Journal of Craniofacial Surgery最新文献

The purpose of the present cadaveric report is to describe the unique combination of 2 rare variations of the venous system. A rare anatomic variation was discovered during the dissection of a 70-year-old donated male cadaver. This unique case revealed an atypical supraclavicular course and termination of the cephalic vein at the confluence of the external, internal, and subclavian veins, coexisting with the external jugular vein's double fenestration before its confluence. This unusual finding, the jugulo-cephalico-subclavian venous complex, holds significant clinical value.

Background: Microtia reconstruction remains one of the most technically demanding procedures in pediatric plastic surgery. Traditional autologous rib cartilage reconstruction is highly operator-dependent, time-intensive, and associated with donor-site morbidity. Although allogeneic cartilage has emerged as a viable alternative, framework fabrication remains challenging and dependent on carving expertise. This study describes the role of allogeneic auricular reconstruction as a potential first step within a proposed auricular reconstructive ladder. The author's technique using a novel interlocking, template-guided approach to auricular framework construction is presented to improve reproducibility and efficiency.

Methods: The author presents a standardized technique for stage I microtia reconstruction using frozen cadaveric rib cartilage in combination with an original set of 3-dimensional, interlocking carving templates designed in-house. The templates guide framework geometry, subunit proportionality, and cartilage selection while intentionally increasing scapha and triangular fossa width to accommodate soft tissue draping. Framework production is performed preoperatively, followed by implantation using established principles of auricular reconstruction.

Results: Template-guided framework construction allowed consistent reproduction of auricular subunits. The interlocking design facilitated construct planning and assembly. Use of allogeneic cartilage eliminated donor-site morbidity and reduced operative time. The wider framework design facilitated skin coverage while preserving surface definition following healing.

Conclusions: The author presents a personal technique using novel 3-dimensional, interlocking templates for auricular framework construction as an efficient alternative to traditional manual carving. The use of allogeneic cartilage is proposed as an emerging option within the auricular reconstructive ladder, offering a biological reconstructive pathway for patients who decline donor-site morbidity associated with autologous rib harvest and the risks inherent to alloplastic reconstruction.

Anatomic education is central to medical training and underpins safe clinical and surgical practice. Despite its importance, traditional methods of anatomy teaching face persistent structural challenges, including limited cadaver availability, high costs, logistical constraints, and restricted ability to demonstrate dynamic and patient-specific anatomic relationships. Artificial intelligence (AI) has emerged as a collection of computational tools that may support anatomic education by enhancing visualization, enabling structured repetition, and expanding access to educational resources. This article provides a critical synthesis of contemporary AI applications relevant to anatomic education, focusing on computer vision, deep learning-based visualisation, learning analytics, and natural language processing. Emphasis is placed on educational utility rather than clinical automation, with attention to validation of anatomic accuracy, risks of misinformation and hallucinations in generative systems, algorithmic bias, cost and infrastructure requirements, and professional accountability. Current evidence suggests that AI-supported tools can complement anatomy-led curricula when implemented with appropriate safeguards, human oversight, and governance. Careful integration is required to ensure that AI augments, rather than compromises, the foundational standards of anatomic education and trainee preparedness for imaging interpretation and procedural planning.

The study aimed to identify factors associated with treatment complications in zygomatic complex fractures (ZCF) through statistical analysis of clinical and radiologic data, providing evidence-based guidance for clinical management. Clinical records, CT scans, and follow-up data of ZCF patients treated between 2013 and 2022 were retrospectively analyzed. Key clinical features were extracted based on previous epidemiological studies. Distribution of baseline information, univariate analysis, and multivariate logistic regression were conducted to assess factors associated with treatment complications. A total of 686 ZCF patients were included with a mean age of 36.5±12.8 years and a male-to-female ratio of 2.2:1. The average injury duration was 13.6 days. Traffic accidents were the leading cause of injury (53.8%), and type B fractures were the most common (56.9%). Open reduction and internal fixation (ORIF) was the primary treatment, with 3-point fixation being the most frequent method. Complications occurred in 159 patients (23.18%), with facial asymmetry, enophthalmos, and infraorbital nerve injury being the most prevalent. Univariate analysis identified injury duration, fracture type, concomitant fractures, orbital floor defects, soft tissue injuries, treatment modality, surgical approach, fixation location and quantity, and adherence to ORIF principles as significant factors (P<0.05). Multivariate logistic regression confirmed comminuted fractures, old fractures, orbital floor defects, and ORIF principles as independent predictors of complications (P<0.05). The study indicated that injury duration, fracture types, multiple injuries, treatment modalities, surgical approaches, and fixation plans significantly impact the rate of complication in ZCF patients. Comprehensive clinical and radiologic evaluation, accurate classification, and precise treatment management are essential for optimizing treatment outcomes.

