Journal of Craniofacial Surgery最新文献

{"title":"Endoscopic-Assisted Harvest of Temporoparietal Fascia Flap Through a Single Incision for Single-Stage Auricular Reconstruction With Porous Polyethylene Framework: How I Do It.","authors":"Ha H Nguyen, Huyen T T Tran, De D Vu, Linh M Ngo","doi":"10.1097/SCS.0000000000011980","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011980","url":null,"abstract":"<p><p>Single-stage auricular reconstruction using a porous polyethylene (PPE) framework with temporoparietal fascia flap (TPFF) coverage has become increasingly popular for microtia correction. This technique reduces the number of operative stages and avoids donor-site morbidity from rib cartilage harvest. We describe our refined approach combining PPE framework implantation with endoscopic-assisted TPFF harvest via a single small incision. Preoperative planning includes 256-slice contrast-enhanced MSCT angiography and Doppler mapping to delineate the branching pattern of the superficial temporal artery (STA), guiding flap design while minimizing risk of damaging the frontal branch of the facial nerve. Intraoperative endoscopic magnification ensures clear visualization of STA branches and interconnections, preserving all small anastomoses to improve flap viability. We also propose an anatomic classification of STA branching patterns. On the basis of our experience with 113 patients, this approach improves surgical precision, reduces complications, enhances team teaching, and achieves excellent aesthetic outcomes.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Our Evolved Technique for Microtia Reconstruction: An Advanced Form of the Yotsuyanagi Method.","authors":"Takatoshi Yotsuyanagi, Ken Yamashita, Asuka Takada, Takayuki Miura","doi":"10.1097/SCS.0000000000011842","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011842","url":null,"abstract":"<p><strong>Background: </strong>Reconstruction of microtia remains a complex challenge in plastic surgery, particularly in achieving both aesthetic and functional outcomes. Since the introduction of costal cartilage grafting, various techniques have evolved, including the Nagata method. However, limitations such as rigidity of the framework, high cartilage volume requirement, and complications from temporoparietal fascia (TPF) flaps persist.</p><p><strong>Methods: </strong>The authors present our refined technique for lobule-type microtia reconstruction, now known in Japan as the Yotsuyanagi Method. This approach emphasizes a hybrid cartilage framework that combines costal cartilage with elastic remnant cartilage to improve flexibility, especially in the tragus and antitragus. Key surgical refinements include defined allocation of costal cartilage segments to auricular components, use of nylon sutures instead of stainless steel wire, and a two-step procedure allowing delayed trimming of excess skin. Auricular elevation is enhanced through the use of banked support cartilage and superficial mastoid fascia, avoiding the need for TPF flaps.</p><p><strong>Results: </strong>This technique allows for the reconstruction of a symmetric, three-dimensional auricle with improved compatibility for earphones and hearing aids. The hybrid cartilage design maintains elasticity without compromising structural integrity. Operation time is reduced, long-term complications such as wire exposure are minimized, and secondary revisions are simplified. Aesthetic results, including sufficient conchal depth and natural contour, have been consistently favorable.</p><p><strong>Conclusion: </strong>Our evolved method for microtia reconstruction offers significant advantages over traditional approaches by reducing patient morbidity, enhancing postoperative outcomes, and achieving a more natural auricular form. Ongoing refinement and long-term evaluation will further optimize results for patients undergoing auricular reconstruction.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Care for Management of Microtia Using a Two-Stage Autologous Costal Cartilage Technique for Auricular Reconstruction: Surgical Method, Outcomes, and Future Directions.","authors":"Neil W Bulstrode, Thomas H Jovic","doi":"10.1097/SCS.0000000000011990","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011990","url":null,"abstract":"<p><p>Auricular reconstruction for microtia remains one of the most technically demanding procedures in craniofacial surgery. The authors present a refined, two-stage approach using autologous costal cartilage. This method, building on the work of Tanzer, Brent, Nagata, and Firmin, demonstrates high aesthetic fidelity and improved patient quality of life. The authors' technique incorporates innovations in framework symmetry, postoperative care, a standardised splinting protocol following the second stage of ear reconstruction, and outcome evaluation using validated health-related quality of life (HRQoL) metrics. This paper outlines the authors' surgical method, reviews published outcomes, and discusses the evolving future of ear reconstruction, including the potential of stem/progenitor cells (such as adipose-derived stem cells) and tissue engineering.