Treatment with an inhibitor of matrix metalloproteinase 9 or cathepsin K lengthens embryonic lower jaw bone.

OBJECTIVES: Skeletal malocclusions are common, and severe malocclusions are treated by invasive surgeries. Recently, jaw bone length has been shown to be developmentally controlled by osteoclasts. Our objective was to determine the effect of inhibiting osteoclast-secreted proteolytic enzymes on lower jaw bone length of avian embryos by pharmacologically inhibiting matrix metalloproteinase-9 (MMP9) or cathepsin K (CTSK). METHODS: Quail (Coturnix coturnix japonica) embryos were given a single dose of an inhibitor of MMP9 (iMMP9), an inhibitor CTSK (iCTSK), or vehicle at a developmental stage when bone deposition is beginning to occur. At a developmental stage when the viscerocranium is largely calcified, the heads were scanned via micro-computed tomography and reproducible landmarks were placed on 3D-reconstructed skulls; the landmark coordinates were used to quantify facial bone dimensions. RESULTS: Approximately half of the quail given either iMMP9 or iCTSK demonstrated an overt lower jaw phenotype, characterized by longer lower jaw bones and a greater lower to upper jaw ratio than control embryos. Additionally, iMMP9-treated embryos exhibited a significant change in midface length and iCTSK-treated embryos had significant change in nasal bone length. CONCLUSION: MMP9 and CTSK play a role in osteoclast-mediated determination of lower jaw bone length. Pharmacological inhibition of MMP9 or CTSK may be a promising therapeutic alternative to surgery for treating skeletal jaw malocclusions, but more preclinical research is needed prior to clinical translation.

[Clinicopathological analysis of 105 patients with fibrous dysplasia of cranio-maxillofacial region].

OBJECTIVE: To compare the clinicopathologic features and prognosis of the different types of fibrous dysplasia (FD) of cranio-maxillofacial region, so as to provide a new reference for clinicians to treat these patients and make prognostic judgement. METHODS: Clinical records, radiographic data and pathological information of 105 patients diagnosed with FD or McCune-Albright syndrome (MAS) at the Department of Oral Pathology, Peking University Hospital of Stomatology from January 2013 to December 2020 were collected. The patients were divided into 4 groups: monostotic FDs, polyostotic FDs, MAS and a specific type called craniofacial fibrous dysplasia (CFD) limited in the craniofacial region. The clinicopathological characteristics, treatment and follow-up data of each type were analyzed. RESULTS: Of all the 105 patients, 46 were males and 59 were females, with a male-to-female ratio of 1 ∶1.3. The onset age ranged from 0 to 56 years and the median age was 12 years. On the basis of different involvement conditions, 4 types were divided. The most common type was monostotic FDs (43 cases, 40.95%), including maxilla (29 cases), mandibular (12 cases) and zygoma (2 cases). 32 cases (30.48%) were diagnosed with polyostotic FDs, 7 cases (6.67%) were MAS, and 23 cases (21.90%) were CFDs confirmed by computed tomography (CT) analysis. CFD was clearly distinct from other types of FD, such as the patient gender and the serum alkaline phosphatase level in peripheral blood before operative surgery. The pathologic findings of various types FD were quite similar, whilst the predominant fibrous tissue hyperplasia could be observed in polyostotic FDs and MAS types. CONCLUSION: The clinicopathologic features of FD in the cranio-maxillofacial region are different from the FD lesions in other parts of the body. The clinicopathological features of CFD are significantly different from those of monostotic and polyostotic FDs in the cranio-maxillofacial region. Therefore, the clinicians should pay attention to distinguish CFD in clinic, imaging and pathology aspects, so as to further clarify its features in clinic management and prognosis.

Automated 3D MRI rendering of the craniofacial skeleton: using ZTE to drive the segmentation of black bone and FIESTA-C images.

