Journal of Craniofacial Surgery最新文献

Background: Geopolitical conflicts in the Middle East have led to mass migrations, with Turkey becoming a major host country. This influx has strained the health care system, particularly regarding specialized care for conditions like cleft lip and palate (CLP). Timely intervention is crucial for optimal outcomes, but cultural, socioeconomic, and logistical barriers often cause delays, impacting physical, functional, and psychosocial development.

Methods: This retrospective study analyzed 72 immigrant pediatric CLP patients treated in Turkey between 2012 and 2022. Data on demographics, medical history, surgical interventions, complications, and treatment delays were collected. Surgical timing was compared with American Cleft Palate Craniofacial Association guidelines, and the impact of socioeconomic status on delays was assessed.

Results: Seventy-two patients underwent a total of 91 surgical interventions, including 29 cleft lip repairs, 22 cleft palate repairs, 6 pharyngeal flaps, 15 fistula closures, 8 corrections of secondary lip scars and whistling deformities, and 11 alveolar bone graftings. A majority (73.6%) had poor socioeconomic status. The average delays for cleft lip, cleft palate, and alveolar bone grafting surgeries were 5.3±4, 7.3±6.1, and 34.1±23.5 months, respectively, and were significantly longer for patients with poor socioeconomic status (P=0.00502, 0.030741, and 0.041878). The average delay for pharyngeal flap surgery, performed in patients with poor socioeconomic status (except for one), was 43.7±14.1 months.

Conclusions: This study highlights the challenges and disparities in CLP care for immigrant children in Turkey due to geopolitical conflict. While surgical complication rates are similar to established data, delays in treatment, especially among those with lower socioeconomic status, are a significant concern. The findings emphasize the need for comprehensive, culturally sensitive care and systemic interventions to improve access and outcomes for this vulnerable population.

Aneurysmal bone cysts (ABCs) are benign bone tumors typically affecting children. Mandibular ABCs can be difficult to treat surgically, given their sensitive anatomic location and functional and cosmetic impacts. This report presents 3 pediatric patients with mandibular ABCs successfully treated with image-guided percutaneous doxycycline sclerotherapy. The first 2 patients presented with pain and swelling, whereas the third was diagnosed incidentally. Sclerotherapy was the sole treatment for cases 1 and 2, whereas case 3 had sclerotherapy after recurrence following prior surgeries. In all 3 patients, clinical symptoms resolved, and stable bone healing was documented on long-term follow-up. There were no functional or cosmetic complications. Doxycycline sclerotherapy is a safe and viable treatment for primary and recurrent mandibular ABCs.

Microtia is a common, complex congenital birth defect in the world. According to the degree of deformity, microtia can be divided into several types. However, it is unclear whether the different degrees of microtia share a common underlying mechanism. In this study, the transcriptomic profiles of auricular cartilage tissues from mild and severe deformities and controls were detected by RNA-seq technology. Relative mRNA abundances were compared and assessed for their function and putative involvement in microtia. A total of 1058, 1648, and 1150 differentially expressed genes (DEGs) were identified in MIC-Ⅱ-vs-NOR, MIC-Ⅲ-vs-NOR, and MIC-Ⅲ-vs-MIC-Ⅱ groups, respectively. Further bioinformatics analysis revealed that some DEGs displayed potential associations with microtia. In the lobular type microtia (MIC-Ⅱ), the changed biological processes mainly enriched in mitosis. And in the conchal type microtia (MIC-Ⅲ), the changed biological processes were not only enriched in mitosis but also in migration. In addition, we also found that the dysregulation of the key genes IL-6 and COMP and key signaling pathway PI3K-AKT signaling pathway were associated with the development of microtia. This study was a report on the transcriptomic detection and bioinformatics analysis of auricular samples of different degrees of microtia. Through this study, we initially explored the correlation of different degrees of microtia pathogenesis, but further research is still needed to confirm these mechanisms.

Synchronous occurrence of solid tumors and hematological malignancy is a rare condition. There is no standard management or therapy for this complicated situation. The authors systematically reviewed articles searched using online databases. The patients are predominantly male, and the average age is similar to each malignancy. According to these studies, most patients are treated in order of aggressiveness. However, when a patient has multiple primary malignancies, all of which are aggressive, the treatment decision is challenging. Due to the limited number of cases, it is hard to have a firm conclusion about an optimal treatment policy. It appears that poor outcomes are mostly related to less adequate therapy. Because the condition is complicated in such cases and there is no standardized treatment, patients should be treated on an individual basis with treatments customized to a given patient's particular circumstances. In addition, multidisciplinary communication and cooperation are crucial in the management of these patients. More in-depth research is still needed to reach a more conclusive treatment strategy and predictable outcomes.

This study investigated the role of social media in the process of cleft lip and palate patients selecting surgeons. Patients utilized social media to obtain information about their health care providers and treatment teams and relied on this information to guide their decisions on where to seek medical care. A retrospective survey was conducted among patients who underwent surgery in our department from December 2020 to May 2023. Through an anonymous questionnaire titled "Factors Influencing the Decision to Choose a Particular Cleft Surgeon," we explored how patients discovered their primary surgeon via social media and the factors they deemed most important in selecting their surgeon. The questionnaire was completed by patients or their guardians. The cleft lip and palate patient population exhibited a distinct geographical distribution. A total of 548 individuals participated in the survey on media usage. Search engines (Baidu) were the most frequently visited (30.5%), followed by short video platforms (TikTok and Kwai), accounting for 21.7%, the hospital's official website at 20.8%, and WeChat at 15%. The primary factors influencing the selection of surgeons were the surgeon's reputation (66.2%), the hospital/medical team's reputation (49.2%), the quality of communication during consultations (15.4%), and the surgical outcomes depicted in postoperative photos (6.9%). The Internet remains the primary source of health information. Therefore, it is crucial to not only provide accurate medical information but also effectively communicate complex medical knowledge through easily accessible media channels in a manner that is comprehensible to patients.

