Maxillofacial Surgery Procedures Research Articles

Pre-prosthetic procedures in maxillofacial surgery: A review of literature

Pre-prosthetic procedures in maxillofacial surgery: A review of literature

Development and validation of a robotic system for milling individualized jawbone cavities in oral and maxillofacial surgery

ObjectivesThis study aimed to develop and validate a robotic system capable of performing accurate and minimally invasive jawbone milling procedures in oral and maxillofacial surgery. MethodsThe robotic hardware system mainly includes a UR5E arm (Universal Robots, Denmark) and the binocular positioning system (FusionTrack 250, Atracsys LLC, Switzerland). The robotic software (Dental Navi 3.0.0, Yakebot Technology Ltd., China) is capable of generating cutting tool paths based on three-dimensional shape description files, typically in the stereolithography format, and selected cutting tool parameters, as well as designing surgical accessories. Fully impacted supernumerary tooth models in the maxilla were fabricated using software and three-dimensional printing. Following the planning of a customized cavity to fully expose the tooth, maxillary bone milling was performed on both the robot and static guide groups (n = 8). After milling, all models underwent scanning for assessment. ResultsIn the experiment with fully buried supernumerary tooth models in the maxilla, the root mean square, translation error, over-removal rate, and maximum distance were significantly smaller in the robot group compared to the static guide group. Moreover, the overlap ratio and Dice coefficient were significantly greater in the robot group. No statistically significant differences were observed between the two groups in terms of the rotation error (P = 0.80) or under-removal rate (P = 0.92). ConclusionsThis study has developed a robotic system for milling individualized jawbone cavities in oral and maxillofacial surgery, and its accuracy has been preliminarily verified to meet clinical requirements. Clinical significanceThe robotic system can achieve precise, minimally invasive, individualized jawbone milling in a variety of oral and maxillofacial surgeries, including tooth autotransplantation, surgical reshaping for zygomatic fibrous dysplasia, removal of fully impacted supernumerary or impacted teeth, and endodontic microsurgery, among other relevant clinical applications.

An Instrumented Hammer to Detect the Rupture of the Pterygoid Plates.

Craniofacial osteotomies involving pterygomaxillary disjunction are common procedures in maxillofacial surgery. Surgeons still rely on their proprioception to determine when to stop impacting the osteotome, which is important to avoid complications such as dental damage and bleeding. Our group has developed a technique consisting in using an instrumented hammer that can provide information on the mechanical properties of the tissue located around the osteotome tip. The aim of this study is to determine whether a mallet instrumented with a force sensor can be used to predict the crossing of the osteotome through the pterygoid plates. 31 osteotomies were carried out in 16 lamb skulls. For each impact, the force signal obtained was analysed using a dedicated signal processing technique. A prediction algorithm based on an SVM classifier and a cost matrix was applied to the database. We showed that the device could always detect the crossing of the osteotome, sometimes before its occurrence. The prediction accuracy of the device was 94.7%. The method seemed to be sensitive to the thickness of the plate and to crack apparition and propagation. These results pave the way for the development of a per-operative decision support system in maxillofacial surgery.

Digital Surgical Guides in Mandibular Genioplasty: Evaluating Precision Against Conventional Techniques.

Mandibular genioplasty, a central procedure in oral and maxillofacial surgery, has traditionally relied on surgeon experience with potential limitations in precision. The advent of digital methods, particularly computer-aided design/computer-aided manufacturing (CAD/CAM), offers a promising alternative. This study aims to evaluate the efficacy of digital surgical guides in improving the precision of mandibular genioplasty. A prospective analysis of 50 patients undergoing genioplasty was performed, 30 in the experimental group using digital surgical guides and 20 in the control group using traditional methods. Three-dimensional reconstructions were obtained using cone-beam computed tomography (CBCT) and digital scans. Osteotomy guides were 3D-printed based on group assignment. Postoperatively, accuracy was assessed by measuring distances between landmarks. The experimental group showed significantly reduced horizontal positioning errors in genioplasty advancement, with no significant differences in vertical errors. For genioplasty retraction, the experimental group showed fewer vertical positioning errors, while horizontal errors remained consistent. The use of digital surgical guides in mandibular genioplasty significantly improves surgical accuracy, resulting in improved outcomes and patient satisfaction. This study highlights the potential of digital methods in refining oral and maxillofacial surgical procedures. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Does Positioning During Oral and Maxillofacial Surgery Operations Influence the Development of Upper Extremity Peripheral Neuropathy?

