Maxillofacial Research Articles

Evolution of Virtual Surgical Planning Use Among Craniofacial Surgeons

Virtual surgical planning (VSP) has benefits in craniofacial surgery with growing popularity. However, while specific use cases are highlighted in the literature, no studies exist providing an overview of VSP use among craniofacial surgeons, and little is known about the extent of exposure to VSP during plastic surgery training. This study surveyed members of The American Society of Maxillofacial Surgeons (ASMS) to better characterize both the landscape of VSP use among practicing craniofacial surgeons and the extent of exposure to VSP throughout surgical training. An electronic survey was administered in the fall of 2023. Response data included surgeon demographics, VSP usage, including the use in residency/fellowship, procedures for which VSP is used, and assessment of VSP’s impact on the surgeon’s practice. Demographics and VSP use were analyzed using descriptive statistics, while categorical and continuous variables were analyzed using χ2 tests and t-tests, respectively. Of the 44 respondents, 40 (90.9%) completed a craniofacial surgery fellowship, and 18 (40.9%) utilized VSP in either residency or fellowship. In respondents’ current practice, VSP is utilized most commonly for orthognathic surgery (n=32, 91.4%), postablative reconstruction (n=23, 82.1%), and facial feminization (n=11, 73.3%). Shorter operative time and improved esthetic outcomes were frequently reported as benefits derived from VSP use. Finally, surgeons in practice for less than 10 years were significantly more likely to have used VSP in both residency (OR=20.3, P<0.01) and in fellowship (OR=40.6, P<0.01) than those practicing for more than 10 years. These findings suggest that craniofacial surgeons apply VSP more commonly for certain procedure types. Our results additionally suggest that incorporation of VSP into residency and fellowship training has become significantly more common over time, with a pivot towards integration in the last decade.

A serial case study of the combined use of intraoperative CT and surgical navigation system for the removal of small foreign bodies in the maxillofacial region

PurposeThe removal of small foreign bodies embedded within the deep soft tissues of the maxillofacial region is a complex and challenging task for maxillofacial surgeons. The purpose of this study was to explore the efficacy of the combination of intraoperative CT and surgical navigation for the removal of small foreign objects in the maxillofacial region. MethodsA serial case study was conducted involving all consecutive patients who underwent surgical removal of small foreign bodies in the maxillofacial region. The combination of intraoperative CT and a surgical navigation system was used at a single medical institution from January 2018 to December 2022. Comprehensive data, including patient demographics, characteristics of the foreign bodies, previous surgical interventions, duration of the surgical procedure, and removal success rate were collected for this study. Relevant data were recorded into Microsoft Excel sheet and analyzed using SPSS version 22.0. ResultsNine patients (6 males and 3 females) were included in this study, with an average age of 37 years. Each patient had previously undergone an unsuccessful removal attempt utilizing conventional surgical methods based on preoperative CT imaging or C-arm guidance at a local healthcare facility. Four patients also experienced unsuccessful attempts with preoperative CT image-based navigation systems. However, by employing the combined approach of intraoperative CT and surgical navigation, the foreign bodies were successfully removed in all 9 patients. The mean duration of the surgical procedure was 59 min, and the average size of the foreign bodies was approximately 26 mm³. Postoperative follow-up exceeding 6 months revealed no complications. ConclusionThe combined use of a surgical navigation system and intraoperative CT represents a potent and effective strategy for the precise localization and subsequent removal of small foreign bodies from the soft tissue structures of the maxillofacial region. This integrative approach appears to increase the success rate of surgical interventions in such cases.

Attitudes of Oral Surgeons and Periodontists towards Immediate Dental Implant Placement.

