Center For Oral & Maxillofacial Surgery

Background Multiple factors contribute to mandibular incisor crowding. However, the role of wisdom teeth in these irregularities remains a controversial issue among clinicians. Therefore, this study aimed to determine the potential association between mandibular incisor crowding and the presence or absence of lower wisdom teeth using CBCT image analysis. Materials and methods A total of 64 CBCT images of adult patients were recruited. These CBCT images were classified into two groups according to the presence or absence of the lower wisdom teeth on the panoramic view. After the classification, the severity of crowding was calculated by utilizing Little’s irregularity index. Points such as A point, Nasion, and B point (Supramentale) were identified on the software program. The significance level was set at P < 0.05. Results There was no statistically significant correlation (P = 0.780) in the crowding of the mandibular incisor among the groups with the presence or absence of the lower wisdom teeth. Group 1 (with wisdom teeth) was 5.85 ± 4.05 mm, classified as a moderate irregularity; similarly, group 2 (without wisdom teeth) showed moderate irregularity with a mean value of 5.32 ± 3.12 mm. There was an incisor crowding with a severe irregularity in 18 patients (28.1%), a minimal irregularity in 15 patients (23.4%), a moderate irregularity in 14 patients (21.9%), a very severe irregularity in 10 patients (15.6%), and a perfect alignment in 7 patients (10.9%). Conclusions The presence and absence of lower wisdom teeth do not influence the mandibular incisor crowding.

Background A 63-year-old presented with reduced left visual acuity and V1 sensation. Imaging demonstrated left sphenoid osseous meningioma narrowing superior orbital fissure with intracranial extension to superior temporal gyrus. Method Endoscopic transorbital approach utilising novel lateral orbit ‘sliding coach door’ osteotomy performed. Lateral canthal incision with lateral canthal ligament division mobilises and decompresses globe infero-medially. Osteotomy performed, tethered by temporalis. Osteotomy slides postero-laterally creating working space lateral to inferior and superior orbital fissures. Conclusion This technique requires reduced soft tissue dissection and facilitates reconstruction. Adequate working space enabled satisfactory resection with residual dural tail requiring future surveillance. Cosmesis was satisfactory.

Background The study aimed to compare the short- and long-term effectiveness of hybrid Hyrax (HH) -Facemask (FM) and HH-mentoplate (MP) treatment protocols for maxillary protraction using Alt-RAMEC. Methods A single-center 2-arm parallel randomized controlled trial. Participants: 28 skeletal class III patients (female: 14, male: 14; average age: 9.7 ± 1.3 years;) were included. Interventions: Two treatment groups where protraction therapy was combined with Alt-RAMEC. Group 1: Facemask group (Hybrid Hyrax + Facemask) and Group 2: Mentoplate group (Hybrid Hyrax + Mentoplate). Objective: To compare skeletal and dental changes between groups using low dose computed tomography (CT) scan from which virtual lateral cephalograms were generated. Outcome: Outcomes include changes in Wits appraisal (primary outcome), and cephalometric analysis of skeletal and dental changes (secondary outcomes) at 1 year and 5 years after treatment initiation. Randomization: 28 patients were allocated to either treatment-protocols using sequentially numbered opaque, sealed envelopes. The randomization sequence was generated with a 1:1 allocation ratio. Blinding: Due to the nature of the trial, the operator and children could not be blinded to the treatment allocation. However, blinding was used when assessing the outcomes. Results Follow-up: one patient was lost at the one-year follow-up and an additional three patients were lost at the 5-year follow-up. Outcomes: Both treatment protocols effectively improved intermaxillary relationship. Wits measurements showed improvements of 4.42 mm (FM) and 2.86 mm (MP) at T1, decreasing slightly to 3.33 mm (FM) and 1.50 mm (MP) at T2. While vertical control and incisor inclination were comparable between groups long-term, short-term differences were noted in upper and lower incisor inclination. Results remained equally stable after five years (T2). Harms: minor harms were encountered with the anchor hooks (fracture or mucosal irritation), however none led to treatment cessation Conclusions Early class III treatment with HH + MP provided similar outcomes and stability to that of HH + FM suggesting that the choice between FM and MP should be based on individual patient factors rather than presumed mechanical advantages. Trial registration Clinical Trials ID: NCT02711111

