Oral and Maxillofacial Surgery

Abstract Background The aim of this study was to analyze trabecular microarchitecture of augmented sinuses with hyaluronic matrix and xenograft by microcomputed tomography, and to investigate whether hyaluronic matrix has an effect on the newly formed bone quality. Materials and methods Thirteen patients undergoing maxillary sinus augmentation were included in this split-mouth study. Right and left sinus sites were randomly assigned to test and control group. In test group, the sinus was grafted with hyaluronic matrix and xenograft; in control group, only with xenograft. Four months after augmentation, bone samples were harvested during implant placement and analyzed for the following trabecular microarchitecture parameters using microcomputed tomography: bone volume (BV), total volume (TV), bone volume fraction (BV/TV), bone surface (BS), specific bone surface (BS/BV), bone surface density (BS/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular pattern factor (Tb.Pf), and fractal dimension (FD). Results There was statistically significant difference only for BS/TV parameter between two groups. BS/TV was higher in hyaluronic matrix group compared with control group. Conclusions Addition of hyaluronic matrix to xenograft may enhance bone quality in terms of bone surface density. However, more research investigating the microstructural variation of augmented sinuses is needed with a greater sample.

Abstract Purpose A hammer is a popular tool among the “do it yourself” (DIY) population who pursue home-improvement projects. While we are aware that hammers have health hazards, no study has yet to explore the craniomaxillofacial injuries that could arise from the use of hammers. The purpose of this study is to describe the characteristics of craniomaxillofacial injuries from hammers. Materials and methods This is a 20-year cross-sectional study conducted using the National Electronic Injury Surveillance System (NEISS). Injuries from hammers were included in this study if they involved the head, face, eyeball, mouth, or ear. The study predictor was the mechanism of injury. The study outcome was the admission rate from the emergency department (ED) and anatomical site injured. Patient and injury characteristics were compared using chi-squared and independent sample tests. Results Our final sample had a total of 2967 hammer-induced injuries. Most of the sample consisted of white (55.3%) males (80.2%). Summer was the most injury-congested season (30.1%). The majority of the patients were over the age of 18 (65.6%). Laceration (47.3%) was the most common primary diagnosis, followed by contusion/abrasion (21.9%). The head (42.9%) was the most commonly injured craniomaxillofacial region followed by the face (29.0%). Craniomaxillofacial injury most frequently transpired at the patient’s home (63.6%). Concerning the mechanism of injury, accidentally self-induced injuries with a hammer were the most common (32.4%). Patients who were injured from the debris were more likely (P < 0.01) to be admitted (7.6%) relative to patients who were not (2.5%). The head was most likely to get injured from a falling hammer (P < 0.01). The face was most likely to get injured through accidental self-injury (P < 0.01). The eyeball was most likely to get injured from debris (P < 0.01). The mouth was, similar to the face, most likely to get injured through accidental self-injury (P < 0.01). Conclusions Craniomaxillofacial injuries secondary to hammers illustrated a predilection to the head. Hammer falling from a height was most likely to injure the head. Debris from hammer strikes was the most dangerous mechanism of injury and was most likely to injure the eyeball. Hence, the authors urge the use of protective gear for the head (i.e., helmet) and eyeball (i.e., glasses) when handling hammers for constructive purposes.

