Journal of Oral and Maxillofacial Surgery最新文献

{"title":"What is the Minimal Perceptible Change for the Dimensional Alteration of Facial Structures in the Frontal View?","authors":"Katkoria Nalin Priyanka, Shivangi Ramteke, Bhaskar Nivethitha, Balasubramanian Madhan","doi":"10.1016/j.joms.2024.08.013","DOIUrl":"10.1016/j.joms.2024.08.013","url":null,"abstract":"<p><strong>Background: </strong>A better understanding of the perceptibility of dimensional changes in facial structures is of interest to all involved in facial esthetics.</p><p><strong>Purpose: </strong>We aimed to determine the minimal perceptible change (MPC) in the dimensional alterations of the facial structures in the frontal view and the influential factors.</p><p><strong>Study design, setting, sample: </strong>This cross-sectional study was conducted on individuals accompanying the patients at the outpatient department of a tertiary-care hospital and students in art and science. Those with impaired cognition, craniofacial anomalies, history of esthetic facial surgeries and health professionals working on facial esthetics were excluded.</p><p><strong>Independent variable: </strong>The observers assessed the frontal photographs of 2 models and their modifications. The independent variables were the anatomic structure modified (mouth, nose, ears, eyes), the percentage change (5, 10, 15%), and the type of modification (magnification or reduction).</p><p><strong>Main outcome variables: </strong>The outcome variables were the MPC (perceived by at least 50% of the observers) and the perceptibility of changes (Yes/No) COVARIATES: The age of the observer, the sex of the observer and the model were the covariates.</p><p><strong>Analyses: </strong>The intergroup differences in perceptibility of changes and the influence of independent variables and covariates were analyzed with χ²/Cochran's Q test and generalized estimating equations, respectively, with statistical significance set at P < .05.</p><p><strong>Results: </strong>The sample comprised 110 males and 110 females, aged 23.9 ± 5.8 years. The MPC was 5% for the mouth, nose, and eyes and 15% for the ears. The changes in the nose [OR = 0.68 (0.56 to 0.83), P < .001], ears [OR = 0.29 (0.24 to 0.36), P < .001], and eyes [OR = 0.78 (0.64 to 0.95), P = .015] were less perceptible than the mouth. The perceptibility was higher in female than male observers [OR = 1.37 (1.11 to 1.69), P = .003] and reduction than magnification [OR = 1.11 (1.00 to 1.23) P = .036]. Compared to a 5% change, the perceptibility was higher for 10 and 15% [OR = 2.00 (1.76 to 2.27), 3.33 (2.84 to 3.91), respectively, P < .001].</p><p><strong>Conclusion and relevance: </strong>The MPC was 5% for the mouth, nose, and eyes and 15% for the ears. The perceptibility of change was influenced by the structure, the extent and type of modification and the observer's sex. These findings may be of use to all professionals involved in esthetic facial corrections.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":"17-25"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289517","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":"Postoperative Antibiotics May Be Unnecessary in Pediatric Patients Hospitalized With Minor Odontogenic Infections.","authors":"Michael V Joachim, Murad AbdelRaziq, Waseem A Abboud, Shareef Araidy, Imad Abu El Naaj","doi":"10.1016/j.joms.2024.10.003","DOIUrl":"10.1016/j.joms.2024.10.003","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic overuse is a growing concern in health care. For pediatric odontogenic infections, the necessity of postoperative antibiotics lacks clear, evidence-based guidelines.</p><p><strong>Purpose: </strong>The purpose of this study was to compare treatment outcomes between pediatric patients hospitalized with vestibular space odontogenic infections who received postoperative antibiotics and those who did not.</p><p><strong>Study design, setting, sample: </strong>This ambispective cohort study was conducted at the Baruch Padeh \"Tzafon\" Medical Center, Poriya, Israel (January 2010-December 2015 for retrospective and November 2018-December 2019 for prospective). The sample included 522 pediatric patients (<15 years) hospitalized for odontogenic infections requiring surgical intervention. Patients with nonodontogenic infections, compromised immune systems, or infections involving deeper spaces were excluded.