International journal of oral and maxillofacial surgery最新文献

The aim of this study was to assess the long-term clinical outcomes of patients with temporomandibular joint (TMJ) ankylosis treated by interpositional arthroplasty using buccal fat pad (BFP). Fifty patients who had undergone the procedure and completed at least 1 year of follow-up were evaluated. no case of reankylosis was noted after a mean follow-up of 51.1 ± 23.7 months. Significant improvements were observed in postoperative mouth opening (35.36 ± 9.25 mm) and lateral excursion movements; ipsilateral excursion increased to 6.56 ± 2.99 mm and contralateral excursion improved to 2.78 ± 2.49 mm (all P < 0.001). Additionally, the study assessed patient quality of life using the Temporomandibular Joint Ankylosis Quality of Life (TMJAQoL) questionnaire, which includes 12 questions in four domains and two global ratings. The patients were divided into two age groups for this analysis: ≥12 years (n = 36) and <12 years (n = 14). Both groups showed significant improvements in the two global ratings and in the total TMJAQoL score. In conclusion, the use of BFP in interpositional arthroplasty for TMJ ankylosis was associated with no recurrence, improved mouth opening and jaw movements, and a significant improvement in patient quality of life.

This study was performed to investigate whether preoperative disc perforation is associated with postoperative condylar resorption (assessed as the 1-year change in mandibular ramus height) in skeletal Class II patients, and to analyse the preoperative temporomandibular joint (TMJ) morphology and synovial biomarkers in Class II and III patients. Orthognathic surgery patients treated between 2020 and 2022, who had undergone preoperative arthroscopy, MRI, CT, and synovial fluid analysis, were included. Three groups of patients were investigated: Class II with disc perforation (Class II/Pf(+); nine patients), Class II without disc perforation (Class II/Pf(-); eight patients), and Class III (seven patients). None of the Class III patients had disc perforation. Anterior disc displacement without reduction was significantly more common in Class II/Pf(+) than in Class II/Pf(-) (P = 0.033) and Class III (P = 0.017), suggesting that progressive disc displacement may lead to disc perforation. Moreover, TMJ osteoarthritis was significantly more frequent in Class II/Pf(+) than in Class II/Pf(-) (P = 0.037) and Class III (P = 0.005). Levels of IL-6 in the synovial fluid were significantly elevated in Class II/Pf(+) compared to Class III (P = 0.011), indicating an association between this inflammatory cytokine and the pathogenesis of TMJ deformities. Postoperative condylar resorption was significantly greater in Class II/Pf(+) (6.5%) than in Class II/Pf(-) (1.7%) (P = 0.019). These findings suggest that disc perforation in preoperative Class II patients is an important factor promoting postoperative condylar resorption. This study highlights the importance of preoperative evaluation of disc perforation in orthognathic surgery planning.

Orthognathic surgery is performed to correct dentoskeletal deformities and restore maxillomandibular symmetry. These changes may affect biometric identification and verification. The aim of this study was to assess the facial recognition capability of a commercially available software application in patients who had undergone orthognathic surgery. This retrospective study included 24 patients, of both sexes, who were treated for dentofacial deformities: 12 skeletal Class II and 12 Class III. Images of these patients taken in neutral expression and in smiling expression, acquired preoperatively and at 6 months postoperative, were analysed using the software via a machine-learning tool through two neural network models. The software identified similarities between the preoperative and postoperative images based on Euclidian distances (ED). Regarding recognition in neutral facial expression, there was no significant difference in the mean ED between classes II and III (P = 0.50). However, in smiling facial expression, a significant difference was observed, with a higher mean ED in Class III (P = 0.009). Moreover, a significant difference between neutral and smiling facial expressions was observed for Class III patients (P = 0.023), but not for Class II patients (P = 0.65). Although orthognathic surgery can result in considerable changes to the face, the program under evaluation demonstrated excellent performance in recognizing patient facial similarities.

