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This paper introduces a new, less invasive, aesthetic, and functional reconstructive method using a transorally inserted, custom-made Cosmofix fixation plate. Two medication-related cases with stage 3 osteonecrosis of the jaw (MRONJ) are presented. Both procedures required a segmental mandibulectomy as the osteonecrosis had progressed to the mandibular inferior margin and was reconstructed by a transoral approach with a good prognosis. The reconstructed sites were satisfactorily restored with good occlusal conditions and with dentures. No esthetic or functional problems were evident >1 year after surgery. Compared to traditional reconstructive surgery involving facial skin incisions, this technique takes less time, is minimally invasive, is not associated with aesthetic complications, and does not cause facial nerve palsy. Therefore, this procedure may be safely performed in patients with advanced MRONJ who are in poor general condition or older patients.
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RATIONALE: Pyogenic spondylodiscitis is an infectious spinal disease that causes significant motor dysfunctions. Its diagnosis can be challenging owing to its rapid onset and nonspecific symptoms. PATIENT CONCERNS: A 79-year-old Japanese man with a history of type 2 diabetes mellitus and polymyalgia rheumatica presented to our department with tongue pain. Following partial glossectomy and wisdom tooth extraction under general anesthesia, on 10 postoperative day (POD) the patient developed right-sided abdominal pain and difficulty in walking. On 12 POD, the patient was admitted to a municipal hospital due to respiratory distress and paraplegia. DIAGNOSES: The patient was diagnosed with pyogenic spondylodiscitis and empyema. Blood tests revealed elevated C-reactive protein levels (36.5), white blood cell count (19,570), and neutrophil count (17,867). INTERVENTIONS: The patient received meropenem hydrate 3 g/2 days as empiric antibiotic treatment for acute infection. Upon admission to the emergency department on 16 POD, the lung abscess was drained, hemilaminectomy was performed. OUTCOMES: Blood cultures, sputum tests, and cultures from the thoracic and spinal abscesses drained during surgery revealed methicillin-sensitive Staphylococcus aureus. The infection was successfully managed, and the respiratory disturbance and inflammatory response improved. However, the lower half of the patient body remained paralyzed. Subsequently, the patient was transferred to a rehabilitation facility on 45 POD. The patient continued to undergo functional restoration training, gradually regained function, and eventually achieved the ability to walk with grasping gait. LESSONS: This is the first case report of S aureus causing pyogenic spondylodiscitis and empyema due to blood stream infection from a post-oral surgical wound. Pyogenic spondylodiscitis arising from a secondary hematogenous infection is difficult to diagnose and can lead to severe functional impairment. Prompt and appropriate diagnosis and treatment based on detailed patient interviews, additional blood tests, and computed tomography are essential.
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Discitis , Neoplasias de la Lengua , Extracción Dental , Humanos , Masculino , Anciano , Extracción Dental/efectos adversos , Discitis/diagnóstico , Discitis/microbiología , Discitis/etiología , Neoplasias de la Lengua/cirugía , Tercer Molar/cirugía , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/etiología , Empiema/etiología , Empiema/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/microbiología , Antibacterianos/uso terapéuticoRESUMEN
Alveolar bone quality at the implantation site affects the initial stability of dental implant treatment. However, the relationship between bone quality and osseointegration has yet to be evaluated. Herein, we aimed to investigate the effect of bone quality on dental implant stability in osseointegration formation changes. Patients underwent computed tomography imaging before dental implantation at the posterior. Hounsfield units were measured at the platform, middle, and tip sites. Implant stability was measured using resonance frequency analysis immediately and at 3 months postoperatively, in which the difference in implant stability quotients (ISQ) was defined as the change between primary and secondary fixation. In multiple regression analysis, the dependent variable was the change between the immediate and secondary fixations. We included 81 implants that conformed to the criteria. Primary fixation yielded the following results: R2 = 0.117, F = 2.529, and P = .047. The difference between the maxilla and mandible of the implantation site (P = .02) and the platform-site Hounsfield units (P = .019) were identified as significant factors. The following results were obtained regarding the change between the immediate and secondary fixation: R2 = 0.714, F = 40.964, and P < .001. The difference between diameter (P = .008) and the immediate ISQ (P < .001) were identified as significant factors. Overall, the bone quality of the implantation site affected initial fixation; however, it had limited effect on secondary fixation. Our findings clarified the period where bone quality affects dental implant treatment and is expected to advance dental implant treatment.
