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Osteochondroma of the craniofacial region is rare. However, the most common site of osteochondroma in the craniofacial region is the mandibular coronoid process and mandibular condyle. Here, we report a case of a 32‐year‐old woman treated by condylectomy and secondary reconstruction with a temporomandibular joint prosthesis. [ABSTRACT FROM AUTHOR]

Hemifacial hyperplasia (HFH) is a rare congenital disorder characterized by marked unilateral overgrowth of the facial tissues. A subtype of HFH is congenital infiltrating lipomatosis of the face (CIL-F). This disease is characterized by unilateral diffuse infiltration of mature adipose cells in the facial soft tissue and is associated with skeletal hypertrophy. This work aims to report a case of a CIL-F patient with right facial asymmetry and progressive growth at adolescent age, causing mandibular asymmetry due to signs of concomitant unilateral condylar hyperplasia. At the age of seventeen, a condylectomy was performed to stop the progression of asymmetric mandibular growth. Five years later, the patient developed CIL-F-associated temporomandibular joint ankylosis, manifesting as progressive restricted mouth opening along with temporal facial pain. In this CIL-F patient, a TMJ reconstruction with an alloplastic total joint prosthesis was successfully performed with optimal maximal mouth opening, complete alleviation of temporal facial pain, and stable dental occlusion one year postoperatively. A TMJ reconstruction with a complete alloplastic total joint prosthesis proved to be a predictable, stable, and safe treatment option in a patient with CIL-F-associated TMJ ankylosis who was previously treated with condylectomy due to progressive mandibular asymmetry. [ABSTRACT FROM AUTHOR]

Purpose: To investigate subjective efficiency outcomes after maxillomandibular advancement (MMA) surgery in obstructive sleep apnea (OSA) patients. Material and Methods: A prospective cohort study was carried out between December 2016 and May 2021, including 30 severe or treatment-refractory OSA patients treated by MMA surgery. All patients answered four validated questionnaires: the Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Mandibular Function Impairment Questionnaire (MFIQ), and EQ-5D-3L (i.e., EQ-5D and EQ-VAS). They also answered one custom-made questionnaire (AMCSQ). Questionnaires were requested to be filled out 1 week before surgery and at least 6 months after surgery. Results: The total preoperative and postoperative scores on the questionnaires were compared. The mean total ESS (p < 0.01), FOSQ (p < 0.01), EQ-5D (p < 0.05), and EQ-VAS (p < 0.01) scores showed significant improvement, which was in accordance with an improvement in the mean postoperative apnea/hypopnea index score (p < 0.01). In contrast, the mean total MFIQ score (p < 0.01) indicated a decline in mandibular function. Conclusion: This study confirms the hypothesis that MMA surgery in OSA patients improves outcomes, both objectively and subjectively, with the exception of postoperative mandibular function. [ABSTRACT FROM AUTHOR]

Purpose: This prospective cohort study aimed to assess early root migration after a coronectomy of the mandibular third molar at 2 and 6 months after surgery. Methods: We included all patients treated with a coronectomy of an impacted mandibular third molar. The primary outcome measure was the extent of postoperative root migration after 2 and 6 months. Migration was measured as the distance between the root complex and a fixed point on the inferior alveolar canal. The secondary aim was to identify factors (age, impaction pattern, and patient sex) that affected the extent of root migration. Results: One hundred and sixty-five coronectomies were performed in 141 patients (96 females and 45 males; mean age 33.1 years, SD 16.0). The 2-month checkup was completed by 121 patients that received 141 coronectomies. The 6-month check-up was completed by 73 patients that received 80 