Pub Date : 2025-10-01DOI: 10.1016/j.jcms.2025.09.002
Shuoyi Hui , Jianing Liu , Yanqi Zhang , Qiang Ning , Fang Jin , Lei Wang
Maxillary expansion in bilateral complete cleft lip and palate (BCLP) poses unique biomechanical challenges due to disrupted anatomy and scarred sutures. This finite element study compared three expander types—conventional Hyrax, pre-positioned Hyrax, and fan-shaped—in a patient-specific BCLP model derived from CBCT data. We evaluated 3D dentoalveolar displacement, craniofacial suture strain, and periodontal ligament (PDL) stress. The fan-shaped expander achieved greater anterior expansion and vertical control but induced higher von Mises stress and buccal tipping, raising concerns over periodontal safety. In contrast, conventional and pre-positioned Hyrax expanders produced more uniform force distribution and better posterior anchorage control. Skeletal displacement patterns were comparable across models. The findings suggest that fan-shaped expanders may be beneficial for cases with severe anterior constriction but require caution due to stress concentration risks, while Hyrax variants offer biomechanically safer alternatives for moderate expansion needs. This study provides novel, evidence-based insight into expander selection in complex cleft patients and emphasizes the importance of individualized, morphology-driven appliance design.
{"title":"Comparative biomechanical analysis of three rapid maxillary expanders in BCLP patients: A three-dimensional finite element study","authors":"Shuoyi Hui , Jianing Liu , Yanqi Zhang , Qiang Ning , Fang Jin , Lei Wang","doi":"10.1016/j.jcms.2025.09.002","DOIUrl":"10.1016/j.jcms.2025.09.002","url":null,"abstract":"<div><div>Maxillary expansion in bilateral complete cleft lip and palate (BCLP) poses unique biomechanical challenges due to disrupted anatomy and scarred sutures. This finite element study compared three expander types—conventional Hyrax, pre-positioned Hyrax, and fan-shaped—in a patient-specific BCLP model derived from CBCT data. We evaluated 3D dentoalveolar displacement, craniofacial suture strain, and periodontal ligament (PDL) stress. The fan-shaped expander achieved greater anterior expansion and vertical control but induced higher von Mises stress and buccal tipping, raising concerns over periodontal safety. In contrast, conventional and pre-positioned Hyrax expanders produced more uniform force distribution and better posterior anchorage control. Skeletal displacement patterns were comparable across models. The findings suggest that fan-shaped expanders may be beneficial for cases with severe anterior constriction but require caution due to stress concentration risks, while Hyrax variants offer biomechanically safer alternatives for moderate expansion needs. This study provides novel, evidence-based insight into expander selection in complex cleft patients and emphasizes the importance of individualized, morphology-driven appliance design.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 2063-2073"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.jcms.2025.08.007
Qianchuan Ding , Jiangling Sun , Huan He , Haijian Zhu , Binjie Xie , Hongchao Feng , Reinhard E. Friedrich
<div><h3>Objective</h3><div>The Cervical Vertebral Maturation(CVM) of normal population and cleft lip and palate population was measured by cone beam computed tomography (CBCT). The fusion of sphenooccipital synchondrosis(SOS)was staged, and the correlation between CVM and SOS fusion staging was analyzed. The reliability of CVM in the diagnosis of SOS joint staging provides some reference for clinical evaluation of the growth and development stage of patients.</div></div><div><h3>Methods</h3><div>100 patients with cleft lip and palate and 100 normal people were randomly selected from January 2020 to December 2023 in Guiyang Stomatological Hospital. There were 121 males and 79 females. The CBCT data of patients were imported into Dolphin software to complete three-dimensional reconstruction and CVM measurement as well as SOS fusion for staging. The experimental results were statistically analyzed by software SPSS25 0.0. The correlation between CVM and SOS fusion staging was analyzed by Spearman analysis. The reliability of CVM diagnosis of SOS fusion staging was calculated by positive likelihood ratio (PositiveLikelihoodRatio,LR+).</div></div><div><h3>Results</h3><div>Spearman rank correlation analysis was used to analyze the consistency of CVM and SOS fusion staging. The results are as follows: 1. The correlation between CVM staging and SOS fusion staging and age was studied in normal group A: male group and female group. The results showed that the two staging methods were highly correlated. The Spearman rank correlation coefficient between CVM staging and SOS fusion stage was 0.922. (<em>p</em> < 0. 01). The correlation coefficient of Spearman grade between SOS fusion degree and age was 0. 842 (<em>p</em> < 0 0.01). 