Journal of Craniofacial Surgery最新文献

Objective: The 5-tone music therapy is a traditional Chinese medical practice that uses the therapeutic properties of specific musical notes to regulate physiological functions and promote psychological well-being. The aim of this study was to evaluate the effects of the 5 musical notes therapy on sleep disorders in individuals with Parkinson disease.

Methods: The data of 74 patients with Parkinson disease who received treatment at our hospital between September 2021 and September 2023 were retrospectively analyzed. The patients who received 5 musical notes therapy were assigned to the study group (n=37), and the patients who received the routine care were assigned to the routine care group (n=37). The Pittsburgh Sleep Quality Index (PSQI), National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) scores were assessed and compared between the 2 groups.

Results: One month after the intervention, PSQI scores were significantly lower in both groups compared with baseline (P<0.05), with the study group demonstrating a greater reduction than the routine care group (P<0.05). MMSE scores increased significantly (P<0.05), and the study group exhibited higher MMSE scores than the routine care group (P<0.05). The SAS and SDS scores decreased in both groups post-intervention, with greater reductions observed in the study group compared with the routine care group (P<0.05). In addition, NHISS scores were significantly lower in the study group than in the routine care group (P<0.05). No significant differences were observed in the overall incidence of complications between the 2 groups (P>0.05).

Conclusions: The application of the 5 musical notes therapy in the management of sleep disorders among patients with Parkinson disease demonstrated significant benefits, including improved sleep quality, enhanced cognitive function, and alleviation of anxiety and depression. This therapeutic approach also contributed to a reduction in NIHSS scores and is recommended for broader clinical implementation.

Objectives: The nasopalatine canal (NPC) is a critical anatomic structure in maxillofacial surgery. Variations in its morphology among individuals with cleft lip and palate (CLP) may increase the risk of neurovascular injury and adversely affect surgical outcomes. This study aimed to investigate the anatomic characteristics of the NPC in CLP patients using cone beam computed tomography (CBCT).

Methods: This retrospective cross-sectional study was conducted at a Turkish university hospital, based on CBCT scan data collected between 2016 and 2024. The primary predictor variable was cleft status (yes/no), and the main outcome variables included NPC shape, number of canaliculi, canal length, diameters, and number of the incisive (IF) and nasopalatine foramen (NF), and buccal bone thickness. Appropriate statistics were computed using a significance threshold of P≤0.05.

Results: A total of 78 unilateral CLP patients (29 females and 49 males; mean age 16.23) and 78 matched controls were included. Tree-branch, needle-shaped, and funnel-shaped canals, as well as type 1 and 2 canaliculi, were significantly more common in the CLP group (P<0.001, P=0.012). CLP patients exhibited significantly fewer NF, shorter canal length, and smaller IF diameters (P<0.001). Buccal bone thickness differed by location, with the CLP group showing higher values at points B to D, and the control group at point A (P≤0.05).

Conclusions: Anatomic variability of the nasopalatine canal in CLP patients underscores the importance of individualized radiographic assessment. Incorporating CBCT into preoperative planning can enhance procedural safety and improve outcomes in maxillofacial interventions such as Le Fort I osteotomy, implant placement, and orthodontic procedures involving anterior tooth movement.

Background: Lateral orbital hollowing is a subtle yet influential contributor of periorbital ageing. It results from attenuation of subcutaneous fat, atrophy of the lateral orbital fat pad, and descent of the orbicularis oculi muscle, creating a concavity that contributes to a fatigued and aged appearance.

Objectives: To evaluate the efficacy and safety of supraperiosteal hyaluronic acid (HA) filler injection for lateral orbital hollowing, with outcomes assessed at the longest available follow-up (6 mo) by both patients and physicians using the Global Aesthetic Improvement Scale (GAIS).

Methods: A single-centre prospective case series enrolled 48 consecutive patients (40 women, 8 men; mean age 46.2±5.8 y) between July and November 2025, treated with cross-linked HA. All injections were performed by a single experienced aesthetic physician using a 30-gauge blunt cannula introduced through a lateral entry point 1.5 cm from the canthus, delivering 0.5 to 0.8 mL per side in the supraperiosteal plane. Standardised photographs were obtained at baseline and at follow-up visits (earliest 1 mo; longest 6 mo). GAIS ratings were completed by 2 independent physicians and by patients; patient satisfaction was additionally summarised as the proportion rating outcomes as good/very good/exceptional versus slight/none.

