The Most Influential Publications in Oral and Maxillofacial Surgery Over the Past Decade.

OBJECTIVE: Reliable metrics are needed to measure the impact of academic publications in order to fully understand and evaluate the contributions of articles published in the field of oral and maxillofacial surgery(OMFS). The aim was to identify and analyze the top 100 articles each year, with the highest Field-Weighted Citation Impact(FWCI) and citation counts, in the field of OMFS over the past decade, totaling 1,000 articles. MATERIALS AND METHODS: The research was conducted on April 20, 2024, using the Scopus database. It identified the top 100 articles each year with the highest FWCI from the top six journals with the highest metric scores in OMFS, totaling 1,000 articles. The citation counts of these publications in Google Scholar were also recorded. The predictor variable was the articles. The primary outcome variable was the FWCI value, while the secondary outcome variable was the number of citations. The covariates were the journals in which the articles were published, the publication year, the type of document, the type of access policy, and the subject of the research. RESULTS: There was a weak positive correlation between FWCI and citation count(rho=.083, P=.009). All covariates significantly affected FWCI(P<.005), while all but access policy significantly affected citation count(P=.167). The highest average FWCI(6.31±5.51) was observed in the Journal of Stomatology, Oral and Maxillofacial Surgery(JSOMS), and the highest citation count was found in the Journal of Oral and Maxillofacial Surgery(JOMS)(61.5±126.4). Orthognathic Surgery and Dentofacial Deformities were the scientific fields with the most publications(14%). COVID-19 and Artificial Intelligence had the highest FWCI(8.65±10.98 and 7.68±6.42, respectively). MRONJ had the highest average citation count(88.6±254). CONCLUSION: This study demonstrates that using both FWCI and citation count metrics can more accurately assess the impact of academic publications in the field of OMFS. These findings can serve as a guide for future research and contribute to strategic decisions aimed at improving clinical practices and patient care.

Evaluating the reproducibility and validity of maximal mouth opening measurement techniques.

OBJECTIVES: A limitation of the maximal mouth opening (MMO) is a frequent complication of oral (cancer) surgery. The measurement between the right central incisors is considered the golden standard for assessing MMO, although it has been noted to overestimate MMO in edentulous patients. This study aims to evaluate the reproducibility and validity of four MMO techniques and to determine the extent to which they are dependent on the remaining dentition. MATERIALS AND METHODS: Four methods for capturing the MMO were recorded in consecutive patients with mixed dentition. The degree of agreement between the different measurement methods was compared using Bland-Altman plots. To investigate the reproducibility of each method, intersession, interobserver and intraobserver reliability were calculated for measurements performed by two clinicians across two sessions. Two subgroups were created based on dentition: (A) cases missing at least one right central incisor, and (B) patients with both right central incisors present. RESULTS: All but one intraclass correlation coefficient (ICC) demonstrated excellent reproducibility (ICC > .9). The highest ICC values were found for the intraoral MMO(iMMO) and corrected intraoral MMO(ciMMO) method. A significant relationship between the MMO in both subgroups was identified only for the intraoral Range of Motion (iROM) method (p=.010*). CONCLUSION: The findings suggest that the current golden standard for measuring MMO does not adequately account for the absence of the right central incisor(s). Two of the proposed methods, which include corrections for missing incisors, should be incorporated into future clinical trials on MMO.

Desmoplastic Fibroma of the Gnathic Bones-A Systematic Review.

