Maxillofacial Plastic and Reconstructive Surgery最新文献

Background: Craniomaxillofacial reconstruction poses significant clinical challenges due to the complexity of the anatomy and the varied causes of defects. Selecting the optimal implant material remains a crucial factor in achieving successful functional and aesthetic outcomes. This study combined a systematic review and a retrospective case series conducted at the Hospital 5, Almaty, Kazakhstan. The sample consisted of 52 patients who underwent craniomaxillofacial reconstruction between 2021 and 2024, receiving either PEEK, titanium, PMMA or silicone implants. Following the surgical procedures, patients were invited to participate in an online survey to evaluate their satisfaction with long-term outcomes.

Results: PEEK implants demonstrated the complication rate at 22.2%, attributable only to hematoma. Titanium implants exhibited the complication rate-22.7%, with cases of asymmetry and diplopia (4.5%), exposure (9.1%), hematoma (4.5%) and infection with rejection (9.1%). Aesthetic outcome scores, measured by the ANA scale, varied across materials. PEEK implants achieved the highest mean ANA rating with 8.86 (SD = 0.35; 8.25-9.25), showing a significant difference over PMMA, silicone and titanium.

Conclusions: PEEK implants demonstrated promising clinical and aesthetic outcomes in craniomaxillofacial reconstruction. However, material selection should be personalised, considering defect location, soft tissue coverage to optimise results.

Background: Odontogenic keratocyst (OKC) and ameloblastoma are benign but locally aggressive jaw lesions that require careful surgical management. While radical resection has traditionally been the preferred treatment, conservative approaches such as surgical excision with peripheral ostectomy have gained interest to prevent significant functional and aesthetic consequences. This study aims to compare the recurrence rates of OKC and ameloblastoma in the maxilla following conservative surgical treatment.

Methods: A retrospective analysis was performed on 31 patients who underwent surgical excision with peripheral ostectomy for OKC (n = 19) or ameloblastoma (n = 12) in the maxilla between 2006 and 2024. Recurrence was monitored through periodic radiographic follow-ups (mean duration: 43 months), including panoramic radiograph and cone-beam computed tomography (CBCT).

Results: Among the 19 OKC cases, tumor recurred in two patients (10.5%) at 5, and 14 years post-surgery, while no recurrences were found in the ameloblastoma group. The majority of OKC (95%) were located in the posterior maxilla, whereas ameloblastoma showed an even distribution between the anterior and posterior regions, with 50% in each. Although Fisher's Exact Test did not demonstrate a statistically significant difference in recurrence rates, simple comparison suggests that OKC may have a higher tendency for recurrence than ameloblastoma following conservative treatment.

Conclusion: Surgical excision with peripheral ostectomy appears to be a viable conservative treatment option for both OKC and ameloblastoma in the maxilla, with a relatively low recurrence rate observed in this study. Notably, recurrences observed even after long-term follow-up indicate the necessity for prolonged monitoring.

Background: Immediate dental implant placement with implant-supported prostheses enables single-stage functional and aesthetic rehabilitation during jaw reconstruction, a technique referred to as "Jaw in a Day®" (JIAD). This study evaluated the feasibility of the JIAD technique combined with retroauricular robot-assisted neck dissection (RA-RAND) in patients with oral cancer undergoing mandibular reconstruction.

Materials and methods: We retrospectively reviewed 75 patients who underwent mandibular reconstruction using fibula free flaps from September 2020 to February 2024. Among them, 31 patients were eligible for analysis. Seven patients had retroauricular robot-assisted neck dissection (RA-RAND), and 24 patients had conventional transcervical neck dissection (CTND). Two patients in the RA-RAND group and nine in the CTND group underwent the JIAD procedure. We compared the time from data acquisition to surgery, reconstruction time, total operation time, and length of hospital stay between the groups.

Results: No significant differences were observed between the RA-RAND and CTND groups in terms of reconstruction time (median 431 min, IQR 274-442 vs. 310 min, IQR 236-420; p = 0.435) or hospital stay (median 20 days, IQR 17-22 vs. 20 days, IQR 18-33; p = 0.275), although the total operation time was significantly longer in the RA-RAND group (median 831 min, IQR 702-898 vs. 526 min, IQR 444-615; p = 0.002). Within the RA-RAND cohort, there were no significant differences between the JIAD and non-JIAD groups regarding time from data acquisition to surgery (median 17.5 days, IQR 14.2-20.8 vs. 13.0 days, IQR 8.0-24.0; p = 1.000), reconstruction time (median 352.5 min, IQR 311.2-393.8 vs. 431.0 min, IQR 278.0-450.0; p = 0.857), total operation time (median 863.5 min, IQR 847.2-879.8 vs. 701.5 min, IQR 649.0-751.5; p = 0.857), or length of hospital stay (median 18.5 days, IQR 15.2-21.8 vs. 20.0 days, IQR 18.0-22.0; p = 0.762).

