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Editorial Board/Reviewing Committee
doi : 10.1016/S0901-5027(21)00442-2
Volume 51, Issue 2, February 2022, Page i
Lateral skull base surgery for posterior oral cavity cancer
Z.-H.Ren123aZ.-M.Yang14aT.-F.Fan1H.-J.Wu1
doi : 10.1016/j.ijom.2021.03.011
Volume 51, Issue 2, February 2022, Pages 143-151
The aim of this study was to better understand posterior oral cavity cancer (POCC) and its surgical treatment. This was a retrospective study of 76 patients who were diagnosed with POCC and underwent surgical treatment. Twenty-eight patients were treated with anatomical unit resection surgery (AURS) and 48 patients with conventional surgery. After initial treatment with curative intent, the patients were followed-up regularly with clinical examinations and imaging; the median duration of follow-up was 30.9 months (range 2–67 months). The 3-year overall survival was 64.3% in the experimental AURS group and 39.6% in the conventional surgery control group (hazard ratio 0.49, 95% confidence interval 0.26–0.93; P = 0.031). The 3-year disease-free survival was 64.3% in the experimental group and 37.5% in the control group (hazard ratio 0.53, 95% confidence interval 0.27–1.02; P = 0.114). In conclusion, AURS is an effective surgical treatment for POCC that can considerably improve patient survival rates.
Oncological outcomes of total glossectomy procedure for advanced tongue cancer: a single-centre experience
H.NemadeA.Chaitanya SS.KumarA.K.AT.S.RaoL.M.C.S.Rao S
doi : 10.1016/j.ijom.2021.04.006
Volume 51, Issue 2, February 2022, Pages 152-158
Surgeons treating advanced carcinoma of the tongue with total glossectomy face many conflicts in view of the morbidity and poor functional and survival outcomes following surgery. It is pertinent to study the patients undergoing total tongue compartment resection as a separate cohort to analyse their outcomes. This study investigated the oncological outcomes of 150 patients with advanced tongue squamous cell carcinoma who underwent total glossectomy. The results suggest that compartment resection significantly improved local control, irrespective of margin status. The presence of multiple positive nodes was found to be an independent poor prognostic factor, and adjuvant radiation significantly improved survival. Total glossectomy is feasible and safe in both the primary and salvage setting and should be considered as the surgical option for advanced tongue cancer.
Oncologic safety of submental island flap reconstruction in clinically node-negative oral cancer patients: a prospective comparative study
A.Mishra1N.Mishra1D.Pati1D.Samal1I.B.Kar1D.Mohapatra2D.F.Sarkar1
doi : 10.1016/j.ijom.2021.05.010
Volume 51, Issue 2, February 2022, Pages 159-165
The purpose of this study was to evaluate the oncologic safety of submental island flap (SIF) reconstruction in clinically node-negative oral cancer patients. Forty-four clinically node-negative oral cancer patients with tumour size T1–T3 were divided into two groups. The Submental group consisted of 21 patients, who underwent submental island flap reconstruction whereas the control group consisted of 23 patients who underwent reconstruction with other locoregional or free flaps. The locoregional recurrence rate (LRR) and recurrence-free survival (RFS) in these two groups were assessed and compared. The follow-up period in the two groups ranged from six to 28 months, with a median follow-up period of 15 months and 21 months, respectively. Results showed that the LRR in the control and the submental group was 21.7% and 19%, respectively (p = 0.825). Kaplan–Meier curve showed that the difference in recurrence-free survival in the two groups was not statistically significant (p = 0.749). Multivariate and bivariate analyses did not establish any relationship between the predictive parameters and locoregional recurrence. Thus, the Submental island flap is a reliable and versatile locoregional flap for the reconstruction of post-resection defects in oral cancer. It has no predictive influence on locoregional recurrence in clinically node-negative oral cancer patients.
