Journal of Oral and Maxillofacial Surgery最新文献

{"title":"Five-Year Experience With Routine Use of Intraoperative Cone-Beam Computed Tomography in Zygomaticomaxillary Complex Fractures","authors":"Dominique Korner ,&nbsp;Daphne Schönegg Dr Med, Dr Med Dent ,&nbsp;Daniel Wiedemeier PhD ,&nbsp;Maximilian Eberhard Hermann Wagner PD Dr Med, Dr Med Dent ,&nbsp;Harald Essig Prof Dr Med, Dr Med Dent ,&nbsp;Michael Blumer PD Dr Med, Dr Med Dent","doi":"10.1016/j.joms.2025.01.013","DOIUrl":"10.1016/j.joms.2025.01.013","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative cone-beam computed tomography (CBCT) during open reduction and internal fixation of zygomaticomaxillary complex (ZMC) fractures may facilitate the re-establishment of a complex 3-dimensional anatomy.</div></div><div><h3>Purpose</h3><div>This study was conducted to measure the occurrence of malpositions after ZMC fracture reduction and intraoperative revision rates after conducting intraoperative CBCT.</div></div><div><h3>Study design, setting, sample</h3><div>This retrospective case series included subjects treated for ZMC fractures with intraoperative CBCT at the Department of Maxillofacial Surgery of the University Hospital Zurich (Switzerland) over a 5-year period (January 2015 to December 2019). The exclusion criteria were a history of facial fracture and incomplete data.</div></div><div><h3>Predictor variable</h3><div>Not applicable.</div></div><div><h3>Main outcome variables</h3><div>The primary outcome variable was malpositioning after ZMC fracture reduction on intraoperative 3-dimensional imaging. Further variables—including intraoperative revisions of ZMC malpositions, osteosynthesis material revisions, and intraoperative assessments of orbital reconstruction—were analyzed.</div></div><div><h3>Covariates</h3><div>Demographic (age and sex) and clinical (associated with facial fractures) characteristics were assessed.</div></div><div><h3>Analyses</h3><div>The analyses included Spearman's rank correlations, mosaic plots, χ² tests, and Fisher's exact tests. The confidence level for hypothesis testing was set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>The sample included 337 subjects, and 589 intraoperative CBCT scans were obtained. ZMC malposition after reduction was observed in 154 (45.7%) subjects; the most common malpositions were caudal displacement, underprojection, and inward rotation of the ZMC. Intraoperative revisions were conducted in 150 (44.5%) subjects: 105 (31.2%) subjects exhibited a ZMC malposition, 13 (3.9%) subjects needed revisions of the osteosynthesis material placement, and 32 (9.5%) subjects required intraoperative orbital floor reconstruction. No secondary revision surgeries were required, excluding 25 secondary orbital floor reconstructions. Preoperative and intraoperative radiographic findings did not correlate regarding indications for orbital floor reconstruction.</div></div><div><h3>Conclusion and relevance</h3><div>The 44.5% intraoperative revision rate underscores the challenges of ZMC fracture surgery. Clinical evaluation of fracture reduction at the latero-orbital rim is recommended to identify caudal displacements, and intraoperative CBCT helps identify candidates for primary orbital floor reconstruction. This technique may enhance quality control and precision, thereby potentially improving patient outcomes.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 5","pages":"Pages 576-584"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433069","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":"Comparison of Lip Revision Rates in Traditional Versus Early Cleft Lip Repair: An Institutional Review","authors":"Idean Roohani ,&nbsp;Marvee Turk MD, MPH ,&nbsp;Dylan G. Choi ,&nbsp;Collean Trotter MAT, MD ,&nbsp;Sarah Alfeerawi ,&nbsp;Naikhoba C.O. Munabi MD, MPH ,&nbsp;William P. Magee III MD, DDS ,&nbsp;Jeffrey A. Hammoudeh MD, DDS","doi":"10.1016/j.joms.2025.01.015","DOIUrl":"10.1016/j.joms.2025.01.015","url":null,"abstract":"<div><h3>Background</h3><div>Traditional cleft lip repair (TLR) is performed between 3 and 6 months of age. For over 10 years, our institution has transitioned from offering presurgical nasoalveolar molding (NAM) before cleft lip repair to performing early cleft lip repair (ECLR) within 2 to 5 weeks of life, circumventing the use of NAM.</div></div><div><h3>Purpose</h3><div>This study aimed to estimate and compare the lip revision rates between patients who underwent ECLR versus TLR ± NAM.