Archives of Craniofacial Surgery最新文献

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Background: Wound healing is a complex process influenced by a variety of environmental factors. Dressing materials play a critical role in creating barriers against contaminants, maintaining optimal moisture levels, and absorbing wound exudate. Therefore, selecting materials tailored to wound characteristics is crucial for enhancing outcomes. Hyaluronic acid (HA) is a natural biocompatible polymer that supports healing by regulating inflammation and promoting tissue repair. This study compared HA- and hydrocolloid-based hydrogels in a rat model to optimize wound care strategies.

Methods: Full-thickness dermal wounds (diameter, 8 mm) were created on the dorsal skin of 12 Sprague-Dawley rats under sevoflurane anesthesia. The wounds were treated with HA/silver sulfadiazine gel (group A), hydrocolloid gel (group B), or left untreated (control), all covered with a transparent dressing. Biopsy specimens on days 3, 7, and 21 were used to assess histological parameters: inflammatory cell infiltration, fibroblast infiltration, collagen deposition, neovascularization, and epithelial thickness, using a semi-quantitative scoring system. Histological analyses were conducted blindly, and statistical analyses were performed using the Kruskal-Wallis test (p< 0.05).

Results: On day 3, group A showed significantly higher inflammatory cell infiltration and collagen deposition than other groups, indicating extracellular matrix formation. By day 7, angiogenesis was highest in group A, followed by group B and controls. By day 21, all wounds had completely healed. Epithelial layer thickness, reflecting inflammation and fibroblast maturity, was significantly higher in group A.

Conclusion: This study compared HA-based hydrogel and hydrocolloid-based dressings through histological analyses to elucidate wound healing mechanics. HA-based hydrogel dressings significantly enhanced wound recovery. However, generalizing these outcomes requires future studies to expand the range of effective wound treatment materials. These findings underscore the potential of HA-based dressings to enhance clinical outcomes in wound management, suggesting avenues for improving therapeutic strategies.

Chorea-acanthocytosis (ChAc) is an extremely rare neurodegenerative disorder characterized by movement disorders and acanthocytosis. Orofacial dyskinesia is a distinct symptom of this disorder that can lead to lip injuries and feeding difficulties. This paper reports the first case of a patient with ChAc presenting with a lip defect, who was managed with surgical and adjuvant onabotulinumtoxinA (BTX-A) therapy. A 43-year-old woman diagnosed with ChAc was referred to our clinic because of a 5× 5 mm lip defect resulting from orofacial dyskinesia. Wedge resection of the scar tissue was carried out, followed by reconstruction by suturing. Postoperatively, BTX-A injections were administered to ameliorate dyskinesia. Thirty units of BTX-A were injected into each masseter muscle, and 40 units were injected into the orbicularis oris muscle. At 1, 2, and 4 weeks after the injections, assessments were performed using the Abnormal Involuntary Movement Scale, and the patient's impression of change was assessed using the Global Rating of Change Scale. Subsequent adjuvant BTX-A treatment yielded subjective and objective improvements in orofacial dyskinesia. In conclusion, lip reconstruction and adjuvant BTX-A injections were effective in treating lip defects associated with orofacial dyskinesia in patients with ChAc, which highlights the need for a multimodal treatment approach.

This paper presents a novel approach to the correction of zygomatic malposition and secondary reconstruction orbital floor fractures, highlighting the use of hydrated acellular dermal matrix (ADM), specifically CGDerm One-Step, in a case where traditional solid implants failed to maintain structural integrity and volume. A 27-year-old woman with persistent facial deformities following a traumatic incident underwent a transformative procedure that utilized ADM for volume correction and structural support, addressing significant challenges such as enophthalmos and facial contour depression. This approach was necessitated by the descent of the entire orbital floor and a previously placed implant (Medpor), leading to unsatisfactory volume correction. By integrating ADM with titanium-reinforced fan plates (Synpor), the surgery successfully restored the patient's facial symmetry and addressed her functional concerns, including diplopia and limited eye movement. Postoperative evaluations demonstrated the long-term effectiveness of this method, with significant improvements in facial contour and eye symmetry. Our findings suggest that ADM, particularly in its hydrated form, offers a reliable alternative to traditional bone grafts and implants for correcting complex craniofacial deformities, providing both aesthetic and functional benefits. This case underscores the importance of adaptable, tissue-mimicking materials in facial reconstructive surgery, offering insights into their potential for broader application in post-traumatic facial corrections.

The severe gummy smile and a skeletal class II profile pose challenges in treatment. This case report outlines an effective alternative for addressing these problems in a patient with skeletal class II division 2, class II molar relationship, retroclination of upper incisors, and lip protrusion. Treatment objectives included normalizing the overjet and overbite, improving the gummy smile, and establishing a satisfactory occlusion. A three-dimensional simulation was performed to consult with the patient, assess possible results, and predict treatment biomechanics. The treatment involved the use of two zygomatic and one inter-radicular temporary anchorage devices, along with botulinum toxin. After the 2-year follow-up, a satisfactory dental occlusion, aesthetic improvement, and adequate function were achieved. This approach offers a viable alternative to orthognathic surgery for adults with skeletal class II malocclusion and a severe gummy smile due to hypermobile lip.

