Category: Statistics

J Craniomaxillofac Surg. 2026 Mar 29;54(6):104538. doi: 10.1016/j.jcms.2026.104538. Online ahead of print.

ABSTRACT

OBJECTIVES: Safe separation of the pterygomaxillary junction (PMJ) is a critical step during Le Fort I (LF-I) osteotomy. The use of a pterygoid osteotome remains controversial due to its potential association with unfavorable fracture patterns and serious complications. This study aimed to evaluate the effect of pterygoid osteotome use on PMJ fracture patterns in horizontal and vertical planes using computed tomography (CT).

MATERIALS AND METHODS: This retrospective study included 83 patients who underwent LF-I osteotomy between 2022 and 2025 and had postoperative CT imaging within the first postoperative month. A total of 166 PMJs were evaluated by analyzing the right and left sides separately. Patients were divided into two groups according to pterygoid osteotome use. Preoperative cone-beam CT was used for anatomical measurements, while postoperative CT images were assessed to classify PMJ separation patterns in horizontal and vertical planes. Fracture patterns were compared between groups.

RESULTS: When analyzed separately by side, a statistically significant difference was observed only in left-sided horizontal fracture patterns, with a higher incidence of posterior maxillary sinus wall fractures (Type 3) in the osteotome-positive group (p < 0.05). When all PMJs were evaluated together, significant differences were found in both horizontal and vertical fracture patterns between groups (p < 0.05). Ideal separation along the pterygomaxillary fissure (Type 1) was more frequent in the osteotome-negative group (63.9%), whereas pterygoid plate fractures (Type 4) were more common in the osteotome-positive group (19.1%) (p = 0.002). High-level vertical fractures near the skull base were also significantly more frequent in the osteotome-positive group (14.9% vs. 5.6%, p = 0.049).

CONCLUSIONS: Osteotomeless pterygomaxillary separation during down-fracture was associated with more ideal and complication-free fracture patterns in both horizontal and vertical planes. In contrast, pterygoid osteotome use was associated with an increased incidence of unfavorable fracture patterns. These findings support the consideration of osteotome-free techniques as a safe and effective alternative during LF-I osteotomy.

PMID:41911644 | DOI:10.1016/j.jcms.2026.104538

Accid Anal Prev. 2026 Mar 29;232:108522. doi: 10.1016/j.aap.2026.108522. Online ahead of print.

ABSTRACT

Spatiotemporal prediction of urban traffic crashes is an important basis for proactive safety management, yet many existing models have difficulty capturing both temporal dynamics and spatial dependence in an interpretable way. This study develops a hybrid framework that integrates Hankel-based Dynamic Mode Decomposition (Hankel-DMD) with a spatiotemporal graph neural network (STGNN) to predict short-term neighborhood-level crash counts. Daily crash records from 2019 to 2021 for 78 neighborhoods in Denver, USA are aggregated into a neighborhood-day matrix. Hankel-DMD is applied to this matrix to extract low-rank spatiotemporal modes that describe dominant trends and recurrent fluctuations. A graph neural network defined on a distance-correlation-based neighborhood graph then learns nonlinear residuals that correct the linear DMD prior and transmit information along the urban network. The proposed model is evaluated in a multi-step prediction setting with horizons of 1, 3, 5, and 7 days, and is compared with statistical time-series models, tree-based machine learning models, a pure Hankel-DMD model, and deep learning baselines including a STGNN. Across all horizons, the hybrid model achieves the lowest mean absolute error and root mean squared error, with improvements of about 17 to 30% in mean absolute error and 13 to 24% in root mean squared error relative to the best deep learning benchmark. Performance gains are consistent across high-, medium-, and low-risk neighborhood groups. Hankel-DMD eigenvalues and spatial modes reveal stable temporal and spatial structures in 2019 and 2021, together with clear deviations in 2020 associated with disrupted mobility patterns. These results show that dynamics-informed graph learning can provide accurate and interpretable crash risk forecasts at the neighborhood scale and can support targeted urban safety interventions.

PMID:41911624 | DOI:10.1016/j.aap.2026.108522

Cont Lens Anterior Eye. 2026 Mar 29;49(3):102648. doi: 10.1016/j.clae.2026.102648. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated tear film parameters during the wear of two daily disposable contact lenses composed of different polymers and examined their association with symptoms of contact lens discomfort.

