Journal of Craniofacial Surgery最新文献

Objective: To investigate the incidence and etiology of maxillofacial trauma (MFT) and its association with traumatic brain injury (TBI).

Background: Anecdotal evidence suggests that there is an association between MFT and TBI and that higher incidences of TBI are associated with frontal bone and mid-facial fractures. Despite the large volume of maxillofacial facial fractures treated in the authors' unit, no study has been undertaken to establish the relationship between TBI and maxillofacial fractures.

Methods: This was a retrospective single-center cross-sectional study that was conducted on patients who presented at Charlotte Maxeke Academic Hospital emergency department with MFT and concomitant TBI over a period of 1 year (January 2019-January 2020). The primary predictor was maxillofacial fractures, which were classified into upper, middle, and lower thirds. The primary outcome variable was TBI indicated by the Glasgow Coma Scale (GCS) and Marshall computed tomography (CT) classification (radiological finding in CT).Variables such as age, etiology, fracture type, and neurological injury indicated by the recorded GCS and Marshall CT classification (I-IV) were collected. Maxillofacial fractures were classified based on the anatomical location. The level of significance was set at P <0.05.

Results: A total of 112 patients (102 males, 10 females) presented with MFT and concomitant TBI. The age group 30 to 39, followed by 20 to 29 years, was most affected. Respectively assault (n = 67), gunshots (n = 16), and falls (n = 16) were the main causes of injury. Supra-orbital rim fractures (P = 0.00193), frontal sinus fractures (P < 0.001,), and panfacial fractures (P < 0.001) were significantly associated with TBI. Severe TBI (GCS: 3-8) was associated with higher Marshall CT grading.

Conclusions: Facial fractures affecting the upper third and panfacial fractures pose a significant risk for TBI. To identify TBIs, a multidisciplinary evaluation of facial fractures is recommended, especially in high-risk groups.

Objective: To confirm the incidence of subcutaneous effusion secondary to cerebrospinal fluid leakage after craniotomy, analyze the risk factors for cerebrospinal fluid leakage leading to subcutaneous effusion, summarize the underlying causes of its occurrence and explore the corresponding treatment strategies.

Methods: A retrospective analysis was conducted on 757 patients who underwent craniotomy at our hospital from January to December 2023. The authors documented the sex, age, surgical characteristics, and history of chronic diseases for all patients, including those who developed subcutaneous effusion secondary to cerebrospinal fluid leakage. These factors were subjected to univariate regression analysis, and the identified risk factors were evaluated in a multivariate regression analysis.

Results: Among 757 patients who underwent craniotomy, 15 developed subcutaneous effusion secondary to cerebrospinal fluid leakage, representing an incidence of 1.98%. This group included 5 patients with acoustic neuroma surgery, 4 with neurovascular decompression, 4 with meningioma surgery, 1 patient undergoing a posterior corpus callosotomy for epilepsy, and 1 patient with cerebellar cavernoma resection. Factors such as acoustic neuroma surgery, neurovascular decompression, infratentorial surgery, longer surgical durations, larger cranial bone removals, higher body mass index, and smoking were associated with an increased risk of developing subcutaneous effusion secondary to cerebrospinal fluid leakage. The average time to onset was 40.8 ± 37.16 days. Three patients with subcutaneous effusion experienced elevated body temperatures, with one testing positive in blood cultures; no other complications were noted. All patients initially received conservative treatment and subsequently underwent surgical repair for the cerebrospinal fluid leak an average of 45.4 ± 57.94 days later, ultimately resulting in recovery and discharge.

Conclusion: In 2023, the incidence of subcutaneous effusion secondary to cerebrospinal fluid leakage after craniotomy at our hospital was 1.98%. The fundamental cause of this complication is the pressure difference between the inside and outside of the dura mater, leading to incomplete dural closure and subsequent fluid leakage. Factors such as younger age, acoustic neuroma surgery, neurovascular decompression, infratentorial surgery, longer surgery durations, larger cranial bone removals, higher body mass index, and smoking are associated with an increased risk of subcutaneous effusion. Once subcutaneous effusion occurs, conservative management is the initial step. To optimize outcomes, surgical repair of the cerebrospinal fluid leak should follow conservative treatment. This approach can significantly reduce the likelihood of treatment failure, decrease hospital stays, and cut unnecessary costs.

