Journal of Craniofacial Surgery最新文献

Objective: To assess the dynamic mandibular movement of patients with condylar hyperplasia before and after simultaneous orthognathic surgery and condylectomy through an intraoral approach.

Methods: Two groups of patients diagnosed with unilateral condylar hyperplasia were studied: the preoperative group consisted of 23 patients and the postoperative group consisted of 13 patients who had undergone simultaneous orthognathic surgery and condylectomy through an intraoral approach with follow-up for more than 1 year. The normal reference value was obtained from 11 individuals without oral and maxillofacial diseases. Three-dimensional mandibular movement trajectories and electromyography of masticatory muscles were recorded.

Results: Patients showed no limitation in mandibular border movement before surgery, but the average amplitude of electromyography of the lower head of lateral pterygoid muscle on the affected side was lower than normal reference value. After condylectomy, the maximum mouth opening decreased [32.00 (26.55, 36.20) mm], mandibular movement deviated to the affected side, and the maximum distance in protrusive movement of the mandibular incisal point and the movement to the normal side were both significantly lowered. Amplitude of electromyography of the lateral pterygoid muscle on the normal side increased in the postoperative group compared with the preoperative group.

Conclusions: Patients with condylar hyperplasia had a restriction in protrusive and to the normal side movement, and mandibular movement deflected to the affected side after condylectomy, which indicates the necessity of postoperative individualized rehabilitation training.

Background: Cranial defects from trauma, surgery, or congenital conditions require precise reconstruction to restore cranial vault integrity. Autogenous calvarial grafts are preferred for their histocompatibility and biomechanical properties, but their success depends on a well-developed diploic space. Although prior studies have described overall skull thickness development, less is known about how diploic thickness changes through adulthood. This study aimed to quantify diploic thickness and density changes with age using computed tomography (CT) imaging.

Methods: A retrospective review of an institution-wide imaging database was performed to identify patients who received CT scans for non-traumatic indications. A total of 110 patients, balanced by sex, were selected across 11 age groups spanning 10 to 109 years. Each patient's skull was aligned to a standardized grid and segmented in 3-dimensional (3D) Slicer using consistent thresholding values to isolate the diploic space from the inner and outer cortical tables. Linear regression models were used to assess the effects of age and sex on diploic thickness.

Results: No statistically significant trends were found between age and diploic thickness (r=-0.06; P=0.50. However, a near-significant trend of decreasing diploic thickness with age was observed in men (r=-0.25; P=0.05) but not in women (r=0.11; P=0.42). The posteromedial parietal region consistently showed the greatest thickness across all age groups. Diploic density also increased significantly with age (r=0.285; P=0.002), indicating progressive ossification of cancellous bone.

Conclusion: Diploic thickness remains stable across the lifespan with slight sex-based differences. However, examination reveals that the density of the diploe increases over time, suggesting age-related changes in cancellous architecture. These findings highlight the importance of individual anatomical variations when harvesting autogenous calvarial grafts to optimize cranial reconstruction outcomes.

Odontogenic keratocysts (OKCs) are an invasive type of odontogenic cyst that rarely occurs in the maxilla. This article presents a case of OKC complicated with ectopic teeth occurring in the maxillary sinus. This article collects a case of a 19-year-old female patient with an ectopic tooth in the maxillary sinus associated with an OKC. The physician opted for the Caldwell-Luc approach to remove the ectopic tooth, the cyst, and the affected mucosa. Concurrently, the bone fragment at the window site was repositioned by applying the bone lid technique after the lesion had been cleared. Postoperative follow-up revealed that the bone fragment had achieved good continuity, effectively reconstructing the anatomical form of the lateral maxillary sinus wall. To clear the large sinus contents and the affected mucosa, physicians may employ the Caldwell-Luc approach combined with a bone lid technique for maxillary sinus antrostomy. Treated by Caldwell-Luc surgery and bone lid technique, the surgical field can be fully exposed, facilitating the surgeon's removal of the affected mucosa and cyst. Moreover, the bone fragments can be repositioned precisely after the lesion is cleared and normal facial features can be restored after bone reconstruction.

