Journal of Craniofacial Surgery最新文献

Background: The use and standardization of innovative artificial intelligence (AI) tools continue to grow and have the potential to enhance the field of plastic surgery. Despite the rapid growth of validated AI tools, there remains a need for a consolidated reference summarizing AI applications in plastic surgery.

Methods: A literature search was conducted to identify peer-reviewed articles studying AI tools applied to the fields of plastic surgery. Tools were organized into the fields of clinical efficiency, imaging and documentation, communication and workflow, and research and data analysis.

Results: There exists a wide variety of AI tools demonstrating clinical utility. Regarding clinical efficiency, virtual assistants such as AIVA improve patient communication, specifically in accurately answering postoperative questions. Large language models such as DeepSeek support decision-making and reduce documentation burden. AI can significantly improve the creation of 2D and 3D imaging for surgical planning, facial analysis, and volumetric prediction through tools such as Vectra and Crisalix. Tools such as Elicit and OpenEvidence can accelerate literature search, chart review, and data extraction. Lastly, workflow tools including TigerConnect and DAX Copilot can improve communication, and FS-net/FLAPMATE has been able to monitor free flaps with high sensitivity.

Conclusions: AI's precision and efficiency at a multitude of clinical and surgical tasks position it as a pivotal tool optimizing patient safety and satisfaction by reducing physician burden and burnout. As AI continues to become more sophisticated and specialized for plastic surgery, these tools will become an integral part of the field, driving safe, efficient, high-quality results for aesthetic and reconstruction procedures.

This study aimed to evaluate the accuracy, reliability, and clarity of information provided by artificial intelligence (AI)-based language models regarding botulinum toxin applications for bruxism treatment. Eighty-five open-ended questions were developed under 7 specific domains by a team comprising an oral and maxillofacial surgeon and 2 orthodontists. These domains included indications, contraindications, procedures, complications, prognoses, advantages, and disadvantages of botulinum toxin use in bruxism treatment. The questions were input into 3 AI chatbots: ChatGPT-4.0, Google Gemini, and Microsoft Copilot. The generated responses were independently evaluated by the researchers through 5 predefined accuracy categories: "Objectively True," "Selected Facts," "Minimal Facts," "Incorrect," and "Misleading." Statistical analysis, including χ2 and the Fisher exact tests, was conducted to assess differences in response accuracy among the AI models, with significance set at P<0.05. A statistically significant association was found between the AI model and response accuracy (P<0.001). ChatGPT-4.0 predominantly delivered answers classified as "Objectively True," surpassing Google Gemini and Microsoft Copilot. Across all domains, ChatGPT-4.0 maintained higher rates of accurate responses, whereas Google Gemini and Microsoft Copilot frequently provided answers categorized as "Selected Facts" or "Minimal Facts." While AI-based language models, particularly ChatGPT-4.0, may serve as a useful adjunct for preliminary patient education and professional reference regarding botulinum toxin use in bruxism, they cannot replace evidence-based clinical judgment. Practitioners should remain vigilant about the risk of misinformation and ensure validation of AI-generated content against established guidelines and authoritative sources before applying it in patient care.

Background: Presurgical infant orthopedics (PSIO) is widely used to reduce cleft severity, improve nasal symmetry, and facilitate primary lip repair. While extensively implemented in high-income countries (HICs), its feasibility, accessibility, and effectiveness in low-income countries and middle-income countries (LMICs) remain uncertain. This study assessed PSIO implementation, accessibility, and outcomes across 5 Smile Train partner centers in LMICs.

Methods: A retrospective multicenter analysis was conducted using the Smile Train Express (STX) database from 5 LMIC centers in Brazil, Mexico, India, Vietnam, and the Philippines. Data on PSIO initiation, completion, follow-up frequency, and surgical timing were collected. Anthropometric outcomes, including nostril width ratio (NWR) and columellar angle (CA), were analyzed to assess treatment effectiveness across different PSIO techniques. The age at surgery was compared between the PSIO and non-PSIO groups.

Results: PSIO significantly reduced cleft severity and improved nasal symmetry in all centers, with no statistically significant differences in NWR and CA between techniques. Treatment initiation ranged from 2.9 to 9.5 weeks, and completion from 2.8 to 8.2 months. PSIO coverage varied (16%-50%), reflecting differences in referral systems. Follow-up frequency ranged from 1.3 to 3.2 visits per month. The interval between PSIO completion and surgery varied across centers. Patients who received PSIO underwent earlier surgery than non-PSIO patients in most centers.

Conclusions: PSIO is effective in LMICs, with alternative techniques achieving comparable outcomes to NAM. Strengthening referral pathways, standardizing protocols, and expanding partnerships with public health systems are essential for optimizing cleft care in resource-limited settings.

