International journal of oral and maxillofacial surgery最新文献

Recurrence is common among patients with loco-regionally advanced oral cancer. This single-centre, retrospective study was performed to compare positron emission tomography-computed tomography (PET-CT) and conventional contrast-enhanced computed tomography (CECT) in evaluation of recurrent oral squamous cell carcinoma, following definitive treatment. Patients with suspected recurrence during 2016-2019 were included. CECT findings were reviewed by two consultants and PET-CT findings by one consultant. All reviewers were blinded to the assessments of others. Concordance between CECT and PET-CT was evaluated. 195 patients met the necessary criteria. Common primary subsites were buccal mucosa (36.4%) and tongue (30.8%). Majority patients had loco-regionally advanced disease (66.3%). Surgery alone was the primary modality of treatment (93.3%). Disease detection was similar among the two individual CECT raters and the PET-CT rater. For the PET-CT rater vs CECT raters combined, detection rate was 69.2% vs 71.8% for local disease, 47.7% vs 51.3% for regional disease, and 22.1% vs 21.5% for distant disease. Kappa values for inter-rater agreement ranged from 0.55 to 0.74 and were statistically significant (all P < 0.001 ), suggesting substantial agreement among the raters. This study revealed that CECT was comparable to PET-CT for detecting oral malignancy recurrence.

In skeletal Class III patients, treatment options range from orthodontics to orthognathic surgery. Choosing the optimal approach requires a comprehensive clinical evaluation, which may be supported by AI tools. The aim of this study was to assess the performance of AI models in predicting the need for orthognathic surgery and in identifying predictors influencing treatment decisions. A PRISMA-guided electronic database search (PubMed, Web of Science; 2009-2024; English/French) was performed to identify studies using machine learning (ML) or deep learning (DL) on cephalometric and clinical data. After screening and assessment for eligibility, 15 studies were critically appraised. Model performance was summarized using accuracy, sensitivity, specificity, and the area under the curve (AUC). ML algorithms (particularly Random Forest and XGBoost) and DL models (ResNet-based convolutional neural networks (CNNs)) achieved high accuracy for predicting surgical need. Frequently selected predictors included Wits appraisal, ANB angle, the maxillomandibular ratio (Mx/Md), overjet, and the divergence of the lower gonial angle. AI methods show promise for assisting treatment decisions in Class III malocclusion, with Random Forest and XGBoost performing well on tabular cephalometric data and CNNs on imaging. Larger, multicentre datasets and external validation are needed to improve reliability, address bias, and support clinical implementation.

There is growing interest in whether artificial intelligence (AI) large language models such as ChatGPT-4 can support clinicians and trainees in the diagnosis of oral and maxillofacial surgery (OMFS) lesions. This pilot study evaluated the diagnostic accuracy of ChatGPT-4 in identifying OMFS lesions using standardized clinical vignettes and assessed the clarity of its diagnostic reasoning compared to expert consensus. Fifty diverse clinical vignettes representing a range of OMFS lesions were developed and validated by three oral and maxillofacial surgeons. Each vignette was entered into ChatGPT-4 with a uniform prompt. The AI's 'most likely diagnosis' was compared to expert consensus. Outcomes included overall and category-wise diagnostic accuracy and expert-rated clarity of diagnostic reasoning. ChatGPT-4 showed overall diagnostic accuracy of 70% (35/50), performing best in odontogenic infections (90%) and worst in soft-tissue malignancies (33%). The model's reasoning clarity received an average score of 3.8 out of 5. While ChatGPT-4 excelled in recognizing classical lesion patterns, it showed limitations in interpreting complex cases. ChatGPT-4 demonstrates moderate diagnostic capability for common OMFS lesions and holds promise as an educational tool. However, its limited performance in complex diagnoses underscores the need for domain-specific optimization and expert oversight before any clinical use.

