Objective:To retrospect the treatment and clinical effect of craniometaphyseal dysplasia(CMD), and summarize the experience of cranial reconstruction and nasal deformity correction in the management of this case.Methods:From June 2004 to June 2018, three male CMD patients of Shanghai Ninth People’s Hospital who received treatment. One patient was 1 year-old child who received drug therapy. A 5 year-old boy was treated with nasal cavity expansion and orbital hypertelorism for plastic and reconstructive surgery. The 7 year-old patient received cranial reconstruction and nasal deformity correction. Moreover, surgical treatments from 1967 to 2017 in the literatures on CMD were reviewed.Results:Indicators (Ca, ATP, PTH) in the laboratory of the first child returned to normal after medication treatment, and there was no obvious abnormality in the following 2 months. Nasal cavity of the second case was enlarged and function of the nose was improved, and interorbital distance was reduced by 16-17 mm. However, cranial facial deformation was not ameliorated obviously. For the third patient, scaphocephaly deformity was significantly improved. Skull thickness decreased from 3cm to 1-2 cm, the anteroposterior diameter of the skull was shortened up to 6 cm. The immediate review of dd dimer was 4.25 mg/L, FDP was 20.6 μg/ml, which was significantly higher than preoperative tests (dd dimer 0.98 mg/L, FDP 7.24 μg/ml). Two weeks after surgery, the patient received skull debridement due to ineffective anti-infective treatment. Ten months later, the child was admitted to the hospital because of infection. CT scan showed bone resorption, and we treated him with skull debridement and cranioplasty. Following 16 months, the patient was in a stable condition without complications until now.Conclusions:Drug therapy has a potential role in CMD treatment. However, surgery is the only effective management of it, although there will be a high risk and many complications, and the patients need repeated operations.

Objective:To quantitatively assess the degree of bone resorption following cranial bone remodeling for children and adolescent congenital cranial deformity cases in Crouzon syndrome.Methods:A total of 14 congenital cranial deformity patients (mean age 7.7 years) who underwent cranial bone remodeling between Mar. 2014 and Dec. 2018 were selected from Shanghai Ninth People’s Hospital, and retrospectively reviewed. They were treated with modified monobloc osteotomy and distraction osteogenesis. Craniectomy and cranial bone remodeling were performed, and the follow-up period was one week(t1) and one year(t2). The patients were scanned by spiral CT at the two following time points. Then data were imported into Mimics to acquire the three-dimensional model of skull. Bone volume was measured with Mimics Research 18.0 after three-dimensional CT reconstruction. The resorption rate was calculated as (V t1-V t2)/V t1×100%(V t1 represented bone volume before distraction osteogenesis, V t2 represented bone volume after distraction osteogenesis), followed by statistical analysis. Results:Among the 14 patients, bone resorption occurred in 11 patients and the resorption rate after 1 year was 3.482%. There was no significant difference between bone volumes at 1 week and 1 year after surgery( t=0.851, P=0.410). Conclusions:Bone resorption following cranial bone remodeling for children and adolescents with congenital cranial deformity did exist, however, it was acceptable. Therefore, the surgical treatment of cranial remodeling and distraction osteogenesis is advisable for children and youth with congenital cranial deformities over 1 year old.

