Maxillofacial Surgery Research Articles

Editorial: Lifestyle Medicine in Maxillofacial Surgery Physicians' Training: A Hidden Power

In the rapidly evolving and highly complex healthcare ecosystem, surgeons, particularly young surgeons in their training, often exhibit poor lifestyle habits and face a high risk of experiencing burnout. To be able to continue to serve their patients effectively, maxillofacial surgeons should adopt sustainable lifestyle changes. However, many of us who are unfamiliar with the concept of lifestyle medicine (LM). This article provides effective ways to improve LM in maxillofacial surgery physicians` training. Six important recommendations from the American College of Lifestyle Medicine (ACLM) are highlighted. Maxillofacial surgeons should establish novel lifestyle goals. Their exposure to the basic education and practices of LM is essential for behavioral change to improve their short-term and long-term wellbeing and to empower them to make positive lifestyle decisions. Elevating awareness, education, and practice regarding such critical factors is paramount. Behavior modification based on healthy lifestyle principles may be challenging but is a key component of this journey. In conclusion, by practicing LM principles, a new generation of maxillofacial surgeons will be created uniquely, allowing them to redesign their way of working and living for themselves and their teams but also to reconsider their sustainable contribution and long-term impact on the global healthcare community.

Three-step Approach for Facial Reconstruction After Injectable Silicon: Surgical Excision, Fat Grafting, and Hyaluronic Acid Filler.

In facial cosmetic surgery, injectable liquid silicone has been used to augment the cheek and the lips and to camouflage facial wrinkles. However, complications started to arise in 1964 as postoperative silicone granuloma formation. The purpose of this study is to introduce our experience in facial reconstruction after injectable silicon oil with a sequential 3-step approach: transoral surgical excision, full-face fat grafting, and hyaluronic acid filler. A retrospective study was conducted for all patients affected by facial granulomatosis due to liquid silicone injection who underwent surgical treatment between January 2018 and June 2020 at the Unit of Maxillo-Facial Surgery at the Hospital "Policlinico San Martino" (Genoa, Italy). Three female patients completed the entire surgical pathway. The mean age of the patients at the time of surgery was 58.7 years (range, 52-65y). There was no clinical recurrence of the facial deformity during a mean follow-up of 14 months. Apart from the standard postoperative discomforts such as bruising, edema, and pain, the authors did not observe major complications. Our 3-step approach is a safe and viable option that can be offered to motivated patients affected by granulomatous facial reactions. Level 3.

Medication-related osteonecrosis of the jaw in patients with cancer using zoledronic acid and denosumab: Single-center retrospective study.

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but potentially severe condition that significantly affects the quality of life of patients with cancer. This study evaluated MRONJ in patients with cancer treated with zoledronic acid (ZOA) and denosumab (Dmab). The survey investigated patients who were diagnosed with MRONJ at the Department of Oral and Maxillofacial Surgery after receiving either ZOA or Dmab at the Saitama Medical Center, Saitama Medical University, between April 1, 2022, and March 31, 2023. Of 252 patients, 27 were ZOA users and 225 were Dmab users. MRONJ was not observed with ZOA. MRONJ was detected in 11 (4.9%) Dmab users, eight male and three female patients with a mean (± standard deviation) age of 74.6 (± 9.2) years (range 61-98 years). The total dose of Dmab was 2724 ± 1838 mg (range: 480-6360 mg). The time from Dmab administration to MRONJ onset was 28.0 ± 16.0 months (range 4.5-53.2 months). Of the 11 patients with MRONJ, four (36.4%) had visited a dentist within the last 12 months. One participant (9.1%) was informed about and understood MRONJ. MRONJ was only observed in Dmab users, with an incidence rate of 4.9%. The percentage of patients with MRONJ receiving regular dental check-ups was 36.4%, and only 9.1% of patients were aware of MRONJ, both of which are low rates. To reduce MRONJ in patients with cancer, face-to-face consultations with pharmacists could serve as a valuable opportunity to inform patients about MRONJ and encourage regular dental visits.

Trends in dentomaxillofacial radiology.

