Aesthetic Complications Research Articles

Septal Bony Paste Graft: A Life-Saving Material in Rhinoplasty Camouflage.

Although cartilage tissue is a priority material in both structural grafting and camouflage, in some special cases, there is not enough material for camouflage due to cartilage insufficiency after it is used in structural grafting. In these cases, it is vital that the bony parts of the septum be prepared as a paste graft and applied for camouflage. The author retrospectively reviewed 62 rhinoplasty patients in whom septal bony paste grafts were applied during surgery from April 2018 to December 2019. A total of 56 patients were female, and 6 were male. The average age was 28 years old (range 18 to 52). The follow-up period ranged between 12 and 29 months (mean: 20.5). Septal bony paste grafts were prepared using a microrasp attached to a motor system. Septal bony paste grafts were used for camouflage of osteotomy lines in 59 patients, dorsum smoothing in 47 patients, camouflage of tip grafts in 36 patients, and camouflage of dorsal onlay grafts in 21 patients. No serious complications related to septal bony paste graft application, including functional or aesthetic complications, were encountered. A septal bony paste graft can be applied for camouflage in rhinoplasty in cases where there is not sufficient cartilage tissue for this purpose. A microrasp attached to a motor system can be used for effective and rapid preparation of the septal bony paste graft. 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 .

The work of the Joint Council for Cosmetic Practitioners and Aesthetic Complications Expert Group

Dr Marytn King provides an insight into the ongoing work of the Joint Council of Cosmetic Practitioners and the Aesthetic Complications Expert Group

Do We Need Support in Prepectoral Breast Reconstruction? Comparing Outcomes with and without ADM.

Background:The majority of two-stage prepectoral breast reconstruction has been described utilizing acellular dermal matrix (ADM). Although reports of prepectoral breast reconstruction without ADM exist, there is a paucity of comparative studies.Methods:A single-institution retrospective review was performed of consecutive patients undergoing immediate prepectoral two-stage breast reconstruction with tissue expanders from 2017 to 2019. Short-term reconstructive and aesthetic complications were compared between cases that utilized ADM for support and those that did not.Results:In total, 76 cases (51 patients) were identified, of which 35 cases utilized ADM and 41 did not. Risk factors and demographics were similar between the two cohorts with the exception of body mass index, which was higher in the ADM cohort (29.3 versus 25.4, P = 0.011). Average follow-up length was also longer in patients who received ADM (20.3 versus 12.3 months, P < 0.001). Intraoperative expander fill was higher in patients who did not receive ADM (296.8 cm3 versus 151.4 cm3, P < 0.001) though final implant size was comparable in both cohorts (P = 0.584). There was no significant difference in the rate of any complication between the ADM and no ADM cohorts (25.7% versus 17.1%, respectively P = 0.357), including major mastectomy flap necrosis (P = 0.245), major infection (P = 1.000), seroma (P = 0.620), expander explantation (P = 1.000), capsular contracture (P = 1.000), implant dystopia (P = 1.000), and rippling (P = 0.362).Conclusions:Immediate two-stage prepectoral breast reconstruction with tissue expanders has comparable rates of short-term complications with or without ADM support. Safety of prepectoral expander placement without ADM may warrant more selective ADM use in these cases.

Treatment of Implant Labial Soft Tissue Dehiscence with Guided Treatment of Implant Labial Soft Tissue Dehiscence with Guided Bone Regeneration vs Subepithelial Connective Tissue Graft. A Bone Regeneration vs Subepithelial Connective Tissue Graft. A Randomized Clinical Trial

