Archives of Craniofacial Surgery最新文献

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.

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.