Maxillofacial Plastic and Reconstructive Surgery最新文献

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.

Objective: Concha bullosa, a common anatomical variation characterized by air-filled cavities in the turbinate bones, can influence sinonasal function and surgical planning. This study aims to evaluate the distribution, laterality, and cranial skeletal type associations of concha bullosa (CB) among patients with confirmed CB findings on computed tomography (CT) scans.

Methods: A retrospective cohort study was conducted on 774 patients who underwent cranial and facial CT scans between March 2023 and March 2024. Patients were classified into mesocephalic, brachycephalic, and dolichocephalic groups based on the cephalic index. The distribution and laterality of concha bullosa were assessed using CT scans, and statistical analyses were performed using the Chi-square test, with a significance level set at P < 0.05.

Results: Among CB-positive patients, left-sided concha bullosa was most common (49.48%), followed by right-sided (31.91%) and bilateral (18.6%) involvement. Mesocephalic individuals constituted the largest proportion of CB-positive cases (55.56%), followed by dolichocephalic (22.86%) and brachycephalic (21.57%) individuals. A significant gender difference was observed in the mesocephalic (P = 0.001) and brachycephalic (P = 0.013) groups, with males exhibiting a higher prevalence of right-sided and bilateral concha bullosa.

Conclusion: Concha bullosa distribution varies significantly among cranial skeletal types among CB-positive patients, with mesocephalic individuals exhibiting the highest overall prevalence. Our findings underscore the influence of cranial morphology on the presentation of CB. This insight may enhance radiological evaluation and individualized surgical planning in CB-positive patients.

Background: Providing adequate dental care and implementing preventive strategies for patients with intellectual disabilities (ID) pose significant challenges in Hungary, where approximately 100,000 individuals with ID require specialized dental care. This study aimed to objectively assess the dental and periodontal care needs of patients with ID in comparison to the general population and those with physical disabilities. Additionally, we developed and evaluated a program focusing on acute treatment and the prevention of dental diseases.

Methods: A retrospective analysis was conducted over a 5-year period, involving the demographics and therapeutic outcomes of 1717 patients with ID who received dental care. Initial screening of dental status was performed for 350 patients with ID, and a structured preventive care program was developed and implemented for 49 patients.

Results: Over the 5 years, 8147 dental interventions were performed under general anesthesia without major complications. Compared to the general population, patients with ID exhibited poorer Decayed and Missing scores but more favorable Filled scores based on the decayed, missing, and filled teeth (DMFT) index. The implementation of preventive measures led to significant improvements in periodontal health within 3-6 months.

Conclusions: Despite the success of preventive measures, the overall therapeutic outcomes in patients with ID were suboptimal, with caries and periodontal diseases increasing with age and severity of disability. Structured oral hygiene programs are essential to improving the oral health of this vulnerable population.

Background: Craniofacial anomalies, particularly Tessier facial clefts, present significant surgical and functional challenges. Bilateral Tessier 3 and Tessier 0 clefts are extremely rare, often requiring complex reconstructive strategies. These clefts result in severe nasal deformities, including absent nasal septum, hypertelorism, and malpositioned alae nasi, affecting both appearance and function. Due to the lack of standardized approaches in such cases, this report highlights a staged surgical reconstruction aimed at restoring nasal structure and improving facial harmony, with a 12-month follow-up showing stable nasal contour and functional airway restoration.

Case presentation: A 16-year-old female presented with bilateral Tessier 3 and Tessier 0 clefts, exhibiting hypertelorism, a wide nasal dorsum, cranial displacement of the alae nasi, and an absent nasal septum. The patient underwent staged reconstruction. The first stage repositioned the alae nasi and created a functional nasal airway. In the second stage, costal cartilage was used to construct an L-shaped septal extension graft and dorsal onlay graft to restore nasal contour and stability. A subsequent procedure refined the nasal dorsum and approximated the alae nasi. Although orbital box osteotomy was planned to correct hypertelorism, the patient declined further intervention.

Conclusion: This case highlights the effectiveness of a staged reconstructive approach in addressing rare craniofacial anomalies. Twelve-month postoperative follow-up confirmed the stability of nasal contour, functional airway patency, and satisfactory facial symmetry. The decision to forgo orbital box osteotomy emphasizes the role of patient-centered care in craniofacial surgery. This case provides valuable insights for optimizing reconstructive techniques in complex facial clefts.

Background: Cleft palate is a prevalent oral and maxillofacial malformation that requires complex surgical interventions. In cleft palate repair, managing flap tension is critical to avoid complications such as flap rupture and impaired healing. Additionally, excessive flap movement can compromise blood supply, affecting postoperative outcomes. A thorough understanding of these biomechanical factors is crucial for surgical success.

Methods: A three-dimensional finite element model was developed using CT scan data to simulate the biomechanical behavior of the cleft palate under surgical conditions. The model was constructed and analyzed using ANSYS Workbench and related software, incorporating material properties of bone, mucosa, and muscle. Stress and deformation distributions were calculated to evaluate surgical incision points and flap movement.

Results: The model identified critical areas of high tension and movement along the surgical incisions on both oral and nasal surfaces. The maximum deformation observed was 3.9885 mm, with stress concentration points along the suture lines and flap edges. The results highlighted specific regions prone to mechanical stress, which are crucial for optimizing surgical strategies.

Conclusion: This study demonstrates the potential of a 3D finite element model in predicting mechanical responses of the cleft palate during surgical repair. The findings provide surgeons with valuable insights for improving incision placement, flap design, and suturing techniques to minimize tension and enhance healing. This personalized approach could significantly improve surgical outcomes and reduce postoperative complications in cleft palate repair.