Aesthetic Deformity Research Articles

Efficacy of Cycled Hyperinflation for Rapid Tissue Expansion

Temporary hyperexpansion at each filling session has previously been confirmed to increase the inflation volume in a conventional expansion procedure. This study employed eight young pigs to evaluate the effect of hyperinflation of this type in rapid expansion performed on 10 consecutive days. Hyperinflation to 120 mmHg for 4 minutes and deflation to 40 mmHg for 2 minutes was repeated five times on the experimental side. This cycled hyperinflation was found to increase the filling volume by 49 percent when compared with the contralateral side, which was not cycled or hyperinflated (control) (p < 0.01). The increase in surface area of the entire skin over the balloon was 178.1 percent in the hyperinflation group and 132.8 percent in the controls (p < 0.01). The actual expansion in surface area was not significantly different: 44.4 percent in the hyperinflation group and 45.7 percent in the control group. The additional gain of skin by cycled hyperinflation was the result of recruitment. The control group required 5 more days to achieve the same amount of skin but resulted in more true expansion and less recruitment. It is concluded that the cycled hyperinflation technique may shorten the time period of the whole reconstruction procedure but may produce an aesthetic deformity and flap necrosis.

Malignant fibrous histiocytoma of the maxilla—a report of two cases

Two cases of malignant fibrous histiocytoma of the maxilla are reported. The tumours were excised via a combined temporal and intra-oral approach in order to gain adequate surgical access and minimise the aesthetic deformity. One patient required orbital exenteration.

Postoperative Platysmal Band Deformity: A Pitfall of Submental Liposuction

Submental liposuction is an established advance in treatment of the aging neck. However, its misapplication may result in an aesthetic deformity involving postoperative anterior platysmal banding. To identify preoperative conditions relating to this sequela, we retrospectively analyzed 301 patients treated with submental liposuction. Submental obesity and an anatomic pattern of platysmal nondecussation were found to be significant correlates in the development of postoperative anterior platysmal banding.

Revision rhinoplasty. An analysis of aesthetic deformities.

Revision rhinoplasty can present difficult and challenging problems, which maximally test the skill and judgment of the facial plastic surgeon. We conducted a retrospective study of 1221 consecutive rhinoplasties, of which 170 were revision procedures. The rate of revision of our own procedures is 5.3%. Postrhinoplastic deformities are divided anatomically into the upper, middle, and lower thirds of the nose. The largest category of deformities occur in the lower thirds of the nose, in which bossa are the most common problem. Overall, pollybeak is the most common deformity in 33% of the procedures performed, followed by bossa in 26%, and excessive dorsal removal in 24%. We analyzed the causes and selected management of these cases.

Splint Appliance for the Management of Posttrauma Lip Deformities

Trauma sustained to the commissures of the lips will result in perioral tissue deficits. Without intervention, this will lead to functional and esthetic deformities. Splinting devices have proven to be an effective and economical means of treatment. Reviews have appeared in the literature describing techniques and treatment regimens for the use of such oral commissure splints. Each has specific advantages and disadvantages in application. A variation of these previously described splints now in use at the University of Chicago Hospitals is presented. Three case histories are presented with discussion of the uses and advantages of this appliance.

Management Of Frontal Sinus Fractures: Changing Concepts

Since the turn of the century, surgeons have handled frontal sinus fractures with a variety of different procedures. The optimal management procedure remains controversial. We have presented a graduated anatomic algorithm for treatment of frontal sinus fractures based on the degree of fracture displacement and nasofrontal duct involvement and presence of CSF leak. Nondisplaced fractures are best handled conservatively, without operative intervention. However, the majority of frontal sinus fractures require operative correction. Uncomplicated anterior table displacement with an aesthetic deformity is treated by fragment reduction and stabilization with miniplates or microplates or wires. Nasofrontal duct obstruction is usually managed by sinus obliteration with spontaneous osteoneogenesis or autologous bone grafting. Finally, comminuted, displaced anterior and posterior table fractures, especially those with persistent CSF leakage and associated nasofrontal duct involvement, are best handled with frontal sinus cranialization. The presented algorithm is simply a treatment guideline. Frontal sinus fracture management must be individualized. However, this graduated anatomic approach provides a pragmatic framework for decision making and understanding this complex and controversial topic.

