Background: This study aimed to evaluate nasal changes after orthognathic surgery using computed tomography (CT) scans.Methods: CT scans of 21 patients who underwent orthognathic surgery were used. These CT scans were performed prior to the surgical procedure (T1) and at least 6 months after orthognathic surgery (T2). The intercanthal distance, alar width of the nose, intercrural distance, right and left nostrils (horizontal and vertical), and the nasolabial angle were measured. Maxillary advancement was measured in millimeters through the anterior nasal spine point of the maxilla.Results: The study included 21 patients, with a mean age of 29.3 years (standard deviation [SD], 8.5 years). The mean maxillary advancement was 4.9 mm (SD, 1.2 mm). Significant postoperative increases were observed in alar width (mean difference, 1.1 mm; p= 0.024), the horizontal dimensions of the right and left nostrils (mean differences, 0.5 and 0.6 mm; p= 0.029 and p= 0.034, respectively), and the nasolabial angle (mean difference, 4.9°; p= 0.007). Other measurements showed no significant postoperative differences.Conclusion: The nasal structures measured in orthognathic surgeries, distance from the alar base, nasolabial angle, and horizontal dimensions of the right and left nostrils showed statistically significant differences in the postoperative period.
Periorbital necrotizing fasciitis is a rare but rapidly progressive infection that may lead to vision loss or death, particularly when associated with orbital and intracranial extension. We report a 63-year-old man with diabetes who presented with rapidly progressive right periorbital swelling and visual impairment. Magnetic resonance imaging revealed extensive infection involving both extraconal and intraconal spaces with suspected meningeal involvement. Broad-spectrum intravenous antibiotics were administered immediately, and early, aggressive surgical debridement was performed, followed by negative-pressure wound therapy to optimize the wound bed. Definitive reconstruction was performed using a radial forearm free flap, designed for subsequent staged division to reconstruct both upper and lower eyelids. A palmaris longus tendon sling was incorporated to provide structural support and prevent lower eyelid malposition. The infection resolved completely, and the flap remained viable, with satisfactory globe protection and partial improvement in visual acuity. This case suggests that advanced periorbital necrotizing fasciitis with orbital involvement can be managed through prompt surgical debridement, broad-spectrum intravenous antibiotics, negative-pressure wound therapy, and carefully planned single-flap reconstruction.
A 10-year-old girl sustained devastating missile-related maxillofacial trauma during the Ukrainian war, resulting in loss of the lips, cheek, and mandible. Flap reconstruction in Russia had failed, resulting in severe scar contracture. The patient presented with profound dysfunction, including trismus, drooling, and gastrostomy dependence. Preoperative angiography identified recipient vessels outside the injury zone, enabling radial forearm free flap reconstruction with a titanium reconstruction plate contoured on a patient-specific three-dimensionally printed mandibular model. Postoperatively, maximal mouth opening improved, and the diet advanced from minimal liquids via a straw to a soft oral diet, reducing gastrostomy dependence. Oral competence partially recovered, with improvements in speech and nutrition. This case emphasizes the importance of preoperative planning for microvascular anastomosis and function-focused reconstruction to restore feeding, speech, and growth in pediatric patients with war-related facial trauma.
Verrucous carcinoma (VC) is a slow-growing, wart-like, well-differentiated subtype of squamous cell carcinoma. The incidence of head and neck VC is approximately 0.075 per 100,000 people per year and has decreased over time. Chewing tobacco, human papillomavirus infection, smoking, and repeated microtrauma have been proposed as potential contributors to VC, although its etiology remains incompletely established. VC most often arises in the oropharynx, genitalia, palmoplantar region, and other cutaneous sites that are not typically exposed to sunlight. By contrast, VC of sun-exposed facial skin is extremely rare and may therefore be overlooked or misdiagnosed. Although VC has an indolent growth pattern, untreated lesions can become locally destructive through progressive invasion of adjacent soft tissue, muscle, cartilage, or bone. We report a rare case of VC in the left malar region of a 91-year-old man. Punch biopsy raised suspicion for VC, and the diagnosis was confirmed after wide excision. The resulting skin defect was reconstructed with a split-thickness skin graft, and the patient recovered without complications or recurrence during the 3-month follow-up period. This case may help improve recognition of facial cutaneous VC and support more accurate diagnosis in similar presentations.
Background: Autogenous iliac crest bone graft is the standard for alveolar cleft reconstruction, but donor-site morbidity has prompted interest in regenerative agents. This review compared and ranked these agents against autogenous bone and one another.Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for network meta-analyses, six databases were searched from January 2000 to June 2026 for controlled studies comparing a regenerative agent with autogenous bone graft. Risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials and the ROBINS-I tool; certainty was assessed using Grading of Recommendations Assessment, Development and Evaluation. A frequentist random-effects network meta-analysis used autogenous bone as the reference and P-scores to rank treatments for new bone formation, bone density, graft volume, and graft success.Results: Twenty-one studies (23 reports) were included. Platelet-rich fibrin (risk ratio [RR], 1.46; 95% confidence interval [CI], 1.07–2.01) and concentrated growth factor (RR, 1.21; 95% CI, 1.02–1.43) were superior to autograft for graft success; platelet-rich fibrin ranked first (P-score, 0.87) and exceeded recombinant human bone morphogenetic protein-2 (RR, 1.44; 95% CI, 1.04–1.99). In one trial, bone marrow aspirate concentrate increased graft volume (standardized mean difference, 2.36; 95% CI, 1.51–3.21). No agent increased new bone formation or bone density. Certainty was moderate for one comparison, low for six, and very low for nine.Conclusion: Autogenous bone remains the volumetric reference standard. The improvement in graft success with platelet-rich fibrin was supported by moderate-certainty evidence and persisted across all sensitivity analyses, including restriction to randomized evidence. The concentrated growth factor finding had low certainty, relied on one retrospective study, and did not persist when analyses were restricted to radiographic outcomes. Adequately powered randomized trials with standardized methods are needed.