METHODS: A prospective, randomized, investigator-masked crossover study was conducted over two months with 20 participants wearing Somofilcon A or Verofilcon A daily disposable lenses. Tear meniscus height (TMH), non-invasive tear breakup time (NITBUT), and lipid layer thickness (LLT) were measured at the beginning of the study and after one month of wearing each lens type, both with lenses in-situ and after removal following at least six hours of wear. Symptoms were assessed using the Contact Lens Dry Eye Questionnaire (CLDEQ-8) and a visual analog scale (VAS). Differences in parameters between lens types and time points were analyzed using repeated measures ANOVA. Associations between tear film parameters and subjective comfort scores were assessed using Pearson’s correlation coefficients. Statistical significance was set at p < 0.05.

RESULTS: The NITBUT-average significantly improved with Verofilcon A (12.98 ± 4.27 s; p < 0.001) and Somofilcon A (12.30 ± 3.46 s; p < 0.001) compared to baseline (9.31 ± 3.29 s), with no significant difference between the lenses (p = 0.456). Significant changes in VAS comfort and CLDEQ-8 scores from baseline were observed for both lens types (p < 0.001). For Verofilcon A, CLDEQ-8 scores decreased, and VAS comfort increased while CLDEQ-8 scores negatively correlating with NITBUT-first break (r = -0.4637, p = 0.0455) and NITBUT-average (r = -0.5758, p < 0.001). i.e. a smaller CLDEQ-8 score (better comfort) associated with longer NITBUT.During Somofilcon A wear, CLDEQ-8 increased, and VAS comfort scores decreased, and VAS negatively correlated with NITBUT-first break (r = -0.5334, p = 0.018) and TMH (r = -0.4856, p = 0.0351).

CONCLUSIONS: Whilst better comfort with Verofilcon A was associated with improved NITBUT, correlations were moderate, and further studies are required to draw stronger conclusions. LLT showed no association with symptoms. Lens material and surface properties, along with ocular surface factors likely influence comfort outcomes.

PMID:41911617 | DOI:10.1016/j.clae.2026.102648

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012682. Online ahead of print.

ABSTRACT

BACKGROUND: Orbital fractures, which frequently involve the floor and medial wall, constitute a significant portion of craniomaxillofacial traumatic injuries. Failure to restore the orbital architecture can result in aesthetic and functional sequelae that significantly affect the patient’s quality of life. Three-dimensional (3D) reconstruction provided essential anatomic data, facilitating surgical planning and diagnosis.

METHODS: This study aimed to investigate 15 cases of patients who underwent surgical intervention for orbital fractures. Radiologic outcome assessment used 3D reconstruction measurements of orbital height, length, width, and globe projection, with the contralateral unaffected orbit as the anatomic control. The patient’s perception was evaluated postoperatively using the adverse effects checklist of the FACE-Q Eye Module.

RESULTS: Morphometric analysis demonstrated that orbital dimensions (height, width, and length) were either preserved or restored, exhibiting statistical stability. Preoperative orbital length asymmetry was eliminated postoperatively. However, the globe projection exhibited persistent statistical asymmetries in both the preoperative and postoperative periods compared with the contralateral side control. The patient perception assessment indicated a low frequency and low intensity of self-reported eye-specific adverse effects. The most frequently reported adverse event was ocular irritation.

CONCLUSIONS: Surgical reconstruction has been demonstrated to be an effective procedure for restoring fundamental orbital dimensions. However, the persistent statistical asymmetry in globe projection indicates the challenge in achieving complete normalization of globe position post-trauma. Surgical effectiveness can be complemented by the patient’s perspective to provide a comprehensive evaluation of functional and aesthetic results.

PMID:41911589 | DOI:10.1097/SCS.0000000000012682

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012689. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study is to determine whether children who undergo adenoidectomy show statistically significant improvements in their eating habits, sleep quality, and weight gain.

METHODS: Fifty individuals who had undergone adenoidectomy and 50 healthy controls matched for age and sex were included in the case-control study. The Eating Improvement Score, Sleep Quality Score, and Weight Gain Rate were assessed using standardized anthropometric measurements and validated parent-reported scales.

RESULTS: Patients who underwent adenoidectomy had considerably higher rates of weight gain (0.74 versus 0.28 kg/mo), Eating Improvement Scores (7.7 versus 4.4), and Sleep Quality Scores (7.8 versus 4.5).

CONCLUSION: Nutritional and functional outcomes are significantly improved after adenoidectomy in children with adenoid hypertrophy, demonstrating that the procedure has benefits beyond clear airways.

