搜索结果：The Journal of craniofacial surgery

International guidelines suggest the presence of more than 18 lymph nodes in the neck dissection (ND) specimen in order to characterize the procedure as adequate. However, the lymph node yield depends not only on the surgeon, but also on the pathologist and on patient factors. Surgeons skeletonize the neck structures after resection of the surrounding fibrofatty tissue. We investigated whether measurement of the weight and volume of the resected fibrofatty tissue could be used to isolate the surgeon's part and investigate its significance. In subjects undergoing ND for head and neck cancer, we measured the weight and volume of the resected fibrofatty tissue, excluding metastatic disease, using a high-accuracy digital weight scale and a volumetric testing tube, respectively. We investigated the correlation between weight and lymph node yield, and between volume and lymph node yield. Corrected for body-mass index, both weight and volume correlated moderately with the lymph node yield (r=0.76; P<0.001) in 30 subjects. In subjects with cN0 neck undergoing ND of levels II-IV, the median (minimum - maximum) weight, volume and lymph node yield were 12.5 (7.0-19.5) grams, 12.5 (8-21) mL and 19 (7-33) lymph nodes, respectively. Regression indicated that 55% of lymph node yield's variation was explained by weight's variation (adjustedR square=0.545; P<0.001). The weight and volume of the ND specimen may assess the surgical quality of ND. Furthermore, surgeon-related factors may explain approximately 55% of variance in lymph node yield, with the remaining proportion being probably attributable to pathologist's and patient's factors.

Rates of developmental and speech delays in the general population range from 2% to 19%. Although craniosynostosis has been linked to developmental delays, this study aims to uncover patient characteristics that may independently impact rates of cognitive and speech delays in synostosis patients. A retrospective chart review identified craniosynostosis patients undergoing surgical correction at our institution from 2016 to 2023. Logistic regression identified predictors of developmental and speech delays. Variables included age, sex, insurance status, sutural involvement, surgical approach, revision surgery, and neurodevelopmental comorbidities. Delay comorbidities were defined as coexistent patient conditions impacting long-term speech and cognition apart from their synostosis. Syndromic cases were excluded from predictive analysis. A total of 259 nonsyndromic patients underwent either endoscopic (53%) or open (47%) surgical correction. Median age at surgery was 4.2 months [IQR: 2.7-10.4&#xa0;mo]. Revision surgery was performed in 3.1% of patients. Developmental delay was diagnosed in 10.0%; 14.7% had speech delays. The most prevalent neurodevelopmental comorbidities included autism (3.9%), hydrocephalus (3.9%), hearing loss (3.5%), and epilepsy (1.5%). Delay comorbidities [OR: 1.31; 95% CI: 1.17-1.47; P<0.001] and need for revision surgery [OR: 1.46; 95% CI: 1.19-1.80; P<0.001] increased the odds of a concurrent developmental delay diagnosis. Odds of speech delay were also increased by delay comorbidities [OR: 1.43; 95% CI: 1.25-1.64; P<0.001] and revision surgery [OR: 1.38; 95% CI: 1.08-1.78; P=0.01]. Factors associated with longitudinal rehabilitation resource utilization at latest follow-up were delay comorbidities [OR: 1.49; 95% CI: 1.26-1.76; P<0.001], age at surgery >6 months [OR: 1.26; 95% CI: 1.06-1.49; P=0.008], male sex [OR: 1.13; 95% CI: 1.01-1.26; P=0.04], and use of early intervention/school programs [OR: 1.53; 95% CI: 1.16-2.02; P=0.003]. Rates of developmental delays in patients undergoing surgical correction of craniosynostosis mirror those of the general population. Consistent predictors of developmental delays in craniosynostosis patients include the need for revision surgery and coexistent developmental comorbidities. Notably, surgical approach, sutural involvement, and age at surgery >6 months were not independent predictors of developmental or speech delays. Future studies linking synostosis to developmental delays and assessing neuropsychological outcomes after surgery should control for these factors.

