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Purpose: To compare the outcomes of immediate and delayed implant placement with bone-level tapered implants. Materials and Methods: In this post-market, multicenter prospective randomized controlled study with a primary endpoint of 1 year, 53 patients were randomized to receive either immediate implant placement (test group) or delayed implant placement (control group). The mean crestal bone level changes from implant loading to 12 months postloading were measured using standardized digital periapical radiographs. Changes in facial plate thickness (as measured on CBCT images), implant success and survival, implant stability, soft tissue changes, patient-centered outcomes, and adverse events were measured to assess outcomes between the test and control treatments at 12 months postloading. Results: Of the original 53 patients, 46 patients completed the study (23 in each group). Mean bone changes from loading to the 12-month follow-up were recorded with no statistically significant difference (P = .950) between the groups. The hypothesis was confirmed that immediate implant placement (test) in extraction sockets produces in similar outcomes as delayed placement (control). The test group was found to be similar to the control group (P = .022) in terms of mean changes in facial plate thickness. Implant survival and success were 95.8% in the test group and 92% in the control group. Stability in the control group was superior at the time of surgery, but there was no difference between the groups at implant loading, producing a nonsignificant P value of .563). Conclusions: This randomized controlled multicenter study showed comparable outcomes 1 year after prosthetic loading in the immediate and delayed implant placement groups. [ABSTRACT FROM AUTHOR]

A retrospective chart review was conducted of CBCT images captured between November 2019 and April 2021 on patients who underwent dental implant placement and had a periodontal charting. The buccal and lingual bone thickness around the implants was measured as an average of three measurements taken from the buccal and lingual aspects of implants. Implants with peri-implantitis were placed in Group 1, and implants with peri-implant mucositis or good peri-implant health were placed in Group 2. Wilcoxon rank sum test was used to compare the differences between the bone thicknesses of the groups. In total, 93 CBCT radiographs were screened, and 15 CBCT images with both an implant and corresponding periodontal charting were analyzed. Of the 15 implants examined, 5 presented with peri-implantitis (33%), 1 with peri-implant mucositis, and 9 with good peri-implant health. Within the limitations of this study, buccal bone thickness averaging ≥ 1.10 mm or midlingual probing depths ≥ 3.4 mm correlates with a more favorable peri-implant response. Larger studies are needed to substantiate these findings. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between the orofacial implant position distance (ID) and facial bone crest thickness (FBCT) in single-tooth implant crowns (STICs) placed in the esthetic zone and to predict the presence of facial bone above the implant shoulder, as well as its impact on Pink and White Esthetic Scores (PES and WES) and patient-related outcome measures (PROMs). Materials and Methods: In this cross-sectional study, all patients treated with STICs in the esthetic zone between 2006 and 2013 with at least 12 months postloading were invited to enroll. CBCTs were used to assess ID and FBCT. Esthetic outcomes included the PES and WES. PROMs included a participant satisfaction questionnaire with 13 questions formulated for this study. Descriptive statistics and receiver operating characteristic curve analysis were used. The associations between ID, FBCT, esthetic outcomes, and PROMs were calculated. Results: Data were available for 60 implants. Mean ID was 2.02 mm (SD = 0.77). Mean FBCT at the implant shoulder was 0.99 mm (SD = 0.98). FBCT was significantly associated with higher PES scores (P = .040), but not with WES scores (P = 0.149). FBCT was significantly associated with ID (P = .009), and implants positioned = 1.6 mm palatal in relation to the adjacent teeth were likely to have higher FBCT. Conclusions: FBCT influences PES and is more predictable if implants are positioned = 1.6 mm palatal in relation to the adjacent teeth. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the optimization of computer-aided design/computer-aided manufacturing (CAD/CAM) patient-specific implants for mandibular facial bone defects and compare the biocompatibility and osseointegration of machined titanium (Ma), Sandblasted/Large-grit/Acid-etched (SLA) titanium, and polyetherketoneketone (PEKK) facial implants. We hypothesized that the facial implants made of SLA titanium had superior osseointegration when applied to the gonial angle defect and prevented the senile atrophy of the bone. Histologic findings of the soft-tissue reaction, hard-tissue reaction, and bone–implant contact (BIC (%) of 24 Ma, SLA, and PEKK facial implants at 8 and 12 weeks were investigated. There was no statistical difference in the soft tissue reaction. Bone was formed below the periosteum in all facial implants at 12 weeks and the BIC values were significantly different at both 8 and 12 weeks (p < 0.05). Ma, SLA, and PEKK facial implants are biocompatible with osseointegration properties. SLA can enhance osseointegration and provoke minimal soft tissue reactions, making them the most suitable choice. They provide an excellent environment for bone regeneration and, over the long term, may prevent atrophy caused by an aging mandible. The bone formation between the lateral surface of the facial implant and periosteum may assist in osseointegration and stabilization. [ABSTRACT FROM AUTHOR]

Background: Aim-The aim of study was to evaluate the prevalence of maxillofacial fracture following road traffic accidents, to access the pattern of maxillofacial fracture and to estimate the most common type of facial fracture following road traffic accidents in patient attending a tertiary health care center. Materials and methods: Patient coming to ENT OPD and casualty of Shri Vasantrao Naik government medical college Yavatmal with facial bone fractures following RTA, were evaluated in this study. Results: Total 140 patients were evaluated with facial bone fracture after RTA. The prevalence of facial fracture in RTA patient is 11.2%. Majority of them were in age group of 21 to 40 years. Male preponderance was seen. Most common facial fracture was mandible 48.5%, followed by nasal bone 18.5%, ZMC 17.1%, multiple bone fracture 10.7%. Among all mandible fractures 47.19% had parasymphysis fracture. Two wheeler accidents were majorly seen 47.1%, 33.6% four wheeler, 16.4% pedestrians and 2.9% three wheeler. Among the 2 wheeler drivers, majority 78.8% were not wearing helmets. Majority 60.7% cases needed surgery and 39.3% were treated conservatively. Among surgical cases 12.9% of cases had complication following surgery. Conclusion: On the basis of data which was reproduced after examination of 140 patients, having RTA with facial bone fractures attending tertiary care hospital, it is concluded that most common fracture following RTA is mandible. In mandible, the most common site is parasymphysis. Two wheeler accidents were majorly seen. Majority of patients were under influence of alcohol. Majority of them were not wearing helmets. To avoid RTA, it is important to implement stringent traffic rules, improving the quality of roads, safety regulation rules should be followed. ORIF being the main stay of treatment in present study followed by IMF. [ABSTRACT FROM AUTHOR]

