Journal of Craniofacial Surgery最新文献

X-linked hypophosphatemic rickets (XLHR) is caused by loss-of-function mutations in the phosphate-regulating endopeptidase homolog X-linked gene (PHEX). Secondary craniosynostosis is one of the complications of XLHR. Early fusion of the coronal, frontal, and sagittal sutures was noted at 11 months of age in an infant diagnosed with XLHR. A fronto-orbital distraction was performed at 14 months of age to increase cranial morphology and intracranial volume. Although the surgical approach utilized distraction osteogenesis, a fronto-orbital fragment was first removed, reshaped, and then a fronto-orbital distraction was performed due to the extensive fusion of the cranial sutures and significant deformity. Postoperatively, new bone formation took somewhat longer than expected due to the nature of the disease. However, bone formed without major issues, the cranial cavity expanded significantly, and a favorable cranial morphology was achieved. Distraction osteogenesis is a more reliable technique because tissue is progressively stretched with a gradual extension of soft tissue as well. Distraction osteogenesis remains an effective treatment option even for craniosynostosis caused by bone disorders like XLHR.

Facial palsy can cause periocular deformities resulting in functional impairment and facial asymmetry. While lagophthalmos and ectropion are common sequelae, some patients develop paradoxical palpebral fissure narrowing due to contracture of the orbicularis oculi during recovery. We report the case of an 81-year-old woman with long-standing unilateral facial palsy who presented with lower eyelid elevation and reduced horizontal and vertical ocular dimensions. The patient was treated with a combined surgical approach consisting of complete lateral canthotomy, lateral canthoplasty, and posterior lamellar shortening for vertical palpebral fissure enlargement. At the 1-year follow-up, objective measurements demonstrated improvement in palpebral fissure width, margin reflex distance 2, exposure of the medial and lateral scleral triangles, and overall ocular symmetry. This case suggests that adapting cosmetic lateral canthoplasty techniques may be an effective option for correcting periocular asymmetry secondary to orbicularis oculi muscle contracture after facial palsy.

Chordoma is a rare, slow-growing yet locally aggressive malignant tumor originating from embryonic remnant notochord tissue. Jugular foramen chordomas pose significant treatment challenges due to their deep location and critical surrounding structures. Clinical symptoms primarily result from tumor compression and erosion of adjacent nerves and blood vessels. This case presents a 59-year-old male patient with jugular foramen chordoma. The diagnosis was confirmed through a combination of imaging studies, 3D Slicer multimodal image fusion reconstruction, pathology, and laboratory tests. The main manifestations were hearing loss in the left ear for 10 years, hoarseness for 1 year, and left-sided facial paralysis for 3 months. Imaging revealed a tumor in the jugular foramen region. The tumor was resected through a translabyrinthine-infralabyrinthine approach, and the patient recovered well postoperatively. This paper aims to explore the diagnosis, treatment, and prognosis of chordoma of the jugular foramen through this case, emphasizing the importance of multidisciplinary collaboration in comprehensive management and providing a reference for clinical practice.

The anterior belly of the digastric muscle (ADB) is known for its marked morphologic variability, which may have important clinical and surgical implications in the submental region. During the educational dissection of a formalin-fixed adult male cadaver, a rare complex asymmetric variation of the ADB was identified. On the right side, the ADB was composed of 4 distinct muscular slips, including 2 deep slips originating from the digastric fossa and 2 superficial accessory slips arising from the inferior border of the mandible. These slips converged in a fan-like manner toward a flattened intermediate tendon (IMT). In contrast, the left ADB consisted of 2 compact slips originating predominantly from the digastric fossa. The IMT and posterior bellies were unremarkable, and no midline fusion was observed. This case demonstrates a complex, asymmetric type II anterior digastric variation and underscores the need to recognize such configurations during imaging interpretation and during surgical procedures involving the submental region.

Purpose: To assess the clinical outcomes and patient satisfaction 6 months after undergoing lower eyelid surgery using the suborbicularis oculi fat (SOOF) lift combined with fat pad transposition in patients aged 40 to 65 in Vietnam.

Materials and methods: This longitudinal interventional study was conducted on 27 patients who underwent SOOF lift combined with fat pad transposition at Vietnam National Eye Hospital, between October 2023 and March 2025. All cases were evaluated based on various factors, including age, gender, Goldberg scale, eye bag height (AB), the orbital rim angle, and Face-Q score before surgery and at 1 week, 1, 3, and 6 months postoperatively.

Results: The study included 27 patients with a mean age of 57.41 years, with 8 males and 19 females. Half of the patients also underwent upper eyelid surgery or brow lift in conjunction with the lower eyelid procedure. At the follow-up visits, all indicators of lower eyelid aging showed significant improvement, with results stabilizing between the 3-month and 6-month assessments. No major complications were reported. All patients expressed satisfaction with the surgical outcomes and estimated an average of 7 years younger than their actual age.

