搜索结果：Archives of craniofacial surgery

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. 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. 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. 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.

Maxillofacial trauma presents with a myriad of complications, including functional disability and aesthetic compromise. Optimal treatment includes management of bone and soft tissue injuries along with dental rehabilitation. Prompt management, including open reduction and internal fixation (ORIF) combined with immediate dental implant rehabilitation, facilitates both functional recovery and aesthetic restoration, thereby leading to improved quality of life. A total of 36 patients with maxillofacial bony trauma, along with non-restorable fractured, avulsed, or missing teeth, were managed with ORIF with dental rehabilitation. Eighteen patients underwent delayed implant placement after 6 months of ORIF, and the other 18 underwent immediate implant rehabilitation during ORIF. The outcomes measured included implant stability, crestal bone loss, and evaluation of pain, swelling, and patient satisfaction. All follow-up visits were scheduled with reference to the post-implant placement period in both groups. Implant stability was significantly increased in the immediate implant placement group of patients at the third- and sixth month follow-up post-implant placement (p< 0.001). Pain assessment revealed that the immediate implant group experienced significantly higher pain scores than the delayed implant group on the first day (p< 0.001), seventh day (p< 0.001), and 28th day (p< 0.001) following implant placement. Significant differences in facial swelling were observed at the third and sixth months (p= 0.009), with the immediate implant group exhibiting lower swelling. Swelling was significantly higher along the tragal-commissure line in the immediate implant group on the first and seventh days (p< 0.001). Patient satisfaction was initially higher in the delayed implant group on the first day (p= 0.047) and remained so by the third month (p< 0.001). However, by the sixth month, both groups demonstrated similar levels of satisfaction after implant placement. Immediate implant rehabilitation during ORIF in patients sustaining maxillofacial trauma improves implant success rates, reduces morbidity, and ultimately enhances patients' overall quality of life.

Orbital floor fractures are among the most common maxillofacial injuries and represent the predominant type of isolated orbital fractures. Residual diplopia is a common complication in these patients, and its management is quite challenging. The present study aimed to investigate predisposing factors for late residual diplopia following surgical repair of orbital floor fractures. Patients presenting with maxillofacial trauma between 2019 and 2024 were retrospectively analyzed. Individuals diagnosed with orbital floor fractures were included. Data regarding concomitant wall involvement, preoperative diplopia, mechanism of trauma, time interval between trauma and surgery, defect size, and postoperative enophthalmos were obtained from patient records. Patients with a follow-up period of less than 3 months were excluded from the study. These variables were statistically compared to assess their relationship with persistent postoperative diplopia. A total of 109 patients with orbital floor fractures were evaluated. Post-traumatic diplopia was observed in 15.6% of cases. The presence of residual enophthalmos was significantly associated with residual diplopia (p< 0.001): 56.3% of patients with enophthalmos exhibited diplopia compared to 8.6% without. "Floor+rim" fractures demonstrated a higher incidence of diplopia (20.9%) than other wall combinations (p= 0.054). The interval between trauma and surgery was not correlated with diplopia (p= 0.425), whereas increasing defect size was significantly associated (p= 0.039). Although diplopia was more frequent in assault (19.4%) and collision (28.6%) cases, the difference was not statistically significant (p= 0.578). Persistent postoperative diplopia remains a challenging complication after orbital fracture repair. The strong association between residual enophthalmos and diplopia underscores the need for meticulous intraoperative reconstruction and close postoperative follow-up to optimize functional and aesthetic outcomes.

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.

