Search Results (31)

Background/Objectives: An accurate description of facial sexual dimorphism is essential in clinical, forensic, and anthropological contexts to support accurate diagnosis of craniofacial dysmorphisms and differences, treatment planning and evaluation, as well as biological profiling, craniofacial reconstruction, and personal identification. This study investigates sexual dimorphism of the facial soft tissues in a sample of healthy Italian adults, providing reference data and deepening our understanding of normal craniofacial variation. Methods: Three-dimensional stereophotogrammetric facial images of 342 Italian adults (172 males and 170 females; 18–40 years old) were analyzed using a 3D spatially dense geometric morphometric approach to assess both shape and form. Principal Component Analysis (PCA) and Partial Least Squares Regression (PLSR) were used to explore facial variation and to quantify sex-related differences. Results: Centroid size was significantly larger in males. While PCA revealed that sex is a significant factor in facial shape and form variation, PLSR highlighted the existence of significant associations between sex and both shape and form. Color-coded morphometric maps underlined the most sexually dimorphic traits: males exhibited bigger faces with deep-set eyes and central facial projection extending from the supraorbital rims to the chin, whereas females display smaller faces with fuller cheeks, and a more vertical forehead profile. Conclusions: While our results are consistent with those of previous studies, our study revealed important, distinctive group-specific traits: flatter labiomandibular folds in males and wider temples and fuller cheeks in the infraorbital region extending to zygomatic and mandibular areas in females. Thus, this study provides high-resolution reference data supporting related applications. Full article

Background: The rising incidence of cutaneous non-melanoma skin cancers underscores the need for individualized reconstruction, particularly for cheek defects that pose distinctive anatomic and functional challenges. This study aimed to analyze reconstructive patterns for cheek skin lesions and to develop a simple, site- and size-based algorithm for small- to medium-sized defects. Methods: We retrospectively reviewed 129 consecutive patients treated between 2022 and 2025 for primary basal cell carcinoma, squamous cell carcinoma, or benign cheek skin tumors. After excision, defects were reconstructed with primary closure, local flaps, or skin grafts. Associations between the largest clinically measured lesion diameter (used as a proxy for the post-excision defect size), anatomical subsite, histopathology, and reconstructive technique were evaluated using ANOVA or Kruskal–Wallis tests, chi-square tests, and Spearman’s correlation. Results: The mean lesion diameter was 19.75 ± 12.93 mm. Reconstruction was performed using local flaps in 62 patients (48.06%), primary closure in 53 (41.09%), and skin grafts in 14 (10.85%). Larger defects were more frequently managed with grafts or flaps (F(2,110) = 4.84, p = 0.010), and lesion size correlated with reconstructive complexity (Spearman’s ρ = 0.229, p = 0.015). Lesion location was also significantly associated with the reconstruction method (χ²(10) = 48.29, p < 0.001; Cramér’s V = 0.44). Margin-negative (R0) excision was achieved in 95.35% of cases, with a low recurrence rate (3.91%) and complication rate (1.56%). Conclusions: Lesion size and anatomical location are key determinants of reconstructive strategy for cheek skin defects. In this cohort, lesions ≤ 20 mm were predominantly managed with primary closure, whereas lesions > 20 mm more frequently required flap reconstruction or skin grafting. This size-based split is cohort-derived and should be interpreted as a pragmatic framework that requires external validation. Full article

Purpose: Reconstructive options for mucosal defects of the oral cavity resulting from the resection of tumors include primary closure, mucosal and split thickness skin grafts, pedicle flaps, and microvascular free flaps. Lately the use of an acellular dermal bilayer matrix has been introduced for the reconstruction of superficial mucosal defects of the oral cavity. Methods: Twenty-one patients treated for SCC of the oral cavity with intraoral resection and simultaneous reconstruction using a bilayer dermal matrix between 1 January 2020 and 31 December 2024 with at least 6 months of follow-up were retrospectively considered. Data were collected regarding the site of the lesion, the initial TNM staging, the size of the surgical defect, the timing of silicone sheet removal, the complications and the long-term outcomes. Results: Tumor site included the tongue in 16 cases, the hard palate in 1 case, the cheek in 2 cases, the floor of the mouth in 1 patient, and the inferior lip in 1 patient. Re-epithelialization was achieved in all cases within 21 days. No major complication was observed. Conclusions: Bilayer dermal matrix demonstrated to be an excellent option for small and superficial oral cavity reconstruction if proper indications are followed. Full article

