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The British Journal of Oral &... Dec 2023The choices for managing a condylar head fracture (CHF) of the mandible are either open surgical or closed functional treatments (CFT) and the decision depends on... (Meta-Analysis)
Meta-Analysis Review
The choices for managing a condylar head fracture (CHF) of the mandible are either open surgical or closed functional treatments (CFT) and the decision depends on various factors. The purpose of this systematic review was to ascertain from the available literature whether the open method or CFT yields better outcomes in managing CHF. We have systematically reviewed published articles according to the PRISMA statement. The search was conducted in PubMed, Google Scholar, Semantic Scholar, and the Cochrane Library database for comparative studies about both open and closed treatments from inception until April 2023. The outcomes of interest were mouth opening (MO), protrusion, laterotrusion, postoperative pain, and malocclusion. Eight studies met the inclusion criteria. The review comprised of 326 cases, among which 177 were managed by open methods and 149 were treated by CFT. The incidence of postoperative malocclusion and pain were significantly less in the open group. MO was better in the open treatment group although this was not statistically significant. Protrusion and laterotrusion occurred slightly more in CFT, although these were also statistically not significant. Overall, meta-analysis favoured open methods of managing CHF. Although enough evidence exists for the use of open methods for selected condylar head fractures, CFT still demonstrated favourable outcomes in undisplaced fractures. The selection of a particular treatment method should be individualised on the basis of each particular case considering the risk/benefits. Further high quality randomised trials are needed to establish a therapeutic guideline.
Topics: Humans; Mandibular Condyle; Mandibular Fractures; Fracture Fixation, Internal; Treatment Outcome; Malocclusion
PubMed: 37996317
DOI: 10.1016/j.bjoms.2023.10.010 -
Journal of Stomatology, Oral and... Jun 2024This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to review the recent literature on the technical accuracy of surgical navigation for patient-specific reconstruction of orbital fractures using a patient-specific implant, and to compare surgical navigation with conventional techniques.
MATERIALS AND METHODS
A systematic literature search was conducted in PubMed (Medline), Embase, Web of Science, and Cochrane (Core Collection) databases on May 16, 2023. Literature comparing surgical navigation with a conventional method using postoperative three-dimensional computed tomography imaging was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy (angular accuracy, linear accuracy, volumetric accuracy, and degree of enophthalmos), preoperative and perioperative times, need for revision, complications, and total cost of the intervention. MINORS criteria were used to evaluate the quality of the articles.
RESULTS
After screening 3733 articles, 696 patients from 27 studies were included. A meta-analysis was conducted to evaluate volumetric accuracy and revision rates. Meta-analysis proved a significant better volumetric accuracy (0.93 cm ± 0.47 cm) when surgical navigation was used compared with conventional surgery (2.17 cm ± 1.35 cm). No meta-analysis of linear accuracy, angular accuracy, or enophthalmos was possible due to methodological heterogeneity. Surgical navigation had a revision rate of 4.9%, which was significantly lower than that of the conventional surgery (17%). Costs were increased when surgical navigation was used.
CONCLUSION
Studies with higher MINORS scores demonstrated enhanced volumetric precision compared with traditional approaches. Surgical navigation has proven effective in reducing revision rates compared to conventional approaches, despite increased costs.
Topics: Humans; Orbital Fractures; Surgery, Computer-Assisted; Plastic Surgery Procedures; Tomography, X-Ray Computed; Imaging, Three-Dimensional
PubMed: 37951500
DOI: 10.1016/j.jormas.2023.101683 -
Facial Plastic Surgery & Aesthetic... 2023Intraoperative computed tomography (CT) allows surgeons to make adjustments during orbital fracture repair that may impact postoperative outcomes. To determine the... (Meta-Analysis)
Meta-Analysis Review
Intraoperative computed tomography (CT) allows surgeons to make adjustments during orbital fracture repair that may impact postoperative outcomes. To determine the impact of intraoperative CT use on intraoperative revision and surgical outcomes for orbital fracture repair. A systematic review was performed in concordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines: the population was patients undergoing orbital fracture repair; intervention was use of intraoperative CT; comparison was patients not undergoing intraoperative CT; and outcomes were intraoperative revision rate, postoperative complications, and secondary revision surgeries. Meta-analysis was performed on the rate of intraoperative revision. The search criteria yielded 790 articles, 377 were eligible for review, and 20 articles met criteria for analysis. In 19, intraoperative imaging led to immediate surgical corrections, with a random pooled effect size of 0.27 (0.20-0.35). Six studies reported secondary revision surgery rates (range 0-10.5%), and six studies reported postoperative complication rates (range 10-30%). Intraoperative imaging helps surgeons make precise, real-time adjustments in 27% of orbital fracture repair cases, which may improve surgical outcomes; however, more research is needed to investigate its impact on health care costs, operating time, and radiation exposure.
