Journal of Craniofacial Surgery最新文献

Progressive hemifacial atrophy (PHA) is a progressive, irreversible disorder characterized by unilateral facial soft tissue atrophy. Conventional treatments, such as isolated fat grafting or synthetic fillers, are often limited by high resorption rates and insufficient structural support. To address these challenges, a staged surgical protocol integrating autologous fat grafting (AFG) and autologous dermal grafting was implemented to optimize outcomes in moderate-to-severe cases. This study evaluates the synergistic efficacy of combined AFG and dermal grafting in the treatment of PHA. Two patients underwent sequential procedures: initial AFG using the Coleman technique with abdominal fat harvest, followed by dermal grafting from the gluteal region to address residual deep depressions. Postoperative evaluations, including long-term follow-up (up to 20 months), assessed volumetric retention, complications, and patient satisfaction. Results demonstrated significant improvements in facial symmetry and contour, with dermal grafts providing durable structural reinforcement in areas where fat resorption persisted. No major complications were observed, and both patients reported high satisfaction with aesthetic outcomes. The staged integration of AFG and dermal grafting offers a minimally invasive, biocompatible solution for complex PHA reconstruction, leveraging dynamic adaptability and natural tissue integration. This dual-modality approach presents a promising strategy for recalcitrant soft tissue defects, particularly where traditional fat grafting alone proves insufficient.

Objective: This study aimed to investigate the effects of submental flap reconstruction during open horizontal partial laryngectomy (OPHL) on improving postoperative swallowing function.

Methods: A total of 72 patients with supraglottic laryngeal cancer were retrospectively divided into 3 groups: group A, including patients (n=30) who underwent classic OPHL; group B, including patients (n=18) who underwent transoral laser microsurgery; and group C, including patients (n=24) who underwent OPHL with submental flap reconstruction. Swallowing function was assessed using the Water Swallow Test (WST) and the Chinese version of the MD Anderson Dysphagia Inventory (MDADI). Voice function was evaluated using the Chinese version of Voice Handicap Index-10, and the incidence of postoperative respiratory distress was recorded.

Results: The WST revealed that group C had significantly superior swallowing function relative to groups A and B. Similarly, MDADI scores were significantly higher in the group C than those in groups A and B. No significant difference was identified in voice function among the 3 groups.

Conclusion: Submental flap reconstruction during OPHL significantly improved postoperative swallowing function and reduced aspiration symptoms, making this technique a valuable surgical option that warrants further consideration.

Background: The muscles of mastication (MMTs) are essential for mandibular function and have recently emerged as potential biomarkers for age-related conditions. However, lifespan morphologic data remain limited, particularly for muscles beyond the temporalis. We aimed to characterize the developmental trajectories of MMTs across the human lifespan using high-resolution MRI and to evaluate bilateral symmetry, sex differences, and comparative morphology.

Methods: A cross-sectional cohort of 211 subjects (36 pediatric and 175 adults; age: 1-87 y) underwent 3.0 T MRI. Length, width, and thickness of the temporalis, masseter, medial pterygoid, and lateral pterygoid (superior and inferior heads) were measured bilaterally. LOESS regression with bootstrap CIs characterized age-related trends; bilateral symmetry was assessed using Bland-Altman analysis.

Results: All muscles demonstrated rapid growth during childhood and adolescence, reaching peak dimensions by age 25 to 30 years. Length and width remained stable throughout adulthood, whereas thickness (particularly of the temporalis and masseter) showed a progressive decline beginning in the fourth decade, with acceleration after the age of 60 years. High bilateral symmetry was observed across all parameters. Sexual dimorphism emerged during adolescence and persisted throughout adulthood, most pronounced in the temporalis and masseter.

Conclusions: MMT morphology follows distinct lifespan trajectories, with thickness being the most age-sensitive parameter. The temporalis and masseter undergo significant age-related thickness decline, while the pterygoid muscles remain more stable. These findings provide essential reference data for interpreting MMT measurements as clinical biomarkers and suggest that parameters beyond temporalis thickness warrant consideration.

