Journal of Craniofacial Surgery最新文献

Objective: In the present study, the morphological characteristic of the pterygomaxillary junction (PMJ) was determined radiologically and its effects on the maxillary expansion pattern were investigated by finite element analysis.

Methods: The 3-dimensional morphology of the PMJ was measured separately for each dimension by examining 240 cone beam computed tomography of maxilla. Seven maxilla models with different three-dimensional pterygomaxillary characteristics were modeled, and the effect of the structural characteristic of the PMJ on the maxillary expansion pattern, and the stresses in the resistance regions were evaluated by simulating the surgically assisted maxillary expansion.

Results: It has been observed that the factor that increases the stress in the pterygomaxillary region the most with the enlargement of the maxilla is the width, followed by thickness and height. The increase in pterygomaxillary region height led to a decrease in stress. In addition, in models with larger PMJ, stresses in areas such as the zygomatic arch, frontozygomatic suture, and medial pterygoid plate increased. The dimensional increase of the PMJ ended with a gradual decrease in the posterior region in transversal expansion.

Conclusion: According to the results of this study, it can be concluded that the increase in the width and thickness of the PMJ are critical factors in determining the need for osteotomy in this region, especially in cases where the transverse deficiency also includes the posterior maxilla.

Background: This study intends to determine the visual recognition of facial differences between patients reconstructed with ocular prostheses and its similarities or differences to the contralateral unaffected eye. The authors hypothesize that a prosthetic eye is an indistinguishable replacement for the appearance of an original eye.

Methods: This is a randomized, local, photo-based survey. Five surveys were designed with ten questions each. Each question included a photo of an eligible patient who underwent prosthetic eye reconstruction. The left and right eyes were marked A and B, respectively. Four options were provided to the surveyees/participants in the study: option A-left eye prosthesis, B-right eye prosthesis, C-both A and B, and (D)-no eye prosthesis.

Results: The overall correctness (OA) is 38.4%. This suggested that 38.4% of occasions public raters correctly identified prosthetic eyes. Furthermore, 69.4% have an average correctness per photo (CP) of <50%. The distribution of data points for correctness per rating (CR) shows a mean of 0.382 which further confirms the percentage calculated for overall correctness of photos, thus validating the results obtained from the study. These results suggest that raters could not tell the difference between the prosthetic and the real eyes, regardless of the photo.

Conclusion: The findings revealed a notable consistency among respondents in discerning between the two, indicating a high level of success in mimicking the natural appearance of an eye through prosthetic means, thus proving our hypothesis.

Iatrogenic internal nasal valve (INV) dysfunction is a significant complication after nasal surgery, often necessitating revision surgeries involving cartilage grafting, which carries high risks of complications such as mucosal synechiae, septal perforations, and chronic inflammation. This study evaluates the efficacy of a modified dermal-fat flap suspension technique as an alternative to conventional cartilage grafting for INV reconstruction. A retrospective review was conducted of 30 patients treated between March 2019 and March 2023, including 8 patients who underwent the modified dermal suspension technique and 22 who received spreader grafts. Preoperative and postoperative nasal obstruction symptom evaluation scores were statistically analyzed using the Mann-Whitney U test. While both groups demonstrated significant postoperative improvements, no statistically significant differences were found between the groups. The modified technique, performed under local anesthesia, was associated with fewer complications and avoided extensive cartilage grafting or mucosal dissection, making it particularly suitable for patients with advanced age, high ASA scores, or complex surgical histories. Common complications included transient orbital edema and rare cases of skin discoloration, which resolved over time. Despite a small sample size and reliance on subjective nasal obstruction symptom evaluation scores, this study highlights the potential of the modified dermal-fat flap suspension technique as a less invasive, effective alternative for managing INV dysfunction, especially in high-risk patients. Further studies with larger cohorts and objective measures are needed to validate these findings.

Liposarcoma is the most prevalent malignant neoplasm originating from mesenchymal tissues, accounting for ~25% of soft tissue sarcomas in adults. It typically occurs in the trunk, limbs, retroperitoneum, and other anatomical regions, while its occurrence in the facial area is relatively rare. Here, the authors present a case involving an Asian male patient who presented to the Department of Dermatology and Cosmetic Surgery at our hospital with a subcutaneous mass located on the left side of the face. After a thorough evaluation, including ultrasonography and additional diagnostic examinations, the lesion was excised completely under local anesthesia. The patient had the sutures removed 1 week postoperatively, and regular follow-up was conducted for 3 months without signs of recurrence or metastasis. The patient expressed satisfaction with the outcome.

Introduction: Pediatric eyelid masses pose a diagnostic challenge, with overlapping presentations between infectious, inflammatory, and neoplastic etiologies. Subcutaneous pyogenic granulomas (SPG), a rare variant, can mimic malignant tumors such as soft tissue sarcomas, leading to potential delays in appropriate management. This case report details the surgical resection of a rapidly growing pediatric eyelid subcutaneous mass, ultimately diagnosed as a subcutaneous pyogenic granuloma with histologic variation.