Diffusion-weighted imaging with histogram analysis of the apparent diffusion coefficient maps in the diagnosis of parotid tumours
A.A.K.Abdel Razek1B.N.Gadelhak1I.A.El Zahabey2G.A.E.A.Elrazzak3B.Mowafey3
doi : 10.1016/j.ijom.2021.03.019
Volume 51, Issue 2, February 2022, Pages 166-174
The aim of this study was to investigate the role of diffusion-weighted imaging (DWI) with histogram analysis of apparent diffusion coefficient (ADC) maps in the characterization of parotid tumours. This prospective study included 39 patients with parotid tumours. All patients underwent magnetic resonance imaging with DWI, and ADC maps were generated. The whole lesion was selected to obtain histogram-related parameters, including the mean (ADCmean), minimum (ADCmin), maximum (ADCmax), skewness, and kurtosis of the ADC. The final diagnosis included pleomorphic adenoma (PA; n = 18), Warthin tumour (WT; n = 12), and salivary gland malignancy (SGM; n = 9). ADCmean (×10−3 mm2/s) was 1.93 ± 0.34 for PA, 1.01 ± 0.11 for WT, and 1.26 ± 0.54 for SGM. There was a significant difference in whole lesion ADCmean among the three study groups. Skewness had the best diagnostic performance in differentiating PA from WT (P = 0.001; best detected cut-off 0.41, area under the curve (AUC) 0.990) and in discriminating WT from SGM (P = 0.03; best detected cut-off 0.74, AUC 0.806). The whole lesion ADCmean value had best diagnostic performance in differentiating PA from SGM (P = 0.007; best detected cut-off 1.16 × 10−3 mm2/s, AUC 0.948). In conclusion, histogram analysis of ADC maps may offer added value in the differentiation of parotid tumours.
Microvascular reconstruction of the mandible with medial femoral condylar flap for treatment of mandibular non-union
F.Arcuri1M.Innocenti2G.Menichini2C.Pantani3M.Raffaini3
doi : 10.1016/j.ijom.2021.05.007
Volume 51, Issue 2, February 2022, Pages 175-181
Mandibular non-union occurs in 2–9% after open reduction and internal fixation of a mandibular fracture (trauma surgery, orthognathic cases, access osteotomy for oncological purposes). The medial femoral condyle (MFC) has emerged more recently as one of the most versatile donor sites in the treatment of challenging bone reconstruction. This is the first description of MFC for treatment of mandibular non-union. A retrospective chart review was conducted for all patients who underwent reconstruction with a microvascular MFC flap for bone defects of the head and neck area between January 2015 and December 2018 at Careggi Hospital of Florence. Inclusion criteria were patients where the FMC was used for mandibular defects arising due to non-union. Seven patients presented mandibular defects reconstructed by MFC flap and were included in this investigation (two cases of segmental mandible defect due to post-traumatic non-union; two patients of pathological mandibular fracture after prolonged bisphosphonate therapy for osteoporosis; three patients with mandibular continuity loss after failed orthognathic surgeries). At one-year follow-up, all patients had satisfactory occlusion. One-year postoperative CTs revealed full osteointegration of the flaps. In conclusion, the MFC free flap is an attractive option for mandibular reconstruction. Small defects (3–5 cm) in poorly vascularized beds are the ideal target.
Removal of patient-specific reconstruction plates after mandible reconstruction with a fibula free flap: is the plate the problem?
