Surgically assisted rapid maxillary expansion induces bone neoformation at the distraction site during the treatment of maxillary transverse deficiency. The aim of this systematic review was to investigate and summarize the effect of surgically assisted rapid maxillary expansion on bone neoformation at the midpalatal distraction site, with emphasis on bone maturation and morphology. A systematic search was performed across PubMed, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials up to June 2026. Selection criteria included randomized controlled trials, prospective and retrospective cohort studies, and case-control studies evaluating bone neoformation following surgically assisted rapid maxillary expansion using tooth- or bone-borne expanders. Eight studies, comprising one randomized controlled trial and seven cohorts involving 147 patients aged 15-59 years, were included. Bone density was evaluated via optical density or Hounsfield units across four regions along the midpalatal suture over follow-up periods of three to ten months. Results indicated that bone density reached its minimum at the start of the retention period, followed by a gradual increase; however, density generally failed to return to baseline values by the final follow-up. Risk of bias was rated as 'Good' for two studies and 'Fair' for six. In conclusion, bone density decreases across all maxillary regions following SARME and typically does not recover to baseline levels within ten months. Due to significant risk of bias and a lack of randomized trials, evidence remains insufficient to establish definitive clinical thresholds for skeletal stability or the initiation of tooth movement.
Patients with unilateral cleft lip nasal deformity (CLND) frequently suffer from nasal airway obstruction, but the precise location of increased resistance remains unclear. This pilot study aimed to investigate the fluid dynamic characteristics of the nasal airway in patients with unilateral CLND using computational fluid dynamics (CFD). Seven patients with unilateral complete CLND who had undergone preoperative cranial computed tomography (CT) were randomly selected. Three-dimensional (3D) upper airway models were reconstructed from CT data, and steady-state simulations were performed using the standard k-ω turbulence model with an inlet flow rate of 400 mL/s. Airflow velocity and pressure at the internal nasal valve (INV), external nasal valve (ENV), and the most deviated portion of the nasal septum were compared between the cleft and non-cleft sides during inspiration and expiration. During inspiration, the mean airflow velocity at the ENV on the cleft side was significantly lower than on the non-cleft side (4.27 ± 1.22 vs 5.71 ± 0.79 m/s; p = 0.022), whereas no significant differences were observed at the INV or nasal septum during inspiration, nor at any site during expiration. Pressure values showed no significant differences between sides at any phase. Pressure contour and velocity vector maps visually confirmed that the greatest pressure drop and flow disturbance occurred in the nasal vestibule/ENV region. In conclusion, this pilot CFD analysis suggests that airflow disturbance in unilateral CLND is mainly localized to the ENV/nasal vestibule region rather than the INV or the deviated septum. These findings should be interpreted as preliminary and hypothesis-generating, and may help guide future studies evaluating whether surgical restoration of lower lateral cartilage position improves nasal airway function.
Background Pierre Robin sequence (PRS) syndrome has clinical features of small mandible, tongue drooping, and respiratory obstruction. This study compared the 3-dimensional (3D) reconstruction of the upper airway anatomy based on computed tomography (CT) data between PRS and normal control (NC) children, and analyzed the dynamical changes and airflow field using computer fluid dynamics (CFD) between the two populations. Methods A retrospective study was conducted on 66 PRS and 23 NC children, and all CT data were obtained and used for reconstruction and numerical simulation. 10 anatomical landmarks were used to estimate the mandibular morphology, while the sectional area (SA), pressure, and velocity of five upper airway cross sections (CS) were measured. The measurement results of 3D reconstruction and CFD were subjected to mean processing. The propensity score matching (PSM) method was used to enhance the degree of demographic matching. Results After PSM correction, 21 cases were finally included in each group. The average month age was (5.29 ± 4.26) months, with 52.4% (n = 22) being male. Besides the similar narrowest SA of the tongue base in the anterior-posterior direction, there were differences in other measurement parameters between two groups. Meanwhile, the SA of CS-1 in the PRS group was larger than that in the NC group (P < 0.001); Correspondingly, the pressure and velocity in the PRS group were significantly lower (both P < 0.001). Furthermore, except for similar SA of CS-5, the other three SA in the PRS group were significantly smaller than those in the NC group (all P < 0.001). Conclusions This study identified the abnormal anatomical characteristics in PRS, thereby helping clinicians establish appropriate airway management plans in clinical practice.