2. Group B: the correlation coefficient of Spearman grade between CVM stage and age was 0.781 <em>(p</em> < 0 0.01). The correlation coefficient of Spearman grade between the fusion degree of SOS and age was 0.765 (<em>p</em> < 0 0.01). Study on the reliability of CVM in the diagnosis of cranial base suture maturity: in group A, CVM1 could diagnose SOS fusion stage 1, CVM2 could diagnose SOS fusion stage 2, CVM3 could diagnose SOS fusion degree 3, CVM4 could diagnose SOS fusion degree 4, while in group B, CVM2 diagnosed SOS fusion stage 3, CVM3 and CVM4 diagnosed SOS fusion stage 4. It can be seen that the degree of CVM and SOS fusion in group B is later than that in group A.</div></div><div><h3>Conclusion</h3><div>CVM staging and SOS fusion staging in cleft lip and palate patients were later than those in normal subjects. In normal people and cleft lip and palate people, CVM stage was highly correlated with the degree of SOS fusion, and gradually fused with the increase of age, female SOS fusion earlier than male.In the normal population, there is a clear correlation between CVM (Cervical Vertebral Maturation) stages and the fusion stages of the spheno-occipital synchondrosis. This standardized diagnostic criterion prov
{"title":"Skeletal maturation in patients with cleft lip and palate and normal population analyzed by CVM analysis and the fusion of sphenooccipital synchondrosis","authors":"Qianchuan Ding , Jiangling Sun , Huan He , Haijian Zhu , Binjie Xie , Hongchao Feng , Reinhard E. Friedrich","doi":"10.1016/j.jcms.2025.08.007","DOIUrl":"10.1016/j.jcms.2025.08.007","url":null,"abstract":"<div><h3>Objective</h3><div>The Cervical Vertebral Maturation(CVM) of normal population and cleft lip and palate population was measured by cone beam computed tomography (CBCT). The fusion of sphenooccipital synchondrosis(SOS)was staged, and the correlation between CVM and SOS fusion staging was analyzed. The reliability of CVM in the diagnosis of SOS joint staging provides some reference for clinical evaluation of the growth and development stage of patients.</div></div><div><h3>Methods</h3><div>100 patients with cleft lip and palate and 100 normal people were randomly selected from January 2020 to December 2023 in Guiyang Stomatological Hospital. There were 121 males and 79 females. The CBCT data of patients were imported into Dolphin software to complete three-dimensional reconstruction and CVM measurement as well as SOS fusion for staging. The experimental results were statistically analyzed by software SPSS25 0.0. The correlation between CVM and SOS fusion staging was analyzed by Spearman analysis. The reliability of CVM diagnosis of SOS fusion staging was calculated by positive likelihood ratio (PositiveLikelihoodRatio,LR+).</div></div><div><h3>Results</h3><div>Spearman rank correlation analysis was used to analyze the consistency of CVM and SOS fusion staging. The results are as follows: 1. The correlation between CVM staging and SOS fusion staging and age was studied in normal group A: male group and female group. The results showed that the two staging methods were highly correlated. The Spearman rank correlation coefficient between CVM staging and SOS fusion stage was 0.922. (<em>p</em> < 0. 01). The correlation coefficient of Spearman grade between SOS fusion degree and age was 0. 842 (<em>p</em> < 0 0.01). 2. Group B: the correlation coefficient of Spearman grade between CVM stage and age was 0.781 <em>(p</em> < 0 0.01). The correlation coefficient of Spearman grade between the fusion degree of SOS and age was 0.765 (<em>p</em> < 0 0.01). Study on the reliability of CVM in the diagnosis of cranial base suture maturity: in group A, CVM1 could diagnose SOS fusion stage 1, CVM2 could diagnose SOS fusion stage 2, CVM3 could diagnose SOS fusion degree 3, CVM4 could diagnose SOS fusion degree 4, while in group B, CVM2 diagnosed SOS fusion stage 3, CVM3 and CVM4 diagnosed SOS fusion stage 4. It can be seen that the degree of CVM and SOS fusion in group B is later than that in group A.</div></div><div><h3>Conclusion</h3><div>CVM staging and SOS fusion staging in cleft lip and palate patients were later than those in normal subjects. In normal people and cleft lip and palate people, CVM stage was highly correlated with the degree of SOS fusion, and gradually fused with the increase of age, female SOS fusion earlier than male.In the normal population, there is a clear correlation between CVM (Cervical Vertebral Maturation) stages and the fusion stages of the spheno-occipital synchondrosis. This standardized diagnostic criterion prov","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 2031-2042"},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-20DOI: 10.1016/j.jcms.2025.09.001
Puneet Batra , Karoon Agrawal , Dhruv Ahuja , Anne Marie Kuijpers-Jagtman
Objective
To assess the effect of a palate-first surgical approach on maxillofacial morphology in unilateral cleft lip, alveolus, and palate (UCLP) patients compared to the conventional lip-first sequence.
