Outcomes and influential factors in functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis aimed to evaluate the factors influencing and success rates of dental implants for functional and dental rehabilitation following microvascular fibula flap reconstruction in the maxillomandibular region. MAIN TEXT: We conducted a comprehensive search of electronic databases, including MEDLINE, Web of Science, Embase, Scopus, and Cochrane's CENTRAL, as well as gray literature sources and manual searches of notable journals. The search was performed from inception until February 2023. Studies were included if they examined functional and dental rehabilitation outcomes in patients receiving maxillofacial reconstruction using microvascular fibula flaps and were retrospective or prospective cohort studies involving human subjects. Case-control studies, research involving other reconstruction methods, and animal-based studies were excluded. Data was extracted and confirmed by two independent researchers, and risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were conducted for dental implant and graft success rate, with separate analyses for different factors affecting the outcome. Heterogeneity was evaluated using Cochran's Q test and the I2 test. The pooled success rate for implants was 92% and for grafts, 95%, with significant heterogeneity. Implants in fibular grafts had a 2.91 times higher failure rate than those in natural bones. Radiated bone and smoking were identified as factors influencing implant failure, with radiated bone having a 2.29 times higher risk and smokers having a 3.16 times higher risk compared to their respective counterparts. Patient-reported outcomes showed improvements in key areas such as dietary intake, mastication, speech, and esthetics. The success rates declined over time, emphasizing the importance of long-term follow-up. CONCLUSIONS: Dental implants in free fibula grafts generally have favorable success rates, with minimal bone resorption, manageable probing depths, and limited bleeding on probing. Implant success is influenced by factors such as smoking and radiated bone.

Panoramic Radiographic Relationship of the Mandibular Foramen to the Anterior Border of the Ramus and Occlusal Plane as an Aid in Inferior Alveolar Nerve Block.

The location of the mandibular foramen (MF) on digital panoramic radiographs can be an important guide for clinicians when administering the inferior alveolar nerve block (IANB) for dental anesthesia of the mandible. This study, aimed to assess the location of the MF relative to the anterior border (AB) of the ramus and the occlusal plane (OP) from digital panoramic radiographs. An observational case series study was conducted on digital panoramic radiographs from the oral and maxillofacial radiology department archives of patients at least 18 years of age with a 1:1 scale (100%). The samples had to have at least 2 lower molar teeth on both sides without any blurring, previous fracture of the ramus or other artifacts. The distance of the MF to the OP and the AB of the ramus was measured using a caliper. The role of age and gender were also analyzed statistically using the 2-way analysis of variance test. One hundred ninety-four digital panoramic radiographs were included in the analysis. The findings showed that the vertical distance of the MF to the OP was a maximum of 14.52 mm and a minimum of -3.0 mm (mean 4.32 ± 2.34 mm). The distance of the MF to the AB of the ramus was a maximum of 25.52 and a minimum 9.68 mm (mean 16.48 ± 3.28 mm). Based on these findings, the IANB target site for injection should be approximately 5 mm above the OP and approximately 16.5 mm beyond the AB of the ramus to achieve successful anesthesia of the mandible via standard IANB in an Iranian population.

Salient Points in Reconstruction of Nasal Skin after Tumor Ablation with Local Flaps.

OBJECTIVE: A variety of nasal skin reconstruction methods are available to meet the esthetic patient's needs. In this article, we review some of modifications of these procedures and share our experience in reconstruction of different parts of the nasal skin following skin tumor ablation. PATIENTS AND METHODS: From January 2010 to January 2014, 171 patients underwent nasal skin reconstruction after excising cancerous lesions of the involved nasal skin. The patient's history, pre- and post-operation photographs, and the surgery data were collected and assessed. Demographic data related to the type of cancer, defect size and location, type of reconstruction were collected. RESULTS: A variety of local flaps were used based on location and defect features. Nearly all flaps healed primarily without postsurgical significant complications. CONCLUSION: According to the results and the outcomes of the operations, we concluded that a certain flaps are more effective than others in nasal skin reconstruction. Local flap reconstruction of the nose has good esthetic result with low complication rate.

Pattern of maxillofacial fractures: a 5-year analysis of 8,818 patients.

