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1.
Oral Maxillofac Surg ; 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34491457

RESUMO

The aim of this bibliometric research was to identify and analyze the top 100 cited systematic reviews in the field of oral and maxillofacial surgery in order to guide any professional level with interest in this topic and to map the current trends the field of oral and maxillofacial surgery. Using the Web of Science database without restrictions on publication year or language, a bibliometric analysis was performed for the five major journals of oral and maxillofacial surgery: International Journal of Oral and Maxillofacial Surgery (IJOMS), Journal of Oral and Maxillofacial Surgery (JOMS), Journal of Cranio-maxillofacial Surgery (JCMS), British Journal of Oral & Maxillofacial Surgery (BJOMS), and Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology (Triple-O). The most top-cited systematic review was published in 2015 with a total of 200 citations on survival and success rates of dental implants, consistent with the finding that "pre- and peri-implant surgery and dental implantology," and "craniomaxillofacial deformities and cosmetic surgery" were the most frequently cited topics (22% each). The majority of top cited papers were published in IJOMS (43%), followed by JOMS (34%), Triple-O (8%), JCMS(8%) and BJOMS(7%). The highest number of contributions was from the Netherlands, followed by Italy and USA. The outcome of this article can be used as a source of information and to guide not just researchers but also clinicians and students to which areas are trending in the field of oral and maxillofacial surgery, thus also having a large impact on the field of oral and maxillofacial surgery. However, this article cannot reflect the quality of the included systematic reviews.

2.
Artigo em Inglês | MEDLINE | ID: mdl-34252369

RESUMO

PURPOSE: There is still no consensus about the best treatment for frontal sinus fractures (FSFs). Thus, the aims of this study were to answer the following questions: 1) what treatment of FSFs has the lowest rate of postoperative complications? 2) does sinus preservation using observation produce a lower complication rate? 3) are FSFs with nasofrontal outflow tract (NFOT) injury associated with greater complication rates following different treatment options when compared to those patients without NFOT involvement? METHODS: A systematic review and meta-analysis were performed based on PRISMA that included several databases with specific keywords, a reference search, and a manual search for suitable articles. Randomized clinical trials, controlled clinical studies, retrospective studies and case series that estimated complications rate after different treatments options for FSFs were included. The predictor variable was treatment groups, including observation, ORIF, cranialization and obliteration. The outcome variable was complication rate and correlation between complication rate and presence/absence of NFOT. A weighted complication rate/proportion using a random effect model, or risk ratio (RR) with a 95% confidence interval (CI), was performed to construct forest plots. Data analysis was done using a comprehensive meta-analysis. RESULTS: A total of 2,911 patients with FSFs enrolled in 23 studies were included in this study. The weighted complication rate for different treatment was as follows: observation (7%), ORIF (9.4%), obliteration (10.6%), and cranialization (11%). Nonsurgical treatment decreased the complication rate by 2.1 times (low quality evidence, RR = 2.1, CI: 1.13 to 3.9, P = .000) when compared to surgical treatments for FSFs. CR for fractures with NFOT was 8 % (55/619) compared to a complication rate of 5% (18/353) for fractures without NFOT with insignificant difference (very low quality evidence, RR = 1.7, CI: 0.75 to 4.1, P = .158). CONCLUSIONS: FSFs vary in their severity and treatments. The more severe fractures, the higher the complication rate, no matter how they were treated.

3.
Clin Oral Investig ; 25(8): 4887-4893, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33469717

RESUMO

OBJECTIVE: Association between length and gauge of dental needle and success rate and pain perception during an inferior alveolar nerve block (IANB) has not been investigated using a randomized clinical trial (RCT). This RCT aimed to compare the success rate of IANB and perceived pain using 27- or 30-gauge needles for the extraction of adult mandibular molars. MATERIAL AND METHOD: A prospective RCT was conducted on two hundred and twelve adult patients requiring extraction of mandibular molars using standard methods as described by Malamed with 1.8 ml of 2% lidocaine with 1:80,000 adrenaline. One hundred six patients received IANB using 27-gauge needles (32 mm × 0.2 mm) and one hundred six patients received IANB using 30-gauge needles (25 mm × 0.15 mm). Predictor variables were 27-gauge and short and 30-gauge. Outcome variables were the success rate of IANB and pain perception during injection using a visual analogue scale. RESULTS: There was a highly significantly increase in the success of IANB using 27-gauge needle (95.28%) versus 30-gauge needle (41.51%) (P = 0.001). There was a significant increase in pain perception for patients who received IANB by shorter and thinner needle (30-gauge) when compared to the long and thicker needle (27-gauge). CONCLUSION: This RCT demonstrated that 27-gauge needle seems to be associated with a higher success rate of IANB and lower pain perception during injection when compared to 30-gauge needle in the extraction of adult mandibular molars when compared to 30-gauge needles. CLINICAL RELEVANCE: For adult patients, when thickness of soft tissue to be penetrated is essential to achieve bony contact, long or large gauge dental needle is preferred to get a higher success rate of IANB with less pain perception during injection.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Adulto , Anestésicos Locais , Carticaína , Método Duplo-Cego , Humanos , Lidocaína , Nervo Mandibular , Dente Molar , Pulpite/cirurgia
4.
J Prosthet Dent ; 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33070972

