Comparison of postoperative complications and facial nerve recovery rates after conventional and partial superficial parotidectomy of benign parotid tumours: a prospective study

The aim of this study was to compare postoperative complications and facial nerve (FN) recovery rates between conventional superficial parotidectomy (CSP) and partial superficial parotidectomy (PSP) as surgical treatment for benign parotid tumours. A prospective study was conducted on 55 consecutive patients who underwent either CSP (n = 35) or PSP (n = 20) for benign parotid tumours. The primary outcomes were FN injury, FN recovery rates, and Frey syndrome. Secondary outcomes were operative time, hospital stay, sialocele, haematoma, and auricular numbness. The degree of FN injury was evaluated at 1 week, 1, 3, 6, and 12 months postoperative using the House–Brackmann grading system. Frey syndrome was assessed using a subjective clinical questionnaire and objective Minor starch–iodine test. No patient in either group experienced permanent FN paralysis. There was a significantly higher incidence of temporary FN weakness in the CSP group (P = 0.007). The respective FN recovery rates at 1, 3, 6, and 12 months were 60%, 88.6%, 94.3%, and 100% in the CSP group and 90%, 95%, 100%, and 100% in the PSP group. No significant difference was observed between the groups regarding the incidence of Frey syndrome, sialocele, and haematoma. The operative time and hospital stay were both shorter in the PSP group. Although the PSP is a more conservative procedure with significantly reduced FN injury, operative time, and hospital stay compared to CSP, the CSP procedure shows a comparable FN recovery rate to the PSP.     

The harmonic scalpel versus electrocautery for parotidectomy: A meta - analysis

ObjectiveParotidectomy is the most classic and unequivocal intervention for parotid neoplasm. The operative outcomes and postoperative complications of parotidectomy between harmonic scalpel and electrocautery gained more prominence in physician. In spite of much research work within the past years, there was an obvious lack of randomized controlled trial to resolve this question. Hence, a quantitative and qualitative meta-analysis was essential to evaluate the differences in these two types of hemostasis method.MethodThe major electronic databases, including Pubmed, Embase, Cochrane library, Google Scholar, China National Knowledge Infrastructure and Chinese Scientific and Technological Journal databases were using the key words “electrocautery”, “electrocoagulation”, “harmonic scalpel”, “ultrasonic scalpel”, “ultrasonic dissector”, “parotidectomy” and “parotid surgery”. 9 articles were included in our systematic review and meta-analysis. The operative time, intraoperative blood loss, hospital stay, salivary fistula and transient facial nerve paralysis were the outcome measures. Odds ratios (ORs) with 95% confidence intervals (CIs) were employed to evaluate the effect size for categorical outcomes and mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes.ResultsIn our meta-analysis, there was a significant reduction in operation time [mean difference: ?20.97; 95%CI=(?24.02,?17.92); P < 0.00001], intraoperative blood loss [mean difference: ?20.75, 95%CI=(?22.32,?19.18); P < 0.00001], hospital stay [mean difference: ?0.83; 95%CI=(?1.10,?0.57); P < 0.00001], salivary fistula [ORs: 0.30, 95%CI=(0.08,1.14)] and transient facial nerve paralysis [OR:0.33, 95%CI=(0.19,0.58),P = 0.0001] in harmonic scalpel group compared with electrocautery group.ConclusionThis meta-analysis indicated that compared with electrocautery, harmonic scalpel (HS)was transcendent in the aspects of operative time, intraoperative blood loss, hospital stay, salivary fistula and transient facial nerve paralysis. The harmonic scalpel, as an efficient and useful instrument, was advocated in parotidectomy.     

Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients

The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. The mean ( ± standard deviation) surgical time did not differ significantly between the groups: 64 ± 22.4 min for PSP and 59 ± 19.8 min for ECD-TFND (P = 0.302). There was a significant difference in sialocele: 18 (36.7%) patients in the PSP group and four (10%) in the ECD-TFND group (P = 0.002). There was also a significant difference in facial nerve injuries: temporary paralysis was observed in 13 (26.5%) patients in the PSP group and two (5%) in the ECD-TFND group (P = 0.007). It appears that TFND is a viable and safe approach when performing ECD for benign tumours in the tail of the parotid gland. ECD-TFND should be preferred over PSP for benign tumours in the tail of the parotid gland.     

