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Oral and Maxillofacial Surgery: Diagnosis, Management and Future Opportunities

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: 30 November 2025 | Viewed by 5392

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Special Issue Editor

Dr. Federico Gelpi

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Guest Editor

Head and Neck Department, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37129 Verona, Italy
Interests: oral implantology; osseointegration; oral surgery; periodontics; implants; prosthetics; crowns; dental

Special Issue Information

Dear Colleagues,

Maxillofacial surgery has expanded its fields of interest in recent decades from traumatology to head and neck oncology, from preprosthetic surgery to reconstructive microsurgery, from malformative surgery to endoscopy of paranasal sinuses and skull base, covering a wide spectrum of problems and sectoralizing in each specific area.

Huge steps forward have been made in every area, from diagnosis to treatment.

Multidisciplinary work and collaboration with different specialists, oncologists, radiotherapists, radiologists, pathologists, dentists, ophthalmologists, ENT specialists, and dermatologists, has become common clinical practice, leading to a substantial improvement in results.

The aim of this Special Issue is to discuss these innovations and future opportunities in the different areas of interest of maxillofacial surgery in the form of original articles, reviews, or in other forms.

Dr. Federico Gelpi
Guest Editor

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Keywords

head and neck oncology
free flaps
oral surgery
malformative surgery
traumatology
endoscopy
preprosthetic surgery
reconstructive surgery
vascular malformations
osteonecrosis

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Published Papers (5 papers)

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16 pages, 996 KB

Open AccessArticle

Frequency and Characteristics of Craniomaxillofacial Tumors: A Five-Year Retrospective Institutional Study

by George-Dumitru Constantin, Ioana Veja, Serban Talpos Niculescu, Crisanta-Alina Mazilescu, Teodora Hoinoiu, Valentina Oana Buda and Roxana Oancea

J. Clin. Med. 2025, 14(17), 6256; https://doi.org/10.3390/jcm14176256 - 4 Sep 2025

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Abstract

Background: Hospital-based data can complement registry estimates for cranio-maxillofacial (CMF) oncology, particularly in under-reported regions. We aimed to describe the institutional case-mix of CMF tumor diagnoses, standardized to ICD-10 sites, and to quantify trends using visit-normalized indicators. Methods: We conducted a retrospective, observational, single-center, hospital-based study of diagnosis-level encounters (2012–2016). Diagnoses were recoded to ICD-10 and restricted to CMF sites (lip, oral cavity, major salivary glands, oropharynx/hypopharynx, nasal cavity/middle ear, paranasal sinuses, eye/adnexa). The primary indicator uses a strict CMF set (malignant CMF codes plus D00.0 and D14.1); odontogenic cysts and non-neoplastic jaw lesions (K09–K10) were excluded, while benign CMF neoplasms are reported descriptively for site distributions. Results: We identified 2729 malignant CMF diagnoses over 2012–2016, peaking in 2014 (n = 751) and lowest in 2016 (n = 367). The combined malignant rate (per 1000 total visits) was 30.6, 43.9, 52.6, 34.4, and 26.7 for 2012→2016. The proportion of malignancies within the strict CMF set was 99.2%, 97.3%, 97.9%, 96.8%, and 95.1%, respectively (overall 97.4%). The most frequent malignant sites cumulatively were the palate (n = 416), parotid gland (n = 376), floor of mouth (n = 344), gingiva (n = 282), and mouth, unspecified (n = 179). Conclusions: After ICD-10 recoding and restriction to CMF sites, malignant tumors predominated within the institutional, diagnosis-level case-mix, with a 2014 peak followed by a decline. These indicators are case-mix monitors and not population incidences; interpretation should consider coding practices and service-mix changes across years. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Diagnosis, Management and Future Opportunities)