K.KreutzerC.SteffenS.NahlesS.KoerdtM.HeilandC.RendenbachB.Beck-Broichsitter
doi : 10.1016/j.ijom.2021.04.003
Volume 51, Issue 2, February 2022, Pages 182-190
Computer-aided microvascular mandible reconstruction is an increasingly common procedure in oral and maxillofacial surgery. The aim of this retrospective single-centre study was to evaluate the rate and specifics of hardware removal after fibula free flap (FFF) fixation with a patient-specific reconstruction plate. The study included patients who underwent hardware removal between April 2017 and October 2019. Statistical analyses were performed regarding the different indications for plate removal (dental implantation versus complication) and the surgical approach (intraoral versus extraoral). Plate removal was performed in 29 of 98 patients (29.6%) after FFF fixation with a patient-specific reconstruction plate. Plate removal was done prior to dental implantation in 58.6% of cases and due to complications in 41.4%. Complications seen between reconstructive surgery and plate removal were less frequent in the dental rehabilitation group (8/17 vs 12/12; PÂ =Â 0.002). Within this group, 35.3% of plates were removed intraorally, and the majority of partial plate removals were performed in the patients with plate removal for dental rehabilitation (72.7% vs 27.3%). Hospitalization was shorter with an intraoral approach (1.7 days vs 4.0 days, PÂ =Â 0.052). The removal of patient-specific reconstruction plates prior to dental implantation is often partial and can be performed intraorally. The use of patient-specific miniplates for fixation of FFF might facilitate later dental rehabilitation.
Salvage mandibular reconstruction: multi-institutional analysis of 17 patients
B.Guo1aX.Fang2aY.Shan3aJ.Li1Y.Shen1C.Ma1
doi : 10.1016/j.ijom.2021.07.014
Volume 51, Issue 2, February 2022, Pages 191-199
Unsuccessful mandibular reconstruction occasionally occurs, leaving the patient with undesirable function and contours. In such cases, second- or third-time corrective operations are challenging. However, published studies on the complicated retreatment of such patients are scarce. A retrospective analysis covering the years 2015–2019 was conducted in three centers. All 17 patients included had undergone prior failed mandibular reconstructions in other institutions. Salvage secondary or tertiary reconstructive surgeries were attempted and the results are presented. Major factors for these failed reconstructions included exposed non-vascularized bone grafts (n = 7, 41.2%), flap loss (n = 4, 23.5%), exposed artificial joint (n = 3, 17.6%), skewed occlusion with deformity (n = 1, 5.9%), non-union (n = 1, 5.9%), and recurrence (n = 1, 5.9%). Fibula flaps were transferred in 15 patients, while iliac flaps were used in two patients for mandibular re-do reconstructions. Virtual surgical designs were conducted in nine (52.9%) patients, with navigation-guided approaches performed in three cases. Postoperative functions were relatively favorable in these complicated mandibular re-do reconstruction cases. Mandibular symmetry (mandibular length and height; P = 0.002) and condylar position (P < 0.001) were regained after these re-do attempts. Secondary or tertiary mandibular re-do reconstruction can still achieve good functional outcomes with appropriate preoperative selection and well-conceived designs, especially with the aid of virtual surgery and navigation.
Penetration of inferior alveolar nerve canal increased by bicortical fixation after bilateral sagittal split osteotomy in mandibular prognathism
S.P.Sinha12T.D.H.Duong123T.-D.T.Duy124E.W.-C.Ko125Y.-R.Chen156C.S.Huang125
doi : 10.1016/j.ijom.2021.04.011
Volume 51, Issue 2, February 2022, Pages 200-205
The purpose of this three-dimensional cone beam computed tomography (CBCT) study was to identify the difference between monocortical fixation (MCF) and bicortical fixation (BCF) in mandibular canal penetration after bilateral sagittal split osteotomy (BSSO) to correct mandibular prognathism, where interosseous fixation was done by BCF or MCF. CBCT was performed 1 week postoperatively and Dolphin 3D software was used to assess direct penetration of the mandibular canal by either type of screw. The primary outcome variable was the presence or absence of mandibular canal penetration and was categorized as a binary coded variable. The BCF and MCF groups were compared by χ2 test, and the odds ratio for canal penetration was estimated. Multiple logistic regression was performed to identify factors related to canal penetration. A total of 118 patients were included. The MCF group had only 6% canal penetrations (3/50 patients) and the BCF group had 58.8% canal penetrations (40/68 patients). The regression model showed that BCF was the only factor causing mandibular canal penetration, with an adjusted odds ratio of 52.5. Awareness of the increased risk of canal penetration with BCF and potential nerve injury might influence case selection.