Background: Acalvaria, or acrania, is a rare congenital cranial vault defect with neurocranium absences, including complete or part of calvaria flat bones, dura mater, and associated muscles, but with a still present in the central nervous system, skull base, facial bones, and skin-covered the defect. It is a sporadic incidence without apparent genetic factors confirmed. Acalvaria is often misdiagnosed as anencephaly; the distinguishable difference is that anencephaly has an absence (partial or complete) of the brain tissue, including the skull and scalp. Acalvaria is considered a fatal anomaly with a low survival rate, and only a few cases of extended survival have been reported until now. To the best of the author's knowledge, no acalvaria case has been published in Papua, and only one reported case of the coexistence of acalvaria with schizencephaly in Brazil (2018). Case report: Herein, we present a case of an indigenous South Papuan living newborn with primary acalvaria and open-lip schizencephaly in a frontoparietal region. A male newborn baby was born from a 39-year-old female Marind-Anim tribe patient with a 38th week of gestation, with no previous history of miscarriage, is not a consanguineous marriage, and had an unremarkable medical history during this pregnancy. Post-natal physical examinations showed an irregularly shaped head with 11.5 cm diameter concave of the right side, with a soft brain-like consistency palpable and the absence of half right frontoparietal calvarium covered with a presence of scalp and hair. Cranial 2-dimension ultrasonography shows an absence of half right frontoparietal calvaria bone with a complete presence of scalp and periosteum covering the defect with a fluid accumulation (anechoic) below the periosteum. A transverse axis view shows a complete structure but hypoplasia of brain cortex with visible slightly dysgenesis of gyrus and sulcus in both hemispheres convincing the acalvaria condition not anencephaly. A fluid accumulation above brain parenchyma of the frontoparietal region happened to be a cerebrospinal fluid coming from a wide-open cleft extending from the left lateral and fourth ventricles to the cerebral cortex, suggesting a typical condition of open-lip schizencephaly. Further health follow-ups until 6 months old showed still normal physical and behavioral development with no sign of complications. Conclusions: No standard acalvaria treatment is being established; conservative and supportive therapy is mostly taken considering their low survival rate. With the advancement of medical technology nowadays, surgical approaches, including scalp defect closure, bone graft, and 3D-printed defect filling, are being performed and have succeeded in a few cases. Long-term follow-up is required to monitor their neuro-psychological development and complication incidences that need further intervention. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to present optimized device‐specific low‐dose cone‐beam computed tomography (CBCT) protocols with sufficient image quality for pre‐surgical diagnostics and three‐dimensional (3D) modelling of cleft defects. Methods: Six paediatric skulls were acquired, and an artificial bony cleft was created. A high‐resolution CBCT scan acted as a reference standard (Accuitomo 170, Morita, Kyoto, Japan) for comparing eight low‐dose protocols of Newtom VGi‐evo (QR Verona, Cefla, Verona, Italy), which included Eco and Regular protocols with different field of views (FOVs). Delineation of lamina dura, cementoenamel junction (CEJ), trabecular bone and bony bridge were assessed. A 3D model of the defect was also evaluated. Result: The dose area product of low‐dose protocols ranged from 31 to 254 mGy*cm2. Despite the dose difference of up to eight times between applied protocols, trabecular bone and CEJ exhibited appropriate image quality in all scans. However, Regular small FOV protocols (5 × 5 and 8 × 5 cm2), for both lamina dura and bony bridge, demonstrated a significant improvement in image quality compared to Eco FOV counterparts. Based on 3D defect analysis, no significant difference existed between low‐dose protocols and the reference standard. Conclusion: The findings highlight the possibility of achieving a considerable reduction (up to eight times) in the radiation dose using low‐dose CBCT protocols while maintaining sufficient image quality for assessing anatomical structures and 3D modelling in cleft cases. [ABSTRACT FROM AUTHOR]

Magnesium as a biodegradable material offers promising results in recent studies of different maxillo-facial fracture models. To overcome adverse effects caused by the fast corrosion of pure magnesium in fluid surroundings, various alloys, and surface modifications are tested in animal models. In specified cases, magnesium screws already appeared for clinical use in maxillofacial surgery. The present study aims to compare the bone healing outcome in a non-load-bearing fracture scenario of the forehead in sheep when fixed with standard-sized WE43 magnesium fixation plates and screws with plasma electrolytic oxidation (PEO) surface modification in contrast to titanium osteosynthesis. Surgery was performed on 24 merino mix sheep. The plates and screws were explanted en-bloc with the surrounding tissue after four and twelve weeks. The outcome of bone healing was investigated with micro-computed tomography, histological, immunohistological, and fluorescence analysis. There was no significant difference between groups concerning the bone volume, bone volume/ total volume, and newly formed bone in volumetric and histological analysis at both times of investigation. The fluorescence analysis revealed a significantly lower signal in the magnesium group after one week, although there was no difference in the number of osteoclasts per mm2. The magnesium group had significantly fewer vessels per mm2 in the healing tissue. In conclusion, the non-inferiority of WE43-based magnesium implants with PEO surface modification was verified concerning fracture healing under non-load-bearing conditions in a defect model. Titanium implants, the current gold standard of fracture fixation, can lead to adverse effects linked to the implant material and often require surgical removal. Therefore, degradable metals like the magnesium alloy WE43 with plasma electrolytic oxidation (PEO) surface modification gained interest. Yet, miniplates of this alloy with PEO surface modification have not been examined in a fracture defect model of the facial skeleton in a large animal model. This study shows, for the first time, the non-inferiority of magnesium miniplates compared to titanium miniplates. In radiological and histological analysis, bone healing was undisturbed. Magnesium miniplates can reduce the number of interventions for implant removal, thus reducing the risk for the patient and minimizing the costs. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Intraosseous vascular anomalies in the facial skeleton present significant diagnostic and therapeutic challenges due to complex anatomy. These anomalies represent about 0.5–1% of bony neoplastic and tumor-like lesions, usually presenting as a firm, painless mass. Most described intraosseous vascular malformations are venous malformations (VMs) and, more rarely, arteriovenous malformations. Objectives: The objectives of this work are to show our experience, protocol and the applications of computer planning, virtual surgery, CAD-CAM design, surgical navigation, and computer-assisted navigated piezoelectric surgery in the treatment of facial intraosseous vascular anomalies and to evaluate the advantages and disadvantages. Methods: Three females and one male with periorbital intraosseous vascular anomalies were treated using en-block resection and immediate reconstruction with a custom-made PEEK prosthesis. One lesion was in the supraorbital rim and orbital roof, one in the frontal bone and orbital roof, and two in the zygomatic region. We accomplished the resection and reconstruction of the lesion using virtual planning, CAD-CAM design, surgical navigation and piezoelectric device navigation. Results: There were no complications related to the surgery assisted with navigation. With an accuracy of less than 1 mm, the procedure may be carried out in accordance with the surgical plan. The surgeon's degree of uncertainty during deep osteotomies and in locations with low visibility was decreased by the use of the navigated piezoelectric device. Conclusions: Resection and reconstruction of facial intraosseous vascular anomalies benefit from this new surgical strategy using CAD-CAM technologies, computer-assisted navigated piezoelectric surgery, and surgical navigation. [ABSTRACT FROM AUTHOR]

Osteomyelitis is a bone inflammation caused by an infectious microorganism, which may lead to complete structure decay. Over time, along with the discovery and usage of powerful antibiotics, it became a rare occurrence in modern practice. In this paper, we will present a case of a patient with craniofacial osteomyelitis, which occurred as a complication of previous trauma and incomplete surgical treatment, due to lack of compliance. Chronic diseases in the non-cooperative patient led to the development of a severe clinical state. We believe that the existence of communication between defects on the anterior wall of the frontal sinus and corresponding subcutaneous and cutaneous tissue may have prevented further complications, in particular endocranial. Despite of a severe local finding, there was no dramatic increase in inflammatory parameters in laboratory analysis, as expected in such cases. A careful diagnostic procedure, identification of causative agent, adequately applied antibiotic therapy followed by surgical treatment debridement, improved the general condition of the patient as well as local finding. A severe form of osteomyelitis of the facial bones can be a complication after facial bone osteosynthesis. The absence of endocranial complications can be explained by drainage of purulent content through defects in the skin of the face. Quick and precise diagnostics, followed by treatment that includes a combination of surgery and conservative treatment, give the best results in such complex conditions. [ABSTRACT FROM AUTHOR]

Introduction: The facial bones are prone to severe injuries due to high exposure and the labile nature of the bones, and they are injured in a significant proportion of trauma patients. Varying from simple, common nasal fractures to communited fractures of the face, management of such injuries can be extremely challenging due to fact that these injuries involve a highly vascular zone with proximity to the airway. In spite of being very well trained in surgeries of face and head neck area, with the exception of nasal bones, not many ENT surgeons in India perform facial bone fracture surgeries. Objective: This questionnaire-based study was planned to explore this key issue to understand as why many ENT surgeons do not perform facial trauma surgeries. Method: A cross-sectional questionnaire-based study was conducted over a period of 2 months Responses were obtained from ENT surgeons across various social groups on a Google Form-based questionnaire. The answers were collected and analysed. Result: A total of 240 valid responses were obtained. Most (56.7%) of the ENT surgeons had more than 15 years of practice. Around half (52%) of surgeons never did facial trauma surgery, and 65% of respondents replied that the main reason for their lack of involvement in facial trauma surgery was that they had no exposure to it during postgraduate training. The majority (65%) also wanted to enter this subspeciality if given a chance. Conclusion: To develop facial trauma management as a subspeciality in ENT, more and more ENT departments in medical colleges should include these surgeries as part of their training programmes. [ABSTRACT FROM AUTHOR]

