Maxillofacial Research Articles

External fixation for tissue preservation following complex mandible trauma and its sequelae: reminder of a time-honored method and case-series of 23 patients

ObjectiveOral and maxillofacial surgeons are often called upon to manage complex mandible injuries, which can be associated with significant tissue loss. External fixation (EF) of comminuted, contaminated, compound and infected fractures can preserve tissue, maintain anatomic integrity, and provide an effective stage in comprehensive reconstruction. The purpose of this report is to review the EF surgical technique and share our outcomes and experience of using EF over six years in 23 patients. Study DesignPatients treated with mandibular EF were identified through a retrospective chart review for a single surgeon. Assessment of surgical outcomes included: evaluation of tissue preservation via clinical and radiographic exams; patients’ subjective tolerance of the treatment; and a need for further reconstructive surgery. ResultsWe identified and reviewed 23 patients who were treated with mandibular EF between September 2018 - June 2024. Diagnostic fracture categories for which the EF was used include: pathologic, infected with non-union, subacute with infection, acute comminuted and compound, and ballistic. Treatment was well accepted and tolerated by most patients largely due to pain relief post-fixation. ConclusionsEF allowed anatomic reduction and healing in patients with acute injuries, served to temporarily stabilize fractures with gap defects, and was excellent for infected fractures. There were no instances of external fixator hardware failure or infection, including in patients with consistently poor hygiene.

Covid-associated osteonecrosis of the midface

The purpose of our study the features of clinical manifestations and treatment of Covid-associated osteonecrosis of the midface (rhinocerebral form of mucormycosis). An analysis of the clinical features and results of surgical treatment of 35 patients with Covid-associated osteonecrosis of the midface was carried out. Difficulties in diagnosing of Covid-associated osteonecrosis led to late hospitalization and extensive surgical treatment with the huge defects formation. Due to the nonspecificity of clinical symptoms and the difficulties of early diagnosis and differential diagnosis of invasive rhinocerebral forms of mucormycosis, the aggressive clinical course with the formation of extensive defects in the midface, long and complex rehabilitation of patients with Covid-associated osteonecrosis of the midface, the vigilance of general practitioners is necessary and specialists: dental surgeons, maxillofacial surgeons, ophthalmologists, otolaryngologists, neurologists, regarding the possibility of developing invasive aggressive forms of mycoses in immunocompromised patients who have suffered a new coronavirus infection COVID-19.

3D surgical microscopes for oral surgical procedures

We look at how 3D microscopes can aid oral surgeons in real time and allow for more accurate treatment.

Ekstrakcije zob pri bolnikih s prirojeno motnjo hemostaze – sodelovanje med strokama

Surgical removal of teeth is the most common surgical procedure for people with hereditary bleeding disorders (HBD). To prevent excessive bleeding during and after the procedure, for people with HBD, even with mild forms of the disease, the procedure is planned with the cooperation of a maxillofacial or oral surgeon and a haematologist. Bleeding after tooth extraction can also be the first manifestation of a mild form of yet unrecognized HBD when the surgeon refers the patient to a haematologist for diagnosis and treatment due to excessive bleeding after the procedure.

Development and application of digital technology in craniomaxillofacial surgery

The treatment of craniomaxillofacial (CMF) defects and deformities is highly challenging due to the complex anatomical structures, significant individual variations and high demands for personalized reconstruction. In recent decades, the integration of cutting-edge technologies from fields such as computer science, mechanical engineering, and material science into medicine has greatly facilitated the transformation of CMF surgery from traditional, experience-based approaches to digitalized and intelligent methods. This review thoroughly analyzes the development and application areas of digital technology in CMF surgery including virtual surgical planning and facial prediction, three-dimensional printing, computer-assisted navigation and robotic surgery, virtual and mixed reality, as well as big data and artificial intelligence technologies. The aim is to offer comprehensive and in-depth reference information for the clinical practice in digital CMF surgery.

