Archives of Craniofacial Surgery最新文献

Neuroendocrine carcinoma (NEC) is a rare aggressive tumor of the skin with a shared phenotype of both endocrine and neuronal features. Its behavior includes rapid progression, common local recurrence, frequent metastasis to local lymph nodes, and occasional systematic involvement. The risk factors for NEC are similar to those for other skin cancers and mainly include ultraviolet light exposure, older age, T-cell immunosuppression, fair skin, and male sex. NEC is seen more frequently in the immunosuppressed population, and we report a rare case of NEC combined with squamous cell carcinoma (SCC) in a patient who underwent kidney transplantation. A 66-year-old man was referred with a brownish plaque on left cheek, and a punch biopsy result indicated SCC in situ. Wide excision was performed, and the defect was reconstructed using a bilobed flap. The final biopsy confirmed SCC combined with carcinoma with neuroendocrine differentiation, and positron emission tomography-computed tomography confirmed the absence of lymph node metastasis or systemic involvement. The patient showed no evidence of recurrence or other postoperative complications.

Background: Lipomas are common benign connective-tissue tumors that usually present as slow-growing, painless, subcutaneous masses. Deeper variants, such as intramuscular, intermuscular, and submuscular lipomas, are larger and rarer. Accurate preoperative depth determination is crucial for planning appropriate surgical resection.

Methods: We retrospectively reviewed 190 lipoma cases treated at a single medical center from January 2013 to August 2023. The accuracy of preoperative imaging techniques-ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI)-in predicting lipoma depth was assessed.

Results: USG, CT, and MRI showed accuracies of 72.5%, 56.5%, and 79.3%, respectively, with MRI showing the highest predictive accuracy. The trunk was the most common site for lipomas (49.5%), followed by the upper (20.5%) and lower extremities (13.2%). USG was more accurate for lipomas in the lower extremities and neck, whereas CT was less accurate for lipomas in the trunk.

Conclusion: MRI is preferable for the preoperative depth assessment of lipomas, especially those located in the trunk. Accurate imaging is essential for guiding surgical planning and avoiding complications. Further studies with larger sample sizes are required to validate our findings.

Background: Orbital medial wall fractures, which are more common than inferior wall fractures, have traditionally been difficult to diagnose with conventional radiography. As the fracture extends deep into the bony orbit, accurately visualizing internal structures becomes challenging, increasing the risk of optic nerve compression. In a previous study, the author introduced a technique for treating medial orbital wall fractures using a combined transethmoidal and transcaruncular approach. In this study, the authors hypothesized that the use of surgical navigation could enhance precision, safety, and anatomical reconstruction in this approach and employed navigation during surgery for medial orbital wall fractures and evaluated whether it improved postoperative functional and anatomical outcomes while minimizing complications.

Methods: From September 2021 to November 2023, 48 patients with isolated medial wall fractures underwent surgical treatment using a combined transcaruncular approach and transethmoidal packing to repair the orbital fracture. Of these patients, 23 underwent surgery with the use of intraoperative navigation, while the other 25 did not. Intraoperative navigation was employed to facilitate precise fracture reduction and reduce the risk of optic nerve injury. The outcomes were compared by dividing the patients into two groups. Preoperative and postoperative assessments included ophthalmologic evaluations, Hertel exophthalmometry, and computed tomography-based orbital volume measurements.

Results: The surgical approach with intraoperative navigation was successfully performed in all patients. Postoperative outcomes showed full recovery without residual symptoms or complications. Orbital volume measurements indicated a significant reduction in the preoperative orbital volume ratio from 109.03% to 104.80% postoperatively (p< 0.001). However, changes in the Hertel scale were not statistically significant (p = 0.086).

Conclusion: The integration of intraoperative navigation in medial orbital wall fracture surgery enhances the precision of medial orbital wall restoration and minimizes postoperative complications, supporting its use in the surgical management of medial orbital fractures.

