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Craniofacial and Reconstructive Plastic Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 9924

Special Issue Editor


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Guest Editor
Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
Interests: plastic, reconstructive and aesthetic surgery; oral and maxillofacial surgery; facial reconstruction; facial surgery

Special Issue Information

Dear Colleagues,

Craniofacial surgery represents a complicated challenge for surgeons, especially due to the impact of the face region on individuals’ social life.

The pathologies that may require craniofacial surgery are innumerable; just think of the global burden of birth defects, such as clefts and craniostenosis, that involve a team of various specialties.

However, the challenges are not limited to congenital and malformation surgery in this Special Issue, and we must also consider traumatic pathologies and reconstructive surgery after tumor exision. The restoration of masticatory, swallowing and phonatory functions is essential in order to enable the patient to continue a normal life, without neglecting the importance of achieving a good aesthetic result. In this Special Issue, we welcome authors to submit papers on the new surgical and aesthetic techniques aimed at restoring facial functions and aesthetics for patients suffering from pathologies of the craniofacial district.

We look forward to receiving your submissions to this Special Issue.

Prof. Dr. Paola Bonavolonta
Guest Editor

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Keywords

  • craniofacial surgery
  • reconstructive surgery
  • cleft surgery
  • orthognathic surgery
  • plastic surgery
  • craniofacial tissue engineering
  • salivary glands surgery

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Published Papers (8 papers)

