Journal of Craniofacial Surgery最新文献

Noonan syndrome (NS) is a rare, genetic multisystem disorder often presenting with associated craniofacial abnormalities. The authors report an identical twin pair with classical features of NS including short stature, mild ptosis, hypertelorism, down-slanting palpebral fissures, low-set angulated ears, and giant cell tumors in the craniofacial skeleton. Interestingly, these patients also presented with bilateral, symmetric, dystrophic auricular calcifications. Genome sequencing revealed identical germline son of sevenless homolog 1 mutations and inversion of chromosome 2 (p11.2q13). Awareness of the association of auricular calcifications and NS may help guide clinical management for these patients, particularly if auricular procedures are indicated.

The paramedian forehead flap is renowned for its versatility and can cover a wide range of nasal defect sizes. Most of the literature discussing outcomes of paramedian forehead flap reconstructions focuses on morbidity at the recipient site. Frontal bone exposure resulting from the use of the paramedian forehead flap is a rare but possible complication, especially when periosteum overlying the bone is damaged during surgery or during healing by secondary intention due to desiccation. In this case, a 53-year-old female underwent nasal reconstruction with a paramedian forehead flap for an extensive nasal defect after Mohs surgery and resection of residual basal cell carcinoma. She missed her postoperative follow-up visit, and her frontal bone was noted to be exposed before the division of the pedicle procedure. During the division of the pedicle, the frontal bone was burred, and a bilayer dermal regeneration matrix was applied. She underwent a split-thickness skin grafting from her thigh at 4 weeks. The graft take was 100%, and wound closure was achieved with an acceptable cosmetic outcome. The successful resolution of the complication through innovative surgical interventions highlights the importance of adaptive surgical strategies and thorough postoperative care, aiming to contribute to the existing body of knowledge and improve future clinical practices in reconstructive surgery.

Background: This experimental study aimed to assess the three-dimensional and histological changes of the alveolar socket with local application of ZA.

Methods: Nine male New Zealand white rabbits were randomly allocated into 4-, 8-, and 12-week groups after the extraction of 4 incisor teeth. The upper and lower right sockets were filled with ZA + collagen sponge (ZA-CS group), while the left sockets were filled with collagen sponge alone (CS group) postoperatively. At 4, 8, and 12 weeks (T1, T2, and T3) after the extraction, radiographic and histomorphometric evaluations were conducted for both groups.

Results: The increase in alveolar bone density of the ZA-CS group at T2 and T3 was significantly higher than the CS group (P＜0.01). Three-dimensional evaluations demonstrated no statistically significant differences in ridge height and width between the 2 groups at T2 and T3. On histological evaluation, the ZA-CS group included significantly fewer TRAP-positive cells than the CS group at T1 (P＜0.05). In ALP staining, all cases in both groups were classified as positive at each time point. Masson trichrome staining showed significantly higher mean red collagen volume fraction in the ZA-CS group (76.09%, 79.64%) than in the CS group (66.17%, 69.22%) at T2 and T3, respectively (P＜0.05 and ＜0.01).

Conclusions: Although local ZA application with collagen sponge did not reduce alveolar ridge contraction, it improved the bone density and maturity of newly formed bone after tooth extraction.

Late secondary reconstruction is sometimes required in patients with suboptimal primary panfacial fracture repair. At this stage, it can be difficult to discern original facial architecture due to malunion and bony remodeling. By utilizing the original postinjury CT scan to complete fracture reduction in the virtual reality (VR) planning environment, the surgeon may attempt to recreate an "ideal" facial bony anatomy for patients. This technique was completed in 2 patients presenting with facial deformity secondary to malunited panfacial fracture. Each had a cone-beam CT (CBCT) scan taken at presentation and the initial postinjury CT scans were obtained. Fracture reductions were completed in VR to recreate the preinjury anatomy. The resulting model was overlaid with current anatomy to create surgical aids. The first patient, a 23-year-old man, presented with malunion of all bones of the midface. Cutting guides were designed for the Lefort 1 segment, left zygomaticomaxillary complex (ZMC), and naso-orbito-ethmoid (NOE) osteotomies. The second patient, a 30-year-old woman, had bilateral ZMC and subcondylar fractures, midface retrusion, and malunion of parasymphyseal fracture. A 2-stage procedure was planned, including an initial Lefort I and bilateral sagittal split osteotomy with midline wedge excision. To address malar projection, a second surgery was planned using custom MEDPOR midface implants for the NOE and zygomatic regions. Both patients were discharged home, and all surgical goals and esthetic objectives were achieved.

Objective: Isolated and noncomminuted mandibular angle fractures are commonly fixed with a single miniplate on the superior border (Champy technique) through an intraoral approach. However, the use of this technique for comminuted mandibular angle fractures has not been reported yet. This article verified that the Champy technique can also be used to treat comminuted mandibular angle fractures.

Methods: The authors compared the therapeutic effects of using the Champy technique for intraoral fixation of comminuted mandibular angle fractures with or without alveolar bone defect. The dislocated teeth were removed. Iodoform gauze was used in a patient with alveolar bone defects and incomplete closure of soft tissue.

