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10 pages, 2220 KiB

Open AccessArticle

Reliability of a Trapezium Miniplate with Endoscope-Assisted Internal Fixation in Mandibular Subcondylar Fractures: A Three-Dimensional Analysis

by Seungwook Jung, Ok Hyung Nam, Yi-Qin Fang, Shavkat Dusmukhamedov and Chunui Lee

J. Clin. Med. 2022, 11(1), 207; https://doi.org/10.3390/jcm11010207 - 31 Dec 2021

Cited by 1 | Viewed by 1700

Abstract

This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of an endoscope. We selected and retrospectively studied 18 patients (12 males and 6 females) with unilateral [...] Read more.

This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of an endoscope. We selected and retrospectively studied 18 patients (12 males and 6 females) with unilateral mandibular subcondylar fractures who visited the Wonju Severance Christian Hospital. The mean age of the patients was 43.43 ± 15.76 years. Patients underwent ORIF with trapezium miniplate application through an intraoral incision under general anesthesia. The clinical and radiographic findings of the fractured side were compared with those of the non-operated side at 6 months follow-up. All occlusions became stable, and transient functional disturbances disappeared within 6 months of periodic follow-up. Functional mandibular movement recovered within the normal range, with an average mouth opening of 41.5 mm, protrusion of 7.5 mm, and lateral excursion of 7 mm at 6 months. Radiographic controls and statistical analysis confirmed a decent anatomical reduction in all 18 cases. In conclusion, the use of a trapezium miniplate with endoscope-assisted ORIF in mandibular subcondylar fractures can be useful for fixation and functional recovery. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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13 pages, 644 KiB

Open AccessArticle

Comparative Study between the Combination of Dexamethasone and Bupivacaine for Third Molar Surgery Postoperative Pain: A Triple-Blind, Randomized Clinical Trial

by Francisco Javier Quesada-Bravo, Ana Rocío García-Carricondo, Fernando Espín-Gálvez, Carmen Fernández-Sánchez, Damaso Fernández-Ginés, María del Mar Requena-Mullor and Raquel Alarcón-Rodríguez

J. Clin. Med. 2021, 10(21), 5081; https://doi.org/10.3390/jcm10215081 - 29 Oct 2021

Cited by 2 | Viewed by 2263

Abstract

Objectives: To compare the possible benefits of the combination of dexamethasone–bupivacaine with articaine–epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL [...] Read more.

Objectives: To compare the possible benefits of the combination of dexamethasone–bupivacaine with articaine–epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL articaine–epinephrine and submucosal reinforcement with 0.8 mg dexamethasone–5% bupivacaine; and control group (91 patients) with standard block: 40/0.005 mg/mL articaine–epinephrine. The surgery consisted of the extraction of the impacted mandibular third molar by performing a procedure following the same repeatable scheme. The visual analogue scale (VAS) was used to analyse postoperative pain. Results: Groups were homogeneous, without significant differences related to epidemiological variables. Postoperative pain among the first, second, and seventh postoperative days was statistically significantly lower in the experimental group compared to the control group (p < 0.001). Drug consumption was lower in the experimental group throughout the study period (p < 0.04). Conclusion: Bupivacaine is an alternative to articaine in oral surgery, being more effective in reducing postoperative pain by reducing patients’ scores on the VAS as well as their consumption of analgesic drugs after surgery. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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14 pages, 972 KiB

Open AccessArticle

The ESTMJS (European Society of Temporomandibular Joint Surgeons) Consensus and Evidence-Based Recommendations on Management of Condylar Dislocation

by Andreas Neff, Niall McLeod, Frederik Spijkervet, Merle Riechmann, Ulla Vieth, Andreas Kolk, Andrew J. Sidebottom, Bernard Bonte, Bernard Speculand, Carrol Saridin, Christian T. Wilms, Constantinus Politis, David Faustino Ângelo, Dušan Hirjak, Esben Aagaard, Fabrizio Spallaccia, Florencio Monje, Gerhard Undt, Giovanni Gerbino, Hadas Lehman, Jacinto F. Sanromán, Louis G. Mercuri, Luke Cascarini, Mattias Ulmner, Maurice Mommaerts, Nadeem R. Saeed, Orhan Güven, Salvatore Sembronio, Vladimir Machoň and Linda Skroch Show full author list Hide full author list

J. Clin. Med. 2021, 10(21), 5068; https://doi.org/10.3390/jcm10215068 - 29 Oct 2021

Cited by 6 | Viewed by 3881

Abstract

Although condylar dislocation is not uncommon, terminology, diagnostics, and treatment concepts vary considerably worldwide. This study aims to present a consensus recommendation based on systematically reviewed literature and approved by the European Society of TMJ Surgeons (ESTMJS). Based on the template of the [...] Read more.