Methods: A 4-year-old male presented with a rapidly growing left upper eyelid mass. Ophthalmologic evaluation, ultrasonography, and orbital MRI with contrast were performed, revealing a highly vascular lesion. Due to rapid growth and concern for malignancy, the patient underwent a surgical biopsy with a frozen section, followed by complete excision. Intraoperative dissection was performed carefully to preserve surrounding eyelid structures.

Results: The excised mass measured ~2×3 cm and was highly vascular. Histopathology revealed anastomosing capillary nodules with mild mitotic activity and minimal atypia, consistent with SPG. At postoperative day 37, the patient showed no signs of recurrence.

Conclusions: Accurate diagnosis of pediatric eyelid masses is essential to guide treatment and avoid unnecessary morbidity. When clinical and imaging findings are inconclusive, surgical excision with histopathologic examination remains the gold standard. This case highlights the importance of a broad differential and multidisciplinary approach in managing pediatric eyelid lesions.

Pharyngeal wall motion is a key component of velopharyngeal closure, essential for normal speech production. This study investigated changes in lateral pharyngeal wall motion in patients with cleft palate who required secondary surgery to correct velopharyngeal dysfunction. A retrospective review was conducted at a tertiary pediatric hospital, including 20 patients who underwent secondary procedures between 2015 and 2021. The procedures included (1) pharyngeal flap, (2) palatal re-repair with buccal flaps, and (3) palatal re-repair only. Lateral pharyngeal wall motion and speech outcomes were assessed preoperatively and postoperatively using measurements from videofluoroscopic imaging and a 4-point perceptual speech score, respectively. Twenty patients with complete assessments were included. Lateral wall motion increased in all patients after secondary palatoplasty, regardless of repair type. Postoperative lateral wall motion significantly improved compared with preoperative measurements (34% to 75%, P<0.001). Among the 3 techniques, postoperative lateral wall percent closure was equivalent (P=0.174). All patients undergoing pharyngeal flap, re-repair with buccal flaps, or re-repair only exhibited improvements in lateral pharyngeal wall closure. These findings of this retrospective review support the assessment of lateral pharyngeal wall motion during speech production both before and after secondary palatal surgery.

Objective: The authors present a case of an infected anterolateral thigh flap repairing the defect after auricular squamous cell carcinoma surgery.

Methods: A 59-year-old male with squamous cell carcinoma in the right auricle was admitted to the hospital. After extended excision of the tumor, the defect was repaired with anterolateral thigh free flap. The flap was accidentally infected with multiple digestive tract bacteria. Computed tomography (CT) angiography was employed to reconstruct the anastomosed artery of the flap. The patient was followed up for 3 years.

Results: The flap survived well. No recurrence or metastasis was observed. In addition, the patient was satisfied with the listening and aesthetic results.

Conclusions: This case suggests that anterior thigh free flap can be a candidate in auricle-mastoid region, CT angiography can serve as an objective predictor to evaluate the vascular status and prognosis of a free flap. It is proved again that free flap is tough in infectious condition.

Purpose: To assist in planning before the rhinoplasty approach, the authors aimed to investigate the changes in nasal morphometry that occur with age over a period of at least 10 years in the same individual.

Materials and methods: Fifty adult patients from the Turkish population, with at least 2 head and neck 3D reconstructive computed tomography scans taken at least 10 years apart, were retrospectively reviewed. Various angular and linear measurements of the nasal region were performed on the initial and final images, and the data were compared based on sex and age groups.

Results: In the study, it was found that all measured parameters showed statistically significant differences for both women and men after an average of 12.16 years. With aging, statistically significant increases were observed in NFRA, NMA, PNL, and NBH parameters in both sexes, while statistically significant decreases were noted in NFAA, NLA, NTA, GA, PA, and NTP parameters. When comparing the differences between the before and after data obtained from 3 different age groups, statistically significant changes were observed in each parameter.

Conclusion: This study highlights significant age-related changes in nasal morphometry over a 10-year period in both men and women. These variations emphasize the importance of incorporating age-related anatomic changes in preoperative rhinoplasty planning. Understanding these changes can lead to more precise and individualized surgical outcomes, improving the overall effectiveness and safety of rhinoplasty procedures.

Emissary foramina (EF) transmit emissary veins interconnecting extracranial veins with intracranial venous plexuses. A unique EF will be presented. A dried male adult skull was further investigated due to its unique morphology. On the left side, an accessory EF was observed inferior to the inferior petrosal sinus groove (IPSG) in the anterior paracondylar region, with 1.59 mm (height) x 2.87 mm (width). The IPSG morphology was an incomplete tunnel with a foramen into the petro-occipital fissure. Also, the jugular foramen (JF) had a complete bony septation that formatted 2 distinct compartments. The novel accessory EF identified in the present case probably transmits an emissary vein interconnecting the inferior petrosal sinus with the anterior condyle confluence. Therefore, it could be defined as "far anterior paracondylar foramen." Knowledge of skull base anatomy is paramount when planning regional interventions because variant structures may be hidden.