The field of head and neck surgery is marked by its complexity, particularly when addressing oncological treatment, including extensive resections and consecutive reconstructive procedures. This introductory exploration will set the foundation for a comprehensive review, shedding light on various factors that may hinder surgical success, mainly through the prism of patients' comorbidities. In these patients, frequently there is a need to simplify the surgical approach and choose the lower ''step" in the reconstructive ladder to balance between the esthetic or functional outcome and the rational perioperative risk for the patient. The analysis of 10 patients diagnosed with cancer of the various subunits in the head and neck area, who, due to the severe comorbidities, were excluded from microsurgical free flap procedures, was conducted. Furthermore, the 10 patients with similar comorbidities who underwent the free flap procedure were analyzed mainly regarding the postoperative complications. In addition, a brief literature review of mostly cited factors that can hinder microsurgical success, mainly through the prism of patients' comorbidities, was performed. The mean age of patients included in the study group was 73.9 years (range 66-83, SD±5.78). Most of the patients were classified as ASA group IV (70%). The postoperative course in the case of all patients included in the study group was uneventful regarding major postoperative complications. There were only 2 minor surgical site complications in the form of wound dehiscence and partial flap loss. Due to the numerous available donor sites within the head and neck region, local flaps and oncoplastic seem to be reasonable solutions in many cases that balance the achieved outcome and the risk of the procedure for the patient with multiple comorbidities.

When Aphrodite promised Helen to Paris, she was offering a mortal version of herself, Helen of Sparta. Thereafter, Helen represents an echo of divine beauty trapped in a mortal frame. This paper explores the implications of her aging, delving into the contrast between the eternal and the ephemeral. In Homer's Odyssey , she reappears as a queen in Sparta, still regal, still enchanting. Her beauty lingers, suggesting a defiance of age that is not biologically explained but mythically preserved. Pausanias recounts that Helen was later worshipped in Sparta, perhaps even divinized-her mortality overwritten by collective reverence. Euripides' Helen distances her from the destructive events of Troy, implying her essence remains pure and unmarred. Across these narratives, Helen is curiously resistant to decay. She is not depicted with wrinkles or frailty but retains her aura of beauty well into her later years. In contemporary esthetic medicine, these figures continue to influence ideals. Aphrodite represents the unattainable: eternal youth, flawlessness, and control. She serves as a guiding archetype for perfection, an ever-receding goal. Helen, however, offers a more tangible model. Her features-radiant, human, and legendary-form the template for surgical emulation. She becomes the idealized mortal, inspiring interventions that aim to preserve or recreate the beauty she symbolized. Helen reminds us that while time etches its mark on the body, beauty can be immortalized through narrative, memory, and art. In Helen, we find not loss but transformation: a journey from the visible to the remembered, from fleeting flesh to timeless legend.

Objective: To investigate the therapeutic effect and safety evaluation of preformed titanium mesh and absorbable plate in 3D print-assisted orbital fracture repair surgery and traditional surgery, respectively.

Methods: This retrospective study analyzed 184 patients diagnosed with orbital blowout fracture from April 2017 to May 2024. The participants were stratified into 4 groups: 3D absorbable group, 3D titanium mesh group, conventional absorbable group, and conventional titanium mesh group. Parameters, including preoperative/postoperative exophthalmometry, orbital volume discrepancy, diplopia, ocular motility restriction, operative duration, and periorbital numbness, were evaluated.

Results: All procedures were successfully completed without severe complications such as infection, implant displacement, or irreversible vision loss, and postoperative CT scans indicated that the fracture sites were anatomically reduced well.The difference in enophthalmos and orbital volume among the 4 groups of patients was significantly reduced postoperatively compared with preoperatively, with a statistically significant difference ( P <0.05). Intergroup comparison showed that the difference in the 3D group was better than that in the conventional group ( P <0.05).In terms of diplopia improvement, the degree of diplopia in all 4 groups was significantly reduced postoperatively compared with preoperatively ( P <0.05), and the improvement in the 3D group was superior to that in the conventional groups ( P <0.05).The degree of restricted eye movement in the 4 groups of patients was significantly improved postoperatively compared with preoperatively ( P <0.05), and the improvement in the 3D absorbable group was better than that in the conventional absorbable group and the conventional titanium mesh group ( P <0.05), and the 3D titanium mesh group was better than the conventional titanium mesh group ( P <0.05).The operation time of the 3D group was significantly shorter than that of the conventional group ( P <0.05), and the operation time of the titanium mesh group in the conventional group was significantly shorter than that of the absorbable group in the conventional group ( P <0.05).

Conclusion: 3D-printing technology enhances the precision of orbital fracture repair, resulting in shorter operative time, better anatomic restoration, and improved functional outcomes compared with conventional methods. Both preformed titanium mesh and absorbable plates are effective implants, with titanium offering greater time efficiency.

