Advantages of virtual planning in reconstructive surgery of bone defects in the maxillofacial region.

OBJECTIVES: Our analysis focuses on the advantages of virtual surgical planning (VSP) compared to a conventional treatment method as well as on a wider range of parameters influencing the surgical procedure, postoperative care, morbidity and lastly, the survival rate of these patients. BACKGROUND: Patients with extensive bone defects of different etiologies of the upper or lower jaw who underwent complex reconstructive surgery with a free fibula flap (FFF). METHODS: We retrospectively analyzed data from a total of 34 patients (12 female and 22 male) whose defects were reconstructed with an osteomyocutaneus FFF. The data were collected over a period of 6 years from 2017 to 2023. We divided the patients into two groups, namely those who underwent conventional surgical treatment (5 patients) and those who underwent computer­planned surgical treatment (29 patients). RESULTS: The duration of surgery showed a significant difference between the VSP group and the conventional group (t(32) = 3.316; p < 0.01), with the VSP group having a significantly shorter surgery time (M= 8:10; SD = 1:18) compared to the conventional group (M = 10:52; SD = 2:41). The independent t-test revealed significant differences between the VSP group (M = 45.967; SD 14.548) and conventional group (M = 17.61; SD = 24.996) for the dose of unfractionated heparin per kilogram administrated immediately after vascular micro anastomosis (t(32) = -3.609; p < 0.001). CONCLUSION: Among all the risk factors, administering a higher unfractionated dosage of heparin administered immediately after completing the anastomosis was identified as a significant predictor of postoperative complications. Using VSP in cases of advanced stage head and neck malignancy for salvage surgery is highly recommended. Shorter duration of these comprehensive surgeries in the VSP group leads to a significantly favorable outcome (Tab. 2, Fig. 2, Ref. 19). Text in PDF www.elis.sk Keywords: virtual planning, microvascular flap, maxillofacial, free fibula flap, reconstructive surgery.

Does orthognathic surgery affect mandibular condyle position? A retrospective study.

PURPOSE: The aim of this study is to analyze mandibular condyle position changes after bilateral sagittal split osteotomy (BSSO) and bimaxillary orthognathic surgery in patients operated at a single department by two surgeons in 2013-2022. Compared were groups of mandibular advancement vs setback and bimaxillary vs BSSO. METHODS: Ninety-nine subjects were included. Inclusion criteria were patients who underwent one of the BSSO or bimaxillary surgery and had CT scans performed before and after surgery. Preoperative CT scans were performed 1 day before surgery and postoperative CT scans 6-12 months afterwards. Changes in mandibular condyle position were measured in axial and sagittal planes. RESULTS: CT condylar position measurements indicated significant postoperative changes in AB angle bilaterally (p = < 0.001). In mandibular advancement and setback comparison, values were significantly lower in ABL angle values in the setback group (p = 0.011326) and significantly higher in FDR in the advancement group (p = 0.005795). There were no statistically significant changes found in BSSO and bimaxillary group comparison. CONCLUSION: Within the limitations of this study, it can be concluded that orthognathic surgery does have a moderate effect on position of the condyles, especially condylar rotation in transversal axis.

Near infrared spectroscopy in monitoring of head and neck microvascular free flaps.

OBJECTIVES: Microvascular free­flap monitoring is crucial to the early detection of flap failure and increases the chance of early intervention in case of disruption of perfusion to a flap. Many clinical alternatives to classical clinical flap monitoring have been proposed, such as color duplex ultrasonography, handheld Doppler, flap thermometry, or implantable Doppler flowmetry. Early detection of critical changes in tissue oxygenation can lead to successful surgical intervention when problems with flap nutrition arise. METHODS: Our clinical study seeks to investigate dynamic monitoring of free flaps with near­infrared spectroscopy (NIRS). NIRS is a non-invasive instrumental technique used for continuous monitoring of peripheral tissue oxygenation (StO2) and microcirculation. All patients were included prospectively from one clinical center. RESULTS: During the clinical research period, 18 patients underwent extraoral head and neck reconstruction with one of three types of free flap, namely with radial forearm free flap (RFFF), anterolateral thigh flap (ALT) or fibula free flap (FFF). Measurements of flap perfusion were taken using NIRS during intraoperative and postoperative phases for 71 hours on average. A total of 6 perfusion disorders were recorded, of which three originated from microanastomoses and three from postoperative bleeding and compression of pedicle. NIRS showed characteristic changes in all 6 cases that were returned to the operating theatre owing to pedicle compromise. In these cases, NIRS had detected the pedicle compromise before it was clinically identified. A single StO2 monitoring was able to detect the vascular compromise with 100% sensitivity and 95.65% specificity. None of the cases were falsely positive. In our study, all compromised flaps were accurately identified by means of NIRS. In most cases, the changes in oxygen saturation became evident on NIRS prior to being clinically observed. CONCLUSION: In our study, the continuous NIRS monitoring securely detected the early stages of arterial and venous thromboses or pedicle compression. The most important aspects of monitoring the flaps´ microvascular perfusion and vitality by means of NIRS lie in its function of recording the dynamics of changes in the values ​​of absolute oxygen saturation (StO2> 50%) alongside with detecting a 30% decrease in tissue saturation over a 60­minute interval (60 min StO2 >30%) before the clinical changes in the microvascular flap become observable. In cases of pedicle compression, the average time of appearance of signs of StO2 values dropping below the reference interval (as detected by NIRS) was 1:29:02 hour (SD= 0:58:42 h) prior to the occurrence of any clinical signs, while in cases of microvascular anastomosis complications, it was 0:35:23 hour (SD=0:08:30 h)  (SD = 0:08:30 h) (Tab. 3, Fig. 7, Ref. 42).

