Journal of Craniofacial Surgery最新文献

The management of oral malignancy necessitates a comprehensive approach focusing on disease eradication and patient quality of life. Surgery remains pivotal, although extensive resection can lead to aesthetic and functional challenges. Reconstruction, often with osteocutaneous radial forearm free flaps (OCRFFF), is crucial for restoring form and function. Prophylactic plating aims to prevent donor site complications, although plate selection is critical. Despite OCRFFF's efficacy in anterior mandible reconstruction, concerns persist regarding donor site morbidity and adequacy for subsequent dental implantation. Collaborative efforts and advancements are essential to optimize outcomes and address limitations in oral cancer management.

Objective: Cervical burn scar contractures can be repaired using many modalities, including skin grafts, pedicled and free flaps. Although preexpanded cervical flaps can provide a like-with-like reconstruction, a simple advancement transfer of the flaps often fails to achieve ideal outcomes. The authors aimed to introduce a method using the preexpanded cervical flaps transferred in a scarf-wrapping manner to repair neck defects.

Methods: The surgery was divided into 2 stages. In the first stage of the surgery, an expander was implanted above the platysma muscle on each side of the neck. After adequate inflation of the expanders, second-stage operations commenced. Following the expander removal, one flap was rotated upward to repair the neck defect, whereas the other flap was rotated downward to repair the neck defect and close the donor site of the first flap. Data on patient demographics, clinical characteristics, and outcomes were also collected.

Results: Between July 2004 and May 2024, 24 patients underwent neck reconstructions using this method. Four patients had grade I cervical contractures, and 20 had grade II. The mean size of the defects was 15.62×5.75 cm (range: 6×6-18×10 cm). The average dimension of the neck flap was 15.02×7.65 cm (range: 9×6-20×10 cm). All the flaps survived with no perfusion-related complications. The average improvement in the cervico-mental angle was 29.25 degrees (range: 10-45 degrees). Postsurgery follow-up ranged from 4 to 155 months (mean: 22 mo). All patients and their families were satisfied with the outcomes.

Conclusions: Preexpanded cervical flaps transferred in a scarf-wrapping manner can be used to reconstruct grade I and II cervical scar contractures and provide a like-with-like reconstruction of the neck.

Objectives: In this study, we retrospectively examined the bleeding that occurred in the 5-year patient series.

Materials and methods: One thousand seven hundred seventy-five patients who underwent septorhinoplasty surgery between 2019 and 2023 were included in the study, and 28 of these patients who presented with bleeding complications were examined. All patients underwent open-technique septorhinoplasty surgery with or without concha intervention and were discharged the next day after overnight hospitalization.

Results: Of the 1775 patients included in the study, 1415 (79.7%) were female and 360 (20.3%) were male. Bleeding was observed in a total of 28 cases (1.6%). There was no difference regarding age or sex in patients with bleeding. It was also observed that concha intervention did not make a difference in terms of bleeding. The bleeding period ranged from 1 to 9 days, with an average period of 5.53 ± 2.36 days and a median bleeding period of 6 days. All bleeding patients were followed up with supportive treatment and were discharged after a 24-hour bleeding-free period. There was no need for interventions in the operating room or blood transfusions in for any patient.

Conclusion: Patients who present with bleeding after rhinoplasty can be observed, and their bleeding can be controlled without further intervention with supportive treatment and sufficient time.

Background: Postoperative infection is one of the main complications that affect the surgical effect of auricular reconstruction with tissue expansion. Understanding the susceptible time and distribution of pathogens is especially important for the treatment.

Method: The data of patients with infection after auricular reconstruction with tissue expansion from September 1, 2018 to August 30, 2024 were collected retrospectively. The microbe species identification results, diagnosis time of infection, surgical methods, and kinds of pathogenic bacteria were analyzed. Statistical methods were used to analyze and calculate the difference in infection time and the distribution of pathogenic bacteria.

Result: From September 1, 2018 to August 30, 2024, 237 cases of infection after auricle reconstruction with tissue expansion were diagnosed, and 252 strains of 18 kinds of pathogenic bacteria were detected. Among them, S. aureus (85 strains, 33.73%) and S. epidermidis (40 strains, 15.87%) were the 2 main pathogens. Postoperative infection mainly occurred in the first stage (72 cases, 30.38%) and the second stage (98 cases, 41.35%). The MRSA infection rate in the second stage (24.46%) was significantly higher than that in the other stages. The infection rate was significantly higher in winter (from November to January) (P<0.05). There was no significant difference among other seasons (P>0.05).

