Journal of Craniofacial Surgery最新文献

Background: The debate continues among craniofacial surgeons regarding the effectiveness of strip craniectomy (SC) compared with cranial vault remodeling (CVR) in achieving optimal functional and aesthetic outcomes in patients with single-suture craniosynostosis. This study aimed to compare long-term patient-reported outcomes (PROs) between SC and CVR procedures at a single institution using the validated FACE-Q Craniofacial module.

Methods: Patients older than or equal to 8 years of age and parents of patients younger than 8 years of age who underwent SC or CVR for single-suture craniosynostosis were eligible. Patients with <2 years of follow-up, lambdoid synostosis, and syndromes were excluded. Primary endpoints were PROs as measured by the FACE-Q, with higher scores indicating increased health-related quality of life. Linear regression was used to control for covariates.

Results: Sixty-two participants completed the module (response rate 33.3%). SC was performed in 29 patients (46.8%), and CVR in 33 patients (53.2%). On unadjusted bivariate analysis, SC patients had higher eye (P=0.03) and forehead (P=0.05) scores. On regression analysis, controlling for sex, race, craniosynostosis type, and follow-up, there were no significant differences between operation types in any domain. Metopic and sagittal synostosis were associated with higher Eye (metopic: 17.61, P=0.049; sagittal: 41.44, P<0.001) and Head scores (metopic: 48.12, P=0.001; sagittal: 49.35, P<0.001), and sagittal synostosis was associated with higher Face (38.16, P<0.001), Forehead (55.93, P<0.001), and Nose scores (19.28, P=0.003).

Conclusions: From patients' and parents' perspectives at a single institution, SC and CVR were equivalent regarding aesthetics and health-related quality of life.

There are reported here multiple rare anatomical variants of the sphenoidal sinus found in a 53-year-old male. The sinus exhibited uncommon features, including a prominent occipital recess extending bilaterally into the basilar part of the occipital bone. A narrow posterior isthmus connected the main chamber to 2 recesses: a superior postsellar recess pneumatising the dorsum sellae, and a postero-inferior occipital recess. The latter extended into the right basilar occipital bone, closely associated with the right hypoglossal canal and coursing alongside the right internal carotid artery. In addition, the sphenoidal sinus had a maxillary recess projecting above the pterygopalatine fossa and joining the right maxillary sinus and bilateral pterygoid recesses. Notably, the left vidian canal was situated superior to the pterygoid recess with no pneumatic space between it and the foramen rotundum, unlike the right side. These anatomical variants are clinically significant due to their proximity to vital neurovascular structures, increasing surgical risks. Partial ossification of the falx cerebri was also identified, potentially complicating neurosurgical procedures.

Background: Facial fractures in children are less common than in adults but can lead to significant long-term complications, including growth abnormalities and functional issues. Mandibular fractures are the most common facial fractures in both age groups, yet there is no consensus on optimal management strategies. This study investigates the epidemiology, presentation, treatment, and outcomes of mandibular fractures in pediatric versus adult populations.

Methods: The authors conducted a retrospective, population-based study using 2016 to 2019 data from the National Trauma Data Bank. Patients with mandibular fractures were categorized into pediatric (below 18 y) and adult (18 y or above) groups. The authors analyzed demographics, fracture mechanism, treatment modality, hospital outcome, and complication data.

Results: Of the 42,866 patients with operative mandibular fractures, 3968 were pediatric (mean age: 13.3 y), and 38,898 were adult (mean age: 36.2 y). The primary fracture etiology for both groups was being struck, followed by motor vehicle incidents and falls. Pediatric patients were more frequently treated at level I trauma centers, had shorter times for surgical intervention, and were more frequently transferred to other facilities compared to adults. Antibiotic use was similar between groups, and hospital complications were infrequent, with low rates of infection and unplanned return to the operating room.

Conclusions: Mandibular fractures in children, though less common than in adults, exhibit unique epidemiological and management characteristics. Children were more frequently transferred for care and received surgical intervention sooner than adults. Antibiotic use and complication rates were low and similar across both groups. Further research is needed to establish specific treatment guidelines for pediatric mandibular fractures.

