The typical management of central giant cell granuloma (CGCG) of the jaws involves curettage or resection; however, in selected cases, medical therapies such as denosumab have emerged as potential alternatives. We presen...The typical management of central giant cell granuloma (CGCG) of the jaws involves curettage or resection; however, in selected cases, medical therapies such as denosumab have emerged as potential alternatives. We present the case of a 22-year-old patient who presented with a right mandibular expansile lesion. Imaging and biopsy confirmed mandibular CGCG. The patient was managed non-surgically with denosumab, and follow-up imaging demonstrated lesion stabilisation and radiographic maturation. Denosumab may represent an alternative to surgery when operative management carries significant morbidity.
Facial gender-affirming surgery (FGAS), historically termed facial feminisation surgery, has evolved into a highly specialised field characterised by increasing technical refinement, safety, and patient expectations. Bas...Facial gender-affirming surgery (FGAS), historically termed facial feminisation surgery, has evolved into a highly specialised field characterised by increasing technical refinement, safety, and patient expectations. Based on a consecutive cohort of 3582 patients treated between 2008 and 2025, this Special Topic paper presents a state-of-the-art overview of contemporary FGAS practice, focusing on surgical sequencing, anatomical planning, and quality standards. The manuscript is organised by facial thirds-upper, middle, lower-and the cervical region, which reflects both anatomical logic and clinical workflow. Current surgical strategies are described for each region, emphasising bone-driven structural feminisation as the foundation for predictable outcomes, followed by staged soft-tissue adaptation when required. The role of advanced diagnostic protocols, three-dimensional imaging, patient-specific cutting guides, piezoelectric instrumentation, and biologically adjunctive therapies is highlighted. Beyond technical aspects, this work underscores the importance of meticulous preoperative assessment, realistic management of expectations, and ethical responsibility in a heterogeneous and vulnerable patient population. By synthesising nearly two decades of focused clinical experience, this article aims to define contemporary standards and provide practical guidance for safe, systematic, and patient-centred FGAS practice.
This study was designed to evaluate the impact of orthognathic surgery on depression and anxiety in patients with dentofacial deformities. PubMed, Embase, Cochrane Library, Web of Science, CNKI and WANFANG databases were...This study was designed to evaluate the impact of orthognathic surgery on depression and anxiety in patients with dentofacial deformities. PubMed, Embase, Cochrane Library, Web of Science, CNKI and WANFANG databases were searched from 2000 to 2025. This systematic review included studies that evaluated the impact of orthognathic surgery on depression and anxiety as measured by the Symptom Checklist-90 (SCL-90), Minnesota Multiphasic Personality Inventory (MMPI), State-Trait Anxiety Inventory (STAI) and Social Appearance Anxiety Scale (SAAS). The review included 12 articles with 613 participants, of which 10 were included in the meta-analyses. It revealed that orthognathic surgery was associated with postoperative improvement in psychological status. Regarding depression, scores at more than 6 months postoperatively were significantly lower than preoperative levels for both SCL-90 (MD 0.20, 95% CI [0.07 to 0.32]) and MMPI (MD 1.77, 95% CI [-0.50 to 4.04]). However, a more pronounced reduction in depression was observed at 3 months postoperatively (MD 0.33, 95% CI [-0.15 to 0.80]) compared to 6 months, suggesting a potential partial relapse during this interim period. For anxiety, significant improvement was noted at more than 6 months using the SAAS (MD 9.41, 95% CI [2.21 to 16.61]), while just a positive trend was observed with the SCL-90 (MD 0.10, 95% CI [-0.07 to 0.27]). Similarly, a more pronounced reduction in anxiety was observed at 3 months postoperatively (MD 0.33, 95% CI [-0.14 to 0.80]). Orthognathic surgery improves psychological status including anxiety and depression in patients with dentofacial deformities, with peak effects observed at 3 months that may relapse by 6 months.
Peripheral facial nerve defects resulting from oncological resection necessitate early repair, and underscore the need for accurate intraoperative assessment of their extent. This study proposes a span-based classificati...Peripheral facial nerve defects resulting from oncological resection necessitate early repair, and underscore the need for accurate intraoperative assessment of their extent. This study proposes a span-based classification system for peripheral facial nerve defects, based on the length and location of the defect. The system delineates specific defect characteristics and provides practical guidance for intraoperative decision-making and personalised repair plans.
Patients contemplating orthognathic surgery are increasingly turning to online forums, such as Reddit, as a supplementary source of information prior to undertaking a surgical treatment pathway. This study was designed t...Patients contemplating orthognathic surgery are increasingly turning to online forums, such as Reddit, as a supplementary source of information prior to undertaking a surgical treatment pathway. This study was designed to profile the main topics pertaining to orthognathic surgery which patients were discussing online, using data analytics methodologies and machine learning algorithms. An Application Programming Interface (API) wrapper was used to identify posts relating to orthognathic surgery on Reddit, within the /jawsurgery subreddit. The information was exported for further analysis. Topic modelling was undertaken with the Latent Dirichlet Allocation (LDA) algorithm, Valence Aware Dictionary and sEntiment Reasoner (VADER) tool was used for sentiment analysis, and a machine learning tool was used to pinpoint language cues in the posts. A total of 10265 posts were included in the analysis. These posts were categorised into one of ten topic groups based on qualitative analysis by the authors. Overall, there was positive sentiment toward orthognathic surgery within each of the topic groups within the subreddit. The topic groups which carried the highest sentiment were aesthetic change, aesthetic preferences and disagreements and, postoperative experience. Patients are actively seeking alternative sources of information regarding orthognathic surgery, particularly pertaining to the experiences of other patients. Whilst overall there is a positive sentiment toward surgery, both positive and negative experiences are posted online.
