Archives of Craniofacial Surgery最新文献

Background: Orbital floor fractures are frequently associated with head trauma, and the complex three-dimensional (3D) structure of the orbital cavity poses a significant challenge for accurate repair of orbital wall defects. Accordingly, this study aimed to compare preoperative titanium mesh bending using 3D-printed models with conventional intraoperative bending techniques, focusing on the accuracy of orbital geometry reconstruction and intraoperative efficiency, with the goal of determining potential advantages in optimizing surgical outcomes.

Methods: This study presents a comparative analysis between a prospective preoperative bending (3D pre-bent) of titanium mesh and retrospective data from conventional intraoperative bending. Clinical and radiographic evaluations of orbital geometry, along with intraoperative efficiency metrics, were assessed at both preoperative and postoperative stages.

Results: Sixty-four patients were included, with 32 in the 3D pre-bend titanium mesh group and 32 in the conventional bending group. Mean operative time was shorter in the 3D pre-bend group (81.07± 13.04 minutes) than in the conventional group (96.07± 4.46 minutes). The 3D pre-bend group achieved more accurate reconstruction, with orbital volume and height correction rates of 96.78% ± 4.91% and 100.62%± 3.77%, respectively, versus 94.88% ± 4.33% and 96.08% ± 5.44% in the conventional group. Patient and surgeon satisfaction was higher in the 3D pre-bend group.

Conclusion: Pre-bending titanium mesh using a 3D-printed model significantly reduces intraoperative time and improves orbital height correction. Additionally, this technique enhances both patient and surgeon satisfaction. However, long-term clinical outcomes remain comparable between groups.

Primary malignant melanoma of the parotid gland (PMMPG) is an exceptionally rare neoplasm, comprising less than 0.7% of all parotid malignancies and often mistaken for metastatic melanoma. This case presents a 66-year-old man with a painless, slowly enlarging right parotid mass. Imaging revealed a lesion localized to the superficial parotid lobe with FDG (fluorodeoxyglucose)-avid level II lymph nodes. Fine-needle aspiration suggested melanoma, confirmed by immunohistochemistry. The patient underwent total parotidectomy, neck dissection, adjuvant radiotherapy and immunotherapy with pembrolizumab under ongoing oncologic surveillance. Histopathology confirmed melanoma with nodal metastasis and negative margins, with no evidence of local recurrence at 6-month follow-up. Diagnosis of PMMPG demands exclusion of other primary sites and prior excision history, making immunohistochemistry essential. Treatment typically involves surgical resection and radiotherapy; however, prognosis remains poor due to high recurrence and metastasis rates. PMMPG requires a coordinated, multidisciplinary approach. Although aggressive intervention offers the best outcomes, the long-term prognosis is limited. Continued research is essential, particularly focusing on molecular differentiation from clear cell sarcoma and the identification of specific molecular markers that can guide targeted therapy.

Background: Inferior orbital blowout fractures (BOF) cause ocular symptoms like diplopia and extraocular muscle limitation, influenced by inferior rectus muscle (IRM) status. This study evaluated the relationship between preoperative IRM status on computed tomography (CT) and ocular symptom recovery time.

Methods: This retrospective study analyzed 127 patients with inferior BOF and ocular symptoms (2012-2024). Inclusion criteria included age 18-80 years and preoperative CT availability. IRM status was assessed for bone interruption, herniation extent, and swelling (short/ long axis ratio < 0.54 or ≥ 0.54). Recovery times were analyzed using t-tests and Kaplan-Meier survival analysis (p< 0.05).

Results: Of 127 patients (mean age, 35 years; 67.7% male), 66 (52.0%) recovered from ocular symptoms within 7 days, 53 (41.7%) within 30-90 days, and eight (6.3%) had diplopia that remained as a permanent sequela at the last follow-up. Diplopia recovery time was longer in IRM-bone contact (16.9± 5.5 days, n= 35) and bone-pierced IRM (29.4± 10.3 days, n= 15) groups versus no-contact (5.1± 4.2 days, n= 77; p= 0.02, t-test). Herniation and swelling showed no significant correlation (p> 0.05).

Conclusion: Preoperative CT-based assessment of the IRM-bone interface predicts diplopia recovery time, with bone-pierced IRM linked to prolonged recovery. Patients with bone-pierced IRM may require closer follow-up and careful consideration of timely surgical management.

