Journal of Oral and Maxillofacial Surgery最新文献

{"title":"RE: Tranexamic Acid Is Associated With Reduced Blood Loss and Transfusion Requirement in Pediatric Midface Reconstruction","authors":"Shahin Darabzadeh DDS, Amin Saedi Germi DDS, Amirhossein Keshavarz MD","doi":"10.1016/j.joms.2025.04.020","DOIUrl":"10.1016/j.joms.2025.04.020","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 10","pages":"Pages 1197-1198"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189952","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":"Distinguishing Postoperative Pain Development Trajectory After Orthognathic Surgery.","authors":"Li-Kuan Wang, Xu-Dong Yang, Hai-Yin Wu, Dan Zhou","doi":"10.1016/j.joms.2025.09.010","DOIUrl":"https://doi.org/10.1016/j.joms.2025.09.010","url":null,"abstract":"<p><strong>Background: </strong>The lack of understanding of postoperative pain patterns makes it challenging to adopt refined pain management for orthognathic patients.</p><p><strong>Purpose: </strong>The purpose was to characterize pain trajectories for the first 5 days following orthognathic surgery and identify factors associated with the trajectories.</p><p><strong>Study design, setting, and sample: </strong>This retrospective cohort study was conducted at Peking University Hospital of Stomatology and included individuals aged ≥18 years who underwent orthognathic surgery. Patients with neuropsychiatric disorders or missing postoperative pain data were excluded.</p><p><strong>Predictor variables: </strong>The predictor variable was postoperative pain intensity, assessed daily from days 1 to 5 after surgery using numerical rating scale.</p><p><strong>Main outcome variables: </strong>The outcome variable was pain trajectory, determined by group modeling of self-reported pain over the first 5 postoperative days.</p><p><strong>Covariates: </strong>Covariates comprised demographic, psychological, surgical, and perioperative variables.</p><p><strong>Analyses: </strong>Descriptive statistics were calculated for each variable. Group-based modeling determined and clustered pain trajectories, and logistic regression identified independent factors. A P value of < .05 was considered significant.</p><p><strong>Results: </strong>The sample was composed of 371 subjects with a median age of 25 years [21 to 29] and 272 (73.3%) were female. We identified three pain trajectories, and there were 208 (56.1%), 111 (29.9%), 52 (14%) subjects in Trajectories 1, 2, and 3 groups, respectively. Trajectory 1 showed gradually decreasing pain. Trajectory 2 showed mild pain that decreased until day 3 and then increased slightly on days 4 to 5. Trajectory 3 showed moderate pain decreasing until day 3, increasing to moderate on day 4 and severe on day 5. Increased Pain Catastrophizing Scale score (adjusted odds ratio (OR), 1.033, 95% confidence interval (CI), 1.006 to 1.060, P = .015), American Society of Anesthesiologists classification I (adjusted OR, 2.593, 95% CI, 1.102 to 6.100, P = .029), increased remifentanil dose (adjusted OR, 1.301, 95% CI, 1.038 to 1.632, P = .023), and dezocine used in the analgesia pump (adjusted OR, 4.883, 95% CI, 1.953 to 12.209, P = .001) were associated with increased likelihood of Trajectory 3. Male had significantly lower risk of Trajectory 2 (adjusted OR, 0.424, 95% CI, 0.264 to 0.680, P < .001) and Trajectory 3 (adjusted OR, 0.489, 95% CI, 0.287 to 0.834, P = .009).</p><p><strong>Conclusion: </strong>Distinct pain trajectories were exhibited after orthognathic surgery. It recommends patient-specific management across different trajectories.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228497","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":"No Evidence of Reduction in Mouth Opening After Biopsy in Oral Submucous Fibrosis-A Prospective Cohort Study.","authors":"Sampurna Raha, Rajiv S Desai, Shivani P Bansal, Pankaj M Shirsat, Pooja S Prasad","doi":"10.1016/j.joms.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.joms.2025.09.009","url":null,"abstract":"<p><strong>Background: </strong>Reluctancy to perform biopsy in oral submucous fibrosis (OSF) is usually observed among clinicians due to the common assumption that maximum mouth opening (MMO) is reduced after biopsy as wound healing occurs by an exaggerated pathological fibrotic response.