Objective: Background: Implant soft tissue dehiscence is a frequently reported esthetic complication, that more often than not affects the functional integrity of the dental implant with eventual loss of osteointegration. Many treatment modalities with different success rates have been proposed aiming to solve this complication or prolong the survival of the dental implant, of which are guided bone regeneration and soft tissue regeneration around the affected implants. Patients and Methods: This prospective study was carried in the hospital of Future University. 11 Patients (1 Male – 10 Females) with 20 Maxillary implant sites demonstrating soft tissue dehiscence were randomly allocated to either a guided bone regeneration (GBR) group (Control) in which patients received a mixture of autogenous and xenogeneic bone graft substitute covered by a native collagen membrane fixated with titanium tacks over the affected implants or a connective tissue graft and coronal flap advancement (CTG + CAF) group (Intervention) in which patients received a de-epithelialized connective tissue graft harvest from the anterio-lateral hard palate combined with a coronally advanced flap. Recession levels were measured at baseline and at 1,3 and 6 months post operatively, while probing depths and bleeding indices were measured at baseline and 6 months post operatively and patient satisfaction levels were recorded through a visual analogue scale (VAS) questionnaire 6 months post operatively after completion of the follow up period. Results: Out of the 11 patients (1 Male – 10 Females) enrolled in this study, no major post-operative complications were encountered, the most common complication was post-operative swelling and edema that usually peaked 48 hours after surgery, which was more evident in the GBR group. Soft tissue recession levels measured from implant platform to gingival margin was significantly higher at baseline in GBR group compared to CTG+CAF group (P=0.042). While there was no significant difference in soft tissue levels between both groups at 1 month (P=0.362), 3 months (P=0.240) and 6 months (P=0.097). There was no statistically significant difference in VAS mean values between GBR and CTG+CAF groups (P=0.510). Conclusion: Based on the results of our study, we concluded that both treatment modalities provided satisfactory and stable results with major improvements in all clinical outcomes after 6 months compared to baseline measurements, however, GBR provided slightly superior clinical outcomes, compared to CTG + CAF

Reconstructive Options for Auricular Trauma.

Given its prominent lateral position, the auricle is a common site of injury after blunt trauma. Auricular injuries can lead to both functional and aesthetic complications. A careful history and examination will help determine the mechanism of injury and identify factors that may influence repair. Auricular reconstruction is highly individualized and depends on the size, location, and nature of injury. Understanding the complex three-dimensional anatomy of the external ear is a necessity for appropriate reconstruction. This article reviews the reconstructive options for simple and complex auricular injuries based on the anatomical site and the intricate three-dimensional structures that form the auricle.

Knowledge, awareness, and perception of dental students, interns, and freshly graduated dentists regarding dental implant complications in Saudi Arabia: a web-based anonymous survey

BackgroundIt is necessary for dental students and freshly graduated dentists to apply their education and practice to different clinical and preclinical procedures. The implant success rate and durability are high. Therefore, this study was designed to assess the level of knowledge, awareness and perception of dental students, interns and freshly graduated students regarding dental implant complications in Saudi Arabia.MethodsA cross-sectional study design using a web-based method was conducted at different dental institutions in Saudi Arabia from December 2019 to March 2020. Data were collected from all (n = 288) undergraduate students, interns and freshly graduated dentists using a pretested standardized self-administered web-based questionnaire that was prepared and circulated using a template provided by Google Forms (Google, Inc., USA). Descriptive statistics and chi-square tests were performed to analyse the data using SPSS (version 20).ResultsA total of 288 participants completed the questionnaire, with a response rate of 83.4%. Of the total participants, 37.5% showed a good level of knowledge regarding dental implant procedures, and 38.9% showed the same level of knowledge regarding implant complications. The most important cause of complications associated with dental implants was case selection, which accounted for 54.17%. Most participants (58.33%) chose massive bone loss related to implant failure as the most common late dental complication, while 26.39% chose postoperative infection as the most common early dental complication. In addition, 30.56% of the participants selected screw loosening as the most frequent mechanical complication. However, lack of implant primary stability was the most common hard-tissue implant complication. Based on aesthetic and reversible complications, restorations that were too buccal or too palatal and prosthetic-related, respectively, were the least common dental implant complications.ConclusionsThe level of knowledge among participants regarding dental implant complications differed among the institutions participating in this study. This difference reflects a significant variation that necessitates reviewing and standardizing dental implant curricula among these institutions.

Augmented fascia temporalis sling for paralytic ectropion of the lower lid.

To report the effect of lower eyelid temporalis fascia sling combined with lateral canthoplasty and tarsorrhaphy for paralytic ectropion. Prospective case series of 10 patients with lower lid paralytic ectropion who were treated with lower eyelid fascia temporalis sling and lateral canthoplasty in addition to lateral tarsorrhaphy as a single-session procedure. Additional medial tarsorrhaphy was applied if the medial lower lid apposition was not adequate at the end of the procedures. Eyelid configuration and function were compared before and after surgery. The mean age of patients was 65.8 ± 10 years. Mean marginal reflex distance 1 (MRD1) and MRD2 changed from 3.5 ± 1.4 and 8.6 ± 2.4 mm to 2.2 ± 1.4 and 5.3 ± 1.2 mm respectively (p = 0.001 and 0.006). Mean pre-operative lagophthalmos improved from 9.2 ± 4.9 to 3.4 ± 1.3 mm (p = 0.001). The mean follow-up was 28.9 ± 12.1 months. Three patients required additional medial tarsorrhaphy to address residual medial ectropion in the same session. Combination of lower lid fascia temporalis sling, lateral canthoplasty and tarsorrhaphy as a single-session procedure can effectively improve the functional and aesthetic complications of paralytic ectropion.

