Journal of Craniofacial Surgery最新文献

The present study was aimed to comprehensively evaluate changes in the masseter muscle in patients with Class III facial asymmetry after bimaxillary orthognathic surgery and explore potential correlations between masseter muscle changes and facial morphology or postoperative mandibular stability. Fifty-two eligible patients with Class III facial asymmetry who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO) with or without genioplasty between January 2019 and June 2023 were included. Cone-beam computed tomography (CBCT) was collected for each patient at 3 stages: 1 week preoperatively (T0), immediately after surgery (T1), and at least 12 months postoperatively (T2). Masseter muscle changes including volume, surface area, length, and width were measured using ITK-SNAP and 3D Slicer and correlations between these changes and facial morphology, skeletal stability were further explored. The length, width, surface area, and volume of the nondeviated side (NDS) masseter muscle were greater than those of the deviated side (DS) before surgery (T0). These parameters of masseter muscle at both sides decreased significantly after surgery (T2), except the length of DS masseter increased slightly. The differences in bilateral masseter length, width, surface area were reduced significantly after surgery and NDS masseter muscle remained greater than DS masseter muscle. Changes in the NDS masseter surface area negatively correlated with FH-MP. However, no significant correlations between masseter volume changes and mandibular postoperative skeletal stability were found. Taken together, our results revealed detailed masseter muscle changes following surgical correction of Class III facial asymmetry.

Aggressive osteomyelitis of the jaw presents with a destructive pattern, including bone necrosis, pain, and swelling, which can sometimes make it difficult to differentiate from malignancy. This article reports a case of a 47-year-old female patient diagnosed with aggressive osteomyelitis that was initially confused with adenoid cystic carcinoma (ACC). ACC is a rare salivary gland tumor that grows slowly but can involve perineural invasion and distant metastasis. In this patient, the clinically reported pain and radiologic findings suggested perineural invasion and skip metastasis, leading to suspicion of ACC. However, intraoperative findings and pathologic evaluation confirmed a diagnosis of chronic osteomyelitis. Through this case review, the authors aim to suggest to surgeons that osteomyelitis be considered as a differential diagnosis for ACC and to highlight the possibility that clinical and radiologic findings may differ from pathologic results.

Objective: To assess the time efficiency of computed tomography (CT) and magnetic resonance imaging (MRI) multimodal scanning protocols in the assessment of acute ischemic stroke (AIS), with potential implications for craniocerebral emergency management.

Methods: A retrospective analysis was conducted to assess the imaging workflows of CT and MRI for the assessment of AIS. The total examination time, derived from DICOM source data, encompassed pre-scan waiting periods, sequence acquisition times, and image reconstruction durations. In addition, the influence of the experience of radiologic technologists on scanning efficiency was analyzed. The CT imaging protocols included noncontrast CT, CT angiography (CTA), and CT perfusion (CTP), whereas the MRI protocols comprised noncontrast MRI, diffusion-weighted imaging (DWI), magnetic resonance angiography (MRA), susceptibility-weighted imaging (SWI), and arterial spin labeling (ASL). Craniocerebral imaging characteristics were documented without additional measurements.

Results: CT multimodal scanning demonstrated a shorter acquisition time, while MRI was associated with a reduced reconstruction duration. The total waiting period for CT (11.76 min) and scanning time (11.65 min) were slightly lower compared with MRI. However, MRI had a significantly shorter reconstruction time (7.09 min) compared with CT (13.42 min), resulting in a longer overall radiology department time for CT (36.83 min) than for MRI (31.00 min). Notably, during the night shift, the waiting period for MRI (12.1 min) was shorter than during the day shift (15.4 min). In addition, the experience of radiologic technologists had a significant impact on procedural efficiency.

Conclusions: MRI demonstrates greater efficiency in AIS evaluation during night shifts in municipal hospitals, leveraging its superior diagnostic capabilities and optimized time efficiency. Conversely, CT is better suited for rapid initial assessments during day shifts, particularly in high-risk scenarios. Aligning imaging protocols with the expertise of radiologic technologists and shift schedules can further enhance the efficiency and effectiveness of stroke management. These findings may inform protocol optimization in craniocerebral emergency settings.

Objective: The authors' aim in this study was to investigate the impact of various living arrangements on the occurrence of perioperative cognitive dysfunction (POCD) (now known as perioperative neurocognitive dysfunction, or PND) among elderly patients.

