FACE

Extracranial arteriovenous malformations (AVMs) are among the most challenging type of vascular anomaly to treat. Optimal management typically requires multimodal therapy delivered by a multidisciplinary team. Because treatment options vary and multiple specialties are involved, care is often fragmented. The purpose of this study was to characterize a cohort of patients with AVM managed at a large academic medical center to illustrate the complexity of treatment and advocate for specialized care coordinators.

A retrospective chart review was performed to identify all patients evaluated for extracranial AVM between 2010 and 2015. Patients were excluded if they had (1) intracranial AVM only, (2) internal organ involvement only, and (3) final diagnosis was inconsistent with AVM. Age, sex, anatomic location, consulting services, diagnostic tests, procedural interventions (embolization/sclerotherapy, laser or excision), and complications were recorded.

Eighty-six patient charts were reviewed, and 42 patients met final inclusion criteria. The average age at time of plastic surgery consult was 23.7 ± 15.2 years. The most common anatomic locations were the face (36%) and upper extremity (31%). Patients required on average 3.3 ± 1.9 consulting services and 4.1 ± 3.5 diagnostic tests. The most common consulting service was interventional radiology (69%), and the most common diagnostic test was MRI/MRA (2.7 per patient). Patients required an average of 6.7 ± 7.3 procedures. In total, 144 embolization/sclerotherapy procedures and 70 excisions were performed. The average duration between the first procedure and the last procedure was 9.7 ± 8.7 years.

Patients with AVM require extensive hospital resources across multiple disciplines for many years. These patients need complex, coordinated care delivered at a specialized center. A robust vascular anomalies program should include a designated care coordinator to help patients navigate the different specialties and treatment options.

To establish normative nasalance scores for the Nasometer II for children speaking Quebec French.

Prospective study using a randomly selected sample of children with typical speech.

Two children’s hospitals in the province of Quebec, Canada.

Eighty-eight children with typical speech, language and hearing development, aged between 6;00 and 11;11 years, were enrolled at the Centre hospitalier universitaire Sainte-Justine in Montreal and the Centre hospitalier universitaire de Québec-Université Laval in Quebec City, Canada.

Mean nasalance scores.

Mean nasalance scores were obtained for oral vowels, nasal vowels, repeated syllables, oral sentences, a nasal sentence, mixed sentences as well as a short text. While there were no meaningful significant effects of sex and age on the nasalance scores, most nasalance scores obtained at the hospital site in Montreal were statistically significantly higher than in Quebec City. Mean nasalance scores, standard deviations and theoretical critical threshold values are provided and can be used for clinical assessment and research.

Nasalance scores differences according to hospital sites may be attributable to dialectal differences, to differences between the nasalance scores obtained by the nasometers in the 2 clinics, or to a combination of the 2. In future research, diagnostic cutoff scores for different nasal resonance disorders can be developed based on these normative scores.

Alloplastic cranioplasty is a common procedure in cranial reconstruction, yet factors related to success and failure have been incompletely characterized.

The authors conducted a large-scale retrospective review of patients who underwent alloplastic cranioplasty between 2014 and 2021 at a single institution. Information was collected regarding demographics, wound healing comorbidities, indications for surgery, and outcomes. A multivariable regression analysis was used to determine variables associated with operative complications, implant explantation, and contour defects.

One hundred and one patients underwent alloplastic cranioplasty. Fifty-seven percent of patients had at least 1 wound healing comorbidity. The most frequent indications for surgery were trauma (44%), cerebrovascular accident (18%), and cancer (18%). The operative complication rate was 24%. Thirty-six percent of patients had a postoperative contour deformity, and 16% underwent additional surgeries related to cosmesis. At a median follow-up of 1.5 years, 99% of patients maintained either a primary (84%) or secondarily placed (15%) implant. On multivariable analysis, level 4 ASA classification (P = .05) and heavy alcohol use (P = .01) were significantly associated with complications. Cerebrovascular accident (CVA) was associated with contour defects (P = .03). The only factor associated with explantation was heavy alcohol use (P = .05).