Conclusion: Based on this case series and comparative analysis, the combination of the JIAD technique with RA-RAND appears technically feasible and does not prolong the operative or postoperative course. However, larger studies are required to confirm these findings.

Background: In patients with hemifacial microsomia accompanied by mandibular fossa deficiency and severe atrophy of the mandibular ramus, customized total joint replacement (TJR) is commonly used to restore masticatory and joint function and improve facial asymmetry. However, in countries where customized TJR is not approved, or for patients for whom the cost is prohibitive, a stock TJR system must be considered. In cases with a severely medially inclined frontal ramal angle and a lack of supporting bone for the fossa component, using a stock TJR poses significant technical challenges.

Case presentation: This case report describes the use of autogenous bone grafting to overcome these limitations. An 18-year-old male with HFM type IIB on the left side received staged procedures, including bone grafting between mandibular proximal and distal segments to increase the frontal ramal angle, autogenous reconstruction of the mandibular fossa to enable fixation of the TJR fossa component, and orthognathic surgery.

Conclusions: The frontal ramal angle improved by approximately 6.5 degrees, and 12.42 mm advancement of the pogonion could be achieved in lateral cephalogram. Successful functional and esthetic outcomes were achieved, with stable maintenance of a stock Biomet TJR over a seven-year period.

Background: Recent advancements in augmented reality (AR) have gained increasing interest in surgical applications, particularly in maxillofacial surgery. This study evaluates the accuracy and reproducibility of an AR-based navigation system using optical see-through (OST) headsets, in comparison to traditional CAD/CAM-guided approaches for Le Fort I osteotomy. Twenty identical stereolithographic skull models were divided into two groups: one group treated with OST-based AR navigation system to visualize virtual surgical lines on the skull models (n = 10) and the other treated with the conventional CAD/CAM procedure using titanium materialise surgical guides (n = 10). Virtual surgical planning (VSP) was carried out identically for both groups.

Results: Surgical accuracy was assessed by measuring deviations (in mm) between planned and postoperative positions of seven cephalometric reference points. All models in the CAD group achieved deviations below the 2-mm clinical threshold (mean deviation: 0.72 ± 0.38 mm). However, only 4 out of 10 in the OST group met this threshold (mean deviation: 2.27 ± 1.24 mm). A statistical analysis using Mann-Whitney U-test with a significance level of 0.05 was carried out to compare the mean accuracy between OST and CAD groups. The results revealed a statistically significant difference between OST and CAD groups (p-value < 0.005). Nevertheless, progressive improvements in the OST group were observed, likely reflecting a learning curve associated with the new technology.

Conclusions: Although CAD/CAM remains more accurate, the AR-based system offers advantages in real-time visualization and reduced costs and preoperative time by eliminating the need for 3D-printed guides. However, the current accuracy limitations highlight the need for further refinement of AR systems and increased operator training. Future studies are needed to validate the clinical applicability and reliability of AR-guided orthognathic surgery.

Background: Bilateral sagittal split osteotomy (BSSO) is a widely adopted surgical procedure for correcting mandibular deformities, yet neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) remains a significant postoperative complication. This complication adversely impacts patients' quality of life due to persistent sensory abnormalities in the lower lip and chin region.

Main body: This narrative review summarizes anatomical risks and prevention/management strategies. Cone-beam CT (CBCT) may clarify canal anatomy and support risk stratification. Nerve-sparing osteotomy modifications are intended to limit traction and direct exposure. Fixation choice may influence surrogate and early clinical outcomes; monocortical miniplates (MCF) may be associated with lower radiographic canal penetration and earlier recovery than bicortical screws (BCF), whereas long-term clinical differences are uncertain. Piezoelectric/ultrasonic devices may improve precision and reduce tissue trauma, and virtual planning with 3D-printed guides may support safer osteotomy paths. For established IAN injury, photobiomodulation (PBM) may support earlier recovery; corticosteroid effects are route-dependent-intravenous dexamethasone mainly reduces edema with uncertain NSD benefit, while local betamethasone at closure may yield early improvement.

Conclusion: Comprehensive management likely requires integrated preoperative assessment, refined technique, and postoperative adjuncts. Current evidence supports considering multimodal approaches-imaging-guided planning, nerve-sparing modifications, and PBM-to potentially reduce NSD and enhance early recovery, while standardized protocols and larger studies are needed before firm recommendations.

