Annals of Maxillofacial Surgery最新文献

Introduction: This study aims to evaluate the three-dimensional (3D) changes in maxillary alveolar morphology following the application of modified nasoalveolar moulding (NAM) in Vietnamese patients with unilateral cleft lip and palate (UCLP).

Materials and methods: A cohort of UCLP patients undergoing modified NAM treatment was assessed using 3D imaging techniques to quantify alterations in maxillary alveolar morphology. Pre-treatment and post-treatment images were analysed to measure changes in alveolar width, height and overall morphology.

Results: The findings indicate significant improvements in maxillary alveolar dimensions post-NAM application, with notable increases in both the width and height of the alveolar ridge. These morphological changes are crucial for optimising surgical outcomes and enhancing the functional and aesthetic aspects of cleft lip and palate repair.

Discussion: Modified NAM positively affects the maxillary alveolar morphology in Vietnamese UCLP patients, highlighting the importance of early cleft care intervention and paving the way for future research on NAM's long-term benefits.

Rationale: Low-flow vascular malformations (LFVMs) of the orofacial region are rare congenital vascular anomalies caused by aberrant development of venous and lymphatic channels, leading to slow or stagnant blood flow. This report highlights the successful management of LFVMs of buccal mucosa using ultrasound-guided bleomycin sclerotherapy.

Patient concerns: A 37-year-old female presented with a 5-year history of progressive, painless swelling of the left buccal mucosa.

Diagnosis: Clinical and radiological evaluation, including computed tomography (CT) angiography, confirmed a LFVM supplied by the left facial artery with venous drainage into the retromandibular vein.

Treatment: The patient underwent three weekly sessions of ultrasound-guided intralesional bleomycin sclerotherapy (15 IU in 10 mL sterile water).

Outcomes: One-year follow-up CT angiography showed minimal residual tissue with no recurrence and a 70% reduction in lesion size was noted.

Take-away lessons: Ultrasound-guided bleomycin sclerotherapy is a safe, minimally invasive and effective treatment for LFVM in cosmetically sensitive facial regions.

Introduction: This study aims to assess pre-operative and post-operative nasal airflow in patients undergoing functional septorhinoplasty aiming to pinpoint the sites of obstruction and tailor precise surgical interventions accordingly.

Materials and methods: A prospective observational cohort study of 57 patients undergoing functional septorhinoplasty was conducted. Nasal airflow was measured using a nasal inspiratory peak flowmeter with and without snoring strips at the internal nasal valve and external nasal valve, both preoperatively and at 2, 4 and 6 months postoperatively along with subjective assessment using the Nasal Obstruction Symptom Evaluation (NOSE) score.

Results: The mean NOSE score fell from 56.05 ± 19.6 to 11.23 ± 9.8 6 months postoperatively (P < 0.01). Nasal inspiratory peak flow (NIPF) measurements showed a gradual mean increase from 55.02 L/min to 101.09 L/min at 6 months postoperatively. Snoring strips at the internal nasal valve improved airflow in 68.4% of patients versus 31.5% at the external valve.

Discussion: NIPF with snoring strips helps diagnose nasal valve dysfunction and guide appropriate grafting technique.

Background: Temporomandibular disorders (TMDs) are complex, multifactorial conditions involving the temporomandibular joint (TMJ) and associated musculoskeletal structures, often characterised by inflammatory involvement. Inflammatory mediators play a key role in symptom severity, disease progression and treatment response. This systematic review aims to synthesise current evidence on the prognostic value of inflammatory biomarkers in TMDs.

Objectives: To evaluate the prognostic reliability of inflammatory biomarkers measured in TMJ synovial fluid for predicting treatment response and disease progression in adults with TMDs.

Data sources & study eligibility criteria: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines.

Participants & interventions: Electronic searches were performed in PubMed, PubMed Central, Scopus, ScienceDirect, the Cochrane Library and Google Scholar for studies published between 2013 and 2023. Randomised controlled trials and clinical trials assessing inflammatory biomarkers in TMJ synovial fluid were included.

Study appraisal & synthesis methods: Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Due to methodological and clinical heterogeneity, a narrative synthesis was performed.