Abstract Purpose To determine the cost of surgically treated mandibular fractures, methods of payments, and the relationship between socioeconomic status of subjects and payment methods in a Nigerian tertiary hospital. Methods A retrospective review of 100 subjects who sustained 148 isolated mandibular fractures was conducted between November 2014 and October 2019. Demographics, socioeconomic status, mechanism of injury, fracture sites, type of treatment, and cost of treatment with methods of payments were obtained from medical records and hospital billing sheets of eligible subjects. The relationship between independent variables (age, sex, payment method, and treatment methods) and dependent variable (income class) was analyzed. Results The mean age of the subjects was 31.8 ± 10.9 years; age range 17–63 years. The majority (75/100) belonged to the middle-income class. The costs of mandibular fractures repairs were ₦42,900 ($119.17) and ₦132,500 ($386.05) for closed reduction (CRMMF) and open reduction and rigid internal fixation (ORIF) respectively. All subjects in the low-income class (4/100) paid out of pocket for their treatment compared with 93% and 62% of the middle- and high-income classes respectively (p = 0.001). Half of the subjects in the low-income class had ORIF compared with 31% and 62% of the middle- and high-income classes respectively. Conclusions The treatments costs of mandibular fractures were ₦42,900 ($119.17) and ₦132,500 ($386.05) for CRMMF and ORIF respectively. The treatment costs were mostly out-of-pocket expenditure meaning that the subjects in the low-and middle-income classes bore the financial burden of their injuries.

Abstract Objectives Investigation in Saudi Arabia or the Arab Gulf States to assess the unfavorable impacts of the bilateral sagittal split osteotomy (BSSO) is non-existent, so questions have been raised about the success rate of this operation and the frequency of unwilling outcome. To address these worries, we directed a case series study to evaluate the hypoesthesia, a type of neurosensory deficit (NSD) of the inferior alveolar nerve (IAN) after BSSO, and if the hypoesthesia outcome will improve if the surgeries performed by a single surgeon. Patients and methods This was a prospective case series study for the patient who underwent BSSO in a medical complex that is considered one of the largest in Saudi Arabia (Riyadh). The inclusion criteria include patient aged 18–40 years, any gender, and American Society of Anesthesiologists (ASA) class I. They will undergo BSSO for either mandibular, retrognathia, prognathic, or to follow the maxilla. The outcome will be measured after evaluating the neurosensory by four means light touch (LT), pinprick (PP), 2-point discrimination (2PD), and thermal sensations (TT) in four repeated measurements (preoperatively, 1 week, 1 month, 3 months postoperatively) as the primary outcome. Other confounding factors were the secondary outcome (age, gender, visualization of the I.A.N, the type of mandibular movement, split favorability, mandibular canal location, and patient reports about paresthesia or dysesthesia on any given side); these data analyses were carried out using SPSS ver. 25 data processing software. Results The nerve was visible in 93% of cases. During the operation, none of the nerves was transected. Hypoesthesia on the first follow-up was 94% of cases for LT, 92% for PP, 82% for TT, and 100% for the 2PD. On the last follow-up, the patients still had hypoesthesia for the LT 51%, PP 35%, TT41%, and 2PD 55%; age and sex did not significantly affect hypoesthesia outcomes. Nerve visibility and inferior alveolar nerve canal (IAC) distance did not influence the results. The level of confidence for all tests was set at p < 0.05. Conclusions The 2PD sensation was the most affected sense on the last visit, and the right side of the chin and lower lip was affected most both on early and long-term follow-up due to several reasons. A 3-month period was enough as a recovery time to restore 100% of neurological sensation for 45% of the sample, which is similar to several studies in the literature. A single surgeon did not show superior result compared to two surgeons’ literature papers. Advancement movement was associated with a high percentage of hypoesthesia.

