Journal of Craniofacial Surgery最新文献

Background: Cranial vault remodeling (CVR) and endoscopic strip craniectomy (SC) are principal operations for nonsyndromic craniosynostosis. Over the past decade, evolving minimally invasive techniques and shifting payer landscapes may have influenced national practice patterns. We evaluated trends in surgical utilization, payer mix, and cost across US children's hospitals from 2016 to 2025.

Methods: A retrospective analysis of the Pediatric Health Information System identified infants with craniosynostosis who underwent CVR or SC between 2016 and 2025 using ICD and CPT codes. Demographics, payer type, and inflation-adjusted cost were compared. Annual trends in utilization, payer mix, and cost were analyzed with linear regression.

Results: Among 15,335 infants, 13,329 underwent CVR and 2006 SC. Strip craniectomy patients were younger (95 versus 280 d, P<0.001), more often male (70.8% versus 64.7%, P<0.001), from higher-income households (median $46,124 versus $42,374, P<0.001), and had a higher proportion of privately insured patients (62.1% versus 47.4%, P<0.001) and a lower proportion of Black children (3.1% versus 8.4%, P<0.001). Strip craniectomy use increased from 8.8% to 20.2% of procedures (β=1.23%/yr, P<0.001). Strip craniectomy cost rose from $14,990 to $21,660 (+$632/yr, P=0.002). Medicaid coverage increased among SC patients (27.0%-39.6%, β= +1.27%/yr, P<0.001) but decreased among CVR patients (48.6%-45.8%, β= -0.40%/yr, P=0.038).

Conclusions: From 2016 to 2025, craniosynostosis care shifted toward increased use of minimally invasive strip craniectomy, accompanied by rising SC costs and greater Medicaid representation. Despite these changes, sociodemographic disparities in access to early, minimally invasive repair persist. These findings provide national benchmarks for utilization, payer patterns, and cost to guide clinical practice and policy.

Choanal polyps are benign solitary soft tissue lesions which originates from the nasal or paranasal sinus mucosa and progress through the natural ostium of the sinus to choana into the nasopharynx. Antrochoanal polyps are most common type. Nasal septum, sphenoid sinus, ethmoid sinus, inferior and middle turbinate, inferior and middle meatus have been reported as ectopic origin of choanal polyp as well. However, choanal polyps originating from uncinate process of nasal cavity has not been reported. Herein, with a review of the literature, we report a rare case of choanal polyps originating from uncinated process of nasal cavity in a 52-year-old woman.

Background: Distraction osteogenesis (DO) is a critical craniofacial technique used to address congenital and acquired skeletal deficiencies through gradual bone elongation. While metallic devices have been traditionally employed for both mandibular distraction (MD) and posterior cranial vault distraction (PCVD), resorbable distractors offer several advantages, including elimination of secondary hardware removal procedures and decreased risk of dural violation. This systematic review evaluates the safety, technical feasibility, and operative outcomes of resorbable distractors in PCVD and MD.

Methods: A comprehensive literature search was conducted according to PRISMA guidelines across PubMed, Cochrane, EMBASE, and ClinicalTrials.gov through April 2024. Studies evaluating resorbable distractor systems in PCVD or MD were included. Data were extracted on operative characteristics, complications, clinical outcomes, and comparisons to metallic controls.

Results: Thirteen studies encompassing 205 patients (5 PCVD, 8 MD) were included. Hybrid systems combining metallic distraction arms with resorbable fixation were common in PCVD, while most MD procedures employed fully resorbable distractors. In PCVD, latency periods ranged from 2 to 5 days, distraction periods from 23 to 48 days, and consolidation durations averaged 3 to 4 months. Mean distraction rate was ~1 mm/d. All patients achieved clinical improvement, with one study reporting a 15.8% intracranial volume increase. Complication rates were low, with only one patient requiring revision surgery. In MD, distraction periods ranged from 10 to 30 days with consolidation times of 4 to 7 weeks. Mean lengthening ranged from 7 to 25.4 mm. Across studies, 100% clinical success was reported in nearly all cohorts, except for 2 patients with persistent airway obstruction. Complications included infections, device displacement, and regression; however, the use of resorbable plates was associated with significantly reduced postoperative regression (5.1% versus 32.9% in controls). Device absorption time ranged from 6 to 12 months.