This study reviews predictive factors for complications, implant explantation, and poor contour outcomes after alloplastic cranioplasty in a large cohort. Results indicate that alloplastic cranioplasty can have a high success rate with reasonable aesthetic outcomes.

Craniosynostosis is a congenital condition characterized by the premature fusion of 1 or more cranial sutures, leading to abnormal skull and facial morphology. Despite significant advancements in its understanding and treatment, variability in clinical practice persists across perioperative care. This underscores the need for evidence-based guidelines to standardize care and improve patient outcomes. The American Society of Craniofacial Surgeons (ASCFS) aims to address this need by presenting a comprehensive clinical practice guideline for the perioperative surgical treatment of craniosynostosis.

American craniofacial centers were surveyed for standardized perioperative care protocols for craniosynostosis. Key topics, including analgesia and preoperative imaging, formed the foundation of this guideline. Literature searches on PubMed and embase were conducted for each topic, with 2 reviewers independently screening titles and abstracts. A third-party reviewer resolved any discrepancies. Full-text reviews identified articles for inclusion. Recommendations were developed using an evidence-based consensus approach and graded using the American Society of Plastic Surgeons’ recommendation grading scale.

Recommendations were developed for 23 topics, including antimicrobial prophylaxis, analgesia, steroids, surgical drains, preoperative imaging, postoperative nausea and vomiting, and agents to manage blood loss such as tranexamic acid, epsilon-aminocaproic acid, and fibrinogen. The strength of recommendation to support these components was variable but allows for each institution to implement the aspects of the protocol that are suitable for their practice patterns in an evidence-based manner.

This standardized perioperative clinical care pathway represents a synthesis of the current literature available to guide perioperative care of patients undergoing cranial vault repair for the treatment of craniosynostosis. These recommendations can be applied to most patients, although as with any clinical practice guideline, they should be guided by each patient’s clinical circumstances and individual institutional policies.

In order to streamline patient care and optimize outcomes, we have undertaken a protocol for patients with cranial/intracranial tumors whereby coordinated resection and reconstruction are performed in a single stage procedure using a virtually planned craniotomy, guides, and implants. This represents an advanced interdisciplinary approach offering operative efficiency while avoiding many clinical and technical challenges. We present our experience and a 9-patient series using this method.

Patients with cranial/intracranial tumors which would create a defect from extirpation or with inadequate bone following repeated craniotomies were evaluated by neurosurgery and craniofacial surgery teams. A virtual surgical planning (VSP) webinar was attended by both services, where extirpation and reconstruction were simultaneously planned. For resection cases, cranial CT images were superimposed with MRI to register precise tumor location in relation to bone anatomy. The virtually planned craniotomy position was transferred to the operating room with a custom cutting guide registered to the patient’s cranial contours. Finally, immediate reconstruction was performed using a custom 3D polyether ether ketone (PEEK) implant designed to extend precisely to the edges of the guided craniotomy.

Nine patients age 29 to 79 years old (mean = 55) underwent coordinated tumor extirpation and cranial reconstruction via our workflow. They were followed for 28 to 65 months (mean = 42.2). There were no intraoperative complications. One patient developed transient blurry vision which resolved. One patient with history of repeated meningioma removal developed recurrence. All patients have healed without long-term complications, and there have been no explants from these procedures.

Our single-stage protocol for cranial tumor extirpation and cranial reconstruction, which includes collaborative preoperative consultation and VSP, is versatile and effective. The use of computer-generated cutting guides and custom implants obviates intraoperative improvisation and minimizes reoperation. Ultimately, this interdisciplinary approach improves the esthetic and functional results for patients, representing an advancement in cranial defect reconstruction.

Many states, including ours, mandate coverage of orthodontic treatment as part of cleft care. Despite these mandates, barriers consistently arise for patients leading to lack of coverage, delays in care, and increased financial burden. This study aims to characterize the experience and challenges to obtaining coverage for braces as part cleft care for pediatric patients at our institution.