The need for secondary orthognathic surgery after high condylectomy in patients with active unilateral condylar hyperplasia
T.AerdenL.VerstraeteC.Politis
doi : 10.1016/j.ijom.2021.04.007
Volume 51, Issue 2, February 2022, Pages 206-213
The need for secondary orthognathic surgery (OS) after a high condylectomy (HC) in patients with active unilateral condylar hyperplasia was assessed in 25 patients, reviewing patient characteristics and treatment planning. At 6–12 months after HC, 13 patients (52%) required secondary OS. The amount of mandibular dental midline shift before the HC (P = 0.037), and a dental crossbite that was present before the HC (P = 0.017) were significantly associated with the need for secondary OS. Overall, the mandibular dental midline coincided with the facial midline in eight patients (32%) at 2 weeks after HC. In 16% of the patients, no additional OS was needed despite this being the initial treatment plan. Additionally, the initially planned type of secondary OS was modified in six other patients. Early HC in skeletally immature patients provided very good results, both aesthetic and functional, with only two of them needing supplementary OS at 6–12 months after HC. The HC remains a valuable treatment in patients with active unilateral condylar hyperplasia, as it can eliminate the need for secondary OS and is very well tolerated by most patients.
Benefits of the enhanced recovery after surgery pathway for orthognathic surgery
M.StrattonP.D.WaiteK.K.PowellM.M.ScopelP.Kukreja
doi : 10.1016/j.ijom.2021.04.008
Volume 51, Issue 2, February 2022, Pages 214-218
The enhanced recovery after surgery (ERAS) protocol was designed to improve patient outcomes and decrease complications, opioid use, and postoperative nausea and vomiting (PONV). The aim of this retrospective cohort study was to examine the effectiveness of ERAS protocols implemented in orthognathic surgeries from 2017 to 2018 at the University of Alabama at Birmingham Hospital by measuring opioid use and PONV. Two groups were identified through chart review, a non-ERAS group (traditional) of patients who had surgery without a protocol and an ERAS group of patients who had surgery with the ERAS protocol. The anesthesia and surgical teams followed a standardized protocol for perioperative management. All procedures were performed by a single surgeon and included single- and double-jaw surgeries and adjunctive procedures. The patient charts were analyzed for postoperative opioid consumption (measured in morphine milligram equivalents, MME) and PONV. IBM SPSS Statistics version 26 was used to conduct the statistical analyses. The ERAS group received less opioids during the postoperative period than the control group (31.2 MME vs 54.6 MME, PÂ =Â 0.002). The ERAS group also had a lower incidence of PONV, with 1.2 episodes of PONV compared to 2.4 episodes in the non-ERAS group (PÂ =Â 0.008). This study demonstrates that the ERAS protocol is effective in decreasing postoperative opioid consumption and PONV.
Accuracy of mandibular proximal segment position using virtual surgical planning and custom osteosynthesis plates
J.Harding1J.K.HartsfieldJr23A.S.Mian4B.P.Allan5S.Naoum1R.J.H.Lee1M.S.Goonewardene1
doi : 10.1016/j.ijom.2021.04.002
Volume 51, Issue 2, February 2022, Pages 219-225
The purpose of this study was to determine whether the use of custom osteosynthesis plates increased the accuracy of proximal segment position following bilateral sagittal split osteotomy in a cohort of 30 patients when compared to a control group of 25 patients who had surgery with conventional plates. Surgery was performed by a single surgeon between October 2015 and December 2017. Post-surgical cone beam computed tomography scans were segmented using Mimics Innovation Suite (Materialise NV), and surface-based superimposition was achieved using ProPlan CMF (Materialise NV). However, there was a tendency for the rotational error to be smaller in the custom group than in the control group. The root mean square error in both groups and for all variables fell within clinical parameters of 2 mm and 4°. In conclusion, the results of this study indicate that customized mandibular fixation plates do not necessarily improve the accuracy of the proximal segments post-surgically; however they may be of benefit in individual patients.
