An essential step in rhinoplasty is correcting the shape of the nostrils by addressing both function and appearance. Traditional methods like alar base reduction, alar rim grafts, nostril sill augmentation, and composite grafts have specific indications and benefits. We introduce a new approach with several potential advantages. It employs a lateral rim graft inserted through a lateral incision for precise placement close to the skin. This technique enhances the nostril's contour without creating an unnatural or bulky appearance by considering the effects of two vectors. The method supplies structural support to the nostril rim while maintaining its natural curve, preventing collapse, and preserving both aesthetic and functional integrity. The recoil rim graft not only improves the nostril contour but also offers biomechanical and functional advantages by retracting the alae of the nose superior-laterally.
BACKGROUND:The goal of cleft palate surgery is to improve speech articulation; however, factors predicting postoperative speech outcome remain unclear. This study aimed to identify anatomical parameters associated with speech outcome in patients with incomplete cleft palate. METHODS:Ninety-eight patients with incomplete cleft palate who underwent palatoplasty and completed long-term follow-up of more than 4 years were included. All surgeries were performed by a single senior surgeon, and eight intraoral parameters were consistently measured intraoperatively. Speech outcomes were evaluated at 4 years of age using the Pittsburgh Weighted Speech Scale (PWSS) and the Simple Speech Screening Protocol (SSSP). Pearson correlation analysis, Kruskal-Wallis test, and multivariable linear regression analyses were performed to assess associations between anatomical parameters and speech outcomes. RESULTS:Most parameters showed no significant correlation with PWSS or SSSP. However, a greater preoperative straight palatal length and a greater postoperative curved palatal length were significantly associated with lower PWSS scores (p< 0.05). In multivariable analysis, postoperative curved palatal length remained independently associated with PWSS, and palatal width also showed a significant association, with wider palate associated with poorer speech outcome (p< 0.05). CONCLUSION:Most intraoral anatomical parameters were not independently associated with speech outcome, suggesting that factors beyond simple anatomical measurements-particularly those related to restoring appropriate velopharyngeal function, such as reconstruction of the levator veli palatini muscle-may play a more important role. Nevertheless, preoperative straight palatal length, postoperative curved palatal length, and palatal width demonstrated meaningful associations with speech outcome. Therefore, these parameters should be considered when planning palatoplasty to optimize postoperative speech outcome.
Non-syndromic craniosynostosis is the most common clinical form of craniosynostosis, but the mature phenotype cannot be accounted for by a purely local model of premature suture fusion. The deformity is the product of interactions among calvarial growth, cranial base geometry, dural and mesenchymal signaling, orbital development, and regional soft-tissue adaptation. This narrative review examines current evidence on epidemiology, developmental biology, diagnosis, imaging, operative timing, and surgical management, with emphasis on systematic reviews, multicenter and population-based data, comparative cohorts, and larger independent series. Contemporary options-conventional cranial vault remodeling, fronto-orbital advancement and remodeling, endoscope-assisted suturectomy with postoperative orthotic therapy, spring-assisted techniques, and distraction osteogenesis-each occupy a legitimate place in selected age groups and phenotypes. This review gives particular attention to distraction because of its potential for individualized, three-dimensional correction: it is the approach in which vector, magnitude, and regional expansion can be adjusted while new bone forms and the surrounding soft-tissue envelope adapts, which is precisely what a three-dimensional deformity demands. Current comparative evidence does not establish superiority for every subtype, but the biologic rationale and available clinical results justify a broader role for distraction in contemporary reconstruction. Osteotomy design and vector geometry should follow the dominant phenotype: transverse expansion when biparietal restriction predominates in sagittal synostosis; multivector correction when orbital, skull-base, or posterior vault distortion is established; and a higher operative threshold in metopic synostosis, where true fronto-orbital narrowing-not suture fusion alone-should drive the decision. Outcomes should be judged by deformity-specific three-dimensional balance, functional safety, treatment burden, and long-term stability, and not by a single cranial index.