Background: Parapharyngeal space tumor is a tumor that occurs in the parapharyngeal space. Parapharyngeal space tumors are uncommon, accounting for about 0.5% of head and neck tumors. Eighty percent of them are benign and 20% are malignant. The pathologic types of tumors are varied, mainly neurogenic tumors and salivary gland tumors. Follicular dendritic sarcomas are much rarer, with an inert biological behavior and a low-grade malignant sarcoma. Clinicians face difficulties in the management of this lesion. Therefore, a comprehensive analysis of the management of this disease is necessary.

Case presentations: In May 2023, a 22-year-old male presented with pharyngeal discomfort, dysphagia, and sleep apnea. The patient underwent MRI which showed a rounded hypodense shadow with a size of 3.2×2.1×4.5 cm in the left lateral pharyngeal wall and a mass located in the posterior aspect of the left submandibular gland. After preliminary diagnosis of left parapharyngeal space tumor and left neck mass, the clinician performed transoral endoscopy-assisted resection of the left parapharyngeal space tumor and transcervical resection of the left cervical mass. The patient has been followed up without recurrence.

Conclusions: This case provided a reference for the diagnosis and management of parapharyngeal space tumors. In particular, new insights into the diagnosis and management of a rare pathologic type were presented, which had the potential to improve the overall understanding of this disease.

Different surgical techniques have been explored over time to treat children with scaphocephaly. The objective of this study is to compare morbidity and cosmetic outcomes in total cranial vault remodelling (TCVR) and minimally invasive suturectomy with postoperative helmet therapy (MISPH) in patients with scaphocephaly. The authors performed a retrospective comparative cohort study, including 43 patients with isolated sagittal craniosynostosis who underwent TCVR (n=17) or MISPH (n=26) at the Antwerp University Hospital between April 2008 and December 2022. MISPH was associated with significantly shorter procedure duration (TCVR 199 ± 48 min, MISPH 69 ± 12 min, P<0.001), decreased blood loss (TCVR 610 ± 298 mL, MISPH 85 ± 73 mL, P<0.001) and lower transfusion rate (TCVR 100%, MISPH 54%, P<0.001). Mean length of stay at the intensive care unit and the hospital were significantly shorter after MISPH (TCVR 6 ± 1 d, MISPH 3 ± 0.5 d). The change in CI after TCVR was significantly larger than after MISPH during the first postoperative year. However, the CI in the MISPH group was significantly higher during the first year compared with the TCVR group. Mean CI of the MISPH group reached normal limits during the first year, while in the TCVR group, mean CI reached normal values 5 years after surgery. The authors could not find a statistically significant difference in cosmetic outcome between the 2 groups. The authors conclude that MISPH is associated with decreased morbidity and comparable cosmetic results when compared with TCVR in the treatment of scaphocephaly.

Orbital wall reconstruction and implant insertion are crucial procedures for temporarily replacing the orbital walls in cases of significant fractures. Traditional methods using planar orbital implants have faced challenges owing to their flat shape, which increases the risk of dislocation from improper cuts and necessitates the use of screws in the orbital rim. This study aims to improve outcomes by employing customized 3-dimensional implants, thereby reducing complications and risk of dislocation resulting from external shock or implant weight postinsertion. This prospective study included 12 Korean individuals diagnosed with facial fractures (orbital wall injuries). Surgeries were performed on 12 patients, and follow-up CT scans were conducted on 10 of them. Therefore, the authors could only address the results for the 10 patients. The authors used bioactive glass ceramics and medical-grade poly-e-caprolactone to 3D print personalized implants, completing the manufacturing process in an average of 4.6 days. Computed tomography scans guided measurements of orbital volumes and exophthalmos. After surgery, we found that the difference values for bone orbital volumes (<0.1 mL) and exophthalmos (<1 mm except one) decreased compared with presurgery values. Independent t tests and Pearson correlation analysis revealed no significant changes between normal and affected sides in both phases. However, R-values increased in the postsurgery phase. Patients monitored postsurgery at 2 weeks, 3 months, and 6 months showed no complications. The 3D-printed patient-specific implants, customized to individual fracture shapes and featuring distinct implants and locking parts with notches, effectively restore bony orbital volumes and reduce exophthalmos. They have been proven feasible and applicable for reconstructing acute orbital wall fractures.

Objective: To investigate the clinical efficacy of negative pressure wound therapy (NPWT) in the treatment of odontogenic cervical Necrotizing fasciitis (CNF).

Methods: Sixteen cases of odontogenic cervical necrotizing fasciitis were randomly divided into observation group and control group after routine debridement and disinfection. The patients in the control group were treated with drainage tube and regular dressing changes, while those in the observation group were treated with NPWT. The therapeutic effects of the 2 groups were compared.

Results: The frequency of operation, treatment length, and cost of treatment in the observation group were significantly less than those in the control group (P<0.05). During the treatment, the VAS (visual analog scale of pain) in the observation group was significantly lower than that in the control group (P<0.05). The levels of WBC, CRP, PCT, IL-6, and TNF-α in the observation group were lower than those in the control group (P<0.05). The levels of Il-10 and VEGF in the observation group were higher than those in the control group (P<0.05), the difference was statistically significant.

Conclusions: The condition of odontogenic cervical necrotizing fasciitis progresses rapidly. Compared with conventional drainage and dressing change, NPWT can control infection in a short time, reduce operation frequency and treatment cost, and promote wound healing, shorten the treatment time, ease the pain of patients, improve the quality of life. The therapeutic scheme is safe, effective, and suitable for clinical application.