Aesthetic Lines Research Articles

Analysis of maxillary teeth and soft tissue profiles among Tibetan and Han Chinese females with facial symmetry for orthodontic treatment planning.

The evaluation of maxillary teeth and soft tissue profiles is a critical component of orthodontic diagnosis and treatment planning. This study aimed to evaluate the correlation between the sagittal position of maxillary anterior teeth and facial profile esthetics among Tibetan and Han Chinese adult females for optimizing orthodontic diagnosis and treatment planning. A total of 100 Tibetan Chinese and 100 Han Chinese adult females with good facial symmetry were recruited. The smiling facial profile images with the maxillary central incisors and forehead in full view were taken based totally on the same standard. The photo measurement and head position were adjusted using the picture-enhancing software. The reference traces associated with forehead inclinations were utilized to assess the anteroposterior (AP) positions of the maxillary central incisors. The results showed that a round forehead was the dominant forehead shape for Tibetan (93%) and Han (55%) Chinese females. In Tibetan females, 85% of the maxillary central incisors were found to be located between the forehead's anterior limit line (the Gall line) and the goal anterior limit line (the Fall line), with 15% located posterior to the Fall line. This distribution manifested a strong association with incisor position and forehead inclination (R2 = 0.742). In Han females, 83% of the maxillary central incisors were located between the Fall line and the Gall line, with 12% posterior to the Fall line and 5% anterior to the Gall line. The positions of the maxillary central incisors exhibited a strong relationship with forehead inclination (R2 = 0.827). The maxillary central incisors were close to the aesthetic line in both ethnic groups, while forehead inclinations were correlated with AP maxillary incisor position. These findings demonstrated that there was a close relationship between the incisor position of Tibetan and Han females with facial symmetry and the forehead FFA factor, indicating a reference in oral hard and soft tissues for optimizing orthodontic diagnosis and treatment planning in terms of facial contour.

Hybrid Dorsal Preservation Rhinoplasty: Reediting an Aesthetic Dorsum.

The prerequisite of a well-shaped dorsum with proper dorsal aesthetic lines that needs no modifications in its width and symmetry is key to letdown and push-down techniques as classically described. The common current concept is that total preservation of the middle vault is obligatory. This, however, obviously limits the indications, since nasal dorsum with natural aesthetic dorsal lines per se is relatively few. The recent, impressive, revival of letdown and push-down procedures has progressively generated numerous technical variations, but all those essentially still left the middle vault unmodified. The concept of splitting the middle vault and modifying its width and symmetry, while leaving the crucial dorsal (central) and lateral Keystone area intact, represents a new hybrid approach to the nasal dorsum. The structural benefits of classical component separation are combined with the major advantage of preserving the flexible chondro-osseous joint at the keystone junction. Osteotomies and/or osteoplasty can be done as necessary to modify the bony dorsum and at the same time any type of septal deformity can be addressed according to the time-tested L-strut principle, a Cottle septoplasty included. This hybrid approach expands indications beyond those of the conventional push-down/letdown technique, including moderate asymmetries of the bony and cartilaginous dorsum. Although splitting the middle vault along the septal T will also facilitate middle vault reshaping in cases where a full letdown procedure is indicated, this paper will clarity address only those instances where no circumferential osteotomy is done. The dorsal bony nasal pyramid is always addressed first by rhinosculpture (osteoplasty) with piezoelectric inserts and/or burrs, in combination with different types of osteotomies as needed. This will allow narrowing of the bridge and correction of bony asymmetries. The osseous-cartilaginous connection of the central dorsal keystone area (DKA) is totally preserved. At this point, three main variations are possible: Type 1) preservation of the septal T and push-down by a high-middle septal strip resection, two different variations (1A and 1B) are possible here, Type 2) reduction in width of the septal T-segment and middle vault restoration by spreader flaps without any push-down of the septal T and Type 3) preservation of the septal T and letdown by low strip resection. Hybrid Dorsal Preservation involves concepts of Structure and Preservation Rhinoplasty. Dorsal and lateral keystone area are preserved, and the middle vault could be modified splitting the septal T in the anatomical plane, expanding patient indications and improve outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Osteotomy Techniques in Preservation Rhinoplasty with an Analysis of a Radix-Skull Base Computed Tomography Series.

