Journal of Craniofacial Surgery最新文献

Objective: There is a lack of comprehensive comparative evidence regarding the effectiveness, intraoperative management, and safety of different surgical procedures for treating nonsyndromic sagittal synostosis. This study aims to evaluate existing clinical studies to provide evidence-based guidance for clinical practice.

Methods: The authors performed a comprehensive search of 5 databases up to August 2024. Key outcomes included clinical effectiveness, measured by cephalic index (CI), and intraoperative management and safety indicators, such as intraoperative blood loss, operative time, and length of hospital stay. Direct and indirect effects, along with treatment rankings, were assessed using Bayesian pairwise and network meta-analysis models.

Results: Fifteen studies with 1436 patients were included, and 4 network meta-analysis models were used to compare 5 surgical techniques: open strip craniectomy (OSS), calvarial vault remodeling (CVR), spring-mediated cranioplasty (SMC), endoscopic strip craniectomy (ESC), and endoscopic spring-mediated cranioplasty (ESMC). No significant differences in postoperative CI were found between the surgical methods. However, CVR was associated with significantly greater blood loss, longer operative time, and longer hospital stays compared with OSS, SMC, and ESC.

Conclusions: Current evidence does not demonstrate a clear superiority of one surgical method over another, with comparable treatment outcomes overall. However, CVR carries higher risks, and the choice of surgical approach should be individualized based on patient-specific factors and clinical judgment.

In the process of orthodontic clinical teaching, it is very important to teach medical students how they are expected to communicate effectively with patients and their families, as this has a direct impact on patient compliance throughout the process of diagnosis and treatment and on patient satisfaction after treatment. Doctor-patient communication is therefore an essential skill for medical students to gain before taking up clinical work. In view of the problems that are often encountered in each stage of orthodontic treatment, the present paper discusses the specific content of doctor-patient communication education in clinical teaching. The discussion is given in both theoretical and practical terms to lay a solid foundation for improving the overall quality of medical service provided by medical students in teaching hospitals and establishing a harmonious medical environment.

Objective: The aim of this study is to assess the comparative effectiveness of transorbital sonography (TOS) and the pupillary penlight visual assessment method in patients with traumatic brain injury (TBI) and periorbital hematoma.

Methods: A total of 140 patients with traumatic brain injury (TBI), meeting the inclusion and exclusion criteria, were selected from a tertiary hospital in Zhejiang Province between January 2022 and December 2023. Pupillary function in all patients was assessed using both TOS and the pupillary penlight visual assessment method on the first, third, and seventh day after admission. The stability and consistency of the measurement results were compared. Stability was determined using the coefficient of variation, whereas consistency was assessed using the intraclass correlation coefficient.

Results: The coefficients of variation for the pupillary transverse diameter values measured by TOS were 29.84% (left) and 29.55% (right) on day 1, 27.81% (left) and 26.88% (right) on day 3, and 26.80% (left) and 25.51% (right) on day 7. These values were consistently lower than those obtained through the pupillary penlight visual assessment method, indicating superior stability with the TOS measurement. In addition, the intraclass correlation coefficient analysis demonstrated consistency between the 2 methods, with values ranging from 0.562 to 0.809 (P<0.05), indicating good consistency.

Conclusion: TOS represents an innovative tool for neurological assessment. It has been validated that the presence or absence of eyelid edema does not compromise the accuracy of ultrasound-based pupillary function measurements. The 2 methods of measurement exhibit good consistency, with the TOS method demonstrating superior stability in monitoring data. This approach provides a more accurate means of assessing pupillary function in patients with TBI who have periorbital hematoma or facial swelling, particularly when opening the eyelid is challenging, thereby addressing a significant clinical nursing challenge.

Aim: This research was designed to make a comparison of the treatment outcomes of endoscopic dacryocystorhinostomy (En-DCR) in nasolacrimal duct obstruction (NLDO) with and without chronic dacryocystitis.

