Journal of Craniofacial Surgery最新文献

Introduction: Incomplete facial paralysis (IFP) poses a clinical challenge due to its heterogeneous etiologies and unpredictable outcomes. While treatment for complete paralysis is well established, effective interventions for IFP remain limited. Recently, combining cross-face nerve grafting (CFNG) with masseter nerve transposition (MNT) has emerged as a promising surgical strategy, aiming to provide both strong motor input and spontaneous facial movement in these patients.

Methods: A systematic review of PubMed and Medscape (2021-2025) was conducted following PRISMA guidelines. Studies were included if they reported clinical outcomes of combined CFNG and MNT in patients with IFP.

Results: Three studies met the inclusion criteria, comprising 48 patients. Bell's palsy was the most frequent etiology, followed by trauma and postsurgical injuries. Biglioli et al provided the only individual-level outcome data, showing postoperative improvement across etiologies and no significant correlation between age and dynamic recovery-findings consistent with larger cohorts, in which age-related trends do not reach significance. Outcome comparison across studies was limited by heterogeneous assessment tools. A clear trend toward end-to-side neurorrhaphy was observed in recent literature, reflecting a shift toward preserving residual motor fibers.

Conclusions: Despite heterogeneity in surgical techniques and outcome assessments, CFNG combined with MNT consistently yielded favorable results. The approach described by Morley, involving end-to-side neurorrhaphy, may offer particular advantages by preserving healthy neural pathways and enhancing functional outcomes. While current evidence supports the effectiveness of dual innervation, standardized evaluation methods and larger patient cohorts are essential to validate these findings and guide individualized treatment strategies.

The objective of this study was to compare the imaging characteristics of intraosseous jaw lesions on panoramic radiographs (PAN) and cone beam computed tomography (CBCT). A total of 216 intraosseous jaw lesions were analyzed according to localization, shape, size, internal structure, borders, associated nonerupted tooth, root resorption, presence of calcification, tooth displacement, affecting anatomic structures, cortical thinning, expansion, and destruction of bones. The definitive histologic diagnoses of lesions were not considered. A χ2 test, Cohen kappa coefficient, and simple kappa (κ) statistics were used in the statistical analysis. Most jaw lesions are commonly located in the posterior region, while the majority of lesions in the maxilla are found in the anterior region. CBCT was more accurate than PAN in the assessment of the border cortication, continuity of border cortication, expansion, cortical thinning, and destruction. PAN evaluation allowed the identification of the lesion's shape, internal contents, and multilocularity, affecting the IC/IAC and causing tooth displacement. The imaging features in the posterior and mandibular regions demonstrated greater agreement compared with those in the anterior and maxillary regions. This study's findings may guide imaging protocols for intraosseous jaw lesions. Larger studies incorporating histopathologic data are needed to confirm CBCT's advantages over PAN in diagnosing and planning treatment for bone lesions.

Objective: This study evaluated the optimal depth of anesthesia guided by closed-loop target-controlled infusion (TCI) in preschool-aged children undergoing dental surgery. Dental procedures in this population are frequently associated with heightened anxiety and procedural distress, often necessitating general anesthesia; however, the appropriate depth of anesthesia remains insufficiently defined.

Methods: A randomized, double-blind, controlled trial was conducted involving 60 children aged 3 to 6 years scheduled for dental surgery. Participants were allocated to 3 groups (A, B, and C), with bispectral index (BIS) values maintained at 50, 55, and 60, respectively, using a closed-loop TCI system. The primary outcomes were heart rate (HR) and mean arterial pressure (MAP), recorded at 7 intraoperative time points. Secondary outcomes included surgical duration, time to first eye opening (defined as eyelid movement in response to verbal command without implying full orientation), extubation time, discharge time, and total propofol dose.

Results: No statistically significant differences were observed among groups in HR or MAP at any intraoperative time point (between-subject effect: HR, F=2.73, P=0.074; MAP, F=1.54, P=0.222). Surgical duration (F=0.521, P=0.596) and total propofol dosage (P=0.165) also did not differ significantly. Recovery parameters demonstrated significant group differences. Time to first eye opening was 37.75±8.81 minutes in group A, 28.35±2.45 minutes in group B, and 20.70±5.21 minutes in group C (P<0.001). Extubation time was 39.40±8.08 minutes, 29.60±2.58 minutes, and 22.70±5.63 minutes in groups A, B, and C, respectively (P<0.001). Discharge time was shortest in group C (135.6±30.9 min), followed by group B (160.5±25.3 min), and longest in group A (202.5±26.5 min) (F=29.77, P<0.001). The incidence of adverse events was comparable across groups, and no serious adverse events occurred.

Conclusions: Maintaining a BIS value of 60 (±5) with a closed-loop infusion system provided adequate anesthetic depth for dental procedures in preschool-aged children, while significantly reducing recovery and discharge times. This anesthetic strategy may support enhanced recovery and improve perioperative efficiency in pediatric populations.

Background: Contemporary filler practice has shifted from isolated volumization to functional anatomy-based lifting. This review synthesizes a framework that integrates skin, SMAS, and ligamentous remodeling (SSLR) to achieve dynamic, expression-compatible elevation with minimal product.

Methods/concept: Drawing on layer-specific anatomy and aging patterns, SSLR sequences small, high-cohesivity boluses into sub-SMAS fat and dense ligamentous insertions to increase regional tissue density, tighten the SMAS, and transmit traction toward fixed retaining points. Dermal/subdermal microdeposits complement this by stretching the envelope and dampening musculocutaneous transmission of wrinkles. The approach is material-agnostic and applicable to hyaluronic acid and collagen-stimulating fillers, with selection guided by rheology and intended plane.

