Brody-Camp Sabrina, Shehan Jennifer, Kariveda Rohith, Spiegel Jeffrey
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA.
Facial Plastic Surgery, The Spiegel Center, Newton, MA, USA.
Craniomaxillofac Trauma Reconstr. 2024 Jun;17(2):115-118. doi: 10.1177/19433875231175703. Epub 2023 May 12.
Retrospective chart review.
The objective of this study was to determine if proceeding with feminization frontal cranioplasty without preoperative imaging adversely affected patient outcomes.
This study retrospectively reviewed all patients undergoing frontal cranioplasty for facial feminization at a single tertiary care center between 2013 and 2019. All procedures were performed by a single surgeon (JS), who operated at multiple sites. The site selected is where the majority of these procedures were performed during this time. Type of cranioplasty (I vs III) was recorded. Primary outcomes included postoperative cerebrospinal fluid (CSF) leak, entering the cranium, or dural exposure or injury.
422 subjects underwent cranioplasty for facial feminization between 2013 and 2019. No preoperative imaging was performed. Zero patients had CSF leak. 334 subjects (79%) had type III cranioplasty, while the remaining 88 subjects (21%) had type I cranioplasty. No subjects had documented episodes of dural injury, or postoperative brain or cranial concerns.
This study demonstrates that frontal cranioplasty for facial feminization does not require routine preoperative imaging. The authors recommend preoperative imaging for patients with a history of congenital cranial abnormality, prior significant head trauma affecting the frontal bone, and in some cases where the patient has had prior surgery or a history of sinus disease or extensive polyposis. Routine preoperative computed tomography is therefore not indicated for patients undergoing feminizing cranioplasty.
回顾性病历审查。
本研究的目的是确定在没有术前影像学检查的情况下进行女性化前额颅骨成形术是否会对患者的预后产生不利影响。
本研究回顾性分析了2013年至2019年间在一家三级医疗中心接受前额颅骨成形术以实现面部女性化的所有患者。所有手术均由同一位外科医生（JS）进行，他在多个地点开展手术。所选地点是这段时间内大多数此类手术的实施地点。记录颅骨成形术的类型（I型与III型）。主要结局包括术后脑脊液漏、进入颅骨、硬膜暴露或损伤。
2013年至2019年间，422名受试者接受了面部女性化颅骨成形术。未进行术前影像学检查。零例患者出现脑脊液漏。334名受试者（79%）接受了III型颅骨成形术，其余88名受试者（21%）接受了I型颅骨成形术。没有受试者记录到硬膜损伤、术后脑部或颅骨相关问题。
本研究表明，面部女性化前额颅骨成形术不需要常规术前影像学检查。作者建议，对于有先天性颅骨异常病史、既往有影响额骨的严重头部外伤史的患者，以及在某些患者曾接受过先前手术或有鼻窦疾病或广泛息肉病史的情况下，应进行术前影像学检查。因此，对于接受女性化颅骨成形术的患者，不建议进行常规术前计算机断层扫描。
