Single-system Langerhans cell histiocytosis (LCH) involving the maxillomandibular complex is rare, and optimal management remains controversial. Intralesional corticosteroid injections have been proposed as a minimally i...Single-system Langerhans cell histiocytosis (LCH) involving the maxillomandibular complex is rare, and optimal management remains controversial. Intralesional corticosteroid injections have been proposed as a minimally invasive alternative to surgery, radiotherapy, or systemic therapy. The aim of this study is to systematically evaluate the effectiveness and safety of intralesional corticosteroid injections for treating LCH of the maxilla or the mandible. A systematic review was conducted according to the PRISMA guidelines, in which PubMed, Embase and Scopus were searched. Eligible studies included English language case reports and case series describing LCH of the mandible and/or maxilla that had been confirmed by biopsy and treated with intralesional corticosteroid injections. Outcomes assessed included the resolution of symptoms, regression of lesions confirmed by radiography, recurrence, and adverse effects. Fifteen studies comprising 28 patients were included. Thirteen patients were treated with triamcinolone acetonide, 13 with methylprednisolone, and two with dexamethasone. Lesions were predominantly unifocal and located in the body or ramus of the mandible. Intralesional corticosteroid therapy was effective in 27 patients. Recurrence was reported in one case 12 months post treatment. Adverse effects were limited to one localised abscess that resolved without sequelae. Intralesional corticosteroid injections are associated with high rates of clinical and radiological improvement in mandibular and maxillary LCH, with minimal morbidity. While the current evidence is limited to low level studies, this approach represents a promising conservative treatment option. Prospective studies with standardised protocols are needed to define its long-term efficacy and role within treatment algorithms.
This study aimed to identify and collate outcomes reported in trials of facial trauma. Searches for randomised controlled trials on facial trauma containing 50 patients or more were conducted on Cochrane CENTRAL, Embase...This study aimed to identify and collate outcomes reported in trials of facial trauma. Searches for randomised controlled trials on facial trauma containing 50 patients or more were conducted on Cochrane CENTRAL, Embase and Ovid MEDLINE on 9 October 2025. Additional studies were identified through review of the reference lists of relevant systematic reviews and included trials, as well as through text searches of Google Scholar. A manual search of clinicaltrials.gov and the International Standard Randomised Controlled Trial Number (ISRCTN) registry was also completed in line with Cochrane guidelines on 20 November 2025. A total of 3,695 studies were screened following PRISMA guidelines, with 131 articles included in the final analysis. Two reviewers (KC and NB) independently performed data extraction, and the outcomes reported were recorded verbatim and mapped on to the World Health Organization International Classification of Functioning, Disability and Health (WHO ICF) framework. A total of 151 distinct outcomes were identified, with a median of four outcomes per trial. Mapping to the WHO ICF yielded 102 outcome domains. Eighty-two studies involved the mandible only, 39 involved the midface only, nine involved the mandible and midface, and one involved the midface and frontal bone. In mandibular fracture trials, immunological system functions that would capture infections (56%), structure of the mouth (53%) and pain (41%), were most frequently reported. In midfacial fracture trials, pain was the most common domain (37%), followed by immunological system functions (31%). Seven patient-reported outcome measures (PROMs) were identified across 10 trials, most commonly the General Oral Health Assessment Index. Outcome reporting in facial trauma trials is highly heterogeneous, spanning all domains of the WHO ICF framework, with limited and inconsistent use of PROMs. Most available PROMs were not designed specifically for facial trauma, and no single instrument was used consistently across the studies. This lack of standardisation limits comparability between trials and hinders meaningful evidence synthesis. These findings support the need for the development of a consensus-based core outcome set for facial trauma to improve consistency, relevance, and quality of outcome reporting in future research.