Results: Five studies met the inclusion criteria. Elevated levels of interleukin-1β (IL1β), IL6 and tumour necrosis factor-alpha (TNF-α) were consistently associated with disease severity and treatment response across studies, although effect sizes varied according to intervention type.

Limitations & conclusions: Inflammatory biomarkers, particularly IL1β, IL6 and TNFα, demonstrate potential prognostic value in TMDs. However, heterogeneity among studies limits quantitative pooling, highlighting the need for standardised biomarker methodologies.

Background: Post-mucormycosis maxillary, mid-facial and mandibular defects are often extensive, multi-planar and occur in medically compromised patients, making conventional obturators, free flaps and standard implant protocols challenging.

Objectives: Three-dimensional (3D)-printed patient-specific implants (PSIs) have emerged as a digitally planned, titanium-based alternative, but clinical evidence remains fragmented.

Data sources: A systematic search of electronic databases and manual sources was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.

Study eligibility criteria: Studies reporting clinical outcomes of 3D-printed PSIs in patients with post-mucormycosis maxillary/mid-facial defects were included. Data on patient/defect characteristics, PSI design, complications, functional and aesthetic outcomes were extracted. Risk of bias was assessed using Joanna Briggs Institute checklists for cohort/case series and case reports.

Participants and interventions: Eleven studies met the inclusion criteria. Defects were predominantly Brown Class II-III maxillectomy and complex mid-facial/orbital defects treated with computed tomography/cone-beam computed tomography-guided, additively manufactured titanium PSIs, often integrated with zygomatic anchorage.

Study appraisal: Pooled analysis of five multi-patient cohorts (n = 67) showed a PSI survival proportion of 0.96 (95% confidence interval = 0.91-1.00) at 6-24 months, with negligible heterogeneity (I ² = 0%). Complications were mostly minor and true PSI loss was rare.

Results: Functional (mastication, speech and leakage control) and aesthetic outcomes, where reported, were generally favourable with high patient satisfaction.

Conclusions: 3D-printed PSIs show excellent short-term survival and promising functional and aesthetic rehabilitation in extensive post-mucormycosis defects, but current evidence is limited to small, high-bias observational studies.

Limitations: Robust prospective and comparative research is needed before routine adoption can be recommended.

Background: Sclerosing microcystic adenocarcinoma (SMAC) is a rare, low-grade malignant salivary gland tumour newly classified in the 2022 World Health Organization (WHO) classification. Its histopathologic resemblance to other lesions and the scarcity of published cases hinder accurate diagnosis and optimal management.

Objectives: To systematically review reported oral and oropharyngeal SMAC cases, summarising clinicopathologic features, treatments, outcomes and study quality.

Data sources: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of MEDLINE (Ovid), PubMed, PubMed Central, Web of Science, SCOPUS, Google Scholar, BU Library Search, LILACS and LIVIVO was conducted, supplemented by cross-referencing. The protocol was registered in PROSPERO (CRD42023430309).

Study eligibility criteria: Included were case reports and case series of histologically confirmed SMAC with demographic, clinical, histopathologic and immunohistochemical data. Excluded were reviews, abstracts, letters, opinions and studies lacking full text or English translation.

Results: Fifteen studies comprising 21 patients (ages 41-73; female predominance) were included. The tongue was the most frequent site. Tumours displayed biphasic epithelial-myoepithelial differentiation, dense sclerosis, and frequent perineural invasion. CK7, EMA, p63, S100 and SMA were commonly positive; CD117 was negative. Surgical excision, with or without neck dissection or radiotherapy, achieved disease-free status in all patients with follow-up (4 months-5 years). Risk of bias was low to moderate.

Limitations: Small sample size, retrospective nature, incomplete follow-up and lack of molecular data limit generalizability.

Conclusions: SMAC is an indolent malignancy with favourable prognosis when completely excised. Greater clinical awareness and molecular studies are needed to refine diagnosis and guide long-term management.

Rationale: Surgery for oral cancer necessitates neck dissection, which is a common and safe procedure. However, it can be associated with few complications. Chyle leak (CL) is one such rare complication of neck dissection surgery, which is a potentially life-threatening complication.

Patient concerns: We report a case of left-sided CL following neck dissection surgery in a case of cancer of the tongue.

