Oromaxillofacial Region Research Articles

The Use of 3D Model Printing for Acute Planning in Oral and Maxillofacial Traumatology

Introduction Due to the complex anatomy of craniomaxillofacial structures, facial reconstruction following high-impact traumas is extremely challenging. Therefore, this study aimed to evaluate the use of biomodels in the surgical planning of complex fractures and the sequelae in the oromaxillofacial region. Materials and Methods This is a cross-sectional, exploratory, descriptive, and quantitative documentary study. It was conducted at the “Dom Luiz Gonzaga Fernandes” Emergency and Trauma Hospital, in the hinterland of the state of Paraíba, in Brazil, based on cases recorded between November 2021 and November 2022. The research instrument utilized was a self-developed questionnaire. Results No statistically significant correlation was observed between the biomodel acquisition time and the length of hospitalization, with a Spearman's correlation coefficient of r = -0.079. Although the need for adjustment of osteosynthesis material was 50% in cases where acrylonitrile butadiene styrene (ABS) models were used, with p (1) = 0.464, in order to be significantly more faithful, it would require a study with a higher sample size. The average length of surgery, in minutes, was 91.25 ± 28.00. The average cost of the materials used to manufacture the biomodels, in Brazilian reais (R$), was R$122.00 ± R$89.09. Conclusion The use of biomodels in the surgical planning of complex fractures and oromaxillofacial sequelae did not increase the length of hospitalization. The material used for the prototype manufacture suggests a potential influence on its faithfulness. The length of surgery was shorter in interventions that utilized biomodels in the planning phase. It was also noted that the average cost of manufacture varies according to the type of material chosen and the quantity required.

Low-Grade Myofibroblastic Sarcoma of Hard Palate-A Diagnostic Challenge with Review of Literature.

Low-grade myofibroblastic sarcoma (LGMS) is categorized as an extremely rare malignant neoplasia of myofibroblasts. To date, only 38 cases describing patients diagnosed with LGMS in the oro-maxillofacial region have been reported in the scientific literature. Here, we introduce a rare case report and, for the first time, also provide a recent update of the literature and a clear review regarding the immunohistochemical panel to diagnose this entity.

Inflammatory processes in the oro-maxillofacial region. statistic data and study of antibioticograms

Inflammatory processes in the oro-maxillofacial region. statistic data and study of antibioticograms

Dental Management of patient with Parkinson’s Disease

Background: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder. This disease affects about 1 in 1000 people in the general population and 1% of the over 60 age group. The main features of the disease are: resting tremor, bradykinesia, postural instability, muscle rigidity and inexpressible face (mask-like face). People with PD face a series of pathological manifestations from the oromaxillofacial region related to the disease, while some of the drugs used to treat PD also lead to adverse effects from the oral cavity. Purpose: The dentist should be able to recognize the basic signs and symptoms of the disease, its basic oral manifestations and the basic dental management protocols of patients with PD. This review aims to contribute in this direction. Method: In pubmed database we searched with keywords “dental and Parkinson’s disease”, “Parkinson disease and dental management”, ‘Parkinson and periodontal’, “oral hygiene and Parkinson disease’, “periodontitis and Parkinson’s disease”. We concluded that 141 papers were to be used in our review. We also used Little’s and Scully’s books on the medically compromised patient, as well as Dougall’s series of articles for disabled patients. Last, we used few website links of official dental sites. Conclusion: PD patients may suffer from a multitude of pathological manifestations from the oral-maxillofacial area, while they need special dental management due to motor, mental and autonomic neural system disorders. The insufficient experience and training of the majority of dentists in treating patients with PD is given. The dental community in collaboration with the medical community and the State is important to contribute to the improvement of the oral health of PD patients, by educating patients and dentists.

Stem-Cell Therapy: Filling Gaps in Oro-Maxillofacial Region.

How do stem cells function? Why should we, as dentists, care about stem cells? How might dental procedures be substituted by stem cells? Are stem cells capable of regenerating a tooth or temporomandibular joint (TMJ)? Although the ability to regenerate a destroyed tissue has been known for a while, research into regenerative medicine and dentistry has made significant strides in molecular biology. A paradigm shift in the therapeutic toolbox for dental and oral diseases is likely to result from a growing understanding of biological concepts inthe regeneration of oral/dental tissues along with stem cell research, leading to an intense search for "biological solutions to biological problems." Among other tissues, orofacial tissues effectively separate stem cells from human tissues. Because they can self-renew and produce different cell types, stem cells offer novel techniques for regenerating damaged tissues and curing illnesses. A number of significant milestone successes have shown their practical applicability, traditional biomaterial-based treatments in regenerative dentistry as therapeutic alternatives that offer regeneration of damaged oral tissues rather than merely "filling the gaps." In order to use these innovative accomplishments for patient well-being, the ultimate goal of this ground-breaking technology, well-designed clinical studies must be implemented as a crucial next step. The review's objective is to briefly synthesize the literature on stem cells in terms of their traits, subtypes, and uses for dental stem cells. It has been highlighted that stem cell therapy has the ability to treat craniofacial abnormalities and regenerate teeth in the oral and maxillofacial regions.

