Journal of Cranio-Maxillofacial Surgery最新文献

Objectives: In previous study, we have found that preoperative serum squamous cell carcinoma antigen (SCCA) and cytokeratin 19 fragment antigen 21-1(CYFRA 21-1) could be used as serum tumor markers for the diagnosis of sinonasal inverted papilloma (SNIP). Thus, we detected the expression of SCCA and CYFRA 21-1 in tumor tissue and serum to further demonstrate the role of SCCA and CYFRA21-1 in SNIP and other differential diseases.

Methods: Clinical data including gender, age, and preoperative serum SCCA and CYFRA 21-1 levels were obtained respectively from 34,91,59 patients with chronic rhinosinusitis with nasal polyps (CRSwNP), SNIP, and sinonasal squamous cell carcinoma (SNSCC). A total of 10 healthy middle turbinate (MT) tissues,12 nasal polyps (NP), 25 SNIP tissues and 15 SNSCC tissues were collected to explore the expression of SCCA and CYFRA 21-1 by quantitative real-time polymerase chain reaction (RT-qPCR) and immunohistochemistry (IHC). Employing logistic regression analysis to identify serum tumor markers, facilitating the diagnosis of both benign and malignant sinus conditions.

Results: Among these groups, SNIP groups had the highest serum SCCA expression, and the highest CYFRA 21-1 serum level was in SNSCC patients. The RT-qPCR and IHC results suggested that the expression of SCCA in the tissues of SNIP patients was still higher than that in other groups, but the immunohistochemical results of CYFRA 21-1 in SNSCC groups were different from the preoperative serum tests and RT-qPCR results. The logistic regression analysis revealed that serum SCCA and CYFRA 21-1 were risk factors for the diagnosis among three groups.

Conclusions: This study provided a more sufficient basis that SCCA and CYFRA 21-1 could be identified as a tumor marker to distinguish patients with CRSwNP, SNIP and SNSCC.

Orthognathic surgery is used to treat dentofacial deformities and causes upper airway dimension changes. Surgical planning includes the study of the upper airway in CT images. The most common geometry-associated parameters used for the analysis are the total volume and the minimal cross-sectional area. However, these measurements do not provide information about the entire airway, potentially allowing irregularities and shape changes to go unnoticed. As a result, obtaining measurements of the cross-sectional areas along the entire upper airway is desirable. This information will prove useful for clinicians to compare changes after surgery and between patients. In this work, we introduce a simple technique for quantifying the cross-sectional area of the upper airway. We began by segmenting CT images of the upper airway. Later, we established its central axis and defined oblique slices perpendicular to this axis for measuring the cross-sectional area. Furthermore, we propose plotting these areas along the central axis, providing clinicians with an easily interpretable overview of the airway. The method was applied to nine patients, comparing pre-operative and post-operative images, clearly demonstrating changes in the cross-sectional areas after surgery. This method will allow for a better understanding of the effects and has the potential to improve the planning of orthognathic surgery. Further research will show how the movements of the jaw and maxilla influence the dimensions of the upper airway.

The study aims to clarify the injury profile and the causes leading to missed injuries in isolated orbital fracture patients. The hypothesis was that orbital fracture patients are prone to underdiagnosis, especially regarding injuries to other body parts. Both injury profiles and causes leading to missed injuries in isolated orbital fracture patients were evaluated in a prospective cohort study. The patients were examined systematically by the oral and maxillofacial surgeon and an on-call orthopaedic traumatologist. The patients were also referred to ophthalmology for consultation. The study includes 213 patients. Associated injuries of other body parts and additional facial injuries were found in 26.2% and 25.8% of the 213 patients, respectively. The most common injuries outside the facial region were upper limb injuries (10.8%) and traumatic brain injuries (9.4%). In all, 18.8% of the patients had at least one injury that was not suspected or diagnosed primarily. More specifically, 28.6% of injuries outside the facial region were found later, and 25.5% of additional facial injuries were not detected or suspected primarily. Of eye injuries requiring further ophthalmological care, 66.7% were found only at the ophthalmologist's examination. Isolated orbital fracture patients require comprehensive examination by traumatologists focusing on orthopaedic and intracranial injuries as well as facial injuries. Additionally, close collaboration with ophthalmologists is recommended in the early stage after injury.

