Aesthetic Results In Patients Research Articles

OP191: Robot-assisted modified radical neck dissection via a retroauricular or modified face lift approach in clinically N+ head and neck cancer: A comparative study with the conventional transcervical neck dissection

Purpose In our feasibility study of robot-assisted neck dissection (RAND), we limited the indication for elective neck dissection (ND) in clinical N0 head and neck cancer. With growing experiences of RAND, we saw potential for therapeutic RAND in positive neck without extracapsular spread (ECS). In this study, we aim to compare the results of therapeutic RAND via a retroauricular (RA) or modified face-lift (MFL) approach with conventional transcervical ND in head and neck cancer. Materials and methods This study involved a total of 53 patients who underwent therapeutic ND for head and neck cancer at the department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea, from May 2010 to July 2012. Patients themselves decided whether the RAND or the conventional open ND would be performed for the treatment of neck metastasis with the information of the advantages and the disadvantages of both procedures. The following variables were assessed: age, gender, body mass index, primary site, TNM stage, operative parameters, pathologic parameters, perioperative complications, and satisfaction of scar. Results The RAND group consisted of 17 males and three females, with a median age of 62.5 years. The conventional ND group consisted of 30 males and three females, with a median age of 63.0 years. The mean operation time for ND of the RAND group was longer than that of the conventional ND group (186 ± 37 vs 150 ± 23) (p = 0.000). The mean number of retrieved lymph nodes in the RAND group (41.60 ± 12.47) showed no significant difference from that in the conventional ND group (44.39 ± 14.35) (p = 0.474). There were no significant differences in the development of postoperative complications between the RAND group and the conventional ND group. The score of satisfaction scar was significantly higher in the RAND group than in the conventional ND group (p = 0.023). The median follow-up periods were 8.0 month in the RAND group and 9.3 month in the conventional ND group. Conclusions Therapeutic RAND via a RA or MFL approach was feasible and successful, with satisfactory aesthetic results in patients with N+ head and neck cancer. This RAND technique via a RA or MFL approach may be applied to the selected cases by an experienced surgeon.

A Modified Surgical Method of Lower-Face Recontouring

In general, the width of the lower face is determined by four parts: the mandible, the masseter muscle, the buccal fat pad, and the subcutaneous fat. In this article, we introduce a modified surgical method to reshape the outline of round faces that have no significant overgrowth or eversion of the lower jawbone. The procedure includes dissection of the masseter muscle and partial lipectomy of the buccal fat pad through the same intraoral small incision. The patients were satisfied with the aesthetic outcome of both the profile and frontal view. Follow-up of more than 6months shows no prospective complications. This method yields an optimal aesthetic result in patients who have a round face without significant overgrowth or eversion of the lower jawbone. 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 .

Odległe wyniki estetyczne chirurgicznego leczenia wrodzonych zniekształceń nosa – porównanie oceny pacjenta i chirurga

IntroductionNose as the most projected face structure focuses the biggest people's attention. Nasal localization causes that even its small deformities are visible and subjected to different opinions. Rhinoplasty is one of the most common procedures in plastic surgery and at the same time one of the most difficult operation in facial surgery.The aim of this research is to analyze the long-term aesthetic results of rhinoplasty in congenital nose deformities in evaluation performed by surgeon and patient. Material and methodThe study was carried out in the group of 50 patients operated on in the Department of Plastic, Reconstructive and Aesthetic Surgery due to congenital nose deformity. The group consisted of 38 women and 12 men, aged from 27 to 56 years. Long-term aesthetic results’ evaluation was performed on the basis of clinical examination done by doctor and questionnaire filled in by patients and surgeon. ResultsEvaluation of long-term results after aesthetic rhinoplasty in patients’ opinion qualified the effects as very good in 70%. In surgeon's opinion such a result was obtained in 62% of patients. Satisfactory result of performed operation was marked by 92% of patients while surgeon qualified results as a satisfactory in the group of 88%. Reoperation was considered by 12% of patients and doctor such a necessity reflected in 10%. ConclusionsSatisfactory results of rhinoplasty in congenital nose deformities are possible to obtain while taking the degree and type of deformity into consideration and choosing proper surgical method. Surgical procedures in congenital nose deformities give good aesthetic results in patients’ and as well as surgeon's opinions. Doctor evaluates surgical results in more critical way.

