Digital Surgical Guides in Mandibular Genioplasty: Evaluating Precision Against Conventional Techniques.

BACKGROUND: Mandibular genioplasty, a central procedure in oral and maxillofacial surgery, has traditionally relied on surgeon experience with potential limitations in precision. The advent of digital methods, particularly computer-aided design/computer-aided manufacturing (CAD/CAM), offers a promising alternative. This study aims to evaluate the efficacy of digital surgical guides in improving the precision of mandibular genioplasty. METHODS: A prospective analysis of 50 patients undergoing genioplasty was performed, 30 in the experimental group using digital surgical guides and 20 in the control group using traditional methods. Three-dimensional reconstructions were obtained using cone-beam computed tomography (CBCT) and digital scans. Osteotomy guides were 3D-printed based on group assignment. Postoperatively, accuracy was assessed by measuring distances between landmarks. RESULTS: The experimental group showed significantly reduced horizontal positioning errors in genioplasty advancement, with no significant differences in vertical errors. For genioplasty retraction, the experimental group showed fewer vertical positioning errors, while horizontal errors remained consistent. CONCLUSIONS: The use of digital surgical guides in mandibular genioplasty significantly improves surgical accuracy, resulting in improved outcomes and patient satisfaction. This study highlights the potential of digital methods in refining oral and maxillofacial surgical procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Monoterpenoid indole alkaloids from Alstonia rupestris with cytotoxic, antibacterial and antifungal activities.

A chemical investigation of the 80% EtOH extract of the aerial plant of Alstonia rupestris afforded four new monoterpenoid indole alkaloids, 6,7-epoxy-8-oxo-vincadifformine (1), 11-acetyl-6,7-epoxy-8-oxo-vincadifformine (2), 11-hydroxy-14-chloro-15-hydroxy-vincadifformine (3), and perakine N1,N4-dioxide (4), together with two known compounds, 11-hydroxy-6,7-epoxy-8-oxovincadifformine (5) and vinorine N1,N4-dioxide (6). Structural elucidation of all the compounds was performed by spectral methods such as 1D- and 2D-NMR, IR, UV, and HRESIMS. Alkaloids 1, 2 and 5 showed significant cytotoxicities against all the tested tumor cell lines of the head and neck squamous cell carcinoma with IC50 value less than 20 µM and antimicrobial activities against two fungi (Alternaria alternata and Phytophthora capsici). Alkaloids 4 and 6 exhibited the activity against bacterium Staphylococcus aureus.

Eagle's syndrome associated with lingual nerve paresthesia: a case report.

Eagle's syndrome is characterized by a variety of symptoms, including throat pain, sensation of a foreign body in the pharynx, dysphagia, referred otalgia, and neck and throat pain exacerbated by head rotation. Any styloid process longer than 25 mm should be considered elongated and will usually be responsible for Eagle's syndrome. Surgical resection of the elongated styloid is a routine treatment and can be accomplished using a transoral or an extraoral approach. We report a patient with a rare giant styloid process that was approximately 81.7 mm. He complained of a rare symptom: hemitongue paresthesia. After removal of the elongated styloid process using the extraoral approach, his symptoms, including the hemitongue paresthesia, were alleviated. We concluded that if the styloid process displays medium to severe elongation, the extraoral approach will be appropriate.

Congenital tri-cavernous hemangiomas of the right buccal region, right accessory parotid gland, and masseter muscle region.

We report a rare case of congenital tri-cavernous hemangiomas of the right buccal region, right accessory parotid gland, and masseter muscle region in an adult. The patient, a 25-year-old woman, complained of 3 masses in her right midcheek. Ultrasonographic and computed tomographic findings showed an irregular-shaped mass (multiple calcifications) with a well-defined margin in the masseter muscle region, an ellipse-shaped mass (multiple calcifications) with a well-defined margin in the right buccal region, and a comma-shaped mass (no calcifications) with a well-defined margin separate from the parotid gland in the right accessory parotid gland region. These iconographic findings suggested that the masses were all hemangiomas separately originating from the parotid gland, accessory parotid gland, and masseter muscle. The masses were completely removed through a standard parotid incision without postoperative facial palsy, skin deformity, and difficulty in secreting saliva. Findings from histologic examination of the tumor revealed multiple, thin-walled, and dilated blood vessels, confirming the diagnosis of cavernous hemangiomas. Ultrasonographic and computed tomographic findings were extremely useful in diagnosing the mass/masses as hemangioma before surgery, clarifying relationships between the mass and adjacent structures, and determining the surgical approach to the mass/masses.

Rare giant epidermal cyst in the infratemporal fossa and middle cranial fossa.

