Journal of Craniofacial Surgery最新文献

Background: Cleft lip repair presents complex surgical challenges requiring precise preoperative planning. Emerging computer vision technologies powered by artificial intelligence (AI) may support more consistent and accurate surgical assessments. This systematic review defines the scope, methods, and performance of computer vision for preoperative soft-tissue landmarking in cleft lip repair.

Methods: Articles were retrieved from Medline and Embase. Inclusion criteria encompassed studies using computer vision techniques for automated soft-tissue analysis before cleft. The selected studies were appraised based on their scope, design, and performance.

Results: Six studies were eligible for inclusion. The included studies used convolutional neural networks (CNNs), generative adversarial networks (GANs), and 3D shape analysis to guide surgical marking, cleft severity scoring, and symmetry assessment. Most models demonstrated high accuracy and efficiency compared with manual methods, showing promise for computer vision as a virtual conduit of surgical expertise.

Conclusion: Computer vision offers strong potential to standardise and improve preoperative cleft lip planning. Future integration into surgical workflows must prioritise ethical design, validation, transparency, and equity of access.

Background: Conventional anterior ptosis correction typically creates an iatrogenic double eyelid, which may be undesirable for patients who wish to preserve single-eyelid morphology. It may also leave a conspicuous scar. This study evaluates a modified eyelid-margin incision technique to correct ptosis while concealing the scar and maintaining a single-eyelid appearance.

Methods: The authors retrospectively reviewed 21 patients (33 eyes) with congenital ptosis who underwent ptosis correction by a palpebral margin incision. Preoperative and postoperative margin reflex distance 1 (MRD1) and palpebral fissure height (PFH) were evaluated. Patients were followed up to document postoperative complications. In addition, a satisfaction survey was conducted to assess the surgical outcome.

Results: Postoperative follow-up ranged from 6 months to 4 years. The technique demonstrated significant functional improvement: the mean MRD1 increased from 0.30±0.92 mm to 3.48±0.51 mm, and the mean PFH increased from 5.06±1.00 mm to 9.15±0.76 mm (P<0.05). The overall satisfaction rate was 90.5%. Complications were rare, limited to a single case of conjunctival prolapse.

Conclusion: The palpebral margin incision technique effectively corrects congenital ptosis and widens the palpebral fissure, while concealing the scar within the lash line. It represents a reliable alternative for patients prioritizing the preservation of natural single-eyelid morphology.

Radiated chronic scalp wounds with exposed bone present a significant reconstructive challenge, particularly when prior attempts have failed or when further surgery is contraindicated due to patient comorbidities or preference. We retrospectively reviewed 10 patients (2014-2024) with radiated chronic scalp wounds with exposed bone who have either failed prior reconstruction, could not medically tolerate anesthesia, or declined surgery. Patients performed daily cleansing with soap and water followed by application of Aquaphor and Silvadene. Treatment duration ranged from 1 to 73 months (mean: 29.4 mo). The area of exposed bone decreased in 6 patients (60%), remained stable in 1 (10%), and increased in 3 (30%). Three of 7 patients with wound improvement (30%) achieved complete healing. Two of 3 patients with wound progression deceased of unrelated causes. To our knowledge, no major complications occurred. These findings support wound care as a safe, and often effective, treatment when larger reconstruction is not feasible.

Midfacial deformities after maxillectomy present complex challenges, requiring restoration of contour, oronasal separation, orbital support, and smile. Despite the advances in immediate reconstruction with free flaps, aesthetic and dynamic deficits often persist. These deficits mimic facial paralysis despite not representing true paralysis. The authors report a 43-year-old woman who underwent secondary dynamic reconstruction using a bi-paddled latissimus dorsi muscle transfer after total maxillectomy and reconstruction with a deep inferior epigastric flap. One muscle flap restored elevation of the oral commissure, whereas the other enabled "eye smiling". The thoracodorsal nerve was anastomosed to the buccal branch of the ipsilateral facial nerve responsible for oral commissure elevation. In addition, 2 tensor fascia lata grafts corrected eyelid drooping and contralateral nasal ala deviation. Muscle contraction appeared at 3 months, and spontaneous smiling with palpebral fissure narrowing was achieved by 21 months. To our knowledge, this is the first successful dual-region dynamic reanimation reported for post-maxillectomy deformity.