An 18-item REDCap survey was distributed to parents of patients who had been seen in our craniofacial orthodontic clinic for braces from 2019 to 2024. The survey was distributed in English and Spanish based on primary language indicated in the patient’s chart. The survey addressed insurance provider status, the claim process, preauthorization requirement, percentage of coverage by medical and dental insurance, out-of-pocket cost after insurance coverage, and a free response for parents to share any additional experiences in obtaining coverage. Standard statistical analysis was performed.

Forty-one complete responses were received, with a response rate of 15.6%. 43.9% of respondents filed a claim with their medical insurance carrier. The claim process duration varied from minimal time to 6 months to 2 years maximum. Among those who did not file, 34.8% cited uncertainty as to whether insurance would cover treatment. Preauthorization was required for 50% of respondents, resulting in treatment delays until approval in 35.9% of survey participants. Medical insurance covered an average of 37.9% of costs, dental insurance covered 35.2%, leaving a median out-of-pocket expense of $2580.75 after coverage from either provider.

Despite mandated coverage, families face significant barriers in securing insurance reimbursement for orthodontia. Additional education, advocacy, and policy enforcement are needed to improve access and compliance with state mandates.

Ameloblastoma is a rare benign odontogenic tumor that occurs mainly in the mandible. It is characterized by a high tendency to recurrence. The aim of this study was to determine the frequency of recurrence and to investigate the risk factors (RF) for recurrence in mandibular ameloblastoma (MA).

We conducted a retrospective descriptive study including patients with MA in the maxillofacial surgery department of Charles Nicolle Hospital over a 26-year period (1997-2022).

The recurrence rate after the first treatment was 30%. Recurrence- free survival was significantly associated with anterior location (P = .033). The recurrence rate was higher for unilocular tumors. The presence of intra-tumoral bone septa was significantly associated with a lower recurrence-free survival rate (P = .042). In cases where the tooth was included in the tumor, patients did not significantly experience recurrence (P = .043). Cortical rupture (CR) was significantly associated with a higher rate of recurrence (P = .045). From a tumor size of 5 cm, the recurrence rate was estimated at 58%. Radical treatment was associated with a non-significantly high rate of recurrence-free survival. Extraction of 2 teeth upstream and downstream of the tumor was significantly associated with a low recurrence rate (P < .001). Multicystic histological type had a statistically significant higher recurrence rate than unicystic ameloblastoma (P = .049).

This updated RF study would enable us to classify AM patients according to their level of risk of recurrence, and thus adjust their surgical management.

The aim of this study was to examine etiology, patterns, and associated demographic factors of facial fractures in Northern Saudi Arabia.

This was a retrospective study of patients admitted to a tertiary care trauma center in Northern Saudi Arabia with a diagnosis of facial fracture. Medical patient records were retrieved for the period 19/1/2000 to 24/11/2015. Retrieved data were demographics (age, gender, nationality), types and etiology of fractures.

A total of 2066 patient records were included. Patients had a mean age of 24.7 ± 11.7 years, (range = 1-90 years). Most patients were males (n = 1755, 84.9%), and young (19-30 years old; 52%). Fractures of the zygomatic maxillary complex and mandibular parasymphysial fractures were the most commonly encountered fractures (n = 609, n = 603 respectively). Road traffic accidents (RTAs; 66.1%), falls (15.2%), and assault (13.0%) were the main causes of fractures. RTAs were significantly identified among age group (19-30; P < .001). Assault was significantly associated with males, age group (19-30) and Saudi nationality (P < .001, P < .001and P = .032 respectively). Lastly, falls had a significant association with male, children and older adults who were >30 years old (P = .001, P < .001 respectively).

RTAs, assaults, and falls are the most frequently reported causes of facial fractures among trauma patients in Northern Saudi Arabia. RTAs are the leading cause of facial fractures in the young adult population, while assaults are significantly seen in young Saudi males. Maxillary and mandibular fractures are the most commonly observed types of facial fractures. Targeted public health interventions are recommended to address road safety education and enforcement of traffic regulations. Community-based prevention programs could mitigate assault-related trauma, particularly among the young male population.

