Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Ahmet Emin Demirbas, Mustafa Karakaya, Suheyb Bilge, Dilek Gunay Canpolat, Nükhet Kütük, Alper Alkan Purpose The aim of the present study was to identify the preemptive analgesic effect of intravenous (IV) ibuprofen before and after mandibular third molar surgery. Materials and Methods We randomly divided 75 patients into 3 groups. Group 1 received IV ibuprofen 60 minutes before surgery and IV placebo (100 mL of saline) after surgery. Group 2 received IV placebo (100 mL of saline) before surgery and IV ibuprofen 60 minutes after surgery. Finally, group 3 received IV placebo (100 mL of saline) 60 minutes before and after surgery. Postoperative pain was recorded using a visual analog scale at 1, 2, 4, 6, 8, 12, and 24 hours within the postoperative period. The total dose of rescue acetaminophen intake was recorded during the first 24 hours of the postoperative period. Results The efficacy of postoperative analgesia was greater within the preoperative IV ibuprofen group compared with the other groups (P < .001). The placebo group had required more rescue analgesia within the first hour compared with the other groups. The average dose of acetaminophen administered in group 1 was 640 mg compared with 1240 mg in group 2 and 1840 mg in group 3 within the first 24 hours after surgery (P < .001). Conclusions The present study has shown that the preemptive use of IV ibuprofen resulted in less pain and a decrease in the requirement for rescue analgesia during the first 24 hours after third molar surgery.

News and Announcements Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s):

Definitive 125I Brachytherapy of Locally Advanced Adenoid Cystic Carcinoma Involving the Skull Base With Satisfying Efficacy and Safety Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Ning Xu, Lei Zheng, Wen-Jie Wu, Ming-Wei Huang, Jie Zhang, Jian-Guo Zhang Purpose Adenoid cystic carcinoma (ACC) involving the skull base is difficult to treat and sometimes unresectable. The purpose of this study was to evaluate the efficacy and safety of 125I radioactive seed interstitial brachytherapy for treatment of these patients. Materials and Methods Patients with ACC involving the skull base treated by definitive 125I brachytherapy from March 2008 through December 2018 at the Peking University Hospital of Stomatology (Beijing, China) were retrospectively identified. Overall survival (OS), as the primary efficacy indicator, and progression-free survival (PFS) and distant metastasis-free survival (DFS), as the secondary efficacy indicators, were analyzed by Kaplan-Meier survival analysis and Cox regression analysis. Adverse radiotherapy (RT) reactions, as safety indicators, were recorded. Results Thirty-two patients with (r)T4b locally advanced disease were enrolled. The prescription dose (PD) was 60 to 120 Gy. The dose delivered to 90% of the target volume was 99.1 to 145.2 Gy, the percentage of the target volume receiving at least 100% of the PD was at least 88.2%, and the percentage of the target volume receiving at least 150% of the PD was smaller than 74.0%. Mean follow-up was 32 months (median, 21 months; range, 3 to 95 months). The 1- and 3-year OS rates were 93.3 and 62.6%, the 1- and 3-year PFS rates were 90.0 and 46.4%, and the 1- and 3-year DFS rates were 91.7 and 61.1%, respectively. Survival was significantly associated with local recurrence (P = .04) and distant metastasis except in the lung (P = .05). The rate of severe chronic adverse RT reactions was 3.1%; no severe acute adverse RT reactions were observed. Conclusion 125I brachytherapy appears to be an effective and safe treatment in the short-term for ACC involving the skull base and could be the preferred treatment for patients with prior RT. Local control with brachytherapy could provide survival benefit even in patients with lung metastasis.

