Facial Contour Research Articles

TEACHING PECULIARITIES OF FACIAL EXAMINATION AND COMPLETE DENTURE FABRICATION IN DENTAL EDUCATION FOR STUDENTS AND CLINICAL RESIDENTS

Esthetic restorations are essential to success in modern dentistry. Unfortunately, assessing the patient's aesthetic expectations and aesthetic prognosis during the initial evaluation can be problematic. A thorough facial research, involving collaboration with the patient, is an important element in the premedical protocol. It is very important to present the importance of facial contours and their change during tooth restoration to students and clinical residents of the Faculty of Dentistry. Identification of midline asymmetries, lip disharmony, excessive visibility of prosthetic abutments, as well as facial shape, vertical/horizontal relationships of residual caries affect both treatment modality and prognosis. Assessment of these esthetic factors by the dentist and the patient prior to initiation of treatment is best accomplished by clinical photography.

Efficacy and Safety of Botulinum Toxin Type A in the Treatment of Benign Parotid Hypertrophy: A Prospective Study.

Benign parotid hypertrophy makes the earlobe area appear swollen and weakens the lateral facial contour and aesthetics. Efficacious treatment for benign parotid hypertrophy is not available. The authors evaluated the efficacy and safety of botulinum toxin type A for benign parotid hypertrophy treatment. Thirty-six participants with benign parotid hypertrophy were enrolled and treated with botulinum toxin type A injection. After 6 months of follow-up, changes in the thickness and length of the superficial lobe of the parotid gland were assessed. Analyses of patient subgroups and image analyses were also undertaken to assess improvement. Thirty-three participants completed this study. Superficial lobe of the parotid gland thickness was reduced significantly after botulinum toxin type A injection, but the longitudinal diameter of the parotid gland was not changed significantly ( p < 0.001 and p = 0.146, respectively). Subgroup analyses showed that the degree of parotid gland hypertrophy affected treatment efficacy and degree of improvement, but age and sex did not ( p < 0.001, p = 0.137, and p = 0.138, respectively). Image analyses showed improvement in the facial contour ( p < 0.05). Serious adverse reactions or complications were not observed. Botulinum toxin type A can be used to treat benign parotid hypertrophy, reduce parotid gland volume, and improve the facial contour. Therapeutic, IV.

MANAGEMENT OF A MAXILLO-ZYGOMATIC FIBROUS DYSPLASIA IN A GROWING-UP CHILD: EIGHT YEARS’ FOLLOW-UP CASE REPORT

Fibrous dysplasia (FD) is a benign dysplastic disorder of bone development in which the normal bone matrix is replaced by fibroblastic proliferation. The aim of this case report is to report a case of a 12-year-old White male patient who was referred to an oral and maxillofacial surgery service with the main complaint of facial asymmetry and tumefaction in the right maxillo-zygomatic region. Physical examination, computed tomography, and incisional biopsy were performed, which confirmed the diagnosis of FD. A stereolithographic model was generated to manufacture a surgical guide. Osteoplasty was conducted under general anesthesia and the patient was follows up every 6 months after surgery. After 8 years of follow-up, a positive control of facial asymmetry, contour, and volume of bone affected were achieved. Final computed tomography showed that the maxilla and zygomatic bones increased in size and volume, with no compression of important structures and no functional damage.

RESECTION OF MANDIBULAR MULTICYSTIC AMELOBLASTOMA: CASE REPORT

Ameloblastoma is an odontogenic tumor that has an aggressive behavior capable of causing extensive involvement of the jaw, especially the mandible. At the first consultation, the patient had an asymptomatic intraoral swelling and on the right side of the face. On tomographic examination, a hypodense multiloculated image with cortical perforation was observed from the posterior portion of the mandibular body to the condylar neck and coronoid process. Incisional biopsy was performed and demonstrated a multicystic ameloblastoma. The treatment started with an en bloc resection of the lesion and temporary reconstruction with a 2.4-mm reconstruction plate, bicortical screws, and polymethylmethacrylate in the mandibular ramus and condyle. After 6 months, definitive reconstruction was performed with a custom prosthesis of the temporomandibular joint. Currently, the patient is in the postoperative period of 7 years with no evidence of infection or recurrence of the lesion, with a restored facial contour and satisfactory masticatory function.

