Journal of Craniofacial Surgery最新文献

Inflammatory myofibroblastic tumor (IMT) is a rare tumor type with a prognosis ranging from benign to locally aggressive. Initially described as a reactive lesion most commonly of the lungs, cases of IMT have now been reported in rare instances in the head and neck, which may be more aggressive than other tumor locations. IMT frequently afflicts children and adolescents, but pediatric cases of IMT in the head and neck region are rare. This report serves to describe a rare presentation of a recurrent and locally aggressive facial IMT in a pediatric patient that required multiple surgical resections alongside medical management.

To our knowledge, there has not been a review article summarizing the current evidence with regard to perinatal risk factors, and our aim is to perform a systematic review and meta-analysis of the evidence of perinatal risk factors in single suture craniosynostosis to inform our practice and identify any need for further research in this area. Our target population was pediatric single-suture craniosynostosis patients, and the intervention was perinatal risk factors. The comparison group was an age and sex-matched control group without craniosynostosis and the outcome we investigated was presence of single suture craniosynostosis. The literature search was done using OVID MEDLINE, Pubmed, and Embase databases from 1946 to 2023. A PRISMA flowchart was created, and statistical analysis was performed using RevMan pooled odds ratios, and 95% CIs were used to combine results from individual studies. Our initial search identified 625 abstracts and these were narrowed down to 16 articles, which were included in the final selection for the review. Out of these, 13 were used for the quantitative meta-analysis. Our meta-analysis showed a possible association between craniosynostosis and the following perinatal risk factors; presence of maternal thyroid disease, maternal age greater than 29, paternal age greater than 29, maternal smoking, gestational age above 37 weeks, and maternal underweight (BMI<18.5). Further prospective studies are warranted to investigate definite associations. The next step is to set up a multicenter prospective study among a craniofacial unit network.

The prevalence of lymphedema is likely to rise substantially in the coming decades, given projected increases in cancer. Lymphedema surgeries can improve patients' quality of life, but the shortage of surgeons capable of performing these surgeries may be a barrier to treatment. Robotic platforms may elevate novice and less-seasoned surgeons' skills, expediting their ability to perform lymphovenous anastomoses. At the same time, robotic systems may ameliorate work-related musculoskeletal stresses, which could extend the careers of microsurgeons. Moreover, as research progresses into novel applications, the integration of advanced robotic technology may become crucial. Continued exploration of these emerging fields will not only expand the possibilities for treatment but also necessitate further advancements in surgical techniques and training methodologies. The ongoing development and implementation of robotic systems like Symani could thus be instrumental in addressing the growing global burden of lymphedema and other complex surgical challenges.

Background: Otoplasty is a cosmetic surgery that is performed to alter the size, shape, or position of the ear by using permanent stitches. Its main purpose is to correct protruding ears, a condition known as prominauris. After the surgery, it is crucial to provide proper care to ensure successful recovery. However, obtaining timely medical advice can be difficult, especially in remote areas or places with limited resources. To address this issue, incorporating advanced artificial intelligence (AI) tools like Chat Generative Pre-trained Transformer (ChatGPT)-4 into postsurgical care could help fill the gap in patient education and support.

Aim: This study aims to assess whether ChatGPT4 can be a reliable, accurate, and effective method for answering the most common patient questions and concerns post-otoplasty. The main objective was to assess the AI chatbot's capacity to deliver precise, concise, and pertinent information, especially in situations where health care professionals are limited in availability.

Materials and methods: In this study, over 50 patients were engaged, and ChatGPT4 was employed to present the same 5 common postoperative questions post-otoplasty surgery care. The AI chatbot's responses were analyzed for accuracy, response time, clarity, and relevance.

Results: The chatbot could potentially provide timely assistance, answer questions, and address concerns related to postsurgical care in otoplasty. The responses exhibited a perfect accuracy rate of 100%, closely corresponding to existing medical guidelines.

Conclusion: This study explores the potential of AI-driven solutions to enhance patient education and support, especially in areas where access to health care professionals may be limited. However, professional medical advice is crucial in postoperative care and cannot be replaced by ChatGPT-4. By leveraging AI tools like chatbots, individuals in remote or resource-limited settings can potentially receive valuable information and guidance, contributing to successful rehabilitation and overall health care outcomes. Ethical considerations around the use of AI in health care must also be carefully addressed to ensure patient privacy, data security, and appropriate clinical oversight.