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Implantes Dentales , Humanos , Implantación Dental Endoósea/métodos , Densidad Ósea , Oseointegración , Tomografía Computarizada por Rayos X , Diseño de Prótesis Dental , Retención de Prótesis Dentales , Maxilar/diagnóstico por imagen , Maxilar/cirugíaRESUMEN
This study aimed to evaluate maxillary bone healing and computed tomography (CT) values after Le Fort I osteotomy with sagittal split ramus osteotomy in patients with class II and III malocclusion. Four absorbable plates and screws were used to fix the maxillary segments in all patients. For 112 sides (58 patients), the bone defect areas at the anterior and posterior sites between the maxillary segments were measured using 3-dimensional CT views reconstructed over a constant CT value at 1 week and 1 year postoperatively. Subsequently, CT values at the upper, middle, and lower sites around the osteotomy line in the medial, middle, and lateral regions were measured. The bone defect area after 1 year increased at the anterior site in class III and at both the anterior and posterior sites in class II (P < 0.05). This study suggests that the increase in bone defect area was affected by lower CT values at the middle site of the middle and lateral regions in class II, and that bony defects between fragments in the maxilla could partially remain in both classes II and III within 1 year after Le Fort I osteotomy.
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Implantes Absorbibles , Placas Óseas , Maxilar , Osteotomía Le Fort , Tomografía Computarizada por Rayos X , Humanos , Femenino , Estudios Retrospectivos , Masculino , Maxilar/cirugía , Maxilar/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Adulto Joven , Adolescente , Maloclusión Clase II de Angle/cirugía , Maloclusión Clase II de Angle/diagnóstico por imagen , Maloclusión de Angle Clase III/cirugía , Maloclusión de Angle Clase III/diagnóstico por imagen , Cicatrización de Heridas/fisiología , Imagenología Tridimensional/métodos , Osteotomía Sagital de Rama Mandibular/métodos , Osteotomía Sagital de Rama Mandibular/instrumentación , Tornillos ÓseosRESUMEN
PURPOSE: This study aimed to assess the correlation between temporomandibular joint (TMJ) disc position and skeletal stability and identify the cephalometric measurements associated with relapse after bimaxillary surgery. METHODS: The participants were 62 women with jaw deformities (124 joints) who underwent bimaxillary surgery. The TMJ disc position was classified into four types (anterior disc displacement (ADD), anterior, fully covered, and posterior) using magnetic resonance imaging, and cephalometric analysis was performed preoperatively and 1 week and 1 year postoperatively. The differences between pre- and 1-week postoperative values (T1) and 1-week and 1-year postoperative value (T2) were calculated for all cephalometric measurements. Moreover, the relationship between skeletal stability using cephalometric measurements, skeletal class, and TMJ disc position was analyzed. RESULTS: The participants included 28 patients in class II and 34 in class III. There was a significant difference in T2 in SNB between class II mandibular advancement cases and class III mandibular setback cases (P = 0.0001). In T2, in ramus inclination, there was a significant difference between the ADD and posterior types (P = 0.0371). Stepwise regression analysis revealed that T2 was significantly correlated with T1 for all measurements. However, the TMJ classification was not applied to all measurements. CONCLUSION: This study suggested that TMJ disc position, including ADD, could not affect skeletal stability, including the maxilla and distal segment after bimaxillary osteotomy, and short-term relapse could be related to the movement amount or angle change by surgery for all measurements.
