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Introduction: Craniopharyngiomas are usually slow growing, benign epithelial tumors, arising from cell remnants of Rathke's pouch with its ultimate site of origin being the embryologic stomadeum. Although considered WHO grade I tumors, they are often locally aggressive. However, malignant transformation is extremely rare. Until now, 42 cases of malignant craniopharyngioma have been reported. In this article, the interdisciplinary, i.e. neurosurgical and maxillofacial, approach to a case of secondary malignant craniopharyngioma with multiple recurrences is discussed.Case report A 73-year-old woman with a history of recurrent, extracranially expanding craniopharyngioma was referred to the department of Neurosurgery following the MRI finding of a 7th tumor recurrence, located at the level of the right lateral orbital wall. Previously, the patient had already undergone five surgical resections and three radiotherapeutic treatments elsewhere. Histopathological examination revealed an adamantinomatous craniopharyngioma with sites of malignant transformation. Tumor resection with exenteration of the right eye was performed with an immediate reconstruction using a PEEK-PSI (Patient Specific Implant) and anterolateral thigh flap. Histopathological examination confirmed the diagnosis of craniopharyngioma with malignant transformation. Conclusions: Malignant transformation in a craniopharyngioma is uncommon but has a poor prognosis. The assumed correlation between radiotherapy and malignant transformation is not yet clearly established. Therefore, radiotherapy remains a good choice to reduce recurrence of a benign cranopharyngioma. PEEK implantation seems a safe option for allogenic reconstruction in patients with large maxillofacial defects. In complex cases the benefit of a multidisciplinary approach should not be underestimated.

The primary purpose of this study was to accurately assess linear, volumetric and morphological changes of maxillary teeth roots following multi-segments Le Fort I osteotomy. A secondary objective was to assess whether patient- and/or treatment-related factors might influence root remodeling. A total of 60 patients (590 teeth) who underwent combined orthodontic and orthognathic surgery were studied retrospectively. The multi-segments group included 30 patients who had either 2-segments or 3-segments Le Fort I osteotomy. The other 30 patients underwent one-segment Le Fort I osteotomy. Preoperative, 1 year, and 2 years postoperative cone beam computed tomography (CBCT) scans were obtained. A validated and fully automated method for evaluating root changes in three dimensions (3D) was applied. No statistical significant differences were found between multi-segments and one-segment Le Fort I for linear, volumetric and morphological measurements. The Spearman correlation coefficient revealed a positive relationship between maxillary advancement and root remodeling, with more advancement leading to more root remodeling. This research may allow surgeons to properly assess root remodeling after combined treatment of orthodontics and the different Le Fort I osteotomies., Competing Interests: Declaration of competing interest None. All authors declare that there are no conflicts of interest., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Mandibular reconstruction with free fibular flaps is frequently used to restore segmental defects. The osteosythesis, including locking and non-locking plate/screw systems, is essential to the mandibular reconstruction. Compared with the non-locking system that requires good adaption between plate and bone, the locking system appears to present a better performance by locking the plate to fixation screws. However, it also brings about limitations on screw options, a higher risk of screw failure, and difficulties in screw placement. Furthermore, its superiority is undermined by the advancing of patient-specific implant design and additive manufacturing. A customized plate can be designed and fabricated to accurately match the mandibular contour for patient-specific mandibular reconstruction. Consequently, the non-locking system seems more practicable with such personalized plates, and its biomechanical feasibility ought to be estimated. Finite element analyses of mandibular reconstruction assemblies were conducted for four most common segmental mandibular reconstructions regarding locking and non-locking systems under incisal biting and right molars clenching, during which the influencing factor of muscles' capacity was introduced to simulate the practical loadings after mandibular resection and reconstruction surgeries. Much higher, somewhat lower, and similar maximum von Mises stresses are separately manifested by the patient-specific mandibular reconstruction plate (PSMRP), fixation screws, and reconstructed mandible with the non-locking system than those with the locking system. Equivalent maximum displacements are identified between PSMRPs, fixation screws, and reconstructed mandibles with the non-locking and locking system in all four reconstruction types during two masticatory tasks. Parallel maximum and minimum principal strain distributions are shared by the reconstructed mandibles with the non-locking and locking system in four mandibular reconstructions during both occlusions. Conclusively, it is feasible to use the non-locking system in case of patient-specific mandibular reconstruction with fibular free flaps based on the adequate safety, comparable stability, and analogous mechanobiology it presents compared with the locking system in a more manufacturable and economical way., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To compare a three-dimensional (3D) artificial intelligence (AI)- driven model with panoramic radiography (PANO) and cone-beam computed tomography (CBCT) in assessing the risk of inferior alveolar nerve (IAN) injury after mandibular wisdom tooth (M3M) removal through a within-patient controlled trial., Methods: From a database of 6,010 patients undergoing M3M surgery, 25 patients met the inclusion criteria of bilateral M3M removal with postoperative unilateral IAN injury. In this within-patient controlled trial, preoperative PANO and CBCT images were available, while 3D-AI models of the mandibular canal and teeth were generated from the CBCT images using the Virtual Patient Creator AI platform (Relu BV, Leuven, Belgium). Five examiners, who were blinded to surgical outcomes, assessed the imaging modalities and assigned scores indicating the risk level of IAN injury (high, medium, or low risk). Sensitivity, specificity, and area under receiver operating curve (AUC) for IAN risk assessment were calculated for each imaging modality., Results: For IAN injury risk assessment after M3M removal, sensitivity was 0.87 for 3D-AI, 0.89 for CBCT versus 0.73 for PANO. Furthermore, the AUC and specificity values were 0.63 and 0.39 for 3D-AI, 0.58 and 0.28 for CBCT, and 0.57 and 0.41 for PANO, respectively. There was no statistically significant difference (p>0.05) among the imaging modalities for any diagnostic parameters., Conclusion: This within-patient controlled trial study revealed that risk assessment for IAN injury after M3M removal was rather similar for 3D-AI, PANO, and CBCT, with a sensitivity for injury prediction reaching up to 0.87 for 3D-AI and 0.89 for CBCT., Clinical Significance: This within-patient trial is pioneering in exploring the application of 3D AI-driven models for assessing IAN injury risk after M3M removal. The present results indicate that AI-powered 3D models based on CBCT might facilitate IAN risk assessment of M3M removal., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Objective: We analyzed the complication rates and outcomes in patients with gastrointestinal disorders who had undergone maxillofacial surgery., Study Design: We retrospectively analyzed 289 patients with inflammatory bowel disease (IBD), 142 with gastroesophageal reflux disease (GERD), and 42 with celiac disease (452 total) who had undergone oral and/or maxillofacial surgery. We examined their characteristics, medications they had taken, surgeries they had undergone, and complications they had experienced. Based on the results of univariate analysis, we selected variables for multivariable logistic regression to identify independent predictors of postoperative complications., Results: We found a complication rate of 10% in patients with IBD, 6.9% in patients with GERD, and 9.5% in patients with celiac disease. Dentoalveolar treatment was significantly associated with an increased risk of postoperative complications in patients with IBD and GERD., Conclusions: Oral and/or maxillofacial surgery is safe in most patients with IBD, GERD, and celiac disease. Preventive measures for postoperative complications should be considered in patients with IBD and GERD undergoing dentoalveolar treatment., Competing Interests: Declaration of interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Autoimmune diseases result from the immune system attacking native cells and tissues due to the recognition of "self" antigens as foreign antigens. This group of disorders is associated with an increased risk of complications after surgical interventions, as the immune system may cause tissue destruction. The study aimed to investigate the risk of surgical