A retrospective review was performed to evaluate the prognostic factors and survival of patients with submandibular gland adenoid cystic carcinomas (ACCs), covering the period January 2006-December 2022. Thirty-eight patients were identified, 25 female and 13 male (age range 25-83 years, median 54.5 years). Surgical excision was performed in all patients, and the occult node metastasis rate was 17.1%. The median follow-up time was 61.5 months (range 13-169 months). Ten patients (26.3%) developed recurrent disease after initial surgery. Nine patients died during follow-up. The 5-year overall survival and disease-free survival rates were 81.1% and 75.4%, respectively. AJCC T-classification 3/4 (vs 1/2), AJCC TNM stage III/IV (vs I/II), positive surgical margin, presence of extra-glandular extension, and histological grade III (vs I/II) had a significant negative impact on both overall survival and disease-free survival. The findings of this study confirm the important impact of several clinicopathological factors on an unfavourable prognosis. Furthermore, radical surgery with tumour-free margins is recommended for patients with localized submandibular gland ACCs. Elective neck treatment is indicated for patients with advanced stage submandibular gland ACCs. Moreover, improvements in disease detection in the early stage and multicentre studies should be encouraged.

This study was performed to propose and validate a fully automatic assessment of volume changes in the mandibular condyles following orthognathic surgery. Two sets of cone beam computed tomography scans were included: one with segmentations of complete mandibles and the other with pre- and postoperative segmentations of the mandibular rami. Two convolutional neural networks predicted a segmentation of the mandible and its ramus segments. Each preoperative ramus segment was registered to the postoperative mandible, and the pre- and postoperative condylar volumes were determined. For validation, the agreement between the fully automatic assessment and a validated semi-automated method was calculated using mean absolute differences (MAD) and intraclass correlation coefficients (ICC). Forty condyles in 20 patients (16 female, four male; mean age 27.6 years) with maxillomandibular retrognathia, who underwent bimaxillary surgery, were assessed. A small difference in condylar volume change measurements was observed between the two methods (MAD 2.7%); the ICC, at 0.993, was excellent. The fully automatic method was considerably faster than the semi-automated method (3 min vs 30 min) and demonstrated high precision and excellent reliability for quantifying condylar volume changes. A fast and reliable assessment of condylar changes can identify volume changes sooner, leading to improved personalized patient care.

This study was performed to compare the outcomes of adjunctive injections (injectable platelet-rich fibrin (iPRF), hyaluronic acid (HA)) and arthrocentesis only (AO) in the treatment of temporomandibular joint osteoarthritis. The study included 127 female patients (mean age 52.3 years). None of them had undergone prior occlusal splint therapy. The pain reduction (visual analogue scale) at 12 months post-treatment was the primary outcome variable, while maximum inter-incisal opening (MIO) at all follow-ups and pain at 1 and 6 months of follow-up were secondary outcome variables. All treatment groups showed significant improvements in pain and MIO at all postoperative follow-ups compared to baseline (P < 0.001). iPRF and HA resulted in significantly better pain relief than AO at all follow-ups (P < 0.01). There was no significant difference in pain alleviation between iPRF and HA. No differences were observed among the three groups in jaw mobility (MIO) at any follow-up. Since iPRF did not provide additional benefits over HA, the two treatments may be considered as alternatives, depending on cost considerations. Of note, the treatment objectives were achieved even without previous occlusal splint use.

The treatment of unilateral cleft lip and palate (UCLP) involves up to four primary surgeries to restore oral function. This study was performed to evaluate the surgical burden and direct healthcare costs of four UCLP surgical protocols at Erasmus University Medical Centre, Rotterdam, to guide optimal protocol selection. This retrospective cohort study included UCLP patients treated during 1990-2024. The patients were categorized into groups based on the hard palate closure timing: Oslo protocol (OP), one-stage palatoplasty protocol (OSPP), early delayed hard palate closure protocol (E-DHPCP), and late delayed hard palate closure protocol (L-DHPCP). Primary surgeries were analysed for operative duration (OD) and length of hospital stay (LOS), and their associated costs were estimated. Overall, 331 patients were included. Mean cumulative OD was significantly shorter for L-DHPCP and OSPP when compared to E-DHPCP and OP, while mean cumulative LOS was significantly longer for E-DHPCP compared to the other protocols. Mean cumulative OD was 408, 465, 425, and 507 min, and mean cumulative LOS was 3.95, 4.84, 4.07, and 4.11 nights for L-DHPCP, E-DHPCP, OSPP, and OP, respectively. Mean total costs were estimated at €17,858, €20,791, €18,545, and €21,158, respectively. L-DHPCP and OSPP demonstrated the lowest surgical burden and direct healthcare costs, although differences were minor. Therefore, the choice between these four surgical protocols should continue to be based on clinical outcomes, rather than differences in burden and costs.

