Background Multiple studies have shown that tumor thickness (TT) or tumor volume (TV) play crucial roles in the diagnosis and treatment of tongue squamous cell carcinoma (TSCC). This study aimed to compare the application value of three-dimensional (3D) TV and TT based on preoperative magnetic resonance imaging (MRI) in forecasting cervical lymph node (CLN) metastases and the prognosis of TSCC. Methods A cohort of 81 patients was included in this study. ITK-SNAP and 3D Slicer software were used to determine 3D TV and TT. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive accuracy of TT and TV for CLN metastasis and to identify the optimal cutoff values. Univariable and multivariable logistic regression analyses were used to identify factors associated with pathologically confirmed CLN metastasis. Overall survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression analysis. A nomogram was subsequently developed to provide individualized visual prediction of survival probability at specific time points. Results The optimal cutoff values for predicting CLN metastasis were 13.5 mm for TT and 5.8 cm3 for TV. Multivariable analyses showed that TT ≥ 13.5 mm was independently associated with pathologically confirmed CLN metastasis and poorer overall survival in patients with TSCC, whereas TV did not retain independent significance. The nomogram incorporating tumor stage, pathological grade, and tumor thickness showed that TT contributed more to survival prediction than the other included clinicopathological variables. However, the small sample size and inaccurate initial T staging limit the reliability of the regression analysis and nomogram.
Complex head and neck defects often require chimeric anterolateral thigh (ALT) perforator flaps for reconstruction. However, the variable anatomy of the lateral circumflex femoral artery (LCFA) makes preoperative perforator mapping essential for successful harvest of multiple skin paddles. We developed a standardized protocol combining computed tomography angiography (CTA) with color Doppler ultrasound (CDU). First, bilateral lower extremity CTA scans from 52 patients (104 thighs) were analyzed to characterize perforator distribution from the descending branch of the LCFA. This protocol was then applied to 12 patients with complex head and neck defects. CDU was used to localize and mark cutaneous perforator exit points before CTA scanning. Perforator characteristics were analyzed, and three-dimensional models created. Detailed vessel data were then transferred through a coordinate system to optimize flap design. All 12 chimeric ALT flaps were harvested successfully according to the preoperative plan, with satisfactory flap viability and favorable clinical outcomes. Integrating CDU identification with subsequent CTA mapping provides a reliable preoperative strategy that enhances the precision and safety of chimeric ALT flap reconstruction for complex head and neck defects.
Despite the increasing representation of women in the global dental workforce, gender disparities persist in academic leadership and high-visibility roles. No comprehensive study has jointly evaluated the gender and geographic distribution of invited speakers at international oral and maxillofacial surgery (OMS) congresses. This retrospective observational study analyzed invited speakers at four major international OMS congresses between 2016 and 2026. Publicly available scientific programs were reviewed, and data on speaker gender and continental affiliation were recorded. Statistical associations were assessed using chi-square and linear-by-linear trend analyses.In total, 3534 invited speakers were identified, of whom 21.7% were women. Gender distribution varied significantly by year, organizing society, and continent (all p < 0.001). Although a modest but significant increase in female representation was observed over time (p = 0.031), North America accounted for the largest proportion of invited speakers (50.8%).Overall, invited-speaker representation remains substantially imbalanced across gender and geographic dimensions. Persistent disparities suggest underlying structural inequalities. Transparent speaker-selection processes, structured mentorship for early-career women, and routine monitoring of representation metrics may help improve equitable academic visibility and strengthen diversity in oral health leadership.
