Journal of Clinical Medicine

Research

13 pages, 802 KiB

Open AccessArticle

Factors Affecting the Duration of Surgery in the Management of Condylar Head Fractures

by Simon Patrik Pienkohs, Axel Meisgeier, Johannes Herrmann, Leontine Graf, Clarissa S. Reichert, Guilherme Trento and Andreas Neff

J. Clin. Med. 2023, 12(22), 7172; https://doi.org/10.3390/jcm12227172 - 19 Nov 2023

Viewed by 642

Abstract

Prolonged operation times should be avoided due to the associated complications and negative effects on the efficiency of the use of operating room resources. Surgical treatment of mandibular condylar head fractures is a well-established routine procedure at our department, nevertheless, we recognized fluctuating [...] Read more.

Prolonged operation times should be avoided due to the associated complications and negative effects on the efficiency of the use of operating room resources. Surgical treatment of mandibular condylar head fractures is a well-established routine procedure at our department, nevertheless, we recognized fluctuating operating times. This study aims to pinpoint the influencing factors, in particular the hypothesis whether the efficiency of intraoperative muscle relaxation may decisively affect the duration of surgery. It analyses 168 mandibular condylar head fractures that were surgically treated in the period from 2007 to 2022 regarding the duration of the surgery and potential factors affecting it. The potential predictors’ influence on the dependent variable operation time was mainly calculated as a bivariate analysis or linear regression. Efficiency of relaxation (p ≤ 0.001), fragmentation type (p = 0.031), and fracture age (p = 0.003) could be identified as decisive factors affecting the duration of surgery, as the first surgeon was a constant. In conclusion, surgical intervention should start as soon as possible after a traumatic incident. In addition, a dosage regimen to optimize the efficiency of relaxation should be established in future studies. Fragmentation type and concomitant fractures should also be considered for a more accurate estimation of the operating time. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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12 pages, 1806 KiB

Open AccessArticle

The Use of Artificial Intelligence for the Classification of Craniofacial Deformities

by Reinald Kuehle, Friedemann Ringwald, Frederic Bouffleur, Niclas Hagen, Matthias Schaufelberger, Werner Nahm, Jürgen Hoffmann, Christian Freudlsperger, Michael Engel and Urs Eisenmann

J. Clin. Med. 2023, 12(22), 7082; https://doi.org/10.3390/jcm12227082 - 14 Nov 2023

Viewed by 812

Abstract

Positional cranial deformities are a common finding in toddlers, yet differentiation from craniosynostosis can be challenging. The aim of this study was to train convolutional neural networks (CNNs) to classify craniofacial deformities based on 2D images generated using photogrammetry as a radiation-free imaging [...] Read more.

Positional cranial deformities are a common finding in toddlers, yet differentiation from craniosynostosis can be challenging. The aim of this study was to train convolutional neural networks (CNNs) to classify craniofacial deformities based on 2D images generated using photogrammetry as a radiation-free imaging technique. A total of 487 patients with photogrammetry scans were included in this retrospective cohort study: children with craniosynostosis (n = 227), positional deformities (n = 206), and healthy children (n = 54). Three two-dimensional images were extracted from each photogrammetry scan. The datasets were divided into training, validation, and test sets. During the training, fine-tuned ResNet-152s were utilized. The performance was quantified using tenfold cross-validation. For the detection of craniosynostosis, sensitivity was at 0.94 with a specificity of 0.85. Regarding the differentiation of the five existing classes (trigonocephaly, scaphocephaly, positional plagiocephaly left, positional plagiocephaly right, and healthy), sensitivity ranged from 0.45 (positional plagiocephaly left) to 0.95 (scaphocephaly) and specificity ranged from 0.87 (positional plagiocephaly right) to 0.97 (scaphocephaly). We present a CNN-based approach to classify craniofacial deformities on two-dimensional images with promising results. A larger dataset would be required to identify rarer forms of craniosynostosis as well. The chosen 2D approach enables future applications for digital cameras or smartphones. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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11 pages, 2976 KiB

Open AccessArticle

Intraoral Microvascular Anastomosis in Immediate Free Flap Reconstruction for Midfacial Tumor Defects: A Retrospective Multicenter Study

by Peer W. Kämmerer, Milad Tavakoli, Alexander Gaggl and Massimo Maranzano

J. Clin. Med. 2023, 12(22), 7064; https://doi.org/10.3390/jcm12227064 - 13 Nov 2023

Viewed by 796

Abstract

(1) Background: The current landscape of midface reconstruction is marked by ongoing evolution, with notable advancements in surgical techniques, microvascular procedures, and the implementation of multidisciplinary approaches, all of which have significantly enhanced both functional and aesthetic outcomes. Conventionally, microvascular anastomoses for free [...] Read more.