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection that rarely involves the periorbital region. We report an unusual case of periorbital NF caused by methicillin-sensitive Staphylococcus aureus (MSSA) in a previously healthy 48-year-old woman, originating from a neglected, recurrent hordeolum-an otherwise benign eyelid condition. The infection resulted in an extensive fullthickness defect of the upper eyelid and adjacent temporal area, presenting major reconstructive challenges. Reconstruction was performed using a radial forearm free flap combined with a buccal mucosal graft to restore both anterior and posterior lamellae, achieving functional eyelid protection and improved visual acuity. This case highlights the potential for seemingly minor, recurrent eyelid infections to progress rapidly to devastating NF even in the absence of systemic symptoms or risk factors. Early recognition and multidisciplinary management were critical to preventing further morbidity. To our knowledge, MSSA has not previously been reported as a causative agent of periorbital NF, underscoring the need for clinical vigilance and timely intervention in common eyelid conditions to avoid catastrophic complications.

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.

Optimal aesthetic and functional outcomes in facial surgery depend on effective wound healing. Although the impact of cigarette smoking on postoperative healing has been widely studied, its specific influence in the context of facial procedures remains debated. This review evaluates how smoking compromises wound healing and increases the risk of postoperative complications by synthesizing current evidence on its influence in facial surgical procedures. This scoping review included original observational studies (cross-sectional, case-control, and cohort) published in English that examined associations between cigarette smoking and wound healing following facial procedures. Eligible participants included patients of any age or sex undergoing facial surgery or sustaining facial trauma. Exposure was defined as active smoking or a history of smoking and was compared with non-smokers or those with documented cessation. Primary outcomes included complications such as skin slough, wound dehiscence, infection, and flap or graft necrosis. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Of 129 screened records, nine studies met the inclusion criteria. Across various facial procedures, active smoking was consistently associated with impaired wound healing, with reported complication risks ranging from 1.8-fold to 12-fold higher among smokers. Commonly reported adverse outcomes included flap necrosis, infection, and wound dehiscence, although several studies reported no statistically significant association in specific procedural contexts. Smoking is strongly associated with poorer wound healing following facial surgery, particularly in flap-based procedures. These findings emphasize the importance of perioperative smoking cessation to improve healing and reduce preventable postoperative complications.

Background: To assess the effectiveness of hyperbaric oxygen therapy (HBOT) as an adjunct to standard treatment in early-stage oral submucous fibrosis (OSMF), focusing on mouth opening, burning sensation, pain, and systemic inflammation.

Methods: A randomized comparative study was conducted on early-stage OSMF patients divided into two groups. Group 1 received HBOT along with intralesional triamcinolone, hyaluronidase, and oral antioxidants. Group 2 received only the standard intralesional therapy with antioxidants. Clinical parameters-interincisal distance, burning sensation, and pain-were recorded at baseline, first, and second follow-up. Serum C-reactive protein (CRP) levels were measured pre- and post-treatment. Statistical analysis included unpaired t-tests and chi-square tests.

Results: Both groups improved clinically, but Group 1 showed significantly greater reductions in burning sensation (p= 0.020), pain, and CRP levels (p= 0.033). Although intergroup differences in mouth opening were not statistically significant, Group 1 showed greater improvement over time. Fibrotic band distribution remained unchanged in both groups. No complications were reported with HBOT.

Conclusion: HBOT provides enhanced symptomatic relief and anti-inflammatory effects in early-stage OSMF when used alongside conventional therapy. While it may not reverse fibrosis, its safety and noninvasive nature support its role in multimodal OSMF management.

Full-thickness skin grafting (FTSG) is frequently used to reconstruct facial soft tissue defects because it provides favorable color and texture matching. Secondary cystic lesions, including milia or epidermal cysts, that develop after FTSG are rare. A 29-year-old woman sustained a dog-bite injury resulting in a 4.5× 2.5 cm defect involving the philtrum and upper lip. The philtrum was reconstructed using a full-thickness skin graft harvested from the retroauricular area, while the upper lip was repaired using a mucosal V-Y advancement flap. Ten months later, hypertrophic scarring developed, and a second FTSG was performed using contralateral retroauricular skin. Despite repeated intralesional triamcinolone injections, the grafted area became tender and pruritic, with the appearance of multiple milia-like lesions. Over the subsequent 9 months, three recurrent cystic nodules developed within the scar tissue and were serially excised. Histopathological examination confirmed the diagnosis of secondary milia. After complete excision, no recurrence was observed for over 3 years. We discuss possible contributing mechanisms, including adnexal survival within grafts and the role of remnant epidermis or ductal obstruction. Awareness of this complication may help guide donor-site selection and wound-bed preparation in perioral reconstruction.

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.