Optimal aesthetic and functional outcomes in facial surgery depend on effective wound healing. Although the impact of cigarette smoking on postoperative healing has been widely studied, its specific influence in the context of facial procedures remains debated. This review evaluates how smoking compromises wound healing and increases the risk of postoperative complications by synthesizing current evidence on its influence in facial surgical procedures. This scoping review included original observational studies (cross-sectional, case-control, and cohort) published in English that examined associations between cigarette smoking and wound healing following facial procedures. Eligible participants included patients of any age or sex undergoing facial surgery or sustaining facial trauma. Exposure was defined as active smoking or a history of smoking and was compared with non-smokers or those with documented cessation. Primary outcomes included complications such as skin slough, wound dehiscence, infection, and flap or graft necrosis. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Of 129 screened records, nine studies met the inclusion criteria. Across various facial procedures, active smoking was consistently associated with impaired wound healing, with reported complication risks ranging from 1.8-fold to 12-fold higher among smokers. Commonly reported adverse outcomes included flap necrosis, infection, and wound dehiscence, although several studies reported no statistically significant association in specific procedural contexts. Smoking is strongly associated with poorer wound healing following facial surgery, particularly in flap-based procedures. These findings emphasize the importance of perioperative smoking cessation to improve healing and reduce preventable postoperative complications.

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. 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. In 100 CT scans (200 sides), the mean PLW width was 5.6&#xb1; 2.4 mm (range, 0-11.15 mm), the mean NLD width was 6.38&#xb1; 1.84 mm (range, 1-11 mm), and the mean angle between the axis of the NLD and the hard palate was 68.6&#xb0;&#xb1; 6.77&#xb0; (range, 54&#xb0;-83&#xb0;). There were no significant differences between sides or genders for any of the measurements. 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.

Epidermoid and dermoid cysts are common congenital lesions of the pediatric periorbital region arising from ectodermal inclusion during embryologic development. Although these lesions originate in the soft tissue, chronic pressure from long-standing masses may induce cortical depression or remodeling of adjacent craniofacial bones, particularly in young children with malleable skeletal structures. We report a case of a 26-month-old girl presenting with a small periorbital epidermoid cyst associated with pressure-induced depression of the zygomatic surface. Radiologic evaluation revealed a well-circumscribed cystic lesion abutting the frontal process of the zygoma with smooth cortical indentation and no features suggestive of aggressive osseous pathology. Complete excision was performed through a lateral brow approach with preservation of the periosteum. Histopathologic examination confirmed an epidermoid cyst. Postoperative follow-up demonstrated progressive spontaneous restoration of the zygomatic contour without the need for bone grafting or alloplastic materials, reflecting the osteogenic potential of the pediatric periosteum. This case emphasizes the importance of distinguishing secondary pressure-related bone remodeling from true intraosseous lesions in the pediatric craniofacial region and highlights the capacity for natural osseous recovery following removal of the compressive source. A brief review of relevant embryologic and radiologic considerations is also provided.

We report a rare case of synchronous presentation of cutaneous CD30 (cluster of differentiation 30)-positive anaplastic large T-cell lymphoma and glomangioma involving the labial mucosa of the upper lip, highlighting its diagnostic challenges and clinical significance. A 61-yearold woman presented with a mildly tender mucosal lump measuring approximately 7&#xd7; 4&#xd7; 2 mm on the inner aspect of the upper lip, without ulceration, discoloration, or other distinctive clinical features. An excisional biopsy was performed under local anesthesia. Histopathological examination revealed a high-grade lymphoproliferative lesion composed of pleomorphic large, atypical cells, consistent with anaplastic large cell lymphoma. Notably, the lymphomatous lesion was located over a well-circumscribed glomangioma characterized by dilated vascular channels. This case underscores the importance of maintaining a high index of suspicion and performing thorough histopathological and immunohistochemical evaluation of all excised lesions, even when clinical features suggest a benign process. The rarity of this synchronous presentation underscores the need for heightened diagnostic vigilance and contributes valuable insight to the existing literature on unusual tumor associations in the oral and maxillofacial region.

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. 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. 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&#xb1; 12.88 minutes for test sites and 45.20&#xb1; 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). The study suggests that chitosan-based dental dressing facilitates early local hemostasis after tooth extraction in anticoagulated patients or patients with bleeding disorders.