This study aims to explain our experience with dorsal preservation osteotomies, focusing on transverse, lateral, and dorsal aesthetic lines (DAL) osteotomies. We describe the utilization of a variety of surgical instruments, including osteotomes, saws, burrs, and piezo. This paper describes our concept of transcutaneous ultrasonic osteotomy, microedged-specific osteotomy, applying drills for lateral wall reshaping, and integrating piezo technology to establish new DAL. Furthermore, we present a radix-skull base computed tomography series analysis to evaluate the safety of transverse and radix osteotomies.

Crowdsourced Assessment of Aesthetic Outcomes of Dorsal Preservation Rhinoplasty

Abstract Goals/Purpose The inherent subjectivity in evaluating aesthetic outcomes presents a unique challenge in assessing rhinoplasty. Crowdsourcing has provided a new metric for objective analysis. The authors designed a study to compare the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We aim to objectively quantify the relative aesthetic advantages of performing a dorsal preservation technique. Additionally, we aim to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome. Methods/Technique This retrospective observational study was approved by the IRB at UCLA. A total of 64 patients who had previously undergone rhinoplasty performed by the senior author were included. All surgeries were performed at the UCLA Ronald Reagan Medical Center. Patients with prior nasal surgery or trauma were excluded. All subjects were photographed using standard rhinoplasty views during the pre-and postoperative visits. Frontal and right profile photographs were then cropped in a standardized fashion (Photos, Version 8.0, Apple Inc.) and used for evaluation. All evaluations and ratings were collected using the HIPPA compliant and encrypted software via a secure online platform (LoveMyDelta, Inc., Philadelphia, PA). All crowd workers were recruited and vetted through this platform, with internal fidelity checks performed. Each crowd worker was shown a profile and frontal view of a patient and asked to score the overall appearance of the nose, the nasal dorsum profile, the symmetry of the dorsal aesthetic lines, and the dorsal contour using a visual analog scale. Scoring was performed using a provided validated visual assessment guide. They were asked whether they believed the subject had undergone rhinoplasty and asked to provide a level of confidence in their guess. Crowdworkers’ responses were aggregated to allow for high-powered intra-rater analysis. Intra-rater reliability and confidence intervals were calculated. Aggregate data from all raters were used to generate an absolute value of aesthetic state for each cohort. A "delta" was then obtained for each value by comparing the preoperative to the postoperative state to obtain a representative value of the improvement after undergoing surgery. Raters were asked if the patient appeared to have had surgery, and each correct and incorrect response was proportionally weighted based on the raters' confidence in their answer. The delta (difference in preoperative to postoperative aesthetic state) for each parameter for the dorsal and non-dorsal preservation cohorts was calculated using non-paired T-tests to determine significance. Results/Complications A total of 64 patients were included for evaluation. The structural rhinoplasty cohort consisted of 34 patients. The dorsal preservation cohort included 30 patients. Both dorsal preservation and non-dorsal preservation rhinoplasty cohorts were associated with improved overall crowdsourced aesthetic outcomes and improved outcomes across all subparameters. Overall, delta (d) improved in both dorsal preservation (0.300, 95% CI +/- 0.047) and structural (0.377, 95% CI +/- 0.055) cohorts. When raters were asked to predict whether a patient had surgery, the correlation coefficient between the confidence in the prediction and that prediction being correct was 0.74 (95% CI +/- 0.47 in the structural group, suggesting that a crowd worker was likely to be correct in identifying whether a patient had structural rhinoplasty. However, the correlation coefficient was -0.0554 (95% CI +/- 0.058) in the dorsal preservation group. This suggests the raters were unable to consistently identify which patients had dorsal preservation rhinoplasty with any confidence. Conclusion In the ongoing challenge to achieve better aesthetic outcomes in plastic surgery, crowdsourcing is a valuable tool for helping to measure these outcomes. We compared the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We found that significant improvements in overall aesthetic outcomes were achieved with both techniques, while a more natural “unoperated” outcome was achieved when performing a dorsal preservation technique. With this type of study and assessment tool, we helped to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome.

Evaluation of the External Soft Tissue Changes Following the Correction of Class II Skeletal Malocclusion in the Adolescence Period Using Removable and Fixed Functional Appliances: A Systematic Review and Meta-Analysis.