Abstract Purpose The purpose of this study was to provide a novel report on the head and neck injuries from the sport of wrestling and their characteristics in the USA. Materials and methods This is a 20-year retrospective cross-sectional study conducted using the National Electronic Injury Surveillance System (NEISS). Reports were included in the analysis if the injury stemmed from combat with another person. The predictor variables were obtained from both patient and injury characteristics. The principal outcome variable was admission rate, which was used to proxy the severity of the injury at hand. Bivariate analysis (i.e., chi-square and independent sample tests) was used to determine if an association existed between two variables of interest. Results The final sample in our study consisted of 4485 cases of craniomaxillofacial injuries secondary to wrestling. The increase in injuries from the year 2000 to 2019 was significant (P < 0.05). The average age of patients was 15.73 (range: 3 to 59 years old). Virtually all of the injuries occurred in males (95.6%). The majority of patients was under the age of 18 (82.3%). With regard to race, white wrestlers (57.1%) comprised the majority of patients. Insight into race was not available for 1245 patients (27.8%). Most wrestling-related injuries took place during the winter season (60.6%). Concussion was the most common primary diagnosis (29.0%). The head (57.1%) was the most commonly injured craniomaxillofacial region. The most common setting in which the injury took place was a place of recreation/sports (49.9%). Among the mechanisms of injuries, the take-down (26.5%) was the most common. Patients who were thrown/taken down (5.04%) were significantly more likely to get admitted (P < 0.01) relative to patients who were injured otherwise (2.6%). Similarly, patients who fell/tripped (6.6%) were significantly more likely to get admitted (P < 0.05) relative to patients who were injured otherwise (3.1%). While cases of concussion (6.0%) were significantly more likely to get admitted (P < 0.01) relative to other cases, cases of contusions/abrasions (0.6%) were significantly less likely to get admitted (P < 0.01) relative to other cases. Similar to contusions/abrasions (0.2%), lacerations were significantly less likely to get admitted (P < 0.01) relative to other cases. Patients aged 12–18 (P < 0.01) were most likely to suffer concussions, whereas patients aged 19–34 (P < 0.01) were least likely to suffer concussions. In contrast to concussions, patients aged 12–18 (P < 0.01) were least likely to suffer lacerations, whereas patients aged 19–34 (P < 0.01) were most likely to suffer lacerations. Patients aged 6–11 (P < 0.01) were most likely to be thrown/taken-down whereas patients aged 19–34 (P < 0.01) were least likely to be thrown. Patients aged 19–34 (P < 0.01) were most likely to be collided against intentionally, while patients aged 6–11 (P < 0.01) were least likely to be collided against intentionally. Patients aged 34 years or older were most likely to fall/trip, while patients aged 12–18 (P < 0.01) were least likely to fall/trip. Conclusions Certain types of injuries that occur during wrestling are more or less common depending on the age groups involved in the sport. Concussions were the most common injury incurred overall, and the head is the most commonly affected craniomaxillofacial area. Take-downs were the most likely mechanism of injury to lead to hospital admissions. The average number of wrestling injuries increased over 20 years being analyzed in this study. Future studies should investigate methods to lessen concussions in wrestling, decrease the number of illegal moves performed, and look into ways to mitigate harm from take-downs, given the increasing number of injuries acquired from this sport.

Abstract Background/aims When facial trauma involves elderly patients, the possible presence of frailty and comorbidities in victims of trauma may worsen the posttraumatic symptoms and decrease quality of life. The aim of this multicenter study was to assess the quality of life following surgical or non-operative management of maxillofacial trauma in elderly patients. Materials and methods This cohort study was based on the administration of validated self-administered questionnaires to all the geriatric patients (70 years or more) with facial fractures from the involved maxillofacial surgical units across Europe, since 1st January 2019 to 31st June 2019. The following questionnaires were administered: SF36 questionnaire; the VFQ-25 questionnaire; the Oral Health Impact Profile – 14 (OHIP14). Outcome variables were VFQ-25 and OHIP-14 results. Results A total of 37 patients (14 male and 23 female patients) met the inclusion criteria and were included in the study. Elderly patients had an improvement in almost all the categories examined by the SF-36 questionnaire 6 months after trauma, with the only exception of a worsening as for role limitations due to physical health. An improvement was observed in almost all the categories at SF-36 test. A worsening of scores of OHIP-14 for all the considered dimensions in the whole study population was observed too. Conclusions Elderly patients following facial trauma experience significant emotional, social, and functional disturbances. We observed that emotional problems, energy/fatigue, social functioning, and generally social limitations played a great role in the decrease of QoL in elderly patients following maxillofacial trauma.

