Microsurgery necessitates precision and skill, with conventional methods often leading to surgeon discomfort due to prolonged static postures. The introduction of robot-assisted microsurgery using the Symani surgical system and a three-dimensional exoscope aims to enhance surgical precision while mitigating these ergonomic issues.

Nonsyndromic anterior plagiocephaly is one of the most common types of craniosynostosis. In recent years, various surgical techniques have been introduced to correct this deformity, which many surgeons believe have not been associated with adequate clinical and aesthetic results. The aim of the study was to introduce a new surgical technique (modified Z-technique of temporal region osteotomy) and to evaluate the aesthetic and anthropometric outcomes of frontal orbital correction for the management of patients with nonsyndromic anterior plagiocephaly.

Keloid is the result of abnormal wound healing, puzzled by the invasive growth and high recurrence rate attributed to its complex pathogenic mechanism. Syndecan1 (SDC1) contributes to regulating cell migration and invasion by activating epithelial-mesenchymal transition (EMT) in tumor and fibrotic disease. Herein, using western blot analysis, the authors assessed the role of SDC1 on EMT in keloid and its underlying mechanism. The authors found keloid fibroblasts exhibited a higher proportion of mesenchymal phenotypes, and SDC1 was significantly upregulated in keloid fibroblasts. Then, the authors transfected small interfering RNA targeting SDC1 in keloid fibroblasts and tested the abilities of cell migration and invasion, as well as the expression of EMT-related markers, including N-cadherin, vimentin, and E-cadherin. The results showed that the knockdown of SDC1 markedly suppressed the migration and invasion abilities of keloid fibroblasts and reduced the phenotypes of EMT by inhibiting Wnt/β-catenin signaling pathway. The authors' findings suggest that SDC1 may influences keloid fibroblasts migration and invasion through targeting Wnt/β-catenin signaling pathway mediated EMT, which supports its potential value as a therapeutic target for the treatment of keloid.

In traditional surgery for patients with secondary deformities of cleft lip, the skin is usually cut open, and forceps are used according to the position of the flap. However, this method cannot predict the postoperative effect before surgery, especially the changes in the patient's lip. Moreover, in surgery, the design of the surgical flap is also quite random, needing more quantitative standards for its position and size, which makes it impossible to optimize the surgical effect, resulting in the surgical effect relying on the surgeon's surgical level. In this study, we attempted to scan the patient's face using infrared scanning equipment, establish a three-dimensional model of the patient's face, and compare the postoperative effects under different surgical positions through finite element analysis, especially comparing the displacement of the affected labial peak point to find the optimal surgical plan. In this way, the authors can predict the surgical effect before cleft lip and cleft palate surgery so that patients can directly see the effect after surgery and choose the most suitable scheme.

Angiosarcomas (AS) are an aggressive subtype of head and neck tumors. Current outcome research is limited to single-surgeon and/or single-institution data. This study analyzes the Surveillance, Epidemiology, and End Results program (SEER) database data to improve outcomes of head and neck AS. In this study, the authors accessed the SEER database from 2000 to 2020 to identify patients who underwent surgical and/or nonsurgical treatment of head and neck AS. Data included demographics, diagnostic workup, tumor characteristics, treatment pathways, and therapy outcomes. The study included 691 patients (210 females, 481 males) with AS of the head and neck. The median tumor size was 40 mm. Most patients (63%) underwent surgery, with surgery followed by radiation being the most common treatment combination (50%). Median survival was 16 months. Patients treated with surgery showed significantly longer survival (18 mo) compared with nonsurgery cases (12 mo, P<0.001). Neoadjuvant treatment significantly improved survival (28 mo) compared with non-neoadjuvant cases (15 mo, P=0.023). Adjuvant treatment also improved overall survival (19 mo) versus nonadjuvant treatment (14 mo, P<0.001). There was no significant difference between neoadjuvant and adjuvant treatment outcomes (P=0.270). Bottom of Form This study compares the outcomes of multimodal treatments, especially surgery and radiotherapy, for head and neck AS, emphasizing tailored approaches to optimize patient outcomes and extend survival. Future research should refine these strategies.

Maxillofacial trauma is a significant concern in emergency departments (EDs) due to its high prevalence and the complexity of its management. However, many ED physicians lack specialized training and confidence in handling these cases, leading to a high rate of facial trauma referrals and increased stress on consult services. Recent advancements in artificial intelligence, particularly in large language models such as ChatGPT, have shown potential in aiding clinical decision-making. This study specifically examines the efficacy of ChatGPT in diagnosing and managing maxillofacial trauma. Ten clinical vignettes describing common facial trauma scenarios were presented to a group of plastic surgery residents from a tertiary care center and to ChatGPT. The chatbot and residents were asked to provide their diagnosis, ED management, and definitive management for each scenario. Responses were scored by attending plastic surgeons who were blinded to the response source. The study included 13 resident and ChatGPT responses. The mean total scores were similar between residents and ChatGPT (23.23 versus 22.77, P > 0.05). ChatGPT outperformed residents in diagnostic accuracy (9.85 versus 8.54, P < 0.001) but underperformed in definitive management (8.35 versus 6.35, P < 0.001). There was no significant difference in ED management scores between ChatGPT and the residents. ChatGPT demonstrated high accuracy in diagnosing maxillofacial trauma. However, its ability to suggest appropriate ED management and definitive treatment plans was limited. These findings suggest that while ChatGPT may serve as a valuable diagnostic tool in ED settings, further advancements are necessary before it can reliably contribute to treatment planning in emergent maxillofacial clinical scenarios.