Results: Follow-up was completed in 48/48. The shortest photographic interval presented was 1 month and the longest follow-up was 6 months. At 6 months, physician GAIS was 4.4±0.5 and patient GAIS was 4.5±0.6. On patient GAIS, 43/48 (89.6%) rated the outcome as "very good" or "exceptional," while 5/48 (10.4%) rated "good"; no patients rated "slight" or "none" (0% dissatisfied). Adverse events were minor and self-limited: bruising in 13/48 (27.1%) and oedema in 14/48 (29.2%); each resolved within 1 week. No serious complications occurred.

Conclusions: Supraperiosteal HA placement for lateral orbital hollowing restored the lateral contour with high satisfaction and minimal downtime through 6 months. Presenting clinical photographs in a single composite figure enables a clear baseline-to-follow-up comparison. Longer-term follow-up beyond 6 months is needed to better define durability and late events in this region.

Level of evidence: Level IV.

Guided bone regeneration (GBR) is a critical technique in craniomaxillofacial surgery, significantly advancing the management of bone defects resulting from trauma, tumor resection, congenital malformations, and insufficient bone volume for dental implants. Autologous GBR capitalizes on the body's inherent regenerative capabilities in conjunction with strategic interventions, benefiting from enhanced biocompatibility and integration with osteogenic processes. This review delineates recent advancements in autologous GBR within the context of craniomaxillofacial surgery. First, it elucidates the fundamental concepts and mechanisms underlying autologous GBR, emphasizing the biological processes of osteogenesis along with various influential factors. Second, it explores material applications in autologous GBR-encompassing both absorbable and nonabsorbable barrier membranes as well as diverse types of bone graft substitutes-highlighting their distinct characteristics and clinical outcomes. Third, this review discusses the clinical applications of autologous GBR across subfields, such as dental implantation, jaw defect repair, and correction of craniofacial deformities through representative evidence-based cases. Fourth, it addresses challenges encountered by autologous GBR-including issues related to regeneration efficiency and complications such as infection or membrane exposure-and proposes optimization strategies to mitigate these concerns. Finally, this review investigates innovative research directions encompassing gene therapy combined with GBR technology as well as applications of 3D printing while forecasting future trends toward multitechnology integration and precision treatment approaches. This comprehensive review serves as an essential reference for clinicians and researchers engaged in craniomaxillofacial surgery and its associated disciplines.

Background: Scar formation remains a significant clinical challenge in facial trauma repair, with the anatomic region-specific propensity poorly understood. This study investigates differential scarring outcomes between the perioral and nasal regions following refined cosmetic suturing.

Methods: A retrospective analysis was conducted on 23 patients with nasal or perioral trauma treated using cosmetic suturing techniques. Scar evaluation was performed using the Scar Cosmesis Assessment and Rating (SCAR) scale by professional plastic surgeons, assessing parameters including scar spread, erythema, depigmentation, track marks or suture marks, hypertrophy or atrophy, and overall impression.

Results: Despite identical surgical techniques, perioral scars exhibited significantly higher SCAR scores (5.56±2.40) compared with nasal scars (3.41±1.90) (P<0.05). Specifically, perioral scars demonstrated greater spread (1.79±0.59 versus 1.09±0.48, P<0.01) and hypertrophy or atrophy (1.43±0.46 versus 0.98±0.58, P<0.05). No significant differences were observed in erythema, depigmentation, or patient items.

Conclusion: The perioral region demonstrates a higher predisposition to scarring than the nasal region despite equivalent repair techniques, highlighting the influence of biomechanical factors. These findings emphasize the need for region-specific preventive strategies in facial scar management.

