International Journal of Oral and Maxillofacial Surgery

The radial forearm free flap (RFFF) is associated with donor site morbidity. This study aimed to quantify the functional and aesthetic outcomes after closure of the RFFF donor site using triangular full-thickness skin grafts (FTSGs) harvested adjacent to the flap or traditional split-thickness skin grafts (STSGs). The study included patients who underwent oral cavity reconstruction with an RFFF between March 2017 and August 2021. The patients were divided into two groups based on the donor site closure method: FTSG or STSG.

This article describes the ‘adaptable condylectomy’ and highlights two innovative treatment protocols for the variety of acquired facial asymmetry and associated malocclusion caused by condylar hyperplasia, as illustrated by the cases of seven patients presenting different manifestations of condylar hyperplasia. Protocol I (three cases) is applied for condylar hyperplasia with a normal occlusion and involves a high condylectomy, with the goal of guiding the mandible back to the original occlusion.

This study was performed to analyse the age-specific characteristics of head and neck second primary malignancies (SPMs) in patients treated for nasopharyngeal carcinoma (NPC). The medical records of 56 NPC patients diagnosed with head and neck SPMs were reviewed retrospectively. Patients < 45 years old at NPC diagnosis were assigned to the younger group and those ≥ 45 years of age were assigned to the older group. The treatment of the index NPC, latency period, pathological TNM stage, survival status, and SPM subsite were analysed.

A prospective study was performed to assess the effect of orthognathic surgery on mild obstructive sleep apnoea (OSA) in patients with an underlying dentofacial deformity treated for occlusal and/or aesthetic reasons. As the main outcome variables, changes in upper airway volume and apnoea–hypopnoea index (AHI) were evaluated at 1 and 12 months of follow-up, in patients undergoing orthognathic surgery with widening movements of the maxillomandibular complex. Descriptive, bivariate, and correlation analyses were performed; significance was set at P < 0.05.

Orbital reconstruction is a common procedure with inherent challenges and important consequences. Intraoperative use of computed tomography (CT) is an emerging application that facilitates accurate intraoperative evaluation to improve clinical outcomes. This review aims to investigate the intraoperative and postoperative outcomes of intraoperative CT use in orbital reconstruction. PubMed and Scopus databases were systematically searched. Inclusion criteria were: clinical studies investigating intraoperative CT use in orbital reconstruction.

This study was performed to compare the diagnostic accuracy of cone beam computed tomography (CBCT) alone and magnetic resonance imaging (MRI) alone in patients with clinical symptoms of temporomandibular joint osteoarthritis (TMJ-OA). Fifty-two patients (83 joints) with clinical signs of TMJ-OA were included in the study. Two examiners evaluated CBCT and MRI images. McNemar and kappa tests and Spearman’s correlation analysis were applied. Radiological findings of TMJ-OA were detected in all 83 joints on CBCT or MRI .

Oral mucosal melanoma is a rare presentation of malignant melanoma with a 5-year survival rate of only 15%. Oral mucosal melanoma in situ (OMMIS) is its assumed precursor. This report describes one of only 20 documented cases of OMMIS and outlines how early clinical recognition resulted in prompt histopathological diagnosis and subsequent complete surgical excision. A literature review of existing reported cases, their management, and latest outcomes was also performed, highlighting this rare condition for consideration in the differential diagnosis of pigmented oral pathologies.

The efficacy of neoadjuvant chemotherapy in the field of head and neck oncology has always been debated. The aim of this study was to determine the efficacy of neoadjuvant chemotherapy followed by surgery in patients with oral squamous cell carcinoma (OSCC) by comparison to upfront surgery, in terms of overall survival, disease-free survival, response rates, positive surgical margins, loco-regional recurrence, distant metastasis, and toxicity. Prospective and retrospective studies were identified from a search of the PubMed, PubMed Central, and Cochrane Library databases (publication date between January 1, 1995 and January 1, 2022), as well as hand searches.

This report describes the case of a middle-aged man who attempted suicide, which resulted in laryngeal webbing and pharyngeal stenosis. The patient was compromised at the level of respiration, necessitating a tracheostomy. Alimentation was also affected, and feeding was done through a gastrostomy tube. Unfortunately, the fibrous tissues were resistant to dilatation and laser treatment. Hence, he underwent a modified partial horizontal supraglottic laryngectomy (PHSL) and pharyngectomy to excise all of the fibrous tissues formed after the incident.

