Journal of Craniofacial Surgery最新文献

Objective: This study aimed to compare the clinical outcomes of repairing acquired palatal defects using palatal island rotation flaps (PRFs) or anteriorly based dorsal tongue flaps (aTFs).

Methods: In total, 39 patients (23 males and 16 females) aged 22 to 74 years (median: 48.4 y) were included. According to the grid-based palatal horizontal plane palatal defect classification system, palatal defects were divided into 3 classes (classes I, II, and III); hard palate defects (classes I and II) were further subdivided into 3 subtypes (a, b, and c). Medium and large-sized defects accounted for 56.4% and 43.6% of the cases, respectively. A circumferential incision was made at the margin of the hard palate defect to create marginal buccal and palatal or cheek flaps, which were infolded to form an intranasal lining. Subsequently, either a PRF (59.0%) or an aTF (41.0%) was prepared to form the intraoral lining. The dimensions of the PRFs and aTFs ranged from 1.2×2.2 to 1.4×2.4 cm and from 1.8×2.8 to 2.4×3.2 cm, respectively. Swallowing and speech functions were evaluated at 3 months postoperatively.

Results: The dimensions of the aTFs were significantly larger than those of the PRFs (median: 2.2×3.0 cm versus 1.3×2.3 cm, P < 0.05). Postoperative complications, such as hemorrhage or bleeding, dehiscence or fistula formation, and partial flap necrosis, were significantly more common in the PRF group than in the aTF group (43.5% versus 12.5%, P < 0.05). The proportion of patients achieving postoperative swallowing and speech function scores of 3 was significantly higher than the proportion based on preoperative scores (P < 0.05). Furthermore, patients with medium-sized defects demonstrated significantly higher rates of achieving postoperative swallowing and speech function scores of 3 compared with those with large-sized defects (P < 0.05).

Conclusions: Both PRFs and aTFs are effective for reconstructing acquired medium to large-sized hard palate defects based on the grid palatal horizontal plane palatal defect classification system. However, aTFs offer advantages for larger defects, with a lower incidence of postoperative complications.

Objectives: This study aimed to investigate the relationship between palate morphology, masticatory muscle thickness, choanae structure, and sphenoidale foramina in individuals with temporomandibular dysfunction (TMD), and to determine how variations in these parameters affect temporomandibular joint (TMJ) function.

Methods: Cone beam computed tomography (CBCT) scans of 36 individuals with TMD and 36 healthy controls, aged 18 to 69 years, were retrospectively analyzed. The possible relationships between TMD and the morphometry of the hard palate, nasi choanae, and sphenoidale foramina were evaluated, and thickness measurements of the masticatory muscles (masseter, temporalis, lateral, and medial pterygoideus) were also correlated with TMD.

Results: Significant relationships were found between TMD and the morphometric features of the craniofacial structures. Statistically significant relationships were found between age and the masseter, temporalis, and medial pterygoid muscle thicknesses in individuals who had TMD (P<0.05). In addition, a significant difference was observed in the hard palate transverse width according to gender in the TMD group (P<0.05). In the control group, a significant relationship was found between medial pterygoid thickness on both sides and left foramen ovale length and hard palate transverse width values depending on gender (P<0.05). Significant differences were found in foramen rotundum width measurements in the comparison of the TMD and control groups (P<0.05).

Conclusion: This study demonstrates the relationship between craniofacial morphology, masticatory muscle thickness, and TMD. The findings suggest that anatomic features of the hard palate and sphenoid region may contribute to TMJ function and deepen the understanding of TMD's structural basis.

Objective: The superior cerebellar artery (SCA) is the most common offending vessel in microvascular decompression (MVD) for trigeminal neuralgia (TN). Among its variations, ventral compression presents unique surgical challenges, yet systematic classification remains limited. This study aimed to establish a novel intraoperative classification of ventral SCA compression and to evaluate its surgical and clinical relevance.

Methods: We retrospectively reviewed patients with TN who underwent MVD by the senior author between February 2019 and February 2024. Intraoperative video recordings were analyzed to categorize ventral-type SCA compression into 4 subtypes, based on the anatomic relationship with the trigeminal nerve and the facial-vestibulocochlear nerve complex. Patient demographics, operative findings, decompression techniques, and postoperative outcomes were compared across subtypes.