Subjects
and Method: This retrospective cross-sectional cephalometric study included two groups of 25 non-syndromic UCLP patients. Group 1 underwent palate repair at 6–9 months, followed by lip, alveolus, and anterior palate repair with primary nasal correction after 3–6 months. Group 2 had lip, alveolus, and anterior palate repair at 3–6 months, with palate repair at 6–18 months. Lateral cephalograms taken at least five years post-second surgery were analyzed. Cephalometric variables between groups were compared using two-sample T-tests.
Results
No significant differences were found in S-N-SS, PM-SS, S-PM, N-SP, S-N-Pg, NSL-ML, and ILS-NL. Only maxillary base inclination (NSL-NL) (p < 0.05) was significantly different between groups (mean difference 1.29°; p = 0.003), indicating a relatively antero-inferior maxillary tip in the palate first approach.
Conclusions
In UCLP, the cleft repair protocol prioritizing palate repair at 6 months before lip repair at 9 months or later compared to conventional lip repair followed palate repair did not show significant differences in midfacial growth within the first 5 years postoperatively. However, given that pubertal growth trajectories were not captured, long-term studies are warranted to evaluate potential effects. Considering the potential to reduce treatment dropout rates in low- and middle-income countries, the palate-first approach may still be considered for broader application.
{"title":"Palate-first versus lip-first surgical repair sequence in unilateral cleft lip, alveolus, and palate: A retrospective cephalometric comparison of maxillary growth at 5-year follow-up","authors":"Puneet Batra , Karoon Agrawal , Dhruv Ahuja , Anne Marie Kuijpers-Jagtman","doi":"10.1016/j.jcms.2025.09.001","DOIUrl":"10.1016/j.jcms.2025.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the effect of a palate-first surgical approach on maxillofacial morphology in unilateral cleft lip, alveolus, and palate (UCLP) patients compared to the conventional lip-first sequence.</div></div><div><h3>Subjects</h3><div><em>and Method</em>: This retrospective cross-sectional cephalometric study included two groups of 25 non-syndromic UCLP patients. Group 1 underwent palate repair at 6–9 months, followed by lip, alveolus, and anterior palate repair with primary nasal correction after 3–6 months. Group 2 had lip, alveolus, and anterior palate repair at 3–6 months, with palate repair at 6–18 months. Lateral cephalograms taken at least five years post-second surgery were analyzed. Cephalometric variables between groups were compared using two-sample T-tests.</div></div><div><h3>Results</h3><div>No significant differences were found in S-N-SS, PM-SS, S-PM, N-SP, S-N-Pg, NSL-ML, and ILS-NL. Only maxillary base inclination (NSL-NL) (p < 0.05) was significantly different between groups (mean difference 1.29°; p = 0.003), indicating a relatively antero-inferior maxillary tip in the palate first approach.</div></div><div><h3>Conclusions</h3><div>In UCLP, the cleft repair protocol prioritizing palate repair at 6 months before lip repair at 9 months or later compared to conventional lip repair followed palate repair did not show significant differences in midfacial growth within the first 5 years postoperatively. However, given that pubertal growth trajectories were not captured, long-term studies are warranted to evaluate potential effects. Considering the potential to reduce treatment dropout rates in low- and middle-income countries, the palate-first approach may still be considered for broader application.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 2019-2025"},"PeriodicalIF":2.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/j.jcms.2025.05.008
Rou Sun , Yinwei Li , Jing Sun , Shuo Zhang , Yang Wang , Xuefei Song , Huifang Zhou
This randomized controlled trial aimed to compare the effectiveness of two surgical approaches to endoscopic orbital decompression for thyroid-associated ophthalmopathy (TAO). In total, 48 moderate-to-severe or sight-threatening TAO orbits were enrolled and randomly assigned into the transconjunctival group or transnasal group. The main outcome was the rate of effectiveness. If the postoperative proptosis was below 18 mm or the value of proptosis reduction was over 8 mm, this was defined as effective. The secondary outcomes included surgical accuracy, best-corrected visual acuity (BCVA), ocular motility grade, diplopia grade, and safety. The effective rate was 87.5 % in the transconjunctival group and 79.2 % in the transnasal group (p = 0.087). The proptosis reduction was 5.38 ± 2.60 mm in the transconjunctival group and 4.40 ± 1.66 mm in the transnasal group (p = 0.435). A significant difference was found between preoperative and postoperative proptosis in both groups (p < 0.01). A higher surgical accuracy in the medial wall was found in the transconjunctival group (p = 0.001). There was no significant difference in both groups between preoperative and postoperative BCVA and ocular motility grade. Complications showed no significant difference between the two groups (p > 0.05). In conclusion, both transconjunctival and transnasal endoscopic orbital decompression were feasible and could be utilized by surgeons.
