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International Journal of Oral and... Feb 2024Orbital reconstruction is a common procedure with inherent challenges and important consequences. Intraoperative use of computed tomography (CT) is an emerging... (Review)
Review
Orbital reconstruction is a common procedure with inherent challenges and important consequences. Intraoperative use of computed tomography (CT) is an emerging application that facilitates accurate intraoperative evaluation to improve clinical outcomes. This review aims to investigate the intraoperative and postoperative outcomes of intraoperative CT use in orbital reconstruction. PubMed and Scopus databases were systematically searched. Inclusion criteria were: clinical studies investigating intraoperative CT use in orbital reconstruction. Exclusion criteria were: duplicates; non-English publications; non-full-text publications; studies with insufficient data. Of the 1022 articles identified, seven eligible articles representing 256 cases were included. The mean age was 39 years. Most cases were male (69.9%). With regards to intraoperative outcomes, the mean revision rate was 34.1%, with plate repositioning being the most common type (51.1%). Intraoperative time was variably reported. With regards to postoperative outcomes, there were no revisions, and only one case that had a complication (transient exophthalmos). Mean volumetric difference between the repaired and contralateral orbits was reported in two studies. The findings of this review present an updated evidence-based summary of the intraoperative and postoperative outcomes of intraoperative CT use in orbital reconstruction. Robust longitudinal comparisons of clinical outcomes between intraoperative and non-intraoperative CT cases are required.
Topics: Adult; Female; Humans; Male; Exophthalmos; Orbit; Orbital Fractures; Postoperative Period; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 37208279
DOI: 10.1016/j.ijom.2023.05.002 -
Journal of Oral Rehabilitation Sep 2023Fractures of the mandibular condyle are the most common jaw fractures. There are several treatment approaches. There is the non-surgical and surgical approach. The... (Review)
Review
Conservative treatment of temporomandibular joint condylar fractures: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.
OBJECTIVE
Fractures of the mandibular condyle are the most common jaw fractures. There are several treatment approaches. There is the non-surgical and surgical approach. The purpose of this systematic literature review is to evaluate the indications and contraindications of either method to help the clinician make the best treatment choice.
METHODS
Pubmed, Web of Science and Lilacs were systematically searched until 20 May 2023. Clinical trials were selected to compare the two treatments for condyle fracture and evaluate indications and contraindications.
RESULTS
Out of 2515 papers, four studies were included. The surgical approach allows faster functional recovery and decreases patient discomfort. The study analyses under what circumstances a surgical procedure is more practical than a non-surgical one.
CONCLUSION
There is no evidence regarding the reliability of either method. Both have superimposable results. However, age, type of occlusion and other factors direct the clinician towards a surgical choice.
Topics: Humans; Treatment Outcome; Fracture Fixation, Internal; Conservative Treatment; Reproducibility of Results; Mandibular Fractures; Mandibular Condyle; Temporomandibular Joint Disorders; Temporomandibular Joint
PubMed: 37191365
DOI: 10.1111/joor.13497 -
Movement Disorders : Official Journal... Jul 2023Double-blind, sham-controlled neurosurgical trials for neurodegenerative disorders are debated as an ethical dilemma, particularly regarding subjects randomized to the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Double-blind, sham-controlled neurosurgical trials for neurodegenerative disorders are debated as an ethical dilemma, particularly regarding subjects randomized to the sham surgery group with general anesthesia.
OBJECTIVE
The objective of this study was to examine the safety of sham surgeries in Parkinson's disease (PD) clinical trials through complications related to the procedure.
METHODS
A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Rates and odds ratios (OR) were compared using random effects analysis.
RESULTS
Seven studies, all randomized, double-blind, sham surgery-controlled trials, with 309 patients with PD, were qualitatively and quantitatively analyzed: 141 patients in sham groups and 168 patients in the experimental arms of gene or cell therapy trials. Sham subjects had lower rates of gastrointestinal, positioning, incision-site, respiratory (hypoxic or hypercapnic respiratory failure), cardiovascular, thromboembolism, postoperative cognitive decline, skull fracture, and intracranial or spinal complications when compared with active treatment subjects. Sham subjects, however, had a higher rate of perioperative respiratory infections, such as pneumonia or sinusitis. Further, sham subjects were less likely to experience postoperative cognitive decline (OR, 0.23; 95% confidence interval [CI]: 0.11-0.47), intracranial or spinal complications (OR, 0.10; 95% CI: 0.01-0.75), total major morbidity (OR, 0.30; 95% CI: 0.19-0.47), or overall complications (OR, 0.59; 95% CI: 0.47-0.75) when compared with patients receiving experimental therapy.
