Facial Soft Tissue Research Articles

Repair of facial dog bite wound utilizing cryopreserved umbilical cord allograft.

In the United States, craniofacial injuries are the most frequently observed traumas in the pediatric population. Human birth tissue products contain growth factors, cytokines, and signaling molecules that can be potentially harnessed for tissue regeneration and wound healing. A cryopreserved ultra-thick amniotic membrane (AM) allograft wound dressing was used in a patient with significant facial soft tissue loss due to a dog bite injury. This is a single case report of a pediatric patient. After obtaining IRB exemption, operative and postoperative clinic notes were reviewed. A 10-year-old female presented to the emergency department after suffering a dog bite to her left cheek and upper lip, resulting in tissue loss. A cryopreserved ultra-thick AM allograft was used to cover the area of tissue loss as part of surgical reconstruction. The patient was followed up at 1 week, 3 weeks, 4 months, and 1 year after the graft was placed, and rapid healing and full epithelialization were achieved in addition to scar contracture due to wound location. In the setting of acute trauma and tissue loss, human birth tissue was found to promote epithelialization and regenerative healing of facial tissues.

A Multicenter Pilot Study of a Novel Allograft Adipose Matrix in Malar and Prejowl Volume Restoration.

Allograft adipose matrix (AAM) offers a novel, off-the-shelf, and readily available natural option in the treatment of facial soft tissue volume and reconstructive deficits. AAM is a natural soft tissue supplement or replacement that can support cushioning and volume correction. A prospective multicenter pilot study evaluated AAM in facial volume restoration. Eleven women (mean age of 55.8 ± 10.9 y) with midface volume deficit were followed up for 24 weeks after AAM treatment in this institutional review board-approved multicenter pilot study. The clinical safety and efficacy of the AAM treatment were evaluated using clinical scales and three-dimensional quantitative facial photography. AAM was safe to address facial volume deficits, with minor site-related adverse events and discomfort that resolved within 2-4 weeks. Observations also revealed facial volume improvements throughout the study with 91% positive responders. At week 24, the subject facial satisfaction scores revealed an 86% increase compared to baseline, along with a statistically significantly improved midface fullness compared to baseline. AAM offers a natural and safe option for midface volume restoration and supports overall satisfaction and volume improvements.

Comparing densely calculated facial soft tissue depths for craniofacial reconstruction: Euclidean vs. perpendicular distances

ABSTRACT For surgical craniofacial reconstruction, preoperative planning may be limited by missing 3D skeletal geometry. In forensic sciences, ‘reconstruction’ models the 3D facial structure from skull geometries using soft-tissue depth mapping. This work investigates ‘reverse engineering’ the forensics’ TD Morpheus model to infer the bony shape from 3D facial surfaces by subtracting tissue depths inwards along the normal vectors. This approach using Euclidean tissue depths successfully estimated the upper and outermost skeletal regions (i.e. frontal, zygoma, and nasal bones) in 24 head CT scans, but concave skeletal surfaces were inaccurately evaluated where the face is convex yielding misshapen anatomy around the orbits and zygomatic arches. A perpendicular tissue depth algorithm was developed to probe inwards along the face’s normal vectors until contacting bone, demonstrating superior performance to the Euclidean depth approach. Accurate regional tissue depths achievable with this approach may provide a useful bridge to connect the 3D face and underlying skull geometry, with the potential for application in craniofacial reconstruction.

High-resolution ultrasound in diagnosing complications after facial contouring injections. A clinical case.

The development of new techniques of procedure and line extensions of products for facial contouring injections leads to an increase in the incidence of facial soft tissue complications and adverse reactions. The article presents a clinical case of complications after previous facial contouring injections with hyaluronic acid-based fillers. In high-resolution ultrasound the signs of inflammatory changes in the facial soft tissues were found, which affected the further treatment strategy.

Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor

ObjectiveTo verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). MethodsRetrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21–42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. ResultsThere was an increase in nasal width with an average of 1.3467mm and an increase in the alar base with an average of 1.7333mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. ConclusionAlthough our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. Level of evidenceLevel 4.