Background: Restoring the integrity of the lower eyelid presents a complex surgical challenge due to its lamellar structure and the high risk of complications. Among these, ectropion is the most frequent and troublesome outcome. Objective: This study aims to present a case of lower eyelid reconstruction following the excision of squamous cell carcinoma using Mohs micrographic surgery combined with the Mustardé cheek rotation flap technique, highlighting its advantages, limitations, and applicability in elderly patients. Case presentation: A 93-year-old female patient with right lower eyelid squamous cell carcinoma underwent Mohs micrographic surgery. The resulting defect was reconstructed using a Mustardé cheek rotation flap, chosen for its suitability in patients with adequate skin laxity. Patient-specific risk factors, including advanced age, a history of ischemic stroke, and class II heart failure (NYHA classification), were considered in the surgical planning stage. Results: The Mustardé cheek rotation flap provided a reliable closure with a favorable esthetic outcome and inconspicuous scarring, aligned with natural anatomical margins. The technique was technically straightforward in this patient owing to age-related skin laxity. No major postoperative complications were observed. Conclusions: The Mustardé cheek rotation flap represents a safe and effective reconstructive option for elderly patients with lower eyelid defects following tumor excision. This case illustrates the esthetic and functional benefits of the technique while emphasizing the need to tailor reconstruction strategies to patient comorbidities and defect characteristics. Full article

Background/Objectives: In the context of facial surgery, particularly reconstructive procedures, sensory recovery is a critical yet often underexplored aspect of functional rehabilitation. Sensory-motor recovery can be considered a key marker of integration following reconstructive surgery. Among sensory modalities, discriminative sensitivity is typically the last to recover, making its evaluation particularly relevant. While established norms for hand sensitivity exist in the literature, there is a paucity of data regarding facial sensitivity. The objective of this study was to evaluate the discriminative sensitivity of the face in a population of healthy women aged 45–60 years. Methods: A total of 20 healthy women were included between January and March 2013. Participants had no history of facial pathologies or trauma. Discriminative sensitivity was measured using the Disk-Criminator™ device across eight facial zones. A detailed mapping of the tested areas was performed. Data obtained were compared with the existing literature. Statistical analyses included Shapiro–Wilk tests for normality, followed by Student’s t-tests for group comparisons. To account for small sample size and verify robustness, non-parametric Mann–Whitney U tests were also performed. Adjustment for multiple comparisons was applied using the Bonferroni correction (adjusted α = 0.0125). Results: The mean age of participants was 52.3 years (±4.0 years). Discrimination threshold values ranged from 2.9 to 14.3 mm. Comparison with existing studies showed no significant age-related differences in zone 2R (cheek) and zone 8 (lower lip), suggesting stable sensitivity in these regions across adulthood. However, a significant decline in sensitivity with age was observed only in zone 1R (forehead), with a p-value < 0.001 after Bonferroni correction. Conclusions: We established a reference framework for cutaneous discriminative sensitivity across eight facial zones. These norms can serve as a baseline for the assessment and monitoring of patients with facial pathologies. Furthermore, our findings contribute to a better understanding of age-related sensory changes. Full article

