Journal of Craniofacial Surgery最新文献

{"title":"Craniofacial Microsomia With Tongue Cleft: Embryological Mechanisms and Clinical Implications From Three Rare Cases.","authors":"Zhifeng Li, Xiaojun Tang, Xiaolei Jin, Wei Liu","doi":"10.1097/SCS.0000000000012008","DOIUrl":"https://doi.org/10.1097/SCS.0000000000012008","url":null,"abstract":"<p><p>Craniofacial microsomia (CFM) accompanied by a congenital tongue cleft is an exceedingly rare developmental anomaly, with fewer than 10 cases reported globally. This study presents 3 nonsyndromic cases of CFM with concurrent midline tongue cleft, characterized by mandibular hypoplasia (M2B), auricular malformations (E1-E3), soft tissue deficiencies (S1-S3), and hypoglossal/facial nerve dysfunctions. Despite the morphologic presence of tongue clefts, all cases were functionally benign and managed conservatively. Surgical treatment focused on mandibular distraction osteogenesis and auricular reconstruction, resulting in improved facial symmetry and function. The consistent involvement of first and second pharyngeal arch derivatives across cases suggests a shared embryopathological mechanism, likely involving disrupted cranial neural crest cell (cNCC) migration and dysregulation of key signaling pathways, such as SHH, BMP, and FGF. The study highlights the importance of tongue-mandible biomechanical coupling during embryogenesis and proposes potential genetic contributors, including FLNA and Meis2 mutations. These findings underscore the diagnostic significance of tongue cleft as an indicator of underlying craniofacial dysmorphogenesis and provide new clinical and mechanistic insights for future research and individualized therapeutic strategies.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131020","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":"Botulinum Toxin A for Improving Cosmetic Outcomes in Facial Wound Healing: A Systematic Review, Meta-Analysis, and Dose-Response Evaluation.","authors":"Thamer M AlBilasi, Reem Mansour Kublan Alkublan, Alanoud S Suayb, Norah A Almudawi, Rawan M Alanazi, Ahmed AlOlaywi, Ahmed Y Azzam, Philip Solomon","doi":"10.1097/SCS.0000000000011973","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011973","url":null,"abstract":"<p><strong>Introduction: </strong>Facial wound healing often results in unsatisfactory scarring with significant aesthetic and psychological impact. Botulinum toxin A (BTX-A) has appeared as a promising intervention to improve cosmetic outcomes by reducing muscle tension during wound healing. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of BTX-A in facial wound management.</p><p><strong>Methods: </strong>We conducted a detailed scientific literature database from inception to 15th of May, 2025, following PRISMA 2020 guidelines. All eligible studies comparing BTX-A with control interventions for facial wound healing were included. Primary outcomes were visual analog scale (VAS) scores and scar width measurements. Secondary outcomes included Vancouver Scar Scale scores, patient satisfaction, and adverse events. Meta-regression investigated dose-response relationships.</p><p><strong>Results: </strong>Fifteen studies with total of 607 participants met inclusion criteria. Botulinum toxin A significantly improved VAS scores (standardized mean difference 0.87, 95% CI: 0.45-1.29, P-value<0.001) and reduced scar width by 0.35 mm (95% CI: -0.52 to -0.18, P-value<0.001). Meta-regression (R²=24%, P-value=0.032) demonstrated a dose-response relationship with effect size increasing by 0.08 SMD units per U/cm. The 5 to 15 U/cm range was identified through safety-efficacy modeling, where doses <5 U/cm showed suboptimal efficacy (SMD 0.65), 5 to 15 U/cm achieved optimal balance (SMD 0.78-1.18, adverse events 1.1%-6.2%), and >15 U/cm showed diminishing returns with increased adverse events. Adverse event rates were comparable between groups (3.9% versus 3.4%, P-value=0.75), with no serious complications reported.</p><p><strong>Conclusions: </strong>Botulinum toxin A demonstrates significant efficacy in improving facial wound cosmetic outcomes with an excellent safety profile. Evidence-based dosing of 5 to 15 U/cm provides the best benefit-risk ratio. On the basis of cost-effectiveness evaluation of included studies, the intervention demonstrates favorable benefit-risk ratios for wounds in high-visibility facial areas, with economic modeling suggesting better utility for longer wounds where scar prevention outweighs treatment costs.