Aesthetic Outcome in Patients after Polymethyl-Methacrylate (PMMA) Cranioplasty: A Questionnaire-Based Single Center Study

Aesthetic Outcome in Patients after Polymethyl-Methacrylate (PMMA) Cranioplasty: A Questionnaire-Based Single Center Study

Analysis of 3D Soft Tissue Changes After 1- and 2-Jaw Orthognathic Surgery in Mandibular Prognathism Patients

Orthognathic surgery has the objective of altering facial balance to achieve esthetic results in patients who have severe disharmony of the jaws. The purpose was to quantify the soft tissue changes after orthognathic surgery, as well as to assess the differences in 3D soft tissue changes in the middle and lower third of the face between the 1- and 2-jaw surgery groups, in mandibular prognathism patients. We assessed soft tissue changes of patients who have been diagnosed with mandibular prognathism and received either isolated mandibular surgery or bimaxillary surgery. The quantitative surface displacement was assessed by superimposing preoperative and postoperative volumetric images. An observer measured a surface-distance value that is shown as a contour line. Differences between the groups were determined by the Mann-Whitney U test. The Spearman correlation coefficient was used to evaluate a potential correlation between patients' surgical and cephalometric variables and soft tissue changes after orthognathic surgery in each group. There were significant differences in the middle third of the face between the 1- and 2-jaw surgery groups. Soft tissues in the lower third of the face changed in both surgery groups, but not significantly. The correlation patterns were more evident in the lower third of the face. The overall soft tissue changes of the midfacial area were more evident in the 2-jaw surgery group. In 2-jaw surgery, significant changes would be expected in the midfacial area, but caution should be exercised in patients who have a wide alar base.

Aesthetic outcome in patients after polymethyl-methacrylate (PMMA) cranioplasty — a questionnaire-based single-centre study

Objectives: Acquired skull deformities are common and most likely treated surgically by cranioplasty. Since data on patient aesthetic outcome after cranioplasty are rare in literature, we aimed to assess patient satisfaction after polymethyl-methacrylate (PMMA) cranioplasty in this study using a questionnaire.Methods: A patient questionnaire was developed to evaluate the grade of satisfaction after surgery. After approval by the institutional ethical review board, we were allowed to send to all 115 patients, who received a cranioplasty from 2001 to 2008 at the University Hospital of Zurich, our questionnaire once to retrospectively analyze the patient response together with the patient hospital records.Results: Out of 115 patients, 36 patients were lost to follow-up and our questionnaire was sent out once to 79 patients. Sixty-three of 79 patients replied to the questionnaire (79·7%) and 16 did not reply. Seventeen declined to participate in this study and out of the remaining 46 patients (58·2%, 18 women, mean age 54 years, range 20–83 years), who agreed to participate in this study, 22 (47·8%) judged their cranioplasty to be aesthetically ‘excellent’, 16 (34·8%) ‘favorable’ and 4 (8·7%) ‘poor’. Another four patients (8·7%) were not satisfied, asking for a surgical revision. Patient age and gender was not related to the assessment of the aesthetic result. A higher satisfaction grade was found in patients with primary PMMA cranioplasty compared to PMMA cranioplasty implanted during a second surgery (Fisher’s exact test, P = 0·031). A dent was strongly associated with absence of satisfaction (P<0·01, Fisher’s exact test).Conclusion: Our questionnaire was suitable to assess patient satisfaction after cranioplasty. Localization of cranioplasty showed to be an important factor of aesthetic outcome, especially in the fronto-temporal region where a carefully planned reconstruction should be performed to guarantee an excellent grade of satisfaction after surgery.