Trogopterus xanthipes (Sciuridae, Rodentia) is a medium-sized flying squirrel species in the monotypic genus Trogopterus, and is endemic to China. It is distinguishable from other squirrels by the long black hairs on the inner and outer sides at the base of the ears and numerous ridges on the crowns of the upper and lower cheek teeth. Mitogenomes have been widely used in phylogenetic studies. We described T. xanthipes morphological features and successfully sequenced its mitogenome for the first time. The T. xanthipes mitogenome was conserved in number and order of genes. We analyzed codon usage patterns, evolutionary mutation rates, K2P distance, and genetic diversity of protein-coding genes. We reconstructed the phylogeny of Sciuridae (94 species and 21 genera in 4 subfamilies). All phylogenetic trees shared the same topologies and consistently supported the monophyly of Sciuridae, and the supported subfamilies relationship as follows: ((Xerinae + Callosciurinae) + Sciurinae) + Ratufinae. The relationship within the Sciurinae clade was ((Glaucomys + Hylopetes) + ((Trogopterus+Pteromys) + Petaurista) + Sciurus). The relationship within the Callosciurinae clade was Exilisciurus + ((Tamiops + Dremomys) + ((Lariscus+Sundasciurus) + Callosciurus)). The relationship within the Xerinae clade was Sciurotamias + (Tamias + (Callospermophilus + (Marmota + (Spermophilus + (Urocitellus + (Ictidomys + Cynomys)))))). The phylogenetic position among different subfamilies of Sciuridae was consistently recovered with high support across different datasets (PCGRNA and PCG12RNA) and supported the monophyletic lineage of each genus of Sciuridae. Trogopterus xanthipes was sister species to Pteromys volans. Species within the genus formed different minor clades, suggesting relatively high interspecific divergences. The tribe Pteromyini was sister taxon of the tribe Sciurini, which was not supported by the traditional division of Sciuridae into subfamilies Pteromyinae and Sciurinae. Hence, our data supported a division of the Sciuridae into five subfamilies. Full article

Background: Myomucosal cheek flaps are currently considered the main reconstructive option for small to moderate oral cavity defects. Many reconstructive techniques following the resectioning of oral tongue squamous cell carcinoma (OTSCC) have been proposed over the years. Methods: We report a case of OTSCC treated surgically and reconstructed with Bozola flap, analyzing the advantages and disadvantages of this surgical technique. The defect was classified according to the glossectomy classification proposed by Ansarin. Results: We believe that the Bozola buccinator myomucosal flap is a viable alternative to free flaps for the reconstruction of certain oral tongue defects. Conclusions: Based on our experience, the Bozola flap is an appropriate primary option for T1–T2 and certain T3 OTSCC defects (excluding the tip) for I–II and IIIa glossectomies, as recorded in the Ansarin classification. Full article

Background/Objectives: Facial soft tissue thickness (FSTT) data are extensively utilized in forensic and medical sciences, serving as a foundational element for craniofacial reconstruction and identification methods. This study aims to analyze the differences in FSTT measurements between upright and supine positions in living subjects. Methods: The study sample consisted of 121 participants aged 20 to 86 years from Slovakia. Biological sex and age data were collected. FSTT measurements were taken at eight medial facial line landmarks and eight bilateral landmarks using a non-invasive General Electric LOGIQe R7 ultrasound device. Results: The results indicate that the head position significantly influenced more than half of the landmarks, with mean differences not exceeding 1.31 mm. Most FSTT values were higher in the horizontal position. Younger males and females exhibited significant differences in FSTT across various regions, including the eye, cheek, nose and mouth, with discrepancies in the forehead, chin, and cheek regions among younger males. In older males, only the gonion region showed a significant position-related difference, while older females demonstrated substantial FSTT changes at five landmarks, with the largest difference (1.31 mm) observed at the mandible, accounting for 15.74% of the mean FSTT. Compared to younger groups, older females exhibited higher FSTT values in the upright position. Conclusions: These findings suggest that measurements in an upright position may be more suitable for facial reconstruction, as positional changes in FSTT can occur in both positive and negative directions. Full article

This case study highlights the use of cinematic rendering (CR) in preoperative planning for the excision of a cyst in the oral and maxillofacial region of a 60-year-old man. The patient presented with a firm, non-tender mass in the right cheek, clinically suspected to be an epidermoid cyst. Conventional imaging, including dental magnetic resonance imaging (MRI) protocols, confirmed the lesion’s size, location, and benign nature. CR reconstructions, combining advanced algorithms and novel skin presets, allow for the generation of highly realistic, three-dimensional visualizations from conventional imaging datasets. CR provided an enhanced, detailed depiction of the lesion within its anatomical context, significantly improving spatial understanding for surgical planning. The surgical excision was performed without complications, and histological analysis confirmed the diagnosis of a benign epidermoid cyst with no evidence of dysplasia or malignancy. This case demonstrates the potential of CR to refine preoperative planning, especially in complex anatomical regions such as the face and jaw, by offering superior visualization of superficial and deep structures. Thus, the integration of CR into clinical workflows has the potential to lead to improved diagnostic accuracy and better surgical outcomes. Full article