BACKGROUND:Cystic hygromas are congenital macrocystic lymphatic malformations. Most cystic hygromas present at birth, during infancy or early childhood. Sclerotherapy is the main treatment, and Bleomycin is the most frequently used sclerosing agent. OBJECTIVES:To evaluate if intralesional Bleomycin (BLM) injection is a safe and effective treatment of cystic hygromas in pediatric patients. STUDY DESIGN:retrospective cohort study. PATIENTS AND METHODS:This case series includes 30 pediatric patients who had cystic hygromas and underwent intralesional Bleomycin injections. INTERVENTIONS:The cystic lymphatic fluid was aspirated from each cystic hygroma, and then the lesion was simultaneously injected with Bleomycin during the first treatment session, then, the lesions were injected at 4-week intervals until satisfactory results were obtained. The Bleomycin 15 IU vial was freshly prepared on each session; 15 mg powdered BLM was dissolved in 15 mL of 0/9% normal saline (1 IU BLM equals 1 mg/mL BLM), with 0.5 IU/kg body weight safe pediatric dose; and 15 IU/session maximum dose. Clinical response was assessed as complete response (>90% reduction of lesion size), marked improvement (>70%), moderate improvement (50 - 70%), slight improvement (<50%), and no response (<10%). Patients were followed up for one year. OUTCOME MEASURES:reduction of lesion size clinically. RESULTS:The 30 patients included 11 males and 19 females; their ages ranged from one month to 5 years; 17/30 patients had a complete response, 7/30 had marked improvement, 6/30 had a moderate improvement, stayed under observation every 12 months, and surgery was delay to after puberty onset. All patients who had a moderate response presented for treatment at age above 1.5 years old and required more treatment sessions. No recurrence was noticed in this study. CONCLUSION:Intralesional Bleomycin injection is a safe, effective, minimally invasive treatment and can be used as a first-line treatment option of cystic hygromas in pediatric patients. Long-term follow-up should be maintained, as recurrence may take place in the future during puberty due to hormonal effects. CLINICAL RELEVANCE:This study highlights the importance of proper diagnosis and early treatment of cystic hygromas to achieve better clinical outcomes and to reduce treatment duration.
Iatrogenic subcutaneous emphysema (SE) is an uncommon but potentially life-threatening dental complication that can rapidly progress into deep cranio-cervicothoracic compartments. This retrospective cohort study systematically evaluated 74 consecutive patients treated at a tertiary referral center over an 11-year period to identify clinical predictors of deep fascial spread and develop a management algorithm. All patients underwent computed tomography (CT) to delineate the volumetric extent of air.Critical compartment involvement (CCI), including deep cervical, orbital, or mediastinal extension, was identified in 48.6% of cases. Multivariate logistic regression identified high-speed air-driven handpieces (OR 4.5, p = 0.002) and procedures involving posterior mandibular teeth (OR 2.8, p = 0.031) as independent predictors of CCI. Clinically, dysphagia served as a significant indicator of deeper fascial extension. While management was predominantly conservative with a mean hospital stay of 2.2 days, pneumomediastinum was confirmed in 16.2% of patients. Systematic CT imaging proved essential for detecting subclinical spread. These findings informed a practical risk-stratified management algorithm designed to enhance patient safety by providing clinicians with a structured framework for early risk recognition and optimized diagnostic and therapeutic pathways.