The aim of this study was to use machine learning (ML) to classify sagittal and vertical skeletal discrepancies in three-dimensional (3D) facial scans, as well as to evaluate shape variability. 3D facial scans from 435 pre-orthodontic patients were subjected to cephalometric analysis and 3D facial landmark identification. Three ML models were used for the discrimination of skeletal discrepancy: random forest, AdaBoost, and multi-layer perceptron. Each model was evaluated by receiver operating characteristic curve and calculating the area under the curve (AUC). Principal component analysis was conducted to evaluate shape variability. The AUCs for Class II and III patients ranged from 0.91 to 0.95. Random forest achieved the highest accuracy for sagittal classification (88.5% for Class II, 95.5% for Class III). Multi-layer perceptron exhibited the best performance for vertical classification (accuracy of 78.8% for hypodivergent, 86.2% for hyperdivergent). Six principal components explained 94.0% of facial morphology variation. ML methods show promise for assisting in the discrimination of sagittal and vertical skeletal discrepancies based on 3D facial scans. 3D facial soft tissue features appear to be suitable for the discrimination of skeletal discrepancies in most cases.

The aim of this study was to clinically validate an artificial intelligence (AI)-based tool for automatic segmentation of the mandibular incisive canal (MIC) on cone beam computed tomography (CBCT), enabling prevention and detection of iatrogenic implant-related nerve injuries. Patient records from University Hospitals Leuven were screened for CBCT related to implant surgery cases with nerve injuries. CBCT scans were imported into Virtual Patient Creator for canal segmentation and 3D model generation. Two oral radiologists compared the AI-segmented canals with respective CBCT images. Five observers then performed canal identification and injury detection (present/absent) and reported their confidence level on a five-point Likert scale. Ten patient cases were assessed (eight female, two male; age 49-81 years). The AI-based tool enabled clear visualization of bilateral MIC in both pre- and postoperative images, revealing implant-canal relationships consistent with recorded post-implant pain or neural disturbance. For preoperative assessment, the AI-based tool significantly improved incisive canal detection (by 25%; P = 0.025) and observer confidence (by 8%; P = 0.038). The AI-based tool proved to be clinically useful to enable bilateral MIC visualization on CBCT images. Through canal segmentation with integrated 3D modelling, preoperative canal detection and the experts' confidence level were significantly improved.

The aim of this research was to determine the soft-to-hard tissue ratio using three-dimensional (3D) analysis in different types of orthognathic surgery and to update the most recent scientific evidence provided in 2017. A systematic search covering the period January 2017-December 2023 was performed in the MEDLINE, Embase, LILACS, Scopus, and Science Direct databases to identify relevant studies. The methodological quality of the included studies was assessed using the method proposed by the Effective Public Health Practice Project. Of 897 articles identified in the database search, 10 were included in this review. These articles included analyses of points or anatomical areas of the face, and all of them used image superimposition for the analysis. The clinical analyses of the perinasal region, upper lip, and chin region produced ambiguous results. The bias in methods and variables, such as the types of surgery, patient variables, and differences in diagnosis may limit the use of the information obtained. There are no data that can be applied to daily clinical practice; the limited evidence that was previously published in 2017 remains.

Ameloblastic fibroma is a rare, benign, biphasic odontogenic tumour that typically presents in young patients and is treated conservatively with an excellent prognosis. An important differential is ameloblastoma, a more common odontogenic neoplasm that shares many of the clinical, radiological, and histological features, but requires more extensive surgery due to its potentially destructive nature. Both tumours demonstrate BRAF V600E mutations. While epithelial staining with BRAF V600E-specific immunohistochemistry is considered a surrogate marker for mutation and is supportive of the diagnosis of ameloblastoma, the staining pattern in ameloblastic fibroma has not been defined previously because of the rarity of the lesion. This report describes a case of ameloblastic fibroma in a 13-year-old, in which BRAF V600E immunohistochemistry showed cytoplasmic staining in both the stromal and epithelial components of the tumour. On review of the literature, this was interpreted to be concordant with the biphasic nature of the lesion.

