To perform a targeted bibliometric analysis of the Oral and Maxillofacial Surgery (OMFS) literature from 2025 to map its current intellectual structure, identify established research hotspots, and detect nascent emerging trends. This cross-sectional bibliometric analysis extracted bibliographic data for ten predefined OMFS topics from the PubMed database for the year 2025. A multi-metric approach was employed using the bibliometrix R-package and VOSviewer. Analyses included descriptive statistics, co-occurrence network analysis of keywords, and calculation of betweenness centrality to identify connective themes. A five-year (2021-2025) longitudinal analysis contextualized growth rates for each topic. The analysis included 17,492 articles across 928 journals. Betweenness centrality analysis revealed high-impact emerging trends centered on a digital revolution, signified by keywords like "virtual surgical planning" (btw: 442.713) and "artificial intelligence" (btw: 308.832). Concurrently, a paradigm shift toward personalized, value-based care was indicated by the prominence of "patient reported outcome measures" (btw: 495.788) and "quality of life" (btw: 644.744). Alarming trends in antimicrobial resistance ("anti-bacterial agents", btw: 2,099,121) and pharmacovigilance (e.g., MRONJ, 523.17% growth) were also identified. The OMFS research landscape in 2025 is undergoing a dual transition: a technological transition driven by digitalization and AI, and a paradigmatic shift toward an integrated, personalized, and patient-centric model of care, alongside pressing challenges in antibiotic resistance.
Lymph node metastasis (LNM) is common in patients with papillary thyroid cancer (PTC), and deciding the scope of surgery and postoperative follow-up depend on appropriately estimating the risk of LNM. As a novel composite indication that combines lipid metabolism and inflammation, the platelet-to-high-density lipoprotein ratio (PHR) has not yet been shown to be associated with PTC LNM. This study aims to evaluate the association between PHR and LNM in patients with PTC using a propensity score-matched (PSM) cohort, identify clinically significant data, ultrasound, and pathological features, and construct a nomogram model in conjunction with PHR, while also exploring the association between other composite indicators and LNM. We gathered information on 784 PTC patients who had surgery at the First Hospital of Lanzhou University's Department of Thyroid Surgery between June 2023 and September 2025. 236 patients in all were eventually included in the trial after being screened in accordance with the inclusion and exclusion criteria. Gather general patient data, complete blood counts, ultrasound results, BRAF V600E mutation test results, preoperative biochemical tests (including lipid profiles), and postoperative pathology reports (including capsular-invasion and LNM status). A total of 162 patients (81 pairs) were eventually included in the trial following a 1:1 propensity score match for age, sex, and body mass index (BMI). PHR, the ratios of triglycerides to high-density lipoprotein (THR), low-density lipoprotein to high-density lipoprotein (LHR), total cholesterol to high-density lipoprotein (TCHR), white blood cells to high-density lipoprotein (WHR), and neutrophils to high-density lipoprotein (NHR) are among the composite indicators that are analyzed. A nomogram was created and characteristics associated with LNM were screened using univariate and multivariate logistic regression. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to assess the model's degree of calibration and discrimination. Following PSM, demographic traits such age, sex, and BMI were balanced between the LNM and non-LNM groups (P > 0.05). Calcification (OR = 2.895, 95% CI 1.395-6.183, P = 0.005), capsularinvasion (OR = 2.276, 95% CI 1.111-4.756, P = 0.026), and PHR (OR = 1.007, 95% CI 1.001-1.014, P = 0.0376) were found to be independently linked to LNM. The multivariate analysis revealed that the remaining five composite indices (THR, LHR, TCHR, WHR, and NHR) were not statistically significant (P > 0.05). The nomogram model based on PHR, calcification, and capsularinvasion had an AUC of 0.715; the model's calibration and clinical net benefit were deemed satisfactory by the DCA and calibration curves. In patients with PTC, elevated PHR, calcification, and capsularinvasion are independent risk factors for LNM. Assisting in the evaluation of patients' risk of LNM and offering direction for the creation of postoperative follow-up regimens, the three-variable logistic regression model exhibits moderate discriminatory power and a definite clinical net benefit. The clinical applicability and generalizability of this approach require additional confirmation through prospective, multicenter investigations because this study was retrospective, single-center, and lacked external validation.