Background: Skin flap necrosis remains a significant challenge in reconstructive surgery, predominantly due to insufficient blood supply. Traditional methods like the surgical delay procedure, while effective, are invasive and associated with considerable patient discomfort and health care costs. This study explores the efficacy of Carbon Dioxide Fractional Laser (CDFL) treatment as a novel, less invasive alternative to enhance skin flap survival.

Methods: Twenty-nine adult male Sprague-Dawley rats were divided into 2 groups: a CDFL treatment group (n=14) and a control group (n=15). The CDFL group received laser pretreatment 1 week before flap surgery, whereas the control group underwent flap surgery without pretreatment. Flap survival was assessed 7 days postsurgery using indocyanine green fluorescence angiography. In addition, histological analysis was conducted to evaluate tissue integrity, capillary density, and VEGF expression.

Results: The CDFL-treated flaps showed significantly increased survival areas compared with controls ( P <0.01). Histological evaluation revealed enhanced capillary dilation and increased VEGF expression in the CDFL group ( P <0.05). Although capillary density was higher in the CDFL group, it did not reach statistical significance ( P =0.052).

Conclusion: CDFL pretreatment significantly improves skin flap survival in rats, suggesting potential as a minimally invasive alternative to traditional surgical delay techniques. This approach could offer substantial benefits in reconstructive surgery, reducing patient morbidity and associated costs. Further studies are warranted to confirm these findings in clinical settings.

The hair-bearing superficial temporal artery flap is one of the traditional options for total eyebrow reconstruction. The anatomical variation of the superficial temporal artery has been well discussed; however, the anatomy of the superficial temporal vein is highly diverse. The authors report the use of preoperative computed tomography (CT) angiography in a 27-year-old man with a total eyebrow defect caused by thermal burn injury. The authors harvested a 6×1.5-cm pedicled hair-bearing superficial temporal artery flap from the area where the parietal branches of the superficial temporal artery and vein were running in close proximity, according to the CT angiography findings. Postoperatively, the flap survived completely without any vascular compromise. The authors believe that preoperative visualization of the superficial temporal vessels with CT angiography is highly beneficial in performing safe eyebrow reconstruction with a hair-bearing superficial temporal artery flap.

Background: Geopolitical conflicts in the Middle East have led to mass migrations, with Turkey becoming a major host country. This influx has strained the health care system, particularly regarding specialized care for conditions like cleft lip and palate (CLP). Timely intervention is crucial for optimal outcomes, but cultural, socioeconomic, and logistical barriers often cause delays, impacting physical, functional, and psychosocial development.

Methods: This retrospective study analyzed 72 immigrant pediatric CLP patients treated in Turkey between 2012 and 2022. Data on demographics, medical history, surgical interventions, complications, and treatment delays were collected. Surgical timing was compared with American Cleft Palate Craniofacial Association guidelines, and the impact of socioeconomic status on delays was assessed.

Results: Seventy-two patients underwent a total of 91 surgical interventions, including 29 cleft lip repairs, 22 cleft palate repairs, 6 pharyngeal flaps, 15 fistula closures, 8 corrections of secondary lip scars and whistling deformities, and 11 alveolar bone graftings. A majority (73.6%) had poor socioeconomic status. The average delays for cleft lip, cleft palate, and alveolar bone grafting surgeries were 5.3±4, 7.3±6.1, and 34.1±23.5 months, respectively, and were significantly longer for patients with poor socioeconomic status ( P =0.00502, 0.030741, and 0.041878). The average delay for pharyngeal flap surgery, performed in patients with poor socioeconomic status (except for one), was 43.7±14.1 months.

Conclusions: This study highlights the challenges and disparities in CLP care for immigrant children in Turkey due to geopolitical conflict. While surgical complication rates are similar to established data, delays in treatment, especially among those with lower socioeconomic status, are a significant concern. The findings emphasize the need for comprehensive, culturally sensitive care and systemic interventions to improve access and outcomes for this vulnerable population.

Background: Although posterior cranial vault distraction osteogenesis (PVDO) is utilized routinely now for the treatment of craniosynostosis, its use as a treatment option for Chiari type 1 malformation (CM1) is limited to case reports and small retrospective case series.

Methods: The authors conducted a systematic review of the published literature for PVDO as a treatment for CM1. The primary outcomes were reported complications, symptom improvement, and reoperation rates in patients that had PVDO surgery for CM1. The authors further investigated differences between patients with CM1 with an associated genetic syndrome and craniosynostosis.