The placement of a columellar cartilage strut graft (CSG) between the medial cartilage crura is an important step for providing tip projection and support in rhinoplasty. While the CSG is placed by direct observation in open rhinoplasty, it can be placed with different approaches in closed rhinoplasty: by dissection from the mucosal side, delivery technique, marginal or lateral incisions from the edge of the columella, direct skin incisions over the columella, or incisions made through the intraoral mucosa. This study suggests the placement of the CSG through a medial crus footplate crease incision as an alternative approach in closed rhinoplasty. A septal cartilage graft is harvested and fashioned into a 16-22 mm long CSG for later insertion. A 3-mm incision is made at the junction of the nasal floor and the lip, at the level of the lower end of the right medial crural footplate. A minimal dissection is performed between the medial crura to the tip using a blunt periosteal elevator, following which the CSG is inserted. This procedure is easy and provides adequate support for the columella and tip without prolonging the operation time. The scar is hidden in the natural fold and heals very well.

The purpose of this study was to compare the effects of anterior releasing of the temporomandibular joint disc during arthroscopic discopexy surgery with a holmium laser versus manual instrumentation. A total of 80 patients (139 joints), divided into two groups. Anterior releasing surgery was performed using manual surgical instruments in 40 patients (70 joints) and with holmium laser assistance in the other 40 patients (69 joints). Statistical analyses, including χ tests and multivariate analysis, assessed factors impacting surgical success. The results showed that discopexy success was significantly higher with holmium laser use compared to manual instruments (odds ratio 4.41, P = 0.003). In addition, a preoperative diagnosis of anterior disc displacement with reduction (ADDwR) was found to be significantly more likely to result in surgical success compared to anterior disc displacement without reduction (ADDwoR) or idiopathic condylar resorption (odds ratio 5.91, P = 0.001). This study found that the use of holmium laser assistance, as compared to manual surgical instruments, significantly enhanced the success rate of arthroscopic discopexy in the temporomandibular joint. Furthermore, patients classified as ADDwR exhibited a notably higher surgical success rate compared to those classified as ADDwoR or idiopathic condylar resorption.

The radial forearm free flap is a common reconstructive option following ablative head and neck surgery. Although uncommon, anatomical variants such as radial artery anomalies pose risks to flap harvest and viability. A rare case of a common radial artery that branched distally into a superficial radial artery and a deep radial artery is reported here. Identified intraoperatively, the superficial radial artery had a radial, superficial course lateral to the cephalic vein. The preoperative Allen test was normal, but a weak radial pulse prompted thorough intraoperative assessment, including Doppler and occlusion testing. This case highlights the importance of recognizing anatomical variations, employing preoperative duplex ultrasound if needed, and ensuring meticulous dissection to optimize flap outcomes.

Pretreatment immune dynamics and nutritional status are important predictors of survival outcomes in various malignancies. This study was performed to evaluate the relationships between survival outcomes and the pretreatment nutritional indices - Onodera's prognostic nutritional index (OPNI) and neutrophil-to-lymphocyte ratio (NLR) - in 42 patients with recurrent or metastatic oral squamous cell carcinoma (OSCC) who underwent treatment with immune checkpoint inhibitors (ICI). Additionally, the relationships between these nutritional indices and T-cell exhaustion in the peripheral blood of the patients were analysed. As a result, the Kaplan-Meier method revealed that lower OPNI was significantly associated with poorer overall survival (OS) and progression-free survival (PFS) (both P < 0.001). Likewise, the results of the multivariate analysis showed that a low OPNI was independently associated with poor 5-year OS (hazard ratio 4.36, P = 0.008) and PFS (hazard ratio 4.04, P = 0.010). Patients with a low OPNI had a significantly higher frequency of PD-1 CD8 T-cells than those with a high OPNI (P = 0.009). These findings demonstrate that pretreatment OPNI is a valuable independent prognostic indicator of OS and PFS in OSCC patients following treatment with ICI. The OPNI might reflect T-cell exhaustion in the peripheral blood of OSCC patients.

The treatment of mandibular fractures affecting the condylar head (CHF) can be either closed or open. In the case of an open approach, the headless bone screw (HBS) is an option. This study was performed to investigate the efficacy of osteosynthesis with HBS using three-dimensional radiographic imaging and clinical evaluation over long-term follow-up. This was a single-centre retrospective study. Clinical parameters and three-dimensional radiographic scans were collected during follow-up, DICOM datasets were segmented, and model analysis was conducted. Forty-five patients who received a HBS and met the eligibility criteria were included. There were significant improvements in all clinical parameters (mouth opening, protrusion, laterotrusion; all P < 0.05) except for the laterotrusion of the unaffected side (P = 0.071). Mean volume and surface area changes (from postoperative (mean 1.9 days) to final follow-up (mean 1675 days)) were 127.2 mm and -22.4 mm, respectively, and were not statistically significant (P = 0.18 and P = 0.51). There were radiographic signs of condylar remodelling. Nine HBS in nine patients required removal due to the screw penetrating the articular surface of the healing condylar head. This single-centre retrospective study found good functional outcomes using HBS for CHF, with a screw removal rate of 20%.