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130965","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":"Fulminant Leptomeningeal Dissemination of Primary Intracranial Malignant Melanoma Following Surgical Resection.","authors":"Yanlong Sun, Shuli Li, Jianqiu Chen, Shumin Luo, Baisheng Li","doi":"10.1097/SCS.0000000000012004","DOIUrl":"https://doi.org/10.1097/SCS.0000000000012004","url":null,"abstract":"<p><p>Primary intracranial malignant melanoma (PIMM) is exceptionally rare and prone to misdiagnosis due to its nonspecific radiologic features. A 32-year-old female presented with a left frontal mass, initially diagnosed as meningioma on imaging. Gross total resection was performed. Histopathology revealed PIMM with an exceptionally high mitotic count (33/2 mm²). Within 5 days postoperatively, she developed hydrocephalus and consciousness disturbance. Cerebrospinal fluid cytology confirmed malignant cells, and spinal MRI demonstrated diffuse leptomeningeal dissemination, indicating rapid cerebrospinal fluid spread. This case highlights the highly aggressive nature of PIMMs with elevated mitotic activity, the risk of misdiagnosis as meningioma, and the potential for surgery to precipitate devastating early leptomeningeal spread. It underscores the need for heightened preoperative suspicion and early postoperative vigilance in similar cases.</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":"145131068","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":"Mythic Geographies of Feminine Beauty: Ancient Archetypes and Their Influence on Modern Esthetic Ideals.","authors":"Kun Hwang","doi":"10.1097/SCS.0000000000011676","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011676","url":null,"abstract":"<p><p>This paper examines how ancient representations of feminine beauty, especially as geographically situated in classic literature and mythology, continue to influence contemporary aesthetic ideals. Drawing on 9 culturally significant or mythic regions; Hellas, Sparta, Phaeacia, Lesbos, Lemnos, Cyprus, Egypt, Sirens' Land, and Tír na nÓg, the study identifies distinct archetypes of beauty embedded in specific spatial imaginaries. Through a qualitative comparative analysis of ancient texts (eg, Homer, Sappho, Apollonius of Rhodes, Herodotus), 3 thematic subgroups emerge: sacred/idealized beauty (associated with classic harmony and virtue), seductive/dangerous beauty (linked to erotic power and political agency), and autonomous/subversive beauty (connected to poetic independence or supernatural liminality). These archetypes were then mapped to modern aesthetic preferences observed in plastic surgery and beauty culture, revealing enduring continuities between mythic spatial symbolism and contemporary beauty practices. For example, classic traits associated with \"natural elegance\" reflect sacred archetypes, while glamorized, high-contrast features mirror seductive ideals. Expressive or gender-fluid styles, common in avant-garde and queer aesthetics, align with subversive mythic figures. The geographic distribution of these regions-Greek mainland, Aegean islands, Eastern Mediterranean, and mythic outer realms-also reflects symbolic boundaries between civic order, marginal autonomy, exotic allure, and supernatural transformation. The study concludes modern aesthetic desires remain deeply influenced by cultural memory, and that recognizing these archetypal continuities can enrich both the anthropological understanding of beauty and the ethical discourse within aesthetic medicine. These findings offer novel, interdisciplinary framework for interpreting the symbolic underpinnings of aesthetic preferences, enabling more personalized and culturally informed approaches in clinical practice.</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":"145131078","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":"Painless Reduction of Temporomandibular Joint Dislocation.","authors":"Ruochen Liao, Kun Lv","doi":"10.1097/SCS.0000000000011977","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011977","url":null,"abstract":"<p><p>Temporomandibular joint (TMJ) dislocation causes significant pain and functional impairment in patients, necessitating prompt manual reduction. Conventional manual reduction techniques often induce substantial discomfort, resulting in unpleasant clinical experiences. The authors have introduced a novel technique for nitrous oxide (N2O)-facilitated spontaneous reduction of TMJ dislocation. This technique is characterized by its simplicity, efficacy, and pain-free nature, eliminating the need for physician intervention.</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":"145131135","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":"Functional Outcomes of Staged Triangular Cheek Flap Commissuroplasty in Oral Cancer Patients With Free Flap Reconstruction of Through-and-Through Defects.","authors":"Rushil R Dang, Angela Chien-Yu Chen, Yi Chieh Chang, Chung-Kan Tsao","doi":"10.1097/SCS.0000000000011901","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011901","url":null,"abstract":"<p><p>This study evaluates functional outcomes of triangular check flap commissuroplasty after free flap reconstruction of through-and-through defects. Twenty-two patients were reviewed from the institutional data set. Outcome variables included postoperative diet, drooling, and change in maximal incisal opening (MIO). A telephonic assessment of the drooling severity and frequency scale (DSFS) was also performed. A Wilcoxon signed rank test for differences between groups and a univariate analysis were performed. The majority of patients were reconstructed with an ALT flap (82%). No significant change in type of diet (P=0.87) or MIO (P=0.63) was noted. Eighty percent of patients reported improvement in drooling with DSFS score being 6.5 ± 2.1 and 4.2 ± 1.6 (P=0.02) preoperatively and postoperatively. No predictors were identified on UV analysis. Triangular cheek flap commissuroplasty did not demonstrate a significant change in MIO or type of diet after revision surgery. In addition, a gross improvement in drooling was noted.