This study was registered with the Chinese clinical trial registry (trial registration number: ChiCTR-INR-17013268; date of access and registration: November 3, 2017).
{"title":"Comparison of transconjunctival and transnasal approaches for orbital decompression: a randomized controlled trial","authors":"Rou Sun , Yinwei Li , Jing Sun , Shuo Zhang , Yang Wang , Xuefei Song , Huifang Zhou","doi":"10.1016/j.jcms.2025.05.008","DOIUrl":"10.1016/j.jcms.2025.05.008","url":null,"abstract":"<div><div>This randomized controlled trial aimed to compare the effectiveness of two surgical approaches to endoscopic orbital decompression for thyroid-associated ophthalmopathy (TAO). In total, 48 moderate-to-severe or sight-threatening TAO orbits were enrolled and randomly assigned into the transconjunctival group or transnasal group. The main outcome was the rate of effectiveness. If the postoperative proptosis was below 18 mm or the value of proptosis reduction was over 8 mm, this was defined as effective. The secondary outcomes included surgical accuracy, best-corrected visual acuity (BCVA), ocular motility grade, diplopia grade, and safety. The effective rate was 87.5 % in the transconjunctival group and 79.2 % in the transnasal group (<em>p</em> = 0.087). The proptosis reduction was 5.38 ± 2.60 mm in the transconjunctival group and 4.40 ± 1.66 mm in the transnasal group (<em>p</em> = 0.435). A significant difference was found between preoperative and postoperative proptosis in both groups (<em>p</em> < 0.01). A higher surgical accuracy in the medial wall was found in the transconjunctival group (<em>p</em> = 0.001). There was no significant difference in both groups between preoperative and postoperative BCVA and ocular motility grade. Complications showed no significant difference between the two groups (<em>p</em> > 0.05). In conclusion, both transconjunctival and transnasal endoscopic orbital decompression were feasible and could be utilized by surgeons.</div><div>This study was registered with the Chinese clinical trial registry (trial registration number: ChiCTR-INR-17013268; date of access and registration: November 3, 2017).</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 1921-1927"},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.jcms.2025.08.014
Sead Abazi , Till Schatzmann , Michel Beyer , Lukas Seifert , Neha Sharma , Shankeeth Vinayahalingam , Alexander Lunger , Dirk J. Schaefer , Florian M. Thieringer
Facial feminization surgery (FFS) is essential for transgender women seeking alignment between facial appearance and gender identity. Frontal bone and sinus reshaping is a key component of FFS to achieve a more traditionally feminine contour. This retrospective study evaluates the effectiveness of frontal debossing by comparing pre- and postoperative volumetric and morphometric data. Sixteen patients who underwent frontal debossing at the University Hospital Basel between 2020 and 2024 were included. Preoperative and postoperative CT or CBCT scans were used to assess volume changes in the frontal bone, frontal sinus, and bilateral supraorbital rims. Additionally, changes in the nasofrontal angle were measured. Significant volume reductions were observed in all analyzed structures: left supraorbital rim (mean reduction 792.28 mm3), right supraorbital rim (726.19 mm3), frontal bone (2930.81 mm3), frontal sinus (2508.84 mm3), and combined frontal structures (3251.83 mm3). The nasofrontal angle increased by an average of 21.71°, indicating a substantial improvement in upper facial contour. These results support the clinical value of frontal debossing as an effective and safe component of FFS, providing quantifiable improvements in facial morphology and symmetry. This study further underscores the importance of individualized planning and objective outcome assessment in gender-affirming craniofacial surgery.