coronectomies. The mean root migrations were 3.30 mm (SD 2.53 mm) at 2 months and 5.27 mm (SD 3.14 mm) at 6 months. In the 2–6-month interval, the mean root migration was 2.58 mm (SD 2.07 mm). The extents of migration were similar during the 0–2-month interval and the 2–6-month interval (p = 0.529). Younger age was associated with greater root migration, and females experienced significantly greater migrations than males (p = 0.002). Conclusion: Roots migrated more rapidly in the first two postoperative months, compared to the 2–6-month interval. Age was negatively correlated with the extent of root migration, and females showed significantly greater migrations than males. [ABSTRACT FROM AUTHOR]

This retrospective cohort study aimed: (1) to analyze the influence of apnea-predominant versus hypopnea-predominant obstructive sleep apnea (OSA) on surgical outcome after maxillomandibular advancement (MMA); and (2) to evaluate whether MMA alters the presence of apnea-predominant to hypopnea-predominant OSA more than vice versa. In total 96 consecutive moderate to severe OSA patients, who underwent MMA between 2010 and 2021, were included. The baseline apnea–hypopnea index, apnea index, and oxygen desaturation index were significantly higher in apnea-predominant group, while the hypopnea index was significantly higher in hypopnea-predominant group (p < 0.001). No significant difference was found between apnea-predominant group and hypopnea-predominant group in the degree of advancement of A-point, B-point, and pogonion. Surgical success and cure were significantly higher in the hypopnea-predominant group compared to the apnea-predominant group, 57.4% versus 82.1% (p = 0.021) and 13.2% versus 55.5% (p = 0.012), respectively. Of the 68 (70.8%) apnea-predominant patients, 37 (54.4%) shifted to hypopnea-predominant after MMA. Of the 28 (29.2%) hypopnea-predominant patients, 7 (25%) shifted to apnea-predominant postoperatively. These findings suggest that preoperative hypopnea-predominant OSA patients might be more suitable candidates for MMA compared to preoperative apnea-predominant OSA patients. Additionally, MMA proved to alter the presence of apnea-predominant to hypopnea-predominant OSA to a larger extend than vice versa. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this review is to provide sleep physicians, dentists, and researchers with an evidence-based overview of the literature on smart mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea., Methods: A systematic literature search was conducted by two blinded reviewers and an information specialist. A smart MAD was defined as any MAD with additional functionality besides mandibular protrusion. The bibliographic databases Medline, Embase, and Scopus were used to identify relevant publications. Studies were included if they described any stage of development of smart MADs. A total of 3162 titles and abstracts were screened for their relevance. In total, 58 articles were selected for full-text screening, 26 of which were included in this review., Results: The overall quality of the available literature was low. Most of the studies were observational, clinical or applied-research articles. The authors classified MADs into two main groups: passive and active. Passive MADs measured patient data, most commonly patient compliance. Active MADs adjusted protrusion of the mandible in response to patient data and were found in various phases of technological readiness (in development, demonstration, or deployment)., Conclusion: Innovations in smart mandibular advancement devices most frequently track patient compliance. Devices measuring other health parameters and active, feedback-controlled, devices are increasingly reported on. However, studies demonstrating their added benefit over traditional methods remain sparse. With further study, smart mandibular advancement devices have the potential to improve the efficiency of obstructive sleep apnea treatment and provide new treatment possibilities., (© 2024. The Author(s).)

