International journal of oral and maxillofacial surgery最新文献

Darwin has a very high volume of facial trauma in a largely decentralized population, providing a unique opportunity to assess mandible fracture patterns. The aim of this study was to determine whether the presence of the mandibular third molar is associated with angle fractures, and whether the absence of the third molar is associated with condyle fractures. A retrospective analysis of all patients admitted to the Royal Darwin Hospital, Australia for open reduction and internal fixation of the mandible between January 2020 and March 2024 was performed. Patients were classified by the presence/absence of the mandibular third molars and the type of mandibular fracture. The third molars were classified according to the Pell and Gregory, and Winter classifications. 475 patients suffered 792 fractures; 289 were angle fractures and 127 were condyle fractures. Angle fractures were significantly associated with the presence of mandibular third molars (odds ratio 3.31, P < 0.001), while no significance was found between the absence of third molars and condyle fractures (P = 0.076). In this study, patients with mandibular third molars were observed to have an increased risk of angle fracture, while there was no increased risk of condyle fracture in those without the third molar.

The aim of this study was to develop a machine learning classification model that can forecast salvage surgery complications. This was a retrospective analysis of all patients who underwent salvage surgery for head and neck cancer at Amrita Institute of Medical Sciences, Kochi, India. Clinical and treatment characteristics were used as predictors. Machine learning models, logistic regression, regularized logistic regression, Random Forest, and Support Vector Machine (SVM) were employed. Overall, 277 patients who underwent salvage surgery were identified, of whom 125 had complications. Random Forest gave the best test sensitivity and specificity of 80.0% (95% confidence interval 59.3-93.2%) and 71.0% (95% confidence interval 52.0-85.8%), respectively. The important features identified were reconstruction status (none), disease-free interval, type of surgery (when primary and neck surgery were combined), alcohol history, and recurrent node positivity. This study explored multiple machine-learning approaches in the predictive analysis of the morbidity of salvage surgery related to head and neck cancers. Random Forest emerged as the best classification model to predict the complications.

Precise image registration is essential for the success of image-guided craniomaxillofacial robotic surgery (IGCRS). However, current methods fail to meet the diverse needs of various craniomaxillofacial procedures. In this study, a comprehensive navigation registration strategy was developed including three techniques: removable marker (RM) registration, intraoral scan-CBCT (IOS) registration, and marker-relay (MR) registration. A phantom study was conducted using four three-dimensionally printed skulls with 20 target points each. Registration accuracy was assessed using fiducial registration error (FRE) and target registration error (TRE), with a U-shaped tube fixed marker (FM) as the control. The mean FRE for FM, RM, IOS, and MR was 0.07 ± 0.01 mm, 0.08 ± 0.04 mm, 0.15 ± 0.03 mm, and 0.14 ± 0.05 mm, respectively, with IOS and MR showing higher FRE than FM and RM. The mean TRE was 0.39 ± 0.03 mm (FM), 0.40 ± 0.03 mm (RM), 0.43 ± 0.03 mm (IOS), and 0.42 ± 0.02 mm (MR). Statistical analysis confirmed non-inferiority of all three techniques compared to the control. In conclusion, this strategy demonstrated accuracy and feasibility, offering a foundation for advancements in IGCRS surgery. Further experiments and clinical trials are necessary to validate these techniques in actual robotic surgeries.

The internal jugular vein (IJV) and omohyoid muscle are important surgical landmarks for the oncological neck dissection procedure. In the normal scenario, the IJV runs under the omohyoid muscle. Although many anatomical variations have been described in the literature, the current report concerns a rare case wherein this relationship was reversed, with the IJV passing over the omohyoid muscle. It appears that this anomaly has not been reported previously. The current report discusses how this rare finding was successfully managed during the surgery and focuses on the clinical implications.

The aim of this study was to compare implant accuracy and surgical efficiency between single-arm and dual-arm dental implant robots. In vitro resin models were printed using preoperative CBCT reconstructions of a real patient's maxilla. Robotic computer-assisted implant surgeries were then performed using single-arm and dual-arm robots. Surgery times were recorded. Postoperative CBCT scans were acquired to compare implant position accuracy. At the immediate implant site, there was no significant difference in deviation between the single-arm and dual-arm implant robots (mean platform, apex, and angular deviation of 0.90 ± 0.16 mm, 0.91 ± 0.12 mm, and 0.54 ± 0.10° versus 0.88 ± 0.14 mm, 0.97 ± 0.13 mm, and 0.55 ± 0.10°, respectively). Results were similar at the delayed implant site (mean deviations of 0.44 ± 0.17 mm, 0.45 ± 0.16 mm, and 0.59 ± 0.18° versus 0.49 ± 0.18 mm, 0.46 ± 0.21 mm, and 0.51 ± 0.10°, respectively). The mean total operation time was 25.04 ± 0.35 min and 22.66 ± 0.81 min (P < 0.001). When used in implant procedures, there was no significant difference in position accuracy between the two robots. However, the single-arm robot took slightly more time.