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21 pages, 3405 KB

Open AccessArticle

Characterization of Factors Associated with Tissue Immunity, Cellular Activity and Angiogenesis in Children with Unilateral Cleft Lip and Palate Before and During Primary Dentition: A Comparative Cross-Sectional Study

by Laura Ozola and Māra Pilmane

J. Clin. Med. 2025, 14(14), 4952; https://doi.org/10.3390/jcm14144952 - 12 Jul 2025

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Abstract

Introduction: Unilateral cleft lip and palate (CLP) is a severe orofacial birth defect characterized by improper fusion of facial parts and disturbed orofacial functions. The defect manifests as a gap in the orofacial tissues that is accompanied by defective healing patterns and chronic inflammation. The immune system’s defense factors modulate immunity, inflammation, and healing. Angiogenesis factors control blood-vessel formation. Therefore, these factors are vital in the immunological assessment and understanding of CLP morphopathogenesis. The aim of the study is to assess the distribution of vascular endothelial growth factor (VEGF), transforming growth factor beta 1 (TGF- β1), the total macrophage population and the M2 subtype, heat-shock proteins (HSP) 60 and 70, and nuclear factor kappa B (NF-κB) p50 and p65 subtypes in the affected tissue of children with CLP before and during primary dentition. Materials and Methods: Tissue samples were obtained from 15 patients aged from 3 to 8 months during veloplastic surgery. Five controls were used for comparison of data. Immunohistochemistry, light microscopy, semi-quantitative evaluation (from 0 to ++++), and statistics (Mann–Whitney U test and Spearman’s rank correlation) were used to evaluate the data for statistically significant differences and correlations between the groups. Results: Epithelial tissues affected by CLP presented with statistically significant increases in levels of VEGF (p = 0.007), total macrophages (p = 0.007), HSP60 (p = 0.001), NF-κB p65 (p = 0.000), and p50 (p = 0.045), but with a decrease in M2 macrophages (p = 0.025). Blood vessels in CLP-affected tissues showed a statistically significant increase in levels of NF-κB p65 (p = 0.003) and a statistically significant decrease in M2 numbers (p = 0.014). Connective tissue presented with no statistically significant differences. Spearman’s rank correlation revealed multiple statistically significant correlations—26 positive and 5 negative. Conclusions: Statistically significant changes in levels of VEGF and both NF-κB subtypes and numbers of total macrophages and M2 macrophages suggest a possible alteration of variable immune and inflammatory reactions and macrophage functions associated with the initiation and maintenance of the chronic process and the resulting damage. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Diagnosis, Management and Future Opportunities)

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12 pages, 1504 KB

Open AccessArticle

Precision of the Fully Digital 3D Treatment Plan in Orthognathic Surgery

by Paula Locmele, Oskars Radzins, Martins Lauskis, Girts Salms, Anda Slaidina and Andris Abeltins

J. Clin. Med. 2025, 14(14), 4916; https://doi.org/10.3390/jcm14144916 - 11 Jul 2025

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Abstract

Background/Objectives: The aim of this study was to investigate the accuracy of implementing a virtual treatment plan in orthognathic surgery. Methods: The study included 30 patients (11 males and 19 females with a mean age of 23.7 years) with a digital surgical plan. All patients underwent bimaxillary orthognathic surgery: LeFort I osteotomy of the maxilla combined with bilateral split sagittal osteotomy (BSSO) of the mandible. Eleven landmarks on the pre-surgical (planned) model and the same landmarks on the post-surgical model were used for comparison and linear difference measurements between the real and predicted outcomes in all three planes—transversal, sagittal, and vertical. Results: All median values fell within the 2 mm range in the transversal plane, and the mean displacement was 0.57 mm. In the sagittal and vertical planes, the treatment outcome in the maxilla was more precise than in the mandible. The mean displacement in the sagittal plane was −0.88 mm and that in the vertical plane was 0.44 mm. All deviations were less than 2 mm. Conclusions: The data obtained in this study show that the digital surgical plan for orthognathic surgery is clinically reliable in all planes. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Diagnosis, Management and Future Opportunities)

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13 pages, 535 KB

Open AccessSystematic Review

The Role of Brachytherapy in the Management of Oral Squamous Cell Carcinoma: A Systematic Review

by Fariba Esperouz, Mauro Lorusso, Alfredo De Lillo, Khrystyna Zhurakivska, Lorenzo Lo Muzio, Domenico Ciavarella and Lucio Lo Russo