Objective:To explore the application of three-dimensional measurement data in the diagnosis and treatment of mandibular angle prominent in Shanghai female youth.Methods:The young females in Shanghai were selected from the Clinical Database of Shanghai Universal Medical Imaging Diagnostic Center in Xuhui and the Second Affiliated Hospital of Naval Medical University from January 2010 to December 2020. Three-dimensional reconstruction of the craniofacial region was performed using computer-aided technology, and the subjects were divided into prominent group, attractive group, and contrast group according to the three-dimensional reconstruction images and doctor’s evaluation results. The mandibular and facial regions of the three groups were measured in three dimensions. The measurement indicators included bone tissue indicators such as mandibular angle (∠Co-Go-Me), mandibular expansion angle (∠Go-Me-Go), mandibular body length/mandibular support height ratio (Go-Me/Co-Go), mandibular angle width/zygomatic width ratio (Go-Go/Zy-Zy), and mandibular width index (Go-Go/Co-Co); and the soft tissue indicators included mandibular angle (∠t-go’-gn), mandibular angle width/midface width ratio (go’-go’/zy’-zy’), and mandibular angle width/mandibular height ratio (go’-go’/s-gn). The data were analyzed using SPSS 18.0 software, with normally distributed metric data expressed as Mean±SD. One-way analysis of variance or Kruskal-Wallis rank sum test was used to compare the three groups, and LSD method was used for comparison among prominent group, contrast group and attractive group. Fisher discriminant analysis was used for indicators with statistical significance. P<0.05 was considered statistically significant. Results:A total of 200 young females in Shanghai were enrolled in this study. 73 cases were included in the prominent group, with an age of (26.1±3.2) years, body weight of (54.3±4.3) kg, and body mass index(BMI) of (21.3±1.9) kg/m 2; 32 cases in the attractive group, with an age of (25.3±3.1) years, body weight of (58.7±3.7) kg, and BMI of (20.0±1.5) kg/m 2; and 95 cases in the contrast group, with an age of (27.2±3.7) years, body weight of (53.3±3.4) kg, and BMI of (20.1±1.3) kg/m 2. There were no significant differences in age, body weight, and BMI among the three groups ( P>0.05). There were significant differences in the measurement values of indicators such as ∠Co-Go-Me, ∠Go-Me-Go, Go-Me/Co-Go, Go-Go/Co-Co, ∠t-go’-gn among the three groups ( P<0.01). The prominent group showed significant outward and posterior protrusion in the mandibular angle area compared with the contrast group in terms of ∠Co-Go-Me (111.69°±4.19° vs. 115.43°±3.01°), ∠Go-Me-Go (66.27°±4.51° vs. 64.19°±3.69°), and ∠t-go’-gn (126.13°±7.51° vs. 130.34°±7.21°) ( P<0.01). The attractive group showed significant differences compared with the contrast group in terms of ∠Co-Go-Me (121.61°±3.22° vs. 115.43°±3.01°), Go-Me/Co-Go (1.67±0.20 vs. 1.58±0.15), and ∠t-go’-gn (137.17°±7.57° vs. 130.34°±7.21°) ( P<0.01). The lower quartile of ∠Co-Go-Me in the prominent group was 110°, and the upper quartile of ∠GO-Me-Go was 72°, with a small overlap in the mode region compared with the other two groups. Three indicators, ∠Co-Go-Me ( D1), ∠Go-Me-Go ( D2), and Go-Me/Co-Go ( D3), were selected to establish Fisher discriminant functions. The Fisher discriminant function for prominent group was Z=0.237 D2-0.084 D1-5.813, with a discriminant rate of 60.3%, and for the attractive group was Z=0.257 D1-0.015 D3-28.610, with a Fisher discriminant rate of 85.3%. Conclusion:The ∠Co-Go-Me, ∠Go-Me-Go, ∠t-go’-gn, and other data in Shanghai female youth can be used to evaluate their mandibular contour morphology, providing a reference for the diagnosis and treatment of mandibular angle prominent. The ∠Co-Go-Me of the mandibular aesthetic group should approach 122°, and ∠Co-Go-Me<110° and ∠Go-Me-Go>72° can be used as preliminary indicators for the diagnosis of mandibular angle prominent in prominent group, guiding clinical practice.

