Journal of Oral and Maxillofacial Surgery最新文献

{"title":"Trends in Opioid Prescriptions to Opioid-Naïve Patients by Oral and Maxillofacial Surgeons in Massachusetts 2012-2022.","authors":"Tim T Wang, Jessica Hao, Cameron C Lee, Danielle DeNufrio Valerio, Netrali Dalvi, David A Keith","doi":"10.1016/j.joms.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.joms.2024.12.009","url":null,"abstract":"<p><strong>Background: </strong>Many oral and maxillofacial surgery patients are young, healthy adults who are opioid-naïve. Over-prescribing opioids increases the risk of subsequent misuse and diversion.</p><p><strong>Purpose: </strong>The purpose of this study was to measure and compare opioid prescriptions to opioid naïve and nonnaïve patients by oral and maxillofacial surgeons in Massachusetts from 2012 to 2022.</p><p><strong>Study design, setting, sample: </strong>This retrospective cohort study used the Massachusetts Prescription Monitoring Program database to identify Schedule II and III opioid prescriptions by providers with specialty of \"oral and maxillofacial surgery\" from 2012 to 2022.</p><p><strong>Predictor/exposure/independent variable: </strong>The predictor variable is opioid exposure coded as opioid naïve (yes/no). Opioid-naïve status was defined as not having filled an opioid prescription in the prior 12 months.</p><p><strong>Main outcome variable: </strong>The main outcome variable was the quantity of opioid prescribed by oral and maxillofacial surgeons measured using morphine milligram equivalent (MME) per prescription. The secondary outcome was days' supply prescribed.</p><p><strong>Covariates: </strong>Covariates of the study included patient age and sex.</p><p><strong>Analyses: </strong>Descriptive statistics and weighted linear regressions were used to analyze differences in MME per prescription and days's supply per prescription to opioid-naïve and nonnaive patients each year and throughout the study period. P < .05 was considered statistically significant.</p><p><strong>Results: </strong>The data included a total of 866,539 prescriptions to 679,616 opioid-naïve patients and 186,923 nonnaïve patients from 2012 to 2022. Compared to nonnaïve patients, the opioid-naïve cohort had a slightly higher proportion of females (P ≤ .01 except for 2020) and were significantly younger (35.9 vs 47.6 yrs, P ≤ .01 for all years). For every study year, there was no statistically significant difference in mean MME per prescription or days' supply per prescription between opioid-naïve and nonnaïve patients (P > .05 in all years for both variables). MME per prescription (β = -7.22, 95% CI: -7.65, -6.80; R² = 0.79) and days' supply per prescription (β = -0.11, 95% CI: -0.11, -0.10; R² = 0.78) decreased at a similar rate throughout the study period for both opioid-naïve and nonnaïve patients.</p><p><strong>Conclusions and relevance: </strong>Oral and maxillofacial surgeons in Massachusetts predominantly prescribed opioids to opioid-naïve patients. The quantity and duration of initial prescriptions to opioid-naïve and nonnaïve patients were similar, yet both steadily decreasing, throughout the study period. These trends are encouraging in the context of recent responsible opioid prescribing policy interventions in Massachusetts.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983895","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":"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}

{"title":"Transdermal Buprenorphine Patch in the Management of Postoperative Acute Pain Following Mandibular Resection and Reconstruction.","authors":"Abid Majeed, Ashok Kumar Jena, Soumya Sarkar, Alok Kumar Sethi","doi":"10.1016/j.joms.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.joms.2024.12.002","url":null,"abstract":"<p><strong>Background: </strong>Transdermal buprenorphine is used for the management of postoperative pain. Its effectiveness for the postoperative pain management following mandibular resection and reconstruction has yet to be evaluated.</p><p><strong>Purpose: </strong>To evaluate the efficacy of transdermal buprenorphine patch (TBP) in managing postoperative pain after mandibular resection and reconstruction with anterior iliac crest graft.</p><p><strong>Study design, setting and sample: </strong>This triple-blinded, randomized controlled trial included 30 subjects in the age range of 18 to 60 years with benign mandibular pathologies. Subjects visiting the outpatient department of the Dept. of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, India, were included in the study. Subjects with known allergies to any drugs, using sedatives, alcohol, pregnant and lactating mothers, and with respiratory problems were excluded.</p><p><strong>Predictor: </strong>The predictor variable was postoperative pain management and subjects were randomly assigned to TBP or a placebo patch group.