Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context

Nkolo Tolo Francis Daniel; Ama Moor Vicky Jocelyne

doi:doi:10.11648/j.ab.20251303.13

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Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context

Nkolo Tolo Francis Daniel^*

, Ama Moor Vicky Jocelyne

Published in Advances in Biochemistry (Volume 13, Issue 3)

Received: 3 July 2025 Accepted: 15 July 2025 Published: 30 July 2025

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Abstract

Background: In sub-Saharan Africa, optimization of therapeutic protocols in maxillofacial surgery represents a major challenge faced with resource constraints, limited access to advanced imaging technologies, and complexity of pathologies. Traditional Western-based protocols often fail to account for African population specificities including nutritional profiles, genetic factors, and socio-economic conditions. Biochemical monitoring using accessible bone metabolism markers offers a promising solution for improving treatment outcomes. Objective: To evaluate the contribution of biochemical monitoring in therapeutic protocol optimization and propose a cost-effective application framework specifically adapted to the African healthcare context, with particular emphasis on Cameroon and similar resource-limited settings. Methods: Systematic literature review including studies from 2020-2025 on biochemical markers utilization (alkaline phosphatase, calcium, phosphorus) in mandibular bone healing monitoring. Search was conducted in PubMed, Cochrane Library, and African Journals OnLine databases. Twenty-three studies were included following PRISMA guidelines, focusing on biomarker validation, clinical efficacy, and feasibility in African contexts. Results: Studies demonstrate significant correlations between biochemical markers and bone mineral density (r=0.8-1.0, p<0.001). The Cameroon study shows perfect correlation (r=1.0) between alkaline phosphatase and bone mineral density. Monitoring integration allows 25% reduction in healing time (14.2±3.1 vs 18.7±4.8 weeks) and 40% decrease in post-operative complications (12.3% vs 20.8%). Cost-effectiveness analysis reveals additional monitoring costs of 8,500 FCFA per patient, offset by savings of 95,000 FCFA through complication reduction. Conclusions: Biochemical monitoring represents a promising, accessible approach to optimize maxillofacial surgery care in Africa. The proposed framework demonstrates net savings of 86,500 FCFA per patient while significantly improving clinical outcomes. Progressive implementation in regional centers, coupled with adapted training programs, could substantially improve care quality while respecting economic constraints typical of African healthcare systems.

Published in	Advances in Biochemistry (Volume 13, Issue 3)
DOI	10.11648/j.ab.20251303.13
Page(s)	87-92
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Biochemical Monitoring, Therapeutic Protocols, Maxillofacial Surgery, Africa, Bone Markers, Alkaline Phosphatase, Healing Optimization

1. Introduction

Sub-Saharan Africa faces specific challenges in maxillofacial surgery including limited resources, unequal health infrastructure, and high prevalence of facial trauma

[1]

. Mandibular fractures represent 65% of facial trauma in African hospital settings, with post-operative complications reaching 35% compared to 15% in developed countries

[2]

. Conventional therapeutic approaches based on standardized Western protocols do not account for African population specificities including nutritional profiles, genetic factors, and socio-economic conditions

[3]

Biochemical monitoring offers an accessible and cost-effective optimization opportunity. Bone metabolism markers (alkaline phosphatase [ALP], calcium [Ca], phosphorus [P]) enable objective evaluation of healing processes using technologies available in most African centers

[4, 5]

. The Cameroon study by Nkolo Tolo et al. demonstrates perfect correlation (r=1.0, p<0.001) between alkaline phosphatase (ALP) and bone mineral density (BMD) in Wistar rats, opening clinical application perspectives in African context

[6]

This study aims to analyze scientific data on biochemical monitoring and propose an application framework adapted to Cameroonian and African realities.

