International journal of oral and maxillofacial surgery最新文献

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.

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.