In this systematic review, we aimed to assess the current evidence regarding the effectiveness of functional treatment with both removable and fixed appliances to normalize the external soft tissue for skeletal class II adolescent individuals. We performed a broad electronic search to retrieve relevant studies from nine databases to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that investigated soft tissue changes following functional treatment and evaluated the changes using 2D lateral cephalometric radiographsand 3D-optical surface laser scanning. A total of three RCTs and eight CCTs were included. Ages ranged from 11 to 16 years with the fixed functional appliances, and from eight to 12 years with the removable ones, including 689 skeletal class II patients. Version 2 of Cochran's risk-of-bias (RoB2), and the risk of bias in non-randomized studies of interventions (ROBIN-I) were used to assess the risk of bias for the included papers. Of the 11 eligible studies, three studies were included in the meta-analysis to assess the upper and lower lip position in relation to the E-line (Ricketts's aesthetic line) in addition to the nasolabial angle. The meta-analysis showed that the upper lip retracted after functional treatment with Twin-block in relation to E-line (mean difference (MD) = -1.93; 95% CI: -2.37, -1.50; p < 0.00001; χ² = 5.43; p = 0.07; I2 = 63%), while the lower lip position did not change after functional treatment with Twin-block in relation to E-line (MD = 0.03; 95% CI: -0.56, 0.61; p = 0.92; χ² = 1.74; p = 0.42; I2 = 0%). The nasolabial angle increased after Twin-block treatment (MD = 5.75; 95% CI: 4.57, 6.93;p < 0.00001; χ² = 6.77; p = 0.03; I2 = 70%). The mentolabial angle and Z-angle also increased after functional therapy, where the facial convexity angle decreased, regardless of the functional devices used. On the other hand, using the 3D-optical surface laser scanning showed that the upper lip length and the commissural width did not change following therapy, but the lower lip increased in length, as well as the total face height. More high-quality RCTs are required to obtain accurate evidence in this field.

Comparative Evaluation of Horizontal Lip Position With Ricketts Esthetic Plane in Preschool and School-Going Children of Bankura, West Bengal: A Craniofacial Anthropometric Study.

Introduction The horizontal lip position and esthetic plane are two important parameters to define facial beauty, and these factors are always given importance in children undergoing fixed orthodontic therapy. The purpose of this study was to evaluate horizontal lip position in primary and mixed dentition children with class I occlusion and to analyze its association with gender among preschool and schoolchildren of villages in the Bankura district in West Bengal. Materials and methods Researchers screened 437 children for the study and selected those who met the inclusion criteria. A total of 407 children were segregated: 201 children aged three to five years with the flush terminal plane and mesial step in primary teeth and 206 children aged seven to eleven years with class I occlusion in mixed dentition were selected from schools in villages in Bankura district, West Bengal, India. The subjects were instructed to hold the head in the natural head position by looking straight, and points were marked on the nose and chin tip, respectively. A metallic ruler was placed from nose to chin, representing Rickett's esthetic line. The horizontal lip distance to the esthetic plane of both upper and lower lips was measured as a linear distance from the most anterior part of the lip to the metallic ruler. The data were recorded, compared with gender, and statistically analyzed using the Chi-square test using the Statistical Package of Social Sciences software (SPSS version 19.0, 2015, IBM Corp., Armonk, NY). Results The most prevalent horizontal lip distance for both upper and lower lips to the esthetic line for primary and mixed dentition in the Bankura region of West Bengal was category I, where the lip is seen beyond the E plane, followed by category II, where lips are at a horizontal distance in the range of 0-1.5 mm from the esthetic line. A significant correlation of lip position with Rickets aesthetic plane was also illustrious with gender in primary dentition, but a non-significant association with gender was noted in mixed dentition. Conclusion Children with class I occlusion from the Bankura district of West Bengal showed a higher percentage of lip position beyond the esthetic plane in both primary and mixed dentition, which is not in line with the inference of Ricketts's studies on the Caucasian population. There is a definite association between gender and horizontal lip distance in Ricketts esthetic plane. Protrusive upper lips were seen more in males, and retrusive lips were seen more in females. Clinical significance The horizontal lip position with reference to Ricketts esthetic plane has been documented in the literature for adults and teens undergoing fixed orthodontic treatment. However, there is no study done to define these measurements in preschool and school-going children, which can assist in determining future esthetic profiles and in preparing a protocol for early age interceptive orthodontics along with aesthetic rehabilitation of the anterior area of the mouth.

