Pang-Yun Chou

Balanitis xerotica obliterans (BXO), the genital manifestation of lichen sclerosus, is a chronic inflammatory dermatosis that may cause progressive sclerosis and anatomical distortion. This case report presents a 58-year-old male with a 2-year history of penile deformity, circumferential hypopigmentation of the glans, sexual discomfort, and lower urinary tract symptoms. Initial assessment showed an International Prostate Symptom Score (IPSS) of 17 and an International Index of Erectile Function-5 (IIEF-5) score of 12. Physical examination revealed circumferential fibrosis with obliteration of the sulcus coronarius and destruction of approximately 70% of glans architecture, while the urethral meatus remained patent. Following excision of fibrotic tissue and penile mobilization, reconstruction was performed using a split-thickness skin graft (STSG) for a 3 cm × 5 cm circumferential defect. At 42-day follow-up, IPSS improved to 8 and IIEF-5–14. Advanced BXO may require reconstructive surgery, with STSG providing satisfactory functional and cosmetic outcomes.

Background: This study explored how Taiwanese schoolchildren perceive the appearance of their peers with and without cleft lip and palate (CLP) and whether this perception affects social interactions. We specifically focused on early adolescents with surgically repaired CLP to assess the impact of residual craniofacial deformities. Methods: A cross-sectional design was used, analyzing three-dimensional (3D) surface images of twenty patients with repaired CLP and five without. A total of 91 schoolchildren (40 with CLP, 51 without) served as raters. Participants used a Likert scale to rate images on facial appearance and perceived social acceptance. The study also measured the reliability of its questionnaires using Cronbach’s alpha. Results: All participants successfully differentiated between images of children with and without CLP, though non-cleft participants had significantly better distinguishing abilities. Non-cleft raters consistently gave more positive appearance ratings to non-cleft images, a pattern less evident among cleft raters. While differences in awareness and acceptance between the two groups were not statistically significant, over half of all responses regarding social interaction were neutral. The questionnaires demonstrated high reliability, with Cronbach’s alpha values greater than 0.85. Conclusions: Despite the ability to perceive residual craniofacial differences, appearance alone did not significantly affect social interactions for early adolescent children with surgically repaired CLP in Taiwan. This suggests that other factors may play a larger role in social dynamics within this population.

Purpose: The authors evaluated pterygomaxillary junction angles across malocclusion patterns and identified the optimal technique for effective pterygomaxillary junction separation during Le Fort I osteotomy, focusing on appropriate osteotome angles and clinical applications. Methods: This retrospective study included 211 patients with malocclusion who had undergone Le Fort I osteotomy at Chang Gung Craniofacial Center between December 2015 and September 2023. The patients were stratified by sex and malocclusion class (class I, II, or III). Preoperative cone-beam computed tomography was performed to measure pterygomaxillary junction angles at 2 axial levels: the posterior nasal spine level and the lower border level corresponding to the maxillary tuberosity. Le Fort I osteotomy involving an angle oscillating saw, and a curved-tip Dautrey osteotome was performed, ensuring the precise placement of the osteotome and tilting of the osteotome handle during pterygomaxillary junction separation. The correlations between the pterygomaxillary junction and appropriate osteotome placement angles were investigated. Results: Among the 211 patients, 5%, 15%, and 80% had class I, class II, and class III malocclusion, respectively. At the posterior nasal spine level, the average angles of the pterygomaxillary junction relative to the coronal plane were 16.76, 19.16, and 17.82 degrees in class I, class II, and class III groups, respectively; the corresponding angles at the lower border level were 27.29, 27.80, and 25.91 degrees. No significant between-class or between-sex differences were observed in pterygomaxillary junction angles; however, significant differences were noted between the 2 levels. Conclusion: Our surgical technique was both safe and effective for pterygomaxillary junction separation.

Background: Plagiocephaly, wherein infants' head exhibits a diagonal asymmetry, is currently diagnosed based on physicians' subjective judgment. Discrepancies between physician and parent perspectives may result in dissatisfaction with treatment outcomes. This problem highlights the need for an objective assessment system aligning with physician-made clinical diagnoses. Methods: Infant heads were modeled using 3-dimensional scanning techniques. We developed a craniofacial asymmetric index (CAI) based on 10 height planes of heads with varying weight. CAI and traditional craniofacial vault asymmetry index (CVAI) of 10 infants undergoing helmet therapy were compared with 11 craniofacial surgeons' judgment. The Pearson correlation coefficient and Bland-Altman plot were used to determine the correlations and agreement between physicians' judgment and the aforementioned assessment methods. The adjusted intraclass correlation coefficient was calculated to evaluate the reliability of between-physician agreement. Results: All 10 infants were divided into the following 3 severity groups: severe, moderate, and mild groups based on craniofacial surgeons' judgment. Notably in CAI, front/back halves of skull and multiangular weighting factors were evaluated. The evaluation revealed perfect alignment in severity classification between the CAI and physicians' judgment, whereas both the CVAI score and MATLAB analysis show varying degrees of difference, 6 and 4 distinct results, respectively. Coefficients of the correlations of physician-assigned scores with the MATLAB analysis, CVAI score, and CAI score were 0.500, 0.833, and 1.000, respectively. Furthermore, Bland-Altman plots revealed the best agreement between CAI and physician-assigned scores. Conclusions: CAI closely aligns with the subjective judgment of craniofacial surgeons' assessing the severity of plagiocephaly in infants.

Background: Although the human body generally exhibits bilateral symmetry, achieving perfect symmetry is exceedingly uncommon. During preadolescent development, a face that approximates symmetry is considered both aesthetically and functionally ideal. This study aimed to investigate the relationship between craniofacial traits and hand predominance, using three-dimensional (3D) stereophotogrammetry to discern whether facial soft-tissue characteristics are correlated with hand preference. Materials and Methods: The study involved children aged 9 and 10 years who were free from any diagnosed craniofacial anomalies. Three-dimensional stereophotogrammetry was conducted to analyze their facial morphology, and 37 distinct anatomical landmarks were manually identified using a MATLAB-developed program. Results: A total of 188 Taiwanese children participated in the study. All participants were healthy, with a mean age of 9.79 years. Among them, 93.1% (175) were right-hand predominant, and 6.9% (13) were left-hand predominant. There were no significant differences in linear parameters or facial asymmetry between right-hand-predominant and left-hand-predominant participants (p > 0.05). However, a consistent trend toward right laterality, especially in the right lateral frontal region of the cranium, was observed, as illustrated by heat maps of the average three-dimensional model. Conclusions: The study found no association between facial morphology and hand predominance. A normal asymmetry with a rightward tendency was noted in children aged 9 to 10 years, which was particularly notable in the lateral frontal region of the head.