Oral and maxillofacial diagnostic imaging is of paramount importance in dental clinical diagnosis, treatment planning, and follow-up procedures. Periapical radiographic examination and numerous panoramic systems are used in routine clinical dental practice. Cone beam CT is widely used and currently the method of choice in oral and maxillofacial implantology, endodontics, maxillofacial surgery, periodontics, degenerative temporomandibular joint disease, orthodontics, airway studies, sleep disorders, and forensic dentistry. Another innovative laboratory research tool that offers three-dimensional (3D) detailed high-resolution images of in vitro teeth and neighboring structures with submicrometric accuracy is microcomputed tomography. Ultra-high radiation doses, long scanning times, and high costs preclude its routine clinical use. In response to the high demand for a technique that could provide real-time images using a cost-effective, rapid, user-friendly, and portable technique without ionizing radiation, some authors proposed ultrasound imaging methods as an alternative to X-ray imaging techniques. Ultrasonography can be used in the dentomaxillofacial region for various diagnostic purposes such as salivary gland and superficial tissue examination. Recently, dedicated dental magnetic resonance imaging with appropriate software, hardware, sequences, and field of view tailored to fit dentomaxillofacial anatomy was introduced. Lately, 3D printing technologies and their application in dentistry has attracted attention. During 3D printing a given material is added in successive layers to create a 3D object. The application of this technology has the potential to decrease operation time and minimize operator bias and the possibility of procedural errors. Another hot topic regarding dentomaxillofacial radiology is artificial intelligence, which is a field related to computer science dedicated to developing systems or machines that can perform tasks traditionally associated with human intelligence. It is obvious that further investigation and research in the field of dentomaxillofacial radiology will make great contributions to diagnostic imaging for various dental specialties.

Sinonasal Mass in the Setting of Prior Maxillofacial Surgery and Solid Organ Malignancy

Fungal rhinosinusitis (FRS) can be classified into invasive and non-invasive forms, with the fungal ball (FB) representing a common non-invasive type with generally favorable outcomes post-operatively. The clinical presentation of FB can vary and be non-specific, and it is important to consider a wide differential diagnosis for sinonasal masses, including malignancy. We present the case of a 74-year-old female presenting with a two-year history of nasal obstruction and drainage. She has a history of breast cancer and prior maxillomandibular surgery, and imaging showed a poorly defined mass in the right maxillary sinus with possible hemorrhagic and/or proteinaceous content. Rigid nasal endoscopy revealed a friable mass, and endoscopic sinus surgery findings were consistent with FB. This case exemplifies the need to consider a broad set of differential diagnoses when evaluating sinonasal masses, especially if the patient has a prior malignancy or maxillomandibular surgical history, including FB and metastases to the paranasal sinuses. Given the presence of non-specific symptoms, it is important to consider early imaging for patients with distorted anatomy and a history of malignancy. Endoscopic sinus surgery, with high success rates, is the gold-standard treatment for FB.

Three-Dimensional-Printed Photopolymer Resin Materials: A Narrative Review on Their Production Techniques and Applications in Dentistry

Additive manufacturing (3D printing) has transformed dentistry by providing solutions with high precision and accuracy achieved through digital workflows, which facilitate the creation of intricate and personalized structures. Additionally, 3D printing promotes cost efficiency by reducing material waste and errors while enabling on-demand production, minimizing the need for extensive inventories. Recent advancements in 3D-printed resin materials have enhanced their clinical applications by improving mechanical strength, biocompatibility, esthetics, and durability. These innovations have facilitated the fabrication of complex and patient-specific structures, such as dental prostheses, surgical guides, and orthodontic appliances, while significantly reducing production time and material waste. Ongoing research and innovation are expected to strengthen resin properties, including strength, translucency, and durability, broadening their clinical applications. The ongoing evolution of 3D printing technology is poised to play a critical role in driving personalized treatments, streamlining clinical workflows, and shaping the future of dental care. This narrative review comprehensively examines the production techniques and clinical applications of 3D-printed photopolymer resins across various dental specialties, including prosthodontics, orthodontics, pediatric dentistry, maxillofacial surgery, periodontology, endodontics, and conservative dentistry. Additionally, the review provides insight into the transformative impact of these technologies on patient care, highlights existing challenges, and suggests future directions for advancing resin properties and their integration into routine dental practice.