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Research

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12 pages, 5334 KiB  
Article
Progress of Ossification after Mandibular Reconstruction by Free Fibula Flap Depending on Different Timing of Radiotherapy: A Retrospective 3D Analysis by CT Scans
by Maximilian Gottsauner, Anne Marie Sroka, Jonas Eichberger, Johannes Schuderer, Florian Zeman, Mathias Fiedler, Michael Maurer, Ingo Einspieler, Torsten E. Reichert and Tobias Ettl
J. Clin. Med. 2024, 13(14), 4104; https://doi.org/10.3390/jcm13144104 - 13 Jul 2024
Viewed by 1029
Abstract
Background: The aim of this study was to evaluate the difference between pre- and post-operative radiotherapy on the progress of ossification after free fibula flap reconstruction of the mandible using three-dimensional (3D) analysis. Methods: A total of 38 free fibula reconstructions of the [...] Read more.
Background: The aim of this study was to evaluate the difference between pre- and post-operative radiotherapy on the progress of ossification after free fibula flap reconstruction of the mandible using three-dimensional (3D) analysis. Methods: A total of 38 free fibula reconstructions of the mandible were evaluated retrospectively for ossification between bone segments by measuring Hounsfield Units (HU) in at least two postoperative computer tomography scans (average of 2.4 scans per patient; around the 5th, 12th, 16th, and 19th month postoperative). Three subgroups were created according to the time of irradiation: preoperative radiotherapy (preORT) (n = 11), postoperative radiotherapy (postORT) (n = 16), and patients without any radiation therapy (n = 11) as the control group (noRT). HU in eight regions of interest (ROI) and overlapping surfaces between segments per contact point, as well as influencing factors, were analyzed. Results: The fastest progress in gain of HU ossification with a difference of 0.30 HU/day was observed in noRT compared to preORT (p = 0.002). postORT was −0.24 HU/day slower than preORT (p = 0.005). Original and grafted bone showed a significantly slower HU uptake than between two graft segments with −84.18 HU/day (p < 0.001). Moreover, a larger initial overlapping surface between the segments in cm2 resulted in a higher rise of HU/day (p < 0.001). Conclusions: 3D analysis of post-reconstructive CT scans shows prolonged ossification of mandible reconstructions by free fibula after head and neck radiation. The effect is distinct in cases with post-operative adjuvant radiotherapy. The effects of radiotherapy on ossification may be minimized by a larger initial contact surface and improved operational techniques. Moreover, HU longitudinal measurements and 3D analysis offer new perspectives for clinical evaluation of successful bony healing. Full article
(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)
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11 pages, 3605 KiB  
Article
Optical Three-Dimensional Imaging for Objective Evaluation of the Donor Site after Anterolateral Thigh Flap Surgery
by Marius Heitzer, Philipp Winnand, Mark Ooms, Anna Bock, Marie Sophie Katz, Florian Peters, Kristian Kniha, Stephan Christian Möhlhenrich, Frank Hölzle and Ali Modabber
J. Clin. Med. 2024, 13(6), 1805; https://doi.org/10.3390/jcm13061805 - 21 Mar 2024
Viewed by 889
Abstract
Background: The high volume of the fasciomyocutaneous anterolateral thigh flaps (ALT) is suitable for the reconstruction of pronounced soft tissue defects. At the same time, harvesting ALT results in a drastic change in thigh shape. Here, we present an optical three-dimensional imaging method [...] Read more.
Background: The high volume of the fasciomyocutaneous anterolateral thigh flaps (ALT) is suitable for the reconstruction of pronounced soft tissue defects. At the same time, harvesting ALT results in a drastic change in thigh shape. Here, we present an optical three-dimensional imaging method for thigh comparison, which can be an objective and reproducible method for evaluating donor sites after ALT harvesting. Methods: In total, 128 thighs were scanned with an optical three-dimensional scanner, Vectra XT ®. Sixty-eight non-operated right and left thighs were compared and served as a control. Sixty thighs were scanned in the ALT group. The average surface area deviations, thigh volume, thigh circumference, and flap ratio to thigh circumference were calculated. The results were correlated with Δthigh circumference and Δvolume of the unoperated thighs of the control group. Results: No significant difference between the thigh volumes of the right and left thighs was found in the control group. Removal of an ALT flap showed a significant (p < 0.007) volume reduction compared to unoperated thighs (2.7 ± 0.8 L and 3.3 ± 0.9 L, respectively). Flap area correlated strongly with the Δthigh circumference (r = 0.66, p < 0.001) and Δvolume (r = 0.68, p < 0.001). Strong correlations were observed between flap ratio and thigh circumference with Δhigh circumference (r = 0.57, p < 0.001) and Δvolume (r = 0.46, p < 0.05). Conclusions: Optical three-dimensional imaging provides an objective and reproducible tool for detecting changes in thigh morphology volume differences after ALT harvesting. Full article
(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)
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15 pages, 4139 KiB  
Article
Patient’s Perception of Outcome after Extracapsular Fractures of the Mandibular Condyle Differs from Objective Evaluation—Experience of a Third-Level Hospital
by Michael Maurer, Tabea Klaes, Mathias Fiedler, Juergen Taxis, Johannes G. Schuderer, Waltraud Waiss, Maximilian Gottsauner, Johannes K. Meier, Torsten E. Reichert and Tobias Ettl
J. Clin. Med. 2024, 13(5), 1395; https://doi.org/10.3390/jcm13051395 - 28 Feb 2024
Viewed by 942
Abstract
Background: The aim of this study is to assess patients’ subjective perception of treatment outcome after extracapsular fractures of the mandibular condyle. Methods: A questionnaire survey regarding facial nerve palsy (FNP), malocclusion, pain, reduction in maximum mouth opening (MMO) and further [...] Read more.
Background: The aim of this study is to assess patients’ subjective perception of treatment outcome after extracapsular fractures of the mandibular condyle. Methods: A questionnaire survey regarding facial nerve palsy (FNP), malocclusion, pain, reduction in maximum mouth opening (MMO) and further discomfort after 3, 6, and 12 months was carried out. Patients aged 18 or more presenting with an extracapsular condylar fracture between 2006 and 2020 were identified by purposive sampling Questionnaires were received from 115 patients. Fractures were classified on the basis of the pre-treatment imaging, the way of treatment was obtained from patients’ medical records. Data were analyzed using Pearsons’ chi-square-test, descriptive statistics and Student’s t-test. Results: 93.0% of the fractures were treated by open reduction and internal fixation (ORIF). MMO reduction was the most common post-treatment complication (55.6%). ORIF was associated with less pain after 3 months (p = 0.048) and lower VAS scores compared to conservative treatment (p = 0.039). Comminuted fractures were more frequently associated with post-treatment malocclusion (p = 0.048), FNP (p = 0.016) and MMO reduction (p = 0.001). Bilateral fractures were significantly accompanied by malocclusion (p = 0.029), MMO reduction (p = 0.038) and pain occurrence (p < 0.001). Conclusions: Patients report less pain after ORIF. Comminuted and bilateral fractures seem to be major risk factors for complications. Subjective perception of complications after extracapsular condylar fractures differs from objectively assessed data. Full article