</p><p><strong>Purpose: </strong>The study purpose was to evaluate and compare MMO in OSF subjects before and after biopsy against baseline MMO of healthy controls.</p><p><strong>Study design, setting, sample: </strong>This was a prospective institutional cohort study including subjects with OSF and healthy controls reporting at Nair Hospital Dental College, Mumbai, India from January to December 2023. Subjects less than 12 years of age, edentulous subjects, missing permanent incisors, subjects having temporomandibular joint disorders like ankylosis, OSF undergoing malignant transformation and previously treated OSF were excluded.</p><p><strong>Predictor variable: </strong>The predictor variable was disease status, and subjects were grouped into healthy controls and OSF subjects.</p><p><strong>Main outcome variable(s): </strong>The outcome variable was jaw function measured using MMO. In healthy controls, baseline MMO was assessed. In study group MMO was evaluated at 4 intervals: 1) before biopsy and 2) after biopsy at (a) 15th day, (b) 1-month, and (c) 6-month follow-up.</p><p><strong>Covariates: </strong>The covariates were age and sex.</p><p><strong>Analyses: </strong>A repeated measures analysis of variance test was employed to find statistical differences between MMO recorded in both groups. P < .05 was considered as statistically significant.</p><p><strong>Results: </strong>The study composed of 200 (100%) subjects with mean age of 45.94 ± 17.29 years and 100 (50%) males. Each group comprised of 100 subjects with healthy controls having mean age of 47.49 ± 21.45 years and OSF group 44.39 ± 11.67 years. A statistically significant difference (P < .001) was observed between MMO in healthy controls (mean = 47.49 ± 4.87 mm, range 35 to 56 mm), and OSF subjects before biopsy (mean = 20.73 ± 5.79 mm, range 9 to 29 mm). MMO of OSF subjects at 4 intervals were 20.73 ± 5.78 mm, 20.92 ± 5.52 mm, 20.98 ± 5.51 mm and 21.01 ± 5.52 mm respectively, showing no statistical significance (P = .3).</p><p><strong>Conclusion and relevance: </strong>No decrease in MMO in OSF subjects after biopsy was observed thus encouraging clinicians to take biopsy to rule out epithelial dysplasia and malignancy.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225707","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":"Rates and Determinants of Prosthodontic Rehabilitation After Segmental Jaw Surgery.","authors":"Amal Idrissi Janati, Ameena Nizar Beema, Jordan Gigliotti, Nicholas Makhoul, Michel El-Hakim, Nour Karra","doi":"10.1016/j.joms.2025.09.008","DOIUrl":"https://doi.org/10.1016/j.joms.2025.09.008","url":null,"abstract":"<p><strong>Background: </strong>Management of maxillofacial pathologies often requires ablative surgeries of the jaw which may include the tooth-bearing segment resulting in loss of oral function. Advances in maxillomandibular reconstruction with vascularized free flaps (VFFs) and dental implants have enabled prosthodontic rehabilitation (PR) in most patients. However, the impact of these advancements on rates and barriers of PR remains unclear.</p><p><strong>Purpose: </strong>The purpose of this study was to estimate the rate of PR and identify risk factors associated with failure to achieve PR.</p><p><strong>Study design, setting, sample: </strong>This 7-year retrospective cohort study was conducted at the Montreal General Hospital and included patients aged ≥15 years who underwent vascularized free fibula (VFF) reconstruction following jaw segmental resection between 2015 and 2021.</p><p><strong>Predictor variable: </strong>Predictor variables included age, sex, smoking, clinical diagnosis, adjuvant radiotherapy, flap type, and anterior tooth loss.</p><p><strong>Main outcome variable(s): </strong>The primary outcome is time to PR and secondary outcomes were PR status (not performed vs performed) and PR type (conventional vs implant-supported) respectively.</p><p><strong>Covariates: </strong>NA.</p><p><strong>Analyses: </strong>Descriptive statistics, comparison tests, Kaplan-Meier analysis, and univariate and multivariate Cox and logistic regression analyses were conducted (P < .05).