{"title":"Postoperative assessment of forehead contouring in facial feminization surgery","authors":"Sead Abazi , Till Schatzmann , Michel Beyer , Lukas Seifert , Neha Sharma , Shankeeth Vinayahalingam , Alexander Lunger , Dirk J. Schaefer , Florian M. Thieringer","doi":"10.1016/j.jcms.2025.08.014","DOIUrl":"10.1016/j.jcms.2025.08.014","url":null,"abstract":"<div><div>Facial feminization surgery (FFS) is essential for transgender women seeking alignment between facial appearance and gender identity. Frontal bone and sinus reshaping is a key component of FFS to achieve a more traditionally feminine contour. This retrospective study evaluates the effectiveness of frontal debossing by comparing pre- and postoperative volumetric and morphometric data. Sixteen patients who underwent frontal debossing at the University Hospital Basel between 2020 and 2024 were included. Preoperative and postoperative CT or CBCT scans were used to assess volume changes in the frontal bone, frontal sinus, and bilateral supraorbital rims. Additionally, changes in the nasofrontal angle were measured. Significant volume reductions were observed in all analyzed structures: left supraorbital rim (mean reduction 792.28 mm<sup>3</sup>), right supraorbital rim (726.19 mm<sup>3</sup>), frontal bone (2930.81 mm<sup>3</sup>), frontal sinus (2508.84 mm<sup>3</sup>), and combined frontal structures (3251.83 mm<sup>3</sup>). The nasofrontal angle increased by an average of 21.71°, indicating a substantial improvement in upper facial contour. These results support the clinical value of frontal debossing as an effective and safe component of <span>FFS</span>, providing quantifiable improvements in facial morphology and symmetry. This study further underscores the importance of individualized planning and objective outcome assessment in gender-affirming craniofacial surgery.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 1966-1973"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.jcms.2025.09.005
Abeer A. Almashraqi , Amira A. Aboalnaga , Maged S. Alhammadi , Ahmed A. Thawaba , Mona M. Salah Fayed
This study sought to compare the three-dimensional osseous characteristics of the temporomandibular joint in patients with skeletal short and long facial patterns with temporomandibular disorders (TMDs) presenting clinically as disc displacement with/without reduction (DDR/DDWR) and those without TMDs (non-TMD). One-hundred sixty adult patients were divided into two groups. Group 1 (n = 79) consisted of patients with DDR/DDWR, and Group 2 (n = 86) consisted of non-TMD patients. Each group was divided into skeletal short and long facial patterns following the mandibular plane inclination (MP/SN). Three-dimensional analysis was done using Cone-Beam Computed Tomography images to compare measurements of the glenoid fossa, mandibular condyles, and joint spaces between the two groups. The MP/SN showed insignificant differences between the DDR/DDWR and non-TMD groups in both patterns. Short facial patients showed significant variance in condyle length and width, while long facial patients demonstrated major differences in condyle height. Differences in condyle inclinations were observed in horizontal planes for short facial patients and in vertical and anteroposterior planes for long facial patients. Joint spaces also varied significantly in anterior, posterior, and medial spaces for long facial patients. The DDR/DDWR group with a long facial skeletal pattern exhibited significant variations in condyle dimensions, orientations, and positions, showing more anterior and inferior condylar placements, as well as differences in joint spaces. In contrast, these variations were not significant in patients with a short facial skeletal pattern.
{"title":"Temporomandibular joint osseous characteristics in skeletal short and long facial types with and without temporomandibular disorders: A three-dimensional comparative study","authors":"Abeer A. Almashraqi , Amira A. Aboalnaga , Maged S. Alhammadi , Ahmed A. Thawaba , Mona M. Salah Fayed","doi":"10.1016/j.jcms.2025.09.005","DOIUrl":"10.1016/j.jcms.2025.09.005","url":null,"abstract":"<div><div>This study sought to compare the three-dimensional osseous characteristics of the temporomandibular joint in patients with skeletal short and long facial patterns with temporomandibular disorders (TMDs) presenting clinically as disc displacement with/without reduction (DDR/DDWR) and those without TMDs (non-TMD). One-hundred sixty adult patients were divided into two groups. Group 1 (n = 79) consisted of patients with DDR/DDWR, and Group 2 (n = 86) consisted of non-TMD patients. Each group was divided into skeletal short and long facial patterns following the mandibular plane inclination (MP/SN). Three-dimensional analysis was done using Cone-Beam Computed Tomography images to compare measurements of the glenoid fossa, mandibular condyles, and joint spaces between the two groups. The MP/SN showed insignificant differences between the DDR/DDWR and non-TMD groups in both patterns. Short facial patients showed significant variance in condyle length and width, while long facial patients demonstrated major differences in condyle height. Differences in condyle inclinations were observed in horizontal planes for short facial patients and in vertical and anteroposterior planes for long facial patients. Joint spaces also varied significantly in anterior, posterior, and medial spaces for long facial patients. The DDR/DDWR group with a long facial skeletal pattern exhibited significant variations in condyle dimensions, orientations, and positions, showing more anterior and inferior condylar placements, as well as differences in joint spaces. In contrast, these variations were not significant in patients with a short facial skeletal pattern.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 2049-2055"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.jcms.2025.09.004
