PURPOSE: This overview presents a description of organofunctional trialkoxysilane coupling agents (silanes), their chemistry, properties, use, and some of the main clinical experiences in dentistry. MATERIALS AND METHODS: The main emphasis was on major dental journals that have been reviewed from 1958 up to the latest research news from 2002. A MEDLINE search with the key words "dental silanes" was used. Special silane literature and journals outside dentistry were also cited. RESULTS: The main emphasis is on the use of silanes in prosthetic and restorative dentistry. Clinical relevance was based mainly on either short- or long-term tests. The interpretation of various results is not given, mainly because of controversial observations that may be very difficult to explain. Nevertheless, the majority of the clinical results pointed to silanes playing a significant role in the adhesion process. Silane reaction mechanisms were not entirely understood, and there exist several theories for bonding mechanisms for silanes and substrates. CONCLUSION: Dental materials offer a continuously challenging forum for silanes, and silanes will play an essential role in material development.
An inherent `black box` nature of artificial intelligence (AI) remains a significant barrier to clinical adoption. Explainable artificial intelligence (XAI) has emerged as an approach to enhance transparency and interpretability. This narrative review evaluates the evolving role of XAI, with particular emphasis on its current applications, prospective utility in endodontics, and inherent challenges. A search was conducted across databases, including PubMed and Scopus, covering literature up to April 2026. The retrieved studies were subsequently synthesised narratively. Studies on the discourse surrounding XAI were reviewed, including the technical foundations of XAI, applications of XAI in dentistry and endodontics, the benefits and challenges of XAI in endodontics, and research gaps and future directions in XAI for endodontics. The investigation of XAI in endodontics remains relatively limited. The literature review highlights the necessity of XAI systems that are methodologically rigorous, clinically relevant, and ethically sound, with their development supported by well-designed prospective studies. XAI development should be advanced as a transformative framework that strengthens the speciality's evidence base and enables interpretable, equitable, and precisely tailored treatment strategies. XAI has the potential to support more transparent, personalised, and reliable endodontic care. By enhancing the transparency of AI systems, XAI have the potential to improve clinical decision-making in endodontics and contribute to the delivery of high-quality, patient-centred care.
Lesions and diseases of children are always a continuous source of interest in general medicine and dentistry. The pattern and symptoms of oral mucosal lesions (OMLs) seem to be different in the paediatric population compared to those of an adult. Understanding their prevalence helps in early detection and management. This study was conducted to evaluate the prevalence and distribution of OMLs and assess gender-related differences among children aged 0-13 years. The children were clinically examined by trained professionals for the presence of OMLs using the standard diagnostic criteria. Lesions were recorded based on clinical appearance and categorised accordingly. Out of the 1024 children examined, 73 were found to have OMLs, resulting in an overall prevalence of 7.12%. A slight male predominance was observed among affected children, with 54.79% ( n = 40) being boys and 45.21% ( n = 33) girls. The study revealed a 7.12% prevalence of OMLs among children aged 0-13 years, with a higher occurrence in boys. These findings highlight the importance of routine oral screening in paediatric populations for early identification and intervention.
There has not been a comprehensive study examining the epidemiology, clinical presentation, and histology of oral lichen planus (OLP) and oral lichenoid lesions (OLL) in New Zealand. The aim of this study was to determine the clinico-pathologic manifestation in a New Zealand population. The study retrospectively analyzed OLP and OLL cases from the electronic database of the Oral Pathology Centre, University of Otago, that were clinically diagnosed and histologically confirmed. Their demographic, clinical, and histopathologic data were comparatively analyzed for statistical significance using Fisher's exact test and chi-square. Of all the samples received over the years 2011 to 2023, 232 were identified as OLP and 563 were identified as OLL. The patient's mean age was 45 years in OLP and 56 years in OLL, and the M:F ratio was 1:1.86 and 1:1.94, respectively. Buccal mucosa and gingiva were the most common sites involved in OLP, but in OLL, the tongue was the second most common site affected. For tongue presentation, OLP was associated with a higher frequency in the female sex, but no such sex predilection was seen in OLL, and these associations were statistically significant. The number of multiple intra-oral anatomical sites affected was higher in the OLP groups compared to OLL. This is the first study to examine the relative frequency of OLP and OLL in a New Zealand population. The current data are consistent with global epidemiological data, with the exception that the female predominance was not seen for tongue OLL lesions. Accurately determining the relative frequency of OLP and OLL is crucial. This effort not only validates our current understanding of these specific lesions within the New Zealand population but also provides a robust, necessary baseline for all subsequent epidemiological and clinical studies.
