International journal of oral and maxillofacial surgery最新文献

Retrogenia, despite its anatomical significance, remains under-recognized as a contributing factor in obstructive sleep apnoea (OSA). While retrognathia and micrognathia are well-documented, retrogenia as an isolated morphological variant has received limited attention in the context of OSA. This technical note introduces the genial swing orthomorphic osteotomy (GSOO), a novel orthomorphic surgical technique specifically designed to address dysmorphology associated with retrogenia. The procedure repositions the genial segment to enhance posterior airway space, while also achieving favourable facial aesthetics. The surgical technique is described in detail, highlighting key anatomical considerations, planning steps, and intra-operative execution. Preliminary application in two patients with OSA secondary to retrogenia demonstrated improvements in airway dimensions, apnoea-hypopnoea index (AHI), and facial profile as well as significant improvement across all eight symptoms domains of the OSA QoL (Quality of Life) questionnaire. The technique presents as a promising intervention for selected patients with OSA linked to retrogenia, warranting further clinical evaluation.

This retrospective study investigated morphological changes in the upper airway in 40 unilateral hemifacial microsomia patients following surgery. Sixteen paediatric patients underwent mandibular distraction osteogenesis (MDO), and 24 adult patients underwent MDO and/or orthognathic surgery. Pre- and postoperative computed tomography scans were acquired. Three-dimensional airway models of pediatric and adult cohorts were separately analyzed to assess volume, cross-sectional area, surface area, asymmetry and shape. In children, total mean ± standard deviation (SD) airway volume increased significantly from 9427.31 ± 4648.74 to 12,476.12 ± 5994.49 mm³ (P = 0.003), and mean ± SD cross-sectional area increased from 138.69 ± 59.89 to 178.39 ± 74.06 mm² (P = 0.006) after surgery. Surface area and minimum cross-sectional area also improved significantly. Asymmetry indices in the glossopharynx and hypopharynx decreased postoperatively. In adults, mean airway volume increased from 16,592.01 ± 3303.73 to 22,166.72 ± 4447.17 mm³ (P < 0.001), with significant gains in all pharyngeal regions except the nasopharynx. Improvements were also seen in surface area, symmetry and airway sphericity. These findings indicate that MDO and orthognathic surgery can improve the structure of the upper airway significantly in hemifacial microsomia patients. Incorporating airway analysis into surgical planning may enhance treatment outcomes for affected individuals.

Despite lower reported accuracy of genioplasty osteotomies, significant variation exists in the accuracy analysis techniques, without full validation. The purpose of this study was to compare the accuracy of surface-based registration (SBR) and regional voxel-based registration (R-VBR) for genioplasty osteotomies, to allow greater rigor in scrutinizing accuracy data. In a retrospective cross-sectional study of consecutive genioplasty patients at a single-center over a 5-year period, postoperative cone-beam computed tomography (CBCT) scans were collected. The CBCTs were oriented to a known pitch/roll/yaw and set as the reference, and compared with the unoriented raw volumes. Both volumes were segmented to surface models, and SBR was performed using the genioplasty segment as the mutual region of interest. Angular (°) and linear (mm) errors at the pogonion and menton were measured, and compared with those of R-VBR, with accuracy thresholds of 0.5° and 0.3 mm. In 34 eligible subjects, angular errors ranged from 0.32° to 0.64°, and linear errors ranged from 0.11 to 0.44 mm for SBR (P < 0.001). R-VBR showed greater angular errors, but smaller linear errors of 0.10 to 0.20 mm (P < 0.001). SBR and R-VBR have variable accuracy for genioplasty, with angular and linear accuracy favoring SBR and R-VBR, respectively.

Oral squamous cell carcinoma (OSCC) and head and neck squamous cell carcinoma (HNSCC) are aggressive malignancies with poor survival rates, largely attributable to late diagnosis. Salivary microRNAs (miRNAs), particularly exosome-derived miRNAs, have emerged as promising non-invasive biomarkers for early detection and prognostic assessment. This systematic review evaluated the diagnostic and prognostic value of free and exosomal salivary miRNAs in OSCC and HNSCC. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for studies published between January 2008 and May 2025. Studies assessing salivary miRNAs in histologically confirmed OSCC/HNSCC using validated molecular techniques were included, with quality assessed using QUADAS-2. Forty-two studies encompassing 2577 patients/samples were analyzed. Several miRNAs, including miR-21, miR-31, miR-1307-5p, and miR-486-5p, demonstrated high diagnostic accuracy (AUC > 0.85), while others were significantly associated with lymph node metastasis, treatment response, and survival outcomes. Exosomal miRNAs generally showed superior stability and predictive performance compared with free miRNAs. However, substantial methodological heterogeneity was observed. Overall, salivary miRNAs-particularly exosomal-represent promising biomarkers for OSCC and HNSCC, although standardized protocols and large-scale validation studies are required for clinical translation.

Surgical techniques in orthognathic surgery have recently evolved and now tend towards soft-tissue-preserving approaches. The concept of minimally invasive Le Fort I osteotomy and down-fracture is interesting, as it preserves almost all paranasal and upper-lip musculature. It has already been described with a four-point fixation on the canine and zygomatic buttress pillars, depending on the mucosal incision length and plate type. This article proposes an alternative technique, respecting the concept of minimally invasive surgery, with a very small medial mucosal incision adding two lateral punctiform incisions, thus enabling a four-point fixation of the Le Fort I fracture. This technique allows wide maxillary movements, significant maxillary expansion; and can be performed even if the surgeon does not have very specific instrumentation. Compared with previously described techniques, this approach offers equivalent surgical exposure, improved access for four-point fixation, and greater safety against mucosal tearing, while maintaining the minimally invasive concept.

