Oral and Maxillofacial Surgery

Sialadenitis May Be Associated With an Increased Risk for Osteoradionecrosis: A Nationwide Population-Based Cohort Study Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): Yi-Fang Huang, Shih-Ping Liu, Chih-Hsin Muo, Chung-Ta Chang, Chun-Hao Tsai, Donald E. Morisky Purpose The impact of sialadenitis on osteoradionecrosis (ORN) is controversial. The aim of this study was to determine the association between sialadenitis and ORN. Materials and Methods Participants were derived from the Taiwanese Longitudinal Health Insurance Database. From January 1, 2000 to December 31, 2008, cases of sialadenitis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 527.2, 527.3, 527.5 to 527.7, 527.9, and 710.2) and ORN (ICD-9-CM codes 526.89, 526.5, 730.0, and 730.1) were identified. Different treatment modalities, including surgery versus medicine, were used to distinguish the severity of sialadenitis. The primary predictor variable was sialadenitis. The secondary predictor variable was severity of sialadenitis. The primary outcome variable was time to developing ORN. Other study variables were grouped for age, gender, risk factor, and medical treatment. Cox proportional hazard regression was used to investigate the associations between sialadenitis and ORN after adjusting for statistical confounders. Results The sample was composed of 47,385 patients with a mean age of 46.6 years (standard deviation, 19.9 yr) and 37.2% were men. Twenty percent had a diagnosis of sialadenitis and 1.13% had a diagnosis of ORN. Sialadenitis was associated with an increased risk of ORN (hazard ratio [HR] = 1.93; 95% confidence interval [CI], 1.61-2.31; P < .0001). After adjustment for confounders, sialadenitis was associated with ORN (multivariable HR = 1.83; 95% CI, 1.52-2.19; P < .0001). Severity of sialadenitis was associated with an increased risk of ORN; risks for ORN were 1.79 (95% CI, 1.49-2.16; P < .0001) and 3.52 (95% CI, 1.67-7.44; P < .001) in patients with mild and serious sialadenitis, respectively, compared with the no-sialadenitis cohort. For the joint effect of ORN between sialadenitis and malignancy type, patients with sialadenitis had 11.6-fold risk for ORN (95% CI, 5.58-23.9) compared with patients without malignancy. Conclusions Sialadenitis markedly increased the risk to develop ORN. The severity of sialadenitis was positively correlated with the incidence of ORN.

News and Announcements Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s):

Deep Parotid Lymph Node Metastasis Is Associated With Recurrence in High-Grade Mucoepidermoid Carcinoma of the Parotid Gland Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): Xue Shang, Qigen Fang, Fei Liu, Junfu Wu, Ruihua Luo, Jinxing Qi Purpose The goal of the present study was to assess the association between intraparotid lymph node (IPN) metastasis and prognosis in high-grade mucoepidermoid carcinoma (MEC) of the parotid gland. Patients and Methods Patients with surgically treated primary high-grade MEC of the parotid gland were retrospectively enrolled. The association between IPN metastasis and clinicopathologic variables was analyzed using χ2 tests, and recurrence-free survival (RFS) rate was calculated by the Kaplan-Meier method; independent prognostic factors were evaluated by the Cox proportional hazards method. Results IPN metastasis was noted in 59 patients (48.4%), including 19 cases in the deep lobe and 47 cases in the superficial lobe of the parotid gland. IPN metastasis was statistically related to tumor stage and node stage regardless of the location of the metastasis in the deep or superficial lobe. Patients with superficial and deep lymph node metastasis had a low 5-year RFS rate of 11%. Cox model analysis reported that the status of IPN metastasis was an independent risk factor for recurrence. Conclusions IPN metastasis substantially decreases the RFS rate, especially when there is lymph node metastasis in the deep lobe of the parotid gland.