Objective:To use the least square method to curve fit the mandibular contours of Chinese women, obtain an ideal fitting function model, and explore the effectiveness of using mathematical curves for bone cutting line design in mandibular osteotomy.Methods:(1) Female cranial CT data were selected from the Second Affiliated Hospital of Naval Medical University and Shanghai Universal Medical Imaging Diagnostic Center. The mandibular morphology of the CT reconstructed images was evaluated using the Likert scale, and samples were selected from individuals with mandibular angle hypertrophy, aesthetically pleasing mandibular morphology, and aesthetically pleasing appearance after osteotomy as references. The Python platform Spyder module was used to analyze the curve fitting of mandibular contour morphology and the goodness of fitting was measured by the coefficient of determination R2( R2 ≥ 0.800 was considered acceptable for the fitted function, while R2≥ 0.900 was deemed sufficient to meet clinical application requirements). The fitting degree of polynomial functions, logarithmic functions, and other mathematical curves in the facial contours of individuals with aesthetically pleasing mandibular morphology were analyzed to obtain an ideal mandibular contour curve fitting function model. (2) Patients with mandibular angle hypertrophy who underwent intraoral mandibular osteotomy from March 2020 to March 2021 at the Department of Plastic and Reconstructive Surgery of Second Affiliated Hospital of Naval Medical University were divided into a mathematical template group (guided by a mathematical curve-based bone cutting plan), a traditional template group (guided by traditional bone cutting templates), and a manual osteotomy group. Three-dimensional reconstruction technology was used to evaluate the efficacy postoperatively. Preoperative preparation time, bone cutting time, surgical time, and postoperative complications were compared among the three groups. Patient self-evaluation of surgical outcomes was assessed using the jawline component of the Face-Q questionnaire. Results:(1) A total of 205 female cranial CT data were selected, including 73 cases of mandibular angle hypertrophy, 32 cases of aesthetically pleasing mandibular morphology, and 5 cases of aesthetically pleasing appearance after osteotomy as reference samples for mandibular contour curve fitting. The result showed that the third-degree polynomial function ( R2=0.918±0.027) and logarithmic function ( R2=0.930±0.039) could be used to simulate the mandibular contour morphology in individuals with aesthetically pleasing mandibular morphology. (2) The mathematical template group (using logarithmic function for bone cutting design), traditional template group, and manual osteotomy group included 28, 14, and 11 patients with mandibular angle hypertrophy, respectively. All patients were satisfied with the postoperative mandibular contour morphology and no complications such as deformity or significant asymmetry were observed. The mathematical template group outperformed the manual osteotomy group in terms of the total score of the jawline questionnaire, surgical time, and bone cutting time(all P<0.01). The preoperative preparation time in the mathematical template group was shorter than that in the traditional template group [(82.39±9.77) min vs. (97.07±17.49) min, P<0.01], and the jawline questionnaire evaluation showed that the patients in the mathematical template group had higher scores in evaluating the lateral view of the mandible and the smoothness of the lower facial contour compared to the traditional template group [3.75±0.44 vs. 3.14±0.36, 3.71±0.46 vs. 3.36±0.50, both P<0.05]. Conclusion:Curve fitting based on the least square method can be used to simulate mandibular angle osteotomy. Models such as logarithmic functions can be used for preoperative design of mandibular osteotomy and have advantages in terms of contour smoothness and symmetry after surgery. Bone cutting design based on mathematical curves can meet patient demands and aesthetic standards, providing precise and individualized solutions for surgery.

