Maxillofacial Plastic and Reconstructive Surgery最新文献

Background: When foreign bodies are located deep within the tissue, removal is often difficult. In recent years, computer-assisted surgery (CAS) has been widely adopted in surgery, including the removal of foreign bodies. Among various techniques, computer-aided design/computer-aided manufacturing (CAD/CAM) technology has been widely employed for hard tissue management in the oral and maxillofacial region, and reports on the application of CAD/CAM technology for procedures involving soft tissues are lacking. In this study, we report a case in which CAD/CAM technology is used to facilitate the removal of a foreign body located in the soft tissue.

Case presentation: A 25-year-old female underwent metal plate and screw removal in 2020; however, a metal fragment remained lodged in the buccal soft tissue on the left side of the lower jaw. Computed tomography (CT) revealed a high-density area, indicating a metal fragment measuring 1.5 × 1.3 × 2.5 mm. We identified the exact location of the fragment using preoperative CT data processed with Mimics^® (Materialise). A surgical guide was designed using Magics^® (Materialise) and fabricated using a 3D printer, enabling precise identification of the vertical and horizontal positions of the foreign body within the soft tissue. The use of CAD/CAM technology facilitated accurate localization and rapid removal of the fragment. The operative time of removal was 1 h and 5 min. Minimal bleeding occurred, and the postoperative course was uneventful, with no signs of infection or nerve damage.

Conclusions: This case demonstrates the successful application of CAD/CAM technology for the identification and removal of a foreign body from soft tissue.

Background: Surface landmarks such as Zuker's point can help localize branches of the facial nerve as a supplement to, or in the absence of intraoperative neuromonitoring. Zuker's point is a previously described landmark located half the distance between the root of the auricular helix and labial commissure with demonstrated efficacy in localizing facial nerve branches. However, prior studies are restricted by two dimensional descriptions based on discrete, linear measurements, and description of the influence of sex, laterality, or face shape is lacking. Geometric morphometric techniques offer a sophisticated approach capable of producing a three-dimensional description of the location of the facial nerve relative to Zuker's point, while discerning the influence of sex, laterality, and face shape.

Methods: Facial nerve at Zuker's point was analyzed in 82 cadaveric hemifaces. Three-dimensional coordinate data for the root of the auricular helix, labial commissure, Zuker's point, and the facial nerve at Zuker's point were captured using a MicroScribe digitizer. Mean landmark configuration and principal component analysis were used to describe the position of the facial nerve relative to Zuker's point, as well as the influence of sex, laterality, and face shape.

Results: Facial nerve systematically deviated towards the 1 o'clock position (if viewed from the lateral position on the right side), irrespective of sex or laterality. The accuracy of Zuker's point was enhanced on those with a longer, rounder face, while in shorter and slimmer faces the nerve takes a more superior and superficial position relative to Zuker's point.

Conclusions: Facial nerve branches can reliably be found at Zuker's point, regardless of sex or laterality, though the nerve does systematically deviate from Zuker's point toward the 1 o'clock position (if viewed on the right side). The position of the facial nerve relative to Zuker's point is influenced by face shape, but not sex or laterality. These results can be used to better localize the facial nerve and improve patient outcomes.

Background: The posterior maxilla is often the site of early tooth loss, frequently requiring sinus augmentation to compensate for vertical bone deficiency. However, the influence of residual bone height (RBH) on clinical outcomes remains unclear.

Materials and methods: This retrospective study evaluated 42 patients who underwent maxillary sinus augmentation using either the lateral or transcrestal approach. Patients were divided into two groups: the severely atrophied group (RBH < 3 mm) and the moderately atrophied group (RBH 3-5 mm). Clinical outcomes assessed included marginal bone loss (MBL), graft resorption, complications, and implant survival.

Results: Clinical outcomes were comparable regardless of RBH. Even in severely atrophied maxillae with RBH < 3 mm, favorable outcomes were achieved using appropriate surgical techniques.

Conclusion: RBH should inform surgical planning but should not be considered a strict prognostic indicator.

Background: Temporomandibular joint (TMJ) surgery carries a risk of facial nerve injury and intraoperative bleeding, especially in patients with anatomical distortion due to ankylosis or inflammation. This study introduces a novel anatomic landmark-the capsular vein-and evaluates a preauricular approach utilizing this vein to improve surgical safety.

Methods: A retrospective cohort study was performed on 104 patients (109 TMJs) who underwent TMJ surgery between 2014 and 2022. During the approach, a vein consistently found at the superior aspect of the glenoid fossa (designated the capsular vein) was identified and ligated without requiring formal facial nerve dissection. The primary outcomes were the incidence and duration of postoperative facial nerve weakness. Secondary outcomes included the presence of any facial paresthesia and other postoperative symptoms.