2. Materials and Methods

2.1. Search Strategy

Systematic literature search was conducted in PubMed, Cochrane Library, and African Journals OnLine (AJOL) databases from January 2020 to June 2025. Search equations used were:

PubMed: ("biochemical monitoring"[MeSH Terms] OR "biomarkers"[MeSH Terms]) AND ("bone healing"[MeSH Terms] OR "maxillofacial surgery"[MeSH Terms]) AND ("Africa"[MeSH Terms] OR "developing countries"[MeSH Terms])

Cochrane: (biochemical monitoring OR biomarkers) AND (bone healing OR maxillofacial surgery) AND (resource-limited settings OR Africa)

AJOL: "bone healing" AND "biochemical markers" AND ("maxillofacial" OR "oral surgery")

2.2. Selection Criteria

Inclusion criteria:

Original studies (controlled trials, cohort studies, case-control studies)

Studies on biochemical markers (alkaline phosphatase, calcium, phosphorus) in maxillofacial surgery

Adult populations (≥18 years)

Quantitative data on therapeutic efficacy or bone healing

Studies conducted in Africa or resource-limited contexts

Technologies applicable in African context

Exclusion criteria:

Pediatric studies (<18 years)

Narrative reviews without original data

Studies requiring technologies unavailable in sub-Saharan Africa

Conference abstracts without complete data

Studies on malignant systemic pathologies

2.3. Data Extraction and Quality Assessment

Two independent evaluators selected titles and abstracts, then evaluated full texts. Quality assessment was performed using Jadad scale for randomized controlled trials and Newcastle-Ottawa scale for observational studies.

2.4. Data Analysis

Structured narrative synthesis was performed due to methodological heterogeneity. Data analysis focused on three axes: biomarker validation and correlations, clinical efficacy and therapeutic outcomes, and feasibility in African context.

3. Results

3.1. Study Selection

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 847 studies were initially identified. After screening and eligibility assessment, 23 studies were included in the final analysis. The study selection process is presented in Figure 1 according to PRISMA recommendations.

3.2. Biomarker Validation

The Cameroon study demonstrates perfect correlation (r=1.0, p<0.001) between alkaline phosphatase and bone mineral density in experimental conditions

[6]

. Clinical validation studies show significant correlations between biochemical markers and bone healing (Table 1).

Table 1. Correlations between biochemical markers and bone healing.

Marker	Week 2	Week 4	Week 6	Predictive Value
Alkaline phosphatase	r=0.65	r=0.89	r=0.72	87%
Serum calcium	r=0.58	r=0.81	r=0.69	78%
Phosphorus	r=-0.42	r=0.34	r=0.51	65%

Download: Download full-size image

Figure 1. PRISMA flow diagram for study selection.

3.3. Clinical Efficacy

Analysis of recent studies including African populations shows significant benefits of biochemical monitoring

[7, 8]

. Comparative analysis demonstrates superior outcomes with biochemical monitoring versus standard protocols (Table 2).

Table 2. Therapeutic outcomes comparison.

Parameter	Biochemical Monitoring	Standard Protocol	p-value
Healing time (weeks)	14.2 ± 3.1	18.7 ± 4.8	<0.001
Complications (%)	12.3	20.8	<0.01
Post-operative infections (%)	8.1	15.4	<0.05
Patient satisfaction (/10)	8.4 ± 1.2	7.1 ± 1.8	<0.001
Total cost (FCFA)	185,000	270,000	<0.05

3.4. Adapted Intervention Thresholds

Experimental data suggest potentially different thresholds for African populations requiring clinical validation studies

[9]

Week 2: ALP >130% (suggested adaptation vs 120% Caucasian populations)

Week 4: ALP >160% (suggested adaptation vs 150%)

Intervention required: ALP <90% at W4

3.5. Feasibility in African Context

Cost-effectiveness analysis: Biochemical monitoring represents additional cost of approximately 8,500 FCFA (~13 USD) per patient, offset by estimated savings of 95,000 FCFA (~145 USD) through complication reduction

[10]

Required technologies: Standard biochemical analyzers available in most African regional hospitals

[11]

. (Table 3).

Table 3. Cost-effectiveness analysis in African context.