The aim of this report was to present a reproducible workflow for integrating three-dimensional (3D) facial scans into computed tomography-based virtual surgical planning of orthognathic surgery, thereby enriching the vi...The aim of this report was to present a reproducible workflow for integrating three-dimensional (3D) facial scans into computed tomography-based virtual surgical planning of orthognathic surgery, thereby enriching the virtual twin with clinically relevant soft-tissue information. This report describes the sequential stages of the workflow: 1) standardised preoperative imaging including computed tomography, intraoral scans (IOS), and three facial scans (rest, smile, lip-retracted); 2) preprocessing of facial scans in 3-Matic to remove dental structures and generate soft-tissue stereolithography (STL) models; 3) virtual twin construction in Materialise Enlight v7.0 by integrating digital imaging and communications in medicine skeletal data, IOS, and surface-based facial models; 4) application of repositioning tools and STL import functions to integrate multiple facial scans; 5) visualisation and analysis of natural head position, digital smile design, and comparison of pre- and postoperative soft-tissue predictions; and 6) finalisation of the case with the generation of intermediate and final splints and export of all planning data. The integration of facial scanning into virtual surgical planning is feasible and may be clinically relevant. While promising, further validation is required to confirm accuracy and reproducibility in routine clinical practice, particularly with respect to natural head position, digital smile design, and soft-tissue prediction. This workflow highlights the potential of recent software advances and facial scanning technologies in orthognathic planning.
This retrospective study examines the factors influencing bone thickness buccal to the implant (BTFU) and alveolar width at follow up (AW1) in immediate implant placement procedures in the upper aesthetic zone. After rev...This retrospective study examines the factors influencing bone thickness buccal to the implant (BTFU) and alveolar width at follow up (AW1) in immediate implant placement procedures in the upper aesthetic zone. After reviewing university records, thirty patients who underwent immediate implant placement before 2020 were recruited for cone-beam computed tomographic (CBCT) scans. Variables such as buccal gap, alveolar width, and buccal bone plate thickness were measured at T0 (pre-extraction) and T1 (study follow up). The results indicated significant effects of the type of bone graft used, buccal gap, alveolar width, and thickness of the buccal plate on BTFU and AW1. The study also showed non-linear relationships between the ratio of buccal gap to thickness of buccal plate (BG/TBP) and the outcome variables. This research provides insights into the complex interplay of these factors, which may guide clinicians in optimising immediate implant placement procedures for better aesthetic and functional outcomes.
The removal rate of titanium miniplates following orthognathic surgery varies widely (3.2-27.5%) due to inconsistent study designs and mixed samples. Plate removal is not routinely conducted in the UK. A 2019-2020 meta-a...The removal rate of titanium miniplates following orthognathic surgery varies widely (3.2-27.5%) due to inconsistent study designs and mixed samples. Plate removal is not routinely conducted in the UK. A 2019-2020 meta-analysis reported a 13.4% removal rate, though regular audits are uncommon. This study evaluates whether audit of local plate removal rates against established benchmarks merits encouragement. A retrospective review was conducted of orthognathic surgery at a tertiary centre (2014-2024). Procedures included Le Fort osteotomy, bilateral sagittal split osteotomy (BSSO), bimaxillary osteotomy (BIMAX), genioplasty, and other mandibular osteotomies. All patients received two postoperative doses of dexamethasone and intravenous antibiotics. Data collected included demographics, smoking status, surgical site, re-plating, and antibiotic use. The primary outcome was return to theatre (RTT) for plate removal or replacement. Chi squared, Fisher's exact, and binomial tests were used to assess statistical significance. Over 10 years, 417 patients underwent 429 orthognathic procedures, including 12 revisions to achieve the desired skeletal and orthodontic outcome. Overall, metalwork removal/adjustment occurred in 46 cases, predominantly within the first year, with infection identified as the leading cause. The removal rate was 10.7% (46/429), consistent with the 13.4% benchmark (p = 0.12). Yearly rates generally aligned with the benchmark, except in 2021, when deviations were likely to have been influenced by COVID-19-related disruptions. Smoking (p = 1.0) and oral antibiotics on discharge (p = 0.09) were not significantly associated with plate removal rates. These findings validate the 13.4% benchmark for metalwork removal. Routine audit and inter-unit collaboration are vital for refining benchmarks and improving patient care.