Treatment decision-making is an integral but complex part of healthcare, particularly in the context of craniofacial surgeries. The aim of the current study was to explore caregiver narratives to inform future surgical care delivery and best practice. 'Life Story' narrative interviews were conducted with US English- and Spanish-speaking caregivers (n = 62) of children aged 3-17 years with craniofacial microsomia (CFM). Extracts relating to treatment decision-making were inductively coded using Reflexive Thematic Analysis. Four themes were identified: 1) 'Grappling with Difference' exemplifies how participants dealt with having a child who was different; 2) 'Seeking Authoritative Guidance' illustrates how participants proactively pursued information about treatment options over several years; 3) 'In the Driving Seat' describes participants' beliefs about whether and how much to involve their child in treatment decisions; and 4) 'Post-Treatment Reflections' depicts participants' reflections of the decision-making experience. Surgeons and other healthcare providers are encouraged to use neutral and accessible language, to ensure families and children have a thorough understanding of all treatment pathways, and to engage in effective shared decision-making practices. Content predominantly focused on surgeries for ear reconstruction and hearing amplification. Future studies would benefit from examining other treatment decisions that caregivers are required to make.

This randomized trial aims to compare the efficacy of Patient Specific Implants in bimaxillary orthognathic surgery via maxilla-guided or mandible-guided technique, focusing on the accuracy of pre-operative planning transfer in the operating room. Twenty patients with dentoskeletal dysmorphism were enrolled and virtual surgical planning (VSP) was performed. Subsequently, they underwent bimaxillary orthognathic surgery using either a maxilla-guided or a mandible-guided approach, as determined via a blind randomization process. Post-operative CBCT scans were conducted one month after surgery to assess maxillo-mandibular positioning. Finally, a roto-translational rigid body analysis was conducted to compare the initial VSP and the post-operative results. Results revealed high reproducibility with both techniques, maxilla-guided approach demonstrating an increased accuracy in vertical, antero-posterior and total translational repositioning of the maxilla, and the antero-posterior repositioning of the mandible compared to the mandible-guided approach. However, the mandible-guided approach offered greater flexibility in controlling the vertical dimension. The two methods have proven to be largely comparable in terms of mandibular rami positioning. Both techniques exhibited clinically equivalent precision in reproducing the VSP, with no surgical complications observed. In conclusion, while the maxilla-guided approach exhibited generally lower discrepancies in the reproduction of the VSP, both techniques were deemed equally effective in bimaxillary orthognathic surgery.

The aim of this retrospective study is to evaluate long-term patient satisfaction after bimaxillary orthognathic surgery planned according to the Face-Airway-Bite (FAB) philosophy. A sample of 65 patients out of 80 consecutively treated between 2015 and 2017 met the inclusion criteria for the study. All patients suffered from different type of malocclusions and were treated with bimaxillary orthognathic surgery at the Unit of Maxillofacial Surgery, University of Verona. Each patient completed a 15-item ad hoc questionnaire investigating the reasons for undergoing treatment and evaluating presurgical and long-term postsurgical satisfaction with facial appearance, breathing, and chewing. Epworth sleepiness scale was administered before and after treatment. In the study group, 48% of patients underwent surgery to correct malocclusion, 22% to enhance facial appearance, 18% to resolve temporomandibular joint pain, and 12% for other reasons. Patients presenting for solely OSAS were excluded from the study to prevent skewing of the data. The mean score for long-term satisfaction was 9.06 ± 1.03/10. The mean facial appearance score was 5.26/10 before and 8.85/10 after surgery, respectively. The mean chewing score was 5.30/10 before and 8.81/10 after surgery. Although none of patients reported breathing problems before surgery, 65% of them referred postoperative breathing improvement. The mean follow-up period for questionnaire administration was 32months. Patients undergoing bimaxillary orthognathic surgery planned according to the FAB principles reported high satisfaction with treatment outcomes. Patients' outcome approval was primarily related to improvement in function and aesthetics; however, airway and pain complaints were additionally improved.