The objective of this study was to compare the effects of irrigation solutions containing chlorhexidine, povidone-iodine, or hydrogen peroxide on pain and swelling following mandibular third molar surgery. This prospective randomized controlled trial employed a single-blind design. Overall, 112 patients were randomized to four groups based on the antiseptic assigned for the intervention: control, chlorhexidine (CHX), povidone-iodine (PI), and hydrogen peroxide (HP). The patients were followed up on days 1, 3, 7, and 15 after surgery, and pain and swelling were assessed. Data were analysed using ANOVA and post hoc multiple comparison tests. The CHX and HP groups demonstrated significantly lower mean pain scores compared to the control group on days 3 (P = 0.021, P = 0.033) and 7 (P = 0.002, P = 0.017). Regarding the difference in swelling from baseline (before surgery) on each follow-up day, the CHX and HP groups showed significantly less swelling compared to the control group on days 1 (P = 0.023, P = 0.012), 3 (P = 0.007, P = 0.001), and 7 (P = 0.002, P = 0.018). Moreover, the CHX and HP groups demonstrated significantly lower mean swelling changes from baseline compared to PI: CHX vs PI on day 7 (P = 0.032), HP vs PI on day 1 (P = 0.037). In conclusion, chlorhexidine and hydrogen peroxide solutions are highly beneficial options for socket irrigation following mandibular third molar surgery. This study showed a more prominent reduction in pain and swelling with chlorhexidine and hydrogen peroxide solutions compared to povidone-iodine solution.

Effective postoperative pain management in orthognathic surgery is essential for optimizing recovery and patient comfort. This comprehensive review was performed to examine multimodal strategies for managing post-orthognathic surgery pain. A literature search identified 13 studies (with 430 patients); 11 of them were randomized controlled trials. The interventions for pain were categorized into four approaches: cooling therapies, light-based treatments, enhanced recovery protocols, and targeted techniques. A narrative synthesis was performed due to the considerable heterogeneity across the studies. Hilotherapy demonstrated superior pain and swelling reduction compared to conventional cooling methods. Light-based therapies, including low-level laser therapy and photobiomodulation, improved early postoperative pain control and functional recovery. Enhanced Recovery After Surgery (ERAS) protocols were associated with lower pain scores and opioid requirements. Targeted analgesic approaches, such as ultrasound-guided trigeminal nerve blocks and acupoint stimulation, showed promise for acute pain relief. The findings highlight the importance of combining multiple modalities to optimize pain management while minimizing opioid use. The quality of the evidence varied, with some studies limited by small sample sizes and short follow-up periods. The synthesis of results was structured into an evidence-based recommendations table, suggesting that an individualized multimodal approach may provide the most effective pain control in orthognathic surgery.

This study investigated the relationship between condylar position, condylar volume, and mandibular relapse following orthognathic surgery in which the proximal segments were temporarily fixed with a positioning device to maintain the condylar position. Computed tomography data (pre-surgery, immediately post-surgery, and 1 year post-surgery) from 12 patients with Class II malocclusion and 20 with Class III were analysed. Condylar volume was significantly lower in Class II patients than in Class III patients at all time-points (P < 0.001), and only Class II patients showed a significant volume reduction from immediately post-surgery to 1 year post-surgery (P < 0.001). Three-dimensional condylar movements from pre-surgery to immediately post-surgery and from pre-surgery to 1 year post-surgery were significantly greater in Class II patients than in Class III patients (both P < 0.001). Additionally, Class II patients exhibited more restoration movements to the preoperative position from immediately post-surgery to 1 year post-surgery, correlating with the volume reduction (r = -0.53, P = 0.007), which in turn correlated significantly with mandibular relapse (r = 0.63, P < 0.001). These findings suggest an association between preoperative volume, intraoperative movement, condyle movement restoration, volume reduction, and postoperative mandibular relapse, particularly in the Class II group. Accurate condylar positioning appears crucial for mitigating mandibular relapse in Class II cases.