RESUMO

STATEMENT OF PROBLEM: Occlusal devices, particularly the stabilization appliances, have been commonly used as treatment for painful temporomandibular disorders (TMDs). However, the mechanisms of action of these devices are still unclear, including the role of the placebo effect in the pain management. PURPOSE: The purpose of this network meta-analysis was to identify to what extent the degree of efficacy of stabilization appliances in the management of painful TMDs arises from the placebo effect only or whether it arises chiefly from an actual effect. MATERIAL AND METHODS: An electronic search was undertaken to identify randomized clinical trials (RCTs) published up to April 2020, comparing the efficacy of the stabilization appliances in patients with painful temporomandibular disorders, with nonoccluding appliances (active placebo), and untreated controls (passive placebo). Outcome variables were pain intensity at follow-ups, the proportion of participants reporting pain improvement, and the number needed to treat. The quality of evidence was rated as per the Cochrane tool for assessing risk of bias. Mean difference was used to analyze via frequentist network meta-analysis by using the STATA software program. RESULTS: Treatment with stabilization appliances showed a significant reduction in pain intensity when compared with the other groups; but, the lower pain intensity at follow-ups in favor of stabilization appliances when compared with nonoccluding appliances was not statistically significant. However, a significantly higher number of participants reported pain improvement after treatment with stabilization appliances when compared with those treated with nonoccluding appliances or untreated participants. CONCLUSIONS: This network meta-analysis showed no significant difference in reported pain intensity at follow-ups between the treatment of painful TMDs with stabilization appliances or nonoccluding appliances (active placebo). However, a significant difference in participants reporting treatment satisfaction with reduced pain, and a significantly lower number needed to treat in favor of stabilization appliances were found. Patient-reported treatment satisfaction probably included more domains than just pain intensity, such as improvements in physical functioning and psychosocial factors, and deserves further investigation. The authors concluded that stabilization appliances treatment efficacy is beyond the placebo effect.

5.
J. oral res. (Impresa) ; 9(4): 259-270, ago. 31, 2020. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1179044

RESUMO

Objective: This review addresses a clinical research question related to lower third molar surgery (L3MS): does the combination of pre-emptive low-dose ketamine with local anesthesia (KLA) reduce postoperative complications compared with local anesthesia (LA) alone? Material and methods: A systematic literature search was performed to identify eligible articles by electronic searches of PubMed, Cochrane Central Register of Controlled Trials, EBSCO Library, Web of Science and grey literature through June 2019 without data or language restrictions. We analyzed all randomized controlled clinical studies (RCTs) comparing use of KLA with use of LA in L3MS regarding pain, swelling, and trismus outcomes. The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Results: Five RCTs encompassing 230 extraction sites (KLA = 115, LA = 115) were included in this study. The standardized mean difference (SMD) with the 95% confidence interval (CI) was used to synthesize the results. The data show that there were significant differences between the two groups in post-operative pain (SMD -1.464, 95% CI -1.683 to -0.949, p= 0.001) and swelling (SMD -0.450, 95% CI -0.758 to -0.142, p= 0.004, all low quality evidence). However, there was no significant difference in the trismus (SMD -0.754, CI -1.487 to -0.022, p = 0.043, very low quality evidence). Conclusion: The combination of pre-emptive low-dose ketamine with LA significantly decreased pain and swelling within the first 24 hours after L3MS compared with the control group.


Objetivo: Esta revisión aborda una pregunta de investigación clínica relacionada con la cirugía del tercer molar inferior (L3MS): ¿la combinación de ketamina preventiva en dosis bajas con anestesia local (KLA) reduce las complicaciones postoperatorias en comparación con la anestesia local (AL) sola? Material y Métodos: Se realizó una búsqueda bibliográfica sistemática para identificar artículos elegibles mediante búsquedas electrónicas en PubMed, Registro Cochrane Central de Ensayos Controlados, Biblioteca EBSCO, Web of Science y literatura gris hasta junio de 2019 sin restricciones de datos ni de idioma. Se analizaron todos los estudios clínicos controlados aleatorios (ECA) que compararon el uso de KLA con el uso de LA en L3MS con respecto a los resultados de dolor, hinchazón y trismo. La calidad de la evidencia se clasificó de acuerdo con la herramienta Cochrane para evaluar el riesgo de sesgo. Resultados: Se incluyeron en este estudio cinco ECA que abarcan 230 sitios de extracción (KLA = 115, LA = 115). La diferencia de medias estandarizada (DME) con el intervalo de confianza (IC) del 95% se utilizó para sintetizar los resultados. Los datos muestran que hubo diferencias significativas entre los dos grupos en el dolor posoperatorio (DME -1,464; IC del 95%: -1,683 a -0,949; p= 0,001) e hinchazón (DME -0,450; IC del 95%: -0,758 a -0,142, p= 0,004, todas las pruebas de baja calidad). Sin embargo, no hubo diferencias significativas en el trismo (DME -0,754; IC: -1,487 a -0,022; p= 0,043, evidencia de muy baja calidad). Conclusión: La combinación de ketamina preventiva en dosis bajas con LA disminuyó significativamente el dolor y la hinchazón dentro de las primeras 24 horas después de la L3MS en comparación con el grupo de control.