BACKGROUND:Ultrasound-guided closed reduction allows for real-time visualization of fracture segments, overcoming the limitations of blind palpation. However, standard probes vary in resolution and adaptability. This study aimed to evaluate the clinical feasibility and efficiency of a wireless handheld ultrasound device (V-scan) by comparing it with high-end linear and hockey stick probes through a retrospective analysis. METHODS:This retrospective comparative study reviewed the medical records of 160 patients with nasal bone fractures treated between January 2024 and January 2026. Closed reductions were performed by four experienced plastic surgeons. Patients were categorized into three groups based on the ultrasound probe used: Group H (hockey stick, 8-18 MHz), Group L (linear, 3-12 MHz), and Group V (V-scan Air, 3-12 MHz). We compared radiologic reduction accuracy (residual depression and deviation), intraoperative image visibility, surgical convenience, and operative time. RESULTS:Baseline fracture characteristics were comparable among the groups, although age differed significantly (p= 0.036). Regarding radiologic outcomes, there were no significant differences in postoperative residual depression depth (p= 0.294) or deviation angle (p= 0.139) among the groups. Even in complex fractures, reduction accuracy was comparable (p= 0.198). Qualitatively, Group H achieved the highest image visibility score (4.79, p< 0.001). However, Group V demonstrated the highest surgical convenience (4.73) and shortest operative times (20.7 minutes) (p< 0.001). CONCLUSION:The wireless handheld ultrasound device demonstrated clinical outcomes comparable to high-end probes. While the hockey stick probe offers superior image clarity, the V-scan provides adequate visualization with superior workflow efficiency, making it a viable tool for nasal fracture management.
Parosteal lipoma is a rare benign neoplasm arising in intimate association with the periosteum. Involvement of the mandible is exceptionally rare. We present the case of a 75-year-old man presenting with a 1-year history of a painless, fixed mass on the left chin. Unlike previous reports of mandibular parosteal lipomas which often feature ossification or neurologic symptoms, this patient was asymptomatic, and imaging revealed a non-ossifying, homogeneous fat-density mass. The tumor was completely excised via an extraoral approach. Surgically, the mass was firmly adherent to the periosteum, requiring meticulous dissection at the subperiosteal level to ensure complete removal. Histopathology confirmed a simple lipoma. This case highlights a critical diagnostic and surgical lesson for plastic surgeons: a fixed mandibular mass, even if asymptomatic and radiologically benign, suggests potential periosteal adherence. Therefore, surgical planning must prioritize deep, periosteal-level dissection rather than simple enucleation to prevent recurrence.
BACKGROUND:Jaw bone regeneration remains a clinical challenge in maxillofacial surgery. Bioactive ceramics and neural crest-derived multipotent mesenchymal stem cells (NC-MSCs) show regenerative potential, but their combined effect in repairing jaw defects has not been fully investigated. To our knowledge, no previous studies have evaluated germanium-doped biphasic calcium phosphate ceramics combined with NC-MSCs from vibrissae in a critical-size mandibular defect model. This study aimed to evaluate biphasic calcium phosphate ceramics doped with 1% germanium (BCPdGe 1%) alone versus BCPdGe 1% combined with NC-MSCs on rabbit mandibular defect regeneration and NC-MSC viability from rabbit vibrissae. METHODS:NC-MSC properties on modified ceramics were assessed in vitro using microscopic, cytochemical, and colorimetric analyses. Nine ceramic samples with different Ge and SiO2 concentrations and NC-MSCs from rabbit vibrissae were tested. The BCPdGe 1% group without stem cells was previously evaluated in the same rabbit mandibular defect model and used as a reference control following ethical 3R principles. In vivo, 30 rabbits with critical-size mandibular defects (7 mm) were assigned to BCPdGe 1% (n= 15) or BCPdGe 1%+NC-MSCs (n= 15). Bone regeneration was analyzed histologically, and data were processed in EZR (p< 0.05). RESULTS:NC-MSCs showed the highest viability with samples no. 3 (pure hydroxyapatite doped with 1.5% germanium), no. 5 (BCPdGe 1%), and no. 7 (biphasic calcium phosphate ceramics doped with SiO2). In vivo, BCPdGe 1% alone achieved significantly better bone regeneration than BCPdGe 1% combined with NC-MSCs. CONCLUSION:Implanted NC-MSCs are highly sensitive to local biological conditions and mechanical stress, highlighting the need for further research on stem cell sources and cultivation methods.
Background: Orthognathic surgery has become increasingly accurate with the integration of computerized technologies. This study aimed to evaluate the accuracy of custom-made plates in transferring the three-dimensional virtual plan to intraoperative maxillary repositioning.Methods: This study included 10 patients. A digital surgical simulation technique was used for preoperative planning. The surgical components— osteotomy/plates, locating guides, and customized titanium plates—were fabricated using computer-aided design and manufacturing techniques, replacing the need for a surgical splint. Postoperative outcomes were assessed using unaltered anatomical landmarks from the preoperative virtual plan. Absolute discrepancies in translational and rotational movements between the planned and actual postoperative positions were measured through superimposition analysis. This evaluation assessed the precision of custom-made plates in transferring the virtual surgical plan, identifying deviations in the cephalocaudal, mediolateral, and anteroposterior directions that could influence functional and esthetic outcomes.Results: No statistically significant differences were observed for any landmarks across the axial, coronal, and sagittal planes. The greatest variability was noted at the posterior nasal spine landmark in the axial plane (1.7 mm), compared with the coronal (0.9 mm) and sagittal (0.5 mm) planes.Conclusion: Customized titanium plates effectively transferred the virtual surgical plan for maxillary repositioning without the need for an occlusal splint. However, potential posterior interference should be considered during surgical execution.