Objective:To retrospect the treatment and clinical effect of craniometaphyseal dysplasia(CMD), and summarize the experience of cranial reconstruction and nasal deformity correction in the management of this case.Methods:From June 2004 to June 2018, three male CMD patients of Shanghai Ninth People’s Hospital who received treatment. One patient was 1 year-old child who received drug therapy. A 5 year-old boy was treated with nasal cavity expansion and orbital hypertelorism for plastic and reconstructive surgery. The 7 year-old patient received cranial reconstruction and nasal deformity correction. Moreover, surgical treatments from 1967 to 2017 in the literatures on CMD were reviewed.Results:Indicators (Ca, ATP, PTH) in the laboratory of the first child returned to normal after medication treatment, and there was no obvious abnormality in the following 2 months. Nasal cavity of the second case was enlarged and function of the nose was improved, and interorbital distance was reduced by 16-17 mm. However, cranial facial deformation was not ameliorated obviously. For the third patient, scaphocephaly deformity was significantly improved. Skull thickness decreased from 3cm to 1-2 cm, the anteroposterior diameter of the skull was shortened up to 6 cm. The immediate review of dd dimer was 4.25 mg/L, FDP was 20.6 μg/ml, which was significantly higher than preoperative tests (dd dimer 0.98 mg/L, FDP 7.24 μg/ml). Two weeks after surgery, the patient received skull debridement due to ineffective anti-infective treatment. Ten months later, the child was admitted to the hospital because of infection. CT scan showed bone resorption, and we treated him with skull debridement and cranioplasty. Following 16 months, the patient was in a stable condition without complications until now.Conclusions:Drug therapy has a potential role in CMD treatment. However, surgery is the only effective management of it, although there will be a high risk and many complications, and the patients need repeated operations.

Objective:To quantitatively assess the degree of bone resorption following cranial bone remodeling for children and adolescent congenital cranial deformity cases in Crouzon syndrome.Methods:A total of 14 congenital cranial deformity patients (mean age 7.7 years) who underwent cranial bone remodeling between Mar. 2014 and Dec. 2018 were selected from Shanghai Ninth People’s Hospital, and retrospectively reviewed. They were treated with modified monobloc osteotomy and distraction osteogenesis. Craniectomy and cranial bone remodeling were performed, and the follow-up period was one week(t1) and one year(t2). The patients were scanned by spiral CT at the two following time points. Then data were imported into Mimics to acquire the three-dimensional model of skull. Bone volume was measured with Mimics Research 18.0 after three-dimensional CT reconstruction. The resorption rate was calculated as (V t1-V t2)/V t1×100%(V t1 represented bone volume before distraction osteogenesis, V t2 represented bone volume after distraction osteogenesis), followed by statistical analysis. Results:Among the 14 patients, bone resorption occurred in 11 patients and the resorption rate after 1 year was 3.482%. There was no significant difference between bone volumes at 1 week and 1 year after surgery( t=0.851, P=0.410). Conclusions:Bone resorption following cranial bone remodeling for children and adolescents with congenital cranial deformity did exist, however, it was acceptable. Therefore, the surgical treatment of cranial remodeling and distraction osteogenesis is advisable for children and youth with congenital cranial deformities over 1 year old.

