International journal of oral and maxillofacial surgery最新文献

Simultaneous alloplastic temporomandibular joint reconstruction (ATMJR) with Le Fort I osteotomy (LFI) may be indicated when significant temporomandibular joint (TMJ) pathology accompanies dentofacial deformities. Currently, the impact of concomitant ATMJR on LFI accuracy is not known. The purpose of this study was to assess the influence of patient-fitted ATMJR on the accuracy of simultaneous LFI. In this retrospective cohort study, patients undergoing LFI with and without ATMJR were enrolled. Preoperative and postoperative cone-beam computed tomography was analyzed using regional voxel-based registration. The primary predictor variable was use of ATMJR, and others included impaction at the maxillary central incisor (U1), age, and sex. The primary outcome variable was the mediolateral/superoinferior/anteroposterior absolute linear surgical error at U1 (U1AE). The secondary outcome variable was the three-dimensional surgical error at U1. In 20 subjects (eight ATMJR, 12 non-ATMJR), median U1AE ranged from 0.50 to 1.30 mm and median three-dimensional surgical error from 1.37 to 2.17 mm. ATMJR was associated with higher anteroposterior U1AE (median difference 0.8 mm, P = 0.012) and under-impaction (mean 0.86 mm, P = 0.036). Simultaneous ATMJR is associated with greater anteroposterior surgical error and a tendency towards under-impaction. Appropriate case selection and planning modifications should be considered as appropriate.

Sagittal split osteotomy (SSO) is a well-established technique for mandibular repositioning, although unfavourable split patterns remain a relevant intraoperative concern. This retrospective study evaluated anatomical factors influencing split morphology, including cortical and medullary bone volumes and mandibular ramus thickness. Pre- and postoperative imaging from 94 SSOs were analysed, and split patterns were classified using the adapted Plooij Lingual Split Scale (LSS). Associations were assessed with the Kruskal-Wallis test, with the Wilcoxon rank sum and Fisher's exact tests used to compare Angle malocclusion classes. Ideal splits (LSS 1) occurred in 68.1% of cases, followed by splits over the canal (LSS 3) in 22.3%, posterior ramus border splits (LSS 2) in 5.3%, and bad splits (LSS 4) in 4.3%. LSS 1 cases showed significantly greater cortical bone volume (P = 0.005) and increased ramus thickness at all measured levels (P < 0.001, P < 0.001, P = 0.0039). Angle class II patients had greater ramus thickness (P = 0.045) and lower medullary bone volume than class III patients. Greater bone volume and ramus thickness were associated with more favourable split outcomes. Further prospective studies are needed to confirm these findings.

This randomized controlled trial evaluated the three-dimensional (3D) accuracy of condylar positioning in mandibular reconstruction using pre-bent plates with customized plate navigation (CPN) compared with the traditional method (TM). Thirty patients with mandibular tumours were randomized to the CPN or TM group (15 each). Pre- and postoperative computed tomography quantified deviations in intercondylar distance and angulation, 3D displacement of the most superior point (assessed in superior-inferior, anterior-posterior, and medial-lateral directions on the affected condyle), and affected condylar axis orientation (coronal, sagittal, transverse). Overall 3D condylar deviation and total operative time (TOT) were also compared. The CPN group showed smaller deviations than the TM group in intercondylar distance (P = 0.031) and angulation (P = 0.023), and in anterior-posterior (P = 0.041) and medial-lateral (P = 0.046) displacement. Condylar axis alignment was improved in the CPN group in the coronal (P < 0.001), sagittal (P < 0.001), and transverse (P = 0.001) planes. Overall 3D condylar deviation on the affected side was smaller with CPN for physiological (P = 0.019) and absolute (P = 0.039) registrations. TOT was shorter with CPN (P < 0.001). Thus, CPN improves surgical precision and efficiency in mandibular reconstruction.