Detailed information on orthognathic surgery (OGS) practices in Germany, including treatment modalities, surgical concepts, and perioperative care standards, is limited. This study analyzed current practices along the patient pathway, from preoperative planning to discharge, through a nationwide survey of the German Association of Oral and Maxillofacial Surgery using dynamic online questionnaires (up to 56 questions). Responses from 169 surgeons (response-rate 9.2%) revealed substantial variability in training, perioperative care, and digital workflow adoption. While 44.4% used a hybrid of digital and conventional planning methods, broader digital integration was limited by high costs and logistical challenges. Perioperative care varied, particularly in support concepts, blood management, and antibiotic prophylaxis duration, with shorter regimens (≤24h) more common at university-hospitals and private practices. However, 98% agreed on the use of prophylaxis. Surgical approaches were more standardized, with most respondents favoring pre-surgical orthodontics, third molar extraction before OGS, and the maxilla-first approach. Postoperatively, 76% transferred patients to standard care, with 3–5 days discharge times. Significant correlations were observed between surgeon experience, case volume, and improved outcomes, including reduced operative time and faster discharge. These findings underscore the need for standardized OGS protocols to enhance patient safety, optimize recovery, and ensure consistent practices across healthcare settings.

Background Tens of millions of people die from wound infections globally each year, and nearly 80% of tissue infections are associated with bacterial biofilms. However, overuse of antibiotics can lead to bacterial resistance. Therefore, it is critical to develop simple and effective strategies to kill bacteria and remove biofilms. Methods The present study used sericin as a reducing and stabilizing agent to synthesize sericin-gold nanoparticles (Ser-Au NPs) and tested its colloidal stability under different pH and salt concentration conditions. Subsequently, functional gold nanocomposites (Ser-Au@MMI) were synthesized by combining Ser-Au NPs with 2-mercapto-1-methylimidazole (MMI). The antimicrobial effect of Ser-Au@MMI was checked by MIC, antimicrobial activity test, and in vitro cytotoxicity was assessed using CCK-8 assay. In vitro anti-biofilm effect was observed by fluorescence microscopy and SEM. Finally, the anti-infective therapeutic efficacy of Ser-Au@MMI was determined in an in vivo rat-infected wound model. Results Sericin as a reducing and stabilizing agent to synthesize Ser-Au NPs exhibited excellent colloidal stability under different pH and salt concentration conditions. The TEM, EDS, and XPS analyses confirmed the successful synthesis of Ser-Au@MMI. It exhibited higher antibacterial activity due to the synergistic effect of MMI and AuNP, which can achieve a bactericidal effect by destroying the integrity of bacterial cell walls and structure. In addition, Ser-Au@MMI10 (HAuCl4:MMI =1:10) concentration (64 μg/mL) could effectively disrupt biofilms formed by four species of bacteria and kill them, including P. aeruginosa, B. subtilis, E. coli, and S. aureus, but was not cytotoxic to mouse fibroblasts (L929) cells. Infected wound modeling showed that Ser-Au@MMI10 accelerated infected wound healing in vivo. Conclusion Ser-Au@MMI nanocomposites are prepared through a facile and environmentally friendly strategy and have the advantages of excellent bactericidal effect and low toxicity, which has the potential for application as a broad-spectrum antimicrobial agent and biofilm disrupting agent in healthcare.

