Background/Objectives: Mixed martial arts (MMA) is a popular full-contact combat sport. The aim of this study was to determine injury mechanisms, rates, severity, patterns, circumstances, and the resulting economic healthcare consequences by conducting a detailed survey of competitive and recreational athletes. Methods: In 2023, MMA athletes were retrospectively questioned regarding their injuries in the last 24 months and the resulting healthcare impact (medical attention, hospitalization, incapacity to work). An injury was defined as any physical complaint resulting from MMA exposure. The severity of the injury was categorized according to the resulting restriction of sport participation (i.e., 'severe': more than four weeks of restriction). Results: A total of 112 participants (93% male; 41% non-competitive and 59% competitive) were included. All in all, 93,857 h of MMA activities were performed, and 127 injuries were recorded, resulting in an overall injury rate of 1.4 injuries per 1000 h of exposure. Non-competitive athletes reported significantly fewer total injuries in the past 24 months (95% CI 0.87-2.04; p = 0.003) and had significantly fewer severe or even critical injuries compared to competitive athletes (OR 0.55; 95% CI 0.21-1.43; p = 0.042). Head- and neck lesions (20%) were the most common injuries. The most common types of injury were joint sprains (21%) and ligament strains (17%). The healthcare burden of these sports-related injuries was minimal: By median, injuries led to zero days of hospitalization and incapacity to work, with no statistically significant differences between recreational and competitive athletes. Conclusions: Competitive athletes suffer more severe injuries compared to recreational athletes. Overall, injuries in MMA are rare, and the economic impact and burden on the healthcare system are negligible compared to other sport disciplines.

Background and Objectives: The masseteric artery (Ma) enters the masseter muscle (Mm) together with the masseteric nerve (Mn) via the mandibular notch. Morphological detail on the intramuscular course of the Ma and its relationship to the Mn remains scarce to date. When utilizing the Mn in facial reanimation surgery, a constant relationship between the Ma and Mn could be used for intramuscular orientation when preparing the Mn and for an indirect localization via ultrasound. This study examines the intramuscular course of the Ma and its relationship to the Mn. Materials and Methods: Sixty hemicrania obtained from thirty postmortem individuals aged between 54 and 99 years and embalmed using the Thiel methods were examined. Results: Four types of Ma were identified according to their endpoint in the Mm. In 5% of cases, no Ma could be identified (Type 0), 48.3% (Type 1) terminated within the upper third, 41.7% (Type 2) in the middle third, and 5% (Type 3) in the lower third. The Ma consistently entered the Mm inferior and in 85% of cases additionally slightly posterior to the Mn. The main trunk of the Ma crossed the Mn in the upper third of the Mm in 31.7% of cases, in the middle third in 23.3%, and in the lower third in 1.7% of cases. Of these, 13.3% had the Ma crossing the Mn. Smaller branches crossed the Mn in 45% of cases. Conclusions: If an Ma is present, it may be used for intramuscular orientation and indirect location of the Mn via the mandibular notch. Since the Ma reaches the lower third of the muscle in only a few cases, it is unsuitable for intramuscular orientation to locate the Mn via a distal approach.

Background and Objectives: The masseteric nerve (Mn) is increasingly used for facial reanimation because of its reliable location, high axon count, low donor morbidity, and favorable clinical outcomes. Precise topographic knowledge of the Mn relative to reproducible intraoperative landmarks is essential for safe dissection. This study investigated the intramuscular position of the Mn relative to two defined reference lines. Materials and Methods: Seventy-two hemicrania from 36 individuals (aged 54–99 years) embalmed postmortem using the Thiel method were examined. Measurements were referenced to two defined anatomical lines: the angle–canthus line (ACL), extending from the mandibular angle to the lateral canthus of the eye, and the articular eminence line (AEL), extending from the articular eminence to the base of the zygomatic temporal process. Results: The Mn crossed the ACL at an average distance of 39.9 ± 5.9 mm from the mandibular angle with up to four branches. The first intramuscular branch arose 15.6 ± 4.7 mm superior to the ACL. The Mn was located 4.9 ± 1.9 mm anterior to the articular eminence and 4.7 ± 1.5 mm inferior to the AEL, coursing at an average angle of 68.5 ± 11.6° to the AEL. The AEL and ACL provide reliable and clearly defined reference lines for locating the Mn and improve intraoperative reproducibility. The Mn followed a predictable oblique course and was consistently identified in the masseter muscle (Mm) beneath an intramuscular aponeurosis. Nerve diameter varied by site, underscoring the need for standardized measurement locations. Distal localization along the ACL may enable preservation of early intramuscular branches and reduce donor morbidity. Further studies should evaluate axon counts at defined points and clarify the relationship of the Mn to the masseteric artery for better intramuscular orientation during dissection. Conclusions: The Mn can be located within a 63 mm2 area beneath the AEL at the masseter entry and more distally on the ACL. ACL-based access may protect the first intramuscular branch of the Mn and the temporal branch of the facial nerve (TBFN), and it represents a potential alternative for smile reconstruction for patients with preserved eye closure.