Application of Patient-Specific PEEK Implant for Aesthetic Considerations in Paranasal Augmentation.

The paranasal area is closely associated with midfacial esthetics. However, there is no special technique available to achieve ideal esthetics paranasal restoration. The present study aims to apply the 3D printed PolyEtherEtherKetone (PEEK) implants as an innovative solution for esthetic paranasal reconstruction. On the basis of the CT scan, the patient-specific PEEK implant and a surgical guiding plate were manufactured aided by a computer. Preoperative and postoperative CBCT data were utilized to evaluate esthetic outcomes. The average follow-up period was 13 months. All patients' wounds healed by first intention. The statistical analysis of preoperative and postoperative esthetic indices revealed light levels of postoperative paranasal depression ( P <0.001) and the wrinkle severity rating scale for nasolabial folds ( P <0.001). Moreover, the nasolabial angle increased ( P <0.05). The established 3D-printing PEEK implanted prosthesis can individually correct the depressed deformity of the paranasal region, and achieve favorable clinical esthetic outcomes.

Would augmentation genioplasty using patient-specific PEEK (Polyether Ether Ketone) implant meet patient’s expectations?

Introduction: Patient-specific implants become very valuable in restoring facial contours, including the chin area. Evaluation of patient satisfaction with the esthetic results should be a primary concern. Aim of study: To evaluate the success of augmentation genioplasty using patient-specific PEEK (Polyether Ether Ketone) implant in meeting patient’s expectations. Methods: Seven patients were enrolled in this study. They were all having deficient chin that was managed by augmentation genioplasty using patient-specific PEEK implant. Preoperative clinical evaluation was performed for all patients. With the help of MIMICS and 3-MATIC soft wares, diagnosis, virtual planning and final implant design were done. Finally, STL file was sent for milling using PEEK material. Under GA, PSI was inserted through an intra-oral vestibular approach and fixed to the underlying bone using mini-screws. Patient expectations were evaluated by Face-Q questionnaire. Result: The study was conducted on 7 cases, 3(42.9%) of which were males and 4(57.1%) were females. The mean age of the cases was (22.00±1.29) years. All patients showed high degree of contentment with the procedure. Conclusions: Patient-specific PEEK implant can be used for chin augmentation with good esthetic results close to that of patients’ expectations.

Individualized Surgical Management of Refractory Port-Wine Stains in the Scalp and Face: A Single-Center Retrospective Study and a Discussion of Surgical Strategies.

ObjectiveRefractory port-wine stain (PWS) usually contains hypertrophic, nodular lesions or severe scars due to improper treatment, making surgical treatment a necessity. This study aims to introduce our experiences in surgical management of refractory PWSs in the scalp and face.MethodsFrom January of 2013 to September of 2018, 25 patients with refractory PWSs in the scalp and face received surgeries in our department. Clinical manifestation of the disease, the surgical procedures and postoperative complications were reviewed. A Visual Analog Scale (VAS) was applied to evaluate the outcomes.ResultsIn this study, surgical procedures included serial resection (4 cases), complete resection followed by local flap transplantation (6 cases) or skin grafting (7 cases), and two-staged surgeries using expanded flaps (5 cases) or expanded prefabricated flap (3 cases). All the skin grafts and flaps survived well. Follow-up evaluation with VAS showed that most patients were satisfied with the surgery.ConclusionThe surgical procedures should depend on the site, area and type of the lesions and patients’ personal requirement. Individualized surgical treatment of refractory PWSs achieved satisfactory results in re-establishing symmetric facial contour and improving the overall appearance.

Paranasal Augmentation: A Viable and Simplified Modality With Diced Expanded Polytetrafluoroethylene.

