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Plastic and Reconstructive Surgery Mar 2022Computer-assisted surgery has become the mainstream in mandibular reconstruction, but the lack of a standard measuring approach for spatial deviations of mandible...
BACKGROUND
Computer-assisted surgery has become the mainstream in mandibular reconstruction, but the lack of a standard measuring approach for spatial deviations of mandible hinders postoperative verification and the comparison of different subjects. This study aims to set up a comprehensive approach for measuring spatial deviations of computer-assisted mandibular reconstruction.
METHODS
A systematic review was conducted to extract all measurements for computer-assisted mandibular reconstruction. Thereafter, eligible measurements were included in the authors' comprehensive approach, which categorized the measurements according to different anatomical structures and landmarks.
RESULTS
A total of 80 studies were included in the authors' systematic review, and 31 measurements were extracted. The authors established a comprehensive panel of anatomical landmarks to facilitate measurement, including parts, points, lines, planes, and angles. These measurements encompassed spatial deviations of the overall mandible, condyle, gonial angle, bone grafts, midline, surgical plate, osteotomy, and miscellaneous indicators. A calculation spreadsheet was developed to collect landmarks and compute deviations automatically with built-in formulas. Finally, a simplified panel of measurements was recommended for spatial deviations of mandibular reconstruction.
CONCLUSIONS
A comprehensive approach for measuring spatial deviations of computer-assisted mandibular reconstruction was established. Future studies will confirm this approach as an effective and scientific system for postoperative verification of computer-assisted mandibular reconstruction.
Topics: Anatomic Landmarks; Cephalometry; Humans; Mandible; Mandibular Reconstruction; Spatial Analysis; Surgery, Computer-Assisted
PubMed: 35196692
DOI: 10.1097/PRS.0000000000008858 -
The British Journal of Oral &... May 2021The aims of the present study were to comprehensively assess all the published cases on dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) in... (Meta-Analysis)
Meta-Analysis Review
Dislocation of the mandibular condyle into the middle cranial fossa. A case of temporomandibular joint arthroplasty with resorbable fixation system and temporalis myofascial flap: systematic review and meta-analysis.
The aims of the present study were to comprehensively assess all the published cases on dislocation of the mandibular condyle into the middle cranial fossa (DMCCF) in the literature in English and describe the clinical, imaging, and therapeutic variables for this condition. An electronic search was undertaken in March 2020 using PubMed/MEDLINE, Web of Science, ScienceDirect, Springer, and Scopus databases. Eligibility criteria included publications with sufficient information to confirm the diagnosis. In addition, we have presented the case report of a 13-year-old boy with DMCCF, who was treated with craniectomy, arthroplasty, and reconstruction with a resorbable osteosynthesis material obtaining favourable and functional results. A total of 72 cases reported in English, including ours, were analysed and discussed. Most of the patients were female (n= 49) with a mean (range) age of 23.4 (5-72) years, the most affected condyle was the right (n= 42), the main aetiology was a motor vehicle accident, and half of the patients had intracranial lesions. Open treatment was performed in the majority with condylar surgery that included condylotomy and condylectomy. Temporomandibular joint arthroplasty was performed with bone, osteosynthesis material, and flap rotation. Timely treatment before four weeks was performed in most of the cases and, despite this, the persistence of the deviation was observed in more than a third of cases, with functional and neurosensorial sequelae. The present study allows an update of the characteristics of DMCCF and gives a current vision of how to manage this rare and complex fracture.
Topics: Adolescent; Adult; Aged; Arthroplasty; Cranial Fossa, Middle; Female; Humans; Joint Dislocations; Male; Mandibular Condyle; Middle Aged; Temporomandibular Joint; Young Adult
PubMed: 33757662
DOI: 10.1016/j.bjoms.2020.08.039 -
Journal of Oral and Maxillofacial... Oct 2020The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction... (Meta-Analysis)
Meta-Analysis
Will Closed Treatment Provide Better Mandibular Motion Than Open Reduction and Internal Fixation in Cases of Unilateral Displaced Subcondylar Fracture? A Systematic Review and Meta-Analysis.
PURPOSE
The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion.
MATERIALS AND METHODS
To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS).
RESULTS
The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P = .112) and -0.633 (P = .079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P = .031) and -0.682 (P = .017), respectively.
CONCLUSIONS
The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.