OBJECTIVE: To summarize published information about the desmoplastic fibroma of the gnathic bones into a descriptive analysis of the main features of this condition. MATERIAL AND METHODS: A systematic review according to the PRISMA guidelines was conducted. Electronic search was performed in four databases and in the gray literature. Case reports and case series were included. Frequencies were obtained for descriptive analysis. RESULTS: We identified 66 articles, for a total of 96 cases. Female patients (55.8%) in the first decade of life (40.6%) with a mean age of 18.2 years were more affected. The mandible was the most affected bone with 81.2% of the cases. The main clinical feature was painless swelling (54.2%). Most of the imaging examinations (radiological, computed tomography, and magnetic resonance) showed well-defined radiolucencies (65.4%) lesions. The treatment was surgical removal in all cases. The recurrence rate was 10.8% and all in the posterior mandible. Spindle cell fibroblasts in a collagenized stroma were often described in the histopathological features. Vimentin, smooth muscle actin, and ß-catenin were common immunohistochemical markers. CONCLUSION: Desmoplastic fibroma is a locally aggressive lesion that commonly affects the jaws in children. Histopathology is essential for diagnosis, and the pathogenesis of this tumor should be further investigated.

Efficacy of Two-Point Versus Three-Point Fixation for Zygomaticomaxillary Fractures: A Systematic Review and Meta-analysis.

Background: The zygomaticomaxillary complex (ZMC) functions as the main buttress for the lateral portion of the middle third of the facial skeleton and because of its prominent position & convex shape, it is frequently fractured, alone or along with other bones of the midface. The management of the ZMC fractures is debatable as the literature is saturated with various theories. A number of techniques, from closed reduction to open reduction and internal fixation can be effectively used to manage these fractures. Controversies lie right from the amount of fixation (mostly 2-, 3-point fixation) required to the ideal approach, and there is no conclusive view on its ideal line of management. Aim: To systematically review the existing scientific literature to determine whether two-point or three-point fixation is a better treatment alternative for the patients with zygomaticomaxillary fractures through a meta-analysis. Methods: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, Google scholar and Ebsco Host were searched from January 2000 to November 2023 for studies reporting treatment of zygomaticomaxillary fractures through two-point and three-point fixation and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included was evaluated using Cochrane risk of bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value < 0.05 as statistically significant. Results: Eleven studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only eight studies were suitable for meta-analysis. The pooled estimate through the standardized mean difference (SMD) of - 0.21 (- 0.83-0.41) favors two-point fixation employing random effect model with I2 (heterogeneity) value of 89% and p value 0.51. Publication bias through the funnel plot showed asymmetric distribution with systematic heterogeneity. Conclusion: In our systematic review, we aimed to evaluate which method of fixation is more effective in the treatment of zygomaticomaxillary complex fractures. Our pooled estimate using quantitative synthesis indicates that both two- and three-point fixation procedures are equally effective in the treatment of zygomaticomaxillary fractures. As a result, two-point fixation is as efficient as three-point fixation in treating zygomaticomaxillary complex fractures.

"Can Perioperative Intravenous Lidocaine Decrease Postoperative Pain After Oral and Maxillofacial Surgeries?": A Randomized Clinical Trial.

Purpose: To determine the efficacy of perioperative intravenous lidocaine in decreasing postoperative pain after oral and maxillofacial surgeries. Methods: Forty patients undergoing various oral and maxillofacial surgeries under general anesthesia were recruited in this prospective, randomized, double blinded controlled trial. Lidocaine group received Lidocaine 2.0%, whereas the control group received Normal saline 0.9% infusion. Pain intensity, sedation, vitals and side effects were assessed at 2 h, 4 h, 6 h, 12 h and 24 h postoperatively. Results: Twenty patients were assigned to each group. There were no significant differences between the groups for the study variables at baseline. The median Numeric Rating Scale (NRS) pain scores were higher in normal saline group than lidocaine group at 2 h, 4 h and 6 h and same at 12and 24 h; however, the differences were not statistically significant. Mean (± SD) analgesic consumed in lidocaine group was 47.37 (± 42.80) mg and 69.47(± 36.13) mg in saline group, which was not significant either. Similarly, no statically significant difference was observed for sedation and vitals at all the time intervals. Conclusion: Perioperative infusion of low dose lidocaine does not have significant effect on reduction in postoperative pain intensity and analgesic consumption, in patients undergoing oral and maxillofacial surgeries. Trail registered at clinicaltrials.gov (NCT03479320).