(1) Background: The current landscape of midface reconstruction is marked by ongoing evolution, with notable advancements in surgical techniques, microvascular procedures, and the implementation of multidisciplinary approaches, all of which have significantly enhanced both functional and aesthetic outcomes. Conventionally, microvascular anastomoses for free flaps in midfacial reconstruction have been executed using cervical vessels. However, this approach necessitates neck access, resulting in extraoral scars and a substantial pedicle length. In light of these considerations, using intraoral anastomoses via the facial vessels emerges as a promising alternative. This retrospective multicentric study aims to provide a comprehensive account of immediate midface reconstruction through intraoral anastomoses. (2) Methods: Between 2020 and 2023, patients were included who underwent intraoral resection of midface/orbit segments (Brown Classes I-VI) as a result of malignant diseases. In all cases, immediate reconstruction was accomplished by utilizing the facial vessels through an intraoral approach. Outcome criteria were identification of vessels, parotid duct or facial nerve damage, success of vascular anastomoses, and flap survival. (3) Results: A total of 117 patients with 132 flaps (91 osseous and 41 cutaneous) were included. The intraoral preparation of facial vessels was successfully completed in less than 1 h, and no complications related to the dissection or anastomoses were observed. In two cases, the vessel diameter was insufficient to facilitate anastomoses, necessitating adopting an extraoral approach. During a follow-up period of 48 months, two osseous flaps were lost, accounting for a 1.5% loss rate out of 132 flaps used. Additionally, 3 flaps experienced partial loss, including a skin island of a scapula, the border zone of a femur, and a rectus flap, resulting in a 2.3% partial loss rate out of 130 flaps utilized. (4) Conclusions: This case series underscores the feasibility of employing intraoral anastomoses for immediate complex midface reconstruction following oncological resection. This approach is particularly advantageous for flaps with shorter pedicles, as it helps mitigate external scarring and minimizes the risk of facial nerve injury. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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13 pages, 5949 KiB

Open AccessArticle

The Impact of Transfer-Related Ischemia on Free Flap Metabolism and Electrolyte Homeostasis—A New In Vivo Experimental Approach in Pigs

by Daniel Stephan, Sebastian Blatt, Julian Riedel, Katja Mohnke, Robert Ruemmler, Alexander Ziebart, Bilal Al-Nawas, Peer W. Kämmerer and Daniel G. E. Thiem

J. Clin. Med. 2023, 12(20), 6625; https://doi.org/10.3390/jcm12206625 - 19 Oct 2023

Viewed by 827

Abstract

Free flap tissue transfer represents the gold standard for extensive defect reconstruction, although malperfusion due to thrombosis remains the leading risk factor for flap failure. Recent studies indicate an increased immune response and platelet activation in connection with pathologic coagulation. The underlying cellular [...] Read more.