This review provides a comprehensive overview of the variety of outcome measures reported following orthognathic surgery. A systematic search of the literature was conducted to identify studies reporting on the outcomes...This review provides a comprehensive overview of the variety of outcome measures reported following orthognathic surgery. A systematic search of the literature was conducted to identify studies reporting on the outcomes of orthognathic surgery until December 2024 within the Embase, PubMed, MEDLINE, Ovid, Web of Science, Cochrane, and Google Scholar databases. The study cohort consisted of 11,703 patients, with 32% undergoing bimaxillary surgery. One hundred and ninety studies were analysed for outcome measures. Five broad categories of outcome measures were identified: Quality of Life (QoL), facial attractiveness scores, masticatory efficiency, occlusal assessment, and cephalometric-based outcomes. QoL was the most reported measure (63%), with in-house and validated questionnaires used inconsistently. Facial attractiveness assessments varied significantly in methods and scoring systems. Masticatory efficiency was commonly evaluated using bite force transducers or particle degradation after chewing, but no consensus on methodology was found. Cephalometric outcomes were primarily angular and linear measurements, though its use was limited. This review highlighted the lack of standardised outcome measures in orthognathic surgery. QoL was the most common measure, yet inconsistencies in the questionnaires highlight the need for global validation and standardisation. Internationally recognised methodologies for facial attractiveness and masticatory efficiency are also essential to enhance comparability and reliability across studies, facilitating advancements in clinical practice worldwide.
Preservation of the inferior alveolar nerve (IAN) during segmental mandibulectomy for osteoradionecrosis (ORN) may improve postoperative sensory function and quality of life, yet outcomes remain poorly described. We repo...Preservation of the inferior alveolar nerve (IAN) during segmental mandibulectomy for osteoradionecrosis (ORN) may improve postoperative sensory function and quality of life, yet outcomes remain poorly described. We report five patients who underwent IAN-preserving segmental mandibulectomy for Notani grade 3 ORN with immediate reconstruction with an osteocutaneous fibular free flap. Follow up ranged from 6 to 28 months. Objective sensory function was assessed across four standardised cutaneous points using light touch, pinprick, brush directional discrimination, and cold sensation testing. Subjective outcomes were evaluated using visual analogue scales (VAS) for lip biting frequency, pain, and tingling, alongside qualitative patient descriptions. Cold and pinprick sensation were the most impaired modalities, particularly in patients with shorter follow up, while mechanoreceptive function was generally preserved. Subjective symptoms mirrored objective findings and improved over time. Patients with over 17 months of follow up reported near-normal sensation with minimal functional disturbance.
Orthognathic surgery is commonly performed in healthy young adults and is associated with a low baseline risk of venous thromboembolism (VTE). However, considerable variation exists in the United Kingdom regarding the ro...Orthognathic surgery is commonly performed in healthy young adults and is associated with a low baseline risk of venous thromboembolism (VTE). However, considerable variation exists in the United Kingdom regarding the routine administration of preoperative pharmacological thromboprophylaxis with low molecular weight heparin (LMWH). The aim of this article is to review the current evidence for preoperative LMWH in orthognathic surgery, focusing on the incidence of VTE and the potential risk of perioperative bleeding, and to report findings of a local audit. Published literature demonstrates that symptomatic VTE following orthognathic surgery is rare, with reported incidences below 0.2% even in centres not using routine chemoprophylaxis. In contrast, anticoagulation has been linked with increased rates of postoperative bleeding complications, including haemorrhage requiring return to theatre, which raises concerns that routine prophylaxis may confer more harm than benefit in low-risk patients. A retrospective audit of 313 patients undergoing orthognathic surgery at a tertiary UK unit between January 2022 and February 2025, all of whom received prophylactic preoperative LMWH, identified no VTE events within three months of the operation. Intraoperative bleeding complications occurred in 12 patients (3.8%). Overall, current evidence does not support routine preoperative LMWH in low-risk orthognathic patients. Risk-stratified approaches are recommended, and prospective multicentre studies are needed to establish clear guidelines.
