Both Type I Bovine Collagen Conduits and Porcine Small Intestine Submucosa Conduits Result in Functional Sensory Recovery Following Peripheral Nerve Microsurgery: A Systematic Review and Meta-Analysis.

PURPOSE: The study purpose was to measure and compare the time to functional sensory recovery (FSR) and incidence of FSR by 6 and 12 months between type I bovine collagen conduits versus porcine small intestine submucosa (SIS) conduits with primary neurorrhaphy for peripheral nerve injury repair. METHODS: A systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. The predictor variable was the type of conduit-either bovine collagen or porcine SIS. The primary outcome variable was the number of months between surgery and the patient achieving FSR. The secondary outcome variable was the proportion of patients who achieved FSR that did so by 6 and 12 months. A log-rank test was performed to evaluate the statistical significance of the differences observed in the overall time-to-FSR data and by 6 and 12 months. RESULTS: We screened 67 publications of which 8 were included. The sample sizes were 137 and 96 patients for the bovine collagen and porcine SIS groups, respectively. The median time to FSR for the bovine collagen conduit group was 9 months (interquartile range: 6); the median time to FSR for the porcine SIS conduit group 6 months (interquartile range: 3 months) (P = .50). Of the patients who achieved FSR, 42% of patients with bovine collagen conduits and 64% of patients with porcine SIS conduits did so within 6 months (P < .01). Of the patients who achieved FSR, 94% of patients with bovine collagen conduits and 82% of patients with porcine SIS conduits did so within 12 months (P < .01). CONCLUSION: Although a significant difference was found in the incidence of FSR at 6 and 12 months, no significant difference was found in overall time to FSR, supporting the use of either conduit for peripheral nerve repair.

Comparing 5-Fluorouracil Versus Modified Carnoy's Solution for the Treatment of Odontogenic Keratocysts: A Systematic Review and Meta-Analysis.

PURPOSE: The primary aim of this study was to compare time to odontogenic keratocyst (OKC) recurrence with 5-fluorouracil (5-FU) versus modified Carnoy's solution (MCS) following enucleation and curettage and peripheral ostectomy. The secondary aim was to compare the frequency (%) of permanent peripheral nerve injury characterized by hypoesthesia and neuropathic pain present at 12 months or more after surgery with 5-FU versus MCS. METHODS: The Cox hazard ratio was calculated to compare time to recurrence between the 2 groups. To compare the frequencies of permanent nerve damage, we fitted a fixed-effects model to the data and calculated the risk ratio. Other variables collected were sex, age, follow-up time, and cyst size. RESULTS: No significant differences in sex, age, follow-up time, and cyst size were found. The median follow-up time for all patients was 60 months (range: 12-180 months, Q1 = 32 months, Q3 = 86 months, interquartile range = 54 months). Of the 114 patients treated with MCS, 27 recurrences with a median recurrence time of 42 months (range = 12-108 months, Q1 = 26.3 months, Q3 = 54 months, interquartile range = 27.7 months) were recorded; no recurrences were observed among the 99 patients treated with 5-FU (hazard ratio = 0.02, 95% CI = 0.00018-0.16, P = 2.27e-07). Of the 112 patients treated with MCS, there were 20 (17.86%) instances of permanent peripheral nerve injury; of the 98 patients treated with 5-FU, there were 7 (7.14%) instances of permanent peripheral nerve injury (risk ratio = 0.44, 95% CI = 0.20-0.97, P = .04). CONCLUSION: The results of this meta-analysis significantly favored 5-FU over MCS for lower OKC recurrence and peripheral nerve injury, supporting the use of 5-FU as the superior adjuvant following enucleation and curettage and peripheral ostectomy for the treatment of OKCs.

Evaluating Lingual Nerve Repair Outcomes: A Systematic Review.

