Journal of Craniofacial Surgery最新文献

Rationale: Titanium mesh is a common material for cranioplasty, but postoperative mesh exposure with infection poses a significant challenge-particularly for small, non-marginal defects where traditional instruments are ineffective.

Patient concerns: A 41-year-old female developed an infected, non-marginal titanium mesh exposure in the frontal region 60 days after implantation, which followed traumatic brain injury surgery.

Diagnoses: Open craniocerebral injury; open frontal bone fracture; focal cerebral contusion and laceration; status post-cranioplasty with titanium mesh; and exposure of frontal titanium mesh complicated by skin infection.

Intervention: An innovative approach was used: (1) A dental high-speed handpiece (tungsten steel burr) was used to precisely resect the exposed mesh; (2) Negative pressure wound therapy was administered to promote granulation tissue formation; (3) A thin skin graft, harvested from the scalp, was transplanted in a second-stage procedure.

Outcomes: The skin graft survived completely, with rapid healing at the donor site and no visible scarring. The wound closed fully, the infection resolved, and the aesthetic outcome was satisfactory.

Lessons: For small, non-marginal titanium mesh exposure, the dental high-speed handpiece is an effective resection tool. When combined with scalp skin grafting, this protocol provides a simple, effective, and cosmetically favorable solution.

Background: Nasoalveolar molding (NAM) is widely used to improve surgical outcomes in cleft lip and palate by reshaping nasal cartilage and aligning the alveolar cleft. However, its lasting impacts on skeletal growth in individuals with bilateral cleft lip and palate (BCLP) remain unclear.

Methods: This retrospective study reviewed individuals with nonsyndromic BCLP born between 1997 and 2017. Two groups were compared: NAM-treated (n=33) and control (n=45). Lateral cephalometric x-rays taken in the mixed dentition before orthodontic intervention or alveolar bone grafting were compared between the 2 groups.

Results: The mean SNA in the NAM group was 78.9 degrees, compared with 78.4 degrees in the control group (P=0.6651), and the mean ANB was 4.6 degrees in the NAM group versus 3.4 degrees in the control group (P=0.2587). No significant differences were found in any of the cephalometric measurements between groups.

Conclusion: No difference was found in skeletal growth pattern during the mixed dentition between individuals with BCLP who underwent NAM and who did not. Using the NAM was not associated with deficient skeletal development during the mixed dentition.

Objectives: This study aimed to characterize the symptoms of nasal obstruction and oral habits in Chilean preschool children with repaired cleft lip and palate, as well as their relationship with oral health-related quality of life.

Methods: Caregivers of 28 children (mean age=50.8±10.2 mo) were surveyed using the Nasal Obstruction Symptoms Questionnaire, Unhealthy Oral Habits Identification Instrument, and the Early Childhood Oral Health Impact Scale (ECOHIS).

Results: The results showed that 82.1% had dental alterations, 71.4% experienced speech difficulties, 53.6% were not breastfed. Symptoms of nasal obstruction symptoms included mouth breathing in 42.9% of the children, difficulty blowing their noses in 35.7%, and snoring in 32.1%. In addition, 39.3% reported concentration problems, and 75% received comments about their pronunciation. The primary oral habit identified was the use of a common pacifier with a bottle, reported by 64.3% of the children for over 2 to 3 years, along with a preference for liquid foods in 57.1%. The ECOHIS also revealed feelings of anger and frustration among the children, which impacted family concerns, guilt, time management, and finances. A multiple correlation analysis indicated a significant relationship between nasal obstruction symptoms and increased difficulties in sleeping and eating, as well as a reduced quality of life.

Conclusions: The main findings highlighted mouth breathing, difficulty blowing the nose, snoring, and the use of a pacifier with a bottle, which affected both functional and emotional domains. Although limited by sample size and lack of control for confounding variables, these results underscore the need for further research using more robust designs.

Background and purpose: Facial injury consults often receive dual coverage by plastic and reconstructive surgery (PRS) and otolaryngology (ENT) services, with reported variations in management patterns between specialties. However, studies have not separated fracture patterns or reported variations in care specific to ENT or PRS. This single-institutional study evaluates differences in management and outcomes of frontal sinus fractures treated by PRS and ENT.