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Maloclusión de Angle Clase III , Disco de la Articulación Temporomandibular , Humanos , Femenino , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Disco de la Articulación Temporomandibular/cirugía , Cóndilo Mandibular , Mandíbula/cirugía , Osteotomía , Cefalometría , Recurrencia , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/cirugía , Osteotomía Sagital de Rama Mandibular/métodos , Articulación Temporomandibular/diagnóstico por imagen , Osteotomía Le FortRESUMEN
This report describes a rare case of a foreign body in the sphenoid sinus from the tip of an osteotome, which was lodged during the Le Fort I osteotomy. After surgery, a 2-mm-diameter round-shaped foreign body was seen as an opaque image in the right sphenoid sinus on computed tomography. The tip of the broken osteotome (Bauer) was confirmed after the intraoperative instruments were investigated. The foreign body was removed using an interventional endoscope and navigation computed tomography, and a good prognosis was obtained.
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The purpose of this study was to quantitatively compare changes in tongue pressure and lip closing force among skeletal Class II and Class III patients, who had undergone orthognathic surgery, and a control group. Maximum tongue pressure and lip closing forces were measured preoperatively and at 6 and 12 months postoperatively. Time-course changes were analyzed and compared among the groups. The control group involved 40 skeletal Class I occlusion volunteers (20 male and 20 female), the Class II group involved 20 female patients, and the skeletal Class III group involved 40 patients, who were subdivided by sex into two groups comprising 20 males and 20 females, respectively. Time-course changes in tongue pressure were not significantly different between and within groups. However, postoperative lip closing forces became gradually higher in the Class III group female and male subjects compared with the control group, although this was not observed in the Class II group. There were significant correlations between tongue pressure and lip closing force before and after surgery (p = 0.001), and these correlations increased over time. Although there was no significant increase in maximum tongue pressure after orthognathic surgery, there was an associated increase in perioral muscle strength. This suggests that an increase in perioral muscle strength may contribute more to the stability of postoperative jaw morphology.
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Maloclusión de Angle Clase III , Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Humanos , Masculino , Femenino , Maloclusión de Angle Clase III/cirugía , Estudios Retrospectivos , Lengua , Labio/fisiología , Presión , CefalometríaRESUMEN
This study aimed to compare the bone healing and stability of the chin with a pre-bent absorbable plate and a manually bent absorbable plate after advancement genioplasty. Patients with class II malocclusion who underwent genioplasty with bimaxillary surgery were included. After genioplasty, two absorbable bicortical screws were fixed on both sides. Then, a pre-bent absorbable plate and screws were used in the center area to fix the segment in advancement genioplasty (PB group). A manually bent absorbable plate was used for the remaining patients (MB group). Computed tomography (CT) was performed before surgery and 1 week and 1 year after surgery. Changes in the pogonion (Pog) and menton (Me) points, soft tissue points, and the ratio of bone squares under the plate were evaluated using lateral cephalometric images reconstructed with 3-dimensional CT data. 32 patients were included in the study. There were no significant differences in the cephalometric measurements in the time interval from 1 week to 1 year. However, the bone square ratio in the PB group showed a significant increase after 1 year (P = 0.0021). Within the limitations of the study it seems that the use of a pre-bent absorbable plate is effective in promoting bone healing after advancement genioplasty.
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Mentoplastia , Mandíbula , Humanos , Mentoplastia/métodos , Mandíbula/cirugía , Estudios de Seguimiento , Tornillos Óseos , Mentón/cirugía , Cefalometría/métodosRESUMEN
OBJECTIVES: This study aimed to examine the relationship between condylar surface computed tomography (CT) values in the coronal plane and condylar morphology in patients with jaw deformities classes II and III before and after orthognathic surgery. MATERIALS AND METHODS: The maximum CT values (pixel values) at three points on the condylar surface, height, and joint space were measured on the coronal plane. The condylar width, thickness, and angle were measured on the horizontal plane preoperatively and at 1 year postoperatively. RESULTS: A total of 112 temporomandibular joints of 56 female patients were divided into two groups according to skeletal class (56 joints each in class II and class III). The maximum CT values of class II were higher than those of class III at the medial, central, and lateral sites on the condylar surface, preoperatively and at 1 year postoperatively (P < 0.05). CT values of the condylar surface were significantly negatively correlated with the condylar heights at the center and lateral sites preoperatively and at 1 year postoperatively (P < 0.05). CONCLUSIONS: Condylar surface CT values in the coronal plane are associated with condylar morphology, including condylar height.