Management of Mandibular Osteomyelitis With Segmental Resection, Nerve Preservation, and Immediate Reconstruction Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): Jeffrey S. Marschall, Robert L. Flint, George M. Kushner, Brian Alpert Purpose The purpose was to present our experience with management of mandibular osteomyelitis with segmental resection, nerve preservation, and immediate reconstruction with nonvascularized bone grafts. Patients and Methods We completed a retrospective analysis of 18 cases overseen by a single practitioner at a university medical center from June 2011 to July 2018. All patients had osteomyelitis and were treated with segmental mandibular resection, inferior alveolar nerve (IAN) preservation, and immediate reconstruction with autogenous bone graft from the tibia. Data obtained from medical records included the chief complaint at initial presentation, resection size, and IAN neurosensory recovery at 6 months, as well as descriptive statistics of the patient cohort. The university institutional review board granted this study exempt status. Results The patient cohort had a mean age of 50.9 years, ranging from 29 to 70 years, and included 11 female and 7 male patients. The mean follow-up time was 15 months. The most common chief complaint at initial presentation was pathologic fracture (39%), followed closely by abscess (33%). The average mandibular resection size of all patients was 8.1 cm (standard deviation [SD], 3.3 cm). The resection size measured 7.1 cm (SD, 2.6 cm) in patients with successful bone grafts (n = 15) and 13.1 cm (SD, 2.0 cm, P = .0016) in those with graft failure (n = 3). IAN neurosensory testing showed that 54% of patients had no meaningful recovery at 6 months, 25% had partial recovery, and 21% had full recovery. Finally, osteomyelitis was eliminated in all patients. Conclusions Segmental mandibular resection is an effective method for eradicating mandibular osteomyelitis. Furthermore, immediate reconstruction via nonvascularized grafts is successful in cases with large defects, with a mean defect size of 7.1 ± 2.6 cm. However, IAN-sparing surgery is not effective for preserving patient IAN function. Taken together, our findings show that mandibular resection with immediate reconstruction is a viable method in the treatment of mandibular osteomyelitis. This method removes infection and shortens the disease course.

Oral Cancer Treatment Through the Ages: Part 2 Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): Vahe Petrosyan, Georgina Kane, Phillip Ameerally Purpose Understanding how oral cancer treatment evolved can pave the way for future management. The literature holds an expansive collection of historical findings regarding oral cancer, yet the authors were unable to find a comprehensive review of oral cancer treatment throughout the ages. Materials A thorough literature review was carried out using multiple scientific databases and languages, as well as examination of historical archives. Articles were included for their relevance and their findings were assimilated. Results Part two of this article considers the development of specific surgical concepts relating to head and neck cancer over the previous two centuries, including neck dissection and reconstruction, as well as exploration of non-surgical cancer therapies. Conclusion This paper demonstrates historical landmarks made in oral cancer treatment and the prominent figures who pioneered them, confirming that head and neck cancer surgeons of today have valuable lessons to learn from their previous counterparts.

Oral Cancer Treatment Through the Ages: Part 1 Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): Georgina Kane, Vahe Petrosyan, Phillip Ameerally Purpose Understanding how oral cancer treatment evolved can pave the way for future management. The literature holds an expansive collection of historical findings regarding oral cancer, yet the authors were unable to find a comprehensive review of oral cancer treatment throughout the ages. Methods A thorough literature review was carried out using multiple scientific databases and languages, as well as examination of historical archives. Articles were included for their relevance and their findings were assimilated. Results Part one of this article reveals a rich history of oral cancer treatment commencing in ancient times, with discussion of Egyptian, Greek and Roman practices, and travelling through the age of discovery to arrive at the dawn of scientific medicine in the 19th century. Conclusion Part one demonstrates how fundamental concepts of oral cancer were discovered, and the significant impact medical innovation had on the success of oral cancer treatment.

Prognostic Impact of Postoperative Complications on Overall Survival in 287 Patients With Oral Cancer: A Retrospective Single-Institution Study Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): Chao Zhang, Meng Ying Xi, Jie Zeng, Yong Li, Cong Yu Purpose To investigate the relation between postoperative complications and long-term survival in patients with oral cancer after surgery and to explore the methods that improve survival rate through analyzing risk factors for postoperative complications. Materials and Methods This is a retrospective single-institution study of a cohort of 287 patients with oral cancer who underwent surgery at the Stomatological Hospital of the Chongqing Medical University (Chongqing, China) from January 1, 2007 through December 31, 2012. Results Postoperative complications occurred in 80 patients (27.9%). Patients with pulmonary complications or delirium had worse overall survival than those without these complications, whereas other postoperative complications, such as surgical site infection, postoperative bleeding, salivary fistula, and chylothorax, were not associated with overall survival. American Society of Anesthesiologists (ASA) status and tracheostomy were risk factors for postoperative pulmonary complications according to the Pearson χ2 test or multivariate analysis. Using the Pearson χ2 test, age, comorbidity, and ASA status were risk factors for the incidence of postoperative delirium. However, in multivariate analysis, only comorbidity and ASA status were identified as risk factors. Conclusions Postoperative pulmonary complications and postoperative delirium could be independent predictors of poorer long-term survival in patients with oral cancer. The risk factors for postoperative pulmonary complications and postoperative delirium could help identify patients who are at high risk and help clinicians take some actions to prevent them.