Methods: A retrospective chart review identified adult patients with frontal sinus fractures from 2010 to 2020. Wilcoxon rank sum and Fisher exact tests compared patient demographics, fracture characteristics, mechanism of injury, type of management, antibiotic usage and duration, and complications of patients managed either by PRS or ENT.

Results: Of 111 patients, 60 were managed by ENT and 51 by PRS. Demographics and comorbidities did not differ significantly. ENT patients presented with more concomitant sphenoid fractures (P=0.02) and were more likely to consult the ophthalmology service (P=0.02). There were no differences in fracture involvement (P=0.66), operative approach (P=0.94), operative time (P=0.93), or time to OR (P=0.80). PRS utilized more antibiotics for both conservative and preoperative management, particularly Augmentin (P=0.0008) and Unasyn (P=0.0113). Hospital stay, ICU status, return to OR, complications, and 30-day mortality were comparable.

Conclusions: Minimal differences were observed between PRS and ENT in the management and outcomes of frontal sinus fractures, except for antibiotic use. To our knowledge, this is the first decade-long study of frontal sinus fractures and highlights opportunities to standardize facial trauma care across specialties.

Background: Artificial intelligence (AI), particularly large language models (LLMs), has demonstrated potential to improve patient communication by delivering accurate, readable, and empathetic medical information. In plastic surgery-a specialty where preoperative counseling is essential-patients often seek online information to understand procedures, risks, and recovery. However, limited research exists on ChatGPT-4o's utility in this context.

Methods: This prospective qualitative study evaluated ChatGPT-4o's responses to 25 standardized patient questions across 5 plastic surgery procedures: rhinoplasty, breast augmentation, abdominoplasty, blepharoplasty, and rhytidectomy. Each procedure was queried with 5 common preoperative questions covering indications, alternatives, risks, surgical steps, and recovery. Responses were reviewed independently by a board-certified plastic surgeon and 2 researchers for accuracy, completeness, and appropriateness. Strengths, weaknesses, omissions, and potentially unsafe guidance were identified and summarized.

Results: ChatGPT-4o provided generally accurate, well-structured, and patient-friendly answers across all procedures, with no unsafe recommendations. Strengths included clear explanations of surgical rationale, common risks, general procedural steps, and recovery expectations. The model promoted safety and professional consultation. However, notable limitations included a lack of procedural nuance, omission of less common but clinically important risks, failure to tailor guidance to individual variables, and incomplete recovery or postoperative care details.

Conclusions: ChatGPT-4o offers significant promise as a supplementary patient education tool in plastic surgery. Its ability to deliver coherent, empathetic, and accessible responses may help bridge health literacy gaps. However, it should not replace detailed, individualized surgeon-patient discussions. Further refinement and real-world validation are needed to enhance its clinical reliability and integration into patient care.

Background: The paramedian forehead flap (PMFF) is the gold standard for reconstructing complex nasal defects. While 2-stage PMFFs commonly require revision, the extent to which they can be safely re-elevated after pedicle division remains unclear. Prior reports describe re-elevation up to 60% to 80%, but no studies have objectively quantified this. This study evaluates the safe extent of PMFF re-elevation using image-based measurements.

Methods: A retrospective review was conducted of patients who underwent 2-stage PMFF reconstruction and at least one revision between January 2020 and June 2025. Standardized photographs taken at division/inset and at revision were analyzed using ImageJ to measure preoperative and postoperative flap circumference. The percentage of flap re-elevation was calculated as the postoperative circumference divided by the preoperative circumference. Patient demographics, defect characteristics, biological adjunct use, and complications were recorded. Univariable and multivariable logistic regression assessed associations between flap elevation and postoperative complications.

Results: Thirty-nine patients were included (mean age 64.7±11.5 years; mean follow-up 14.3±12.3 mo). The mean flap elevation percentage at the first revision was 87.95%±9.27%. Nine patients underwent a second revision (mean elevation 83.06%±13.36%). The overall complication rate was 7.69%, including 2 infections and one partial flap necrosis; no total flap losses occurred. Flap elevation percentage was not associated with complications on univariable or multivariable analysis (P>0.05).