Free flap tissue transfer represents the gold standard for extensive defect reconstruction, although malperfusion due to thrombosis remains the leading risk factor for flap failure. Recent studies indicate an increased immune response and platelet activation in connection with pathologic coagulation. The underlying cellular and molecular mechanisms remain poorly understood, however. The presented study, therefore, aims to investigate if transfer-related ischemia alters intra-flap metabolism and electrolyte concentrations compared to central venous blood after free flap transfer in pigs to establish a novel experimental model. Free transfer of a myocutaneous gracilis flap to the axillary region was conducted in five juvenile male pigs. The flap artery was anastomosed to the axillary artery, and intra-flap venous blood was drained and transfused using a rubber-elastic fixed intravenous catheter. Blood gas analysis was performed to assess the effect of transfer time-induced ischemia on intra-flap electrolyte levels, acid–base balance, and hemoglobin concentrations compared to central venous blood. Time to flap reperfusion was 52 ± 10 min on average, resulting in a continuous pH drop (acidosis) in the flaps’ venous blood compared to the central venous system (p = 0.037). Potassium (p = 0.016), sodium (p = 0.003), and chloride (p = 0.007) concentrations were significantly increased, whereas bicarbonate (p = 0.016) and calcium (p = 0.008) significantly decreased within the flap. These observations demonstrate the induction of anaerobic glycolysis and electrolyte displacement resulting in acidosis and hence significant tissue damage already after a short ischemic period, thereby validating the novel animal model for investigating intra-flap metabolism and offering opportunities for exploring various (immuno-) thrombo-hemostatic issues in transplantation surgery. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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12 pages, 1697 KiB

Open AccessArticle

Impact of Salvage Surgery on Health-Related Quality of Life in Oral Squamous Cell Carcinoma: A Prospective Multi-Center Study

by Sven Zittel, Julius Moratin, Sinclair Awounvo, Thomas Rückschloß, Kolja Freier, Oliver Ristow, Michael Engel, Jürgen Hoffmann, Christian Freudlsperger and Dominik Horn

J. Clin. Med. 2023, 12(20), 6602; https://doi.org/10.3390/jcm12206602 - 18 Oct 2023

Viewed by 865

Abstract

Background: Patients with recurrent oral squamous cell carcinoma (OSCC) have limited treatment options. Salvage surgery offers potential curative therapy. The need for extensive ablative surgery together with microvascular reconstruction implies invasive and painful treatment with questionable functional outcome. To address the impact of [...] Read more.

Background: Patients with recurrent oral squamous cell carcinoma (OSCC) have limited treatment options. Salvage surgery offers potential curative therapy. The need for extensive ablative surgery together with microvascular reconstruction implies invasive and painful treatment with questionable functional outcome. To address the impact of salvage surgery on the health-related quality of life (HRQoL) of patients suffering from recurrent OSCC, a multi-center prospective analysis was initiated. Material and Methods: Patients with recurrent OSCC from 2015 to 2022 at two German cancer centers were included. Interdisciplinary tumor board decisions determined surgery as the only curative treatment modality. HRQoL, was assessed via a EORTC questionnaire (European Organization for Research and Treatment of Cancer—EORTC: QLQ-C30 and QLQ-H&N35) in dependence of the recurrent tumor stage. Patients completed the questionnaires once before surgery (baseline) and then every 3 months during follow-up or up to the end of treatment. Results: In total, 55 patients were included. The mean follow-up period was 26.7 ± 19.3 months. Global health status showed superior mean scores after 12 months (60.83 ± 22.58) compared to baseline (53.33 ± 26.41) in stage 1 and 2 recurrent tumors. In advanced recurrent tumors’ mean scores for global health showed only minor positive differences after 12 months (55.13 ± 22.7) compared to baseline (53.2 ± 25.58). In terms of the mouth pain, mean scores were lower after salvage surgery in small recurrent tumors after 12 months (20.37 ± 17.73) compared to baseline (41.67 ± 33.07; Wilcoxon two-sample signed-rank test p = 0.028). In advanced recurrent tumors, a significant reduction in mean scores was detected 3 months after salvage surgery (29.7 ± 22.94) compared to baseline (47.76 ± 25.77; Wilcoxon two-sample signed-rank test p = 0.003). Up to 12 months, swallowing function was evaluated inferior compared to baseline independent of tumor stage (Mean score recurrent stage I/II: 12-months 48.15 ± 27.57, baseline 28.7 ± 22.87; stage III/IV: 12-months 49.36.42 ± 27.53; baseline 30.13 ± 26.25). Conclusion: Improved HRQoL could be obtained in advanced recurrent OSCC after salvage surgery despite reduced swallowing function. In small recurrent tumors, overall, HRQoL was superior to baseline. Salvage surgery positively affected pain burden. For advanced recurrent tumors, important pain relieve could be observed as soon as 3 months after surgery. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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12 pages, 1058 KiB

