Journal of Craniofacial Surgery最新文献

Retrobulbar hematoma (RBH) is a rare but potentially devastating complication of orbital fracture repair. Although timely orbital decompression within 90 minutes of symptom onset can restore vision, a delayed diagnosis may result in irreversible blindness. Special care should be taken to prevent the elderly from neglecting the symptoms and signs. Furthermore, medical checkups before surgery and imaging modalities, such as computed tomography scans, need to be considered. We report a case of postoperative RBH after right zygomaticomaxillary and orbital floor fracture repair, in which delayed recognition led to permanent visual loss despite emergency hematoma evacuation.

Objective: To establish normative data for key morphometric measurements in prenatal mandibular development.

Methods: Forty-two human embryonic and fetal specimens, ranging from 8 to 37 weeks of gestational age (GA), without known abnormalities, were selected. Mandibles were segmented on histologic, micro-CT, or MDCT images. Fourteen anatomic landmarks were annotated, and key morphometric measurements were extracted, including bigonial width, bicondylar width, body length, ramus height, and gonial angle. Quadratic regression models were fitted to the measurements as a function of gestational age to assess developmental trends.

Results: Mandibular ossification was first observed at Carnegie stage 19 (8+4 wk GA), adjacent to Meckel cartilage. Strong, statistically significant correlations with GA were found for all linear measurements (R2>0.95, P<0.0001). The gonial angle showed a moderate but significant inverse correlation with age (R2=0.65, P<0.0001).

Conclusion: This study provides comprehensive normative reference data for prenatal mandibular development, spanning early embryonic to late fetal stages. The established growth curves can serve as valuable tools in prenatal diagnostics, enabling earlier and more accurate detection of craniofacial anomalies associated with syndromic and nonsyndromic mandibular malformations. The presented normative data may also aid age estimation in forensic and archeological investigations.

Background: Craniosynostosis surgery poses complex challenges for caregivers. Often, they utilize large language models (LLMs) for preoperative and postoperative information. Although LLMs offer accessible guidance, persistent concerns center on their information quality and readability, especially in specialized surgical contexts.

Methods: This study evaluates the readability and quality of responses from 4 leading LLMs, ChatGPT-4o, Google Gemini 2.0, DeepSeek, and OpenEvidence, to 20 standardized perioperative questions about craniosynostosis surgery. Quality was assessed using modified DISCERN criteria, and readability was measured using SMOG Index. Statistical analysis included 1-way ANOVA and Tukey HSD.

Results: By SMOG score, OpenEvidence produced responses at the highest reading level (17.54), indicating a graduate-level comprehension requirement. ChatGPT (14.45), DeepSeek (14.40), and Google Gemini (15.17) generated information at an undergraduate reading level. By information quality, measured by modified DISCERN scores, Google Gemini achieved the highest score (42.95, P <0.001) out of maximum 45, significantly outperforming ChatGPT (36.25), DeepSeek (37.55), and OpenEvidence (36.75). Gemini's responses were rated highest in clarity, citation use, and support for shared decision-making.

Conclusions: LLMs vary significantly in readability and information quality. Google Gemini offered the most trustworthy content, whereas DeepSeek was most accessible. No single model excelled across all dimensions, suggesting that clinicians should guide caregivers toward LLMs best suited to their literacy level. Generative AI holds promise for augmenting patient education in craniosynostosis care. However, it should be used alongside clinician input to ensure clarity, accuracy, and relevance.

Oral and maxillofacial defects that were unreconstructed or inadequately reconstructed often lead to aesthetic and functional impairments, resulting in socio-emotional and psychological concerns of patients, which impact their quality of life. This justifies the needs of oral and maxillofacial reconstructive surgery to minimize aesthetic deformity; to restore these functions (mastication, swallowing, speech, etc.); to maintain an adequate airway permeability; thereby, to improve the patients' quality of life. The etiologies of oral and maxillofacial defects include surgical resection of malignant tumors, some benign tumors, aggressive cysts, some infections and inflammatory diseases, defects post severe traumatic injuries, some congenital and developmental deformities, and burns. The free flaps (FF) remain the first choice for reconstruction of large oral and maxillofacial defects because their overall success rate is very high (more than 90%). However, pedicled flaps (PF) still play a role in situations where the use of free flaps presents some limitations and risks. Pectoralis major flap (PMF) and submental island flap (SIF) represent excellent options for the reconstruction of oral and maxillofacial defects; they are good alternatives to free flaps when the latter are contraindicated or their use is limited by the absence of sufficient resources.