Malocclusion disorders affecting the alignment between the upper (maxilla) and lower (mandible) jaws can lead to both aesthetic and functional problems. In Angle Class 2 malocclusion, the mandible is positioned relatively backward. Treatment typically involves orthodontic preparation followed by orthognathic surgery to advance the mandible. However, a common issue following such procedures is postoperative recurrence, where the mandible tends to revert toward its original position. One significant factor influencing recurrence is the method of bone fixation during surgery. This study aimed to compare 2 fixation techniques-3 bicortical screws (classic method) versus a combination of 1 bicortical screw and 4 monocortical screws on a plate (mixed method) in terms of long-term postoperative stability. Patients who underwent mandibular advancement through bilateral sagittal split ramus osteotomy between January 2019 and June 2023 were divided into 2 groups based on the fixation method used. Group 1 received the mixed method, while group 2 underwent the classic method. SNB angles were measured preoperatively, on the first postoperative day, and at 1-year postsurgery using CT imaging. Thirty patients (15 males, 15 females; mean age: 24.7) were followed for an average of 19 months. Results showed that group 1 had more stable SNB angles over time, with statistically significant improvements from baseline and less recurrence at 1 year. In contrast, group 2 showed greater recurrence. The mixed fixation method demonstrated superior long-term stability compared with the classic method, suggesting it may be more effective in reducing recurrence after mandibular advancement in Angle Class 2 malocclusion cases.

Reviewing, whether of literary essays or scientific manuscripts, is a discipline that extends beyond the application of formal scoring rubrics. Having engaged in both domains-as a referee of student essay competitions and as a reviewer for scientific journals-the author reflects on the common principles and distinct challenges that underlie these processes. Literary works are judged for authenticity, emotional resonance, and aesthetic depth, while scientific manuscripts are evaluated for novelty, rigor, and utility. Despite these differences, both forms of writing share essential foundations: clarity, honesty, and structural coherence. In the current publishing climate, the responsibilities of reviewers are amplified by the proliferation of more than 19,000 new journals worldwide. Alongside opportunities for knowledge dissemination come significant ethical challenges, including fabricated data, plagiarized content, and the growing presence of AI-generated manuscripts. Reviewers must now act not only as evaluators but also as guardians of integrity. Principles of good practice include careful attention to originality, internal consistency of data and methods, awareness of suspicious or formulaic text, impartiality, and timely communication of ethical concerns to editors. The essay also addresses the dilemma faced when a paper that has been reviewed is later retracted. Such events should not be viewed solely as failures of the review process but as demonstrations of the corrective mechanisms inherent in scholarly publishing. Ultimately, the reviewer's role is to ensure that literature-whether literary or scientific-remains a trustworthy medium for meaning, truth, and human connection.

Since Tanzer's seminal work introducing costal cartilage for ear reconstruction, subsequent advances by Brent, Nagata, and Firmin have refined surgical techniques and aesthetic outcomes. However, fundamental aspects of the procedure-such as planning incisions, achieving accurate ear positioning, and guiding chest wall incisions for rib harvest-have seen limited innovation. The current standard practice of using projection paper or transparent templates to replicate the contralateral ear position remains imprecise. Similarly, autologous cartilage harvest can be particularly challenging in patients with higher BMI, due to difficulty in accurate rib palpation and visualization. Misplaced chest wall incisions can result in suboptimal rib harvest, longer operative times, and increased morbidity. In this study, we introduce patient-specific, three-dimensional (3D) printed masks, termed hEARo masks, as a novel and user-friendly tool for ear framework positioning. Furthermore, we present the integration of augmented reality (AR) technology to enhance preoperative planning and intraoperative guidance during microtia repair, enabling more precise incision placement for rib harvest. The combined use of 3D printing and AR facilitates complex ear reconstruction, offering increased surgical precision, reduced operative time, and potentially improved patient outcomes. These innovations represent a significant advancement in the personalization and accuracy of auricular reconstruction.

Virtual surgical planning (VSP) has revolutionized craniofacial surgery by enhancing preoperative planning and surgical precision, though its optimal applications in pediatric cases remain incompletely defined. The purpose of this study is to evaluate the evolution and expanding applications of VSP in craniomaxillofacial surgery at our tertiary pediatric hospital. A retrospective review of index craniofacial procedures performed between 2011 and 2023 at a tertiary pediatric hospital was conducted, analyzing VSP utilization, including the use of stereolithographic models, cutting guides, splints, and patient-specific implants. Demographic data, operative times, and surgical outcomes were collected for all procedures. During the study interval, 2112 index craniofacial procedures were performed, of which 19.9% (n=420) cases were virtually planned. Virtual surgical planning was most frequently used in orthognathic operations (n=284, 67.6%). From 2011 to 2014, VSP was solely applied to orthognathic and midface cases, with the addition of box osteotomies for hypertelorism in 2015, cranioplasties in 2016, anterior vault advancements in 2019, and posterior/middle vault expansions in 2021. The use of patient-specific implants significantly decreased operative duration in bimaxillary orthognathic cases compared with traditional fixation methods (207.5 min versus 234.0 min, P =0.021). Virtual surgical planning has become integral to pediatric craniofacial procedures requiring high precision or involving complex anatomy, though its utility is currently limited in operations where cranial growth must be considered. As 3D analysis software and manufacturing advances, VSP may find broader applications in pediatric craniomaxillofacial surgery.