</p><p><strong>Results: </strong>The study included 184 subjects with a mean age of 58 years (SD = 17), and 52% (n = 95) were men. The median follow-up was 20 months (interquartile range = 32). Malignancy was the most common diagnosis leading to surgery (n = 106; 58%), followed by benign tumors (n = 46; 25%). Cumulative proportion of PR was 41% (n = 76), including 19.5% (n = 36) of implant-supported prostheses. Median time to start PR was 44 months (95% CI: 30 to 78) and was significantly delayed in men, ever smokers, cancer patients, and those who received radiotherapy. In multivariate analysis, radiotherapy was the main predictor of failure to receive PR overall (P = .014) and implant-supported PR specifically (P = .025).</p><p><strong>Conclusion and relevance: </strong>Many patients with dental morbidity after segmental jaw surgery, especially cancer patients requiring radiotherapy, did not receive PR, and even fewer received implant-supported prostheses, highlighting the need for preradiotherapy solutions.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225818","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 50 Most-Cited Publications on Mandibular Condyle Fractures: A Bibliometric Study.","authors":"Liam Costello, Éanna O'Kelly-Lynch, Mark Wilson, Akinsola Ogunbowale","doi":"10.1016/j.joms.2025.09.006","DOIUrl":"https://doi.org/10.1016/j.joms.2025.09.006","url":null,"abstract":"<p><strong>Background: </strong>Mandibular condyle fractures represent 16.5 to 56% of mandibular injuries and remain controversial in management. This bibliometric analysis evaluates the top 50 most-cited studies to identify research trends and gaps. We systematically searched the Web of Science for mandibular condyle fracture studies, analyzing the top most-cited 50 articles by citation counts, authorship, institutions, journals, and keywords using the VOSviewer for bibliometric coupling.</p><p><strong>Findings: </strong>Studies (citations: 42 to 243) peaked in the 1990s to 2000s, declining after 2015. Germany 22% and the USA 12% led contributions, with the Journal of Oral and Maxillofacial Surgery publishing most articles (17 of 50). Dominant keywords included \"open reduction\" and \"osteosynthesis,\" yet 84% of studies were low-level evidence (levels III to IV). Key contributors were Eckelt U and Lindqvist C, with the Technical University of Dresden as the top institution.</p><p><strong>Conclusion and relevance: </strong>The field relies on older, lower-quality studies with stagnant high-impact research since 2015. Future work should prioritize prospective studies to resolve management controversies.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186179","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":"Quadrangular Cartilage Disarticulation Septoplasty: A Biomechanical Approach to Nasal Septal Deviation.","authors":"Khaled Al Tabaa, Benoît Faucon, Benjamin Verillaud, Florian Chatelet","doi":"10.1016/j.joms.2025.09.002","DOIUrl":"10.1016/j.joms.2025.09.002","url":null,"abstract":"<p><p>This technical note presents quadrangular cartilage disarticulation septoplasty, a novel method for complex septal deviations by resolving growth conflicts between the quadrangular cartilage, vomer, and perpendicular plate. The technique systematically releases cartilage insertions while preserving superior piriform attachments, avoiding resection-related complications. In 7 patients with \"watch-glass\" deformities, outcomes improved significantly: Nasal Obstruction Symptom Evaluation scores dropped from 15.4 ± 2.4 to 6.0 ± 5.9 (P = .022); Nasal Appearance and Function Evaluation Questionnaire scores rose from 38.8 ± 8.1 to 58.1 ± 8.1 (P = .014). All cases were outpatient with 24-hour splint removal, showing 0% revisions vs. 3.8% with Cottle technique. The biomechanical rationale aligns with septal development anatomy, preserving native structure. Though technically demanding, its efficiency and safety (no perforations/saddle deformities) make it promising for complex deviations. Multicenter studies are needed to compare efficacy to traditional techniques.