Journal of the Korean Association of Oral and Maxillofacial Surgeons
- P-ISSN2234-7550
- E-ISSN2234-5930
- SCOPUS, KCI, ESCI
ISSN : 2234-7550
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e-SubmissionVol.50 No.6
Abstract
In recent years, many advances have been made in surgical fields of oral and maxillofacial reconstruction, and the variety and complexity of available surgical approaches consider different functionalities of the jaw and the aesthetics of the face. There is no validated or scientifically proven basis for deciding which flap to use for reconstruction, so decisions are often made based on the direct and indirect experiential knowledge of the reconstructive surgeon. Considering the modified ladder, elevator, and pie reconstructive options, their risk and donor morbidity, and their long-term outcomes, the simplest option that will achieve the best long-term outcome in terms of form and function and with the lowest donor morbidity should be chosen for the patient’s health and social welfare. This manuscript summarizes current options for jaw and facial reconstruction and their limitations by offering updated guidelines for various defect conditions.
Abstract
Objectives: This study is a retrospective analysis of patients who visited the emergency room (ER) following dental treatment over a period of 3 years, with the aim to enhance the understanding of emergency situations that may arise after dental procedures and to develop appropriate postoperative management and emergency care methods. Patients and Methods: A total of 796 emergency patients whose visits were attributed to dental procedures, of 4,241 patients who visited the ER at Pusan National University Yangsan Hospital from January 2021 to January 2024, was included in the study. Patients were categorized based on the reason for visit into bleeding, inflammation, and other categories. Analysis was conducted on variables such as types of dental treatment, underlying conditions, and emergency treatment methods using ER records. Results: Among the 796 patients, 68.4% (539 patients) were in the bleeding group, 27.7% (219 patients) in the inflammation group, and 4.8% (38 patients) in the other complications group. Among the bleeding group, there were no associations between postoperative bleeding and systemic diseases, antithrombotic medications, or dental treatments. In 36.2% of cases, compression hemostasis alone was sufficient to resolve the bleeding. In the inflammation group, 29% of the cases required extraoral incision and drainage as emergency treatment, while 53% of the cases required subsequent hospitalization. Factors associated with hospitalization included underlying diseases (especially diabetes mellitus), procedures on mandibular teeth (especially third molars), and age older than 30 years. Conclusion: Ensuring adequate hemostasis after dental procedures is essential regardless of the patient’s underlying medical conditions. Dentists must also educate patients on pressure hemostasis techniques. Patients with underlying medical conditions, such as diabetes, have a higher possibility of requiring hospitalization if inflammation occurs. Therefore, preventive measures against inflammation should be implemented in these patients.
Abstract
Objectives: The aim of this study was to evaluate oral hygiene using quantitative light-induced fluorescence (QLF) and to compare its results with those of oral examination to determine the applicability of QLF technology for assessing oral health status and oral hygiene in intensive care unit (ICU) patients. Materials and Methods: We analyzed oral health status, oral examination findings, oral hygiene evaluations using QLF technology, and dry mouth in a sample of 70 hospitalized ICU patients. The relationship between oral hygiene assessments using QLF technology and oral examinations was analyzed using Pearson correlation coefficients. Results: The average participant age was 62.16 years, and the average ICU hospitalization period was 144.94 days. Oral hygiene assessments based on QLF and examination showed a significant positive correlation with the red fluorescence intensity of oral biofilm and number of teeth requiring extraction. Conclusion: Oral hygiene evaluations of hospitalized ICU patients using QLF technology were confirmed and classified based on the red fluorescence intensity of oral biofilm. Increases in red fluorescence intensity and distribution area were correlated with the number of teeth requiring extraction.
Abstract
Objectives: The objective of this study was to evaluate the long-term clinical outcomes of one-piece narrow-diameter implants (NDIs), with diameters of 2.5 mm and 3.0 mm, and to investigate the factors that affect marginal bone loss (MBL) around these implants. Materials and Methods: This study analyzed patients who were treated with 2.5 mm and 3.0 mm MS SA narrow ridge implants (Osstem Implant) at the Section of Dentistry in Seoul National University Bundang Hospital from 2007 to 2022 and had more than 6 years of follow-up data. MBL was measured using periapical radiographs. Age, sex, implant location, timing of implant placement and loading, placement depth, guided bone regeneration (GBR), fixture diameter, type of implant prosthesis, and opposing dentition type were investigated in relation to MBL. The implant survival rate was analyzed using Kaplan–Meier survival curves, and univariate and multivariate logistic regression models were used to identify factors associated with MBL. All analyses were conducted using R software (version 4.1.0 for Microsoft Windows; R Foundation). Results: Twenty-five patients with 40 NDIs were included in this study. The mean observation period after implant function was 10.5 years (range, 6.1 to 14.0 years), and the survival rate of the NDIs was 95.1% at the implant level and 96.0% at the patient level. The average amount of MBL was 0.44±0.57 mm. The only factor that showed a significant association with MBL was the presence of GBR (P=0.046). Conclusion: Within the limitations of a retrospective evaluation, NDIs have demonstrated optimal clinical outcomes over a long period in areas in which anatomical structures are limited. MBL around the NDI also showed clinically acceptable results, and a correlation with MBL was observed in cases in which a bone graft was performed. Further studies with a larger number of implants over extended periods are needed in the future.