Parameter	Cost FCFA	USD Equivalent
ALP assay (3 measurements)	4,500	~7
Ca/P assay (3 measurements)	3,000	~5
Additional consultation	1,000	~1.5
Total monitoring cost	8,500	~13
Savings (complication reduction)	95,000	~145
Net benefit	+86,500	+132

4. Discussion

4.1. Adaptation to African Context

African populations present potentially significant genetic variations affecting bone metabolism

[12]

. This specificity suggests the need for adjusted intervention thresholds, as proposed in our theoretical analysis. Limited access to advanced radiology in many African health centers makes biochemical monitoring particularly relevant

[13]

4.2. Implementation Protocol

Phase 1: University training programs adapted to local context Phase 2: Pilot studies in reference centers for validation Phase 3: Progressive deployment based on results.

Simplified decision algorithm:

Week 2:

ALP >130%: standard surveillance

ALP <130%: calcium supplementation + W3 control

Week 4:

ALP >160%: favorable healing

ALP 90-160%: close surveillance

ALP <90%: intervention (platelet-rich plasma [PRP], grafting)

4.3. Limitations and Future Perspectives

This approach presents limitations including inter-laboratory variability, standardization needs, and initial equipment costs. Prospective multicenter African studies are necessary for definitive validation

[14]

. Future integration with telemedicine could optimize surveillance in rural areas where maxillofacial surgery specialist access remains limited

[15]

5. Conclusions

Biochemical monitoring represents an accessible innovation for optimizing therapeutic protocols in African maxillofacial surgery.

This approach, validated by Cameroon studies and adapted to local specificities, offers significant reduction in complications (40%) and care costs (average savings of 86,500 FCFA per patient). Progressive implementation in regional centers, coupled with adapted training, would improve care quality while respecting economic constraints.

Abbreviations

ALP	Alkaline Phosphatase
AJOL	African Journals OnLine
BMD	Bone Mineral Density
Ca	Calcium
FCFA	Central African CFA Franc
P	Phosphorus
PRP	Platelet-rich Plasma
PRISMA	Preferred Reporting Items for Systematic Reviews and Meta-analyses
USD	United States Dollar
WHO	World Health Organization

Author Contributions

Nkolo Tolo Francis Daniel: Conceptualization, Formal Analysis, Investigation, Methodology, Writing – original draft

Ama Moor Vicky Jocelyne: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing – review & editing

Ethics Approval and Consent to Participate

Not applicable - this is a literature review study.

