Dental anxiety has a major impact on patient compliance, which frequently requires pre-operative pharmacological intervention. Although commonly utilised, melatonin, an endogenous hormone with analgesic and anxiolytic effects and alprazolam, a short-acting benzodiazepine, are not frequently compared in minor oral surgical procedures. This study compares melatonin and alprazolam as anxiolytic and analgesic agents in patients undergoing minor oral surgical procedures. In a triple-blind, randomised controlled trial, 42 American Society of Anesthesiologists (ASA) I/II patients (ages 20-50) with pre-operative anxiety (visual analogue scale [VAS] >50) were randomly assigned to either oral melatonin 3 mg (Group A) or oral alprazolam 0.5 mg (Group B) one hour prior to surgery. Pre-, intra- and postoperatively, anxiety (VAS, Trail Making Test), sedation (Ramsay Sedation Scale) and recovery (Modified Aldrete Score) were evaluated. The Mann-Whitney U and Wilcoxon signed-rank tests (SPSS v25) were used for statistical analysis. Both groups showed a significant intra-group decrease in VAS anxiety scores (P < 0.001). A post-operative inter-group comparison showed that melatonin provided superior anxiolysis (P = 0.03) and less sedation (P = 0.01). The modified Aldrete scores were similar (P = 1.00), and no negative effects were noted. Although both treatments are successful in lowering perioperative anxiety, melatonin's superior anxiolytic effects and a positive sedation-recovery profile make it a potential substitute for benzodiazepines in minor oral surgical operations.

Bone invasion critically influences staging and surgical planning in oral squamous cell carcinoma (OSCC). Accurate pre-operative imaging is essential to detect cortical and medullary involvement. The study was to compare the diagnostic efficacy of cone-beam computed tomography (CBCT) versus conventional radiography for detecting bone invasion in OSCC. PubMed, Embase, Scopus, Web of Science and Cochrane Library. Comparative or observational studies evaluating CBCT and/or conventional radiography for OSCC bone invasion, using histopathology or intraoperative findings. Patients with OSCC undergoing preoperative imaging; index tests included CBCT and conventional panoramic/periapical radiography. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-2020 and PRISMA-DTA compliant review with PROSPERO registration. Two reviewers independently screened, extracted data and assessed quality using Quality Assessment of Diagnostic Accuracy Studies-2. Owing to heterogeneity and incomplete 2 × 2 data, findings were narratively synthesised; a summary area under the curve (AUC) was estimated where possible. Nineteen studies (sample sizes 14-197) were included. CBCT showed higher sensitivity (84.8%-100%) and specificity (60%-100%) than conventional radiography (sensitivity 24%-74.1%; specificity 68%-75%). CBCT facilitated earlier detection of cortical and trabecular changes and performed comparably to CT for osseous invasion, while magnetic resonance imaging (MRI) remained superior for soft-tissue and marrow evaluation. Across studies with extractable data, the summary AUC was 0.59, reflecting modest overall discrimination. Substantial heterogeneity in methodology and CBCT protocols, observer variability and risk of bias limited pooling and generalisability. CBCT outperforms conventional radiography for detecting OSCC-related bone invasion, which should be considered in pre-operative evaluation, complemented by MRI where soft-tissue involvement is suspected. Standardised protocols and artificial intelligence-driven CBCT analysis warrant future validation.

Management of temporomandibular joint (TMJ) osteoarthritis (OA) is a challenging issue in modern gnathology and maxillofacial surgery. Identifying various signs of TMJ OA, their relationship with internal derangement and studying the features of combined (uni-, bilateral) pathology contribute to an accurate assessment of TMJ condition and appropriate management. Conventionally, besides clinical examination, this state was diagnosed by computed tomography. However, magnetic resonance imaging (MRI) allows the assessment of both bone and soft tissue. The aim of the study was to identify the correlation between degenerative changes in bone structures and various forms of internal TMJ disorders based on MRI data, as well as to assess the morphofunctional changes in the TMJ in cases of uni-, bilateral joint pathology. Two hundred and twenty-two patients (444 joints) underwent a clinical examination and MRI of the TMJ (Siemens Magnetom Verio MRI scanner Germany 3.0 T). Exclusion criteria included systemic diseases, joint trauma and prior treatments. Osteodegeneration predominated in cases of anterior disc displacement without reduction (ADDWoR): osteophytes on the condylar head (74.8%), flattening (40.2%), erosions (31.8%) and subchondral sclerosis (88.8%). As the degree of disc displacement progressed, the decrease of volume of condyle, changed from 373.8 mm2 with normal disc position (NDP) to 251.3 mm2 with ADDWoR. In cases with NDP, unilateral OA was present in 2.3% of and bilateral OA in 4.1%. Bilateral displacement is characterised by bilateral OA in 26.1%, whereas unilateral OA in 12.2%. There is a positive correlation between the position of the disc in the sagittal projection and degenerative changes. Strong correlation was identified between degenerative changes in the bone structures of the TMJ and various types of internal disorders.