complications in patients with autoimmune diseases, who are at a higher risk of complications due to their condition. Among 886 patients who underwent orthognathic surgery, twelve types of autoimmune diseases with 22 patients were identified. For this case-series study, 12 patients were selected with a follow-up period of at least two years. The surgical procedures were executed by a single surgical team, which involved single or multi-piece Le Fort I osteotomy, Hunsuck/Epker modification of bilateral sagittal split osteotomy (BSSO), and/or genioplasty. The recorded outcome variables were postoperative adverse events, including respiratory or blood-related complications, wound infection, neurosensory disturbances, temporomandibular joint (TMJ) complications, and relapse. Only two patients recovered after surgery without any postoperative complications, whereas others had delayed recovery from neurosensory disturbance (5/12), infection (5/12), TMJ complications (2/12), and other complications. The findings of this study suggest that patients with autoimmune diseases undergoing orthognathic surgery are at higher risk of complications, highlighting the importance of careful consideration of patient selection and risk stratification before surgical intervention. The study also emphasizes the importance of close postoperative follow-up to detect and manage complications promptly., Competing Interests: Declaration of Competing Interest The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objectives: Dentists and oral surgeons often face difficulties distinguishing between radicular cysts and periapical granulomas on panoramic imaging. Radicular cysts require surgical removal while root canal treatment is the first-line treatment for periapical granulomas. Therefore, an automated tool to aid clinical decision making is needed., Methods: A deep learning framework was developed using panoramic images of 80 radicular cysts and 72 periapical granulomas located in the mandible. Additionally, 197 normal images and 58 images with other radiolucent lesions were selected to improve model robustness. The images were cropped into global (affected half of the mandible) and local images (only the lesion) and then the dataset was split into 90% training and 10% testing sets. Data augmentation was performed on the training dataset. A two-route convolutional neural network using the global and local images was constructed for lesion classification. These outputs were concatenated into the object detection network for lesion localization., Results: The classification network achieved a sensitivity of 1.00 (95% C.I. 0.63-1.00), specificity of 0.95 (0.86-0.99), and AUC (area under the receiver-operating characteristic curve) of 0.97 for radicular cysts and a sensitivity of 0.77 (0.46-0.95), specificity of 1.00 (0.93-1.00), and AUC of 0.88 for periapical granulomas. Average precision for the localization network was 0.83 for radicular cysts and 0.74 for periapical granulomas., Conclusions: The proposed model demonstrated reliable diagnostic performance for the detection and differentiation of radicular cysts and periapical granulomas. Using deep learning, diagnostic efficacy can be enhanced leading to a more efficient referral strategy and subsequent treatment efficacy., Clinical Significance: A two-route deep learning approach using global and local images can reliably differentiate between radicular cysts and periapical granulomas on panoramic imaging. Concatenating its output to a localizing network creates a clinically usable workflow for classifying and localizing these lesions, enhancing treatment and referral practices., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

The aim of this study was to better characterize head and neck solitary fibrous tumors (SFTs) and to evaluate surgical treatment. This retrospective study included patients who presented with head and neck SFTs. Clinical, radiological, and histological information and data regarding the treatments performed were collected. The risk of locoregional and distant metastases was calculated, and for orbital SFTs a specific classification was used. Overall, 34 patients were included. The majority of the SFTs were found in the oral cavity (n = 10), followed by the neck region (n = 8). The mean time to recurrence was 67.4 months. All patients underwent primary surgical resection. Recurrence was observed in five patients with a low risk of locoregional recurrence and distant metastasis. The treatment of choice is complete resection. Recurrence seems to be highly correlated with positive surgical margins. The safety margin should be increased when removing the lesion, and long-term follow-up should be performed., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The present aim was to estimate direct health care costs of patients suffering from post-traumatic trigeminal neuropathy (PTTN) and to compare the use of health care services, medications, and costs between temporary and persistent (>3 months) PTTN cohorts. A pre-existing clinical dataset of PTTN patients visiting a tertiary orofacial pain clinic in Belgium was utilized, including symptoms and quality of life measurements. Cost and resource utilization data were obtained by Belgium's largest health insurance provider for a period of 5 years after onset. Data from 158 patients was analyzed. The average cost per patient in the first year after injury was €2353 (IQR 1426-4499) with an out-of-pocket expense of 25% of the total cost. Hospitalization and technical interventions were the main drivers of cumulative costs, followed by consultation costs. For each cost category, expenditure was significantly higher in patients with persistent PTTN than in those with temporary PTTN (median 5-year total costs in persistent PTTN patients yielded €8866 (IQR 4368-18191) versus €4432 (IQR 2156-9032) in temporary PTTN, p <0.001) PTTN patients received repeated and frequent head and neck imaging (mean number of imaging investigations per patient was 10 ± 12). Medication consumption was high, with an unwarranted higher use of opioids and antibiotics in persistent PTTN patients. Within the limitations of this study, it seems there is a need for informing patients in detail on the inherent risks of nerve damage during dental and oromaxillofacial procedures. Every surgery should be preceded by a risk-benefit assessment in order to avoid unnecessary nerve damage., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To describe the prevalence and characteristics of patients with systemic conditions in an orthognathic surgery population., Study Design: A retrospective review was conducted of 1653 patients undergoing orthognathic surgery between 2001 and 2020. Patients were grouped per category of systemic condition and relevant information was retrieved from medical records. Clinical and perioperative characteristics were compared between patients with and without systemic conditions using χ 2 tests and 95% confidence intervals. Age was compared using a cumulative logit model., Results: The proportion of patients with systemic conditions undergoing orthognathic surgery was 16% (272 of 1653 patients). Patients with systemic conditions were on average 6 years older than patients without systemic conditions (P < .001). Significant differences in age compared to healthy patients were found for endocrinological (12 years; 95% confidence interval [CI], 8-16 years), gastrointestinal (10 years; 95% CI, 3-18 years), pneumological (5 years; 95% CI, 2-13 years), and cardiovascular disorders (17 years; 95% CI, 12-21 years)., Conclusion: Nearly 1 out of 6 patients undergoing orthognathic surgery has a systemic condition. Knowledge of the prevalence and characteristics of these patients creates awareness among surgeons and a foundation for future studies on perioperative management., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The aim of the present study was to identify the risk factors for removal of osteosynthesis material after multi-piece Le Fort I osteotomy compared to standard one-piece Le Fort I osteotomy (LF1). Medical files of patients treated with multi-piece or one-piece LF1 were retrospectively reviewed, including the indication for removal and time between insertion and removal. A total of 339 patients were included: 290 patients with LF1 and 49 patients with multi-piece LF1. Patients undergoing multi-piece LF1 had 2.7-times significantly higher (p < 0.001) relative risk of osteosynthesis removal in the upper jaw (42.9%) than patients undergoing LF1 (15.9%). Significant independent predictors of removal of osteosynthesis material after multi-piece LF1 were older age (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.0-1.2; p = 0.028), simultaneous bilateral sagittal split osteotomy (OR 7.8, 95% CI 1.2-50.3; p = 0.031), and no previous surgically assisted rapid palatal expansion (OR 0.14, 95% CI 0.03-0.69; p = 0.15). Significantly higher removal rates of osteosynthesis material were found after multi-piece LF1. Therefore, all patients must be informed of the higher risk for removal of osteosynthesis material when undergoing a multi-piece LF1., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest regarding this analysis., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The aim of the study was to quantify the postoperative condylar remodeling after Le Fort I surgery. Patients treated with a Le Fort I osteotomy were investigated. CBCT scans were acquired preoperatively, one week and one year postoperatively. A preoperative 3D cephalometric analysis was performed on the preoperative CBCT. Surgical movements were quantified using a voxel-registration based method (OrthoGnaticAnalyser). After rendering of the condyles from the CBCT, a volumetric analysis was performed. The correlation between the surgical movement of the maxilla and the postoperative condylar volume changes was determined with analysis of variance. RESULTS: A total of 45 subjects were included in this study. 