Surgical options for chronic recurrent temporomandibular joint (TMJ) dislocation remain heterogeneous. Digitally planned patient-specific onlay augmentation may provide a reproducible mechanical stop while minimizing intraoperative guesswork. Eleven patients (> 16 years) with chronic recurrent TMJ dislocation/hypermobility (maximal incisal opening > 40mm) underwent augmentation eminoplasty using a digitally planned patient-specific implant and CAD/CAM workflow. Clinical outcomes included pain (VAS 0-10) and maximal incisal opening (MIO) assessed preoperatively, at 2 weeks, and at 6 months; radiologic assessment included panoramic TMJ views and MSCT at 6 months. The cohort was predominantly female (72.7%) with mean age 20.55 ± 4.08 years. Mean VAS pain decreased from 8.80±0.53 preoperatively to 8.07±0.73 at 2 weeks and 6.29±1.29 at 6 months (all pairwise comparisons p<0.001). Mouth opening decreased significantly after surgery and remained reduced at follow-up; there was no significant difference between 2-week and 6-month mouth opening (p=0.082). Two patients (18.2%) developed right-sided postoperative infection requiring implant removal. Clinical signs suggestive of infection were first recognized at approximately 3 weeks postoperatively and ultimately led to implant removal at around 2 months after failure of initial conservative treatment. No clinical recurrence of dislocation/open-lock was documented during the available 6-month follow-up. Digitally planned patient-specific onlay eminoplasty demonstrated short-term feasibility, reduction in pain, and controlled postoperative mouth opening; however, the observed infection rate and limited functional follow-up warrant cautious interpretation."

Castleman disease (CD) is a rare lymphoproliferative disorder characterized by non-neoplastic lymph node hyperplasia. Unicentric Castleman disease (UCD), the most common clinical form, typically presents as a solitary, asymptomatic mass. Involvement of intraparotid lymph nodes is rare and often mimics salivary gland neoplasms, complicating preoperative diagnosis. A 35-year-old female presented with a painless, enlarging mass in the left parotid region. Contrast-enhanced CT revealed a well-demarcated, homogeneously enhancing mass with additional smaller lesions in adjacent lymph node regions. A conservative excisional approach was performed with preservation of the facial nerve. Histopathological evaluation confirmed the hyaline-vascular variant of UCD. Postoperative follow-up showed spontaneous regression of adjacent lymphadenopathy and resolution of transient facial nerve palsy. CD should be considered in the differential diagnosis of encapsulated parotid masses with associated lymphadenopathy. Recognizing its clinical and radiologic features may facilitate accurate diagnosis and prevent overtreatment. Complete surgical excision is curative in most UCD cases.

Surface landmarks such as Zuker's point can help localize branches of the facial nerve as a supplement to, or in the absence of intraoperative neuromonitoring. Zuker's point is a previously described landmark located half the distance between the root of the auricular helix and labial commissure with demonstrated efficacy in localizing facial nerve branches. However, prior studies are restricted by two dimensional descriptions based on discrete, linear measurements, and description of the influence of sex, laterality, or face shape is lacking. Geometric morphometric techniques offer a sophisticated approach capable of producing a three-dimensional description of the location of the facial nerve relative to Zuker's point, while discerning the influence of sex, laterality, and face shape. Facial nerve at Zuker's point was analyzed in 82 cadaveric hemifaces. Three-dimensional coordinate data for the root of the auricular helix, labial commissure, Zuker's point, and the facial nerve at Zuker's point were captured using a MicroScribe digitizer. Mean landmark configuration and principal component analysis were used to describe the position of the facial nerve relative to Zuker's point, as well as the influence of sex, laterality, and face shape. Facial nerve systematically deviated towards the 1 o'clock position (if viewed from the lateral position on the right side), irrespective of sex or laterality. The accuracy of Zuker's point was enhanced on those with a longer, rounder face, while in shorter and slimmer faces the nerve takes a more superior and superficial position relative to Zuker's point. Facial nerve branches can reliably be found at Zuker's point, regardless of sex or laterality, though the nerve does systematically deviate from Zuker's point toward the 1 o'clock position (if viewed on the right side). The position of the facial nerve relative to Zuker's point is influenced by face shape, but not sex or laterality. These results can be used to better localize the facial nerve and improve patient outcomes.