The surgical treatment of mandibular fractures aims to improve patient rehabilitation and function. Complications, such as limitations in mandibular movements, can be observed during the postoperative period. This study aimed to evaluate the effects of photobiomodulation therapy (PBMT) after surgical treatment of mandibular fractures with longitudinal observation of mandibular movements as the outcome. In this randomized clinical trial, we compared a PBMT group (n = 18) with a control group (n = 15) of patients with mandibular fractures who underwent surgical intervention. The sessions were performed 24 hours after the surgical procedure, and repeated weekly for 5 weeks after hospital discharge. Maximum opening, laterality sum, and maximal protrusion were measured during the same periods in both groups. The Statistical Package for the Social Sciences (SPSS) version 25.0 (IBM Software Group) was used for statistical analyses. The level of significance was set at P&#x2264;0.050. There was a progressive increase in mandibular movements in both groups, and significantly greater values, particularly in terms of mouth opening and protrusion, were observed in the PBMT group. In addition, when the fracture location was considered, a progressive increase in mouth opening was observed in most locations, whereas improvements were noted in the lateral movements of patients with condylar fractures. In addition, significant improvements in mouth opening were observed with both the intraoral and extraoral approaches. The PBMT resulted in better mandibular movement recovery after surgical treatment, mainly in terms of mouth opening, irrespective of surgical access, with a limited influence of the fracture location.

Congenital muscular torticollis (CMT) is a common postural disorder in infants, frequently accompanied by craniofacial asymmetry. Despite its prevalence, detailed characterization of the 3-dimensional (3D) craniofacial morphology in CMT remains limited. This study aimed to explore the craniofacial patterns in children with CMT using 3D computed tomography scan reconstruction and assess their relationship with clinical classifications. Forty-four children aged 5 to 92 months were included in this study. Ten craniofacial parameters were visually assessed by multiple raters, including medical and nonmedical professionals, and frontline and specialized clinicians. High reproducibility was observed for features such as mandibular tip deviation and parietal bone measurements. The sternocleidomastoid tumor and torticollis subgroups of CMT show similar craniofacial asymmetry profiles, and molded baby syndrome to a lesser extent. The postural torticollis subgroups showed different profiles. Multiple factor analysis followed by hierarchical clustering revealed 6 distinct morphologic groups that did not correspond to the clinical, sex, or age subgroups, highlighting the significant variability in craniofacial morphology in CMT. These results emphasize that imaging assessment provides complementary information but cannot replace a thorough clinical evaluation. Our study confirmed that CMT-associated craniofacial asymmetry is a 3D asymmetry that remains difficult to understand.

Craniofacial trauma causes many admissions and severe complications. Different systems assess injury severity but lack predictive validity for determining mortality in critically ill craniofacial trauma patients. This study therefore evaluated various trauma scores and clinical variables to determine their predictive value for mortality. In this retrospective, single-centre study, 54 adult patients with craniofacial trauma were admitted to the intensive care unit. Their injuries were graded on admission using various methods, including ISS, TRISS, RTS, CCL, APACHE-II, and GCS to assess severity. The ROC curve analysis was used to assess the accuracy of the scoring systems. Multivariate analysis was used to identify predictors of in-hospital mortality. Clinical variables included patient age, sex, mechanism of injury, and use of protective equipment. Of 54 patients, 9 (16.6%) died during hospitalisation. None had used protective safety equipment at the time of injury. Survivors stayed in the hospital and ICU for less time than nonsurvivors. Survivors had GCS scores of 13, while nonsurvivors had 8 (P=0.003). Median ISS (27 versus 59), APACHE II (18 versus 33), and TRISS (96.8 versus 21.7) scores also differed significantly between the 2 groups. TRISS and APACHE-II showed excellent discrimination, with AUC values of 0.872 and 0.863, respectively. RTS and GCS also performed well, while ISS and CCL demonstrated moderate predictive ability. FISS demonstrated no meaningful value. TRISS and APACHE II provide the most accurate mortality prediction in critically ill patients with craniofacial trauma. Physiological scores with anatomic assessments may better predict risk and support decisions for this high-risk group.