Background/Objectives: Currently, there is a lack of a comprehensive classification system for soft-palate defects that provides synthetic information to guide functional reconstructive treatment. Our awareness, shaped by extensive experience, of the superiority of myomucosal flaps to fasciocutaneous flaps in functional palate reconstruction has driven us to introduce a new defect-based classification system and propose a new algorithm for reconstructing soft-palate defects using buccinator myomucosal flaps. Methods: Soft-palate defects were classified into five classes. A reconstruction algorithm employing buccinator myomucosal flaps—including axial, island, and tunnelized flaps along with their variants as described in previous studies—was utilized. Clinical records, including tumor stage, location, defect size, and details of the myomucosal flap used, were documented. Postoperative speech intelligibility, swallowing, and quality of life (QoL) were evaluated. Donor-site morbidity and complications were also assessed. Spearman’s rank correlation was employed to assess relationships between clinical parameters and functional outcomes. Results: Twenty-two patients who had undergone soft-palate resection and subsequent reconstruction were reviewed. Favorable recovery of swallowing and speech was reported in all cases, with a median deglutition score of 6.04 ± 0.85 and no severe velopharyngeal insufficiency observed (speech score: 0.36 ± 0.58). Quality of life assessments indicated satisfactory recovery across physical, social, emotional, and functional parameters. Donor-site morbidity was low (average score: 8.3), with only minor complications observed. Tumor stage showed a significant correlation with speech score (r = 0.44, p = 0.04). Conclusions: The proposed classification introduces a comprehensive, simple, and user-friendly categorization of soft-palate defects, accompanied by a myomucosal reconstructive algorithm designed to guide surgeons through the reconstructive process, aiming to provide optimal functional reconstruction. The study’s small sample size and monocentric design may have limited the detection of meaningful correlations, highlighting the need for larger, multicentric studies with objective methods to validate findings. Full article

Three-dimensional (3D) facial models have been increasingly applied in orthodontics, orthognathic surgery, and various medical fields. This study proposed an approach to reconstructing 3D facial models from standard orthodontic frontal and lateral images, providing an efficient way to expand 3D databases. A total of 23 participants (average age 20.70 ± 5.36 years) were enrolled. Based on the Hifi3D face model, 3D reconstructions were generated and compared with corresponding face scans to evaluate their accuracy. Root mean square error (RMSE) values were calculated for the entire face, nine specific facial regions, and eight anatomical landmarks. Clinical feasibility was further assessed by comparing six angular and thirteen linear measurements between the reconstructed and scanned models. The RMSE of the reconstruction model was 2.00 ± 0.38 mm (95% CI: 1.84–2.17 mm). High accuracy was achieved for the forehead, nose, upper lip, paranasal region, and right cheek (mean RMSE < 2 mm). The forehead area showed the smallest deviation, at 1.52 ± 0.88 mm (95% CI: 1.14–1.90 mm). In contrast, the lower lip, chin, and left cheek exhibited average RMSEs exceeding 2 mm. The mean deviation across landmarks was below 2 mm, with the Prn displaying the smallest error at 1.18 ± 1.10 mm (95% CI: 0.71–1.65 mm). The largest discrepancies were observed along the Z-axis (Z > Y > X). Significant differences (p < 0.05) emerged between groups in the nasolabial, nasal, and nasofrontal angles, while the other 13 linear and 3 angular measurements showed no statistical differences (p > 0.05). This study explored the feasibility of reconstructing accurate 3D models from 2D photos. Compared to facial scan models, the Hifi3D face model demonstrated a 2 mm deviation, with potential for enriching 3D databases for subjective evaluations, patient education, and communication. However, caution is advised when applying this model to clinical measurements, especially angle assessments. Full article

Background: Malignant eyelid tumours present a considerable challenge in the field of ophthalmic oncology, necessitating a combination of precision oncological care and meticulous reconstruction to ensure the preservation of eyelid functionality and the maintenance of facial aesthetics. Method: This study presents a review of the outcomes of 167 patients who underwent eyelid reconstruction following the excision of primary non-melanocytic malignant tumours. The choice of reconstruction technique was dependent on a number of factors, including the stage of the tumour, its location, and the characteristics of the patient. The most commonly used techniques included regional flaps, local flaps, and skin grafts. The most frequently employed reconstruction techniques were forehead flaps (59 cases), simple excisions (38 cases), and Mustarde cheek flaps (16 cases). Result: The postoperative complications, including ectropion, epiphora, and flap necrosis, were recorded. However, no significant correlation was found between the risk of complications and either the location of the tumour or the reconstruction method employed. Despite the complexity of medial canthal and lower eyelid reconstruction, satisfactory aesthetic and functional outcomes were generally achieved. Conclusions: This study emphasises the importance of individualised surgical planning, highlighting the advantages and limitations of various techniques to optimise both the functional and aesthetic results. Full article

