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1.
J Craniomaxillofac Surg ; 51(10): 635-643, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37858483

RESUMEN

This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.


Asunto(s)
Tercer Molar , Diente Impactado , Masculino , Femenino , Humanos , Adulto , Tercer Molar/cirugía , Estudios Prospectivos , Hipoestesia/etiología , Mandíbula/cirugía , Extracción Dental/efectos adversos , Diente Impactado/cirugía , Dolor/etiología , Percepción , Dolor Postoperatorio/etiología
2.
Stomatologija ; 24(3): 71-79, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-37140256

RESUMEN

BACKGROUND AND OBJECTIVE: The aim of the study was to detect postoperative changes in the temporomandibular joints (TMJs) and masticatory muscles of Angle class II malocclusion patients who underwent mandibular advancement surgery. MATERIAL AND METHODS: Twenty-three patients were selected for mandibular advancement by bilateral sagittal split ramus osteotomy (BSSO). Cephalograms and clinical evaluation were performed before the surgery as well as fourteen days and six months after surgery. Clinical examination included measurement of overjet, overbite and of the amplitude of mandibular movements, registration of deviation on mouth opening, of TMJ pain and pathological sounds and of tenderness of masticatory muscles on palpation. Mandibular position was determined by cephalometric analysis. Statistical analyses were performed using a mixed-level longitudinal random intercept model with a confidence level of 95% and a P-value of 0.05 to reveal significant differences. RESULTS: Statistical results showed a mean mandibular advancement of 4 mm (3.1-5.0). Cephalometric measurements, overjet and overbite remained stable six months after surgery. Postoperative amplitude of mandibular movements was limited and did not completely recover 6 months later. Mouth opening was the most affected, showing an average reduction of 7.5 mm six months after surgery. Deviation on mouth opening, pathological TMJ sounds, TMJ pain and masticatory muscle tenderness did not show significant changes. CONCLUSIONS: Moderate mandibular advancement surgery offers stable results, yet the amplitudes of mandibular movements, were significant smaller after surgery and did not completely recovered 6 months following surgery. TMJ and masticatory muscles symptoms did not change after the surgery, suggesting that mandibular advancement surgery does not change the course of TMD.


Asunto(s)
Maloclusión Clase II de Angle , Avance Mandibular , Sobremordida , Humanos , Avance Mandibular/métodos , Articulación Temporomandibular , Mandíbula/cirugía , Mandíbula/fisiología , Maloclusión Clase II de Angle/cirugía , Músculos Masticadores , Dolor
3.
Minerva Dent Oral Sci ; 71(1): 48-52, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34636215

RESUMEN

INTRODUCTION: The aim of the present article was to review and depict the main radiological features of odontogenic keratocysts (OKCs), thus helping the differential diagnoses from other odontogenic cysts and neoplasms. EVIDENCE ACQUISITION: A review of articles published between January 2000 and October 2020 using Medline and the MeSH Term "odontogenic keratocyst" in combination with the following terms "imaging," "radiology," "panoramic radiograph," and "computed tomography," was performed. EVIDENCE SYNTHESIS: Radiographically, OKCs are well-defined unilocular or multilocular radiolucencies bounded by corticated margins. Most lesions are unilocular; instead, multilocular OKCs represent about the 30% of cases, mainly involving the posterior mandible. When, particularly in large lesions, OKCs display a multilocular presentation with adjacent satellite cysts (daughter cysts) a "soap-bubble appearance" can be recognized. DISCUSSION: Panoramic radiograph and CT still play an important role in the diagnosis and treatment planning of OKCs. Unfortunately, it may not be easy to differentiate OKCs from other odontogenic lesions, especially when they are small and unilocular. CONCLUSIONS: Histopathological findings are still necessary to obtain a definitive diagnosis.