Assault-related facial fractures: does the injury mechanism matter?

This study clarified the injury characteristics and occurrence of associated injuries in patients with assault-related facial fractures. Data from 840 assault-related facial fracture patients were included; demographic factors, facial fracture type, associated injuries, alcohol use, and injury mechanisms were recorded. Assault mechanisms most often included combinations of different mechanisms (57.5%) and resulted in the victim falling (50.1%). The perpetrator was most commonly a stranger (52.5%) and acted alone (57.7%). A total of 123 patients (14.6%) had associated injuries, with the most common being traumatic brain injury. Associated injuries occurred most frequently in patients with combined fractures of the facial thirds (24.2%) and upper third fractures (42.9%). The most significant differentiating factors for associated injuries were the number of perpetrators, falling, the use of an offensive weapon, and if the events of the assault remained unknown. In adjusted logistic regression analyses, statistically significant associations with associated injuries were found for age (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03–1.07; P < 0.001), falling due to the assault (OR 2.87, 95% CI 1.49–5.50; P = 0.002), and upper third facial fractures (OR 6.93, 95% CI 2.06–23.33; P = 0.002). A single punch also caused severe injuries and should therefore not be overlooked, as this can be as dangerous as other assault mechanisms.     

面神经中段解剖法在区域性腮腺切除术中的应用

目的 提出经腮腺实质内面神经中段解剖法并评价其在区域性腮腺切除术中的应用效果。方法 回顾性统计了自2016年1月至2017年12月行腮腺良性肿瘤手术患者136例,按照面神经解剖方法分类,分为顺行总干解剖法（顺行组,70例）、逆行分支解剖法（逆行组,34例）、实质内中段解剖法（中段组,32例）,比较3组的手术时间,面神经损伤和耳垂感觉状况,涎瘘、Frey’s综合征发生率,并进行美学评价。结果 中段组手术时间较其他两组明显缩短（P<0.05）;中段组术后未出现涎瘘患者,顺行组涎瘘发生的比例较高（9例,12.9%）（P<0.05）;中段组和顺行组术后面神经损伤率均较低（顺行组3例,4.3%;中段组1例,3.1%）,逆行组面神经损伤比例偏高（7例,20.6%）（P<0.05）;中段组和逆行组均未出现耳垂感觉减退情况,而顺行组出现比例较高（12例,17.1%）（P<0.05）;术后中段组及顺行组患者对术后面部外形比较满意,而逆行组对美观评价一般（P<0.05）。结论 面神经中段解剖法在技术上是可以实行的,在腮腺良性肿瘤的区域性切除术中,可以取得较好的临床效果,具有一定的临床应用价值。     

Postoperative complications after removal of pleomorphic adenoma from the parotid gland: A long-term follow up of 297 patients from 2002 to 2016 and a review of publications

Pleomorphic adenomas are rounded, lumpy, capsulated lesions that are more common in women. They are typically benign, but can be associated with malignancy in a minority of cases (such as carcinoma ex pleomorphic adenoma), between 3% - 12% of the time, according to available data. The purpose of our study was to evaluate clinical outcomes in patients with benign parotid gland tumours after extracapsular dissection (ECD) or superficial parotidectomy (SP). We made a retrospective study of 297 patients who had had benign tumours of the parotid gland, and had been referred to our department from 2002 – 2016 to have either procedure. We measured the statistical differences between the two techniques (evaluated recurrence rate and complications) with the chi squared test. The chosen level of statistical significance was p < 0.05. Median (range) follow-up time was 43 months (25–168) months. Haematoma and hypoaesthesia were significantly more common after SP than after ECD (8.9% compared with 7.7%, and 16.8% compared with 5.6%, respectively). Transient facial nerve injury, Frey syndrome, and facial paralysis were significantly more common after SP than after ECD (23.6% compared with 1.5%, 6.7% compared with 1% and 6,7% compared with 0%, respectively). ECD had the advantage of reduced operating time, lower morbidity and lower recurrence rate, and could be considered the treatment of choice for pleomorphic adenoma of the parotid gland up (to 3 cm) which are mobile and sited in the superficial lobe of the parotid gland.     