BackgroundControversy exists regarding the role of specific etiology and mitigating factors in perioperative upper extremity peripheral neuropathy (PUN) development during oral and maxillofacial surgery (OMS) procedures. PurposeThe purpose of this study was to measure the association between upper extremity positioning and developing PUN in oral and maxillofacial surgery operations. Study design, setting, sampleThe investigators implemented a retrospective cohort study. Patients referred to the Department of Oral and Maxillofacial Surgery at Jefferson Health who underwent orthognathic, telegnathic, or free flap surgery from April 2017 through December 2021 were identified. Exclusion criteria were age less than 13, revision surgery, ablative case without free flap reconstruction, incomplete medical record, pre-existing neuropathy, and upper extremity position other than tucked or abducted. Predictor variableThe predictor variable was upper extremity (UE) position during surgery, which had two levels-- tucked or abducted. Outcome variableThe outcome variable was self-reported development of PUN, defined as new sensory and/ or motor deficit in a non-operated extremity diagnosed within 48 hours of surgery. CovariatesDemographic covariates included age, gender, and race. Perioperative covariates included American Society of Anesthesiologists (ASA) physical status and body mass index (BMI). The operative covariate was general anesthesia (GA) duration. AnalysesDescriptive statistics were calculated. Shapiro-Wilk test was used to assess normality of the sample. Categorical variables were analyzed with Fisher’s exact test. Continuous variables were analyzed with Mann-Whitney U test. Significance was defined at P<0.05. ResultsOf the 432 patients identified, 342 met inclusion criteria. Median (IQR) ages for the abducted and tucked cohorts were 40 (31) and 34 (28) years, respectively (P<0.01). Males comprised 55.4% (n=41) and 54.1% (n=145) of abducted and tucked groups, respectively (P=0.9). PUN frequency was 6.8% (n=5) for abducted subjects and 3.7% (n=10) for tucked subjects (relative risk 1.8, 95%CI [0.7,5.1]; P=0.33). PUN was associated with gender (P=0.01), ASA status (P=0.03), BMI (P=0.01), and GA duration (P<0.01) on bivariate analysis. When adjusting for covariates, only GA duration (P<0.01) and BMI (P=0.03) were associated with PUN development Conclusion and relevanceThe findings suggest that PUN development during OMS procedures was not associated with upper extremity position.

Expert consensus on standardized clinical applications of minimally invasive tooth extraction techniques

Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery. Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients, and is widely recommended as a first-line clinical treatment. But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices. To address this issue, this consensus, based on a comprehensive literature review and clinical experiences of experts, systematically summarizes the indications, target patients, and contraindications of minimally invasive tooth extraction, the overall workflow of this procedure (preoperative preparation, surgical steps, postoperative management, postoperative instructions, medications, and follow-up), and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.

Management of a solitary bone cyst using a custom-made surgical guide for a minimally invasive approach: technical note and case report