Firework-related injuries to the face are underreported in the literature compared to hand trauma, despite their significant prevalence and potential for long-term functional and aesthetic consequences. There is a need to better understand the epidemiology, management, and outcomes of these injuries to guide clinical care and prevention efforts.

A systematic review was conducted, screening 293 articles to identify studies focused on the management of firework-induced facial trauma. Fourteen relevant studies were included for analysis. Additionally, a representative clinical case of an 11-year-old male with facial injuries from a firework explosion is presented.

The literature indicates that young males are disproportionately affected by firework-related facial injuries. Pediatric patients are primarily injured by handheld fireworks, typically sustaining soft tissue injuries requiring suturing or minor reconstruction. Adult cases more often involve high-energy fireworks, resulting in facial fractures and ocular trauma necessitating advanced interventions. The presented case involved an 11-year-old male with facial burns, lacerations, and fractures, managed successfully with local tissue rearrangement and scar revision, leading to favorable functional and aesthetic outcomes.

Firework-related facial injuries present unique age-specific challenges. Management in children should focus on techniques that minimize long-term scarring, while adults often require complex reconstructive strategies. Standardized treatment protocols and targeted public safety measures are essential to improve outcomes and prevent injuries. Increased awareness and further research are needed to address the specific challenges associated with firework-induced facial trauma.

Trauma patients are at increased risk for loss to follow up, readmission, and re-presentation to emergency departments. Specialists in the Violence Recovery Program (VRP) provide social and mental support, case management, and education to patients to address socioeconomic barriers. We aim to investigate the impact of VRP on no-show rate after facial trauma.

A retrospective review of facial trauma patients consulted to plastic surgery at a Level 1 trauma center was performed. Two cohorts were identified: (1) Low-VRP cohort (May 2018-October 2018) and (2) High-VRP cohort (January 2024-June 2024). Data collected included VRP intervention and demographics including insurance and injury mechanism. Baseline differences between cohorts, and factors affecting no-show rates within cohorts were assessed. Multivariate logistic regression analysis was conducted to determine predictors of no-show.

In total, 204 patients were included in the High-VRP cohort and 139 in the Low-VRP cohort. There was a higher rate of no-show in the Low-VRP cohort (n = 42, 30.2%) compared to the High-VRP cohort (n = 32, 15.7%; OR: 2.32, P = .001), and higher VRP intervention in the High-VRP cohort (n = 82, 40.2%) than the Low-VRP cohort (n = 4, 2.9%; OR: 22.73, P < .001). There was not a significant difference in age or gender between cohorts. There was a significant difference found in insurance providers (P < .001) between cohorts. There was a significant association between no-show rate and gender (P = .009) within the High-VRP cohort. VRP intervention was significantly associated with clinic attendance in the combined cohort, and remained a significant predictor after regression analysis (OR: 2.50, P = .015).

The integration of a comprehensive social services program is associated with decreased no-show rates after facial trauma. This data highlights the impact of social services on patient engagement.

Firearm-related injuries are the leading cause of injury-related deaths among children. This study explores the relationships between pediatric firearm injury incidence, Childhood Opportunity Index (COI) as a measure of social determinants of health (SDOH), state gun laws, and surgical specialties involved.

The Pediatric Health Information System (PHIS) was used to identify children diagnosed with firearm injuries and required care from 2015 to 2023. Patient demographics, COI, clinical, and geographic data were examined using univariate analysis, t-tests, and logistic regression. State gun laws were categorized into restrictive, moderate, or permissive based on the Giffords Scorecard and population-adjusted analyses were conducted using U.S. Census Bureau data.

One thousand six hundred thirty-six children were included, with a mean age of 11.8 ± 5.0 years. Most injuries occurred in males (79.8%) and White children (64.8%). Mortality was positively associated with low COI scores (OR: 1.010, P = .025). Greater distance from hospitals (OR: 1.01, P = .002) had higher rates of mortality while older age was protective (OR: 0.997, P = .021). Permissive states accounted for 76.4% of injuries, 10.4% in moderate states, 13.2% in restrictive states. Population-adjusted analyses showed higher injury incidences in permissive states versus restrictive states (P < .01). Pediatric, orthopedic, and plastic surgery were the most involved surgical specialties.