Background/Objectives: Primary cleft lip repair is a procedure to restore lip function and harmonious nasolabial appearance. However, the actual effects on nasolabial appearance have been insufficiently investigated. The aim of this study was therefore to critically review surgical results using well-validated objective and subjective methods and standardised outcome measures. Methods: A total of 26 non-syndromic patients with unilateral cleft lip +/- cleft palate were assessed retrospectively. Uniform 2D photographs of the nasolabial region were objectively analysed using SymNose software. The Cleft Aesthetic Rating Scale was employed for the subjective evaluation by a total of 255 observers with different backgrounds and experience levels in cleft surgery. Results: Significant positive correlation was identified between objective measurement of upper lip asymmetry and subjective assessment (p = 0.02). Furthermore, a significant difference emerged in the assessment of the nasolabial region depending on the rater's professional background (p < 0.001). A major discrepancy was observed between the rating of maxillofacial consultants and those of laypersons and patients affected by cleft lip +/- cleft palate. Conclusions: The evaluation of attractiveness depends significantly on the professional background of the observer. The more interaction people have with individuals after cleft lip repair, the less they consider the aesthetics conspicuous. Achieving the highest possible postoperative nasolabial symmetry should be a main objective in primary cleft lip repair.

Clear cell odontogenic carcinoma is a very rare malignant tumor of the jaw. Diagnosis and treatment may be challenging as the tumor grows locally aggressive and infiltrative with possible metastatic spread, while the clinical presentation varies, and the definitive diagnosis can only be confirmed by immunohistopathology. The case of a 25-year-old male patient with clear cell odontogenic carcinoma of the mandible is presented. Therapeutic treatment included primary surgical resection with bilateral removal of cervical lymph nodes followed by a two-stage reconstruction approach. Continuous follow-up over 7.5 years showed no signs of tumor recurrence.

Bilateral sagittal split osteotomy is a commonly used, standard procedure in orthognathic surgery to correct malocclusion and jaw misalignment. Postoperative vascular complications are extremely rare and under-reported in the literature. This contribution presents the case of a 48-year-old male patient who underwent bilateral sagittal split osteotomy due to class II skeletal malocclusion. There were no abnormalities during the surgery. However, the patient developed facial palsy and experienced a pulse-synchronised murmur. Computed tomographic angiography (CTA) revealed an arteriovenous fistula between the right external carotid artery and the pterygoid plexus with pseudoaneurysm. Following the diagnosis, the patient was successfully treated with an intervention involving coiling and sealing with histoacrylic glue. It is crucial to be aware of serious vascular complications following orthognathic surgery, as a delay in diagnosis and treatment can lead to life-threatening bleeding or long-term damage. CTA is the most rapid and accurate method of confirming the diagnosis. If there is clinical suspicion, this examination should not be delayed, and the therapeutic approach should be determined on an interdisciplinary basis.

This prospective study aims to compare the clinical outcomes of two different bridging plate systems in complex mandibular reconstruction surgery. A prospective, single-blinded, randomized controlled clinical trial was conducted on 40 patients with complex mandibular bone defects requiring reconstruction using load-bearing osteosynthesis. Patients were randomly assigned to receive either a novel bridging plate method (MODUS 2 Mandible TriLock Bridging Plate, intervention group) or a traditional method (MODUS 2.5 Locking Reconstruction Plate; control group). The outcome of the two systems was evaluated through an intraoperative usability assessment done by surgeons, as well as multiple assessments concerning complication rates and patient-reported quality of life using the SF-36 questionnaire, up to one year post-operation. The intervention group showed significantly improved intraoperative usability across most evaluated categories (wilcoxon rank sum test: p < 0.05). Postoperative complication rates were lower in the intervention group, with a hazard ratio of 0.36 (cox proportional hazards regression model: 95 % CI, 0.14-0.95). Quality of life improved in both groups over time, however the intervention group demonstrated higher scores at 6 and 12 months post-surgery. For mandibular reconstruction, the novel grid plates offer improved intraoperative usability and demonstrated reduced complications in comparison to the traditional reconstruction system. The novel system is efficient to use and entirely clinically reliable.