BackgroundSolitary Bone Cyst (SBC), also known as a simple bone cyst, hemorrhagic cyst, or traumatic cyst is classified by the WHO among non-odontogenic benign lesions of the jaw. The article explores the use of a static 3D-printed surgical guide to treat mandibular SBC, emphasizing a minimally surgical approach for this lesion.Case PresentationA 20-year-old woman was referred for a persistent mandibular SBC lacuna, without specific complaints. Her medical history included a previous bone trepanation for a SBC in the same area, radiologically and surgically confirmed. X-ray assessment showed a well-defined unilocular radiolucency surrounding the root of the first left lower molar (tooth #36), measuring 10 × 10 mm. Pulp sensitivity was normal. CBCT data and STL files of dental cast were obtained preoperatively and registered. A 3D-printed surgical guide was used for minimally invasive trepanation of the buccal cortical. The simulation used a targeted endodontic microsurgery approach in order to determine axis and diameter of the trephine. Surgery was performed under local anesthesia. The guide was tooth supported integrating tubes and a fork for guiding precise trepanation. A 3.5 mm round bone window was created, leaving an empty cavity confirming SBC diagnosis and permitting bone curettage. A blood clot was obtained to promote bone healing. Complete reossification was observed after 6 months. The follow-up at 2 years confirmed a complete bone healing with normal pulp sensitivity.DiscussionThe 3D-printed windowed surgical guide with dental support offers big advantages, including improved visibility and reduced errors. Compared to traditional guides, it eliminates visual hindrance and allows easier and quick access to confined areas as well as an improved irrigation during drilling process. The article also highlights the importance of preoperative planning while acknowledging potential limitations and errors and surgical complications.ConclusionThe use of the 3D-printed surgical guide could be used in routine for minimally invasive intervention of SBC. This case also demonstrates the potential utility of this approach in various procedures in oral and maxillofacial surgery. The technique provides precise localization, reducing complications and enhances operative efficiency.

EFFICACY OF SUBLINGUAL VERSUS ORAL PIROXICAM IN MANAGEMENT OF POST-SURGICAL PAIN, SWELLING AND TRISMUS AFTER LOWER 3RD MOLAR SURGERY- A RANDOMIZED CONTROL CLINICAL TRIAL

Background of the study: Third molar surgical removal is a common procedure in oral and maxillofacial surgery, causing moderate to severe pain, swelling, and trismus. Postoperative pain control improves patient recovery and oral function, with commonly used analgesics including Ibuprofen, Aceclofenac, Ketorolac, Tramadol, Paracetamol, Nalbuphine, Nimusulide, and Buprenorphine. Aim and Objective: The study compares oral and sub-lingual Piroxicam for managing post-surgical pain after extraction of impacted third molars, focusing on analgesia onset, pain intensity, swelling, and trismus degree. Materials and method: A randomized control trial was conducted on 30 patients who underwent surgical removal of mandibular impacted third molars. The patients were divided into two groups: Group I (Study) and Group II (Control). All patients underwent the procedure by a single surgeon. Post-operative medications were prescribed according to the study design, with Piroxicam 20mg administered sub-lingually (Group I) and 20mg orally (Group II). The parameters were assessed and measured for both groups, and the results and statistical analysis were compared. Result: The results revealed that the inter-group difference for the post-operative symptoms evaluated using a t-test for Equality of means by comparing the pre-op, POD 2, POD 7 values was statistically significant. Mean onset time taken and pain perception by Group I (Sub-lingual) in the first dose was 32.3 minutes and for Group II was 51.21 minutes which was established to be significantly (P&lt;0.05) low for the sub-lingual group by statistical analysis. Conclusion: The study found that the sublingual route of administering Piroxicam had a faster onset of action and better analgesia postoperatively compared to the oral route. This is crucial for patients and surgeons to improve compliance and comfort post-operatively after impaction surgery, as potent analgesics are essential for effective pain management.

Using an instrumented hammer to detect the rupture of the pterygoid bone plate: an animal study

Craniofacial osteotomies involving pterygomaxillary disjunction are common procedures in maxillofacial surgery to detach the pterygoid plates from the palatal bones. Surgeons still rely on their proprioception to determine when to stop impacting the osteotome, which is important to avoid complications such as dental damage and bleeding. Our group has developed a technique consisting in using an instrumented hammer that can provide information on the mechanical properties of the tissue located around the osteotome tip. The aim of this study is to determine whether a mallet instrumented with a force sensor can be used to predict the crossing of the osteotome through the pterygomaxillary plate. 31 osteotomies were carried out in 16 lamb skulls. For each impact, the force signal obtained was analyzed using a dedicated signal processing technique. A prediction algorithm based on an SVM classifier was applied to the database. We showed that the device can detect the crossing of the osteotome, sometimes before its occurrence. The prediction accuracy of the device was 94.7%. The method seemed to be sensitive to the thickness of the plate and to crack apparition and propagation. These results pave the way for the development of a per-operative decision support system in maxillofacial surgery.