Abstract
Objectives: This study aims to identify patterns and to describe the clinical course of delayed adverse tissue responses in patients who underwent orthognathic osteotomy with biodegradable osteofixation. Patients and Methods: Through a retrospective review of cases between 2013 and 2020, we identified three patients who underwent bimaxillary osteotomy and fixation with unsintered-hydroxyapatite/poly-L lactic acid (u-HA/PLLA) devices, after which they developed delayed inflammation. These lesions were treated with drainage and/or removal of the devices. Histological evaluations were conducted using H&E staining, and structural changes in the u-HA/PLLA devices were assessed by scanning electron microscopy (SEM). Results: Inflammatory lesions developed only in the mandible, with onset ranging from 12 to 35 months post-operation. Histological studies identified foreign-body granulomas or secondarily infected lesions. SEM analysis indicated biodegradation and tissue integration. Conclusion: Orthognathic patients treated using u-HA/PLLA devices should be informed about the potential for delayed inflammation and monitored for at least 3 years.
Abstract
Pedicle ossification is a rare but significant complication following mandibular reconstruction using a fibular free flap (FFF), a technique widely employed in maxillofacial surgery due to its reliable vascularized bone supply and low donor site morbidity. The FFF supports dental implantation and prosthetic rehabilitation, with its vascularized periosteum enhancing osteogenic potential. Despite these advantages, unexpected ossification of the flap’s vascular pedicle may occur, potentially mimicking tumor recurrence and causing diagnostic uncertainty. This case report describes a 38-year-old male with left buccal squamous cell carcinoma treated by wide excision, modified radical neck dissection, and reconstruction using a radial forearm free flap. Postoperative radiotherapy led to complications including trismus and alveolar bone exposure, culminating in a pathological mandibular fracture. Mandibular reconstruction was performed using an FFF. Over 4 years of follow-up, computed tomography revealed ossification within the vascular pedicle. Notably, the patient remained asymptomatic, maintaining normal speech and swallowing without functional impairment. Pedicle ossification may present radiographically as a suspicious bony change misinterpreted as tumor recurrence. Routine follow-up imaging such as computed tomography is essential for differentiation. Although trismus, bony swelling, or pain may occur, surgical intervention is typically deferred unless symptoms develop. Therefore, careful clinical assessment and monitoring remain crucial.
Abstract
It is crucial to reconstruct extensive soft tissue defects following oral cancer resection to restore both function and aesthetics. Single anterolateral thigh flaps may not suffice for large defects. This report highlights the use of chimeric flaps, which feature multiple paddles with individual perforators, to reconstruct large intraoral and extraoral defects, adapting to wide defects, and covering areas with extensive tissue damage. This case series demonstrates the adaptability and effectiveness of chimeric flaps, demonstrating them to be a superior option for satisfactory healing and functional outcomes in reconstruction of complex defects.
Abstract
The submandibular displacement of a mandibular third molar residual root presents major challenges to oral and maxillofacial surgeons due to the proximity to critical anatomical structures such as the lingual nerve and sublingual artery. Preoperative imaging can approximate the location of the residual tooth root; however, accurately determining its exact position is difficult because of the dynamic nature of the mandible and the difficulty of realtime synchronization of imaging. This study presents the successful extraction of a residual mandibular third molar root in a 67-year-old female patient achieved using a magnetic field-based navigation system. The sublingually-displaced residual root was localized using the navigation system, marked using a virtual implant placement, and positioned by a hand piece using synchronized real-time sensor data. The root was successfully removed with a minimally-invasive approach. No complications occurred postoperatively, and follow-up showed no major issues. Due to the small size of the marker, ease of calibration, and independence from visual obstacles, magnetic field-based navigation systems are a promising tool for the removal of residual roots displaced into adjacent soft tissue.