To describe clinical changes observed after standardized complete decongestive therapy (CDT) in patients with head and facial lymphedema (HFL) in a retrospective single-arm case series. Eighteen patients with HFL treated between April 2021 and October 2023 were retrospectively included. All participants underwent standardized CDT. The primary quantitative outcome was subcutaneous percentage water content (PWC), measured using the LymphScanner (Delfin Technologies, Finland) at baseline and post-treatment. Composite hemifacial length, calculated from facial linear distances measured at prespecified anatomical landmarks, was evaluated as an exploratory secondary outcome. PWC, the primary quantitative outcome, was lower post-treatment (P < 0.001). Exploratory composite hemifacial length was also lower post-treatment (P < 0.001), and the within-patient changes in the two measures were positively correlated (r = 0.793, P < 0.001). Patient-reported symptoms showed descriptive improvement. The association between longer self-management and less deterioration was exploratory. In this small uncontrolled retrospective series composed predominantly of patients with early-stage HFL, lower post-treatment PWC and exploratory composite hemifacial length, together with improvement in patient-reported symptoms, were observed following CDT. These findings cannot establish causality or be generalized to advanced HFL and should be considered preliminary and hypothesis-generating.
Resection of tumours involving the mandibular condyle, ramus, or temporomandibular joint region removes the joint and, when the ramus or body is included, mandibular continuity. This review examined outcomes, prosthetic approaches, and complications of alloplastic total temporomandibular joint replacement (TMJR) after such resections. PubMed/MEDLINE, Scopus, and Embase were searched to 30 May 2026, with a supplementary search on 15 October 2026 and citation searching. Studies of contemporary total TMJR with at least one identifiable neoplasm-related ramus-condyle resection were eligible; case series required at least three patients. Studies were appraised with ROBINS-I or the JBI case-series checklist. Synthesis followed SWiM by tumour stratum (vote counting by direction of effect), supplemented by an exploratory random-effects meta-analysis of the change in mouth opening; neither was prespecified. Certainty was rated with GRADE (PROSPERO CRD420261406211). Forty studies (1169 total TMJR patients) included 232 neoplasm-related patients (209–210 unique): 124 with benign tumours confined to the condyle or joint, 50 with benign tumours requiring ramus or ramus–body resection, and 38 with malignant tumours. After condyle-confined resection, opening increased by about 6 mm in the two largest series, and joint-preserving low condylectomy gave similar pain relief and better lateral excursion in one comparison. After ramus or ramus–body resection, opening reached about 30–37 mm, but permanent facial nerve deficits followed 29–41
This scoping review mapped the use of mixed reality and augmented reality (MR/AR) as intraoperative navigation-transfer templates in orthognathic surgery. PubMed, Embase and the Cochrane Library were searched from inception to 19 September 2026, supplemented by a manual/citation search; screening and data charting were performed independently by two reviewers, with disagreements resolved by a third. Searches identified 364 records (363 from databases, 1 via citation searching); after removing 13 duplicates and screening 350 records, 23 reports were sought for retrieval (0 not retrieved) and assessed for eligibility, of which 3 were excluded. Twenty studies were included (19 from databases, 1 from citation searching; 12 clinical and 8 preclinical/phantom studies). MR/AR was used mainly for osteotomy-line transfer, maxillary or mandibular segment repositioning, occlusion verification, and plate or patient-specific implant (PSI) fixation. Optical-see-through head-mounted displays, especially HoloLens or HoloLens 2, were the most frequently reported platform, and marker-based registration predominated over markerless teeth- or surface-matching approaches. Reported accuracy varied by error type and workflow task and is presented separately for registration/tracking error, surface-distance error and postoperative repositioning error rather than as a single pooled range. Twelve of 20 studies were single-arm accuracy studies assessed only against a reference standard (planned virtual surgical plan vs. postoperative imaging), and 8 of 20 included a concurrent comparator arm. MR/AR is used mainly as an intraoperative adjunct for transferring the virtual surgical plan in orthognathic surgery. The available evidence suggests technical feasibility and generally sub-millimetre-to-2 mm deviations under favourable conditions, but remains heterogeneous and dominated by small, early-phase, largely single-arm studies; it should not be read as a validated or pooled accuracy estimate. Well-designed comparative studies with standardized, clinically anchored outcome thresholds are still needed.
Cleft lip and/or palate causes complex nasal deformities that result in persistent obstruction. This study aimed to quantitatively assess nasal airflow and simulate virtual surgical interventions using CT-based Computational Fluid Dynamics (CFD) in pediatric cleft patients. CT scans from two pediatric cleft patients (10 months and 5 years old) and age-matched controls were used to generate 3-dimensional nasal models. CFD simulations quantified mass flow rate, pressure drop, and nasal resistance during peak inspiration and expiration. Time-varying pressure–flow data allowed generation of virtual rhinomanometry curves. Virtual surgeries included isolated rhinoplasty, isolated septoplasty, and combined rhinoseptoplasty. Baseline cleft models exhibited markedly elevated nasal resistance and asymmetric airflow. The functional effects of virtual anatomical correction differed between patients. Septal correction accounted for most of the resistance reduction in the 10-month-old model, whereas combined correction of the septum and nasal framework produced the closest approximation to control airflow in the 5-year-old model. CFD provides a quantitative, patient-specific characterization of the airflow mechanics underlying nasal obstruction in pediatric cleft patients. The magnitude of functional improvement produced by virtual anatomical correction varied markedly between the two patients, underscoring the patient-specific nature of nasal airflow mechanics across early childhood. Virtual surgery, coupled with CFD, offers a realistic framework for exploring the mechanical determinants of nasal obstruction in this population, with future automation potentially facilitating its integration into individualized, physiology-based assessment.
Microvascular free flap transfer is essential in contemporary oral and maxillofacial reconstruction. However, acquiring microvascular anastomosis skills remains challenging in low-resource settings due to a heavy dependence on high-cost instruments and expert supervision. This scoping review (ScR) mapped the existing evidence on immersive reality (IR) technologies for microvascular anastomosis training and explored their potential applications in educationally limited and low-resource environments. Comprehensive literature searches were performed in PubMed/MEDLINE, Embase, the Cochrane Library, and Scopus for studies published between 2010 and April 2026, following the PRISMA-ScR guidelines. Seven studies published between 2010 and 2024 met the inclusion criteria. Although these studies supported specific microsurgical tasks, most described proof-of-concept prototypes with limited validation. Furthermore, none evaluated a structured microvascular reconstruction curriculum. Crucially, no included study directly evaluated maxillofacial reconstructive surgeons or trainees, nor did any specifically address head and neck microvascular anastomosis curricula. Current evidence indicates technical promise alongside significant literature gaps, as effectiveness, clinical transfer to the operating room, and cost-effectiveness remain unproven. To address training disparities, we introduce an author-proposed staged curriculum framework wherein lower-cost IR platforms provide foundational orientation, instrument handling, depth perception, suture sequencing, and ergonomic visualization before trainees’ progress to bench, biological, and supervised clinical training.