Traditional Surgical management of cleft lip has been shown to achieve successful functional outcomes and reasonable aesthetic results. However, the postsurgical scar still presents an aesthetic concern. Recently, the development of fractional photothermolysis has revolutionized laser scar surgery, including cleft lip repair. However, this therapeutic technique has not been used in the early postoperative surgical correction of cleft lip. A new protocol has been suggested. Fifty-two children with unilateral cleft-lip deformity, 27 were males (51.9%), and 25 were females (48.1%), with an age range of 83 to 308 days, were included in this study. From June 17, 2021, to June 4, 2024, at the author's private clinic, all patients received a CO2 fractional laser session after primary cleft lip surgery to improve the surgical outcomes of their cleft lip scars. The number of fractional laser sessions ranged from 3 to 10 sessions. The time period between sessions was 4 to 6 weeks. Basically, the assessment interval was 1 month. The evaluation of scar improvement was performed by showing each patient 2 photographs (first and last) using the Vancouver Scar Scale (VSS) and a new scale for the level of the vermilion notch. The study showed a highly significant improvement in the pliability, vascularity, and notching scores for the treated patients. However, the level of improvement for both pigmentation and height criteria scores was found to be statistically insignificant. The new protocol shows promising results in minimizing cleft lip surgical scars in the early postoperative phase. Early fractional CO2 laser proved to be a valuable treatment modality for the rehabilitation of cleft lip. It was found to be highly effective from both healing and aesthetic criteria.

To investigate whether 3D mandibular-condylar morphology features derived from cone-beam CT can differentiate between normal and pathologic developmental patterns in patients with asymmetric skeletal class III malocclusion. A 3D skull model was generated from cone beam CT scans of 90 patients (mean age: 19.4&#xb1;5.0&#xa0;y; 53 female, 37 male). On the basis of menton deviation, unilateral mandibular skeletal patterns were classified into 3 groups: deviated group (DG, nondeviated/long side), nondeviated group (NDG, deviated/short side), and nonmandibular deviation group (NMDG, no detectable deviation). The novel 3D Condylar Remodeling Scoring System (CRSS) was used to qualitatively assess condylar morphologic changes and stability. Quantitative analyses of condylar development included measurements of condylar volume, condylar height (CH), and the CH-to-ramus height ratio (CH/RPH). On the basis of the Obwegeser criteria, paired-sample t tests were first used to compare anatomic differences between the long side and short side. Through the test results, unilateral mandibular bones were scientifically classified, and the classification characteristics and patterns of unilateral mandibular bones in patients with skeletal class III mandibular deviation were systematically analyzed. Cortical continuity was intact in 99.4% (179/180) of condyles. No significant differences in CRSS scores were observed among DG, NDG, and NMDG (8.1-8.7, P>0.05). The DG exhibited significantly greater CH (25.5&#xb1;3.8&#xa0;mm) compared with the NDG (23.2&#xb1;3.8&#xa0;mm, P=0.001) and NMDG (23.2&#xb1;4.8&#xa0;mm, P=0.004) groups. CH/RPH differed significantly across groups (Kruskal-Wallis H=11.06, P=0.004), with DG (0.69) showing higher values than NMDG (0.59, P=0.004). This study analyzed all mandibular asymmetry cases with hemimandibular elongation using the Obwegeser classification, revealing exclusive mandibular condylar hyperplasia (MCH) with nonmandibular ramal hyperplasia (nMRH)/nonmandibular body hyperplasia (nMBH). In skeletal class III malocclusion with mandibular deviation, short-side condyles with continuous cortical architecture and CRSS &#x2265;8 are classified as normally developing, while long-side condyles exhibit hyperplastic growth. The CH/RPH ratio (&#x2248;0.59 for normal versus &#x2265;0.69 for hyperplastic condyles) critically distinguishes these developmental patterns. Using the Obwegeser classification, this study demonstrates that skeletal class III malocclusion with mandibular asymmetry exclusively presents as type II (simple condylar hyperplasia) in unilateral mandibles, with significant enrichment of condylar hyperplasia in the long-side group.