Coronectomy: A Knowledge, Attitude and Practice Survey (KAP) Among Oral and Maxillofacial Surgeons.

Introduction: Since mandibular third molars are frequently impacted, third molar extractions are among the most common procedures performed by oral surgeons (35.9-58.7% of all surgical procedures). Inferior alveolar nerve (IAN) injury is major postoperative complication in 0.81-22% of the cases leading to a permanent injury in 1-4% of the cases. Prior studies have proven that coronectomy, a procedure that involves the removal of the crown and coronal one-third of the roots of the third molar with intentional retention of the two-third apical roots to protect the IAN, can thus prove to be a viable alternative in such cases of close proximity to the IAN. Aim: This study was conducted in India to determine the knowledge, attitudes, and practices of oral and maxillofacial surgeons regarding coronectomy and its role in the prevention of IAN injury. Methodology: The questionnaire entitled: "Coronectomy: A Knowledge, Attitude and Practice (KAP) Survey among Oral and Maxillofacial Surgeons" was sent to 120 oral and maxillofacial surgeons. Five questions in each domain, i.e., knowledge, attitude, and practice were designed to know the level of awareness, acceptance, and current status of the performance of coronectomy among oral and maxillofacial surgeons (OMFS). Teeth with acute infection and mobile teeth were excluded from the consideration of coronectomy procedures. Results: Out of the 120 questionnaires sent, 50 responses were obtained, thus producing a response rate of 41.6%. The male-to-female ratio in the study was 34:16. 52% of the surgeons had performed up to 5 coronectomies during their entire practice, while 16 % had never even attempted the procedure. Only 42% of the respondents preferred coronectomy, but most of the surgeons were in support of practice-oriented continuing.

Role of Whey Protein in the Treatment Outcome of Maxillofacial Trauma Patients: An Interventional Study.

Introduction: Maxillofacial fracture severely affects the diet of the patients leading to reduction of body weight. Facial trauma affects the muscles of mastication and the bones of face leading to reduction in bite force. The purpose of our study was to investigate the effect of whey protein supplement in the postoperative period of maxillofacial trauma patients with respect to body weight, bite force and callus formation. Methodology: Patients were divided into control group and study group having 20 patients each. The control group received usual modified diet for maxillofacial fracture and study group received same diet along with whey protein for 6 weeks. Results: There was mean weight loss of 3.15 kg in control group whereas there was no weight loss of in the study group. There was statistically significant increase in bite force in the study group compared to the control group with p value < 0.05. Early callus formation was seen in study group compared to control group. Conclusion: Our results showed that patients who were supplemented with whey protein had no loss of body weight, better masticatory efficiency, better healing of the fracture sites and overall early recovery.

Involvement of the Oral Mucosa by Ingestion of Caustic Substances due to a Suicide Attempt and Its Treatment with the Use of Photobiomodulation: Report of Two Cases.

Suicide is a major public health challenge worldwide, affecting both classes, sex and ages. The WHO estimates that 700,000 people die from this condition worldwide. With the onset of the pandemic, they believe that these numbers have increased, affecting mainly the most vulnerable. The ingestion of caustic substances is one of the most used means in suicides with significant damage to the oral cavity and gastrointestinal tract, in which the dental surgeon is the professional who must provide care for the treatment and oral rehabilitation in these cases. Thus, due to the scarcity of studies, we aim to report two cases of attempted self-extermination with the ingestion of caustic substances that caused great damage to the oral cavity and the care carried out in the intensive care unit, using oral care protocols associated with photobiomodulation with expressive results. We carried out the treatment in the intensive care unit with photobiomodulation, using low-power laser therapy, obtaining significant responses with an average time of four sessions of application of the protocol. We believe that because these are cases of high complexity and high mortality and morbidity rates, the presence of well-defined and applied protocols provides benefits to these patients.

Analyzing the Burden of Midface Fractures Due to Road Traffic Accidents in Vietnam: An Epidemiological Approach.

