Journal of Craniofacial Surgery最新文献

The expanded forehead flap based on the frontal branch of the superficial temporal artery (STA-Fbr) is a versatile technique for reconstructing cervicofacial defects. The aim of this study was to summarize STA-Fbr forehead flap harvesting patterns. Between July 2003 and July 2023, 66 patients (43 males) underwent face and neck defect reconstruction using STA-Fbr-based forehead flaps. These were divided into pattern I (vascular-pedicled) and pattern II (cutaneous-pedicled) flaps. Pattern II was subdivided into unilateral (IIa) and bilateral (IIb) cutaneous-pedicled flaps. Pattern IIa flaps were categorized as traditional or scarless based on pedicle location. Of the 66 flaps, 62 survived without perfusion-related complications. There were 10 Pattern I and 56 pattern II flaps (11 traditional IIa, 19 scarless IIa, and 26 IIb). Venous congestion occurred in 3 pattern I and 1 scarless IIa flap. After conservative management, 3 flaps survived; 1 pattern I flap developed distal necrosis. Defects were located in the temporal region, eyebrow, eyelid, nose, cheek, ear, mentum, and neck. Expanders ranged from 50 to 400 mL (average: 236 mL), with expansion times of 3 to 16 months (average: 5.9 mo). Defect dimensions ranged from 3 × 2 cm to 27 × 8 cm (average: 10.8 × 5.3 cm), and flap dimensions ranged from 4 × 3 cm to 30 × 9 cm (average: 16.3 × 6.6 cm). The STA-Fbr-based forehead flap remains a reliable and effective option for cervicofacial defect reconstruction, delivering functional and aesthetic outcomes. Successful surgery requires thorough anatomical knowledge, meticulous flap design, and in-depth patient communication.

Although scaffold materials serve as effective bone substitutes for mandibular reconstruction, their high resorption and biodegradation rates decrease the success of the therapeutic effect. This study aims to explore the bone regenerative potential of bovine-derived osteoid matrix xenografts coupled with cell-free treatments. The study was conducted as a randomized in vivo experiment to repair critical-sized defects in rabbit mandibles. Two treatment groups were established with 10 rabbits: the right hemimandibles were reconstructed with xenograft (control), and the left hemimandibles were reconstructed with dental pulp stem cell (DPSCs)-derived exosomes soaked xenograft (experimental group) within the same rabbit. Micro-computed tomography and histologic analysis were performed at 4 weeks postoperatively. The histopathologic analysis revealed a significant difference in new bone formation scores between the experimental group (4.87±0.78) and the control group (2.87±0.41). Although the micro-computer tomography analysis did not show a statistically significant difference in new bone volume and surface between the groups, it did reveal that the experimental group had greater bone mineral density, trabecular thickness, and separation. The combination of DPSCs-derived exosomes and xenografts proved to be a promising strategy for enhancing new bone formation and regenerative scores in repairing critical-size defects in rabbit mandibles.

Introduction: The strategy of adipose component transplantation has been proposed and widely used in both reconstructive and aesthetic surgery. However, there is no uniform standard for the preparation of component fat, and the volume calculation of liposuction and injection in clinical applications is mostly based on experience. This study aims to analyze the volume of component fat obtained during clinical series.

Methods: Patients undergoing abdominal or thigh liposuction and autologous component fat grafting from September 2020 to October 2024 were included. The high-density fat was harvested from the inferior one-third layer of the standard Coleman fat. The SVF-gel was obtained by mechanical emulsification and centrifugation of the oil layer and upper two-third layer of adipose tissue. Correlation analysis was conducted between the volume of SVF-gel and patient characteristics.

Results: Sixty-five with an average age of 33.9 years were included. For breast augmentation, the volume of prepared high-density fat and SVF-gel were 331.7±70.8 and 60.3±13.1 mL, with the proportion of SVF in fat aspirated amounting to 6.4%±1.9%. For the treatment of temporal depression, the volume of prepared high-density fat and SVF-gel were 48.3±27.3 and 14.5±8.6 mL, respectively, with the proportion of SVF in fat aspirated amounting to 10.3%±2.0%. There was a significant difference between the proportion of SVF-gel in low-density fat and aspirated fat obtained from the abdomen and thigh.

Conclusion: There is a significant negative correlation between the obtained SVF-gel proportion with BMI and the amount of fat aspirated. For the preparation of a large amount of SVF-gel, especially for individuals with high levels of BMI, the total volume of fat aspirated would be much higher.

Level of evidence: Level IV.

A 37-year-old woman with a history of facelift surgery presented with a painless temporal mass after surfboard trauma. Physical examination revealed a 1 cm pulsatile mass, and ultrasound confirmed a superficial temporal artery pseudoaneurysm. Surgical excision was complicated by adhesions from previous facial surgery and steroid injections. Histopathology showed vessel wall disruption and fibrosis consistent with pseudoaneurysm. This case highlights the potential risk of vascular complications in patients with prior aesthetic procedures, emphasizing the need for careful evaluation of persistent swelling in this population. Surgeons should exercise caution during temporal region procedures and maintain vigilance for delayed vascular complications in previously operated areas.