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75–33.49; p < 0.01), and of 4.57% for overall surgical complications (95% CI: 1.97–7.15; p < 0.01). No significant difference in risk was found for flap failure (95% CI: ?4.33–9.90; p = 0.44), surgical site infection (95% CI: ?0.88–2.60; p = 0.33) and fistula formation (95% CI: ?3.81–3.71; p = 0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I² = 63.02%; p = 0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.     

The effect of alcohol on facial Trauma outcomes: an analysis of the National Trauma Data Bank

Maxillofacial trauma costs emergency departments approximately one billion dollars annually. Facial trauma has increased since 2000 and has been attributed to both increased use of computed tomography and interpersonal violence. Alcohol, male sex, and age 18–35 years are significant risk factors for interpersonal violence. This study is novel in using a large database to look at the effect of alcohol on clinical outcomes in facial trauma. A data analysis was performed in Stata/MP 14.2 using variables coded from the National Trauma Data Bank (NTDB); logistic regression was applied. A total 580,313 patient records were analyzed. Operations for facial fractures were performed in 20.19% of cases (n = 117,139). A positive alcohol test reduced the odds of requiring operative fixation in both the unadjusted (odds ratio (OR) 0.8, 95% confidence interval (CI) 0.79–0.82, P < 0.001) and adjusted (OR 0.67, 95% CI 0.66–0.68, P < 0.001) models. Age and being struck (adjusted OR 1.99, 95% CI 1.91–2.07, P < 0.001) or shot (adjusted OR 1.95, 95% CI 1.84–2.06, P < 0.001) had a significant effect on operative fixation. Injury mechanisms related to interpersonal violence appeared to have higher operative fixation rates. This study did not find a correlation between acute intoxication and the need for an operative intervention. This further demonstrates the multifactorial nature of facial trauma and stresses the importance of injury and violence prevention on clinical outcomes.     

Comparison of surgical techniques for benign parotid tumours: a multicentre retrospective study

This study aimed to compare the outcomes of three surgical techniques for the treatment of patients with benign parotid tumours: superficial parotidectomy (SP; group 1), partial superficial parotidectomy (PSP; group 2), and ultrasonic scalpel-assisted minimal extracapsular dissection (US-MECD; group 3). Groups 1 and 2 received the conventional surgical technique, while group 3 underwent surgery with an ultrasonic scalpel. A total of 281 patients treated during 2012–2016 were included: 98 in group 1, 91 in group 2, and 92 in group 3. The mean surgical time and blood loss during surgery, as well as drainage time and amount, were significantly lower for US-MECD (P < 0.01). The great auricular nerve and parotid fascia were both preserved with US-MECD (P < 0.01), while the rate of capsule rupture with US-MECD was slightly higher than in the other groups (P > 0.05). There was less transient facial nerve paralysis and Frey syndrome with US-MECD (P < 0.01). No significant difference in wound infection, sialocele, or permanent facial nerve paralysis was observed among the three groups. Patients enrolled during 2012–2013 were selected to evaluate the recurrence rates, and no statistically significant differences were found among the groups. In conclusion, US-MECD showed similar effectiveness and fewer side effects than SP and PSP. The long-term effects of the new technique require further study.     