Aesthetic Resection of the Submandibular Salivary Gland

This paper analyzes some pathologies of the submandibular salivary gland that present a special interest for facial aesthetic surgeons. Even up-to-date techniques to correct the aesthetic deformities of the submandibular and cervical regions can be disappointing when the patient presents an increasing volume or ptosis of the submandibular salivary gland. Sometimes, even though the submandibular gland has not been preoperatively identified, it may become evident postoperatively, compromising the submandibular and cervical contour because the musculocutaneous flaccidity has been corrected and the fatty tissue present in this area has been eliminated. A personal approach is presented to treat the ptosis or the submandibular salivary gland enlargement that compromises rhytidoplasty results. A partial resection of the superficial part of the gland is suggested to treat some cases of ptosis or enlargement of the submandibular salivary gland.

Surgical Treatment of Metopic Synostosis

Metopic synostosis can present with various skull abnormalities for which early surgical treatment can provide significant benefit to the patient. Correction of skull deformities associated with metopic synostosis requires accurate assessment of the full range of craniofacial defects within context of the patient's age. Alteration in the characteristics of cranial bone as the child grows older necessitates modifications in techniques used for bony remodeling. Changes in the rate of brain and cranial vault growth also must be considered for adjustments in fixation methods. Thus, both the patient's age and the severity of aesthetic deformity dictate the surgical techniques used in the correction of metopic synostosis.

Treatment of the anophthalmic cavities: Twenty years of experience

The author reports his experience (1968‐1988) in the treatment of the poor esthetic appearance and other deformities observed in the anophthalmic cavities. Depending on the clinical picture, a new classification system was applied to 894 cases and for each classification group a definite surgical procedure was indicated.The author has used what is commonly considered to be an almost perfect result (an unesthetic eye covered with a painted shell) as a standard for reconstruction, after eviscerations and enucleations, which are performed by replacing the orbital volume by a primary implant. Because these cases had not presented any problems, especially conjunctival retraction, the same standard was applied to the treatment of anophthalmic cavities. So, 331 anophthalmic cavity cases were reconstructed by inserting a secondary implant alone or associated with mucosal or dermal grafts.The author uses acrylic spheres covered with preserved sclera (including the cornea whenever possible) as primary or secondary ...

Surgical management of macrocheilia of the lower lip

The indications for and the surgical management of macrocheilia of the lower lip are presented. The use of the technique in two cases of differing aetiology and degree of functional and aesthetic deformity is described.

Tissue-Expanded Radial Forearm Free Flap in Neck Burn Contracture

Neck contracture after burn injury can result in severe functional as well as aesthetic deformities. Contracture can recur even after wide and complete release and full-thickness skin grafting. Recurrence is partly due to the inherent difficulties in both early postoperative immobilization and the required long-term splinting. When adjacent tissues are also burned, adequate local tissue for reconstruction may not be available; therefore, free-tissue transfer may be necessary. The large surface area that is required after adequate release may be provided by tissue expansion before free-tissue transfer. In the case presented the use of tissue-expanded radial forearm free flap for the reconstruction of a recurrent neck contracture is described.

Inventory of potential reconstructive needs in the patient with burns.

The rehabilitation and reconstruction of patients who survive large burns is an arduous task. To facilitate it we have devised an inventory form to accurately record the somatic abnormalities caused by burns and also the severity and location of burns. This form was used in the assessment of 25 pediatric patients with massive burns. It was found to be a very useful tool that allowed the identification of more specific functional and esthetic deformities than is possible with currently available forms. It also served as a template for the systematic planning of reconstructive procedures.

The effect of supracrestal tricalcium phosphate ceramic-microfibrillar collagen grafting on postsurgical soft tissue levels.

