Archives of Craniofacial Surgery最新文献

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.

Eagle syndrome is defined as the constellation of signs and symptoms caused by an elongated styloid process or calcification of the stylohyoid ligament. It is a rare condition that occurs secondary to irritation or compression of surrounding structures due to the abnormal styloid process. Clinical manifestations are variable and may include neck pain, dysphagia, odynophagia, and a foreign body sensation. Although neck pain is a common and significant problem in the outpatient setting, Eagle syndrome is an exceedingly rare cause that is not often considered in the differential diagnosis of cervical pain. We report a case of Eagle syndrome presenting as recurrent neck pain in a young woman. We discuss Eagle syndrome as a rare differential diagnosis for recurrent neck pain and the diagnostic challenges this condition may pose. Eagle syndrome is a rare entity with a challenging diagnosis. Despite being an exceedingly rare cause of cervical pain, it should be considered in the differential diagnosis of recurrent neck pain.

Background: This study aimed to evaluate the satisfaction of patients rehabilitated with maxillary fixed prostheses supported by zygomatic implants, using the Liverpool Oral Rehabilitation Questionnaire (LORQ-v3) and the Oral Health Impact Profile (OHIP).

Methods: Fifty-two patients with maxillary bone defects who were rehabilitated with fixed prostheses supported by zygomatic implants were included in this questionnaire-based study. Patients were asked to evaluate their dental problems both before prosthesis fabrication and at 1 year post-rehabilitation, using LORQ-v3 and OHIP-14. Responses were assessed on a Likert scale. Patient perceptions of quality of life were measured in relation to general satisfaction, comfort and stability, speech, esthetics, self-esteem, and functionality.

Results: Overall improvement in oral health-related quality of life (OHRQoL) was observed among all participants. In LORQ-v3, item-specific improvement ranged from 8% pretreatment to 43% posttreatment. In OHIP, scores improved from 21% to 69% between baseline and 1 year.

Conclusion: Prosthetic rehabilitation with zygomatic implants for maxillary defects significantly improved patients' OHRQoL.

Tracheal defects that occur after resection can be reconstructed in various ways. Depending on the depth of the tumor invasion or the circumference of the trachea defect, options such as local flaps, free flaps, or primary closure can be used. We report a case of reconstruction using a sternocleidomastoid myoperiosteal flap for partial tracheal defect following tumor resection. A 77-year-old woman was diagnosed with papillary thyroid cancer with tracheal invasion. The patient underwent total thyroidectomy and partial tracheal resection. The resulting partial tracheal defect was reconstructed with a sternocleidomastoid myoperiosteal flap. The flap was elevated including the periosteum of the sternal head and the clavicular head of the sternocleidomastoid, and was inset into the tracheal defect. No complications were observed. At 3 months after operation, the patient reported no discomfort, laryngoscope and neck computed tomography examinations revealed no abnormal findings.

Giant cell tumor (GCT) of bone is a benign tumor originating from undifferentiated mesenchymal cells of the bone marrow. It most commonly arises in the epiphyseal regions of long bones. The skull represents an extremely rare location for GCT. Certain radiologic features involving the temporal or sphenoid bone strongly suggest this diagnosis. Skull GCT is a locally aggressive condition, posing surgical challenges and exposing the patient to a considerable risk of recurrence. In this article, we describe the diagnosis and surgical management of two patients with GCT of the temporal bone. The first patient is a 24-year-old man who presented with progressive left temporal swelling and hearing loss. Computed tomography revealed a 5.6× 4.6× 4.2 cm osteolytic lesion of the left temporal bone. The patient underwent neartotal resection and exhibited no recurrence after 10 years of follow-up. The second patient was a 55-year-old man presenting with gradual hearing loss in the right ear and trismus. Computed tomography showed a 4.7× 4.2× 3 cm temporo-sphenoidal erosive lesion. Complete surgical resection was performed with a favorable outcome and no recurrence.

Background: Bone defects can result from trauma, neoplasms, infections, or congenital anomalies. A common strategy for managing these defects is bone grafting, which must meet three essential biological requirements: osteoconductivity, osteogenicity, and osteoinductivity. Bone graft materials may be sourced from either natural or synthetic origins. Among natural materials, hydroxyapatite derived from marine coral has attracted attention as a bioceramic due to its compositional similarity to the mineral phase of human bone.

Methods: Coral-derived hydroxyapatite primarily serves as an osteoconductive scaffold, supporting the attachment, proliferation, and differentiation of stem cells and osteoblasts. This process facilitates bone regeneration and the formation of new bone tissue. Additionally, coral hydroxyapatite may contribute to osteoinduction by stimulating local stem cells and osteoblasts, thus promoting osteogenesis and enhancing bone healing.