A retrospective analysis for the management of oromaxillofacial invasive mucormycosis and systematic literature review

PurposeMucormycosis is a type of fatal infectious disease, rarely involved in the oromaxillofacial region. This study aimed to describe a series of 7 cases with oromaxillofacial mucormycosis and to discuss the epidemiology, clinical features, and treatment algorithm thereof.MethodologySeven patients in the author’s affiliation have been treated. They were assessed and presented as per their diagnostic criteria, surgical approach, and mortality rates. Reported cases of mucormycosis originally happened in craniomaxillofacial region were synthesized through a systematic review so as to better discuss its pathogenesis, epidemiology, and management.ResultsSix patients had a primary metabolic disorder, and one immunocompromised patient had a history of aplastic anemia. The criteria for a positive diagnosis of invasive mucormycosis were based on clinical presentation of signs and symptoms, and a biopsy for microbiological culture and histopathologic analysis. Each patient used antifungal drugs and five of them also underwent surgical resection at the same time. Four patients died due to the unregulated spread of mucormycosis, and one patient died owing to her main disease.ConclusionsAlthough uncommon in clinical practice setting, mucormycosis should be of great concern in oral and maxillofacial surgery, due to the life-threatening possibility of this disease. The knowledge of early diagnosis and prompt treatment is of utmost importance for saving lives.

Diagnostic features of cervical lymphadenitis in children

The aim of the current study is to reflect the most used clinical and paraclinical methods for diagnosing lymphadenitis in the oro–maxillo–facial region in children. The analysis of clinical and paraclinical methods applied to patients with cervical lymphadenitis has shown that there are several consecutive steps that will help the physician to find out the etiology, clinical appereance and final diagnosis of lymphadenopathy.

Management of failed stainless steel implants in the oromaxillofacial region of dogs.

Management of complications of fracture fixation in the oromaxillofacial (OMF) region may present a diagnostic and therapeutic challenge. While titanium and stainless steel implants have been utilized in successful fracture fixation in the OMF region, the use of titanium implants is preferred due to the superior intrinsic properties of titanium. Nonetheless, stainless steel materials are still used due to their availability and familiarity. In the present methods report, we describe our approach to the management of failed stainless steel plates and screws used to treat traumatic injuries in the OMF region. Furthermore, we exemplify our approach with five dogs that exhibited complications of stainless steel implants in the OMF region and their subsequent management. In those cases, all failed implants were removed. Reconstruction with a combination of recombinant human bone morphogenetic protein-2 (rhBMP-2) and titanium implants was utilized in two cases while a mandibulectomy was performed in one case. Three cases required removal of the stainless-steel implant with no additional surgical therapy. We conclude that the success of treatment of failed stainless steel implants depends on the use of advanced imaging findings, appropriate antimicrobial therapy, as well as potentially regenerative reconstructive surgery.

An evaluation of mandibular canal variations: a systematic review and meta-analysis.

The inferior alveolar nerve and vessels are carried via the mandibular canal, which extends bilaterally from the inferior alveolar foramen to the mental foramen. Bifid and trifidmandibular canals result from abnormal fusions of nerve canals. The purpose of this study was to provide an up-to-date and comprehensive analysis of the prevalence ofmandibular canalvariations among healthy adults, and to identify any potential ethnic, sex, or laterality predilections. The prevalence of the bifid mandibular canal was 18.87% and that of the trifid canal 1.3%. Unilateral variants were three times commoner than bilateral. Eachmandibular half had four canals emanating from separate openings on the lingual surface of the mandibular ramus. Retromolar and forward canals were the predominant subtypes, followed by dental; buccolingual were the least frequent. The mean length and diameter ofthe bifid mandibular canalwere 13.62mm and 1.63mm, respectively. The possibility of a bifid mandibular canal is a crucial consideration in dental medicine. Because anatomical variations of themandibular canal are fairly common, awareness of them is essential for anatomy teachers and for surgeons who operate in the oromaxillofacial region.

