Journal of Craniofacial Surgery最新文献

Background: Feminizing genioplasty warrants chin modification to achieve feminine characteristics. This study compared female and male facial skeletal dimensions and shape to guide feminizing genioplasty.

Methods: Skulls stored at the Cleveland Museum of Natural History were analyzed. Sex, age, and race were documented. Heights and widths of the face and chin were measured, normalized, and compared.

Results: Forty-three male (43.58±12.52-y-old) and 43 female (40.48±12.04-y-old) skulls were included. Within each group, 25 skulls were of African American (AA) origin and 18 were of Caucasian (C) origin. Absolute chin heights were larger in AA and C males compared with females (P<0.05). After normalization to lower facial height, there was a trend toward greater chin height in AA males compared with females (P=0.07). Parasagittal chin width in AA males was significantly larger than AA females (P=0.0006). Interforaminal chin width in C males trended toward being significantly larger than females (P=0.08). Following normalization of chin widths, no significant sex-based differences were noted for AA skulls except for the interforaminal/intergonial ratio, which was smaller in AA males (P=0.04). For C skulls, most normalized ratios were significantly smaller in males (P<0.05). C females had wider angles at the point of maximum chin projection (P=0.007) and wider symphyseal inclinations (P<0.0001). These differences were not present in AA skulls (P>0.05). Regardless of race, male chins appeared square, whereas female chins were round.

Conclusions: While chin width reduction is not needed for most patients, height reduction could be considered. Chin contouring is the most central component of feminizing genioplasty.

Background: Ear keloids are pathologic scar hyperplasia in the ear region. The most therapeutic approach was surgical shave excision with radiation therapy. However, radiation therapy is easily delivered to healthy surrounding tissues. In the last years, injections with botulinum toxin type A (BTX-A) have been proven to improve surgical scars effectively in clinical trials. This study aimed to evaluate the effect of immediate injections of BTX-A after surgical excision for ear keloids.

Methods: From January 2020 to January 2023, 33 consecutive patients with ear keloids were enrolled. All patients underwent scar excision and revision at the same time when they needed BTX-A. It was injected into surgical wound closure immediately after surgery. The results of this study were evaluated at follow-up from 7 to 18 months using the Vancouver Scar Scale (VSS) and the Visual Analogue Scale (VAS).

Results: From January 2020 to January 2023, 33 patients received concomitant therapy of immediate injections of BTX-A after surgery for ear keloids. The patients were evaluated at follow-ups lasting 7 to 18 months. Only one case recurred within the follow-up period, and no adverse effects were reported.

Conclusion: This study demonstrates that significant cosmetic outcomes in ear keloid treatment were achieved after early postsurgical BTX-A injections. The patients reported high satisfaction and few complications.

This study aimed to assess the usefulness of ChatGPT Plus generated responses to clinical-specific questions in oral and maxillofacial surgery. This cross-sectional study was conducted with questions composed according to the Clinical Practise Guide of Ege University, School of Dentistry, and with different subjects of oral and maxillofacial surgery at the undergraduate level. These questions were classified according to their difficulty level (easy, medium, and hard) and inputted into ChatGPT Plus. Three researchers evaluated the responses using a 7-point Likert-type accuracy scale and a modified global quality scale (range: 1-5). Also, error analysis was carried out for the questions scored ≤4 according to the accuracy assessment. A total of 66 questions were enrolled in this study. The questions included dental anesthesia, tooth extraction, preoperative and postoperative complications, suturing, writing prescriptions, and temporomandibular joint examination. The median accuracy score of ChatGPT Plus responses was 5, with 75% of the responses scoring 4 or above. The median quality score was 4, with 75% of the responses scoring 3 or above. There was a significant difference among the 3 difficulty levels, both in accuracy and quality scores (P<0.001 and 0.001, respectively). The median scores of hard-level questions were found to be lower than the easy-level and medium-level questions. The study outcomes emphasized high accuracy and quality in ChatGPT Plus's responses, except for the questions requiring a detailed response or a comment.

Multiple primary cavernous hemangiomas of the skull are exceedingly rare, with surgery often being the treatment of choice. The complexity of radiologic diagnosis means that the identification of these hemangiomas still largely depends on pathologic analysis. This article outlines the diagnostic and therapeutic journey of a 52-year-old female patient afflicted with multiple primary cavernous hemangiomas of the skull. Although the occurrence of multiple cavernous hemangiomas in this patient may seem fortuitous, the authors aim to contribute to understanding the pathogenesis of such conditions through this case report.

Intracranial hypertension is considered a common and severe complication of cryptococcal meningitis (CM), contributing to early mortality and neurological sequelae. Timely and effective control of elevated intracranial pressure is crucial for the management of CM. Herein, the authors present a case of ventricular abdominal wall drainage for CM accompanied with acute intracranial hypertension. Notably, the patient has a history of taking immunosuppressants for thoracic and abdominal diffuse lymphangiomatosis. After continuous drainage of cerebrospinal fluid combined with standardized antifungal treatment, the patient recovered well.

Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral part of the neck. They may not present clinically until later in life. Surgical excision is a definitive treatment for branchial cleft cysts. This article presents the clinical report where the big inflamed cysts were excised under local anesthesia. It also presents guidelines for minimally invasive surgery under local anesthesia, which can be used in adequately selected cases.

Background: Reconstruction of significant soft tissue defects in the head and neck region after resection of extensive plexiform neurofibromas, as well as preservation and restoration of cosmetic and functional aspects, presents a considerable challenge.

Aims: The purpose is to evaluate the feasibility of eTMF in repairing substantial defects after the complete resection of NF1 PN.

Patients and methods: Patients diagnosed with substantial neurofibromatosis (NP) type 1 (NF1), according to the revised criteria, underwent complete resection and remodeling of the facial aesthetic unit. An extended vertical lower trapezius island myocutaneous flap (eTIMF) was used for the defect reconstruction. Perioperative complications were evaluated using the Clavien-Dindo classification. ECOG PS was assessed. Postoperative follow-up at 6 months and completion of UW-QOL. The questionnaire included swallowing, chewing, speech, and quality of life scores. Two patients had pathogenic missense variants: c.5609G>A (p.Arg1870Gln) in exon 38 of NF1 in the first case, and c.4600C>T (p.Arg1534*) in exon 35 in the second case.

Results: Two eTMFs were harvested successfully. Five facial esthetic units were remodeled, and 4 units were remodeled. Two extensive tumors were nearly entirely removed. No severe complications were noted. The ECOG PS improved from grade 3 in the first week postsurgery to grade 0 by the eighth week. The UW-QOL results indicated that swallowing, chewing, and speaking functions returned to their preoperative levels, with a 40% improvement in quality of life, reaching 60% and 80%, respectively.

Conclusions: eTMF to repair substantial defects following total resection of NF1 PN and facial esthetic unit remodeling enhances appearance, function, and psychosocial outcomes. This technique is safe, efficient, resource-conserving, and simple to implement.

With the development and introduction of orthodontic techniques and surgical protocols, modern patient prototypes are emerging. This paves the way for new approaches to the treatment of dentomaxillofacial deformities. The aim of the authors' study is to determine the appropriate timing and procedure for orthognathic surgery and to obtain the best patient and physician-oriented results. It is stated that surgery first and surgery only approaches are protocols that increase the motivation for treatment, with esthetic improvement being the priority. In this case report, the treatment of the authors' patient, who complained of asymmetry and planned to have a prosthetic restoration after correction of the skeletal deformity, with only a surgical protocol, is described. Treatment of dentomaxillofacial deformities involves a comprehensive analysis of patient, orthodontist, and surgeon-specific variables. Within appropriate indications, only a surgical approach can be an ideal approach for patients and specialist physicians in a short time.

Pediatric condylar fractures are commonly managed conservatively, as the condyle typically exhibits spontaneous remodeling. However, should conservative treatment be administered for severe deviated condylar processes? In a case involving a 7-year-5-month-old girl who fell from a height of 3 m, she sustained a mandibular parasymphysis fracture and bilateral condylar fractures, including a condylar base fracture with 60-degree medial deviation on the right side and a condylar head fracture, Neff type A, on the left side. To address the fractures, internal fixation was performed on the right condyle via a classical retromandibular approach, and a mini-plate was removed four months postsurgery. At a follow-up 12 years and 7 months later, the patient showed normal occlusion, TMJ function, and no visible scars. In addition, there was no facial deviation, although the surgical site condyle was larger than the nonsurgical site, suggesting that the surgical site facilitated normal growth while the nonsurgical site impeded it.

Challenges such as difficult wound healing, ischemic necrosis of skin flaps, and skin aging are prevalent in plastic surgery. Previous research has indeed suggested that these challenges in plastic surgery are often linked to cellular energy barriers. As the powerhouses of the cell, mitochondria play a critical role in sustaining cellular vitality and health. Fundamentally, issues like ischemic and hypoxic damage to organs and tissues, as well as aging, stem from mitochondrial dysfunction, which leads to a depletion of cellular energy. Hence, having an adequate number of high-quality, healthy mitochondria is vital for maintaining tissue stability and cell survival. In recent years, there has been preliminary exploration into the protective effects of mitochondrial transplantation against cellular damage in systems such as the nervous, cardiovascular, and respiratory systems. For plastic surgery, mitochondrial transplantation is an extremely advanced research topic. This review focuses on the novel applications and future prospects of mitochondrial transplantation in plastic surgery, providing insights for clinicians and researchers, and offering guidance to patients seeking innovative and effective treatment options.