Purpose Evidence on the outcomes of transoral endoscopically-assisted treatment of mandibular subcondylar fractures remains limited. The primary aim of this study was to evaluate surgical outcomes, complication rates, revision rates, and long-term functional results following transoral endoscopically-assisted treatment of subcondylar fractures. The secondary aim was to identify predictors of postoperative complications, revision surgery, and craniomandibular dysfunction. Methods This monocentric observational study comprised a retrospective and a prospective study arm. The retrospective cohort included all patients with mandibular subcondylar fractures treated by transoral endoscopically-assisted open reduction and internal fixation without transbuccal trocars between December 2014 and August 2024. Fractures were classified using the AO CMF and Spiessl–Schroll Classification Systems based on preoperative CT imaging. Demographic, clinical, radiographic, surgical, and postoperative data were collected. The prospective cohort consisted of patients who underwent standardized clinical follow-up at least 12 months after surgery, including assessment of temporomandibular disorders, mandibular function, occlusion, pain, and maximum mouth opening using standardized DGFDT examination protocols. Primary outcomes were postoperative complications and revision surgery; long-term functional outcome was evaluated as a tertiary endpoint. Descriptive statistics, exploratory bivariate analyses, and multivariable logistic regression were performed to identify factors associated with postoperative complications. Results A total of 132 patients with 144 subcondylar fractures were included. Postoperative complications occurred in 43.8 % of fractures, whereas intraoperative revision following 3D C-arm imaging and postoperative revision surgery were required in 15.3 % and 2.8 % of cases, respectively. The most common complications were malocclusion (20.1 %), osteosynthesis material failure (15.3 %), and wound infection (14.6 %). Multivariable analysis identified longer intermaxillary fixation as the only independent predictor of postoperative complications (OR 1.052, 95 % CI 1.008–1.109; p = 0.036). Follow-up examinations demonstrated generally favorable long-term functional outcomes, although 22.7 % of patients showed signs of temporomandibular disorders and 31.8 % presented with objective occlusal disturbances. Conclusions Transoral Endoscopically-assisted open reduction and internal fixation provided reliable surgical management of subcondylar mandibular fractures, with a low revision rate and favorable long-term functional outcomes. Prolonged postoperative intermaxillary fixation was the only independent predictor of postoperative complications, while routine intraoperative 3D imaging supported accurate fracture reduction and implant positioning.
OBJECTIVE Soft tissue sarcomas (STSs) involving the infratemporal fossa (ITF) are extremely rare, and the existing literature is limited to case reports. We aim to describe their clinical characteristics and to analyze the risk factors affecting overall survival (OS) and progression-free survival (PFS). METHODS A total of 30 STSs involving ITF cases were included, comprising 5 patients treated at our institution and 25 cases reported in the literature. Clinical data were systematically collected, and prognostic risk factors were analyzed using Kaplan-Meier survival analyze. RESULTS Among the 30 patients included, one patient was an infant whose sex was not specified. Among the remaining 29 patients, there were 12 females and 17 males. Among all 30 available cases, the mean age was 35.0 ± 18.5 years (range, 0.25-72 years). A total of 14 (46.7%) patients had bone invasion. Regarding histopathological margin status, 6 (20%) cases were classified as R0, 15 (50%) as R1, and 9 (30%) as R2. After a mean follow-up of 31.3 ± 38.9 months, local recurrence occurred in 12 (42.9%) cases, postoperative lymph node metastasis occurred in 1 (3.8%) case, distant metastasis occurred in 4 (14.3%) cases, and 6 (21.4%) patients died. Kaplan-Meier survival curves were used to illustrate OS stratified by R0+R1 VS R2 (Chi Square = 3.949, p = 0.0469) and no bone invasion VS bone invasion (Chi Square = 7.458, p = 0.0063). Kaplan-Meier survival curves were used to illustrate PFS stratified by R0+R1 VS R2 (Chi Square = 7.672, p = 0.0056) and no bone invasion VS bone invasion (Chi Square = 5.588, p = 0.0181). CONCLUSION Bone invasion by the tumor was associated with poorer PFS and OS. Maximal surgical resection of the tumor, is the optimal treatment strategy. Whether to administer radiotherapy or chemotherapy postoperatively is determined by the specific pathological subtype. Further studies with larger cohorts are needed to validate our findings.
Background/aims: Managing early oral squamous cell carcinoma (OSCC) with a solitary ipsilateral lymph node metastasis (pN1) and no additional adverse features remains controversial, with conflicting international guidelines. Our study examined the effect of postoperative radiotherapy (PORT) compared with surgery only (SO) on several survival outcomes in a clinical cohort. Methods: Patients diagnosed with a primary pT1-2 OSCC and a single ipsilateral lymph node metastasis (pN1) without an extranodal extension were retrospectively identified. Factors associated with receiving PORT were assessed using logistic regression. Adjusted Cox regression models were used to examine the association between PORT and overall survival (OS) and regional recurrence-free survival (R-RFS) in the whole cohort and in different subgroups. Results: In total, 85 patients were included in our study, of whom 43 received PORT. Three factors were predictors of receiving PORT in our cohort, namely: poor differentiation, high-risk margins, and bilateral neck dissection. Overall survival and probability of regional recurrence after 60 months were comparable between groups: 63% and 30% in the SO group and 65% and 25% in the PORT group, respectively. After adjusting for established confounders, PORT was not associated with improved OS HR (PORT vs SO = 0.94; 95% CI 0.46-1.92; p = 0.9) nor with improved regional recurrence-free survival (PORT vs SO = 0.81; 95% CI 0.30-2.17; p = 0.7. Subgroup analyses revealed potential benefit from PORT in patients with pT2 tumors, age under 70 years, and inadequate neck dissection (lymph node yield < 18 nodes). Conclusion: While registry-based studies often lack granular data on comorbidities and specific recurrence types, our results suggest that the marginal gains of PORT may not justify its high morbidity, including significant long-term impacts on quality of life. Observation seems to be a safe alternative to routine irradiation in carefully selected pT1-2 pN1 OSCC cases, provided surgical neck management is adequate.
Unfavourable splits remain an important intraoperative complication of sagittal split osteotomy (SSO). We updated the evidence to quantify contemporary incidence and to reassess claims concerning third-molar status and osteotomy design. PubMed/MEDLINE and Europe PMC were searched from 13 August 2015 to 24 August 2026, and Embase was searched on 3 October 2026. Eighteen independent contemporary incidence cohorts reported 279 events among 11,159 osteotomy sites. A binomial-normal generalized linear mixed model, which required no continuity correction, estimated an incidence of 2.66% (95% confidence interval [CI] 1.71%-4.11%). Between-study heterogeneity was substantial (tau =1.09 on the logit scale), with an approximate 95% prediction interval of 0.30%-19.66%. The crude proportion was 2.50%, compared with the published historical aggregate of 2.35% (458/19,527 sites). Third-molar studies compared clinically heterogeneous states; study-specific estimates are therefore presented without a single causal summary. For long versus short medial osteotomy, the risk ratio was 1.78 (95% CI 0.76-4.17). The evidence does not establish that third-molar timing or a particular medial-cut design prevents unfavourable splitting.