A multicenter cross-sectional diagnostic study was carried out including 45 children with nontuberculous mycobacterial cervicofacial lymphadenitis and controls. The tested immunoassay, detecting M. avium-specific anti-glycopeptidolipid-core immunoglobulin A antibodies, had inadequate diagnostic performance in the studied population and seems to be of no additional value in detecting cases of nontuberculous mycobacterial cervicofacial lymphadenitis., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Maxillomandibular advancement has been shown to be an effective treatment for obstructive sleep apnea; however, the literature focuses mainly on sleep-related parameters such as apnea-hypopnea index, respiratory disturbance index and Epworth sleepiness scale. Other factors that may be important to patients, such as esthetics, patient satisfaction, nasality, swallowing problems and so forth have been reported in the literature but have not been systematically studied. Together with an information specialist, an extensive search in Medline, Embase and Scopus yielded 1592 unique articles. Titles and abstracts were screened by two blinded reviewers. In total, 75 articles were deemed eligible for full-text screening and 38 articles were included for qualitative synthesis. The most common categories of non-sleep related outcomes found were surgical accuracy, facial esthetics, functional outcomes, quality of life, patient satisfaction, and emotional health. All categories were reported using heterogenous methods, such that meta-analysis could not be performed. There was lack of consistent methods to assess these outcomes. This work is the first to systematically review non-sleep related outcomes of maxillomandibular advancement. Despite growing interest in evaluating surgical outcomes through patient subjective experiences, this review points to the need of standardized, validated methods to report these outcomes., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Multiple prediction models were developed for critical outcomes of COVID-19. However, prediction models using predictors which can be easily obtained in clinical practice and on dental status are scarce., Aim: The study aimed to develop and externally validate prediction models for critical outcomes of COVID-19 for unvaccinated adult patients in hospital settings based on demographics, medical conditions, and dental status., Methods: A total of 285 and 352 patients from two hospitals in the Netherlands were retrospectively included as derivation and validation cohorts. Demographics, medical conditions, and dental status were considered potential predictors. The critical outcomes (death and ICU admission) were considered endpoints. Logistic regression analyses were used to develop two models: for death alone and for critical outcomes. The performance and clinical values of the models were determined in both cohorts., Results: Age, number of teeth, chronic kidney disease, hypertension, diabetes, and chronic obstructive pulmonary diseases were the significant independent predictors. The models showed good to excellent calibration with observed: expected (O:E) ratios of 0.98 (95%CI: 0.76 to 1.25) and 1.00 (95%CI: 0.80 to 1.24), and discrimination with shrunken area under the curve (AUC) values of 0.85 and 0.79, based on the derivation cohort. In the validation cohort, the models showed good to excellent discrimination with AUC values of 0.85 (95%CI: 0.80 to 0.90) and 0.78 (95%CI: 0.73 to 0.83), but an overestimation in calibration with O:E ratios of 0.65 (95%CI: 0.49 to 0.85) and 0.67 (95%CI: 0.52 to 0.84)., Conclusion: The performance of the models was acceptable in both derivation and validation cohorts. Number of teeth was an additive important predictor of critical outcomes of COVID-19. It is an easy-to-apply tool in hospitals for risk stratification of COVID-19 prognosis., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Background: Acromegaly is an uncommon syndrome caused by growth hormone-producing pituitary adenoma or pituitary gland hypertrophy. Acromegaly is known to be characterized by progressive somatic disfigurement and a wide range of systematic manifestations. This case study describes a rare case of severe obstructive sleep apnea (OSA) caused by acromegaly., Clinical Presentation: A female patient presented to the consultant clinic with the chief complaint of progressively worsening sleep and was diagnosed with severe OSA. Because of a peculiar facial appearance of the patient, acromegaly was suspected and confirmed by the findings of hormonal analysis and magnetic resonance imaging (MRI). After transsphenoidal resection of the pituitary adenoma, her OSA was almost cured, with residual AHI of 5.5., Conclusion: This case highlights the importance of a comprehensive clinical examination of OSA patients. In every sleep-related breathing disorder case, sleep clinicians should be aware of alternate problems that could cause upper airway obstruction.