Mandibular fractures are common maxillofacial injuries among children and adolescents, but treatment remains controversial. The aim of this study was to analyse the methods and outcomes of open reduction and internal fixation (ORIF) for non-condylar mandibular fractures in paediatric patients among 14 maxillofacial centres. Patients ≤16 years of age undergoing ORIF for non-condylar mandibular fractures between 2011 and 2022 were included. Age, gender, dentition stage, site and type of fracture, surgical approach, material, thickness, and number of plates, and outcome were recorded. 179 patients (mean age, 11.1 years) reported 120 single and 59 double fractures, 79% involving at least one displaced or comminuted site. Single fractures were preferentially treated with rigid osteosynthesis in all dentition groups (64%), while double fractures with non-rigid osteosynthesis in mixed and permanent dentition patients (59% and 43%) and mixed osteosynthesis in deciduous dentition patients (50%). Mean follow-up was 21 months. Surgical would infection was the most common complication (8.9%), followed by minor malocclusion (1.7%) and osteitis (1.7%). In conclusion, the centres opted for fixation patterns like those recommended for adults, favoring non-rigid or mixed osteosynthesis for double fractures. The low complication rate shows ORIF is effective and safe for non-condylar mandibular fractures in paediatric patients.

Background: The morphology of the zygomatic complex significantly influences facial appearance, leading to a focus on zygomatic osteotomy. The current technique, the "L-shaped" zygomatic osteotomy, requires a small incision and preoperative osteotomy design for an osteotomy guide. However, the use of multiple software programs in the design process makes it time-consuming and clinically challenging.

Method: Artificial intelligence technology offers a solution by integrating digital medical technology into medicine. AI algorithms were developed based on point cloud models, using 2000 cases of three-dimensional CT data for training. Eighty CT data sets were randomly chosen for both AI and manual skull segmentation designs. The effectiveness, symmetry, safety, and aesthetic outcomes were compared.

Result: The AI zygomatic osteotomy showed superior performance in symmetry and aesthetics compared to manual zygomatic osteotomy. The complex structure of the zygomatic arch highlights the advantages of AI-driven osteotomy design, especially in intricate cases. Additionally, the AI osteotomy scheme demonstrated no compromise in safety indicators compared to the manual approach.

Conclusion: AI zygomatic osteotomy proves to be a safe and effective alternative to manual zygomatic osteotomy, showcasing enhanced symmetry and aesthetic outcomes. The efficiency and precision of AI-driven design in complex zygomatic osteotomies make it a promising advancement in this field.

This study evaluated the outcomes of perceptual speech, breathing, snoring, and nasal regurgitation following Orticochea pharyngoplasty, and investigated patient characteristics associated with the resolution or improvement of velopharyngeal insufficiency (VPI) in cleft patients. The study involved a retrospective review of consecutive patients who underwent Orticochea pharyngoplasty for VPI management between 2016 and 2024 in the Department of Maxillofacial Surgery, Woman-Mother-Child Hospital, Lyon, France. Demographic data, speech and breathing characteristics, and the presence of snoring and nasal regurgitation were recorded using a standardized protocol. Preoperative and postoperative VPI severity was assessed using the Borel-Maisonny scale. All 89 patients included in the study had at least minimal VPI preoperatively (stage IIB), with 83% graded as having moderate or severe VPI. Improvement was observed in 88.76% of the patients after one surgery, and in 98.9% following a second surgery. Orticochea pharyngoplasty improved physiological breathing rates by 22% and reduced nasal regurgitation in 75% of the cases. This indicated that Orticochea pharyngoplasty is a reliable, safe, and reproducible surgical technique.