This case report presents a virtual treatment simulation of the orthodontic treatment and surgery-first orthognathic surgery employed to treat a patient with a repaired unilateral cleft lip and alveolus with Class III malocclusion and lower third facial asymmetry. The patient exhibited a negative overjet of 9 mm, a missing lower right second premolar, and a 5 mm gap between the upper right central and lateral incisors with midline discrepancy. The three-dimensional virtual planning began with virtual pre-surgical orthodontics, followed by the positioning of the facial bones and teeth in their ideal aesthetic and functional positions. The sequence of steps needed to achieve this outcome was then reverse-engineered and recorded using multiplatform Nemostudio software (Nemotec, Madrid, Spain), which facilitated both surgical and orthodontic planning. The treatment included a two-piece segmental maxillary osteotomy for dental space closure, a LeFort I maxillary advancement, and a mandibular setback with bilateral sagittal split osteotomy to correct the skeletal underbite and asymmetry. A novel approach was employed by pre-treating the patient for orthognathic surgeries at age 11, seven years prior to the surgery. This early phase of orthodontic treatment aligned the patient's teeth and established the dental arch form. The positions of the teeth were maintained with retainers, eliminating the need for pre-surgical orthodontics later. This early phase of treatment significantly reduced the treatment time. The use of software to predict all the necessary steps for surgery and post-surgical orthodontic tooth movements made this approach possible. Multi-step virtual planning can be a powerful tool for analyzing complex craniofacial problems that require multidisciplinary care, such as cleft lip and/or palate. [ABSTRACT FROM AUTHOR]

Background: Tear trough‐eye bag deformities may appear in young Asian patients due to the weak support of their facial skeletons. For these patients with better periorbital skin elasticity, the injection may be more suitable than surgery for treating tear trough‐lower eyelid bag deformity. Aims: Identify the clinical efficacy and safety of non‐cross‐linked HA in the treatment of tear trough‐lower eyelid bag deformity. Methods: In this study, we analyzed pre‐ and postinjection photographs of 55 patients treated with non‐cross‐linked hyaluronic acid (HA) for tear trough‐lower eyelid bag deformity. Results: The mean [SD] scores of modified Goldberg score suggested that the most significant improvement of preoperative and postoperative scores was in tear trough depression, followed by infraorbital triangular depression, orbital fat prolapse, loss of skin elasticity, and skin transparency. Only transient localized complications were observed, including bruising, swelling, and erythema. There were no serious complications, such as skin necrosis or visual impairment. Conclusions: Our study confirmed the beneficial efficacy and minor complications of composite non‐cross‐linked HA for the treatment of tear trough‐lower eyelid bag deformity. [ABSTRACT FROM AUTHOR]

Replacement of missing or hopeless teeth in the esthetic zone is one of dentistry's most critical challenges. In the past, multiple surgical procedures have been needed to reconstruct compromised extraction sites. The surgeries have been associated with long healing times and increased morbidity, all the while patients are using either fixed or removable interim restorations. The procedures identified in this paper minimize surgical operating times, healing times, and delays in obtaining definitive restorations by combining multiple surgical procedures in one visit. The procedures are technique sensitive. This particular patient has been followed for 1 year post‐operatively with clinical photographs and CBCT scans. Excellent clinical results were obtained. Benefits and limitations of the procedures have also been identified. [ABSTRACT FROM AUTHOR]

Introduction: Intraosseous lipomas (IL) are rare benign neoplasms of bone which very rarely occur in the facial bones such as the mandible. Of the documented cases, many are often asymptomatic and consequently, are an incidental finding discovered by the practitioner. Case Report: The following case report recounts a 22‐year‐old patient referred for extraction of a carious molar at an Oral and Maxillofacial unit with an incidental finding of pathology involving the contralateral lower left wisdom tooth (LL8) on radiographic examination. Further investigations showed associated external root resorption of the lower left wisdom tooth and a provisional diagnosis of a radicular cyst was made. The case was managed by extracting the associated tooth and enucleating the lesion. During the procedure, fatty tissue was curetted at the apex instead of the expected cystic content. Subsequent histopathology confirmed the diagnosis of an IL. Conclusion: To the authors' knowledge, this is only the second documented case of an IL associated with tooth resorption. Findings from this case further our knowledge of the relatively uncommon pathology of intraosseous lipomas in the mandible and highlight the need for histopathological documentation and reporting of apical lesions. [ABSTRACT FROM AUTHOR]

Objective: Develop a model for the study of Electronic Nicotine Device (ENDS) exposure on craniofacial development. Design: Experimental preclinical design followed as pregnant murine dams were randomized and exposed to filtered air exposure, carrier exposure consisting of 50% volume of propylene glycol and vegetable glycine (ENDS Carrier) respectively, or carrier exposure with 20 mg/ml of nicotine added to the liquid vaporizer (ENDS carrier with nicotine). Setting: Preclinical murine model exposure using the SciReq exposure system. Participants: C57BL6 adult 8 week old female pregnant mice and exposed in utero litters. Interventions: Exposure to control filtered air, ENDS carrier or ENDS carrier with nicotine added throughout gestation at 1 puff/minute, 4 h/day, five days a week. Main Outcome Measures: Cephalometric measures of post-natal day 15 pups born as exposed litters. Results: Data suggests alterations to several facial morphology parameters in the developing offspring, suggesting electronic nicotine device systems may alter facial growth if used during pregnancy. Conclusions: Future research should concentrate on varied formulations and exposure regimens of ENDS to determine timing windows of exposures and ENDS formulations that may be harmful to craniofacial development. [ABSTRACT FROM AUTHOR]

Simple Summary: The treatment of a transverse maxillary constriction is a challenge for orthodontists, as the expansion approach depends on the midpalatal suture maturation. A conventional palatal expander provides skeletal effects in an unfused suture, while surgically or miniscrew-assisted expansions are suggested in a closed suture. The midpalatal suture development is affected by multiple variables, such as age, sex, and facial growth patterns. Consequently, we conducted a CBCT study among 263 patients aged from 8 to 20 in order to evaluate the relation between midpalatal suture maturation and age, sex, and vertical and sagittal growth patterns. The midpalatal suture was classified into five stages from A to E according to the progressively increasing maturation stage. The youngest individuals, the male participants, and the hyperdivergent subjects tended to show lower stages. Therefore, our study provided a further analysis of the potential predictors involved in midpalatal suture maturation that are useful to the clinician to choose the most effective expansion approach. Background. The evaluation of midpalatal suture maturation is essential to undertake the most predictable maxillary expansion approach. Several factors, such as age, gender, and facial growth patterns, seem to be involved in midpalatal suture staging and, consequently, in its opening; however, the link between these variables and the stages of midpalatal suture development remains poorly understood. Our study aimed to analyse the midpalatal suture maturation in relation to age, sex, and skeletal growth patterns by CBCT. Methods. We enrolled 263 patients (119 males and 144 females) aged from 8 to 20 years. The midpalatal suture maturation was defined according to Angelieri et al.'s classification using a low-dose CBCT. The chi-square test and linear regression were applied to investigate the suture stages by age, sex, and vertical and sagittal growth patterns. Results. Stage A was present in 8- and 9-year-olds with a larger prevalence in boys, while the prevalence of stage E increased progressively with age. Stage D was the most prevalent in our sample. The statistical analysis described that stage A was more likely in the youngest subjects, and stage E in the oldest participants. The males tended to have lower maturation stages. Moreover, the hypodivergent and normodivergent subjects tended to have higher maturation stages, while Class III was more likely in subjects in stages D or E. Conclusions. A total of 127 patients were in stages A, B, and C, showing an unfused suture. In young individuals, the opening of the midpalatal suture leads to a proper facial growth development by correcting the transverse superior hypoplasia. The midpalatal sutural maturation classification was related to age, sex, and divergence. [ABSTRACT FROM AUTHOR]

