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  1. Book ; Online ; E-Book: Management of Orbito-zygomaticomaxillary Fractures

    Marwan, Hisham / Sawatari, Yoh / Peleg, Michael

    2020  

    Abstract: This excellently illustrated book provides a thorough overview of the management of orbito-zygomaticomaxillary fractures, which can be complex since both function and facial form may be affected. Practical guidance is offered on all aspects, including ... ...

    Author's details by Hisham Marwan, Yoh Sawatari, Michael Peleg
    Abstract This excellently illustrated book provides a thorough overview of the management of orbito-zygomaticomaxillary fractures, which can be complex since both function and facial form may be affected. Practical guidance is offered on all aspects, including clinical examination, CT assessment, surgical planning, surgical access and techniques, soft tissue management, intra- and postoperative assessment, and management of complications. In addition, important technological advancements in planning and treatment are described, including the use of navigation systems and 3D printing. Finally, the authors discuss strategies involving delayed surgical intervention and revision surgery for the malpositioned zygomatic maxillary complex. Management of Orbito-zygomaticomaxillary Fractures will be of value for oral and maxillofacial/craniomaxillofacial surgeons at all levels of experience.
    Keywords Oral surgery ; Maxillofacial surgery ; Fractures ; Cirurgia maxil·lofacial ; Cirurgia oral ; Visualització tridimensional ; Informàtica mèdica ; Oral and Maxillofacial Surgery
    Subject code 617.52059
    Language English
    Size 1 online resource (VIII, 112 p. 102 illus., 93 illus. in color.)
    Edition 1st ed. 2020.
    Publisher Springer International Publishing ; Imprint: Springer
    Publishing place Cham
    Document type Book ; Online ; E-Book
    Remark Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
    ISBN 3-030-42645-9 ; 3-030-42644-0 ; 978-3-030-42645-3 ; 978-3-030-42644-6
    DOI 10.1007/978-3-030-42645-3
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  2. Article: Odontogenic Sarcomas of the Mandible.

    Akers, Jared / Geisler, Emily / Qiu, Suimin / Konofaos, Petros / Marwan, Hisham

    Biomedicines

    2024  Volume 12, Issue 3

    Abstract: Odontogenic sarcomas are exceedingly rare and account for less than 5% of all Maxillofacial Sarcomas. It usually affects the younger population. The posterior mandible is the most commonly affected site. Radiographically, it appears as a large ... ...

    Abstract Odontogenic sarcomas are exceedingly rare and account for less than 5% of all Maxillofacial Sarcomas. It usually affects the younger population. The posterior mandible is the most commonly affected site. Radiographically, it appears as a large destructive radiolucent lesion with ill-defined margins. Histopathological diagnosis is usually difficult. Surgery is the mainstay treatment. The role of chemotherapy and radiation therapy is not clear. Here, we present a case study of a 30-year-old female patient diagnosed with odontogenic sarcoma that impinged on her airway. The treatment and postoperative course will be discussed in detail.
    Language English
    Publishing date 2024-03-08
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2720867-9
    ISSN 2227-9059
    ISSN 2227-9059
    DOI 10.3390/biomedicines12030615
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The Use of Urinary Bladder Matrix for Reconstructing Avulsed Traumatic Soft Tissue Injuries to the Maxillofacial Region.

    Amin, Dina / Marwan, Hisham / Rowan, Brian / Abramowicz, Shelly / Zaid, Waleed

    The Journal of craniofacial surgery

    2023  Volume 34, Issue 8, Page(s) 2317–2320

    Abstract: Introduction: The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma.: Materials and methods: This retrospective case series ... ...