Lip arteriovenous malformations (AVMs) are rare vascular anomalies that cause significant functional and aesthetic problems. The aim of this study was to evaluate the effectiveness and safety of multimodal therapy combining percutaneous sclerotherapy, partial excision, and pulsed dye laser. A retrospective review was conducted of 20 patients (11 female, nine male; median age 37 years) with lip AVMs treated between 2008 and 2019. All patients underwent ultrasound-guided percutaneous sclerotherapy using 3% foamed polidocanol, with additional use of absolute ethanol in four patients. Near-infrared fluorescence imaging and mechanical compression techniques were employed to optimize sclerosant delivery. Patients with residual swelling after nidus reduction underwent partial excision, and pulsed dye laser was used for persistent superficial erythema. The median number of sclerotherapy sessions was three, and the median follow-up period was 58 months. Partial excision was performed in 16 patients, and laser therapy in six patients. The clinical outcome was classified as 'controlled' in nine patients and 'improved' in 11 patients. Complications occurred in two patients: mucosal ulceration in one patient and wound dehiscence in the other. These results suggest that this stepwise multimodal approach provides favourable outcomes with a low complication rate in the management of lip AVMs.

Primary sebaceous adenocarcinoma (SAC) of the parotid gland is extremely rare, and because of its rarity, its behaviour is not fully understood. The aim of this study was to clarify the behaviour of SAC of the parotid gland, including the main features and their relationships to the prognosis. Sixty-six reported cases of the disease were identified and included in the study, and these were reviewed and analysed. SAC of the parotid gland occurred in patients aged 6-92 years, with a bimodal age distribution (20 s and 50-70 s). Of the 66 patients, 59% were female and 41% were male, giving a male to female ratio of 1:1.4. The prognosis was statistically superior for cases without perineural invasion (P = 0.030), those in age group <70 years when compared ≥70 years (P = 0.008), primary cases when compared to secondary cases (P = 0.009), and cases in which the primary treatment was surgery only (P = 0.007). The results showed that in SAC of the parotid gland, the death rate from cancer (66.7%) was higher than that for skin SAC, while the 5-year survival rate (71.4%) was lower than that in skin SAC.

This retrospective multicentre study investigated the effects of pterygomaxillary disjunction (PD) and nasal septum disinsertion (NSD) by comparing two minimally invasive bone-anchored surgically assisted rapid palatal expansion techniques in adult patients. The analysis focused on their impact on the nasal septum and the extent of palatal expansion. Forty patients were allocated to two groups: G1 (without PD and NSD) and G2 (with PD and NSD). The transverse opening pattern in the anterior and posterior regions, as well as changes in the position of the nasal septum, were evaluated using cone beam computed tomography images. Both groups showed significant anterior and posterior transverse gains (G1: 4.8 mm and 2.9 mm; G2: 5.7 mm and 3.8 mm; all P ≤ 0.001). There was no significant difference between the groups in anterior or posterior opening (P = 0.44, P = 0.20). Both groups showed slight nasal septum displacement, but without statistical relevance (linear: P = 0.099, P = 0.072; angular: P = 0.062, P = 0.16). Both techniques were effective in treating maxillary deficiency in adult patients. The study suggests that PD and NSD may not be essential steps to achieve adequate palatal expansion with minimally invasive surgeries.

Tooth loss in the aesthetic zone, particularly of a maxillary incisor, can substantially affect function, appearance, and patient well-being. Immediate implant placement with provisionalization is widely used, but is traditionally limited to non-inflamed extraction sites. This retrospective cohort study compared the 1-year outcomes of immediately placed dental implants replacing a maxillary incisor in patients with and without chronic peri-apical periodontitis. Clinical records of patients treated between January 2019 and December 2022 were reviewed. Outcome variables included implant survival, preoperative clinical and/or radiological inflammation, primary implant stability measured by the implant stability quotient (ISQ), and peri-implant soft tissue aesthetics assessed using the pink aesthetic score (PES) on standardized pre- and postoperative photographs. A total of 133 implants were included, of which 42 were placed in inflamed extraction sockets and 91 in non-inflamed sockets. After 1 year, implant survival was 97.6% in the inflamed group and 97.8% in the non-inflamed group, with no statistically significant difference (P = 0.96). No significant intergroup differences were observed for ISQ (P = 0.35) or change in PES from baseline to 1 year (P = 0.89). These findings suggest that immediate implant placement for maxillary incisor replacement provides comparable 1 year survival, stability, and aesthetic outcomes.

Revision surgery remains the standard treatment for parotid recurrent pleomorphic adenoma (RPA). Despite recent advancements in surgical techniques, the management of the facial nerve (FN) during parotid RPA surgery still poses a challenge. This retrospective study collected demographic data, clinical characteristics, and details of the surgical procedure, with a particular focus on FN management of parotid RPA patients between 2020 and 2024. Sixty-six patients who underwent parotid RPA surgeries were included; the FN was successfully preserved in 39 (59%). A significant difference in recurrence frequency was observed between patients with and without FN preservation (P = 0.006). Among the 27 patients who underwent intraoperative FN sacrifice, eight received direct coaptation, 12 underwent great auricular nerve grafting, three were treated with nerve transfer, and four received dual innervation. Postoperative recovery was favourable (HBGS ≤ III) in 19 of these patients. Based on these findings, an algorithm for FN management during parotid RPA revision surgery is proposed. Preservation of the FN should be prioritized during parotid RPA revision surgery. In cases of FN sacrifice, immediate repair is recommended. The proposed algorithm offers a structured approach to FN management in various surgical scenarios during parotid RPA revision procedures.