Complications of total temporomandibular joint replacement: a systematic review and meta-analysis

The aim of this systematic review was to determine the most prevalent complications resulting from total temporomandibular joint (TMJ) replacement. An electronic search was performed using the Embase, LILACS, MEDLINE (via PubMed), SciELO, Scopus, and Web of Science databases up to June 2022. Prospective and retrospective clinical studies on patients who underwent TMJ replacement were included. Two reviewers performed the study selection, data extraction, and individual risk of bias assessment using the Joanna Briggs Institute Critical Appraisal Tools. The pooled prevalence of each complication was calculated through a proportion meta-analysis using the random-effects model. Twenty-eight studies met the eligibility criteria and were included in the review. All of the eligible studies had a low risk of bias. The results of the meta-analysis revealed that the most prevalent complication was paresis or paralysis of the facial nerve branches (7.8%; 95% confidence interval (CI) 2.6–15.1%, I² = 94.5%), followed by sensory alterations (1.8%; 95% CI 0.6–4.9%, I² = 88.8%), heterotopic bone formation (1.0%; 95% CI 0.1–2.5%, I² = 75.8%), and infection (0.7%; 95% CI 0.1–1.6%, I² = 22.7%). In conclusion, TMJ replacement has a low prevalence of complications, and most of them can be managed successfully.     

Soft Tissue Changes in Patients With Dentoalveolar Protrusion Treated With Maximum Anchorage: A Systematic Review and Meta-analysis

ObjectiveThis meta-analysis aimed at comparing the angular and linear changes of soft tissue profile using conventional anchorage techniques and mini-implant (MI)-based space closure in patients with dentoalveolar protrusion.Materials and MethodsElectronic databases, viz. PubMed, Embase, and Cochrane Central Register of Controlled Trials, were searched for relevant literature from their inception to December 2017 according to the specific inclusion and exclusion criteria. The following Medical Subject Heading terms were used for searching: “skeletal anchorage”, “temporary anchorage devices”, “miniscrew implant”, “mini-implant”, “micro-implant”. Selected randomized control trials (RCTs) were assessed for their quality using Cochrane's Risk of Bias Tool, whereas the Newcastle-Ottawa scale was used for non-RCTs. Standardized mean difference (SMD) and 95% confidence interval (CI) were obtained with either fixed- or random-effects models based on the heterogeneity of the included studies.ResultsA total of 5 articles (2 RCTs with moderate risk of bias and 3 high-quality non-RCT studies) were included in the final analysis. The nasolabial angle had significantly greater changes in the MI group than in the conventional anchorage group (SMD = 0.68, 95% CI = 0.39 to 0.97, P < .0001). Significantly higher retraction of the upper lip was seen in the MI group than in the conventional group (SMD = ?0.51, 95% CI = ?0.84 to ?0.18; P = .002). No significant difference was seen in the facial convexity (SMD = ?0.34, 95% CI = ?0.76 to 0.07, P = .106) and lower lip retraction (SMD = 0.28, 95% CI = ?1.72 to 2.28, P = .784) between the groups.ConclusionIt was seen that MIs facilitated favorable soft tissue profile than the conventional anchorage devices. However, more high-quality studies are warranted to confirm the clinical effectiveness of MIs.     

Association between methylenetetrahydrofolate reductase polymorphisms and non-syndromic cleft lip with or without palate susceptibility: an updated systematic review and meta-analysis

Methylenetetrahydrofolate reductase (MTHFR) polymorphisms are thought to be involved in the development of cleft lip with or without cleft palate (NSCL/P), but published results are contradictory. We therefore designed an updated meta-analysis to pool eligible studies and to evaluate further the possible relations between MTHFR polymorphisms (c.677C > T and c.1298A > C) and susceptibility to NSCL/P. A comprehensive search based on PubMed, Medline, Web of Science, and Embase databases was made up to February 2018. Twenty-three case-control and 10 case-parent trio studies (including 1149 cases and 1161 controls) were retrieved. Odds ratio (OR) with 95% CI were used to estimate the pooled strength of association under different genetic models. The Q test and I² test were used to estimate heterogeneity among studies, the quality of which was assessed using the Newcastle-Ottawa scale. In the MTHFR c.677C > T polymorphism group, there were significant overall results for the recessive (OR 1.231, 95%CI 1.092 to 1.387) and homozygote (OR 1.252, 95%CI 1.078 to 1.456) models. Subgroup analysis by subjects and ethnicity identified only associations in European mothers for the recessive model and the homozygote model. For the c.1298A > C group, there were no significant results for either European or Asian patients for all genetic models. The MTHFR c.677C > T polymorphism might increase susceptibility to NSCL/P in European mothers, but was negatively associated in Asian patients, and the MTHFR c.1298A > C polymorphism is not involved in the development of NSCL/P in either European or Asian patients.     