Asunto(s)
Quistes Odontogénicos , Tumores Odontogénicos , Humanos , Mandíbula/patología , Quistes Odontogénicos/diagnóstico , Tumores Odontogénicos/diagnóstico , Radiografía , Tomografía Computarizada por Rayos X
4.
J Craniomaxillofac Surg ; 50(1): 1-6, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34625371

RESUMEN

The objective of the present study was to assess the epidemiology including demographic variables, diagnostic features, and the management of odontogenic keratocyst (OKCs) at several European departments of maxillofacial and oral surgery. This study is based on a systematic computer-assisted database that allowed the recording of data from treated OKCs. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, site, size, radiographic features, treatment of OKCs, length of hospital stay, complications, recurrence, management and complications of eventual recurrence. A total of 405 patients, 249 male and 156 female, with 415 OKCs (407 sporadic and 8 syndromic lesions) were included in the study: 320 lesions were found in the mandible, whereas 95 were found in the maxilla. In the mandible, the most frequently involved subsite was the angle, whereas in the maxilla it was the molar region. The most frequently performed treatment option was enucleation plus curettage/peripheral ostectomy in 204 OKCs (recurrence rate, 9%). Decompression without residual cystectomy (recurrence rate, 66%), marsupialization with residual enucleation with the use of Carnoy's solution (recurrence rate, 50%), decompression with residual cystectomy (recurrence rate, 43%), and simple enucleation (recurrence rate, 24%) were the treatment options with the highest recurrence rates. An appropriate management of odontogenic keratocysts should be individualized, taking into consideration clinical and radiological findings, as well as patients' age and comorbidities.


Asunto(s)
Quistes Odontogénicos , Tumores Odontogénicos , Procedimientos Quirúrgicos Orales , Femenino , Humanos , Masculino , Mandíbula , Quistes Odontogénicos/epidemiología , Quistes Odontogénicos/cirugía , Estudios Retrospectivos
5.
Oral Maxillofac Surg ; 26(3): 383-392, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34499265

RESUMEN

BACKGROUND/AIMS: When facial trauma involves elderly patients, the possible presence of frailty and comorbidities in victims of trauma may worsen the posttraumatic symptoms and decrease quality of life. The aim of this multicenter study was to assess the quality of life following surgical or non-operative management of maxillofacial trauma in elderly patients. MATERIALS AND METHODS: This cohort study was based on the administration of validated self-administered questionnaires to all the geriatric patients (70 years or more) with facial fractures from the involved maxillofacial surgical units across Europe, since 1st January 2019 to 31st June 2019. The following questionnaires were administered: SF36 questionnaire; the VFQ-25 questionnaire; the Oral Health Impact Profile - 14 (OHIP14). Outcome variables were VFQ-25 and OHIP-14 results. RESULTS: A total of 37 patients (14 male and 23 female patients) met the inclusion criteria and were included in the study. Elderly patients had an improvement in almost all the categories examined by the SF-36 questionnaire 6 months after trauma, with the only exception of a worsening as for role limitations due to physical health. An improvement was observed in almost all the categories at SF-36 test. A worsening of scores of OHIP-14 for all the considered dimensions in the whole study population was observed too. CONCLUSIONS: Elderly patients following facial trauma experience significant emotional, social, and functional disturbances. We observed that emotional problems, energy/fatigue, social functioning, and generally social limitations played a great role in the decrease of QoL in elderly patients following maxillofacial trauma.


Asunto(s)
Traumatismos Maxilofaciales , Fracturas Craneales , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Traumatismos Maxilofaciales/epidemiología , Traumatismos Maxilofaciales/cirugía , Estudios Prospectivos , Calidad de Vida , Fracturas Craneales/cirugía
6.
J Craniomaxillofac Surg ; 49(12): 1107-1112, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34583885