</div></div><div><h3>Study design, setting, sample</h3><div>A retrospective cohort study was conducted. Patients with nonsyndromic unilateral cleft lip who underwent primary repair between 2004 and 2021 at Children’s Hospital Los Angeles were included. Exclusion criteria were as follows: American Society of Anesthesiologists classification III or higher, syndromic or bilateral cases, gestational-corrected age of more than 6 months at lip repair, and less than 2 years of follow-up.</div></div><div><h3>Predictor variable</h3><div>The predictor variable was the timing of primary cleft lip repair. Subjects were allocated to 1 of 2 treatment cohorts: ECLR (&lt;3 months) and TLR ± NAM (3 to 6 months).</div></div><div><h3>Main outcome variable</h3><div>The primary outcome was lip revision surgery at any time during the patient’s cleft care. Secondary outcomes included the extent and timing of the revision surgeries.</div></div><div><h3>Covariates</h3><div>Data collection included presurgical NAM use, surgeon, cleft phenotype, and cleft width ratio.</div></div><div><h3>Analyses</h3><div>A 2-phased coarsened exact matching process was performed to match cohorts based on surgeon, cleft phenotype, and cleft width ratio at a 1:1 ratio. Kaplan-Meier analyses were used to estimate and compare the revision rates.</div></div><div><h3>Results</h3><div>A total of 1,101 patients underwent primary repair during the study period. After applying the exclusion criteria, 362 patients remained before matching. Among these, 154 patients (77 ECLR, 77 TLR ± NAM) were included after matching. Kaplan-Meier analysis estimated a lower 5-year revision rate for the ECLR cohort compared to the TLR ± NAM cohort (17.3 vs 32.6%, log-rank <em>P</em> &lt; .05). Median follow-up time was 6.6 years [interquartile range 4.4 to 9.2].</div></div><div><h3>Conclusions and relevance</h3><div>ECLR resulted in approximately a 2-fold reduction in lip revision rates compared with TLR ± NAM. These findings suggest that cleft lip repair at approximately 1 month of age may decrease the burden of secondary procedures later in life.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 5","pages":"Pages 528-542"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472500","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 A Surgeon’s Self-Perceived Level of Anxiety Associated With the Type of Surgical Procedure Being Performed?","authors":"Onur Odabaşı DMD ,&nbsp;Mehmet Emrah Polat DMD","doi":"10.1016/j.joms.2025.01.016","DOIUrl":"10.1016/j.joms.2025.01.016","url":null,"abstract":"<div><h3>Background</h3><div>Surgical procedures result in some level of anxiety for the surgeon. It is unclear if the type of surgical procedure being performed by oral and maxillofacial surgeons influences the self-perceive level of anxiety.</div></div><div><h3>Purpose</h3><div>The purpose of this study was to measure the association between different oral and maxillofacial surgical procedures and anxiety levels, and to identify procedures associated with the highest level of performance anxiety.</div></div><div><h3>Study design, setting, sample</h3><div>A retrospective cross-sectional survey was conducted among oral and maxillofacial surgeons in Turkey, distributing surveys electronically via social media platforms, including Instagram and WhatsApp.</div></div><div><h3>Predictor variable</h3><div>The primary predictor variable was surgical procedure. The procedures were 15 different operations, including simple and complex tooth extraction, impacted mandibular and maxillary canine–premolar extraction, impacted mandibular and maxillary third molar extraction, dental implant surgery, sinus lifting, grafting (simple and complex), cyst operations, Le Fort I surgery, sagittal split ramus osteotomy, genioplasty, and temporomandibular joint (TMJ) surgery.</div></div><div><h3>Main outcome variable</h3><div>The main outcome variable was self-reported anxiety level during various surgical procedures, assessed using an 11-point Likert scale ranging from 0 (no anxiety) to 10 (extreme anxiety).</div></div><div><h3>Covariates</h3><div>Covariates included demographics (age and sex), experience (years) and institution type (public universities, private universities, private clinics, private health institutions, and Ministry of Health-affiliated hospitals.)</div></div><div><h3>Analyses</h3><div>Normality was tested with the Shapiro-Wilks test. Anxiety scores were compared among categorical variables with more than 2 categories using the Kruskal–Wallis test, and by sex using the Mann–Whitney U test. Statistical significance was indicated by <em>P</em> value &lt; .05.