Although condylar dislocation is not uncommon, terminology, diagnostics, and treatment concepts vary considerably worldwide. This study aims to present a consensus recommendation based on systematically reviewed literature and approved by the European Society of TMJ Surgeons (ESTMJS). Based on the template of the evidence-based German guideline (register # 007-063) the ESTMJS members voted on 30 draft recommendations regarding terminology, diagnostics, and treatment initially via a blinded modified Delphi procedure. After unblinding, a discussion and voting followed, using a structured consensus process in 2019. An independent moderator documented and evaluated voting results and alterations from the original draft. Although the results of the preliminary voting were very heterogenous and differed significantly from the German S3 guideline (p < 0.0005), a strong consensus was achieved in the final voting on terminology, diagnostics, and treatment. In this voting, multiple alterations, including adding and discarding recommendations, led to 24 final recommendations on assessment and management of TMJ dislocation. To our knowledge, the ESTMJS condylar dislocation recommendations are the first both evidence and consensus-based international recommendations in the field of TMJ surgery. We recommend they form the basis for clinical practice guidelines for the management of dislocations of the mandibular condyle. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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19 pages, 9735 KiB

Open AccessArticle

Intraosseous Venous Malformation of the Zygomatic Bone: Comparison between Virtual Surgical Planning and Standard Surgery with Review of the Literature

by Raúl Antúnez-Conde, Carlos Navarro Cuéllar, José Ignacio Salmerón Escobar, Alberto Díez-Montiel, Ignacio Navarro Cuéllar, Giovanni Dell’Aversana Orabona, José Luis del Castillo Pardo de Vera, Carlos Navarro Vila and José Luis Cebrián Carretero

J. Clin. Med. 2021, 10(19), 4565; https://doi.org/10.3390/jcm10194565 - 30 Sep 2021

Cited by 5 | Viewed by 1669

Abstract

Intraosseous venous malformations affecting the zygomatic bone are infrequent. Primary reconstruction is usually accomplished with calvarial grafts, although the use of virtual surgical planning, cutting guides and patient-specific implants (PSI) have had a major development in recent years. A retrospective study was designed [...] Read more.

Intraosseous venous malformations affecting the zygomatic bone are infrequent. Primary reconstruction is usually accomplished with calvarial grafts, although the use of virtual surgical planning, cutting guides and patient-specific implants (PSI) have had a major development in recent years. A retrospective study was designed and implemented in patients diagnosed with intraosseous venous malformation during 2006–2021, and a review of the scientific literature was also performed to clarify diagnostic terms. Eight patients were treated, differentiating two groups according to the technique: four patients were treated through standard surgery with resection and primary reconstruction of the defect with calvarial graft, and four patients underwent resection and primary reconstruction through virtual surgical planning (VSP), cutting guides, STL models developed with CAD-CAM technology and PSI (titanium or Polyether-ether-ketone). In the group treated with standard surgery, 75% of the patients developed sequelae or morbidity associated with this technique. The operation time ranged from 175 min to 210 min (average 188.7 min), the length of hospital ranged from 4 days to 6 days (average 4.75 days) and the postoperative CT scan showed a defect surface coverage of 79.75%. The aesthetic results were “excellent” in 25% of the patients, “good” in 50% and “poor” in 25%. In the VSP group, 25% presented sequelae associated with surgical treatment. The operation time ranged from 99 min to 143 min (average 121 min), the length of hospital stay ranged from 1 to 2 days (average of 1.75 days) and 75% of the patients reported “excellent” results. Postoperative CT scan showed 100% coverage of the defect surface in the VSP group. The multi-stage implementation of virtual surgical planning with cutting guides, STL models and patient-specific implants increases the reconstructive accuracy in the treatment of patients diagnosed with intraosseous venous malformation of the zygomatic bone, reducing sequelae, operation time and average hospital stay, providing a better cover of the defect, and improving the precision of the reconstruction and the aesthetic results compared to standard technique. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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10 pages, 13748 KiB

Open AccessArticle

Changes in Tongue Area, Pharyngeal Area, and Pharyngeal Airway Velocity after Correction of Mandibular Prognathism

by Chun-Ming Chen, Ting-Ying Yu, Szu-Ting Chou, Jung-Hsuan Cheng, Shih-Chieh Chen, Chin-Yun Pan and Yu-Chuan Tseng

J. Clin. Med. 2021, 10(19), 4560; https://doi.org/10.3390/jcm10194560 - 30 Sep 2021

Cited by 2 | Viewed by 2291

Abstract

This study aimed to investigate the correlation between the amount of mandibular setback, and the related changes of the tongue area, pharyngeal area, and pharyngeal airflow velocity. Twenty-five patients treated for mandibular prognathism, and serial cephalograms were obtained (T1: preoperation, T2: more than [...] Read more.