Pediatric firearm injuries affect children in neighborhoods with low COI scores, those living farther from hospitals, and in states with permissive gun laws. Plastic surgery was the third most utilized surgical specialty when treating these patients. Further research is needed to inform health policy aimed at mitigating this public health crisis.

Chiari malformation I (CM1) often results from craniocerebral disproportion such as that caused by craniosynostosis (CS). The association between CM1 and CS has been described in several retrospective studies, but a comprehensive meta-analysis of the cumulative data has not been reported. This systematic review and meta-analysis aims to quantify the association between CM1 and CS, including both non-syndromic and syndromic subtypes.

A systematic review and meta-analysis was performed following PRISMA guidelines. Search terms related to Chiari malformation and craniosynostosis (including multi-sutural and single-suture variants) were applied to 3 databases—OVID (Medline), CINAHL, and Scopus—as well as 1 trial register, Cochrane Trials. Three independent reviewers screened records by review. Studies were included if they reported on the presence of CM1 in patients with any type of craniosynostosis.

The initial search yielded 688 articles with 21 meeting inclusion criteria. A total of 1617 patients were included in the study. CM1 was reported in 11% (n = 71) patients with non-syndromic single suture craniosynostosis, 22.7% of patients with syndromic craniosynostosis, and 28.0% of patients with non-syndromic multi-suture craniosynostosis. In patients with single-suture synostosis, the rates were highest in lambdoid synostosis (45.5%) and uni-coronal synostosis (7.14%). Among syndromic cases, the rates were highest in patients with Pfieffer syndrome (68.2%), Crouzon syndrome (44.9%), and Apert syndrome (18.1%).

This meta-analysis demonstrates a strong association between Chiari malformation type I (CM1) and both lambdoid craniosynostosis and multi-suture craniosynostosis. Furthermore, CM1 is significantly associated with syndromic craniosynostosis, particularly in patients with Pfeiffer, Crouzon, and Apert syndrome. These results underscore the need for thorough assessment and vigilant screening for CM1 in higher-risk craniosynostosis subtypes, as this may optimize clinical decision-making, guide surgical strategies, and improve overall patient care.

The present study compares lower eyelid complication rates between preseptal and retroseptal transconjunctival approaches for orbital fracture repair.

MEDLINE, Embase, Cochrane, and Web of Science were searched from inception to November 2024 in accordance with PRISMA 2020 guidelines. Studies were included if they reported original data (n > 1) on orbital or peri-orbital fracture repair using either preseptal or retroseptal transconjunctival approaches, with at least 1 postoperative lower eyelid complication. Both comparative and single-arm studies were included due to limited available evidence. Risk of bias was assessed using RoB 2.0, ROBINS-I, and MINORS tools as appropriate. Pooled proportions and risk ratios were calculated using random-effects meta-analysis.

Three hundred studies were screened and 39 studies (n = 2665 patients) met inclusion criteria. Of these, 1976 patients underwent preseptal and 689 underwent retroseptal approaches. For isolated orbital floor fractures, a retroseptal approach was used more often (59.9%) than a preseptal approach (34.9%). Scleral show was the most frequent complication overall (1.4%) and was more common in retroseptal cases (2.9%) than in preseptal cases (0.9%). Entropion occurred in 0.8% of preseptal and 0.9% of retroseptal cases; ectropion occurred in 0.4% and 0.7%, respectively. The pooled proportion of total eyelid complications was 2% (95% CI: 1-5) for preseptal and 3% (95% CI: 1-9) for retroseptal approaches. Meta-analysis of 5 comparative studies (n = 556) demonstrated no significant difference in complication risk (RR 0.80; 95% CI: 0.26-2.41). GRADE certainty of evidence was moderate.

Both transconjunctival approaches associated with low complication rates, but they are not clinically interchangeable. Retroseptal access may be preferred in older patients or isolated fractures requiring minimal dissection, while preseptal incisions may benefit younger patients or complex fractures requiring broader exposure. Until stronger comparative evidence emerges, patient anatomy and fracture pattern should guide approach selection.

