Journal of Oral and Maxillofacial Surgery最新文献

{"title":"Comparing the Infection Rates of Strut Versus Straight Plates in Sagittal Split Osteotomies.","authors":"Stephen E Higgins, Valmont Desa","doi":"10.1016/j.joms.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.joms.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>Sagittal split osteotomies can be rigidly fixated through various methods. Unfortunately, infection remains a common postoperative complication.</p><p><strong>Purpose: </strong>The purpose was to estimate postoperative infection rates between strut and straight plates for internal fixation of sagittal split osteotomies.</p><p><strong>Study design, setting, sample: </strong>We implemented a retrospective cohort study and included a consecutive series of patients with sagittal split osteotomies performed at the University of Nebraska Medical Center. The cases were performed by a single surgeon with a chief as resident surgeon. Exclusion criteria included any patient with unilateral surgery, mandibular midline osteotomy, previous mandible reconstruction, distraction osteogenesis, previous facial trauma history, and less than 12 weeks of follow-up.</p><p><strong>Predictor variable: </strong>Primary predictor variable was plate type (strut vs straight). The choice of plate was not based on the surgical plan.</p><p><strong>Main outcome variable(s): </strong>The primary outcome variable was postoperative infection. This was defined as purulent discharge, incision and drainage, or prescription of antibiotics. Secondary outcomes include hardware removal and neurosensory function.</p><p><strong>Covariates: </strong>Covariates included demographics, smoking, alcohol and drug use, single/double jaw, advancement/setback, length of movement, and perioperative third molar extraction.</p><p><strong>Analyses: </strong>Fisher's exact test, χ² test, and Student's t test were computed to measure bivariate association. The relative risks (RRs) and their 95% CIs were reported. P values < .05 were considered statistically significant.</p><p><strong>Results: </strong>The sample comprised 112 subjects: 51 (45.5%) straight plate and 61 (54.5%) strut plate. There were 32 (62.7%) women in the straight plate group, mean age 25.55 ± 13.34 years and 39 women (63.9%) in the strut plate group, mean age 29.02 ± 11.97 years. Postoperative infection was the most common reason for plate removal (n = 10). Strut plates, relative to straight plates, were associated with a 23% increase (RR 1.23, 95%, CI 0.47 to 2.16, P < .7) in infections, a 25% increase (RR 1.25, 95%, CI 0.45 to 2.27, P < .5) in hardware removal, and a 17% increase (RR 1.17, 95% CI 0.33 to 2.44, P < .7) in postoperative neurosensory disturbance at 3 months for sagittal split osteotomies.</p><p><strong>Conclusions and relevance: </strong>The choice of internal fixation plate, strut versus straight, was not associated with postoperative infection, hardware removal, or postoperative neurosensory function deficit.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perineural Invasion and Lymph Node Ratio Quartile Are Associated With Extranodal Extension in Oral Cavity Squamous Cell Carcinoma.","authors":"Piper A Wenzel, Steven L Van Meeteren, Nitin A Pagedar, Marisa R Buchakjian","doi":"10.1016/j.joms.2025.02.012","DOIUrl":"https://doi.org/10.1016/j.joms.2025.02.012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In contrast to extranodal extension (ENE), tumor characteristics can often be evaluated preoperatively in patients with oral cavity squamous cell carcinoma (OCSCC). If correlations exist between primary tumor characteristics and the presence of ENE, evaluating these factors could help provide more accurate patient counseling and adjuvant treatment planning before undergoing surgical therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The study's purpose was to identify associations between OCSCC pathologic characteristics and ENE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design, setting, sample: &lt;/strong&gt;We performed a retrospective cohort study of adult patients who underwent upfront curative-intent surgery for OCSCC at the University of Iowa Hospitals and Clinics from 2004 to 2018. The treating service was otolaryngology-head and neck surgery. Exclusion criteria included patients who did not undergo neck dissection, primary tumor occurring outside the oral cavity, pathologic N0, cancer previously treated with radiation or surgically at another institution, and gross disease remaining after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Predictor variable: &lt;/strong&gt;The predictor variable was a set of tumor characteristics, including oral cavity subsite, T- and N- classification, perineural invasion (PNI), lymphovascular invasion, bone invasion, and positive lymph node ratio (LNR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome variable: &lt;/strong&gt;The main outcome variable was ENE status, defined as positive (at least 1 lymph node reported to have ENE) or negative, identified from pathology reports.