Topics: Adult; Fracture Fixation; Fracture Fixation, Internal; Humans; Mandible; Mandibular Condyle; Mandibular Fractures; Open Fracture Reduction; Range of Motion, Articular; Treatment Outcome
PubMed: 32554064
DOI: 10.1016/j.joms.2020.05.020 -
BMC Oral Health Mar 2022This study aimed to assess whether functional mandibular advancement (FMA) will cause temporomandibular joint disorders (TMD) or have side effects on temporomandibular... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aimed to assess whether functional mandibular advancement (FMA) will cause temporomandibular joint disorders (TMD) or have side effects on temporomandibular joint (TMJ) in adolescent patients.
METHODS
All searched databases, including PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trails and Scopus were searched. Gray literature and unpublished literature was also searched. Randomized controlled trails (RCT) and non-randomized studies of the effects of interventions (NRSI) directly observe the condition of adolescent patients' TMJ after finishing treatment will be considered to include in our study. According to Cochrane Handbook, Cochrane Collaboration risk of bias tool was used to assess the quality of included RCTs, and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool was used to assess the quality of included NRSIs.
RESULT
Finally 18 researches were evaluated as eligible to include in this study. 5 of the studies were RCTs, 8 were NRSIs and 5 were systematic reviews. The data of RCTs and NRSIs were statistically pooled in meta-analysis. The number of samples under investigated among primary studies was 579 individuals,there were 80 patients who developed temporomandibular symptoms during or after treatment. But all the subjective symptoms disappeared during follow-up time. The statistical outcomes proved that patients received FMA didn't show more tendency to develop temporomandibular symptoms [I = 27%, OR = 0.54, 95%CI (0.33,0.87), p = 0.01].
CONCLUSION
(1) TMJ symptoms may occur during the functional oral appliance wearing, but the symptoms will release or disappear after treatment or during the follow-up period. (2) Less convincing evidence indicates that slightly previous TMD and condyle-glenoid fossa relationship will be improved after treatment. (3) There is TMJ disc anterior displacement observed during treatment, but most of them will return to the normal position later. (4) Moderate evidence support that FMA will not have side effects on TMJ of adolescent patients.
Topics: Adolescent; Humans; Malocclusion, Angle Class II; Mandibular Advancement; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 35241050
DOI: 10.1186/s12903-022-02075-8 -
Oral Surgery, Oral Medicine, Oral... Dec 2020The aim of this study was to evaluate the level of evidence in the literature on etiology and management of idiopathic condylar resorption (ICR) of the mandible.
OBJECTIVE
The aim of this study was to evaluate the level of evidence in the literature on etiology and management of idiopathic condylar resorption (ICR) of the mandible.
STUDY DESIGN
A systematic search of articles published from 1982 to 2019 was conducted via PubMed, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. English language reports of human studies that addressed the etiology or management of ICR were included. Case reports, opinion or perspective articles, and nonhuman or non-English language articles were excluded. The quality of the included studies was assessed by using the Oxford Center for Evidence-Based Medicine criteria.
RESULTS
The search yielded 230 studies, and 40 met the criteria for inclusion. The etiology of ICR was the focus of 33 studies; the remaining 8 assessed its management. The total number of patients in the included studies was 1399. The level of evidence assessing the etiology of ICR averaged 3.16 (range 2b-to 3b). Proposed etiologies and contributing factors included female gender, 17β-estradiol levels, condylar anatomy, and history of orthognathic surgery. The level of evidence of studies assessing the management of ICR was 3.7 (range 2b-4). Treatment strategies included disk repositioning, autologous condylar reconstruction (costochondral graft), and alloplastic total joint reconstruction. Average follow-up was 46.8 ± 38.2 months.
CONCLUSIONS
The proposed etiology and management of ICR, as reported in the literature, vary considerably. Condylectomy with autogenous or alloplastic reconstruction appears to be the most stable management strategy. The levels of evidence regarding the etiology and management of ICR are low.