Oral Mucositis and xerostomia are common debilitating side effects of radiotherapy in head and neck cancer patients, leading to treatment interruptions and negatively impacting quality of life. This review was performed to examine the efficacy and safety of interventions for managing these complications, evaluated in completed Phase III and IV clinical trials registered on ClinicalTrials.gov. A range of pharmacological and non-pharmacological therapies were reviewed, with analysis of intervention types, outcomes, and sample sizes. For oral mucositis, effective pharmacological agents included palifermin, avasopasem manganese, doxepin, morphine mouthwash, and gabapentin, while non-pharmacological options such as low-level laser therapy, honey, and Aloe vera showed additional benefit in reducing severity and improving healing. In managing radiotherapy-induced xerostomia, pilocarpine, amifostine, and cevimeline significantly enhanced salivary function, with adaptive radiotherapy techniques offering protective effects on the salivary glands. Phase IV studies supported the role of benzydamine, MuGard, Biotène, and herbal mouthwashes in symptom relief and patient comfort. Although several interventions demonstrated promising clinical efficacy, the heterogeneity in study design, outcome measures, and follow-up duration limits definitive conclusions. Therefore, customized, evidence-driven approaches informed by existing recommendations and developed data are crucial for enhancing outcomes and reducing the burden of therapy-induced toxicities in head and neck cancer patients.

Accurate identification of AI-generated content is critical for preserving scientific credibility. This exploratory study was performed to assess the effectiveness of eight AI detection tools (free versions) in differentiating human-written from AI-generated articles within the oral and maxillofacial surgery field. The analysis included 24 human-written articles and 12 AI-generated articles produced using ChatGPT, DeepSeek, Gemini, and Copilot. The primary outcome was the detection effectiveness of each tool, expressed as a mean percentage score, for human-written and AI-generated text. Secondary outcomes were usability and processing limitations. The statistical analysis was performed in RStudio (P < 0.05). For published human-written text, QuillBot showed perfect detection (none detected as AI-written), and was fast and easy to use. For the AI texts, Copyleaks performed best (mean score 99.6/100), followed by Sapling (mean score 95.6/100). A weak, non-significant correlation was found between manuscript length and detection effectiveness for published human-written (ρ = -0.15, P = 0.44) and AI-generated texts (ρ = -0.08, P = 0.70). QuillBot appears to be an accessible and effective tool for distinguishing human- from AI-generated text. Its effectiveness could be enhanced when used alongside other detection tools like Sapling or Copyleaks, allowing articles produced with excessive reliance on AI to be detected.

When temporomandibular joint (TMJ) lysis and lavage procedures fail to treat intraarticular pain and dysfunction (IPD), the therapeutic effectiveness of advanced arthroscopy to treat persistent symptoms remain debatable. This is a retrospective study of 34 subjects at the University of Michigan from November 2020 to July 2023 with persistent IPD (Wilkes II-V diagnosis) after arthrocentesis or arthroscopic lysis and lavage, who then underwent advanced arthroscopy. Subjects had a mean age of 35.9±15.3 years and 33 (97%) were female with minimum 3-month follow-up. Outcomes were jaw function (measured by jaw functional limitation scale) and pain intensity (by visual analogue scale from 0-100). Linear regression was used to analyze the impact of subject demographics, pre-operative and intra-operative variables on JFLS outcomes while linear mixed-effects models assessed the potential impact of the same variables on pain scores. Paired t-tests assessed pre- versus postoperative changes. Statistical significance was set at p<0.05. Mean JFLS improved from 79.9±27.9 to 55.4±37.0 (p=0.004), and mean pain decreased from 64.7±20.4 to 43.0±32.8 (p<0.0001). Among covariates, only positive serologic markers correlated with greater functional limitation (p=0.012). These results suggest that advanced arthroscopy is associated with improvements in subjects with persistent IPD after failing lysis and lavage procedures.