Deep lobe parotid tumours are difficult to remove due to their location and proximity to the facial nerve. Total parotidectomy is standard but has high complication rates. Selective deep lobe parotidectomy preserves the...Deep lobe parotid tumours are difficult to remove due to their location and proximity to the facial nerve. Total parotidectomy is standard but has high complication rates. Selective deep lobe parotidectomy preserves the superficial lobe and may reduce morbidity. This study is the first systematic review and meta-analysis of selective deep lobe parotidectomy outcomes. A PRISMA-based systematic review and meta-analysis was performed. Databases searched on 23 August 2025 included MEDLINE, Embase, CINAHL, PubMed, Google Scholar, and CENTRAL. Eligible studies reported outcomes of selective deep lobe parotidectomy. Data were analysed with a random-effects model, and risk of bias was assessed using the Newcastle-Ottawa Scale. Eight studies (299 patients) met the study criteria. All tumours were benign. Pleomorphic adenoma accounted for 225 cases (75.3%); other benign histologies were less commonly found. No malignancies were reported. Temporary facial weakness occurred in 24.2%, permanent weakness in 3.0%, Frey's syndrome 1.1%, infection 0.8%, contour deformity 11.8%, haematoma 3.1%, seroma 2.7%, auricular numbness 36.7%, and recurrence 0.8%. Heterogeneity was low. Selective deep lobe parotidectomy is a safe option for benign deep lobe tumours with low complication and recurrence rates. Larger prospective comparative studies with long-term follow up are required.
Unilateral condylar hyperactivity (CH) is a craniofacial condition characterised by excessive growth of one mandibular condylar process that leads to progressive facial asymmetry. Patients commonly require combined ortho...Unilateral condylar hyperactivity (CH) is a craniofacial condition characterised by excessive growth of one mandibular condylar process that leads to progressive facial asymmetry. Patients commonly require combined orthodontic and surgical interventions to restore function, facial symmetry, and quality of life, posing substantial financial burdens on individuals and healthcare systems. Diagnosis has traditionally relied on clinical and imaging findings, including visible facial asymmetry, enlargement of the mandibular ramus and/or condyle on two-dimensional (2D) and three-dimensional (3D) imaging, and increased metabolic activity on single photon emission computed tomography (SPECT), typically defined as a ≥10% side-to-side difference. Treatment, which depends on the activity level of the condylar tissue and severity of the resulting deformity, can include condylectomy and corrective surgery to correct the mandibular deformity. When CH is not progressing, treatment consists of orthodontic and surgical correction, with condylectomy used selectively. Despite extensive clinical experience, the aetiology of CH remains unclear, limiting the possibility of preventive or orthopaedic treatments. When current knowledge of the clinical features of CH, together with knowledge of temporomandibular joint morphology and metabolism, and cartilage and bone biomechanics, are brought together, there is strong evidence to suggest that CH develops as a result of a mechanical adaptation of the bone and cartilage. This article proposes the reframing of CH as extreme cases of a morphological variation that can lead to functional consequences, depending on severity. This perspective emphasises mechanistic insights that may improve diagnostic precision and guide more effective, biologically-grounded management strategies.
This study aimed to assess condylar changes using a fully automated deep learning-based cone-beam computed tomography (CBCT) workflow. Preoperative and postoperative CBCT scans of 50 skeletal Class III patients (100 cond...This study aimed to assess condylar changes using a fully automated deep learning-based cone-beam computed tomography (CBCT) workflow. Preoperative and postoperative CBCT scans of 50 skeletal Class III patients (100 condyles) were analysed using a fully automated pipeline integrating nnU-Net-based segmentation, rigid surface registration, and standardised surface cropping. Condylar changes were quantified using volumetric and linear measurements and surface-based metrics. Segmentation accuracy was high (Dice: mandible 0.98, condyle 0.99). Mean (SD) condylar volume changes ranged from -12.3 (6.2) to -0.03 (11.1) mm on the left and from -11.3 (10.7) to -0.95 (12.6) mm on the right. Significant differences in inter-side volume were observed in left and right rotation groups (p = 0.003), but not in the non-rotation group (p = 0.442). Direction of mandibular rotation significantly affected change in condylar volume bilaterally (p = 0.039). Surface-based metrics differed significantly among rotation groups (p = 0.036). Change in condylar volume showed a negative correlation with preoperative volume (r = -0.44 to -0.77, p < 0.001). Condylar remodelling after mandibular setback surgery is rotation-dependent and regionally heterogeneous. The proposed automated CBCT-based workflow enables reproducible, operator-independent quantification of condylar changes, and provides a standardised framework for postoperative assessment.