Background:Understanding the anatomical relationship between the pneumatized middle turbinate (PMT) and ethmoid roof structures is crucial for minimizing complications in endoscopic sinus surgery. We aimed to evaluate the association between PMT and the dimensions of the anterior ethmoid roof using cone-beam computed tomography (CBCT) imaging. Methods:A retrospective, cross-sectional study was conducted on 249 CBCT scans obtained at a maxillofacial radiology center. All images were acquired using a NewTom VGi scanner (QRsrl, Verona, Italy) with a 15 × 15 cm field of view and 1-mm slice thickness. Measurements were taken from coronal sections displaying the infraorbital nerve canal. Key anatomical points, including the medial and lateral ethmoid roof points (MERP and LERP) and the cribriform plate (CP), were identified. The width and height of these structures were measured. PMT was classified as lamellar, bulbous, or extensive. Statistical analyses included chi-square, t-test, and Pearson correlation tests. Results:A significant relationship was found between the axial dimensions of PMT and the anterior ethmoid roof width (AER) in both genders (P<0.05). Differences in ethmoid roof dimensions were statistically significant between PMT types. In males, vertical PMT dimensions were correlated with CP and AER height. AER width was greater in males than females, particularly in cases with PMT. Conclusion:A close anatomical relationship exists between PMT and ethmoid roof dimensions, especially AER width. Recognition of these variations is essential for surgical planning and avoiding complications in sinus and skull base surgery.
Background: We compared two endoscopic brow lift fixation techniques in a 2023 randomized clinical trial: bone tunnel fixation versus temporary tape fixation. The primary objective was to evaluate the stability of the brow lift over time. Methods: Patients were randomly assigned to either the bone tunnel group or the tape fixation group, where a mesh tape was secured to the scalp and removed 7-10 days post-surgery. In total, 36 individuals participated in the study, including 18 patients in the Taping group and 18 patients in the Bony Fixation group. Pre-operative eyebrow measurements were taken, and patients were followed up at one and nine months to assess outcomes Results: While the bone tunnel technique required a significantly longer surgical time, it was more effective at maintaining the brow lift in both the medial and lateral regions of the eyebrow after nine months. Complication rates were similar between the two groups. Conclusion: Bone tunnel fixation provides superior long-term stability for endoscopic brow lift compared to temporary tape fixation, despite the longer procedure duration. Further research with extended follow-up is recommended to confirm long-term outcomes.
The rare odontogenic tumor known as ameloblastoma presents serious problems for kids because of its aggressive nature and capacity to hinder development and function. In order to maximize results, the mural subtype of unicystic ameloblastoma necessitates precision surgical intervention and creative restorative techniques. A 12-year-old girl who presented with discomfort, swelling, and tenderness in her left mandible is described in this report. The patient was admitted to Velayat Hospital in Mashhad, Iran, in 2024 and received the necessary medical treatment there. Histopathological and radiographic analysis verified mural ameloblastoma. A segmental resection of the mandible was part of the treatment, with an emphasis on protecting vital anatomical features including the inferior alveolar nerve and periosteum. Allograft and xenograft materials were applied after a prefabricated plate was used to accomplish reconstruction. Frequent radiography follow-ups showed excellent mandibular continuity restoration and spontaneous bone regeneration. Occlusal modifications boosted functional outcomes, guaranteeing both functional and aesthetic rehabilitation. This example emphasizes the value of a customized strategy in the treatment of pediatric ameloblastoma, stressing the need to strike a balance between growth preservation and efficient tumor eradication. The treatment addressed the aggressive character of the tumor while reducing the chance of recurrence by combining precise surgical procedures with cutting-edge reconstructive strategies. Results were further improved by the use of adaptive dental measures and the preservation of important components. Managing pediatric ameloblastoma requires a customized, multidisciplinary treatment plan. This case demonstrates the efficacy of combining radical and conservative procedures to provide long-term growth, functional restoration, and minimal recurrence risk. Early diagnosis, meticulous surgical planning, and continuous postoperative monitoring enabled the positive results.