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Cóndilo Mandibular , Cirugía Ortognática , Humanos , Femenino , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Tomografía Computarizada de Haz Cónico/métodos , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Tomografía Computarizada por Rayos XRESUMEN
RATIONALE: Infections that spread to the pterygomandibular muscle can be misdiagnosed as temporomandibular disorder (TMD) because of the resulting difficulty in opening the mouth. Importantly, infection of the pterygomandibular space can extend to the skull base in the early stages, and a delay in therapeutic intervention can lead to severe complications. PATIENT CONCERNS: A 77-year-old Japanese man with trismus after pulpectomy was referred to our department. This case report describes a rare instance of meningitis with septic shock caused by an odontogenic infection, initially misdiagnosed as TMD due to similar symptoms, leading to life-threatening complications. DIAGNOSIS: The patient was diagnosed with sepsis and meningitis resulting from cellulitis in the pterygomandibular space caused by iatrogenic infection after pulpectomy of the right upper second molar. INTERVENTIONS: After emergency hospitalization, the patient developed septic shock and required blood purification. Subsequently, abscess drainage and extraction of the causative tooth were performed. However, the patient developed hydrocephalus secondary to meningitis and underwent ventriculoperitoneal shunting to alleviate the condition. OUTCOMES: The infection was controlled and the patient level of consciousness improved following treatment for hydrocephalus. The patient was transferred to a hospital for rehabilitation on the 106th day of hospitalization. LESSONS: Infections of the pterygomandibular space may be misdiagnosed as TMD, owing to the main symptoms of restricted mouth opening and pain on mouth opening. A prompt and appropriate diagnosis is crucial because these infections can lead to life-threatening complications. A detailed interview, along with additional blood tests and computed tomography (CT) scans, can aid in making an accurate diagnosis.
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Diagnóstico Diferencial , Errores Diagnósticos , Meningitis , Trastornos de la Articulación Temporomandibular , Humanos , Masculino , Anciano , Choque Séptico/etiología , Meningitis/complicaciones , Meningitis/diagnóstico , Trastornos de la Articulación Temporomandibular/diagnósticoRESUMEN
This retrospective study aimed to evaluate the efficacy of support splint treatment for deformities and deviations of the nasal septum after Le Fort I osteotomy (LFI). Patients were divided into two groups: the retainer group wore a nasal support splint immediately after LFI for 7 days, and the no retainer group did not wear a nasal support splint. Evaluation was performed by measuring the ratio of the difference between the left and right sides of the nasal cavity area (ratio of nasal cavity) and the angle of the nasal septum using three computed tomography frontal images (anterior, middle, and posterior) before and one year postoperatively. Sixty patients were included and divided into two groups, the retainer and no retainer group (n=30 each). Regarding the ratio of nasal cavity on middle images at one year postoperatively, the retainer and no retainer groups differed significantly (0.79±0.13 and 0.67±0.24, respectively; P =0.012). The angle of the nasal septum on anterior images at one year postoperatively was 164.8±11.7° in the retainer group and 156.9±13.5° in the no retainer group, showing a significant difference ( P =0.019). This study suggests that support splint treatment after LFI is effective in preventing post-LFI nasal septal deformation or deviation.
