Facial Appearance Of Patients Research Articles

018. Supraclavicular Flap and Reconstruction With Radial Forearm Flap In Basal Cell Carcinoma Of The Buccal Region: A Rare Case Report

Background: Basal cell carcinoma (BCC) progression can invade surrounding tissues, causing local destruction and disfigurement. About 85-90% cases of BCC occur on the head, greatly affecting facial appearance of patients. Functional or cosmetic concerns require skin flap or graft. Case: A patient presented with a wound on his left cheek for 8 years, bleeds easily and painful. There is a muscle-based ulcer, penetrating the oral cavity and a post-biopsy wound is covered with granulation tissue. Laboratory examination showed moderate anemia and chest x-ray did not show any metastases. A supraclavicular flap and intraoral and supraclavicular insertion and intraoral and supraclavicular insertion were performed. In addition, harvesting of the radial forearm flap and partial palmaris longus tendon was conducted. Conclusion: Reconstruction of facial defects in different facial esthetic units is essential following excision of BCC. But it is necessary to plan the stages of reconstruction when more than one facial region is involved. Surgeon skills, patient’s preference, defect size and location are important determinants of esthetic outcomes

Skeletal and Soft Tissue Surgeries in the Long-term Management of Patients With Syndromic Craniosynostosis: A 20-Year Review.

Soft tissue procedures are often crucial for normalizing the long-term facial appearance in patients with syndromic craniosynostosis, yet they are underrepresented in the literature and existing treatment algorithms. This study evaluated secondary soft tissue surgeries in relation to skeletal operations in patients with syndromic craniosynostosis. A retrospective review evaluated patients with syndromic craniosynostosis treated at a tertiary children's hospital from 2003 to 2023. Craniofacial skeletal and soft tissue procedures were assessed for timing and frequency. Skeletal surgeries included redo fronto-orbital advancements, monobloc advancement/distraction ± facial bipartition, and LeFort III or III/I advancement/distraction. Soft tissue surgeries encompassed oculoplastic procedures, scalp reconstruction, fat grafting, and septorhinoplasty. Of 106 patients with syndromic craniosynostosis, 57 (57.8%) underwent ≥1 secondary skeletal operation, and 101 (95.3%) underwent ≥1 soft tissue procedures, averaging 3.7 ± 3.3 soft tissue procedures per patient. Patients who underwent secondary forehead advancement had significantly higher rates of subsequent lateral canthopexy (71.4% vs 25.6, P < 0.001), ptosis reconstruction (17.9% vs 7.7%, P = 0.025), and frontotemporal fat grafting (50.0% vs 15.4%, P < 0.001) than those who did not. Patients who underwent midface advancement surgery had significantly higher rates of subsequent lateral canthopexy (65.4% vs 11.1%, P < 0.001), medial canthopexy (7.7% vs 0.0%, P = 0.038), scalp reconstruction (36.5% vs 16.7%, P = 0.020), frontotemporal fat grafting (34.6% vs 14.8%, P = 0.018), malar fat grafting (11.5% vs 0.0%, P = 0.010), and septorhinoplasty (26.9% vs 1.9%, P < 0.001) than those who did not. Specifically, LeFort III or III/I advancement/distractions were significantly associated with higher rates of subsequent septorhinoplasties (33.3% vs 1.6%, P < 0.001). The mean follow-up was 10.2 ± 7.0 years. This study revealed an intricate interplay between skeletal and soft tissue surgery in patients with syndromic craniosynostosis. Exploring techniques to reduce the need for further corrective surgery and anticipating necessary secondary interventions may improve patient counseling and outcomes.

Changes in facial appearance alter one's sensitivity not only to the self but also to the outside world.

Changes in facial appearance due to orthognathic surgery are known to improve a patient's postoperative quality of life, however, potential changes in cognitive function are unknown. This study examined the effects of changes in facial appearance due to orthognathic surgery on the sensitivity to self and to outside objects in patients with jaw deformities. Patients with jaw deformities (n = 22) and healthy controls (n = 30) were tested at 3 months preoperatively, at 1 month preoperatively, and at 1 month postoperatively to assess their impression of objects (positive, negative, and neutral pictures) and their evaluation of their own face and body. The results showed that changes in facial appearance improved self-evaluation and increased their sensitivity to emotional objects even when the objects were identical. Furthermore, the improving rating for own face was associated with the sensitivity for objects. The changes in facial appearance in patients may have helped to clear the sensitivity to these emotional objects. These findings may provide a new indicator of efficacy in orthognathic surgery.

