Journal of Oral and Maxillofacial Surgery最新文献

{"title":"What Are the Complications of Temporomandibular Joint Arthrocentesis?","authors":"Burcu Baş PhD, DDS ,&nbsp;Emine Asena Singer DDS ,&nbsp;Rabia Tül Adeviye Çankaya DDS","doi":"10.1016/j.joms.2024.12.012","DOIUrl":"10.1016/j.joms.2024.12.012","url":null,"abstract":"<div><h3>Background</h3><div>Arthrocentesis is a minimally invasive procedure for treating intra-articular temporomandibular disorders. While it is considered relatively safe, like any surgical intervention, it carries potential risks.</div></div><div><h3>Purpose</h3><div>The study purpose was to estimate the frequency of complications associated with temporomandibular joint arthrocentesis, identify risk factors, and improve preparedness for effective prevention and management strategies.</div></div><div><h3>Study design</h3><div>In this retrospective cohort study, the investigators analyzed data from patients who underwent arthrocentesis treatment between 2015 and 2024 at Ondokuz Mayıs University, Faculty of Dentistry. Inclusion criteria were a diagnosis of painful intra-articular temporomandibular disorders. Patients with prior temporomandibular joint surgery or systemic conditions affecting joint function were excluded.</div></div><div><h3>Independent variable</h3><div>The independent variables included age, sex, and the presence of unilateral or bilateral arthrocentesis.</div></div><div><h3>Main outcome variables</h3><div>The main outcome variables are major (intervention required) and minor (no intervention) complications observed during the procedure and in the early follow-up period in patients. These complications include fluid extravasation, minor bleeding, transient facial paralysis, subcutaneous emphysema, external auditory fluid, and preauricular inflammation.</div></div><div><h3>Covariates</h3><div>Not applicable in this study.</div></div><div><h3>Analyses</h3><div>Descriptive statistics were used to report the occurrence of complications. The χ² test was used for categorical variables. As this is a case series, hypothesis testing is not feasible. A <em>P</em> value &lt;.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>The sample comprised 210 subjects (252 joints) with a mean age of 39.16 ± 14.59 (18-82 years). Nine (4.29%) were male, and 201 (95.71%) were female. Major and minor complication rates observed in patients are 2.84 and 28.1%, respectively. The distribution of complications in the treated joints is as follows: fluid extravasation (25.71%), transient facial paralysis (14.28%), minor bleeding (1.9%), subcutaneous emphysema (0.47%), fluid outflow from the ear (0.95%), and preauricular infection (1.42%). A statistically significant relationship was found between transient facial paralysis and fluid extravasation (<em>P</em> &lt; .001). Bilateral arthrocentesis was defined as a risk factor (<em>P</em> = .003). No significant relationship was found between the independent variables and complications.</div></div><div><h3>Conclusions and relevance</h3><div>The findings indicate that complications during and after arthrocentesis are common but manageable. Understanding these complications and their frequencies is crucial for surgeons to know the associated risks.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 414-420"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006921","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 Third Rail","authors":"Thomas B. Dodson DMD, MPH (Editor-in-Chief)","doi":"10.1016/j.joms.2024.09.007","DOIUrl":"10.1016/j.joms.2024.09.007","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 397-398"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746978","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":"Condyle Preservation in Patients With Mandibular Resection Is Associated With Enhanced Quality of Life and Function","authors":"Hassan Mirmohammad Sadeghi DMD, MD ,&nbsp;Mohammad Khosousi Sani DMD ,&nbsp;Sahba Khosousi Sani DMD ,&nbsp;Reza Tabrizi DMD ,&nbsp;Shervin Shafiei DMD ,&nbsp;Seyed Sepehr Mirebeigi-Jamasbi DMD","doi":"10.1016/j.joms.2024.12.014","DOIUrl":"10.1016/j.joms.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Operative treatment of advanced mandibular tumors may require excision of a portion of the mandible including the condyle. It is not clear how condylar excision affects postoperative quality of life (QoL).</div></div><div><h3>Purpose</h3><div>The study purpose was to measure the association between operative management of the condyle and postoperative health-related QoL and temporomandibular joint (TMJ) function.