Maxillofacial Plastic and Reconstructive Surgery最新文献

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.

Background: Patients with mandibular prognathism exhibit not only its characteristic maxillofacial morphology but also discrepancies in stomatognathic function, and understanding this morphology and function is vital for establishing a plan for surgical orthodontic treatment or providing guidance for recovery after orthognathic surgery. However, few studies have yet addressed the objective evaluation of masticatory function before and after surgical orthodontic treatment. In particular, the masticatory behaviors that show how you chew in your daily meals, including the number of chews, chewing rate, and posture during chewing, has not yet been fully studied in patients with mandibular prognathism. The aim of this study was to compare the masticatory behaviors of patients with mandibular prognathism with that of patients with individualized normal occlusion, to clarify the characteristics of masticatory behaviors in mandibular prognathism and to search for a relationship with maxillofacial morphology.

Methods: Participants were 23 patients (12 men, 11 women; mean age 17.9 years) with mandibular prognathism (patient group) and 23 patients (12 men, 11 women; mean age 24.4 years) with normal occlusion that had been achieved by orthodontic treatment (control group). Masticatory behaviors were measured by a wearable device fitted to each participant's right ear. Parameters such as number of chews, chewing rate, number of chews per bite, mealtime, and head and neck posture were recorded, while participants consumed a 100-g rice ball. Body mass index, occlusal contact area, and lateral cephalograms were also measured, and their associations with masticatory behaviors were investigated.

Results: In patient group, the number of chews was lower, mealtime was shorter, and the head and neck were tilted further forward. There was a significant positive correlation between overjet and anteroposterior head and neck posture and a significant negative correlation between overbite and anteroposterior head and neck posture.

Conclusion: Due to morpho/functional discrepancies in the stomatognathic system, patient group chewed fewer times and for a shorter time and leaned further forward while chewing. The characteristics of the masticatory behaviors of patients with mandibular prognathism identified in the present study may be helpful when devising plans for changing behavior before and after orthodontic treatment or orthognathic surgery.

Background: The subnasal lip lift has emerged as a popular intervention for correcting an elongated upper lip, although postoperative scarring remains a topic of concern. Various techniques have been discussed in the literature, with the Tri-Lift suspension technique highlighted in this study offering to reduce such complications and to assess the impact of modification in the deep plane subnasal lip lift, which includes triple suspension sutures, on nasal and labial aesthetic parameters.

Results: A total of 193 female patients (mean age: 28 years) underwent the Tri-Lift suspension technique, while 50 female patients (mean age: 32.48 years) underwent the traditional lip lift (bullhorn technique). In the Tri-Lift group, 78.7% reported "very much improvement," 20.2% "much improvement," and 1% "no change," compared to 43% "very much improvement," 28.6% "much improvement," 21.4% "improved," and 7% "no change" in the traditional lip lift group. Quantitative measurements of philtral length, vermilion height, and dental show recorded preoperatively and 6 months postoperatively showed significant improvements in both groups. However, the Tri-Lift suspension technique achieved higher satisfaction rates, fewer adverse outcomes, and statistically significant differences in satisfaction levels (P < 0.05) compared with the traditional lip lift.

Conclusions: The Tri-Lift suspension technique offers a solution to the common issue of scarring in subnasal lip lifts, enhancing both nasal and lip aesthetics. It presents a promising alternative to the traditional method, providing higher patient satisfaction and better aesthetic outcomes with reduced scarring.

Background and objectives: To compare clinical outcomes and donor site morbidity between medial sural artery perforator (MSAP) flap and radial forearm free (RFF) flap for soft tissue reconstruction of head and neck.

Methods: Forty-six patients who underwent free flap reconstruction at the head and neck cancer center from February 2019 to March 2021 were included, of which 25 RFF flaps and 21 MSAP flaps. The patient and flap characteristics (age, sex, flap size, harvest time, etc.) and outcomes (success rate, donor site complications including infection, hematoma, and fistula, donor site morbidity including abnormal sensation, weakness, range of motion, postoperative oral function) were recorded and compared. Patients were followed up for at least 12 months after surgery. The patients were assessed subjective donor-site morbidity and satisfaction with overall functional results using a self-reported questionnaire.