BACKGROUND: This multicenter study assessed the demographics, prevalence, causes, types, treatment, and complications of maxillofacial (MF) fractures managed by MF surgeons nationwide. METHODS: This 5-year retrospective descriptive analytical chart study evaluated 8,818 patients treated for MF fractures from 2007 to 2012 at 11 medical centers. Parameters, including age, sex, cause of injury, site of injury, type of injury, fracture patterns, treatment modalities, and complications, were evaluated from patient charts and radiographs. Collected data were analyzed via t test or χ test using SPSS 20 (Chicago, IL). A p value of less than 0.05 was considered statistically significant. This retrospective chart study was exempt from institutional review board approval. RESULTS: There were 7,369 male patients (83.6%), 1,376 female patients (15.7%), and 73 patients (0.8%) of unknown sex (aged 6 months to 112 years); 39.54% (3,457 patients) were in the 21-year to 30-year age group (mean, 28.18 years). We found 5,737 mandibular fractures (65.1%); mandible fracture was the most common (p < 0.05), followed by maxillary (1,641, 18.6%), zygomatic (3,240, 36.0%), orbital floor (743, 8.4%), naso-orbitoethmoidal (472, 5.4%), nasal (848, 9.6%), and frontal (344, 3.9%) fractures. Road traffic accidents were the most common cause. Posttreatment documented complications included remaining neurosensory disturbance of the inferior alveolar nerve (16.01%) and the infraorbital nerve (15.5%), remaining neuromotor disturbance of the facial nerve (2.3%), blurred vision (2.43%), diplopia (3.2%), limitation of eye movement (1.6%), exophthalmoses (1.88%), blindness (0.8%), as well as postoperative infection and chronic osteomyelitis (1.0%). CONCLUSION: On the basis of our study, mandibular fractures, in males and resulting from road traffic accidents in the third decade of life, were significant findings. Although the prevalence of MF fractures, demographics, and causes vary from one country to another and awareness of these patterns can provide insight to prevention protocols, this study shows that, despite better law enforcement of traffic regulations, better roads, better automobiles, and the like, the pattern of MF fractures in Iran has not changed significantly during the past 10 years. LEVEL OF EVIDENCE: Epidemiologic study, level IV.

Opium usage as an etiologic factor of oral cavity cancer.

PURPOSES: The aim of this study was to evaluate the role of opium in causing oral cancer. PATIENTS AND METHODS: Eighty patients and 80 selected matched controls who were referred to the ear-nose-throat department of an academic hospital were included in this study between October 2008 and September 2010. In addition to demographic data, information regarding alcohol, tobacco, and opium use was documented in the subjects. Finally, the effect of each risk factor was assessed. RESULTS: There was no significant difference in patient demographics between the 2 groups. Smoking (P = 0.042) and poor oral hygiene (P = 0.016) significantly correlated with cancer. Finally, opium addiction showed a significant relationship with oral cavity cancer with an odds ratio of 4 (95% confidence interval, 1.2-13.6). CONCLUSION: Opium use is among the possible risk factors for oral cancer.

Assessment of 120 maxillofacial aneurysmal bone cysts: a nationwide quest to understand this enigma.

PURPOSE: Compared with other maxillofacial lesions, oral and maxillofacial (OM) aneurysmal bone cysts (ABCs) are rare, and most studies have been case reports. Because the features or radiographic findings of 1 case could not be representative of the whole, conclusions cannot be drawn and data analyses will not be feasible. Our aim was to assess and describe the clinical and histopathologic characteristics of a large sample of subjects with ABCs. To our knowledge, the present case series of OM ABCs is the largest ever reported. MATERIALS AND METHODS: To address our research purpose, we designed and implemented a retrospective case series. A multicenter retrospective cohort study of patient charts dated from 1967 to 2013 (46 years) at 10 major universities in 8 cities was undertaken to assess OM ABCs nationwide. Subjects were included if they had documented chart data and definitive histopathologic slides confirming the diagnosis and treatment of ABC. They were excluded if their histopathologic slides did not confirm the diagnosis of an ABC. Data were collected, and special forms were completed. Variables such as age, gender, site (ie, maxilla, mandible, anterior, posterior), histologic type (ie, solid, mixed, vascular), signs, symptoms, radiographic features (ie, radiolucency, unicystic or multilocular), and outcomes (ie, treatment modal, recurrence, complications) of the lesion were evaluated and documented by OM surgeons and confirmed by OM pathologists for assurance. Data analyses were performed using Statistical Package for Social Sciences, version 20, software (SPSS, Chicago, IL) (P < .05). RESULTS: We assessed the medical records and histopathologic slides of 120 patients diagnosed and treated for OM ABCs nationwide. Of these patients, 69 were male (57.5%) and 51 were female (42.5%), with no predilection found. The key findings were as follows. The mean age of occurrence was 20.7 ± 2.5 years (range 4 to 78), and occurrence was significantly greater in the first 2 decades of life (P < .001). The incidence was 2.6 cases/year. ABCs were significantly more common in the mandible (P < .05) and posterior areas (P < .05). The most common histopathologic type was the mixed type (P < .05). Firm swelling was the most common clinical presentation (P < .05); all cases were radiolucent and commonly unilateral (P < .05). Most were treated by excision and curettage. Recurrence was reported in 11 patients (9.2%) during the follow-up period (1 to 45 years). CONCLUSIONS: The present retrospective cohort found ABCs with a variable presentation, disease course, and histopathologic type, with no gender predilection. ABCs were significantly more common in childhood and adolescence and in the mandible and posterior areas of the jaws. Of the cases reviewed, 90% were treated by excision and curettage. ABCs had a relatively low recurrence rate (<10%), precluding the need to perform aggressive surgery primarily.

