Aesthetic Discomfort Research Articles

Current Management of Pediatric Patients with Post-Burn Scars: Case Study

Background. Post-burn scars are common among pediatric patients. Pathological scarring is clear indication for conservative or surgical management of pediatric patients who continue to grow and develop after the resolution of burn injuries. Such lesions can significantly reduce patients' quality of life and, moreover, cause significant functional and aesthetic discomfort. Clinical cases description. The results of observation over two children (2 years 7 months and 12 years) with developing post-burn scars are demonstrated. Successful management method using physiotherapeutic complex (including monopolar radiofrequency treatment combined with ultrasound therapy, photodynamic therapy, and close-focus X-ray therapy) is presented. Conclusion. Modern trends in post-burn scars management are based on timely implementation of effective and safe methods early on rehabilitation stages and tissue restoration after burn injury to prevent pathological scarring and achieve control over its activity.

Breast Implants: Low Rate of Annual Check-Ups Results in Delayed Presentation of Ruptured Implants.

Background: Breast-implant-based reconstruction is one of the most performed procedures in plastic surgery. Despite the high durability of breast implants, various complications are accompanied with prolonged inlay duration, particularly implant rupture. Many aftereffects can be associated with implant rupture, especially siliconoma and BIA-ALCL. Without regular implant check-ups, implant-related issues may remain underrecognized. Here, we analyzed the number of breast implant carriers needing revisions and if patients adhered to annual implant follow-up recommendations. Methods: We reviewed 1128 breast procedures at the department of plastic surgery at the University Clinic of St. Poelten between August 1st 2018 and December 31st 2023. Patients were analyzed to see whether regular check-ups of their breast implants were performed. Additionally, implant-related complications were investigated, as well as if they were noticed by implant carriers. Results: Only 15.46% of breasts implants were regularly checked at least once a year in our cohort. The remaining 84.54% of patients consulted our department due to pain or aesthetic discomfort without periodical follow-ups. Most implant ruptures (73.8%) were diagnosed in patients consulting acutely due to pain or capsular contraction after an average of 17.36 ± 10.57 years. Routine examination uncovered 26.2% of silent implant ruptures without patients yet complaining of clinical symptoms as early as 15.44 ± 11.17 years. Conclusions: Most implant ruptures develop clinical symptoms as an indicator that removal is warranted. However, only regular follow-ups can identify implant complications several years earlier and possibly reduce severe sequalae such as BIA-ALCL. This highlights the significance and necessity of annual breast implant controls by surgeons and radiologic imaging to prevent devastating implant-associated aftereffects.

СОВРЕМЕННОЕ ЛЕЧЕНИЕ РУБЦОВОЙ ДЕФОРМАЦИИ ТКАНЕЙ

The problem of scar treatment is one of the most widespread in modern medicine. Treatment of scar formations is one of the most difficult tasks, as there is no single standard that is favorable in terms of efficacy and safety despite the active development in this area of research. Currently, conservative methods of treatment of scar tissue deformities such as corticosteroid administration, botulinum therapy, cryotherapy, microneedling, as well as surgical excision in combination with therapeutic methods are widely used, due to which the most favorable result is achieved. This study is devoted to the study of various modern methods of correction of hypertrophic and keloid scars that are becoming widespread in medicine, their comparison and identification of important advantages and disadvantages in order to choose the most effective treatment technique. Currently used conservative methods of treatment allow to cope with the problem of scar formations, but due to the high incidence of side effects, there is a tendency to search for the combined use of each of them, including with surgical excision to prevent the development of recurrences and to achieve a pronounced cosmetic effect and satisfaction among patients. Thanks to the constant development of medicine and the improvement of various methods, each patient can receive a personalized treatment approach that is guaranteed to reduce aesthetic discomfort due to the existing pathology, which is the main and important aspect of scar correction.

Importance of an Evaluation Phase When Increasing the Occlusal Vertical Dimension: A Systematic Review.

