搜索结果：The Journal of craniofacial surgery

Velopharyngeal insufficiency (VPI) is a significant complication of palate repair, with the potential to markedly impair speech quality and intelligibility. The modified superior-based pharyngeal flap technique represents an innovative approach to address velopharyngeal insufficiency (VPI), a condition characterized by incomplete closure of the velopharyngeal port during speech production. This study's focus on evaluating the efficacy of this modified technique underscores the ongoing efforts in the field of cleft palate and craniofacial surgery to refine and optimize treatment strategies for VPI. Thirty patients with VPI were included, with 15 patients undergoing the modified technique (study group) and 15 undergoing traditional pharyngeal flap surgery with Hogan modification (control group). Preoperative and postoperative nasalance scores and fiberoptic nasopharyngoscopy records were compared between the 2 groups. The results showed significant postoperative improvements in nasalance scores for various syllables and sentences in both groups. However, the study group demonstrated more significant improvements in certain sounds and had a lower postoperative complication rate than the control group. The modified technique involves folding the flap to cover open areas, which is thought to increase soft tissue stability, reduce air leakage, and minimize the risk of residual openings. These advantages are particularly evident in patients with preserved lateral wall mobility. The findings suggest that the modified pharyngeal flap technique may be a promising alternative for the treatment of VPI, offering both functional and healing benefits. However, careful patient selection and individualized surgical planning based on comprehensive preoperative evaluation are essential for optimal outcomes. Further long-term studies with larger sample sizes are required to validate the efficacy of this technique.

To assess the effect of buccal mucosal flaps for cleft palate (CP) repair on dental hygiene and eruption of the posterior molar teeth. A retrospective review of CP patients between 2008 and 2015 from our prospective (live) CP database. A single-center University Hospital with a senior cleft surgeon and a senior pediatric dentist undertaking the dental review. All CP patients who underwent a buccal mucosal flap (n=38).Exclusion criteria included incomplete dental data sets or previous buccal flap pedicle division, leaving n=31 patients. Key parameters of dental hygiene and development were recorded. To assess posterior molar eruption and hygiene. Thirty-one patients were included: (n=2) had a fistula, and (n=29) had a buccal band, with (n=5) receiving division of the buccal band (as an adjunct to another procedure). The "presence of plaque on the buccal surface of the most distal molar tooth score"=0 bilaterally (n=7), 1 bilaterally (n=19), 2 (n=3), and 3 unilaterally (n=2). The gingival probing depth was between 1 and 2 mm bilaterally (n=30) and 3 mm on the side of the buccal flap (n=1). The crown height measurements varied from 2 to 8 mm and were symmetrical (n=24) or within 1 mm of each other (n=4) or 2 mm of each other (n=3). Depth of the buccal sulcus to the most distal upper molar tooth measurements varied from a difference between sides of: 0 mm (n=8), 1 mm (n=6), 2 mm (n=13), and 3 mm (n=4). The single-stage buccal mucosal flap is a useful technique in CP repair and appears to have minimal negative effects on dental hygiene and no observed significant impact on dental eruption.

Dysthyroid optic neuropathy (DON) is occasionally resistant to corticosteroid treatment. In these cases, emergent transnasal endoscopic orbital decompression may be the optimal therapy method. We evaluated 13 patients with steroid-resistant DON to determine the potential benefit of this surgical intervention. Thirteen patients with steroid-resistant DON seen at Shenzhen Eye Hospital (China) between January 2023 and April 2025 were included in our study. All patients underwent emergent transnasal endoscopic orbital decompression and received postoperative corticosteroids and neurotrophic medication. The rate of improvement in postoperative best-corrected visual acuity (BCVA) was an important criterion for successful postoperative therapy. In all, 13 patients (range, 34-72&#xa0;y) with 13 eyes (8 right eyes and 5 left eyes) were included in our study. The duration of DON ranged from 9 to 36 months (median time 17.4&#xa0;mo). Eleven of 13 patients (84.61%) had a statistically significant improvement in BCVA from 0.76&#xb1;0.28 LogMAR to 0.23&#xb1;0.18 postoperatively ( P <0.01). These 11 patients underwent decompression within <26 months of diagnosis. Three of these 11 patients demonstrated pronounced BCVA improvement: 2 of them improved from counting fingers to 0.6 and 0.02, respectively, and the other improved from hand motion to 0.3. However, the remaining 2 showed no improvement. Emergent transnasal endoscopic orbital decompression surgery is a very useful and effective treatment for dysthyroid optic neuropathy (DON) that is refractory to corticosteroid therapy. Its efficacy seems inversely correlated with disease duration rather than preoperative BCVA. As such, longer disease duration may be associated with poorer postoperative outcomes.