PURPOSE: The lingual nerve (LN) is susceptible to injury during oral and maxillofacial procedures, leading to neurosensory deficits. Advances in microsurgical techniques necessitate a comprehensive review of overall effectiveness and influencing factors. METHODS: A systematic review was performed via Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies. Inclusion criteria were full text availability, studies written in english, and studies published after 2000 reporting LN repair. The primary outcome was sensory improvement defined via functional sensory recovery (FSR) or neurosensory testing (NST). Sex, time from injury to repair, method of repair, and graft length were examined to see if each influenced outcomes. RESULTS: A sample of 786 subjects across 17 studies was examined. Most patients were female (73.3%) and suffered injuries from third molar extractions (72.8%). Of the studies, 10 defined improvement by FSR with a total of 88.8% (500/563) of nerves achieving such. Of those achieving FSR, 91% did so within a year. The remaining 7 studies defined sensory improvement by individually setting various NST thresholds, with the combined improvement rate being 88.6% (203/229). Positive outcomes were achieved with graft lengths up to 70 mm. Results on time to repair were mixed. The methods of repairs were not different based on statistical analysis short of performing an equivalence trial. CONCLUSION: Conclusions made from studies using FSR were similar to studies using NST, meaning the method of measuring outcomes does not seem to be a confounder. FSR is the superior scale due to being objective and standardized. LN repair produced high rates of sensory improvement, which is expected to occur within 1 year postoperative. Sex and graft length did not influence outcomes. More research is needed to determine the effect of time to repair on efficacy. Most methods of repair produced similar outcomes, suggesting multiple valid techniques exist.

Is ChatGPT an Accurate and Readable Patient Aid for Third Molar Extractions?

BACKGROUND: Artificial intelligence (AI) platforms such as Chat Generative Pre-Trained Transformer (ChatGPT) (Open AI, San Francisco, California, USA) have the capacity to answer health-related questions. It remains unknown whether AI can be a patient-friendly and accurate resource regarding third molar extraction. PURPOSE: The purpose was to determine the accuracy and readability of AI responses to common patient questions regarding third molar extraction. STUDY DESIGN, SETTING, SAMPLE: This is a cross sectional in-silico assessment of readability and soundness of a computer-generated report. INDEPENDENT VARIABLE: Not applicable. MAIN OUTCOME VARIABLES: Accuracy, or the ability to provide clinically correct and relevant information, was determined subjectively by 2 reviewers using a 5-point Likert scale, and objectively by comparing responses to American Association of Oral and Maxillofacial Surgeons (AAOMS) clinical consensus papers. Readability, or how easy a piece of text is to read, was assessed using the Flesch Kincaid Reading Ease (FKRE) and Flesch Kincaid Grade Level (FKGL). Both assess readability based on mean number of syllables per word, and words per sentence. To be deemed readable, FKRE should be >60 and FKGL should be <8. COVARIATES: Not applicable. ANALYSES: Descriptive statistics were used to analyze the findings of this study. RESULTS: AI-generated responses above the recommended level for the average patient (FKRE: 52; FKGL: 10). The average Likert score was 4.36, suggesting that most responses were accurate with minor inaccuracies or missing information. AI correctly deferred to the provider in instances where no definitive answer exists. Of the responses that addressed content in AAOMS consensus papers, 18/19 responses closely aligned with them. All prompts did not provide citations or references. CONCLUSION AND RELEVANCE: AI was able to provide mostly accurate responses, and content was closely aligned with AAOMS guidelines. However, responses were too complex for the average third molar extraction patient, and were deficient in citations and references. It is important for providers to educate patients on the utility of AI, and to decide whether to recommend using it for information. Ultimately, the best resource for answers is from the practitioners themselves because the AI platform lacks clinical experience.

Evaluating Stromal Vascular Fraction As a Treatment for Peripheral Nerve Regeneration: A Scoping Review.

PURPOSE: This study aims to investigate the potential of stromal vascular fraction (SVF) for peripheral nerve regeneration. METHODS: A scoping review of Scopus and PubMed databases was conducted. Inclusion criteria were human or animal studies exploring the use of SVF for peripheral nerve regeneration. Studies were categorized by assessed outcomes: pain assessment, neural integrity, muscle recovery, and functional recovery. Level of evidence and study quality were assessed. RESULTS: Nine studies met the inclusion criteria. SVF injection in humans with trigeminal neuropathic pain reduced pain scores from 7.5 ± 1.58 to 4.3 ± 3.28. SVF injection improved sensation in humans with leprosy neuropathy. Repairing transected rat sciatic nerves with SVF-coated nerve autografts improved wet muscle weight ratios (0.65 ± 0.11 vs 0.55 ± 0.06) and sciatic functional index (SFI) scores (-68.2 ± 9.2 vs -72.5 ± 8.9). Repairing transected rat sciatic nerves with SVF-coated conduits increased the ratio of gastrocnemius muscle weights (RGMW) (7-10% improvement), myelinated fibers (1,605 ± 806.2 vs 543.6 ± 478.66), and myelin thickness (5-20% increase). Repairing transected rat facial nerves with SVF-coated conduits improved whisker motion (9.22° ± 0.65° vs 1.90° ± 0.84°) and myelin thickness (0.57 µm ± 0.17 vs 0.45 µm ± 0.14 µm). Repairing transected rat sciatic nerves with SVF-coated nerve allografts improved RGMW (85 vs 50%), SFI scores (-20 to -10 vs -40 to -30), and Basso, Beatie, and Bresnahan locomotor scores (18 vs 15). All metrics mentioned above were statistically significant. The human studies were level 4 evidence due to being case series, while animal studies were the lowest level of evidence. CONCLUSION: Despite initial promising results, the low-level evidence from the included studies warrants further investigation.