Merkel cell carcinoma (MCC) is a rare but highly aggressive cutaneous neuroendocrine malignancy that typically arises in sun-exposed skin and may secondarily invade deeper soft tissues. Primary MCC arising from non-cutaneous structures is exceedingly uncommon. We describe an unusual case of a large MCC presenting as a submandibular mass without any clinically or radiologically identifiable overlying skin lesion. This report highlights the need to include MCC in the differential diagnosis of rapidly enlarging submandibular masses lacking an apparent cutaneous origin.
Epidermoid and dermoid cysts are common congenital lesions of the pediatric periorbital region arising from ectodermal inclusion during embryologic development. Although these lesions originate in the soft tissue, chronic pressure from long-standing masses may induce cortical depression or remodeling of adjacent craniofacial bones, particularly in young children with malleable skeletal structures. We report a case of a 26-month-old girl presenting with a small periorbital epidermoid cyst associated with pressure-induced depression of the zygomatic surface. Radiologic evaluation revealed a well-circumscribed cystic lesion abutting the frontal process of the zygoma with smooth cortical indentation and no features suggestive of aggressive osseous pathology. Complete excision was performed through a lateral brow approach with preservation of the periosteum. Histopathologic examination confirmed an epidermoid cyst. Postoperative follow-up demonstrated progressive spontaneous restoration of the zygomatic contour without the need for bone grafting or alloplastic materials, reflecting the osteogenic potential of the pediatric periosteum. This case emphasizes the importance of distinguishing secondary pressure-related bone remodeling from true intraosseous lesions in the pediatric craniofacial region and highlights the capacity for natural osseous recovery following removal of the compressive source. A brief review of relevant embryologic and radiologic considerations is also provided.
Syndromic craniosynostosis is characterized by premature fusion of multiple cranial sutures accompanied by progressive craniofacial dysostosis and neurological complications. Although reduction of intracranial volume (ICV) was historically regarded as the principal mechanism underlying elevated intracranial pressure (ICP), contemporary evidence suggests that intracranial hypertension in syndromic craniosynostosis is multifactorial. Abnormal cerebrospinal fluid circulation, venous hypertension, upper airway obstruction, and premature cranial base fusion appear to contribute substantially to disease progression. A narrative review was performed using previously published clinical studies, radiologic investigations, and institutional experience regarding syndromic craniosynostosis, with emphasis on Crouzon syndrome, cranial base suture fusion, increased ICP, hydrocephalus, and surgical outcomes. Recent radiologic investigations demonstrated that cranial base sutures and synchondroses exhibit characteristic physiologic closure patterns during childhood. In syndromic craniosynostosis, particularly Crouzon syndrome, premature cranial base fusion correlates with recurrent increased ICP and repeated cranial vault remodeling procedures. Elevated ICP cannot be explained solely by reduced ICV because many patients maintain relatively normal ICV through compensatory cranial growth. Clinical manifestations of intracranial hypertension are often nonspecific, whereas papilledema and radiologic changes remain useful surveillance markers. Contemporary surgical management includes fronto-orbital advancement, cranial vault remodeling, distraction osteogenesis, endoscopic strip craniectomy, and long-term multidisciplinary monitoring. Syndromic craniosynostosis represents a progressive disorder involving not only major calvarial sutures but also cranial base structures. Premature cranial base fusion may serve as an important prognostic factor for recurrent intracranial hypertension and disease severity. Improved understanding of cranial base pathology may facilitate individualized treatment strategies and improve long-term neurological outcomes.