Background: Orthodontic and surgical technical advances in recent years have resulted in treatment opportunities for a whole range of craniofacial skeletal disorders either in the adolescent or adult patient. In the growing child, these can include myofunctional orthodontic appliance therapy or distraction osteogenesis procedures, while in the adult, the mainstay approach revolves around orthognathic surgery. The literature agrees that for a change in craniofacial morphology to remain stable, the muscles acting upon the facial skeleton must be capable of adaptation in their structure and, therefore, their function. Failure of the muscles to adapt to the change in their length or orientation will place undesirable forces on the muscle attachments leading to potential instability of the skeleton. Adaptation can occur through various processes including those within the neuromuscular feedback mechanism, through changes within muscle structure or through altered muscle physiology, and through changes at the muscle/bone interface. It is now accepted that because there is no single method of assessing masticatory function, several measures should be taken, and whenever possible, simultaneously. Methods: This investigation was designed to apply several, newly developed and more sophisticated methods of measuring muscle structure and function to a situation where adaptation of muscle is pivotal to the success of a therapeutic approach. Patients attending the combined orthodontic/orthognathic surgery clinic at the Clitrofa – Centro Médico, Dentário e Cirúrgico, in Trofa, Portugal, were screened. Ten patients scheduled for a bimaxillary osteotomy involving a combination of maxillary Le Fort I impaction procedure coupled with a sagittal split advancement of the mandible were selected to form the study group. The patients have MRI of the masseter muscle to evaluate the masseter muscle volume and fibre orientation changes. This exam was taken before surgery (T0), 6 to 12 months after surgery (T1), and 3 years after surgery (T2), by two independent observers, according to the protocol jointly developed between the Eastman Dental Institute – University of London and the MRI Centre - Department of Radiology at John Radcliffe Hospital – University of Oxford. Results: Significant differences (p < 0.05) have been identified between Time 0 (pre-op) and Time 1 (6–12 months post-op) regarding the masseter area (mm2). The differences against Time 0 (pre-op) seem to disappear at Time 2 (3 years post-op). Conclusions: MRI therefore seems to be a valid tool for measuring differences in the masseter muscle area and volume associated with high-severity occlusal deformities, although showing not to be as efficient in detecting the same differences in cases of low-severity occlusal deformities. [ABSTRACT FROM AUTHOR]

The shared functions of the skull are thought to result in common evolutionary patterns in mammalian cranial shape. Craniofacial evolutionary allometry (CREA) is a particularly prominent pattern where larger species display proportionally elongate facial skeletons and smaller braincases. It was recently proposed that CREA arises from biomechanical effects of cranial scaling when diets are similar. Thus, deviations from CREA should occur with changes in cranial biomechanics, for example due to dietary change. Here, we test this using 3D geometric morphometric analysis in a dataset of Australian murine crania, which are highly allometric. We contrast allometric and non‐allometric variation in the cranium by comparing evolutionary mode, allometry, ordinations, as well as allometry, integration, and modularity in functional modules. We found evidence of stabilising selection in allometry‐containing and size‐free shape, and substantial non‐allometric variation aligned with dietary specialisation in parallel with CREA. Integration among cranial modules was higher, and modularity lower, with size included, but integration between rostrum and cranial vault, which are involved in the CREA pattern, dropped dramatically after size removal. Our results thus support the hypothesis that CREA is a composite arising from selection on cranial function, with substantial non‐allometric shape variation occurring alongside CREA where dietary specialisation impacts selection on gnawing function. This emphasises the need to research mammalian cranial evolution in the context of allometric and non‐allometric selection on biomechanical function. [ABSTRACT FROM AUTHOR]

BACKGROUND: The human face is a complex area formed by the combination of many different components and varies among individuals according to gender, age, and ethnicity. OBJECTIVE: The aim of this study was to evaluate age-related changes in the facial and calvarial bones in a large sample of both genders. METHODS: The retrospective study included nontraumatic brain computed tomography scans of 280 Turkish adults. Participants were divided into 7-decade groups with the age ranging from 20 to 89 years. Measurements of the face and calvaria were recorded, and calvarial volume was calculated. The relationship of these parameters with age and gender was examined. RESULTS: Statistically significant differences were observed in all the facial and calvarial measurements, except the transverse diameter of the head, with increasing age in both genders. Regardless of age, no significant differences were found in facial and calvarial measurements between genders. In addition, there was a significant decrease in the calvarial volume in both genders after the seventh decade of life. CONCLUSION: The structure of the face and calvarium continues to change and differentiate throughout life. Taking these changes into account during surgical and facial rejuvenation procedures can help predict outcomes and avoid the use of incorrect techniques. [ABSTRACT FROM AUTHOR]

Background Development of malocclusion can be promptly recognized through an understanding of the optimal position of the bone structures in the orofacial system and their relationship to the cranial base and jaw base. The aim of this study was to assess the relationship between the cranial base, mandible, and hyoid bone in different anteroposterior skeletal malocclusions. Materials and Methods This retrospective study evaluated 120 lateral cephalometric radiographs of individuals aged between 15 and 30 years. The subjects were classified using Burstone's analysis into three groups based on the N perpendicular to point A and N perpendicular to point B. The collected lateral cephalograms of the selected individuals were analyzed using Nemoceph v.12 software (Nemotec, Spain). The nasion-sella-articulare (NSAr), hyoidale angle (C3HyD), sella-articulare-hyoid angle (SArHy), and nasion-sella-hyoid (NSHy) angles were measured and compared among all the three groups. Results In the present study, considering the various angles among the three study groups, a statistically significant difference was observed for the SArHy angle (p < 0.05). However, the saddle angle (NSAr) and hyoidale angle (C3HyD) showed no statistically significant difference between the three study groups. Post hoc Bonferroni test was applied to compare the differences between two groups. A statistically significant difference (p < 0.05) was observed between class I and class II and between class II and class III groups. Conclusion Though the findings of the present study concluded that there is no variation in saddle angle among the three groups, the significant association of SArHy angle among class I, class II, and class III skeletal relationships, suggests an adaptation of the hyoid bone position in various skeletal patterns. We also suggest that the posterior positioning of the hyoid bone is related to skeletal class II malocclusion, whereas a forward positioning of the hyoid bone is related to skeletal class III malocclusion. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the hard and soft tissue alterations of immediate implant placement and provisionalization with customized definitive abutments in the esthetic zone. Materials and Methods: Single unsalvageable maxillary anterior teeth were replaced with immediate implant placement and provisionalization with definitive abutments in 22 participants. Digital impressions and CBCT images were obtained presurgery, immediately after surgery, and 6 months after surgery. Horizontal and vertical buccal bone changes in thickness and height (HBBT, VBBH), vertical changes for the gingiva margin, mesial and distal papilla height, and horizontal changes for soft tissue (HCST) were analyzed using a 3D superimposition method. Results: Twenty-two participants completed the study. No implant failed, and there were no mechanical or biologic complications for any patients. At 6 months after surgery, the mean HBBT changes at 0, 1, 2, 3, 5, 7, 10, 11.5, and 13 mm were -0.92 ± 0.73, -0.83 ± 0.53, -0.82 ± 0.49, -0.70 ± 0.64, -0.65 ± 0.47, -0.50 ± 0.51, -0.15 ± 0.45, -0.10 ± 0.57, and -0.00 ± 0.64 mm, respectively. The mean VBBH change was -0.61 ± 0.76 mm. The mean HCSTs at -3, -2, -1, 0, 1, 2, and 3 mm sub- and supra-implant shoulder were -0.65 ± 0.54, -0.70 ± 0.56, -0.65 ± 0.51, -0.61 ± 0.56, -0.47 ± 0.54, -0.47 ± 0.59, and -0.46 ± 0.59 mm, respectively. The mean gingiva margin recession was -0.38 ± 0.67 mm. The mean mesial papilla height recession was -0.03 ± 0.50 mm. The mean distal papilla height recession was -0.12 ± 0.56 mm. Conclusion: The definitive abutment used with immediate implant placement and provisionalization could potentially maintain the buccal bone thickness and height. For the facial soft tissue, it also benefited the maintenance of the midfacial gingival margin position and papilla height during the 6-month follow-up. [ABSTRACT FROM AUTHOR]