The objective of this systematic review and meta-analysis was to collectively summarize the available evidence on the use of autogenous tooth bone graft (ATBG) in osseous defects following mandibular third molar surgery. A literature search was performed in Scopus, MEDLINE/PubMed, and Cochrane Library to find randomized clinical trials that used ATBG to augment bone defects following impacted mandibular third molar surgery and compared this with normal healing or with other materials. Eight studies were included, six of which were included in the meta-analysis. The results showed that sites grafted with ATBG yielded significantly higher bone defect fill (standardized mean difference (SMD) 1.10, 95% confidence interval (CI) 0.20-1.99, P = 0.016) and significantly less probing depth (SMD -1.46, 95% CI -2.53 to -0.39, P = 0.007) when compared to the control, at 6 months postoperatively. Based on the GRADE system, the level of evidence on these outcomes was judged as moderate. Within the limitations, this study showed that the ATBG could be an alternative to other materials for augmenting bone defects following the surgical removal of an impacted mandibular third molar, offering the option of using the extracted tooth to produce a material that can be used for bone regeneration.

Dynamic navigation is an innovative technology in implant surgery that enhances the precision of implant placement through real-time guidance for clinicians. This technology allows on-the-spot adjustments during surgery, reducing the risk of complications and improving implant outcomes. The aim of this systematic review was to assess the accuracy of various dynamic navigation systems in implant placement using in vitro models. A comprehensive literature search was performed across several databases, focusing on studies published between 2016 and 2024 that reported three-dimensional (3D) and angular deviations. Seven in vitro studies were included, analysing five dynamic navigation systems (ImplaNav, Navident, Denacam, X-Guide, and DCARER), with 649 implants evaluated. Results showed mean coronal 3D deviations between 0.46 mm and 1.58 mm, while apical deviations ranged from 0.48 mm to 2.12 mm. Angular deviations varied between 1.01° and 4.24°. Maximum deviations reached up to 4.80 mm for coronal 3D deviation and 10.70° for angular deviation. All systems demonstrated high accuracy within clinically acceptable limits, with X-Guide showing the lowest numerical errors. Factors like tracking technology, calibration methods, and user experience were found to influence accuracy. Overall, dynamic navigation significantly improves implant placement accuracy compared to freehand methods but remains dependent on technical factors.

The aim of this study was to evaluate the success rate, prosthesis-related quality of life (QoL), and satisfaction of patients undergoing rehabilitation with endosseous implants in the auricular region. This was a retrospective mixed cohort study involving 22 consecutive eligible patients (11 female, 11 male) with ear defects, treated during 1999-2019. The variables analysed were sex, age at the time of implant placement, date of last prosthesis delivery, level of education, aetiology of the deformity, and radiation history. The questionnaire results were analysed using IBM SPSS Statistics software. The correlation between QoL and satisfaction was evaluated using the Pearson correlation coefficient. Implant success was calculated clinically using the number of integrated implants, mobility, and presence of a purulent discharge. For the 22 patients, the mean duration since prosthesis placement was 10.2 ± 5.2 years. Among 47 implants inserted, one failed because of osseointegration failure. Hence, the overall success rate of the auricular implants was 97.9%. The mean ± standard deviation total QoL score and satisfaction score were 52.5 ± 7.10 (maximum possible score 80) and 42.1 ± 6.29 (maximum possible score 55), respectively. The results demonstrate the importance of prosthetic rehabilitation for improved patient QoL and satisfaction.

Visualization of the inferior joint space of the temporomandibular joint (TMJ) by arthroscopy is still a challenge for many surgeons, because there are no standard references for how to approach it. This study describes the steps for performing a TMJ arthroscopy technique in the inferior joint space, using anatomical and numerical references. It consists of three steps: marking the reference points, entering the inferior joint space with the cannula, and inserting a needle for continuous Ringer solution irrigation. The precision of this new technique allows greater reproducibility and safety in clinical application.

Intraosseous lipomas are rare benign tumors of mesenchymal origin, particularly unusual in the maxilla. Spindle cell lipomas, a histological subtype, are even more uncommon, with limited cases reported in the literature. This report documents a rare case of intraosseous spindle cell lipoma in the anterior maxilla of a 66-year-old male and presents a review of 39 gnathic lipoma cases from the literature published between 1976 and 2024. The majority of the gnathic intraosseous lipomas (32/39, 82%) occurred in the mandible. The posterior region was more frequently affected than the anterior region (24/39, 62%), in both maxilla and mandible cases (86% and 56%, respectively). Most lesions presented as a well-defined radiolucency; however, the lesions may appear multilocular and may range from radiolucent to mixed radiolucent-radiopaque to 'ground glass'. Surgical excision or enucleation was the most common treatment. Intraosseous spindle cell lipomas are exceedingly rare. Based on the available evidence, surgical excision is the recommended treatment with a favorable prognosis and low recurrence rate.