(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)
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11 pages, 534 KiB  
Article
Analgesic Efficacy of Oxycodone in Postoperative Dressings after Surgical Treatment of Burn Wounds: A Randomised Controlled Trial
by Grzegorz Kowalski, Wojciech Leppert, Małgorzata Domagalska, Monika Grochowicka, Artur Teżyk, Krzysztof Słowiński, Agnieszka Bienert, Danuta Szkutnik-Fiedler and Katarzyna Wieczorowska-Tobis
J. Clin. Med. 2024, 13(3), 784; https://doi.org/10.3390/jcm13030784 - 29 Jan 2024
Cited by 2 | Viewed by 1218
Abstract
Introduction: This study aimed to assess the analgesic efficacy of oxycodone at doses of 10 mg and 20 mg in dressings after surgery of burn wounds. Material and Methods: Twenty adult patients who underwent surgical treatment of third-degree burn wounds under general anaesthesia [...] Read more.
Introduction: This study aimed to assess the analgesic efficacy of oxycodone at doses of 10 mg and 20 mg in dressings after surgery of burn wounds. Material and Methods: Twenty adult patients who underwent surgical treatment of third-degree burn wounds under general anaesthesia were included. Burn wounds were treated with dressings, to which oxycodone was added at 20 mg in Group 1 and 10 mg in Group 2. After the surgery, plasma oxycodone and noroxycodone concentrations were assayed, and pain intensity was assessed with Numerical Rating Scale (NRS). Results: In Group 1, no patient reported pain; in Group 2, four patients reported pain. The pain intensity, according to NRS, was 1–8. Plasma concentration of oxycodone in the blood serum was in the range of 1.24–3.15 ng/mL and 1.09–1.28 ng/mL in Group 1 and Group 2, respectively. Noroxycodone was not detected in the plasma. Adverse effects were not observed in any of the treated patients. Conclusions: Oxycodone in dressings provides patients with adequate and safe analgesia. Full article
(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)
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12 pages, 1201 KiB  
Article
The Role of Intraoperative and Early Postoperative Blood Pressure Variations, Fluid Balance and Inotropics in Fibula Free Flap Head and Neck Reconstruction: A Retrospective Analysis
by John-Patrik Burkhard, Alena Wepfer, Lukas M. Löffel, Kaspar F. Bachmann and Patrick Y. Wuethrich
J. Clin. Med. 2023, 12(24), 7753; https://doi.org/10.3390/jcm12247753 - 18 Dec 2023
Cited by 2 | Viewed by 1004
Abstract
Background: In head and neck reconstructive surgery, postoperative complications are a well-known concern. Methods: We examined 46 patients who underwent ablative surgery and received fibula free flap reconstruction. The main focus was to assess the influence of intraoperative blood pressure fluctuations and the [...] Read more.
Background: In head and neck reconstructive surgery, postoperative complications are a well-known concern. Methods: We examined 46 patients who underwent ablative surgery and received fibula free flap reconstruction. The main focus was to assess the influence of intraoperative blood pressure fluctuations and the administration of inotropic drugs on complications, either related to the flap or systemic, serving as the primary endpoint. Results: Utilizing logistic regression models, we identified that intraoperative mean arterial blood pressure (MAP) drops did not correlate with the occurrence of either flap-related complications (MAP < 70, p = 0.79; MAP < 65, p = 0.865; MAP < 60, p = 0.803; MAP < 55, p = 0.937) or systemic medical complications (MAP < 70, p = 0.559; MAP < 65, p = 0.396; MAP < 60, p = 0.211; MAP < 55, p = 0.936). The occurrence of flap-related complications significantly increased if a higher dosage of dobutamine was administered (median 27.5 (IQR 0–47.5) vs. 62 (38–109) mg, p = 0.019) but not if norepinephrine was administered (p = 0.493). This correlation was especially noticeable given the uptick in complications associated with fluid overload (3692 (3101–4388) vs. 4859 (3555–6216) mL, p = 0.026). Conclusion: Intraoperative and immediate postoperative blood pressure fluctuations are common but are not directly associated with flap-related complications; however, dobutamine application as well as fluid overload may impact flap-specific complications. Full article
(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)
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12 pages, 1306 KiB  
Article
Animal Bite Injuries to the Face: A Retrospective Evaluation of 111 Cases
by Michael Maurer, Cornelius Schlipköter, Maximilian Gottsauner, Waltraud Waiss, Johannes K. Meier, Mathias Fiedler, Johannes G. Schuderer, Juergen Taxis, Torsten E. Reichert and Tobias Ettl
J. Clin. Med. 2023, 12(21), 6942; https://doi.org/10.3390/jcm12216942 - 6 Nov 2023
Cited by 3 | Viewed by 2003
Abstract
The treatment of bite wounds to the face is discussed controversially in relation to surgery and antibiotics. The aim of this study is a retrospective evaluation of 111 cases of animal bite injuries to the face that presented to our unit of oral [...] Read more.
The treatment of bite wounds to the face is discussed controversially in relation to surgery and antibiotics. The aim of this study is a retrospective evaluation of 111 cases of animal bite injuries to the face that presented to our unit of oral and maxillofacial surgery over a 13-year period. Children under 10 years of age were predominantly involved. A total of 94.5% of the assessed injuries were caused by dogs. Wound infections occurred in 8.1%. Lackmann type II was the most common type of injury (36.9%). The perioral area was affected most frequently (40.5%). Primary wound closure was carried out in 74.8% of the cases. In 91.9% of the cases, antibiotic prophylaxis was prescribed. The most often administered type of antibiotic was amoxicillin with clavulanic acid (62.1%). Patients without antibiotics showed an increased infection rate without significance. Wound infections occurred significantly more frequently in wounds to the cheeks (p = 0.003) and when local flap reconstruction was necessary (p = 0.048). Compared to the other surgical treatment options, primary closure showed the lowest infection rates (4.8%, p = 0.029). We recommend antibiotic prophylaxis using amoxicillin with clavulanic acid and wound drains for wounds of Lackmann class II or higher. Primary closure seems to be the treatment of choice whenever possible. Full article
(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)
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Review