Elbow wounds secondary to septic olecranon bursitis are a challenging problem to treat. Neurotized fasciocutaneous free anterolateral thigh (ALT) flaps provide a reliable soft tissue coverage option with the opportunity to provide protective sensation to a common pressure point. Free flaps can provide coverage when alternative options lower on the reconstructive ladder are unavailable. A 69-year-old man with rheumatoid arthritis presented with septic olecranon bursitis requiring serial debridement resulting in significant soft tissue loss and bone exposure. A free ALT, with fascial tacking sutures, was used for reconstruction with subsequent neurotization resulting in successful resolution of bursitis and persistent fluid drainage. Neurotized free ALT flaps provide durable soft tissue coverage for a challenging area to treat while also providing sensory protection to a pressure point area.
Background: Neck tissue expansion is a widely accepted method for facial scar reconstruction due to its optimal color and texture match Methods: This retrospective study evaluated outcomes in 42 patients who underwent hemifacial scar reconstruction using tissue expanded transposition flaps from the ipsilateral neck. Results: Patient records were reviewed for demographic data, surgical variables, and complications. The majority (95.2%) had burn-induced scars; a single expander was used in 92.9% of cases, while three patients required two expanders. The mean expansion duration was 115.86 days. Major complications occurred in 9.5% of patients, and minor complications in 14.3%; extrusion and infection were most common Conclusion: Transfer of expanded neck skin as transposition flap, is demonstrated to be a reliable reconstructive technique for complete resurfacing of hemifacial scars with minimal contour deformities and optimal final scar.
Background:Breast hypertrophy significantly impairs quality of life, causing musculoskeletal pain, poor posture, and psychological distress, including reduced self-esteem. Reduction mammoplasty offers a surgical approach to mitigate these challenges. We evaluated patient satisfaction with aesthetic and functional outcomes following the procedure at a specialized referral center. Methods:This retrospective, cross-sectional analysis was conducted on 16 patients who underwent reduction mammoplasty for gigantomastia in the Hospital General "Dr. Manuel Gea González" Mexico City, Mexico from January 1, 2022, to July 31, 2024. Data from medical records included demographics (age, BMI), surgical indications, resected tissue weight, and BREAST-Q responses assessing satisfaction with breast appearance, surgical outcomes, and psychosocial, physical, and sexual well-being. Results:Patients had a mean age of 46.5 years, with 43.7% classified as obese. Physical discomfort was the primary surgical indication (62.5%), and 62.5% had 501-1000 g of tissue resected. High satisfaction was reported for surgical outcomes (87.5%) and physical well-being (93.7%), yet dissatisfaction was notable with breast appearance (56.2%), psychosocial well-being (100%), and sexual well-being (81.2%). Satisfaction with the surgeon was 87.5%, and with other staff, 62.5%. Conclusion:Reduction mammoplasty effectively improves physical health and surgical satisfaction; however, persistent dissatisfaction with aesthetic and psychosocial outcomes highlights the need for enhanced preoperative counseling. Tailored discussions could better align patient expectations with achievable results, improving overall care.
Background: Venous thromboembolism (VTE) is one of the known medical complications in autologous breast reconstruction (ABR) which is associated with a short and long-term morbidity as well as mortality. Identifying VTE risk factors is crucial for appropriate VTE prophylaxis measurements to lower this complication following ABR. Methods: Using American College of Surgeons National Surgery Quality Improvement Project database, we examined the clinical data of patients who underwent ABR from 2016-2020 in the US. The frequency of VTE, day of occurrences and risk factors associated with VTE were evaluated. Results: Overall, 11,847 patients underwent ABR in the study period. The overall VTE rate was 1.0%. Totally 117 patients experienced VTE with a total occurrence of 127. Postoperative day 1 and 2 were reported with the highest frequency of VTE (21/127). Using multivariate regression analysis, independent risk factors associated with a higher VTE rate were length of hospital stay>=5 d [adjusted odd's ratio (AOR), 3.29], operative time longer than 10 h (AOR,2.17), and immediate reconstruction (AOR,1.51). Although free flap breast reconstruction was associate with a higher VTE rate compared with pedicled flap reconstruction (1.2% vs. 0.8%); however, multivariate regressing analysis did not show this factor as an independent VTE risk factor. Conclusion: Being proactive to make the patients ready to discharge by POD-4 and having strategy to shorten the length of operation could help to lower the rate of VTE in ABR. Plastic surgeons should consider these factors and use appropriate prophylactic measures to minimize the risk of VTE development.