Shear wave elastography assessment of buccinator stiffness in patients of different age groups

Objective: to assess the capabilities of lower face muscles stiffness measurement with shear wave elastography in female patients of various age groups.Material and methods. Ultrasound examination with buccinator muscle stiffness measurement in shear wave elastography was performed in 45 healthy female patients divided into three equal groups by the age (20–30, 31–40 and 41–50 years old) with the use of Epiq 5 (Phillips, the Netherlands) with a linear probe (4–18 MHz). Exclusion criteria were: a history of facial soft tissue pathology, neuromuscular disorders, invasive or minimally invasive facial cosmetology, long-term activity with an active use of facial muscles and articulation. The values of Young's modulus (kPa) were measured in the central and lateral parts of the buccinator muscle in the standing and supine positions of the patients.Results. There was no significant differences of Young's modulus in the central and lateral parts measured standing compared to supine position in all age groups (except the lateral part in group 1). A signifi cant progressive decrease of the buccinator muscle stiffness obtained in three age groups with minimal values of Young’s modulus in the age group of 41–50 years: median – from 5.8 to 9.1 kPa (minimum–maximum values – from 4.1 to 11.3 kPa ) depending on the area of measurements and the position of the patient. In patients of the age group 20–30 years – 8.6–13.8 kPa (7.6–16.5 kPa), 31–40 years – 8.0–11.8 kPa (6.0–13.7 kPa ), respectively.Conclusion. Shear wave elastography allows the assessment of age-related changes in soft tissue, as demonstrated by the decrease of buccinator muscle stiffness

Quantitative analysis of facial soft tissue using weighted cascade regression model applicable for facial plastic surgery

Localization of facial landmarks plays an important role in the measurement of facial metrics applicable for beauty analysis and facial plastic surgery. The first step in detecting facial landmarks is to estimate the face bounding box. Clinical images of patients' faces usually show intensity non-uniformity. These conditions cause common face detection algorithms do not perform well in face detection under varying illumination. To solve this problem, a modified fuzzy c-means (MFCM) algorithm is used under varying illumination modeling. The cascade regression method (CRM) has an appropriate performance in face alignment. This algorithm has two main drawbacks. (1) In the training phase, increasing the real data without considering normal data can lead to over-fitting. To solve this problem, a weighted CRM (WCRM) is presented. (2) In the test phase, using a mean shape causes the initial shape to be either near to or far from the face shape. To overcome this problem, a Procrustes-based analysis is presented. One of the most important steps in facial landmark localization is feature extraction. In this study, to increase detection accuracy of the cephalometric landmarks, local phase quantization (LPQ) is used for feature extraction in all three channels of RGB color space. Finally, the proposed algorithm is used to measure facial anthropometric metrics. Experimental results show that the proposed algorithm has a better performance in facial landmark localization than other compared algorithms.

Clockwise versus counterclockwise rotation in bimaxillary surgery: 3D analysis of facial soft tissue outcomes.

This study aimed to compare facial 3D soft tissue changes in subjects with Class III deformities who underwent bimaxillary clockwise (CW) and counterclockwise (CCW) rotational orthognathic surgery. Asian Class III subjects who completed bimaxillary surgical orthodontic treatments were enrolled and categorized into CW and CCW groups based on maxillary occlusal plane alterations. Preoperative and 9-month follow-up cone-beam computed tomography (CBCT) and 3D stereophotogrammetry were obtained, superimposed, and quantified for skeletal movements and soft tissue changes in six facial regions. Inverse probability of treatment weighting (IPTW) adjusted for potential confounding factors. Thirty-seven subjects were included (CW group, n = 20; CCW group, n = 17). Postsurgical chin volume significantly reduced in the CW group compared to the CCW group (mean difference 6362 mm3; p = 0.037), and intergonial width significantly decreased in the CW group (mean difference 6.2mm; p = 0.005). The postoperative alar width increased by 1.04mm and 1.22mm in the CW and CCW groups, respectively (p = 0.70). However, these changes were not significantly correlated to the direction of MMC pitch. Clockwise rotation of the bimaxillary complex demonstrated a significant advantage in reducing chin volume and intergonial width compared to counterclockwise rotation, leading to a reduced frontal lower face width among Asian Class III subjects.