Towards Wiser Prescribing of Antibiotics in Dental Practice: What Pharmacists Want Dentists to Know

Antibiotics have various indications for treatment and prophylaxis in dental practice. While only a handful of antibiotics are typically prescribed in dentistry, unlike in medicine, clear indications and appropriate dosing and duration remain controversial among antibiotic-prescribing dentists, which may result in inappropriate or excessive antibiotic prescriptions. This practice can increase the risk of antibiotic resistance and expose patients to unnecessary side effects. Moreover, the concept of antibiotic stewardship in dental practice remains in its early stages. This review was developed by pharmacists (general and infectious disease pharmacists) in collaboration with a periodontist and a maxillofacial surgeon to provide an antibiotic prescription guide for dentists who frequently prescribe antibiotics. It also sheds light on antibiotic stewardship. The review discusses in detail antibiotic indications for treatment and prophylaxis in dental practice and provides tables that can be used by dentists in their everyday practice. It also discusses the concept of antibiotic stewardship and provides recommendations that can be applied to the practice of antibiotic prescribing in dentistry. Antibiotic prescribing in dental practice should be limited to cases with documented infections or when indicated for prophylaxis. Every dentist can act as an antibiotic steward by prescribing antibiotics wisely and only when necessary, using their discernment to identify appropriate cases and exclude those that do not meet infection criteria. Collaboration with pharmacists is encouraged to provide such recommendations and implement antibiotic stewardship interventions, such as developing antibiotic prescription protocols.

Squamous Cell Carcinoma Arising in a Squamous Odontogenic Tumor of the Maxilla: Case Report and Review of the Literature.

Squamous odontogenic tumor (SOT) is an exceedingly rare, benign epithelial odontogenic tumor showing squamous differentiation. It is composed of variably sized and shaped islands of cytologically bland, mature squamous epithelium within a fibrous stroma. In this report, we present a rare transformation of a squamous odontogenic tumor (SOT) of the maxilla into a well-differentiated squamous cell carcinoma (SCC) with involvement of the pterygoid plates. To the best of our knowledge, only two cases of malignant transformation of SOT has been reported in the literature. Herein, we seek to report this extremely rare occurrence to raise awareness of oral and maxillofacial surgeons and pathologists of this unusual, but serious event and perform a literature review of squamous odontogenic tumors.

P-56037191-1383 - How the angle of dental implants is affected by the experience of oral and maxillofacial surgeons?

P-56037191-1383 - How the angle of dental implants is affected by the experience of oral and maxillofacial surgeons?

Antibiotic use in pediatric dental infections: knowledge and awareness levels of dentists

Antibiotics are crucial in treating infections; however, their unnecessary and incorrect use can lead to numerous health issues, notably antibiotic resistance. Evaluating the accuracy and awareness of antibiotic prescription practices among dentists, who play a significant role in antibiotic use, is critical in developing effective health policies and professional training programs. This study assesses dentists’ knowledge levels and practice habits regarding antibiotic use. Using a structured questionnaire, the research employed a cross-sectional design and was conducted with 202 general dentists, 98 pediatric dentists, and 43 oral and maxillofacial surgeons. Data were analyzed using demographic characteristics, antibiotic prescription practices, and scenario-based questions measuring knowledge levels. The results revealed that while most participants were generally knowledgeable about antibiotic use, inconsistencies in prescription practices were evident. Notably, unnecessary antibiotic prescriptions were identified in some cases, contributing to significant health issues such as antibiotic resistance. This study emphasizes the necessity of promoting conscious antibiotic use by evaluating dentists’ practices. Therefore, the urgent need for developing professional training programs and strengthening strategies to combat antibiotic resistance is paramount.

