Journal of Oral and Maxillofacial Surgery最新文献

{"title":"The Use of Clear Aligners for Orthognathic Surgery: A Systematic Review.","authors":"Hooman Shafaee, Shirin Shahnaseri, Mahsa Ghorbani, Erfan Bardideh, Seyed Amir Mousavi, Sercan Akyalcin","doi":"10.1016/j.joms.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.joms.2025.03.009","url":null,"abstract":"<p><strong>Purpose: </strong>Clear aligners, known for their esthetic appeal, are now increasingly utilized in orthognathic surgery treatment, offering preoperative and postoperative benefits. This systematic review aims to answer the research question: Are clear aligners as effective as traditional fixed appliances in achieving dental and skeletal changes, improving oral health, and enhancing patient-reported satisfaction in patients requiring orthognathic surgery?</p><p><strong>Methods: </strong>We conducted a systematic review following a predefined protocol. We searched databases including MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL from inception until September 2024, with no language or date restrictions. Studies were included based on the Population, Intervention, Comparison, and Outcome (PICO) criteria, focusing on patients requiring orthognathic surgery (Population), the use of clear aligners (Intervention), compared with traditional fixed appliances (Comparison), and outcomes related to dental and skeletal changes, oral health, and patient satisfaction (Outcome). Inclusion criteria were clinical studies addressing the PICO question, while exclusion criteria were studies not involving human subjects or unrelated to orthognathic surgery with clear aligners. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) and Cochrane Risk of Bias 2.0 (ROB.02) tools. Data extraction included publication year, study design, participant demographics, malocclusion type, surgical procedures, aligner specifications, treatment protocols, aligner utilization stages, treatment durations, and evaluated outcomes.</p><p><strong>Results: </strong>Our comprehensive search identified 765 studies, supplemented by 12 from manual searching. After screening, 34 studies underwent full-text review, and 16 clinical studies (375 patients) were included in the qualitative review: 2 randomized clinical trial, 2 prospective, and 12 retrospective studies. Four studies using presurgical aligners reported an increase in the incisor mandibular plane angle by 3 to 15° for Class III cases, while 2 studies on postsurgical aligners noted similar decompensatory movements, such as a change in incisor mandibular plane angle exceeding 10°. The remaining 7 studies used aligners before and after surgery and sometimes during surgery to create surgical splints. Comparative results between aligners and fixed appliances indicated no significant differences in dental and skeletal changes. Aligners had higher patient satisfaction scores (3 to 5 points higher on a 10-point scale) and better periodontal health outcomes. The Peer Assessment Rating score reductions were similar (60% for aligners vs 69% for fixed appliances). Overall, clear aligners may provide similar effectiveness to fixed appliances in orthognathic surgery while enhancing periodontal health and patient satisfaction. However, due to the low quality of evidence","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803649","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":"Navigation-Guided Management of Comminuted Zygomaticomaxillary Complex Fracture Concurrent With Orbital Reconstruction.","authors":"Shuo Zhang, Fan Yang, Zhengkang Li, Yuan Deng","doi":"10.1016/j.joms.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.joms.2025.03.008","url":null,"abstract":"<p><strong>Background: </strong>Comminuted zygomaticomaxillary complex (ZMC-C) fracture with orbital reconstruction poses challenges for surgeons. Navigation-guided technique may be valuable for surgical reduction.</p><p><strong>Purpose: </strong>This study aimed to measure the difference error between planned and actual reduction of ZMC-C fracture with orbital reconstruction using navigation-guided technique.</p><p><strong>Study design, setting, sample: </strong>This retrospective single-arm cohort study involved subjects with ZMC-C and orbital fractures from Jan 2017 to Jun 2019 at the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China. Subjects with brain damage, unstable vital signs, allergy to titanium alloy implants, trauma to other facial bones or postoperative facial trauma were excluded.</p><p><strong>Main outcome variables: </strong>The primary outcome variable was the mean 3-dimensional (3D) (Euclidean) distance error between surgical plan and actual outcome. Secondary outcomes included mean absolute distance error in transverse, vertical and anterior-posterior planes, visual analog scale score of subjects' self-satisfaction with facial aesthetics and function, orbital volume, exophthalmometry, position of bilateral zygomatic bones and surgical complications.