</p><p><strong>Main outcome variable: </strong>It was the postoperative pain, which was measured by visual analog scale (VAS) for 7 consecutive days. Secondary outcome variables were requirement of rescue analgesics and drug-related adverse effects.</p><p><strong>Covariates: </strong>Age at surgery, sex, diagnosis, duration of the operation, and amount of fentanyl used during the operation were covariates.</p><p><strong>Analyses: </strong>Descriptive statistics, Mann-Whitney U test, χ², repeated measures analysis of variance, and post-hoc analysis (Bonferroni test) were used. A P value <.05 was considered a level of statistical significance.</p><p><strong>Results: </strong>Thirty subjects were randomly allocated to TBP and control group. The mean VAS score during the study period was 0.8 ± 2.37, and 3.49 ± 2.37 in TBP and control group subjects respectively (P < .001). Compared to control group, the mean VAS score in TBP group subjects were significantly less till the end of postoperative day 4 (P < .001). The mean rescue analgesic requirement during the postoperative period was 5.33 ± 15.8 mg and 47.6 ± 37.7 mg in the TBP and control group subjects, respectively (P < .001). Nausea was the most common drug-related adverse effect in both the group subjects (46.7%) (P > .9).</p><p><strong>Conclusion and relevance: </strong>The highest VAS score in TBP group subjects was 1.53 ± 0.92 on the morning of postoperative day 1, whereas it was 6.47 ± 1.3 at 6 hours after operation in control group subjects. Thus, a TBP was adequate for the management of postoperative pain following mandibular resection and reconstruction.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872208","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":"Volumetric Analysis of Orbital Volume Discrepancy as a Marker of Change in Globe Position After Three-Point Fixation of Zygomatic Complex Fractures.","authors":"Gharam Mefleh Alharbi, Khalid Zabin Alotaibi, Ghada Amin Khalifa","doi":"10.1016/j.joms.2024.11.015","DOIUrl":"10.1016/j.joms.2024.11.015","url":null,"abstract":"<p><strong>Background: </strong>Many researchers have proposed incorporating orbital volume (OV) discrepancies between the affected and unaffected orbits into routine diagnostic processes as an indicator for early surgical repair of zygomatic complex fractures (ZMCFxs) to avoid postoperative ocular complications.</p><p><strong>Purpose: </strong>The study aimed to determine the correlation between the preoperative OV discrepancy and postoperative globe position.</p><p><strong>Study design, setting, sample: </strong>A retrospective cohort study was performed on patients with unilateral ZMCFxs associated with orbital floor fractures, treated at Al-Zahraa Hospital, Al-Azhar University, from January 2020 to July 2023. Patients with comminuted ZMCFxs, medial or superior orbital wall fractures, or corrective surgeries were excluded.</p><p><strong>Predictor variable: </strong>The predictor variable was the preoperative OV discrepancy between the affected and unaffected orbits.</p><p><strong>Outcome variables: </strong>The outcome variables were the 3-month postoperative globe position, which was classified as normal, enophthalmos, or exophthalmos, and the orbital repair quality, that was categorized as well-corrected, under-corrected, or over-corrected.</p><p><strong>Covariates: </strong>They included age, sex, ethnicity, side, etiology, type of orbital floor fractures, timing, and indication for surgery.</p><p><strong>Statistical analysis: </strong>χ², Pearson's correlation, and linear regression analyses were used; the statistical significance was set at P < .05.</p><p><strong>Results: </strong>The study included 111 patients, with an average age of 30.3 ± 6.6 years and male predominance. The preoperative OV discrepancy between both orbits was 5.1± 1 cc³, associated with enophthalmos in the patients. Postoperatively, the OV discrepancy became 0.9 ± 0.7 cc³, but the globe position was heterogenic. Thirty-seven patients (33.3%) had normal globe position. Sixty-three (56.8%) subjects had enophthalmos. Eleven (9.9%) individuals had exophthalmos. The preoperative OV discrepancy and postoperative globe position had a significant weak positive linear correlation. For every one-cubic-centimeter change in OV, the globe moved 0.1 mm (P < .05). The majority of the patients had under-corrected orbits, followed by over-corrected and well-corrected orbits. Every category of globe position was recorded with every category of orbital repair, and the findings showed no correlation between globe position and orbital repair quality (P = .08).</p><p><strong>Conclusion: </strong>Preoperative OV discrepancies between both orbits should not be employed as the sole predictor of globe position because a one-cubic-centimeter change in OV affects globe position by only 0.1 mm.