Порівняльна оцінка профілометричних показників нижньої частини обличчя у дорослих пацієнтів з вродженими незрощеннями верхньої губи і піднебіння до і після ортопедичного лікування

Topicality. Despite the search for diverse options for medical and social care for people with congenital cleft upper lip and palate after surgical interventions in adulthood, there are still problems related to the specifics of orthopedic treatment for such patients that need to be resolved. An important criterion for evaluating the effectiveness and success of treatment of patients with congenital cleft upper lip and palate is the improvement of their quality of life in the process of complex rehabilitation. One of the possible options for improving the quality of life of such patients and their social adaptation is orthopedic rehabilitation using numerous options for orthopedic designs of dentures, which reproduce both functional and, in part, aesthetic capabilities. The aim of the study. To conduct a comparative assessment of the presence of facial profile aesthetics before and after orthopedic rehabilitation of patients with congenital cleft upper lip and palate after surgical interventions. Materials and methods. A comparative assessment of the aesthetics of the face profile before and after orthopedic rehabilitation of 37 patients aged 17 to 42 years with congenital cleft upper lip and palate (CCULP) after surgical interventions was carried out. Researched: ratio in the area of the frontal height of the face (N-Sn-Gn), nasolabial angle (C-Sn-UL), conducted lip analysis according to Ricketts, as well as the angle between the line that passed through points (N-Pog’) and Ricketts’ line (aesthetic line) and profile concavity angle (G-An-Pog’) before and after orthopedic treatment as a percentage of these indexes. Conclusion. The analysis of the parameters of the profile of the lower part of the face, in particular the parameters of the lips according to Ricketts and the nasolabial angle, testify that as a result of orthopedic rehabilitation of patients with CCULP, regardless of the type of nonunion, both fixed and removable (combined) prosthetics, the profile of the lower part of the face improved significantly, which affected aesthetic parameters of the face. Key words: congenital cleft lip and palate, maxillofacial anomalies, defects and deformities of the maxillofacial system, orthopedic rehabilitation of adult patients, orthopedic structures, photostatic analysis of the face profile.

Biopolitica, anatomía, y dolor social

This article reflects on the ways of representing Picasso’s human anatomy in relation to the biopolitical and, above all, thanatopolitical development of fascism during the 1930s and 1940s in Spain and Europe, according to the theoretical proposals of Arendt, Foucault and Esposito. To this end, we have chosen three works: Guernica (1937), Woman Weeping (1937) and The Ossuary (1945), which make up the Malaga painter’s analytical and aesthetic line around his process of deconstructing the human anatomy from a Cubist viewpoint, but, from 1937, with a clearly vindictive function, of international struggle and denunciation against fascism. On the other hand, we have attempted to approach these works by Picasso from the point of view of the plastic art of Grünewald, Bosch, Goya and, much more closely, the painting of the expressionist Otto Dix, that is to say, we have looked at the pictorial tradition that has dealt with the human body, pain and war, in order to establish possible threads linked to Picasso’s work. In this sense, our objective has been to analyze the relationship between totalitarian power and the ways of understanding the representation of the human body, deconstructed anatomy, monstrosity, and collective suffering through the different aesthetic interpretations of Pablo Picasso.

Nasal Osteotomies Revisited in Asians: Surface Aesthetics, Anatomical and Technical Considerations.

Background Although osteotomy is commonly performed in rhinoplasty, it is difficult for less experienced surgeon to understand mechanism of the procedure. The primary goal of this study is to improve understanding of nasal osteotomy in Asians by considering the surface aesthetics and anatomy of the nose as well as their relationships with the surgical procedure. Methods Surface aesthetics, anatomic considerations, kinetics of medial and lateral osteotomy, fracture levels of osteotomy were discussed in detail by reviewing the previous publications and 18 years of our experience. Moreover, the technical details of osteotomy were explained and personal tips for performing successful osteotomy were described. Results Dorsal and lateral aesthetic lines, dorsal and basal widths are main characteristics related to the surface aesthetics of nose to perform the osteotomy. In addition, these features are different in Asian population due to the anatomic difference with Caucasians, which makes the procedure difficult and requires more attention to perform osteotomy. Conclusion Because osteotomy is one of the most traumatic and invasive part of the rhinoplasty, it is crucial for the rhinoplasty surgeon to understand the relationship between surface aesthetics and osteotomy techniques to produce consistent and reproducible results.