47 of 90 condyles (52%) showed a mean volume reduction of 93 mm 3 (4.9 volume-%) postoperatively. The maxilla was impacted in 12 patients (2.44 ± 2.49 mm) and extruded in 33 patients (1.78 ± 1.29 mm). The maxillary impaction group showed a volume reduction of 50 ± 122 mm 3 and the extrusion group showed a mean volume gain of 21 ± 139 mm 3 (p = 0.028). CONCLUSION: Clinicians should be aware of potential condylar remodeling following solitary Le Fort I osteotomies, particularly in female patients with maxillary impaction., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: A combination of short titanium plates fabricated using additive manufacturing (AM) provides multiple advantages for complete mandible reconstruction, such as the minimisation of inherent implant deformation formed during AM and the resulting clinical impact, as well as greater flexibility for surgical operation. However, the biomechanical feasibility of this strategy is still unclear, and therefore needs to be explored., Method: Three different combinations of short mandible reconstruction plates (MRPs) were customised considering implant deformation during the AM process. The resulting biomechanical performance was analysed by finite element analysis (FEA) and compared to a conventional single long MRP., Results: The combination of a long plate and a short plate (Design 3 [LL61 mm/RL166 mm]) shows superior biomechanical properties to the conventional single long plate (Design 1 [TL246 mm]) and reveals the most reliable fixation stability among the three designs with short plates. Compared to conventional Design 1, Design 3 provides higher plate safety (maximum tensile stress on plates reduced by 6.3%), lower system fixation instability (relative total displacement reduced by 41.4%), and good bone segment stability (bone segment dislocation below 42.1 μm) under masticatory activities., Conclusions: Preclinical evidence supports the biomechanical feasibility of using short MRPs for complete mandible reconstruction. Furthermore, the results could also provide valuable information when treating other large-sized bone defects using short customised implants, expanding the potential of AM for use in implant applications., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Patient-specific mandibular reconstruction plate (PSMRP), as one of the patient-specific implants (PSIs), offers a host of benefits to mandibular reconstruction. Due to the limitation of fabricating screw hole threads in the PSMRP, 3D printed PSMRP is applied to the non-locking system directly in the mandibular reconstruction with bone graft regardless of the locking system. Since the conventional manual-bending reconstruction plate (CMBRP) provides better fixation in the locking system, it needs to be validated whether the locking PSMRP performs better than the non-locking PSMRP in the patient-specific mandibular reconstruction. Thereupon, the purpose of this study was to compare the biomechanical behavior between the locking and non-locking PSMRP. Finite element analysis (FEA) was used to conduct the biomechanical comparison between the locking PSMRP and non-locking PSMRP by simulating the momentary incisal clenching through static structural analysis. Mandible was reconstructed through the virtual surgical planning, and subsequently a 3D model of mandibular reconstruction assembly, including reconstructed mandible, PSMRP, and fixation screws, was generated and meshed for the following FEA simulations. In the form of equivalent von Mises stress, equivalent elastic strain, and total deformation, the locking PSMRP demonstrated its higher strengths of preferable safety, desirable flexibility, and anticipated stability compared with the non-locking PSMRP, indicated by much lower maximum stress, lower maximum strain and equivalent displacement. Locking PSMRP/screw system provides a better fixation effect to the patient-specific mandibular reconstruction than the non-locking one as a result of its productive fixation nature. FEA plays a paramount role in pre-validating the design of PSMRP through the biomechanical behavior evaluation in static structural analysis., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: To develop and validate a layered deep learning algorithm which automatically creates three-dimensional (3D) surface models of the human mandible out of cone-beam computed tomography (CBCT) imaging., Materials & Methods: Two convolutional networks using a 3D U-Net architecture were combined and deployed in a cloud-based artificial intelligence (AI) model. The AI model was trained in two phases and iteratively improved to optimize the segmentation result using 160 anonymized full skull CBCT scans of orthognathic surgery patients (70 preoperative scans and 90 postoperative scans). Finally, the final AI model was tested by assessing timing, consistency, and accuracy on a separate testing dataset of 15 pre- and 15 postoperative full skull CBCT scans. The AI model was compared to user refined AI segmentations (RAI) and to semi-automatic segmentation (SA), which is the current clinical standard. The time needed for segmentation was measured in seconds. Intra- and inter-operator consistency were assessed to check if the segmentation protocols delivered reproducible results. The following consistency metrics were used: intersection over union (IoU), dice similarity coefficient (DSC), Hausdorff distance (HD), absolute volume difference and root mean square (RMS) distance. To evaluate the match of the AI and RAI results to those of the SA method, their accuracy was measured using IoU, DSC, HD, absolute volume difference and RMS distance., Results: On average, SA took 1218.4s. RAI showed a significant drop (p<0.0001) in timing to 456.5s (2.7-fold decrease). The AI method only took 17s (71.3-fold decrease). The average intra-operator IoU for RAI was 99.5% compared to 96.9% for SA. For inter-operator consistency, RAI scored an IoU of 99.6% compared to 94.6% for SA. The AI method was always consistent by default. In both the intra- and inter-operator consistency assessments, RAI outperformed SA on all metrics indicative of better consistency. With SA as the ground truth, AI and RAI scored an IoU of 94.6% and 94.4%, respectively. All accuracy metrics were similar for AI and RAI, meaning that both methods produce 3D models that closely match those produced by SA., Conclusion: A layered 3D U-Net architecture deep learning algorithm, with and without additional user refinements, improves time-efficiency, reduces operator error, and provides excellent accuracy when benchmarked against the clinical standard., Clinical Significance: Semi-automatic segmentation in CBCT imaging is time-consuming and allows user-induced errors. Layered convolutional neural networks using a 3D U-Net architecture allow direct segmentation of high-resolution CBCT images. This approach creates 3D mandibular models in a more time-efficient and consistent way. It is accurate when benchmarked to semi-automatic segmentation., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: This study aimed to perform a surgery-related and patient-related outcome analysis of a case-matched series of patients treated with computer-assisted surgery (CAS) and traditional freehand surgery., Methods: A total of 153 patients who underwent mandibular reconstruction by VFF were included from Jan 1999 to Dec 2019. The mandibular resection and reconstruction were performed by four experienced oral and maxillofacial surgeons. Reasons for reconstruction were oncologic, osteoradionecrosis, trauma, and osteoporosis. All the patients were followed up postoperatively for at least 1 year. Eighteen pairs were formed with the matched cohort consisting of a total of 36 patients who underwent primary mandibular reconstruction without additional combined flaps. The surgery-related and patient-related continuous and categorical parameters were assessed in both groups., Results: The average operation time and bleeding volume in the CAS group were less than those in the non-CAS group. Additionally, both hospitalization and ICU days were lower in the CAS group without any significant difference. The only significant finding related to surgical parameters was observed for the ischemia time, which was lower in the CAS group., Conclusions: Computer-assisted surgery indicated improved efficiency considering reduced ischemia time, operation time, and length of hospital stay with lower early complications than that of conventional surgical procedures. It can thus be considered as an optimized alternative to the freehand approach., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to analyze patients with thrombophilia who underwent oral and/or maxillofacial surgery at our center., Study Design: We performed a retrospective analysis of patients with hereditary or acquired thrombophilia who had undergone oral/maxillofacial surgery between January 1, 2000 and December 31, 2019. Data regarding demographic and patient characteristics, surgical treatment modalities, antithrombotic therapies, and complications were analyzed., Results: A total of 76 eligible patients (26 male, 50 female) were included in this study, with a mean follow-up period of 3.8 months (range, 0-51 months). The mean age at time of surgery was 44.7 ± 19.4 years. Seven different hereditary and acquired thrombophilia were identified: factor V Leiden (n = 31; 40.8%), prothrombin G20210A mutation (n = 5; 6.6%), protein C deficiency (n = 4; 5.3%), protein S deficiency (n = 11; 14.5%), antiphospholipid syndrome (n = 10; 13.2%), hyperhomocysteinemia (n = 8; 10.5%), and elevated factor VIII (n = 2; 2.6%). Complications occurred in 9 patients (11.8%) and included postoperative infections (n = 6; 7.9%) and postoperative bleeding (n = 3; 3.9%)., Conclusion: Our data suggest that oral and/or maxillofacial surgery in patients with a confirmed diagnosis of thrombophilia is not associated with a burden of thrombosis or high complication rates. Furthermore, we formulated a guideline for preoperative antithrombotic therapy for patients with thrombophilia undergoing oral and/or maxillofacial surgery., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: This study proposed and investigated the performance of a deep learning based three-dimensional (3D) convolutional neural network (CNN) model for automatic segmentation of the pharyngeal airway space (PAS)., Methods: A dataset of 103 computed tomography (CT) and cone-beam CT (CBCT) scans was acquired from an orthognathic surgery patients database. The acquisition devices consisted of 1 CT (128-slice multi-slice spiral CT, Siemens Somatom Definition Flash, Siemens AG, Erlangen, Germany) and 2 CBCT devices (Promax 3D Max, Planmeca, Helsinki, Finland and Newtom VGi evo, Cefla, Imola, Italy) with different scanning parameters. A 3D CNN-based model (3D U-Net) was built for automatic segmentation of the PAS. The complete CT/CBCT dataset was split into three sets, training set (n = 48) for training the model based on the ground-truth observer-based manual segmentation, test set (n = 25) for getting the final performance of the model and validation set (n = 30) for evaluating the model's performance versus observer-based segmentation., Results: The CNN model was able to identify the segmented region with optimal precision (0.97±0.01) and recall (0.96±0.03). The maximal difference between the automatic segmentation and ground truth based on 95% hausdorff distance score was 0.98±0.74mm. The dice score of 0.97±0.02 confirmed the high similarity of the segmented region to the ground truth. The Intersection over union (IoU) metric was also found to be high (0.93±0.03). Based on the acquisition devices, Newtom VGi evo CBCT showed improved performance compared to the Promax 3D Max and CT device., Conclusion: The proposed 3D U-Net model offered an accurate and time-efficient method for the segmentation of PAS from CT/CBCT images., Clinical Significance: The proposed method can allow clinicians to accurately and efficiently diagnose, plan treatment and follow-up patients with dento-skeletal deformities and obstructive sleep apnea which might influence the upper airway space, thereby further improving patient care., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: The planning accuracy and stability during follow-up of segmented Le Fort I osteotomy, often evaluated using 2D cephalometry and dental cast analysis, is controversial. The aim of this study is to develop and validate a 3D semi-automatic, voxel-based registration assessment protocol to evaluate planning accuracy and stability of segmented Le Fort I osteotomy with individualization of the maxillary segments., Methods: Preoperative, immediate postoperative and six months postoperative CBCT images were used to evaluate accuracy and stability of the individual segments in 20 patients (13 female; 7 male) who underwent segmented Le Fort I osteotomy. Three translational (left/right, intrusion/extrusion, anterior/posterior) and three rotational (pitch, roll, yaw) dimensions were calculated for each maxillary segment by means of a user-friendly module. Inter- and intra-observer Inter Class Coefficient (ICC) and mean absolute difference (MAD) were calculated., Results: The inter- and intra-observer reliability ICC varied between 0.93 and 0.99 for the translational and rotational accuracy and stability assessments, indicating excellent reliability. The MAD ranged between 0.21 mm and 0.32 mm for the translational error and between 0.6° and 0.9° for the rotational dimension., Conclusions: The 3D assessment protocol for accuracy of segmented Le Fort I planning and short-term follow-up, proved to have high reliability with only a small margin of error., Clinical Significance: The proposed 3D assessment protocol allows future in-depth analysis of segmented Le Fort I osteotomy and might implicate future improvement where necessary., (Copyright © 2021. Published by Elsevier Ltd.)

The aim of this article is to evaluate the early and late morbidities of the donor- and recipient-site in patients undergoing mandibular reconstruction using either vascularized fibular flap (VFF) or vascularized iliac flap (VIF). Electronic databases, including PubMed, Web of Science, Cochrane Central and Embase, were explored for literature published until October 2020. A total of twenty-four articles reporting complications following mandibular reconstruction surgery with follow-up periods ranging from six to 63 months were selected based on the exclusion criteria. For each research, the JBI Critical Assessment Tool and the ROBINS-I Tool were used to analyze the methodological quality and the risk of bias. A single-arm meta-analysis was performed to have a synthesized analysis of the donor- and recipient-site early and late morbidities. Results showed that the early morbidities in VFF group ranged from 3% to 12%, and the late morbidities in VFF group ranged from 5% to 67%. In VIF group, the early morbidities ranged from 3% to 16%, and the donor-site late morbidities ranged from 6% to 43%. Complications with the top three morbidities in the VFF group were: chronic sensory disturbances at the donor-site (67%), malocclusion (22%) and chronic lower limb weakness (20%); and in the VIF group were: chronic sensory disturbances at the donor-site (43%), chronic pain at the donor-site (26%), chronic gait disturbance (20%). Further controlled clinical trials are needed to assess the long-term outcome of VFF or VIF grafting., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: To assess the anatomical and tactile quality of 3D printed models derived from medical printers for application in orthognathic surgery., Methods: A CBCT-scan of an 18 years old female patient was acquired with NewTom VGi evo (NewTom, Verona, Italy). Thereafter, mandibular bone was segmented and isolated from the scan using Mimics inPrint 2.0 software (Materialise NV, Leuven, Belgium). Six printers with different technologies were utilized for printing skeletal models, which included stereolithography (ProX800, 3D Systems, Rock Hill, SC, USA), digital light processing (Perfactory 4 mini XL, Envisiontec, Dearborn, MI, USA), fused deposition modeling (uPrint SE, Stratasys, Eden Prairie, MI, US), colorjet (ProJet CJP 660Pro, 3D Systems, Rock Hill, SC, USA), multijet (Objet Connex 350, Stratasys, Eden Prairie, MN, USA) and selective laser sintering (EOSINT P700, EOS GmbH, Munich, Germany). A questionnaire was designed, where 22 maxillofacial residents scored whether the printed models were able to mimic bone color, texture and anatomy. Five maxillofacial surgeons performed bone cutting with screw insertion/removal to assess the tactile perceptibility., Results: In relation to texture and cortical and medullary anatomy replication, Perfactory 4 mini XL printer showed the highest mean score, whereas, Objet Connex 350 scored highest for color replication. The haptic feedback for cutting and screw insertion/removal varied for each printer, however, overall it was found to be highest for ProX800, whereas, EOSINT P700 was found to be least favorable., Conclusions: The digital light processing based Perfactory 4 mini XL printer offered the most acceptable anatomical model, whereas, deficiencies existed for the replication of haptic feedback to that of real bone with each printer., Clinical Significance: The study outcomes provide pearls and pitfalls of 3D printed models utilizing various printers and technologies. There is a need for research on multi-material printing as such to improve the haptic feedback of skeletal models and render the models more human bone-like to improve surgical planning and clinical training., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: The initial position of an impacted maxillary canine might influence the outcome of surgically assisted exposure and orthodontic alignment. Therefore, the purpose of this study was to evaluate existing correlations between the initial position of the maxillary canine and the outcomes of treatment., Methods: A retrospective cohort study was designed, containing data of 132 patients (47 males, 106 females; median age at the