Search Results (359)

The objective of the present study was to investigate whether orthodontic treatment alters the morphology and bone mineral density (BMD) distribution of the mandibular condyle in growing adolescent patients. Cone-beam computed tomography (CBCT) images were retrospectively analyzed for 29 patients (10 males and 19 females, aged 12.5 to 17.0 years) treated with full fixed orthodontic appliances. The right and left mandibular condyles were digitally isolated. For the internal control sample, the basal cortical bone (CB) at both mandibular first molar sites was also digitally dissected. A frequency plot of the CBCT gray values, proportional to BMD, was analyzed to calculate the mean and the 5th percentile of low and high gray values (Low₅ and High₅). Morphological changes in the condylar surface were assessed based on temporomandibular joint osteoarthritis (TMJOA) counts. Lateral cephalometric radiographs were used to measure facial morphology parameters and classify skeletal patterns. The cervical vertebral gray values of the same patients were compared. No radiographic signs of TMJ disorder were observed with no significant difference in TMJOA counts between before and after treatment (p = 0.56). The volume, mean and Low₅ gray values of the mandibular condyle, facial morphology parameters, and cervical vertebral gray values significantly increased following orthodontic treatment (p < 0.05). Skeletal Class II patients exhibited greater changes in mean, Low₅, and High₅ mandibular condyle gray values compared to their Class I patients (p < 0.05), whereas cervical vertebral gray values were not significantly influenced by skeletal classification (p > 0.19). The findings suggest that orthodontic treatment, combined with natural patient growth, contributes to nonpathological condylar alterations in adolescent patients. Full article

Background: Primary intraosseous carcinoma (PIOC) is a rare and aggressive odontogenic malignancy that originates within the jaw bones without initial mucosal involvement. Its atypical and nonspecific symptoms frequently lead to diagnostic delays, especially in maxillary presentations. Methods: A 74-year-old male presented with persistent trigeminal-like neuralgic pain along the ophthalmic branch, initially misdiagnosed as secondary trigeminal neuralgia. MRI revealed a 45 × 46 × 34 mm mass occupying the right maxillary sinus with orbital wall destruction and dural invasion. Following histopathological confirmation of malignancy, a multidisciplinary team performed total maxillectomy with orbital exenteration and dural resection, followed by reconstruction using a temporoparietal flap. Adjuvant radiotherapy was administered. Results: Histopathology revealed invasive odontogenic carcinoma with atypical squamous features, dentinoid deposition, and perineural invasion. Postoperative recovery was uneventful, with complete pain resolution. MRI and PET surveillance over 2.5 years demonstrated no local recurrence. Conclusions: Maxillary PIOC may present exclusively with neuropathic pain, mimicking trigeminal neuralgia and leading to delayed diagnosis. In cases of unexplained facial pain with sinus or skull base involvement, odontogenic malignancies should be considered in the differential diagnosis. Early imaging and multidisciplinary management are key to achieving timely diagnosis, effective treatment, and improved quality of life. Full article

Background/Objectives: Basal cell carcinoma (BCC) is the most common form of skin cancer, typically exhibiting slow growth and limited metastatic potential. However, in rare, long-standing cases, particularly in high-risk facial regions, deep infiltration into structures such as bone may occur. This study aimed to evaluate whether BCC with bone involvement remains a relevant clinical issue, based on three decades of clinical experience, supplemented by a review of the existing literature. Methods: Medical records of patients treated for facial BCC between 1994 and 2025 at a dermatologic surgery department in Lower Silesia were retrospectively reviewed. Among more than 10,000 cases, eight instances of histologically confirmed bone invasion were identified. Clinical and surgical parameters were analyzed, including patient age, tumor size and location, prior treatment and reconstruction method. Relevant literature was incorporated to provide broader clinical context. Results: Patients with bone-invasive BCC were elderly (mean age: 75.3 years, SD: 10.94 years) and lesions were typically large (mean diameter 38.9 mm), most frequently located on the nose and forehead. Many cases lacked previous treatment. Smaller nasal tumors were managed with local flaps, while larger lesions on the forehead and temple required skin grafts. Findings from the literature confirm that bone invasion is rare and usually associated with long-standing tumors in anatomically high-risk areas. Conclusions: Although rare, BCC with bone infiltration remains a clinically relevant phenomenon, particularly in elderly patients with advanced or recurrent tumors. Early diagnosis, complete excision with histologically clear margins, and individualized surgical planning are essential to prevent deep tissue involvement. Imaging should be reserved for cases in which advanced local invasion is clinically suspected. Full article