Prenatal alcohol exposure (PAE) causes cognitive impairment and a distinctive craniofacial dysmorphology, due in part to apoptotic losses of the pluripotent cranial neural crest cells (CNCs) that form facial bones and cartilage. We previously reported that PAE rapidly represses expression of >70 ribosomal proteins (padj = 10-E47). Ribosome dysbiogenesis causes nucleolar stress and activates p53-MDM2-mediated apoptosis. Using primary avian CNCs and the murine CNC line O9-1, we tested whether nucleolar stress and p53-MDM2 signaling mediates this apoptosis. We further tested whether haploinsufficiency in genes that govern ribosome biogenesis, using a blocking morpholino approach, synergizes with alcohol to worsen craniofacial outcomes in a zebrafish model. In both avian and murine CNCs, pharmacologically relevant alcohol exposure (20mM, 2hr) causes the dissolution of nucleolar structures and the loss of rRNA synthesis; this nucleolar stress persisted for 18-24hr. This was followed by reduced proliferation, stabilization of nuclear p53, and apoptosis that was prevented by overexpression of MDM2 or dominant-negative p53. In zebrafish embryos, low-dose alcohol or morpholinos directed against ribosomal proteins Rpl5a, Rpl11, and Rps3a, the Tcof homolog Nolc1, or mdm2 separately caused modest craniofacial malformations, whereas these blocking morpholinos synergized with low-dose alcohol to reduce and even eliminate facial elements. Similar results were obtained using a small molecule inhibitor of RNA Polymerase 1, CX5461, whereas p53-blocking morpholinos normalized craniofacial outcomes under high-dose alcohol. Transcriptome analysis affirmed that alcohol suppressed the expression of >150 genes essential for ribosome biogenesis. We conclude that alcohol causes the apoptosis of CNCs, at least in part, by suppressing ribosome biogenesis and invoking a nucleolar stress that initiates their p53-MDM2 mediated apoptosis. We further note that the facial deficits that typify PAE and some ribosomopathies share features including reduced philtrum, upper lip, and epicanthal distance, suggesting the facial deficits of PAE represent, in part, a ribosomopathy. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to assess the thickness of the soft tissue facial profile (STFP) in relation to the skeletal malocclusion, age and gender. Methods: All patients, aged 7–35 years, who were seeking orthodontic treatment at the Department of Orthodontics, Medical University of Warsaw between 2019 and 22 were included in the study. All patients had lateral head radiographs taken before the treatment. The cephalometric analysis was performed including the STFP analysis. The patients were allocated to one of six groups based on age and skeletal relations (ANB angle). The minimum number of patients in each group was 60 with equal gender distribution. The STFP analysis included ten linear measurements. Results: A total of 300 patients were included in the study and allocated to five groups. Group 6 (growing patients with skeletal Class III malocclusion) was not included in the study as it failed to achieve the assumed group size. There were significant differences in the thickness of the STFP in relation to the skeletal malocclusions. Adults with skeletal Class III malocclusion had significantly thicker subnasal soft tissues compared to patients with skeletal Class I and Class II malocclusions. The thickness of the lower lip in patients with Class II skeletal malocclusion was significantly bigger compared to the other groups. Children and adolescents with Class II malocclusions had thicker lower lip in comparison to the group with Class I malocclusion. The majority of the STFP measurements were significantly smaller in children and adolescents compared to adults. The thickness of the STFP in males was significantly bigger in all age groups compared to females. Conclusions: The thickness of facial soft tissues depends on the patient's age and gender. The degree of compensation of the skeletal malocclusion in the STFP may be a decisive factor during orthodontic treatment planning regarding a surgical approach or a camouflage treatment of skeletal defects. [ABSTRACT FROM AUTHOR]

Objectives: To compare immediate implant placement (IIP) with early implant placement (EIP) for single tooth replacement in the aesthetic area in terms of aesthetic, clinical, and patient‐reported outcomes. Materials and Methods: Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to February 2023. Randomized Controlled Trials (RCTs) comparing IIP with EIP were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue change. Secondary outcomes were horizontal midfacial soft tissue change, vertical papillary change, pink esthetic score (PES), implant survival, buccal bone thickness, marginal bone level change, patient discomfort, chair time, and patient satisfaction. Results: Out of 1185 records, 6 RCTs were selected, reporting on 222 patients who received 222 single implants (IIP: 112 implants in 112 patients; EIP: 110 implants in 110 patients) in the anterior maxilla or mandible. Patients had a mean age ranging from 35.6 to 52.6 years and were followed between 8 and 24 months. Two RCTs showed some concerns, and four showed a high risk of bias. Four studies could be included in a meta‐analysis on the primary outcome and three only considered cases with an intact buccal bone wall. Meta‐analysis failed to demonstrate a significant difference in terms of vertical midfacial soft tissue change between IIP and EIP (mean difference: 0.31 mm, 95% CI [−0.23; 0.86], p =.260; I2 = 83%, p <.001). No significant differences were found for PES (standardized mean difference: 0.92, 95% CI [−0.23; 2.07], p =.120; I2 = 89%, p <.001), implant survival (RR: 0.98, 95% CI [0.93, 1.03], p =.480; I2 = 0%, p =.980), and marginal bone level change (mean difference: 0.03 mm, 95% CI [−0.12, 0.17], p =.700; I2 = 0%, p =.470). Insufficient data were available for meta‐analyses of other secondary outcomes. Conclusion: In low‐risk patients with an intact buccal bone wall, there seems to be no difference between IIP and EIP in terms of aesthetic and clinical outcomes. The strength of this conclusion is rated as low since studies showed an unclear or high risk of bias. In addition, state‐of‐the‐art therapy was only delivered in a minority of studies. Future RCTs should also provide data on patient‐reported outcomes since these have been underreported. [ABSTRACT FROM AUTHOR]

Giant cell tumor (GCT) of bone is a rare, benign, osteolytic neoplasm that most commonly occurs in early adulthood and often involves the long bones of the body. Although GCT largely affects the epiphyses of long bones, several reports of GCT involvement of the cranial and facial bones exist in the literature. In addition to reviewing other reported cases of GCT of the lateral skull base in the literature, the authors report here on the clinical presentation, radiographic findings, and management of a patient found to have a GCT of the squamous part of temporal bone invading the middle ear and infratemporal fossae, which was treated by en bloc resection of the lateral skull base. [ABSTRACT FROM AUTHOR]

The anatomically complex craniofacial skeleton demands special consideration when caring for cases of polytrauma or medically compromised patients with craniofacial fractures. This paper utilises a systematic review and multidisciplinary opinions to create an algorithm for the hospital-based care of patients with craniofacial fractures (base of skull, orbit, paranasal sinus, and mandible) who require non-invasive ventilation (NIV). Each fracture location has a unique predisposition to a different type of emphysema and associated morbidity. The risk of developing emphysema, combined with its potential severity, is stratified against the harm of not providing NIV for the holistic care of the patient. The aim of this paper is to synthesise evidence from a systematic review of existing literature with multidisciplinary opinions to develop a concise algorithm that outlines the optimal treatment of patients with craniofacial fractures who require NIV. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic. Methods: This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed. Results: The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration Conclusions: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period. [ABSTRACT FROM AUTHOR]

Purpose: Mandibular reconstruction remains a challenging procedure despite the availability of various flaps and grafts. The ultimate objective is to restore oral functioning and attain acceptable morphological outcomes while considering donor site morbidity. This study describes the vascular supply and harvesting technique of a pedicled clavicular bone. The proximity of the clavicle is conducive to a mandibular replacement and allows the use of vascularized bone with a single surgical field. Methods: The osteoperiosteal clavicular pedicled flap was harvested on the right side of ten fresh cadaver specimens. The cervical transverse artery was injected with colored latex in some cases and methylene blue in others. Results: The vascular periosteal supply of the clavicular flap was highlighted. The clavicular bone was linked to its pedicle which was composed of vascular and adipose-fascial tissues, without any overlying skin paddle. Its vasculature was supplied by a reverse flow from the ascending cervical artery. The pedicled clavicular bone readily reached the mandible in all dissections. Conclusion: The osteoperiosteal vasculature of the clavicular flap is based on the transverse cervical artery which receives a reverse blood supply from the ascending cervical artery. This vascular pattern is reliable because of the existence of the sub-occipital microvascular network named the "Bosniak node." This pedicled clavicular flap seems to be a robust perspective in both mandibular and facial bone reconstruction. We do not claim that it will replace the existing approaches, but it will expand the surgical panel of mandibular reconstruction. Its clinical realisation will judge its functionality. [ABSTRACT FROM AUTHOR]