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876950","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":"Identifying Pain Subtypes in Patients With Craniofacial Lesions of Fibrous Dysplasia/McCune-Albright Syndrome.","authors":"Camryn Berry, Alison M Boyce, Leonard B Kaban, Zachary S Peacock, Michael Mannstadt, Jaymin Upadhyay","doi":"10.1016/j.joms.2024.12.001","DOIUrl":"10.1016/j.joms.2024.12.001","url":null,"abstract":"<p><strong>Background: </strong>Fibrous dysplasia/McCune-Albright syndrome (FD/MAS) is a genetic disorder, marked by bone lesions, often affecting the craniofacial skeleton. Pain is a prevalent yet heterogeneous symptom reported by patients with craniofacial FD. Effective treatments are currently lacking, posing a significant clinical challenge to patient care.</p><p><strong>Purpose: </strong>This preliminary study examined pain profiles in craniofacial FD and aimed to identify subtypes of patients based on pain phenotypes and emotional health.</p><p><strong>Study design, setting, sample: </strong>A prospective, cross-sectional study involving 15 patients with FD/MAS, conducted at Boston Children's Hospital and Massachusetts General Brigham's Hospitals.</p><p><strong>Predictor/exposure/independent variable: </strong>Headache frequency, craniofacial pain severity, neuropathic pain quality, pain interference, allodynia, photophobia, depression, and anxiety were assessed using clinical questionnaires.</p><p><strong>Main outcome variable(s): </strong>The primary outcome variable was the symptom profile derived from standardized clinical questionnaires and analyzed using principal component analysis and K-means clustering.</p><p><strong>Covariates: </strong>Covariates included demographic data, diagnosis, and lesion location(s).</p><p><strong>Analyses: </strong>Principal component analysis and K-means clustering of patient-reported measures of pain and emotional health were performed. Analysis of variance was conducted to determine significant differences among patient subtypes. Statistical significance was set at (P < .05).</p><p><strong>Results: </strong>The study included 15 subjects with FD/MAS, with a mean age of 36.2 (13.9) years, including 1 male. Clustering analysis identified 3 subtypes of patients with distinct symptom profiles. Cluster 1 (n = 2) averaged 70 (28.3) headache days in a 90-day period, pain level of 7.5 (0.7) on a 0-10 scale, and severe anxiety, depression, allodynia, photophobia, and pain interference. Cluster 2 (n = 7) patients reported an average of 5.4 (7.5) headache days, an average pain level of 2.7 (2.6), mild or no anxiety, depression, allodynia, photophobia, and pain interference. Cluster 3 (n = 6) patients displayed a mixed symptom profile with an average of 47.3 (36.4) headache days and a pain level of 5.25 (1.4). Notably, patients with temporal and skull base lesions were predominantly found in Clusters 1 and 3, which exhibited the most severe symptomatology.</p><p><strong>Conclusions and relevance: </strong>This study establishes a basis for future longitudinal research aimed at understanding underlying pain mechanisms and evaluating the response to personalized pain management strategies in subtypes of patients with craniofacial FD.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877011","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":"Prediction of Medication-Related Osteonecrosis of the Jaw in Patients Receiving Antiresorptive Therapy Using Machine Learning Models.","authors":"Kritsasith Warin, Sirasit Lochanachit, Praphan Pavarangkoon, Engkarat Techapanurak, Rachasak Somyanonthanakul","doi":"10.1016/j.joms.2024.11.013","DOIUrl":"10.1016/j.joms.2024.11.013","url":null,"abstract":"<p><strong>Background: </strong>Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication associated with the use of antiresorptive agents, impacting patient quality of life and treatment outcomes. Predictive modeling may aid in a better understanding of MRONJ development.</p><p><strong>Purpose: </strong>The study aimed to evaluate machine learning (ML)-based models for predicting MRONJ in patients receiving antiresorptive therapy.</p><p><strong>Study design, setting, sample: </strong>This retrospective in silico study analyzed electronic medical records from Thammasat University Hospital, covering the period from January 2012 to December 2022. The sample included subjects receiving antiresorptive therapy, excluding those with a history of radiation therapy or metastatic jaw disease.</p><p><strong>Predictor variables: </strong>The primary predictor variable was the predicted probability of MRONJ development from the ML models.</p><p><strong>Outcome variables: </strong>The outcome variable was MRONJ status coded as present or absent based on chart review.