Conclusion: The main pathogen of infection after ear reconstruction with tissue expansion is Staphylococcus aureus, and winter is the peak period of infection. There are some differences in infection rate and distribution of pathogenic bacteria in different stages of surgery.

Introduction: Alcohol intoxication significantly increases an individual's risk for a variety of injuries including craniofacial injuries, although this research is limited to adults. Further research is needed on pediatric craniofacial injuries related to alcohol use in children, a group inherently different in anatomy and developmental considerations from adults. This study aims to identify alcohol-related craniofacial injury patterns, injury mechanisms, and patient disposition in the pediatric population presenting to the emergency department.

Methods: A cross-sectional analysis of alcohol-related injuries in the pediatric population (0-18 years of age) was performed using the National Electronic Injury Surveillance System (NEISS) database from 2019 to 2023. Patient demographics, specific primary and secondary injury diagnoses, injury mechanism, location, and discharge disposition were collected. Descriptive statistics and χ2 tests were used to understand injury patterns.

Results: A total of 266 patients with alcohol-related craniofacial injuries were identified, with an age range of 12 to 18 years. The most common craniofacial injuries were brain injury, facial laceration, and concussions. Additional injuries occurred in most patients and were often either poisoning or an additional craniofacial injury. Injury mechanisms included falls, motorized and non-motorized recreational vehicles, motor vehicle collisions, and others. Although most patients were discharged from the emergency department, some required transfer or admission, particularly those with brain injuries or fractures.

Conclusion: This study evaluates pediatric craniofacial injuries involving alcohol. Falls emerged as the most common injury mechanism, and most injuries occurred in older adolescents. This population had high rates of brain injury and concomitant injuries, highlighting the significant morbidity present.

Lip augmentation has become one of the most popular esthetic procedures globally, driven by societal standards that equate full lips with youth and sensuality. While young individuals often seek volume enhancement for lip beautification, older adults pursue lip rejuvenation to counter aging effects, such as volume loss, fine lines, and reduced definition. A range of techniques has been developed to meet these esthetic goals, but achieving natural and safe results remains a challenge. This study evaluates the single-point technique (SPT), a novel approach for lip augmentation that utilizes a single injection point to reshape and enhance the lips while prioritizing vascular safety. Single-point technique applies linear retrograde injections to project, define, and evert the lips with minimal trauma. Two cases of M-shaped lips demonstrate the effectiveness of SPT in achieving balanced, esthetically pleasing results with lasting effects beyond 6 months. Through a detailed review of lip anatomy, filler selection, and injection techniques, this paper presents SPT as a refined approach for practitioners seeking optimal, natural lip enhancement outcomes.

Objective: Managing facial trauma in patients with severe polytrauma presents significant challenges due to competing priorities, poor systemic conditions, and delayed surgical timing. At a national level I trauma center, the authors evaluated the feasibility and outcomes of proactive surgical intervention for unilateral zygomaticomaxillary complex (ZMC) fractures in severe trauma patients.

Methods: This retrospective study included 81 patients with unilateral ZMC fractures treated at a regional level I trauma center between October 2019 and August 2021. Patients were categorized into high and low trauma severity groups based on the injury severity score (ISS). Three-dimensional (3D) computed tomography analyses were performed to evaluate surgical outcomes, including dimensional distances (Dx, Dy, and Dz) and the Asymmetry Index.

Results: Of the 81 patients, 52 underwent surgical intervention. No significant differences were observed in 3D distances (Dx, Dy, and Dz) between the high and low ISS groups, both preoperatively and postoperatively. However, postoperative symmetry was superior in the high ISS group ( P < 0.010). The average delay from injury to surgery was slightly longer in the high ISS group (8.69 versus 7.35 d, P = 0.248). Complications such as diplopia and paresthesia were more common in the high ISS group, but no significant differences in overall complication rates were observed between the groups.