Open AccessArticle

Comparison of Fluid Replacement with Sterofundin ISO^® vs. Deltajonin^® in Infants Undergoing Craniofacial Surgery—A Retrospective Study

by Benjamin Tan, Isabel Schütte, Michael Engel, Thomas Bruckner, Markus A. Weigand and Cornelius J. Busch

J. Clin. Med. 2023, 12(19), 6404; https://doi.org/10.3390/jcm12196404 - 08 Oct 2023

Viewed by 1098

Abstract

In recent decades, infusion solutions such as NaCl 0.9% and lactate Ringer’s solution have been replaced in clinical practice. Since 2017, the national guidelines for perioperative infusion therapy in children recommend balanced isotonic solutions to maintain fluid balance. The composition of balanced infusion [...] Read more.

In recent decades, infusion solutions such as NaCl 0.9% and lactate Ringer’s solution have been replaced in clinical practice. Since 2017, the national guidelines for perioperative infusion therapy in children recommend balanced isotonic solutions to maintain fluid balance. The composition of balanced infusion solutions varies with respect to their electrolyte content. Hyperchloremia may be mistaken for hypovolemia and may interfere with volume therapy in pediatric patients. Sterofundin ISO^® balanced solution contains 127 mmol/L chloride and may cause hyperchloremic acidosis if administered in large volumes. Objectives: The purpose of this study was to compare the effects of Sterofundin ISO^® (SF) therapy with the balanced isochloremic solution Deltajonin^® (DJ) (106 mmol/L chloride) on the acid–base status in infants undergoing craniofacial surgery. Methods: This retrospective, non-blinded study included 100 infants undergoing craniectomy due to isolated nonsyndromic sagittal craniosynostosis. The first 50 infants received Sterofundin ISO^®. Due to changes in national guidelines, the infusion was changed to the isoionic Deltajonin^® in an additional 50 infants in 2017. Pre- and postoperative values of chloride, pH, base excess, bicarbonate, and albumin and phosphate were determined, and the strong-ion difference, strong-ion gap, anion gap, and weak acids were calculated. Results: Both groups were comparable in terms of their age, sex, underlying disease, preoperative electrolytes (except K at 3.9 ± 0.3 mmol/L (SF) vs. 4.1 ± 0.3 mmol/L (DJ) and lactate 8.7 ± 2.1 (SF) vs. 9.6 ± 2.6 mmol/L (DJ)). In the Sterofundin ISO^® group, hyperchloremic metabolic acidosis was observed in 19 patients, whereas only 2 infants in the Deltajonin^® group had hyperchloremic metabolic acidosis. The postoperative chloride level was 111 ± 2.7 mmol/L (SF) vs. 108 ± 2.4 mmol/L (DJ). The difference in anion gap was 12.5 ± 3.0 mmol/L (SF) vs. 14.6 ± 2.8 mmol/L (DJ), and the difference in SIDa (apparent strong-ion difference) was 30.9 mmol/L (SF) vs. 33.8 mmol/L (DJ). Conclusions: Hyperchloremic acidosis can be induced by the volume replacement with high-chloride-concentration crystalloids such as Sterofundin ISO^®. This can be detected using the Stewart model. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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15 pages, 13085 KiB

Open AccessArticle

Accuracy of Patient-Specific Implants in Virtually Planned Segmental Le Fort I Osteotomies

by Reinald Kuehle, Mats Scheurer, Frederic Bouffleur, Jennifer Fuchs, Michael Engel, Jürgen Hoffmann and Christian Freudlsperger

J. Clin. Med. 2023, 12(18), 6038; https://doi.org/10.3390/jcm12186038 - 18 Sep 2023

Viewed by 892

Abstract

(1) Background: In orthognathic surgery, segmental Le Fort I osteotomies are a valuable method to correct maxillary deformities or transversal discrepancies. However, these procedures are technically challenging, and osteosynthesis can be prone to error. (2) Methods: In this retrospective, monocentric cohort study, patients [...] Read more.