Conclusion: The combination of SOOF lift and fat pad transposition in lower blepharoplasty offers a safe, effective, and long-lasting solution for addressing age-related changes in the lower eyelid region, leading to significant improvements in both aesthetic outcomes and patient satisfaction.

Oro-nasal fistulas may result from congenital defects, trauma, infections, neoplasms, or chronic cocaine use, affecting speech, swallowing, and quality of life. The tongue flap stands out for its rich vascularization and low donor-site morbidity. A 36-year-old female presented with nasal speech and liquid regurgitation through the nose. She had a history of chronic cocaine use for 7 years, discontinued 2 years prior. Clinical and radiographic examination revealed a 2.0 cm oro-nasal fistula in the hard palate. Reconstruction was performed under general anesthesia using an anteriorly based pedicled tongue flap, secured to the recipient bed with 3-0 Vicryl sutures. Maxillomandibular fixation was maintained for 21 days, and the flap was divided after 3 weeks. The anteriorly based tongue flap proved to be a reliable and effective technique for closing large cocaine-induced oro-nasal fistulas, offering excellent functional and aesthetic outcomes.

Full-thickness eyelid defects present a significant reconstructive challenge, as successful repair must restore both ocular protection and periocular aesthetics. Reconstruction of the posterior lamella is particularly critical, since inadequate support can lead to corneal exposure, entropion, or eyelid retraction. Conventional substitutes for conjunctival lining are often limited by donor-site morbidity, insufficient tissue availability, or the risk of eyelid-globe adhesions. The authors describe a single-stage technique using autologous preputial mucosa as a posterior lamellar substitute in lower eyelid reconstruction. A 55-year-old male with a traumatic full-thickness defect underwent circumcision, and the inner preputial mucosa was harvested and grafted to the conjunctival margin. The anterior lamella was reconstructed with local nasolabial and advancement flaps. At 1-year follow-up, the graft remained viable, maintaining stable eyelid contour, adequate lubrication, and satisfactory functional and aesthetic outcomes without adhesions or ocular surface complications. This case demonstrates that preputial mucosa is a thin, pliable, and readily available autologous graft for posterior lamellar reconstruction, avoiding additional donor-site morbidity. This novel technique may provide a valuable option for plastic surgeons and warrants further evaluation in larger clinical series.

Background: Reduction malarplasty is a widely performed facial contouring procedure, particularly in Asian populations, to achieve a slimmer and more oval facial shape. While various surgical techniques exist, there is a lack of standardized guidelines for tailoring the procedure to different zygomatic morphologies. This study aims to establish a strategic classification-based approach to optimize reduction malarplasty outcomes.

Patients and methods: A total of 3997 patients underwent a reduction malarplasty over a 3-year period. Patients were classified into 3 distinct zygomatic types based on clinical and radiological assessments. The surgical technique was customized for each type, incorporating variations in ostectomy, rotation, setback of the zygomatic body, and medial impaction of the zygomatic arch.

Results: The classification-based approach allowed for precise modifications in osteotomy techniques, resulting in improved contouring and patient satisfaction. The beveled osteotomy of the zygomatic arch facilitated enhanced bone healing, reduced palpability, and minimized anterior malar depression. In addition, high L-osteotomy and orbital rim shaving were utilized in cases with a prominent inferolateral orbital rim to optimize outcomes.

Conclusions: By categorizing patients into distinct zygomatic types, this study presents a systematic surgical approach that enhances precision and predictability in reduction malarplasty. These findings highlight the importance of individualized surgical planning to achieve optimal aesthetic outcomes and patient satisfaction. Further studies with long-term follow-up are needed to refine these techniques.

Congenital syndromes with subtle changes in maxillofacial morphology can pose significant diagnostic challenges, wherein artificial intelligence holds great promise in aiding diagnosis through shape analysis. The authors applied the recently proposed Swap Disentangled Variational Autoencoder (SD-VAE) in diagnosis of Beckwith-Wiedemann syndrome (BWS). The SD-VAE model was trained on a data set primarily comprised of surface 3D head scans [stereophotogrammetry (3D SPG)], gathered using a 3dMD Head System (3dMD LLC). It was also trained on CT scans when available. A total of 72 syndromic scans were used belonging to 56 different BWS patients. Scans of head shapes were pre-processed and annotated with 68 anatomic landmarks. This aided in achieving uniformity between the scans and a template mesh, making a better comparison possible. The SD-VAE model outputs were then visualized in a 2-dimensional space and classified as 'BWS-patient' or 'control'. For each anatomic facial region, the performance of the classification model was evaluated. This allowed us to understand the classification accuracy for each anatomic region as well as calculate the sensitivity and specificity for each region. The model demonstrated perfect diagnostic accuracy for BWS on the test set, with the most characteristic regions being the chin, cheeks, zygoma, eyes, jaw, and supraorbital region. This paper demonstrates how SD-VAE can be applied to 3D head meshes, to quantify the characteristic features of BWS. The authors distinguished BWS-specific features from those of the general population with high diagnostic accuracy. This makes SD-VAE a promising tool for aiding the referral and diagnosis of BWS in the future.