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Covariates: &lt;/strong&gt;Covariates included subject sex, age, and smoking history.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analyses: &lt;/strong&gt;Bivariate comparisons and multivariate logistic regression analyses were performed to identify correlations between predictor variables/covariates and presence of ENE. Statistical significance was set at P = .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The sample comprised 233 subjects with a mean age of 60.5 (SD 12.5) years, and 154 (66.1%) were male. Of 233 subjects with nodal metastasis, 122 (52.4%) had ENE in at least 1 node, and the median (interquartile range) positive LNR was 0.083 (0.094). On bivariate analysis, PNI (relative risk = 1.49; 95% CI, 1.14 to 1.96; P = .002), bone invasion (relative risk = 1.42; 95% CI, 1.13 to 1.80; P = .005), LNR quartile (P &lt; .001), and pathologic T-class (eighth edition; P = .001) were significantly correlated with ENE. On multivariate logistic regression analysis, PNI (odds ratio = 2.29; 95% CI, 1.21 to 4.31; P = .01) and LNR quartile (P &lt; .001) remained significantly correlated with ENE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study offers insight into important clinicopathologic details of lymph node metastases in OCSCC with an emphasis on tumor characteristics and odds of ENE in 1 or more lymph nodes. This information may be beneficial for patient counseling and treatment planning, especially in patients with PNI and hi","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Study of Speech and Swallowing Postoperative Outcomes in Oral Cancer: Impact of Lateral Mandibular Continuity Restoration","authors":"Abhipsa Mishra MDS ,&nbsp;Raveena R. Nair MS ,&nbsp;Sandeep Vijay MS ,&nbsp;Anoop Attakkil MS ,&nbsp;Aswin Mullath MDS ,&nbsp;Aby K. Babu MDS","doi":"10.1016/j.joms.2024.10.020","DOIUrl":"10.1016/j.joms.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Surgical resection with mandibulectomy in advanced oral cancer results in complex defects. The influence of reconstruction of mandibular continuity on postoperative speech and swallowing function, though crucial, is not widely studied.</div></div><div><h3>Purpose</h3><div>The purpose of study was to compare the speech and swallowing outcomes of oral squamous cell carcinoma (OSCC) patients with lateral mandibulectomy, with or without the restoration of mandibular continuity.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This retrospective cohort study was performed at the Malabar Cancer Centre, Kerala, India, on patients who had undergone lateral mandibulectomy for OSCC from January 2016 to December 2021. Patients with recurrent or second primary OSCC, or with psychiatric disorders and cognitive impairment, or in whom any type of glossectomy was done, were excluded from the study.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was reconstruction status of mandibular continuity, coded as yes when it is restored and no for vice-versa.</div></div><div><h3>Main Outcome Variable(s)</h3><div>The outcome variables were postoperative speech outcome measured with a 7-point rating speech intelligibility scale and swallowing outcome measured with functional oral intake scale.</div></div><div><h3>Covariates</h3><div>Covariates included age, sex, tumor subsite, mandibular defect, and adjuvant treatment.</div></div><div><h3>Analyses</h3><div>Data analyses included χ², Fisher's exact test, independent t test, Spearman's correlation test, and one-way analysis of variance test. <em>P</em> values &lt; .05 were considered statistically significant.</div></div><div><h3>Results</h3><div>The study sample had 201 patients, with continuity restored in 74 (36.82%) patients and vice versa in 127 (63.18%) patients. The mean age in the continuity restored group was 54.97 ± 9.68 years, and in the continuity not restored group, it was 59.49 ± 9.95 years (<em>P</em> &lt; .05). Both the groups had more male patients (<em>P</em> = .15). The speech scores in both groups at 1 month (<em>P</em> = .66), 3 months (<em>P</em> = .45), and 6 months (<em>P</em> = .33) of postoperative period were compared and had no statistically significant difference. The swallowing scores in groups at 1 month (<em>P</em> = .5), 3 months (<em>P</em> = .5), and 6 months (<em>P</em> = .7) of postoperative period were also compared and had no statistically significant difference.</div></div><div><h3>Conclusion and Relevance</h3><div>Reconstruction of lateral mandibular continuity was not associated with improved postoperative speech and swallowing.