PURPOSE: Automated bone segmentation from MRI datasets would have a profound impact on clinical utility, particularly in the craniofacial skeleton where complex anatomy is coupled with radiosensitive organs. Techniques such as gradient echo black bone (GRE-BB) and short echo time (UTE, ZTE) have shown potential in this quest. The objectives of this study were to ascertain (1) whether the high-contrast of zero echo time (ZTE) could drive segmentation of high-resolution GRE-BB data to enhance 3D-output and (2) if these techniques could be extrapolated to ZTE driven segmentation of a routinely used non bone-specific sequence (FIESTA-C). METHODS: Eleven adult volunteers underwent 3T MRI examination with sequential acquisition of ZTE, GRE-BB and FIESTA-C imaging. Craniofacial bone segmentation was performed using a fully automated segmentation algorithm. Segmentation was completed individually for GRE-BB and a modified version of the algorithm was subsequently implemented, wherein the bone mask yielded by ZTE segmentation was used to initialise segmentation of GRE-BB. The techniques were subsequently applied to FIESTA-C datasets. The resulting 3D reconstructions were evaluated for areas of unexpected bony defects and discrepancies. RESULTS: The automated segmentation algorithm yielded acceptable 3D outputs for all GRE-BB datasets. These were enhanced with the modified algorithm using ZTE as a driver, with improvements in areas of air/bone interface and dense muscular attachments. Comparable results were obtained with ZTE+FIESTA-C. CONCLUSION: Automated 3D segmentation of the craniofacial skeleton is enhanced through the incorporation of a modified segmentation algorithm utilising ZTE. These techniques are transferrable to FIESTA-C imaging which offers reduced acquisition time and therefore improved clinical utility.

Big Data Statistical Analysis of Facial Fractures in Korea.

BACKGROUND: The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA. METHODS: We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software. RESULTS: The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011. CONCLUSION: We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.

Dental caries on CT in the ER population: prevalence and reporting practices.

PURPOSE: Although dental caries can be identified on CT and may be treatable, the literature provides little, if any, guidance on the responsibility of a neuroradiologist in reporting them. Untreated dental caries can impact diet and nutrition and can result in a variety of complications such as an odontogenic abscess, tooth loss, sinusitis, and dental pain, which can impact quality of life. The estimated prevalence of untreated dental caries in adults is 27%. In our experience, the prevalence of untreated dental caries in patients presenting to the Emergency Department (ED) is higher but dental caries are often unmentioned or unrecognized. We aim to determine the frequency of unreported dental caries and propose a paradigm for reporting and management. METHODS: Our research was IRB-approved and HIPPA compliant. We searched the radiology database for adult patients who underwent a CT of the facial bones while in the Emergency Department between January 1, 2015 and June 30, 2015. The examinations were reviewed by a faculty neuroradiologist for the presence of untreated dental caries. Untreated dental caries were documented and characterized by depth. Caries that were partially or completely obscured by dental amalgam artifact were excluded. The radiology reports were reviewed to evaluate reporting frequency. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. RESULTS: A total of 200 patients (113 male, 87 female; age 18-98 years) underwent 200 CT examinations of the facial bones. One hundred fourteen (57%) patients had at least one dental caries. When caries were present, 14.9% of radiology reports included caries in the findings section and 9.6% of the reports mentioned caries in the impression. CONCLUSIONS: The presence of dental caries should be mentioned in the radiology report. The prevalence of untreated dental caries is higher in our cohort than reported in the general population, and dental caries are underreported by neuroradiologists at our institution. A paradigm for reporting and management was created upon collaboration with faculty from the University of Vermont Dental and Oral Health practice. A visit with a dentist should be recommended within 6 months if caries are limited to the enamel, within 3 months if caries involve the dentin, and within 2 weeks if caries extend in to the pulp. Further research is necessary to determine the clinical impact of improved reporting.

Epidemiology of facial fractures among older adults: A retrospective analysis of a nationwide emergency department database.