This meta-analysis compares the accuracy of mandible-first and maxilla-first approaches in bimaxillary orthognathic surgery to improve clinical decision-making. A systematic search was performed in PubMed, Web of Science, Embase, and Cochrane databases up to August 2024. The analysis included randomized controlled trials and cohort studies with a minimum of 10 patients. Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and pooled effect estimates for continuous outcomes were calculated using weighted mean difference (WMD) with 95% CIs. Heterogeneity was assessed using Cochran I2 and Q statistics, with a random-effect model applied when I2 exceeded 50%. Seven studies involving 316 patients were included. The analysis showed no significant differences in vertical (WMD: -0.05, 95% CI: -0.57 to 0.48, P = 0.86), transverse (WMD: -0.17, 95% CI: -0.43 to 0.09, P = 0.21), and sagittal (WMD: -0.41, 95% CI: -0.98 to 0.15, P = 0.15) surgical errors between the two approaches. Rotational surgical errors were also similar, including pitch (WMD: 0.07, 95% CI: -0.11 to 0.25, P = 0.29), roll (WMD: 0.01, 95% CI: -0.18 to 0.25, P = 0.69), and yaw (WMD: 0.12, 95% CI: -0.56 to 0.81, P = 0.72). The findings suggest that there is no significant difference in surgical accuracy between mandible-first and maxilla-first approaches. Therefore, the choice of sequence should be based on patient-specific factors rather than a presumed advantage of one method over the other. Further research, including large-scale randomized controlled trials, is needed to confirm these results and evaluate long-term outcomes.

Objective: Finite element analysis (FEA) of the biomechanical properties of the modified extraoral distractor device used in the mandibular distraction of craniofacial microsomia patients.

Materials and methods: Finite element analysis (FEA) models of 5 patients under 2 working conditions, the instance when the distractor is activated and when the distractor participates in mastication, were included in the current study. To conduct the FEA, load boundary conditions (35.6 N on the distractor for the first working condition and 50 N on the unoperated side, 100 N and 200 N on both sides for the second working condition) were applied. Besides, constraint boundary conditions and contact conditions were also applied.

Results: With 5 or 3 bioabsorbable screws fixing the upper fixing plate, the maximal displacement of the mandible was <3 mm and the maximal stress distributed on distractor and bioabsorbable screws was less than the yield strength of corresponding materials under the 2 working conditions when setting 50 N on the unoperated side and 100 N on both sides for the second working condition. However, when setting 200 N on both sides for the second working condition, the maximal displacement of the mandible slightly increased, and stress distributed on distractor and bioabsorbable screws exceeded the yield strength of corresponding materials in some patients.

Conclusion: In most cases, both 5 and 3 poly-L-lactic acidscrews could firmly fix the distractor on the mandible without plastic deformation, although the situation would be different when the mastication force was too powerful.

Purpose: To identify the key craniofacial anatomic characteristics associated with the prevalence of severe obstructive sleep apnea (OSA) in patient cohorts stratified by age and body mass index (BMI).

Methods: This prospective study was conducted at the Beijing Anzhen Hospital Center for Sleep Medicine and Science between December 2023 and March 2024. Patients suspected of having OSA underwent overnight polysomnography, along with computed tomography scans of the head and neck, to evaluate the skeletal and soft tissue characteristics. Multivariable analysis was conducted to explore the independent risk factors associated with the prevalence of severe OSA (apnea hypopnea index ≥30 events/h) after adjusting for age, sex, BMI, and neck circumference.

Results: Among the 118 participants, 75 (63.6%) were diagnosed with severe OSA. Skeletal variables, such as vertical airway length, and soft tissue-related variables, like soft palate length, were independently correlated with the prevalence of severe OSA. Furthermore, subgroup analysis revealed that all skeletal variables and a few soft tissue parameters were associated with severe OSA in patients aged older than 40 years, whereas only a specific soft tissue variable was independently associated with the occurrence of severe OSA in those aged younger than or equal to 40 years. In addition, certain soft tissue-related variables were notably associated with severe OSA in obese patients (BMI >28 kg/m2), whereas only specific skeletal variables were acted independent risk factors for severe OSA in non-obese patients (BMI ≤28 kg/m2).

Conclusion: Craniofacial skeletal and soft tissue features play essential roles in the prevalence of severe OSA, with variations observed based on age and BMI.

Background: To analyze the serial changes in cranial asymmetry (CA) during helmet therapy for deformational plagiocephaly (DP).

Methods: The subjects were 159 patients with DP who visited National Center for Child Health and Development between October 2011 and March 2014 and completed helmet therapy. The authors retrospectively collected information from medical records and analyzed the rate of improvement of deformation.