The superior thyroid artery (STA) and its branch, the superior laryngeal artery (SLA), are key vascular structures within the carotid triangle, and variations in their origins, branching patterns, and courses are of significant clinical importance during cervical surgical procedures. A 72-year-old male cadaver of Greek origin demonstrated a rare combination of vascular variations. On the left side, a linguofacial trunk arose from the external carotid artery, while the STA originated from the common carotid artery; notably, the SLA was absent, with no identifiable compensatory arterial supply. On the right side, the STA arose from the external carotid artery in its typical position; however, the SLA followed an aberrant course, penetrating the thyroid cartilage before entering the larynx. This case highlights an exceptional coexistence of arterial variations within the carotid triangle. Awareness of such complex vascular configurations is essential for safe surgical dissection and for minimizing the risk of iatrogenic neurovascular injury during head and neck procedures.

The Milano-Cortina 2026 Winter Olympic Games highlighted the persistent risk of craniofacial injuries across multiple high-velocity winter sports. This editorial reviews the most clinically relevant injury events, including a severe periorbital skate-blade trauma resulting in zygomatic fracture during short-track speed skating, as well as concussive and cervical injury patterns observed in sliding and alpine disciplines. Despite advances in protective equipment, significant vulnerabilities remain, particularly in facial protection and impact mitigation. Current standards in several sports appear insufficient to address predictable mechanisms of craniofacial trauma. The evidence discussed underscores the need for improved, sport-specific protective strategies and stronger implementation of evidence-based safety regulations. Enhanced preventive measures may reduce the burden of craniofacial injuries in future Olympic competitions.

To investigate the association between craniofacial scar severity and psychological status in patients with craniofacial scars. This cross-sectional study enrolled adult patients with craniofacial scars. Scar severity was objectively assessed using the Vancouver Scar Scale (VSS), while depressive and anxiety symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Multivariable linear regression analyses were performed to examine the associations between scar severity and psychological outcomes, adjusting for age, sex, scar etiology, scar location, time since injury, appearance-exposed occupation, prior psychological history, and previous scar treatment. After multivariable adjustment, higher VSS scores were significantly associated with higher PHQ-9 and GAD-7 scores. Time since injury showed a negative association with both depressive and anxiety symptom scores. Other demographic and clinical variables were not significantly associated with psychological outcomes after adjustment. Greater objective severity of craniofacial scars may be associated with increased depressive and anxiety symptoms. These findings highlight the importance of psychological assessment and appropriate support in the comprehensive management of patients with craniofacial scars.

Maxillofacial skeletal defects lead to functional impairments, aesthetic disfigurement, and psychosocial burdens, while traditional surgical approaches face challenges in precision and personalization. Recent advancements in artificial intelligence (AI) and digital technologies offer potential for enhanced precision and innovation. A bibliometric analysis was conducted to explore the current applications, research trends, and development process of AI and digital technologies in maxillofacial skeletal reconstruction. Five hundred sixteen articles published from 1996 were retrieved from the Web of Science Core Collection. Data were analyzed using CiteSpace and VOSviewer to evaluate publication trends, journal/institutional contributions, collaborations, co-citation, and keyword bursts. On average, 17.64 articles were published annually, and this number increased significantly, with a notable surge in AI-related studies post-2022. The Journal of Stomatology Oral and Maxillofacial Surgery ranked highest in publication volume (36 articles), while the Journal of Cranio-Maxillofacial Surgery received the most citations (1213). China led in productivity (86 articles), whereas the USA had the most citations (1777). Keyword bursts revealed evolving research focus: early emphasis on rapid prototyping (2008-2016) transitioned to artificial intelligence (2023-2025) and machine learning (2022-2025). Collaborative networks highlighted partnerships among China, Germany, Italy, and the USA. Artificial intelligence (AI) and digital technologies were revolutionizing maxillofacial reconstruction through enhanced precision and innovation. However, challenges such as data bias, algorithmic transparency, and regional disparities require global collaboration and standardized protocols. Future efforts should prioritize integrating AI tools, diversifying data sets, and expanding inclusion of non-English literature. This study underscored the transformative potential of AI while advocating for equitable technological advancement.