</p><p><strong>Covariates: </strong>Covariates included age and sex.</p><p><strong>Analyses: </strong>Outcomes were tested using t-tests with significance at P < .05 to determine differences between preoperative and postoperative measurements and symmetry.</p><p><strong>Results: </strong>The sample included 20 subjects with a median age of 39 years (interquartile range = 24.5) and 19 (95%) were male. The mean 3D distance errors were 0.5 ± 0.3 mm at the midpoint of the fracture line at the zygomatic frontal suture, 0.7 ± 0.3 mm at the most prominent point on the surface of zygoma and 0.6 ± 0.4 mm at the intersection point of the zygomatic alveolar buttress and fracture line. The maximum mean absolute distance error was 0.8 ± 0.2 mm. Postoperative visual analog scale score improved in all subjects. Mean orbital volume was reduced by 2.2 ± 0.6 cm³, and enophthalmos improved to 0.4 ± 0.3 mm (all P < .01). There were no significant differences in exophthalmometry, orbital volume and position of bilateral zygomatic bones between the affected and unaffected sides (P > .05).</p><p><strong>Conclusion and relevance: </strong>Deficient movement in the anterior-posterior plane mainly contributes to 3D distance error. The mean distance error was clinically acceptable with the aid of navigation-guided technique in managing ZMC-C fracture with orbital reconstruction.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is 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}

{"title":"Effectiveness of Concentrated Growth Factor on Improving Postoperative Comfort in Patients Undergoing Coronectomy for Impacted Lower Third Molars: A Double-Blinded Split-Mouth Randomized Controlled Clinical Study.","authors":"Muharrem Ergun Dudak, Aylin Calis, Huseyin Koca","doi":"10.1016/j.joms.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.joms.2025.03.005","url":null,"abstract":"<p><strong>Background: </strong>Following coronectomy, pain and edema are adverse side effects. Concentrated growth factor (CGF) is recognized for its potential to enhance wound healing, reduce inflammation and may help to improve postoperative comfort following coronectomy.</p><p><strong>Purpose: </strong>The study purpose was to measure and compare postoperative pain and edema between CGF and control treatments in patients undergoing bilateral coronectomies.</p><p><strong>Study design, setting, and sample: </strong>In this split-mouth, double-blind, randomized controlled study conducted at Ege University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery in Izmir, Turkey, patients aged 18 to 65 years at risk of mandibular nerve injury underwent bilateral coronectomy. Patients over 65 years of age or those with systemic conditions contraindicating surgery were excluded. Patients and the researcher responsible for data collection and analysis were blinded to the intervention.</p><p><strong>Independent variable: </strong>The independent variable was wound management. Within subjects, the treatment sides were randomly assigned to CGF treatment or control.</p><p><strong>Main outcome variable: </strong>The outcome variable was postoperative comfort measured using pain and edema. Pain was measured using the visual analog scale for 7 days after surgery. Edema was quantified in millimeters in 3 planes preoperatively and on postoperative days 2 and 7.</p><p><strong>Covariates: </strong>Age, sex, and depth of impaction were covariates.</p><p><strong>Analyses: </strong>The conformity of edema measurements to normal distribution was assessed with the Shapiro-Wilk test, analysis of variance for repeated measures and Bonferroni correction, and supported by paired two-sample t test (significant interaction); since pain levels did not fit the normal distribution (ordinal scale), the nonparametric Brunner and Langer model (LD-F2) and Benjamini-Hochberg procedure were used. Statistical significance was defined as (P < .01).</p><p><strong>Results: </strong>The sample included 35 subjects, comprising 12 (34.3%) males and 23 (65.7%) females, with a mean age of 32.7 ± 11.42 (standard deviation). Visual analog scale scores were significantly lower on the CGF side for the first 6 days (P < .001) but not on day 7 (P = .6). Postoperative second day edema was statistically significantly lower in the 2 planes on the CGF side (P < .001, P = .007, P = .8) but not on day 7 in any plane (P = .5, P = .8, P = .1).</p><p><strong>Conclusions and relevance: </strong>Our study shows that CGF enhances postoperative comfort by minimizing pain and edema. Additional interventions may be necessary for patients undergoing coronectomy due to the potential for significant postoperative discomfort.