Results: The success rates of RFF flaps and MSAP flaps were 96% and 95.2%. There were no significant differences in age, sex, flap size, pedicle length, postoperative treatment, and postoperative oral function. MSAP flap showed less donor site morbidity and better subjective satisfaction at the donor site than RFF flap did after a 12-month follow-up. A dominant perforator of the medial sural artery emerges constantly near the point which is approximately 15 cm from the popliteal fossa center vertically, and 3 cm from the postor midline of the leg horizontally.

Conclusion: Due to less donor site morbidity and higher patient satisfaction, MSAP flap can be used as a replacement for RFF flap for small to medium-sized defects in head and neck reconstruction.

Background: This study aimed to evaluate the effects of 4-hexylresorcinol (4HR), a synthetic compound with antioxidant and stress-modulating properties, on diabetic sarcopenia in the masseter muscle.

Methods: A controlled, parallel-arm study was conducted using 38 Sprague-Dawley rats divided into diabetic and non-diabetic groups. Diabetes was induced with streptozotocin (STZ), and the groups were further subdivided to receive weekly subcutaneous injections of either 4HR or saline. Muscle volume was assessed using micro-computed tomography (μCT), and glycogen storage and protein expression were analyzed using periodic acid-Schiff (PAS) staining and immunohistochemistry.

Results: μCT analysis revealed that diabetic rats exhibited significantly reduced masseter muscle volume compared to non-diabetic rats. However, 4HR treatment partially mitigated muscle volume loss in diabetic animals. Histological analysis showed higher PAS staining intensity in the diabetic group treated with 4HR compared to the untreated diabetic group, suggesting improved glycogen storage. Immunohistochemistry demonstrated that 4HR treatment significantly increased Glut4 and phosphorylated AMPKα (p-AMPKα) expression in diabetic muscle, indicating enhanced glucose uptake and metabolic activity.

Conclusions: 4HR effectively alleviates diabetes-induced sarcopenia by preserving muscle volume, enhancing glycogen storage, and upregulating Glut4 and p-AMPKα expression. These findings suggest that 4HR holds potential as a therapeutic agent for combating muscle wasting in diabetes.

Background: An orofacial cleft significantly impacts the oral health-related quality of life of children and teenagers. Secondary reconstruction is a more complex procedure due to tissue deficiency and scarring. The study aimed to evaluate the use of Pfeifer's wave-line incision method and the rotational flap method in the secondary reconstruction of unilateral lip clefts in patients with unilateral cleft lip and ala nasi aged 5-25 years utilizing anthropometry assessment.

Methods: It was a double-blinded, randomized, parallel-group, active-controlled trial with two arms. Twenty-four patients were randomly divided into two groups. Group 1: Rotational flap method. Group 2: Control group, Pfeifer's wave-line incision method. The following anthropometric measurements were considered: Lb(X):En-En: The horizontal position of the center of the cupid's bow. Ch-Lt(l:r): The distance between the cheilion and the tip of the cupid's bow. Lt-Lb(l:r): The length of the cupid's bow. Lt(Y)(l:r): The size of the upper lip. Lt-Lt'(l:r): The height of the vermilion at the tip of the cupid's bow. Photographs were performed according to the follow-up periods: At the baseline and before surgery (t₀). Immediately after surgery (t₁). Two weeks after surgery (t₂). Six months after surgery (t₃).

Results: The rotational flap method did not outperform Pfeifer's method in the studied anthropometric measurements. In the rotational flap method group, there was a significant improvement in the mean value of Ch-Lt(l:r) from t₀ (1.156 ± 0.206) to t₃ (0.962 ± 0.098), and in the average value of Lt(Y)(l:r) from t₀ (0.944 ± 0.023) to t₃ (0.990 ± 0.011) (p < 0.05). In Pfeifer's method group, the mean value of Ch-Lt(l:r) was (1.141 ± 0.158) at t₀, and then improved to become (1.007 ± 0.084) at t₃ (p < 0.05), the average value of Ch-Lt(l:r) at t₀ was (0.942 ± 0.026), which improved to (0.991 ± 0.012) at t₃, and the average value of Lt-Lt'(l:r) increased from t₀ (1.308 ± 1.174) to t₃ (1.050 ± 0.054) (p < 0.05).

Conclusion: Pfeifer's wave-line incision and rotational flap methods achieve similar aesthetic results in the appearance of the lip or Cupid's bow after a 6-month follow-up.

Trial registration: ISRCTN registry, ISRCTN36320776, registered 06 November 2024.

