Archives of Craniofacial Surgery最新文献

Background: The attractiveness of a person's smile is influenced by several factors, including gingival display, incisor show, and facial asymmetries. Malocclusion has long been recognized as having a significant negative impact on smile aesthetics. Addressing dentofacial deformities is a major treatment goal in orthodontic and orthognathic interventions, aiming to improve both functional and aesthetic outcomes. We sought to quantify and assess the impact of orthognathic surgery on a patient's expression of happiness within their smile, thereby addressing the current research gap in this highly subjective field.

Methods: We utilized FaceReader, a commercially available and previously validated artificial intelligence (AI) system, to analyze preoperative and postoperative facial photographs of 216 Chinese patients who underwent orthognathic surgery between January 1, 2021, and December 31, 2022. The AI software measures seven cardinal emotions and associated facial action units, providing an objective evaluation of emotional outcomes.

Results: Our findings indicated a significant postoperative increase in patients' expression of "happiness" while smiling, accompanied by a concurrent decrease in their estimated age. Patients with insufficient incisor show and open bite exhibited notable improvements in emotional expression, while those with a gummy smile showed no significant change. Additionally, stratification based on malocclusion classification (class I, II, III) revealed consistent improvements in emotional outcome scores among class II and III patients.

Conclusion: Our findings underscore the potential of AI in providing objective insights into emotional changes following orthognathic surgery.

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.

Elastofibroma is a rare soft tissue tumor that most commonly occurs in the subscapular region. It has also been reported in several other anatomical locations. To our knowledge, no previous reports have described elastofibromas in the anterior aspect of the face. A 36-year-old man with intellectual disability was referred to our department for the evaluation of a painless multinodular lesion on the philtrum. The lesion was initially misdiagnosed as a dermatologic condition by the department of dermatology and was treated accordingly, however, it worsened, prompting referral to our department. We performed a surgical excision of the lesion and reconstructed the resulting skin defect with a skin graft. Histopathological examination confirmed the diagnosis of elastofibroma. This case underscores the importance of including elastofibroma in the differential diagnosis of facial neoplasms, particularly when the presentation is phymatous.

Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare but well-documented complication of bisphosphonate therapy. Bisphosphonates are prescribed to millions of patients for the treatment of osteoporosis, Paget's disease, multiple myeloma, bone metastases, and other bone-related conditions. These drugs inhibit bone resorption by binding to hydroxyapatite, particularly in areas of active resorption, thereby preventing osteoclasts from attaching to the bone. Long-term bisphosphonate therapy is considered a primary risk factor for MRONJ. Bisphosphonate-induced osteonecrosis typically manifests as exposed alveolar bone, which may occur spontaneously or following invasive dental procedures such as extractions, apicectomies, or implant placement. This case report describes a female who developed osteonecrosis in the maxilla and mandible after undergoing bisphosphonate therapy for multiple myeloma and subsequent tooth extractions.

Background: There are diverse treatment modalities available for managing pediatric dentate mandibular fractures, ranging from various closed reduction techniques to open reduction methods. This systematic review and meta-analysis aim to evaluate the most appropriate and preferred management method for pediatric dentate mandibular fractures, focusing on outcomes such as wound infection and malocclusion.

Methods: A systematic search was performed using the PubMed Central and Scopus databases from January 1980 to December 2022, following PRISMA guidelines. The inclusion criteria comprised case reports with more than 10 cases, clinical trials, and prospective and retrospective clinical studies addressing the management of displaced dentate-segment mandibular fractures in patients up to 15 years old using open and/or closed reduction techniques.

Results: Six retrospective studies were included in the systematic review and meta-analysis. The primary outcomes assessed were wound infection and malocclusion. The pooled estimate for wound infection significantly favored the maxillomandibular fixation (MMF) group (p= 0.0007). In contrast, although the pooled estimate for malocclusion favored surgical treatment, the difference was not statistically significant (p= 0.86).

Conclusion: The risk of wound infection is significantly lower with MMF in pediatric mandibular fractures, while open reduction and internal fixation (ORIF) using miniplates is associated with a relatively lower risk of malocclusion, although this difference is not statistically significant. The authors conclude that, based on reduced wound infection rates, MMF should be the preferred management approach, whereas ORIF should be reserved for severely displaced and comminuted fractures. Future randomized controlled trials with larger sample sizes are needed to validate and strengthen these findings.

Background: Chitosan, a cationic polysaccharide, exerts hemostatic activity by promoting platelet adhesion and aggregation. This clinical study aimed to evaluate the effectiveness of chitosan-based dental dressing in achieving early local hemostasis, in comparison to gauze packs, after dental extractions in patients with deranged coagulation profiles.

Methods: This study included 102 patients (204 extraction sites), of whom 86 were on anticoagulant therapy,15 had liver cirrhosis, and one with thrombocytopenic purpura required two or more tooth extractions. These sites were randomly divided into test and control sites. Patients with deranged coagulation profiles, including an international normalized ratio of 1.5-4, altered prothrombin time, activated partial thromboplastin time, and decreased platelet counts, were selected. Hemostasis was assessed at 10, 30, and 60 minutes post-extraction. Patients were evaluated on days 1, 3, and 7 for dry sockets and other adverse effects.