Atypical fibroxanthoma (AFX) is a rare fibroblastic cutaneous malignancy that predominantly arises in sun-exposed regions of the head and neck in elderly individuals. Accurate diagnosis of AFX remains challenging because of its rarity and histopathologic overlap with other spindle- cell tumors, especially when the initial biopsy findings are inconclusive. The authors encountered a 90-year-old woman who presented with a rapidly growing, ulcerative nodule on the left cheek. An initial biopsy performed at a local dermatology clinic showed spindle cell proliferation without a definitive diagnosis. A subsequent punch biopsy confirmed AFX. The patient showed no evidence of metastasis or lymphadenopathy in the preoperative examination. The tumor was treated with a wide local excision using a 1 cm safety margin, followed by a reconstruction with a full-thickness skin graft. At 1-year follow-up, the patient showed no evidence of local recurrence or metastasis, and the aesthetic outcome was satisfactory. This case highlights the diagnostic difficulty of AFX, particularly in elderly patients with nonspecific biopsy findings. Careful histopathologic evaluation, appropriate surgical management, and long-term follow-up are essential for optimal outcomes. Reporting well-documented cases like the present one may help improve the diagnostic accuracy and clinical management of this uncommon malignancy.
Recurrent scalp compromise following deep brain stimulation (DBS) implantation remains a challenging reconstructive problem, particularly in patients with chronic infection and repeated revision procedures. We present an acellular dermal matrix (ADM)-assisted salvage strategy using rotational scalp flap coverage with adjunctive calvarial recession for preservation of exposed DBS hardware. After debridement and subperiosteal flap elevation, ADM was applied over the exposed hardware as a biologic reinforcement layer prior to tension-free closure. Adjunctive calvarial recession was performed to reduce hardware prominence. Postoperative computed tomography demonstrated decreased hardware projection, and stable wound healing without recurrent dehiscence or infection was maintained during follow-up. This combined approach may represent an effective salvage option for recurrent DBS scalp compromise while preserving functional neuromodulation hardware.
Scalp angiosarcoma is a rare, aggressive malignancy with poor prognosis, particularly when multifocal. We report a 62-year-old woman with multifocal scalp angiosarcoma, a 3.5× 3.5 cm ulcerated vertex lesion within an approximately 10× 10 cm clinically abnormal vertex field and three 1× 1 cm temporal satellite lesions (two in the right temporal region and one in the left temporal region). Initial wide excision with frozen biopsy-guided margins and reconstruction using a rotation flap and split-thickness skin grafts was followed by adjuvant radiotherapy. At 7 months after completion of radiotherapy, radiation-induced necrosis with bone exposure developed in the frontal and occipital regions, with multiple biopsies negative for recurrence. Double free flap reconstruction (radial forearm free flap and adipofascial anterolateral thigh flap using a piggyback anastomosis) was performed 11 months after radiotherapy using a single recipient vessel pair. Venous congestion on postoperative day 1 was successfully revised with vein graft interposition, resulting in complete flap survival. The patient was disease-free with stable flap coverage at the latest follow-up, more than 2.5 years after radiotherapy. This case demonstrates that double free flap reconstruction using a piggyback technique can be a safe and effective reconstructive option for extensive irradiated scalp defects in multifocal angiosarcoma.
Nasopharyngeal teratomas are rare extragonadal germ cell tumors that occur infrequently in the head and neck region, with an incidence of 1 in 40,000 live births. These tumors, often detected at birth or in early infancy, consist of various tissues derived from multiple germ cell layers and can pose significant clinical challenges due to their propensity to obstruct the airway. We report a case of a 46-day-old boy who presented with respiratory distress due to a mature teratoma located in the right nasopharyngeal region. Following initial respiratory management and diagnostic workup, which included bronchoscopy and imaging, the patient underwent surgical debulking using a modification of the Loeb palatal incision by a multidisciplinary team to alleviate airway obstruction. Histopathology confirmed a mature teratoma, and postoperative care included intensive monitoring and metabolic management. This case underscores the critical need for early diagnosis, prompt intervention, and collaborative management to prevent life-threatening complications in neonates with nasopharyngeal teratomas. Surgical excision remains the primary treatment for these cases, with postoperative monitoring essential for ensuring patient stability. This case contributes to the literature on neonatal nasopharyngeal teratomas, emphasizing the role of a multidisciplinary approach in achieving favorable outcomes in complex presentations of this rare condition.
Dermatofibrosarcoma protuberans (DFSP) is a rare locally aggressive cutaneous sarcoma, whereas actinic keratosis (AK) is a common premalignant epidermal lesion. The coexistence of these two entities within a single facial lesion is extremely rare and may complicate diagnosis, particularly when an initial biopsy captures only the epidermal component. We present the case of an 80-year-old man with a persistent facial lesion initially diagnosed as AK on punch biopsy. Owing to the atypical clinical features, a repeat deep biopsy revealed the coexistence of DFSP and bowenoid AK. Immunohistochemistry confirmed the presence of DFSP with strong CD34 expression. The lesion was excised using Mohs micrographic surgery to achieve clear margins. This case highlights the importance of clinicopathological correlation and repeat biopsy for the accurate diagnosis of complex skin lesions. Surgical excision with sufficient margins is the key for optimal management.