This cross-sectional study aimed to evaluate the factors that determine the choice of oral surgeons and periodontists to perform immediate dental implant placement. An anonymous survey was carried out from January 6, 2024 to February 29, 2024. The questionnaire was distributed online to Lithuanian specialists - oral surgeons and periodontists, who perform implantation procedures. A total of 186 professionals were included in this survey. Chi-square test, its degrees of freedom was used for the analysis of variables. The main reason for refusing immediate implant placement is a periapical lesion greater than 5 mm, reported by 91.7% of oral surgeons and 96.9% of periodontists. Good aesthetics and preservation of anatomical structures are identified as an advantage by 99.2% of oral surgeons and 92.3% of periodontists. In the aesthetic zone, for periodontists, the main criterion for choosing a method is the quantitative and qualitative indicators of the soft tissue of the extraction socket 96.9%, and for oral surgeons - the morphology of the bone walls of the socket 87.6%. Only 43.1% of periodontists and 33.9% of oral surgeons are familiar with and use extraction socket morphology assessment classifications for immediate dental implant placement. Taking into account study's results, it is recommended to adjust the teaching programs at Universities and to increase the knowledge of specialists performing dental implantation procedures, by carrying out continuous educational programs.

Procedure for Certification of Stomatologists (Dentists) and Maxillofacial Surgeons in Ukraine as of 2024: Analysis of General Provisions and Provisions on Certification Commissions

Each country has different legislative features of continuing professional development (CPD) of doctors and corresponding state сertification. The purpose of this paper is to highlight and to make the quick analysis of two aspects of the Procedure for Certification of Stomatologists and Maxillofacial Surgeons of the Order of the Ministry of Healthcare of Ukraine dated February 22, 2019, No. 446 (as amended by the Order of the Ministry of Healthcare of Ukraine dated August 18, 2021, No. 1753). First aspect is General Provisions of the Procedure for Certification of Doctors and second ascpect is Provision on Certification Commissions. The General Provisions include seven clauses, and the Provisions on Certification Commissions include 11 detailed clauses. Clauses of the General Provisions include such topics as (1) the mechanism for the сertification of doctors, (2) tasks of conducting certification, (3) terminology, (4) types of certifications, (5) the List of medical positions in health care institutions, according to which certification is carried out, (6) the main place of work and part-time work during the certification, and (7) deadlines for submitting documents for the next voluntary certification. Clauses of the Provisions on Certification Commissions include information about (1) state bodies under which certification commissions are created, (2) the procedure for approving the personal composition of the certification commission, (3) composition of the Central Certification Commission, (4) composition of the certification commissions and its subcommittees, (5) the periodicity of renewal is not less than 1/3 of the composition of certification commissions, (6) quantitative composition of certification commissions at their meetings, (7) frequency of meetings of certification commissions, (8) the decision-making mechanism of commissions, (9) functions of the Central Certification Commission, (10) list of doctors certified by the Central Certification Commission, and (11) places of certification of doctors working in health care institutions that are part of the management of central executive bodies, other bodies where relevant certification commissions have been established. This certification procedure in Ukraine applies to doctors of all eight stomatological (dental) specialties, namely (1) doctors-stomatologists, (2)pediatric doctors-stomatologists, (3) doctors-stomatologists-orthodontists, (4) doctors-stomatologists-prosthodontists, (5) doctors-stomatologists-periodontists, (6) doctors-stomatologists-therapists, (7) doctors-stomatologists-surgeons, and (8) maxillofacial surgeons (also known as maxillofacial doctors-stomatologists). Certificate of assignment of a higher qualification category to a doctor-stomatologist-surgeon in the specialty “Surgical Stomatology” (also known as “Oral Surgery”) has been added to the article for clarity. This article provides a detailed analysis of the translation of the General Provisions and the Provisions on Certification Commissions as two basic parts of the Procedure for the certification of doctors in Ukraine.