J. Clin. Med. 2025, 14(17), 6033; https://doi.org/10.3390/jcm14176033 - 26 Aug 2025

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Abstract

Background: This systematic review evaluates the effectiveness and safety of brachytherapy (BT), including low-dose-rate (LDR) and high-dose-rate (HDR) techniques, in the treatment of oral squamous cell carcinoma (OSCC). Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science up to April 2025, according to PRISMA guidelines. The review was registered in PROSPERO (CRD42024581512). Eligible studies included cohort, case-control, and longitudinal studies in English investigating BT in OSCC patients. Risk of bias was assessed using ROBINS-I. Results: A total of 26 studies with 2286 patients were included where BT was employed as primary or adjuvant therapy, primarily for tumors of the tongue and floor of the mouth. Local control rates ranged from 72% to 95% for both LDR and HDR. HDR BT showed similar efficacy to LDR and offered logistical advantages. Acute and late toxicities included mucositis, soft tissue necrosis, and osteoradionecrosis, particularly with higher doses and large volumes. Combined BT and external beam radiotherapy (EBRT) improved outcomes in selected patients. Conclusions: BT remains an effective, organ-preserving option for early-stage OSCC. HDR BT is increasingly adopted due to its comparable efficacy and improved practicality. Optimal patient selection and precise dosimetric planning are crucial to minimize complications. Further prospective studies are warranted to define its role in modern multimodal treatment strategies. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Diagnosis, Management and Future Opportunities)

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19 pages, 1407 KB

Open AccessSystematic Review

Low-Level Laser Therapy in the Management of Bisphosphonate-Related Osteonecrosis of the Jaw

by Vincenzo Bitonti, Rocco Franco, Lorenzo Cigni, Domenico Familiari, Gioele Gravili, Giuseppe Vazzana and Pietro di Michele

J. Clin. Med. 2025, 14(13), 4441; https://doi.org/10.3390/jcm14134441 - 23 Jun 2025

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Abstract

Background: Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) is a severe complication associated with bisphosphonate therapy, commonly used in the treatment of osteoporosis and metastatic bone diseases. Low-Level Laser Therapy (LLLT) has been proposed as a potential treatment modality for BRONJ, with its anti-inflammatory, analgesic, and regenerative effects being of particular interest. This systematic review aims to critically assess the current evidence regarding the efficacy of LLLT in the management of BRONJ. Methods: This review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of electronic databases, including PubMed, Scopus, and Web of Science, was performed to identify relevant studies published up to September 2024. The systematic review protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) with the number 423003. All studies considered are observational. Studies were included if they investigated the application of LLLT in BRONJ treatment, reporting clinical outcomes such as pain reduction, lesion healing, and quality of life. The quality of the studies was assessed using the Cochrane Risk of Bias tool, and the data were synthesized descriptively. Results: A total of four studies met the inclusion criteria. The findings indicate that LLLT, particularly when used in conjunction with surgical debridement and pharmacological therapy, significantly may reduce pain and promote soft tissue healing in patients with BRONJ. However, the heterogeneity of study designs, laser parameters, and outcome measures limits the generalizability of these results. Furthermore, most studies were small-scale, with moderate to high risk of bias. Conclusions: The current evidence suggests that LLLT may be a beneficial adjunctive therapy in the treatment of BRONJ. However, conclusions are limited by the lack of randomized controlled trials and methodological heterogeneity, particularly for pain management and soft tissue regeneration. However, further high-quality randomized controlled trials with standardized laser protocols are necessary to establish its efficacy and optimize clinical application. Therefore, one of the limitations of this literature review with meta-analysis is that only four studies were considered and, moreover, they were observational. The results of the meta-analysis showed that there is not enough evidence to declare a statistical correlation; this result will surely be due to the small number of studies and heterogeneity. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Diagnosis, Management and Future Opportunities)

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