Journal of Craniofacial Surgery最新文献

Unicoronal synostosis is a rare condition leading to anterior plagiocephaly with facial scoliosis and deformation of the anterior cranial fossa. Fronto-orbital advancement and remodelling (FOAR) is the standard of care for management, aiming to normalise the brow shape and position while ameliorating the risk of raised intracranial pressure (ICP) throughout childhood. Published long-term surgical outcome data for unicoronal synostosis is lacking. The authors present our series of 151 cases of FOAR for unicoronal synostosis between January 2000 and January 2023. The average age at surgery was 22.7 months, with an average follow-up of 87 months. Ninety-six patients (66.2%) had no comorbidity. Nineteen (13.1%) had named genetic or chromosomal disorders. There was a 33.1% dural tear rate with no related postoperative CSF leak. Ninety-three patients (67.8%) had a blood transfusion with average donor exposure <1. The total early complication rate was 8.6% most commonly infection and wound dehiscence at 3.4% and 2.8%, respectively. The most common late complication was temporal recession in 30 (20.1%) patients and 3 of these patients required revision surgery. None of our patients required investigation for, or treatment of, raised ICP after the primary surgery. There were no life-threatening complications or mortalities. The authors compare our results to a previous publication on trigonocephaly patients and other available published data. The authors present our recommendations, which include support for a supraregionalized service that encompasses high-volume workload and multidisciplinary care.

Forehead osteomas are benign tumors commonly excised for cosmetic and functional reasons. However, removing osteomas from the anterior table of the frontal sinus presents specific challenges, particularly in determining the appropriate removal thickness. Inaccurate resection depth may result in fracture or perforation of the anterior table of the frontal sinus, or incomplete resection. The authors propose a novel drilling and groove-cutting technique to ensure safe and complete excision while minimizing risks of fracture or perforation of the anterior table. In this study, the authors present a 51-year-old female patient with a recurrent osteoma. Preoperative computed tomography (CT) imaging-guided depth-limiting drilling at the osteoma's center, followed by groove-cutting to establish excision boundaries. Then divided osteoma blocks were excised completely. Postoperatively, the patient showed no sensory deficits or forehead asymmetry and achieved pleasing frontal contour with minimal scarring. This technique effectively safeguards the anterior table and ensures complete removal, demonstrating its utility in craniofacial surgery.

Thalamic hemorrhage is a type of intracerebral hemorrhage with high disability and mortality rates. Because of its deep bleeding location, irregular shape of the hematoma, and compression of the third ventricle, it is not suitable for craniotomy. This paper reports a case of a 63-year-old male patient who sought medical attention for left-sided basal ganglia and thalamus hemorrhage that broke into the ventricles. Upon admission, the patient exhibited impaired consciousness and was diagnosed with thalamic hemorrhage accompanied by ventricular hemorrhage through the head CT and CTA scan. To address the patient's unique circumstances, a 3D-printed guide plate was utilized to guide the puncture and drainage surgery, thereby ensuring a relatively smooth and less traumatic process. After the surgery, the patient's consciousness recovered well, and there was significant improvement in clinical indicators. This case demonstrates that a 3D-printed guide plate has the advantage of precise localization and minimal trauma in guiding thalamic hemorrhage surgery, showing promising clinical application prospects and being worthy of promotion in future clinical practice.

Objective: This study evaluated the degree of paresthesia and recovery of the lower lip and chin in patients who underwent sagittal split ramus osteotomy (SSRO) by measuring the preoperative and postoperative trigeminal somatosensory evoked potential (TSEP).

Study design: Thirty-seven patients with skeletal class II and III malocclusion who underwent SSRO were included. TSEP was measured at 7 points: preoperatively and 1 week, 1, 3, 6, 12, and 18 months postoperatively. The Semmes-Weinstein monofilament test (SW test) was also performed concurrently.