Topics: Bone Resorption; Female; Humans; Mandible; Mandibular Condyle; Orthognathic Surgery; Orthognathic Surgical Procedures
PubMed: 32807713
DOI: 10.1016/j.oooo.2020.07.008 -
International Journal of Oral and... Jun 2024Bone scans, reflecting blood flow and metabolic activity in a region of interest, are frequently used to evaluate mandibular growth disorders. Increased uptake is a... (Review)
Review
Bone scans, reflecting blood flow and metabolic activity in a region of interest, are frequently used to evaluate mandibular growth disorders. Increased uptake is a non-specific finding and can occur as a result of multiple causes. The correlation between radioactive tracer uptake and growth activity has not been consistently demonstrated. The aim of this study was to assess the accuracy of planar skeletal scintigraphy (SS), single-photon emission computed tomography (SPECT), and SPECT with computed tomography (CT) images (SPECT/CT) in detecting abnormal mandibular growth activity compared to clinical and radiographic/tomographic methods (reference standard) and histologic findings. A systematic review was conducted following the PRISMA guidelines. Sensitivity, specificity, and accuracy were calculated for planar SS, SPECT, and SPECT/CT. Compared to the reference standard, SPECT/CT had the best diagnostic accuracy (76.5% sensitivity, 90.4% specificity, 83.2% accuracy), followed by planar SS (81.8% sensitivity, 84.5% specificity, 83.0% accuracy) and SPECT (77.7% sensitivity, 72.4% specificity, 74.5% accuracy). The results of this study indicate that SPECT/CT has the best clinical correlation, but the certainty of the evidence is low. The differences in sensitivity and specificity between the three index tests were not clinically significant. The three tests can be useful, with only a small difference in their diagnostic value. Histopathology was found not to be satisfactory as a reference standard.
Topics: Humans; Mandible; Tomography, Emission-Computed, Single-Photon; Radionuclide Imaging; Sensitivity and Specificity; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography
PubMed: 38158243
DOI: 10.1016/j.ijom.2023.12.006 -
Journal of Oral and Maxillofacial... Dec 2019Mandibular condylar fractures are relatively common fractures, accounting for 29 to 52% of all mandibular fractures. Recently, the debate between closed versus open... (Meta-Analysis)
Meta-Analysis
PURPOSE
Mandibular condylar fractures are relatively common fractures, accounting for 29 to 52% of all mandibular fractures. Recently, the debate between closed versus open treatment of the condylar fracture has shifted toward more specific surgical questions concerning the number and pattern of the fixation method for the condylar region. We have attempted to resolve the controversy with the systematic review and meta-analysis. The purpose of the present study was to compare the outcomes of different methods of fixation for mandibular condylar fractures.
MATERIALS AND METHODS
We conducted an electronic database search for clinical studies evaluating the stability of internal fixation of condylar fractures. The search was restricted to studies reported in the English language from January 2000 to July 2018. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines.
RESULTS
The initial search returned 285 studies reported from January 2000 through July 2018. After reviewing the full-text reports, only 16 studies were deemed eligible for the review. The total sample size was 831 patients with mandibular subcondylar fractures. The patients were classified into 25 groups according to the fixation method, follow-up period, use of intermaxillary fixation, and the presence of associated fractures.
CONCLUSIONS
The results of our systematic review and meta-analysis showed that single plate fixation has been associated with more complications with poor outcomes, including hardware failure, screw loosening, and postoperative malocclusion.
Topics: Bone Plates; Bone Screws; Fracture Fixation; Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Treatment Outcome
PubMed: 31472103
DOI: 10.1016/j.joms.2019.07.012 -
The Angle Orthodontist May 2020To evaluate the impact of rapid maxillary expansion (RME) on the condylar position, disc joint, joint space, and interarticular relationship in growing patients.
OBJECTIVE
To evaluate the impact of rapid maxillary expansion (RME) on the condylar position, disc joint, joint space, and interarticular relationship in growing patients.
MATERIALS AND METHODS
A systematic search was performed in nine databases. The clinical studies selected included those with pre- and post-magnetic resonance, conventional computed tomography or cone beam tomography in growing patients. Risk of bias assessment was performed using the Cochrane Collaboration tool for controlled clinical studies and National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment for Before-After Studies With No Control Group.
RESULTS
Initially, 4303 records were identified. Only eight studies fulfilled the criteria and were included in the qualitative analysis. Of those, two were controlled clinical studies with a risk of uncertain to high bias. The remaining papers had a low to moderate risk of bias. Results showed that RME in children and adolescents promoted the following: remodeling in the head and or condylar branch, changes in condylar position and joint space, maintenance of improved symmetry between the condyles, and no ability to modify the position or shape of the articular disc.