Nasal tip rhinoplasty constitutes a cornerstone of both aesthetic and reconstructive rhinoplasty. In East Asia, this procedure presents distinct surgical challenges and has undergone a unique evolutionary trajectory-shaped by region-specific nasal anatomy and culturally embedded aesthetic ideals. This review traces the historical development of East Asian nasal tip rhinoplasty, charting its progression from the initial adoption of Western techniques to contemporary, locally developed innovations grounded in anatomic evidence. First, the authors delineate key anatomic differences between East Asian and Western nasal structures. Subsequently, the authors examine 3 chronological phases: (1) the era of Western technique transplantation-characterized by direct adoption and preliminary adaptation; (2) the phase of technical refinement and contextual integration-focused on enhancing structural support, achieving natural contouring, and optimizing facial harmony; and (3) the current era of indigenous innovation-defined by conceptually original, clinically validated techniques explicitly informed by East Asian nasal anatomy. Particular emphasis is placed on homegrown methodologies, including Dai exogenous extension stents. Furthermore, the authors synthesize current evidence regarding clinical outcomes, strategies for complication prevention and management, and the evolution of aesthetic paradigms-from early emulation of Western ideals toward a confident, culturally resonant standard of beauty. This review offers a rigorous, historically grounded, and clinically relevant synthesis of advances in East Asian nasal tip rhinoplasty, serving as a scholarly resource for global practitioners and fostering cross-cultural collaboration in rhinoplasty science and practice.

To evaluate the clinical utility of robot-assisted incision and drainage in the management of a polymicrobial brain abscess located in the central region. We retrospectively analyzed a case of polymicrobial odontogenic brain abscess in a 71-year-old male who presented with stroke-like symptoms. The patient was admitted due to progressive right-sided weakness, initially mimicking an acute ischemic stroke. Gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) revealed ring-enhancing lesions in the left precentral gyrus and the right temporal lobe, with corresponding high signal on diffusion-weighted imaging (DWI), highly suggestive of a brain abscess. Following empirical antibiotic therapy (vancomycin and meropenem), the patient clinically deteriorated, and a repeat MRI demonstrated enlargement of the left central abscess. During the Remebot robotic navigation, the abscess was incised and drained, yielding thick, yellowish-white purulent material. Postoperative metagenomic next-generation sequencing (mNGS) of the pus identified a polymicrobial infection comprising Fusobacterium nucleatum, Streptococcus constellatus, Parvimonas micra, and Porphyromonas gingivalis. Based on the microbiological findings, the antibiotic regimen was tailored to a triple combination of vancomycin, meropenem, and metronidazole for 2 weeks, followed by vancomycin plus meropenem for an additional 4 weeks, complemented by rehabilitation and hyperbaric oxygen therapy. The patient demonstrated remarkable neurological recovery. One month post-surgery, right limb muscle strength had returned to grade 5, with only mild residual impairment in fine-motor coordination of the right hand. Three-month follow-up MRI revealed complete resolution of the previously observed intracranial ring-enhancing lesions. For eloquent-area brain abscesses that progress despite medical management, robot-assisted incision and drainage offers a safe, precise, and efficacious minimally invasive surgical option. Integration of mNGS technology for pathogen identification enables targeted antimicrobial therapy, a pivotal step toward achieving favorable outcomes in complex infections.

