Journal of Oral and Maxillofacial Surgery最新文献

{"title":"Oral and Maxillofacial Surgery Complication Rates at a Major Teaching Hospital: A 9-Year Retrospective Review","authors":"Mary Cho DDS ,&nbsp;Nagi Demian DDS, MD ,&nbsp;Brendan Moxley BS ,&nbsp;Pearl Craig DDS, MsD","doi":"10.1016/j.joms.2025.02.011","DOIUrl":"10.1016/j.joms.2025.02.011","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative complications in oral and maxillofacial surgery (OMS) can prolong recovery, increase health care costs, and negatively impact patient outcomes. Identifying complication trends is crucial for improving patient care and safety, particularly in academic settings where balancing surgical training and patient safety is essential.</div></div><div><h3>Purpose</h3><div>The study purpose is to measure and identify trends in the prevalence of OMS complications over a 9-year period at a major teaching hospital.</div></div><div><h3>Study Design, Setting, Sample</h3><div>This retrospective cohort study was conducted at Memorial Hermann Hospital, Texas Medical Center, Houston. The study included 4,466 documented operations performed between July 1, 2014, and June 30, 2023, with no exclusions.</div></div><div><h3>Predictor Variable</h3><div>The primary predictor variable was date of surgery, measured in years. A secondary predictor variable was procedure type, categorized into 8 groups: trauma, infection, dentoalveolar, reconstruction, pathology, critical care, orthognathic, and temporomandibular joint disorder.</div></div><div><h3>Main Outcome Variable</h3><div>The primary outcome variable was the occurrence of postoperative complications, defined as any adverse outcome or unintended consequence resulting from medical or surgical treatment and documented as a morbidity or mortality event. A secondary outcome variable was complication type.</div></div><div><h3>Covariates</h3><div>Age and sex associated with procedures were collected.</div></div><div><h3>Analyses</h3><div>Demographic variables were computed at the subject level. Descriptive analysis at the procedure level was used to calculate the prevalence of complications. A generalized linear model assessed trends in complication prevalence, procedure volume, and complication type over time, while Fisher’s exact test examined the relationship between procedure type and complication type. A <em>P</em> value of &lt;.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>The sample was composed of 4,466 operations and 4,453 subjects with a mean age of 41.4 (±4.6) and 2,724 (61%) were male. There were 325 (7.28%) complications. There was no statistically significant trend in the prevalence of complications over time (B-coefficient 0.002, 95% CI −3.9 to 0.004, <em>P</em> = .1). There was a significant association between procedure type and complication type (<em>P</em> &lt; .001). Orthognathic procedures exhibited the highest proportion of complications at 17.4% (n = 4), while critical care procedures demonstrated the lowest at 2.0% (n = 4).</div></div><div><h3>Conclusion and Relevance</h3><div>No statistically significant trend in the prevalence of complications was observed, but procedure type was associated with complication type.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 711-719"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649327","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 A. Ritchie DMD, MD ,&nbsp;Lauren Hayes BS ,&nbsp;Guihua Zhai PhD ,&nbsp;Brian E. Kinard DMD, MD","doi":"10.1016/j.joms.2025.03.002","DOIUrl":"10.1016/j.joms.2025.03.002","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Purpose</h3><div>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.</div></div><div><h3>Study Design, Setting, and Sample</h3><div>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.</div></div><div><h3>Predictor Variables</h3><div>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.</div></div><div><h3>Main Outcome Variable</h3><div>The primary outcome variable was the LSS. LSS1 to 3 are variations of a favorable SRO split, while LSS4 is unfavorable.</div></div><div><h3>Covariates</h3><div>Covariates include age, sex, and previous mandibular osteotomies.</div></div><div><h3>Analyses</h3><div>The significance level was defined as <em>P</em> &lt; .05. Multivariate regression analyses assessed variables that were near statistically significant (<em>P</em> &lt; .2). Hemimandibles were correlated and the subject factor was accounted for using generalized estimating equations.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions and Relevance</h3><div>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).</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 670-680"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","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":"Is Treatment at a Level 1 Trauma Center Associated With Better Outcomes Among Patients With Isolated Mandible Fractures?","authors":"Cameron C. Lee DMD, MD ,&nbsp;Tim T. Wang DMD, MD, MPH ,&nbsp;Lang Liang BS ,&nbsp;Nicholas Wilken DDS, MD ,&nbsp;Donita Dyalram DDS, MD ,&nbsp;Gary Warburton DDS, MD ,&nbsp;Joshua Lubek DDS, MD ,&nbsp;John Caccamese DMD, MD","doi":"10.1016/j.joms.2025.03.007","DOIUrl":"10.1016/j.joms.2025.03.007","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Purpose</h3><div>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.</div></div><div><h3>Study Design, Setting, Sample</h3><div>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.</div></div><div><h3>Predictor/Exposure/Independent Variable</h3><div>The primary predictor was trauma center designation (level 1 or nonlevel 1).