Maxillofacial Plastic and Reconstructive Surgery最新文献

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.

Background: With the increasing demand for comprehensive smile esthetics, pink esthetics-referring to the harmonious appearance of the gingival tissues-has gained significant attention. However, conditions such as gingival recession, black triangles, and gummy smiles can compromise these outcomes and remain challenging to manage with conventional surgical approaches. This study aimed to review minimally invasive and simplified approaches for pink esthetic enhancement using biomaterials such as collagen matrix, hyaluronic acid dermal fillers, and botulinum toxin.

Main text: The use of a collagen matrix for gingival phenotype modification has demonstrated effectiveness in achieving root coverage and increasing gingival thickness while offering a less invasive alternative to traditional surgical techniques. Interdental papilla loss-commonly referred to as the "black triangle"-remains difficult to correct using both surgical and restorative procedures; however, hyaluronic acid dermal fillers offer a promising solution for reconstructing interdental gingival architecture. Additionally, excessive gingival display (gummy smile) caused by hyperactivity of the upper lip elevator muscles can be efficiently managed with botulinum toxin injections, providing a nonsurgical option for improving smile esthetics.

Conclusions: The use of these biomaterials in pink esthetic management enables clinicians to achieve favorable esthetic outcomes with reduced invasiveness. This approach minimizes the need for additional restorative or surgical interventions, thereby enhancing patient comfort and satisfaction.

Background: The clinical outcome of unilateral cleft lip closure depends on both the incision pattern and vertical scar retraction as well as complete lip muscle closure. Existing techniques focus on the lengthening of the cleft side with reducing visible scarring in addition to correct muscle adaptation but are still struggling with scar contraction. We aimed to optimize clinical results by developing a new incision design integrating benefits of established techniques with our own considerations.

Methods: A study-using 10 adult cadavers-compared two vertical incision lines: the Millard advancement-rotation flap and our Z-back-cut cheiloplasty which reassembles a Z-plasty at the nostril by combining with a back cut at the lower columella rim. A skin distraction model assessed the impact of tension on lengthening. Our technique demonstrated increased vertical height compared to Millard's method. Based on these findings, we applied our approach in clinical settings.

Results: The Millard flap showed significantly less elongation (up to 35%) between the lateral cupid's bow and the columella base than our method. This suggests that the Z-plasty principle is beneficial in unilateral cleft lip closure. Clinical outcomes confirmed its applicability in both partial and complete clefts.

Discussion: Applying our findings in pediatric patients yielded at least equivalent results to the Millard II technique, even in cases with postoperative wound infections and increased contraction risk.

Conclusion: Our research supports integrating Z-plasty principles into unilateral cleft lip repair. We plan to use this technique in future surgeries where indicated.

Background: Virtual surgical planning (VSP) improves accuracy in orthognathic surgery, but its differences from conventional surgical planning (CSP) remain unclear. This study compares VSP and CSP accuracy in maxillary repositioning.

Methods: A randomized controlled trial of 20 patients undergoing bimaxillary surgery was conducted. Patients were assigned to VSP (3D planning, 3D-printed splints) or CSP (cast model surgery, conventional splints). Pre- and postoperative Computed Tomography (CT) scans were superimposed using voxel-based registration, measuring anteroposterior (Y), mediolateral (X), and vertical (Z) positional changes of A point, ANS, U1, U3, U6 landmarks.

Results: No significant differences in planned and actual surgical outcomes (p > 0.05). 2D planning (P2D) and 3D planning (P3D) showed significant differences in key maxillary landmarks, indicating that 3D planning provides additional refinements in skeletal positioning. However, VSP showed larger absolute discrepancies in U1L, U1R, U3L, U6L (p < 0.05), particularly in the anteroposterior (Y-axis) direction. Splint thickness and condylar simulation methods could also affect accuracy.

Conclusions: VSP and CSP provide comparable accuracy; however, VSP shows greater anterior-posterior discrepancies. Further studies should examine splint design and condylar modeling to optimize surgical precision.

Aim: The aim of the present study was to evaluate condylar volume and mandibular ramus in patients undergoing orthognathic surgery.

Method: Relevant keywords were searched in the international databases Cochrane, Embase, and MEDLINE up to February 2025. Study selection criteria were based on the PICOS strategy; randomized clinical trial studies, cohort studies, cross-sectional studies, case-control studies (study (S)) that examined changes in condylar and ramus position (Outcome (O)) in orthognathic surgery as skeletal treatment (Intervention (I)) for Class III versus Class II (Comparison (C)) in patients who had undergone orthognathic surgery (Population (P)). Data were collected based on study findings from three-dimensional (3D) cephalometric/cone-beam computed tomographic (CBCT)analysis and measurements of condylar angle, volume, and position. The methodological index for non-randomized studies (MINORS) used to determine the quality of the studies. Mean differences were used as an effect size with fixed-effects model and inverse-variance methods of 95% confidence intervals (CI). Meta-analysis was performed using Stata (as of version 17).

Result: The mean differences in condylar height between Class II and Class III were 2.19 mm (MD 2.19 mm 95% CI; 1.32 mm, 3.96 mm; p < 0.05). The mean differences in ramus angle between Class II and Class III were - 0.02° (MD - 0.02 95% CI - 0.06, 0.03; p > 0.05).

Conclusion: Based on the meta-analysis of the present study, orthognathic surgery did not significantly affect the microstructure of the mandibular ramus in the correction of class III malocclusions. In Class II, the condyle height was significantly reduced after orthognathic surgery, while the condyle width did not change.