Background: Free vascularized fibula reconstruction is the gold standard for oromandibular defect reconstruction following tumor ablative surgery. However, in patients with poor prognosis, compromised general health, or inadequate vascular status in the lower extremities or chest, less invasive alternatives may be preferable. This study evaluated outcomes and complication rates of mandibular defect reconstruction using a reconstruction plate covered with a pedicled pectoralis major muscle flap (PMMF), performed after tumor ablation or for osteoradionecrosis. Methods: A retrospective review was conducted of twenty-one patients who underwent PMMF coverage of a mandibular reconstruction plate following oral cavity cancer resection or for osteoradionecrosis at the Leiden University Medical Center (LUMC) between April 2011 and August 2023. Primary outcomes included plate exposure, wound dehiscence, and flap vitality. Results: Twenty-one patients (eleven men, ten women) were included, with a median follow-up of 20.5 months (range 1.6 months to 2.4 years). Plate exposure occurred in eleven patients (52.4%) after a median of 2.7 weeks; six required plate removal. Two patients underwent successful re-coverage without removal, and three were managed expectantly. Wound dehiscence occurred in eighteen patients (85.7%), and partial flap necrosis in eight (38.1%). Conclusion: Mandibular reconstruction using a plate covered with a PMMF is associated with high complication rates, particularly plate exposure, frequently necessitating reoperation and adversely affecting quality of life. These findings question the suitability of this approach in patients who are not candidates for free fibula reconstruction. Although high complication rates of soft tissue coverage over reconstruction plates are well documented, our results underscore the need to refine patient selection, optimize plate characteristics, improve surgical technique, and consider alternative strategies, including PMMF reconstruction without plate placement.
INTRODUCTION:Arthrocentesis improves pain and function in arthrogenic temporomandibular disorders (TMD), but the added value of biologics such as injectable platelet-rich fibrin (iPRF), platelet-rich plasma (PRP), and hyaluronic acid (HA) is uncertain. MATERIALS AND METHODS:This retrospective cohort study included 44 patients (33 females, 11 males) with arthrogenic TMD who underwent arthrocentesis between 2022 and 2024. Patients received iPRF (n = 18), PRP-HA (n = 12), or saline (NaCl; n = 14). The primary endpoint was pain at rest (VAS 0-10). Secondary outcomes included pain on mastication (VAS) and palpation (temporomandibular joint (TMJ), temporalis, masseter and lateral pterygoid muscle; binary), maximum interincisal distance (MID), and TMJ noises. Follow-up was performed at 1 week, 1, 3, 6, and 12 months after surgery. RESULTS:All groups showed significant postoperative improvements in pain at rest and during mastication, with no differences between groups for the primary endpoint. In secondary outcomes, PRP-HA was associated with the lowest prevalence of TMJ noises in the first week (8.3%), first and 12 month (8.3% and 10%, respectively; p < 0.0001) and with the most consistent MID values over follow-up. It also showed the most sustained absence of temporalis muscle pain at the whole 12 months period (p < 0.0001). By contrast, iPRF was linked to transiently higher muscle tenderness; saline showed greater variability including late lateral pterygoid pain. CONCLUSION:Arthrocentesis provides durable pain relief in arthrogenic TMD independent of the adjunctive injectate. While no differences were observed for the primary endpoint, secondary outcomes indicate that PRP-HA may be associated with favorable effects on joint noises and muscle tenderness, warranting further investigation.
The aim of this study was to quantify postoperative regional condylar remodeling and its role in skeletal relapse after bimaxillary surgery using CBCT scans. 40 patients with mandibular hypoplasia who underwent bimaxillary surgery were analyzed. CBCT scans were acquired preoperatively, one-week postoperatively and two-years postoperatively. Deep-learning based 3D regional condylar volume analysis was performed and skeletal relapse was quantified through voxel-based matching. The maxilla and mandible were advanced by a mean of 2.87 mm and 8.37 mm, respectively, with a corresponding mean sagittal relapse of .57 mm and 1.62 mm. Postoperative volume loss was observed in 78% of condyles (mean loss = 242 mm3; 16%). Linear regression analyses identified age, gender and magnitude of advancement as significant predictors of relapse. Condylar volume loss significantly mediated the relationship between surgical advancement and skeletal relapse, accounting for 29.1% of the total effect. No statistically significant correlation was found between specific condylar regional sub-volumes and directions of surgical movement. These findings underline the importance of condylar volume stability in predicting long-term skeletal stability among patients who undergo bimaxillary surgery with large advancements. The results also indicated that condylar remodeling is a generalized phenomenon related to surgical movements rather than a localized process restricted to specific anatomical regions of condyles.
