A 40-year experience with a proven protocol of repair for primary bilateral cleft lip/nose is presented. The Dallas surgical protocol for primary bilateral cleft lip/nose repair depends on the anatomy of the deformity. In cases of complete and partial bilaterally symmetric cleft lip, alveolus, and palate, 1-stage lip closure was performed at 3 months of age. In cases of asymmetric or incomplete bilateral clefts, an extremely small prolabium (<6 mm in vertical height), or a displaced or severely projected premaxilla, a 2-stage lip closure is more feasible ("Primary Bilateral Cleft Lip/Nose Repair Part II"). Primary nasal reconstruction was at 1 year of age. Early nasal reconstruction eliminates severe secondary deformity and the need for major early surgery. Orthognathic surgery was performed in approximately 40% of the senior surgeon's bilateral cleft patients to achieve optimal facial balance and aesthetics. Ten completed cases are presented with their long-term outcomes. The long-term outcomes of speech, occlusion, and facial balance are good to excellent in most of our bilateral patients. But in many cases, outcome of the lip/nose is still unsatisfying in the senior author's opinion compared with the results of unilateral cleft patients. These long-term outcomes are determined by the severity of the cleft deformity, primary repair technique, secondary surgery, and, most important, a protocol performed by a multidisciplinary experienced team until growth is complete. This technique should be considered in the treatment of all bilateral clefts, depending on the anatomy and team availability.
This consensus specifies the terms, definitions, requirements, and test methods for auxiliary surgical devices and auxiliary surgical systems using robotic technology under high-stress conditions. This expert consensus applies to auxiliary surgical devices and auxiliary surgical systems using robotic technology under high-stress conditions.
Deficiencies in maxillary growth have often been implicated in suboptimal results of cleft lip and palate therapy. Cone-beam computed tomography provides an opportunity to look at the dimensions of the maxillary complex in three dimensions in a way that is not possible with lateral cephalograms or dental models. The purposes of this preliminary study were to outline a new set of 18 cone-beam computed tomographic measurements, apply them to 6 patients with unilateral cleft lip and palate (UCLP), and contrast them to a comparable sample of 7 normal young adults. The patients with UCLP were treated with a single protocol by a single surgeon and orthodontist. The 18 measurements had a mean intrarater reliability of 0.95 and ranged from 0.40 to 2.23 for the individual measurements. The mean interrater reliability was 1.01 and ranged from 0.40 to 2.45 for the individual measurements. Significant differences between the patients with UCLP and control subjects (combined sex samples) were found in palate length, anterior palate thickness, overall sagittal maxillary length, and premaxillary height (Mann-Whitney U tests, P ≤ 0.037). The body of the maxilla and its heights appear less affected. These methods and preliminary findings lay the groundwork for larger scale and prospective studies that evaluate such dimensional data in conjunction with positional data and other vital outcomes of cleft lip and palate therapy such as speech and occlusion.
Since our team reported the application of robot-assisted surgery in facial contouring surgery in 2020, further clinical trials with large samples have been conducted. This paper will report the interim results of a single-center, large-sample randomized controlled trial of the first robot developed by our team for facial contouring surgery. Meanwhile, this research field will be systematically reviewed and prospected.
Rapid developments in 3-dimensional(3D) printing technologies in craniofacial plastic surgery have provided a new treatment modality for patients. In this article, we intend to share our institution’s experience using 3D printing in 3 modes-namely, 3-dimensional printing for manufacturing contour models, guides, and implants. Fifty-nine patients were enrolled in our study between September 2009 and September 2021. Among the 3D printing-assisted technologies, 41 cases were used for congenital malformations, 82 for trauma repair, and 112 for cosmetic surgery. Preoperative design and postoperative data were compared and analyzed based on imaging data. In craniofacial plastic surgery, all patients had excellent postoperative objective bone measurements close to the preoperative design and improved esthetic appearance. Our survey of postoperative satisfaction showed that patients were quite satisfied with the surgery, especially concerning congenital deformities. Rapid prototyping 3-dimensional printing technology provides a practical and anatomically accurate means to produce patient-specific and disease-specific translational tools. These models can be used for surgical planning, simulation, and clinical evaluation. Expanding this technology in craniofacial plastic surgery will provide adequate assistance to practitioners and patients.