Trial registration: PROSPERO CRD420251054773.

Background: Velopharyngeal insufficiency (VPI) occurs in 5-36% of patients after primary palatorrhaphy for cleft palate, causing hypernasality and nasal emissions due to inadequate velopharyngeal closure. Although various surgical treatments are available, they may present limitations and potential risks, including obstructive sleep apnea. The buccinator myomucosal flap, with a reliable blood supply, provides a versatile option for VPI correction. In addition, it is associated with a low risk of complications, further supporting its safety and applicability in clinical practice. We report successful palatal lengthening using a modified bilateral buccinator myomucosal flap with a buccal fat flap in a 14-year-old patient with persistent VPI despite prior interventions.

Case presentation: A 14-year-old female with a bilateral complete cleft lip and palate underwent primary cheiloplasty at 3 months and palatorrhaphy at 9 months of age. Despite 10 years of speech therapy and 4 years of speech aid use, hypernasality persisted. To address this, palatal lengthening was performed using bilateral buccinator myomucosal flaps combined with buccal fat flaps. At 1 month postoperatively, partial necrosis of the buccal fat grafts was observed but healed without further complications. At 8 months postoperatively, soft palate elongation exceeding 1 cm was achieved, and nasometric assessments demonstrated nasality reductions of 25.5 percentage points for high vowels (/i/, /wi/) and 19.5 percentage points at the sentence level. In the consonant accuracy evaluation, the patient's word-level accuracy increased from 72.09% preoperatively to 88.37% at 6 months postoperatively. These objective improvements correlated with subjective reports of improved speech and reduced vocal effort.

Conclusion: As seen in this case, the combined use of buccinator myomucosal and buccal fat flaps can be a viable surgical option for addressing VPI through soft palate lengthening. This approach can lead to improvement in hypernasality with minimal complications, and its efficacy may be further supported by future long-term follow-up studies involving larger patient populations.

Background: Nonessential amino acids (NEAAs) are traditionally regarded as dispensable because they can be synthesized endogenously from glucose-derived intermediates. Emerging evidence, however, shows that the capacity for de novo NEAA biosynthesis declines in aged tissues, rendering several of these molecules conditionally essential during periods of stress such as surgery or fracture repair.

Main body: In the cranio-maxillofacial arena - where bone and soft-tissue regeneration must occur in an environment already compromised by osteoporosis, multimorbidity, and restricted oral intake - insufficient NEAA supply may translate into delayed union, wound dehiscence, and heightened infection risk. This narrative review integrates biochemical, preclinical, and clinical data to map age-dependent changes in the serine/glycine, glutamine/glutamate, arginine/citrulline, cysteine/trans-sulfuration, and alanine cycles, examines their impact on osteogenesis and mucosal healing, and evaluates nutritional or pharmacological strategies to restore NEAA sufficiency. Particular attention is paid to serine-one-carbon metabolism, the intestinal-renal arginine axis, and redox-sensitive cysteine pathways, all of which are intimately linked to collagen deposition, osteoblast differentiation, and immune modulation.

Conclusion: We conclude that proactive optimization of NEAA status - through targeted supplementation or metabolic activation - represents a low-risk, biologically rational adjunct to enhance postoperative outcomes in geriatric maxillofacial patients.

Background: Orthognathic surgery addresses skeletal dysgnathias, enhancing both function and aesthetics. Despite its benefits, potential complications underscore the need for well-trained surgeons. 3D-printed anatomical models, a product of additive manufacturing, aid surgical education, especially for young surgeons lacking on-the-job training. This study focuses on an economically designed 3D-printed simulator for orthognathic surgery training.

Results: Evaluation from 31 participants of two orthognatic surgery workshops using the 3D-printed simulator highlighted positive assessments for realism (7.16 ± 2.03/10) and usefulness in training for specific procedures. While commended for simulating limited oral cavity movements and providing a realistic general simulation, soft tissue realism (4.51 ± 2.66/10) suggested room for improvement. Notably, the simulator demonstrated outstanding cost-efficiency (€ 181.55), with reusable components.

Conclusions: The 3D-printed simulator offers a realistic, cost-effective tool for orthognathic surgery training, despite soft tissue realism limitations. The study anticipates further enhancements in 3D-printing technology to address these aspects and advance future iterations.

Background: This study evaluated the zygomaticus major muscle and lip-closing force before and after orthognathic surgery. Sixty female patients with jaw deformities who underwent orthognathic surgery were included. Lip-closing force and computed tomography (CT) assessments were conducted preoperatively and 1 year postoperatively. Lip pressure was measured using the Lip De Cum LDC-110R® (Cosmos Instruments Co., Ltd., Tokyo, Japan). CT images were reconstructed using ProPlan CMF (Materialize, Belgium), and zygomaticus major muscle width and CT values were analyzed. To the best of our knowledge, no previous studies have employed CT values to assess muscles in the oral and maxillofacial area.

Results: In both class II and class III females, postoperative zygomaticus major muscle width was significantly higher than preoperative values. In class II females, postoperative zygomaticus major muscle CT values were also significantly higher than preoperative values. Simple linear regression analysis with age as the dependent variable revealed significant associations between pre- and postoperative zygomaticus major muscle widths in both groups. Additionally, simple linear regression analysis with CT values as the dependent variable demonstrated significant associations with postoperative lip-closing force in both class II and class III females.

Conclusions: This study suggests that orthognathic surgery significantly modifies the zygomaticus major muscle morphology and function, impacting CT values.