The aim of this study was to compare the virtually planned position to the postoperative position of the maxilla, having performed the maxilla-first sequence or mandible-first sequence orthognathic surgery. An audit of 64 patients who underwent bimaxillary surgery between 2017 and 2020 was performed. Thirty patients had maxilla-first surgery and 34 had mandible-first surgery. The planned and post-surgical positions were analyzed using specific skeletal landmarks. Differences were calculated and the two-sample t-test was used to compare the groups.

Neurofibromas are frequently present in the skin, but are uncommon in the oral and maxillofacial region. There are three histological variants of neurofibroma: localized, diffuse, and plexiform. The plexiform histological variant of neurofibroma is the least common and is a rare occurrence in the oral cavity. Furthermore, plexiform neurofibroma is usually pathognomonic of neurofibromatosis type 1. A case of solitary plexiform neurofibroma of the tongue with no evidence of neurofibromatosis in a 50-year-old female Chinese patient is reported here.

Follow-up studies on odontogenic keratocysts have reported widely varying recurrence rates. This raises the question of how reliable these studies are and how the results should be interpreted. The aim of this study was to critically assess the information from all follow-up studies published since 2004 against a set of criteria to determine how thorough the study was. These criteria include the exclusion of the orthokeratinized variant, exclusion of cysts associated with nevoid basal cell carcinoma syndrome, and appropriate reporting of dropouts.

Head and neck malignancies share similar risk factors as carotid artery stenosis and these can often present together. Patients who require external beam radiotherapy are at a higher risk of developing significant worsening stenosis. The workup of the oncologic patient often includes computed tomography, which can reveal underlying carotid artery stenosis, offering an opportunity to address both conditions in one operation and prevent the need for a complicated carotid endarterectomy (CEA) in irradiated and previously operated tissue.

Osseous genioplasty and chin augmentation with implants are the two main treatment options for retrognathia. This retrospective cohort study was performed to compare the prevalence of complications and patient satisfaction following osseous genioplasty and chin augmentation by implant. Eighty patients were included: 38 underwent advancement osseous genioplasty and 42 received chin implants (alloplastic, either Medpor or Silastic) intraorally or extraorally. The patients were assessed for complications 12 months after surgery, including neurosensory disturbances, infection or extrusion, wound dehiscence, and the need for reoperation.

The anatomy of the posterior mandibular ridge and the anatomical structures present in this region are important in the planning and execution of dental treatments. The aim of this study was to examine all forms of alveolar ridge in detail to provide a comprehensive description of the posterior mandibular ridge. This study included 1865 cross-sectional sections of cone beam computed tomography scans obtained from 511 Iranian patients with a mean age of 48.14 years (280 female, 231 male). The alveolar ridge was described based on the ridge shape, including the existence and location of convexity and concavity.

Postoperative delirium (POD) following microvascular head and neck reconstruction negatively impacts patient outcomes, and only a few risk factors have been identified. The aim of this study was to identify additional risk factors for POD after intraoral reconstruction with microvascular free flaps. Data from 377 patients who underwent intraoral microvascular free flap reconstruction between 2011 and 2019 were analysed retrospectively. Preoperative, intraoperative, and postoperative variables were compared between 40 patients with POD and 40 patients without POD who were matched for previously identified risk factors (i.e., sex, age, American Society of Anesthesiologists class, preoperative arterial hypertension, tracheotomy, operation time, and blood transfusion).

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents.

The stability of a microvascular anastomosis is an important prerequisite for successful tissue transfer. Advances in tissue adhesives are potentially opening new avenues for their use in sutureless microsurgical anastomosis, however they have not yet gained clinical acceptance. In this ex vivo study, a novel polyurethane-based adhesive (PA) was used in sutureless anastomoses and its stability compared with that of sutureless anastomoses performed with fibrin glue (FG) and a cyanoacrylate (CA). Stability was assessed using hydrostatic (15 per group) and mechanical tests (13 per group).

This study aimed to investigate the clinical, radiological, and pathological characteristics of pathologies involving the buccal fat pad (BFP) and to explore the treatment protocols. The cases of 109 patients with primary pathologies involving the BFP (pBFP) diagnosed between January 2013 and September 2021 were assessed. The patients’ clinical presentations and radiological and histopathological findings were analysed retrospectively, and their treatment outcomes were evaluated. The 109 pBFP were categorized as benign tumours (n = 17), malignant tumours (n = 29), vascular malformations (n = 38), and inflammatory masses (n = 25).