Mandibular prognathism (Class III malocclusion) is a craniofacial anomaly characterized by an anteriorly positioned mandible, a concave facial profile and impaired mastication, and appears unusually frequently in Dolang sheep (Ovis aries). We combined clinical phenotyping and three-dimensional (3D) genome profiling to investigate this trait in a Dolang sheep flock. We examined 959 animals using standardized criteria, estimated a local prevalence of 10.3%, and assembled a 200 affected/200 unaffected case–control cohort for genomic analyses. As an exploratory pilot study of 3D genome architecture, we generated in situ Hi-C datasets from mandibular bone of two affected and two control sheep. At 40 kb resolution, global topologically associating domain (TAD) organization and boundary strength were broadly conserved between groups, but sliding-window analyses identified a small number of 1 Mb hotspots where affected animals showed increased TAD-boundary density and strengthened insulation. These UNDER-enriched windows lay near genes with plausible roles in craniofacial development, including ROBO2, COL27A1, VRK2 and a cytokine cluster (IL22/IL26/IFNG with MDM1). Together, our data indicate that mandibular prognathism in Dolang sheep is associated with localized remodeling of chromatin insulation at a restricted set of gene-proximal loci and highlight candidate regions and mechanisms for integration with whole-genome sequencing, association and transcriptomic data. Full article

Background: Pediatric craniofacial fractures represent a distinct clinical entity characterized by unique anatomical and developmental factors that differentiate them from adult facial trauma. Despite their relative rarity, these injuries pose diagnostic and therapeutic challenges due to the presence of active growth centers and the potential for long-term functional and esthetic sequelae. Methods: A retrospective observational study was conducted among pediatric patients aged 0–17 years treated for craniofacial fractures between 2020 and 2024 at the Department of Cranio-Maxillofacial Surgery, University Hospital in Kraków, Poland. Demographic data, injury mechanisms, fracture distribution, treatment modality, and associated injuries were analyzed. Multivariate logistic regression was applied to identify predictors of surgical intervention. Results: Ninety-eight patients met the inclusion criteria. The mean age was 12 years, with a male predominance. Midfacial fractures were most common, with orbital floor fractures representing the single most frequent injury. Surgical management was performed in 72 cases, predominantly using the transconjunctival approach and autologous bone grafting. Orbital floor fractures were identified as the only independent predictor of operative treatment (p < 0.05). Central nervous system trauma was the most frequent concomitant injury. No significant changes in etiology or fracture distribution were observed during the COVID-19 pandemic. Conclusions: Pediatric craniofacial trauma follows a reproducible, age- and mechanism-dependent pattern. Effective management requires individualized, growth-preserving, and function-oriented treatment strategies. Standardization of care protocols and multicenter prospective studies are essential to optimize outcomes and develop evidence-based, age-specific guidelines for the management and prevention of pediatric facial fractures. Full article

Background and Objectives: To evaluate the surgical management and outcomes of lateral semicircular canal fistulas (LSCFs) in patients with middle ear cholesteatoma, focusing on hearing preservation and vestibular function. Materials and Methods: A retrospective study was conducted on nine adult patients diagnosed with LSCFs secondary to cholesteatoma who underwent surgery at a tertiary referral center between 2018 and 2024. The preoperative evaluation included otoscopy, audiometry, vestibular testing (HINTS), and high-resolution CT (HRCT) of the temporal bone. Surgical techniques included canal wall up (CWU) or canal wall down (CWD) mastoidectomy, depending on the disease extent. Cholesteatoma matrix removal from the fistula was performed carefully. Fistula closure involved layered grafts of temporalis fascia, temporalis muscle, and/or gelfoam. The postoperative follow-up included audiometry and vestibular assessments. Results: Nine patients with LSCFs were identified (one Type III, three Type IIb, and four Type I/IIa). Five patients were found to have additional disease complications intraoperatively, including facial nerve involvement and middle fossa dehiscence. Postoperatively, hearing outcomes varied, with some patients experiencing improvement, others demonstrating stable hearing, and some exhibiting further decline, particularly in cases with extensive disease. Vestibular symptoms, including vertigo, generally resolved postoperatively, although some patients required prolonged vestibular rehabilitation. Conclusions: LSCF management in cholesteatoma surgery requires a careful preoperative assessment, meticulous surgical technique, and individualized fistula closure based on the size and type. While hearing preservation remains a challenge, particularly in extensive cases, the “underwater technique” and layered grafting may contribute to minimizing further damage and promoting fistula closure. Vestibular rehabilitation plays a crucial role in managing postoperative balance issues. A long-term follow-up is essential to monitor for recurrence and assess both auditory and vestibular function. Full article