Introduction. A postsurgical ciliated cyst (PSCC) is an epithelial cyst that usually develops in the maxilla, although in rare cases, it can affect the mandible or other facial bones. The typical age of diagnosis is 40-50 years, with no gender prevalence, and the mean cyst development occurs approximately 10-15 years following a surgical or traumatic event. Some epithelial respiratory cells can be trapped into the bone tissue during maxillary surgical procedures or maxillary fractures. The pathogenetic mechanism can be attributed to an inflammatory process that stimulates epithelial proliferation, leading to cyst expansion caused by osmotic pressure difference. Methods. This study presents case series involving three surgical ciliated cysts located in the left maxilla, affecting two female patients (aged 49 and 55 years) and one male patient (aged 39 years). In all three cases, symptoms such as pain or swelling were mild and not consistently present. Two cases showed cyst development 10 and 15 years after implant placement, while one case was not associated with any surgical or traumatic event. CT scan identified well-defined unilocular lesions in the maxillary bone in each patient. Results. Histopathological examination of the surgical specimens confirmed the suspected diagnosis of a PSCC of maxilla. The cystic walls consisted of fibrous connective tissue with chronic inflammatory infiltrate, lined exclusively by a thin layer of ciliated pseudostratified columnar epithelium. In the third patient, it was not possible to rule out an unusual radicular cyst. Conclusions. Although PSCCs are not commonly encountered in daily practice, clinicians should consider this possibility including it in the differential diagnosis of odontogenic jaw cysts and benign jaw tumors, particularly in patients who have undergone previous surgeries in the maxillary area. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective cohort study evaluates the influence of connective tissue grafts (CTG) on bone regeneration at implant sites with total loss of the buccal bone wall treated with flapless immediate implant placement (IIP) and reconstruction with autogenous bone chips (AB) within a follow-up of up to 13 years. Methods: Sixty implants were inserted in 55 patients in sites with total loss of the buccal bone wall between 2008 and 2021. The implants were inserted and the buccal gaps were grafted by AB. A subgroup of 34 sites was grafted additionally with CTG using tunnel technique. Primary outcome was the vertical bone regeneration in height and thickness. Secondary outcome parameters were interproximal marginal bone level, recession, soft tissue esthetics (PES), width of keratinized mucosa (KMW) and probing depths (PPD). Results: Mean follow-up period was 60.8 months. In 55 sites a complete vertical bone regeneration was documented. The mean buccal bone level increased by 10.6 mm significantly. The thickness of the buccal bone wall ranged between 1.7 and 1.9 mm, and was significantly thicker in sites without CTG. Interproximal marginal bone level was at implant shoulder level. The mean recession improved significantly by 1.2 mm. In sites with CTG, recessions and PES improved significantly more. Conclusions: Additional CTG in extraction sites with total buccal bone loss followed by IIP with simultaneous AB grafting led to improved PES and recession, but also to a thinner buccal bone wall compared to sites grafted just with AB. [ABSTRACT FROM AUTHOR]

Background: Hemifacial microsomia is characterized by the hypoplasia of the mandible and temporomandibular joint, involving a variety of abnormalities of the craniofacial area. Since it gradually worsens as patients grow, it is necessary to understand the characteristics of facial bone growth and facial deformity in hemifacial microsomia patients in order to determine appropriate treatment timing and treatment methods. Main body: Appropriate classification of hemifacial microsomia would facilitate accurate diagnosis, selection of treatment methods, and prognosis prediction. Therefore, in this article, we review previously published hemifacial microsomia classification and provide an overview of the growth of the facial skeleton and the characteristics of hemifacial microsomia-related facial deformities. The OMENS system is the most comprehensive classification method based on the characteristics of hemifacial microsomia deformity, but it needs to be improved to include malar/midface abnormalities and nerve involvement. In hemifacial microsomia, growth is progressing on the affected side, but to a lesser degree than the unaffected side. Therefore, surgical intervention in growing patients should be performed selectively according to the severity of deformity. Conclusion: Understanding growth patterns is important to develop appropriate treatment protocols for correcting asymmetry in adult patients and to minimize secondary anomalies in growing patients. [ABSTRACT FROM AUTHOR]

Introduction: Mandible is the strongest and most durable facial bone. Methods: 202 Dental Panoramic Tomograph (DPT) consisted of 116 females and 86 males between ages of 18-34 years old were selected from the computer server at radiology department of Kulliyyah of Dentistry ranging from 2010 until 2020. The DPT were viewed on Planmeca Romexis software where linear and angular mandibular parameters were assessed accordingly in milimeters and degree, respectively. Relationship and correlation analysis among the mandibular morphometry measurements with regards to sex and age were tested respectively. Results: Four bilateral linear mandibular parameters (maximum ramus breadth, MxrB; minimum ramus breadth, MnRB; coronoid height, CH and condylar height, CdH) showed statistically significant difference (p <0.0.5) in terms of relationship between sex and mandibular. Meanwhile, only maximum ramus breadth (MxRB) bilaterally, right minimum ramus breadth (MnRB), right coronoid height (CH) and right gonial angle (GA) were found to be statistically significant and correlated with age. Hence, the regression equations for the correlated mandibular measurements were generated accordingly. Conclusion: In conclusion, DPT mandibular measurements were proved to be a good tool for sex and age assessment for certain morphometry. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Cardiovascular Disease Research, discusses a study on faciomaxillary injuries in females. The study aims to evaluate the incidence, etiology, fracture patterns, and management of these injuries. The results show that the most common cause of these injuries is road traffic accidents, followed by assault. Mandibular fractures were found to be the most common, and most fractures were managed operatively. The study highlights the importance of understanding the risk factors and implementing safety measures to prevent these injuries. [Extracted from the article]

Introduction: Computed Tomography (CT) has revolutionized medical imaging, particularly in anatomically complex regions like the maxillofacial region. It stands as the preferred investigation for assessing facial bone fractures resulting from trauma. Objective: Frequency and Type of Fractures: To Describe the frequency and types of fractures in patients with maxillofacial injuries using multislice CT and 3D reconstruction. Comparison of Imaging Modalities: To Compare the utility of three-dimensional (3D) reconstructed images with two-dimensional axial images in evaluating maxillofacial injuries. Materials and methods: A cross-sectional study involved 180 patients (100 men, 80 women; Age: 10-65 years) with a history of maxillofacial trauma. A 128-slice CT scanner was utilized, and both axial and 3D images were reconstructed, including coronal Multiplanar Reconstruction (MPR). Results: Demographics showed male predominance, with the most common age group being 30-40 years. Road traffic accidents (RTA) were the most common mode of injury. Fracture distribution revealed maxillary and nasoethmoid fractures as most common. In imaging comparison, 3D images were similar or superior to axial images in most aspects, except for fractures involving thin bones in the orbitoethmoid and maxillary regions. Coronal reconstructed images were effective in detecting fractures in all examined regions. Interpretation and Conclusion: This study underscores the pivotal role of Multidetector Computed Tomography (MDCT) in evaluating maxillofacial injuries. The advantages of 3D reconstructed images, particularly in the identification of Le Fort fracture lines, are highlighted. Coronal reconstructed images outperformed in detecting fractures in the maxilla and orbit. However, the study recognizes the limited role of 3D images in assessing fractures in the naso-orbitoethmoid region, especially in cases with minimal displacement. [ABSTRACT FROM AUTHOR]

