Journal of Craniofacial Surgery最新文献

{"title":"When Did We Learn to See Malocclusion? Böcklin's Death, the Deviated Mandible, and the Orthodontic Eye.","authors":"Kun Hwang, Se Il Lee","doi":"10.1097/SCS.0000000000013489","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013489","url":null,"abstract":"<p><p>Arnold Böcklin's Self-Portrait with Death Playing the Fiddle (1872) is usually interpreted as a modern memento mori: the artist pauses at his work while Death plays a fiddle immediately behind him. Yet a closer anatomical inspection reveals another striking feature. Böcklin's own mouth is closed, whereas Death's skull has an open jaw that appears to deviate laterally. The skeleton seems almost to sing while playing a fiddle with only one string-the lowest G string. Although the apparent mandibular displacement should not be diagnosed as malocclusion from a painting, it invites an orthodontic reading that would not have been available in its modern form when Böcklin painted the work. More than 2 decades later, Edward H. Angle published his Classification of Malocclusion (1899), establishing a systematic framework in which normal occlusion provided the reference for recognizing deviation. His subsequent writings, including Some Basic Principles in Orthodontia (1903) and Some Studies in Occlusion (1905), further developed occlusion as a central subject of orthodontic thought. This essay does not suggest that Böcklin intentionally depicted malocclusion. Rather, it explores how later anatomical and orthodontic knowledge changes what we are able to see in an earlier work of art. The painting itself has not changed; the observer's eye has. Böcklin's silent face and Death's impossible mouth thus become a small but revealing encounter between art, anatomy, and the history of perception.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167512","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":"Anatomy of the Upper Lip and Nose Muscular Bundle Tendon and Its Application During Unilateral Cleft Lip Repair.","authors":"Percy Rossell-Perry","doi":"10.1097/SCS.0000000000013450","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013450","url":null,"abstract":"<p><strong>Background: </strong>While several authors have previously described the anatomy of the nasolabial muscles in patients with unilateral cleft lip, some personal intraoperative findings may provide additional information on this topic. The aim of this study is to describe the anatomy and histopathology of the tendon of the upper lip and nose muscle bundle on the cleft side and the role of myrtiform muscles during primary repair of the unilateral cleft lip.</p><p><strong>Methods: </strong>The anatomy of this structure has been described during primary cleft lip repair, and small pieces of the muscle and tendon of the upper lip muscular bundle were excised and embedded in paraffin for histopathologic study. In addition, a retrospective cross-sectional study was performed to evaluate the utility of this anatomic structure in cleft lip and nose repair. The outcomes were anthropometric measurements of the repaired lip and nose at the age of 5 years.</p><p><strong>Results: </strong>The anatomic descriptions during cleft lip repair and the histopathologic study confirm the existence of this tendon structure in all the studied cases. A well-defined tendon was detected at the base of the nasal ala on the cleft side. There was no statistically significant difference between cleft and noncleft alar base positions on the operated side in patients who underwent the described muscular repair.</p><p><strong>Conclusions: </strong>A tendon structure has been documented and demonstrated in operated patients with unilateral cleft lip and palate nose deformity; it has not been previously described in the literature. The observed outcomes after primary cleft lip repair using this structure support its utility and underscore the importance of the myrtiform muscles during unilateral cleft lip repair.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166228","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":"Microsurgical Revascularization for Thrombosed Middle Cerebral Artery Dissecting Aneurysms: Classification Scheme and Surgical Strategies.","authors":"Pengcheng Wang, Jinpeng Wang, Dacheng Ding, Xuan Wang, Yanguo Shang, Minggang Shi, Luhao Jin, Wenzhuang Li, Jie Qiao, Xiaoguang Tong","doi":"10.1097/SCS.0000000000013498","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013498","url":null,"abstract":"<p><strong>Objective: </strong>Thrombosed dissecting aneurysms represent highly challenging lesions in neurosurgery. Among these, thrombosed middle cerebral artery (MCA) dissecting aneurysms are clinically rare and exceptionally difficult to manage. Their defining feature is the extensive organized thrombus within the aneurysmal lumen and the subsequent progressive mass effect, which presents a significant dilemma for traditional endovascular treatment and microsurgical clipping to balance safety and efficacy. To address this, the authors summarize the clinical experience of a single senior surgeon at our center to establish a classification scheme for thrombosed MCA dissecting aneurysms to provide a clinical reference.