Cleft lip re-repair is a procedure frequently endorsed to enhance a compromised nasolabial appearance. However, the actual effect of such revision surgery on the nasolabial appearance has scarcely been studied. Therefore, the aim of this study was to critically review surgical outcomes of patients that underwent surgical re-do of their cleft lip, using well-validated objective and subjective methods and standardised outcome measures. 20 patients with at least 6 months follow-up after cleft lip re-repair were assessed. Standardised pre- and postoperative photographs were analysed. The objective assessment was carried out using the SymNose-software. Furthermore, a subjective evaluation of the nasolabial area was conducted by ten examiners who rated seven parameters using a Likert-scale ranging from 1to5. The objective evaluation showed substantial improvement regarding symmetry values. Significant postoperative decrease in labial asymmetry from 26.42% (+8.13) to 18.77% (+6.28) (p < 0.001) and upper lip asymmetry in relation to the facial midline (26.91% (+8.03) vs. 18.27% (+5.17) (p < 0.001)) was observed. Similar results were corroborated in the subjective analysis. Differences regarding the ratings were detected considering the examiners' professional background and level of expertise. Cleft re-repair was found to significantly improve upper lip symmetry and lead to a more harmonious nasolabial appearance.

(1) Background: This study aimed to integrate an augmented reality (AR) image-guided surgery (IGS) system, based on preoperative cone beam computed tomography (CBCT) scans, into clinical practice. (2) Methods: In preclinical and clinical surgical setups, an AR-guided visualization system based on Microsoft’s HoloLens 2 was assessed for complex lower third molar (LTM) extractions. In this study, the system’s potential intraoperative feasibility and usability is described first. Preparation and operating times for each procedure were measured, as well as the system’s usability, using the System Usability Scale (SUS). (3) Results: A total of six LTMs (n = 6) were analyzed, two extracted from human cadaver head specimens (n = 2) and four from clinical patients (n = 4). The average preparation time was 166 ± 44 s, while the operation time averaged 21 ± 5.9 min. The overall mean SUS score was 79.1 ± 9.3. When analyzed separately, the usability score categorized the AR-guidance system as “good” in clinical patients and “best imaginable” in human cadaver head procedures. (4) Conclusions: This translational study analyzed the first successful and functionally stable application of the HoloLens technology for complex LTM extraction in clinical patients. Further research is needed to refine the technology’s integration into clinical practice to improve patient outcomes.

Zusammenfassung Der transkonjunktivale Zugang ist ein etabliertes Verfahren in der Mund‑, Kiefer- und Gesichtschirurgie zur Durchführung operativer Eingriffe in der Orbitaregion. Das breite Indikationsspektrum umfasst dabei nicht nur die Traumatologie und die Therapie von Tumorerkrankungen des Gesichtsschädels und angeborenen Gesichtsfehlbildungen, sondern zunehmend auch Behandlungen zur Wiederherstellung und Optimierung der Gesichtsästhetik. Der Zugangsweg vereint eine gute intraoperative Einsehbarkeit des Operationsgebiets mit einem unauffälligen postoperativen periorbitalen Erscheinungsbild ohne äußerlich sichtbare Narbenbildung. Neben den genannten Vorteilen des transkonjunktivalen Verfahrens ist dieser chirurgische Zugang allerdings auch mit relevanten Komplikationen verbunden, deren Beherrschung unbedingt gewährleistet sein muss. Das Komplikationsprofil umfasst u. a. das Auftreten von Lidfehlstellungen (Entropium oder Ektropium), kanthale Malpositionen, die Chemosis oder das Symblepharon. Ziel dieses Beitrags ist es, die häufigen Komplikationen im Rahmen des transkonjunktivalen Zugangs zu beleuchten und deren Management detailliert aufzuarbeiten, um einen praxisrelevanten Überblick zu schaffen, der in dieser Form in der Literatur noch nicht beschrieben wurde.

The purpose of the current study was to compare two different antithrombotic protocols for free flap reconstruction in head and neck squamous cell carcinoma (HNSCC) patients. Postoperative complications were graded using the Clavien-Dindo (CD) classification and compared between the two groups: the low-molecular-weight heparin (LMWH) group (n = 57) and the unfractionated heparin (UFH) group (n = 59). Patients with HNSCC from January 2010 to January 2022 were included. A total of 116 patients with a mean age of 60.46 years (range 43-83 years) were included in this study. In all, 81 were male (69.8%), and 35 were female (30.2%). Most patients (48.3%) had only grade 1 or 2 complications. CD grades (1-5) were similar between the two groups. Flap loss occurred in 2 patients (1.7%) in the LMWH group (p = 239). Prognostic factors of flap loss were high BMI, hypertension, high T stage, and high N stage. No differences were found between the groups in regard to age, sex, operating times, flap source, recipient vessels and overall complications. The results of this study demonstrate that UFH was as safe and effective as LMWH regarding postoperative complications. Free flap surgery is safe and effective for head and neck reconstruction.

