International journal of oral and maxillofacial surgery最新文献

Central giant cell granuloma (CGCG) is a rare, benign but aggressive osteolytic lesion affecting the jaws. Traditional surgical management, while effective, often results in functional and aesthetic deficits due to the resection of bone and soft tissue. Medical treatment with corticosteroids, subcutaneous calcitonin, or intravenous bisphosphonates has demonstrated variable success. Recent studies have shown that denosumab, a monoclonal antibody targeting RANKL (receptor activator of nuclear factor kappa-B ligand), can inhibit osteoclast activity, thus providing a novel treatment approach. This study reports the outcomes of eight patients with CGCG treated with intralesional denosumab injections (mean follow-up 36 months, range 12-61 months), highlighting its efficacy in reducing the size of the lesion, increasing bone density, and avoiding the need for surgery in most of the cases.

Dedifferentiated liposarcoma (DDLPS) is a rare and aggressive malignant soft-tissue tumour with a poor prognosis. This report describes a case of giant DDLPS in the oral cavity, arising in the mandible. A 65-year-old woman was referred to the authors' hospital with a mandibular swelling. A presumptive diagnosis of mandibular malignant tumour (DDLPS; T3N0M0, stage III) was made based on correlation of the clinicopathological features. Before radical surgery, a tracheostomy was performed, as there was narrowing of the pharyngeal cavity due to tumour growth. A bilateral supraomohyoid neck dissection, segmental mandibulectomy, and reconstruction with titanium plates and a free rectus abdominis musculocutaneous flap were performed under general anaesthesia. Neither neoadjuvant nor adjuvant chemoradiotherapy was administered. Immunohistochemistry was positive for MDM2, CDK4, and p16, and genetic testing showed amplification of the MDM2 and CDK4 genes. No evidence of recurrence was observed after 18 months of follow-up.

Craniosynostosis is a condition involving premature fusion of the skull, which causes increased intracranial pressure. Posterior cranial vault expansion distraction osteogenesis (PCVDO) may be applied to expand the intracranial volume and relieve the increased intracranial pressure, but its impact on intraorbital volume and ophthalmology outcomes remains unclear. This study was performed to evaluate the changes in intracranial and intraorbital volumes and key ophthalmological parameters (degree of proptosis, intraocular pressure, lagophthalmos, papilledema, optic disc hyperaemia, optic atrophy, retinal vascular tortuosity, and strabismus) in six children with syndromic craniosynostosis treated with PCVDO. The volumetric and ophthalmological parameters were assessed using computed tomography scans and patient records. Following PCVDO, all patients showed increased intracranial and intraorbital volumes. There was a significant improvement in intraocular pressure (right eye P = 0.004, left eye P = 0.005), papilledema (P = 0.039), and optic disc hyperaemia (P = 0.037). However, the results showed no significant improvement in optic atrophy, strabismus, retinal vascular tortuosity, ocular proptosis, or lagophthalmos from pre- to post-PCVDO. The study findings suggest that PCVDO effectively reduces intraocular pressure, papilledema, and optic disc hyperaemia, with potential implications for ocular health and ocular proptosis.

Orthognathic surgery using pre-bent titanium plates and cutting guides has been shown to enhance surgical precision in positioning the maxilla. This technical note introduces an innovative approach that utilizes mixed reality to pre-bend titanium plates and simulate surgical guides with osteotomy lines and drilling holes, thereby aiding in the localization of the maxilla. Postoperative computed tomography showed a discrepancy of <2 mm in comparison to the preoperative virtual design. The virtual surgical planning for orthognathic surgery was dynamically transferred to the surgical procedure in real time, eliminating the need for complex guide systems, optimizing navigation methods, and enhancing navigation accuracy.

The aim of this study was to determine the impact of postoperative delirium (POD) on 2-year survival and identify perioperative risk factors contributing to POD in patients undergoing oral and maxillofacial reconstructive surgery. A retrospective observational study was conducted at Hokkaido University Hospital. The cohort included 65 patients who underwent oral and maxillofacial reconstructive surgery between January 2016 and May 2022. Patients were categorized into POD (n = 20) and non-POD (n = 45) groups. POD diagnosis was based on clinical criteria assessed by psychiatrists. Survival was analysed using Kaplan-Meier curves and a Cox proportional hazards model adjusted for age, American Society of Anesthesiologists (ASA) physical status, malignancy, and disease classification. POD occurred in 30.8% of patients. Two-year survival estimated by Kaplan-Meier analysis was significantly lower in POD group (60%) than in non-POD group (87%) (P = 0.009). POD was an independent risk factor for decreased survival (hazard ratio 3.40, 95% confidence interval 1.10-10.57; P = 0.034). No significant perioperative predictors of POD were identified. POD was associated with a substantial decrease in long-term survival following oral and maxillofacial reconstructive surgery. Early recognition and management of POD are critical to improving outcomes in this high-risk population.

