Search Results (147)

Exosome-derived microRNAs (miRNAs) have been proposed as minimally invasive biomarkers for laryngeal squamous- cell carcinoma (LSCC). Because oral and maxillofacial surgeons are integral to head-and-neck oncologic and reconstructive pathways, such liquid-biopsy signals could support perioperative decision-making (selection for organ-preserving surgery), margin surveillance, and reconstructive planning. We conducted a preregistered, protocol-driven search of PubMed/MEDLINE, Web of Science, and Scopus from inception to 1 June 2025. Given the very small number of clinically comparable diagnostic studies, discordant index tests/thresholds, and high heterogeneity, we did not perform quantitative pooling or publication-bias testing. Instead, we undertook a narrative synthesis and constructed an evidence map; risk of bias tools (QUADAS-2; ROBINS-I) were applied descriptively to inform qualitative confidence. Nine studies were formally analysed based on eligibility to the study topic. Two serum-based case–control investigations (111 LSCC, 80 controls) reported areas under the ROC curve of 0.876 (miR-21 + HOTAIR) and 0.797 (miR-941), with corresponding sensitivities of 94% and 82%. Seven mechanistic papers showed that vesicular cargos—including miR-1246, circPVT1, and LINC02191—drive STAT3-dependent M2 polarisation, NOTCH1-mediated stemness, Rap1b-VEGFR2 angiogenesis, and glycolytic re-programming, producing 1.6–2.6-fold increases in invasion, tube formation, or xenograft growth. Only three studies fulfilled MISEV-2018 characterisation criteria, and none incorporated external validation. This narrative review and evidence map identifies promising but preliminary diagnostic signals and biologically plausible mechanisms for exosomal miRNAs in LSCC; however, the evidence is sparse, single-region, methodologically inconsistent, and at high risk of bias. Findings do not support clinical implementation at this stage. Priorities include harmonised EV workflows, prespecified thresholds, and prospective, multi-centre validation. Full article

Additive manufacturing (AM), commonly known as 3D printing, is revolutionizing modern dentistry, introducing high-precision, patient-specific, and digital-driven workflows across prosthodontics, orthodontics, implantology, and maxillofacial surgery. Extensive analysis explores the leading platforms in 3D printing such as stereolithography (SLA), fused deposition modeling (FDM), selective laser sintering (SLS), digital light processing (DLP), and PolyJet which all achieve superior performance across multiple areas including resolution capabilities, material compatibility options, clinical application readiness, and cost-effectiveness. Additionally, an extensive overview of common materials, including biocompatible polymers (PLA, PMMA, PEEK), metals (titanium, cobalt-chromium), and ceramics (zirconia, alumina, glass-ceramics), sheds light on the critical role of material selection for patient safety, durability, and functional performance. The review explores new advancements such as 4D printing with shape-adaptive smart biomaterials as well as artificial intelligence-enabled digital processes and prosthesis design for the transformation of regenerative dentistry and intraoral drug delivery operations into new domains and the automation of clinical planning. Equally groundbreaking are 3D printing applications in pediatric dentistry, surgical simulation, and dental education. However, full-scale adoption of AM technology is not without challenges, including material toxicity, regulatory hurdles for approval, high initial investments, and the need for extensive digital expertise training. Sustainability concerns are also being addressed, with recycled materials and circular economy models gaining traction. In conclusion, this article advocates for a future where dentistry is shaped by interdisciplinary collaboration, intelligent automation, and hyper-personalized biocompatible solutions, with 3D printing firmly established as the backbone of next-generation dental care. Full article

Experimental animal models of orofacial pain have been instrumental in elucidating biological pathways underlying the antinociceptive effect of botulinum neurotoxin type A (BoNT/A). Although several mechanisms have been proposed to explain how BoNT/A relieves pain, the precise modes of action, particularly in the oral and maxillofacial areas, remain elusive. The purpose of this review was to synthesize and assess the latest proposed mechanisms of action through which BoNT/A attenuates orofacial pain in established animal models. A comprehensive search was conducted using the terms “botulinum neurotoxin,” “mechanism,” and “orofacial pain” or “trigeminal neuralgia.” Only animal studies involving the establishment of an orofacial pain model were selected. Additional relevant studies were identified through manual screening of cited references. Over the past five years, several animal pain models have been established to decipher the mechanisms underlying the BoNT/A-mediated antinociception in orofacial pain. The proposed mechanisms include retrograde transport, neuronal excitability regulation, neuropeptide inhibition, inflammatory modulation, and opioid system stimulation in both the peripheral and central nervous systems. Despite the insubstantial number of investigations and findings, BoNT/A exhibits multidimensional modulation of nociceptive responses and, therefore, remains a promising therapeutic agent for managing orofacial pain conditions, with animal studies consistently providing insights into the mechanism of its antinociceptive action. Full article