Sialendoscopy in treatment of obstructive sialadenitis.

OBJECTIVES: Sialendoscopy is a relatively new mini-invasive method that allows direct visualisation and intervention in the salivary gland ductal system. The aim of the study was to evaluate the results of sialendoscopy in the treatment of obstructive sialadenitis. MATERIALS AND METHODS: This is a 15-year retrospective study analysing the treatment results of patients treated in the period of 2007-2022 at the Department of Oral and Maxillofacial Surgery, Comenius University Bratislava, Slovakia. RESULTS: The total number of performed sialendoscopies was 70, of which 44 (62.9 %) were performed on the submandibular gland and 26 (37.1 %) on the parotid gland; 46 procedures (65.7 %) were performed via natural ductal system opening without the need for surgical assistance while 24 sialendoscopies (34.3 %) required surgical assistance. The most frequent perioperative findings were the sialoliths (37) in quantities ranging from one to four. Non-calculi pathologies (23) included mucous plugs, strictures, plaque, erythema or foreign bodies. No pathology was found on 10 sialendoscopies. In 82 % (n = 55) of patients, sialendoscopy prevented the salivary gland from being excised. In 18 % (n = 12) of cases, sialendoscopy findings indicated that salivary gland excision was needed. CONCLUSION: The study acknowledges the significant benefit of sialendoscopy in the treatment of obstructive sialadenitis (Tab. 3, Fig. 6, Ref. 39). Text in PDF www.elis.sk Keywords: sialendoscopy, sialadenitis, duct obstruction, sialolith, minimally invasive surgery.

Rare Location of a Dermoid Cyst in the Parotid Gland: A Case Report.

Dermoid cyst of the parotid gland is a lesion composed of benign tissues of ectodermal and mesodermal origin. Although a dermoid cyst can be encountered across nearly all sites of the body, its location in the head and neck area is quite uncommon and even more unusual inside the parotid gland. We present a case of a patient with gradually enlarging tumour in her right parotid gland who underwent surgical removal of the tumour histologically corresponding to a dermoid cyst.

Where Is the Artificial Intelligence Applied in Dentistry? Systematic Review and Literature Analysis.

This literature research had two main objectives. The first objective was to quantify how frequently artificial intelligence (AI) was utilized in dental literature from 2011 until 2021. The second objective was to distinguish the focus of such publications; in particular, dental field and topic. The main inclusion criterium was an original article or review in English focused on dental utilization of AI. All other types of publications or non-dental or non-AI-focused were excluded. The information sources were Web of Science, PubMed, Scopus, and Google Scholar, queried on 19 April 2022. The search string was "artificial intelligence" AND (dental OR dentistry OR tooth OR teeth OR dentofacial OR maxillofacial OR orofacial OR orthodontics OR endodontics OR periodontics OR prosthodontics). Following the removal of duplicates, all remaining publications were returned by searches and were screened by three independent operators to minimize the risk of bias. The analysis of 2011-2021 publications identified 4413 records, from which 1497 were finally selected and calculated according to the year of publication. The results confirmed a historically unprecedented boom in AI dental publications, with an average increase of 21.6% per year over the last decade and a 34.9% increase per year over the last 5 years. In the achievement of the second objective, qualitative assessment of dental AI publications since 2021 identified 1717 records, with 497 papers finally selected. The results of this assessment indicated the relative proportions of focal topics, as follows: radiology 26.36%, orthodontics 18.31%, general scope 17.10%, restorative 12.09%, surgery 11.87% and education 5.63%. The review confirms that the current use of artificial intelligence in dentistry is concentrated mainly around the evaluation of digital diagnostic methods, especially radiology; however, its implementation is expected to gradually penetrate all parts of the profession.