Results: Owing to these properties, coral hydroxyapatite is considered a promising material for encouraging bone regeneration in defect sites.

Conclusion: Hydroxyapatite obtained from marine coral represents a viable and effective bone graft substitute for reconstructing bone defects.

Background: Rhinologists frequently encounter challenging cases of septal perforation, and to date, no definitive consensus exists regarding the most appropriate surgical technique.

Methods: The study included adult patients with anterior septal perforation. All patients underwent a general and ear-nose-throat examination (including upper airway endoscopy) as well as computed tomography of the nose and paranasal sinuses. The endoscopic unilateral anteriorly-based nasal flap procedure was performed under general anesthesia.

Results: Fourteen patients with anterior septal perforations measuring 11-25 mm in diameter were included. The procedure was performed smoothly without intraoperative complications, with operative times ranging from 40 to 70 minutes. The follow-up period ranged from 6 to 14 months. Postoperative pain was minimal and well tolerated. Nasal crusting was mild and resolved almost completely within 2 weeks. By the end of the first postoperative month, no patient reported nasal obstruction. Complete resolution of preoperative symptoms occurred in 12 of 14 patients (85.7%), while the remaining two patients (14.3%) experienced symptomatic improvement.

Conclusion: The anteriorly-based nasal floor mucoperiosteal flap yields favorable outcomes in patients with septal perforation, with minimal morbidity.

Background: Nasal bone fractures are among the most common facial injuries. This study aimed to compare the clinical outcomes of a no-packing approach with and without Kirschner wire (K-wire) splinting in the treatment of less severe nasal bone fractures.

Methods: We conducted a retrospective study comparing cases of simple fractures classified as type II-III according to Higuera's classification that were treated surgically with closed reduction. Patients were divided into two groups: the control group (no packing, no K-wire splint) and the experimental group (no packing with K-wire splint). We calculated the difference in the distance (mm) between the centerline of the triangle and the apex on facial bone on computed tomography scans immediately after surgery and at a mean of 3.6 months after surgery, assessing postoperative symptoms at 3 days after surgery.

Results: The experimental group (no packing with K-wire splint) showed no statistically significant difference in radiological outcomes compared to the control group. The distance from the apex to the centerline of the triangle was 0.009± 0.012 mm in the control group and 0.008± 0.009 mm in the experimental group. However, the control group reported fewer postoperative symptoms, including nasal obstruction and dry mouth.

Conclusion: The packing-free approach without K-wire splinting may reduce postoperative discomfort without compromising surgical outcomes compared to K-wire splinting without packing.

Mucoperiosteal flap necrosis is a rare but serious complication following cleft palate repair, often resulting in the formation of oronasal fistulas. Although several factors-such as excessive flap tension, pedicle injury, infection, and hematoma-have been implicated in its pathogenesis, the precise mechanisms remain poorly understood. Herein, we report two nonsyndromic siblings with complete bilateral cleft lip and palate, both of whom developed anterior mucoperiosteal flap necrosis on postoperative day 5 after primary palatoplasty performed with a same two-flap technique incorporating a vomer flap. Neither case involved intraoperative complications, but flap necrosis occurred at the same anatomical site. The underlying cause remains unclear to date. This series raises the question of whether factors beyond surgical technique-such as congenital anatomical variations or genetic predisposition-may contribute to the development of flap necrosis. Recognizing such patient-specific risks may help surgeons anticipate complications in familial cleft cases and better tailored preoperative planning or intraoperative modifications. Further investigations may clarify whether specific subgroups of patients with cleft lip and palate possess an inherent susceptibility to flap necrosis after primary repair.

Background: The pre-lacrimal window (PLW) approach is a promising technique for accessing otherwise inaccessible maxillary sinus lesions. The objective of this study was to determine the computed tomography (CT) dimensions, measurements, and grading of the PLW.

Methods: One hundred paranasal CT scans were included in the study. For all subjects, axial images were obtained, and multiplanar reformats were used to obtain detailed views in the coronal and sagittal planes. The width of the PLW, the width of the nasolacrimal duct (NLD), and the angle between the axis of the NLD and the hard palate were measured and graded.

Results: In 100 CT scans (200 sides), the mean PLW width was 5.6± 2.4 mm (range, 0-11.15 mm), the mean NLD width was 6.38± 1.84 mm (range, 1-11 mm), and the mean angle between the axis of the NLD and the hard palate was 68.6°± 6.77° (range, 54°-83°). There were no significant differences between sides or genders for any of the measurements.

Conclusion: The CT dimensions of the PLW should be carefully evaluated when considering different endoscopic approaches to, or through, the anterior aspect of the maxillary sinus. The current study enhances surgeon and radiologist awareness of PLW measurements and their variations, ultimately improving the application of the PLW approach.