Photogrammetric and Cephalometric Analyses of Ricketts' Esthetic Line in Malaysian Malay Adults: A Cross-sectional Study

Objective: To compare and correlate the Ricketts Esthetic Line measurement between photographs and lateral cephalogram. The norm for evaluating Ricketts' E-Line in the Malaysian Malay population is to be established. Materials and Methods: This was a cross-sectional study involving 126 pre-existing photographs and lateral cephalometric radiographs of skeletal Class I Malaysian Malay aged 19 to 40 recruited from the Orthodontic Clinic of Universiti Teknologi MARA (UiTM). Photogrammetric and cephalometric analyses of the upper and lower lips to Ricketts' E-line were performed. A paired t-test was performed to determine any statistically significant difference between the photographic and cephalometric variables. In addition, Pearson correlation was conducted to estimate the correlations between the photographic and cephalometric variables. Results: There was no significant difference between photographs and lateral cephalogram methods in the upper and lower lip to E-line measurement (p&gt;0.05). For the photogrammetric analysis, the distance from the upper lip to the E-line was -0.30mm ±2.46, whereas the cephalometric analysis was -0.43mm ±2.63. The lower lip distance to the E-line for the photogrammetric analysis was 1.44mm ±2.8, whereas the cephalometric analysis was 1.24mm ±3.08. The Pearson correlation coefficient (r) for photographs and lateral cephalometric variables was close to 1 (0.914 and 0.898, respectively), indicating a robust positive correlation between the two variables. Conclusions: Photographic and cephalometric analysis can be used synonymously in measuring the Ricketts E line. Malaysian Malay has a more protrusive upper and lower lip to the E-line, compared to Caucasians, and the norm for the investigated population was established.

Aesthetic and Functional Consequences of Spreader Graft without Suturing To the Upper Lateral Nasal Cartilage: A Randomized Double-Blinded Clinical Trial.

Considering the importance of the spreader graft technique in order to prevent collapse and airway retention and the importance of its effect on the dorsal aesthetic line and nasal width, in this study we compared the outcome of suturing spreader graft to septum _upper lateral cartilageas the classic technique to suturing spreader graft only to septum. This comparative observational study was conducted on 50 consecutive patients referred to Rhinoplasty Department in 15 khordad Hospital from 2019 - 2020 . The study participants were randomly assigned into two groups which scheduling the new spreader graft technique without suturing the upper lateral cartilage (n = 25) or the frequent spreader graft technique with suturing to both septum and upper lateral nasal cartilage (n = 25). The nasal obstruction degree, the status and health-related quality of life, patients' satisfaction, and subjective mental image of the nasal structure were the study endpoint. The patients were followed-up for six months. The two groups were matched for gender and age. Although all study endpoints significantly improved in both groups, but the six-month trend of the change in each parameter was different in the two groups with superior improvement in those who planned for spreader graft technique without suturing the upper lateral cartilage. In patients scheduling for selective rhinoplasty, new procedural technique including spreader graft without suturing to upper lateral cartilage can lead to more postoperative favorable outcome with regard to patients' satisfaction of the procedure, lack of obstructive symptoms, aesthetic feature, and health-related quality of life as compared to suturing to both septum and upper lateral cartilage.

Efficiency of Middle Vault Reconstruction with Dorsal Septal T Flap in Achieving Ideal Dorsal Aesthetic Lines and Regularity.