Objective:To explore the application of three-dimensional measurement data in the diagnosis and treatment of mandibular angle prominent in Shanghai female youth.Methods:The young females in Shanghai were selected from the Clinical Database of Shanghai Universal Medical Imaging Diagnostic Center in Xuhui and the Second Affiliated Hospital of Naval Medical University from January 2010 to December 2020. Three-dimensional reconstruction of the craniofacial region was performed using computer-aided technology, and the subjects were divided into prominent group, attractive group, and contrast group according to the three-dimensional reconstruction images and doctor’s evaluation results. The mandibular and facial regions of the three groups were measured in three dimensions. The measurement indicators included bone tissue indicators such as mandibular angle (∠Co-Go-Me), mandibular expansion angle (∠Go-Me-Go), mandibular body length/mandibular support height ratio (Go-Me/Co-Go), mandibular angle width/zygomatic width ratio (Go-Go/Zy-Zy), and mandibular width index (Go-Go/Co-Co); and the soft tissue indicators included mandibular angle (∠t-go’-gn), mandibular angle width/midface width ratio (go’-go’/zy’-zy’), and mandibular angle width/mandibular height ratio (go’-go’/s-gn). The data were analyzed using SPSS 18.0 software, with normally distributed metric data expressed as Mean±SD. One-way analysis of variance or Kruskal-Wallis rank sum test was used to compare the three groups, and LSD method was used for comparison among prominent group, contrast group and attractive group. Fisher discriminant analysis was used for indicators with statistical significance. P<0.05 was considered statistically significant. Results:A total of 200 young females in Shanghai were enrolled in this study. 73 cases were included in the prominent group, with an age of (26.1±3.2) years, body weight of (54.3±4.3) kg, and body mass index(BMI) of (21.3±1.9) kg/m 2; 32 cases in the attractive group, with an age of (25.3±3.1) years, body weight of (58.7±3.7) kg, and BMI of (20.0±1.5) kg/m 2; and 95 cases in the contrast group, with an age of (27.2±3.7) years, body weight of (53.3±3.4) kg, and BMI of (20.1±1.3) kg/m 2. There were no significant differences in age, body weight, and BMI among the three groups ( P>0.05). There were significant differences in the measurement values of indicators such as ∠Co-Go-Me, ∠Go-Me-Go, Go-Me/Co-Go, Go-Go/Co-Co, ∠t-go’-gn among the three groups ( P<0.01). The prominent group showed significant outward and posterior protrusion in the mandibular angle area compared with the contrast group in terms of ∠Co-Go-Me (111.69°±4.19° vs. 115.43°±3.01°), ∠Go-Me-Go (66.27°±4.51° vs. 64.19°±3.69°), and ∠t-go’-gn (126.13°±7.51° vs. 130.34°±7.21°) ( P<0.01). The attractive group showed significant differences compared with the contrast group in terms of ∠Co-Go-Me (121.61°±3.22° vs. 115.43°±3.01°), Go-Me/Co-Go (1.67±0.20 vs. 1.58±0.15), and ∠t-go’-gn (137.17°±7.57° vs. 130.34°±7.21°) ( P<0.01). The lower quartile of ∠Co-Go-Me in the prominent group was 110°, and the upper quartile of ∠GO-Me-Go was 72°, with a small overlap in the mode region compared with the other two groups. Three indicators, ∠Co-Go-Me ( D1), ∠Go-Me-Go ( D2), and Go-Me/Co-Go ( D3), were selected to establish Fisher discriminant functions. The Fisher discriminant function for prominent group was Z=0.237 D2-0.084 D1-5.813, with a discriminant rate of 60.3%, and for the attractive group was Z=0.257 D1-0.015 D3-28.610, with a Fisher discriminant rate of 85.3%. Conclusion:The ∠Co-Go-Me, ∠Go-Me-Go, ∠t-go’-gn, and other data in Shanghai female youth can be used to evaluate their mandibular contour morphology, providing a reference for the diagnosis and treatment of mandibular angle prominent. The ∠Co-Go-Me of the mandibular aesthetic group should approach 122°, and ∠Co-Go-Me<110° and ∠Go-Me-Go>72° can be used as preliminary indicators for the diagnosis of mandibular angle prominent in prominent group, guiding clinical practice.