</p><p><strong>Predictor/independent variable: </strong>The primary predictor was postoperative antibiotic management (administration vs no administration), decided at hospital admission.</p><p><strong>Main outcome variable(s): </strong>The primary outcome variable was hospital length of stay (LOS), categorized as short (1 to 2 days) or extended (≥3 days). LOS was chosen as a proxy for recovery time and symptom resolution, reflecting the overall efficacy of the treatment approach.</p><p><strong>Covariates: </strong>Demographic, clinical, and laboratory data were collected.</p><p><strong>Analyses: </strong>Descriptive statistics, Student t-tests, χ² tests, and multivariable logistic regression were used (P < .05).</p><p><strong>Results: </strong>Of 522 patients (411 control, 111 study), mean LOS was similar between groups: 1.7 ± 0.91 days (control) versus 1.67 ± 0.9 days (study) (P = .76). Short stays were not significantly different (90.99 vs 87.10%, P = .32). Multivariable analysis showed no association between withholding antibiotics and extended stay (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.45 to 1.89, P = .82), but identified age (OR = 1.11, 95% CI: 1.02 to 1.21, P = .02) and initial white blood cell count (OR = 1.08, 95% CI: 1.01 to 1.15, P = .03) as predictors of extended stay.</p><p><strong>Conclusion and relevance: </strong>Withholding routine postoperative antibiotics in pediatric patients with odontogenic infections does not significantly impact length of hospital stay. While length of stay is not a direct measure of clinical outcome, it serves as a proxy for recovery. This approach may contribute to antibiotic stewardship efforts without compromising patient care, though future studies with direct clinical outcome measures are needed to confirm these findings.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":"70-78"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546013","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":"How Can Confucian Philosophies Apply in Modern Day Oral & Maxillofacial Surgery Research?","authors":"Bernadette Quah, Chee Weng Yong, Sung-Kiang Chuang","doi":"10.1016/j.joms.2024.08.068","DOIUrl":"https://doi.org/10.1016/j.joms.2024.08.068","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 1","pages":"3-5"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921982","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":"Trouble, Trouble, Citing Double.","authors":"Thomas B Dodson","doi":"10.1016/j.joms.2024.07.007","DOIUrl":"https://doi.org/10.1016/j.joms.2024.07.007","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 1","pages":"1-2"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921992","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":"Geographic Trends in the Oral and Maxillofacial Surgery Residency Match.","authors":"Joshua R Weirich, Sruthi Satishchandran, Shelly Abramowicz","doi":"10.1016/j.joms.2024.08.064","DOIUrl":"10.1016/j.joms.2024.08.064","url":null,"abstract":"<p><strong>Background: </strong>Matching into Oral and Maxillofacial Surgery (OMS) residency in the United States (US) is competitive. Various surgical and medical specialties found that a relationship exists between the geographic location where an applicant attends medical school and the location where they attend residency. However, information regarding this geographic relationship does not exist in OMS.</p><p><strong>Purpose: </strong>The purpose of this study was to investigate if a relationship exists between the location of an applicant's dental school and the location of the OMS program where they match for residency.</p><p><strong>Study design, setting, sample: </strong>Study team conducted a cross-sectional review of all civilian OMS applicants who participated in the Postdoctoral OMS Matching Program from 2012 to 2022. US States and the District of Columbia were subdivided into a specific Region and Division as defined by the US Census Bureau.</p><p><strong>Predictor variable: </strong>The primary predictor variable was the geographic location of the applicant's dental school.</p><p><strong>Main outcome variable: </strong>The outcome variable was the geographic location where the applicant matched for residency.</p><p><strong>Covariates: </strong>There were no covariates analyzed in the study.</p><p><strong>Analyses: </strong>Frequency tables were created for the expected and observed values for each possible combination of dental school and residency location. MATLAB R2023a software was used for statistical analysis. χ² test, odds ratio and confidence interval were calculated to investigate association between variables. P values were <.05.