Reconstructing severe cervical scar contractures (SCSC) remains a considerable challenge. This study presents a novel approach to SCSC reconstruction using a combination of pre-expanded bipedicled forehead and lower trapezius musculocutaneous flaps. A retrospective analysis was conducted on 25 patients who underwent this procedure between April 2004 and July 2020. Sixteen patients received a forehead flap combined with a unilateral lower trapezius musculocutaneous flap; in contrast, 9 patients underwent reconstruction using bilateral lower trapezius musculocutaneous flaps. The surgery was performed in 4 stages. First, tissue expanders were inserted into the forehead and back. After sufficient expansion, the lower trapezius musculocutaneous flap(s) were transferred to repair cervicothoracic contractures in the second stage. In the third stage, the pre-expanded bipedicled forehead flaps were elevated to reconstruct lower facial and submental defects. Finally, the forehead flap pedicle was divided after 3 weeks. Patient demographics and surgical outcomes were collected and analyzed. All flaps survived without perfusion-related complications. Postoperatively, improvements were observed in neck range of motion, inferior mandibular border definition, and subhyoid depression. The cervicomental angle reduced considerably from 177.08±1.28 degrees to 106.6±1.18 degrees. In addition, the color and texture of the reconstructed flaps matched the adjacent skin. No scar contracture recurrence was reported during follow-up, which ranged from 4 months to 8 years. The technique, combining pre-expanded bipedicled forehead and lower trapezius musculocutaneous flaps, provides excellent functional and aesthetic outcomes for SCSC reconstruction. It effectively restores the cervicomental angle, inferior mandibular borders, and subhyoid depressions.

Aim: The aim of this study was to investigate the impact of the Lean Six Sigma management approach on the standardization of nurses' prefilled anticoagulant subcutaneous injection practices, with a focus on improving anticoagulation outcomes, reducing patient complications, and enhancing overall patient satisfaction.

Background: The lack of standards for prefilled anticoagulant injection has resulted in a high complication rate, decreased patient satisfaction, and diminished service quality. This study investigated the impact of the Lean Six Sigma management approach on the standardization of nurses' prefilled anticoagulant subcutaneous injection practices.

Methods: This study compared pre-implementation and post-implementation data from Lean Six Sigma. A baseline investigation was conducted to determine the type and incidence of complications caused by anticoagulant injection. The nurses' injection process was observed and analyzed to determine problems with the injection technology and the reasons for the reduction in injection quality. Solutions were developed to address these root causes, including formulating a standard process for the subcutaneous injection of preperfusion anticoagulant; recording teaching videos; formulating the standard operating procedure (SOP) while refining, quantifying, and optimizing the operation steps as much as possible; and making an injection site rotation card. Comparative assessments were conducted pre-training and post-training, focusing on nurses' knowledge, standardization of operations, duration of procedures, patient complication rates, and satisfaction with nursing care.

Result: Post-training, there was a significant increase in nurses' knowledge and standardization of injection procedures. In addition, there was a notable reduction in the duration of the procedure and patient complications and an increase in patient satisfaction (P<0.01 or P<0.05).

Conclusion: Implementing the Lean Six Sigma management approach effectively standardized nursing procedures for prefilled anticoagulant subcutaneous injections, improved anticoagulation outcomes, minimized patient complications, reduced injection time, and elevated the overall quality of clinical nursing and patient satisfaction.

Introduction: In facial cosmetic surgery, injectable liquid silicone has been used to augment the cheek and the lips and to camouflage facial wrinkles. However, complications started to arise in 1964 as postoperative silicone granuloma formation. The purpose of this study is to introduce our experience in facial reconstruction after injectable silicon oil with a sequential 3-step approach: transoral surgical excision, full-face fat grafting, and hyaluronic acid filler.

Methods: A retrospective study was conducted for all patients affected by facial granulomatosis due to liquid silicone injection who underwent surgical treatment between January 2018 and June 2020 at the Unit of Maxillo-Facial Surgery at the Hospital "Policlinico San Martino" (Genoa, Italy).

Results: Three female patients completed the entire surgical pathway. The mean age of the patients at the time of surgery was 58.7 years (range, 52-65 y). There was no clinical recurrence of the facial deformity during a mean follow-up of 14 months. Apart from the standard postoperative discomforts such as bruising, edema, and pain, the authors did not observe major complications.

Conclusions: Our 3-step approach is a safe and viable option that can be offered to motivated patients affected by granulomatous facial reactions.

Level of evidencebased medicine ebm: Level 3.