To assess whether an evaluation period is necessary for patient and clinical success when increasing the occlusal vertical dimension (OVD) for a full mouth rehabilitation. A systematic search was conducted in six databases: MEDLINE, Web of Science, Scopus, CENTRAL, VHL, and EMBASE. The eligibility criteria of this systematic review used the PICO framework to address the following research question: "In dentate adults requiring an increase in occlusal vertical dimension (OVD) (P), is an evaluation period of the new OVD (I) superior to no evaluation period (C) in terms of success (O)?" Study characteristics, survival, and success rates were extracted from each article. No language restrictions were applied. Study quality was appraised using Cochrane's Risk of Bias 2 tool and Newcastle-Ottawa Scale (NOS) according to the study design. The electronic search yielded 1188 titles after duplicates were removed. One RCT and 103 non-comparative articles were found relevant to the search question. Out of the 103 articles, 80 had an evaluation phase and 23 did not. The included RCT revealed that removable devices tended to cause chewing difficulties, unclear speech, and esthetic discomfort. Therefore, the use of a removable appliance to functionally or esthetically evaluate OVD was not indicated prior to the definitive treatment. Esthetics was the highest reported parameter preoperatively for the non-comparative studies, at 85% with an evaluation and 86% without. At present, there is lack of evidence that an evaluation period improves clinical and patient-reported outcomes when increasing OVD for full mouth rehabilitations. Thus, an increase in OVD can be successful with or without an evaluation phase. The evaluation phase helps the clinician manage patient expectations and assist with the treatment sequencing. This phase is most effective with fixed restoration, such as temporary crowns or adhesive restorations. However, there is limited evidence that this phase improves clinical or patient-reported outcomes.

Benign Solitary Schwannoma of the Cheek: A Case Report and a Review of the Literature.

Schwannomas are generally known to be benign tumors that arise from Schwann cells. The most frequently encountered tumors of this type in ENT are vestibular schwannomas or acoustic neuromas. However, head and neck localization, although rare, has been documented in the literature. We present the case of a 13-year-old girl who presented with chronic swelling of the left cheek, leading to aesthetic discomfort. Clinical examination objectified a palpable swelling on both the external and internal sides of the left cheek. No other abnormalities were detected during the clinical examination. Ultrasound of the soft tissues identified the left cheek swelling as corresponding to a subcutaneous cyst. No further investigations were indicated for this patient. The treatment consisted of surgical excision via an intraoral approach with an internal buccal incision. Histological analysis confirmed the diagnosis of schwannoma. Schwannoma, a benign neurologic tumor, is rarely located in the face, particularly in the jaw. Its diagnosis is confirmed through histopathological examination, and treatment typically involves complete surgical removal when feasible.

Thermal Ablation for Benign Thyroid Nodules and Papillary Thyroid Microcarcinoma.

Ultrasound-guided minimally invasive thermoablative (MIT) therapies are a therapeutic option for selected patients with large, hypoenhancing, benign thyroid nodules that cause compression disorders or aesthetic discomfort. MIT, which does not require general anaesthesia, causes thermal necrosis of the treated nodule, which is reduced in size by 50 % without functional consequences, and is indicated for patients who are not too young or in the presence of anaesthesia-related risk factors or recurrence following thyroidectomy or refusal of surgery. For the above indications, MIT complements surgery but does not replace it; it must always be performed in centres and by surgeons with proven technical skills and clinical experience. Subject to appropriate informed consent, the treatment is short-duration, well-tolerated by the patient, safe, and non-invasive. It does not require anaesthesia and complications are rare and transient. MIT, and in particular laser-based procedures (TAL), can also be effective and safe for the treatment of potentially destructible papillary microcarcinoma, as shown by the limited but sufficient literature, including the most recent guidelines, which consider it to be a therapeutic alternative that requires a better understanding of its efficacy and safety.