Topics: Humans; Orbital Fractures; Tomography, X-Ray Computed; Reoperation; Plastic Surgery Procedures; Intraoperative Care; Postoperative Complications
PubMed: 37782903
DOI: 10.1089/fpsam.2023.0143 -
Journal of Oral and Maxillofacial... Dec 2023The use of intraoperative imaging (IOI) to improve the reduction adequacy of zygomatic arch (ZMA) fractures has been reported, but few systematic reviews have examined... (Meta-Analysis)
Meta-Analysis
PURPOSE
The use of intraoperative imaging (IOI) to improve the reduction adequacy of zygomatic arch (ZMA) fractures has been reported, but few systematic reviews have examined this topic. The aim of this review was to investigate and compare the value of IOI with conventional methods without IOI (N-IOI) for the closed reduction of ZMA fractures.
METHODS
Electronic retrieval of MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and citation search until December 2, 2022, was used to identify controlled clinical trials that employed IOI for improving adequacy in closed reduction of ZMA fractures. The predictor variable was the use of IOI-yes/no (IOI vs N-IOI). The covariates included imaging technique (ultrasound, C-arm, and cone beam computed tomography) and ZMA fracture type (M-shape fracture, mechanistic force in 1 direction; variable fracture, mechanistic force in 2 directions). The primary outcome variables were the reduction adequacy of ZMA fractures (the remaining cortical step and dislocation angle) compared with the ideal mirrored position. Weighted or mean differences, risk ratios, and corresponding 95% confidence intervals were calculated, where P >.05 and I<50% fixed effect model was adopted, and a vice versa random effect model was adopted.
RESULTS
A total of 1250 studies were identified, of which 6 studies with 259 participants were included. The meta-analysis results indicated that compared with N-IOI, IOI yielded fewer cortical steps (-1.76 [-2.42, 1.10], P <.00001, fixed model) and dislocation angles (-5.60 [-8.08, 3.12], P<.00001, fixed model) in patients with variable ZMA fractures, while no significant difference was detected in the M-shape ZMA fracture (-0.72, [-2.93, 1.48], P = .52; -1.48, [-3.51, 0.55], P = .15). Although there was no significant difference in postoperative correction (0.35, [0.06, 2.01] P = .24, fixed model), all secondary revision cases occurred in the N-IOI group. Descriptive analysis showed that IOI yielded better symmetry and appearance satisfaction.
CONCLUSION
IOI improved the adequacy of the procedure and led to a better postoperative appearance, especially for patients with variable ZMA fractures. Furthermore, the use of IOI avoided the risk of secondary surgery. In future studies, researchers should standardize the scale and outcomes to facilitate the intuitive evaluation of reduction adequacy.
Topics: Humans; Zygoma; Zygomatic Fractures; Skull Fractures; Cone-Beam Computed Tomography; Ultrasonography
PubMed: 37775088
DOI: 10.1016/j.joms.2023.09.003 -
Oral Surgery, Oral Medicine, Oral... Nov 2023Surgical innovation led to an endoscopic-assisted intraoral approach for managing condyle fractures. The purpose of this systematic review is to purview the role of the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Surgical innovation led to an endoscopic-assisted intraoral approach for managing condyle fractures. The purpose of this systematic review is to purview the role of the endoscope and determine the range of information, summarizing the evidence for the benefit of surgeons on an endoscopic-assisted intraoral approach.
STUDY DESIGN
A literature search was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library databases for studies mentioning the endoscopic intraoral approach for managing mandibular condylar fractures. Outcomes include the role of the endoscope, challenges, adjunct armamentarium, duration, and complications associated with the transoral and transbuccal approach for screw fixation. The meta-analysis was conducted with prevalence estimates and standardized means using STATA.