Soluble recombinant expression of Aedes aegypti mosquito midgut proteases in Escherichia coli prove to be difficult. These enzymes depend on disulfide bond formation for structural stability. Initial attempts in BL21(DE3) were unsuccessful due to a reducing cytoplasm. The use of T7 SHuffle cells (with a more oxidizing cytoplasm) led to soluble expression. However, other factors had to be altered (use of richer media and lower (< 25 °C) growth temperature). Not all mosquito proteases were equally soluble. Therefore, given the importance of IPTG in initiating transcription and translation, we set out to determine if low IPTG concentrations (< 0.1 mM) at 10 °C would increase soluble production of midgut proteases. Additionally, we investigated the effect of the small molecule osmolyte betaine on the soluble expression of midgut proteases. For this study, the focus was on Aedes aegypti Late Trypsin (AaLT), Early Trypsin (AaET), Serine Protease I (AaSPI), Serine protease V (AaSPV), and Juvenile Hormone Associated 15 (JHA15). The colder bacterial growth, along with low IPTG, slows the rate of transcription/translation of T7 RNA polymerase. Lower expression of T7 RNA polymerase, along with slower transcription activity at 10 °C, prevents rapid simultaneous translation of midgut proteases thereby promoting soluble expression. In addition, we found that different growth periods also varied among the proteases. Soluble expression for AaLT and AaET was maximal at 52 h post-induction, 72 h for JHA15, and 168 h for AaSPI and AaSPV. Surprisingly, for AaET, temperature was the only important factor. The addition of betaine to the growths had a more pronounced effect at higher (> 0.05 mM) IPTG. Low IPTG at 10 °C slows the rate of transcription/translation of recombinantly expressed mosquito proteases in bacteria. By preventing rapid accumulation in the cell, prevents aggregation, and ultimately inclusion body formation. Betaine works better at higher IPTG concentrations, but more studies are needed to better understand how this osmolyte stabilizes proteins during recombinant bacterial expression. Nonetheless, this study provides a blueprint for researchers who have never attempted IPTG concentrations < 0.05 mM to recombinantly express proteins in bacteria.
Recently introduced milled and 3D-printed resin dental restorations are designed for long-term use. They must endure the mechanical stresses of chewing in the oral environment. This study aimed to evaluate the effect of artificial toothbrushing on wear, surface roughness and hardness of additive-manufactured and milled ceramic filled resin restorative materials. Thirty bar-shaped specimens (15 mm x 4 mm x 1.5 mm) were divided into three groups (n = 10): 3D printed CROWNTEC Saremco permanent resin (CT), 3D printed Flexcera Smile Ultra+ (FSU), and CAD-CAM BRILLIANT Crios (BC). All groups underwent the same finishing protocol using a composite polishing kit. The specimens baseline weight was first measured using a sensitive electronic balance, then tested for surface microhardness using the Vickers hardness test (VHN), and for surface roughness using confocal laser scanning microscopy (CLSM). Wear testing was conducted using an artificial toothbrushing machine. Specimen wear was calculated by evaluating weight loss. The Vickers hardness test and surface roughness test were then repeated. Differences in wear and hardness were analyzed using one-way ANOVA followed by Tukey's post hoc test with Bonferroni correction. Changes before and after artificial toothbrushing were assessed using a paired t-test. The Kruskal-Wallis test, followed by Dunn's post hoc test with Bonferroni adjustment, was employed to analyze surface roughness values. The Wilcoxon signed-rank test was used to assess changes in surface roughness after toothbrushing. Flexcera Smile Ultra+ demonstrated the least wear reduction, CROWNTEC the middle, and BRILLIANT Crios the most. All groups had significant change in hardness before and after intervention. BRILLIANT Crios changed least, CROWNTEC somewhat, and Flexcera Smile Ultra+ most. Using One Way Analysis of Variance ANOVA, significant wear and hardness differences were found between groups before and after the intervention (p < 0.0001). The Kruskal-Wallis test showed significant surface roughness changes between groups before and after intervention (p < 0.0001). The intervention reduced surface roughness differently across materials, with Flexcera Smile Ultra+ showing the largest consistent reduction. All materials that were tested exhibited notable variations in terms of wear, hardness, and surface roughness both prior to and following an artificial toothbrushing, which depended on their respective qualities. Regarding wear, FSU exhibited the least reduction, CT showed a moderate reduction, and BC experienced the most significant reduction. In terms of hardness, BC underwent the least change, CT displayed a moderate change, while FSU experienced the greatest change. Milled resin was found to have the lowest surface roughness, whereas 3D printed resin demonstrated the highest surface roughness.