A magnetic resonance imaging study on the temporomandibular joint disc–condyle relationship in young asymptomatic adults
D.Luo12Z.Yang3C.Qiu4Y.Jiang5R.Zhou6J.Yang2
doi : 10.1016/j.ijom.2021.06.010
Volume 51, Issue 2, February 2022, Pages 226-233
The aim of this study was to assess the temporomandibular joint (TMJ) disc–condyle relationship in asymptomatic young adults. Ninety-three volunteers aged 19–23 years without temporomandibular disorder (TMD) symptoms underwent TMJ magnetic resonance imaging (MRI). The condylar centre and apex methods were used to measure and analyse the position of the disc in the oblique sagittal plane, and the reliability of the two methods was compared by calculating the intra-class correlation coefficient (ICC). Furthermore, 18 of the volunteers were randomly selected for three-dimensional (3D) reconstruction of the TMJ structure and the disc–condyle relationship. The 3D TMJ structure was established by semi-automatic segmentation of the condyle and articular disc in ITK-SNAP software; the condylar apex method was then performed. It was found that only 33.3% of the posterior edge of the articular discs were located in the normal 12 o’clock position with respect to the condyle. Moreover, this study suggests that the condylar centre method lacks accuracy when compared to the condylar apex method in regard to the measurement of the TMJ disc–condyle relationship (0 < ICCcen < ICCapex < 1). The position of the articular disc (left and right) was more forward in young women when compared to young men. However, there was no significant difference in the TMJ disc–condyle position between the left and right sides in the same individual, although the two joint discs in the same individual were not completely symmetrical.
Alveolar ridge preservation: an overview of systematic reviews
C.Aribau-Gumà 1A.Jorba-GarcÃa1A.Sánchez-Torres12M.À.Sà nchez-Garcés12
doi : 10.1016/j.ijom.2021.06.002
Volume 51, Issue 2, February 2022, Pages 234-242
The aim of this overview was to assess the methodological quality of systematic reviews of randomized clinical trials on alveolar ridge preservation after a tooth extraction. During March 2020, two independent reviewers performed an electronic search of the PubMed (MEDLINE), Scopus, Web of Science, and Cochrane Library databases to identify all relevant systematic reviews including randomized clinical trials on alveolar ridge preservation. A manual search of articles in renowned journals was also conducted. The methodological quality of the included reviews was determined using the AMSTAR-2 tool. From the 53 initially retrieved studies, 11 were finally included: three systematic reviews and eight systematic reviews with meta-analyses. The methodological quality of the included reviews was low or critically low. Higher quality clinical studies should be conducted prior to performing further reviews and these should meet the methodological requirements that are fundamental to this type of research.
Patient- and clinician-reported outcomes for the additively manufactured sub-periosteal jaw implant (AMSJI) in the maxilla: a prospective multicentre one-year follow-up study
C.Van den Borre1M.Rinaldi2B.De Neef3N.A.J.Loomans45E.Nout6L.Van Doorne7I.Naert8C.Politis9H.Schouten10G.Klomp6L.Beckers11M.M.Freilich121314M.Y.Mommaerts1516
doi : 10.1016/j.ijom.2021.05.015
Volume 51, Issue 2, February 2022, Pages 243-250
The clinical outcomes of maxillary rehabilitation with the additively manufactured sub-periosteal jaw implant (AMSJI; CADskills BV) were evaluated in edentulous patients with a Cawood–Howell atrophy classification ≥5 in all regions of the maxilla. Fifteen consecutive patients were included in the study and followed up for 1 year. They were interviewed using a survey protocol and were examined clinically and radiographically preoperatively (T0) and at 1 (T1), 6 (T2), and 12 (T3) months after permanent upper prosthesis placement. The patients reported an increased oral health-related quality of life. The overall mean Oral Health Impact Profile-14 score at T0 was 17.20 (standard deviation (SD) 6.42). When results at T0 were compared to those at T1 (mean 8.93, SD 5.30), a statistically significant difference was seen (P = 0.001). At T3, the mean value was 5.80 (SD 4.18). Compared to T0, there was also a statistically significant difference at T3 (P = 0.001). General satisfaction based on the numerical rating scale was a mean 49.93 at T1, which was less than patient expectation prior to treatment at T0 (52.13). A higher overall value was seen at T3 (53.20) when compared to T0. Within the constraints of the short follow-up, the AMSJI appears to be a promising tool for patients with extreme jaw atrophy. The high patient expectations were met without complications.