</p><p><strong>Results: </strong>1768 applicants were reviewed. The inclusion criteria consisted of civilian OMS applicants from 2012 to 2022 who matched into residency. Of the 968 applicants who met the inclusion criteria, 48.45% (469/968, P -value < .001) matched into a residency in the same US Region as their dental school; 36.26% (351/968, P value < .001) matched into the same US Division. Applicants were found to be significantly more likely to match into a program in the same US Region and Division as their dental school.</p><p><strong>Conclusion and relevance: </strong>It is likely that individuals will match into OMS residency in the same US Region and Division as their dental school. This information helps applicants and residency programs during the match process.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":"113-122"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289515","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":"Association Analysis Between Albumin Level and Maxillofacial Space Infection Severity.","authors":"Ying Huang, Lei Lu, Hetong Fei, Jing Ma, Jianfeng Dong, Fuqiang Xie","doi":"10.1016/j.joms.2024.09.005","DOIUrl":"10.1016/j.joms.2024.09.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Early detection and treatment of maxillofacial space infection (MSI) can lead to successful outcomes; however, delayed intervention may result in severe systemic manifestations, posing a potential threat to life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The purpose of this study was to measure the association between albumin (ALB) levels and MSI severity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design, setting, sample: &lt;/strong&gt;This was a retrospective cohort study including patients who were diagnosed with MSI at the Second Hospital of Lanzhou University from 2013 to 2023. Patients with unknown etiology, incomplete data, and those with psychiatric disorders and malignant tumors were excluded. Cured subjects are defined as the absence of clinical symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Predictor variable: &lt;/strong&gt;The primary predictor variable was the ALB levels measured at the time of admission. We categorized ALB levels at admission into &lt;30 g/L, 30-35 g/L, and &gt;35 g/L.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome variable(s): &lt;/strong&gt;The outcome variables were MSI severity measured by the length of stay (LOS) and death. LOS &gt;14 days was a prolonged length of hospital stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Covariates: &lt;/strong&gt;Covariates included age, sex, involved anatomical spaces, neutrophil proportion and white blood cell counts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analyses: &lt;/strong&gt;Statistical analysis was conducted using Pearson's χ&lt;sup&gt;2&lt;/sup&gt; test, one-way analysis of variance, independent sample t-test, multivariate logistic regression, Fisher's exact test, Kruskal-Wallis H test, Mann-Whitney U test, and the Gamma test. The P value was set at .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study encompassed 201 patients, of whom 123 were male (61.19%) and 78 were female (38.81%). Among these, 190 subjects (94.53%) were cured. The mean LOS was 16.38 ± 18.93 days, and 81 subjects (42.63%) had a LOS exceeding 14 days. There were 11 deceased patients (5.47%). The neutrophil proportion (χ&lt;sup&gt;2&lt;/sup&gt; = 8.31; P &lt; .01), and white blood cell count (χ&lt;sup&gt;2&lt;/sup&gt; = 11.14; P &lt; .01) were significantly higher in deceased patients compared to those who were cured, and among the deceased patients, there was a greater percentage of patients with odontogenic infections (χ&lt;sup&gt;2&lt;/sup&gt; = 7.48; P = .02). There was no difference in ALB levels among the deceased patients (χ&lt;sup&gt;2&lt;/sup&gt; = 3.08 P = .21). A reduction in ALB levels is associated with an increased risk of prolonged LOS (χ&lt;sup&gt;2&lt;/sup&gt; = 21.77; P &lt; .001). The relative risk (RR) of LOS extension when the ALB level is between 30 and 35 g/L is 1.32 times higher than when the ALB level exceeds 35 g/L (RR = 1.32, 95% confidence interval (CI) = 0.99 to 1.76). Furthermore, when ALB levels fall below 30 g/L, the RR increases to 2.19 times higher compared to ALB levels greater than 35 g/L (RR = 2.19, 95% CI = 1.47 to 3.26). Moreover, the LOS was used to measure the severity of MSI. Multivariate regression analysis found ALB levels were negatively associated with LOS. Subjects wi","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":"79-88"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468070","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":"Modified Approach to Segmental Maxillary Surgery: Midline Osteotomy and Parasagittal Soft Tissue Incisions.","authors":"Charles H Henry, Pushkar Mehra, Larry M Wolford","doi":"10.1016/j.joms.