BACKGROUND: Starting a genioplasty osteotomy on the curved anterior mandible can cause the saw to skid. This poses a risk of deviating from the planned trajectory and potentially injuring the mental nerve. We propose a simple modification: pre-scoring the osteotomy line with a fissure bur to create shallow cortical tracks. These tracks act as a mechanical guide for the micro-saw. METHODS: After bilateral exposure of the parasymphysis with visualization of the mental nerve, the planned osteotomy was marked beneath the foramina. A fissure bur was then used with copious irrigation to gently score the marked line, creating linear cortical tracks. A reciprocating or oscillating micro-saw was then introduced and advanced within these tracks to complete the osteotomy. RESULTS: In a representative adult case, the saw engaged the bur-scored grooves without skidding, allowing the osteotomy to follow the planned path. The segment was mobilized and plated as intended. The pre-scoring step added approximately 2 minutes to the procedure and required no additional instruments. Transient lower-lip/chin hypoesthesia resolved by 8 weeks, and no re-operations were necessary. CONCLUSION: Pre-scoring provides a low-cost, easily adopted anti-skid step that improves initial directional control of the saw during genioplasty. This modification uses routine instruments and may enhance accuracy and safety near the mental nerve. However, meticulous retraction and irrigation remain essential.
Contemporary cosmetic surgical approaches to facial rejuvenation have undergone a significant transformation due to the integration of new technologies aimed at addressing age-related facial changes. Among the most commonly used minimally invasive techniques are neuromuscular blocking agents and injectable fillers. The scope of minimally invasive procedures encompasses a broad range of modalities, including nutritional and hormonal interventions, light- and laser-based therapies, minimal-incision surgeries, as well as botulinum toxin and dermal filler injections. This study specifically focuses on injectable techniques for facial rejuvenation. Botulinum toxin type A has demonstrated efficacy in softening hyper functional lines in both the upper and lower face, with notable improvements observed in areas such as the glabella, forehead, periorbital region, lips, and platysma muscle. More recently, hyaluronic acid and other injectable fillers have gained widespread use. These temporary fillers effectively diminish wrinkles and creases, enhance deep nasolabial folds, augment thin lips, and correct volume loss in periorbital hollows and other facial depressions or contour irregularities. A major paradigm shift has occurred in facial rejuvenation, with injectable, minimally invasive methods now offering solutions for age-related and acquired deformities of the head and neck-providing temporary yet effective corrections that were historically managed through more invasive surgical approaches.
Ameloblastic fibro-odontoma (AFO) is a rare benign mixed odontogenic tumor characterized by both soft tissue proliferation and dental hard tissue formation. This case report presents a 16-month-old male with AFO in the anterior mandible, representing one of the youngest documented cases. The patient presented with progressive facial swelling first noted at 10 months of age. Clinical examination revealed facial asymmetry with non-tender buccal expansion, while CT imaging demonstrated a well-defined 23×28mm lytic lesion with internal calcifications in the right parasymphyseal region. Treatment consisted of conservative surgical enucleation and curettage under general anesthesia, with extraction of involved teeth. Histopathological analysis confirmed the diagnosis of AFO, showing islands of ameloblastic epithelium within mesenchymal stroma and evidence of dentin and cementum formation. A literature review of AFO cases in children under 5 years (2014-2024) yielded eight cases with equal gender distribution and no clear predilection for maxilla versus mandible. All reported cases showed lesional expansion, and most were treated with enucleation and curettage with no recurrence noted during follow-up periods. The patient recovered uneventfully with resolution of facial asymmetry and showed no signs of recurrence at six-month follow-up. This case highlights that AFO could manifest at an exceptionally young age, expanding the recognized age range and underscoring the effectiveness of conservative surgical management for this rare odontogenic tumor.
Background:The aim of this article was to perform a bibliometric analysis of Iranian researchers in orthognathic surgery. Methods:A bibliographical search for orthognathic surgery literature on Iran was conducted on Wef of Science. Mendeley and Microsoft Excel were used for tabulation and data visualization. Some statistical tests were performed with a 95% confidence interval, considered significant. Results:From 7,535 articles, 86 included at least one Iranian author, making Iran the second highest contributor in the Middle East after Turkey. Notable topics beyond orthodontic treatment included cosmetic surgery, obstructive sleep apnea, blood clotting, and anesthesiology, with complications being the most studied. Emerging themes were Virtual Surgical Planning and technology. Statistical analysis showed a very high Pearson correlation between the number of ranked institutions and both the number of published articles (ρ=0.85) and the quantity of citations (ρ=0.80), and a moderate correlation with the H-index (ρ=0.46). No correlation was found between citations per document and the number of ranked institutions (ρ= -0.27). Conclusion:Iran is a leading country in the field of orthognathic surgery, both regionally and globally. This article provides valuable insights for Iranian researchers and academics, highlighting the potential of international collaboration and free open-source technology to advance knowledge in areas like Virtual Surgical Planning. Promoting global partnerships and utilizing innovative technologies can enhance patient outcomes and benefit practitioners in resource-limited regions worldwide.