Objective: To investigate a clinical case of simultaneous implantation therapy for a patient with fibroskeletal disease of the jaw, and to provide a clinical basis for the treatment of such patients by clinical prosthetists.

Methods: The clinical data of a patient with fibroskeletal disease of the jaw undergoing implant treatment were collected, and the clinical repair plan for this patient was discussed by reviewing the literature.

Results: The patient, a female, 49 years old, right upper posterior tooth missing for 1 year, through the maxillofacial surgery consultation, according to the imaging data, the maxillary fibroskeletal lesions were considered. The tumor was removed, bone regeneration was guided, and microimplants were implanted at the same time. Cone Beam Computed Tomography was performed at 3, 9, and 20 months postoperatively, and according to clinical evaluation, the patient did not show any signs of recurrence. At the same time, a literature search was conducted to summarize the data on simultaneous implantation therapy for fibroskeletal lesions of the jaw.

Conclusion: The treatment plan of tumor removal → guided bone regeneration → simultaneous implantation of microimplants can effectively achieve implant repair and reduce the failure rate of implants in patients with jaw fibroskeletal lesions.

To our knowledge, there has not been a review article summarizing the current evidence with regard to perinatal risk factors, and our aim is to perform a systematic review and meta-analysis of the evidence of perinatal risk factors in single suture craniosynostosis to inform our practice and identify any need for further research in this area. Our target population was pediatric single-suture craniosynostosis patients, and the intervention was perinatal risk factors. The comparison group was an age and sex-matched control group without craniosynostosis and the outcome we investigated was presence of single suture craniosynostosis. The literature search was done using OVID MEDLINE, Pubmed, and Embase databases from 1946 to 2023. A PRISMA flowchart was created, and statistical analysis was performed using RevMan pooled odds ratios, and 95% CIs were used to combine results from individual studies. Our initial search identified 625 abstracts and these were narrowed down to 16 articles, which were included in the final selection for the review. Out of these, 13 were used for the quantitative meta-analysis. Our meta-analysis showed a possible association between craniosynostosis and the following perinatal risk factors; presence of maternal thyroid disease, maternal age greater than 29, paternal age greater than 29, maternal smoking, gestational age above 37 weeks, and maternal underweight (BMI<18.5). Further prospective studies are warranted to investigate definite associations. The next step is to set up a multicenter prospective study among a craniofacial unit network.

This retrospective observational study evaluates the trans-tragal approach for the treatment of mandibular head and neck condylar fractures. From January 2009 to May 2024, 34 patients (20 males, 14 females, mean age 34 years) with 36 condylar fractures were treated using this approach. Surgical outcomes were assessed based on occlusal relationship, maximum mouth opening, and facial nerve function (House-Brackmann scale). Postoperative imaging included computed tomography scans, with follow-ups at 1, 3, 6 months, and 1 year. Complications such as wound infection, hematoma, and salivary fistula were also evaluated. Results showed satisfactory postoperative outcomes, with 32 patients maintaining normal occlusion and a mean interincisal opening distance of 40 mm. Three patients experienced complications, including temporary facial nerve numbness in one case, with complete recovery in 2 weeks, and 2 cases requiring reoperation due to condylar segment displacement. No cases of permanent facial nerve damage, salivary fistula, or tragal cartilage necrosis were observed. Aesthetic outcomes were satisfactory, with scars hidden in natural folds. The trans-tragal approach provides adequate surgical exposure to the posterior condylar region while minimizing the risk of facial nerve injury. Although the results of this study indicate favorable outcomes, further randomized controlled studies are required to validate these findings due to the non-randomized design and small sample size.

Cleft lip and palate are the most common congenital anomalies of the cranial segment worldwide. Particularly in low-income and middle-income countries, these conditions are associated with increased morbidity and mortality, socioeconomic challenges, and considerable psychological and social integration difficulties for affected individuals. This study aims to evaluate the epidemiological profile of patients with these conditions treated at a newly established specialized center in the Brazilian Amazonian Region. Data were extracted from medical records at a Reference Service for Clefts and Craniofacial Anomalies in the north of Brazil, covering the period from 2016 to 2020. These were compared with data from the official epidemiological health portal of the Brazilian Ministry of Health. The study recorded a total of 852 patients, with males comprising 54.4%. The predominant type of cleft was the transforaminal cleft, which accounted for 69.4% of cases, followed by postforamen clefts at 17.3%. The left side was more frequently affected in 63% of the cases. The primary surgical intervention performed was cheiloplasty, representing 39.5% of all procedures. Notably, 52% of the patients were from the interior regions of the state. The 2019 DataSUS data indicated a prevalence of cleft lip and palate in the State of Pará of 4.26 per 10,000 live births. However, data from this single specialized hospital showed a higher prevalence of 7.58 per 10,000 live births. These results may reflect underreporting of the number of cases reported in national official data sets.