The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has increased substantially. Transoral robotic surgery (TORS) provides detailed pathological assessment that may support risk-adapted treatment strategies; however, integrated evidence on oncologic, functional, and economic outcomes remains limited. To systematically evaluate oncologic, functional, and economic outcomes of TORS-based treatment strategies in patients with HPV-positive OPSCC. A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, Wiley Online Library, MDPI, Cureus, and medRxiv were searched for studies published between 2019 and 2025. Pre-specified subgroup meta-analyses (randomized/clinical trial versus observational studies, and primary versus salvage settings) were performed using random-effects models for overall survival (OS), postoperative bleeding, tracheostomy rate, and long-term gastrostomy dependence. Twenty-two studies (20 clinical and 2 economic) were included, with 14 contributing to quantitative synthesis. The pooled 2-year OS was 94% (95% CI: 0.90-0.98), the 3-year OS was 96% (95% CI: 0.92-0.99), and the 5-year OS was 92% (95% CI: 0.90-0.95). In the salvage setting, the pooled 2-year OS was 76% (95% CI: 0.71-0.80), with no observed statistical heterogeneity, although based on a limited number of studies. Subgroup analyses indicated higher survival estimates in randomized/clinical trial settings compared with observational cohorts. Functional outcomes were generally favorable, with pooled postoperative hemorrhage of 7% (95% CI: 0.04-0.11), tracheostomy rate of 9% (95% CI: 0.03-0.14), and long-term gastrostomy dependence of 2% (95% CI: 0.00-0.03).Across included studies, TORS provided detailed pathological information that may support risk stratification and inform adjuvant treatment decisions; however, the extent of treatment de-escalation varied across studies. TORS appears to be an effective treatment option in selected patients with HPV-positive OPSCC, with generally favorable oncologic and functional outcomes. However, interpretation of these findings is limited by heterogeneity in study design and patient populations. Further prospective studies are required to clarify its role in treatment de-escalation and long-term outcomes.Registration: PROSPERO (CRD420251240194).
Adenomatoid Odontogenic Tumor (AOT) is a benign encapsulated epithelial odontogenic tumor that contains rosette or duct-like structures and has an indolent behavior. AOT is an uncommon tumor characterized by slow and progressive growth, as well as a non-invasive nature. Being an unusual tumor, the prevalence of AOT has been primarily reported in cross-sectional studies with variations across countries and geographical locations. Understanding of its global prevalence estimate is crucial for understanding the burden of this rare tumor. So, this study aims to update and extend previous knowledge on the epidemiology of this condition. An electronic search was conducted using the following search engines and databases: Web of Science (WOS), Scopus, Google Scholar, PubMed/MEDLINE, and Embase. We adhered to the PRISMA guidelines and utilized the PRISMA checklist. Eligible English studies were reviewed and analyzed. Relevant studies on the prevalence of AOT both in odontogenic tumors and in all documented biopsies were identified and included in the meta-analysis. Random-effects models were used to calculate the pooled prevalence. Where heterogeneity was present, subgroup analysis and meta-regression were conducted to identify sources of heterogeneity in the meta-analysis. The meta-analysis included eighty-three eligible studies, providing the global prevalence of AOT as 4.5% of odontogenic tumors and 0.12% of all biopsies. The pooled mean age of presentation was 18.7 years, and a predilection for the female gender, maxilla, and anterior jaw location was observed. With significant heterogeneity, moderator analysis revealed that the continent of publication, decreasing age of presentation, and institution type had a significant impact on the estimated pooled prevalence of AOT. The overall global prevalence of AOT at 0.12% corroborates observational studies, indicating that it is a rare odontogenic tumor with notable geographical differences. Standardization of case series and cohort studies will improve the accurate estimation of prevalence in future systematic reviews and meta-analyses. The systematic review and meta-analysis were registered with PROSPERO with ID CRD42023491394.