Abstract The aim of this bibliometric research was to identify and analyze the top 100 cited systematic reviews in the field of oral and maxillofacial surgery in order to guide any professional level with interest in this topic and to map the current trends the field of oral and maxillofacial surgery. Using the Web of Science database without restrictions on publication year or language, a bibliometric analysis was performed for the five major journals of oral and maxillofacial surgery: International Journal of Oral and Maxillofacial Surgery (IJOMS), Journal of Oral and Maxillofacial Surgery (JOMS), Journal of Cranio-maxillofacial Surgery (JCMS), British Journal of Oral & Maxillofacial Surgery (BJOMS), and Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology (Triple-O). The most top-cited systematic review was published in 2015 with a total of 200 citations on survival and success rates of dental implants, consistent with the finding that “pre- and peri-implant surgery and dental implantology,” and “craniomaxillofacial deformities and cosmetic surgery” were the most frequently cited topics (22% each). The majority of top cited papers were published in IJOMS (43%), followed by JOMS (34%), Triple-O (8%), JCMS(8%) and BJOMS(7%). The highest number of contributions was from the Netherlands, followed by Italy and USA. The outcome of this article can be used as a source of information and to guide not just researchers but also clinicians and students to which areas are trending in the field of oral and maxillofacial surgery, thus also having a large impact on the field of oral and maxillofacial surgery. However, this article cannot reflect the quality of the included systematic reviews.

Abstract Background Accurate placement of TMJ implant components may be facilitated by virtual surgical planning (VSP) technologies. The aim of this study was to assess the accuracy of a typical VSP protocol and describe the pattern of surgical error associated with total alloplastic TMJ replacement. Methods A retrospective analysis was undertaken on 40 adult patients who were implanted with a fully customised, 3D printed TMJ prosthesis due to end-stage TMJ disease. Planned TMJ implant position based on preoperative CBCT images was compared with final position on postoperative OPGs using a previously validated linear rescaling method. Translational discrepancy was described in the anterior-posterior direction and superior-inferior direction. Rotational discrepancy was described as anterior or posterior. Results Lin’s concordance between preoperative and postoperative position was 0.97, with no significant differences (p > 0.05). The Bland-Altman analysis showed a 95% limit of agreement between planned and final position of − 5.9 to 5.4 mm. Overall, final implant position was more anterior (0.4 mm), superior (0.4 mm) and posteriorly rotated (2.4°) compared with planned position. Conclusion The use of VSP in TMJ replacement surgery results in accurate implant placement with good agreement between planned and final implant position. Discrepancies in planned and final implant position tended to result in the mandibular component of the implant being translated anterior superiorly and rotated posteriorly, with potential implications for the biomechanical performance of the implant and overall device longevity. These results should be used to assist TMJ surgeons pre- and intraoperatively to facilitating accurate implant positioning and optimal surgical rehabilitation.

Abstract Purpose The purpose of this study was to evaluate patients’ health-related quality of life (HRQoL) before and after surgical treatment of orbital blow-out fracture. Methods This prospective study comprises of all adult patients undergoing a surgical reconstruction of an orbital blow-out fracture in 2006–2010. Their HRQoL was evaluated for 6 months postoperatively with the aid of the standardized 15D instrument and was compared with that of an age- and gender-standardized sample of the general Finnish population. A complementary questionnaire for more detailed information was also administered. Results Twenty-six patients completed the study. Mean 15D score among the patients preoperatively (0.898) was statistically significantly and clinically importantly worse than the score of the control population (0.936). Six months postoperatively, the mean 15D score was 0.920, with no significant difference compared with the control population and the significant differences on the different dimensions had disappeared. The most common complaint at 6 months postoperatively was diplopia in daily life (19%). Disturbances in facial sensation (27%) and defects in facial appearance (15%) were the most unpleasant subjective outcomes. Conclusion The HRQoL is significantly decreased after orbital blow-out fracture compared with the general population but will recover completely in 6 months. Thus, the negative impact of orbital blow-out fracture on HRQoL is only transient. Disturbances in facial sensation, defects in facial appearance, and diplopia are the most common subjective complaints after the injury and its surgical treatment. However, these do not appear to affect the overall quality of life in the long term.