Comparison between Retromandibular Anteroparotid Approach, Retromandibular Transparotid Approach and High Subangulomandibular Approach for Mandibular Subcondylar Fracture Fixation: A Prospective Randomised Study

Background: Condylar fractures remain a subject of ongoing debate in the field of oral and maxillofacial surgery. The choice of surgical approach depends on various functional and aesthetic considerations. This original research article compares three surgical approaches—retromandibular anteroparotid approach, retromandibular transparotid approach and high subangulomandibular approach—by evaluating facial nerve injury, scar aesthetics, and sialocele formation. Materials and Methods: A prospective study was conducted at the Sanjay Gandhi Institute of Trauma and Orthopedics, Bangalore, involving 33 patients who were divided into three groups of 11 patients each. The outcomes assessed included facial nerve injury, scar aesthetics, and sialocele formation, with follow-up for 3 months. Data analysis was performed using the Chi-square test. Results: The comparison of facial nerve injury incidence between different time intervals in each group, analyzed using Cochran's Q test, revealed that 9.1% of patients in Group A (retromandibular anteroparotid approach), 36.4% in Group B (retromandibular transparotid approach), and 18.2% in Group C (high subangulomandibular approach) experienced facial nerve injury on Day 1. Group B showed a statistically significant result with a p-value of 0.02. Sialocele formation on Day 1 occurred in 27.3% of Group A, 45.5% of Group B, and none in Group C, with a statistically significant p-value of 0.04. The comparison of mean scar aesthetic scores showed 1.45 ± 0.52 for Group A, 2.36 ± 0.51 for Group B, and 2.45 ± 0.52 for Group C, with a statistically significant result (p = 0.001). Significant differences were found between Group A and Group B (p = 0.002) and Group A and Group C (p = 0.001). Conclusion: This study indicates that the retromandibular anteroparotid approach (Group A) had the least incidence of facial nerve injury and better scar aesthetics. The high subangulomandibular approach (Group C) showed the least incidence of sialocele formation, though it posed challenges in accessing the fracture site. Therefore, the high subangulomandibular approach is recommended for low subcondylar fractures rather than high subcondylar fractures.

Primary surgery of subcondylar mandibular fracture using patient-specific implant: the Helsinki protocol

PurposePreoperative virtual planning and osteosynthesis with patient-specific implants (PSIs) have become a quotidian approach to many maxillofacial elective surgery setups. When a process is well-organized, a similar approach can be harnessed to serve the needs of exact primary reconstructions, especially in midfacial trauma cases. PSI osteosynthesis of the mandible is, however, more challenging because a mirror technique of the facial sides is often unreliable due to inherent lack of symmetry, and movement of the mandible increases the risk of loosening of the osteosynthesis. The purpose of this study was to present clinical results of the Helsinki protocol concept of utilizing PSIs in the primary surgery of unilateral mandibular subcondylar fractures as the first publication on the subject.MethodsA single-center study of a new Helsinki protocol is presented for surgical treatment of subcondylar mandibular fractures using patient-specific, titanium-milled repositator plates. Ten patients with dislocated subcondylar mandibular fractures received surgery and osteosynthesis with PSI via a retromandibular approach.ResultsClinical and radiological outcomes were excellent; none of the patients had fixation-related major complications or developed postoperative malocclusion.ConclusionsStudy results show that the Helsinki protocol, treating mandibular condylar fractures primarily with PSI plates, is a viable treatment option.

Clinical patterns and outcomes of patients affected by primary malignant melanoma of the oral mucosa: A European multicenter retrospective chart review.

The purpose of this European multicenter study was to describe and assess the characteristics, diagnosis, management, and recurrence of oral malignant melanoma at different European oral and maxillofacial surgery centers. This study was based on a systematic computer-assisted database that allowed the recording of data for all primary oral mucosal melanomas treated in the involved surgical units across Europe between January 1, 2003 and December 31, 2022. The following data were recorded for each patient: gender, age, site, TNM staging, metastases, symptoms, imaging features, histopathological features, treatment, complications, recurrence, follow up, and survival. A total of 29 patients (15 females, 14 males) with a primary oral mucosal malignant melanoma fulfilled the inclusion criteria. The mean age was 64.4 years. The most frequent primary site was the vestibular and crestal maxillary gum. Nineteen patients had been diagnosed with a T3 oral melanoma, nine patients with a T4a oral melanoma, and one patient with a T4b neoplasm. Three patients had distant metastases at diagnosis. Clinically, the most frequently observed clinical features were hyperpigmentation, nodular appearance, ulceration, and hemorrhage. Among the 27 surgical cases, radical/clear margins were obtained in 24 cases, non-radical/invaded margins were obtained in two cases, while in one case a non-specific result of margin positivity was found. The overall 2-year survival was 62%. The 2-year disease-free survival was 52%. Oral mucosal melanoma is an aggressive and often asymptomatic malignancy. The overall long-term survival for patients with oral mucosal melanoma is poor, with a high rate of distant metastasis, independently from the performed treatment. Prevention and early diagnosis could be crucial to improving the disease-free survival of patients with oral mucosal melanomas.