This single-arm trial aimed to compare the effectiveness of two surgical approaches, the intraoral approach (IOA) and the extraoral approach (EOA), to segmental mandibulactomy followed by immediate fibular free flap (FFF) reconstruction. In total, 7 patients with benign mandibular lesions were enrolled. Flap survival sever as the surgery success indicator. Patients were followed up for one year, with the Patient and Observer Scar Assessment Scale(POSAS) as the main outcome measure. Key parameters of 12 patients who underwent EOA during the same period were compared to evaluate the feasibility of the new method. All 7 patients successfully completed FFF microvascular reconstruction through IOA without serious complications. One year postoperatively, based on the follow-up assessment results of the POSAS scale, the score of the IOA group was significantly lower than that of the EOA. All patients were satisfied with the aesthetic and functional outcomes. Compared to the EOA group, there were no significant differences in defect type(p = 0.347), number of fibular segments(p = 0.354), hemoglobin level decrease(p = 0.223), or hospital stay (p = 0.790). However, the IOA resulted in a significantly longer operative time(p = 0.002). Reconstrction with the FFF through the IOA offers improved scar outcomes and higher patient satisfaction, thereby representing a favorable option for eligible patients.
This retrospective comparative cohort study assessed whether maxilla-first versus mandible-first sequencing affects postoperative TMD outcomes. Consecutive patients undergoing bimaxillary orthognathic surgery between 1998 and 2025 were included when standardized preoperative and postoperative temporomandibular joint assessments were available. TMD evaluation comprised Research Diagnostic Criteria for Temporomandibular Disorders diagnoses, as well as Helkimo Anamnestic (Ai) and Clinical Dysfunction (Di) indices. Primary outcomes included postoperative disc displacement (DD) and myofascial pain dysfunction (MPD), whereas secondary outcomes were postoperative Ai and Di severity. Descriptive, bivariate, and multiple logistic regression analyses were performed, with statistical significance set at P ≤ 0.05. A total of 292 patients were included, of whom 153 underwent maxilla-first and 139 mandible-first surgery. Surgical sequencing was not independently associated with postoperative DD, MPD, Ai, or Di outcomes. In contrast, baseline TMD status emerged as the strongest predictor of postoperative dysfunction. Preoperative DD independently predicted postoperative DD (OR, 3.01; P < 0.001), whereas preoperative MPD independently predicted postoperative MPD (OR, 5.13; P < 0.001). Increasing age and female sex were also associated with greater postoperative symptom severity. These findings suggest that postoperative TMD outcomes are primarily driven by baseline TMD severity and patient-related factors rather than by the intraoperative osteotomy sequence.
Sublingual hematoma is a rare but life-threatening condition with heterogeneous etiologies that complicate emergency decision-making. This study compared clinical characteristics and management outcomes between implant-induced sublingual hematoma (ISH) and spontaneous sublingual hematoma (SSH), and developed an etiology-guided treatment algorithm through integrated statistical and machine-learning analyses. A systematic literature search through January 2025 identified 77 studies comprising 85 cases (ISH, n = 33; SSH, n = 52). Clinical variables were compared statistically, and random forest and decision tree models were applied to identify determinants of treatment and prognosis. SSH was strongly associated with cardiovascular comorbidities and anticoagulant therapy (84.6% vs 12.1%; p < 0.001), whereas ISH required surgical intervention more often (54.5% vs 13.5%; p < 0.001), with shorter hospital stays (5.3 ± 3.9 vs 10.5 ± 9.8 days). Machine learning identified symptom-to-treatment time and surgical parameters as major predictors for ISH management, while warfarin use and respiratory distress determined SSH severity. These findings indicate that sublingual hematoma requires prompt, etiology-specific management: immediate surgical hemostasis for implant-induced cases and correction of coagulopathy with airway vigilance for spontaneous cases. The proposed framework provides preliminary data-informed guidance for managing this rare but critical condition.