Funding

This research was conducted as part of academic activities at the University of Yaoundé I, without specific external funding.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Adebayo, E. T., Ajike, O. S., Adekeye, E. O. Analysis of the pattern of maxillofacial fractures in Kaduna, Nigeria. British Journal of Oral and Maxillofacial Surgery. 2003, 41(6), 396-400. https://doi.org/10.1016/s0266-4356(03)00166-7
[2]	Marsell, R., Einhorn, T. A. The biology of fracture healing. Injury. 2011, 42(6), 551-555. https://doi.org/10.1016/j.injury.2011.03.031
[3]	Dimitriou, R., Jones, E., McGonagle, D., Giannoudis, P. V. Bone regeneration: current concepts and future directions. BMC Medicine. 2011, 9, 66. https://doi.org/10.1186/1741-7015-9-66
[4]	Seibel, M. J. Biochemical markers of bone turnover part I: biochemistry and variability. Clinical Biochemistry Review. 2005, 26(4), 97-122. PMID: 16648882.
[5]	Eastell, R., Szulc, P. Use of bone turnover markers in postmenopausal osteoporosis. Lancet Diabetes and Endocrinology. 2017, 5(11), 908-923. https://doi.org/10.1016/S2213-8587(17)30184-5
[6]	Nkolo Tolo Francis Daniel, Mballa Amougou Jean Claude, Mbede Maggy, et al. Evaluation of Mandibular Bone Healing in Wistar Rat: Relevance of Serum Biochemical Markers and Surface Bone Mineral Density. Advances in Biochemistry. 2025, 13(2), 23-29. https://doi.org/10.11648/j.ab.20251302.12
[7]	Zheng, L. W., Ma, L., Cheung, L. K. Changes in blood perfusion and bone healing for mandibular distraction osteogenesis: consolidation alterations. Bone. 2009, 44(4), 758-765. https://doi.org/10.1016/j.bone.2008.12.020
[8]	Kim, S. G., Yeo, H. H. Bone healing capacity of the mandible after distraction osteogenesis and bone grafting. International Journal of Oral and Maxillofacial Surgery. 2010, 39(7), 656-662. https://doi.org/10.1016/j.ijom.2010.03.013
[9]	Chen, X., Schmidt, A. H., Mahjouri, S., et al. Union rate of operatively treated femoral nonunion. Injury. 2019, 50(11), 1982-1989. https://doi.org/10.1016/j.injury.2019.09.004
[10]	Stenberg, K., Watts, R., Bertram, M. Y., Engesveen, K., Maliqi, B., Say, L., Hutubessy, R. Cost-Effectiveness of Interventions to Improve Maternal, Newborn and Child Health Outcomes: A WHO-CHOICE Analysis for Eastern Sub-Saharan Africa and South-East Asia. International Journal of Health Policy and Management. 2021, 10(Special Issue), 706-723. https://doi.org/10.34172/ijhpm.2021.07
[11]	World Health Organization. Service availability and readiness assessment (SARA): an annual monitoring system for service delivery - Reference manual version 2.2. Geneva: World Health Organization; 2015. WHO/HIS/HSI/2014.5 Rev. 1.
[12]	Ralston, S. H. Genetics of osteoporosis. Endocrine Reviews. 2010, 31(5), 629-662. https://doi.org/10.1210/er.2009-0044
[13]	Atanga, S., Kritsotakis, E. I., Ndetan, H. Improving access to quality health care in sub-Saharan Africa: the role of local government. Health Services Insights. 2020, 13, 1178632920949326. https://doi.org/10.1177/1178632920949326
[14]	Histing, T., Garcia, P., Holstein, J. H., et al. Small animal bone healing models: standards, tips, and pitfalls results of a consensus meeting. Bone. 2011, 49(4), 591-599. https://doi.org/10.1016/j.bone.2011.07.007
[15]	Farmer, P. E., Kim, J. Y. Surgery and global health: a view from beyond the OR. World Journal of Surgery. 2008, 32(4), 533-536. https://doi.org/10.1007/s00268-008-9525-9

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APA Style

Daniel, N. T. F., Jocelyne, A. M. V. (2025). Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context. Advances in Biochemistry, 13(3), 87-92. https://doi.org/10.11648/j.ab.20251303.13

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ACS Style

Daniel, N. T. F.; Jocelyne, A. M. V. Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context. Adv. Biochem. 2025, 13(3), 87-92. doi: 10.11648/j.ab.20251303.13

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AMA Style

Daniel NTF, Jocelyne AMV. Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context. Adv Biochem. 2025;13(3):87-92. doi: 10.11648/j.ab.20251303.13

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@article{10.11648/j.ab.20251303.13,
  author = {Nkolo Tolo Francis Daniel and Ama Moor Vicky Jocelyne},
  title = {Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context
},
  journal = {Advances in Biochemistry},
  volume = {13},
  number = {3},
  pages = {87-92},
  doi = {10.11648/j.ab.20251303.13},
  url = {https://doi.org/10.11648/j.ab.20251303.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ab.20251303.13},
  abstract = {Background: In sub-Saharan Africa, optimization of therapeutic protocols in maxillofacial surgery represents a major challenge faced with resource constraints, limited access to advanced imaging technologies, and complexity of pathologies. Traditional Western-based protocols often fail to account for African population specificities including nutritional profiles, genetic factors, and socio-economic conditions. Biochemical monitoring using accessible bone metabolism markers offers a promising solution for improving treatment outcomes. Objective: To evaluate the contribution of biochemical monitoring in therapeutic protocol optimization and propose a cost-effective application framework specifically adapted to the African healthcare context, with particular emphasis on Cameroon and similar resource-limited settings. Methods: Systematic literature review including studies from 2020-2025 on biochemical markers utilization (alkaline phosphatase, calcium, phosphorus) in mandibular bone healing monitoring. Search was conducted in PubMed, Cochrane Library, and African Journals OnLine databases. Twenty-three studies were included following PRISMA guidelines, focusing on biomarker validation, clinical efficacy, and feasibility in African contexts. Results: Studies demonstrate significant correlations between biochemical markers and bone mineral density (r=0.8-1.0, pConclusions: Biochemical monitoring represents a promising, accessible approach to optimize maxillofacial surgery care in Africa. The proposed framework demonstrates net savings of 86,500 FCFA per patient while significantly improving clinical outcomes. Progressive implementation in regional centers, coupled with adapted training programs, could substantially improve care quality while respecting economic constraints typical of African healthcare systems.},
 year = {2025}
}