Evaluation of Clinical Outcomes and Aesthetic Results after Autologous Fat Grafting for Contour Deformities of the Reconstructed Breast

Autologous fat grafting is gaining widespread acceptance for the management of soft-tissue deformities of the reconstructed breast. However, published data on long-term outcomes and aesthetic results of fat grafting to the breast are lacking. The purpose of this study was to review the authors' early experience of fat grafting in the correction of acquired contour deformities after postmastectomy breast reconstruction. A detailed retrospective review of 49 patients who underwent fat grafting to 68 reconstructed breasts was carried out. Clinical outcomes were analyzed and aesthetic results were assessed with objective grading of preoperative and postoperative photographs by two independent, blinded plastic surgeons. On average, 67 cc of fat was injected into each breast per session. There were 111 fat injection procedures, as more than one injection was required in 51.5 percent of cases. Average follow-up time was 2.4 years. Complications occurred in 6.3 percent of procedures, including fat necrosis (3.6 percent), oil cysts (1.8 percent), and infection (0.9 percent). Aesthetic outcome was significantly improved across all measurements, including volume, contour, placement, and superomedial fullness (p<0.001 for all). Although further studies are required to provide surgeons with definitive guidelines for the implementation of this technique, fat injection is a safe intervention and significantly improves the aesthetic results in patients with contour deformities of the reconstructed breast. Therapeutic, IV.

Long-term Results of Autologous Periorbital Lipotransfer

To evaluate the long-term aesthetic results in patients treated with autologous periorbital lipotransfer. A retrospective review of 114 consecutive patients during 4 years who underwent autologous periorbital lipotransfer. Of these patients, 99 were identified who had complete photographic and medical records and were therefore included in the study. Patients were placed into 5 groups based on their total length of postoperative follow-up. Periorbital volume augmentation was assessed by 3 independent masked evaluators using a standard aesthetic scale from 0 to 2 (with 0 indicating no improvement; 1, mild improvement; and 2, marked improvement). Interobserver correlation was determined by κ correlation, and Mann-Whitney tests were used to assess for statistical significance comparing the same patients in each group. Scores from the 3 independent evaluators correlated well (κ = 0.316); aesthetic improvement was seen in almost all patients (86.4%), who had demonstrated improvement for the first 3 years of follow-up. The degree of improvement decreased each year, and only mild improvement was retained in most patients (68.2%) by the 3-year follow-up point (P = .049). Results from most patients who underwent autologous periorbital lipotransfer demonstrated improvement that lasted as long as 3 years. Autologous periorbital lipotransfer remains a valid and effective technique for periorbital rejuvenation and demonstrates long-term potential effectiveness.

Buttock Augmentation With Solid Silicone Implants

Buttock augmentation with solid silicone implants has become an increasingly popular procedure in the United States, but few outcomes studies have been undertaken to evaluate its safety and efficacy. The author examines the results of buttock augmentation with solid silicone implants in his private practice. A retrospective chart review was conducted of 200 consecutive patients who underwent bilateral buttock augmentation with a total of 400 solid silicone implants over an eight-year period from June 2001 through August 2009. Implants were placed in the subfascial position in 154 patients and in the intramuscular position in 46 patients. Most intramuscular implant placements occurred early in the series, before the author refined his technique. Data from all patients were analyzed to determine the rate of complication, need for surgical revision, and aesthetic outcome. Twenty-six men and 174 women were included in the study. The mean duration of follow-up was three years. The overall reoperation rate for these patients was 13% (n = 26). Seroma formation was the most common complication, occurring in 28% (n = 56) of patients. The infection rate was 6.5% for both subfascial and intramuscular implants (n = 13). The implant infection rate was 3.8% (15 of the 400 implants). Hematoma formation occurred in 2% (n = four) of patients. Wound dehiscence occurred in 1.5% (n = three) of patients. Capsular contracture was noted in 1% (n = two) of patients. Data showed that additional aesthetic procedures at the time of buttock augmentation did not affect the complication rate. In terms of patient satisfaction, patients with intramuscular implants complained more often about a lack of inferior gluteal fullness. Buttock augmentation with solid silicone implants is a safe and satisfying procedure for both patient and surgeon. The most common complication in this series was seroma formation, which was treated with serial aspiration in most cases. Gluteal implants were successfully placed in either the subfascial or intramuscular position with no significant difference in complication rate, but subfascial implant placement can produce better aesthetic results in patients requiring inferior gluteal fullness.