</div></div><div><h3>Results</h3><div>A total of 154 surveys were distributed, and 96 responses (62.3%) were received and analyzed. Among the respondents, 34 (35.4%) were female and 62 (64.6%) were male. Anxiety levels differed significantly by surgical procedure (<em>P</em> &lt; .001), with the highest mean in TMJ surgery (8.10 ± 2.23) and the lowest mean in simple tooth extraction (1.44 ± 1.86).</div></div><div><h3>Conclusions and relevance</h3><div>The anxiety levels associated with different oral and maxillofacial surgical procedures vary for surgeons. Developing targeted anxiety management strategies is important, especially for procedures with high anxiety levels, such as TMJ surgery and bilateral sagittal split ramus osteotomy.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 5","pages":"Pages 632-639"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492363","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":"Alveoloplasty: A Paradigm Shift to a More Efficient Surgical Technique.","authors":"Jason A Buschman","doi":"10.1016/j.joms.2025.04.016","DOIUrl":"10.1016/j.joms.2025.04.016","url":null,"abstract":"<p><p>Preprosthetic surgery has been an integral part of the oral and maxillofacial surgeon's practice since first described by Obwegeser in the 1970s. Since then, minimal changes or advancements in techniques have been described and are still taught in dental schools. Recent advancements in research now highlight areas of greatest force on alveolar bone during mastication. With this knowledge, surgical planning can improve, helping to avoid buccal bone fractures and other complications that reduce the patient's ability to wear a prosthesis. It has also been demonstrated that longer surgical times increase complication risks, thus the surgeon's goal should be to reduce complications, preserve adequate bone, reshape the alveolar ridge, and minimize surgical time. This technical method introduces a new technique for performing alveoloplasty with extractions, enhancing the surgeon's ability to meet these goals.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094125","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":"Outcomes of Pediatric Maxillofacial Giant Cell Lesion Management in Syndromic Versus Nonsyndromic Patients: A 21-Year Review.","authors":"Asli Pekcan, Raina Patel, Melanie Bakovic, Valeria Mejia, Priyanka Naidu, Pasha Shakoori, Jeffrey Hammoudeh","doi":"10.1016/j.joms.2025.04.017","DOIUrl":"10.1016/j.joms.2025.04.017","url":null,"abstract":"<p><strong>Background: </strong>Maxillofacial giant cell lesions (GCLs) may occur in isolation or as a part of a genetic syndrome, where they are often multifocal. The functional deficits and psychosocial impact necessitate urgent treatment; however, a consensus on management is lacking given the rarity and the variable presentation in children.</p><p><strong>Purpose: </strong>This study aims to compare the treatment and outcomes of pediatric maxillofacial GCLs in syndromic and nonsyndromic subjects.</p><p><strong>Study design, setting, and sample: </strong>A retrospective cohort study of pediatric subjects with histologically confirmed maxillofacial GCLs at a tertiary children's hospital between 2003 and 2024 was performed. Patients with incomplete documentation and less than 6 months of follow-up were excluded.</p><p><strong>Predictor variable: </strong>The predictor variable was syndromic diagnosis.</p><p><strong>Main outcomes variable(s): </strong>The primary outcome was tumor recurrence. The secondary outcome was final disease status (remission, progressive, or nonprogressive lesion).</p><p><strong>Covariates: </strong>Demographic characteristics including syndromic diagnosis, tumor characteristics, and adjuvant pharmacologic therapy (APT), including duration of treatment and side effects, were collected. Lesions were classified as aggressive or nonaggressive according to Chuong et al. ANALYSES: Univariate and bivariate statistics were used to compare treatment characteristics and outcomes between syndromic and nonsyndromic cohorts, with statistical significance determined by P values less than .05. Time to tumor recurrence was estimated using Kaplan-Meier analysis.</p><p><strong>Results: </strong>The sample was composed of 28 subjects (16 nonsyndromic, 12 syndromic), with a mean age of 10.7 ± 4.8 years and 17 (60.7%) were male. Overall, 96.4% of lesions were aggressive. Nonsyndromic subjects were more frequently treated with APT compared to syndromic subjects (75.0 vs 25.0%, P = .020). Recurrence occurred in one nonsyndromic subject (6.2%) and 50% of syndromic subjects (P = .008). The estimated median time to recurrence was 89 weeks. Remission was achieved in 100% of the nonsyndromic cohort and only 8.3% of the syndromic cohort (P < .001).