Dural closure is a crucial step in cranial surgery, essential for preventing complications like cerebrospinal fluid leakage, wound infections, and meningitis. Traditional suturing techniques, however, pose challenges such as technical difficulty and the potential for tissue damage. This retrospective study aimed to assess the safety and effectiveness of a nonsuture dural closure method using medical glue for direct adhesion of a patch to the dura mater. It was conducted from September 2019 to September 2023, including 169 patients with supratentorial brain injuries who underwent nonsuture dural closure (glue group) and 209 patients who received suture dural closure (suture group). The study compared the operation time and material costs between the two groups, with patients followed for 3 months to monitor complications and adverse events. The results showed that the operation time for dural closure was significantly shorter in the glue group (8.4 ± 3.7 min) compared with the suture group (21.7 ± 4.1 min). Postoperative complications were significantly lower in the glue group. There were no significant differences in adverse events between the groups. These findings suggest that nonsuture dural closure with medical glue is a simple, efficient, and safe alternative to traditional suturing, effectively reducing postoperative complications.

External rigid distraction is an established method for achieving subcranial Le Fort III advancement in severe syndromic craniosynostosis. Craniofacial surgeons commonly use halo-type devices for these corrections, as they allow for multiple vectors of pull and facilitate larger midfacial advancements. Although most complications related to their use involve pin displacement or infection, rare complications such as skull fractures have been reported. At 3 months of age, a patient with Apert Syndrome underwent endoscopic-assisted craniectomies for bilateral coronal craniosynostosis. After a year of helmet therapy, he developed pansynostosis and required fronto-orbital advancement. Later at the age of 6, a Le Fort III distraction using a RED II rigid external distractor was performed to address his midfacial hypoplasia, exorbitism, and severe obstructive sleep apnea. While placing the RED II distractor, a shift in the device was noted upon pin fixation, raising suspicion for a unilateral depressed skull fracture. Although computed tomography imaging revealed pin displacement, there was no clinical indication for immediate repair. Given the surgical and psychological burden this could have on the patient, the decision was made to leave the RED II device in place and proceed with the distraction. After distraction and an 8-week latency period for complete consolidation of the facial bony architecture, the RED II device was removed, and the skull fracture was repaired. In patients with multi-operated skulls and residual cranial defects, halo-type devices may present an increased risk of skull fractures. This report discusses alternatives in the literature and presents an example of a rare complication successfully managed with delayed repair.

Background: Nasal septal abscesses (NSA) necessitate prompt recognition and management to prevent morbidity and long-term sequelae. To date, no comprehensive review of NSA alone has been conducted.

Objective: To conduct a systematic review of the presentation and management of NSA and determine patients at risk of sequelae.

Methods: Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. PubMed, Web of Science, Cochrane, and reference lists were searched. Patient demographic information, etiology, presentation, management, and outcomes were recorded and analyzed.

Results: A total of 79 articles (90 cases) were included. The mean age was 32.86 years old with a slight male predominance. The most common signs were nasal pain (44.86%, N=48), trouble breathing (23.36%, N=25), and headache (15.89%, N=17). All cases were treated with intranasal drainage. Most patients (66.67%, N=60) were asymptomatic at last follow-up. Most abscesses (73.07%) were located in the anterior septum. Of those patients who experienced complications, common complications were saddle nose deformity (70.59%, N=24), nasal obstruction (5.88%, N=2), and septal perforation (5.88%, N=2). No significant association between age (P = 0.23), sex (P = 0.99), history of diabetes (P = 0.11), history of nasal trauma (P = 0.91), history of nasal/dental surgery (P = 0.14), location (P = 0.18), or postoperative nasal packing (P = 0.65) and NSA outcomes was found.

Conclusion: Patients with or without a history of immunodeficiency, trauma, or nasal surgery are at risk of developing NSA. Without adequate treatment, NSA can be associated with functional and aesthetic sequelae.

The coexistence of intracranial multiple meningiomas and neurofibromatosis type 1 is a rare occurrence in the field of neurosurgery, presenting complex treatment challenges, unfavorable prognoses, and significant burdens on both families and society. Currently, the primary objective is to perform surgical total resection as far as possible, while considering postoperative adjuvant radiotherapy for cases where complete tumor resection is challenging. In this case, the patient has previously undergone multiple brain tumor resections and received radiation therapy. Currently, the tumor is exerting pressure on the brain stem, leading to a diminished quality of life. Considering the patient's personal preferences, overall physical condition, and economic circumstances, it was determined that surgical decompression would no longer be pursued. Instead, symptomatic treatment will be administered to alleviate pain and provide compassionate care.