(1) Background: In orthognathic surgery, segmental Le Fort I osteotomies are a valuable method to correct maxillary deformities or transversal discrepancies. However, these procedures are technically challenging, and osteosynthesis can be prone to error. (2) Methods: In this retrospective, monocentric cohort study, patients were enrolled who underwent a virtually planned segmental maxillary osteotomy during their combined treatment. Positioning and osteosynthesis were achieved by either a 3D-printed splint and conventional miniplates or patient-specific implants (PSI). The preoperative CT data, virtual planning data, and postoperative CBCT data were segmented. The deviation of all the segments from the desired virtually planned position was measured using the analysis function of IPS CaseDesigner. (3) Results: 28 Patients in the PSI Group and 22 in the conventional groups were included. The PSI group showed significantly lower deviation from the planned position anteroposteriorly (−0.63 ± 1.62 mm vs. −1.3 ± 2.54 mm) and craniocaudally (−1.39 ± 1.59 mm vs. −2.7 ± 3.1 mm). For rotational deviations, the pitch (0.64 ± 2.59° vs. 2.91 ± 4.08°), as well as the inward rotation of the lateral segments, was positively influenced by PSI. (4). Conclusions: The presented data show that patient-specific osteosynthesis significantly reduces deviations from the preoperative plan in virtually planned cases. Transversal expansions and vertical positioning can be addressed better. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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20 pages, 843 KiB

Open AccessArticle

Controversial Aspects of Diagnostics and Therapy of Idiopathic Condylar Resorption: An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project

by Merle Riechmann, Christopher Schmidt, M. Oliver Ahlers, Ima Feurer, Johannes Kleinheinz, Andreas Kolk, Christoph Pautke, Andreas Schön, Marcus Teschke, Astrid Toferer, Christopher J. Lux, Christian Kirschneck, Gabriele A. Krombach, Peter Ottl, Ulla Vieth, Johanna Stengel, Caroline Völker and Andreas Neff

J. Clin. Med. 2023, 12(15), 4946; https://doi.org/10.3390/jcm12154946 - 27 Jul 2023

Viewed by 1343

Abstract

Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- [...] Read more.

Idiopathic condylar resorption (ICR), though a rare event, is associated with severe detrimental sequelae for the patient. To date, the etiology remains unknown, and treatment strategies are highly controversial. Therefore, the aim of this study is to present an analysis of the consensus- and evidence-based approach to ICR by a German interdisciplinary guideline project of the AWMF (Association of the Scientific Medical Societies in Germany). Following a systematic literature search, including 56 (out of an initial 97) publications, with a predominantly low level of evidence (LoE), two independent working groups (oral and maxillofacial surgery and interdisciplinary, respectively) voted on a draft comprising 25 recommendations in a standardized anonymized and blinded Delphi procedure. While the results of the votes were relatively homogeneous, the interdisciplinary phase required a significantly higher number of rounds (p < 0.001). Most of the controversial recommendations were related to initial imaging (with consensus on CT/CBCT as the current diagnostic standard for imaging), pharmacotherapy (no recommendation due to lack of evidence), discopexy (no recommendation possible due to low LoE) and timing of orthognathic surgery (with consensus on two-staged procedures after invasive TMJ surgery, except for single-stage procedures if combined with total joint reconstruction). Overall, the Delphi procedure resulted in an interdisciplinary guideline offering the best possible evidence- and consensus-based expertise to date in the diagnosis and treatment of ICR. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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12 pages, 1894 KiB

Open AccessArticle

Free-Flap Reconstruction in Early-Stage Squamous Cell Carcinoma of the Oral Cavity—A Prospective Monocentric Trial to Evaluate Oncological Outcome and Quality of Life

by Julius Moratin, Sven Zittel, Dominik Horn, Rouven Behnisch, Oliver Ristow, Michael Engel, Jürgen Hoffmann, Kolja Freier and Christian Freudlsperger

J. Clin. Med. 2023, 12(14), 4833; https://doi.org/10.3390/jcm12144833 - 22 Jul 2023

Cited by 1 | Viewed by 1750

Abstract

Surgery is generally accepted as standard treatment in oral cancer, but the reconstructive procedures remain a matter of debate. The aim of this study was to evaluate oncological outcome and quality of life following surgical resection and free-flap reconstruction in patients with early [...] Read more.