Assuntos
Humanos , Dor Pós-Operatória/tratamento farmacológico , Complicações Pós-Operatórias/terapia , Ketamina/administração & dosagem , Anestesia Local , Dor , Morbidade , Dente Serotino/cirurgia
6.
J Oral Rehabil ; 47(7): 910-922, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32159870

RESUMO

OBJECTIVE: A network meta-analysis (NMA) of randomised clinical trials (RCTs) was performed aiming to compare the treatment outcome of dry needling, acupuncture or wet needling using different substances in managing myofascial pain of the masticatory muscles (TMD-M). METHOD: An electronic search was undertaken to identify RCTs published until September 2019, comparing dry needling, acupuncture or wet needling using local anaesthesia (LA), botulinum toxin-A (BTX-A), granisetron, platelet-rich plasma (PRP) or passive placebo versus real active placebo in patients with TMD-M. RCTs meeting the inclusion criteria were stratified according to the follow-up time: immediate post-treatment to 3 weeks, and 1 to 6 months post-treatment. Outcome variables were post-treatment pain intensity, increased mouth opening (MMO) and pressure threshold pain (PPT). The quality of evidence was rated according to Cochrane's tool for assessing risk of bias. Mean difference (MD) was used to analysed via frequentist NMA using Stata software. RESULTS: Twenty-one RCTs involving 959 patients were included. The quality of evidence of the included studies was low or very low. There was significant pain decrease after PRP when compared to an active/passive placebo and acupuncture. There was a significant improvement of MMO after LA (MD = 3.65; CI: 1.18-6.1) and dry needling therapy (MD = 2.37; CI: 0.66-4) versus placebo. The three highest ranked treatments for short-term post-treatment pain reduction in TMD-M (1-20 days) were PRP (95.8%), followed by LA (62.5%) and dry needling (57.1%), whereas the three highest ranked treatments at intermediate-term follow-up (1-6 months) were LA (90.2%), dry needling (66.1%) and BTX-A (52.1%) (all very low-quality evidence). LA (96.4%) was the most effective treatment regarding the increase in MMO followed by dry needling (72.4%). CONCLUSION: Based on this NMA, one can conclude that the effectiveness of needling therapy did not depend on needling type (dry or wet) or needling substance. The outcome of this NMA suggests that LA, BTX-A, granisetron and PRP hold some promise as injection therapies, but no definite conclusions can be drawn due to the low quality of evidence of the included studies. This NMA did not provide enough support for any of the needling therapies for TMD-M.


Assuntos
Terapia por Acupuntura , Síndromes da Dor Miofascial , Humanos , Músculos da Mastigação , Metanálise em Rede , Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Int J Oral Maxillofac Implants ; 35(1): 79­90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31532823

RESUMO

PURPOSE: The aim of this study was to compare tissue-engineered bone using mesenchymal stem cells (MSCs) and conventional bone grafts in terms of histomorphometric outcome, bone gained, and implant failure in the atrophic maxilla. MATERIALS AND METHODS: A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted. An electronic search of several databases was performed. RCTs comparing tissue-engineered bone using MSCs to bone graft alone in rehabilitation of the atrophic maxilla were included. Outcome variables were a mean percentage of new bone formation, residual graft particles, and connective tissue. Bone gained and implant failure rate were also assessed. Risk ratio (RR) or standardized mean differences (SMD) were statistically analyzed. RESULTS: A total of 190 augmented sites enrolled in 12 RCTs were included in this study. Nine of the 12 RCTs included 153 maxillary sinuses that underwent sinus elevation, and three RCTs included 28 patients with bone grafting only. There was no significant increase in new bone formation between the two groups at 3 to 4 months (SMD = -0.232, CI, -0.659 to 0.195, low-quality evidence). However, at 6 months postgrafting, a statistically significant increase in new bone formation was found in favor of the tissue-engineered bone using the MSC group (SMD = 0.869%, CI, -1.98 to 9.310, moderate-quality evidence). No substantial difference was found between the two groups with respect to residual graft particles, connective tissue, bone gained, and implant failure rate (RR = 2.8, CI: 0.517 to 16.6, P = .226, very low-quality evidence). CONCLUSION: There is moderate- to very low-quality evidence supporting the use of tissue-engineered bone using MSC therapy in maxillary alveolar bone regeneration compared with conventional bone grafting without MSCs.