This study aimed to investigate the correlation between the amount of mandibular setback, and the related changes of the tongue area, pharyngeal area, and pharyngeal airflow velocity. Twenty-five patients treated for mandibular prognathism, and serial cephalograms were obtained (T1: preoperation, T2: more than one year postoperation). The postoperative area of the tongue, pharyngeal airway space, and pharyngeal airflow velocity were investigated. Statistical analysis was performed with the Student t-test and Pearson correlation. The amount of mandible setback was significant after surgery (12.8 mm; p < 0.001). The pharyngeal area was significantly reduced 115.5 mm² (p = 0.046). There was a slight reduction of the tongue area (43.2 mm²; p = 0.305) and an increase of pharyngeal airflow velocity (0.3 m/s; p = 0.133). The Pearson correlation coefficient test showed no statistical significance among the amount of horizontal setback and vertical movement of the mandible, such as the reductions in the tongue area, the pharyngeal airway space, and the increase in pharyngeal airflow velocity. Larger amounts of mandibular setback caused a significant reduction of pharyngeal airway area, but without significant changes of the tongue area and pharyngeal airflow velocity. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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16 pages, 3265 KiB

Open AccessArticle

Does Mandibular Gonial Angle Influence the Eruption Pattern of the Lower Third Molar? A Three-Dimensional Study

by Selene Barone, Alessandro Antonelli, Fiorella Averta, Federica Diodati, Danila Muraca, Francesco Bennardo and Amerigo Giudice

J. Clin. Med. 2021, 10(18), 4057; https://doi.org/10.3390/jcm10184057 - 8 Sep 2021

Cited by 25 | Viewed by 2716

Abstract

Lower third molars (M3M) are the most frequent impacted teeth. The aim of this study was to evaluate the correlation between M3M position and gonial angle. A retrospective cross-sectional study was conducted. The study population included patients with unilateral or bilateral M3M and [...] Read more.

Lower third molars (M3M) are the most frequent impacted teeth. The aim of this study was to evaluate the correlation between M3M position and gonial angle. A retrospective cross-sectional study was conducted. The study population included patients with unilateral or bilateral M3M and underwent Cone Beam Computed Tomography. A morphometric analysis of the mandible was performed after three-dimensional reconstruction, recording gonial angle (GA), ramus high, ramus width, ramus divergency, and retromolar space. GA was the primary predictor variable. The primary outcome variable was the position of M3M analyzed in sagittal, axial, and coronal planes. Descriptive, bivariate, and multiple regression statistics were performed (p < 0.05). Study sample included 172 patients (mean age: 26.3 ± 4.6 years); 266 M3Ms were analyzed. The average GA was 122.6° ± 4.8°. A reduced GA value was significantly associated with a deeply impacted M3M in the ramus. With a progressive decrease of GA, M3M assumed a more horizontal position closer to the mandibular canal (p < 0.05). A lower GA showed a reduced retromolar space with more complex impacted M3M (p < 0.05). The results confirm a statistically significant correlation between GA and the position of M3M. Higher incidence of impacted M3M was related to a reduction of the GA value. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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11 pages, 8987 KiB

Open AccessArticle

Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients

by Carlos Navarro Cuéllar, Manuel Tousidonis Rial, Raúl Antúnez-Conde, Marc Agea Martínez, Ignacio Navarro Cuéllar, José Ignacio Salmerón Escobar and Carlos Navarro Vila

J. Clin. Med. 2021, 10(16), 3625; https://doi.org/10.3390/jcm10163625 - 17 Aug 2021

Cited by 8 | Viewed by 2493

Abstract

Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who [...] Read more.

Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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10 pages, 277 KiB

Open AccessArticle

Preoperative Doppler Ultrasonography Allen Test for Radial Forearm Free Flap in Oral Cancer Reconstruction: Implications in Clinical Practice

by Manuel Tousidonis, José Ignacio Salmerón Escobar, Santiago Ochandiano Caicoya, Carlos Navarro Vila, Ignacio Navarro Cuéllar, Alberto Díez Montiel, Ana María López López and Carlos Navarro Cuéllar

J. Clin. Med. 2021, 10(15), 3328; https://doi.org/10.3390/jcm10153328 - 28 Jul 2021

Cited by 1 | Viewed by 1706

Abstract

The Radial Forearm Free Flap (RFFF) is one of the most widely used microsurgical flaps for intraoral reconstruction. Although the Clinical Allen Test (CAT) is the most widely used preoperative diagnostic method with which to study the distal patency of the hand prior [...] Read more.