Middle ear pathology and Eustachian tube dysfunction are commonly seen in patients with cleft lip and palate (CLP). Various palatoplasty techniques aim to improve velopharyngeal function, but their impact on middle ear recovery remains incompletely understood. The aim of this study was to compare the recovery of middle ear pathology between two primary palatoplasty techniques through audiometric evaluation. A retrospective cohort study of 211 CLP patients was conducted who underwent primary palatoplasty between January 2023 and December 2024 at a tertiary cleft center. Participants were divided into two groups based on the surgical technique received: Group 1 underwent Modified Two-flap palatoplasty with Intravelar veloplasty, while Group 2 underwent Modified Furlow's palatoplasty. The primary outcome was middle ear status assessed through standardized audiometric evaluation performed preoperatively and 6 months postoperatively. Chi-square test was used for categorical variables and independent t-tests was applied for continuous variables, with p < 0.05 considered significant. After propensity score matching, 76 matched pairs were analyzed with comparable baseline characteristics. Middle ear pathology recovery at 6 months was significantly higher in the Furlow's group (61.8%, 47/76) versus Bardachs group (23.7%, 18/76; p < 0.001). Type A tympanograms increased to 61.8% versus 15.8% respectively. Positive otoacoustic emissions improved to 56.6% versus 22.4% (p < 0.001). Multivariable analysis confirmed Furlow's superiority (OR 5.23, 95% CI 2.58-10.61, p < 0.001). Modified Furlow's palatoplasty demonstrated significantly better recovery of Eustachian tube function compared to Modified Two-flap palatoplasty with Intravelar veloplasty at 6 months post-surgery. This superior outcome is likely attributable to more radical transposition of the Tensor veli palatini muscle in the Furlow's technique, resulting in improved middle ear ventilation and better audiological outcomes in CLP patients.
Objective: We conducted a network meta-analysis to evaluate and prioritize scalpels and energy-based soft-tissue management tools used during pediatric oral surgeries. This was based on postoperative pain levels and wound healing results. Materials and methods: A systematic review and network meta-analysis were conducted. This analysis was performed following the PRISMA-NMA guidelines. The electronic databases PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane Library were searched from inception to December 2025. Randomized controlled trials and prospective comparative studies of pediatric patients undergoing oral soft-tissue surgery were eligible for inclusion. The included interventions were scalpel surgery, diode laser, CO2 laser, Nd:YAG laser, and electrosurgery. The primary outcomes were postoperative pain and wound healing. The risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Frequentist and Bayesian random-effects network meta-analyses were performed. Treatment ranking was estimated by reporting the surface under the cumulative ranking curve (SUCRA) values. Results: Twelve studies were included in this review. All energy-based modalities produced less postoperative pain than scalpel surgery. The highest ranking probability for reducing pain was observed with electrosurgery (SUCRA 71.2%), followed by Nd: YAG laser (SUCRA 66.8%) and diode laser (SUCRA 56.5%). Scalpel surgery had the lowest probability ranking (19.7%). Diode laser had the highest probability for wound healing (SUCRA 86.6%). This was followed by scalpel surgery (71.8%). Electrosurgery had the lowest ranking probabilities for all wound healing outcomes (SUCRA 5.5%). No significant inconsistency was observed between the direct and indirect comparisons. Publication bias was low for the postoperative pain. Conclusion: Energy-based modalities offer outcome-selective advantages over conventional scalpel surgery for minor oral soft-tissue procedures. The maximum reduction in postoperative pain was achieved using electrosurgery and Nd: YAG laser. Diode lasers offer the best wound-healing results. These results validate an approach to pediatric oral surgery that focuses on individual outcomes using personalized techniques.
