Moghadam Shahrzad, Shariati Kaavian, Huang Kelly X, Chin Madeline G, LaGuardia Jonnby S, Bedar Meiwand, Khetpal Sumun, Cronin Brendan J, Lee Justine C
Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, 200 Medical Plaza Suite 460, Los Angeles, CA, 90095-6960, USA.
David Geffen School of Medicine, UCLA Gender Health Program, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
Aesthetic Plast Surg. 2024 Dec;48(23):4778-4783. doi: 10.1007/s00266-024-04341-2. Epub 2024 Sep 18.
Feminizing fronto-orbital reconstruction involves one of four possibilities with the Ousterhout Type III anterior table frontal sinus osteotomy and setback performed in most patients while the Type I reduction recontouring is reserved for patients without frontal sinuses or thick anterior tables. However, patients with frontal sinuses and either a moderately thick anterior table or a shallow frontal sinus in the sagittal plane represent an intermediate morphology. For such morphologies, we introduce the novel Type I+ fronto-orbital reconstruction technique, consisting of frontal bone recontouring supplemented with anterior table reconstruction and split cranial bone graft.
Transgender and gender non-conforming patients who underwent Type I+ or Type III feminizing fronto-orbital reconstruction (2019-2023) were included for retrospective review and comparison of techniques.
In the 123 patients (mean age 32.2 ± 9.5 years) included, 6.5% underwent Type I+ and 94.5% underwent Type III feminizing fronto-orbital reconstruction. Morphologically, Type I+ patients displayed a shallower frontal sinus compared to Type III patients (median anterior to posterior table depth 4.1[interquartile range, IQR, 1.1-5.0] versus 9.8[IQR 7.5-12.0]mm, p<0.001). At the maximum prominence, Type I+ patients also demonstrated thicker anterior tables compared to Type III patients (median 6.6[IQR 5.0-8.8] versus 2.2[IQR 0.4-4.7]mm, p=0.001). Patients receiving Type I+ procedures underwent an anterior table reduction of 2.7±1.2mm versus 4.2 ± 1.2mm for Type III procedures in the sagittal plane (p=0.002).
The current work introduces a novel solution to an intermediate frontal sinus phenotype for gender-affirming facial feminization surgery.
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女性化额眶重建术有四种术式，多数患者采用奥斯特豪特III型额窦前壁截骨术及后推术，而I型复位重塑术则适用于无额窦或前壁较厚的患者。然而，有额窦且前壁厚度适中或矢状面额窦较浅的患者则呈现出一种中间形态。针对这种形态，我们引入了新型的I+型额眶重建技术，该技术包括额骨重塑，并辅以额窦前壁重建及颅骨劈开植骨术。
纳入2019年至2023年期间接受I+型或III型女性化额眶重建术的变性者及性别不一致患者，进行回顾性研究并比较这两种技术。
纳入的123例患者（平均年龄32.2±9.5岁）中，6.5%接受了I+型手术，94.5%接受了III型女性化额眶重建术。形态学上，I+型患者的额窦比III型患者浅（前后壁深度中位数4.1[四分位间距，IQR，1.1 - 5.0]对9.8[IQR 7.5 - 12.0]mm，p<0.001）。在最大突出处，I+型患者的前壁也比III型患者厚（中位数6.6[IQR 5.0 - 8.8]对2.2[IQR 0.4 - 4.7]mm，p = 0.001）。接受I+型手术的患者在矢状面的前壁后推量为2.7±1.2mm，而III型手术为4.2±1.2mm（p = 0.002）。
本研究为性别肯定性面部女性化手术中额窦中间表型提供了一种新的解决方案。
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