The surgical management of scaphocephaly in a seven-month-old infant

Introduction: Scaphocephaly is a cranial malformation resulting from premature closure of the sagittal suture. In some cases, the diagnosis is made late, leading to delayed corrective surgery. Due to the necessity of early surgical intervention, we present this condition to facilitate understanding by any physician and improve the quality of life for patients. Observation: A seven-month-old female infant presented with worsening cranial vault deformity present since birth. Morphologically, the patient exhibited a narrow and elongated head, accompanied by a median frontal bulge, with a cranial circumference of 49 cm. Standard frontal and lateral radiographs revealed an elongated skull with closure of the sagittal suture. CT scan revealed complete fusion of the sagittal suture with the classic appearance of "boat-shaped" skull. We employed the standard H-type craniectomy method. The surgical outcome, assessed 8 months post-intervention, was satisfactory both neurologically and in terms of psychomotor and aesthetic development. Conclusion: Without intervention, scaphocephaly can lead to aesthetic discomfort and contribute to low self-esteem, as well as difficulties in social, academic, and professional integration.

Braille glove design toward interdisciplinary approach for visually impaired people: developing independent sensing design with MXene and embroidery

This study developed a wearable device designed to aid visually impaired people (VIP) who are unfamiliar with Braille and/or struggle to learn and use Braille employing the design thinking process. VIP often face challenges in learning and using Braille, and even with existing equipment, including smart technologies, they frequently experience aesthetic and emotional discomfort beyond usability and accessibility. The interdisciplinary research team conducted mixed-method research following the double diamond module of the design thinking process. Initially, qualitative interviews to analyze VIP’s Braille utilization were conducted to derive design factors. Subsequently, identified design factors were applied to conduct experiments with appropriate embroidery methods and connection structures using MXene-coated yarn. The strategies effectively enhanced pressure sensing performance by two times and realized highly localized and independent sensing to enable Braille recognition. Finally, a specific design for the wearable Braille recognition glove was proposed that incorporated these findings. The proposed wearable glove, equipped with a high-performance Braille recognition sensor, is designed to enhance the psychological and aesthetic satisfaction of VIP. The glove’s universal design and accompanying technical support allow VIP to maintain their existing Braille reading methods while enjoying enhanced performance and avoiding social stigmas.

Combined Double-breasted Full-thickness Abdominal Flap Plication and Acellular Dermal Matrix in Prune-belly Syndrome Reconstruction.

Reconstruction of the abdominal wall in patients with prune-belly syndrome (PBS) following previous intra-abdominal procedures is a challenging problem with a high incidence of revision due to persistent bulging or herniation. The abdominal wall flaccidity not only produces a severe psychological and aesthetic discomfort for the patient but often determines functional disabilities, including inability to cough properly, impaired bowel and bladder function, and delay in posture and balance. The authors describe three cases of reconstruction of abdominal wall using a modified double-breasted abdominoplasty fascial plication with additional acellular dermal matrix interposition and review the literature for innovations in the use of abdominal repair for reconstruction of these difficult cases. Three children with PBS at a mean age of 7.3 years achieved successful reconstruction of the abdominal wall, using the modified double-breasted abdominoplasty fascial plication with acellular dermal matrix interposition. Patients underwent previous procedures, including orchiopexy in two patients and bilateral nephrectomy in one patient. No postoperative complications have been found, apart from superficial skin dehiscence along the abdominal incision treated conservatively in one child. At mean follow-up of 42 months (range 28-56 months), no patient presented incisional hernia, persistent or recurrent fascial laxity with abdominal bulging. All patients achieved significant aesthetic and functional improvements, including children's ability to cough, spontaneous gain of abdominal tonus, balance, and ambulation. Modification of the original vertical, two-layer plications of the deficient abdominal interposing biological mesh has the purpose of improving strength, aesthetics, and function of the abdominal wall in pediatric patients with PBS.