CONCLUSIONS
Patients with PD in the sham surgery control arm of cell transplantation or gene therapy clinical trials have a low risk of procedure-related adverse events overall and fewer complications than patients in the experimental groups. There were no reported deaths attributed to sham surgery-controlled PD clinical trials. © 2023 International Parkinson and Movement Disorder Society.
Topics: Humans; Parkinson Disease; Postoperative Cognitive Complications; Randomized Controlled Trials as Topic
PubMed: 37165974
DOI: 10.1002/mds.29406 -
The Journal of Craniofacial SurgeryOrbital volume increase has been previously linked with post-traumatic enophthalmos. However, this varies and some studies show no correlation. This systematic review... (Meta-Analysis)
Meta-Analysis
PURPOSE
Orbital volume increase has been previously linked with post-traumatic enophthalmos. However, this varies and some studies show no correlation. This systematic review and meta-analysis aimed to synthesize the correlation between orbital volume and enophthalmos and to determine if surgical intervention, enophthalmos measurement method, fracture location, or timing affect this correlation.
METHODS
Automation tools were used to assist in this review of 6 databases. Searches were performed across all dates. Included studies quantitatively reported orbital volume and enophthalmos following traumatic orbital wall fractures in at least 5 adult subjects. Correlational data were extracted or calculated. Random-effects meta-analysis was used with subgroup analyses for each of the secondary aims.
RESULTS
Twenty-five articles describing 648 patients were included. The pooled correlation between orbital volume and enophthalmos was r =0.71 ( R2 =0.50, P <0.001). Operative status, enophthalmos measurement method, and fracture location did not affect pooled correlation. The delay between trauma or surgery and enophthalmos measurement was not shown to modulate correlation for unoperated patients ( R2 =0.05, P =0.22) but showed a negative relationship for postoperative patients ( z =-0.0281, SE=0.0128, R2 =0.63, P =0.03), but this was heavily influenced by a single article. All results had high residual heterogeneity. Studies were rated as moderate, low, or very low quality with few stating explicit hypotheses or limitations.
CONCLUSIONS
Bony orbital volume expansion accounts for around 50% of post-traumatic enophthalmos. The other half is probably explained by soft tissue or geometric bony, rather than volumetric, changes.
Topics: Adult; Humans; Enophthalmos; Orbital Fractures; Eye Injuries; Automation; Orbit; Retrospective Studies
PubMed: 37101317
DOI: 10.1097/SCS.0000000000009312 -
Journal of Oral and Maxillofacial... Jul 2023The application of a computer-aided navigation system (CANS) in zygomatic complex (ZMC) fractures has been extensively reported, but individual results are... (Meta-Analysis)
Meta-Analysis
PURPOSE
The application of a computer-aided navigation system (CANS) in zygomatic complex (ZMC) fractures has been extensively reported, but individual results are heterogeneous. The purpose of this systematic review was to evaluate the role of CANS in the surgical treatment of unilateral ZMC fractures.
METHODS
Electronic retrieval of MEDLINE, Embase, and Cochrane Library (CENTRAL) and manual searching until November 1, 2022 were used to identify cohort studies and randomized controlled trials employing CANS in the surgical treatment of ZMC fractures. The identified reports contained at least 1 of the following outcome variables: accuracy of reduction, total treatment time, amount of bleeding, postoperative complications, satisfaction, and cost. Weighted or mean differences (MD), risk ratios, and corresponding 95% confidence intervals (CI) were calculated, where P<.05 and I>50% random-effect model was adopted, and a vice versa fixed-effect model was adopted. Descriptive analysis was applied to qualitative statistics. The protocol was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered with PROSPERO (CRD42022373135).