Septal perforation is an anatomical defect of the nasal septum that leads to impaired nasal function, including obstruction and respiratory issues. In this study, a novel surgical approach was introduced to address septal perforations, focusing on the use of costal composite chondro-perichondrial grafts bilaterally in a symmetric manner. This composite graft, composed of costal cartilage and perichondrium, provides mechanical support, aids vascularization, and minimizes perichondrial shrinkage. A case study of a 23-year-old patient with septal perforation resulting from multiple rhinoplasty procedures is presented. The surgical procedure involved the use of a composite graft to close the septal perforation and correct the nasal deformity. The postoperative results demonstrated successful septal perforation closure and relief from nasal discomfort. This study highlights the advantages of this method, particularly its simplicity and straightforward surgical procedures for closing septal perforations of various sizes, and its suitability for rhinoplasty surgeons who are familiar with costal cartilage harvesting.

Background: Following primary cleft palate repair, individuals face a heightened risk of hearing problems, particularly conductive hearing loss, compensatory articulation disorders (CADs), resonance disorders, delayed speech and language development, and voice disorders. This study aimed to investigate the prevalence and impact of these challenges in children with cleft palate with or without cleft lip (CP± L).

Methods: This cross-sectional study included 38 children with CP± L aged 5 to 13 years. A comprehensive evaluation involved audiological assessments (audiograms, tympanograms) by an audiologist and speech-language pathology assessments (Thai Speech Parameters for Patients with Cleft Palate, Articulation Screening Test) by speech-language pathologists.

Results: The prevalence of hearing loss affected 27.63% of participants (21 out of 76 ears) and majority of cases involved conductive hearing loss. Velar substitution was the most common CAD, followed by nasalized voiced pressure consonants, phoneme-specific nasal air emission, and pharyngeal substitution. A moderate correlation was found between these CAD patterns and hypernasality at the word, sentence, and screening levels (r= 0.44, p< 0.01; r= 0.43, p< 0.01; and r= 0.40, p= 0.01).

Conclusion: For summary, the most common type of hearing loss was conductive hearing loss. The predominant CAD pattern was velar substitution. The protocol could be designed to enhance early improvement in hearing and articulation, thereby supporting academic achievement and long-term quality of life.

Cranial prostheses are frequently required for patients with cranial defects secondary to trauma, decompressive craniectomy, or other pathologies. When the resected or craniotomized bone cannot be reused, cranioplasty with artificial materials offers both aesthetic and protective benefits. However, high-end custom-made options, like polyether ether ketone or titanium prostheses, are expensive and not widely available. Heat-cured polymethyl methacrylate (PMMA) prostheses are generally preferred over their cold-cured counterparts. In-house dental laboratories can provide a cost-effective and practical solution by employing a lost-wax technique akin to denture fabrication, utilizing a three-dimensional printed custom open mold. Fabricating large heatcured PMMA cranioplasts presents certain challenges, such as the need for large flasks and potential porosity. These can be overcome by using a large stainless steel container (a tiffin box) and M-Seal epoxy to ensure an airtight curing process. This method can be easily adopted by standard dental laboratories. At our center, four patients have successfully fitted with cranioplasty prostheses produced using this technique. Even though the patients are outside of the scope of this technical note all of them indicated high satisfaction, and no complications were reported. This straightforward approach demonstrates that in-house, heat-cured PMMA cranioplasts can represent a viable, cost-effective option for cranial reconstruction.

A 59-year-old woman presented to our clinic with a 3.5× 3-cm protruding mass on her forehead. A skull X-ray revealed a radiolucent osteolytic lesion on the left side of the frontal bone. Additionally, computed tomography showed a 3.1× 1.7× 3.6-cm mass exhibiting a "sunburst" pattern situated between the outer and inner tables of the skull, just superior and lateral to the left frontal sinus. This pattern suggested the presence of an intraosseous vascular malformation (IVM). The lesion was approached via a bicoronal incision. En-bloc resection was performed, removing the mass along with approximately 0.5 cm of the surrounding normal bone without injury to the exposed frontal sinus mucosa. The exposed mucosa was reinforced with a galeal flap, and cranioplasty with bone cement was performed to repair the resulting bony defect. Pathological examination confirmed a diagnosis of intraosseous cavernous-type malformation with mixed cavernous and capillary histological features. We report this case of IVM and review the existing literature, highlighting the satisfactory functional and aesthetic outcomes after surgery.

Ethmoid myoepithelial carcinoma is a rare tumor, with only 14 cases reported to date. This report discusses the largest tumor of this type ever recorded in the ethmoid region. The tumor caused extensive damage to facial structures, complicating treatment. The patient's age and comorbidities increased the risk of intraoperative bleeding, presenting challenges to the complete removal of the tumor and the reconstruction of the damaged structures. To reduce the risk of intraoperative hemorrhage, shorten the surgery time, and manage potential heartrelated complications, arterial embolization was performed using gelatin sponges and coils. Definitive surgery was then carried out using a skin flap and mucosal flap to successfully reconstruct the defect. Postoperative radiotherapy was deemed unnecessary. The patient recovered well, with a satisfactory aesthetic outcome. No recurrence was observed during a 3-year follow-up period.