Risk factors for post-extraction infection of mandibular third molar: A retrospective clinical study

Post-extraction infection is one of the most concerning complications of mandibular third molar extraction, which is the most common procedure in oral and maxillofacial surgery. We investigated risk factors for post-extraction infection by retrospectively analyzing 2,513 teeth/cases of mandibular third molar extraction (1,040 males, 1,473 females) performed at a single medical facility in Kobe, Japan from January 2014 to May 2022. The predictive variables were categorized as patient attributes, health status, and anatomic, pathological, and operative variables that may be associated with post-extraction infection. The outcome variable was the post-extraction infection rate. The post-extraction infection rate was 5.73 % (144 of the 2,513 teeth), and the mean age of the patients with a post-extraction infection was 41.76 ± 16.8 years. Our analyses also revealed that the postoperative infection rate was significantly increased in patients aged ≥36 years. A multivariate logistic regression analysis showed that the following variables were significantly associated with post-extraction infection: preoperative antibiotic administration (odds ratio [OR] 4.68, p < 0.001), postoperative paresthesia of the inferior alveolar nerve (OR 4.34, p < 0.001), intraoperative hemostatic procedure (OR 1. 74, p = 0.008), position of Pell and Gregory classifications (OR 1. 70, p < 0.001), Winter's classification (OR 1.28, p < 0.03), and age (OR 1.03, p < 0.001). Oral and maxillofacial surgeons should be aware of these risk factors.

Adjunctive Effect of Photobiomodulation Therapy with Nd:YAG Laser in the Treatment of Inferior Alveolar Nerve Paresthesia.

Background: Disruption of peripheral branches of the trigeminal nerve in the field of maxillofacial surgery is a known risk due to the close connection of these branches with the bony structures of the maxilla and mandible. As a result, injuries of the lingual nerve and inferior alveolar nerve take place within routine maxillofacial surgery procedures, including local anesthetic injection, wisdom tooth surgery, and dental implant placement, resulting in paresthesia and dysesthesia. During the last three decades, low-level lasers (LLL) have been frequently used in various medical fields. Lately, this application has increased in several sectors. Methods and materials: This experiment was designed to explore the effect of low-level laser therapy (LLLT) with Nd:YAG on the paresthesia and dysesthesia of the lower lip. This ethics committee of Tbzmed, Tabriz, Iran, proved the present experiment with ethical code: IR.TBZMED.REC.1401.839. Results: After completing 10 sessions of laser therapy for the case group consisting of 25 patients with lower lip anesthesia, the visual analog scale index results revealed that following six sessions of laser therapy, a significant difference appeared in contrast to the control group. Also, according to the two-point tests, significant difference among the experimental and the control group appeared after ninth session of the laser therapy. Conclusions: Altogether, these data suggested LLLT with Nd:YAG as an effective treatment option for decreasing the anesthesia of the lower lip.

Platelet-rich fibrin for rehydration and pre-vascularization of an acellular, collagen membrane of porcine origin

ObjectivesPre-vascularization of the collagen membranes with autologous platelet concentrates is a standard procedure in oral and maxillofacial surgery. This study analyzed the possible interaction of an acellular collagen membrane of porcine origin (NM) with platelet-rich fibrin (PRF) regarding its rehydration protocol with differences in pH values and effect on angiogenesis.Materials and methodsNM was analyzed alone and combined with solid PRF by plotting or co-culturing with injectable PRF. Different media (venous blood, buffer solution with a fixed pH value of 7, saline solution, and injectable PRF) were used to analyze the influence on pH value during rehydration. Chorion allantois membrane assay (CAM) was applied to check pro-angiogenic effects after 24, 48, and 72 h, followed by immunohistochemical analysis.ResultsRehydration in injectable PRF showed acidity over time (p < 0.05). A definite pro-angiogenic effect of NM alone was found regarding neo-vessel formation supported by the respective light microscopically analysis without significant differences to PRF alone (p > 0.005). This pro-angiogenic effect could not be exaggerated when NM was combined with liquid/solid PRF (each p > 0.005).ConclusionsRehydration with liquid PRF of the collagen membrane results in acidity compared to a saline solution or patient’s blood. The significant pro-angiogenic potential of the membrane alone resulted in enhanced neo-vessel formation that could not be optimized with the addition of PRF.Clinical relevance statementUsing injectable PRF for rehydration protocol of the collagen membrane leads to acidosis that can ultimately optimize wound healing. Differences in the physio-mechanical interplay of collagen matrices and autologous platelet concentrates must result in clinical algorithms if pre-vascularization can maximize outcomes.