</div></div><div><h3>Study design, setting, and sample</h3><div>This prospective cohort study included patients with benign mandibular lesions who underwent hemi-mandibulectomy and were treated at Taleghani and Imam Hossein Hospitals in Tehran, Iran. Patients were excluded from the study if they had a history of preoperative or postoperative radiotherapy and chemotherapy, previous TMJ surgery or trauma, autoimmune diseases that affect TMJ function, bruxism or clenching, previous TMJ problems such as degenerative joint disease, failed to return for follow-up, or refused study enrollment.</div></div><div><h3>Predictor variable</h3><div>The predictor variable was operative management of the condyle and it was grouped into 2 levels, preserved or resected.</div></div><div><h3>Main outcome variable(s)</h3><div>The primary outcome was the oral health-associated QoL, which was determined using the Oral Health Impact Profile-14 questionnaire. Secondary outcome variables included maximum mouth-opening values, visual analog scale pain score, joint clicking, and joint crepitus. Outcome variables were determined pretreatment, immediately postsurgery, and 6 and 12 months postsurgery.</div></div><div><h3>Covariates</h3><div>Age, sex, and defect size were the study covariates.</div></div><div><h3>Analyses</h3><div>Repeated measures analysis of variance was conducted to compare QoL questionnaire scores, maximum mouth opening, and visual analog scale pain scores (<em>P</em> &lt; .05).</div></div><div><h3>Results</h3><div>The sample was composed of 46 subjects. Mean age was 46 ± 13.1 years in both groups and 25 patients (54%) were male. Presurgery QoL scores were 79.22 ± 1.72 for the resection group and 82.38 ± 1.21 for the preservation group (<em>P</em> = .6). At 12 months postsurgery, QoL, maximum mouth-opening, and pain scores were 65.89 ± 3.82, 31.56 ± 2.30, and 5.44 ± 2.45 for the resection group, while the preservation group showed significantly better scores with 78.69 ± 2.10, 40.77 ± 2.20, and 1.15 ± 0.90, respectively (<em>P</em> &lt; .001 for all).</div></div><div><h3>Conclusion and relevance</h3><div>Condyle preservation in resection treatments is associated with higher QoL scores, reduced TMJ pain, and increased maximum mouth opening. Preservation of the condyle should be considered during surgery whenever possible.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 485-493"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039621","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":"Use of Bipolar Nerve Stimulator as an Alternative to Neural Integrity Monitor During Hypoglossal Nerve Stimulator Placement","authors":"Ketan Patel PhD, DDS ,&nbsp;Hannah Afwerke Lynch DDS","doi":"10.1016/j.joms.2024.12.008","DOIUrl":"10.1016/j.joms.2024.12.008","url":null,"abstract":"<div><div>Hypoglossal nerve stimulation is a key step in insertion of a hypoglossal nerve stimulator for sleep apnea. The hypoglossal nerve stimulator works through assessment of apneic events that result in stimulation of the protrusion fibers of the hypoglossal nerve causing protrusion of the tongue and opening of the oropharynx resulting in ability for the patient to adequately breath. Therefore, during insertion of the hypoglossal nerve stimulator, a key portion of the procedure is inclusion of the protrusive fibers of the hypoglossal nerve and exclusion of the retrusive fibers. In the past, this was assessed by neural integrity monitor, which has limitations such as difficult and time-consuming setup, bulky equipment, and increased sharps injury. Our institution, North Memorial Hospital in Robbinsdale, Minnesota, has updated our protocol to utilize a bipolar nerve stimulator, which has decreased operating time and use of sharps and increased accuracy of the procedure. This article further discusses utilization and benefit of the bipolar nerve stimulator for placement of hypoglossal nerve stimulators for sleep apnea patients.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 439-441"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983900","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 Role of Anticoagulation Regimen on Flap Outcome in Microvascular Head and Neck Reconstruction","authors":"Samah Mouzannar MD ,&nbsp;Amirmohsen Jalaeefar MD ,&nbsp;Mohammad Shirkhoda MD ,&nbsp;Fereidoon Memari MD ,&nbsp;Ali Arab Kheradmand MD ,&nbsp;Ata Garajei MD ,&nbsp;Arshia Zardoui MD ,&nbsp;Seyed Masoumeh Valizadeh-Otaghsara MSc ,&nbsp;Amirmohammad Bakhtiari MSc ,&nbsp;Amirsina Sharifi MD","doi":"10.1016/j.joms.2024.12.011","DOIUrl":"10.1016/j.joms.2024.12.011","url":null,"abstract":"<div><h3>Background</h3><div>Thrombus formation following flap reconstruction reduces perfusion and can lead to flap compromise. Effective anticoagulation protocols are essential to prevent this complication.</div></div><div><h3>Purpose</h3><div>The study’s purpose was to measure and compare flap compromise associated with 3 different anticoagulation protocols.