Osteopetrosis is a rare systemic skeletal disorder characterized by increased bone density and mass resulting from suboptimal or impaired resorption of osteoclastic bone. Compromised bone marrow function and associated disorders of red blood cells contribute to hematopoietic abnormalities, which exacerbate the risk of complex, recurrent infections such as jaw osteomyelitis. This case report describes the treatment of a 68-year-old Korean female with autosomal-dominant osteopetrosis who presented with severe and persistent jaw osteomyelitis complicated by hematopoietic dysregulation. Clinical findings included skin necrosis, purpura, and ecchymosis, which were likely due to underlying hematopoietic insufficiency and impaired wound healing. Despite suboptimal conservative interventions, partial mandibulectomy was ultimately unavoidable. Reconstruction was performed with a pectoralis major myocutaneous flap, as microvascular and osteocutaneous flaps were not viable due to limitation of the patient's vessels and bone marrow. Conservative debridement, rigorous wound care, and transfusion support were essential to manage the infection and promote healing. This case underscores the challenges of treating osteomyelitis in patients with osteopetrosis, particularly given the likelihood of systemic hematopoietic compromise and a suboptimal healing environment. Conservative approaches, supportive transfusions, and close monitoring of the skin and hematological complications are vital for achieving favorable outcomes.

Patients with localized scleroderma on the face typically exhibit asymmetrical linear or patchy skin lesions and indentations on areas such as the scalp and forehead, with a smooth, waxy surface. In the early stages, medication is used to control the progression of the disease. In later stages, plastic surgery is performed to repair facial skin lesions. The authors treated 2 patients with localized scleroderma of the face using high-density fat combined with stromal vascular fraction gel transplantation surgery. The patients were satisfied with the color and texture of their skin, as it closely resembled the surrounding normal skin. In addition, the facial indentations were corrected, restoring a normal appearance to the face. This method is aesthetically pleasing, durable, and safe.

Hyaluronic acid (HA) injection, traditionally used for non-surgical rhinoplasty, is often associated with adverse effects such as increased nasal dorsum width. This study introduces the linear stereoscopic stack volume enhancement (LSSVE) injection technique as a solution for patients with low-profile noses, aiming to improve the nasal dorsum dimension, prevent long-term nasal widening, and address related concerns. A retrospective analysis was conducted on the clinical registry data of patients treated at Shanghai Phiskin Clinic from December 2020 to June 2024, who received HA injections using the LSSVE technique. Each rhinoplasty patient received a personalized injection, with doses ranging from 0.59 to 1.03 mL, adjusted based on specific characteristics of their nose and forehead. The procedure utilized a 25G blunt cannula to administer HA between the nasal bone periosteum and fascial layer using the LSSVE technique. The primary endpoint was patient improvement assessed 6 months post-injection using the Global Aesthetic Improvement Scale (GAIS), evaluated by a blinded assessor. In addition, patient satisfaction and complications were assessed. A total of 189 patients (181 females and 28 males) were included in the study, all of whom received a single HA LSSVE injection. Six months post-injection, the GAIS improvement rate was 82.83%, with a patient satisfaction rate of 84.83%. The injection effect was maintained for 6 months without any nasal dorsum widening, and a significant increase in the nasofrontal angle was observed (P<0.001). No long-term complications were reported post-injection. The LSSVE injection technique demonstrated effectiveness in overcoming the limitations of traditional HA rhinoplasty and preventing long-term nasal dorsum widening.

This cross-sectional observational study aimed to investigate the relationship between satisfaction with facial appearance among young women, as measured by the FACE-Q tool, and facial asymmetry quantified through stereophotogrammetry. A total of 50 women aged 18 to 30 years with a normal body mass index were recruited for the study. Participants were categorized as either symmetrical or asymmetrical based on facial asymmetry assessments obtained through clinical examination and stereophotogrammetry using the Vectra M3 system. Facial asymmetry was quantified using root mean square (RMS) distances, with participants classified into symmetrical (RMS ≤0.68) and asymmetrical (RMS >0.68) groups. The statistical analysis included the intraclass correlation coefficient (ICC) to assess the repeatability of RMS measurements (ICC=0.945), Receiver operating characteristic (ROC) curve analysis (area under the curve=0.900), and independent t tests to compare FACE-Q scores between groups. Results showed no significant differences in FACE-Q satisfaction scores between the symmetrical and asymmetrical groups. In addition, simple linear regression analysis indicated that RMS values were not predictive of FACE-Q scores, suggesting that facial asymmetry, as measured in this study, did not have a direct effect on self-reported satisfaction with appearance. These findings highlight the nuanced nature of individual satisfaction with facial appearance, suggesting that health care providers should combine clinical evaluation with empathetic communication to address both the aesthetic and functional concerns of patients more effectively.