date of surgical exposure 14 ± 4.6 years; range, 10-39 years) with a total of 153 impacted maxillary canines. The sample was based on orthodontic referrals over 4 years at the Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, the Netherlands. The esthetic outcome, treatment duration, and success and failure rate were investigated in relation to the initial position of the maxillary canine as assessed on pretreatment panoramic radiographs (vertical and anteroposterior sector position and angulation of the canine [α-angle]). The esthetic evaluation was performed using the Maxillary Canine Aesthetic Index. The success of treatment was defined as achieving a fully functional eruption of the canine, with an esthetically excellent result, without the need for reinterventions. Failure of treatment was defined as the need for reintervention or removal of the canine., Results: In 96% of the impacted canines, a successful orthodontically assisted eruption was achieved. Age, vertical distance, and angulation are predictors of the esthetic outcome of impacted canines after treatment. Age, bilateral impaction, sector, vertical distance, and angulation are predictors of treatment duration. Age, vertical distance, and buccolingual position are predictors of the need for reintervention., Conclusions: Pretreatment radiographic variables can help in predicting the outcome and treatment duration of surgically exposed maxillary impacted canines., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

The aim of this review was to investigate the skeletal and soft tissue stability of isolated advancement genioplasty after more than 1 year, and to observe the influence of associated risk factors. A literature search was performed on PubMed, Web of Science, Embase, ScienceDirect, and Cochrane. Only studies with at least 10 patients who underwent an isolated advancement genioplasty, and with a follow-up period of at least 1 year, were included. Of the 2224 records initially identified, eight articles met the eligibility criteria. The mean age of the total study population was 23 years and ranged from 19.1 to 26.5 years in the individual studies. The average surgical advancement at pogonion was 8.2 mm and ranged from 6.2 to 11.7 mm in the individual studies. After 1 year, the horizontal hard tissue relapse at the level of pogonion varied from 0.1 to 2.1 mm. In two studies, this was reported as statistically significant. Regarding the soft tissue, the horizontal relapse varied from 0.3 to 2.9 mm, which was also considered statistically significant in two studies. Isolated advancement genioplasty was found to be a predictable and stable orthognathic procedure in the sagittal plane at both soft and hard tissue levels. The amount of relapse was not associated with the fixation method or with the amount of surgical advancement., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: To date, there is a lack of evidence related to the long-term evaluation of recipient-site functional outcomes following mandibular reconstruction with vascularized bone grafts. Therefore, the aim of this systematic review and meta-analysis was to evaluate the long-term recipient-site functional outcomes in oral oncology patients who require mandibular reconstruction with either vascularized fibular flap (VFF) or vascularized iliac flap (VIF)., Methods: An extensive electronic search was conducted in PubMed, Web of Science, Cochrane, and Embase databases for identifying articles published until April 2020. All papers were dual screened for eligibility in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. The risk of bias was assessed using the MINORS tool. A meta-analysis of functional outcome parameters was performed to estimate single incidence rates., Results: A total of 257 patients with a mean follow-up period of 38.6 ± 19.5 months were included in this meta-analysis, where 174 patients underwent VFF reconstruction and 83 patients involved reconstruction with VIF. The functional outcomes in patients reconstructed with VIF showed improved scoring for mastication, deglutition, diet, and speech. Speech showed highest score among all functional parameters, whereas, mastication was the most poorly recovered parameter in relation to reconstruction with both flaps. No significant difference in functional outcomes was observed between both flaps., Conclusion: Current evidence seems to indicate that VIF offers improved long-term recipient-site functional outcomes. Yet, considering a high level of data heterogeneity in published studies, future long-term standardized comparative studies should be conducted., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Biofilm infections pose a rising threat to public health due to its existing protective shield, which preventing biocide penetration. Here, the oleate-capped iron oxide nanoparticles (OIONPs) were synthesized by the high-temperature method first; after then, the poly(acrylic acid)-capped iron oxide nanoparticles (PIONPs) were obtained via a ligand exchange reaction between OIONPs and sodium poly(acrylic acid). The physicochemical properties of PIONPs were evaluated by Fourier-transform Infrared Spectroscopy (FT-IR), X-ray Diffraction (XRD), Scanning Transmission Electron Microscopy (STEM), Dynamic Light Scattering (DLS), and zeta potential. The FT-IR analysis confirmed the successful ligand exchange on the surface of iron oxide nanoparticles. STEM images displayed that the prepared PIONPs were monodisperse spherical nanoparticles. The PIONPs were stable in ultrapure water and could be kept for 5 weeks without aggregation. Next, Cell Counting Kit-8 (CCK-8) assay and fluorescent images confirmed the excellent cytocompatibility of PIONPs, while the iron concentration of PIONPs was in the range of 5∼120 mg/L. Finally, PIONPs exhibited efficient antibacterial activity against E. coli and S. aureus, and Staphylococcus aureus subsp. aureus Rosenbach (SASAR) biofilm could be destroyed by treating PIONPs under alternating current (AC) applied field conditions., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: The primary objective of this study was to compare the aesthetic outcome of palatally impacted canines treated with an open or closed surgical exposure technique using the Maxillary Canine Aesthetic Index (MCAI) at least 1 year after debonding. Secondary objectives were set on the periodontal outcome, tooth color, pulpal status, and self-reported contentment., Methods: The sample of this retrospective study consisted of 53 patients with an average age of 20 years and 7 months at the time of the investigation. A total of 53 canines were investigated. All canines were aesthetically scored with the MCAI. Other outcome variables were investigated, such as gingival inflammation, pocket probing depth, vitality, percussion sensitivity, and tooth color. All patients received a questionnaire to evaluate their appraisal of different parameters., Results: A statistically significant difference (P < 0.001) was found between the groups treated with an open and closed technique in terms of the MCAI. The closed technique scored excellent in terms of aesthetics, whereas the open technique scored good. The closed technique had more discoloration (P < 0.001) and a delayed response to the cold test (P = 0.021). In general, patients were satisfied with both techniques but considered the treatment time to be very long., Conclusions: A closed surgical exposure of palatally impacted maxillary canines is preferred in terms of aesthetics when measured with the MCAI. There was no difference between the 2 techniques in terms of periodontal outcome. Canines treated with a closed exposure tended to have a darker color and delayed response to cold testing., (Copyright © 2020 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: Surgically assisted rapid palatal expansion (SARPE) is a well-known surgical intervention for treating maxillary transverse deficiencies (MTDs). This investigation aimed to evaluate the complication rate after SARPE, and its relationship to patient age., Materials and Methods: Based on multivariate analyses, the complication rate after SARPE and its association with increasing age in 111 patients with MTD was evaluated. In every case the following variables were evaluated: age, gender, concomitant surgery, expander appliance, perioperative and dental complications, pain score, neurosensory disturbances (NSDs), postoperative excessive haemorrhage, length of hospital stay, infection, oronasal communication, palatal ulceration, asymmetrical maxillary expansion, mal- or non-union of the bone, lacrimation, and mechanical failure., Results: Overall, 58 (52.25%) patients had minor-to-severe complications. The most common complications were NSDs (27.03%) and postoperative pain (13.51%). Multivariate analysis showed that the frequency of dental complications (mean age 35.9; SD = 10.5140; p = 0.0021∗), NSDs in general (mean age 30; SD = 9.9827; p = 0.0157∗), NSDs lasting more than 4 weeks (mean age 30,9583; SD = 10.6260; p = 0.0105∗), and NSDs lasting more than 1 year (mean age 36.2; SD = 8.7579; p = 0.0201∗) increased significantly with patient age., Conclusion: Detailed data analysis revealed a limited number of severe, long-term complications after SARPE. However, careful patient selection is recommended in elderly cases., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: We evaluated the accuracy of computer-assisted mandibular reconstructions., Patients and Methods: We retrospectively reviewed data for 26 patients who had mandibular reconstruction with a microvascular free fibula flap, January 2015 to June 2018. Postoperative mandible models were obtained from computed tomography scans. After registering the models to the corresponding preoperative plan, we performed comparative measurements. Patients were grouped by condylar involvement and subdivided based on number of fibular segments used for reconstruction. For each segment, we measured length and osteotomy angles. For the final postoperative outcome, we compared intercoronoid, intergonial, and anteroposterior distances and intersegmental plane shift., Results: Means (SD) for deviation of each osteotomy angle and fibular segment length were 1.98° (2.98) and 1.78 mm (2.69), respectively, remaining constant across subgroups. Other mean values were as follows: intercoronoid distance deviation, 3.86 mm (range, 0.20-11.21 mm); intergonial distance deviation, 3.14 mm (range, 0.05-8.28 mm); anteroposterior distance deviation, 2.92 mm (range, 0.03-8.49 mm); and intersegmental plane shift, 11.00° (range, 2.76-24.15°). Where the condyle was preserved, the intercoronoid and intergonial deviation means differed significantly (respectively 5.02 mm and 4.88 mm, both P < 0.05) for one-segmented and three-segmented fibular reconstructions. Furthermore, reconstructions involving the condylar region compared with condyle preservation showed significantly different intersegmental plane shifts (7.18°; P < 0.05)., Conclusion: Computer-assisted surgery provides cutting guides for obtaining accurate fibular segments, but current fixation methods lead to inaccuracies and reproducibility errors. In multisegmental transfer with condylar involvement, computer-assisted fixation is recommended to ensure accuracy of the preoperative plan., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The orbital floor (OrF) and infraorbital rim (IOR) repair in cases of complete destruction is challenging mainly due to the fact that the defect length cannot be measured. The aim of the current study is to develop a method of calculating the Orf length by using the gender and the lengths of the medial, superior and lateral orbital walls (OrW) of the same orbit., Material and Methods: Ninety-seven (59 male and 38 female) European adult dry skulls were classified according to age: 20-39, 40-59 and 60 years and above. The length of each OrW was measured by using the direct distance between the optic foramen and a landmark in each orbital rim., Results: A side asymmetry was detected for the lengths of the inferior, superior and medial OrW. Although a gender dimorphism was detected, no correlation with the age was found. Using the Stepwise multiple regression analysis two formulas were developed, one for the right and one for the left OrF with coefficient of determination R 2 0.43 and 0.57, respectively., Conclusions: The proposed formulas represent a simple, applicable and individualized method to calculate the OrF linear length in cases of complete destruction of the IOR and OrF, with accuracy and without the use of expertise material. Such data may improve the surgery planning of orbital floor fractures and complex orbital reconstructions., (Copyright © 2018. Published by Elsevier Ltd.)

Objectives: Ameloblastoma is a benign, slow-growing, locally invasive epithelial tumor of odontogenic origin, with unlimited growth capacity and a strong tendency to recur. This multicentric study analyzed ameloblastoma diagnosed in Nigeria among different ethnic groups., Study Design: This retrospective study included ameloblastoma cases diagnosed from 1964 to 2017 at 10 hospitals or medical centers in Nigeria. Age, sex, tribe, and location of the ameloblastoma in the jaw were analyzed. Associations between variables were tested by using χ 2 and Fisher's exact test., Results: A total of 1246 ameloblastoma cases were recorded (mean patient age 32.51 ± 14.54 years; range 4-86 years; male-to-female ratio 1.2:1). Approximately 60% of ameloblastoma cases occurred in young adults (age range 18-40 years). Ninety-eight lesions were located in the maxilla and 1103 in the mandible; the posterior mandible was the most common site (31.3% on the right and 26.5% on the left, respectively), followed by the anterior (26.0%) mandible. No significant differences were noted in the distribution of ameloblastoma within the tribes with respect to age (P = .92) and sex (P = .71)., Conclusions: The mandible is a common site of ameloblastoma in patients in Nigeria, and in most cases, it occurs in young adults. Early presentation, diagnosis, and treatment are important to reduce postoperative disfigurement and morbidity., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Bilateral sagittal split ramus osteotomy (BSSO) surgery is used to correct various dento-skeletal deformities. Clinical outcomes are critically dependent on accurate and proper positioning of skeletal units created by BSSO. Monitoring skeletal changes postoperatively is a major part of follow-up. Between January 2015 and December 2015, 24 patients underwent BSSO surgery without any other segmental osteotomy (mean age, 29.9 ± 14.2 [range, 17-67] years; 18 females). Cephalometric X-rays and cone-beam computed tomography scans were performed 6 weeks and 12 months postoperatively. We compared the position displacement at three mandibular points at both postoperative time points using 2- and 3-dimensional analysis separately and examined the relationship between these methods. Horizontally in at least in 14/24 patients, the difference between 2-dimensional and 3-dimensional measurements was >1 mm. Vertically in at least in 16/24 patients, the difference between 2-dimensional and 3-dimensional measurements was >1 mm. A scatter plot with orthogonal regression indicated the relationships between the 2-dimensional measurement and the corresponding 3-dimensional measurement in the horizontal and vertical directions. Skeletal relapse with 2-dimensional-measurements differed significantly from the 3-dimensional measurements. There was no evidence of a relationship between the two types of measurements regarding the direction and the location of the landmarks., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

This study evaluated the impact of class III correction by elastic traction on four miniplates and the failure rate of bone-anchored miniplates in nonsyndromic patients. A total of 218 patients (112 males and 106 females; average 11.4 years), treated by 38 orthodontists, received four miniplates (total 872 miniplates) from 2008 to 2016 at three maxillofacial centers in two countries. Factors affecting the success and failure of the miniplates were retrospectively examined and skeletal changes on cephalometric radiographs examined for 52 patients. Elastic traction was performed for 22.9 months, on average. The miniplate survival rate was 93.6%; 25.7% of the patients suffered failure of one of the miniplates. Postoperative antibiotics and placement of the neck of the miniplate in the attached gingiva significantly improved the success rate. Miniplate failure was six times higher in the maxilla and occurred more in younger patients. Self-drilling screws were significantly better than self-tapping screws for fixing the miniplate. Small cephalometric changes were seen: SNA (+1.9°), SNB (+0.4°), ANB (+1.4°), Wits analysis (+1.3 mm). In conclusion, bone-anchored maxillary protraction on four miniplates is an effective method for correcting a class III relationship, but has less skeletal effect than previously reported in the literature., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Orthognathic surgery is indicated for the treatment of significant skeletal malocclusions and facial dysmorphosis. Recent technological developments allow surgeons to virtually plan the orthognathic jaw movements. When producing intermediate splints, overlap between the upper and lower dentitions can occur. Autorotation of the mandible is often used as a solution for this problem. The purpose of this study was to present an optimized approach to fabricate digital intermediate splints based on the use of a scanned thick wax bite to overcome dental overlap during planning. Twenty patients (9 males and 11 females) undergoing bimaxillary orthognathic surgery participated in this prospective study. Planning of the maxillary movements was conducted by the same surgeon. The thick wax bite was scanned using an intraoral scanner and a special CBCT protocol. The fabrication of the intermediate splints was done by means of conventional model surgery and virtual 3D planning-printing. The splints were clinically assessed by comparing the digitally printed intermediate splints to the corresponding conventional set-up which served as the clinical standard. Moreover, reproducibility and comparison tests between the scanned wax bites were implemented. The root mean square (RMS) for the reproducibility and comparison tests was respectively 0,15 mm (SD 0,24 mm) and 0,19 mm (SD 0,08 mm). 19 out of the 20 intermediate digitally 3D printed splints were clinically accepted. This proposed protocol can be considered as an optimization to the current 3D planning protocols of bimaxillary orthognathic surgery., (Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