Systematic Assessment of Mammalian Skull Specimens for Dental and Temporomandibular Joint Pathology.

Museum skull specimens represent a non-invasive, informative, and readily available means to study temporomandibular joint (TMJ) lesions, dental pathology, and anatomic variations in many mammalian species. Studying the teeth and jaws of an array of species can present a challenge requiring attention to detail and understanding of a species' normal anatomy. In the present article, a systematic and precise protocol for examining skull specimens is discussed that has been applied to a variety of mammals to define characteristic diseases in the oromaxillofacial region. The procedure outlined is simultaneously precise, repeatable, and adaptable to the highly differing skull and tooth shapes and anatomy across species. Specifically, specimens are examined for missing teeth, periodontal disease, endodontal disease, TMJ pathology, and anatomical variations. Results gleaned from research on museum specimens may reflect the natural history, health, and disease status of individuals and species. Furthermore, these data can inform ecological and conservation research efforts, as well as the care of captive individuals.

Prognosis of adenoid cystic carcinoma in head and neck region treated with different regimens-A single-centre study.

No study has evaluated the impact of regimen on recurrence, metastasis and survival in patients with adenoid cystic carcinoma (ACC). The present study aimed to compare the efficacy of radioactive seed implantation and other regimens in treating ACC, so as to investigate the clinical applicability of radioactive seed implantation and determine the indications for this regimen. A total of 188 patients with ACC in oromaxillofacial region were allocated to four groups according to the treatment regimen: group 1 was treated with a combination of surgery and 125 I seed therapy, group 2 with a combination of surgery and external radiotherapy, group 3 with surgery, whereas group 4 was untreated. The Kaplan-Meier method was used to assess the survival rates, and the Cox regression analyses were used to identify the associated prognostic factors. The overall survival rates of 188 patients and groups 1, 2, 3 and 4 were 85.7%, 75%, 68.2% and 37.5%, respectively. Cox regression analysis revealed that age, T stage, N stage and regimen were independent prognostic factors of survival. Amongst patients with primary ACC, the efficacy of radioactive seed implantation was higher in those with perineural invasion than in those without. Patient age, T stage, N stage and regimen are independent prognostic factors of survival in patients with ACC. Patients treated with surgery combined with postoperative 125 I seed radiotherapy have a higher overall survival rate, and those with perineural invasion are more suitable for radioactive seed implantation therapy.

The oromaxillofacial region as a model for a one-health approach in regenerative medicine.

The concept of a one-health approach in regenerative medicine has gained tremendous momentum in the scientific and public communities in recent years. Knowledge derived from this approach informs innovative biomedical research, clinical trials, and practice. The ultimate goal is to translate regenerative strategies for curing diseases and improving the quality of life in animals and people. Building and fostering strong and enthusiastic interdisciplinary and transdisciplinary collaboration between teams with a wide range of expertise and backgrounds is the cornerstone to the success of the one-health approach and translational sciences. The veterinarian's role in conducting clinical trials in client-owned animals with naturally occurring diseases is critical and unique as it may potentially inform human clinical trials. The veterinary regenerative medicine and surgery field is on a steep trajectory of discoveries and innovations. This manuscript focuses on oromaxillofacial-region regeneration to exemplify how the concept of interdisciplinary and transdisciplinary collaboration and the one-health approach influenced the authors' work experience at the University of California-Davis.

Penetrating Injury to the Floor of Mouth in a Child

Penetrating injuries of the oro-maxillofacial region are not only rare but difficult to manage in the pediatric age group. We report a case of a six-year-old girl who was injured with a penetrating reinforcing bar (rebar) in the floor of the mouth, where both ends of the rebar protruded out. The girl fell off a partially constructed terrace and was hanging with the rebar in her neck for hours. On examination, the vital structures of the neck were not involved. The child was taken for surgery after stabilization, abiding by COVID protocols. The rebar was removed under ketamine sedation with repair of the injury in the floor of her mouth. The postoperative period was uneventful and the child was discharged on the fifth postoperative day. Managing this pediatric trauma emergency was challenging in terms of imaging, securing an airway, and assuring parents about the choices for intervention during lockdown.

An eye opener COVID-19 complication in oro-maxillofacial region: Case report

The aim of this report is to discuss an eye-opening case about the complication in oromaxillofacial region in COVID-19 recovered youth. The aftermath of COVID infection lead to various complexities in multiple organs. Recurrent follow ups of such recovered patients are necessary to identify early dreadful effects and combat them in time. Hence, present study throws a light on one such post-COVID complication occurring in oromaxillofacial region, its pathophysiology and treatment to overcome its worsening upshot.

