Journal of Craniofacial Surgery最新文献

Using the free latissimus dorsi muscle flap for dynamic reconstruction for established facial paralysis helps reconstruct various facial dysfunctions, depending on nerve and muscle arrangements. The authors divided the latissimus dorsi muscle into 3 flaps, 2 placed in the cheek area to reconstruct a "voluntary and spontaneous smile" and 1 fixed to the fascia implanted in the eyelid to treat lagophthalmos in a 1-stage procedure in a 61-year-old woman who underwent tumor resection for a left facial nerve schwannoma and developed complete facial paralysis. Fascia lata and free latissimus dorsi muscle grafting were performed. Spontaneous smile was reconstructed using the contralateral facial nerve as a motor source. Voluntary smile and eyelid closure were reconstructed using the ipsilateral masseter nerve, dividing the latissimus dorsi muscle flap into 3 muscle bodies. This procedure restored her smile and eyelid closure ability, with a nearly normal overall facial impression, making it a valuable technique for 1-term reconstruction of smiles and eyelid closure.

The management of micrognathia in adults necessitates intricate surgical procedures. A vascularized bone graft, notably the free fibular flap (FFF), offers a novel viable solution for repairing significant defects. However, the limited utilization of FFF in adult micrognathia contributes to gaps in understanding its outcomes. A retrospective case series of 2 patients aged 28 and 65, with severe micrognathia due to neglected trauma and osteoradionecrosis, underwent refracture and reconstruction with FFF. Intraoperatively, no significant complications occurred. The FFF were molded to fit the gaps of refractured mandible sites, with similar surgical approaches for both patients. Upon 3 months' follow up, their quality of life (QoL), structural changes, and sensation alterations were assessed and showed promising results. The sensory impairment caused did not hinder the quality of life. Thus, the free fibular flap demonstrates promising outcomes as the initial treatment for adult micrognathia, yielding minimal morbidities and significant functional and anatomic improvements.

In implant-supported prosthetic treatments, the jaw bones may not always have enough bone to accommodate implants. Allogeneic grafts can also be preferred as an alternative to autogenous grafts in cases of vertical and horizontal bone deficiencies. The aim of this study is to evaluate the osseointegration levels of lathe-faced titanium implants placed together with allogeneic bone tissue transplants obtained from tibia, femur, and mandible bones using a biomechanical method. Twenty-eight female Sprague Dawley rats were included in the study. The subjects were divided into groups where bone transplantations were performed together with implant placement from the tibia (n=7), femur (n=7), and lower jaw (n=7) regions. Four rats (left and right) were used as donors. Grafts, along with implants, were surgically placed in the corticocancellous part of the metaphyseal parts of the tibia bones of rats. At the end of the 2-week experimental setup, all rats were killed, and the implants and surrounding bone tissues were subjected to biomechanical reverse torque analysis (N/cm), no statistical difference was detected in terms of bone-implant fusion between the groups in which the femur and tibia bones were transplanted ( P >0.05), while the bone-implant fusion value in the group in which the lower jaw bone was transplanted was found to be statistically higher than the femur and tibia bones ( P <0.05). Based on the limited results of this study, it can be thought that the lower jaw allogeneic jawbone has a higher osseointegration potential than allogeneic grafts obtained from the femur and tibia.

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.

Purpose: The aim of this study was to evaluate the stress changes in the temporomandibular joint (TMJ) after sagittal split ramus osteotomy (SSRO) with finite element analysis (FEA).

Material and methods: 5 and 10 mm mandibular setback and advancement were applied to models by using SSRO and a control model without osteotomy evaluated. The articular disc was modeled as superelastic, and the stresses on the articular fossa, disc, and condyle were evaluated.

Results: The stresses on the cartilage were 1.150 MPa on the 5 mm advancement model and 1.506 MPa on the 10 mm advancement model. The stresses on the disc were 11.56 MPa on the 5 mm advancement model, 7.94 MPa on the 10 mm advancement model and the amount were significantly higher than other models. The stress, especially in the cartilage, increased with the amount of advancement. In the setback models, the stresses on the condylar cartilage and the disc were higher than in the control model, and the stress in the condylar cartilage increased with the amount of setback.

Conclusion: SSRO increases the stresses in the TMJ components and stresses increase depending on the amount of advancement and setback and may cause the development of joint problems.

Purpose: This study aimed to use reconstructive methods for complex oral and maxillofacial defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) multiple paddle flaps.

