Journal of Craniofacial Surgery最新文献

Chondrosarcoma is a rare malignant tumor of epithelial origin, with fewer than 0.1% of cases affecting the nasal septum. Maxillofacial oncological surgery presents significant challenges, particularly in maxillary reconstruction, often requiring complex rehabilitation. This case report describes the use of point-of-care manufacturing, customized cutting guides, and 3D printing technology for fibular-free flap reconstruction and guided dental implant placement in a 42-year-old male with centrofacial nasal chondrosarcoma. After a bilateral maxillectomy, continuity across the maxillomalar buttress was restored using a fibular-free flap and a patient-specific reconstruction plate. Immediate implant placement and prosthetic loading were performed, supported by the Implant Stability Quotient (ISQ), which provided objective data on implant stability, allowing immediate loading due to high primary stability. The integration of point-of-care manufacturing and ISQ enhances precision in guided surgery, facilitating quicker functional and esthetic rehabilitation, and offering faster recovery and improved quality of life for oncological patients requiring complex maxillofacial reconstruction.

Objective: The purpose of this study was to generate a nomogram for predicting long-term facial nerve (FN) function at 3 months following large vestibular schwannoma (VS) resection.

Materials and methods: Retrospective data were evaluated from patients who underwent VS resection from May 2014 to May 2023 at Huashan Hospital. The nomogram was conducted based on the results of univariate and multivariate logistic regression analysis of the risk factors for poor long-term FN function after VS resection.

Results: A total of 166 cases were finally included in this study. The univariate and multivariate logistic regression analysis showed that tumor size [P=0.022, odds ratio (OR): 1.11, 95% CI: 1.02-1.22), intraoperative stimulation threshold (ST) (P=0.005, OR: 12.17, 95% CI: 2.10-70.68), tumor type (P=0.009, OR: 7.46, 95% CI: 1.64-33.86) and 3-month postoperative HB grade (P=0.005, OR: 0.883, 95% CI: 0.062-12.61) were independent risk factors for poor long-term FN function. A nomogram was conducted based on these indicators, which demonstrated good discrimination and favorable calibration.

Conclusion: A nomogram based on 4 indicators was conducted to predict long-term FN function at 3 months following large VS resection. Patients presented with little chance of long-term FN recovery are candidates for early intervention.

Little consensus exists regarding the proper timing of mandibular fracture fixation. Given the proximity of the oral flora to the mandible, many surgeons advocate for early fixation to mitigate infection risk. This retrospective study evaluates the safety of treating mandible fractures in a subacute period. After institutional review board approval, a retrospective analysis was performed of all mandibular fractures presented to a single center from 2013 to 2023. Patient, injury, medical, and operative details were reviewed. Area deprivation index (ADI) was used to approximate patient socioeconomic disadvantage. Data analysis included χ2, univariate, and logistic regression. Six hundred forty patients were analyzed. Most were male (75.8%) with an average age of 39.2 years. The mandibular body and angle were the most common fracture sites. On average, patients underwent surgery 6.9 days postinjury, with 49.7% undergoing ORIF. The average antibiotic duration was 11.7 days. Infection occurred in 3.8% of patients and typically presented in postoperative month 3. Injury mechanism, history of smoking, and treatment with oral clindamycin were found to be significant predictors of mandible infection (P<0.005) on logistic regression. Time from injury to the operating room, time from injury to antibiotics, duration of antibiotics, fracture location, and patient ADI had no influence on infection rate. Although time from injury to the operating room was previously thought to influence the infection rate, our study demonstrated no increased risk of infection with subacute mandibular fracture management. Factors completely out of the control of the surgeon, including patient comorbidities and mechanism of injury, may pose a greater risk than previously recognized.

Background: Subbrow blepharoplasty has become popular in Asian populations for redundant skin and lateral hooding in the upper lid. How to imrpove the effects of the procedure becomes urgent.

Objective: To investigate the effects of orbicularis muscle and suborbicularis fat fixation in subbrow blepharoplasty.