BACKGROUND: Road traffic accidents have significantly impacted public health in Vietnam. This study investigated the patterns of midface fractures in Vietnam and their correlation with road traffic accidents in the country. METHODOLOGY: This retrospective cross-sectional study reviewed 2187 medical records of patients with midface fractures in Ho Chi Minh City. After applying exclusion criteria, the fractures were categorized. Statistical analyses, including chi-squared and logistic regression, were conducted to identify associations and relationships among the types and causes of fractures. RESULTS: The study found that 89.3% of midface fractures stemmed from road traffic accidents, with 55.2% and 14.4% zygomatic complex fractures and Le Fort type II fractures, respectively. Adults aged 19-39 accounted for 65.1% of patients, with males at 80.5%. Traffic accidents were significantly associated with an 18.7 times higher risk of concomitant mandibular fractures and a 10.5 times higher risk of Le Fort type II fractures, irrespective of age and gender. CONCLUSION: This study underscores the need for targeted prevention strategies to decrease the incidence of maxillofacial injuries resulting from road traffic accidents in Vietnam, particularly among high-risk groups such as males and young adults.

Prenatal ultrasound diagnosis of fetal maxillofacial teratoma: Two case reports.

BACKGROUND: Facial teratoma is a rare benign tumor that accounts for about 1.6% of all teratomas and can be diagnosed by prenatal ultrasound (US). The purpose of this report was to describe our experience with the diagnosis of fetal facial teratoma by prenatal US at second trimester to provide a reference for clinical diagnosis of fetal maxillofacial teratoma. CASE SUMMARY: We present two cases of patients with abnormal fetal facial findings on US at second trimester of pregnancy in our department. Case 1 was a 31-year-old G3 P1 + 1 female, with US revealing a heterogeneous echogenicity of 32 mm × 20 mm × 31 mm on the fetal face, most of it located outside the oral cavity and filling the root of the oral cavity. Case 2 was a 29-year-old G1P0 female, with fetal head and neck US revealing a cystic-solid echo mass measuring 42 mm × 33 mm × 44 mm, the upper edge of the lesion reaching the palate and filling the oral cavity. The contours of the lesions were visualized using three-dimensional (3D) US imaging. Both patients decided to give up treatment. Biopsies of the lesions were performed after induction of labor, and diagnosed as maxillofacial teratoma. CONCLUSION: Fetal maxillofacial teratomas can be diagnosed by US in early pregnancy, allowing parents to expedite treatment decisions.

Effects of frailty on patients with oral and maxillofacial space infection: a retrospective analysis.

OBJECTIVES: To investigate the implications of frailty as a predictive factor for outcomes among patients with oral and maxillofacial space infection. METHODS: A retrospective cohort study was conducted to analyze 348 medical records, gathering data on several key aspects. These included the etiology of infection, the location of inflamed areas, the treatment administered, and the ultimate treatment outcomes. Additionally, the study collected information on the Symptom Severity (SS) score, frailty score, age, gender, the presence of systemic diseases, alcohol consumption, and smoking history. RESULTS: A total of 155 patients were classified as frailty, while 193 patients were classified as non-frailty. We found a significantly different in age, BMI, hospitalization expenses, length of hospital stay, SS, fibrinogen and admission to ICU between the frail group and the non- frail group. CONCLUSIONS: Frailty serves as a valuable predictor of outcomes among patients with oral and maxillofacial space infections. By identifying high-risk patients, frailty can be employed as a clinical tool to guide perioperative care, ultimately optimizing patient outcomes. Notably, frail patients often require more ICU treatment.

Head, face and neck injury patterns for electric scooter accidents identified on computed tomography scanning: Does legislative change enforcing safer riding practices have an impact on morbidity for significant head, face and neck trauma?

