Journal of Craniofacial Surgery最新文献

Objective: This study aimed to investigate the delay in dental development in patients with cleidocranial dysplasia (CCD) applying a longitudinal approach of maturational stages of teeth. A secondary objective was to examine whether an increasing number of supernumerary teeth influences dental development.

Methods: A total of 38 patients were included, consisting of 13 patients with CCD and 25 without CCD, selected from the Generation R Study. Both groups were matched by age and number of supernumerary teeth.Dental development was assessed using the Demirjian method. Linear mixed models were used to study the longitudinal aspects of dental development delay between the 2 timepoints. Subgroup analysis was performed using 3 linear regression models to study the extent of dental development delay in CCD patients compared with the control group and to evaluate the influence of an increasing number of supernumerary teeth on developmental delay.

Results: No significant decelerations in dental development between late childhood and early adolescence were found in both groups. However, the CCD group showed a delay in dental development of 3.3 years [β -0.8; 95% CI (-4.3,-2.2)] in comparison to the control group when confounded for sex and supernumerary teeth. The number of supernumery teeth proved not to be a significant determinant as there was a P-value of 0.22.

Conclusions: The authors' findings indicate that dental development in CCD patients is delayed by ~3.3 years, which stays stable from adolescence. An increasing number of supernumerary teeth did not contribute to further delays in dental development.

Introduction: The objective of this article is to assess and describe the incidence of postoperative hemorrhage after cleft palate surgery (palatoplasty), specifically focusing on the need for a return to the operating room for the management of postoperative hemorrhage.

Methods: The TriNetX federated database was used to identify patients with a diagnosis of cleft lip and/or palate undergoing primary cleft palate repair over a 20-year period from 2003 until 2023. Primary endpoints assessed include postoperative hemorrhage resulting in blood transfusion and/or return to the operating room; Kaplan-Meier analysis was used for statistical analysis.

Results: A total of 13,161 patients with cleft lip or palate over the last 20 years underwent operative intervention (palatoplasty). Of those patients, 97 patients were found to have diagnosis of postoperative bleeding. One hundred seventy-five patients experienced postoperative hemorrhage requiring transfusion of blood product. Seventy patients required return to the operating room for postoperative bleeding in the immediate postoperative period.

Conclusions: Historical reporting of postoperative bleeding suggests a moderate rate of postoperative hemorrhage rate after palatoplasty, occasionally necessitating transfusion and return to operating room after index palatoplasty. The authors' retrospective review of a national database demonstrates a lesser incidence of postoperative hemorrhage than previously noted.

The ethical implications of promoting cosmetic surgery as a means to "fix" aging raise significant concerns, particularly regarding the medicalization of aging and the reinforcement of ageist narratives. Presenting aging as a condition requiring surgical intervention can perpetuate the perception that older bodies are inherently flawed, fostering insecurities and pressuring individuals-especially vulnerable populations-into unnecessary procedures. In addition, issues of informed consent become particularly pressing for older patients, who may face cognitive decline or be influenced by societal expectations that prioritize youth over natural aging. A more ethical approach requires reframing cosmetic surgery as a personal choice rather than a corrective measure. If society embraces aging as a natural and valuable process, the role of cosmetic surgery could shift toward enhancing individual features rather than erasing signs of age. This shift would emphasize "age-affirming" rather than "anti-aging" procedures, allowing individuals to align their external appearance with their self-perception without conforming to restrictive beauty standards. Furthermore, a cultural transformation that values the beauty of aging could reposition cosmetic surgery as a means of self-expression rather than a response to societal pressure. As the emphasis on youth diminishes, psychological well-being and personal empowerment could become central motivations for elective procedures. Ultimately, by fostering an inclusive perspective that honors diverse representations of beauty across all life stages, the field of cosmetic surgery can evolve into a discipline that supports individuality and self-acceptance rather than perpetuating age-related stigma.

In children born with a cleft in the palate with or without a cleft in the lip (CP±L), velopharyngeal insufficiency may persist even after successful surgical closure of the palate. This results in speech disorders including both resonance and speech sound disorders. These speech disorders may have a severe impact on the children's speech understandability and speech acceptability which may, in turn, influence psychosocial well-being, quality of life, and inclusion into society. This article provides an overview of the most important speech characteristics per age group (ie, 0-4​​​​​​, 4-6, 6-12, and >12 y). In addition, a state-of-the-art overview of current practices in speech diagnosis and speech intervention is included.