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Tabique Nasal , Deformidades Adquiridas Nasales , Osteotomía Le Fort , Complicaciones Posoperatorias , Férulas (Fijadores) , Tabique Nasal/diagnóstico por imagen , Tabique Nasal/cirugía , Humanos , Osteotomía Le Fort/efectos adversos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Cavidad Nasal , Masculino , Adulto , Maxilar/cirugía , Deformidades Adquiridas Nasales/etiología , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Mandíbula/cirugía , Resultado del Tratamiento , FemeninoRESUMEN
PURPOSE: This study aimed to evaluate changes in computed tomography (CT) value of ramus bone after sagittal split ramus osteotomy (SSRO) in class II and class III patients using absorbable plates and screws. PATIENTS AND METHODS: In the retrospective study, the participants were female patients with jaw deformities who underwent bilateral SSRO with Le Fort I osteotomy. Maximum CT values (pixel values) of lateral and medial cortexes at anterior and posterior sites of the ramus were measured preoperatively and 1 year postoperatively by using horizontal planes at the mandibular foramen level (upper level) and 10 mm under the mandibular foramen level (lower level) parallel to Frankfurt horizontal plane. RESULTS: Fifty-seven patients and 114 sides (28 class II: 56 sides and 29 class III: 58 sides) were evaluated. Although CT values decreased at most sites of the ramus cortical bone after 1 year of surgery, they increased at the posterior-medial site at the upper level in class II ( P =0.0012) and the lower level in class III ( P =0.0346). CONCLUSION: This study suggested that bone quality at the mandibular ramus could change after 1 year of surgery, and there could be differences between mandibular advancement and setback surgery.
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Maloclusión de Angle Clase III , Avance Mandibular , Prognatismo , Humanos , Femenino , Masculino , Prognatismo/cirugía , Estudios Retrospectivos , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Osteotomía Sagital de Rama Mandibular , Tomografía Computarizada por Rayos X/métodos , Placas Óseas , Polímeros , Cefalometría/métodosRESUMEN
[This retracts the article DOI: 10.1016/j.jds.2020.04.002.].
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PURPOSE: This study aimed to evaluate and predict the factors that affect the postoperative maxillary sinus and inferior nasal cavity conditions after Le Fort I osteotomy. SUBJECTS AND METHODS: The rate of aerated (healthy) sinus area and the inferior nasal airway area were calculated by preoperative computed tomography measurements and at 1 week and 1 year postoperatively. Factors predicting the rate of aerated sinus area and the ratio of the inferior nasal cavity area after 1-week were examined using these variables. RESULTS: The subjects consisted of 112 patients (224 sides) who underwent Le Fort I osteotomy with sagittal split ramus osteotomy. The rate of aerated sinus area after 1 week was significantly correlated with sex, age, and amount of blood loss ( P < 0.0001). The rate of the inferior nasal cavity area after 1 week was significantly correlated with the anterior impaction amount of the maxilla and the preoperative rate of the inferior nasal airway area ( P= 0.0017). CONCLUSIONS: This study suggests that attention should be paid to females, older patients, and the amount of blood loss to prevent sinusitis, and larger maxillary impaction at the anterior site should be carefully planned to prevent severe nasal obstruction immediately after Le Fort I osteotomy.
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Seno Maxilar , Osteotomía Le Fort , Femenino , Humanos , Maxilar/cirugía , Osteotomía Le Fort/métodos , Osteotomía Sagital de Rama Mandibular , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: This study aimed to evaluate intercellular bridges in the depth of invasion (DOI) measurement area as prognostic factors in oral squamous cell carcinoma (OSCC). STUDY DESIGN: The mode of invasion was determined based on the Yamamoto-Kohama classification system by observing the hematoxylin-eosin-stained whole-slide images of specimens obtained from 78 patients with OSCC, and the clinicopathologic features were characterized. The presence of intercellular bridges was analyzed in 46 patients with