Abstract Background Severe microretrognathia with the absence of ascending mandibular ramus is a challenging deformity and treatment must aim to avoid tracheostomy or remove it as soon as possible. Although it is not often reported, mandibular distraction osteogenesis represents a valid treatment option in infants affected by hypoplastic mandible Pruzansky-Kaban type IIb and III. Case presentation The authors describe 3 cases of infants affected by severe respiratory insufficiency due to congenital mandibular hypoplasia, with follow up ranging from 4 to 8 years. Clinical and technical considerations on treatment choices and outcomes are discussed starting from review of the literature and direct clinical experience. Conclusion Early mandibular distraction, specifically bidirectional distraction, is an effective and repeatable technique that leads to mandible lengthening with counterclockwise rotation, pogonion projection increase, anteropositioning of the tongue base, and expansion of oropharyngeal volume with positive effect on the respiratory problems of the infant. Even in Treacher Collins patients, known to have a low decannulation rate, all of these elements are essential for effective speech and swallowing therapy and for a subsequent attempt of decannulation.

Abstract Purpose The primary objective of this study is to delineate the data on maxillofacial trauma in rugby utilizing the National Electronic Injury Surveillance System (NEISS) database. Specifically, we want to establish the prevalence of facial rugby injuries in terms of age, mechanism of injury, and degree of injury in order to develop ways to limit facial trauma in the future. Methods The NEISS database was accessed in February 2020 in order to identify adult patients (> 19 years of age) presenting to the emergence department (ED) for rugby-related head and facial injuries from the previous 10 years (2009–2018). Descriptive statistics were organized and presented. Chi-squared testing (χ2) was performed to compare categorical variables, and ANOVA was performed to compare continuous variables. Results A total of 507 patients (national estimate = 18,952) from 2009 to 2018 were identified as appropriate for study inclusion. The most common injuries were those to the facial region including the eyelid, eye area, and nose (59.4%). The most frequently encountered facial fracture while playing rugby was the nasal bone (58.6%). Overall, 98.4% of patients who presented to the ED with rugby injuries were treated and released, 1.2% were admitted or observed, and 0.4% left against medical advice. Conclusions When evaluating a patient with a rugby-related injury, one should expect injuries to the eyelid, eye area, or nose. The most common fracture pattern will most likely be nasal bone. Despite these injuries, the vast majority of patients will be treated and released.

Abstract Purpose To compare resorbable plates with titanium plates for the fixation of zygomatic fractures, taking into account postoperative complications. Methods This systematic review followed the guidelines of PRISMA and the recommendations of the Cochrane Handbook and was registered in PROSPERO. The electronic search was performed in the Web of Science, PubMed, Virtual Health Library, and Cochrane Library databases and in the gray literature. The study selection and the data extraction were performed by three calibrated and independent researchers. The assessment of the risk of bias in the studies was performed using the Cochrane Risk of Bias Tool for clinical trials. Meta-analyses were performed using Review Manager Software version 5.3, using the Peto’s Odds Ratios (PORs), and when I2 > 30, the random effect model was used. The evaluation of the quality of the evidence was carried out through GRADE. Results A total of 2651 studies were screened and only nine were included; 7 of which were used for quantitative assessment. The follow-up time for patients ranged from 6 months to 5 years. All studies showed a low risk of bias in the “incomplete outcome data” domain. The need for plate removal (POR: 0.11, 95% CI: 0.02 to 0.81, I2 = 0%) and dehiscence (POR 0.12, 95% CI 0.02 to 0.63, I2 = not applied) was lower for the group of patients who used resorbable plates than for titanium plates. Conclusion There was no difference in the occurrence of infection, diplopia, or paresthesia between the fixation methods. Resorbable plates showed better postoperative clinical performance.