RESUMEN

The present study aimed at assessing the epidemiology including demographic variables, diagnostic features, and management of ameloblastomas at several European departments of maxillofacial and oral surgery. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, site, size, radiographic features, type, histopathological features, kind of treatment, length of hospital stay, complications, recurrence, management and complications of the recurrence. A total of 244 patients, 134 males and 110 females with ameloblastomas were included in the study. Mean age was 47.4 years. In all, 81% of lesions were found in the mandible, whereas 19% were found in the maxilla. Mean size of included ameloblastomas was 38.9 mm. The most frequently performed treatment option was enucleation plus curettage/peripheral ostectomy in 94 ameloblastomas, followed by segmental resection (60 patients), simple enucleation (46 patients), and marginal resection (40 patients). A recurrence (with a mean follow up of 5 years) was observed in 47 cases out of 244 ameloblastomas (19.3%). Segmental resection was associated with a low risk of recurrence (p = 0003), whereas enucleation plus curettage/peripheral ostectomy was associated with a high risk of recurrence (p = 0002). A multilocular radiographic appearance was associated with a high risk of recurrence (p < .05), as well as the benign solid/multicystic histologic type (p < .05). Within the limitations of the study it seems that the management of ameloblastomas will probably remain controversial even in the future. Balancing low surgical morbidity with a low recurrence rate is a difficult aim to reach.


Asunto(s)
Ameloblastoma , Neoplasias Mandibulares , Ameloblastoma/diagnóstico por imagen , Ameloblastoma/epidemiología , Ameloblastoma/cirugía , Legrado , Femenino , Humanos , Masculino , Mandíbula , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/epidemiología , Neoplasias Mandibulares/cirugía , Maxilar , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología
7.
Dent Traumatol ; 36(3): 241-246, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31863620

RESUMEN

BACKGROUND/AIMS: Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery. MATERIALS AND METHODS: This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017. RESULTS: A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association (P < .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age (P < .000005). CONCLUSIONS: Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired.


Asunto(s)
Traumatismos Maxilofaciales/epidemiología , Fracturas Craneales/epidemiología , Anciano , Humanos
8.
Oral Maxillofac Surg ; 24(1): 65-71, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31848774

RESUMEN

INTRODUCTION: Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery. METHODS: This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications. RESULTS: A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases. CONCLUSIONS: Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.


Asunto(s)
Arcada Edéntula , Fracturas Mandibulares , Atrofia , Placas Óseas , Europa (Continente) , Fijación Interna de Fracturas , Humanos , Mandíbula
9.
J Craniomaxillofac Surg ; 47(12): 1929-1934, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810843

RESUMEN

INTRODUCTION: The objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented. METHODS: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay. RESULTS: A total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study population was 75 years. Statistically significant associations were found between Luhr classes I - II and condylar fractures on one hand (p < .0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p < .05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries. CONCLUSIONS: The management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites.


Asunto(s)
Fijación Interna de Fracturas/métodos , Arcada Edéntula/cirugía , Fracturas Mandibulares/cirugía , Anciano , Atrofia , Europa (Continente)/epidemiología , Femenino , Humanos , Arcada Edéntula/epidemiología , Masculino , Fracturas Mandibulares/epidemiología , Resultado del Tratamiento
10.
Artículo en Inglés | MEDLINE | ID: mdl-31221613

RESUMEN

OBJECTIVES: The purpose of this European multicenter prospective study was to obtain more precise information about the demographic characteristics and etiologic/epidemiologic patterns of motor vehicle accidents (MVA)-related maxillofacial fractures. STUDY DESIGN: Of the 3260 patients with maxillofacial fractures admitted within the study period, 326 traumas were caused by MVAs with a male/female ratio of 2.2:1. RESULTS: The maximum incidence was found in Zagreb (Croatia) (18%) and the minimum in Bergen (Norway) (0%). The most frequent mechanisms were car accidents, with 177 cases, followed by motorcycle accidents. The most frequently observed fracture involved the mandible, with 199 fractures, followed by maxillo-zygomatic-orbital (MZO) fractures. CONCLUSIONS: In all the 3 groups (car, motorcycle, and pedestrian), mandibular and MZO fractures were the 2 most frequently observed fractures, with some variations. The importance of analyzing MVA-related facial injuries and their features and characteristics should be stressed.


Asunto(s)
Fracturas Mandibulares , Traumatismos Maxilofaciales , Fracturas Craneales , Fracturas Cigomáticas , Accidentes de Tránsito , Femenino , Humanos , Masculino , Vehículos a Motor , Noruega , Estudios Prospectivos , Estudios Retrospectivos
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