Reconstruction of large scalp defects in patients who have previously received external beam radiation therapy (EBRT) is technically challenging due to radiation-induced vascular compromise and poor wound healing. While free tissue transfer is commonly used, pedicled scalp flaps may offer a simpler, more reliable alternative in certain patients. The objective of the study is to evaluate the outcomes of pedicled scalp flap reconstruction in a large cohort of irradiated patients with substantial scalp defects and to identify risk factors associated with flap complications. The authors conducted a retrospective review of 216 patients treated by a single surgeon from January 1998 to December 2024. Inclusion criteria were prior EBRT to the scalp, a defect size &#x2265;15&#xa0;cm2, use of pedicled scalp flaps, and a minimum follow-up of 6 months. Data collected included demographics, prior scalp surgeries, indication for reconstruction, flap design, complications, flap survival, and need for reoperation. Of the 216 patients (143 men, 73 women; mean age: 79.4 and 77.8&#xa0;y, respectively), 149 had prior scalp surgery (including skin grafts, biologics, or previous flaps). Indications were recurrent/persistent malignancy in 187 and necrotic or exposed calvarium in 29. Complete healing without complications occurred in 189 patients (87.5%). Sixteen patients developed wound breakdown managed with local flaps; 8 had partial flap loss (&#x2264;50%) requiring further scalp flap in 5 or free flap in 3; and 3 had major flap loss (>50%) necessitating free-flap reconstruction. All patients with partial or major flap loss had a history of prior scalp flaps. Pedicled scalp flaps, when designed and executed with careful respect to vascular principles, provide a reliable reconstructive option even in radiated patients with large defects. A history of prior scalp flap significantly increases the risk of flap loss. These findings support the continued use of pedicled scalp flaps in this demanding population and suggest that prior flap history must factor into risk stratification and planning.

Biparietal osteodystrophy, also known as bilateral parietal calvarium bone thinning, is a rare calvarial condition characterized by loss of diploic bone within the parietal region. Although historically described in anthropologic and radiologic literature, current understanding of its epidemiology, pathogenesis, clinical relevance, and management remains fragmented. This review synthesizes current evidence and highlights emerging studies on biparietal osteodystrophy. Epidemiologic reports indicate that biparietal osteodystrophy affects a broad age range but appears most frequently in older adults, with several series suggesting a slight female predominance. Prevalence is difficult to estimate due to incidental detection, though modern imaging has increased recognition of the condition. Histologically and anatomically, biparietal osteodystrophy is marked by thinning of the outer table and loss of the diploic space, with little osteoblastic or osteoclastic remodeling. Proposed pathogenic mechanisms include chronic degenerative change, impaired vascular supply to the diplo&#xeb;, and other theories, although no single explanation fully accounts for its complete presentation. Clinically, most patients remain asymptomatic, with complications such as calvarial fractures and traumatic brain injury being rare but highlighting the structural vulnerability associated with severe thinning. Management strategies are not standardized, and the use of anti-osteoporotic drugs and cranioplasty has been reported to offer benefit in select cases, although no treatment has been formally validated for biparietal osteodystrophy. As the understanding of biparietal osteodystrophy continues to evolve, future research is needed to clarify its natural history, identify potential etiologic pathways, and establish evidence-based management guidelines.

Reconstruction of the upper lip in pediatric patients is challenging due to the need to restore function, symmetry, and aesthetic harmony within facial subunits. Descriptions of techniques that respect the aesthetic units of the face are limited. This study evaluates the outcomes of a cheek advancement flap designed according to facial aesthetic subunits for reconstruction of the lateral cutaneous upper lip in pediatric patients. A retrospective analysis was conducted on 7 pediatric patients who underwent reconstruction of isolated lateral upper lip skin defects using a cheek advancement flap between 2005 and 2025. Demographic variables, etiology, laterality, follow-up, and complications were recorded. Postoperative aesthetic outcomes were objectively assessed by 4 independent plastic surgeons using the Strasser Scale. Three females and 4 males were included. The most common etiology was congenital nevus (57%). Six patients underwent unilateral flap advancement and one required bilateral reconstruction. The mean follow-up was 3.5 years (range: 6&#xa0;months-10&#xa0;years). No intraoperative or postoperative complications were observed. Aesthetic evaluation demonstrated excellent results in 5 patients, good results in one patient, and a mediocre result in one patient who presented with extensive sequelae from upper lip necrosis secondary to mucormycosis. The perialar semilunar cheek advancement flap is a safe and reproducible technique that provides reliable aesthetic outcomes for reconstruction of the lateral upper lip. By adhering to facial aesthetic subunit principles, this approach achieves harmonious results, discreet scars, and avoids secondary deformities, making it an excellent option for localized upper lip skin defects.

