Journal of Craniofacial Surgery最新文献

Background: Double eyelid blepharoplasty, a procedure to create a supratarsal fold in the upper eyelid, is among the most frequently performed aesthetic surgeries in East Asian populations. The buried suture technique is often preferred due to its ability to produce natural-appearing results with minimal scarring, procedural simplicity, and reversibility. A continuous variation of this technique has recently gained popularity due to its reversibility; however, the optimal suture length required for this method has not been previously established. This study aimed to identify the optimal suture length for the continuous buried suture technique in double eyelid blepharoplasty, with the aim of enhancing procedural precision, reducing the learning curve, minimizing postoperative complications, and improving patient satisfaction.

Methods: A total of 74 patients who underwent double eyelid blepharoplasty using the continuous buried suture technique between March and August 2024 were retrospectively analyzed. The effective suture length used was calculated by subtracting the lengths of the residual and excised tail segments from the original suture length.

Results: The required suture length varied across individuals, with the majority ranging between 60 and 70 mm. The mean suture length was 66.9±1.7 mm for the left upper eyelid and 69.5±1.9 mm for the right, with a statistical significant difference between the 2 sides (P<0.05), indicating a longer length requirement on the right.

Conclusion: This study addresses a previously unexamined aspect of the continuous buried suture technique by providing quantitative data on optimal suture length. The findings provide practical guidance for surgeons, potentially reducing procedural variability, shortening the learning curve, and improving surgical outcomes and patient satisfaction.

Retrograde cricopharyngeal dysfunction or R-CPD has a variety of symptoms including the inability to belch. Often, physical examination and additional testing reveal no abnormalities. Botulinum toxin injections into the cricopharyngeal muscle is the most described treatment in patients with R-CPD. Dosages range from 10 to 200 units, injected in one or several sites of the cricopharyngeal muscle. This study is a retrospective case series study of 3 consecutive patients referred for botulinum toxin injection in the cricopharyngeal muscle after diagnostic work-up for inability to belch. The dose ranged from 12.5 to 17.5 units. A clinical swallowing evaluation was carried out by a speech-language pathologist either before or after surgery in 2 out of 3 patients. Low dose botulinum toxin injection resulted in symptomatic improvement in all 3 patients. Two out of the 3 patients did require revision surgery for this improvement to occur. There were no intraoperative or postoperative complications. A clinical swallowing evaluation demonstrated a hypertonia of the neck musculature combined with weak tongue strength in 2 out of the 3 patients. Low dose botulinum toxin injection is an effective but unpredictable treatment in this case series of three patients. All patients had an improvement of symptoms but 2 patients required revision surgery for this improvement to occur.

Objective: This study aimed to evaluate and compare the accuracy, reliability, and comprehensibility of information provided by 4 artificial intelligence (AI)-based language models (ChatGPT-4, Google Gemini, Microsoft Copilot, and DeepSeek-v3) for orthognathic surgery.

Methods: A cross-sectional content analysis was carried out to evaluate the responses generated by ChatGPT-4, Gemini, Copilot, and DeepSeek-v3. A total of 118 questions covering 12 domains related to orthognathic surgery were formulated, and the AI-generated answers were systematically assessed. A 5-point Likert scale was used to independently score the responses. Descriptive statistics were used. The Fisher exact test was applied to examine relationships between categorical variables when the expected value was <5. All analyses were performed by the IBM SPSS 27 program.

Results: Significant differences were observed among the AI models (P=0.022). DeepSeek-v3 demonstrated the highest proportion of objectively true responses (87.3%), outperforming Gemini, ChatGPT-4, and Copilot. While ChatGPT-4 and DeepSeek-v3 performed significantly better in the "postoperative" domain by providing "objectively true" answers (P=0.038), Gemini and Copilot generated a greater proportion of "selected facts." Domain-specific variations were statistically significant only for Gemini (P<0.001).

Conclusions: The results indicate that the reliability of AI-assisted language models in delivering medical information is subject to variation depending on the specific topic addressed. In its first comparative assessment within this study, DeepSeek-v3 outperformed the other evaluated models in terms of informational accuracy.

This study investigates how socioeconomic status, insurance type, and geography shape access to inpatient synthetic facial implant surgery in the United States. Using HCUP-NIS data from 2016 to 2020 (n=68), the authors show that lower-income patients are more likely to be publicly insured, experience significantly longer hospital stays, and are underrepresented in cosmetic and gender dysphoria-related procedures, while higher-income, urban patients more often self-pay for elective implants clustered in large metropolitan and Pacific regions. Despite low overall complication rates, inpatient admissions are associated with high costs, and rural and low-income patients face pronounced barriers to care, particularly for facial feminization surgery. This work highlights the need for broader outpatient data capture, qualitative research among marginalized groups, and standardized insurance coverage policies to promote equitable, cost-effective access to functional and aesthetic facial implant procedures.