Introduction This study aimed to correlate preoperative 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) tumor staging, and maximum standardized uptake values (SUVmax) with preoperative CT data, postoperative tumor classification, and histopathological parameters of oral squamous cell carcinoma (OSCC). Material and methods Thirty-seven OSCC patients staged via full-body 18F-FDG-PET/CT, including contrast agent CT of the head and neck in 2020 and 2021, were enclosed. Patients received tumor resection and stage-dependent neck dissection. Preoperative clinical (c) 18F-FDG-PET/CT UICC tumor stages and TNM classifications were correlated to corresponding CT and to postoperative histopathological (p) UICC tumor stages and TNM classifications. SUVmax of the primary tumor was associated with pUICC and pTNM, including extranodal extension (ENE), perineural invasion (Pn), lymphatic spread (L), vascular invasion (V), tumor grading (G), and -thickness. Results Comparing 18F-FDG-PET/CT and CT, cUICC, cT, and cN differed in 32.3%, 16.7%, and 37.8% of the cases, respectively. For 18F-FDG-PET/CT, a moderate correlation was found between c- and pUICC (0.494; p = 0.0018) with a misestimation of c- compared to pUICC in 43.2% of the cases. Comparing c- and pTNM, misestimations concerning c- and pT were seen in 51.4% and concerning c- and pN in 37.8% of the cases. An increased SUVmax significantly correlated with increased pT- and pUICC (adjusted Odds ratio 1.103; p = 0.042 and 1.126; p = 0.021, respectively). The predictive quality of an SUVmax cutoff value for detecting cervical lymph node metastases and G was poor, as indicated by the low AUC values from the ROC analysis. No correlations were found between SUVmax and ENE, Pn-, L-, and V-status. A strong correlation was found between SUVmax and tumor thickness with an adjusted coefficient of 1.034 (p = 0.01). Conclusion The predictive value of 18F-FDG-PET/CT and SUVmax on histopathological tumor classification and parameters appears limited. Clinical relevance 18F-FDG-PET/CT can not unreservedly be recommended for primary OSCC staging. There is an urgent need to specify its indications in detail further.

Introduction This epidemiological retrospective study evaluated cone beam computed tomography (CBCT) as a reliable and valid tool in assessing maxillary sinus (MS) morphology, location and prevalence of accessory maxillary ostia (AMO) and evaluating its distribution with regards to gender and its subtypes. Materials and Methods The reporting of the study was done in accordance to strengthening the reporting of observational studies in epidemiology guidelines/checklist. Two hundred CBCT scans (400 MSs) were analysed for height and width of the maxillary sinuses (MSs) and its distribution with regards to gender. The prevalence of AMO and its different types of shapes were evaluated. Results Between the male and female groups, differences on both the right and left sides with respect to the MS height were observed ( P > 0.05). However, the male group showed statistically significant higher values for right-sided MS width ( P < 0.05).The prevalence of AMO in 400 MSs was found to be 65%, of which 63% of AMOs were present in the male group. The prevalence of types of accessory maxillary ostia revealed that the round and ovoid shapes were similar in number as compared to slit shapes. Discussion The forensic anthropology through CBCT can utilise the MS width as a tool to assess various anatomical variations. The frequency of AMOs can be utilised as a critical indicator for assessing such morphological and anatomical variations. As a result, the excellent spatial resolution of CBCT enables it as a reliable tool for identification of even smallest anatomical variations in MS.

Rationale This case series evaluates the effectiveness of the buccal advancement flap and buccal pad of fat for treating oroantral fistula (OAF) in uncontrolled diabetic patients, focusing on healing, complications and success rates. Patient Concern OAF is a condition marked by abnormal communication between the oral cavity and maxillary sinus, often leading to infections, purulent discharge, nasal regurgitation and discomfort. Diabetic patients face additional healing challenges. Diagnosis OAF is commonly caused by posterior maxillary teeth extractions with symptoms exacerbated by chronic sinus infection, especially in uncontrolled diabetics. Treatment Two surgical techniques were employed: the buccal advancement flap and buccal pad of fat. Both aim to enhance fistula closure and minimise complications in diabetic patients. Outcomes Both approaches achieved successful fistula closure with satisfactory healing despite the patients’ impaired healing capacity. Take-away Lessons Buccal advancement flap and buccal pad of fat provide effective and reliable solutions for OAF management in uncontrolled diabetic patients.