Zygomaticomaxillary complex (ZMC) fractures are among the most common midfacial injuries, with significant implications for both function and facial esthetics. Optimal management requires restoring the normal anatomical alignment and symmetry of the zygomatic region to prevent long-term deformity and functional deficits. However, the decision-making surrounding surgical intervention, particularly in isolated ZMC fractures with moderate displacement, remains nuanced. This review discusses contemporary surgical approaches for isolated ZMC fractures and examines how objective morphometric analysis can guide critical decisions such as the timing of surgery, choice of surgical approach, and extent of fixation. Conventional assessment tools like computed tomography (CT), cephalometric measurements, and intraoperative imaging provide foundational data on fracture anatomy. Emerging technologies, including three-dimensional (3D) photogrammetry, stereophotogrammetry, artificial intelligence (AI)-based symmetry analysis, and surgical navigation systems, offer advanced means to quantify facial symmetry and bone alignment. By integrating these objective metrics into clinical practice, surgeons can enhance preoperative planning and postoperative outcome evaluation, with a particular focus on achieving facial symmetry for optimal esthetic and functional results. We also outline clinical decision-making frameworks that incorporate quantitative measurements, and we discuss current limitations, future directions, and the potential for standardizing protocols in the management of ZMC fractures. Full article

Von Hippel–Lindau disease-associated endolymphatic sac tumors (VHL-associated ELSTs) present diagnostic challenges due to their rarity and nonspecific symptoms. This study describes clinical, pathological and genotypic features to guide treatment. We retrospectively analyzed seven patients with VHL-associated ELSTs. The mean age of otologic symptom [hearing loss (100%) and facial nerve paralysis (85.71%)] onset was 22.43 ± 8.68 years (range: 10–33). Surgical management included trans-labyrinthine and subtotal temporal bone resection approaches. Among three patients with severe preoperative facial nerve dysfunction, two underwent great auricular nerve grafting improved to House–Brackmann grade IV, while one receiving hypoglossal–facial nerve anastomosis reached grade V. Genetic testing identified pathogenic VHL gene missense mutations in three patients. Two female patients demonstrated disease progression during pregnancy. Literature analysis revealed exon-specific patterns: Exon 1 mutations correlated with cerebellar/spinal hemangioblastomas in female patients, while Exon 3 mutations were associated with multisystem tumors. These findings support that VHL-associated ELSTs manifest early with otologic symptoms and demonstrate exon-specific phenotypic patterns. Optimal management requires complete surgical resection, genetic diagnosis, and a multidisciplinary approach to address these complex tumors and achieve favorable outcomes. Full article

Objectives: The middle cranial fossa (MCF) approach is valued for preserving hearing while accessing the internal auditory canal (IAC), petrous apex, inner ear, and related structures. This study evaluated its clinical outcomes across otolaryngological diseases, focusing on postoperative complications, hearing preservation, and the effect of IAC manipulation on auditory function. Methods: We retrospectively analyzed 35 patients who underwent MCF otologic surgery at a single center over twelve years. We calculated the proportion of MCF cases among all otologic surgeries and assessed postoperative complications and hearing changes (bone conduction thresholds). Outcomes were compared between patients with and without IAC manipulation. Results: MCF procedures comprised 1.4% of all otologic surgeries. Petrous bone cholesteatoma was the leading indication (15 cases). Intracranial complications occurred in 4 patients (11.4%): seizures, epidural abscess, and cerebral infarction. Facial nerve paralysis occurred in 3 (10.7%) patients without any cerebrospinal fluid leaks. In patients without IAC manipulation, hearing functions were preserved (22.3 ± 7.8 dB HL pre- vs. 25.7 ± 9.5 dB HL postoperatively), whereas those with IAC manipulation showed significantly greater deterioration. Conclusions: The middle cranial fossa approach, though technically demanding and infrequently used, offers a safe and effective option across various otolaryngological diseases. This approach achieved favorable hearing preservation with a low complication rate, particularly when intradural manipulation of the IAC was not required. Full article

