Aesthetic Complaints Research Articles

SURGICAL APPROACH OF OSTEOMA IN THE CORONOID PROCESS: CASE REPORT

The present study aims to report a clinical case of a unilateral osteoma in a rare region and to discuss its clinical characteristics and possible forms of treatment for this lesion. In this clinical case the osteoma affected a mandibular coronary process, with a marked clinical characteristic, mushroom shape, causing zygomatic bone expansion and important limitation of buccal opening. The etiology of this lesion is unknown, but may present an association with infection, trauma, ionizing radiations, and hormonal and genetic influence. Osteoma can lead to an aesthetic complaint and, like coronoid process hyperplasia and osteochondroma, the osteoma can form a pseudoanquilosis; its treatment consists of surgical removal and osteoplasty. The treatment was satisfactorily performed through intraoral access, ostectomy, and osteoplasty.

Review of publications on the possible advantages of a direct cheek incision for accessory parotid gland masses.

Lesions of the accessory parotid gland (APG) are rare and surgical management is generally under-discussed. The surgical approach should provide complete resection, while minimising complications and aesthetic complaints. The current study reviews recent publications on the surgical management of APG masses, and discusses the advantages, and limitations of, and our experience with, direct cheek incision. Papers on the surgical management of APG masses published in the last 10 years were systematically searched. Information was obtained regarding the surgical approach, type of excision, and postoperative complications. In the included studies, 253 APG masses were selected for analysis, whereof six were treated with the direct cheek incision. Although no local recurrence or postoperative complications were observed after this, the approach was usually not recommended due to a higher reported risk of recurrence and complications in older papers. More recent studies, however, indicate that the direct cheek incision should be considered as a valuable alternative to standard approaches in selected patients.

Cisto epidermoide em assoalho bucal: relato de caso

Cistos epidermoides (CE) são patologias benignas que podem se desenvolver em qualquer parte do corpo. É uma malformação cística do desenvolvimento, que acontece com uma baixa frequência, sendo raros na cavidade oral e representam cerca de 0,01% de todos os cistos na cavidade oral. O objetivo deste artigo é relatar o caso de um paciente do gênero masculino, 16 anos de idade, com histórico de aumento de volume em região de soalho bucal com exteriorização cervical há cerca de 14 anos, clinicamente apresentando disfagia, dislalia e queixas estético funcionais. O tratamento cirúrgico escolhido foi a enucleação total da lesão sob anestesia geral. O histopatológico evidenciou presença de parede cística revestida por tecido epitelial pavimentoso estratificado ortoceratinizado com áreas de descamação de ceratina intraluminal e ausência de apêndices cutâneos, favorecendo o diagnóstico de CE. A enucleação cirúrgica com remoção de todo epitélio da cápsula cística constitui uma terapêutica adequada.

Orthodontical Management of Secondary Dental Migration Associated with a Reduced Periodontium: A Case Report

Introduction: Dental migrations following periodontal pathology may lead to significant aesthetic and functional complaints. In this case report, the presence of evident gingival recessions and mandibular crowding pushed us to opt for an ortho-periodontal multidisciplinary treatment plan, using extractions and incisive repositioning. Through this, we ensured tissue gain at the level of the superficial and deep periodontitis, thus avoiding the use of periodontal surgery.Clinical Case: A Moroccan 26-years-old female medical secretary who, being very concerned about her appearance and facial aesthetics, presented with pathological dental migrations following severe periodontitis, an unsatisfactory periodontal status, a clear mandibular crowding of the anterior inter-incisive diastemas, gingival recessions, attachment losses and quite large pocket depths with advanced bone resorptions in different areas. This required a specific multidisciplinary approach aiming at creating a healthy and well-structured periodontal environment through extensive periodontal treatment, combined with regular plaque control, and supplemented by an orthodontic treatment using extractions and incisive repositioning in order to avoid any vestibular movement that may worsen the recessions and will require possible overlapping. After 22 months of combined treatment, a stable occlusion was obtained with class I molar and canine relationship, perfect dental alignment, healthy periodontal architecture, and significant attachment gain and bone growth. In addition, the patient’s facial aesthetics and self-confidence have been significantly improved. Conclusion: The orthodontic treatment supplementing the meticulously planned periodontal therapy that was administered for this patient has helped to improve functionality, facial aesthetics as well as psychological self-confidence. However, it must be gradual with an application of mild forces and constant control of the periodontal status, for optimal tissue response.