Clinical effect of botulinum toxin type A combined with autologous fat grafting in patients with nasolabial fold depression.

Nasolabial fold (NLF) depression can affect the facial appearance of patients to some extent and increase their psychological burdens. In recent years, autologous fat grafting (AFG) combined with botulinum toxin A (BTX-A) injection (AFG + BTX-A injection) has been gradually applied in the treatment of patients with NLF depression. Although studies have been conducted on the efficacy and safety of AFG + BTX-A injection in treating NLF depression, the experimental design, observational indicators, and sample enrollment criteria vary remarkably, making it difficult to draw convincing and consistent conclusions. Thus, further relevant research is warranted. To assess the esthetic improvement, efficacy, and safety of AFG + BTX-A injections in patients with NLF depression. This study included 60 patients with NLF depression who were treated in our hospital from February 2019 to April 2021. These patients were categorized into control (n = 30) and observation (n = 30) groups. The observation group received AFG + BTX-A injection, whereas the control group underwent AFG only. All patients were evaluated using the wrinkle severity rating scale (WSRS) and global aesthetic improvement scale. The compactness of facial contours, skin evaluation indexes, adverse reactions, and satisfaction of the two groups were evaluated 3 months postoperatively. The WSRS scores of the observation group at 1, 3, and 6 months postoperatively were lower than those of the control group (P < 0.05). Three months postoperatively, facial fine lines and pores showed obvious improvement and the skin index score was higher in the observation group than in the control group (P < 0.05). The compactness of facial contours was better in the observation group than in the control group (P < 0.05). In addition, no remarkable differences were noted in the incidence of postoperative adverse reactions such as facial stiffness, facial asymmetry, facial bruising, and facial concavity inequality (P > 0.05). AFG + BTX-A injection is a highly safe, cost-effective, effective, and long-lasting treatment for NLF depression with high esthetic value, which should be promoted in the future.

Correlation of Orthognathic Surgical Movements to Perception of Facial Appearance in Patients With Cleft Lip and Palate.

Cephalometric scans were compared before and after surgery to assess the degree of correction. Correlations between skeletal movements and survey outcomes were determined using multivariate regression analysis. This study aims to identify relationships between subjective observer-reported improvements in esthetics and emotional appearance with specific surgical movements. Ten patients at a single tertiary institution (average age: 18.1 ± 0.8), 9 males and 1 female, underwent orthognathic repair and had comprehensive cephalometric records. Standardized anterior posterior and lateral pre and postoperative photographs of patients were included in a survey to clinicians to assess noncognitive domains on a Likert Scale (1-10). CLEFT-Q was administered to gauge patient satisfaction in categories of appearance, speech, and quality of life. Per clinicians, multiple domains increased including facial attractiveness (4.1 ± 0.7 versus 7.3 ± 0.7, P < 0.001), friendliness (4.5 ± 0.4 versus 7.3 ± 0.5, P < 0.001), confidence (4.1 ± 0.4 versus 7.1 ± 0.4, P < 0.001), and recommendation for surgery decreased (8.9 ± 0.1 versus 3.6 ± 0.5, P < 0.001). Speech distress decreased with increased SNA and convexity, whereas Psychological and Social scores decreased with an increased ANB. Functional eating and drinking scores increased with maxillary depth. Orthognathic surgery improves many noncognitive domains in patients with cleft lip and palate as assessed by both patients and clinicians on all aspects of facial attractiveness and perception. These findings demonstrate objective bases of skeletal adjustments for perceived improvements in facial appearance and emotion.

Perceived Effects of Orthognathic Surgery versus Orthodontic Camouflage Treatment of Convex Facial Profile Patients.