The aim was to investigate the effects of botulinum toxin type A (BTX-A) treatment on sleep quality in patients diagnosed with probable sleep bruxism and awake bruxism. A prospective observational study was conducted on 40 female patients. All participants received standardized BTX-A injections (30 units in the masseter muscles, 20 units in the temporalis muscles). Sleep quality was assessed pre- and post-treatment using the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses compared pre- and post-treatment PSQI scores and included subgroup analyses. Significant improvements were observed in subjective sleep quality and in sleep latency, efficiency, duration, and disturbance (all P < 0.05). The proportion of patients with good sleep quality (PSQI ≤5) increased from 17.5% pre-treatment to 60% post-treatment (P < 0.001). Daytime function also improved significantly (P = 0.002). BTX-A treatment was associated with improved sleep quality in patients with probable bruxism, including reductions in sleep latency and disturbances, along with enhanced sleep duration and efficiency. Although the lack of a control group limits causal inference and the placebo effect remains unknown, the study findings suggest BTX-A injections may be an effective therapeutic approach for bruxism-related sleep impairments, highlighting the relationship between awake bruxism and sleep quality.

Acute airway obstruction in patients with head and neck conditions often results in a 'can't intubate, can't oxygenate' (CICO) situation, which requires a different management approach than the airway emergency guidelines in the context of anaesthesiology. This systematic review and meta-analysis synthesized and analysed the patient demographics, causes, presentations, complications, operators, and outcomes of emergent surgical airways performed in patients with head and neck conditions, and proposed a targeted management pathway. A total of 1011 emergent surgical airways reported in 14 studies were identified, including 961 tracheostomies and 50 cricothyrotomies. The analysis of patient demographics showed that 79% of the patients were male (95% confidence interval (CI) 73.3-84.1%), and mean age was 56.0 years (95% CI 51.5-60.5 years). The most common underlying cause was neoplasm (56.0%, 95% CI 37.4-73.7%). The most common preceding symptom was dyspnoea (66.6%, 95% CI 44.3-85.7%). The pooled mean complication rate was 16.8% (95% CI 8.8-26.6%). The airway-related mortality rate was 0.2% (95% CI 0.0-0.8%). The odds of successful decannulation were significantly increased in non-malignant tumour cases compared to malignant cases. The odds of complications were significantly increased for emergent surgical airways performed in locations other than the operating room.

Head orientation is a key component of orthognathic surgical planning, and sets the reference frame on which clinical assessment and surgical planning are performed. Hard tissue-based (HT) and soft tissue-based (ST) head orientation methods are commonly used, but their impact on symmetry is unclear. The purpose of this study was to analyze the impact of head orientation technique on symmetry assessment. Patients who underwent orthognathic surgery at a single center over 13 months were studied retrospectively. Preoperative computed tomography were oriented using HT and ST methods, and the roll and mediolateral positions of the maxillary dental midline (U1) and pogonion (Pog) were compared. In fifty-seven eligible subjects, the median roll difference was 0.64° (range 0-2.85°; P = 0.003), and the median absolute mediolateral position difference was 0.9 mm at U1 and 1.2 mm at Pog (both P = 0.003). The reliability of the both methods was excellent (intra-class correlation coefficient > 0.974; both P < 0.001). Use of HT and ST head orientation methods resulted in differing symmetry assessments, which could result in clinically significant deviations. Clinicians must balance the advantages and disadvantages of the HT and ST methods to properly apply each to their surgical workup protocols.