Microvascular reconstruction in oral and maxillofacial surgery: a Europe-wide data collection.

This study aims to analyze microvascular reconstruction in Oral and Maxillofacial Surgery (OMFS) in Europe. Based on previous studies, a dynamic online questionnaire was developed and subjected to internal and external evaluation. The questionnaire comprised multiple-choice, rating, and open-ended questions, addressing general and specific aspects and the impacts of the COVID-19 pandemic on microvascular reconstruction in OMFS in Europe. It was implemented into SurveyMonkey's® online survey software and emailed to OMFS departments registered with the European Association for Cranio-Maxillofacial Surgery (EACMFS). Seventy-five participants from 23 European countries participated. Among them, 89% perform between 1 and 70 microvascular free flaps (MFF) annually. 38% of the participants reported a reduction in MFF due to the COVID-19 pandemic. The radial forearm (41% of participants) and fibula free flap (31%) are the most reported MFF. In most cases (59%), MFF procedures are exclusively performed by OMFS for OMFS patients, while 43% of participants reported cooperations with plastic surgeons to perform MFF for OMFS patients. Many participants prefer arterial end-to-end anastomoses (54%) using the facial artery (54%) and, if available, two venous anastomoses (68%). Low molecular weight heparin is the most used postoperative anticoagulant, reported by 67% of participants. For flap monitoring, clinical assessment and Doppler ultrasound are preferred by most participants (95% and 78%, respectively). Many participants (66%) indicated that tracheotomy is only performed when necessary. Differences were observed in relation to CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) techniques, types of osteosynthesis, and dental implant treatment. This study highlighted variability in microvascular reconstruction in OMFS in Europe. Further studies are needed to assess these aspects in detail.

Incidence of deep vein thrombosis following oral and maxillofacial surgery: a systematic review of reported cases and risk factors

Incidence of deep vein thrombosis following oral and maxillofacial surgery: a systematic review of reported cases and risk factors

Anatomical interrelationship between infraorbital canal and maxillary sinus: a CBCT-driven exploratory study

The anatomical relationship between the infraorbital canal (IOC) and the maxillary sinus (MS) is of critical importance in maxillofacial surgery, implantology, and endodontics. This exploratory study aims to investigate this relationship using cone-beam computed tomography (CBCT) imaging to provide precise anatomical insights. A retrospective analysis was conducted on CBCT scans of 174 patients, evaluating the positional variations, distances, and morphological characteristics of the Infraorbital canal in relation to the Maxillary Sinus. The results demonstrated significant variations in the proximity and spatial orientation of the infraorbital canal and maxillary sinus, highlighting the necessity for careful preoperative planning to avoid complications during surgical interventions. This study underscores the value of CBCT in enhancing the understanding of maxillofacial anatomy, thereby improving clinical outcomes and patient safety in procedures involving the maxillary region.

Efficacy of Nalbuphine as An Adjunct to 0.5% Bupivacaine in Ultrasound- Guided Suprazygomatic Maxillary Nerve Block in Patients Undergoing Nasal and Maxillofacial Surgery – A Randomized Clinical Comparative Study

Background & Aims: Ultrasound-guided suprazygomatic maxillary nerve block (MNB) is safe and efficacious in nasal and maxillofacial surgeries. The analgesic effect of nalbuphine is equal to that of morphine, with a ceiling effect on respiration. Therefore, this study aims to evaluate the efficacy of 0.2 mg/kg nalbuphine as an adjuvant to 0.5% bupivacaine compared to plain 0.5% bupivacaine in maxillary nerve block. Material & Methods: One hundred ASA I-II patients of either sex, scheduled for elective nasal and maxillofacial surgeries under general anesthesia, were randomly allocated into Group A and B (n=50) to receive USG-guided suprazygomatic MNB. Group A and Group B received 0.5% bupivacaine with 0.2 mg/kg of nalbuphine and 0.5% bupivacaine, respectively. The mean duration of analgesia, total consumption of opioids, and 24-hour postoperative side effects were recorded in both groups. The data were compared using Student's t-test, Chi-square test, and Mann–Whitney U test. P < 0.05 was considered statistically significant. Results: The mean duration of postoperative analgesia was significantly prolonged in the nalbuphine group (769.2 ± 117 vs. 559.2 ± 75 minutes; p = 0.002), with a significant reduction in the total consumption of nalbuphine (26.4 ± 5.06 vs. 52.77 ± 7.46 mg; p = 0.007) compared to the bupivacaine group. Conclusion: 0.2 mg/kg nalbuphine can be effective as an adjuvant to local anesthetics in MNB to prolong the postoperative duration of analgesia without significant side effects.