OBJECTIVE:To quantitatively assess treatment-associated trabecular bone changes following intralesional corticosteroid therapy in central giant cell granuloma (CGCG) using cone-beam computed tomography (CBCT)-based fractal analysis. MATERIALS AND METHODS:This retrospective pilot study included 10 adult patients with histopathologically confirmed CGCG treated with intralesional corticosteroid injections. CBCT images obtained before treatment and at 6-8 months follow-up were analyzed. Fractal dimension (FD) values were calculated from standardized regions of interest on corresponding cross-sectional slices using ImageJ software. Pre- and post-treatment FD values were compared to evaluate trabecular bone changes. RESULTS:Post-treatment FD values were significantly higher than pre-treatment values across all evaluated slices (p = 0.002 for all comparisons). These findings remained statistically significant after Bonferroni correction (adjusted p = 0.010). Rank-biserial correlation coefficients indicated large effect sizes across all slice comparisons, and FD values increased in all patients during follow-up. No statistically significant differences were observed among slice-based FD changes (p = 0.665). CONCLUSION:Intralesional corticosteroid therapy was associated with increased trabecular complexity on CBCT-based fractal analysis. These findings suggest that fractal analysis may provide an objective method for monitoring trabecular bone reorganization during follow-up of conservatively managed CGCG lesions. Further studies with controlled designs are needed to clarify the relationship between these radiologic changes and treatment outcomes.
Anatomical barriers, such as the sublingual and paralingual spaces, may affect tumor spread, but reliable imaging-based predictors of cervical lymph node metastasis (LNM) in oral tongue squamous cell carcinoma (OTSCC) are limited. This study aimed to evaluate the association of the magnetic resonance imaging (MRI)-derived barrier-to-depth ratio (BDR) with cervical LNM and survival in OTSCC, and to integrate BDR into a prognostic nomogram. A retrospective cohort study was performed at Beijing Stomatological Hospital, Capital Medical University, including patients with OTSCC who underwent preoperative MRI and primary surgical resection. The BDR was measured and its predictive value for cervical LNM was analyzed using logistic regression. Survival outcomes were assessed using Cox proportional hazards models. A nomogram combining BDR and other clinicopathological factors was constructed. Of 125 subjects, 58 (46.4%) had cervical LNM. The mean BDR was significantly lower in patients with cervical LNM than in those without (p < 0.001). Patients with a BDR ≤0.22 had significantly poorer OS and DSS than those with BDR >0.22 (p < 0.001). The nomogram incorporating BDR achieved a C-index of 0.748, compared with 0.683 for TNM staging alone. MRI-derived BDR appears to be a novel and clinically relevant prognostic parameter in OTSCC. Incorporation of BDR into risk stratification models may improve individualized prognostic assessment and support clinical decision making regarding elective neck dissection.
Injection lipolysis represents a commonly used modality for non-surgical facial contouring and is generally considered safe. We report a rare and severe complication following jawline injection lipolysis in a 35-year-old woman who developed progressively severe trismus and pain. Imaging revealed a solid mass within the right masseter muscle, which required subsequent surgical excision. Histopathology demonstrated heterotopic ossification of the affected masseter muscle. Postoperatively, mouth opening markedly improved. This case highlights an uncommon but serious adverse event of injection lipolysis, emphasizing the importance of precise injection technique, detailed anatomical knowledge, and awareness of potential off-target effects in facial applications.