What We Know About Facial Volume Restoration with Autogenous Fat.

Facial rejuvenation involves a careful analysis of a patient's anatomic changes that are secondary to aging and then the application of several methods, tools, and technologies to reverse those changes. A central component of facial aging is the changes seen in facial soft tissue volume that occurs with atrophy and malpositioning of normal facial volume through several underlying aging processes. Although many surgical and nonsurgical interventions are available to remedy many of the sequela of aging, the restoration of volume is one of the most important goals that has to be engaged. Over the years, autogenous fat has emerged as one of the safer and reliable methods to restore the diminished volume of the aging face. The purpose of this manuscript is to relate some of the history, clinical practices, research, and current literature supporting the use of autologous fat in facial rejuvenation.

Which Skeletal Factors Can Affect Lip Canting in Facial Asymmetry?: Statistical Analysis.

Lip canting, which is a noticeable factor in patients with facial asymmetry, can be influenced by the dentofacial skeleton. During orthognathic surgery, postoperative changes in facial soft tissue occur along the newly positioned hard tissue. Therefore, the evaluation of soft tissue before surgery is important. The purpose of this study was to investigate the skeletal factors that can affect lip canting by statistically comparing 2 facial horizontal planes using a three-dimensional reconstruction model. The findings of the present study showed a statistical correlation between lip canting and 3 skeletal factors: menton deviation, maxillary canting, and ramal length differences. Furthermore, a statistical correlation was identified between the Frankfort Horizontal plane and the intercanthal plane compared with the lip canting line. This result suggests that the intercanthal plane could be a standard horizontal plane in three-dimensional reconstruction model analysis.

LeFort III Versus Monobloc Frontofacial Advancement: A Comparative Analysis of Soft Tissue Changes.

The LeFort III and monobloc are commonly used midface advancement procedures for patients with syndromic craniosynostosis with well characterized postoperative skeletal changes. However, the differential effects of these procedures on facial soft tissues are less understood. The purpose of this study was to critically analyze and compare the effects of these 2 procedures on the overlying soft tissues of the face. Frontal and lateral preoperative and postoperative photographs of patients undergoing monobloc or LeFort III were retrospectively analyzed using ImageJ to measure soft tissue landmarks. Measurements included height of facial thirds, nasal length and width, intercanthal distance, and palpebral fissure height and width. Facial convexity was quantified by calculating the angle between sellion (radix), subnasale, and pogonion on lateral photographs. Twenty-five patients with an average age of 6.7 years (range 4.8-14.5) undergoing monobloc (n=12) and LeFort III (n=13) were identified retrospectively and analyzed preoperatively and 6.4±3.6 months postoperatively. Patients undergoing LeFort III had a greater average postoperative increase in facial convexity angle acuity (28.2°) than patients undergoing monobloc (17.8°, P =0.021). Patients in both groups experience postoperative increases in nasal width ( P <0.001) and decreases in palpebral fissure height ( P <0.001). Both subcranial LeFort III advancements and monobloc frontofacial advancements resulted in significant changes in the soft tissues. Patients undergoing LeFort III procedures achieved greater acuity of the facial convexity angle, likely because the nasion is not advanced with the LeFort III segment.

Management of Soft Tissue Injuries in Children-A Comprehensive Review.

Airway injury, Ocular injury and neurovascular tissue damage, burns is all a spectrum of pediatric soft tissue injury complex. Soft tissue injuries to the head and neck area in children are challenging to manage, because these injuries significantly affect the child's overall health and development. Management of such injuries requires a multidisciplinary approach involving surgical and nonsurgical interventions and close collaboration among health care professionals, parents, and caregivers. This article reviews the various causes of injuries, specific considerations for each region of the head and neck, and approaches to the surgical management of soft tissue injuries in pediatric patients, including surgical and adjuvant therapies. Specific anatomic regions reviewed include the scalp/forehead, periorbital region, nose, cheeks, lips, ears, and neck/airway.Laceration repair in the growing pediatric populations may require revisions in the future. Facial soft tissue injuries are prone to poor cosmesis as in many occasions as may be constrained by available surgical specialists, thus proper multispecialty team approach along with surgical alignment and symmetry should be considered comprehensively.