Inflammatory myofibroblastic tumor (IMT) of the soft tissues of the neck is a rare pathological entity. We present the case of a 32-year-old patient who had a painful, slowly enlarging mass in the neck's soft tissues. Radiological examination revealed a well-defined, dense lesion. The mass was surgically removed through local excision. Immunohistological analysis confirmed the diagnosis of IMT. After nearly 2 years of follow-up, there was no evidence of recurrence or distant metastases. In conclusion, although IMT of the soft tissues of the neck is uncommon, it should be considered in the differential diagnosis of neck tumors. Further research is necessary to understand the pathogenetic mechanisms of IMT, which could lead to the development of more effective treatments for this tumor.

Liposuction is a widely performed aesthetic plastic surgery procedure used for various purposes. The use of advanced liposuction techniques has reduced the risk of complications. Nevertheless, they can still occur unexpectedly. Herein, we report a rare case of a 44-year-old patient who experienced a broken cannula tip lodged in her neck during cervicofacial liposuction. This case highlights the need for vigilance in preventing such complications through rigorous preoperative equipment inspections and proper instrument maintenance. Additionally, when attempting to remove a broken instrument tip, it is crucial to perform imaging examinations both before and during the procedure to precisely locate and extract the fragments, ensuring patient safety and a successful outcome.

Sublingual hematoma is a serious complication associated with anterior mandible surgery. It presents considerable risk due to the potential for airway obstruction, which can be life-threatening and necessitates prompt diagnosis and intervention. This case report describes the occurrence of sublingual hematoma following mandibular midline osteotomy and the subsequent management of this condition. Mandibular midline osteotomy is performed to correct skeletal or dental discrepancies in the transverse plane. Sublingual hematoma as a complication of a midline osteotomy has not been previously documented in the literature. This article provides a comprehensive review of the various etiologies associated with sublingual hematoma, along with its management modalities.

Background: This systematic review aimed to determine whether cone-beam computed tomography (CBCT) and panoramic radiography (PR) yield consistent results in determining the degree of impacted lower third molar teeth based on existing classification parameters.

Methods: A comprehensive literature search was conducted of PubMed, Embase, Cochrane, and PLOS One, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, a manual search was also carried out. There were no restrictions on publication dates, allowing a broader scope of literature. Only articles published in English were eligible for inclusion. Furthermore, all studies that compared the outcomes of CBCT and panoramic images concerning the position of impacted teeth, according to the Winter and the Pell & Gregory classifications, were included.

Results: Four studies met the inclusion criteria. One study used the Pell & Gregory classification to assess differences, finding a significant result (P< 0.001). Two studies used both the Winter and the Pell & Gregory classifications. In these assessments, one study found no significant differences in the Winter classification (p= 1.000) or the Pell & Gregory assessment (p= 0.500). However, another study identified significant differences using both the winter and the Pell & Gregory classifications (P< 0.001). One study conducted an assessment using only Winter classification and found no significant differences between PR and CBCT (P> 0.05).

Conclusion: There are inter-modality differences in the agreement concerning the degree of impaction of the third molar when using CBCT compared with panoramic imaging across various classification levels. Improved assessment methods are necessary to determine the most appropriate imaging modality for therapeutic management.

Background: Vascular anomalies are disorders of the vascular system. These anomalies are classified as either vascular tumors or vascular malformations, with each possessing distinct characteristics. This study was performed to analyze vascular anomaly referrals to a tertiary center, identify patterns of misdiagnosis, and create a proforma to ensure the comprehensiveness of clinical information.

Methods: We retrospectively analyzed vascular anomaly referral letters received by Hospital Tunku Azizah from 2018 to 2023. Specifically, we descriptively analyzed the inclusion of vascular anomaly characteristics, the demographic profiles of referrers and patients, and basic clinical findings. Subsequently, we developed a redesigned proforma.