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. While pulmonary and dermatological manifestations are well documented, oral involvement is rare and presents significant diagnostic challenges for dental practitioners. This systematic review synthesizes current literature on oral sarcoidosis, focusing on clinical presentations, diagnostic pathways, treatment outcomes, and dental implications. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science (January 2021 - January 2026) using terms related to sarcoidosis and oral manifestations. English-language case reports, case series, and observational studies reporting oral or maxillofacial involvement were included. A narrative synthesis was performed, and study quality was assessed using a modified JBI checklist for case reports and case series. Study selection and data extraction were performed by a single reviewer; a second independent reviewer was not available (acknowledged as a limitation). From 243 initially identified records, 13 studies met the inclusion criteria, comprising 13 patients with oral sarcoidosis (primary analysis). A previously published systematic review (Jaber et al., 2025) reported pooled data from 77 patients, which we discuss for context but not as a primary data source. Two distinct clinical entities emerged: soft-tissue lesions (submucosal nodules, gingival swelling, salivary gland enlargement) often presenting as early signs of systemic disease, and bony involvement (jaw lesions with tooth mobility and bone loss) indicative of later, more destructive stages. Gingiva and salivary glands were the most frequently involved sites. Diagnosis relied on histopathological confirmation of non-caseating granulomas and exclusion of other granulomatous diseases. Corticosteroids (topical or systemic) were the mainstay of treatment, with methotrexate and hydroxychloroquine used as steroid-sparing agents. Outcomes were generally favorable with early diagnosis. Oral sarcoidosis, though rare, can be the first manifestation of systemic disease. Dental professionals should maintain a high index of suspicion for persistent oral swellings or unexplained granulomatous lesions. Biopsy with histopathological examination is essential. Multidisciplinary management and long-term follow-up are recommended.
Dentofacial deformities are associated with functional, esthetic, and psychosocial impairments that negatively affect quality of life. Orthognathic surgery is used to correct these deformities; however, changes in postoperative quality-of-life may be influenced by both clinical and psychosocial factors. This prospective observational study included 71 patients who underwent orthognathic surgery between June 2023 and June 2024. Oral health-related quality of life was assessed preoperatively, at 6 weeks postoperatively, and at 6 months postoperatively using the Oral Health Impact Profile-14 (OHIP-14) and the Orthognathic Quality of Life Questionnaire (OQLQ). Sociodemographic and psychosocial characteristics were recorded preoperatively. Changes in total and subscale scores were analyzed over time and according to gender, malocclusion type, clinical symptoms, and psychosocial variables. Significant improvements in all OHIP-14 and OQLQ subscale and total scores were observed over time (p < 0.05), with the greatest improvements at the 6-month follow-up. Greater improvements were observed among patients with preoperative speech-related symptoms, school-, work-, or social life-related problems, and mandibular complaints. Gender-related differences were noted, with females showing greater esthetic-related improvements and males showing greater functional improvement. Higher preoperative esthetic severity perception and motivation levels were associated with smaller changes in quality-of-life scores. No significant differences were observed according to malocclusion type or occupation. Improvements in functional, esthetic, and psychosocial aspects of quality of life were observed over time following orthognathic surgery. These changes appear to be associated not only with surgical treatment but also with patients' baseline impairments, expectations, and psychosocial characteristics, highlighting the importance of a multidisciplinary, patient-centered approach in orthognathic treatment planning.
This article focuses on the series of viewpoints on the prevention and treatment of medication-related osteonecrosis of the jaw issued by the American Association of Oral and Maxillofacial Surgery (AAOMS), and puts forward several uncertain issues from a clinical perspective. The points of doubt in diagnosis include the definition of drug categories and the threshold of bone exposure duration, as well as the significance of imaging features of bone lesions for diagnostic and treatment decisions. The concerns in terms of prevention include drug risks and disease incidence, tooth extraction and drug holiday, intervention measures promoting bone wound healing and their effectiveness. In terms of treatment, with integration of the author's practical experience, the discussion points focused on the dominant principles of non-surgical treatment, the identification and confirmation of the surgical bone incision boundary, the application of buccal fat pads, chin flaps and submandibular gland transposition, as well as the applicable conditions for permanent repair of fibular transplantation, temporary repair of reconstruction plate bridging, compromise mandibular resection and maxillary sinus opening, etc. The article suggests seeking evidence-based research on the above issues. 本文围绕美国口腔颌面外科学会（AAOMS）发布的关于药物相关性颌骨坏死防治的系列意见书，从临床角度对其带有不确定性的若干问题提出商榷意见。在诊断方面的质疑点包括对药物类别和骨暴露持续时间阈值的界定、骨病变影像学特征对诊断和治疗决策的意义；在预防方面的关注点包括药物风险与疾病发生率、拔牙与药物假期、促进骨创愈合的干预措施及其有效性；在治疗方面融入了笔者的实践体会，讨论点集中于非手术治疗的主导原则，手术中对手术切骨边界的确认，颊脂垫、颏瓣和颌下腺转位的应用，以及腓骨移植永久性修复、重建板桥接暂时性修复、姑息性下颌骨切除和上颌窦开放适用条件等。文章建议对上述问题寻求循证研究。.