Evaluation of patients’ perception of gingival recession, its impact on oral health-related quality of life, and acceptance of treatment plan

Objective: Gingival recessions (GR) may cause aesthetic and hypersensitivity complaints which might affect oral health-related quality of life (OHRQoL). The aim of this study was to evaluate the patients’ awareness of their own GR, the impact of GR on OHRQoL and the acceptance of suggested treatment modalities.Materials and Methods: This cross-sectional study was conducted with 205 patients. The demographic variables were recorded and patients’ perception of GR was questioned. Full-mouth examination was carried out and clinical parameters were recorded. Gingival recessions, GR related complaints were evaluated and GR treatments were suggested and acceptance were also recorded by the examiner. The patients filled out OHRQoL-United Kingdom (OHRQoL-UK) questionnaire regarding to their GR and were asked if GR have/would have impact on oral health and if the GR will/would get worsen. Data was analysed with independent t test and Mann–Whitney U test.Results: 4819 teeth were evaluated and 733 GR examined in 147 patients. Fifty-seven patients were unaware of their GR. A strong belief that GR have impact on oral health (88.78%) and GR will progress (86.34%) was detected. Acceptance of treatment was increased and non-invasive modalities were preferred if patients had complaints. The awareness of GR status increases and the misperception decreases the OHRQoL-UK scores. The results revealed that hypersensitivity decreases the OHRQoL-UK scores and aesthetic concerns and hypersensitivity decreases the OHRQoL-UK physical scores significantly (p < .05).Conclusions: The results indicated that the patients might be unaware of their GR and the GR related factors may lead to poorer OHRQoL.

V07-07 REVISION VAGINOPLASTY WITH ROBOTIC ASSISTANCE FOR NEOVAGINAL OBLITERATION SECONDARY TO RECURRENT RECTO-NEOVAGINAL FISTULA

You have accessJournal of UrologyLower-Tract Reconstruction II: ED/Infertility & Transgender Surgery (V07)1 Apr 2020V07-07 REVISION VAGINOPLASTY WITH ROBOTIC ASSISTANCE FOR NEOVAGINAL OBLITERATION SECONDARY TO RECURRENT RECTO-NEOVAGINAL FISTULA Alexandr Pinkhasov*, Kathryn Scott, Prashant Upadhyaya, Gennady Bratslavsky, and Dmitriy Nikolavsky Alexandr Pinkhasov*Alexandr Pinkhasov* More articles by this author , Kathryn ScottKathryn Scott More articles by this author , Prashant UpadhyayaPrashant Upadhyaya More articles by this author , Gennady BratslavskyGennady Bratslavsky More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000897.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe a case of neovagina revision following vaginal stenosis and complete obliteration in a patient 1 year post gender affirmation surgery. METHODS: The patient was a 23 year old transgender female who underwent combined penile and urethral inversion vaginoplasty in 2017. The initial postoperative course was complicated by unrecognized rectovaginal fistula formation. She subsequently underwent multiple repairs which impaired her ability to perform vaginal dilation. Dilations were stopped with eventual development of vaginal stenosis and ultimately obliteration. The patient underwent reconstruction with a combined perineal and robotic approach. The surgical steps included: 1) dissection of the urethral plate to be used in later neovaginal creation 2) robotic pelvic dissection; a plane between the prostate and rectum was developed for implantation of the neo-vagina 3) revision urethroplasty and meatal repositioning 4) creation of neovagina from local flaps; the ventral plate of the penile urethra was used to construct the anterior vaginal wall while the posterior was composed of excess scrotal skin in combination with perineal flaps 5) robotic fixation of neovagina. The reconstructed neo-vagina was inverted into the pelvis where robotic assisted dissection had developed a cavity. The neovagina was secured to the perivesical and peritoneal tissues. The patient underwent revision clitoroplasty and labioplasty for esthetic complaints. RESULTS: The patient was discharged on postoperative day 1 and vaginal packing removed on day 7. She was followed with regular exams and questionnaires. At two month follow-up she was performing vaginal dilations without difficulty or pain and by six months she was found to have a vaingal depth of 12 cm. On global response assessment survey she rated herself as “markedly improved” CONCLUSIONS: Revision vaginoplasty with neo-vaginal reconstruction may be used to correct complications related to prior fistula and/or cavity obliteration. A combined perineal and robotic approach is recommended to allow for careful dissection in a previously operated field. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e645-e645 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandr Pinkhasov* More articles by this author Kathryn Scott More articles by this author Prashant Upadhyaya More articles by this author Gennady Bratslavsky More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Minimally invasive aesthetic treatment of white spots by dental fluorosis in children: case report