Are women more susceptible than men to iatrogenic inferior alveolar nerve injury in dental implant surgery?
E.Pääsky1A.Suomalainen23I.Ventä1
doi : 10.1016/j.ijom.2021.05.008
Volume 51, Issue 2, February 2022, Pages 251-256
An over-representation of women in dental implant-related inferior alveolar nerve injuries (IANIs) is recognized in the literature but has not been investigated. Therefore, a nationwide retrospective register study was conducted to analyse how IANIs compare with other implant-related complications (infection, implant malposition, lack of bone at implant site, mechanical damage, or failed osseointegration) separately in women and men. Financially compensated malpractice claims related to dental implant surgery were collected from the Finnish Patient Insurance Centre for the years 1997—2013, while the total number of nationally placed implants was ascertained from the implant register held by the Finnish Institute for Health and Welfare. In the 242 complications, the following were analysed: age of subject, absolute risk for complication, and aetiological factor of IANI. Statistical tests applied include Mann–Whitney U-test, Chi-squared test, and Fisher’s exact test. Women sustaining IANI were more likely older than those having infection, mechanical damage, or failed osseointegration (P < 0.05), while no significant differences emerged in men. Women were more likely at risk for IANI (P < 0.01) or implant malposition (P < 0.05) than men. The results support earlier propositions that women are more vulnerable than men to iatrogenic IANI.
Evaluation of anatomical references for locating the course of the posterior superior alveolar artery for dental implant surgery
A.Takahashi1K.Kamada1T.Kudoh1K.Kudoh1N.Takamaru1N.Kurio1C.Sugawara2Y.Miyamoto1
doi : 10.1016/j.ijom.2021.05.013
Volume 51, Issue 2, February 2022, Pages 257-262
This retrospective cohort study aimed to identify the best anatomical reference for predicting the posterior superior alveolar artery (PSAA) location. Computed tomographic images of 90 maxillary sinuses were evaluated. We studied five references, including the alveolar crest, maxillary sinus floor, zygomatoalveolar crest, hard palate and soft palate, and measured the distances between them and the PSAA. Variations in the distance were evaluated by the standard deviation and coefficient of variation (CV). The zygomatoalveolar crest was an unstable reference, owing to its high standard deviation and CV. The smallest CV was for the distance between the alveolar crest and PSAA, although the distance was smaller in edentulous jaws than dentulous jaws. The distance between the sinus floor and PSAA was larger in male and edentulous patients. The PSAA was detected in 40.0%, 44.4%, 54.4% and 56.7% of the sinus walls at the first and second premolar and the first and second molar positions, respectively. At these tooth positions, the respective heights above the hard palate were 11.2 ± 4.9, 8.2 ± 4.9, 6.2 ± 2.8 and 8.1 ± 2.9 mm. The hard palate was the most stable reference for predicting the location of the PSAA, irrespective of sex, age and dentition.
