Archives of Craniofacial Surgery最新文献

Our purpose is to present a novel cost-effective therapeutic option for replacing lost mandibular condyle in developing countries. Condyle replacement remains challenging, particularly in reproducing an anatomical form that fits precisely within the glenoid cavity. When rehabilitating patients who have lost their condyle due to tumor resection, idiopathic condylar resorption or ankyloses of the temporomandibular joint, the main difficulty resides in finding a form that fits into the glenoid cavity. Our idea is to use this intact functional condyle preserved and resected from a benign jaw tumor as a scanned model to replace and serve as a template to replace lost mandibular condyles.

Dermatofibrosarcoma protuberans (DFSP) is a rare locally aggressive cutaneous sarcoma, whereas actinic keratosis (AK) is a common premalignant epidermal lesion. The coexistence of these two entities within a single facial lesion is extremely rare and may complicate diagnosis, particularly when an initial biopsy captures only the epidermal component. We present the case of an 80-year-old man with a persistent facial lesion initially diagnosed as AK on punch biopsy. Owing to the atypical clinical features, a repeat deep biopsy revealed the coexistence of DFSP and bowenoid AK. Immunohistochemistry confirmed the presence of DFSP with strong CD34 expression. The lesion was excised using Mohs micrographic surgery to achieve clear margins. This case highlights the importance of clinicopathological correlation and repeat biopsy for the accurate diagnosis of complex skin lesions. Surgical excision with sufficient margins is the key for optimal management.

Background: Infraorbital nerve dysfunction frequently occurs after maxillary fractures. This study aimed to determine whether maxillary fractures involving the infraorbital foramen affect the recovery of infraorbital nerve function.

Methods: In this prospective study, 60 patients who received treatment for unilateral maxillary fractures between January 2020 and December 2022 were analyzed, with a follow-up period of over 1 year. Computed tomography scans were employed to categorize the fractures into three types according to the location of the fracture line relative to the infraorbital foramen. Sensory changes in four predetermined areas, supplied by the infraorbital nerve, were evaluated preoperatively and at 1 week, 1 month, 3 months, 6 months and 1 year postoperatively using the two-point discrimination test and the monofilament test.

Results: Paresthesia was observed in all patients with maxillary fractures. In the majority of instances, sensory deficits resolved spontaneously within 1 year. However, in patients whose fracture lines encroached upon the infraorbital foramen, the severity of paralysis was greater, and the rates of recovery were slower.

Conclusion: The degree of infraorbital nerve function after a maxillary fracture was influenced by the involvement of the infraorbital foramen. Therefore, in the management of patients with maxillary fractures, computed tomography scans can serve as a predictive tool for the potential severity of paresthesia and the anticipated recovery rate.

Nasopharyngeal teratomas are rare extragonadal germ cell tumors that occur infrequently in the head and neck region, with an incidence of 1 in 40,000 live births. These tumors, often detected at birth or in early infancy, consist of various tissues derived from multiple germ cell layers and can pose significant clinical challenges due to their propensity to obstruct the airway. We report a case of a 46-day-old boy who presented with respiratory distress due to a mature teratoma located in the right nasopharyngeal region. Following initial respiratory management and diagnostic workup, which included bronchoscopy and imaging, the patient underwent surgical debulking using a modification of the Loeb palatal incision by a multidisciplinary team to alleviate airway obstruction. Histopathology confirmed a mature teratoma, and postoperative care included intensive monitoring and metabolic management. This case underscores the critical need for early diagnosis, prompt intervention, and collaborative management to prevent life-threatening complications in neonates with nasopharyngeal teratomas. Surgical excision remains the primary treatment for these cases, with postoperative monitoring essential for ensuring patient stability. This case contributes to the literature on neonatal nasopharyngeal teratomas, emphasizing the role of a multidisciplinary approach in achieving favorable outcomes in complex presentations of this rare condition.

Background: Cleft palate results from incomplete fusion of the palatine shelves during embryonic development and varies in severity. It affects speech, hearing, and feeding, often leading to complications such as nasal regurgitation and recurrent infections. The condition is common worldwide and frequently coexists with cleft lip. Surgery remains the primary treatment, aiming to restore both palatal length and function. In this study, Furlow's double Z-plasty and von Langenbeck palatoplasty have been compared for their effectiveness in minimizing complications and improving outcomes.

Methods: This study included 22 children aged 6 to 18 months with non-syndromic complete cleft palates, randomly assigned into two groups. Group A underwent von Langenbeck's palatoplasty with intravelar veloplasty, while Group B underwent Furlow's double opposing Z-plasty.

Results: Preoperative palatal measurements were comparable between the two groups. Cleft width did not significantly affect surgical outcomes, and both techniques effectively achieved tension-free closure. Von Langenbeck's repair with intravelar veloplasty was as effective as Furlow's palatoplasty in achieving palatal lengthening, while offering the additional advantage of being an anatomically based repair associated with lower fistula rates.