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176129","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 Reiki Therapy ReducePreoperative Anxiety andPostoperative Pain in ThirdMolar Surgery? A Randomized Controlled Trial.","authors":"Meltem Ozden Yuce, Birant Simsek, Omer Faruk Dadas, Candan Efeoglu","doi":"10.1016/j.joms.2025.09.003","DOIUrl":"https://doi.org/10.1016/j.joms.2025.09.003","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety in patients undergoing third molar extraction can influence pain perception. Limited evidence suggests Reiki therapy may help manage anxiety and pain, but its effectiveness in dentistry is unclear.</p><p><strong>Purpose: </strong>This study evaluated whether Reiki therapy reduces preoperative anxiety and postoperative pain in third molar surgery.</p><p><strong>Study design: </strong>A single-blind randomized controlled trial was conducted at the Ege University Faculty of Dentistry (İzmir, Türkiye) between March 2021 and February 2023. Participants were 18 to 45 years old, in good general health, with mandibular Class II-B impaction (Pell and Gregory classification), and no prior third molar extraction or Reiki therapy. Exclusion criteria included systemic disease, pregnancy, acute infection, pathological lesions, use of anxiolytic/antidepressant drugs, and inability to provide consent.</p><p><strong>Predictor variable: </strong>The predictor variable was the type of preoperative intervention. Participants were randomly assigned to 1 of 3 conditions: Reiki therapy, sham Reiki, or no intervention.</p><p><strong>Main outcome variable: </strong>Primary outcomes were preoperative anxiety [State-Trait Anxiety Inventory I, State-Trait Anxiety Inventory II, and Beck Anxiety Inventory] and postoperative pain [visual analog scale over 7 days]. Analgesic use during the first postoperative week was recorded.</p><p><strong>Covariates: </strong>Covariates included sex, baseline anxiety scores, surgery duration, and the quantity/timing of additional analgesic intake in the first postoperative week.</p><p><strong>Analyses: </strong>Nonparametric tests were used with R software. The Brunner-Langer model assessed group differences in anxiety, pain, and analgesic use. Kruskal-Wallis and Wilcoxon signed-rank tests compared intergroup and intragroup outcomes (P < .05 considered significant).</p><p><strong>Results: </strong>The sample included 180 participants (mean age 27.4 ± 6.1 years). Randomization resulted in an equal distribution of males and females across the groups. Reiki therapy did not significantly reduce preoperative anxiety (mean State-Trait Anxiety Inventory I: 36.6 ± 10.0; P = .079) compared with sham Reiki (40.1 ± 10.1) and no intervention (40.8 ± 10.8). Postoperative pain scores were significantly lower in the Reiki group (mean 2.7 ± 1.8) compared with sham Reiki (3.0 ± 1.7) and no intervention (3.5 ± 1.9) (P = .045).</p><p><strong>Conclusion and relevance: </strong>Reiki therapy did not reduce preoperative anxiety but was associated with lower postoperative pain. Further trials are warranted to clarify its role in oral surgery.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182073","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 is the Role of Depth of Invasion With Site Specificity in Managing the Clinically Negative Neck for Patients With Stage I Oral Cavity Squamous Cell Carcinoma? (cT1N0).","authors":"Paul L Shivers, Jonathan Troost, Brent B Ward","doi":"10.1016/j.joms.2025.09.001","DOIUrl":"10.1016/j.joms.2025.09.001","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for elective neck dissection (END) in oral cavity squamous cell carcinoma (OSCC) remain controversial with observation, sentinel lymph node biopsy or END in all subjects inconsistently proposed. The current study evaluated the performance of the (D)OI (depth of invasion) and (S)site to determine (E)lective (N)eck (D)issection (DSEND) algorithm in recommending END for cT1N0 OSCC subjects.</p><p><strong>Study design, setting, sample: </strong>This is a retrospective case series of subjects treated between 2017 and 2023. All cT1N0 subjects treated with the DSEND algorithm were included. Exclusion criteria included subjects with recurrent disease, prior radiation therapy of the head and neck, or follow-up less than 1 year.