Surgery is generally accepted as standard treatment in oral cancer, but the reconstructive procedures remain a matter of debate. The aim of this study was to evaluate oncological outcome and quality of life following surgical resection and free-flap reconstruction in patients with early oral squamous cell carcinoma. The presented trial was performed as a prospective, single-center observation study. Inclusion criteria were primary surgery in early-stage oral squamous cell carcinoma with free-flap reconstruction. Endpoints were overall and progression-free survival and quality of life up to 24 months after surgery. Twenty-six patients were included. Overall survival was 100% and progression-free survival was 92.3% in a maximum follow-up time of 21 months. Global quality of life showed no significant alteration after surgery. Patients reported a significant reduction in pain (p = 0.048) and a decreasing impairment of speech one year after surgery (p = 0.021). Free-flap reconstruction is a safe procedure that results in excellent oncological outcome and quality of life. Functional outcome is of high relevance in early-stage tumors of the head and neck and may mostly be affected by reconstructive procedures. Therefore, a prospective evaluation to explore success and the effects of surgical therapy is highly warranted. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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11 pages, 1957 KiB

Open AccessArticle

An Automatic Voxel-Based Method for Optimal Symmetry Plane Generation for the Maxillofacial Region in Severe Asymmetry Cases

by Yu-Ching Hsiao and Jing-Jing Fang

J. Clin. Med. 2022, 11(19), 5689; https://doi.org/10.3390/jcm11195689 - 26 Sep 2022

Cited by 2 | Viewed by 1291

Abstract

Symmetry is representative of aesthetics and health in all kinds of vertebrates, especially the human face. Therefore, to automatically locate the appropriate symmetry plane is crucial. The aim of this study was to develop an automatic and reliable method to determine the symmetry [...] Read more.

Symmetry is representative of aesthetics and health in all kinds of vertebrates, especially the human face. Therefore, to automatically locate the appropriate symmetry plane is crucial. The aim of this study was to develop an automatic and reliable method to determine the symmetry plane of the maxillofacial region. We compared the proposed method of determining the symmetry plane by assessing landmark-based and surface-based methods by way of quantitative symmetry assessments. Statistical analysis was applied to evaluate whether significant difference existed among these three kinds of symmetry planes. Twenty cases who had a diagnosis of severe facial asymmetry were evaluated retrospectively. The results showed that searching for the symmetry plane using a voxel-based method, named the optimal symmetry plane (OSP), achieved the most representative symmetry according to the outcomes of the trials. The OSP was significantly more symmetrical than the other two planes, as determined by other methods. The paired-voxel computation method proposed in this research is a robust and reliable method for identifying the unique symmetry plane for patients with severe facial asymmetry. Symmetry is of crucial significance for all kinds of vertebrates, including its clinical implications for surgical planning in orthognathic surgery. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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Review

Jump to: Research, Other

16 pages, 8040 KiB

Open AccessReview

Preprosthetic Surgery—Narrative Review and Current Debate

by Hendrik Terheyden, Gerry M. Raghoebar, Mats Sjöström, Thomas Starch-Jensen and John Cawood

J. Clin. Med. 2023, 12(23), 7262; https://doi.org/10.3390/jcm12237262 - 23 Nov 2023

Viewed by 1293

Abstract

This review describes the role of modern preprosthetic surgery. The atrophic edentulous jaw can cause severe functional impairment for patients, leading to inadequate denture retention, reduced quality of life, and significant health problems. The aim of preprosthetic surgery is to restore function and [...] Read more.

This review describes the role of modern preprosthetic surgery. The atrophic edentulous jaw can cause severe functional impairment for patients, leading to inadequate denture retention, reduced quality of life, and significant health problems. The aim of preprosthetic surgery is to restore function and form due to tooth loss arising from congenital deformity, trauma, or ablative surgery. Alveolar bone loss is due to disuse atrophy following tooth loss. The advent of dental implants and their ability to preserve bone heralded the modern version of preprosthetic surgery. Their ability to mimic natural teeth has overcome the age-old problem of edentulism and consequent jaw atrophy. Controversies with preprosthetic surgery are discussed: soft tissue versus hard tissue augmentation in the aesthetic zone, bone regeneration versus prosthetic tissue replacement in the anterior maxilla, sinus floor augmentation versus short implants in the posterior maxilla—interpositional bone grafting versus onlay grafts for vertical bone augmentation. Best results for rehabilitation are achieved by the team approach of surgeons, maxillofacial prosthodontists/general dentists, and importantly, informing patients about the available preprosthetic surgical options. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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28 pages, 2319 KiB