Results: The capsular vein was identified and ligated in all cases. No intraoperative bleeding requiring hemostasis (e.g., electrocautery) was observed. Temporary facial nerve weakness occurred in 3.8% of patients (n = 4). Additional complications included transient facial paresthesia (1.9%, n = 2) and headache (4.8%, n = 5), with no permanent deficits reported.

Conclusion: The capsular vein serves as a reliable anatomic landmark for TMJ surgery, enabling a safe and efficient approach without the need for facial nerve dissection. Its use minimizes intraoperative bleeding and nerve injury, particularly in patients with ankylosis or severe inflammation, and may improve surgical outcomes across a variety of TMJ procedures.

Background: Postoperative stability is a significant problem in the orthognathic management of anterior open bite malocclusion. The general tendency of modern preadjusted fixed appliances is towards unwanted and unplanned extrusion of the maxillary incisor and canine teeth as the dental arch is levelling. Following surgical repositioning of the jaws, the relapse potential of the extruded anterior dentition will be to intrude, leading to some reopening of the surgically corrected anterior open bite.

Case presentation: A 19-year-old male white Caucasian patient presented with a clinically significant anterior open bite of predominantly skeletal aetiology. The objective of preoperative levelling in the maxillary dental arch was to avoid any extrusion of the anterior dentition. To achieve this aim, two temporary anchorage devices (TADs) were placed in the maxillary alveolar bone, and relatively passive elastic force was applied from the archwire to the TADs in order to prevent maxillary incisor extrusion during arch levelling. This elastomeric chain was maintained throughout the alignment and levelling of the maxillary dental arch. The patient had a Le Fort I osteotomy of the maxilla with differential posterior impaction and advancement, and mandibular forward autorotation and small setback of the mandibular body with bilateral sagittal split osteotomy, to achieve a Class I incisor and skeletal position. No vertical movement of the teeth was carried out or required following surgery. The patient was debonded 3 months following surgery and fitted with removable retainers. Cephalometric superimpositions demonstrated that no extrusion of the anterior maxillary dentition occurred, which is the main parameter to improve postoperative stability of the anterior open bite correction.

Conclusions: To improve the potential stability of anterior open bite correction with orthognathic surgery, TADs in the anterior maxillary alveolar bone region may be used with elastomeric chains to prevent any unintended and unplanned extrusion of the maxillary incisor teeth in the preoperative orthodontics.

Background: This study aims to evaluate the outcomes of secondary alveolar bone grafting in patients with cleft lip and palate by comparing the clinical effectiveness of autologous bone grafts and xenogeneic graft materials. The objective is to provide evidence-based insight into the comparative efficacy of these grafting approaches.

Main body: A systematic search of the literature published between January 2004 and January 2023 identified 606 studies. Following a series of screening processes, five studies met the inclusion criteria, including only two randomized controlled trials (RCTs). The selected studies specifically evaluated xenogeneic bone graft materials derived from bovine sources, with allograft materials excluded. The results demonstrated no statistically significant difference between autologous and xenograft grafts in terms of postoperative bone graft volume and height in patients with cleft lip and palate. These findings provide important insight into the comparative effectiveness of grafting materials used in secondary alveolar bone grafting.

Conclusions: In summary, the findings indicate that autologous and xenogeneic graft materials yield comparable outcomes in secondary alveolar bone grafting for patients with cleft lip and palate. These results may inform clinical decision-making and guide future research in optimizing grafting strategies.

Background: Reconstructive surgery following head and neck cancer resection is inherently complex and technically demanding. Procedures such as osteotomy and flap inset involve a steep learning curve, yet opportunities for hands-on training are increasingly limited. Physical simulation using cost-effective, anatomically realistic models offers a promising solution. This study aimed to evaluate the educational value of 3D-printed training models and custom-made fibula models in enhancing surgical skills, supported by structured assessments and feedback.

Methods: A hands-on workshop was conducted for 30 plastic surgery residents utilizing in-house 3D-printed models, created via fused deposition modeling (FDM), and acrylic-based fibula models. Participants performed simulated osteotomies and flap insets. Their performance was assessed using the 4-point Zwisch scale by two independent, blinded consultants. Additionally, a 6-item questionnaire was administered to capture self-reported improvements in anatomical understanding, surgical technique, and procedural planning. Pre- and post-training questionnaire scores were compared using Wilcoxon signed-rank test.

Results: Post-training, the average questionnaire scores significantly improved from 12.03 ± 2.20 to 20.30 ± 1.56 (p < 0.01). The greatest improvement was noted in the participants' comprehension of surgical planning. Zwisch scale evaluations demonstrated a clear progression toward greater technical independence. Participants also expressed high satisfaction with the anatomical realism, durability, and affordability of the training models.