Dante Gabriel Rossetti's portraits-most notably Lady Lilith (1867)-present a distinctive facial structure characterized by a broad mandible, heavy lower face, and a pronounced yet softened lantern jaw. This "Rossetti jaw," repeated across his muses, stands in marked contrast to both Victorian feminine ideals and contemporary aesthetic norms that privilege a V-line taper, reduced mandibular width, and accentuated midfacial contours. By examining Rossetti's visual vocabulary through the combined perspectives of art history, cultural studies, and modern craniofacial aesthetics, this paper argues that the Rossetti jaw operates simultaneously as an aesthetic, symbolic, and cultural disruption. In Victorian culture, the broad jaw implicated anxieties about female agency, sexuality, and the emerging figure of the New Woman. In modern contexts, it challenges the narrow globalized beauty template shaped by evolutionary cues-youthfulness, neoteny, and gracile features-and reinforced by cosmetic surgery trends. Through comparative morphologic analysis, symbolic interpretation, physiognomic literature, and psychological readings, this study explores the jaw as an axis of power, autonomy, and embodied identity. Within Rossetti's mythopoetic framework, a strong jaw signals female will, erotic authority, and the capacity to resist male control. In contemporary plastic-surgery discourse, such morphology raises questions about whether aesthetic norms genuinely reflect natural diversity or merely reproduce cultural anxieties about assertive femininity. Ultimately, the Rossetti jaw illuminates the tensions between historical ideals, modern surgical preferences, and deeper archetypes of the powerful feminine, revealing how facial structure can encode both beauty and subversion across time.

Postsurgical recovery of oral soft tissues plays a crucial role in determining the outcome of dental surgical interventions. This research investigates Gelcide Essential, a bioadhesive formulation containing essential oils, recognized for its antimicrobial and anti-inflammatory characteristics. A randomized controlled trial was conducted to evaluate the comparative efficacy of Gelcide Essential against 0.20% chlorhexidine-HA and a no-treatment control group following upper premolar extractions. Forty-five participants were randomly distributed across 3 treatment groups. Assessment parameters included pain intensity (Visual Analog Scale measurement at 24 hours), inflammatory response (24 hours), and tissue swelling (48 hours). Findings demonstrated superior outcomes in the Gelcide Essential cohort, which exhibited reduced pain scores, diminished inflammatory markers, and decreased edema compared with both comparison groups. While chlorhexidine showed therapeutic benefits, its performance was intermediate between the test and control groups. The untreated control group demonstrated the most severe postoperative complications. These findings suggest that Gelcide Essential represents a promising, safe therapeutic option for optimizing oral tissue regeneration following surgical procedures and may function as either an adjunct or alternative to standard treatment protocols.

To overcome these issues, video-assisted laryngeal masks (VLMAs) have been developed, allowing for real-time visualization of glottic structures through integrated camera systems. Data can be provided for patient longevity and durability, comparing ETT and SaCoVLM LMA placement times, number of attempts, hemodynamic responses, stability in head and neck positions, and postoperative changes (throat guarantee, dysphagia, dysphonia, and laryngospasm) across sections in tympanoplasty procedures. In our randomized prospective clinical search, after cases were divided into 2 groups, demographic and operation information, airway device placement trial and duration, hemodynamic data, and postoperative complications were recorded. Patient demographics were homogeneous. Anesthesia duration, operative times, insertion times, and the number of attempts were shorter in the SaCoVLM LMA group. Hemodynamic data showed higher arterial pressures and heart rates immediately after insertion, at 1-minute and 5-minute postinsertion. Postoperative complications were less widespread in the SaCoVLM LMA group. In conclusion, our data analysis suggests that the SaCo VLM LMA may be advantageous over the ETT regarding insertion time, cardiovascular stability, and postoperative complications. However, it should be noted that the placement may shift during use, especially during head rotation, potentially leading to ventilation problems.

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.