Dorsal aesthetic lines and irregularities are the most critical points that can be manipulated in rhinoplasty operations. Although spreader grafts and flaps have been used for this purpose in the reconstruction of the keystone area for a long time, dorsal irregularity is often inevitable. This study aims to evaluate the effectiveness of dorsal septal T flap and nasal dorsum reconstruction in achieving ideal dorsal aesthetic lines and regularity. Thirty-four patients (30 women, 4 men) who underwent closed technique rhinoplasty between 2019 and 2021 were included in the study. The mean age of the patients was 25.4 years. Patients with crooked nose, severe deviation, and severe dorsal hump were also excluded. All patients included in the study underwent Rhinoplasty Outcome Evaluation (ROE) questionnaires preoperative and postoperative 1st year. The mean age of the patients was 25.4 years (range 18-40years). A total of 34 patients, including 30 women and four men, were operated. The mean follow-up period was 13.2 months, ranging from 12 to 14months. In the physical examinations performed at the control visits, no functional problem was encountered in any patients. Preoperative and postoperative mean ROE scores were 60.9 and 92.7, respectively. With the technique described in the study, dorsal hump recurrence is minimized compared to other preservation techniques. Since the keystone area transition can be fine-tuned, continuity is ensured, and ideal dorsal aesthetic lines are created. The stability of the upper lateral cartilages is provided, thus eliminating the need for spreader grafts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Occlusal Plane Steepness and Profile Change Following TAD-Based One-Step Retraction on Four-Unit Extraction Cases: A Retrospective Study.

With the introduction of high-tech appliances, anchorage devices, and improved patient awareness of the risks associated with maxillofacial surgery, treating complex situations with orthodontic treatment has become more difficult in recent years. This study was conducted to demonstrate that orienting the occlusal plane, all the dental, skeletal, and soft tissue parameters, would be improved and to find which of these parameters could be correlated with the steepness of the occlusal plane. This was a retrospective study including 40 cephalometric interpretations for patients who were planned for four-unit extractions (20 cephalometric radiographies before treatment and 20 after finishing the treatment). All were treated in the same orthodontic clinic with the same protocol using the McLaughlin-Bennett-Trevisi (MBT) prescription, with 22 slots and one-step retraction following four-unit extraction based on temporary anchorage devices (TADs). There was no significant change in the canting of the occlusal plane, and it remained relatively stable from 6.31° to 7.55°, while all the soft tissue-related cephalometric measurements were reduced significantly, except the nasolabial angle, as the relation of the upper and lower lip to the esthetic line of Ricketts' (E-Line) was reduced by 2.91 and 2.46°, respectively; furthermore, the angle of convexity was reduced from 10.92° to 9.79°. Besides, the upper incisor display was reduced by 0.38° Conclusions: Both the Frankfort mandibular angle and upper-incisor-to-Frankfort horizontal plane were significant parametric factors associated with profile change after extraction treatment having a positive 0.01-level Pearson association with occlusal plane steepness. Therefore, using the MBT prescription with TAD-based retraction is one of the favorable methods for the management of complex cases.

GEOPOETICS OF THE ART NOUVEAU ERA: SOUTHERN ITALY THROUGH THE EYES OF RUSSIAN AUTHORS OF THE LATE 19TH - EARLY 20TH CENTURY

The article dwells on the semantically integral system of Southern Italy Russian reception in the heyday of Belle époque. Its connection with the European context dating back to Goethe and purely national features are shown. Based on Berdyaev’s relevant texts, the imagological constants of the Silver Age ‘Russian Italy’ are reconstructed. Three different models of it are demonstrated, opposing the aesthetic line of Italy reflection in the mirrors of the arts, embodied by P.P. Muratov (Images of Italy, 1912): in the works of D.S. Merezhkovsky, M.A. Osorgin and I.A. Bunin. It is proved that they are united by an unexpected in the depiction of the bright Italian South antirhetoric, expressive asceticism, opposition to decorative redundancy and polemic in relation to the romantic apology of the ‘Mediterranean Arcadia’. In the case of Merezhkovsky, this even laid the foundation for a special potential type of alternative poetics, which could but never managed to reach the center of the writer’s artistic system.

Common Dorsal Flaws Following Preservation Rhinoplasty: A Systemic Analysis.