Assuntos
Aumento do Rebordo Alveolar , Transplante Ósseo , Implantação Dentária Endo-Óssea , Células-Tronco Mesenquimais , Humanos , Maxila/cirurgia , Seio Maxilar
8.
J Craniomaxillofac Surg ; 48(1): 9-23, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31870713

RESUMO

PURPOSE: Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness. MATERIAL AND METHODS: An electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in post-treatment pain reduction and maximum mouth opening (MMO) were analysed. RESULTS: Thirty-six RCTs were identified that performed comparative outcome assessments for pain and 33 RCTs for MMO. At the short term (≤5 months), IAI-HA (SMD = -2.8, CI: -3.7 to -1.8) and IAI-CS (SMD = -2.11, CI: -2.9 to -1.2) (all very low quality evidence) achieved a substantially greater pain reduction than control/placebo. At intermediate term (≥6 months), a statistically significant decrease in posttreatment pain intensity was observed following Arthroscopy-PRP (SMD = -3.5, CI: -6.2 to -0.82), Arthrocentesis-PRP (SMD = -3.08, CI: -5.44 to -0.71), Arthroscopy-HA (SMD = -3.01, CI: -5.8 to -0.12), TMJ surgery (SMD = -3, CI: -5.7 to -0.28), IAI-HA (SMD = -2.9, CI: -4.9 to -1.09) (all very low quality evidence), Arthroscopy-alone (SMD = -2.6, CI: -5.1 to -0.07, low quality evidence) and Arthrocentesis-HA (SMD = -2.3, CI: -4.5 to -018, moderate-quality evidence) when compared to the control/placebo groups. Relative to MMO, the most effective treatments for short- and intermediate-term improvement were the arthroscopy procedures (PRP > HA > alone, all very low-quality evidence) followed by Arthrocentesis-PRP (very low-quality evidence) and Arthrocentesis-HA (moderate-quality evidence). The non-invasive procedures of occlusal splint therapy, physical therapy, conservative therapy, placebo/control provided significantly lower quality outcomes relative to pain and MMO. CONCLUSION: The results of the present meta-analysis support a paradigm shift in arthrogenous TMJ disorder treatment. There is a new evidence (though on a very low to moderate quality level) that minimally invasive procedures, particularly in combination with IAI of adjuvant pharmacological agents (PRP, HA or CS), are significantly more effective than conservative treatments for both pain reduction and improvement of MMO in both short (≤5 months) and intermediate term (6 months-4 years) periods. In contrast to traditional concepts mandating exhaustion of conservative treatment options, minimally invasive procedures, therefore, deserve to be implemented as efficient first-line treatments (e.g. IAIs and/or arthrocentesis) or should be considered rather early, i.e. as soon as patients do not show a clear benefit from an initial conservative treatment.


Assuntos
Transtornos da Articulação Temporomandibular/terapia , Artrocentese , Humanos , Injeções Intra-Articulares , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
J Oral Maxillofac Surg ; 77(1): 70.e1-70.e33, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30243705

RESUMO

PURPOSE: The most effective rehabilitation method for patients with edentulous posterior maxillas with an intermediate (4 to 8 mm) residual bone height (RBH) below the maxillary sinus is unclear. Evidence derived from conventional meta-analysis is limited because of the lack of head-to-head studies. This network meta-analysis (NMA) was performed to identify the most effective method to treat patients with intermediate posterior RBH. MATERIALS AND METHODS: An NMA of randomized controlled clinical trials (RCTs) was conducted to assess various rehabilitation methods using implant-supported prostheses for patients with intermediate posterior maxillary RBH (4 to 8 mm). Publications from 1970 through March 2018 in 3 major databases were searched. Parallel and split-mouth RCTs that reported the outcomes of interest with follow-up of at least 6 months from initial loading were included. Predictor variables were short implants (SIs; ≤8 mm) alone, SIs in conjunction with osteotome sinus floor elevation (OSFE) with or without bone grafting, long implants (LIs) in conjunction with OSFE with and without bone grafting, and LIs combined with lateral sinus floor elevation (LSFE) with bone grafting. Outcome variables were implant and prosthesis failure rates, marginal bone loss, and complications. Frequentist NMA was performed using STATA software. RESULTS: Twenty RCTs involving 770 patients with intermediate posterior maxillary RBH and 837 concerned maxillary sinuses who received 1,486 implants using any of the 4 rehabilitation methods were included. There were no statistically significant differences among the 4 groups for implant and prosthesis failure rates and marginal bone loss at follow-up (range, 6 months to 5 years after loading). There was a marked decrease in complications for SIs alone compared with LIs combined with LSFE. For implant and prosthesis survival rates, SIs in conjunction with OSFE with or without bone grafting ranked first as the most effective option (77.1%) followed by LIs plus OSFE with or without bone grafting (62%), LIs plus LSFE with bone grafting (43.9%), and SIs alone (24.8%). CONCLUSION: There is moderate-quality evidence derived from this NMA showing that OSFE combined with SI or LI placement with or without bone grafting or SI placement alone is superior to LI placement combined with LSFE and bone grafting when used for patients with intermediate maxillary RBH (4 to 8 mm). Furthermore, the results of this study show that LSFE for patients with intermediate RBH is not a suitable treatment option because of unjustified high cost and rate of complications.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Seio Maxilar , Levantamento do Assoalho do Seio Maxilar , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Humanos , Maxila , Metanálise em Rede , Resultado do Tratamento
10.
J Craniomaxillofac Surg ; 46(8): 1223-1231, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29929912

