Aesthetic Disorders Research Articles

Syndrome of fascial incarceration of the long thoracic nerve: winged scapula

ObjectiveTo analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula. MethodsSix patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up. ResultsThe patients achieved improvement of their symptoms 6–20 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders. ConclusionThe approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle.

ATUAÇÃO DA RADIOFREQUÊNCIA NA GORDURA LOCALIZADA NO ABDÔMEN: revisão de literatura

The requirement of body silhouette within agreed st andards of beauty has been increasing over the year s. Men and women want a body free of imperfections, and locali zed fat has been one of the biggest reasons demand for treatment in beauty centers , gyms, spas and nutritionists. The Radio Frequency is a technique mainly used for stim ulation and production of collagen, but also generates an energ y that makes the machine reach the layers of fat, t hereby reducing the volume of fat cells and speeding up your metabolism, making it a treatment modern and complete aesthet ic in the loss of waist measurement. The main objective of this re search is to review the literature on radiofrequenc y technique applied in localized fat in the abdomen. For these purposes, several searches were made in scientific articles available in scientific databases. A current research show that technological advances can contribute greatly to im prove aesthetic disorders such as is seen in the use of radio frequ ency.

Síndrome do aprisionamento fascial do nervo torácico longo: escápula alada

ObjectiveTo analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula. MethodsSix patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up. ResultsThe patients achieved improvement of their symptoms six to twenty months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders. ConclusionThe approach of early surgical release seems to be a better predictor for recovery from non‐traumatic paralysis of the anterior serratus muscle.

Physical therapy in the treatment of body aesthetics dysfunctions - literature review.

Introduction: The esthetic disorders, such as skin laxity, localized fat and cellulite, arecommon complaints among the population in general. The physiotherapy providestechniques for treatment of these dysfunctions noninvasively. Objective: To review thephysical therapy techniques used to treat the body dysfunction aesthetic through aliterature review. Method: It was performed a literature review of studies publishedbetween September/1997 and October/2013, in Portuguese or English, in the Scielo,PEDro, Pubmed, Lilacs e Medline database. Results: A total of 1.165 articles were found.Of these, 37 were potentially eligible after reading the title and summary, and a total of11 studies were included. The studies addressed some techniques like radiofrequency,combination of bipolar radiofrequency, infrared, vacuum and mechanical massage(Velashape), ultrasound of high intensity focused, cellulite cream, mechanical massage,lymphatic drainage and tissue manipulation, ultrasound of low intensity, andcryolipolysis. Conclusion: We conclude that the physical therapy techniques areeffectives, safe and well tolerated by patients in the treatment of localized fat. They helpto sculpt the body and to reduce cellulite. However, it is necessary to performrandomized controlled trials, with larger sample size, since the majority of the includedstudies are prospective and retrospective clinical trials.

Ketidaknyamanan Tongue Crib sebagai Faktor Risiko untuk Keberhasilan Koreksi Anterior Tongue Thrust Swallow

Anterior Tongue Thrust Swallow (ATTS), a swallowing pattern by pushing the tongue onto anterior dentition, can initiate malocclusion in the anterior region, which will create psycho-physiological problems due to aesthetic, speech, and mastication disorders. The use of a Tongue Crib (TC) as a corrective device for ATTS is to block the force of tongue against the anterior teeth. Wearing a TC will have an experience of discomfort for the patient and can be an obstacle in using TC regularly, lengthening the period of treatment. A clinical trial with 25 subjects using TC in their retention period, and 48 patients only using Hawley retainer without crib as control, was carried out from September 2004 until May 2005 in the FKG UI Orthodontics clinic, the Orthodontics Clinic of Lembaga Kedokteran Gigi (Ladokgi) TNI AL R.E. Martadinata and in a specialist clinic. The survival analysis for the TC users, associated with sensor time, indicates that 25 of the TC users had not succeeded to correct ATTS. A discomfort questionnaire (DQ) was specifically designed for this study, consisting of 9 items. A significant result was that the discomfort experienced was one of the risk factor for the ineffectiveness of Tongue Crib in correcting ATTS. DOI: 10.14693/jdi.v15i1.90