Background and Clinical Significance: Meningiomas are among the most common primary intracranial tumors, usually benign and slow-growing. Extracranial extension is exceptionally rare, particularly when arising from convexity meningiomas extending into the temporal fossa. Such cases pose unique diagnostic and therapeutic challenges due to their atypical growth patterns and anatomical complexity. Case Presentation: A 63-year-old woman previously treated for a right temporal convexity meningioma with subtotal resection and Gamma Knife radiosurgery demonstrated progressive extracranial tumor growth over five years, while the intracranial component remained stable. MRI revealed infiltration of the temporalis and lateral pterygoid muscles and erosion of the temporal bone. Due to extensive extracranial involvement and limited neurosurgical accessibility, resection was performed by a maxillofacial surgical team through a preauricular approach. Intraoperatively, the tumor was encapsulated but adherent to the deep temporal fascia and zygomatic arch. The temporal branch of the facial nerve was identified and preserved. Histopathology confirmed a meningothelial meningioma, WHO Grade I, with low proliferative activity (Ki-67 < 1%). Postoperative recovery was uneventful, with transient facial nerve weakness that resolved within weeks. Conclusions: This report adds to the limited literature describing temporal fossa involvement by convexity meningiomas and illustrates the value of collaboration between neurosurgical and maxillofacial teams. Regular MRI surveillance every 6–12 months is advised for early detection of recurrence. Full article

Background: Central giant cell granuloma of the jaw is a benign but potentially aggressive lesion that can cause pain, facial deformity, tooth loss, and jaw destruction. Many treatment methods are described in the literature, but the less invasive ones are associated with a higher recurrence rate. For several decades, extensive bone resection procedures have been the most effective treatment to date. This study aimed to evaluate a minimally invasive treatment protocol combining multiple weekly intralesional steroid injections with surgical removal of residual tumor tissue and chemical cauterization using Carnoy’s solution. Methods: Thirteen patients with histologically confirmed central giant cell granulomas of the jaws were treated according to the protocol, including weekly triamcinolone injections and, when necessary, fenestration of the cortical bone to access residual lesions. Patients were monitored clinically and radiologically over six years, with reconstruction of bone defects using autogenous grafts and platelet-rich fibrin. Results: The treatment effectively reduced tumor size, restored cortical bone, and allowed preservation of jaw structure. Only one recurrence was observed, and complications were minor and transient. The protocol was equally effective for both aggressive and non-aggressive lesions, regardless of patient age or comorbidities. Conclusions: These findings suggest that combining pharmacological and surgical approaches with chemical cauterization provides a safe, effective, and tissue-preserving strategy for managing central giant cell granulomas, minimizing recurrence while reducing surgical morbidity. Full article

Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity, often necessitating extensive surgical resection. Such interventions may result in complex intraoral defects requiring immediate reconstruction to restore function and aesthetics. Objective: This case report highlights the surgical management of a patient with OSCC involving the tongue, floor of the mouth and mandibular ridge, reconstructed using a radial forearm free flap (RFFF). Case report: A 51-year-old male with a history of heavy smoking presented with a necrotic lesion affecting the left mandibular alveolar ridge, floor of the mouth, and tongue. Methods: Histopathological examination confirmed a diagnosis of moderately differentiated keratinizing OSCC (G2). After oncologic resection and selective neck dissection, the defect was reconstructed using an RFFF harvested from the left forearm. The facial artery and anterior jugular vein served as recipient vessels for microvascular anastomosis. A split-thickness skin graft (STSG) was used to close the donor site. Results: The postoperative course was generally favorable. Minor complications, including a localized hematoma and neck wound dehiscence, were conservatively managed. Functional outcomes such as oral intake and wrist mobility were successfully restored with rehabilitation. The RFFF provided durable, well-vascularized coverage over exposed mandibular bone, critical for minimizing the risk of osteoradionecrosis in the context of planned adjuvant radiotherapy. Conclusions: The radial forearm free flap remains a reliable reconstructive option for complex oral defects post-OSCC resection. Multidisciplinary collaboration and meticulous surgical technique are essential to achieve optimal oncologic, functional, and aesthetic outcomes. Full article