RESUMO

PURPOSE: The purpose of this study was to identify whether the incidence of systematically identified or incidentally encountered facial nerve branches during dissection to approach condylar fractures increases risk of transient and/or permanent facial nerve weakness. METHODS: A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when open reduction and internal fixation (ORIF) of condylar process fractures was performed using different surgical approaches. The articles had to have documented the number of encountered facial nerve branches during ORIF. The main outcome variable was transient and permanent facial nerve injury. The dependent variable was the event and/or number of encountered facial nerve branches during surgery, and how they were handled (i.e. dissected, retracted, etc.). RESULTS: A total of 1202 mandibular condylar fractures were enrolled in 29 studies. Rate of transient facial nerve injury (TFNI) was 11.3 % (136/1202). The number of facial nerve branches encountered intraoperatively was 543, namely buccal, marginal mandibular, zygomatic and temporal nerve branches. There was a significant correlation suggesting that there is a strong positive linear relationship between TFNI and encountered facial nerve branches (Coef = 0.1916, P = 0.001). There was no significant relationship between permanent facial nerve injury and encountered facial nerve branches (P = 0.808). TFNI was 4.3% and 18.7% for those studies expressly reporting that facial nerve branches were encountered incidentally without dissection and with dissection, respectively. For studies reporting deliberate and systematic facial nerve dissection, TFNI was 20.9%. Finally, studies that did not report any encounters of facial nerve branches, TFNI was 7.9 %. CONCLUSION: This meta-analysis demonstrated that manipulation of the facial nerve during different surgical approaches causes different incidences of facial nerve injury. The choice of surgical approach for a given fracture should take this into consideration.


Assuntos
Doenças do Nervo Facial/etiologia , Nervo Facial/cirurgia , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Humanos , Côndilo Mandibular/cirurgia , Fatores de Risco
11.
J Craniomaxillofac Surg ; 46(3): 398-412, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29339001

RESUMO

PURPOSE: The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches. MATERIALS AND METHODS: A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches. RESULTS: A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid approach with preauricular extension 2.3% for CNFs/CBFs. H) For preauricular approach a) deep subfascial dissection plane 0% in CHFs b) for subfascial approach using traditional preauricular incision 10% (8.5% in CHFs and 11.5% in CNFs). I) For retroauricular approach 3% for CHFs. PFNI rates reported in the literature were as follows: A) for low submandibular approach 2.2%, B) for retromandibular transparotid approach 1.4%; C) for preauricular approach 0.33%; D) for high submandibular approach 0.3%; E) for deep retroparotid approach 1.5%. CONCLUSION: According to published data for CHFs, a retroauricular approach or deep subfascial preauricular approach was the safest to protect the facial nerve. For CNFs, a transmassetric anteroparotid approach with retromandibular and preauricular extension was the safest approach to decrease risk of FNI. For CBFs, high submandibular incisions with either transmassetric anteroparotid approach with retromandibular or transmassetric subparotid approach, followed by intraoral (with or without endoscopic/transbuccal trocar) were the safest approaches with respect to decreased risk of FNI.


Assuntos
Traumatismos do Nervo Facial/epidemiologia , Fixação Interna de Fraturas , Complicações Intraoperatórias/epidemiologia , Côndilo Mandibular/lesões , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/classificação , Fraturas Mandibulares/cirurgia , Redução Aberta , Procedimentos Cirúrgicos Bucais/métodos , Humanos
12.
J Craniomaxillofac Surg ; 45(10): 1716-1723, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28843406

RESUMO

PURPOSE: The aim of this study was to identify, through meta-analysis, whether patients who require orthognathic surgery have a higher prevalence of temporomandibular disorders (TMDs) than controls, both before treatment and after. MATERIAL AND METHODS: A systematic review and meta-analysis were conducted based on PRISMA guidelines, to address the study purposes. A search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was performed to locate all pertinent articles published from inception to June 2016. Inclusion criteria were controlled clinical studies, either prospective or retrospective, and case-control studies comparing preoperative and postoperative signs and symptoms of TMDs in patients who undergo orthognathic surgery to those of a healthy volunteer population with no dentofacial deformities. The predictor variables were patients with dentofacial deformities who underwent orthognathic surgery and patients with no dentofacial deformities and with good maxillomandibular relations and normal occlusion. The outcomes variables were the weighted, prevalence rate (proportion) in signs and symptoms of TMDs in patients with dentofacial deformities and risk ratio (RR) of signs and symptoms of TMDs before and after orthognathic surgery, compared to the control group. RESULTS: A total of 542 patients enrolled in 6 studies were included in this analysis. The overall pooled weighted rate or prevalence of TMDs for orthognathic surgery patients preoperatively was 32.5% (95% CI = 26.7%-38.9%). There was a significant difference between the 2 groups with respect to TMDs before surgery, but no significant difference in TMDs after surgery. The RR for patients who had dentofacial deformities before orthognathic surgery compared with a control group was 1.634 (95% CI = 1.216-2.194; P = 0.001). The RR for patients after orthognathic surgery compared with a control group was 1.262 (0.718; 95% CI = 0.805-1.979; P = 0.311). CONCLUSION: The results of this study show that patients who are going to have a correction of their malocclusion by orthodontics and orthognathic surgery have a significant incidence of TMDs when compared to a control population, but that after treatment, the incidence of TMDs does not differ from a control population. The reasons for these findings are not clear.