Associations Between Poor Oral Health and Risk of Squamous Cell Carcinoma of the Head and Neck: A Meta-Analysis of Observational Studies Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Shuai Xu, Gang Zhang, Chao Xia, Ying-hui Tan Purpose Many epidemiologic studies have reported an association of poor oral health, especially periodontal disease (PD) and tooth loss, with the risk of squamous cell carcinoma of the head and neck (SCCHN). However, these studies have yielded inconsistent results. Therefore, the present study investigated whether poor oral health is an independent predictor of SCCHN through a meta-analysis of observational studies. Materials and Methods The PubMed, EMBASE, and Cochrane Library databases were systematically searched for relevant observational studies of the association between oral health and risk of SCCHN conducted up to October 2017. The meta-analysis was conducted using STATA 12.0 (StataCorp, College Station, TX). A fixed- or random-effects model was applied to evaluate pooled risk estimates, and sensitivity and subgroup analyses were performed to identify sources of heterogeneity and pooled estimation. Publication bias was assessed using the Begg test, the Egger test, and funnel plots. Results Twenty-seven relevant observational studies were identified, consisting of 24 case-and-control studies, 2 prospective studies, and 1 cross-sectional study, with 26,750 participants. Notably, oral health correlated meaningfully with SCCHN (odds ratio [OR] = 2.24; 95% confidence interval [CI], 1.77-2.82). In subgroup analyses, participants with PD (OR = 2.52; 95% CI, 1.43-4.44) had a higher risk of developing SCCHN than those with tooth loss (OR = 2.13; 95% CI, 1.63-2.78). The risk estimates exhibited substantial heterogeneity. Evidence of publication bias was limited. Conclusions The results of this meta-analysis suggest that patients with tooth loss or PD might face a substantial and independent risk of SCCHN, even after adjusting for smoking and alcohol consumption. However, the pooled estimates from observational studies could not establish a causative relation among PD, tooth loss, and SCCHN. Additional investigations of this correlation are warranted.

Reconstruction of a Unilateral Alveolar Cleft Using a Customized Allogenic Bone Block and Subsequent Dental Implant Placement in an Adult Patient Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Oliver Blume, Michael Back, Teresa Born, Phil Donkiewicz Cleft lip and palate is the most common congenital deformity with severe effects on the quality of life of affected patients. The deformity often includes an alveolar cleft (AC). In most cases, osteoplasty will be performed using autogenous bone transplants harvested from the iliac crest. Thus, this treatment represents a highly invasive procedure. With freeze-dried bone allografts (FDBAs) becoming an increasingly accepted alternative to autogenous bone grafting for several indications, their application might also be suitable for AC reconstruction. We present the use of a customized allogenic bone block in a guided bone regeneration procedure for reconstruction of a unilateral AC and the successful insertion of dental implants after a healing period of 6 months. The use of FDBA seems to represent a successful treatment option for AC reconstruction. The allogenic bone block demonstrated high volume stability with ideal integration and revascularization, resulting in functional bone tissue suitable for implantation and esthetic rehabilitation. Nevertheless, further investigations, especially concerning the long-term stability of the augmented bone and dental implants, are needed to draw definite conclusion regarding the performance of allogenic bone blocks in orofacial cleft osteoplasty.

Pharyngeal Airway Modifications in Skeletal Class III Patients Undergoing Bimaxillary Advancement Surgery Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Viviane da Silva Machado, Bruno Andrade Cantharino de Carvalho, Silvia Amélia Scudeler Vedovello, Heloisa Valdrighi, Milton Santamaria Júnior Purpose The purposes were to study the pharyngeal airway in patients with skeletal Class III malocclusion submitted to surgical orthodontic treatment and to correlate the alterations with bone movements. Materials and Methods The sample consisted of multislice computed tomography images from 13 patients obtained before and 6 months after maxillomandibular advancement surgery. The following measurements were obtained using Dolphin Imaging software (Dolphin Imaging, Chatsworth, CA): volume and area of the oropharynx, nasopharynx, and total airway, as well as the most constricted area, anteroposterior and lateral dimensions of the narrowest axial cross-sectional area, and airway length. The paired t test was applied at a significance level of 5%. Results Sagittal displacement of the maxilla and mandible was correlated with airway alterations using the Pearson correlation test. Alterations in airway measurements were observed in all patients after surgery. We noted a significant increase (P < .05) in total airway area, oropharyngeal area, and anteroposterior dimension of the most constricted area, as well as a significant reduction (P < .05) in airway length. A significant correlation (P < .05) was observed between nasopharyngeal area and maxillary movement and between airway length and mandibular movement (P < .05). Conclusions The results of this study suggest significant alterations in pharyngeal airway measurements when preoperative and postoperative periods of bimaxillary advancement surgery were compared.