Results: Eighty-eight patients with SCA compression were identified and classified into 4 subtypes: type 0 (36.4%), SCA rostral to the trigeminal nerve; type I (35.2%), SCA ventral to the nerve without extending below its inferior border; type II (18.2%), SCA looping ventrally with its lowest point between the trigeminal and facial-vestibulocochlear nerves; and type III (10.2%), SCA extending ventrally beyond the superior border of the facial-vestibulocochlear complex. No statistically significant differences were observed in postoperative pain relief or complication rates across subtypes (P>0.05). However, surgical complexity varied considerably, with hidden compression at the trigeminal root entry zone and excessive vascular tortuosity contributing to greater intraoperative difficulty. Tailored surgical strategies, including the "push-and-flip" technique, enabled safe and effective decompression.

Conclusions: This study proposes a novel intraoperative classification of ventral SCA compression in TN. While short-term clinical outcomes were similar across subtypes, the classification emphasizes key anatomic variations that significantly affect surgical complexity. Recognition of these subtypes may facilitate operative planning, improve surgical safety, and reduce the risk of recurrence in patients undergoing MVD.

Objective: This study aimed to evaluate the efficacy of Xinghanxiang nasal inhalation therapy in treating obstructive sleep apnea-hypopnea syndrome (OSAHS) and its effects on upper airway inflammation.

Methods: A total of 180 patients with OSAHS were matched according to disease severity and randomly divided into a control group and an intervention group, with 90 patients in each group. In the control group, patients with mild OSAHS received routine therapy, whereas those with moderate to severe OSAHS received continuous positive airway pressure (CPAP) therapy. In the intervention group, patients with mild OSAHS received routine therapy plus Xinghanxiang nasal inhalation therapy, and those with moderate to severe OSAHS received routine therapy combined with Xinghanxiang nasal inhalation therapy along with CPAP therapy. Clinical symptoms, the Epworth Sleepiness Scale (ESS), apnea-hypopnea index (AHI), and levels of C-reactive protein (CRP) and interleukin (IL)-6 in nasal lavage fluid were evaluated.

Results: Both groups demonstrated significant improvements in clinical symptoms (including quality-of-life scores), ESS, and AHI compared with baseline (P<0.05), with greater improvement observed in the intervention group (P<0.05). CRP and IL-6 levels in nasal lavage fluid decreased significantly in both groups after treatment, with more pronounced reductions in the intervention group (P<0.05). CRP levels in nasal lavage fluid were lower in the intervention group than in the control group (P<0.05). IL-6 levels in nasal lavage fluid were significantly lower in patients with moderate to severe disease in the intervention group compared with the control group (P<0.05), whereas no significant difference was observed in patients with mild disease (P>0.05).

Conclusions: Xinghanxiang nasal inhalation therapy significantly improves clinical symptoms in patients with OSAHS. Combined therapy with CPAP further improves ESS and AHI, with no significant adverse effects, supporting the need for large-scale studies and broader clinical application. Furthermore, Xinghanxiang nasal inhalation therapy significantly reduces CRP and IL-6 levels in nasal lavage fluid, suggesting that its mechanism of action may be related to alleviation of upper airway inflammation.

Historically, management of craniosynostosis (CS) has been marked by substantial variation. Although recent advances in diagnostics, minimally invasive techniques, and computer-assisted planning might be expected to promote greater uniformity, significant differences persist, as shown in a large US survey of current practice patterns. To clarify the extent of heterogeneity in the Nordic countries (28 million inhabitants), the authors conducted a comprehensive survey of all centers treating CS in the region. All 11 centers responded (100%). Marked heterogeneity was evident across organizational structures, preferred surgical techniques, and follow-up routines. Although Norway has fully centralized treatment of CS, Denmark and Sweden divide management between 2 high-volume centers each, and Finland uses a mixed model combining major reference centers with smaller regional units. Surgical management of isolated sagittal synostosis also varies substantially, ranging from minimally invasive suturectomy with postoperative helmet therapy (9%) and spring-assisted cranioplasty (27%) to open suturectomy/strip craniectomy (9%) and more extensive cranial vault remodeling including H-craniectomy (55%). Syndromic and multi-suture cases are generally managed in multidisciplinary settings, although team composition differs between centers. Additional variation was seen in the use of computer-assisted planning, 3D models, intraoperative cutting guides, postoperative imaging, neurocognitive testing, craniometry, and patient-reported or parent-reported outcome measures. Despite advances in surgical techniques and technology, CS management across the Nordic region remains highly heterogeneous. Whether this variation affects neurocognitive, cosmetic, or functional outcomes is unknown. Future collaborative research will be essential to harmonize care and ensure optimal outcomes for children with craniosynostosis.