INTRODUCTION: The purpose of this study is to review whether legislative change enforcing safer riding conditions for Electric Scooters (E-Scooter), regardless of other factors, had an impact on reducing significant head, facial and neck trauma. Additionally, to identify the radiological injury patterns for head, face and neck injuries identified on CT imaging for a patient's initial presentation to the emergency department (ED) resulting from an E-Scooter accident. METHODS: A retrospective single-centre observational study at a metropolitan tertiary ED of patients presenting after an E-Scooter accident comparing 6 months before and after legislative change. RESULTS: Four hundred and forty-three patients presented following an E-Scooter accident: 191 patients 6 months before and 252 patients 6 months after legislative change. One hundred and sixty-two patients pre- and 217 patients post-legislative change had negative CT studies. Twenty-nine patients pre- and 35 patients post-legislative change had CT studies demonstrating significant head, face or neck trauma. The most common type of intracranial bleeding was subarachnoid haemorrhage followed by subdural haemorrhage with a significant proportion (41%) presenting with multi-factorial intracranial bleeding. There was no specific injury pattern involving the cranial vault or cervical spine. Of the patients presenting with a significant injury, facial bones were the most common injury site (84% (n = 54)). The most common site of facial fractures was the nasal bones followed by dental trauma and maxillary fractures. CONCLUSION: This single-centre, retrospective observational study has shown no reduction in serious head, neck and facial injuries. Large-scale, multicentre studies will need to be undertaken to understand the true impact of legislative change.

Development and validation of a robotic system for milling individualized jawbone cavities in oral and maxillofacial surgery.

OBJECTIVES: This study aimed to develop and validate a robotic system capable of performing accurate and minimally invasive jawbone milling procedures in oral and maxillofacial surgery. METHODS: The robotic hardware system mainly includes a UR5E arm (Universal Robots, Denmark) and the binocular positioning system (FusionTrack 250, Atracsys LLC, Switzerland). The robotic software (Dental Navi 3.0.0, Yakebot Technology Ltd., China) is capable of generating cutting tool paths based on three-dimensional shape description files, typically in the stereolithography format, and selected cutting tool parameters, as well as designing surgical accessories. Fully impacted supernumerary tooth models in the maxilla were fabricated using software and three-dimensional printing. Following the planning of a customized cavity to fully expose the tooth, maxillary bone milling was performed on both the robot and static guide groups (n = 8). After milling, all models underwent scanning for assessment. RESULTS: In the experiment with fully buried supernumerary tooth models in the maxilla, the root mean square, translation error, over-removal rate, and maximum distance were significantly smaller in the robot group compared to the static guide group. Moreover, the overlap ratio and Dice coefficient were significantly greater in the robot group. No statistically significant differences were observed between the two groups in terms of the rotation error (P = 0.80) or under-removal rate (P = 0.92). CONCLUSIONS: This study has developed a robotic system for milling individualized jawbone cavities in oral and maxillofacial surgery, and its accuracy has been preliminarily verified to meet clinical requirements. CLINICAL SIGNIFICANCE: The robotic system can achieve precise, minimally invasive, individualized jawbone milling in a variety of oral and maxillofacial surgeries, including tooth autotransplantation, surgical reshaping for zygomatic fibrous dysplasia, removal of fully impacted supernumerary or impacted teeth, and endodontic microsurgery, among other relevant clinical applications.

Role of Oral Veillonella Species in Predicting Surgical Site Infections After Maxillofacial Trauma: A Prospective Observational Study.