Patients and methods: The authors performed a retrospective case series of 33 patients who underwent oral and maxillofacial defect reconstruction using the ALT multiple paddle flaps. The design and harvest of the flaps, methods for defects reconstruction, and reconstructive efficacy are described.

Results: All 33 patients were men, with a mean age of 49.5 years. Of the flaps, triple skin paddles plus muscle paddles were included in 3 cases, triple skin paddles were included in 1 case, 2 skin paddles plus muscle paddles were included in 29 cases. The skin paddles measured 3×5 cm to 10×16 cm. Postoperatively, all flaps survived completely. Parotid salivary fistula and orocutaneous fistula occurred in 1 patient of each, thigh wound infection and effusion occurred in 1 and 2 patients, respectively. All patients were followed up for ~2 to 93 months; most patients' oral functions and appearance were acceptable, and thigh motor dysfunction was not observed.

Conclusions: With separate skin paddles for defects of different positions, individualized muscle flap for dead spaces, combination of different skin paddles for larger defects, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT multiple paddle flaps are an ideal candidate for complex oral and maxillofacial defects reconstruction.

Background: Blood transfusion is common in cranial vault surgery, and protocolized efforts to minimize transfusion have been reported in recent years. This study assesses the long term, prospective outcomes of a pediatric blood management protocol for the cranial vault reconstruction (CVR) population.

Materials and methods: Data from a retrospective control cohort and a prospective cohort employing a protocol for preoperative hematologic optimization of patients undergoing CVR from January 2015 to October 2023 was reviewed. Preoperative hemoglobin (Hgb) determined the preoperative protocol. Intraoperative tranexamic acid (TXA) and/or aminocaproic acid, cell-saver technology, and postoperative iron or erythropoietin alfa supplementation were also used in the protocol. For statistical analysis, P <0.05 was deemed significant.

Results: The cohort consisted of 194 successive patients (20 control and 174 treatment). Age, sex, and weight were not significantly different between groups. Mean postoperative Hgb was significantly higher in the control group ( P <0.01). No difference was observed in Hgb at discharge between control and treatment groups. Mean estimated blood loss, volume of intraoperative packed red blood cells, rate of packed red blood cell transfusion, and mean total transfusion volume during hospitalization were significantly higher in the control group compared with the treatment group ( P <0.01). Mean length of stay did not differ between groups.

Conclusion: Efforts to optimize blood management in the CVR population are critical. This prospective study represents a robust and reproducible protocol for pediatric blood management with significant reductions in transfusion requirements.

This anatomic study was designed to assess the position of the facial artery concerning the soft tissue landmarks, pogonion (Pog)and Gonion (Go). Sixty freshly frozen cadavers were used in this study. On the right side, the mean distance between the facial artery and Pog was 7.05±0.66 cm. The mean distance between the facial artery and Go was 3.34±0.36 cm. The results indicated that the facial artery was 32.32%±2.05 of a mandibular length to Go and 67.78%±2.05 Pog. On the left side, the mean distance between the facial artery and Pog was 7.10±0.65 cm. The mean distance between the facial artery and Go was 3.23±0.34 cm. The results indicated that the facial artery was 31.30±2% of the mandibular length at Go and 68.71±2% at Pog. The ratio of the facial artery distance to Pog and Go did not correlate with the mandibular length ( P >0.05). However, the distance between the facial artery, Pog, and Go correlated with mandibular length. ( P <0.001). The ratio of the cross-point of the facial artery with the mandibular border to the length of the mandible about Go and the Pog was generally found to be independent of mandibular length.

Face transplantation is a highly sensationalized procedure in the media. The purpose of this study is to assess the content and readability of online materials that prospective patients/public encounter regarding face transplantation. A search for face transplantation was performed on Google. Sites were categorized under 3 groups: established face transplant programs, informational third-party sources (eg, Wikipedia), and news article/tabloid sites. Each site was assessed for readability using 6 different readability metrics, while quality was assessed utilizing JAMA benchmark criteria and DISCERN instrument. One-way ANOVA with post hoc Tukey's multiple comparisons test was used for analysis. News sources were significantly easier to read than face transplant program sites (10.4 grade reading level vs. 12.4). For the JAMA benchmark, face transplant programs demonstrated the lowest average score relative to third-party sites, and news sources (2.05 vs. 2.91 vs. 3.67, respectively; P <0.001), but had significantly greater DISCERN scores than news sources (53.50 vs. 45.83, P =0.019). News sources were significantly more accessible, readable, and offered greater transparency of authorship compared with reputable sources, despite their lack of expertise on face transplantation. Face transplant programs should update their websites to ensure readability and accessibility of the information provided to the public.