Abstract OT-23-02: Volumetric analysis of the pectoralis major muscle as preoperative tool to select patients undergoing pre-pectoral versus sub-pectoral implant based breast reconstruction after risk reducing mastectomy

Abstract Background: Proper patient selection is crucial to maximize aestethic outcome in breast reconstructive surgery. No specific patients selection criteria have been developed to choose between prepectoral versus subpectoral implant-based reconstruction. A quantitative tool able to determine the pectoralis muscle individual characteristics might be helpful to discriminate a priori the patients who will experience better aesthetic outcome and less complications following a pre-pectoral versus a sub-pectoral approach. Preoperative pectoralis muscle assessment may optimize patients’ selection for the breast reconstructive technique. Trial design: This is a multicentric trial in which, patients candidated to risk reducing mastectomy fulfilling inclusion criteria, will undergo a preoperative MRI prior to randomization to pre-pectoral versus sub-pectoral implant placement in immediate breast reconstruction. Volumetric analysis of the pectoralis major muscle (cm2) and measurement of the subcutaneous adipose tissue in the breast region, will be performed to assess anatomic characteristics of the pectoralis muscle using a sagittal T1 fat suppressed sequence. The volume of the pectoralis muscle will be calculated by measuring differences in density with the MRI. In all patients, the pectoralis muscle area on the left and right side will be determined separately and the two values will be averaged. The volumetric assessment will be performed by two expert radiologists. BREAST-Q© questionnaire will be completed by each patient prior to surgery and at the follow up evaluations. Breast reconstruction will be performed immediately after nipple-sparing mastectomy (Arm 1: breast implant placed above the pectoralis major muscle (pre-pectoral); Arm 2: breast implant placed below the pectoralis major muscle (sub-pectoral)). Number of revisional surgeries, explantations, infections, seromas, flap necrosis, will be compared between two groups and correlated with MRI pectoralis muscle volume. Post-operative follow-up evaluations at 6 and 12-months to assess capsular contracture and BREAST-Q changes will be performed. Eligibility criteria: Inclusion criteria: •Female patient•Ages 18-60•Patients undergoing risk reducing mastectomy with immediate implant-based reconstruction •Signed informed consent Exclusion Criteria: •Prior chest wall irradiation •Patients with a contraindication to immediate breast reconstruction.•Patients with history of smoking, •BMI&amp;gt; 40, •D cup breast size•grade III ptosis Aims: To identify variables measured at preoperative MRI pectoralis muscle’s volumetric analysis that correlate with aesthetic outcome and complication rate in pre-pectoral versus sub-pectoral implant based reconstruction. Statistical methods: The assumption of distributional normality will be tested using the Shapiro-Wilk test. Comparisons of two variables will be carried out using the Wilcoxon test for paired groups and the Mann-Whitney test for unpaired groups. Present accrual and target accrual: The trial has been submitted for IRB approval at the ethical commission of Italian Switzerland. Recruitment has not started yet. With an enrollment ratio of 1:1, fifty patients (25 per arm) need to be recruited to ensure a power of 80% with a two sides alpha error of 0.05. Contact information: marialuisa.gasparri@eoc.ch Citation Format: Maria Luisa Gasparri, Thorsten Kuehn, Isabel Rubio, Philip Poortmans, Diana Lueftner, Orit Kaidar-Pearson, Beat Thuerlimann, Yves Harder, Daniel Schmauss, Francesco Meani, Claudia Rauh, Michael David Mueller, Malgorzata Banys-Paluchowski, Andrea Papadia, Valerio Vitale, Stefania Rizzo, Oreste Davide Gentilini. Volumetric analysis of the pectoralis major muscle as preoperative tool to select patients undergoing pre-pectoral versus sub-pectoral implant based breast reconstruction after risk reducing mastectomy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-23-02.