The rise of evolutionary theory in the 19th century was shaped not only by Charles Darwin's synthetic insight but also by the foundational work of anatomists whose structural analyses provided the empirical substrate for evolutionary reasoning. Among them, Jacob Henle (1809-1885) stands out as a pivotal figure. Although not an evolutionist himself, Henle's systematic anatomy, especially his detailed mapping of facial musculature, supplied crucial evidence that Darwin later incorporated into The Expression of the Emotions in Man and Animals (1872). Henle's descriptions of muscles such as the musculus malaris demonstrated the structural continuity between human and animal expressions, reinforcing Darwin's argument that emotional behaviors are inherited and biologically grounded rather than culturally constructed. This article examines how anatomists like Henle contributed to the formation of evolutionary thought by establishing the comparative and morphologic frameworks that Darwin transformed into evolutionary arguments. It further explores how Darwin's reinterpretation of anatomic homologies-long documented by anatomists but rarely theorized historically-shifted anatomy from a static descriptive science to one infused with evolutionary meaning. The interplay between Darwin and Henle exemplifies a broader intellectual phenomenon: anatomists inadvertently laid the architectural scaffolding for Darwinian theory through their meticulous cataloguing of structural correspondences across species. By analyzing this convergence, the article underscores the central role of anatomy in the emergence of evolutionary biology and highlights how nineteenth-century anatomic science both informed and was reshaped by Darwin's revolutionary ideas.

The development of the skull base during the fetal period is critical, as the configuration of the cavernous sinus, middle fossa, and paraclival triangles forms the basis for future neurovascular relationships relevant to skull base surgery. Despite their clinical importance, normative morphometric data for these regions during the second trimester are limited. This study aimed to characterize the anatomical organization of fetal skull base triangles and to evaluate whether their proportional arrangement and bilateral symmetry are established prenatally. Second-trimester fetal specimens were examined using microsurgical dissection under operative microscopy. The cavernous sinus, middle fossa, and paraclival triangles were identified according to established classifications, and bilateral area measurements were obtained using a digital caliper. Intraobserver reliability was assessed by repeated measurements and Pearson correlation analysis. No significant differences were observed between the right and left sides (P>0.05), indicating preserved bilateral symmetry at this developmental stage. Within each side, a consistent hierarchical organization was evident, with clinoidal and oculomotor-related triangles occupying proportionally larger areas, while middle-fossa triangles were smaller. High intraobserver reliability was demonstrated across all measurements. These findings indicate that the proportional and hierarchical organization of skull base triangles is already established during the second trimester, suggesting that fundamental surgical corridors of the anterior and middle cranial base are present well before birth. This normative data set provides a foundation for future anatomical, embryological, and neurosurgical studies.

We propose a minimally invasive surgical approach for open reduction and internal fixation (ORIF) of zygomatic arch fractures. The incision is made within the preauricular hairline. A "double-channel tunnel-like" approach achieves complete exposure of the zygomatic arch without requiring any special instruments or auxiliary incisions. This enables precise reduction and robust fixation of zygomatic arch fractures under full direct visualization. A patient presenting with a left zygomatic arch fracture following a fall underwent closed reduction via Keen technique, which proved unsuccessful. Subsequently, zygomatic arch fracture reduction and fixation were achieved via a preauricular incision. Postoperative computed tomography revealed that the fracture had been satisfactorily reduced and fixed. The postoperative scar was inconspicuous, and no injury to the frontal branch of the facial nerve was observed. This technique significantly streamlines the surgical procedure for zygomatic arch fractures.

