Aesthetic Discomfort Research Articles

Axillary Accessory Breast Tissue Mimicking Lipoma

Accessory breast tissue is rare congenital condition which occurs in 0.4-6% of women, it is usually bilateral, asymptomatic and commonly present in axilla. Diagnosis is difficult when it is unilateral with absence of areola and nipple, it can be made by ultrasonography. Surgical excision is warranted in case of functional symptoms or aesthetic discomfort. Herein, we report a case of right-sided accessory breast in a 36-year-old woman manifested in axillary swelling, clinically argued for a possible lipoma. Diagnosis was confirmed by ultrasonography and histological examination followed by surgical excision which relieved functional symptoms with significant cosmetic improvement.

Assessment of Satisfaction Level of Edentulous Patients Rehabilitated with Implant-Supported Prostheses.

Edentulism usually leads to esthetic, functional, and emotional discomfort resulting in a loss of self-esteem and a decrease of the patient's quality of life. Dental implants provide new possibilities to ensure the comfort and efficacy of prosthetic rehabilitation. The aim of this study was to evaluate the satisfaction level of patients rehabilitated using the Brånemark protocol or overdenture implant-supported prostheses. Fifty-two patients were rehabilitated using the Brånemark protocol and 23 using overdenture prostheses. Then, an adapted oral health-related quality of life questionnaire was administered in addition to a clinical exam to determine the condition of the dental implants and prostheses. The results for treatment expectation, understanding of the type of treatment, phonetic function, chewing comfort, pain, and self-esteem improvement were analyzed with Fisher exact test (P ≤ .05). Both treatments presented satisfaction of above 87%, with no statistical difference between them. Eighty-two percent of patients treated with overdenture prostheses and 80.8% of those treated with the Brånemark protocol had no complaint of pain (P = .087). The treatments analyzed in this study were highly satisfactory with regard to functional and esthetic factors, resulting in an increase in self-esteem and quality of life. The psychological factor is a complex variable in patient satisfaction that directly influences quality of life. Considering the desires of patients in choosing the type of prosthesis is critical to treatment success.

Éventrations lombaires symptomatiques après néphrectomies par lombotomie : quels sont les facteurs de risque ?

Lumbar incisional hernias after open nephrectomy are rare but can lead to aesthetic disorder, discomfort or intestinal obstruction. The aim of the study is to highlight their risk factors. The characteristics of patients who suffered from symptomatic and surgically treated lumbar incisionnal hernia after open nephrectomy (study group "GE") were compared to those of patients who underwent open nephrectomy without postoperative incisional hernia (control group "GT") using the Student's t test and Mann-Whitney test (statistical significance P value<0.05). GT patients were randomly selected with a 1/4 ratio (1 lumbar incisionnal hernia vs 4 controls). From 2004 to 2014, 417 open nephrectomies were performed in one university hospital. Forty-five patients were included: 9 in GE and 36 in GT. There was no statistically significant difference between GT and GE for weight, height, body mass index (BMI), emergency, partial nephrectomy, laterality, rib resection, laparoscopic conversion to open surgery, postoperative complications, smoking, diabetes mellitus, cardiovascular history, obesity and sex, but there was a statistically significant difference for age, operative time, chronic obstructive pulmonary disease (COPD) and severe obesity (BMI>35) with, respectively, P=0.05, P=0.02, P=0.04 and P=0.02. Risk factors for lumbar incisional hernia after open nephrectomy are age, operative time, severe obesity and COPD. 5.

Full-mouth rehabilitation of the patient with severe tooth wear using all ceramic restorations

Tooth wear is known as a normal physiological process which gradually progresses. It is reported that vertical dimension can be kept stable because amount of physiologically worn loss could be compensated by growth of alveolar bone and tooth eruption. However, excessive tooth wear as pathologic wear can cause pathologic pulp, disharmony with occlusal plane, functional disorders and esthetic problems so that full mouth rehabilitation could be needed in these cases. Recovery of function and esthetic improvement should be considered for alteration of the vertical dimension. Determination of the vertical dimension of occlusion is needed to be in harmony with the neuromuscular system. This clinical report describes 36 year-old female patient who had chief complaint of severely worn dentition and esthetic discomfort. An increase of 2.0 mm at maxillary incisal edge was done to restore vertical dimension. It was based on the degree of tooth wear and esthetics. (J Korean Acad Prosthodont 2016;54:306-13)

Aesthetic discomfort in hand osteoarthritis: results from the LIège Hand Osteoarthritis Cohort (LIHOC).