Orbital floor fractures are primarily caused by blunt trauma to the area around the eyes. These injuries most commonly affect the orbital floor and medial wall due to the fragility of these structures. The mechanism typically involves transmission of force through the orbital rim or an acute increase in intraorbital pressure caused by globe displacement. Blowout fractures often occur alongside additional maxillofacial fractures and periorbital soft tissue injuries. The reported causes mirror those of general maxillofacial trauma and include motor vehicle collisions, interpersonal violence, falls, sports-related injuries, incidents involving firearms, and occupational accidents. Here, we present the case of a 56-year-old male patient who sustained an exceptionally rare injury pattern characterized by a complete orbital floor fracture with globe dislocation into the maxillary sinus. Such extensive fractures are associated with significant functional impairments, including diplopia, enophthalmos, and restricted extraocular muscle movement, as well as marked aesthetic deformity. Comprehensive diagnostic imaging, comprising coronal, sagittal, and three-dimensional CT reconstructions, was crucial for accurately assessing the extent of bony disruption and soft tissue involvement. Particular emphasis should be placed on imaging that clearly delineates the extraocular muscles and the optic nerve, as precise evaluation of these structures is essential for surgical planning and prognosis. Surgical management involved repositioning of the globe and the orbital contents, followed by reconstruction of the orbital floor using a titanium mesh anchored to the infraorbital rim. This case highlights the technical challenges of total orbital floor reconstruction, emphasizing the importance of meticulous anatomical restoration for achieving optimal functional and aesthetic outcomes. Full article

Hemophilic pseudotumor (HP) is a rare but severe complication of hemophilia, characterized by progressive bleeding in the muscles, joints, and bone tissue, which can lead to lytic lesions. Its prevalence is approximately 1–2% among patients with hemophilia. This report presents a male patient with mild hemophilia A who developed an intraosseous lesion in the posterior region of the right maxilla, with a prior history of endodontic treatment in the area. Surgical excision was performed and, following clinicopathological correlation, the lesion was diagnosed as HP. Background/Objectives: This review aims to identify previously reported cases of HP located in the maxilla. Methods: The study protocol followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The databases PubMed, Scopus, and ScienceDirect were searched, and Google Scholar was used to identify gray literature. The Joanna Briggs Institute (JBI) tool was employed to assess the risk of bias and the quality of the included reports and case series. Results: A total of 1487 publications were identified using specific keywords. After removing duplicates and non-relevant titles/abstracts, 42 full-text articles were reviewed. Of these, 10 met the inclusion criteria: 7 case reports and 3 case series, comprising 13 cases of HP in the maxilla, including the case presented here. Although rare in the maxillofacial region, when it does occur, it is more commonly seen in the mandible and is often linked to prior trauma. In this case, endodontic treatment may have triggered lesion development. Conclusions: This report highlights that, although uncommon, HP can manifest with involvement of the maxilla, and that specific dental interventions may represent potential triggering events. Full article

Objectives: Periapical periodontitis, which is a periodontal dysfunction, is a current clinical problem. Due to the frequency of occurrence and the adverse effects they cause, they are considered a social disease. They require detailed diagnostics to implement appropriate treatment. Mathematical calculations based on data obtained from radiological images used in routine clinical practice may help differentiate the forms of periodontitis. This study aimed to evaluate the areas affected by periodontitis in comparison to the healthy tissues of the periapical area. Methods: The study analyzed texture components using the gray-level co-occurrence matrix (GLCM) and the gray-level run-length matrix (GRLM) on an orthopantomogram (OPG) from 50 patients with clinically confirmed periodontitis treated at the Department of Maxillofacial and Plastic Surgery, University of Bialystok. Texture analysis was performed on defined regions of interest (ROIs) to distinguish diseased from healthy tissues. We employed four classification algorithms to assess model performance. Results: The data set included 50 patients, with 76 cases of periodontitis and 50 healthy ROIs. The reference standard was clinical diagnosis confirmed by two specialist doctors. The best-performing algorithm achieved an AUC of 98%. Conclusions: The obtained results showed significant statistical differences in the inflamed regions compared to the control, which may aid in diagnosing and selecting the treatment method for periodontitis. Full article