Results: The average age at the start of the helmet was 24.1 weeks old [standard deviation (SD): 5.0], and the average treatment period was 21.2 weeks (SD: 5.3). The average CA before the start of helmet therapy was 16.3 mm (SD: 4.2), and it improved to 7.7 mm (SD: 3.5) after therapy. The analysis in the present article was limited to 16 weeks after initiation of helmet therapy when 1/4 of patients completed the therapy. In general, improvement of CA occurred inverse proportionally to the enlargement of head circumference. In subgroup analysis, for those who started earlier than 24 weeks of age or those with the severity of Argenta 1 or 2, improvement occurred rapidly and reached nearly a plateau at 12 weeks of treatment. For those started later or those with more severe deformity, improvement occurred slower and it continued even after 12 weeks of treatment.

Conclusion: The rate of improvement was rapid at the early stage of treatment for those started earlier or with milder severity. This rapid improvement was obtained when the cranial enlargement was rapid. By understanding the course of improvement, evaluation of treatment responsiveness and ideal timing to finish therapy is possible.

This narrative review explores the various injection techniques utilized in facial filler procedures, emphasizing their applications, benefits, and potential complications. The increasing demand for total facial contouring and rejuvenation has led to a rise in the use of volumizing fillers and the integration of these procedures with other treatments such as toxins, threads, lasers, radiofrequency, and ultrasound. Achieving satisfactory results necessitates a comprehensive understanding of facial anatomy and the effects of aging on skin tissue. Key injection techniques discussed include retrograde and anterograde injections, linear and serial threading, serial puncture, fanning, cross-hatching, bolus, towering, sandwich, tenting, and specialized methods like fern leaf and duck walk injections. Each technique offers unique advantages, such as the retrograde technique's ability to minimize vascular complications and the dual plane technique's effectiveness in achieving optimal volumization and contouring by layering different types of fillers at varying depths. The dual-plane injection technique, in particular, is highlighted for its ability to provide natural and lasting results by combining firm fillers in deep layers with softer fillers superficially, minimizing surface irregularities and filler migration. The review also underscores the importance of preprocedure planning, including the marking of injection points to ensure precision, especially in patients with facial asymmetry. This comprehensive review aims to equip practitioners with the knowledge to select and master appropriate injection techniques, tailored to the specific needs of different facial areas, thereby enhancing treatment outcomes and patient satisfaction while minimizing risks.

The management of oral malignancy necessitates a comprehensive approach focusing on disease eradication and patient quality of life. Surgery remains pivotal, although extensive resection can lead to aesthetic and functional challenges. Reconstruction, often with osteocutaneous radial forearm free flaps (OCRFFF), is crucial for restoring form and function. Prophylactic plating aims to prevent donor site complications, although plate selection is critical. Despite OCRFFF's efficacy in anterior mandible reconstruction, concerns persist regarding donor site morbidity and adequacy for subsequent dental implantation. Collaborative efforts and advancements are essential to optimize outcomes and address limitations in oral cancer management.

Objective: Cervical burn scar contractures can be repaired using many modalities, including skin grafts, pedicled and free flaps. Although preexpanded cervical flaps can provide a like-with-like reconstruction, a simple advancement transfer of the flaps often fails to achieve ideal outcomes. The authors aimed to introduce a method using the preexpanded cervical flaps transferred in a scarf-wrapping manner to repair neck defects.

Methods: The surgery was divided into 2 stages. In the first stage of the surgery, an expander was implanted above the platysma muscle on each side of the neck. After adequate inflation of the expanders, second-stage operations commenced. Following the expander removal, one flap was rotated upward to repair the neck defect, whereas the other flap was rotated downward to repair the neck defect and close the donor site of the first flap. Data on patient demographics, clinical characteristics, and outcomes were also collected.

Results: Between July 2004 and May 2024, 24 patients underwent neck reconstructions using this method. Four patients had grade I cervical contractures, and 20 had grade II. The mean size of the defects was 15.62×5.75 cm (range: 6×6-18×10 cm). The average dimension of the neck flap was 15.02×7.65 cm (range: 9×6-20×10 cm). All the flaps survived with no perfusion-related complications. The average improvement in the cervico-mental angle was 29.25 degrees (range: 10-45 degrees). Postsurgery follow-up ranged from 4 to 155 months (mean: 22 mo). All patients and their families were satisfied with the outcomes.

Conclusions: Preexpanded cervical flaps transferred in a scarf-wrapping manner can be used to reconstruct grade I and II cervical scar contractures and provide a like-with-like reconstruction of the neck.