Management of perforations of the nasal septum: can extracorporeal septoplasty be an effective option?

PURPOSE: Perforation of the nasal septum is a frustrating problem frequently reported in the literature. Surprisingly, in most reports, iatrogenic perforation during septoplasty and electrocautery are the leading causes of this complication. This article presents the management of septal perforations and the indications for an extracorporeal approach. MATERIALS AND METHODS: Fourteen patients with septal perforations were referred for treatment. Treatment was chosen based on defect size. Flaps, extracorporeal repair, or no treatment was used as indicated. RESULTS: Two of 14 perforations were small and were repaired by local flaps, 5 cases were treated by extracorporeal repair, and the 7 remaining cases required no surgical procedure. CONCLUSIONS: The extracorporeal technique, when indicated, can be used effectively for the repair of nasal septum perforations in selected cases.

Evaluation of cytotoxic effects of Anbarnesa on fibroblast L929: Can it be used as a mouthwash?

AIMS: In Iranian traditional medicine Anbarnesa (derived from smoke from burning female donkey's stool) has been used to treat ulcers and inflammatory conditions like stomatitis and ear infections (otitis). We assess the properties of Anbarnesa as an alternative mouthwash. MATERIALS AND METHODS: In this experimental study, Anbarnesa smoke was analyzed using aGC-mass device. The smoke collected was dissolved at different densities in propylene glycol and incubated in Dulbecco's modified Eagle's medium in direct contact with fibroblast cells. Assessment of cytotoxicity was done at 1, 24 and 72 h. Cell viability was measured by methyl thiazolyl tetrazolium test, and ELISA Reader machine was used to read the results. Data were analyzed using one-way ANOVA test. RESULTS: The findings of this study showed Anbarnesa was nontoxic in 1/64, 1/128 and 1/256 dilutions. In 1/32 dilution, toxicity was seen after 72 h. In dilutions, 1/8 and 1/16 toxicity were seen in the 1(st) h. CONCLUSION: According to the initial results of Anbarnesa may be used as an alternative mouthwash with fewer side-effects for plaque control and prevention of periodontal disease.

Effect of plasma rich in growth factors on alveolar osteitis.

INTRODUCTION: The high prevalence of dry socket or alveolar osteitis (AO) is of concern in surgical removal of third molars. The aim of the present study was to assess the preventive effect of plasma rich in growth factors (PRGF) on AO and also its effect on pain management and healing acceleration in third molar extraction sockets of high-risk patients. MATERIALS AND METHODS: This split-mouth, double-blind clinical trial included 40 bilateral third molar extractions (80 sockets) with at least one identified risk factor for AO. PRGF was obtained from patient's own blood, based on manufacturer's instruction, and blindly placed in one of the two bilateral sockets (PRGF group; n = 20) of each patient. The contralateral socket was treated with a placebo (control group; n = 20). Samples were evaluated for AO and pain incidence on days 2, 3 and 4 and healing and infection on days 3 and 7. Data were analyzed in SPSS v16 using Wilcoxon test. RESULTS: There was a significant difference in dry socket and pain incidence and healing rate between the two groups. Intensity of pain and occurrence of dry socket in the study group was lower than the controls. Also the healing rate was higher (P < 0.05) for the PRGF group. No sign of infection was seen in either group. CONCLUSION: The application of PRGF may significantly reduce the incidence of AO or its associated pain and may accelerate healing. The prophylactic use of PRGF following third molar extraction may be suggested especially in the patients at risk of AO.

