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Oral Radiology Jul 2024Double puncture arthrocentesis (DPA) of the temporomandibular joint (TMD) is considered an effective preservative option for managing mandibular condylar head fractures....
OBJECTIVES
Double puncture arthrocentesis (DPA) of the temporomandibular joint (TMD) is considered an effective preservative option for managing mandibular condylar head fractures. However, the procedure is commonly performed by a traditional "blind" method using anatomical characteristics. In the present study, an ultrasonography (US) device was applied for the treatment of a case with a fractured mandibular condyle.
METHODS
A 79-year-old female was diagnosed right side condylar head fracture complaining pain of right TMD and reduced mouth opening range: inter-incisor distance of 20 mm. Since the fracture position was high and inoperable, the decision was made to perform DPA of the TMD. The US probe was positioned parallel and slightly oblique to the major axis of the mandibular ramus. Both the posterior and anterior insertions into the joint space were performed according to the axis mentioned above, which enabled the operator to visualize the entirety of the needle.
RESULTS
The device offered safety and ensured accuracy by providing real-time visual aid to the surgeon. The procedure provided an early increase in the inter-incisor distance (31 mm) and pain relief.
CONCLUSIONS
Hence, for the preservative treatment of mandibular condylar head fractures, based on the present study, we recommend US-guided arthrocentesis as a safe, feasible, and effective therapeutic option instead of the conventional "blind" method.
Topics: Humans; Female; Aged; Mandibular Condyle; Mandibular Fractures; Arthrocentesis; Ultrasonography, Interventional
PubMed: 38568392
DOI: 10.1007/s11282-024-00744-8 -
Cureus Feb 2024Pediatric maxillofacial fractures, which are not very prevalent, account for around 5% of all face injuries. Children under the age of 13 are more susceptible to...
Pediatric maxillofacial fractures, which are not very prevalent, account for around 5% of all face injuries. Children under the age of 13 are more susceptible to craniofacial injuries because they have a larger cerebral mass-to-body ratio than adults. The fracture pattern in children does not resemble that of adults, due to which the treatment of pediatric fractures differs from that of adults and can pose substantial difficulties to the pediatric dentist due to many factors, including the complex anatomy of the developing jaw. In this case report, a 5-year-old male patient presented with an injury to the upper and lower jaw. A case was managed with a conservative approach by using a modified open cap splint. A radiographic investigation, including CT brain and face, was done, which revealed the mandibular symphyseal fracture, bilateral condyle, and right Lefort II fracture. A modified open cap splint was fabricated and fixed with circummandibular and circumzygomatic wiring under general anesthesia. After two months, the fractured site showed good healing on orthopantomography (OPG), and satisfactory occlusion was achieved. The patient was kept on monthly follow-ups for up to five months. Treatment guidelines for pediatric maxillary and mandibular fractures are different from those for adults in that most pediatric cases are managed by a conservative approach. Cap splints are a versatile treatment option for juvenile mandibular fractures because they can be used to restore function and aesthetics with minimal morbidity, do not impede jaw growth or the development of dentition, and can be applied to patients of a wider range of ages.
PubMed: 38558710
DOI: 10.7759/cureus.55191 -
Journal of Stomatology, Oral and... Jun 2024This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation... (Comparative Study)
Comparative Study
OBJECTIVE
This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation method, which is crucial for improving post-operative aesthetic and functional outcomes.
MATERIAL AND METHODS
Healthy patients and patients with surgically treated ZMC fractures were retrospectively reviewed. Using Brainlab Elements® the zygomatic bone and the orbit of each patient was segmented and mirrored. Subsequently, the mirrored side was matched with the other side via volume-based registration, using the segmented orbit as reference. Volumetric asymmetry was measured using 3-matic software, and a surface-based matching technique was used to calculate the mean absolute differences (MAD) between the surfaces of the two sides of the ZMC. The reliability of this novel method using volume-based registration was tested, and the intra-class correlation coefficient was assessed.
RESULTS
The MAD between the surfaces of the left and right sides in the control group was 0.51 mm (±0.09). As for the ZMC fracture group, MAD was 0.78 mm (±0.20) and 0.72 mm (±0.15) pre- and post-operatively, respectively. The MAD showed statistically significant differences between pre- and post-operative groups (p = 0.005) and between control and post-operative groups (p < 0.001). The intra-class correlation coefficient was high (≥0.99).
CONCLUSIONS
This evaluation method using mirroring and volume-based registration to determine the symmetrical position of the ZMC is reliable. The surface-based measurements revealed an improved symmetry after surgery. However, the symmetry of the treated patients remained lower than the control group.
Topics: Humans; Zygomatic Fractures; Female; Male; Imaging, Three-Dimensional; Retrospective Studies; Adult; Maxillary Fractures; Middle Aged; Facial Asymmetry; Reproducibility of Results; Young Adult
PubMed: 38556166
DOI: 10.1016/j.jormas.2024.101857 -
Journal of Stomatology, Oral and... Jun 2024Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally...