We present the case of a 32-year-old male patient complaining of recurrent mandibular pain for 3.5 years. Panoramic radiography indicated increased cortical density of the mandibular lower border. Scintigraphy and single-photon emission computed tomography revealed metabolic hyperactivity in that region without pathologic lymph nodes. A bone biopsy specimen of the mandibular lower border did not have inflammation or cytologic atypia. Endocrinologic investigation confirmed secondary hyperparathyroidism as a result of hypovitaminosis D. Several weeks after starting therapy with oral vitamin D supplements, the symptoms completely disappeared. Increased cortical density is a rare manifestation of secondary hyperparathyroidism, which normally causes the lamina dura to vanish and produces a ground-glass appearance as a result of blurring of the trabecular bone pattern. Because focal hyperostosis can have multiple benign or malignant causes, radiologic examination of the jaw bones is indispensable for evaluating orofacial pain. Increased cortical density may be caused by metabolic diseases, requiring further investigations, including biopsy and blood analysis., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate the bacterial population in patients with medication-related osteonecrosis of the jaw (MRONJ) after treatment with doxycycline and metronidazole., Study Design: A total of 38 patients with MRONJ (age range 55-88, mean age 73 + 8.82 standard deviation) treated with doxycycline first and with metronidazole second were enrolled in this study. Two swabs were taken at the margin of the infected MRONJ lesion after applying pressure on the marginal mucosa, and visible pus was secreted. Real-time polymerase chain reaction was used to analyze 20 periopathogenic and commensal species and the total bacterial level. Bacterial counts were compared between antibiotic treatments and with a control group of orally healthy patients who didn't have periodontal pockets of more than 3 mm (n = 29) by means of a Mann-Whitney U test. Comparisons between the two antibiotic treatments were performed by a paired Wilcoxon signed rank test., Results: The total bacterial level was significantly higher in the MRONJ patients treated with systemic antibiotics compared with the control group. However, significant lower bacterial amounts were found for 12 of the 20 investigated bacteria. We couldn't establish a significant advantage of metronidazole administration after doxycycline treatment., Conclusion: Our findings suggest that the total bacterial level in MRONJ patients is higher even when treated with systemic antibiotics. The significantly different bacterial amounts of the selected species suggest an alteration in the microbial population., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The soft-tissue pogonion closely follows changes of the bony pogonion, but it is unknown how often an augmented bony pogonion reaches the intended position. Here we assessed the agreement between planned surgical changes and achieved results in chin surgery., Materials and Methods: Surgical treatment was planned based on clinical examination, cast model analysis, and cephalometric image analysis. The mobile chin segment was stabilized using one chin plate. Preoperative and postoperative cephalometric X-ray images were digitized, and cephalometric tracing was performed. We calculated and analyzed the changes between the preoperative and postoperative images as well as between planned genioplasty movements and actual surgical changes in the horizontal and vertical directions., Results: This study included 36 patients. In 34 patients, the absolute mean horizontal difference was less than 2 mm. We found a higher range of absolute error in vertical (0.00-5.60) compared to horizontal (0.01-3.64) movement. There was no significant difference between the mean planned chin movement and the mean achieved position with regard to the horizontal and vertical movement (p = 0.97 and 0.79, respectively)., Conclusions: The mean values for linear difference in both the horizontal and vertical directions were in line with the acceptable mean of ≤2 mm proposed in the literature., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: Tooth autotransplantation (TAT) offers a viable biological approach to tooth replacement in children. To enhance the outcome predictability of the TAT procedure, a cone-beam computed tomographic (CBCT)-based surgical planning and transfer technique has been developed. The aim of this study was to optimize the CBCT scanning protocol to achieve a dose as low as possible and to maintain sufficient image quality., Methods: A sectional head phantom (SK150; The Phantom Laboratory, Salem, NY) was scanned using 18 exposure protocols in 3 different CBCT machines: 3D Accuitomo 170 (Morita, Kyoto, Japan), ProMax 3D MAX (Planmeca, Helsinki, Finland), and NewTom VGI EVO (QR Verona, Verona, Italy). The effective dose (ED) was calculated using Monte Carlo simulation and pediatric voxel phantoms (5- and 8-year-old males and a 12-year-old female). Image quality was assessed by comparing segmented teeth volumes, evaluation of the visibility of the lamina dura, and morphologic surface analysis of 3-dimensional models. A general linear mixed model was fit to combine image quality parameters and radiation effective dose for each protocol in order to rank and compare the protocols examined in the study., Results: The ED for the preoperative scan can be reduced to the range of 74.6-157.9 μSv, with ProMax with ultra-low-dose high-definition reconstruction (Planmeca) 100 × 90 scoring the highest. The ED for the postoperative scan can be reduced to the range of 24.2-41.5 μSv with ProMax with ultra-low-dose normal-dose reconstruction 50 × 55 and NewTom 50 × 50 with the standard mode scoring the highest., Conclusions: A considerable reduction in the pediatric ED can be achieved while maintaining sufficient image quality for tooth autotransplantation planning and follow-up using the dose optimization protocols., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: We evaluated the effectiveness of a custom-made neurostimulator with which to treat patients for refractory trigeminal neuropathic pain (TNP) at the level of the Gasserian ganglion., Materials and Methods: A retrospective analysis of 22 patients referred to our pain clinic, AZ Sint-Nikolaas, between 2010 and 2015, was conducted using the McGill Pain and EuroQoL questionnaire before, two weeks after, and at the final follow-up after neurostimulator treatment., Results: Successful test stimulations were achieved for 77.3% of patients, with satisfactory long-term pain relief reported by 44% at 24 months. The predictive value of the trial stimulation was 80%, with 82.4% of patients reporting one or more complication, the most common being neck discomfort due to fibrosis. A small cohort size (22) limited our statistical analyses. However younger patients presented with a higher incidence of negative results after 24 months or physical complications. Cut-off ages were set at the age of 62 and 58 years respectively., Conclusion: Stimulation of the Gasserian ganglion is a promising technique for the treatment of refractory TNP and should be considered ahead of more invasive techniques such as motor cortex or deep brain stimulation. The referral of refractory TNP patients should also be accomplished as early as possible to improve outcome., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to evaluate the volumetric accuracy and reliability of cone beam computed tomography (CBCT)-based tooth segmentation using 4 different CBCT exposure protocols., Methods: Two dry, intact adult human mandibles of unknown gender were scanned using 4 different CBCT exposure protocols (3 CBCT systems). The available mandibular premolars (3 per mandible) were segmented, resulting in a total of 24 segmented teeth. To assess the accuracy of the segmented teeth, volumetric and morphologic differences between the real anatomic teeth and the reconstructed images were evaluated both physically and using a high-resolution micro-computed tomography system., Results: Results revealed a high accuracy of CBCT reconstructed images when comparing volumetric measures of CBCT-based segmented premolars to physical measurements of corresponding physical teeth. Volumetric differences were below 2%. Morphologic differences using the segmented model and the corresponding micro-computed tomography scans of the physical teeth indicated that when inaccuracies occurred, they were at the apical and coronal parts of the tooth., Conclusion: Based on these results, CBCT can be used as a tool for segmentation and pretherapeutic planning procedures., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: This study investigated the prevalence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) and compared patient profiles and outcomes between HPV-positive and HPV-negative groups., Study Design: This retrospective study included all patients treated for OPSCC in the University Hospitals of Leuven between 2004 and 2012. Paraffin-embedded tumor tissue was available for all patients. Patient characteristics, treatment, and follow-up data were retrieved from medical files. HPV status was determined by immunohistochemical staining for the p16 epitope., Results: Among 94 