</p><p><strong>Methods: </strong>Over a 10-year period, 12 patients with thrombosed MCA dissecting aneurysms underwent microsurgical revascularization. These lesions were classified into 4 types: stenotic type (n=2, 16.7%), dolichoectatic type (n=5, 41.7%), saccular mass type (n=3, 25.0%), and composite type (n=2, 16.7%).</p><p><strong>Results: </strong>Among the 12 patients, 5 underwent aneurysm excision combined with interposition bypass grafting [4 using a radial artery graft (RAG) and 1 using a superficial temporal artery (STA)]. Six patients underwent extracranial-to-intracranial bypass (2 through EC-radial artery graft-M1 bypass and 4 through STA-MCA bypass, including one double-barrel STA bypass). One patient underwent aneurysm excision combined with wrapping reconstruction. Postoperative angiography demonstrated complete aneurysm obliteration in 10 cases (83.3%) and shrinkage in 2 cases (16.7%); all bypass grafts remained patent. The mean postoperative follow-up period was 48.4 months (range: 6-87 mo). Eleven patients experienced no complications or showed an improved modified Rankin Scale score, while one patient developed hemiplegia due to perforator vessel injury. No postoperative mortalities occurred.</p><p><strong>Conclusions: </strong>Although thrombosed MCA dissecting aneurysms are rare, microsurgical revascularization represents a safe and effective treatment strategy offering favorable long-term outcomes. The classification scheme and surgical strategies proposed in this study provide a valuable clinical reference for these complex lesions.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148197","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":"Orbital Fracture Repair Materials: Research Hotspots, Clinical Applications, and Emerging Technologies.","authors":"Xiaolin Huang, Leilei Zhang, Yuan Deng","doi":"10.1097/SCS.0000000000013490","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013490","url":null,"abstract":"<p><p>Orbital fractures, particularly of the medial and inferior walls, often require precise reconstruction to restore orbital volume and prevent enophthalmos, diplopia, and facial deformity. The selection of repair material, ranging from titanium meshes and porous polyethylene to resorbable polymers and tissue-engineered scaffolds, is therefore central to surgical success, yet a clinically oriented synthesis of the available options remains lacking. This study combines a bibliometric mapping with a focused review of repair materials to chart how the field has evolved and to clarify the relationship between material properties, fracture pattern, and treatment strategy. Literature published from 1990 to 2025 was retrieved from the Web of Science Core Collection and analyzed using VOSviewer, CiteSpace, and the R package \"bibliometrix\"; 1156 articles were included. The USA contributed the largest number of publications (272), followed by South Korea (124) and China (118), with the University of Helsinki (58 articles) and the Journal of Craniofacial Surgery (H-index 32) being the most productive institution and journal, respectively. Six thematic clusters were identified: biomaterial types, outcome prediction, complications, absorbable polymers, allografts, and surgical approaches. Keyword burst analysis highlighted emerging interests in \"floor\" (2021-2025) and \"intraoperative navigation\" (2022-2025). We further map these clusters onto concrete clinical scenarios: small orbital floor defects may be managed with resorbable polymers, whereas extensive, comminuted fractures or cases with severe enophthalmos require the rigid support of titanium or patient-specific implants (PSI). The field is progressing from conventional fixation toward computer-assisted planning, PSI, and bioactive tissue-engineered constructs. Future efforts should prioritize validating navigation-guided implantation for orbital floor reconstruction while advancing novel biomaterials that promote osteogenesis and minimize complications.