The forehead flap is the gold standard for nasal reconstruction and follows the subunit principle. This traditional method relies on surgical experience and involves a steep learning curve. The authors propose a method that uses 3D scanning to directly flatten 3-dimensional images into a 2-dimensional template, enhancing precision and efficiency in forehead flap design. From July 2018 to June 2022, a total of 24 patients who underwent staged forehead flaps for nasal reconstruction were included. Preoperative 3D images were retrieved through a 3D scanner (Artex Space Spider), and the images were flattened with Unfold3D software (Polygonal Design, Version 9) to 2-dimensional templates for forehead flap design. The outcomes were assessed through photographic records and photogrammetry to evaluate the effectiveness of the reconstruction. Among the 24 patients included in the study, 15 males and 9 females were included, with a mean age of 43.75 years. The average follow-up period was 29.54 months (range: 7-57). For hemi-nasal reconstruction, the average differences between the reconstructed side and the contralateral normal side were 6.14% in alar width, 4.20% in alar height, and 2.23% in the alar area. The operative time was reduced by 15 minutes for single-subunit reconstructions and ~30 minutes for total nasal reconstructions. Postoperative complications included 2 cases of partial flap infection, both of which resolved with appropriate wound care. Computer assistance, which involves flattening the 3D structure into a 2D template, streamlines forehead flap planning for nasal reconstruction, reducing the operative time while achieving satisfactory outcomes.

Objective: Nasal tip hypertrophy is common in Asians, and surgical refinement usually relies on tip grafts or structural implants. For patients who refuse any implant and whose bulbous tip is mainly caused by excessive soft tissue rather than cartilaginous deformity, available surgical options are limited. Herein, we introduce a new external nasal tip reduction procedure that removes redundant skin-superficial musculoaponeurotic system (SMAS)-fat tissue through a rhombus excision design to improve nasal tip contour without cartilage manipulation or implant placement.

Methods: A total of 13 patients with soft tissue-dominant nasal tip hypertrophy and refusal of implants were included in this study. All patients undergoing external skin excision and soft-tissue debulking were analyzed retrospectively. In this surgery, no grafts or implants were needed. Patient satisfaction and scar morphology were assessed at every follow-up visit.

Results: All procedures were completed successfully, and nasal tip hypertrophy improved immediately after surgery. No infection, ischemia, or nasal tip collapse occurred. One patient developed mild hypertrophic scarring and underwent superficial scar removal surgery. All remaining patients showed inconspicuous scars. Five patients (5/13) reported being "very satisfied", 7 (7/13) reported being "satisfied", and 1 (1/13) being dissatisfied with nasal refinement and scar appearance. Follow-up ranged from 12 to 24 months, and no secondary implant-based revision was required. The procedure also produced slight nasal lengthening in patients with short noses.

Conclusions: This external nasal tip soft-tissue reduction technique provides an alternative option for Asian patients with nasal tip hypertrophy who refuse implants and have relatively small alar bases and thick nasal skin. With precise excision design and layered closure, visible scarring is minimal, and nasal tip contour can be refined safely and effectively. However, strict surgical indications must be respected.

Level of evidence: Level IV-therapeutic study.

Introduction: Incomplete facial paralysis (IFP) poses a clinical challenge due to its heterogeneous etiologies and unpredictable outcomes. While treatment for complete paralysis is well established, effective interventions for IFP remain limited. Recently, combining cross-face nerve grafting (CFNG) with masseter nerve transposition (MNT) has emerged as a promising surgical strategy, aiming to provide both strong motor input and spontaneous facial movement in these patients.

Methods: A systematic review of PubMed and Medscape (2021-2025) was conducted following PRISMA guidelines. Studies were included if they reported clinical outcomes of combined CFNG and MNT in patients with IFP.

Results: Three studies met the inclusion criteria, comprising 48 patients. Bell's palsy was the most frequent etiology, followed by trauma and postsurgical injuries. Biglioli et al provided the only individual-level outcome data, showing postoperative improvement across etiologies and no significant correlation between age and dynamic recovery-findings consistent with larger cohorts, in which age-related trends do not reach significance. Outcome comparison across studies was limited by heterogeneous assessment tools. A clear trend toward end-to-side neurorrhaphy was observed in recent literature, reflecting a shift toward preserving residual motor fibers.

Conclusions: Despite heterogeneity in surgical techniques and outcome assessments, CFNG combined with MNT consistently yielded favorable results. The approach described by Morley, involving end-to-side neurorrhaphy, may offer particular advantages by preserving healthy neural pathways and enhancing functional outcomes. While current evidence supports the effectiveness of dual innervation, standardized evaluation methods and larger patient cohorts are essential to validate these findings and guide individualized treatment strategies.