This retrospective case series aimed to evaluate clinical and MRI-based changes after temporomandibular joint (TMJ) disc anchorage surgery in adolescents with anterior disc displacement without reduction and condylar resorption, and to explore factors associated with postoperative condylar remodeling. Seventy adolescent patients (11-20 years old) diagnosed with anterior disc displacement without reduction were treated with temporomandibular joint disc anchorage followed by occlusal splint therapy. All 70 patients completed the 6-month postoperative follow-up, while 65 patients reached the 12-month follow-up; the remaining 5 patients had not yet reached the 12-month postoperative time point. Clinical and MRI assessments included maximum mouth opening (MMO), visual analog scale (VAS), Helkimo index, disc length (DL), condylar height (CH), bone marrow edema (BME), and occlusal classification. At 6 months, MMO, DL, and CH increased significantly, while VAS and Helkimo index decreased significantly. In the 12-month subgroup, clinical improvement and DL were maintained, and CH continued to increase significantly. Univariable GEE analyses indicated that bruxism, unilateral mastication, and BME were associated with increased odds of non-remodeling at 6 months, whereas splint wear was associated with reduced odds. At 12 months, only three sides showed decreased CH; therefore, associations with potential factors were evaluated descriptively because of the sparse number of events. Open TMJ disc anchorage with postoperative splint therapy was associated with symptom improvement, stable disc repositioning, and favorable MRI-based condylar remodeling. However, causal inference and treatment superiority cannot be established due to the retrospective design, absence of control groups, and limited 12-month follow-up.
Hypopharyngeal cancer often requires wide surgical resection with free flap reconstruction. Robotic approaches are increasingly adopted to improve surgical access and reduce visible scarring, but direct comparative outcomes with conventional transcervical methods in patients requiring complex pharyngeal reconstruction remain underexplored. This retrospective comparative pilot study analyzed 19 consecutive patients who underwent curative hypopharyngectomy with neck dissection and immediate microvascular free flap reconstruction at Yonsei University Severance Hospital (2020-2024). Patients were divided into robotic alternative approaches (retroauricular and minimal transcervical, n = 10) and conventional transcervical (n = 9) groups. Primary outcomes included major postoperative complications (saliva pooling, dysphagia, stricture) and hospital stay duration. No statistically significant differences were observed between groups regarding major complications, hospital stay, or operation time. Total resection was associated with increased dysphagia risk (OR: 20.71, p = 0.030). Patients with saliva pooling had longer hospital stays (median: 65.5 vs 30.0 days; p = 0.029). Immediate controlled pharyngostoma formation reduced hospital stay compared with delayed intervention (35.0 ± 4.2 vs 72.0 ± 26.9 days; p = 0.020). Robotic alternative approaches demonstrated outcomes comparable to conventional methods while providing superior cosmetic results. Prophylactic controlled pharyngostoma may benefit selected high-risk patients; larger studies are warranted to confirm these preliminary findings.
This study aimed to evaluate the influence of local photobiomodulation (LPBM) and vascular photobiomodulation (VPBM) on early bone healing after alveolar bone grafting (ABG) in patients with cleft lip and palate (CLP). Eighty-seven CLP patients (104 cleft areas) underwent secondary ABG with autogenous bone from the mandibular symphysis or iliac crest. Eighty-seven patients with CLP, corresponding to 104 grafted alveolar cleft sites, were included from two independent clinical protocols conducted at the same craniofacial rehabilitation center. LPBM was evaluated in patients with unilateral cleft lip and palate (UCLP), whereas VPBM was evaluated in patients with bilateral cleft lip and palate (BCLP). In each protocol, the PBM group was compared with the corresponding control group, which received simulated laser application. All patients underwent secondary ABG with autogenous bone harvested from the mandibular symphysis or anterior iliac crest, according to the established surgical protocol of the hospital. LPBM was performed using a GaAlAs laser (880 ± 10 nm, 100 mW, 4 J per point) applied in continuous mode at 14 standardized extraoral points. VPBM was performed using a red-spectrum laser (660 ± 10 nm, 100 mW), applied over the radial artery for 10 min in patients aged 9-17 years and 15 min in adults, corresponding to total energies of 60 J and 90 J, respectively. Irradiation was performed immediately after surgery (T0) and 24 h postoperatively (T1). Standardized periapical radiographs were obtained preoperatively and 2 months after ABG (T2). Cleft morphology was assessed by measuring height and width using digital calipers. Bone bridge formation was evaluated at T2 using the Chelsea scale. Statistical analysis included one-way ANOVA, Kruskal-Wallis, and logistic regression tests (α = 0.05). LPBM showed a higher proportion of favorable Chelsea classes (80%) than control (45%) and VPBM (37.5%) groups (p < 0.05). No differences were found between donor sites or baseline cleft dimensions. VPBM results were similar to control values. LPBM enhanced bone bridge formation after ABG, suggesting a stimulatory effect on bone repair. VPBM, under the tested parameters, did not improve outcomes.