Craniofacial basal cell carcinoma (CFBCC) accounts for the majority of basal cell carcinomas (BCCs) by anatomic distribution yet represents only a small proportion of head and neck malignancies, with disproportionate morbidity due to involvement of anatomically complex and functionally critical facial regions. Management is challenged by subclinical tumor spread along embryologic fusion planes, perineural invasion, and proximity to ocular, neural, and skull base structures. This narrative review synthesizes contemporary evidence on epidemiology, histopathologic subtypes, molecular pathogenesis, diagnostic evaluation, surgical management, reconstruction, and emerging therapies for CFBCC. High-risk and advanced disease includes aggressive histologic variants, chronically neglected or large tumors, recurrent lesions, and cases with orbital, bone, or skull base involvement. Clinical assessment, including regional nodal evaluation, is complemented by advanced imaging modalities, including magnetic resonance imaging, computed tomography, reflectance confocal microscopy, and optical coherence tomography. Mohs micrographic surgery provides optimal margin control for high-risk facial subsites, while deeply invasive tumors may require craniofacial resection. Advances in Hedgehog pathway-targeted therapies, digital surgical planning, and multidisciplinary reconstruction continue to expand treatment options and improve functional and aesthetic outcomes.

Frontal sinus fractures (FSF) can lead to detrimental intracranial infections, yet there is variability in the literature regarding the efficacy of antibiotic prophylaxis. This study aims to provide guidance on the role of prophylactic antibiotics in mitigating infection following FSF. A retrospective cohort study was conducted from January 2018 to December 2022 comparing the incidence of infection between patients managed with versus without antibiotics. Patients with FSF diagnosed by CT scan and at least 18 years old were included. Our primary outcome was the incidence of infection following FSF. Of 201 patients, 26 (12.9%) had a dural tear or cerebrospinal fluid leak (CSF). Patients managed with antibiotics were significantly more likely to have a dural tear or CSF leak [25 (15.4%), 1 (2.6%), P=0.032], and none of these patients developed an infection. A total of 6 (3%) patients developed infection, including 4 meningitis cases and 2 sinusitis cases. Infections occurred in 5 of 162 patients (3.1%) who received antibiotics, compared with 1 infection (2.6%) in the 39 patients without antibiotic prophylaxis, with no statistically significant difference (P=1.0). The most common prophylactic antibiotic among patients who developed infection was IV cefazolin. The majority of fractures (149, 74%) were managed conservatively, including all patients who developed infections. Although further randomized controlled trials are needed to better define the role of antibiotic prophylaxis in preventing infections, antibiotics may not be necessary for all FSF patients. In the subset of patients with CSF leak, the absence of infection might indicate the protective effects of antibiotics.

Multisutural craniosynostosis, involving premature fusion of cranial sutures, leads to abnormal skull shape and elevated intracranial pressure (ICP), threatening neurodevelopment. This case report describes a 6-day-old infant with multisutural craniosynostosis associated with an ERF gene mutation. Imaging confirmed elevated ICP. At 2 months, posterior cranial and foramen magnum decompression effectively reduced ICP, deferring fronto-orbital advancement. By age 2, the child had achieved normal developmental milestones with stable cranial morphology and no Chiari I malformation. Early posterior decompression is a viable first-line intervention for syndromic craniosynostosis, promoting natural bone reformation and reducing secondary surgeries. Multidisciplinary management is essential.

Background: Velopharyngeal insufficiency (VPI) is caused by incomplete closure of the velopharyngeal port and can occur despite primary cleft palate repair. Pharyngeal Flap (PF) and Sphincter Pharyngoplasty (SP) are commonly used operations to treat VPI. This review aims to compare the efficacy of these operations in resolving VPI and assess speech outcomes and complications, including sleep apnea.

Methods: The PubMed, Embase, and World of Science databases were searched in October 2024. The title, abstract, and qualifying full-text article screening were performed by 2 authors, with a third author providing consensus. Articles including cleft palate patients and both procedures were included. The studies were then extracted and assessed for risk of bias using the Cochrane and Newcastle-Ottawa risk of bias tools. Meta-analysis was performed using a random effects model.

Results: A total of 10 articles with 531 total patients were included in this study. Meta-analysis of VPI resolution and hypernasality yielded insignificant differences between PF and SP. Sleep apnea was shown to be significantly higher in PF patients after sensitivity analysis. Complication and reoperation rates were also found to be similar in patients receiving PF and SP.

Conclusions: PF and SP can both effectively treat VPI with similar rates of VPI resolution, hypernasality, and complications. However, SP had a reduced incidence of sleep apnea. Limitations of this study include a lack of standardization for reporting outcomes. Thus, prospective studies should report outcomes using standardized scales.