The aim of this study was to evaluate the clinical efficacy of maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) patients with a percentage of central and mixed apnea index in the total apnea-hypopnea index (CMAI%) ≧25%. Patients treated with MMA for OSA were retrospectively evaluated for baseline and postoperative patient data and polysomnographic results. The pre- and postoperative obstructive, central and mixed apnea parameters were compared. Of the included 78 patients, 21 patients (27%) presented with CMAI% ≧25% (median CMAI%, 49.1%; 35.9-63.8) prior to MMA. In 67% of these cases, MMA resulted in CMAI% <25 (median CMAI%, 6.1%; 2.1-8.9) and significantly improved the apnea-hypopnea index (AHI) (p < 0.001), the lowest oxyhemoglobin saturation (p < 0.001), central and mixed apnea index (p < 0.001), percentage of central and mixed apneas of total AHI (p = 0.004), central apnea index (p < 0.001), and mixed apnea index (p < 0.001). CMAI% ≧25% emerged in 25% of patients after MMA (median CMAI%, 49.1%; 35.9-63.8). Within the undeniable limitations of the study, it seems that the presence of CMAI% ≧25% should not be regarded as a contraindication for MMA in OSA patients., Competing Interests: Declaration of competing interest Nico de Vries is a member of the Medical Advisory Board of Night Balance. He is also an investigator for Inspire, Nyxoah and Jazz Pharmaceutics, consultant to Philips and Olympus. The other authors declare they have no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Obstructive sleep apnoea is a challenging medical problem due to its prevalence, its impact on quality of life and performance in school and professionally, the implications for risk of accidents, and comorbidities and mortality. Current research has carved out a broad spectrum of clinical phenotypes and defined major pathophysiological components. These findings point to the concept of personalised therapy, oriented on both the distinct clinical presentation and the most relevant pathophysiology in the individual patient. This leads to questions of whether sufficient therapeutic options other than positive airway pressure (PAP) alone are available, for which patients they may be useful, if there are specific indications for single or combined treatment, and whether there is solid scientific evidence for recommendations. This review describes our knowledge on PAP and non-PAP therapies to address upper airway collapsibility, muscle responsiveness, arousability and respiratory drive. The spectrum is broad and heterogeneous, including technical and pharmaceutical options already in clinical use or at an advanced experimental stage. Although there is an obvious need for more research on single or combined therapies, the available data demonstrate the variety of effective options, which should replace the unidirectional focus on PAP therapy., Competing Interests: Conflict of interest: W. Randerath reports receiving payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Weinmann, Heinen & Löwenstein, Resmed, Jazz Pharmaceuticals, Inspire, Philips Respironics, Bioprojet, and Vanda Pharma; and support for attending meetings and/or travel received from Heinen & Löwenstein, Resmed, Jazz Pharmaceuticals, Inspire, Philips Respironics and Bioprojet; participation on a data safety monitoring or advisory board for Bioprojet, Jazz Pharmaceuticals and Philips Respironics. He is Head of European Respiratory Society Assembly 4 (Sleep Disordered Breathing) and an associate editor of this journal. J. Steier is a named inventor on a patent for KCL/GSTT (Apparatus for treatment of snoring and sleep apnoea; WO2016124739A1) outside the submitted work. J. Verbraecken reports grants or contracts received from Philips Respironics, Heinen & Löwenstein, ResMed, Total Care, Fisher & Paykel, Bioprojet, Jazz Pharmaceutics, AirLiquide, Total Care, Westfalen Medical, Somnomed, Medidis, Wave Medical, OSG, Mediq Tefa, NightBalance, Accuramed, Bekaert Deslee Academy, UCB Pharma, Vivisol and Inspire Medical Systems, outside the submitted work; consulting fees received from Vemedia; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events received from Sanofi, Agfa-Gevaert, Astra-Zeneca, TotalCare, Springer and OSA Academy; support for attending meetings and/or travel received from Bioprojet; participation on a data safety or advisory board for Bioprojet, Oxford Pharmagenesis, Idorsia, MSD and Desitin. He was President (until August 2021) and is Past President of the Belgian Association for Sleep Research and Sleep medicine (since September 2021), and is an associate editor of this journal. The remaining authors have nothing to disclose., (Copyright ©The authors 2022.)

Study Objectives: (1) To investigate if drug-induced sleep endoscopy (DISE) findings are predictive of surgical response for patients undergoing maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) and (2) to investigate the predictive value of the jaw thrust maneuver during DISE in terms of surgical response to MMA., Methods: A retrospective cohort study was conducted in patients with OSA who underwent a baseline polysomnography (PSG) and DISE followed by MMA and a 3- to 6-month follow-up PSG between September 1, 2011, and September 30, 2020., Results: Sixty-four patients with OSA (50 males [78.1%]; mean ± SD age = 51.7 ± 9.5 years; mean ± SD apnea-hypopnea index = 49.0 ± 20.8 events/h) were included. Thirty-nine patients were responders, and 25 were nonresponders. Adjusting for baseline characteristics and surgical characteristics (eg, age, baseline apnea-hypopnea index, degree of maxillary advancement), patients with complete anteroposterior epiglottic collapse had 0.239 times lower odds for response to MMA (95% confidence interval, 0.059-0.979; P = .047). No significant relationship was found between complete concentric velum collapse and MMA response. There was no statistically significant association between effect of jaw thrust maneuver during DISE on upper airway patency and treatment outcome of MMA., Conclusions: This study indicates that DISE is a promising tool to identify patients who will or will not respond to MMA for treating OSA. Patients with complete anteroposterior epiglottic collapse may be less suitable candidates for MMA., Citation: Zhou N, Ho J-PTF, de Vries N, Bosschieter PFN, Ravesloot MJL, de Lange J. Evaluation of drug-induced sleep endoscopy as a tool for selecting patients with obstructive sleep apnea for maxillomandibular advancement. J Clin Sleep Med . 2022;18(4):1073-1081., (© 2022 American Academy of Sleep Medicine.)