Morphologic variations of sesamoid cartilages of the nose in Iranian cadavers.

BACKGROUND: Accessory cartilages are small nasal cartilages between the lateral crus and piriform aperture of the nose bilaterally. These cartilages are among the supporting structures of the nasal tip. STUDY DESIGN: This prospective cross-sectional study was conducted on Iranian fresh cadavers for evaluation of ethnic differences. Seventy-two sesamoid cartilages in 41 cadavers (mean age 42 years) were dissected to evaluate anatomy and anthropometry of the sesamoid cartilages. Elevation of the dorsal nasal flap after a collumellar incision was done. After the separation of the lower lateral cartilages and sesamoid cartilages on each side, the anatomy and anthropometry of the cartilages were assessed. RESULTS: In 12% (5) of the cadavers there were no sesamoid cartilages, and in 88% (36) of the cadavers there was 1 sesamoid on each side. The shape of the sesamoid cartilages was rectangular in 66% (27) and triangular in 22% (9). The mean length, width, and thickness were 3 mm, 2 mm, and 0.75 mm, respectively. CONCLUSIONS: This cartilage was single on each side of the nose and its shape was an irregular rectangle or triangle and has an important role in preserving nasal alar contour and tip projection. These findings confirm ethnic variations in the sesamoid nasal cartilages when this Iranian population is compared with other populations assessed in earlier reports.

Oral and maxillofacial injuries in civilians during training at military garrisons: prevalence and causes.

OBJECTIVES: The prevalence of physical injuries sustained in civilian recruits at military training garrisons is significant. Civilian recruits sustain injuries mostly during the intensive and rigorous military combat-training period. We sought to determine the prevalence and causes of oral and maxillofacial injury as the first step in reducing and preventing them in our population of recruits (men aged ≥18 years) called to serve the 2-year mandatory military service. STUDY DESIGN: In this 2-year study, we referred to 3 major military training garrisons in 3 provinces and collected data from available medical records of military clinics at each garrison. Injuries occurring during the intense 2-month military combat-training period were documented. Data regarding the number of civilian trainees, percentage of those injured, site where the injury was sustained, type of injury and causes, etc. as well as demographic data were collected relevant to civilian recruits called to service. RESULTS: The number of civilians called to military service was 36,000 (18,000/y). The ratio of those injured was 1,228/36,000. The percentage of maxillofacial injuries was 23.6% (290/1,228). The majority of maxillofacial injuries occurred at the military camps (67%) and were due to nonmilitary (71%) rather than military (29%) causes. From among the military causes, bullets (70%) were the most common cause of injury, and falls (84%) were the major cause of nonmilitary injuries. Mountainous terrain was the main cause of falls (59%). The most common military incidents which led to injury related to artillery fire and explosions (52%). Nasal bone fracture was the most common maxillofacial fracture (51%), and lacerations were the most common soft tissue injury (76%). Among dental injuries, tooth fracture was the most common (73%). CONCLUSIONS: The large number of general and maxillofacial injuries in civilian recruits during the 2-month combat-training period at military garrisons is disconcerting. This issue warrants further research to implement methods for identifying, decreasing, and preventing injuries in civilians at military-training garrisons.

A survey of breast cancer knowledge and attitude in Iranian women.

BACKGROUND: Breast cancer (BC) is the most common cancer among Iranian women. It is recommended that women be under national screening for early detection of cases to improve survival and decrease mortality. Because of shortage of facilities, breast self-examination (BSE) instead of clinical-based examination (CBE) and mammography is advocated as the first step of screening in developing countries including Iran. It is quite clear that the related knowledge, attitude, and practice (KAP) of the community is necessary to have a successful screening program particularly for BSE. MATERIALS AND METHODS: A community-based descriptive study on 650 females aged more than 18 years was carried out with a well-structured and valid questionnaire to demonstrate the knowledge and practice of women for BSE, CBE and mammography. RESULTS: The mean age of participants was 40.72 years with standard deviation (SD) of 9.58. Eighty-two point six percent (82.6%) were married and 48.4% were post graduates. A painless mass (60.8%) and bloody discharge (44.9%) were reported as the two important symptoms for BC. In this assay, 80.3% of participants knew females are at risk of BC and 70.6% of them perceived that early detection and operation in early stages are effective issues. Thirty point eight percent (30.8%) of respondents knew the BSE and this knowledge had significant association with their educational status. Fifty-nine point nine percent (59.9%) of participants were able to do BSE but only 12.9% of respondents practiced BSE regularly. CONCLUSION: Community awareness and education level are important elements in BSE as a substitute for traditional screening in BC for early detection.