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.joms.2024.12.005","url":null,"abstract":"<p><p>Traditional surgical techniques for segmental maxillary surgery include a combination of interdental osteotomies with paramidline bony cuts while keeping the palatal soft tissue intact. Besides surgical complexity, segmental maxillary procedures have been associated with higher incidence of relapse and complications. We present our experience with specific hard- and soft-tissue modifications (midline bony osteotomy and reflection of palatal soft tissue with carefully designed incisions) which will allow surgeons to perform larger expansions with a low incidence of complications and decreased relapse.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921916","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 Two-Point Versus Three-Point Fixation in Treatment of Zygomaticomaxillary Complex Fractures: An Updated Meta-Analysis.","authors":"Lele Guo, Tianping Cheng, Lixia Feng, Jin Feng, Xiangyun Li","doi":"10.1016/j.joms.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.joms.2024.12.006","url":null,"abstract":"<p><strong>Purpose: </strong>Zygomaticomaxillary complex (ZMC) fractures are a prevalent form of craniofacial trauma. However, no universally accepted fixation method has been established to prevent postreduction displacement in ZMC fractures.</p><p><strong>Methods: </strong>Computerized and additional manual searches of the Medline, Embase, Chinese National Knowledge Infrastructure, and Cochrane Central database for potential studies, published from inception to May 2024, were performed. The inclusion criteria were as follows: randomized controlled trials comparing two-point and three-point fixation for managing ZMC fractures; studies with at least 5 weeks of follow-up; sufficient data published to estimate relative risk or standard mean difference (SMD) with a corresponding 95% CI. The following exclusion criteria were applied: nonrandomized prospective studies, retrospective studies, case series, case reports, animal and in vitro studies; letters to the editor; review articles; case reports, and studies without discrete outcomes data. The predictor variable was type of fixation. The primary outcome variables assessed in this study encompassed fracture instability, malar asymmetry grade, malar height, and vertical dystopia. These parameters were employed as quantitative measures of displacement. The secondary outcome was postoperative complications, including enophthalmos. Systematic review with meta-analyses, 2 reviewers independently extracted the relevant data, with disagreements resolved by consensus. Statistical analyses were performed using Stata, version 18.0 (StataCorp LLC, College Station, TX, USA).</p><p><strong>Results: </strong>After reviewing 205 publications, the final sample was composed of 8 studies, with 189 participants in the two-point group and 187 in the three-point group. Patients were followed up for at least 5 weeks in all the studies. Fracture instability was greater with 2-point fixation than with 3-point fixation (relative risk 2.63 [95% CI: 1.95-3.56] P < .001). Less vertical dystopia at 3 and 6 weeks were seen with 3-point fixation than with 2-point fixation (SMD 0.59, [95% CI 0.31-0.87] P < .001) (SMD 6.30, [95% CI 3.02-9.58] P < .001). Enophthalmos, malar asymmetry grade II (3 months), operation duration, malar height, and vertical dystopia (mm) 1 week did not differ between the groups.</p><p><strong>Conclusions: </strong>Three-point fixation may provide more stability and less vertical dystopia than two-point fixation. This finding should help surgeons in making evidence-based decisions when selecting an optimal fixation pattern.