</p><p><strong>Predictor: </strong>The predictor variable was management of the neck-observation versus END per DSEND algorithm. Subjects who reached the site-specific threshold were treated with END. A secondary analysis compared preoperative depth and intraoperative depth to evaluate if one was more accurate compared to final pathology depth.</p><p><strong>Outcome variable: </strong>The outcome variable was isolated neck recurrence (yes/no) during the follow-up period. The secondary analysis outcome variable was depth of invasion measured preoperative, intraoperative and on final pathology.</p><p><strong>Covariates: </strong>The covariates were age, sex (male/female), smoking and alcohol status (yes/no), tumor size (cm), nodal status (positive/negative), anatomical subsite and final pathology depth of invasion (mm).</p><p><strong>Analyses: </strong>We report descriptive statistics, accuracy of DSEND, comparison of preoperative versus intraoperative frozen section to final pathology depth of invasion using Student's t-test, setting P < .05 as statistically significant.</p><p><strong>Results: </strong>The sample was composed of 88 subjects with a mean age of 63.7 (standard deviation 13.2). Females represented 51% (45 of 88) of the subjects. DSEND protocol was used for 80 subjects. Observation of the neck was recommended in 57.5% (46 of 80) of subjects with only 1 developing isolated neck recurrence (false negative 2% (1 of 46)). In patients managed with END 6% (2 of 33) experienced isolated neck recurrence. The difference between final pathology and intraoperative depth was significantly smaller than final pathology compared to preoperative depth.</p><p><strong>Conclusions and relevance: </strong>The DSEND algorithm applied to cT1N0 OSCC allowed for nonsurgical management of the neck in 57.5% (46 of 80) of subjects with a 2% (1 of 46) false negative. Frozen section analysis was more accurate than preoperative depth of invasion from biopsy.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182080","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 Dexmedetomidine Affect Opioid Consumption Following Orthognathic Surgery?","authors":"Allen F Champion, Jung-Me Lee, Daniel Taub, Yu Jin Lee","doi":"10.1016/j.joms.2025.08.015","DOIUrl":"https://doi.org/10.1016/j.joms.2025.08.015","url":null,"abstract":"<p><strong>Background: </strong>Despite its purported analgesic effects, controversy exists regarding dexmedetomidine's efficacy as an opioid-sparing anesthetic adjunct.</p><p><strong>Purpose: </strong>The purpose of this study is to measure the association between dexmedetomidine (DEX) administration during orthognathic surgery and postoperative opioid consumption.</p><p><strong>Study design, sample, and setting: </strong>A single-blind randomized prospective cohort study was implemented. Patients consenting for orthognathic surgery at Thomas Jefferson University from January 2022 to October 2024 were screened. American Society of Anesthesiologists physical status I to III individuals aged ≥14 years were included. Exclusion criteria were revision surgery, recreational drug use, opioid prescription within 2 years, and chronic pain.</p><p><strong>Predictor variable: </strong>The predictor variable was anesthetic adjunct. Subjects were randomized to receive DEX or no DEX (control).</p><p><strong>Main outcome variables: </strong>The primary outcome variable was 24-hour postoperative opioid consumption, which was calculated as morphine milligram equivalents (MME). Postoperative pain was assessed using a visual analog scale (VAS) at 6 hours and upon patient-controlled analgesia (PCA) discontinuation at 7:00 am the following day (VASPCA). The ratio of PCA that attempts to bolus deliveries was calculated.</p><p><strong>Covariates: </strong>Covariates included age, sex, body mass index (BMI), and operative duration.</p><p><strong>Analyses: </strong>Descriptive statistics were calculated. Shapiro-Wilk test was used to assess sample normality. Relationships between continuous variables and DEX were studied using t test or Wilcoxon rank-sum test; χ² test was used for the categorical covariate. Significance was P < .05.