Interdisciplinary Approaches by Polish Orthodontists, Periodontists, and Oral Surgeons to Soft Tissue Augmentation in Adult Patients: A Survey Study

This study evaluates the preferences of dentists regarding the interdisciplinary treatment of patients with gingival recession (GR) and a thin periodontal phenotype, based on their specialization. A cross-sectional study was conducted among Polish dentists, between May and October 2022, using an online survey. The dentists were first asked to provide details regarding their specialization and the length of their professional career. In the second part of the survey, they responded to questions about the preferred timing of a consultation and soft tissue augmentation in patients who planned to undertake orthodontic treatment (OT). Moreover, factors undermining the decision-making process regarding soft tissue augmentation and the methods used for the evaluation of periodontal tissues were assessed. In total, 554 dentists completed the survey, among whom 328 were orthodontists and 226 were periodontists/oral surgeons. A third of the surveyed periodontists/oral surgeons (33%) reported that they receive referrals from orthodontists prior to OT and 39% of orthodontists indicated that they refer patients for soft tissue augmentation before commencing OT. The majority of periodontists/oral surgeons (51%) and the most significant proportion of orthodontists (45%) agreed that the ideal timing of soft tissue augmentation is dependent on each specific case. Both groups of surveyed dentists considered “planned tooth movement” as the most important factor in clinical decision-making. Among the periodontists/oral surgeons, the most popular methods to assess periodontal tissues were: 3D radiological examination, the visual method, and gingival transparency with the use of a periodontal probe. On the other hand, the surveyed orthodontists preferred the visual method, followed by 2D radiological examination, and then by 3D radiological examination. The majority of surveyed periodontists/oral surgeons and orthodontists agreed that the ideal timing of soft tissue augmentation in patients undertaking orthodontic treatment should be decided on a case-by-case basis, with planned tooth movement being the determining factor.

Barriers and Willingness to Continue Using Telehealth Services Beyond the COVID-19 Pandemic from the Perspectives of Oral and Maxillofacial Surgeons in Australia: A Mixed-Method Study.

Patient demand for oral and maxillofacial telehealth services increased during COVID-19. To explore the potential for their continued use post-COVID-19, an assessment was conducted by examining the association between the clinical and socio-demographic characteristics of consultants and the perceived facilitators and barriers influencing their future intent. Practicing oral and maxillofacial consultants were recruited through purposive and snowball sampling methods. Data were collected through surveys and key informant interviews. Chi-square tests were used to determine whether consultants' clinical and socio-demographic characteristics and perceptions were associated with a willingness to use telehealth in the future. Coded interview transcripts were analyzed thematically to identify the main themes influencing their willingness. Among the 42 respondents, 82% expressed a willingness to continue using telehealth services with the majority having at least 2 to 3 years (p = 0.028) of experience utilizing these services. The four main themes impacting consultants willingness include the accessibility of oral and maxillofacial healthcare, challenges addressing patient needs, the uncertainty of diagnostic accuracy and effectiveness as a post-operation observation tool. Most oral and maxillofacial consultants favored the routine use of telehealth services beyond COVID-19. Concern for patients' needs was a key determinant of their continued use. Co-designing strategies to eliminate barriers and unmet needs for consultants and patients may improve oral and maxillofacial telehealth uptake.

Evaluation of validity and reliability of AI Chatbots as public sources of information on dental trauma.

This study aimed to assess the validity and reliability of AI chatbots, including Bing, ChatGPT 3.5, Google Gemini, and Claude AI, in addressing frequently asked questions (FAQs) related to dental trauma. A set of 30 FAQs was initially formulated by collecting responses from four AI chatbots. A panel comprising expert endodontists and maxillofacial surgeons then refined these to a final selection of 20 questions. Each question was entered into each chatbot three times, generating a total of 240 responses. These responses were evaluated using the Global Quality Score (GQS) on a 5-point Likert scale (5: strongly agree; 4: agree; 3: neutral; 2: disagree; 1: strongly disagree). Any disagreements in scoring were resolved through evidence-based discussions. The validity of the responses was determined by categorizing them as valid or invalid based on two thresholds: a low threshold (scores of ≥ 4 for all three responses) and a high threshold (scores of 5 for all three responses). A chi-squared test was used to compare the validity of the responses between the chatbots. Cronbach's alpha was calculated to assess the reliability by evaluating the consistency of repeated responses from each chatbot. The results indicate that the Claude AI chatbot demonstrated superior validity and reliability compared to ChatGPT and Google Gemini, whereas Bing was found to be less reliable. These findings underscore the need for authorities to establish strict guidelines to ensure the accuracy of medical information provided by AI chatbots.