Fracture of surgical instruments in dental practice is not usually reported in the literature. Management involves searching for and retrieving the fragment to avoid issues such as infection, swallowing, or aspiration. Although foreign bodies may not cause symptoms for years, some can cause chronic pain. The authors describe herein the unusual case of an unintentionally retained broken elevator blade left for 8 years before being found during an orthodontic evaluation. Panoramic radiography revealed a foreign body in the alveolar bone of the right mandibular third molar that was causing mild chronic pain. The patient was unaware whether routine radiographic examination had revealed its presence. Cone-beam computer tomography was performed to identify the position of the blade fragment, and surgery was performed to retrieve it. The mild chronic pain disappeared after removal. It is advisable to use high-quality surgical instruments and to perform routine checkups before and after surgery.

Introduction: Over the past decade, there has been an improvement in access to gender-affirming surgical care for the transgender population. Even with improvements, this population continues with a high level of inequity among access to specialized surgical care. While multiple studies have previously focused on trends among top and bottom surgery, this study provides trends specifically among facial gender affirmation surgery (FGAS) within the United States.

Methods: The National Inpatient Sample (NIS) was utilized to identify patients who underwent FGAS from 2012 to 2019. The diagnostic codes for gender identity disorder and gender dysphoria were used to identify the desired patient population. CPT coding released in a medical policy for transgender care coverage was used to identify those who underwent FGAS. Frequency distributions from the patient population were analyzed to determine differences among characteristics.

Results: In total, 660 patients underwent FGAS from 2012 to 2019. The incidence of FGAS has increased by 1433%. Geographically, FGAS was more likely to be performed in the West and Northeast geographical regions (P<0.0001). There was a statistically significant difference in hospital length of stay and the total number of charges when stratified by race (P<0.0001 and P=0.0003), hospital location (P<0.0001 and <0.0001), and insurance type (P<0.0001 and <0.0001). The largest cohort of patients paid out-of-pocket (P<0.0001).

Conclusions: FGAS is one of the fastest-growing GAS procedures. Currently, FGAS procedures are not equally distributed, with higher concentrations occurring among wealthier, white individuals in certain geographical regions. Future studies are warranted to understand further trends within FGAS.

Dacryocystography (DCG) has been used to illustrate the morphological and functional aspects of the lacrimal drainage system in the evaluation of patients with maxillofacial trauma and epiphora. This study developed deep-learning models for the automatic classification of the status of the lacrimal passage based on DCG. The authors collected 719 DCG images from 430 patients with nasolacrimal duct obstruction. The obstruction images were further manually categorized into 2 binary categories based on the location of the obstruction: (1) upper obstruction and (2) lower obstruction. An upper obstruction was defined as one occurring within the canaliculus or common canaliculus, whereas a lower obstruction was defined as one within the lacrimal sac, duct-sac junction, or nasolacrimal duct. The authors then established a deep-learning model to automatically determine whether a passage was patent or obstruction. The accuracy, precision, sensitivity, F1 score, and area under the receiver operating characteristic curve for the evaluation set of each deep-learning model were 99.3%, 98.8%, 99.5%, 99.2%, and 0.9998, respectively, for obstruction detection, and 95.5%, 93.0%, 93.0%, 93.0%, and 0.9778 for classifying the obstruction location. Both receiver operating characteristic curves were skewed toward the left-upper region, indicating the high reliability of these models. The high accuracies of the obstruction detection model (99.3%) and the obstruction classification model (95.5%) demonstrate that deep-learning models can be reliable diagnostic tools for DCG images. This deep-learning model could enhance diagnostic consistency, enable non-specialists to interpret results accurately and facilitate the efficient allocation of medical resources.