Consistent Reconstruction of Sacrococcygeal Pressure Ulcers using Modification of En Bloc Sliding Gluteus Maximus Myocutaneous Flap Technique

Background: The en bloc sliding gluteus maximus myocutaneous flap was introduced to preserve the vasculature, muscular integrity, sensory innervation, and normal gluteal contour with a midline scar in sacrococcygeal pressure ulcer reconstruction. However, its critical disadvantages include incomplete detachment of the origin of the gluteus maximus and central tension of the closed wound due to round ulcer excision. Therefore, we reviewed the surgical anatomy and applied modifications to achieve sufficient flap mobilization and to decrease complications.Methods: After fusiform or rocket-shaped ulcer excision, submuscular flap elevation was initiated by completely detaching the origin of the gluteus maximus, including the posterior iliac crest, followed by comprehensive lateral submuscular dissection in the gluteal space while preserving the neurovascular pedicles. Bony protrusions were tangentially resected from the lower sacrum and upper coccyx. After en bloc medial advancement of the bilateral flaps, defects were closed in layers, with muscle ligament fixation at the midline.Results: Twenty-nine patients underwent surgery for sacrococcygeal pressure ulcers (primary, n=22; recurrent, n=7). Transverse width of the excised ulcers was 5–12 cm (final defect, 7–15 cm). During the follow-up period (6 months to 7 years), no early postoperative complications or late aesthetic or functional discomfort occurred; however, intermittent skin sloughing occurred in four cases and one coccygeal sore recurrence occurred. The recurrent ulcer was treated using the same surgical method, with no recurrence after 2 years.Conclusion: This modification can be successfully used for the reconstruction of primary and recurrent sacrococcygeal pressure ulcers.

AESTHETIC IMPROVEMENT IN ONE VISIT PERIODONTAL PLASTIC SURGERY USING SCALPEL AND LASER SURGICAL TECHNIQUE (CASE REPORT)

Introduction: A charming smile is formed from good harmonization of teeth and gums. Short teeth clinical crown, dark gingival color, diastema between the maxillary central incisors can interfere the aesthetic of the smile. This case report aims to describe the treatment of periodontal plastic surgery in form of aesthetic crown lengthening, gingival depigmentation and frenectomy to improve function and aesthetic in one visit using scalpel and laser. Case: A 23 year old male patient complained that the maxillary front teeth spaced, short and small, and the gum of the upper jaw is dark, which caused aesthetic discomfort. Objective examination showed high frenal attachment reaching the interdental papilla to palatal, diastema of the maxillary central incisors, short clinical crown and brownish maxillary gingiva. aberrant frenum labialis superior, altered passive eruption and gingival hyperpigmentation diagnoses was made in this case. Case Treatment: Aesthetic crown lengthening treatment with scalpel, gingival depigmentation using scrapping technique and frenectomy using combination of laser and scalpel surgical technique was carried out in one visit. Discussions: The advantages performing three periodontal plastic surgeries in one visit is require just once preparation of surgical materials and instruments, once surgical trauma, once prescription and less number of control visits. Conclusions and Suggestions: Treatment of crown lengthening, gingival depigmentation and frenectomy in one visit are considered effective and efficient based on time, trauma, and costs required. The periodontal plastic surgery technique can be choosing based on clinical finding on patient, patient’s needed and clinical skills of operator.

Plexiform Neurofibroma: Case Report

Plexiform neurofibroma (PNF) is a benign nerve tumor, most often developing in the cephalic region. It is usually considered pathognomonic for neurofibromatosis type 1 (NF1) or Von Recklinghausen disease. We report the case of a patient treated in our training for plexiform neurofibroma on NF1. This is a 28-year-old patient, without any particular ATCD, who consulted for a left scalpo-fronto-palpebral subcutaneous swelling that had been present for 12 years, causing major aesthetic discomfort. Furthermore, it presented numerous (> 6) café au lait spots greater than 15mm in diameter. The patient underwent excision of the left scalpo-fronto-palpebral tumor under general anesthesia with direct closure. The pathological examination confirmed the diagnosis of plexiform neurofibroma. The postoperative course was simple and the result satisfactory. Surgical excision remains the only treatment for plexiform neurofibomas in Von Recklinghausen disease.