Open AccessReview

The Effectiveness of Three-Dimensional Osteosynthesis Plates versus Conventional Plates for the Treatment of Skeletal Fractures: A Systematic Review and Meta-Analysis

by Iva Ilse Raghoebar, Leander Dubois, Jan de Lange, Tim Schepers, Peter Don Griot, Harald Essig and Frederik Rozema

J. Clin. Med. 2023, 12(14), 4661; https://doi.org/10.3390/jcm12144661 - 13 Jul 2023

Viewed by 1007

Abstract

Purpose: To assess the difference between preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates for the treatment of skeletal fractures in terms of anatomical reduction, operation time, approach, patient outcomes, and complications. Material and Methods: MEDLINE (1950 to February [...] Read more.

Purpose: To assess the difference between preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates for the treatment of skeletal fractures in terms of anatomical reduction, operation time, approach, patient outcomes, and complications. Material and Methods: MEDLINE (1950 to February 2023), EMBASE (1966 to February 2023), and the Cochrane Central Register of Controlled Trials (inception to February 2023) databases were searched. Eligible studies were randomised clinical trials, prospective controlled clinical trials, and prospective and retrospective cohort studies (n ≥ 10). Inclusion criteria were studies reporting the outcomes of preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates after treating skeletal fractures. Outcome measures included anatomical reduction, stability, operation time, hospitalisation days, patients’ outcomes, and complications. Two independent reviewers assessed the abstracts and analysed the complete texts and methodologies of the included studies. Results: In total, 21 out of the 5181 primarily selected articles matched the inclusion criteria. A meta-analysis revealed a significant difference in operation time in favour of the preformed anatomical plates and patient-specific implants versus conventional plates. Significant differences in operation time were found for the orbital (95% CI: −50.70–7.49, p = 0.008), upper limb (95% CI: −17.91–6.13, p < 0.0001), and lower limb extremity groups (95% CI: −20.40–15.11, p < 0.00001). The mean difference in the rate of anatomical reduction in the lower limb extremity group (95% CI: 1.04–7.62, p = 0.04) was also in favour of using preformed anatomical plates and patient-specific implants versus conventional plates. Conclusions: This systematic review showed a significant mean difference in surgery time favouring the use of preformed anatomical plates and patient-specific implants for orbital, upper, and lower limb extremity fractures. Additionally, preformed anatomical plates and patient-specific implants in the lower limb group result in a significantly higher rate of anatomical reduction versus conventional flat plates. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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22 pages, 4852 KiB

Open AccessFeature PaperReview

Superior Dislocation of the Mandibular Condyle into the Middle Cranial Fossa: A Comprehensive Review of the Literature

by Kazuya Yoshida

J. Clin. Med. 2023, 12(11), 3781; https://doi.org/10.3390/jcm12113781 - 31 May 2023

Viewed by 1955

Abstract

The superior dislocation of the condyle into the cranium occasionally requires invasive procedures due to the absence of a timely diagnosis. This review analyzed the available clinical data to provide information on treatment decisions. The reports were assessed using electronic medical databases from [...] Read more.

The superior dislocation of the condyle into the cranium occasionally requires invasive procedures due to the absence of a timely diagnosis. This review analyzed the available clinical data to provide information on treatment decisions. The reports were assessed using electronic medical databases from inception to 31 October 2022. A total of 116 cases from 104 studies were assessed; among the patients, 60% and 87.5% of the affected women and men required open reduction, respectively. The ratio of closed to open procedures within 7 days after injury was maintained; however, closed reduction decreased over time, and all cases required open reduction after 22 days. Eighty percent of the patients with a total intrusion of the condyle required open reduction, whereas the frequency for both procedures was comparable in the remaining patients. Open reduction was significantly more frequently performed for men (p = 0.026, odds ratio; 4.959, 95% confidence interval; 1.208–20.365) and less frequently performed in cases with partial intrusion (p = 0.011; odds ratio: 0.186; 95% confidence interval: 0.051–0.684); the frequency varied according to the time until treatment (p = 0.027, odds ratio; 1.124, 95% confidence interval; 1.013–1.246). Appropriate diagnostic imaging and prompt diagnosis are indispensable for minimally invasive treatment of this condition. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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15 pages, 1765 KiB