Abstract Background Septic arthritis of the temporomandibular joint (TMJ) is rare. It usually causes isolated, locoregional symptoms related to the infected intra-articular space but may also cause fever and malaise. Case report We present a case of a 72-year-old male with septic arthritis of the TMJ complicated by extensive peri-articular necrosis, septic shock, cerebral abscess, Lemierre’s syndrome, and a pathological fracture of the mandibular condyle. Conclusion Case reports describing such a severe course of the disease are few. Moreover, this is the first report of septic arthritis of the TMJ to cause Lemierre’s syndrome.

Abstract Introduction Well leg compartment syndrome is a rare postoperative condition that occurs as a result of non-traumatic ischemic insult. It has similar pathophysiology to compartment syndrome; however, no definitive etiology is identified. Several risk factors such as patient position, leg position, young age, and high BMI for the development of this condition are considered. Case report A 30 years old male smoker and overweight, underwent mandibular and maxillary osteotomies in reverse Trendelenburg position. He developed a WLCS post-operative and treated with fasciotomy. Conclusion Increased Awareness of this rare occurrence and predisposition aids in understanding and prompt management. This article provides a rare case that has occurred in reverse Trendelenburg position with less obvious risk factors than typically reported in the literature

Abstract Purpose The aim of the present study was to perform a comparative analysis of the utility, outcomes, and complications of DCIA (deep circumflex iliac artery) flap for the reconstruction of maxillofacial defects between two institutions that continue to use the DCIA flap as a reconstructive resource. Materials and methods This retrospective analysis included a total of 68 patients (mean age 51.1 years) at the University Hospital of Parma, Parma, Italy, and the University of Maryland, Baltimore, USA, between January 2010 and April 2019. Results No statistical differences were found in relation to the site of reconstruction (p = 0.09), bone graft quantity (p = 0.93), rehabilitation with dental implants (p = 0.464), length of hospitalization (p = 0.086), BMI (0.677), swallow function (p = 0.419), medical comorbidities (p = 0.933), pre-existing radiation (p = 0.691), adjuvant treatment (p = 0.298), ECOG-PS pre-and post-surgery (p = 0.329; p = 0.545), and flap failure: one partial failure observed (p = 0.412) and donor site morbidities (p = 0.742). A noted trend to increased risk of hernia without the use of a primary mesh repair was observed (p = 0.059). Conclusion The DCIA free flap represents a useful and reliable reconstructive flap for maxillofacial reconstruction. Reconstructive microvascular surgeons should be proficiently trained in this flap technique for its consideration as a first-line option in maxillofacial reconstruction.

Abstract Objective To evaluate the canalis sinuosus (CS) in individuals with cleft lip and palate (CLP) and compare the findings with individual’s NON-CLP using cone beam computed tomography (CBCT). Materials and methods The sample consisted of 100 CBCT exams of NON-CLP individuals (G1 group) and 200 of CLP individuals (G2 group). Recorded parameters included presence of CS, accessory canal to the CS, diameter greater than 1 mm, gender, age, localization in relation to teeth, and adjacent structures. Statistical tests were used to compare the findings between groups. A p value of < 0.05 was considered as significant. Results A higher prevalence of accessory canal was found in the G2 (p < 0.001). The anteroposterior diameter of the right side CS in G2 was higher than G1 (p < 0.05), with average of 1.4 mm ± 0.4 mm. The accessory canal had a larger diameter in G2 than G1 (p < 0.05) with average of 1.3 mm ± 0.3 mm. Between UCLP, the CS presented the largest diameter for the side NON-CLP (p < 0.001). The accessory canal was more distant from the cortical buccal in G2 (P < 0.05). The dental region incidence of the accessory canal was molars and premolars for G2 and canines and incisors in G1. Conclusion Individuals with CLP show higher prevalence of accessory canal to the CS with larger diameters than NON-CLP. It is necessary that the professional make adequate planning prior to surgeries, using the CBCT, in order to avoid neurovascular lesions, since these individuals undergo several surgeries in the CS region.