IntroductionThe primary complaint of patients with hand osteoarthritis (OA) is frequently the inelegant appearance of their hands. Only one study has been conducted to assess the magnitude of and identify the determinants of aesthetic discomfort in hand OA.MethodsThe LIège Hand Osteoarthritis Cohort is a prospective cohort of 203 patients diagnosed with hand OA. At baseline, these patients rated their aesthetic discomfort on a 100-mm visual analogue scale (VAS) and used a Likert scale (range 0–7) to quantify the magnitude of their aesthetic damage.ResultsThe median value of the aesthetic discomfort VAS was 35.0 [interquartile range (Q1–Q3) 6.0–59.0]. The median damage was rated 3.0 (Q1–Q3 1.0–4.0), corresponding to a moderate level. Both were significantly (p < 0.02) associated with the female gender, the duration of hand OA, the radiological severity of OA (Verbruggen–Veys and Kellgren–Lawrence scales) and pain, disability, or stiffness [Australian Canadian Osteoarthritis Hand Index (AUSCAN) and Functional Index for Hand Osteoarthritis ]. After a stepwise analysis, the parameters correlated to the aesthetic discomfort were the presence of erosive joints (p = 0.0048), the AUSCAN score (p < 0.0001), the number of joints with severe radiological damage (p = 0.023), and gender (p = 0.0009). For aesthetic damage, the parameters associated were AUSCAN score (p < 0.0001), duration of hand OA >10 years (p = 0.001), and presence of erosive joints (p < 0.0001). Compared with patients with low aesthetic discomfort (VAS ≤33 mm), those with the highest discomfort (VAS ≥66 mm) had more erosive OA (p = 0.014), a higher Verbruggen and Veys score (p = 0.0039), and a higher AUSCAN score (p < 0.001).ConclusionsAesthetic discomfort and damage are significant complaints in patients with hand OA. The determinants of the magnitude of these are gender, radiological severity, duration of hand OA, presence of erosive joints, and impact on pain, function, and stiffness as assessed with the AUSCAN.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0807-y) contains supplementary material, which is available to authorized users.

Nail involvement in adult patients with plaque-type psoriasis: prevalence and clinical features.

BACKGROUND:Psoriasis is a disease of worldwide distribution with a prevalence of 1 to 3%. Nail psoriasis is estimated in 50% of patients with psoriasis, and in the presence of joint involvement, it can reach 80%.OBJECTIVE:To study the nail changes - and their clinical implications - presented by patients with psoriasis vulgaris under surveillance in a university hospital from the south of Brazil.METHODS:his cross-sectional study evaluated 65 adult patients from January 2012 to March 2013. Cutaneous severity was assessed according to the Psoriasis Area and Severity Index (PASI). The Nail Psoriasis Severity Index (NAPSI) was used to evaluate patient's nails. The diagnosis of psoriatic arthritis was established according to the Classification Criteria for Psoriatic Arthritis (CASPAR).RESULTS:The prevalence of NP was 46.1%. These patients had a median [interquartilic range (IQR)] NAPSI of 1 (0-15). A total of 63.3% of patients reported aesthetic discomfort or functional impairment related to their nails. Onycholysis was the most common feature (80%). When compared with patients without nail involvement, patients with NP had lower mean age at psoriasis onset [21 (18-41) vs. 43 (30-56) years, p=0,001]; longer disease duration [15.5 (10-24) vs. 6 (2-12) years, p=0.001]; higher PASI [9.2 (5-17) vs. 3.7 (2-10), p=0.044], higher frequency of psoriatic arthritis (43.3 vs. 3.7, p = 0.002) and more often reported family history of psoriasis (40% vs. 7.4%, p = 0.011).CONCLUSION:Onycholysis was the most frequent finding and most patients feel uncomfortable with the psoriatic nail changes that they experience.

Monsplasty after massive weight loss: Assessment of its aesthetic and functional impact