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743044","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":"Evaluation of Lingual Fracture Pattern Following Sagittal Split With the 'Low and Short' Medial Osteotomy.","authors":"Collin Ritchie, Lauren Hayes, Guihua Zhai, Brian E Kinard","doi":"10.1016/j.joms.2025.03.002","DOIUrl":"10.1016/j.joms.2025.03.002","url":null,"abstract":"<p><strong>Background: </strong>The lingual split scale (LSS) following sagittal ramus osteotomy (SRO) is an objective scale where LSS1 to 3 are variations of a favorable split, while LSS4 is an unfavorable split. LSS influences postoperative bone overlap, posterior interferences, and fixation methods. There is currently no study evaluating LSS following SRO using the low and short medial osteotomy modification.</p><p><strong>Purpose: </strong>The purpose of this study is to describe the lingual fracture pattern of the distal segment through the LSS following SRO using the low and short medial osteotomy modification.</p><p><strong>Study design, setting, and sample: </strong>A retrospective cohort study of subjects undergoing SRO with the low and short medial osteotomy by a single surgeon at The University of Alabama at Birmingham between February 2020 and July 2024. Subjects with incomplete records were excluded.</p><p><strong>Predictor variables: </strong>Anatomic predictor variables were ramus width and length and the vertical height of the lingula. Procedural predictor variables were height and angle of the medial osteotomy, medial osteotomy relative to the lingula and to the mandibular canal, and third molar removal at the time of SRO.</p><p><strong>Main outcome variable: </strong>The primary outcome variable was the LSS. LSS1 to 3 are variations of a favorable SRO split, while LSS4 is unfavorable.</p><p><strong>Covariates: </strong>Covariates include age, sex, and previous mandibular osteotomies.</p><p><strong>Analyses: </strong>The significance level was defined as P < .05. Multivariate regression analyses assessed variables that were near statistically significant (P < .2). Hemimandibles were correlated and the subject factor was accounted for using generalized estimating equations.</p><p><strong>Results: </strong>The study sample had 210 subjects (419 hemimandibles). LSS variations of favorable splits resulted in 263 (62.8%) vertical fractures (LSS1), 8 (1.9%) horizontal fractures (LSS2), and 139 (33.2%) fractures along the mandibular canal (LSS3). Nine (2.2%) unfavorable splits (LSS4) were present. No variables were found to be significantly associated with unfavorable fractures (LSS4).</p><p><strong>Conclusions and relevance: </strong>SRO using the low and short medial osteotomy resulted in predictable LSS patterns. Favorable fracture patterns (LSS1 to 3) were present in 97.8% (410) of SROs, while unfavorable fracture patterns (LSS4) were present in 2.2% (9). No variables were identified to be significantly associated with unfavorable fracture (LSS4).</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730535","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":"Aromatherapy on Anxiety, Pain, and Quality of Life Following Surgery of Mandibular Third Molars: A Randomized, Double-Blind Clinical Trial.","authors":"Ylana Rosa Matos, Maria Fernanda da Silva Nascimento, Maria Clara Mendes Gomes, João Emanuel Sousa de Almeida, Paulo Goberlânio de Barros Silva, Edson Luiz Cetira Filho","doi":"10.1016/j.joms.2025.03.003","DOIUrl":"10.1016/j.joms.2025.03.003","url":null,"abstract":"<p><strong>Background: </strong>The control of anxiety is significant in the management of mandibular third molar removal surgery and may impact patients' pain.</p><p><strong>Purpose: </strong>This study aimed to measure the effects of aromatherapy on the control of anxiety, pain, and quality of life in lower third molar removal surgery.</p><p><strong>Study design: </strong>From 2023 to 2024, a double-blinded randomized clinical trial was performed on patients with indications for removal of unilateral mandibular third molars at our institution. Subjects were excluded if they received additional mandibular teeth extractions, were unable to complete the questionnaire, or had medical contraindications.</p><p><strong>Predictor variable: </strong>The predictor variable is aromatherapy exposure, and subjects were randomly assigned to lavender oil or distilled water. Each patient underwent an aromatherapy session in a closed room, with the diffuser turned on 30 minutes before the patient's entry following its use during the operation.</p><p><strong>Main outcome variables: </strong>The outcome variables were pain measured using a visual analog scale, anxiety measured using the Dental Anxiety Scale questionnaire, and quality of life measured using the Oral Health Impact Profile questionnaire. The outcomes were measured preoperatively and 7 days after the operation.</p><p><strong>Covariates: </strong>The covariates are hemodynamic parameters, sex, age, race, educational level, and family income.</p><p><strong>Analyses: </strong>Mann-Whitney independent test (between groups) or Friedman/Dunn and Wilcoxon's test (intragroup analysis); the statistical significance was set at P < .05.