Maxillofacial silicone prostheses are prone to microbial colonization due to their long-term use and exposure to the oral and facial environment, especially in immunocompromised patients. Effective disinfection is essential to maintain hygiene without compromising the material’s physical and esthetic properties. This review aims to evaluate the effect of plant-based and chemical disinfectants on the physical properties and antimicrobial performance of silicone elastomers used in maxillofacial prostheses.

An extensive search was conducted across electronic databases, including Google Scholar, ScienceDirect, and PubMed, as well as journals related to maxillofacial surgery and prosthodontics. The search covered literature up to February 2025. All relevant English-language in vitro studies published up to February 2025 were considered, with no time restrictions applied. A total of 14 studies were included based on pre-established inclusion and exclusion criteria.

The findings indicate that both chemical and plant-based disinfectants demonstrated antimicrobial efficacy against commonly colonizing organisms. However, many chemical agents, such as sodium hypochlorite and chlorhexidine, were associated with changes in surface roughness, hardness, and color degradation of silicone elastomers. In contrast, plant-based agents such as neem extract, tea tree oil, and Thymus vulgaris extract showed comparable antimicrobial performance with fewer adverse effects on material properties.

Overall, the need for biocompatible and non-damaging disinfection methods, especially for patients with compromised immunity, plant-based disinfectants offer a promising and safer alternative for maintaining prosthesis hygiene. Their efficacy, combined with lower cytotoxicity and better material compatibility, supports their consideration in clinical cleaning protocols for maxillofacial prostheses.

Surgical simulation offers an opportunity for trainees to practice complex surgeries in a controlled setting. Three-dimensional (3D) printing is a growing technology that can provide a low-cost method of generating patient-specific simulation models. This study systematically evaluated applications, cost, and outcomes of 3D-printed models in craniofacial surgical simulation.

A systematic review was conducted and PubMed, Embase, Web of Science, Cochrane, and Scopus were searched on June 16, 2025. Articles that examined 3D-printed models used for simulation in craniofacial procedures, involved surgeons or trainees, and provided evaluation data were included. Data extracted included anatomy printed, simulator design, costs, and outcomes after implementing simulation. Risk of bias and confidence were assessed using the Medical Education Research Study Quality Instrument and GRADE, respectively.

Thirty-six studies met inclusion criteria. Printer costs ranged $120 to $500,000 while per-construct costs ranged $2 to $750. 3D-printed models included cleft lip/palate (n = 18), skull models (n = 8), mandible/maxilla models (n = 6), nasal models (n = 3), and an orbit model (n = 1). Twenty-seven studies (75%) reported quantitative outcomes; every study showed significant improvements in knowledge, technical execution, or operative efficiency. All studies assessed qualitative outcomes; participants found 3D-printed models realistic and beneficial, reporting enhanced anatomical understanding and overall high face validity.

Compared to traditional learning methods, 3D-printed simulators for craniofacial surgeries may enhance trainee procedural preparedness by improving anatomical understanding, technical skills, and confidence. Future research should emphasize the impact of how preoperative 3D printed surgical simulation can reduce operating room time and improve operative performance.

Since the establishment of craniofacial (CF) fellowship programs in North America, the specialty has expanded in scope and complexity. This study aimed to characterize current fellowship program structure, examine workforce trends, and capture directors’ perspectives on the future of the specialty.

An 82-item electronic survey was distributed to 34 CF fellowship program directors (PDs) participating in the 2025 match cycle. The survey covered 4 domains: demographics, institutional/practice characteristics, workforce and hiring trends, and perceptions of the field. Responses underwent descriptive analysis.