Soft tissue-based registration of intraoral scan with cone beam computed tomography scan
J.T.Deferm1#J.Nijsink2#F.Baan3L.Verhamme3G.Meijer14T.Maal3
doi : 10.1016/j.ijom.2021.04.004
Volume 51, Issue 2, February 2022, Pages 263-268
The aim of this study was to evaluate a novel soft tissue-based method to register an intraoral scan (IOS) with a cone beam computed tomography (CBCT) scan. IOS and CBCT data were obtained from eight dentate patients (mean age 21 ± 2 years; three male, five female) and 14 fully edentulous patients (mean age 56 ± 9 years; eight male, six female). An algorithm was developed to create a soft tissue model of the CBCT scan, which allowed a soft tissue-based registration to be performed with the IOS. First, validation was performed on dentate jaws with registration of the palatal mucosal surface and accuracy evaluation at the level of the teeth. Second, fully edentulous jaws were registered using both the palatal and alveolar crest mucosal surfaces. Distance maps were created to measure the method accuracy. The mean registration error was 0.49 ± 0.26 mm for the dentate jaws. Registration of the fully edentulous jaws had a mean error of 0.16 ± 0.08 mm at the palate and 0.16 ± 0.05 mm at the alveolar crest. In conclusion, the high accuracy of this registration method may allow the digital workflow to be optimized when no teeth are available to perform a regular registration procedure.
Virtual planning and navigation for targeted excision of intraorbital space-occupying lesions: proposal of a computer-guided protocol
A.Tel1F.Murta2S.Sembronio1F.Costa1M.Robiony1
doi : 10.1016/j.ijom.2021.07.013
Volume 51, Issue 2, February 2022, Pages 269-278
The purpose of this study was to present an innovative approach for the preoperative assessment and intraoperative targeted excision of masses occupying the intraorbital space based on multimodal image fusion, segmentation, virtual models, digital planning, and navigation. Nineteen patients were studied and underwent surgery using the presented workflow, in both open and endoscopic procedures. Three main scenarios were standardized for the application of computer-guided surgery: single masses of the superior-lateral compartment, single masses of the inferior-medial compartment, and multifocal masses. An operative protocol was devised, and the accuracy of the osteotomies was analysed. All patients were managed successfully by applying the same protocol. No intraoperative complications were reported. The accuracy of the osteotomies was evaluated as a surrogate endpoint for the overall precision of surgery, showing average discrepancies of <1 mm for lateral marginotomies and <0.5 mm for endoscopic osteotomies. This study outlines an operative workflow for the implementation of virtual models to excise orbital masses, enhancing in-depth preoperative understanding of the anatomical relationships within the orbital space and increasing precision in both open and endoscopic approaches.
Efficacy of platelet-rich fibrin and tacrolimus on facial nerve regeneration: an animal study
S.I.Mourad1S.A.Al-Dubai1S.A.Elsayed2R.R.El-Zehary3
doi : 10.1016/j.ijom.2021.05.016
Volume 51, Issue 2, February 2022, Pages 279-287
This study was performed to investigate the effect of platelet-rich fibrin membrane (PRFM), alone and with topical tacrolimus application, on regeneration of the crushed facial nerve (FN). Thirty healthy 7-week-old albino rats were used. The left FN was damaged by crushing in all rats. Three random groups of rats were formed: group 1, untreated; group 2, treated with PRFM; group 3, treated with PRFM plus topical tacrolimus. Functional recovery and histological and immunohistochemical evaluations were performed 4 and 8 weeks later. Anti-S100 was used to detect myelin sheath. At 4 weeks, blinking reflex recovery was more rapid in group 3 than in groups 2 and 1 (4.30 ± 0.48, 3.40 ± 0.52, and 2.20 ± 0.42, respectively); the difference was statistically significant (P = 0.001). Histologically, group 3 showed more apparent normal FN structures than the other groups. Immunohistochemical caspase-3 evaluation of the axon area revealed a significant difference between group 2 (PRFM alone; 8.67 ± 0.029) and group 3 (PRFM plus topical tacrolimus; 4.42 ± 0.028) (P = 0.001). Group 3 showed the greatest positive staining in the myelin sheath. Based on the results of this animal study, clinical studies should be performed to determine whether the combination of PRF and tacrolimus also improves the outcome of nerve regeneration in humans.