Friedrich Mrosk, Emilia Schott, Victoria Vertic, Maximilian Richter, Jan Oliver Voß, Christian Doll, Carsten Rendenbach, Norbert Neckel, Kilian Kreutzer, Max Heiland, Steffen Koerdt
Microvascular free flap reconstruction is a standard technique in head and neck surgery with high success rates. Nevertheless, complications like early flap loss, locoregional recurrence of head and neck cancer and osteoradionecrosis may require further flap procedures. This study aims to assess outcomes and challenges associated with subsequent free flap procedures. In this retrospective cohort study, all patients who received subsequent free flaps between January 2013 and December 2022 were assessed and examined by explorative descriptive analysis. Furthermore, one exemplary case is presented. Overall, 69 patients with 150 free flaps were included, with up to 4 subsequently performed flaps. Reasons for subsequent flaps included early failure, local cancer recurrence, osteoradionecrosis and wound healing disorders. After early failures, subsequent flaps were successful in 97 % of this cohort. The more flaps were performed, the more likely the contralateral neck was used for vascular anastomosis and the more likely vein grafts were used. Subsequent free flap procedures are safe and viable options in head and neck reconstruction, even in cases of previous flap failure. Even if previous surgeries, already harvested flaps and radiation therapy might complicate the choice of reconstruction, this should not be a deterrent to achieve consistent rehabilitation of the patient.
{"title":"Clinical efficacy of subsequent microvascular free flaps in head and neck reconstructive surgery","authors":"Friedrich Mrosk, Emilia Schott, Victoria Vertic, Maximilian Richter, Jan Oliver Voß, Christian Doll, Carsten Rendenbach, Norbert Neckel, Kilian Kreutzer, Max Heiland, Steffen Koerdt","doi":"10.1016/j.jcms.2025.09.004","DOIUrl":"10.1016/j.jcms.2025.09.004","url":null,"abstract":"<div><div>Microvascular free flap reconstruction is a standard technique in head and neck surgery with high success rates. Nevertheless, complications like early flap loss, locoregional recurrence of head and neck cancer and osteoradionecrosis may require further flap procedures. This study aims to assess outcomes and challenges associated with subsequent free flap procedures. In this retrospective cohort study, all patients who received subsequent free flaps between January 2013 and December 2022 were assessed and examined by explorative descriptive analysis. Furthermore, one exemplary case is presented. Overall, 69 patients with 150 free flaps were included, with up to 4 subsequently performed flaps. Reasons for subsequent flaps included early failure, local cancer recurrence, osteoradionecrosis and wound healing disorders. After early failures, subsequent flaps were successful in 97 % of this cohort. The more flaps were performed, the more likely the contralateral neck was used for vascular anastomosis and the more likely vein grafts were used. Subsequent free flap procedures are safe and viable options in head and neck reconstruction, even in cases of previous flap failure. Even if previous surgeries, already harvested flaps and radiation therapy might complicate the choice of reconstruction, this should not be a deterrent to achieve consistent rehabilitation of the patient.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 2026-2030"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.jcms.2025.09.003
Jakob Fenske, Philipp Lampert, Henri Kreiker, Claudius Steffen, Steffen Koerdt, Christian Doll, Norbert Neckel, Max Heiland, Carsten Rendenbach , Kilian Kreutzer
Reconstructing complex head and neck defects using multiple simultaneous or chimeric microvascular free flaps is rare, with no established guidelines on indications. This study evaluates the indications, flap combinations, outcomes, and complications associated with these techniques in maxillofacial reconstruction. A retrospective analysis was conducted on patients who underwent either two simultaneous free flaps or chimeric free flaps for head and neck defects between February 2018 and December 2024. Flap success rates and complication rates were assessed. Twenty-two patients received simultaneous free flaps, with a flap-level success rate of 91 % and a complication rate of 55 %. The most common combination was a fibula free flap with an anterolateral thigh flap. Thirty-six patients underwent chimeric flap reconstruction, achieving a success rate of 94 % and a complication rate of 39 %. Indications for these reconstructions fell into three broad categories: extensive composite defects, complex extraoral defects requiring additional bone reconstruction, and defects involving compromised tissues due to prior radiotherapy or multiple surgeries. Chimeric flaps are a viable option for addressing complex defects in more vulnerable patients, while simultaneous free flaps are feasible for selected cases. Despite acceptable success rates, the elevated complication risks associated with simultaneous flaps necessitate vigilant postoperative monitoring.