Twenty-five PDs (73.5%) completed the survey. Most PDs identified as male (80%) and Caucasian (64%), and all had completed CF fellowship training in North America. Over two-thirds (68%) of programs were based in stand-alone children’s hospitals, and 44% of PDs worked at academic institutions. The majority (88%) trained plastic surgery residents, with additional collaboration with otolaryngology, oral surgery, and other specialties. Programs reported 64 hires over the past decade, driven by surgeon departure (50%) and clinical volume growth, with 40 additional hires anticipated in the next 10 years. The greatest perceived threats were competition from other surgical specialties (92%), salary limitations (64%), and intra-specialty competition (48%). While directors expressed concern over stagnant job growth, most supported maintaining current fellowship graduate numbers and endorsed initiatives such as formal program accreditation and the Certificate of Added Qualification.

This survey provides a timely snapshot of CF fellowship leadership and training structures in North America. While hiring data suggest a moderately healthy job market, challenges remain in recruitment, diversity, institutional recognition, and inter-specialty competition. Ongoing refinement of training pathways, clearer specialty identity, and stronger societal advocacy remain essential for the sustainability of the field.

Craniofacial surgery specializes in the treatment of the craniomaxillofacial skeleton and soft tissues. Historically, craniofacial surgery fellowship programs have most often focused on the treatment of pediatric congenital anomalies. However, the scope of the discipline has evolved, and in a recent survey of early-career craniofacial surgeons, nearly 70% of respondents reported their practice was primarily focused on adult patients. The purpose of this study is to systematically analyze the conditions and procedures advertised on craniofacial fellowship websites to ascertain the scope of training opportunities currently available within craniofacial surgery fellowship programs.

In November 2024, the American Society of Craniofacial Surgeons’ (ASCFS) Fellowship Directory was used to identify endorsed craniofacial fellowships in the United States and Canada. Each program website was evaluated for the medical conditions and operative procedures or techniques to which trainees would be exposed.

The search identified 36 ASCFS endorsed fellowships, all of which had a website available. From the 34 websites that listed conditions and/or procedures to which trainees are exposed, 69 themes were elucidated. The top 10 themes were cleft lip and palate (91%), craniosynostosis (85%), orthognathic/jaw deformity surgery (77%), acute and secondary trauma reconstruction (71%), pediatric craniofacial surgery (68%), pediatric plastic surgery (56%), microsurgery or free flap reconstruction (56%), distraction osteogenesis (50%), vascular anomalies (47%), and craniofacial syndromes (41%). The least reported themes were neuroplastic reconstruction, tooth extraction, canthopexy, facelift, fat grafting, torticollis, transplant surgery, congenital chest, muscle reinnervation, bone substitutes, adult facial reconstruction, dermatology, preservation rhinoplasty, adult reconstruction, and surgically assisted rapid palatal expansion.

There is a discrepancy between the training advertised on ASCFS-endorsed program websites and what recent craniofacial fellowship graduates report practicing. Increasing exposure to non-pediatric craniofacial surgery may better prepare graduates for practice in the evolving landscape of craniofacial surgery.

Choosing a specialty is a challenging, multifactorial decision for medical students, especially when considering competitive residencies like plastic and reconstructive surgery (PRS). This study examines students’ exposure to the field as well as influential factors when considering a PRS career.

A cross-sectional survey was distributed to U.S. and Canadian medical students interested in PRS to investigate attitudes, demographics, influential factors, and exposures.

Eighty-seven submissions were analyzed. Of those, 47.1% report being hesitant to fully pursue PRS—58.5% of whom cite a lack of resources to feel confident in matching. Between students with and without a home program, there were notable differences in resource availability. Considering positive factors of PRS, 80.5% highlighted patient impact, with 64.4% ranking it as a top motivator. Conversely, 70.1% identified the competitive nature as a deterrent, followed by residency duration and perception of the general public. Among PRS subspecialties, cosmetic and breast surgery had the highest levels of exposure. Overall, the most cited sources of exposure were self-research (45.5%) and shadowing (43.6%)—many times experienced before medical school. There were no significant differences between students with and without home programs in their interest in, exposure to, or knowledge of the included subspecialties.

Given new heights for a successful match into PRS, early interest is crucial to begin research, foster supportive networks, and engage with PRS communities. This data can guide institutions and PRS organizations to enhance early exposures and targeted resources, ultimately making this field more equitable and accessible for all applicants.