PMID:41911587 | DOI:10.1097/SCS.0000000000012689

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012723. Online ahead of print.

ABSTRACT

BACKGROUND: Cat allergy is a common cause of allergic rhinitis and asthma and is associated with significant symptom burden and impaired quality of life. Complete avoidance of cat allergens is often impractical, and allergen-specific immunotherapy (AIT) represents a potential disease-modifying treatment option. However, real-life data regarding the effectiveness and safety of cat allergen immunotherapy remain limited.

OBJECTIVE: To evaluate the real-life clinical effectiveness and safety of subcutaneous cat allergen immunotherapy using a cat allergen extract in patients with cat-induced allergic rhinitis and/or asthma.

METHODS: This retrospective observational study included patients who received subcutaneous cat allergen immunotherapy for at least 6 months between January 2023 and December 2025. Sensitization to cat allergen was confirmed by both skin prick testing and serum cat-specific IgE (≥0.35 kU/L). Clinical outcomes, including symptom scores, medication scores, Visual Analog Scale (VAS), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores, were assessed at baseline and during follow-up. Changes between baseline and the sixth month of treatment were analyzed using nonparametric statistical methods.

RESULTS: A total of 12 patients were included, all of whom were female, with a mean age of 35.17 ± 8.68 years. Asthma was present in 25% of patients. At the sixth month of immunotherapy, significant improvements were observed across all evaluated clinical parameters. Median symptom scores decreased from 3.0 to 1.0 (P = 0.002), medication scores from 2.0 to 1.5 (P = 0.038), and VAS scores from 9.0 to 5.0 (P = 0.002). RQLQ scores also showed a significant reduction from 113.0 to 86.0 (P = 0.028). Improvements were associated with large effect sizes. Ten patients achieved a >30% reduction in VAS scores. Moderate correlations were observed between changes in symptom and medication scores and improvements in quality of life. Immunotherapy was generally well tolerated; moderate-to-severe systemic reactions occurred in a subset of patients, with no life-threatening reactions or permanent treatment discontinuation.

CONCLUSION: In this real-life cohort, subcutaneous cat allergen immunotherapy was associated with significant improvements in clinical symptoms, medication use, and quality of life, with an acceptable safety profile. These findings support the role of cat allergen immunotherapy as an effective treatment option in selected patients with persistent symptoms despite medical therapy.

PMID:41911585 | DOI:10.1097/SCS.0000000000012723

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012692. Online ahead of print.

ABSTRACT

Patients with unilateral cleft lip nasal deformities (UCLND) suffer from both cosmetic deformities and functional impairments. While secondary rhinoplasty primarily targets aesthetic enhancement, its long-term effects on patient-reported function, particularly airway patency and olfactory function, are not well-documented. The primary purpose of this study is to conduct a longitudinal assessment of patient-reported satisfaction, nasal patency, and olfactory function following secondary rhinoplasty in patients with UCLND. This study included 144 patients who underwent secondary rhinoplasty of UCLND between February 2022 and November 2023. Nasal morphology and function were assessed using the Rhinoplasty Outcome Evaluation (ROE) scale, Nasal Obstruction Symptom Evaluation (NOSE) scale, and the Visual Analog Scale (VAS) for olfactory function. A total of 144 patients were followed for 6 months postoperatively, of whom 100 completed an additional follow-up at 12 months. Comparison between preoperative and 6-month postoperative outcomes revealed significant improvements in both ROE and olfactory VAS scores (both P<0.001), whereas the NOSE score showed no statistically significant change (P=0.83). At 12 months postoperatively, ROE and olfactory VAS scores remained significantly elevated compared with preoperative levels, and the NOSE score demonstrated a significant reduction (P<0.001, P<0.001, and P=0.003, respectively). Secondary rhinoplasty for unilateral cleft lip nasal deformity has been shown to improve nasal satisfaction and subjective perception of nasal airway patency and olfactory sense. Notably, the improvement in patient-reported nasal patency appears to be a progressive and sustained process over time.

PMID:41911582 | DOI:10.1097/SCS.0000000000012692

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012595. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine variations in the morphology of the sphenoid ridge (SR) between individuals with trisomy 21 (T21) and healthy controls.