Increased facial profile convexity has a common occurrence in the population and is a primary reason for seeking orthodontic treatment. The present study aimed to compare the perceived changes in facial profile appearance between patients treated with combined orthognathic/orthodontic treatment versus only orthodontic camouflage treatment. For this reason, 18 pairs of before- and after-treatment facial profile photos per treatment group (n = 36 patients) were presented to four types of assessors (surgeons, orthodontists, patients, laypeople). Ratings were recorded on 100 mm visual analogue scales depicted in previously validated questionnaires. All rater groups identified minor positive changes in the facial profile appearance after exclusively orthodontic treatment, in contrast to substantial positive changes (14% to 18%) following combined orthodontic and orthognathic surgery. The differences between the two treatment approaches were slightly larger in the lower face and the chin than in the lips. The combined orthodontic and orthognathic surgery interventions were efficient in improving the facial appearance of patients with convex profile, whereas orthodontic treatment alone was not. Given the significant influence of facial aesthetics on various life aspects and its pivotal role in treatment demand and patient satisfaction, healthcare providers should take these findings into account when consulting adult patients with a convex facial profile.

Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in‑house virtually planned mandibular reconstruction

Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in‑house virtually planned mandibular reconstruction

Osteogenic differentiation of 3D-printed porous tantalum with nano-topographic modification for repairing craniofacial bone defects.

Introduction: Congenital or acquired bone defects in the oral and cranio-maxillofacial (OCMF) regions can seriously affect the normal function and facial appearance of patients, and cause great harm to their physical and mental health. To achieve good bone defect repair results, the prosthesis requires good osteogenic ability, appropriate porosity, and precise three-dimensional shape. Tantalum (Ta) has better mechanical properties, osteogenic ability, and microstructure compared to Ti6Al4V, and has become a potential alternative material for bone repair. The bones in the OCMF region have unique shapes, and 3D printing technology is the preferred method for manufacturing personalized prosthesis with complex shapes and structures. The surface characteristics of materials, such as surface morphology, can affect the biological behavior of cells. Among them, nano-topographic surface modification can endow materials with unique surface properties such as wettability and large surface area, enhancing the adhesion of osteoblasts and thereby enhancing their osteogenic ability. Methods: This study used 3D-printed porous tantalum scaffolds, and constructed nano-topographic surface through hydrothermal treatment. Its osteogenic ability was verified through a series of in vitro and in vivo experiments. Results: The porous tantalum modified by nano-topographic surface can promote the proliferation and osteogenic differentiation of BMSCs, and accelerate the formation of new bone in the Angle of the mandible bone defect of rabbits. Discussion: It can be seen that 3D-printed nano-topographic surface modified porous tantalum has broad application prospects in the repair of OCMF bone defects.

A comparative study of quality of life of patients with maxillofacial fracture and healthy controls at two tertiary healthcare institutions.

ObjectivesDespite treatment, the pre-traumatic facial appearance of patients with maxillofacial fractures might not be able to be restored, and this difference can affect the person’s quality of life (QoL). This study was designed to evaluate changes in QoL of people with maxillofacial fractures.Materials and MethodsThe study population was comprised of participants with maxillofacial fracture and age- and sex-matched healthy controls without history of such fracture. QoL was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF) questionnaire, which was administered to the patients before treatment (Time 1), at 6 weeks post-treatment (Time 2), and at 12 weeks postoperatively (Time 3). The values were compared with those of healthy controls. The QoL was compared between closed reduction group and open reduction and internal fixation group.ResultsThe QoL scores of people with maxillofacial fracture before treatment were significantly lower (P=0.001) than those of healthy controls in all domains of the WHOQOL-BREF. The QoL scores in the psychological and social domains of patients with maxillofacial fracture at Time 3 were still lower than those of healthy controls (P=0.001).ConclusionThe QoL of patients with maxillofacial fracture was significantly reduced before treatment in all domains and remained reduced in both psychological and social domains weeks after treatment. Therefore, clinicians must be aware of and manage the residual psychosocial issues that can accompany the post-treatment period of maxillofacial injury.

Self-perception of dentition and facial appearance in patients with orthodontic disorders

Self-perception of dentition and facial appearance in patients with orthodontic disorders

Child and Caregiver Perspectives Towards Facial Appearance in Children With Microtia With or Without Craniofacial Microsomia Using a Newly Developed Likert Scale.