Methods: This was a retrospective study. Thirty-eight patients were subjected to the operation from January 2018 to June 2024. All patients had dermatochalasis and lateral hooding of the upper eyelid. In the procedure of subbrow blepharoplasty, the orbicularis muscle flap in combination of the suborbicularis fat was pulled up and fixed to the periosteum over the suraorbital rim. The follow-up period ranged from 6 months to 2 years. The results were evaluated. The complications were reviewed.

Results: The resection of skin was 12.2±1.9 mm in width. The length of subbrow skin excised was 39.4±4.4 mm. The height correction of the brow descending was 2.8±1.0 mm at the midpupil line and 3.8±1.0 mm at the lateral canthus line. The operative time of both sides was about 50 minutes. Thirty-seven patients (97.4%) were satisfied with the surgical results, 1 patient (2.6%) complained about slight asymmetry. There was no serious complications related to surgery.

Conclusions: Subbrow blepharoplasty incorporated with orbicularis muscle and suborbicularis fat fixation is reliable with high patient satisfaction in the patients with dermatochalasis and lateral hooding of the upper eyelid.

Objective: The aim of this study is to examine the dynamic esthetic characteristics of spontaneous smiles in Hani and Han youths in Yunnan Province.

Methods: Employing a multistage stratified cluster random sampling approach, participants from the Hani and Han ethnic groups in Yunnan Province were recruited. Digital videography was used to capture facial characteristics at both rest and during spontaneous smiles. Subsequently, selected images were analyzed for dynamic esthetic parameters concerning the lips, teeth, and gingiva using image measurement software.

Results: The study included youths from the Hani (n = 68) and Han (n = 59) ethnic groups in Yunnan Province. During spontaneous smiles, the exposure of maxillary central incisors was more pronounced compared with maxillary lateral incisors and canines in both ethnic groups. Variations in gingival display of central incisors were observed among males in the 2 ethnic groups (P < 0.05). The mobility of the mouth corner's width was significantly greater in Han males compared with Hani males (P < 0.05). Conversely, the width of the mouth corner during spontaneous smiles was greater in Hani females than in Han females (P < 0.05). Regarding the relationship between the gingival line and the upper lip, the unexposed type was predominant among males of both ethnicities, whereas the parallel type was predominant among females. Parallel and straight smile arcs were commonly observed among participants from both ethnicities.

Conclusion: The dynamic esthetic characteristics of the lips, teeth, and gingiva exhibit similarities between the youth of Hani and Han ethnicities in Yunnan Province. However, notable differences in certain dynamic smile esthetic traits exist between the sexes.

Background: Internal carotid artery cavernous sinus fistula (CCF) occurs when the cavernous segment of the internal carotid artery or its branches within the cavernous sinus rupture, creating an abnormal communication between arterial and venous blood. This leads to increased pressure within the cavernous sinus and a range of clinical manifestations. The prevalence of CCF is ~0.17% to 0.27%. Its etiology can be classified into 2 main types: traumatic, accounting for about 75% of cases, and spontaneous, accounting for the remaining 25%. The primitive trigeminal artery (PTA) is a rare remnant of the embryonic circulatory system that forms a connection between the internal carotid artery and the vertebrobasilar system. Its prevalence is estimated at 0.1% to 0.6%. A rupture of a PTA aneurysm leading to a cavernous sinus fistula of the internal carotid artery is even more uncommon. Current clinical approaches to managing this condition are still evolving and require further study.

Case report: A 53-year-old female patient presented with a one-month history of diplopia. Digital subtraction angiography (DSA) revealed a ruptured aneurysm of the primitive trigeminal artery, resulting in a cavernous sinus fistula of the internal carotid artery. After discussions with her family, she underwent successful interventional embolization to treat the fistula. At the 6-month follow-up, the patient's diplopia had resolved completely, and no recurrence of the cavernous sinus fistula was observed on DSA.

Conclusion: Rupture of a primitive trigeminal artery aneurysm resulting in a cavernous sinus fistula of the internal carotid artery is an exceptionally rare condition. Transarterial embolization has proven to be a feasible treatment approach; however, due to the limited number of reported cases, treatment strategies require further investigation and refinement.