Results: In total, 42 patients with an average age of 41.1 months were used in our analysis. A total of 38.1% of the patients had a diagnosed syndrome, 78.6% of patients had associated craniosynostosis, and 26/42 (61.9%) total patients-reported symptom improvement. Of 26 patients that reported symptom improvement, 20 (76.9%) had associated syndromes and 6 (23.1%) did not ( P =0.011). In addition, of these 26 symptom improved patients, 17 (65.4%) were associated with craniosynostosis while 9 (36.4%) did not have craniosynostosis ( P =0.008).

Conclusions: Posterior cranial vault distraction osteogenesis seems to be a promising new surgical intervention for treatment of CM1. Most patients saw symptom improvement after treatment (61.9%). There was a clinically and statistically significant difference in symptom improvement for patients with syndromic CM1 when compared with nonsyndromic CM1 patients.

Background: The aim of this study is to explore surgical treatment techniques and clinical attributes associated with calvarial metastases, while providing a comprehensive review of the treatment experiences relevant to this particular type of tumor.

Methods: This study involves a retrospective analysis of clinical data from 12 patients diagnosed with calvarial metastatic tumors who underwent surgical intervention. Among these patients, 5 had a history of previous malignant tumor resections, while 7 presented with calvarial metastatic tumors as their initial symptom. In all cases, the surgical approach consisted of calvarial tumor resection followed by titanium mesh repair. Following the surgical intervention, all patients underwent a comprehensive course of treatment, encompassing both local radiotherapy and systemic chemotherapy.

Results: In 1 instance, a patient presented with multiple tumors located in the central area of the frontal bone and the right temporal bone. The larger tumor situated in the middle of the frontal bone was surgically excised, while the tumor in the right temporal bone was treated using radiotherapy. In 2 cases characterized by multiple metastases within the skull, a comprehensive excision of all tumors was accomplished in a single surgical procedure. In the remaining cases featuring a solitary metastatic growth, the respective tumors were surgically removed. There were 10 instances of dura mater invasion and 3 cases involving the invasion of brain tissue. Pathologic examinations revealed 1 case of metastatic lung adenocarcinoma, 1 case of metastatic paraganglioma, 1 case of metastatic hepatocellular carcinoma, 2 cases of metastatic thyroid carcinoma, and 7 cases of metastatic clear cell renal cell carcinoma. Throughout the follow-up period, spanning from 14 to 90 months, various outcomes were noted. These included three occurrences of in situ recurrence. In addition, 1 patient required 3 distinct surgical interventions, while 2 other patients underwent 2 separate surgical procedures each. Notably, 1 of these cases involved the exposure of the titanium mesh on the scalp, necessitating the removal of the titanium mesh. Regrettably, there have been 9 recorded fatalities among the patients, while 3 individuals have survived.

Conclusion: Solitary metastasis of calvarium region is rare, and surgical resection is effective. However, it is necessary to extend the resection range and combine with local radiotherapy to avoid local recurrence. Surgical intervention can significantly enhance the quality of life for affected patients. The prognosis of the patients mainly depends on the treatment of the primary disease and the situation of important organ dissemination and treatment.

Background: Financial toxicity is the detrimental impact of health care costs that must be mitigated to achieve universal health coverage. Catastrophic health expenditure (CHE) is widely used to measure financial toxicity but does not capture patient perspectives of unaffordable health care costs. Financial hardship (FH), a patient-reported outcome measure, is currently underutilized but may be an important adjunct metric. The authors compare CHE to FH as metrics evaluating financial toxicity.

Methods: A prospective, multicenter cohort study was conducted across 3 public and private tertiary-care hospitals in India. Adult surgical trauma inpatients in plastic and orthopedic surgery departments were assessed. The development of CHE, health expenditures >10% of annual income, and FH, the patient-reported impact of financial toxicity in the form of asset liquidation, debt acquisition, and job loss, were compared by the health system and using logistic regression models.

Results: Among 744 surgical trauma patients, low income, longer hospital stays, and increased injury severity were significantly associated with the likelihood of incurring CHE and FH (P<0.05). Only FH was significantly associated with lack of insurance (OR: 0.22; 95% CI: 1.14-2.71). Public hospitals had higher rates of FH than CHE (55% versus 23%). Private hospitals had more CHE than FH (53% versus 32%).

Conclusions: FH is an important metric of financial toxicity that provides important adjunct information to CHE for at-risk populations. FH is particularly informative for public institutions with low direct medical costs. Nuanced utilization of CHE and FH provides a more comprehensive, patient-oriented approach to evaluating unaffordable health care costs that can help shape financial risk protection policy.