Parry-Romberg syndrome (PRS), also known as progressive hemifacial atrophy (PHA),is a rare acquired disease that is characterized by progressive atrophy of hemifacial soft tissue, which leads to atrophy of bony structures in severe cases. This study presents the first bibliometric analysis of PHA literature to map its global research landscape. Related articles were retrieved from the Web of Science Core Collection. Visual analysis of authors/countries/institutions/cited journals/keywords was performed using CiteSpace and VOSviewer. The U.S. led in total publications, followed by China and Italy. Among Chinese institutions, the Chinese Academy of Medical Sciences and Shanghai Jiao Tong University published most frequently. Stone J was the most influential author; Plastic and Reconstructive Surgery was the most co-cited journal-forming the core of the knowledge network. Keyword clustering revealed three main research themes: surgical repair/reconstruction, neurological complications, and differential diagnosis/related diseases. The timeline and burst analysis show an evolution from early case reports toward etiology, pathogenesis, and differential diagnosis. Recently, fat transplantation-and its technical refinements-has emerged as a sustained hotspot; 3D digital analysis for precision surgery represents a new frontier. This study is used to make quantitative analysis of the existing literature to provide reference for scholars in related fields. It also prospects the future research trend of hemifacial atrophy, which provides a reference for project planning and experimental design.However, it is important to note that the reliance on a single database and the lack of experimental data limit the comprehensiveness and broader applicability of the findings.
This study aimed to evaluate whether specific mandibular anatomical features are associated with postoperative neurosensory disturbance (NSD) in patients undergoing sagittal split osteotomy (SSO) and to identify cone-beam computed tomography (CBCT)-based measurements that may improve preoperative risk assessment. Preoperative CBCT scans and patient-related variables, including demographic characteristics, type of deformity, side, fixation method, and third molar status, were retrospectively evaluated in patients who underwent SSO between 2016 and 2022. Measurements between the mandibular canal and key anatomical landmarks related to SSO were obtained. Neurosensory disturbance of the inferior alveolar nerve (IAN) was assessed using clinical sensory tests and patient-reported assessments. Outcomes were compared between patients with and without NSD. A total of 52 patients (35 women and 17 men; mean age, 24.2 ± 6.1 years) were included. In univariate analysis, female sex was associated with a higher frequency of NSD. The distance between the lingula and sigmoid notch, total bone thickness inferior to the canal, and cancellous bone thickness buccal to the canal at the mesial aspect of the second molar were significantly shorter in patients with NSD. At the distal aspect of the second molar, total bone thickness buccal and inferior to the mandibular canal, as well as cancellous bone thickness inferior to the canal, were also significantly reduced. However, none of these variables remained significant in multivariate analysis. Although no independent predictive factor for NSD was identified, female sex and reduced mandibular canal-related bone dimensions may be associated with a higher incidence of postoperative NSD. Preoperative CBCT evaluation of these parameters may support surgical planning and help reduce the risk of inferior alveolar nerve injury.
Early diagnosis of oral malignant lesions is essential for improving outcomes in head and neck oncology, yet overlapping clinical features often hinder recognition. Multimodal large language models (LLMs), which integrate text and image inputs, may provide adjunctive diagnostic support. We applied vision-weighted diagnostic gain (VWDG), a novel metric to quantify the added value of visual input, in a comparative evaluation of ChatGPT-5 and Gemini Pro 2.5. A paired diagnostic accuracy study was conducted on 150 biopsy-confirmed oral lesions, comparing ChatGPT-5 (OpenAI) and Gemini Pro 2.5 (Google) with board-certified oral medicine experts. Each vignette included structured clinical data and images. Diagnostic accuracy was measured at Top-1, Top-3, and Top-5 ranks. VWDG was expressed as absolute gain, relative gain, and error reduction, with subgroup analyses by lesion type and difficulty. ChatGPT-5 showed consistent vision-driven improvements, with Top-1 accuracy increasing from 27.3% (text) to 50.0% (image+text). Gains were most pronounced in oral potentially malignant disorders (+133% relative gain) and in moderate-to-high difficulty cases. Gemini Pro 2.5 demonstrated stable text-only performance but derived minimal or inconsistent benefit from images, including negative gains at higher ranks. Experts achieved the highest Top-1 accuracy (65.3%), but ChatGPT-5 multimodal outputs approached expert-level performance at Top-3 and Top-5. VWDG provided a reproducible framework for quantifying the contribution of visual input in multimodal LLMs. ChatGPT-5 benefited substantially from images, particularly in complex cases, whereas Gemini Pro 2.5 showed limited integration. These findings highlight both the promise and current constraints of multimodal AI in oral oncology.