Traumatic intrusion of the mandibular condyle into the middle cranial fossa is an extremely rare and life-threatening condition. It often lacks specific clinical manifestations, particularly in patients with polytrauma, which typically leads to oversight or misdiagnosis. Although many individuals present without obvious neurological deficits, associated craniofacial injuries such as concussion, intracranial hemorrhage, cerebrospinal fluid leakage, otorrhagia, hearing impairment, and facial nerve dysfunction are commonly observed. Most published cases have involved condylar fractures; however, intracranial penetration by an intact condyle is extremely rare. While guidelines for condylar fractures suggest prompt condylar removal and skull base repair, the feasibility of skull base reconstruction depends on the complexity of the trauma. Treatment decisions, including the choice of surgical approach and reconstruction, were individualized for each case. In the present case, skull base repair was not performed because of a comminuted fracture during emergency surgery. Despite severe craniocerebral injuries, emergency surgery could not resolve the issue, and the patient refused secondary surgery and opted for conservative treatment, which ultimately resulted in a favorable outcome. This case highlights that conservative treatment can be a prudent choice when surgical conditions are limited. This report describes a rare case of intact intracranial penetration of the mandibular condyle, discusses its clinical and imaging characteristics, and reviews therapeutic strategies, providing insights into early diagnosis and personalized management.

Although postoperative edema and ecchymosis are expected results of rhinoplasty, the authors attempt to limit them by applying a cold compress to osteotomy lines after rhinoplasty. Many forms of cold eye masks and facial masks have been described. In this report, the authors present a method for preparing a simple but well-fitting ice pack to use in rhinoplasty patients. To prepare this ice pack, the last 2 digits of a regular surgical glove are filled with tap water and a knot is tied to form a V shape. The rest of the glove is removed. This pack is then placed into the freezer until the end of the rhinoplasty procedure. This simple ice pack fits completely on the lateral osteotomy line. Benefits are: it is easily prepared, it fits appropriately on the lateral osteotomy line, this pack is perfectly fitted to the target area without blocking the patient's vision, thus, patients typically keep it on during their transfer from the operation theatre to their room, which can take a long time in some hospitals, and it is very effective and easy to create and apply. In addition, it is almost free of charge. This pack is perfectly fitted to the target area without blocking the patient's vision. Thus, patients typically keep it on during their transfer from the operation theatre to their room, which can take a long time in some hospitals.

Accurate knowledge of cervical vascular anatomy is essential during neck dissection (ND) to prevent serious intraoperative complications. While several variations in the cervical course of the internal carotid artery (ICA) have been documented, an ICA coursing posterior to the internal jugular vein (IJV) remains extremely rare and may increase the risk of vascular injury by altering expected anatomic relationships. Therefore, a thorough preoperative imaging evaluation is critical for a safe surgical procedure. This report presents two oral cavity cancer patients who exhibited an uncommon posterior course of the ICA located behind the IJV. In both cases, preoperative enhanced computed tomography (CT) demonstrated a tortuous, posteriorly displaced ICA, which was subsequently confirmed during selective ND. Tumor resection and ND were performed with meticulous dissection around the carotid sheath, allowing safe preservation of the vascular variation. Postoperative healing was uneventful, and no local recurrence or regional metastasis was observed during follow-up. An ICA coursing posterior to the IJV represents a rare but clinically significant vascular variation encountered during ND. Surgeons should recognize that, even when such variations are identified on preoperative imaging, atypical ICA courses may still pose challenges during dissection, particularly within routinely explored cervical regions. Awareness and careful intraoperative identification of these variations contribute to safer surgical outcomes.