</p><p><strong>Covariates: </strong>Covariates included demographic data, MRONJ occurrence, location and staging of MRONJ, comorbidities, diseases related to antiresorptive agents, types of antiresorptive agents, therapy duration, concurrent medications, blood calcium levels, and dental factors.</p><p><strong>Analyses: </strong>Model performance was assessed via accuracy, sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve. Additionally, univariate and multivariate Cox regression analyses were conducted to identify factors significantly associated with MRONJ development. P ≤ .05 was statistically significant.</p><p><strong>Results: </strong>The study analyzed data from 5,305 subjects with a mean age of 75 ± 11.1 years, predominantly female. MRONJ was observed in 81 cases (1.5%), with a median time to development of 33 months (interquartile range = 3). Among the 6 models tested, the best-performing model had an accuracy of 0.95 and an area under the receiver operating characteristic curve of 0.89-0.90. Significant predictors identified through Cox regression included metabolic syndrome (hazard ratio = 14.064, 95% confidence interval = 1.111-178.067, P = .041) and patients receiving intravenous pamidronate (hazard ratio = 5.932, 95% confidence interval = 1.755-20.051, P = .004), indicating their association with MRONJ development.</p><p><strong>Conclusions and relevance: </strong>ML-based predictive and time-to-event models effectively predict MRONJ risk, aiding in the strategic prevention and management for patients undergoing antiresorptive therapy.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864520","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":"Effect of Statins on Patients With Osteoradionecrosis of the Jaw","authors":"Junya Kusumoto DDS, PhD ,&nbsp;Yumi Muraki DDS, PhD ,&nbsp;Akiko Sakakibara DDS, PhD ,&nbsp;Shungo Furudoi DDS, PhD ,&nbsp;Masaya Akashi DDS, PhD","doi":"10.1016/j.joms.2024.08.002","DOIUrl":"10.1016/j.joms.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Osteoradionecrosis of the jaw (ORN) is a late complication of radiation therapy. Radiation-induced fibrosis is the most likely mechanism for developing ORN, and statins are effective against radiation-induced fibrosis. However, no reports have indicated the direct effectiveness of statins in treating ORN.</div></div><div><h3>Purpose</h3><div>This study aimed to measure the association between statin exposure and ORN disease resolution.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This retrospective cohort study included patients with ORN diagnosed between January 2008 and December 2020 at the Hospital's Department of Oral and Maxillofacial Surgery. Patients who were immunocompromised or followed up for &lt; 6 months were excluded.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was statin exposure, which was defined as the use of statins for dyslipidemia.</div></div><div><h3>Main Outcome Variable</h3><div>The main outcome variable was ORN disease progression status (good prognosis). Patients who showed full recovery and improvement were included in the good prognosis group, and those who showed invariance and deterioration were included in the poor prognosis group.</div></div><div><h3>Covariates</h3><div>We analyzed the clinicodemographic including the age of onset, sex, history of smoking, alcohol consumption, history of chemotherapy, tumor site, association with dental treatment, location (maxilla or mandible), the time to ORN onset from radiation therapy, and stage of ORN, and treatment characteristics including hyperbaric oxygen therapy, long-term macrolide administration, and sequestrectomy.</div></div><div><h3>Analyses</h3><div>We analyzed the association between statin exposure or covariates and time to ORN improvement using bivariate and multivariate Cox regression. The significance level was set at <em>P</em> = .05.</div></div><div><h3>Results</h3><div>We analyzed 102 patients, and the improvement rate was 32.4%. The favorable prognostic factors were statin exposure (adjusted hazard ratio [HR], 3.71; 95% confidence interval [CI], 1.62 to 8.50; <em>P</em> = .002), onset in the maxilla (HR, 2.15; 95% CI, 1.02 to 4.55; <em>P</em> = .045), and stage 1 of ORN (HR, 2.65; 95% CI, 1.20 to 5.83; <em>P</em> = .016).</div></div><div><h3>Conclusion and Relevance</h3><div>In this study, statin exposure, onset in the maxilla, and stage 1 of Lyons's classification were favorable prognostic factors for ORN. Although this study's findings were insufficient to recommend statin use for ORN, statins may be a novel and effective treatment for ORN.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"82 12","pages":"Pages 1585-1595"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108424","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}