Impact of Mucous Adhesive Membrane in Reducing Edema and Pain Post-Surgical Removal of Lower Wisdom Teeth

One of the most prevalent challenges that a specialized oral surgeon might encounter involves extracting impacted lower wisdom teeth, which can lead to post-operative complications like swelling and pain. Various techniques have been developed to mitigate these issues. In this research, we aimed to introduce a novel approach in oral surgery known as adhesive membrane oral aid. This study utilized a split-mouth design to assess the efficacy and impact of the adhesive membrane following the surgical removal of lower wisdom teeth in 10 patients. The split-mouth design enables both the control and study groups to be assigned within the same patient, reducing variability between different patients. The research involved a total of 10 patients who presented bilateral impaction of lower wisdom teeth and were recommended for surgical extraction. In the control group, the patient's ipsilateral side was sutured without the use of a membrane. After one month, the contralateral side of the same patient was sutured with a membrane using figure 8 sutures.

A New Method to Design and Manufacture a Low-Cost Custom-Made Template for Mandible Cut and Repositioning Using Standard Plates in BSSO Surgery.

In this study, a new methodology for designing and creating a custom-made template for maxillofacial surgery has been developed. The custom-made template can be used both for cutting and repositioning of the mandible arches for executing a BSSO (bilateral sagittal split osteotomy) treatment. The idea was developed in order to give the possibility of using a custom-made template with standard plates, thus reducing long times, high costs and low availability of custom-made plates; this represents the proof of novelty of the proposed template, based on a well-established methodology. The methodology was completely developed in the CAD virtual environment and, after the surgeons' assessment, an in-vitro experiment by a maxillofacial surgeon was performed in order to check the usability and the versatility of the system, thanks to the use of additive manufacturing technologies. When computer-aided technologies are used for orthognathic surgery, there are significant time and cost savings that can be realised, as well as improved performance. The cost of the whole operation is lower than the standard one, thanks to the use of standard plates. To carry out the procedures, the proposed methodology allows for inexpensive physical mock-ups that enable the BSSO procedure to be performed.

Evaluation of Turkish dentists’ knowledge about oral cancer and oral mucosal lesions

Background/purposeOral cancer, including malignancies of the tongue, lips, floor of the mouth, cheek mucosa, gums, palate, and oropharynx, is life-threatening. Early diagnosis and appropriate treatment are crucial for long-term survival. Dentists frequently encounter oral cancers due to the nature of their work. This study aimed to evaluate the knowledge and experience of dentists in Turkey regarding oral cancers.Materials and methodsA total of 361 participants were included in the study, and survey questions were sent via email. The survey consisted of 16 questions measuring demographic data and knowledge about oral cancerous lesions. Participants were grouped based on their specialization and knowledge level, and differences in responses among groups were examined.ResultsOnly 21.3% of the participants felt they had sufficient knowledge and experience about oral cancerous lesions. Overall, the correct answer rates indicated a moderate level of knowledge and experience. When grouped by specialization, oral surgeons had the highest accuracy in their responses (p < 0.05).ConclusionDentists are the professional group that most frequently encounters clinically oral cancerous lesions. Therefore, it is critically important for them to be knowledgeable and experienced to reduce morbidity and mortality through early diagnosis. This study evaluated the knowledge status of dentists in Turkey regarding oral cancer and highlighted the need for improved education.

Assessment of traumatic mandibular nerve using MR neurography sequence: a preliminary study