Background: Pituitary adenomas (PA) exhibit complex comorbidity with various psychiatric disorders, suggesting a potential shared genetic basis.

Objective: This study aims to explore the genetic correlation between PA and 8 psychiatric disorders, revealing potential shared pathogenic mechanisms.

Methods: This study utilized large-scale genome-wide association study (GWAS) summary data to systematically assess the genetic relationships between PA and psychiatric disorders through global genetic correlation analysis, local genetic correlation analysis, summary-data-based Mendelian randomization (SMR), and multitrait analysis of pleiotropic loci (MTAG).

Results: The study found significant genome-wide genetic correlations between PA and schizophrenia, anxiety disorders, bipolar disorder, and depression. Local genetic correlation analysis identified several significant regions, with 1674 (chr11: 64594823-66782661) prominently associated with PA's correlations with bipolar disorder (BD) and major depressive disorder (MDD). MTAG identified 1463 potential pleiotropic loci, whereas SMR analysis revealed 287 pleiotropic genes. Tissue-specific analysis and pathway enrichment analysis indicated that these genes are primarily enriched in synaptic transmission and ion channel activity pathways related to the hypothalamic-pituitary-adrenal (HPA) axis.

Conclusion: This study provides important evidence for understanding the genetic association between pituitary adenomas and psychiatric disorders, emphasizing the role of the HPA axis in the shared genetic etiology of both disease types and guiding future intervention strategies.

This bibliometric study analyses the top 50 most-cited articles on nasoethmoid orbital (NOE) fractures, sourced from PubMed and Scopus. Using VOSviewer software, the authors performed keyword co-occurrence analysis to identify thematic clusters and research trends. Four major clusters emerged: orbital fracture anatomy, facial trauma, CT imaging, and Nose Fracture & nasal injury. The findings highlight the dominance of anatomic complexity, imaging technologies, and surgical planning in NOE fracture literature. This study provides a structured overview of the field and suggests future directions for clinical and academic focus.

Mandibular symphysis segmentation for the correction of transverse deformities has been recently described in the literature, highlighting its potential in the management of dentofacial deformities. However, the use of osteosynthesis systems in this context has not yet been fully standardized, mainly due to the difficulty of obtaining standard plates with specific designs for these procedures. The aim of this report is to present a solution to this limitation using a standard plate that provides adequate spacing and 3-dimensional stability. This approach optimizes the osteosynthesis stage, reduces the amount of material required, and shortens surgical time.

Frontalis muscle flap suspension (FMFS) is a well-established surgical option for severe ptosis in patients with poor levator muscle function. Although its efficacy has been widely reported in congenital ptosis, the application of FMFS in elderly patients remains insufficiently addressed. Age-related anatomic and physiological changes, including chronic frontalis muscle hyperactivity, reduced tissue elasticity, and decreased ocular surface tolerance, may increase the risk of postoperative complications in this population. This retrospective case series presents 3 elderly male patients (aged 83-87 y) with severe ptosis and poor or absent levator function who underwent FMFS. Preoperative evaluation emphasized frontalis muscle activity, eyelid skin redundancy, brow-to-lid distance, and baseline ocular surface tolerance. Technical considerations included conservative skin excision, preservation of the palpebral orbicularis oculi muscle, avoidance of overcorrection, and flexible modification of flap design and fixation. All patients demonstrated improvement in upper eyelid position and functional visual field. Two patients achieved stable correction without clinically significant lagophthalmos, ectropion, or ocular surface complications. One patient with a severe sunken upper eyelid and a long brow-to-lid distance developed early postoperative overcorrection and lagophthalmos, which were successfully managed with revision surgery using an inferiorly based orbital septal flap. These cases highlight that FMFS can be safely and effectively applied in elderly patients with severe ptosis when age-specific anatomic and functional factors are carefully considered. Meticulous surgical planning and individualized technical adjustments are essential to minimize complications and achieve stable outcomes in this challenging patient population.