The purpose of the current study was to assess the quality of facial linear scars. The Stony Brook Scar Evaluation Scale (SBSES) was developed and validated as a tool to assess postoperative scars. Postoperative facial scars were rated using high-quality macrophotographs and SBSES by three independent raters at baseline and three months thereafter. Percentage agreement (PA) and intraclass correlation coefficient (ICC) were used to measure interrater and intrarater reliability. Scar outcomes ranging from 0 (worst) to 5 (best) were evaluated against age and gender. One-hundred-sixty-six patients with a mean age of 30.6 years (range of 17-59) were included in this study. Forty-four were male (26.5%), and 122 were female (73.5%). Mean total SBSES scores were 4.63 (range of 4.56-4.76) at baseline and 4.60 (range of 4.54-4.72) at three months. As patient's age increased, mean total SBSES scores also decreased significantly (r = -0.216, p = 0.005). Gender did not significantly affect raters' perception of scar cosmesis (p = 0.847). Interrater reliability showed an ICC of 0.675 (95% CI, 0.609-0.731) and a PA of 65.4% at baseline, and an ICC of 0.655 (95% CI, 0.585-0.715) and a PA of 64.2% at three months. Intrarater reliability found ICCs ranging from 0.988 to 0.990 and a PA of 96.8% with 3 separate raters. Within the limitations of the study it seems that the transbuccal approach during osteosynthesis of a sagittal split osteotomy seems still to be acceptable when the patient gives his or her informed consent and advanced instruments like an angled screwdriver are not available.

The aim of this prospective, randomized, double-blind, controlled clinical study was to evaluate the analgesic effect of ibuprofen versus diclofenac plus orphenadrine on postoperative pain in orthognathic surgery. Patients who underwent orthognathic surgery were randomized into two groups to receive intravenously either 600 mg of ibuprofen (I-group) or 75 mg diclofenac plus 30 mg orphenadrine (D-group), both of which were given twice daily. Additionally, both groups were given metamizole 500 mg. Rescue pain medication consisted of acetaminophen 1000 mg and piritramide 7.5 mg as needed. To assess the pain intensity, the primary end point was the numeric rating scale (NRS) recorded over the course of the hospital stay three times daily for 3 days. One hundred nine patients were enrolled (age range, 18 to 61 years) between May 2019 and November 2020. Forty-eight bilateral sagittal split osteotomies (BSSO) and 51 bimaxillary osteotomies (BIMAX) were performed. Surgical subgroup analysis found a significant higher mean NRS (2.73 vs.1.23) in the BIMAX D-group vs. I-group (p = 0.015) on the third postoperative day. Additionally, as the patient’s body mass index (BMI) increased, the mean NRS (r = 0.517, p = 0.001) also increased. No differences were found between age, gender, length of hospital stay, weight, operating times, number of patients with complete pain relief, acetaminophen or piritramide intake, and NRS values. No adverse events were observed. The results of this study demonstrate that ibuprofen administration and lower BMI were associated with less pain for patients who underwent bimaxillary osteotomy on the third postoperative day. Therefore, surgeons may prefer ibuprofen for more effective pain relief after orthognathic surgery. Ibuprofen differs from diclofenac plus orphenadrine in class and is a powerful analgetic after orthognathic surgery.

When choosing local anesthetics, risk factors such as underlying diseases, use of other medications and allergies have to be taken into consideration. Systematic complications might occur if a specific limit in the plasma concentration is exceeded. Articaine and prilocaine are metabolized extrahepatically. In case of an absolute contraindication for vasoconstrictors, the use of mepivacaine, bupivacaine or articaine is recommended.

Dieser Beitrag gibt einen Überblick über die Anwendung, die therapeutischen Wirkungen und die Nebenwirkungen der antibiotischen Substanz Metronidazol. Metronidazol ist wirksam zur Unterstützung der Behandlung von Parodontitis, mikrobiell bedingtem Mundgeruch, perioralen Hautinfektionen und odontogenen Hart- oder Weichgewebeabszessen, die auf anaerobe bakterielle Infektionen zurückzuführen sind. Aufgrund seiner antiparasitären Wirkung ist Metronidazol auch bei der Behandlung von Protozoen wirksam. Bei Erwachsenen und Kindern ab 12 Jahren können 200 mg Metronidazol bis maximal 2000 mg Metronidazol pro Tag verabreicht werden. Bei Kindern unter 12 Jahren wird eine antibiotische Dosis von Metronidazol zwischen 20 und 30 mg pro Kilogramm Körpergewicht empfohlen.