RESULTS
Thirty-nine studies were included. A 30° angulated, 4-mm-thick endoscope was the most commonly used endoscope. Two mini plates were most commonly used for fixation. Facial nerve weakness was higher in the transbuccal approach (1.24%) than in the transoral approach (0.8%). Pooled analysis (6 studies) showed that the duration of the surgical procedure was less in the transoral approach compared with the transbuccal approach for screw fixation. The bailout was 1.49%.
CONCLUSIONS
The endoscopic-assisted intraoral approach is reliable for condylar fracture management. The transoral and transbuccal approaches can be used for screw fixation with comparable outcomes.
Topics: Humans; Mandibular Condyle; Fracture Fixation, Internal; Endoscopy; Mandibular Fractures; Bone Screws; Treatment Outcome; Bone Plates
PubMed: 37635009
DOI: 10.1016/j.oooo.2023.04.013 -
PloS One 2023The aim of this META-analysis was to evaluate the efficacy of photobiomodulation (PBM) therapy in the treatment of inferior alveolar nerve (IAN) injury due to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this META-analysis was to evaluate the efficacy of photobiomodulation (PBM) therapy in the treatment of inferior alveolar nerve (IAN) injury due to orthognathic surgeries, extraction of impacted third molars and mandibular fractures.
METHODS AND MATERIALS
A electric search was conducted by a combination of manual search and four electric databases including Pubmed, Embase, Cochrane library and Web of Science, with no limitation on language and publication date. Gray literature was searched in ClinicalTrials.gov and googlescholar. All retrieved articles were imported into ENDNOTE software (version X9) and screened by two independent reviewers. All analysis was performed using the REVMAN software (version 5.3).
RESULTS
Finally, 15 randomized controlled trials met the inclusion criteria for qualitative analysis and 14 for META-analysis from 219 articles. The results showed that PBM therapy had no effect on nerve injury in a short period of time (0-48h, 14 days), but had significant effect over 30 days. However, the effect of photobiomodulation therapy on thermal discrimination was still controversial, most authors supported no significant improvement. By calculating the effective rate of PBM, it was found that there was no significant difference in the onset time of treatment, whether within or over 6 months.
CONCLUSIONS
The results of this META-analysis show that PBM therapy is effective in the treatment of IAN injures no matter it begins early or later. However, due to the limited number of well-designed RCTs and small number of patients in each study, it would be necessary to conduct randomized controlled trials with large sample size, long follow-up time and more standardized treatment and evaluation methods in the future to provide more accurate and clinically meaningful results.
Topics: Humans; Low-Level Light Therapy; Tooth Extraction; Mandibular Nerve; Mandibular Fractures
PubMed: 37561792
DOI: 10.1371/journal.pone.0287833 -
Child's Nervous System : ChNS :... Dec 2023Minimally invasive (MIS) approaches to neurosurgical diseases continue to increase in popularity due to their association with decreased infection risk, shorter recovery... (Review)
Review
Minimally invasive (MIS) approaches to neurosurgical diseases continue to increase in popularity due to their association with decreased infection risk, shorter recovery time, and improved cosmesis. Cosmesis and lower morbidity are especially important for pediatric patients. The supraorbital keyhole craniotomy (SOKC) is one MIS approach shown to be effective for both neoplastic and vascular pathologies in pediatric patients. However, it is limited data on its use in pediatric trauma patients. Two cases employing SOKC in pediatric trauma patients are presented here along with a systematic review of the literature. We queried PubMed, Scopus, and Web of Science databases from inception to August 2022 using the Boolean search term: (supraorbital OR eyebrow OR transeyebrow OR suprabrow OR superciliary OR supraciliary) AND (craniotomy OR approach OR keyhole OR procedure) AND (pediatric OR children OR child OR young) AND "trauma". Studies that discussed the use of an SOKC in a pediatric patient having sustained trauma to the frontal calvarium and/or anterior fossa/sellar region of the skull base were included. Details were extracted on patient demographics, trauma etiology, endoscope use, and surgical and cosmetic outcomes. We identified 89 unique studies, of which four met inclusion criteria. Thirteen total cases were represented. Age and sex were reported for 12 patients, 25% of whom were male; the mean age was 7.5 years (range: 3-16). Pathologies included acute epidural hematoma (9), orbital roof fracture with dural tear (1), blowout fracture of the medial wall of the frontal sinus with supraorbital rim fracture (1), and compound skull fracture (1). Twelve patients were treated with a conventional operating microscope, while one underwent endoscope-assisted surgery. Only one significant complication (recurrent epidural hematoma) was reported. There were no reported cosmetic complications. The MIS SOKC approach is a reasonable option for select anterior skull base trauma in the pediatric population. This approach has been used previously for successful frontal epidural hematoma evacuation, which is often treated by a large craniotomy. Further study is merited.