Management of Maxillofacial Soft Tissue Trauma with Parotid Gland Exposure: Case Report

Introduction: Soft tissue trauma in Oral and Maxillofacial cases occurs quite often in the Emergency Room at Hasan Sadikin Hospital, Bandung. Trauma that occurs to the facial area is very susceptible to causing problems, both aesthetic sensory and motor function problems in that area. The existence of important structures in the facial area, such as the parotid gland and the location of the Facial Nerve (N.VII) in the facial area, requires special attention in treating soft tissue trauma to the face. Emergency management aims to ensure appropriate action in treating wounds, preventing infection, and ensuring the presence or absence of gland damage, as well as involvement of N.VII damage. Management of soft tissue wounds in the facial area is carried out by suturing, pain management and administering antibiotics. Emergency management of soft tissue trauma must be carried out quickly and precisely to obtain maximum results and consider function and aesthetics. Case report: A 16 year old female came with complaints of bleeding from the face and ears due to a motorbike accident approximately 2 hours before entering the hospital. Physical examination revealed an asymmetrical face, a torn wound on the left cheek with the parotid gland exposed and otorrhea. The patient's intraoral examination was normal. Conclusion: In this paper we will report a case of trauma to the maxillofacial soft tissue with exposure of the parotid gland. It is hoped that this article will expand insight into how to examine damage to the parotid gland and examine the function of N.VII in soft tissue trauma to the facial area. Keywords: Facial Soft Tissue Trauma; Parotid Gland; Management, N.VII

The Relationship of Facial Soft Tissue A’N’B Angle and Facial Hard Tissue ANB Angle in Determination of Skeletal Relations

Background: Cephalometric analysis used in orthodontics to informs the diagnosis, treatment planning, quantifies changes during treatment, and provides data for clinical research. It has been used for determination of Skeletal Relations using facial hard tissue ANB Angle. Points A and B on the facial hard tissue correlate closely with the positions of the corresponding points on the soft tissue. This study aims to determine the relationship between the A'N’B angle of soft tissue and the ANB angle of hard tissue in determining the class of skeletal relations&#x0D; Method: The sample used in this study was 75 cephalograms, which had been selected according to the criteria. Cephalometric tracing is done manually. Inter-observer and intra-observer measurements were carried out to increase the validity and reliability of the research instrument. The Bland-Altman method is used as a statistical fit test. The results of the research data were then tested for normality with the Kolmogorov-Smirnov test. For further testing to test the significance of the correlation coefficient obtained in the Pearson test, the significance test of the t-test is used.&#x0D; Result: The results of t-count &gt; t-table, which means that there is a strong linear relationship between hard tissue ANB and soft tissue A'N’B with a correlation coefficient (r) &gt; 0.05.&#x0D; Conclusion: The soft tissue A'N'B' angle can be used as an alternative in determining the class of skeletal relationships in addition to the hard tissue ANB angle

Pre- and Postoperative Evaluation of Immediate and Early Implant Placement in Esthetic Areas with Pre-Extraction Facial Dehiscence: A Retrospective Clinical Study.

The clinical requirement for a good esthetic result for immediate implant placement is the absence of dehiscence in the anterior facial alveolar bone. In the presence of dehiscence, it is recommended to use a connective tissue graft in addition to immediate implant placement or to change to early implant placement. However, the literature focusing on dehiscence is scarce, and the influence of different placement times and combined use of connective tissue graft on postoperative esthetics in cases with dehiscence is unclear. Therefore, we quantitatively evaluated the pre-extraction dehiscence morphology and postoperative changes in the facial tissue of implants in three groups: immediate implant placement (Group I), immediate implant placement with connective tissue graft (Group IC), and early implant placement (Group E). To this end, 52 implants were obtained (20 in Group I, 16 in Group IC, and 16 in Group E). A wider dehiscence increases the risk of soft tissue regression, which was one reason for choosing early implant placement. A combination of immediate implant placement and connective tissue graft, or early implant placement, tended to result in less soft tissue regression due to the thicker postoperative facial soft tissue volume.