Craniofacial microsomia (CFM) is the second most common congenital craniofacial malformation characterized by asymmetric malformation of the ear and mandible. Numerous studies have reported the importance of child perspective and psychosocial issues in patients with craniofacial abnormalities. However, clinical tools to evaluate child and caregiver perspectives in patients with microtia with or without CFM have been limited or not reported in the literature. The authors aimed to (1) To develop a tool for measuring patient and caregiver evaluation of facial appearance as it relates to microtia and craniofacial microsomia (CFM). (2) To utilize this tool in comparing children, between 7 and 20 years of age, and caregiver perspectives towards facial appearance in patients with microtia with or without craniofacial microsomia (CFM). A prospective single center study conducted from 2016 to 2017 using newly developed 13-item (Microtia) and 27-item (CFM) 5-point Likert scale Likert scale questionnaires given to patients with CFM and caregivers at a craniofacial center. Aged 7 to 20 (N = 25) and their caregivers. A total of 25 patients (13 male, 12 female; mean age at time of survey 13.2 ± 3.7) met criteria for the study. The Likert scale developed and presented in this study may be a useful tool for clinical use in investigating patient and caregiver perspectives for planning surgical timeline. Based on our pilot data it is important to incorporate all voices into decision-making on timing.

Patients With OSA Are Perceived as Younger Following Treatment With CPAP

The aim of this study was to compare the effects of CPAP treatment and placebo intervention on the facial appearance of patients with OSA. Patients with severe OSA were randomized to receive either CPAP treatment or nasal dilator (placebo) intervention for 1month. The sequence was interposed by 15days of washout with no treatment. Patients were evaluated by using questionnaires, polysomnography, and facial photographs at baseline and at the end of both interventions. In an electronic survey, the photographs were presented in a randomized order to 704 observers who rated the perceived age, health, attractiveness, and tiredness of the patients. Observers were unaware of the patients' conditions. Thirty patients (age, 46 ± 9 years; 21 men; apnea-hypopnea index, 61.8 ± 26.2) were evaluated. During each intervention period, patients used CPAP 6.0 ± 1.7h per night on 94%of the nights and the placebo intervention on 98%of the nights. After CPAP treatment, patients were rated younger (47.9 ± 3.5 years) than they appeared at baseline (53.9 ± 4.0 years) and following the placebo treatment (49.8 ± 3.7 years) (P< .001). Linear regression analysis identified that CPAP adherence, total sleep time, and percentage of total sleep time with oxyhemoglobin saturation< 90%were predictors of a decreased age rating following CPAP treatment. Patients with severe OSA had a younger appearance following 1month of CPAP treatment. This benefit can serve as an additional source of motivation for patients with OSA to comply with CPAP treatment and may facilitate OSA management. ClinicalTrials.gov; No.: NCT02117271; URL: www.clinicaltrials.gov.

Evaluation of facial appearance in patients with repaired cleft lip and palate: comparing the assessment of laypeople and healthcare professionals

BackgroundThe present study aimed to determine whether laypeople and professionals rate the facial appearance of individuals with repaired complete unilateral or bilateral cleft lip and palate (UCLP, BCLP) similarly based on viewing full facial images.MethodsThe study followed a cross-sectional analytical design where five young patients aged 10 to 14 years, who had completed all stages of their unilateral or bilateral cleft lip and palate treatment (bilateral: three, unilateral: two), were evaluated by two groups. The assessment was done by laypeople and 97 qualified professionals (33 orthodontists, 32 plastic surgeons, and 32 oral and maxillofacial surgeons). Professionals were not involved in any stage of the patients’ treatment.ResultsThe facial appearance assessment of the professional groups on different facial aesthetics was significantly lower than that of laypeople, and they had higher perceived need for further treatment. On the other hand, laypeople had higher aesthetic ratings and lower perceived need for further treatment. Differences were also observed between the assessments of the professional groups. Participants who had lower aesthetic assessments of the repair tended to report a higher influence of cleft lip and palate on social activities and professional life.ConclusionDifferences in perception exist between healthcare professionals and laypeople. The discrepancies between the professional groups could be attributed to different treatment modalities and protocols.

