Journal of Craniofacial Surgery最新文献

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson tumor, is a rare benign vascular lesion characterized by reactive endothelial proliferation within the vessel lumen. Eyelid involvement is exceedingly uncommon and may clinically mimic malignant vascular tumors. The authors report a case of post-traumatic IPEH of the eyelid in a 50-year-old man presenting with a slowly enlarging purplish nodule in the lateral canthal region. Complete surgical excision was performed. Histopathologic examination revealed tuft-like papillary endothelial proliferation confined within an expanded vein with associated thrombus, without cytologic atypia or mitotic activity, consistent with the pure type of IPEH. Immunohistochemical staining showed diffuse CD34 positivity and negative p53 expression, supporting the diagnosis and excluding angiosarcoma. No recurrence was observed during follow-up. This case underscores the extreme rarity of eyelid involvement and emphasizes that, despite a history of trauma, accurate subtype classification of IPEH relies on histopathologic rather than clinical findings.

Correcting the scaphocephalic skull shape caused by sagittal craniosynostosis has likely produced a wider variety of treatment approaches than any other single-suture synostosis. Considering that the goals of surgery are to enlarge the intracranial space to facilitate cerebral blood flow and to normalize appearance in all 3 dimensions, the ideal repair should safely and effectively accomplish both objectives. A technical variation on a remodeling procedure is presented, based on the creation of a sagittal bandeau, which provides the foundation for a correction that not only widens the posterior biparietal distance but also remedies the posterior reduction in skull height, resulting in both an expansion of the intracranial space and a normalization of appearance.

Mandibular deficiency correction demands precise control of both advancement and rotation to achieve optimal function and facial harmony. The Barakat modification introduces an intraoral adaptation of the inverted L osteotomy, which enables simultaneous mandibular advancement and controlled counterclockwise rotation, eliminating the need for grafting and reducing morbidity. Cephalometric evaluation demonstrated consistent forward mandibular repositioning (mean SNB increase ≈ +1 degree) accompanied by reductions in FMA (≈ -3 to -5 degrees) and gonial angle (≈ -2 to -4 degrees), confirming effective rotational control with vertical shortening. Postoperative assessments revealed a stable occlusion, accurate bony alignment, and enhanced lower facial proportions, with no complications. The Barakat modification offers a predictable, minimally invasive solution for managing mandibular deficiency, combining advancement precision with rotational control to deliver superior aesthetic and functional outcomes.

The Chosin Reservoir campaign of the Korean War represents one of the most extreme environments in which modern military medicine was tested. Among its casualties was First Lieutenant John Yancey of the US Marine Corps, who sustained a devastating open facial gunshot wound with orbital destruction while defending Hill 1282 in December 1950. Remarkably, Yancey survived the initial injury, remained conscious, retained command, and continued combat operations before eventual evacuation and surgical care. This paper revisits Yancey's injury as a historical and clinical lens through which to examine the origins and ethical foundations of modern maxillofacial trauma care. Using contemporary craniofacial trauma frameworks, the injury is reconstructed as a severe open midfacial fracture with globe involvement, extreme risk of hemorrhage, infection, and airway compromise. Survival was contingent on a confluence of factors: sparing of major vascular and neural structures, environmental vasoconstriction, evolving evacuation systems, and surgical principles refined during the World Wars by pioneers such as Gillies and McIndoe. Beyond technique, Yancey's case foregrounds enduring ethical questions central to facial trauma surgery-identity, dignity, and the limits of reconstruction. His continued leadership despite permanent facial loss underscores that reconstructive success cannot be measured solely by aesthetic restoration. For contemporary craniofacial surgeons practicing in an era increasingly shaped by elective aesthetics, revisiting such wartime cases restores clarity of purpose. Maxillofacial surgery was forged not to perfect faces, but to save lives and preserve function under conditions of profound scarcity. Remembering this lineage remains essential to maintaining the ethical core of the specialty.

Objective: This study aimed to compare the clinical outcomes of repairing acquired palatal defects using palatal island rotation flaps (PRFs) or anteriorly based dorsal tongue flaps (aTFs).