Abstract Purpose Malignant tumours in the parotid gland can originate either from the gland itself or as a result of metastatic spread of other tumours, such as cutaneous squamous cell carcinomas (CSCC) of the head and neck area. The aim of this study was to analyse and compare the clinical behaviour of primary as well as CSCC metastatic parotid cancers with special emphasis on therapy and oncologic outcome. Methods Clinical and histopathological data of 342 patients with parotid gland malignomas surgically treated in a tertiary referral centre between 1987 and 2015 were retrospectively assessed. Oncologic outcomes of all cases with CSCC metastasis of the parotid gland (n = 49) were compared to those of primary parotid gland carcinomas (n = 293). Results Mean age at diagnosis was 72.3 years for CSCC patients versus 56.8 years in patients with primary parotid carcinoma. A total of 83.7% of CSCC patients were male, compared to 48.8% in the group of primary carcinomas. Forty-five out of 49 CSCC patients underwent total parotidectomy and neck dissection (91.8%). A total of 93.9% out of all CSCC patients received adjuvant radiotherapy. Five-year overall survival (OS) was 32.6% in CSCC patients versus 77.2% in primary parotid carcinoma patients. Conclusion As compared to primary parotid cancers, we could show that patients suffering from CSCC metastases to the parotid gland presented with significantly higher age and worse survival.

Abstract Objective To histologically analyze the effect of a curettage of the granulation tissue on healing at implants installed immediately after the extraction of teeth presenting periapical lesions. Material and methods In seven dogs, the dental pulp was removed from the pulp chamber and from the root canals of the right and left third and the fourth mandibular premolars and of the left second premolar. The chambers were left opened and, after 3 months, apical lesions were present, and the premolars were extracted. One alveolus each premolar was selected and, before implant installation, the apical lesions of two alveoli were curetted (curettage group) while the other three were not treated (no-treatment group). The second right premolar was also extracted (Negative control group). Six implants each dog were installed, and a fully submerged healing was allowed. Four months after, biopsies were collected, and histological analyses were performed. Results The proportions of new bone at the entire body of the implant was 70.2 ± 10.7% at the no-treatment group, 72.1 ± 14.8% at the curettage group, and 69.6 ± 3.7% at the negative control group. The respective new bone proportion at the apical aspect of the implants was 68.4 ± 17.5%, 61.5 ± 27.3%, and 78.1 ± 5.7%. None of the differences among the various groups were statistically significant. No inflammatory infiltrates were seen in the apical region. Conclusions In this experimental study, it is concluded that the removal of the granulation tissue seems not to be necessary to obtain a proper osseointegration of implants installed immediately after the extraction of teeth presenting a periapical lesion.

Abstract Background Head and neck surgeons often face a challenge in order to achieve adequate three-dimensional resection of tumours in the oral cavity, especially in the dentate patient. Methods We compared the outcomes of lip-split mandibulotomy and trans-oral access, respectively, in patients treated for primary pT2 oral tongue SCC with regard to the status of the resection margins and the incidence of tumour recurrence. Results Multivariate analysis showed a non-significant effect of the surgical technique used to the reported recurrence, F(1, 224) = 0.350, p = .555 and a significant effect on the margins achieved F(1, 224) = 11.381, p = .001. Conclusions Defects after excision of larger and more posterior tumours that are going to be reconstructed with free flaps represent a more probable indication for using an osteotomy access technique. Lip-split mandibulotomy is a low-morbidity technique which can deliver a sound oncological outcome and can be relatively easily taught to less experienced surgeons.