BACKGROUND/AIMS: The prevalence of facial fractures among older adults has increased in recent years, and nationwide studies about the epidemiological profile and outcomes of hospital-based ED visits for facial fractures among older adults are scarce. The aim of this study was to provide USA-wide data of hospital-based Emergency Department (ED) visits for facial fractures among older adults, and to investigate the outcomes associated with these visits. MATERIAL AND METHODS: The Nationwide Emergency Department Sample (NEDS) for the years 2008-2014 was used for the present study. All ED visits with a diagnosis of facial fractures in any of the diagnoses fields and only patients aged 65 years and above were included. RESULTS: A total of 540 748 ED visits matched the criteria (62.7% were females). Public insurance-Medicare-(85.2%) was the most common payer. The three most frequent facial fractures included fractures of the nasal bones (61.3%), fractures of "other" facial bones (16.7%), and fractures of the orbital floor (15.0%). Falls were the most common causes of facial fractures (81.8%). Following ED visits, 64.1% were treated and released, and 30.6% were admitted into the hospital. The mean ED charge per visit was US$5507. Total ED charges across the entire United States was US$2 518 289 555. CONCLUSIONS: Among older adults, nasal bone fractures are the most common type of facial fracture. Facial fractures are mainly caused by falls. There was no significant trend in mortality rates over the study period, and there was a significant financial burden associated with the facial fracture-related ED visits.

[Skin ageing-General features of facial ageing and therapeutic choices]. / Vieillissement cutané ­ Vieillissement facial global : orientation thérapeutique.

Correction of cutaneous and facial ageing is the key reason for consultations in aesthetic dermatology. This demand on the part of patients, which has become a social phenomenon, has increased thanks to the remarkable progress made in nonsurgical and less invasive therapies such as lasers, botulinum toxin and fillers. But in order to optimise their use and to provide a personalised touch, since each face ages differently, an overall facial analysis, both static and dynamic, is essential. Indeed, ageing is obviously not restricted to skin but also concerns underlying tissue such as muscle, fat tissue and supporting bone. In this article, we provide a clinical and physiopathological analysis of the ageing of skin and of the various types of ageing, whether chronological, hormonal or environmental, and we examine the major role played by UV radiation, as well as tobacco smoke and, in certain cases, pollution. The description of cutaneous ageing covers not only the face, in which photoaging is the predominant factor, but also ageing of skin throughout the rest of the body. Next we describe the general modes of facial ageing for the subcutaneous structures, first those of the skin muscles, which compensate for their atrophy by means of permanent hypercontraction that result in dynamic wrinkles, then those of fat tissue in which ptosis can occur, coupled in some cases with atrophy and loss of the fullness and harmonious facial curves of youth, and those of supporting bone structures and preferential areas of resorption, which are also where the most pronounced ageing of soft tissue is discernible. The upper third, middle and lower third of the face do not age in the same way and the relevant methods of correction thus differ. Finally, we briefly discuss the therapeutic choices available, taking into account the generally extremely reasonable expectations of patients, who tend to seek moderate and natural rejuvenation in keeping with their personality, as well as the elimination of negative expressions associated with ageing, and who want neither a rigid face nor aesthetic cloning.

Iliac and mandible osteoblasts exhibit varied responses to LMHF vibration.