</p><p><strong>Conclusion: </strong>The results of this study demonstrated that syndromic subjects were less likely to receive APT for the management of pediatric maxillofacial GCLs, and exhibited higher recurrence and lower remission rates compared to their nonsyndromic counterparts. These findings emphasize the importance of long-term surveillance and anticipatory counseling for families of syndromic patients.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086222","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 Novel Bipartite 3D Printed CAD/CAM Splint for Treatment of Mandibular Fractures.","authors":"Varad Rajendra Saptarshi, Srivalli Natarajan, Suraj Arjun Ahuja, Chinmay Vasant Rao","doi":"10.1016/j.joms.2025.04.019","DOIUrl":"10.1016/j.joms.2025.04.019","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078739","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":"Autografts, Bone Substitutes, and Combined Approaches for Secondary Alveolar Bone Grafting: A Systematic Review and Meta-Analysis.","authors":"Saman Baghaei, Masood Feizbakhsh, Bijan Movahedian Attar, Alireza Khoshdel, Hossein Abdali","doi":"10.1016/j.joms.2025.04.018","DOIUrl":"10.1016/j.joms.2025.04.018","url":null,"abstract":"<p><strong>Background: </strong>Alveolar clefts require bone grafting to restore function and esthetics. Although autogenous iliac crest grafts remain gold standard, their morbidity motivates exploration of alternative materials.</p><p><strong>Purpose: </strong>This systematic review and meta-analysis evaluated 3 approaches to alveolar cleft repair: 1) autogenous bone grafts combined with alternative bone substitute materials (group A), 2) alternative bone substitutes alone (group B), and 3) autogenous iliac crest grafts as the reference standard (group C). Outcomes such as bone density, volume, height, bone formation rates, operative time, and recovery were compared to guide clinical decision-making.</p><p><strong>Data sources: </strong>A comprehensive search was conducted across the Scopus, PubMed, Web of Science, Cochrane Central, and Embase databases for studies published between January 1, 2000, and July 18, 2024. Medical Subject Heading terms and keywords related to alveolar cleft repair and bone grafting techniques were used, with studies limited to the English-language and peer-reviewed randomized controlled trials.</p><p><strong>Study selection: </strong>Inclusion criteria focused on randomized controlled trials evaluating secondary alveolar bone grafting with a minimum 6-month follow-up, involving radiographic assessments of cleft regions. Studies on patients with syndromes or primary dentition grafting were excluded. As a result, 3,962 articles were first identified, 15 studies entered the final full evaluation, and eventually, 10 studies with 186 patients met the final criteria.</p><p><strong>Data extraction and synthesis: </strong>Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA flowchart) were followed, with independent reviewers extracting the data. The risk of bias was assessed using Consolidated Standards of Reporting Trials guidelines. Outcomes were pooled using fixed- and random-effects models as appropriate.</p><p><strong>Main outcome(s) and measure(s): </strong>The primary outcomes included bone volume, density, height, and bone formation rate. The secondary outcomes were the operative time, hospital stay, and blood loss.</p><p><strong>Results: </strong>Group A achieved the highest bone density and volume retention at 6 and 12 months. Group C demonstrated superior bone formation rates and height but posed greater surgical challenges. Group B offered logistical advantages with reduced invasiveness, but underperformed bone density and formation. These findings emphasize the need for tailored approaches that balance efficacy and patient-specific considerations.</p><p><strong>Conclusions and relevance: </strong>These findings underscore the need for personalized approaches in alveolar cleft repair, balancing effectiveness, and patient-specific considerations. Enhanced materials and standardized protocols are vital for optimizing outcomes.