Maxillofacial Research Articles

Total Temporomandibular Joint Replacement: Bridging Current Practice With Innovative Horizons For Oral And Maxillofacial Surgeons

Total temporomandibular joint replacement represents a significant advancement in oral and maxillofacial surgery by addressing the complex issues of temporomandibular joint dysfunction and degeneration. This procedure entails the implantation of a joint customized to the patient’s specific requirements, addressing conditions such as benign and malignant lesions, osteoarthritis, and more severe disorders. Available options range from standard commercial prosthetics to custom designs that leverage high-quality graphics and 3D printing for enhanced fit and functionality. Recent innovations have notably advanced temporomandibular joint surgery, with improvements in integration through information matching and shared processes that boost efficiency and longevity. Additionally, the adoption of minimally invasive techniques and robotic assistance has contributed to shorter recovery times, reduced complications, and increased surgical precision. However, challenges persist. Extended implant times, complications, and the need for ongoing patient care remain significant concerns. Long-term follow-up is crucial for evaluating the effectiveness and durability of new prosthetic designs. The field of temporomandibular joint replacement is rapidly evolving, driven by ongoing research and technological advancements aimed at improving patient outcomes, alleviating pain, and enhancing overall health. This review underscores the need for continuous innovation to address the complexities of integration and to advance patient care in the face of evolving surgical demands.

Ocular Complications of Zygomatic Dental Implants: A Systematic Review.

Zygomatic implants are a form of dental implant that anchors in the zygomatic bone with potential for complications to the eye and orbit. This article presents a systematic review of the literature regarding ophthalmological complications of zygomatic implantsto familiarize ophthalmologists with the potential complications and their treatment options. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various searches using PubMed, Elsevier, and Google Scholar were used to search for articles using search terms including 'zygomatic', 'dental', 'implant', 'complications', 'eye,' and 'orbit.' Exclusion criteria included articles that were unavailable in English or written before 1980. Twenty-four articles were included in this review: nine case reports, one case series, nine cohort studies, one randomized controlled trial, and four review articles. The most common complication was infraorbital paresthesia, followed by intraoperative orbital penetration. Other complications included implants placed into the orbit, orbital hematomas, extraocular muscledamage, diplopia, subconjunctival hemorrhage, periorbital fistulae, infraorbital rim infections, and orbital emphysema. Of 41 cases, which included outcomes, 10 patients required further procedures, and five patients had irreversible damage. It is important for both oral and maxillofacial surgeons and ophthalmologists to recognize these complications for proper coordination of care and treatment.

Percentage Of Dentists And Dental Practices Affiliated With Private Equity Nearly Doubled, 2015-21.

Over the course of the past twenty years, private equity (PE) has played a role in acquiring medical practices, hospitals, and nursing homes. More recently, PE has taken a greater interest in acquiring dental practices, but few data exist about the scope of PE activity within dentistry. We analyzed dentist provider data for the period 2015-21 to examine trends in PE acquisition of dental practices. The percentage of dentists affiliated with PE increased from 6.6percent in 2015 to 12.8percent in 2021. During this period, PE affiliation increased particularly among larger dental practices and among dental specialists such as endodontists, oral surgeons, and pediatric dentists. PE-affiliated dental practices were more likely to participate in Medicaid than practices not affiliated with PE. Future research should investigate whether PE's role in dentistry affects the affordability and quality of dental services.

Agreement Between Clinical and Histopathological Diagnoses of Oral and Maxillofacial Lesions and Influencing Factors: A Five-Year Retrospective Study.