There has recently been a resurgence of interest in preservation rhinoplasty (PR) for dorsal hump elimination or dorsal projection reduction. However, no studies have scrutinized aesthetic outcomes to identify common pattern of flaws seen in published images to aid those with ardent enthusiasm for this technique to become aware of the frequency of these flaws and find ways to reduce imperfections. A systematic literature review was performed using search terms ("preservation" OR "let down", "push down") AND "rhinoplasty" on PubMed, Cochrane, SCOPUS, and EMBASE databases for studies between January 2000 and December 2022. Patient images from these studies were analyzed by three reviewers (MWW, IAC, and BG) for dorsal flaws. Raw interrater agreement percentage and Krippendorff's alpha were calculated to determine interrater reliability. A descriptive and comparative analysis with Fisher's exact test was performed for the aggregate data. There were 59 patient images with 464 views from 24 studies included for final analysis. Optimal dorsal aesthetic lines (DAL) were noted in 12 patients (20.3%), while optimal profile was observed in 15 patients (25.4%) (p=0.66). Combined ideal front and profile view of dorsum was not observed on any patients. The most common flaws were DAL irregularities (n=45; 78.0%), dorsal deviation (n=32, 54.2%), and residual hump (n=25, 42.4%). There was excellent interrater agreement. While PR may have some advantages, it has shortcomings in outcomes, particularly dorsal irregularities, dorsal deviation, and residual humps. Awareness of these imperfections may compel those performing this procedure to modify their techniques and improve their results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Exploring the Resurgence of the Preservation Rhinoplasty: A Systematic Literature Review.

The underlying principles of preservation rhinoplasty (PR) center around maintaining the soft tissue envelope, dorsum, and alar cartilage through surgical manipulations and tip suture techniques. In particular, the let-down (LD) and push-down (PD) techniques have been described, although reports of indications and outcomes in the literature are sparse. A systematic review of the literature was performed using search terms "preservation" OR "let down" OR "push down" AND "rhinoplasty" on PubMed, Cochrane, SCOPUS, and EMBASE databases. Patient demographic information, operative details, and surgical outcomes were recorded. Sub-cohorts for patients who underwent LD and PD techniques were analyzed utilizing Fischer's exact test for categorical variables and Student's t test for continuous variables. Overall, there were 5967 PR patients in 30 studies in the final analysis, with 307 patients in the PD cohort and 529 patients in the LD cohort. The Rhinoplasty Outcome Evaluation Questionnaire showed a significant increase of patient satisfaction after PR compared to before PR (62.13 vs 91.14; p < 0.001). There was a significantly lower rate of residual dorsal hump or recurrence of 1.3% (n = 4) in the PD when compared to 4.6% (n = 23) in LD cohorts (p = 0.02). The revision rate of PD (0%, n = 0) was also significantly lower than that of LD (5.0%, n = 25) (p < 0.001). Based on these published articles, it seems that preservation rhinoplasty is safe and efficacious procedure with improved dorsal aesthetic lines, reduced dorsal contour irregularities, and claimed excellent patient satisfaction. In particular, the PD technique has fewer reported complications and revisions than LD approach, although PD is often indicated in patients with smaller dorsal humps. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Perception of laypersons, orthodontists, and oral and maxillofacial surgeons about the transverse occlusal plane

Transverse occlusal plane (TOP) should be parallel to the true horizontal lines of the face (ie, the interpupillary line [IP] and commissural line [CL]). This study aimed to investigate the opinions of laypersons, orthodontists, and oral and maxillofacial surgeons about the impact of imbalanced IP and CL on facial attractiveness. We used a symmetrical face image as the reference. Then, using Photoshop software, we constructed the following 6 photographs: TOP roll relative to CL and IP (3° and 6°) with parallelism of CL and IP, CL roll relative to TOP and IP (3° and 6°) with parallelism of TOP and IP, TOP and CL roll relative to IP (3° and 6°). Consequently, the participants rated the photographs on the basis of their attractiveness. Kruskal-Wallis and Mann-Whitney U tests were used to compare the ratings. One hundred thirty-one laypersons, 22 orthodontists, and 20 surgeons participated in this study. It was found that 51.1% of laypersons, 86.4% of orthodontists, and 70% of surgeons selected the reference photograph as the most beautiful, followed by the photograph with a 3° roll of CL relative to TOP, with parallelism of TOP and IP (29% of laypersons, 31.8% of orthodontists, and 35% of surgeons). Most participants selected the reference photograph as the most beautiful and realized a roll in the horizontal planes up to 3°. The parallelism of the esthetic line of dentition relative to interpupillary is preferred over its parallelism relative to CL.