Discussion: PMFFs can be safely re-elevated to nearly their full circumference following pedicle division. Extensive re-elevation does not increase complications and supports more aggressive contouring during revision to optimize nasal form and function.

Background: Submucous cleft palate (SMCP) is a unique type of cleft palate. Delayed diagnosis is frequently associated with suboptimal speech outcomes. Early detection of SMCP has thus emerged as a key priority in mitigating this challenge.

Objective: This study aims to identify early diagnostic indicators of SMCP by analysing the association between chief complaints and age, along with early symptoms reported by caregivers before the onset of speech problems.

Patients and methods: Medical records of 278 consecutive SMCP outpatients were retrospectively reviewed between January 1, 2013 and September 30, 2023. Three clinical manifestations related to SMCP were identified in medical records: speech problems, abnormal palatal morphology, and feeding difficulties. Descriptive statistical analyses were performed to evaluate the distribution of chief complaints across different age groups and the percentage of feeding difficulties and abnormal palatal morphology in the subgroup with speech problems as the chief complaint.

Results: Regarding the chief complaint, speech problem was the most common chief complaint for consultation (183 patients, 65.8%), followed by abnormal palatal morphology (88 patients, 31.7%), and 7 (2.5%) patients reporting feeding difficulties as the chief complaint. Abnormal palatal morphology emerged as the most common chief complaint in patients younger than 2 years (47 patients, 92.2%). In contrast, the number of patients reporting speech problems as the chief complaint increased significantly in patients older than 2 years (183 patients, 80.6%).

Conclusion: Speech problem was identified as the most frequent reason for consultation among patients with SMCP. Feeding difficulties, including nasal regurgitation, were among the earlier diagnostic indicators for SMCP.

Background: Facial hypertrophic scar is a common clinical problem after trauma and surgery. Different injury types and healing processes may affect its risk, but a systematic analysis of relevant predictive factors is lacking.

Objective: To analyze the relationship between different types of facial injuries and inflammation-healing-related factors and the occurrence of hypertrophic scar, and to construct a predictive model.

Methods: Sixty patients who developed facial scars between June 2020 and June 2025 were retrospectively included. The primary outcome was the occurrence of hypertrophic scar. Firth-corrected univariate and multivariate logistic regression analyses were used to screen predictive factors, and the model performance was evaluated using ROC curves and bootstrap internal validation.

Results: Hypertrophic scar occurred in 29 of the 60 patients, with an incidence rate of 48.3%. The highest incidence of hypertrophic scar was observed in burn patients (87.5%). Univariate analysis showed that burns, infection, and prolonged epithelialization time were significantly associated with hypertrophic scarring. In multivariate analysis, delayed epithelialization, infection, and burns remained independent risk factors. The apparent AUC of the predictive model was 0.815, and the bootstrap-corrected AUC was 0.792, indicating good calibration performance.

Conclusion: Burn injury type, infection, and delayed epithelialization are important predictors of hypertrophic scarring in the head and face. The model constructed based on clinical indicators has good predictive ability and can provide a reference for early risk assessment.

Background: Lower lip defects are frequently encountered in clinical practice. However, approaches tailored to extensive, asymmetric defects resulting from malignant tumor resection remain limited. This report presents a case involving the immediate reconstruction of a large, asymmetric lower lip defect following excision of a giant squamous cell carcinoma and evaluates the applicability and outcomes of a modified surgical method.

Case presentation: An older adult diagnosed with squamous cell carcinoma of the lower lip underwent complete tumor resection, followed by immediate reconstructive surgery. A modified nasolabial flap technique was used to address the extensive asymmetric defect. Postoperative assessments focused on facial symmetry, oral competence, and preservation of lip motor function.

Conclusion: The modified nasolabial flap technique demonstrated effective reconstruction of extensive, asymmetric lower lip defects. This procedure ensured maintenance of lip contour and functionality, with minimal changes to overall facial appearance. Postoperative outcomes indicated high patient satisfaction and functional restoration.

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.