The Radial Forearm Free Flap (RFFF) is one of the most widely used microsurgical flaps for intraoral reconstruction. Although the Clinical Allen Test (CAT) is the most widely used preoperative diagnostic method with which to study the distal patency of the hand prior to the use of RFFF, several authors have reported potentially preventable serious vascular complications. This study included 87 consecutive patients with cancer of the oral cavity and RFFF as the flap of choice who were treated between 2010 and 2020, and compares the results of the Clinical Allen Test (CAT), the Doppler Allen Test (DAT) and the Surgical Allen Test (SAT). The preoperative vascular study found vascular abnormalities severe enough for the surgical team to change the preoperative flap of choice in 39% of patients. The Kappa index showed a weak concordance between the CAT and DAT. The study reflected a total concordance in the preoperative results of the Doppler study and the intraoperative results of the SAT. Due to its excellent agreement with SAT, the DAT would be the preoperative test of choice in patients who are candidates for RFFF. This study of vascular mapping tests with Doppler is intended to inform therapeutic decisions and present methods to gain information that cannot be obtained by physical examination alone. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

10 pages, 1910 KiB

Open AccessArticle

Transconjunctival and Subciliary Approach in the Treatment of Orbital Fractures: A Study on Oculoplastic Complication

by Lorenzo Trevisiol, Antonio D’Agostino, Silvia Gasparini, Pierfrancesco Bettini, Massimo Bersani, Riccardo Nocini and Vittorio Favero

J. Clin. Med. 2021, 10(13), 2775; https://doi.org/10.3390/jcm10132775 - 24 Jun 2021

Cited by 4 | Viewed by 6171

Abstract

(1) Background: The aim of the present study was to compare lower eyelid post-operative complications, such as ectropion, entropion, and scleral show of orbital floor fractures, associated to the subciliary vs transconjunctival approaches. (2) Materials and Methods: A retrospective comparative study of patients [...] Read more.

(1) Background: The aim of the present study was to compare lower eyelid post-operative complications, such as ectropion, entropion, and scleral show of orbital floor fractures, associated to the subciliary vs transconjunctival approaches. (2) Materials and Methods: A retrospective comparative study of patients who underwent surgery for orbital fractures by means of a transconjunctival or a subciliary approach at the Clinic of Dentistry and Maxillofacial Surgery of the University of Verona from January 2013 through September 2018 was designed. Data related to the trauma and to surgical procedures were retrieved, as well as a series of anthropometric parameters extrapolated from standardized photographs. Statistical analysis was performed on the outcomes. (3) Results: 33 patients underwent surgery by means of a transconjunctival approach and 36 patients by means of a subciliary approach. Ectropion was observed to a greater extent in the subciliary group, however the difference resulted to be not statistically significant. Patients in which osteosynthesis devices were used presented with a greater incidence of scleral show with respect to the remaining patients. No statistically significant difference was observed for any of the parameters taken into account. (4) Conclusions: Since the two approaches does not seem to be associated with remarkable differences in terms of outcomes, the choice of technique should be tailored to the patient’s features and the surgeon’s experience. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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17 pages, 1118 KiB

Open AccessArticle

Intensive Care as an Independent Risk Factor for Infection after Reconstruction and Augmentation with Autologous Bone Grafts in Craniomaxillofacial Surgery: A Retrospective Cohort Study

by Jonas P. Jung, Kathrin Haunstein, Hans-Helge Müller, Ingo Fischer and Andreas Neff

J. Clin. Med. 2021, 10(12), 2560; https://doi.org/10.3390/jcm10122560 - 9 Jun 2021

Cited by 2 | Viewed by 1900

Abstract

Autologous bone grafts for reconstruction and augmentation are routinely used for maintaining functionality and facial aesthetics. Associated complications, however, have a significant impact on patients and health care systems. This study aims to investigate the possible risk factors associated with the occurrence of [...] Read more.