Results: A patient with comminuted mandibular angle fractures without alveolar bone defect experienced primary wound healing and good occlusion after surgery. A patient with comminuted mandibular angle fractures accompanied by alveolar bone defect and incomplete closure of soft tissue has an intraoral fistula and bone resorption until 2 months postoperatively. At 6 months postoperatively, the occlusion remained stable and callus healing had been completed.

Conclusion: The Champy technique for intraoral single plate fixation is feasible for comminuted mandibular angle fractures. Incomplete closure of soft tissue leads to exposure of the bone marrow cavity, resulting in delayed fracture healing.

Objective: It is difficult to identify disease entities underlying lymphadenopathy in the head and neck region based solely on imaging. This often results in metastatic squamous cell carcinoma (Sqcc)-induced lymphadenopathy being mistaken for lymphoma. This study aimed to analyze clinical characteristics and computed tomographic features that aid in distinguishing between metastatic Sqcc and lymphoma when lymphadenopathy resembles a large solitary lymphoma.

Methods: The authors retrospectively enrolled 5 patients, managed between 2010 and 2024, with metastatic Sqcc mistaken for lymphoma and 9 patients with lymphadenopathy of 2 cm or larger due to lymphoma.

Results: Among the 5 patients, 3 exhibited a homogeneous lymphadenopathy phenotype, whereas the remaining 2 displayed heterogeneous enhancement with multiple small necrotic areas within the affected masses. Measurement of the Hounsfield units (HU) for lymphadenopathy, the sternocleidomastoid muscle, and the submandibular gland (SMG) was conducted for each patient. The ratio of lymphadenopathy HU to the average HU of the sternocleidomastoid muscle and the SMG was significantly higher in patients diagnosed with metastatic Sqcc compared with those with lymphoma (P = 0.01).

Conclusion: In computed tomography scans, heterogeneous lymphadenopathy or enhancement levels that approach or exceed those of the SMG may indicate the likelihood of Sqcc rather than lymphoma.

Complications following mandibular fracture repair (MFR) may carry significant morbidity to patients. The purpose of our study is to determine the risk factors for postoperative complications following MFR. The authors conducted a retrospective cohort study of trauma patients who underwent MFR in 2018 and 2019. Excluded were patients below 18 years old and those with postoperative follow-up <2 weeks. The primary outcome was the incidence of major and minor postoperative complications following MFR. Of n=275 patients included, mean (SD) age was 35 (14) years and median (IQR) follow up was 49 (26-117) days. Most patients [n=208 (76%)] underwent both maxillomandibular/intermaxillary fixation (MMF/IMF) and open reduction and internal fixation (ORIF). The incidence of major postoperative complications was 19% (n=51) including malunion [n=8 (2.9%)], malocclusion [n=21 (7.6%)], and unplanned reoperation [n=26 (9.5%)]. The incidence of minor postoperative complications was 61% (n=167). Alcohol use at the time of surgery and greater MISS score were associated with greater odds of major complications [adjusted odds ratio (aOR) 95% CI: 3.4 (1.2-9.0), 1.09 (1.02-1.160), respectively]. Smoking at the time of surgery and moderately (>2 mm) and severely displaced fractures (>4 mm) were associated with greater odds of minor complications [aOR (95% CI): 2.1 (1.04-4.2), 2.7 (1.2-6.4), 2.7 (1.1-6.6), respectively]. Alcohol use, smoking, greater MISS score, and displaced fractures >2 mm were significant risk factors for postoperative complications following MFR. Our findings can help guide informed decision making and surgical planning in patients with mandibular fractures.

Symphyseal fractures of the mandible with concomitant bilateral condylar fractures can often be a particularly challenging fracture pattern for the facial surgeon. Improper reduction of these fractures may lead to facial widening that proves difficult to correct secondarily. Here the authors describe a method to prevent this unwanted facial widening with the use of an orthopedic periarticular reduction clamp. This method allows for not only increased ease of reduction but also reduces the burden of assistance in manual reduction of the fracture.

There is no consensus on the surgical options for repairing mild-to-moderate eyebrow defects due to burns, trauma, and skin tumors, and the outcome of the surgery is unclear. In this study, the authors evaluated the surgical outcomes and patient-reported outcomes of eyebrow defect repair with the "kite flap" in a cross-sectional study. Case data and imaging data of twelve patients with eyebrow defects undergoing repair from July 2018 to June 2021 were retrospectively analyzed, and the surgical outcomes were statistically analyzed by the Face-Q subjective evaluation scale and the surgical objective evaluation scale. In the postoperative objective evaluation, 66.67% of the patients were "very satisfied," and the scores of the Face-Q scale for the assessment of appearance and psychosocial function were significantly improved compared with those of the preoperative period, with a statistically significant difference in the data changes (P<0.05). The study showed that the "kite flap" is an excellent surgical method for repairing mild-to-moderate defects of the eyebrow, and it can meet the requirements of both function and appearance after surgery.

Background: The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery.

Methods: A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale.

Results: Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3 cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures.

Conclusion: Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.