Cephalometric Norms in Sudanese Sample: A Pilot Study

Aims: In this study, cephalometric norms for Sudanese with class I normal occlusion were introduced, and the results were compared to those from other studies in various populations. Materials and Methods: 29 cephalographs with ages ranging from 18 to 25 made up the sample. The selection criteria were met by all competitors. After that, cephalometric findings were compared to earlier findings from research among reported Arabs, as well as research among Oriental and Black races. Results: When compared to Caucasian cephalometric norms, Sudanese showed greater mean values of the sagittal and vertical relationships. The inter-incisal angle decreased, and the upper and lower incisors were proclined in reference to their dental bases. The soft tissue variables show that the nasolabial angle was less acute and that the lips were slightly protruding in relation to Rickett's esthetic line. Black and Oriental races, as well as Arab populations possessed bimaxillary proclination and protrusion of the upper and lower incisors, whereas Caucasians had retrusive dentition. Conclusion: Due to the small sample size, drawing a firm conclusion is challenging. Therefore, it is advised to use large sample sizes for both sexes in order to establish cephalometric norms, which will be very beneficial to not only orthodontists but also oral and maxillofacial surgeons, as well as pedodontist.

Functional and Aesthetic Outcomes of No-Dissection Nasal Dorsum Using Subdorsal Septal Excision in Preservation Rhinoplasty.

Dorsal preservation (DP) caused privilege change in the concept of rhinoplasty and a promising superior functional and aesthetic transformation in rhinoplasty surgery. Avoiding dissection of the dorsal nasal bone and cartilage will leave the soft-tissue envelope intact, leading to a fine and smooth appearance, faster operation with less subsequent edema, and overall preservation of the dorsal aesthetic line. This prospective study included 113 patients who underwent DP rhinoplasty for nasal hump treatment with minimum dissection of nasal dorsum soft-tissue envelope. Results were evaluated using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). The mean preoperative SCHNOS score was 7.21; the mean obstructive score was 2.95 ± 1.068 and the mean aesthetic score was 4.27 ± 0.771. The average lowering of the dorsal hump was 4.4 mm. Approximately 96% of patients showed improvement in the SCHNOS score after surgery, 86.7% (98 patients) showed improvement in the obstructive symptoms and 95.6% (108 patients) showed improvement in the aesthetic score. Complications were seen in 22.11% (most commonly residual hump in 13.27% of cases and dorsal indentation in 5.31%), bleeding was seen in 2.65%, and granuloma formation at the dorsal osteotomy site was seen in 0.88%. There was a very significant improvement in the aesthetic, obstructive, and overall SCHNOS score ( P = 0.000) for each parameter. DP rhinoplasty is a safe and very effective procedure, with very low risk of complications. Most of the treated patients have improvement of the obstructive and aesthetic outcome after surgery. Therapeutic, IV.

Go Micro Aesthetics: A Cross-Sectional Study to Assess Anterior Hard and Soft Tissue Parameters in Young Adults of Bhopal City.

Background In the maxillary aesthetic zone, the symmetry and proportions of hard and soft dental tissue play a crucial role. A dental practitioner should have a thorough knowledge of parameters such as crown length (CL), crown width (CW), zenith point, and gingival angle (GA) to perform teeth restorations. This study aims to assess the anterior hard and soft tissue parameters and determine the crown shape and its correlation with the gingival parameters of young adults' anterior teeth. Methods In the study, 110 patients were assessed and divided into two groups: Group I with 55 females and Group II with 55 males. Using a calibrated vernier caliper, the following parameters were calculated: crown width (CW)/crown length (CL) ratio, gingival angle (GA), distance from the lateral incisor (LI) to the gingival aesthetic line (GAL), interdental papilla height (PH) between the two central incisors (CI), distance between the central incisor (CI) and the lateral incisor (LI), and distance between LI and canine. Results Statistical analysis of data was performed using the independent samples t-test (P<0.05). The mean value of CW, CL, CW/CL ratio, and GA, along with the distance from LIs to GALs and PHs of the anterior teeth, were lower in females than in males. The correlation between the GA and the CW/CL ratio indicated that higher GAs and CW/CL ratios give teeth a square appearance. Moreover, a lower GA and CW/CL ratio will make teeth appear round ornarrow. Conclusion The present study concluded that the mean values of hard and soft dental tissue parameters are higher in males than in females. These values can be used to restore functional aesthetics in accordance with the results of a local population and could help form restorative, aesthetic, and cosmetic procedures while maintaining focus on the size and shape of teeth and the level of gingiva at various significant treatment stages.