Artificial Intelligence in Oral and Maxillofacial Surgery: Bridging the Gap between Technology and Clinical Practice a Narrative Review

Objective: To provide a comprehensive overview of current applications and future prospects of artificial intelligence (AI) in oral and maxillofacial surgery (OMFS), while critically analyzing implementation challenges and exploring potential advancements.  Methods A systematic literature review was conducted using PubMed/MEDLINE and Embase databases, encompassing English-language articles up to December 30, 2023. Search terms combined OMFS and AI concepts, with database-specific syntax employed.  Results AI applications in OMFS span multiple domains, including image analysis, surgical planning, intraoperative guidance, and clinical decision support. Deep learning models have demonstrated high accuracy in detecting mandibular fractures, performing cephalometric analyses, and classifying maxillofacial pathologies. AI-enhanced surgical planning and robotic systems show promise in improving precision and outcomes across various OMFS procedures. However, challenges persist in data quality, clinical validation, and seamless workflow integration.  Conclusions AI technologies have the potential to significantly enhance diagnostic accuracy, surgical precision, and treatment outcomes in OMFS. Future research directions include developing multimodal AI systems, advancing AI-powered surgical navigation, and exploring federated learning approaches. Successful implementation of AI in OMFS practice will require collaborative efforts among clinicians, researchers, engineers, and policymakers to address technical, ethical, and regulatory challenges. As these hurdles are overcome, AI is poised to become an integral part of OMFS, augmenting surgical capabilities and elevating patient care standards.

Buccal fat pedicle flap with a delayed tarsoconjunctival flap for lower eyelid retraction: a new surgical methodology.

The aim of this retrospective case review is to present a novel surgical technique used in the treatment of recalcitrant lower eyelid retraction. This study was performed as a retrospective case review of 4 patients who have failed standard conservative surgical interventions for lower eyelid retraction repair. 3 patients developed lower eyelid retraction following surgical intervention for orbital trauma and 1 patient developed lower eyelid retraction in the setting of granulomatosis with polyangiitis. The surgical technique was identical in each patient and performed by an oculofacial plastic surgeon, sometimes together with an oral and maxillofacial surgeon. Follow-up results for all patients were assessed at 1 week, 1 month, and 3 months. All four patients demonstrated initial improvement in lower eyelid position, fullness, and height. A common finding was mild lateral postoperative entropion, which was easily overcome with an upper eyelid tarsoconjunctival flap. There were no surgical complications sustained in any of the cases. This retrospective case review provides a novel surgical option for the correction of recalcitrant lower eyelid retraction. The excellent vascularity provided by this flap, location, and easy access support its use. A prospective study comparing alternative solutions would be useful in comparing the buccal fat pad vascularized pedicle to alternative methods used to correct refractory and cicatricial lower eyelid retraction.

Microsurgical Treatment of a Large Through-and-Through Periapical Lesion with Apicomarginal Defect using Guided Tissue Regeneration (GTR): A Case Report of a Two-Year Follow-Up

In case of a long-term periapical lesion, destruction of both vestibular and oral cortical plates is sometimes observed and even a through-and-through periapical lesion occurs. The success of the treatment decreases when an apicomarginal defect is added to the through-and-through periapical lesion. Large periapical lesions should be treated initially by orthograde root canal therapy. When the signs and symptoms of the infection don’t recede after the treatment, then surgical approaches should be considered. In this case report, a 22-year-old female with previously initiated therapy was referred for an endodontic microsurgery of tooth 22 (i.e., upper left lateral incisor). After the endodontic treatment the patient was referred to the oral surgeon for apicoectomy with augmentation of the bone defect. The sinus tract in the apex area of the tooth 22 remained active since the surgical intervention. Endodontic microsurgery and guided tissue regeneration were performed. The article presents diagnostic data, namely pre- and post-operative images of cone beam computed tomography (after 2 years), as well as pre-, intra- and post-operative clinical images. All pre- and intraoperative procedures and stages are detailed. In particular, separation of platelet-rich fibrin (PRF) from venous blood, retrograde preparation with an ultrasonic tip and a device using a dental operating microscope and the use of a collagen membrane. After two-year follow-up, radiographic examination revealed significant bone reconstruction and clinical signs and symptoms were absent. The patient hasn’t reported any symptoms since. The paper also analyzes scientific sources on the use of PRF and collagen membranes in bone defects of the jaws. Attention is also paid to the formation of a flap during operations of this type. The main six success factors in the treatment of such complex cases are highlighted. Rethinking the previously performed surgery (apicoectomy) in this patient, attention was paid to the main five factors that could contribute to the failure.