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 374-381"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photobiomodulation With Infrared and Dual-Wavelength Laser Induces Similar Repair and Control of Inflammation After Third Molar Extraction: A Double-Blinded Split-Mouth Randomized Controlled Trial","authors":"Davisson Alves Pereira PhD, DDS ,&nbsp;Mariana Silva Bonatto PhD, DDS ,&nbsp;Eduvaldo Campos Soares Jr. PhD, DDS ,&nbsp;Pedro Gomes Junqueira Mendes MSc ,&nbsp;Roberto Sales e Pessoa PhD, DDS ,&nbsp;Guilherme José Pimentel Lopes de Oliveira PhD, DDS","doi":"10.1016/j.joms.2024.11.009","DOIUrl":"10.1016/j.joms.2024.11.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Photobiomodulation therapy (PBMT) has been showed to have beneficial effects on the healing and control of inflammation associated with oral surgical wounds. However, different PBMT protocols have been proposed and it is not clear if different protocols impact the hard and soft tissues healing equally.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To compare the tissue repair of postextraction alveoli of third molars between treated with dual-wavelength PBMT (red and infrared) or PBMT with infrared laser (IRL) alone.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design, Setting, Sample&lt;/h3&gt;&lt;div&gt;This split mouth randomized controlled trial enrolled 20 patients, who were submitted to the extraction of the 4 partially erupted or fully impacted third molars between August 2023 and December 2023 at the clinic of the INPES postgraduate school (Institute for Clinical Health Research), and at the Federal University of Uberlândia. Adult with all the 4 molars were included in this study, while patients with systemic diseases/conditions, with less than 4 third molars were excluded of this study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure Variable&lt;/h3&gt;&lt;div&gt;The exposure variable is PBMT treatment. Treatment side was randomly allocated to according to the PBMT protocol applied on the postextraction sockets: IRL-PBMT: irradiation with PBMT with an IRL (808 nm) and IRL-RL-PBMT: irradiation with dual-wavelength PBMT (660 and 808 nm).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Variable(s)&lt;/h3&gt;&lt;div&gt;The primary outcome variable was the bone tissue healing that was measured using the fractal analysis and bone tissue density assessed using the radiographic images. The secondary outcome variable was soft tissue healing measured assessing the facial dimensions variations and a healing index that assessed the tissue consistence, color, exudation, bleeding, and edema. Additionally, the analyses centered on the patients’ perceptions was assessed by the application of a visual analogic scale to assess pain, bleeding, edema, difficulty in chewing, and mouth opening conditions. Subjects were clinically evaluated at 3, 7, 14, 30, and 90 days after the surgical procedure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Covariates&lt;/h3&gt;&lt;div&gt;The covariates are the tooth position, and the demographic data (age and sex).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analyses&lt;/h3&gt;&lt;div&gt;The evaluation of the effects of the independent variables (Treatment and period of evaluation) on the primary and secondary outcomes was performed through the application of the repeated measures ANOVA (&lt;em&gt;P&lt;/em&gt; &lt; .05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The sample was composed of 20 subjects with a mean age of 28.58 ± 8.94 years, and 12 (60%) were females. There were no statistically significant differences between the 2 treatments for any outcome variables (&lt;em&gt;P&lt;/em&gt; &gt; .10).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion and Relevance&lt;/h3&gt;&lt;div&gt;It can be concluded that PBMT with dual wavelengths (red and infrared) and an IRL alone induced similar postoperative clinical results after","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 332-343"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Social Media Increase Perioperative Anxiety in Patients Undergoing Impacted Third Molar Surgery?","authors":"Ufuk Tatli DDS, PhD ,&nbsp;Tahayasin Kalkan DDS","doi":"10.1016/j.joms.2024.11.010","DOIUrl":"10.1016/j.joms.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>In anticipation of third molar surgery, patients may experience increased anxiety. Patients frequently access social media platforms and view content about surgical treatments.</div></div><div><h3>Purpose</h3><div>The study purpose was to measure the level of perioperative anxiety of patients scheduled for third molar surgery exposed to social media and identify factors associated with patient anxiety.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This is a prospective cohort study of patients undergoing impacted mandibular third molar surgery from September 2021 to August 2022 at the outpatient clinic of Cukurova University School of Dentistry.