INTRODUCTION
Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally advanced disease, radiotherapy (RT) play an important role, this with or without chemotherapy in organ preservation strategies. More specific for early stage localized disease, RT (or surgery) seems to give similar results on locoregional control (LRC) and choice is made according to the organ preservation issue. Despite the fact that technical improvements have been made to optimize the radiation dose delivery and minimize the normal tissue toxicity, RT is associated with potential early and late toxicities. Osteoradionecrosis of the jaw (ORNJ), especially seen after teeth extraction, is one of the associated toxicities and can significantly impair the patient's quality of life. Because of the fear of developing ORNJ, one is very reluctant to extract or place a dental implant post-radiotherapy, especially in high irradiation dose zones (>40 Gy). Hence, it is important to define teeth at risk of future extraction before initiating RT and to handle those in high-risk irradiation zones. In order to optimise extractions, we created a predictive model of the expected irradiation dose, and thus the need for extraction, to the teeth bearing bones. The aim of this study is to validate our model and to define the potential relationship between the radiation dose received by each tooth and the dental complications observed.
MATERIAL AND METHODS
Between March 2012 and March 2018, patients with HNSCC treated by intensity modulated RT were retrospectively analysed. The mean irradiation dose for each tooth was generated on the administered treatment plan by contouring each tooth separately on each dosimetric scan section using dedicated software (Eclipse, Varian). In order to validate our predictive model, we compared the actual generated/administered teeth irradiation doses with the irradiation doses predicted by our model.
RESULTS
Our predictive model was accurate in 69.6% of the cases. In 12.5% of cases the predicted dose was higher than the calculated dose and lower in 17,8% of the cases. A correct- or over-estimation (is the latter being clinically less worrying than an underestimated dose) was achieved in 82% of cases. For the 18% of cases underfitting, the mean margin of error was 5.7 Gy. No statistically significant association was found between the development of caries and doses to the teeth, doses to the parotid glands or dental hygiene. However, a significant association between dental irradiation at more than 40 Gy and the occurrence of dental fractures (p = 0.0002) were demonstrated.
CONCLUSIONS
Our predictive model seems to be 82% accurate for dose prediction, hence might be helpful for optimizing/minimizing prophylactic extractions. Indeed, following our model, professionals could decide not to extract damaged teeth in areas not at risk of ORNJ, lowering morbidity during and after RT. Contrary to the literature, no relationship was found between the occurrence of dental caries and parotid irradiation and the patient's oral hygiene. However, for the first time, a highly significant correlation between the occurrence of dental fracture and dental irradiation at more than 40 Gy was observed.
Topics: Humans; Retrospective Studies; Osteoradionecrosis; Head and Neck Neoplasms; Male; Female; Middle Aged; Aged; Radiotherapy Dosage; Tooth Extraction; Adult; Squamous Cell Carcinoma of Head and Neck; Aged, 80 and over
PubMed: 38556165
DOI: 10.1016/j.jormas.2024.101858 -
Quintessence International (Berlin,... Mar 2024Radiation treatment plays a mainstream role in the management of head and neck squamous cell carcinomas (HNSCCs). Adverse effects from radiation therapy include...
Radiation treatment plays a mainstream role in the management of head and neck squamous cell carcinomas (HNSCCs). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathologic fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCCs. Adverse impacts on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCCs exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathologic fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC who had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with the growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dental practitioner may encounter such patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; Immune Checkpoint Inhibitors; Dentists; Fractures, Spontaneous; Professional Role; Head and Neck Neoplasms; Jaw
PubMed: 38534035
DOI: 10.3290/j.qi.b5128663 -
Computers in Biology and Medicine May 2024It is very important to detect mandibular fracture region. However, the size of mandibular fracture region is different due to different anatomical positions, different...
BACKGROUND
It is very important to detect mandibular fracture region. However, the size of mandibular fracture region is different due to different anatomical positions, different sites and different degrees of force. It is difficult to locate and recognize fracture region accurately.
METHODS
To solve these problems, MYOLOv5 model is proposed in this paper. Three feature enhancement strategies are designed, which improve the ability of model to locate and recognize mandibular fracture region. Firstly, Global-Local Feature Extraction Module (GLFEM) is designed. By effectively combining Convolutional Neural Network (CNN) and Transformer, the problem of insufficient global information extraction ability of CNN is complemented, and the positioning ability of the model to the fracture region is improved. Secondly, in order to improve the interaction ability of context information, Deep-Shallow Feature Interaction Module (DSFIM) is designed. In this module, the spatial information in the shallow feature layer is embedded to the deep feature layer by the spatial attention mechanism, and the semantic information in the deep feature layer is embedded to the shallow feature layer by the channel attention mechanism. The fracture region recognition ability of the model is improved. Finally, Multi-scale Multi receptive-field Feature Mixing Module (MMFMM) is designed. Deep separate convolution chains are used in this modal, which is composed by multiple layers of different scales and different dilation coefficients. This method provides richer receptive field for the model, and the ability to detect fracture region of different scales is improved.