Methods: The authors' study cohort consisted of 162 elderly patients who underwent laparoscopic radical surgery for gastrointestinal cancer under general anesthesia. The authors categorized them into the following 5 groups based on their preoperative living arrangements: living with the spouse and children (group A); living with the spouse (group B); living with children (group C); living alone (group D); and living in a nursing home (group E). The authors observed and compared the preoperative and postoperative cognitive functions of the patients in the 5 groups.

Results: There was no statistically significant difference in age, sex, years of education, duration of surgery, duration of anesthesia, or postoperative visual Analog Scale (VAS) scores among the 5 groups of patients. However, the 5 groups of patients differed significantly with respect to preoperative mini-mental state examination (MMSE) scores, the difference between preoperative and postoperative scores, the preoperative rate of cognitive impairment, and the prevalence of postoperative POCD. When the authors examined the Montreal cognitive assessment (MoCA) scale scores, there were statistically significant differences in the preoperative scores, the difference between preoperative and postoperative scores, and the prevalence of postoperative POCD among the 5 groups. The prevalence of preoperative cognitive impairment, as diagnosed by the MMSE and MoCA scales, and the occurrence of POCD at 3 and 5 days post-surgery were similar. Logistic regression analysis of risk factors for POCD prevalence revealed that the living arrangement of elderly patients was a risk factor for the prevalence of POCD on day 3 post-surgery, whereas the living arrangement and the presence of preoperative cognitive impairment were risk factors for POCD on day 5 post-surgery.

Conclusion: The authors' study results highlighted the type of living arrangements of elderly patients as one of the factors that influence the prevalence of POCD in the immediate postoperative period. Elderly patients who preoperatively resided in a nursing home or those who lived alone were more likely to be associated with developing POCD.

The torcular herophili is a crucial anatomical landmark in suboccipital craniotomy, dictating the surgical exposure area. Variability in the location of the torcular can be observed in congenital cranial malformations. This study explores the feasibility of conducting posterior fossa surgery in cases of an extremely low-positioned torcular. A suboccipital craniotomy was performed on a patient with an extremely low torcular, without any associated cranial malformations. A left cerebellar hemisphere tumor was accessed through the narrow space (20 mm) between the low torcular and foramen magnum. The left cerebellar hemisphere tumor was totally resected. The patient experienced a favorable postoperative course with no complications. Significant variability in the location of the torcular can appear in patients without cranial malformation. This is the first report demonstrating the applicability of suboccipital craniotomy in patients with an extremely low torcular.

Objective: The intraoral approach for resection of oral cancer in a posterior site is insufficient for exposing the entire lesion and/or allowing the surgical device to resect it cleanly. Therefore, an extraoral approach is required for safe resection of the lesion. The cheek-splitting transbuccal approach (CSTBA) technique allows the surgeon to reach the posterior side of the oral cavity. The authors propose here 2 types of CSTBAs-inferior and superior-and the application of these approaches in 7 cases.

Patients and methods: Inferior CSTBA was applied in 6 cases for marginal mandibulectomy. Superior CSTBA was applied in only one case of early cancer in the root of the tongue.

Results: The tumor was resected safely in all cases. During follow-up, subsequent lymph adenopathy was detected in 2 cases.

Conclusion: Two types of CSTBAs were useful for resection of oral cancer in a posterior site without compromising the integrity of the submandibular region, where lymph nodes are located.

Objective: This study aimed to investigate the optimization of expanded flaps for the repair of large facial defects, while also providing insights and strategies for the prevention and management of complications.

Methods: A retrospective study was conducted with 5 patients who underwent repair of skin soft tissue defects of the head and face with expanded flap at First Affiliated Hospital of Kunming Medical University between October 2018 and May 2021. Patient data were collected, including age, diagnosis, lesion area, and photographs, together with details of the type, volume, placement, and depth of the expander, the duration of expansion, the type of flap used for repair, and follow-up results. All patients with large soft tissue defects of the head and face, resulting from the resection of benign lesions, underwent preoperative implantation of expanders. The defects were subsequently repaired by established flap design principles after the expanded flap was obtained through continuous water injection and expansion.