Le Fort I osteotomy is a common orthognathic surgery procedure, but can result in unpredictable nasolabial changes, highlighting the need for a greater understanding of its effects on the soft tissue and evaluation of alternative techniques. The aim of this study was to compare the subspinal Le Fort I osteotomy (SSLFI) to conventional Le Fort I osteotomy (cLFI) regarding their impact on the nasolabial angle (NLA), with the goal of clarifying their clinical implications and assessing the utility of the subspinal approach. This retrospective analysis included 38 patients who underwent maxillary advancement between 2010 and 2023, using either the cLFI or SSLFI. Soft tissue changes were evaluated at a minimum of six months postoperatively, corresponding to the early healing phase when some residual swelling may persist. The mean maxillary advancement was 6.16 mm in the cLFI group and 6.37 mm in the SSLFI group. NLA tended to decrease in the cLFI group and increase in the SSLFI group, with the most pronounced differences observed when advancement exceeded 5 mm. Sex had no effect on NLA change. These findings underscore the importance of careful surgical planning and patient counseling, while recognizing that soft tissue adaptations may continue beyond the early postoperative period.

The plane-matching method is a bone-reference virtual surgery protocol determining bone position by matching the local midsagittal plane (MSP) with the global MSP. Using an optimized mandibular MSP may ensure the optimal surgery planning, but is limited by its complex optimization process. A simpler yet clinically viable alternative would enhance its utility. The aim of this retrospective cross-sectional study was to identify the optimal pretreatment skeletal Class III patients were included. A total of 727 landmarks were digitized on the distal segment of the mandible. The root mean square (RMS) distances between the original and mirrored landmarks across six candidate mandibular MSPs (one optimized and five cephalometric) were compared in symmetric and asymmetric groups. The results revealed no significant interaction between facial asymmetry and the MSPs (P = 0.39). The asymmetric group had a significantly larger RMS distance than the symmetric group (2.5 ± 1.7 mm vs 1.7 ± 1.5 mm; P < 0.001). Among the cephalometric MSPs, Go.Go.Me_Me.midGo, MF.MF.PM_Me.bisectMF, and B.Me.midGo had the lowest RMS distances and were statistically equivalent (P = 1.0). In conclusion, these three cephalometric MSPs are viable alternatives to the optimized MSP. With proper selection guidelines, the plane-matching method utilizing these cephalometric MSPs may enhance the diagnostic benefits of bone-referenced virtual surgery planning.

Custom-made temporomandibular joint implants provide an excellent anatomical fit for total joint replacement in complex cases, but are associated with high costs and lengthy production times. In contrast, stock temporomandibular joint prostheses offer lower costs and faster availability, but lack the precision fit required for patients with altered anatomy from trauma, congenital deformities, or prior surgeries. This Technical Note presents a structured workflow that enables precise adaptation of stock temporomandibular joint implants by reshaping the patient's anatomy using virtual surgical planning, computer-aided design, and custom-made surgical guides, without altering the implant itself. Preoperative imaging was used to virtually plan the implant position and required bone modification. Based on this plan, patient-specific modification guides were produced and used intraoperatively to optimize the skeletal anatomy for improved stock implant fit. This workflow is applicable in cases where anatomical reshaping can be performed without compromising bone integrity or surgical safety, supporting broader access to personalized temporomandibular joint surgery.

The objective was to assess patient perceptions of recovery following surgical removal of mandibular third molar (SRM3) with application of advanced platelet-rich fibrin (A-PRF) (test) compared with SRM3 and no extraction socket intervention (control). Predictors of impaired convalescence were analysed. Eighty patients were randomly allocated (1:1) to test or control. A compulsory analgesic regimen was applied and the pain intensity before and after analgesic intake was recorded in a pain diary. Preoperative patient parameters, questionnaire results (OHIP-14, MDAS, SF-36, PASS-20), and the DMFT index were correlated with the numbers of days with pain and of sick leave. Postoperative assessments of the effects on work attendance, social and physical activities, sleep, speech, diet, and quality of life, as well as satisfaction with the treatment, were conducted after 30 days. The application of A-PRF within the extraction socket was not associated with a significant reduction in pain or in the number of days with pain (mean 8.7 vs 10.2 without A-PRF) or on sick leave (mean 1.3 vs 1.6 without A-PRF) (all P > 0.05). No significant difference was found for any of the outcomes. Preoperative employment status (employed) and the SF-36 'physical function' domain score were found to be predictors of impaired convalescence. Routine application of A-PRF following SRM3 is, therefore, not recommended.

The decision to either preserve or divide the pharyngeal flap during cleft orthognathic surgery (OGS) involves balancing maxillary advancement and maintaining velopharyngeal function. In this study, post-OGS velopharyngeal function and maxillary relapse were compared between patients with preserved and divided pharyngeal flaps. A retrospective review was conducted of cleft patients with a previous pharyngeal flap who underwent OGS between 2016 and 2020. Skeletal changes were evaluated via lateral cephalometry at three time-points: preoperative, immediately postoperative, and 1 year postoperative. Among the 26 patients included, 14 underwent pharyngeal flap preservation (PFP group) and 12 underwent pharyngeal flap division (PFD group). Horizontal A-point changes (A(X)) were significantly smaller in the PFP group (3.6 ± 2.0 mm) than in the PFD group (6.0 ± 2.3 mm) (P = 0.004). After OGS, velopharyngeal function deteriorated significantly more in the PFD group (75%) than in the PFP group (21.4%) (P = 0.016). Regression analysis suggested that pharyngeal flap division was associated with an increased risk of postoperative velopharyngeal function deterioration (odds ratio 14.06, P = 0.029), while horizontal maxillary surgical changes were inversely related to the maxillary relapse rate (regression coefficient = -0.79, P = 0.003). In conclusion, preserving the pharyngeal flap during cleft OGS is recommended to prevent speech deterioration without increasing the risk of maxillary relapse.