Results: Hemostasis was achieved in 83.1% of test sites within 10 minutes, compared to only 18.8% of control sites. By 30 minutes, an additional 16.8% of test sites had achieved hemostasis versus an additional 16.7% of control sites. By 60 minutes, a further 5.9% of test sites had achieved hemostasis, compared to 63.7% of control sites. The mean postoperative hemostasis times were 15.10± 12.88 minutes for test sites and 45.20± 20.62 minutes for control sites. Dry socket incidence was slightly higher in test sites, but this tendency was not statistically significant (p>0.05).

Conclusion: The study suggests that chitosan-based dental dressing facilitates early local hemostasis after tooth extraction in anticoagulated patients or patients with bleeding disorders.

Background: Road traffic incidents, particularly those involving motorcycles, pose a significant public health concern, especially in low-income countries. This study aims to investigate the incidence and patterns of head and neck injuries, as well as to analyze factors contributing to these injuries.

Methods: A retrospective analysis was undertaken utilizing the medical records of motorcycle incident patients derived from the provincial injury surveillance data collected between January 1, 2021, and December 31, 2021, at a single center. The study encompasses data on age, sex, rider classification, types and quantities of alcohol ingested, helmet employment, Glasgow Coma Score, Injury Severity Score, and classifications of head and neck injuries. The incidence rate of head and neck injuries correlated with motorcycle incidents will be delineated. Subsequently, a logistic regression analysis was conducted to discern the factors associated with head injury severity.

Results: The study examined motorcycle incident trauma in 1,413 patients. The incidence of head and neck injuries was 20%. Multivariable logistic regression analysis identified the age of more than 60 years, non-helmeted riding, and alcohol consumption as significant factors for head injuries, with odds ratios of 1.86, 1.76, and 4.17, respectively.

Conclusion: This study emphasizes the protective role of helmets in reducing head injuries and highlights potential associations between alcohol consumption and the severity of head injuries. These findings may be utilized to advocate for improvements in road safety policies and reduce healthcare costs related to motorcycle accidents.

Background: The invasion of Ukraine by Russian troops on February 24, 2022, had significant humanitarian consequences. This conflict provides valuable data on the types and characteristics of war-related injuries, their epidemiology under modern warfare conditions, and the effectiveness of medical support and treatment strategies applied under challenging military circumstances with limited staff and resources. Therefore, this study aimed to analyze the prevalence and characteristics of war-related maxillofacial injuries during the Russian- Ukrainian war.

Methods: This retrospective multicenter study examined the demographic features, etiology, and characteristics of ballistic injuries among military personnel and civilians. Data were collected from the maxillofacial departments of six specialized military and civilian medical institutions in Kyiv and its surrounding regions. The study analyzed 415 patients with gunshot and blast injuries admitted to these hospitals from February 24, 2022, to February 24, 2024. For each patient, parameters such as age, sex, social status, trauma-associated complications, concomitant injuries to other organs and systems, New Injury Severity Scores, and Facial Injury Severity Scale scores were recorded.

Results: Among the 415 patients, 96.9% were male. Isolated maxillofacial injuries were observed in 75 patients (18%), while ophthalmic injuries were present in 208 patients (50.1%). Primary care for the majority of patients was provided in military hospitals near the front line or in primary, secondary and tertiary regional medical institutions. Wound debridement and closure were performed as primary interventions in 358 patients (86.3%), and more than half of the patients received primary maxillofacial care within 24 hours of injury.

Conclusion: The primary cause of war-related maxillofacial injuries was high-energy blast trauma resulting from artillery strikes, mines, drones, rocket attacks, and bombings. War-related military trauma involved soft tissue damage in 97.1% of cases.

Background: Pneumatization of turbinates, also known as concha bullosa (CB), is associated with nasal septal deviation and sinonasal pathologies. This study aims to evaluate the performance of deep learning models in detecting CB in coronal cone-beam computed tomography (CBCT) images.

Methods: Standardized coronal images were obtained from 203 CBCT scans (83 with CB and 119 without CB) from the radiology archives of a dental teaching hospital. These scans underwent preprocessing through a hybridized contrast enhancement (CE) method using discrete wavelet transform (DWT). Of the 203 CBCT images, 162 were randomly assigned to the training set and 41 to the testing set. Initially, the images were enhanced using a CE technique before being input into pre-trained deep learning models, namely ResNet50, ResNet101, and MobileNet. The features extracted by each model were then flattened and input into a random forest (RF) classifier. In the subsequent phase, the CE technique was refined by incorporating DWT.

Results: CE-DWT-ResNet101-RF demonstrated the highest performance, achieving an accuracy of 91.7% and an area under the curve (AUC) of 98%. In contrast, CE-MobileNet-RF recorded the lowest accuracy at 82.46% and an AUC of 92%. The highest precision, recall, and F1 score (all 92%) were observed for CE-DWT-ResNet101-RF.

Conclusion: Deep learning models demonstrated high accuracy in detecting CB in CBCT images. However, to confirm these results, further studies involving larger sample sizes and various deep learning models are required.

Genioplasty is a crucial procedure in maxillofacial and craniofacial surgery for both aesthetic and functional chin correction. The procedure is performed using various techniques-including sliding genioplasty, advancement, setback, vertical augmentation, and narrowing genioplasty-with each approach offering specific benefits tailored to patient needs. Advances in virtual surgical planning, pre-bent absorbable plates, and three-dimensional printing technology have enhanced the precision of genioplasty, leading to improved functional and aesthetic outcomes. This review examines the historical evolution, contemporary techniques, clinical outcomes, and future directions of genioplasty, with a focus on technological advancements that increase procedural accuracy and patient satisfaction.