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191947","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":"Computed Tomography-Based Predictors of Difficult Intubation in Oral and Maxillofacial Surgery Patients.","authors":"Jiayi Wang, Pengcheng Zhao, Ren Zhou, Jia Yan, Hong Jiang","doi":"10.1016/j.joms.2025.04.011","DOIUrl":"10.1016/j.joms.2025.04.011","url":null,"abstract":"<p><strong>Background: </strong>The incidence of difficult airway is higher in oral and maxillofacial surgery (OMS) operations than those in general surgery. Current predictors, including clinical tools like the LEMON (Look Externally, Evaluate Mallampati Classification, Obstruction, Neck Mobility, Motion of Jaw) score, are often inaccurate, leading to underdiagnosis and increased risks to patient safety.</p><p><strong>Purpose: </strong>This study aimed to identify computed tomography (CT) findings associated with difficult intubation in patients receiving OMS operations.</p><p><strong>Study design, setting, sample: </strong>This prospective cohort study was conducted at the Shanghai Ninth People's Hospital from October 2018 to October 2021 and included patients undergoing OMS operations under general anesthesia. Exclusion criteria included individuals who received regional anesthesia, had contraindications to mask ventilation, lacked preoperative CT imaging, or did not provide informed consent.</p><p><strong>Predictor variables: </strong>The predictor variables were 21 midsagittal plane CT parameters and five 3-dimensional airway reconstruction parameters.</p><p><strong>Outcome variable: </strong>The outcome variable was ease of intubation, categorized as difficult intubation (grade III or IV laryngeal view under direct laryngoscopy) and easy intubation (grade I or II laryngeal view under direct laryngoscopy).</p><p><strong>Covariates: </strong>Covariates included demographic variables (age, weight, body mass index, and sex) and anatomical variables (modified Mallampati classification, hyoid thyroid cartilage distance, hyoid mental distance, thyromental distance, atlanto-occipital joint extension, and interincisor distance).</p><p><strong>Analyses: </strong>Least absolute shrinkage and selection operator was used to select significant variables. Logistic regression was then used to construct the predictive model. The model's performance was evaluated using receiver operating characteristic curve.</p><p><strong>Results: </strong>The study included 630 patients, with 35.2% experiencing difficult intubation. The model was composed of 10 midsagittal plane and two 3-dimensional airway reconstruction parameters from CT images, with area under the curve values of 0.78 in the training cohort (n = 336) and 0.76 in the validation cohort (n = 72). In the validation cohort, the model achieved a sensitivity of 0.74 and a specificity of 0.75. In contrast, the area under the curve value of LEMON score was 0.62.</p><p><strong>Conclusions and relevance: </strong>This study developed a CT-based model that identifies patients at risk of difficult intubation in OMS, outperforming the LEMON score and underscoring the relevance of CT parameters, particularly those involving the tongue, uvula, and hyoid bone, in guiding clinical decision-making.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078832","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":"Deep-Learning Method for the Diagnosis and Classification of Orbital Blowout Fracture Based on Computed Tomography.","authors":"Suyoung Kim, Hyeon Kang Koh, Hyungwoo Lee, Hyun Jin Shin","doi":"10.1016/j.joms.2025.04.010","DOIUrl":"10.1016/j.joms.2025.04.010","url":null,"abstract":"<p><strong>Background: </strong>Blowout fractures (BOFs) are common injuries. Accurate and rapid diagnosis based on computed tomography (CT) is important for proper management. Deep-learning techniques can contribute to accelerating the diagnostic process and supporting timely and accurate management, particularly in environments with limited medical resources.</p><p><strong>Purpose: </strong>The purpose of this retrospective in-silico cohort study was to develop deep-learning models for detecting and classifying BOF using facial CT.</p><p><strong>Study design, setting, and sample: </strong>We conducted a retrospective analysis of facial CT from patients diagnosed with BOF involving the medial wall, orbital floor, or both at Konkuk University Hospital between December 2005 and April 2024. Patients with other facial fractures or those involving the superior or lateral orbital walls were excluded.</p><p><strong>Predictor variable: </strong>The predictor variables are the outputs as each model's designated categories from the deep-learning models, which include the predicted 1) fracture status (normal or BOF), 2) fracture location (medial, inferior, or inferomedial), and 3) fracture timing (acute or old).