The aim of this study was to explore the prognostic predictive importance of the pre-treatment systemic oxidative stress score (SOS) in surgically treated patients with oral squamous cell carcinoma (OSCC). A prospective cohort study was conducted involving 591 patients who underwent surgical treatment for OSCC between May 2011 and March 2022. The SOS was derived from a composite integration of clinically relevant oxidative stress biomarkers: total bilirubin, blood urea nitrogen, creatinine, lactate dehydrogenase, and serum albumin. A variety of analytical methods, including competing risk models, generalized boosted regression modelling (GBM), and propensity score matching analysis, were employed to evaluate the prognostic significance of the SOS. Multivariable Fine-Gray analysis revealed that patients with a high pre-treatment SOS exhibited significantly worse disease-specific survival (DSS) than those with a low SOS (original cohort: hazard ratio 3.58, 95% confidence interval 2.19-5.85, P < 0.001; matched cohort: hazard ratio 3.60, 95% confidence interval 2.10-6.43, P < 0.001). GBM revealed that the relative influence of SOS ranked third. Elevated SOS was confirmed as an independent factor for poor DSS in patients with OSCC. This index may be used to facilitate personalized treatment strategies and optimized postoperative follow-up.

Surgical planning using three-dimensional (3D) technologies has become increasingly popular in complex procedures, notably in maxillofacial surgery. Most existing literature emphasizes preoperative planning and guide fabrication, with limited focus on intraoperative validation of these plans. This study presents a novel protocol incorporating intraoperative 3D planning and cone-beam computed tomography verification in paediatric mandibular distraction osteogenesis for hemifacial microsomia. The proposed workflow integrates preoperative 3D planning, 3D printing of surgical guides, and intraoperative CBCT assessment to evaluate distractor positioning and surgical accuracy in real time. A retrospective analysis of seven cases demonstrated that intraoperative planning enabled the detection of distractor deviations. The results show that the use of 3D technologies in the planning and execution of paediatric mandibular distraction procedures is a valuable tool that has the potential to improve the accuracy and efficiency of the surgical process. It allows for an intraoral approach, a personalized surgical planning, and real-time feedback during the procedure.

Unilateral condylar hyperplasia (UCH) is a rare growth disorder characterized by progressive mandibular asymmetry. The imbalance in bone activity within the mandibular condyles can lead to masticatory dysfunction and esthetic concerns. Although several associated factors have been proposed, the precise etiology of UCH remains unknown. In this prospective study, we analyzed the expression patterns of SRY-box transcription factor 9 (SOX9) and insulin-like growth factor 1 (IGF-1) in condylar tissues from 11 patients with UCH treated by proportional condylectomy and compared them to condylar samples from five control patients with other mandibular requiring normal condyles to be included in a mandibular resection benign pathology. Resected condyles were demineralized, paraffin-embedded, and subjected to histological and immunohistochemical analysis. Results demonstrated a marked overexpression of SOX9 (P = 0.0080) and IGF-1 (P = 0.0009) in UCH specimens compared to controls, and a significant association with histopathological type according Slootweg classification (r = 0.9017, P = 0.0014 for SOX9 and r = 0.6549, P = 0.0471 for IGF-1). These findings suggest that SOX9 and IGF-1 may be key players in the signaling pathways underlying UCH, providing new insights into its pathophysiology and offering potential targets for future therapeutic strategies in skeletal growth disorders.

Medication-related osteonecrosis of the jaw is a severe complication of anti-resorptive and anti-angiogenic therapies, with the mandible being particularly susceptible due to its limited vascularity. This retrospective study evaluated surgical outcomes and prognostic factors in 197 patients with advanced mandibular disease who underwent radical surgery (≥ 6-month follow-up). Surgical procedures included marginal resection with local mucoperiosteal flap closure, segmental resection with direct closure, and segmental resection with various reconstruction methods, including fibula free flap, reconstruction plate with submental island flap, or submandibular gland translocation. The overall success rate was 67.0%. Segmental resection demonstrated significantly higher success than marginal resection (78.6% vs 54.3%, P < 0.001). Among reconstruction methods, fibula free flap achieved the highest success rate at 93.8%. Multivariate analysis identified normal preoperative hemoglobin and serum calcium levels, and the presence of purulent discharge, as protective factors, while bilateral involvement and preoperative pain were associated with poorer outcomes. Although surgical outcomes improved over time with technical advances, success was constrained by patients' compromised systemic conditions. This study confirms that tailored radical surgery, combined with complete lesion removal, appropriate reconstruction, and optimization of modifiable systemic factors, remains an effective strategy for advanced mandibular medication-related osteonecrosis of the jaw.