Bicycle helmets are protective against facial injuries,including facial fractures: a meta-analysis

Cycling is a popular activity. However there are risks associated with cycling, including facial injury. Helmets are often worn to prevent head injury. Evidence for their protection against facial injury is limited. This meta-analysis investigated the effect of bicycle helmets on the incidence of facial injury. The PubMed/MEDLINE, Google Scholar, and Cochrane Library databases were searched. Studies included were observational and involved adult participants. Paediatric studies, studies on helmet legislation, and those combining facial injuries with other injury types were excluded. The studies were evaluated by two reviewers. Risk of bias was assessed using the RevMan bias assessment tool. Odds ratios (OR) were extracted for facial injuries and facial fractures. Two meta-analyses were performed using these categories. Nine of the 102 studies identified were included. Helmets were protective against facial injury (OR 0.69, 95% confidence interval 0.63–0.75, P < 0.0001). Five studies reported facial fracture rates; helmets were protective against these also (OR 0.79 95% confidence interval 0.70–0.90, P = 0.0003). There are no randomized controlled trials on this topic and the number of studies available is small. Bicycle helmets offer protection against facial injuries and this should be considered by cyclists when deciding whether or not to use one.     

Effects of phenytoin spray in prevention of fistula formation following cleft palate repair

BackgroundThe effectiveness of topical phenytoin has been reported for the treatment of oral biopsy ulcers, chemotherapy-induced oral mucositis, and chronic periodontitis. This study aimed to investigate the effects of topical phenytoin 2% on the prevention of fistula formation after cleft palate repair.MethodThis randomized clinical trial studied patients with nonsyndromic cleft palate who were referred to a tertiary center and underwent cleft palate repair from March 2010 to February 2015. Patients in the phenytoin group received phenytoin spray 2% for 8 weeks and were compared with an age- and sex-matched control group.ResultsA total of 160 patients in two phenytoin and control groups (n = 80 for each group) were recruited to the study. The mean ages of patients in the phenytoin and control groups were 11.42 ± 1.30 and 11.08 ± 1.25 months, respectively. The results showed that six patients (7.5%) in the phenytoin group and 15 patients (18.8%) in the control group formed fistulas during the 6-month follow-up period. There was a significant difference in fistula formation between the phenytoin and control groups (p = 0.035). Furthermore, fistula size was significantly smaller in the phenytoin group compared with the control group (p < 0.001).ConclusionMore frequent use of phenytoin spray can be considered, although there is insufficient information on the long-term side-effects of the chosen drug.     

Association of depressiveness with chronic facial pain: A longitudinal study

Abstract

Objective. Depression and pain are often co-morbid. Temporomandibular disorders (TMD) include facial pain as one main symptom. Reports are lacking on the association between chronic facial pain and earlier depressiveness. The aim of the study was to investigate whether depressiveness increases the risk for chronic facial pain in a longitudinal population-based study. Materials and methods. Subjects included in the Northern Finland Birth Cohort 1966 (n = 5696) answered a questionnaire on facial pain and depressiveness using the Symptom Checklist-25 depression sub-scale at the age of 31 years. In addition, reported depression diagnosed by a doctor was enquired about. Three years later a sub-sample of the cohort, including 63 cases with chronic facial pain and 85 pain-free controls, was formed based on the question concerning facial pain. Results. Of the chronic facial pain cases 17.5% and of the pain-free controls 7.1% were depressive 3 years earlier at baseline (p = 0.050, χ ² test, crude OR = 2.8, 95% CI = 1.0–8.0). Of the chronic facial pain cases 6.3% and of the pain-free controls 1.2% reported having had diagnosed depression (p = 0.085, crude OR = 5.7, 95% CI = 0.6–52.2). After adjusting the gender, the association between depressiveness reported at the baseline and chronic facial pain was significant (OR = 4.2, 95% CI = 1.1–16.2). When widespread pain was included in the analysis, the association was not significant. Conclusions. Depressiveness increases the risk for chronic facial pain in a 3-year follow-up. This association seems to be mediated through widespread pain.     