Methods: NLDO (obstruction group) and chronic dacryocystitis (dacryocystitis group) patients treated with En-DCR in the Eye Hospital of Wenzhou Medical University from March 2021 to February 2022 were retrospectively analyzed. According to CT dacryocystography, patients in each group were assigned into the high obstruction group (obstruction located in the lacrimal sac) and the low obstruction group (obstruction located at or below the junction of the nasolacrimal duct and dacryocystis). The surgery outcomes of patients in the 2 groups were compared 12 months postoperation.

Results: One hundred four patients (104 eyes: obstruction group: 49 eyes; dacryocystitis group: 55 eyes) were recruited. Patients with high obstruction accounted for 61.2% in the obstruction group and 32.7% in the dacryocystitis group. There were significantly more high obstruction patients in the obstruction group versus the dacryocystitis group (P<0.05). At 12 months postoperative follow-up, the total anatomic and functional success rate was 83.7% and 80.8%, respectively. Higher anatomic success rate (90.9%) and functional success rate (89.1%) were noted in the dacryocystitis group versus the obstruction group (75.5% and 71.4%, respectively, P<0.05).

Conclusions: The obstruction site is higher in the obstruction group in comparison to that in the dacryocystitis group. En-DCR is effective in the treatment of NLDO and chronic dacryocystitis, and its efficacy on chronic dacryocystitis is better than that on NLDO.

Objectives: This study aims to compare the safety and efficacy between carbon dioxide (CO2) laser excision and surgical excision for the treatment of eyelid margin benign tumors.

Methods: In this single-center, prospective, randomized, and single-blind study, 32 patients diagnosed with eyelid margin benign tumors were enrolled from February 2019 to February 2020 and randomly divided into 2 groups. The sexes, ages, tumor size (length×width), scar, procedure time, physicians' assessment score, patients' satisfaction score, and complications were recorded. Histologic analyses were obtained in all patients.

Results: No significant difference in baseline data (sexes, ages, and tumor size) was found between the 2 groups. The mean scar length at 1-week post-treatment in the CO2 laser excision group was significantly shorter than surgical excision group (0.3±0.1 versus 0.5±0.1 cm, P<0.05), and procedure time in CO2 laser excision group was significantly shorter than surgical excision group (5.8±1.5 versus 26.7±6.4 min, P<0.05). There was no statistically significant difference in the physicians' assessment score and patients' satisfaction score between the 2 groups. During the follow-up period, no severe complications were observed.

Conclusions: Compared with surgical excision, CO2 laser excision was a rapid procedure and associated with favorable cosmetic outcomes.

Chin augmentation and jawline contouring have emerged as significant procedures in aesthetic medicine, addressing both structural and age-related changes in the lower face. This review explores anatomic-based diagnosis and filler injection techniques for these treatments. Ethnic variations in facial structure necessitate different approaches, with Western patients often seeking jawline definition, while Asian patients frequently require chin projection. The evolution of beauty standards and widespread orthodontic treatments have influenced treatment goals, emphasizing overall facial harmony. Successful outcomes rely on a thorough understanding of facial anatomy, including the complex interplay of muscles, fat layers, and soft tissue landmarks. The distinction between bony and soft tissue landmarks is crucial for optimal filler placement. Treatment techniques involve careful selection of filler consistency and injection depth, with high-viscosity fillers used for deep structural support and softer fillers for surface refinement. The use of cannulas in jawline treatments offers advantages in reducing complications and ensuring even distribution. Vascular anatomy knowledge is essential to avoid complications, particularly regarding the facial artery and its branches. Post-treatment management, including massage and follow-up assessments, is vital for achieving and maintaining desired results. This comprehensive approach ensures safe, effective, and aesthetically pleasing outcomes in chin and jawline enhancement procedures.

Hyaluronic acid filler treatment is increasingly prevalent in the realm of plastic surgery, serving to correct a range of facial changes resulting from aging. Nevertheless, with its expanded application, an uptick in complications has been observed. This article reported a 30-year-old female patient who received chin hyaluronic acid filler treatment 5 years ago started experiencing atrophy and progressive deterioration at the injection site a year ago. Currently, she presents with a pronounced depression beneath the left corner of her mouth, along with changes in skin tone and scarring. The patient exhibited progressive hemifacial atrophy within the region that had been injected with hyaluronic acid. Progressive hemifacial atrophy at the injection site may be a novel adverse effect associated with the injection of fillers, and it is important to be vigilant about this possibility.