Introduction Orofacial space infections are potentially fatal and often need emergency medical and surgical care. Prompt diagnosis of these infections can sometimes be difficult because of diffuse swelling and trismus. Early treatment response is a key to the management and recovery. Conventional markers of infection, such as C-reactive protein (CRP) and white blood cell (WBC) counts fail to properly evaluate the progress. Procalcitonin (PCT) has high sensitivity and specificity for identifying bacterial infections and helps in treatment monitoring. Materials and Methods After ethical committee approval, 20 cases of maxillofacial space infections who came to the Department of Oral and Maxillofacial Surgery with involvement of more than two spaces were included in the study. Demographic data and vital signs were recorded. Total WBC, CRP levels and PCT levels were measured at admission, 48 h and 96 h. The values were subjected to statistical analysis. Results The decrease in PCT values was found to be statistically significant ( P < 0.05) when compared to the total WBC count and CRP values between admission/48 h period as well as 48/96-h periods, thus showing the positive response of patients to antibiotic therapy which was seen as clinical improvement. Discussion PCT succeeds as being a promising biomarker to determine the treatment response in maxillofacial space infections and guiding antibiotic regimen accordingly.

Background Neoadjuvant treatment with ipilimumab and nivolumab has shown efficacy in melanoma patients with nodal metastases in clinical trials. Real world data on neoadjuvant therapies is lacking. Patients and Methods This study investigates the effectiveness of neoadjuvant therapy in a real‐world setting and included all melanoma patients who received combined anti‐CTLA4/PD1 immunotherapy prior to resection. Pathologic and radiologic responses as well as treatment‐related adverse events were assessed, and recurrence‐free survival (RFS) was compared between patients with major pathologic response (mPR) and patients without mPR. Results In total, 24 patients were analyzed, including patients with distant metastases and patients with prior adjuvant treatment. Median follow‐up was 21.5 months. Upon histologic assessment, mPR was achieved in 50% (12/24) of the patients, including two patients with lung metastases and three patients who progressed after prior adjuvant anti‐PD1 therapy. Radiologic response after neoadjuvant treatment correlated with mPR. No patient with mPR relapsed during follow‐up (median RFS not reached) compared to six out of 12 patients without mPR (median RFS = 13 months, p = 0.005). Conclusions Neoadjuvant treatment with ipilimumab and nivolumab is effective in real‐world patients with different melanoma subtypes, different stages of disease and even advanced primary tumor.

Objectives To compare autogenous bone (AB) harvested from the mandibular ramus or a mixture of bovine bone mineral (BBM) with 25% locally harvested autogenous bone chips from the maxilla for maxillary sinus floor augmentation (MSFA). Material and Methods Patients requiring bilateral MSFA and implant placement were enrolled in this study. Maxillary sinuses were randomly assigned (1:1) to one of the two groups: MSFA + AB (AB group) or MSFA + AB + BBM (BBM group). AB was harvested from the mandible (AB group) or locally during MSFA (BBM group). Implants were placed after 4–6 months of healing and loaded 4–6 months later. Patients were examined at baseline (1 month post‐loading) and 12 months post‐loading. Outcome measures included clinician‐ and patient‐reported outcomes. Results Fifty patients with 198 implants were included (AB = 99, BBM = 99). Twelve implants failed before loading (AB = 6, BBM = 6), and three failed post‐loading (AB = 2, BBM = 1). Implant survival was 92.9% (AB group) and 93.9% (BBM group) at 12 months post‐loading, with no significant differences between the groups (HR, 0.85; 95% CI, 0.28–2.54; p = 0.770). Implant success was 98.8% (AB group) and 97.6% (BBM group), with no significant differences between the groups (HR, 0.49; 95% CI, 0.03–8.05; p = 0.620). No significant differences in marginal bone loss or clinical parameters were found between groups ( p > 0.05). Patient satisfaction significantly improved at follow‐ups compared to screening ( p = 0.005). Conclusion Implants placed after MSFA with AB or BBM showed comparable results. This indicates that MSFA can be successfully performed without requiring AB from an additional donor site, potentially reducing patient morbidity. Trial Registration This study was registered in the Dutch Trial Register with number NL59578.078.16 on 09‐05‐2017. The study start date was on 21‐08‐2017