Three-dimensional navigation in maxillofacial surgery - the way to minimize surgical stress and improve accuracy in fibula free flap and Eagles syndrome surgical procedures.

BACKGROUND: Surgical navigation with three-dimensional (3D) printing techniques presents two major advantages: First, from a technical aspect, it facilitates orientation in target anatomical structures resulting in improvement of the accuracy of surgery. Moreover, it shortens the time of complex surgical interventions by preparing the exact position of customized autologous grafts with fixation devices. Second, from a clinical point of view, it also lessens the impact of surgical stress to adjacent tissues by decreasing the duration of surgery. MATERIAL AND METHODS: Two maxillofacial procedures were evaluated in this study using 3D navigation and planning approach - resection of the styloid process due to Eagles syndrome and microvascular mandibular reconstruction with the fibula free flap. All patients who underwent these procedures were divided into two groups (with or without 3D navigation). RESULTS: In the Eagles syndrome group procedure independent t-test showed  significant difference in the operating time between group 1 (M = 148; SD = 0) and group 2 (M = 78; SD = 4.24) t (1) = 13.472; P = 0.047. There was no significant difference in the duration of postoperative hospitalization (2 days), which was equal in all patient groups. Regarding the fibula free flap procedure, the independent t-test revealed significant difference in operating time with (M = 8: 40 : 25; SD = 0 : 58 : 07) and without 3D printing guides (M = 10 : 43 : 15; SD = 3 : 04 : 32) t (14)=2.133, P = 0.051. Similarly, there was no significant difference between groups (group 1 M = 15.5; SD = 0,71; group 2 M = 13; SD = 1,63) in the duration of postoperative hospitalization time t (4) =1,98; P = 0.119. CONCLUSION: In summary, reduction in operation time in Eagles syndrome and in microvascular mandibular reconstruction with the fibula free flap group mitigates the surgical stress on target tissues enabling faster tissue healing and quicker recovery.

The Syndrome of Elongated Styloid Process, the Eagle's Syndrome-From Anatomical, Evolutionary and Embryological Backgrounds to 3D Printing and Personalized Surgery Planning. Report of Five Cases.

Background and Objectives: The symptoms of Eagle's syndrome are associated with the elongated styloid process of the temporal bone or calcification of the stylohyoid ligament. The first mention of pain syndrome associated with the elongated styloid process dates back to 1937, when it was described by Watt Weems Eagle. Over the last decade, experts in the field have shown a lively interest in the issue of the relationship between the elongated styloid process and various symptoms. This article presents the correlation between the clinical signs of Eagle's syndrome and alterations in surrounding anatomical structures. It includes a brief review of the evolutionary, embryological and clinical anatomical background of the elongated styloid process. Materials and Methods: Between 2018 and 2019, five patients were admitted to our workplace with 1-3-year history of bilateral or unilateral throat pain, otalgia and pharyngeal foreign body sensation. As a therapeutic novelty in the surgical approach to this condition, we used individual 3D printed models to measure and identify the exact location of the resection of the styloid process without damaging the surrounding anatomical structures, such as the facial, accessory, hypoglossal, and vagal nerves; the internal jugular vein; and the internal carotid artery. Results: Compared to traditional surgical methods without 3D models, 3D models helped to better identify cutting edges and major landmarks used in surgical treatment of Eagle's syndrome. Printed models provided assistance with the exact location of the styloid process resection position without damaging the surrounding anatomical structures such as the facial, accessory, hypoglossal, and vagal nerves; the internal jugular vein; and the internal carotid artery. Conclusion: In our clinical report, we used 3D printed models for navigation and planning during surgical procedures involving resections of the elongated styloid process. Additionally, we can formulate a new hypothesis: the elongated styloid process is a form of atavism of the bony hyoid apparatus in our evolutionary ancestors that is evolutionarily encoded or arises from disrupted degeneration of the middle portion of embryonal Reichert´s cartilage of the second pharyngeal arch. Under normal conditions, this portion does not ossify but degenerates and transforms into a connective tissue band, the future stylohyoid ligament.