The stratum corneum presents a significant barrier to transdermal delivery. TargetCool is a cooling-assisted delivery device developed to enhance skin penetration, with potential synergistic effects when combined with microneedling systems such as the Turtle pin (0.5 mm) and MTS (1.5 mm). This study aimed to evaluate the effect of TargetCool on the permeability of Acetyl Hexapeptide-8-FITC in an ex vivo human skin model, comparing its performance alone and in combination with microneedling devices. Facial skin samples from Korean female donors aged 50 to 70 years were prepared into 2 × 2 cm sections and assigned to 6 groups: control (topical application only), Turtle pin 0.5 mm, MTS 1.5 mm, Turtle pin 0.5 mm plus TargetCool, MTS 1.5 mm plus TargetCool, and TargetCool alone. Samples were cultured for 24 hours in a Transwell system following treatment with Acetyl Hexapeptide-8-FITC, then processed for H&E and DAPI staining. Optical and fluorescence microscopy were used to assess tissue structure, fluorescence intensity, and penetration depth, with quantitative analysis performed using ImageJ. No structural damage was observed in any group. Compared with the control, fluorescence intensity increased by 504% with Turtle pin, 700% with MTS, 1272% with Turtle pin plus TargetCool, 1000% with MTS plus TargetCool, and 492% with TargetCool alone. Penetration depth increased by 19.01%, 33.10%, 36.88%, 47.75%, and 35.86%, respectively. TargetCool, particularly in combination with microneedling, substantially enhanced the skin penetration and depth of Acetyl Hexapeptide-8-FITC in ex vivo human skin without inducing structural damage. These findings support its potential clinical application in improving transdermal delivery for dermatologic and aesthetic treatments.
Despite evidence that racial and ethnic minoritized groups experience greater pain burden and poorer treatment outcomes, Asian Americans (AAs)-one of the fastest-growing U.S. populations-remain largely invisible in pain research. Cultural factors strongly shape how pain is perceived, expressed, and managed, yet standardized assessments and treatments often overlook these differences, reinforcing disparities. This study explored the lived experience of chronic pain among Korean Americans (KAs) to address gaps in understanding cultural influences on pain perception, reporting, and management. This study represents the first phase of a sequential exploratory mixed methods project aimed at developing a culturally relevant psychosocial education intervention to reduce chronic pain among KAs. Semi-structured focus groups were conducted with KA adults experiencing chronic pain (n = 15), and data were analyzed using Braun and Clarke's six-phase reflexive thematic analysis. Eight themes emerged-four related to pain perception and four to pain management. Perception themes included: the strong desire to understand pain causes, unhelpful thoughts and distress, "immigrant illness" and accumulated pain from migration burdens, and the virtue of endurance and delayed help-seeking. Management themes included: language barriers and communication challenges, differing expectations about healthcare, ambivalence toward medication, and self-management strategies. Key themes-such as epistemic urgency grounded in a traditional biomedical approach, frustration related to unmet needs in pain management, and limited trust in healthcare-highlight the need to consider sociocultural and structural factors in improving chronic pain management. PERSPECTIVE: Findings indicate that cultural norms related to endurance and emotional restraint may shape pain reporting and management among KAs, and that linguistic and epistemic mismatches may affect patient-clinician communication. Strategies such as narrative-based assessments, biopsychosocial validation of pain, and culturally tailored psychoeducation may support more effective and equitable pain care.