Introduction: The presence of white spots due to dental fluorosis can cause aesthetic discomfort, being one of the factors for a search for dental treatment. Objective: Report a clinical case in which the aesthetic complaint was solved through the association of the dental bleaching to the microabrasion technique. Case report: Male patient, 13 years, attended to the Integrated Clinic of the School of Dentistry of the Federal University of Rio de Janeiro, with fluorosis, mainly in the antero-superior teeth and aesthetic complaint. Initially, it was made an immediate bleaching with hydrogen peroxide at 35%, in 3 sessions of 15 minutes each, to soften the disparity of shades between tooth-stain. The result was insufficient and the dental microabrasion technique was adopted. A pumice paste was applied together with gel of phosphoric acid at 37% under relative isolation, in a total of 8 applications (1 minute each). At the end of each application, it was made an abundant water washing, microengine mounted fine-grained disc polishing and topical application of neutral NaF2 in gel (4 minutes each application) to eliminate possible postoperative sensitivity. Conclusion: The dental bleaching and the microabrasion technique promoted satisfactory immediate clinical results that increased self-esteem of the patient in a minimally invasive way to dental structure.

Class III Reversion with Immediate Complete Denture and Immediate Implant-Retained Overdenture: Case Report

With the increased life expectancy, complete dentures have been used in the treatment of edentulism progressively. It restores stomatognathic system functions, providing improvements in chewing, aesthetics, and phonetics. The aim was to report an oral rehabilitation of a patient with severe aesthetic and functional impairment, with Angle’s class III malocclusion. The patient sought the extension project of the School of Dentistry of the Federal University of Minas Gerais with aesthetic complaints. After clinical and radiographic evaluation, the proposed planning was immediate complete denture maxilla and immediate implant-retained overdenture in mandible. During clinical evaluation it was observed that the patient was Angle’s III. The rehabilitation was performed as proposed and at the end of the treatment, it was possible to revert the class III occlusal pattern to Angle’s I. The excellent maxillomandibular relationship was achieved, which ensured optimal facial aesthetics and functional condition. It was concluded that the immediate complete dentures and immediate implant-retained overdenture might be beneficial for restoring the aesthetics and function of patients with Angle’s class III malocclusion.

Reabilitação estética de incisivo central superior severamente escurecido

Dental unit darkening is the cause of aesthetic complaint by the patient, mainly because it is easily noticed by the human eye. Tooth whitening and ceramic veneers allow aesthetic rehabilitation in a pattern of visual equality to the natural dentition, by restoring teeth color and shape symmetry, bringing to the face a harmonious impact that is reflected in the entire set that composes it. By recovering teeth healthy appearance, this association of procedures restores people’s self-confidence. This study reports a clinical case of an esthetic management for darkened tooth 21, describing the sequence of techniques association of dental whitening and ceramic veneer to achieve aesthetics balance, showing the advantages and limitations of these procedures.