BackgroundIatrogenic mandibular nerve damage resulting from oral surgeries and dental procedures is painful and a formidable challenge for patients and oral surgeons alike, mainly because the absence of objective and quantitative methods for diagnosing nerve damage renders treatment and compensation ambiguous while often leading to medico-legal disputes. The aim of this study was to examine discriminating factors of traumatic mandibular nerve within a specific magnetic resonance imaging (MRI) protocol and to suggest tangible diagnostic criteria for peripheral trigeminal nerve injury.MethodsTwenty-six patients with ipsilateral mandibular nerve trauma underwent T2 Flex water, 3D short tau inversion recovery (STIR), and diffusion-weighted imaging (DWI) acquired by periodically rotating overlapping parallel lines with enhanced reconstruction (PROPELLER) pulse sequences; 26 injured nerves were thus compared with contra-lateral healthy nerves at anatomically corresponding sites. T2 Flex apparent signal to noise ratio (FSNR), T2 Flex apparent nerve-muscle contrast to noise ratio (FNMCNR) 3D STIR apparent signal to noise ratio (SSNR), 3D STIR apparent nerve-muscle contrast to noise ratio (SNMCNR), apparent diffusion coefficient (ADC) and area of cross-sectional nerve (Area) were evaluated.ResultsMixed model analysis revealed FSNR and FNMCNR to be the dual discriminators for traumatized mandibular nerve (p < 0.05). Diagnostic performance of both parameters was also determined with area under the receiver operating characteristic curve (AUC for FSNR = 0.712; 95% confidence interval [CI]: 0.5660, 0.8571 / AUC for FNMCNR = 0.7056; 95% confidence interval [CI]: 1.011, 1.112).ConclusionsAn increase in FSNR and FNMCNR within our MRI sequence seems to be accurate indicators of the presence of traumatic nerve. This prospective study may serve as a foundation for sophisticated model diagnosing trigeminal nerve trauma within large patient cohorts.

Automatic classification and segmentation of multiclass jaw lesions in cone-beam CT using deep learning.

To develop and validate a modified deep learning (DL) model based on nnU-Net for classifying and segmenting five-class jaw lesions using cone-beam CT (CBCT). A total of 368 CBCT scans (37 168 slices) were used to train a multi-class segmentation model. The data underwent manual annotation by two oral and maxillofacial surgeons (OMSs) to serve as ground truth. Sensitivity, specificity, precision, F1-score, and accuracy were used to evaluate the classification ability of the model and doctors, with or without artificial intelligence assistance. The dice similarity coefficient (DSC), average symmetric surface distance (ASSD), and segmentation time were used to evaluate the segmentation effect of the model. The model achieved the dual task of classifying and segmenting jaw lesions in CBCT. For classification, the sensitivity, specificity, precision, and accuracy of the model were 0.871, 0.974, 0.874, and 0.891, respectively, surpassing oral and maxillofacial radiologists (OMFRs) and OMSs, approaching the specialist. With the model's assistance, the classification performance of OMFRs and OMSs improved, particularly for odontogenic keratocyst (OKC) and ameloblastoma (AM), with F1-score improvements ranging from 6.2% to 12.7%. For segmentation, the DSC was 87.2% and the ASSD was 1.359 mm. The model's average segmentation time was 40 ± 9.9 s, contrasting with 25 ± 7.2 min for OMSs. The proposed DL model accurately and efficiently classified and segmented five classes of jaw lesions using CBCT. In addition, it could assist doctors in improving classification accuracy and segmentation efficiency, particularly in distinguishing confusing lesions (eg, AM and OKC).

Is there a difference in quality of photographs obtained using smartphones, compared to the photographs obtained via digital single-lens reflex camera?

PurposeThe purpose of this study was to compare the quality of photographs obtained with three different cameras: I-phone, Samsung, and DSLR, as assessed by Oral and Maxillofacial Surgeons (OMSs). MethodsThis was an anonymous online survey study. The study population consisted of OMSs in New Jersey, New York, Pennsylvania, and Massachusetts who were members of their state societies. Primary outcome variable was ratings on the quality of extraoral and intraoral photographs obtained with three different cameras. Predictor variable was type of camera used to obtain the photographs: I-Phone, Samsung, and DSLR camera. Descriptive statistics were computed. Spearman test was utilized to analyze correlation between the outcome variables. ResultsMajority of respondents were from full time private practice (n = 84, 77.06%), followed by full time academia (n = 12, 11.01%). Spearman test revealed negligible correlation between extraoral and intraoral photographs on the best quality rating (0.15, p=0.13). Negligible correlation between extraoral and intraoral photographs were noted on the second best (0.15, p=0.11), and least quality rating (0.09, p=0.32). ConclusionStudy results revealed that there is no difference between the quality of photographs obtained using smartphones, compared to the photographs obtained via DSLR camera. Future discussions on an ideal application on smartphones would allow for consent and transfer of high-quality photographs via a secure messaging system between healthcare providers to address ethical concerns of confidentiality.