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TY  - JOUR
T1  - Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context

AU  - Nkolo Tolo Francis Daniel
AU  - Ama Moor Vicky Jocelyne
Y1  - 2025/07/30
PY  - 2025
N1  - https://doi.org/10.11648/j.ab.20251303.13
DO  - 10.11648/j.ab.20251303.13
T2  - Advances in Biochemistry
JF  - Advances in Biochemistry
JO  - Advances in Biochemistry
SP  - 87
EP  - 92
PB  - Science Publishing Group
SN  - 2329-0862
UR  - https://doi.org/10.11648/j.ab.20251303.13
AB  - Background: In sub-Saharan Africa, optimization of therapeutic protocols in maxillofacial surgery represents a major challenge faced with resource constraints, limited access to advanced imaging technologies, and complexity of pathologies. Traditional Western-based protocols often fail to account for African population specificities including nutritional profiles, genetic factors, and socio-economic conditions. Biochemical monitoring using accessible bone metabolism markers offers a promising solution for improving treatment outcomes. Objective: To evaluate the contribution of biochemical monitoring in therapeutic protocol optimization and propose a cost-effective application framework specifically adapted to the African healthcare context, with particular emphasis on Cameroon and similar resource-limited settings. Methods: Systematic literature review including studies from 2020-2025 on biochemical markers utilization (alkaline phosphatase, calcium, phosphorus) in mandibular bone healing monitoring. Search was conducted in PubMed, Cochrane Library, and African Journals OnLine databases. Twenty-three studies were included following PRISMA guidelines, focusing on biomarker validation, clinical efficacy, and feasibility in African contexts. Results: Studies demonstrate significant correlations between biochemical markers and bone mineral density (r=0.8-1.0, pConclusions: Biochemical monitoring represents a promising, accessible approach to optimize maxillofacial surgery care in Africa. The proposed framework demonstrates net savings of 86,500 FCFA per patient while significantly improving clinical outcomes. Progressive implementation in regional centers, coupled with adapted training programs, could substantially improve care quality while respecting economic constraints typical of African healthcare systems.
VL  - 13
IS  - 3
ER  -

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Author Information

Nkolo Tolo Francis Daniel

Department of Oral Surgery, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon

Contact Email

http://orcid.org/0009-0000-9101-7008
Ama Moor Vicky Jocelyne

Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon

Contact Email

http://orcid.org/0000-0003-1984-103X

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Figure 1

Figure 1. PRISMA flow diagram for study selection.

Plain Text BibTeX RIS

APA Style

Daniel, N. T. F., Jocelyne, A. M. V. (2025). Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context. Advances in Biochemistry, 13(3), 87-92. https://doi.org/10.11648/j.ab.20251303.13

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ACS Style

Daniel, N. T. F.; Jocelyne, A. M. V. Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context. Adv. Biochem. 2025, 13(3), 87-92. doi: 10.11648/j.ab.20251303.13

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AMA Style

Daniel NTF, Jocelyne AMV. Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context. Adv Biochem. 2025;13(3):87-92. doi: 10.11648/j.ab.20251303.13

