Objective:To investigate a new method for the reconstruction of hemifacial microsomia by sagittal osteotomy of the affected mandibular outer cortex combined with bone graft of mandibular outer cortex from healthy side.Methods:From March 2006 to March 2023, the clinical data of patients with hemifacial microsomia admitted to the Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. Preoperative diagnosis and surgical design were performed based on clinical manifestations and imaging findings. All cases were operated under general anesthesia. The affected mandibular outer cortex was previously split by an intraoral approach, and then the mandibular outer cortex of appropriate shape and size on the healthy side was harvested and grafted into the split bone space according to the preoperative design, following by internal rigid fixation. Complications, facial appearance improvement, and patient satisfaction were followed up. Photographs were taken preoperative, immediately postoperative and at the long-term(last) postoperative follow-up, and the severity of the deformity was analyzed. CT data from preoperative, immediate postoperative, and long-term follow-up visits were imported into Surgicase Proplan medical three-dimensional image workstation in Dicom format. The mandible was reconstructed using Segmentation, and the thickness of the mandible was measured during pre-operative, immediate post-operative and long-term follow-up visits. Anova with repeated measurement design was used to compare measurements and LSD test was used for multiple comparisons. The Kruskal-Wallis rank sum test were used to statistically analyze malformation severity. P< 0.05 is considered statistically significant. Results:A total of 39 patients were included in this study, including 13 females and 26 males, with an average age of (22.21±4.57) years (15-27 years). All patients were followed up for an average of (45.56±39.41) months (6-153 months) after surgery. The grafted mandibular outer cortex grows well with the adjacent bone tissue, and the mandibular angle and mandibular body are significantly wider. Of the 39 cases, 1 developed an infection 1 year after surgery, the titanium plate was exposed, and the patient healed after debridement and removal of the immobilizing splint. The facial appearance of the other patients improved significantly. Preoperative, immediate postoperative and long term follow up of mandibular thickness measurements were compared in pairs, and the differences were statistically significant (all P<0.05). The patient’s appearance satisfaction score: the preoperative score was [2.0(1.5, 2.0)] points, the immediate postoperative score was [4.0(4.0, 4.0)] points, the score of the last postoperative follow up was [4.0(4.0, 4.0)] points. There was statistical difference in satisfaction among the three groups ( P<0.01). The preoperative scores were compared with the scores of the immediate postoperative and the last postoperative follow-up respectively, and the differences were statistically significant( P<0.01). There was no statistical significance in satisfaction between the immediate postoperative score and the score of the last postoperative follow up ( P>0.05). Conclusion:The sagittal splitting osteotomy of the mandibular outer cortex is consistent with the features of mandibular anatomy, and provides a good condition for the grafting and healing of autogenous bone. Removing the outer cortex of the mandible on the healthy side not only increases the thickness of the affected side, but also decreases the width of the angle of the mandible on the healthy side, so as to effectively correct the asymmetric deformity of the mandible. The method is simple, with few complications and good results, and is one of the ideal treatments to correct hemofacial microsomia.