Background: The most critical factor for successfully performing setback and superior/posterior impaction of the maxilla in orthognathic surgery is securing sufficient space. This space can be achieved through pterygoid plate fracture, removal, or grinding. However, most studies to date have provided limited investigation into the management of the pterygoid process itself.

Main text: Safe manipulation of the pterygoid plate demands a precise understanding of the surrounding anatomy. The course of the internal maxillary artery demonstrates substantial anatomical and ethnic variability. In the relationship with the lateral pterygoid muscle, lateral positioning of the artery is more common in Asian populations, and symmetric courses occur more frequently than asymmetric ones. Preservation of the descending palatine artery helps maintain perfusion of the maxilla, although ligation may be indicated in certain situations. The risk of vascular injury increases when the osteotome is placed more than 15 mm superior to the most inferior point of the pterygomaxillary junction. To avoid high-level fractures, the osteotome should be positioned with its lower end at the base of the pterygomaxillary fissure and its tip directed superiorly. These anatomical considerations are essential for selecting the appropriate technique among available options, including fracture, removal, and grinding.

Conclusions: All three methods of pterygoid plate management-fracture, removal, and grinding-are all effective methods that provide skeletal stability and demonstrate no significant differences in complications including bleeding. Optimal technique selection should be guided by detailed anatomical knowledge, patient-specific factors, and intraoperative findings to maximize surgical safety and effectiveness.

Background: Orthognathic Le Fort I osteotomy (LF-IO) reinstates an accurate anatomical and functional interrelation between the facial skeletal structures. There are numerous reports in the literature regarding nasal ventilation after LF-IO, yet the number of studies focused on nasal septum angle/deviation is limited.

Purpose: This systematic review was designed to gather and analyze all of the human studies that have investigated nasal septum angle and deviation before and after LF-IO. DATA SOURCES: An electronic search was executed in Medline via PubMed, Web of Science, Scopus, and Google Scholar to identify eligible studies Only in English language up to July 10, 2025.

Study selection: Randomized and non-randomized human clinical studies on adult patients undergoing single-piece or segmental LF-IO with no history of facial traumas and/or anomalies.

Data extraction and synthesis: Random-effects model analysis was used in all cases. The risk of publication bias was assessed using a funnel plot and Egger's test. All statistical analyses were executed using Comprehensive Meta-analysis software with the significance threshold of 0.05.

Main outcomes and measures: Changes in nasal septum angle measured in degrees and through radiography and alar base width changes measured in millimeters.

Results: One non-randomized clinical trial, ten retrospective and One prospective cohort studies were included; 579 patients were enrolled with a gender ratio of 217:362 (male:female) and an age range of 16 to 56 years old. Four of the included studies had high and eight had moderate qualities regarding their risk of bias. Most patients underwent LF-IO to correct Class III malocclusions. Single-piece LF-IO combined with alar base cinch suture was the most popular surgical procedure. Frontal sections in computed tomography before and 12 months after LF-IO was the most utilized evaluation method. Six studies were selected for various meta-analyses with significantly low publication bias. Releasing nasal septum during LF-IO leads to significant increases in septum angle. CONCLUSIONS AND RELEVANCE: LF-IO, especially maxillary advancement, significantly increases nasal septum angle and alar base width. A clear definition and diagnosis protocol must be established for nasal septum deviation. Future studies must focus on highlighting a fine line between significant and insignificant changes in nasal septum after LF-IO.

Background: Maxillofacial defects compromise both function and aesthetics, posing significant challenges in rehabilitation. The advent of digital technologies has enabled the development of patient-specific implants (PSIs), providing individualized solutions that enhance clinical outcomes.

Main body: This scoping review, conducted following the PRISMA-ScR protocol, explored literature published between January 2015 and January 2025 across PubMed, SCOPUS, Web of Science, and COCHRANE databases using the PCC framework. Eligible studies included original research, case reports, randomized and non-randomized trials, and finite element analyses addressing intraoral rehabilitation with PSIs. Evidence highlights that CAD/CAM and 3D printing facilitate the fabrication of anatomically precise, patient-matched implants. These technologies contribute to reduced surgical time, high implant survival, improved mastication, and enhanced speech outcomes, while complication rates remain low. Comparative findings suggest no major differences in fit or longevity between milled and printed PSIs. Furthermore, ongoing innovations such as bioprinting and tissue engineering offer potential pathways toward biologically integrated maxillofacial solutions.

Conclusion: PSIs represent a promising modality in maxillofacial prosthetic rehabilitation. Optimizing outcomes requires continued research into advanced materials and digital fabrication techniques to expand their clinical scope.