Introduction: Gonial angle is an important craniofacial parameter providing information about symmetry and vertical dimensions of the facial skeleton. It can be measured on panoramic radiographs and lateral cephalograms. Reliable assessment of the gonial angle is challenged by the superimpositions associated with lateral cephalograms. The aim of the current study was to assess the precision of panoramic imaging in measuring the gonial angles compared to lateral cephalograms in adult patients with different mandibular divergence patterns. Methods: Panoramic radiographs and lateral cephalograms of 448 adults (18– 30 years old) were utilized in the study. The gonial angle was determined on the lateral cephalograms using an online AI-driven assessment tool (WebCephTM) and compared to the panoramic measurements among the different gender, malocclusion, and mandibular divergence groups. Results: Statistically significant differences were recorded between measurements taken on lateral cephalograms or panoramic radiographs (p=0.022). In addition, statistically significant differences were reported in gonial angle measurements on panoramic radiographs among the different mandibular divergence groups (p=0.004) for FMA (p=0.002) for Sn-GoMe. Conclusion: While cephalometry is considered the gold standard tool for reliable gonial angle assessment, panoramic radiographs were more accurate in detecting the differences between the divergence groups in the current study. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze the prevalence of and complications resulting from temporal bone fractures in adult and pediatric patients evaluated for cranio-facial trauma in an emergency setting. Methods: A retrospective blinded analysis of CT scans of a series of 294 consecutive adult and pediatric patients with cranio-facial trauma investigated in the emergency setting was conducted. Findings were compared between the two populations. Preliminary reports made by on-call residents were compared with the retrospective analysis, which was performed in consensus by two experienced readers and served as reference standard. Results: CT revealed 126 fractures in 116/294 (39.5%) patients, although fractures were clinically suspected only in 70/294 (23.8%); p < 0.05. Fractures were longitudinal, transverse and mixed in 69.5%, 10.3% and 19.8% of cases, respectively. Most fractures were otic-sparing fractures (95.2%). Involvement of the external auditory canal, ossicular chain and the osseous structures surrounding the facial nerve was present in 72.2%, 8.7% and 6.3% of cases, respectively. Temporal bone fractures extended into the venous sinuses/jugular foramen and carotid canal in 18.3% and 17.5% of cases, respectively. Vascular injuries (carotid dissection and venous thrombosis) were more common in children than in adults (13.6% versus 5.3%); however, the observed difference did not reach statistical significance. 79.5% of patients with temporal bone fractures had both brain injuries and fractures of the facial bones and cranial vault. Brain injuries were more common in adults (90.4%) than in children (63.6%), p = 0.001. Although on-call residents reliably detected temporal bone fractures (sensitivity = 92.8%), they often missed trauma-associated ossicular dislocation (sensitivity = 27.3%). Conclusions: Temporal bone fractures and related complications are common in patients with cranio-facial trauma and need to be thoroughly looked for; the pattern of associated injuries is slightly different in children and in adults. [ABSTRACT FROM AUTHOR]

Objectives: This prospective clinical study aimed to evaluate the accuracy and 1‐year clinical follow‐up performance of dental implant placement with an autonomous dental implant robot (ADIR) system in full‐arch implant surgery. Materials and Methods: Twelve patients with edentulous arches or final dentition received 102 implants using the ADIR system. Global platform deviation, global apex deviation, and global angular deviation between the planned and actual implants were calculated after surgery. Data were statistically analyzed for factors including jaws, implant positions, patient sequences, implant systems, and implant length. Surgery duration was recorded. Patients were followed for 3 months and 1 year after surgery. Periodontal parameters, buccal bone thickness (BBT), and facial vertical bone wall peak (IP‐FC) were recorded. Results: Among the 102 implants, the mean (SD) global platform deviation, global apex deviation, and global angular deviation were 0.53 (0.19) mm, 0.58 (0.17) mm, and 1.83 (0.82)°, respectively. The deviation differences between the mandible and maxilla did not show statistical significance (p >.05). No statistically significant differences were found for the jaws, implant positions, patient sequences, implant systems, and implant length to the deviations (p >.05). The periodontal parameters, the BBT, and IP‐FC remained stable during 1‐year follow‐up. Conclusion: The ADIR system showed excellent positional accuracy. The 1‐year follow‐up after full‐arch implant surgery indicated that the ADIR system could achieve promising clinical performance. Additional clinical evidence is requisite to furnish guidelines for the implementation of the ADIR system in full‐arch implant surgery. [ABSTRACT FROM AUTHOR]

Throughout history, people have struggled to find out the secret of youth. The aim of the manuscript is to review the main achievements regarding the exploration of the aging face phenomenon. It should be very important to know the evolution in this field due to the increase in life expectancy among the population. Our purpose is for the current study to serve as a starting point towards exploring novel research avenues in molecular biology and the confocal immunofluorescence of cervicofacial soft tissues, employing cutting-edge techniques. All changes in the shape of the facial skeleton, soft tissue, retaining ligaments, fat compartments, and the skin envelope contribute to facial aging to varying degrees. [ABSTRACT FROM AUTHOR]

The mammalian cranium (skull without lower jaw) is representative of mammalian diversity and is thus of particular interest to mammalian biologists across disciplines. One widely retrieved pattern accompanying mammalian cranial diversification is referred to as 'craniofacial evolutionary allometry' (CREA). This posits that adults of larger species, in a group of closely related mammals, tend to have relatively longer faces and smaller braincases. However, no process has been officially suggested to explain this pattern, there are many apparent exceptions, and its predictions potentially conflict with well‐established biomechanical principles. Understanding the mechanisms behind CREA and causes for deviations from the pattern therefore has tremendous potential to explain allometry and diversification of the mammalian cranium. Here, we propose an amended framework to characterise the CREA pattern more clearly, in that 'longer faces' can arise through several kinds of evolutionary change, including elongation of the rostrum, retraction of the jaw muscles, or a more narrow or shallow skull, which all result in a generalised gracilisation of the facial skeleton with increased size. We define a standardised workflow to test for the presence of the pattern, using allometric shape predictions derived from geometric morphometrics analysis, and apply this to 22 mammalian families including marsupials, rabbits, rodents, bats, carnivores, antelopes, and whales. Our results show that increasing facial gracility with size is common, but not necessarily as ubiquitous as previously suggested. To address the mechanistic basis for this variation, we then review cranial adaptations for harder biting. These dictate that a more gracile cranium in larger species must represent a structural sacrifice in the ability to produce or withstand harder bites, relative to size. This leads us to propose that facial gracilisation in larger species is often a product of bite force allometry and phylogenetic niche conservatism, where more closely related species tend to exhibit more similar feeding ecology and biting behaviours and, therefore, absolute (size‐independent) bite force requirements. Since larger species can produce the same absolute bite forces as smaller species with less effort, we propose that relaxed bite force demands can permit facial gracility in response to bone optimisation and alternative selection pressures. Thus, mammalian facial scaling represents an adaptive by‐product of the shifting importance of selective pressures occurring with increased size. A reverse pattern of facial 'shortening' can accordingly also be found, and is retrieved in several cases here, where larger species incorporate novel feeding behaviours involving greater bite forces. We discuss multiple exceptions to a bite force‐mediated influence on facial proportions across mammals which lead us to argue that ecomorphological specialisation of the cranium is likely to be the primary driver of facial scaling patterns, with some developmental constraints as possible secondary factors. A potential for larger species to have a wider range of cranial functions when less constrained by bite force demands might also explain why selection for larger sizes seems to be prevalent in some mammalian clades. The interplay between adaptation and constraint across size ranges thus presents an interesting consideration for a mechanistically grounded investigation of mammalian cranial allometry. [ABSTRACT FROM AUTHOR]

Midface hypoplasia in syndromic craniosynostosis (SC) may lead to serious respiratory issues. The aim of this study was to analyse the morphometric correlation between midface and cranial base parameters in paediatric SC patients in order to formulate predictive regression models. The computed tomography scans of 18 SC patients and 20 control were imported into Materialise Mimics Medical version 21.0 software for the measurement of multiple craniofacial landmarks and correlation analysis. The results showed a strong correlation of anterior cranial base (SN), posterior cranial base (SBa), and total cranial base (NBa) (r = 0.935) to maxilla length and width (ZMR–ZML) (r = 0.864). The model of NBa = − 1.554 + 1.021(SN) + 0.753(SBa) with R 2 = 0.875 is proposed to demonstrate the development of the cranial base that causes a certain degree of midface hypoplasia in SC patients. The formula is supported using a prediction model of ZMR–ZML = 5.762 + 0.920(NBa), with R 2 = 0.746. The mean absolute difference and standard deviation between the predicted and true NBa and ZMR–ZML were 2.08 ± 1.50 mm and 3.11 ± 2.32 mm, respectively. The skeletal growth estimation models provide valuable foundation for further analysis and potential clinical application. [ABSTRACT FROM AUTHOR]