Subcutaneous emphysema (SE) is a notably rare complication of surgical procedures, particularly in the context of rhinoplasty. In this report, we present a novel case of recurrent nasal SE following routine open septorhinoplasty in a 59-year-old male. This patient developed persistent subcutaneous air over the nasal dorsum, linked to a fistula tract to the nasal vault, despite initial conservative management with needle aspiration. The patient required surgical intervention to repair the mucosalized fistula tract, leading to a successful long-term outcome. This case highlights a significant gap in the current understanding of SE, as previous reports have primarily focused on periorbital involvement rather than nasal SE and underscores the importance of recognizing nasal SE as a potential complication of rhinoplasty.

New surgical techniques that access the orbit and intracranial cavity have been developed in recent years called transorbital neuroendoscopic surgery. The superior eyelid route, as a transorbital corridor, is a clinically feasible route to access selected anterior and middle skull base pathologies. However, studies regarding the suitability of this approach in vascular surgery are lacking. In this study, transorbital endoscopic dissections were performed bilaterally in 4 cadavers through the superior eyelid approach. The authors aimed to define the arterial vascular structures that can be accessed through this approach. In this study, the M1 and M2 segments of the middle cerebral artery and the branches originating from it were accessible with a 0 degree endoscope after an appropriate dissection. Thus, the endoscopic superior eyelid approach may be a novel alternative approach for some cranial pathologies.

Simultaneous reconstruction after removal of nasal silicone implants was published as diced, autologous rib and ear auricular cartilages, and each had their shortcomings. Temporoparietal fascial grafts were used for facial and nasal contouring, vascularized tissue coverage, and augmentation the nose, lip. The temporoparietal fascia graft may be considered for in-time replacement of allografts and remaining bulkiness. From 2006 until 2008, the temporoparietal fascial graft was used in 20 referred patients with nasal allografts in a medical center. The female-to-male ratio is 17:3. The mean age is around 32.6 years old. All the patients refused disfigurement after the removal of the implants for at least 3 months. All the patients were followed up for 5 years. All patients recovered within 1 to 2 weeks. The nasal skin envelop was preserved or healed. There was neither graft exposure, nor recurred infection. The procedure is a useful method of eliminating inflammatory squeals. The temporoparietal fascial graft used, was able to bridge the 3-month gap without the implant. The smooth nasal dorsum skin was regained with adequate nasal projection. All patients were followed up in plastic surgery clinics without recurrence. There are no reports in the English literature of the use of temporoparietal fascial grafts to treat nasal implant infection. The temporoparietal fascial graft is a simple and reliable method to provide thin, broad, pliable, easy neovascularized, adequate coverage, contour, and bulk on the cartilage dorsum of the nose, an inconspicuous donor site, consistency, and minimal resorption.

Scaphocephaly represents the most frequent single-suture craniosynostosis, with a male prevalence. In many cases, prominent frontal bossing (sphenocephaly) is the major aesthetic concern, typically in school-aged children. This aspect is also usually found in patients with late presentation (after 1 year of age). Several techniques have been described for the correction of frontal bossing in these patients, most involving wide frontal bone exposure and reconstruction. The authors describe a different, less invasive technique, useful in severe sphenocephalic patients, independently from age.

In patients with syndromic craniosynostosis and midface hypoplasia, the Le Fort III osteotomy is a surgical intervention that alleviates nasopharyngeal obstruction and improves facial features that influence societal perceptions of a patient's attractiveness and interpersonal characteristics. This study determines how perceptions of personality traits, expressed emotion, interpersonal experiences, and expected life achievements and experiences changed in pediatric patients with syndromic craniosynostosis and midface hypoplasia undergoing Le Fort III osteotomy with distraction osteogenesis. The goal of this study is to help quantify the significance of surgical interventions on these perceived social parameters to guide preoperative education and manage expectations with patients and their families.

Complex spinal surgery in the pediatric population can lead to devastating complications and morbidity. Paraspinal muscle flaps are commonly performed after complications to optimize wound closure. However, some advocate for their prophylactic use at the index surgery. The aim of this study is to determine the utility of prophylactic muscle flaps in pediatric spine surgery.

A superficial circumflex iliac perforator (SCIP) flap is gaining popularity in microsurgical free flap reconstruction, especially for extremity defects. However, its application in the head and neck region is still uncommon. Besides a thin, pliable skin paddle, the SCIP flap can be elevated with a part of the iliac bone. In this brief clinical study, the authors describe 3 different reconstructions of maxilla defects, ranging from small to very extensive, using an osteocutaneous SCIP flap. In their opinion, this flap provides many advantages, such as a relatively large bony element that is highly mobile in relation to other components and minimal donor site morbidity. Therefore, it is worthwhile to consider utilizing the SCIP flap in reconstructions after maxillectomies.