Objective:To investigate a new method for the reconstruction of hemifacial microsomia by sagittal osteotomy of the affected mandibular outer cortex combined with bone graft of mandibular outer cortex from healthy side.Methods:From March 2006 to March 2023, the clinical data of patients with hemifacial microsomia admitted to the Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. Preoperative diagnosis and surgical design were performed based on clinical manifestations and imaging findings. All cases were operated under general anesthesia. The affected mandibular outer cortex was previously split by an intraoral approach, and then the mandibular outer cortex of appropriate shape and size on the healthy side was harvested and grafted into the split bone space according to the preoperative design, following by internal rigid fixation. Complications, facial appearance improvement, and patient satisfaction were followed up. Photographs were taken preoperative, immediately postoperative and at the long-term(last) postoperative follow-up, and the severity of the deformity was analyzed. CT data from preoperative, immediate postoperative, and long-term follow-up visits were imported into Surgicase Proplan medical three-dimensional image workstation in Dicom format. The mandible was reconstructed using Segmentation, and the thickness of the mandible was measured during pre-operative, immediate post-operative and long-term follow-up visits. Anova with repeated measurement design was used to compare measurements and LSD test was used for multiple comparisons. The Kruskal-Wallis rank sum test were used to statistically analyze malformation severity. P< 0.05 is considered statistically significant. Results:A total of 39 patients were included in this study, including 13 females and 26 males, with an average age of (22.21±4.57) years (15-27 years). All patients were followed up for an average of (45.56±39.41) months (6-153 months) after surgery. The grafted mandibular outer cortex grows well with the adjacent bone tissue, and the mandibular angle and mandibular body are significantly wider. Of the 39 cases, 1 developed an infection 1 year after surgery, the titanium plate was exposed, and the patient healed after debridement and removal of the immobilizing splint. The facial appearance of the other patients improved significantly. Preoperative, immediate postoperative and long term follow up of mandibular thickness measurements were compared in pairs, and the differences were statistically significant (all P<0.05). The patient’s appearance satisfaction score: the preoperative score was [2.0(1.5, 2.0)] points, the immediate postoperative score was [4.0(4.0, 4.0)] points, the score of the last postoperative follow up was [4.0(4.0, 4.0)] points. There was statistical difference in satisfaction among the three groups ( P<0.01). The preoperative scores were compared with the scores of the immediate postoperative and the last postoperative follow-up respectively, and the differences were statistically significant( P<0.01). There was no statistical significance in satisfaction between the immediate postoperative score and the score of the last postoperative follow up ( P>0.05). Conclusion:The sagittal splitting osteotomy of the mandibular outer cortex is consistent with the features of mandibular anatomy, and provides a good condition for the grafting and healing of autogenous bone. Removing the outer cortex of the mandible on the healthy side not only increases the thickness of the affected side, but also decreases the width of the angle of the mandible on the healthy side, so as to effectively correct the asymmetric deformity of the mandible. The method is simple, with few complications and good results, and is one of the ideal treatments to correct hemofacial microsomia.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the influence on osteogenesis during mandibular augmentation with a new sandwichosteotomy with interpositional natural coral and coralline hydroxyapatite (CHA).Methods:Nine goats were randomly divided into three groups and observed at 6 months, 12months and 18 months after surgery. All goats received splitting of bilateralmandibular outer cortex and interpositional grafting with natural coral and corallinehydroxyapatite respectively (sandwich osteotomy). Partial mandible in each group had been harvested to do histology examination(HE staining and Toluidine blue staining) and ultrastructure analyses (Scanning electron microscope, SEM).Results:All subjects were evaluated atdifferent time points. Both natural coral and coralline hydroxyapatite side healed at three groups. Natural coral were degraded at about 6 months postoperation, coralline hydroxyapatite at about 12 months. The results of HE staining, Toluidine blue staining and SEM revealed that natural coral side had better osteogenesis than coralline hydroxyapatite side at 6 months after operation.However, Natural coral and coralline hydroxyapatite side had no significant differences at 12 and 18months.Conclusions:This study suggests an alternative method for mandibular augmentation witha sandwich osteotomy and interpositional grafting with natural coral and CHA.Bothcoral hydroxyapatite and natural coral have good osteogenesic effect for mandibular augmentation.

Objective:To investigate the influence on osteogenesis during mandibular augmentation with a new sandwichosteotomy with interpositional natural coral and coralline hydroxyapatite (CHA).Methods:Nine goats were randomly divided into three groups and observed at 6 months, 12months and 18 months after surgery. All goats received splitting of bilateralmandibular outer cortex and interpositional grafting with natural coral and corallinehydroxyapatite respectively (sandwich osteotomy). Partial mandible in each group had been harvested to do histology examination(HE staining and Toluidine blue staining) and ultrastructure analyses (Scanning electron microscope, SEM).Results:All subjects were evaluated atdifferent time points. Both natural coral and coralline hydroxyapatite side healed at three groups. Natural coral were degraded at about 6 months postoperation, coralline hydroxyapatite at about 12 months. The results of HE staining, Toluidine blue staining and SEM revealed that natural coral side had better osteogenesis than coralline hydroxyapatite side at 6 months after operation.However, Natural coral and coralline hydroxyapatite side had no significant differences at 12 and 18months.Conclusions:This study suggests an alternative method for mandibular augmentation witha sandwich osteotomy and interpositional grafting with natural coral and CHA.Bothcoral hydroxyapatite and natural coral have good osteogenesic effect for mandibular augmentation.

Objective To establish a cranial bone defect model of goat and to study application in craniomaxillo-facial surgery.Methods Electron beam computed tomography (EBCT) scanner was used to scan goat'heads and faces in series and thin layers.Data of EBCT were input in workstation from digital inlet,and then to three-dimensional reconstruction with method of surface shadow.After final data were transformed to the files,the rapid prototyping machine was able to identify and establish the 3D model.Results The EBCT continuous thin-layer (1 mm) scanning data were passed to wave filter,falling coarse,distinguishing and collecting the outline,3D-reconstruction,curved surface reconstruction with CAD and the substance reconstruction.The final data were input into the laser rapid prototyping machine.Three-dimensional bionic cranium models were fabricated by machine in layer by layer manufacturing principle.Conclusions Establishment of the cranial bone defect model in the goat is very useful to the three-dimensional measurement,individualized reconstruction and basic and clinical research for the cranial bone defect.

