International journal of oral and maxillofacial surgery最新文献

Surgery is the preferred treatment option for those with severe or refractory osteoradionecrosis (ORN). This retrospective cohort study evaluated surgical management outcomes for mandibular ORN in 36 patients treated at The Royal Melbourne Hospital between 2017 and 2024. Most patients were male (mean age 67.9 years) with Notani Stage III ORN (81%). Common risk factors included radiation >60 Gy (83.6%), smoking (66.6%), and alcohol use (77.8%). A total of 59 surgeries were performed: 46 debridement and 13 segmental mandibulectomies. ORN was associated with high morbidity and mortality (19% died during follow up). Debridement gave long-term relief in 13% of patients, delaying second and third surgeries by 10 and 23 months, respectively. Segmental resections were significantly associated with ORN healing (odds ratio = 10.7, P < 0.001). Segmental mandibulectomy provided sustained relief in 62% and was 10 times more effective than debridement in achieving healed ORN. Debridement and segmental mandibulectomy both have a role in management of mandibular ORN. Debridement provides more time for tissues to recover post-radiotherapy, to exit the high-risk period for cancer recurrence and to allow medical interventions, e.g., smoking cessation.

In splint-based Le Fort I osteotomy (LFI), variations in condyle-fossa relationship can influence surgical accuracy. The aim of this study was to investigate the impact of the preoperative joint space (JS) on surgical errors. This retrospective study included patients status post splint-based maxilla-first LFI at a single institution in a 7-month period. Preoperative JS was measured on preoperative cone-beam computed tomography (CBCT), while angular and linear surgical movements at the maxillary dental midline (U1) were measured using regional voxel-based registration. In 26 eligible subjects, the mean absolute linear and angular errors were 0.82-1.18 mm and 0.87-1.21°, respectively. The greatest superior and posterior preoperative JS correlated with mediolateral (P = 0.020) and anteroposterior (P = 0.019) error, respectively. JS was not associated with angular errors (P > 0.05). Laterality of the greater posterior preoperative JS was associated with the mediolateral linear error (P = 0.026). Regression analysis showed that 3.92 mm posterior preoperative JS resulted in 1 mm anteroposterior error, and a left-to-right posterior preoperative JS differential of 1.35 mm resulted in 1 mm mediolateral error. Vertical and anteroposterior preoperative JS can affect accuracy in maxilla-first splint-based LFI. Routine preoperative evaluation can help identify at-risk cases.

Arthrocentesis is commonly employed for symptomatic temporomandibular joint (TMJ) disorders when conservative treatments are unsuccessful. To date, the optimal timing for initiating arthrocentesis remains unclear. This retrospective cohort study, undertaken at a tertiary centre over two decades, aimed to evaluate the association between symptom duration and treatment success of initial arthrocentesis. Adults with painful TMJ disorders were included. The exclusion criteria were prior TMJ surgery, systemic rheumatic or connective tissue diseases, bony ankylosis, dentofacial deformities or significant TMJ trauma. The primary study outcome was patient-reported treatment success over 5 years. Generalized estimating equation (GEE) models were performed to evaluate the association between symptom duration and treatment success, and included the prognostic factors age, gender, diagnosis, preoperative conservative treatments, and adjuvant therapy during arthrocentesis. A total of 438 subjects were included in the study. GEE models indicated that a longer symptom duration was significantly associated with lower odds of patient-reported treatment success over a follow-up period of 5 years (odds ratio 0.974 per month, 95% confidence interval 0.966-0.983; P < 0.001). Within its limitations, this study indicates that performing arthrocentesis at an earlier stage may increase the likelihood of reaching adequate symptom reduction in the management of painful TMJ disorders.

Severe atrophy of the edentulous maxilla poses a significant surgical challenge. This technical note presents a novel approach combining Le Fort I osteotomy, bilateral sinus augmentation, and titanium mesh guided bone regeneration. Preoperative prosthetic planning allows accurate maxillary repositioning to restore a skeletal Class I relationship and enable an implant-supported prosthesis without prosthetic gingiva. The titanium mesh provides stable, three-dimensional support for uniform ridge reconstruction, enabling ideal implant placement. This technique offers a reproducible and less invasive alternative to conventional autogenous grafting in pre-implant reconstructions.

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.