The facial and long bones have distinct developmental origins, structures, and cellular compositions. This study aimed to compare the in vitro responses of human mandible and long bone osteoblasts to low-magnitude, high-frequency (LMHF) mechanical vibration in terms of expression of mediators of bone remodeling. Osteoblast-like cell cultures were prepared from iliac crest and mandibular bone specimens from three individuals and cultured in osteogenic induction media. Induction of mature osteoblastic phenotypes was confirmed by analysis of DNA content, alkaline phosphatase activity and gene expression every 3 days for 27 days. Based on gene expression, mature osteoblasts formed by day 15 of induction culture. After 15 days of culture in induction media, mature osteoblasts were subjected to vibration (0, 30, or 60 Hz) for 30 min every 24 h. After 48 h, RANKL, OPG, IL-1ß, IL-6 and TGF-ß gene, and protein expression were determined by real-time PCR analysis of total cellular mRNA and ELISAs of the cell supernatants. Both iliac and mandible osteoblasts responded to LMHF vibration: IL-1ß and RANKL mRNA were downregulated and IL-6 mRNA was upregulated. However, TGF- ß mRNA was unaltered and OPG mRNA was upregulated in iliac osteoblasts, whereas both TGF-ß and OPG mRNA were downregulated in mandible osteoblasts. As a result, LMHF reduced the RANKL/OPG mRNA ratio in iliac osteoblasts but did not alter the RANKL/OPG mRNA ratio in mandible osteoblasts. This study suggests mature iliac osteoblasts exhibit a more potent anti-resorptive response to vibration, while this tendency was not obviously apparent in mature mandible osteoblasts.

Non-odontogenic tumors of the facial bones in children and adolescents: role of multiparametric imaging.

Tumors of the pediatric facial skeleton represent a major challenge in clinical practice because they can lead to functional impairment, facial deformation, and long-term disfigurement. Their treatment often requires a multidisciplinary approach, and radiologists play a pivotal role in the diagnosis and management of these lesions. Although rare, pediatric tumors arising in the facial bones comprise a wide spectrum of benign and malignant lesions of osteogenic, fibrogenic, hematopoietic, neurogenic, or epithelial origin. The more common lesions include Langerhans cell histiocytosis and osteoma, while rare lesions include inflammatory myofibroblastic and desmoid tumors; juvenile ossifying fibroma; primary intraosseous lymphoma; Ewing sarcoma; and metastases to the facial bones from neuroblastoma, Ewing sarcoma, or retinoblastoma. This article provides a comprehensive approach for the evaluation of children with non-odontogenic tumors of the facial skeleton. Typical findings are discussed with emphasis on the added value of multimodality multiparametric imaging with computed tomography (CT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), positron emission tomography CT (PET CT), and PET MRI. Key imaging findings and characteristic histologic features of benign and malignant lesions are reviewed and the respective role of each modality for pretherapeutic assessment and post-treatment follow-up. Pitfalls of image interpretation are addressed and how to avoid them.

The Adelaide Facial Bone Rule: A simple prediction model and clinical guideline for the presence of facial fractures using CT brain scans in victims of minor trauma.

BACKGROUND: Facial fractures bleed, resulting in high-density fluid in the sinuses (haemosinus) on computed tomography (CT) scans. A CT brain scan includes most maxillary sinuses in the scan field, which should allow detection of haemosinus as an indirect indicator of a facial fracture without the need for an additional CT facial bone scan, yet no robust evidence for this exists in the literature. The aim of this study was to determine whether the presence of haemosinus on a CT brain scan, alone or in combination with other clinical information, can predict the presence of facial fractures. METHODS: 1231 adult patients, who had both brain and facial CT scans performed on the same day, were selected from a seven year period. Patients were eligible if scans were requested for trauma. Brain and facial scans were reviewed separately for the presence of facial fractures, haemosinus, emphysema and intra-cranial haemorrhage. Prediction modelling was used to assess whether findings from brain scans could be used to identify patients requiring further CT scanning. FINDINGS: The full prediction model included four predictors and showed excellent discrimination (AUROC 0.982; 95 % CI 0.971 - 0.993). A simplified model, more suitable for clinical implementation, used only facial fractures and haemosinus as predictors. This model showed only marginally poorer discrimination (AUROC 0.964; 95 % CI 0.945 - 0.983) and excellent performance on other measures. CONCLUSION: Based on the excellent performance of the simplified prediction model, we present the Adelaide Facial Bone Rule: The absence of blood in the sinuses or facial fractures on a CT brain scan means a CT facial bone scan does not need to be routinely performed in the setting of clinically-determined minor trauma.