A 50-year-old man presented with a rare giant crossing cranium-temporal combined epidermal cyst. Physical examination found left facial numbness and temple severely numbness with light pressure. Horizontalis craniocerebral computed tomography demonstrated a mass lesion of 3.0 × 2.0 cm in the middle cranial fossa area; sagittal craniocerebral magnetic resonance scanning demonstrated a mass consisting of 2 leaves (the upper one, 4.0 × 3.0 cm; the lower one, 2.0 × 1.5 cm). Computed tomography angiography showed that the blood supply of the lesion came from superficial temporal artery and middle cranial fossa artery. The clinical diagnosis was neurilemmoma. Surgery revealed a pearly cyst consisting of 2 leaves (connected by a narrowed bridge located at the articular fossa of temporal bone) was 6 × 3 × 3 cm. Histologic examination disclosed disintegrated keratinizing epithelium layer, keratinizing epithelium layer, and stratified squamous epithelium layer from inner to outer and found no hair follicles or sebaceous gland with the diagnosis of epidermoid cyst. Surgery was successfully performed, and the patient was discharged home with severer left facial numbness relatively and left jaw slight opening. The present case suggests that epidermoid cysts can be seen in any location, even giant crossing cranium-temporal combined lesion, and the blood supply should be considered as a factor judging its pathogenesis.

[The complications of nerve injury after the Le Fort I osteotomy].

OBJECTIVE: To investigate the incidence of the temporary and permanent sensory disturbance of the inferorbital nerve (ION) after Le Fort I osteotomy. METHODS: Thirty patients with 60 inferorbital nerves were examined preoperatively, 1 week, 1 month, 3 months and 6-months after the operation of the Le Fort I osteotomy by using sharp-blunt testing, 2-point discrimination, electric pain response test (ZGK-1 electrometer). RESULTS: The incidence of the temporary nerve impairment was 75% (45 of 60) and the obvious recovery was found after 1 to 3 months after the operation. No permanent sensory disturbance was found in the patients. CONCLUSIONS: The inferorbital nerve injury after Le Fort I osteotomy is usually temporary and the sensory recovery was in 1 to 3 months after the operation.

[Nerve injury and neurosensory recovery following bilateral mandibular sagittal split osteotomy].

OBJECTIVE: The purpose of this study was to determine the incidence of temporary and permanent sensory disturbance of the inferior alveolar nerve (IAN) after bilateral sagittal split osteotomy (BSSO) of the mandible. METHODS: 14 patients were selected for this study. Before BSSO and at 1 week, 1, 3, 6 and 12 months after BSSO, the sensibility of bilateral inferior alveolar nerves were examined using sharp-blunt testing, 2-point discrimination, electronic pain response test (ZGK-1 electrometer). RESULTS: With conventional sharp-blunt and 2-point discrimination test, electronic pain response test, the incidence of temporary impairment of IAN after BSSO was 78% (22/28). Obvious sensory recovery of IAN was found 6 to 12 months postoperatively. Permanent sensory disturbance of unilateral inferior alveolar nerve occurred in 2 patients. CONCLUSIONS: Sensory recovery of the inferior alveolar nerve after bilateral sagittal split osteotomy of the mandible would take 6 to 12 months. Serious injury of the IAN would cause permanent neurosensory deficits.

[The lingual region upper airway CT scan of obstructive sleep apnea patients].

OBJECTIVE: To compare the lingual region upper airway CT scan results of OSAS patients and normal adults to explore if there are upper airway stricture in OSAS patients and the reason of stricture. METHODS: 59 patients with OSAS and 57 normal adults were included in the study. CT evaluated the lingual region upper airway with the use of a Philips Tomoscan AV Expander E1 spiral scanner. The shapes of lingual region upper airway were observed. The area and the dimensions of lingual region was studied, and the thickness of retropharyngeal and lateral pharyngeal tissue were evaluated too. The another focus area was tongue, and the evaluated data included the tongue width, genioglossus width, hyogolssus width, tongue length and tongue area. RESULTS: The data comparative results of OSAS and normal groups were as follows: the right to left diameter and area of OSAS patients' lingual region upper airways were less than those of normal adults, the thickness of lateral pharyngeal, tongue width, genioglossus width, hyogolssus width and tongue area were more than those of normal adults. And there were not obviously difference between OSAS patients and normal adults in tongue length, anterior-to-posterior dimension and thickness of retropharyngeal wall tissue of upper airway. CONCLUSIONS: The study suggests that there are obviously difference between the patients with OSAS and normal adult in lingual upper airway CT scan measure. And the anatomic stricture of lingual upper airway is one of the etiology of OSAS. The main reasons of stricture are increasing of thickness of lateral pharyngeal, tongue width, genioglossus width, hyogolssus width and tongue area.