RESULTS
A total of 562 studies were identified, of which 2 cohort studies and 3 randomized controlled trials with 189 participants were included. Meta-analysis indicated that employing CANS significantly decreased the reduction error (MD = -0.86, 95% CI -1.58 to -0.14; P = .02, random-effect model) compared with conventional surgery without using CANS. The differences in total treatment time (preoperative planning time: MD = 1.44, 95% CI -3.55 to 6.43; P = .57 and operative time: MD = 3.02, 95% CI -9.21 to 15.26; P = .63, fixed-effect model) and amount of bleeding (MD = 14.86, 95% CI -8.86 to 38.58; P = .22, fixed-effect model) were not statistically significant between the two groups. Descriptive analysis suggested that postoperative complications, postoperative satisfaction, and cost were also similar with or without CANS.
CONCLUSION
Within the limitations of the present review, the reduction accuracy of unilateral ZMC fractures using CANS is superior to that of conventional surgery. CANS presents limited influence on operation time, amount of bleeding, postoperative complications, postoperative satisfaction, and cost.
Topics: Humans; Zygomatic Fractures; Surgery, Computer-Assisted; Postoperative Complications; Operative Time; Postoperative Hemorrhage
PubMed: 37084764
DOI: 10.1016/j.joms.2023.03.010 -
Tomography (Ann Arbor, Mich.) Feb 2023The purpose of this systematic review was to analyze evidence based on existing studies on the ability of initial CT imaging to predict mortality in severe traumatic... (Meta-Analysis)
Meta-Analysis Review
The purpose of this systematic review was to analyze evidence based on existing studies on the ability of initial CT imaging to predict mortality in severe traumatic brain injuries (TBIs) in pediatric patients. An experienced librarian searched for all existing studies based on the inclusion and exclusion criteria. The studies were screened by two blinded reviewers. Of the 3277 studies included in the search, data on prevalence of imaging findings and mortality rate could only be extracted from 22 studies. A few of those studies had patient-specific data relating specific imaging findings to outcome, allowing the data analysis, calculation of the area under the curve (AUC) and receiver operating characteristic (ROC), and generation of a forest plot for each finding. The data were extracted to calculate the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predicted value (NPV), AUC, and ROC for extradural hematoma (EDH), subdural hematoma (SDH), traumatic subarachnoid hemorrhage (tSAH), skull fractures, and edema. There were a total of 2219 patients, 747 females and 1461 males. Of the total, 564 patients died and 1651 survived; 293 patients had SDH, 76 had EDH, 347 had tSAH, 244 had skull fractures, and 416 had edema. The studies included had high bias and lower grade of evidence. Out of the different CT scan findings, brain edema had the highest SN, PPV, NPV, and AUC. EDH had the highest SP to predict in-hospital mortality.
Topics: Male; Female; Humans; Child; Retrospective Studies; Brain Injuries, Traumatic; Subarachnoid Hemorrhage, Traumatic; Tomography, X-Ray Computed; Skull Fractures; Hematoma, Epidural, Cranial; Edema
PubMed: 36961003
DOI: 10.3390/tomography9020044 -
Otolaryngology--head and Neck Surgery :... May 2023The aim of this study is to review the current literature on treatment of subcondylar fractures using traditional open reduction internal fixation (ORIF), closed... (Review)
Review
OBJECTIVE
The aim of this study is to review the current literature on treatment of subcondylar fractures using traditional open reduction internal fixation (ORIF), closed reduction with maxillomandibular fixation (MMF), and endoscopic open approaches.
DATA SOURCES
PubMed, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and WHO ICTRP.
REVIEW METHODS
A comprehensive database search was performed in accordance with PRISMA guidelines. All English-only texts published in the last 20 years with ≥10 patients were included. Studies that included patients <16 years old were excluded.
RESULTS
Thirty-two studies met the final inclusion criteria. Nine studies compared ORIF with closed reduction using MMF, 12 studies evaluated ORIF via different approaches, and 10 studies evaluated outcomes after endoscopic approaches. Five studies reported significant improvement in mouth opening with ORIF compared to closed reduction. In 1 study that recorded patient-reported outcomes measure (FACE-Q scale), quality of life scores and patient satisfaction were significantly higher in the ORIF group. Among the 10 studies that used the endoscopic approach, transient facial nerve injury ranged from 0% to 10%.
CONCLUSION
Several studies report better mouth opening, dental occlusion, and functional outcomes after ORIF compared to closed reduction, while some found no significant difference. Endoscopic approaches provide ease of access to the condyle with a low incidence of facial nerve injury. However, limitations include special equipment, longer operative times, and a steep learning curve using an endoscope. This review provides surgeons with an overview of the current literature on subcondylar fractures to allow for an individualized management approach for each patient.