A columellar deformity caused by a congenital schwannoma

Schwannoma is a benign neoplasm arising from Schwann cells of the peripheral nerve. It very rarely located in the nasal tip. We report two cases of congenital schwannoma of the nasal columella and discuss the surgical approach of such tumor. Case report: Case 1: An 18 year-old female was referred to us for a very slow growing tumor of the columella. The deformity had been present since the birth. The patient underwent an excision of its tumor using an open rhinoplasty approach. The histological examination revealed a schwannoma. No recurrence was found within 2 years of follow up. Case 2: A 4 month male baby presenting a congenital tumor of his columella. He underwent an excision using open rhinoplasty approach. The histological examination showed a plexiform schwannoma. Discussion: Schwannoma of the nasal tip is a benign tumor that gradually causes aesthetic and functional disorders. Congenital schwannoma of columella is an extremely rare clinical situation. Its diagnosis and treatment can pose certain challenges. The treatment is surgical excision and histological analysis of the specimen. Open rhinoplasty approach provided a good surgical exploration and a good cosmetic result on this nasal tip tumor.

Use of a three-way stopcock in grafting of autologous fat: technical note

Fig. 1. Conventional hospital 3-way stopcock. The 3 systems are connected. utologous fatty tissue is used routinely to treat conditions s varied as syndromic defects, post-traumatic and postperative complications, velopharyngeal insufficiency, and esthetic disorders. Fat has been transferred by injection since he beginning of the last century, although the technique has ecome more popular in the last 25 years.1 Many different aspects have been reported and cover the onor site, methods of aspiration, local anaesthesia, processng of fatty tissue,2 reinjection, and stability of the graft. ne such technique is that proposed by Coleman,2 in which he Luer-Lok® syringe system is necessary throughout the rocedure. A 10 ml Luer-Lok® syringe attached to a 2-holed cannula s used to harvest autologous fat. Care should be taken not to amage the fatty parcels. The graft can be processed using entrifugation: the syringes are spun at 3000 rpm for 3 min, fter which time the oil and aqueous layers are decanted and rained.3 The next step is injection of the fat using a 1 ml Luerok® syringe. However, transferring fatty tissue from the 0 ml syringe to the 1 ml syringe can be difficult. Coleman laced the 10 ml syringe in the open barrel of a 1 ml syringe rom which the plunger had been removed and held the 1 ml yringe upwards and obliquely to minimise the introduction 4 f air bubbles. However, this position could cause the tisue to spill. An alternative could be to use a Luer-Lok®

Étude du service rendu de la chirurgie des séquelles d’amaigrissement au CHU de Lille

Cutting the excess of skin body contouring surgery in post-massive weight loss patients seems to only improve functional and aesthetic disorders. But other benefits can be determinated such as psychosocial effects. The first two are usually evaluated. The last two are rarely researched. The goal of this study is to evaluate the benefits of body contouring surgery by comparing patient satisfaction on these different aspects. One hundred thirty-four patients with more that 30 kg's weight loss had body contouring surgery at the university hospital in Lille between June 2004 and June 2008. Seventy-eight patients agreed to respond to a study on quality-of-life improvements after body contouring surgery which evaluated aesthetic, functional, and psychosocial aspects. The data were compared before and after the surgery to assess the benefits of the surgery in these areas. All the aforementioned aspects were clearly improved with the body contouring surgery. However, the improvement in the physical aspects seems to be somehow disappointing, not living up to the patients expectations. Exactly 52.5 % of the patients wanted morphologic alteration, while the scars were well tolerated in 78.2 % of the cases. On the other hand, psychosocial discomfort was improved in ways not expected by the patients. Two new findings were remarkable: a decrease of 56.7 % in the sense of feeling depressed and an improvement in finding a job after body contouring surgery. The psychosocial improvements represent the true benefits of body contouring surgery.