Background: Herpes zoster (HZ) is one of the most common skin diseases caused by viruses. Facial HZ develops when the varicella-zoster virus affects the trigeminal nerve, and alveolar osteonecrosis is a rare complication. However, the exact pathogenesis of postherpetic alveolar osteonecrosis remains unclear. Case description: We encountered a patient who presented to the dermatology clinic with facial HZ and tooth exfoliation in the upper right jaw, and panoramic radiography revealed decreased bone density and poor alveolar socket healing in his right maxilla. Biopsy of the alveolar process revealed fragments of nonvital lamellar bone, which were devoid of osteoblasts and osteocytes and were surrounded by numerous neutrophils and bacterial aggregates. Thus, the diagnosis of alveolar osteonecrosis following facial HZ was confirmed. He then underwent resection of the osteonecrotic tissue. The pathological findings of postoperative tissue were similar to those of previous biopsies. Varicella-zoster virus and multiple types of bacteria were detected through next-generation sequencing, and the species of bacteria were consistent with the results of bacterial culture. Antibiotics and valaciclovir were administered during the perioperative period. The patient showed good recovery at the 9-month follow-up. Conclusions: The coexistence of bacterial and viral infection may play an important role in the pathogenesis of alveolar osteonecrosis following HZ. To our knowledge, we are the first to directly explore microbial pathogens in a case of postherpetic alveolar osteonecrosis through next-generation sequencing and bacterial culture. We recommend that oral examinations be carefully conducted for patients who are diagnosed with facial HZ, even if their facial rashes have faded away. We suggest that a prolonged and full-dose antiviral therapy course may be beneficial for the treatment of facial HZ with intraoral lesions. The implementation of dental preventive measures should be considered for patients with facial HZ. The application of antibiotics and excision of necrotic bone may reduce the abundance of bacteria in lesions and improve wound healing. [ABSTRACT FROM AUTHOR]

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Introduction: Establishment of identity is required both in living and dead bodies and in both civil and criminal cases. Unclaimed body is defined as dead person who had no next of kin or no relative or no authorized representative willing to make final disposition of the remains. Aims and objective: The aim of this study was to determine the pattern and distribution of injuries and to find out the cause of the death in unclaimed bodies. Material and methods: In this retrospective study all the autopsies of unclaimed body from September 2018 to August 2022 were included. Results: A total 75 unclaimed body were brought to mortuary for autopsy. Out of 75 cases, 65 (87%) were male and 10 (13 %) were female. Majority of unclaimed bodies in this study belonged to age group 40-50. Contusion on the body was most common type of external injury. Lower limb was most common body part for external injuries. Skull was most common site for fracture. Temporal and temporoparietal were most common cranial bone fractured. Mandible was most common facial bone fractured. Liver laceration was most common internal organ injured in unclaimed bodies. Subarachnoid haemorrhage was most common intracranial haemorrhage. Most common cause of death in the present study was haemorrhage and shock due to antemortem injury. Conclusions: Identification of unclaimed dead body need to be increased by police workforce. Bodies which are unclaimed should be brought to mortuary just after prompt investigation so that autopsy should be started before decomposition which may interfere with autopsy finding and even in identification of the unclaimed body. Colour photography, DNA sampling, finger printing and maintaining dental records should be done for every unclaimed body. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: This study aimed to outline the socio-epidemiological profile of patients with facial fractures treated at a state hospital in a medium-sized city in northeastern Brazil. Methods: The medical records of patients who suffered facial trauma treated at the hospital in question in the las five years (2018-2022) were evaluated. Results: In 2021, the highest number of cases were recorded. There was a male predominance (81.00%), the average age was 35.13. The maxillary zygomatic orbit complex was the most affected bone, which represented 28.00%, with motorcycle accidents as the main etiology, osteosynthesis of the maxillary zygomatic orbit complex the most used means of treatment, and Parnaíba the city with the most patients. Conclusion: It is noticed that young adults were more affected, with motorcycle accidents as the main etiology. In this way, oral and maxillofacial trauma could be avoided with the increase of more educational measures in traffic and greater punishment for reckless drivers.

This article discusses the development of a system for facial image alignment using 83 facial landmarks. The researchers discovered these landmarks by identifying unique anatomical structures of the face, including ligaments and skeletal points. The system incorporates additional points and length parameters to improve precision in lesion quantification during photo analysis. The accuracy and efficiency of the 83 facial landmarks system surpass those of other proposed landmark quantities, making it a valuable tool for facial recognition and analysis. [Extracted from the article]

Introduction: Facial trauma represents significant incapacitation for the victim, as well as a challenge for healthcare teams due to its complexity and involvement of important structures. Analyzing its epidemiology allows us to coordinate public health measures to improve care and prevention. Method: Observational, descriptive, longitudinal study with a retrospective approach based on the medical records of patients who suffered facial trauma treated by the surgical clinic between 2010 and 2019. Results: Among in individuals aged 20 to 29 years, which corresponds to 31.76% of total cases. It was also more common in males, corresponding to 78.45% of total cases. Car accidents were the most common cause, described in 22.31% of medical records, and the main fracture, present in 85.83% of cases, was of the bones of the nose. Conclusion: Victims of oral and maxillofacial trauma treated at the Hospital de Clínicas da Universidade Federal do Triângulo Mineiro are predominantly men in their third decade of life, involved in automobile accidents, with injuries to the bones of the nose that were treated electively.

Aging of craniofacial skeleton significantly impairs the repair and regeneration of trauma-induced bony defects, and complicates dental treatment outcomes. Age-related alveolar bone loss could be attributed to decreased progenitor pool through senescence, imbalance in bone metabolism and bone-fat ratio. Mesenchymal stem cells isolated from oral bones (OMSCs) have distinct lineage propensities and characteristics compared to MSCs from long bones, and are more suited for craniofacial regeneration. However, the effect of epigenetic modifications regulating OMSC differentiation and senescence in aging has not yet been investigated. In this study, we found that the histone demethylase KDM4B plays an essential role in regulating the osteogenesis of OMSCs and oral bone aging. Loss of KDM4B in OMSCs leads to inhibition of osteogenesis. Moreover, KDM4B loss promoted adipogenesis and OMSC senescence which further impairs bone-fat balance in the mandible. Together, our data suggest that KDM4B may underpin the molecular mechanisms of OMSC fate determination and alveolar bone homeostasis in skeletal aging, and present as a promising therapeutic target for addressing craniofacial skeletal defects associated with age-related deteriorations.

The development of craniofacial skeletal structures is fascinatingly complex and elucidation of the underlying mechanisms will not only provide novel scientific insights, but also help develop more effective clinical approaches to the treatment and/or prevention of the numerous congenital craniofacial malformations. To this end, we performed a genome-wide analysis of RNA transcription from non-coding regulatory elements by CAGE-sequencing of the facial mesenchyme of human embryos and cross-checked the active enhancers thus identified against genes, identified by GWAS for the normal range human facial appearance. Among the identified active cis-enhancers, several belonged to the components of the PI3/AKT/mTORC1/autophagy pathway. To assess the functional role of this pathway, we manipulated it both genetically and pharmacologically in mice and zebrafish. These experiments revealed that mTORC1 signaling modulates craniofacial shaping at the stage of skeletal mesenchymal condensations, with subsequent fine-tuning during clonal intercalation. This ability of mTORC1 pathway to modulate facial shaping, along with its evolutionary conservation and ability to sense external stimuli, in particular dietary amino acids, indicate that the mTORC1 pathway may play a role in facial phenotypic plasticity. Indeed, the level of protein in the diet of pregnant female mice influenced the activity of mTORC1 in fetal craniofacial structures and altered the size of skeletogenic clones, thus exerting an impact on the local geometry and craniofacial shaping. Overall, our findings indicate that the mTORC1 signaling pathway is involved in the effect of environmental conditions on the shaping of craniofacial structures. Children's faces resemble their parents to various degrees. Here they show that the maternal diet affects the facial appearances of newborns and that inherited and adaptive mechanisms sculpturing facial bones are linked via dietary protein levels and the mTOR signaling pathway. [ABSTRACT FROM AUTHOR]