Journal of Craniofacial Surgery最新文献

Purpose: The aim of this study was to evaluate the stress changes in the temporomandibular joint (TMJ) after sagittal split ramus osteotomy (SSRO) with finite element analysis (FEA).

Material and methods: 5 and 10 mm mandibular setback and advancement were applied to models by using SSRO and a control model without osteotomy evaluated. The articular disc was modeled as superelastic, and the stresses on the articular fossa, disc, and condyle were evaluated.

Results: The stresses on the cartilage were 1.150 MPa on the 5 mm advancement model and 1.506 MPa on the 10 mm advancement model. The stresses on the disc were 11.56 MPa on the 5 mm advancement model, 7.94 MPa on the 10 mm advancement model and the amount were significantly higher than other models. The stress, especially in the cartilage, increased with the amount of advancement. In the setback models, the stresses on the condylar cartilage and the disc were higher than in the control model, and the stress in the condylar cartilage increased with the amount of setback.

Conclusion: SSRO increases the stresses in the TMJ components and stresses increase depending on the amount of advancement and setback and may cause the development of joint problems.

Purpose: This study aimed to use reconstructive methods for complex oral and maxillofacial defects, explore their feasibility, and evaluate the efficacy of defect reconstruction using anterolateral thigh (ALT) multiple paddle flaps.

Patients and methods: The authors performed a retrospective case series of 33 patients who underwent oral and maxillofacial defect reconstruction using the ALT multiple paddle flaps. The design and harvest of the flaps, methods for defects reconstruction, and reconstructive efficacy are described.

Results: All 33 patients were men, with a mean age of 49.5 years. Of the flaps, triple skin paddles plus muscle paddles were included in 3 cases, triple skin paddles were included in 1 case, 2 skin paddles plus muscle paddles were included in 29 cases. The skin paddles measured 3×5 cm to 10×16 cm. Postoperatively, all flaps survived completely. Parotid salivary fistula and orocutaneous fistula occurred in 1 patient of each, thigh wound infection and effusion occurred in 1 and 2 patients, respectively. All patients were followed up for ~2 to 93 months; most patients' oral functions and appearance were acceptable, and thigh motor dysfunction was not observed.

Conclusions: With separate skin paddles for defects of different positions, individualized muscle flap for dead spaces, combination of different skin paddles for larger defects, effective reduction or avoidance of wound complications, and acceptable donor site morbidity, the ALT multiple paddle flaps are an ideal candidate for complex oral and maxillofacial defects reconstruction.

Background: Blood transfusion is common in cranial vault surgery, and protocolized efforts to minimize transfusion have been reported in recent years. This study assesses the long term, prospective outcomes of a pediatric blood management protocol for the cranial vault reconstruction (CVR) population.

Materials and methods: Data from a retrospective control cohort and a prospective cohort employing a protocol for preoperative hematologic optimization of patients undergoing CVR from January 2015 to October 2023 was reviewed. Preoperative hemoglobin (Hgb) determined the preoperative protocol. Intraoperative tranexamic acid (TXA) and/or aminocaproic acid, cell-saver technology, and postoperative iron or erythropoietin alfa supplementation were also used in the protocol. For statistical analysis, P <0.05 was deemed significant.

Results: The cohort consisted of 194 successive patients (20 control and 174 treatment). Age, sex, and weight were not significantly different between groups. Mean postoperative Hgb was significantly higher in the control group ( P <0.01). No difference was observed in Hgb at discharge between control and treatment groups. Mean estimated blood loss, volume of intraoperative packed red blood cells, rate of packed red blood cell transfusion, and mean total transfusion volume during hospitalization were significantly higher in the control group compared with the treatment group ( P <0.01). Mean length of stay did not differ between groups.

Conclusion: Efforts to optimize blood management in the CVR population are critical. This prospective study represents a robust and reproducible protocol for pediatric blood management with significant reductions in transfusion requirements.