Accurate preoperative risk stratification is essential in craniofacial surgery, where complex procedures and prolonged recovery place significant physiological demands on patients. Body mass index (BMI) is commonly used in clinical practice due to its simplicity; however, its ability to predict surgical outcomes remains inconsistent. BMI does not distinguish between fat and lean mass, account for adipose distribution, or reflect functional and metabolic reserve. This can lead to variability in risk assessment. This is particularly evident in craniofacial surgery, where operative fields contain relatively limited adipose tissue, and outcomes may be more closely tied to wound healing capacity, nutritional status, and overall physiological resilience. Body composition offers a more detailed characterization of these underlying factors by quantifying skeletal muscle mass, adiposity, and their distribution. Emerging evidence demonstrates that body composition phenotypes, including sarcopenia, sarcopenic obesity, and metabolically abnormal normal-weight states, may be more consistently associated with perioperative complications, delayed recovery, and adverse functional outcomes than BMI alone. These relationships are especially relevant in vulnerable craniofacial populations. These consist of pediatric patients with high metabolic demands and oncologic patients at risk for malnutrition and muscle depletion. This review examined the limitations of BMI, outlines methods for assessing body composition, and synthesizes current evidence linking body composition to surgical outcomes, with a focus on its application in craniofacial surgery.

Facial asymmetry is defined as a clinical discrepancy between the 2 sides of the face and is considered multifactorial in origin. It may affect any facial region, although it is most frequently observed in the lower third of the face. In this context, the mandibular condyle represents a primary growth center whose variations in behavior may lead to changes in volume and morphology. The aim of this study was to analyze the morphologic characteristics of the mandibular condyle in subjects with facial asymmetry associated with sagittal class II deformity (AF-CII) and in subjects with facial asymmetry associated with sagittal class III deformity (AF-CIII). A cross-sectional study was conducted including candidates for orthognathic surgery. Cone-beam computed tomography (CBCT) was used for dentofacial assessment. Condylar width and condylar height were measured, and both condyles were evaluated in each scan to identify the larger and smaller condyle relative to the contralateral side. Condylar morphology was classified as convex (normal) or irregular/flattened based on the characteristics of the superior articular surface. A total of 119 subjects with facial asymmetry and sagittal skeletal deformity were analyzed and divided into AF-CII and AF-CIII groups. In the AF-CIII group, only 4 subjects (3.27%) presented unilateral condylar morphologic alterations. In contrast, the AF-CII group demonstrated greater morphologic variability, with condylar alterations observed in 67.24% of cases, including both unilateral and bilateral changes. Statistically significant differences in condylar dimensions were identified between AF-CII and AF-CIII subjects (P=0.0001). Conclusions: Facial asymmetry in patients with sagittal dentofacial deformity is associated with differences in mandibular condylar size. AF-CII is related to condylar morphologic alterations, whereas AF-CIII does not demonstrate relevant morphologic changes. Facial deviation predominantly occurs toward the side of the smaller condyle.