Introduction: Nasal deviations have been observed in patients following midface surgery. Therefore, the purpose of this study was to evaluate the development of clinically visible nasal deviations following midface surgery and to assess the natural course of the nose over time.

Methods: This retrospective study included all Apert and Crouzon patients who underwent midface surgery (Le Fort III (LF3), monobloc (MB), or facial bipartition (FB)). Clinical nasal deviation was assessed on preoperative, short-term postoperative (≤ 1 year), and long-term postoperative (> 1 year) 2D facial photographs by consensus of pediatric ENT surgeons and one craniofacial surgeon. Additionally, pre- and postoperative CT scans were reviewed when available.

Results: Sixty-eight procedures were included (27 Apert, 41 Crouzon); 34 LF3, 31 MB, and 3 FB. The median age at surgery was 10.2 years. Twenty-five (37%) patients were found to have clinically worsening nasal asymmetry, of whom 4 (16%) had pre-existing deviation preoperatively. Seventeen patients with worsening deviation had long-term postoperative facial photographs available (median time 5.8 years), and in 9 (53%), the postoperative clinical nasal deviation appeared to improve spontaneously. We were unable to identify predictive factors for postoperative nasal deviation.

Conclusion: In 16% of the patients, a clinically deviated nose was observed preoperatively. Nasal deviation worsened in 37% of the patients after midface surgery, but also spontaneously improved in 53% of these patients over the long-term. Since predicting the occurrence of nasal deviation and self-correction is difficult, the possibility of developing nasal deviation should be discussed with the patient and their parents.

Advances in prenatal imaging and genetic testing have improved the detection of orofacial anomalies, allowing for early diagnosis and comprehensive counseling. This study aims to provide an overview of current prenatal care practices for orofacial clefts and/or suspected Robin sequence (RS) across European countries and to identify disparities to inform future improvements. A cross-sectional survey was distributed to health care professionals affiliated with the European Reference Network CRANIO, collecting data on prenatal imaging, genetic testing, counseling, and termination of pregnancy. Responses were obtained from 31 health care professionals in 27 hospitals across 17 European countries. All participating countries have some sort of prenatal screening program. Ultrasound examination was performed at 1 or 2 timepoints during pregnancy, with varying techniques used to assess orofacial structures. Fetal MRI was performed in 59% of centers, primarily for multiple (severe) anomalies. Centers utilizing specific imaging techniques reported fewer missed diagnoses. Prenatal genetic testing was available in 96% of centers, with array-based copy number variation and whole-exome sequencing performed in 59% and 52% of centers, respectively. Nearly half of the centers provided multidisciplinary counseling, with team composition and session frequency varying widely. Pregnancy termination for orofacial clefts or micro-/retrognathia was not legal in 7 countries. Termination rates and trends differed across centers. In conclusion, variability exists in prenatal care for orofacial clefts and/or suspected RS across Europe, particularly in imaging techniques, genetic testing, and pregnancy termination practices. These findings highlight the need for standardized guidelines and equitable access to multidisciplinary care to optimize outcomes for affected pregnancies.

Objective: This study aims to evaluate the clinical effect of skin replacement epicanthoplasty combined with SAJT (septoaponeurosis junctional thickening) double eyelidplasty.

Methods: This retrospective study included 114 patients (2 males, 112 females) who underwent skin replacement epicanthoplasty combined with SAJT double eyelidplasty between July 2015 and June 2021. Surgical outcomes were measured using intercanthal distance (ICD)/interpupillary distance (IPD) ratios, and postoperative upper eyelid morphology. The subjective satisfaction and incidence of complications were also documented.

Results: After 12 months of postoperative follow-up, the postoperative ICD ratio significantly reduced from 0.58 preoperatively to 0.53 postoperatively (P<0.05). The Vancouver Scar Scale (VSS) score averaged 1.1 ± 0.4, and no hypertrophic scarring was observed. The majority of patients (98.2%) were "very satisfied" or "satisfied" with the cosmetic outcomes. There were no significant complications.

Conclusion: This study demonstrates the safety and efficacy of skin replacement epicanthoplasty combined with SAJT double eyelidplasty, with high patient satisfaction and minimal postoperative complications.