Dynamic Nasolabial Growth After Primary Surgery for Patients With Bilateral Cleft Lip: A Five-Year Follow-Up Study Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Yuhao Wei, Tianhang Zhong, Xing Yin, Bing Shi, Qian Zheng, Jingtao Li Purpose Bilateral complete cleft lip (BCCL) causes severe tissue deficit and usually requires multiple revisions after primary repair. In the present study, we aimed to illustrate the nasolabial changes after primary BCCL correction. Patients and Methods The present retrospective cohort study compared patients who had undergone BCCL and palate (BCCLP) and cleft palate only (CPO). All included patients had undergone surgery at the same treatment center (West China Hospital of Stomatology) from 2007 to 2012. The patients returned for follow-up surgery at 6 months and 5 years after their primary repair surgery. We retrieved the facial plaster casts of the enrolled patients and recorded the key nasolabial measurements. The outcome variables included the prolabial length (PL), peak distance, nasal width, and columellar length (CL). The data were analyzed using a general linear model for repeated measures, and the linear association was tested using SPSS. The level of testing efficiency (P value) was set at .05. Results A total of 160 patients, 80 who had undergone BCCLP and 80 CPO controls, were included. All nasolabial measurements in the BCCLP group had increased during the 5-year follow-up period. The PL of the BCCLP group had increased more quickly than the PL of the CPO group (P = .000 < .05), but the CL had increased nearly as much (P = .270). Conclusions For the primary correction of bilateral cleft lip nose deformity, dissection and repositioning of the cleft lip and nose did not significantly inhibit the growth of the nasolabial region in the first 5 years after surgery. Nose deformities should not remain uncorrected after primary surgical repair. In contrast, cleft surgeons should focus on the finer adjustment of columella with less doubt regarding adverse effects.

Comparative Study of the Effect of Paranasal Augmentation With Autologous Bone in Orthognathic Surgery Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Young-Tae Jeon, Se-Jin Han Purpose The purpose of the present study was to compare the effectiveness of the 3 orthognathic surgical options among the patients who had had mandibular prognathism with a concave midfacial profile. Patients and Methods A total of 72 patients with mandibular prognathism with a concave midfacial profile were divided into 3 groups. We compared the lateral profile changes using lateral cephalograms. The images were taken before surgery (T0) and at least 6 months to 1 year after surgery (T1). After computerization of the preoperative cephalograms (T0), the surgical changes (T1 minus T0) were measured by computerizing the postoperative cephalograms. Group 1 (n = 21) had undergone bilateral sagittal split osteotomies, group 2 (n = 36) had undergone bilateral sagittal split osteotomy with autologous bone paranasal augmentation, and group 3 (n = 15) had undergone bilateral sagittal split osteotomies and Le Fort I osteotomy. Results After surgery, all the landmarks and values showed changes. Among them, quantitative changes could be observed in all the cheek points and cheek lines. The average of the overall cheek points had increased by ∼0.56 mm in group 1, ∼1.85 mm in group 2, and ∼2.39 mm in group 3, horizontally. Conclusions The results of the present study suggest approximately comparative values among the 3 surgical options for patients and surgeons considering orthognathic surgery. In addition, autologous bone paranasal augmentation can be considered as an alternative for Le Fort I osteotomy in specific conditions.