Objective: To design the aesthetic new gonion and osteotomy line for patients with prominent mandibular angle patients using computer-aided techniques, and to investigate the application of three-dimensional digital planning in gonioplasty. Methods: From April 2016 to April 2017, 14 female patients with prominent mandibular angle underwent preoperative surgical design and surgical simulation using digital technology. Gonioplasty was performed under the guide of surgical templates, preoperative, surgical simulation and postoperative data were measured including bilateral mandibular angles, the height of ramus(Co-Go) and the length of mandibular body(Go-Me). Paired t test was used to compare the differences between surgical simulation and postoperative measurements. Results: Gonioplasty was performed in 14 patients successfully, and all were satisfied with their facial outcomes. The mandibular angle was improved from 113.86°±4.11° to 124.52°±1.26° on the left side, and 114.30°±4.01° to 124.29°±1.24° on the right side respectively. The average ratio of Go-Me/Co-Go was 2.011 on both sides after operation, which was very close to surgical planning. No significant differences were found between surgical planning and postoperative measurements with respect to mandibular angle or the ratio of Go-Me/Co-Go on both sides(P>0.05). The deviations between them were 1.00°±0.68° and 0.058±0.038 on the left side, and 0.85°±0.63° and 0.072±0.053 on the right side respectively. Conclusions Computer-assisted gonioplasty could improve the efficiency and accuracy of surgery, reduce the risk of surgical complications, and attain higher patients′ satisfaction.

Objective: To design a method of mandibular division for plastic surgery. Methods: From January 2009 to June 2017, 118 patients who underwent mandibular plastic surgery were observed, measured and analyzed. Combined with clinical experience, a new method of mandibular division was designed. The mandible was divided into right and left sides and each side was subdivided into five subunits (A, B, C, D, E). Area A is mandibular ramus upper 1/2 and mandibular coracoid area; Area B is mandibular lower 1/2 area; Area C is mandibular body area; Area D is chin area; Area E is mandibular angle. Results: The mandibles of 118 patients were divided according to the new method to obtain the characteristics of mandibular deformities and guide the design of the surgical plan. Conclusions The new method of mandibular division is concise and scientific, which is in favor of the diagnosis and surgical design of plastic surgery.

Objective: To discuss the establishment of three-dimensional mirror image plane ofhemifacial microsomia. Methods: 32 cases of hemifacial microsomia from Jan. 2006 to Jan. 2017 were collected in our hospital. CT scanning was performed for all patients. Then, the deformity characteristics were summarized through three steps: 3D reconstruction, mirror and discrepancy analysis. Results: After statistical analysis, the stability of these three points was good. Clinical result showed that the patient′s appearance was greatly improved. Conclusions Using these three points to determine the mirror image plane is helpful to analyze the patient's facial features and facilitate the surgical design.

Objective To aesthetically evaluate the mandible,to position the gonion landmark of the aesthetic female with digital techniques and to establish three-dimensional mandibular measurements database of the aesthetic female.Methods 14 aesthetic volunteers were chosen by plastic surgeons and ordinary people based on the identical view of esthetic mandible.The heads were scanned by a spiral CT scanner,and the data were imported into Mimics 18.0 to generate the 3D skull images.Distance,angle and ratio measurements,which could represented the aesthetic characters of the mandible,were made on the images.All the data were transferred into the SPSS 22.0 software to perform statistical analysis.A two-tailed t test was used to compare the symmetry of bilateral mandibles.Dynamic database of aesthetic mandibles was established.The mean,standard deviation,standard error and 95％ confidence interval of data were calculated by statistical software automatically.Results The results suggested that the mean of aesthetic mandibular angle was 123.91°,and the mean of mandibular plane angle was 27.03°.The ratio between the mandibular body and ramus approximated to 2 ∶ 1,and the ratio of the distance between gonion and mental foramen to ramus was close to 1.4.Conclusions The study of mandibular esthetics contributes to positioning the new gonion accurately for patients with prominent mandibular angle and gonion reconstruction,and it can assist surgeons in surgical designing,simulating and performing.