Yamamoto-Kohama classification grade ≥3 whose DOI was measured by dividing the measurement area into 3 parts: the surface, center, and front of the tumor. RESULTS: Univariate analyses identified lymph node metastasis, loss of intercellular bridges in the DOI measurement area, DOI of ≥4500 µm, and pattern of invasion 4C-4D as negative prognostic factors. Multivariate analyses revealed that lymph node metastasis and the loss of intercellular bridges in the entire area were independent factors, with hazard ratios of 9.34 (95% confidence interval, 2.09-42.03; P = .003) and 3.64 (95% confidence interval, 1.10-11.99; P = .045), respectively. CONCLUSIONS: Loss of intercellular bridges in the DOI measurement area is a negative prognostic factor for OSCC and may be useful in selecting treatment.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Carcinoma de Células Escamosas/patología , Neoplasias de Cabeza y Cuello/patología , Humanos , Metástasis Linfática , Neoplasias de la Boca/patología , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y CuelloRESUMEN
Surface modification of various materials using ultraviolet (UV) irradiation improves their wettability. The purpose of this study was to investigate the wettability of a ß-tricalcium phosphate (TCP) surface and the composition changes and bioactivity of ß-TCP after UV irradiation. We applied 172 nm UV treatment to a ß-TCP surface and measured the contact angle before and after UV irradiation. Energy-dispersive X-ray and Fourier transform infrared spectroscopy examinations were performed on the ß-TCP disk with or without UV treatment. In an adhesion test of bone marrow cells using ß-TCP disks with and without UV irradiation, cell attachment was measured 10, 30, 50, and 70 h after ß-TCP insertion. UV-irradiated ß-TCP osteogenesis and absorption of bone substitutes were evaluated using hematoxylin and eosin and tartrate-resistant acid phosphatase (TRAP) staining in a rabbit sinus model. The contact angle on the TCP surface decreased from 70° to 10° owing to UV irradiation. Conversely, UV irradiation did not change the composition of carbon, oxygen, and phosphorus. In the cell adhesion test, UV-irradiated ß-TCP significantly increased cell adhesion compared with UV-unirradiated ß-TCP after 10 to 30 h of culture. In the rabbit sinus model, TRAP staining showed that UV-irradiated ß-TCP significantly increased the number of TRAP-positive cells compared with unirradiated ß-TCP granules in the central part of ß-TCP. Our results indicate that the UV irradiation of ß-TCP improves its clinical utility for surgical bone augmentation in the oral and maxillofacial region.
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Sustitutos de Huesos , Animales , Sustitutos de Huesos/farmacología , Fosfatos de Calcio/química , Osteogénesis , ConejosRESUMEN
BACKGROUND: The purpose of this study was to evaluate the association between theãimmunohistochemistry (IHC) of protein tyrosine kinase 7 (PTK7) expression and clinicopathological factors of oral squamous cell carcinoma (OSCC). METHODS: Tissue specimens were obtained from 80 patients with primary OSCC. IHC scoring was conducted according to the rate of positive cell and staining intensity. We used the IHC score to classify the degree of PTK7 expression and evaluate clinicopathological factors and prognosis. RESULTS: The number of the high expression group (IHC Score 2 or 3) was 45 cases and that of the low expression group (IHC Score 0 or 1) was 35 cases. A significant difference between high expression and low expression groups was found in the N category (p = .008), degree of differentiation (p < .001), and pattern of invasion (p < .001). In accordance with the exacerbation of OSCC with respect to three parameters (N category, degree of differentiation, and pattern of invasion), the ratio of high expression of PTK7 increased. The overall 5-year survival rate was 59.3% in the high expression group and 87.3% in the low expression group (p < .05). The pathological prognostic signs affecting overall survival were evaluated by univariate analysis and multivariate analysis with Cox proportional hazards model and showed an association with lymph node metastasis and invasion patterns. CONCLUSION: This study suggests that a high IHC score of PTK7 is a potential biomarker for predicting potential metastasis.