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was level of exposure to viewing third molar surgery-related social media before the surgery. Subjects were divided into 2 groups based on social media viewing preferences at their own discretion: the control group involved patients who did not view social media and study group involved patients who viewed social media before the surgery.</div></div><div><h3>Main Outcome Variables</h3><div>The outcome variables were patients' anxiety levels assessed using Modified Dental Anxiety Scale and Spielberger State Anxiety Inventory.</div></div><div><h3>Covariates</h3><div>Covariates were age, sex, education level, history of previous dentist visit, and impacted third molar surgery.</div></div><div><h3>Analyses</h3><div>Student t-test, Mann-Whitney U test, χ² test, Kruskal-Wallis test, one-way analysis of variance, and post hoc tests were used according to data. Level of significance was set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>The study sample comprised 162 patients; 82 (50.6%) patients were in the control group and 80 (49.4%) were in the social media group. The Modified Dental Anxiety Scale scores of the social media group (11.95 ± 4.50) were statistically higher than the control group (9.66 ± 4.28) (<em>P</em> = .001). The Spielberger State Anxiety Inventory scores of the social media group (46.43 ± 5.80) were statistically higher than the control group (44.52 ± 5.53) (<em>P</em> = .03). There were statistical differences in anxiety levels considering some covariates. In social media group, there were some statistical differences in anxiety levels of patients who viewed different social media type and content.</div></div><div><h3>Conclusion and Relevance</h3><div>Patients who viewed social media on their own preferences before the surgery had higher perioperative anxiety compared to those who did not. The effects of demographic variables, different social media types and content on perioperative anxiety should be taken into account during stress management of the patients.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 344-352"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Orbital Fractures Caused by Sports Injuries in Children","authors":"Joyce Xu DMD, MD, MS ,&nbsp;Shelly Abramowicz DMD, MPH","doi":"10.1016/j.joms.2024.11.011","DOIUrl":"10.1016/j.joms.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Sports injuries account for 11.3 to 42.1% of the facial fractures. Injuries from contact with a ball, a bat or stick, or another player raise safety concerns.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to assess the patterns of sports-related maxillofacial injuries involving orbital bone fractures in children.</div></div><div><h3>Study design, setting, and sample</h3><div>This was a retrospective case series of children who presented to Children's Healthcare of Atlanta from 2015 to 2021, with orbital injuries resulting from sports.</div></div><div><h3>Independent variable</h3><div>None.</div></div><div><h3>Outcome variable</h3><div>The outcome variables, including the fracture location, pattern, and the management of injury.</div></div><div><h3>Covariates</h3><div>The medical record were reviewed for the following variables: <em>1)</em> demographic information, <em>2)</em> mechanism of injury, <em>3)</em> type of sport, <em>4)</em> symptoms, <em>5)</em> length of inpatient stay, and <em>6)</em> duration of follow-up.</div></div><div><h3>Analysis</h3><div>Data were collected using a standardized collection form. Descriptive statistics were calculated.</div></div><div><h3>Results</h3><div>Overall, 101 patients (92 males) with an age of 13 ± 3 met the inclusion criteria. The most common sport was baseball or softball (n = 78, 77.2%). The mechanisms of injuries were largely due to collision with the ball (n = 79, 78.2%) or with another player (n = 13, 12.9%). Orbital fractures occurred mostly in the floor (n = 87, 86.1%), followed by the medial wall (n = 22, 21.8%), with an average of 1 surface involved. Maxillary sinus (n = 23, 22.8%) and/or nasal bone (n = 17, 16.8%) were the other facial bones outside of orbit commonly injured. The fractures patterns are minimally/nondisplaced (n = 68, 67.3%), displaced (n = 30, 29.7%), or comminuted (n = 3, 3%). The managements include surgical and nonsurgical. Twenty-three patients (22.8%) underwent surgical intervention. Twelve of them had an emergent operation due to extraocular muscle entrapment.</div></div><div><h3>Conclusion</h3><div>Sports injuries are a common cause of orbital trauma in children. Most injuries are due to baseball/softball from collision with the ball. They were mostly managed without surgery, except for the individuals that presented with entrapment, oculocardiac reflex, and a large-size defect. The information from this project could be utilized in implementing safety equipment use for participants to further prevent such injuries.