Introduction: Pediatric craniofacial trauma, particularly from non-accidental trauma (NAT), is a significant cause of injury with enduring physical and psychological impacts. This study analyzes demographic patterns, injury characteristics, and trends in NAT-related craniofacial injuries to inform early identification, intervention, and prevention efforts.

Methods: Analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed for the years 2009 to 2019. Patients aged 0 to 17 with craniofacial injuries and a diagnosis of non-accidental trauma were identified based on current procedural codes; demographic and temporal trends were analyzed.

Results: Overall, 306,115 patients with craniofacial injuries and 20,540 patients with non-accidental trauma (NAT) were identified. Patients with NAT represented 2.6% of all craniofacial injuries, with a greater proportion of males affected. On average, 39% of all NAT cases involved a craniofacial injury. The most common injury patterns were intracranial (50.1%), superficial head injuries (37.7%), and craniofacial fractures (31.9%. Isolated facial fractures were rare, comprising <1% of all cases. Although the average in-hospital mortality was 6.78%, temporal analysis demonstrated significant reductions in in-hospital mortality and length of hospitalization (P<0.001).

Conclusions: Pediatric craniofacial injuries from NAT remain a significant public health concern. However, the observed decrease in both hospitalization length and in-hospital deaths suggests improvements in early intervention and treatment outcomes. Continued efforts to refine diagnostic strategies, enhance provider awareness, and strengthen prevention initiatives are essential to mitigate the devastating impacts of NAT in the pediatric population.

Purpose: This study aimed to investigate frontal sinus volume as a potential indicator of cranial compensatory growth in unoperated normocephalic nonsyndromic sagittal craniosynostosis (NNSC) patients compared with age-matched and sex-matched controls. Previous studies have suggested that frontal sinus volume is suppressed in unoperated craniosynostosis and may be an intracranial space conservation phenomenon.

Methods: Head computed tomographies (CTs) from 22 unoperated NNSC patients at our institution were utilized in this study and matched with age-matched and sex-matched control subjects. Frontal sinus volumes were measured using Syngo.Via, and statistical analysis was performed. Inclusion criteria for patients included the presence of a frontal sinus with unoperated sagittal craniosynostosis, whereas inclusion criteria for controls included the presence of a frontal sinus and no craniofacial trauma. Pearson correlation coefficient and significance values were calculated to evaluate the relationship between frontal sinus volume and craniosynostosis.

Results: Six of 22 patients with NNSC were found to have the presence of a frontal sinus volume, compared with controls where all patients had the presence of a frontal sinus. When compared with age-sex matched controls, our analysis revealed a Pearson correlation coefficient of 0.993 and a high significance of P < 0.001, indicating a strong association between decreased-to-absent frontal sinus volume in unoperated NNSC patients.

Conclusion: The findings of this study demonstrate a correlation between decreased-to-absent frontal sinus volume in patients with NNSC in comparison to normal controls. These findings highlight the potential utility of frontal sinus volume as a diagnostic tool in identifying the degree of compensation that the skull has undergone in nonsyndromic sagittal craniosynostosis.

Introduction: Single-stage bilateral cleft lip repair may require preoperative naso-alveolar molding (NAM) to decrease cleft widths and reposition the premaxilla. Staged operations may be performed in centers or regions without easy access to NAM. This retrospective study aims to examine the national prevalence of single-stage and staged bilateral cleft lip repairs over the past 23 years.

Methods: This retrospective study used TriNetX, a national deidentified aggregate database. The study used CPT codes to identify patients younger than 12 months who underwent single-stage (CPT-40701) or staged (CPT-40702) operation for bilateral cleft lip repair between 1/1/2000 to 9/16/2023. Patients were categorized by the year of their cleft lip repair. Patient demographics were analyzed through TriNetX. Linear regression analysis was conducted using PRISM software.

Results: Of the 1303 patients who underwent bilateral cleft lip repair, 57 patients were billed for both operations and were excluded from the analysis. In the remaining cohort, 1136 (91%) patients had a single-stage, and 110 (9%) had a staged bilateral cleft lip repair. No significant demographic differences were found between the 2 groups.The incidence of staged operations increased from 0 patients in 2000 to 14 patients in 2022. The incidence of single-stage operations increased from 6 patients in 2000 to 81 patients in 2022. Staged operations were rare in the first decade, accounting for 2% (n=5) of all bilateral cleft lip repairs between 2000 and 2011. The prevalence of staged operations showed a positive linear correlation (R2=0.75, P<0.0001) over the 23-year period, rising from 0% (n=0) in 2000 to 17% (n=12) in 2023.

Conclusion: Most bilateral cleft lip repairs have remained single-stage operations; however, staged approaches have also increased in popularity. This could indicate that NAM is less effective in patients with wide, severe bilateral cleft lip and palate, and surgeons may need to rely on a 2-stage approach for these patients.