Results: Patients were considered to have recovered when the preoperative values were achieved postoperatively. Stimulation and latency N25 showed significant positive correlations with the SW test. Stimulation measured using TSEP was significantly lower than that measured in the SW test at each time point (P<0.001). In contrast, latency N25 measured using TSEP was significantly higher than that measured in the SW test (P<0.001). TSEP measurements indicated earlier remission compared with the SW test (P<0.001).

Conclusion: The gap between qualitative and quantitative evaluations was indicated. Therefore, TSEP may be a more sensitive alternative for evaluating trigeminal nerve paresthesia after orthognathic surgery. Furthermore, it enables a detailed analysis of the degree of nerve recovery.

The aim of the present study is to introduce a new anthropometric landmark (sap), parameter (sap-sap) for measuring a width of nasal tip and 7 new proportion indexes. For determinate data mean with standard deviation, 200 healthy individuals (100 men and 100 women) were included in the study. The authors determined and pointed 9 paired cranio-facial anthropometric landmarks: sap, al, ac, mf, en, ex, zy, ch, go. Measurement of the head and face included 9 linear horizontal parameters. Proportion indices expressed as the ratio of: nasal tip width/nose width index: sap-sap ×100/al-al; nasal tip width/nasal base width index: sap-sap ×100/ac-ac; nasal tip width/nasal root width index: sap-sap ×100/mf-mf; nasal tip width/biocular width index: sap-sap ×100/ex-ex; nasal tip width/intercanthal width index: sap-sap ×100/en-en; nasal tip width/face width index: sap-sap ×100/zy-zy; nasal tip width/mouth width index: sap-sap ×100/ch-ch. Statistical analysis of the data was carried out using the Student t test. The identification of the new anthropometric landmarks of the nasal tip, the measurements of the width between them, the calculation of proportions will help to evaluate the nasal tip.

Pterygomaxillary separation (PMS) is an important step in Le Fort I osteotomy procedure, without which complete mobilization of the maxilla cannot be achieved. The aim of this study was to evaluate PMS patterns and their relationship with the anatomic measurements in Le Fort I osteotomy. In this prospective observational study cone beam computed tomography (CBCT) was used to measure the anatomic variables of the pterygomaxillary junction (PMJ) region including thickness, width, the distance between the most concave point at the lateral surface of PMJ and the greater palatine foramen (C-GPF), and the angle preoperatively, and the separation patterns postoperatively divided into the clean-cut type, maxillary sinus type, and the pterygoid fracture type. Twenty-seven patients (54 sides) were included in this study. Nineteen females (70.4%) and 8 males (29.6%) with a mean (standard deviation) of 22.1 (5.5) years. The mean PMJ thickness, width, C-GPF, and angle were 5.6 mm, 8.6 mm, 6.55 mm, and 91.5 degrees, respectively. The most common PMS pattern was the clean-cut type (38/54, 70.4%), followed by the pterygoid plate fracture type (10/54, 18.5%), and the maxillary sinus type (6/54, 11.1%). There were non-significant relationships between the anatomic variables of PMJ and PMS patterns (thickness P=0.179, width P=0.234, C-GPF P=0.174, and angle P=0.792). There were non-significant relationships between PMS patterns and age, sex, and skeletal classification of the patients (P= 0.941, 0.211, and 0.519, respectively).

Osteoma is a rare, asymptomatic, and slowly growing benign tumor of bone. Upon reviewing the literature, only 21 cases were previously reported in the mandibular condyle. A 19-year-old male patient presented to the Department of Oral and Maxillofacial Surgery of Ain Shams University complaining of hypomobility and facial asymmetry involving the lower jaw. He stated that he was involved in a road traffic accident (RTA) and sustained a traumatic injury to the head a few years ago. Upon examination, it was noticed that the chin deviated to the right side with some discomfort during function. Computed tomography scans revealed the presence of a hyperdense mass medial to the right condylar pole. Condylectomy was carried out using a preauricular approach. A diagnosis of osteoma was confirmed histopathologically. The defect was reconstructed using the coronoid process as an autogenous-free graft.