</p><p><strong>Main outcome variables: </strong>The main outcomes were the human assessments serving as the gold standard, including the presence or absence of BOF, fracture location, and timing.</p><p><strong>Covariates: </strong>The covariates were age and sex.</p><p><strong>Analyses: </strong>Model performance was evaluated using the following metrics: 1) accuracy, 2) positive predictive value (PPV), 3) sensitivity, 4) F1 score (harmonic average between PPV and sensitivity), and 5) area under the receiver operating characteristic curve (AUC) for classification models.</p><p><strong>Results: </strong>This study analyzed 1,264 facial CT from 233 patients with multiple CT slices taken from each patient in various coronal views (mean age: 37.5 ± 17.9 years; 79.8% male-186 subjects). Based on these data, 3 deep-learning models were developed for 1) BOF detection (accuracy 99.5%, PPV 99.2%, sensitivity 99.6%, F1 score 99.4%, AUC 0.9999), 2) BOF location (medial, inferior, or inferomedial; accuracy 97.4%, PPV 92.7%, sensitivity 89.0%, F1 score 90.8%), and 3) BOF timing (accuracy 96.8%, PPV 90.1%, sensitivity 89.7%, F1 score 89.9%). In addition, the BOF detection model had an AUC of 0.9999.</p><p><strong>Conclusions and relevance: </strong>Deep-learning models developed with Neuro-T (Neurocle Inc, Seoul, Republic of Korea) can reliably diagnose and classify BOF in CT, distinguishing acute from old fractures and aiding clinical decision-making.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018185","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":"Risk Factors Associated With Complications in Treated Mandibular Fractures: A Retrospective Cohort Study.","authors":"Jamie Rose, Edwin M Rojas, Jameela Broadie, Boyu Ma, Somsak Sittitavornwong","doi":"10.1016/j.joms.2025.04.008","DOIUrl":"10.1016/j.joms.2025.04.008","url":null,"abstract":"<p><strong>Background: </strong>Identifying factors associated with complications in the management of mandibular trauma may improve clinical decision-making.</p><p><strong>Purpose: </strong>The purpose of this study was to identify risk factors associated with complications in management of mandible factures.</p><p><strong>Study design, setting, sample: </strong>We conducted a retrospective cohort study of participants treated at the University of Alabama at Brimingham for mandibular trauma from 2016 to 2023. Subjects under 20 years old and those with lack of follow-up were excluded.</p><p><strong>Independent variable(s): </strong>The independent variable is a set of risk factors including exposure to tobacco, alcohol, marijuana, other illicit substances, and number of substances.</p><p><strong>Main outcome variable(s): </strong>The main outcome variable was the presence of a major complication in the management of mandible fractures. Major complications included sequalae requiring hospitalization or further surgical intervention.</p><p><strong>Covariates: </strong>The covariate variables collected were demographics, injury characteristics, and treatment modality.</p><p><strong>Analyses: </strong>Descriptive statistics were used to compare average age among groups. Student's t-test, Fisher's exact test, and the Koopman asymptotic score were used for contingency table analyses. Binomial logistic regression models, adjusted to age, sex, and race, were fit to compute the adjusted odds ratio for having a complication from an independent variable. Statistical significance was set at a P value < .05. Statistical analyses were performed on GraphPad Prism 10.4.1.</p><p><strong>Results: </strong>The study sample was composed of 260 subjects who met the inclusion/exclusion criteria. The ratio of males to females was 4:1 with an average age of 42.3 (±15.7) years. The overall complication rate was 8.5%. The presence of tobacco use and illicit substance use were associated with post-treatment complications risk ratio 3.65, 95% confidence interval: (1.2 to 11.4), P = .02; risk ratio 3.69, 95% confidence interval: (1.6 to 8.0), P = .009, respectively. The use of no substances was associated with fewer post-treatment complications (P = .006).</p><p><strong>Conclusions and relevance: </strong>Tobacco use and illicit substance use were associated with higher complication rates in the management of mandibular fractures. Refrainment from substance use in general was associated with fewer complications. Surgeons may use this information to guide clinical decision-making and discussions of consent when counseling patients with these injuries.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016166","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}