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This retrospective cohort study included patients with head and neck cancer who underwent flap reconstruction. Exclusion criteria included patients who did not consent to participate, did not receive the anticoagulation regimen, or had a history of adverse reactions to heparin or aspirin (ASA).</div></div><div><h3>Exposure</h3><div>The primary exposure was the anticoagulation protocol, which was divided into 3 groups: intravenous unfractionated heparin (IV-UFH), subcutaneous UFH (SC-UFH), and SC-UFH plus ASA.</div></div><div><h3>Main Outcome Variable</h3><div>The outcome variable was postoperative flap outcome coded as compromised or not.</div></div><div><h3>Covariates</h3><div>Covariates included patient demographics, cancer type, neoadjuvant therapy, flap type, surgical procedure, intensive care unit stay, medical history, and postoperative complications.</div></div><div><h3>Analyses</h3><div>χ², Mann–Whitney U, and Kruskal–Wallis tests were used for baseline data analysis. Multivariate logistic regression was conducted to examine the adjusted association between anticoagulation protocol and flap outcome. <em>P</em> values &lt; .05 were considered statistically significant.</div></div><div><h3>Results</h3><div>The study sample consisted of 300 patients who met inclusion criteria with a mean age of 48.3 (±17.69) years, 202 (67.3%) of whom were male. There were 28 (9.3%) cases of flap compromise. The unadjusted analysis showed that patients receiving IV-UFH had a significantly higher risk of flap compromise compared to those receiving SC-UFH (relative risk: 3.43 [1.62 to 7.28]). Adding ASA to SC-UFH did not result in a statistically significant reduction in the risk of flap compromise (relative risk: 0.95 [0.35 to 2.61]). After adjusting for confounding factors, the anticoagulant type was not associated with flap compromise (<em>P</em> = .05). However, in the subgroup analysis, compared to SC-UFH, subjects receiving IV-UFH still had higher odds of flap compromise (odds ratio = 2.69, 95% CI [1.003 to 7.205], <em>P</em> = .049)</div></div><div><h3>Conclusion and Relevance</h3><div>Postoperative thrombosis in head and neck microsurgery remains a significant risk factor for poor outcomes. SC-UFH administration may be a practical approach to managing these risks compared to intravenous administration; however, the choice of anticoagulation protocol is not associated with the flap compromise.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 467-475"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006918","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":"Self-Irrigation Device for Intraoral Home Care","authors":"Liszen Tang MDS (Oral & Maxillofacial Surgery) ,&nbsp;Kar Tsyeng Ng BDS ,&nbsp;Mukhriz Hamdan MClinDent (Oral & Maxillofacial Surgery) ,&nbsp;Rithuan Awang MClinDent (Oral & Maxillofacial Surgery)","doi":"10.1016/j.joms.2024.12.013","DOIUrl":"10.1016/j.joms.2024.12.013","url":null,"abstract":"<div><div>Following surgical treatment of a jaw cyst, bony cavities are formed. These cavities are prone to infection when they communicate with the oral environment. Hence, proper irrigation is a crucial aspect of postsurgical care, as it helps to reduce debris buildup and the risk of infection. However, the irrigation method of using a cannula is ineffective due to poor patient compliance. In response, we present a novel solution to this problem.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 456-458"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143039623","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 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 ,&nbsp;Marcelo Moraes Valença ,&nbsp;Heitor Ferreira de Souza Neto ,&nbsp;Henrique Lima Ferreira de Souza ,&nbsp;Carlos Augusto Pereira do Lago","doi":"10.1016/j.joms.2024.12.004","DOIUrl":"10.1016/j.joms.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Purpose</h3><div>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.</div></div><div><h3>Study design, setting, and sample</h3><div>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.</div></div><div><h3>Predictor variable</h3><div>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.</div></div><div><h3>Main outcome variables</h3><div>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).</div></div><div><h3>Covariates</h3><div>None.</div></div><div><h3>Analyses</h3><div>Descriptive statistical analysis was performed using mean and SD. Analaysis of variance (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.</div></div><div><h3>Results</h3><div>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, <em>P</em> &lt; .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 (<em>P</em> &lt; .05). The SSI also showed a delay in recovery with the 10 mg/kg/day dose (−62.50 ± 6.72, <em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>The daily treatment with fluoxetine failed to bring any improvement to motor or sensory recuperation after injury to the sciatic nerve in Wistar rats.