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 317-321"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AAOMS Author Disclosure forms","authors":"","doi":"10.1016/S0278-2391(25)00021-7","DOIUrl":"10.1016/S0278-2391(25)00021-7","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages A9-A11"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolution of Virtual Surgical Planning in Craniomaxillofacial Surgery: A Comprehensive Review","authors":"Michael V. Joachim DMD, MSc, MHA ,&nbsp;Michael Miloro DMD, MD","doi":"10.1016/j.joms.2024.11.001","DOIUrl":"10.1016/j.joms.2024.11.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Virtual surgical planning (VSP) has significantly transformed craniomaxillofacial surgery over the past 2 decades, leading to diverse applications and improved surgical outcomes. However, variations in technological approaches, clinical outcomes, and economic implications persist. This review aims to comprehensively examine the evolution of VSP in craniomaxillofacial surgery, assess its impact on surgical precision and patient outcomes, and identify current trends and future directions. A synthesis of current knowledge is essential to establish evidence-based guidelines for VSP implementation and optimize patient care in this rapidly advancing field.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted in PubMed, Embase, and IEEE Xplore databases from their inception to September 2024. Search terms included combinations of “virtual surgical planning” OR “computer-assisted surgery” AND “craniomaxillofacial” OR “maxillofacial” OR “craniofacial” AND “evolution” OR “development” OR “advancement”. From 540 initially identified articles, studies focusing on VSP in craniomaxillofacial surgery that reported technological advancements, surgical outcomes, or precision metrics were included. Eligible studies comprised case series with 5 or more subjects, comparative studies, and validation studies. Data extraction included study characteristics, technology details, surgical applications, outcome measures, and economic factors. Quality assessment was performed using appropriate tools based on study design.</div></div><div><h3>Results</h3><div>Out of 540 articles, 36 studies spanning from 1999 to 2024 met the inclusion criteria. The evolution of VSP was categorized into 3 phases: early foundations (1999 to 2004), expansion of applications and improved accuracy (2005 to 2014), and advanced integration with emerging technologies (2015 to 2024). Orthognathic surgery was the commonest application (52.8% of studies), followed by tumor resection and reconstruction (22.2%). Studies consistently demonstrated smaller linear discrepancies between planned and actual outcomes with VSP compared to conventional methods (VSP: 0.04 to 0.25 mm vs conventional: 0.29 to 1.33 mm). Recent advancements include the integration of artificial intelligence, mixed reality, and robotic systems, enhancing both preoperative planning and intraoperative guidance.</div></div><div><h3>Conclusion</h3><div>VSP has considerably evolved in craniomaxillofacial surgery, improving accuracy as demonstrated by reduced linear discrepancies between planned and actual outcomes across various procedures. While promising, challenges remain, including the need for standardization, comprehensive cost-effectiveness analyses, and long-term outcome studies.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 294-306"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What are the Pterygomaxillary Fracture Patterns in Cleft Orthognathic Surgery?","authors":"Isabela Toledo Teixeira da Silveira MSc ,&nbsp;Bruno Gomes Duarte MSc ,&nbsp;Luciano Reis de Araújo Carvalho MSc ,&nbsp;Bhárbara Marinho Barcellos OMS ,&nbsp;Marina de Almeida Barbosa Mello MSc ,&nbsp;Renato Yassutaka Faria Yaedú PhD","doi":"10.1016/j.joms.2024.11.016","DOIUrl":"10.1016/j.joms.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cleft lip and palate (CLP) often exhibit unique anatomical variations in the pterygoid plates, which can influence fracture patterns at the pterygomaxillary junction (PMJ) during Le Fort I osteotomy. These differences may increase the risk of unfavorable fractures, complicating surgery and recovery.</div></div><div><h3>Purpose</h3><div>The study purpose was to measure the association between the osteotomy level with the PMJ fracture patterns in CLP patients undergoing Le Fort I osteotomy.</div></div><div><h3>Study Design, Setting, and Sample</h3><div>This retrospective cohort study included 100 patients with CLP, representing 200 tomographic views of the right and left pterygomaxillary regions. Preoperative tomographic scans were analyzed to measure morphometric features of the pterygomaxillary suture in the axial and sagittal planes.</div></div><div><h3>Predictor Variable</h3><div>The primary predictor was osteotomy level: at the level or above of the PMJ.