Journal of Craniofacial Surgery最新文献

Background: Numerous microsurgical approaches are available for treating middle cerebral artery (MCA) mirror aneurysms. However, a definitive conclusion regarding which approach yields the best outcome has yet to be reached.

Methods: Thirty-three patients with MCA aneurysms were categorized into 2 groups: one-stage unilateral approach and other surgical approaches. Prognostic differences were compared using the Modified Rankin Scale (mRS). In addition, the length of hospital stay and costs were also compared. Among the patients with a proposed preoperative one-stage unilateral approach, they were divided into success and failure groups, and these factors were collected, including Hunt-Hess grade, contralateral aneurysm orientation and maximum diameter, contralateral A1+M1 length, and contralateral ICA bifurcation angle. These parameters were analyzed using multivariate logistic regressions to identify the risk factors.

Results: The prognosis of patients in the one-stage unilateral approach group did not differ significantly from that of other surgical approaches. However, patients in the one-stage unilateral approach group experienced shorter hospital stays and incurred lower hospital expenses. In the multivariate regressions, the length of the contralateral A1+M1 was identified as an independent risk factor.

Conclusions: The one-stage unilateral pterional approach for clipping bilateral aneurysms is an effective method of treating MCA mirror aneurysms. However, in cases where patients have an excessive length of A1+M1 on the contralateral side, this approach may result in surgical failure.

Few alloplastic implant materials have been successfully used in nasal reconstruction. The high-density porous polyethylene (HDPE) implant is the most widely accepted alloplastic material for reconstructing the nasal structure. Some authors suggest that the problems associated with using grafts and biocompatible materials are often due to errors on the part of the surgeon or the technique used. This study aims to report several cases of complications related to using HDPEs in the nose. A total of 23 patients who reacted negatively to alloplastic implants were treated. The removal of HDPE is complex due to the formation of connective tissue within it. These complications can cause permanent atrophic changes to the skin of the nose. Most of the patients presented with extrusion of their HDPE implants in the nasal columella region. All patients underwent implant removal, cleaning, disinfection, and secondary rhinoplasty. Surgeons must be able to recognize these possible complications and manage them successfully. Even today, many professionals use alloplastic grafts for reconstruction and esthetics of the nasal region. The potential for permanent damage to the skin and soft tissues, as well as complications such as infection and extrusion of the implant, makes the use of autogenous tissue preferable over alloplastic implants. Early detection and immediate treatment of complications are essential to minimize the severity of the deformity.

Introduction: Plastic surgery played a crucial role during the World Wars. Surgeons dedicated their careers to reconstructing facial injuries and residual deformities incurred during combat. Times of unprecedented trauma led to rapid innovation in plastic surgery, with invaluable impact on practice today. Pioneers such as Harold Gillies are well-known for their work. There are numerous additional contributors who deserve wider recognition.

Methods: A literature review was performed to identify key surgeons who treated soldiers' craniofacial injuries during World Wars I and II. Biographical information, country of practice, and technical contributions to plastic surgery were compiled.

Results: Nineteen plastic surgeons were identified who contributed significantly to craniofacial surgery during the World Wars. These surgeons were: Albéric Pont, Archibald Mcindoe, Arthur Mowlem, Harold Gillies, Hippolyte Morestin, James Barrett Brown, Jaques Joseph, Johannes Esser, John Staige Davis, John Reese, Otto Lanz, Paul Tessier, Robert Ivy, Suzanne Blanche Gros Noël, Thomas Kilner, William Kelsy Fry, Varaztad H. Kazanjian, Vilray P. Blair, and Vladimir Petrovich Filatov. Fourteen were active during WWI. Nine were active during WWII. Notable technical developments were made in maxillofacial fracture fixation, bone grafting, rhinoplasty, dental prosthetics, flap-based coverage, skin grafting, and burn reconstruction.

Conclusion: Plastic surgeons played an unheralded role in managing the disfiguring craniofacial injuries of World Wars I and II. By treating tens of thousands of war victims, these surgeons contributed not only to the rehabilitation of soldiers but also to the advancement of craniofacial surgery and the establishment of plastic surgery as a distinct subspecialty.