Schwannoma of the Nasal Tip: Diagnosis and Treatment

Schwannoma is a neurogenic neoplasm rarely found in the sinonasal tract. It is a benign tumor arising from the sheath of myelinated nerve fibers that may occur in any part of the body. Its diagnosis and treatment can pose certain challenges. A 35-year-old woman presented to the senior surgeon with a nasal tip tumor that had been developing for almost 10years. Ultrasound showed edema of the nose because of multiple solid nodes. The computed tomography (CT) scan did not show invasion of the bony framework around the tumor (maxilla, septum, nasal bones). Magnetic resonance imaging (MRI) showed a deviation of the septum and well-defined round nodes at the nasal tip with a thick layer of skin around them. Resection of the tumor was performed using open rhinoplasty. The limits of the excision were free of tumor, and histologic analysis of the tumor showed the characteristics of a schwannoma. At this writing, 2years postoperatively, the patient is free of recurrence. Schwannoma of the nasal tip is a benign tumor that gradually causes aesthetic and functional disorders. Radiologic examinations can assist in its diagnosis. The treatment is surgical excision and histologic analysis of the specimen.

Retrospective study of the rhinoscleroma about 14 cases in ENT departments of university hospitals (Côte d’Ivoire)

To report the epidemiological, clinical, therapeutic and evolutionary aspects of rhinoscleroma in ENT departments of university hospitals (Côte d'Ivoire). Retrospective study of rhinoscleroma conducted in the ENT and head and neck surgery departments in Côte d'Ivoire from January 1980 to December 2008 including the cases of confirmed rhinoscleroma and the treated cases. Fourteen cases of rhinoscleroma were found in 28 years. The early manifestations were not specific enough so the patients were seen with clinical status with obvious disorders or physical discomfort. Treatment was medical and surgical. Medical therapy was based on streptomycin, thiopenicol or ciprofloxacin administration. Surgery consisted in removing the fibrous adhesions to correct the functional and aesthetic disorders. Rhinoscleroma has become a more and more rare disease because of the sensitivity to the new molecules. Diagnosis can be difficult and delayed because of its clinical polymorphism.

Gummy smile and botulinum toxin: A new approach based on the gingival exposure area

Gummy smile (GS) is an aesthetic disorder for some patients, which can be corrected by injection of botulinum toxin. We sought to classify GS according to the area of gingival exposure and the respective muscles involved in order to perfect the botulinum toxin injection technique for each patient. Sixteen patients with GS were evaluated before receiving botulinum toxin injections. Based on the area of excessive gum displayed and identification of the muscles involved, 4 different types of GS were identified: anterior, posterior, mixed, and asymmetric. AbobotulinumtoxinA (Dysport, Ipsen Biopharm Limited, Wrexham, UK) was injected using a different injection technique for each type of GS, based on the main muscles involved. With the aid of two computer programs, the area of gum exposed was measured before and after the application of abobotulinumtoxinA, to evaluate the level of improvement. There was a decrease in the degree of gum display in all patients. The general average improvement achieved was 75.09%. Two patients showed slight adverse effects that were easily corrected with additional doses of abobotulinumtoxinA. For this study, there was no sample size calculation and no statistical analysis of the cases. The authors conclude that it is important to identify the type of GS and therefore the main muscles involved, so that the correct injection technique can be used. AbobotulinumtoxinA was shown to be effective and safe for use in all types of GS in the present sample.