Background/Objectives: The deep circumflex iliac artery (DCIA) free flap with internal abdominal oblique muscle (IAOM) is a well-known method of reconstruction used in cases of oral cavity neoplasms. Because the IAOM can be insufficient for extensive defects after removal of advanced carcinomas of the tongue, floor of the mouth, or gingiva, the additional preparation of a perforator-supported external abdominal oblique (EAOM) muscle flap can be useful. The aim of this study was to introduce the use of a DCIA flap with an IAOM and EAOM island in the reconstruction of oral cavity compound defects. Methods: A retrospective analysis was performed involving eight patients who underwent reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Patients underwent the operation between June 2021 and February 2025 in the Department of Maxillofacial Surgery of the Rydygier Hospital in Kraków, Poland. Results: A group of eight patients underwent an operation due to squamous cell carcinoma of the oral cavity. The most common primary subsite of disease was the floor of the mouth (n = 4, 50%), followed by the lower gingiva (n = 2, 25%) and retromolar area (n = 2, 25%). All patients required resection involving part of the mandible, the floor of the mouth, and part of the tongue simultaneously with reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Osteotomies were performed in two flaps (one single osteotomy, one double osteotomy). Reconstruction was successfully performed in seven out of eight patients (overall success rate 88%). Conclusions: The DCIA free flap with IAOM and perforator-supported EAOM flap is a reliable method for compound soft tissue and bone defects in maxillofacial reconstruction. The use of IAOM and EAOM can be helpful in cases of three-dimensional soft tissue defects of the lower gingiva, the floor of the mouth, and the tongue. The lower gingiva and floor of the mouth can be reconstructed with IAOM, while the more mobile part of the tongue can be reconstructed with a perforator-supported EAOM island. Full article

Objectives: The increasing popularity of electric scooters (E-scooters) has led to a rise in trauma-related injuries, particularly in the craniofacial region. This study aims to compare dentoalveolar trauma (DT) patterns between E-scooter and bicycle accidents in a German urban area to identify differences in injury characteristics, risk factors, and treatment approaches. Materials and Methods: This retrospective study analyzed 178 patients treated for DT following E-scooter (n = 56) or bicycle (n = 122) accidents between January 2022 and December 2022 at a single oral and maxillofacial surgery department in a German urban area. Demographic, clinical, temporal, and therapeutic data were collected and statistically compared. Results: E-scooter patients were significantly younger (mean age: 33.6 vs. 47.0 years, p < 0.001) and predominantly female (85.7% vs. 26.2%, p < 0.001) compared to bicycle patients. E-scooter accidents more frequently occurred at night (69.6%) and on weekends (62.5%) and were significantly associated with alcohol consumption (55.4%) and low helmet use (8.9%). Clinically, E-scooter accidents resulted in more complex dental injuries, including a higher incidence of root fractures (14.3% vs. 0%, p < 0.001), complicated crown fractures (25.0% vs. 9.0%, p = 0.004), and crown-root fractures (32.1% vs. 9.8%, p < 0.001). Mandibular injuries were more prevalent in the E-scooter group, and concomitant facial fractures (excluding alveolar) were also more common (28.6% vs. 19.7%, p = 0.018). Conclusion: E-scooter accidents are associated with a distinct DT pattern involving younger, often alcohol-intoxicated, and helmetless patients, typically presenting with more severe and complex DT-injuries. These findings highlight the urgent need for targeted prevention strategies, legislative measures on helmet use, and clinician awareness of specific trauma profiles linked to E-scooter use. Full article