We report a patient who developed ocular penetration with a traumatic cataract following double-eyelid blepharoplasty. A 19-year-old woman experienced immediate visual loss in her left eye after surgery. A slit-lamp examination revealed puncture wounds involving the cornea, iris, and full-thickness lens capsule, suggesting a linear penetrating injury. Due to the development of a traumatic cataract, the patient underwent phacoemulsification with intraocular lens implantation combined with pars plana vitrectomy. Postoperatively, visual acuity improved significantly without retinal complications. This case emphasizes the potential for severe intraocular injury during eyelid surgery and highlights the need for greater attention to cautious anesthetic techniques.

Nonmelanoma skin cancers are the most frequent skin neoplasias occurring on the face. Surgical excision of these tumors results in significant soft tissue defects. The ear, especially the postauricular surface, represents a challenging area due to the paucity of reconstructive options (skin grafts or local flaps comprise the usual reconstructive options for such soft tissue defects after the excision of local tumors). We present the Keystone island perforator flap as a single-stage immediate reconstructive option addressing soft tissue defects in the posterior surface of the ear following skin cancer excision. The proximal part of the flap can be undermined, elevated, adding a third dimension, transposed, and extended to cover the soft tissue area until the rim of the helix, with very satisfactory functional and cosmetic results for the patient, maintaining the normal posterior ear-head sulcus. The keystone island perforator flap from the retroauricular skin is a reliable option for covering soft tissue defects of the postauricular surface owing to its robust vascularity, skin color matching, and minimal donor-site morbidity. The case of a 36-year-old female patient with a skin lesion on the posterior surface of the right ear measuring 3.0 cm×2.5 cm is presented, and a detailed description of the surgical procedure employed for reconstruction of the postauricular defect is provided. Treatment included the surgical excision of the lesion in the retroauricular area and immediate reconstruction of the subsequent defect using the Keystone perforator island flap from the retroauricular tissue of the mastoid area.

The three-dimensional (3D) facial scanning system plays a crucial role in orthognathic surgery, with significant advancements in related technologies. However, high costs and limited portability have restricted the accessibility of existing scanners, highlighting the need for a mobile device-based 3D facial scanning system. To address this, a new mobile device-compatible 3D facial scanning software (i3Dface) was developed, installed, and tested on mobile tablets. From August 2021 to December 2022, 50 volunteers participated in evaluating i3Dface's reproducibility and accuracy for facial digitization and orthognathic applications. i3Dface demonstrated strong reproducibility in environments with optimal light intensity (600-2100 lux) and shooting angles (-20 degrees-10 degrees). When comparing absolute deviations in facial measurements, i3Dface showed no significant difference from the established stereophotogrammetry system (3dMD), aligning closely with manual clinical measurements. In assessing 3D spatial deviation, i3Dface's accuracy varied by facial region, with the highest accuracy (0.59 ± 0.13 mm) in the chin area and the lowest (1.17±0.16 mm) in the midface. For clinical applications in orthognathic surgery, i3Dface facial images showed effective alignment with CBCT soft tissue images. In summary, i3Dface offers reproducibility in suitable environments and accuracy comparable to 3dMD, meeting essential clinical requirements and supporting digital technology use in orthognathic surgery.

Introduction: Orthognathic surgery is traditionally considered painful, often prompting opioid use. In the context of rising opioid-related harm, this study assessed postoperative pain levels, factors influencing analgesic requirements, and the actual need for opioids after orthognathic procedures.