</div></div><div><h3>Main Outcome Variable</h3><div>The primary outcome was any complication. Secondary outcomes were return to the operating room, length of stay, adverse discharge disposition, and specific complications.</div></div><div><h3>Covariates</h3><div>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).</div></div><div><h3>Analyses</h3><div>Descriptive, bivariate, and multiple regression statistics were performed to evaluate the association between trauma center designation and outcomes.</div></div><div><h3>Results</h3><div>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; <em>P</em> = .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.</div></div><div><h3>Conclusions and Relevance</h3><div>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.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 720-727"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","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":"RE: Application of Handheld Point-of-Care Ultrasound in the Setting of Craniomaxillofacial Trauma: A Technical Note","authors":"Srinivedha Cholappadi Vijayakumar MDS,&nbsp;Rinku Kurian George MDS,&nbsp;Raja Sethupathy Cheeman MDS","doi":"10.1016/j.joms.2025.01.018","DOIUrl":"10.1016/j.joms.2025.01.018","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Page 655"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184760","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 ,&nbsp;Steven L. Van Meeteren ,&nbsp;Nitin A. Pagedar MD, MPH ,&nbsp;Marisa R. Buchakjian MD, PhD","doi":"10.1016/j.joms.2025.02.012","DOIUrl":"10.1016/j.joms.2025.02.012","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;The study’s purpose was to identify associations between OCSCC pathologic characteristics and ENE.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design, Setting, Sample&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Predictor Variable&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Variable&lt;/h3&gt;&lt;div&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;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Covariates&lt;/h3&gt;&lt;div&gt;Covariates included subject sex, age, and smoking history.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analyses&lt;/h3&gt;&lt;div&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 &lt;em&gt;P&lt;/em&gt; = .05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&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; &lt;em&gt;P&lt;/em&gt; = .002), bone invasion (relative risk = 1.42; 95% CI, 1.13 to 1.80; &lt;em&gt;P&lt;/em&gt; = .005), LNR quartile (&lt;em&gt;P&lt;/em&gt; &lt; .001), and pathologic T-class (eighth edition; &lt;em&gt;P&lt;/em&gt; = .001) were significantly correlated with ENE. On multivariate logistic regression analysis, PNI (odds ratio = 2.29; 95% CI, 1.21 to 4.31; &lt;em&gt;P&lt;/em&gt; = .01) and LNR quartile (&lt;em&gt;P&lt;/em&gt; &lt; .001) remained significantly correlated with ENE.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and Relevance&lt;/h3&gt;&lt;div&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 informati","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 768-775"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","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":"Standardization of Dental Clearance Pathway for Preoperative Cardiac Transplant Preparation","authors":"Ariana Benedetto DDS ,&nbsp;Ariel Blanchard DMD ,&nbsp;Gwendolyn Reeve DMD","doi":"10.1016/j.joms.2025.02.013","DOIUrl":"10.1016/j.joms.2025.02.013","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 647-650"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184758","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":"Are Orbital Fracture Location, Visual Disturbances, and Head Injury Associated With Severe Ocular and Periocular Injuries? A Retrospective Cohort Study","authors":"David Lopez Oliver MD ,&nbsp;Steven Gernandt MD, DMD ,&nbsp;Romain Aymon ,&nbsp;Paolo Scolozzi MD, DMD","doi":"10.1016/j.joms.2025.03.012","DOIUrl":"10.1016/j.joms.2025.03.012","url":null,"abstract":"<div><h3>Background</h3><div>Cranio-maxillofacial fractures involving the orbits are common and may be associated with severe ocular and periocular injuries (OPOIs) requiring prompt management.</div></div><div><h3>Purpose</h3><div>The purpose of the study was to measure the association between orbital fracture (OF) location, visual disturbances (VDs), head injury (HI), and OPOI severity.</div></div><div><h3>Study Design, Setting, and Sample</h3><div>A retrospective cohort study was conducted at the University Hospital of Geneva (2008–2021). Inclusion criteria are as follows: subjects ≥18 years with OF due to blunt trauma, who underwent head computed tomography, comprehensive ophthalmological assessment, and had ≥1-year follow-up. Exclusion criteria: subjects &lt;18 years, prior orbital/ophthalmic surgery, penetrating trauma, prior monocular or nonstereoscopic vision, lack of ophthalmological assessment, insufficient clinical data, or follow-up &lt;1 year.</div></div><div><h3>Predictor Variables</h3><div>Predictors included OFs (categorized by anatomic location), VD (subjective/objective visual acuity decrease or diplopia), and HI, defined as (a) loss of consciousness, (b) Glasgow Coma Scale score, and/or (c) intracranial hemorrhage.</div></div><div><h3>Main Outcome Variable</h3><div>The primary outcome was OPOI severity. Severe OPOI was defined as requiring immediate ophthalmic treatment (performed without delay or within 6 hours), while nonsevere OPOI did not require immediate intervention.</div></div><div><h3>Covariates</h3><div>Covariates included demographic and injury-related parameters.