    Abstract Introduction: The purpose of the study was to provide an overview of our initial experience utilizing urinary bladder matrix (UBM) for reconstructing avulsed injuries resulting from trauma.
    Materials and methods: This retrospective case series evaluated patients presented with avulsed soft tissue injuries to the head and neck who underwent reconstruction with UBM. Patients were treated by Oral and Maxillofacial Surgery Service in Louisiana State University Health Sciences Center (Baton Rouge, LA). Descriptive variables were collected. Descriptive statistics were calculated.
    Results: Eight patients (mean age 55.8 y) met our inclusion criteria. Wounds were located in the scalp (n=2, 25%), mandible (n=2, 25%), upper eyelid (n=1, 12.5%), cheek (n=1, 12.5%), nose (n=1, 12.5%), or neck (n=1, 12.5%). The depth of the wound extended from the skin to the subcutaneous tissue (n=1, 12.5%), muscle (n=2, 25%), bone (n=3, 37.5%), and/or cartilage (n=1, 12.5%). The mean wound diameter was 47.9 cm 2 (range 17-85 cm 2 ). Wounds were classified as acute (n=6, 75%) or chronic wounds (n=2, 25%). At 6 months, all patients had achieved complete healing with no need for additional surgical procedures (n=8, 100%) with a mean healing time of 36.5 days (range 14-90 d).
    Conclusion: Urinary bladder matrix minimize donor-side morbidity, eliminates contraction, and offers a wide range of product sizes to cover a wide range of maxillofacial soft tissue defects in a single-stage manner.
    MeSH term(s) Humans ; Middle Aged ; Plastic Surgery Procedures ; Urinary Bladder/surgery ; Retrospective Studies ; Soft Tissue Injuries/surgery ; Wound Healing ; Skin Transplantation ; Treatment Outcome
    Language English
    Publishing date 2023-09-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1159501-2
    ISSN 1536-3732 ; 1049-2275
    ISSN (online) 1536-3732
    ISSN 1049-2275
    DOI 10.1097/SCS.0000000000009699
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Cholesterol Granuloma: An Unusual Presentation Within the Mandible of a Pediatric Patient.

    Gosnell, Joseph M / Marwan, Hisham / Qiu, Suimin

    Cureus

    2022  Volume 14, Issue 4, Page(s) e24163

    Abstract: Cholesterol granulomas, while a common pathological finding, are rarely reported within the mandible. Herein, we report the case of a pediatric patient who presented with a cholesterol granuloma within a periapical cyst, extending from the inferior ... ...

    Abstract Cholesterol granulomas, while a common pathological finding, are rarely reported within the mandible. Herein, we report the case of a pediatric patient who presented with a cholesterol granuloma within a periapical cyst, extending from the inferior aspect of tooth #31 to the mandibular condyle, with no prior history of infection or trauma to the region and underwent successful marsupialization of the lesion.
    Language English
    Publishing date 2022-04-15
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.24163
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Sentinel lymph node biopsy versus elective neck dissection in management of the clinically negative (cN0) neck in patients with oral squamous cell carcinoma: A systematic review and meta-analysis.

    Al-Moraissi, Essam Ahmed / Marwan, Hisham / Elayah, Sadam Ahmed / Traxler-Weidenauer, Denise / Paraskevopoulos, Konstantinos / Amir Rais, Mohammed / Zimmermann, Matthias

    Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery

    2024  Volume 52, Issue 2, Page(s) 141–150

    Abstract: Oral squamous cell carcinoma (OSCC) is the most prevalent type of head and neck cancer, and lymph node metastasis is a crucial prognostic factor that has a direct correlation with the survival rate. The standard procedure for managing clinically negative ...

    Abstract Oral squamous cell carcinoma (OSCC) is the most prevalent type of head and neck cancer, and lymph node metastasis is a crucial prognostic factor that has a direct correlation with the survival rate. The standard procedure for managing clinically negative (cN0) neck in OSCC patients is elective neck dissection (END), but it can lead to various complications that affect the patient's quality of life. Therefore, medical professionals are exploring the use of the sentinel lymph node biopsy (SLNB) to manage cN0 neck in OSCC patients. The aim of this systematic review and meta-analysis was to compare the overall survival (OS) and disease-free survival (DFS) of patients undergoing SLNB and END in the surgical management of early cN0 neck in OSCC patients. To conduct this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to report the systematic reviews. The study included all comparative clinical studies, including randomized clinical trials (RCTs), clinical perspective studies, and retrospective studies that compared END to SLNB for early cN0 neck in OSCC patients. The hazard ratio (HR) and risk ratio (RR) with 95% confidence interval (CI) were calculated using comprehensive meta-analysis. The primary outcome variables were OS, DFS, and disease-specific survival (DSS). The secondary outcome variable was the nodal recurrence rate without local or distant metastasis. The GRADE system was used to assess the evidence's certainty. The meta-analysis included 12 clinical studies, comprising three RCTs and seven non-RCTs. The results showed no statistically significant difference between END and SLNB concerning OS (HR = 0.993, CI: 0.814 to 1.211, P = 0.947, low-quality evidence), DFS (HR = 0.705, CI: 0.408 to 1.29, P = 0.21, low-quality evidence), and nodal recurrence (RR = 1.028, CI: 0.969 to 1.090, P = 0.907, low-quality evidence). Additionally, SLNB was non-inferior to END regarding DSS (RR = 1.028, CI: 0.969 to 1.090, P = 0.907, low-quality evidence). In conclusion, this research affirms the safety and precision of SLNB as a means to stage cN0 OSCC patients, with outcomes that are comparable to END in terms of survival and nodal recurrence. Nevertheless, it's crucial to acknowledge that the quality of evidence in this study was relatively low. Therefore, additional RCTs comparing END to SLNB are warranted to validate these results and offer more robust guidance for managing cN0 OSCC patients.
    MeSH term(s) Humans ; Neck Dissection/methods ; Sentinel Lymph Node Biopsy/methods ; Squamous Cell Carcinoma of Head and Neck/surgery ; Squamous Cell Carcinoma of Head and Neck/pathology ; Carcinoma, Squamous Cell/pathology ; Mouth Neoplasms/pathology ; Head and Neck Neoplasms/surgery ; Head and Neck Neoplasms/pathology ; Neoplasm Staging
    Language English
    Publishing date 2024-01-03
    Publishing country Scotland
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 91267-0
    ISSN 1878-4119 ; 1010-5182 ; 0301-0503
    ISSN (online) 1878-4119
    ISSN 1010-5182 ; 0301-0503
    DOI 10.1016/j.jcms.2023.12.012
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: What Is the Most Stable Fixation Technique for Mandibular Condyle Fracture?