It is estimated that 30 million people in the United States have a rare disease, and few of these conditions have available cures. The diversity of rare disease etiologies and phenotypes has hindered both diagnostics and treatment approaches. Many rare diseases are caused by pathogenic genetic variations and involve the craniofacial structures and function. Dental care providers are called on to serve the population with rare diseases and support their desire for optimal health. To address these oral health care challenges, JADA is presenting a special issue on rare diseases through a series of articles. These reviews will address some of the more common rare diseases and those that share features such as involvement of the dentition, skeleton, immune system, skin, or facial clefts. The authors searched the 5 major databases, including PubMed, Google Scholar, Web of Science, Embase, and Ovid MEDLINE, for articles pertaining to rare diseases and disorders affecting oral health and oral health care. The authors conducted an exhaustive search of the literature from 1990 through March 30, 2026, for articles on rare diseases, with a specific focus on oral health care. There is no existing reliable classification that groups all of these complex syndromes into clinically identifiable clusters. This special issue may be the first of its kind in which the authors attempt to format a meaningful classification to group these entities of similar etiopathogenesis and phenotype. The medical and dental management of rare disorders often requires teams of specialists and advocates to address the developmental, structural, functional, psychosocial, and economic aspects that can confront affected patients.
暂无摘要（点击查看详情）
This longitudinal, prospective, multicenter observational cohort study investigates the associations between maternal nutritional status-assessed using the first trimester SIMPLE score and pregestational BMI-and fetal growth trajectories and velocity, as proxies for intrauterine development. Healthy women with singleton pregnancies undergoing first trimester screening were enrolled. Adherence to a healthy lifestyle was evaluated using the SIMPLE score, categorizing participants into low (<6) and high (≥6) adherence groups. Fetal growth parameters - including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)- were assessed during second and third trimester ultrasounds, and birth outcomes were recorded. Multi-adjusted linear mixed models examined associations between SIMPLE score groups, individual score items, pregestational BMI, and fetal growth, with analyses stratified by fetal sex. Out of 938 enrolled women, 109 (11.6%) were classified as the low adherence group. Multi-adjusted linear mixed models showed that low adherence was associated with decreased EFW acceleration from the second to the third trimester. Stratification by fetal sex confirmed the association only among male fetuses. Analysis of pregestational BMI and individual SIMPLE score items revealed significant positive associations between pregestational BMI, AC, and EFW growth velocity, and a negative association between first trimester hemoglobin [>110 g/l] and EFW growth velocity. Overall, these findings confirm the clinical utility of the SIMPLE score, demonstrating significant associations with intrauterine growth trajectories and velocity, independent of other markers of nutritional status (e.g., pregestational BMI).
Dental students and practitioners may have an increased risk of COVID-19 infection due to frequent aerosol-generating procedures (AGP) and close patient contact. We examined the role of vaccination status, work role, and AGP frequency on positive SARS-CoV-2 PCR surveillance test using a Cox proportional hazards regression and weighted for dropout. A total of 410 dental health workers (200 students, 104 faculty, and 106 staff) had 8,270 screening tests performed between May 2020 and February 2022, with 158 positive tests; 60 (38%) occurred in January 2022. Omicron had a significant impact on vaccination effectiveness. Vaccine effectiveness within < 4 months was 91% (HR: 0.09,95% CI: 0.02-0.40) prior to Omicron, which decreased after its emergence. Work role was not associated with risk of positive test. Reported AGP frequency was also not associated with positive test risk; however, these analyses were limited to a subset of participants and should be considered exploratory. More than a third of all positive tests occurred during one month of Omicron. We found a high vaccine effectiveness prior to the Omicron surge, which decreased after the emergence of Omicron. Our results support encouraging dental healthcare workers (DCWs) to maintain up-to-date vaccination and continue engaging in preventive measures.
Motor vehicle accidents remain a leading cause of craniofacial trauma, with injury severity evolving alongside automotive safety advancements. While airbags and seatbelts have revolutionized trauma prevention, reducing worldwide mortality by over 70,000 lives in five years, their mechanics can paradoxically modify or exacerbate facial injuries due to occupant positioning, chemical factors, and collision dynamics. This study examines injury patterns, mechanisms, and trauma prevention strategies related to airbag-related maxillofacial trauma. A scoping review was conducted across PubMed, Google Scholar, and Scopus (up to October 2025). Search terms included "airbag," "maxillofacial injuries," and "occupant restraint system injuries." Inclusion criteria focused on human studies reporting airbag-related facial trauma. Two reviewers independently screened literature, resolving discrepancies via consensus. Orbital fractures (particularly blow-out fractures) and ocular trauma dominated reported injuries, attributed to blunt force distribution during a car crash with airbag deployment. Soft tissue lesions, chemical burns, and atypical fractures were also documented. Case analyses revealed that injury severity and pattern were highly variable, significantly influenced by risk factors such as pre-impact braking, seatbelt nonuse, and close occupant proximity to the steering wheel. These findings underscore that trauma prevention strategies must extend beyond the presence of safety devices to include public education on optimal occupant positioning and restraint system interactions. Furthermore, continued technological refinements aimed at mitigating deployment kinetics and chemical risks remain critical. Airbags provide indispensable protection in motor vehicle collisions, yet a balance between their lifesaving benefits and potential for injury requires multidisciplinary collaboration. Future efforts should integrate biomechanical research, clinical findings, and policy updates to improve occupant safety and optimize protective outcomes.