Objective: The 5-tone music therapy is a traditional Chinese medical practice that uses the therapeutic properties of specific musical notes to regulate physiological functions and promote psychological well-being. The aim of this study was to evaluate the effects of the 5 musical notes therapy on sleep disorders in individuals with Parkinson disease.

Methods: The data of 74 patients with Parkinson disease who received treatment at our hospital between September 2021 and September 2023 were retrospectively analyzed. The patients who received 5 musical notes therapy were assigned to the study group (n=37), and the patients who received the routine care were assigned to the routine care group (n=37). The Pittsburgh Sleep Quality Index (PSQI), National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) scores were assessed and compared between the 2 groups.

Results: One month after the intervention, PSQI scores were significantly lower in both groups compared with baseline (P<0.05), with the study group demonstrating a greater reduction than the routine care group (P<0.05). MMSE scores increased significantly (P<0.05), and the study group exhibited higher MMSE scores than the routine care group (P<0.05). The SAS and SDS scores decreased in both groups post-intervention, with greater reductions observed in the study group compared with the routine care group (P<0.05). In addition, NHISS scores were significantly lower in the study group than in the routine care group (P<0.05). No significant differences were observed in the overall incidence of complications between the 2 groups (P>0.05).

Conclusions: The application of the 5 musical notes therapy in the management of sleep disorders among patients with Parkinson disease demonstrated significant benefits, including improved sleep quality, enhanced cognitive function, and alleviation of anxiety and depression. This therapeutic approach also contributed to a reduction in NIHSS scores and is recommended for broader clinical implementation.

Objectives: The nasopalatine canal (NPC) is a critical anatomic structure in maxillofacial surgery. Variations in its morphology among individuals with cleft lip and palate (CLP) may increase the risk of neurovascular injury and adversely affect surgical outcomes. This study aimed to investigate the anatomic characteristics of the NPC in CLP patients using cone beam computed tomography (CBCT).

Methods: This retrospective cross-sectional study was conducted at a Turkish university hospital, based on CBCT scan data collected between 2016 and 2024. The primary predictor variable was cleft status (yes/no), and the main outcome variables included NPC shape, number of canaliculi, canal length, diameters, and number of the incisive (IF) and nasopalatine foramen (NF), and buccal bone thickness. Appropriate statistics were computed using a significance threshold of P≤0.05.

Results: A total of 78 unilateral CLP patients (29 females and 49 males; mean age 16.23) and 78 matched controls were included. Tree-branch, needle-shaped, and funnel-shaped canals, as well as type 1 and 2 canaliculi, were significantly more common in the CLP group (P<0.001, P=0.012). CLP patients exhibited significantly fewer NF, shorter canal length, and smaller IF diameters (P<0.001). Buccal bone thickness differed by location, with the CLP group showing higher values at points B to D, and the control group at point A (P≤0.05).

Conclusions: Anatomic variability of the nasopalatine canal in CLP patients underscores the importance of individualized radiographic assessment. Incorporating CBCT into preoperative planning can enhance procedural safety and improve outcomes in maxillofacial interventions such as Le Fort I osteotomy, implant placement, and orthodontic procedures involving anterior tooth movement.

Background: Lateral orbital hollowing is a subtle yet influential contributor of periorbital ageing. It results from attenuation of subcutaneous fat, atrophy of the lateral orbital fat pad, and descent of the orbicularis oculi muscle, creating a concavity that contributes to a fatigued and aged appearance.

Objectives: To evaluate the efficacy and safety of supraperiosteal hyaluronic acid (HA) filler injection for lateral orbital hollowing, with outcomes assessed at the longest available follow-up (6 mo) by both patients and physicians using the Global Aesthetic Improvement Scale (GAIS).

Methods: A single-centre prospective case series enrolled 48 consecutive patients (40 women, 8 men; mean age 46.2±5.8 y) between July and November 2025, treated with cross-linked HA. All injections were performed by a single experienced aesthetic physician using a 30-gauge blunt cannula introduced through a lateral entry point 1.5 cm from the canthus, delivering 0.5 to 0.8 mL per side in the supraperiosteal plane. Standardised photographs were obtained at baseline and at follow-up visits (earliest 1 mo; longest 6 mo). GAIS ratings were completed by 2 independent physicians and by patients; patient satisfaction was additionally summarised as the proportion rating outcomes as good/very good/exceptional versus slight/none.