Paediatric temporomandibular joint ankylosis (TMJA) is a debilitating condition that impairs mandibular function and disrupts normal craniofacial growth. Costochondral graft (CCG) reconstruction has been widely used due to its biological compatibility and presumed growth potential; however, its long-term behaviour remains controversial. Purpose was to systematically evaluate the functional outcomes and growth potential of costochondral graft reconstruction in paediatric TMJA. A systematic review was conducted in accordance with PRISMA guidelines. Electronic databases, including PubMed, Scopus, Web of Science, and Google Scholar, were searched from inception to December 2025. Studies involving paediatric patients (3-16 years) undergoing TMJ reconstruction with costochondral grafts, with a minimum sample size of 10 and follow-up of at least 1-year, were included. The primary outcome was maximal incisal opening (MIO), while secondary outcomes included mandibular growth, re-ankylosis, facial asymmetry, and complications. Data were synthesised qualitatively due to heterogeneity among studies. Six studies comprising 92 patients (107 joints) were included. All studies demonstrated significant improvement in MIO, with postoperative values generally exceeding 30 mm, indicating consistent functional recovery. Re-ankylosis was reported in 7 cases (7.6%). Growth outcomes were variable, ranging from satisfactory mandibular development to overgrowth and undergrowth, reflecting the unpredictable nature of CCG behaviour. Facial symmetry improved in most patients, although residual deformity was observed in cases with abnormal graft growth. Complications included facial nerve paresis in 11 patients (11.9%), graft overgrowth in 8 (8.7%), and rare instances of graft resorption, fracture, pneumothorax, and perichondritis. Costochondral graft reconstruction in paediatric temporomandibular joint ankylosis appears to provide consistent improvement in functional outcomes, particularly in terms of mouth opening. However, the evidence regarding its growth potential remains variable and unpredictable. While CCG continues to be a useful reconstructive option in growing patients, careful patient selection and long-term follow-up are essential. Further well-designed prospective studies with standardized outcome measures are required to establish more reliable and generalizable conclusions.
Fibula free flap (FFF) reconstruction is a cornerstone of maxillofacial and mandibular reconstruction, particularly for oncologic and traumatic defects. Although smoking is a well-established risk factor for impaired wound healing and microvascular complications, its specific impact on FFF outcomes remains debated. In this multicenter retrospective study, we evaluate the association between smoking and 30-day perioperative outcomes in FFF reconstruction. A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP; 2009-2023). Patients undergoing FFF reconstruction were categorized as smokers or non-smokers. Demographic and perioperative variables were analyzed using chi-squared tests, t-tests, and multivariable logistic regression to assess associations between smoking and surgical complications, overall morbidity, and reoperation or readmission rates. Among 373 patients, 230 (62%) were male and 143 (38%) were female, with 104 (28%) classified as currently smoking. Male patients comprised a greater proportion of the smoking population than female patients (70% and n = 73 vs. 30% and n = 31, p = 0.04). Patients who smoked were significantly younger (54 ± 14 vs. 58 ± 17 years, p = 0.03) and had lower BMI (26 ± 6.4 vs. 28 ± 6.5 kg/m², p = 0.01) than non-smokers. Operative time (606 ± 215 min), hospital length of stay (11 ± 6.8 days), and overall complication rates (64%vs. 60%, p = 0.42) did not significantly differ between groups. Systemic vascular events such as stroke, myocardial infarction, pulmonary embolism, and deep vein thrombosis were rare and occurred at similar rates in smokers and non-smokers. However, patients who smoked exhibited higher rates of surgical complications (37%vs. 23%, p = 0.01), particularly with increased rates of superficial incisional infections (17%vs. 9.7%, p = 0.04) and dehiscence (13%vs. 5.2%, p = 0.01). Multivariate analysis confirmed smoking as an independent predictor of surgical complications (OR 2.3, 95% CI 1.3-4.0, p = 0.01), but not of overall complications (OR 1.4, 95% CI 0.78-2.4, p = 0.28), medical complications (OR 0.87, 95% CI 0.51-1.5, p = 0.61), reoperation (OR 0.93, 95% CI 0.48-1.8, p = 0.83), or readmission (OR 1.3, 95% CI 0.61-2.8, p = 0.50). A correlation between smoking and risk of surgical complications in FFF reconstruction is identified, although overall complications are seen to not differ. These findings highlight the importance of preoperative smoking cessation counseling and risk stratification to optimize surgical outcomes.