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Moléculas de Adhesión Celular , Neoplasias de la Boca , Proteínas Tirosina Quinasas Receptoras , Carcinoma de Células Escamosas de Cabeza y Cuello , Moléculas de Adhesión Celular/genética , Humanos , Neoplasias de la Boca/patología , Pronóstico , Proteínas Tirosina Quinasas , Proteínas Tirosina Quinasas Receptoras/genética , Carcinoma de Células Escamosas de Cabeza y Cuello/patologíaRESUMEN
OBJECTIVE: The Yamamoto-Kohama criteria are clinically useful for determining the mode of tumor invasion, especially in Japan. However, this evaluation method is based on subjective visual findings and has led to significant differences in determinations between evaluators and facilities. In this retrospective study, we aimed to develop an automatic method of determining the mode of invasion based on the processing of digital medical images. STUDY DESIGN: Using 101 digitized photographic images of anonymized stained specimen slides, we created a classifier that allowed clinicians to introduce feature values and subjected the cases to machine learning using a random forest approach. We then compared the Yamamoto-Kohama grades (1, 2, 3, 4C, 4D) determined by a human oral and maxillofacial surgeon with those determined using the machine learning approach. RESULTS: The input of multiple test images into the newly created classifier yielded an overall F-measure value of 87% (grade 1, 93%; grade 2, 67%; grade 3, 89%; grade 4C, 83%; grade 4D, 94%). These results suggest that the output of the classifier was very similar to the judgments of the clinician. CONCLUSIONS: This system may be valuable for diagnostic support to provide an accurate determination of the mode of invasion.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Humanos , Aprendizaje Automático , Neoplasias de la Boca/diagnóstico por imagen , Neoplasias de la Boca/patología , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y CuelloRESUMEN
The aim of the study was to examine lateral pterygoid muscle (LPM) and temporomandibular joint (TMJ) disc before and after Le Fort I osteotomy with and without intentional pterygoid plate fracture and sagittal split ramus osteotomy (SSRO) in class II and class III patients. Le Fort I osteotomy and SSRO were performed in class II and class III patients. LPM measurements using oblique sagittal computed tomography (CT) images and TMJ disc position using magnetic resonance imaging (MRI) were examined. Statistical comparisons were performed for the LPM and TMJ between class II and class III patients and between those with and without intentional pterygoid plate fracture in Le Fort I osteotomy. The subjects comprised 60 female patients (120 sides), with 30 diagnosed as class II and 30 as class III. Preoperatively, the width of the condylar attachment, width at eminence, length of the LPM, angle of the LPM, and square of the LPM were significantly smaller in the class II group than in the class III group (p < 0.05). After 1 year, the width of the condylar attachment, width at eminence, and angle of the LPM remained significantly smaller in the class II group than in the class III group (p < 0.0001). TMJ disc position was significantly related to the width of the condylar attachment of the LPM, both pre- and postoperatively (p < 0.0001). However, postoperative disc position did not change in all patients. Next, the class II patients (60 sides) were divided into two groups who underwent Le Fort I osteotomy with or without intentional pterygoid plate fracture. Changes in all measurements of the LPM showed no significant differences between these two groups. Our study suggested that TMJ disc position classification could be associated with the width of condylar attachment of the LPM before and after surgery, while the surgical procedure, including Le Fort I osteotomy with intentional pterygoid plate fracture, might not affect postoperative LMP or disc position in class II patients.
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Maloclusión de Angle Clase III , Osteotomía Sagital de Rama Mandibular , Femenino , Humanos , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/cirugía , Mandíbula , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Osteotomía Le Fort , Músculos Pterigoideos/diagnóstico por imagen , Articulación Temporomandibular , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Disco de la Articulación Temporomandibular/cirugíaRESUMEN
PURPOSE: This study was performed to evaluate changes in nasal airflow, nasal airway resistance, nasal cross-sectional area, pharyngeal horizontal area, nasopharyngeal and oropharyngeal volume following Le Fort I osteotomy (L1) impaction with sagittal split ramus osteotomy (SSRO) in classes II and III. MATERIALS AND METHODS: The subjects consisted of 35 patients (6 males and 29 females, 70 sides) 17 of which were diagnosed as class II and 18 as class III who underwent L1 and SSRO. Nasal airflow and resistance were measured using the rhinomanometry system (GM NR-6 EXECUTIVE) before and at 1 and 6âmonths after surgery. Nasal, cross-sectional area, and volume were measured using a 3-dimensional computed tomography respectively, before and 1-year after surgery. RESULTS: Although a significant decrease was found in nasal volume after surgery (Pâ=â0.0042), there was no difference between before and after surgery in the nasal airway resistance in class II.A significant decrease in nasal volume was found after surgery (Pâ=â0.0005) and there were no postoperative changes in both nasal airflow and resistance in class III. CONCLUSION: The study suggested that L1 impaction with SSRO did not worsen nasal function such as nasal airflow and nasal airway resistance, although nasal volume significantly decreased in both groups.