Assuntos
Má Oclusão/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/etiologia , Humanos , Procedimentos Cirúrgicos Ortognáticos , Prevalência
13.
J Craniomaxillofac Surg ; 45(10): 1647-1654, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28823598

RESUMO

PURPOSE: This study compared complications between subciliary and transconjunctival approaches to the infraorbital rim/orbital floor, using systematic review and meta-analysis. MATERIALS AND METHODS: A systematic review with meta-analysis was conducted according to PRISMA guidelines. An electronic search in PubMed, Embase, and Cochrane Library was performed. Randomized controlled and controlled (retrospective or prospective) clinical studies, with the aim of comparing subciliary to transconjunctival approaches in the management of infraorbital rim/orbital floor fractures, were included. Outcome variables were lower lid malposition including ectropion, entropion, scleral shows, canthal malpositions, and others complications. An odds ratio (OR) of outcome variables, using a Mantel-Haenszel (M-H) test with 95% confidence intervals (95% CIs), was calculated using Comprehensive Meta-analysis Software. A descriptive analysis of postoperative complications was also presented. RESULTS: The subciliary approach had a significantly higher incidence of ectropion and scleral show when compared with the subconjunctival approach (p < 0.001). The subconjunctival approach had a significantly higher incidence of entropion than the subciliary approach (p < 0.001). CONCLUSIONS: Both the subciliary and the transconjunctival approaches are associated with specific complications. Overall, the transconjunctival approach shows the lowest incidence of complications.


Assuntos
Fraturas Orbitárias/cirurgia , Túnica Conjuntiva , Pálpebras , Fixação de Fratura/métodos , Humanos
14.
J Oral Maxillofac Surg ; 75(9): 1835-1847, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28419845

RESUMO

PURPOSE: There is still controversy about whether orthognathic surgery negatively or positively affects temporomandibular disorders (TMDs). The purpose of this study was to determine whether orthognathic surgery has a beneficial or deleterious effect on pre-existing TMDs. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 major databases to locate all pertinent articles published from 1980 to March 2016. All subjects in the various studies were stratified a priori into 9 categories based on subdiagnoses of TMDs. The predictor variables were those patients with pre-existing TMDs who underwent orthognathic surgery in various subgroups. The outcome variables were maximal mouth opening and signs and symptoms of a TMD before and after orthognathic surgery based on the type of osteotomy. The meta-analysis was performed using Comprehensive Meta-Analysis software (Biostat, Englewood, NJ). RESULTS: A total of 5,029 patients enrolled in 29 studies were included in this meta-analysis. There was a significant reduction in TMDs in patients with a retrognathic mandible after bilateral sagittal split osteotomy (BSSO) (P = .014), but no significant difference after bimaxillary surgery (BSSO and Le Fort I osteotomy) (P = .336). There was a significant difference in patients with prognathism after isolated BSSO or intraoral vertical ramus osteotomy and after combined BSSO and Le Fort I osteotomy (P = .001), but no significant difference after BSSO (P = .424) or bimaxillary surgery (intraoral vertical ramus osteotomy and Le Fort I osteotomy) (P = .728). CONCLUSIONS: Orthognathic surgery caused a decrease in TMD symptoms for many patients who had symptoms before surgery, but it created symptoms in a smaller group of patients who were asymptomatic before surgery. The presence of presurgical TMD symptoms or the type of jaw deformity did not identify which patients' TMDs would improve, remain the same, or worsen after surgery.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Transtornos da Articulação Temporomandibular/etiologia , Transtornos da Articulação Temporomandibular/cirurgia , Humanos , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos
15.
J Oral Maxillofac Surg ; 75(4): 805-821, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27889535