Practice Profile of Practicing Plastic Surgeons: A 20-year Review of Plastic Surgery Statistics.

Evaluation of practice patterns by American Board of Plastic Surgery (ABPS) diplomates allows for a greater understanding as to how the field is progressing. Understanding evolving procedural trends can give insight into plastic surgeons' subspecialty focus and influence resident training to prepare them for future practice. American Society of Plastic Surgeons member only projections for aesthetic and reconstructive procedures were reviewed from 1999 to 2018 in 5-year increments to identify shifts in frequency between the beginning (1999-2003) and end (2014-2018) of the timeframe. Tracer utilization for all four ABPS modules were also examined between 2014 and 2018. Descriptive statistics were performed to identify significant changes (P < 0.05) in subspecialty focus and procedure trends. Annual procedure incidence between 2014 and 2018 was compared with that between 1999 and 2003. The annual number of procedures more than doubled from 3,244,084 to 6,628,082. Among reconstructive procedures, there was a statistically significant increase in the number of breast reconstruction, breast implant removal, and maxillofacial surgery procedures, and a statistically significant decrease in the number of procedures focused on reconstruction of birth defects, burn injuries, and hand anomalies. In aesthetic surgery, significant increases were seen in the number of augmentation mammoplasty, abdominoplasty, and mastopexy procedures, with significant decreases in the number of blepharoplasty and rhinoplasty procedures. Understanding the changing practice patterns of ABPS diplomates is essential to define the direction that our specialty is taking over time, and to guide program directors in plastic surgery on areas of focus for appropriate training of plastic surgeons.

A Novel Dressing Method to Achieve Early Natural Tracheostoma Closure.

Tracheotomy is a routine surgical procedure in oral and maxillofacial surgery. After decannulation, spontaneous tracheostoma closure is usually expected. However, wound healing is often delayed, requiring 1 to 2 weeks for healing and resulting in the need for surgical closure. Although many reports have described the surgical closure of a tracheostoma, few reports have focused on the dressing methods for closure of tracheal openings after decannulation. Herein, the authors report a new tracheostoma closure method that does not rely on surgical closure or the adhesive strength of the tape. The authors' conventional dressing method was to place gauze over the tracheostoma after decannulation and apply pressure through elastic tape or with a film dressing to seal the tracheostoma and achieve natural closure by reducing the leakage of air and tracheal secretions. However, the conventional method cannot completely prevent the leakage of air and tracheal secretions. We developed a novel method to achieve early closure by markedly reducing the leakage by partially inserting the gauze into the tracheostoma.

Cannabis Users Require More Anesthetic Agents for General Anesthesia in Ambulatory Oral and Maxillofacial Surgery Procedures