Utilização do conceito digital Smile Design na odontologia restauradora

Due to the advancement of digital dentistry, the Digital SmileDesign (DSD) technique has been gaining credibility on the part ofprofessionals and patients. The planning of aesthetic and functionalrestorative treatments becomes more predictable with its use. Thiscase report presents a patient with aesthetic complaint of thesize and shape of her anterior teeth, associated with great gingivalexposure. Photographs were important assistants in the planning ofdental intervention. These were used for facial analysis, drawings ofguidelines and more suitable dental forms. A software called Keynotewas used, capable of managing photos, creating measurements,straight and curved lines, facilitating the planning of a new dentalproportion. At the end of this process, the patient can observe, throughthe help of photographs, the new smile that was built virtually. Thatway, it became easier for her to accept the treatment plan, allowingher to make a test of her new smile with the mock-up.

ERUPTED ODONTOMA ASSOCIATED WITH IMPACTED TEETH—CASE REPORT

Odontomas are the most common odontogenic tumors, although odontomas erupting into the oral cavity are rare. This clinical case is related to a 24-year-old female patient with aesthetic complaint in the upper front teeth region. Intraoral examination revealed multiple small teeth-like structures present in the maxillary anterior region on the right side, while the lateral incisor and canine were not erupted. The tomography revealed multiple well-defined radiopaque structures with density of dental tissues in the alveolar region, while the lateral incisor and canine were included on the palate. The diagnosis was erupted compound odontoma, based on clinical and imaging examination. The treatment consisted of a surgical removal of odontoma, and the patient was referred to an orthodontist for assessment of the possibility of orthodontic traction. After 1-year follow-up, there was no recurrence. The patient is under orthodontic treatment. Odontomas are the most common odontogenic tumors, although odontomas erupting into the oral cavity are rare. This clinical case is related to a 24-year-old female patient with aesthetic complaint in the upper front teeth region. Intraoral examination revealed multiple small teeth-like structures present in the maxillary anterior region on the right side, while the lateral incisor and canine were not erupted. The tomography revealed multiple well-defined radiopaque structures with density of dental tissues in the alveolar region, while the lateral incisor and canine were included on the palate. The diagnosis was erupted compound odontoma, based on clinical and imaging examination. The treatment consisted of a surgical removal of odontoma, and the patient was referred to an orthodontist for assessment of the possibility of orthodontic traction. After 1-year follow-up, there was no recurrence. The patient is under orthodontic treatment.

LIP HEMANGIOMA IN A YOUNG PATIENT: AN AESTHETIC CHALLENGE MANAGED BY AN ASSOCIATION OF TREATMENT TECHNIQUES

Treatment of benign lip vascular anomalies can be an aesthetic challenge even though several techniques are available to manage these lesions. A difficult case treated with an association of techniques is presented. A 12-year-old boy with an extensive congenital hemangioma in the upper lip was referred with an aesthetic complaint and past history of treatment failures. Sclerotherapy with 5% ethanolamine oleate was proposed. Intriguingly, after 6 sessions of sclerotherapy, the size and the consistency of the lesion remained almost the same, although some color improvement was observed. Therefore, an aesthetic surgery was considered and the patient was referred to a vascular surgeon. After arteriography, 3 sessions of percutaneous embolization with 3% polidocanol foam was performed. Afterward, the patient underwent 2 surgical interventions using diode high-potential laser achieving a satisfactory result. Although uncommon, a refractory vascular lesion may occur and an association of different techniques may be necessary.

Venous Malformations Sclerotherapy: Outcomes, Patient Satisfaction and Predictors of Treatment Success.

To retrospectively evaluate the results of sclerotherapy for venous malformations, with emphasis on patient satisfaction, complications and predictors of positive response to treatment. Three hundred and nine patients were treated with ethanol sclerotherapy for venous malformations in our center between the years 2000 and 2014. All of them were sent a self-assessment questionnaire for evaluation of their satisfaction and treatment complications. In total, 153 patients (mean age 21, range 6weeks to 67years) responded to the questionnaire. We analyzed clinical and imaging data from the medical records of these patients. Sixty-four (42%) patients had venous malformations in the lower extremities, 35 (23%) in head and neck regions, 33 (22%) in the trunk, 14 (9%) in the upper extremities and 5 (3%) in the buttock and genitalia. Complete relief of swelling, pain, functional and esthetic complaints was reported in 23%, 22%, 17% and 12% of patients, respectively. Thirty-eight (25%) patients reported being very satisfied with treatment outcomes, 55 (36%) were satisfied, 49 (32%) were not satisfied and 11 (7%) were very unsatisfied. We did not find significant correlations between patient satisfaction and demographics characteristics, lesion location, lesion size, tissue involvement or total sclerosant quantity. The rate of class 3 complications was 7% and that of class 4 complications was 2%. Ethanol sclerotherapy is an effective treatment for venous malformations. Nonetheless, this treatment has a significant complication rate. Patient satisfaction is independent of lesion characteristics and is not as high as may be expected.