A flat or concave lower midface profile is generally considered less attractive. Paranasal augmentation is usually performed to move paranasal deficiency to relative convexity. Herein, we present a viable and simplified modality with diced expanded polytetrafluoroethylene to correct paranasal deficiency. Between February of 2020 and April of 2021, 19 patients underwent procedures to correct paranasal deficiency. Paranasal augmentation was performed with diced expanded polytetrafluoroethylene. All procedures were performed via intranasal approach. Preoperative and postoperative photographs were taken. Of these 19 patients (18 women and 1 man), deficiency of 18 patients were caused by congenital factors and 1 by cleft deformities. All but 1 procedures were carried out bilaterally. Procedures were performed in conjunction with additional operations mainly including rhinoplasty and minimally invasive midface lift. Age of patients ranged from 19 to 57 years, with a mean of 37 years. Follow-up time ranged from 8 to 22 months, with a mean of 12.6 months. All patients were satisfied with esthetic improvement and facial holistic profile. No severe complications and reoperation arisen in any of the patients. Temporary discomfort involved foreign body sensation in 1 case and numbness in 2 cases. The present technique provides a viable and simplified method to give the face a more balanced appearance and achieves esthetically superior results.

Minimally Invasive Approach to Skin Tightening of the Face and Body: Systematic Review of Monopolar and Bipolar Radiofrequency Devices.

Radiofrequency treatment is a relatively new and increasingly popular option for patients desiring skin tightening and an improvement in facial or body contour without undergoing an excisional surgical procedure. A systematic review of the literature was performed to investigate the safety and efficacy of monopolar and bipolar radiofrequency devices for facial and body rejuvenation. A computerized search of the MEDLINE database was performed for clinical studies investigating the use of monopolar and bipolar radiofrequency devices in facial and body rejuvenation. Data on the type of device, treated areas, number of patients, number of treatments, follow-up, complications, and outcomes were collected. The systematic review was performed in September of 2020. A total of 207 articles examined the use of radiofrequency technology for cosmetic purposes, and 23 articles remained after all inclusion and exclusion criteria were considered. Nine articles evaluated monopolar devices and five articles evaluated bipolar devices for treatment of the face. Three articles evaluated monopolar devices and six articles evaluated bipolar devices for treatment of various body areas. There is clinical evidence that monopolar and bipolar radiofrequency devices produce measurable improvement in skin laxity of the face and body with an acceptable complication profile. The majority of reported complications are minor and transient in nature; major complication rates are higher with the use of monopolar devices than with the use of bipolar devices.

Management of Aesthetical and Functional Complications after Total Parotidectomy. First Long-Term Experiences with Dermal Matrix Surgimend ® in Patient Affected by Malignant Parotid Tumors

Abstract Background This is an observational cohort study on patients affected by malignant parotid tumors treated with total parotidectomy. The aim of our work is to analyze and compare the effects and complications after parotidectomy, using or not SurgiMend ®. Methods 40 patients were retrospectively enrolled between September 2014 and June 2020. Basing on the placement of SurgiMend ® for parotid lodge reconstruction, the samples were divided into two groups. Thus, the incidence rate of complications after the surgical procedure was analyzed between the two groups. Results Patients in whom SurgiMend ® was used reported a lower rate of complications. The ANOVA test (p = 0.05) revealed a significant difference of Vancouver Scar Scale (VSS) between the two groups, representation as vascularity and pigmentation improvement, changing scar color, scar height reduction, and increased pliability. Conclusion Although many techniques are available to fill the parotidectomy defect, improve facial contour and prevent Frey’s syndrome, the use of SurgiMend ® matrix is one of most effective and reliable method to address these complications, with the advantage of decreased operative time due to not require an additional surgical donor site.

Complicated Facial Fillers: Management Algorithm.