Patients with abnormal relative position of the upper and lower jaws (the main part of the facial bones) require orthognathic surgery to improve the occlusal relationship and facial appearance. However, in addition to the retraction and protrusion of the maxillomandibular advancement, these patients may also develop asymmetry. This study aims to use a semi-supervised learning method to demonstrate the maxillary and mandible retraction, protrudation and asymmetry of patients before orthognathic surgery through automatic segmentation of 3D cone beam computed tomography (CBCT) images and landmark detection, so as to provide help for the preoperative planning of orthognathic surgery. Among them, the dice of the semi-supervised algorithm adopted in this study reached 93.41 and 96.89% in maxillary and mandibular segmentation tasks, and the average error of landmark detection tasks reached 1.908 ± 1.166 mm, both of which were superior to the full-supervised algorithm with the same data volume annotation. Therefore, we propose that the method can be applied in a clinical setting to assist surgeons in preoperative planning for orthognathic surgery.

Background Although available evidence indicates that gingival thickness may affect periodontal surgical outcomes, there are no studies on the effect of gingival thickness on gingival excisional wound healing. This prospective study aimed to assess the effect of gingival thickness on the healing of standardized experimental gingival wounds. Methods Healthy non-smokers with thick or thin gingiva were recruited. Standardized circular buccal gingival excisional wounds were created. Follow-up visits were conducted on postoperative day 3 (D3), 7 (D7), and 14 (D14). Healing Score Index (HSI) and H2O2 test were used to assess wound healing and epithelialization, respectively. Digital photographs were obtained to assess wound surface area. Patient-centered outcomes were assessed using custom and OHIP-14 questionnaires. Results Twenty-six volunteers (24–36 years old) with thin/thick gingiva (n = 13 per group, age- and sex-matched) completed the study. HSI predictably increased from D3 to D14, without significant intergroup differences at any time point (p ≥ 0.99). Wound epithelialization was 0% on D3, 61–69% on D7, and 92–100% on D14, without significant intergroup differences at any time (p ≥ 0.99). Over 95% of the immediate postoperative wound area was closed by D14, without significant intergroup differences at any time (p ≥ 0.25). Although OHIP-14 scores did not differ significantly between groups (p ≥ 0.99), thin group reported more pain after the anesthesia wore off (day of the surgery; p = 0.0391). Conclusions Within the limitations of the present study, standardized buccal gingival wounds heal predictably within a short period of time, with no evidence that clinically determined gingival thickness has any effects on the wound healing.

Longer procedure time (PT) predicts worse prognosis after endovascular treatment (EVT) in acute vertebrobasilar artery occlusion (VBAO), but it remains unknown whether it is worth pursuing recanalization when the PT is obviously extended. Patients with acute VBAO who received EVT were retrospectively enrolled from 21 stroke centers in China from December 2015 to December 2018. Multivariable logistic analysis was performed to analyze the associations of PT with favorable outcome (defined as modified Rankin Scale score of 0 to 3) and mortality at 90 days. A total of 541 patients with median age of 64 years (IQR, 55–73) were included. The median baseline National institutes of Health stroke scale score was 23 (IQR, 14–28) and PT was 110 min (IQR, 74–156). The rate of favorable outcome was 36.5% in patients with PT 111–155 min (adjusted OR 0.51 [95% CI 0.28–0.92]) and 33.3% in patients with PT > 155 min (adjusted OR 0.52 [95% CI 0.29–0.93]) compared with 42.9% in patients with PT ≤ 75 min. Compared with the PT ≤ 75 min, PT of 111–155 min (adjusted OR 1.96 [95% CI 1.11–3.46]) and PT > 155 min (adjusted OR 2.10 [95% CI 1.21–3.66]) were associated with increased risks of mortality. Recanalization within four PT intervals were consistently associated with better outcomes compared with failure of recanalization (all P < 0.05). For acute VBAO patients treated with EVT, recanalization regardless of PT was associated with improved prognosis than failure of recanalization, supporting the continued pursuit of recanalization despite the PT being obviously extended. The findings need validation in randomized controlled trials. Graphical Abstract