Background: Free fibular flap (FFF) is the main modality in the reconstruction of maxillofacial defects. Micrognathia is a condition where the mandible is smaller than it should be. Micrognathia is typically treated with mandibular distraction osteogenesis, bilateral sagittal split osteotomy, and conventional costochondral graft. In cases in which these procedures cannot be performed, FFF becomes a suitable alternative. Publications regarding the use of FFF in cases of micrognathia are currently still limited. In this case, we present the use of FFF in the reconstruction of a severely micrognathic mandible in an adult patient.

Case presentation: A 28-year-old woman with micrognathia was referred to Dr. Ciptomangunkusumo Hospital for reconstruction. The patient had previously undergone temporomandibular joint (TMJ) reconstruction surgery with interpositional TMJ arthroplasty 10 years prior due to an ankylosing TMJ that prevented the opening of the jaw. The treatment for ankylosing TMJ was necessitated due to the patient's inability to open their mouth, resulting in significant challenges with alimentation, speech, and facial morphology. Here the authors reported mandibular lengthening reconstruction in the anteroposterior axis with FFF. A surgical osteotomy was performed on the posterior segment of the bilateral mandibular ramus, then the segmented fibula was inserted into the resulting defect. Flap refinement was also performed following FFF. Postsurgical evaluation revealed notable enhancements in the patient's esthetic appearance, occlusal function, and amelioration of obstructive sleep apnea symptoms.

Conclusions: FFF for mandibular reconstruction is feasible and effective in improving esthetic and functional outcomes in patients with micrognathia.

Objective: Facial feminization surgery (FFS) treats gender dysphoria in transfeminine patients by addressing the facial bony and soft tissue components. Individuals seeking FFS may be taking gender-affirming hormone replacement therapy [gender-affirming hormone therapy (GAHT)]. This study aims to better characterize the GAHT's impact on venous thromboembolism (VTE) risk, surgical planning, and outcomes.

Methods: A systematic review and meta-analysis of the literature were carried out to assess the effect of perioperative GAHT continuation on VTE. Cochrane Q and I2 statistics measured study heterogeneity with the following meta-regression exploring these results. Simultaneously, a retrospective review of the senior author's FFS cohort was conducted to investigate GAHT duration's impact on FFS revision rate, complication incidence, and facial structures operated on.

Results: Eleven articles were included: 602 patients stopped GAHT, of whom 3 VTEs were recorded (0.49%). This is compared with one episode among the 925 who continued GAHT perioperatively (0.11%). Study heterogeneity was low (0%), but limited VTE sample size precluded meta-analytic conclusions. Gender-affirming hormone therapy duration does not impact the incidence of all-cause complications (P = 0.478), wound infection (P = 0.283), hematoma (P = 0.283), or VTE (P = 1). The only procedures significantly less associated with higher GAHT were tracheal shaving (P = 0.002) and mandibuloplasty (P = 0.003). Finally, the FFS revision rate was not associated with GAHT duration (P = 0.06).

Conclusion: There is a paucity of data to assess the safety or harm of continuing GAHT in the FFS perioperative period. Thus, a shared provider-patient decision-making process examining the risks and benefits of GAHT perioperative continuation is warranted. As patients seeking gender-affirming care are diverse, a "one-protocol-fits-all" is not appropriate.

Craniosynostosis is a congenital disorder characterized by the premature fusion of cranial sutures, leading to abnormal skull development and potential neurodevelopmental complications. The role of metabolic influences in craniosynostosis remains underexplored. This study investigates the causal relationship between specific blood metabolites and the risk of craniosynostosis using a 2-sample Mendelian randomization (MR) approach. Genetic instruments were selected from a genome-wide association study on blood metabolites and craniosynostosis data from the FinnGen database. The MR analysis was conducted using inverse variance weighted regression as the primary method, with MR-Egger and weighted median methods as sensitivity analyses. Additional tests for pleiotropy and heterogeneity were performed to validate the robustness of the findings. The analysis identified significant associations between elevated levels of gamma-glutamylglycine [odds ratio (OR) = 2.379, 95% CI = 1.261-4.488, P = 0.007], N6-acetyllysine (OR = 2.731, 95% CI = 1.081-6.901, P = 0.034), phosphocholine (OR = 2.205, 95% CI = 1.226-3.658, P = 0.038) and glycine (OR = 2.118, 95% CI = 1.226-3.658, P = 0.007) with an increased risk of craniosynostosis. Conversely, higher levels of 3-hydroxy-2-methylpyridine sulfate (OR = 0.411, 95% CI = 0.1717-0.988, P = 0.047) and 5,6-dihydrothymine (OR = 0.293, 95% CI = 0.098-0.876, P = 0.028) were associated with reduced risk. Sensitivity analyses confirmed the robustness of these findings, with no significant evidence of pleiotropy or heterogeneity detected. This study provides evidence that specific blood metabolites may causally influence the risk of craniosynostosis, suggesting potential metabolic pathways that could be targeted for therapeutic intervention. These findings help to develop metabolite-based strategies for the prevention and treatment of craniosynostosis.