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Speech Outcomes in Unilateral Cleft Lip and Palate: A Comparative Study of Early and Delayed Hard Palate Closure.","authors":"V L van Roey, L Hofman, P A J van der Goes, H G Poldermans, S J Haverkamp, E C Paes, A B Mink van der Molen, I M J Mathijssen, S L Versnel","doi":"10.1097/SCS.0000000000011975","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011975","url":null,"abstract":"<p><strong>Background: </strong>Evidence on the comparative effectiveness of surgical protocols for cleft lip and palate remains limited, especially regarding long-term speech outcomes. Therefore, this study evaluates speech outcomes at 5, 12, and 22 years in patients with unilateral cleft lip and palate (UCLP) to guide protocol selection.</p><p><strong>Methods: </strong>This prospective cross-sectional study included 285 UCLP patients treated at 2 Dutch academic hospitals. Patients were assessed at 1 of 3 predefined ages (5, 12, or 22 y) during routine follow-up; only a minority were assessed at more than one time point. Four protocols with different timing for hard palate closure were compared: Late Delayed Hard Palate Closure Protocol (L-DHPCP), Early Delayed Hard Palate Closure Protocol (E-DHPCP), One-Stage Palatoplasty Protocol (OSPP), and Oslo Protocol (OP). Speech outcomes were assessed using the ICHOM standard set for cleft lip and palate, including clinical (Percent Consonant Correct, Velopharyngeal Competence) and patient-reported (Intelligibility in Context Scale, CLEFT questionnaire) outcome measures and compared using ordinal logistic regression.</p><p><strong>Results: </strong>At 5 years, OSPP showed the most favourable speech results, significantly outperforming L-DHPCP and E-DHPCP. At 12 years, OP exhibited the most favourable results, while differences between protocols diminished. By 22 years, no significant differences were observed between the available protocols (E-DHPCP and L-DHPCP), though speech errors persisted in some patients.</p><p><strong>Conclusion: </strong>Early hard palate closure protocols, particularly OSPP and OP, were associated with better short-term and intermediate speech outcomes compared with DHPCPs. While differences diminished by 22 years, early closure should be prioritised in nonsyndromic UCLP patients to prevent persistent speech errors and minimise the burden of speech-enhancing surgery and speech therapy.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pakistan Palatal Fistula Difficulty Index (PPFDI): Development and Initial Validation of a Novel Scoring Index for Surgical Complexity and Referral Guidance.","authors":"Muhammad Daiem, Ghulam Q Fayyaz, Muhammad Sohail, Farrukh A Khalid, Muhammad M Bashir, Marvee Turk, Samra Bokhari, Muhammad A Mustehsan, Marshall G Miles, Peter J Taub, Phuong Nguyen, Jesse Taylor, Corstiaan Breugem","doi":"10.1097/SCS.0000000000011991","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011991","url":null,"abstract":"<p><p>Palatal fistulae remain the most common complication following cleft palate repair, with recent studies reporting incidence rates ranging from 2% to 35%. Existing classification systems offer limited guidance on surgical complexity or referral pathways. This study developed and validated the Pakistan Palatal Fistula Difficulty Index (PPFDI), a novel scoring system designed to quantify fistula complexity based on 6 domains: location, size, configuration, number of fistulae, recurrence history, and velopharyngeal function. A 3-tiered framework was proposed to guide referral based on complexity level and surgeon experience. Each domain was scored on a 3-point ordinal scale, yielding a total score range of 6 to 18. Content and face validity were established through a modified Delphi process involving 30 expert cleft surgeons, with all 6 domains achieving ≥70% agreement. Inter-rater reliability was assessed using standardized, anonymized clinical case files (n=30) independently scored by 4 senior cleft surgeons. The PPFDI demonstrated strong inter-rater reliability (ICC=0.87, 95% CI: 0.87-0.95), with domain-specific ICCs ranging from 0.78 to 0.92. The mean PPFDI score was 11.1 (SD=2.9), with 43.3% of cases classified as high complexity (score ≥12). Agreement between PPFDI-informed referral tier and clinician-determined referral need was 91.7% (Cohen kappa=0.81), indicating excellent alignment. The PPFDI offers a reliable and clinically meaningful method to stratify palatal fistula complexity and may support more structured decision-making in both low-resource and high-resource settings. Further validation through multicenter studies and correlation with surgical outcomes is warranted to confirm its broader clinical applicability.