Aging and Environmental Associated Changes of Facial Soft Tissues are Detectable on Clinical High Resolution MRI Scans

Aging and Environmental Associated Changes of Facial Soft Tissues are Detectable on Clinical High Resolution MRI Scans

Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap

To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap. A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer. Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes. Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.

Longitudinal Three-Dimensional Stereophotogrammetric Growth Analysis in Infants with Unilateral Cleft Lip and Palate from 3 to 12 Months of Age.

This longitudinal study aimed to evaluate facial growth and soft tissue changes in infants with complete unilateral cleft lip, alveolus, and palate (CUCLAP) at ages 3, 9, and 12 months. Using 3D images of 22 CUCLAP infants, average faces and distance maps for the entire face and specific regions were created. Color-coded maps highlighted more significant soft tissue changes from 3 to 9 months than from 9 to 12 months. The first interval showed substantial growth in the entire face, particularly in the forehead, eyes, lower lip, chin, and cheeks (p < 0.001), while the second interval exhibited no significant growth. This study provides insights into facial soft tissue growth in CUCLAP infants during critical developmental stages, emphasizing substantial improvements between 3 and 9 months, mainly in the chin, lower lip, and forehead. However, uneven growth occurred in the upper lip, philtrum, and nostrils throughout both intervals, with an overall decline in growth from 9 to 12 months. These findings underscore the dynamic nature of soft tissue growth in CUCLAP patients, highlighting the need to consider these patterns in treatment planning. Future research should explore the underlying factors and develop customized treatment interventions for enhanced facial aesthetics and function in this population.

Immediate Implant and Customized Healing Abutment Promotes Tissues Regeneration: a 5-year Clinical Report.

Significant alveolar bone resorption follows tooth extraction. Immediate implant placement alone is not sufficient to prevent this phenomenon. In this clinical case, a fractured upper first premolar was replaced by an immediate implant and a customized healing abutment designed on the perimeter of the extractive alveolus. After 3 months, the implant was restored. The facial and interdental soft tissue was maintained with appreciable success after 5 years. The pre- and 5-year-post-treatment CT scans showed no bone loss. The use of an interim customized healing abutment helps preventing hard and soft tissues collapse. This technique is very straightforward and might represent a smart preservation strategy when there is no indication for adjunctive hard or soft tissue grafting.

Global facial soft tissue thicknesses for craniofacial identification (2023): a review of 140years of data since Welcker's first study.

This year (2023) marks 140years since the first publication of a facial soft tissue thickness (FSTT) study. Since 1883, a total of 139 studies have been published, collectively tallying > 220,000 tissue thickness measurements of > 19,500 adults. In just the last 5-years, 33 FSTT studies have been conducted. Herein, we add these data (plus an additional 20 studies) to the 2018T-Table to provide an update of > 81,000 new datapoints to the global tallied facial soft tissue depths table. In contrast to the original 2008T-Table, some notable changes are as follows: increased FSTTs by 3mm at infra second molar (ecm2-iM2'), 2.5mm at gonion (go-go'), 2mm at mid-ramus (mr-mr'), and 1.5mm at zygion (zy-zy'). Rolling grand means indicate that stable values have been attained for all nine median FSTT landmarks, while six out of nine bilateral landmarks continue to show ongoing fluctuations, indicating further data collection at these landmarks holds value. When used as point estimators for individuals with known values across 24 landmarks (i.e., C-Table data), the updated grand means produce slightly less estimation error than the 2018T-Table means (3.5mm versus 3.6mm, respectively). Future efforts to produce less noisy datasets (i.e., reduce measurement and sampling errors as much as possible between studies) would be useful.