Conclusion: Low-cost 3D-printed training models and custom-made fibula models represent an effective and reproducible training tool for developing technical skills in head and neck reconstructive surgery. Their ease of fabrication, affordability, and anatomical accuracy make them particularly valuable in resource-limited settings. These models offer significant educational utility and warrant integration into structured surgical training curriculum.

Background: Excessive gingival display is a common and often distressing aesthetic concern among patients. With the increasing emphasis on dental aesthetics, it has become essential to investigate and develop various treatment modalities to address patients' expectations. Achieving a balanced and attractive smile has therefore become a key challenge for dental practitioners worldwide.

Methods: This study is a single-center, parallel, randomized controlled open-label trial aimed to compare performing lip repositioning surgery (LRS) utilizing carbon dioxide (CO₂) laser with conventional scalpel in managing excessive gingival display (EGD) (4-6 mm) with special consideration to lip dimensions, and 20 participants were included in this study setting in the Faculty of Dentistry, 70% females and 30% males, with an average age of 26.4 and 24.8 years in laser and scalpel groups, respectively, randomly allocated into two groups. All patients fulfilled the study. A partial thickness flap was excised from the vestibule, with both edges of the donor wound closed using sutures; clinical measurements were recorded preoperatively and followed up for 6 months.

Results: Postoperative pain was significantly reduced in the laser group; both groups demonstrated a significant decrease in gingival display at 6-month post-operation: external upper lip length was significantly longer in the laser group in smile position at 1-month post-operation, and internal upper lip length at rest was significantly longer in the scalpel group at 3-month post-surgery (significance level was set at P < 0.05).

Conclusions: The CO₂ laser is an effective, safe, and conservative alternative to the scalpel in performing LRS, offering decreased pain and improved visualization. Adequate training in laser techniques and safety is essential.

Trial registration: The study is registered at International Standard Randomized Controlled Trial, registration number ISRCTN.

Introduction: The submandibular fossa (SF), a depression on the lingual surface of the mandible extending from the mental foramen to the molar region, accommodates the submandibular salivary gland, influencing its depth and shape. Accurate knowledge of this region is essential for reducing complications during oral surgeries, such as implant placement and extractions. This study was aimed to assess SF depth, mandibular canal (MC) diameter, and concavity angles between males and females via cone-beam computed tomography (CBCT).

Methodology: CBCT scans of 160 patients (80 males and 80 females) aged 18-35 years were analysed. SF depth was classified into three types: Type I (< 2 mm), Type II (2-3 mm), and Type III (> 3 mm). The MC diameter and concavity angles were measured in the interradicular region of the mandibular molars. The data were statistically analysed via unpaired t tests and chi-square tests (p < 0.05 was considered significant).

Results: Males presented greater mean SF depth, MC diameter, and concavity angles than females did. SF depth was generally more pronounced on the left side in both sexes. Type I SF was the most frequently observed SF depth classification.

Conclusion: CBCT provides valuable insights into mandibular anatomy. Although certain anatomical differences were observed between sexes, particularly in MC diameter, not all findings reached statistical significance. These results suggest the importance of individualized radiographic assessment during surgical planning.

Background: Cleft lip and palate (CLP) represent one of the most prevalent congenital anomalies of the maxillofacial region, resulting in significant structural deformities that impact nasal function, facial aesthetics, and psychosocial well-being. These anomalies often lead to nasal obstruction and asymmetry. Surgical correction of the associated nasal deformities through rhinoplasty is essential to restore nasal airway function, achieve symmetrical nasal contour, and improve overall facial harmony. Autologous costal cartilage serves as an excellent grafting material due to its versatility, biocompatibility, and structural integrity, making it suitable for reconstructing various components of the nasal framework.

Case report: A retrospective, single-center, non-consecutive case series was conducted at our institution, involving eight patients diagnosed with cleft lip and palate (CLP) between 2019 and 2024. The cohort comprised four male and four female patients, of whom seven presented with unilateral CLP. The mean age at the time of surgery was 21 years. All patients were followed for a duration of 6 months postoperatively. Postoperative assessments demonstrated an increase in the tip projection ratio and a decrease in the alar width ratio, indicating improvement in nasal symmetry and projection.

Conclusion: Secondary structural rhinoplasty using autologous rib cartilage graft remains the definitive surgical approach for correcting nasal deformities in patients with cleft lip and palate (CLP). Despite its effectiveness, the procedure is technically demanding and requires meticulous planning and execution. A systematic and well-considered surgical strategy is essential to achieve optimal nasal tip definition and improved projection. Postoperative evaluations in our series demonstrated significant aesthetic improvements, including enhanced nasal tip projection and a reduction in alar base width, contributing to better nasal symmetry.