Orbital solitary fibrous tumour (SFT) is a rare, typically benign neoplasm that presents a challenge to management due to its tendency to recur and the potential complications associated with surgical treatment. Complete surgical excision is the standard treatment, with adjuvant therapies considered in high-risk cases, although evidence remains limited. The case of a 56-year-old man with an orbital SFT exhibiting a high rate of recurrence, resulting in 13 surgical interventions over a 20-year period, is reported here. After multiple surgical approaches and radiotherapy following incomplete resections, the tumour recurred intra- and extraorbitally. Following tumour progression and reclassification as World Health Organization grade 2, an anterosuperior orbitotomy was performed, and five flexible catheters were placed for high-dose-rate (HDR) brachytherapy. The patient received 32 Gy over 8 days, with no recurrence at the 2-year follow-up. This case report describes a novel use of intraorbital HDR brachytherapy for orbital SFT. The clinical course, treatment strategy, and outcomes are presented, suggesting HDR brachytherapy as a promising adjuvant therapy for selected recurrent cases.

This article presents a novel and simple technique for anesthetic blockade of the auriculotemporal nerve, aimed at minimizing complications such as transient facial paralysis during minimally invasive procedures in the temporomandibular joint (TMJ). By accessing the auriculotemporal nerve in the preauricular subcutaneous tissue, this method allows for effective anesthesia without affecting the facial nerve. This approach optimizes the use of anesthetic, and provides adequate depth of anesthesia for interventional procedures, such as TMJ arthrocentesis, while reducing the risk of complications associated with the traditional technique.

Surgery is the preferred treatment option for those with severe or refractory osteoradionecrosis (ORN). This retrospective cohort study evaluated surgical management outcomes for mandibular ORN in 36 patients treated at The Royal Melbourne Hospital between 2017 and 2024. Most patients were male (mean age 67.9 years) with Notani Stage III ORN (81%). Common risk factors included radiation >60 Gy (83.6%), smoking (66.6%), and alcohol use (77.8%). A total of 59 surgeries were performed: 46 debridement and 13 segmental mandibulectomies. ORN was associated with high morbidity and mortality (19% died during follow up). Debridement gave long-term relief in 13% of patients, delaying second and third surgeries by 10 and 23 months, respectively. Segmental resections were significantly associated with ORN healing (odds ratio = 10.7, P < 0.001). Segmental mandibulectomy provided sustained relief in 62% and was 10 times more effective than debridement in achieving healed ORN. Debridement and segmental mandibulectomy both have a role in management of mandibular ORN. Debridement provides more time for tissues to recover post-radiotherapy, to exit the high-risk period for cancer recurrence and to allow medical interventions, e.g., smoking cessation.

In splint-based Le Fort I osteotomy (LFI), variations in condyle-fossa relationship can influence surgical accuracy. The aim of this study was to investigate the impact of the preoperative joint space (JS) on surgical errors. This retrospective study included patients status post splint-based maxilla-first LFI at a single institution in a 7-month period. Preoperative JS was measured on preoperative cone-beam computed tomography (CBCT), while angular and linear surgical movements at the maxillary dental midline (U1) were measured using regional voxel-based registration. In 26 eligible subjects, the mean absolute linear and angular errors were 0.82-1.18 mm and 0.87-1.21°, respectively. The greatest superior and posterior preoperative JS correlated with mediolateral (P = 0.020) and anteroposterior (P = 0.019) error, respectively. JS was not associated with angular errors (P > 0.05). Laterality of the greater posterior preoperative JS was associated with the mediolateral linear error (P = 0.026). Regression analysis showed that 3.92 mm posterior preoperative JS resulted in 1 mm anteroposterior error, and a left-to-right posterior preoperative JS differential of 1.35 mm resulted in 1 mm mediolateral error. Vertical and anteroposterior preoperative JS can affect accuracy in maxilla-first splint-based LFI. Routine preoperative evaluation can help identify at-risk cases.