Congenital absence of nasal cartilage elements is a rare finding in patients undergoing elective rhinoplasty. We report a case of a 27-year-old woman with no prior trauma, respiratory complaints, or syndromic features, who presented for aesthetic rhinoplasty. Intraoperatively, congenital agenesis of the left middle and lateral crura of the lower lateral cartilage (LLC) was identified. Reconstruction was performed using septal cartilage harvested during submucosal resection. The patient had an excellent aesthetic and functional outcome. This case highlights the importance of surgeon preparedness for unexpected congenital anomalies, even in cosmetic settings.
Backgrounds:Autologous fat grafting is a promising modality for burn scar improvement due to its potential for tissue regeneration. However, the effectiveness of injection methods remains debated. This study compares sharp versus blunt needle techniques for adipose tissue transplantation into burn scars. Methods:Nineteen patients with mature burn scars underwent split-scar fat grafting using both blunt and sharp needle injections. Fat was harvested, processed, and injected at 0.5 cc/cm² under anesthesia. Scars were clinically assessed using POSAS by both observers and patients at baseline and six months post-procedure. Statistical analyses compared changes in scar quality and complication rates between groups. Results:Both injection methods produced significant improvements in scar pliability, pigmentation, and overall appearance according to patient and observer POSAS scores. No statistically significant differences in efficacy or complication rates were found between sharp and blunt needle injections. Conclusions:This study confirmed that fat injection has been capable of improving the quality of burn scar, regardless of blunt Vs sharp needle technique with similar complication rates. However, sharp injection of fat in burn scar is technically easier and faster compared to blunt injection.
Ameloblastoma, a benign but locally aggressive neoplasm, frequently requires substantial surgical resection to avert recurrence, potentially leading to considerable mandibular abnormalities. This case report examines a 31-year-old female patient diagnosed with a multilocular ameloblastoma, originally treated with marginal excision and subsequent reconstruction utilizing a conventional plate. The patient was admitted to Velayat Hospital in Mashhad, Iran, in 2024 and received the necessary medical treatment there. Complications, including as plate exposure and jaw deviation, arose a year later, requiring further operation. The patient underwent a second operation to remove the defective plate and to insert a bespoke digital reconstructive plate. The customized plate was engineered to conform to her distinct anatomical configuration, guaranteeing accurate alignment and enhanced biomechanical efficacy. The post-operative recovery was positive, with restored mandibular alignment, enhanced function, and no recurrence of problems. This case demonstrates the effectiveness of tailored digital reconstruction plates in managing intricate mandibular abnormalities, yielding improved results in functionality, aesthetics, and patient comfort.
Background:Cryolipolysis has emerged as a promising, non-invasive body contouring technique that employs controlled cooling to selectively eliminate adipocytes without damaging surrounding skin or tissues. As global demand rises for non-surgical aesthetic treatments, cryolipolysis offers an appealing alternative to traditional liposuction for individuals seeking fat reduction with minimal recovery time and fewer complications. Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed, Scopus, and Web of Science was conducted up to November 2024. Studies included were randomized controlled trials and prospective cohort studies evaluating the outcomes of cryolipolysis on body contouring. Statistical analysis was performed using Review Manager 5.4 software, calculating mean differences (MD) and 95% confidence intervals (CI). Results:The use of cryolipolysis was associated with decreased BMI showing MD= -1.71 (95%CI: -2.6, -0.82, P=0.0002). However, no significant difference was observed regarding weight with MD= -1.81 (95%CI: -3.93, 0.31, P=0.09). The use of cryolipolysis was also associated with decreased circumference of different body parts with MD= -3.45 (95%CI: -5.55, -1.34, P=0.001), and I2=92%, P<0.00001 and decreased fat thickness with MD= -3.56 (95CI: -4.63, -2.48, P<0.00001), and I2=95%, P<0.00001. Conclusion:Cryolipolysis is effective in reducing BMI, local circumference, and fat thickness, confirming its utility for non-invasive body contouring. However, it does not significantly affect overall weight. The benefits are more pronounced in short-term follow-up and vary by body region. Further long-term and comparative studies are recommended.