The research of biomaterials is an area of significant interest in the biomedical field, and the present study investigates how the strontium (Sr) concentration influences the microstructure, corrosion resistance, and both in vitro and in vivo behavior of alloys in the ternary Mg-Ca-Sr system. Using an induction furnace with a controlled atmosphere (argon as the shielding gas), Mg-0.5Ca-xSr alloys (x = 0.5; 1; 1.5; 2; 3 at.%) were synthesized. Microstructural analyses, performed using optical microscopy and scanning electron microscopy (SEM), revealed a uniform and refined structure. Corrosion behavior assessments, carried out using linear and cyclic potentiometry, demonstrated favorable corrosion resistance for all samples. However, for the system containing 0.5% Sr, the corrosion rate values were lower compared to the other systems, and this alloy also exhibited the lowest corrosion current density. Cytocompatibility assay indicated the cytocompatible behavior of all the studied alloys, with favorable influence on cell viability and a stimulatory effect on the osteoblastic cell proliferation. In vivo biocompatibility assessments of the alloys showed that, for alloys containing 0.5% and 1% Sr, a more rapid degradation occurred in comparison with the other alloys (1.5, 2 and 3% Sr), which still persisted at the tissue level even after 12 weeks post-implantation. In all the batches examined, the inflammatory reaction was directly proportional and persistent in relation to the presence of the material in the tissue. In regions where the material was resorbed/degraded, the local inflammatory response was reduced or absent, and the fibrous tissue was denser and better organized. The field of biomaterials is in continuous development, and this study highlighted the applicability of these five alloy systems for dental and maxillofacial applications such as implants, plates, and related devices. Full article

Background: This retrospective study aimed to assess the prevalence and distribution of common soft tissue ossifications and calcifications in the head and neck area, such as tonsilloliths, calcified lymph nodes, atherosclerotic plaques, stylohyoid ligament calcifications, and laryngeal cartilage calcifications, using panoramic radiographs (PRs) from a Turkish population. A secondary objective was to analyze these findings based on age and gender, ultimately seeking to enhance clinicians’ awareness of these incidental findings and their potential diagnostic significance. Methods: PRs of 1207 patients applying to the Department of Oral and Maxillofacial Radiology at Necmettin Erbakan University Faculty of Dentistry between 2021 and 2022 were reviewed. Out of these, 1193 images meeting quality criteria and showing distinct anatomical details were included. Patients with prior diagnosed bone metabolic disorders were excluded. Two radiologists independently assessed the images for the presence of soft tissue calcifications and ossifications. Inter-observer reliability was quantified using Cohen’s Kappa coefficient, which was found to be 0.78, indicating substantial agreement (95% CI: [0.72–0.83], p < 0.001). The calcifications and ossifications were categorized according to age, gender, and type. Data were analyzed employing descriptive statistical methods and Chi-square tests, with a significance level set at p < 0.05. Results: Soft tissue calcification or ossification was observed in 122 (10.22%) of the 1193 retrospectively evaluated PRs. The most common findings included stylohyoid ligament ossifications (n = 31), laryngeal cartilage calcifications (n = 28), tonsilloliths (n = 25), calcified atherosclerotic plaques (n = 18), and calcified lymph nodes (n = 18). Two antroliths were also identified. Arteriosclerosis, phleboliths, and sialoliths were not detected in this cohort. Although some types of calcification showed numerical variations across age groups and genders (e.g., higher prevalence of most anomalies in patients aged 31 years and older; more frequent laryngeal cartilage calcification in women and tonsilloliths in men), Chi-square analyses revealed no statistically significant association between the presence of these calcifications or ossifications and either age group (p = 0.284) or gender (p = 0.122). Conclusions: PRs serve as an effective initial screening instrument for identifying soft tissue calcifications within the head and neck region, owing to their widespread availability, cost-effectiveness, and minimal radiation exposure. The detection of such findings is of paramount importance, as they may indicate underlying systemic conditions necessitating further diagnostic evaluation. While clinicians should remain vigilant to these anomalies, definitive diagnosis typically requires supplementary imaging modalities such as cone-beam computed tomography (CBCT), ultrasound, or histopathological analysis. Full article