Assessing the Efficacy of Allogeneic Nerve Grafts in Trigeminal Nerve Repair: A Systematic Review.

PURPOSE: Our primary objective was to assess the efficacy of allogeneic nerve grafts in inferior alveolar nerve or lingual nerve repair. We hypothesized that using allogeneic nerve grafts would be effective, as evidenced by achieving high rates of functional sensory recovery (FSR). Additionally, we looked if sex, time from injury to repair, etiology of nerve damage, and graft length affected outcomes. METHODS: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. PubMed and Scopus databases were searched using specific search strategies to generate eligible studies. Inclusion criteria encompassed studies reporting use of allogeneic grafts, assessing FSR using either Medical Research Council Scale or Neurosensory Testing, and published within the past 15 years. RESULTS: Across 10 studies conducted between 2011 and 2023, analysis was performed on 149 patients and 151 reconstructed nerves. Allogeneic nerve grafts showed an average FSR rate of 88.0%. Kaplan-Meier analysis of time to FSR postoperatively revealed that of those achieving FSR, 80% achieved it within 6 months and 98% achieved it by 1 year. The mean graft length was 29.92 mm ± 17.94 mm. The most common etiology for nerve damage was third molar extractions (23.3%). Sex distribution among patients revealed that 85 were female (57.0%) and 64 were male (43.0%). CONCLUSION: Our primary hypothesis was supported as nerve allografts achieved high rates of FSR. FSR was achieved in normative timeframes, which is 6 to 12 months postoperatively. Furthermore, allografts reduced the risk of posttraumatic trigeminal neuropathy. Time from injury to repair, graft length, etiology of nerve damage, and sex did not affect FSR. As the assessed variables in our study did not affect outcomes, there needs to be a more nuanced approach to understanding and addressing various factors influencing sensory recovery.

A combination of hyaluronic acid filler, subnasal lip lift, chemical peel, and onabotulinum toxin A superiorly reestablishes perioral esthetics: a case report.

With increasing age and edentulism, numerous esthetic changes occur to the perioral region. The upper lips lose definition, flatten, and lengthen, the cupid's bow is lost, and the oral commissures descend. The nasolabial folds deepen, marionette lines become prominent, vertical rhytids around the lips form, and chin rhytids form. Chronic exposure to UVA radiation from the sun can lead to photodamage, characterized by wrinkles, lentigines, actinic keratoses, and other pigment changes. In addition, edentulism leads to jaw atrophy, which often compromises soft tissue support. Removable dentures, the conventional treatment to restore missing teeth, not only replace teeth, but also provide support to the lips via the labial flange. Implant-supported fixed prostheses are a very popular option to restore completely edentulous arches; these prostheses are flangeless, providing no bulk to the lips. Addressing changes in the perioral region due to aging and edentulism requires a combination of treatments, with each addressing different issues. Onabotulinum toxin A can be used to treat dynamic perioral and chin rhytids, and upturn the corners of the mouth. Hyaluronic acid filler can be used to treat deep nasolabial folds, marionette lines, and re-volumize the lips. Chemical peels can treat photodamaged skin, static rhytids, and other dermatologic pathologies. The subnasal lip lift, developed by Cardoso and Sperli in 1971, has become an increasingly common technique used to rejuvenate the upper lip in elderly and edentulous patients. This case report describes an elderly patient who was treated with a combination of subnasal lip lift, hyaluronic acid filler, onabotulinum toxin A, and chemical peel to achieve superior perioral esthetics. This case highlights the synergy of each procedure when done in combination to achieve highly effective results.