</div></div><div><h3>Analyses</h3><div>Descriptive, bivariate, and multivariate multinomial logistic regression analyses were performed to identify factors associated with OPOIs. Statistical significance was set at <em>P</em> ≤ .05.</div></div><div><h3>Results</h3><div>The study included 824 patients (mean age: 47.2 ± 23.6 years), the majority of whom were male (n = 580; 70.4%). Adjusted analysis showed severe OPOIs were associated with medial orbital wall fractures (odds ratio [OR], 3.54; 95% CI, 1.78-7.07; <em>P</em> &lt; .01); VD (OR, 3.57; 95% CI, 1.92-6.66; <em>P</em> &lt; .01); HI (OR, 1.99; 95% CI, 1.06-3.74; <em>P</em> = .03) and older age (OR: 1.02; 95% CI: 1.01–1.03; <em>P</em> &lt; .01).</div></div><div><h3>Conclusion and Relevance</h3><div>Within the limitations of the study, it appears that medial OFs, VD, HI, and older age are associated with severe OPOIs. These findings may help guide early risk assessment and management in patients with OFs.</div></div>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 700-710"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005704","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":"RE: The Modified Caldwell-Luc Approach for Treating Odontogenic Maxillary Sinusitis Without Need for Functional Endoscopic Sinus Surgery: A Retrospective Study","authors":"Christian Bacci DDS, PhD, MMSc","doi":"10.1016/j.joms.2025.02.009","DOIUrl":"10.1016/j.joms.2025.02.009","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 656-657"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184818","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":"June 2025 AAOMS News and Announcements","authors":"","doi":"10.1016/j.joms.2025.03.006","DOIUrl":"10.1016/j.joms.2025.03.006","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 776-780"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184993","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":"Pretreatment Pain as a Prognostic Predictor in Oral Tongue Squamous Cell Carcinoma: The Mediating Role of Perineural Invasion","authors":"Sisi Liu MD ,&nbsp;Jia Kang MD ,&nbsp;Guanzheng Chen MD ,&nbsp;Xiaohong Yuan MD ,&nbsp;Chang Liu MD ,&nbsp;Zhien Feng PhD ,&nbsp;Zhengxue Han PhD","doi":"10.1016/j.joms.2025.03.010","DOIUrl":"10.1016/j.joms.2025.03.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The potential effects of pretreatment pain on prognosis of tongue squamous cell carcinoma (TSCC) and the role that perineural invasion (PNI) plays in this process remains unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;The purposes of this study are to estimate the prognostic value of pretreatment pain and identify whether PNI is a mediating factor in the relationship between pretreatment pain and prognosis in TSCC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design, Setting, Sample&lt;/h3&gt;&lt;div&gt;This retrospective cohort study included TSCC patients who underwent first resections of primary lesions at the Beijing Stomatological Hospital of Capital Medical University between January 2009 and December 2019. Patients who had incomplete medical records and pathological data, received neoadjuvant radiotherapy and chemotherapy before surgery, and did not receive a TSCC diagnosis, were excluded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Predictor Variable&lt;/h3&gt;&lt;div&gt;The predictor variables are pretreatment pain and PNI. The visual analog scale (VAS) was used to assess pretreatment pain levels, and the PNI status was evaluated by pathological section.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Variable(s)&lt;/h3&gt;&lt;div&gt;The main outcome variables were the 3-year disease-specific survival (DSS) and disease-free survival (DFS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Covariates&lt;/h3&gt;&lt;div&gt;Covariates included age, sex, smoking history, alcohol history, growth pattern, and T-stage.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analyses&lt;/h3&gt;&lt;div&gt;The χ&lt;sup&gt;2&lt;/sup&gt; test was used to describe the baseline data. Kaplan-Meier analysis was used to estimate the 3-year DSS and DFS. The Cox regression model was adapted for univariate and multivariate analysis. The association between VAS score and PNI was analyzed using logistic regression analysis and mediation analysis. &lt;em&gt;P&lt;/em&gt; value less than .05 indicated statistical significance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The study included 307 subjects with a mean age of 52 (±12.1) years, and 164 (53.4%) were male. There were 65 (21.2%) with high VAS (&gt;5) and 242 (78.8%) with low VAS (≤5). The DSS and DFS of high VAS were 64.6% (95% CI: 23.6 to 80.9%) and 52.3% (95% CI: 35.3 to 92.8%), of patients with PNI were 62.7% (95% CI: 19.6 to 64.5%) and 46.7% (95% CI: 25.9 to 66.9%), respectively. The group high VAS/with PNI had lower DSS and DFS than group high VAS/without PNI (55.3 and 40.4% vs 88.9 and 83.3%). The VAS and PNI were identified as independent factors associated with prognosis (&lt;em&gt;P&lt;/em&gt; &lt; .05). Mediation analysis revealed that the indirect effect of VAS on DFS was 0.071 (95% CI: 0.011 to 0.135, &lt;em&gt;P&lt;/em&gt; = .024), while the total effect was 0.187 (95% CI: 0.074 to 0.296, &lt;em&gt;P&lt;/em&gt; &lt; .001), VAS score affected the DFS of TSCC through the mediating effect of PNI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion and Relevance&lt;/h3&gt;&lt;div&gt;Our findings confirmed that pretreatment pain is associated with worse outcomes in TSCC. Patients with TSCC and severe pretreatment pain are more likely to be diagnosed","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":"83 6","pages":"Pages 757-767"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811640","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}