The use of subperiosteal implants for the rehabilitation of atrophic maxillae has taken attention recently as a validated option in the treatment of severe atrophy. The systems have been improved by technological advancements and the analysis of variables affecting their prognosis. However, one of the most frequent issues to resolve is the unwanted exposure of a portion of the metal mesh close to the abutment and prosthetic connections, which can result in infections, hygiene problems, and, in some instances, complete failure. It seems that the surgical approach is a hot topic for the success of these implants. This article describes a surgical technique that lowers the risk of unintended implant exposure by enabling the subperiosteal implant to be installed from the lateral approach and enabling the right access to the prosthetic abutments in a transfixing way from palatal approach, away from the primary surgical access.

The incidence of colorectal cancer ranks third among all types of cancer. Effective treatment for colorectal cancer patients has not only improved their survival rate but it has also increased the possibility of tumor metastasis. It has been reported that the incidence of brain metastasis in colorectal cancer is low, but the improvement in patient survival and the lack of routine brain imaging may lower the actual incidence of brain metastasis in colorectal cancer. This article discusses a case of a patient with colorectal cancer brain metastasis, who was found to have a subdural hematoma as the main symptom.

Marin-Amat syndrome is a rare, irreversible, and hard-to-treat neurological sequalae that has recently been associated with COVID-19 vaccination. Given the rarity of this condition and the absence of curative treatment to date, the authors herein review the literature to date and report the first ever successful surgical treatment of 2 patients who developed Marin-Amat syndrome after ChAdOx1 nCoV-19 vaccination.

A mandible fracture is a common traumatic craniofacial injury for which surgery is sometimes indicated. Post-fracture and postoperative pain are often controlled through prescribed narcotics, which have received increased attention for potential abuse. The current work identified 90-day opioid prescribing patterns following surgically treated mandible fractures. Patients who underwent open reduction and internal fixation to treat a closed mandible fracture between 2011 and 2021 were identified in the PearlDiver Mariner165 database. Exclusion criteria included: (1) patients with records active for fewer than 180 days before the injury and 90 days post-fracture, (2) age younger than 18, and (3) those with long bone fracture within 30 days of mandible fracture. Variables associated with filling an opioid prescription and utilizing excess morphine milligram equivalents (MMEs) were identified through multivariate regression. Prescribing patterns between 2011 and 2021 were analyzed using simple linear regression. A total of 15,049 patients were identified. Of these patients, opioid prescriptions were filled by 10,389 (69.0%). Greater MMEs were filled for those with greater age, prior opioid use, and history of chronic pain (P < 0.01 for all). The proportion of patients who received opioids decreased from 2011 to 2021 (73.3% versus 61.9%) during which declines were also seen for median MMEs (225.0 versus 128.4) and mean number of filled prescriptions (4.1 versus 2.8). The present work identified age and preexisting risk factors as significantly associated with excess MMEs following open reduction and internal fixation-treated mandible fracture. The decreasing proportion of patients receiving opioids along with decreasing MMEs suggests more refined practice with regard to their use.

The authors aim to clarify the morphology of the nasal airway in patients with cleft lip nose deformities and to analyze the causes of increased nasal resistance.

Scaphocephaly is the most common form of craniosynostosis, characterized by premature closure of the sagittal suture. Surgical intervention is the standard treatment, aimed at correcting cranial shape and improving the cephalic index (CI), the key metric to quantify postsurgical outcomes. Controversies exist in the literature regarding the optimal timing of surgery and the choice of surgical technique. At our center, children aged 6 to 24 months presenting with sagittal synostosis and frontal bossing without significant occipital bullet undergo subtotal (anterior 2/3) vault remodeling, whereas those with both occipital bullet and frontal bossing are treated with total vault remodeling. This retrospective monocenter study tracks the progression of CI in pediatric patients undergoing these 2 techniques at 3 timepoints. From 2007 to 2015 the authors operated on 32 patients, excluding syndromic cases and reoperations. Twenty-three patients underwent subtotal and 9 total vault remodeling. The mean age at surgery was 12.66 months (range 6-24 months). The CI improved significantly in all patients after surgery. Overall, the CI increased from 66.67% preoperatively to 76.67% postoperatively and to 76.83% at 4 years. In the subtotal vault remodeling group, CI increased from 67.27% to 76.81% postoperatively, reaching 77.27% at 4 years. In the total vault remodeling group, CI rose from 65.11% to 76.29% postoperatively but decreased to 75.07% at 4 years. The authors' data show a sustained improvement in CI postoperatively, with a slight reduction in the total vault remodeling group at long-term follow-up.

Auricular reconstruction is one of the most challenging procedures in plastic surgery. However, traumatic auricular defects present more uncertainty and complexity than congenital microtia with various surgical options in auricular reconstruction. The purpose of this article is to review advances in the use of microsurgical techniques for the treatment of traumatic ear defects.