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Journal: International journal of oral and maxillofacial surgery

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Post-surgical neuropathy is a known complication of many surgical procedures for which few remedies are effective. This study used neurosensory assessments and biochemical assays to evaluate the efficacy of melatonin on nerve healing following orthognathic surgery. Thirty randomly allocated orthognathic patients were prophylactically administered either oral melatonin or identical placebo for 21 consecutive days. Pre- and post-surgical clinical parameters included subjective pain, numbness, and objective neurosensory function. Pre- and post-surgical biochemical parameters were serum hydrogen peroxide and antioxidant enzyme levels. Melatonin was found to significantly reduce subjective pain perception by 50% in the early postoperative days. A 30% reduction in subjective numbness perception was observed at 1-week postoperative, increasing to an over 80% reduction by 3 months postoperative (P<0.00001). Objective neurosensory testing showed a significant improvement in healing profile in the melatonin group. Postoperatively, the hydrogen peroxide concentration was lower in the melatonin group (P<0.00001), and the levels of antioxidant enzymes were higher (P<0.00001). The strong correlations between clinical outcomes and biochemical changes suggest a link between antioxidant effects and reduced postsurgical pain and sensory recovery. The study findings suggest that the prophylactic administration of melatonin confers significant clinical benefits in terms of reduced postoperative pain and opioid use and improved sensory recovery following surgery.

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Dental migration into the ethmoid sinus is extremely rare. Furthermore, it is very unusual that a displaced dental implant is associated with a concomitant fungus ball in the ethmoid sinus. Herein, we report an unusual case of the coexistence of a dental implant and fungus ball in the ethmoid sinus. It appears that this condition has not been reported previously.

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The aim of this study was to examine the accuracy of three dimensionally (3D) printed models of the bony orbit derived from magnetic resonance imaging (MRI) for the purpose of preoperative plate bending in the setting of orbital blowout fracture. Retrospective computed tomography (CT) and MRI data from patients with suspected orbital fractures were used. Virtual models were manually generated and analysed for spatial accuracy of the fracture margins. 3D-printed models were produced and orbital fan plates bent by a single operator. The plates were then digitized and analysed for spatial discrepancy using reverse engineering software. Seven orbital blowout fractures were evident in six orbits. Analysis of the virtual models revealed high congruence between blowout fracture margins on CT and MRI (n=7, average deviation 0.85mm). Three zygomaticomaxillary complex fractures were seen, for which MRI did not demonstrate the same accuracy. For plates bent to the 3D-printed models of blowout fractures (n=6), no significant difference was found between those bent to CT versus those bent to MRI when compared for average surface and average border deviation (Wilcoxon signed rank test). Orbital blowout fractures can be defined on MRI with clinically acceptable accuracy. 3D printing of orbital biomodels from MRI for bending reconstructive plates is an acceptable and accurate technique.

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Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction that affects the mandible and maxilla of patients exposed to bone-targeting agents such as anti-resorptive and anti-angiogenic agents. Several MRONJ cases have been reported after dental extractions in patients under treatment with anti-angiogenic agents, including receptor activator of nuclear factor κB ligand (RANKL) inhibitor, anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibody, mammalian target of rapamycin (mTOR) inhibitors, and tyrosine kinase inhibitors (TKIs). The aim of this article was to describe an original case of lenvatinib-related osteonecrosis of the jaw in a patient affected by thyroid cancer. A 58-year-old man diagnosed with Hurthle cell thyroid cancer, who was undergoing treatment with lenvatinib, developed maxillary osteonecrosis after a dental extraction. No other concomitant local or systemic risk factors for MRONJ were present. With new cancer therapies applied every year, it is important to note this novel case of lenvatinib osteonecrosis of the jaw in a patient undergoing cancer treatment.

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A clinicopathological review of parotid tumours treated surgically in two oral and maxillofacial surgery departments was conducted. The performance of fine needle aspiration cytology (FNAC) was also assessed. This retrospective study included 250 consecutive patients treated surgically for parotid gland-related tumours. Benign tumours (n=211, 84.4%) were more prevalent than malignancies (n=39, 15.6%). A predominance of pleomorphic adenoma (48.8%) was identified, and epithelial-myoepithelial carcinoma (3.6%) was the most common malignant tumour. Overall, the sensitivity and specificity of FNAC were 64% and 99%, respectively. Subgrouping resulted in sensitivity and specificity of 50% and 100% for clinically assisted FNAC versus, 72% and 99% for ultrasound guidance. Surgically, 31.6% underwent complete superficial parotidectomy and 28.4% underwent extracapsular dissection. Overall, facial nerve palsy was the most prevalent postoperative complication, affecting 29.2% (70/240); loss of function was transient in 21.2% (51/240) and permanent in 7.9% (19/240). Extracapsular dissection and superficial parotidectomy with facial nerve preservation were the treatments of choice when a benign tumour was suspected. Facial nerve palsy was quite frequent; treatment options however are scarce. Preoperative diagnostic workup using imaging and ultrasound-guided FNAC was essential in identifying malignancy so that surgical planning could be adapted.