In this clinical study, a combined tricalcium phosphate ceramic (TCP) microfibrillar collagen supracrestal graft was used in conjunction with pocket elimination surgery as a soft tissue space filler to maintain marginal and interproximal tissue heights. Fifteen volunteer adult patients (8 male, 7 female) aged 37 to 48 years were selected. Standardized clinical probing measurements were used to evaluate soft tissue recession, clinical attachment, and probing pocket depths. Intraoral photographs and radiographs supplemented documentation. Twenty-five paired test and control sites were evaluated. Following flap surgery and minor osteoplasty, test defects received supracrestal grafts of TCP microfibrillar collagen prior to flap closure. Intrabony defects were excluded. Treatment modalities were compared by analyzing changes in clinical probing measurements over four months using the students t test for paired samples at the 0.01 level of significance. Supracrestal grafting resulted in 16.74% less soft tissue recession than the control sites. In addition, there was a significant gain in clinical attachment levels compared with the controls. All implanted sites demonstrated an advantage in the use of supracrestal TCP-collagen grafts compared with the controls. This treatment modality may have value in reducing esthetic deformities, food impaction areas, and root exposure that often occur following periodontal surgery.

Treatment of plagiocephaly in infancy.

Plagiocephaly is commonly attributed to the synostosis of a single coronal suture. Esthetic deformities associated with plagiocephaly range from mild to severe. Because the deformities are progressive, and more difficult to correct in older children and adults, early diagnosis and correction are important. Linear craniectomies, previously widely practiced, have not yielded good results. Current craniofacial techniques allow extensive orbitocranial reconstruction, which can be done safely in infants and in older children as well. These techniques have produced excellent cosmetic results and are routinely used in craniofacial centers.

The Stair-step Flap for Nasal Reconstruction

The stair-step nasal flap, which was originally designed to allow re-creation of the alar rim, has proved to be equally versatile for reconstruction of many other soft tissue defects of the nose. When a skin graft is unwarranted, this is a simple method for local flap transposition that minimizes any aesthetic deformity while allowing primary donor site closure. It is best suited for small or moderate sized defects of the lower and middle thirds of the nose.

サマリウムコバルト合金磁石を利用した歯根挺出法

It is always submitted to indication of tooth extraction when advanced caries, traumatic destruction, or lateral root perforation reaches to alveolar bone crest. However, if we can forcedly elongate such conditioned tooth, then sound tooth structure will appear out of gingiva and we can make a restoration very easily.The orthodontic wire technique which elongates tooth is not often used for the adults in daily clinical practice, since it is difficult to adjust orthodontic forces, in addition it produces anterior aesthetic deformities and uncomfortableness.Here we introduce SmCo5 magnetic elongation technique, which makes up for the above mentioned demerits, and its clinical cases.

Aesthetic Abdominal Deformities: A Personal Approach to the Posterior Rectus Sheath and Rectus Muscles

Aesthetic Abdominal Deformities: A Personal Approach to the Posterior Rectus Sheath and Rectus Muscles

Restoration of movement to the upper eyelid in facial palsy by an individual gold implant prosthesis

F acial nerve palsy causes lagophtalmia of the upper lid (Fig. 1). In addition to being an esthetic deformity, it may lead to recurrent keratitis, keukoma, conjunctivitis, and even blindness. In facial palsy, overaction of the levator palpebrae muscle is present. Closure of the eye and downward movement of the lid can be achieved by adding weight to the upper lid. This article describes a technique for providing upper lid implants of gold for patients who have experienced facial palsy.

Aesthetic surgery of the upper and lower limbs

Aesthetic deformities of both the upper and lower limbs are primarily a result of fat excess or flacidity. Surgical correction of these lipodystrophies should be done when clinical and physiotherapeutic methods fail to considerably reduce these deformities. The scars are generally large, conspicuous, and sometimes of poor quality, due to natural tension on the borders. The technique, success, and advisability of surgery varies for the several upper and lower limb deformities, and a number of factors, including type and placement of incision, can improve the results.

Lengthening the short nose.

In the more difficult cases of short nose deformity in which there is loss of septal membrane, lining as well as cartilage must be provided to adequately correct the functional and aesthetic deformity. A discussion of these techniques is outlined and a procedure discussed that makes use of staggered septal incisions to aid in implanting the composite conchal graft. After release of the entire inferior septal columella unit, a gap remains, which is filled by a composite conchal graft. The mechanics of the steplike incisions enable the bare-grafted cartilage, which has been denuded of conchal perichondrium, to be covered by normal septal perichondrium. The risk of perforation or graft failure is greatly reduced due to the rich blood supply of the septal mucosa, which provides nutrition to the cartilaginous surfaces. The benefits, complications, and limitations of the procedure are described.