Benefits of 3D printing applications in jaw reconstruction: A systematic review and meta-analysis

BackgroundThree-dimensional (3D) printing has changed surgical practice over the past few years, especially in maxillofacial surgery. However, little is known about its real clinical impact. The objectives of our study were to identify clinical outcomes that have been evaluated in the literature regarding 3D printing applications in jaw reconstruction, and to quantify the impact of this technology on operating times.MethodsA systematic review was conducted by searching PubMed and EMBASE to collect comparative studies on 3D printing applications in jaw reconstruction. A meta-analysis of operating times was then performed. A Cochran's Q test was used to determine heterogeneity, and the overall effect size was calculated using a random effects model.ResultsFourteen studies were included in our review. Eighteen clinical end-points were identified, of which the most frequently reported were operating time (n = 5; 35.7%) and the final aesthetic result (n = 4; 28.6%). Operating times were significantly lower in the 3D printing groups, with an overall estimated effect of 21.2% (95% CI 10–33%; p < 0.001).ConclusionThe use of 3D printing in jaw reconstruction was associated with a significant reduction in operating times. The end-points evaluated differed largely among the studies. More studies with higher levels of evidence are needed to confirm our results.     

Efficacy of Alternative Medicaments for Pulp Treatment in Primary Teeth in the Short Term: A Meta-analysis

ObjectiveThis systematic review and meta-analysis aimed to evaluate the overall, clinical, and radiographical success rates of alternative pulpotomy medicaments in primary teeth.MethodsA systematic search of five databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Prospective clinical trials using alternative pulpotomy medicaments in children were included. The outcome measures were overall, clinical, and radiographic success, expressed in percentages and converted to odds ratios. Fifteen articles were included in the meta-analysis.ResultsCombined odds ratios for overall, clinical, and radiographic success was 0.55 (95% confidence interval [CI]: 0.12-2.41; P = .42; I² = 76%), 1.03 (95% CI: 0.57-1.86; P = .92; I² = 0%), and 0.84 (95% CI: 0.54-1.47; P = .66; I² = 34%), respectively. The results suggest an inconclusive outcome in the success rate of alternative medicaments.ConclusionsThere is insufficient evidence to support the efficacy of alternative pulpotomy medicaments for use in primary teeth. Further robust studies are required before such alternative medicaments should be used in clinical practice.     

The association between interleukin polymorphism and recurrent aphthous stomatitis: A meta-analysis