This retrospective study aimed to evaluate the different conservative (ie, speech therapy) and surgical treatment approaches of velopharyngeal insufficiency (VPI) associated speech pathology in patients with submucous cleft palate (SMCP), performed within a single tertiary cleft care centre. Thirty-three patients treated for SMCP between January 1999 and December 2023, registered in a database of the Maastricht University Medical Centre and MosaKids Children's Hospital and a database of the Dutch Association for Cleft Palate and Craniofacial Anomalies (NVSCA), were included. The decrease in VPI-associated speech pathology after treatment was retrospectively scored using the Cleft Audit Protocol for Speech-Augmented (CAPS-A) in the Dutch language, based on the Dutch Cleft Speech Evaluation Test (DCSET). A significant reduction of the sum scores of the CAPS-A Dutch was seen in surgery combined with speech therapy (95% CI: 1.46-4.19) and speech therapy after surgery (95% CI: 0.85-3.48). Speech therapy only lowered the sum scores, but did not show a significant effect (95% CI: -1.30 to 1.30). Both surgical and conservative treatment resulted in a reduction of VPI-associated speech pathology, but only surgery significantly reduced hypernasality (P=0.005) and improved speech intelligibility (P=0.005). This study confirms the need for a multimodal treatment approach for VPI in SMCP by combining surgical cleft palate repair with pre- and post-operative specialised cleft speech therapy for optimal speech outcomes.

Global disparities in pediatric craniofacial burns are underexplored, yet the lasting impact and disease burden they present merit further study. This study leverages data from the WHO Global Burn Registry to evaluate differences in pediatric craniofacial burn characteristics and outcomes across income settings, and to identify structural and contextual factors contributing to disparities in care. The registry was queried for craniofacial burns in patients aged 0 to 18 years (n=1625). Patients were stratified by World Bank income classification. Descriptive statistics and multivariable regression models were used to evaluate associations between income level and outcomes, including length of stay, surgery, and discharge status. Patients in lower-income settings were older and had larger burns. They were more likely to experience delayed presentation and had significantly lower access to critical care. Higher-income settings demonstrated increased surgical intervention and longer hospital stays. Mortality was substantially higher in lower-income countries (26.14% versus 8.02%), with an 88.5% lower adjusted risk of death in higher-income settings. Increasing total body surface area was the strongest predictor of mortality. Differences in supervision and timing of injury were also observed across income levels. Outcomes in pediatric craniofacial burns are influenced not only by injury severity but also by socioeconomic context and access to care. Disparities in care capacity, supervision, and healthcare infrastructure contribute significantly to global differences in outcomes. Prevention efforts should be context-specific and address the need for improved caregiver supervision, home safety measures, and access to specialized burn care.

This study uses bibliometric analysis and knowledge mapping methods to systematically explore the emerging research frontiers and development trajectories of focused ultrasound (FUS) technology in the treatment of Alzheimer's disease (AD), and provides new clues and research directions for future research by exploring hotspots and new topics. A comprehensive literature search was conducted through the Science Citation Index Expanded Core Collection (WoSCC) database to identify relevant articles and reviews published between January 2014 and 2025 on the application of FUS technology in AD. For data analysis and visualization, we used VOSviewer software, CiteSpace, and the R package "bibliometrix" to conduct rigorous bibliometric analysis and build knowledge domain maps. A total of 1531 papers involving 9220 contributors were identified between 2014 and 2025. The field demonstrated consistent growth (R2=0.9272), peaking in 2025 with 225 publications. China led in total output (475 papers), while the United States achieved the highest academic impact (12,965 citations, H-index: 56). The Chinese Academy of Sciences was the most prolific institution, whereas Harvard Medical School recorded the highest citation impact. The Journal of Alzheimer's Disease and Scientific Reports emerged as the leading publication venues, while Theranostics and Alzheimer's & Dementia provided high-prestige platforms. Tianfu Wang and Baiying Lei were the most productive authors, though Isabelle Aubert garnered the highest total citations. International collaboration analysis revealed a robust, multi-centric network anchored by the USA, China, Canada, and Italy. Co-citation analysis identified Leinenga G (2015) as the foundational study for ultrasound-mediated amyloid-beta clearance. Lipsman N (2018) marked a critical clinical inflection point, exhibiting a strong citation burst (17.3) that catalyzed a shift from preclinical models to human safety trials. Recent bursts extending into 2025 focus on multicenter clinical validation and long-term efficacy. Keywords analysis confirms that non-invasive blood-brain barrier (BBB) opening via microbubble-enhanced focused ultrasound (FUS) is the central research paradigm. Emerging frontiers have shifted from basic technical validation toward neuroinflammation, oxidative stress, tau pathology, and deep-learning-assisted diagnostics, reflecting an evolving focus on molecular mechanisms and precision neurosurgery. Focused ultrasound technology has made significant progress in the field of Alzheimer's disease research and has become a research frontier with considerable therapeutic potential. With ongoing technological progress, the clinical translation of FUS is expected to bring new breakthroughs in AD treatment.