CONCLUSIONS
RME in growing patients is able, in the short term, to modify the condyle-fossa relationship but does not change the position or shape of the articular disc. The intercondylar symmetric relationship is maintained or improved. Although the NHLBI score shows low to moderate risk of bias, the clinical relevance of these review findings is limited by Cochrane and Grades of Recommendation, Assessment, Development and Evaluation scores.
Topics: Adolescent; Child; Cone-Beam Computed Tomography; Head; Humans; Mandibular Condyle; Palatal Expansion Technique; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 33378434
DOI: 10.2319/080619-517.1 -
Oral Surgery, Oral Medicine, Oral... Sep 2022This systematic review aimed to summarize the morphologic changes in the temporomandibular joint (TMJ) in patients who underwent orthodontic treatment and were assessed... (Review)
Review
OBJECTIVE
This systematic review aimed to summarize the morphologic changes in the temporomandibular joint (TMJ) in patients who underwent orthodontic treatment and were assessed by 3-dimensional (3D) imaging techniques (e.g., magnetic resonance imaging, cone beam computed tomography, and multidetector computed tomography).
STUDY DESIGN
The authors searched PubMed, Web of Science, and Embase databases to identify original articles from 2014 to 2021 containing keywords for morphologic changes in the TMJ, orthodontic treatment, and three-dimensional imaging methods. Prospective and retrospective studies, including observational, cross-sectional, randomized, and nonrandomized clinical trials, cohort studies, and case-control studies, were reviewed. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The risk of bias was assessed in studies selected for the full-text review.
RESULTS
The search strategy yielded 294 publications. After an initial screening and the application of exclusion criteria, 13 studies were selected for the final review.
CONCLUSION
Differences were found in condylar positioning, typically in an anterior position; condylar morphology, primarily with increased diameter or head height; and articular disk position within the anterior-posterior plane post-treatment. Changes in the glenoid fossa were not consistent between the studies. The overall risk of bias among studies was moderate. The influence of orthodontic treatment on morphologic changes in the TMJ remains unclear.
Topics: Cross-Sectional Studies; Humans; Mandibular Condyle; Prospective Studies; Retrospective Studies; Temporomandibular Joint
PubMed: 35871168
DOI: 10.1016/j.oooo.2022.05.003 -
Plastic and Reconstructive Surgery Apr 2023Many fractures of the mandibular condylar neck are amenable to both open reduction and internal fixation (ORIF) and closed treatment. Clinical outcomes following these... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many fractures of the mandibular condylar neck are amenable to both open reduction and internal fixation (ORIF) and closed treatment. Clinical outcomes following these two modalities remains a topic of debate. This systematic review critically appraises the literature to compare them following these treatment options.
METHODS
A systematic review and meta-analysis was performed to test the null hypothesis of no difference in clinical outcomes in ORIF versus closed treatment of mandibular condyle fractures. The PubMed, Embase, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development, and Evaluation methodology.
RESULTS
Of 1507 screened articles, 14 met inclusion criteria. ORIF was favored significantly when evaluating temporomandibular joint pain [relative risk (RR), 0.3; 95% CI, 0.1 to 0.7] (number needed to treat to prevent an outcome in one patient, 3; 95% CI, 2 to 6), laterotrusive movements of the mandible (mean difference, 2.3; 95% CI, 1.7 to 3.0) (standardized mean difference, 0.9; 95% CI, 0.4 to 1.3), and malocclusion (RR, 0.5; 95% CI, 0.4 to 0.7) (number needed to treat to prevent an outcome in one patient, 19; 95% CI, 10 to 200). However, ORIF yielded a higher incidence of postoperative infection (RR, 3.6; 95% CI, 0.9 to 13.8) and must be weighed against the understood risk of facial nerve injury.
CONCLUSIONS
Meta-analysis of high-level evidence in randomized controlled trial suggests that ORIF significantly improves functional outcomes, decreases pain, and restores occlusion and jaw symmetry. These long-term benefits must be weighed against the increased risk of postoperative infection and exposure of the facial nerve to potential injury.
Topics: Humans; Fracture Fixation, Internal; Treatment Outcome; Fracture Fixation; Mandibular Fractures; Mandibular Condyle; Postoperative Complications; Pain
PubMed: 36729783
DOI: 10.1097/PRS.0000000000010009