Objective:To use the least square method to curve fit the mandibular contours of Chinese women, obtain an ideal fitting function model, and explore the effectiveness of using mathematical curves for bone cutting line design in mandibular osteotomy.Methods:(1) Female cranial CT data were selected from the Second Affiliated Hospital of Naval Medical University and Shanghai Universal Medical Imaging Diagnostic Center. The mandibular morphology of the CT reconstructed images was evaluated using the Likert scale, and samples were selected from individuals with mandibular angle hypertrophy, aesthetically pleasing mandibular morphology, and aesthetically pleasing appearance after osteotomy as references. The Python platform Spyder module was used to analyze the curve fitting of mandibular contour morphology and the goodness of fitting was measured by the coefficient of determination R2( R2 ≥ 0.800 was considered acceptable for the fitted function, while R2≥ 0.900 was deemed sufficient to meet clinical application requirements). The fitting degree of polynomial functions, logarithmic functions, and other mathematical curves in the facial contours of individuals with aesthetically pleasing mandibular morphology were analyzed to obtain an ideal mandibular contour curve fitting function model. (2) Patients with mandibular angle hypertrophy who underwent intraoral mandibular osteotomy from March 2020 to March 2021 at the Department of Plastic and Reconstructive Surgery of Second Affiliated Hospital of Naval Medical University were divided into a mathematical template group (guided by a mathematical curve-based bone cutting plan), a traditional template group (guided by traditional bone cutting templates), and a manual osteotomy group. Three-dimensional reconstruction technology was used to evaluate the efficacy postoperatively. Preoperative preparation time, bone cutting time, surgical time, and postoperative complications were compared among the three groups. Patient self-evaluation of surgical outcomes was assessed using the jawline component of the Face-Q questionnaire. Results:(1) A total of 205 female cranial CT data were selected, including 73 cases of mandibular angle hypertrophy, 32 cases of aesthetically pleasing mandibular morphology, and 5 cases of aesthetically pleasing appearance after osteotomy as reference samples for mandibular contour curve fitting. The result showed that the third-degree polynomial function ( R2=0.918±0.027) and logarithmic function ( R2=0.930±0.039) could be used to simulate the mandibular contour morphology in individuals with aesthetically pleasing mandibular morphology. (2) The mathematical template group (using logarithmic function for bone cutting design), traditional template group, and manual osteotomy group included 28, 14, and 11 patients with mandibular angle hypertrophy, respectively. All patients were satisfied with the postoperative mandibular contour morphology and no complications such as deformity or significant asymmetry were observed. The mathematical template group outperformed the manual osteotomy group in terms of the total score of the jawline questionnaire, surgical time, and bone cutting time(all P<0.01). The preoperative preparation time in the mathematical template group was shorter than that in the traditional template group [(82.39±9.77) min vs. (97.07±17.49) min, P<0.01], and the jawline questionnaire evaluation showed that the patients in the mathematical template group had higher scores in evaluating the lateral view of the mandible and the smoothness of the lower facial contour compared to the traditional template group [3.75±0.44 vs. 3.14±0.36, 3.71±0.46 vs. 3.36±0.50, both P<0.05]. Conclusion:Curve fitting based on the least square method can be used to simulate mandibular angle osteotomy. Models such as logarithmic functions can be used for preoperative design of mandibular osteotomy and have advantages in terms of contour smoothness and symmetry after surgery. Bone cutting design based on mathematical curves can meet patient demands and aesthetic standards, providing precise and individualized solutions for surgery.

Objective: To observe the influence of lower wide pedicle frontal periosteum flap on frontal bone absorption rate after cranioplasty. Methods: From February 2016 to July 2017, the lower wide pedicle frontal periosteum flap was produced in 12 patients of Shanghai Ninth People′s Hospital (7 males/5 females, aged 5-9 years, 10 hypertelorism, 2 Crouzon syndrome), who accepted intro-cranio-route plastic surgery, to cover the frontal bone window. A spiral CT scans were applied one week (t1) and one year (t2) after surgery. DICOM data was imported into Mimics software to reconstruct the 3D model of skull. The bone window covered the frontal bone was selected and the bone volume was calculated. The absorption rate was calculated as (Vt₁-Vt₂)/Vt₁×100%. As a control group, the CT data of 20 patients (from January 2010 to December 2015, 11 males/9 females, 7 hypertelorism, 12 Crouzon syndrome, 1 Pfeiffer syndrome) were analyzed retrospectively in the same way, and compared to the experimental group. Results: The average bone absorption rate in experimental group was 8.65%±2.56% (n=12), while in control group it was 26.51%±5.23% (n=20). Significant statistical difference was observed. No further cranial defect was observed in one-year follow-up in both two groups. Conclusions The lower wide pedicle frontal periosteum flap reduces the bone absorption rate after intro-cranio-route plastic surgery. It could also help to repair the anterior cranial base defect during the surgery. This technique was recommend as a regular step in craniofacial surgeries.