RESUMO

PURPOSE: This study was designed to determine the stability of counterclockwise rotation (CCWR) of the maxillomandibular complex (MMC) in orthognathic surgery with or without surgical correction of coexisting temporomandibular joint (TMJ) pathology. MATERIALS AND METHODS: The authors implemented a systematic review and meta-analysis. A search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was performed. Inclusion criteria were studies that analyzed CCWR of the MMC in regard to skeletal stability after orthognathic surgery in patients with or without pre-existing TMJ pathology that was or was not surgically corrected concomitantly. The predictor variables were patients who underwent CCWR of the MMC in the following subgroups: 1) healthy TMJs (presumed healthy based on history, clinical evaluation, and radiographic analysis but without magnetic resonance imaging [MRI] confirmation), 2) no TMJ assessment, 3) untreated TMJ disc displacement (confirmed by MRI), 4) TMJ disc displacement (confirmed by MRI) repositioned using Mitek anchors, and 5) reconstruction with TMJ total joint prosthesis. Outcome variables were surgical relapse for angular and linear measurements. Postsurgical mean changes for the occlusal plane (OP) and linear measurements using a fixed-effects model with a 95% confidence interval were analyzed. RESULTS: A total of 345 patients enrolled in 12 studies were included in this study. There was significant OP relapse and horizontal relapse at the B point and menton for studies with untreated TMJ disc displacement and studies without TMJ assessment (P < .005). There was significant horizontal relapse at the A point for studies with healthy TMJs, without assessment of the TMJs, and with TMJ reconstruction with total joint prostheses (P < .005). There was no significant vertical relapse at the B and A points for all subgroup analyses (P < .005). CONCLUSION: The result of the meta-analysis suggests that CCWR of the MMC is a stable procedure for patients with healthy TMJs, patients undergoing concomitant TMJ disc repositioning with Mitek anchors, and patients with TMJ patient-fitted total joint prostheses but unstable in the presence of untreated TMJ disc displacements and when TMJ status is not assessed.


Assuntos
Instabilidade Articular/fisiopatologia , Procedimentos Cirúrgicos Ortognáticos , Transtornos da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/cirurgia , Articulação Temporomandibular/fisiopatologia , Articulação Temporomandibular/cirurgia , Humanos , Rotação
16.
J Craniomaxillofac Surg ; 45(1): 131-144, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27955959

RESUMO

PURPOSE: Among the different surgical treatments for keratocystic odontogenic tumors (KOTs), there is no single method associated with a zero recurrence rate (RR). Thus, this study aimed to seek the best surgical treatment with the least RR using a weighted event rated meta-analysis. MATERIALS AND METHODS: To address our study purpose, a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was performed. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without language restrictions from inception to August 2016. Relevant articles were selected based on the following inclusion criteria: prospective, retrospective, and case series studies that assessed various treatments in non-syndromic KOTs in which RRs were included. The predictor variable was treatment groups, namely: enucleation alone, enucleation with peripheral ostectomy, enucleation with Carnoy's solution application, enucleation with cryotherapy, marsupialization alone, decompression followed by residual cystectomy, and resection. The outcome variable was RR. A weighted RR using a random effect model (because of variation in follow-up time) with a 95% confidence interval (CI) was performed. Data analysis was performed using a comprehensive meta-analysis software. RESULTS: A total of 2287 KOTs in 35 studies were included in this analysis. The weighted RR for various treatment techniques was as follows: enucleation alone (23.1%), enucleation with curettage (17.4%), enucleation and Carnoy's solution (11.5%), enucleation plus liquid nitrogen cryotherapy (14.5%), marsupialization alone (32.3%), decompression followed by residual cystectomy (14.6%), and resection (8.4%). The pooled weighted overall RR of KOTs for all different treatments was 16.6%. CONCLUSION: Radical resection remains the certain option for obtaining the lowest recurrence with KOTs. However, low recurrence accompanies enucleation with application of Carnoy's solution or cryotherapy as the first-line treatment for primary KOTs. Marsupialization (where indicated) must be followed by secondary cystectomy to minimize recurrence. We believe that to achieve the least possible morbidity, resections should be reserved for multiple recurrent lesions and possibly syndromic cases.


Assuntos
Doenças Mandibulares/cirurgia , Doenças Maxilares/cirurgia , Cistos Odontogênicos/cirurgia , Humanos , Recidiva , Resultado do Tratamento
17.
J Oral Maxillofac Surg ; 74(10): 2066.e1-2066.e12, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27371873

RESUMO

PURPOSE: To compare postsurgical skeletal stability between counterclockwise rotation (CCWR) of the maxillomandibular complex (MMC) and clockwise rotation (CWR) of the MMC for the correction of dentofacial deformities. MATERIALS AND METHODS: To address the study purpose, we designed and implemented a systematic review with meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search strategy was developed, and a search of major databases-PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)-was conducted to find all pertinent articles published from inception through March 2016. The inclusion criteria were randomized controlled trials, controlled clinical trials, retrospective studies, and case series with the aim of comparing postsurgical stability of CCWR and CWR of the MMC. The analysis was performed using lateral cephalometric analysis of postsurgical mean values and correlation between the surgical and postsurgical changes of the occlusal plane angle and linear changes at A point and B point. A weighted mean difference analysis using a random-effects model with 95% confidence intervals was performed. RESULTS: A total of 133 patients were enrolled from 3 studies (CCWR, n = 83; CWR, n = 50). All included studies were at moderate risk of bias. There was a statistically significant difference between CCWR and CWR of the MMC in the postsurgical changes of the occlusal plane angle (P = .034), but no statistically significant difference was found in the correlation between the surgical and postsurgical changes of the occlusal plane angle in the 2 groups. There was no statistically significant difference between CCWR and CWR of the MMC for stability between assessments immediately after surgery and at longest follow-up relative to the vertical and horizontal positions at A point and B point (P > .05). CONCLUSIONS: CCWR compared with CWR for the correction of dentofacial deformities in the absence of pre-existing temporomandibular joint pathology is skeletally stable relative to the postsurgical changes of the occlusal plane, as well as the vertical and horizontal changes of the maxilla and mandible.