This anatomic study was designed to assess the position of the facial artery concerning the soft tissue landmarks, pogonion (Pog)and Gonion (Go). Sixty freshly frozen cadavers were used in this study. On the right side, the mean distance between the facial artery and Pog was 7.05±0.66 cm. The mean distance between the facial artery and Go was 3.34±0.36 cm. The results indicated that the facial artery was 32.32%±2.05 of a mandibular length to Go and 67.78%±2.05 Pog. On the left side, the mean distance between the facial artery and Pog was 7.10±0.65 cm. The mean distance between the facial artery and Go was 3.23±0.34 cm. The results indicated that the facial artery was 31.30±2% of the mandibular length at Go and 68.71±2% at Pog. The ratio of the facial artery distance to Pog and Go did not correlate with the mandibular length ( P >0.05). However, the distance between the facial artery, Pog, and Go correlated with mandibular length. ( P <0.001). The ratio of the cross-point of the facial artery with the mandibular border to the length of the mandible about Go and the Pog was generally found to be independent of mandibular length.

Introduction: Sarcomas are relatively rare malignant tumors of mesenchymal origin, representing only about 1% of tumors in the head and neck region.

Materials and methods: A retrospective study involved patients with sarcomas of the head and neck region who were diagnosed and treated over a 5-year period.

Results: Nine patients were included, 4 men and 5 women. The mean age of the patients was 51 years. Eight patients had soft tissue sarcomas, and 1 patient had osteosarcoma. The most common histologic types were dermatofibrosarcoma protuberans and angiosarcoma. Tumors presented predominantly with local symptomatology. All patients were treated only by surgical excision. No distant or regional metastases were found in any patient. Complete surgical excision was achieved in all cases, except in patients with chondrosarcoma of the nose and sinuses, who died due to local progression in the second year of follow-up. Other patients were disease-free during the observed period; a patient with osteosarcoma died in the fourth year of follow-up without recurrence of the malignant disease.

Conclusion: Large prospective and multicenter studies are necessary to provide relevant data on the distribution of different types of sarcoma in the head and neck region, their clinical behavior and response to therapeutic modalities, as well as on recurrence, presence of metastases, and survival.

Enhanced recovery after surgery (ERAS) protocols have informed perioperative care across multiple surgical specialties, optimizing patient outcomes through surgical stress management and accelerated recovery. This study evaluates the familiarity and adoption of ERAS elements among craniofacial and oral and maxillofacial surgeons in pediatric orthognathic surgery, a field where a formal ERAS protocol has not been established. A closed-ended survey of 102 surgeons was conducted to assess familiarity with and utilization of 14 ERAS elements. The survey garnered a 40.2% response rate, with 41 surgeons participating. The majority of respondents (68.3%) specialized in craniofacial (CF) surgery, and their annual pediatric orthognathic surgery caseload varied widely. Key findings revealed that 7 ERAS elements were widely adopted, including hypothermia prevention, normovolemia maintenance, intraoperative tranexamic acid use, and minimized opioid use for postoperative pain control. However, elements such as liposomal bupivacaine and postoperative goal-directed fluid therapy were less utilized, primarily due to limited availability or knowledge. Surgeons demonstrated high familiarity with elements like jaw immobilization and minimizing opioid use but showed knowledge gaps in areas such as preoperative nutritional screening and goal-directed fluid therapy. These insights underline the need for further education and the development of a standardized ERAS protocol tailored for pediatric orthognathic surgery. The study underscores the importance of multidisciplinary collaboration and comprehensive preoperative education in implementing ERAS protocols. This study serves as a foundation for future research into optimizing perioperative care for pediatric patients undergoing orthognathic surgery.

Background: This paper presents the authors' team's research on a craniofacial surgical robot developed in China. Initiated in 2011 with government funding, the craniofacial surgical robot project was officially launched in Shanghai, developed jointly by the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine and the Shanghai Jiao Tong University medical-engineering team. Currently, based on multiple rounds of model surgeries, animal experiments, and clinical trials, our team is applying for approval as a Class III medical device from the National Medical Products Administration (NMPA). As an innovative tool in the field of craniofacial surgery, it fills a technological gap within the country.

Methods: This study is a multicenter cohort study based on patient data from Shanghai Ninth People's Hospital from 2019 to 2024. Inclusion criteria included patients who underwent craniofacial surgery with complete follow-up data, with the primary variable being the use of robotic assistance in craniofacial surgery. Data analysis involved descriptive statistics, t tests, and multivariable regression, with a significance level set at P<0.05.