Midface hypoplasia in syndromic craniosynostosis: predicting craniofacial growth via a novel regression model from anatomical morphometric analysis.

Midface hypoplasia in syndromic craniosynostosis (SC) may lead to serious respiratory issues. The aim of this study was to analyse the morphometric correlation between midface and cranial base parameters in paediatric SC patients in order to formulate predictive regression models. The computed tomography scans of 18 SC patients and 20 control were imported into Materialise Mimics Medical version 21.0 software for the measurement of multiple craniofacial landmarks and correlation analysis. The results showed a strong correlation of anterior cranial base (SN), posterior cranial base (SBa), and total cranial base (NBa) (r = 0.935) to maxilla length and width (ZMR-ZML) (r = 0.864). The model of NBa = - 1.554 + 1.021(SN) + 0.753(SBa) with R2 = 0.875 is proposed to demonstrate the development of the cranial base that causes a certain degree of midface hypoplasia in SC patients. The formula is supported using a prediction model of ZMR-ZML = 5.762 + 0.920(NBa), with R2 = 0.746. The mean absolute difference and standard deviation between the predicted and true NBa and ZMR-ZML were 2.08 ± 1.50 mm and 3.11 ± 2.32 mm, respectively. The skeletal growth estimation models provide valuable foundation for further analysis and potential clinical application.

Maxillofacial Bone Involvement in Fibro-Osseous Lesions: Emphasizing the Significance of Differential Diagnosis.

The World Health Organization's (WHO) 2022 update on the classification of odontogenic and maxillofacial bone tumors has revolutionized diagnostic and treatment paradigms by integrating novel molecular insights. Fibro-osseous lesions of the maxillo-facial bones constitute a heterogeneous group encompassing fibrous dysplasia, Psammomatoid Ossifying Fibroma (PSOF), Juvenile Trabecular Ossifying Fibroma (JTOF), and other variants. Despite histological similarities, their distinct clinical manifestations and prognostic implications mandate precise differentiation. The intricacies of diagnosing fibro-osseous lesions pose challenges for pathologists, maxillofacial surgeons, dentists and oral surgeons, underscoring the importance of a systematic approach to ensure optimal patient management. Herein, we present two cases, fibrous dysplasia and Cemento-Ossifying Fibroma, detailing their clinical encounters and management strategies. Both patients provided informed consent for publishing their data and images, adhering to ethical guidelines.

Risk of complications in panfacial bone fracture according to surgeons: A meta-analysis.

BACKGROUND: Panfacial bone fractures pose intricate challenges because of severe fragmentation and the loss of landmarks. Surgeons use a variety of reduction techniques, including bottom-up and top-down approaches. This single proportional meta-analysis explores sequencing differences and complications between oral and maxillofacial surgery surgeons (OMSs) and plastic and reconstructive surgeons (PRSs) in treating panfacial bone fractures. METHODS: The PubMed and Scopus databases were searched systematically, and we compiled 14 studies published between 2007 and 2023 involving 1238 patients. A systematic review of the included studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data on the reduction techniques; total complication rates; and rates of malocclusion, enophthalmos, infection, asymmetry, and esthetic complications were collected. RESULTS: The bottom-up technique was the most prevalent for both types of surgeons (57.1%, 8 out of 14). Malocclusion rates (I2 = 0% for OMSs and 41% for PRSs) were similar between the groups (p = 0.72), but PRSs tended to have a lower enophthalmos rate (I2 = 0% for OMSs and 32% for PRSs) than OMSs (p < 0.01). Infection rates remained consistent across all studies. However, high heterogeneity was observed for the total complication rate (I2 = 94% for OMSs and 85% for PRSs) and asymmetry and esthetic complications (I2 = 88% for OMSs and 92% for PRSs), making direct comparison between the two groups inconclusive. CONCLUSIONS: In this study, the differences in surgical techniques and levels of interest have a greater impact on the outcomes of the panfacial bone fracture than the surgeon's specialty. However, more in-depth studies are needed to accurately pinpoint panfacial bone fracture reduction trends and differences in postoperative complications in the two expert groups.