Modern Approaches to Treatment of Alopecia X in Dogs: Review of Research

Introduction. Noninflammatory alopecia is a disorder of canine appearance, which brings aesthetic discomfort to dog owners. Among foreign studies there are only few publications on implementing the drugs of the humane medicine for treatment of this disorder. The publications in the national literature present the descriptions of the individual clinical cases. The reviews of research containing the analysis and summary of the canine noninflammatory alopecia treatment methods are unavailable in the scientific literature. Therefore, this work aims at providing a comparative analysis of the canine noninflammatory alopecia treatment methods (based on the literature sources analysis).Materials and Methods. Searching by subject area was conducted in the eLIBRARY.RU, PubMed, Crossref and Google Scholar databases for materials published from 2000 to 2023 by the following keywords: dog AND alopecia, dog*AND alopecia X, dog*AND “name of the drug”. The selected materials were structured, 111 publications were analysed, 69 of which were included in the present review.Results. The studies on the use of humane medicine methods and drugs for treatment of alopecia X in dogs were analysed. The information was systemized into thematic blocks depending on the physiological causes of alopecia X and the drugs used. The main methods and approaches to be investigated were the use of melatonin, mitotane, trilostane, minoxidil, hormonal drugs, microneedling and microtrauma techniques.Discussion and Conclusion. Currently, the unified protocol for treatment of alopecia X in dogs is not developed in the veterinary medicine. Upon analysis of the treatment methods described in the literature, microneedling, oral administration of melatonin and trilostane, along with the use of subcutaneous implants of deslorelin acetate have been identified as the optimal ones, combining high efficiency with minor side effects. The use of mitotane, minoxidil and osaterone acetate causes the serious side effects, that prevents them from being the future-oriented methods.

REMOVAL SURGICAL OF MESIODENS IN THE PALATE FOR OCCLUSAL REESTABLISHMENT: A CASE REPORT

The purpose of this work is to report on the reestablishment of the patient's occlusion through the surgical removal of mesiodens in the palate. A 15-year-old male patient sought care at the dental clinic at Nilton Lins University accompanied by his guardian, carrying a panoramic radiograph and presenting aesthetic discomfort due to fracture of tooth 21 as the main complaint, the clinical evaluation verified the presence of a structure similar to a supernumerary tooth, this structure prevented a satisfactory occlusion of the patient, destabilizing the lower arch and acting on the intrusion effect of the lower incisors of the third quadrant. Based on the clinical characteristics presented along with the imaging exam, the person responsible for the removal of the mesiodens for occlusal reestablishment and subsequent fabrication of composite resin restoration with return of the disocclusion guide was chosen. The mesiodens was extracted and the occlusal normality was reestablished. Therefore, in view of the clinical resolution presented, the treatment was satisfactory, allowing the advancement to the restorative stages, and returning a normal pattern of the patient's occlusal profile.

Experiencing Revulsion: Aesthetic Discomfort and Ordinary Life

Abstract Drawing on recent theories and debates concerning the everydayness of non-artistic and even private aesthetic experiences, this article aims at differentiating new ways of dealing with revulsion at the intersection of negative and everyday aesthetics, as another manner of extending or transcending the scope of traditional art-oriented aesthetics. The paradigms that I will trace in the history of negative aesthetics are not mere occurrences of disgust or repulsiveness in art and in everyday life, but ways of addressing the repulsive in relation to the culturally variable scope of art and aesthetics. Besides the classical paradigm that associates repugnant subjects with their pleasure-inducing imitations in art, and the transgressions of modern and contemporary art that increasingly shocked their audience, revulsion can also be regarded as a form of displeasure linked to the quotidian, yet aesthetically relevant forms of life. By virtue of this ordinary nature, which is not unfamiliar to other (non-Western) cultures, revulsion could be placed at the core of everyday aesthetics, since it confirms both the transition from contemplation to action in recent aesthetics, that is, the practical preoccupation with the aesthetic quality of living, and the broader redefinition of aesthetics in terms of sensory reactions.

Idiopathic Scrotal Calcinosis: Surgical Treatment of a Rare Cutaneous Disorder

Idiopathic scrotal calcinosis is a rare, painless and benign disease characterized by the presence of multiple painless calcified nodules of the scrotum with no abnormalities of phosphocalcic metabolism. The main reason for consult among patients is the aesthetic discomfort. Histology shows basophilic calcium deposits in the scrotal dermis and calcified fibroids surrounded by foreign body giant cell granulomas. Treatment is based on surgical removal of the nodules. We report the case of a 27-year-old patient with no notable pathological history who consulted for multiple cystic nodular lesions of the scrotum, painless and non- infected, with no notion of previous trauma, evolving for 12 years. The patient underwent surgical removal of the scrotal nodules under local anesthesia. No recurrence was noted; the follow-up was one year. After a review of the literature, we discuss the pathogenic, clinical and therapeutic aspects of this poorly understood pathology.

