Journal of Craniofacial Surgery最新文献

This study investigated the characteristics of the maxillary sinus in adult patients with isolated cleft palate (ICP). Cone-beam computed tomography (CBCT) data from 50 unrepaired, non-syndromic adult ICP patients and 35 controls were retrospectively analyzed. 3D reconstruction and measurements of maxillary sinus length, depth, height, and volume were performed using Mimics software. The presence of maxillary sinusitis and 3D parameters was compared between ICP patients and controls. Statistical analyses were performed using the SPSS, with the significance level set at P=0.05. Maxillary sinusitis was detected in 18 ICP patients (36.0%) and 5 controls (14.3%). No significant differences were observed between sides or sexes in either group (P>0.05). In ICP patients, the mean maxillary sinus length, depth, height, and volume were 31.58 mm, 38.85 mm, 39.23 mm, and 13642.46 mm3, respectively. Corresponding values in controls were 36.35 mm, 43.21 mm, 44.57 mm, and 19690.01 mm3. All measurements in ICP patients were significantly smaller than those in controls (P<0.001). Unrepaired adult ICP patients exhibited a higher prevalence of maxillary sinusitis and reduced sinus dimensions compared with controls, indicating that cleft palate may adversely affect maxillary sinus development.

Reconstruction of extensive midfacial defects poses significant challenges due to the need for simultaneous restoration of function and appearance. In this report, the authors present a case of an extensive midfacial defect following nasal cavity cancer resection, in which favorable functional and aesthetic outcomes were achieved through reconstruction using three free flaps. The first free flap-a thoracodorsal artery perforator flap combined with scapular bone was used for hard palate reconstruction; the second, a forearm flap prefabricated with costal cartilage was used to reconstruct the external nose; and the third anterolateral thigh flap was used to release contracture and improve facial contour. As a result of this carefully staged reconstructive strategy, the patient, who initially had dysphagia due to a palatal defect, was able to resume oral intake following scapular flap reconstruction and dental implant placement. Moreover, the correction of midfacial deformity, including the external nose, led to the recovery of social function.

Metopic craniosynostosis causes characteristic cranial deformities such as a keel-shaped forehead, known as trigonocephaly. Mild trigonocephaly refers to cases of metopic craniosynostosis in which the cranial deformity is generally mild. The authors report a case of mild trigonocephaly accompanied by an atypical horizontal constricting ring of the skull that was successfully treated surgically. The patient was a 3-month-old boy with no notable medical history who presented to a pediatric clinic with frontal prominence. Computed tomography (CT) revealed premature fusion of the metopic suture, and he was referred to the authors' department for surgical treatment. A midline frontal ridge was observed but the keel-shaped forehead was not prominent, and the patient was diagnosed with mild trigonocephaly. Mild depression was observed in the temporal regions, and CT demonstrated a horizontal constricting ring of the skull (circumferential depression) extending approximately three-quarters of the way from the frontal region to both temporal areas. At 11 months of age, 1-stage cranial reconstruction was performed for mild trigonocephaly, along with correction of the constricting deformity. Through a coronal incision, the supraorbital bar and frontal bone flap were removed and reshaped. The parietal and temporal bones posterior to the frontal bone flap were barrel-staved, and the depressed bone fragments were elevated to reconstruct the constricted region. Postoperatively, the frontal contour improved, and the constricting ring observed before surgery resolved, resulting in an overall satisfactory cranial shape. One year after surgery, no signs of developmental delay or neurological impairment were observed. The authors experienced a rare case of mild trigonocephaly accompanied by an atypical horizontal constricting ring of the skull. Cases of nonsyndromic craniosynostosis with a horizontal constricting ring are extremely rare, and to our knowledge, none have been previously reported. Possible etiologies include an amniotic constriction band, a constricting ring caused by squamosal suture fusion as seen in cloverleaf skull, or compensatory deformation associated with restricted cranial growth; however, the exact mechanism remains unclear. In the present case, cranial reconstruction successfully improved the deformity, though long-term follow-up is necessary.