{"title":"Reconstructing complexity: Indications for simultaneous and chimeric free flaps in extensive maxillofacial defects","authors":"Jakob Fenske, Philipp Lampert, Henri Kreiker, Claudius Steffen, Steffen Koerdt, Christian Doll, Norbert Neckel, Max Heiland, Carsten Rendenbach , Kilian Kreutzer","doi":"10.1016/j.jcms.2025.09.003","DOIUrl":"10.1016/j.jcms.2025.09.003","url":null,"abstract":"<div><div>Reconstructing complex head and neck defects using multiple simultaneous or chimeric microvascular free flaps is rare, with no established guidelines on indications. This study evaluates the indications, flap combinations, outcomes, and complications associated with these techniques in maxillofacial reconstruction. A retrospective analysis was conducted on patients who underwent either two simultaneous free flaps or chimeric free flaps for head and neck defects between February 2018 and December 2024. Flap success rates and complication rates were assessed. Twenty-two patients received simultaneous free flaps, with a flap-level success rate of 91 % and a complication rate of 55 %. The most common combination was a fibula free flap with an anterolateral thigh flap. Thirty-six patients underwent chimeric flap reconstruction, achieving a success rate of 94 % and a complication rate of 39 %. Indications for these reconstructions fell into three broad categories: extensive composite defects, complex extraoral defects requiring additional bone reconstruction, and defects involving compromised tissues due to prior radiotherapy or multiple surgeries. Chimeric flaps are a viable option for addressing complex defects in more vulnerable patients, while simultaneous free flaps are feasible for selected cases. Despite acceptable success rates, the elevated complication risks associated with simultaneous flaps necessitate vigilant postoperative monitoring.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 2043-2048"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.jcms.2025.08.018
Yue Liu, Xue Zhao, Chengbi Xu, Dan Yu, Xueshibojie Liu
Objective
To investigate the application value, technical advantages, clinical efficacy, educational impact, and challenges in promotion of the Da Vinci robotic surgical system (Transoral Robotic Surgery, TORS) in complex head and neck surgeries, providing a reference for the advancement of precise and intelligent surgery in this field.
Methods
The technical principles and evolution of the Da Vinci system were analyzed. Its clinical application data in laryngeal, oropharyngeal, obstructive sleep apnea (OSA), nasal cavity, and thyroid surgeries were reviewed. The supporting role of digital technologies (AI, 3D visualization, VR, 3D printing) was assessed. Challenges related to cost and training requirements were summarized.
Results
Leveraging advantages such as instrument flexibility, high-definition 3D visualization, tremor filtration, and precise manipulation, the Da Vinci system significantly enhanced outcomes in head and neck surgery: precise resection of laryngeal cancer reduced operative risks; efficient treatment of early-stage oropharyngeal squamous cell carcinoma (OPSCC) was achieved with fewer complications; favorable long-term survival rates were observed for OPSCC; OSA symptoms were effectively improved; and it demonstrated both minimally invasive benefits and therapeutic efficacy in recurrent nasal cavity cancers and thyroid surgeries. Digital technologies enhanced surgical precision and medical training efficiency. However, high unit costs and stringent training requirements limit its adoption in small and medium-sized hospitals.
Conclusion
The Da Vinci system, integrated with digital technologies, significantly improves the safety, precision, and patient prognosis in head and neck surgery, while elevating medical education standards. High costs and intensive training needs are issues for why it is not widely used. Future tasks should emphasize cost-cutting to enhance patient care access and improve quality across the medical spectrum.