Diagnosing oral and maxillofacial lesions is a multi-step, multidisciplinary process. If a clinical diagnosis is achievable, then a histopathological diagnosis is indicated to support and confirm the diagnosis. Histopathological examination of tissue biopsies is therefore an essential part of the diagnosis and/or treatment plan. The purpose of this study was to investigate the agreement between the clinical and histopathological diagnoses of oral and maxillofacial lesions and the patient, lesion, and healthcare provider factors that may affect this agreement. This was an observational, cross-sectional study of all patients who had been referred to the Oral Pathology Central Laboratory at the Faculty of Dentistry and University Dental Hospital at King Abdulaziz University in Jeddah, Saudi Arabia, between 2018 and 2022 for diagnosis of oral and maxillofacial lesions. Data extracted included information about the referring dental provider such as their clinical experience (number of years), specialty, certification, and education. Agreement between the clinical and histopathological diagnoses was evaluated, and logistic regression was used to assess provider characteristics associated with the accuracy of diagnosis. The clinical and pathological diagnoses were concordant in 44.1% (n=378) of cases, and concordance was highest for odontogenic tumors (72.7%, n=24), significantly higher than for inflammatory lesions (37.3%, n=111). The anatomical locations with the highest diagnostic accuracy were the ventral surface of the tongue (71.4%, n=5), followed by the lips (52.6%, n=20). Patient age and sex and the dentist's years of experience were not associated with diagnostic agreement (p=0.2, p=0.9, and p=0.08, respectively). However, concordant diagnoses were significantly associated with the dentist's rank (p=0.02) and specialty (p=0.01). Clinical diagnoses made by oral surgeons at the time of biopsy were 1.6-times more likely (p=0.01) to agree with the pathological diagnosis compared with those made by other specialties when controlling for education, certification, and years of experience. These data are a reminder that a clinical diagnosis alone is not sufficient to secure the final diagnosis and to plan treatment. Histopathological examination remains essential for most oral and maxillofacial lesions.

Decision-Making in Endodontics Prior to the Surgical Removal of Large Cysts Involving Vital Teeth.

Introduction Maintaining pulp vitality is crucial; however, treatment options forlarge lesions may hinder the vitality of the teeth involved within the lesion.Some clinicians are not updated about the diagnostic terminology of the American Association of Endodontists (AAE) which may affect their decision-making. In the literature, there was no absolute treatment to manage such cases. The purpose of this study is to explore different opinions, identify the evidence of practice and treatment options to help in decision-makingand assess if clinicians are acknowledged by the AAE guidelines. Materials and methods This cross-sectional study was conducted through a qualitative survey designed to interview randomly selected endodontists, oral maxillofacial surgeons, oral medicine specialists, oral pathologists, and general partitioners to record their decisions and management about a structured case scenario. Atotal of 120 participants were included in the study.The interviewswere conducted bya single investigator, and the answers were recorded by another investigator. Finally, the responses of the interviewees were collected using Google Forms (Google, Mountain View, California). Results We found that there are dissimilarities between the different groups in decision-making concerning the management of teeth involved in large cystic lesions. Regarding the AEE guidelines, almost all the endodontics and general dentists were aware of the guidelines when compared with the other groups. Conclusion The management of teeth involved in large cystic lesions is controversial. Furthermore, the AEE guidelines are not a common language between the different disciplines. Randomized clinical trials are needed to investigate the prognosis and management of teeth associated with large cystic lesions.

BONE GRAFTS IN THE RECONSTRUCTION OF LE FORT 1 FRACTURES

Fractures of the midface are complex injuries that affect important bone structures such as the maxilla, zygoma and naso-orbito-ethmoidal complex (NOE), being classified by René Le Fort 1nto three categories: Le Fort 1, II and III. Such fractures generally result from car accidents, assaults, falls, sports and work accidents.Treatment aims at complete rehabilitation of the patient, stabilizing the fragments and restoring masticatory function, dental occlusion and anatomical relationships. Different approaches can be used for this purpose, such as osteotomies and bone grafts. Bone grafts provide stability to fractures, create a foundation for dental rehabilitation, and reduce the risk of complications. There are many options available such as autogenous, allogeneic, xenogeneic and alloplastic grafts. The autogenous graft is taken from the patient himself and is considered the gold standard, although obtaining it may increase the morbidity of the procedure. Each graft category has its advantages and disadvantages, and it is essential to consider factors such as biocompatibility, osteoinductive and osteoconductive capacity, in addition to market availability and possible complications. Selection of the ideal material is exceptionally important for the success of the procedure. Autogenous and allogeneic grafts have been widely used, viable alternatives are xenogeneic and alloplastic grafts. However, more studies are needed to assess its long-term effectiveness. The procedure for placing bone grafts in a hospital in the dental area is carried out by oral and maxillofacial surgeons and has open and minimally invasive techniques. Recovery time varies according to the type of graft and the extent of the procedure, requiring adequate post-operative care.A multidisciplinary approach, as well as collaboration between different medical specialties, are very important for a comprehensive and personalized assessment of the patient, ensuring an efficient intervention and a complete recovery, not only physical, but also emotional and social.