Background: Compared with direct linear resection, the triangular flap insertion method is a correction method that purportedly reduces the incision tension of dog ears deformity. Randomized clinical trials comparing these 2 methods seem to be limited or absent.

Objective: A randomized study was planned to compare the cosmetic effect and scar in the defect area between the triangular flap insertion method and direct linear resection in the repair of dog ear deformities after the suture of the facial circular defect.

Methods: The authors' study was prospective, 2-arm, randomized, evaluator-blinded clinical trial in a single-center outpatient academic plastic surgery center. Patients were eligible if they or their parents were able to provide informed consent and had dog ear deformity higher than 8 mm at both ends of the incision after suture of a circular or oval facial defect. Each dog ear deformity at the ends of the incision, half accept direct linear random resection, the other half to accept triangular flap insert. At 3-month and 6-month follow-up, each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale (POSAS).

Results: In all, 52 subjects completed the study. At the 3-month follow-up, there was a statistically significant difference in the mean total POSAS scores for both the blinded observer and patients, indicating a preference for the side with the triangular flap insertion method. However, at the 6-month follow-up, this difference was lost.

Conclusion: Three months after surgery, the triangular flap insertion method resulted in a better scar outcome than direct linear resection in correction of dog ear deformities on the face. At 6 months' follow-up, this difference diminished, with scars for both sides appearing similar.

Level of evidence: Level II.

Objective: This study aimed to compare the biomechanics of implant prostheses and peri-implant bone among 6 different mandibular reconstruction models based on patient data involving the use of an upper free-end double-barrel fibula.

Methods: This study was an observational study. Five models were reconstructed using fibular-supported and implant-supported partial dentures. Two of these models were double-barrel fibula models with different gaps between the upper and lower segments. The other 2 were single-layered fibular models (the fibula was placed at the inferior or superior mandibular borders). The fifth model was a double-barrel fibula with a free distal end on the upper segment. In addition, a typical mandibular model was created for comparison. Two fixed partial-denture models were used in this study. The von Mises stress and strain of the models were analyzed.

Results: The maximum stress decreased with increasing gap between the upper and lower fibula. The distal free-end double-barrel fibula showed a potential to reduce the maximum stress around the implant apex while increasing it around the implant neck compared with a fixed distal-end double-barrel fibula.

Conclusions: Utilizing a free distal end on the upper fibula may be a viable option for mandibular reconstruction, especially when the fibula length is limited.

Objective: There is a lack of comprehensive comparative evidence regarding the effectiveness, intraoperative management, and safety of different surgical procedures for treating nonsyndromic sagittal synostosis. This study aims to evaluate existing clinical studies to provide evidence-based guidance for clinical practice.

Methods: The authors performed a comprehensive search of 5 databases up to August 2024. Key outcomes included clinical effectiveness, measured by cephalic index (CI), and intraoperative management and safety indicators, such as intraoperative blood loss, operative time, and length of hospital stay. Direct and indirect effects, along with treatment rankings, were assessed using Bayesian pairwise and network meta-analysis models.

Results: Fifteen studies with 1436 patients were included, and 4 network meta-analysis models were used to compare 5 surgical techniques: open strip craniectomy (OSS), calvarial vault remodeling (CVR), spring-mediated cranioplasty (SMC), endoscopic strip craniectomy (ESC), and endoscopic spring-mediated cranioplasty (ESMC). No significant differences in postoperative CI were found between the surgical methods. However, CVR was associated with significantly greater blood loss, longer operative time, and longer hospital stays compared with OSS, SMC, and ESC.

Conclusions: Current evidence does not demonstrate a clear superiority of one surgical method over another, with comparable treatment outcomes overall. However, CVR carries higher risks, and the choice of surgical approach should be individualized based on patient-specific factors and clinical judgment.