</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":"145131108","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":"Costal Cartilage Chip Grafting for High-Arched Narrow Palate Deformity Secondary to Palatal Bone Fracture.","authors":"Hajime Nakaya, Nobuyuki Mitsukawa, Yoshihisa Yamaji","doi":"10.1097/SCS.0000000000011986","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011986","url":null,"abstract":"<p><p>Palatal bone fractures are often associated with vertical maxillary fractures, but direct reduction of the palatal bone itself is rarely performed. We report a case in which a high-arched narrow palate deformity following palatal bone fracture associated with multiple facial fractures was successfully corrected by grafting costal cartilage chips to the hard palate. The patient was a 25-year-old man. At the age of 19, he sustained a cervical spinal cord injury at the C4 level and multiple facial fractures-including maxillary fracture with zygomatic and palatal bone fractures, as well as mandibular fracture-due to a traffic accident. Open reduction of the facial fractures was performed at another hospital. During follow-up at our institution, he complained of food accumulation in the depression of the hard palate caused by the palatal fracture and requested treatment. Although he could take food orally, cervical spinal cord injury had resulted in restricted tongue mobility and complete paralysis below the neck, making removal of food residues with his tongue or hands difficult. Intraoral examination revealed a reverse V-shaped depression of the palate, consistent with a high-arched narrow palate deformity. Surgery was performed by elevating a mucoperiosteal flap of the hard palate, slicing costal cartilage harvested from the 7th rib into chips, and grafting them into the depressed area of the hard palate. At 3 years postoperatively, the depression of the hard palate had markedly improved, and no food retention was observed. In general, deformities of the hard palate resulting from palatal bone fracture rarely cause functional impairment, and few reports of surgical treatment exist. In this case, we achieved a favorable outcome for a chronic high-arched narrow palate deformity using costal cartilage chip grafting. Costal cartilage chips, which are also used in the treatment of old orbital fractures with enophthalmos, offer advantages such as balanced and adjustable filling of depressed defects and low resorption compared with bone or soft tissue grafts. This method appears to be a useful surgical option for symptomatic high-arched narrow palate deformities.</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":"145131031","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":"Causal Links Between Psychiatric Disorders, Sleep Apnea, and Oral and Maxillofacial Diseases Modules: A Mendelian Randomization Study.","authors":"Chi Zhang, Minsheng Zheng, Chenxinzi Lin, Mingjuan Li, Chongjie Zhu, Mohan Zhu, Qilong Wan","doi":"10.1097/SCS.0000000000011976","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011976","url":null,"abstract":"<p><p>The impact of psychiatric disorders on oral/maxillofacial diseases through sleep apnea syndrome (SAS) remains incompletely understood. Using bidirectional and multivariable Mendelian randomization (MR), this study aimed to investigate potential causal links between psychiatric disorders, SAS, and oral/maxillofacial diseases, while assessing the mediating role of SAS. The authors analyzed genome-wide association study (GWAS) summary statistics using univariable MR to evaluate whether genetically predicted psychiatric disorders influence oral/maxillofacial manifestations; bidirectional MR and mediation MR were used to determine causal directionality and mediation effects. Univariable MR revealed that major depressive disorder increased risks of dentofacial anomalies (OR=1.25, 95% CI: 1.06-1.48, P=0.007), temporomandibular disorders (TMD) (OR=1.54, P=8×10-5), and temporomandibular muscle pain (OR=1.52, P=0.0008); post-traumatic stress disorder elevated risks of dentofacial anomalies (OR=1.07, P=0.02) and TMD (OR=1.09, P=0.04); autism spectrum disorder was associated with temporomandibular muscle pain (OR=8.10, P=0.008). Bidirectional MR confirmed mutual causation between SAS and dentofacial anomalies. Mediation analysis estimated SAS mediated 21.5% (95% CI: 13.1%-31.2%) of the effect of major depressive disorder on dentofacial anomalies. Psychiatric disorders exert causal effects on oral/maxillofacial diseases, partially mediated by SAS; these results highlight SAS as a mediator between psychiatric disorders and oral/maxillofacial diseases and underscore its bidirectional causality with dentofacial anomalies, suggesting novel targets for preventive interventions.