Surgical extraction of impacted third molars is a common procedure in maxillofacial surgery. Wound closure is typically achieved using knotted sutures, which require time and may lead to knot-related complications. Knotless sutures, widely used in various surgical fields, offer potential benefits for intraoral applications. This study evaluated the clinical utility of knotless sutures following third molar surgery. A randomised split-mouth clinical study was conducted on 29 patients undergoing bilateral mandibular third molar removal. Each patient received two types of sutures: knotless polyglyconate barbed sutures and control group: knotted polyglactin 910 sutures. Parameters assessed included suturing time, pain and discomfort during suturing (via Visual Analogue Scale) and post-operative outcomes on day 7, soft tissue healing (Modified Landry Index), wound dehiscence, facial swelling and maximum interincisal opening. The knotless group showed significantly reduced suturing time and lower pain and discomfort scores. Improved soft tissue healing and reduced wound dehiscence were observed compared to the control group. No significant difference was found in facial swelling or mouth opening between the groups. Knotless sutures are effective for intraoral wound closure after third molar extraction. They reduce operative time, minimise patient discomfort and enhance wound healing, offering a viable alternative to conventional knotted sutures.

Oral and maxillofacial surgery (OMFS) continues to evolve at the intersections of technology, biology, and precision science. The past decade has transformed surgical practice by incorporating digital planning, virtual surgical simulation, regenerative biomaterials, and tissue engineering. However, at the level of fundamental experimentation, the quest to truly replicate human biology remains incomplete. Most in vitro systems simplify the very complexity that defines maxillofacial tissues, while animal models – although indispensable – often fail to reproduce the fidelity of human-specific cellular and immune responses. Lab-on-Chip (LoC) platforms represent an emerging solution to this long-standing translational gap. By integrating human cells into microengineered, physiologically active environments, these systems recapitulate the biochemical and biomechanical conditions of native tissues at microscale resolution. The result is a dynamic, human-relevant model that can reveal cellular behavior under controlled mechanical loading, perfusion, and immune stimulation – conditions central to craniofacial physiology and pathology.[1] For oral and craniomaxillofacial surgery, the implications are extensive.[2] LoC systems can be used to study the effects of genetic mutations on craniofacial development, simulate graft integration under stress, or explore the mechanisms of tissue resorption and regeneration. Their ability to model osteogenic, vascular, and immunologic interactions provides a realistic platform for investigating complex wound healing, bone-implant dynamics, and biomaterial performance. In reconstructive and transplant surgery, the potential extends further – immune-on-chip systems may simulate host-graft interactions, allowing individualized testing of immunosuppressive regimens and preoperative risk stratification in composite tissue allotransplantation.[1,3,4] Future applications are poised to reshape the scope of preclinical assessment. Bone-on-chip models could refine implant selection for atrophic ridges; Temporomandibular joint (TMJ)-on-chip devices might offer patient-specific insights into degenerative joint disorders; carcinoma-on-chip systems could help oncologic teams test therapies on a patient’s own tumor cells before clinical application. When integrated with artificial intelligence, organoid platforms, and high-content imaging, these chips evolve from the experimental tools into personalized diagnostic and predictive instruments. Furthermore, most importantly, it may help to achieve the holy grail of maxillofacial surgery – facial transplants – LoC systems can replicate patient-specific immune and vascular interactions, allowing simulation of host-graft dynamics before surgery. This may enable personalized immunosuppressive strategies and improved prediction of graft acceptance, advancing safer and more successful facial transplantation. The pathway to clinical translation will demand standardization, validation, and strong interdisciplinary collaboration. Surgeons must remain active contributors in this dialog, guiding the development of models that answer clinically relevant questions. As the specialty advances toward biologically precise, data-integrated surgical care, LoC technology stands as a powerful conduit between laboratory discovery and patient-specific intervention. By embracing and utilizing these platforms, OMFS could expand, reaffirms its identity at the frontiers of science and surgery through the deeper understanding and individualized care they enable.

