Archives of Craniofacial Surgery最新文献

Keloids are benign fibroproliferative skin tumors that typically arise after cutaneous injuries, such as surgical incisions, burns, lacerations, tattoos, or infections. Malignant transformation of keloids is exceedingly rare, with only sporadic reports of squamous cell carcinoma. To date, sarcomatoid squamous cell carcinoma-an uncommon, highly aggressive squamous cell carcinoma variant-has not been described in association with keloidal scars. We present the first known case of sarcomatoid squamous cell carcinoma developing within a post‑acupuncture keloid scar, detailing its clinical presentation, histopathology, and surgical management. This report underscores the importance of malignancy screening in keloids displaying atypical features, particularly in trauma-exposed regions.

Pott puffy tumor (PPT) is characterized by frontal bone osteomyelitis associated with a subperiosteal abscess, presenting as a localized, firm swelling of the forehead. This report describes the first documented case of PPT in a patient following facial feminization surgery. We present a case involving a 30-year-old transgender female who developed PPT 1 year after undergoing upper third facial feminization surgery, specifically frontal bone reduction osteoplasty and anterior table frontal sinus setback osteoplasty. The patient experienced rapid resolution following operative exploration with thorough irrigation, in conjunction with intravenous antibiotics. Importantly, the aesthetic outcome post-resolution of PPT was satisfactory, with no observed soft tissue distortion or irregularity that compromised the feminizing effect of her previous surgery. This case underscores that such complications can be managed successfully without sacrificing the aesthetic goals of gender-affirming procedures.

Background: Ameloblastoma is a benign odontogenic tumor that predominantly occurs in the mandible and is frequently associated with the BRAFV600E mutation, which activates the mitogen-activated protein kinase (MAPK) signaling pathway. These mutations indicate potential targets for molecular therapies. This systematic review evaluated the effectiveness of molecular-targeted therapies, particularly BRAF inhibitors such as dabrafenib and vemurafenib, in the treatment of ameloblastoma and their effects on clinical outcomes and quality of life.

Methods: In accordance with PRISMA guidelines (PROSPERO: CRD42024627944), a comprehensive search of databases including PubMed/MEDLINE and Scopus identified 4,620 studies, of which eight case reports met the inclusion criteria for analysis.

Results: The selected case reports involved patients aged 13 to 85, most of whom had experienced prior surgical recurrences. Treatment with BRAF/MEK (mitogen-activated protein kinase kinase) inhibitors resulted in significant tumor regression and improved quality of life, although some manageable side effects were observed.

Conclusion: BRAF inhibitors demonstrate promising efficacy in the management of ameloblastoma, especially in patients harboring BRAFV600E mutations. These therapies may reduce the necessity for extensive surgical procedures and enhance patient outcomes. Further research is needed to establish standardized treatment protocols and to assess long-term effects on recurrence and quality of life.

Background: The most complex and debated aspect of head and neck reconstructive surgery is the management of midface defects caused by malignant or non-malignant diseases. This study proposes a new classification system for patients with midface defects arising from non-malignant and non-traumatic diseases.

Methods: In this study, 107 patients with midface defects resulting from mucormycosis were evaluated according to the anatomical locations of involvement and the differences between the affected areas.

Results: Diabetes was identified as the most common underlying disease, while the paranasal sinuses were the most frequently involved sites in cases of mucormycosis. Fourteen patients developed mucormycosis without any associated risk factors, and one patient exhibited brain tissue involvement.

Conclusion: To the best of our knowledge, this study is the first to present a comprehensive classification system for patients presenting with midface defects due to mucormycosis.

Background: Compensatory articulation disorders are the most common issues among children with cleft palates with or without cleft lips (CP ± L). To improve their speech, these children typically require consistent, long-term speech therapy. During situations such as the COVID-19 pandemic or similar epidemics that necessitate social distancing, speech therapy becomes particularly challenging. Telemedicine or telepractice could serve as a strategy to facilitate speech therapy under these conditions. The aim of this study was to determine the effectiveness of telepractice using an application for articulation therapy in improving the percentage of correct consonants (PCC).

Methods: Eighteen children with CP ± L (aged 5-13 years) were enrolled in a therapy program lasting 5 months. The Thai Speech Parameters for Patients with Cleft Palate in a Universal Reporting System test was administered to assess PCC before and after therapy. A total of 20 speech therapy sessions, comprising 15 telepractice sessions and five face-to-face sessions, were delivered using the Application for Articulation Therapy-Thai (AAT-T). The paired t-test was used to compare mean differences (MDs) in PCC scores before and after intervention.

Results: Post-intervention analysis demonstrated significant increases in mean PCC scores at both word and sentence levels (word level: MD, 17.20; standard deviation [SD], 17.37; 95% confidence interval [CI], 8.56-25.83; sentence level: MD, 20.90; SD, 16.51; 95% CI, 12.69-29.11). These results indicate meaningful improvements in speech production accuracy.

Conclusion: Telepractice using the AAT-T was an effective strategy for articulation therapy in children with CP ± L, particularly in situations requiring social distancing.