METHODS: The work included computed tomography scans from 45 patients with T21 (mean age: 9.40±3.87 y) and 45 healthy controls (mean age: 8.56±4.87 y). Measurements were taken for SR in terms of its length (LSR), angle (ASR), lateral tip width (WL), and midline width (WML). ASR was categorized as follows: Type A for values >130 degrees, Type B for values between 110 and 130 degrees, and Type C for values <110 degrees.

RESULTS: In the T21 group, LSR, ASR, WL, and WML were measured as 40.07±3.83 mm, 119.58±10.08 degrees, 2.65±0.90 mm, and 9.09±2.45 mm, respectively. In controls, LSR, ASR, WL, and WML were measured as 42.28±4.26 mm, 122.50±8.67 degrees, 2.62±0.80 mm, and 7.95±2.08 mm, respectively. LSR (P<0.001) and ASR (P=0.039) were found to be smaller in individuals with T21 compared with the control group. WML was greater in T21 than controls (P=0.019), but WL was statistically similar in both groups (P=0.812). The comparison of ASR configurations between the T21 group (types A: 8.9%, B: 76.7%, and C: 14.4%) and the control group (types A: 17.8%, B: 72.2%, and C: 10%) indicated no significant association between T21 and this classification (P=0.173).

CONCLUSION: LSR and ASR could correspond to anterior fossa width and middle fossa depth, respectively. As a result, patients with T21 tend to have a narrower anterior fossa and a shallow middle fossa.

PMID:41911572 | DOI:10.1097/SCS.0000000000012595

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012696. Online ahead of print.

ABSTRACT

OBJECTIVE: The lingula and antilingula are important anatomic references in oral and maxillofacial procedures. This study aims to characterize morphologic variations of the lingula and antilingula in unilateral craniofacial microsomia (CFM) and evaluate their associations.

METHODS: Cranial CT scans of 98 unilateral CFM patients (Pruzansky-Kaban types I, IIA, and IIB) were retrospectively analyzed. Lingula morphology was classified as nodular, triangular, truncated, or assimilated (absent); antilingula was recorded as present/absent. Statistical analyses included χ2 tests, Cochran-Armitage trend tests, and Cohen κ for concordance.

RESULTS: Among 196 mandibular sides, lingula absence occurred in 19.4%, with higher prevalence on affected sides (35.7% versus 3.1%, P<0.001). Antilingula absence increased significantly with Pruzansky-Kaban severity on affected sides (type IIB: 62.1% versus type I: 9.1%, P=0.003). Lingula-antilingula concordance was weak (κ=0.157, P=0.020).

CONCLUSIONS: CFM patients exhibit high variability in lingula and antilingula anatomy, particularly on the affected side. Preoperative 3‑dimensional CT evaluation is therefore crucial for safe osteotomy planning.

PMID:41911566 | DOI:10.1097/SCS.0000000000012696

J Craniofac Surg. 2026 Mar 30. doi: 10.1097/SCS.0000000000012686. Online ahead of print.

ABSTRACT

BACKGROUND: Epilepsy is rarely observed in patients with craniofacial syndromes, with few reports in the literature devoted to identifying epilepsy predictors for this patient population. This study aims to determine potential predictors of epilepsy in syndromic craniosynostosis.

METHODS: This retrospective study analyzed data from 476 patients with Apert, Crouzon, or Pfeiffer syndromes treated at 2 craniofacial centers between 2007 and 2022. Patients were divided into 2 groups: those diagnosed with epilepsy (group A) and those without (group B). Independent variables included age, number of surgeries, previous surgery performed elsewhere, neurosurgical complication during craniofacial surgery, Chiari malformation type I, meningitis, systemic complication, encephalomalacia, hydrocephalus, placement of a ventriculoperitoneal shunt, and family history of epilepsy. These variables were compared between groups. Statistical analyses were conducted using logistic regression models to identify significant epilepsy predictors.

RESULTS: Epilepsy was diagnosed in 24 patients, resulting in a prevalence of 5%. Significant predictors of epilepsy included previous surgeries performed elsewhere and neurosurgical complications during craniofacial surgery, with odds ratios of 853 and 902, respectively. These factors suggest that epilepsy in this population is primarily acquired rather than congenital.

CONCLUSION: The study identified a higher prevalence of epilepsy among children with syndromic craniosynostosis compared with the general population. Intracranial complications, particularly those associated with surgeries performed outside specialized centers, are key predictors of epilepsy. These findings emphasize the importance of specialized surgical care to mitigate epilepsy risk in this patient population.

PMID:41911563 | DOI:10.1097/SCS.0000000000012686