Anatomic variations found on dissection of depressor septi nasi muscles in cadavers.

OBJECTIVES: To define variations of the depressor septi muscle in Iranians; to provide guidance for modification of this muscle during rhinoplasty in patients with an active muscle and short upper lip; and to correlate our findings with our clinical experience to develop the applied algorithms. METHODS: This study was conducted by dissecting 82 depressor septi nasi muscles in 41 Iranian cadavers. Origin and insertion points of each muscle were studied. RESULTS: Three variations were found in muscle insertion points: periosteal, orbicularis oris, and floating. Forty-four percent of the muscles were inserted into the periosteum of the maxilla (n = 36); 39% of muscles were inserted into the orbicularis oris muscle (n = 32); and 17% were diminutive or floating (n = 14). Periosteal insertion was thicker and stronger than the other variations. In all cadavers, the origin of the muscle was medial crus of alar cartilage and caudal of the nasal septum. CONCLUSIONS: This cadaveric dissection showed that the percentage of depressor septi muscle insertions is not similar to that found in other surveys. In this study, periosteal insertion of the depressor septi muscle was the most common variation.

Analysis of stress distribution on fixation of bilateral sagittal split ramus osteotomy with resorbable plates and screws using the finite-element method.

PURPOSE: To determine the most appropriate stress distribution in fixation with resorbable screws and plates after bilateral sagittal split ramus osteotomy using the finite-element method. MATERIALS AND METHODS: This experimental study was performed on simulated human mandibles using computer software. The osteotomy line was applied to the simulated model and experimental loads of 75, 135, and 600 N were exerted on the model in accordance with the vector of occlusal force. The distribution pattern of stress was assessed and compared in 8 fixation methods: 1 resorbable screw, 2 resorbable screws in a vertical pattern, 2 resorbable screws in a horizontal pattern, 3 resorbable screws in an L pattern, 3 resorbable screws in a backward-L pattern, 1 miniplate with 2 screws, 1 miniplate with 4 screws, and 2 parallel miniplates with 4 screws each. RESULTS: Among the simulated fixations, 2 parallel miniplates showed the greatest primary stability and the single screw and the 2-hole miniplate showed the least tolerance to posterior forces. CONCLUSIONS: This study showed the 2-miniplate/4-hole plate pattern was the strongest and the single-screw and 2-hole plate patterns were the weakest of fixations in this bilateral sagittal split ramus osteotomy model. The finite-element method showed that polymer-based resorbable screws and plates (polyglycolic acid and d,l-polylactide acid) provide satisfactory primary stability in this model.

Effectiveness of Mouth Washes on Streptococci in Plaque around Orthodontic Appliances.

Background and Purpose. Fixed orthodontics may be associated with accumulation of Mutans Streptococci (MS), enamel demineralization, and an increased number of carious lesions, predominantly in sites adjacent to brackets. This study was undertaken to assess the effectiveness of Listerine, Oral-B, and Ortho-kin on the accumulation of MS in plaque around orthodontic brackets. Materials and Methods A double-blind randomized cross-over clinical trial on 25 orthodontic patients, classified into 6 groups was done to assess MS in plaque and saliva with the side specific modified Strip-Mutans technique and the plaque (PI) was measured before and after rinsing using 3 types of commercial mouth-rinses. A washout period (3 weeks) was awaited between using each mouth-rinse and the data was analyzed via Wilcoxon and Kruskal Wallis statistical tests. Results. This study of 25 patients, 5 men and 20 women, with an average age of 19 ± 6/3 assessed the effectiveness of mouth-rinses on MS. Our results showed that Ortho-kin had a better effect than Oral-B and Listerine (P < 0/09). Ortho-kin also had better effects than Oral-B and Listerine on plaque accumulation (P < 0/001). Conclusion. Ortho-kin showed better effects on decreasing MS and PI because it contained chlorhexidine.