Cleft lip and/or palate (CLP) is one of the most prevalent congenital craniofacial anomalies, with a global incidence of approximately 1 in 700-1000 live births. Surgical management varies substantially across centers in technique, timing, and perioperative care, which complicates evidence-based standardization. To synthesize high-level evidence from systematic reviews and meta-analyses on the surgical and perioperative management of CLP in children aged 0-6 years, with emphasis on technique comparisons, key clinical outcomes, and analgesic protocols. A systematic search of PubMed/MEDLINE, Embase, and Scopus (2010-2026) identified eligible systematic reviews and meta-analyses. Study selection, data extraction, and quality appraisal were performed independently by two reviewers using AMSTAR 2 and the GRADE framework. Overlap across included reviews was quantified using the corrected covered area (CCA) method. Eleven systematic reviews and meta-analyses (n = 6463+ patients) met inclusion criteria. The Furlow double-opposing Z-plasty was associated with significantly lower fistula and velopharyngeal insufficiency (VPI) rates, compared with alternative palatoplasty techniques. One-stage palatoplasty reduced fistula and VPI risk in the two-stage repair. Intraoperative nerve blocks demonstrated robust opioid-sparing effects; the PROSPECT Working Group endorses suprazygomatic maxillary blocks combined with acetaminophen and NSAIDs as the recommended perioperative analgesic strategy. GRADE certainty was high for pain management and moderate-to-low for speech and facial growth outcomes. No single palatoplasty technique is universally superior across all clinically relevant outcomes. Furlow palatoplasty demonstrates consistent advantages for fistula and VPI reduction based on moderate certainty evidence, and multimodal analgesia incorporating nerve blocks should be considered standard perioperative practice. Standardized outcome measures and multicenter studies are needed to advance evidence-based cleft care.
The aim of this study was to evaluate the time-dependent changes in vital signs during mandibular impacted third molar surgery and to examine the relationship between these changes and levels of dental anxiety and dental fear. In addition, whether MDAS and DFS scores differed according to gender was evaluated. This study with repeated measurements included 46 patients scheduled for mandibular impacted third molar surgery in the mesioangular position and Pell-Gregory Class II-B. Dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS), and dental fear was assessed using the Dental Fear Scale (DFS). Heart rate, systolic and diastolic blood pressure, oxygen saturation, and body temperature were recorded preoperatively (T0), after local anesthesia (T1), after incision (T2), at the 10th minute of the operation (T3), and postoperatively (T4). The mean age of the patients was 21.50±2.12 years, and 78.3% were female. Significant changes over time were observed in all vital signs. Heart rate showed a significant change across time points, with the highest mean value observed at T1 after local anesthesia (Friedman χ²=35.781, p<0.001). MDAS and DFS scores showed significant positive correlations with preoperative and post-local anesthesia heart rate. Among DFS groups, a significant difference was found only for T1 heart rate (p=0.033). MDAS and DFS scores were significantly higher in females than in males (p<0.001). Vital signs change according to surgical stages during mandibular impacted third molar surgery. The finding that heart rate reached its highest level after local anesthesia and that MDAS/DFS scores were associated with early heart rate measurements suggests that dental anxiety and dental fear may be related to the early cardiac stress response.