ObjectiveTo assess the association between interleukin gene polymorphism and recurrent aphthous stomatitis (RAS).DesignsTwo electronic databases, PubMed and Embase, were utilized to assemble potentially relevant studies meeting the inclusion criteria. A meta-analysis was conducted using Revman 5.3 software (London, UK), and the pooled odds ratio (OR) and 95% confidence interval (CI) were then used to evaluate the strength of the relationship between the gene polymorphisms of IL-1beta(−511C/T), IL-1beta(+3954C/T), IL-6(−174G/C) and IL-10(−1082G/A) and the risk of RAS.ResultsTen studies were included in the final meta-analysis, with 884 cases and 1104 controls participating. The results demonstrated that the polymorphism of IL-1beta(−511C/T) significantly increased the probability of the development of RAS in Europeans. (T vs. C: OR = 1.35, 95%CI = 1.09–1.67; CC vs. CT + TT: OR = 1.77, 95%CI = 1.24–2.53; CC vs. TT: OR = 1.86, 95%CI = 1.18–2.95). Furthermore, the C allele in IL-1beta(+3954C/T) was determined to be related to the risk of RAS in Americans (C vs. T: OR = 1.52, 95%CI = 1.07–2.17) and the presence of the C gene was considered a risk variant (CC + CT vs. TT: OR = 1.46, 95%CI = 1.01–2.11), but no relationship was found between the polymorphism of IL-10(−1082G/A) and the risk of RAS.ConclusionsThe meta-analysis suggested that the mutation of IL-1beta(−511C/T) in Europe and IL-1beta(+3954C/T) in America tend to increase the risk of RAS, but the polymorphism of IL-10(−1082G/A) appears to have no association with RAS risk in America. Further study is required to confirm the above conclusions.     

Prevalence of maxillary sinus septa: systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to determine the prevalence and characteristics of maxillary sinus septa using cone beam computed tomography and computed tomography data. Publications were searched until October 5, 2020 in three electronic databases. Additionally, article bibliographies were searched, and authors were contacted if required. This review has been registered in PROSPERO (CRD42019124933). Two independent evaluators assessed methodological quality using the Joanna Briggs Institute levels of evidence; inter-rater reliability tests were performed (Cohen’s κ). The prevalence of maxillary sinus septa was expressed as a proportion; differences according to sex were reported in terms of the odds ratio (OR) and 95% confidence interval (95% CI). Heterogeneity and sources of heterogeneity were evaluated by meta-regression. Publication bias was assessed by visual analysis of the funnel plot. Statistical significance was set at P < 0.05. The 62 studies identified and included in the review involved 13,701 patients (22,460 sinuses). The meta-analysis of 35 studies (14,664 sinuses) revealed an overall mean sinus septa prevalence per sinus of 33.2% (95% CI 27.8–38.5%; I² = 98.32%). The meta-analysis of 42 studies (9631 patients) found an overall mean sinus septa prevalence per patient of 41.0% (95% CI 36.0–46.0%, I² = 96.45%). The OR for the difference in septa prevalence between sexes was 0.785 (95% CI 0.590–1.046; P = 0.098, I² = 73.24%). Septa were most frequent in the middle area of the sinus and with a transverse orientation (86.0%). Within the limitations, the results suggest a high proportion of septa in the sinus, commonly in the middle area, which can interfere with the success of sinus floor elevation required for implant rehabilitation.     

Extracapsular dissection (ECD) and extended ECD: description of the technique and outcome of treatment

Over the last two decades the senior author has exclusively applied the technique of extracapsular dissection (ECD) and extended ECD to treat discrete, apparently benign parotid tumours. This article describes both techniques and evaluates their application. Simple principles are described to anticipate unexpected malignant tumours and manage lumps safely by wide excision. A retrospective analysis of 97 consecutive patients with discrete, apparently benign parotid lumps is presented. The tumours were classified using the European Salivary Gland Society (ESGS) classification for benign tumours of the parotid gland. The ECD or extended ECD technique was employed irrespective of tumour site or size. A review of patients was carried out after a minimum of six months post surgery by two independent clinicians. The mean (range) hospital stay was one (0-4) night (median 1). Complications were both modest and transient. The temporary facial nerve injury rate was 5/97 (6%). Other complications included haematoma (n=2), sialocele (n=2), and first-bite syndrome (n=2). Independent review post surgery demonstrated a mean Sunnybrook facial grading system score of 98/100 and a mean Stony Brook scar assessment score of 4.5/5. In this series 5/97 (5%) of discreet mobile lumps concealed a low-grade salivary cancer. Experience with the application of ECD in conjunction with its extended form in 97 consecutive patients with discrete parotid lumps is described. The technique is amenable to all parotid lumps, is not restricted by site or size, and has shown minimal morbidity. The risk of recurrent disease could not be addressed.