The Chimeric LFC and DCIA Flap in Combined Mandibular and Condylar Head and Neck Reconstruction-A Case Series.

Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery.

What are the incidence and costs associated with interfacility emergency department transfer patients treated by oral and maxillofacial surgeons?

ObjectiveInterfacility emergency department transfers (IET) for maxillofacial trauma and infections are prevalent in the US, with significant implications for healthcare costs. Limited availability of oral and maxillofacial surgeons (OMS) exacerbates unnecessary transfers and associated expenses. This study aimed to determine the incidence and costs of OMS IET. Study designA retrospective cohort study was performed for maxillofacial trauma and infection IET at the University of Illinois Health main hospital via electronic medical record query for terms “infection [or] trauma [and] transfer”. Inclusion criteria required presentation 01/01/22 to 06/30/22; ED-ED transfer; consultation by OMS. Distance transferred, insurance type, location of treatment, weekend presentation, and associated costs were collected. Results1,099 records were identified, including 46 trauma IET and 122 infection IET. Costs ranged from $2,683,918.90 to $7,984,912.89, indicating ∼$1.5 billion annual expenditure across US OMS programs. Three trauma IET required urgent treatment; no infection IET were "emergent." Trauma IET averaged 20.7+17.1 miles and infection IET 22.0+17.4 miles for transfer distance. Among trauma IET, 28 were treated in the OR, 10 had outpatient follow-up, and 8 ED treatment. Among infection IET, 57 received ED treatment, 56 OR treatment, and 9 received antibiotics/no treatment. ConclusionsMaxillofacial trauma and infection IET impose significant healthcare costs. Increased funding for OMS training may mitigate the shortage and improve patient care. Further research is needed for better triaging and reimbursement strategies.

Clinical Evaluation of 51 Patients with Cleft Lip and/or Palate in Social Work at Syariah Hospital.

The study aims to evaluate the surgical outcomes, including post-operative complications, in patients undergoing cleft lip and palate surgery in social work. The study was conducted on 51 patients in three social work settings, with inclusion criteria of age over 3 months, weight over 10 pounds, and normal chest x-ray results. Patients with syndromic or cardiac abnormalities were excluded from the study. The surgery was performed by a team of oral and maxillofacial surgeons with a minimum of 2 years of surgical experience. The study found that post-operative complications were relatively rare and could be managed well. This study has important implications for improving the quality of healthcare services for patients with cleft lip and palate, as well as increasing public awareness of the importance of proper medical care for this condition.

Does the Addition of Oral Sampling Improve Waveform Capnography When Compared to Traditional Nasal Sampling in Open-Airway Patients?

BackgroundEnd-tidal carbon dioxide (EtCO2) is an invaluable anesthesia measure due to minimal delay in monitoring ventilation. Oral and Maxillofacial Surgery (OMS) presents special challenges because oral exhalations are not sampled effectively via nasal cannula normally used to avoid interfering with procedures. PurposeThe purpose of the study was to compare EtCO2 waveforms obtained in subjects using nasal monitoring and combined nasal and oral monitoring under simulated ventilatory conditions. Study design, setting, sampleA single-blinded, randomized crossover controlled study was conducted at the University of Illinois Chicago with healthy volunteers, who were blinded to the monitoring system used. Inclusion criteria required subjects be >18 years of age, be consentable and English-speaking. Exclusion criteria required no airway abnormalities, no edentulism, no conditions that preclude undergoing an OMS procedure under sedation. Predictor variableThe primary predictor variable was the EtCO2 monitoring system: nasal with a standard nasal cannula, and combined with a nasal cannula and oral device. The secondary predictor variable evaluated three ventilatory states (nasal breathing, oral breathing, apnea) in each arm, standardizing by maintaining consistent breath counts across observation periods. Main outcome variableThe main outcome variable was the number of waveforms recorded over 30 seconds for nasal and combined monitoring. Each recording was standardized by dividing it by the baseline waveforms and multiplying by 20. Higher values, closer to baseline, were considered more accurate depictions of ventilation. CovariatesCovariates were body mass index (BMI), age, sex, Mallampati score, and breathing method. AnalysesANOVA, ANCOVA, and MANOVA were performed. P-value<0.05 was considered statistically significant. ResultsThe sample included 25 subjects (18 male, 7 female) with mean age 29.9+7.98 years and BMI 23.9+3.51 kg/m2. Combined sampling detected more waveforms during nasal and oral breathing (p<0.001). Higher BMI correlated with reduced waveform capture during nasal sampling in oral breathing (p=0.013). Combined sampling detected more waveforms during nasal breathing (p=0.005) in subjects with BMI < 23.5 kg/m2. Mallampati score correlated with increased waveforms during nasal breathing. Conclusions and RelevanceOral EtCO2 sampling may improve accuracy of capnography waveform capture. Further clinical studies in sedated subjects undergoing OMS procedures are needed.