Techniques chirurgicales avancées dans la féminisation du front et la redéfinition de la ligne des cheveux chez les patientes transgenres

Facial Gender-Affirming Surgery (FGAS) has emerged as a transformative option for individuals who wish to align their external appearance with their asserted gender identity. This article delves into the surgical techniques employed in forehead feminization and hairline redefinition, highlighting the nuanced approaches used to modify specific facial characteristics to achieve the desired feminizing outcomes. Our extensive experience, encompassing over 2300 forehead feminization surgeries conducted over the past 16 years, provides a robust foundation for understanding the complexities and intricacies of these procedures. This knowledge is crucial for maxillofacial and plastic surgeons, as well as other healthcare professionals involved in comprehensive gender-affirming care, ensuring they are well-equipped to deliver optimal results for their patients.

Unravelling the vital role of maxillofacial surgeons in paediatric oral and maxillofacial surgery: a case series

Unravelling the vital role of maxillofacial surgeons in paediatric oral and maxillofacial surgery: a case series

Research progress on perioperative management of tooth extraction in denosumab-treated patients

Denosumab, a human monoclonal antibody, is used for the prevention of malignant tumor-related bone events and the treatment of osteoporosis with high fracture risk. Since its approval in China in 2019, denosumab-related osteonecrosis of the jaw (DRONJ) has attracted increasing attention. DRONJ, similar to bisphosphonate-related osteonecrosis of the jaw, often occurs after tooth extraction and manifests as exposed bone necrosis, purulent discharge, facial swelling and pain, severely impacting patients' quality of life. However, the perioperative management strategies for DRONJ differ from those for bisphosphonate-related osteonecrosis of the jaw. This article summarizes the perioperative management strategies for high-risk DRONJ patients from aspects such as oral hygiene care, antibiotic use, drug discontinuation during the perioperative period, and surgical strategy selection, aiming to provide guidance for oral surgeons in managing tooth extraction in denosumab-treated patients.

Spindle Cell Sarcoma of the Maxilla: A Rare Entity, Case Report, and Review of the Literature.

Spindle cell sarcoma (SCS) is a malignancy, with the most recent Surveillance, Epidemiology, and End Results (SEER) data citing a total of 250 reported cases occurring in the head and neck. Of these cases, none originated in the maxillofacial hard tissue. The diagnosis of SCS requires its differentiation from other sarcomas and spindle cell neoplasms. Therefore, a comprehensive review to reinforce its inclusion in oral and maxillofacial surgeons' differential diagnosis for osseous neoplastic pathology is desired. In the present case report, we have described a recurrent case of Maxillary Undifferentiated Spindle cell sarcoma in a 11 year old male child post chemoradiotherapy which was excised intoto successfully .

The awareness and attitudes of oral disease specialists, pathologists, and maxillofacial surgeons in oral exfoliative cytology in Kerman, Iran

Background: The present work examines the awareness and attitudes of specialists in oral diseases, pathology, and maxillofacial surgery in 2022 regarding oral exfoliative cytology. Methods: This study was an analytical and cross-sectional research. The statistical population of the present study included Iranian oral disease specialists, pathologists, and maxillofacial surgeons. A researcher-made questionnaire was given to the specialists by a senior (final-year) student. The results were analyzed using the chi-square test and t-test using SPSS 18 software. The significance level in data analysis was P<0.05. Results: A total of 192 questionnaires were completed in the study; the study revealed that only 18 participants used the exfoliative cytology technique. Moreover, 62% of people had a positive attitude towards the application and performance of cytology. There was a significant relationship between positive attitude, field of study, graduation year, and age. The mean awareness scores in men and women were 32.38±4.21 and 34.42±3.89, respectively. The participants had a high awareness and positive attitude towards this technique. Additionally, the mean awareness scores of oral specialists, surgeons, and pathologists were 33.12±4.23, 33.65±5.12, and 33.45±5.34, respectively. Conclusion: The study revealed that only 9.4 percent of participants used the exfoliative cytology technique. However, they were highly aware of and had a positive attitude to this technique.