Orthognathic surgery represents a critical intervention within the continuum of care for patients with cleft lip and palate (CLP). Postoperative relapse is a significant complication and often necessitates reoperation. This study assesses risk factors for reoperation due to relapse following cleft orthognathic surgery. A retrospective review was conducted of patients with CLP who underwent orthognathic surgery for correction of class III malocclusion between 2005 and 2024, excluding those with under 6 months of follow-up. Maxillary advancement techniques included surgically assisted maxillary protraction (SAMP), LeFort I advancement (LF1), and distraction osteogenesis (DO). The outcome of interest was reoperation for late relapse. Overall, 133 patients met the inclusion criteria. The median age at surgery was 18.4 years, and the median follow-up was 2.1 years. Sixteen patients (12.0%) underwent SAMP, 101 (76.9%) LF1, 7 (5.3%) DO, and 9 (6.8%) staged DO followed by LF1. Bilateral sagittal split osteotomy (BSSO) for mandibular setback was performed in 48.4%. The incidence of reoperation was 13.5%. Maxillary advancements >8.5 mm were 6.3 times more likely to require reoperation (P<0.001). Multivariable regression identified bilateral CLP (P=0.038) and multiple prior maxillary operations (P=0.009) as significant predictors of reoperation, while BSSO was associated with decreased odds of reoperation (P=0.027). Patients with bilateral CLP and multiple prior maxillary operations were significantly more likely to require reoperation for late relapse. Limiting sagittal movements to <8.5 mm or performing concurrent BSSO may mitigate the risk of reoperation.

Objective: To investigate the feasibility and related anatomical structures of the infratemporal fossa (ITF) through minimally invasive endoscopic lateral approach, so as to provide anatomical data and basis for clinical surgery.

Methods: Six adult cadaveric heads were used to simulate the surgical dissection of the ITF through a minimally invasive endoscopic lateral approach, and the important vessels, nerves, and other structures in the surgical pathway and the surrounding adjacent relationships were observed, and relevant pictures were collected.

Results: The maxillary arteries of 6 cadaver specimens (12 sides) were located on the surface of the lateral pterygoid muscle in 9 cases, and between the upper and lower heads of the lateral pterygoid muscle in 3 cases, constant branches were the deep temporal artery, pterygoid artery, masseter artery, and buccal artery. The superior posterior alveolar nerve branches off V2 in the ITF and descends along with its accompanying artery by the posterior wall of the maxilla. The buccal nerve branches out from the mandibular nerve and passes between the superior and inferior pterygoid muscles, runs anteriorly between the temporalis and lateral pterygoid muscle, and innervates the buccal muscles.

Conclusion: The endoscopic minimally invasive lateral approach can expose the important structures, such as vessels and nerves related to the ITF well, and can be used as a minimally invasive surgical approach to treat the lesions of the infra- temporal fossa; it can also assist the endoscopic anterior approach to treat a series of lesions extending from the deep part of the pterygopalatine fossa to the posterior lateral side of the ITF.

The question mark ear is a rare external auricular deformity characterized by the cleft between the helix and earlobe. There is also limited guidance on the management of these deformities. A noteworthy aspect of the question mark ear is the broadening of the upper auricle, yet this feature can be easily overlooked. The hybrid technique, consisting of antihelix reformation, scapha reduction, and helical rim flap advancement, was proposed to correct the deformity and restore the natural appearance of the auricle. Auricular measurements, including the length and width of the auricle, the lateral circumference of the helix rim from the superior apex to the inferior apex, and the height of the cleft, were performed preoperatively and postoperatively. Fourteen patients with question mark ear deformities were treated, 11 unilaterally and 3 bilaterally. The patient's ages ranged from 5 to 23 years old and 14.3 years on average. Follow-up ranged from 4 to 24 months and 10 months on average. Preoperative measurements indicated that the auricular width of the question mark ear was greater than that of the contralateral side, while postoperative measurements showed no significant difference in auricular width compared to the contralateral side. In addition, auricular measurements demonstrated a notable enhancement in the overall auricular configuration and cleft repair. The hybrid technique was applicable to correct question mark deformities with good results. The vertical mattress suture technique could reform the natural appearance of the antihelix. Scapha reduction and helical rim flap advancement were effective in correcting the cleft between the helix and earlobe.