BACKGROUND AND AIM:Oral cancer, mainly arising from the oral mucosa, is most commonly squamous cell carcinoma. Helicobacter pylori has been linked to benign oral conditions such as stomatitis, glossitis, halitosis, and periodontal disease. This study aimed to examine the presence of Helicobacter pylori in squamous cell carcinoma and healthy oral mucosa using immunohistochemistry. METHOD:In present descriptive-cross-sectional study, samples of squamous cell carcinoma from 30 patients from the archives of the Pathology Department of Tabriz School of Dentistry were examined. All samples were re-examined with hematoxylin-eosin staining to confirm the diagnosis and then prepared for immunohistochemical staining. For the examined samples, IHC staining was performed using anti-Helicobacter pylori antibody. Data were analyzed using SPSS statistical software version 23. RESULT:Of the 30 samples with oral squamous cell carcinoma, 18 (60%) were positive, and of the 30 samples from healthy mucosa, 7 (23.3%) were positive. In positive samples, based on IHC staining, 7 samples (38.9%) had staining in the epithelium and 11 samples (61.1%) had staining in the stroma. In comparing the location of positive lesions in terms of anti-Helicobacter pylori antibodies, the most lesions were located on the tongue, followed by the mandibular alveolar ridge. CONCLUSION:According to present results there was a possible association between the presence of Helicobacter pylori in the oral mucosa and an increased risk of developing oral squamous cell carcinoma.
BACKGROUND:Reduction malarplasty is a common procedure for midface contouring in Asian populations. However, patients with elongated coronoid processes face an increased risk of postoperative mouth opening restriction. This study aims to evaluate whether combining partial coronoidectomy with reduction malarplasty yields superior outcomes compared to malarplasty alone in this specific patient population. METHODS:A retrospective analysis was conducted on 54 patients (2019-2024) with radiologically confirmed elongated coronoid processes. Patients were divided into two groups: Group A (n = 27) underwent L-shaped reduction malarplasty combined with partial coronoidectomy, while Group B (n = 27) received L-shaped reduction malarplasty alone. All procedures were performed by the same senior surgeon. Surgical outcomes were evaluated through CBCT imaging (preoperative, 7-day, and 6-month postoperative), skeletal stability assessed by root mean square error (RMSE) analysis using Mimics and Geomagic software, complication rates, and FACE-Q satisfaction scores. RESULTS:Group A demonstrated a superior safety profile with no serious complications observed. In contrast, Group B experienced seven complications, including nonunion (n = 3), mouth opening restriction (n = 2), facial asymmetry (n = 1), and microplate fracture (n = 1). RMSE analysis revealed significantly better skeletal stability in Group A (t(52) = 2.68, P < 0.05). While both groups showed improvement in FACE-Q scores postoperatively, Group A reported significantly higher levels of patient satisfaction. CONCLUSIONS:For patients with elongated coronoid processes, the combination of partial coronoidectomy with reduction malarplasty significantly enhances skeletal stability, reduces complication rates, and improves patient satisfaction compared to malarplasty alone. This integrated surgical approach provides a superior treatment strategy, optimizing both functional and aesthetic outcomes in this specific patient population. LEVEL OF EVIDENCE:IV.
Mandibular defects following tumor resection can severely affect facial form, occlusal stability, and temporomandibular joint (TMJ) function. We developed a condyle-oriented digital workflow designed to optimize postoperative condylar position and improve functional reconstruction. Preoperative CT data were used to generate mirrored mandibular models based on the ideal condylar relationship, followed by fibular segment planning and the creation of a full set of patient-specific guides incorporating a shared screw-hole strategy for precise intraoperative alignment. Seventeen patients underwent reconstruction using this protocol and were evaluated through CT-based three-dimensional analyses, TMJ functional assessment, and the Research and Treatment of Cancer Head and Neck Cancer Quality of Life Questionnaire (EORTC QLQ-H&N35). Postoperative condylar position and mandibular morphology showed no significant differences compared with preoperative measurements, indicating high reconstruction accuracy. TMJ function was comparable to that reported for traditional occlusion-guided reconstruction, while EORTC QLQ-H&N35 scores demonstrated improvement in domains related to diet. These findings suggest that our condyle-oriented planning combined with a fully digitalized guide system can achieve accurate anatomic restoration and favorable functional rehabilitation in mandibular reconstruction.