Nonsurgical Correction of Facial Asymmetry and Occlusal Plane Cant in a Nongrowing Female: A Case Report

The present article describes a case report of a 19-year-old female with facial asymmetry and chin deviation towards the right. Sequential extraction of all four first premolars was performed for midline correction and alignment of blocked out lateral incisors. After the teeth were aligned in the arch, asymmetric elastics were used for correction of the canine and molar relation. Improved facial and dental esthetics were achieved after orthodontic treatment. The posttreatment results were maintained 1 year after the treatment. Orthodontic treatment can successfully improve facial appearance in patients with mild facial asymmetry, thus eliminating the need for orthognathic surgery in such cases.

Three-Dimensional Printing of Reduction Template in the Contouring of Craniofacial Fibrous Dysplasia.

Contouring is a minimal invasive procedure to remove excess lesions and restore facial appearance of patients with craniofacial fibrous dysplasia; however, it is difficult to measure the amount of excess lesions. This study is to demonstrate the use of reduction template produced by three-dimensional printer in contouring procedure. Computed tomography data were reconstructed into a three-dimensional model by Mimics software. The unaffected side was mirrored and superimposed on the affected side. Excess fibrous dysplasia lesions were calculated by Boolean operations. Lesions to be removed were separated and saved as stereolithography file. This model was further constructed in 3-matic package of Mimics software, and several holes were designed to indicate the variation in depth. Finally, the virtual model was exported into three-dimensional printer to produce physical template. With the direct guidance of three-dimensional reduction template, contouring procedure was performed easily and accurately. Good facial symmetry was achieved with reduced operative time and loss of bleeding. The application of reduction template produced by three-dimensional printer in contouring procedure improves the efficient and safety of surgery. Good outcomes are obtained without extra requirement in craniofacial surgery.

Recognizable facial features in patients with alternating hemiplegia of childhood.

Alternating hemiplegia of childhood is an early onset neurodevelopmental disorder characterized by paroxystic episodes of alternating hemiplegia, variable degrees of intellectual disability, and dystonic movements. The main causative gene, ATP1A3, is also responsible for other neurodevelopmental disorders. While the neurological profile of this condition is well defined, the question whether a recognizable pattern of physical anomalies does exist in this condition is still open. We performed a morphological evaluation of 30 patients at different ages. All patients were evaluated independently by each author and evaluation sheets were compared, discussed, and agreed afterwards. This study started before the identification of ATP1A3 as the causative gene, and the patients were selected upon their neurological picture. Four of these 30 patients tested negative for ATP1A3 mutations and were excluded from the present work. On physical ground, almost all patients shared a similar physical phenotype consisting of hypotonia, long face, thin eyebrows, strabismus, hypertelorism, long palpebral fissures, downturned mouth, and slender habitus. Such phenotype is sufficiently typical to generate a recognizable gestalt. We also evaluated patients photographs taken from the parents in early childhood (6-20 months) to delineate a clinical profile possibly recognizable before the neurological signs suggest the diagnosis. Our data suggest that the typical early gestalt is sufficient to advise the molecular analysis of ATP1A3, even in absence of the pathognomonic neurological signs. Finally, since a number of patients is now adult, some information can be drawn on the phenotypic evolution of the facial appearance of patients with alternating hemiplegia of childhood. © 2016 Wiley Periodicals, Inc.

Evaluation of Facial Appearance in Patients With Cleft Lip and Palate by Laypeople and Professionals: A Systematic Literature Review.

Objective To identify whether laypeople and professionals rate the facial appearance of patients with cleft lip and palate (CLP) similarly based on viewing full facial images. Design Several electronic databases were searched. A hand search was performed among reference lists and relevant journals. Studies that assessed the full facial appearance of patients with CLP based on two-dimensional (2D) photographs, 3D images, or clinical examination by laypeople and professionals using a visual analog scale (VAS) or a categorical rating scale were included. Two authors independently assessed articles using methodologic-quality scoring protocol. Results Eleven articles were included in qualitative synthesis, including four high-level and seven moderate-level papers. Three studies found that laypeople were more critical than professionals, three found there was no significant difference between laypeople and professionals, and five reported that professionals were more critical than laypeople when assessing facial appearance of patients with CLP. Conclusions It still remains unknown whether laypeople are more or less critical than professionals when rating facial appearance of patients with repaired CLP. Professionals are more familiar with the esthetic outcomes and difficulties of treating patients. The opposite maybe true for laypeople; this disparity between what is achievable by professionals and what is expected by laypeople may be a source of dissatisfaction in facial appearance outcome. Further well-designed studies should be carried out to address this question and the clinical significance of the difference in rating scores for patients with CLP.