Brain-computer interface (BCI) technology is increasingly relevant to craniofacial nerve functional reconstruction because it can decode cortical motor intent and convert it into physical or digital output when peripheral motor pathways are impaired. Facial nerve palsy, dysphagia, and oromandibular motor dysfunction remain difficult to treat when conventional nerve repair, muscle transfer, or electrical stimulation cannot restore coordinated and natural movement. This narrative review synthesized peer-reviewed literature on BCI-related craniofacial functional reconstruction. A targeted search of PubMed, Embase, Web of Science, and Google Scholar was performed, covering English-language articles published from 2014 to April 12, 2026. Eligible core articles addressed BCI-based facial motor restoration, swallowing or oromandibular BCI paradigms, speech or orofacial neuroprosthetics, neural interface integration in craniofacial surgery, flexible facial bioelectronic sensing, or functional electrical stimulation systems with direct relevance to craniofacial nerve recovery. Background literature was cited separately to contextualize disease burden, conventional reconstruction, dysphagia, outcome assessment, calibration, and neuroethical issues. Twenty-two core articles were included in the final thematic synthesis and organized into 3 domains: facial expression motor reconstruction, oromandibular and swallowing rehabilitation, and neural interface integration in craniofacial surgery. EEG-based facial-expression decoding has shown promising accuracy under controlled laboratory conditions, speech neuroprosthetics provide potentially transferable frameworks for orofacial motor decoding that remain unproven in facial palsy or dysphagia rehabilitation, swallowing motor-imagery studies support physiological feasibility for dysphagia-oriented BCI, and flexible facial biosensors may support future closed-loop systems. BCI technology should be regarded as a potential complement to conventional craniofacial reconstruction rather than a replacement for established surgical techniques. Current evidence supports technical feasibility, but clinical translation will require naturalistic decoding, durable interfaces, faster patient-specific calibration, meaningful outcome measures, and early attention to ethical issues.

Osteoradionecrosis (ORN) of the mandible or maxilla is a significant complication of head and neck radiotherapy. Conservative management often fails, necessitating major composite reconstruction. Vascularised soft tissue flaps represent an intermediate surgical option for nonadvanced disease (Notani stages I-II), yet their outcomes remain incompletely characterized. A PICO-structured systematic search of MEDLINE, Embase, Web of Science, the Cochrane Database, and major trial registries was conducted (initial search: March 2022; rerun: May 2025). Two reviewers independently screened records using Rayyan software. Study quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for case series. Given the absence of direct comparative studies, a narrative synthesis was performed, and pooled proportions with Wilson 95% CIs were calculated for binary outcomes. The review is registered on PROSPERO (CRD420250295833). No randomized controlled trials or direct comparative studies were identified. Fourteen retrospective case series (207 patients, 212 flaps) met the inclusion criteria. Pooled ORN resolution was 95.2% (95% CI: 91.3-97.4), flap failure was 3.4% (95% CI: 1.6-6.8), secondary surgery was 5.0% (95% CI: 2.7-8.9), minor complication rate was 7.4%, and mean length of stay was 4.5 days. All proportions are per patient. Periosteal flaps demonstrated osteoinductive capacity, with radiologic new bone formation confirmed in 2 studies. Vascularised soft tissue flaps achieve high ORN resolution rates with low morbidity, reduced trismus, and short hospitalization for refractory nonadvanced disease. Indirect evidence supports a clinically meaningful benefit over continued conservative management and a substantial reduction in the eventual need for composite osseous reconstruction. These interventions provide meaningful patient choice when conservative management has failed or is unlikely to succeed. Randomized controlled trials are needed to establish definitive superiority.