Peri-implantitis therapy aims at overcoming peri-implant inflammation and preventing further marginal bone loss; however, the achievement of stable reconstructive outcomes remains challenging in non-contained defects. This retrospective study evaluated the 5-year effectiveness of reconstructive surgical protocol using a mixed graft composed of deproteinized bovine bone mineral and biphasic calcium sulfate in non-contained peri-implant defects around standard-length implants. Patients treated for peri-implantitis at a university clinic between January 2018 and June 2019 were retrospectively screened: 28 (32 implants) met the inclusion criteria (probing depth ≥5 mm with bleeding and/or suppuration on probing and radiographic bone loss ≥3 mm). Surgical treatment consisted in full-thickness flap elevation, implant surface decontamination using a standardized protocol, defect grafting, and non-submerged tension-free closure. Clinical and radiographic parameters were assessed at surgery, 3- and 5-year follow-up. Mean follow-up was 61.4 ± 8.5 months. Implant survival at 5 years was 100%. Implant-based treatment success was 75%, disease recurrence occurred in 25% of implants. Probing depth and clinical attachment level showed significant improvements from baseline to both follow-up time points (p < 0.001); radiographic analyses demonstrated significant defect fill and improvement in bone-related parameters (p ≤ 0.002). The proposed reconstructive approach provided stable results in the long-term for non-contained peri-implant defects.
Tumour budding (TB) is known as a histopathological parameter defined as single tumour cells or clusters of up to 4 cells at the tumour invasion front (TIF) (TB score 1: 0-4 buds, TB score 2: 5-9 buds, TB score 3: ≥10 buds). However, conventional assessment based on a single section may not capture heterogeneity within the TIF. Therefore, this study applied a novel quantitative approach (TB rel), in which all available sections were evaluated and summarized as an average score. 256 patients with oral squamous cell carcinomas (OSCC) were included and 1289 haematoxylin and eosin-stained sections were analysed. Based on TB rel, patients were stratified into prognostic clusters: Cluster C1 (TB rel = 1.0) and cluster C2 (TB rel >1.0). Increased TB rel was associated with adverse histopathological features reflecting tumour aggression. In clinically node-negative patients (cN0), TB rel identified occult lymph node metastasis (pN+) with an odds ratio of 6.32. Furthermore, patients with higher TB rel showed a higher risk of poorer overall disease progression and survival compared to patients having consistently low TB scores along the TIF. Given its prognostic relevance, TB rel should be integrated into routine diagnostics. This may support more individualized indication for neck dissections.
Virtual surgical planning (VSP)-assisted reconstruction is increasingly used as an alternative to conventional free-hand (FH) techniques in mandibular and maxillary free-flap reconstruction. This systematic review and meta-analysis compared clinical outcomes and proposed a Reconstruction Complexity-Completeness classification. PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and reference lists were searched from inception to 20 June 2026. Comparative studies were eligible. Risk of bias was assessed using RoB 2 or the Newcastle-Ottawa Scale. Random-effects meta-analyses used restricted maximum likelihood estimation and Hartung-Knapp adjustment. Forty-two studies included 2763 patients (1204 VSP; 1559 FH). VSP significantly reduced operative time (33 studies; MD -64.75 min, 95% CI -83.51 to -46.00), ischemia time (15 studies; MD -37.40 min, 95% CI -48.97 to -25.82), and hospital stay (16 studies; MD -1.75 days, 95% CI -3.43 to -0.08). VSP was associated with significantly lower odds of bony non-union (OR 0.31, 95% CI 0.16-0.59) and malocclusion (OR 0.14, 95% CI 0.03-0.64), whereas flap loss, surgical site infection, and plate exposure did not differ significantly. VSP-assisted reconstruction was associated with improved operative efficiency, shorter hospitalization, and lower odds of bony non-union and malocclusion, while no statistically significant differences were detected in flap loss, surgical site infection, or plate exposure. The proposed classification may support complexity-adjusted reporting and comparison.