Improving Esthetic Results in Benign Parotid Surgery: Statistical Evaluation of Facelift Approach, Sternocleidomastoid Flap, and Superficial Musculoaponeurotic System Flap Application

The purpose of this article was to analyze the efficacy of facelift incision, sternocleidomastoid muscle flap, and superficial musculoaponeurotic system flap for improving the esthetic results in patients undergoing partial parotidectomy for benign parotid tumor resection. The usefulness of partial parotidectomy is discussed, and a statistical evaluation of the esthetic results was performed. From January 1, 1996, to January 1, 2007, 274 patients treated for benign parotid tumors were studied. Of these, 172 underwent partial parotidectomy. The 172 patients were divided into 4 groups: partial parotidectomy with classic or modified Blair incision without reconstruction (group 1), partial parotidectomy with facelift incision and without reconstruction (group 2), partial parotidectomy with facelift incision associated with sternocleidomastoid muscle flap (group 3), and partial parotidectomy with facelift incision associated with superficial musculoaponeurotic system flap (group 4). Patients were considered, after a follow-up of at least 18 months, for functional and esthetic evaluation. The functional outcome was assessed considering the facial nerve function, Frey syndrome, and recurrence. The esthetic evaluation was performed by inviting the patients and a blind panel of 1 surgeon and 2 secretaries of the department to give a score of 1 to 10 to assess the final cosmetic outcome. The statistical analysis was finally performed using the Mann-Whitney U test for nonparametric data to compare the different group results. P less than .05 was considered significant. No recurrence developed in any of the 4 groups or in any of the 274 patients during the follow-up period. The statistical analysis, comparing group 1 and the other groups, revealed a highly significant statistical difference (P < .0001) for all groups. Also, when group 2 was compared with groups 3 and 4, the difference was highly significantly different statistically (P = .0018 for group 3 and P = .0005 for group 4). Finally, when groups 3 and 4 were compared, the difference was not statistically significant (P = .3467). Partial parotidectomy is the real key point for improving esthetic results in benign parotid surgery. The evaluation of functional complications and the recurrence rate in this series of patients has confirmed that this technique can be safely used for parotid benign tumor resection. The use of a facelift incision alone led to a high statistically significant improvement in the esthetic outcome. When the facelift incision was used with reconstructive techniques, such as the sternocleidomastoid muscle flap or the superficial musculoaponeurotic system flap, the esthetic results improved further. Finally, no statistically significant difference resulted comparing the use of the superficial musculoaponeurotic system and the sternocleidomastoid muscle flap.

Reconstruction of Extensive Nasal Defects with Staged Bilateral Paramedian Forehead Flaps

Reconstruction of near-total and total nasal defects is technically challenging, particularly in patients with an extensive smoking history. One of the keys to a successful esthetic and functional reconstruction is the use of intranasal lining that is reliable and not susceptible to necrosis. Unlike mucosal flaps and skin turn-in flaps with a random blood supply, paramedian forehead flaps have an axial blood supply and are less likely to be adversely affected by a patient's smoking history. In this report, we describe the use of staged bilateral paramedian forehead flaps as an alternative technique for patients with isolated near-total or total nasal defects where local tissue is of insufficient quality or quantity for intranasal flap design. The use of staged bilateral forehead flaps can result in acceptable functional and esthetic outcomes in patients with extensive nasal defects.

Absorbable or non-absorbable sutures? A prospective, randomised evaluation of aesthetic outcomes in patients undergoing elective day-case hand and wrist surgery

We prospectively evaluated aesthetic outcomes in a group of randomised patients who underwent elective day-case hand and wrist surgery using either absorbable or non-absorbable sutures. A cohort of 100 adult patients were randomised using sealed envelopes to receive either absorbable or non-absorbable sutures for their wound closure. Clinical review was carried out at 6 weeks. A postal questionnaire was sent to all patients 3 months following surgery comprising a visual analogue scale (VAS) for wound satisfaction, a validated 6-point patient scar assessment tool and the shortened version of the disabilities of the arm, shoulder and hand questionnaire (QuickDASH). From the postal questionnaire, 70 responses were received. There was no statistically significant difference between the two groups in terms of VAS, patient scar assessment tool and quick DASH. For elective day-case hand and wrist surgery, either suture material can be used confidently with respect to overall aesthetic appearance in such patients.