The purpose of this study is to explore the present situation and related factors of big 5 personality in Asian patients with facial contour surgery and to provide experience for clinical individualized medical care.Total 235 patients with facial contour surgery were selected in this study. The Neo Five-factor Inventory was used to investigate them.The scores of conscientiousness and openness in the Neo Five-factor Inventory were higher than others, whereas neuroticism score was lowest in patients with facial contour surgery. The scores of extroversion and agreeableness were in the middle level. Among the big 5 personality the age, educational background, self-rated personality, the only child in a family and other cosmetic surgery history had significant differences in patients.Patients with facial contour surgery for different sex, different marital status, different body mass index, there is no significant difference in the big 5 personality through this study. However, older patients had higher score for conscientiousness, patients with higher educational background had higher scores in openness and patients with introverted personality had higher neuroticism score. The authors should take individualized personality traits during perioperative care to help the patients to establish a correct and healthy esthetic concept, as well as postoperative body image concept, to build their self-confidence and social competitiveness.
Introduction: Mandibular deformity can be caused by congenital anomalies, trauma and tumors ect. leading to impairment of aesthetic and function such as communication, swallowing and mastication.To assess the clinical value of the computer-assisted design and computer-assisted manufactured(CAD/CAM) technology and evaluate the clinical experience of manufactured artificial bone precision to repair the mandibular asymmetrical deformity. Methods: From July 2013 to August 2016, computer-assisted 3D printing technology was applied in 72 patients with mandibular asymmetrical deformity in Craniofacial Department, Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine. The measurement data was conducted and compared with three-dimensional CT result during the 6months of follow-up. To evaluate the effectiveness of the surgery, the distance between the corresponding three anatomical points on the mandible to the mid-sagittal plane were measured and compared by asymmetic ratio Q value and the patients satisfaction survey was carried out. The measurements of mean discrepancy of corresponding three anatomical points between the virtual design and post operative CT during the 6 months of follow up. Results: The patients’ mandibular asymmetry was improved, the asymmetrical ratio Q value decreases from 13.57%±8.73% to 9.01%±8.18% (P<0.001) with high patients’ satisfaction score (score=4.78, Score 5=Completely satisfied). The mean deviation of the preoperative design and postoperative CT was 1.43±0.12mm, basically similar with the preoperative simulation. Pre-designed implant also decreased the intraoperative time with the mean value of 2.15±0.27 h.All patients were treated successfully without serious complications. Conclusion: Three-dimensional design of patients’ specific artificial bone implant in repair of mandibular asymmetrical deformity is a valuable technology, by relying on quantitative design and preoperative simulation using the customized CAD/CAM technology, making the complex reconstruction simple and improve the accuracy of surgery,ultimately improve the facial symmetry. The patients showed high satisfaction rate with low surgical complications and long-term efficacy.
Hemifacial microsomia (HFM), a congenital craniofacial malformation, is characterized by unilateral mandibular dysplasia. At present, the Pruzansky classification is the most common descriptive classification used clinically, which involves mandibular deformities. Although multiple classification systems have been proposed for HFM, a quantitative classification has not yet been proposed. This study intended to propose a quantitative classification for HFMaccording to the mandibular volume on the affected side. Patients with HFM from January 2017 to January 2018 were included, and the A/U ratio (volume of the affected side/volume of the unaffected side) was measured. This study proposed a classification for HFM(mandibular-volume classification, MVC) according to the A/U ratio and compared the new classification system with the Pruzansky classification using consistency and correlation tests. A total of 48 patients were included. The results of MVC based on the A/U ratio were as follows: A/U>0.85, classified asmild; 0.73-0.85, as moderate; and <0.73 assevere; the weighted kappa value of the Pruzansky and MVC classifications was 0.616 (P<0.01). The quantitative classification of HFMbased on the A/U ratio can serve asa viable evaluation index for patients withHFM and can provide a new reference index for determiningthe treatment plan.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)