Background:Various materials have been developed as skin fillers to correct wrinkles of the face. Dermal fillers are classified based on their biodegradability into bioresorbable versus nonbioresorbable. All dermal fillers have a potential risk of complications, which can be classified as early and late onset events. Among all the complications of filler injections, inflammatory nodules and granulomas are the most annoying and disfiguring. The purpose of the study was to provide a surgical treatment algorithm that allows us to deal with the complications of facial fillers through three surgical techniques.Methods:Thirty-one patients with complaints of facial contour abnormalities after filler injection, three surgical techniques were adopted according to the presenting case including face lift incision, needle aspiration and intraoral excision after preoperative preparation of the case with postoperative follow-up for 6 months.Results:Among our studied patients treated by these surgical techniques, dissection was difficult owing to the fibrosis and the granulomatous reaction post complicated filler injection. There were two cases of hematoma, 1 case of seroma, and 1 case of facial nerve injury that improved after 4 months, in which marked improvement of facial contour and skin quality was observed.Conclusions:The use of the facelift technique as a surgical treatment for post filler complication granuloma excision provides a useful and satisfactory method for patients complaining of major facial deformities following repeated complicated filler injections. Despite being more difficult than other techniques it is more satisfactory in facial rejuvenation post complicated facial fillers.

Combined Effects of Botulinum Toxin Injection and Oral Appliance Therapy on Lower Facial Contouring: A Randomized Controlled Trial.

(1) Background: Botulinum toxin (BoNT) injection is an esthetically effective and safe treatment for contouring the lower face. This study aimed to evaluate the combined effects of BoNT and supplementary oral appliance (OA) therapy on lower facial contouring. (2) Methods: We conducted a prospective randomized controlled trial from January 2015 to June 2016 at the Yonsei University Dental Hospital. Volunteers aged 20–45 years with masseter hypertrophy were randomly assigned to one of two groups: the non-OA group and the OA group. The non-OA group received BoNT injections alone, whereas the OA group received an OA in addition to BoNT injections. Changes in the bulkiest height of the lower face were evaluated by three-dimensional laser scanning before and 4, 8, 12, and 24 weeks after injections in both groups. (3) Results: In both groups, the bulkiest height reductions decreased, with a significant interaction between group (p = 0.046) and time (p < 0.001), although the overall reduction was at a similar level at 24 weeks. (4) Conclusions: The pattern of the bulkiest height reduction of the lower face after BoNT injection differed between standalone treatment and OA therapy, implying a normalizing effect of OA on masseter muscle activity.

Redefining Mandibular Sub-units: The "ABC" Classification and Surgical Strategies for Lower Face Contouring.

In east Asia, lower face contouring surgeries including reduction mandibuloplasty and genioplasty are the most popular aesthetic craniofacial surgeries. Conventional selection of surgical strategies mainly relied on the visual judgment of the mandibular angle, without overall assessment of the mandibular sub-units. Furthermore, only a few studies offered quantitative assessment of the mandibular shape. From 2010 to 2021, 1241 patients diagnosed with square faces and received customized lower face contouring surgeries by the senior author were reviewed and analyzed to propose an "ABC" classification system for facilitating surgical planning. Among them, 998 (80.42%) received bilateral mandible reshaping, 155 (12.49%) underwent bilateral mandible reshaping combined with genioplasty, and 88 (7.09%) received asymmetric mandible reshaping. A modified classification system composed of three critical parameters (height, morphology/thickness, divergence) in three aesthetic zones (mandibular angle, mandibular body, chin) was proposed based on quantitative summarization of the CT database and the senior author's 12-year experience. The way to facilitate surgical planning with this classification was demonstrated. This modified classification system ushered a decision-making process that prioritized several critical measurements and proposed an operative planning form. Meanwhile, it can also be cooperated into the three-dimensional virtual surgical plan. 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 http://www.springer.com/00266 .