Methods: In total, 39 patients (23 males and 16 females) aged 22 to 74 years (median: 48.4 y) were included. According to the grid-based palatal horizontal plane palatal defect classification system, palatal defects were divided into 3 classes (classes I, II, and III); hard palate defects (classes I and II) were further subdivided into 3 subtypes (a, b, and c). Medium and large-sized defects accounted for 56.4% and 43.6% of the cases, respectively. A circumferential incision was made at the margin of the hard palate defect to create marginal buccal and palatal or cheek flaps, which were infolded to form an intranasal lining. Subsequently, either a PRF (59.0%) or an aTF (41.0%) was prepared to form the intraoral lining. The dimensions of the PRFs and aTFs ranged from 1.2×2.2 to 1.4×2.4 cm and from 1.8×2.8 to 2.4×3.2 cm, respectively. Swallowing and speech functions were evaluated at 3 months postoperatively.

Results: The dimensions of the aTFs were significantly larger than those of the PRFs (median: 2.2×3.0 cm versus 1.3×2.3 cm, P < 0.05). Postoperative complications, such as hemorrhage or bleeding, dehiscence or fistula formation, and partial flap necrosis, were significantly more common in the PRF group than in the aTF group (43.5% versus 12.5%, P < 0.05). The proportion of patients achieving postoperative swallowing and speech function scores of 3 was significantly higher than the proportion based on preoperative scores (P < 0.05). Furthermore, patients with medium-sized defects demonstrated significantly higher rates of achieving postoperative swallowing and speech function scores of 3 compared with those with large-sized defects (P < 0.05).

Conclusions: Both PRFs and aTFs are effective for reconstructing acquired medium to large-sized hard palate defects based on the grid palatal horizontal plane palatal defect classification system. However, aTFs offer advantages for larger defects, with a lower incidence of postoperative complications.

Objectives: This study aimed to investigate the relationship between palate morphology, masticatory muscle thickness, choanae structure, and sphenoidale foramina in individuals with temporomandibular dysfunction (TMD), and to determine how variations in these parameters affect temporomandibular joint (TMJ) function.

Methods: Cone beam computed tomography (CBCT) scans of 36 individuals with TMD and 36 healthy controls, aged 18 to 69 years, were retrospectively analyzed. The possible relationships between TMD and the morphometry of the hard palate, nasi choanae, and sphenoidale foramina were evaluated, and thickness measurements of the masticatory muscles (masseter, temporalis, lateral, and medial pterygoideus) were also correlated with TMD.

Results: Significant relationships were found between TMD and the morphometric features of the craniofacial structures. Statistically significant relationships were found between age and the masseter, temporalis, and medial pterygoid muscle thicknesses in individuals who had TMD (P<0.05). In addition, a significant difference was observed in the hard palate transverse width according to gender in the TMD group (P<0.05). In the control group, a significant relationship was found between medial pterygoid thickness on both sides and left foramen ovale length and hard palate transverse width values depending on gender (P<0.05). Significant differences were found in foramen rotundum width measurements in the comparison of the TMD and control groups (P<0.05).

Conclusion: This study demonstrates the relationship between craniofacial morphology, masticatory muscle thickness, and TMD. The findings suggest that anatomic features of the hard palate and sphenoid region may contribute to TMJ function and deepen the understanding of TMD's structural basis.

Objective: The superior cerebellar artery (SCA) is the most common offending vessel in microvascular decompression (MVD) for trigeminal neuralgia (TN). Among its variations, ventral compression presents unique surgical challenges, yet systematic classification remains limited. This study aimed to establish a novel intraoperative classification of ventral SCA compression and to evaluate its surgical and clinical relevance.

Methods: We retrospectively reviewed patients with TN who underwent MVD by the senior author between February 2019 and February 2024. Intraoperative video recordings were analyzed to categorize ventral-type SCA compression into 4 subtypes, based on the anatomic relationship with the trigeminal nerve and the facial-vestibulocochlear nerve complex. Patient demographics, operative findings, decompression techniques, and postoperative outcomes were compared across subtypes.

Results: Eighty-eight patients with SCA compression were identified and classified into 4 subtypes: type 0 (36.4%), SCA rostral to the trigeminal nerve; type I (35.2%), SCA ventral to the nerve without extending below its inferior border; type II (18.2%), SCA looping ventrally with its lowest point between the trigeminal and facial-vestibulocochlear nerves; and type III (10.2%), SCA extending ventrally beyond the superior border of the facial-vestibulocochlear complex. No statistically significant differences were observed in postoperative pain relief or complication rates across subtypes (P>0.05). However, surgical complexity varied considerably, with hidden compression at the trigeminal root entry zone and excessive vascular tortuosity contributing to greater intraoperative difficulty. Tailored surgical strategies, including the "push-and-flip" technique, enabled safe and effective decompression.