Results: All 5 patients underwent successful surgery with complete flap survival. In 1 case, a failure of forehead expander placement was addressed by utilizing a expanded flap derived from the remaining 2 expanders. In addition, a case of cheek expander infection was resolved through the removal of the infected expander and repair using a expanded flap from the neck expander. One patient did not return for treatment of postoperative incisional scar hyperplasia due to her predisposition to keloids. The remaining 4 patients were actively followed postoperatively and exhibited flaps that closely matched the surrounding skin in color and texture. All patients were satisfied with their postoperative results and appearance.

Conclusions: In cases of significant soft tissue defects following the resection of benign cephalofacial lesions, the utilization of expanding flap repair is a practical and effective approach. When employed optimally, this technique results in more satisfactory postoperative outcomes and a reduction in complications.

This study aims to elucidate the effect of thyroid eye disease on perceived facial aging. In this cross-sectional cohort study, an artificial intelligence (AI) model (previously trained to infer patient age from facial photographs) was used to analyze facial aging changes in 2 groups: (1) TED patients and (2) age-matched controls. Standardized photos were analyzed from initial and final visits of patients with more than 5 years of clinic follow-up. The performance of the AI model was compared to that of an expert group composed of oculoplastic surgeons. Chronological, AI-inferred, and expert-estimated ages were compared. AI initially estimated TED subjects to be 4.3 years older than their actual age, compared to 0.63 years older in control subjects (P=0.005). At the final timepoint, TED patients were estimated to be 5.0 years younger than their actual age, compared to 1.4 years younger in controls (P=0.004). The mean difference between actual and AI-inferred change in age was 9.3 years for TED patients and 2.0 years for controls (P<0.001). Human experts tended to underestimate age across all groups and time points. The AI model was significantly more accurate than human experts in estimating the age of controls at the final time point. AI estimated that TED patients were older than their chronological age initially and younger than their chronological age at the final follow-up. This may be due to initial pathologic soft tissue volume expansion in TED, which may compensate for age-related soft tissue deflation.

In this study, the authors proposed to determine the superiority or inferiority of the 3D fixation method and 2 miniplate fixation methods in mandibular angle fractures. The purpose of this study was to evaluate the efficacy of a 3D curved angle strut plate and 2 miniplates in mandibular angle fracture fixation. The aim of this study was to evaluate the efficacy of 3-dimension curved angle strut plate versus 2 miniplates in mandibular angle fracture fixation. Sixteen patients requiring internal fixation of the mandibular angle fractures divided into 2 groups 8 in each group, group I was treated with using 3D curved angle strut plate. Group II was treated using two 2-mm miniplates. The results of this study suggested that there are statistically significant in time elapsed between plate adaptation and definitive fixation (min) between 2 groups. The 3D curved angle plate has relatively few or no postoperative complications compared with other techniques.

Purpose: To determine the surgical outcomes of endoscopic dacryocystorhinostomy (DCR) by analyzing preoperative dacryocystography (DCG) findings.

Methods: This retrospective study included 304 cases involving 197 patients. The following 6 obstruction levels on DCG were categorized: (1) patent, (2) canaliculus, (3) common canaliculus, (4) lacrimal sac, (5) duct-sac junction, and (6) nasolacrimal duct obstructions. Obstructions within the canaliculus and common canaliculus were defined as proximal obstructions, while those beyond the common canaliculus were classified as distal obstructions. The authors defined the following 2 types of success: (1) complete success, characterized by a patent ostium with no symptom of epiphora; and (2) favorable success, defined as a patent ostium with at least 50% symptom improvement.

Results: The rate of complete success varied with DCG findings, being 52.9% for patent cases and 65.5%, 70.7%, 78.9%, 81.3%, and 82.0% for canaliculus, common canaliculus, lacrimal sac, duct-sac junction, and nasolacrimal duct obstructions, respectively. The complete-success rate was lower in proximal than distal obstructions (P=0.042). However, the favorable-success rate was 84.3% in the patent group and 94.1% for proximal obstructions, and did not differ with the DCG findings. In addition, a narrower lacrimal sac on DCG was associated with worse outcomes (P=0.045).

Conclusions: Findings such as a small lacrimal sac indicating contracture, proximal obstructions, and patency on DCG were identified as predictors of worse surgical outcomes. However, endoscopic DCR often produces favorable outcomes even in cases with patency and proximal obstructions.