Laryngeal cancer invasion and metastasis, the primary causes of mortality, have generated a vast scientific knowledge base. This study employs bibliometrics to decode this intellectual landscape, mapping its evolutionary structure and identifying pivotal collaborations. Based on 3866 publications retrieved from the Web of Science Core Collection (1996-2025), a comprehensive visual analysis was conducted using VOSviewer and COOC. The results reveal a robust upward trend in scholarly output, with China emerging as the dominant contributor. Fudan University, Harbin Medical University, and Sun Yat-sen University led in publication volume, while network analysis identified Harbin Medical University and the Chinese Academy of Medical Sciences as central collaborative hubs. Thematically, research has concentrated on "Prognosis," "Radiotherapy," and "Neck Dissection," forming distinct, specialized clusters. In conclusion, this bibliometric analysis reveals a China-led surge in research driven by key clinical themes. However, the field is characterized by specialized clusters rather than a fully integrated network. Future progress requires fostering synergistic global collaborations to bridge these thematic divides and accelerate clinical translation.

To summarize the clinical characteristics, key imaging diagnostic points, surgical treatment strategies, and prognosis of sellar pituitary adenoma complicated with Rathke cleft cyst (RCC). A retrospective analysis was conducted on the clinical data of 4 patients with pathologically confirmed sellar pituitary adenoma complicated with RCC who underwent endoscopic transsphenoidal surgery in the Department of Neurosurgery of the authors' hospital from January 2017 to March 2025. The data included preoperative symptoms, imaging findings, surgical methods, and follow-up results, and a comprehensive analysis was performed in combination with domestic and international literature. The 4 patients were aged 28 to 66 years, including 3 males and 1 female. The main symptoms were decreased visual acuity, headache, and acromegaly. MRI showed "cystic + solid" mixed space-occupying lesions in the sellar region: the solid part was enhanced on contrast-enhanced scans, while the cystic part was nonenhanced. All patients underwent lesion resection through the endoscopic transsphenoidal approach, with clear intraoperative separation of cystic structures and solid tumors. Pathologic confirmation was obtained postoperatively. During the 6 to 48 months of follow-up, all 4 patients achieved significant symptom relief, normalized hormone levels, no severe complications such as cerebrospinal fluid leakage or intracranial infection, and no recurrence was observed on reexamination MRI. Sellar pituitary adenoma complicated with RCC is clinically rare. Preoperative MRI showing "double-layered signal" is an important diagnostic clue. The endoscopic transsphenoidal approach is a safe and effective treatment method, and long-term postoperative follow-up of hormone levels and imaging changes is required.

Background: Metopic craniosynostosis (MCS) is defined by premature fusion of the metopic suture, resulting in trigonocephaly and potential neurodevelopmental implications. Advances in diagnosis and treatment over the past 2 decades have improved landmarking and evaluation using objective imaging metrics. While computed tomography (CT) remains the diagnostic standard, concerns over pediatric radiation exposure have increased reliance on 3D photogrammetry. Both modalities, however, have limitations in capturing the full range of craniofacial dysmorphology. This systematic review evaluates current craniometric parameters and emerging machine learning (ML) models used to assess MCS morphology.

Methods: A systematic search of PubMed and Google Scholar, following PRISMA guidelines, identified English-language studies reporting imaging-based craniometric or ML methods for MCS assessment. Extracted outcomes included severity metrics, roles in surgical decision-making, and postoperative evaluation. Due to study heterogeneity, findings were descriptively synthesized.

Results: Fifty-eight studies involving 9068 patients met the inclusion criteria. A total of 2425 (26.7%) had MCS. CT was the most common imaging modality (78.4%), followed by 3D (15.7%) and 2D (7.8%) photogrammetry. Over 100 craniometric parameters were reported, most frequently the interfrontal angle (IFA) and endocranial bifrontal angle (EBA). Eighteen studies (31%) utilized ML models introducing indices such as the Metopic Severity Score, Cranial Morphology Deviation score, and Head Shape Anomaly index, which showed high diagnostic accuracy for severity grading and outcome prediction.

Conclusions: CT-based metrics remain standard, but ML models using advanced imaging offer radiation-free, objective, and reproducible assessments. Future efforts should emphasize multicenter data sharing, standardized variables, longitudinal imaging, and integration of genotypic and neuropsychological data.