The aim of this study is to analyze the Struldbrugs, beings who are immortal but continue to age, from the perspective of plastic surgery and esthetic medicine. In Gulliver's Travels, Gulliver encounters a unique group known as the Struldbrugs. Upon reaching the age of 30, they start to lose their vitality. By the time they are 80, they are deemed legally dead and stripped of their civil rights and property. After this age, their condition worsens significantly; they become increasingly frail, forgetful, and bitter, suffering from all the ailments associated with old age, yet they are denied the relief of death. They do not only physically decay but also mentally deteriorate, losing their memories and the ability to form coherent thoughts. The Struldbrugs' appearance serves as a stark reminder of the consequences of unchecked aging. Swift's portrayal of their decaying bodies, juxtaposed with their immortality, prompts significant ethical and philosophical considerations regarding cosmetic interventions designed to preserve a youthful appearance. Struldbrugs symbolize the human apprehension of aging and the foolishness of yearning for eternal life without fully understanding its consequences. Lacking youth and vitality, eternal life transforms into a torturous ordeal. Analyzing the Struldbrugs through the lens of an antiaging medicine doctor and plastic surgeon provides valuable insights into the paradoxes and challenges of pursuing eternal youth and life extension. Swift's Struldbrugs serves as a compelling metaphor for the harsh realities of unchecked aging, prompting reflection on contemporary interventions designed to slow or reverse the physical and psychological aspects of aging.

Background: Lower blepharoplasty is a widely used cosmetic surgical procedure to improve under-eye bags and tear trough deformities, aiming to enhance facial aesthetics and achieve a more youthful appearance. The formation of these deformities is often associated with factors such as aging, skin laxity, and fat displacement. Traditional surgical methods include orbital septal fat repositioning and fat grafting, each with its own advantages and limitations. Transconjunctival blepharoplasty avoids external incisions by performing the surgery through the conjunctiva, thereby reducing postoperative scarring and recovery time. However, orbital septal fat repositioning alone is often insufficient to completely address issues of inadequate orbital septal fat and lax tear trough ligaments. Therefore, a combined approach of orbital septal fat repositioning and SVF-gel injection has been proposed to achieve more lasting and satisfactory results.

Objective: This study aims to investigate the advantages and rationality of combining orbital septal fat repositioning with SVF-gel injection in lower blepharoplasty, to assess the improvement in tear trough deformities and lower eyelid skin quality, to define its indications, and to achieve personalized treatment.

Methods: This study involved 42 patients who underwent transconjunctival blepharoplasty combined with fat repositioning and SVF-gel injection from January to December 2023. The surgical steps included donor site selection, fat harvesting, SVF-gel preparation, blepharoplasty, and SVF-gel injection. Postoperative follow-ups were conducted to evaluate the effectiveness and complications through gray value measurements and patient satisfaction surveys.

Results: The study results demonstrated that 92.9% of patients were very satisfied with the surgical outcomes, with only 2.4% of patients experiencing mild tear trough indentation postoperatively. Gray value measurements indicated a significant improvement in postoperative gray values, suggesting a reduction in lower eyelid pigmentation.

Conclusion: This study confirms that the combined use of orbital septal fat repositioning and SVF-gel injection can effectively improve tear trough deformities and lower eyelid skin quality, enhancing patient satisfaction. This combined technique demonstrates good adaptability and long-lasting effects, providing new options for personalized treatment. Further research is needed to optimize the surgical techniques and long-term outcomes.

Multisutural syndromic craniosynostosis is strongly associated with secondary Chiari malformation. Although less commonly described, single suture synostosis can also be associated with secondary Chiari malformation due to craniocephalic disproportion. These children have traditionally been treated with posterior vault expansion; however, in patients with sagittal synostosis, increasing only the posterior vault volume can worsen the scaphocephalic deformity. In addition, treating a Chiari malformation with a decompression without addressing the craniocephalic disproportion during a period of continued skull growth can be insufficient for the future neurodevelopment of the patient. Our study describes 3 cases of craniosynostosis (2 isolated sagittal, 1 sagittal with partial lambdoid-upper 1/3 of the suture) with concurrent Chiari malformation that were successfully treated with middle 1/3 vault expansion using the Pi-Hung Span procedure. As this procedure avoids a craniotomy over the torcular and transverse sinus, this method also decreases the risk of sinus injury during surgery. All 3 patients, with 6 to 18 months of follow-up, experienced both symptomatic improvement and radiographic improvement of tonsillar herniation. Supratentorial vault expansion should be considered as a viable surgical treatment for children with Chiari malformation secondary to craniosynostosis to prevent worsening scaphocephaly and to provide a complete reconstruction for the overall anatomic disproportion in the setting of continued skull growth.