INTRODUCTION: There are comparatively fewer surgical site infections after craniofacial trauma than after trauma to the extremities, and the etiology is complex. Gram-negative facultative anaerobic bacteria Veillonella is a common commensal in the oral cavity and has been linked to osteomyelitis and surgical site infections in prosthetic joint infections. They serve as early biological indicators. AIMS/OBJECTIVES: This study aims to assess the presence of Veillonella in patients presenting with maxillofacial trauma, to document the difference in colony count in patients requiring surgical intervention at different time intervals as against patients with surgical site infections, and to provide better hospital care and management so as to improve the standard of care with an attempt to prevent the possibility of postoperative surgical site infections. METHODOLOGY: In this study, individuals with trauma/fractures of the maxillofacial region requiring surgical intervention at varied time spans, early, intermediate, and late, were included. After obtaining informed consent, the examination was done; the fracture type and site were noted, and a swab was taken on the day of admission, on the day of surgery, and on the day of discharge and given for microbiological evaluation. Findings were recorded. RESULTS: The primary and secondary objectives of the study were established. The mean colony count in colony-forming units/milliliter for patients undergoing early surgical intervention, on the day of admission, was 2.01E+0.6. On the day of discharge, the mean colony count was 1.51E+0.6. In contrast, for patients with surgical site infection, on the day of admission, the mean was 6.5E+0.7, and on the day of discharge, the mean colony count reduced to 4.01E+0.6. The time-colony-forming unit graph showed a difference in the colony count of Veillonella in patients operated at different time intervals as against patients with surgical site infection and modified relation with a number of other oral commensals. The colony count in patients with osteomyelitis was found and compared. CONCLUSION: There is a change in the colony count of Veillonella species and its relation to their commensals when intervened at different time intervals. Our study indicates that the estimation of Veillonella species and the colony count could aid in determining the possibility of a surgical site infection. This study also stresses on the appropriate reporting of maxillofacial trauma in cases of a poly-trauma for appropriate management.

The Impact of Standing Electric Scooters on Maxillofacial Fractures: An Italian Multi-Centric Epidemiological Study.

Objectives: This study aimed to determine the impact of standing electric scooters on maxillofacial on the Italian territory. Methods: The authors analyzed the epidemiology of the injuries to define electric mobility's impact on maxillofacial surgery practice. For this retrospective cohort study, data were collected by unifying the standing e-scooter-related fractures database from 10 Italian maxillofacial surgery departments. The reference period considered was from January 2020 to December 2023. The main data considered included age, gender, type of access, time slot of admission, type of admission, alcohol level, helmet use, dynamics of the accident, and area of the fracture. Results: A total of 79 patients were enrolled. The average age of the participants was approximately 31 years. The blood alcohol level was found to be above the Italian norm in 15 cases (19%). Only one patient wore a helmet. The most affected facial third was the middle one with 36 cases (45.5%), followed by the lower one (31, 39.3%). The most recurrent patterns were fractures of the orbito-malar-zygomatic complex (15, 19%), followed by multifocal (bifocal, trifocal) fractures of the mandible (14, 17.5%). Conclusions: This study demonstrated how maxillofacial fractures related to the use of electric scooters are associated with complex patterns, associated with a high rate of post-surgical aftermaths.

Intraoral Scanning Enables Virtual-Splint-Based Non-Invasive Registration Protocol for Maxillofacial Surgical Navigation.

Background/Objectives: Surgical navigation has advanced maxillofacial surgery since the 1990s, bringing benefits for various indications. Traditional registration methods use fiducial markers that are either invasively bone-anchored or attached to a dental vacuum splint and offer high accuracy but necessitate additional imaging with increased radiation exposure. We propose a novel, non-invasive registration protocol using a CAD/CAM dental splint based on high-resolution intraoral scans. Methods: The effectiveness of this method was experimentally evaluated with an ex vivo 3D-printed skull measuring the target registration error (TRE). Surgical application is demonstrated in two clinical cases. Results: In the ex vivo model, the new CAD/CAM-splint-based method achieved a mean TRE across the whole facial skull of 0.97 ± 0.29 mm, which was comparable to traditional techniques like using bone-anchored screws (1.02 ± 0.23 mm) and dental vacuum splints (1.01 ± 0.33 mm), while dental anatomical landmarks showed a lower accuracy with a mean TRE of 1.84 ± 0.44 mm. Multifactorial ANOVA confirmed significant differences in TRE based on the registration method and the navigated level of the facial skull (p < 0.001). In clinical applications, the presented method demonstrated high accuracy for both midfacial and mandibular surgeries. Conclusions: Our results suggest that this non-invasive CAD/CAM-splint-based method is a viable alternative to traditional fiducial marker techniques, with the potential for broad application in maxillofacial surgery. This approach retains high accuracy while eliminating the need for supplementary imaging and reduces patient radiation exposure. Further clinical trials are necessary to confirm these findings and optimize splint design for enhanced navigational accuracy.