In Maxillofacial Reconstruction Applications (MRA), nonunion is one of the critical complications after the reconstruction process and fracture treatment, including bone grafts and vascularized flap. Nonunion describes the failure of a fractured bone to heal and mend after an extended period. Different systems and methods have been developed to monitor bone regeneration and fracture healing during and after the treatment. However, the developed systems have limitations and are yet to be used in MRA. The proposed smart reconstruction plate is a microdevice that could be used in MRA for wireless monitoring of fracture healing by measuring the forces applied to the reconstruction plate. The device is wireless and can transmit the acquired data to a human–machine interface or an application. The designed system is small and suitable for use in MRA. The results of finite element analysis, as well as experimental verification, showed the functionality of the proposed system in measuring small changes on the surface strain of the reconstruction plate and determining the corresponding load. By using the proposed system, continuous monitoring of bone regeneration and fracture healing in oral and maxillofacial areas is possible. Full article

Background: Reconstructive surgery with free flaps is a fundamental component in head and neck surgery, but flap failure remains a significant concern. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a prognostic factor commonly applied in the evaluation of patients suffering from malignant tumours. This score has emerged as a potential preoperative risk assessment tool; however, its predictive accuracy for free flap failure has not been fully evaluated. The potential of this formula, in the cervical–facial reconstructive area, has not yet been well studied in the international literature. Methods: This retrospective study included patients who had undergone free flap reconstruction in the maxillofacial surgery departments of Perugia and Ancona over the past ten years. To optimize the HALP formula, advanced machine learning technologies, mainly the Julius AI platform, were applied. The HALP formula was refined through three phases: the original formula, a weighted version, and the final “Modified HALP.” Predictive performance was assessed using ROC curve analysis, multivariate logistic regression, and internal validation. Results: The final version of the HALP score, created in the present study, achieved an AUC-ROC of 0.95 (95% CI: 0.91–0.99), outperforming the original and weighted versions. At the optimal cut-off, the final “Modified” HALP score demonstrated 90.91% sensitivity and 92.36% specificity, remaining an independent predictor of flap failure after adjusting for confounders. Conclusions: The aim of the study was to optimize the HALP score by integrating clinical information with the aim of making significant progress in the prediction of failure in reconstructive flaps. The Modified HALP score emerges as a powerful tool for preoperative risk stratification in free flap surgery, potentially improving patient outcomes through targeted interventions. Future research should focus on external validation and exploring the underlying biological mechanisms. Full article

Introduction: Hypoglossal nerve stimulation (HNS) “Inspire_© therapy” has garnered popularity among obstructive sleep apnea (OSA) patients seeking an alternative to continuous positive airway pressure (CPAP) therapy. The growth in HNS has been particularly high in older adults living with OSA. Consistent and proper use of HNS in the geriatric population faces unique age-associated barriers: a high rate of multiple chronic conditions (MCC) and polypharmacy (being on five or more drugs). Early recognition and patient-centered management of these barriers will allow older patients to obtain maximum benefits from HNS. HNS has distinct advantages in the geriatric population because it overcomes many concerns related to CPAP therapy adherence, such as mechanical limitations due to manual dexterity, maxillofacial anatomy, dental issues such as usage of dentures, allergy/otolaryngology-related disorders, and pre-existing post-traumatic stress disorder-related claustrophobia. This paper describes how we worked with older patients with OSA and their care partners to overcome these barriers so patients can continue to derive cardiovascular, neurologic, and quality of life benefits resulting from optimal OSA management. These benefits are especially important in the older population because of higher rates of comorbidities (dementia, coronary artery disease, and atrial fibrillation) exacerbated by sub-optimally treated OSA. In this article, we describe our clinical experience with elderly patients on Inspire_© therapy, with a focus on the everyday difficulties faced by these patients and the measures implemented to address and mitigate these barriers. Methods: A retrospective chart review was conducted to identify patients aged 65 and above who underwent hypoglossal nerve stimulator insertion. Experiences of older patients during and after the insertion procedure were documented and compared to a younger population of patients on HNS therapy. We specifically collected information on difficulties encountered during activation or follow-up visits and compared them between the different age groups. Using this information, we identified areas to improve treatment adherence from the patients’ perspectives. Results: We identified 43 geriatric (65 to 86 years old) patients who received the Inspire implant at a tertiary academic medical center and compared them to a younger population of 23 patients. Most common challenges noted—with a potential to impact adherence—included orofacial and lingual neuropraxia (ischemic or demyelination-induced neuropathy) at activation, cognitive dysfunction (memory problems), preexisting anxiety, and insomnia. Other difficulties that are less commonly reported but equally important to consistent and proper use of HNS included headaches, concerns of device malfunction, change in comfort levels after cardiac procedures, and general intolerance of the device. The older patient population had a statistically significant higher incidence of cognitive difficulties (30.2% vs. 4.4%) and a smaller social support system (62.8% vs. 91.3%) affecting device usage compared to the younger population. There were no statistically significant differences in the rates of other more commonly reported adverse effects such as headaches, dry mouth, and anxiety between the two age groups. Conclusion: Despite several challenges faced by geriatric patients, Inspire_© hypoglossal nerve stimulation remains a viable, alternative treatment option for OSA with improved tolerance and adherence compared to CPAP. After identifying less commonly reported barriers such as cognitive decline, sensory deficits, and decreased social support systems, minor adjustments and appropriate education on use allows older patients to correctly use and benefit from Inspire_© device therapy, with subsequent improvement in sleep and overall quality of life. Full article