</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":"145131040","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":"Defining the Normal Range of Forehead Convexity in Infants: Moving Toward an Objective Diagnosis of Metopic Craniosynostosis.","authors":"Austin Tapp, Esperanza Mantilla-Rivas, Theodore Hyman, David García-Mato, Sohel Rana, Perry S Bradford, Nathan Oh, Athena Zhang, Kathleen N Johnson, Robert Keating, Albert Oh, Marius George Linguraru, Gary F Rogers","doi":"10.1097/SCS.0000000000011741","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011741","url":null,"abstract":"<p><strong>Background: </strong>Metopic craniosynostosis (MCS) presents unique diagnostic challenges. Objective measures to correctly diagnose MCS have been developed, but mostly rely on thresholds obtained through subjective clinical diagnosis. This study quantifies the spectrum of normal infant anterior cranial shapes using an entirely automated method to aid in diagnosis of MCS using population statistics.</p><p><strong>Methods: </strong>A retrospective review of computed tomography (CT) scans from patients aged 0 to 24 months was completed. Patients with known craniosynostosis or associated syndromes, hydrocephalus, or other brain or cranial abnormalities were excluded. Optimal interfrontal angle (oIFA), transverse forehead width (TFW), skull circumference (SC), intracranial volume (ICV), and malformation range (MR) were calculated using an automated analysis pipeline.</p><p><strong>Results: </strong>A total of 582 subjects were included. Median age at CT scan was 11.6 months. Males demonstrated significantly higher median ICV, TFW, and SC than females (P<0.001 for all). OIFA was inversely correlated with age, decreasing by approximately 8 degrees between neonates and 24-month-old children. Transverse forehead width, SC, and ICV all increased significantly over the same age range (P<0.001 for all).</p><p><strong>Conclusion: </strong>This study provides the largest and most comprehensive evaluation of normal frontal cranial shape in infants to date. The data presented show that forehead convexity follows a normal distribution after correcting for age. These oIFA measurements were collected using an automated method, allowing analysis of forehead shape without any basis in subjective interpretation. This data provides a basis for abandoning subjective, clinical diagnosis of MCS.</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":"145131056","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":"A Comparison of Plating Techniques for the Treatment of Mandible Fractures: A Systematic Review and Network Meta-Analysis.","authors":"Tyler Jacobs, Ariana L Shaari, Disha Patil, Saad Mohammed, Vincent B Ziccardi","doi":"10.1097/SCS.0000000000011965","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011965","url":null,"abstract":"<p><p>The purpose of this study was to compare complication rates for mandibular fracture management using 1 mini-plate, 2 mini-plates, reconstruction plates, and 3D plates. Complications that were assessed included infections, malocclusion, neurosensory disturbances, wound dehiscence, hardware failure, and malunion/nonunion. A network meta-analysis was conducted to compare the overall number of complications with each plating system. A traditional meta-analysis was then performed for the 6 pairwise comparisons between the 4 plating techniques for the overall number of complications. A subnetwork meta-analysis was conducted for each complication type with 1 mini-plate as the common comparator. The primary outcome assessed was the overall postoperative complication rate, which was defined as the percentage of total complications out of the total number of patients observed with each surgical technique. The secondary outcome assessed was the rate of each individual type of complication, defined as the percentage of each specific complication out of the total number of complications. Fifteen studies with 676 patients (1 mini-plate: 183 patients, 2 mini-plates: 301 patients, reconstruction plate: 32 patients, 3D plate: 160 patients) were included. Thirty-six percent, 32%, 9%, and 8% of patients with 1 mini-plate, 2 mini-plates, reconstruction plates, and 3D plates, respectively, experienced complications. Overall, the most common complication was neurosensory disturbances, which accounted for 46% of all complications. 3D mini-plates were associated with the fewest number of complications. Further research into the optimal plating scheme for patients with mandibular fractures is warranted.</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":"145130870","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}