Postoperative Komplikationen in der plastischen Chirurgie

Plastic surgery covers a broad spectrum of diseases and conditions in the areas of reconstructive surgery, hand, burn and aesthetic surgery. Besides acquired defects or malformations an increasing number of patients are being treated for surgical or multimodal complications. In a considerable number of patients plastic and reconstructive surgery remains the only therapeutic alternative after other therapy has failed. Therefore complication management in plastic surgery is of utmost importance for a successful outcome. In addition patient expectations in the results of plastic surgery as a discipline of invention and problem solving are steadily increasing. This challenge is reflected in clinical patient management by intensive research in tissue engineering and regenerative medicine. Patients in plastic surgery are recruited from all age groups of either gender, involving traumatic and oncologic as well as congenital and aesthetic disorders. The demographics of aging, multimorbidity and obesity pose new challenges to plastic surgery. Although age over 70 years is not an independent risk factor per se for complications in plastic surgery, e.g. for complex free flap transfer, medical problems are present at a higher rate, which is to be expected in this age group. Risk factors such as alcoholism and coronary heart diseases seem to be independent predictors of perioperative complications. Therefore older patients can also benefit from plastic surgery and recurrent operations by the corresponding risk and complication management. Complication management necessitates careful patient selection, estimation of operative risks and patient-adapted selection of procedures. In addition to expertise in plastic surgery a thorough knowledge of non-surgical and surgical back-up procedures for technical incidents as well as vascular circulatory and wound healing disorders is required to deal successfully with complications in plastic surgery. This article presents these specific aspects of postoperative complication management in plastic surgery.

Monostotic fibrous dysplasia: a 23-year follow-up of a patient with spontaneous bone remodeling

Fibrous dysplasia is a benign fibro-osseous disease that affects one or more bones. Although its etiology has been defined, the mechanism of spontaneous resolution is still unclear. There is strong evidence indicating the occurrence of stabilization when bone maturation is completed. Deformities that lead to esthetic and functional disorders are observed in almost all cases. Plastic surgery is often recommended when the maxilla and mandible are involved. In the case of mild deformities, careful follow-up during skeletal growth is recommended. We describe here the 23-year follow-up of a patient with monostotic fibrous dysplasia whose disease had stabilized by 13 years of follow-up.

Correlation between oral health-related quality of life (OHQoL) and oral disorders in a Turkish patient population

The purpose of the present study is to determine the nature of the complaints that bring patients to our clinic and to what degree these complaints affect their quality of life (QoL). We also aimed to determine any associations between gender, education or harmful habits and each patient's oral health-related quality of life (OHQoL). A total of 1090 patients, consisting of 651 females (59.7 %) and 439 males (40.3 %), were included in this study. Of these patients, 220 constituted healthy controls. Two patient-centered outcome measures, the 14 item OHIP-14 and the 16 item OHQoL-UK measures were used. Most of the patients presented with toothache and caries (50.1 %), 11.2 % had suffered tooth loss and had denture needs, 9.2 % had periodontal problems, 1.8 % had temporomandibular joint (TMJ) disorders, 3.8 % had buried third molars, 2.4 % had orthodontic and aesthetic disorders, 1.3 % had suffered injury due to trauma, and 20.2 % came only for control checkups. OHQoL was best in the control group and the worst in patients who had suffered trauma. In addition, we noted correlations between gender, education and harmful habits, and that of the patient's oral health-related quality of life. According to our results, OHQoL is associated with the oral complaints of patients. Furthermore, OHQoL may not only be associated with the oral health status of patients, but factors such as gender, education and harmful habits may also play a role.

Dental anomalies and associated factors in 2‐ to 5‐year‐old Brazilian children

Dental anomalies in primary teeth may lead to functional and aesthetic disorders, and their recognition contributes to early diagnosis and long-term treatment planning. This study investigated the prevalence of dental anomalies in primary dentition and associated factors in Brazilian preschoolers. The study population of this cross-sectional study comprised 1260 2- to 5-year-old children from public nurseries in Canoas, southern Brazil. Dental anomalies were recorded by five trained examiners according to Kreiborg criteria; classification included double teeth, hypodontia, supernumerary, and microdontia. Dental anomalies as a group were found in 2.5% of children, although no significant difference occurred between genders and races. All the anomalies were observed in the anterior region, with no significant differences between the arches. However, supernumerary teeth were significantly more frequent among the non-white racial group (Fisher; P = 0.025) and double teeth on the lower arch (McNemar; P = 0.020). Individual anomaly frequencies were: double teeth, 1.3%; hypodontia, 0.6%; supernumerary, 0.3%; and microdontia, 0.3%. The frequency of primary dentition anomalies as a group was greater than that reported in other populations; the findings of this study provide a clear vision of the distribution of this oral condition and may well contribute to early detection and treatment planning.