Background: The use and standardization of innovative artificial intelligence (AI) tools continue to grow and have the potential to enhance the field of plastic surgery. Despite the rapid growth of validated AI tools, there remains a need for a consolidated reference summarizing AI applications in plastic surgery.

Methods: A literature search was conducted to identify peer-reviewed articles studying AI tools applied to the fields of plastic surgery. Tools were organized into the fields of clinical efficiency, imaging and documentation, communication and workflow, and research and data analysis.

Results: There exists a wide variety of AI tools demonstrating clinical utility. Regarding clinical efficiency, virtual assistants such as AIVA improve patient communication, specifically in accurately answering postoperative questions. Large language models such as DeepSeek support decision-making and reduce documentation burden. AI can significantly improve the creation of 2D and 3D imaging for surgical planning, facial analysis, and volumetric prediction through tools such as Vectra and Crisalix. Tools such as Elicit and OpenEvidence can accelerate literature search, chart review, and data extraction. Lastly, workflow tools including TigerConnect and DAX Copilot can improve communication, and FS-net/FLAPMATE has been able to monitor free flaps with high sensitivity.

Conclusions: AI's precision and efficiency at a multitude of clinical and surgical tasks position it as a pivotal tool optimizing patient safety and satisfaction by reducing physician burden and burnout. As AI continues to become more sophisticated and specialized for plastic surgery, these tools will become an integral part of the field, driving safe, efficient, high-quality results for aesthetic and reconstruction procedures.

Background: This study seeks to determine the benefit that virtual reality (VR) may confer over 2D in teaching first-year medical students (MS1) and second-year medical students (MS2) to suture.

Methods: Ten MS1s and 12 MS2s were randomly stratified into 2 cohorts: VR and 2D. Each student watched instructional videos and performed the suturing tasks on a cadaver. Performance was blindly assessed by 2 graders. The average grade for each student was compared using one-tailed Mann-Whitney U tests and one-tailed t tests.

Results: The overall global rating scale was significantly higher in the VR cohort (P=0.04). When stratified by skill, the VR cohort scored significantly higher for subcuticular (P=0.04). Although not significant, the VR cohort scored higher for the remaining skills. Similarly, the VR cohort had a significantly higher score for subcuticular procedural performance (P=0.01). The remaining procedural scores did not have a significant difference. Student confidence significantly increased in both cohorts (VR, P=0.000; 2D, P=0.001). When stratified by year, both modalities significantly increased confidence for MS2s (VR MS2, P=0.000; 2D MS2, P=0.004), whereas only VR was significant for MS1s (VR MS1, P=0.000; 2D MS1, P=0.064).

Conclusion: Virtual reality (VR) offers greater improvement in suturing compared with 2D, particularly for the subcuticular stitch. Both VR and 2D modalities significantly improve student confidence, with VR conferring greater benefit for MS1 students.

Osteosclerotic jaw lesions, often incidentally detected on routine radiographs, are rarely biopsied due to their benign appearance and proximity to delicate anatomic structures. This case report presents a fully digital workflow for guided biopsy of a deep mandibular osteosclerotic lesion, integrating artificial intelligence-based segmentation, intraoral scanning, CAD design, and 3D printing of surgical templates. A 3D-printed guide with depth-control stops was used to safely and precisely position trephine burs between the roots of tooth 4.6 and the mandibular canal. The approach allowed accurate tissue sampling for histopathologic diagnosis (osteoma), minimizing invasiveness and risk to adjacent structures. Postoperative CBCT confirmed the accuracy of the biopsy, with deviations of 0.6 mm (linear), 4 degrees (angular), and -0.2 mm (depth). This technique demonstrates the potential of artificial intellingence-assisted digital planning and 3D printing to enhance biopsy precision for intraosseous lesions.