Personalized Temporomandibular Joint Total Alloplastic Replacement as a Solution to Help Patients with Non-Osteosynthesizable Comminuted Mandibular Head Fractures.

Background: Treatment methods for mandibular head fractures are controversial, although effective techniques for open reduction and rigid fixation (ORIF) have been known since the late 1990s. Notably, some forms of posttraumatic comminution of the mandibular head can be reduced or fixed. Methods: This study presents a personalized treatment to cure patients with nonreduced comminuted fractures of the mandibular head: total temporomandibular joint alloplastic replacement (18 patients). The reference group included patients who underwent ORIF (11 patients). Results: Personalized alloplastic joint replacements resulted in a more stable mandibular ramus after three months compared with ORIF. Conclusions: The authors recommend not performing osteosynthesis when the height of the mandibular ramus cannot be stably restored or when periosteal elevation from most of the mandibular head is necessary for ORIF. Personalized TMJ replacement should be considered in such patients. Personalized medicine allows patients to maintain a normal mandibular ramus height for a long period of time.

Outcomes of non-surgical management of non-condylar mandibular fractures: a systematic review and meta-analysis.

Surgical intervention utilising open and (less commonly) closed reduction, are the main methods for the management of fractures of the mandible that do not involve the condyle or coronoid. Non-surgical management of these fracture patterns is rare. This systematic review aimed to collate current evidence surrounding this topic. A systematic review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were adults with mandibular fractures. Exclusion criteria included any form of surgical intervention including open or closed reduction, and fractures of the condyle or coronoid. Four studies satisfied the eligibility criteria and comprised 80 patients. A total of 69 patients (86%) who were managed non-surgically produced satisfactory clinical outcomes with no surgical intervention required. The evidence suggests that non-surgical management can successfully avoid surgery in most cases when certain criteria are applied. This has huge health economic implications as it reduces morbidity and requirements for theatre and inpatient stay. Further research is required to establish which fracture patterns are most amenable to this approach, the most effective non-surgical instructions, and the recommended follow-up period.

Solitary Myofibroma of the oral and maxillofacial regions in pediatric patients: A clinicopathological analysis of ten patients and review of 75 cases.

BACKGROUND: The imaging manifestations of oral and maxillofacial myofibroma/myofibromatosis can vary among patients. Although many clinical cases have been reported, a consensus on the clinicopathological features of and treatment principles for this disease is lacking. PURPOSE: This study aimed to summarize the clinicopathological features of solitary myofibroma of the oral and maxillofacial regions in pediatric patients. METHODS: The clinical data, histological features, and immunohistochemical characteristics of ten pediatric patients who underwent surgical removal and subsequent pathological diagnosis of myofibroma were collected and retrospectively and cross-sectionally analyzed. RESULTS: Seven patients were male, and 3 were female, with ages ranging from 3 months to 6 years (mean: 2.6 years). The patients presented with solitary lesions involving the mandibular gingiva and adjacent mandible (4 patients), mandible (2 patients), oral floor and submandibular area and adjacent mandible (1 patient), gingiva (1 patient), maxilla (1 patient), and oropharynx (1 patient). Light microscopy revealed spindle-shaped tumor cells organized in bundles or vortex patterns, forming a hemangiopericytoma-like perivascular pattern, whereas immunohistochemical staining revealed diffuse smooth muscle actin (SMA) positivity. All patients underwent surgical resection, and none experienced recurrence over the 12- to 82-month follow-up. CONCLUSIONS: Solitary myofibroma in the oral and maxillofacial regions is predominantly observed in infants and young children, with a higher incidence among males. The prognosis is favorable following localized lesion resection or curettage of jawbone lesions. Accurate recognition of the clinical, radiological, and pathological features of the disease will reduce the misdiagnosis rate.