Habu M, Oda M, Takahashi O
… +10 more, Tsurushima H, Otani T, Yoshiga D, Wakasugi-Sato N, Matsumoto-Takeda S, Sasaguri M, Nishimura S, Nishina S, Yoshioka I, Morimoto Y
The present study aimed to elucidate the characteristics of imaging findings for medication-related osteonecrosis of the jaw (MRONJ) in patients with cemento-osseous dysplasia (COD). Images from patients with MRONJ and C...The present study aimed to elucidate the characteristics of imaging findings for medication-related osteonecrosis of the jaw (MRONJ) in patients with cemento-osseous dysplasia (COD). Images from patients with MRONJ and COD from among patients with osteomyelitis, including MRONJ, that were obtained from multidetector row computed tomography (MDCT), magnetic resonance imaging (MRI), panoramic radiographs, and dental radiographs, were retrospectively analysed. The characteristics of imaging findings for MRONJ in patients with COD were then analysed. Significant differences in the presence of sequester, periosteal reaction, pathological fracture, spread into soft tissue, cortical perforations, and separation between cortical and cancellous bone were observed between patients with MRONJ and those with non-medication-related osteomyelitis. In patients with MRONJ, no significant differences in inflammatory imaging features were observed between those with and without COD. Findings indicate that hyperdense lesions in the periapex of the involved teeth tend to remain in patients with MRONJ and COD. In addition, the sequestrum was sometimes composed of hyperdense lesions in the periapex of the involved teeth. Imaging findings in patients with MRONJ and COD were not necessarily different from those in patients with MRONJ without COD, which suggests that the diagnosis of patients with MRONJ and COD should be based on characteristic imaging findings, such as a sequestrum involving fusion between hyperdense structures and osteosclerosis. When performing necrotic bone removal, this characteristic should be considered during the procedure. Additionally, because COD is prone to inflammation, extra caution must be exercised regarding infection during and after the procedure compared with standard care.
The prevalence of cutaneous malignancies in the head and neck region appears to be increasing. This is of great relevance to dentists as they may be the first medical professional to notice a suspicious lesion. However,...The prevalence of cutaneous malignancies in the head and neck region appears to be increasing. This is of great relevance to dentists as they may be the first medical professional to notice a suspicious lesion. However, education on this varies across institutions and countries, influencing future clinicians' clinical competence to address these lesions. This project aimed to understand the importance of awareness and education about cutaneous malignancies, to explore the differences in teaching in dental schools in Birmingham, UK and Melbourne, Australia, and to investigate the outcomes of related teaching in these schools. The project used qualitative and quantitative research, including comparisons of curricula and a survey to assess students' confidence and knowledge to manage suspicious lesions in practice. Analysis of the Birmingham and Melbourne dental school curricula showed differences in teaching hours and learning objectives. Results from the survey showed that Birmingham students felt more confident to identify cutaneous malignancies, and performed better in identifying referral timeframes than Melbourne students. However, both groups performed similarly in recognising these lesions. Dentists are well placed to identify cutaneous malignancies, but changes in curricula and teaching are needed to improve undergraduate education. This could then increase early recognition and improve patient outcomes.
Inferior alveolar nerve (IAN) injuries are common complications of orthognathic surgery, with incidences reported from 0% to 85% due to inconsistent definitions, assessment methods and follow-up protocols. These limitati...Inferior alveolar nerve (IAN) injuries are common complications of orthognathic surgery, with incidences reported from 0% to 85% due to inconsistent definitions, assessment methods and follow-up protocols. These limitations hinder comparisons, emphasising the need for standardised evaluation. This 10-year retrospective cohort study investigates IAN injury rates following mandibular osteotomies, focusing on medium-long term outcomes and risk factors. A retrospective cohort study was conducted at a tertiary orthognathic centre (2014-2024) on sagittal split osteotomies, performed either as stand-alone or as part of bimaxillary surgeries. Altered sensation was assessed via patient-reported outcomes during clinical follow ups (0-60+ months). While a final review was typically conducted at 6 months, extended follow ups addressed nerve symptoms, revision surgeries, or COVID-19 disruptions. Chi squared tests, Fisher's exact test and odds ratios evaluated associations with demographics, split quality, and nerve injuries. The primary outcome was altered sensation at ≥6 months. Of 221 procedures, 75.6% (n = 167) had follow ups ≥6 months, with 44.3% (n = 74/167) reporting altered sensation, primarily in the lower lip. Rates were 49% (n = 49/100) at 6-12 months, 50% (n = 13/26) at 13-18 months, and 29.2% (12/41) beyond 18 months. Females (OR = 1.07) and the 41-50 age group (50%, n = 2/4) showed slightly increased sensory changes, although they were not statistically significant. Unsatisfactory splits had higher altered sensation rates (60%, n = 6/10) compared with satisfactory splits (43.9%, n = 65/148) although these were not statistically significant (p = 0.15). Among documented nerve injuries, 100% (n = 7) resulted in sensory changes at ≥6 months. Altered sensation affected 44.3% (74/167); non-standardised follow up limits interpretation and supports standardised neurosensory reporting.