Objectives: At 31%, the risk of postoperative bleeding after tooth extraction is particularly high in patients who receive rivaroxaban therapy. The aim of this rodent study was to compare the hemostyptic properties and gingival healing between novel polyurethane‐based adhesive VIVO and gelatin sponge (GESP) under ongoing rivaroxaban therapy over a period of 10 days. Materials: In total, 120 extractions of the first upper molar were proceeded in rodents treated with rivaroxaban. Of these, 60 postextraction sites were treated with VIVO and 60 with GESP. The duration of the surgical procedure and the clinical parameters of postoperative bleeding and wound evaluation score were recorded. In vivo fluorescence imaging and laser Doppler flowmetry and tissue spectrophotometry (LDF‐TS) were performed. Results: GESP provided a faster procedure at 1:06 ± 0:17 min, but postoperative bleeding time was significantly shorter in VIVO sockets at 1:39 ± 0:03 min. Nonsignificant mild bleeding events and comparable wound evaluation scores were recorded in both treatments. LDF‐TS showed a significant increase in mean oxygen saturation SO 2 (%) and mean blood flow (AU) for both treatments. Only GESP showed a significant increase in relative hemoglobin (rHb). Conclusion: In the context of a rodent study, VIVO showed favorable hemostasis and promising gingival healing properties postextraction under ongoing rivaroxaban therapy.

The purpose of this study is to delineate differences between mandibular and maxillary desmoplastic fibroma (DF) via analysis of published cases. Details of cases were analyzed for distribution, demographics, presentation, treatment, and follow-up. Between 1961 and 2022, 195 cases were reported, averaged 2.7 annually. There were 159 (81.5%) mandibular and 36 (18.5%) maxillary cases. The posterior mandible was most commonly affected (91.2%; p < 0.05). Maxillary DF mostly involved the anterior region (53.1%; p < 0.05). The female:male ratio was 1:1.3 (1:2 mandibular and 1:4 maxillary), and the average age was 13.5 years (12.1 mandibular and 20.5 maxillary) with a peak frequency in both jaws in the first decade of life (p < 0.05). Mandibular cases mostly affected whites, and maxillary cases affected a higher percentage of Asians (p < 0.05). Maxillary cases caused more pain and intraoral ulceration (p < 0.05). The combined cure rate of all treatment modalities for mandibular and maxillary cases was 74.8 and 81.5%, respectively. The most effective single-modality treatment for DF of both jaws was surgery (p < 0.05). To the best of our knowledge, this review is the first to delineate difference between mandibular and maxillary DF. This work will aid attaining an improved management protocol of this uncommon disease.

Objectives The ultimate goal of stem cell (SC) transplantation is the regeneration of salivary gland function by transplanted SCs differentiating into salivary gland cells. Therefore, this study aimed to evaluate the regenerative capacity of bone marrow–derived mesenchymal stem cells (BM-MSCs) transplantation in irradiated mice using the immunohistochemical markers Ki-67 and CD34. Material and Methods Four groups of male mice were included in the study. Group I (normal control) comprised six mice that were not subjected to gamma radiation. Group II comprised six irradiated mice that were not treated with BM-MSCs. Group III comprised 12 irradiated mice that were treated with intraglandular injection of labeled BM-MSCs into their submandibular salivary glands, 24 hours postradiation. Group IV comprised 12 irradiated mice that were treated with intraglandular injection of labeled BM-MSCs into their submandibular salivary glands, on day 11 postradiation. Statistical Analysis Data were presented as mean and standard deviation. The different groups were compared using a one-way analysis of variance (ANOVA). Results The ANOVA test revealed that the difference between all groups was extremely statistically significant (p < 0.003), and Tukey's post hoc test revealed a statistically significant difference between group II and groups I, III, and IV included in the study regarding microvessel density of CD34 immunoexpression in different groups. Conclusion BM-MSCs have a regeneration potential on induced damaged submandibular salivary glands in mice; time is an essential factor in the regeneration capacity of BM-MSCs.