The aim of this study was to evaluate the effect of preoperative anaemia on the risk of occurrence of regional metastases and second primary tumours in patients with early-stage (cT1–T2N0M0) oral squamous cell carcinoma (OSCC) after primary surgical treatment. Consecutive patients with OSCC who were referred to University Hospital Dubrava and University Clinical Centre of Kosovo between January 1, 2000 and December 31, 2010, and who met the following criteria, were included: adult> 18 years of age; verified cT1–T2N0M0 stage; available data on clinical and laboratory work-up allowing the assessment of demographics, lifestyle/habits, anaemia, and comorbidities.

Orbital floor fractures are common injuries seen in the emergency department (ED). In this study, the National Trauma Data Bank (NTDB, 2016–2017) was used to identify patients presenting with isolated orbital floor trauma. Patient-specific factors were analyzed to determine associations with management. The sample comprised 912 patients; 285 (31.3%) of these patients were discharged from the ED, 541 (59.3%) were admitted to the hospital but did not undergo an operation, and 86 (9.4%) underwent operative treatment.

The objective of this study was to assess endo-sinus bone gain (ESBG) following osteotome-mediated sinus floor elevation with Bio-Oss Collagen (test) compared with no grafting material (control) using two- and three-dimensional radiographic methods, as part of a randomized controlled trial (ClinicalTrials.gov, NCT04618900). Forty healthy patients who met the necessary eligibility criteria were allocated by block randomization to either the test group (20 patients) or control group (20 patients).

The aim of this study was to compare single- and double-layer digital template-assisted genioplasty for the correction of jaw deformity resulting from temporomandibular joint ankylosis (TMJA). Thirteen patients with jaw deformity resulting from TMJA who underwent lateral arthroplasty, costochondral graft, or total joint replacement combined with single- or double-layer digital template-assisted genioplasty were included. Computed tomography data were obtained for the preoperative design. Digital templates were designed and manufactured using three-dimensional printing to assist with the chin osteotomy and repositioning in single- or double-layer genioplasty.

This report presents a case of worsening obstructive sleep apnea (OSA) post-chemoradiation therapy that improved significantly after placement of a hypoglossal nerve stimulator. The patient was a 66-year-old male, diagnosed with head and neck cancer, who experienced exacerbation of OSA after receiving chemoradiation. A hypoglossal nerve stimulator was placed, with minimal complications. The patient showed a significant improvement in OSA as exhibited by the reduction in apnea–hypopnea index. Hypoglossal nerve stimulator placement appears to be a potential treatment option for induced or worsened OSA, which is a known complication of head and neck cancer treatment.

The digital articulation of dental models is gradually replacing the conventional physical approach for occlusal prediction planning. This study was performed to compare the accuracy and reproducibility of free-hand articulation of two groups of digital and physical dental models, 12 Class I (group 1) and 12 Class III (group 2). The models were scanned using an intraoral scanner. The physical and digital models were independently articulated 2 weeks apart by three orthodontists to achieve the maximum inter-digitation, with coincident midlines and a positive overjet and overbite.

Sialendoscopy is a minimally invasive technique used mainly in the diagnosis and treatment of obstructive salivary gland disorders. There has yet to be a report on its use in the diagnosis of metastatic disease. While metastatic cancer has been described in numerous head and neck anatomic subsites, it has not been reported to be found in a mucous plug in Stensen’s duct. Sialendoscopy was performed in a 68-year-old female patient who presented with symptoms of ductal obstruction. Basket removal of a mucous plug was done and histopathological analysis of this specimen found adenocarcinoma.

The purpose of this study was to review the existing evidence from randomized controlled trials (RCTs) on the effect of autogenous bone grafts combined with a platelet-rich concentrate on alveolar clefts. An electronic search was conducted in the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov databases for studies published between January 2000 and April 2022. This study included six RCTs to evaluate bone quantity (bone formation ratio, %) and quality (bone density in Hounsfield units, HU), as well as complications as a way to assess the safety of the technique.

We appreciate the interest of the authors of the Letter to the Editor in our systematic review on complications of total temporomandibular joint (TMJ) replacement,1 as well as the time and effort dedicated to providing valuable comments and suggestions. After carefully reading the Letter, we would like to explain some points.