Utilizing Deep Learning for Diagnosing Radicular Cysts.

The purpose of this study was to develop a deep learning algorithm capable of diagnosing radicular cysts in the lower jaw on panoramic radiographs. In this study, we conducted a comprehensive analysis of 138 radicular cysts and 100 normal panoramic radiographs collected from 2013 to 2023 at Clinical Hospital Dubrava. The images were annotated by a team comprising a radiologist and a maxillofacial surgeon, utilizing the GNU Image Manipulation Program. Furthermore, the dataset was enriched through the application of various augmentation techniques to improve its robustness. The evaluation of the algorithm's performance and a deep dive into its mechanics were achieved using performance metrics and EigenCAM maps. In the task of diagnosing radicular cysts, the initial algorithm performance-without the use of augmentation techniques-yielded the following scores: precision at 85.8%, recall at 66.7%, mean average precision (mAP)@50 threshold at 70.9%, and mAP@50-95 thresholds at 60.2%. The introduction of image augmentation techniques led to the precision of 74%, recall of 77.8%, mAP@50 threshold to 89.6%, and mAP@50-95 thresholds of 71.7, respectively. Also, the precision and recall were transformed into F1 scores to provide a balanced evaluation of model performance. The weighted function of these metrics determined the overall efficacy of our models. In our evaluation, non-augmented data achieved F1 scores of 0.750, while augmented data achieved slightly higher scores of 0.758. Our study underscores the pivotal role that deep learning is poised to play in the future of oral and maxillofacial radiology. Furthermore, the algorithm developed through this research demonstrates a capability to diagnose radicular cysts accurately, heralding a significant advancement in the field.

Liver Clot: The Rare Post-Extraction Complication Striking within 72 Hours

Oral and Maxillofacial Surgeons may encounter complications while performing major as well as minor surgical procedures, either intraoperatively or postoperatively. Bleeding after a dental extraction is a frequent complication following surgery. This article discusses an uncommon postoperative complication characterized by prolonged bleeding and the formation of a "liver clot" coagulum, observed 72 hours following the extraction of root stump in an elderly female during a follow-up visit.

Is ChatGPT an Accurate and Readable Patient Aid for Third Molar Extractions?

Artificial intelligence (AI) platforms such as Chat Generative Pre-Trained Transformer (ChatGPT) (Open AI, San Francisco, California, USA) have the capacity to answer health-related questions. It remains unknown whether AI can be a patient-friendly and accurate resource regarding third molar extraction. The purpose was to determine the accuracy and readability of AI responses to common patient questions regarding third molar extraction. This is a cross sectional in-silico assessment of readability and soundness of a computer-generated report. Not applicable. Accuracy, or the ability to provide clinically correct and relevant information, was determined subjectively by 2 reviewers using a 5-point Likert scale, and objectively by comparing responses to American Association of Oral and Maxillofacial Surgeons (AAOMS) clinical consensus papers. Readability, or how easy a piece of text is to read, was assessed using the Flesch Kincaid Reading Ease (FKRE) and Flesch Kincaid Grade Level (FKGL). Both assess readability based on mean number of syllables per word, and words per sentence. To be deemed "readable", FKRE should be >60 and FKGL should be <8. Not applicable. Descriptive statistics were used to analyze the findings of this study. AI-generated responses above the recommended level for the average patient (FKRE: 52; FKGL: 10). The average Likert score was 4.36, suggesting that most responses were accurate with minor inaccuracies or missing information. AI correctly deferred to the provider in instances where no definitive answer exists. Of the responses that addressed content in AAOMS consensus papers, 18/19 responses closely aligned with them. All prompts did not provide citations or references. AI was able to provide mostly accurate responses, and content was closely aligned with AAOMS guidelines. However, responses were too complex for the average third molar extraction patient, and were deficient in citations and references. It is important for providers to educate patients on the utility of AI, and to decide whether to recommend using it for information. Ultimately, the best resource for answers is from the practitioners themselves because the AI platform lacks clinical experience.