BACKGROUND:Length of hospital stay (LOS) after surgery for oral cavity squamous cell carcinoma (OCSCC) reflects both surgical complexity and host status. Whether routine nutritional and inflammatory biomarkers can identify patients at risk of prolonged stay has not been clearly established. METHODS:Single-centre retrospective cohort study of 168 patients who underwent primary curative-intent surgery for OCSCC between 2015 and 2021. Length of stay was dichotomised at the 75th percentile (≥23 days). Inflammatory and nutritional parameters (NLR, LMR, PLR, Prognostic Nutritional Index [PNI], serum albumin, fibrinogen) were measured at three perioperative timepoints. Associations were evaluated using ROC analysis with Youden's index, multivariable logistic regression, and Kaplan-Meier time-to-discharge. RESULTS:Median LOS was 16.5 days (IQR 11-23); prolonged stay occurred in 46 patients (27.4%). Optimal cutoffs were PNI <35.8 (AUC 0.654) and postoperative fibrinogen ≥553 mg/dL (AUC 0.620). In multivariable analysis adjusted for age, sex, T and N stage, reconstructive modality, smoking, diabetes and cardiovascular comorbidity, low PNI on the day of surgery was the only independent predictor of prolonged stay (OR 2.87, 95% CI 1.19-6.91; p = 0.019; model AUC 0.772). Kaplan-Meier curves confirmed significantly longer admissions in patients with low PNI or elevated postoperative fibrinogen (log-rank p < 0.001 for both). The discriminatory capacity of biomarkers was concentrated in patients managed without free flap reconstruction (AUC 0.71-0.74), whereas in microsurgical patients hospital stay was governed by post-flap monitoring protocols. CONCLUSIONS:Day-of-surgery PNI and postoperative fibrinogen identify patients with OCSCC at increased risk of prolonged hospital stay. Their predictive value is most relevant in non-microsurgical patients, in whom proactive nutritional optimisation could shorten admission.
Facial scanning devices are widely used in dentistry, but their accuracy needs improvement. This study developed a portable face scanning application (named Face Rebuilder) for iPhone/iPad and compared its accuracy to that of a commercially available handheld 3-dimensional (3D) facial scanner based on stereophotogrammetry (DS-FSCAN, Hangzhou, China). It has not been commercially released. Twenty-two volunteers were recruited. Eighteen markers were affixed to each volunteer's face, and the accuracy of the facial scanning systems was evaluated by measuring the distances between these markers. Direct physical measurements using a vernier caliper (GREENER IP54, Shandong, China) served as the reference measurement for accuracy assessment. Two groups were compared: study group (Face Rebuilder) and control group (DS-FSCAN). The absolute deviations from the reference measurement were calculated. The data analysis comprised the Shapiro-Wilk test for normality assessment, followed by the Mann-Whitney U test for group comparisons.No significant difference (p > 0.05) was observed between the proposed method and the stereophotogrammetry-based facial scanning method. The bias value for the proposed method was 0.945 ± 0.765 mm, whereas that of the stereophotogrammetry-based method was 1.006 ± 0.787 mm. The portable 3D scanning method based on LiDAR achieved high-precision face-scanning data acquisition, when using a Vernier caliper as reference measurement.