Melanoma is a highly aggressive tumor. Although immunotherapy has improved clinical outcomes, its efficacy remains limited by low response rates and acquired resistance, making nanomaterials promising tools for enhancing melanoma immunotherapy. This study aimed to comprehensively evaluate the research status and trends in this field using bibliometric analysis. Relevant publications published between January 1, 2006, and December 31, 2025, were obtained from the Science Citation Index Expanded database within the Web of Science Core Collection. A total of 935 publications were analyzed using VOSviewer, CiteSpace, the Bibliometrix R package, and Microsoft Office Excel to identify research trends, major contributors, and emerging hotspots. The annual number of publications showed a steady upward trend from 2006 to 2025. China (577 publications) and the United States (264 publications) were the dominant contributors in this field, with most leading institutions from China and the most productive authors mainly from China and the United States. ACS Nano (69 publications), Journal of Controlled Release (59 publications), and Biomaterials (46 publications) were the core journals. Keyword analysis identified 3 major research hotspots: anticancer mechanisms, multifunctional nanoplatforms, and combinatorial therapeutic strategies. Future studies should prioritize the development of precision immunotherapy strategies and advance the clinical translation of nanomaterial-based approaches for the treatment of melanoma.

This study aims to summarize the spectrum, characteristics, treatment strategies, and long-term prognosis of pediatric parotid gland masses. The authors retrospectively reviewed 136 children who underwent surgeries for parotid gland masses from January 2015 to December 2024. This review analyzed data regarding clinical presentations, imaging examinations, postoperative pathologic findings, and the results of long-term follow-up (&#x2265;12&#xa0;mo). Congenital lesions were the most common, accounting for 63.2% (86/136) of cases, and included hemangiomas, lymphangiomas, and first branchial cleft fistulas. Pleomorphic adenomas of the parotid gland represented 15.4% (21/136), while all malignant tumors identified were lymphomas, comprising 6.6% (9/136). During a median follow-up period of 38 months, the incidence of temporary facial nerve palsy following surgery was recorded at 5.1% (7/136), and the overall recurrence rate was 7.4% (10/136). A total of 119 patients achieved complete remission, with no deaths occurring during the study period. Benign lesions are the predominant type of parotid gland masses in children, and CT scans are vital for the diagnosis and preoperative assessment of these lesions. Surgery is the main treatment method. Long-term follow-up has shown that for vascular lymphatic malformations prone to recurrence, local injection of bleomycin is a safe and effective adjunctive therapy. This study provides empirical evidence for optimizing the clinical management pathway for this disease.

Neuromodulators, primarily botulinum toxin type A (BoNT-A), are a widely used nonsurgical intervention for facial aesthetics. Their applications have expanded from the upper face to the midface, lower face, and neck, driven by advances in anatomic understanding, injection techniques, and patient-tailored approaches. The growing number of available BoNT-A formulations and advanced injection techniques necessitates a detailed understanding to optimize outcomes and minimize complications. Although all BoNT-A products share a common mechanism of action, variability in molecular potency, receptor interactions, patient biology, and injection technique contributes to heterogeneous clinical outcomes. This review synthesizes current mechanistic, biochemical, and clinical evidence within the framework of a series of postulates, which describe how toxin-receptor binding, synaptic vesicle protein 2 (SV2) receptor availability, intracellular light chain delivery, and toxin distribution collectively determine efficacy, onset, and duration of effect. Central to this model is the concept of molecular potency as the primary driver of clinical response, independent of labeled unit dose, and its interaction with patient-specific factors such as muscle mass, receptor density, and immunogenicity. The framework also highlights the importance of injection variables, including reconstitution volume and the number of injection sites, in optimizing anatomic distribution and clinical outcomes. Emerging innovations, including hybrid toxins, microdroplet microbotox techniques, and ultrasound-guided injections, are further contextualized within this mechanistic model as strategies to enhance precision, efficacy, and consistency of treatment. Neuromodulators are central to modern facial aesthetics, with expanding formulations and innovations. We propose a series of postulates that may assist clinicians in optimizing toxin selection, injection strategy, and patient outcomes while minimizing adverse effects.