</p><p><strong>Results: </strong>The study sample included 32 patients (17 female [53%] and 15 male [47%], mean age 24.72 ± 4.63 years). The peak of pain in both groups was observed 2 hours after surgery, with a reduction after 12 hours, and there were no differences between the 2 groups about pain (P = .9). Regarding anxiety control and hemodynamic parameters, there was an improvement in both groups, with a reduction of 2 points in the score (P = .011).</p><p><strong>Conclusions: </strong>Aromatherapy is not statistically significantly effective compared to distilled water in reducing pain and improving quality of life. However, it showed favorable results in reducing anxiety and hemodynamic parameters.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730531","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":"Comparing the Infection Rates of Strut Versus Straight Plates in Sagittal Split Osteotomies.","authors":"Stephen E Higgins, Valmont Desa","doi":"10.1016/j.joms.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.joms.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>Sagittal split osteotomies can be rigidly fixated through various methods. Unfortunately, infection remains a common postoperative complication.</p><p><strong>Purpose: </strong>The purpose was to estimate postoperative infection rates between strut and straight plates for internal fixation of sagittal split osteotomies.</p><p><strong>Study design, setting, sample: </strong>We implemented a retrospective cohort study and included a consecutive series of patients with sagittal split osteotomies performed at the University of Nebraska Medical Center. The cases were performed by a single surgeon with a chief as resident surgeon. Exclusion criteria included any patient with unilateral surgery, mandibular midline osteotomy, previous mandible reconstruction, distraction osteogenesis, previous facial trauma history, and less than 12 weeks of follow-up.</p><p><strong>Predictor variable: </strong>Primary predictor variable was plate type (strut vs straight). The choice of plate was not based on the surgical plan.</p><p><strong>Main outcome variable(s): </strong>The primary outcome variable was postoperative infection. This was defined as purulent discharge, incision and drainage, or prescription of antibiotics. Secondary outcomes include hardware removal and neurosensory function.</p><p><strong>Covariates: </strong>Covariates included demographics, smoking, alcohol and drug use, single/double jaw, advancement/setback, length of movement, and perioperative third molar extraction.</p><p><strong>Analyses: </strong>Fisher's exact test, χ² test, and Student's t test were computed to measure bivariate association. The relative risks (RRs) and their 95% CIs were reported. P values < .05 were considered statistically significant.</p><p><strong>Results: </strong>The sample comprised 112 subjects: 51 (45.5%) straight plate and 61 (54.5%) strut plate. There were 32 (62.7%) women in the straight plate group, mean age 25.55 ± 13.34 years and 39 women (63.9%) in the strut plate group, mean age 29.02 ± 11.97 years. Postoperative infection was the most common reason for plate removal (n = 10). Strut plates, relative to straight plates, were associated with a 23% increase (RR 1.23, 95%, CI 0.47 to 2.16, P < .7) in infections, a 25% increase (RR 1.25, 95%, CI 0.45 to 2.27, P < .5) in hardware removal, and a 17% increase (RR 1.17, 95% CI 0.33 to 2.44, P < .7) in postoperative neurosensory disturbance at 3 months for sagittal split osteotomies.</p><p><strong>Conclusions and relevance: </strong>The choice of internal fixation plate, strut versus straight, was not associated with postoperative infection, hardware removal, or postoperative neurosensory function deficit.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700654","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":"Perineural Invasion and Lymph Node Ratio Quartile Are Associated With Extranodal Extension in Oral Cavity Squamous Cell Carcinoma.","authors":"Piper A Wenzel, Steven L Van Meeteren, Nitin A Pagedar, Marisa R Buchakjian","doi":"10.1016/j.joms.2025.02.012","DOIUrl":"10.1016/j.joms.2025.02.012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In contrast to extranodal extension (ENE), tumor characteristics can often be evaluated preoperatively in patients with oral cavity squamous cell carcinoma (OCSCC). If correlations exist between primary tumor characteristics and the presence of ENE, evaluating these factors could help provide more accurate patient counseling and adjuvant treatment planning before undergoing surgical therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The study's purpose was to identify associations between OCSCC pathologic characteristics and ENE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design, setting, sample: &lt;/strong&gt;We performed a retrospective cohort study of adult patients who underwent upfront curative-intent surgery for OCSCC at the University of Iowa Hospitals and Clinics from 2004 to 2018. The treating service was Otolaryngology-Head and Neck Surgery. Exclusion criteria included patients who did not undergo neck dissection, primary tumor occurring outside the oral cavity, pathologic N0, cancer previously treated with radiation or surgically at another institution, and gross disease remaining after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Predictor variable: &lt;/strong&gt;The predictor variable was a set of tumor characteristics, including oral cavity subsite, T- and N- classification, perineural invasion (PNI), lymphovascular invasion, bone invasion, and positive lymph node ratio (LNR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome variable: &lt;/strong&gt;The main outcome variable was ENE status, defined as positive (at least 1 lymph node reported to have ENE) or negative, identified from pathology reports.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Covariates: &lt;/strong&gt;Covariates included subject sex, age, and smoking history.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analyses: &lt;/strong&gt;Bivariate comparisons and multivariate logistic regression analyses were performed to identify correlations between predictor variables/covariates and presence of ENE. Statistical significance was set at P = .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The sample comprised 233 subjects with a mean age of 60.5 (SD 12.5) years, and 154 (66.1%) were male. Of 233 subjects with nodal metastasis, 122 (52.4%) had ENE in at least 1 node, and the median (interquartile range) positive LNR was 0.083 (0.094). On bivariate analysis, PNI (relative risk = 1.49; 95% CI, 1.14 to 1.96; P = .002), bone invasion (relative risk = 1.42; 95% CI, 1.13 to 1.80; P = .005), LNR quartile (P &lt; .001), and pathologic T-class (eighth edition; P = .001) were significantly correlated with ENE. On multivariate logistic regression analysis, PNI (odds ratio = 2.29; 95% CI, 1.21 to 4.31; P = .01) and LNR quartile (P &lt; .001) remained significantly correlated with ENE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study offers insight into important clinicopathologic details of lymph node metastases in OCSCC with an emphasis on tumor characteristics and odds of ENE in 1 or more lymph nodes. This information may be beneficial for patient counseling and treatment planning, especially in patients with PNI and hi","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Study of Speech and Swallowing Postoperative Outcomes in Oral Cancer: Impact of Lateral Mandibular Continuity Restoration","authors":"Abhipsa Mishra MDS ,&nbsp;Raveena R. Nair MS ,&nbsp;Sandeep Vijay MS ,&nbsp;Anoop Attakkil MS ,&nbsp;Aswin Mullath MDS ,&nbsp;Aby K. Babu MDS","doi":"10.1016/j.joms.2024.10.020","DOIUrl":"10.1016/j.joms.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Surgical resection with mandibulectomy in advanced oral cancer results in complex defects. The influence of reconstruction of mandibular continuity on postoperative speech and swallowing function, though crucial, is not widely studied.</div></div><div><h3>Purpose</h3><div>The purpose of study was to compare the speech and swallowing outcomes of oral squamous cell carcinoma (OSCC) patients with lateral mandibulectomy, with or without the restoration of mandibular continuity.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This retrospective cohort study was performed at the Malabar Cancer Centre, Kerala, India, on patients who had undergone lateral mandibulectomy for OSCC from January 2016 to December 2021. Patients with recurrent or second primary OSCC, or with psychiatric disorders and cognitive impairment, or in whom any type of glossectomy was done, were excluded from the study.</div></div><div><h3>Predictor Variable</h3><div>The predictor variable was reconstruction status of mandibular continuity, coded as yes when it is restored and no for vice-versa.</div></div><div><h3>Main Outcome Variable(s)</h3><div>The outcome variables were postoperative speech outcome measured with a 7-point rating speech intelligibility scale and swallowing outcome measured with functional oral intake scale.</div></div><div><h3>Covariates</h3><div>Covariates included age, sex, tumor subsite, mandibular defect, and adjuvant treatment.</div></div><div><h3>Analyses</h3><div>Data analyses included χ², Fisher's exact test, independent t test, Spearman's correlation test, and one-way analysis of variance test. <em>P</em> values &lt; .05 were considered statistically significant.