Autologous bone grafts for reconstruction and augmentation are routinely used for maintaining functionality and facial aesthetics. Associated complications, however, have a significant impact on patients and health care systems. This study aims to investigate the possible risk factors associated with the occurrence of complications in order to provide evidence for the outcome of autologous bone graft reconstructive procedures. Patients from 2008 to 2018 who underwent autologous (mostly mandibular) reconstruction were included in the observational study. Clinical, pathological, and therapeutic factors were examined in univariate and multivariate analysis for significance with occurring complications. A multivariate model was used to create a prognostic model predicting the occurrence of complications. Graft complications requiring revision were exhibited by 33/128 patients. Infections were most frequent, with 4/22 patients affected by multi-resistant germs. Multivariate analysis showed radiotherapy (OR = 5.714; 95% CI: 1.839–17.752; p = 0.003), obstructive pulmonary disease (OPD) (OR = 4.329; 95% CI: 1.040–18.021; p = 0.044) and length of defect (in mm) (OR = 1.016; 95% CI: 1.004–1.028; p = 0.009) as independent risk factors associated with graft complications with high accuracy of prediction (AUC = 0.815). Intensive care (OR = 4.419; 95% CI: 1.576–12.388; p = 0.005) with a coefficient between intensive care and OPD (0.214) being low was identified as the most relevant risk factor for infection. Although intensive care is not a classic risk factor, but rather a summation of factors not reaching significance in the individual case, a stay in ICU (intensive care unit) needs to be considered for graft complications. As a clinical consequence, we recommend using the best possible hygienic measures during procedures e.g., while performing dressing and drainage changes in ICU. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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12 pages, 2402 KiB

Open AccessArticle

New Perspective for Soft Tissue Closure in Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Barbed Sutures

by Johannes Laimer, Martin Hechenberger, Johanna Maria Lercher, Eva Born, Michael Schomaker, Sibylle Puntscher, Uwe Siebert and Emanuel Bruckmoser

J. Clin. Med. 2021, 10(8), 1677; https://doi.org/10.3390/jcm10081677 - 14 Apr 2021

Cited by 1 | Viewed by 2183

Abstract

The aim of this study was to compare the effectiveness of barbed versus smooth sutures for soft tissue closure of exposed jawbone sites in medication-related osteonecrosis of the jaw (MRONJ) patients. Exposed necrotic jawbone sites surgically managed by intraoral soft tissue closure were [...] Read more.

The aim of this study was to compare the effectiveness of barbed versus smooth sutures for soft tissue closure of exposed jawbone sites in medication-related osteonecrosis of the jaw (MRONJ) patients. Exposed necrotic jawbone sites surgically managed by intraoral soft tissue closure were evaluated. Either barbed sutures (Stratafix™ or V-Loc™) together with Prolene^® or Vicryl^® sutures were used. We estimated the effect of barbed sutures (BS) with Prolene^® compared to smooth sutures (Vicryl^®) on the hazard rate of intraoral soft tissue dehiscence using a multivariate Cox regression model within a target trial framework, adjusting for relevant confounders. In total, 306 operations were performed in 188 sites. In the primary analysis 182 sites without prior surgery were included. Of these, 113 sites developed a dehiscence during follow-up. 84 sites were operated using BS and Prolene^®. A total of 222 sites were operated with Vicryl^® (control group). In the BS group, the median time to event (i.e., dehiscence) was 148 days (interquartile range (IQR), 42–449 days) compared to 15 days (IQR, 12–52 days) in the control group. The hazard rate of developing intraoral dehiscence was 0.03 times (95%-confidence interval (CI): 0.01; 0.14, p < 0.001) lower for BS patients compared to the control group. Within the limits of a retrospective study, BS showed a high success rate and are therefore recommended for soft tissue closure of exposed jawbone sites in MRONJ patients. Additional studies are warranted to further evaluate this novel application of BS. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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11 pages, 7621 KiB

Open AccessArticle

Handheld Near-Infrared Fluorescence Imaging Device Using Modified Action Cameras for Peri-Operative Guidance of Microvascular Flap Surgery

by Hyunwoo Yang, Jihong Kim, Woong Nam, Hyung Jun Kim, In-ho Cha and Dongwook Kim

J. Clin. Med. 2021, 10(3), 410; https://doi.org/10.3390/jcm10030410 - 21 Jan 2021

Cited by 4 | Viewed by 2607

Abstract

Indocyanine green near-infrared fluorescence (ICG-NIRF) imaging has recently come into use as a novel method in peri-operative microvascular flap assessment. However, a majority of the many commercial devices launched for clinical use lack mobility, portability, and cost-efficiency and are thus unsuitable for intra-oral [...] Read more.

Indocyanine green near-infrared fluorescence (ICG-NIRF) imaging has recently come into use as a novel method in peri-operative microvascular flap assessment. However, a majority of the many commercial devices launched for clinical use lack mobility, portability, and cost-efficiency and are thus unsuitable for intra-oral applications. This study introduces a cost-effective, customized, handheld NIRF device following principles of ICG-NIRF imaging. Moreover, the novel characteristics of our prototype, considered in conjunction with a literature review highlighting the significance of fluorescence devices in microvascular surgery, point to a new generation of devices for use in microvascular flap surgery. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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8 pages, 982 KiB

Open AccessArticle

Treatment of Mandible Fractures Using a Miniplate System: A Retrospective Analysis

by Lauren Bohner, Fabian Beiglboeck, Stephanie Schwipper, Rômulo Maciel Lustosa, Carla Pieirna Marino Segura, Johannes Kleinheinz and Susanne Jung

J. Clin. Med. 2020, 9(9), 2922; https://doi.org/10.3390/jcm9092922 - 10 Sep 2020

Cited by 10 | Viewed by 7587

Abstract

Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study [...] Read more.

Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study was to evaluate the use of a 3D miniplate system for the treatment of patients with mandibular fractures. Patients with mandibular fractures treated with a 3D plate system at the Department of Oral and Maxillofacial Surgery, University Hospital Münster, during a period of 5 years, were included in this study. Mandibular fracture conditions and minor and major post-operative complications were reported. In total, 336 patients and 391 mandibular fractures were assessed. The most common fracture site was anterior mandible, and 155 cases involved a tooth-bearing area. Minor complications were seen in 8.03% of cases, whereas only 1.49% of patients suffered from major complications. The treatment of mandible fractures using 3D miniplates resulted in fracture reduction with a low complication rate. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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8 pages, 233 KiB

Open AccessArticle

The Accuracy of Jaws Repositioning in Bimaxillary Orthognathic Surgery with Traditional Surgical Planning Compared to Digital Surgical Planning in Skeletal Class III Patients: A Retrospective Observational Study

by Martina Barone, Alberto De Stefani, Ugo Baciliero, Giovanni Bruno and Antonio Gracco

J. Clin. Med. 2020, 9(6), 1840; https://doi.org/10.3390/jcm9061840 - 12 Jun 2020

Cited by 10 | Viewed by 2163

Abstract

Background: Technological progress has led to the transition to digital methods to perform surgical planning and to obtain surgical splints with CAD/CAM technologies. The present study aimed to compare the accuracy of jaw repositioning in bimaxillary orthognathic surgery using traditional and digital surgical [...] Read more.

Background: Technological progress has led to the transition to digital methods to perform surgical planning and to obtain surgical splints with CAD/CAM technologies. The present study aimed to compare the accuracy of jaw repositioning in bimaxillary orthognathic surgery using traditional and digital surgical planning in skeletal class III patients. Methods: This study included 60 skeletal class III patients divided into two groups based on the method used to perform surgical planning: traditional (T, n = 30) and digital (D, n = 30). For each patient, a 2D presurgical Visual Treatment Objective (VTO) was prepared and the outcome of the surgery was compared with that planned by using determined cephalometric measurements (ANB, SNA, SNB, Ar-Go-Me, S-Ar-Go). Statistical analysis showed that the measurements planned and those obtained after surgery were equivalent in Group D. For Group T, the analysis showed equivalence only for one of the considered measurements (ANB). By comparing the results of the two groups, Group D presented a lower level of error than Group T. Conclusions: Digital surgical planning performed significantly better in terms of accuracy of jaw repositioning than the traditional protocol. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

14 pages, 3489 KiB

Open AccessArticle

Deep Learning for Automated Detection of Cyst and Tumors of the Jaw in Panoramic Radiographs

by Hyunwoo Yang, Eun Jo, Hyung Jun Kim, In-ho Cha, Young-Soo Jung, Woong Nam, Jun-Young Kim, Jin-Kyu Kim, Yoon Hyeon Kim, Tae Gyeong Oh, Sang-Sun Han, Hwiyoung Kim and Dongwook Kim

J. Clin. Med. 2020, 9(6), 1839; https://doi.org/10.3390/jcm9061839 - 12 Jun 2020

Cited by 84 | Viewed by 12022

Abstract

Patients with odontogenic cysts and tumors may have to undergo serious surgery unless the lesion is properly detected at the early stage. The purpose of this study is to evaluate the diagnostic performance of the real-time object detecting deep convolutional neural network You [...] Read more.

Patients with odontogenic cysts and tumors may have to undergo serious surgery unless the lesion is properly detected at the early stage. The purpose of this study is to evaluate the diagnostic performance of the real-time object detecting deep convolutional neural network You Only Look Once (YOLO) v2—a deep learning algorithm that can both detect and classify an object at the same time—on panoramic radiographs. In this study, 1602 lesions on panoramic radiographs taken from 2010 to 2019 at Yonsei University Dental Hospital were selected as a database. Images were classified and labeled into four categories: dentigerous cysts, odontogenic keratocyst, ameloblastoma, and no lesion. Comparative analysis among three groups (YOLO, oral and maxillofacial surgeons, and general practitioners) was done in terms of precision, recall, accuracy, and F1 score. While YOLO ranked highest among the three groups (precision = 0.707, recall = 0.680), the performance differences between the machine and clinicians were statistically insignificant. The results of this study indicate the usefulness of auto-detecting convolutional networks in certain pathology detection and thus morbidity prevention in the field of oral and maxillofacial surgery. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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Review