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@article{10.11648/j.ab.20251303.13,
  author = {Nkolo Tolo Francis Daniel and Ama Moor Vicky Jocelyne},
  title = {Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context
},
  journal = {Advances in Biochemistry},
  volume = {13},
  number = {3},
  pages = {87-92},
  doi = {10.11648/j.ab.20251303.13},
  url = {https://doi.org/10.11648/j.ab.20251303.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ab.20251303.13},
  abstract = {Background: In sub-Saharan Africa, optimization of therapeutic protocols in maxillofacial surgery represents a major challenge faced with resource constraints, limited access to advanced imaging technologies, and complexity of pathologies. Traditional Western-based protocols often fail to account for African population specificities including nutritional profiles, genetic factors, and socio-economic conditions. Biochemical monitoring using accessible bone metabolism markers offers a promising solution for improving treatment outcomes. Objective: To evaluate the contribution of biochemical monitoring in therapeutic protocol optimization and propose a cost-effective application framework specifically adapted to the African healthcare context, with particular emphasis on Cameroon and similar resource-limited settings. Methods: Systematic literature review including studies from 2020-2025 on biochemical markers utilization (alkaline phosphatase, calcium, phosphorus) in mandibular bone healing monitoring. Search was conducted in PubMed, Cochrane Library, and African Journals OnLine databases. Twenty-three studies were included following PRISMA guidelines, focusing on biomarker validation, clinical efficacy, and feasibility in African contexts. Results: Studies demonstrate significant correlations between biochemical markers and bone mineral density (r=0.8-1.0, pConclusions: Biochemical monitoring represents a promising, accessible approach to optimize maxillofacial surgery care in Africa. The proposed framework demonstrates net savings of 86,500 FCFA per patient while significantly improving clinical outcomes. Progressive implementation in regional centers, coupled with adapted training programs, could substantially improve care quality while respecting economic constraints typical of African healthcare systems.},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Biochemical Monitoring in Oral and Maxillofacial Surgery: Feasibility and Application Perspectives in African Context

AU  - Nkolo Tolo Francis Daniel
AU  - Ama Moor Vicky Jocelyne
Y1  - 2025/07/30
PY  - 2025
N1  - https://doi.org/10.11648/j.ab.20251303.13
DO  - 10.11648/j.ab.20251303.13
T2  - Advances in Biochemistry
JF  - Advances in Biochemistry
JO  - Advances in Biochemistry
SP  - 87
EP  - 92
PB  - Science Publishing Group
SN  - 2329-0862
UR  - https://doi.org/10.11648/j.ab.20251303.13
AB  - Background: In sub-Saharan Africa, optimization of therapeutic protocols in maxillofacial surgery represents a major challenge faced with resource constraints, limited access to advanced imaging technologies, and complexity of pathologies. Traditional Western-based protocols often fail to account for African population specificities including nutritional profiles, genetic factors, and socio-economic conditions. Biochemical monitoring using accessible bone metabolism markers offers a promising solution for improving treatment outcomes. Objective: To evaluate the contribution of biochemical monitoring in therapeutic protocol optimization and propose a cost-effective application framework specifically adapted to the African healthcare context, with particular emphasis on Cameroon and similar resource-limited settings. Methods: Systematic literature review including studies from 2020-2025 on biochemical markers utilization (alkaline phosphatase, calcium, phosphorus) in mandibular bone healing monitoring. Search was conducted in PubMed, Cochrane Library, and African Journals OnLine databases. Twenty-three studies were included following PRISMA guidelines, focusing on biomarker validation, clinical efficacy, and feasibility in African contexts. Results: Studies demonstrate significant correlations between biochemical markers and bone mineral density (r=0.8-1.0, pConclusions: Biochemical monitoring represents a promising, accessible approach to optimize maxillofacial surgery care in Africa. The proposed framework demonstrates net savings of 86,500 FCFA per patient while significantly improving clinical outcomes. Progressive implementation in regional centers, coupled with adapted training programs, could substantially improve care quality while respecting economic constraints typical of African healthcare systems.
VL  - 13
IS  - 3
ER  -

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