Cervical chondrocutaneous branchial remnants (CCBRs) are rare developmental anomalies that arise during early embryogenesis. Because of their rarity, most published reports consist of small case series, and no standardized classification system has been established. The purpose of this study was to define the standardized clinical characteristics of CCBRs and to propose a comprehensive classification system based on the largest cohort reported to date. We retrospectively reviewed 55 CCBRs in 53 patients who underwent surgical excision between 2014 and 2023. Data collected included sex, age at diagnosis, age at surgery, associated anomalies, pathological findings, laterality, anatomical location, morphological shape, and intraoperative characteristics. All CCBRs were bounded superiorly by the inferior border of the thyroid cartilage, inferiorly by the upper border of the sternoclavicular junction, and laterally by the posterior border of the sternocleidomastoid muscle (SCM). Location was divided into three zones: "central" above the trachea, "medial" between the trachea and SCM, and "lateral" over the SCM. Morphology was classified by protrusion pattern-pedunculated or sessile-and further categorized as spherical, ovoid, lobed, or nodular according to cross-sectional geometry. A total of 55 CCBRs were identified. No significant differences were observed in sex distribution (male 53%, female 47%) or laterality (right 50.9%, left 49.1%). Histopathological examination revealed elastic cartilage in all evaluated specimens. Associated congenital anomalies were minimal (7.5%), and no serious systemic anomalies were identified. Medial lesions were most common (47%), followed by lateral (38%). Sessile lesions (60%) were more frequent than pedunculated lesions (40%). Ovoid configuration was most common (36%), followed by nodular (25%) and spherical (23%). This study presents a standardized, globally applicable classification system for CCBRs, facilitating comparative research and promoting unified nomenclature for international academic communication.

Primary malignant melanoma of the parotid gland (PMMPG) is an exceptionally rare neoplasm, comprising less than 0.7% of all parotid malignancies and often mistaken for metastatic melanoma. This case presents a 66-year-old man with a painless, slowly enlarging right parotid mass. Imaging revealed a lesion localized to the superficial parotid lobe with FDG (fluorodeoxyglucose)-avid level II lymph nodes. Fine-needle aspiration suggested melanoma, confirmed by immunohistochemistry. The patient underwent total parotidectomy, neck dissection, adjuvant radiotherapy and immunotherapy with pembrolizumab under ongoing oncologic surveillance. Histopathology confirmed melanoma with nodal metastasis and negative margins, with no evidence of local recurrence at 6-month follow-up. Diagnosis of PMMPG demands exclusion of other primary sites and prior excision history, making immunohistochemistry essential. Treatment typically involves surgical resection and radiotherapy; however, prognosis remains poor due to high recurrence and metastasis rates. PMMPG requires a coordinated, multidisciplinary approach. Although aggressive intervention offers the best outcomes, the long-term prognosis is limited. Continued research is essential, particularly focusing on molecular differentiation from clear cell sarcoma and the identification of specific molecular markers that can guide targeted therapy.

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. 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. 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. 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.

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. 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. 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&#xb1; 0.012 mm in the control group and 0.008&#xb1; 0.009 mm in the experimental group. However, the control group reported fewer postoperative symptoms, including nasal obstruction and dry mouth. The packing-free approach without K-wire splinting may reduce postoperative discomfort without compromising surgical outcomes compared to K-wire splinting without packing.

Melanoma, though less common than other cutaneous malignancies, remains clinically significant. In Asia, acral and nailunit melanoma-less related to ultraviolet exposure-pose diagnostic and reconstructive challenges. Clarifying temporal and anatomic trends in melanoma within plastic surgery practice may enhance early recognition and guide standardized reconstruction. We retrospectively reviewed 960 surgically treated cutaneous malignancies (2000-2022) in a tertiary plastic surgery department, classifying tumors as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), malignant melanoma (MM), or others. For MM, we analyzed anatomic site (head/neck, trunk, non-acral extremity, acral), sex, age, comorbidities, and lifestyle factors, comparing period A (2000-2017) with period B (2018-2022). Group comparisons used the chi-square or Fisher exact test and the Mann-Whitney test. Incidence rates were calculated with Poisson confidence intervals; between-period differences were evaluated using exact binomial tests and rate ratios. Of 960 tumors, BCC, SCC, MM, and others comprised 47.4%, 44.3%, 5.8%, and 2.5%. MM site distribution was heterogeneous: head/neck 14.3%, trunk 30.4%, non-acral extremity 21.4%, acral 33.9%. Distribution shifted significantly (chi-square p= 0.043), with head/neck lesions decreasing from 28.0% to 3.2% and trunk and acral lesions each increasing to 38.7%. Annual MM incidence rose from 1.39 to 6.20 cases per year (rate ratio, 4.46; p< 0.001). Hypertension (64.5%) and diabetes (35.5%) were more frequent in period B. Recent years showed a sharply increased MM caseload and redistribution toward trunk and acral sites with greater metabolic comorbidity, reflecting both epidemiologic change and evolving detection or referral patterns.