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21 pages, 960 KiB

Open AccessReview

Outcomes and Stability of Anterior Open Bite Treatment with Skeletal Anchorage in Non-Growing Patients and Adults Compared to the Results of Orthognathic Surgery Procedures: A Systematic Review

by Piotr Malara, Susanne Bierbaum and Beata Malara

J. Clin. Med. 2021, 10(23), 5682; https://doi.org/10.3390/jcm10235682 - 1 Dec 2021

Cited by 8 | Viewed by 3051

Abstract

The objective of this review is to evaluate, on the basis of the available literature, if anterior open bite (AOB) can be successfully treated with the intrusion of molar teeth using skeletal anchorage in non-growing patients and adults and if this treatment modality [...] Read more.

The objective of this review is to evaluate, on the basis of the available literature, if anterior open bite (AOB) can be successfully treated with the intrusion of molar teeth using skeletal anchorage in non-growing patients and adults and if this treatment modality provides comparable results to those obtained by orthognathic surgery procedures. Methods: A systematic review of published data in major databases from 2000 to 2021 was performed. Results: In total, 92 articles were included in title and abstract screening, and only 16 articles (11 concerning AOB correction by molar intrusion with skeletal anchorage, and five considering AOB treatment by orthognathic surgical intervention) qualified for thorough data extraction and analysis. Conclusions: On the basis of this review, it seems to be possible to obtain successful results for AOB treatment in non-growing patients and adults by means of the intrusion of molar teeth with skeletal anchorage. However, due to the different methods of assessing treatment outcomes used by different authors, it is not possible to state conclusively whether the treatment of AOB by means of molar intrusion with skeletal anchorage provides long-term results that are comparable to orthognathic surgery procedures. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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10 pages, 2094 KiB

Open AccessReview

Skeletal Stability after Mandibular Setback via Sagittal Split Ramus Osteotomy Verse Intraoral Vertical Ramus Osteotomy: A Systematic Review

by Chun-Ming Chen, Dae-Seok Hwang, Szu-Yu Hsiao, Han-Sheng Chen and Kun-Jung Hsu

J. Clin. Med. 2021, 10(21), 4950; https://doi.org/10.3390/jcm10214950 - 26 Oct 2021

Cited by 3 | Viewed by 2243

Abstract

Purpose: The purpose of present study was to review the literature regarding the postoperative skeletal stability in the treatment of mandibular prognathism after isolated sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO). Materials and Methods: The articles were selected from [...] Read more.

Purpose: The purpose of present study was to review the literature regarding the postoperative skeletal stability in the treatment of mandibular prognathism after isolated sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO). Materials and Methods: The articles were selected from 1980 to 2020 in the English published databases (PubMed, Web of Science and Cochrane Library). The articles meeting the searching strategy were evaluated based on the eligibility criteria, especially at least 30 patients. Results: Based on the eligibility criteria, 9 articles (5 in SSRO and 4 in IVRO) were examined. The amounts of mandibular setback (B point, Pog, and Me) were ranged from 5.53–9.07 mm in SSRO and 6.7–12.4 mm in IVRO, respectively. In 1-year follow-up, SSRO showed the relapse (anterior displacement: 0.2 to 2.26 mm) By contrast, IVRO revealed the posterior drift (posterior displacement: 0.1 to 1.2 mm). In 2-year follow-up, both of SSRO and IVRO presented the relapse with a range from 0.9 to 1.63 mm and 1 to 1.3 mm respectively. Conclusion: In 1-year follow-up, SSRO presented the relapse (anterior displacement) and IVRO posterior drift (posterior displacement). In 2-year follow-up, both of SSRO and IVRO showed the similar relapse distances. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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18 pages, 1462 KiB

Open AccessReview

Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review

by Alejandro I. Lorenzo-Pouso, José Bagán, Leticia Bagán, Pilar Gándara-Vila, Cintia M. Chamorro-Petronacci, Pablo Castelo-Baz, Andrés Blanco-Carrión, María Ángeles Blanco-Fernández, Óscar Álvarez-Calderón, Javier Carballo and Mario Pérez-Sayáns

J. Clin. Med. 2021, 10(19), 4367; https://doi.org/10.3390/jcm10194367 - 24 Sep 2021

Cited by 14 | Viewed by 5682

Abstract

Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data [...] Read more.

Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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14 pages, 3439 KiB

Open AccessReview

The Use of Titanium 3D Mini-Plates in the Surgical Treatment of Fractures of the Mandibular Condyle: A Systematic Review and Meta-Analysis of Clinical Trials

by Maciej Sikora, Maciej Chęciński, Zuzanna Nowak, Kamila Chęcińska, Tomasz Olszowski and Dariusz Chlubek

J. Clin. Med. 2021, 10(16), 3604; https://doi.org/10.3390/jcm10163604 - 16 Aug 2021

Cited by 8 | Viewed by 3341

Abstract

Introduction: Fixing fractures of the base and neck of mandibular condyles is demanding due to the difficulties in surgical access and the various shapes of bone fragments. Classic fixation techniques assume the use of straight mini-plates, utilized for other craniofacial bone fractures. Three [...] Read more.

Introduction: Fixing fractures of the base and neck of mandibular condyles is demanding due to the difficulties in surgical access and the various shapes of bone fragments. Classic fixation techniques assume the use of straight mini-plates, utilized for other craniofacial bone fractures. Three dimensional mini-plates may provide a reasonable alternative due to their ease of use and steadily improved mechanical properties. The multitude of different shapes of 3D mini-plates proves the need for their evaluation. Aim: This paper aims to summarize the clinical trials regarding the use of various types of 3D condylar mini-plates in terms of need for reoperation and the incidence of loosening and damage to the osteosynthetic material. Materials and Methods: A systematic review was conducted in accordance with PICOS criteria and PRISMA protocol. The risk of bias was assessed using ROBINS-I and RoB 2 Cochrane protocols. The obtained data series was analyzed for correlations (Pearson’s r) respecting statistical significance (Student’s t-test p > 0.05) and visualized using OriginLab. Results: 13 clinical trials with low overall risk of bias regarding 6 shapes of 3D mini-plates were included in the synthesis. The number of reoperations correlates with the number of fixations (r = 0.53; p = 0.015) and the total number of screw holes in the mini-plate (r = −0.45; p = 0.006). There is a strong correlation between the number of loosened osteosynthetic screws and the total number of fractures treated with 3D mini-plates (r = 0.79; p = 0.001 for each study and r = 0.99; p = 0.015 for each mini-plate shape). A correlation between the percentage of lost screws and the number of distal screw holes is weak regarding individual studies (r = −0.27; p = 0.000) and strong regarding individual mini-plate shape (r = −0.82; p = 0.001). Three cases of 3D mini-plate fractures are noted, which account for 0.7% of all analyzed fixation cases. Discussion: The reasons for reoperations indicated by the authors of the analyzed articles were: mispositioning of the bone fragments, lack of bone fragment union, secondary dislocation, and hematoma. The known screw loosening factors were poor bone quality, bilateral condylar fractures, difficulties in the correct positioning of the osteosynthetic material due to the limitations of the surgical approach, fracture line pattern, including the presence of intermediate fragments, and mechanical overload. Fractures of the straight mini-plates fixing the mandibular condyles amounts for up to 16% of cases in the reference articles. Conclusions: There is no convincing data that the number of reoperations depends on the type of 3D mini-plate used. The frequency of osteosynthetic screw loosening does not seem to depend on the 3D mini-plate’s shape. Clinical fractures of 3D mini-plates are extremely rare. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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13 pages, 600 KiB

Open AccessReview

Variants and Modifications of the Retroauricular Approach Using in Temporomandibular Joint Surgery: A Systematic Review

by Maciej Sikora, Maciej Chęciński, Zuzanna Nowak and Dariusz Chlubek

J. Clin. Med. 2021, 10(10), 2049; https://doi.org/10.3390/jcm10102049 - 11 May 2021

Cited by 11 | Viewed by 2469

Abstract

Introduction: The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of [...] Read more.

Introduction: The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of the mandibular head, which allows for the preservation of the lateral temporomandibular joint ligaments in the course of open intracapsular surgery. Aim: The aim of this study is to systematically review the currently used variants and modifications of RA. Materials and Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was performed based on the PubMed and BASE search engines; furthermore the authors performed a more detailed search in the Google Scholar article database as well as a loop search within the references of papers included in the systematic review. Results: Searching medical articles databases, Google Scholar, and references yielded a total of 85 records. First the titles and abstracts were blindly screened which was followed by a full-text eligibility check resulting in eventually including and qualifying 7 articles for detailed analysis. Discussion: All known variants and modifications of RA are characterized by high safety for the facial nerve and an aesthetically hidden scar. There were no reports of auricle necrosis in the collected material. Conclusions: In this systematic review, 2 variants and 2 modifications of RA that allow for open temporomandibular joint surgery have been identified; all of them together cover a large spectrum of indications for joint surgery, including reposition and osteosynthesis of mandibular head fractures, eminoplasty, or eminectomy and treatment of some forms of ankylosis. Full article

(This article belongs to the Special Issue New Perspectives in Maxillo-Facial Surgery)

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