International journal of oral and maxillofacial surgery最新文献

This retrospective study examined factors influencing labial bone resorption in the anterior maxilla 6 months after implant insertion with simultaneous guided bone regeneration. Involving 79 patients (118 implants), the study measured labial horizontal bone width and vertical dimensions using cone beam computed tomography scans taken immediately after surgery and at 6 months. A generalized linear mixed model analyzed potential influencing factors: age, sex, implant site, timing of placement, buccal bone width at the implant platform level post-surgery, implant connection, and bone defect morphology. Significant bone resorption was noted at 6 months. The statistical analysis revealed that buccal bone width at the implant platform, implant connection, and bone defect morphology significantly impacted labial bone resorption, while patient age, sex, timing of placement, and implant site did not. Implants with a buccal bone width ≥2 mm showed significantly less labial horizontal and vertical bone resorption (horizontal P < 0.001, vertical P = 0.001), and healing abutments reduced resorption compared to cover screws (horizontal P = 0.002, vertical P = 0.034). More significant vertical resorption occurred in non-contained bone defects after guided bone regeneration (P = 0.040).

Midface resection is a surgical procedure with varying degrees of complexity, ranging from partial upper jaw removal to exposure of the dura mater after resection. Existing classifications for the resulting midfacial defects are inconsistent and have issues regarding terminology, therefore a consensus is needed. The aim of this review was to analyse the previously published classifications, identify defining parameters, determine their strengths and weaknesses, and propose a universal classification for midfacial defects with the goal of being sufficiently detailed yet easily applied in clinical practice. A scoping review was conducted according to the PRISMA guidelines using the PubMed, Embase, and Wiley Online Library electronic resources. Analysis of the various midfacial resection classifications identified in the search revealed common parameters including anatomical landmarks, the walls removed, and the presence of oroantral communication, as well as an accompanying algorithm and options for reconstruction. The articles with the most detailed descriptions were noted. A new classification is proposed that includes elements of the three most detailed existing classifications, incorporating the vertical and horizontal extents of the defect, but with more specific details concerning severity and aimed at greater practical clinical utility.

Local anaesthetic injections, commonly used in dentistry and oral surgery, often cause discomfort. This review aimed to examine the impact of intraoral photobiomodulation therapy (PBMT) on pain associated with local anaesthesia. Up to March 2024, two independent reviewers searched four databases, ultimately screening 17 randomized controlled trials for meta-analysis using Stata 17.0. The results indicate that intraoral PBMT application significantly reduces the perception of pain associated with local anaesthetic injections (standardized mean difference (SMD) -0.89, 95% confidence interval (CI) -1.27 to -0.52; P < 0.001). This analgesic effect remained consistent irrespective of concurrent topical anaesthetics, and PBMT was efficacious in paediatric (SMD -0.53, 95% CI -0.89 to -0.17; P = 0.004) and adult (SMD -1.46, 95% CI -2.32 to -0.61; P = 0.001) populations. Subgroup analysis provided very low to low-quality evidence that using a wavelength between 900 nm and 980 nm (SMD -0.87, 95% CI -1.36 to -0.39; P < 0.001) and an irradiation time of 13-40 s (SMD -0.94, 95% CI -1.35 to -0.53; P < 0.001) are associated with significant pain reduction. The use of PBMT could aid in reducing pain perception for patients during dental injections, encouraging earlier presentation for dental consultations.

The purpose of this study was to evaluate the performance of convolutional neural network (CNN)-based image segmentation models for segmentation and classification of benign and malignant jaw tumors in contrast-enhanced computed tomography (CT) images. A dataset comprising 3416 CT images (1163 showing benign jaw tumors, 1253 showing malignant jaw tumors, and 1000 without pathological lesions) was obtained retrospectively from a cancer hospital and two regional hospitals in Thailand; the images were from 150 patients presenting with jaw tumors between 2016 and 2020. U-Net and Mask R-CNN image segmentation models were adopted. U-Net and Mask R-CNN were trained to distinguish between benign and malignant jaw tumors and to segment jaw tumors to identify their boundaries in CT images. The performance of each model in segmenting the jaw tumors in the CT images was evaluated on a test dataset. All models yielded high accuracy, with a Dice coefficient of 0.90-0.98 and Jaccard index of 0.82-0.97 for segmentation, and an area under the precision-recall curve of 0.63-0.85 for the classification of benign and malignant jaw tumors. In conclusion, CNN-based segmentation models demonstrated high potential for automated segmentation and classification of jaw tumors in contrast-enhanced CT images.