Background: The aim of this study is to evaluate the effect of using local anesthesia at the incision area during external dacryocystorhinostomy (E-DCR) to control intraoperative hemorrhage on hemodynamic and clinical outcomes.

Methods: All patients aged 18 years and older who underwent external dacryocystorhinostomy at Niğde Training and Research Hospital between January 2024 and March 2025 with a diagnosis of primary acquired nasolacrimal duct obstruction were included in the study. Patients included in the study were randomly divided into 2 groups: those who used local anesthesia (20 mg/mL lidocaine hydrochloride and 0.0125 mg/mL epinephrine, 3 mL) at the incision site during surgery (group 1) and those who did not (group 2). Hemodynamic parameters were measured at three different time points: before osteotomy, during osteotomy, and after osteotomy. Postoperative pain was assessed using the visual analog scale (VAS) score at 0, 2, 6, and 12 hours postoperatively.

Results: A total of 39 patients were included in the study. While the average intraoperative hemorrhage was 4.2±1.0 mL in group 1, 6.6±1.2 mL in group 2. This difference observed between the groups was statistically significant (P<0.001). The average patient satisfaction score was 8.4±0.8 in group 1 and 7.4±0.7 in group 2, and significantly higher in group 1 (P<0.001).

Conclusions: In conclusion, when the appropriate anatomical approach is used during E-DCR, local anesthesia improves visibility of the surgical area. It also prevents unnecessary cauterization and may increase postoperative patient satisfaction. This approach is a safe and effective method for patients with acquired nasolacrimal duct obstruction.

Background: Nasal bone fractures are the most common type of facial bone fracture. Closed reduction is the standard treatment and is typically followed by intranasal packing. Conventional materials such as Vaseline or Furacin roll gauze and Merocel are widely used, but biodegradable synthetic polyurethane foam (SPF, Nasopore) has recently gained popularity as it does not require removal. This study focused on postoperative pain primarily caused by mucosal injury, and investigated whether polyvinylpyrrolidone (PVP), a mucosal protective agent, could reduce pain when applied to SPF packing.

Methods: A retrospective review was conducted of 117 patients who underwent closed reduction for nasal bone fractures at the authors' hospital between March 2019 and February 2022. Sixty patients received PVP-soaked SPF, while 57 patients received SPF alone. Postoperative pain was assessed by comparing the mean frequency of daily analgesic administrations during hospitalization.

Results: Of the 117 patients, 57 were included in the SPF group (group A) and 60 in the PVP-SPF group (group B). The mean frequency of analgesic administration until postoperative day 2 was 0.68 in group A and 0.50 in group B, demonstrating a significantly lower analgesic requirement in the PVP-SPF group (P = 0.013).

Conclusion: Following closed reduction of nasal bone fractures, intranasal packing serves to stabilize the fracture site, achieve hemostasis, and protect the nasal mucosa. As pain is predominantly derived from mucosal injury rather than osseous movement, the use of PVP-soaked SPF may effectively reduce postoperative discomfort and improve patient satisfaction. These findings suggest that PVP-soaked SPF represents a valuable option for postoperative nasal packing.

This study aimed to establish a CT-based normalization protocol for the mandibular condylar (CoP) and coronoid (CrP) processes and to determine whether pathology-specific patterns can be distinguished from physiologic variation. Retrospective CT data of 251 patients without mandibular pathology (502 hemi-mandibles) were analyzed. Posterior mandibular height (PMH) was defined as the distance between the mandibular angle tangent and the deepest point of the mandibular notch. CoP and CrP lengths were measured perpendicular to this baseline and expressed as CoP/PMH and CrP/PMH ratios. Additional CT scans of patients with coronoid hyperplasia (n=7; 12 sides), condylar hyperplasia (n=8; 9 sides), and condylar resorption (n=7; 10 sides) were evaluated, and associations between pathology and normalized ratios were examined using linear mixed-effects models. In the control group, both ratios showed narrow prediction intervals and defined reference values. Coronoid hyperplasia was associated with a significantly increased CrP/PMH ratio, condylar hyperplasia with an increased CoP/PMH ratio, and condylar resorption with a decreased CoP/PMH ratio, demonstrating distinct, pathology-specific measurement patterns. Normalizing posterior mandibular process lengths to PMH effectively reduces interindividual variability and differentiates physiologic from pathologic changes on routine CT. The protocol is applicable to both CT and CBCT and may support earlier recognition and monitoring of mandibular alterations. Larger prospective studies and correlation with clinical severity and functional imaging are needed to refine diagnostic thresholds and further standardize quantitative craniofacial assessment.