Anatomical complexities and socket configuration in anterior maxilla often results in challenging immediate implant placement, where implants tend to be facially positioned. Implants with facially placed shoulders exhibited three times more midfacial recession. Despite using surgical guides, osteotomy drills tend to follow the least resistance path dictated by socket anatomy. This prospective clinical trial aimed to measure the deviation from the planned implant position during immediate implant placement in the anterior maxilla and its impact on esthetic outcomes, utilizing a new computer-guided plateau drilling protocol. Twenty-six patients (7 males and 19 females, ages 20-42) with non-restorable maxillary anterior teeth participated in this study. Virtual planning was done using the Safe Angle Concept and the implants were placed with a partially guided approach. Standard tessellation language files obtained from scanned casts and initial computed tomography scans were used to plan the virtual position of the implants and surgical guides fabrication. Angular, global platform and global apex deviations from the planned implant position were measured after three-months. Bone formed labial to the implant and pink esthetic score were assessed after nine-months. The current investigation showed that the use of the new computer-guided plateau drilling protocol resulted in clinically acceptable ranges of angular, global platform, and global apex deviation 4.56 ± 3.14°, 0.91 ± 0.61 mm, 1.47 ± 0.88 mm respectively. Radiographic analysis revealed mean mm amount of bone formed labial to the implant of 2.13 ± 0.99 mm and pink esthetic score displayed a mean of 11.89 ± 1.75, with a median of 12.5 after nine months. The virtual safe angle planning concept combined with plateau drilling protocol showed promising accuracy in immediate implant placement in the anterior maxilla. The resultant deviation had no influence on the esthetic outcomes. The current trial was registered at Clinical trials.gov (ID: NCT05750004, Date: 19-February-2023).
Once considered to be passive oxygen carriers, erythroid cells are now recognized as dynamic modulators of immune responses. Erythroid progenitors and precursors, collectively known as CD71⁺ erythroid cells, can suppress innate and adaptive immune responses in neonates, in mothers during pregnancy, in chronic conditions such as cancer and autoimmunity, and during infection with viruses, including SARS-CoV-2 and HIV. Mature red blood cells engage pathogens directly, scavenge chemokines, cytokines and nucleic acids, and modulate immune functions through redox buffering and receptor-mediated interactions. The immune effects of red blood cells are highly context dependent, ranging from suppression to activation. This Review highlights the emerging field of erythroid-immune crosstalk and its translational potential in the settings of infection, cancer, pregnancy and chronic inflammatory conditions.
Diabetes is associated with progressive microvascular remodelling, commonly assessed using retinal imaging, yet alternative non-invasive vascular biomarkers remain underexplored. Conjunctival vessels are directly visible and may reflect systemic microvascular changes; however, reliable quantification is challenged by the need to preserve vascular topology during segmentation. In this work, we introduce a curated conjunctival imaging dataset with diameter-specific vessel annotations and demonstrate that topology-preserving vessel extraction is essential for robust tortuosity estimation. We develop a deep learning framework that prioritises vascular continuity and geometric fidelity while selectively segmenting clinically relevant vessel calibres, integrating multi-scale contextual modelling and attention-guided feature fusion to reduce fragmentation without post-processing. Compared with multiple state-of-the-art segmentation methods, the proposed approach achieves substantially lower tortuosity error and centreline deviation, even when pixel-wise accuracy is comparable. Applied to conjunctival images from individuals with diabetes and healthy controls, mean conjunctival vessel tortuosity was significantly elevated in the diabetic group, consistent with established retinal microvascular findings. Together, these results support conjunctival imaging as a non-invasive modality for microvascular phenotyping and suggest its potential utility for scalable, external-eye-based vascular assessment in diabetes research contexts.