Systematic review of non-invasive ventilation and craniofacial fractures: a multidisciplinary perspective and recommendations for management.

The anatomically complex craniofacial skeleton demands special consideration when caring for cases of polytrauma or medically compromised patients with craniofacial fractures. This paper utilises a systematic review and multidisciplinary opinions to create an algorithm for the hospital-based care of patients with craniofacial fractures (base of skull, orbit, paranasal sinus, and mandible) who require non-invasive ventilation (NIV). Each fracture location has a unique predisposition to a different type of emphysema and associated morbidity. The risk of developing emphysema, combined with its potential severity, is stratified against the harm of not providing NIV for the holistic care of the patient. The aim of this paper is to synthesise evidence from a systematic review of existing literature with multidisciplinary opinions to develop a concise algorithm that outlines the optimal treatment of patients with craniofacial fractures who require NIV.

Return-to-play guidelines following facial fractures.

Despite bone healing and the management options of facial fractures being reported at length, there is a lack of evidence-based return-to-play criteria for sportspeople who have sustained these fractures. This shortage of evidence has resulted in a lack of consensus among health professionals. A prospective study of 20 cases of sportsmen who have returned to competitive play 3 weeks after injury or treatment for facial fractures is reported. The risks and benefits of early return-to-play are discussed and return-to-play guidelines for these patients are proposed.

Ewing's Sarcoma of the Zygoma: A Very Rare Location.

Ewing's sarcoma is a rare and aggressive neoplasm that typically affects the long bones. The presence of a primary tumor in the facial bones is extremely uncommon. Here, we present a case of a 21-year-old male with Ewing's sarcoma of the zygoma. To date, only a few such cases have been reported worldwide in the literature.

The ideal shape of the female jaw angle: An online survey.

The aim of this study was to determine the characteristics of an attractive white female jaw angle in the three dimensions. An online survey of photographs of celebrities and laypeople was used to rate their attractiveness using 6 questions and a 3-item Likert scale. If ≥ 80% of participants rated a model as having attractive aesthetic features, it was considered attractive. The following features were considered important: a gonial angle in profile of 125.5° and in anterior view of 142°, an intergonial-interzygomatic width ratio of 0.83 and the vertical position of the jaw angles at the level of the stomion or upper lip. Surgeons can use these consensus criteria to help design a jaw angle implant, define orthognathic surgical strategies, or shape the angle using injectables.

Craniofacial involvement in Langerhans cell histiocytosis: A review of 44 cases at a single medical center.

BACKGROUND: Craniofacial bones are the most commonly involved site of Langerhans cell histiocytosis (LCH). The main purpose of this study was to clarify the relation between subsites of craniofacial bone and clinical presentation, treatment modalities, outcomes, and permanent consequences (PCs) in patients with LCH. METHODS: Forty-four patients diagnosed with LCH involving the craniofacial region presenting at a single medical center during 2001-2019 were collected and divided into four groups: single system with unifocal bone lesion (SS-LCH, UFB); single system with multifocal bone lesions (SS-LCH, MFB); multisystem without risk organ involvement (MS-LCH, RO-); and multisystem with risk organ involvement (MS-LCH, RO+). Data including demographics, clinical presentation, treatments, outcomes, and the development of PC were retrospectively reviewed. RESULTS: Temporal bone (66.7% versus 7.7%, p = 0.001), occipital bone (44.4% versus 7.7%, p = 0.022), and sphenoid bone (33.3% versus 3.8%, p = 0.041) involvement were more common in SS-LCH, MFB than they were in SS-LCH, UFB. No difference of reactivation rate was noted among the four groups. The most common PC is diabetes insipidus (DI), reported in 9 of the 16 (56.25%) patients with PC. The single system group was reported with the lowest incidence of DI (7.7%, p = 0.035). The reactivation rate was also higher in patients with PC (33.3% versus 4.0%, p = 0.021) or DI (62.5% versus 3.1%, p < 0.001). CONCLUSION: An increased risk of multifocal or multisystem lesions was associated with temporal bone, occipital bone, sphenoid bone, maxillary bone, eye, ear, and oral involvement, which may indicate poor outcomes. Longer follow-up may be indicated if there is the presence of PC or DI due to the high risk of reactivation. Therefore, multidisciplinary evaluation and treatment according to risk stratification are vital for patients diagnosed with LCH involving the craniofacial region.

