FACE

Evans, Robin J.

doi: 10.1177/27325016261446301pmid: N/A

The scope of craniomaxillofacial surgery has expanded dramatically over the past century, driven less by incremental progress than by episodic paradigm shifts and the interdisciplinary collaboration that made them possible. From the reconstructive efforts of Gillies in the early 20th century to the craniofacial revolutions of Tessier and McCarthy, the field has continuously redefined its boundaries. This paper examines the historical development, philosophical underpinnings, and contemporary opportunities for scope expansion in craniomaxillofacial surgery. Through analysis of training models, emerging technologies, and institutional strategy, we propose a framework for the next paradigm shift in craniofacial and maxillofacial surgery; 1 integrating virtual surgical planning, biologic reconstruction, and systems-based leadership. Expanding the scope of practice in craniomaxillofacial surgery will not happen passively. It requires claiming complex cases, measuring outcomes that matter to patients, and training surgeons who lead multidisciplinary teams rather than defer to them. The future of craniomaxillofacial surgery depends on our willingness to redefine its borders rather than simply defend them.

Quirarte, Diego M.; Gonzales, Julian J.; Ortegon, Sergio; Buchanan, Edward P.

doi: 10.1177/27325016261449414pmid: N/A

Background:Maxillary defects resulting from tumor resection or trauma can lead to substantial functional and esthetic impairment, including malocclusion, impaired mastication, disordered speech, and loss of midface projection. Free tissue transfer has become the primary method of reconstruction for large maxillary defects, yet flap failure and patient-specific contraindications can limit its use. Custom patient-specific implants have emerged as a potential alternative for patients who are unable to undergo or have previously failed traditional reconstruction.Case Presentation:We present the case of a 23-year-old man who acquired severe maxillary bone loss following childhood fibrous dysplasia treated with hemi-maxillectomy. Over 7 years, he underwent multiple reconstructive attempts at our institution, including 2 fibula free flaps that ultimately failed, prompting consideration for reconstructive alternatives. This patient was selected for custom maxillary reconstruction with a digitally planned, titanium subperiosteal implant using the IPS Implants® Preprosthetic system. The implant was successfully placed in a single-stage procedure, providing immediate, stable structural support for definitive prosthetic rehabilitation.Conclusions:This case highlights the role of custom patient-specific implants as a viable reconstructive option for patients with extensive maxillary loss who are poor candidates for free tissue transfer. Patient-specific subperiosteal implants may provide durable skeletal support and reliable dental rehabilitation for complex cases in which traditional methods have failed.

Surapaneni, Akhil; Francis, Ashish; Frommer, Sarah A.; Kelley, Patrick K.; George, T. M.; Harshbarger, Raymond J.

doi: 10.1177/27325016261455020pmid: N/A

Objective:To describe early and mid-term outcomes of Viabahn stenting for extensive aorto-iliac occlusive disease involving the external iliac artery.Methods:In this single center retrospective study, all consecutive patients in whom a covered self-expanding Viabahn stent was implanted (W.L Gore & Associates, Inc., Flagstaff, AZ–USA) in the external iliac artery for symptomatic TASC II C and D lesions between 2012 and 2020 were included. Lesions limited to the iliac artery were treated percutaneously. Iliac lesions extending down to the common femoral artery were treated with a hybrid approach. Patency, major adverse limb events, target lesion revascularization (TLR) and limb salvage rates were estimated using Kaplan-Meier curves.Results:Out of 118 limbs, 48 (41%) were treated for claudication, 33 (28%) for rest pain, and 37 (31%) for tissue loss. Lesions were TASC C (n = 43 limbs, 36%) or TASC D (n = 75 limbs, 64%). Chronic total iliac occlusions were identified in 26 limbs (22%). Concomitant common femoral artery lesions were recorded in 97 limbs (82%). All lesions involved the external iliac artery. Technical success was achieved in 100% of cases. Six (5.7%) perioperative major adverse cardiovascular events occurred, including 4 (3.8%) deaths. Eleven (7.6%) early major adverse limb events were recorded. Two-years primary patency, assisted primary patency and secondary patency were 85%, 88%, and 95%, respectively. After multivariate analysis, small-diameters stents (<8 mm) was associated with lower primary patency rates (HR 3.20, 95% CI 1.26-8.13, P = .014) and lower freedom from TLR rates (HR 2.61, 95% CI 1.02-6.66, P = .045). Adjunctive common femoral artery endarterectomy was significantly associated with higher primary patency rates (HR 0.38 95% CI 0.15-0.95, P = .038).Conclusion:The use of Viabahn self-expanding covered stents for extensive aorto-iliac disease involving the external iliac artery provided acceptable post-operative morbidity and high rates of mid-term secondary patency, similar to those usually reported with aortobifemoral bypass. Adjunctive common femoral artery endarterectomy was a major determinant of patency and should be considered an essential component of the treatment strategy. Additional long-term data are necessary to evaluate the role of self-expanding covered stents for the treatment of such lesions.

Munkwitz, Sara E.; Shah, Hana; Mirsky, Nicholas A.; Kassira, Wrood M.; Thaller, Seth R.

doi: 10.1177/27325016261455706pmid: N/A

Purpose:Authorship plays a crucial role in academic medicine. It significantly impacts residency placement for students, especially in competitive specialties like plastic surgery. Despite the existing guidelines, widespread ethical concerns remain unsettled. This study aimed to explore the understanding, perceptions, and attitudes of authorship practices among medical students interested in plastic surgery to evaluate the need for more comprehensive analysis and to generate hypothesis-driven insights to enhance research integrity.Design:An IRB-approved, anonymous 29-question survey was distributed to medical students interested in plastic surgery to explore their understanding, perceptions, and attitudes in authorship practices.Results:A total of 46 students met inclusion criteria. Although 82.6% reported awareness of authorship criteria, only 21.7% reported receiving any formal training. Misconceptions were common, as many students endorsed non-qualifying contributions as sufficient for authorship. Perceived unethical authorship practices, including ghost and honorary authorship, were reported by 32.6% and 52.2% of respondents, respectively. These were often reported to be driven by seniority, institutional norms, and publication pressure. More than a third of respondents reported experiencing unfair authorship orders. Over a quarter had experienced disputes, yet few were aware of or utilized institutional resources.Conclusion:Medical students interested in plastic surgery report frequent challenges related to authorship in research. These findings likely reflect a combination of misunderstandings of authorship criteria and true deviations from established standards, both of which have important implications for ethics education, mentorship, and institutional policies. As a preliminary analysis, these results support the need for further large-scale investigation to validate findings.