Inflammatory Responses in Oro-Maxillofacial Region Expanded Using Anisotropic Hydrogel Tissue Expander

Objective: Reconstruction of oral and facial defects often necessitate replacement of missing soft tissue. The purpose of tissue expanders is to grow healthy supplementary tissue under a controlled force. This study investigates the inflammatory responses associated with the force generated from the use of anisotropic hydrogel tissue expanders. Methods: Sprague Dawley rats (n = 7, body weight = 300 g ± 50 g) were grouped randomly into two groups—control (n = 3) and expanded (n = 4). Anisotropic hydrogel tissue expanders were inserted into the frontal maxillofacial region of the rats in the expanded group. The rats were sacrificed, and skin samples were harvested, fixed in formalin, and embedded in paraffin wax for histological investigation. Hematoxylin and eosin staining was performed to detect histological changes between the two groups and to investigate the inflammatory response in the expanded samples. Three inflammatory markers, namely interleukin (IL)-1α, IL-6, and tumor necrosis factor-α (TNF-α), were analyzed by immunohistochemistry. Result: IL-1-α expression was only observed in the expanded tissue samples compared to the controls. In contrast, there was no significant difference in IL-6, and TNF-α production. Histological analysis showed the absence of inflammatory response in expanded tissues, and a negative non-significant correlation (Spearman’s correlation coefficient) between IL-1-α immune-positive cells and the inflammatory cells (r = −0.500). In conclusion, tissues that are expanded and stabilized using an anisotropic self-inflating hydrogel tissue expander might be useful for tissue replacement and engraftment as the expanded tissue does not show any sign of inflammatory responses. Detection of IL-1-α in the expanded tissues warrants further investigation for its involvement without any visible inflammatory response.

Potential biological damage of human peripheral blood lymphocytes induced by computed tomography examination of the oromaxillofacial region

The aim of this study was to examine whether oromaxillofacial computed tomography (CT) examination causes biologic damage in lymphocytes and whether the biologic damage is related to radiation dose, patient age, or gender. Peripheral blood was taken from 51 individuals and divided into control, in vivo, and in vitro irradiation groups. Biologic damage was assessed by comparing rates of chromosomal aberrations (CAs), including dicentric chromosomes (dics), centric rings, and acentric fragments; and nuclear aberrations, including micronuclei (MN), nuclear buds (NBUDs), and nucleoplasmic bridges (NPBs) in the peripheral blood before and after CT examination. Absorbed and effective doses were calculated with the software VirtualDose, and the blood dose was estimated accordingly. The rates of acentric fragments, MN, NBUDs, and NPBs in the in vivo (P ≤ .008) and in vitro (P ≤ .003) irradiation groups were significantly higher than those in the control groups. The acentric fragment rate (P=.013) and MN rate (P=.002) were higher in the in vitro group than in the in vivo group. There was no correlation between change rates of CAs and nuclear aberrations with radiation dose. Positive correlations of MN rates with age were found in all groups (ρ ≥ 0.590). Certain doses of radiation in oromaxillofacial CT examination may induce CAs and nuclear aberrations in lymphocytes.

Contribution of Pathology in Surgical Oncology in Malignant Tumors of the Salivary Glands

The practice of oncology continues to be an area of continuous renewal. The volume of knowledge in the field of cancer therapy is increasing rapidly compared to any other medical discipline, constraining the need for permanent information. The first data on malignancies are linked to the 11th century BC. The concerns of physicians were attracted to the cancerous disease, the observations and hypotheses regarding it being mentioned in different writings of the time. The increased frequency of cancer in the oro-maxillofacial region is favored by a number of factors: the great diversity of maxillofacial structures and the very important changes in the phylogenesis and ontogeny of these structures; the embryonic existence of the branchial arches, with the possibility of remaining residues in this stage; function of the intense quality of the face region and the oral region, as the first segment of the matter import apparatus; the multitude of irritant factors, which play an important role in the occurrence of cancer ( temperature, food hardness, dust, chemical noxiousness). The improvement of the methods and techniques of the surgical operations performed on the maxillofacial region had a decisive influence on the treatment of this region. In patients whose pathologic (bleeding diathesis, heart disease, liver disease, diabetes, etc.) can lead to various complications (local and general), interventions of oral and maxillofacial surgerycan perform as a preparation prior appropriate. The study includes a sample of 48 patients with malignant tumors of the salivary glands. The treatment of malignant tumors of the salivary gland have to be as wide early and surgically, with radiotherapy and / or multi-agent chemotherapy. Radiotherapy alone is insufficient, indicated only as palliative treatment.