Introduction: The planning of oral reconstruction after tumor resection is a pivotal point for head and neck surgeons. It is mandatory to consider two aspects: the size of the surgical defect and the complexity of the oral cavity as an anatomical region. We offer a review of the literature that focuses on four types of locoregional flaps that can be profitably used for such reconstruction: infrahyoid (IF), nasolabial (NF), platysma (PF), and submental (SF). Methods: The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review was carried out according to the PICOS acronym through a comprehensive electronic search on PubMed/MEDLINE, Cochrane Library, and Google Scholar databases. For each selected article, we extrapolated eight main parameters, of which all mean values were compared through an ANOVA test. The dimensions of the oral defects were referred to as “small” (<7 cm²), “medium” (7–50 cm²), or “large” (>50 cm²). Results: A total of 139 articles were selected with a total of 5898 patients. The mean ages for each type of flap were not statistically significant (p = 0.30, p > 0.05). Seven sublocations of oral defects were reported: The most common was the tongue (2003 [34.0%] patients), followed by the floor of the mouth (1786 [30.4%]), buccal mucosa (981 [16.6%]), cheek (422 [7.2%]), hard palate (302 [5.1%]), alveolar ridge (217 [3.7%]), and retromolar trigone (187 [3.2%]). The defects were mainly medium-sized (4507 [76.4%] patients), and fewer were small-sized (1056 [17.9%]) or large-sized (335 [5.7%]). Complications were noted, the most frequent of which was flap necrosis, seen in 0.57% of cases. The functional and esthetical results were mainly positive. Conclusions: Locoregional flaps represent a good alternative in medium-sized defects as well as a fairly good alternative in small- and large-sized defects when other options are ruled out. Full article

This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective investigation was conducted on patients who underwent reconstruction for facial defects due to skin cancer. Data on the patients’ gender, age, anesthesia method, diagnosis, defect location, flap size, complications, and follow-up periods were collected. There are several principles for designing the PBIF: finger-pinching method, alignment with the direction of wrinkles, the smaller width and longer length of the flap, and proximal attachment to the muscle. A total of 32 patients were included, with an average age of 63.6 years. Surgeries were performed in various regions, such as the infraorbital area, nose, cheek, philtrum, and the anterior/posterior/inferior auricular regions, with an average flap size of 7.63 cm². There were no complications, such as venous congestion or vascular insufficiency in the skin flaps, although one case required revisional closure due to flap disruption. The PBIF is a useful and effective method for the restoration of facial defects. This method can provide simple yet aesthetically satisfying results, showing stable outcomes without complex surgeries or complications. This study indicates the potential for this method to be more widely employed in reconstructive surgeries in the future. Full article

Study Design: Descriptive study of 17 patients with primary or secondary reconstruction using a supraclavicular flap. Objective: Describe the different options for primary and secondary reconstruction using the supraclavicular flap, as well as the complications that may arise. Methods: The present study analyzed the outcomes of 17 patients who underwent reconstruction using the supraclavicular artery island flap at the Maxillofacial Department of Hospital Universitario Virgen de las Nieves (Granada, Spain) from November 2017 to June 2023. Results: The SCAIF served as the primary reconstructive option in 9 cases, covering skin defects in the parotid region (4 patients), cervical area (1 patient), partial tongue defects (3 patients), and cheek defects (1 patient). Additionally, the flap was used as a secondary reconstructive option in 8 patients affected by osteoradionecrosis (ORN) with bone and plate exposure. Complications included a single case of shoulder joint septic arthritis and 3 patients who experienced cervical fistula and neck infection. Conclusions: The supraclavicular flap represents a highly effective option for oncological reconstruction within the head and neck region. This flap is particularly useful in patients with significant clinical concerns and contraindications, both local and systemic, for microsurgical free flap procedures due to its reliability, versatility, and safety. Full article