Improving supragluteal contouring using curved liposuction cannulas introduced through a single midline port

Aim: The definition of beauty has changed in the last 10-15 years where women seek more a highly defined curved body regarding buttocks in relation to the waist and thighs. The supragluteal area needs a long learning curve to have a smooth transition between the back and gluteal region. In our study we adopted a single port liposuction for this technically difficult region using a curved liposuction cannula instead of the usual three port site incisions and a straight cannula adopted by many surgeons.Method: From 2017-2020, 94 Female patients had gluteal augmentation using fat grafting and liposuction of the lower trunk, age ranging from 22 - 54 with a mean age of 32.Studying the use of a single incision in the intergluteal crease for liposuction of the supragluteal area using the curved shaft liposuction cannula size 3 mm and size 4 mm to reach the desired contour instead of adding another two paramedian supragluteal incisions. The main goal is to reach the upper lateral supragluteal region.Results: The transition zone between the lower back and buttocks was greatly achieved with a very high surgeon and patient satisfaction in more than 85% of the cases. (80 cases), There was no any major aesthetic complication in terms of Step-off’s , irregularities, over-resection or musculanization.Conclusion: Curved liposuction cannulas can greatly contribute to minimizing unnecessary extra incisions to reach various areas in the body specially the technically challenging upper outer supragluteal region as mentioned in our study.Level of Evidence: Therapeutic, V.

The peri-implant phenotype and implant esthetic complications. Contemporary overview.

To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications. The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications. While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications. Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.

The prevalence of odontogenic maxillary osteitis at the Cocody University Hospital's Odontostomatological Consultation and Treatment Center (CCTOS), Abidjan (Ivory Coast): clinical and therapeutic aspects

Maxillary osteitis is a bone tissue disease or condition with a dentoalveolar origin. This condition remains a public health concern in most developing countries, particularly in the Ivory Coast. Without appropriate management, it can alter the patient's overall health owing to aesthetic, functional, and psychological complications. This study aimed to provide a better understanding of odontogenic maxillary osteitis to consequently improve its diagnosis and medical care. Three major etiologies of maxillary osteitis have been reported: infectious, traumatic, and physicochemical causes. According to the literature, osteitis is grouped into two clinical forms, namely circumscribed osteitis and diffuse osteitis. Their diagnosis is based on a rigorous clinical examination as well as radiographic, histological, and bacteriological examinations. At the Cocody University Hospital's Odontostomatological Consultation and Treatment Center (CCTOS), patients with the late stages of the condition present with significant, disabling, and unsightly osteocutaneous-mucous lesions. Treatment of this osteitis is preventive, curative, and restorative. Odontogenic maxillary osteitis is encountered frequently and typically at a late stage at the Cocody University Hospital's CCTOS. To limit aesthetic and functional damage, raising awareness among African people about oral hygiene and the need for regular consultations should be encouraged.

Immediate Implant Placement and Provisionalization in the Esthetic Zone Revisited: The Marginal Migration Concept (MMC)

Immediate implant placement and provisionalization in the esthetic zone is a desirable approach that presents several advantages but at the same time embosses several risk factors that can lead to sever esthetic complications. The purpose of this article was to propose a new protocol that could allow for the maintenance and even the improvement of the hard and soft tissue topography, leading to superior esthetic results. The proposed protocol, when certain criteria are met, could be applied even for cases where the extraction socket morphology is currently proposed as a contra-indication for immediate implant placement and provisionalization.

An Update on the Posterior Earlobe/Concha Mastoid Suspension Suture to Correct "Pixie Ear" Following Facelift: Review of 40 Cases.

Auricular displacement (AD) and earlobe distortion, such as "pixie ear," are commonly seen deformities after rhytidectomies. In 2018, the authors of this article published a prophylactic technique (posterior earlobe rotation flap [PERF] and concha-mastoid suspension suture [CMSS]) to prevent such cosmetic-related complications in primary facelift surgery. Here, the authors review the utilization of this technique to correct such deformities in patients receiving revision facelift surgeries. The authors sought to demonstrate the usefulness of this technique in reconstructive cases suffering from such aesthetic deformities. A total 25 secondary and 15 tertiary rhytidectomies were operated between 2015 and 2018. A combination PERF/CMSS technique was performed bilaterally during each revision facelift surgery (n = 80). A retrospective data analysis (preoperatively; 1 year postoperatively) was conducted to detect any deformities. No "pixie ear" deformities were seen in any of our patients postoperatively. AD was detected twice and unilateral hypertrophic scarring once. The postoperative photometric analysis showed a natural ptosis grade I/II in all our patients. The total rate of aesthetic-related complications in our patient cohort was 3.75% (AD: 2.5%; hypertrophic scarring: 1.25%). After demonstrating the effectiveness of the PERF and CMSS techniques in primary facelifts, the authors reviewed the technique's effectiveness for restoring earlobe distortion and AD in secondary or tertiary rhytidectomy cases. In addition to its prophylactic utilization, this method also possesses strong reconstructive power to change tension vectors applied on the face (CMSS) and/or to correct pre-existing aesthetic complications, such as "pixie ear" formation (PERF).