RESULTS
The precision rate, mAP value, recall rate and F1 value of MYOLOv5 model on mandibular fracture CT data set are 97.18%, 96.86%, 94.42% and 95.58% respectively. The experimental results show that there is better performance about MYOLOv5 model than the mainstream detection models.
CONCLUSION
The MYOLOv5 model can effectively recognize and locate the mandibular fracture region, which is of great significance for doctors' clinical diagnosis.
Topics: Humans; Mandibular Fractures; Information Storage and Retrieval; Neural Networks, Computer; Semantics
PubMed: 38522254
DOI: 10.1016/j.compbiomed.2024.108291 -
Journal of Plastic, Reconstructive &... May 2024Currently, there are several methods of achieving maxillomandibular fixation (MMF), each with its unique operative considerations and subsequent patient outcomes and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Currently, there are several methods of achieving maxillomandibular fixation (MMF), each with its unique operative considerations and subsequent patient outcomes and complications. In this study, we reviewed the literature to evaluate and compare all MMF methods.
METHODS
A systematic review of all MMF types was conducted and post-operative outcome data were analyzed and compared among the different types. Conventional Erich arch bars were compared to hybrid arch bars, MMF screws, and eyelet interdental wiring. A random-effects meta-analysis was used to determine the mean differences, and 95% confidence intervals (CIs) with a statistical significance of P < 0.05.
RESULTS
Among the 4234 articles identified, 24 were included, and 17 were meta-analyzed. Time to achieve MMF (-43.38 min; 95% CI, -58.20 to -28.56; P < 0.001), total operative time (-30.33 min; 95% CI, -61.05 to 0.39; P = 0.05), incidence of wire puncture injuries and glove perforations (0.11; 95% CI, 0.04 to 0.30; P < 0.001), and incidence of poor oral hygiene (0.08; 95% CI, 0.02 to 0.28; P < 0.001) were lower for alternative MMF interventions compared to those of the conventional Erich arch bars.
CONCLUSIONS
Alternative MMF methods required shorter operative time to achieve MMF and demonstrated other increased efficiencies of practice such as shorter total operative time and decreased glove perforations, when compared to conventional Erich arch bars. If a patient is a candidate for MMF, the presented alternative MMF techniques should be considered depending on the clinical context and availability of institutional resources.
Topics: Humans; Postoperative Complications; Jaw Fixation Techniques; Mandibular Fractures; Treatment Outcome; Operative Time
PubMed: 38520780
DOI: 10.1016/j.bjps.2024.02.075 -
Journal of the Mechanical Behavior of... Jun 2024The mechanical properties of the jawbone play a critical role in determining the successful integration of dental prostheses. Chronic kidney disease (CKD) has been...
The mechanical properties of the jawbone play a critical role in determining the successful integration of dental prostheses. Chronic kidney disease (CKD) has been identified to abnormally accelerate bone turnover rates. However, the impact of CKD on the mechanical characteristics of the jawbone has not been extensively studied. This study sought to evaluate the time-dependent viscoelastic behaviors of rat jawbones, particularly in the scenarios both with and without CKD. We hypothesized that CKD might compromise the bone's innate toughening mechanisms, potentially owing to the time-dependent viscoelasticity of the bone matrix proteins. The maxillary and mandibular bones of Wistar rats were subjected to nanoindentation and Raman micro-spectroscopy. Load-hold-displacement curves from the cortical regions were obtained via nanoindentation and were mathematically characterized using a suitable viscoelastic constitutive model. Raman micro-spectroscopy was employed to identify nuanced vibrational changes in local molecular structures induced by CKD. The time course of indenter penetration onto cortical bones during the holding stage (creep behavior) can be mathematically represented by a series arrangement of the Kelvin-Voigt bodies. This configuration dictates the overall viscoelastic response observed during nanoindentation tests. The CKD model exhibited a reduced extent of viscoelastic contributions, especially during the initial ramp loading phase in both the maxillary and mandibular cortical bones. The generalized Kelvin-Voigt model comprises 2 K-Voigt elements that signify an immediate short retardation time (τ) and a subsequent prolonged retardation time (τ), respectively. Notably, the mandibular CKD model led to an increase in the delayed τ alongside an increase in non-enzymatic collagen cross-linking. These suggest that, over time, CKD diminishes the bone's capability for supplementary energy absorption and dimensional recovery, thus heightening their susceptibility to fractures.