Mitek Anchor–Augmented Static Facial Suspension

To evaluate the efficacy of the Mitek minianchor suture system as an adjunctive procedure for static facial suspension and assess its ability to improve functional and aesthetic outcomes in patients with complete facial paralyses. A retrospective review of 5 patients who underwent adjunctive static facial suspension with the Mitek GII minianchor suture system at a tertiary care academic center. A bone anchor in the maxilla connected to 2 suture arms was used. One suture arm elevated the oral commissure on the paralyzed side. The second suture arm adjusted for upper lip segment asymmetry and Cupid's bow deviation, or lateralized the external nasal valve. Outcome was evaluated by photodocumentation and clinical examination. There was an average of 76.9% improvement in vertical symmetry of the oral commissure (range, 43%-100%), an average of 65.0% improvement in horizontal deviation of the Cupid's bow (range, 50%-100%), and an average of 85.3% improvement in symmetry of upper lip segments (range, 67%-100%). All patients experienced improvement in oral-nasal competency. The Mitek minianchor suture system is a safe and effective adjunctive method to improve facial symmetry and oral-nasal competency in patients with facial paralyses. Its multivector design approximates the ideal positions of key anatomical points of the midface during static facial suspension surgery.

Mitek Anchor–Augmented Static Facial Suspension

To evaluate the efficacy of the Mitek minianchor suture system as an adjunctive procedure for static facial suspension and assess its ability to improve functional and aesthetic outcomes in patients with complete facial paralyses. A retrospective review of 5 patients who underwent adjunctive static facial suspension with the Mitek GII minianchor suture system at a tertiary care academic center. A bone anchor in the maxilla connected to 2 suture arms was used. One suture arm elevated the oral commissure on the paralyzed side. The second suture arm adjusted for upper lip segment asymmetry and Cupid's bow deviation, or lateralized the external nasal valve. Outcome was evaluated by photodocumentation and clinical examination. There was an average of 76.9% improvement in vertical symmetry of the oral commissure (range, 43%-100%), an average of 65.0% improvement in horizontal deviation of the Cupid's bow (range, 50%-100%), and an average of 85.3% improvement in symmetry of upper lip segments (range, 67%-100%). All patients experienced improvement in oral-nasal competency. The Mitek minianchor suture system is a safe and effective adjunctive method to improve facial symmetry and oral-nasal competency in patients with facial paralyses. Its multivector design approximates the ideal positions of key anatomical points of the midface during static facial suspension surgery.

Video-Assisted Breast Surgery and 3-Dimensional Computed Tomographic Mammary Lymphography &lt;1&gt; Aesthetic Results and Curability of Video-assisted Breast Surgery