Objective: To determine the readability and accuracy of information regarding mandible fractures generated by Chat Generative Pre-trained Transformer (ChatGPT) versions 3.5 and 4o.

Background: Patients are increasingly turning to generative artificial intelligence to answer medical queries. To date, the accuracy and readability of responses regarding mandible fractures have not been assessed.

Methods: Twenty patient questions regarding mandible fractures were developed by querying AlsoAsked (https://alsoasked.com), SearchResponse (https://searchresponse.io), and Answer the Public (https://answerthepublic.com/). Questions were posed to ChatGPT 3.5 and 4o. Readability was assessed by calculating the Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, number of sentences, and percentage of complex words. Accuracy was assessed by a board-certified facial plastic and reconstructive otolaryngologist using a 5-point Likert Scale.

Results: No significant differences were observed between the two versions for readability or accuracy. Readability was above recommended levels for patient education materials. Accuracy was low, and a majority of responses were deemed inappropriate for patient use with multiple inaccuracies and/or missing information.

Conclusion: ChatGPT produced responses written at a high level inappropriate for the average patient, in addition to containing several inaccurate statements. Patients and clinicians should be aware of the limitations of generative artificial intelligence when seeking medical information regarding mandible fractures.

Objective: To quantitatively assess the impact of early versus late surgical intervention on midfacial growth using a mouse model.

Methods: A full-thickness mucoperiosteal flap surgery was performed on newborn (P17) mice and on neonatal (P30) mice. High-resolution micro-computed tomographic imaging coupled with histomorphometric analyses was used to assess craniomaxillofacial growth. Histology and immunohistochemical analyses were used to assess cellular and molecular responses postsurgery.

Results: Early surgical intervention at P17 resulted in significant midfacial growth arrest, with pronounced maxillary hypoplasia. Histomorphometric analyses revealed significant (P < 0.05) growth disruptions in the mid-palatal suture complex, including premature removal of the cartilaginous growth plate and its replacement by bone. In the suture itself, cell proliferation was significantly reduced (P < 0.05) compared with controls. The same surgical intervention performed in mice at P30 did not lead to significant midfacial growth arrest.

Conclusions: Early surgical intervention in a mouse model mirrors the adverse growth outcomes in children undergoing early cleft repair. Molecular and cellular observations accompanying this midfacial growth arrest may inform therapeutic strategies to mitigate midfacial growth disturbances in patients and highlight the need for refined surgical techniques to minimize adverse growth outcomes.

This study presents retrospective 8-year clinical performance data from a patient cohort treated with immediately loaded maxillary full prostheses supported by zygomatic implants combined with implants placed in the nasopalatine canal, as a treatment for severely resorbed edentulous ridges. A retrospective analysis was conducted on data of maxillary edentulous patients with severe bone atrophy. All of them received zygomatic implants in combination with an implant placed in the nasopalatine foramen and an immediately loaded fixed temporary prosthesis in the first 24 hours. The frequency of major and minor adverse events was presented according to the time of occurrence. Fifteen patients were included in the study, without cases of implant loss or sensitivity in the nasopalatine region were observed up to 8 years. Only 1 major complication was observed, whereas minor complications were more frequent. In conclusion, this 8-year follow-up study demonstrated that the nasopalatine canal can be considered a viable implant site, with no major risks, to improve biomechanics by enabling a polygonal distribution in severely atrophic maxillae treated with zygomatic implants and immediate loading.