Healthcare-associated infections (HAIs) are common complications in head and neck free flap reconstruction and can negatively impact patient outcomes. This prospective multicentre study, conducted between 2019 and 2022 across three Spanish institutions, included 150 patients. The incidence, characteristics, associated complications, and risk factors of HAIs were assessed. A predictive risk score was developed using logistic regression analysis. The incidence of HAIs was 58%, with surgical site infections being the most prevalent. HAIs were associated with longer hospital stays (odds ratio (OR) 41.52, 95% confidence interval (CI) 14.59-118.11; P < 0.001), reoperations (OR 12.59, 95% CI 4.12-38.49; P < 0.001), and delays in initiating adjuvant radiotherapy (OR 5.76, 95% CI 1.94-17.13; P = 0.002). Independent risk factors included prior radiotherapy, malignant tumour, female sex, and tracheostomy. These risk factors and ASA classification III-IV were included in the predictive score. The score assigned 1 point per risk factor, based on its β-coefficient. The observed incidence of HAIs increased with higher scores: 0% (score 0), 30% (score 1), 41% (score 2), 74% (score 3), 83% (score 4), 100% (score 5). The area under the curve for the score was 0.76, suggesting its utility in identifying high-risk patients. In conclusion, HAIs were associated with worse outcomes and their development could be predicted using the proposed risk score.

The aim of this study was to evaluate the effectiveness of enamel matrix derivative (EMD) in preventing and treating medication-related osteonecrosis of the jaws (MRONJ). The study included 60 rats divided into five equal-sized groups. The preventive effect of EMD was evaluated in groups 1 (healthy control), 2 (bisphosphonate control), and 3 (bisphosphonate + EMD), and treatment efficacy was examined in groups 4 (osteonecrosis control) and 5 (osteonecrosis + EMD). Intraperitoneal zoledronic acid was administered to induce MRONJ, and the left mandibular molar teeth were extracted in all groups. Saline-impregnated absorbable collagen sponges (ACS) were placed in the extraction sockets of the control groups, and EMD-impregnated ACS were placed in the study groups. After 8 weeks of healing, histomorphometry, immunohistochemistry, and micro-CT analyses were performed. The rate of complete mucosal closure in the extraction socket was significantly higher in the EMD groups compared to the controls (P = 0.015 , P = 0.009). VEGF, OPG, and RANKL expression levels were higher in the EMD groups compared to their respective controls; however, this was only significant for group 3 vs group 2 (all P < 0.01). Micro-CT examinations demonstrated significantly improved values in the EMD groups compared to the controls. EMD administration may enhance soft and hard tissue healing in MRONJ cases, promoting angiogenesis and bone apposition and increasing levels of VEGF and OPG. EMD may be a potential agent for the prevention and treatment of osteonecrosis.

Dental implant placement in fibula bone is a standard of care for restoring dentition in reconstructed jaws. An observational analysis of 100 fibulas was performed using the CT component of PET-CT scans, to assess anatomical characteristics of the fibula and determine the ideal fibula region for dental implant placement. The total anatomical fibula length (TAL) was measured on each scan. After removing 6 cm of fibula from each end, five equidistant cross-sectional points were located (A-E) and analysed for four parameters: height of available bone volume for implant installation (a-d dimension), cross-sectional shape, cortical thickness, and radiodensity. The cross-sectional points were compared, and differences according to sex were investigated. Median TAL was 35.4 cm ; adequate for reconstruction of the jaws. The maximum a-d dimension was observed for cross-section C (median 11.5 mm, interquartile range 10.2-13.0 mm). Median cortical thickness ranged between 2.48 mm and 3.91 mm, and median radiodensity between 1073 HU and 1356 HU. Cross-section D more frequently showed a favourable cross-sectional anatomy: triangular with apex downwards (71%). The distal portion of the fibula (segment C-D, spanning 17.74 -23.66 cm from the head end) is deemed most favourable site for dental implants.

A series of enlarged sublingual glands (SLG) that affected dental implantation procedures and prosthodontic rehabilitation is presented, along with their management. All patients were referred by their treating prosthodontists due to swelling in the floor of the mouth that caused difficulties in fitting dental implants or rehabilitation. Sixteen patients aged 27-80 years (12 female, 4 male), treated between 2015 and 2022, were included in this study. Thirteen patients had unilateral enlargement and three had bilateral enlargement of the SLG. Four patients refused to undergo surgical removal of the SLG, while 12 patients suffering from pain and discomfort around the implant underwent this procedure. All patients who underwent the surgery completed their dental rehabilitation by prosthodontists, while the patients who refused to undergo the surgery did not proceed with rehabilitation, leaving the implants submerged. Considerable difficulty is often encountered when performing implant-based mandible rehabilitation in the presence of SLG enlargement . In such cases, careful gland excision is safe and eliminates this problem. Thus, removal of the enlarged SLG can be considered before dental implantation procedures in relevant cases.

This study was performed to evaluate the amount of bone implant engagement (BIE) of zygomatic implants (ZIs) at the malar bone level and its correlation with the ZAGA classification (zygoma anatomy-guided approach). One hundred ZIs placed in 32 patients with severe maxillary atrophy using a fully digital protocol were assessed: 80 placed in pairs (40 anterior (AI), 40 posterior (PI)) and 20 as single ZIs (SI). The ZAGA classification was determined preoperatively. Postoperative computed tomography scans were analysed using 3D Slicer to measure medial and lateral BIE, the mean value of these (mvBIE), and the ferrule area. Comparisons of the mean mvBIE of the implants (AI, PI, SI) were made according to the ZAGA categories and within each ZAGA group. Descriptive statistics and a linear mixed-effects model were performed (α = 0.05). The overall mean mvBIE was 12.38 ± 3.53 mm (AI: 12.38 ± 3.85 mm, PI: 11.50 ± 3.01 mm, SI: 14.16 ± 3.32 mm). A significant relationship was found between mvBIE and the ZAGA classification (0.005