Local anesthesia is indispensable in dentistry. Worldwide, millions of local anesthetic injections are administered annually, and are generally considered safe invasive procedures. However, adverse effects are possible, of which dentists should be aware of. This scoping review aimed to provide an extensive overview of the reported literature on the adverse effects of dental local anesthesia. The types of papers, what is reported, and how they are reported were reviewed. Additionally, the incidence and duration of adverse effects and factors influencing their occurrence were also reviewed. An electronic search for relevant articles was performed in PubMed and Embase databases from inception to January 2, 2020. The titles and abstracts were independently screened by two reviewers. The analysis was narrative, and no meta-analysis was performed. This study included 78 articles. Ocular and neurological adverse effects, allergies, hematomas, needle breakage, tissue necrosis, blanching, jaw ankylosis, osteomyelitis, and isolated atrial fibrillation have been described. Multiple adverse effects of dental local anesthesia have been reported in the literature. The results were heterogeneous, and detailed descriptions of the related procedures were lacking. Vital information concerning adverse effects, such as the dosage or type of anesthetic solution, or the type of needle used, was frequently missing. Therefore, high-quality research on this topic is needed. Finally, the adverse effects that are rarely encountered in real-world general practice are overrepresented in the literature., Competing Interests: DECLARATION OF INTEREST: The authors have no conflicts of interest to declare., (Copyright © 2021 Journal of Dental Anesthesia and Pain Medicine.)

Objectives: To provide dental practitioners and researchers with a comprehensive and transparent evidence-based overview of the characteristics of literature regarding initiatives of robot technology in dentistry., Data: All articles in which robot technology in dentistry is described, except for non-scientific articles and articles containing secondary data (reviews). Amongst others, the following data were extracted: type of study, level of technological readiness, authors' professional background and the subject of interaction with the robot., Sources: Bibliographic databases PubMed, Embase, and Scopus were surveyed. A reference search was conducted. The search timeline was between January 1985 and October 2020., Study Selection: A total of 911 articles were screened on title and abstract of which 161 deemed eligible for inclusion. Another 71 articles were excluded mainly because of unavailability of full texts or the sole use of secondary data (reviews). Four articles were included after hand searching the reference lists. In total, 94 articles were included for analysis., Conclusions: Since 2013 an average of six articles per year concern robot initiatives in dentistry, mostly originating from East Asia (57%). The vast majority of research was categorized as either basic theoretical or basic applied research (80%). Technology readiness levels did not reach higher than three (proof of concept) in 55% of all articles. In 84%, the first author of the included articles had a technical background and in 36%, none of the authors had a dental or medical background. The overall quality of literature, especially in terms of clinical validation, should be considered as low., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: To provide dental practitioners and researchers with a comprehensive and transparent evidence-based overview of physical robot initiatives in all fields of dentistry., Data: Articles published since 1985 concerning primary data on physical robot technology in dentistry were selected. Characteristics of the papers were extracted such as the respective field of dentistry, year of publication as well as a description of its usage., Sources: Bibliographic databases PubMed, Embase, and Scopus were searched. A hand search through reference lists of all included articles was performed., Study Selection: The search timeline was between January 1985 and October 2020. All types of scientific literature in all languages were included