Background: I have studied endoscopic surgery for breast diseases and have studied 3-dimensional computed tomographic lymphography for sentinel node biopsy. In this chapter, I introduced my works of the endoscopic breast surgery. I devised a new endoscopic operation for breast diseases: video-assisted breast surgery. The goal of endoscopic breast surgery is to obtain better cosmetic outcomes. Methods: A 2.5-cm axillary or periareolar skin incision was made. Under video assistance, the mammary gland was partially or totally resected with a gasless method. A transaxillary retromammary route approach was used even for tumors of the medial aspect of the breast. For malignant tumors, sentinel node biopsy was performed, and axillary nodes were dissected. Breast reconstruction was performed simultaneously. Cosmetic results: Cosmetic results were assessed with a standard 4-step method and the method described in the Japanese guidelines for breast-conserving therapy. More-objective quantitative methods are breast retraction assessment, the method reported by the research group of Sawai, and ABNSW, a 5-item, 4-step method that evaluates asymmetry (A) , breast shape (B) , nipple deformation (N) , skin condition (S) , and wound scar (W) . The cosmetic results in endoscopic breast surgery showed that almost 90% of patients received a total score greater than 11 points, which indicates that this video-assisted breast surgery achieves better cosmetic results. The reconstruction methods in breast-conserving therapy are mammary gland translocation, the lateral tissue flap filling method, and absorbable thread mesh filling. The filling methods are superior to the translocation at the point of less deformation of the breast shape. Reconstruction with filling methods will allow wider excision of the mammary gland while achieving better cosmetic results. Results: Video-assisted breast surgery is less invasive, produces no scars on the breast skin, and achieves better aesthetic outcomes for patients with breast cancer. It also improves quality of life. The long-term results of this surgery in regards to morbidity have proven good after a maximum follow-up period of 8 years. Conclusions: Video-assisted breast surgery achieves good locoregional control and provides aesthetic advantages. It can be used to treat multiple breast diseases and advanced disease after preoperative systemic treatment.

A Simple and Accurate Method for Mounting Models in Orthognathic Surgery

Traditionally, a facebow device is used to register the 3-dimensional relationship of the maxillary dental arch to the Frankfort horizontal plane (FHP) using either the patient’s external meati or the condylar heads (depending on the requirements of the facebow) as the posterior reference. Auxiliary components can be attached to the facebow to aid in the anterior alignment using nasion or infraorbitale. This facebow registration is transferred to the articulator to position and mount the maxillary dental model. The mandibular dental model is then mounted with an interocclusal registration. Unfortunately, this facebow registration method often creates inaccuracies in the mounted maxillary model position, thus presenting the models in a significantly different orientation compared with the actual relationship of the patient’s jaws to the cranial base structures. 2-5 The predetermined surgical movements derived from the patient evaluation and prediction tracing, when performed on malaligned dental models, may result in significant malpositioning of the jaw structures at the actual surgery, producing compromised functional and esthetic outcomes for patients. There are reasons for inaccuracies in the traditional facebow mounting of dental models: 1) the vertical, anteroposterior (A-P), and/or mediolateral position of the patient’s external meati or condyles (depending on the reference for the facebow) may be asymmetric from side to side compared with the fixed symmetric position of the facebow mounting rods on the articulator; 2) due to anatomical variances, the patient’s FHP as determined by the facebow may be significantly different than the fixed FHP of the articulator; 3) the facebow may be improperly positioned on the patient, or facebow components could shift when tightening the bolts, nuts, and/or screws during the registration procedure; 4) cranial base and jaw aberrations may be present that are not reproducible on the articulator; 5) anatomical structures may be absent (ie, hemifacial microsomia), rendering the facebow mounting totally arbitrary; and 6) shifting of the facebow components can occur with inadequate tightening of the bolts, nuts, and/or screws at registration acquisition or with rough handling during the mounting of the maxillary model. The purpose of this article is to describe a simple and accurate method for mounting dental models using the SAM Occlusal Plane Indicator (OPI) device (Figs 1, 2) for the SAM articulator (SAM-Prazisionstechnik, Munchen, Germany: US distributor: Great Lakes Orthodontics, LTD, Tonawanda, NY). The OPI

Rehabilitation of Severely Atrophied Mandible Using Free Iliac Crest Bone Grafts and Dental Implants: Report of Two Cases

The purpose of this study was to reveal the improvement in facial esthetics and maintenance of mastication in severely atrophied mandibles with inadequate alveolar ridges in 2 patients. Bone graft harvested from iliac crest was used for the reconstruction in the first case, followed by the application of 2 dental implants after 6 months. A free iliac bone graft and 2 dental implants were also used simultaneously with a 1-stage surgery in the second case; the patient had previously had a mandibular reconstruction with a rib graft. Both of the patients achieved remarkably functional and esthetic improvements after treatment. Free iliac bone graft is considered to be a favorable alternative for the maintenance of satisfactory functional and esthetic results in patients with severely atrophied alveolar ridges.