Discriminating between the maxillary tuberosity and the alveolar tuberosity– a critical pictorial review

PurposeThe maxillary tuberosity, a critical anatomical landmark in dentistry and maxillofacial surgery, is burdened by terminological confusion. This inconsistency hampers clinical practice and communication across disciplines.MethodDifferent resources were used to argue for the necessity of standardising the terminology related to maxillary tuberosity to enhance diagnostic precision and ultimately improve patient outcomes.ResultsMost clinical and surgical studies dealing with the distal alveolar bone of the maxilla erroneously indicate it as “maxillary tuberosity”. By recognising the diverse definitions of this structure, errors and misinterpretation of studies could be reduced, and interdisciplinary collaboration could be improved. The term “alveolar tuberosity” is recommended to refer specifically to the distal end of the alveolar process of the maxilla. Anatomically, the maxillary tuberosity belongs to the body of the maxilla and forms part of the posterior wall of the maxillary sinus; therefore, it should not be located in the alveolar process.ConclusionAdhering to the Terminologia Anatomica will clarify the critical clinical and surgical landmarks and enhance communication in clinical and academic settings.

Assessment of Geriatric Problems and Risk Factors for Delirium in Surgical Medicine: Protocol for Multidisciplinary Prospective Clinical Study.

An aging population in combination with more gentle and less stressful surgical procedures leads to an increased number of operations on older patients. This collectively raises novel challenges due to higher age heavily impacting treatment. A major problem, emerging in up to 50% of cases, is perioperative delirium. It is thus vital to understand whether and which existing geriatric assessments are capable of reliably identifying risk factors, how high the incidence of delirium is, and whether the resulting management of these risk factors might lead to a reduced incidence of delirium. This study aimed to determine the frequency and severity of geriatric medical problems in elective patients of the Clinics of Oral and Maxillofacial Surgery, Vascular Surgery, and Orthopedics, General Surgery, and Trauma Surgery, revealing associations with the incidence of perioperative delirium regarding potential risk factors, and recording the long-term effects of geriatric problems and any perioperative delirium that might have developed later the patient's life. We performed both pre- and postoperative assessments in patients of 4 different surgical departments who are older than 70 years. Patient-validated screening instruments will be used to identify risk factors. A geriatric assessment with the content of basal and instrumental activities of daily living (basal activities of daily living [Katz index], instrumental activities of daily living [Lawton and Brody score], cognition [6-item screener and clock drawing test], mobility [de Morton Mobility Index and Sit-to-Stand test], sleep [Pittsburgh Sleep Quality Index and Insomnia Severity Index/STOP-BANG], drug therapy [polypharmacy and quality of medication, Fit For The Aged classification, and anticholinergic burden score], and pain assessment and delirium risk (Delirium Risk Assessment Tool) will be performed. Any medical problems detected will be treated according to current standards, and no intervention is planned as part of the study. In addition, a telephone follow-up will be performed 3, 6, and 12 months after discharge. Recruitment started in August 2022, with 421 patients already recruited at the time of submission. Initial analyses of the data are to be published at the end of 2024 or the beginning of 2025. In the current study, we investigate whether the risk factors addressed in the assessment are associated with an increase in the delirium rate. The aim is then to reduce this comprehensive assessment to the central aspects to be able to conduct targeted and efficient risk screening. German Clinical Trials Registry DRKS00028614; https://www.drks.de/search/de/trial/DRKS00028614. DERR1-10.2196/59203.