The Brazilian version of the Quality Care Questionnaire - Palliative Care (QCQ-PC) is an instrument developed to assess the quality of care provided in palliative care. To structurally validate the Brazilian version of the QCQ-PC for use in individuals with HF eligible for palliative care. This study aimed to structurally validate the QCQ-PC, following the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN). Data were collected using the QCQ-PC, 36-Item Short Form Health Survey Instrument (SF-36), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Internal consistency was calculated using Cronbach's alpha and, structural validity was assessed using confirmatory factor analysis (CFA). Construct validity was assessed by correlations between QCQ-PC and SF-36. The study sample (n = 113) consisted predominantly of middle-aged to older adults mainly classified as NYHA class I (36.3%) or III (32.7%). The structural validity of the two-domain of the QCQ-PC was confirmed by adequate fit indices: χ²/df = 1.46; CFI = 0.979; TLI = 0.971; RMSEA = 0.064; SRMR = 0.067; and with factor loadings ≥ 0.30. Construct validity was demonstrated by correlations of less than 0.30 between the QCQ-PC and SF-36 domains. Reliability was adequate, with ICC values ​​above 0.80 for both domains, measurement error less than 10%, and Cronbach's alpha greater than 0.70. The internal structure with two domains is the most suitable for use in individuals with FH eligible for palliative care through the QCQ-PC. The constructs are valid and reliable, with adequate internal consistency.
Injectable dermal fillers represent a rapidly evolving class of soft-tissue biomaterials whose clinical behavior is determined by their underlying material properties. Despite widespread use in aesthetic medicine, the relationships between structure and behavior that dictate filler performance remain incompletely synthesized across material classes. This review examines the material science foundations of modern dermal fillers, spanning hyaluronic acid formulations, collagen-based materials, and biostimulatory systems, including calcium hydroxylapatite, poly-L-lactic acid, and polycaprolactone. Emphasis is placed on the material parameters that govern filler behavior in vivo, such as polymer chemistry, crosslinking methodology, particulate microstructure, and degradation kinetics. These factors collectively determine key rheological characteristics such as storage modulus (G'), loss modulus (G″), cohesivity, and injectability. In turn, these influence material stability, tissue integration, and resistance to mechanical deformation within dynamic facial environments. Recent advances in formulation strategies, including multiphasic fillers, microspheres, and hybrid systems, illustrate how modification of microstructure can be leveraged to improve durability, biocompatibility, and tissue remodeling potential. This review establishes a mechanistic framework linking filler composition to rheological performance and degradation behavior. As the first part of a 2-part review, the focus here is on the material science and bioengineering principles that inform filler behavior in order to provide the scientific foundation for the clinical decision-making framework explored in Part B.
Pediatric mandibular desmoid tumors are rare, locally aggressive lesions that can create composite defects in a growing craniofacial skeleton. We retrospectively reviewed biopsy-proven pediatric desmoid tumors involving the mandible region treated at a tertiary children's hospital (2004-2024) and mapped each case to an institutional, algorithm-based reconstructive pathway (A-D) incorporating a mandibular resection index (RI; threshold 32%) and 2 modifiers (modifier 1: systemic therapy/radiotherapy; modifier 2: staged bony reconstruction for inadequate bone stock). We summarized pathway assignments, transitions over time, and cumulative operative burden. Eight mandibular cases were included in the algorithm analysis. Initial pathway assignments were A (n=4), B (n=3), C (n=1), and D (n=0). Modifier 1 was applied in 2/8 (25%) and modifier 2 in 4/8 (50%). During follow-up, 4/8 patients escalated to a higher pathway (A→B→C, B→C, B→D, C→D). Among 7 operative patients, median age at index reconstructive surgery was 5.1 years (range: 0.9-11.9), with mean cumulative hospitalization of 25.1±21.8 days and mean cumulative operative time of 18.4±12.7 hours. Patients requiring pathway escalation had higher cumulative burden (hospitalization 34.0±21.8 days; operative time 26.5±10.6 hours; median 5 operations). Algorithm-based pathway assignment captures the longitudinal reconstructive reality of pediatric mandibular desmoid tumors. Early recognition of predictable failure modes (infection, hardware compromise, and inadequate bone stock) may help teams select definitive reconstruction earlier in select patients and reduce cumulative surgical burden.
暂无摘要（点击查看详情）