Accuracy of virtual planning and intraoperative navigation in zygomaticomaxillary complex fractures: A systematic review

ObjectiveThis systematic review aims to investigate the effect of virtual planning on the treatment of zygomaticomaxillary complex (ZMC) traumatology followed by intraoperative navigation. Furthermore, clinical outcomes following intraoperative navigation surgery or conventional surgery will be compared. Materials and methodsA systematic literature search was conducted in PubMed, Embase, Web-of-Science, and Cochrane on January 1st, 2022. Inclusion criteria were articles using preoperative three-dimensional (3D) virtual planning combined with intraoperative navigation or comparing these 3D methods with conventional methods. Furthermore, at least one of the following outcomes needed to be included in the article: technical accuracy of the procedure, preoperative planning time, operative time, number of fixation points, patient satisfaction, complications, or total costs of the intervention. ResultsFollowing the screening of 4478 articles, 17 were included. Five articles appeared to indicate a significantly better technical linear accuracy, one article reported better accuracy for rotation and two articles showed better accuracy in restoring orbital volume when using navigation. Nine articles investigated operative time with varying results. Seven articles calculated the additional costs, of which three concluded no extra cost while the others indicated high additional costs or questionable cost-effectiveness. ConclusionVirtual planning and intraoperative navigation technologies have the potential to assist maxillofacial trauma surgeons in reducing ZMC fractures significantly more accurately and restoring the facial contour in a less invasive manner at an acceptable cost. RegistrationThe protocol for this systematic review (CRD42020216717) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).

Evaluating patients’ satisfaction level after using 3D printed PEEK facial implants in repairing maxillofacial deformities

Backgroundit is generally the case in any traumatic accident where a loss in hard tissue occurs to preform restorative plastic surgery, as there are many materials and approaches used to restore the loss, this research sheds the light on the use of one such material and approach being 3D printed facial implants manufactured from PolyEther Ether Ketone (PEEK) and to evaluate the level of patients’ satisfaction following the use of said method in repairing maxillofacial deformities. Materials and methodsa research sample consisting of 10 patients with facial deformities underwent maxillofacial reconstructive surgery between 2020 and 2021 in the Department of Oral and Maxillofacial Surgery in the Tishreen University Hospital - Latakia - Syria. All patients underwent Computed Tomography (CT) scans, then the design of the required facial implant was carried out, the final form of the facial implant was printed from PolyEther Ether Ketone (PEEK), and then surgical work was performed, a check-up after 3 months of the surgical procedure was carried out to evaluate the level of satisfaction on a scale of 1–5. ResultsThe results from the 10 patients showed a good level of satisfaction except in one case where the facial implant had to be removed due to recurrent infection where the patient showed no signs of response to medicinal treatment following the surgery. Conclusionsthis research suggests that the use of 3D printed PEEK facial implants to be very agreeable in terms of functionality and aesthetics in treating various facial deformities.

Evaluating the results of the surgery of benign parotid tumors

Background: Benign tumors account for 80% of parotid salivary gland tumors, early diagnosis and effective treatment will contribute to reducing complications of surgery. Objective: To evalutate surgical results of benign parotid tumors on facial paralysis and other complications. Research Methodology: including 51 patients with benign parotid salivary gland tumors at Hue University of Medicine and Pharmacy Hospital from June 2019 to October 2021 were operated on and monitored for facial paralysis after 1 week, 1 month, 3 months, and 6 months according to the House-Brackmann facial nerve grading system and noted other complications. Results: Pleomorphic adenoma and Warthin tumors are the two most common types of benign tumors. The rate of facial paralysis at the time points after 1 week, 1 month, 3 months, and 6 months gradually decreased by 56.9%, 35.3%, 19.6%, 0%, respectively. Most temporary facial paralysis grade II (mild) and grade III (moderate) (classification of House - Brackmann). The surgical method was significantly related to facial paralysis (p &lt; 0.05). Other complications such as numbness around the ear, hemorrhage, sialocele, salivary fistula, depression of facial contour, bad scars. Nevertheless, no cases of tumor recurrence and Frey’s syndrome were recorded after 6 months. Conclusion: Surgery is an effective and safe treatment for benign parotid salivary gland tumors. Facial paralysis accounts for a high incidence after surgery, but it will fully recover after 6 months. Choosing the appropriate treatment method helps to minimize complications and recurrence after surgery of parotid salivary gland tumors. Key words: benign parotid tumors, facial paralysis, parotidectomy.