Topics: Humans; Adolescent; Treatment Outcome; Fracture Fixation, Internal; Mandibular Fractures; Facial Nerve Injuries; Quality of Life; Mandibular Condyle
PubMed: 36939481
DOI: 10.1002/ohn.185 -
The Statistical Fragility of Orbital Fractures: A Systematic Review of Randomized Controlled Trials.Journal of Oral and Maxillofacial... Jun 2023The P value has often been used as a tool to determine the statistical significance and evaluate the statistical robustness of study findings in orthopedic literature.... (Review)
Review
BACKGROUND
The P value has often been used as a tool to determine the statistical significance and evaluate the statistical robustness of study findings in orthopedic literature. The purpose of this study is to apply both the fragility index (FI) and the fragility quotient (FQ) to evaluate the degree of statistical fragility in orbital fracture literature. We hypothesized that the dichotomous outcomes within the orbital fracture literature will be vulnerable to a small number of outcome event reversals and will be statistically fragile.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors identified all dichotomous data for randomized controlled trials (RCTs) in orbital fracture literature and performed a PubMed search from 2000 to 2022. The FI of each outcome was calculated through the reversal of a single outcome event until significance was reversed. The FQ was calculated by dividing each FI by study sample size. The interquartile range (IQR) was also calculated for the FI and FQ.
RESULTS
Of the 3,329 studies screened, 28 met the criteria with 10 RCTs evaluating orbital fractures included for analysis. A total of 58 outcome events with 22 significant (P < .05) outcomes and 36 nonsignificant (P ≥ .05) outcomes were identified. The overall FI and FQ for all 58 outcomes was 5 (IQR: 4 to 5) and 0.140 (IQR: 0.075 to 0.250), respectively. Fragility analysis of statistical significant outcomes and nonsignificant outcomes had an FI of 3.5 with no IQR and 5 (IQR 4-5), respectively. All of the studies reported a loss to follow-up data, where 20% (2) was greater than the overall FI of 5.
CONCLUSION
The orbital fracture literature provides treatment guidance by relying on statistical significant results from RCTs. However, the RCTs in the orbital fracture peer-reviewed literature may not be statistically stable as previously thought. The sole reliance of the P value may depict misleading results. Thus, we recommend standardizing the reporting of the P value, FI, and FQ in the orbital fracture literature to aid readers in reliably drawing conclusions based on fragility outcome measures impacting clinical decision-making.
Topics: Humans; Orbital Fractures; Randomized Controlled Trials as Topic; Sample Size
PubMed: 36931316
DOI: 10.1016/j.joms.2023.02.012 -
Heliyon Feb 2023To estimate the efficacy of three-dimensional (3D) models for medical education.
UNLABELLED
To estimate the efficacy of three-dimensional (3D) models for medical education.
METHODS
A systematic scoping review was performed containing diverse databases such as SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS. MeSH terms and keywords were stipulated to explore randomized clinical trials (RCTs) in all languages. Solely RCTs that accomplished the eligibility criteria were admitted.
RESULTS
Fifteen RCTs including 1659 medical students were chosen. Five RCTs studied heart models, 3 RCTs explored facial, spinal and bone fractures and the rest of the trials investigated eye, arterial, pelvic, hepatic, chest, skull, and cleft lip and palate models. Regarding the efficacy of 3D models, in terms of learning skills and knowledge gained by medical students, most RCTs reported higher scores. Considering the test-taking times, the results were variable. Two RCTs showed less time for the 3D group, another RCT indicated variable results in the response times of the test depending on the anatomical zone evaluated, while another described that the students in the 3D group were slightly quicker to answer all questions when compared with the traditional group, but without statistical significance. The other 11 experiments did not present results about test-taking times. Most students in all RCTs indicated satisfaction, enjoyment, and interest in utilizing the 3D systems, and recognized that their abilities were enhanced.
CONCLUSIONS
Higher efficacy in terms of learning skills and knowledge gained was observed when the 3D systems were used by medical students. Undergraduates also expressed great satisfaction with the use of these technologies. Regarding the test-taking times, the results favored the 3D group.
PubMed: 36816291
DOI: 10.1016/j.heliyon.2023.e13395 -
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