Evaluation of quality of life profile of patients submitted to bichectomy

Introduction: The bichectomy has been increasingly sought in dental practice, whether due to functional or aesthetic complaints. It is considered an aesthetic and functional surgery, for improving both facial harmony and chewing. Objective: This study aimed to establish a quality of life profile of patients submitted to bichectomy surgery in a private service in Curitiba, PR, Brazil. Material and methods: The OHIP-14 was applied in a single moment in patients who underwent bichectomy in the last 6 to 18 months. Results: Thirty-six individuals of both sexes were evaluated, being 1 man and 35 women, with the median age of 31 (19-53) years. The median OHIP-14 scores were 0.00 (0-24) points. There was no association between OHIP-14 with age, postoperative complications, postoperative time or tobacco smoking (p &gt; 0.05). Conclusion: The individuals were satisfied after performing the surgical procedure, presenting very low scores when compared to the literature.

Evaluation of quality of life profile of patients submitted to bichectomy

The bichectomy has been increasingly sought in dental practice, whether due to functional or aesthetic complaints. It is considered an aesthetic and functional surgery, for improving both facial harmony and chewing. Objective: This study aimed to establish a quality of life profile of patients submitted to bichectomy surgery in a private service in Curitiba, PR, Brazil. Material and methods: The OHIP-14 was applied in a single moment in patients who underwent bichectomy in the last 6 to 18 months. Results: Thirty-six individuals of both sexes were evaluated, being 1 man and 35 women, with the median age of 31 (19-53) years. The median OHIP-14 scores were 0.00 (0-24) points. There was no association between OHIP-14 with age, postoperative complications, postoperative time or tobacco smoking (p &gt; 0.05). Conclusion: The individuals were satisfied after performing the surgical procedure, presenting very low scores when compared to the literature.

A series of 33 older patients with lip venous lake treated by sclerotherapy.

Venous lake lesion is a venous ectasia that can occur on the lips of older people. Although different therapies have been used, there is no guideline for treating this lesion. The purpose of this study was to evaluate whether sclerotherapy is an effective and acceptable option for treatment of venous lake lesions of the lips in older patients. Medical records and images were retrieved from the archives of a geriatric dentistry clinic between 2005 and 2017. A total of 33 older patients treated with 5% ethanolamine oleate were included. Clinical information was selected and described. The female gender was predominant (64%), and the patients' age ranged from 66 to 90years. The majority of the patients were Caucasian (91%), and 82% were under treatment for hypertension. In 91% of the cases, the lesions were located on the lower lip and varied from 3 to 10mm in diameter. A complaint period lasting longer than 2years was reported by 58% of the patients. Color alteration was the most common type of esthetic complaint. Only one application of sclerotherapy was performed in 85% of the cases. For the remaining patients, two sessions were necessary. The total dose ranged from 0.3 to 0.9ml. Complete regression of the lesions was observed in all cases. No complications or recurrences were reported. Sclerotherapy with ethanolamine oleate is an effective, affordable, and predictable treatment for venous lake lesions of the lips in older patients.

Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment.