Orofacial esthetics and dental anxiety: Associations with oral and psychological health

Objective. Severe dental anxiety (DA) is associated with both oral health and psychosocial consequences in what has been described as a vicious circle of DA. The aim of this study was to investigate self-rated orofacial esthetics in patients with DA and its relationship to psychological and oral health. Materials and methods. A consecutive sample of 152 adult patients who were referred or self-referred to a specialized dental anxiety clinic filled out the Orofacial Esthetic Scale (OES) as well as measurements on DA, self-rated oral health and general anxiety and depression. Clinical measures of dental status were also obtained. Results. Compared with the general population, patients with DA had lower ratings of satisfaction on all aspects of their orofacial esthetics, which included the teeth, gingiva, mouth and face, as well as a global orofacial assessment. Furthermore, the perception of the orofacial appearance was related both to dental status and self-rated oral health, as well as to general anxiety and depression. The level of dissatisfaction with the orofacial appearance was similar for both genders, but women reported more regular dental care and better dental status. Conclusions. The results of this study clearly show less satisfaction with dental and facial appearance in patients with DA, and that the self-rating of orofacial esthetics is related to both oral and psychological health. The OES can be used to assess orofacial esthetics in patients with DA.

Piezoelectric osteotomies in craniofacial procedures: a series of 15 pediatric patients

Frontoorbital advancement has become a standard method both to increase intracranial volume and to improve facial appearance in patients with syndromal or nonsyndromal craniosynostosis. Relevant complications of this procedure include severe hemorrhage and trauma to intracranial, orbital, or facial soft tissues, which mostly arise during the process of bone exposure or osteotomy. To minimize the risk of soft tissue injury and to increase the precision of the osteotomy, the authors applied a piezoelectric osteotome for frontoorbital advancement in 15 patients with craniosynostosis seen consecutively (mean age 11.3 months). They demonstrated that this new device can cut cranial bones using ultrasonic microvibrations created by piezoelectric effects. In all patients, this instrument allowed an easy and precise handling during osteotomy with a reduced amount of trauma to adjacent soft tissues and with no complications. Although the time required for piezoelectric osteotomy was longer compared with conventional techniques, the total operation time remained approximately the same because the preparation requirements are less extensive. Postoperatively, bone regeneration was uneventful. The authors conclude that this new technique of piezoelectric osteotomy is a valuable tool for craniofacial reconstructive surgery in pediatric patients.

Dental arches and occlusion in bilateral cleft lip and palate patients after two different routines for palatal surgery.

Delayed hard palate repair (DHPR) is believed by many researchers to improve maxillary growth and facial appearance in patients born with cleft lip and palate. However, only few studies dealing with the midfacial growth outcome after this type of surgery in bilateral cleft patients have been published. The purpose of this retrospective study was to compare long-term results of maxillary morphology, dental arches and occlusion in two groups of patients with bilateral cleft lip and palate. The palatal surgery differed between the two groups, particularly with respect to the timing of hard palate repair. The DHPR group (n = 16) underwent soft palate closure at 12 months and hard palate repair at around 8 years, whereas the early palatal repair group (EPR) (n = 12) had completed two-stage palatal closure during the first year of life. These latter subjects had undergone more traditional palatal surgery with vomer flaps for repair of the anterior part and push-back closure for the posterior part of the cleft. Surgery was performed in both groups by the same surgical team at Sahlgrenska University Hospital, Göteborg, Sweden. Dental casts were used to analyze the pre- and postoperative maxillary morphology, dental arch dimensions, and occlusion of both samples, which were followed longitudinally from infancy to early adulthood. Differences recorded in both maxillary growth and occlusion were generally in favor of the DHPR group. However, major intragroup variations and relatively small sample sizes precluded statistical verification of the differences, except for development during the early stages.