Applications of virtual reality (VR) have grown in significance in medicine, as they are able to recreate real-life scenarios in 3D while posing reduced risks to patients. However, there are several interaction challenges to overcome when moving from 2D screens to 3D VR environments, such as complex controls and slow user adaptation. More intuitive techniques are needed for enhanced user experience. Our research explored the potential of intelligent speech interfaces to enhance user interaction while conducting complex medical tasks. We developed a speech-based assistant within a VR application for maxillofacial implant planning, leveraging natural language processing (NLP) to interpret user intentions and to execute tasks such as obtaining surgical equipment or answering questions related to the VR environment. The objective of the study was to evaluate the usability and cognitive load of the speech-based assistant. We conducted a mixed-methods within-subjects user study with 20 participants and compared the voice-assisted approach to traditional interaction methods, such as button panels on the VR view, across various tasks. Our findings indicate that NLP-driven speech-based assistants can enhance interaction and accessibility in medical VR, especially in areas such as locating controls, easiness of control, user comfort, and intuitive interaction. These findings highlight the potential benefits of augmenting traditional controls with speech interfaces, particularly in complex VR scenarios where conventional methods may limit usability. We identified key areas for future research, including improving the intelligence, accuracy, and user experience of speech-based systems. Addressing these areas could facilitate the development of more robust, user-centric, voice-assisted applications in virtual reality environments. Full article

Negative-pressure wound therapy (NPWT) using vacuum-assisted closure (VAC) is a well known tissue defect bridging method that applies a vacuum pump to sterile, open-cell foam dressings via suction tubes. Although it has mostly been described for soft tissue use, there are also a few studies concerning its use on hard tissue. However, as oral and maxillofacial surgery has to deal with both soft and hard tissue, which lie next to each other in these regions, there is a particular need to assess the influence of negative pressure on bone. Therefore, the effects of different negative pressure levels (530 mbar and 725 mbar) and atmospheric pressure (1013 mbar) on bone tissue cultures and osteoblast cell cultures were investigated over periods of 1, 3, and 6 weeks. During the culture period, osteoblast growth and the tissue regeneration of bone defects were studied in vitro using tissue cultures that were histologically supplemented by cytological investigations and quantitative RNA expression studies. In the bone defect model, there was a faster defect reduction using NPWT; the effect was especially strong for 530 mbar. Compared to the control group, up to 30% more newly generated bone tissue was detected. This effect on the mineralization capacity was assessed by the mRNA expression of osteogenic marker genes, as well as the receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG), two multifaceted cytokines that regulate bone metabolism. The influence of negative pressure consequently resulted in a decreased RANKL/OPG ratio in osteoblasts. Associated with the upregulation of marker genes to up to 400%, including Col1, BMP4, OCN, and RUNX2, the decrease in the RANKL/OPG ratio to 41% indicates the stimulation of osteogenesis. Since VAC has been shown to be a safe and effective method to close wounds in general, these data suggest that patients suffering from compound bone and soft tissue defects in the maxillofacial area may benefit from an adapted therapy approach accelerating both soft and hard tissue regeneration. Full article