Backgrounds:Dental implants are often utilized to replace missing teeth in the maxillary posterior region. Following tooth extraction, bone grafting, and implant placement are carried out in stages. However, in medical procedures errors are inevitable; therefore, measures should be taken to address and reduce these errors in future treatments. Methods:Implants displaced inside the maxillary sinus were reviewed to identify the best techniques for retrieving them. We conducted a comprehensive search in Scopus, PubMed, and Web of Science databases from January 2000 to January 2023. Inclusion criteria were original studies including original cohorts, case-controls, and clinical trials that evaluated methods of retrieving displaced maxillary implants. Results:Overall, 258 publications were identified. After elimination of duplicates and those not meeting the inclusion criteria, full texts of 24 articles were reviewed. Of the 120 displaced implants, 57 were dislocated during surgery. The most common complication following implant displacement is maxillary sinusitis, which typically manifests a year post-op. Conclusion:Displacement of implants in the maxillary sinus is a common occurrence caused by a variety of factors. Implant displacement could lead to complications in the maxillary sinuses, paranasal sinuses, and other adjacent anatomical spaces and structures.
Stem cell polyphenols represent a promising avenue for enhancing wound healing through their multifaceted biological activities. Polyphenols, naturally occurring compounds with potent antioxidant properties, can modulate inflammatory responses, reduce oxidative stress, and promote the proliferation and migration of essential cells involved in tissue repair, such as fibroblasts and keratinocytes. Additionally, they play a critical role in angiogenesis, facilitating improved blood supply to healing tissues. Research indicates that the synergistic use of polyphenols with stem cell therapies could further optimize wound healing outcomes by enhancing stem cell function and survival. As conventional skin disease treatments, primarily corticosteroids, often provide only temporary relief and come with significant side effects, there is increasing interest in stem cell therapies for skin conditions. Stem cells have shown positive outcomes in treating eczema, psoriasis, diabetic wounds, and burns, utilizing both animal and plant stem cell products. However, plant-derived stem cells and natural products, including phytochemicals like resveratrol and curcumin, are preferred due to their reduced side effects and sustainability. These natural compounds aid all stages of wound healing by modulating signaling pathways associated with skin repair and regeneration, thereby minimizing residual wound effects. This review explores the effectiveness of specific natural products and introduces plant derivatives, including plant stem cells and cytokines, highlighting their potential in advancing therapeutic strategies for improved wound healing and skin regeneration. Further clinical investigations are needed to elucidate the optimal types and dosages of polyphenols for clinical applications in regenerative medicine.
Cleft lip and palate is one of the most common congenital malformations of the skull and face (craniofacial). The deformity is characterized by a loss of integrity of the lip muscles, alveolar bone, and hard and soft palate. The severity of the deformity can range from a small hole in the lip to a large fissure extending into the roof of the mouth and nose. Management and control of cleft patients is a challenge. Intervention in these patients begins very early in life, from the fetal period, and continues into adulthood, and the patient's relatives are always involved in the treatment process. Since there are multiple problems in these patients, the treatment process is managed in a group and multidisciplinary manner to achieve the desired result. The goal of all treatment measures for a person with a cleft lip and palate is to provide intelligible speech, hearing within a normal range, good facial appearance, proper lip and nose symmetry, an attractive smile, good occlusion, healthy oral structures, and ultimately appropriate self-confidence. In the current study, I reviewed the causes, pathophysiology, surgical repair, and treatment approaches in patients with cleft lip and palate.
This case report describes the surgical management and outcome of a 24-year-old female engineer who suffered a total scalp avulsion injury caused by an industrial food mixer. The injury extended from the level of the eyebrows to the back of her neck and was complicated by the traumatic amputation of her right-hand first finger. Successful replantation of the scalp was achieved using microsurgical techniques, with postoperative challenges including venous congestion requiring secondary intervention. This case highlights the importance of timely surgical intervention, comprehensive trauma management, and postoperative anticoagulation in extensive avulsion injuries.