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.

Avoiding Complications in Functional and Aesthetic Rhinoplasty.

Historically, nasoseptal surgery favoring functional considerations has compromised aesthetic ones, and vice versa, but modern techniques have evolved that allow symbiotic achievement of both goals. Nasoseptal surgery is among the most commonly performed plastic surgical procedures in the United States, and while it is generally well tolerated, there are a few surgical and aesthetic complications of which to be aware. Herein, we review surgical techniques that improve the nasal airway and nasal aesthetics in a top-down approach with a discussion of possible ensuing complications.

Evaluation of The Efficacy of Argon Laser in Treatment of Xanthelasma Palpebrarum using Ultrasound Biomicroscopy

Background: Xanthelasma palpebrarum [XP] is the most common of the xanthomas with asymptomatic, symmetrical, bilateral, soft, yellow, polygonal papules around the eyelids. The surgical laser offers an extremely elegant and powerful solution to this problem. Aim of the work:To evaluate the efficacy of Argon Laser in treatment of xanthelasma palpebrarum, based on ultrasound biomicroscopy [UBM]. Preoperatively, full history and clinical examination had been carried out. Patients and Methods: The study included 45 eyelids of 27 patients [13 males and 14 females] presenting with xanthelasma lesion. They underwent single session treatment of XP by Argon Laser, which had been performed on an outpatient basis. Postoperative UBM had been used to ensure eradication of the lesion. Follow up of the patient every 2 weeks in the first month then after 6 months]. Results: The UBM was successfully used preoperatively to determine the maximal lesion thickness that can be effectively safely eradicated in only single session. The therapy was well tolerated, and all lesions responded to the therapy in only single session. There were no functional or relevant aesthetic complications. The cosmetic outcome was considered to be excellent in 80% and good in 6.7%of the cases. The study included 45 eyelids, 36 [80.0%] of them had excellent, 3 [6.7%] had good, 2 [4.4%] had satisfactory and only 4[8.9%] patients had poor cosmetic outcome. There were no recorded recurrent cases [0.0%] in the present study. Conclusion: Argon laser photocoagulation [single session] represents an alternative treatment in selected cases. It is easy to be performed well tolerated by the patients. In addition, UBM was important to determine the maximal lesion thickness that can be eradicated safely in only one session.

New technique of dissection of internal mammary vessels for breast reconstruction.

Although internal mammary vessels are considered the best recipients for free flap breast reconstruction, they present the notable drawback of limited accessibility. The aim of this study was to develop a minimally invasive surgical technique for the dissection of internal mammary vessels as recipients for breast reconstruction. From 2008 to 2018, we performed 32 unilateral microsurgical breast reconstructions (mean patient age: 40.1±8.7 years; range, 23-58 years). As internal mammary vessels were exclusively used as recipients, they were dissected using a technique of minimally invasive video-assisted thoracoscopic surgery (VATS) developed in our hospital. The mean surgery time was 5.4±0.55 hours (range, 4.5-6.5 hours), and the mean duration of VATS dissection of internal mammary vessels was 20.6±2.9 minutes (range, 16-27 minutes). Of the specific complications associated with VATS, we only observed reductions in forced expiratory volume in the first second of >15% in 3 patients (9.4%), 10-15% in 8 patients (25%), and <10% in 21 patients (65.63%). We did not have any cases of significant bleeding or postoperative infection in this series of patients. With regard to aesthetic complications, we observed 1 and 2 cases of total necrosis and partial necrosis of the deep inferior epigastric perforator (DIEP) flap, respectively and 2 cases of partial necrosis of supercharged transverse rectus abdominis muscle flap. Endoscopic dissection of internal mammary vessels is a simple and feasible technique. When performed by experienced surgeons, it is a fast procedure that is associated with low rate of complications.