Conclusions: This study proposes a novel intraoperative classification of ventral SCA compression in TN. While short-term clinical outcomes were similar across subtypes, the classification emphasizes key anatomic variations that significantly affect surgical complexity. Recognition of these subtypes may facilitate operative planning, improve surgical safety, and reduce the risk of recurrence in patients undergoing MVD.

Objective: This study aimed to evaluate the efficacy of Xinghanxiang nasal inhalation therapy in treating obstructive sleep apnea-hypopnea syndrome (OSAHS) and its effects on upper airway inflammation.

Methods: A total of 180 patients with OSAHS were matched according to disease severity and randomly divided into a control group and an intervention group, with 90 patients in each group. In the control group, patients with mild OSAHS received routine therapy, whereas those with moderate to severe OSAHS received continuous positive airway pressure (CPAP) therapy. In the intervention group, patients with mild OSAHS received routine therapy plus Xinghanxiang nasal inhalation therapy, and those with moderate to severe OSAHS received routine therapy combined with Xinghanxiang nasal inhalation therapy along with CPAP therapy. Clinical symptoms, the Epworth Sleepiness Scale (ESS), apnea-hypopnea index (AHI), and levels of C-reactive protein (CRP) and interleukin (IL)-6 in nasal lavage fluid were evaluated.

Results: Both groups demonstrated significant improvements in clinical symptoms (including quality-of-life scores), ESS, and AHI compared with baseline (P<0.05), with greater improvement observed in the intervention group (P<0.05). CRP and IL-6 levels in nasal lavage fluid decreased significantly in both groups after treatment, with more pronounced reductions in the intervention group (P<0.05). CRP levels in nasal lavage fluid were lower in the intervention group than in the control group (P<0.05). IL-6 levels in nasal lavage fluid were significantly lower in patients with moderate to severe disease in the intervention group compared with the control group (P<0.05), whereas no significant difference was observed in patients with mild disease (P>0.05).

Conclusions: Xinghanxiang nasal inhalation therapy significantly improves clinical symptoms in patients with OSAHS. Combined therapy with CPAP further improves ESS and AHI, with no significant adverse effects, supporting the need for large-scale studies and broader clinical application. Furthermore, Xinghanxiang nasal inhalation therapy significantly reduces CRP and IL-6 levels in nasal lavage fluid, suggesting that its mechanism of action may be related to alleviation of upper airway inflammation.

Historically, management of craniosynostosis (CS) has been marked by substantial variation. Although recent advances in diagnostics, minimally invasive techniques, and computer-assisted planning might be expected to promote greater uniformity, significant differences persist, as shown in a large US survey of current practice patterns. To clarify the extent of heterogeneity in the Nordic countries (28 million inhabitants), the authors conducted a comprehensive survey of all centers treating CS in the region. All 11 centers responded (100%). Marked heterogeneity was evident across organizational structures, preferred surgical techniques, and follow-up routines. Although Norway has fully centralized treatment of CS, Denmark and Sweden divide management between 2 high-volume centers each, and Finland uses a mixed model combining major reference centers with smaller regional units. Surgical management of isolated sagittal synostosis also varies substantially, ranging from minimally invasive suturectomy with postoperative helmet therapy (9%) and spring-assisted cranioplasty (27%) to open suturectomy/strip craniectomy (9%) and more extensive cranial vault remodeling including H-craniectomy (55%). Syndromic and multi-suture cases are generally managed in multidisciplinary settings, although team composition differs between centers. Additional variation was seen in the use of computer-assisted planning, 3D models, intraoperative cutting guides, postoperative imaging, neurocognitive testing, craniometry, and patient-reported or parent-reported outcome measures. Despite advances in surgical techniques and technology, CS management across the Nordic region remains highly heterogeneous. Whether this variation affects neurocognitive, cosmetic, or functional outcomes is unknown. Future collaborative research will be essential to harmonize care and ensure optimal outcomes for children with craniosynostosis.