BACKGROUND:Radiation-induced oral complications, notably xerostomia and oral mucositis (OM), are common and debilitating in patients with head and neck cancer (HNC), adversely affecting swallowing, nutritional intake, and overall quality of life (QoL). OBJECTIVES:This review aimed to quantify the prevalence of radiation-induced xerostomia and OM and synthesize their impact on dysphagia and nutritional status among HNC patients undergoing radiotherapy (RT). METHODS:A systematic review and meta-analysis were conducted following PRISMA guidelines. Comprehensive searches were performed in MEDLINE, Scopus, SciFinder, Embase, and PubMed for studies published between January 2019 and December 2025. Data from 51 studies were extracted and synthesized. RESULTS:The pooled prevalence was 85% (95% CI: 81.6-87.9%) for xerostomia and 88.3% (95% CI: 73.9-95.3%) for any-grade OM. Severe OM (Grade 3-4) had a prevalence of 39.5% (95% CI: 23.1-58.8%). These complications were strongly interrelated and significantly associated with dysphagia (69.8%; 95% CI: 53.1-83.7%), malnutrition (66.6%; 95% CI: 37.3-95.9%), and poor QoL (pooled mean QoL score: 64.13/100). Studies employing advanced radiation techniques (e.g., IMRT) demonstrated a lower prevalence of xerostomia (OR = 0.58, 95% CI: 0.42-0.80) compared to conventional RT. CONCLUSION:Radiation-induced oral complications (xerostomia & OM) remain prevalent and clinically significant burden in HNC patients, contributing to a cascade of functional impairments and diminished QoL. These findings highlight the need for preventive strategies, symptom management interventions, and the broader adoption of advanced RT techniques. Longitudinal research is warranted to further evaluate long-term outcomes and guide patient-centered care models.
With the rising popularity of minimally invasive facial aesthetic procedures, injection-related complications in the cranio-maxillofacial region pose an increasing diagnostic and therapeutic challenge. We report a rare case of refractory delayed-onset inflammatory nodules in a 36-year-old woman with a self-reported allergic history following sequential injections of polyvinyl alcohol (PVA), poly-L-lactic acid (PLLA), and polycaprolactone (PCL) based biostimulatory fillers in distinct facial subunits. More than one year post-injection, the patient developed progressive erythema, induration, tenderness, and nodular swelling at multiple sites. Lesions showed poor response to intralesional corticosteroids and aspiration. High-frequency ultrasonography and magnetic resonance imaging facilitated precise lesion mapping and guided surgical excision. Site-specific histopathology revealed retained particulate material with foreign-body giant cells, granulomatous inflammation, and collagen-rich fibrosis. Exploratory transcriptomic profiling and immunofluorescence supported a shared inflammatory-fibrotic response but remained hypothesis-generating. This case underscores the clinical importance of refractory multisite foreign-body granulomas after sequential exposure to different persistent or biostimulatory injectable materials. It raises, but does not establish, the possibility of a host-related contribution and highlights the value of detailed injection history, multimodal imaging, site-specific histopathology, judicious material selection, and individualized management.
After continuity resection of the jaw, free bony flaps are used for reconstruction. Despite implementation of a digital workflow and additively manufactured custom-made implants for flap fixation, plate complications such as bony non-union remain a clinical challenge. This is the first description of the finite element analysis of a novel 3D-printed implant system for mandibular reconstruction designed to overcome this limitation. Virtual surgical planning and patient-specific finite element analysis were performed in 12 cases requiring segmental mandibulotomy. The novel custom-made implants (IPS® MotionPlate), with spring elements, were virtually designed and tested in terms of interfragmentary motion and relative load capacity in comparison with a standard plate and its physical material limits. Significant differences were found between all tested motion directions and locations of the MotionPlate versus the standard plate, aside from tilt rotation at the anterior position (p = 0.09). With the MotionPlate separation of the interfragmentary motion increased by 0.05 mm, 0.01 mm, and 0.02 mm at the posterior, medial, and anterior segments, respectively. Shear of the intefragmentary motions rose by 0.04 mm, 0.05 mm, and 0.05 mm at posterior, medial, and anterior segments, respectively. Tilt of the interfragmentary motions increased by 0.36° at the posterior segment and 0.24° at the medial segment. Inclination of interfragmentary motions increased by 0.35°, 0.35°, and 0.36° at posterior, medial, and anterior segments, respectively. The MotionPlate resulted in higher stresses than the standard plate; however, no MotionPlate stress exceeded the combined maximum shear and von Mises stresses normalized to their material limits, with a median of 0.8 and a maximum of 0.95 (IQR 0.66-0.91). The novel implant system favors interfragmentary motion while simultaneously not raising the stresses above the material limits. These findings suggest that the included spring elements effectively modulate construct stiffness, avoiding excessive rigidity without compromising overall strength.