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11 pages, 741 KiB  
Review
Dynamic Repair Surgery for Late-Stage Facial Paralysis: Advances in Restoring Movement and Function
by Qing Sun, Xing Li, Zhihui Zhu, Xiting Xiang and Tao Zhang
J. Clin. Med. 2024, 13(16), 4955; https://doi.org/10.3390/jcm13164955 - 22 Aug 2024
Viewed by 961
Abstract
Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function [...] Read more.
Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included “dynamic repair”, “late-stage facial paralysis”, “nerve and muscle transplantation”, “muscle flap”, and “tendon transposition”. Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies. Full article
(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)
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Other

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20 pages, 1041 KiB  
Systematic Review
Reconstruction of Segmental Mandibular Defects with Double-Barrel Fibula Flap and Osseo-Integrated Implants: A Systematic Review
by Saad Khayat, Ángela Sada Urmeneta, Borja González Moure, Diego Fernández Acosta, Marta Benito Anguita, Ana López López, Juan José Verdaguer Martín, Ignacio Navarro Cuéllar, Farzin Falahat and Carlos Navarro Cuéllar
J. Clin. Med. 2024, 13(12), 3547; https://doi.org/10.3390/jcm13123547 - 17 Jun 2024
Viewed by 1136
Abstract
Background: Mandibular defects resulting from oncological treatment pose significant aesthetic and functional challenges due to the involvement of bone and soft tissues. Immediate reconstruction is crucial to address complications such as malocclusion, mandibular deviation, temporomandibular joint (TMJ) changes, and soft tissue retraction. These [...] Read more.
Background: Mandibular defects resulting from oncological treatment pose significant aesthetic and functional challenges due to the involvement of bone and soft tissues. Immediate reconstruction is crucial to address complications such as malocclusion, mandibular deviation, temporomandibular joint (TMJ) changes, and soft tissue retraction. These issues can lead to functional impairments, including difficulties in chewing, swallowing, and speech. The fibula flap is widely used for mandibular reconstruction due to its long bone segment and robust vascular supply, though it may not always provide adequate bone height for optimal dental rehabilitation. This systematic review aims to determine if the double-barreled fibula flap (DBFF) configuration is a viable alternative for mandibular reconstruction and to evaluate the outcomes of dental implants placed in this type of flap. Materials and Methods: This study adhered to the Cochrane Collaboration criteria and PRISMA guidelines and was registered on the International Platform of Registered Systematic Review and Meta-Analysis Protocols Database (INPLASY2023120026). We included clinical studies published in English, Spanish, or French that focused on adult patients undergoing segmental mandibulectomy followed by DBFF reconstruction and dental rehabilitation. Data sources included Medline/PubMed, the Cochrane Library, EMBASE, Scopus, and manual searches. Two reviewers independently screened and selected studies, with discrepancies resolved by a third reviewer. Data extraction captured variables such as publication year, patient demographics, number of implants, follow-up duration, flap survival, implant failure, and aesthetic outcomes. The risk of bias was assessed using the JBI appraisal tool, and the certainty of evidence was evaluated using the GRADE approach. Results: A total of 17 clinical studies were included, evaluating 245 patients and 402 dental implants. The average patient age was 43.7 years, with a mean follow-up period of 34.3 months. Flap survival was high, with a 98.3% success rate and only four flap losses. The implant failure rate was low at 1.74%. Esthetic outcomes were varied, with only three studies using standardized protocols for evaluation. The overall certainty of evidence for flap survival was moderate, low for implant failure, and very low for aesthetics due to the subjective nature of assessments and variability in reporting. Conclusions: The primary limitations of the evidence included in this review are the observational design of the studies, leading to an inherent risk of bias, inconsistency in reporting methods, and imprecision in outcome measures. Additionally, the subjective nature of aesthetic evaluations and the variability in assessment tools further limit the reliability of the findings. The DBFF technique demonstrates excellent outcomes for mandibular reconstruction, with high flap survival and low implant failure rates, making it a viable option for dental rehabilitation. However, the evidence for aesthetic outcomes is less certain, highlighting the need for more rigorous and standardized research. This review supports the DBFF as a good alternative for mandibular reconstruction with successful dental implant integration, although further studies are needed to enhance the reliability of aesthetic evaluations. Full article
(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)
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