Results: Overall, 47 referral letters were analyzed. The patients comprised 25 boys and 22 girls, with ages ranging from birth to 14 years. Patient name, sex, and date of birth, along with the referrer's name and address, were satisfactorily documented. The review revealed that 44 (93.6%) of the letters included the patient's presenting problem, 43 (91.5%) contained clinical findings, 37 (78.7%) reported diagnostic investigations, and 29 (61%) referenced medical history. Regarding characteristics of vascular conditions, over half of the letters detailed time of appearance (n= 40, 85%), growth (n= 24, 66%), complications (n= 25, 53.2%), color (n= 32, 68%), and shape (n= 34, 72%). However, fewer than half mentioned compressibility (n= 7, 14.8%), pulsation (n= 7, 14.7%), and associated conditions (n= 2, 4.3%), and none referenced involution.

Conclusion: Although demographic data were generally well-documented, critical medical history information was frequently omitted, including a lack of adequate pre-referral investigations. Key characteristics of vascular anomalies, namely compressibility, pulsation, associated conditions, and involution, were frequently overlooked. Accurate documentation of these features is crucial for determining treatment urgency. A standardized proforma must be implemented to ensure that vital information is captured, thus facilitating diagnosis and optimizing patient care.

Background: Coronavirus disease 2019 (COVID-19)-associated mucormycosis of the maxilla emerged as a significant concern in India during the second wave of the pandemic, necessitating surgical interventions such as maxillectomy. This study investigated the quality of life following prosthodontic rehabilitation with interim obturators in patients who underwent bilateral total maxillectomy due to COVID-19-associated mucormycosis of the jaws.

Methods: The study was conducted using questionnaire-based interviews administered by a single investigator employing the Oral Health Impact Profile-14 (OHIP-14) and Obturator Functioning Scale (OFS) questionnaires. Responses were evaluated on a Likert scale. All statistical analyses were performed using SPSS version 21.0 for Windows. A significance level of 5% was applied to all tests. The Wilcoxon signed-rank and chi-square tests were utilized to compare categorical and quantitative variables across groups. Responses to the questionnaires were recorded on numerical Likert scales ranging from 1 to 5 for OFS and 0 to 4 for OHIP-14. The mean OHIP-14 and OFS scores were compared between the pre-rehabilitation and post-rehabilitation stages.

Results: A comparison between the pre-rehabilitation and post-rehabilitation scores from the OHIP-14 questionnaire revealed a significant difference (p= 0.001). The OFS results indicated significant improvements across all domains following the use of obturators.

Conclusion: Interim obturators play a vital role in improving speech, swallowing, and mastication during the recovery period for patients who have undergone bilateral total maxillectomy. Despite the altered anatomy resulting from the resection, patients adapted effectively and exhibited improvements in their social, psychological, and mental health.

Background: The ongoing COVID-19 pandemic and the current shortage of speech-language pathologists in Thailand have limited access to speech services for children with cleft palate with or without cleft lip (CP± L). A combination of telepractice (TP) and face-to-face therapy could address the lack of continuous service and improve accessibility to speech therapy providers. This study aimed to compare the percentage of consonants correct (PCC) before and after speech therapy in children with CP± L.

Methods: This study included 19 children with CP± L, aged 5 to 13 years, who underwent primary cheiloplasty and palatoplasty. A perceptual assessment was conducted using the Thai Speech Parameters for Patients with Cleft Palate in a Universal Reporting System to evaluate speech before and after therapy. The intervention consisted of five 30-minute face-to-face speech therapy sessions and fifteen 30-minute TP sessions, totaling twenty sessions. Paired t-tests were used to analyze the mean differences in PCC for pre- and post-articulation errors, as well as caregiver satisfaction levels at the conclusion of the evaluation period.

Results: Children with CP± L exhibited a significant increase in PCC; the mean difference (standard deviation, SD) was 9.36 (11.87), with a 95% confidence interval (CI) of 3.64 to 15.08 at the word level, and a mean difference (SD) of 13.25 (13.71), with a 95% CI of 6.65 to 19.86 at the sentence level. Caregivers rated their satisfaction as excellent.

Conclusion: The integration of TP with traditional face-to-face speech therapy has proven to be a highly effective approach for reducing articulation errors in children with CP± L. Additionally, this method was well-suited for the constraints imposed by the COVID-19 pandemic.