concerning fields of dentistry ranging from student training to implantology. Robot technology solely for the purpose of research and maxillofacial surgery were excluded. In total, 94 articles were included in this systematic review., Conclusions: This study provides a systematic overview of initiatives using robot technology in dentistry since its very beginning. While there were many interesting robot initiatives reported, the overall quality of the literature, in terms of clinical validation, is low. Scientific evidence regarding the benefits, results and cost-efficiency of commercially available robotic solutions in dentistry is lacking. The rise in availability of open source control systems, compliant robot systems and the design of dentistry-specific robot technology might facilitate the process of technological development in the near future. The authors are confident that robotics will provide useful solutions in the future but, strongly, encourage an evidence-based approach when adapting to new (robot) technology., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Multilevel surgery (MLS) and maxillomandibular advancement surgery (MMA) are two established options in surgical management of obstructive sleep apnea (OSA), which target different levels of airway obstruction. The objective of this review was to comparatively evaluate the clinical efficacy and safety of MMA and MLS in the treatment of OSA. MEDLINE and Embase databases were searched for studies on MMA and/or MLS in OSA patients. Twenty MMA studies and 39 MLS studies were identified. OSA patients who underwent MMA showed significant improvements in AHI, LSAT, ODI, and ESS by -46.2/h, 13.5%, -30.3/h, and -8.5, respectively. The pooled rates of surgical success and cure for MMA were 85.0% and 46.3%, respectively. Patients who underwent MLS showed significant improvements in AHI, LSAT, ODI, and ESS by -24.7/h, 8.7%, -19.1/h, and -5.8, respectively. The pooled surgical success and cure rates for MLS were 65.1% and 28.1%, respectively. The rates of major complication of MMA and MLS were 3.2% and 1.1%, respectively, and the rate of minor complication of MMA was higher than that of MLS. We conclude that both MMA and MLS are effective treatment options for OSA. Compared to MLS, MMA may be more effective in improving OSA. However, the complication rate of MMA is higher., Competing Interests: Conflicts of interest The authors declare that they have no conflict of interest., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Study Objectives: (1) To evaluate surgical success in patients with obstructive sleep apnea undergoing maxillomandibular advancement (MMA) stratifying for the reduction of both the total apnea-hypopnea index (AHI) and the AHI in the supine and nonsupine position; (2) to evaluate the influence of position dependency on surgical outcome; and (3) to analyze the prevalence of residual position-dependent obstructive sleep apnea (OSA) in nonresponders after MMA., Methods: A single-center retrospective study including a consecutive series of patients with OSA undergoing MMA between August 2011 and February 2019., Results: In total, 57 patients were included. The overall surgical success was 52.6%. No significant difference in surgical success between nonpositional patients (NPP) and positional patients (PP) with OSA was found. Surgical success of the supine AHI was not significantly different between NPP and PP, but surgical success of the nonsupine AHI was significantly greater in NPP than in PP. Of the 17 preoperative NPP, 13 of them moved to being PP with less severe OSA postoperatively. In total, 21 out of 27 nonresponders (77.8%) were PP postoperatively., Conclusions: No significant difference in surgical success between NPP and PP undergoing MMA was found. However, the improvement of total and nonsupine AHI in NPP was significantly greater compared to PP. In nonresponders, a postoperative shift from severe OSA in NPP to less severe OSA in PP was found, caused by a greater reduction of the nonsupine AHI than the supine AHI postoperatively. In patients with residual OSA in the supine position after MMA, additional treatment with positional therapy can be indicated., (© 2020 American Academy of Sleep Medicine.)