Conclusions: Resorbable distractor systems in both PCVD and MD demonstrate excellent safety profiles and favorable functional and aesthetic outcomes. These systems offer meaningful operative advantages, including reduced surgical morbidity, fewer revisions, and avoidance of secondary procedures, making them a valuable alternative to metallic hardware in select pediatric craniofacial populations.

Objective: To investigate the factors contributing to the recurrence of hemifacial spasm after microvascular decompression (MVD) and the outcomes of reoperation with MVD.

Methods: The authors retrospectively collected clinical data from 24 patients with recurrent hemifacial spasm after MVD treated at the Department of Neurosurgery, Suzhou Kowloon Hospital, from January 2017 to December 2022. These patients underwent reoperation with MVD. The causes of recurrence were analyzed based on intraoperative findings.

Results: The causes of recurrence in the 24 patients were as follows: 10 cases due to excessive size or improper placement of the Teflon pledget compressing the facial nerve; 7 cases due to displacement or detachment of the Teflon pledget, leading to compression of the facial nerve by the original offending vessel; 3 cases due to compression by the vertebral artery with high tension, resulting in insufficient initial decompression; 3 cases due to compression by new offending vessels; and 1 case due to traction and distortion of the facial nerve caused by arachnoid adhesion and thickening. The average follow-up period was 49.2 months, with a surgical efficacy rate of 95.8% during follow-up.

Conclusion: In cases of recurrent hemifacial spasm after MVD, improper placement of the Teflon pledget, leading to compression of the facial nerve exit zone by the vessel or pledget, is the main cause. Reoperation with MVD remains safe and effective for recurrent cases. The key to successful surgery includes the surgeon's proficient microsurgical techniques, rich surgical experience, cautious and patient intraoperative manipulation, and meticulous perioperative management.

Objective: The early detection of acute kidney injury (AKI) in patients with traumatic brain injury (TBI) may enable the prompt initiation of preventive strategies and the development of personalized treatment plans, thereby enhancing prognostic outcomes. This study seeks to develop a predictive model for AKI in TBI patients.

Methods: An analysis was conducted on data from 409 adult TBI patients treated at our hospital between January 2021 and December 2021, with the outcome being the incidence of AKI. A logistic regression model was constructed, using the least absolute shrinkage and selection operator (LASSO) regression to select optimal variables. The model's performance was assessed using several metrics, including the Brier score, the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).

Results: AKI was identified in 9.0% of the patients. The final model included 5 variables: estimated glomerular filtration rate, a Glasgow Coma Scale score of <6, mechanical ventilation upon admission, hyperuricemia, and serum cystatin C levels exceeding 1.16 mg/L. Upon validation using bootstrapping, the model exhibited robust performance, evidenced by a Brier score of 0.069 (95% CI: 0.066-0.074) and the AUC of 0.809 (95% CI: 0.760-0.823). The calibration plot demonstrated a high degree of concordance between observed outcomes and model predictions. In addition, DCA affirmed the model's clinical utility.

Conclusion: The predictive model proficiently identifies patients at elevated risk for AKI, thereby facilitating timely intervention and management.

A 28-year-old woman with facial asymmetry after aligner treatment visited our hospital. She complained of an asymmetric gummy smile and a deviated mental area developed after clear aligner treatment. On CT examination, occlusal cant was found, leading to facial asymmetry. We made a clinical diagnosis of jaw deformity with an asymmetric face, and recommended her orthognathic surgery using wire orthodontics. She accepted jaw surgery; however, she refused wire orthodontic treatment. Therefore, we selected bimaxillary osteotomy with a surgical-first approach using her clear aligner to correct the inclined occlusal plane and improve the deviated jaw. The functional occlusion could be established, and improvement of facial form could be gained with a proper occlusal plane. This case report is a rare case, in which retreatment of the surgical approach for bimaxillary osteotomy for marked facial asymmetry developed after aligner treatment. We must be aware of the necessity of thorough and careful examination to avoid misdiagnosis.