Longitudinal follow-up data of 1557 patients with cleft palate (CP) was used to identify risk factors for palatal fistula (PF) formation after double-opposing Z-plasty (DOZ), performed by a single surgeon. Overall, 104 (6.7%) of the patients developed PF, all of which were identified within the first month following DOZ. The incidence of PF for clefts of Veau class 1, 2, 3, and 4 was 0%, 6.5%, 4.4%, and 20.3%, respectively. The PFs were pinpoint-shaped in 38.5% of cases, slit-shaped in 40.4% (2-8 mm), and other (10-96 mm²) in 21.1% . Among patients with PF, 14 (13.5%) chose surgical repair; recurrence was observed in four patients, of whom two showed secondary healing. Among the 90 unrepaired cases, 68 (75.6%) showed symptom resolution, mostly within 1-3 years. Recovery varied by PF size category: 81.1% of pinpoint, 71.4% of slit-shaped, and 100% of other fistulas healed spontaneously over a median 9, 3, and 21.5 months, respectively. Multivariate logistic regression analysis identified cleft width as the most significant predictor of PF development (odds ratio 1.25, P < 0.001), while the Veau classification was not a significant determinant. This study identified cleft width as a critical determinant of the risk of PF following DOZ. A conservative strategy that prioritizes symptomatology over PF size (for PFs <1 cm²) is worthy of consideration.

Vascular complications occurring in Eagle syndrome are seldom described. The aim of this study was to systematically review the occurrence, characteristics, and management outcomes of vascular complications occurring in Eagle syndrome. A systematic review was conducted with a search in several databases. The research question was "What characterizes Eagle syndrome with vascular complications and how should it be managed?" The initial search yielded 4145 results; 150 of these were included, reporting a total of 231 patients with vascular complications. Arterial impingement (67.5%) was more frequent than venous impingement (32.5%). The most frequent consequence of arterial impingement was stroke (46.8%), while for venous impingement it was chronic headache (68%). Seventy-nine patients underwent styloidectomy as initial treatment: 78.5% of the patients were cured and 19.0% improved, while only 2.5% showed a recurrence. On the other hand, among the 106 patients treated medically without initial styloidectomy, only 24.5% of the patients were cured, 28.3% improved, and 47.2% had a recurrence. The association of symptoms of classic Eagle syndrome with neurovascular symptoms should prompt clinicians to consider this diagnosis and to measure the styloid length. Styloidectomy is the treatment of choice to obtain the best cure rate and reduce recurrence.

Temporomandibular joint (TMJ) prostheses are considered an important alternative for the treatment of severe end-stage TMJ disorders. However, unilateral TMJ replacement may affect the healthy contralateral TMJ. The purpose of this study was to systematically review the literature on the effects of unilateral total TMJ prosthesis placement on the contralateral healthy TMJ. The PubMed, Scopus, Web of Science, and Cochrane Library databases were searched for English-language articles published up to December 2023. Inclusion criteria encompassed clinical studies (randomized, prospective, retrospective, observational) that evaluated clinical and patient-reported outcomes after total unilateral TMJ prosthesis placement (both glenoid and mandibular components). The initial search identified 141 non-duplicate studies, of which eight remained after title and abstract reading. Four studies included only unilateral prostheses; the other four included bilateral interventions and/or control groups without any TMJ intervention. The studies reported on stock and custom prostheses, with custom prostheses being the most used. As the studies had different specific objectives, no pattern of data reporting was found and the research question could not be answered. Randomized clinical trials with standardized variables are required to achieve reliable conclusions. Furthermore, long-term follow-up is necessary to determine whether the function of the healthy TMJ is compromised.

The last decades have witnessed significant improvements in orthognathic surgery, but a true standardization of cephalometric analysis to guide clinical assessment in three-dimensional (3D) virtual planning is still lacking. Therefore, the aim of this study was to validate the 'total face approach' (TFA) 3D cephalometric model for the diagnosis of dysmorphia and to analyse its correlation with the clinical diagnosis and virtual surgical planning performed in the Maxillofacial Surgery Clinic in Udine. This model was validated by studying different cephalometric points in three modules (vertical dimensions, sagittal dimensions, and symmetry) and their sections. Each section of the different modules evaluates the range of the studied patient according to the TFA analysis executed in Planmeca Romexis software and compares it with the ProPlan CMF data. The results of the statistical analysis defined the degree of concordance for each point studied. An overall high correlation was demonstrated for each of the cephalometric categories (weighted kappa between 0.442 and 0.642 in vertical dimension, between 0.587 and 1 in sagittal dimension, and between 0.773 and 1 in symmetry). The TFA model can be considered a valuable guide for the diagnosis of dysmorphia and 3D virtual planning of orthognathic maxillofacial surgery.