Neuromast cells are specialized mechanosensory receptor cells embedded within the lateral line system of aquatic vertebrates, enabling the detection of water movement and vibration that are essential for navigation, prey capture, and predator avoidance. These cells share common evolutionary and functional homology with mammalian inner ear hair cells, both of which rely on stereocilia-mediated mechano-transduction and ion channel activation to convert mechanical stimuli into neural signals. Unlike their mammalian counterparts, neuromast hair cells possess a regenerative capacity following damage, making the lateral line system a unique model for studying hair cell regeneration and sensory restoration. This study examines the potential of the Mexican tetra (Astyanax mexicanus) as a novel model organism for investigating ototoxicity and regeneration of neurosensory hair cells. Here, we explore the cranial and trunk lateral line neuromasts, including deep canal neuromast cells located in facial bones, such as the mandible and circumorbital bones. In the present study, juvenile surface-dwelling Mexican tetra were exposed to a 500 µM neomycin for 4 h to induce targeted hair cell damage. The samples were collected at 4-, 12-, 24-, and 72 h post-exposure. Furthermore, neuromast cell viability was assessed using [2-(4-(Dimethylamino) styryl)-N-ethylpyridinium iodide] (DASPEI). Gene expression analysis revealed a modest increase in Fibroblast Growth Factor 1 (fgf1) and Axis Inhibition Protein 2 (axin2) expression following treatment; however, these changes were not statistically significant. The SRY-box transcription factor 2 (sox2) remains constant throughout the exposure and recovery period. These findings highlighted the regenerative dynamics of neuromast cells in Mexican tetra. This work lays the foundation for future therapeutic strategies targeting human sensory deficits, particularly those involving inner ear hair cell degeneration. Full article

The stylohyoid complex (SHC), comprising the styloid process (SP), stylohyoid ligament, and lesser horn of the hyoid bone, arises from Reichert’s cartilage and plays a central role in head and neck organization. Although anatomically small, it occupies a strategic position in the parapharyngeal space, linking neural, vascular, and visceral compartments. This review integrates embryological, comparative, anatomical, and clinical perspectives to provide an updated synthesis of SHC morphology and significance. Developmental studies highlight the early segmentation of Reichert’s cartilage, its transient relationships with the otic capsule, facial canal, and carotid arteries, and its role in shaping muscular and fascial compartments. Comparative anatomy demonstrates the evolutionary transition from a continuous ossicular chain to a vestigial human structure, reflecting a trade-off between rigidity and vocal tract flexibility. In humans, the SHC exhibits marked variability in length, angulation, segmentation, and ligamentous ossification, which directly influence its spatial relationships with the internal and external carotid arteries, the internal jugular vein, and the lower cranial nerves. These variations underpin the clinical spectrum of Eagle’s syndrome and vascular complications, including carotid artery dissection and jugular compression syndromes. Recognition of these embryological origins, evolutionary trajectories, and anatomical variants is essential for accurate diagnosis, imaging interpretation, and surgical planning. As both an embryological remnant and a clinical landmark, the SHC bridges fundamental anatomy with practical implications for imaging, diagnosis, and surgery. Full article

This retrospective study reviews the clinical features, computed tomography (CT) findings, complications and outcomes of horses with skull fractures involving the facial bones. Medical records from the Royal Veterinary College, Hatfield, United Kingdom, and the Universidad Complutense, Madrid, Spain, were reviewed to identify horses presented for head CT with a history of skull fracture involving the facial bones between 2018 and 2022. Thirteen horses were included. Secondary sinusitis was present in 10 of the horses with the rostral maxillary, caudal maxillary and ventral conchal sinuses being the most commonly affected. There was associated fracture of dental structures in three cases. Treatment was conservative in seven cases, while in six horses some minimal surgical intervention was undertaken and included the removal of loose bony fragments and trephination for sinoscopy in two cases, fragment removal and sinus flush through a Foley catheter in three cases and dental extraction in one case. Prognosis was reported to be good to excellent in 10 horses. Among the most common complications, cosmetic sequalae was recorded in three cases. Overall conservative management of skull fracture should be considered a viable option for cases where perfect cosmetic results are not expected and where economics may be a limitation. Full article