FACE-Q satisfaction following upper third facial gender-affirming surgery using custom bone-section guides.

Postoperative satisfaction after facial gender-affirming surgery (FGAS) has not yet been assessed using a validated questionnaire. There is currently no postoperative satisfaction questionnaire specific to transgender patients concerning facial surgery. The contributions of three-dimensional planning in fronto-orbital surgery in trans women and the use of bone cutting guides for facial feminization surgery have been demonstrated. The primary objective of this study was to evaluate postoperative satisfaction with the upper third of the face in trans women using a validated questionnaire - FACE-Q - after fronto-orbital surgery using custom-made bone cutting guides. The secondary objective was to determine predictive factors of satisfaction. Forty-two patients who underwent frontoplasty with frontal sinus impaction osteotomies using custom bone cutting guides between May 2018 and September 2020 were included. Three-dimensional preoperative computed tomography planning was performed for each patient. Evaluations were performed preoperatively and at 1 year postoperative using FACE-Q items relating to the upper third of the face (fronto-orbital area) and general questionnaire items. At 1 year, the following FACE-Q scales had improved significantly in comparison to the preoperative evaluation: overall facial appearance (33.6 ± 19.4 vs 70.1 ± 21.1; P < 0.001), forehead and eyebrow appearance (38.3 ± 19.7 vs 80.1 ± 15.9; P < 0.001), wrinkles between the eyebrows (54.1 ± 26.7 vs 82.6 ± 19.9; P = 0.001), appearance-related psychological distress (58.1 ± 18.1 vs 24.6 ± 24.5; P < 0.001). No factors predictive of postoperative satisfaction were found for the included frontal FGAS. In the absence of a validated questionnaire specific to facial feminization surgery in transgender patients, the FACE-Q questionnaire showed an improvement in patient satisfaction after FGAS of the upper third using custom-made cutting guides.

An analysis of lateralized neural crest marker expression across development in the Mexican tetra, Astyanax mexicanus.

The biological basis of lateralized cranial aberrations can be rooted in early asymmetric patterning of developmental tissues. However, precisely how development impacts natural cranial asymmetries remains incompletely understood. Here, we examined embryonic patterning of the cranial neural crest at two phases of embryonic development in a natural animal system with two morphotypes: cave-dwelling and surface-dwelling fish. Surface fish are highly symmetric with respect to cranial form at adulthood, however adult cavefish harbor diverse cranial asymmetries. To examine if lateralized aberrations of the developing neural crest underpin these asymmetries, we used an automated technique to quantify the area and expression level of cranial neural crest markers on the left and right sides of the embryonic head. We examined the expression of marker genes encoding both structural proteins and transcription factors at two key stages of development: 36 hpf (∼mid-migration of the neural crest) and 72 hpf (∼early differentiation of neural crest derivatives). Interestingly, our results revealed asymmetric biases at both phases of development in both morphotypes, however consistent lateral biases were less common in surface fish as development progressed. Additionally, this work provides the information on neural crest development, based on whole-mount expression patterns of 19 genes, between stage-matched cave and surface morphs. Further, this study revealed 'asymmetric' noise as a likely normative component of early neural crest development in natural Astyanax fish. Mature cranial asymmetries in cave morphs may arise from persistence of asymmetric processes during development, or as a function of asymmetric processes occurring later in the life history.