Background A number of studies have suggested that there is a need for improved understanding of dento‐maxillofacial cone beam computed tomography (CBCT) technology, and to establish optimized imaging protocols. While several ex vivo/in vitro studies, along with a few in vivo studies, have addressed this topic, virtual imaging trials could form a powerful alternative but have not yet been introduced within the field of dento‐maxillofacial imaging. Purpose To introduce and illustrate the potential of utilizing a virtual imaging trial (VIT) platform for dento‐maxillofacial CBCT imaging through a number of case studies. Methods A framework developed in‐house, simulating an existing CBCT scanner, and the necessary digital patient phantoms were prepared for the following potential studies: I) the impact of intracanal material type (Ni‐Cr alloy, fiberglass, gutta‐percha) and acquisition settings (tube current (mA), tube voltage (kVp)) on root fracture (RF) visibility; II) image artefact levels from candidate new restorative materials, such as graphene; III) the effect of patient rigid motion on image artifacts; IV) the effect of a metal artifact reduction algorithm on RF visibility in a tooth treated endodontically and restored with a metal post. In addition, features not available on the real system, including automatic exposure control and extended tube current and tube voltage ranges, were added to study the impact of these parameters. Patient dose levels were also quantified. Results The generated images showed the influence of different restorative materials, dose levels, rigid motion, and image processing on the quality of the final images. Results of these simulated conditions were consistent with findings in the literature. Patient effective dose levels ranged between 22 and 138 μSv$\mu{\rm Sv}$ for all simulated scenarios. Images were considered sufficiently realistic according to an experienced oral radiologist. Furthermore, the platform was able to simulate scenarios that are difficult or impossible to replicate physically in a controlled and repeatable way. Conclusions A virtual imaging trial platform has the potential to improve the understanding and use of CBCT technology. Improved insight into system performance can lead to optimized imaging protocols, and help to reduce the large variation in system setup and performance currently seen in clinical practice in dento‐maxillofacial CBCT imaging.

Background The choice between free flaps and locoregional flaps for soft tissue reconstruction in oral cavity cancer patients is critical for determining long-term functional and oncological outcomes. This systematic review evaluates the efficacy of these reconstructive techniques, focusing on survival, recurrence, quality of life (QoL), and functional parameters such as speech, swallowing, and the need for gastrostomy or tracheostomy. Methods A systematic review adhering to PRISMA guidelines was conducted using PubMed, Scopus, Cochrane, and EBSCO databases. The search strategy included terms related to oral cancer and reconstructive flap outcomes. Studies published between January 2000 and August 2024 were included if they reported statistical outcomes with at least a 3-month follow-up. A total of 32 studies involving 6620 patients met the inclusion criteria. Most patients were male, aged 45 to 65 years, with squamous cell carcinoma (SCC) accounting for over 70% of cases. Results Free flaps, particularly radial forearm free flaps (RFFF) and anterolateral thigh (ALT) flaps, were predominantly used for larger tumor resections and demonstrated superior functional outcomes. These flaps were associated with higher 5-year survival rates (65%–75%) compared with locoregional flaps (50–60%) and a lower local recurrence rate (12% for free flaps versus 26% for sternocleidomastoid flaps; P <0.05). Free flaps also yielded better QoL scores, especially in speech, social interaction, and emotional well-being. Functional recovery was significantly better, with 76.8% of patients resuming normal oral intake within 6 months compared with 58.3% for locoregional flaps ( P <0.05). Although locoregional flaps offered shorter operative times (mean: 6 h 53 min versus 9 h 18 min for free flaps) and faster initial recovery, they were linked to higher rates of flap necrosis and donor site complications. Conclusions Free flaps, particularly RFFF, offer superior oncological and functional outcomes for complex oral cavity reconstructions. Although locoregional flaps, such as submental island flaps (SMIF) and sternocleidomastoid (SCM) flaps, may be suitable for smaller defects due to shorter operative times and faster recovery, their use is associated with poorer long-term functional results and higher complication rates. These findings support the preferential use of free flaps for extensive reconstructions. Future research should prioritize multicenter randomized trials to validate these findings and refine patient-centered reconstructive strategies.