Molluscum contagiosum (MC) is a self-limited infectious dermatosis, frequent in pediatric population, sexually active adults, and immunocompromised individuals. It is caused by molluscum contagiosum virus (MCV) which is a virus of the Poxviridae family. MCV is transmitted mainly by direct contact with infected skin, which can be sexual, non-sexual, or autoinoculation. Clinically, MC presents as firm rounded papules, pink or skin-colored, with a shiny and umbilicated surface. The duration of the lesions is variable, but in most cases, they are self-limited in a period of 6–9 months. The skin lesions may vary in size, shape, and location, which is more frequent in immunosuppressed patients, and could present complications such as eczema and bacterial superinfection. The diagnosis is based on clinical findings. A useful clinical tool is dermoscopy. If the diagnostic doubt persists, confocal microscopy or skin biopsy could be performed. The need for active treatment for MC is controversial; however, there is a consensus that it should be indicated in cases of extensive disease, associated with complications or aesthetic complaints. There are several treatment modalities which include mechanical, chemical, immunomodulatory, and antivirals. The objective of this article is to review the current evidence in etiology, clinical manifestations, diagnosis, and management alternatives of MC.

Algorithm for the treatment of external nasal valve insufficiency

IntroductionNasal obstruction is one of the most prevalent complaints in the population. The main causes of nasal obstruction are inflammatory, infectious or anatomical alterations. Anatomical alterations include nasal septum deviation, turbinate hypertrophy, and nasal valve insufficiency (external and/or internal). The diagnosis of nasal valve insufficiency remains a clinical one and is based on inspection and palpation of the nose, evaluating both its static and dynamic functions. The literature presents several options for the correction of external nasal valve insufficiency. These are chosen according to the choice and experience of each surgeon. ObjectiveTo create a practical algorithm for the treatment of external nasal valve insufficiency that can guide nasal surgeons in their choice of treatment for the different anatomical alterations found in patients with these disorders. MethodsWe used the treatment options found in the literature and correlated them with our surgical options for each type of anatomical alteration found. Therefore, we used basically three parameters related to physical examination findings (degree of insufficiency and characteristics of the lower lateral cartilage) and the patient's complaint (present or absent aesthetic complaint regarding the nasal tip). ResultA practical algorithm was developed for the treatment of external nasal valve insufficiency according to the degree of insufficiency (mild-to-moderate or severe), aesthetic complaint of the nasal tip (present or absent) and characteristics of the lower lateral cartilage (size and orientation). ConclusionThrough this simple algorithm, one can use each type of graft and/or maneuver according to the patients’ complaints and the anatomical alterations found.

Gingival recession and periodontal therapy

Background: Gingival recession is defined as the apical migration of the gingival margin below the cementoenamel junction (CEJ), resulting in exposure of the root surface and it is one of the main esthetic complaints of patients. The management of gingival recession and its sequelae is based on a thorough assessment of the etiological factors and the degree of tissue involvement.

Patient-reported outcome measures (PROMs) and maintenance events in 2-implant-supported mandibular overdenture patients: A 5-year prospective study.

To prospectively evaluate patient-reported outcome measures (PROMs) and treatment outcomes of mandibular two-implant retained overdentures (IOD) in an edentulous geriatric cohort with history of deficient complete dentures (CD). A total of 103 patients with deficient CD received new optimal CD. After a period of 3months, 80 of the patients voluntarily received IOD. Outcomes collected at pre-, post-CD/post-IOD treatment annually up to 5years, included (a) Clinical outcomes: denture-quality (Woelfel's index), complications, and maintenance events, (b) PROMs: patient complaints (maxillary, mandibular functional complaint scores, generic aesthetic complaint scores, frequency, and intensity of complaints) and patient satisfaction, and (c) Maintenance events: technical complications and adverse events. Five-year data were collected from 67 patients (mean age at initiation=71.3years, mean observation=5.9years) with cumulative implant survival rate=98.72%. Multiple comparisons for 8 time points showed significant improvements in denture quality and PROMs after new CD and IOD delivery. Further significant improvements were only after IOD delivery in: mandibular denture-quality, mandibular and generic functional complaints, frequency, intensity of complaints, and overall patient satisfaction score. Thereafter, denture-quality and PROMs remained stable. Maintenance events clustered on 1st year and within a minority of patients. Technical complications and overall maintenance events significantly correlated with overall patient satisfaction score at 1st year. Mandibular IOD was a beneficial treatment option for seniors with history of deficient CD, improving denture-quality, patient satisfaction, and reducing patient complaints up to 5years. Maintenance events clustered on 1st year, showing no significant impact on long-term patient satisfaction and other PROMs.