Journal of Craniofacial Surgery最新文献

Guided bone regeneration (GBR) is a critical technique in craniomaxillofacial surgery, significantly advancing the management of bone defects resulting from trauma, tumor resection, congenital malformations, and insufficient bone volume for dental implants. Autologous GBR capitalizes on the body's inherent regenerative capabilities in conjunction with strategic interventions, benefiting from enhanced biocompatibility and integration with osteogenic processes. This review delineates recent advancements in autologous GBR within the context of craniomaxillofacial surgery. First, it elucidates the fundamental concepts and mechanisms underlying autologous GBR, emphasizing the biological processes of osteogenesis along with various influential factors. Second, it explores material applications in autologous GBR-encompassing both absorbable and nonabsorbable barrier membranes as well as diverse types of bone graft substitutes-highlighting their distinct characteristics and clinical outcomes. Third, this review discusses the clinical applications of autologous GBR across subfields, such as dental implantation, jaw defect repair, and correction of craniofacial deformities through representative evidence-based cases. Fourth, it addresses challenges encountered by autologous GBR-including issues related to regeneration efficiency and complications such as infection or membrane exposure-and proposes optimization strategies to mitigate these concerns. Finally, this review investigates innovative research directions encompassing gene therapy combined with GBR technology as well as applications of 3D printing while forecasting future trends toward multitechnology integration and precision treatment approaches. This comprehensive review serves as an essential reference for clinicians and researchers engaged in craniomaxillofacial surgery and its associated disciplines.

Background: Scar formation remains a significant clinical challenge in facial trauma repair, with the anatomic region-specific propensity poorly understood. This study investigates differential scarring outcomes between the perioral and nasal regions following refined cosmetic suturing.

Methods: A retrospective analysis was conducted on 23 patients with nasal or perioral trauma treated using cosmetic suturing techniques. Scar evaluation was performed using the Scar Cosmesis Assessment and Rating (SCAR) scale by professional plastic surgeons, assessing parameters including scar spread, erythema, depigmentation, track marks or suture marks, hypertrophy or atrophy, and overall impression.

Results: Despite identical surgical techniques, perioral scars exhibited significantly higher SCAR scores (5.56±2.40) compared with nasal scars (3.41±1.90) (P<0.05). Specifically, perioral scars demonstrated greater spread (1.79±0.59 versus 1.09±0.48, P<0.01) and hypertrophy or atrophy (1.43±0.46 versus 0.98±0.58, P<0.05). No significant differences were observed in erythema, depigmentation, or patient items.

Conclusion: The perioral region demonstrates a higher predisposition to scarring than the nasal region despite equivalent repair techniques, highlighting the influence of biomechanical factors. These findings emphasize the need for region-specific preventive strategies in facial scar management.

Craniofacial basal cell carcinoma (CFBCC) accounts for the majority of basal cell carcinomas (BCCs) by anatomic distribution yet represents only a small proportion of head and neck malignancies, with disproportionate morbidity due to involvement of anatomically complex and functionally critical facial regions. Management is challenged by subclinical tumor spread along embryologic fusion planes, perineural invasion, and proximity to ocular, neural, and skull base structures. This narrative review synthesizes contemporary evidence on epidemiology, histopathologic subtypes, molecular pathogenesis, diagnostic evaluation, surgical management, reconstruction, and emerging therapies for CFBCC. High-risk and advanced disease includes aggressive histologic variants, chronically neglected or large tumors, recurrent lesions, and cases with orbital, bone, or skull base involvement. Clinical assessment, including regional nodal evaluation, is complemented by advanced imaging modalities, including magnetic resonance imaging, computed tomography, reflectance confocal microscopy, and optical coherence tomography. Mohs micrographic surgery provides optimal margin control for high-risk facial subsites, while deeply invasive tumors may require craniofacial resection. Advances in Hedgehog pathway-targeted therapies, digital surgical planning, and multidisciplinary reconstruction continue to expand treatment options and improve functional and aesthetic outcomes.

Frontal sinus fractures (FSF) can lead to detrimental intracranial infections, yet there is variability in the literature regarding the efficacy of antibiotic prophylaxis. This study aims to provide guidance on the role of prophylactic antibiotics in mitigating infection following FSF. A retrospective cohort study was conducted from January 2018 to December 2022 comparing the incidence of infection between patients managed with versus without antibiotics. Patients with FSF diagnosed by CT scan and at least 18 years old were included. Our primary outcome was the incidence of infection following FSF. Of 201 patients, 26 (12.9%) had a dural tear or cerebrospinal fluid leak (CSF). Patients managed with antibiotics were significantly more likely to have a dural tear or CSF leak [25 (15.4%), 1 (2.6%), P=0.032], and none of these patients developed an infection. A total of 6 (3%) patients developed infection, including 4 meningitis cases and 2 sinusitis cases. Infections occurred in 5 of 162 patients (3.1%) who received antibiotics, compared with 1 infection (2.6%) in the 39 patients without antibiotic prophylaxis, with no statistically significant difference (P=1.0). The most common prophylactic antibiotic among patients who developed infection was IV cefazolin. The majority of fractures (149, 74%) were managed conservatively, including all patients who developed infections. Although further randomized controlled trials are needed to better define the role of antibiotic prophylaxis in preventing infections, antibiotics may not be necessary for all FSF patients. In the subset of patients with CSF leak, the absence of infection might indicate the protective effects of antibiotics.