Importance: To date, no consensus exists regarding optimal perioperative care of patients with obstructive sleep apnea (OSA) undergoing upper airway (UA) surgery. These patients are at risk related to anesthesia and postoperative analgesia, among other risks associated with difficult airway control, and may require intensified perioperative management., Objective: To provide a consensus-based guideline by reviewing available literature and collecting expert opinion during an international consensus meeting with experts from relevant speciliaties., Evidence Review: In a consensus meeting conducted on April 4, 2018, a total of 47 questions covering preoperative, intraoperative, and postoperative care were formulated by 12 international experts with extensive clinical experience in the field of UA surgery for OSA. Systematic literature searches were performed by an independent information specialist and 6 researchers according to the Oxford and GRADE systems, and 164 articles published on or before December 31, 2011, were included in the analysis. Two moderators chaired the meeting according to the Amsterdam Delphi Method, including iteration of literature conclusions, expert discussion, and voting rounds. Consensus was reached when there was 70% or more agreement among experts., Findings: Of 47 questions, 35 led to a recommendation or statement. The remaining 12 questions provided no additional information and were excluded in the judgment of experts. Consensus was reached for 32 recommendations. For 1 question there was less than 70% agreement among experts; therefore, consensus was not achieved. Highlights of these recommendations include (1) postoperative bleeding is a complication described for all types of UA surgery; (2) OSA is a relative risk factor for difficult mask ventilation and intubation, and plans for difficult airway management should be considered and implemented; (3) safe perioperative care should be provided, with aspects such as OSA severity, adherent use of positive airway pressure, type of surgery, and comorbidities taken into account; (4) although there is no direct evidence to date, in patients undergoing UA surgery, preoperative treatment with positive airway pressure may reduce the risk of postoperative airway complications; and (5) alternative pain management options perioperatively to reduce opioid use should be considered., Conclusions and Relevance: This consensus contains 35 recommendations and statements on the perioperative care of patients with OSA undergoing UA surgery and may be used as a guideline in daily practice.

Objective: The study aim was to investigate variations in the symmetry of the zygomaticomaxillary complex (ZMC) in normal individuals., Method: Computed tomography datasets of 200 individuals without facial fractures were analyzed using a validated three-dimensional analysis technique. The absolute average distance (AD) and 90th percentile distance (NPD) were calculated, representing respectively the overall and maximum symmetry between bilateral ZMCs., Results: The mean AD and NPD of the total study group was 0.9 ± 0.3 mm (95% CI 0.3-2.3) and 1.7 ± 0.5 mm (95% CI 0.5-3.9), respectively. The mean AD and NPD in males were 1.0 ± 0.3 mm (95% CI 0.28-2.34) and 1.9 ± 0.5 mm (95% CI 0.5-3.9) versus 0.8 ± 0.3 mm (95% CI 0.4-1.7) and 1.6 ± 0.5 mm (95% CI 0.8-2.9), respectively, for females. A statistically significant difference between male and female was found for both AD and NPD (p < 0.01). The male population <40 years had a mean AD and NPD of 1.0 ± 0.3 mm and 1.8 ± 0.5 mm, which was not statistically significant when compared with males >40 years., Conclusion: The naturally occurring anatomic variation in ZMC symmetry described in this study is proposed as a benchmark for evaluating the amount of preoperative displacement and postoperative reduction of ZMC in trauma cases., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: The study aim was to validate a new method for measuring zygomaticomaxillary complex (ZMC) symmetry, which can be helpful in analyzing ZMC fractures., Methods: Three-dimensional virtual hard-tissue models were reconstructed from computed tomography (CT) datasets of 26 healthy individuals. Models were mirrored and superimposed. Absolute average distance (AD) and 90th percentile distance (NPD) were used to measure overall and maximal symmetry. The Intraclass Correlation Coefficient (ICC) was calculated to measure interobserver consistency. In order to determine whether this technique is applicable in ZMC fracture cases, 10 CT datasets of individuals with a unilateral ZMC fracture were analyzed., Results: For the unaffected group the mean AD was 0.84 ± 0.29 mm (95% CI 0.72-0.96) and the mean NPD was 1.58 ± 0.43 mm (95% CI 1.41-1.76). The ICC was 0.97 (0.94-0.98 as 95% CI), indicating almost perfect interobserver agreement. In the affected group the mean AD was 2.97 ± 1.76 mm (95% CI 1.71-4.23) and the mean NPD was 6.12 ± 3.42 mm (95% CI 3.67-8.57). The affected group showed near-perfect interobserver agreement with an ICC of 0.996 (0.983-0.999 as 95% CI)., Conclusions: The method presented is an accurate instrument for evaluation of ZMC symmetry, which can be helpful for advanced diagnostics and treatment evaluation., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)