This contribution gives an overview of the use, therapeutic effects and side effects of the antibiotic substance Metronidazole. Metronidazole is effective in the treatment support of paradontitis, microbial-caused halitosis, perioral skin infections and odontogenic hard or soft tissue abscess formations related to anaerobic bacterial infections. Due to its anti- parasitic effect, Metronidazole is also effective in the treatment of protozoa. In adults and children from 12 years on, 200 mg Metronidazole to a maximum of 2000 mg Metronidazole per day can be administered. In children below 12 years of age, an antibiotic dose of Metronidazole between 20 to 30 mg per kilogram body weight is advised.

Das höhere Alter allein stellt keine Kontraindikation für die Gabe von Lokalanästhetika dar. Für die Wahl und Dosierung des Wirkstoffs ist eine umfassende Anamnese obligat.

Aim: This study aimed to analyse the possible linkage between diabetes mellitus (DM) and oral cancer among Austrians. Patients and Methods: We performed a retrospective DM and/or impaired fasting glucose (IFG) screening in 573 patients who underwent maxillofacial surgery under general anaesthesia between January 1, 2018 and December 31, 2019. Results: Of the total patients, 26.5% (n=152) had cancer diagnosis, whereas the remaining 73.5% (n=421) formed the control group. The prevalence of glucose metabolism disorder (GMD) was significantly (p<0.00001) more common among cancer patients (59.9% vs. 36.5%). Squamous cell carcinoma and sublingual tumours represented the most common tumour type (93.4%) and location (35.5%), respectively. Smoking was significantly (p=0.00093) more common within the cancer group. Conclusion: Our data suggest an association between GMD and oral cancer.

Introduction: The anatomical position of the inferior alveolar artery (IAA) within the mandibular canal and in relation to the substructures of the neurovascular mandibular bundle has been sparsely described to date. More detailed information on the exact IAA position would be beneficial for both dental and maxillofacial surgical procedures to minimize complications such as bleeding, nerve compression hematoma, and sensory deficiency. Material and methods: In 31 Thiel-preserved and fresh-frozen cadaver hemimandibles the position of the IAA in relation to the structures of the inferior alveolar neurovascular bundle and the mandible borders was analyzed anatomically and histologically. Results: In 77.4% of the cases, rotation of the IAA around the mental nerve was apparent, resulting in a typical site-dependent IAA position. While the IAA was situated buccally within the pterygomandibular space, buccal-inferior in the mandibular foramen, superior in the molar region, and lingually in the premolar region. In 12.9% of the cases, a persistent lingual position of the IAA was observed for the entire mandibular canal. In one case, an additional mandibular canal and an accessory IAA were identified. Discussion: This study provides new and encompassing information on the complete course and position of the IAA. This course is of practical use for oral implantology and various surgical procedures in dental-and maxillofacial surgery. Variations in the typical IAA course and site-dependent positional changes may be referred to as mandible growth and functional adaption to occlusion anomalies. This report helps enhance the morphological and functional understanding of IAA relationship during mandible development. (c) 2021 The Author(s). Published by Elsevier GmbH. CC_BY_4.0

Extensive defects in the head and neck area often require the use of advanced free flap reconstruction techniques. In this study, the thoracodorsal perforator-scapular free flap technique based on the angular artery (TDAP-Scap-aa flap) was postoperatively evaluated regarding the quality of life and the donor site morbidity using the standardized SF-36 and DASH questionnaires (short form health 36 and disabilities of the arm, shoulder and hand scores). Over a five-year period (2016–2020), 20 selected cases (n = 20) requiring both soft and hard tissue reconstruction were assessed. On average, the harvested microvascular free flaps consisted of 7.8 ± 2.1 cm hard tissue and 86 ± 49.8 cm2 soft tissue components. At the donor site (subscapular region), only a mild morbidity was observed (DASH score: 21.74 ± 7.3 points). When comparing the patients’ postoperative quality of life to the established values of the healthy German norm population, the observed SF-36 values were within the upper third (>66%) of these established norm values in almost all quality-of-life subcategories. The mild donor site morbidity and the observed quality of life indicate only a small postoperative impairment when using the TDAP-Scap-aa free flap for the reconstruction of extensive maxillofacial defects.