Journal of Craniofacial Surgery最新文献

Background: Percutaneous balloon compression (PBC) is an important treatment for trigeminal neuralgia (TN). Establishing the duration of balloon compression involves a tradeoff between outcome and postoperative complications. We aimed to explore the effect of the duration of balloon compression on the numbness response in areas innervated by the branches of the trigeminal nerve.

Methods: Thirty-three patients with TN were included as an exploratory cohort, and the response area and compression time to the onset of facial numbness were recorded intraoperatively. Seventy-six patients with TN were then randomly divided into experimental (EG) and control groups (CG) for validation. The EG was treated with balloon compression times adjusted to reflect the compression-time effect observed in the initial investigation, whereas the CG was treated with a standardized compression time of 180 s. Patients were followed up postoperatively for pain relief and facials to verify the reliability of the effect.

Results: We found that the mean compression time to numbness in the region innervated by the ophthalmic meridian (V1) was 89.09 ± 8.99 s; by V1 and the maxillary nerve (V2), 123.52 ± 7.97 s; and by V1, V2, and the mandibular nerve (V3), 181.33 ± 10.29 s. All 76 patients used to verify the effect had complete relief of pain, and the EG had significantly less numbness than the CG.

Conclusion: In PBC, with the extension of balloon compression time, the numbness response of each branch of the trigeminal nerve appears in a certain order. This effect can guide PBC in mitigating complications while ensuring efficacy.

The pharyngeal arches are the foundation of face and neck development. Impaired development of these embryologic structures can result in craniofacial abnormalities. Surgeons who manage head and neck pathology will invariably encounter conditions associated with aberrant pharyngeal arch anatomy, and a thorough understanding of the normal development of these structures is paramount to accurate diagnosis and treatment. This manuscript is the second of a four-part series written for plastic surgeons, focusing on the abnormal development of pharyngeal arches leading to pathologic ear and neck anomalies seen in clinical practice.

This study aimed to assess the quality, credibility, and readability of online health information concerning turbinoplasty, given the increasing reliance on internet resources for health education. Using four search terms related to turbinoplasty, we analyzed 71 text-based webpages from Google.com, Bing.com, and Yahoo.com. Readability was evaluated using the Flesch-Kincaid grade level, Gunning-Fog Index, SMOG Index, and Coleman-Liau Index were utilized. Web page quality was computed through the DISCERN Instrument (DISCERN), the Journal of the American Medical Association benchmark criteria (JAMA), Novel Turbinoplasty Index (NTI), and presence of code certification by Health on The Net (HON). Seventy-one text-based web pages were assessed. Information quality was measured by an average DISCERN score of 47.4±7.40, indicating "fair" quality. The average readability was a grade level of 9.7±1.57, notably higher than AMA and NIH recommendations. Of all web pages, only 11 (15.49%) proficiently met all 4 listed JAMA criteria. Significant correlations between web page classification and average DISCERN (P=0.0042), as well as JAMA score (P<0.001) were discovered. The web pages that had HON code certification revealed significantly higher quality metrics such as DISCERN scores (P<0.001), JAMA scores (P<0.001), and NTI scores (P=0.038). Online health information for turbinoplasty is of "fair" quality, and the average readability is several grade levels above current AMA and NIH recommendations. Health care providers should aim to guide their patients on finding appropriate educational resources and should improve the readability of their patient education materials.

Lingual mandibular bone depression, also known as the Stafne bone cavity, commonly presents as an asymptomatic unilocular cyst-like radiolucency located below the mandibular canal. Surgical exploration of this lesion is relatively rare in the literature. A 49-year-old male was admitted to the hospital for a space-occupying lesion located in the right mandibular angle region and was performed surgical exploration. The content of the lesion was excised and prepared for histologic investigation, which revealed fibrous connective tissue, adhering muscle and nervous tissue with no evidence of epithelium tissue. Thus, the lesion was diagnosed as lingual mandibular bone depression. Of the various theories of the etiology of lingual mandibular bone depression, the most popular "glandular theory" seemed to be inapplicable in the present case. Providing misleading information in this case, B-mode ultrasonography was proved to be of little help in diagnosing this lesion.

Objective: This study aims to evaluate the effectiveness of pure polycaprolactone (PCL) mesh in reconstructing complex bilateral orbital floor fractures associated with Le Fort II fractures. PCL mesh is traditionally viewed as less suitable for severe fractures due to its perceived weakness. This study challenges that perception by demonstrating the utility of PCL mesh in high-severity cases.

Materials and methods: Two patients with Le Fort II fractures and bilateral orbital floor fractures underwent orbital reconstruction using a 3D-printed PCL mesh. The mesh was molded and inserted through subciliary or transconjunctival incisions. Orbital volumes were analyzed preoperatively and postoperatively using CT scans and a 3D Analysis program.

Results: Both cases demonstrated significant correction of orbital volume differences postoperatively, leading to improved symmetry and successful reconstruction. For case 1, the preoperative orbital volume difference of 3.2 cc was reduced to 1.1 cc postoperatively. For case 2, the preoperative orbital volume difference of 1.18 cc was reduced to 0.4 cc postoperatively. The PCL mesh provided adequate structural support and facilitated effective tissue integration. Despite the radiolucency of the PCL mesh on CT scans, volumetric analysis confirmed stable and balanced orbital volumes.

Conclusions: Pure PCL mesh is a viable alternative for orbital floor reconstruction in severe craniofacial fractures, offering a balance of structural support and biocompatibility. To validate these findings, further research with larger samples and long-term follow-up is recommended.