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pectoralis Major Myocutaneous Flap Reconstruction in Locally Advanced Head and Neck Malignant Solitary Fibrous Tumors: Functional and Oncologic Outcomes.","authors":"Dongyue Li, Fuxin Ma, Peihang Jing, Suchi Qiao, Fangfang Zhao, Jin Wang, Yongqian Bian, Julin Gu","doi":"10.1097/SCS.0000000000011832","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011832","url":null,"abstract":"<p><strong>Background: </strong>Malignant solitary fibrous tumor (MSFT), a rare mesenchymal malignancy with aggressive local infiltration and metastatic propensity, poses significant therapeutic challenges in the head and neck region. Locally advanced cases requiring extensive resection necessitate reliable reconstruction strategies to balance oncologic control and functional preservation.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 7 consecutive patients with T3/T4N0-2M0 head and neck MSFT undergoing radical resection and immediate pedicled pectoralis major myocutaneous flap (PMMF) reconstruction (2017-2024). Outcomes included surgical parameters, University of Washington Quality of Life (UW-QoL) scores at 6 months, and disease-free survival (DFS).</p><p><strong>Results: </strong>All patients achieved R0 resection with 100% flap survival. Mean operative time was 276±24 minutes, with no major complications (Clavien-Dindo ≥III). UW-QoL scores demonstrated significant functional recovery: pain control (75.6±3.2), swallowing (78.6±5.1), and speech (95.7±2.4), with total scores exceeding 800/1200 in all cases. Over a mean follow-up of 35.1 months (range: 6-84), DFS was 100%. Four high-risk patients received adjuvant radiotherapy (50-70 Gy) without acute toxicity.</p><p><strong>Conclusions: </strong>PMMF reconstruction provides a technically accessible solution for locally advanced head and neck MSFT, enabling radical tumor clearance while optimizing functional rehabilitation and QoL. The absence of microvascular anastomosis and a low morbidity profile make it particularly suitable for resource-constrained settings. Prospective multicenter studies are needed to validate these findings.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Pleomorphic Adenoma of the Palate: Diagnostic Challenges and the Role of Core Needle Biopsy.","authors":"Nathalia De León Fernández, Brandon Galviz Tabares, Silvia V Agudelo Mendoza, Ilse G García Rodríguez, Adonis Tupac Ramirez-Cuéllar","doi":"10.1097/SCS.0000000000012000","DOIUrl":"https://doi.org/10.1097/SCS.0000000000012000","url":null,"abstract":"<p><p>Pleomorphic adenoma (PA) is the most common benign salivary gland tumor and can also arise in minor salivary glands, particularly in the palate. Although generally benign, PA carries a risk of recurrence and malignant transformation, emphasizing the importance of accurate diagnosis. We report the case of a 16-year-old male with a 2-year history of an asymptomatic palatal mass. Initial open biopsy was performed, followed by magnetic resonance imaging, which revealed a subepithelial mass without invasion of surrounding structures. Complete surgical excision with local flap reconstruction was achieved, complicated by wound dehiscence that required revision. Final histopathology confirmed PA, and the patient remains disease-free after 2 years of follow-up. This case highlights the diagnostic and therapeutic challenges of minor salivary gland tumors in pediatric patients, particularly the limitations of open biopsy and fine-needle aspiration. Evidence from recent studies suggests that core needle biopsy provides higher diagnostic accuracy with fewer complications and may represent a safer, less invasive alternative. Further prospective studies are needed to validate core needle biopsy as the standard diagnostic tool for minor salivary gland tumors.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study of Computer-Aided Designed PEEK Implants Versus Autologous Bone Flap in Cranioplasty: Clinical Efficacy and Medical Economics Analysis.","authors":"Xingwang Sun, Chunlei Ma, Mingjun Zhan, Zhibin Zhang, Rucai Zhan","doi":"10.1097/SCS.0000000000011775","DOIUrl":"10.1097/SCS.0000000000011775","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Cranial defects, often resulting from decompressive craniectomy, require timely repair to mitigate neurological risks and psychological sequelae. This study compares polyetheretherketone (PEEK) and autologous bone grafts in cranial reconstruction, focusing on clinical outcomes, cost-effectiveness, and utilization trends.