Causes and Patterns of Dental Extraction in Dental College of Sebha University

Objectives: This study aimed to identify the primary cause of permanent teeth extraction among patients attending the Oral and Maxillofacial Surgery (OMFS) department of dental college, Sebha University, and its correlation with age, gender, and tooth type. Methods: A cross-sectional study was conducted over ten months; and included 509 patients aged 16-90 years, who underwent tooth extraction. Variables studied were the patient's age, gender, tooth type, and extraction cause. SPSS was used for data analysis, and Chi-Square and ANOVA tests were used to evaluate variables associated with the cause of tooth loss. A p-value of less than 0.05 was considered statistically significant. Results: Overall, 509 permanent teeth were extracted, males (62.1%) and females (37.9%). The primary reasons for tooth extraction were dental caries (76.62%), mobility (10.80%), prosthodontics (6.86%), orthodontics, and impaction (2.95%). The most common age group was 36-45 years (24.36%) and 26-35 years (23.38%). The highest percentage of tooth extraction was in the third and first molars (29.1% and 24.4%, respectively), and the lateral incisor (1.77%) was the lowest. There was an insignificant association between the cause of extraction and gender; a significant association between the cause of extraction and age p&lt;0.001; and a significant association between (gender and age) with tooth type p&lt; 0.001. Conclusion: dental caries was the main reason for tooth extraction in OMFS department, dental college, Sabha University.

Unlocking dental solutions: strategies for axenfeld rieger syndrome care

Axenfeld-Rieger syndrome encompasses systemic abnormalities such as dental, cardiac, craniofacial, and abdominal-wall defects. As a rare autosomal dominant condition, it presents as a heterogeneous group of features. Managing this syndrome requires a multidisciplinary approach involving dentists, orthodontists, oral surgeons, and geneticists due to the complexity of dental anomalies and the rarity of the condition. Early diagnosis is pivotal not only for addressing dentofacial appearance and function but also for detecting systemic abnormalities that could impact vision. Collaboration among specialists, including ophthalmologists and maxillofacial surgeons, is vital for comprehensive care. Diagnosis is typically based on clinical and ophthalmologic examinations, supplemented by genetic analysis if the syndrome is suspected. Treatment plans are customized by specialized teams to meet the distinct needs of each patient.

Rare case of assault with knife penetrating base of the skull – Retrieval and management

Addressing a penetrating injury in the maxillofacial region poses significant challenges for oral and maxilofacial surgeons due to the presence or critical structures. Damage to these structures can lead to varying degrees of impairment and a decreased quality of life for the patient. A 48-year-old individual sustained a stabbing injury to the left side of their face. The knife remained lodged inside for 7 h until they were admitted to the trauma unit. The assailant had unsuccessfully attempted to remove the weapon by bending its handle. Following thorough examinations to pinpoint the exact location of the knife, it was safely removed under sedation. The patient experienced successful healing without major complications. The minimisation of scar tissue was achieved through proper debridement and layered linear wound closure. Subsequently, the patient was transferred to the general ward for monitoring and prescribed antibiotics to prevent wound infection. This report includes a detailed account of the weapon retrieval process and is management, along with a review of relevant literature Reconstruction of complicated facial wounds is difficult for surgeons, and early treatment is necessary to avoid additional harm.