    Marwan, Hisham / Sawatari, Yoh

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons

    2019  Volume 77, Issue 12, Page(s) 2522.e1–2522.e12

    Abstract: Purpose: Mandibular condylar fractures are relatively common fractures, accounting for 29 to 52% of all mandibular fractures. Recently, the debate between closed versus open treatment of the condylar fracture has shifted toward more specific surgical ... ...

    Abstract Purpose: Mandibular condylar fractures are relatively common fractures, accounting for 29 to 52% of all mandibular fractures. Recently, the debate between closed versus open treatment of the condylar fracture has shifted toward more specific surgical questions concerning the number and pattern of the fixation method for the condylar region. We have attempted to resolve the controversy with the systematic review and meta-analysis. The purpose of the present study was to compare the outcomes of different methods of fixation for mandibular condylar fractures.
    Materials and methods: We conducted an electronic database search for clinical studies evaluating the stability of internal fixation of condylar fractures. The search was restricted to studies reported in the English language from January 2000 to July 2018. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guidelines.
    Results: The initial search returned 285 studies reported from January 2000 through July 2018. After reviewing the full-text reports, only 16 studies were deemed eligible for the review. The total sample size was 831 patients with mandibular subcondylar fractures. The patients were classified into 25 groups according to the fixation method, follow-up period, use of intermaxillary fixation, and the presence of associated fractures.
    Conclusions: The results of our systematic review and meta-analysis showed that single plate fixation has been associated with more complications with poor outcomes, including hardware failure, screw loosening, and postoperative malocclusion.
    MeSH term(s) Bone Plates ; Bone Screws ; Fracture Fixation ; Fracture Fixation, Internal ; Humans ; Mandibular Condyle/injuries ; Mandibular Fractures/surgery ; Treatment Outcome
    Language English
    Publishing date 2019-08-01
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 392404-x
    ISSN 1531-5053 ; 0278-2391
    ISSN (online) 1531-5053
    ISSN 0278-2391
    DOI 10.1016/j.joms.2019.07.012
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Letters to the Editor.

    Sawatari, Yoh / Marwan, Hisham

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons

    2019  Volume 77, Issue 5, Page(s) 889

    MeSH term(s) Bibliometrics ; Joint Prosthesis ; Mandibular Prosthesis ; Temporomandibular Joint ; Titanium
    Chemical Substances Titanium (D1JT611TNE)
    Language English
    Publishing date 2019-02-20
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 392404-x
    ISSN 1531-5053 ; 0278-2391
    ISSN (online) 1531-5053
    ISSN 0278-2391
    DOI 10.1016/j.joms.2019.01.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Does Immediate Long-Span Nerve Allograft Reconstruction Affect the Incidence of Chronic Postsurgical and Neuropathic Pain in the Reconstructed Mandible Following Resection for Benign and Malignant Disease.

    Zuniga, John R / Kim, Roderick Y / Miloro, Michael / Petrisor, Daniel / Marwan, Hisham / Young, Simon / Hernández-Nuño de la Rosa, María F

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons

    2023  Volume 81, Issue 12, Page(s) 1587–1593

    Abstract: Background: Peripheral nerve injury can lead to chronic postsurgical pain (CPSP) and neuropathic pain following major surgery.: Purpose: Determine in patients undergoing ablative mandibular operations with transection of the trigeminal nerve: do ... ...