Few studies have demonstrated the reliability of biodegradable osteosynthesis systems in orthognathic surgery; however, studies on the use of biodegradable osteosynthesis systems after mandibular osteotomy, including sagittal split ramus osteotomy (SSRO), are limited. This pilot study aimed to compare the safety and skeletal stability after segmental fixation using curved titanium and box-type biodegradable systems in SSRO for mandibular prognathism. Patients who underwent SSRO for correction of mandibular protrusion with malocclusion between September 2024 and March 2025 were included. After conventional SSRO, the bilateral segments were fixed using curved 6-hole titanium plates (Ti group) or 6-hole box-type biodegradable plates (Bi group). Lateral and frontal cephalograms and computed tomography images were obtained before (T0), 5&#xb1;2 days after (T1), and 6&#xb1;1 months after surgery (T2). In the Ti group, although the absolute change in the ramus plane and gonial angles from T1 to T2 was -2.3&#xb1;5.1 and 3.6&#xb1;7.4 degrees, respectively, no significant change was observed in any of the measured angles. In contrast, in the Bi group, significant changes from T1 to T2 were observed in the mandibular plane (4.8&#xb1;2.3 degrees), ramus plane (-5.7&#xb1;4.0 degrees), and gonial angles (8.8&#xb1;4.2 degrees). The changes in the vertical and horizontal positions of point B, menton and pogonion were not significantly different between the 2 groups. The results of this pilot study with a small sample size suggested that in patients undergoing SSRO, bone segmental fixation using 6-hole box-type biodegradable plates may provide acceptable short-term skeletal stability and safety. Since definitive comparisons require larger prospective studies, further prospective studies with larger sample sizes are warranted.

Advanced (Notani III) osteoradionecrosis (ORN) often requires microvascular free-flap (MVFF) reconstruction, yet comparative outcomes by flap category and the effect of peri-oncologic factors on postoperative events remain uncertain. We compared outcomes after bony versus soft-tissue MVFF and evaluated potential risk factors for reconstructive failure (RF) and acute and late complications. This single-center retrospective cohort study included adults with Notani III ORN who underwent MVFF reconstruction at a tertiary hospital between 2008 and 2024. Twenty-three patients were included: 9 bony free flaps and 14 soft-tissue free flaps. Primary endpoints were total flap loss and RF. RF was defined as major RF requiring salvage flap and/or hardware removal or minor RF requiring return to the operating theater without new flap/hardware removal. Secondary endpoints included acute complications during index admission and late complications &#x2265;3 months post-reconstruction. Fisher's exact test and exploratory logistic regression were used. The mean age of patients was 60.3 years, and 74% were male. There were no total flap losses. RF occurred in 26% (major 9%, minor 17%), with no significant differences between bony and soft-tissue flaps in either group. Acute complications occurred in 39% of patients and late complications in 52%. Pre-radiotherapy (RT) dental interventions were associated with a statistically significant increase in acute complications (OR 2.13, 05% CI 1.28-3.52, P=0.04). Prior immunotherapy was associated with lower odds of acute complications (OR 0.30, 95% CI 0.15-0.59, P=0.04). MVFF provided durable reconstruction for Notani III ORN with no flap failures and a low rate of major RF. Outcomes did not differ by flap category. Pre-RT dental interventions and prior immunotherapy modify perioperative risk and warrant validation in larger, multicentre cohorts.

The aim of this study was to retrospectively review patients diagnosed with paranasal sinus osteoma and to present our clinical experience, focusing on the role, applicability, and outcomes of current surgical approaches in the management of these lesions. Patients with paranasal sinus osteomas who underwent surgical treatment (endoscopic, external, or combined approaches) at a tertiary referral center between January 2010 and January 2025 were retrospectively evaluated. A total of 43 patients were enrolled in the study. Demographic data, preoperative and postoperative records, paranasal sinus computed tomography scans, surgical notes, and histopathology results were analyzed. The study consisted of 43 patients (21 men, 22 women) with a mean age of 45.6 (range: 23-72). Osteomas were located in the frontal sinus (n=14), frontoethmoid region (n=8), ethmoid sinuses (n=19), and maxillary sinus (n=2). The most frequently observed complaint was headache (65.1%), followed by nasal obstruction (37.1%). The mean size of the osteomas was 16.4&#xa0;mm (range: 4-60&#xa0;mm). Endoscopic surgery was performed in 31 patients (72.1%), external surgery in 6 patients, and a combined approach in 6 patients; all external approaches were utilized in frontal sinus osteomas. Advances in endoscopic surgical techniques and instrumentation have established endoscopic surgery as the primary treatment modality for paranasal sinus osteomas. External or combined approaches should be reserved for selected cases in which complete endoscopic resection is not feasible due to the size, location, or extent of the lesion.

