International journal of oral and maxillofacial surgery最新文献

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.

This report describes a case of peripheral ameloblastoma of the mandible with metastasis to a cervical lymph node. The clinicopathological characteristics of both the primary and metastatic tumours are presented. In addition, a comprehensive review of the literature pertaining to this rare phenomenon was performed, covering the past 50 years. A 76-year-old male, who had undergone successful surgical resection of a right mandibular peripheral ameloblastoma 10 years earlier, presented with metastatic lesions in a cervical lymph node. Both the primary lesion and the metastatic specimen were re-examined using haematoxylin-eosin staining and immunohistochemical methods. Pathological examination revealed that both the primary and metastatic lesions were cytologically benign. The literature search identified 207 articles, among which 59 reported cases of ameloblastoma with metastasis. All reported cases involved intraosseous ameloblastoma, with the exception of one case of peripheral ameloblastoma reported in 1987. The diagnosis in such cases is often challenging due to the presence of multiple lesions. Both haematogenous and lymphatic metastases may occur, particularly in cases with multiple local recurrences and surgical interventions. In summary, metastatic ameloblastoma is very rare, and peripheral ameloblastoma with lymph node metastasis is even more uncommon, especially after successful surgery for the primary lesion.

There is a well-documented relationship between the monoclonal antibody (MAB) denosumab and medication-related osteonecrosis of the jaw (MRONJ). However, the association between other MABs and MRONJ remains unclear. A systematic search was conducted across MEDLINE, Embase, and Web of Science to identify articles describing cases of MRONJ associated with the use of MABs excluding denosumab. The Joanna Briggs Institute (JBI) critical appraisal checklist for case reports and case series was used to critically appraise all included studies. Demographics, clinical presentation, risk factors, MRONJ staging as per the American Association of Oral and Maxillofacial Surgeons (2014), treatment modalities, and outcomes were extracted and analysed. A total of 2324 articles were identified and screened, of which 30, describing 32 cases of MRONJ, met the inclusion criteria. In most cases, MRONJ presented at an advanced stage (stage 2 or 3), and it was often precipitated by dental extractions. Bevacizumab was the most common MAB linked to MRONJ, followed by other MABs including infliximab, pembrolizumab, adalimumab, and rituximab. This review demonstrated a broad spectrum of MABs associated with MRONJ and highlights the need for enhanced preventive measures, early diagnosis, and effective management strategies.

Device failures during critical medical procedures can jeopardize treatment outcomes. This report documents the innovative use of 3D scanning and resin 3D printing to fabricate a modified screwdriver to achieve effective activation of bilateral mandibular external multi-vector distraction devices on a patient undergoing counterclockwise craniofacial distraction osteogenesis. The modified screwdriver served as a rescue device, as the external midface device obstructed activation of the mandibular external distractors with the manufacturer-supplied activation screwdriver. By designing and fabricating a custom screwdriver, successful device activation and treatment continuation were ensured.

Nevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal dominant hereditary condition associated with developmental abnormalities and tumourigenesis with a prevalence rate of 1:60,000. The objective of this study was to identify NBCCS in patients diagnosed with odontogenic keratocysts (OKC) at Nair Hospital Dental College in Mumbai, India, and to compare the findings with those from Indian and international studies. Archived institutional data on OKC cases from the years 2009-2024 were analysed for NBCCS based on the criteria established by Kimonis et al. in 1997. Of the 231 cases of OKC identified, 39 (16.9%) met the diagnostic criteria for NBCCS; 27 were male and 12 were female (age range 8-55 years). Major criteria observed were OKC, palmar/plantar pits, rib anomalies, calcification of the falx cerebri, basal cell carcinomas, and a positive family history. Minor criteria included ocular hypertelorism, frontal bossing, macrocephaly, multiple pigmented nevi, syndactyly, Sprengel deformities, ovarian fibromas, and vertebral anomaly. Synophrys was found in 76.9% of cases. Analysis of criteria across countries suggests that NBCCS features in India may vary due to genetic or geographical factors The high prevalence of synophrys in this study suggests its inclusion as a new diagnostic criterion for NBCCS.

Extended reality (XR) technologies, including augmented reality (AR), mixed reality (MR), and virtual reality (VR), are increasingly transforming surgical disciplines. Oral and maxillofacial surgery, given the anatomical complexity and precision required, is particularly suited to benefit from these innovations. The aim of this scoping review was to map the clinical applications of XR in oral and maxillofacial surgery and compare the most commonly used commercial headsets. A comprehensive literature search was performed across the PubMed, Scopus, and Web of Science databases, covering studies published between January 2018 and June 2025. The PRISMA-ScR guidelines were followed. Overall, 759 records were identified in the database and subsequent citation search, of which 90 met the predefined inclusion criteria. The studies were categorized based on the type of application: training, preoperative planning, virtual surgical planning (VSP), and intraoperative guidance. The analysis revealed that AR and MR are predominantly employed in intraoperative procedures, enhancing surgical navigation and precision. In contrast, fully immersive VR is primarily employed in training, preoperative simulation, and VSP, while its adoption in the postoperative phase remains a promising area for future exploration. XR technologies hold significant potential in oral and maxillofacial surgery and are evolving rapidly and diversifying in their applications. Further research and regulatory validation are needed to support clinical integration and evaluate long-term outcomes.

The aim of this study was to analyse the spontaneous changes in ramal inclination following mandibular setback surgery in patients with asymmetric prognathism. The stability of these changes and their impact on the condylar head position and joint space were evaluated. Fifty-three condyles were included and categorized into deviated side (D) and non-deviated side (ND) groups. Data were collected from cone beam computed tomography scans obtained preoperatively (Pre), immediately postoperative (Post), and at 6 months postoperative (6 m). The raw files were analysed using 3D software. On the deviated side, the condylar heads shifted significantly laterally and rotated inward (yaw) during surgery. On the non-deviated side, they shifted inferiorly and rotated outward (roll). These intraoperative rotations (ramal yaw, ramal roll) were maintained throughout the remodelling period (P = 0.001 and P = 0.006, respectively). Spontaneous rotation of the ramus helped resolve the imbalance in ramal inclination between the deviated and non-deviated sides. It did not significantly affect condylar head volume or joint space (Pre-6 m, P > 0.05). These findings suggest that intentional adjustment of the ramal inclination may be a feasible approach to compensate for imbalances in yawing and rolling in patients with deviated mandibular prognathism.