Background: Oral ulcers are painful mucosal lesions prone to infection and inflammation. To evaluate the effectiveness of treatments, a suitable experimental animal model with an appropriate healing period is required. The aim of this study was to develop an animal model for oral ulcer research by comparing oral burn wounds of different sizes and locations in diabetic rats.

Methods: Forty-four male Sprague-Dawley rats with induced diabetes were divided into six groups based on burn wound location and size: T5 (n = 10, tongue 5 mm), T3 (n = 10, tongue 3 mm), P5 (n = 10, palate 5 mm), P3 (n = 10, palate 3 mm), CT (n = 2, control tongue), and CP (n = 2, control palate). The burn wounds were induced by applying a heated device (100-120 °C) for 3 s. At 1- and 2-weeks post-surgery, macroscopic examination, histological staining, immunohistochemistry, and Western blot analysis were performed to compare the healing progress.

Results: Healing progressed more rapidly in the second week than in the first for all groups, with burns on the tongue (Groups T5 and T3) showing more advanced healing compared to burns on the palate (Groups P5 and P3). By the second week, Group T3 was almost completely healed, while Group T5 had some remaining wounds. In contrast, Groups P5 and P3 showed minimal healing. This faster healing on the tongue was further supported by significantly lower expression levels of TNF-α and IL-1β and a reduction in ulcer size, particularly on the tongue compared to the palate.

Conclusion: A 3 mm or 5 mm burn wound on the tongue of diabetic rats can serve as a useful animal model for evaluating new treatments for wound healing, particularly up to the first week. However, for studies extending to the second week, the 5 mm burn wound model on the tongue might be more advantageous.

Background: Non-surgical method is a treatment option for mandibular condylar fracture; however, it is questionable whether bone fragments are adequately reduced and remodeled. The purpose of this study was to identify three-dimensional positional changes in the mandibular condyles in patients treated non-surgically, analyze factors influencing the extent of positional changes, and evaluate clinical prognosis.

Methods: This retrospective study included 31 patients with unilateral mandibular condylar fractures treated non-surgically at the Ajou University Dental Hospital between 2005 and 2023. Computed tomography was performed at the time of the fracture (T ₀) and > 6 months after non-surgical treatment (T ₁). The extent of recovery of the highest point of the condyle head was measured in three-dimensional x-, y-, and z-axes. At the last follow-up > 6 months after remodeling (T ₁), the prognosis was evaluated by clinical examination of mouth opening limitation, malocclusion, deviation on opening, temporomandibular joint disorder (TMD), and facial asymmetry.

Results: Position differences were statistically significant between T₀ and T₁ (paired Student's t-test, P < 0.05), and between the x-, y-, and z-axes (Welch's ANOVA, P < 0.05). The degree of positional recovery in the superior and lateral directions showed a statistically significant negative correlation with age (Pearson's correlation analysis, P < 0.05). The average amount of recovery between two age groups of over and under 19 years old was statistically significant (independent t-test, P < 0.05). Complications included TMD (6.4%), malocclusion (3.2%) and facial asymmetry (3.2%).

Conclusion: After non-surgical treatment, the condyle head of the fractured mandible recovered significantly laterally and superiorly in under 19-year-olds. The functional prognosis was favorable in all age groups. Non-surgical treatment can be an applicable treatment option for patients with mandibular condylar fractures.

Background: Although more than 200 techniques have been reported for the reconstruction of the upper and lower lip defects since 1000 BC, none of them is ideal. Local flaps may result in extra skin incisions and in some cases, the surgeon may be confronted with the lack of sufficient tissues for the reconstruction of large defects. Several techniques have been described for near-total lip reconstruction. The two major available techniques are local flap reconstruction (Bernard-von Burrow-Webster technique) and free micro-vascular tissue transfer. In this study, we are going to evaluate the functional results of using local muscles transposition-assisted dermal fat flap and muco-buccal flap in the treatment of large upper or lower lip defects.

Materials and methods: This study was carried out on 128 patients, who presented to us with malignant tumors affecting the lips.

Results: Lip defect sizes ranged from 4 to 6 cm in diameter. No flap failure was seen and desirable function and accepted esthetic results were obtained. The flap survival was 100%, and healing was eventful in all cases. No cases of microstomia were reported.

Conclusion: The use of local muscle transposition-assisted dermal fat flap and muco-buccal flap technique, showed excellent results in regaining oral competence and lip mobility, and as much as possible, increased the aesthetic outcome.

Level of evidence: IV therapeutic study.