</p><p><strong>Results: </strong>Of 66 enrollees, 50 (75.8%) subjects completed the trial (25 DEX, 25 no DEX). The mean (SD) ages for the no DEX and DEX group cohorts were 35.9 (13.5) and 41.3 (13.6), respectively (P = .2). There were no statistically significant differences in the distribution of covariates between the 2 study groups. Median (interquartile range (IQR)) morphine milligram equivalents consumption was 16.4 (15.4) and 14.8 (12.4) for no DEX and DEX groups, respectively (P = .9). No difference in pain scores was observed at 6 hours (P = .1). Median (interquartile range) VASPCA scores were 5(1) and 4(2) for no DEX and DEX cohorts, respectively (P < .01). Median ratios of PCA that attempts to boluses administered (1.23) were identical between cohorts (P = .9).</p><p><strong>Conclusions and relevance: </strong>The findings suggest that opioid consumption following orthognathic surgery was not associated with dexmedetomidine administration.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124889","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":"Comparative Evaluation of Z-Plasty and Linear Closure in Ankyloglossia Patients: A Randomized Study of Effects on Speech Articulation and Airway Volume.","authors":"Adil Gandevivala, Varad Rajendra Saptarshi, Srivalli Natarajan, Nitesh Dinesh Patkar, Pranave Prasad, Suraj Arjun Ahuja","doi":"10.1016/j.joms.2025.08.017","DOIUrl":"10.1016/j.joms.2025.08.017","url":null,"abstract":"<p><strong>Background: </strong>Tongue-tie (ankyloglossia) is a congenital tongue anomaly that may be associated with speech articulation defects, impacting social integration and self-confidence in affected children. Intervention is aimed at improving functional speech outcomes and potentially mitigating orofacial developmental disturbances. Ankyloglossia has also been implicated in altering upper airway anatomy due to its restrictive nature.</p><p><strong>Purpose: </strong>The primary objective was to compare the effectiveness of z-plasty closure versus linear closure following lingual frenuloplasty in improving speech articulation. The secondary objective was to assess changes in oropharyngeal airway volume following surgical correction.</p><p><strong>Study design, setting, and sample: </strong>This was a prospective randomized controlled study conducted at the dedicated cleft and craniofacial surgery unit of a tertiary academic center. Subjects were children with Kotlow Grade III/IV ankyloglossia and documented speech articulation defects, with exclusion criteria including developmental delay, syndromic diagnoses, or cleft lip/palate.</p><p><strong>Predictor variable: </strong>The predictor variable was the surgical technique used post-lingual frenuloplasty:z-plasty closure or linear closure.</p><p><strong>Outcome variables: </strong>The primary outcome was speech articulation, which was measured using the percentage of correct vowels and consonants (PCVC) and speech intelligibility (SI) scores. The secondary outcome was change in oropharyngeal airway volume, as quantified by cone beam computed tomography (CBCT).</p><p><strong>Covariates: </strong>The covariates were age and sex.</p><p><strong>Results: </strong>There was no significant difference in age (z-plasty: 6.46 ± 2.16 years vs linear closure: 6.80 ± 2.04 years; P = .6) or sex distribution (male/female: 8/7 vs 9/6; P = .7) between groups. Postoperatively, the z-plasty group demonstrated significantly greater improvement in percentage of correct vowels and consonants (mean change: 26.47 ± 2.94 vs 17.26 ± 2.18; P < .001) and SI scores (mean change: 2.06 ± 0.45 vs 1.2 ± 0.67; P < .001). Both groups showed increased oropharyngeal airway volume, with a larger mean percentage increase in the z-plasty group (12.11 ± 2.33% vs 10.43 ± 1.47%; P = .026).</p><p><strong>Conclusion and relevance: </strong>Lingual frenuloplasty using z-plasty closure yields superior speech articulation outcomes and a greater increase in oropharyngeal airway volume compared to linear closure, likely attributable to enhanced tissue mobilization and reduced contracture. These findings support z-plasty as the preferred surgical approach for functional rehabilitation in ankyloglossia.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124924","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}