Massive weight loss frequently leads to a ptosis or a pubic bulge. This deformation is a source of functional as well as aesthetic discomfort, and it also has psychological repercussions. We have analyzed the degree of satisfaction reported by 23 female patients having undergone a monsplasty procedure and have also proposed a decisional algorithm designed to facilitate surgical care according to type of pubic deformation. This is a one-year prospective study involving 23 female patients having undergone a monsplasty procedure following massive weight loss. The interventions were all carried out in standardized fashion by the same surgeon according to stage of deformation. Analysis of the patients' degree of aesthetic and functional satisfaction was performed using a questionnaire filled out during preoperative and postoperative consultations, the latter taking place 6 months to one year after the operation. It included a self-esteem assessment based on the Rosenberg scale, appraisal of functional benefits (clothing, sexual activity, daily physical activities, intimate hygiene) and evaluation of the pubis in aesthetic terms. Assessment of impact on self-esteem revealed average improvement of 10.08 points, rising from 25.87 to 35.95. All of the patients, without exception, were satisfied or very satisfied with the impact of monsplasty on the different items under evaluation. stage 3 and stage 4 patients were particularly sensitive to improvement involving personal hygiene, physical activities and the clothes they wore. In most cases, they likewise reported a positive impact on their sexual experience. Abdominoplasty or body lift without monsplasty can entail long-lasting aesthetic and functional discomfort. Thorough preoperative semiological analysis is essential to optimized surgical care conducive to successful integration of the monsplasty. An appropriate caretaking attitude enhances both the aesthetic result and patient self-esteem.

Effective and Efficient Herbst Appliance Therapy for Skeletal Class II Malocclusion Patient with a Low Degree of Collaboration with the Orthodontic Treatment.

The current concept for effective and efficient treatment of skeletal Class II malocclusion prescribes that interceptive approach should be delivered during the pubertal growth stage. However, psychosocial issues and a greater risk of dental trauma are also factors that should be addressed when considering early Class II therapy. This paper reports a case of a patient that sought orthodontic treatment due to aesthetic discomfort with the incisors' protrusion. Two previous treatments failed because patient's collaboration with removable appliances was inadequate. Given his history of no collaboration and because the patient was in the prepubertal stage, it was decided to try a different approach in the third attempt of treatment. Traumatic injury protective devices were used during the prepubertal stage and followed by Herbst appliance and fixed multibrackets therapy during the pubertal stage, resulting in an adequate outcome and long-term stability.

Intralesional Cryosurgery to Treat Keloid Scars: Results from a Retrospective Study

Background: A variety of treatment modalities have been proposed to treat keloid scars, but outcomes are often disappointing. Intralesional cryosurgery may significantly reduce these scars. Objective: To evaluate the clinical safety and efficacy of intralesional cryosurgery to treat keloid scars. Feedback from patients on pain, pruritus and aesthetic discomfort was recorded before and after treatment. Methods: A total of 10 patients with 14 keloid scars resistant to conventional treatments were enrolled in a retrospective study between October 2007 and October 2013. The efficacy of this treatment was evaluated by measuring the reduction in scar surface. Results: Scar surface was reduced by an average of 58.5% after intralesional cryosurgery treatment for all scars (average pre-operative keloid scar surface: 874.6 ± 954.1 mm²; average post-operative keloid scar surface: 505.8 ± 1,024.7 mm²; p = 0.002). Pain and aesthetic discomfort were significantly decreased after treatment in all patients (p = 0.008 and p = 0.012, respectively). Conclusion: Our data suggest that intralesional cryosurgery is an effective treatment for keloids.

Reconstruction dynamique de tendon d’Achille par lambeau perforant composite avec évaluation fonctionnelle

Achilles tendon are common in patients after immobilization, therefore the reconstruction of a ruptured Achilles tendon with defects remains a surgical challenge. The ideal characteristics are a thin layer of skin, a strong tendon component, combined with a reliable blood supply and minimal morbidity at the donor site. We present a reconstructive technique using a composite anterolateral thigh perforator free flap, meeting these criteria, for the treatment of rupture of Achilles tendon with cutaneous and tendon defect. A 34-year-old patient presenting a third rupture of his left Achilles tendon with 4cm composite defect was reconstructed with a contralateral anterolateral thigh perforator flap with part of the fasciae latae. The latter was raised by dissecting one intramuscular perforating artery from a descending branch of the lateral circumflex femoral artery. The postoperative observation period was one year. The functional outcome was determined by clinical scores (IKDC, OAK and Lysholm-Tegner). The healing time was 21days. At six months, the aesthetic and functional result was satisfactory without delayed healing or secondary rupture. The aesthetic discomfort at the donor site was considered negligible by the patient. At one year, there is a continuing stability with no recurrence. The functional result was considered good with a clinical score of 75/100. Therefore, this method seems to be a good option for complex reconstruction of Achilles meeting the requirements of reconstruction with good stability at a distance.

AB0768 Aesthetic Discomfort in Women with Hand Osteorthritis Means NO Less than the Pain and Functional Impairment

BackgroundOsteoarthritis (OA) is one of the most common causes of pain in the hands after 40-45 years resulting in poor health-related quality of life (HRQoL). This reduction caused not only...