Diagnosis: Postoperatively, excessive drain output collection and biochemical analysis of fluid confirmed CL.

Treatment: Immediate conservative measures were taken. Ligation of the thoracic duct was performed which successfully ceased CL.

Outcomes: There was no sign of CL after ligation of the thoracic duct, and the patient was then discharged uneventfully.

Take-away lessons: In any case of CL, early diagnosis and prompt aggressive treatment is imperative to reduce morbidity as well as mortality. The management of CL includes low fat diet, parenteral nutrition, the use of pressure dressings and ligation of the thoracic duct.

Introduction: Non-syndromic cleft lip and/or palate (NSCL/P) is a common congenital deformity, influenced by both genetic and environmental factors. The thymocyte selection-associated high-mobility group box-3 (TOX3) gene is suggested to influence NSCL/P development, though its role remains unclear. This study investigates environmental factors associated with NSCL/P and explores the association between TOX3 mutations and these factors.

Materials and methods: A cross-sectional retrospective study was conducted amongst 50 Malay patients with NSCL/P who underwent surgery at Hospital Universiti Sains Malaysia (January 2022-January 2023). Participants were selected based on inclusion criteria from electronic medical records. Data on environmental and familial risk factors were obtained using validated pro formas, and TOX3 gene copy number was analysed using quantitative polymerase chain reaction.

Results: Cleft lip and palate (CL/P) were the most common deformity, accounting for 74% of cases, and 56% of patients were male. Significant risk factors for NSCL/P included consanguineous marriage, family history of clefts, maternal radiation exposure, traditional medicine use, allergies, paternal smoking and infant heart anomalies (P ≤ 0.05). Maternal pregnancy age was inversely correlated with TOX3 expression in CL/P cases (r = -0.387, P = 0.018).

Discussion: The findings highlight complex gene-environment interactions in NSCL/P aetiology. Genetic predisposition, parental exposures and maternal factors jointly increase risk. Larger studies are needed to confirm these findings and further investigate gene-environment interactions in NSCL/P. The study underscores the role of TOX3 and environmental influences in NSCL/P pathogenesis, supporting targeted prevention and genetic counselling in the Malay population.

Introduction: To evaluate and assess the facial asymmetry correction by orthomorphic surgery in mandibular dysmorphia by unilateral temporomandibular joint (TMJ) ankylosis.

Materials and methods: This is a prospective in vivo study in which six patients having mandibular dysmorphology due to unilateral TMJ ankylosis were treated using orthomorphic surgery. The patients were evaluated for outcomes in terms of subjective and objective two-dimensional photography in profile and lateral views, lateral cephalography, three-dimensional (3D) computed tomography and 3D printing. Vertical and antero-posterior occlusal relationship, assessment of mouth opening before and after surgery and mental nerve paraesthesia/neurosensory deficit and post-operative complications are also assessed. Descriptive statistics, Wilcoxon signed-rank test, Friedman's test and Cochran's Q test were used.

Results: Our present study revealed results in support of technique mentioned, showing excellent success rate in terms of mandibular asymmetry correction when used in moderate-to-severe facial dysmorphology states.

Discussion: Orthomorphic surgery improves facial aesthetics by correction of mandibular asymmetry.

Genioplasty remains a key procedure in facial aesthetic surgery, particularly regarding gender affirmation, due to the significant role of the chin in defining lower facial proportions and sexual dimorphism. While T-shaped osteotomy (TSO) has conventionally been used to narrow the chin in feminisation procedures, its ability to provide three-dimensional (3D) control of bone segments also enables vertical and transverse modifications, including widening when combined with anterior advancement and controlled rotation. The sequential protocol using a 3D plan and customised surgical guide for osteotomy and reposition has not been fully published. This paper aims to report the use of TSO for combined advancement, vertical reduction and proportional transverse remodelling in a male Class II patient undergoing orthognathic surgery. The patient presented with retrusive, narrow and elongated chin morphology associated with Class II skeletal deformity, and underwent orthognathic surgery complemented by TSO genioplasty. Virtual surgical planning and customised surgical guides were manufactured. The technique included controlled bone segment repositioning to achieve both projection and desired contour. TSO provides a versatile and biologically favourable approach for genioplasty in aesthetic facial surgery.