Odontogenic cystic lesion segmentation on cone-beam CT using an auto-adapting multi-scaled UNet.

Precise segmentation of Odontogenic Cystic Lesions (OCLs) from dental Cone-Beam Computed Tomography (CBCT) is critical for effective dental diagnosis. Although supervised learning methods have shown practical diagnostic results in segmenting various diseases, their ability to segment OCLs covering different sub-class varieties has not been extensively investigated. In this study, we propose a new supervised learning method termed OCL-Net that combines a Multi-Scaled U-Net model, along with an Auto-Adapting mechanism trained with a combined supervised loss. Anonymous CBCT images were collected retrospectively from one hospital. To assess the ability of our model to improve the diagnostic efficiency of maxillofacial surgeons, we conducted a diagnostic assessment where 7 clinicians were included to perform the diagnostic process with and without the assistance of auto-segmentation masks. We collected 300 anonymous CBCT images which were manually annotated for segmentation masks. Extensive experiments demonstrate the effectiveness of our OCL-Net for CBCT OCLs segmentation, achieving an overall Dice score of 88.84%, an IoU score of 81.23%, and an AUC score of 92.37%. Through our diagnostic assessment, we found that when clinicians were assisted with segmentation labels from OCL-Net, their average diagnostic accuracy increased from 53.21% to 55.71%, while the average time spent significantly decreased from 101s to 47s (P<0.05). The findings demonstrate the potential of our approach as a robust auto-segmentation system on OCLs in CBCT images, while the segmented masks can be used to further improve OCLs dental diagnostic efficiency.

Establishment of a selective puncture method of the temporomandibular joint targeting the superior and inferior joint spaces using a human cadaver under the guidance of an ultrasound device

To investigate an ultrasound-guided selective puncture method for the temporomandibular joint (TMJ), targeting superior (SJS) and inferior joint spaces (IJS), using a human cadaver. The study utilized five cadavers donated by members of our university. The cadaver's left side was aimed at the SJS, while the right side was at the IJS. Nonionic contrast was injected into each joint using a crossing technique, with the linear ultrasound probe placed parallel to the long axis of the mandibular branch and punctured perpendicularly into the joint cavity. Cone-beam computed tomography scans assessed both the TMJs examining discs and other components for damage using a gross anatomical technique. Computed tomography images confirmed successful contrast agent injection into all joint spaces without damaging the articular discs or cartilage of the mandibular head. Our findings suggest that the ultrasound device can selectively puncture the TMJ in the SJS and IJS. In the future, the success rate is expected to improve with additional cadaver punctures. We aim to establish this technique as a viable treatment method that can be performed by oral surgeons with limited clinical experience in cadaver surgery training and a surgical technique training program using human cadavers.

Consensus Report and Recommendations on the Management of Late-stage Internal Derangement of the Temporomandibular Joint.

Introduction: This report investigates late-stage internal derangement (ID) of the temporomandibular joint (TMJ) with the aim of establishing a more effective and personalized treatment protocol to improve patients' quality of life (QoL). Material and methods: A consensus was reached among maxillofacial surgeons specializing in LSID, based on a literature research and collective expert experience following the Delphi method. Consensus was considered to be achieved when a response received at least 80% of votes. Results: Four expert groups were established, respectively, focusing on diagnosis, minimally invasive surgery (MIS), open surgery and joint replacement. A comprehensive approach to late-stage ID of the TMJ requires a consensus report. This underscores the need for a personalized treatment plan, considering the variability in clinical presentations and progression of this pathology. Our recommendations aim to optimize clinical outcomes and enhance patient QoL.