To what extent is oral and maxillofacial surgery educational content posted on Instagram?

Hashtags on Instagram help users globally search for posts to their liking. This study aimed to determine who posts the most popular oral and maxillofacial surgery (OMS) hashtags on Instagram and to evaluate the impact of educational content. The posts were analyzed for the type of post and differences between content creators when posting OMS-related content. This cross-sectional study evaluated OMS content categorized by 36 hashtags. The top 9 posts with each hashtag were evaluated based on the type of content creator, if it was a video or picture, and if it was educational or for marketing purposes. 6 million posts existed among 36 hashtags. Regarding the categories of person/organization posting the content (US or non-US oral and maxillofacial surgeon, residency program, patient, and ‘other’), the top posts (N = 295) were posted by ‘other’ and the least by ‘residency program’. Among the posts by non-US oral and maxillofacial surgeons, there was 3.8-fold more marketing content, while among the posts by US oral and maxillofacial surgeons, there was 2-fold more educational content. Educational posts achieved the highest engagement in terms of ‘likes’. This study highlights how oral and maxillofacial surgeons can educate the general population and expand their reach.

Knowledge, Perception, and Awareness of the Specialty of Oral and Maxillofacial Surgery Among the Public and Medical Field in Hail, Saudi Arabia: A Cross-Sectional Study.

Aim and background Oral and maxillofacial surgery is a crucial medical specialty focused on diagnosing, treating, and preventing diseases and injuries affecting the oral cavity, jaw, and face. There is a lack of awareness about this field in the specific study area of hail. This study aimed to assess the knowledge, awareness, and perception of maxillofacial surgery among healthcare professionals and the public. Methods The study included 225 participants, consisting of dental and medical professionals and the general public in Hail, Saudi Arabia. Convenience sampling was employed, and participants needed to be at least 20 years old and residents of Hail. A validated online questionnaire, translated into Arabic, was used for data collection. Results A proportion (78.2%) of dental professionals were aware of the specialty of oral and maxillofacial surgery. Among the general population and most medical professionals, the most commonly associated procedures with maxillofacial surgery were the treatment of injuries, bone fractures, and morphological changes in the mouth, jaw, and face, reported by 85.8% of the participants. Furthermore, 60.9% of the participants believed that maxillofacial surgery was the appropriate referral for cleft lip correction. Conclusion The study highlighted significant knowledge about the role of oral and maxillofacial surgeons among the target population. Out of the 225 participants, 137 participants (60.9%) chose thespecialty of maxillofacial surgery for surgical intervention to treat cleft lips. Moreover, 75.1% (n = 169) of the participants had previously heard about oral and maxillofacial surgery, while 24.9% (n = 56) had never heard of this specialty. The findings also showed that 189 participants were not aware that a maxillofacial surgeon is responsible for treating severe deformities that cannot be eliminated using orthodontics, such as growth disorders, hypoplasia and hypoplasia of the lower jaw, and asymmetry of the lower jaw (prognathism and retrognathism of the jaw). To bridge this knowledge gap, it is crucial to implement targeted educational initiatives and awareness campaigns among both the general population and healthcare professionals. By increasing awareness and understanding of the specialized role of oral and maxillofacial surgeons, patient care can be optimized, and appropriate referrals to these specialists can be ensured. Clinical significance This study shows the importance of increasing awareness of oral and maxillofacial surgery among health professionals and the general public. Improved understanding of this specialty can lead to better patient outcomes and early referrals.

Can ChatGPT-4o provide new systematic review ideas to oral and maxillofacial surgeons?