Topics: Humans; Child; Male; Female; Craniotomy; Skull Base; Neurosurgical Procedures; Orbit; Hematoma, Epidural, Cranial; Orbital Fractures
PubMed: 37432398
DOI: 10.1007/s00381-023-06043-7 -
Scientific Reports Jul 2023Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to... (Meta-Analysis)
Meta-Analysis
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
Topics: Humans; Mandibular Fractures; Surgical Wound Infection; Prevalence; Prospective Studies; Retrospective Studies
PubMed: 37430033
DOI: 10.1038/s41598-023-37652-6 -
The American Journal of Emergency... Sep 2023While blunt cerebrovascular injury (BCVI) is a rare complication of blunt trauma, it is associated with significant morbidity and mortality. In the pediatric population,... (Review)
Review
BACKGROUND
While blunt cerebrovascular injury (BCVI) is a rare complication of blunt trauma, it is associated with significant morbidity and mortality. In the pediatric population, unique anatomy and development require screening criteria that accurately diagnose these injuries while limiting unwarranted radiation.
METHODS
We searched Medline OVID, EMBASE, and Cochrane Library databases for studies that investigated the risk factors of BCVI in individuals younger than 18 years of age. We adhered to the Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the quality of each study using the Newcastle-Ottawa Scale. We compared key characteristics of the papers, including incidence of BCVI, incidence of risk factors, and statistical significance of risk factors.
RESULTS
Of 1304 studies, 16 met the inclusion criteria. Of these, 15 were retrospective cohort studies and one was a retrospective case control study. Most of the studies included all pediatric blunt trauma admissions, but four only included those which underwent imaging, one only included those with cervical seatbelt sign, and one excluded those who did not survive 24-h post-admission. The ages included as pediatric varied between papers. Papers examined different risk factors and reported differing statistical significances. Though no single risk factor was found to be statistically significant in every study, cervical spine and skull fractures were found to be significant by most. Maxillofacial fractures, depressed GCS score, and stroke were found to be statistically significant by multiple studies. Twelve studies examined cervical soft tissue injury, and none found it to be statistically significant.
CONCLUSIONS
The risk factors most found to be statistically significant for BCVI were cervical spine fracture (10/16 studies), skull fracture (9/16), maxillofacial fractures (7/16), depressed GCS score (5/16), and stroke (5/16). There is a need for prospective studies on this topic.
LEVEL OF EVIDENCE
Level III, Systematic Review.
Topics: Child; Humans; Retrospective Studies; Case-Control Studies; Wounds, Nonpenetrating; Cerebrovascular Trauma; Risk Factors; Skull Fractures; Stroke
PubMed: 37327710
DOI: 10.1016/j.ajem.2023.06.006 -
The Journal of Craniofacial Surgery Sep 2023Blowout fractures are a common type of facial injury that requires accurate measurement of the fracture area for proper treatment planning. This systematic review aimed...
Blowout fractures are a common type of facial injury that requires accurate measurement of the fracture area for proper treatment planning. This systematic review aimed to summarize and evaluate the current methods for measuring blowout fracture areas and explore the potential role of artificial intelligence (AI) in enhancing accuracy and reliability. A comprehensive search of the PubMed database was conducted, focusing on studies published since 2000 that investigated methods for measuring blowout fracture area using computed tomography scans. The review included 20 studies, and the results showed that automatic methods, such as computer-aided measurements and computed tomography-based volumetric analysis, provide higher accuracy and reliability compared with manual and semiautomatic techniques. Standardizing the method for measuring blowout fracture areas can improve clinical decision-making and facilitate outcome comparison across studies. Future research should focus on developing AI models that can account for multiple factors, including fracture area and herniated tissue volume, to enhance their accuracy and reliability. Integration of AI models has the potential to improve clinical decision-making and patient outcomes in the assessment and management of blowout fractures.
Topics: Humans; Artificial Intelligence; Reproducibility of Results; Orbital Fractures; Tomography, X-Ray Computed; Clinical Decision-Making
PubMed: 37322582
DOI: 10.1097/SCS.0000000000009486