Jacob's disease associated with true coronoid hyperplasia (CH) is a rare condition characterized by a pseudo-joint between the coronoid process and the zygomatic arch. Malar asymmetry resulting from zygomatic bone deformation has been reported, but long-term morphological outcomes are seldom documented. A 13-year-old boy presented with progressive restriction of maximal incisal opening (MIO) of 20 mm and zygomatic asymmetry. Computed tomography (CT) scan and histopathological examination confirmed the diagnosis of Jacob's disease with CH. An intraoral coronoidectomy was performed, followed by a structured program of jaw-stretching exercises. The patient achieved a sustained improvement in MIO. A CT scan at 17 months showed spontaneous zygoma remodeling with resolution of facial asymmetry. Coronoidectomy with physical therapy can restore MIO effectively. This is the first report of spontaneous correction of zygomatic asymmetry, suggesting the appropriateness of an expectant attitude in this clinical scenario.

Introduction:This study was performed to analyse the oral health-related quality of life (QoL) and masticatory functional efficiency after release of temporomandibular joint (TMJ) ankylosis.Materials and Methods:There were two groups with Group 1 having 12 operated cases of TMJ ankylosis and Group 2 having 12 normal participants with age- and gender-matched controls. The maximum voluntary bite force (MVBF) of the cases was measured at 3 months, 6 months and 1 year postoperatively with a digital gnathodynamometer. The patients completed 14-item Oral Health Impact Profile (OHIP-14) questionnaires once before and after surgery. The weight of the operated cases was measured on the same follow-up appointments to ascertain weight gain.Results:Compared to controls, 70.5% reported efficient bite force at 6 months and all 77.4% had efficient bite forces at 1 year postoperatively. There was an increase in the mean weight by 5.57 kg in the patients by 1 year after surgery. All the OHIP showed a significant improvement.Discussion:We conclude that with the attainment of efficient MVBF values, the patient’s masticatory performance improved concomitantly after release of TMJ ankylosis leading to improvement in oral health maintenance and QoL.

Rationale:Langerhans cell histiocytosis (LCH) is a rare disease involving neoplastic proliferation of myeloid precursor cells, primarily affecting bones such as ribs, pelvis, femur, and mandible with rare simultaneous involvement of the maxilla and mandible.Patient Concerns and Diagnosis:A 48-year-old male presented with swelling and tooth mobility since 6 months. Orthopantomogram revealed extensive destruction in the mandible and right maxillary posterior region. Histological examination confirmed LCH using immunohistochemical staining with S-100, CD1a.Treatment:As patient refused of surgery, intralesional methylprednisolone injections were selected as non-invasive treatment approach for localized LCH.Outcome:Three months post-treatment, remission was observed, though some residual lesion remained. Follow-up at six months showed no further disease progression, supporting the efficacy of corticosteroid injections.Take-away Lessons:Treatment should be based on the diagnosis of LCH along with the extent of involvement of bones. Based on review of the literature and our own findings, intralesional corticosteroids were found to be effective for localized LCH.

Mesiodens are supernumerary teeth located in the pre-maxilla between the two central incisors with a prevalence rate of 0.15-1.9%. An impacted mesiodens may cause delayed eruption of permanent incisors, ectopic eruption, pathological disturbances and malalignment of teeth. The patient complained of missing upper front teeth associated with pain in the same region for two weeks. Upon clinical and radiographic examination, it was diagnosed as triple impacted mesiodens with impacted permanent maxillary central incisors. The clinicians in the study approached the issue by surgical removal of the impacted mesiodens and orthodontic treatment for extrusion of the impacted permanent maxillary central incisors. The patient was relieved of the pre-operative concerns and followed up regularly for the eruption of permanent maxillary central incisors. The authors advocate the importance of timely diagnosis and proper management of such rare pathologies.

Intraorbital osteomas are incidentally found and occasionally require surgical treatment. Depending on their localisation, a single technique may not provide a sufficient surgical field. We report a 16-year-old male with a left upper medial palpable mass. Computed tomography revealed a dense bony mass extending from the ethmoid sinus to the superior wall of the frontal sinus, with protrusion into the orbital cavity. The combination of upper fornix transconjunctival and endoscopic transnasal approaches was chosen for the surgical removal procedure. The two-pathway approaches resulted in the clear removal of the mass. Post-operative recovery was rapid, although a slight restriction of the inferomedial duction remained at three months. This combination of techniques can provide a wide surgical field for the resection of frontoethmoidal osteomas with orbital extension.