The use of cannabis in the general population has steadily increased over recent years and there is limited literature regarding the anesthetic implications of chronic cannabis use, particularly in the setting of outpatient anesthesia. To determine whether chronic cannabis users undergoing deep sedation or general anesthesia during ambulatory procedures require more anesthetic agents than nonusers. A retrospective cohort study of subjects undergoing deep sedation or general anesthesia at the Oklahoma University Oral and Maxillofacial Surgery Clinic from January to December 2022 was performed. The inclusion criteria were duration of anesthetic procedure between 15 to 40minutes, use of propofol, fentanyl, ketamine, and midazolam, and extraction of at least 2 teeth. The exclusion criterion was patients undergoing adjunctive procedures other than extractions during sedation. Cannabis use status was grouped as users and nonusers. A user was defined as a subject who self-reported any regular use of cannabis. The primary outcome variable was the amount of intravenous anesthetic agents administered. Secondary outcome variables included the length of the procedure and the number of teeth extracted. Age, sex, and the senior-most resident involved in the sedation. IBM SPSS was utilized to perform descriptive statistics, paired t-tests, ANOVA, and multivariate linear regression. A level of significance of 5% (P<.05) was used for all analyses. Four hundred and ninety nine subjects were identified, 189 met the inclusion criteria, and 57 reported using cannabis. The mean age of nonusers was 28.2±7.8years and that of users was 26.6±6.4years (P=.09). Females represented 71.9% of nonusers and 72.7% of users. Cannabis users received significantly more propofol (117.5mg±71.3 vs 152.5mg±101.8; P=.004), midazolam (4.7mg±1.0 vs 5.1mg±1.5; P=.01), ketamine (40.2mg±15.7 vs 46.1mg±16.9; P=.01), and fentanyl (75.2μg±26.3 vs 88.6μg±32.8; P=.002) than nonusers, despite extracting a similar number of teeth (4.5±3.1 vs 4.4±3.5; P=.37) in a similar amount of time (25.5±7.3 vs 27.3±7.8; P=.06). Cannabis users required more propofol, midazolam, ketamine, and fentanyl than non-cannabis users during outpatient oral and maxillofacial surgery procedures.

Probing real-world Central European population midfacial skeleton symmetry for maxillofacial surgery.

Symmetry is essential for computer-aided surgical (CAS) procedures in oral and maxillofacial surgery (OMFS). A critical step for successful CAS is mirroring the unaffected side to create a template for the virtual reconstruction of the injured anatomical structure. The aim was to identify specific anatomical landmarks of the midfacial skeleton, to evaluate the symmetry in a group of the real-world Central European population, and to use these landmarks to assess midfacial symmetry in CT scans. The retrospective cross-sectional study defined landmarks of the midface's bony contour using viscerocranial CT data. The distances of the skeletal landmarks (e.g., the frontozygomatic suture and temporozygomatic suture) of the left and right sides from the midline were measured and statistically compared. Midfacial symmetry for reference points was defined as a difference within 0mm and their mean difference plus one standard deviation. We examined a total of 101 CT scans. 75% of our population shows symmetrical proportions of the midface. The means of the differences for the left and right sides ranged from 0.8 to 1.3mm, averaging 1.1 ± 0.2mm for all skeletal landmarks. The standard deviations ranged from 0.6 to 1.4mm, with a computed mean of 0.9 ± 0.3mm. We established a methodology to assess the symmetry of the bony midface. If the determined differences were equal to or lower than 2.5mm in the mentioned midfacial skeletal landmarks, then the symmetry of the bony midface was considered present, and symmetry-based methods for CAS procedures are applicable. Many CAS procedures require facial symmetry. We provide an easy-to-apply method to probe for symmetry of the midface. The method may be used for population-based research, to check for proper reduction of fractures after reposition or to screen for symmetry prior to CAS planning.

Comparative Evaluation of Intranasal Dexmedetomidine Spray Versus Intranasal Normal Saline Spray in Patients Undergoing Transalveolar Extractions for Anxiety Reduction: A Randomized Control Study.

Dexmedetomidine has dose-dependent selectivity for alpha 2 adrenoceptors. It is a good sedative with analgesic characteristics and good haemodynamic stability. Intranasal sedation is a non-invasive medication delivery method that is both safe and well accepted by both children and adults. One of the most common procedures in maxillofacial surgery is transalveolar extraction. In minor oral surgery, a painless transalveolar extraction with little post-operative pain would be ideal. To examine the effectiveness of intranasal dexmedetomidine spray against intranasal normal saline spray in patients undergoing transalveolar extractions for anxiety relief. We compared sedation effect by Ramsay sedation scale, analgesia by visual analogue scale, monitored BP and pulse rate for anxiety, and spo2 levels for any complication in this prospective double-blinded randomized control study for two groups, A group with intranasal dexmedetomidine spray and the B group of intranasal NS spray for placebo effect at 0min, 15min, 30min, and 45min until transalveolar extraction. As a result of the intranasal spray of dexmedetomidine, there were no related problems such as respiratory depression. There was a substantial difference in sedation and analgesia between group A and the placebo group, as well as a significant decrease in pulse rate and hypotension in the dexmedetomidine group to reduce anxiety. Intranasal injection of atomized dexmedetomidine (1.5mcg/kg) for patient sedation having transalveolar extractions or other minor surgical operations in oral and maxillofacial surgery is clinically effective, convenient, lowers anxiety, and safe.Clinical Trial Registration: No. CTRI/2021/07/035181.