Distribution of Specialties Providing Surgical Management of Cleft-Related Speech Disorders in Children 3 years of Age and Older: 2004 to 2021.

Given the overlap in specialties performing secondary correction of velopharyngeal incompetence (VPI), the present study investigated the specialty distribution for surgical providers of cleft care from 2004 to 2021. Data were obtained from 45 hospitals from 2004 to 2021 through the Pediatric Health Information System database. Cases of secondary surgical management of VPI were retrieved, identifying the year of surgery and specialty of the providing surgeon. A total of 7090 procedures were included in this study, of which 36.0% were secondary palatoplasty/lengthening, 34.1% were sphincter pharyngoplasty, and 29.8% were pharyngeal flap. Secondary management of VPI was performed by plastic surgeons (67%), otolaryngologists (31%), and oral and maxillofacial surgeons (OMFS, 12%). Palatal revision and/or lengthening procedures were the most common secondary procedure performed by plastic surgeons (42%) and OMFS (64%), whereas sphincter pharyngoplasty was the most common procedure performed by otolaryngologists (55%; P<0.001). The proportion of sphincter pharyngoplasty performed by plastic surgeons significantly decreased from 2017-2021 (P<0.05). Plastic surgeons performed most procedures for secondary management of VPI from 2004 to 2021, followed by otolaryngologists and OMFS. The type of procedure selected for secondary management of VPI differed significantly between the provider's specialty, with otolaryngologists more likely to perform sphincter pharyngoplasty.

Mandibular second molar impaction: introducing a novel and validated 3D classification system

BackgroundMandibular second molar (M2M) impaction is a clinically significant manifestation of eruption disturbance in dental development. The primary aim of this study was to investigate the impact of the three-dimensional (3D) characterization on clinical and therapeutic decisions for M2M impaction. The secondary aim was to introduce a validated 3D classification system incorporating both surgical and orthodontic parameters.MethodsBidimensional (2D) and 3D radiological records of 15 impacted M2M were collected and deidentified. Ten experienced clinicians (5 oral surgeons;5 orthodontists) categorized each case, first based on 2D records and then with 3D scans. The degree of orthodontic and surgical difficulty in treating impacted M2M was evaluated using a novel classification system based on anatomical and radiological features. The primary outcome variable was the assessment of differences in diagnosis and decision-making protocol using 2D or 3D records, where clinical relevance ranged from 0 to 4. The secondary outcome variable was the validation analysis of the proposed 3D classification system to determine the concordance among the clinicians. Descriptive statistics and multivariable inferential analysis based on Akaike information criterion (AIC) were performed (α = 0.05).Results3D examination allowed a better visualization of M2M impaction with higher clinical relevance for diagnosis of M2M root relationship to alveolar nerve and lingual plate, height to alveolar crest, depth, and inclination relative to the first molar and position relative to the third molar (range:2.69–3.43). The proposed 3D classification of M2M impaction changed clinical decisions regarding surgical-orthodontic approach, biomechanics, patient education, and treatment time estimate (range:2.59–3.33). In the validation analysis of the classification, no evidence of inter- or intra-group (surgeon/orthodontist) bias in score attribution occurred: the model with the minimum AIC was the null model (AIC = 718.04).Conclusion3D evaluation of impacted M2Ms could enhance diagnostic accuracy, and a classification system was proposed and validated by a group of experienced surgeons and orthodontists with high concordance.