Assuntos
Deformidades Dentofaciais/cirurgia , Mandíbula/anormalidades , Mandíbula/cirurgia , Maxila/anormalidades , Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos , Humanos , Rotação
18.
J Craniomaxillofac Surg ; 44(9): 1395-403, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27452613

RESUMO

The purpose of this study was to compare the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs) in patients who underwent enucleation with or without adjuvant therapy, to patients who underwent decompression with or without residual cystectomy. An extensive search of major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date and language restrictions from inception to December 2015. Relevant articles were selected based on the specific inclusion criteria. A weighted RR and odds ratio (OR) using a Mantel-Haenszel (M-H) test and random effect model with 95% confidence interval (CI) were performed. Meta-regression analysis was conducted to further identify the influence of the duration of follow-up periods on the overall OR. A total of 997 KOTs enrolled in 14 studies were included in this analysis. There was a significant advantage for the enucleation ± adjuvant therapy group in preventing recurrence for patients with KOTs (M-H, OR, 0.514; 95% CI, 0.302-0.875; p = 0.014). The overall pooled weighted RR for enucleation ± adjuvant therapy and decompression ± secondary cystectomy were 18.2% and 27.1%, respectively. The meta-regression analysis showed that duration of follow-up time did not significantly influence the OR of KOT recurrence (Q = 0.506, p = 0.646). In conclusion, initial cystectomy ± adjuvant therapy was associated with fewer recurrences than decompression ± secondary cystectomy.


Assuntos
Tumores Odontogênicos/terapia , Terapia Combinada , Descompressão Cirúrgica , Humanos , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Procedimentos Cirúrgicos Bucais
19.
J Oral Maxillofac Surg ; 74(10): 1974-82, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27134155

RESUMO

PURPOSE: The purpose of this study was to identify whether there is scientific evidence to support excision of the overlying mucosa (EOM) in conjunction with cyst enucleation to decrease the recurrence rate (RR) of keratocystic odontogenic tumors (KOTs). MATERIALS AND METHODS: A systematic review with meta-analysis conforming to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of 3 major databases through PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify all relevant articles published without date or language restrictions from inception to December 2015. Eligible articles were selected based on the following inclusion criteria: randomized, prospective, or retrospective studies comparing enucleation with EOM to enucleation without EOM for patients with KOTs. The predictor variable was treatment group (enucleation with EOM vs enucleation without EOM). The outcome variables were RR of KOTs, presence of epithelial islands and microcysts in the excised overlying mucosa, and correlation between recurrent cortically perforated KOTs. A weighted RR and odds ratio (OR; using a random- or fixed-effect model) and the Mantel-Haenszel test with 95% confidence interval (CI) were performed using comprehensive meta-analysis software. RESULTS: Eleven studies were included in this review. There was no significant difference between enucleation with and without EOM (random; OR = 3.259; 95%, 0.975-10.901, P = 0.055). The weighted event rates for enucleation with Carnoy's solution plus EOM and enucleation without EOM in cortically perforated lesions were 6.2% (random; 95% CI, 2.6-14) and 9.1% (random; 95% CI, 1.6-38.2), respectively. The weighted event rate for the presence of epithelial islands and microcysts in overlying mucosa of KOTs was 68.8% (random; 95% CI, 27.2-92.9). CONCLUSION: The results of this study suggest that enucleation of KOTs plus the use of Carnoy's solution or liquid nitrogen (when indicated) should be combined with EOM to obtain the lowest RR, specifically for retromandibular trigone, posterior maxillary, and cortically perforated lesions. However, the results from this study do not provide sufficient scientific evidence for EOM in combination with enucleation of KOTs.


Assuntos
Mucosa Bucal/patologia , Mucosa Bucal/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Tumores Odontogênicos/patologia , Tumores Odontogênicos/cirurgia , Ácido Acético , Clorofórmio , Crioterapia , Etanol , Humanos
20.
Br J Oral Maxillofac Surg ; 54(1): 118, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27110619

RESUMO

The publisher regrets that within the paper the following text was found which should have been removed prior to publication: "References: please check them carefully to make sure that they are numbered correctly in the text. In addition they required a lot of editing to put them into the style of the journal (see Instructions to Authors if in doubt)." Additionally, the final sentence of the conclusion has been updated to "Other variables such as cost of treatment and assessment of bone density at fracture sites using cone-beam computed tomography should also be studied to find out what differences there are between one miniplate and two miniplates for treatment of isolated fractures of mandibular angles".The publisher would like to apologise for any inconvenience caused.

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