Topics: Rats; Animals; Rats, Wistar; Jaw; Bone Matrix; Mandible; Renal Insufficiency, Chronic
PubMed: 38518511
DOI: 10.1016/j.jmbbm.2024.106506 -
Chinese Journal of Traumatology =... Mar 2024This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and...
PURPOSE
This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.
METHODS
Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled. Clinical treatment was classified into 3 phases. In phase I, techniques such as orthognathic surgery, microsurgery, and distraction osteogenesis were employed to reconstruct the correct three-dimensional (3D) jaw position relationship. In phase II, bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions. In phase III, implant-supported overdentures or fixed dentures were used for occlusal reconstruction. A summary of treatment methods, clinical efficacy evaluation, comparative analysis of imageological examinations, and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects. All data are summarized using the arithmetic mean and standard deviation and compared using independent sample t-tests.
RESULTS
In 15 patients with old jaw fractures and dentition defects (an average age of 32 years, ranging from 18 to 53 years), there were 7 cases of malocclusion of single maxillary fracture, 6 of malocclusion of single mandible fracture, and 2 of malocclusion of both maxillary and mandible fractures. There were 5 patients with single maxillary dentition defects, 2 with single mandibular dentition defects, and 8 with both maxillary and mandibular dentition defects. To reconstruct the correct 3D jaw positional relationship, 5 patients underwent Le Fort I osteotomy of the maxilla, 3 underwent bilateral sagittal split ramus osteotomy of the mandible, 4 underwent open reduction and internal fixation for old jaw fractures, 3 underwent temporomandibular joint surgery, and 4 underwent distraction osteogenesis. All patients underwent jawbone augmentation, of whom 4 patients underwent a free composite vascularized bone flap (26.66%) and the remaining patients underwent local alveolar bone augmentation. Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation (73.33%). The 15 patients received 81 implants, of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures. The survival rate of all implants was 93.82%. The final imageological examination of 15 patients confirmed that the malocclusion was corrected, and the clinical treatment ultimately achieved occlusal function reconstruction. The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy, phonetics, aesthetics, and comfort after treatment.
CONCLUSION
Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment, consisting of 3D spatial jaw correction, alveolar bone augmentation and soft tissue augmentation, and implant-supported occlusal reconstruction, achieving satisfactory clinical therapeutic efficacy.
PubMed: 38514297
DOI: 10.1016/j.cjtee.2024.03.004 -
Acta Biomaterialia Apr 2024Failure-resistant designs are particularly crucial for bones subjected to rapid loading, as is the case for the ambush-hunting northern pike (Esox lucius). These fish...
Failure-resistant designs are particularly crucial for bones subjected to rapid loading, as is the case for the ambush-hunting northern pike (Esox lucius). These fish have slim and low-density osteocyte-lacking bones. As part of the swallowing mechanism, the cleithrum bone opens and closes the jaw. The cleithrum needs sufficient strength and damage tolerance, to withstand years of repetitive rapid gape-and-suck cycles of feeding. The thin wing-shaped bone comprises anisotropic layers of mineralized collagen fibers that exhibit periodic variations in mineral density on the mm and micrometer length scales. Wavy collagen fibrils interconnect these layers yielding a highly anisotropic structure. Hydrated cleithra exhibit Young's moduli spanning 3-9 GPa where the yield stress of ∼40 MPa increases markedly to exceed ∼180 MPa upon drying. This 5x observation of increased strength corresponds to a change to brittle fracture patterns. It matches the emergence of compressive residual strains of ∼0.15% within the mineral crystals due to forces from shrinking collagen layers. Compressive stresses on the nanoscale, combined with the layered anisotropic microstructure on the mm length scale, jointly confer structural stability in the slender and lightweight bones. By employing a range of X-ray, electron and optical imaging and mechanical characterization techniques, we reveal the structure and properties that make the cleithra impressively damage resistant composites. STATEMENT OF SIGNIFICANCE: By combining structural and mechanical characterization techniques spanning the mm to the sub-nanometer length scales, this work provides insights into the structural organization and properties of a resilient bone found in pike fish. Our observations show how the anosteocytic bone within the pectoral gridle of these fish, lacking any biological (remodeling) repair mechanisms, is adapted to sustain natural repeated loading cycles of abrupt jaw-gaping and swallowing. We find residual strains within the mineral apatite nanocrystals that contribute to forming a remarkably resilient composite material. Such information gleaned from bony structures that are different from the usual bones of mammals showcases how nature incorporates smart features that induce damage tolerance in bone material, an adaptation acquired through natural evolutionary processes.
Topics: Animals; Esocidae; Bone and Bones; Stress, Mechanical; Nanoparticles; Compressive Strength; Biological Evolution; Elastic Modulus; Collagen
PubMed: 38513725
DOI: 10.1016/j.actbio.2024.03.017