HAND OSTEOARTHROSIS: ON THE QUALITY OF LIFE AND AESTHETIC DISCOMFORT

Osteoarthrosis (OA) is one of the most common causes of hand pains, leading to lower quality of life (QL). In addition to pain and functional impairment, the patients' aesthetic dissatisfaction that cannot be now determined or measured is of prime importance Objective: to assess a number of QL aspects and to measure the level of aesthetic discomfort in patients with hand OA. Subjects and methods. Sixty women aged 45–75 years with hand OA were included. The number of painful and deformed joints was determined and functional impairments were evaluated using the AUSCAN questionnaire. The patients filled out the questionnaire to determine the level of dissatisfaction with the appearance of their hands; the Ellis stress test for irrational beliefs was carried out. Results. The patients with hand OA were found to have significant aesthetic discomfort comparable with level of joint pain. Deformity phobia in the future and external discomfort because of hand deformity were most pronounced; a wish for surgical correction was less pronounced. Comparison of the results obtained in different age groups determined the highest levels of anxiety and wish for surgical correction in younger women. The patients' aesthetic dissatisfaction was also influenced by employment and internet usage. Conclusion. Aesthetic discomfort is an important component of lower QL in patients with hand OA. Further investigation of this factor and elaboration of criteria for its estimation are needed.

Aqua splint suture technique in isolated zygomatic arch fractures

Various methods have been used to treat zygomatic arch fractures, but no optimal modality exists for reducing these fractures and supporting the depressed bone fragments without causing esthetic problems and discomfort for life. We developed a novel aqua splint and suture technique for stabilizing isolated zygomatic arch fractures. The objective of this study is to evaluate the effect of novel aqua splint and suture technique in isolated zygomatic arch fractures. Patients with isolated zygomatic arch fractures were treated by a single surgeon in a single center from January 2000 through December 2012. Classic Gillies approach without external fixation was performed from January 2000 to December 2003, while the novel technique has been performed since 2004. 67 consecutive patients were included (Classic method, n = 32 and Novel method, n = 35). An informed consent was obtained from all patients. The novel aqua splint and suture technique was performed by the following fashion: first, we evaluated intraoperatively the bony alignment by ultrasonography and then, reduced the depressed fracture surgically using the Gillies approach. Thereafter, to stabilize the fracture and obtain the smooth facial figure, we made an aqua splint that fit the facial contour and placed monofilament nonabsorbable sutures around the fractured zygomatic arch. The novel aqua splint and suture technique showed significantly correlated with better cosmetic and functional results. In conclusion, the aqua splint suture technique is very simple, quick, safe, and effective for stabilizing repositioned zygomatic arch fractures. The aqua splint suture technique can be a good alternative procedure in isolated zygomatic arch fractures.

AB0590 Aesthetic discomfort in women with hand osteoarthritis in russian federation

BackgroundOsteoarthritis is the most common joint disease with the highest prevalence of hand osteoarthritis (HOA). According to various sources, the age of onset of the disease accounts for 45-47 years...

An Innovative Approach to Treat Incisors Hypomineralization (MIH): A Combined Use of Casein Phosphopeptide-Amorphous Calcium Phosphate and Hydrogen Peroxide—A Case Report

Molar Incisor Hypomineralization (MIH) is characterized by a developmentally derived deficiency in mineral enamel. Affected teeth present demarcated enamel opacities, ranging from white to brown; also hypoplasia can be associated. Patient frequently claims aesthetic discomfort if anterior teeth are involved. This problem leads patients to request a bleaching treatment to improve aestheticconditions.Nevertheless, hydrogen peroxide can produce serious side-effects, resulting from further mineral loss. Microabrasion and/or a composite restoration are the treatments of choice in teeth with mild/moderate MIH, but they also need enamel loss. Recently, a new remineralizing agent based on Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) has been proposed to be effective in hypomineralized enamel, improving also aesthetic conditions. The present paper presents a case report of a young man with white opacities on incisors treated with a combined use of CPP-ACP mousse and hydrogen peroxide gel to correct the aesthetic defect. The patient was instructed to use CPP-ACP for two hours per day for three months in order to obtain enamel remineralization followed by a combined use of CPP-ACP and bleaching agent for further two months. At the end of this five-month treatment, a noticeable aesthetic improvement of the opacities was observed.