Maxillary expansion and downward repositioning are among the least stable movements in orthognathic surgery. However, they are often necessary for functional and aesthetic purposes. Although combining these movements can reduce the need for multiple surgical procedures, it increases the risk of instability and requires stabilization techniques to prevent relapse. A multitude of approaches have been described, yet the literature remains limited in optimal strategies to enhance long-term outcomes. This retrospective study evaluated patients who underwent simultaneous maxillary expansion and downward repositioning using segmental Le Fort I osteotomy over a 24-month follow-up period. All patients underwent orthodontic preparation, followed by miniplate stabilization and interpositional bone grafting with tibial allogenic blocks. Data collected included surgical movements performed, dental cast measurements, postoperative imaging, and clinical assessment. Overall, 23 patients (mean age: 41.1±10.3 years) were included. All patients underwent maxillary advancement (3-9 mm) with inferior repositioning (2-9 mm), while 19 patients (82.6%) had concomitant mandibular procedures. Intercanine widths increased from 24.0±2.2 mm to 27.5±2.1 mm ( p <0.001), while intermolar widths increased from 33.0±0.6 mm to 38.7±0.7 mm ( p <0.001). Over 24 months, no complications were reported, including dehiscence, graft exposure, gingival recession, root injury, or relapse. Aesthetic improvement was evident in exposure of the incisors, and radiographs confirmed stable bone healing. When using current surgical methods and interdisciplinary coordination, this technique can be executed as a single-stage procedure with safety and reliability, minimizing patient morbidity and eliminating the need for additional interventions.

Background: Cranial vault remodeling (CVR) and endoscopic strip craniectomy (SC) are principal operations for nonsyndromic craniosynostosis. Over the past decade, evolving minimally invasive techniques and shifting payer landscapes may have influenced national practice patterns. We evaluated trends in surgical utilization, payer mix, and cost across US children's hospitals from 2016 to 2025.

Methods: A retrospective analysis of the Pediatric Health Information System identified infants with craniosynostosis who underwent CVR or SC between 2016 and 2025 using ICD and CPT codes. Demographics, payer type, and inflation-adjusted cost were compared. Annual trends in utilization, payer mix, and cost were analyzed with linear regression.

Results: Among 15,335 infants, 13,329 underwent CVR and 2006 SC. Strip craniectomy patients were younger (95 versus 280 d, P<0.001), more often male (70.8% versus 64.7%, P<0.001), from higher-income households (median $46,124 versus $42,374, P<0.001), and had a higher proportion of privately insured patients (62.1% versus 47.4%, P<0.001) and a lower proportion of Black children (3.1% versus 8.4%, P<0.001). Strip craniectomy use increased from 8.8% to 20.2% of procedures (β=1.23%/yr, P<0.001). Strip craniectomy cost rose from $14,990 to $21,660 (+$632/yr, P=0.002). Medicaid coverage increased among SC patients (27.0%-39.6%, β= +1.27%/yr, P<0.001) but decreased among CVR patients (48.6%-45.8%, β= -0.40%/yr, P=0.038).

Conclusions: From 2016 to 2025, craniosynostosis care shifted toward increased use of minimally invasive strip craniectomy, accompanied by rising SC costs and greater Medicaid representation. Despite these changes, sociodemographic disparities in access to early, minimally invasive repair persist. These findings provide national benchmarks for utilization, payer patterns, and cost to guide clinical practice and policy.

Choanal polyps are benign solitary soft tissue lesions which originates from the nasal or paranasal sinus mucosa and progress through the natural ostium of the sinus to choana into the nasopharynx. Antrochoanal polyps are most common type. Nasal septum, sphenoid sinus, ethmoid sinus, inferior and middle turbinate, inferior and middle meatus have been reported as ectopic origin of choanal polyp as well. However, choanal polyps originating from uncinate process of nasal cavity has not been reported. Herein, with a review of the literature, we report a rare case of choanal polyps originating from uncinated process of nasal cavity in a 52-year-old woman.