Virtual Surgical Planning of Superior Orbital Rim Fractures in Calvarial and Maxillofacial Trauma

Superior orbital rim fractures are challenging fractures as they often concomitantly occur with additional calvaria fractures. Virtual surgical planning (VSP) has been underutilized in this area of craniomaxillofacial trauma for reconstruction. The purpose of this study is to qualitatively describe the use of VSP and anatomically perfected stereolithic models in treatment of superior orbital rim fractures in combined neurosurgery/oral and maxillofacial surgery cases. This study is a retrospective case series of subjects who were treated at the Massachusetts General Hospital (July 2022 to November 2022). Inclusion criteria include subjects who had both calvaria and maxillofacial injuries requiring concurrent operative intervention on their superior orbital rim fractures and the use of VSP. Not applicable. The outcome variable of interest is the difference in the planned position of the orbital rim repair compared to the actual position achieved. None. Heat map analysis was used to compare the difference in the planned position versus the actual position achieved. There were six orbits (five subjects, mean age 33.8±21.49years) that met the criteria. The mean difference in planned versus actual orbital volume achieved was 2.52±2.48cm3. The superimposition of the postoperative scan to the planned simulation revealed 84%±3.27% of the voxel surface was within+2 and -2millimeters of its planned position. This study has demonstrated the use of VSP in combined neurosurgery and oral and maxillofacial surgery procedures in the fixation of superior orbital rim fractures. This case series highlights that the postoperative position achieved in the six orbits was within 84% of the planned position.

The Topographic Location of The Nasolacrimal Duct as An Anatomical Reference Point for Surgical Procedures in Maxillofacial Surgery

The study aimed to measure the distance of the nasolacrimal duct to adjacent anatomical structures in a sample of 150 CT scans from the San Ignacio University Hospital in Bogotá, Colombia, in 2021. The data was collected in a retrospective observational study based on non-probabilistic sampling. The results showed that the length of the nasolacrimal duct is greater in men than in women and decreases as age increases. The study highlights the need for studies that consider the specific characteristics of the Latin American population to establish reference points for surgical procedures in maxillofacial surgery.

Morphological Studies to Identify the Nasopalatine and Inferior Alveolar Nerve Using a Special Head and Neck MRI Coil.

Procedures in oral and maxillofacial surgery bear a high risk of nerve damage. Three-dimensional imaging techniques can optimize surgical planning and help to spare nerves. The aim of this study was to investigate the diagnostic value of a 1.5 T magnetic resonance imaging (MRI) scanner with a dedicated dental signal amplification coil for the assessment of nerves in the oral cavity as compared with cone beam computed tomography (CBCT). Based on 6 predefined criteria, the assessability of the inferior alveolar and nasopalatine nerves in CBCT and MRI with a dedicated 4-channel dental coil were compared in 24 patients. Compared with CBCT, MRI with the dental coil showed significantly better evaluability of the inferior alveolar nerve in the sagittal and axial plane and the nasopalatine nerve in the axial plane. In the sagittal plane; however, the assessability of the nasopalatine nerve was significantly better in CBCT as compared with MRI. Yet, pertaining to overall assessability, no significant differences between modalities were found. In this pilot study, it can be reported that 1.5- T MRI with a dedicated dental coil is at least equivalent, if not superior, to CBCT in imaging nerve structures of the stomatognathic system. Preoperative, 3-dimensional images are known to simplify and refine the planning and execution of operations in maxillofacial surgery. In contrast to computed tomography and CBCT, MRI does not cause radiation exposure while enabling visualization of all relevant hard and soft tissues and, therefore, holds an advantage over well-established techniques.