Journal of Craniofacial Surgery最新文献

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.

The objective of this study was to compare the imaging characteristics of intraosseous jaw lesions on panoramic radiographs (PAN) and cone beam computed tomography (CBCT). A total of 216 intraosseous jaw lesions were analyzed according to localization, shape, size, internal structure, borders, associated nonerupted tooth, root resorption, presence of calcification, tooth displacement, affecting anatomic structures, cortical thinning, expansion, and destruction of bones. The definitive histologic diagnoses of lesions were not considered. A χ2 test, Cohen kappa coefficient, and simple kappa (κ) statistics were used in the statistical analysis. Most jaw lesions are commonly located in the posterior region, while the majority of lesions in the maxilla are found in the anterior region. CBCT was more accurate than PAN in the assessment of the border cortication, continuity of border cortication, expansion, cortical thinning, and destruction. PAN evaluation allowed the identification of the lesion's shape, internal contents, and multilocularity, affecting the IC/IAC and causing tooth displacement. The imaging features in the posterior and mandibular regions demonstrated greater agreement compared with those in the anterior and maxillary regions. This study's findings may guide imaging protocols for intraosseous jaw lesions. Larger studies incorporating histopathologic data are needed to confirm CBCT's advantages over PAN in diagnosing and planning treatment for bone lesions.

Objective: This study evaluated the optimal depth of anesthesia guided by closed-loop target-controlled infusion (TCI) in preschool-aged children undergoing dental surgery. Dental procedures in this population are frequently associated with heightened anxiety and procedural distress, often necessitating general anesthesia; however, the appropriate depth of anesthesia remains insufficiently defined.

Methods: A randomized, double-blind, controlled trial was conducted involving 60 children aged 3 to 6 years scheduled for dental surgery. Participants were allocated to 3 groups (A, B, and C), with bispectral index (BIS) values maintained at 50, 55, and 60, respectively, using a closed-loop TCI system. The primary outcomes were heart rate (HR) and mean arterial pressure (MAP), recorded at 7 intraoperative time points. Secondary outcomes included surgical duration, time to first eye opening (defined as eyelid movement in response to verbal command without implying full orientation), extubation time, discharge time, and total propofol dose.

Results: No statistically significant differences were observed among groups in HR or MAP at any intraoperative time point (between-subject effect: HR, F=2.73, P=0.074; MAP, F=1.54, P=0.222). Surgical duration (F=0.521, P=0.596) and total propofol dosage (P=0.165) also did not differ significantly. Recovery parameters demonstrated significant group differences. Time to first eye opening was 37.75±8.81 minutes in group A, 28.35±2.45 minutes in group B, and 20.70±5.21 minutes in group C (P<0.001). Extubation time was 39.40±8.08 minutes, 29.60±2.58 minutes, and 22.70±5.63 minutes in groups A, B, and C, respectively (P<0.001). Discharge time was shortest in group C (135.6±30.9 min), followed by group B (160.5±25.3 min), and longest in group A (202.5±26.5 min) (F=29.77, P<0.001). The incidence of adverse events was comparable across groups, and no serious adverse events occurred.

Conclusions: Maintaining a BIS value of 60 (±5) with a closed-loop infusion system provided adequate anesthetic depth for dental procedures in preschool-aged children, while significantly reducing recovery and discharge times. This anesthetic strategy may support enhanced recovery and improve perioperative efficiency in pediatric populations.

Background: Contemporary filler practice has shifted from isolated volumization to functional anatomy-based lifting. This review synthesizes a framework that integrates skin, SMAS, and ligamentous remodeling (SSLR) to achieve dynamic, expression-compatible elevation with minimal product.

Methods/concept: Drawing on layer-specific anatomy and aging patterns, SSLR sequences small, high-cohesivity boluses into sub-SMAS fat and dense ligamentous insertions to increase regional tissue density, tighten the SMAS, and transmit traction toward fixed retaining points. Dermal/subdermal microdeposits complement this by stretching the envelope and dampening musculocutaneous transmission of wrinkles. The approach is material-agnostic and applicable to hyaluronic acid and collagen-stimulating fillers, with selection guided by rheology and intended plane.

Findings: Compared with lever-based "myomodulation" and the ligament-centric True Lift, SSLR explains clinical lifting as a tension-redistribution phenomenon independent of muscle type (levator/depressor). Cadaveric and clinical observations suggest that sub-SMAS expansion and ligament reinforcement produce predictable improvement of midface descent, nasolabial prominence, and jawline blunting using conservative volumes. Emerging evidence of Ruffini-like mechanoreceptors in mimetic muscles supports a complementary neuromechanical hypothesis for filler-related modulation of facial tone.

Conclusions: Functional anatomy clarifies why small, plane-specific filler deposits can create outsized lifting. SSLR offers a reproducible, anatomy-guided strategy to restore 3-dimensional harmony across diverse sexes and ethnicities while preserving natural animation.

Unicoronal synostosis (UCS) causes asymmetric forehead morphology and is commonly managed with fronto-orbital advancement (FOA). However, optimal reconstruction remains challenging as the location of the forehead's pivot line, the hinge axis for advancement, often remains uncertain. We conducted a geometric morphometric analysis using 235 cranial landmarks in 16 patients with UCS (aged <2 y) and 11 age-matched controls. CT-derived cranial models were assessed with generalized Procrustes analysis and principal component analysis (PCA) to evaluate morphologic asymmetry and identify potential pivot lines. PC1 (35.7%) captured asymmetric differences, whereas PC2 (22.8%) represented symmetric variation. Compared with controls, patients with UCS exhibited frontal retrusion and temporal bossing on the affected side, along with frontal bossing on the contralateral side. Wireframe deformation revealed morphologic deviation concentrated near the orbit but not along the cranial midline. Importantly, pivot lines differed between the frontal bone and the supraorbital bandeau, suggesting independent hinge axes. In UCS, the pivot line is not at the midline but lateralized near the orbit. Consequently, the frontal bone and supraorbital bandeau should be repositioned around a separate hinge axis during FOA. These findings support more symmetric and individualized cranial reconstruction.

Background: To establish normative midsagittal corpus callosum (CC) morphometric data in healthy native Tibetan adults and to examine sex- and age-related differences after adjustment for brain size.

Methods: High-resolution T1-weighted MRI was acquired in 156 native Tibetan adults (70 men, 86 women; age 18-66 y, mean 35.2±12.7 y) living permanently above 3500 m. In total, 7 subregional CC areas (Witelson scheme) were manually measured on midsagittal slices and normalized to the midsagittal intracranial area.

Results: After brain-size adjustment, total CC area showed no sex difference. Men exhibited a significantly larger rostrum (W1; P=0.016). Contrary to typical age-related atrophy in lowland populations, splenial area (W7) showed robust positive associations with age in both men (ρ=0.382, P=0.001) and women (ρ=0.241, P=0.025); rostral area increased with age in men only (ρ=0.261, P=0.029).

Conclusions: Native Tibetan adults display a unique CC profile with localized anterior sexual dimorphism and age-associated posterior preservation. These findings likely reflect neuroplastic adaptations to lifelong hypobaric hypoxia and provide essential population-specific reference values to prevent misinterpretation of adaptive morphology as pathology in neurosurgical and craniofacial practice at high altitude.