BACKGROUND:Cleft palate results from incomplete fusion of the palatine shelves during embryonic development and varies in severity. It affects speech, hearing, and feeding, often leading to complications such as nasal regurgitation and recurrent infections. The condition is common worldwide and frequently coexists with cleft lip. Surgery remains the primary treatment, aiming to restore both palatal length and function. In this study, Furlow's double Z-plasty and von Langenbeck palatoplasty have been compared for their effectiveness in minimizing complications and improving outcomes. METHODS:This study included 22 children aged 6 to 18 months with non-syndromic complete cleft palates, randomly assigned into two groups. Group A underwent von Langenbeck's palatoplasty with intravelar veloplasty, while Group B underwent Furlow's double opposing Z-plasty. RESULTS:Preoperative palatal measurements were comparable between the two groups. Cleft width did not significantly affect surgical outcomes, and both techniques effectively achieved tension-free closure. Von Langenbeck's repair with intravelar veloplasty was as effective as Furlow's palatoplasty in achieving palatal lengthening, while offering the additional advantage of being an anatomically based repair associated with lower fistula rates. CONCLUSION:Von Langenbeck's repair with intravelar veloplasty is as effective as Furlow's palatoplasty in achieving palatal lengthening and provides the advantage of an anatomically sound repair with a reduced fistula rate.
BACKGROUND:Infraorbital nerve dysfunction frequently occurs after maxillary fractures. This study aimed to determine whether maxillary fractures involving the infraorbital foramen affect the recovery of infraorbital nerve function. METHODS:In this prospective study, 60 patients who received treatment for unilateral maxillary fractures between January 2020 and December 2022 were analyzed, with a follow-up period of over 1 year. Computed tomography scans were employed to categorize the fractures into three types according to the location of the fracture line relative to the infraorbital foramen. Sensory changes in four predetermined areas, supplied by the infraorbital nerve, were evaluated preoperatively and at 1 week, 1 month, 3 months, 6 months and 1 year postoperatively using the two-point discrimination test and the monofilament test. RESULTS:Paresthesia was observed in all patients with maxillary fractures. In the majority of instances, sensory deficits resolved spontaneously within 1 year. However, in patients whose fracture lines encroached upon the infraorbital foramen, the severity of paralysis was greater, and the rates of recovery were slower. CONCLUSION:The degree of infraorbital nerve function after a maxillary fracture was influenced by the involvement of the infraorbital foramen. Therefore, in the management of patients with maxillary fractures, computed tomography scans can serve as a predictive tool for the potential severity of paresthesia and the anticipated recovery rate.
BACKGROUND:Maxillofacial trauma presents with a myriad of complications, including functional disability and aesthetic compromise. Optimal treatment includes management of bone and soft tissue injuries along with dental rehabilitation. Prompt management, including open reduction and internal fixation (ORIF) combined with immediate dental implant rehabilitation, facilitates both functional recovery and aesthetic restoration, thereby leading to improved quality of life. METHODS:A total of 36 patients with maxillofacial bony trauma, along with non-restorable fractured, avulsed, or missing teeth, were managed with ORIF with dental rehabilitation. Eighteen patients underwent delayed implant placement after 6 months of ORIF, and the other 18 underwent immediate implant rehabilitation during ORIF. The outcomes measured included implant stability, crestal bone loss, and evaluation of pain, swelling, and patient satisfaction. All follow-up visits were scheduled with reference to the post-implant placement period in both groups. RESULTS:Implant stability was significantly increased in the immediate implant placement group of patients at the third- and sixth month follow-up post-implant placement (p< 0.001). Pain assessment revealed that the immediate implant group experienced significantly higher pain scores than the delayed implant group on the first day (p< 0.001), seventh day (p< 0.001), and 28th day (p< 0.001) following implant placement. Significant differences in facial swelling were observed at the third and sixth months (p= 0.009), with the immediate implant group exhibiting lower swelling. Swelling was significantly higher along the tragal-commissure line in the immediate implant group on the first and seventh days (p< 0.001). Patient satisfaction was initially higher in the delayed implant group on the first day (p= 0.047) and remained so by the third month (p< 0.001). However, by the sixth month, both groups demonstrated similar levels of satisfaction after implant placement. CONCLUSION:Immediate implant rehabilitation during ORIF in patients sustaining maxillofacial trauma improves implant success rates, reduces morbidity, and ultimately enhances patients' overall quality of life.