Stomatologie gériatrique

The practice of stomatology and maxillo-facial surgery in the elderly has become more frequent, in relation with lengthened life expectancy. The management of older patients induces frequent and constraining problems due to the repercussions of ageing on orofacial tissues; these repercussions consist of various intricate diseases that more or less directly interfere with the general disease. Besides, “normal senescence” may not or hardly be distinguished from a pathological state. The frailty of older patients, their uncertain participation, the constraints and risks related to their poly-medication constitute a wide range of problems in their therapeutic management. The risk of under- or over-consumption of drugs is also to be considered, particularly in cutaneous or oral cancerology. Lastly, it should be reminded that in most cases, age-related functional and aesthetic disorders are the main reason for seeking treatment. Consequently, all concerned practitioners (maxillo-facial surgeon, stomatologist, odontologist) have to aim the preservation of these patient's quality of life.

口内法により摘出即時再建を行った下顎エナメル上皮腫症例におけるインプラントの応用

Ameloblastoma often tends to infiltrate or recur, although it is a benign tumor with slowly expansive growth. Based on these features, extensive surgical resection similar to that for malignant tumors is considered the treatment of choice. However, such treatment sometimes results in functional and aesthetic disorders. This article describes three female patients with mandibular ameloblastoma who underwent marginal resection and mandibular reconstruction with bone grafts by an intraoral approach. The mandibular defect was repaired with an iliac bone graft combined with particulate cancellous bone and marrow in two patients, and with chin bone in one patient. About 7 months after the operation, endosseous implants were placed. After confirming osseointegration (about 6.5 months later), abutments were placed, and prosthetic reconstruction was carried out. In all patients, masticatory function was well restored by dental implants in the grafted bone, and good aesthetic results were achieved. We believe that intraoral resection and reconstruction with a bone graft followed by application of dental implants is one of the treatments of choice for mandibular ameloblastoma.

Apparatuses with a system of spring elements for the treatment of dental anomalies

There are various conservative methods for the treatment and prevention of dentoalveolar anomalies. Undoubtedly, early initiation of orthodontic treatment allows not only to eliminate morphological and functional disorders of the oral cavity and jaws, but also to create conditions for the harmonious development of the facial skeleton. Refusal of early treatment leads to consolidation and aggravation of anomalies and aesthetic disorders, which are more difficult to treat in adulthood.

舌形態異常を伴った遠位関節拘縮症候群の１例

We report a rare case of distal arthrogryposis syndrome associated with a tongue anomaly. A 3-year-old girl visited us complaining of articulation and aesthetic disorders, caused by a tongue anomaly and a tongue habit. At birth, she had flexion contracture of both fingers, equinus deformity of both feet, slight abduction disturbance of the right hip joint and a tongue anomaly, in which the tongue was shaped like a cylinder. There were five similar cases of tongue anomaly within her family, whereas no other case had bone or joint disorders. The diagnosis of this case was distal arthrogryposis syndrome type II. The width of the maxillary dentition was decreased. The length of the maxillary and mandibular dentition was increased. The patient had an articulation disorder, evaluated as fricative alveolar/s, z/, but she articulated single sounds almost clearly. She had no difficulty in everyday conversation. To manage her tongue habit, she uses a tongue-guard while asleep.

Ｏｓｓｅｏｉｎｔｅｇｒａｔｅｄ ｉｍｐｌａｎｔの顎顔面領域への応用 第４報： 眼か内容摘出術に伴う広範囲上顎骨欠損の１症例

Wide defects of the maxilla due to maxillary malignant tumors cause functional and esthetic disorders. To treat these disorders we designed a maxillary obturator prosthesis and an orbital epithesis using osseointegrated implants.In conclusion, osseointegrated implants were useful for the maxillary obturator prothesis and orbital epithesis in a patient with a wide defect of the maxilla associated with orbital exenteration. As the patient had previously undergone irradiation, hyperbaric oxygen therapy to induce osseointegration done pre-and post-operatively to facilitate fixture installation.