Accurate preoperative differentiation between benign and malignant parotid gland tumors is essential for guiding surgical planning and treatment decisions. However, early-stage malignant tumors often lack distinctive imaging features on contrast-enhanced CT, making diagnosis challenging. This study aimed to develop an artificial intelligence (AI)-assisted diagnostic system based on a multi-view learning framework and evaluate its diagnostic performance on contrast-enhanced CT images. In this retrospective study, contrast-enhanced CT images were collected from 578 patients (472 benign, 106 malignant) with pathologically confirmed parotid gland tumors at Peking University School and Hospital of Stomatology (2015-2023). An AI system was developed comprising a U-Net-based segmentation network and a multi-view classification model that uses multi-angle reconstructed images and a majority-voting strategy for case-level classification. The diagnostic performance was evaluated using accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). The nnU-Net model achieved a mean Dice score of 0.90 and IoU of 0.83 across 115 testing cases, providing precise segmentation with minimal outliers. For the diagnostic classification task on the test set, the ResNet model outperformed the other evaluated neural networks, achieving the highest accuracy of 89.7% and an AUROC of 85.7%. It correctly identified 57.1% (8/14) of malignant and 96.9% (62/64) of benign tumors. The proposed AI-assisted diagnostic system demonstrates promising performance in preoperative differentiation of benign and malignant parotid gland tumors. This system has the potential to serve as a valuable decision-support tool for clinical decision-making and surgical planning, ultimately improving patient outcomes.
The retromandibular vein (RMV) is considered a potential risk for hemorrhage during sagittal split ramus osteotomy (SSRO), depending on its course patterns. This retrospective study investigated the relationship between the course of the RMV and craniofacial morphology in patients with jaw deformities. Forty sides from 20 patients were evaluated using contrast-enhanced computed tomography (CECT) and cephalometric analysis. The RMV courses were classified based on lateral and posterior views of the mandible. Cephalometric and dental cast measurements were compared between groups, and multiple logistic regression was performed to identify the factors influencing the RMV course patterns, with the RMV classification as the dependent variable and cephalometric and model analysis values as the independent variables. RMVs running posterior to the mandibular ramus were associated with high-angle skeletal patterns, characterized by increased mandibular plane angle and gonial angle (p < 0.05). The lower RMV position showed a significant association with an increased mandibular plane angle and narrow nasal width, tending to run along the posterior border of the mandibular ramus. The findings suggest that vertical skeletal features and mandibular shape, rather than anteoposterior jaw discrepancies, influence RMV positioning. Cephalometric analysis may serve as a practical and non-invasive method for preoperative screening of RMV injury risk, contributing to improved safety in orthognathic surgery.
Human papillomavirus (HPV)-associated benign epithelial lesions often exhibit overlapping clinical and histopathological features, making differential diagnosis challenging. To investigate the clinicodemographic profiles of benign HPV-associated epithelial lesions diagnosed in anatomical and oral pathology laboratories. A retrospective cross-sectional study was conducted and included cases diagnosed between January 2014 and April 2023 in six pathology laboratories. Rendered diagnoses were squamous papilloma (SP), condyloma acuminatum (CA), verruca vulgaris (VV), multifocal epithelial hyperplasia (MEH), and sinonasal papilloma (SNP). Patient sex and age, and lesion site were recorded. For statistical analysis, the chi-square test (p < 0.05) was used. A total of 113 cases were identified with 54.0% of them from anatomical pathology laboratories and 46.0% from oral pathology. Lesions were slightly more frequent in males (55.8%) and in patients ≤ 40 years (50.4%). SP was the most common diagnosis (71.7%). Tongue (28.4%) and oropharynx (23.3%) were the most frequently affected sites. Significant associations were observed between SP and patients ≤ 40 years (p = 0.003), CA and SNP with patients ≥ 41 years (p = 0.048 and p = 0.016, respectively), SP with the oropharynx (p = 0.001), and MEH with labial and buccal mucosa (p = 0.013). Lingual lesions were more frequent in women (p = 0.008), whereas oropharyngeal lesions predominated in men (p = 0.008). Benign HPV-associated epithelial lesions demonstrate age- and sex-related anatomical predilections. Careful clinicopathological correlation remains essential for accurate diagnosis and appropriate management.