    Abstract Background: Peripheral nerve injury can lead to chronic postsurgical pain (CPSP) and neuropathic pain following major surgery.
    Purpose: Determine in patients undergoing ablative mandibular operations with transection of the trigeminal nerve: do those who undergo immediate repair, when compared to those whose nerves are not repaired, have a decreased or increased risk for CPSP or post-traumatic trigeminal neuropathic pain (PTTNp)?
    Study design, setting, sample: A multisite, retrospective cohort of patients who underwent resection of the mandible for benign or malignant disease with either no repair or immediate repair of the intentionally transected trigeminal nerve with a long-span nerve allograft were analyzed for the presence or absence of CPSP and PTTNp at 6 months.
    Predictor variable: The primary predictor was the immediate repair or no repair of the trigeminal nerve.
    Main outcome variable: The primary outcome was the presence or absence of CPSP and PTTNp at 6 months postsurgery.
    Covariates: There were 13 covariate variables, including age, sex, ethnicity, nerve injury, type of PTTNp, malignant or benign pathology and subtypes of each, use of radiation or chemotherapy, treatment of transected nerve end, longest follow-up time, pain scale, and onset of pain.
    Analyses: Two-tailed Student's t test and Welch's t test were performed on mean scores and post hoc logistics and linear regression modeling were performed when indicated. The confidence level for statistical significance was P value <.05.
    Results: There were 103 and 94 subjects in the immediate and no-repair groups, respectively. The incidence of CPSP in the no-repair group was 22.3% and PTTNp was 2.12%, while there was 3.8% CPSP and 0% PTTNp in the repair group, which was statistically significant (P = <.001). Logistic regression modeling showed a statistically significant inverse relationship between the immediate repair and the incidence of CPSP/PTTNp with an odds ratio of 0.43, 95% confidence interval 0.18 to 1.01, P = .05. Greater age, malignant pathology, and chemo/radiation treatments were covariates found more frequently in the no repair group.
    Conclusion and relevance: Immediate repair of an intentionally transected trigeminal nerve with a long-span nerve allograft during resection of the mandible for both benign and malignant disease appears to reduce CPSP and possibly eliminate the development of PTTNp.
    MeSH term(s) Humans ; Retrospective Studies ; Incidence ; Neuralgia/epidemiology ; Neuralgia/etiology ; Neuralgia/surgery ; Pain, Postoperative ; Mandible/surgery ; Allografts ; Chronic Pain/complications
    Language English
    Publishing date 2023-09-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392404-x
    ISSN 1531-5053 ; 0278-2391
    ISSN (online) 1531-5053
    ISSN 0278-2391
    DOI 10.1016/j.joms.2023.09.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Does Accurate Positioning of the Temporomandibular Joint Titanium Condylar Prosthesis Prevent Complications?

    Sawatari, Yoh / Marwan, Hisham / Alzahrani, Shadi / Peleg, Michael / Marx, Robert

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons

    2018  Volume 76, Issue 11, Page(s) 2296–2306

    Abstract: Purpose: Reconstruction of the temporomandibular joint defect is challenging. The purposes of this study were to identify factors associated with the accuracy of positioning of a titanium condylar prosthesis and to measure the association between the ... ...

    Abstract Purpose: Reconstruction of the temporomandibular joint defect is challenging. The purposes of this study were to identify factors associated with the accuracy of positioning of a titanium condylar prosthesis and to measure the association between the accuracy of the condylar prosthesis position and postoperative complications.
    Materials and methods: We designed a retrospective cohort study and enrolled a sample of patients whose condyle was reconstructed with an alloplastic condylar prosthesis. The primary predictor variable was the accurate positioning of the prosthesis in the fossa in comparison with the native condyle. The primary outcome variable was the development of postoperative complications related to the inaccurate positioning of the condylar prosthesis. Other variables were included and discussed in detail in the article. In addition, the postoperative pain level was assessed with a visual analog scale score. Because of the small sample size, we elected to use a descriptive data analysis for the research.
    Results: The final sample was composed of 40 patients, with a mean age of 38 years. A postoperative complication developed in 6 patients (15%), including cutaneous plate exposure after radiation therapy, erosion through the tympanic plate of the condylar fossa, and erosion into the temporal bone. The average displacement of the condylar prosthesis in the patients in whom complications developed was 5.04 mm in the vertical and 1.5 mm in the lateral dimension, which was less than the average of all other patients in the study. Seven patients reported higher levels of pain represented by the visual analog scale score, and this was associated with increased deviation of the condylar prosthesis position by 4.4% and 16.6% in the vertical and lateral dimensions, respectively.
    Conclusions: This retrospective study showed that the amount of displacement of the temporomandibular joint prosthesis did not correlate with the incidence of complications or postoperative pain.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement/methods ; Female ; Humans ; Joint Prosthesis ; Male ; Middle Aged ; Pain Measurement ; Postoperative Complications/prevention & control ; Retrospective Studies ; Temporomandibular Joint Disorders/diagnostic imaging ; Temporomandibular Joint Disorders/surgery ; Titanium ; Tomography, X-Ray Computed/methods ; Treatment Outcome
    Chemical Substances Titanium (D1JT611TNE)
    Language English
    Publishing date 2018-05-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392404-x
    ISSN 1531-5053 ; 0278-2391
    ISSN (online) 1531-5053
    ISSN 0278-2391
    DOI 10.1016/j.joms.2018.05.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Recurrent Malignancy in Osteoradionecrosis Specimen.