Cleft palate is associated with a high prevalence of middle ear dysfunction, even after palatal repair. The aim of this study was to evaluate the effects of robot-enhanced soft palate closure on middle ear functioning. This retrospective study compared two patient groups after soft palate closure with a modified Furlow double-opposing Z-palatoplasty technique. Dissection of the palatal musculature was performed using a da Vinci robot in one group and manually in the other. Outcome parameters were otitis media with effusion (OME), tympanostomy tube use, and hearing loss during 2 years of follow-up.

We would like to make a few pertinent observations in reference to the recently published clinical paper on “Gland-sparing neck dissection: oncological and functional outcomes in oral cancer patients”, by Shih et al.1 Proponents of submandibular gland (SMG) preservation in early oral squamous cell carcinoma claim that the gland seldom has intra-glandular lymph nodes and is only directly involved by contiguous invasion from a bulky tongue/floor of the mouth primary or extranodal extension from malignant nodes around it.

We read the article “Complications of total temporomandibular joint replacement: a systemic review and meta-analysis” by Peres Lima et al.1 with interest. The authors have provided a detailed review of the “most prevalent complications resulting from total temporomandibular joint replacement”.

We would like to thank the authors for carefully reading our recently published article entitled “Gland-sparing neck dissection: oncological and functional outcomes in oral cancer patients”,1 and putting forward several precise and practical comments. We would like to thoughtfully respond to these comments.

This in silico kinematic study was performed to evaluate the best attainable outcomes of maxillary distraction osteogenesis given the constraints of linear and helical motion. The study sample included the retrospective records of 30 patients with maxillary retrusion who had been treated with distraction or had been recommended this treatment. The primary outcomes were the errors of linear and helical distraction. The study measured two types of error: misalignment of key upper jaw landmarks and misalignment of the occlusion.

The advantages of immediate implant placement for patients include a reduced number of surgical procedures and a shorter overall treatment time. Disadvantages include a higher risk of aesthetic complications. The aim of this study was to compare xenogeneic collagen matrix (XCM) versus a subepithelial connective tissue graft (SCTG) used for soft tissue augmentation in combination with immediate implant placement without provisionalization. Forty-eight patients requiring a single implant-supported rehabilitation were selected and assigned to one of two surgical procedures: immediate implant with SCTG (SCTG group) or immediate implant with XCM (XCM group).

Odontogenic fibroma is a rare benign mesenchymal odontogenic tumor, with its histological diversity possibly posing diagnostic challenges. A case of the amyloid variant of central odontogenic fibroma, with epithelial cells in perineural and intraneural locations, is reported herein. The 46-year-old female patient had experienced discomfort related to her anterior right hard palate for approximately 25 years. Clinical examination revealed a depression in the anterior hard palate, and radiographic examination showed a well-defined radiolucent lesion with root resorption of the adjacent teeth.

Radiation doses in dentomaxillofacial imaging are typically very low. However, diagnostic and follow-up protocols in orthognathic surgery result in a patient-specific risk in effective dose. Estimating the cancer risks from these exposures remains abstract for many maxillofacial surgeons. In this study, 40 orthognathic patients were randomly sampled and their cumulative effective dose (ED) calculated. The lifetime attributable risk of cancer (LAR) was calculated based on the standard radiological protocol for orthognathic surgery follow-up using methods described in the BEIR VII report and RadRAT.

It is with interest that we read the clinical case report on intraosseous carcinoma of the anterior maxilla identified as occult primary tumour of carcinoma of unknown primary1 (CUP) in the December issue of the International Journal of Oral and Maxillofacial Surgery.

Soft tissue deposits, also known as tumour deposits (TDs), have not been studied well in head and neck squamous cell carcinoma (HNSCC) and are not included in any of the staging systems or treatment guidelines. The aim of this systematic review was to determine the prevalence and prognostic implications of TDs in patients with HNSCC. This systematic review of the literature was conducted following the PRISMA guidelines. The PubMed, Embase, and Scopus electronic databases were searched for relevant studies, from inception to August 2022.

Despite the importance of studies evaluating the long-term prognosis of burning mouth syndrome (BMS), there is a paucity of reliable literature available on this subject. We read with interest a recently published article by Kim et al.,1 titled “Long-term prognosis of burning mouth syndrome following treatment”, which concluded that the long-term prognosis of BMS was good in patients who responded well to treatment, and that xerostomia and taste disturbance were associated with a relapse of oral discomfort in some of the responders.