Interest of a 3D custom-made implant in the reconstruction of bone defects of the cranial vault

The authors report a case of a patient managed for severe cranial vault depression following combined neurosurgery and radiotherapy. This situation caused major aesthetic discomfort and was potentially dangerous due to the mechanical weakness of the bone flap. The authors had a CAD (computer aided design) silicone elastomer custom-made implant made to fill perfectly the depression. Beforehand, an expansion was performed to cover the implant after removal of the radiated skin. The surgery and post-operative course raised no concerns. After one year of follow-up, the result is very good and the patient very satisfied, proving that this technique certainly has its place in the therapeutic arsenal when faced with a tissue defect of the cranial vault.

CERVICAL MATRIX AS A RESTORATIVE APPROACH IN NON-CARIOUS CERVICAL LESIONS: CASE REPORT

Introduction: Non-Carious Cervical Lesions (NCCL´s) are pathological conditions of multifactorial etiology. Aim: This case report highlights the use of a cervical matrix for technical simplification of the procedure of class V restoration. Case report: Patient attended a specialized center for diagnosis and treatment of non-carious diseases, complaining of dentin hypersensitivity and aesthetic discomfort due to loss of tooth structure in the cervical region. The proposed treatment plan was basic periodontal treatment and subsequent restoration of all cervical lesions that had a loss of tooth structure greater than 1 mm. The transparent cervical matrix was used to promote correct anatomical contour of the cervical third of the buccal surface and the emergence profile. Conclusion: The use of the cervical matrix is presented as a facilitating tool for the restorative treatment of NCCL´s.

Probiotic Weissella cibaria displays antibacterial and anti-biofilm effect against cavity-causing Streptococcus mutans

Streptococcus mutans is a significant contributor to dental caries and causes functional and aesthetic discomfort. Weissella cibaria strains were isolated from kimchi, and their functional properties were determined. In this study, the antibacterial and antibiofilm effects of four W. cibaria strains (D29, D30, D31, and B22) were evaluated against three S. mutans strains using culture fluid and cell-free supernatants. The results showed that W. cibaria reduced the exopolysaccharides production and auto-aggregation, increased co-aggregation, and downregulated virulence factors, leading to the inhibition of bacterial growth and biofilm formation. These findings were confirmed using scanning electron microscopy and confocal laser scanning microscopy. These results indicate that oral health can be potentially improved by W. cibaria.

Profil clinique et étiologique des onychomycoses à Lomé (Togo)

Objective: The aim of this study was to describe the clinical and etiological profile of onychomycosis at Lomé (Togo). Patients and Method: This is a descriptive prospective study, carry out from September 2020 to September 2021, on patients seen for onychomycosis in the public dermatology services of Lomé (Togo). Results: During the study period, 108 (1.7%) of the 6230 new patients had mycologically confirmed onychomycosis. The patients mean age was 43.03±14.5 with a female predominance (sex ratio: 0.2). Diabetes was the most frequent past medical history. Aesthetic discomfort was the main complaint, and hyperkeratosis the main physical sign, respectively at 86.1% and 75.9%. Distolateral onychomycosis (52.8%) clinical form was the most frequent. Yests (60.2%) were the most isolated group of fungi followed by dermatophytes and moulds respectively 26.9% and 12.9%. Candida albicans with a preferential location on the hands (p<0.01) and Trichophyton rubrum on the feet (p=0.03) were the main pathogens. Conclusion: Our study showed a low hospital based prevalence of onychomycosis with a predominance of Candida albicans complex in the hands and Trichophyton rubrum in the feet. Key words: onychomycosis, Candida albicans, Trichophyton rubrum, Lomé (Togo)