BackgroundPostoperative stability is a significant problem in the orthognathic management of anterior open bite malocclusion. The general tendency of modern preadjusted fixed appliances is towards unwanted and unplanned extrusion of the maxillary incisor and canine teeth as the dental arch is levelling. Following surgical repositioning of the jaws, the relapse potential of the extruded anterior dentition will be to intrude, leading to some reopening of the surgically corrected anterior open bite.Case presentationA 19-year-old male white Caucasian patient presented with a clinically significant anterior open bite of predominantly skeletal aetiology. The objective of preoperative levelling in the maxillary dental arch was to avoid any extrusion of the anterior dentition. To achieve this aim, two temporary anchorage devices (TADs) were placed in the maxillary alveolar bone, and relatively passive elastic force was applied from the archwire to the TADs in order to prevent maxillary incisor extrusion during arch levelling. This elastomeric chain was maintained throughout the alignment and levelling of the maxillary dental arch.The patient had a Le Fort I osteotomy of the maxilla with differential posterior impaction and advancement, and mandibular forward autorotation and small setback of the mandibular body with bilateral sagittal split osteotomy, to achieve a Class I incisor and skeletal position. No vertical movement of the teeth was carried out or required following surgery. The patient was debonded 3 months following surgery and fitted with removable retainers.Cephalometric superimpositions demonstrated that no extrusion of the anterior maxillary dentition occurred, which is the main parameter to improve postoperative stability of the anterior open bite correction.ConclusionsTo improve the potential stability of anterior open bite correction with orthognathic surgery, TADs in the anterior maxillary alveolar bone region may be used with elastomeric chains to prevent any unintended and unplanned extrusion of the maxillary incisor teeth in the preoperative orthodontics.

BackgroundPatients with mandibular prognathism exhibit not only its characteristic maxillofacial morphology but also discrepancies in stomatognathic function, and understanding this morphology and function is vital for establishing a plan for surgical orthodontic treatment or providing guidance for recovery after orthognathic surgery. However, few studies have yet addressed the objective evaluation of masticatory function before and after surgical orthodontic treatment. In particular, the masticatory behaviors that show how you chew in your daily meals, including the number of chews, chewing rate, and posture during chewing, has not yet been fully studied in patients with mandibular prognathism. The aim of this study was to compare the masticatory behaviors of patients with mandibular prognathism with that of patients with individualized normal occlusion, to clarify the characteristics of masticatory behaviors in mandibular prognathism and to search for a relationship with maxillofacial morphology.MethodsParticipants were 23 patients (12 men, 11 women; mean age 17.9 years) with mandibular prognathism (patient group) and 23 patients (12 men, 11 women; mean age 24.4 years) with normal occlusion that had been achieved by orthodontic treatment (control group). Masticatory behaviors were measured by a wearable device fitted to each participant’s right ear. Parameters such as number of chews, chewing rate, number of chews per bite, mealtime, and head and neck posture were recorded, while participants consumed a 100-g rice ball. Body mass index, occlusal contact area, and lateral cephalograms were also measured, and their associations with masticatory behaviors were investigated.ResultsIn patient group, the number of chews was lower, mealtime was shorter, and the head and neck were tilted further forward. There was a significant positive correlation between overjet and anteroposterior head and neck posture and a significant negative correlation between overbite and anteroposterior head and neck posture.ConclusionDue to morpho/functional discrepancies in the stomatognathic system, patient group chewed fewer times and for a shorter time and leaned further forward while chewing. The characteristics of the masticatory behaviors of patients with mandibular prognathism identified in the present study may be helpful when devising plans for changing behavior before and after orthodontic treatment or orthognathic surgery.

BackgroundThe present systematic review intended to evaluate the current evidence on the modalities used for treating iatrogenic late paresthesia in the oral tissues innervated by the mandibular branch of the trigeminal nerve.Main textAs a common side effect of dental procedures, paresthesia can exert a profound adverse effect on patients’ quality of life. The inferior alveolar nerve (IAN) and lingual nerve (LN) have the highest chance of injury during several dental procedures, including mandibular orthognathic surgeries, implant placement, extraction of the third molar, anesthetic injections, flap elevation, and endodontic treatments. Moreover, several methods have been proposed for treating iatrogenic late paresthesia, including photobiomodulation (PBM), microsurgery, medication, and close observation until achieving spontaneous recovery of sensation. However, no gold standard treatment for iatrogenic paresthesia has been agreed upon up to now. The present study included a comprehensive search of the databases of PubMed, Embase, Scopus, and Web of Science up to December 04, 2023, resulting in a total of 3122 related studies. Then, the titles, abstracts, and full texts of the studies were evaluated. Ultimately, seven controlled randomized trials (RCTs) were included in the final analysis. Also, the risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Among all fields, randomization, allocation concealment, and data analysis were found to have the highest chance of bias in the included studies.ConclusionsIn conclusion, PBM, vitamin B12, and corticosteroids could accelerate the recovery of late paresthesia. However, considering the low sample size of the included studies and the high risk of methodological bias, it is recommended to perform further RCTs with robust study designs following Good Clinical Practice (GCP) guidelines to achieve more reliable results.