We thank the authors of the Letter to the Editor for their interest in our case report, “Intraosseous carcinoma of the anterior maxilla identified as the occult primary tumour of carcinoma of unknown primary”.1

The Sistrunk procedure has long been the method of choice for treating patients with thyroglossal duct remnants (TDRs). However, the extent of the surgical resection in the suprahyoid segment of the TDR remains controversial, as this anatomical site is the origin of both disease recurrence and surgical morbidity. The aim of this two-centre retrospective cohort study was to investigate the outcomes of a modified muscle-sparing Sistrunk procedure in primary TDRs. The primary predictor was the surgical approach, and the outcome variable was the recurrence rate.

The aim of this study was to determine whether there are any differences in morphology between temporomandibular joint ankylosis (TMJA) of traumatic and infective origin. Cone beam computed tomography (CBCT) scans of 25 patients (28 joints) with TMJA of traumatic origin (trauma group) and 15 patients (15 joints) with TMJA of infectious origin (infection group) were included. The following morphological parameters were evaluated on multiple sections of the CBCT scans: lateral juxta-articular bone growth, residual condyle, residual glenoid fossa, ramus thickening, ankylotic mass fusion line, sclerosis of the ankylosed condyle and spongiosa of the glenoid fossa, and mastoid and glenoid fossa air cell obliteration.

This cross-sectional study was performed to examine sources of variation in distress associated with altered appearance and fundamental functions in oral cancer patients at 2 months, 12–15 months, 24–36 months, and ≥ 5 years post-definitive treatment. Eligible patients completed six scales from the FACE-Q Head and Neck Cancer Module. Pre-specified regression models were used to examine sources of variation in study outcomes for 145 patients. Patient self-reports indicated that distress associated with altered appearance and fundamental functions was highly variable, and distress was present beyond 5 years post-definitive treatment in some patients.

After tooth extraction, alveolar bone resorption and labial bone plate thinning occur due to the lack of periodontal ligaments. The socket shield method was developed to preserve the alveolar ridge. A split-mouth study was performed in which eight patients were treated using alloplast with socket shield on one side (alloplast group, control) and autogenous dentin graft with socket shield on the contralateral side (dentin group, test). After 3 months, a trephine bone core was collected from all sites and evaluated by histological, histomorphometric, and radiographic analysis.

We would like to thank the authors of the Letter for their interest in our article “Long-term prognosis of burning mouth syndrome following treatment”,1 published in the International Journal of Oral and Maxillofacial Surgery.

The aim of this study was to determine whether arthrocentesis is superior to conservative treatment in the management of painful temporomandibular joint disorders with restricted opening. A systematic review was undertaken of prospective randomized controlled trials (RCT) comparing arthrocentesis to conservative management, identified in the MEDLINE and PubMed databases. Inclusion criteria included a 6-month follow-up, with clinical assessment of the patients and painful restricted mouth opening.

The pterygoid implant is a feasible alternative for posterior dental rehabilitation without grafting; however, the ideal pterygoid implant placement continues to be debated. The aim of this study was to identify effective landmarks and establish valid guidelines to determine the ideal pterygoid implant placement. Cone beam computed tomography (CBCT) data of 100 severely atrophied maxillae requiring implant rehabilitation, obtained between January 2015 and December 2018, were included. The CBCT data were obtained in DICOM format from the radiographic database and imported into Nobel Clinician software (Nobel Biocare) for radiographic analysis.

Gunshot wounds of the lower face are a challenge for the surgeon. Customized distraction osteogenesis (DO) is a well-established procedure for managing facial gunshot wounds. However, differences between the preoperative planning and postoperative outcomes are often noted. This multi-centre, retrospective study was performed to analyse the differences between the planning and outcomes for the lower third of the face, in patients undergoing the computer-assisted repair of mandible gunshot wounds using patient-specific distraction devices.

Pathological diagnosis is important for the definite diagnosis of immunoglobulin G4-related sialadenitis (IgG4-RS). Core needle biopsy (CNB) is a scarless technique; however the pathological heterogeneity of IgG4-RS (a particular feature of this disease) could be the potential cause of the inferior diagnostic capability of submandibular gland CNB (SMG-CNB) for IgG4-RS. The aim of this study was to explore technical improvements in SMG-CNB and improve its diagnostic power in IgG4-RS diagnosis. Eighteen patients clinically suspected for IgG4-RS were enrolled and underwent both SMG-CNB and SMG surgical biopsy.