Improvement of Functional and Aesthetic Results for Patients after Creation of Diversion Loop for Cervical Esophagus-Case Report

Choking is a serious problem in pharyngoesophageal reconstruction. These patients have to make a choice between preservation of vocal function but using permanent jejunostomy for feeding, and oral intake but using permanent tracheostomy for breathing. For patients who had chocking from previous injury to epiglottis, a new solution is creation of a diversion loop which allows food to pass from the oral vestibule to cervical esophagus. However, there is a disadvantage of the diversion loop. Because the jejunal flap was placed at subcutaneous layer, the patients may complain of the disfigurement due to the bulging of the chin. When the patients who received this procedure of diversionary loop had established good swallowing function, and they complained the disfigurement of the bulging of the chin, these patients are evaluated, including the mandible X-ray which is used to make sure the position of the tooth buds. A transverse skin incision is made for exploration of the mandibular tubercle, which is then trimmed off about 0.7~1 cm in height and 2 cm in width. The neck scar is also revised with multiple Z-plasties. Significant improvement in the function and aesthetic results was achieved. This is revealed on psychological interview. After removal of the mandibular margin some patients even got improvement in the speed of swallowing as revealed by dynamic esophagogram. The marginal mandibulectomy further contributed to the value of the diversion loop method, especially for young female patients.

Oncologic and Aesthetic Results Following Breast-Conserving Therapy with 0.5 cm Margins in 100 Consecutive Patients

The purpose of this study was to evaluate the oncologic and aesthetic results of patients undergoing breast-conserving therapy with 0.5 cm surgical margins and determine the factors that influence the need for reconstruction. One hundred consecutive patients who underwent breast-conserving surgery with 0.5 cm surgical margins followed by radiotherapy for invasive cancer and ductal carcinoma in situ (DCIS) were followed prospectively and evaluated for recurrence and aesthetic result. Thirteen patients underwent reexcision to achieve a 0.5 cm margin. Factors including breast size, location of the tumor, specimen size and volume, tumor size and volume, and TNM stage, if axillary dissection or reexcision were required, were included in the analysis. Aesthetic evaluation consisted of both patient rating and an independent observer rating on a 10-point scale that assessed volume, shape, symmetry, areola/nipple, and scar. Of the 100 patients that underwent breast-conserving therapy, the overall aesthetic results revealed that 8% of the patients scored themselves seven or less, another 8% were scored seven or less by the independent observer, and another 7% were scored seven or less by both the patient and the observer. Of these patients, only one proceeded to have a reconstructive procedure. Analysis of variance revealed a significant correlation between tumor size (cm(2)) and an aesthetic score of seven or less (p = 0.023), and specimen volume (cm(3)) and an aesthetic score of seven or less (p = 0.039). Chi-squared analysis revealed a significant difference (chi(2) = 4.39, p < 0.5) in the aesthetic result in patients with stage IIA disease. Other independent factors such as age, breast size, location of the tumor, axillary dissection, and reexcision did not influence the overall aesthetic result. A Pearson correlation of patient and independent observer ratings showed a positive correlation (r = 0.4; 95% confidence interval [CI] 0.19-0.57) between the two groups. There were zero local recurrences of breast cancer during the study period. Our results demonstrate that following breast-conserving therapy with a minimum of 0.5 cm resection margins, it is possible to achieve excellent oncologic and aesthetic results. Patients with large tumors that require a large volume of resection or with stage IIA disease should be considered for reconstructive evaluation.

Treatment Planning for Multiunit Restorations—The Use of Diagnostic Planning to Predict Implant and Esthetic Results in Patients With Congenitally Missing Teeth

Patients afflicted with congenitally missing teeth are a unique patient population for consideration of treatment with osseointegrated implants. Frequently, these patients have limited development of the alveolar process and differences in spatial position relative to the opposing arch, which places emphasis on ancillary treatment with orthodontics and oral surgery. A thorough diagnostic workup should include an interdisciplinary approach to ensure optimal treatment and timing of treatment in those who are developing. This article outlines considerations for treating these types of patients and scenarios of treatment paths frequently taken to restore the partially dentate and edentulous to esthetics and function.