Maxillomandibular Advancement with the Use of Virtual Surgical Planning and the CAD/CAM Technology in OSA Surgery: Volumetric Analysis of the Posterior Airway Space

Background and Objectives: Obstructive sleep apnea is an extremely diffuse pathology that, if left untreated, can lead to very serious cardiovascular consequences. The primary goal of treatment is to maintain airflow in the upper airway tract, which can be obtained thanks to orthognathic surgery such as maxillo-mandibular advancement (MMA). This procedure increases the volume of the posterior airway space (PAS)—a parameter considered fundamental in OSA physiology. However, the correlation between the degree of advancement, the volume increase, and the clinical improvement in OSA is not yet clear, even in patients who undergo virtual surgical planning. Aiming to test the correlation of these parameters and the role of PAS volume changes, we present our pre- and post-operative volumetric analysis of the PAS using cone beam computed tomography (CBCT) following CAD/CAM-assisted maxillomandibular advancement. Materials and Methods: We collected information from patients who underwent MMA for moderate or severe OSA, planned virtually with custom-made devices, between 2020 and 2022 at the Maxillofacial Surgery and Odontostomatology Unit of the Policlinico Hospital in Milan. The degree of mandibular advancement (pogonion antero-posterior advancement) was noted. All patients underwent pre- and post-operative CBCT and pre- and post-operative polysomnography to measure the Apnea–Hypopnea Index (AHI) parameters. Both exams were performed within six months before and after surgery. The surgeries were planned virtually along with the production of custom-made devices (cutting guides and mandibular osteosynthesis plates). Volumetric analysis of the PAS was performed pre- and post-CBCT images using medical segmentation software (Mimics, Materialise, Mimcs 26.0). Results: Ten patients (nine men and one woman) with a mean age of 51 years were included in this study. The mean pogonion advancement was 14.5 mm, ranging from 13.8 to 15.6. The mean pre-surgical AHI was 52.31 events/h, while the mean post-surgical AHI was 5.94 events/h (SD 5.34). The improvement in AHI was statistically significant (Wilcoxon matched-pairs signed-rank test, p value 0.004). The mean pre-surgical PAS volume was 8933 mm3, while the mean post-surgical volume was 10,609 mm3. In 8 out of 10 patients, the volume increased, with a mean increase of 2640 mm3 (max. 5183, min. 951), corresponding to a percentage increase variation ranging from 78% to 6%. In two patients, the volume decreased by 1591 (−16%) and 2767 mm3 (−31%), respectively. The difference between pre- and post-operative results was not statistically significant (paired t-test, p value 0.033). Conclusions: The results obtained confirm the efficacy of virtually planned MMA performed with custom-made devices in OSA therapy. However, they also show that PAS volume should not be used as a comprehensive parameter for OSA treatment evaluation because it does not always have a positive correlation with advancement and AHI.

Deep Circumflex Iliac Artery (DCIA) Free-Flap Mandibular Reconstruction Using Patient-Specific Surgical Guides and Customized Plates: A Preliminary Study

Background: Mandibular reconstruction remains challenging in oral and maxillofacial surgery due to its complex anatomy and functional requirements. While Deep Circumflex Iliac Artery (DCIA) flaps offer advantages in bone height and natural contour, their application with computer-aided surgical planning remains limited. Aim: This preliminary study aimed to evaluate the accuracy and clinical outcomes of mandibular reconstruction using DCIA free flaps with patient-specific surgical guides and customized plates. Materials and Methods: A pilot study of five patients who underwent mandibular reconstruction using DCIA free flaps was conducted. Virtual surgical planning was performed using Cone-Beam Computed Tomography (CBCT) and pelvic Computed Tomography (CT) data to design patient-specific cutting guides and reconstruction plates. All surgeries were performed by a single experienced surgeon using standardized techniques. Results: The mean deviation between the virtual planning and actual surgical outcomes was 0.73 ± 0.23 mm, with maximum deviations ranging from 3.87 to 7.83 mm. All flaps achieved 100% survival, with one case (20%) experiencing screw loosening that required plate removal. This complication led to the modification of the plate design to include six or more holes in subsequent cases. Conclusions: Despite limitations including the small sample size and short follow-up period, our preliminary results demonstrate that computer-aided surgical planning with patient-specific devices can significantly improve the accuracy and predictability of DCIA flap mandibular reconstruction, even in challenging revision cases. Further studies with larger patient cohorts are needed to validate these findings.

The current landscape of artificial intelligence in oral and maxillofacial surgery- a narrative review.