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was conducted on the clinical data of 188 patients who underwent skull repair surgery in the neurosurgery department of the First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital) from June 1, 2015, to August 31, 2022. The patients were divided into a polyetheretherketone (PEEK) group (n=80) and an autogenous bone flap group (n=108) based on the different materials used for skull repair. Analyze the baseline data, repair materials, skull defect duration, hospitalization expenses, surgical information (duration of surgery, presence or absence of blood transfusion), and postoperative complications (epilepsy, hydrocephalus, subdural effusion, bone resorption, and infection) of the 2 groups of patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There was no significant difference in baseline data, primary disease, and time of skull defect between the 2 groups of patients ( P &gt;0.05). Comparison showed that traumatic brain injury (54.80%) was the main cause of skull repair surgery, followed by bleeding (22.30%) and cerebral infarction (18.10%). There was no significant difference in hospitalization time between the 2 groups of patients ( P &gt;0.05), and there was no significant difference in the postoperative recovery of skull repair materials. However, the hospitalization cost of the PEEK group was higher than that of the autogenous bone group, and the difference was statistically significant ( P &lt;0.05). The surgery time of PEEK group patients was shorter than that of the autogenous bone group, with PEEK 144 (109-185.75) minutes and autogenous bone 171.5 (155.25-187) minutes, respectively, and the difference was statistically significant ( P &lt;0.05). In terms of postoperative complications, a total of 82 people experienced complications during the 3-month follow-up, including 19 people in the PEEK group (23.70%) and 63 people in the autogenous bone group (58.30%). There was no significant difference between the 2 groups in postoperative epilepsy, hydrocephalus, infection, etc. ( P &gt;0.05). In terms of material selection for repairs, the use of PEEK has been on the rise year by year, and as the number of repair personnel tends to stabilize, the proportion of PEEK usage has been increasing year by year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;PEEK emerges as a cost-effective, clinically robust alternative to autologous bone grafts, particularly for complex defects. Policy interventions, including DRG-exempt payments and volume-based procurement, could further enhance its accessibility. These findings support broader a","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microtia Construction: Secondary Cases.","authors":"Maria Fernanda Valotta","doi":"10.1097/SCS.0000000000011966","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011966","url":null,"abstract":"<p><p>Secondary microtia construction is even more challenge, even for experienced surgeons. This paper describes how the author analyzes the cases, makes a planning, and executes the surgical techniques for those extremely difficult cases.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microtia Reconstruction With Costal Cartilage: How I do it?","authors":"Stéphane Guichard, Elle Vandervord","doi":"10.1097/SCS.0000000000011948","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011948","url":null,"abstract":"<p><p>The correction of microtia, whether isolated or associated with other facial malformations, follows the same fundamental principle: sculpting a framework from autologous costal cartilage to replicate the contours of the normal ear and covering this framework with skin using the available local tissue. Cartilage carving can be mastered with training and continually refined through self-assessment. However, the skin coverage technique must be mastered from the outset, as complications at this stage can lead to poor outcomes that are difficult to correct. It is therefore essential to have a clear vision of the overall strategy, as well as its precise application to each individual case. Over the past 40 years and with more than 3000 cases operated on, Françoise Firmin and later myself, have encountered all the challenges and explored the solutions to address them. In this \"How I do it?\" article, the authors aim to share this experience, which will hopefully help to accelerate the learning curve.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}