Multisutural craniosynostosis, involving premature fusion of cranial sutures, leads to abnormal skull shape and elevated intracranial pressure (ICP), threatening neurodevelopment. This case report describes a 6-day-old infant with multisutural craniosynostosis associated with an ERF gene mutation. Imaging confirmed elevated ICP. At 2 months, posterior cranial and foramen magnum decompression effectively reduced ICP, deferring fronto-orbital advancement. By age 2, the child had achieved normal developmental milestones with stable cranial morphology and no Chiari I malformation. Early posterior decompression is a viable first-line intervention for syndromic craniosynostosis, promoting natural bone reformation and reducing secondary surgeries. Multidisciplinary management is essential.

Background: Velopharyngeal insufficiency (VPI) is caused by incomplete closure of the velopharyngeal port and can occur despite primary cleft palate repair. Pharyngeal Flap (PF) and Sphincter Pharyngoplasty (SP) are commonly used operations to treat VPI. This review aims to compare the efficacy of these operations in resolving VPI and assess speech outcomes and complications, including sleep apnea.

Methods: The PubMed, Embase, and World of Science databases were searched in October 2024. The title, abstract, and qualifying full-text article screening were performed by 2 authors, with a third author providing consensus. Articles including cleft palate patients and both procedures were included. The studies were then extracted and assessed for risk of bias using the Cochrane and Newcastle-Ottawa risk of bias tools. Meta-analysis was performed using a random effects model.

Results: A total of 10 articles with 531 total patients were included in this study. Meta-analysis of VPI resolution and hypernasality yielded insignificant differences between PF and SP. Sleep apnea was shown to be significantly higher in PF patients after sensitivity analysis. Complication and reoperation rates were also found to be similar in patients receiving PF and SP.

Conclusions: PF and SP can both effectively treat VPI with similar rates of VPI resolution, hypernasality, and complications. However, SP had a reduced incidence of sleep apnea. Limitations of this study include a lack of standardization for reporting outcomes. Thus, prospective studies should report outcomes using standardized scales.

In computer-assisted surgery for complex maxillofacial fractures, surgical navigation combined with 3-dimensional models and surgical guides remains the mainstream approach, whereas applied research on 3-dimensional-printed personalized bone plates remains relatively limited. Our team presents a case of complex maxillofacial fractures with multiple systemic injuries, retrospectively analyzing surgical outcomes and focusing on the advantages of 3-dimensional-printed, personalized bone plates in maxillofacial fracture repair, and the potential impact of residual stress caused by the manual bending of thicker plates.

Objective: To evaluate the dose-dependent effects of locally applied allantoin on bone regeneration during mandibular distraction osteogenesis (DO) in rabbits, focusing on the microarchitecture, collagen deposition, and expression of key osteogenic and chemotactic markers.

Methods: Twelve New Zealand rabbits underwent unilateral mandibular DO. Animals were randomly assigned to 4 groups receiving local injections into the distraction gap of saline (group A) or allantoin at 0.5, 1.0, or 2.0 mg/kg (groups B-D) on the surgery day and on days 6 and 15. In vivo CT was used to verify distraction and regenerate continuity. After sacrifice, mandibles were analyzed by micro-CT, histology (HE and Masson), and immunohistochemistry for RUNX2, BMP2, COL1, and CXCR4. Appropriate parametric or nonparametric tests were used (P<0.05).

Results: All animals completed the protocol without major complications. Micro-CT showed significantly higher BMD, BV/TV, Tb.Th, and Tb.N in allantoin groups versus controls, with peak values in group C (1.0 mg/kg); Tb.Sp did not differ significantly. Histomorphometry revealed maximal bone and collagen area fractions in group C, intermediate values in groups B and D, and the lowest values in group A. Immunohistochemistry demonstrated a similar gradient: RUNX2, BMP2, COL1, and CXCR4 expression levels were highest in group C, moderately increased in groups B and D, and minimal in controls.

Conclusion: Local allantoin administration enhances regenerative quantity and quality in rabbit mandibular DO in a dose-dependent manner, with 1.0 mg/kg providing the most favorable improvement in trabecular microarchitecture, matrix deposition, and osteogenic/CXCR4 signaling. Higher dosing (2.0 mg/kg) confers no additional benefit, suggesting a bell-shaped dose-response and underscoring the need for dose optimization before clinical translation.

Lipoid proteinosis is a rare, autosomal recessive inherited metabolic disorder. Its low prevalence contributes to a relatively high rate of clinical misdiagnosis. A 5-year-old female with progressive hoarseness over 4 years and the development of multiple papules on the eyelids over the past 6 months. Physical examination revealed pale, sesame-sized papules densely distributed along both eyelids; irregular, pale white patches on the oral mucosa; and clustered pale patches without evident scaling on the left forearm. Histopathologic analysis demonstrated deposition of lightly stained, homogeneous, and transparent material within the dermis, around appendages, and perivascular regions. Periodic acid-Schiff (PAS) staining was positive. Whole-exome sequencing supported a diagnosis of lipoid proteinosis. The treatment regimen included topical carbon dioxide laser therapy and oral administration of acitretin at a dose of 10 mg daily. This case report may contribute to improved clinical recognition of lipoid proteinosis and aid in reducing diagnostic errors.