Overview of the development of temporomandibular joint surgery in China from the perspective of oral and maxillofacial surgeons

Temporomandibular joint (TMJ) surgery in China, as an important part of oral and maxillofacial surgery, has made significant progress in the past 20 years. It is mainly reflected in the reduction of TMJ dislocated joint disc, prosthetic total TMJ reconstruction, and the treatment of adult condylar fracture. There are major controversies about the surgical methods and indications for the reduction of the dislocated/displacement joint disc of the temporomandibular disorders.

Assessing Use and Familiarity of Enhanced Recovery After Surgery Elements in Pediatric Orthognathic Surgery

Enhanced recovery after surgery (ERAS) protocols have informed perioperative care across multiple surgical specialties, optimizing patient outcomes through surgical stress management and accelerated recovery. This study evaluates the familiarity and adoption of ERAS elements among craniofacial and oral and maxillofacial surgeons in pediatric orthognathic surgery, a field where a formal ERAS protocol has not been established. A closed-ended survey of 102 surgeons was conducted to assess familiarity with and utilization of 14 ERAS elements. The survey garnered a 40.2% response rate, with 41 surgeons participating. The majority of respondents (68.3%) specialized in craniofacial (CF) surgery, and their annual pediatric orthognathic surgery caseload varied widely. Key findings revealed that 7 ERAS elements were widely adopted, including hypothermia prevention, normovolemia maintenance, intraoperative tranexamic acid use, and minimized opioid use for postoperative pain control. However, elements such as liposomal bupivacaine and postoperative goal-directed fluid therapy were less utilized, primarily due to limited availability or knowledge. Surgeons demonstrated high familiarity with elements like jaw immobilization and minimizing opioid use but showed knowledge gaps in areas such as preoperative nutritional screening and goal-directed fluid therapy. These insights underline the need for further education and the development of a standardized ERAS protocol tailored for pediatric orthognathic surgery. The study underscores the importance of multidisciplinary collaboration and comprehensive preoperative education in implementing ERAS protocols. This study serves as a foundation for future research into optimizing perioperative care for pediatric patients undergoing orthognathic surgery.

The Most Influential Publications in Oral and Maxillofacial Surgery Over the Past Decade

Reliable metrics are needed to measure the impact of academic publications in order to fully understand and evaluate the contributions of articles published in the field of oral and maxillofacial surgery(OMFS). The aim was to identify and analyze the top 100 articles each year, with the highest Field-Weighted Citation Impact(FWCI) and citation counts, in the field of OMFS over the past decade, totaling 1,000 articles. The research was conducted on April 20, 2024, using the Scopus database. It identified the top 100 articles each year with the highest FWCI from the top six journals with the highest metric scores in OMFS, totaling 1,000 articles. The citation counts of these publications in Google Scholar were also recorded. The predictor variable was the articles. The primary outcome variable was the FWCI value, while the secondary outcome variable was the number of citations. The covariates were the journals in which the articles were published, the publication year, the type of document, the type of access policy, and the subject of the research. There was a weak positive correlation between FWCI and citation count(rho = 0.083, P = .009). All covariates significantly affected FWCI(P < .005), while all but access policy significantly affected citation count(P = .167). The highest average FWCI(6.31 ± 5.51) was observed in the Journal of Stomatology, Oral and Maxillofacial Surgery(JSOMS), and the highest citation count was found in the Journal of Oral and Maxillofacial Surgery(JOMS)(61.5 ± 126.4). Orthognathic Surgery and Dentofacial Deformities were the scientific fields with the most publications(14 %). COVID-19 and Artificial Intelligence had the highest FWCI(8.65 ± 10.98 and 7.68 ± 6.42, respectively). MRONJ had the highest average citation count(88.6 ± 254). This study demonstrates that using both FWCI and citation count metrics can more accurately assess the impact of academic publications in the field of OMFS. These findings can serve as a guide for future research and contribute to strategic decisions aimed at improving clinical practices and patient care.