</div></div><div><h3>Main Outcome Variable</h3><div>The main outcome was the pterygomaxillary fracture pattern, categorized as favorable or unfavorable.</div></div><div><h3>Covariates</h3><div>The covariates included age, sex, side of the mandible, pterygomaxillary suture thickness, pterygomaxillary suture width, distance between the greater palatine canal and the pterygoid suture, length of the medial plate, length of the lateral plate, insertion of the pterygomaxillary suture in the posterior part of the maxilla, and the length and height of the tuber.</div></div><div><h3>Analysis</h3><div>Statistical analyses included t-tests for mean differences (<em>P</em> &lt; .05) and χ² tests for associations. Relative risk was calculated for osteotomy levels to assess the significance of associations with fracture patterns.</div></div><div><h3>Results</h3><div>The study comprised 100 participants (47 men, 53 women), with a mean age of 23 years (SD = 2.31). In total, 110 (55%) fractures were classified as favorable. The frequency of unfavorable fractures was significantly higher when the osteotomy was performed above the PMJ (<em>P</em> &lt; .005). The relative risk for unfavorable fractures was 23.06 on the right side (95% confidence interval = [5.94, 89.53], <em>P</em> &lt; .001) and 65.00 on the left side (95% confidence interval = [9.30, 454.52], <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>The study findings suggest that in cleft surgery the osteotomy should be performed at the level of the PMJ to reduce the risk of inadvertent pterygomaxillary fractures.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 307-316"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Complexity of Arthroscopic Temporomandibular Joint Surgery Associated With Short-Term Complication Rates?","authors":"Daniel Jerez-Frederick DDS, MSc ,&nbsp;Daniela Albers DDS, Msc ,&nbsp;Carlos Fuenzalida DDS ,&nbsp;German Laissle DDS ,&nbsp;Camila Ávila-Oliver DDS, MSc","doi":"10.1016/j.joms.2024.11.008","DOIUrl":"10.1016/j.joms.2024.11.008","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopy is regarded as a minimally invasive surgical procedure, with complication rates ranging from 1.7 to 4.4%. It remains unclear whether the complexity of the arthroscopic procedure is associated with the frequency of complications.</div></div><div><h3>Purpose</h3><div>The study purpose was to measure the association between the level of arthroscopic complexity and short-term postoperative complications.</div></div><div><h3>Study Design, Setting, Sample</h3><div>The researchers implemented a prospective cohort study. Subjects presenting to Clinica Bupa Santiago, a tertiary care hospital in Chile between 2022 and 2023 who requires arthroscopy were enrolled. Inclusion criteria required subjects to have a history of joint disorder and a preoperative magnetic resonance imaging (MRI) to be scheduled for an arthroscopic surgery with a 6-month follow-up. Subjects lacking 6-month follow-up were excluded.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was the arthroscopy complexity level: level I (single puncture diagnostic sweep), level II (double puncture with instrumentation or shaver), and level III (discopexy or discectomy).</div></div><div><h3>Main Outcome Variable</h3><div>The main outcome variable was intraoperative and postoperative complications, which were defined as any unwanted development resulting in lasting consequences, additional surgeries, or unresolved issues, and these were coded as either present or absent.</div></div><div><h3>Covariates</h3><div>The covariates included age, sex, duration of symptoms, prior conservative therapies, history of previous open joint surgery, and Wilkes stage.</div></div><div><h3>Analyses</h3><div>Data were analyzed using descriptive statistics with statistical significance set at <em>P</em> value &lt;.05. χ² or Fisher’s exact test was used depending on the variable type.</div></div><div><h3>Results</h3><div>A total of 165 subjects (285 joints) with a mean age of 28.9 years (SD 13.0) were included. Of these, 149 (90.3%) were female and 16 (9.7%) were male. Level I procedures were performed on 37 joints (13.0%) in 23 subjects (16.3%), level II on 53 joints (18.6%) in 27 subjects (16.3%), and level III on 195 joints (68.4%) in 116 subjects (69.9%). Complications occurred only in level III (7 procedures, 2.5%, <em>P</em> = .33), affecting 5 subjects (3.0%). Observed complications included transient frontal facial paresis, mouth floor edema, transient neuropathic pain, suture rejection, and emphysema.</div></div><div><h3>Conclusion and Relevance</h3><div>The postoperative complication rate after arthroscopy was 2.5%, with no statistically significant association with operative complexity. Although more complications were observed in advanced arthroscopies, this increase was not significant.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 270-278"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}