Sphenoid wing meningiomas are characterized by bony hyperostosis and dural invasion. Surgical resection is often extensive, giving rise to complex orbital defects. Orbital reconstruction is associated with improved structural and functional outcomes. Patient-specific cranioplasty implants facilitate the accurate orbital volume reconstruction, with polyetheretherketone (PEEK) exhibiting advantageous material properties. This retrospective case series evaluates the clinical outcomes of immediate PEEK-implant reconstruction of complex orbital defects in patients undergoing sphenoid wing meningioma resection via a combined anterolateral approach between 2015 and 2024. Outcome measures include complications, re-operations, long-term implant retention and visual outcomes. A total of 25 patients underwent follow-up of 43.8 (31.4) months. Emergency re-operations were performed in 16.0 % of cases, including CSF leak repair (8.0%), extradural haematoma evacuation (4.0%) and orbital exploration (4.0%), all involving immediate implant reinsertion. No implant infection cases were reported. The exophthalmic index was reduced from 1.36 (0.27) to 1.06 (0.08) at 1year post-operatively (Z = 4.5, p < 0.01). Visual acuity was preserved in 88.0%. This study highlights the immediate PEEK-implant cranioplasty via the combined anterolateral approach as a valid reconstructive option for complex orbital defects in sphenoid wing meningioma patients. Prospective comparative studies are warranted to determine the ideal method of reconstruction in this challenging patient population.
This prospective study assessed hyaluronic acid (HA) and proinflammatory cytokine levels in temporomandibular joint (TMJ) synovial fluid of patients with skeletal Class Ⅱ and Class Ⅲ dentofacial deformities undergoing orthognathic surgery. The concentrations of interleukin-1β (IL -1β), IL-6, tumor necrosis factors-α (TNF-α), interferon-γ (IFN-γ) and HA in synovial fluid samples obtained from 59 patients were analyzed using enzyme-linked immunosorbent assays. Evaluations of condylar morphology, disc position, and joint effusion (JE) were also performed using clinical and imaging findings. In the Class Ⅲ group, IL-6 levels were significantly higher whereas IFN-γ levels were significantly elevated in the Class Ⅱ group. Furthermore, the Class Ⅱ patients showed a significantly reduced HA concentration. Neither IL-1β nor TNF-α was detected in either group. Subgroup analysis of the Class Ⅱ group revealed significantly higher IL-6 expression in TMJs with condylar deformity, anterior disc displacement without reduction, and JE. These findings suggest that inflammatory cytokine activities, particularly involving IL-6 and IFN-γ, and reduced HA levels are associated with TMJ pathology in skeletal Class Ⅱ dentofacial deformities. They also indicate that comprehensive evaluation of TMJ biological status can be helpful for assessing joint deterioration risk and ensuring postoperative occlusal stability in patients undergoing orthognathic surgery.
Historical and contemporary subperiosteal implants continue to encounter issues with peri-implantitis, peri-implant mucositis and bacterial colonisation of the implant substructure, leading to failure of the entire implant. Combining Poly (ε-capro-lactone) (PCL) overlay scaffolds with subperiosteal implants could improve their success by encasing the implant in bone. A large animal study was undertaken with 4 groups (Titanium-only control, PCL Open, PCL Closed, and Nano PCL). Titanium subperiosteal implants were inserted with various overlying 3D printed PCL scaffold designs. Uncovered titanium was used as a control. Bony deposition was assessed at 3 months and 6 months via computed tomography, and histology at 6 months. PCL scaffolds reliably enabled bony deposition over the subperiosteal implants. A Mixed Model Analysis showed a statistically significant result both radiographically and histologically between the Titanium-only control group and the PCL Closed group, particularly surrounding the regenerated bone volumes and bone heights (maximum and mean). The PCL Open design was the next most reliable scaffold when compared against the Titanium-only group. This pilot study demonstrates that functionalised PCL scaffolds overlying subperiosteal implants can lead to bone deposition over titanium, with successful conversion into endosteal implants. PCL closed scaffold was the most effective design. This provides a basis for future clinical trials to improve the success rates of subperiosteal implants.