Pierre-Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and airway obstruction, often requiring early surgical intervention. Multiple techniques have been described to treat the associated mandibular deformities, including mandibular distraction osteogenesis, bone grafting, and orthognathic surgery. In severe mandibular deficiency at skeletal maturity, a free vascularized bone transfer, most commonly a fibular flap, is often utilized. The medial femoral condyle (MFC) flap has been applied to mandible reconstruction but is thought to be limited in size and ability to confer cortical strength and structure. This report describes a case involving the use of 2 exceptionally large medial femoral condyle (MFC) flaps containing long cortical bone segments for bilateral reconstruction of the mandibular rami and condyles in a patient with severe micrognathia and PRS.

We present a case of large (75 and 80 mm) MFC flaps and conventional orthognathic surgery in a 15-year-old patient with non-syndromic PRS, a history of multiple failed mandibular reconstructions, and bilateral congenital below-the-knee amputations.

The staged procedure was performed successfully with minimal donor-site morbidity. The patient tolerated the surgery well, with resolution of airway obstruction and improved mastication, swallowing, and speech. Initial postoperative imaging noted improved dentofacial and mandibular arch form. Over time, however, the patient developed a relapse of malocclusion, and subsequent imaging showed substantial resorption of bone, necessitating revision surgery.

We describe the first reported case of bilateral (MFC) flaps containing long segments of cortical bone used for reconstruction of bilateral mandibular rami and condyles. While the patient experienced symptomatic improvement, recurrence of Class II occlusion and bone resorption was observed radiographically. Additional research is necessary to evaluate the viability of this technique as a potential option for large segment reconstruction of the mandibular ramus and condyle.

Eyebrow duplication-syndactyly syndrome (EDSS) is an exceedingly rare entity, with only 2 reports in the literature. Here, we describe a novel phenotypic variant characterized by eyebrow duplication, polydactyly, sagittal craniosynostosis, and a ventricular septal defect (VSD), potentially representing new iteration of this syndrome, termed eyebrow duplication-polydactyly syndrome (EDPS).

A male infant born after an intrauterine growth-restricted pregnancy presented with scaphocephaly, right thumb duplication, and a systolic murmur. Diagnostic evaluation included cranial CT imaging, echocardiography, and radiographs. Surgical interventions addressed craniosynostosis, thumb duplication, and eyebrow duplication.

Imaging revealed near-complete fusion of the sagittal suture, and echocardiography demonstrated a small, restrictive perimembranous VSD. At 3 months, the patient underwent endoscopic-assisted strip craniectomy with helmet therapy. At 12 months, he underwent Bilhaut-Cloquet reconstruction of the thumb and excision of the duplicated eyebrow. Pathology confirmed the excised tissue as microscopically consistent with eyebrow skin. No familial history of similar anomalies was present.

This is the first case report to describe eyebrow duplication-polydactyly syndrome, characterized by polydactyly and craniosynostosis. The absence of family history of similar findings suggests either autosomal recessive inheritance or a de novo autosomal dominant inheritance. Recognition of eyebrow duplication as a diagnostic marker may facilitate earlier identification and characterization of this rare syndrome.

Osteochondroma is a benign neoplasm that often occurs in the distal long bones. Rare cases of this tumor have been reported in the facial region. In this publication we describe the 11th case to date of an osteochondroma of the zygomatic arch.

A 12 year-old female presented to our clinic with a left cheek swelling that she started to note 3 years before. The CT scan revealed a tumorous bone outgrowth orginating from the left zygomatic arch. The cortical bone and cancellous bone of the tumor are continuous with the cortical bone and cancellous bone of the zygomatic arch. The patient was operated on under general anaesthesia. The procedure was performed endobuccally. The anatomopathological study of the operative specimen concluded that it was an osteochondroma. After the surgery, the patient had a smooth recovery with no complications or facial nerve weakness, and was discharged on the same day. One week later, a 25 mm opening was observed with no deflection.

Surgeons should be cognizant of the potential occurrence of an osteochondroma of the zygomatic arch and consider the associated implications in terms of surgical approach.