To characterize age-related changes in the tarsal plate, with a focus on meibomian gland loss and alterations in collagen, elastic, and reticular fibers. Central sagittal sections of 31 upper eyelids from 20 East Asian cadavers, fixed in 10% formalin, aged 36 to 97 years were examined using Masson's trichrome staining. Additional sections of 25 upper eyelids from 16 cadavers, fixed in 10% formalin, aged 36-94 years were evaluated with Elastica-van Gieson and silver staining. In individuals in their 30s and 40s, acini extended to the superior tarsal region in most specimens, although 2 specimens from one 36-year-old individual showed complete acinar loss. Acinar loss became more apparent in the 50s and was pronounced after the 60s, although some specimens still retained acini in the central to superior tarsus. Acinar loss was consistently greater on the conjunctival side than on the skin side. Elastic fibers were typically present around the meibomian ducts but were nearly absent in acinar-loss areas. Reticular fibers were abundant in acinar-containing regions and remained densely distributed in acinar-loss areas, where collagen fibers filled the original acinar spaces. Meibomian gland volume generally decreased with age, although individual variation was evident. Preferential acinar loss on the conjunctival side suggests regional susceptibility. The disappearance of elastic fibers, together with dense reticular and collagen fiber deposition, raises the possibility that inflammatory remodeling may contribute to age-related meibomian gland loss.

Medication-related osteonecrosis of the jaw (MRONJ) is a known complication of antiresorptive therapy, but it is rarely reported in pediatric patients. We present a 10-year-old girl with familial multicentric carpotarsal osteolysis (MCTO) associated with an MAFB mutation, who was referred for incidental radiographic abnormalities detected during orthodontic evaluation. The patient had received prolonged and sequential antiresorptive therapy, including alendronate, denosumab, and subsequent intravenous pamidronate and zoledronate. Imaging revealed diffuse periradicular sclerosis and irregular cortical resorption of the right mandibular ramus and coronoid process with periosteal reaction and suspected sequestration, raising concern for osteonecrotic change. Clinically, the patient was asymptomatic, with no exposed bone or signs of infection, and did not meet the diagnostic criteria for MRONJ. The lesion was therefore considered a possible subclinical manifestation associated with antiresorptive therapy. This case highlights that radiographic abnormalities may precede clinical MRONJ in high-risk pediatric patients, supporting the need for careful surveillance and conservative management.

Periorbital defects following Mohs micrographic surgery (MMS) require precise reconstruction to preserve both function and aesthetics. To evaluate reconstructive outcomes for periorbital nonmelanoma skin cancers treated with MMS and assess the influence of defect size and subunit localization on surgical decisions. Sixty-eight patients treated between 2014 and 2022 were retrospectively reviewed. Data on tumor characteristics, defect dimensions, reconstructive techniques, and complications were analyzed across 4 periorbital subunits. Basal cell carcinoma was the most frequent malignancy (95.6%), primarily involving the lower eyelid (61.8%). Complex repairs (56%)-predominantly transposition flaps for lower eyelids and glabellar rotation flaps for the medial canthus-slightly outnumbered simple repairs (44%). Statistical analysis revealed no significant association between defect size and reconstruction method (P=0.679) or anatomic subunit (P=0.143). Complications occurred in 7.4% of cases, mainly including ectropion and hypertrophic scarring. Notably, ectropion was associated with inadequate vertical tension management rather than defect size alone. The retrospective, single-center design and the relatively small sample size for certain subunits, such as the upper eyelid, are the primary limitations of this study. Nevertheless, our findings demonstrate that periorbital reconstruction following MMS should prioritize individualized, subunit-specific strategies over rigid size-based protocols. A flexible approach focused on vertical tension management and anatomic integrity ensures optimal functional and cosmetic outcomes while minimizing malposition risks.