Conclusion: Proactive surgical management of unilateral ZMC fractures in major trauma patients is effective. Despite the systemic challenges in this population, timely intervention resulted in superior postoperative symmetry in the high ISS group and comparable 3D outcomes across trauma severities.

The management of patients with facial asymmetry caused by condylar hyperplasia remains a subject of ongoing debate. This study compared active patients with unilateral condylar hyperplasia (UCH) who underwent proportional condylectomy with ceased patients with UCH who underwent orthognathic surgery, evaluating esthetics, function, and satisfaction. The retrospective study included 2 groups: group A, with 15 active patients with UCH who underwent proportional condylectomy, and group B, with 22 ceased patients with UCH who underwent orthognathic surgery. Facial, occlusal, and skeletal changes were analyzed using photographic and radiologic records, along with a satisfaction questionnaire. Both groups showed significant improvements. Group A's chin deviation, dental midline, and occlusal plane canting improved by 58.5% (P < 0.001), 56.5% (P < 0.001), and 70.0% (P < 0.001), respectively. Group B's corresponding improvements were 60.1% (P < 0.001), 79.4% (P < 0.001), and 64.9% (P < 0.001). Patient satisfaction was high in both groups, without significant differences in postoperative results, esthetics, and functional satisfaction. In conclusion, Proportional condylectomy for UCH achieves comparable outcomes with orthognathic surgery in facial, occlusal, and skeletal improvements and patient satisfaction.

The spindle cell tumor is a variant of sarcomatoid carcinoma that mostly affects the oral cavity. Bone involvement in this tumor leads to a wide excision, which sometimes requires resection of both the maxilla and mandible. The maxilla and mandible are important bones that function to form the 3-dimensional dimensions of the facial bones. The fibular bone can be selected to replace the facial bone because of its strong structure with a skin paddle, long pedicle, and proper bone shape. The authors present the case of a 24-year-old female who underwent maxillectomy and total hemimandibulectomy after a spindle cell tumor resection. The free fibular flap was harvested and divided into several segments to close the mandible and maxilla. However, the vascularized bone was insufficient; thus, non-vascularized bone was used in combination to reconstruct the maxilla. Six months after bone reconstruction, a dermofat graft was placed to fill the cheek structure. During the 6 months of follow-up, the vascularized and non-vascularized fibular bones were well arranged. Intraoral placement of a skin paddle covering the maxilla and mandible was viable. Both functional and esthetic outcomes were attained in patients with high satisfaction rates. Although there are many reconstruction options for patients with post-wide tumor excision, the fibula free flap remains the main choice as a replacement for facial bones because it has a strong and firm bone structure that can resemble facial bones; thus, a non-vascularized bone graft can be used in combination to cover the defects.

Introduction: Macroglossia is a frequent clinical feature of Beckwith-Wiedemann syndrome (BWS), a congenital overgrowth disorder. Macroglossia can lead to abnormal breathing, feeding, speech, and dentoskeletal development. Partial glossectomy is a common intervention aimed at reducing these abnormalities. The optimal timing of partial glossectomy remains controversial due to the potential need for secondary surgery and the ongoing growth of the tongue in early childhood.

Materials and methods: After PRISMA-ScR and PRISMA-S reporting standards, this systematic review included English language studies of patients with BWS who underwent partial glossectomy. Data were extracted, including patient age, clinical outcomes, and follow-up. Study evidence levels were categorized based on a recognized hierarchy, and bias was assessed using the MINORS criteria.

Results: Early tongue reduction surgery (<24 mo) was associated with a lower incidence of class 3 occlusion and anterior open bite compared with later surgery. Improvements in speech intelligibility, tongue mobility, and breathing outcomes, including a reduction in obstructive sleep apnea, were observed, especially in early surgical groups. Feeding and drooling outcomes improved across both early and late surgical interventions, although no direct comparisons were made between the 2. Overall, tongue reduction surgery demonstrated benefits in functional outcomes, whereas dentoskeletal improvements remained variable.

Conclusion: Although there is a lack of consensus to the optimal age for the procedure, overall tongue reduction surgery in BWS seems to have functional benefits, including in speech, feeding, and breathing. Dentoskeletal outcomes are more variable. Variability in macroglossia severity, surgical technique, and surgeon experience may account for differences in reported outcomes across studies.