</div></div><div><h3>Results</h3><div>The study sample had 201 patients, with continuity restored in 74 (36.82%) patients and vice versa in 127 (63.18%) patients. The mean age in the continuity restored group was 54.97 ± 9.68 years, and in the continuity not restored group, it was 59.49 ± 9.95 years (<em>P</em> &lt; .05). Both the groups had more male patients (<em>P</em> = .15). The speech scores in both groups at 1 month (<em>P</em> = .66), 3 months (<em>P</em> = .45), and 6 months (<em>P</em> = .33) of postoperative period were compared and had no statistically significant difference. The swallowing scores in groups at 1 month (<em>P</em> = .5), 3 months (<em>P</em> = .5), and 6 months (<em>P</em> = .7) of postoperative period were also compared and had no statistically significant difference.</div></div><div><h3>Conclusion and Relevance</h3><div>Reconstruction of lateral mandibular continuity was not associated with improved postoperative speech and swallowing.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 374-381"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693234","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":"Photobiomodulation With Infrared and Dual-Wavelength Laser Induces Similar Repair and Control of Inflammation After Third Molar Extraction: A Double-Blinded Split-Mouth Randomized Controlled Trial","authors":"Davisson Alves Pereira PhD, DDS ,&nbsp;Mariana Silva Bonatto PhD, DDS ,&nbsp;Eduvaldo Campos Soares Jr. PhD, DDS ,&nbsp;Pedro Gomes Junqueira Mendes MSc ,&nbsp;Roberto Sales e Pessoa PhD, DDS ,&nbsp;Guilherme José Pimentel Lopes de Oliveira PhD, DDS","doi":"10.1016/j.joms.2024.11.009","DOIUrl":"10.1016/j.joms.2024.11.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Photobiomodulation therapy (PBMT) has been showed to have beneficial effects on the healing and control of inflammation associated with oral surgical wounds. However, different PBMT protocols have been proposed and it is not clear if different protocols impact the hard and soft tissues healing equally.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To compare the tissue repair of postextraction alveoli of third molars between treated with dual-wavelength PBMT (red and infrared) or PBMT with infrared laser (IRL) alone.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design, Setting, Sample&lt;/h3&gt;&lt;div&gt;This split mouth randomized controlled trial enrolled 20 patients, who were submitted to the extraction of the 4 partially erupted or fully impacted third molars between August 2023 and December 2023 at the clinic of the INPES postgraduate school (Institute for Clinical Health Research), and at the Federal University of Uberlândia. Adult with all the 4 molars were included in this study, while patients with systemic diseases/conditions, with less than 4 third molars were excluded of this study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure Variable&lt;/h3&gt;&lt;div&gt;The exposure variable is PBMT treatment. Treatment side was randomly allocated to according to the PBMT protocol applied on the postextraction sockets: IRL-PBMT: irradiation with PBMT with an IRL (808 nm) and IRL-RL-PBMT: irradiation with dual-wavelength PBMT (660 and 808 nm).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Variable(s)&lt;/h3&gt;&lt;div&gt;The primary outcome variable was the bone tissue healing that was measured using the fractal analysis and bone tissue density assessed using the radiographic images. The secondary outcome variable was soft tissue healing measured assessing the facial dimensions variations and a healing index that assessed the tissue consistence, color, exudation, bleeding, and edema. Additionally, the analyses centered on the patients’ perceptions was assessed by the application of a visual analogic scale to assess pain, bleeding, edema, difficulty in chewing, and mouth opening conditions. Subjects were clinically evaluated at 3, 7, 14, 30, and 90 days after the surgical procedure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Covariates&lt;/h3&gt;&lt;div&gt;The covariates are the tooth position, and the demographic data (age and sex).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analyses&lt;/h3&gt;&lt;div&gt;The evaluation of the effects of the independent variables (Treatment and period of evaluation) on the primary and secondary outcomes was performed through the application of the repeated measures ANOVA (&lt;em&gt;P&lt;/em&gt; &lt; .05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The sample was composed of 20 subjects with a mean age of 28.58 ± 8.94 years, and 12 (60%) were females. There were no statistically significant differences between the 2 treatments for any outcome variables (&lt;em&gt;P&lt;/em&gt; &gt; .10).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion and Relevance&lt;/h3&gt;&lt;div&gt;It can be concluded that PBMT with dual wavelengths (red and infrared) and an IRL alone induced similar postoperative clinical results after","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 3","pages":"Pages 332-343"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791807","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}