Results: The craniofacial surgical robot has been widely explored in the fields of congenital deformities, tumor reconstruction, and esthetic surgery. In the clinical trials discussed in this article, which included experiments on both craniofacial deformity correction surgeries and esthetic surgeries, a total of 39 patients were enrolled. In mandibular osteotomy surgery, robotic-assisted procedures can reduce osteotomy length error by an average of 2.2 mm and mandibular angle error by 9.09 degrees, while also decreasing the average surgery time by 10.43 minutes. In hemifacial microsomia distraction osteogenesis surgery, robotic-assisted surgery can reduce osteotomy length error by an average of 4.6 mm and shorten the average surgery time by 60 minutes. The robotic-assisted group also showed better perioperative outcomes for patients. The surgical precision was improved and there was a significant reduction in postoperative complications.

Conclusion: The authors' research team has completed the first multicenter study on craniofacial surgical robots in China, demonstrating that this robot significantly enhances surgical precision, reduces operation time, and improves perioperative patient indicators. These findings indicate that the robot is highly effective in assisting surgeons with complex procedures. The study suggests that, in the future, this robot is likely to be widely adopted in craniofacial surgery, significantly advancing surgical efficiency and precision, and bringing transformative progress to clinical practice.

Introduction: The surgical requirement for cleft lip and palate repair remains unmet in many developing areas of the world, including remote regions of Ghana. This article reviews the utilization of Internet education and online consultation for cleft lip and palate surgical training in Sunyani Regional Hospital (SRH), Ghana.

Methods: The cleft lip and palate treatment was promoted to patients in remote areas of Sunyani, Ghana region, through a charitable outreach program. These basic designs and settings were managed by local participants such as doctors, residents, nurses, and staff in SRH, Ghana.

Results: From November 2014 to December 2020, the authors collaborated in surgical treatment for 84 cases that were diagnosed with unilateral cleft lip, bilateral cleft lip, hard and soft palate cleft, and microstomia. The type of surgery has varied and has included cheiloplasty, palatoplasty, and others. The average scores of esthetic outcome evaluation were nasal form=2.4, symmetry of the nose=2.9, and vermillion border=2.9. Through the program, the surgeons and residents became significantly more proficient at cleft lip and palate surgery. The seminar topics have covered essential and sustainable topics based on SRH's current needs and showed the effectiveness in the current coronavirus disease-19 pandemic situation.

Conclusions: The shortage of orofacial cleft surgeons working in rural areas like Sunyani, Ghana, remains an obstacle that poses a challenge to any effort to improve health care quality in these rural communities. Sustainable remote education is essential for the training of local cleft surgeons to fill this local need; our collaborative and charitable program could be a recommended education design for cleft surgeons and institutes for their sustainable education.

Purpose: Previous studies have lacked a comprehensive analysis of imaging modalities for diagnosing Moyamoya disease (MMD). This study aims to bridge this gap by utilizing multi-modal imaging to provide a more detailed understanding of the clinical and imaging characteristics of MMD.

Methods: A retrospective analysis was conducted on seventy-eight adult MMD patients enrolled from March 2018 to March 2021. The study focused on clinical features, imaging findings, and treatment outcomes, with a particular emphasis on the comparative efficacy of different imaging modalities.

Results: In this series, clinical manifestations varied depending on the type of MMD, with intracerebral hemorrhage (ICH) being the most common (69.2%), followed by cerebral infarction (25.6%). Imaging techniques provided critical diagnostic insights: magnetic resonance imaging (MRI) demonstrated superior sensitivity over computed tomography (CT) in detecting hemorrhages, whereas computed tomography angiography (CTA) and digital subtraction angiography (DSA) identified intricate vascular lesions, including moyamoya vessels and aneurysms. Notably, cerebral perfusion imaging (CTP) highlighted significant differences in cerebral blood flow and volume between infarction and hemorrhage cases. This comprehensive imaging approach guided varied therapeutic strategies, including bypass surgery in 57 patients and interventional embolization for aneurysms in 14 patients.

Conclusion: The authors' findings underscore the critical role of early diagnosis using DSA, whereas highlighting CTA and MRA as valuable noninvasive tools for screening and follow-up. The integration of multi-modal imaging provides a detailed vascular assessment crucial for individualized patient management, facilitating timely interventions and significantly improving clinical outcomes.