    Marwan, Hisham / Green, J Marshall / Tursun, Ramzey / Marx, Robert E

    Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons

    2016  Volume 74, Issue 11, Page(s) 2312–2316

    Abstract: Purpose: Osteoradionecrosis (ORN) is a well-known complication of head and neck radiation therapy. Statistically, the mandible is the most commonly affected site. The incidental finding of malignancy in the resection specimen has been documented but is ... ...

    Abstract Purpose: Osteoradionecrosis (ORN) is a well-known complication of head and neck radiation therapy. Statistically, the mandible is the most commonly affected site. The incidental finding of malignancy in the resection specimen has been documented but is somewhat rare. The aim of this review is to investigate the presence of recurrent carcinoma and sarcoma or new primary malignancies in resection specimens previously diagnosed and treated as ORN.
    Patients and methods: This study is a retrospective case series. We conducted a chart review of all cases managed at the University of Miami Miller School of Medicine/Jackson Memorial Hospital. The inclusion criteria included a history of head and neck carcinoma treated with radiation of at least 6,000 cGy; clinical diagnosis of ORN; and surgical intervention with osseous resection for treatment of ORN. The study endpoint measured included microscopic evidence of malignancy in the resected ORN specimen. Additional data collected included gender, age, and type of primary pathology.
    Results: A total of 564 patients met the inclusion criteria. Of these patients, 14 had microscopic evidence of cancer in the specimen (2.48%) and 5 had a proven second primary malignancy in the foregut (1 in the lung, 0.18%, and 4 in the oropharynx, 0.70%). In 1 of the 14 patients, a high-grade sarcoma was diagnosed and the patient died within 1 year of diagnosis. In the treatment of our ORN patient population, a total of 19 malignancies were found collectively (3.37%). Of the 564 patients, 352 were men and 212 were women. The median age was 46 years (range, 33 to 97 years). Head and neck squamous cell carcinoma represented 531 cases in our sample, followed by 28 cases of salivary gland carcinoma and only 5 cases of sarcoma.
    Conclusions: Although the finding of malignancy in ORN patients is relatively rare (3.37% in this study), oral and maxillofacial surgeons should be cognizant of its potential presence. The treatment of malignant disease is different than that of ORN, and a multidisciplinary treatment approach is recommended if a malignancy is diagnosed in an ORN patient.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/diagnosis ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/secondary ; Carcinoma, Squamous Cell/surgery ; Female ; Follow-Up Studies ; Head and Neck Neoplasms/diagnosis ; Head and Neck Neoplasms/radiotherapy ; Head and Neck Neoplasms/secondary ; Head and Neck Neoplasms/surgery ; Humans ; Incidental Findings ; Male ; Mandibular Diseases/etiology ; Mandibular Diseases/surgery ; Mandibular Neoplasms/diagnosis ; Mandibular Neoplasms/secondary ; Mandibular Neoplasms/surgery ; Middle Aged ; Neoplasm Recurrence, Local/surgery ; Neoplasms, Second Primary/diagnosis ; Osteoradionecrosis/etiology ; Osteoradionecrosis/surgery ; Radiotherapy, Adjuvant/adverse effects ; Retrospective Studies ; Sarcoma/diagnosis ; Sarcoma/secondary ; Sarcoma/surgery ; Squamous Cell Carcinoma of Head and Neck
    Language English
    Publishing date 2016-05-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392404-x
    ISSN 1531-5053 ; 0278-2391
    ISSN (online) 1531-5053
    ISSN 0278-2391
    DOI 10.1016/j.joms.2016.04.028
    Database MEDical Literature Analysis and Retrieval System OnLINE

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