BackgroundSeveral osteotomies are required for orthognathic surgery to reposition the jaws correctly. This study aimed to evaluate whether Kinesiotaping can reduce swelling, pain, and trismus following orthognathic surgery of the facial skull.Materials and methodsThe present study consists of two phases. In the split-mouth phase, 16 skeletal class III patients underwent Bimax Orthognathic surgery, and Kinesiological tape (KT) was applied on one half of the face. In the prospective case–control phase, 30 patients were divided into two groups. Kinesio tape was applied on both sides of the face of the Kinesio group, and pressure dressing and ice therapy were used for the second group. The tape was parallel to the lower border of the mandible along its entire length, tangent to the labial commissure area on the studied side. The tape was placed in place for 5 days. Edema was evaluated by measuring the distance from the menton to the lower edge of the tragus. The maximum mouth-opening trismus was evaluated, and the VAS index was used to evaluate pain.ResultsThere was evidence of swelling reduction after KT; within the same study, differences between the left and right sides as well as for the same side were statistically significant (p < 0.001). As a result of tapping lymphatic Kinesio tape on the affected area, tension was reduced, and lymphatic circulation was restored. Blood and lymph microcirculation was improved, enabling the body to heal itself.ConclusionKinesio tape reduced swelling after orthognathic surgery in a positive way. As a simple, non-traumatic, economical method, Kinesio taping seems promising.

BackgroundMedication-related osteonecrosis of the jaw (MRONJ) is one of the complications caused by various drugs. As there are increasing reports of MRONJ, it is important to diagnose and identify patients who have the potential risk of the disease. The aim of this study was to analyze the systemic diseases, etiology, and treatment results of MRONJ.Material and methodsA total of 265 MRONJ operations were reviewed retrospectively. This study included patients who were diagnosed as MRONJ and those who also received surgery, ranging from simple extraction to reconstruction with free flaps, from 2009 to 2021. Each patient’s systemic disease and eitology and basic demographic information was taken into consideration.ResultsThe most common diseases related were osteoporosis (n = 127), breast cancer (n = 77), multiple myeloma (n = 27), prostate cancer (n = 26), and etc. (n = 12). The related causes of MRONJ were extraction (n = 138), implants (n = 40), and irritations by prosthesis (n = 29); however, 55 cases were occurred spontaneously. Out of 265 patients, 214 were women while 51 were men. The average age when the surgery took place was 67.7 and 69.8 years for male and female patients, respectively. Saucerization and sequestrectomy (n = 252) was the most common surgical treatment, followed by mandibulectomy (n = 12) and partial maxillectomy (n = 1). While 4 cases occurred in both jaws, 168 cases were in the mandible and 93 cases were in the maxilla.ConclusionNearly 50 % of the MRONJ patients had osteoporosis and the other patients who received bone targeting agents parentral had bone metastasis of various cancers. Extraction is the most common related event for MRONJ.

BackgroundMesiodentes are the most common supernumerary teeth. The cause is not fully understood, although proliferations of genetic factors and the dental lamina have been implicated. Mesiodentes can cause delayed or ectopic eruption of permanent incisors, which can further alter occlusion and appearance. Careful attention should be paid to the position and direction of the mesiodentes because of possible damage to adjacent roots in the permanent dentition period, errant extraction in the deciduous and mixed dentition periods, and damage to the permanent tooth embryo. To avoid these complications, we applied mixed reality (MR) technology using the HoloLens® (Microsoft, California). In this study, we report on three cases of mesiodentes extraction under general anesthesia using MR technology.ResultsThe patients ranged in age from 6 to 11 years, all three were boys, and the direction of eruption was inverted in all cases. The extraction approach was palatal in two cases and labial in one case. The average operative time was 32 min, and bleeding was minimal in all cases. No intraoperative or postoperative complications occurred. An image was shared preoperatively with all the surgeons using an actual situation model. Three surgeons used Microsoft HoloLens® during surgery, shared MR, and operated while superimposing the application image in the surgical field.ConclusionsThe procedure was performed safely; further development of MR surgery support systems in the future is suggested.

BackgroundMesenchymal stem cell (MSC) therapy gained interest among scientists following the discovery of its therapeutic potential. However, their clinical use has been hindered due to their immunogenicity and tumorigenicity. Relatively recently, it has been unveiled that the mechanism by which MSC promote healing is by secreting exosomes. This raised the interest in developing cell-free therapy, avoiding the obstacles that deterred the translation of MSC therapy into clinical practice.ReviewThis comprehensive narrative review summarises the current understanding of exosome biogenesis and content. Moreover, the existing research on exosome use in bone tissue engineering is discussed.ConclusionsExosome-based therapy may provide excellent potential in the field of bone tissue engineering and craniofacial reconstructive surgery. Further investigation is required before the technology can be translated into clinical practice.