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 459-466"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","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":"OA","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 MD ,&nbsp;Tianping Cheng MD ,&nbsp;Lixia Feng MD ,&nbsp;Jin Feng MD ,&nbsp;Xiangyun Li MD","doi":"10.1016/j.joms.2024.12.006","DOIUrl":"10.1016/j.joms.2024.12.006","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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 standardized 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).</div></div><div><h3>Results</h3><div>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] <em>P</em> &lt; .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] <em>P</em> &lt; .001) (SMD 6.30, [95% CI 3.02–9.58] <em>P</em> &lt; .001). Enophthalmos, malar asymmetry grade II (3 months), operation duration, malar height, and vertical dystopia (mm) 1 week did not differ between the groups.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 448-455"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","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 Transformative Potential of Artificial Intelligence in Oral and Maxillofacial Surgery","authors":"Pascal Eber MD ,&nbsp;Yannick Martin Sillmann DDS ,&nbsp;Fernando Pozzi Semeghini Guastaldi DDS, MSc, PhD","doi":"10.1016/j.joms.2024.11.017","DOIUrl":"10.1016/j.joms.2024.11.017","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 4","pages":"Pages 402-405"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746980","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":"Is Treatment at a Level 1 Trauma Center Associated With Better Outcomes Among Patients With Isolated Mandible Fractures?","authors":"Cameron C Lee, Tim T Wang, Lang Liang, Nicholas Wilken, Donita Dyalram, Gary Warburton, Joshua Lubek, John Caccamese","doi":"10.1016/j.joms.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.joms.2025.03.007","url":null,"abstract":"<p><strong>Background: </strong>The trauma literature suggests that treatment at a level 1 trauma center is associated with improved outcomes for a diversity of injuries. However, differences in outcomes with respect to trauma center designation are poorly studied in the facial trauma demographic.</p><p><strong>Purpose: </strong>The purpose of this study was to measure the association between trauma center designation and clinical outcomes in patients undergoing management of isolated mandible fractures.</p><p><strong>Study design, setting, sample: </strong>This was a retrospective cohort study using the 2018 to 2022 American College of Surgeons National Trauma Data Bank. Adult patients with an isolated mandibular fracture undergoing open reduction internal fixation or closed reduction were included. Patients missing demographic or outcomes data were excluded.</p><p><strong>Predictor/exposure/independent variable: </strong>The primary predictor was trauma center designation (level 1 or nonlevel 1).</p><p><strong>Main outcome variable: </strong>The primary outcome was any complication. Secondary outcomes were return to the operating room, length of stay, adverse discharge disposition, and specific complications.</p><p><strong>Covariates: </strong>Covariates were categorized into demographic (age, sex), medical (Elixhauser Comorbidity Index), injury severity, operative intervention (open reduction internal fixation or closed reduction), and hospital characteristics (teaching status, bed size).</p><p><strong>Analyses: </strong>Descriptive, bivariate, and multiple regression statistics were performed to evaluate the association between trauma center designation and outcomes.</p><p><strong>Results: </strong>The cohort was composed of 28,897 subjects with a mean age of 35.1 ± 14.0 years, and 23,718 were male (82.1%). There were 16,788 (58.1%) and 12,109 (41.9%) subjects treated at level 1 and nonlevel 1 trauma centers, respectively. Complication rates were 1.10% (188) and 1.00% (120) at level 1 and nonlevel 1 trauma centers, respectively (relative risk: 0.88; 95% confidence interval: 0.70 to 1.11; P = .3). After adjusting for demographic, medical, injury severity, operative intervention, and hospital characteristic covariates, treatment at a level 1 trauma center was not independently associated with complications, nor was it associated with return to the operating room, length of stay, or adverse discharge disposition.</p><p><strong>Conclusions and relevance: </strong>Trauma center designation was not an independent predictor of adverse outcomes. Additional studies are needed to identify which patients will benefit most from treatment at a level 1 trauma center in this demographic.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753072","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}