Significant advances in reconstructive head and neck surgery with free microvascular flaps have had a positive impact on esthetic outcomes and quality of life. However, complications still occur in some patients. This study investigated the influence of the Hemoglobin, Albumin, Lymphocyte, and Platelet Score (HALP score), an immunonutritive marker, on complications and flap success. The retrospective analysis included 194 patients who underwent reconstruction of head and neck defects with free microvascular flaps. The HALP score correlated strongly with overall complications, including flap necrosis, infection, fistula, and hematoma. Hemoglobin, albumin, lymphocytes, and platelets individually showed associations with specific complications. HALP score was an extremely strong predictor of complications (AUC = 0.85). HALP score may be valuable for assessing patient status and predicting complications in microvascular free-flap reconstruction to allow timely interventions and improve outcomes. Further research is needed to investigate additional predictors and improve postoperative care.

Objectives: The purpose of this study was to develop a deep learning algorithm capable of diagnosing radicular cysts in the lower jaw on panoramic radiographs. Materials and Methods: In this study, we conducted a comprehensive analysis of 138 radicular cysts and 100 normal panoramic radiographs collected from 2013 to 2023 at Clinical Hospital Dubrava. The images were annotated by a team comprising a radiologist and a maxillofacial surgeon, utilizing the GNU Image Manipulation Program. Furthermore, the dataset was enriched through the application of various augmentation techniques to improve its robustness. The evaluation of the algorithm’s performance and a deep dive into its mechanics were achieved using performance metrics and EigenCAM maps. Results: In the task of diagnosing radicular cysts, the initial algorithm performance—without the use of augmentation techniques—yielded the following scores: precision at 85.8%, recall at 66.7%, mean average precision (mAP)@50 threshold at 70.9%, and mAP@50-95 thresholds at 60.2%. The introduction of image augmentation techniques led to the precision of 74%, recall of 77.8%, mAP@50 threshold to 89.6%, and mAP@50-95 thresholds of 71.7, respectively. Also, the precision and recall were transformed into F1 scores to provide a balanced evaluation of model performance. The weighted function of these metrics determined the overall efficacy of our models. In our evaluation, non-augmented data achieved F1 scores of 0.750, while augmented data achieved slightly higher scores of 0.758. Conclusion: Our study underscores the pivotal role that deep learning is poised to play in the future of oral and maxillofacial radiology. Furthermore, the algorithm developed through this research demonstrates a capability to diagnose radicular cysts accurately, heralding a significant advancement in the field.

Mandibular fractures, particularly condylar process fractures, are common in maxillofacial surgery and require effective treatment methods that minimize complications while ensuring functional and esthetic recovery. This paper presents two cases of mandibular condylar process fractures treated using a transoral endoscopically assisted technique (EATA), thus marking the first documented application of this approach in Croatia. The aim was to evaluate the efficacy of this minimally invasive method compared to traditional extraoral approaches, which often carry risks such as visible scarring, facial nerve injury, and prolonged postoperative recovery. A 30° rigid endoscope and specialized angled instruments were utilized in both cases to achieve precise visualization, reduction, and fixation of the fractures. The first case involved a young male with a double mandibular fracture, while the second case addressed an isolated condylar fracture in an older female with comorbidities. Both patients were successfully treated without complications, including facial nerve injury, hematomas, or salivary fistulas. Hospitalization periods were shorter compared to traditional approaches, and recovery included restored temporomandibular joint function (TMJ), stable occlusion, and the absence of visible scars. The EATA method proved to be safe and effective, offering numerous advantages such as reduced morbidity, minimal soft tissue trauma, and superior aesthetic outcomes. Despite requiring specialized equipment and additional surgical training, EATA has significant potential to become a standard treatment modality for mandibular fractures. The findings of this study contribute to the growing body of evidence supporting the clinical benefits of this minimally invasive technique.