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921894","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":"The Influence of Fluoxetine on the Sensorimotor Function of the Sciatic Nerve in Wistar Rats after Axonotmesis: An Experimental Animal Model.","authors":"Michelly Cauás de Queiroz Gatis, Marcelo Moraes Valença, Heitor Ferreira de Souza Neto, Henrique Lima Ferreira de Souza, Carlos Augusto Pereira do Lago","doi":"10.1016/j.joms.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.joms.2024.12.004","url":null,"abstract":"<p><strong>Background: </strong>Fluoxetine, a serotonin reuptake inhibitor antidepressant, raises extracellular serotonin levels and promotes angiogenesis and neurogenesis. Numerous animal models have shown its beneficial effects on recovery from peripheral nerve injury.</p><p><strong>Purpose: </strong>The primary objective of this study was to analyze the influence of fluoxetine on the sensory-motor function recovery of the sciatic nerve in Wistar rats after axonotmesis.</p><p><strong>Study design, setting, and sample: </strong>This study utilized an experimental rat model, conducted in the laboratory at the Federal University of Pernambuco. The sample consisted of 40 male Wistar rats.</p><p><strong>Predictor variable: </strong>The primary predictor variable was the fluoxetine exposure. The animals were randomly divided into 4 groups (control and 3 experimental groups), with 10 animals in each group. They were injected subcutaneously with saline or fluoxetine 5, 10, and 20 mg/kg/day, respectively.</p><p><strong>Main outcome variables: </strong>The main outcome variables were postoperative motor and sensory sciatic nerve function. Sensory nerve function was measured using the withdrawal reflex by thermostimulation. Motor nerve function was measured using the Sciatic Nerve Recovery Index and the Static Sciatic Nerve Index (SSI).</p><p><strong>Covariates: </strong>None.</p><p><strong>Analyses: </strong>Descriptive statistical analysis was performed using mean and SD. The F-test (ANOVA) was used for comparisons between the groups and Dunnett's multiple comparisons test was used in case of significant differences between the groups. Statistical Analysis System was the software used for statistical analyses.</p><p><strong>Results: </strong>During the study, 15 animals were lost (3 in the control group and 4 in each experimental group), with no specific cause identified. On day 35, the latency time of the withdrawal reflex was significantly different, with decreased pain perception in the 5 mg/kg/day fluoxetine group (3.80 ± 1.20, P < .05). On day 14, the Sciatic Nerve Recovery Index showed greater deficits in the l0 and 20 mg/kg/day groups (-65.67 ± 7.20 and -63.57 ± 11.59, respectively) compared to the control group (P < .05). The SSI also showed a delay in recovery with the 10 mg/kg/day dose (-62.50 ± 6.72, P < .05).</p><p><strong>Conclusion: </strong>The daily treatment with fluoxetine failed to bring any improvement to motor or sensory recuperation after injury to the sciatic nerve in Wistar rats.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895538","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, Bruno Gomes Duarte, Luciano Reis de Araújo Carvalho, Bhárbara Marinho Barcellos, Marina de Almeida Barbosa Mello, Renato Yassutaka Faria Yaedú","doi":"10.1016/j.joms.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.joms.2024.11.016","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Purpose: </strong>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.</p><p><strong>Study design, setting, and sample: </strong>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.</p><p><strong>Predictor variable: </strong>The primary predictor was osteotomy level: at the level or above of the PMJ.</p><p><strong>Main outcome variable: </strong>The main outcome was the pterygomaxillary fracture pattern, categorized as favorable or unfavorable.</p><p><strong>Covariates: </strong>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.</p><p><strong>Analysis: </strong>Statistical analyses included t-tests for mean differences (P < .05) and χ² tests for associations. Relative risk was calculated for osteotomy levels to assess the significance of associations with fracture patterns.</p><p><strong>Results: </strong>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 (P < .005). The relative risk for unfavorable fractures was 23.06 on the right side (95% confidence interval = [5.94, 89.53], P < .001) and 65.00 on the left side (95% confidence interval = [9.30, 454.52], P < .001).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-09","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}