Sagittal craniosynostosis, the most common nonsyndromic form, typically causes scaphocephaly and occurs more often in males. This report describes a 2-month-old boy with sagittal craniosynostosis associated with a rare chromosome 16p13.3 duplication, detected by chromosomal microarray analysis despite a normal karyotype. He had dysmorphic facies, cardiac defects, and undescended testes. At 23 months, he underwent cranial vault remodeling with marked improvement; follow-up showed a normal head shape but mild developmental delay. This case underscores the value of chromosomal microarray in diagnosing syndromic craniosynostosis and highlights the need for multidisciplinary care. It represents a previously unrecognised association between chromosome 16p13.3 duplication and craniosynostosis.

The anterior nasal spine (ANS) anchors the septum and supports nasal tip projection; hypoplasia or absence of the ANS can disrupt nasal symmetry. In rhinoplasty, rigid fixation of the nasal framework to the facial skeleton is critical for lasting results. This report aims to describe a technique using a titanium miniplate for ANS reconstruction in aesthetic rhinoplasty. Two adult women (54 and 56 y) underwent rhinoplasty using a 1.5 mm L-shaped titanium miniplate fixed to the premaxilla to recreate a stable ANS. Septal extension grafts (SEG) were secured to the plate, complemented by spreader grafts to control projection and rotation while avoiding bulky cartilage grafts. L-plate-assisted ANS reconstruction is a feasible and reproducible option when bony support is inadequate, helping stabilize the nasal framework and preserve valve shape, tip support and long-term aesthetic results with skeletal anchorage. Larger series with longer follow-ups are needed to define late complications and results.

Artificial intelligence (AI) is increasingly integrated into plastic and reconstructive surgery. It supports preoperative prediction and imaging analysis, intraoperative visualization, and postoperative monitoring. While these advancements demonstrate AI's growing potential across the surgical continuum, their adoption also presents ethical, legal, and regulatory challenges. Concerns surrounding algorithmic bias, data privacy, and informed consent are particularly relevant in fields shaped by individualized anatomy, aesthetic nuance, and patient-specific goals. This analysis reviews the current landscape of AI in plastic surgery and medicolegal frameworks shaping its use. Existing legal doctrines, ranging from antidiscrimination and privacy protections to common-law informed consent, offer partial guidance for AI use in plastic surgery. Traditional liability models struggle to accommodate adaptive algorithms. Early litigation has focused largely on insurance decision-making rather than procedural use of AI. In the absence of clear precedent, regulatory efforts remain fragmented. The EU imposes strict oversight for high-risk medical AI, and US federal and state policies emphasize transparency and human oversight. However, there remains limited direction on liability or intraoperative use. These gaps highlight the need for more comprehensive, procedure-specific regulation as AI integrates into surgical care and plastic surgery more broadly. This analysis proposes a decision-making framework. We emphasize transparent informed consent, patient privacy protections, and clinician awareness of algorithmic bias, to guide safe integration of AI tools into active clinical practice. While AI may meaningfully enhance plastic surgery, its limited generalizability and susceptibility to bias reinforce its current role as an adjunct to, rather than a substitute for, a surgeon's expertise.

Craniofrontonasal dysplasia (CFND) is a rare X-linked craniofacial malformation that manifests with midline defects such as hypertelorism, coronal craniosynostosis, and extracranial skeletal anomalies. The standard timeline for surgical management typically includes early cranial vault remodeling and later orbital hypertelorism correction, most commonly through orbital box osteotomies at mixed dentition. For infants presenting with unicoronal craniosynostosis (UCS), fronto-orbital advancement (FOAR) is often used to correct asymmetry and allow for cranial expansion. However, in patients with known or expected need for future hypertelorism correction, the authors argue that traditional FOAR imposes a significant scar burden and disruption to surgical planes that may complicate future reconstruction. As an alternative, the authors propose endoscopic-assisted fronto-orbital distraction osteogenesis for those patients presenting with UCS and CFND.