Augmentation Mastopexy with Surgical Excision of the Lower Pole to Avoid Waterfall Deformity: A Surgical Technique and Nipple Areolar Complex Case Series.

Purpose of this article is to demonstrate a way of avoiding the waterfall deformity in augmentation mastopexy patients. We will show a case series of results and explain how this technique gives satisfying aesthetic results for patients seeking breast augmentation who also require mastopexy. We will show how addressing the breast parenchyma on the lower pole via direct excision can give reliable results and avoids the waterfall deformity. The surgical technique used by the senior author combines the principles of breast augmentation, mastopexy, and breast reduction. We apply these principles during the initial single operation. Our goal is to achieve the best anatomical results for the patient. We describe 1538 consecutive patients whom underwent single-stage breast augmentation with mastopexy. All implants were submuscular with 12% being saline and 88% were silicone implants. Vertical mastopexies were performed in 8% and wise pattern incisions were used in 92%. There were no life-threatening complications such as deep vein thrombosis, pulmonary embolism, and so on. Tissue-related complications included wound infection (1%) and hematomas (1%). Implant-related complications included malposition or implant displacement 9% and capsular contracture 1%. Aesthetic complications included dystopia of NAC (4%) and volume asymmetries (10%). Revision surgery was tissue related (2%), implant related (3%), and aesthetic related (10%). There were no cases of waterfall deformity seen in the cohort. In conclusion, we believe that the technique detailed here is easy to do, uses principles already known of breast augmentation and reduction and gives consistent results with low reoperation rates.

Displasia de streeter (síndrome de bridas amnióticas) a propósito de un caso

Introducción: La Displasia de Streeter o Síndrome de Bandas Amnióticas (SBA) es un grupo de defectos al nacimiento, que ocurre cuando algunas partes del feto en desarrollo (generalmente brazos, piernas o dedos) se “enredan” en bandas amnióticas de tipo fibrinoso dentro del útero, las cuales restringen el flujo sanguíneo y linfático, afectando el desarrollo del bebé.&#x0D; Objetivo: Describir un caso clínico de bandas amnióticas como causa de malformacion en las extremidades.&#x0D; Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico.&#x0D; Resultados: En este trabajo se presenta el caso de un recién nacido varón que al nacimiento presenta sindactilia en mano izquierda, pie derecho y en tercio distal de pierna, banda de constricción profunda que provoca, edema y linfangitis así como hipertrofia de tercio distal de pierna y pie izquierdos.&#x0D; Conclusiones: Es importante la revisión de este caso puesto que la intervención debe ser multidisciplinaria (cirugía plástica, cirugía vascular, ortopedia y traumatología, pediatría, psicología) y precoz con la finalidad de evitar complicación vascular, funcional y estética.&#x0D; Resultados: En este trabajo se presenta el caso de un recién nacido varón que al nacimiento presenta sindactilia en mano izquierda, pie derecho y en tercio distal de pierna, banda de constricción profunda que provoca, edema y linfangitis así como hipertrofia de tercio distal de pierna y pie izquierdos.&#x0D; Conclusiones: Es importante la revisión de este caso puesto que la intervención debe ser multidisciplinaria (cirugía plástica, cirugía vascular, ortopedia y traumatología, pediatría, psicología) y precoz con la finalidad de evitar complicación vascular, funcional y estética

Clinical outcomes of lithium disilicate glass-ceramic crowns fabricated with CAD/CAM technology: A systematic review.

The use of ceramic materials and the computer-aided design/computer-aided manufacturing (CAD/CAM) technology for the fabrication of complete-coverage restorations has significantly increased in the last decade. The aim of this study was to evaluate the survival rate of anterior and posterior monolithic and bilayered lithium disilicate glass-ceramic (LDGC) CAD/CAM crowns, and to identify the types of complications associated with the main clinical outcomes reported in clinical trials. MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched by 2 independent reviewers for clinical studies published between 2006 and 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The electronic search was supplemented by a hand search. Quality assessment for the included studies was performed. Qualitative and quantitative data was extracted from each study. Out of 219 studies, 6 studies that evaluated LDGC CAD/CAM crowns were identified and used for data extraction. The included studies had 154 participants, who received 204 crowns. The shortto medium-term survival and success rates were high. Biological complications occurred more frequently than technical complications. No esthetic complications were reported. This review indicated that the medium-term survival rate of LDGC CAD/CAM crowns was high. Further multicenter studies with longer follow-ups and larger sample sizes are needed in order to augment the data already in existence.