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The purpose of this study was to determine whether tooth extraction for patients with ventricular assist devices (VADs) could be performed without interruption of anticoagulant and/or antiplatelet therapy and whether treatment with von Willebrand factor concentrates and desmopressin is required. The study consisted of three groups of patients undergoing oral surgery. The two experimental groups comprised patients with VADs, while the third group included cardiovascular patients without VADs who served as controls. All patients were treated intraoperatively with topical haemostatic agents (oxidized cellulose or collagen). The first group was additionally treated with fibrin glue. All 75 oral surgical procedures were performed under local anaesthesia without sedation. Three of 40 patients in the experimental groups and two of 20 patients in the control group suffered a haemorrhage, with no significant difference in the incidence of haemorrhage between the groups. The findings suggest that dental extraction can be performed without modification of oral anticoagulation or antiplatelet treatments, providing that INR is less than 3.5 on the day of the operation. It can further be hypothesized that an acquired coagulopathy in VAD patients does not influence the bleeding risk in dental extractions, and so the administration of desmopressin and/or von Willebrand factor concentrates is not required.

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The purpose of this systematic review was to investigate the efficacy of antibiotic prophylaxis (AP) in intraoral bone grafting procedures for the prevention of postoperative infection (POI). Electronic and manual searches were conducted to identify randomized controlled trials (RCTs). The primary outcome assessed was receptor site POI; secondary outcomes assessed included donor site POI, wound dehiscence, pain, graft failure, need for re-grafting, adverse events, patient satisfaction, and quality of life. A random-effects meta-analysis was conducted to obtain risk ratios of dichotomous data. Four RCTs were selected: one examined AP versus placebo and concluded that there was an increased risk of POI without AP; three examined comparative antibiotic regimens and found no statistically significant difference between them. A meta-analysis of prophylactic regimens, including data from the two RCTs that compared preoperative AP to perioperative AP, indicated no statistically significant difference in POI outcomes (P= 0.94, risk ratio 0.94). It was not possible to conduct further meta-analyses for POIs or for any secondary outcomes due to insufficient published data. The risk of bias assessment indicated an overall unclear risk of bias. On the basis of the present review, there is insufficient evidence to support or refute AP for the prevention of POIs in intraoral bone graft placement procedures.

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The aim of this study was to introduce a method to evaluate the risk of inferior alveolar nerve (IAN) injury following the extraction of impacted lower third molars. Two hundred impacted lower third molars adjacent to the IAN were evaluated. These were divided into four classification groups according to preoperative cone beam computed tomography (CBCT) findings: AR, apical region; LT, lateral region of the tapered root; LE, lateral region of the enlarged root; AE, adjacent to the enlarged root. All teeth were dislocated along the long axis or arc of the root by tooth sectioning technique and extracted by a single surgeon. The primary outcome variable was postoperative neurosensory impairment of the IAN. The χ2 test was used to evaluate differences in postoperative IAN injury between the classifications. Logistic regression analysis was used to evaluate the risk factors for postoperative IAN injury. The overall incidence of postoperative IAN injury was 7%. Specifically, most injuries involved classification AE (AE 36%, LE 8.6%, LT 3.6%, AR 0%), and the difference was statistically significant (P< 0.05). Logistic regression showed that classification AE was the only risk factor for postoperative IAN injury (P< 0.001). According to preoperative CBCT, the risk of postoperative IAN injury is higher when the IAN is adjacent to the enlarged part of the root.

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The aim of this study was to identify interaction effects among risk factors for long-term skeletal relapse. The study sample consisted of 96 patients who underwent mandibular advancement with bilateral sagittal split osteotomy. Ten predictor variables were analyzed for an interaction effect: sex, age, preoperative temporomandibular joint symptoms, mandibular plane angle (MPA), single or double jaw surgery, clockwise or counterclockwise mandibular rotation, magnitude of mandibular advancement, concomitant genioplasty, type of fixation, and follow-up duration. Modeling interactions between pairs of covariates were applied to detect a significant interaction among these risk factors on horizontal and vertical long-term skeletal relapse, respectively. Stratification analyses and two-way full factorial interaction analyses were performed to demonstrate how the interaction influenced the associations between covariates and relapse. The interactions between sex and mandibular rotation (P=0.006) and between MPA and mandibular rotation (P=0.002) were statistically significant for horizontal long-term skeletal relapse. No significant interaction was identified for vertical relapse. This study showed that female patients and those with an MPA ≥30° undergoing counterclockwise mandibular rotation are predisposed to greater horizontal long-term skeletal relapse. Therefore, the judicious use of counterclockwise rotation is recommended in order to minimize the relapse, especially in female patients and those with a high MPA.

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Skeletal advancement surgery with sagittal split ramus osteotomy (SSRO) or mandibular distraction osteogenesis (MDO) is effective in treating patients with obstructive sleep apnoea (OSA) and may improve their quality of life (QoL). This study aimed to evaluate the longitudinal QoL changes in moderate-to-severe OSA patients after skeletal advancement surgery. Eighteen patients were randomized to receive SSRO (n=9) or MDO (n=9) alone or as part of the skeletal advancement surgery. Baseline QoL was compared with that of a control group (n=36). QoL was compared between the SSRO group and MDO group over a period of 2 years postoperative. The Epworth Sleepiness Scale (ESS), Calgary Sleep Apnea Quality of Life Index (SAQLI), Functional Outcomes of Sleep Questionnaire (FOSQ), and Short Form Health Survey (SF-36) were used as instruments. The OSA group had worse ESS, SF-36, FOSQ, and SAQLI preoperatively than the control group. The MDO and SSRO groups showed significant improvements in ESS at all postoperative time points (P≤0.021). The FOSQ, SAQLI, and SF-36 of both groups at 2 years postoperative were similar to those of the control group. No differences in QoL were found between the SSRO and MDO groups. This study showed QoL was improved in patients with moderate-to-severe OSA after skeletal advancement surgery by SSRO or MDO.