Results: Follow-up was completed in 48/48. The shortest photographic interval presented was 1 month and the longest follow-up was 6 months. At 6 months, physician GAIS was 4.4±0.5 and patient GAIS was 4.5±0.6. On patient GAIS, 43/48 (89.6%) rated the outcome as "very good" or "exceptional," while 5/48 (10.4%) rated "good"; no patients rated "slight" or "none" (0% dissatisfied). Adverse events were minor and self-limited: bruising in 13/48 (27.1%) and oedema in 14/48 (29.2%); each resolved within 1 week. No serious complications occurred.

Conclusions: Supraperiosteal HA placement for lateral orbital hollowing restored the lateral contour with high satisfaction and minimal downtime through 6 months. Presenting clinical photographs in a single composite figure enables a clear baseline-to-follow-up comparison. Longer-term follow-up beyond 6 months is needed to better define durability and late events in this region.

Level of evidence: Level IV.

Guided bone regeneration (GBR) is a critical technique in craniomaxillofacial surgery, significantly advancing the management of bone defects resulting from trauma, tumor resection, congenital malformations, and insufficient bone volume for dental implants. Autologous GBR capitalizes on the body's inherent regenerative capabilities in conjunction with strategic interventions, benefiting from enhanced biocompatibility and integration with osteogenic processes. This review delineates recent advancements in autologous GBR within the context of craniomaxillofacial surgery. First, it elucidates the fundamental concepts and mechanisms underlying autologous GBR, emphasizing the biological processes of osteogenesis along with various influential factors. Second, it explores material applications in autologous GBR-encompassing both absorbable and nonabsorbable barrier membranes as well as diverse types of bone graft substitutes-highlighting their distinct characteristics and clinical outcomes. Third, this review discusses the clinical applications of autologous GBR across subfields, such as dental implantation, jaw defect repair, and correction of craniofacial deformities through representative evidence-based cases. Fourth, it addresses challenges encountered by autologous GBR-including issues related to regeneration efficiency and complications such as infection or membrane exposure-and proposes optimization strategies to mitigate these concerns. Finally, this review investigates innovative research directions encompassing gene therapy combined with GBR technology as well as applications of 3D printing while forecasting future trends toward multitechnology integration and precision treatment approaches. This comprehensive review serves as an essential reference for clinicians and researchers engaged in craniomaxillofacial surgery and its associated disciplines.

Background: Scar formation remains a significant clinical challenge in facial trauma repair, with the anatomic region-specific propensity poorly understood. This study investigates differential scarring outcomes between the perioral and nasal regions following refined cosmetic suturing.

Methods: A retrospective analysis was conducted on 23 patients with nasal or perioral trauma treated using cosmetic suturing techniques. Scar evaluation was performed using the Scar Cosmesis Assessment and Rating (SCAR) scale by professional plastic surgeons, assessing parameters including scar spread, erythema, depigmentation, track marks or suture marks, hypertrophy or atrophy, and overall impression.

Results: Despite identical surgical techniques, perioral scars exhibited significantly higher SCAR scores (5.56±2.40) compared with nasal scars (3.41±1.90) (P<0.05). Specifically, perioral scars demonstrated greater spread (1.79±0.59 versus 1.09±0.48, P<0.01) and hypertrophy or atrophy (1.43±0.46 versus 0.98±0.58, P<0.05). No significant differences were observed in erythema, depigmentation, or patient items.

Conclusion: The perioral region demonstrates a higher predisposition to scarring than the nasal region despite equivalent repair techniques, highlighting the influence of biomechanical factors. These findings emphasize the need for region-specific preventive strategies in facial scar management.

Craniofacial basal cell carcinoma (CFBCC) accounts for the majority of basal cell carcinomas (BCCs) by anatomic distribution yet represents only a small proportion of head and neck malignancies, with disproportionate morbidity due to involvement of anatomically complex and functionally critical facial regions. Management is challenged by subclinical tumor spread along embryologic fusion planes, perineural invasion, and proximity to ocular, neural, and skull base structures. This narrative review synthesizes contemporary evidence on epidemiology, histopathologic subtypes, molecular pathogenesis, diagnostic evaluation, surgical management, reconstruction, and emerging therapies for CFBCC. High-risk and advanced disease includes aggressive histologic variants, chronically neglected or large tumors, recurrent lesions, and cases with orbital, bone, or skull base involvement. Clinical assessment, including regional nodal evaluation, is complemented by advanced imaging modalities, including magnetic resonance imaging, computed tomography, reflectance confocal microscopy, and optical coherence tomography. Mohs micrographic surgery provides optimal margin control for high-risk facial subsites, while deeply invasive tumors may require craniofacial resection. Advances in Hedgehog pathway-targeted therapies, digital surgical planning, and multidisciplinary reconstruction continue to expand treatment options and improve functional and aesthetic outcomes.