Virtual Orthodontic Surgical Planning to Improve the Accuracy of the Surgery-First Approach: A Prospective Evaluation Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Giovanni Badiali, Enrico Costabile, Elisa Lovero, Marco Pironi, Paola Rucci, Claudio Marchetti, Alberto Bianchi Purpose We developed an innovative computer-assisted method to increase the accuracy of the surgery-first (SF) approach by linking the virtual orthodontic planning (VOP) with the virtual surgical planning (VSP). Materials and Methods Fifteen consecutive patients were enrolled from 2013 to 2015. All 15 patients had initially undergone cone-beam computed tomography (CBCT; 15 × 15 field-of-view) and intraoral digital scanning of the dental arches. The DICOM (Digital Imaging and Communications in Medicine) data set and STL files were processed using the SimPlant O&O platform (Dentsply-Sirona, York, PA), which facilitates skeletal, dental, and soft tissue modeling and subsequent realization of the VOP/VSP. The VSP was reproduced using computer-aided design and computer-aided manufacturing surgical splints, and the VOP was realized via postoperative orthodontic treatment. At the end of treatment, all the patients underwent repeat CBCT and digital scanning of the dental arches, and the new data sets were compared with the original data sets to determine the deviations. To evaluate skeletal accuracy, we assessed all points within an arbitrary range of −2 to +2 mm. To evaluate dental accuracy, the arbitrary range was −0.8 to +0.8 mm. Results The average duration of orthodontic treatment was 17.9 months. The accuracy of maxillary treatment averaged 0.0702 ± 2.0724 mm and that of mandibular treatment, 0.2811 ± 1.9993 mm. The average upper and lower dental arch accuracy was −0.0029 ± 1.125 and −0.0147 ± 1.263 mm, respectively. The maxillary surgery accuracy was 75.3% and that of mandibular surgery 74.0%, both within the −2 to +2-mm range. The upper and lower arch accuracy was 58.86 and 51.53%, respectively, both within the −0.8 to +0.8-mm range. Conclusions The use of the VOP/VSP improved the diagnostic and therapeutic SF preoperative planning. VOP contributed significantly in this context. The accuracy of skeletal repositioning was acceptable; however, the VSP should be rendered more reproducibly in the future to minimize the need for orthodontic compensation and to maximize the advantages of SF.

Outcomes After Tooth-Bearing Maxillomandibular Facial Transplantation: Insights and Lessons Learned Publication date: October 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 10 Author(s): Elie P. Ramly, Rami S. Kantar, J. Rodrigo Diaz-Siso, Allyson R. Alfonso, Pradip R. Shetye, Eduardo D. Rodriguez Purpose To highlight the challenges and lessons learned in tooth-bearing maxillomandibular facial allotransplantation. Patients and Methods Two patients with ballistic composite facial injury underwent tooth-bearing maxillomandibular facial transplantation (FT) after informed consent and institutional review board approval. Patient 1 had undergone total face, double jaw, teeth, and tongue transplantation in March 2012. Patient 2 had undergone partial face, double jaw, and teeth transplantation in January 2018. Le Fort III and bilateral sagittal split skeletal osteotomies were performed in both transplants. Computerized surgical planning was used in both cases, and the allografts were transferred in intermaxillary fixation (IMF) with prefabricated dental splints before rigid skeletal fixation. Results Normal class I occlusion was achieved at the conclusion of each surgery. Patient 1 had developed a 2 × 2-mm palatal fistula in the early postoperative period and had also gradually developed class III malocclusion. Orthodontic treatment was started at 5 months after transplantation but failed. A Le Fort III advancement was performed 1 month later with successful restoration of class I occlusion. The palatal fistula was successfully repaired at 9 postoperative months. Patient 2 developed a postoperative palate and floor of mouth dehiscence, requiring palatal repair and hyoid and genioglossus advancement on postoperative day (POD) 11. Orthodontic treatment was initiated for Class II malocclusion. On POD 108, left mandibular nonunion was diagnosed. Left coronoidectomy, open reduction, and internal fixation were performed. IMF was maintained for 2 weeks. Orthodontic treatment was then resumed, with normalization of the occlusion by 10 months after FT. Conclusions Maxillomandibular transplantation is a viable reconstructive solution for composite midface defects not amenable to autologous reconstruction. Improvement of functional outcomes and prevention of major complications rely on close attention to occlusal relationships, temporomandibular joint dynamics, dental health, and the intraoral donor–recipient soft tissue interface.