Anterior disc displacement without reduction of the temporomandibular joint is a prevalent condition associated with pain and functional limitation, and minimally invasive arthroscopic approaches are increasingly favored over open surgery due to lower morbidity. This study compared three arthroscopic interventions: classical myotomy (CM), minimally invasive anterior arthroscopic myotomy (MIAAM), and posterior ligament electrocoagulation (PLE). A total of 86 patients were included: 24 (27.9%) underwent CM, 30 (34.8%) underwent MIAAM, and 32 (37.2%) underwent PLE. Outcomes were assessed using visual analog scale (VAS) pain, maximum mouth opening (MMO), and joint function at baseline and at 1 and 6 months postoperatively. Pain improved significantly over time in all groups (F = 5.02; df = 2; p < 0.05), with no significant differences between techniques. Maximum interincisal opening (MIO) and mandibular protrusion also improved significantly (F = 14.6; df = 2; p < 0.05 and F = 8.949; df = 2; p < 0.05, respectively), again without inter-group differences. MIAAM was associated with faster pain relief at 1 month and slightly better 12-month outcomes, although these differences were not statistically significant. Overall, PLE showed comparatively less favorable results, suggesting MIAAM may represent a balanced option in terms of efficacy and safety.
BACKGROUND:Progressive hemifacial atrophy is a rare craniofacial disease that commonly involves withered skin, soft tissue, cartilage, or bone on one side of the face. The author proposed a therapeutic algorithm tailored to PHA's severity, which revealed a paradigm shift from subjective evaluation on 2D photographs to more objective assessment using 3D stereophotogrammetry. METHODS:This retrospective observational study comprised all patients diagnosed with PHA between February 2000 and August 2025. Patients were categorized into three tiers according to deficits in soft tissue, facial skeletal contour, and occlusal function. Photographs, three-dimensional laser scanning, and computed tomography were obtained if needed to evaluate facial asymmetry, the defective area, and depth. RESULTS:186 patients were treated. Thirty - three patients (17.7%) had concurrent linear scleroderma (mainly en coup de sabre). 59.7% underwent sequential autologous fat grafting as the primary therapeutic method. 29.6% underwent adipofascial tissue transplantation combined with subsequent procedures, including graft debulking or lipofilling. 10.8% had bony and soft tissue reconstruction approaches. The complication rate (3.8%) was acceptable with rational treatment. CONCLUSION:Treating PHA is a challenge, and 3D stereophotogrammetry is a useful adjunct for formulating therapeutic modalities. The authors shared their personal experiences and proposed a therapeutic algorithm. Although there is no "perfect" strategy, hopefully, this algorithm will enrich the current body of literature and inspire further thoughts.
BACKGROUND:There are two established timepoints for microvascular bone reconstruction of the jaw in patients with oral squamous cell carcinoma (OSCC): 1. Primary reconstruction together with tumour resection and 2. Secondary reconstruction after successful adjuvant therapy. However, the decision between primary and secondary reconstruction remains controversial and is often made on a case-by-case basis. OBJECTIVE:This study aimed to compare clinical outcomes of primary versus secondary osseous jaw reconstruction in patients with OSCC. The aim of this study was to retrospectively describe and compare clinically relevant oncological, functional, and perioperative outcomes of primary versus secondary microvascular osseous jaw reconstruction in patients with oral squamous cell carcinoma receiving adjuvant therapy. METHODS:A retrospective cohort study was conducted including OSCC patients who underwent continuity resection of the jaw followed by microvascular reconstruction and adjuvant therapy between 01/2017 and 06/2024. Patients were retrospectively categorized into primary and secondary osseous reconstruction cohorts. Data on oncological, surgical, economical and functional outcomes were analyzed. RESULTS:A total of n = 191 patients were included (n = 133 primary, n = 58 secondary). The primary reconstruction group showed significantly lower time to dental rehabilitation (p < .001) and days of hospitalisation (p < .001), but no significant difference in local recurrence-free survival (p = .44) and transplant loss (p > .93) compared to the secondary group. CONCLUSION:None of the therapies can be considered superior in terms of oncological success. The results do not allow for a clear recommendation in favour of one therapy over the other.