Background: The Twin Block (TWB) appliance is widely employed for treating Class II malocclusion in children and adolescents. This study aimed to evaluate the three-dimensional treatment effects of the TWB on the upper airway and temporomandibular joint (TMJ), and to investigate the association between airway changes and TMJ alterations.

Methods: This retrospective study examined 24 cone-beam computed tomography (CBCT) scans from 12 patients (mean age, 12.30 ± 1.24 years) diagnosed with Class II Division 1 malocclusion and treated with the TWB appliance. CBCT scans were acquired both at pretreatment (T0) and posttreatment (T1). Romexis 6.2.1 imaging software was used to assess changes in the upper airway and TMJ. The paired t-test was used to compare the pretreatment and posttreatment measurements, while Pearson correlation coefficient analysis evaluated the relationship between the upper airway and TMJ measurements.

Results: A statistically significant increase was observed in the upper airway volume, condylar volume, and condylar dimensions after treatment. No significant correlation was detected between the upper airway and TMJ measurements at T0, T1, or in the net changes (T1-T0) during TWB therapy.

Conclusion: Growing patients treated with the TWB appliance demonstrated a statistically significant increase in upper airway volume. In addition, there was a significant increase in condylar volume, width, and length, with the condyle repositioned more anteriorly within the glenoid fossa. However, no statistically significant correlation was found between the TMJ and upper airway measurements.

Restoration of skeletal form and occlusion in bilateral parasymphysis fractures is technically demanding due to the fragmented mandible and the unfavorable muscular biodynamics. Accurate reduction is crucial for restoring the sagittal projection and transverse dimension of the anterior mandible. This case report describes a straightforward technique that facilitates precise anatomical reduction and stabilization during fixation of the central fragment using a Carroll-Girard screw.

Background: The mandible and maxilla are the most robust facial bones, protecting the facial skull. Fractures of these bones rank among the most common facial injuries sustained in motor vehicle accidents due to the exposed location of the face. Such injuries can have serious health consequences, from functional impairment to death.

Methods: The review adhered to the PRISMA Guidelines. Conducted across four electronic databases: Web of Science, PubMed, Embase, and Google Scholar. Keywords were selected based on a search strategy structured around the Population, Intervention, Comparison, and Outcome framework. Risk of bias was assessed using the Scottish Intercollegiate Guidelines Network criteria.

Results: The literature search yielded 42 articles published in the last 5 years (2019-2024). After the predefined inclusion and exclusion criteria were applied, six articles met the eligibility criteria. Data from these studies, along with their bias assessments, were summarized in tabular format.

Conclusion: The reported incidence of maxillary and mandibular fractures varies across studies. The summarized analysis in this article indicates various fracture patterns. This review also emphasizes the role of trauma severity indices-essential tools for prognostic evaluation, treatment planning, and cost of injury assessment in trauma patients-along with their applications in situations involving triage and multidisciplinary scientific approaches.

Background: Free flaps, skin grafts, and local flaps are viable options for reconstructing large facial defects. When skin grafts, free flaps, or a single local flap are either not feasible or unlikely to yield satisfactory results, reconstruction can be performed using three or more local flaps. To evaluate the effectiveness of this surgical technique, this study analyzed the outcomes of reconstructions that utilized three or more local flaps.

Methods: This study included 10 patients who underwent facial reconstruction with three or more flaps following Mohs micrographic surgery (MMS) for skin cancer from 2016 to 2021. We investigated the types of flaps used, complications, and the recurrence rates of skin cancer. Patient satisfaction regarding color, contour, and scar was assessed through a questionnaire.

Results: Of the 10 patients, nine underwent reconstruction with three flaps, while one patient required four flaps. There were no major complications such as flap loss. Partial necrosis occurred in one patient but was successfully managed with conservative treatment. There were no recurrences of the skin cancer that caused the initial defect, and overall patient satisfaction was high. Patients expressed high satisfaction with color, but lower satisfaction with contour and scar.

Conclusion: For large facial defects where free flaps or skin grafts would yield aesthetically or functionally inferior results, and reconstruction with a single flap is challenging, the application of three or more flaps has achieved good surgical outcomes. Utilizing three or more flaps can be considered a clinically useful method for reconstructing large facial defects.

Verrucous carcinoma, a variant of squamous cell carcinoma, is notable for its lower aggressiveness; however, it presents considerable diagnostic challenges. This tumor is often misdiagnosed, leading to delays in treatment. We describe the case of an 84-year-old woman with verrucous carcinoma presenting as a warty lesion on the lip. The initial biopsy established a diagnosis of verrucous carcinoma, after which wedge resection with a lateral advancement flap was performed. Although the operation was successful, tumor recurrence was observed at the surgical site within several weeks, and a subsequent biopsy identified squamous cell carcinoma. Further surgical intervention proved effective, with no recurrence observed 6 months after treatment. This case emphasizes the importance of precise diagnosis and vigilant management in verrucous carcinoma, highlighting the need for clinicians and pathologists to recognize atypical progression, including hybrid variants. Further research is needed to refine diagnostic criteria and therapeutic strategies for this distinctive and unpredictable malignancy.