To compare the biomechanical performance of different implant-supported rehabilitation concepts in the atrophic maxilla by using finite element analysis. Five three-dimensional finite element models were generated from CT data and classified as "All-on-4" (Model 1), "M-4" (Model 2), "V-4" (Model 3), zygomatic implants combined with conventional implants (Model 4), and "Quad-Zygoma" (Model 5). All materials were assumed linear elastic, homogeneous, and isotropic. Models were constrained at posterior and superior regions, and a unilateral vertical load of 150 N was applied to the right first molar via a 20 mm "foodstuff". A mesh convergence analysis confirmed model reliability with an error below 3%. Stress distributions were evaluated by using von Mises, maximum principal (Pmax), and minimum principal (Pmin) stresses. All stresses were expressed in MPa (N/mm²). The highest von Mises stresses were observed in Model 2, with values of 80.010 MPa in the implants, 62.961 MPa in the abutments, and 57.76 MPa in the metal framework. In contrast, the lowest stresses were recorded in Model 5, with corresponding values of 66.222 MPa, 61.564 MPa, and 42.209 MPa, respectively. Similarly, cortical bone exhibited the highest stress concentrations in Model 2 and the lowest in Model 5, with Pmax and Pmin values of 11.978 MPa and -49.535 MPa in Model 2, and 9.725 MPa and -22.206 MPa in Model 5, respectively. Notably, Pmin values in Models 4 and 5 were approximately 50% lower than those in Models 1-3. Trabecular bone stresses showed minimal variation across all models. Although all models demonstrated acceptable biomechanical behavior, zygomatic implant configurations (Models 4 and 5) showed reduced stress concentrations, particularly in terms of compressive stresses in cortical bone. These findings may indicate a potential biomechanical advantage of zygomatic implant approaches, especially the "Quad-Zygoma" concept, in the rehabilitation of the atrophic maxilla.
Desmoplasia, characterized by excessive expansion of cancer-associated fibroblasts (CAFs) and aberrant extracellular matrix (ECM) deposition, is widely present especially in invasive cancers. The extranodal extension (ENE) of nodal metastasis involves the extension of invasive tumor cells through the lymph node capsule into the perinodal adipose tissue, leading to systemic metastasis. Thus, the specific roles of desmoplasia in ENE formation need to be identified. This study aimed to investigate the association between desmoplasia and its role in ENE formation of oral squamous cell carcinoma, with a focus on Yes-associated protein (YAP)-mediated fibroblast activation and ECM remodeling. Transcriptome profiling and histopathology study based on tissue microarrays were performed to explore the association of metastasis-associated CAFs (MAFs) in ECM remodeling with ENE formation. Primary MAFs were isolated from ENE-positive (ENE+) and ENE-negative (ENE-) lymph nodes for functional characterization. The regulatory role of YAP in MAF-mediated ECM remodeling was investigated through immunohistochemistry, gene knockdown, and co-culture assays with HSC-3 tumor cells. A high degree of desmoplasia and rich collagen remodeling in lymph nodes was associated with higher ENE risk. ENE+ MAFs exhibited superior proliferative capacity, enhanced migration, and increased ECM remodeling activity compared to ENE- MAFs. Co-culture experiments demonstrated that ENE+ MAFs significantly promoted HSC-3 cell invasion through Matrigel. Exploratory RNA sequencing revealed enrichment of ECM receptor interaction and Hippo-YAP pathway in ENE+ lymph nodes. Nuclear YAP localization in MAFs correlated with elevated expression of ECM components (collagen type I alpha 1 [COL1A1], fibronectin 1 [FN1], Tenascin C) and matrix metalloproteinase-2. YAP knockdown in ENE+ MAFs significantly attenuated both ECM remodeling capacity and pro-invasion ability in vitro. These findings suggest that YAP-activated MAFs contribute to ECM remodeling that may create a stromal environment permissive for ENE formation, though direct in vivo validation is needed to establish causality.
This study aimed to evaluate reconstruction strategies and clinical outcomes for post-oncologic resection maxillofacial bone defects, with a focus on comparing the advantages and limitations of different flap techniques to provide evidence for individualized surgical decision-making. A retrospective analysis was performed on 54 patients with maxillofacial bone defects following tumor resection at our institution between January 2020 and January 2023. Reconstructive techniques included vascularized bone flaps (fibular and iliac crest flaps) and soft-tissue flaps combined with titanium plates (anterolateral thigh flap). Outcomes were evaluated in terms of flap survival, complication rates, and multidimensional assessments of aesthetics, function, and patient-reported satisfaction. Of the 54 reconstructed cases, vascularized bone flaps achieved significantly better outcomes across all assessment domains compared with soft-tissue flaps combined with titanium plates. Individualized selection of vascularized bone flaps, particularly fibula or iliac crest flaps, represents the most effective approach for maxillofacial reconstruction. These techniques not only restore mandibular morphology and functional integrity but also significantly improve postoperative quality of life.