A 32-year-old male presented with a painless swelling on his nasal dorsum, persisting for over 3 months. He reported a gradual increase in the size of the mass, with no identifiable triggers except occasional skin redness. He denied nosebleeds, rhinorrhea, nasal obstruction, trauma, prior surgery, or spontaneous pain. His medical history revealed gout, managed with colchicine and diclofenac. Despite dietary and pharmaceutical interventions, he continued to have bouts of hyperuricemia, with blood uric acid levels measuring 739 μmol/L. Multiple tophi were evident, especially on the left first metatarsophalangeal joint (Figure 1A). Examination revealed an irregularly shaped, immobile, hard swelling at the nasal radix, measuring 3 cm×2 cm. Computerized tomography (CT) imaging of the nose showed bilateral nasal bone destruction from the lesion. Given its impact on the patient's appearance and his history of gout, the mass was initially diagnosed as unusual gouty tophus. The patient requested surgical removal of the lesion, and the dissection revealed a mass partly encased by a capsule-like connective tissue adherent to the nasal bone. As the lesion damaged the nasal bone, removal of the lesion led to defect of nasal bone. After an extensive rinse of the surgery site, the incision was sutured.

Objective: This study aims to investigate the efficacy of early intervention in cerebrospinal fluid leakage following traumatic brain injury through the utilization of pedicled autologous fascia flaps.

Methods: A retrospective case series, spanning from May 2021 to May 2022, analyzed 8 traumatic brain injury cases with concomitant cerebrospinal fluid leakage. Each patient underwent simultaneous brain surgery and transcranial repair of the cerebrospinal fluid leak, employing a pedicled autologous fascia flap. Clinical and imaging data were comprehensively recorded throughout the entire duration of the cases, and patient follow-ups were conducted through outpatient visits and telephone consultations.

Results: The study comprised 8 enrolled patients, consisting of 7 males and 1 female, all of whom sustained injuries from traffic accidents. The mean age ranged from 17 to 55 years. Among the patients, three presented with acute epidural hematoma, three with simple concave fractures, and 2 with concave fractures accompanied by brain contusion. Frontal sinus fractures were observed in all cases. All surgical interventions were successful, with no instances of cerebrospinal fluid leakage postoperatively. In addition, none of the patients developed intracranial infections. At the conclusion of the follow-up period, recurrent cerebrospinal fluid leakage was not observed in any of the patients.

Conclusions: In cases where surgical intervention is necessary for cerebrospinal fluid leakage resulting from anterior cranial base fractures, the application of pedicled autologous fascia flaps in the acute stage proves effective in repairing leaks at the anterior cranial base. This approach may contribute to a reduction in the incidence of intracranial infections, ultimately yielding satisfactory patient recovery.

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.

Purpose: Reconstruction of nasal defects, particularly in the lower third of the nose, presents significant challenges due to the area's complex 3-dimensional structure and thicker, more sebaceous skin. The bilobed flap, a double transposition flap, has been a popular method for addressing these nasal defects.

Methods: This retrospective review examines a single surgeon's experience with bilobed flaps for nasal reconstruction over the last 15 years. Demographics, defect characteristics, intraoperative details, postoperative complications, and revisionary procedures were documented, and univariate and multivariate logistic regression analyses were used to assess complication rate associations.

Results: In all, 148 bilobed reconstructions were analyzed, with a mean patient age of 62.6 years and 46.0% male prevalence. The most common indication for the procedure was basal cell carcinoma following Mohs surgery, with the majority of the defects located on the lower third of the nose. The average defect size was 1.11 cm². Complications occurred in 52.0% of cases, including pincushioning, scar thickening, asymmetry, alar stenosis, and wound dehiscence. Reoperations and additional treatments such as dermabrasion, steroid injections, and laser therapy were frequently necessary to address these issues. Logistic regression analysis demonstrated significantly more postoperative complications when the defect was located on the lower third of the nose when compared with the upper two-thirds.

Conclusions: While the bilobed flap can provide adequate skin coverage with perfect color match, it is associated with notable complications that impact esthetic outcomes. Proper patient selection and surgical technique are crucial for optimizing results.

Facial nerve (FN) injury is a significant risk during complex cranial reconstruction surgeries, especially in revision cases where normal anatomy is distorted. The authors introduce a technique to mitigate FN injury, including preoperative FN mapping, intraoperative FN mapping, and continuous FN monitoring. Preoperative mapping uses a handheld ball-tip stimulator to elicit compound muscle action potentials (CMAP) in the frontalis muscle. Needle electrodes are placed above the orbital margin to record responses, starting at the stylomastoid foramen and extending until the entire temporal branch is mapped. Intraoperatively, continuous mapping is achieved using an electrified insulated suction device, allowing dynamic mapping during soft tissue dissection. Continuous monitoring involves placing stimulation electrodes near the stylomastoid foramen and recording CMAP responses from the frontalis and orbicularis oculi/orbicularis oris muscles. The authors tested this technique in 5 patients. The authors successfully mapped the temporal branch of the FN with isolated frontalis CMAP recordings in all patients. Intraoperative FN mapping and continuous monitoring were successfully performed in all cases. Two patients experienced complete cessation of FN CMAPs, which resumed upon loosening the tension on the myocutaneous flap held by fishhooks. One patient showed a 39% decrement in frontalis CMAP that did not recover. Despite these issues, all patients had intact FN function postoperatively and at follow-up. Our technique shows promise in mitigating FN injury during complex cranial reconstruction and cranioplasty revision surgery. Further research with a larger cohort is needed to confirm efficacy and statistical significance.