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148463","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":"Endoscopic Techniques in Facial Rejuvenation: Indications, Technical Refinements, and Avoidance of Unsatisfactory Results.","authors":"Renato Saltz, Fernanda Scala","doi":"10.1097/SCS.0000000000013389","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013389","url":null,"abstract":"<p><p>Endoscopic techniques have largely replaced open coronal approaches for brow and midface rejuvenation, offering enhanced visualization, minimal scarring, and lower complication rates. Here, we review indications, technical principles, and strategies for avoiding unsatisfactory results in endoscopic brow and midface rejuvenation, drawing on the senior author's 30 years of experience and more than 2500 cases, with attention to complication management and the selective role of adjunctive CO2 laser resurfacing for concurrent cutaneous photoaging. Endoscopic access is achieved through temporal and paramedian incisions guided by a 3-zone anatomical framework, with complete retaining ligament release and multipoint absorbable fixation of the brow and midface; CO2 laser resurfacing, when indicated, is applied to nonundermined periorbital and perioral units. Patient satisfaction rates have consistently reached 90% to 95% at 1 year, with overall complication rates of 3% to 10% when proper patient selection and meticulous technique are used. Endoscopic facial rejuvenation, with or without adjunctive CO2 laser resurfacing, provides natural, durable results with a favorable safety profile when guided by sound anatomical principles, complete retaining ligament release, and appropriate fixation.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147597","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":"Review of \"The International Medical Graduate Paradox\" by de Virgilio CM, Neumayer LA, Walsh RM, Rosenthal R, Itani KMF, Charles A, Klingensmith ME, Matthews JB. Annals of Surgery 2026;284(3):451-457.","authors":"Anthony M Shadid, Larry H Hollier","doi":"10.1097/SCS.0000000000013486","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013486","url":null,"abstract":"","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148233","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":"Implementation of Spring Assisted Cranioplasty at a Single Institution.","authors":"Samantha D Morin, Adam B Fleming, Henry H Taylor, Ronald R McCall, Colton Fernstrum, Kendall C Pitre, Laura S Humphries, Ian C Hoppe","doi":"10.1097/SCS.0000000000013482","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013482","url":null,"abstract":"<p><p>Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique for the treatment of craniosynostosis that may reduce operative morbidity compared with traditional open cranial vault remodeling procedures. A retrospective review was conducted of all patients who underwent SAC between May 2019 and August 2024 at a single academic institution serving a socioeconomically vulnerable population. Demographic, clinical, and operative variables were collected, including suture involvement, spring configuration, perioperative outcomes, complications, and need for secondary procedures. A total of 43 patients met the inclusion criteria, of whom 84% had single-suture craniosynostosis, most commonly sagittal synostosis (78%). The mean age at surgery was 3.79±0.37 months. Springs remained in place for an average of 89.00±9.59 days with a mean total exertional force of 26.26±2.12 N. No intraoperative complications occurred. Four patients (9.3%) experienced postoperative complications, including hematoma or seroma formation and wound infection, with 1 patient (2.3%) requiring hospitalization for postoperative infection following spring removal. No cases of spring migration or hardware failure were observed. Five patients (11.6%) required additional cranial procedures and were more likely to be female, syndromic, and have multisuture or coronal craniosynostosis. The mean length of stay following spring insertion was 2.81±0.19 days. These findings support the feasibility of implementing SAC in a high-social-vulnerability patient population and demonstrate favorable early outcomes following adoption of this minimally invasive approach for craniosynostosis management.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148252","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":"Multistage Reconstruction of Complex Postburn Facial Scars: A Multidimensional Reconstructive Approach.","authors":"Trần Thiết Sơn, Phan Tuấn Nghĩa, Đặng Phương Nam, Hoàng Tuấn Anh","doi":"10.1097/SCS.0000000000013497","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013497","url":null,"abstract":"<p><strong>Background: </strong>Severe postburn facial scars may involve multiple anatomical units with different functional and aesthetic requirements. Reconstruction of such deformities may therefore require a staged and individualized approach rather than a single reconstructive procedure.</p><p><strong>Case presentation: </strong>A 30-year-old man presented with severe postburn deformities involving the upper lip, lower lip, chin, submental region, and anterior neck. The deformities included severe upper-lip contracture, hyperpigmented scars of the lower lip and chin, and cervical contracture limiting neck extension and rotation. Reconstruction was performed in 2 stages with different flap techniques tailored to each anatomical unit. The upper lip was reconstructed with a hair-bearing superficial temporal artery flap, while the anterior neck was used a supraclavicular fasciocutaneous flap. Six months later, the lower lip, chin, and submental region were rebuilt with a customized, thinned ALT flap with 2 skin paddles. All flaps survived without vascular issues. At 8 years, the patient had good facial contour, color match, natural beard growth over the upper lip, functional lips without distortion, and a soft, stable lower lip and chin. The neck showed no recurrent contracture, with restored cervicomental angle and full extension. Scars remained soft, without hypertrophic recurrence, and the patient was satisfied with both functional and aesthetic results.