This narrative review aims to explore the current applications and future prospects of AI within the subfields of oral and maxillofacial surgery (OMS), emphasizing its potential benefits and anticipated challenges. A detailed review of the literature was conducted to evaluate the role of AI in oral and maxillofacial surgery. All domains within OMS were reviewed with a focus on diagnostic, therapeutic and prognostic interventions. AI has been successfully integrated into surgical specialties to enhance clinical outcomes. In OMS, AI demonstrates potential to improve clinical and administrative workflows in both ambulatory and hospital-based settings. Notable applications include more accurate risk prediction, minimally invasive surgical techniques, and optimized postoperative management. OMS stands to benefit enormously from the integration of AI. However, significant roadblocks, such as ethical concerns, data security, and integration challenges, must be addressed to ensure effective adoption. Further research and innovation are needed to fully realize the potential of AI in this specialty.

Multicentric Epidemiological Analysis on Medial Wall Fractures of the Orbit: 10‐Year Retrospective Study Between the Centres of Perugia and Ancona

ABSTRACTStudy Design and ObjectivesThe incidence of isolated fractures of the orbital medial wall is moderate because of the low bone thickness. Our study aimed to investigate demographic variables, fracture features and statistical correlations associated with these fractures retrospectively.Materials and MethodsA total of 57 patients with isolated orbital medial wall fracture, admitted at the Maxillofacial Surgery Unit of Perugia University Hospital and Maxillofacial Surgery Unit of Ospedali Riuniti di Ancona, from 2014 to 2023 were enrolled in the study.Age, sex, comorbidities, post‐traumatic clinical manifestations and defect size and side were all evaluated in patients. Pearson's regression coefficient (r) was used for statistical analysis.ResultsThe fractures were more frequent in men (male to female ratio 2.16:1) primarily as a result of motor vehicle accidents (30% of cases); the average age was 48 years; enophthalmos, diplopia and ocular motility abnormalities were observed in 31%, 23% and 21%, respectively.According to statistical analysis, fracture area was significantly correlated with age, with older patients having larger fractures (p < 0.001); interpersonal violence and traffic accidents were related to younger age (p < 0.001). In a recent analysis of the data, it was found that isolated orbital medial wall fractures occur more frequently in young men (< 40 years) due to road accidents or interpersonal violence. Patients' age is statistically correlated with fracture area, with older patients having larger defects.ConclusionsThis research assesses both the demographic and fracture characteristics of pure medial orbital wall fractures, aiming to enhance the understanding of this clinical scenario and to evaluate optimal treatment strategies.

The clinical application and anatomical analysis of proximal peroneal artery perforator in free fibula flap based on CTA

BackgroundThe vascularized free fibular flap is increasingly recognized as the standard technique for the repair of complex soft tissue and hard tissue defects in oral and maxillofacial surgery. Conventionally, the vascular supply to the skin island is derived from the distal perforators of the peroneal artery. However, complications may arise if these distal perforators are either absent or damaged during surgical procedures, highlighting the necessity to employ the proximal peroneal perforators as an alternative. This study aims to investigate the anatomical characteristics—including the presence, distribution, and origin—of proximal peroneal perforators through computed tomography angiography (CTA) prior to surgical intervention. A secondary objective is to confirm their viability when distal perforators are unavailable or when dual-skin paddles are needed.MethodsA comprehensive review was conducted involving 50 patients who underwent CTA examinations. Three-dimensional reconstruction of DICOM data was utilized to document the presence, quantity, location, and variations of proximal perforators. Relative positions of the origin points were measured, and the distances from these points to the fibula were calculated. Additionally, 11 studies were included in which a proximal perforator was successfully used to prepare a free fibula chimeric myocutaneous flap for the reconstruction of maxillofacial defects.ResultsAmong the 100 lower limbs evaluated, a successful identification rate of 98% for proximal perforators was achieved via CTA. Of those identified, 70% were found to originate from the fibular artery, 22% branched concurrently with it, and 8% emerged prior to the point of emergence of the fibular artery. Analysis through curve fitting indicated that the origin points of proximal perforators were predominantly located approximately 13.17 mm below the origin of the fibular artery, with their endpoints projecting about 123.9 mm below the fibular head.ConclusionsThe high prevalence of proximal peroneal perforators identified in this population, along with their relatively stable anatomical positions, suggests their significant surgical potential. In scenarios where the distal peroneal perforator is absent or suffers intraoperative injury, the proximal peroneal perforator can serve as a reliable alternative for preparing a free fibula osteal flap combined with a proximal peroneal perforator skin paddle.