patients, the prevalence of HPV-positive OPSCC was 22.34%. Compared with HPV-negative tumors, HPV-positive tumors were correlated with less smoking and alcohol consumption, tonsillar sublocalization (P < .05), and younger age. HPV-positive OPSCC was associated with better overall survival (62.2%) compared with HPV-negative OPSCC (42.5%; P = .0588)., Conclusions: Among patients with OPSCC, those with HPV exhibited profiles different from those without HPV. HPV-positive OPSCC was associated with better overall survival compared with HPV-negative OPSCC. HPV-positive OPSCC prevalence increased over time., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Our aim was to determine the accuracy of 3-dimensional reconstructed models of teeth compared with the natural teeth by using 4 different 3-dimensional printers., Study Design: This in vitro study was carried out using 2 intact, dry adult human mandibles, which were scanned with cone beam computed tomography. Premolars were selected for this study. Dimensional differences between natural teeth and the printed models were evaluated directly by using volumetric differences and indirectly through optical scanning. Analysis of variance, Pearson correlation, and Bland Altman plots were applied for statistical analysis., Results: Volumetric measurements from natural teeth and fabricated models, either by the direct method (the Archimedes principle) or by the indirect method (optical scanning), showed no statistical differences. The mean volume difference ranged between 3.1 mm(3) (0.7%) and 4.4 mm(3) (1.9%) for the direct measurement, and between -1.3 mm(3) (-0.6%) and 11.9 mm(3) (+5.9%) for the optical scan. A surface part comparison analysis showed that 90% of the values revealed a distance deviation within the interval 0 to 0.25 mm., Conclusions: Current results showed a high accuracy of all printed models of teeth compared with natural teeth. This outcome opens perspectives for clinical use of cost-effective 3-dimensional printed teeth for surgical procedures, such as tooth autotransplantation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Within the field of dental tissue engineering, the establishment of adequate tissue vascularization is one of the most important burdens to overcome. As vascular access within the tooth is restricted by the apical foramen, it is of major importance to implement effective vascularization strategies in order to recreate viable components of teeth and periodontal tissues. However, while the current regenerative approaches focus on the use of dental stem cells (DSCs), little is known about these cells and their ability to promote angiogenesis. Therefore, the present study aimed to elucidate the paracrine angiogenic properties of postnatal DSCs, in particular dental pulp stem cells (DPSCs), stem cells from the apical papilla (SCAPs) and dental follicle precursor cells (FSCs). An antibody array, together with RT-PCR and ELISA, pointed out the differential expression of pro-angiogenic as well as anti-angiogenic factors by cultured DSCs and human gingival fibroblasts (HGF-1). Despite the secretion of proliferation-promoting factors, DSCs caused no notable increase in the proliferation of human microvascular endothelial cells (HMEC-1). With regard to other aspects of the angiogenic cascade, DPSCs, SCAPs and HGF-1 significantly promoted endothelial migration in a transwell migration assay. DPSCs also had a pronounced effect on endothelial tubulogenesis, as was shown by an in vitro Matrigel™ assay. In the last part of this study, a chorioallantoic membrane assay demonstrated a sustained pro-angiogenic impact of DPSCs and SCAPs in an in vivo setting. Collectively, these data indicate a predominant pro-angiogenic influence of DPSCs and SCAPS in vitro and in vivo in comparison to FSCs, suggesting that both stem cell populations could potentially promote the vascularization of regenerated dental tissues., (Copyright © 2014. Published by Elsevier B.V.)

Objective: This study assesses the incidence of neuropathic pain after orthognathic surgery at our center and briefly reports the cases found., Study Design: All records of orthognathic surgical patients between 2001 and 2011 were exported from the hospital information system into a Portable Document Format platform (Adobe Acrobat) to simplify keyword searching. Records of patients that developed debilitating chronic pain were isolated and examined., Results: Records included 982 bilateral sagittal split osteotomies, 536 LeFort I procedures, and 335 surgically assisted rapid palatal expansion procedures. Six records were identified that described cases in which patients developed debilitating chronic neuropathic pain after orthognathic surgery (mean age at surgery, 43 years)., Conclusions: The exposure of the inferior alveolar nerve or partial axonal injury together with a disruption of the bony environment of the inferior alveolar nerve is a risk factor after bilateral sagittal split osteotomy., (Copyright © 2014 Elsevier Inc. All rights reserved.)

A retrospective chart review of 387 patients with condylar and subcondylar fractures revealed 2 cases of inferior alveolar nerve (IAN) and lingual nerve (LN) anaesthesia following the subcondylar fracture. Only 5 cases have been reported previously. The mechanism of action remains unknown but a review of the literature and an analysis of 120 dry human skulls supported the hypothesis that compression of the mandibular nerve at a high level, close to the foramen ovale, could cause anaesthesia. This complication is rare, because it requires compression at a particular angle. The antero-median angulation of the condyle must be close to the foramen ovale, and the fracture must be a unilaterally displaced fracture. The presence of an enlarged lateral pterygoid plate appeared to enhance the risk of compression. The IAN and LN anaesthesia could be resolved after open reduction of the fracture and IAN and LN anaesthesia constitute a strict indication for an early open fracture reduction., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to analyse combined surgical-orthodontic treatment plans, compare them with the actual surgery performed, and define factors resulting in changes of the original plan during orthodontic pre-surgical preparation., Study Design: The clinical files of 312 orthognathic surgery patients, operated between January 2008 and December 2010, were retrospectively reviewed. Of these 312 patients, 129 had a bimaxillary operation. One hundred sixty patients had osteotomy of the lower jaw only and 23 had osteotomy of the upper jaw only. Factors analysed in the study include Angle Class malocclusion, patient sex, and age. Lip-to-incisor relationship, overjet, overbite and midline deviations of the upper and lower jaw were recorded. Effects of surgical assisted rapid palatal expansion (SARPE) on the eventual surgery were also investigated. Reasons for changing the original treatment plan at the time of the finished pre-surgical-orthodontic alignment were analysed., Results: The original treatment plan was changed in 42 of the 312 patients (13.5%). Changes occurred generally in case of a larger interval between set-up of the first treatment plan and the eventual operation (average 22.4 versus 16.4 months for patients with changed versus unchanged treatment plan, respectively). All Class I patients had surgery performed as planned. Class III patients had a significantly higher rate of altered treatment plan (27.3%) than Class II patients (7.6%). More men (52.4%) saw their treatment plan changed, although there were more women than men in the study population (59.6 versus 40.4%)., Conclusion: One in seven patients (13.5%) had a different operation than was planned at the start of treatment. Class III patients with small overjet and overbite commonly have a treatment plan for a monomaxillary operation that, after decompensation, needs to be adapted to a bimaxillary operation., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: Perioperative navigation is a recent addition to orthognathic surgery. This study aimed to evaluate the accuracy of anatomical landmarks-based registration., Materials and Methods: Eighty-five holes (1.2 mm diameter) were drilled in the surface of a plastic skull model, which was then scanned using a SkyView cone beam computed tomography scanner. DICOM files were imported into BrainLab ENT 3.0.0 to make a surgical plan. Six anatomical points were selected for registration: the infraorbital foramena, the anterior nasal spine, the crown tips of the upper canines, and the mesial contact point of the upper incisors. Each registration was performed five times by two separate observers (10 times total)., Results: The mean target registration error (TRE) in the anterior maxillary/zygomatic region was 0.93 ± 0.31 mm (p < 0.001 compared with other anatomical regions). The only statistically significant inter-observer difference of mean TRE was at the zygomatic arch, but was not clinically relevant., Conclusion: With six anatomical landmarks used, the mean TRE was clinically acceptable in the maxillary/zygomatic region. This registration technique may be used to access occlusal changes during bimaxillary surgery, but should be used with caution in other anatomical regions of the skull because of the large TRE observed., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)