</p><p><strong>Conclusions: </strong>Complex postburn facial deformities involving multiple anatomical units can be effectively managed through a multistage, defect-driven reconstructive strategy. Selecting flap techniques based on the specific functional and aesthetic requirements of each defect may provide more appropriate tissue replacement and favorable long-term outcomes.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147832","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":"Parent-Reported Health-Related Quality of Life at 3 Years of Age in Children Treated for Sagittal or Metopic Synostosis.","authors":"Marizela Kljajić, Katerina Papadopoulou, Madiha Bhatti Söfteland, Giovanni Maltese, Peter Tarnow, Lars Kölby","doi":"10.1097/SCS.0000000000013491","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013491","url":null,"abstract":"<p><p>Early surgical intervention is recommended for sagittal (SS) and metopic (MS) synostosis to correct head shape and reduce the risk of later social stigmatization. However, the impact of craniosynostosis (CS) and its surgical treatment on health-related quality of life (HRQoL) in early childhood remains insufficiently understood. To evaluate parent-reported HRQoL at 3 years of age in children treated for SS or MS. At the 3-year follow-up, parents of children treated for SS or MS completed the Pediatric Quality of Life Inventory (PedsQL) version 2 to 4 years. Age- and nationality-matched healthy controls were recruited from child health care centers. The study included 138 children treated for CS (SS, n=94; MS, n=44) and 104 controls. Compared with controls, children treated for SS had higher total PedsQL scores (P<0.0001, effect size=0.86) and higher scores in physical, emotional, and social functioning (all P<0.0001; effect sizes 0.58-0.78). Daycare functioning was also significantly higher for SS compared with controls. (P=0.018, effect size=0.34). No significant differences were found between the MS and controls. Compared with the MS group, the SS group had higher total PedsQL scores (P=0.0002, effect size=0.77) and higher scores in physical (P<0.0001, effect size=0.71), emotional (P=0.024, effect size=0.43), social (P=0.0021, effect size=0.62), and daycare functioning (P=0.001, effect size=0.68). At 3 years of age, children treated for SS had higher parent-reported HRQoL than both healthy controls and children treated for MS, whereas children treated for MS did not differ from controls.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147163","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 L-Shaped Lateral Crural Graft: A Single-Graft Technique for the Correction of Alar Concavity and Nasal Valve Insufficiency.","authors":"Alper Yenigun, Muhammed F Ozgan, Remzi Dogan, Erol Senturk, Sabri B Eren, Orhan Ozturan","doi":"10.1097/SCS.0000000000013483","DOIUrl":"https://doi.org/10.1097/SCS.0000000000013483","url":null,"abstract":"<p><p>Nasal valve insufficiency and alar concavity are challenging sequelae of previous rhinoplasty, often resulting from a weakened or scar-deformed lateral crus. We describe the L-shaped lateral crural graft, a single autologous costal cartilage construct designed to simultaneously address lateral crural weakness, alar concavity, and nasal valve insufficiency in revision rhinoplasty. The graft is shaped into an L configuration: the long limb is positioned along the lateral crus to reinforce the crus and correct concavity, whereas the short limb is directed dorsally to support the lateral nasal wall and internal nasal valve region. In this single-center consecutive case series, 12 patients (7 male and 5 female; aged 18-55 y) underwent bilateral L-shaped lateral crural grafting, with a mean follow-up of 9.5 months. All patients reported improved nasal breathing and expressed satisfaction with the outcome. Clinical examination revealed increased lateral nasal wall support, and photographic assessment demonstrated reduced alar concavity with improved contour and symmetry. No infection, graft exposure, visibility, contour irregularity, asymmetry, warping, resorption, or recurrent collapse was observed. The L-shaped lateral crural graft may be a feasible option for simultaneous functional and aesthetic correction in selected revision cases, although larger comparative studies using validated outcome measures are warranted.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149880","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}