Aesthetic Reconstruction of a Facial Defect After Subtotal Resection of the Parotid Gland Using a Superficial Circumflex Iliac Artery Pure Skin Perforator Flap.

In the reconstruction of facial defects, thin and flexible coverage of the defect is desirable for cosmetic reasons. A free flap is 1 possible surgical option; however, a flap containing a fatty layer is bulky. in this study, the authors describe the reconstruction of a facial defect after subtotal parotidectomy for right parotid carcinoma using a superficial circumflex iliac artery pure skin perforator flap, with consideration given to facial contour. The superficial circumflex iliac artery pure skin perforator flap is a viable option to achieve the desired clinical and aesthetic outcome.

Guidelines for Botulinum Neurotoxin Injection for Facial Contouring.

The hypertrophied temporalis and masseter muscles give a muscular shaped and bulky contour to the face. Botulinum neurotoxin injection methods are commonly used for facial contouring; however, adverse effects have been reported owing to a lack of delicate anatomical information. The anatomical considerations when injecting botulinum neurotoxin into the temporalis and masseter muscles were reviewed in the present study. Current knowledge on the localization of the botulinum neurotoxin injection point with more recent anatomical dissection and modified Sihler staining procedures was assessed. The authors found that, for the muscles, the injection point can be more precisely demarcated. Optimal injection sites are presented for the temporalis and masseter muscles, and the injection technique is suggested. The authors propose the optimal injection sites in relation to external anatomical landmarks for the frequently injected muscles of the face to facilitate the efficiency of botulinum neurotoxin injections. In addition, these guidelines would aid in more precise practice without the adverse effects of botulinum neurotoxin.

Long-term facial symmetry after pediatric mandibular reconstruction using the vascularized fibula free flap: A photogrammetric analysis

The fibula free flap is the standard of care in the reconstruction of large mandibular defects in pediatric patients, enabling adequate restoration of the facial contour. However, the unpredictable growth potential of the reconstructed mandible could influence the preservation of the initially restored symmetry over time. Being mindful of the importance of facial appearance during developmental stages, this study aimed to evaluate the long-term facial symmetry after mandible reconstruction using this technique in growing patients. A photogrammetric analysis of facial symmetry using the "Asymmetry Index" (AI) was performed from preoperative and postoperative frontal photographs in 17 pediatric patients (9 males and 8 females) who underwent mandibular reconstruction with the vascularized fibula free flap and had a minimum follow-up of 5 years. Comparisons between preoperative and postoperative measurements-as well as postoperative comparisons between condyle-reconstructed and condyle-preserved patients-were conducted. The mean follow-up was 76.9 (± 19.0) months (range, 60-120). The average age at intervention was 9.23 (± 3.8) years. Mean AI was 15.31 (± 1.81) preoperatively and 3.59 (± 0.97) postoperatively. Differences between preoperative and postoperative measurements were statistically significant in all the assessed parameters (p<0.001). Postoperative differences between the condyle-reconstructed and the condyle-preserved groups were not significant (p>0.05). No secondary procedures were required to enhance symmetry in the late postoperative period. Mandibular reconstruction using the vascularized fibula free flap provides adequate restoration of facial symmetry that could be predictably maintained throughout the developmental period in children and adolescents, regardless of the need for condylar reconstruction.

A Method of Improving Accuracy in Expression Recognition

In order to improve the accuracy of a special kind of facial expression recognition problem, a method for precise face detection and segmentation combined with the particle swarm optimization is proposed. The method uses three key technologies: skin color segmentation, particle swarm search and curve approximation. Firstly, the face contour is roughly obtained through skin color segmentation. Secondly, the accurate face position is detected by particle swarm optimization. Thirdly, the face contour is reduced and regulated further via the curve approximation. The experimental results show that this method can eliminate the interference factor, and then improve the accuracy of expression recognition.