Conclusion: Von Langenbeck's repair with intravelar veloplasty is as effective as Furlow's palatoplasty in achieving palatal lengthening and provides the advantage of an anatomically sound repair with a reduced fistula rate.

Background: Skull base defects, accidental or planned during tumor resections, present significant reconstructive challenges. Effective repair prevents cerebrospinal fluid (CSF) leaks, meningitis, and pneumocephalus.

Methods: This retrospective observational study analyzed 26 patients with anterior or lateral skull base defects treated between 2018 and 2024 at a tertiary care center in Western India. Both planned iatrogenic and accidental intraoperative defects were included. Patient demographics, surgical approach, defect characteristics, reconstruction techniques, and postoperative outcomes were recorded. All patients underwent multilayered repair with tailored perioperative management, including selective lumbar drainage.

Results: Among 26 patients, 14 (53.8%) had anterior and 12 (46.2%) had lateral skull base defects. Intraoperative CSF leak occurred in 11 patients (42.3%). Defects were repaired using combinations of autologous tissue (fat, fascia lata, muscle), allogenic grafts (DuraGen), and vascularized flaps. Seven patients (26.9%) required lumbar drains. All reconstructions were successful with no secondary failures. However, two major complications were observed: one case of pneumocephalus and one of postoperative vision loss following ossifying fibroma excision. No postoperative meningitis or recurrent CSF leaks were noted.

Conclusion: Meticulous multilayered repair strategies and structured perioperative protocols provide excellent outcomes in skull base defect reconstruction. Differentiating between planned and accidental iatrogenic defects allows for better preoperative planning and individualized management. Despite a 100% repair success rate, rare but serious complications such as vision loss highlight the need for careful surgical technique near critical neurovascular structures.

Background: Maxillofacial trauma presents with a myriad of complications, including functional disability and aesthetic compromise. Optimal treatment includes management of bone and soft tissue injuries along with dental rehabilitation. Prompt management, including open reduction and internal fixation (ORIF) combined with immediate dental implant rehabilitation, facilitates both functional recovery and aesthetic restoration, thereby leading to improved quality of life.

Methods: A total of 36 patients with maxillofacial bony trauma, along with non-restorable fractured, avulsed, or missing teeth, were managed with ORIF with dental rehabilitation. Eighteen patients underwent delayed implant placement after 6 months of ORIF, and the other 18 underwent immediate implant rehabilitation during ORIF. The outcomes measured included implant stability, crestal bone loss, and evaluation of pain, swelling, and patient satisfaction. All follow-up visits were scheduled with reference to the post-implant placement period in both groups.

Results: Implant stability was significantly increased in the immediate implant placement group of patients at the third- and sixth month follow-up post-implant placement (p< 0.001). Pain assessment revealed that the immediate implant group experienced significantly higher pain scores than the delayed implant group on the first day (p< 0.001), seventh day (p< 0.001), and 28th day (p< 0.001) following implant placement. Significant differences in facial swelling were observed at the third and sixth months (p= 0.009), with the immediate implant group exhibiting lower swelling. Swelling was significantly higher along the tragal-commissure line in the immediate implant group on the first and seventh days (p< 0.001). Patient satisfaction was initially higher in the delayed implant group on the first day (p= 0.047) and remained so by the third month (p< 0.001). However, by the sixth month, both groups demonstrated similar levels of satisfaction after implant placement.

Conclusion: Immediate implant rehabilitation during ORIF in patients sustaining maxillofacial trauma improves implant success rates, reduces morbidity, and ultimately enhances patients' overall quality of life.

Background: The orbicularis oculi myocutaneous (OOMC) flap offers an excellent match in color, thickness, and texture for periorbital defects, yet large-scale, long-term data remain scarce. To determine whether indications, flap‑design preferences, and complication profiles change as surgical experience accumulates, cases were stratified into an early practice phase (2001-2017) and a contemporary phase following technique refinement and wider adoption (2018-2024).

Methods: All periorbital reconstructions utilizing OOMC flaps between November 2001 and December 2024 were retrospectively reviewed. Cases were stratified into Group A (2001-2017) and Group B (2018-2024). We analyzed patient age, sex, etiology, defect site/number, flap design (V-Y advancement, unipedicle/bipedicle switch, pivot), adjunctive procedures, and complications.

Results: Seventy-eight OOMC flaps were performed in 57 patients for 70 defects. Group A included 25 patients, 30 defects, and 36 flaps, while Group B included 32 patients, 40 defects, and 42 flaps. Basal cell carcinoma was the leading etiology in both periods (77%). The proportion of V-Y advancement flaps rose from 50% (18/36) in Group A to 83% (35/42) in Group B. No flap necrosis occurred, and tumor recurrence was observed only once in Group A.

Conclusion: Despite the relatively short observation window for Group B, OOMC flap use increased markedly, confirming that accumulated surgical experience promotes even more frequent application in periorbital reconstruction. The V-Y advancement variant, in particular, expanded in indication without added morbidity and appears highly reliable for a broad spectrum of periorbital defects.