ObjectiveThis study aims to evaluate the capacity of ChatGPT-4o to generate new systematic review ideas in the field of oral and maxillofacial surgery. The data obtained from this study will provide evidence-based information to oral and maxillofacial surgeons regarding the academic use of GPT-4o. Materials and methodsChatGPT-4o was asked to provide four previously unpublished systematic review ideas each for the topics of impacted third molars, dental implants, orthognathic surgery, and temporomandibular disorders. A literature search was conducted in the PubMed database to check if the ideas generated by GPT-4o had been previously published, and the search results were compared with the ideas generated by the AI. ResultsThe PubMed database search resulted in a total of 871 publications, with 37 publications found to be related to the topics generated by GPT-4o after the first and second screening. Out of the 16 publication ideas generated by GPT-4o, 9 (56.25 %) were determined to be previously unexplored according to the PubMed database search. There was no statistically significant relationship between the presence of ChatGPT's suggestions in PubMed and the subject areas of the studies. ConclusionChatGPT-4o has a high potential to be used as a valuable tool for suggesting systematic review topics in oral and maxillofacial surgery. Additionally, this tool can assist researchers not only in proposing publication ideas but also in developing the methodology of the study.

Craniomaxillofacial landmarks detection in CT scans with limited labeled data via semi-supervised learning

BackgroundThree-dimensional cephalometric analysis is crucial in craniomaxillofacial assessment, with landmarks detection in craniomaxillofacial (CMF) CT scans being a key component. However, creating robust deep learning models for this task typically requires extensive CMF CT datasets annotated by experienced medical professionals, a process that is time-consuming and labor-intensive. Conversely, acquiring large volume of unlabeled CMF CT data is relatively straightforward. Thus, semi-supervised learning (SSL), leveraging limited labeled data supplemented by sufficient unlabeled dataset, could be a viable solution to this challenge. MethodWe developed an SSL model, named CephaloMatch, based on a strong-weak perturbation consistency framework. The proposed SSL model incorporates a head position rectification technique through coarse detection to enhance consistency between labeled and unlabeled datasets and a multilayers perturbation method which is employed to expand the perturbation space. The proposed SSL model was assessed using 362 CMF CT scans, divided into a training set (60 scans), a validation set (14 scans), and an unlabeled set (288 scans). ResultThe proposed SSL model attained a detection error of 1.60 ± 0.87 mm, significantly surpassing the performance of conventional fully supervised learning model (1.94 ± 1.12 mm). Notably, the proposed SSL model achieved equivalent detection accuracy (1.91 ± 1.00 mm) with only half the labeled dataset, compared to the fully supervised learning model. ConclusionsThe proposed SSL model demonstrated exceptional performance in landmarks detection using a limited labeled CMF CT dataset, significantly reducing the workload of medical professionals and enhances the accuracy of 3D cephalometric analysis.

Golden hour intervention by maxillofacial surgeons in the emergency room: a case report

Golden hour intervention by maxillofacial surgeons in the emergency room: a case report

Risk prediction of complicated course in patients undergoing major head and neck surgery with free flap reconstruction

The British Association of Oral and Maxillofacial Surgeons (BAOMS) Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) reconstructive audit aims to provide surgical teams with risk adjusted comparative performance data. The goal is to enable surgeons to optimise surgical pathways. Risk adjustment requires that data on appropriate predictive variables are collected. This study looked at variables predicting major complications and flap failure in a single institution with the aim of determining whether the QOMS dataset adequately captures the appropriate data points. A prospective database of head and neck flap procedures and associated postoperative complications has been maintained in the maxillofacial surgery department since August 2009 up to August 2022 (n=1327). A total of 25 putative risk variables were extracted from the health records for each patient. The outcomes of interest were total flap failure and major complications. Independent predictors of flap failure were recipient site (sinonasal/anterior skull base), previous major surgery, previous major surgery and radiotherapy, and flap selection. For major complications ACE-27 comorbidity score, flap type, use of tracheostomy, elevated preoperative plasma C-reactive protein (CRP) and flap selection were independently predictive. Apart from preoperative activated innate immunity all relevant risk stratification variables identified in this study form part of the QOMS dataset. QOMS is therefore likely to adequately risk stratify patients based upon currently collected variables.