Assessment and determinants of aesthetic discomfort in hand osteoarthritis

BackgroundDissatisfaction with hand appearance is frequently the presenting complaint of patients with hand osteoarthritis (HOA), yet no tool exists for its measurement and few studies have examined aesthetic discomfort.ObjectivesThe aims...

Plaintes et besoins des patients atteints de sclérodermie systémique : une meilleure connaissance afin d’améliorer le suivi

PurposeSystemic sclerosis (ScS) is very heterogeneous in its clinical presentation and its therapeutic care is not codified. A better knowledge of the patients’ needs and complaints could improve the patient educational strategies and their global care. MethodsA self-administered questionnaire aimed to the ScS patient was developed by subspecialty physicians and nurses involved in patient education. It was a cross-sectional study that also included several validated scales: the health control locus scale, the Mactar, HAD and sHAQ scales. ResultsOne hundred and eight patients (91 women; 18 limited ScS, 71 limited cutaneous ScS, 19 diffuse ScS) filled in the questionnaires. Fatigue was the main complaint in all types of ScS, independently of the ScS type. The aesthetic discomfort mentioned by the patients suffering from cutaneous sclerosis or from telangectasia was important and reached 52±33mm on a 100-mm visual scale. It was more common in the patients presenting a diffuse form of the illness but the difference did not reach a statistical significance (P=0.06). Twenty-seven percent of the patients said they were very or extremely worried because of the degradation of their physical appearance. The functional discomfort linked to the cutaneous sclerosis was rated 50±32mm on a 100-mm visual scale. The intensity of the pain, the importance of the functional discomfort linked to the sclerosis and the intensity of the dyspnea were correlated to the sHAQ (P<0.001). Patients having more frequent recurrent digital ulcers had higher sHAQ scores (P=0.04). The repercussions on the professional life were linked to fatigue first, to the Raynaud's syndrome and to arthralgia. The repercussions on the personal life were mainly linked to the fatigue, the pain and the dyspnea. The patients’ compliance was good. ConclusionFatigue, pain, dyspnea and discomfort linked to sclerosis are major chronic symptoms of the patients with ScS. Identifying the needs and complaints of the patients with ScS should help to improve their care by implementation of an educational program.

Is breast reduction a functional or a cosmetic operation? Proposal of an objective discriminating criterion

Classification of breast reduction as a functional or cosmetic operation is an unresolved issue. Surgical reduction of the breast is equally indicated both for correction of functional sequelae of breast hypertrophy and for a merely subjective aesthetic discomfort. Although several criteria are currently adopted by the national and international associations of plastic surgeons, none of them appears to fulfil the aim of objectively discriminating the functional from cosmetic indications. An original, simple and synthetic objective criterion was developed at the Plastic and Reconstructive Surgery Department of the University of Pavia using some basic anthropometric measurements.

Cosmetic vulvovaginal surgery

Cosmetic vulvovaginal surgery arouses considerable media interest. There are significant ethical and technical challenges posed by such procedures, which may not be justified on medical grounds. Many such operations are performed without adequate evidence of either safety or psychosocial benefit. The best established female genital cosmetic procedure is reduction labioplasty. Women request reduction surgery for their labia for two distinct indications: aesthetic dissatisfaction or discomfort. There are a variety of techniques, none of which has high-quality supporting evidence. Hymenoplasty is even more controversial than labioplasty, perhaps because it is seen to perpetuate misogynist myths about virginity. Despite its persistent popularity there is little evidence of successful outcomes. Vaginal laxity is a common complaint among parous women, and has a complex relationship with sexual dysfunction. When a multidisciplinary, conservative approach fails, surgical intervention, with either perineorraphy or posterior colporrhaphy may be justified. Recent publications suggest some benefits to sexual function. Throughout this area, prospective appropriately controlled studies, using validated patient-centred outcomes are needed in order to assess the benefits. Until such evidence is available, it will remain difficult appropriately to advise patients requesting surgical intervention.

Risk factors for developing upper limb lymphedema after breast cancer treatment

Secondary lymphedema occurs in 14 to 28% after breast cancer treatment. Many studies have defined risk factors of lymphedema. Number of axillary nodes removed and radiotherapy especially on axillary nodes are the main risk factors. Others factors have been described such as type of surgery (mastectomy/tumorectomy), overweight at time of cancer, weight gain after surgery, skin puncture, reduction of physical activity. Risk of lymphedema and its complications (cellulitis, psychological and aesthetic discomfort) may be reduce by improvement in radiotherapy methods, sentinel lymph node biopsy, weight control, maintain of level physical activity after treatment and avoidance of skin puncture on ipsilateral arm.