The Feasibility of Using the Posterior Auricular Branch of the Facial Nerve as a Donor for Facial Nerve Reanimation Procedures: A Cadaveric Study Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): Shogo Kikuta, Joe Iwanaga, Koichi Watanabe, Jingo Kusukawa, R. Shane Tubbs Purpose Facial nerve paralysis can result in critical complications, including those to the visual, respiratory, and digestive systems. The facial nerve has been reanimated using various nerves, but the posterior auricular nerve (PAN) branching off the facial nerve has not been explored for this purpose. Materials and Methods Ten sides from 6 fresh-frozen adult cadavers were used for dissection of the PAN to explore its potential as a donor for facial nerve reanimation. The facial nerve trunk (FNT) and PAN were consistently and readily identified by deep dissection using the tragal cartilage and tragal pointer as landmarks. The PAN was transected at the point of insertion of its innervated muscles. Its length and diameter were measured, and it was transposed anteriorly to the FNT and its 2 major extracranial divisions. Results The PAN was observed on all sides. Its available length was 27.11 ± 5.02 mm and its mean diameter was 0.85 ± 0.20 mm. In all specimens, the PAN readily reached the FNT and its 2 major divisions without tension. Conclusion No previous study has explored the use of the PAN as a donor for facial nerve reanimation. Based on the present cadaveric study, surgeons might consider it for this purpose.

Three-Dimensional Evaluation of the Postsurgical Stability of Mandibular Setback With the Surgery-First Approach: Comparison Between Patients With Symmetry and Asymmetry Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): LiJun Sun, Kyung-Min Lee Purpose The purpose of the present study was to evaluate the 3-dimensional postsurgical stability of mandibular setback with a surgery-first (SF) orthodontic treatment approach in patients with skeletal Class III malocclusions and facial asymmetry using cone-beam computed tomographic (CBCT) images. Patients and Methods Thirty-six patients who underwent mandibular setback with an SF approach for the correction of mandibular prognathism were enrolled in the present study. Patients were divided into symmetrical (n = 18) and asymmetrical (n = 18) groups according to their degree of menton deviation. CBCT images were acquired before surgery, 1, 6, and 12 months after surgery, and at the end of treatment. After reorienting of CBCT images using automatic volume-based registration, the position of the mandible at each time point was evaluated relative to its post-treatment position. MATLAB (MathWorks, Natick, MA) was used to represent all sequential changes in postoperative mandibular position. The increase in posterior vertical dimension at surgery was measured and then correlated with postsurgical mandibular stability. Results For up to 6 months after surgery, the position of the mandible differed considerably from its post-treatment position. At 12 months after surgery, the position of the mandible no longer differed substantially from its post-treatment position. The asymmetry group exhibited greater outward displacement of the proximal segment. The symmetrical and asymmetrical groups exhibited a positive correlation between postsurgical mandibular instability and the increase in posterior vertical dimension. Conclusion These results indicate that mandibular position stabilizes 12 months after surgery performed with an SF approach. It is necessary to consider mandibular forward movement from the increase in posterior vertical dimension in surgical occlusion during the treatment planning stage. Moreover, clinicians should maintain the surgical position of proximal segments during postsurgical orthodontic treatment at least until 12 months after surgery.

Maintenance of Segmental Maxillary Expansion: The Use of Custom, Virtually Designed, and Manufactured Palatal Appliances Without the Use of an Occlusal Splint Publication date: July 2019 Source: Journal of Oral and Maxillofacial Surgery, Volume 77, Issue 7 Author(s): Mohammed Ismail, John Wessel, Brian Farrell Expansion of the maxilla using a segmental Le Fort I osteotomy is a routine and commonly used procedure in the treatment of dentofacial deformities. Although orthognathic surgery has seen tremendous advancement in technology, including virtual surgical planning and customized hardware, some room for advancement exists in the maintenance of surgical maxillary expansion. Traditionally, this has been accomplished with retention of a maxillary occlusal splint 4 to 8 weeks postoperatively. This article introduces some novel techniques to help maintain this expansion, including the intraoperative transpalatal archwire and custom palatal strap appliance in conjunction with autogenous bone harvest and grafting in lieu of using occlusal-based splints. The aim of these techniques is to improve postoperative patient comfort and surgical outcomes and shorten postoperative orthodontic treatment time.

Alexandros Sfakianakis
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