Orbital floor fractures are frequently associated with head trauma, and the complex three-dimensional (3D) structure of the orbital cavity poses a significant challenge for accurate repair of orbital wall defects. Accordingly, this study aimed to compare preoperative titanium mesh bending using 3D-printed models with conventional intraoperative bending techniques, focusing on the accuracy of orbital geometry reconstruction and intraoperative efficiency, with the goal of determining potential advantages in optimizing surgical outcomes. This study presents a comparative analysis between a prospective preoperative bending (3D pre-bent) of titanium mesh and retrospective data from conventional intraoperative bending. Clinical and radiographic evaluations of orbital geometry, along with intraoperative efficiency metrics, were assessed at both preoperative and postoperative stages. Sixty-four patients were included, with 32 in the 3D pre-bend titanium mesh group and 32 in the conventional bending group. Mean operative time was shorter in the 3D pre-bend group (81.07&#xb1; 13.04 minutes) than in the conventional group (96.07&#xb1; 4.46 minutes). The 3D pre-bend group achieved more accurate reconstruction, with orbital volume and height correction rates of 96.78% &#xb1; 4.91% and 100.62%&#xb1; 3.77%, respectively, versus 94.88% &#xb1; 4.33% and 96.08% &#xb1; 5.44% in the conventional group. Patient and surgeon satisfaction was higher in the 3D pre-bend group. Pre-bending titanium mesh using a 3D-printed model significantly reduces intraoperative time and improves orbital height correction. Additionally, this technique enhances both patient and surgeon satisfaction. However, long-term clinical outcomes remain comparable between groups.

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.

Facial asymmetry involving extensive maxillofacial skeletal discrepancy presents a complex surgical challenge. This case report presents a comprehensive surgical solution for a 35-year-old woman with pronounced facial asymmetry due to unilateral mandibular hypoplasia. The patient was treated using a surgery-only orthognathic approach combined with adjunctive facial contouring and revision genioplasty. The surgical plan included Le Fort I osteotomy and a combination of sagittal split and vertical ramus mandibular osteotomies, supplemented by reduction malarplasty, reduction mandibular anguloplasty, buccal fat pad removal, and revision genioplasty following liquid silicone extraction with genial muscle realignment. The patient's preexisting stable occlusion allowed for the omission of orthodontics, aligning with her primary aesthetic concerns. Postoperative assessments over 12 months demonstrated stable occlusion, enhanced facial symmetry, and high patient satisfaction. This case supports that, in carefully selected patients, a surgery-only orthognathic approach combined with targeted facial contouring can provide efficient, predictable, and aesthetically favorable correction of complex facial asymmetry.

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&#xd7; 4.6&#xd7; 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&#xd7; 4.2&#xd7; 3 cm temporo-sphenoidal erosive lesion. Complete surgical resection was performed with a favorable outcome and no recurrence.

Eagle syndrome is defined as the constellation of signs and symptoms caused by an elongated styloid process or calcification of the stylohyoid ligament. It is a rare condition that occurs secondary to irritation or compression of surrounding structures due to the abnormal styloid process. Clinical manifestations are variable and may include neck pain, dysphagia, odynophagia, and a foreign body sensation. Although neck pain is a common and significant problem in the outpatient setting, Eagle syndrome is an exceedingly rare cause that is not often considered in the differential diagnosis of cervical pain. We report a case of Eagle syndrome presenting as recurrent neck pain in a young woman. We discuss Eagle syndrome as a rare differential diagnosis for recurrent neck pain and the diagnostic challenges this condition may pose. Eagle syndrome is a rare entity with a challenging diagnosis. Despite being an exceedingly rare cause of cervical pain, it should be considered in the differential diagnosis of recurrent neck pain.