Automatic Detection and Classification of Dental Restorations in Panoramic Radiographs

Aim/Purpose: The aim of this study was to develop a prototype of an information-generating computer tool designed to automatically map the dental restorations in a panoramic radiograph. Background: A panoramic radiograph is an external dental radiograph of the oro-maxillofacial region, obtained with minimal discomfort and significantly lower radiation dose compared to full mouth intra-oral radiographs or cone-beam computed tomography (CBCT) imaging. Currently, however, a radiologic informative report is not regularly designed for a panoramic radiograph, and the referring doctor needs to interpret the panoramic radiograph manually, according to his own judgment. Methodology: An algorithm, based on techniques of computer vision and machine learning, was developed to automatically detect and classify dental restorations in a panoramic radiograph, such as fillings, crowns, root canal treatments and implants. An experienced dentist evaluated 63 panoramic anonymized images and marked on them, manually, 316 various restorations. The images were automatically cropped to obtain a region of interest (ROI) containing only the upper and lower alveolar ridges. The algorithm automatically segmented the restorations using a local adaptive threshold. In order to improve detection of the dental restorations, morphological operations such as opening, closing and hole-filling were employed. Since each restoration is characterized by a unique shape and unique gray level distribution, 20 numerical features describing the contour and the texture were extracted in order to classify the restorations. Twenty-two different machine learning models were evaluated, using a cross-validation approach, to automatically classify the dental restorations into 9 categories. Contribution: The computer tool will provide automatic detection and classification of dental restorations, as an initial step toward automatic detection of oral pathologies in a panoramic radiograph. The use of this algorithm will aid in generating a radiologic report which includes all the information required to improve patient management and treatment outcome. Findings: The automatic cropping of the ROI in the panoramic radiographs, in order to include only the alveolar ridges, was successful in 97% of the cases. The developed algorithm for detection and classification of the dental restorations correctly detected 95% of the restorations. ‘Weighted k-NN’ was the machine-learning model that yielded the best classification rate of the dental restorations - 92%. Impact on Society: Information that will be extracted automatically from the panoramic image will provide a reliable, reproducible radiographic report, currently unavailable, which will assist the clinician as well as improve patients’ reliance on the diagnosis. Future Research: The algorithm for automatic detection and classification of dental restorations in panoramic imaging must be trained on a larger dataset to improve the results. This algorithm will then be used as a preliminary stage for automatically detecting incidental oral pathologies exhibited in the panoramic images.

Stem Cell in Dentistry – Potential Contributions, Challenges and Future

Stem cells are unspecialised and unclassified cells but their unique property “pluripotency” makes them special because it has opened the new doors of opportunities and possibilities in the field of dentistry and regenerative medicine to regenerate different organs and tissues. Currently, several studies are undergoing on dental stem cells (SCs) to find out their possible uses in oromaxillofacial region and various stem cells have already been identified for their application in orofacial region. Therefore, a new separate branch of dentistry names as “Regenerative Dentistry” is emerging very fast as dental stem cells offer a lot of benefits over outdated procedures andhave the ability to replace the old restorative techniques of repairing oromaxillofacial trauma which involve disadvantages like scarring, loss of function of replaced part, infection and donor site morbidity with early and late complications [1]. Although oromaxillofacial region is difficult to repair because of its complex anatomical structure but undoubtedly,from past few decades, regeneration of this region using stem cell therapy has also fascinated the entire world of stem cell biologists, molecular biologists, geneticists, clinicians and dentists to discover new advancements in the field of craniofacial engineering[2]. Clearly, future of dentistry lies in stem-cell based powerful therapeutic approach which can potentially transform the reparative and regeneration process of defective hard and soft tissues in orofacial region.

The historical materials of stomatology in the All Things, Prescriptions of Fifty-two Diseases and Yinshu

All Things, Prescriptions of Fifty-two Diseases and Yinshu were three bamboo and silk medical manuscripts which form-time was no later than the late Warring States period. From the visible bamboo and silk, the ancient Chinese knew the relationships between some drugs and the volume of saliva and used compound drugs to treat dental caries. Some oral and maxillofacial diseases, such as inflammation and pain of oromaxillo-facial region, temporomandibular dislocation and the methods of treatment were descriped in these books. Mouth-rinsing and tooth-picking were the more often used methods for maintaining oral hygiene. Kouchi(clicking the tooth)was also used for prevention and/or treatment of caries. Most of these knowledge were the first documents in ancient China.