{"title":"Robotic surgery: The convergence of digital innovations in head and neck surgery","authors":"Yue Liu, Xue Zhao, Chengbi Xu, Dan Yu, Xueshibojie Liu","doi":"10.1016/j.jcms.2025.08.018","DOIUrl":"10.1016/j.jcms.2025.08.018","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the application value, technical advantages, clinical efficacy, educational impact, and challenges in promotion of the Da Vinci robotic surgical system (Transoral Robotic Surgery, TORS) in complex head and neck surgeries, providing a reference for the advancement of precise and intelligent surgery in this field.</div></div><div><h3>Methods</h3><div>The technical principles and evolution of the Da Vinci system were analyzed. Its clinical application data in laryngeal, oropharyngeal, obstructive sleep apnea (OSA), nasal cavity, and thyroid surgeries were reviewed. The supporting role of digital technologies (AI, 3D visualization, VR, 3D printing) was assessed. Challenges related to cost and training requirements were summarized.</div></div><div><h3>Results</h3><div>Leveraging advantages such as instrument flexibility, high-definition 3D visualization, tremor filtration, and precise manipulation, the Da Vinci system significantly enhanced outcomes in head and neck surgery: precise resection of laryngeal cancer reduced operative risks; efficient treatment of early-stage oropharyngeal squamous cell carcinoma (OPSCC) was achieved with fewer complications; favorable long-term survival rates were observed for OPSCC; OSA symptoms were effectively improved; and it demonstrated both minimally invasive benefits and therapeutic efficacy in recurrent nasal cavity cancers and thyroid surgeries. Digital technologies enhanced surgical precision and medical training efficiency. However, high unit costs and stringent training requirements limit its adoption in small and medium-sized hospitals.</div></div><div><h3>Conclusion</h3><div>The Da Vinci system, integrated with digital technologies, significantly improves the safety, precision, and patient prognosis in head and neck surgery, while elevating medical education standards. High costs and intensive training needs are issues for why it is not widely used. Future tasks should emphasize cost-cutting to enhance patient care access and improve quality across the medical spectrum.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 2005-2011"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.jcms.2025.09.006
Ying Xie , Ye-Xin Yue , Yu-Chuan Fu , Xiao-Le Wang , Jian Li
Traditional surgical approaches typically involve end-to-end suturing of the orbicularis oris muscle during cleft lip repair. However, this method often leads to a flattened lip and requires subsequent secondary revision surgery. This retrospective single-arm study aims to evaluate the efficacy and aesthetic improvement of an orbicularis oris muscle reorientation technique for philtrum reconstruction in correcting secondary bilateral cleft lip nasolabial deformities. From October 2020 to January 2024, 34 patients with secondary bilateral cleft lip nasolabial deformities were included, with ages ranging from 16 to 36 years. The orbicularis oris muscle reorientation technique was employed to address nasolabial deformities. In the 34 patients, the nasolabial morphology was significantly improved postoperatively, with successful reconstruction of the vermilion tubercle (Ls-Sto) and the philtrum structure. The Ls-Sto thickness increased from an average preoperative of 7.02 2.63 mm to 11.33 3.04 mm. The extremely large columellar base (CobR-CobL) was reduced by 24.5 %, and the Cupid's peak distance (ChpR-ChpL) was reduced by 18 %. The convexity of the philtral ridge and the concavity of the philtral dimple were significantly enhanced. This study demonstrates that the orbicularis oris muscle reorientation technique is an effective approach for correcting secondary bilateral cleft lip nasolabial deformities. It successfully constructs a three-dimensional philtral ridge and achieves significant morphological improvement with stable outcomes observed during the 7-month follow-up period.
{"title":"Secondary bilateral cleft lip repair: An orbicularis oris muscle reorientation technique for philtrum reconstruction","authors":"Ying Xie , Ye-Xin Yue , Yu-Chuan Fu , Xiao-Le Wang , Jian Li","doi":"10.1016/j.jcms.2025.09.006","DOIUrl":"10.1016/j.jcms.2025.09.006","url":null,"abstract":"<div><div>Traditional surgical approaches typically involve end-to-end suturing of the orbicularis oris muscle during cleft lip repair. However, this method often leads to a flattened lip and requires subsequent secondary revision surgery. This retrospective single-arm study aims to evaluate the efficacy and aesthetic improvement of an orbicularis oris muscle reorientation technique for philtrum reconstruction in correcting secondary bilateral cleft lip nasolabial deformities. From October 2020 to January 2024, 34 patients with secondary bilateral cleft lip nasolabial deformities were included, with ages ranging from 16 to 36 years. The orbicularis oris muscle reorientation technique was employed to address nasolabial deformities. In the 34 patients, the nasolabial morphology was significantly improved postoperatively, with successful reconstruction of the vermilion tubercle (Ls-Sto) and the philtrum structure. The Ls-Sto thickness increased from an average preoperative of 7.02 <span><math><mrow><mo>±</mo></mrow></math></span> 2.63 mm to 11.33 <span><math><mrow><mo>±</mo></mrow></math></span> 3.04 mm. The extremely large columellar base (CobR-CobL) was reduced by 24.5 %, and the Cupid's peak distance (ChpR-ChpL) was reduced by 18 %. The convexity of the philtral ridge and the concavity of the philtral dimple were significantly enhanced. This study demonstrates that the orbicularis oris muscle reorientation technique is an effective approach for correcting secondary bilateral cleft lip nasolabial deformities. It successfully constructs a three-dimensional philtral ridge and achieves significant morphological improvement with stable outcomes observed during the 7-month follow-up period.</div></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"53 11","pages":"Pages 2056-2062"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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