Accurate anatomical segmentation in computed tomography (CT) imaging is vital for diagnostics and virtual surgical planning in head and neck surgery, yet manual methods remain time-consuming and inconsistent. This study presents a dual-model artificial intelligence (AI) system that automates the segmentation of key craniofacial structures. A total of 388 clinical CT scans were processed using a two-stage nnU-Net-based approach: a coarse global model (3.0 mm resolution) followed by a fine local model (0.5 mm resolution). Ground truth segmentations of the skull, mandible, teeth, sinuses, and soft tissue were created by a single annotator and compared to the AI-based segmentation results using the Dice similarity coefficient (DSC), mean surface distance (MSD), and Hausdorff distance (HD) . High accuracy was achieved: mean DSC of 0.963 for mandible and skull, and 0.986 for soft tissue. Mean MSD values were lowest for maxillary sinus (0.134 mm) and mandible (0.150 mm). While HD remained low overall, soft tissue showed high variability (mean 25.138 mm). The AI system proved robust across varied imaging protocols, including low-resolution scans. By significantly reducing manual segmentation efforts while ensuring clinical precision, this open-access dual-model framework offers a scalable solution for diagnostic, surgical, and educational applications in craniofacial care.

The rising incidence of oral tongue cancer (OTC) among younger populations and females represents an emerging epidemiological shift for which the aetiology remains unclear. This systematic review and meta-analysis examined the epidemiological trends of OTC in female patients and aimed to identify related risk factors and exposures. Forty-nine studies were identified following PRISMA guidelines, with pooled analyses including 35,733 females and 57,821 males from 21 studies. Overall, females showed lower odds of developing OTC compared to males (odds ratio 0.51, 95% confidence interval 0.41-0.62; P < 0.001). However, females exhibited a significantly higher annual percentage change (APC) in OTC incidence when compared to males (P = 0.010), despite significantly lower rates of smoking and alcohol consumption habits (P < 0.001). This trend was particularly pronounced in developed countries compared to developing countries (P < 0.001). The younger OTC cohort showed distinct clinical features, lower human papillomavirus infection rates, and unique mutational profiles, although current data remain insufficient to form definitive conclusions. This review highlights an epidemiological shift in OTC characterized by significantly higher APC among females, particularly in developed countries and in Western nations.

In the management of the lower third molars, coronectomy has gained popularity in recent years due to its effectiveness in preventing neurosensory deficits, particularly when the tooth is in close proximity to the inferior alveolar nerve (IAN). This long-term prospective study was performed to evaluate the outcomes of patients who presented for mandibular third molar extraction and underwent coronectomy, with a minimum follow-up of 10 years. A total of 362 coronectomies performed on 277 patients (165 female, 112 male) were included. Fifty-five of the 362 coronectomy cases followed up for ≥10 years (15.2%) underwent reoperation due to exposed roots (8.0%), pain (3.9%), or infection (1.9%). Cox regression analysis showed no significant association between demographic or clinical characteristics and the need for reoperation to remove the retained roots. Kaplan-Meier analysis revealed that, at 10 years post-coronectomy, no reoperation would be required in 87.5% of cases. Notably, no nerve deficit occurred in any of the reoperation cases. The findings of this prospective study involving a large cohort and high rate of follow-up at ≥10 years after coronectomy suggest that this is a safe and efficient procedure for managing third molars in close proximity to the IAN.

In maxillofacial surgery, orbital reconstruction requires precision to address both functional and aesthetic considerations arising from both acute and elective conditions. This study presents a novel, fully automated segmentation software designed specifically for the orbital floor. This software enhances surgical planning through superior accuracy, efficiency, and usability. The authors' transdisciplinary team compiled a dataset of 1004 expert-segmented orbits from computed tomography images across multiple countries, ensuring broad anatomical representation. Developed with the nnU-Net framework, the software achieved segmentation accuracy with a mean Dice similarity coefficient of 0.935 and a mean surface distance of 0.292 mm for the orbit, and a Dice similarity coefficient of 0.917 and mean surface distance of 0.287 mm for the orbital floor-all within approximately 1 s. This performance surpasses traditional manual segmentation, which averages 25 min per orbit. The system delivered consistent results across a range of imaging sources, affirming its reliability for a wide range of clinical applications. By introducing this fully automated, high-precision tool, this study pioneers advancements in AI-driven orbital reconstructions, setting new standards for patient-specific surgical planning. Further development and integration holds the key to transforming the field, ensuring ethical compliance and enhancing informed consent.