Open AccessReview

Injectable Platelet-Rich Fibrin (I-PRF) Administered to Temporomandibular Joint Cavities: A Scoping Review

by Marcin Sielski, Kamila Chęcińska, Maciej Chęciński and Maciej Sikora

J. Clin. Med. 2023, 12(9), 3326; https://doi.org/10.3390/jcm12093326 - 07 May 2023

Cited by 3 | Viewed by 2095

Abstract

The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The [...] Read more.

The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The assessment of the level of evidence was based on the Oxford Center for Evidence-Based Medicine 2011 scale. The risk of bias was assessed for randomized controlled trials with the RoB2 tool. Extracted data were tabulated, and the changes in effect values were calculated. A total of eight studies qualified, of which five trials on 213 patients were randomized and controlled (RCTs). In each of the RTC study groups, arthrocentesis was performed, and 1–2 mL per joint of I-PRF (700 rpm/3 min/60 g centrifugation) was administered. Articular pain in three months decreased to 0–25% of the initial pre-interventional values in the study and 38–50% in the control groups. Mandible mobility increased to 121–153% and 115–120% in the I-PRF groups and controls, respectively. The main limitations of the evidence were the small number of RCTs and the lack of any RCT study groups receiving I-PRF without prior arthrocentesis. In conclusion, supplementing the temporomandibular joint rinsing with I-PRF administration further relieves pain and improves mandible mobility. The lack of RCTs on the intra-articular administration of I-PRF as a stand-alone procedure encourages further research. This research received no external funding. The review protocol has not been previously published. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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Open AccessCase Report

Temporomandibular Joint Prosthesis in a Patient with Congenital Infiltrating Lipomatosis of the Face with Bony Ankylosis of the Temporomandibular Joint: A Case Report

by Lauren C. M. Bulthuis, Jean Pierre T. F. Ho, Petra C. M. Zuurbier, Michail Koutris, Jitske W. Nolte and Jan de Lange

J. Clin. Med. 2023, 12(24), 7723; https://doi.org/10.3390/jcm12247723 - 16 Dec 2023

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Abstract

Hemifacial hyperplasia (HFH) is a rare congenital disorder characterized by marked unilateral overgrowth of the facial tissues. A subtype of HFH is congenital infiltrating lipomatosis of the face (CIL-F). This disease is characterized by unilateral diffuse infiltration of mature adipose cells in the [...] Read more.

Hemifacial hyperplasia (HFH) is a rare congenital disorder characterized by marked unilateral overgrowth of the facial tissues. A subtype of HFH is congenital infiltrating lipomatosis of the face (CIL-F). This disease is characterized by unilateral diffuse infiltration of mature adipose cells in the facial soft tissue and is associated with skeletal hypertrophy. This work aims to report a case of a CIL-F patient with right facial asymmetry and progressive growth at adolescent age, causing mandibular asymmetry due to signs of concomitant unilateral condylar hyperplasia. At the age of seventeen, a condylectomy was performed to stop the progression of asymmetric mandibular growth. Five years later, the patient developed CIL-F-associated temporomandibular joint ankylosis, manifesting as progressive restricted mouth opening along with temporal facial pain. In this CIL-F patient, a TMJ reconstruction with an alloplastic total joint prosthesis was successfully performed with optimal maximal mouth opening, complete alleviation of temporal facial pain, and stable dental occlusion one year postoperatively. A TMJ reconstruction with a complete alloplastic total joint prosthesis proved to be a predictable, stable, and safe treatment option in a patient with CIL-F-associated TMJ ankylosis who was previously treated with condylectomy due to progressive mandibular asymmetry. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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