Methods: A retrospective analysis of 122 patients undergoing Le-Fort-I osteotomy, bilateral sagittal split osteotomy (BSSO), or bimaxillary surgery was performed. Pain levels (Numeric Analog Scale) were recorded 3 times daily for 5 postoperative days. Analgesic use was documented according to the WHO analgesic ladder, and associations with surgical type, gender, maxillary impaction, and mandibular advancement were analyzed.

Results: Pain levels were mild overall and declined steadily over 5 days. BSSO patients reported the lowest pain and required fewer non-opioid analgesics. Le-Fort-I and bimaxillary procedures showed higher early analgesic demand. Only 5.7% of patients required opioid rescue medication, with no corresponding increase in pain scores. Gender, maxillary impaction, and mandibular advancement showed no significant impact on analgesic requirements.

Discussion: Non-opioid analgesics effectively controlled postoperative pain across procedures, and no subgroup demonstrated a consistent need for opioids.

Conclusions: Routine opioid prescription after orthognathic surgery seems unnecessary. Opioid-sparing protocols provide adequate pain control and support safer postoperative recovery.

Background: Craniofacial microsomia (CFM) is the second most common congenital craniofacial anomaly. As patients increasingly seek health information online, large language models (LLMs) like ChatGPT and DeepSeek have emerged as potential sources of medical information. This study evaluates the performance of ChatGPT-5 and DeepSeek-V3.2 in providing bilingual responses to CFM-related questions.

Methods: Twenty-two questions covering CFM definition, etiology, diagnosis, treatment, and prognosis were developed. Each question was submitted in English and Chinese to both LLMs using a zero-prompt approach. Responses were evaluated for accuracy using a predefined 4-point scale, with readability assessed using the Flesch Reading Ease score for English and the Chinese Readability Platform for Chinese. Safety statement frequency was also recorded.

Results: DeepSeek demonstrated significantly higher accuracy than ChatGPT in both English (score 1: 86.4% versus 45.5%, P=0.004) and Chinese (77.3% versus 40.9%, P=0.014). However, only DeepSeek produced responses with inaccurate or misleading content (score 3). For English readability, DeepSeek scored significantly higher (39.4±5.5 versus 35.1±8.4, P=0.031), while Chinese readability was comparable. DeepSeek also included safety statements more frequently (54.5%-72.7% versus 4.5%-18.2%).

Conclusions: Both LLMs show potential for CFM patient education, with DeepSeek offering superior accuracy and readability in English, though it occasionally produced misleading information. ChatGPT provided safer but less detailed responses. These findings highlight the need for model-specific optimization and clinician oversight when integrating LLMs into patient education for complex craniofacial conditions.

This study explored the therapeutic effect of nanosilver dressing combined with silver sulfadiazine cream on burn wounds. A total of 100 patients treated between January 2022 and March 2023 were randomly divided into 2 groups: a control group (silver sulfadiazine cream alone, n=50) and an observation group (nanosilver dressing plus silver sulfadiazine, n=50). Clinical efficacy, complication rate, wound healing time, bacterial infection rate, pigmentation fading time, and inflammatory factor levels were compared. The total effective rate of the observation group (97%) was significantly higher than that of the control group (88%). The incidence of complications in the observation group (10%) was significantly lower than that in the control group (64%). On the 7th, 12th, and 17th day of treatment, the wound healing rate of the observation group was higher than that of the control group, and the wound healing time was shorter than that of the control group. The pigmentation subsidence time of the observation group was significantly shorter than that of the control group. After treatment, the levels of inflammatory factors TNF-α and IL-6 and CRP indicators in the observation group were significantly lower than those in the control group. The bacterial infection rate in the nanosilver antibacterial dressing group was significantly lower than that in the silver sulfadiazine cream group. Nano-silver dressing combined with silver sulfadiazine cream has a significant therapeutic effect on burn wounds, which can improve the overall treatment efficiency, shorten wound healing time, pigmentation subsidence time, and reduce inflammatory reaction.