosis of the jaw and oral mucositis due to its ability to reduce osteoclast differentiation and inhibit angiogenesis. A 73-year-old woman had been receiving osimertinib for recurrence after lung adenocarcinoma surgery; 3 years later she presented with bone exposure and buccal mucosal necrosis. After the clinical diagnosis of medication-related osteonecrosis of the jaw with soft tissue necrosis, osimertinib was discontinued. Four months after discontinuing osimertinib, she underwent hemimandibular resection and immediate fibular graft reconstruction under general anesthesia. Eight months postoperatively, the wound had healed, and graft ossification was satisfactory. This case highlights that osimertinib may be linked to osteonecrosis of the jaw and soft tissue necrosis. When discontinuing osimertinib, close cooperation between cancer physicians and dentists is essential, given the potential for underlying disease progression.

Artificial intelligence (AI) is increasingly used in oral and maxillofacial surgery (OMS) for imaging, planning, and robotic/navigation support, yet ethical and legal governance remains unsettled. We conducted a PRISMA-ScR scoping review to map clinical applications and associated risk domains. PubMed/MEDLINE, Scopus, and Web of Science were searched for English-language articles published from January 2015 to July 2025. Eligible records reported a clinical AI application in OMS or analyzed ethics/legal issues relevant to OMS; purely technical papers without clinical linkage, non-indexed sources and conference abstracts, non-English items, and records without an abstract were excluded. Two reviewers screened studies independently with consensus on inclusion. Of 2158 records, 99 met eligibility. Ethical discussions most often addressed accuracy/reliability, transparency/explainability, and bias/fairness. External multicenter validation and calibration were uncommon, prospective decision-impact or effectiveness studies were rare, and no large randomized trials were identified. Recurrent ethical-legal themes included informed consent for AI involvement, fairness auditing, privacy and data protection, allocation of responsibility for decision-support versus autonomous functions, and post-deployment monitoring for performance drift. AI shows encouraging technical performance in OMS, but patient benefit will require stepwise, monitored integration, standardized reporting, prospective studies, strengthened consent processes, fairness and privacy safeguards, and clear professional and manufacturer accountability.

The intraoral vertical ramus osteotomy (IVRO) is a widely used for mandibular prognathism, offering segmental mobility, lateral overlap, immediate repositioning of the proximal segment, and direct cortex-to-cortex contact between the segments. Unlike the sagittal split ramus osteotomy, IVRO provides a dynamic healing environment with unrestricted segment movement. This retrospective study was performed to analyze the osseous healing and remodeling patterns following IVRO, using CBCT. CBCT images obtained at 1 month and 1 year postoperatively were assessed to evaluate osseous union and segment overlap. At 1 month postoperative, complete osseous union was significantly more frequent in rami with an intersegmental gap ≤1.5 mm compared to those with a gap >1.5 mm (P = 0.002 and P = 0.003, for the two planes of observation). There was no significant relationship between the type of overlap pattern at 1 month postoperative and osseous union at 1 year postoperative. A significant positive correlation was observed between the intersegmental gap at 1 month postoperative and total ramus width at 1 year postoperative; total width increased by approximately 0.55 mm for every 1-mm increase in intersegmental gap (P = 0.008). The study findings suggest that maintaining a gap below the critical threshold of 1.5 mm enhances osseous healing.

The aim of this study was to analyse and compare the biomechanical performance of a novel drilling technique known as osseodensification, which focuses on bone preservation and compaction rather than removal, against the conventional osteotomy technique in implant placement. Online databases were searched to identify relevant articles published in English during the last 10 years (up until September 11, 2025), reporting in vivo clinical trials involving a healthy adult population undergoing single or multiple implant placement, and comparing osseodensification and standard osteotomy drills, in a partially or fully edentulous segment of alveolar bone. Biomechanical measures analysed were the insertion torque and implant stability quotient (ISQ). Risk of bias and study quality were evaluated using the RoB 2 tool, Newcastle-Ottawa Scale, and GRADE system. The results were synthesized. Overall, a total of 555 patients (59.2% female, in studies reporting the sex distribution), received a total of 685 implants (343 using osseodensification). The overall mean insertion torque in the osseodensification group was 45.75 ± 6.55 N·cm, while in the standard osteotomy group it was 38.00 ± 7.01 N·cm (P < 0.001). The estimated average mean difference in ISQ (random-effects model) was 3.24 (95% confidence interval 0.72-5.95; P = 0.024). The data showed that sites prepared with osseodensification resulted in higher implant torque and primary stability of the implant (ISQ) immediately postoperative. However, longitudinal data were insufficient to allow a meaningful statistical analysis of ISQ trends over time.

In oral squamous cell carcinoma (OSCC) with mandibular invasion, precise preoperative delineation of the tumour within bone is crucial for three-dimensional (3D) virtual surgical planning and postoperative outcomes. Magnetic resonance imaging (MRI) and computed tomography (CT) enable 3D delineation, but MRI often overestimates tumour size due to inflammation and peri-tumoral oedema, potentially leading to excessive resections and increased morbidity. A quantitative 3D analysis of overestimation by MRI is lacking. A postoperative pathological assessment workflow to determine delineation accuracy was developed in this study. Eight patients with OSCC who underwent mandibular resection were included. A guide enabled precise gross sectioning of resected mandibles, and the sections were analysed histopathologically for bone invasion and erosion. Delineation error was measured and expressed as the length of over-resected bone. MRI-based delineation overestimated tumour size in all patients, with a mean length of over-resected mandibular bone, omitting the 10-mm safety margin, of 32 ± 16 mm. Bone invasion and erosion were observed in six cases. This study highlights the need for improved imaging feedback. Overestimation from MRI may lead to excessive resection of healthy tissue. Enhanced imaging feedback is essential to support radiologists and surgeons in achieving more precise delineations and preserving healthy tissue.