Diagnosing child abuse still poses a challenge for healthcare professionals. We will present a case in which a physically and emotionally abused four-year-old boy had an undiagnosed lower jaw fracture for almost eight months. The child first presented with a peri-mandibular swelling and was treated with antibiotics prescribed by his doctor of dental medicine. After not having responded to antibiot-ic treatment, the boy was referred to the Department of Oral and Maxillofacial Surgery, accompanied by his birth mother. The deciduous mandibular molars with deep cavities were extracted since we thought that they were the reason for swelling. After several visits with his foster mother, the child was finally diagnosed with a lower jaw fracture and a psychosomatic disorder. Physical abuse by his birth parents was later on confirmed, and the consequences were insufficient growth, non-perception of pain and reduced speech development. After having been with his foster mother for almost a year, the child learned to complain when he was in pain. This report emphasizes the importance of taking a detailed medical history along with a thorough clinical examination.

Background/Objectives: This case report describes a rare case of bilateral coronoid hyperplasia (CPH) with suspected Jacob’s disease in a young female patient, managed by endoscopically assisted coronoidectomy, and provides quantitative oral-health-related quality of life (OHRQoL) and pain outcomes. Methods: An 18-year-old female with severely restricted mouth opening underwent bilateral endoscopically assisted intraoral coronoidectomy. OHRQoL and pain were assessed with the Oral Health Impact Profile 14 (OHIP-CRO14) and a 100 mm visual analogue scale (VAS) preoperatively, daily for seven postoperative days, and at one year. Results: Maximum mouth opening improved from 8 mm to 35 mm at nine months (+338%). OHIP-14 total scores remained within a “poor”-to-“moderate” impact and low quality of life from the preoperative value (38) throughout the postoperative week (31–38) and decreased to 14 at one year (−63%; “good” impact, very high quality of life). Psychological disability and psychological discomfort were the most affected domains. VAS scores rose from 36 preoperatively, peaked at 55 on day 2, fluctuated as mild pain (27–44), and resolved at one year. Conclusions: Endoscopically assisted intraoral coronoidectomy restored functional mouth opening and produced clinically meaningful improvements in pain and OHRQoL, with the largest gains in psychological domains. To the authors’ knowledge, this is the first case report providing quantified, domain-resolved OHRQoL outcomes after coronoidectomy.

Background: Second primary tumors (SPTs) are a major survivorship challenge in oral squamous cell carcinoma (OSCC), yet their biological phenotypes may differ according to exposure status and immune background. Methods: In this retrospective cohort (2011–2020), 242 surgically treated primary OSCC patients were classified as non-smoking, non-drinking (NSND; never smokers/never drinkers) or smoking and/or drinking (SD; any history of smoking and/or alcohol consumption). SPTs were categorized as extra-oral SPTs (eoSPTs) or multifocal oral SCC (mOSCC), with mOSCC (≥3) denoting ≥3 oral primaries. Immune background was assessed by documenting immune-modulating conditions (including oral lichen planus as an immune-mediated mucosal disorder). Multivariable logistic regression was used to evaluate predictors of eoSPTs and mOSCC. Results: SPT occurred in 82/242 (33.9%), comprising 54 eoSPT (22.3%) and 28 mOSCC (11.6%). Overall SPT prevalence was similar in NSND and SD patients (29.8% vs. 36.1%), but phenotype composition differed significantly (chi-square p = 0.004): eoSPTs were more common in SD (27.8% vs. 11.9%), whereas mOSCC was more common in NSND (17.9% vs. 8.2%); mOSCC (≥3) occurred in 10.7% of NSND versus 1.3% of SD patients. Immune-modulating conditions were associated with mOSCC but not eoSPTs. Within the immune-modulating spectrum, OLP showed strong phenotype specificity (0/20 eoSPTs; mOSCC in 7/20 [35.0%), particularly among NSND patients (38.9% with OLP vs. 12.1% without). In adjusted models, NSND status was associated with lower odds of eoSPT (OR 0.37, 95% CI 0.15–0.96), while OLP independently predicted mOSCC (OR 3.47, 95% CI 1.04–11.52). Conclusions: SPTs in OSCC comprise distinct phenotypes: SD patients predominantly develop eoSPTs consistent with carcinogen-associated aerodigestive field effects, whereas NSND patients exhibit an immune-associated, oral-restricted pattern with frequent mOSCC, supporting phenotype-tailored surveillance.