Findings: Compared with lever-based "myomodulation" and the ligament-centric True Lift, SSLR explains clinical lifting as a tension-redistribution phenomenon independent of muscle type (levator/depressor). Cadaveric and clinical observations suggest that sub-SMAS expansion and ligament reinforcement produce predictable improvement of midface descent, nasolabial prominence, and jawline blunting using conservative volumes. Emerging evidence of Ruffini-like mechanoreceptors in mimetic muscles supports a complementary neuromechanical hypothesis for filler-related modulation of facial tone.

Conclusions: Functional anatomy clarifies why small, plane-specific filler deposits can create outsized lifting. SSLR offers a reproducible, anatomy-guided strategy to restore 3-dimensional harmony across diverse sexes and ethnicities while preserving natural animation.

Unicoronal synostosis (UCS) causes asymmetric forehead morphology and is commonly managed with fronto-orbital advancement (FOA). However, optimal reconstruction remains challenging as the location of the forehead's pivot line, the hinge axis for advancement, often remains uncertain. We conducted a geometric morphometric analysis using 235 cranial landmarks in 16 patients with UCS (aged <2 y) and 11 age-matched controls. CT-derived cranial models were assessed with generalized Procrustes analysis and principal component analysis (PCA) to evaluate morphologic asymmetry and identify potential pivot lines. PC1 (35.7%) captured asymmetric differences, whereas PC2 (22.8%) represented symmetric variation. Compared with controls, patients with UCS exhibited frontal retrusion and temporal bossing on the affected side, along with frontal bossing on the contralateral side. Wireframe deformation revealed morphologic deviation concentrated near the orbit but not along the cranial midline. Importantly, pivot lines differed between the frontal bone and the supraorbital bandeau, suggesting independent hinge axes. In UCS, the pivot line is not at the midline but lateralized near the orbit. Consequently, the frontal bone and supraorbital bandeau should be repositioned around a separate hinge axis during FOA. These findings support more symmetric and individualized cranial reconstruction.

Background: To establish normative midsagittal corpus callosum (CC) morphometric data in healthy native Tibetan adults and to examine sex- and age-related differences after adjustment for brain size.

Methods: High-resolution T1-weighted MRI was acquired in 156 native Tibetan adults (70 men, 86 women; age 18-66 y, mean 35.2±12.7 y) living permanently above 3500 m. In total, 7 subregional CC areas (Witelson scheme) were manually measured on midsagittal slices and normalized to the midsagittal intracranial area.

Results: After brain-size adjustment, total CC area showed no sex difference. Men exhibited a significantly larger rostrum (W1; P=0.016). Contrary to typical age-related atrophy in lowland populations, splenial area (W7) showed robust positive associations with age in both men (ρ=0.382, P=0.001) and women (ρ=0.241, P=0.025); rostral area increased with age in men only (ρ=0.261, P=0.029).

Conclusions: Native Tibetan adults display a unique CC profile with localized anterior sexual dimorphism and age-associated posterior preservation. These findings likely reflect neuroplastic adaptations to lifelong hypobaric hypoxia and provide essential population-specific reference values to prevent misinterpretation of adaptive morphology as pathology in neurosurgical and craniofacial practice at high altitude.

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson tumor, is a rare benign vascular lesion characterized by reactive endothelial proliferation within the vessel lumen. Eyelid involvement is exceedingly uncommon and may clinically mimic malignant vascular tumors. The authors report a case of post-traumatic IPEH of the eyelid in a 50-year-old man presenting with a slowly enlarging purplish nodule in the lateral canthal region. Complete surgical excision was performed. Histopathologic examination revealed tuft-like papillary endothelial proliferation confined within an expanded vein with associated thrombus, without cytologic atypia or mitotic activity, consistent with the pure type of IPEH. Immunohistochemical staining showed diffuse CD34 positivity and negative p53 expression, supporting the diagnosis and excluding angiosarcoma. No recurrence was observed during follow-up. This case underscores the extreme rarity of eyelid involvement and emphasizes that, despite a history of trauma, accurate subtype classification of IPEH relies on histopathologic rather than clinical findings.

Correcting the scaphocephalic skull shape caused by sagittal craniosynostosis has likely produced a wider variety of treatment approaches than any other single-suture synostosis. Considering that the goals of surgery are to enlarge the intracranial space to facilitate cerebral blood flow and to normalize appearance in all 3 dimensions, the ideal repair should safely and effectively accomplish both objectives. A technical variation on a remodeling procedure is presented, based on the creation of a sagittal bandeau, which provides the foundation for a correction that not only widens the posterior biparietal distance but also remedies the posterior reduction in skull height, resulting in both an expansion of the intracranial space and a normalization of appearance.

Mandibular deficiency correction demands precise control of both advancement and rotation to achieve optimal function and facial harmony. The Barakat modification introduces an intraoral adaptation of the inverted L osteotomy, which enables simultaneous mandibular advancement and controlled counterclockwise rotation, eliminating the need for grafting and reducing morbidity. Cephalometric evaluation demonstrated consistent forward mandibular repositioning (mean SNB increase ≈ +1 degree) accompanied by reductions in FMA (≈ -3 to -5 degrees) and gonial angle (≈ -2 to -4 degrees), confirming effective rotational control with vertical shortening. Postoperative assessments revealed a stable occlusion, accurate bony alignment, and enhanced lower facial proportions, with no complications. The Barakat modification offers a predictable, minimally invasive solution for managing mandibular deficiency, combining advancement precision with rotational control to deliver superior aesthetic and functional outcomes.