Objective: To assess the dynamic mandibular movement of patients with condylar hyperplasia before and after simultaneous orthognathic surgery and condylectomy through an intraoral approach.

Methods: Two groups of patients diagnosed with unilateral condylar hyperplasia were studied: the preoperative group consisted of 23 patients and the postoperative group consisted of 13 patients who had undergone simultaneous orthognathic surgery and condylectomy through an intraoral approach with follow-up for more than 1 year. The normal reference value was obtained from 11 individuals without oral and maxillofacial diseases. Three-dimensional mandibular movement trajectories and electromyography of masticatory muscles were recorded.

Results: Patients showed no limitation in mandibular border movement before surgery, but the average amplitude of electromyography of the lower head of lateral pterygoid muscle on the affected side was lower than normal reference value. After condylectomy, the maximum mouth opening decreased [32.00 (26.55, 36.20) mm], mandibular movement deviated to the affected side, and the maximum distance in protrusive movement of the mandibular incisal point and the movement to the normal side were both significantly lowered. Amplitude of electromyography of the lateral pterygoid muscle on the normal side increased in the postoperative group compared with the preoperative group.

Conclusions: Patients with condylar hyperplasia had a restriction in protrusive and to the normal side movement, and mandibular movement deflected to the affected side after condylectomy, which indicates the necessity of postoperative individualized rehabilitation training.

Background: Cranial defects from trauma, surgery, or congenital conditions require precise reconstruction to restore cranial vault integrity. Autogenous calvarial grafts are preferred for their histocompatibility and biomechanical properties, but their success depends on a well-developed diploic space. Although prior studies have described overall skull thickness development, less is known about how diploic thickness changes through adulthood. This study aimed to quantify diploic thickness and density changes with age using computed tomography (CT) imaging.

Methods: A retrospective review of an institution-wide imaging database was performed to identify patients who received CT scans for non-traumatic indications. A total of 110 patients, balanced by sex, were selected across 11 age groups spanning 10 to 109 years. Each patient's skull was aligned to a standardized grid and segmented in 3-dimensional (3D) Slicer using consistent thresholding values to isolate the diploic space from the inner and outer cortical tables. Linear regression models were used to assess the effects of age and sex on diploic thickness.

Results: No statistically significant trends were found between age and diploic thickness (r=-0.06; P=0.50. However, a near-significant trend of decreasing diploic thickness with age was observed in men (r=-0.25; P=0.05) but not in women (r=0.11; P=0.42). The posteromedial parietal region consistently showed the greatest thickness across all age groups. Diploic density also increased significantly with age (r=0.285; P=0.002), indicating progressive ossification of cancellous bone.

Conclusion: Diploic thickness remains stable across the lifespan with slight sex-based differences. However, examination reveals that the density of the diploe increases over time, suggesting age-related changes in cancellous architecture. These findings highlight the importance of individual anatomical variations when harvesting autogenous calvarial grafts to optimize cranial reconstruction outcomes.

Odontogenic keratocysts (OKCs) are an invasive type of odontogenic cyst that rarely occurs in the maxilla. This article presents a case of OKC complicated with ectopic teeth occurring in the maxillary sinus. This article collects a case of a 19-year-old female patient with an ectopic tooth in the maxillary sinus associated with an OKC. The physician opted for the Caldwell-Luc approach to remove the ectopic tooth, the cyst, and the affected mucosa. Concurrently, the bone fragment at the window site was repositioned by applying the bone lid technique after the lesion had been cleared. Postoperative follow-up revealed that the bone fragment had achieved good continuity, effectively reconstructing the anatomical form of the lateral maxillary sinus wall. To clear the large sinus contents and the affected mucosa, physicians may employ the Caldwell-Luc approach combined with a bone lid technique for maxillary sinus antrostomy. Treated by Caldwell-Luc surgery and bone lid technique, the surgical field can be fully exposed, facilitating the surgeon's removal of the affected mucosa and cyst. Moreover, the bone fragments can be repositioned precisely after the lesion is cleared and normal facial features can be restored after bone reconstruction.